cns depressants and muscle relaxants Flashcards
1
Q
sedatives
A
- drugs that have inhibitory effect on the CNS to the degree where they reduce nervousness, excitability and irritability
2
Q
hypnotics
A
- cause sleep
- more potent than sedatives
- sedative can become a hypnotic if dose is large enough
3
Q
CNS depressants
A
- large doses= cause sleep
- small doses= calm CNS without causing sleep
- 3 groups= barbiturates, benzodiazepines, miscellaneous drugs
4
Q
sleep
A
- cyclic and repetitive
- response to stimuli is reduced
-REM and non REM
5
Q
benzodiazepines
A
- favourable adverse effects profiles, efficacy and safety
- classified as sedative-hypnotic or anxiolytic (relieves anxiety)
6
Q
benzodiazepines (sedative hypnotic) long acting, intermediate and short
A
- long acting= diazepam (valium)
- intermediate acting= lorazepam (ativan)
- short acting= midazolam hcl
7
Q
benzodiazepine MOA
A
- depresses CNS
- affect hypothalamic, thalamic and limbic system of brain
- GABA receptors
- dont suppress REM as much as barbituates
- dont increase metabolism of other drugs
8
Q
benzodiazepine drug effects
A
- calms CNS
- controls agitation and anxiety
- reduces sensory stimulation inducing sleep
- induces skeletal muscle relaxation
9
Q
benzodiazepine indications
A
- sedation
-sleep induction - muscle relaxation
- anxiety relief
- anxiety related depression
10
Q
benzodiazepine uses
A
-treatment of acute seizures
- treatment of alc withdrawal
- short term therapy for insomnia
11
Q
benzodiazepine adverse effects
A
- headaches
- drowsiness
- ataxia
- paradoxical nervousness
- dizziness
- cognitive impairment
- vertigo
- lethargy
- fall hazard in older adults
- hangover effect of daytime sleepiness
12
Q
benzodiazepine contraindications
A
pregnancy and glaucoma
13
Q
benzodiazepine toxicity and overdose
A
somnolence, confusion, coma, diminished reflexes
- rarely results in hypotension and resp depression unless taken with other CNS depressants (alc)
- treatment symptomatic and supportive
14
Q
antidote for benzodiazepine toxicity
A
flumazenil
15
Q
benzodiazepine interactions
A
- azole antifungals, verapamil, diltiazem, protease inhib, macrolide antibiotics, grapefruit juice
- CNS depressants
- kava and valerian
- food drug interactions with grapefruit
16
Q
diazepam (valium)
A
- first available benzo
- treatment of anxiety
- long acting
17
Q
midazolam
A
- short acting
- used pre-op and for procedural sedation
- causes amnesia and anxiolysis
- IV admin in adults
- liquid oral dosage is available for children
18
Q
lorazepam (ativan)
A
- intermediate acting benzo
- used to treat anxiety
- max dose 4mg/day
- induces sleep within 30-60min
- long onset so take 1hr before bed
19
Q
nonbenzodiazepine (zopiclone)
A
- imovane, rhovane
- short acting benzodiazepinelike drug
- very short half life
- short term treatment of insomnia (7-10 days)
20
Q
kava indications and adverse effects
A
- relieve anxiety, stress and restlessness
- causes temporary jaundice, scaly skin and visual disturbances
21
Q
kava interactions
A
- interactions with alc, barbituates and psychoactive drugs
22
Q
kava contraindications
A
- liver disease, alcoholism, parkinsons
23
Q
dont operate heavy machinery with
A
kava and valerian
24
Q
valerian
A
- relieve anxiety, restlessness and sleep disorders
25
valerian adverse effects
- CNS depression, heaptotoxicity, nausea, vomiting, anorexia, headache, restlessness and insomnia
26
valerian interactions
- CNS depressants, MAOIs, phenytoin, warfarin, alcohol
27
valerian contraindications
- cardiac and liver disease
28
barbituates
- introduced in 1903, were the standard drug for insomnia and sedation
- low therapeutic index (easy to become toxic)
-contraindicated in pregnancy
29
barbituates MOA
- acts on brainstem (reticular formation)
- potentiates action of GABA, nerve impulses traveling in the cerebral cortex are inhibited
30
barbituates indications
- sedatives
- anticonvulsants
- anaesthesia for surgical procedures
31
barbiturates adverse effects: cardiovascular
vasodilation, hypotension
32
barbiturates adverse effects: CNS
drowsiness, lethargy, vertigo
33
barbiturates adverse effects: resp
resp depress and cough
34
barbiturates adverse effects: GI
nausea, vomiting, diarrhea, constipation
35
barbiturates adverse effects: hematological
agranulocytosis and thrombocytopenia
36
barbiturates adverse effects other
hypersensitivity. stevens-johnson syndrome, paradoxical excitement in children, confusion in older adults
37
barbiturate overdose
resp depression and resp arrest
CNS depression
can be therapeutic for:
- anaesthesia induction
- uncontrollable seizures
-phenobarbital coma
38
treatment of barbiturate overdose
- symptomatic and supportive
- maintain adequate airway
- assisted ventilation or o2 therapy
- fluids
- alkalization
-activated charcoal
39
barbiturates additive effects
- alc, antihistamines, benzodiazepines, opioids, tranquilizers
40
barbiturates inhibited metabolism
- MAOIs prolong the effects of barbiturates
41
barbiturates increased metabolism
- reduces anticoagulant response leading to possible clot formation
42
barbiturate example
phenobarbital
43
phenobarbital
- prototypical barbiturate
- long acting
- for prevention of generalized tonic clonic seizures and fever induced convulsions as well as treatment of hyperbilirubinemia in neonates
- rarely used
-adverse effect: anemia
- taper dose to prevent seizures and hallucinations
44
OTC hypnotics
- doxylamine succinate (unisom-2)
- dyphenhydramine hcl (sleep-eze)
- acetaminohpen/diphenhydramine (extra strength Tylenol nighttime)
45
muscle relaxants
- relieve pain from muscle spasms
- central acting (CNS)
-similar to other CNS depressants
- direct acting (on skeletal muscle, closely resemble GABA)
46
muscle relaxant indications
- relief of painful musculoskeletal conditions
- management of MS and cerebral palsy
- works best with physical therapy
47
muscle relaxant adverse effects
- euphoria, lightheadedness, dizziness, drowsiness, fatigue, confusion, muscle weakness
48
common muscle relaxants
-baclofen injectable (lioresal
- cyclobenzaprine hcl PO (novocycloprine)
49
when to administer hypnotics
30-60 mins before bed for max effectiveness
50
benzodiazepine hangover effect
REM interference and tiredness the next day in older adults
51
rebound insomnia
may occur after a 3-4 week regimen has been discontinued
