Central+Nervous+System+Stimulants+and+Depressants

Central Nervous System Stimulants and Depressants By: Amanda Gidaszewski, Karina Del Toro, Samantha Ruiz, Amanda Hilliard

= Stimulants = - Drugs that stimulate a specific part of the brain or spinal cord. - Sympathomimetic agents - Stimulate fight of flight

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Uses:
-ADHD: Cannot maintain attention span. Hyperactivity and impulsivity. May have a genetic predisposition. -Narcolepsy: Person unexpectedly falls asleep in the middle of normal day activities. -Migraine HA: Severe pain felt on one or both sides of the head. May have N/V, increased sensitivity to light and sound. -Analeptics: Reversal of anesthesia-induced respiratory depression -Anorexiants: May suppress the appetite control center of the brain.

S/E:
Wide-range, dose related Speed up body systems -palpitations, tachycardia, hypertension, angina, dysrhythmias, insomnia, increase urine frequency, N/V/D, restlessness, nervousness, anxiety

-Analeptics: Highly toxic and abuse potential
*Caffeine (No-Doz, Vivarin)- found in OTC & combo Rx drugs n foods. Caution in pt w/ Peptic ulcer, MI, dysrhythmias. *Doxapram (Dopram)- treats respiratory depression associated with overdose of CNS depressants.

-Anorexiants: appetite suppressants
*Orlistat (Xenical)- alters fat metabolism *Sibutramine (Meridia)- decreases appetite

-Amphetamines: stimulate the CNS, increase mental alertness
*Amphetamine (Adderall)- treatment of ADHD, narcolepsy, and obesity *Methylphenidate (Concerta, Ritalin)- for ADHD and narcolepsy



-Serotonin Agonists
*Sumatriptan (Imitrex)- Acute treatment of migraines. Should not be given to pt w/ CAD! *Sibutramine (Meridia)- for weight loss, inhibits the reuptake of norepinephrine and serotonin

Nursing Implications
-Look for contraindications, interactions. -Cardiac abnormalities, seizure, liver problems. -Height and weight of children. -Methylphenidate (Concerta, Ritalin) should be given at least 6 hours before bedtime to reduce insomnia, and 45 minutes before meals. -Orlistat (Xenical) should be taken with meals that contain fat. -Sumatriptan (Imitrex), Sibutramine (Meridia) should avoid foods containing tyramine.

= Depressants = -Sedatives -Hypnotics -Sedative Hypnotics-dose dependent

** *Sedatives **
Drugs that have inhibitory effect on CNS to reduce nervousness, exictability, and irritability w/out causing sleep. Can become hypnotic if given in large enough doses.

** *Hypnotics **
Calm or soothe CNS to cause sleep.

** *Sedative hypnotics **
Act as sedative or hypnotic, low doses calm CNS w/out causing sleep, high doses calm to the point of causing sleep.

-Cyclic & repetitive REM- REM Rebound: from prolonged use of sedative-hypnotics. Reduce amt of REM Sleep results in daytime fatigue. NREM- 4stages
 * Sleep **

** Sedative-Hypnotics Barbituates **
-Have low therapeutic index. Very habit forming.

1. Ultrashort: onset <15 mins, duration 2-4 hrs. -Mephobexital, thiamylal, thiopental 2. Short: onset 15-20 mins, duration 2-4 hrs. -Pentobarbital, secobarbital 3. Intermediate: onset 20-30 mins, duration 2-4 hrs. -Butabarbital 4. Long: onset 30-60, duration 6-8 hrs. -Phenobarbital, mephobarbital
 * Four Categories **

Low doses- sedative High doses- hypnotic Enzyme-inducers- stimulate liver enzymes, causing breakdown of many drugs. (shortens duration of action for many drugs)
 * Drug Effects **

-induce sleep -reduce nervousness, irritability, w/out causing sleep -anticonvulsant -anesthesia for surgical procedure
 * Uses: **

Pentobarbital (Nembutol)-reduces anxiety before surgery Phenobarbital (Luminal)-prevents seizures Secobarbital (Seconal)-hypnotic to induce sleep
 * Most common **

Drug allergy, pregnancy, respiratory difficulty, liver disease, used w/ alcohol, opioids, benzodiazepines, and other additive CNS depression agents.
 * Contraindications **

Drowsiness, lethargy, coma, respiratory depression, bronchospasms, N/V/D, constipation, agranulocytosis, hypertension
 * S/E **

-Leads to respiratory arrest. sleep-coma-death Treatment: maintain airway and support respiration. NO ANTAGONIST EXISTS Alcohol, antihistamines, benzodiazepines, narcotics, tranquilizers, MAOIs.
 * Toxicity & overdose **
 * Drug Reactions: **

** Benzodiazepines (sedative-hypnotics) **
*most commonly prescribed drug classes, favorable S/E profiles.

-Don't suppress REM sleep -Don't induce microsomal enzyme activity

-Sedation -Sleep induction -Skeletal muscle relaxation -Anxiety relief -Treatment of alcohol withdrawl -Agitation -Depression -Epilepsy -Balanced anesthesia
 * Uses: **

Calm of CNS, controll agitation and anxiety, reduce sensory stimulation, skeletal muscle relaxation.
 * Drug effects: **

Depress CNS activity, affect hypothalamic, thalamic, and limbic systems of brain -don't suppress REM sleep, so have less HANGOVER EFFECT! -don't increase metabolism of other drugs
 * Mechanism of Action ** :

*Flurazepam (Dalmane)- long-acting hypnotic used for short-term therapy of insomnia *Temazepam (Restoril)- short-term treatment of insomnia. Don't use in pt w/ narrow angle glaucoma. *Triazolam (Halcion)- short-term treatment of insomnia.
 * Drugs: **

-Headache, drowsiness, dizziness, vertigo, lethargy, paradoxical excitement (nervousness), HANGOVER EFFECT! :D
 * S/E **

Somnolence, confusion, coma, diminished reflexes
 * Overdose **

** Muscle relaxants **
-Relieve pain related to skeletal muscle spasms. Majority are central acting, and direct acting. Closely resembles GABA.

*Dantrolene (Dantrium)- malignant hyperthermia *Baclofen (Lioresal) *Cyclobenzaprine (Flexeril)
 * Drugs **

*Metaxalone (Skelaxin)

relief of painful musculoskeletal conditions, muscle spasms, MS, cerebral palsy. Works best with physical therapy.
 * Uses: **

Euphoria, lightheadedness, dizziness, drowsiness, fatigue, muscle weakness, risk for falls!
 * S/E **

** Nursing Implications: **
-Check for allergies, medical history, and medications. -Baseline vitals and I&O -Take 15-30 minutes before bedtime -May cause REM rebound, a tired feeling the next day. Careful with elderly (fall risks) -Avoid alcohol and other CNS depressants -May take up to 2-3 weeks to see improvement in sleep with barbiturates. -SAFETY: side rails up, bed alarms, no smoking, assist with ambulation, keep call light within reach.

Follow the link below to review and test your knowledge...
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 * Lane, L, Collins, S, Harrington, S, Rainforth, S, & S., J. (2010). Pharmacology and the Nursing Process. Mosby Inc. **


 * Petges, Nancy. RN MSN. Pharmacology: Central Nervous System Stimulants and Depressants Powerpoint, 2011. **