Central Nervous System Depressants and Muscle Relaxants Flashcards
What is a sedative?
A drug that has the ability to inhibit the CNS causing reduced:
Nervousness
Excitability
Irritability
What are hypnotics?
Drugs that cause sleep
T/F: Hypnotics are less potent than seditives
F: Hypnotics are more potent than sedatives
Which drug can become a hypnotic if given in large doses?
Sedatives
What are the three groups of CNS depressants?
Barbiturates
Benzodiazepines
Miscellaneous drugs
What is more commonly prescribed Benzodiazepines or Nonbenzodiazepines? Why?
Nonbenzodiazepines due to favorable AEs, efficacy, and safety
What are the three types of Benzodiazepines? Which drugs are in these categories?
Long acting: Diazepam
Intermediate acting: Lorazepam
Short acting Midazolam Hydrochloride
What is the MOA of Benzodiazepines?
They depress the CNS, by interfering in the hypothalamic, thalamic, and limbic regions of the brain as well influence GABA receptors
What effect do Benzodiazepines have on the body?
They calm the CNS
used for agitation and anxiety
Reduce sensory stimuli = sleep
induce skeletal muscle relaxation
What are Benzodiazepines indicated for? Examples?
Sedation (short term insomnia therapy)
Sleep induction
Skeletal muscle relaxation (seizures)
Agitation or anxiety relief (Alcohol withdrawal)
Anxiety-related depression
What are the AEs of Benzodiazepines?
Mild and infrequent
Headache
Drowsiness
Paradoxical excitement of nervousness
Dizziness
Cognitive impairment
Vertigo
Lethargy
Fall hazard for older adults
“Hangover” effect or daytime sleepiness
What are the S&S of Benzodiazepines Toxicity and OD?
Somnolence (strong sleepy feeling)
Confusion
Coma
Diminished reflexes
What is the antidote for Benzodiazepines OD?
Flumazenil
What consumables do Benzodiazepines interact with?
CNS depressants (alcohol, opioids, muscle relaxants)
grapefruit and grapefruit juice
What drugs do Benzodiazepines interact with?
Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics
Kava and valerian
What was the first available benzodiazepine drug?
Diazepam
What sedative is commonly used preop and during the procedure?
Midazolam
What route can Midazolam be adminstred?
Normally IV (adults), liquid oral (children)
What dose Midazolam cause?
Reduces anxiety and sedation
When should a pt take Lorazepam before going to bed?
1 hour before due to long OSA
What type of benzodiazepinelike drug is zopiclone?
Short acting
What is Kava?
A herbal product used to relive anxiety, stress, restlessness, and help sleep
What are some AEs of Kava?
yellow skin discoloration, scaly skin, vision changes
What dose Kava interact with?
alcohol, barbiturates, and psychoactive drugs
What is Kava contraindicated for?
liver disease, alcoholism, operating heavy machinery
What is Valerian?
A drug used to relive anxiety, restlessness, sleep disorder
What are some AEs of Valerian?
CNS depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, insomnia
What dose Valerian interact with?
CNS depressants, monoamine oxidase inhibitors (MAOIs), phenytoin, warfarin, and alcohol
What is Valerian contraindicated for?
Cardiac and liver disease, operating heavy machinery
What is the MOA of Barbiturates?
Work in the reticular formation (brain stem) to inhibit GABA nerve impulses in the Cerebral cortex
What are the indications of Barbiturates?
Sedatives
Anticonvulsants
Anaesthesia for surgical procedures
What are the AEs of Barbiturates?
Cardiovascular: Vasodilation, hypotension
CNS: Drowsiness, lethargy, vertigo
Respiratory: Respiratory depression, cough
Gastrointestinal: Nausea, vomiting, diarrhea, constipation
Hematological: Agranulocytosis, thrombocytopenia
Other: Hypersensitivity reactions, Stevens-Johnson syndrome
What is the common use of Barbiturates in Canada?
Anesthesia induction’
Uncontrollable seizures
Coma (Phenobarbital)
What should be done for a Barbiturate OD?
Maintain adequate airway
Assisted ventilation or oxygen therapy
Fluids
Alkalization
Activated charcoal
What drugs have an additive effect on Barditurates?
Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers
What substances inhibit metabolism of Barbiturates?
MAOIs prolong the effects of barbiturates
What substances increase the metabolism of barbiturates?
Reduces anticoagulant response, leading to possible clot formation
What is the Barbiturate drug you need to know for the exam?
phenobarbital
What is Phenobarbital used for?
Seizure prevention
prevent hyperbilirubinemia in neonates
rarely used as a sedative
What are some OTC hypnotics?
Doxylamine succinate
diphenhydramine hydrochloride
acetaminophen/diphenhydramine
When CNS depressants are combined with ____ it can cause respiratory depression/arrest
Alcohol
What is the purpose of Muscle relaxants?
relive pain relating to muscle spasms
Where do most Muscle relaxants work in the body?
CNS
What do Muscle relaxants act on?
Skeletal muscles
What are the indications of Muscle relaxants?
Relief of painful muscle spasms
(MS, cerebral palsy)
Muscle relaxants work best when combined with what?
Physical therapy
What are the AEs of Muscle relaxants?
Euphoria
Lightheadedness
Dizziness
Drowsiness
Fatigue
Confusion
Muscle weakness, others
What are the Muscle relaxant drugs you need to know for the exam?
Baclofen
Cyclobenzaprine HCl
What needs to be obtained before admin of Central Nervous System Depressants and Muscle Relaxants?
HH
Allergies
med hx
VS (supine and standing BP)
I/O
contraindications/ drug intx
When should hypnotics be administered for max effect?
30-60 mins before bed
What do most benzodiazepines cause?
REM interference and a tired feeling the next day; use with caution in older adults.
What should patients taking Central Nervous System Depressants and Muscle Relaxants drugs avoid?
Alcohol
T/F: Rebound insomnia may occur after 3-4 week regime has been stoped?
T
What safety considerations must the nurse take when patient is taking Central Nervous System Depressants and Muscle Relaxants?
Keep side rails up or use bed alarms.
Do not permit smoking.
Assist patients (especially older adults) with ambulation .
Keep call light within reach
monitor for AEs
What are the signs that the drug is working?
Increased ability to sleep at night
Fewer awakenings
Shorter sleep-induction time
Few adverse effects, such as “hangover” effects
Improved sense of well-being because of improved sleep
For muscle relaxants: decreased spasticity, decreased rigidity, pain relief
What is the max dose of Lorazepam per day?
4 mg
