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)
, MOA: short acting non-benzodiazepine hypnotic
Caution:
- controlled release (CR): approved for long term use but can cause somnambulation
(sleep walking)
- allow 8 hours of sleep
Adverse effect: fall risk in older adults
Interactions:
- alcohol
- other CNS depressants
ramelteon (Rozerem)
MOA:
- similar to melatonin
- no dependency risk
Caution:
- take 30 minutes before bed
- contraindicated in severe liver dysfunction
Adverse effects:
- hormonal --> amenorrhea, decreased libido, infertility, and galactorrhea (nipple
discharge)
Interactions:
- high fat meals delay absorption --> so take on an empty stomach
Muscle Relaxants
Examples:
- cyclobenzaprine (Flexeril)
- baclofen (Lioresal)
MOA:
- work within CNS
- muscle relaxant effects r/t CNS depressant activity
- work best when used along with physical therapy
Indications:
- muscle spasm r/t muscle injury
- management of spasticity in chronic disorders (MS and cerebral palsy)
- malignant hyperthermia
Contraindication: severe renal impairment
Adverse effects:
- extension of effects on CNS and skeletal muscles --> euphoria, lightheadedness,
dizziness, drowsiness, fatigue, muscle weakness, nausea, constipation, and urinary
retention
- serious: seizures (from baclofen)
Interactions:
- other CNS depressants (alcohol and benzos) can cause confusion, anxiety, tremors,
and additive hypoglycemia
to decrease pain when paired with therapy
What is the goal of muscle relaxant drugs?
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)
, MOA: short acting non-benzodiazepine hypnotic
Caution:
- controlled release (CR): approved for long term use but can cause somnambulation
(sleep walking)
- allow 8 hours of sleep
Adverse effect: fall risk in older adults
Interactions:
- alcohol
- other CNS depressants
ramelteon (Rozerem)
MOA:
- similar to melatonin
- no dependency risk
Caution:
- take 30 minutes before bed
- contraindicated in severe liver dysfunction
Adverse effects:
- hormonal --> amenorrhea, decreased libido, infertility, and galactorrhea (nipple
discharge)
Interactions:
- high fat meals delay absorption --> so take on an empty stomach
Muscle Relaxants
Examples:
- cyclobenzaprine (Flexeril)
- baclofen (Lioresal)
MOA:
- work within CNS
- muscle relaxant effects r/t CNS depressant activity
- work best when used along with physical therapy
Indications:
- muscle spasm r/t muscle injury
- management of spasticity in chronic disorders (MS and cerebral palsy)
- malignant hyperthermia
Contraindication: severe renal impairment
Adverse effects:
- extension of effects on CNS and skeletal muscles --> euphoria, lightheadedness,
dizziness, drowsiness, fatigue, muscle weakness, nausea, constipation, and urinary
retention
- serious: seizures (from baclofen)
Interactions:
- other CNS depressants (alcohol and benzos) can cause confusion, anxiety, tremors,
and additive hypoglycemia
to decrease pain when paired with therapy
What is the goal of muscle relaxant drugs?
