Central Nervous System Depressants

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants
Sedatives
‡ Drugs that have an inhibitory effect on the CNS to the degree that they reduce:
± Nervousness ± Excitability ± Irritability ± without causing sleep

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants
Hypnotics
‡ Calm or soothe the CNS to the point that they cause sleep

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants
Sedative-Hypnotics² Sedative-Hypnotics²dose dependent:
‡ At low doses, calm or soothe the CNS without inducing sleep ‡ At high doses, calm or soothe the CNS ‡ to the point of causing sleep

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
‡ First introduced in 1903, standard agents for insomnia and sedation ‡ Habit-forming Habit‡ Only a handful commonly used today due in part to the safety and efficacy of: BENZODIAZEPINES

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Four categories:
‡ Ultrashort
± mephobexital, thiamylal, thiopental

‡ Short
± pentobarbital, secobarbital

‡ Intermediate
± aprobarbital, butabarbital

‡ Long
± phenobarbital
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Barbiturates have a very narrow therapeutic index.

Therapeutic Index
‡ Dosage range within which the drug is effective but above which is rapidly toxic.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Mechanism of Action
‡ Site of action: ± Brain stem (reticular formation) ± Cerebral cortex ‡ By inhibiting GABA, nerve impulses traveling in the cerebral cortex are also inhibited.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Drug Effects
‡ Low doses: Sedative effects

‡ High doses:

Hypnotic effects (also lowers respiratory rate)

Notorious enzyme inducers

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Therapeutic Uses
‡ Hypnotics ‡ Sedatives ‡ Anticonvulsants ‡ Surgical procedures

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Side Effects Body System
CNS

Effects
Drowsiness, lethargy, vertigo mental depression, coma Respiratory depression, apnea, bronchospasms, cough

Respiratory

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Side Effects Body System
GI Other

Effects
Nausea, vomiting, diarrhea Agranulocytosis, vasodilation, hypotension, StevensStevens-Johnson syndrome

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Toxicology
‡ Overdose frequently leads to respiratory depression, and subsequently, respiratory arrest. ‡ Can be therapeutic: ± Anesthesia induction ± Uncontrollable seizures: ³phenobarbital coma´

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

SedativeSedative-Hypnotics: Barbiturates
Drug Interactions
‡ Additive effects: ± ETOH, antihistamines, benzodiazepines, narcotics, tranquilizers ‡ Inhibited metabolism: ± MAOIs will prolong effects of barbiturates ‡ Increased metabolism: ± Reduces anticoagulant response, leading to possible clot formation
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Most frequently prescribed sedative-hypnotics sedative‡ Most commonly prescribed drug classes ‡ Favorable side effects ‡ Efficacy ‡ Safety

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Classified as either: ‡ Sedative-hypnotic or Anxiolytic Sedative(Medication that relieves anxiety)

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
SedativeSedative-Hypnotic Type
‡ Long-Acting: Long± flurazepam (Dalmane), quazepam (Doral) ‡ Short-Acting: Short± estazolam (Prosom), temazepam (Restoril), ± triazolam (Halcion)

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Anxiolytic Type
‡ alprazolam (Xanax) ‡ chloridiazepoxide (Librium) ‡ diazepam (Valium) ‡ lorazepam (Ativan) ‡ midazolam (Versed)
zolpidem (Ambien) and zaleplon (Sonata) (nonbenzodiazepine hypnotic agents, share characteristics)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Mechanism of Action
‡ Depress CNS activity ‡ Affect hypothalamic, thalamic, and limbic systems of the brain ‡ Benzodiazepine receptors

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Drug Effects ‡ Calming effect on the CNS ‡ Useful in controlling agitation and anxiety

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Therapeutic Uses
‡ Sedation ‡ Sleep induction ‡ Skeletal muscle relaxation ‡ Anxiety relief ‡ Treatment of alcohol withdrawal ‡ Agitation ‡ Depression ‡ Epilepsy ‡ Balanced anesthesia
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Benzodiazepines
Side Effects ‡ Mild and infrequent
Headache Drowsiness Dizziness Vertigo Lethargy Paradoxical excitement ³Hangover effect´

(nervousness)

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Nursing Implications
‡ Before beginning therapy, perform a thorough history regarding allergies, use of other medications,health history, and medical history. ‡ Obtain baseline vital signs and I & O, including supine and erect BPs. ‡ Assess for potential disorders or conditions that may be contraindications, and for potential drug interactions.
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Nursing Implications
‡ Give 15 to 30 minutes before bedtime for maximum effectiveness in inducing sleep. ‡ Most benzodiazepines (except flurazepam) cause REM rebound and a tired feeling the next day; use with caution in the elderly. ‡ Patients should be instructed to avoid alcohol and other CNS depressants.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Nursing Implications
‡ Check with physician before taking any other medications, including OTC medications. ‡ It may take 2 to 3 weeks to notice improved sleep when taking barbiturates. ‡ Abruptly stopping these medications, especially barbiturates, may cause rebound insomnia.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Nursing Implications
‡ Safety is important
± Keep side rails up ± Do not permit smoking ± Assist patient with ambulation (especially the elderly) ± Keep call light within reach

‡ Monitor for side effects
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

CNS Depressants: Nursing Implications
‡ Monitor for therapeutic effects
± Increased ability to sleep at night ± Fewer awakenings ± Shorter sleep induction time ± Few side effects, such as hangover effects ± Improved sense of well-being because of wellimproved sleep

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Sign up to vote on this title
UsefulNot useful