Depressants
What do CNS depressants bind too?
● Bind to GABA receptors
● GABA: Endogenous neurotransmitters that can excite and inhibit
What are the main indications for Benzodiazepines? -PAM
● Adults: Anxiety, Sleep Aids (sedation), CNS depressants (seizures)
● Children: Sleepwalking/Night terrors
How are Benzodiazepines used in the clinical setting?
● Sedation, treat anxiety and insomnia
Why do you wean off Benzodiazepines?
● Dependency Potential, Withdrawal Symptoms & Fast Relapse
What schedule drug are Benzodiazepines?
● Schedule 4
What are the names of 3 long-acting Benzos? (duration of action is longer)
● Chlordiazepoxide (Librium)
● Diazepam (Valium) (Duration: 12-24hr)
● Clonazepam (Klonopin)
What are the names of 3 intermediate acting Benzos? (for acute situations)
● Lorazepam (Ativan)
● Alprazolam (Xanax)
● Temazepam (Restoril)
What are the names of 2 short acting Benzos?
● Midazolam (Versed) (pre-op anxiety)
● Triazolam (Halcion)
What are the names of 4 Sleeping pills? (Everyone Requires So Much Sleep -zzz)
● Eszopiclone (Lunesta)
● Ramelteon (Sleep induction rather than sleep maintenance)
● Suvorexant
● Modafinil (Narcolepsy only, 2 months for therapeutic level affects)
● Zolpidem (Ambien)
What population of patients should not take Benzos?
● Pregnant Women & Narrow-Angle Glaucoma
What are potential adverse effects of Benzos?
● CNS changes (dizziness, confusion, fatigue, drowsiness/ “hangover”) OD with alcohol,
Dependency Potential, Fall Hazard, Withdrawal (if abruptly stopped)
Why is important not to give patients on Benzos other CNS depressants?
, ● Too much sedation causing OVERDOSE
What are symptoms a nurse would see in a patient who overdosed on Benzos?
● Dilated Pupils (Mydriasis), Coma, Confusion, Hypoventilation
What drug is used to treat a patient who overdosed on Benzos and how does it work?
● Flumazenil, reverses respiratory depression (GABA antagonist)
What are patient educations points that should be shared with patients taking Benzos?
● Don’t take with CNS depressants
● Don’t stop abruptly (wean off)
● Makes you drowsy (no driving, lifting, high-intensity activities)
What is a potential adverse effect of Valium in children?
● Could have a paradoxical effect (children are more sensitive)
What are the potential adverse effects of Alprazolam in elderly patients?
● Fall Hazard
● Ataxia
● Oversedation
What are important educational points to share with patients regarding sleeping pills?
Shouldn’t use every night (dependency risk)
● Eszopiclone (1 year use)
○ First hypnotic for long term use
○ Don’t use with older pts and children
○ Don’t take after high fat meal
○ Lower dose when taking other drugs that inhibit CYP3A4 enzymes
○ Unpleasant Taste
● Zolpidem- Ambien (up to 10 days only, similar to Benzos)
○ Sleepwalking is common
○ Anterograde Amnesia
○ Don’t use in pts with depression
○ Rebound insomnia
What are the names of two muscle relaxants?
● Baclofen (intense muscle spasms)
○ Urinary frequency
○ Hypotension
○ Hyperglycemia
○ Start with small doses and increase
● Cyclobenzaprine hydrochloride (Flexeril- light muscle spasms)
○ Don’t use in pts with MI, HF, dysrhythmia, hyperthyroidism
○ Dry mouth, Urinary retention, Constipation, Tachycardia, don’t use more than 2-3 weeks
● Dantrolene (straight to PNS)
What are the most common adverse effects of muscle relaxants?
, ● CNS changes (dizziness, drowsiness, confusion)
● Muscle Weakness
● Adverse effects resolve once PTs tolerate it
What nursing considerations are important when taking care of a patient receiving muscle relaxants?
● Safety Concerns, High Fall Risk (especially elderly)
Why/ How do you use Baclofen?
● 1st dose is intrathecal injection (2nd dose of Intrathecal is 48 hrs. before pump)
● Used for lower back pain/ muscle spasms
How is the drug Baclofen administered?
● PO
● Intrathecal Pump
What are potential adverse reactions of Baclofen?
● CNS changes, Hypotension, Hyperglycemia, Respiratory/Cardiac Depression
What are important teaching points to share with a patient taking Cyclobenzaprine?
● Do not use more than 2-3 weeks
CNS Stimulants
What disorders are treated with amphetamines?
● ADHD & Narcolepsy
What are the names of 4 amphetamines?
● Dextroamphetamine (Dexedrine)
● Dextroamphetamine/Amphetamine (Adderall)
● Lisdexamfetamine (Vyvanse)
● Methamphetamine (Ritalin)
What is Methylphenidate (Ritalin) used to treat?
● A non-amphetamine (once a day drug, can last all day)
● ADHD, Narcolepsy
● Schedule 4
What are the potential adverse effects of amphetamines?
● Speeds up all your systems (Cardiac, GI, CNS)
● Tachycardia, Abuse Risk, Weight Loss, Insomnia
What patients should not take amphetamines?
● Cardiac Disorders, Hx of drug abuse, Anorexia, Pregnancy, Anxiety
What drugs and herbs interact with amphetamines and how?
What do CNS depressants bind too?
● Bind to GABA receptors
● GABA: Endogenous neurotransmitters that can excite and inhibit
What are the main indications for Benzodiazepines? -PAM
● Adults: Anxiety, Sleep Aids (sedation), CNS depressants (seizures)
● Children: Sleepwalking/Night terrors
How are Benzodiazepines used in the clinical setting?
● Sedation, treat anxiety and insomnia
Why do you wean off Benzodiazepines?
● Dependency Potential, Withdrawal Symptoms & Fast Relapse
What schedule drug are Benzodiazepines?
● Schedule 4
What are the names of 3 long-acting Benzos? (duration of action is longer)
● Chlordiazepoxide (Librium)
● Diazepam (Valium) (Duration: 12-24hr)
● Clonazepam (Klonopin)
What are the names of 3 intermediate acting Benzos? (for acute situations)
● Lorazepam (Ativan)
● Alprazolam (Xanax)
● Temazepam (Restoril)
What are the names of 2 short acting Benzos?
● Midazolam (Versed) (pre-op anxiety)
● Triazolam (Halcion)
What are the names of 4 Sleeping pills? (Everyone Requires So Much Sleep -zzz)
● Eszopiclone (Lunesta)
● Ramelteon (Sleep induction rather than sleep maintenance)
● Suvorexant
● Modafinil (Narcolepsy only, 2 months for therapeutic level affects)
● Zolpidem (Ambien)
What population of patients should not take Benzos?
● Pregnant Women & Narrow-Angle Glaucoma
What are potential adverse effects of Benzos?
● CNS changes (dizziness, confusion, fatigue, drowsiness/ “hangover”) OD with alcohol,
Dependency Potential, Fall Hazard, Withdrawal (if abruptly stopped)
Why is important not to give patients on Benzos other CNS depressants?
, ● Too much sedation causing OVERDOSE
What are symptoms a nurse would see in a patient who overdosed on Benzos?
● Dilated Pupils (Mydriasis), Coma, Confusion, Hypoventilation
What drug is used to treat a patient who overdosed on Benzos and how does it work?
● Flumazenil, reverses respiratory depression (GABA antagonist)
What are patient educations points that should be shared with patients taking Benzos?
● Don’t take with CNS depressants
● Don’t stop abruptly (wean off)
● Makes you drowsy (no driving, lifting, high-intensity activities)
What is a potential adverse effect of Valium in children?
● Could have a paradoxical effect (children are more sensitive)
What are the potential adverse effects of Alprazolam in elderly patients?
● Fall Hazard
● Ataxia
● Oversedation
What are important educational points to share with patients regarding sleeping pills?
Shouldn’t use every night (dependency risk)
● Eszopiclone (1 year use)
○ First hypnotic for long term use
○ Don’t use with older pts and children
○ Don’t take after high fat meal
○ Lower dose when taking other drugs that inhibit CYP3A4 enzymes
○ Unpleasant Taste
● Zolpidem- Ambien (up to 10 days only, similar to Benzos)
○ Sleepwalking is common
○ Anterograde Amnesia
○ Don’t use in pts with depression
○ Rebound insomnia
What are the names of two muscle relaxants?
● Baclofen (intense muscle spasms)
○ Urinary frequency
○ Hypotension
○ Hyperglycemia
○ Start with small doses and increase
● Cyclobenzaprine hydrochloride (Flexeril- light muscle spasms)
○ Don’t use in pts with MI, HF, dysrhythmia, hyperthyroidism
○ Dry mouth, Urinary retention, Constipation, Tachycardia, don’t use more than 2-3 weeks
● Dantrolene (straight to PNS)
What are the most common adverse effects of muscle relaxants?
, ● CNS changes (dizziness, drowsiness, confusion)
● Muscle Weakness
● Adverse effects resolve once PTs tolerate it
What nursing considerations are important when taking care of a patient receiving muscle relaxants?
● Safety Concerns, High Fall Risk (especially elderly)
Why/ How do you use Baclofen?
● 1st dose is intrathecal injection (2nd dose of Intrathecal is 48 hrs. before pump)
● Used for lower back pain/ muscle spasms
How is the drug Baclofen administered?
● PO
● Intrathecal Pump
What are potential adverse reactions of Baclofen?
● CNS changes, Hypotension, Hyperglycemia, Respiratory/Cardiac Depression
What are important teaching points to share with a patient taking Cyclobenzaprine?
● Do not use more than 2-3 weeks
CNS Stimulants
What disorders are treated with amphetamines?
● ADHD & Narcolepsy
What are the names of 4 amphetamines?
● Dextroamphetamine (Dexedrine)
● Dextroamphetamine/Amphetamine (Adderall)
● Lisdexamfetamine (Vyvanse)
● Methamphetamine (Ritalin)
What is Methylphenidate (Ritalin) used to treat?
● A non-amphetamine (once a day drug, can last all day)
● ADHD, Narcolepsy
● Schedule 4
What are the potential adverse effects of amphetamines?
● Speeds up all your systems (Cardiac, GI, CNS)
● Tachycardia, Abuse Risk, Weight Loss, Insomnia
What patients should not take amphetamines?
● Cardiac Disorders, Hx of drug abuse, Anorexia, Pregnancy, Anxiety
What drugs and herbs interact with amphetamines and how?
