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Nursing Semester 2 > Monica - Exam 5: CNS depressants > Flashcards

Monica - Exam 5: CNS depressants Flashcards

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1
Q

What is insomnia?

A

inability to fall asleep or remain asleep

*may be associated with anxiety d/t lack of restful sleep

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2
Q

short-term vs. long-term insomnia

A

short: attributed to unresolved daily conflicts/stressors
long: lasting 30 days or longer; associated with depression, manic disorders, or chronic pain

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3
Q

Chronic lack of sleep can be a risk factor in the development of ______.

A

DM type 2

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4
Q

factors that contributing to a restless sleep pattern:

A
  • stimulant-containing foods/beverages (caffeine)
  • tobacco
  • alcohol
  • large meal close to bedtime
  • too much light
  • room temp
  • snoring
  • recurring nightmares
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5
Q

How does alcohol affect sleep?

A

Decreases quality of sleep by increasing the occurance of vivid dreams and periods of waking.

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6
Q

non-pharmacological sleep interventions:

A
  • decrease/avoid caffeine intake
  • smoking cessation
  • limit/avoid alcohol
  • daytime exercise
  • sleep routine/pattern
  • herbal products
  • deal with stress (counseling)
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7
Q

herbal products that promote sleep:

A

valerian root, kava, chamomile, lavender

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8
Q

When recommending herbal sleep products to a patient what needs to be assessed?

A

**possible contraindications with other drugs being taken

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9
Q

When is pharmacotherapy indicated for sleep?

A

when lack of sleep interferes with ADLs

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10
Q

define anxiety

A
  • worry, apprehension, fear or uneasiness over a perceived threat/danger (usually everyday life/activities)
  • excessive irrational response that worsens if not treated
  • response can last at least 6 months
  • may affect quality of life
    sxs: restlessness, nervous, decreased focus, muscle tension, sense of doom, fight-or-fligh sxs
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11
Q

Anxiety activates the ___ and triggers symptoms of ________.

A

SNS, fight-or-flight - increased BP, HR, diaphoretic, dry mouth, GI upset

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12
Q

Anxiety may increase the risk of ___ and ___ issues.

A

GI and CV

*CV issues d/t increased HR, BP

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13
Q

5 anxiety disorders:

A
  1. obsessive compulsive disorder
  2. PTSD
  3. general anxiety disorder
  4. panic disorder
  5. social anxiety disorder
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14
Q

OCD

A

obsessive thoughts and actions that occupy time (at least 1 hour/day), disrupting life and relationships

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15
Q

panic disorder

A

live in debilitating fear/terror of having an uncontrollable panic attack

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16
Q

social anxiety disorder

A

social phobia characterized by an unreasonable and persistant fear of being judged and ridiculed by others
sxs: sweating, trembling, blushing, cramps

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17
Q

non-pharmacological interventions for anxiety

A

First, address the cause or underlying disorder causing anxiety.
Other strategies: cognitive-behavioral feedback, counseling, biofeedback, meditation, herbal products (valerian root)

18
Q

When is pharmacotherapy indicated for treatment of anxiety?

A

When the severity of anxiety interferes with ADLs. However, drugs should only be used short-term and do not treat the cause.

19
Q

CNS depressants are categorized into _______ and _______. Drugs from both categories are known as ______ or _____ depending on the amount of depression.

A

benzodiazepines and non-benzodiazepines; sedatives and hypnotics

20
Q

CNS depressants are used for:

A

sleep and anxiety disorders

21
Q

sedatives vs. hypnotics

A

sedatives: lower doses taken during the day that cause relaxation, calmness, and reduce anxiety
hypnotics: larger doses taken at night to induce sleep

22
Q

T/F: A sedative and a hypnotic can be the same drug.

A

True - same drug but given at diferent doses to produce a range of CNS depression: lower dose = relaxation (sedative) vs. larger dose = sleep (hypnotic)

23
Q

Hypnotics used to be called tranquilizers.

A

True

24
Q

Physical dependence

A
  • altered physical condition d/t repeated substance use
  • tolerance: body becomes accustomed to abused substance
  • withdrawal symptoms when d/c: tremors, altered metation, diaphoresis, skin crawling restlessness
25
Q

psychological dependence

A
  • rely on drug to cope with stressors
  • overwhelming desire to continue drug-seeking despite negative consequences
  • higher doses for prolonged period (months or years)
  • *no obvious physical signs of discomfort/withdrawal when d/c drug
26
Q

Two benzodiazepines we talked about in class:

A
  1. lorazepam PO, IV (Ativan)
  2. temazepam
    * there are 15 drugs in this classification
27
Q

Benzodiazepine drug names end in:

A
  • lam

- pam

28
Q

lorazepam: indication

A 
general anxiety (anxiolytic)
*off-label uses: insomnia, seizures, alcohol withdrawal sxs
29
Q

lorazepam: action

A

binds to GABA receptors and intensifies GABA effects

*GABA is an inhibitor neurotransmitter

30
Q

lorazepam: adverse effects

A
  • dizziness, hypotension, *daytime drowsiness, confusion, *paradoxical excitation, “hangover effect”
  • IV increases risk of respiratory depression
  • increased CNS depression with other CNS depressants (opioids)
  • slow tapering to avoid withdrawal sxs
31
Q

lorazepam: antidote

A

flumazenil

*given IV in low doses, then assessed, and more given/assessed until pt is alert

32
Q

temazepam: indication

A

short-term therapy of insomnia < 4 wks

*taken at bedtime

33
Q

temazepam: adverse effects

A
  • similar to other benzos: dizziness, hypotension, confusion…
  • risk of physical and/or psychological dependence
  • complex sleep-related behaviors: sleep driving
  • daytime sedation d/t long half-life
34
Q

non-benzodiazepines: two drugs and their action

A
  1. zolpidem CR (Ambien)
  2. eszopiclone (Lunesta)
    * *similar action to benzodiazepines - binds to GABA receptors and potentiates effect
35
Q

zolpidem and eszopiclone: indication and effect

A

only for sleep!

  • improves length and quality of sleep by decreasing sleep-onset time and nighttime awakenings
  • *need 7-8 hours of sleep!
36
Q

zolpidem (Ambien): AEs

A
  • daytime drowsiness, dizziness, hallucinations, HA, behavioral changes (sleep driving), hangover
37
Q

eszopiclone (Lunesta): AEs

A

newer drug so not enough data to determine frequent AEs

38
Q

If zolpidem or eszopiclone are discontinued abruptly or taken for a long period of time there is a risk of:

A

rebound insomnia : (

39
Q

geriatric considerations when taking CNS depressants

A
  • medication-related sleep problems d/t change in circadian rhythm
  • accumulates in system (d/t decreased kidney and liver fx) increasing side effects
  • lowest effective dose: “start low, go slow”
  • excessive drowsiness or dizziness can increase risk of falls and injury
40
Q

What home modifications may be necessary for geriatrics taking CNS depressants?

A
  • making sure walking areas are clear of tripping hazards like rugs, cords, etc.
  • not doubling up on doses, even if first dose is ineffective

Nursing Semester 2 (7 decks)

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