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-Hypnoticsdose 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

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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.

Sedative-Hypnotics: Barbiturates
Four categories:
Ultrashort
mephobexital, thiamylal, thiopental

Short
pentobarbital, secobarbital

Intermediate
aprobarbital, butabarbital

Long
phenobarbital
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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.

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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.

Sedative-Hypnotics: Barbiturates
Drug Effects
Low doses: High doses: Sedative effects

Hypnotic effects (also lowers respiratory rate)

Notorious enzyme inducers

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

Sedative-Hypnotics: Barbiturates
Therapeutic Uses
Hypnotics Sedatives Anticonvulsants Surgical procedures

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

Sedative-Hypnotics: Barbiturates
Side Effects
Body System
CNS

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

Respiratory

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Sedative-Hypnotics: Barbiturates
Side Effects
Body System
GI Other

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

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Sedative-Hypnotics: Barbiturates
Toxicology
Overdose frequently leads to respiratory depression, and subsequently, respiratory arrest.

Can be therapeutic:
Anesthesia induction Uncontrollable seizures: phenobarbital coma

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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.

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.

CNS Depressants: Benzodiazepines

Classified as either:
Sedative-hypnotic or Anxiolytic (Medication that relieves anxiety)

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CNS Depressants: Benzodiazepines

Sedative-Hypnotic Type
Long-Acting: flurazepam (Dalmane), quazepam (Doral) Short-Acting: estazolam (Prosom), temazepam (Restoril), triazolam (Halcion)

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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)
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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
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CNS Depressants: Benzodiazepines

Side Effects
Mild and infrequent
Headache Drowsiness Dizziness Vertigo Lethargy Paradoxical excitement Hangover effect

(nervousness)

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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.
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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 improved sleep

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