CNS Depressants and Muscle Relaxants CNS DEPRESSANTS
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Transcript CNS Depressants and Muscle Relaxants CNS DEPRESSANTS
CNS
Depressants and Muscle
Relaxants
CNS
DEPRESSANTS
AND
MUSCLE RELAXANTS
Discuss the action and uses of the classes of drugs used as sedatives
and hypnotics
Describe the nursing process related to patients receiving sedation
Compare and contrast the uses of barbiturates and related nursing
care
Describe the steps in caring for patients with acute depressant drug
overdose
Discuss the action and uses of direct skeletal muscle relaxants
CNS DEPRESSANTS
SLEEP
State of unconsciousness from which a patient
can be aroused by appropriate stimulus
Needed to maintain psychiatric equilibrium and
physical well-being
Divided into two phases: REM and NREM
REM sleep associated with dreaming
NREM sleep divided into four stages
CNS DEPRESSANTS
SLEEP CYCLE
Stage I
Transition from wakefulness to
sleep; 2%-5% of sleep time
Stage II
Experienced as drifting, floating;
50% of sleep time
Stage III
Transition from lighter to deeper
sleep
Stage IV
Delta sleep—deep, dreamless,
restful; 10%-15% of sleep time in
healthy young adults
CNS DEPRESSANTS
REM SLEEP
Accounts for 20% to 25% of normal sleep
Amount of REM peaks around 5:00 AM
Characterized by:
Rapid eye movements, increased heart rate, irregular
breathing
Secretion of stomach acids, muscular activity, dreaming
Important for re-establishment of psychological
equilibrium & Memory
CNS DEPRESSANTS
REM SLEEP
The healthy young adult cycles through NREM
and REM in a 90-minute period
Stage I → Stage II → Stage III → Stage IV →
Stage III → Stage II → REM
CNS DEPRESSANTS
INSOMNIA
Most common sleep disorder
Experienced by 95% of adults at some time
Usually mild and short lived
Common causes
Lifestyle or environmental changes
Pain, illness, anxiety
Large amounts of caffeine; large meals before bedtime
CNS DEPRESSANTS
INSOMNIA
Three types of insomnia
Initial: difficulty falling asleep
Intermittent: difficulty staying asleep
Terminal: waking and an inability to fall back to sleep
CNS DEPRESSANTS
SEDATIVES / HYPNOTICS
Hypnotic—drug that produces sleep
Sedative—drug that relaxes the patient, but is not
necessarily accompanied by sleep
Actions:
Increase total sleeping time, mainly in Stages II and IV
Decrease number of REM cycles and amount of REM sleep
May cause REM rebound when drug
use is stopped
CNS DEPRESSANTS
SEDATIVES / HYPNOTICS
Actions
Sedatives produce relaxation and rest;
hypnotics produce sleep
Same drug may serve both functions
Classes of sedative-hypnotics
Barbiturates
Benzodiazepines
Nonbarbiturate, nonbenzodiazepines
Miscellaneous agents
CNS DEPRESSANTS
SEDATIVES / HYPNOTICS
Uses
Temporary treatment of insomnia
Decrease anxiety and increase relaxation and/or
sleep before diagnostic or operative procedures
Anticonvulsive agents
CNS DEPRESSANTS
NURSING PROCESS
Take baseline assessments
Note sleep disruption patterns
Determine activities done just before bed
Ask about patient stressors
Identify caffeine sources in dietary history
CNS DEPRESSANTS
NURSING PROCESS
Before administering a sedative-hypnotic,
determine the actual need for it
Patients with history of sleep apnea or
respiratory difficulties -higher risk for
respiratory depression
Older adults may react paradoxically
CNS DEPRESSANTS
NURSING PROCESS
Encourage standard bedtime
Avoid late, heavy meals
Limit caffeine and alcohol intake
Control sleep environment
Promote stress-reducing techniques
Discuss benefits of medication compliance and nonpharmacologic
interventions
Encourage patient use of self-assessment form
CNS DEPRESSANTS
NURSING PROCESS
Perform ongoing monitoring for therapeutic and
adverse effects
There should be written standards that specify
minimum monitoring criteria for providing safe
care
Always follow the policies and procedures of the
organization and document the monitored
findings
CNS DEPRESSANTS
BARBITURATES
First introduced in 1903
Mainstay of therapy until 1960
Use has declined in favor of benzodiazepines
Common barbiturates:
butabarbital (Butisol)
pentobarbital (Nembutol)
phenobarbital (Luminal)
secobarbital (Seconal)
CNS DEPRESSANTS
BARBITURATES
Actions
Reversibly depress excitable tissues
Effect depends on dose, tolerance, route of
administration, patient’s condition
Suppress REM and Stage III/IV sleep patterns
when used for hypnosis
Long half-lives; residual sedation common
CNS DEPRESSANTS
BARBITURATES
Uses
Anticonvulsant
General anesthetic (ultrashort acting)
Sedation before a diagnostic procedure (short acting)
Sedative and hypnotic effect (rare use)
CNS DEPRESSANTS
BARBITURATES
Baseline assessment should include
Respiratory rate and depth
Level of consciousness
State of arousal
Behavior
Motor function
Side effects to report
Habitual use—can result in physical dependence
Hypersensitivity—infrequent; hives, rash, pruritus
Blood dyscrasias—rare; schedule routine lab studies
CNS DEPRESSANTS
BARBITURATES
Patient Education: Side effects to expect
Morning “hangover”
Blurred vision
Transient hypotension on arising
Impaired coordination
Lethargy
Drug interactions
Alcohol, antihistamines, tranquilizers, and analgesics
increase effects of barbiturates
Patients taking phenytoin and barbiturates for
seizure control should have drug levels monitored to
ensure adequate dosages
Reduced effectiveness of other medicines
CNS DEPRESSANTS
BENZODIAZEPINES
Wide safety margin
More than 200 derivatives
Difficult to describe as a class, but include:
Anticonvulsants
Antianxiety agents
Sedative-hypnotic agents
Hypnotic Drugs:
Long acting
estazolam (Prosom), flurazepam (Dalmane), others
Short acting
temazepam (Restoril),triazolam (Halcion)
CNS DEPRESSANTS
BENZODIAZEPINES
Actions
Act on specific CNS sites
Decrease Stage III/IV sleep and to a lesser extent, REM
Uses
E.g., sedative-hypnotics affect type 1 and type 2 GABA receptors; bind to the
receptors to stimulate the release of GABA
Most commonly used sedative-hypnotics
Preoperative sedative
Conscious sedation
Agitation
Depression
Balanced anesthesia
Therapeutic outcomes
To produce mild sedation
For short-term use to produce sleep
Preoperative sedation with amnesia
CNS DEPRESSANTS
NURSING PROCESS
Assessment
Vital signs, especially blood pressure, should be assessed while the patient is sitting and lying
down before administering benzodiazepines
Give15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep
Most benzodiazepines cause REM rebound and a tired feeling the next day;
use with caution in the elderly
Check liver function tests
Side effects to report
Physical dependence can result from chronic use
Blood dyscrasias; hepatotoxicity
Patient Education
Side effects to expect: Morning “hangover,” blurred vision, transient hypotension on arising
Toxic effects - increased if used with alcohol, tranquilizers, antihistamines, analgesics, and
anesthetics
Smoking increases the metabolism of benzodiazepines
CNS DEPRESSANTS
NON-BARBITURATES
/ NON-BENZODIAZEPINES
All cause CNS depression, but mechanisms of action differ
zalepion (Sonata), zolpidem (Ambien), and eszoplicone (Lunesta)
Share many characteristics of benzodiazepines
Used to treat insomnia
Actions
Uses
Variable effects on REM sleep
Tolerance development
Rebound REM sleep
Insomnia after discontinuation
Sedative and hypnotic effects
Therapeutic outcomes
To produce mild sedation
For short-term use to produce sleep
CNS DEPRESSANTS
NON-BARBITURATES/NON-BENZODIAZEPINES
Nursing Process:
Vital signs, especially blood pressure, should be assessed
while the patient is sitting and lying down before
administering
Laboratory results should be monitored for hepatic
dysfunction or blood abnormalities
Patient Education:
Side effects to expect:
Morning “hangover”
Blurred vision
Transient hypotension on arising
Restlessness, anxiety
CNS MUSCLE RELAXANTS
Relieves pain associated with skeletal muscle spasms
Majority are central acting
Direct acting
CNS is the site of action
Similar in structure and action to other CNS depressants
Acts directly on skeletal muscle
Closely resembles GABA
Relief of painful musculoskeletal conditions
Muscle spasms
Management of spasticity of severe chronic disorders
Multiple sclerosis, cerebral palsy
Work best when used along with physical therapy
CNS MUSCLE RELAXANTS
Adverse Effects
Usually seen in 0.2% of patients treated for more
than 60 days – to be used only for short term
Extension of effects on CNS and skeletal muscles
Euphoria
Lightheadedness
Dizziness
Drowsiness
Fatigue
Muscle weakness, others
Toxicity
Overdose involves CNS – airway, IV fluids, cardiac
monitor
CNS MUSCLE RELAXANTS
dantrolene (Dantrium)
Works directly on skeletal muscle
Uses: Malignant hyperthermia crisis & Spasticity
CNS MUSCLE RELAXANTS
baclofen (Lioresal)
cyclobenzaprine (Flexeril)
dantrolene (Dantrium)
metaxalone (Skelaxin)
CNS MUSCLE RELAXANTS
NURSING PROCESS
Patient Assessment
Determine allergies, mental status,
Sleep diary & review sleep habits
Renal and hepatic function testing
Patient Education
Intended for short term use
Same precautions as with benzodiazepines
Avoid alcohol and benzodiazepines
Caution to avoid overdose
CNS
DEPRESSANTS & MUSCLE RELAXANTS
As individuals age, their sleep becomes:
a. more fragmented.
b. more sound.
c. characterized by fewer nocturnal awakenings
d. both 2 and 3
CNS
DEPRESSANTS AND MUSCLE RELAXANTS
Long term administration of benzodiazepines
may result in:
a. nephrotoxicity.
b. withdrawal symptoms if withdrawn rapidly.
c. a rush of morning energy with repeated
usage.
d. seizures during the time it is being
administered.
CNS
DEPRESSANTS & MUSCLE RELAXANTS
1. Benzodiazepines work by ________________. An example of a
benzodiazepine is _______________.
2. Restoril is used as a ________________________ and has the adverse
effects of ___________.
3. Larger dosages of sedative-hypnotics result in a _____________ effect.
Smaller doses have a _______________ effect.
4. Phenobarbital is a(n) ____________________ drug.
5. Zolpidem is classified as a(n) _______________drug.
6. The only skeletal muscle relaxant that acts directly on skeletal
muscle is __________.