Pharm110 Chp 27 CNS sedatives and Hypnotics

Question 1

CNS Sedatives and Hypnotics

Answer 1

• Both are CNS depressants
• Sedatives (decrease irritability or excitement without producing sleep)
• Hypnotics (tend to have a more dependant effect on the CNS and produce sleep)

3 types

• Benzodiazepines
• Barbiurates
• Non-Benzodiazepines/Non-Barbiturates

Question 2

Administration do’s and don’ts

Answer 2

• Pre-admin vitals and LOC (level of consciousness, e.g. alert, confused or lethargic)
• Change in vitals may occur after admin.
• At least 2 hrs, should elapse between admin of a hypnotic and any other CNS depressant.

Question 3

Sedative and Hypnotic adverse effects

Answer 3

• Hang over effect
• Orthostatic hypotension
• Older adults are at greater risk for over sedation, dizziness, confusion or ataxia (unsteady gait). Notify Dr. for any of these symptoms.
• paradoxical reaction, (excitement or confusion) at q 5-10 min intervals and institutes safety measures to prevent injury.
• Alcohol, will cause a synergy effect and could result in DEATH.

Question 4

Administration do’s and don’ts

Answer 4

• A person who takes barbiturates for its sedative effect develop tolerance to that effect, but the dose now required to achieve sedative effect has a toxic effect on the respiratory system.
• Best given for no more than 2 weeks.
• Become less effective after taken for prolonged periods.
• Do not increase or decrease the dose unless a change is approved by Dr.
• Can cause drug dependency
• Never suddenly discontinue drugs
• Gradually withdraw from taking the drug to prevent withdrawal symptoms, restlessness, excitement, euphoria and confusion.

Question 5

Barbiturates

Answer 5

Prefix “barbatol”
Action:
-CNS depressant
-Reduce nerve impulses to cerebral cortex
-Inhibit nerve impulse transmission by potentiating an inhibitory amino acid known as GABA (gamma-aminobutyric acid)
-Effects are dose related (low sedative, high hypnotic)
-Doesn’t need GABA
Adverse effects
-Raise seizure threshold
-Treats epilepticus, tetanus and drug induced convulsions
-Drowsiness, lethargy, dizziness, hangover
-Paradoxical restlessness or excitement
-Depress REM sleep
Abrupt stop of meds
-Rebound REM
-Nightmares
No antagonist

Question 6

Benzodiazepines

Answer 6

Prefix "am" or "pam"
Action:
-CNS depress, affect hypothalamic, thalamic, and limbic systems.
-Receptors resemble GABA receptors
-Useful hypnotic
-Relax skeletal muscles
-Treat alcohol withdrawal
Toxicity 
-Somnolence, confusion, coma, diminished reflexes
Toxicity treatment 
-Syrup of Ipecac
-Charcoal with gastric lavage
Antagonist
-Flumazenil (Romazicon)

Question 7

Patient and family education

Answer 7

• Do not increase dose
• Do not drink alcohol 2hrs before or 8hrs after
• Not for pregnant women
• No OTC cold, cough or allergy meds
• OTC cold, cough meds may contain antihistamines synergizing CNS depression
• OTC cold, cough meds may contain adrenergics reversing sedative effect

Question 8

Alcohol

Answer 8

• Potent CNS depressant

- Used to relax patient and make more social

Question 9

Zolpidem tartrate (Ambien)
Non benzodiazpiem/ Non barbiturates

Answer 9

Zolpidem tartrate (Ambien)
Action
-Hypnotic similar to benzos but without muscle relaxation
-Used frequently in elderly
-Do not take with food (fat interferes with absorption)

Question 10

Barbiturate toxicity

Answer 10

Signs of toxicity
-heavy sleep, coma, pupillary constriction (leads to dilation in terminal stage), cyanosis, clammy skin and hypotension.
Lavage used to treat if within 4 hours diagnosed, followed by dialysis.