CNS Depressants PDF

Chapter 12 Central Nervous System Depressants and Muscle Relaxants CNS 2 Depressants Sedatives Drugs that have an inhibitory e3ect on the CNS to the degree that they reduce: Nervousness Excitability Irritability CNS Depressants 3 (Cont.)...

Chapter 12 Central Nervous System Depressants and Muscle Relaxants CNS 2 Depressants Sedatives Drugs that have an inhibitory e3ect on the CNS to the degree that they reduce: Nervousness Excitability Irritability CNS Depressants 3 (Cont.) Hypnotics Cause sleep Much more potent e2ect on CNS than sedatives A sedative can become a hypnotic if it is given in large enough doses.  4 CNS Depressants (Cont.) Sedative-hypnotics: dose dependent At low doses, calm the CNS without inducing sleep. At high doses, calm the CNS to the point of causing sleep. Classi=ed into three main groups: Barbiturates Benzodiazepines Miscellaneous drugs 5 CNS Depressants: Benzodiazepines Formerly the most commonly prescribed sedative-hypnotic drugs Nonbenzodiazepines are currently more frequently prescribed. Favorable adverse ecacy in treating both positive and negative symptoms.  Psychotic illness, most commonly 7 Antipsychoti 4 c Drugs schizophrenia Indications Anxiety and mood disorders  Agranulocytosis and hemolytic anemia Drowsiness 7 Antipsychoti 5 c Drugs Adverse EPS E4ects Involuntary muscle symptoms similar to those of Parkinson’s disease Akathisia (distressing muscle restlessness) Acute dystonia (painful muscle spasms) Treated with benztropine (Cogentin) and trihexyphenidyl (Artane) https://youtu.be/2xfu-d_aYWs  7 6 Antipsychotic Drugs Adverse E4ects Con’t Tardive dyskinesia (TD) Involuntary contractions of oral and facial muscles Choreoathetosis (wavelike movements of extremities) Occurs with continuous long-term antipsychotic therapy Valbenazine (Ingrezza) used to treat tardive dyskinesia in adults https://youtu.be/FUr8ltXh1Pc Metabolic Syndrome  Indications: long-term treatment of psychosis Contraindications: hypersensitivity, Parkinson’s disease, and in patients 7 Haloperidol taking large amounts of CNS 7 (Haldol) depressants Oral, intramuscular, intravenous Useful in treating patients with schizophrenia who were nonadherent with their drug regimen  7 8 Atypical Antipsychotics Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Aripiprazole (Abilify)  7 9 Atypical Antipsychotics Mechanism of Action Block speci;c Also block speci;c Advantageous dopamine receptors: serotonin receptors: properties over conventional drugs dopamine-2 (D2) serotonin 2 (5-HT2) receptors receptors This is responsible for their improved eFcacy and safety pro;les.  8 0 Risperidone (Risperdal) Adverse e>ects: Indication: minimal EPS at schizophrenia, therapeutic including negative dosages of 1 to 6 symptoms mg/day Risperdal Consta: long-acting Invega Sustenna: injectable form; long-acting lasts injection; lasts approximately 2 1 month weeks  8 1 Antipsychotics: Nursing Implications Assessment perform and document a thorough nursing history and mental status examination CV, cerebrovascular, neurologic, GI, GU, renal, hepatic, and hematologic functioning Weight gain may occur Suicidal ideation, orthostatic changes in BP, EPS, confusion, headache, GI upset, abnormal muscle movements, rashes, and dry mouth Drug interactions Avoid alcohol and other CNS depressants with these medications. Long-term haloperidol therapy- EPS Monitor liver and renal function studies, CBC, and UA before and during therapy. May cause drowsiness, dizziness, or fainting; change positions slowly. Therapeutic Outcomes For antipsychotics Improved mood and aOect Alleviation of psychotic symptoms and episodes Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope Chapter 17 Substance Use Disorder  A.ects people of all ages, sexes, ethnic, and socioeconomic groups 8 Substance 3 Abuse Leads to: Physical dependence Psychologic dependence Habituation Addiction Commonly Abused 8 4 Substances Opioids: Synthetic versions of pain- relieving substances Heroin: One of the most commonly abused opioids Codeine Hydrocodone Hydromorphone Morphine Oxycodone Copyright © 2020 Elsevier Inc. All Rights Reserved.  8 5 Also known as narcotics Bind to speci9c opioid pain receptors in brain and cause an analgesic response, the Opioids: reduction of pain sensation Mechanism The ability to produce of Action euphoria is one reason for potential of abuse. ECects primary centered in CNS  8 6 Intended drug e4ects of opioids: Relieve pain Reduce cough Relieve diarrhea Induce anesthesia Opioids: Certain opioid drugs are used to Indication treat opioid dependence. s Methadone Goal Relapse rates are often high; the drug can be abused.  8 7 CNS: Diuresis Miosis Convulsions Nausea, vomiting Opioids: Respiratory depress Adverse Non-CNS: E.ects Hypotension Constipation Urinary retention Flushing Urticaria/pruritus  8 8 Opioid: Drug Withdrawal Peak period: 1 to 3 days Duration: 5 to 7 days Signs/Symptoms Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, elevated blood pressure (BP), and pulse, muscle cramps, arthralgia, anxiety,n/v/d, yawning, insomnia  8 9 Many patients require a formal detoxi?cation program. Management Most common cause of of death with opioids is Withdrawal, respiratory depression. Toxicity, and Naloxone is an opioid Overdose antagonist used in opioid overdose. Now standard with ?rst responders  9 0 Relapse Prevention Naltrexone Works by blocking the opioid receptors so that the use of opioid drugs do not produce euphoria Must be 1 week free from opioids to begin this therapy  9 1 More accurately known as ethanol (ETOH) Causes CNS depression by dissolving in lipid membranes in the CNS Few legitimate uses of ethanol Alcohol and alcoholic beverages (Ethanol) Used as a solvent for many drugs Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution)  CNS depression Respiratory stimulation or depression 9 Ethanol: 2 Vasodilation, producing Drug warm, @ushed skin E.ects Increased sweating Diuretic e.ects  9 3 Nutritional and vitamin de/ciencies (especially B vitamins) Wernicke’s encephalopathy E"ects of Korsako"’s psychosis Chronic Polyneuritis Nicotinic acid deDciency Ethanol encephalopathy Ingestion Seizures Alcoholic hepatitis, progressing to cirrhosis Cardiomyopathy  9 4 Fetal alcohol syndrome E"ects of (FAS) Chronic Craniofacial Ethanol abnormalities Ingestion CNS dysfunction (Cont.) Prenatal and postnatal growth retardation  9 5 Intensi'es sedative e,ects of medications that work in the CNS Alcohol Interacts with antibiotic Interaction metronidazole s Hepatotoxicity with acetaminophen Increase bioavailability of blood thinner warfarin  9 6 Ethanol Withdrawal Elevated blood Signs and symptoms pressure, pulse Insomnia Tremors Agitation rate, and temperature Classi&ed as mild, moderate, and severe  9 7 Benzodiazepines are the treatment of choice Dosage and frequency depend on severity For severe withdrawal, monitoring in an intensive care unit is recommended. Ethanol Disul