CNS Depressants and Muscle Relaxants Flashcards
Baclofen
Chemical Classification
GABA chlorophenyl derivative
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
Functional Classification
Skeletal Muscle Relaxant, Central Acting
