Chapter 12 CNS Depressants and Muscle Relaxants

Question 1

sedatives

Answer 1

drugs with calming effect, depress the CNS, reduce nervousness, excitability , and irritability WITHOUT causing sleep

Question 2

hypnotics

Answer 2

drugs with calming effect, depress the CNS, DO cause sleep, and more potent to the CNS

Question 3

REM sleep

Answer 3

last third of sleep

Question 4

non REM sleep

Answer 4

first third to half, 4 stages from drifting to very deep sleep

Question 5

how many cycles of sleep per night on average?

Answer 5

5 cycles

Question 6

benzodiazepines

Answer 6

• sedative hypnotics or axiolytics
  -short, intermediate, and long acting types

Question 7

benzodiazepines mechanism of action

Answer 7

depress CNS activity, effects on hypothalamus, thalamus, and limbic system

Question 8

benzodiazepines indications

Answer 8

sedation, relief of anxiety, sleep induction (insomnia), skeletal muscle relaxation, treatment of acute seizure disorders, treatment of alcohol withdrawal

Question 9

benzodiazepines counterindications

Answer 9

drug allergy, narrow angle glaucoma, pregnancy

Question 10

benzodiazepines adverse effects

Answer 10

-harmful in a high dose or mixed with alcohol
-headache, drowsiness, paradoxical excitedness/nervousness, dizziness, cognitive impairment
-high fall risk!
-daytime sleepiness and sometimes withdrawal

Question 11

benzodiazepines toxicity

Answer 11

-confusion, diminished reflexes, unresponsiveness
-can cause death if combined with barbiturates and alcohol
-don’t use with grapefruit

Question 12

benzodiazepine drug examples

Answer 12

“Pams”
-Diazepam
-Midazolam - makes people forget what’s going on
-Temazepam- induces sleep in 30 to 40 mins, take before bedtime

Question 13

nonbenzodiazepine drug examples

Answer 13

-Eszopiclone- long term use
-Ramelteon- similar to melatonin, used to help fall asleep
-Zolpidem- prevents daytime sleepiness

Question 14

barbiturates

Answer 14

• very old drugs (1903)
  -used for insomnia and inducing sedation
  -rarely used today

Question 15

barbiturates mechanism of action

Answer 15

-CNS depressants that act on brainstem in reticular formation
-reduce nerve impulses traveling to cerebral cortex, potentiate GABA receptors
-raise seizure threshold

Question 16

barbiturates indications

Answer 16

-no longer recommended for insomnia
-anesthesia for short procedures, seizure control, reduction of intracranial pressure

Question 17

barbiturates contraindications

Answer 17

known allergy, pregnancy, respiratory difficulties, severe kidney and liver disease

Question 18

barbiturates adverse effects

Answer 18

drowsiness, lethargy, dizziness, hangover

Question 19

barbiturates toxicity

Answer 19

-maintain airway, assisted ventilation, O2 administration, support BP
-alkalization of urine

Question 20

barbiturate drug examples

Answer 20

-Pentobarbital - shorter, pre op
-Phenobarbital- longer acting, seizure prevention
-both reduce intracranial pressure

Question 21

over the counter hypnotics

Answer 21

-often contain antihistamines
-Doxylamine
-Diphenhydramine
-often added to analgesics like Tylenol PM

Question 22

muscle relaxants

Answer 22

acts on CNS to relieve pain with skeletal muscle spasms

Question 23

muscle relaxants mechanism of action

Answer 23

-most beneficial effects are from their sedative effects rather than direct muscle relaxation
-Dantrolene acts directly on excitation / contraction of muscle fibers, all others work on the level of CNS
-decreased response of muscle to stimuli, relaxes striated muscles, weakens skeletal muscles, decreased force of muscle contraction

Question 24

muscle relaxer indications

Answer 24

relied of painful musculoskeletal condition, chronic conditions associated with muscle spasticity

Question 25

muscle relaxer counter indications

Answer 25

drug allergy, severe renal impairment

Question 26

muscle relaxer adverse effects

Answer 26

-effects on CNS and skeletal muscles
-euphoria, light headedness, dizziness, fatigue, confusion, muscle weakness

Question 27

muscle relaxer toxicity

Answer 27

no reversal agent, supportive care measures, watch use with other CNS depressants

Question 28

muscle relaxer drug examples

Answer 28

-Baclofen
-Cyclobenzaprine - most common in spasms, cause drowsiness

Question 29

CNS depressent nursing considerations

Answer 29

-perform thorough neuro and sleep assessments
-increased sensitivity in elderly and very young
-drug interactions, patient teaching