NCM 235

Drugs Acting on the

central and
peripheral nervous
system
Neurotransmitters and their Functions:
Dopamine, Glutamate, Serotonin,
Norepinephrine, and Epinephrine

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Physiology of the Nervous System

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 NCM 235

Anxiolytic and
Hypnotic Drugs
Anxiolytic and Hypnotic Drugs:

Anxiety – is a feeling of tension,

nervousness, apprehension, or fear that
usually involves unpleasant reactions to
a stimulus, whether actual or unknown.
Anxiolytic and Hypnotic Drugs:

Sedation - the loss of awareness and reaction

to environmental stimuli

Hypnosis – extreme sedation results in

further central nervous system (CNS)
depression and sleep
States Affected by Anxiolytic and Hypnotic
Drugs:
Anxiety – is a feeling of tension, nervousness,
apprehension, or fear that usually involves
unpleasant reactions to a stimulus, whether actual
or unknown.
Sedation - the loss of awareness and reaction to
environmental stimuli
Hypnosis – extreme sedation results in further
central nervous system (CNS) depression and sleep,
 NCM 235

Benzodiazepines
 Adverse Effects
• Drowsiness and confusion
• Ataxia occurs at high doses
• Cognitive impairment (decreased long-term recall and
retention of new knowledge)
• Used cautiously in patients with liver disease
• Alcohol and CNS depressants enhance the sedative-
hypnotic effects
• Administration in 3rd trimester can result in “floppy-
infant syndrome”
Therapeutic Uses;
1. Anxiety disorders secondary to panic disorder,
generalized anxiety disorder (GAD), social anxiety
disorder, performance anxiety, post traumatic
stress disorder, obsessive-compulsive disorder,
extreme anxiety disorder associated with phobias,
and anxiety related to depression and
schizophrenia
2. Alcohol withdrawal symptoms – chlordiazepoxide,
chlorazepate, diazepam and oxazepam
Therapeutic Uses;
3. Sleep disorders
4. midazolam: Facilitate amnesia while causing
sedation prior to anesthesia
5. lorazepam and diazepam: drug of choice in
terminating status epilepticus
6. diazepam: Muscular disorders or spasticity
from degenerative disorders such as multiple
sclerosis and cerebral palsy
 Nursing Implementation
1. Do not mix intravenous (IV) drugs in solution with any
other drugs to avoid potential drug–drug interactions.
2. Give parenteral forms only if oral forms are not feasible
or available and switch to oral forms, which are safer
and less likely to cause adverse effects, as soon as
possible.
3. Give IV drugs slowly because these agents have been
associated with hypotension, bradycardia, and cardiac
arrest
4. Arrange to reduce the dose of narcotic
analgesics in patients receiving a
benzodiazepine to decrease potentiated effects
and sedation.
5. Maintain patients who receive parenteral
benzodiazepines in bed for a period of at least
3 hours. Do not permit ambulatory patients to
operate a motor vehicle after an injection to
ensure patient safety.
6. Taper dose gradually after long-term therapy,
especially in epileptic patients. Acute withdrawal
could precipitate seizures in these patients. It may
also cause withdrawal syndrome.
7. Provide comfort measures to help patients tolerate
drug effects, such as having them void before dosing,
instituting a bowel program as needed, giving food
with the drug if GI upset is severe, providing
environmental control (lighting, temperature,
stimulation), taking safety precautions (use of side
rails, assistance with ambulation), and aiding
NCM 235

Barbiturates
Barbiturates used as anxiolytic–hypnotics
include:
• amobarbital (Amytal Sodium)
• butabarbital (Butisol),
• mephobarbital (Mebaral)
• pentobarbital (Nembutal)
• phenobarbital (Luminal)
• secobarbital (Seconal)
• Barbiturates are general CNS depressants that
inhibit neuronal impulse conduction in the
ascending RAS, depress the cerebral cortex,
alter cerebellar function, and depress motor
output.
• Can cause sedation, hypnosis, anesthesia, and,
in extreme cases, coma
• Indicated for the relief of the signs and
symptoms of anxiety and for sedation,
insomnia, preanesthesia, and the treatment of
seizures
• Cardiovascular effects: bradycardia,
hypotension (particularly with IV
administration), and syncope
• Serious hypoventilation may occur,
and respiratory depression and
laryngospasm may also result,
particularly with IV administration
• CNS effects: drowsiness, somnolence,
lethargy, ataxia, vertigo, a feeling of a
“hangover,” thinking abnormalities,
paradoxical excitement, anxiety, and
hallucinations
• GI effects: nausea, vomiting,
constipation, diarrhea, and epigastric
pain may occur
 Nursing Implementation
1. Give parenteral forms only if oral forms are not
feasible or available, and switch to oral forms as
soon as possible to avoid serious reactions or
adverse effects.
2. Give IV medications slowly because rapid
administration may cause cardiac problems.
3. Provide standby life-support facilities in case of
severe respiratory depression or hypersensitivity
reactions.
4. Taper dose gradually after long-term therapy,
especially in patients with epilepsy. Acute
withdrawal may precipitate seizures or cause
withdrawal syndrome in these patients.
5. Provide comfort measures to help patients
tolerate drug effects, including small, frequent
meals; access to bathroom facilities; bowel
program as needed; consuming food with the
drug if GI upset is severe; and environmental
control, safety precautions, orientation, and
appropriate skin care as needed.
Advantages of Benzodiazepines over Barbiturates
• The “Z-drugs” are oral drug for short-
term treatment of insomnia
• Special considerations: patient should
take before bed and devote 4–8 h to
sleep, use with caution in patients with
hepatic or renal impairment, elderly
patients are especially sensitive to these
drugs so administer a lower dose and
monitor these patients carefully