CNS Depressants and Muscle Relaxants Flashcards
Baclofen
Functional Classification
Skeletal Muscle Relaxant, Central Acting
Baclofen
Mechanism of Action
Inhibits synaptic responses in CNS by stimulating GABAb receptor subtype, which decreases neurotransmitter function; decreases frequency, severity of muscles spasms
Baclofen
Uses
Spasticity with spinal cord injury, multiple sclerosis
Baclofen
Contraindications
Hypersensitivity
Baclofen
Side Effects
CNS: Dizziness, Weakness, Fatigue, Drowsiness, headache, Disorientation, insomnia, paresthesias, tremors; SEIZURES, LIFE-THREATENING CNS DEPRESSION, COMA; CNS INFECTION (IT)
CV: hypotension, chest pain, palpitations, edema, CARDIOVASCULAR COLLAPSE (IT)
EENT: nasal congestion, blurred vision, mydriasis, tinnitus
GI: Nausea, constipation, Vomiting, increased AST, alk phos, abdominal pain, dry mouth, anorexia
GU: urinary frequency, hematuria
INTEG: rash, pruritus
RESP: dyspnea; respiratory failure (IT)
Baclofen
Nursing Considerations
ASSESS:
- MULTIPLE SCLEROSIS: spasms, spasticity, ataxia; improvement should occur with product BP, weight, blood glucose, hepatic function periodically
- SEIZURES: for increased seizure activity with seizure disorders; product decreases seizure threshold; EEG in epileptic patients
- I&O ratio; check for urinary frequency
- Allergic reactions: rash, fever, respiratory distress
- Severe weakness, numbness in extremities
- Tolerance: increased need for medication, more frequent requests for medication, increased pain
- WITHDRAWAL SYMPTOMS: CNS depression, dizziness, drowsiness, psychiatric symptoms
- INTRATHECAL: have emergency equipment nearby; assess test dose and titration; if no response, check pump, catheter for proper function
PERFORM/PROVIDE:
-Assistance with ambulation if dizziness, drowsiness occurs
Baclofen
Overdose Treatment
Induce emesis of conscious patient, activated charcoal, dialysis, physostigmine to reduce life-threatening CNS side effects
Cyclobenzaprine
Functional Classification
Skeletal muscle relaxant, central acting
Cyclobenzaprine
Chemical Classification
Tricyclic Amine Salt
Cyclobenzaprine
Mechanism of Action
Reduces tonic muscle activity at the brain stem; may be related to antidepressant effects
Cyclobenzaprine
Uses
Adjunct for relief of muscle spasm and pain in musculoskeletal conditions
Cyclobenzaprine
Contraindications
Children <12yr, acute recovery phase of MI, dysrhythmias, heart block, CHF, hypersensitivity, intermittent porphyria, thyroid disease, QT prolongation
Cyclobenzaprine
Side Effects
CNS: Dizziness, Weakness, Drowsiness, headache, tremor, depression, insomnia, confusion, paresthesia, nervousness
CV: postural hypotension, tachycardia, DYSRHYTHMIAS
EENT: diplopia, temporary loss of vision
GI: Nausea, vomiting, hiccups, dry mouth, constipation, hepatitis
GU: urinary retention, frequency, change in libido
INTEG: rash, pruritus, fever, facial flushing, sweating
Cyclobenzaprine
Nursing Considerations
ASSESS:
- PAIN: location, duration, mobility, stiffness at baseline, periodically
- ALLERGIC REACTIONS: rash, fever, respiratory distress
- severe weakness, numbness in extremities
PERFORM/PROVIDE:
-Assistance with ambulation if dizziness, drowsiness occur, especially for geriatric patients
Cyclobenzaprine
Overdose Treatment
Administer activated charcoal; use anticonvulsants if indicated; monitor cardiac function
Temazepam
Functional Classification
Sedative/Hypnotic
Temazepam
Chemical Classification
Benzodiazepine, short to intermediate acting
Temazepam
Mechanism of Action
Produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter gamma aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Temazepam
Uses
Insomnia
Temazepam
Contraindications
Pregnancy (X), breastfeeding, hypersensitivity to benzodiazepines, intermittent porphyria
Temazepam
Side Effects
CNS: Lethargy, Drowsiness, Daytime Sedation, dizziness, confusion, light-headedness, headache, anxiety, irritability, complex sleep-related reactions (sleep-driving, sleep eating), fatigue
CV: chest pain, pulse changes, hypotension
EENT: blurred vision
GI: nausea, vomiting, diarrhea, heartburn, abdominal pain, constipation, anorexia
SYST: SEVERE ALLERGIC REACTIONS
Temazepam
Nursing Considerations
ASSESS:
- Mental status: mood, sensorium, affect, memory (long, short)
- Type of sleep problem: falling asleep, staying asleep
- DEPENDENCY: restrict amount given to patient, assess for physical/psychological dependency; high-level risk for abuse
PERFORM/PROVIDE:
- Assistance with ambulation after receiving dose
- Safety measures: night-light, call bell within easy reach
- Checking to confirm that PO medication has been swallowed
Temazepam
Overdose Treatment
Lavage, activated charcoal; monitor electrolytes, VS
Zaleplon
Functional Classification
Sedative/Hypnotic, Nonbarbiturate
Zaleplon
Chemical Classification
Pyrazolpyrimidine
Zaleplon
Mechanism of Action
Binds selectively to omega-1 receptor of the GABA(A) receptor complex; results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Zaleplon
Uses
Insomnia
Zaleplon
Contraindications
Hypersensitivity, Severe Hepatic Disease
Zaleplon
Side Effects
CNS: Lethargy, Drowsiness, Daytime Sedation, dizziness, confusion, anxiety, amnesia, depersonalization, hallucinations, hyperesthesia, paresthesia, somnolence, tremor, vertigo, complex sleep related reactions: sleep driving, sleep eating
EENT: vision change, ear/eye pain, hyperacusis, parosmia
GI: nausea, abdominal pain, constipation, anorexia, colitis, dyspepsia, dry mouth
MISC: asthenia, fever, headache, myalgia, dysmenorrhea
SYST: SEVERE ALLERGIC REACTIONS
Zaleplon
Nursing Considerations
ASSESS:
- Mental Status: mood, sensorium, affect, memory (long, short term) excessive sedation, impaired coordination
- SLEEP DISORDER: type of sleep problem: falling asleep, staying asleep
PERFORM/PROVIDE:
- Assistance with ambulation
- Safety measure: night-light, call bell within easy reach
- Check to see if PO medication has been swallowed
Zolpidem (Ambien)
Functional Classification
Sedative/Hypnotic
Zolpidem (Ambien)
Chemical Classification
Imidazopyridine
Zolpidem (Ambien)
Mechanism of Action
Produces CNS depression at limbic, thalamic, hypothalamic levels of CNS; may be mediated by neurotransmitter gamma aminobutyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activitym anxiolytic action
Zolpidem (Ambien)
Uses
Insomnia, short-term treatment; insomnia with difficulty of sleep onselt/maintenance (ext rel)
Zolpidem (Ambien)
Contraindications
Hypersensitivity to benzodiazepines
Zolpidem (Ambien)
Side Effects
CNS: headache, lethargy, drowsiness, daytime sedation, dizziness, confusion, lightheadedness, anxiety, irritability, amnesia, poor coordination, complex sleep-related reactions (sleep driving, sleep eating), depression, somnolence, SUICIDAL IDEATION, abnormal thinking/behavior changes
CV: chest pain, palpitations
GI: nausea, vomiting, diarrhea, heartburn, abdominal pain, constipation
HEMA: LEUKOPENIA, GRANULOCYTOPENIA (rare)
MISC: myalgia
SYST: SEVERE ALLERGIC REACTIONS
Zolpidem (Ambiem)
Nursing Considerations
ASSESS:
- Mental Status: mood, sensorium, affect, memory (long, short term), excessive sedation, impaired coordination, SUICIDAL THOUGHTS/BEHAVIORS
- Blood dyscrasias: fever, sore, throat, bruising, rash, jaundice, epistaxis (rare)
- Type of sleep problem: falling asleep, staying asleep
PERFORM/PROVIDE:
-Assistance with ambulation after receiving dose
Zolpidem (Ambien)
Overdose Treatment
Lavage, activated charcoal; monitor electrolytes, VS
Baclofen
Chemical Classification
GABA chlorophenyl derivative
