Monica - Exam 5: CNS depressants Flashcards
What is insomnia?
inability to fall asleep or remain asleep
*may be associated with anxiety d/t lack of restful sleep
short-term vs. long-term insomnia
short: attributed to unresolved daily conflicts/stressors
long: lasting 30 days or longer; associated with depression, manic disorders, or chronic pain
Chronic lack of sleep can be a risk factor in the development of ______.
DM type 2
factors that contributing to a restless sleep pattern:
- stimulant-containing foods/beverages (caffeine)
- tobacco
- alcohol
- large meal close to bedtime
- too much light
- room temp
- snoring
- recurring nightmares
How does alcohol affect sleep?
Decreases quality of sleep by increasing the occurance of vivid dreams and periods of waking.
non-pharmacological sleep interventions:
- decrease/avoid caffeine intake
- smoking cessation
- limit/avoid alcohol
- daytime exercise
- sleep routine/pattern
- herbal products
- deal with stress (counseling)
herbal products that promote sleep:
valerian root, kava, chamomile, lavender
When recommending herbal sleep products to a patient what needs to be assessed?
**possible contraindications with other drugs being taken
When is pharmacotherapy indicated for sleep?
when lack of sleep interferes with ADLs
define anxiety
- 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
Anxiety activates the ___ and triggers symptoms of ________.
SNS, fight-or-flight - increased BP, HR, diaphoretic, dry mouth, GI upset
Anxiety may increase the risk of ___ and ___ issues.
GI and CV
*CV issues d/t increased HR, BP
5 anxiety disorders:
- obsessive compulsive disorder
- PTSD
- general anxiety disorder
- panic disorder
- social anxiety disorder
OCD
obsessive thoughts and actions that occupy time (at least 1 hour/day), disrupting life and relationships
panic disorder
live in debilitating fear/terror of having an uncontrollable panic attack
social anxiety disorder
social phobia characterized by an unreasonable and persistant fear of being judged and ridiculed by others
sxs: sweating, trembling, blushing, cramps
non-pharmacological interventions for anxiety
First, address the cause or underlying disorder causing anxiety.
Other strategies: cognitive-behavioral feedback, counseling, biofeedback, meditation, herbal products (valerian root)
When is pharmacotherapy indicated for treatment of anxiety?
When the severity of anxiety interferes with ADLs. However, drugs should only be used short-term and do not treat the cause.
CNS depressants are categorized into _______ and _______. Drugs from both categories are known as ______ or _____ depending on the amount of depression.
benzodiazepines and non-benzodiazepines; sedatives and hypnotics
CNS depressants are used for:
sleep and anxiety disorders
sedatives vs. hypnotics
sedatives: lower doses taken during the day that cause relaxation, calmness, and reduce anxiety
hypnotics: larger doses taken at night to induce sleep
T/F: A sedative and a hypnotic can be the same drug.
True - same drug but given at diferent doses to produce a range of CNS depression: lower dose = relaxation (sedative) vs. larger dose = sleep (hypnotic)
Hypnotics used to be called tranquilizers.
True
Physical dependence
- 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
psychological dependence
- 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
Two benzodiazepines we talked about in class:
- lorazepam PO, IV (Ativan)
- temazepam
* there are 15 drugs in this classification
Benzodiazepine drug names end in:
- lam
- pam
lorazepam: indication
general anxiety (anxiolytic) *off-label uses: insomnia, seizures, alcohol withdrawal sxs
lorazepam: action
binds to GABA receptors and intensifies GABA effects
*GABA is an inhibitor neurotransmitter
lorazepam: adverse effects
- 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
lorazepam: antidote
flumazenil
*given IV in low doses, then assessed, and more given/assessed until pt is alert
temazepam: indication
short-term therapy of insomnia < 4 wks
*taken at bedtime
temazepam: adverse effects
- 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
non-benzodiazepines: two drugs and their action
- zolpidem CR (Ambien)
- eszopiclone (Lunesta)
* *similar action to benzodiazepines - binds to GABA receptors and potentiates effect
zolpidem and eszopiclone: indication and effect
only for sleep!
- improves length and quality of sleep by decreasing sleep-onset time and nighttime awakenings
- *need 7-8 hours of sleep!
zolpidem (Ambien): AEs
- daytime drowsiness, dizziness, hallucinations, HA, behavioral changes (sleep driving), hangover
eszopiclone (Lunesta): AEs
newer drug so not enough data to determine frequent AEs
If zolpidem or eszopiclone are discontinued abruptly or taken for a long period of time there is a risk of:
rebound insomnia : (
geriatric considerations when taking CNS depressants
- 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
What home modifications may be necessary for geriatrics taking CNS depressants?
- making sure walking areas are clear of tripping hazards like rugs, cords, etc.
- not doubling up on doses, even if first dose is ineffective
