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CNS Depressants
- 2. 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.
- 3. CNS Depressants
Hypnotics
• Calm or soothe the CNS to the point that they
cause sleep
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 4. CNS Depressants
Sedative-Hypnotics—dose 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.
- 5. Sedative-Hypnotics: Barbiturates
• First introduced in 1903, standard agents
for insomnia and sedation
• Habit-forming
• 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.
- 6. Sedative-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.
- 7. Sedative-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.
- 8. Sedative-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.
- 9. Sedative-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.
- 10. Sedative-Hypnotics: Barbiturates
Therapeutic Uses
• Hypnotics
• Sedatives
• Anticonvulsants
• Surgical procedures
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 11. Sedative-Hypnotics: Barbiturates
Side Effects
Body System Effects
CNS Drowsiness, lethargy, vertigo
mental depression, coma
Respiratory Respiratory depression, apnea,
bronchospasms, cough
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 12. Sedative-Hypnotics: Barbiturates
Side Effects
Body System Effects
GI Nausea, vomiting, diarrhea
Other Agranulocytosis,
vasodilation, hypotension,
Stevens-Johnson syndrome
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 13. Sedative-Hypnotics: Barbiturates
Toxicology
• Overdose frequently leads to respiratory depression,
and subsequently, respiratory arrest.
• Can be therapeutic:
– Anesthesia induction
– Uncontrollable seizures: “phenobarbital coma”
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 14. Sedative-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.
- 15. CNS Depressants: Benzodiazepines
Most frequently prescribed sedative-hypnotics
• Most commonly prescribed drug classes
• Favorable side effects
• Efficacy
• Safety
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 16. CNS Depressants: Benzodiazepines
Classified as either:
• Sedative-hypnotic or Anxiolytic
(Medication that relieves anxiety)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 17. CNS Depressants: Benzodiazepines
Sedative-Hypnotic Type
• Long-Acting:
– flurazepam (Dalmane), quazepam (Doral)
• Short-Acting:
– estazolam (Prosom), temazepam (Restoril),
– triazolam (Halcion)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 18. 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.
- 19. 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.
- 20. 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.
- 21. 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.
- 22. CNS Depressants: Benzodiazepines
Side Effects
• Mild and infrequent
Headache Drowsiness
Dizziness Vertigo
Lethargy
Paradoxical excitement (nervousness)
“Hangover effect”
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.
- 23. 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.
- 24. 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.
- 25. 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.
- 26. 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.
- 27. 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
improved sleep
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.