Central Nervous System Depressants and Muscle Relaxants

Question 1

What is a sedative?

Answer 1

A drug that has the ability to inhibit the CNS causing reduced:
Nervousness
Excitability
Irritability

Question 2

What are hypnotics?

Answer 2

Drugs that cause sleep

Question 3

T/F: Hypnotics are less potent than seditives

Answer 3

F: Hypnotics are more potent than sedatives

Question 4

Which drug can become a hypnotic if given in large doses?

Answer 4

Sedatives

Question 5

What are the three groups of CNS depressants?

Answer 5

Barbiturates
Benzodiazepines
Miscellaneous drugs

Question 6

What is more commonly prescribed Benzodiazepines or Nonbenzodiazepines? Why?

Answer 6

Nonbenzodiazepines due to favorable AEs, efficacy, and safety

Question 7

What are the three types of Benzodiazepines? Which drugs are in these categories?

Answer 7

Long acting: Diazepam
Intermediate acting: Lorazepam
Short acting Midazolam Hydrochloride

Question 8

What is the MOA of Benzodiazepines?

Answer 8

They depress the CNS, by interfering in the hypothalamic, thalamic, and limbic regions of the brain as well influence GABA receptors

Question 9

What effect do Benzodiazepines have on the body?

Answer 9

They calm the CNS
used for agitation and anxiety
Reduce sensory stimuli = sleep
induce skeletal muscle relaxation

Question 10

What are Benzodiazepines indicated for? Examples?

Answer 10

Sedation (short term insomnia therapy)
Sleep induction
Skeletal muscle relaxation (seizures)
Agitation or anxiety relief (Alcohol withdrawal)
Anxiety-related depression

Question 11

What are the AEs of Benzodiazepines?

Answer 11

Mild and infrequent
Headache
Drowsiness
Paradoxical excitement of nervousness
Dizziness
Cognitive impairment
Vertigo
Lethargy
Fall hazard for older adults
“Hangover” effect or daytime sleepiness

Question 12

What are the S&S of Benzodiazepines Toxicity and OD?

Answer 12

Somnolence (strong sleepy feeling)
Confusion
Coma
Diminished reflexes

Question 13

What is the antidote for Benzodiazepines OD?

Answer 13

Flumazenil

Question 14

What consumables do Benzodiazepines interact with?

Answer 14

CNS depressants (alcohol, opioids, muscle relaxants)
grapefruit and grapefruit juice

Question 15

What drugs do Benzodiazepines interact with?

Answer 15

Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics
Kava and valerian

Question 16

What was the first available benzodiazepine drug?

Answer 16

Diazepam

Question 17

What sedative is commonly used preop and during the procedure?

Answer 17

Midazolam

Question 18

What route can Midazolam be adminstred?

Answer 18

Normally IV (adults), liquid oral (children)

Question 19

What dose Midazolam cause?

Answer 19

Reduces anxiety and sedation

Question 20

When should a pt take Lorazepam before going to bed?

Answer 20

1 hour before due to long OSA

Question 21

What type of benzodiazepinelike drug is zopiclone?

Answer 21

Short acting

Question 22

What is Kava?

Answer 22

A herbal product used to relive anxiety, stress, restlessness, and help sleep

Question 23

What are some AEs of Kava?

Answer 23

yellow skin discoloration, scaly skin, vision changes

Question 24

What dose Kava interact with?

Answer 24

alcohol, barbiturates, and psychoactive drugs

Question 25

What is Kava contraindicated for?

Answer 25

liver disease, alcoholism, operating heavy machinery

Question 26

What is Valerian?

Answer 26

A drug used to relive anxiety, restlessness, sleep disorder

Question 27

What are some AEs of Valerian?

Answer 27

CNS depression, hepatotoxicity, nausea, vomiting, anorexia, headache, restlessness, insomnia

Question 28

What dose Valerian interact with?

Answer 28

CNS depressants, monoamine oxidase inhibitors (MAOIs), phenytoin, warfarin, and alcohol

Question 29

What is Valerian contraindicated for?

Answer 29

Cardiac and liver disease, operating heavy machinery

Question 30

What is the MOA of Barbiturates?

Answer 30

Work in the reticular formation (brain stem) to inhibit GABA nerve impulses in the Cerebral cortex

Question 31

What are the indications of Barbiturates?

Answer 31

Sedatives Anticonvulsants Anaesthesia for surgical procedures

Question 32

What are the AEs of Barbiturates?

Answer 32

Cardiovascular: Vasodilation, hypotension CNS: Drowsiness, lethargy, vertigo Respiratory: Respiratory depression, cough Gastrointestinal: Nausea, vomiting, diarrhea, constipation Hematological: Agranulocytosis, thrombocytopenia Other: Hypersensitivity reactions, Stevens-Johnson syndrome

Question 33

What is the common use of Barbiturates in Canada?

Answer 33

Anesthesia induction' Uncontrollable seizures Coma (Phenobarbital)

Question 34

What should be done for a Barbiturate OD?

Answer 34

Maintain adequate airway Assisted ventilation or oxygen therapy Fluids Alkalization Activated charcoal

Question 35

What drugs have an additive effect on Barditurates?

Answer 35

Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers

Question 36

What substances inhibit metabolism of Barbiturates?

Answer 36

MAOIs prolong the effects of barbiturates

Question 37

What substances increase the metabolism of barbiturates?

Answer 37

Reduces anticoagulant response, leading to possible clot formation

Question 38

What is the Barbiturate drug you need to know for the exam?

Answer 38

phenobarbital

Question 39

What is Phenobarbital used for?

Answer 39

Seizure prevention prevent hyperbilirubinemia in neonates rarely used as a sedative

Question 40

What are some OTC hypnotics?

Answer 40

Doxylamine succinate diphenhydramine hydrochloride acetaminophen/diphenhydramine

Question 41

When CNS depressants are combined with ____ it can cause respiratory depression/arrest

Answer 41

Alcohol

Question 42

What is the purpose of Muscle relaxants?

Answer 42

relive pain relating to muscle spasms

Question 43

Where do most Muscle relaxants work in the body?

Answer 43

CNS

Question 44

What do Muscle relaxants act on?

Answer 44

Skeletal muscles

Question 45

What are the indications of Muscle relaxants?

Answer 45

Relief of painful muscle spasms (MS, cerebral palsy)

Question 46

Muscle relaxants work best when combined with what?

Answer 46

Physical therapy

Question 47

What are the AEs of Muscle relaxants?

Answer 47

Euphoria Lightheadedness Dizziness Drowsiness Fatigue Confusion Muscle weakness, others

Question 48

What are the Muscle relaxant drugs you need to know for the exam?

Answer 48

Baclofen Cyclobenzaprine HCl

Question 49

What needs to be obtained before admin of Central Nervous System Depressants and Muscle Relaxants?

Answer 49

HH Allergies med hx VS (supine and standing BP) I/O contraindications/ drug intx

Question 50

When should hypnotics be administered for max effect?

Answer 50

30-60 mins before bed

Question 51

What do most benzodiazepines cause?

Answer 51

REM interference and a tired feeling the next day; use with caution in older adults.

Question 52

What should patients taking Central Nervous System Depressants and Muscle Relaxants drugs avoid?

Answer 52

Alcohol

Question 53

T/F: Rebound insomnia may occur after 3-4 week regime has been stoped?

Answer 53

T

Question 54

What safety considerations must the nurse take when patient is taking Central Nervous System Depressants and Muscle Relaxants?

Answer 54

Keep side rails up or use bed alarms. Do not permit smoking. Assist patients (especially older adults) with ambulation . Keep call light within reach monitor for AEs

Question 55

What are the signs that the drug is working?

Answer 55

Increased ability to sleep at night Fewer awakenings Shorter sleep-induction time Few adverse effects, such as “hangover” effects Improved sense of well-being because of improved sleep For muscle relaxants: decreased spasticity, decreased rigidity, pain relief

Question 56

What is the max dose of Lorazepam per day?

Answer 56

4 mg