CNS Drugs

Question 1

Define sedative.

Answer 1

A drug that calms or relaxes and may induce a sleep state.

Question 2

Define hypnotic.

Answer 2

A drug that induces sleep. Many drugs are classified as sedative-hypnotics.

Question 3

Define anxiolytic.

Answer 3

A drug that reduces anxiety or tension.

Question 4

Define anesthetic.

Answer 4

A drug that depresses the CNS, creating a loss of sensation and potentially a loss of consciousness.

Question 5

Define analgesic.

Answer 5

A drug that reduces pain or the sensation of pain.

Question 6

Define antipsychotic.

Answer 6

A drug used to treat psychosis (altered sense of reality).

Question 7

What order do sedatives act on the CNS in?

Answer 7

1. Cortex (cerebral, motor, etc.)
2. Reticular activating system in the brainstem
3. Medulla oblongata in the lower part of the brainstem.

Question 8

What are the stages of CNS depression?

Answer 8

Relief from anxiety, disinhibition, hypnosis (sleep), general anesthesia, coma, death.

Question 9

What kind of receptors are GABA receptors?

Answer 9

They are the main inhibitory receptor in the CNS

Question 10

How do GABA receptors cause inhibition?

Answer 10

Stimulation of the receptors causes ion channel opening and an influx of Cl- into the cell, making the cell hyperpolarized and more difficult to cause action potential.

Question 11

What are the main effects of GABA receptor stimulation?

Answer 11

Drowsiness and relaxation, amnesia, and lowered anxiety.

Question 12

How do benzodiazepines work?

Answer 12

They are GABA receptor agonists.

Question 13

What effects do benzodiazepines have on the body?

Answer 13

Sedation, decrease in anxiety, amnesia, muscle relaxation, and seizure prevention.

Question 14

True or false: benzodiazepines have analgesic properties.

Answer 14

False

Question 15

What class of drug is Diazepam?

Answer 15

Benzodiazepine.

Question 16

What is the generic name for Valium?

Answer 16

Diazepam

Question 17

What is the administration route and length of effect of diazepam (Valium)?

Answer 17

24 hours, given PO or IV

Question 18

What class of drug is Lorazepam?

Answer 18

Benzodiazepine

Question 19

What is the generic name for Ativan?

Answer 19

Lorazepam

Question 20

What is the length of effect and route of administration for Lorazepam (Ativan)?

Answer 20

10 hours, PO or IV

Question 21

What class of drug is Midazolam?

Answer 21

Benzodiazepine

Question 22

What is the generic name for Versed?

Answer 22

Midazolam

Question 23

What is the length of effect and route of administration for Midazolam (Versed)?

Answer 23

1-4 hours, given PO, IV, or IM

Question 24

What is the onset time for Midazolam (Versed)?

Answer 24

Rapid onset of 1-2 minutes.

Question 25

Which benzodiazepine is used as a short term sedative?

Answer 25

Midazolam (Versed)

Question 26

What class of drug is Flumazenil (Anexate)?

Answer 26

A benzodiazepine antagonist.

Question 27

What does Flumazenil (Anexate) do?

Answer 27

It blocks the benzo-specific site on the GABA receptor to reverse the sedative and respiratory depression of benzos.

Question 28

How do barbiturates work?

Answer 28

They are GABA receptor agonsits.

Question 29

What are the main problems with barbiturates?

Answer 29

They have a narrow therapeutic index, cause respiratory depression and hypotension, and have a high risk of addiction if used in the community.

Question 30

What class of drug is Phenobarbital?

Answer 30

A barbiturate

Question 31

What is Propofol (Diprivan)?

Answer 31

A GABA receptor agonist that is used as the main IV anesthetic agent.

Question 32

What are the benefits of Propofol?

Answer 32

Fast onset (1-2 minutes), easily titrated to effect, and has significant amnesia effect.

Question 33

Where is Propofol used?

Answer 33

In the OR for induction and maintenance of anesthetic state and in the ICU or ER as procedural sedation or maintenance of sedative state.

Question 34

What is the generic name of Propofol?

Answer 34

Diprivan

Question 35

What class of drug is Ketamine?

Answer 35

It is a dissociative anesthetic (opioid).

Question 36

What are some benefits to using Ketamine?

Answer 36

Minimal to no respiratory depression, mild cardiac stimulation, mild bronchodilatory effect, anti-inflammatory, no loss of upper airway muscle tone, and some analgesic effects.

Question 37

What is Dexmedetomidine (Precedex)?

Answer 37

A sedative-hypnotic with analgesic effects.

Question 38

How does Dexmedetomidine (Precedex) work?

Answer 38

It is an agonist for adrenergic receptors in the brain.

Question 39

How is Dexmedetomidine (Precedex) given?

Answer 39

As a continuous IV infusion

Question 40

What is Dexmedetomidine (Precedex) used for?

Answer 40

It has a short effect so it is used specifically for "fast-track" surgeries. It may also be used as continuous ICU sedation and may have benefit for conscious sedations.

Question 41

What are the benefits of using Dexmedetomidine (Precedex)?

Answer 41

Patients will respond to questions and stimuli and has minimal respiratory depression.

Question 42

What kind of drug is Haloperidol (Haldol).

Answer 42

An anti-psychotic

Question 43

How does Haloperidol (Haldol) work?

Answer 43

It blocks dopamine receptors in the CNS.

Question 44

How is Haloperidol (Haldol) given?

Answer 44

IV, IM, or PO

Question 45

What kind of drug is Quetiapine (Seroquel)?

Answer 45

An antipsychotic and antidepressant.

Question 46

How does quetiapine (Seroquel) work?

Answer 46

It blocks dopamine, serotonin, and adrenergic receptors in the CNS.

Question 47

What is Quetiapine (Seroquel) used for in the community?

Answer 47

Severe depression, schizophrenia, and bipolar disorders.

Question 48

What are the pathways for opioid analgesia?

Answer 48

Elevating pain threshold, dissociating from pain perception, and decreasing the response of the body to pain

Question 49

What is Codeine used for?

Answer 49

It is a weak analgesic taken PO for minor pain management (not used for severe acute pain).

Question 50

What is Morphine used for?

Answer 50

Moderate to severe pain levels

Question 51

How long does morphine last and how is it given?

Answer 51

Lasts 3-4 hours and is given IV, IM, sub-q, orally, inhaled, or via PCA pump for post-surgical pain, significant pain events, and palliative care.

Question 52

What is Hydromorphone?

Answer 52

Dilaudid. An artificial opioid that is used similarly to morphine but has easier fine tuning.

Question 53

What is Fentanyl used for?

Answer 53

Surgical procedures and induction.

Question 54

What are some symptoms of opioid overdose?

Answer 54

Pinpoint pupils, somnolence and coma, depressed or absent ventilation, and hypotension.

Question 55

What is the only depolarizing muscle blockade used in Canada?

Answer 55

Succinylcholine (Anectine)

Question 56

How does succinylcholine work?

Answer 56

It binds to nicotinic receptors on skeletal muscle (mimics ACh) which causes depolarization and prevents them from repolarizing.

Question 57

What non-depolarizing muscle blocker is normally used?

Answer 57

Rocuronium (Zemuron).