PME Nervous System Part 1 Flashcards
autonomic nervous system (ANS)
- responds to stress or danger
- maintains regulatory body functions
- affects cardiac and smooth muscle and glands
neurotransmitters in the ANS and receptors they stimulate
- acetylcholine | cholinergic receptors
- epinephrine | adrenergic receptors
- norepinephrine | adrenergic receptors
- dopamine
ANS agonists
stimulate function, enhance effects of neurotransmitter
antagonists
block effects of neurotransmitter
drugs that being with “anti-“ and end with “-ase”
block degradation of neurotransmitter
ANS receptor subtypes
location determines subtype
cholinergic subtypes
- nicotinic
- muscarinic
adrenergic subtypes
- Alpha1, 2
- Beta1, 2
goals of CNS meds
- depress or increase activity of CNS
- regulate amounts of CNS neurotransmitters
- stimulate or block autonomic receptors
- treat psychiatric disorders
CNS depressant types to treat sleep disorders
- benzodiazepines
- non-benzodiazepines
benzodiazepines therapeutic use
- relieve insomnia
- decreased repeated awakenings at night
- relieve anxiety
- treat status epilepticus
- relax muscle spasms
- help with moderate sedation
benzodiazepines
- usually end in “-pam”
- temazepam
- diazepam
- lorazepam
- flurazepam
- prototype
- temazepam
- others for sleep
- triazolam
- flurazepam
MOA of benzodiazepines
- enhance inhibitory effects of GABA
- promote sleep via sedation
side effects of benzodiazepines
- drowsiness
- dizziness
- confusion
- anxiety
- tolerance: develops over weeks
- withdrawal
- can cause paranoia, panic attacks, muscle twitching, hallucinations
- taper dose
nursing interventions for benzodiazepines
- oversee nighttime ambulation, especially for older adults
- watch for S of toxicity
- monitor for paradoxical reactions, especially in older adults
- monitor for S of dependence and tolerance
- taper to prevent withdrawal
s/sx of benzodiazepine toxicity
- weakness
- slurred speech
- ataxia: defective muscle coordination
- uncoordinated muscle movements
- respiratory depression
administering benzodiazepines
give oral preparations 30 min HS
patient education for temazepam
- take about 30 min HS and ensure 8 hr for sleep
- do not take with ETOH or other depressants
- stop taking and notify provider if paradoxical reaction occurs
contraindications and precautions for benzodiazepines
- contra
- pregnancy (Category X)
- lactation
- glaucoma
- children < 18 yo
- caution
- renal or hepatic impairment
- suicidal ideation
- ETOH dependence
- neuromuscular disorders
- chronic respiratory disorders
- sleep apnea
interactions with benzodiazepines
- other CNS depressants: severe sedation and respiratory depression
- kava kava and valerian root: ↑ sedation
- cimetidine: ↑ benzodiazepine levels
- smoking: ↓ effects of benzodiazepines
non-benzodiazepines
- use: short-term Tx of insomnia
- prototype: zolpidem (Ambien)
- other
- zaleplon (Sonata)
- eszopiclone (Lunesta)
MOA of non-benzodiazepines
enhance inhibitory effects of GABA
SE of non-benzodiazepines
- daytime drowsiness
- headache
- anxiety
- dizziness
- diplopia
- confusion in older adults
- amnesia: ambulating, eating, driving
nursing interventions for non-benzodiazepines
- monitor for adverse effects
- take precautions to prevent falls, especially in older adults
- monitor for need to ↓ dose
administering non-benzodiazepines
- oral form for immediate or extended-release
- oral spray: direct absorption via nasal mucosa
- give HS, ensure 8 hr for sleep
- give on empty stomach for full effect
pt education for non-benzodiazepines
- take HS with 8 hr to sleep
- do not take extra doses
- report dizziness or vision changes
- do not take with ETOH or other CNS depressants
- be aware that amnesia, memory impairment, and sleep driving may occur
contraindications and precautions for non-benzodiazepines
- contra
- children < 18 yo
- suicidal ideation
- L&D
- caution
- older adults
- prone to substance abuse
- Hx of depression
- chronic respiratory disorders
- sleep apnea
- hepatic or renal dysfunction
interactions with non-benzodiazepines
- ETOH
- other CNS depressants
- take on empty stomach
types of CNS depressants for muscle spasms
- centrally acting muscle relaxants
- peripherally acting muscle relaxants
centrally acting muscle relaxants
- relieve muscle spasms due to
- spinal cord injury
- multiple sclerosis
- cerebral palsy
- MSK injury or other disorders
- prototype: baclofen
- other
- carisoprodol
- chlorzoxazone
- cyclobenzaprine
MOA of centrally acting muscle relaxants
enhance inhibitory effects of GABA
side effects of centrally acting muscle relaxants
- drowsiness and dizziness early in therapy
- nausea
- constipation
- withdrawal
- anxiety
- restlessness
- visual hallucinations
- Sz
administering centrally acting muscle relaxants
- oral
- start with low dose, gradually ↑
- give oral dose with food or milk
- encourage fluids, ↑ fiber
- D/C drug: taper dose over 1-2 wks
- intrathecal infusion
- directly into spine via needle attached to pump
- do not stop abruptly
pt education for centrally acting muscle relaxants
- drowsiness and other CNS effects will ↓ with time
- change position slowly if dizzy
- do not drive or use heavy machinery if drowsy
- take with food or milk
- ↑ fiber and fluid intake
- report constipation
- do not stop abruptly: taper over 1-2 wks
contraindications and precautions for centrally acting muscle relaxants
- contra
- allergy to drug
- cyclobenzaprine
- use of MAOI in past 2 wks
- cerebral palsy
- caution
- older adults
- children
- severe mental illness
- Sz disorder
- CVA
interactions with centrally acting muscle relaxants
- ETOH and other CNS depressants: ↑ sedation
- DM: ↑ insulin or oral antidiabetics for ↑ BG
- hypertensive crisis: cyclobenzaprine + MAOI
peripherally acting muscle relaxants
- use: relax skeletal muscle spasms r/t
- CVA
- spinal cord injury
- multiple sclerosis
- cerebral palsy
- prevent and treat malignant hyperthermia
- prototype: dantrolene
MOA for peripherally acting muscle relaxants
- inhibit release of Ca
- block contraction of muscles
SE of peripherally acting muscle relaxants
- muscle weakness
- drowsiness
- dizziness
- diarrhea
- liver toxicity
nursing interventions for peripherally acting muscle relaxants
- assess muscle strength frequently
- monitor for CNS effects (drowsiness)
- start oral dantrolene at low doses and gradually ↑
- monitor for diarrhea, especially early in Tx
- monitor LFTs
administering peripherally acting muscle relaxants
- oral or IV
- for prophylaxis of MH, orally for 1-2 days before
- use IV to treat MH
pt education for peripherally acting muscle relaxants
- report
- muscle weakness
- prolonged diarrhea
- avoid
- driving, other activities that require alertness
- CNS depressants
- potential liver damage
contraindications and precautions for peripherally acting muscle relaxants
- contra: liver dz
- cardiac dz
- pulmonary dz
- neuromuscular disorder
- pts > 35 yo
interactions with peripherally acting muscle relaxants
- estrogen: ↑ risk of liver toxicity in women > 35 yo
- CNS depressants: ↑ risk of severe sedation
- IV use: calcium channel blockers ↑ risk for severe cardiac dysrhythmia
