| Question | Answer |
| sedatives | drugs that have an inhibitory effect on the CNS
-can act as a hypnotic if given in large enough doses |
| Symptoms that sedatives reduce | -nervousness
-excitability
-irritability w/o causing sleep |
| hypnotics | cause sleep |
| dose size | helps determine if drug is sedative or hypnotic, larger doses are typically hypnotic |
| low doses | calm the CNS w/o inducing sleep |
| High doses | calm the CNS to the point of causing sleep |
| Sleep-cycle balance | all sleep needs to be balanced thru all the stages, and sleep drugs will suppress at least one aspect of the cycle |
| Non-REM sleep stage 1 | 2-5% of sleep time
-dozing/drifting off to sleep, can be easily awakened |
| Non-REM sleep stage 2 | 50% of sleep time
Relaxation, but person can easily be awakened
person has occasional REMS and slight eye movements |
| Non-REM sleep state 3 | 5% of sleep time
Deep sleep, difficult to wake person
vital stats may decrease |
| Non-REM sleep state 4 | 10-15% of sleep time
-very difficult to wake person who may be quite groggy if awakened
-dreamin occurs, esp about daily events
-sleep walking and enuresis can occur |
| REM sleep | REMs occur
vivd dreams occur
breathing may be irregular |
| Barbiturates | a sedative-hypnotic drug
-only a handful commonly used presently b/c of the safety and efficacy of benzodiazepines |
| Categories of Barbiturates | Ultrashort-anesthesia & other uses
Short & intermediate-sedative/hypnotic and convulsive condition control
Long- sedative/hypnotic, epileptic seizure prophylaxis & other uses
Long- sedative/hypnotic, |
| secobarbital | Short acting Barbiturate |
| Barbiturate therapeutic index | is very narrow, effective dose is very close to toxic level |
| how barbiturates work | in brainstem (reticular formation) bariturates inhibit GABA, therefore nerve impulses traveling in the cerebral cortex are also inhibited |
| low doses of barbiturates | sedative effects |
| high doese of barbiturates | hypnotic effects
& lowers respiratory rate
-alcholo will double the effect of barbituates |
| Barbiturate affect on enzymes | notorious inducer
-stimulates liver enzymes that cause the metabolism of many drugs shortening their duration of action |
| severe AEs of Barbiturates | -respiratory depression
-reduced REM sleep resulting in agitation (Psychotic) and inability to deal w/ normal stress
-overdose produces CNS depression (sleep to coma to death) |
| other therapeutic uses of barbiturates | -anesthesia induction
-uncontrollable seizures "Phenobarbital coma" |
| Benzodiazepines | most frequently prescribed sedative-hypnotic for it's favorable drug effect profiles |
| types of benzodiazepines | -sedative-hypnotic
-anxiolytic (medication that relieves anxiety) |
| long acting benzodiazepines | estazolam (Prosom)
flurazepam (Dalmane)
others |
| short acting benzodiazepines | temazepam (Restoril)
triazolam (Halcion) |
| Nonbenzoidazepine hypnotics | CNS depressants
share many characteristics of benzodiazepines
used to treat insomnia |
| types of nonbenzodiazepines | -salepion (Sonata)
-zolpidem (Ambien)
-eszoplicone (Lunesta) |
| affects of benzodiazepines | depress CNS activity
less suppression of REM sleep than barbiturates
Do not increase metabolism of other drugs |
| Benzodiazepines uses | -sedation,sleep induction, balanced anesthesia, moderate/conscious sedation
-skeletal muscle relaxation (mus. spasm relief)
-anxiety, agitation, depression and epilepsy relief,
-treatment of alcohol withdrawal |
| AEs of benzodiazepines | mild and infrequent
-fall hazard for frail/elderly persons
-avoid alcohol and other CNS depressants while taking bezodiazepines |
| Muscle relaxants | -act to relieve pain associ. w/ skeletal muscle spasms |
| Action of muscle relaxants | -CNS site of action
-structure and action similar to other CNS depressants
-acts directly on skeletal muscle & resembles GABA |
| muscle relaxant uses | -relief of muscle spasms
-mgmt of spasticity or severe chronic disorders
-MS, Cerebral palsy
-work best with concurrent physical therapy |
| dantrolene (Dantrium) | muscle relaxant used in malignant hyperthermia crisis |
| AEs of muscle relaxants | CNS depression symptoms |
| cyclobenzaprine (Flexeril) | commonly used muscle relaxant
central acting & treats spasticity |
| baclofen (Lioresal) | -muscle relaxant
-oral or intrathecal(spinal) route |
| temazepam (Restoril) | -benzodiazapine used for short-term MGMT of insomnia |
| zaleplon (Sonata) | -nonbeenzodiazepine hypnotic drug
-short acting (4 hrs to sleep minumim)
-effective up to 5 wks |
| zolpidem (Ambien) | - Short-acting nonbenzodiazepine hypnotic
-limit treatment of insomnia to 7-10 days
-more grogginess than sonata |
