(2) CNS Depressants

actions of CNS depressants

Sedatives: reduce nervousness, excitability, and irritability w/o causing sleep

Hypnotics: cause sleep, more potent effect on CNS than a sedative

Sedative-Hypnotic: can act as either, based on dose

Key Class: Benzodiazepines “pams”

Uses for Benzodiazepines

• sedations (Res. De.; v careful w/ elderly!)

• relief of acute agitation (b/c of rapid onset) or anxiety

• Tx of anxiety-related depression (adjunct related [b/c has high lvl of dependence/addiction])

• sleep induction/insomnia (short term use only)(b/c assoc. w tolerance)

• skeletal muscle relaxation

• Tx of acute seziure disorders

• amnestic properties during procedures

• Tx/prevention of alcohol withdrawals (acute)

CIed if: drug allergy, narrow-angle glaucoma, pragnancy

Antidote: Flumazenil

Midazolam (Versed)

Uses: procedural sedation and amnesia in ventilated pts

Admin: IV, IM, PO

SE:

• BLACK BOX WARNING related to severe Res. De.

• sedation

• physical dependence

• HOTN

NI:

• MUST be monitored when receiving IV doses

  • monitor respirations & LOC

• educate pts on potential for abuse and risks assoc. w/ oral form

Diazepam (Valium)

Uses: decreases seizures & anxiety

Admin: IV (status epilepticus, acute agitation), PO (chronic anxiety, seizure management)

SE:

• over sedation (impairs cognition/reaction time/coordination)

• decreased alertness “

• paradoxical (opposite) response (insomnia, anxiety, rage)

NI:

• monitor sedation lvl

• pt’s have an increased risk of falls (wanna be aware of in elderly pts of pts w/ brain injuries & developmental disabilities)

Edu:

• do not mix w/ alcohol or other CNS depressants drugs (danger for Res. De.)

• avoid activities that require alertness

• do not stop abruptly in pts w/ chronic use

  • causes paradoxical response

Temazepam (Restoril)

should be used short term, tolerance/dependence w/ prolonged use

Uses: helps control insomnia w/o borader sedative effects

Admin: PO

SE: can cause drowsiness/daytime drowsiness

NI:

• take 20-40min b4 sleep, has long onset of action so pts shud take approx. 1hr before going to bed

• do not mix w/ alcohol or other sedative drugs

Zolpidem (Ambien)

Use: induction of sleep

• ***Non-Benzodiazepine

• (also used for short term insomnia management and not ideal for maintenance)

Admin: PO (immediate release, so take right as get into bed)

SE:

• BLACK BOX WARNING related to sleep-walking, sleep eating, and other abnormal sleep behavirs

• situational amnesia

• falls

• daytime sleepiness

NI:

• do not give unless full night of sleep is planned

• implement fall precautions

• assess for quality of sleep

• educate on safety at home, including falls and possible abnormal sleep behaviors (wanna teach family members; ensure safety around pt bed — sleep walking and falls)

a patient is taking pregabalin but does not have a history of seizures. the nurse recognizes that this drug is also indicated for which of the following?

postherpetic neuralgia — pregabalin can be used for the Tx of neuropathic pain