CNS Depressants and Muscle Relaxants Flashcards
Sedatives
- inhibitory effect on the CNS
- reduce nervousness
- excitability
- irritability
Hypnotics
- cause sleep
- more poteint effect on CNS than sedatives
- sedative can become a hypnotic if given in large enough dosages
CNS depressants
- barbiturates
- benzodiazepines
- miscellaneous
- benzodiazepines
- formerly most commonly prescribed
- non-benzos are more commonly prescribed due to high addiction rates
- classified as either sedative-hypnotic or anxiolytic
- depress CNS activity
- dont supress REM sleep as much as barbiturates fo
- dont increase metabolism of other drugs
- control agitation and anxiety, msk relaxtion and sensory stimuli
- acute sezuire disorder
- alcohol withdrawl
- insomnia
Sedative- Hypnotic Benzo
long acting
* diazepam (valium)
intermediate acting
* lorazepam (ativan)
short acting
midazolam hydrochloride
Adverse Effects of Benzos
headache
drowiness
paradoxical excitement
dizziness
cognitive impariment
vertigo
lethargy
fall hazard
hangover effect or day time sleepiness
Benzo Overdose
- flumazenil is the antidote
- confusion, flush skin, coma
Benzo Interactions
- azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics grapefruit juice
- CNS depressants
- Kava and valerian
Diazepam (valium)
- long acting benzo
Midazolam
short acting benzo
used pre op and procedural for sedation
causes amnesia and anxiolysis and sedation
IV in adults
liquid oral dosage form is available for children
Lorazepam (ativan)
- intermediate- acting
- used to treat anxiety
- induces sleep within 30-60 min
- long onset of action, take 1hr before going to bed
Nonbenzo: Zopiclone (imovane, rhovane)
- short acting benzo like drug
- very short half life
- short term treatmemt of insomnia 7-10 days
Herbal Products Kava
- relieve anxiety, stress and restlrssness to promote sleep
- may cause temporary skin discoloration, scaly skin and visual disturbances
- interacts with alcohol, barbiturates and psychoactive drugs
- contraindicated in liver disease, alcoholism
- dont operate heavy machinery during use
Herbal Products Valerian
- relieve anxiety, restlessness and sleep disorders
- may cause CNS depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, insomnia
- interacts with CNS depressants, MAOI, phenytoin, warfarin and alcohol
- contraindicated in cardiac and liver disease
Barbiturates
- older drug
*benzos are more commonly used - MOA: potentiating the action of GABA, nerve impulses travelling in the cerebral cortex are inhibited
- sedatives, anticonvulsants, anaesthesia
Adverse Effects Barbiturates
- vasodilation, hypotension
- resp depression, cough
- agranulocytosis, **thrombocytopenia **
- stevens-johnson syndrom
**Contraindications:
pregancy
severe COPD
liver diasease
use of opiod **
Barbiturates Overdose
- rarely used
- overdose leads to resp depression and subsequent resp arrest
- coma and death
- activated charchol
- pentobarbital in canada
Barbiturates Interactions
- alcohol, antihistamines, benzo, opioids, tranquilzers
- Inhibited metabolism of MAOI
- increased metabolism of anticogulant, leading to clot formation as it reduces there affect
Doxylamine succinate (unisom-2), diphenhydramine hydrochloride (sleep- eze) and acetaminophen/ diphenhydramine (extra strength tyenol night time)
- non- prescription sleeping aids, have CNS depressants (antihistamines)
Phenobarbital
- protypical barbiturate
- long acting
- prevntion of tonic-clonic sezures and fever induced convulsions
- treatment of hyperbillirubinemia in neonates
- rarley used today as a sedative and no longer recommeneded as a hypnotic
Baclofen (Lioresal)
relaxing your muscles, which reduces muscle stiffness
Muscle Relaxants
adverse effects: euphoria, light headed, dizzy, drowsy, fatigue, confusion, muscle weakeness
Cyclobenzaprine hydrochloride (novo-cycloprine)
A centrally acting skeletal muscle relaxant, it is used in the symptomatic treatment of painful muscle spasm. It has a role as a muscle relaxant and an antidepressan
Nursing Considerations
- administer hypnotics 30-60 min before bed
- most benzo cause REM sleep interferance adn a tired next day feeling the next day, use with caution in older adults
- avoid alcohol and other CNS depressants
- rebound insomnia may occue for a few nights after a 3-4 week regimen has been discontinued
- consider saftey aspects for fall risk
