CNS Depressants Flashcards
Children’s reaxtion to anxiolytic agents is
unpredictable
can have paradoxical effect
Benzodiazepines
-pam -lam
alprazolam
clonazepam
diazepam
lorazepam
midazolam
temazepam
Actions of Benzos
act in limbic sys and the RAS
make GABA more effective
What do higher doses and lower doses do
higher dose = sedation
lower dose = anxiety
indications of benzos
anxiety disorders, alcohol withdrawal, panic, restless leg, sz, insomnia
contraindications for benzos
psychosis
acute narrow angle glaucoma
shock
coma
acute ETOH
preg
BBW for Benzos
use with opioids = resp depression, coma, and death
Adverse effects of Benzos
dry mouth, const, N,V
hypoTN
urinary retention
sedation, drowsiness, depression, lethargy, blurred vision, confusion
DDI for benzos
alcohol = CNS depression
cimetidine, oral contraceptives, disulfiram = more effective
decrease in effect if given with theophylline
Flumazenil
antidote for benzo OD
Implementation for Benzos
admin IV slowly
IV only if oral is not available
no opioids or reduced
monitor for at least 3 hours. Do not permit ambulatory pt operate vehicle
taper dose gradually after long-term therapy to prevent sz
Barbiturates
-barbital
pentobarbital
phenobarbital
secobarbital
Assessment for barbituates
check RR
check BP, VS
bowel sounds, urinary, lesions, check whole body for baseline
Actions of barbiturates
CNS depressants
Inhibit neuronal impulse conduction in RAS
Depress cerebral cortex
depress motor output
sedation hypnosis, anesthesia, coma
Indication for Barbiturates
relief of s/s of anxiety
sedation
insomnia
preanesthesia
sz
Allergy to barbiturates
previous hx of addiction
latent or manifest porphyria
hepatic impairment
resp distress/dysfunct
pregnancy
Contraindications for barbiturates
ADE for barbiturates
CNS depression
Addictive
Hypovent
drowsy/somnolence/lethargy
ataxia, vertigo
N/V/Const
DDI for barbiturates
phenytoin = decrease sz threshold
alcohol, antihistamines = dpress CNS more
MAOI cause increase serum levels and effect
Anticoags, digoxin, tricyclic antidepressants, corticosteroids, oral contraceptives = decreased effectiveness
Implementation for Barbiturates
do not administer these drugs intra-arterially (arterial spasm)
noncompatable with any other IV drug
Give IV meds slowly
Provide standby life support
taper dose gradually
fall precautions/no driving/ no big decisions/ safety/ storage
Antihistamines
promethazine, diphenhydramine
preop medications and postoperative to decrease need for opioids
Buspirone
reduces s/s of anxiety w/out severe CNS and adverse effects
Eszopiclone
insomnia
ramelteon
melatonin receptor agonist; treat insomnia characterized by difficulty w/ going to sleep
suvorexant
insomnia
zaleplon and zolpidem
short-term treatment of insomnia
T or F busprione has no sedative
T it is a anticonvulsant, muscle relax prop, does reduce anxiety
T or F women >35 yrs have increased risk of hepatoxicity with dantrolene
T it is linked to estrogen and increases liver dysfunct with increased estrogen
Centrally acting skeletal muscle relaxants
baclofen
carisoprodol
cyclobenzaprine
metaxalone
methocarbamol
Tizanidine
Baclofen is used for what
spinal cord injury w/ rehab
Actions of centrally acting skeletal muscle relaxants
work in upper levels of CNS to interfere w/ reflexes causing muscle spasm
lyse/destroy spasm
exact mechanism unkown, thought to involve action in upper or spinal interneurons
Indications of centrally acting sk. muscle relaxants
adjunct to rest, PT and OT
relief of discomfort associated w/ acute painful musculoskeletal conditions
Contraindications for central muscle relaxants
allergy, rheumatic disorders (have no effect with muscle relaxants)
Cautions for central muscle relaxants
epilepsy
cardiac dysfunct
conditions with muscle weakness
hepatic/renal impairment
preg
Adverse Effects of central acting muscle relaxants
drowsy, fatigue, weakness, confusion, HA, N, dry mouth
hypoTN
urinary frequency
