CNS Depressants and Stimulants Flashcards
1
Q
Explain Anxiety
A
Reaction to a perceived or physical externa stimulus that leads to feeling nervous, fearful or tense.
2
Q
Explain Anxiolytic
A
Drugs that depress the CNS and reduce anxiety.
3
Q
Explain ADHD
A
Neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning.
4
Q
What are Barbiturates?
A
CNS depressant agent that causes sedation, hypnosis and anesthetic effect.
5
Q
What are Benzodiazepines?
A
Drug that enhances GABA, whihc is an inhibitor that decreases neuron firing. It is a CNS depressor used to reduce anxiety but can cause sedation and hypnosis at high doses.
6
Q
What is Hypnosis?
A
Extreme sedation resulting in further CNS depression and sleep
7
Q
What is a hypnotic?
A
Drugs used to cause CNS depression and sleep - drugs that leads to the state of hypnosis.
8
Q
Explain Sedation?
A
Loss of awareness and reaction to environmental stimuli
9
Q
What is a Sedative?
A
Drugs that cause CNS depression and leads to a loss of awareness and ability to react to the environment. - drugs that lead to a sedative state.
10
Q
What is Basal Ganglia?
A
Group of brain structure that control smooth muscle movement, formation and various cognitive and emotional functions.
11
Q
What is the Cerebellum?
A
Part of the lower brain responsible for coordination of muscle movements both voluntary and unconscious.
12
Q
What is the Extrapyramidal tract?
A
Network of motor pathways in the brain and spinal chord that helps regulate involuntary and fine tuned movements. it also helps with posture, muscle tone and works alongside the pyramidal tract.
13
Q
What is the Golgi tendon organ?
A
Receptor that perceives muscle tension. Too much tension will signal and inhibit neurons that decreases motor activity which causes the muscle to relax.
14
Q
What is Hypertonia?
A
Too much muscle tension.
15
Q
What is Interneuron?
A
Neuron that only communicates with other neurons and does not communicate with muscles or glands.
16
Q
Explain muscle spasms
A
Sudden, involuntary contraction of a muscle, caused by injury or damage. Repeated spasms can be extremely painful.
17
Q
What are muscle spindles?
A
Fibers in skeletal muscle that detect stretch or changes in muscle length and help regulate muscle tone and coordination.
18
Q
What is the Pyramidal tract?
A
Group of fibers that travels through the brainstem into the spinal cord and are most important for controlling precise, intentional movements.
19
Q
What is sliding filament mechanism?
A
The theory o how muscles contract and relax.
20
Q
Explain spasticity
A
When muscles sustain contraction, stopping any normal movement and are resistant to stretching or flexibility while it is happening. It is usually caused by damage to the brain or spinal cord.
21
Q
Can anxiety ever be a good thing? Why/ Why not?
A
Yes in moderation. It can motivate us to take extra precautions in dangerous scenarios. It is a helpful tool for the body to protect itself.
22
Q
When is anxiety a problem?
A
When it becomes paralyzing and you are so anxious that you do nothing. For example too much social anxiety may cause people to never leave the house. A person cannot function properly or perform ADL’s due to the anxiety.
23
Q
How does Anxiolytics help with anxiety?
A
They are used to depress the CNS and disrupt the constant stream of anxious thoughts and allow the person to participate in life the way they want to.
24
Q
When are sedatives used in patients?
A
Used for patients who are overreacting to external stimuli, as well as patients who are nervous, irritable or restless.
The sedatives decrease their awareness to their surroundings , therefore decreasing their responsiveness to their environment. We should however make sure that we are not causing too much drowsiness.
25
When are hypnotics used in patients?
When we are trying to get patients to sleep. Effective hypnotics work on the reticular activating system areas to block the brain from responding to incoming stimuli.
Hypnosis is an extreme form of sedation where patients are not responding to any environmental stimuli vs sedation where reaction is diminished.
26
What lifespan considerations should be taken with children and hypnotic agents?
○Response is unpredictable - there may be aggressiveness, crying or irritability which is not the desired reaction to the medication.
○Good sleep hygiene is preferred for insomnia over drugs.
○Monitor closely for CNS depression and excitability
○Antihistamines commonly used to induce sleep
27
What are some examples of good sleep hygiene?
Set bedtime routine
Sticking to a bedtime
No electronics an hour before bedtime
No caffeine.
28
What lifespan considerations should be taken with adults and hypnotic agents?
○Short-term use only for insomnia
○Good sleep hygiene is preferred for insomnia
○For anxiolytics, may need referral for counseling
○Monitor liver during therapy
○Contraindicated in pregnancy and lactation - antihistamines should be used instead.
29
What can happen with long term use of insomnia medication?
Can lead to dependance, tolerance and potential side effects.
30
How should we approach the treatment of anxiety?
Medication AND therapy.
31
What lifespan considerations should be taken with older adults and hypnotic agents?
○More susceptible to adverse effects
○Dosage should be reduced
○Monitor closely for toxic effects
○Provide safety measures
○Liver and renal function should be monitored
○Use non-drug measures to reduce anxiety and induce sleep
32
What are the suffix(es), drug names and potential outliers for Benzodiazepines?
End in (-pam) or (-lam)
●Alprazolam
●Clonazepam
●Diazepam
●Lorazepam
●Midazolam
●Temazepam
33
Where does Benzodiazepines act in the body?
In the limbic system whihc regulates emotions and stress responses and is influenced by GABA.
34
Does Benzodiazepines work quickly or slowly?
Quickly, which is why they can be used for panic attacks and seizures.
35
Does Benzodiazepines cause a lot of sedation?
No
36
How does Benzodiazepines work in the body?
Make GABA more effective. Gaba calms emotions by reducing brain activity in this area. They also make Gaba more stable which reduces the amount that the neuron can fire,
37
Is the exact mechanism of action known for Benzodiazepines?
No.
38
What does lower doses of Benzodiazepines help with?
Anxiety
39
What does higher doses of Benzodiazepines cause?
sedation and hypnosis
40
What are the indications for giving a patient Benzodiazepines?
Anxiety disorders, alcohol withdrawal, panic disorders, restless leg syndrome, seizure disorders, insomnia
41
What are some known contraindicators that would indicate that Benzodiazepines should be avoided in a patient?
○Allergy
Patients experiencing Psychosis, glaucoma, Shock, Coma or Acute alcohol intoxication should not take because conditions will be exacerbated.
○Pregnancy and lactation - number of birth defects in first trimester.
42
What are some known cautions that we should be aware of if Benzodiazepines is considered for a patient?
○Older adults/debilitated patients
○Renal or hepatic dysfunction
43
Is there a Black Box Warning for Benzodiazepines, and if so, what is it?
If used with opioids they can result in profound sedation, respiratory depression, coma or death
44
What are some adverse reactions that a patient may experience when taking Benzodiazepines?
Adverse reactions mainly caused by how they react with CNS and Peripheral nervous system.
○Dry mouth, constipation, nausea, vomiting - decrease salvation and slow GI motility due to effect on autonomic nervous system.
○Hypotension
○Urinary retention
○Sedation, drowsiness, depression, lethargy, blurred vision, confusion
○Anemia
○Altered sexual function
○If stopped abruptly can lead to withdrawal symptoms
45
What can happen if a dependency has happened and there is a sudden stop in medication?
Nausea, Vomiting, HA, Vertigo, Malaise, Seizures.
46
Are there any known DDI's for Benzodiazepines, and if so, what are they?
○Increased CNS depression when taken with alcohol or other CNS depressants
○Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
○Decrease in effect if given with theophylline
47
Prior to giving Benzodiazepines, what are some patient assessments that we should be doing?
○Assess for contraindications or cautions
○Assess for baseline status before beginning therapy
■Temperature and weight; skin color and lesions; affect, orientation, reflexes, and vision; pulse, blood pressure, and perfusion; respiratory rate, adventitious sounds, and presence of chronic pulmonary disease; and bowel sounds on abdominal examination.
○Perform renal and liver function tests and CBC
48
Prior to giving Benzodiazepines, what are some nursing diagnoses that we should be anticipating?
○Altered thought processes and disturbed sensory perception (visual, kinesthetic) related to CNS effects
○Injury risk related to CNS effects
○Altered sleep pattern related to CNS effects
○Knowledge deficit risk regarding drug therapy
49
What medication should we give patients if they are having a Benzodiazepine overdose?
Flumazenil
50
Is Flumazenil a complete cure for Benzodiazepine overdose?
No. It reverses respiration and sedation, however, it will not address other adverse reactions and there is a high risk of immediate withdrawal symptoms or seizures.
51
What can happen is Benzodiazepine is given via an arterial IV?
It can cause arterial spasms and gangrene.
52
What is Gangrene?
Decay of body tissue typically caused by lack of blood flow leading to tissue death which causes severe irritation to injection site and other potentially life threatening conditions if not addressed.
53
Benzodiazepine is __________ to veins.
Caustic (able to burn or erode)
54
What do we need to do with Benzodiazepine before giving it to patients?
We need to dilute the medication and give it slowly due to the caustic effect it can have on the veins.
55
What are some implementations that we should be expecting to do after giving patients Benzodiazepines? (long answer)
○Be prepared to administer flumazenil
○Do not administer intra-arterially
○Give IV drugs slowly; do not mix IV drugs in solution with any other drugs
○Give parenteral forms only if oral forms are not feasible or available and switch to oral
forms as soon as possible
○Arrange to reduce the dose of opioid analgesics and monitor closely in patients receiving a benzodiazepine
○Maintain patients who receive parenteral benzodiazepines in bed for a period of at least 3 hours. Do not permit ambulatory patients to operate a motor vehicle
○Monitor hepatic and renal function, as well as CBC, during long-term therapy
○Taper dose gradually after long-term therapy, especially in epileptic patients
○Provide comfort measures to help patients tolerate drug effects
○Provide thorough patient teaching
56
I receiving Benzodiazepine parentally, for how long would a patient need to stay in bed before ambulating?
At least 3 hrs to decrease fall risk.
57
What are the suffix(es), drug names and potential outliers for Barbiturates?
(-barbital)
●Pentobarbital
●Phenobarbital
●Secobarbital
58
Are Benzodiazepines or Barbiturates more likely to cause dependency?
Barbiturates . They also have more adverse reactions.
59
What are Barbiturates?
CNS depressants
60
How does Barbiturates work in the body?
Work on the GABA but have a broader effect than Benzodiazepines.
Works by inhibit the RAS.
○Cause: sedation, hypnosis, anesthesia, and coma
61
What does the RAS regulate?
Wakefulness and alternes. By inhibiting RAS we cause sedation and relaxation.
62
What are some indications to giving Barbiturates to a patient?
○Relief of the signs and symptoms of anxiety
○ Induce Sedation
○Insomnia
○Preanesthetic - for preoperative anxiety.
○Seizures
63
What are some known contraindications that should tell us to not give Barbiturates to a patient?
○Allergy to any barbiturate - Steven Johnson syndrome.
○Previous history of addiction to sedative–hypnotic drugs
○Latent or manifest porphyria (deficiency or dysfunction of enzymes in the hemi biosynthesis pathway and the body cannot produce Hemi properly) This causes buildup of harmful substances.
○Marked hepatic impairment or nephritis
○Respiratory distress or severe respiratory dysfunction
○Pregnancy & lactation
64
What are the symptoms of Porphyria?
Skin sensitivity to sunlight, blistering or redness on the skin, severe abdominal pain, nausea, vomiting, muscle weakness & neurological issues such as confusion, seizures or hallucination.
65
What are some adverse reactions that a patient may experience when taking Barbiturates?
○CNS Depression
○Physical Dependency
○Serious hypoventilation
○Drowsiness, somnolence, lethargy
○Ataxia (lack of coordination), vertigo
○Nausea, vomiting, constipation
○Paradoxical excitement, anxiety
or hallucinations
○CV effects
66
What are some CV effects that may happen if giving Barbiturates via IV?
bradycardia, hypertension and syncope.
67
Are there any known DDI's with Barbiturates, and if so, what are they?
Other CNS drugs - may cause too much sedation.
phenytoin - Altered response and seizure activity may increase.
MAOI - increased effectiveness, doses may need to be lowered.
Decrease effectiveness of the following drugs: anticoagulants, digoxin, tricyclic antidepressants, corticosteroids and oral contraceptives
68
Barbiturates have an effect on which enzymes?
Live enzymes which makes them more effective at clearing out medications. We need to ensure that the other medications are achieving their desired effect when taken with Barbiturates.
69
If we need to give a patient two different drugs that both act on the CNS, what do we need to do?
Lower the dose on both medications to avoid serious side effects.
70
Prior to giving a patient Barbiturates, what are some things that we should be assessing for?
○Assess for contraindications or cautions
○Assess for baseline status
■Assess temperature and weight; blood pressure and pulse, including perfusion; skin color and lesions; affect, orientation, and reflexes; respiratory
rate and adventitious sounds; and bowel sounds
71
Prior to giving Barbiturates to a patient what are some nursing diagnoses that we should be anticipating?
○Altered thought processes and altered sensory perception (visual, auditory, kinesthetic, tactile) related to CNS effects
○Injury risk related to CNS effects
○Altered gas exchange related to respiratory depression
○Knowledge deficit risk regarding drug therapy
72
After administering Barbiturates to a patient, what are some implementations that we should be doing or be prepared to do?
○Do not administer these drugs intra-arterially
○Give IV medications slowly
○Do not mix IV drugs in solution with any other drugs
○Give parenteral forms only if oral forms are not feasible or available, and switch to oral forms as soon as possible
○Provide standby life support facilities
○Taper dose gradually after long-term therapy, especially in patients with epilepsy.
○Provide comfort measures to help patients tolerate drug effects
○Provide thorough patient teaching
73
If a epileptic patient is taking Barbiturates regularly and want to stop the medication, what do we need to do?
We need to taper off the medication slowly because suddenly stopping the medication can lead to seizures.
74
Can we give Barbiturates via an arterial line?
No, They are caustic and can cause problems to the artery.
75
What are signs of Barbiturate dependancy?
Increased tolerance, withdrawal symptoms such as anxiety, tremors and seizures when the drug is reduced or strong craving to continue to use the medication.
76
What are the two names for the antihistamines that are also used as anxiolytic and hypnotic drugs?
promethazine, diphenhydramine
77
Why are promethazine & diphenhydramine given?
Given as preoperative medications and postoperative to decrease the need for opioids.
78
What does Buspirone do?
Works as an anxiolytic. Exact MOA is not known. Works on anxiety without CNS depression but takes 1-4 weeks to start working.
79
What is the indication for giving a patient Eszopiclone?
Insomnia. Works on the GABA.
80
What is Ramelteon?
Increases the effect of melatonin and can cause hormonal effects, depression and worsening of sleep apnea.
81
What does Ramelteon do?
Treat insomnia characterized by difficulty with sleep onset
82
What is the indication for giving a patient Suvorexant?
Insomnia. It suppresses the drive to wake up, and patients need to take the medication right before bed to avoid injury from CNS effect.
83
Why would we give a patient Zaleplon and zolpidem?
For short-term treatment of insomnia - bind to GABA.
84
Name 2 Neuromuscular Abnormalities that we can treat with medication.
Muscle Spasm & Muscle Spasticity
85
Explain what Muscle Spasm are.
Often results from injury to the muscle tissue such as a torn ligament, pulled muscle, or torn tendon which may cause constant muscle contrition which may be painful.
The damage tissue keeps sending impulses to contract to the spinal cord. Contractions cuts off blood flow to injured area which increases lactic acid buildup.
86
Explain what Muscle Spasticity is.
Result of damage to neurons within the CNS and not the muscles themselves. This can lead to difficulty moving and stiffness. It is more likely to be permanent. and can be due to a lack of inhibitory CNS input.
87
Where does most muscle relaxants work within the body?
In the brain or spinal cord to mitigate the connection between the muscle spasm and pain.
88
Which muscle relaxants work directly on the muscles?
Dantrolene and Botulin toxins.
89
What lifespan considerations should be taken with children and Muscle Relaxants?
○Safety and effectiveness of some drugs have not been established
○Dosage based on weight
○Monitor for CNS and Hepatic toxicity
90
What lifespan considerations should be taken with adults and Muscle Relaxants?
○Safety precautions
○Use non-drug measures for muscle injury or pain
○Contraindicated in pregnancy and lactation
○Females >35 years have increased risk of hepatoxicity with dantrolene
91
What lifespan considerations should be taken with older adults and Muscle Relaxants?
○More likely to experience adverse effects
○Lower doses may be needed
○Monitor closely for toxicity
○Older women using hormone replacement at same increased risk for hepatoxicity as premenopausal
women
92
What should be used along with Muscle Relaxers for best effect?
Non-pharmacological methods like heat, massage and PT.
93
What drugs do we need to know for Centrally Acting Skeletal Muscle Relaxants?
●Baclofen
●Carisoprodol
●Cyclobenzaprine
●Metaxalone
●Methocarbamol
●Tizanidine
94
When using centrally acting muscle relaxants, what else should the patient be using to reduce inflammation in acute injuries?
Mainly ice, but also resting the muscle , using compression, elevation and sometimes heat.
95
Where in the body does Centrally Acting Skeletal Muscle Relaxants work?
In the upper levels of the CNS.
96
How does Centrally Acting Skeletal Muscle Relaxants work?
By targeting the upper levels of the CNS, which interfere with reflexes that cause the muscle spasms which lyses or destroy the spasm (spasmolytics).
97
What are the indications that would prompt us to give a patient Centrally Acting Skeletal Muscle
Relaxants?
For pain related to musculoskeletal conditions.
And as an adjunct to rest, physical and occupational therapy, and other measures
98
What are the contraindications that would prompt us to NOT give Centrally Acting Skeletal Muscle
Relaxants to a patient?
○Known allergy
○Rheumatic disorders
99
What are some known patient conditions that should make us exhibit caution when giving patients Centrally Acting Skeletal Muscle Relaxants?
○Epilepsy - can lower the seizure threshold
○Cardiac dysfunction - May cause HTN & arrythmias
○Conditions masked by muscle weakness - Myasthenia Gravis
○Hepatic or renal impairment
○Pregnancy or lactation
100
What are some adverse reactions that patients may experience with Centrally Acting Skeletal Muscle
Relaxants?
All associated with depressing the CNS:
○Drowsiness, fatigue, weakness, confusion, headache
○Nausea, dry mouth
○Hypotension
○Urinary frequency
101
Are there any DDI's with Centrally Acting Skeletal Muscle Relaxants and if so, what are they?
○CNS depressants
○Alcohol
102
Prior to giving patients Centrally- Acting Skeletal Muscle Relaxants, what are some things that we should be assessing for?
○Assess for contraindications or cautions
○Perform a physical assessment
■Assess temperature; skin color and lesions
■Assess orientation, affect, reflexes, bilateral grip strength, and spasticity evaluation
■Monitor bowel sounds and reported output
○Monitor liver and renal function tests
103
Prior to giving patients Centrally- Acting Skeletal Muscle Relaxants, what are some Nursing Diagnoses that we could anticipate?
○Impaired comfort related to GI and CNS effects
○Altered thought processes related to CNS effects
○Injury risk related to CNS effects
○Knowledge deficit regarding drug therapy
104
After administrating Centrally- Acting Skeletal Muscle Relaxants, what are some implementations that we should do/ be prepared to do?
○Provide additional measures to relieve discomfort
○Discontinue drug at any sign of hypersensitivity reaction or liver dysfunction
○If using baclofen, taper the drug slowly over 1 to 2 weeks to prevent withdrawal.
○If patient is receiving baclofen through a delivery pump, the patient should understand the pump, the reason for frequent monitoring, and how to adjust the dose and program the unit
○Monitor respiratory status
○Provide thorough patient teaching
105
What are the names of the Direct-acting Skeletal Muscle Relaxants that we should know?
-botulinum
●IncobotulinumtoxinA
●OnabotulinumtoxinA
●RimabotulinumtoxinB
and
●Dantrolene
106
Which direct-acting skeletal muscle drug is especially effective in treating malignant hyperthermia?
Dantrolene.
107
What is Malignant hyperthermia?
A disease that is passed down through genes. If a patient with malignant hyperthermia comes into contact with anesthetic gasses, their body uncontrollably releases calcium in muscle cells which leads to a rapid increase in bod temperature, muscle rigidity, tachycardia, rapid breathing, hypercapnia, sweating, dark urine, acidosis and potentially death.
108
How does Direct-acting Skeletal Muscle Relaxants work?
Enter the muscle to prevent muscle contraction directly
109
How does Dantrolene specifically work in the body?
Works by inhibiting the release of calcium from the sarcoplasmic reticulum in muscle cells, which reduces muscle contraction and spasticity.
110
What are the indications for giving a patient Dantrolene ?
Muscle spasticity in patients with multiple sclerosis or cerebral palsy, malignant hyperthermia
111
How does Botulinum toxins specifically work in the body?
By blocking the release of acetylcholine from nerve endings at the neuromuscular junction which prevents muscle contraction and cause temporary muscle paralysis.
112
What are the indications for giving a patient IncobotulinumtoxinA ?
cervical dystonia, blepharospasm, and chronic sialorrhea (excessive drooling)
113
What are the indications for giving a patient OnabotulinumtoxinA ?
chronic migraines, muscle spasms, excessive sweating,
overactive bladder, and is the botox used for wrinkles
114
What are the indications for giving a patient RimabotulinumtoxinB ?
treat pain associated with cervical dystonia, treat
chronic sialorrhea
115
Does Direct-acting skeletal muscle relaxants affect the CNS?
No, they directly affect the muscle tissue rather than the CNS which is why there are less adverse reactions. There can, however be some side affects related to indirectly affecting the CNS.
116
What would contraindicate the use of Direct-Acting Skeletal Muscle Relaxants?
○Known allergy
○Pregnancy and Lactation
○Spasticity- that contributes to locomotion, upright position, or increased function / allowing patients to move and walk.
○Hepatic disease
117
With which direct-acting skeletal muscle relaxants are we most concerned with allergic reactions?
Botulinum toxins because anaphylactic shock has been associated with these.
118
What patient conditions would caution us against using Direct-Acting Skeletal Muscle Relaxants ?
○Women
○All patients older than 35 years - increased risk of liver damage.
○Liver disease - may worsen
○Cardiac disease, respiratory depression - may be exacerbated.
119
What are some known adverse reactions that patients may have when taking Direct-Acting Skeletal Muscle
Relaxants?
Caused by indirectly affecting the CNS and these side effects are less likely than with centrally acting muscle relaxants.
○Fatigue
○Weakness
○Confusion
○GI irritation
○Enuresis - particularly in patients with underlying bladder issues.
120
Are there any DDI's to Direct-Acting Skeletal Muscle
Relaxants, and if so, what are they?
○Estrogen
○Neuromuscular junction blockers and others that interfere with neuromuscular transmission
121
What should we be assessing for prior to giving patients Direct-Acting Skeletal Muscle Relaxants?
○Assess for contraindications or cautions
○Perform a physical assessment
■Assess temperature; skin color and lesions
■Assess orientation, affect, reflexes, bilateral grip strength, and spasticity
■Assess respiration and adventitious sounds; pulse, electrocardiogram, and cardiac output
■Monitor bowel sounds and reported output
○Monitor liver and renal function tests - a must due to the risks of hepatoxicity.
122
What nursing diagnoses can be made prior to giving patients Direct-Acting Skeletal Muscle Relaxants?
○Impaired comfort related to GI and CNS effects
○Altered thought processes related to CNS effects
○Injury risk related to muscle weakness and CNS effects
○Knowledge deficit regarding drug therapy
123
What implementations should we do/be prepared for once we have administered Direct-Acting Skeletal Muscle Relaxants to a patient?
○Discontinue the drug at any sign of liver dysfunction and hold drug immediately.
○Do not administer botulinum toxins into any area with an active infection due to risk for exacerbation.
○Monitor intravenous access sites of dantrolene for potential extravasation
○Institute other supportive measures (e.g., ventilation, anticonvulsants as needed, cooling blankets) for the treatment of malignant hyperthermia.
○Periodically discontinue dantrolene for 2 to 4 days to monitor therapeutic effectiveness.
○Establish a movement goal before beginning oral therapy with dantrolene
○Discontinue dantrolene if diarrhea becomes severe
○Provide thorough patient teaching
124
What are the drug names that we need to know for Central Nervous System Stimulants?
●Amphetamine
●Armodafinil
●Atomoxetine
●Dexmethylphenidate
●Dextroamphetamine
●Lisdexamfetamine
●Methylphenidate
●Modafinil
125
What characterizes Narcolepsy?
Daytime sleepiness and sudden periods of loss of wakefulness
126
What causes Narcolepsy?
Reason is not fully understood but believed to be related to problems with REM sleep regulation.
May be related to an autoimmune process
127
What are signs of Narcolepsy?
Excessive daytime sleepiness, sudden muscle weakness, sleep paralysis, hallucinations, disrupted nighttime sleep and automatic behaviors (when complete tasks are being fulfilled without the person being fully awake)
128
When does REM sleep occur?
About 15 minutes after sleep has started.
129
What characterizes ADHD?
○Persistent behaviors such as inattention, hyperactivity, and/or impulsivity. Can affect a persons ability to focus.
○Can persist into adulthood
130
What causes ADHD?
○Exact pathophysiology unknown
○Evidence of genetic and environmental
influences that cause alterations in dopaminergic, serotonergic, and glutamatergic neurotransmitter systems - that affects mood.
○May be an inflammatory component
131
How does CNS stimulants work in the body?
By increasing the release of dopamine and norepinephrine from presynaptic neurons leading to an increase in stimulation of the postsynaptic neurons.
Amphetamine stimulants block reuptake of norepinephrine and dopamine and increase more of their release
132
What are the 2 indications to the use of CNS stimulants?
○ADHD - help induce focus and reduce hyperactivity
○Narcolepsy and various sleep disorders - help manage daytime sleepiness.
133
What would contraindicate the use of CNS stimulants?
Known allergy.
Stimulating the CNS can exacerbate anxiety, agitation, or tension.
severe fatigue due to sleep disruption.
glaucoma - due to increasing intraocular pressure
cardiac disease - increase HR and BP and increase risk of MI
134
With what patient conditions should we be cautious of administering CNS stimulants?
Patients with history of seizures due to lowering seizure threshold.
History of drug dependence, including alcoholism due to dependency risk of the drug,
Hypertension - can be worsened
Pregnancy and lactation - effects not known
135
What are some known adverse reactions to the use of CNS stimulants?
All related to drugs being CNS stimulants.
Nervousness,
insomnia,
dizziness,
headache,
blurred vision,
anorexia,
nausea,
weight loss
136
Are there any DDI's to CNS stimulants, and if so, what are they?
○MAOI/TCAs - Can lead to toxicity
○Some OTC cold medications - Can increase CNS effect.
○Caffeine - Can increase CNS effect
137
Prior to giving a patient CNS stimulants, what are some things that we should be assessing for?
○Assess for contraindications or cautions
○Perform physical assessment
■Assess temperature; body weight, skin color, and lesions
■Assess orientation, affect, and reflexes; ophthalmic examination
■Monitor bowel sounds and reported output; urinary output
■Assess pulse, auscultation, and blood pressure, including orthostatic blood pressure; respiration rate and adventitious sounds
○Obtain a CBC
138
Prior to giving a patient CNS stimulants, what are some nursing diagnoses that we would anticipate?
○Altered thought processes related to CNS effects of the drug
○Altered vital signs related to CV effects of the drug
○Injury risk related to CNS and visual effects of the drug
○Knowledge deficiency regarding drug therapy
139
After giving a patient CNS stimulants, what implementations should be made?
○Ensure proper diagnosis of behavioral syndromes and narcolepsy
○Arrange for an overall treatment plan that includes family and cognitive–behavior therapy
○Arrange to interrupt the drug periodically in children who are receiving the drug for behavioral syndromes
○Arrange to dispense the least amount of drug possible
○Administer drug before 6 pm
○Monitor weight, CBC, and ECG
○Consult with the school nurse or counselor
○Provide safety measures if CNS effects occur
○Provide thorough patient teaching
140
What is the difference between sedation and hypnosis?
With sedation external stimuli is diminished.
Hypnosis is extreme sedation where they no longer react to environmental stimuli.
141
A patient is taking Barbiturates and Digoxin at the same time, what do we need to monitor?
We need to monitor that Digoxin is still having the desired effect since Barbiturates may reduce the effect of Digoxin.
142
How long does it take for Buspirone to work?
1-4 weeks.
143
When taking Eszopiclone, how much sleep does the patient need afterwards?
The patient should take Eszopiclone at bedtime and should ensure that they get 8 hrs of uninterrupted sleep due to the sedative effect.
144
Which medication works on Melatonin receptors?
Ramelteon.
145
Women over the age of 35 is at a significantly higher risk of Hepatoxicity with whihc drug?
Dantrolene
146
Which drug is the better choice for older adults with renal and hepatic problems?
Carisoprodol
147
Which patient group is at the same risk of hepatotoxicity as women aged 35 and up?
Postmenopausal women who are using hormone replacement.
148
Patients with what condition will not benefit from treatment with centrally acting skeletal muscle relaxants?
Patients with Rheumatic disorders because these drugs will not work on the type of muscle spasms associated with these disorders.
149
True/ False
Centrally acting Skeletal Muscles does not lower the seizure threshold in patients with epilepsy unlike so many other drugs.
False - it has been known to lower the seizure threshold in patients with epilepsy.
150
If a patient with undiagnosed Myasthenia Gravis takes centrally acting muscle relaxants, what can happen.
Masked symptoms of the disease which may further impair muscle functioning.
151
When Baclofen is given with pump, how and where is this pump implanted?
The pump is implanted under the skin and the medication is slowly infused into the intrathecal space surrounding the spinal cord. This helps manage spasticity.
152
When Baclofen is given with pump, do we need larger or smaller doses and why?
Using a pump allows for a much smaller dose of baclofen compare to PO, which provides the patient targeted relief with fewer systemic side effects.
153
A nurse is caring for a patient with a history of epilepsy and heart disease who is prescribed tizanidine for muscle spasms. What should the nurse prioritize?
Assessing the patient for hypotension or arrythmias, as tizanidine may worsen cardiac conditions in patients with heart disease.
154
What happens when Dantrolene reacts with Estrogen?
Increased Hepatotoxicity.
155
What happens when Direct-acting skeletal muscle relaxants interact with other agents working at the neuromuscular junction such as cholinergic medications and magnesium?
Combining them can increase the risk of severe muscle weakness or respiratory depression.
156
Why do we need to perform a spasticity evaluation prior to administrating muscle relaxers?
To ensure that the medication is working.
157
With which mediations should the patient periodically take 2-4 days off to evaluate therapeutic effectiveness?
Dantrolene.
158
Which drug block reuptake of norepinephrine and dopamine and increase more of their release?
Amphetamine.
159
A patient is prescribed onabotulinumtoxinA for the treatment of chronic migraine headaches. The nurse reviews the patient's medical history and notes the patient has a known allergy to botulinum toxin and a history of mild liver disease. What should the nurse do?
Hold the medication and contact healthcare provider to discuss and alternative treatment plan.
160
Central Nervous System Stimulants are not controlled substances.
True/False
False
They are controlled substances and should be kept locked away from children.
161
It is a good idea to take CNS stimulants before bedtime
True/False
False - taking these drugs before bedtime will most likely keep the patient up for a long time or cause insomnia.
