Chapter 12

  • Discussing central nervous system depressants and stimulants

  • Depressants can be sedatives or hypnotics

  • Sedatives reduce nervousness, excitability, and irritability

  • Hypnotics induce sleep and have a more potent effect on the CNS

  • Sedatives can become hypnotics in large doses

  • Depressants are classified into three categories: Benzodiazepines, barbiturates, and miscellaneous drugs

  • Benzodiazepines are commonly prescribed sedative hypnotic drugs

  • They work on GABA receptors to reduce anxiety, agitation, and induce sleep

  • Benzodiazepines are used for sedation, sleep induction, anxiety relief, skeletal muscle relaxation, and more

  • Contraindications include drug allergy, narrow-angle glaucoma, and pregnancy

  • Benzodiazepine withdrawal symptoms can occur in babies born to mothers who take the drug

  • Toxicity and overdose symptoms include somnolence, confusion, coma, and diminished reflexes

  • Benzodiazepines can interact with alcohol and other medications to depress the CNS

  • Treatment for overdose is symptomatic and can include flumazenil as an antidote

  • Interactions with antifungals, grapefruit juice, herbal medications, and opioids

  • Side effects of benzodiazepines include headache, drowsiness, cognitive impairment, lethargy, and daytime sleepiness

  • Valerian is an herbal medication used to reduce anxiety and sleep disorders

  • Diazepam (Valium) and temazepam (Restoril) are examples of benzodiazepines used for anxiety and procedures

  • Drugs for sleep have a specific window of effectiveness

    • Patients should be ready to go to bed after taking the medication

    • If they don't fall asleep within the window, it may not work

  • Ambien is a non-Benzodiazepine sleep medication

    • It is zolpidem, a short-acting nonbenzo hypnotic

    • Has a lower incidence of daytime sleepiness compared to other drugs

    • Potential for sleepwalking as a side effect

  • Barbiturates are less commonly prescribed for sleep

    • Introduced in 1903, habit-forming with low therapeutic index

    • Benzos are more commonly prescribed

    • Work on GABA receptors like benzos, with different durations of action

    • Most barbiturates end in "barb" or "barbitol"

    • Phenobarbital is a commonly used barbiturate

    • Contraindications include drug allergy, pregnancy, respiratory/kidney/liver issues

    • Side effects include cardiovascular vasodilation, drowsiness, respiratory depression, nausea

    • Overdose can cause respiratory depression and potential coma or death

    • Phenobarbital can be used to induce a coma to stop seizures

  • Treatment for barbiturate overdose is symptomatic and supportive

  • Assisted ventilation, intubation, oxygen therapy may be needed

  • Activated charcoal can be used as an antidote if the patient is conscious

  • Beta barbitol is a long-acting barbiturate used for prevention of tonic clonic seizures and febrile convulsions

  • Over-the-counter sleep aids often contain antihistamines like diphenhydramine (Benadryl)

  • Certain medications depress the CNS, such as Eudasol, Diphenhydramine (Benadryl), and Tylenol PM (Tylenol and Benadryl combination)

  • Patients may unknowingly be taking multiple medications with the same active ingredients

  • Over-the-counter sleeping aids should be used with caution to avoid double-dosing

  • Alcohol should be avoided when taking these medications

  • Muscle relaxants relieve pain associated with skeletal muscle spasms

  • Commonly used muscle relaxants include Baclofen, Flexeril (cyclobenzaprine), Zanaplex, and Soma

  • Non-pharmacological interventions should be used in conjunction with medication for treating injuries or conditions

  • Muscle relaxants can cause side effects such as euphoria, lightheadedness, dizziness, drowsiness, fatigue, and muscle weakness

  • Driving or engaging in potentially harmful activities should be avoided while on muscle relaxants

  • Supportive measures are the best treatment for overdose or toxicity of muscle relaxants

  • Nursing implications include obtaining a thorough medication history, monitoring vital signs, administering sleep medications an hour before bedtime, avoiding alcohol and other CNS depressants, educating patients about rebound insomnia, and monitoring for therapeutic