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Pharm Final > CNS depressants and Stimulants > Flashcards

CNS depressants and Stimulants Flashcards

1
Q

What drugs are Benzodiazepines?

A 
"-pam" & "-lam"
Alprazolam
Clonazepam
Diazepam
Lorazepam
Midazolam
Temazepam
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2
Q

How do Benzo’s work?

A

They act in the limbic system and make GABA more effective

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3
Q

What are the indications for Benzo’s?

A
  • anxiety disorders
  • alcohol withdrawal
  • hyperexcitability
  • agitation
  • preoperative relief for balance anesthesia
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4
Q

What are the contra/cautions for Benzo’s?

A
  • allergy
  • psychosis
  • acute narrow angle glaucoma
  • shock
  • coma
  • acute alcohol intoxication
  • preg & lact
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5
Q

What are the Adverse effects of Benzo’s?

A
  • hypotension
  • dry mouth
  • constipation
  • N/V
  • urinary retention
  • sedation, drowsiness, depression, lethargy, blurred vision, confusion
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6
Q

What are the drug-drug’s for Benzo’s?

A
  • alcohol: CNS depression
  • PO contraceptives, cemetidine, disulfiram: increase effects
  • theophylline & ranitidine: decrease effects
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7
Q

What are your Nursing Considerations for Benzo’s?

A
  • 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
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8
Q

what are our Barbiturates?

A

“-barbital”
pentobarbital
phenobarbital
secobarbital

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9
Q

What are the actions of Barbiturates?

A

it is a CNS depressant

depressed the crebral cortex and motor output

(sedation, hypnosis, coma and anestheisa)

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10
Q

What are the indications of Barbiturates?

A
  • rarely used for anxiety and insomnia
  • sedation
  • pre-anesthesia
  • status epliptacus (non-stop seizure)
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11
Q

What are the contra/cautions of Barbiturates?

A
  • allergy
  • HX of addiction to sedative hypnotics
  • latent or manifest porphyria
  • marked hepatic impairment or nephritis
  • respiratory distress/dysfunction
  • pregnancy
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12
Q

What are the adverse effects of Barbiturates?

A
  • CNS depression
  • physical dependence
  • drowsiness, somnolence and lethargy
  • ataxia and vertigo
  • N/V + constipation
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13
Q

What are the drug-drug for Barbiturates?

A
  • 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
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14
Q

what are our nursing considerations for Barbiturates?

A
  • 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
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14
Q

What is the use of Antihistamines on the CNS?

promethazine and diphenhydramine

A

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

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15
Q

What is the use of Busporione on the CNS?

A

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

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16
Q

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

ambien

A

short term treatment of insomnia

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17
Q

what is muscle spasticity?

A

the result of damaged neurons in the CNS

possibly from and increase in excitatory influences or a decrease in inhibitory influences within the CNS

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18
Q

Life span for Muscle relaxants

A
  • 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
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19
Q

What are our centrally acting muscle relaxants?

A 
Baclofen
Carisaprodol
Cyclobezaprine
Metaxalone
Methocarbamol
Tizandine
20
Q

How do centrally acting muscle relaxants work?

A
  • 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
21
Q

centrally acting muscle relaxants indications?

A

alleviate s/s of spasticity

used in spinal cord injuries or dz

22
Q

centrally acting muscle relaxants contraindications and cautions

A
  • allergy
  • rheumatic disorders
  • epilepsy
  • cardiac dysfunctions
  • conditions marked by muscle weakness
  • hepatic or renal impairment
  • pregnancy or lactation
23
Q

centrally acting muscle relaxants adverse effects

A
  • related to CNS depression: drowsiness, fatigue, weakness, confusion, HA
  • nausea and dry mouth
  • hypotension
24
Q

centrally acting muscle relaxants drug-drug?

A

CNS depressants

alcohol

25
Q

nursing considerations of centrally acting muscle relaxants

assessment

A

good history and physical of spasticity
neurological exam with reflexes and bilateral strength baselines and throughout
report output with bowels
monitor liver and kidneys

26
Q

nursing diagnosis of centrally acting muscle relaxants

A

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

27
Q

centrally acting muscle relaxants implementation

A

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

28
Q

evaluation of centrally acting muscle relaxants

A

improve in pain and spasticity/spams
monitor effectiveness of comfort measures
monitor adverse effects of CNS, GI and urinary

29
Q

What are our direct-acting muscle relaxants?

A

dantrolene
incobatulinumtoxinA
onabotulinumtoxinA
rimabotulinumtoxinB

(-botulinumtoxin)

30
Q

what are the actions of direct-acting muscle relaxants?

A

they interfere with the release of calcium from muscle and directly affect muscle fibers to prevent contractions

31
Q

what are the indications of direct-acting muscle relaxants?

A

treatment of spasticity directly affecting peripheral muscle contractions
management of spasticity diseases, MS, myesthenia gravis, cord injury

32
Q

what are the contra/cautions of direct-acting muscle relaxants?

A
  • 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
33
Q

what are adverse effects of direct-acting muscle relaxants?

A

most common: fatigue, weakness, confusion

  • GI irritation
  • enuresis
34
Q

direct-acting muscle relaxants drug-drug interactions

A
  • estrogen: increase risk of hepatic toxicity

- neuromuscular junction blockers: additive effects

35
Q

direct-acting muscle relaxants assessments

A
  • history and physical
  • full neuro exam, vitals, ECG, monitor bowel sounds
  • worried of renal and hepatic
36
Q

direct-acting muscle relaxants nursing diagnosis

A
  • acute pain r/t GI and CNS effects
  • risk for injury r/t CNS effects
  • disturbed thought process r/t CNS effects
37
Q

direct-acting muscle relaxants implementation

A
  • 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
38
Q

direct-acting muscle relaxants evaluation

A
  • improved spasticity/movement/activities, sweating with botulinum toxins
  • monitor for adverse effects
39
Q

What are our CNS stimulants?

A 
armodafinil
dexmethylphenidate
dextroamphetamine
methlyphenidate
modafinil
40
Q

CNS stimulants actions?

A

act on cortical and RAS system leading to increase stimulation in the brain to respond to incoming stimulation

41
Q

CNS stimulants indications

A

attention deficit syndromes

narcolepsy

42
Q

contra/cautions for CNS stimulants

A
  • allergy
  • anxiety
  • agitation
  • severe fatigue
  • glaucoma
  • cardiac dz
  • HX seizures, drug dependence including alcoholism
  • hypertension
43
Q

CNS stimulants adverse effects

A

most common: nervousness, insomnia, dizziness, anorexia or weight loss

  • HA
  • blurred vision
  • nausea
44
Q

drug-drug for CNS stimulants

A
  • MAOIs: increase adverse effects and toxicity
  • guanethidine: decrease antihypertensive effects of that med
  • tricyclic antidepressants, phenytoin: increase drug levels
45
Q

assessment for CNS stimulants

A
  • HX and physical exam
  • do they have contra/cautions?
  • full neurological exam and ophthalmic exam
  • Labs: CBC
46
Q

nursing diagnosis for CNS stimulants

A
  • disturbed thought process r/t CNS effects
  • risk for injury r/t CV effects
  • decreased cardia output r/t CV effects
47
Q

implementation for CNS stimulants

A
  • 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
48
Q

evaluation with CNS stimulants

A
  • decrease behavioral syndromes
  • decrease in daytime sleep/narcolepsy
  • physiological or physical dependence

Pharm Final (15 decks)

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