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nurs 252 > cns depressants and muscle relaxants > Flashcards

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
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2
Q

hypnotics

A
  • cause sleep
  • more potent than sedatives
  • sedative can become a hypnotic if dose is large enough
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3
Q

CNS depressants

A
  • large doses= cause sleep
  • small doses= calm CNS without causing sleep
  • 3 groups= barbiturates, benzodiazepines, miscellaneous drugs
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4
Q

sleep

A
  • cyclic and repetitive
  • response to stimuli is reduced
    -REM and non REM
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5
Q

benzodiazepines

A
  • favourable adverse effects profiles, efficacy and safety
  • classified as sedative-hypnotic or anxiolytic (relieves anxiety)
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6
Q

benzodiazepines (sedative hypnotic) long acting, intermediate and short

A
  • long acting= diazepam (valium)
  • intermediate acting= lorazepam (ativan)
  • short acting= midazolam hcl
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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
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8
Q

benzodiazepine drug effects

A
  • calms CNS
  • controls agitation and anxiety
  • reduces sensory stimulation inducing sleep
  • induces skeletal muscle relaxation
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9
Q

benzodiazepine indications

A
  • sedation
    -sleep induction
  • muscle relaxation
  • anxiety relief
  • anxiety related depression
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10
Q

benzodiazepine uses

A

-treatment of acute seizures
- treatment of alc withdrawal
- short term therapy for insomnia

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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
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12
Q

benzodiazepine contraindications

A

pregnancy and glaucoma

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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

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14
Q

antidote for benzodiazepine toxicity

A

flumazenil

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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
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16
Q

diazepam (valium)

A
  • first available benzo
  • treatment of anxiety
  • long acting
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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
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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
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19
Q

nonbenzodiazepine (zopiclone)

A
  • imovane, rhovane
  • short acting benzodiazepinelike drug
  • very short half life
  • short term treatment of insomnia (7-10 days)
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20
Q

kava indications and adverse effects

A
  • relieve anxiety, stress and restlessness
  • causes temporary jaundice, scaly skin and visual disturbances
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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
Q

valerian adverse effects

A
  • CNS depression, heaptotoxicity, nausea, vomiting, anorexia, headache, restlessness and insomnia
26
Q

valerian interactions

A
  • CNS depressants, MAOIs, phenytoin, warfarin, alcohol
27
Q

valerian contraindications

A
  • cardiac and liver disease
28
Q

barbituates

A
  • introduced in 1903, were the standard drug for insomnia and sedation
  • low therapeutic index (easy to become toxic)
    -contraindicated in pregnancy
29
Q

barbituates MOA

A
  • acts on brainstem (reticular formation)
  • potentiates action of GABA, nerve impulses traveling in the cerebral cortex are inhibited
30
Q

barbituates indications

A
  • sedatives
  • anticonvulsants
  • anaesthesia for surgical procedures
31
Q

barbiturates adverse effects: cardiovascular

A

vasodilation, hypotension

32
Q

barbiturates adverse effects: CNS

A

drowsiness, lethargy, vertigo

33
Q

barbiturates adverse effects: resp

A

resp depress and cough

34
Q

barbiturates adverse effects: GI

A

nausea, vomiting, diarrhea, constipation

35
Q

barbiturates adverse effects: hematological

A

agranulocytosis and thrombocytopenia

36
Q

barbiturates adverse effects other

A

hypersensitivity. stevens-johnson syndrome, paradoxical excitement in children, confusion in older adults

37
Q

barbiturate overdose

A

resp depression and resp arrest
CNS depression
can be therapeutic for:
- anaesthesia induction
- uncontrollable seizures
-phenobarbital coma

38
Q

treatment of barbiturate overdose

A
  • symptomatic and supportive
  • maintain adequate airway
  • assisted ventilation or o2 therapy
  • fluids
  • alkalization
    -activated charcoal
39
Q

barbiturates additive effects

A
  • alc, antihistamines, benzodiazepines, opioids, tranquilizers
40
Q

barbiturates inhibited metabolism

A
  • MAOIs prolong the effects of barbiturates
41
Q

barbiturates increased metabolism

A
  • reduces anticoagulant response leading to possible clot formation
42
Q

barbiturate example

A

phenobarbital

43
Q

phenobarbital

A
  • 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
Q

OTC hypnotics

A
  • doxylamine succinate (unisom-2)
  • dyphenhydramine hcl (sleep-eze)
  • acetaminohpen/diphenhydramine (extra strength Tylenol nighttime)
45
Q

muscle relaxants

A
  • relieve pain from muscle spasms
  • central acting (CNS)
    -similar to other CNS depressants
  • direct acting (on skeletal muscle, closely resemble GABA)
46
Q

muscle relaxant indications

A
  • relief of painful musculoskeletal conditions
  • management of MS and cerebral palsy
  • works best with physical therapy
47
Q

muscle relaxant adverse effects

A
  • euphoria, lightheadedness, dizziness, drowsiness, fatigue, confusion, muscle weakness
48
Q

common muscle relaxants

A

-baclofen injectable (lioresal
- cyclobenzaprine hcl PO (novocycloprine)

49
Q

when to administer hypnotics

A

30-60 mins before bed for max effectiveness

50
Q

benzodiazepine hangover effect

A

REM interference and tiredness the next day in older adults

51
Q

rebound insomnia

A

may occur after a 3-4 week regimen has been discontinued

nurs 252 (23 decks)

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