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Questions and Answers

What is the primary reason for limiting the duration of hypnotic drug therapy?

To enhance sleep quality over time

To decrease withdrawal symptoms

To prevent drug dependence and tolerance (correct)

To manage longer-term insomnia effectively

Which of the following side effects may occur from abruptly discontinuing a high dosage of a hypnotic?

Enhanced daytime alertness

Increased sleep efficiency

Improved mental clarity

Agitation and trembling (correct)

What distinguishes short-acting hypnotics from intermediate-acting hypnotics?

Their potential for causing nightmares

Their impact on anxiety levels

Their effectiveness duration (correct)

The dosage recommended for insomnia

Which of the following is a possible effect of barbiturates when used for sedation induction?

Worsening of sleep-related disorders Signup and view all the answers

Which type of hypnotic is characterized by causing residual drowsiness or hangover in the morning?

Intermediate-acting hypnotics Signup and view all the answers

Which of the following is a common side effect of high dosages of sedative-hypnotic medications?

Hypotension Signup and view all the answers

Why are barbiturates no longer accepted for use in older adults with insomnia?

They can cause ataxia and confusion Signup and view all the answers

What is a significant risk associated with the use of benzodiazepines as hypnotics?

They may lead to sleep-related behaviors Signup and view all the answers

Which drug is prescribed primarily for ADHD and may cause sudden death in patients with structural cardiac abnormalities?

Dexmethylphenidate HCL Signup and view all the answers

What is the primary therapeutic indication for analeptics?

Respiratory stimulation Signup and view all the answers

Which of the following is NOT a common side effect associated with the use of modafinil?

Weight gain Signup and view all the answers

Benzphetamine HCL is primarily used for which purpose?

Short-term treatment for obesity Signup and view all the answers

What potential cardiovascular side effect is associated with appetite suppressants?

Hypertension Signup and view all the answers

Which condition is a contraindication for the use of anorexiants?

Hyperthyroidism Signup and view all the answers

Which of the following CNS depressant classes primarily functions to reduce pain?

Analgesics Signup and view all the answers

Which side effect is common with both caffeine citrate and theophylline?

Tachycardia Signup and view all the answers

What is the primary purpose of a saddle block in anesthesia?

To block sensation in the lower end of the spinal column Signup and view all the answers

Which stage of anesthesia is characterized by confusion, excitement, and shortened induction time?

Excitement or delirium Signup and view all the answers

What is a significant contraindication of Halothane usage in anesthesia?

It is contraindicated in obstetrics Signup and view all the answers

What is a common use for Sevoflurane in anesthesia?

For induction and maintenance during surgery Signup and view all the answers

What effect can Desflurane have following its administration?

Rapid recovery with hypotension Signup and view all the answers

Which intravenous anesthetic is noted for causing conscious sedation but should be avoided in patients with cardiopulmonary disorders?

Midazolam Signup and view all the answers

Which inhalation anesthetic can cause hypotension and respiratory depression?

Desflurane Signup and view all the answers

What is the primary drawback of using nitrous oxide as an inhalation anesthetic?

It must be administered with a mixture of oxygen Signup and view all the answers

Which of the following side effects is NOT associated with Remifentanil?

Pulmonary edema Signup and view all the answers

What is a primary feature of balanced anesthesia?

A combination of drugs to minimize the amount of general anesthetics needed Signup and view all the answers

What is the primary therapeutic use of Ramelteon?

Chronic insomnia Signup and view all the answers

Which of the following is an example of a short-acting local anesthetic?

Procaine hydrochloride (Novocain) Signup and view all the answers

What should be avoided when administering Eszopiclone?

High fat meals Signup and view all the answers

Which of the following sedative-hypnotics is classified as a controlled substance?

Zolpidem Signup and view all the answers

What distinguishes intravenous anesthesia from other methods?

It has a rapid onset and short duration of action Signup and view all the answers

Where is spinal anesthesia commonly injected?

In the subarachnoid space at the 3rd or 4th lumbar space Signup and view all the answers

Which of the following actions is recommended for patients taking Zolpidem?

Avoid taking it long term Signup and view all the answers

What life-threatening effect could occur with Zolpidem usage?

Renal failure Signup and view all the answers

Which anesthetic would be classified as having a long duration of action?

Etidocaine (Duranest) Signup and view all the answers

Eszopiclone primarily works by acting on which part of the central nervous system?

Melatonin receptors Signup and view all the answers

What is the purpose of topical anesthetics?

To block pain at the site of administration while maintaining consciousness Signup and view all the answers

In case of Zolpidem overdose, which treatment is recommended?

Activated charcoal Signup and view all the answers

Which type of block is characterized by the anesthetic being placed in the outer covering of the spinal cord?

Epidural block Signup and view all the answers

Which of the following statements about inhalation anesthetics is true?

Nitrous oxide was the first anesthetic used in the 1800s. Signup and view all the answers

Study Notes

CNS Stimulants

May cause euphoria, confusion, anorexia, abdominal pain, weight loss, growth suppression, palpitations, tachycardia, high blood pressure, and erectile dysfunction.
Modafinil is used for narcolepsy, ADHD, shift work sleep disorder, and sleep apnea.
Modafinil may cause headache, dizziness, anxiety, anorexia, dry mouth, insomnia, rhinitis, and back pain.
Dexmethylphenidate HCL is used for ADHD.
Dexmethylphenidate HCL may cause dizziness, restlessness, anxiety, anorexia, nausea, dry mouth, abdominal pain, and nasal congestion.
Dexmethylphenidate HCL may cause sudden death in patients with structural cardiac abnormalities.
Pitolisant is used for excessive daytime sleepiness associated with narcolepsy.
Pitolisant may cause headache, anxiety, nausea, infection, and musculoskeletal pain.

Analeptics

Stimulate the brainstem, spinal cord, and cerebral cortex.
Primarily used to stimulate respiration.
May cause restlessness, tremors, palpitations, tachycardia, insomnia, GI irritation, and urinary frequency.

Anorexiants

Stimulate the hypothalamic and limbic regions of the brain to suppress appetite.
Long-term use may cause severe side effects such as euphoria, restlessness, palpitations, tachycardia, erectile dysfunction, and high blood pressure.
Contraindicated in patients with high blood pressure, hyperthyroidism, glaucoma, within 14 days of MAOI therapy, and children below 12 years old.

Anorexiant Medications

Benzphetamine HCL: short-term treatment (8-12 weeks) for obesity, may cause dizziness, restlessness, headache, insomnia, dry mouth, and dysgeusia.
Naltrexone HCL/bupropion HCL: used short-term for obesity, may cause headache, dizziness, insomnia, vomiting, suicidal ideation, high blood pressure, and erectile dysfunction.
Caffeine citrate (methylxanthines): used for neonatal apnea and mental alertness, may cause headache, insomnia, nausea, tachycardia, palpitations, and urinary frequency.
Theophylline: used for airway obstruction and bronchospasm prophylaxis, may cause headache, insomnia, vomiting, seizure, dysrhythmia, hypokalemia, hypercalcemia, and tachycardia.

CNS Depressants

Cause varying degrees of depression (reduction in functional activity) within the CNS.
Broad classifications:
- Sedative-hypnotics
- General & Local Anesthetics
- Analgesics
- Anticonvulsants
- Antipsychotics
- Antidepressants

Sedative-Hypnotics

Commonly ordered for the treatment of sleep disorders.
Sedation diminishes physical and mental responses at lower dosages but does not affect consciousness.
Increasing the dosage of sedative-hypnotics can cause hypnotic effects (form of natural sleep).
Hypnotic drug therapy should usually be short-term to prevent drug dependence and tolerance.
Abruptly discontinuing a high-dose hypnotic can cause withdrawal symptoms:
- Trembling & tremors
- Muscle pain or aches
- Hunger or loss of appetite
- Fatigue
- Sweating
- Irritability & agitation
- Depression
- Anxiety
- Nausea
- Vomiting
- Confusion
- Paranoia
- Seizures
- Dilated pupils

Types of Sedative-Hypnotics

Short-Acting Hypnotics: useful in achieving sleep because they allow clients to awaken early in the morning without experiencing lingering side effects.
Intermediate Acting Hypnotics: useful for sustaining sleep, however, the client may experience residual drowsiness or hangover in the morning.

Categories of Sedative-Hypnotics

Barbiturates
Benzodiazepines
Nonbenzodiazepines

Barbiturates

Short acting: Secobarbital Sodium – for sedation induction and insomnia, effectiveness is lost within 2 weeks, may cause confusion, drowsiness, constipation, withdrawal, sleep-related behaviors, nightmares, and suicidal ideation.
Intermediate acting: Butabarbital Sodium – to manage anxiety, sedation induction, and insomnia, use short term and avoid alcohol with all barbiturates, may cause ataxia, drowsiness, sleep-related disorders, agitation, hypotension, depression, and angioedema. This drug is no longer accepted for use in older adults or debilitated adult patients with insomnia.
Long acting: Phenobarbital – used for seizure control, sedation induction, and insomnia, may cause ataxia, depression, bradycardia, hypotension, dizziness, confusion, drowsiness, and impaired judgment. Monitor for respiratory depression.

Opioid Agonists

Remifentanil: used for general anesthesia and maintenance and moderate to severe pain, may cause dizziness, pruritus, confusion, chest wall rigidity, bradycardia, and dysrhythmia.

Nonbenzodiazepines

Zolpidem (Ambien): a non-benzodiazepine that differs in chemical structure from benzodiazepines, used for short-term treatment.
Ramelteon: newest category of sedative-hypnotics, a melatonin agonist for sleep disorders, not classified as a controlled substance and it acts by selectively targeting melatonin receptors to regulate circadian rhythms, the only major sedative hypnotic approved for treating chronic insomnia.
Circadian rhythm: the 24-hour internal clock in the brain that regulates the cycle of alertness & sleepiness by responding to light changes in our environment.

Zolpidem (Ambien)

Used for adequate sleep.
Best taken 30 minutes to 1 hour before bedtime.
Do not take it long-term.
Side effects: drowsiness, blurred vision, lethargy, headache, palpitations.
Adverse effects: leukopenia & granulocytopenia (low WBC).
Life-threatening effects: pulmonary edema, renal failure.
Avoid driving and alcohol.
Take small frequent feedings.
Activated charcoal is used to treat overdose.
Check: ALT, AST (tests in assessing liver).

Eszopiclone (Lunesta)

Treatment for insomnia.
Increased sleep duration and decreased nocturnal awakening due to the hypnotic effect from CNS depression.
Best administered immediately before bedtime.
Do not give with or immediately following a high-fat or heavy meal.
Advise against alcohol intake; instruct the patient to have at least 8 hours allotted for sleep before the start of daily activity.
Side effects: unpleasant taste and headache.
Report worsening insomnia that persists for more than 7-10 days.
Presence of abnormal thoughts or behavior, memory loss, or anxiety.

Anesthetics

Used to prevent pain during surgery and other procedures.

Types of Anesthetics

General Anesthetics: depress the CNS, alleviate pain, and cause loss of consciousness
- Balanced anesthesia: a combination of drugs frequently used in general anesthesia.
  - Hypnotic given the night before surgery.
  - Premedication of narcotic analgesic to decrease secretion.
  - Short-acting barbiturate.
  - Inhaled gas & muscle relaxant as needed.
  - Because of lesser general anesthetics given, there are fewer adverse reactions.
- Inhalation Anesthetics: gas or volatile liquids administered as gas, used to deliver general anesthesia.
  - Ex: Nitrous oxide – “laughing gas”; was the first anesthetic (1800).
- Intravenous Anesthesia: for the induction stage of anesthesia, have rapid onsets & short duration of action.
  - Ex: droperidol (Innovar), ketamine hydrochloride (Ketalar).
Local Anesthetics: block pain at the site where the drug is administered, allowing consciousness to be maintained.
- Used for dental procedures, suturing skin lacerations, performing short-term (minor) surgery at a localized area, and for diagnostic procedures such as lumbar puncture and thoracentesis.
- Short acting: ½ to 1 hour; Procaine hydrochloride (Novocain).
- Moderate acting: 1 to 3 hours; Lidocaine hydrochloride (Xylocaine).
- Long acting: 3 to 10 hours; etidocaine (Duranest).
Topical Anesthetics: limited to mucous membranes, broken or unbroken skin surfaces and burns, decreases the sensitive nerve endings of the affected area.
- Could be in solution, liquid spray, ointment, cream, and gel.
- Ex: Xylocaine Gel, Lidoderm, lidocaine.

Spinal Anesthesia

local anesthetic injected in the subarachnoid space at the 3rd or 4rth lumbar space (L3 to L4).
Encourage the patient to remain flat on the bed after surgery.

Sites of Spinal Column for Anesthesia

Spinal block: the penetration of the anesthetic into the subarachnoid membrane.
Epidural block: placement of local anesthetic in the outer covering of the spinal cord, or the dura matter.
Caudal block: an epidural block placed by administering anesthetic in the sacral hiatus.
Saddle block: given at the lower end of the spinal column to block the perineal area.

Stages of Anesthesia

Analgesia: Begins with consciousness and ends with loss of consciousness, speech is difficult, sensations of smell and pain are lost, dreams and auditory visual hallucinations may occur. May be called the induction stage.
Excitement or delirium: produces a loss of consciousness caused by depression of the cerebral cortex, confusion, excitement or delirium occur and induction time is short.
Surgical: Surgical procedure is performed during this stage. As anesthesia deepens, respirations become shallower and the respiratory rate is increased.
Medullary paralysis: toxic stage of anesthesia in which respirations are lost and circulatory collapse occur, ventilatory assistance is necessary.

Inhalation Anesthetics

Halothane: Contraindicated in obstetrics, recovery is rapid, could decrease blood pressure.
Isoflurane: Frequently used in inhalation therapy, has a smooth and rapid induction of anesthesia and rapid recovery. This drug should not be used during labor because it suppresses uterine contractions. Cardiovascular effect is minimal.
Sevoflurane: For induction and maintenance during surgery. Sevoflurane may be given alone or combined with nitrous oxide.
Desflurane: Volatile anesthetic, recovery is rapid after anesthetic administration has ceased. Could cause hypotension and respiratory depression.
Inhalation gas (nitrous oxide): Must be administered at no less than a mixture of oxygen; potency is low. Recovery is rapid with minimal cardiovascular effect.

Intravenous Anesthetics

Benzodiazepines
- Diazepam: for induction of anesthesia, no analgesic effect.
- Midazolam: for induction of anesthesia and for endoscopic procedure. Can cause conscious sedation and should be avoided if cardiopulmonary disorder is present.
**Fentanyl: ** for neuroleptic analgesic used with a general anesthesia, can also be used as a pre-anesthetic drug and also used for diagnostic procedure.

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Description

This quiz covers key information regarding CNS stimulants and analeptics. It explores their uses, side effects, and important considerations for medications such as Modafinil, Dexmethylphenidate HCL, and Pitolisant. Test your understanding of these pharmacological agents and their impact on health.