CNS depressants and Stimulants Flashcards by Ashley Arellano

What drugs are Benzodiazepines?

"-pam" & "-lam"
Alprazolam
Clonazepam
Diazepam
Lorazepam
Midazolam
Temazepam

How well did you know this?

Not at all

Perfectly

How do Benzo’s work?

They act in the limbic system and make GABA more effective

How well did you know this?

Not at all

Perfectly

What are the indications for Benzo’s?

anxiety disorders
alcohol withdrawal
hyperexcitability
agitation
preoperative relief for balance anesthesia

How well did you know this?

Not at all

Perfectly

What are the contra/cautions for Benzo’s?

allergy
psychosis
acute narrow angle glaucoma
shock
coma
acute alcohol intoxication
preg & lact

How well did you know this?

Not at all

Perfectly

What are the Adverse effects of Benzo’s?

hypotension
dry mouth
constipation
N/V
urinary retention
sedation, drowsiness, depression, lethargy, blurred vision, confusion

How well did you know this?

Not at all

Perfectly

What are the drug-drug’s for Benzo’s?

alcohol: CNS depression
PO contraceptives, cemetidine, disulfiram: increase effects
theophylline & ranitidine: decrease effects

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

what are our Barbiturates?

“-barbital”
pentobarbital
phenobarbital
secobarbital

How well did you know this?

Not at all

Perfectly

What are the actions of Barbiturates?

it is a CNS depressant

depressed the crebral cortex and motor output

(sedation, hypnosis, coma and anestheisa)

How well did you know this?

Not at all

Perfectly

What are the indications of Barbiturates?

rarely used for anxiety and insomnia
sedation
pre-anesthesia
status epliptacus (non-stop seizure)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What are the adverse effects of Barbiturates?

CNS depression
physical dependence
drowsiness, somnolence and lethargy
ataxia and vertigo
N/V + constipation

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the use of Antihistamines on the CNS?

promethazine and diphenhydramine

as preoperative medications and post-op to decrease the need of narcotics

How well did you know this?

Not at all

Perfectly

What is the use of Busporione on the CNS?

to decrease the s/s of anxiety without severe CNS adverse effects

How well did you know this?

Not at all

Perfectly

What is the use of Zaleplon and Zolpidem on the CNS?

ambien

short term treatment of insomnia

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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