NURS 2004 Pharmacology: Drug Therapy for the Central Nervous System 2

what are the 2 main types of CNS depressants

1. sedatives

2. hypnotics

what 3 things do sedatives reduce

1. nervousness

2. excitability

3. irritability

do sedatives cause sleep

no

do hypnotics cause the same effects as sedatives

yes. THEY CAUSE SLEEP THO

what are the 3 types of sedatives/hypnotics

1. barbiturates

2. benzodiazepines

3. miscellaneous agents

what are 2 herbals that are sedatives/hypnotics

1. kava

2. valerian

what is normal sleep classified as

cyclic and repetitive

a sleeping person's response to stimuli is markedly _______________

reduced

what are the 2 main types of sleep

1. REM sleep

2. non REM sleep

what is REM interference caused by

prolonged sedative/hypnotic use. reduces REM, causing fatigue

what can REM rebound occur upon

discontinuing a sedative or hypnotic drug

REM sleep is the most ____________ part of sleep

restful. it is when you dream

what do benzodiazepines bind to

benzodiazepine receptors, similarly to GABA

what do benzodiazepines cause depression of

the CNS by inhibition of brain stimulation

what are the 8 indications to use benzodiazepines

1. agitation

2. anxiety relief

3. anticonvulsant

4. skeletal muscle relaxation

5. sedation

6. sleep induction

7. alcohol withdrawal

8. balanced anaesthesia

do benzodiazepines suppress REM sleep

no

do benzodiazepines increased metabolism of other drugs like barbiturates

no. they also have no "hangover" effects or daytime fatigue

specific effects of benzodiazepines on the body are _______ related

dose

what are the 8 adverse effects of benzodiazepines

1. headache

2. drowsiness

3. paradoxical excitement

4. dizziness

5. cognitive impairment

6. vertigo

7. lethargy

8. "hangover effect"

benzodiazepines can impose a ________ hazard

fall

what are the 4 S&S seen with an overdose of benzodiazepines

1. somnolence

2. confusion

3. coma

4. diminished reflexes

what is rarely seen with overdoses of benzodiazepines, only seen if taken with other CNS depressants

1. hypotension

2. respiratory depression

what is the benzodiazepine antagonist

flumazenil. usually given when there are toxic effects of overdose

what are the 3 types of benzodiazepines

1. long acting (clonazepam)

2. intermediate acting (alprazolam)

3. short acting (midazolam)

what kind of benzodiazepine is midazolam

a short acting benzodiazepine

what is midazolam most commonly used for

preop and procedural sedation

what 2 things does midazolam cause

2. amnesia

2. anxiolysis

how is midazolam usually administered in adults

via IV

how is midazolam usually administered in children

in a liquid oral dosage form

what is zoplicone classified as

a non-benzodiazepine

why is zoplicone considered a non-benzodiazepine

because it has a very short half life, decreasing "hangover effect"

what is zoplicone used for

short-term treatment of insomnia (7-10 days)

what are 3 herbal products (sedative/hypnotic)

1. kava

2. valerian

3. melatonin

what 3 things does kava relieve

1. stress

2. anxiety

3. restlessness. promotes sleep

what are 3 potential interactions with kava

1. alcohol

2. barbiturates

3. psychoactive drugs

what 2 things is kava contraindicated in

1. liver disease

2. alcoholism

what 3 things does valerian relieve

1. anxiety

2. restlessness

3. sleep disorders

what are 8 adverse effects of valerian

1. CNS depression

2. hepatotoxicity

3. nausea

4. vomiting

5. anorexia

6. headache

7. restlessness

8. insomnia

what is melatonin

a hormone produced by the body. it is a sleep aid

what do barbiturates potentiate the action of

inhibitory neurotransmitter GABA

what do barbiturates inhibit

nerve impulses

what are the 3 indications to use barbiturates

1. sedation

2. anticonvulsant

3. anaesthesia

what are the 6 adverse effects of barbiturates

1. drowsiness

2. lethargy

3. dizziness

4. hangover effect

5. paradoxical restlessness

6. rebound insomnia

if barbiturates are given too rapidly, what 2 things may occur

1. hypotension

2. respiratory depression

what do barbiturates increase in the liver

enzyme metabolism, or enzyme induction. this will decrease the effects of other drugs as they will be metabolized too quickly

what do barbiturates deprive clients of

REM sleep

barbiturates have a _____ therapeutic index

low. there is a small difference between therapeutic and toxic doses

what can overdose of barbiturates lead to

CNS depression (sleep-> coma-> death)

why are barbiturates therapeutic for anesthesia induction

the client is on a vent to breathe anyways so respiratory depression does not matter

why are barbiturates therapeutic for uncontrollable seizures

since neurons in the brain are rapid firing

what is phenobarbital

a barbiturate

phenobarbital is a ______ acting barbiturate

long

what is phenobarbital used in the prevention of (2)

1. generalized tonic-clonic seizures

2. fever induced convulsions

what is phenobarbital used for in neonates

treatment of hyperbilirubinemia

is phenobarbital used today

yes, but rarely, no longer recommended to be used as a hypnotic drug

what 2 things should the client avoid when using sedatives and hypnotics

1. driving

2. smoking

what should the client do if GI upset occurs when taking sedatives and hypnotics

take it with meals

what do most central nervous system stimulants stimulate

a specific area of the brain or spinal cord, specifically by stimulating the excitatory neurons in the brain

what are central nervous system stimulants also known as

sympathomimetic drugs, as they "mimic the sympathetic"

what are 5 major therapeutic uses of central nervous system stimulants

1. anti ADHD

2. antinarcoleptic

3. anorexiant

4. antimigraine

5. analeptic

what is the definition of attention deficit hyperactivity disorder (ADHD)

the inappropriate ability to maintain attention span with hyperactivity and impulsivity

what is the definition of narcolepsy

when clients unexpectedly fall asleep in the middle of normal daily activities

what are the 3 types of drugs for ADHD and narcolepsy

1. amphetamines

2. nonamphetamine stimulant

3. nonstimulant drugs

what do amphetamines stimulate

the areas of the brain associated with mental alertness

what are the 4 effects of amphetamines

1. euphoria

2. increased mental alertness/capacity for work

3. decreased fatigue

4. prolonged wakefulness

what are nonamphetamine stimulants used for

excessive daytime sleepiness and with "shift work" sleep disorders

nonstimulant drugs are ____________

nonaddictive

what will drugs for ADHD do to body systems

speed them up

why should drugs for ADHD be given 4-6 hours before bed time

they'd be up all night

drugs for ADHD may cause dry ___________

mouth

drugs for ADHD should be taken on an _______________ stomach

empty

what may drugs for ADHD require

"drug holidays" ordered by a physician

CNS stimulant drugs have an ____________________ effect with other CNS stimulant drugs

additive

what are 4 herbal and OTC drugs that stimulate the CNS

1. ephedra

2. ginseng

3. ginkgo

4. guarana

what are the 3 vagal adverse effects of CNS stimulant drugs

1. stimulation of gastric secretions

2. diarrhea

3. reflex tachycardia

what are the 2 vasomotor adverse effects of CNS stimulant drugs

1. flushing

2. sweating

what is the one respiratory adverse effect of CNS stimulant drugs

elevated respiratory rate

what are the 2 musculoskeletal adverse effects of CNS stimulant drugs

1. muscular tension

2. tremors

read slide 23 well...

read slide 23 well...

what is the definition of a seizure

a brief episode of abnormal electrical activity in nerve cells of the brain, may or may not lead to a convulsion

what is the definition of a convulsion

it is involuntary spasmodic contractions of any or all voluntary muscle throughout the body, including skeletal, facial, and ocular muscles

what is the definition of epilepsy

chronic, recurrent pattern of seizures

what are the 2 goals of antiepileptic drug therapy

1. control or prevent seizures while maintaining a reasonable quality of life

2. minimize adverse effects and drug-induced toxicity

what must AED therapy prevent

the generation and spread of excessive electrical discharge from abnormally functioning nerve cells

what must AED therapy protect

the surrounding normal cells

is the exact MOA of AED therapy known

no

with AED use, neurons are what

stabilized

with AED use, hyperexcitability is ______________

decreased, and excessive nerve impulses are decreased

what are the 6 types of antiepileptic drugs

1. barbiturates

2. benzodiazepines

3. hydantoins

4. succinimides

5. iminostilbenes

6. miscellaneous antiepileptics

what are the 3 good things about using barbiturates as antiepileptic drugs

1. effective

2. inexpensive

3. few AEs

what do barbiturates as antiepileptic drugs suppress

seizures, with minimal CNS effects (sedation is common)

barbiturates as antiepileptic drugs have the ______________ half life of AEDs

longest

what do barbiturates as antiepileptic drugs increase

the rates of inactivation of many drugs, as they induce hepatic enzymes

what do barbiturates as antiepileptic drugs intensify

the effects of other CNS depressants

what is the first line of treatment for status epilepticus

using benzodiazepines as antiepileptic drugs

what do hydantoins as antiepileptic drugs not produce

generalized CNS depression

what kind of seizures are hydantoins as antiepileptic drugs effective for

tonic/clonic seizures (not absence)

hydantoins as antiepileptic drugs have a ________________ therapeutic index

narrow

what are the 3 common adverse effects of hydantoins as antiepileptic drugs

1. lethargy

2. abnormal movements

3. confusion

what are the 5 long term adverse effects of hydantoins as antiepileptic drugs

1. osteoporosis

2. gingival hyperplasia (swollen gums)

3. dilantin facies (extra facial tissue)

4. acne

5. hirsutism