Week 6 Concepts: Intracranial Regulation
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:
,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.
,Sedative-hypnotics
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.
methohexital and thiopental pentobarbital and secobarbital butabarbital phenobarbital and
mephobarbital
Use induction of anesthesia prevent hyperbilirubinemia in neonates sedation prevention of seizures
Sedative-hypnotics
Match the sedative-hypnotic CNS Depressant medication to its subclass.
,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
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:
,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.
,Sedative-hypnotics
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.
methohexital and thiopental pentobarbital and secobarbital butabarbital phenobarbital and
mephobarbital
Use induction of anesthesia prevent hyperbilirubinemia in neonates sedation prevention of seizures
Sedative-hypnotics
Match the sedative-hypnotic CNS Depressant medication to its subclass.
,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
