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NURS 252 (Pharmacology 2) > CNS depressants and Muscle Relaxants > Flashcards

CNS depressants and Muscle Relaxants Flashcards

1
Q

What are hypnotics and what is the relationship between hypnotics and sedatives?

A

Drugs that cause sleep.
A sedative can become a hypnotic if given in large enough doses

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2
Q

What are sedatives?

A

Drugs that reduce nervousness, excitability and irritability without causing sleep

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3
Q

What are the three main groups of sedatives-hypnotics?

A

Barbiturates
Benzodiazepines
Miscellaneous drugs/ Nonbenzodiazepines

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4
Q

What is REM interference?

A

A drug-induced reduction of REM sleep time

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5
Q

What is REM rebound?

A

Excessive REM sleep following discontinuation of a sleep altering drug

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6
Q

Name a long acting, intermediate acting and short acting benzodiazepine

A

L: Diazepam
I: Lorazepam
S: Midazolam HCL

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7
Q

What is the MOA of benzodiazepines and what are 2 favourable characteristics

A

Specifically affect the hypothalamic, limbic and thalamic systems of the brain
Do not suppress REM sleep as much as barbiturates and do not increase metabolism of other drugs

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8
Q

What are the drug effects of benzodiazepines?

A

Controls agitation and anxiety
Reduces excessive sensory stimulation, inducing sleep
Skeletal muscle relaxation

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9
Q

What are the indications of benzodiazepines?

A

Sedation
Sleep induction
Skeletal muscle relaxation
Agitation or anxiety relief
Anxiety-related depression
Treatment of acute seizure disorders
Treatment of alcohol withdrawal
Short-term therapy for insomnia

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10
Q

What are the adverse effects of benzodiazepines?

A

Headache
Drowsiness
Paradoxical excitement or nervousness
Dizziness
Vertigo
Lethargy
Fall hazard for older adults
Cognitive impairment
Hangover effect or daytime sleepiness
Amnesia (Sometimes used prophylactically)

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11
Q

What are the contraindications of benzodiazepines?

A

Glaucoma
Pregnancy

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12
Q

What are signs of a benzodiazepine OD?

A

Somnolence
Confusion
Coma
Diminished reflexes

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13
Q

What is the antidote for OD on a benzodiazepine?

A

Flumanezil

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14
Q

What are possible interactions of benzodiazepines?

A

Alcohol
Opioids
Grapefruit (Prolonged effect)
Kava and valerian

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15
Q

What is the first clinically available benzodiazepine drug?

A

Diazepam

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16
Q

When is midazolam most commonly used?

A

Preop and for procedural sedation

17
Q

What is the onset of lorazepam and what is a consideration?

A

Induces sleep within 30 to 60 minutes
Longer onset of action so it is recommended to take it around 1 hour before going to bed

18
Q

What is the max daily dosage of lorazepam?

A

4 mg

19
Q

What is zopiclone?

A

A short-acting benzodiazepinelike drug
Indicated for short term treatment of insomnia and should be limited to 7-10 days of treatment
Contraindicated in people <18

20
Q

What is Kava? (Indications, contraindications, interactions, adverse effects)

A

Relieves anxiety, stress and restlessness
AE: Yellow skin discolouration, scaly skin and visual disturbances
IE: Alcohol, barbiturates, psychoactive drugs
CI: Liver disease, alcoholism, parkinsons, alcoholism, those operating heavy machinery, breastfeeding and pregnant women

21
Q

What is valerian? (Indications, contraindications, interactions, adverse effects)

A

ID: Anxiety, restlessness and sleep disorders
AE: CNS depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, insomia
IE: CNS depressants, MAOIs, Phenytoin, warfarin, alcohol
CI: Cardiac and liver disease, heavy machinery use

22
Q

Why aren’t barbiturates used as commonly today?

A

Safety and efficacy of benzodiazepines
Low therapeutic index (Easy to become toxic)

23
Q

What is the MOA of barbiturates

A

Act primarily on the reticular formation (brain stem)
By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited

24
Q

What are the indications of barbiturates?

A

Sedatives
Anticonvulsants
Anesthesia for surgeries

25
Q

What are the adverse effects of barbiturates?

A

Vasodilation, hypotension
Drowsiness, lethargy, vertigo
Respiratory depression, cough
Nausea, vomiting, diarrhea, constipation
Agranulocytosis, thrombocytopenia
Steven-johnsons syndrome

26
Q

What can OD on barbiturates be used therapeutically for?

A

Anesthesia induction
Uncontrolled seizures
Phenobarbital coma

27
Q

What are the treatments for an OD on barbiturates ?

A

Assisted ventilation or O2 therapy
Fluids
Alkalization
Activated charcoal (binds to drug molecules in the stomach)

28
Q

What are possible interactions with barbiturates?

A

Additive: Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers
Inhibited metabolism: MAOIs
Reduces effects of anticoagulants
Increased risk of pregnancy with oral contraceptives

29
Q

Name a barbiturate

A

Phenobarbital

30
Q

What is phenobarbital?

A

Long acting barbiturate
Used for prevention of generalized seizures and fever-induced convulsions, as well as treatment of hyperbilirubinemia in neonates

31
Q

Name 3 OTC Hypnotics

A

Doxylamine succinate
Diphenhydramine HCL
Acetaminophen/diphenhydramine

32
Q

What are the indications of muscle relaxants?

A

Relief of painful MSK conditions
Work best when used along with physio

33
Q

What are the adverse effects of muscle relaxants?

A

Euphoria
Lightheadedness
Dizziness
Drowsiness
Fatigue
Confusion
Muscle weakness

34
Q

Name 2 muscle relaxants

A

Baclofen
Cyclobenzaprine HCL

35
Q

Why should benzodiazepines be used with caution in older adults?

A

Most cause REM interference and a tired feeling in the morning

36
Q

What can cause rebound insomnia?

A

A few nights after a 3 to 4 week regimen is discontinued

37
Q

What are some interactions with melatonin?

A

Birth control, Immunosuppressants, antidiabetics and anticoagulants

NURS 252 (Pharmacology 2) (23 decks)

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