2021-04-22T12:22:35+03:00[Europe/Moscow] en true When you think CNS depressants, which general term can be used to describe side effects?, What are two common herbal supplements that interfere with CNS depressants, Kava kava, Valerian, Demographics that suffer from insomnia?, Non-pharmacologic Sleep Aid, Benzodiazepines are indicated for, Benzo MOA, Benzo's are contraindicated in?, Benzodiazepines adverse effects, Benzodiazepines nomenclature, Benzodiazepines Toxicity, Benzodiazepines overdose/anesthesia, Flurazepam, Diazepam, Clonazepam, Alprazolam, Temazepam, Triazolam, Estrazolam, Benzodiazepines Interactions, Non-benzodiazepines example, Zolpidem, Non-benzodiazepines indications, Adverse Effects of non-benzodiazepines, Barbituates MOA, Barbituates indications, Barbiturates adverse effects, Barbiturate toxicity treatment, Barbiturates as a sleep aid, Assessment for Benzos and non benzos, Implementation of Benzos and non benzos, Assessment barbiturates, Implementation of barbiturates, Patient teaching with barbituates/benzos, Sedatives and the elderly, CNS Muscle relaxants, direct acting muscle relaxants, Cyclobenzaprine, Dantrolene, Amphetamines, Amphetamines are indicated for, COntraindications amphetamines, Most important amphetamine adverse effects, This should especially be monitored in children who take amphetamines or amphetamine like drugs, Interactions Amphetamines, Methylphenidate is also known as, Methylphenidate, Patient Teaching with amphetamines, Sumatriptan MOA and use, Signs of a stroke, Sumatriptan adverse effects, What is a seizure?, Post-ictal phase, seizure versus epilepsy, partial seizure, complex partial seizure, Partial simple seizure, Generalized seizures, Auras, Pregnancy and Seizures, Hydantoins, Phenytoin, Important adverse effects of phenytoin, Phenytoin interacts with, Phenytoin administration, Phenobarbital, Phenobarbital MOA, Phenobarbital administration, Phenobaribital adverse effects, Limostilbenes, Carbamazepine, Carbamazepine adverse effects, Carbamazepine administration, Valproic Acid, valproic acid contraindications, Valproic acid adverse effects, Valproic acid administration, febrile seizures, Assessment for anticonvulsants, Implementation of anticonvulsants, Patient teaching anticonvulsants, Opioid Substance abuse, Stimulant withdrawal, Depressant withdrawal, Alcohol withdrawal, Nicotine withdrawal, Parasympathetic nervous system, sympathetic nervous system, Non pharma treatment of anxiety, Benzodiazepines for anxiety, Busiprone, Busiprone interactions, affective disorders, manic phase, depressed phase of bipolar, Carbomazepine, Lithium, Li MOA, Li toxicity flashcards
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  • When you think CNS depressants, which general term can be used to describe side effects?
    "Hangover" poor judgement, amnesia, coordination loss and headache
  • What are two common herbal supplements that interfere with CNS depressants
    Kava kava and Valerian
  • Kava kava
    An herbal supplement made of dried rhizomes from Piper methysticum. Can cause discoloration of hair skin and nails with long term use. It has CNS depressing effects and is used to treat anxiety, insomnia and sometimes ADHD.
  • Valerian
    The root of contains acids that are used to treat anxiety, restlessness or sleep disorders. It is used as a CNS depressant. It interacts with most CNS depressants, MAOIs and Phenytoin.
  • Demographics that suffer from insomnia?
    Primarily women, 10-20% suffer from in the US, increases with age.
  • Non-pharmacologic Sleep Aid
    Specific sleep schedule/ritual
  • Benzodiazepines are indicated for
    insomnia, muscle spasms, anxiety, anesthesia, seizures, and status epilepticus
  • Benzo MOA
    Depress CNS- thought to stimulate GABA
  • Benzo's are contraindicated in?
    narrow angle glaucoma, allergy or pregnancy
  • Benzodiazepines adverse effects
    hangover- drowsy, lethargic confused dizzy amnesic and impaired cognitively
  • Benzodiazepines nomenclature
    They end in -pam and -lam
  • Benzodiazepines Toxicity
    More likely when used with other CNS depressants including alcohol, valerian or kava kava
  • Benzodiazepines overdose/anesthesia
    Flumazenil is antidote for overdose/ or do bring patient out of anesthesia. Not often used for general toxicity as it can cause seizures.
  • Flurazepam
    Benzodiazepine
  • Diazepam
    Benzodiazepine
  • Clonazepam
    Benzodiazepine
  • Alprazolam
    Benzodiazepine
  • Temazepam
    Benzodiazepine
  • Triazolam
    Benzodiazepine
  • Estrazolam
    Benzodiazepines
  • Benzodiazepines Interactions
    1.Alcohol and other CNS depressants.
  • Non-benzodiazepines example
    Zolpidem (Ambien)
  • Zolpidem
    Non−benzodiazepine hypnotic, acts via inhibition of the BDZ1 (omega1) neurotransmitter receptor subtype and is reversed by flumazenil; less amnesia and muscle relaxation; lower dependence liability
  • Non-benzodiazepines indications
    Indicated for use in insomniacs
  • Adverse Effects of non-benzodiazepines
    "hangover" (especially amnesic), tolerance, dependence and binge eating.
  • Barbituates MOA
    Facilitate GABA(a) action by inc duration of Cl- channel opening --> dec neuron firing
  • Barbituates indications
    insomniacs, seizure disorders, anesthetic
  • Barbiturates adverse effects
    Most life threatening: respiratory depression, hypotension
  • Barbiturate toxicity treatment
    supportive: Ventilation (mainstay airway assisted ventilation due to respiratory depression), oxygen, fluid replacement and vasopressors (counteract hypotension)
  • Barbiturates as a sleep aid
    No longer used to regularly used to treat insomniacs because of dependency and rapid development of tolerance. Not prescribed more than 2 weeks for sleep.
  • Assessment for Benzos and non benzos
    Drug history, including supplement use (kava/valerian)
  • Implementation of Benzos and non benzos
    -give at night
  • Assessment barbiturates
    -Drug history: Previous use, drugs that may interact
  • Implementation of barbiturates
    Use bed alarm for elderly or first time users
  • Patient teaching with barbituates/benzos
    don't drive, do not use or supplement other drugs with CNS depressing effects, do not stop treatment abruptly and will not take longer than 2 weeks for barbits or 3-4 weeks benzos
  • Sedatives and the elderly
    1 Identify cause of insomnia
  • CNS Muscle relaxants
    relaxes skeletal muscle via CNS stimulus; indicated for muscle spasms; contraindicated in those with severe renal impairment and na glaucoma; has anticholinergic effects, hallucinations, ED, hypotension and fatigue; Interacts with CNS depressants
  • direct acting muscle relaxants
    Emergency drug! act directly on skeletal muscle, Closely resemble GABA; indicated for malignant hyperthermia or neuroleptic malignant syndrome.
  • Cyclobenzaprine
    CNS acting Muscle Relaxant
  • Dantrolene
    direct acting muscle relaxant
  • Amphetamines
    drugs that stimulate norepinephrine and dopamine release, causing speeded-up body functions and associated energy and mood changes
  • Amphetamines are indicated for
    ADHD and Narcolepsy
  • COntraindications amphetamines
    glaucome, hyperthyroidism, structural cardiac abnormalities, parkinson's and anxiety
  • Most important amphetamine adverse effects
    Tachycardia, palpitations and hypertension
  • This should especially be monitored in children who take amphetamines or amphetamine like drugs
    failure to gain weight with age/weight loss that can be symptomatic of growth deficiency
  • Interactions Amphetamines
    MAOIs- hypertensive crisis that can lead to stroke or MI
  • Methylphenidate is also known as
    Ritalin
  • Methylphenidate
    Amphetamine-like drug used to treat adhd
  • Patient Teaching with amphetamines
    1. Report tachycardia or palpitations
  • Sumatriptan MOA and use
    Migraine tx; constricts cranial arteries, but can have systemic effects; therefore should not be used in patients with cardiovascular disease or uncontrolled hypertension, previous MI or stroke.
  • Signs of a stroke
    numbness, tingling and warm sensation
  • Sumatriptan adverse effects
    tingling, numbness, warm sensation N/V/D, muscle cramps dysrhythmia, thromboembolism MI and Stroke
  • What is a seizure?
    Paroxysmal, uncontrolled electrical discharge of neurons in the brain that interrupts normal function.
  • Post-ictal phase
    The final phase of a generalized seizure, during which the patient becomes extremely fatigued and is recovering.
  • seizure versus epilepsy
    Seizure is a one time occurrence or one time collection of seizures due to trauma.
  • partial seizure
    a seizure that affects only one part or one side of the brain
  • complex partial seizure
    a partial seizure, starting from a focus and remaining localized, that produces loss of consciousness
  • Partial simple seizure
    the patient maintains consciousness, is aware and remembers
  • Generalized seizures
    seizures that involve the entire brain
  • Auras
    peculiar sensations that precede a seizure, may take the form of a taste, smell, sight, or sound; dizziness; or funny feeling
  • Pregnancy and Seizures
    Increased risk of having a seizure while pregnant, hypoxia occurs during these episodes putting mom and fetus at risk, many drugs are teratogens and can inhibit optimum pregnancy folate and potassium levels
  • Hydantoins
    Most commonly prescribed antiepileptic and are indicated for use in tonic-clonic and complex/partial seizures
  • Phenytoin
    Hydantoin Anticonvulsant
  • Important adverse effects of phenytoin
    can cause gingival hyperplasia and is a teratogen
  • Phenytoin interacts with
    Anti coagulants- warfarin
  • Phenytoin administration
    Very small therapeutic range 10-20mcg/mL
  • Phenobarbital
    a barbiturate used as a sedative and as an anticonvulsant
  • Phenobarbital MOA
    brain stem depressant
  • Phenobarbital administration
    Narrow therapeutic range 15-40 mcg/mL
  • Phenobaribital adverse effects
    sedation and tolerance
  • Limostilbenes
    anticonvulsant class of drugs including carbamazepine
  • Carbamazepine
    Anticonvulsant
  • Carbamazepine adverse effects
    bone marrow suppression
  • Carbamazepine administration
    Narrow therapeutic range (4-12 mcg/mL)
  • Valproic Acid
    Anticonvulsant
  • valproic acid contraindications
    pregnancy, caution in young pts and elderly, pts with hepatic impairment
  • Valproic acid adverse effects
    Liver failure/ jaundice
  • Valproic acid administration
    Narrow therapeutic range (50-125 mcg/mL)
  • febrile seizures
    Seizures that result from sudden high fevers; most often seen in children and lead to increased risk of developing epilepsy.
  • Assessment for anticonvulsants
    Assess location, duration, and characteristics or seizure activity
  • Implementation of anticonvulsants
    IV phenytoin can only be mixed with normal saline
  • Patient teaching anticonvulsants
    Maintain proper oral hygeine and biannual dentist visits
  • Opioid Substance abuse
    Peak:1-3 days
  • Stimulant withdrawal
    Peak:1-3 days
  • Depressant withdrawal
    Short acting
  • Alcohol withdrawal
    Mild alcohol withdrawal: symptoms similar to other depressants.
  • Nicotine withdrawal
    Nicotinic receptors all over body, reduced stimulation=w/drawl S/S
  • Parasympathetic nervous system
    the division of the autonomic nervous system that calms the body, conserving its energy. Rest and Digest
  • sympathetic nervous system
    the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations.
  • Non pharma treatment of anxiety
    relaxation techniques, group therapy, solo therapy.
  • Benzodiazepines for anxiety
    Lorazepam (Ativan) and diazepam (Valium)
  • Busiprone
    Psych
  • Busiprone interactions
    grapefuit juice
  • affective disorders
    Emotional disorders that are characterized by changes in mood.
  • manic phase
    a person experiences elation, extreme confusion, distractibility, feelings of grandeur and racing thoughts
  • depressed phase of bipolar
    lack of energy, concentration, low self esteem, loss of interest, and helplessness
  • Carbomazepine
    Indicated for SEIZURES and BIPOLAR disorder
  • Lithium
    Last resort bipolar treatment as it has lts of adverse effect, narrow therapeutic range and lots of interactions
  • Li MOA
    Alters Na transport in neurons
  • Li toxicity
    At toxic levels, Li can cause ataxia, dysarthria, coarse tremors, and delirium, potentially culminating in seizures, coma, and death.