Pharmacology Chapter 12 Central Nervous System Depressants and Muscle Relaxants

4 There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the gastrointestinal tract, preventing absorption into the bloodstream. The nurse would not anticipate that naloxone, flumazenil, or ipecac syrup would be prescribed.

A patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes before arrival. The nurse can anticipate that which drug will be prescribed? 1 Naloxone 2 Flumazenil 3 Ipecac syrup 4 Activated charcoal

2 Overdose of barbiturates may cause respiratory depression. Therefore, maintaining an adequate airway with assisted ventilation is the priority of the therapy. Administration of furosemide can hasten the elimination of the barbiturate. However, the intervention should be performed only after the patient's airway has been maintained. Intravenous fluids are administered only if indicated. Activated charcoal is a common regimen for treating the overdose of barbiturates; however, this is not the priority approach for treatment.

A patient is admitted to the hospital after a suspected overdose of barbiturates. What is the priority treatment approach for this patient? 1 Administration of furosemide 2 Maintenance of an adequate airway 3 Administration of intravenous fluids 4 Administration of activated charcoal

1 Flumazenil has a short half-life, and its duration of effect is 1 to 4 hours. Therefore, the dose of the reversal drug may wear off and the patient may become unconscious again. Administration of flumazenil in higher doses is required for recovery when the patient becomes unconscious again. Consuming alcohol along with benzodiazepines results in hypotension and respiratory depression. Administration of 0.2 mg (2 mL) of flumazenil IV over 15 seconds is required for reversal of moderate sedation or general anesthesia.

A patient is admitted to the hospital in an unconscious state caused by an overdose of benzodiazepines. The nurse administers flumazenil, and the patient regains consciousness but becomes unconscious again after some time. What is the reason for the patient becoming unconscious again? 1 The half-life of flumazenil is short. 2 A high dose of flumazenil was given. 3 Alcohol was consumed with the benzodiazepines. 4 0.2 mg (2 mL) of flumazenil was given intravenously (IV).

1 Thiopental is an ultrashort-acting drug that is used as anesthesia for short surgical procedures. Butabarbital is used as a sedative. Pentobarbital is used to control convulsive conditions. Phenobarbital is used for the prophylaxis of epileptic seizures.

A patient is scheduled to have a brief surgical procedure. Which drug does the nurse expect to be used during surgery? 1 Thiopental 2 Butabarbital 3 Pentobarbital 4 Phenobarbital

1 Hispanics, Asians, Pacific Islanders, and African Americans have a high incidence of lactose intolerance. Such patients should not be advised to drink warm milk at bedtime to enhance sleep. Consumption of milk may lead to gastrointestinal distress, abdominal cramping, and bloating. However, lactose-free milk may be used. Exercising just before going to bed may hamper sleep. The primary health care provider may prescribe a mild sedative, if required. Coffee is a stimulant and its consumption must be stopped at least 6 hours before sleep.

A patient of Hispanic origin who experiences insomnia visits the community nurse for counseling. The nurse educates the patient about self-care activities that may enhance sleep. Which statement indicates the need for additional teaching? 1 "I will have a glass of warm milk before bed." 2 "I should avoid exercise just before going to bed." 3 "I may be prescribed benzodiazepines to promote sleep." 4 "I will stop drinking coffee at least 6 hours before bedtime."

4 Establishing a set sleep pattern with a time to go to bed at night and a regular time to get up in the morning helps reset the internal clock. Consuming alcohol results in fragmented sleep. Using tobacco at bedtime disturbs the sleep pattern. Too much sleep may lead to fragmented sleep patterns and shallow sleep.

A patient reports unusual sleep patterns and lack of sleep. What is the best nonpharmacologic patient teaching the nurse can provide to reset the patient's internal clock? 1 Avoiding alcohol at bedtime 2 Avoiding tobacco at bedtime 3 Sleeping more during the day 4 Establishing a set sleep pattern

4 Intake of grapefruit juice decreases the metabolism of diazepam by inhibiting the cytochrome P-450 system, which causes prolonged sleep. Rifampin increases the metabolism of diazepam and may not result in prolonged sleep. Olanzapine increases the effects of diazepam but may not affect sleep. Phenobarbital has an additive effect with diazepam and increases the central nervous system depression. It does not have any significant effect on sleep.

A patient who has difficulty sleeping has been prescribed diazepam. On the follow-up assessment, the nurse finds that the patient has prolonged sleep. What assessment finding is the reason for the prolonged sleep? 1 The patient takes rifampin along with diazepam. 2 The patient takes olanzapine along with diazepam. 3 The patient takes phenobarbital along with diazepam. 4 The patient takes grapefruit juice along with diazepam.

1, 2, 4 Tricyclic antidepressants, MAOIs, and RMAOIs interact with barbiturates. These drugs increase the activity of barbiturates and may lead to severe central nervous system depression. SSRIs and SNRI are not contraindicated with barbiturates, because they do not prolong the effects of barbiturates.

A patient with epilepsy is prescribed barbiturates. On further assessment, the nurse finds that the patient has depression. What classes of antidepressants does the nurse expect the primary health care provider to avoid when prescribing to this patient? Select all that apply. 1 Tricyclic antidepressant 2 Monoamine oxidase inhibitor (MAOI) 3 Selective serotonin reuptake inhibitor (SSRI) 4 Reversible monoamine oxidase inhibitor (RMAOI) 5 Serotonin and noradrenaline reuptake inhibitor (SNRI)

4 Baclofen falls under the barbiturates category, and drowsiness, lethargy, and blurred vision are adverse effects of baclofen, which will make it difficult for this patient to participate actively in rehabilitation activities. Gastrointestinal distress is one of the adverse effects of niacin, which is an antilipemic drug. Another adverse effect of antilipemic drugs is increased muscle pain associated with activity. Impaired physical mobility is an adverse effect related to antiemetic and antinausea drugs.

A patient with multiple sclerosis participates in a rehabilitation program. The patient takes baclofen to help manage muscle spasticity. How will the baclofen interfere with the patient's rehabilitation activities? 1 By causing gastrointestinal distress 2 By impairing coordinated movements 3 By increasing pain associated with activities 4 By producing drowsiness, lethargy, and blurred vision

2 Asians have a high incidence of lactose intolerance, so the use of milk at bedtime to promote sleep may lead to gastrointestinal (GI) distress, abdominal cramping, and bloating. Hence, lactose-free milk may be used. Some Asian Americans may practice acupuncture for sleep. However, it may not be effective for GI upset that has been caused by lactose intolerance. Chinese patients require lower doses of benzodiazepines to promote sleep. However, these drugs may not help to treat lactose intolerance. Some Hispanics may use home remedies of vegetables and herbs for sleep. However, these may not be effective for lactose intolerance.

An Asian patient reports unusual sleep patterns and lack of sleep. The nurse asks the patient to drink warm milk before going to sleep. However, the patient develops diarrhea. What is the best nonpharmacologic nursing intervention to promote patient comfort? 1 Suggest acupuncture therapy. 2 Suggest drinking lactose-free milk at bedtime. 3 Suggest taking lower doses of benzodiazepines. 4 Suggest using home remedies of vegetables and herbs.

1 Symptoms such as drowsiness and confusion after taking diazepam indicate drug overdose. The nurse should immediately administer 0.2 mg (2 mL) IV flumazenil for 30 seconds, and then a maintenance dose of 0.3 mg (3 mL) for 30 seconds is given to reverse the symptoms. Flumazenil is administered at 0.5 mg (5 mL) IV for 30 seconds if the patient does not respond to the initial dose or if a reversal in sedation is not seen. Flumazenil is administered at 0.2 mg (2 mL) IV for 15 seconds for the reversal of moderate sedation after general anesthesia. It can then be administered at 0.2 mg (2 mL) IV for 60 seconds if the patient doesn't respond to the initial dose of 0.2 (2 mL) IV for 15 seconds.

How is flumazenil administered when treating diazepam overdose? 1 0.2 mg (2 mL) intravenously (IV) over 30 seconds 2 0.5 mg (5 mL) IV over 30 seconds 3 0.2 mg (2 mL) IV over 15 seconds 4 0.2 mg (2 mL) IV over 60 seconds

1 Midazolam is known to cause amnesia and anxiolysis as well as sedation and is therefore commonly used before certain procedures. The other answers are not common side effects of midazolam.

Midazolam has been prescribed for a patient to be administered by intravenous injection 2 minutes before a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is what? 1 Amnesia 2 Dry mouth 3 Constipation 4 Decreased heart rate

3 Deep sleep is the third stage of sleep. The person finds it difficult to wake, and the respiratory rate, pulse rate, and blood pressure may decrease. Dozing is the first stage of sleep. The person has feelings of drifting off to sleep. Relaxation is the second stage of sleep. The person can easily be awakened. In the fourth stage of sleep, it is very difficult to wake the person up, and sleepwalking may occur during this stage.

The nurse is teaching a group of nursing students about the stages of non-rapid eye movement (non-REM) sleep. Which is the third stage of sleep? 1 Dozing 2 Relaxation 3 Deep sleep 4 Sleepwalking

3 An overdose of baclofen can cause respiratory depression as a result of excessive central nervous system depression, so the nurse has to maintain an open airway with the use of oxygen and a bag for ventilation. General supportive therapy and seizure therapy, including cardiac monitoring, gastric lavage, and fluid therapy, are then instituted to maintain vital functions until the depressant effects of baclofen wear off. Although comfort measures are usually appropriate, the nurse's priority is the maintenance of vital functions. An antidote to baclofen does not exist.

The nurse notes that a patient has taken an excessive dose of baclofen. Which action does the nurse implement immediately? 1 Comfort measures 2 Seizure precautions 3 Airway maintenance 4 Antidote preparation

1 Benzodiazepine doses for children and the elderly should start small with gradual increases to prevent ataxia and excessive sedation. Thus, these patients should be closely monitored for these adverse effects. Dyspnea, alertness and hallucinations are not potential side effects of benzodiazepines.

The nurse should monitor older adults who are prescribed a benzodiazepine for insomnia for which potential side effect? 1 Ataxia 2 Dyspnea 3 Alertness 4 Hallucinations

2 Because the receptors for benzodiazepines and alcohol addiction are present in the same area in the CNS, some benzodiazepines such as diazepam and chlordiazepoxide are used for alcohol withdrawal. Sedation is not required for a patient who has symptoms of alcohol withdrawal. Benzodiazepines are combined with anesthetics, analgesics, and neuromuscular blocking agents for their amnesic properties, but this does not help in treating alcohol withdrawal. Benzodiazepines produce sedation by acting on GABA receptors, but this does not reduce the symptoms of alcohol withdrawal.

The primary health care provider has asked the nurse to administer diazepam to a patient who has symptoms of alcohol withdrawal. Why does the primary health care provider select this drug for the patient? 1 The patient may need to be sedated to relieve symptoms of alcohol withdrawal. 2 The drug acts on benzodiazepine receptors that play a role in alcohol addiction. 3 The drug may reduce the memory of painful symptoms related to alcohol withdrawal. 4 The drug acts on gamma-aminobutyric acid (GABA) receptors in the central nervous system (CNS).

1 Use of rifampin increases the metabolism of benzodiazepine. This would reduce the effect of benzodiazepine, so the patient would have less sleep than normal. The patient may have low blood pressure or respiratory depression if using central nervous system depressants. The use of antifungal medications such as azole would reduce the benzodiazepine metabolism. Consequently, the patient would sleep longer than expected.

The primary health care provider has prescribed rifampin for tuberculosis and a benzodiazepine to induce sleep in a patient. What report may the nurse expect from this patient during a follow-up visit? 1 "I sleep less than I used to." 2 "I feel like I breathe too deeply." 3 "Nowadays I sleep for long hours." 4 "I often feel dizzy and lightheaded."

3 When a benzodiazepine and rifampin are administered simultaneously, rifampin decreases the benzodiazepine's effect by increasing its metabolism. Daytime sleepiness is sometimes observed in elderly patients who are on benzodiazepine therapy. However, it is not an effect of a drug interaction between benzodiazepines and rifampin. Administering macrolide antibiotics or azole antifungals with benzodiazepines prolongs the effects of the benzodiazepines. Simultaneously administering CNS depressants and benzodiazepines promotes CNS depression.

What is the result of a potential drug interaction between benzodiazepines and rifampin? 1 Increased daytime sleepiness 2 Prolonged benzodiazepine action 3 Decreased benzodiazepine effects 4 Increased central nervous system (CNS) depression

1, 2, 4 Barbiturate overdose causes respiratory depression. This may lead to signs such as coughing and Cheyne-Stokes respirations. As the respiratory center is depressed, the oxygenation of the blood is also reduced. This causes cyanosis, which is manifested as a bluish discoloration of the extremities. Barbiturates are central nervous system depressant medications, and thus an overdose would cause decreased body temperature and decreased blood pressure.

While monitoring a patient who has been administered pentobarbital, the nurse finds that the patient is developing signs of barbiturate toxicity. What conditions does the nurse observe in the patient? Select all that apply. 1 Frequent coughing 2 Peripheral cyanosis 3 Increased blood pressure 4 Cheyne-Stokes respirations 5 Increased body temperature

3 The onset of action of temazepam is 1 hour. Thus, the nurse should advise the patient to take the medication 1 hour before going to bed. Gastrointestinal upset is a side effect associated with benzodiazepine drugs. This effect may not be prevented by taking the drug 1 hour before bed. The drug is known to prevent early morning awakening. Drug activity is not affected if the patient sleeps immediately. However, the patient will not be able to sleep immediately after taking the drug, because the drug requires some time to show its effect.

When teaching a patient about temazepam, the nurse advises the patient to take it 1 hour before going to bed. Why does the nurse give this advice to the patient? 1 Temazepam may cause gastrointestinal upset. 2 Temazepam causes early awakening after sleep. 3 Temazepam induces sleep in approximately 1 hour. 4 The therapeutic activity of temazepam is reduced with sleep.

2 Midazolam is used during the preoperative period to relieve anxiety, provide sedation, and help induce general anesthesia. Its rapid onset and brief duration of action provide the nurse with a higher degree of control over the effects of the drug. Diazepam is an old benzodiazepine used to relieve anxiety, induce muscle relaxation, and control seizure activity. Flurazepam, temazepam, and other older benzodiazepines are indicated for insomnia; these have been supplanted by newer drugs.

Which benzodiazepine has rapid onset, is short acting, relieves anxiety, and provides sedation before and during procedures? 1 Diazepam 2 Midazolam 3 Flurazepam 4 Temazepam

1 Barbiturates can be used as hypnotics, sedatives, and anticonvulsants and for anesthesia. This class of drugs is contraindicated in patients with known drug allergy, pregnancy, or severe kidney or liver disease. Valerian (Valeriana officinalis) is an herbal product that is contraindicated in patients with cardiac disease. Barbiturates are indicated for the treatment of epileptic disease because of their anticonvulsant properties. Narrow-angle glaucoma contraindicates benzodiazepines.

Which condition contraindicates barbiturates? 1 Drug allergy 2 Cardiac disease 3 Epileptic disease 4 Narrow-angle glaucoma

3 Ramelteon is recommended for the treatment of insomnia. This drug is contraindicated for patients with COPD or sleep apnea. Zaleplon is a nonbenzodiazepine drug used for the treatment of insomnia. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Diazepam is a benzodiazepine drug used for the treatment of sleep disorders. It is contraindicated in patients with drug allergy, glaucoma, or pregnancy. Pentobarbital is a barbiturate class of drug used as hypnotic, sedative, and anticonvulsant. It is contraindicated in patients with drug allergy, pregnancy, or severe kidney or liver disease.

Which drug is contraindicated in patients with chronic obstructive pulmonary disease (COPD)? 1 Zaleplon 2 Diazepam 3 Ramelteon 4 Pentobarbital

2 Benzodiazepines induce daytime sleeping in a few cases. To reduce the daytime sleep, these patients may be prescribed zolpidem, which is a nonbenzodiazepine drug. This drug is known to cause sleepwalking (somnambulation) as a side effect. Bedwetting is more related to neurologic problems and is not an effect of nonbenzodiazepines. Perspiration and body weight are not affected by nonbenzodiazepine therapy.

Which is a side effect of the nonbenzodiazepine drug zolpidem? 1 Bedwetting 2 Sleepwalking 3 Increased perspiration 4 Increased body weight

3 REM rebound is an abnormally large amount of REM sleep that often leads to frequent and vivid dreams. Bedwetting and sleepwalking may occur in stage 4 non-REM sleep. At this stage, it is very difficult to wake a person. Daytime fatigue occurs in cases of REM interference, which is a reduction in the cumulative amount of REM sleep as a result of prolonged sedative-hypnotic use.

Which is the characteristic feature of rapid eye movement (REM) rebound sleep? 1 Bedwetting 2 Sleepwalking 3 Vivid dreams 4 Daytime fatigue

1 Because of the prolonged effects of benzodiazepines on the central nervous system (CNS), the patient may develop suicidal tendencies. Therefore, the nurse should closely monitor the teenage patient for this. Older adults may have an increased risk of falling because of excessive drowsiness. The nurse should assess the risk for injury or falls if the patient is elderly. The nurse encourages the patient to increase the intake of fluids for complete excretion of the drug from the body, which helps to reduce its adverse effects, but this is not the most important intervention. The nurse should monitor renal and hepatic function to prevent potential toxicity or complications resulting from decreased excretion or metabolism, but monitoring for suicidal tendencies is the priority.

Which is the most important nursing intervention while caring for a teenage patient who is on benzodiazepine therapy? 1 Monitoring for suicidal tendencies 2 Encouraging the patient to drink more fluids 3 Assessing the patient's risk for injury or falls 4 Monitoring the patient's renal and hepatic function

4 African Americans have a high incidence of lactose intolerance; if the patient drinks warm milk at bedtime to promote sleep, it may lead to gastrointestinal distress, abdominal cramping, and bloating. Therefore, the nurse should advise the patient to consume a glass of warm lactose-free milk at bedtime to promote sleep. Some Asian-American patients believe in yin and yang and may practice meditation. Some Hispanics believe that a well-balanced diet and physical exercise help promote sleep. Chinese patients may require lower doses of benzodiazepines to treat insomnia.

Which nursing intervention may be particularly beneficial to an African-American patient with insomnia? 1 Teaching the patient about meditation 2 Encouraging the patient to maintain a well-balanced diet 3 Instructing the patient to take low doses of benzodiazepines 4 Recommending that the patient consume a glass of warm lactose-free milk at bedtime

2 Midazolam is a benzodiazepine. Hypotension is a sign of severe benzodiazepine toxicity. A patient experiencing benzodiazepine toxicity should be given flumazenil at a maximum dose of 3 mg, which acts as an antidote. Flumazenil at maximum dose of 1 mg is given when moderate toxicity is seen. Moderate toxicity causes symptoms such as confusion and drowsiness but not hypotension. Phenylephrine is administered to correct hypotension but is not used as an antidote for benzodiazepine.

While assessing a patient who has been administered midazolam, the nurse finds that the patient's blood pressure is very low. Which prescription will the nurse discuss with the primary health care provider? 1 Flumazenil at a maximum dose of 1 mg 2 Flumazenil at a maximum dose of 3 mg 3 Phenylephrine at a maximum dose of 2 mg 4 Phenylephrine at a maximum dose of 5 mg

1 Zaleplon is a commonly prescribed drug for patients who have trouble with waking up early. This drug is to be taken in the night at least 4 hours before the patient plans to wake up. Zolpidem is a long-acting hypnotic that can induce sleep for a prolonged period. Diazepam has many indications like muscle relaxation, preprocedure sedation, status epilepticus, acute anxiety, and agitation. Midazolam is used to produce preoperative sedation.

While teaching about a medication regimen, the nurse advises the patient to take the medication no later than midnight and at least 4 hours before the patient usually awakens. Which drug has been prescribed to the patient? 1 Zaleplon 2 Zolpidem 3 Diazepam 4 Midazolam

4 Muscle relaxants are prescribed for patients with Huntington disease to reduce choreiform movement. These drugs are more effective when used in combination with physical therapy. Muscle relaxants are primarily used for relief from painful musculoskeletal conditions but are also used to relieve the pain associated with trigeminal neuralgia, or nerve pain. Muscle relaxants are used to reduce muscular rigidity in patients with Parkinson's disease. Lightheadedness is an adverse effect of muscle relaxants.

Why are muscle relaxants prescribed for patients with Huntington disease? 1 To relieve nerve pain 2 To reduce muscle rigidity 3 To prevent lightheadedness 4 To reduce choreiform movement