CNS Depressants and Stimulants

Sedatives

Drugs that have an inhibitory effect on the CNS to the degree that they reduce, nervousness, excitability, irritability

Hypnotics

Cause sleep, much more potent effect on CNS than sedatives, sedative can become a hypnotic if it is given in large enough doses.

Sedative-hypnotics

Dose dependent, sedative at low doses, hypnotic at high doses, classified into benzodiazepines and non-benzo CNS depressants

Benzodiazepines

Clonazepam (Klonopin), diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), temazepam (Restoril), midazolam (Versed)

Benzodiazepines indications

Anxiety relief, acute seizure disorder, alcohol withdrawal treatment, sedation, sleep induction

Benzodiazepines adverse effects

Drowsiness, dizziness, confusion, amnesia, hypotension, fall hazard; respiratory depression, especially when taken with other CNS depressants

Benzodiazepines antidote

Flumazenil

Non-benzo CNS depressants (hypnotics)

eszopiclone (Lunesta), zolpidem (Ambien)

Eszopiclone

Designed to provide a full 8 hours of sleep, pts should allot 6-8 hours of sleep time, avoid taking if must awaken in less than 6 hours

Zolpidem side effects

Somnambulation

OTC hypnotics

Also have CNS depressant effect; doxylamine (Unisom), diphenhydramine (Sominex/benadryl), acetaminophen/diphenhydramine (Extra Strength Tylenol PM)

Muscle relaxant indications

Relief of painful musculoskeletal conditions; muscle spasms, management of spasticity of severe chronic disorders (spinal cord injuries, strokes, MS, cerebral palsy)

Common muscle relaxants

Baclofen (Lioresal), cyclobenzaprine (Flexeril), methocarbamol (Robaxin)

Muscle relaxant adverse effects

Dizziness, drowsiness, fatigue, muscle weakness

CNS stimulant indications

ADHD, narcolepsy, anorexiant, neonatal apnea, post-op respiratory depression

Analeptics indications

Treat neonatal apnea, post-op respiratory depression, late night studying

Amphetamines indications

Treat ADHD and narcolepsy

Amphetamine medications

Methylphenidate (Concerta, Ritalin), amphetamine/dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse)

Anorexiant indications

Used for weight management, appetite suppression

Anorexiant medications

Phentermine (Ionamin), orlistat (Xenical) (not a stimulation)

Stimulant adverse effects

Tend to “speed up” body systems, palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, N/V/D, dry mouth, increased urinary frequency, loss of appetite

Simulant nursing implications

Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia, small, frequent, high-calorie meals, monitor children for continued physical growth, including height and weight