Week 6 Concepts: Intracranial Regulation Stuvia.com - The Marketplace to Buy and Sell your Study Material
CNS Depressants Prepare: CNS Depressants
CNS Depressants Central Nervous System (CNS) Depressants are drugs that result in a calming effect by inhibiting the transmission of nerve impulses to the CNS. Subclass of CNS Depressants Barbiturates are the subclass of CNS Depressants which inhibit nerve impulses by acting on the brainstem and GABA receptors resulting in the inhibition of nerve impulses in the cerebral cortex. Black Box Warning Benzodiazepines carry a black box warning regarding what? The combination of all opioids with all benzodiazepines can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death). The use of benzodiazepines while driving can cause severe sleepiness. The dosage of benzodiazepines. The use of benzodiazepines in patients with a history of depression.
Self-Check: CNS Depressant
CNS Depressant Choose the correct CNS Depressant (sedatives, hypnotics, or sedative-hypnotic) based on the degree to which it causes the inhibition of nerve impulses in the CNS. Sedatives produce a sense of calm, reduce nervousness, excitability, and irritability without causing sleep unless given in a large enough dose. Hypnotics cause sleep with a much more potent CNS effect than sedatives. Sedative-Hypnotics can act as either a sedative or a hypnotic depending on the dose and patient responsiveness. In low doses, they calm the CNS without causing sleep. In high doses, they calm the CNS and cause sleep.
Self-Check: Sedative-hypnotics
Sedative-hypnotics Sedative-hypnotics, the group of CNS depressants that have either a sedative or hypnotic effect, or both, dependin on various factors, are broken into 3 groups based on their chemical makeup. Which of them carries the highest ri for dependence and are therefore used less? Barbiturates Sedative-hypnotics Benzodiazepines Hypnotics
Self-Check: Barbiturates: Safety Considerations
Barbiturates: Safety Considerations Barbiturates carry with them many contraindications, risk for dependence and overdose, as well as many drug-dru interactions. Drag the statements below that apply to barbiturates and drop them to the right side column:
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Self-Check: Benzodiazepines Benzodiazepines Choose all the statements below that are correct regarding Benzodiazepines. (Select all that apply.) alprazolam, lorazepam, and temazepam are long-acting benzodiazepines Produce more REM suppression than barbiturates Affect the hypothalamic, thalamic, and limbic systems of the brain (GABA receptors) Induce relaxation of skeletal muscles clonazepam, diazepam, and flurazepam are short-acting benzodiazepine Reduce excessive sensory stimulation which induces sleeps
Self-Check: Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines act on the CNS and act very much like benzodiazepines. Orexin Receptor Antagonists (also called hypocretins) act on the CNS and act very much like benzodiazepines.
Reflect: CNS Depressant
CNS Depressants Pentobarbital is a short- acting barbiturate now used for preoperative anxiety and to produce sedative effects, to treat symptoms of withdrawal from other barbiturates and nonbarbiturates, control status epilepticus, and to prevent hyperbilirubinemia in neonates. Phenobarbital is a long- acting barbiturate used to prevent generalized tonic-clonic seizures and fever-induced convulsions as well as treatment of hyperbilirubinemia in neonates. It is no longer used as a sedative or hypnotic.
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Sedative-hypnotics Stuvia.com - The Marketplace to Buy and Sell your Study Material Choose the correct statement(s) below regarding sedative-hypnotics. (Select all that apply.) Prolonged use of sedative-hypnotics can cause REM interference resulting in daytime fatigue. Discontinuation of a sedative-hypnotic can cause REM interference resulting in daytime fatigue. Discontinuation of a sedative-hypnotic can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams. Prolonged use of sedative-hypnotics can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams. Sedative-hypnotic Drugs Which of the following are currently the more frequently prescribed sedative-hypnotic drugs? Nonbenzodiazepines Long-acting barbiturates Ultrashort-acting barbiturates Benzodiazepines
CNS Depressants Select the true statement(s) regarding CNS depressants. (Select all that apply.) Herbal supplements kava and valerian have CNS stimulant effects. There are significant drug-drug interactions with benzodiazepines, especially with other CNS Depressants, due to th intensity of benzodiazepines and the combined CNS depressant effects. There is a black box warning regarding the combination of all opioids with all benzodiazepines which can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death). Alcohol should not be used with these CNS Depressants because the combination multiples the CNS depressive effects. Barbiturates Which of the following statements are true regarding barbiturates? (Select all that apply.) The long-term use of barbiturates can lead to harmful effects on sleep due to the deprivation of REM sleep. Increased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers. Overdose of barbiturates typically leads to respiratory arrest, coma, and death. MAOIs (antidepressants) result in a longer duration of action of barbiturates. Barbiturates are a type of sedative-hypnotic. Decreased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers. The long-term use of barbiturates can lead to harmful effects on sleep due to the prolongation of REM sleep. Sedative-hypnotics Select the true statement below regarding sedative-hypnotics. Sedatives at low doses calm the CNS and cause sleep. Hypnotics at high doses calm the CNS and cause sleep. Hypnotics at low doses calm the CNS without causing sleep. Sedatives at high doses calm the CNS without causing sleep. Barbiturates Match each barbiturate drug to its common use.
Use
methohexital and thiopental
pentobarbital and secobarbital
butabarbital
phenobarbital and mephobarbital
induction of anesthesia
prevent hyperbilirubinemia in neonates
sedation
prevention of seizures
Sedative-hypnotics Match the sedative-hypnotic CNS Depressant medication to its subclass. Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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IF CAN’T READ Intermediate-acting benzodiazepines - alprazolam, lorazepam, temazepam Long-acting benzodiazepines - clonazepam, diazepam, flurazepam Short-acting barbiturates - pentobarbital, secobarbital, pentobarbital Long-acting barbiturates – phenobarbital, mephobarbital, phenobarbital GABA receptor antagonist that is the antidote to benzodiazepines – flumazenil Long-acting benzodiazepine most commonly used to treat for status epilepticus - diazepam benzodiazepine most commonly used for preoperative anxiety and for moderate sedation - midazolam Non-benzodiazepine, a short-acting hypnotic with a relatively low incidence of daytime sleepiness - zolpidem
Intermediate Acting Benzodiazepines (alprazolam) Prepare: Intermediate Acting Benzodiazepines (alprazolam) Which of these medications is an intermediate-acting benzodiazepines used for its anxiolytic effects? zolpidem butabarbital diazepam alprazolam Benzodiazepines are contraindicated in pregnancy and lactation because they: (Select all that apply.) Cause CNS depression May cause sedation and respiratory issues in newborns Cross into breastmilk May cause anxiety in the mother Benzodiazepines are most often used for which of these effects? Barbiturate Anxiolytic Sedative Hypnotic
Self-Check: Intermediate Acting Benzodiazepines Intermediate-acting benzodiazepines are so called because: There onset and duration of action takes much longer than those of short-acting benzodiazepines They sometimes have an increased CNS depressive effect when taken with barbiturates In relation to short- and long-acting benzodiazepines, their onset and duration of action take place over a period of time that is neither fast nor slow They are sometimes less effective when taken with other CNS Depressants Benzodiazepines Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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Benzodiazepines are contraindicated in pregnancy because they cause CNS depression. This can subsequently lead to Stuvia.com - The Marketplace to Buy and Sell your Study Material respiratory issues in the neonate.
Self-Check: alprazolam Which of these are indications for the use of alprazolam? (Select all that apply.) Generalized anxiety disorder (GAD) Anxiety associated with depression Panic disorder Sedative to induce and maintain sleep Adjunct in the treatment of acute mania and acute psychosis Prevention of alcohol withdrawal alprazolam is administered Oral (PO) alprazolam is a/an oral benzodiazepine used for its anxiolytic effects by reducing anxiety.
Reflect: Intermediate Acting Benzodiazepines (alprazolam) alprazolam: Indications for Use Identify the applicable indications for the use of alprazolam:
alprazolam In administering alprazolam to a client with COPD which of the following is a concern? Anxiety and panic attacks can induce hyperventilation Alprazolam is contraindicated with medications used to treat COPD Alprazolam is a CNS depressant Someone who has anxiety is more likely to have an exacerbation of a respiratory illness CNS Depressants and Drug Interactions Which of the following items have CNS depressive effects and should be used with caution in patients taking alprazolam? (Select all that apply.) caffeine antipsychotics muscle relaxants alcohol benzodiazepines flumazenil anxiolytics opioids
Dosage of alprazolam How might the dosage of alprazolam be adjusted in an elderly patient and why? Elderly patients are less sensitive to benzodiazepines and therefore higher doses may be used in this population. Elderly patients have a much lower risk for dependency to benzodiazepines and therefore higher doses may be use in this population. Elderly patients have a great risk for dependency to benzodiazepines and therefore lower doses may be used in this population. Elderly patients are sensitive to benzodiazepines and therefore lower doses may be used in this population. Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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Nicotine Nicotine causes increased benzodiazepine metabolism which causes the medication to be less effective. For a patient who a smoker and is also taking alprazolam for generalized anxiety disorder, this could mean that their symptoms of anxiety do not improve. alprazolam: Classifications Which of the following characteristics describe alprazolam? CNS Depressant Sedative-hypnotic CNS Stimulant Barbiturate Intermediate-acting benzodiazepine Nonbenzodiazepine Anxiolytic
Benzodiazepines Which of the following is the most accurate statement related to the increased risk for dependence and addiction when benzodiazepines (such as Xanax) are taken with other CNS Depressants? Benzodiazepines have a long-acting duration causing the user to remain sedated for a long period of time when tak with other CNS Depressants. Benzodiazepines administered to patients who have uncontrolled severe pain will cause an increased risk for dependency, especially when taken with other CNS Depressants. Benzodiazepines administered to patients who have never taken them before pose the greatest risk for addiction, especially when taken with other CNS Depressants. Benzodiazepines typically peak and trough quickly causing the user to crave more and more when taken with other CNS Depressants. CNS Depressant A patient taking alprazolam, or any CNS Depressant, should avoid which of the following? (Select all that apply.) Grapefruit juice Valerian root Green tea Kava
Nursing Application: CNS Depressants Prepare: Nursing Application: CNS Depressants
Nursing Assessment A nurse is completing an assessment of a patient taking a CNS Depressant medication. The nurse will monitor for symptom of CNS depression such as respiratory depression associated with the inhibition of nerve impulse transmission to the CNS. pentobarbital: Indications You are the nurse caring for a patient taking pentobarbital, a short-acting barbiturate. Based on your knowledge of the indications for this medication, you know that this patient may have a history of seizures Risks of CNS Depressants In educating clients taking benzodiazepines with other CNS depressants, the nurse indicates this may put the client at risk toxicity.
Self-Check: Nursing Assessment Nursing Assessment As the nurse caring for a patient taking a CNS Depressant. Which adverse effect does the nurse need to consider when assessing a client prescribed a CNS depressant? Downloaded by: STUDYGUIDEnTESTBANKS | writesmartessay@gmail.com Distribution of this document is illegal
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Excessive sedation Hypertension Nausea and vomiting Insomnia
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Patient Education When reviewing a client’s medications for discharge, she asks you if she can continue to take kava for her insomnia. You understand that kava causes CNS depression.
Self-Check: Nursing Assessment: Specific Medications Barbiturates You are caring for a patient for whom you have an order to administer a barbiturate. Based on your knowledge of this subclass and its contraindications, you check the patient’s lab results to ensure that she is not pregnant.
Self-Check: Nursing Interventions
You are the nurse caring for a patient who has been prescribed zolpidem, a hypnotic CNS Depressant. You plan to adminis this medication at this time in order to maximize its sleep-inducing effectiveness: 30-60 minutes before bedtime Nursing Interventions As the nurse caring for the patient taking a CNS Depressant, you are planning nursing interventions used to minimize some of the risks associated with this drug class, such as: (Select all that apply.) Teaching the patient to stop taking the medication once he’s feeling better To avoid driving while taking this medication Assistance with ambulation Teaching the patient to minimize alcohol use when taking this medication
Reflect: Nursing Application: CNS Depressants Nursing Assessment In reviewing benzodiazepine use in an elderly client, you anticipate: (Select all that apply.) Insomnia and tachycardia Decreased CNS depressive effects Risk of low respiratory rate and excessive sedation Increased CNS depressive effects
Nursing Interventions You are the nurse caring for a 24-year-old patient who is recovering from a surgical procedure. He has recently bee admitted to your unit from the post-anesthesia care unit and is recovering well and is tolerating drinking liquids. Y were told in a report that he received diazepam for sedation during the procedure as an adjunct anesthetic to aid in intubation. You enter the room to check his vital signs and notice that his mom is handing him a drink she brought from home and notice that it is grapefruit juice. Based on your knowledge of this interaction, your first action is to: Advise him not to drink citric beverages. Advise him not to have food or beverages from home as they may interact with his medications. Assess his sedation level, respiratory effort, and vital signs. Prepare to administer flumazenil, the antidote to benzodiazepines.
Patient Teaching You are the nurse caring for Stephanie, a 42-year-old woman for whom you are completing discharge instructions and patie teaching. She has been prescribed a nonbenzodiazepine. However, she mentioned to you during your conversation that sh is allergic to acetylsalicylic acid. You tell Stephanie that those with an allergy to acetylsalicylic acid are more likely to have a allergy to nonbenzodiazepines.
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