CNS depressants and stimulants Flashcards
Drug names for centrally acting skeletal muscle relaxants
Baclofen Carisoprodal Cyclobenzaprine Metaxalone Methocarbamol Tizanidine
Action for centrally acting skeletal muscle relaxants
- work in upper levels of CNS to interfere with reflexes causing muscle spasm
- possible depression anticipated with use
- lyse or destroy spasms (spasmolytic)
- Exact MOA unknown, thought to involve action in upper or spinal interneurons
indication?
why would I use centrally acting skeletal muscle relaxants?
alleviation of s/sx of spasticity, use in spinal cord injuries or diseases
Adverse effects for centrally acting skeletal muscle relaxants
drowsy fatigue weakness confusion HA dry mouth nausea hypotension
contraindications for centrally acting skeletal muscle relaxants
known allergy
thermostatic disorders
cautions for centrally acting skeletal muscle relaxants
epilepsy cardiac dysfunction conditions marked by muscle weakness hepatic or renal impairment P/L
drug/ drug for centrally acting skeletal muscle relaxants
- CNS depressants
- Alcohol
Nursing Diagnosis for centrally acting skeletal muscle relaxants
Acute pain r/t GI and CNS
Disturbed through process r/t CNS
Risk for injury r/t CNS
Deficient knowledge regarding drug therapy
Assessment for centrally acting skeletal muscle relaxants
- known allergy, cardiac depression, epilepsy, muscle weakness or rheumatic disorder
- CNS orientation, affect, reflexes, bilateral grip strength and spasticity, evaluations, BS and reported output
Implementation for centrally acting skeletal muscle relaxants
- provide additional measures to relieve discomforts
- discontinue drug at sign of hypersensitivity reactive or liver dysfunction
- if using Baclofen, taper drug slowly over 1-2 weeks
- if getting Baclofen through delivery pump should understand pump, reason fro frequent monitoring, how to adjust dose and program unit
- monitor respiratory status
- pt teaching
evaluation for centrally acting skeletal muscle relaxants
response to drug:
improvement in muscle spasms and relief of pain, improvement in muscle spasticity
Monitor ADE:
CNS changes, GI depression, urinary urgency
drug names for direct acting skeletal muscle relaxants
Dantrolene
Incobotulinumtoxin A
Onabotulinumtoxin B
Rimabotulinumtoxin B
Actions for direct acting skeletal muscle relaxants
- interfering with the release of calcium from muscle tubules
- this prevents the muscles from contracting
- does not interfere with neuromuscular transmission
Indication?
why would I use direct acting skeletal muscle relaxants?
- tx of spasticity directly affecting peripheral muscle contraction
- management of spasticity associated with neuromuscular disease.
Adverse effects for direct acting skeletal muscle relaxants
fatigue weakness confusion GI irritation enuresis
contraindications for direct acting skeletal muscle relaxants
known allergy
spasticity that contributes to locomotion, upright position or increased fx
hepatic disease
lactation
cautions for direct acting skeletal muscle relaxants
women patients older than 35 cardiac disease respiration depression pregnancy
nursing diagnosis for direct acting skeletal muscle relaxants
acute pain r/t GI and CNS
disturbed thought process r/t CNS
risk for injury r/t CNS
deficient knowledfe
Assessment for direct acting skeletal muscle relaxants
cardiac depression epilepsy muscle weakness respiratory depression P/L renal/hepatic dysfx
Assess CNS, bilateral grip strength, and spasticity. VS, LS, ECG, BS, CO urinary output
Implementation for direct acting skeletal muscle relaxants
discontinue drug at any sign of liver dysfx
do not administer botulism toxins into any area with active infection
monitor IV access sites of dantrolene for potential etravasation
institute other supportive measures (ventilation, anticonvulsants as needed, cooling blanket for tx of malignant hyperthermia.
periodically discontinue dantrolene 2-4 days to monitor therapeutic effectiveness
establish therapeutic goal before starling dantrolene
discontinue dantrolene if diarrhea becomes severe
evaluation for direct acting skeletal muscle relaxants
response to drug:
improvement in spasticity, improvement in movement and activities, improvement in continence, migraines, dystonia, facial lines, sweating with botulin toxins.
monitor ADE:
CNS changes, diarrhea, liver toxicity, urinary urgency
Drug names for central nervous system stimulants
Armodafinil dexmethylphenidate dextroamphetamine methylphenidate modafinil
Action for Central nervous system stimulant
- CNS stimulation, act as cortical and RAS, possible increasing the release of catecholamines from presynaptic neurons leading to an increase in stimulation of the postsynaptic neurons
Indication?
Why would I use Central nervous system stimulants?
tx attention deficit syndrome (ADD, ADHD)
narcolepsy (sleeping disorder)
Adverse effects for Central nervous system stimulants
nervousness insomnia* dizziness HA blurred vision anoerxia* nausea weight loss*
Contraindication for Central nervous system stimulant
known allergy
marked anxiety
agitation or tension and severe fatigue or glaucoma
cardiac disease
Caution for Central nervous system stimulants
tx of seizures
hx of drug dependance - including alcoholism
HTN
Drug/drug for Central nervous system stimulants
MAOIs
Guanethedine
tricyclic antidepressants- phenytoin
nursing diagnosis for Central nervous system stimulants
disturbed thought process r/t CNS
decreased CO r/t CV
risk for injury r/t CNS and visual effects of drug
deficient knowledge
Assessment for Central nervous system stimulant
glaucoma, anxiety, tension, fatigue or seizure disorder, cardiac disease or HTN
p/l hx of leukemia, drug dependance including alcoholism
assess skin color and lesions, CNS, opthalmic exam, BS, urinary output, VS, LS
Labs: CBC
Implementation for Central nervous system stimulants
ensure proper diagnosis of behavioral syndromes and narcolepsy arrange to interrupt drug periodically in children who are receiving for behavioral syndromes use least amount of drug possible give before 6pm monitor weight, CBC, ECG consult with school nurse or counselor safety for CNS controlled substance
Evaluation for Central nervous system stimulants
response to drug:
decreased manifestation of behavioral syndromes, decreased daytime sleep and narcolepsy
monitor ADE:
CNS stimulation, CV effects, rash, physical or psychological dependance, GI dysfunction