CNS depressants and Stimulants Flashcards
What drugs are Benzodiazepines?
"-pam" & "-lam" Alprazolam Clonazepam Diazepam Lorazepam Midazolam Temazepam
How do Benzo’s work?
They act in the limbic system and make GABA more effective
What are the indications for Benzo’s?
- anxiety disorders
- alcohol withdrawal
- hyperexcitability
- agitation
- preoperative relief for balance anesthesia
What are the contra/cautions for Benzo’s?
- allergy
- psychosis
- acute narrow angle glaucoma
- shock
- coma
- acute alcohol intoxication
- preg & lact
What are the Adverse effects of Benzo’s?
- hypotension
- dry mouth
- constipation
- N/V
- urinary retention
- sedation, drowsiness, depression, lethargy, blurred vision, confusion
What are the drug-drug’s for Benzo’s?
- alcohol: CNS depression
- PO contraceptives, cemetidine, disulfiram: increase effects
- theophylline & ranitidine: decrease effects
What are your Nursing Considerations for Benzo’s?
- conditions made worse via depressants
- baseline vitals, weight, skin color and leisions
- watch for disturbed sensory perception
- DO NOT MIX IV DRUGS
- DO NOT MIX INTRA-ARTERIALLY
- admin slowly to prevent hypotension and CA
- PO forms are best
- monitor 3hrs before they leave
what are our Barbiturates?
“-barbital”
pentobarbital
phenobarbital
secobarbital
What are the actions of Barbiturates?
it is a CNS depressant
depressed the crebral cortex and motor output
(sedation, hypnosis, coma and anestheisa)
What are the indications of Barbiturates?
- rarely used for anxiety and insomnia
- sedation
- pre-anesthesia
- status epliptacus (non-stop seizure)
What are the contra/cautions of Barbiturates?
- allergy
- HX of addiction to sedative hypnotics
- latent or manifest porphyria
- marked hepatic impairment or nephritis
- respiratory distress/dysfunction
- pregnancy
What are the adverse effects of Barbiturates?
- CNS depression
- physical dependence
- drowsiness, somnolence and lethargy
- ataxia and vertigo
- N/V + constipation
What are the drug-drug for Barbiturates?
- alcohol, antihistamines and tranquilizers: worsen CNS depression
- MAOI’s: increase serum level and effects
- anticoag, digoxin, PO contraceptives, corticosteroids, tricyclic antidepressants: decrease effectiveness of these
what are our nursing considerations for Barbiturates?
- HX of addiction?
- baseline vitals, weight, skin color and lesions
- watch for disturbed sensory perception and risk for injury
- comfort measures to tolerate effects
- DO NOT MIX INTRA-ARTERIALLY (can cause arteriospasm and gangrene)
- DO NOT MIX IV DRUGS W/ OTHERS
- admin SLOWLY
- PO is best, switch asap from IV
- taper when stopping
What is the use of Antihistamines on the CNS?
promethazine and diphenhydramine
as preoperative medications and post-op to decrease the need of narcotics
What is the use of Busporione on the CNS?
to decrease the s/s of anxiety without severe CNS adverse effects
What is the use of Zaleplon and Zolpidem on the CNS?
ambien
short term treatment of insomnia
what is muscle spasticity?
the result of damaged neurons in the CNS
possibly from and increase in excitatory influences or a decrease in inhibitory influences within the CNS
Life span for Muscle relaxants
- Botulism toxins not approved in children
- females >35yrs have increased risk of hepatotoxicity with dantrolene
- older adults more likely to experience s/e
- older women used hormone replacement at increased risk for hepatotoxicity as premenoposals
What are our centrally acting muscle relaxants?
Baclofen Carisaprodol Cyclobezaprine Metaxalone Methocarbamol Tizandine
How do centrally acting muscle relaxants work?
- work in the CNS and on reflexes to depress muscle spams
- they are spasmolytics as they lyse/destroy the spasm
- exact mechanism unknown, possibly action in upper/spinal interneurons
centrally acting muscle relaxants indications?
alleviate s/s of spasticity
used in spinal cord injuries or dz
centrally acting muscle relaxants contraindications and cautions
- allergy
- rheumatic disorders
- epilepsy
- cardiac dysfunctions
- conditions marked by muscle weakness
- hepatic or renal impairment
- pregnancy or lactation
centrally acting muscle relaxants adverse effects
- related to CNS depression: drowsiness, fatigue, weakness, confusion, HA
- nausea and dry mouth
- hypotension
centrally acting muscle relaxants drug-drug?
CNS depressants
alcohol
nursing considerations of centrally acting muscle relaxants
assessment
good history and physical of spasticity
neurological exam with reflexes and bilateral strength baselines and throughout
report output with bowels
monitor liver and kidneys
nursing diagnosis of centrally acting muscle relaxants
acute pain r/t GI and CNS effects
disturbed though process r/t CNS effects
risk for injury to CNS effects
deficient knowledge regarding therapy
centrally acting muscle relaxants implementation
give non-pharma measures and NSAIDs for pain
d/c if liver dysfunction
baclofen must be tapered over 1-2 weeks to avoid psychosis and hallucinations
educate on how to use pump if on one
monitor respiratory status to avoid depression
safety is important
evaluation of centrally acting muscle relaxants
improve in pain and spasticity/spams
monitor effectiveness of comfort measures
monitor adverse effects of CNS, GI and urinary
What are our direct-acting muscle relaxants?
dantrolene
incobatulinumtoxinA
onabotulinumtoxinA
rimabotulinumtoxinB
(-botulinumtoxin)
what are the actions of direct-acting muscle relaxants?
they interfere with the release of calcium from muscle and directly affect muscle fibers to prevent contractions
what are the indications of direct-acting muscle relaxants?
treatment of spasticity directly affecting peripheral muscle contractions
management of spasticity diseases, MS, myesthenia gravis, cord injury
what are the contra/cautions of direct-acting muscle relaxants?
- allergy
- spasticity: that contributes to locomotion, upright position as it would block it
- hepatic disease
- lactation
- women over 35 r/t hepatocellular disease
- cardiac dz and respiratory depression
- pregnancy
what are adverse effects of direct-acting muscle relaxants?
most common: fatigue, weakness, confusion
- GI irritation
- enuresis
direct-acting muscle relaxants drug-drug interactions
- estrogen: increase risk of hepatic toxicity
- neuromuscular junction blockers: additive effects
direct-acting muscle relaxants assessments
- history and physical
- full neuro exam, vitals, ECG, monitor bowel sounds
- worried of renal and hepatic
direct-acting muscle relaxants nursing diagnosis
- acute pain r/t GI and CNS effects
- risk for injury r/t CNS effects
- disturbed thought process r/t CNS effects
direct-acting muscle relaxants implementation
- d/c at any sign of liver dysfunction
- do not administer botulin toxin to sights with infection
- monitor for possible extravasation
- stop dantrolene for 2-4 days to monitor therapeutic effects
direct-acting muscle relaxants evaluation
- improved spasticity/movement/activities, sweating with botulinum toxins
- monitor for adverse effects
What are our CNS stimulants?
armodafinil dexmethylphenidate dextroamphetamine methlyphenidate modafinil
CNS stimulants actions?
act on cortical and RAS system leading to increase stimulation in the brain to respond to incoming stimulation
CNS stimulants indications
attention deficit syndromes
narcolepsy
contra/cautions for CNS stimulants
- allergy
- anxiety
- agitation
- severe fatigue
- glaucoma
- cardiac dz
- HX seizures, drug dependence including alcoholism
- hypertension
CNS stimulants adverse effects
most common: nervousness, insomnia, dizziness, anorexia or weight loss
- HA
- blurred vision
- nausea
drug-drug for CNS stimulants
- MAOIs: increase adverse effects and toxicity
- guanethidine: decrease antihypertensive effects of that med
- tricyclic antidepressants, phenytoin: increase drug levels
assessment for CNS stimulants
- HX and physical exam
- do they have contra/cautions?
- full neurological exam and ophthalmic exam
- Labs: CBC
nursing diagnosis for CNS stimulants
- disturbed thought process r/t CNS effects
- risk for injury r/t CV effects
- decreased cardia output r/t CV effects
implementation for CNS stimulants
- proper diagnosis
- rule out other behavioral syndromes
- arrange to interrupt drug periodically in kids
- arrange to dispense small amounts at a time
- give before 6pm
- monitor weight
evaluation with CNS stimulants
- decrease behavioral syndromes
- decrease in daytime sleep/narcolepsy
- physiological or physical dependence
