CNS Depressants
What is the mechanism of action for midazolam?
Enhances GABA effect on CNS
Decreases neuronal excitability leading to sedation
What is the mechanism of action for baclofen?
Enhances GABA in CNS to reduce muscle spasticity
What is the mechanism of action for cyclobenzaprine?
Prevents release of calcium in skeletal muscles (inhibiting muscle contraction) to decrease muscle spasticity
What is the mode of action of phenytoin?
Sodium channel blocker
What is the mechanism of action for phenobarbital?
Increases GABA which results in CNS depression
Inhibits neurotransmission which decreases seizure activity
What are the side effects of midazolam?
Sedation, amnesia, respiratory depression
What are the side effects of baclofen?
Drowsiness, nausea, constipation
What are the side effects of cyclobenzaprine?
Drowsiness, muscle weakness, GI upset
What are the side effects of phenytoin?
Gingival hyperplasia, vision issues, dizziness, GI upset
What are the side effects of phenobarbital?
Drowsiness, lethargy, hypotension, respiratory depression
What is the antidote for midazolam?
Flumazenil
What is an important patient teaching about baclofen?
Increase fiber and fluid intake to prevent constipation
What is the black box warning for cyclobenzaprine?
Hepatotoxicity
Do not take with MAOIs - serotonin syndrome
What are the nursing considerations for a patient on phenytoin?
Monitor phenytoin blood levels during therapy (therapeutic range is 10 - 20 mcg/mL)
What are the nursing considerations for a patient on phenobarbital?
Monitor vital signs
Have resuscitation equipment at bedside
What is an important patient teaching when prescribed midazolam?
Do not discontinue abruptly
Why would a patient be prescribed baclofen?
Spasticity related to spinal cord injury, cerebral palsy, multiple sclerosis (MS)
What are the nursing considerations for a patient taking cyclobenzaprine?
Monitor for signs of liver damage
What type of patient teaching needs completed for a patient taking phenytoin?
Do anticonvulsants offer a cure for epilepsy?
No - they treat symptoms.
What is the black box warning for midazolam?
Severe respiratory depression
Respiratory arrest
What are the contraindications for centrally acting muscle relaxants?
Children
Concurrent MAOI use
AV block, QT prolongation
Avoid with sedatives - increases CNS depression
When would cyclobenzaprine be prescribed?
Acute spasms (injury-related)
Chronic spasticity
What is the black box warning for phenytoin?
Administer slow - too fast of administration can cause hypotension and cardiac arrhythmias
What is the mechanism of action for succinimide?
Blocks T-type calcium channels and is used for absence seizures