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Pharm Test 2 > CNS Depressants > Flashcards

CNS Depressants Flashcards

1
Q

Anxiety

A

A state of apprehension, tension, fear, dread, or uneasiness S/S of anxiety:
palpitations
SOB
sweating
dry mouth
fight or flight symptomsA state of apprehension, tension, fear, dread, or uneasiness

S/S of anxiety:
palpitations
SOB
sweating
dry mouth
fight or flight symptoms

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2
Q

Insomnia

A

most common sleep disorder
problems falling asleep
frequent awakenings with inability to fall back to sleep
early morning awakenings
sleepiness during day in spite of adequate sleep duration
less sleep than required can cause:
apathy, fatigue, irritability, paranoia

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3
Q

Nonprescription Antihistaminesfor Insomnia

A

diphenhydramine (Benadryl)-long 1/2 life
(often used in combination - ___ PM)
promethazine HCL (Sominex)
doxylamine (Nytol)
long half-life, cause drowsiness for up to 12 hours
use no longer than 7 days
contraindicated in: glaucoma, enlarged prostate (most older men), kidney disease, lung problems like asthma or COPD (thick mucus in lungs), HTN, hyperthyroidism

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4
Q

Benzodiazepines

A

used for anxiety, insomnia, muscle spasm, anesthesia
low doses produces calm and relaxation (sedative)
higher doses produce sleep (hypnotic)
very high doses produce analgesia
these are schedule IV drugs

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5
Q

How Benzodiazepines Work

PROTOTYPE Benzodiazepine

A

They bind to the gamma-aminobutyric acid (GABA) receptor
The GABA is a natural inhibitory neurotransmitter
GABA reduces the activity of neurons
This binding intensifies the effects of GABA in the brain

Ativan

given primarily for anxiety, or short-term insomnia

given as pre-anesthetic (IV)

for symptoms of ETOH withdrawal

treatment of status epilepticus (IV)

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6
Q

Benzo adverse effects/interventions

A

Ativan

Adverse effects:
dizziness, ataxia, blurred vision
sedation and confusion, falls
orthostatic hypotension (rare)
Dependence

Contraindications:
Pregnancy
Glaucoma
COPD

Stop med and call for:
Depression symptoms
Thoughts of suicide
Risk-taking activities

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7
Q

Antidote for Ativan Overdose

A

flumazenil (Romazicon)-competes for benzo receptors
it is a benzodiazepine antagonist
given IV
short half-life (30-45 seconds)
may be repeated at 60-second intervals

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8
Q

Nonbenzodiazepine sedative/hypnotics

A

PROTOTYPE: zolpidem (Ambien, Tovalt)
for short-term treatment (7-10 days)
not used for anxiety, used for insomnia
adverse effects:
daytime drowsiness
depression
sleepwalking and sleep-eating with amnesia
dependency with long-term use
falls

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9
Q

Antidepressants used for Anxiety

A

Selective serotonin reuptake inhibitors (SSRIs)
Prototype is fluoxetine (Prozac)
Atypical antidepressants
duloxetine (Cymbalta)
venlafaxine (Effexor)
desvebkafaxube (Prestiq)
Tricyclic antidepressants: prototype: imipramine (Tofranil)
MAOIs: prototype: phenelzine (Nardil)

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10
Q

Barbiturates used for Insomnia (scheduleII)

A

potent CNS depressants with sedative, hypnotic and antiseizure effects
at high doses are anesthetics
rarely prescribed for anxiety or insomnia
high risk of dependence
may induce production of hepatic CYP450 enzymes

develop tolerance after 2 weeks, increase dosage, could stop breathing. limit to 14 days

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11
Q

Prototype Barbiturate:

A

Luminal

Used for status epilepticus

Used prior to general anesthesia

Narrow margin of safety

Binds to GABA receptors

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12
Q

Prototype Barbiturate adverse effects/interventions

A

Stevens-Johnson syndrome (erythema multiforme)-dermal edema
angioedema, thrombophlebitis
oversedation with risk for falls
constipation. toxic, dermal, life threatining

interventions:

D/C gradually to avoid:
nightmares, insomnia, tremors, hallucinations
nausea and vomiting, abdominal pain

Withdrawal syndrome: severe, may be fatal

Overdose:
Respiratory depression, shock, hypotension

contraindications

COPD, (respiratory depression or arrest)
Diabetes
Anemia
Pregnancy
Alcohol use (causes excessive sedation)

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13
Q

Seizures

A

disturbances of electrical activity in brain
abnormal neuronal discharges
loss of consciousness
alterations in motor activity
over 20 types of seizures

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14
Q

Barbiturates

A

Luminal

sedative/hypnotic and antiepileptic
takes several weeks to work
inexpensive, long-acting
Not many problems with sedation
pt. does develop drug tolerance
requires blood levels

low dosage, anti seizure, takes longer to work, prevention

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15
Q

Benzodiazepines (seizures)

A

Prototype: Valium

may be used IV for status epilepticus (ativan IV is also used)
Adverse effects:
cardiovascular collapse-low BP, edema, tacycardia
drowsiness, dizziness, vertigo
Sedation with alcohol
decreases effectiveness of birth control pills or patch
dependence

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16
Q

Hydantoins

A

Prototype: Dilantin

approved for prevention (except absence seizures)
SLOW IV for status (rapid injection can cause cardiovascular collapse)
narrow margin of safety (requires blood levels)

therapeutic range is 10-20 mcg/ml
toxic range is 30-50 mcg/ml

Works by:
Delaying influx of sodium ions in neurons
This slows speed of abnormal neuronal discharge

17
Q

Adverse effects of Hydantoins

A

Dilantin

lethargy, headache, drowsiness
high doses: nystagmus, confusion, ataxia, coma, seizures
gingival hyperplasia, weight loss, liver necrosis
thrombocytopenia, aplastic anemia
abrupt D/C can induce status epilepticus
teratogenic
pink to red-brown urine (expected side effect)

Precautions: Impaired liver or renal function

Diabetes – can increase blood glucose
Extravasation-damage tissue from IV
Use with alcohol-extreme sedation

18
Q

Neuronal Sodium Channel Modulator

A

Prototype: Tegritol, Carbatrol

narrow margin of safety
inhibits sodium channels to block repetitive firing of neurons
indicated also for nerve pain
adverse effects:
drowsiness, dizziness, ataxia, vision disturbances (all temporary)-tends to get better
heart block
aplastic anemia
dermatologic toxicity (rash, alopecia, can cause Stevens-Johnson syndrome)

19
Q

GABA Analog (med that is similar to something else)

A

Prototype: Neurontin

for partial seizures
for nerve pain

adverse effects:
nystagmus and dizziness
drowsiness and fatigue
nausea
teratogenic
seizures if abruptly discontinued
peripheral edema

Teach patient to report behavior changes
Increase dose gradually
Decrease/discontinue gradually
Do not “catch up” on missed doses

20
Q

GABA Agonist

A

Prototype: Depakene, Depakote

for seizures and prevention of migraine headache
increases GABA in brain
requires blood levels
adverse effects:
nausea, vomiting, diarrhea, abdominal pain, anorexia
drowsiness
Pancreatitis and liver damage
bleeding (diminishes platelet aggregation-clumping together)

Teach to report:
Abdominal pain, nausea, decreased appetite (indicates early damage to pancreas)
Pregnancy
Changes in mood or activities
S/S overdose:
sleepiness
cardiac dysrhythmias
loss of consciousness

Pharm Test 2 (3 decks)

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