Chapter 18: Depressants Flashcards by Jessica Britney

Classification of CNS Depressants

Sedative-hypnotics
General anesthetics
Analgesics
Opioid and nonopioid analgesics
Anticonvulsants
Antipsychotics
Antidepressants

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The inability to fall asleep or remain asleep

Insomnia

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Two phases of normal sleep

REM and NREM

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Intervals of REM and NREM sleep

90 minutes

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Transition period between wakefulness and sleep
Lasts around 5-10 mins

NREM 1

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Body temperature drops and heart rate begins to slow
Lasts approximately 20 minutes

NREM 2

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Muscles relax, bp and breathing rate drop
Deepest sleep occurs

NREM 3

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Brain becomes more active
Body becomes relaxed and immobilized
Dreams occur and eyes move rapidly

REM

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What are nonpharmacologic methods to promote sleep?

Arise at a specific hour in the morning
Take a few or no daytime naps.
Avoid smoking nicotine and drinks that contain caffeine and alcohol 6 hours before bedtime.
Avoid heavy meals or strenuous exercise before bedtime.
Take a warm bath, listen to quiet music or perform other soothing activities before bedtime.
Decrease exposure to loud noises.
Avoid drinking too much fluid before sleep.
Drink warm milk before bedtime.

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These are commonly prescribed as treatment for sleep disorders

Sedative-hypnotics

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Mildest form of CNS depression

Sedation/Sedatives

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Increasing the drug dose of sedatives can produce…

Hypnotic effect, form of natural sleep

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What happens with high doses of sedative-hypnotics?

Anesthesia may be achieved

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Useful in achieving sleep because they allow the patient to awaken early in morning without lingering side effects

Short-acting hypnotics

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Useful for sustaining sleep but patient may experiences drowsiness or hangover in the morning

Long-acting hypnotics

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Contraindications of Hypnotics

Patients with severe respiratory disorders and pregnant

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Only major sedative-hypnotic approved for long term use and used for treating chronic insomnia

Ramelteon

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Common Side effects and adverse effects of Sedative-Hypnotics

Hangover - residual drowsiness, intermediate and long acting hypnotics are the cause.

REM Rebound - results in vivid dreams and nightmares, occurs after prolonged used and abruptly stopping

Dependence - result of chronic hypnotic use

Tolerance - results when there is a need to increase dosage over time to obtain desired effect.

Excessive depression - long-term use is the cause

Respiratory depression - high doses can suppress respiratory center in medulla

Hypersensitivity - skin rashes and urticaria can result when taking barbiturates.

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Categories of Sedative-Hypnotics

Barbiturates
Benzodiazepines
Nonbenzodiazepines

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Classification of Barbiturates

Long-acting - includes phenobarbital, used to control seizures and epilepsy

Intermediate-acting - butabarbital, useful as sleep sustainers for maintaining long periods of sleep.

Short-acting - secobarbital, used for procedure sedation

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How long should barbiturates be used?

Short term, 2 weeks or less

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Classification of Barbiturates as CSS

Short-acting - II
Intermediate-acting - III
Long-acting - IV

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Examples of short-acting barbiturates

Secobarbital sodium CSS II
Pentobarbital CSS II

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Pentobarbital and secobarbital are used for?

Short-term treatment of insomnia
Control of seizures
Preoperative anxiety
Sedation induction

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Example of Intermediate-acting barbiturate

Butabarbital Sodium

Example of Long-acting barbiturate

Phenobarbital CSS IV

Depressants that produce sedation, hypnosis, anxiety and muscle spasm relief and reduce seizures. Drug prescribed as sedative-hypnotics for inducing sleep

Benzodiazepines

Examples of Benzodiazepines

Alprazolam - anxiety and panic treatment Estazolam - insomnia treatment Lorazepam - sedation induction and anxiety relief Temazepam - insomnia treatment Triazolam - insomnia management

A benzodiazepine antagonist

Flumazenil

Examples of Nonbenzodiazepines

Zolpidem tartrate Eszopiclone Zaleplon

Half-life of Benzodiazepines

8-24 hours

Alprazolam food interaction

Grapefruit - increases drug levels Green tea - decreases drug effects

A phase of our daily life cycle when the brain and body rest and rejuvenate.

SLEEP

A nonbenzodiazepine that is used for short-term treatment of insomnia

Zolpidem

A sedative-hypnotic drug under melatonin agonists for insomnia treatment

Ramelteon

Adverse effects of Ramelteon

Drowsiness and dizziness Fatigue, headache and nausea Suicidal Ideation

What type of sedative-hypnotics should not be prescribed to older adults for sleep? and what is the alternative?

Barbiturates Benzodiazepines, estazolam, temazepam, triazolam

Classification of anesthetics

General and local

Anesthetic that depresses CNS, alleviate pain and cause a LOC.

General anesthetics

The first anesthetic used for surgery, also called the "laughing gas".

Nitrous Oxide

Pathophysiology of inhalation anesthetics

1. Lipid structure of cell membranes is altered > impaired physiologic functions 2. GABA is activated to the GABA receptor > Decreases action potentials of neurons 3. Ascending reticular activating system is altered > neurons cease to transmit information to the brain.

A Balance Anesthesia is

A combination of drugs frequently used in general anesthesia, may include the ff: 1. Hypnotic given the night before 2. Premedication with opioid analgesic or benzodiazepine + atropine given about 1 hours before surgery 3. Short-acting nonbarbiturate (propofol) 4. Inhaled gas, combination of inhalation anesthetic, nitrous oxide, oxygen 5. Muscle relaxant PRN

Why is balanced anesthesia better than general anesthesia?

Minimizes cardiovascular problems and organ function disturbance Decreases the amount GA need Reduces possible postanesthesia nausea and vomiting Decreases pain

Stages of Anesthesia

1. Analgesia - begin with consciousness and ends with LOC 2. Excitement or delirium - produces LOC causes by depression of cerebral cortex 3. Surgical - procedure is done in this stage, respiration becomes shallower, RR increase 4. Medullary paralysis - toxic stage, respirations are lost, circulatory collapse occurs.

Inhalation Anesthesias Examples

Volatile liquids: Halothane - highly potent anesthetic Enflurane - can depress respiratory function Isoflurane - frequently used in inhalation therapy Desflurane Sevoflurane - for induction and maintenance during surgery Gas: Nitrous Oxide

IV Anesthetics examples

Ultra-short-acting barbiturates: Methohexital sodium - used for induction, part of balanced anesthesia Thiamylal sodium - used for induction, anesthesia for electroshock therapy Benzodiazepines: Diazepam - induction of anesthesia Midazolam - for endoscopic procedures

Adverse effects of inhalation anesthetics

Respiratory depression Hypotension Dysrhythmias Hepatic dysfunction

Used for general anesthesia or induction of anesthesia

IV Anesthetics

Preferred anesthetics for outpatient surgery

IV Anesthetics

Commonly used to provide a Total Intravenous Anesthetic (TIVA)

Propofol, droperidol, etomidate and ketamine hydrochloride

Adverse effects of IV anesthetics

Respiratory and Cardiovascular depression

Anesthetic that is limited to mucous membranes, broken or unbroken skin surfaces and burns

Topical anesthetics

Forms of topical anesthetics

Gels, cream, solutions, liquid spray, ointment, powder

Type of anesthetic that blocks pain at the site where drug is administered by preventing conduction of nerve impulses

Local Anesthesia

Local anesthetics are useful in

Dental procedures Suturing skin lacerations Minor surgeries at a localized area Diagnostic procedure (lumbar puncture) Provided analgesia for surgery in lower or upper extremities

Two groups of local anesthetics

Ester Amides - very low incidence of allergic reactions

Examples of local anesthetics

Short-acting: Chloroprocaine hydrochloride Procaine hydrochloride Moderate acting: Lidocaine hydrochloride Prilocaine hydrochloride Long-acting: Bupivacaine hydrochloride Dibucaine hydrochloride

Is performed by placing a needle between the lumbar vertebrae and through the dura

Spinal Anesthesia

Where is the local anesthetic injected in spinal anesthesia?

Subarachnoid space below first lumbar space (L1) in adults and 3rd lumbar space (L3) in children

Results from penetration of the anesthetic into the subarachnoid space

Spinal block

Placement of local anesthetic in the epidural space

Epidural block

An epidural block placed by administering a local anesthetic through the sacral hiatus

Caudal block

Given at the lower end of the spinal column to block the perineal area

Saddle block