CNS Depressants and Stimulants Flashcards
Explain Anxiety
Reaction to a perceived or physical externa stimulus that leads to feeling nervous, fearful or tense.
Explain Anxiolytic
Drugs that depress the CNS and reduce anxiety.
Explain ADHD
Neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning.
What are Barbiturates?
CNS depressant agent that causes sedation, hypnosis and anesthetic effect.
What are Benzodiazepines?
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.
What is Hypnosis?
Extreme sedation resulting in further CNS depression and sleep
What is a hypnotic?
Drugs used to cause CNS depression and sleep - drugs that leads to the state of hypnosis.
Explain Sedation?
Loss of awareness and reaction to environmental stimuli
What is a Sedative?
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.
What is Basal Ganglia?
Group of brain structure that control smooth muscle movement, formation and various cognitive and emotional functions.
What is the Cerebellum?
Part of the lower brain responsible for coordination of muscle movements both voluntary and unconscious.
What is the Extrapyramidal tract?
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.
What is the Golgi tendon organ?
Receptor that perceives muscle tension. Too much tension will signal and inhibit neurons that decreases motor activity which causes the muscle to relax.
What is Hypertonia?
Too much muscle tension.
What is Interneuron?
Neuron that only communicates with other neurons and does not communicate with muscles or glands.
Explain muscle spasms
Sudden, involuntary contraction of a muscle, caused by injury or damage. Repeated spasms can be extremely painful.
What are muscle spindles?
Fibers in skeletal muscle that detect stretch or changes in muscle length and help regulate muscle tone and coordination.
What is the Pyramidal tract?
Group of fibers that travels through the brainstem into the spinal cord and are most important for controlling precise, intentional movements.
What is sliding filament mechanism?
The theory o how muscles contract and relax.
Explain spasticity
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.
Can anxiety ever be a good thing? Why/ Why not?
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.
When is anxiety a problem?
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.
How does Anxiolytics help with anxiety?
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.
When are sedatives used in patients?
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.
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.
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
What are some examples of good sleep hygiene?
Set bedtime routine
Sticking to a bedtime
No electronics an hour before bedtime
No caffeine.
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.
What can happen with long term use of insomnia medication?
Can lead to dependance, tolerance and potential side effects.
How should we approach the treatment of anxiety?
Medication AND therapy.
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
What are the suffix(es), drug names and potential outliers for Benzodiazepines?
End in (-pam) or (-lam)
●Alprazolam
●Clonazepam
●Diazepam
●Lorazepam
●Midazolam
●Temazepam
Where does Benzodiazepines act in the body?
In the limbic system whihc regulates emotions and stress responses and is influenced by GABA.
Does Benzodiazepines work quickly or slowly?
Quickly, which is why they can be used for panic attacks and seizures.
Does Benzodiazepines cause a lot of sedation?
No
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,
Is the exact mechanism of action known for Benzodiazepines?
No.
What does lower doses of Benzodiazepines help with?
Anxiety
What does higher doses of Benzodiazepines cause?
sedation and hypnosis
What are the indications for giving a patient Benzodiazepines?
Anxiety disorders, alcohol withdrawal, panic disorders, restless leg syndrome, seizure disorders, insomnia
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.
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
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
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
What can happen if a dependency has happened and there is a sudden stop in medication?
Nausea, Vomiting, HA, Vertigo, Malaise, Seizures.
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
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
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
What medication should we give patients if they are having a Benzodiazepine overdose?
Flumazenil
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.
What can happen is Benzodiazepine is given via an arterial IV?
It can cause arterial spasms and gangrene.
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.
Benzodiazepine is __________ to veins.
Caustic (able to burn or erode)
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.
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
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.
What are the suffix(es), drug names and potential outliers for Barbiturates?
(-barbital)
●Pentobarbital
●Phenobarbital
●Secobarbital
Are Benzodiazepines or Barbiturates more likely to cause dependency?
Barbiturates . They also have more adverse reactions.
What are Barbiturates?
CNS depressants
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
What does the RAS regulate?
Wakefulness and alternes. By inhibiting RAS we cause sedation and relaxation.
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
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
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.
