Unit2 Chap12: Central Nervous System Depressants and Muscle Relaxants

REVIEW : Cyclobenzaprine (flexeril)

Centrally acting muscle relaxer. CNS is depressed. Indicted for muscle spams. May cause light headedness, dizziness.

The nurse should monitor an older adult patient prescribed a benzodiazepine for treatment of insomnia for which potential adverse effect? a.Red rash b. Unsteady gait c. Muscle spasms d. Shortness of breath

B. Unsteady gait Benzodiazepine doses for children and older adults should be small with gradual increases to avoid ataxia (unsteady gait) and excessive sedation. Thus, these patients should be closely monitored for these adverse effects.

REVIEW: Phenobarbital (Nembutal)

Barbiturate. Ultra short acting anesthesia and may be used to control convulsions. Causes hang over effect. Pregnancy, respiratory difficultly, kidney dz, and live dz are contraindications. There is no antidote for barbiturates. The use of activated charcoal binds to the drug in the stomach and gastrointestinal tract, preventing absorption.

During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement? a. "There really is no difference; the terms are used interchangeably." b. "Whereas sedative drugs induce sleep, hypnotic drugs induce a state of hypnosis." c. "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses." d. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time."

C. "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses." Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses

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? a. Ipecac syrup b. Naloxone (Narcan) c. Flumazenil (Romazicon) d. Charcoal (Activated charcoal)

D. Charcoal (Activated charcoal) There is no antidote for barbiturates. The use of activated charcoal binds to the drug in the stomach and gastrointestinal tract, preventing absorption.

A patient is admitted to the hospital with a diagnosis of benzodiazepine overdose. The nurse anticipates the health care provider will prescribe which antidote for benzodiazepine overdose? a. Naloxone (Narcan) b. Naltrexone (ReVia) c. Nalmefene (Revex) d. Flumazenil (Romazicon)

D. Flumazenil is the antidote for benzodiazepine overdose. The other options are only effective against opioid agonist effects.

Which nursing diagnosis is appropriate for a patient who has just been administered a sedative-hypnotic drug? a. Risk for infection b. Deficient knowledge c. Imbalanced nutrition d. Risk for injury and falls

D. Risk for injury and falls Sedative-hypnotic drugs cause central nervous system depression, putting the patient at risk for injury and falls.

REVIEW: Zolpidem

Short acting nonbenzodiazepine used for insomnia and may cause sleep walking FDA recommends 5mg is max dose

REVIEW: Tamazepam Diazepam (Valium)

They are sedative-hypnotics benzodiazepines. Depress activity in the CNS to treat agitation and anxiety. Not to used in patients with narrow angle glaucoma and pregnancy. Avoid driving when taking due to sedative effect . Risk for fall. Suppress REM sleep. Flumazenil is the antidote

The nurse will monitor the patient who is taking a muscle relaxant for which adverse effect? a. CNS depression b. Hypertension c. Peripheral edema d. Blurred vision

a. CNS depression

A patient has been admitted to the emergency department because of an overdose of an oral benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate intervention? a. Hemodialysis to remove the medication b. Administration of flumazenil c. Administration of naloxone d. Intubation and mechanical ventilation

b. Administration of flumazenil

The nurse is reviewing the prescriptions for a patient who will be discharged to home after being hospitalized for a hysterectomy. The patient asked for a sleeping pill, and the surgeon wrote a prescription for Ambien, 10 mg at bedtime as needed for sleep. What is the nurse's priority action at this time? a. Review the potential adverse effects with the patient. b. Suggest that the patient try drinking a glass of wine at bedtime. c. Contact the prescriber to question the dose of the Ambien. d. Assist the patient to find a pharmacy to fill the prescription on her way home.

c. Contact the prescriber to question the dose of the Ambien. FDA recommends 5mg is max dose

An older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the patient was awake most of the night, watching television and reading in bed. The nurse documents that the patient has had which type of reaction to the medication? a. Allergic b. Teratogenic c. Paradoxical d. Idiopathic

c. Paradoxical

Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative-hypnotic drug? (Select all that apply.) a. These drugs are intended for long-term management of insomnia. b. The drugs can be administered safely with other CNS depressants for insomnia. c. The dose needs to be given about 1 hour before the patient's bedtime. d. The drug is used as a first choice for treatment of sleeplessness. e. The patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken.

c. The dose needs to be given about 1 hour before the patient's bedtime. e. The patient needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine is taken.

A hospitalized patient is complaining of having difficulty sleeping. Which action will the nurse take first to address this problem? a. Administer a sedative-hypnotic drug if ordered. b. Offer tea made with the herbal preparation valerian. c. Encourage the patient to exercise by walking up and down the halls a few times if tolerated. d. Provide an environment that is restful, and reduce loud noises.

d. Provide an environment that is restful, and reduce loud noises. Implement nonpharmacologic measures first to enhance sleep. This is important because the use of CNS depressants for treatment of sleep deficit or insomnia often leads to interference with the REM stage of sleep, hangover effects, and/or tolerance, as well as other adverse effects.