Chapter 18 : CNS depressants Flashcards by Brina Quintanilla Reyes

What is insomnia?

Inability to fall asleep and remain asleep

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What is REM stand for?

Rapid eye movement

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What does NREM mean?

Non rapid eye movement

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REM is also classified as what?

Dreaming

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What are some non pharmacology methods to help patients fall asleep ?

Arise at specific hour in morning
Limit day time maps
Avoid caffeine, alcohol, 6 hours before bedtime
Avoid heavy meals,strenuous exercise and drinking large amount of fluid before bedtime

Take warm bath, listen to quite music or perform other sooth activists like drinking warm milk before bedtime

Decrease exposure to loud noises

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What are the medication class name to help treat insomnia or sleeping disorders?

Sedative-hypnotics

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What does sedatives mean?

Low doses calm CNS without inducing sleep, high doses cause sleep

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What are 5 sedative-hypnotics medications classes we are going to talk about?

Barbiturates
Benzodiazepines
Nonbenzodiazepine
Melatonin agonists
Sedative-hypnotics for older adults

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What are general side effects of sedative-hypnotics?

Residual drowsiness ( hangover )
Vivid dreams & nightmares
Drug dependence
Drug tolerance
Excessive cns depression
Respiratory depression
Hypersensitivity
Fall risk

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Sedative-hypnotics
Barbiturates

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Long/intermediate or short acting barbiturates medication names

Phenobarbital
Pentobarbital

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Why is barbiturates restricted to such a short term usage, less than 2 week?

Because of its drug tolerance and high risk of addiction

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What does barbiturates interactions with? (3)

Alcohol
Opioids
Other sedative-hypnotics

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What is the biggest side effect of barbiturates?

Hepatotoxicity

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Notes
Barbiturates
Adverse effects
- hypotension
Drowsiness
Lethargy
Vertigo
Respiratory depression
GI upset
Blood dyscrasias
Reduced rem
Agitation
Nightmares
Inability to deal with normal stress

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Barbiturates notes
Contraindications
Allergy
Pregnancy
Severe respiratory disease
Severe liver or kidney disease

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Maois prolongs the effects of _____

Barbiturates

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Bariburatues increase the risk of what with anticoagulants?

Making it not work
So blood clots

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Benzodiazepines

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Benzodiazepines
Alprazolam (Xanax)
Estazolam
Lorazepam (Ativan)
Temazepam (restoril)
Triazolam (halcion)

For sleep disorders and anxiety

Action
Interacts with gaba to reduce neuro excitability

Treat
Reduce anxiety and treat insomnia

Mechanism of action
Depress cns activity
Can cause vivid dreams
Avoid using more than 3-4 weeks

Effects
Controls agitation and anxiety
Sleep aid
Skeleton muscle relaxation

Prolonged action of
Azole antifungal
Calcium channel blockers
Grapefruit juice

Increase CNS depressions
Alcohol, opioids, muscle relaxants

Decrease benzo effect
Rifampin

Contraindications
Glaucoma and pregnancy

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Clinical judgment Benzodiazepines
Concept
Sleep

Recognize cues
Determine whether the patient has a history of insomnia or anxiety disorders

Anazlye cues and prioritize hypothesis
Decrease functional ability reduced stamina

Generate solutions
Patient will relieve adequate sleep when taking benzodiazepines

Take action
Encourage patient to avoid alcohol and other can depressants to avoid respiratory depression

Monitor vital signs, increased risk of falls

Teach patient to use Nonpharmacologic methods to induce sleep

Advise patients to report adverse reactions

Teach patient that benzodiazepines should be gradually withdrawn

Evaluate outcomes

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Nonbenzodiazepine

Nonbenzodiazepines
Zolpidem (ambien)
Short term use
- less than 10 days
Action
- neurotransmitter inhibition
Duration of action 6-8 hours
Patient should not take if they will be unable to get 6-8 hours of sleep

What are the major side effects of Nonbenzodiazepines?

Amnesia
Memory impairment
Nightmares
Binge eating
Hypotension
Angioedema
Dustheymjas
Depression
Suicidal ideation

What are the 2 life threatening nonbenzodiapeines side effects?

Pulmonary edema and renal failure

Sedatives and hypnotics for older adults - use Nonpharmacologic methods first - short to intermediate acting bendoziapies such as estazolam, temazepam, triazolam Avoid benzodaizeines such as flurazepam quazepam and diazepam

Clinical judgment Non-benzodiazepines Concept Sleep Recognize cues Ascertain the patients problem with sleep disturbances Obtain drug history Analyze cues and prioritize hypothesis Decrease level of consciousness Reduced stamina Generate solutions Patient will remain asleep for 6-8 hours Take action Observer patient for side effects of nonbenzdoaipeines such as hangovers dizziness confusion Encourage patient to avoid alcohol, antidepressants, antipsychotics, and opioids while taking nonbenzo Evaluate outcomes Evaluate effectiveness of sedative hypnotic in promoting sleep

The part of CNS depressants that actually matter ANESTHETICS

There are 2 types of anesthetics Which are?

General and local

What is general anesthetic? (3)

Depressed the CNS Alleviates pain Causes Loss of consciousness

What is local anesthetics?

Pain relief in limited area

With local anesthetic we mix what? If it’s an area with good blood supply

Epinephrine ; vasoconstrictor

Never administer epi where?

Face Fingers Toes Because vasoconstrictor don’t allow good blood supply

What is balanced anesthesia? Brooks words

Combination of medications that we use to create general anesthesia. That patient recovery and wake up faster

Balanced anesthesia pt2 definition textbook

Minimizes cardiovascular problems Decrease the amount of general anesthetic needed, reduces possible post anesthesia and decreases pain. Faster recovery time

Assessment before surgery Like what ? Dont over think it

Age Current health disorder Pregnancy History of heavy smoking Frequent use of alcohol and drugs

Anesthetic routes?

Inhalation IV Topical Local Spinal

If we can use topical anesthetic, we are gonna what?

Prefer because less side effects because it isn’t systemic

What are some forms of topical/local anesthetics?

Solution Liquid spray Ointment Cream Gel and powder

What is the biggest importance of local and topical anesthetics?

If you have a spray in your throat or something. You don’t have a gag reflex

When you don’t have a gag reflex, what is the nurses job?

Risk of aspiration Make sure gag reflex returned before eating and drinking

What is spinal anesthesia and epidural?

Anesthesia directly into the spine

Spinal anesthesia 2 biggest side effects?

Respiratory distress Hypotension

With epidural and spinal anesthesia, before you give someone this, what do we want to make sure?

They are well hydrated A shit ton of fluids in their body because the risk of hypotension is so so sooo big

What is spinal block? What is epidural block? What is caudal block? What is saddle block?

Subsrachnorid membrane between pia mater & arachnoid membrane Spinal cord or dura mater Sacral hiatus Spinal column block the perineal area

Clinical judgment anesthetics Concept Intraopertive care Recognize cues Obtain a drug and health history, noting drugs that affect the cardiopulmonary system Analyze cues and priorities hypothesis Pain, airway obstruction Generate solution Patient will participate in Preoperative preparation and will understand postoperative care Take action Monitor the postoperative state of sensorium Observe preoperative and postoperative urine output Monitor vital signs following general and local anesthesia for hypotension and respiratory depression Administer an analgesic with caution until the patient fully recovers from the anesthetic Evaluate outcomes

Nerve blocks Somebody has shingles Sometime we can do a nerve block Or multiple rib fractures Flare chest Because people end up ventilation We can do a nerve block To block the nerves in that area so it doesn’t hurt that much Or even surgery to avoid medications and pain

Practice question 1 Which nursing intervention would be most appropriate for a patient taking temazepam? A. Monitor for fever B. Give drug intravenously only C. Monitor daily weights D. Tell patient to ask for help before standing

D. Tell patient to ask for help before standing

Practice question 2 What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching? A. The patient wants to listen to music on the radio B. The patient has saved her urine to be measured C. The patient says she has taken 1800ml of fluid today D. The patient requests a cup of kava kava tea to help her get to sleep faster

D. The patient requests a cup of kava kava tea to help her get to sleep faster

Practice question 3 An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue? A. Take Benadryl pills each evening before bedtime B. Drink warm milk or chamomile tea before bedtime C. Develop an exercise regimen for the evening hours D. Take naps during the day whenever you feel drowsily

B. Drink warm milk or chamomile tea before bedtime

Practice question 4 A patient is taking hypnotic nightly to enhance sleep. Which of the following is most associated with adverse effects of vivid dreams and nightmares? A. Hangover B. Tolerance C. Hypersensitivity D. REM rebound

D. REM rebound

Practice question 5 Which of the following is a most serious adverse effect of spinal anesthesia? A. Hypotension B. Headache C. Respiratory distress D. Tachycardia

C. Respiratory distress

Practice question 6 Which drug is commonly used for conscious sedation? A. Midazolam B. Halothane C. Isoflurane D. Lidocaine

A. Midazolam