central nervous system depressants and muscle relaxants (4)

Question 1

_____: depress CNS to reduce nervousness, excitability, and irritability

Answer 1

sedatives

Question 2

______: cause sleep and are more powerful than sedatives

Answer 2

hypnotics

Question 3

what are sedative-hypnotics dependent on

Answer 3

the dose (low = sedative, high = hypnotic)

Question 4

what are the three main groups of sedative-hypnotics

Answer 4

• benzodiazepines
• barbiturates
• miscellaneous drugs that work like benzodiazepines

Question 5

what are benzodiazepines classified as (2)

Answer 5

sedative-hypnotic or anxiolytic (anti-anxiety)

Question 6

name some adverse effects of benzodiazepines

Answer 6

toxicity = somnolence, confusion, coma, diminished reflexes

Question 7

name three drugs that are benzodiazepines

Answer 7

• diazepam (very potent; adults = injection, children = oral; preop or moderate sedation)
• midazolam
• temazepam (induces sleep within 20-40 mins; long onset of action, should take ~1hr before bed)

Question 8

______: first benzodiazepine drug (oral, rectal, injection)

Answer 8

diazepam

Question 9

name four indications for diazepam

Answer 9

antianxiety, procedural sedation and anesthesia, anticonvulsant therapy, skeletal muscle relaxant

Question 10

_____: drugs used for sleep/sedation but are addictive and have a low effect

(benzodiazepines are safer)

Answer 10

barbiturates

Question 11

name four contraindications for barbiturates

Answer 11

pregnancy, respiratory difficulties, severe kidney or liver disease, caution for older adults (increased side/adverse effects)

Question 12

what interactions have additive effects with barbiturates

Answer 12

alcohol, antihistamines, benzodiazepines, opioids, tranquilizers

Question 13

barbiturates reduce the effects of what drug

Answer 13

anticoagulant drugs (risk for clots)

Question 14

name two adverse effects of barbiturates

Answer 14

stevens-johnson syndrome and bone marrow suppression

Question 15

what are three adverse effects that bone marrow suppression can cause

Answer 15

agranulocytes (infection); thrombocytopenia (clots); anemia (fatigue)

Question 16

name some side effects of barbiturates (4)

Answer 16

reduced REM sleep, daytime tiredness, irritability, agitation

Question 17

what does overdose of barbiturates produce

Answer 17

CNS depression and respiratory depression (sleep to coma to death)

Question 18

how do you treat overdose of barbiturates

Answer 18

there are no antidotes/antagonists to counteract barbiturates
- symptomatic and supportive interventions for depressed CNS and respiratory system

Question 19

phenobarbital is a barbiturate prototype drug for ______

Answer 19

seizure management, sedation/anxiety (rarely), hyperbilirubinemia in neonates

Question 20

name three nonbenzodiazepine hypnotics

Answer 20

• eszopiclone
• zolpidem (lower incidence of daytime sleepiness that w benzodiazepine hypnotics)
• suvorexant

Question 21

_____ is the first hypnotic to be FDA approved for long-term use

Answer 21

eszopiclone

Question 22

eszopiclone is designated to provide ____ hours of sleep

Answer 22

full 8 hours

Question 23

when should you avoid taking hypnotics

Answer 23

when you must be awake in less than 6-8 hours

Question 24

suvorexant has a 12 hour half-life, why is this a safety concern

Answer 24

safety concern due to daytime tiredness and unconscious nighttime behaviors

Question 25

two examples of herbal products for sleep and anxiety

Answer 25

kava and valerian

Question 26

what are herbal products for sleep and anxiety contraindicated in

Answer 26

liver disease, alcoholism, cardiac and renal disorders

Question 27

name some potential interactions for herbal products that are for sleep and anxiety

Answer 27

alcohol, barbiturates, psychoactive drugs

Question 28

name some side effects of herbal products for sleep and anxiety

Answer 28

dizziness/drowsiness (CNS depression) - patient should not operate heavy machinery during use (NO DRIVING)

Question 29

name three examples of muscle relaxants

Answer 29

- baclofen (may need to test dose to confirm responsiveness; use of implanted pump may treat chronic spastic muscular conditions) - cyclobenzaprine - dantrolene

Question 30

when do muscle relaxants work best

Answer 30

when used with physical therapy

Question 31

name three uses for muscle relaxants

Answer 31

- relieve pain from muscle spasms - management of muscle spasticity (multiple sclerosis, cerebral palsy) - IV dantrolene used for malignant hyperthermia*

Question 32

what is a treatment for toxicity of muscle relaxants

Answer 32

- no specific antidote - must provide airway, breathing, circulation support

Question 33

what is the most common muscle relaxant

Answer 33

cyclobenzaprine (most common but has strong sedative effects)

Question 34

CNS depressants and muscle relaxants should be used with caution in what patients

Answer 34

older adults

Question 35

what should you avoid while taking CNS depressants/muscle relaxants

Answer 35

alcohol and other CNS depressants (can lead to severe CNS depression)

Question 36

benzodiazepines and barbiturates lower REM sleep, resulting in what

Answer 36

tired, irritable, anxious the next day