NR293 exam 3, Latest 2022.

airway, breathing, and circulation ** requires frequent and close observation of the patient at all times What is the priority of general, moderate, and local anesthetics? No. Only general and moderate cause amnesia.  Do local anesthetics cause amnesia?  They paralyze the muscles. They DO NOT provide sedation/analgesia.  What do neuromuscular blocking drugs do?  1. Barbiturates 2. Benzodiazepines 3. Miscellaneous drugs  ** muscle relaxants are also CNS depressants  What are the 3 main groups of CNS depressants?  it is a drug that causes sleep What is a hypnotic drug?  High doses calm the CNS to the point of causing sleep. Low doses calm the CNS without causing sleep.  Do high doses of sedative-hypnotics cause sleep? How about low doses?  Benzodiazepines  "zepam" and "zolam" Examples: - midazolam (Versed) - alprazolam (Xanax) - diazepam (Valium) - lorazepam (Ativan)  MOA: reduces neural excitability  Indications: - relief of anxiety, agitation, and insomnia - treatment of alcohol withdrawal and acute seizure disorders (seizures that won't stop) - balanced anesthesia Contraindications: - allergy - pregnancy - narrow angled glaucoma - sleep apnea - respiratory depression Caution:  - older adults - substance use disroder - mental illness - liver disease  Adverse effects: - CNS depression -- sedation, drowsiness, lethargy, cognitive impairment, amnesia, headache, dizziness, and vertigo  - “hangover” effect (daytime sleepiness) - fall hazard in elderly - withdrawal effects Antidote: flumazenil (Romazicon) Nursing implications: - withdrawal effects can occur if stopped abruptly (taper down on medication)  - addicting; can cause dependency  - don't take with alcohol or other CNS depressants  BBW: benzos + opioids = profound sedation Barbiturates  Example: - phenobarbital (Ancalixir)  MOA: reduce nerve impulses to the cerebral cortex (depress the activity of the CNS); cause memory and judgment impairment Indications: - sedation - seizures  Contraindications:  - respiratory difficulty - severe kidney/liver disease - pregnancy  Adverse effects: - drowsiness, lethargy, dizziness, paradoxical effects, hangover, REM rebound  - increased risk of falls in elderly  Interactions: - enzyme inducer -- drugs metabolize faster - lunesta (Eszopicolone) - zolpidem / zolpidem CR (Ambien) - ramelteon (Rozerem)  What are the 3 miscellaneous drugs for insomnia in the CNS depressant category?  lunesta (eszopiclone) MOA: hypnotic  Caution:  - must allow 8 hours of sleep time - older adults Interactions:  - alcohol  - other CNS depressants  zolpidem (Ambien)