CNS Stimulants + Depressants Exam 2

  • Identify several nonpharmacologic ways to induce sleep

    • these methods should be used first to promote sleep

      • arise at a specific hour in the morning

      • take few or no daytime naps

      • avoid drinks that have caffeine and alcohol 6 hours before bedtime

      • avoid smoking nicotine products 6 hours before bedtime

      • take a warm bath, listen to quiet music

      • avoid heavy meals or strenuous exercise before bed

      • decrease exposure to loud noises

      • avoid drinking copious amounts of fluids before sleep

      • drink warm milk before bedtime

  • Discuss the uses of benzodiazepines as a hypnotic, including patient education

    • actions

      • interacts with neurotransmitter GABA to reduce neuron excitability

      • lower doses assist with anxiety

      • higher doses cause sedation and hypnosis

      • pre op relief of anxiety and tension to aid in balanced anesthesia

    • indications

      • anxiety disorders, alcohol withdrawl, hyperexcitability and agitation, and as a sedative hypnotics for inducing sleep

    • patient education

      • teach pt to use nonpharmacologic methods to induce sleep

      • teach pt that benzodiazepines should be gradually withdrawn

      • teach pt to avoid alcohol and other cns depressants to avoid respiratory depression

      • advise pts not to drive a motor vehicle or operate machinery while on benzodiazepines

  • Discuss the different hypnotics, their mode of action, and patient teaching

    • barbiturates (ends in -am)

      • mode of action

        • depress cns activity by binding to barbiturate site at GABA-receptor complex enhancing GABA activity, depressing reticular activity system

      • pt teaching

        • provide standby life support in case of severe respiratory depression or hypersensitivity reaction

        • taper dose gradually after long term therapy- may cause withdrawal s/s

        • monitor pt response (alleviation of s/s of anxiety, sleep)

        • monitor for adverse reactions (sedation, hypotension, hepatic or renal dysfunction, skin reactions)

    • nonbenzodiazepines (zolpidem; or ambien)

      • mode of action

        • acts at GABA receptors to influence inhibitory neurotransmission throughout the cns

        • duration of action is 6-8 hours

      • pt teaching

        • observe pt for side effects such as hangover, dizziness, or confusion

        • encourage pts to avoid alcohol, antidepressants, antipsychotics, and opioids while taking nonbenzodiazepines

        • advise pts to urinate prior to taking to prevent sleep disruptionss

        • warn pt to use caution while driving as drowsiness may occur

    • melatonin agonists (ramelteon)

      • mode of action

        • similar to melatonin

        • selectively targets melatonin receptors to regulate circadian rhythm to treat insomnia 

      • pt teaching

    • sedative hypnotics for older adults

      • use nonpharmacologic methods first

      • short to intermediate acting benzodiazepines such as estazolam, temazepam, and triazolam

      • avoid flurazepam, quazepam, and diazepam benzodiazepines

  • Compare ADHD disorders and narcolepsy and nursing assessments with treatment

    • ADHD

      • amphetamine drugs

        • methylphenidate

          • ritalin (short acting)

          • concerta (long acting)

        • dexmethylphenidate

        • nursing interventions

          • encourage pts to use sugarless gum to relieve dry mouth

          • advise pts to record weight 2x week and report any weight loss

          • tell pt to not abruptly discontinue drug; dose must be tapered to avoid withdrawal

          • be aware of caffeine in OTC drugs 

          • tell family seek counseling for child with adhd

          • explain that long term use may lead to drug abuse

          • advise that pt needs regular blood draws 

          • emphasize that drugs are not a cure

          • teach pt to take drug before meals

    • narcolepsy

      • amphetamine drugs

        • modafinil (provigil)

          • armodafinil (nuvigil); updated version of provigil

        • side effects

          • headache, dizziness, insomnia, depression, anxiety, vertigo

          • chest pain, palpitations, tachycardia

          • epitaxis, pharyngitis

          • nausea, diarrhea, anorexia, dyspepsia, constipation, flatulence, abdominal pain 

  • Compare and contrast the common side effects of amphetamines, analeptics, and caffeine

    • amphetamines

      • cv: tachycardia, palpitations, hypertension, and dysrhythmias

      • cns: restlessness, tremors, irritability, dizziness, headache, blurred vision, euphoria, confusion, seizures, insomnia

      • gi: anorexia, dry mouth, diarrhea, weight loss

    • analeptics

      • cv: tachycardia, flushing, sweating

      • cns: insomnia,, nervousness, restlessness, tremors, seizures, headache, dizziness, confusion

      • respiratory: cough, dyspnea, laryngospasm

    • caffeine

      • similar to anorexiants

        • cv: palpitations, tachycardia, dysrhythmias

        • cns: headache, insomnia, tremors, nervousness, restlessness, seizures

        • gi; nausea

        • renal: urinary frequency

      • excess caffeine can cause dysrhythmias and convulsions