CNS Depressants

Question 1

Use of Anxiolytic and Hypnotic Agents across the lifespan of: CHILDREN

Answer 1

-Response is unpredictable (children can react to anxiety attacks and hypnotic medication with inappropriate aggressiveness, crying, or irritability)
-Good sleep hygiene is preferred for insomnia (bedtime routine, no caffeine, no electronics 1 hour before bedtime)
-Monitor closely for CNS depression and excitability
-antihistamines commonly used to induce sleep and rest

Question 2

Use of Anxiolytic and Hypnotic Agents across the lifespan of: ADULTS

Answer 2

-short term use only for insomnia
-Good sleep hygiene is preferred for insomnia first
-for anxiolytics may need referral for counseling
-Monitor liver during therapy
-contraindicated in pregnancy and lactation

Question 3

Use of Anxiolytic and Hypnotic Agents across the lifespan of: OLDER ADULTS

Answer 3

-more susceptible to adverse effects (hallucinations are the biggest concern because of the increased safety concerns)
-dosages should be reduced
-monitor closely for toxic effects
-provide safety measures
-liver and renal function should be monitored
-use non-drug measures to reduce anxiety and induce sleep

Question 4

Drug class: Benzodiazepines
What are the suffixes/names in this class?

Answer 4

(-Pam or -lam)
-Alprozalam
-Clonazepam
-Diazepan
-Lorazepam
-Midazolam
-Temazepam

Question 5

Drug class: Benzodiazepines
What are the Actions?

Answer 5

Act in the limbic system and the RAS
they work quickly
-Make GABA more effective
-Causes interference with neurons firing
○Exact mechanism of action is not clearly understood
○Lower doses assist with anxiety
○Higher doses cause sedation and hypnosis

Question 6

Drug class: Benzodiazepines
What are the indications?

Answer 6

○Anxiety disorders, alcohol withdrawal, panic disorders, restless leg syndrome,
seizure disorders, insomnia, preoperative anxiety

Question 7

Drug class: Benzodiazepines
What are the contraindications?

Answer 7

○Allergy
○Psychosis
○Acute narrow angle glaucoma
○Shock
○Coma
○Acute alcohol intoxication
○Pregnancy and lactation

Question 8

Drug class: Benzodiazepines
What are the cautions?

Answer 8

○Older adults/debilitated patients
○Renal or hepatic dysfunction

Question 9

Drug class: Benzodiazepines
What’s the black box warning?

Answer 9

○Concomitant use with opioids can result in profound sedation, respiratory depression, coma or death

Question 10

Drug class: Benzodiazepines
What are the adverse effects?

Answer 10

○Dry mouth, constipation, nausea, vomiting
○Hypotension
○Urinary retention
○Sedation, drowsiness, depression, lethargy, blurred vision, confusion
○Blood dyscrasias
○Altered sexual function
○If stopped abruptly can lead to withdrawal symptoms

Question 11

Drug class: Benzodiazepines
What are the drug-drug interactions?

Answer 11

○Increase CNS depression when taken with alcohol or other CNS depressants
○Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
○Decrease in effect if given with theophylline

Question 12

Nursing Considerations for Benzodiazepines:
Assessment-

Answer 12

○Assess for contraindications or cautions
○Assess for baseline status before beginning therapy
- Temperature and weight; skin color and lesions; affect, orientation, reflexes, and
vision; pulse, blood pressure, and perfusion; respiratory rate, adventitious sounds, and
presence of chronic pulmonary disease; and bowel sounds on abdominal examination.
○Perform renal and liver function tests and CBC

Question 13

Nursing Considerations for Benzodiazepines:
Nursing diagnoses-

Answer 13

○Altered thought processes and disturbed sensory perception (visual, kinesthetic) related to CNS effects
○Injury risk related to CNS effects
○Altered sleep pattern related to CNS effects
○Knowledge deficit risk regarding drug therapy

Question 14

Nursing Considerations for Benzodiazepines:
Implementations-

Answer 14

○Be prepared to administer flumazenil
○Do not administer intra-arterially (can cause gangrene)
○Give IV drugs slowly; do not mix IV drugs in solution with any other drugs
○Give parenteral forms only if oral forms are not feasible or available and switch to oral forms as soon as possible
○Arrange to reduce the dose of opioid analgesics and monitor closely in patients receiving a benzodiazepine
○Maintain patients who receive parenteral benzodiazepines in bed for a period of at least 3 hours. *Do not permit ambulatory patients to operate a motor vehicle
○Monitor hepatic and renal function, as well as CBC, during long-term therapy
○Taper dose gradually after long-term therapy, especially in epileptic patients
○Provide comfort measures to help patients tolerate drug effects
○Provide thorough patient teaching

Question 15

Nursing Considerations for Benzodiazepines:
Evaluation-

Answer 15

○Monitor patient response to the drug (alleviation of signs and symptoms of anxiety; sleep; sedation).
○Monitor for adverse effects (sedation, hypotension, cardiac arrhythmias, hepatic or renal dysfunction, blood dyscrasias, CNS depression, anterograde amnesia, paradoxical response).
○Evaluate the effectiveness of the teaching plan (patient can give the drug name, dosage, possible adverse effects to watch for, specific measures to help avoid adverse effects, and the importance of continued follow-up).
○Monitor the effectiveness of comfort measures and adherence to the regimen.

Question 16

Drug class: Barbiturates
What are the drug names/suffixes in this class?

Answer 16

(-barbital)

●Pentobarbital
●Phenobarbital
●Secobarbital

Question 17

Drug class: Barbiturates
What are the actions?

Answer 17

○CNS depressants
○Inhibit neuronal impulse conduction in the ascending RAS
○Depress cerebral cortex
○Depress motor output
○Cause: sedation, hypnosis, anesthesia, and coma

Question 18

Drug class: Barbiturates
What are the indications?

Answer 18

○Relief of the signs and symptoms of anxiety
○Sedation
○Insomnia
○Preanesthesia
○Seizures

Question 19

Drug class: Barbiturates
What are the contraindications?

Answer 19

○Allergy to any barbiturate
○Previous history of addiction to sedative–hypnotic drugs
○Latent or manifest porphyria
○Marked hepatic impairment or nephritis
○Respiratory distress or severe respiratory dysfunction
○Pregnancy & lactation

Question 20

Drug class: Barbiturates
What are the adverse effects?

Answer 20

○CNS Depression
○Physical Dependency
○Serious hypoventilation
○Drowsiness, somnolence, lethargy
○Ataxia, vertigo
○Nausea, vomiting, constipation
○Paradoxical excitement, anxiety or hallucinations
○CV effects

Question 21

Drug class: Barbiturates
What are the drug drug interactions?

Answer 21

●Increase CNS depression when given with alcohol, antihistamines, and other tranquilizers
●Altered response to phenytoin
●MAOI cause increase serum levels and effect
●Decrease effectiveness of the following drugs: anticoagulants, digoxin, tricyclic antidepressants, corticosteroids and oral contraceptives

Question 22

Nursing Considerations for Barbiturates
Assessment:

Answer 22

○Assess for contraindications or cautions (allergy, hx of addiction, porphyria, hepatic or renal impairment, respiratory dysfunction, pregnancy or lactation)
○Assess for baseline status
■Assess temperature and weight; blood pressure and pulse, including perfusion; skin color and lesions; affect, orientation, and reflexes; respiratory rate and adventitious sounds; and bowel sounds

Question 23

Nursing Considerations for Barbiturates
Nursing diagnoses:

Answer 23

○Altered thought processes and altered sensory perception (visual, auditory, kinesthetic, tactile) related to CNS effects
○Injury risk related to CNS effects
○Altered gas exchange related to respiratory depression
○Knowledge deficit risk regarding drug therapy

Question 24

Nursing Considerations for Barbiturates
Implementations:

Answer 24

○Do not administer these drugs intra-arterially
○Do not mix IV drugs in solution with any other drugs
○Give parenteral forms only if oral forms are not feasible or available, and switch to oral forms as soon as possible
○Give IV medications slowly
○Provide standby life support facilities
○Taper dose gradually after long-term therapy, especially in patients with epilepsy
○Provide comfort measures to help patients tolerate drug effects
○Provide thorough patient teaching

Question 25

Nursing Considerations for Barbiturates
Evaluation:

Answer 25

○Monitor patient response to the drug (alleviation of signs and symptoms of anxiety, sleep, sedation, reduction in seizure activity).
○Monitor for adverse effects (sedation, hypotension, cardiac arrhythmias, hepatic or renal dysfunction, skin reactions, dependence).
○Evaluate the effectiveness of the patient teaching plan (patient can give the drug name, dosage, possible adverse effects to watch for, specific measures to help avoid adverse effects, and the importance of continued follow-up).
○Monitor the effectiveness of comfort measures and adherence to the regimen.

Question 26

Other Anxiolytic and Hypnotic Drugs

Answer 26

●Antihistamines (promethazine, diphenhydramine): Preoperative medications and postoperative to decrease the need for opioids
●Buspirone: Reduces the signs and symptoms of anxiety without severe CNS and adverse effects (takes 1-4 weeks to start working)
●Eszopiclone: Insomnia
●Ramelteon: Melatonin receptor agonist; treat insomnia characterized by difficulty with sleep onset (can cause depression, hormonal effects, and can worsen sleep apnea)
●Suvorexant: Insomnia
●Zaleplon and zolpidem: Short-term treatment of insomnia