Pharmacology Nursing Final
COVERS THE CNS: DEPRESSANTS AND MUSCLE RELAXERS
Chapter 12 CNS Depressants and Muscle Relaxers
Benzodiazepines
● Diazepam (Valium)- short acting: IV immediate PO- 30 min
Uses: treat anxiety, procedure sedation, anaesthesia, anticonvulsant,
skeletal muscle relaxer following orthopedic injury or surgery
● Midazolam (versed)- short acting: IV 1-5 min * oral suspension usually, not used
causes amnesia, sedation, reduce anxiety
● Temazepam (Restoril)- intermediate acting: PO 30-60 min
Uses: induces sleep 20-40 minutes.
Nurse implications- take 1 hour prior to sleep.
MOA: affects hypothalamus, thalamus and limbic systems of brain. Thought to work on
GABA receptors *main inhibitory receptor in brain Inhibits stimulation in brain
Indications:
-Sedation -reduce agitation/anxiety -reduce anxiety related depression -sleep
-inducers -skeletal muscle relaxers -treats acute seizure disorders -
alcohol withdrawal
Contraindications:
-known allergy -narrow angle glaucoma -pregnancy
-dangerous when given with alcohol
Adverse Effects:
-headache -dizziness -paradoxical excitement or nervousness -drowsiness
-vertigo -lethargy -cognitive impairment
*Fall hazard in elderly
*Hangover effect- daytime sleepiness
Rebound insomnia occurs when abruptly
stopped! When Benzo and other CNS depressants (alcohol, barbiturates) it
may cause hypotension & respiratory depression.
Flumazenil- benzo antidote (used when overdosed)
Interactions:
Any drugs that result in further CNS depressant symptoms. EX: reduce blood
pressure, reduce respiratory rate, sedation, confusion, diminished reflexes.
>Grapefruit >kava >valerian
> Riframpin -increases metabolism of benzo which decreases its effects.
,>Azole antifungals-decreases benzo metabolism which causes prolong benzo
effects Nonbenzodiazepines
, ● Eszopiclone (Lunesta) short act 30-60 min
Uses: provide full 8 hours of sleep.
Nurse implications: allow for 8 hours sleep time.
● Ramelton (Rozerem)
Uses: similar to melatonin(helps with onset of sleep), regulates sleep cycle,
can be used as hypnotic,
>avoid in patients using fluconazole, ketoconazole, and riframpin
● Zaleplon (Sonata) Short act- rapid
Uses: helps with early waking during the night.
Nurse implications: do not take within 4 hours of waking up.
● Zolpidem (Ambien) short act 30 min
Uses: 3 drug reservoirs, one releases drug to put to sleep and the other
reservoir extends drug to stay asleep
Nurse implications: risk for next morning effect.
Risk for sleep walking
Barbiturates
● MOA: CNS depressant acts on brainstem (reticular
formation) -Inhibit nerve impulses transmission
-increase action of inhibitory neurotransmitter GABA
● Indications:
- Anaesthesia for short surgical procedures
- Control convulsions
- Reduction of intracranial pressure
- Sedation
- Control of convulsive conditions
Long Acting
- Epileptic seizure prophylaxis
● Contraindications:
-known drug allergy -pregnancy - significant respiratory difficulties
-severe kidney or liver disease
Fall risk in the elderly
● Adverse effects
- Drowsiness -lethargy -dizziness -hangover -vasodilation
-nausea -vomiting -diarrhea -constipation -
thrombocytopenia -vertigo -respiratory depression
-steven johnson syndrome
- paradoxical excitement or restlessness
*effects on normal sleep are detrimental.
COVERS THE CNS: DEPRESSANTS AND MUSCLE RELAXERS
Chapter 12 CNS Depressants and Muscle Relaxers
Benzodiazepines
● Diazepam (Valium)- short acting: IV immediate PO- 30 min
Uses: treat anxiety, procedure sedation, anaesthesia, anticonvulsant,
skeletal muscle relaxer following orthopedic injury or surgery
● Midazolam (versed)- short acting: IV 1-5 min * oral suspension usually, not used
causes amnesia, sedation, reduce anxiety
● Temazepam (Restoril)- intermediate acting: PO 30-60 min
Uses: induces sleep 20-40 minutes.
Nurse implications- take 1 hour prior to sleep.
MOA: affects hypothalamus, thalamus and limbic systems of brain. Thought to work on
GABA receptors *main inhibitory receptor in brain Inhibits stimulation in brain
Indications:
-Sedation -reduce agitation/anxiety -reduce anxiety related depression -sleep
-inducers -skeletal muscle relaxers -treats acute seizure disorders -
alcohol withdrawal
Contraindications:
-known allergy -narrow angle glaucoma -pregnancy
-dangerous when given with alcohol
Adverse Effects:
-headache -dizziness -paradoxical excitement or nervousness -drowsiness
-vertigo -lethargy -cognitive impairment
*Fall hazard in elderly
*Hangover effect- daytime sleepiness
Rebound insomnia occurs when abruptly
stopped! When Benzo and other CNS depressants (alcohol, barbiturates) it
may cause hypotension & respiratory depression.
Flumazenil- benzo antidote (used when overdosed)
Interactions:
Any drugs that result in further CNS depressant symptoms. EX: reduce blood
pressure, reduce respiratory rate, sedation, confusion, diminished reflexes.
>Grapefruit >kava >valerian
> Riframpin -increases metabolism of benzo which decreases its effects.
,>Azole antifungals-decreases benzo metabolism which causes prolong benzo
effects Nonbenzodiazepines
, ● Eszopiclone (Lunesta) short act 30-60 min
Uses: provide full 8 hours of sleep.
Nurse implications: allow for 8 hours sleep time.
● Ramelton (Rozerem)
Uses: similar to melatonin(helps with onset of sleep), regulates sleep cycle,
can be used as hypnotic,
>avoid in patients using fluconazole, ketoconazole, and riframpin
● Zaleplon (Sonata) Short act- rapid
Uses: helps with early waking during the night.
Nurse implications: do not take within 4 hours of waking up.
● Zolpidem (Ambien) short act 30 min
Uses: 3 drug reservoirs, one releases drug to put to sleep and the other
reservoir extends drug to stay asleep
Nurse implications: risk for next morning effect.
Risk for sleep walking
Barbiturates
● MOA: CNS depressant acts on brainstem (reticular
formation) -Inhibit nerve impulses transmission
-increase action of inhibitory neurotransmitter GABA
● Indications:
- Anaesthesia for short surgical procedures
- Control convulsions
- Reduction of intracranial pressure
- Sedation
- Control of convulsive conditions
Long Acting
- Epileptic seizure prophylaxis
● Contraindications:
-known drug allergy -pregnancy - significant respiratory difficulties
-severe kidney or liver disease
Fall risk in the elderly
● Adverse effects
- Drowsiness -lethargy -dizziness -hangover -vasodilation
-nausea -vomiting -diarrhea -constipation -
thrombocytopenia -vertigo -respiratory depression
-steven johnson syndrome
- paradoxical excitement or restlessness
*effects on normal sleep are detrimental.
