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65 Cards in this Set
- Front
- Back
what are drugs that have a calming effect on the CNS?
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Sedatives and Hypnotics
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what are sedatives?
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reduce nervousness, excitability, and irritability without causeing sleep, but can become a hypnotic if it is given in large enough doses.
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what is a hypnotic
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causes sleep. much more potent effect on the CNS.
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sedatives-hypnotics
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barbiturates, benzodiazepines, and misc drugs.
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sleep
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decrease in physical activity and consciousness. during sleep a person is no longer aware of sense stimuli.
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effects if sedatives-hypnotics on sleep
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decrease REM sleep making you tired. after stop using them REM rebound can occur and you can have vivid dreams.
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Barbiturates act primarily on what?
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brainstem called the reticular formation
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Barbiturates act by
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reducing the nerve impulses traveling to the area of the brain called the cerebral cortex
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GABA
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gamma-aminobutyric acic which is found in high concentrations in the CNS.
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Barbiturates are capable of raising
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seizure thresholds some are udrf in prophylaxis for epileptic seizures
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Barbiturates have an effect on the liver and cause
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many drugs to be metabolized more quickly.
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ultrashort acting Barbiturates
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anesthesia for short procedures, control convulsions, narcoanalysis, reduce intracranial pressure in neurosergical pts.
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short acting Barbiturates
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sedative-hypnotic and control of convulsion conditions
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intermediate acting Barbiturates
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sedative-hypnotic and control of convulsion conditions
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long acting Barbiturates
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sedative-hypnotic, epileptic seizure prophylaxis and tx of neonatal hyperbilirubinemia
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side effects of Barbiturates
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drowsiness, lethargy, dizziness, hangover, and paradoxical restlessness of excitment. alcohol produces side effects.
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cardivascular side effects
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vasodilation and hypotension
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GI side effects
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nausea, vomiting, diarrhea, constipation
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Hameatological side effects
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Agranulocytosis, thrombocytopenia, megaloblastic anemiaq
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nervous side effects
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drowniness, larthargy, nertigo, HA, mental depression, myalgic, neuralgic, arthralgic pain
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respiratory side effects
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respiratory depression, apnea, laryngospasm, bronchospasm, coughing
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other side effects
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Hypersensitivity reactions, urticaria, angioedema, rash, fever, serum sickness, steven-johnson syndrom
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steven-johnson syndrome
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(SJS) is a severe and potentially life-threatening (15% of cases) disease, it is a hypersensitivity complex affecting the skin and the mucous membranes
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what are the characteristics of SJS
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fever, sore throat, and headache leading to the sudden development of circular mucocutaneous lesions (target lesions) that can cover the majority of the skin. These lesions begin as macules and can develop into papules, vesicles, bullae, or urticarial plaques. The most extreme cases are termed Toxic Epidermal Necrolysis Syndrome (TENS) or Lyell's Syndrome, in these cases the entire skin is affected.
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How do you treat SJS
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is initially similar to that of patients with thermal burns, and continued care can only be supportive (e.g. IV fluids) and symptomatic (e.g. analgesic mouth rinse for mouth ulcer); there is no specific drug treatment (2002). An ophthalmologist should be consulted if eyes are involved.
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when can intention OD of barbituates be used?
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anesthesia and to control seizures
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OD of barbituates can produce
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coma and death
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S/S of OD barbituates
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cold and clammy skin, hypothermic, fever, areflexia, tachycardia, and hypotension, pupils constricted
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TX of OD barbituates
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symptomatic and supportive, make sure aduquate airway NG tube with activated charcoal, alkalication of urine will help too.
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don't give barbituates with these...
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MAOI's, anticoagulants, oral contraceptives
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Butalan-butabarbital
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intermediate acting, preop sedative schedule III
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nembutal-pentobarbital
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insomnia, preop to reduce anxiety and provide sedation, control epilepticus or acute seizures, treat withdrawl of barbituates and hypnotics category D schedule II
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Luminal-phenobarbital
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long acting, prevention of tonic clonic seizures and fever-induced convulsions, tx of hyperbilirubinemia in neonates and Gilbert's syndrome
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Benzodiazepines
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are the most commonly perscribed sedative-hypnotic, they produce sedation or sleep
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anxiolytic
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relieves anxiety
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how to Benzodiazepines work
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depress the hypothalamic, thalamic, adn limbic systems of the CNS.
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Benzodiazepines are different for barbituates by
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don't affect REM sleep, don't induce hepatic microsomal enzyme activity.
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what do Benzodiazepines do
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control agiation and anxiety, adn reduces sensory stimuli, induces sleep, relaxed skeletal muscle, use to treat withdrawl from alcohol
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common side effects
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HA, drowiness, paradoxialexcitment or nervousness, dizziness or vertigo, cognitive impairment, and lethargy. also create fall hazards
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less common side effects
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palpitations, dry mouth, vomiting, hypokinesia, and occasional nightmares
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S/S of OD
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somnolence, confusion, hypokinesia, and nightmares, hypotension and respiratory depression
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TX of OD
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syrup of ipecac, gastric lavage, activated charcoal
*Flumazenil |
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don't take Benzodiazepines with
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kava kava, grapefruit or grapefruit juice
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Prosom-estazolam
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short acting adults- 1-2mg elderly 0.5mg
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dalmane-flurazepam
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long-acting 15-30mgs cause hangover effect category X
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doral-quazepam
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long-acting 7.5-15mg category X
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restoril-temazepam
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short acting, adult 15-30mg elderly 7.5 mg catergory X
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Halcion - trazolam
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short acting adult .25-.5mg elderly .125-.25mg catergory X
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Sonata- Zaleplon
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short acting don't take more than 10 days due to dependancy short half life category C adult 10mg elderly 5mg
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Ambiem-zolpidem
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short acting limit 7-10 day tx less hangover feel catergory B adult 10mg elderly 5mg
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what do muscle relaxants do
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work with the CNS to relieve pain associated with skeletal muscle spasms
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what is the only muscle relaxants to work directly on the skeletal muscle
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dantrolene
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What do the other muscle relaxants effect
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enchance GABA central inhibitory effects at eh spinal cord
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what parts of the brain do muscle relaxants effect
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brainstem, thalamus, basal ganglia
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what is muscle relaxants used for
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management of multiple sclerosis, cerebral lesions. cerebral palsy, rheumatic disorders, huntington's chorea, parkinsons, trigeminal neuralgia
*use with PT |
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normal side effects muscle relaxants
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euphoria, lightheadedness, dixxiness, drowiness, fatigue, and muscle weakness
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less common side effects of muscle relaxants
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diarrhea, GI upset, HA,slurred speach, dizziness, muscle stiffness, constipation, sexual difficulties in males, hypetension, tachycardia,and weight gain
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Side effect of Dantrolene
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hepatotoxicity
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TX of muscle relaxants OD
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gastric lavage, EEG need to be ran, large amount of IV fluids
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interactions with muscle relaxants
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alcohol may cause mental confusion, anxiety, tremors, and hypoglycemic activity.
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Lioresal-baclofen
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central acting 10-20mg tabs and injectables category C
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Flexeril-cyclobenzaprine
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central acting 10mg dose catergory B
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dantrium-danteolene
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direct acting 25,50,100 mg tab and 20mg injection can be use to treat mild hyperthermia catergory c
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skelaxin-mataxalon
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central acting acute pain spasticity
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zanaflex-tizanidine
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central acting
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