MOA Effects Drug Class Adverse Effects Monitoring CNS Depressants Benzodiazepines - (-zepam) (-zolam) - [lorazepam] Intensify GABA (bind to benzodiazepine receptors on a GABA receptor As the dose increase: anxiolytic effects → anticonvulsant effects → a reduction in muscle tonus → sedation and hypnosis Indicated for: Short term insomnia, GAD, controlling seizures, alcohol withdrawal, muscle relaxation, pre-anesthesia - Barbiturates - (-barbital) - Hypnotic/Sedative - - [Melatonin] - Dependence and tolerance Drowsiness Sedation Memory loss Weakness Disorientation Ataxia Sleep disturbances Hypotension Blurred/double vison Nausea and vomiting - Respirations BP LOC Muscle tone GI status Vision Changes Cognitive Changes Enhance GABA (bind to barbiturate receptor on GABA receptor) Low doses reduce anxiety Moderate doses promote sleep and have anticonvulsant activity (rarely prescribed anymore for anxiety or insomnia because of side effects) Use benzodiazepine receptor to potentiate GABA – but much more specific (GABA1) Only cause sedation (no anxiolytic or anticonvulsant properties Short term use preferred [zopiclone] Miscellaneous - Can act on any neurotransmitter Any drug that causes sedation can potentially use to induce or prolong sleep (even if it is an adverse effect) Includes antihistamines such as diphenhydramine, dimenhydrinate, or hydroxyzine - Significant dependence and Tolerance Dizziness Headache Daytime drowsiness Dyspepsia Dry mouth Bitter metallic taste (zopliclone) Nausea Anterograde amnesia - LOC Presence of side effects Daytime drowsiness level Appropriate use Memory changes GI status Drug choice depends on the pharmacokinetic characteristics (onset and duration of action) ** Caution with other CNS depressants** Anything that inhibits brain activity will have an additive effect - Aren’t as good for anxiety or seizures Good for convulsions - Must be tapered off if used long term Respirations and BP not likely necessary to monitor CNS depressant CAUTION Elderly and very young (more sensitive and unpredictable response) Pregnancy Suicidal potential Impaired renal or liver function Hazardous activities, or ability to manage daytime drowsiness? Other CNS depressants?