pharmacology CNS depressants and stimulants

severe CNS depression

• decreased respiratory rate - maybe even respiratory failure

• unconscious

moderate CNS depression

• drowsiness

• decreased muscle tone

mild CNS depression

• decreased ability to concentrate

• decreased interest in activities

CNS depressants: barbiturates (phenobarbital)

• CNS depressant

• increases GABA

• administered PO/IV

CNS depressant: barbiturates (phenobarbital) - therapeutic use

• seizures

• sedation

• anxiolytic drug

• sleep

CNS depressant: barbiturates (phenobarbital) - RN intervention

• no antidote

• monitor respiratory rate

• GCS (LOC)

• SJS

• fall assessment

CNS depressant: barbiturates (phenobarbital) - complications

• respiratory depression/arrest

• low safety margin

• dependency

• narrow therapeutic window

• SJS

CNS depressant: barbiturates (phenobarbital) - contraindications

• elderly pt, children, pregnant women

CNS depressant: barbiturates (phenobarbital) - interactions

• caution w other CNS depressants

  • alcohol, diphenhydramine

CNS depressant: barbiturates (phenobarbital) - education

• be careful they don’t fall

• be careful they don’t get any rashes or lesions (SJS)

• don’t drive

• practice contraception (do not get pregnant on this drug)

• do not stop taking the drug abruptly

CNS depressant: benzodiazepines types

• diazepam: used for muscle relaxation and seizures

• lorazepam: used for seizures and sedation (used to break and active seizure)

• chlordiazepoxide: PO and used for alcohol withdrawal

• alprazolam (xanax): anxiety

• midazolam: seizures and sedation

CNS depressant: benzodiazepines - purpose & med admin

• depress CNS

• increase GABA

• administered PO and IV

CNS depressant: benzodiazepines - therapeutic use

• seizures

• sedation

• alcohol withdrawal

• anxiety

• muscle relaxation

CNS depressant: benzodiazepines - complications & contraindications

• CNS depression

• respiratory depression/arrest

• fall risk

• caution in elderly

• cannot take if pregnant

CNS depressant: benzodiazepine - RN intervention & interactions

• RN intervention

  • monitoring respiratory rate

  • fall assessment

  • monitor GCS

• interactions

  • other CNS depressants (including alcohol)

CNS depressant: benzodiazepine - reversal agent

FLUMAZENIL

CNS depressant: benzodiazepine - education

• fall risk

• do not drive

• do not use with other CNS depressants

• do not drink alcohol

CNS depressant: zolpidem (ambien)

• CNS depressant

• increases GABA

• admin PO

CNS depressant: zolpidem (ambien) - therapeutic use

• improved sleep

• insomnia

CNS depressant: zolpidem (ambien) - complications

• trouble waking up

• drowsiness

• waking up a lot in the middle of the night

• not feeling rested

CNS depressant: zolpidem (ambien) - what dose to give which pt

• if pt has trouble falling asleep: need short acting version of drug

• if pt has trouble staying asleep: need long acting version of drug (extended release)

CNS depressant: zolpidem (ambien) - education

• be aware of sleep walking/eating/driving - if living alone: lock doors, hide keys,

• take immediately before going to bed

• caution upon waking

CNS depressant: zolpidem (ambien) - contraindications & interactions

• not safe in pregnancy

• safety issues

• don’t take w other CNS depressants

CNS depressant: zolpidem (ambien) - evaluation

• is whatever the problem was fixed now?

• overall improved sleep, feel more rested

• continue sleep log so we can review if med is working for trouble falling asleep and/or staying asleep

dantrolene

• peripherally acting

• purpose: blocking calcium release from muscles which causes muscle relaxation

CNS depressant: dantrolene - therapeutic use

• decrease muscle spasms

• decrease pain

• increase ROM

• reversal for malignant hyperthermia caused by anesthetics

• med admin: PO but IV for MH

CNS depressant: dantrolene - complications

• muscle weakness

• hepatotoxic

• can cause increased HR and BP changes

CNS depressant: dantrolene - RN intervention

• monitor for CV changes (tachycardia)

• monitor for hepatotoxicity (signs of jaundice, LFT’s)

  • AST, ALT (any stupid thing, always liver trouble)

CNS depressant: dantrolene - interactions and education

• interactions: other hepatotoxic drugs (acetaminophen, alcohol)

• education: reporting signs and symptoms of liver toxicity

CNS depressant: cyclobenzaprine & baclofen

• both centrally acting

• increase GABA

• decrease norepinephrine

• CNS depressant

• muscle relaxants

CNS depressant: cyclobenzaprine & baclofen - therapeutic use

• increase ROM

• decrease pain

• decrease muscle spasms

CNS depressant: cyclobenzaprine & baclofen - RN intervention & med admin

• monitor respiratory rate

• GCS

• fall assessment

• admin PO & baclofen can be intrathecal

CNS depressant: cyclobenzaprine & baclofen - what to watch for

• cyclobenzaprine: anticholinergic effects (dries up mucous membranes & causes dry mouth, urinary retention), hepatotoxicity

• baclofen: nausea/constipation, urinary retention

CNS stimulant: methylphenidate (ritalin)

• increases dopamine

• increases serotonin

• increase norepinephrine

• CNS stimulant

CNS stimulant: methylphenidate (ritalin) - therapeutic use

• ADHD (inattention, impulse control, hyperactivity, lack of executive function, decrease in academic performance)

• narcolepsy

• mood disorders

• weight loss

CNS stimulant: methylphenidate (ritalin) - complications

• insomnia (take when wake up in morning)

• increased HR and BP

• anxiety

• lowered appetite

CNS stimulant: methylphenidate (ritalin) - contraindications

• seizure disorders

• cardiovascular disease

CNS stimulant: methylphenidate (ritalin) - RN intervention & med admin

• monitor increased HR and BP

• growth/weight in children

• med admin: PO, take in am, does not work right away, drug holidays

CNS stimulant: methylphenidate (ritalin) - education & interactions

• education: diet, monitoring vital signs

• interactions: other stimulants (caffeine, xanthine), beta adrenergics, pseudoephedrine

CNS non-stimulant: atomoxetine

• purpose: decrease breakdown of norepinephrine (preventing it from breaking down)

CNS non-stimulant: atomoxetine - therapeutic use

• ADHD

• narcolepsy

• mood disorders

CNS non-stimulant: atomoxetine - complications

• some decreased appetite (less than stimulant)

• hepatotoxicity

• suicidal ideologies

CNS non-stimulant: atomoxetine - contraindications

seizure disorders

CNS non-stimulant: atomoxetine - RN intervention

• diet

• monitoring liver

• monitoring mood (suicidal ideologies)

CNS non-stimulant: atomoxetine - education & med admin

• education: diet, monitor liver, monitor mood

• med admin: PO, takes time to work