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Pharmacology Exam #3 > CNS Stimulants and Depressants > Flashcards

CNS Stimulants and Depressants Flashcards

1
Q

3 Psychological States Affected by Anxiolytic and Hypnotic Drugs

A

⭐ Anxiety: Feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
⭐ Sedation: Loss of awareness and reaction to environmental stimuli
⭐ Hypnosis: Extreme sedation resulting in further CNS depression and sleep

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2
Q

Lifespan Considerations for Anxiolytic and Hypnotic Drugs
In Children

A
  • Response is unpredictable
  • Good sleep hygiene is preferred for insomnia
  • Monitor closely for CNS depression and excitability
  • Antihistamines commonly used
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3
Q

Lifespan Considerations for Anxiolytic and Hypnotic Drugs
In Adults

A
  • Short term use ONLY for insomnia; good sleep hygiene is preferred
  • With anxiolytics, may need referral for counseling
  • Monitor liver during therapy
  • Contraindicated in pregnancy and lactation
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4
Q

Lifespan Considerations for Anxiolytic and Hypnotic Drugs
In Older Adults

A
  • More susceptible to adverse effects
  • Dosage should be reduced
  • Monitor closely for toxic effects
  • Provide safety measures
  • Liver and renal function tests should be monitored
  • Use non-drug measures to reduce anxiety and induce sleep whenever possible
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5
Q

Benzodiazepines
Drug Names

A

“-pam” or “-lam”
Alprazolam
Clonazepam
Diazepam
Lorazepam
Midazolam
Temazepam

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6
Q

Benzodiazepines
Mechanism of Action

A
  • Act in the limbic system and the RAS
  • Make GABA more effective
  • Cause interference with neurons firing
  • Exact mechanism not clearly understood
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7
Q

Benzodiazepines
Indications

A
  • Lower doses: anxiety
  • Higher doses: sedation and hypnosis
  • Anxiety Disorder, alcohol withdrawal, panic disorders, restless leg syndrome, seizure disorders, insomnia
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8
Q

Benzodiazepines
Contraindications

A

Absolute:
* Allergy
* Psychosis
* Acute narrow angle glaucoma
* Shock
* Coma
* Acute alcohol intoxication
* Pregnancy and lactation

Cautions:
* Older adults/debilitated patients
* Renal or hepatic dysfunction

Black Box Warning:
Concomitant use with opiods can result in profound sedation, respiratory depression, coma, or death

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9
Q

Benzodiazepines
Adverse Effects

A

🤢 GI: Dry mouth, nausea, vomiting
💓 CV: Hypotension
🧠 CNS: sedation, drowsiness, depression, lethargy, blurred vision, confusion
🟡 GU: Urinary retention
🩸 Blood dyscrasias: anemia
😳 Altered sexual funtion
🚫 If stopped abruptly: Can lead to withdrawal symptoms (N/V, headache, seizures)

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10
Q

Benzodiazepines
Drug Interactions

A
  • Alcohol or other CNS depressants (⬆️ CNS depression)
  • Cimetidine, oral contraceptives, disulfiram (⬆️ in effect)
  • Theophylline (⬇️ in effect)
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11
Q

Benzodiazepines
Assessment

A

History:
* Check for allergy, pregnancy, lactation, psychosis, glaucoma, acute alcohol intoxication, shock, coma

Physical:
* Temperature and weight
* Skin color and lesions
* Affect, orientation, reflexes, vision
* Pulse, BP, perfusion
* Respiratory rate, lung sounds, check for COPD
* Bowel sounds

Labs:
* Renal and liver function tests
* CBC

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12
Q

Benzodiazepines
Implementation/Patient Teaching

A
  • Have emergency med. available: Flumazenil (Competitive agonist @GABA receptor)
  • DO NOT administer intra-arterially: can cause arterial spasm and gangrene
  • Toxic to veins: Give IV drugs SLOWLY; do NOT mix with any other drugs
  • Give parenteral forms ONLY when oral forms are not feasible or available; switch to oral forms ASAP
  • Reduce the dose of opioid and monitor closely
  • Patients need to stay in bed for 3 hours after parenteral administration
  • No operation of motor vehicles
  • Monitor hepatic and renal levels; and CBC
  • Taper dose gradually after long term use; especially in epileptic patients
  • Report: memory problems, blurred vision, confusion, muscle weakness
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13
Q

Benzodiazepines
Nursing Diagnoses/Conclusions

A
  • Altered thought processes and disturbed sensory perception (r/t CNS effects)
  • Injury risk (r/t CNS effects)
  • Altered sleep pattern (r/t CNS effects)
  • Knowledge Deficit
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14
Q

Barbituates
Drug Names

A

“-barbital”
Pentobarbital
Phenobarbital
Secobarbital

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15
Q

Barbituates
Mechanism of Action

A
  • Inhibits neuronal impulse conduction in the ascending RAS
  • Depresses the cerebral cortex
  • Depresses motor output
  • Causes: sedation, hypnosis, anesthesia, and coma
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16
Q

Barbituates
Indication

A
  • Relief of the signs and symptoms of anxiety
  • Sedation
  • Insomnia
  • Preanesthesia
  • Seizures
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17
Q

Barbituates
Contraindications

A

Absolute:
* Allergy to any barbituate
* Previous history of addiction to sedative-hypnotic drugs
* Latent or manifest porphyria (build up of the chemicals needed to make hemoglobin)
* Marked hepatic impairment
* Nephritis
* Respiratory distress or severe respiratory dysfunction
* Pregnancy and lactation

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18
Q

Barbituates
Adverse Effects

A
  • 🧠 CNS Depression: Ataxia, vertigo, somnolence, drowsiness, lethargy, syncope
  • 🫁 Serious hypoventilation
  • 🤢 Nausea, vomiting, constipation
  • 💓 CV effects
  • Paradoxical excitement, anxiety, or hallucinations
  • Physical dependency
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19
Q

Barbituates
Drug Interactions

A
  • Alcohol, antihistamines, other tranquilizers: Increased CNS depression
  • Phenytoin: altered response to phenytoin, seizures may increase
  • MAOI: increase serum levels and effect
  • Will decrease effectiveness of: anticoagulants, digoxin, TCAs, corticosteroids, oral contraceptives
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20
Q

Barbituates
Assessment

A

History:
* Check for allergy or any other contraindication

Physical:
* Temperature and weight
* Blood pressure and pulse, perfusion
* Skin color and lesions
* Affect, orientation, reflexes
* Respiratory rate, lung sounds
* Bowel sounds

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21
Q

Barbituates
Nursing Diagnoses/Conclusions

A
  • Altered thought process (r/t CNS effects)
  • Injury risk (r/t CNS effects)
  • Altered gas exchange (r/t respiratory depression)
  • Knowledge deficit
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22
Q

Barbituates
Implementation/Patient Teaching

A
  • DO NOT administer intra-arterially: Serious risk of gangrene
  • Do not mix IV drugs in a solution with any other drugs
  • Give parental forms only when oral forms are not feasible or available; switch to oral ASAP
  • Give IV medications slowly
  • Provide standby life support facilities
  • Taper dose gradually after long-term therapy, especially in pts with epilepsy
  • Avoid driving
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23
Q

Other Anxiolytic and Hypnotic Drugs

A
  • Antihistamines (promethazine, diphenhydramine): Preoperative and postoperative to decrease need for opioids
  • Buspirone: reduces the signs and symptoms of anxiety without serious CNS effects; No sedative effect; takes 1-4 weeks to take effect
  • Eszopiclone: Insomnia; works on GABA receptors; take before bed and allow 8 hours to sleep (risk of sleep driving)
  • Ramelteon: Insomnia - difficulty with sleep onset; melatonin receptor agonist
  • Suvorexant: Insomnia; suppresses drive to wake up
  • Zaleplon and zolpidem: Short term treatment of insomnia; sedating (risk of sleep driving)
24
Q

What is a muscle spasm?

A

Problem IN the muscles
* Often results from injury to the musculoskeletal system
* Caused by the flood of sensory impulses coming to the spinal cord from the injured area

25
Q

What is muscle spasticity?

A

Problem is in the neurons
* Result of damage to neurons in the CNS
* May result from an increase in excitatory influences or a decrease in inhibitory influences within the CNS

26
Q

Lifespan consideration for Muscle Relaxants
In Children

A
  • Safety and effectiveness of some drugs have not been established
  • Dosage based on weight
  • Monitor for CNS and GI toxicity
27
Q

Lifespan consideration for Muscle Relaxants
In Adults

A
  • Safety precautions
  • Use non-drug therapies for muscle pain or injury
  • Contraindicated in pregnancy and lactation
  • Females >35 have increased risk of hepatotoxicty with dantrolene
28
Q

Lifespan consideration for Muscle Relaxants
In Older Adults

A
  • 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 hepatotoxicity as premenopausal women
29
Q

Centrally Acting Skeletal Muscle Relaxants
Drug Names

A

Baclofen
Carisoprodol
Cyclobenzaprine
Metaxalone
Methocarbamol
Tizanidine

30
Q

Centrally Acting Skeletal Muscle Relaxants
Mechanism of Action

A
  • Works on GABA receptors in upper levels of CNS to interfere with reflexes causing muscle spasm
  • Lyse or destroy spasm (spasmolytics)
  • Exact mechanism unknown, thought to involve action in upper or spinal interneurons
31
Q

Centrally Acting Skeletal Muscle Relaxants
Indications

A
  • Relief of discomfort associated with acute, painful musculoskeletal conditions
  • Adjunct to rest, physical and occupational therapy, and other measures
32
Q

Centrally Acting Skeletal Muscle Relaxants
Contraindications

A

Absolute:
* Allergy
* Rheumatic disorder

Cautions:
* Epilepsy (lowers seizure threshold)
* Cardiac dysfunction (worsens)
* Conditions marked by muscle weakness (ex. Myasthenia Gravis)
* Hepatic or Renal Impairment
* Pregnancy or lactation

33
Q

Centrally Acting Skeletal Muscle Relaxants
Adverse Effects

A
  • 🧠 CNS: Drowsiness, fatigue, weakness, confusion, headache
  • 🤢 GI: Nausea, dry mouth
  • 💓 CV: Hypotension
  • 😳 GU: Urinary frequency
34
Q

Centrally Acting Skeletal Muscle Relaxants
Drug Interactions

A
  • CNS Depressants
  • Alcohol
35
Q

Centrally Acting Skeletal Muscle Relaxants
Assessment

A

History:
* Check for allergy, rheumatic disorders, epilepsy, cardiac dysfunction, pregnancy, lactation, renal or hepatic impairment, or muscle weakness conditions

Physical:
* Temperature
* Skin color and lesions
* Orientation, affect, reflexes, bilateral grip strength, spasticity
* Bowel sounds
* Urinary output

Labs:
* Liver and renal function tests

36
Q

Centrally Acting Skeletal Muscle Relaxants
Nursing Diagnoses/Conclusions

A
  • Impaired Comfort (r/t GI and CNS effects)
  • Altered thought processes (r/t CNS effects)
  • Injury Risk (r/t CNS effects)
  • Knowledge deficit
37
Q

Centrally Acting Skeletal Muscle Relaxants
Implementation

A
  • Provide additional measures to relieve discomfort (heat/ice)
  • Discontinue drug at any sign of hypersensitivity reaction or liver dysfunction
  • Baclofen: Taper drug slowly over 1-2 weeks
  • Baclofen delivered through a pump - teach patient how to use it
  • Monitor respiratory status
  • Report: Excessive drowsiness, rash, blurry vision
38
Q

Direct-Acting Skeletal Muscle Relaxants
Drug Names

A
  • Dantrolene
  • IncobotulinumtoxinA
  • OnabotulinumtoxinA
  • RimabotulinumtoxinB
39
Q

Direct-Acting Skeletal Muscle Relaxants
Mechanism of Action

A
  • Enters the muscle to directly prevent muscle contraction (inhibits calcium release)
40
Q

Direct-Acting Skeletal Muscle Relaxants
Indications

A
  • Treatment of spasticity directly affecting peripheral muscle contraction
  • Management of spasticity associated with neuromuscular diseases
  • Dantrolene: Muscle spasticity in patients with multiple sclerosis or cerebral palsy, malignant hyperthermia
  • IncobotulinumtoxinA: cervical dystonia, blepharospasm, and chronic sialorrhea (excessive drooling)
  • OnabotulinumtoxinA: chronic migraines, muscle spasms, excessive sweating, overactive bladder, and is the botox used for wrinkles
  • RimabotulinumtoxinB: treats pain associated with cervical dystonia, treats chronic sialorrhea
41
Q

Direct-Acting Skeletal Muscle Relaxants
Contraindications

A

Absolute:
* Allergy
* Pregnancy and lactation
* Spasticity that contributes to locomotion, upright position, or increased function
* Hepatic disease

Cautions:
* Women
* All patients older than 35
* Liver disease (even mild)
* Cardiac disease
* Respiratory depression

42
Q

Direct-Acting Skeletal Muscle Relaxants
Adverse Effects

A
  • Fatigue, weakness, confusion
  • GI irritation
  • Enuresis (night time bedwetting)
43
Q

Direct-Acting Skeletal Muscle Relaxants
Drug Interactions

A
  • Estrogen (can cause severe liver toxicity)
  • Neuromuscular junction blockers and others that interfere with neuromuscular transmission (increase in severe muscle weakness)
44
Q

Direct-Acting Skeletal Muscle Relaxants
Assessment

A

History:
* Check for all contraindications and cautions

Physical:
* temperature
* skin color and lesions
* orientation, affect, reflexes, bilateral grip strength, spasticity
* Respiration rate and lung sounds
* Pulse and cardiac output
* ECG
* Bowel sounds
* Urinary output

Labs:
* Renal and liver function tests

45
Q

Direct-Acting Skeletal Muscle Relaxants
Nursing Diagnoses/Conclusions

A
  • Impaired comfort (r/t GI and CNS effects)
  • Altered thought processes (r/t CNS effects)
  • Injury Risk (r/t CNS effects)
  • Knowledge Deficit
46
Q

Direct-Acting Skeletal Muscle Relaxants
Implementation/Patient Teaching

A
  • Discontinue drug at any sign of liver dysfunction
  • Do not administer botulinumtoxins into any area with active infection
  • Monitor IV sites of dantrolene for potential extravasation (leakage of fluid/drug into surrounding tissues)
  • Institute other supportive measures (ventilation, anticonvulsants, cooling blankets) for treatment of malignant hyperthermia
  • Periodically discontinue dantrolene for 2 to 4 days to monitor therapeutic effectiveness
  • Establish a therapeutic goal before beginning oral dantrolene therapy
  • Discontinue dantrolene if diarrhea becomes too severe
47
Q

Central Nervous System Stimulants
Drug names

A
  • Amphetamine
  • Dextroamphetamine
  • Lisdexamfetamine
  • Atomoxetine
  • Dexmethylphenidate
  • Methylphenidate
  • Armodafinil
  • Modafinil
48
Q

Central Nervous System Stimulants
Mechanism of Action

A
  • Increase the release of catecholamines 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
49
Q

Central Nervous System Stimulants
Indications

A
  • ADHD
  • Narcolepsy and various sleep disorders
50
Q

What is Narcolepsy?

A
  • Daytime sleepiness and sudden periods of loss of wakefulness

Causes:
* May reflect problems with REM sleep regulation
* High rate of HLA subtype DQB1-0602
* Hypocretin 1 and 2 may be deficient
* May be related to an autoimmune process

51
Q

What is ADHD?

A
  • Persistent behaviors demonstrating inattention, hyperactivity, and/or impulsivity
  • Can persist into adulthood

Causes:
* Exact pathophysiology unknown
* Evidence of genetic and environmental influences that cause alterations in dopaminergic, serotonergic, and glutamatergic neurotransmitter systems
* May be an inflammatory component

52
Q

Central Nervous System Stimulants
Contraindications

A

Absolute:
* Allergy
* Marked anxiety, agitation, or tension
* Severe fatigue
* Glaucoma
* Cardiac Disease

Cautions:
* History of seizures
* History of drug or alcohol dependence
* Hypertension

53
Q

Central Nervous System Stimulants
Adverse Effects

A
  • CNS: nervousness, insomnia, dizziness, headach, blurred vision
  • GI: anorexia, nausea, weight loss

Black Box Warning: controlled substance

54
Q

Central Nervous System Stimulants
Drug Interactions

A
  • MAOIs/TCAs
  • Some OTC cold medications
  • Caffeine
55
Q

Central Nervous System Stimulants
Assessment

A

History:
* Check for allergy, anxiety, glaucoma, cardiac disease, pregnancy, lactation, history of seizures, drug or alcohol dependence, and hypertension

Physical:
* Temperature and weight
* Skin color and lesions
* Orientation, affect, reflexes
* Ophthalmic exam
* Bowel sounds and output
* Urinary output
* Pulse and BP
* Orthostatic BPs
* Respiration rate and lung sounds

Labs:
* CBC

56
Q

Central Nervous System Stimulants
Nursing Diagnoses/Conclusions

A
  • Altered thought processes (r/t CNS effects)
  • Altered vital signs (r/t CV effects)
  • Injury risk (r/t CNS and visual effects)
  • Knowledge Deficit
57
Q

Central Nervous System Stimulants
Implementation

A
  • Ensure proper diagnosis
  • Arrange for overall treatment plan that includes cognitive-behavioral therapy
  • Interrupt the drug periodically in children receiving them for behavioral syndromes
  • Dispense the least amount of drug possible
  • Adminsiter drug before 6pm
  • Consult with school nurse/counselor
  • Report: unexplained weight loss, severe N/V, mood changes, signs of infection, tingling or numbness, difficulty urinating, tremors

Pharmacology Exam #3 (14 decks)

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