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NR 293 Week 6 Concepts; Intracranial Regulation

$20.00
Contributor
Robin Williams
Category
Nursing
Course
NR 293 Pharmacology
Institute
Chamberlain
Pages
70

Week 6 Concepts: Intracranial Regulation CNS Depressants Prepare: CNS Depressants CNS Depressants Central Nervous System (CNS) Depressants are drugs that result in a calming effect by inhibiting the transmission of nerve impulses to the CNS. Subclass of CNS Depressants Barbiturates are the subclass of CNS Depressants which inhibit nerve impulses by acting on the brainstem and GABA receptors resulting in the inhibition of nerve impulses in the cerebral cortex. Black Box Warning Benzodiazepines carry a black box warning regarding what? The combination of all opioids with all benzodiazepines can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death). The use of benzodiazepines while driving can cause severe sleepiness. The dosage of benzodiazepines. The use of benzodiazepines in patients with a history of depression. Self-Check: CNS Depressant CNS Depressant Choose the correct CNS Depressant (sedatives, hypnotics, or sedative-hypnotic) based on the degree to which it causes the inhibition of nerve impulses in the CNS. Sedatives produce a sense of calm, reduce nervousness, excitability, and irritability without causing sleep unless given in a large enough dose. Hypnotics cause sleep with a much more potent CNS effect than sedatives. Sedative-Hypnotics can act as either a sedative or a hypnotic depending on the dose and patient responsiveness. In low doses, they calm the CNS without causing sleep. In high doses, they calm the CNS and cause sleep. Self-Check: Sedative-hypnotics Sedative-hypnotics Sedative-hypnotics, the group of CNS depressants that have either a sedative or hypnotic effect, or both, depending on various factors, are broken into 3 groups based on their chemical makeup. Which of them carries the highest risk for dependence and are therefore used less? Barbiturates Sedative-hypnotics Benzodiazepines Hypnotics Self-Check: Barbiturates: Safety Considerations Barbiturates: Safety Considerations Barbiturates carry with them many contraindications, risk for dependence and overdose, as well as many drug-drug interactions. Drag the statements below that apply to barbiturates and drop them to the right side column: Self-Check: Benzodiazepines Benzodiazepines Choose all the statements below that are correct regarding Benzodiazepines. (Select all that apply.) alprazolam, lorazepam, and temazepam are long-acting benzodiazepines Produce more REM suppression than barbiturates Affect the hypothalamic, thalamic, and limbic systems of the brain (GABA receptors) Induce relaxation of skeletal muscles clonazepam, diazepam, and flurazepam are short-acting benzodiazepine Reduce excessive sensory stimulation which induces sleeps Self-Check: Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines and Orexin Receptor Antagonists Nonbenzodiazepines act on the CNS and act very much like benzodiazepines. Orexin Receptor Antagonists (also called hypocretins) act on the CNS and act very much like benzodiazepines. Reflect: CNS Depressant CNS Depressants Pentobarbital is a short- acting barbiturate now used for preoperative anxiety and to produce sedative effects, to treat symptoms of withdrawal from other barbiturates and nonbarbiturates, control status epilepticus, and to prevent hyperbilirubinemia in neonates. Phenobarbital is a long- acting barbiturate used to prevent generalized tonic-clonic seizures and fever-induced convulsions, as well as treatment of hyperbilirubinemia in neonates. It is no longer used as a sedative or hypnotic. Sedative-hypnotics Choose the correct statement(s) below regarding sedative-hypnotics. (Select all that apply.) Prolonged use of sedative-hypnotics can cause REM interference resulting in daytime fatigue. Discontinuation of a sedative-hypnotic can cause REM interference resulting in daytime fatigue. Discontinuation of a sedative-hypnotic can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams. Prolonged use of sedative-hypnotics can cause REM rebound resulting in too much REM sleep and frequent, vivid dreams. Sedative-hypnotic Drugs Which of the following are currently the more frequently prescribed sedative-hypnotic drugs? Nonbenzodiazepines Long-acting barbiturates Ultrashort-acting barbiturates Benzodiazepines CNS Depressants Select the true statement(s) regarding CNS depressants. (Select all that apply.) Herbal supplements kava and valerian have CNS stimulant effects. There are significant drug-drug interactions with benzodiazepines, especially with other CNS Depressants, due to the intensity of benzodiazepines and the combined CNS depressant effects. There is a black box warning regarding the combination of all opioids with all benzodiazepines which can cause serious CNS depression (extreme sleepiness, respiratory depression, coma and death). Alcohol should not be used with these CNS Depressants because the combination multiples the CNS depressive effects. Barbiturates Which of the following statements are true regarding barbiturates? (Select all that apply.) The long-term use of barbiturates can lead to harmful effects on sleep due to the deprivation of REM sleep. Increased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers. Overdose of barbiturates typically leads to respiratory arrest, coma, and death. MAOIs (antidepressants) result in a longer duration of action of barbiturates. Barbiturates are a type of sedative-hypnotic. Decreased CNS depression occurs when administered with alcohol, antihistamines, benzodiazepines, opioids and tranquilizers. The long-term use of barbiturates can lead to harmful effects on sleep due to the prolongation of REM sleep. Sedative-hypnotics Select the true statement below regarding sedative-hypnotics. Sedatives at low doses calm the CNS and cause sleep. Hypnotics at high doses calm the CNS and cause sleep. Hypnotics at low doses calm the CNS without causing sleep. Sedatives at high doses calm the CNS without causing sleep. Barbiturates methohexital and thiopental pentobarbital and secobarbital butabarbital phenobarbital and mephobarbital Use induction of anesthesia prevent hyperbilirubinemia in neonates sedation prevention of seizures Match each barbiturate drug to its common use. Sedative-hypnotics Match the sedative-hypnotic CNS Depressant medication to its subclass. IF CAN’T READ Intermediate-acting benzodiazepines - alprazolam, lorazepam, temazepam Long-acting benzodiazepines - clonazepam, diazepam, flurazepam Short-acting barbiturates - pentobarbital, secobarbital, pentobarbital Long-acting barbiturates – phenobarbital, mephobarbital, phenobarbital GABA receptor antagonist that is the antidote to benzodiazepines – flumazenil Long-acting benzodiazepine most commonly used to treat for status epilepticus - diazepam benzodiazepine most commonly used for preoperative anxiety and for moderate sedation - midazolam Non-benzodiazepine, a short-acting hypnotic with a relatively low incidence of daytime sleepiness - zolpidem Intermediate Acting Benzodiazepines (alprazolam) Prepare: Intermediate Acting Benzodiazepines (alprazolam) Which of these medications is an intermediate-acting benzodiazepines used for its anxiolytic effects? zolpidem butabarbital diazepam alprazolam Benzodiazepines are contraindicated in pregnancy and lactation because they: (Select all that apply.) Cause CNS depression May cause sedation and respiratory issues in newborns Cross into breastmilk May cause anxiety in the mother Benzodiazepines are most often used for which of these effects? Barbiturate Anxiolytic Sedative Hypnotic Self-Check: Intermediate Acting Benzodiazepines Intermediate-acting benzodiazepines are so called because: There onset and duration of action takes much longer than those of short-acting benzodiazepines They sometimes have an increased CNS depressive effect when taken with barbiturates In relation to short- and long-acting benzodiazepines, their onset and duration of action take place over a period of time that is neither fast nor slow They are sometimes less effective when taken with other CNS Depressants Benzodiazepines Benzodiazepines are contraindicated in pregnancy because they cause CNS depression. This can subsequently lead to respiratory issues in the neonate. Self-Check: alprazolam Which of these are indications for the use of alprazolam? (Select all that apply.) Generalized anxiety disorder (GAD) Anxiety associated with depression Panic disorder Sedative to induce and maintain sleep Adjunct in the treatment of acute mania and acute psychosis Prevention of alcohol withdrawal alprazolam is administered Oral (PO) alprazolam is a/an oral benzodiazepine used for its anxiolytic effects by reducing anxiety. Reflect: Intermediate Acting Benzodiazepines (alprazolam) alprazolam: Indications for Use 0209142Identify the applicable indications for the use of alprazolam: alprazolam In administering alprazolam to a client with COPD which of the following is a concern? Anxiety and panic attacks can induce hyperventilation Alprazolam is contraindicated with medications used to treat COPD Alprazolam is a CNS depressant Someone who has anxiety is more likely to have an exacerbation of a respiratory illness CNS Depressants and Drug Interactions Which of the following items have CNS depressive effects and should be used with caution in patients taking alprazolam? (Select all that apply.) caffeine antipsychotics muscle relaxants alcohol benzodiazepines flumazenil anxiolytics opioids Dosage of alprazolam How might the dosage of alprazolam be adjusted in an elderly patient and why? Elderly patients are less sensitive to benzodiazepines and therefore higher doses may be used in this population. Elderly patients have a much lower risk for dependency to benzodiazepines and therefore higher doses may be used in this population. Elderly patients have a great risk for dependency to benzodiazepines and therefore lower doses may be used in this population. Elderly patients are sensitive to benzodiazepines and therefore lower doses may be used in this population. Nicotine Nicotine causes increased benzodiazepine metabolism which causes the medication to be less effective. For a patient who is a smoker and is also taking alprazolam for generalized anxiety disorder, this could mean that their symptoms of anxiety do not improve. alprazolam: Classifications Which of the following characteristics describe alprazolam? CNS Depressant Sedative-hypnotic CNS Stimulant Barbiturate Intermediate-acting benzodiazepine Nonbenzodiazepine Anxiolytic Benzodiazepines Which of the following is the most accurate statement related to the increased risk for dependence and addiction when benzodiazepines (such as Xanax) are taken with other CNS Depressants? Benzodiazepines have a long-acting duration causing the user to remain sedated for a long period of time when taken with other CNS Depressants. Benzodiazepines administered to patients who have uncontrolled severe pain will cause an increased risk for dependency, especially when taken with other CNS Depressants. Benzodiazepines administered to patients who have never taken them before pose the greatest risk for addiction, especially when taken with other CNS Depressants. Benzodiazepines typically peak and trough quickly causing the user to crave more and more when taken with other CNS Depressants. CNS Depressant A patient taking alprazolam, or any CNS Depressant, should avoid which of the following? (Select all that apply.) Grapefruit juice Valerian root Green tea Kava Nursing Application: CNS Depressants Prepare: Nursing Application: CNS Depressants Nursing Assessment A nurse is completing an assessment of a patient taking a CNS Depressant medication. The nurse will monitor for symptoms of CNS depression such as respiratory depression associated with the inhibition of nerve impulse transmission to the CNS. pentobarbital: Indications You are the nurse caring for a patient taking pentobarbital, a short-acting barbiturate. Based on your knowledge of the indications for this medication, you know that this patient may have a history of seizures Risks of CNS Depressants In educating clients taking benzodiazepines with other CNS depressants, the nurse indicates this may put the client at risk for toxicity. Self-Check: Nursing Assessment Nursing Assessment As the nurse caring for a patient taking a CNS Depressant. Which adverse effect does the nurse need to consider when assessing a client prescribed a CNS depressant? Excessive sedation Hypertension Nausea and vomiting Insomnia Patient Education When reviewing a client’s medications for discharge, she asks you if she can continue to take kava for her insomnia. You understand that kava causes CNS depression. Self-Check: Nursing Assessment: Specific Medications Barbiturates You are caring for a patient for whom you have an order to administer a barbiturate. Based on your knowledge of this subclass and its contraindications, you check the patient’s lab results to ensure that she is not pregnant. Self-Check: Nursing Interventions You are the nurse caring for a patient who has been prescribed zolpidem, a hypnotic CNS Depressant. You plan to administer this medication at this time in order to maximize its sleep-inducing effectiveness: 30-60 minutes before bedtime Nursing Interventions As the nurse caring for the patient taking a CNS Depressant, you are planning nursing interventions used to minimize some of the risks associated with this drug class, such as: (Select all that apply.) Teaching the patient to stop taking the medication once he’s feeling better To avoid driving while taking this medication Assistance with ambulation Teaching the patient to minimize alcohol use when taking this medication Reflect: Nursing Application: CNS Depressants Nursing Assessment In reviewing benzodiazepine use in an elderly client, you anticipate: (Select all that apply.) Insomnia and tachycardia Decreased CNS depressive effects Risk of low respiratory rate and excessive sedation Increased CNS depressive effects Nursing Interventions You are the nurse caring for a 24-year-old patient who is recovering from a surgical procedure. He has recently been admitted to your unit from the post-anesthesia care unit and is recovering well and is tolerating drinking liquids. You were told in a report that he received diazepam for sedation during the procedure as an adjunct anesthetic to aid in intubation. You enter the room to check his vital signs and notice that his mom is handing him a drink she brought from home and notice that it is grapefruit juice. Based on your knowledge of this interaction, your first action is to: Advise him not to drink citric beverages. Advise him not to have food or beverages from home as they may interact with his medications. Assess his sedation level, respiratory effort, and vital signs. Prepare to administer flumazenil, the antidote to benzodiazepines. Patient Teaching You are the nurse caring for Stephanie, a 42-year-old woman for whom you are completing discharge instructions and patient teaching. She has been prescribed a nonbenzodiazepine. However, she mentioned to you during your conversation that she is allergic to acetylsalicylic acid. You tell Stephanie that those with an allergy to acetylsalicylic acid are more likely to have an allergy to nonbenzodiazepines. Nursing Interventions You are the nurse caring for Sara, a 25-year-old female patient for whom suvorexant is prescribed. Based on your knowledge of this medication, you are aware that she may experience: An increased risk for daytime sleepiness Priority of Assessment You are caring for a patient taking a CNS Depressant. You are considering your plan of care for this patient based on the subjective and objective data you have collected, as well as your knowledge of this drug class. You choose the following as the priority focus for your nursing care: Risk for injury Respiratory depression Drug dependence Confusion Patient Education You are the nurse caring for Steven, a 72-year-old male who is being discharged home. He has been prescribed a barbiturate to treat seizures. His medical record indicates that he suffers from seasonal allergies for which he takes over-the-counter medication, drinks alcoholic beverages on occasion, and has a history of Deep Vein Thrombosis (DVTs) and depression. You discuss with the patient the adverse effects that may result in particular when taken with other CNS depressive substances. 0373453Which of the following statements do you include in your patient's education regarding barbiturates in regard to his particular medical history? Contraindications You are the nurse caring for Ed, a 51-year-old man with a history of hypertension, glaucoma, and Deep Vein Thrombosis (DVTs). He has been prescribed a benzodiazepine. Based on your knowledge of Ed’s medical history, this drug class and its possible contraindications and drug-drug interactions, you know that: (Select all that apply.) Benzodiazepines interact with anticoagulants causing an increased risk for Deep Vein Thrombosis (DVTs). Benzodiazepines are contraindicated in patients with narrow-angle glaucoma. Benzodiazepines are contraindicated in patients with hypertension. Verapamil and diltiazem are antihypertensives that cause a decrease in benzodiazepine metabolism. CNS Depressant Safety Considerations Risk for Injury Risk for Sedation Risk for Dependence Discharge Instructions Avoid driving or operating heavy machinery May be higher risk for falls Can cause confusion or memory loss Do not use with kava or valerian root Do not use with alcohol or opioids Do not use with sleep aids Do not stop taking abruptly after prolonged use Many CNS depressants are controlled substances The nurse is preparing discharge instructions for a client being sent home with a prescription for a benzodiazepine. Match the following instructions to the potential risks of this medication class. Muscle Relaxants Prepare: Muscle Relaxants Muscle relaxants are categorized by their mechanism of action. Muscle Relaxants: Indications for Use Muscle relaxants and other CNS Depressants have different indications for use including insomnia and sedation. Abused Drug Carisoprodol has become a commonly abused drug, in particular in combination with an opioid and a benzodiazepine. Self-Check: Muscle Relaxants Muscle Relaxants Most muscle relaxants work on the CNS and. (Select all that apply.) act directly on the excitation-contraction coupling of skeletal muscle fibers. are known as central acting. are known as direct-acting. decrease the force of muscle contraction and relax strained, stiff and weakened muscles. have no direct effects on the muscles or conduction of nerves. decrease the amount of calcium released. decrease the muscle’s response to stimuli. Muscle Relaxants Muscle relaxants are found to be the most effective when combined with physical therapy. Self-Check: Safety Considerations Muscle Relaxant Overdose The reversal drug for muscle relaxant overdose is which of the following? flumazenil zolpidem temazepam muscle relaxants do not have a specific antidote or reversal drug for an overdose Adverse Effects Which words/phrases describe the primary adverse effects of muscle relaxants that work on both the central nervous system and directly on skeletal muscles? Select all that apply. Drowsiness Gastrointestinal upset Euphoria Fatigue Tachycardia Headaches Self-Check: Common Muscle Relaxants Direct-acting Muscle Relaxants Which of the following is a direct acting skeletal muscle relaxant? dantrolene baclofen tizanidine cyclobenzaprine Reflect: Muscle Relaxants Muscle Relaxants: Drug Name Which of these muscle relaxants in IV form is used to treat skeletal muscle spasms caused by malignant hyperthermia? cyclobenzaprine baclofen methocarbamol dantrolene Muscle Relaxant Drugs Centrally-acting Skeletal Muscle Relaxants Direct-acting Skeletal Muscle Relaxant Drug Names chlorzoxazone / carisoprodol / baclofen / cyclobenzaprine dantrolene Match the drug to the correct category of muscle relaxant: Muscle Relaxants: Indications for Use Muscle relaxants are indicated for the use of: (Select all that apply.) Low back strain Arthritis Insomnia Multiple sclerosis Treatment of withdrawal symptoms Anxiety-related depression Pre-operative adjunct to anesthesia Parkinson's Disease Cerebral palsy Muscle Relaxants: Mechanism of Action Centrally-acting Skeletal Muscle Relaxants Direct-acting Skeletal Muscle Relaxants Mechanism of Action Provide sedative effects Act directly on the CNS Have no direct effects on the muscles Have no effect on conduction of nerves Act at the level of the brainstem and thalamus Decrease the force of muscle contraction Relax strained, stiff and weakened muscles Small group of muscle relaxants Act directly on skeletal muscle Decrease the muscle’s response to stimuli Decrease the amount of calcium released Match the mechanism of action to the correct category of muscle relaxant: Muscle Relaxants Effects For which of these muscle relaxants is marked sedation a common result of use? cyclobenzaprine carisoprodol dantrolene baclofen Muscle Relaxants Which of the following muscle relaxants is used to treat muscle spasms and can be used in an implantable pump device? cyclobenzaprine dantrolene metaxalone baclofen Commonly Abused Drug Which of these muscle relaxants is commonly abused in combination with an opioid and a benzodiazepine, together referred to as “The Holy Trinity”, producing a heroin-like effect? chlorzoxazone dantrolene carisoprodol cyclobenzaprine Muscle Relaxant Interactions As with all CNS Depressants, there is a potential for adverse effects and toxicity or overdose when muscle relaxants are taken with other CNS depressive substances and drugs. Muscle relaxant overdose requires more aggressive treatment than does an overdose of other CNS Depressants. The priority is the ABCs, including airway maintenance, heart rhythm monitoring, and IV fluids. Nursing Application: Muscle Relaxants Prepare: Nursing Application: Muscle Relaxants Nursing Assessment The nurse caring for a patient prescribed a muscle relaxant is aware that, in addition to most of the side effects associated with all CNS Depressants, the assessment of this patient will include awareness of muscle function, pain, and range of motion. Nursing Implications The nurse caring for a patient prescribed a muscle relaxant is aware that there are two categories, each with a mechanism of action and subsequent nursing implications that are unique to this subclass. Side Effects As the nurse caring for a patient taking a muscle relaxant, you are aware of the side effects general to all CNS depressants and those specific to muscle relaxants such as muscle spasticity, pain and stiffness. Self-Check: Nursing Assessment Nursing Assessment You are the nurse caring for a patient taking dantrolene for malignant hyperthermia resulting from a recent surgical procedure. Your assessment of this patient will include areas specific to this drug’s mechanism of action and malignant hyperthermia. These areas include cardiovascular depression associated with all CNS depressants. respiratory depression associated with all CNS depressants. successful induction of sleep associated with the hypnotic effects of dantrolene. relief of muscle rigidity associated with malignant hyperthermia. Nursing Assessment You are the nurse caring for a patient taking a muscle relaxant. Although you know that muscle relaxants are used for the treatment of muscle spasms and pain, they are still types of CNS depressants. For this reason, you assess for some of the effects of CNS depressants in which of these situations? Relief of muscle spasm associated with malignant hyperthermia Sedative effects such as drowsiness and dizziness if taking dantrolene Relief of insomnia if taking baclofen Sedative effects such as drowsiness, dizziness if taking cyclobenzaprine Self-Check: Nursing Implementation Patient Teaching As the nurse caring for a patient taking cyclobenzaprine, a centrally acting muscle relaxant, you ensure that you teach the patient which of the

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NR 449 Week 2 Quiz 1.

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NR 449 Week 5 Quiz 3..

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NR 542 Test Plan for Authorization Follow-Up

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NR 546 Week 1 Discussion; Norepinephrine

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