CNS Depressants/ Muscle Relaxants Chapter 12

Question 1

Baclofen uses/class

Answer 1

Therapeutic: CENTRALLY ACTING (antispastic agents, skeletal muscle relaxants)

Question 2

Baclofen dose

Answer 2

Dosages: Adult:PO: 5mg 3x/day May increase q3 days by 5mg/dose up to 80mg/day
IT: 100-800 mcg/day infusion does determined during screening phase
C: 25-1200 mcg/day dose determined during screening phase

Question 3

Baclofen side effects

Answer 3

Side effects: CNS: Seizures, dizziness,drowsiness, fatigue, weakness GI Nausea

Question 4

Baclofen nursing implications

Answer 4

NI: A: muscle spascisity before and periodically during therapy Observe for dizziness, drowsiness or ataxia May cause incr. in serum glucose alkaline phosphate, AST and ALT

Question 5

Baclofen interactions

Answer 5

Interactions: D/D Incr CNS depression with other CNS depressants including alcohol, anthistamines, opioid analgesics and sedatives/hypnotics
Natural: kava, valerian and chamomile increase cns depression

Question 6

Cyclobenzaprine uses/class

Answer 6

Therapeutic: CENTRALLY ACTING (skeletal muscle relaxants)

Question 7

cyclobenzaprine dose

Answer 7

Dosages: Adults PO IR 10mg 3x/day (range 20-40 mg/day in 2-4 divided doses) ER: 15-30 mg once daily Fibromyalgia-5-40 mg at bedtime

Question 8

cyclobenzaprine side effects

Answer 8

Side effects: CNS dizziness, drowsiness EENT dry mouth

Question 9

cyclobenzaprine interactions

Answer 9

Interactions: D/D:Additive CNS depressants incl alcohol, antihistamines, opioid analgesics, sedative hypnotics Additive anticholingeric effects with drugs possessing anthicholinergic properties incl. antihistamines, antidepressants, atropine, disopyramide, haloperidol, phenothiazines. Avoid use w/i 14 days of MAOI
Natural: kava, valerian, chamomile or hops

Question 10

cyclobenzaprine nursing implications

Answer 10

NI: A: assess pt for pain, muscle stiffness, and range of motion before and periodically t/o therapy

Question 11

temazepam uses/ class

Answer 11

therapeutic: sedative/hypnotics
pharmacologic: BENZODIAZEPINES

Question 12

temazepam dose

Answer 12

Dosages: PO A: 15-40 mg at bedtime initially if needed; some pts may only need 7.5 mg PO(Geriatric or debilitated) 7.5 mg at bedtime

Question 13

temazepam side effects

Answer 13

Side Effects: CNS: hangover

Question 14

temazepam interactions

Answer 14

Interactions: D/D: incr CNS depression with alcohol, antidepressants, antihistamines, opioid analgesics, other sedative/hypnotics may decr. levodopa Rifampin or smoking incr metabolism and my decr. effectivness of temazepam Probenecid may prolong effects of temazepam sedative effects may be decr by theopylline
Natural: concomitant use of kava, valerian, skullcap, chamomile or hops can incr cns depression

Question 15

temazepam nursing implications

Answer 15

NI: A: assess mental status (orientation, mood, behavior)and potential for abuse to administering medication
Assess sleep pattern before and periodically t/o therapy
prolonger high-dose therapy may lead to psych or physical dependence. Restrict amt of drug avail to pt especially if pt is depressed or suicidal or has hx of addiction
Geri: Assess CNS effects and risk for falls. Impl fall prevention

Question 16

zaleplon use/ class

Answer 16

SHORT-ACTING NONBENZODIAZEPINE HYPNOTIC (sedative/hypnotics)

Question 17

zaleplon dose

Answer 17

Dosage A:<50kg: initiate therapy at 5mg at bedtime not to exceed 10 mg
Hepatic impairment: initiate therapy at 5mg at bedtime not to exceed 10 mg

Question 18

zaleplon side effects

Answer 18

Side effects: CNS: anormal thinking, amnesia, anxiety, behavior changes, dizziness, drowsiness, impaired memory (briefly following dose) impaired psychomotor function (briefly following dose)

Question 19

zaleplon interactions

Answer 19

Interactions: D/D: Cimetidine-decr metabolism and incr effects (initiate therapy at lower dose) Additive CNS depression with other phenothiazines and tricyclic antidepressants. Effects may be decr by drugs that induce the CYP 50 3A4 enzyme including rifampin, phenytoin, carbamazepine and phenobarbital.
Natural: concomitant use of kava, valerian, chamomile or hops can incr CNS depression
D/Food: concurrent ingestion of high fat meal slows rate of absorption

Question 20

zaleplon nursing implications

Answer 20

NI: A: assess mental status, sleep patterns and potential for abuse prior to administering this med. Used to treat short tem difficulty in faling asleep, decreases time to sleep onset May not incr total sleep time or decr. # of times waking after falling asleep. Prolonged use >7-10 days may lead to physical and pyschological dependence. Limit amt accessible to pt
Assess alertness at time of peak effect Notify health care professional if desired sedation doesnt occur.
Assess pt for pain medicate as needed untreated pain decreases sedative effects

Question 21

zolpidem uses/ class

Answer 21

SHORT ACTING NONBENZODIAZEPINE HYPNOTIC

Therapeutic: sedative/hynotic

Question 22

zolpidem side effects

Answer 22

Side Effects: ** Anaphylactic Reacations, daytime drowsiness, dizziness

Question 23

zolpidem interactions

Answer 23

Interactions: D/D: CNS depression incr with sedativehypnotics alcohol, phenothiazines, tricyclic antidepressants, opioid analgesics or antihistamines
Natural: concomitant use of kava, valerian or chamomile can incr CNS depression
D/Food: food decr and delays absorption

Question 24

zolpidem dose

Answer 24

dosage: PO, SL Adults: Tablets, spray or SL tablets 10 mg at bedtime; extended release tablets 12.5 mg at bedtime
Geriatric, debilitated, or hepatic impairment: tablets, spray or sl tablets-5 mg at bedtime initially extended release tablets 6.25 mg at bedtime

Question 25

zolpidem nursing implications

Answer 25

NI: A: Assess mental status, sleep pattern and potential for abuse prior to administration. Prolonged use <7-10 days may lead to physical and psychological dependence. Limit amt of drug avail. to pt. Assess alertness at time of peak effect. Notify health care prof if desired sedation doesnt occur Assess pt for pain medicate as needed untreated pain decr sedative effects.