Seizure & Insomnia Medications

CNS depressants
1. Sedative Hypnotics
2. General Anesthetics
3. Opioid and Non-Opioid Analgesics
4. Anticonvulsants
5. Antipsychotics
6. Antidepressants

Non-Pharm Methods for Sleep
1. Good sleep pattern
2. Limit naps
3. Avoid caffeine, ETOH, Nicotine
4. time meals, fluids, and exercise
5. alter environment

Sedative Hypnotics Goal
1. Diminish physical and mental responses
2. Anxiolytics
3. Promote natural sleep
4. Lowest effective dose
5. Maintain consciousness`

Adverse Effects of Sedative Hypnotics
1. hangover
2. REM rebound
3. Dependence
4. Tolerance
5. Resp. depression
6. Hypersensitivity

Sub-Groups of Sedatives
1. Short Acting (go to sleep)
2. Intermediate – acting (stay asleep)

sedative Hypnotics
1. Barbiturates (Schedule 2-4)
2. Benzodiazepines (schedule 4)
3. Non-benzodiazepines (Schedule 4)

GABA receptor agonists = potentiate the effect of GABA = decrease sensory cortex, decrease motor activity, and alter cerebellar function = drowsiness, sedation, and hypnosis


Barbiturate Types
1. ultrashort acting
2. short acting
3. intermediate acting
4. long acting

Barbiturates Indications
1. Insomnia (short acting)
2. Seizures (long acting)
3. sedation pre-procedure (all except short acting)

Barbiturates Drug-Drug Interactions
2. other sedatives
3. Increased metabolism of certain drugs
4. decrease effectiveness of anticoagulants, glucocorticoids, and tricyclic antidepressants

Nursing Implications for Barbiturates
1. Safety – (avoid heavy machines, falls,mixing w/other sedating things, keep meds safe)
2. Education to pt. about tolerance, dependence and to take as prescribed

Benzo Indications
1. Anxiolytic
2. Sedative Hypnotic
3. Insomnia
4. seizures

Benzo advantages
1. rapid onset
2. well-tolerates
3. little CV effects
4. generic available

Benzo’s disadvantages
1. CNS depressant
2. Resp. depression
3. Anterograde amnesia
4. tolerance
5. dependence
6. toxicity
7. abuse
8. readily crosses placenta and enters breast milk

Anterograde Amnesia
Anterograde amnesia is a loss of the ability to create new memories after the event that caused the amnesia

Alprazolam (Xanax)
– benzo
– binds to specific receptor sites in GABA receptors = enhances and amplifies actions of GABA
-reduce neuron excitability

Alprazolam (Xanax) Indications
1. Anxiety
2. Panic Disorders
3. Pre-procedural sedation

Alprazolam (Xanax) Pharmacokinetics
– PO only b/c highly absorbed
– half-life = 11-16 hrs

Alprazolam (Xanax) Side Effects
1. Lethargy
2. drowsiness
3. dizziness
4. decreased libido
5. disinhibition
6. Confusion = BIG ISSUE
7. Incontinence

Alprazolam (Xanax) Nursing Implications
1. SAFETY!! ( b/c of falls r/t to syncope, dependence, and tolerance)

Alprazolam (Xanax) Food-Drug Interaction
Grapefruit and grapefruit juice interfere with intestinal enzymes that metabolize Xanax.

Alprazolam (Xanax) Dose
adjusted by age

Flumanzenil (Romazicon)
Competitive benzodiazepine antagonist
– used for Alprazolam (Xanax) overdose
– onset = 1-2 minutes
– peak = 6-10 minutes
– duration = 19-50 minutes

Flumanzenil (Romazicon) Indications
1. Post-anesthesia to reverse sedation
2. Benzodiazepine overdose

potentially fatal seizures
In benzodiazepine overdose, flumanzenil should be used with caution, b/c it can cause _______ ________ ________.

Non- benzodiazepines
– chemically different structure from benzodiazepines.
– very similar pharmacodynamic effects to benzodiazepines

Zolpidem (Ambien)
– Class: non-benzo
– MOA: enhances the activity of GABA, leading to decreased neuronal excitability
– minimal anxiolytic properties

Zolpidem (Ambien) should not be used to treat ______ b/c it has minimal effects on that.

Zolpidem (Ambien) Indication
strictly only for SLEEP!!!!

Zolpidem (Ambien) Pharmacokinetics
metabolized by liver, and excreted in urine, bile, and feces

Zolpidem (Ambien) Side Effects
1. Paradoxical reactions (keep awake)
2. drowsiness
3. depression exacerbation
4. Suicidal ideation
5. aggressive behavior
6. “hangover”
7. Tolerance
8. Dependence
9. Sleep related behaviors (driving, cooking)

Zolpidem (Ambien) Nursing Implications
1. Safety
2. Avoid ETOH
3. Dose adjusted for age and sex. (females no more than 5 mg)

Non-Scheduled Sleep Medications
1. Tetracyclic Antidepressants – Trazodone ( rarely used for depression b/c its so sedating 600 mg for depression and 100 mg for sleep; also causes priapism in adolescents)
2. Antihistamines – Hydroxyzine and diphenhydramine (make pt. jittery)
3. Melatonin Agonists – Ramelteon

Alternative Therapies for Sleep Medications
1. Kava kava- banned in Europe and Canada
2. Valerian root
3. melatonin
4. over the counter – usu. have diphenhydramine

Nursing Implications for Insomnia Agents
1. Non-pharm always best!!
– get into a pattern
– limit daytime naps
– avoid caffeine, ETOH, and nicotine
– Time meals, fluids, and exercise
– alter environment
2. Give meds within 15-30 minutes of bedtime

Abnormal electric discharges from the cerebral neurons.
– characterized by loss/disturbance of consciousness and convulsions

Seizure Causes
1. 75% are primary/idiopathic
2. 25% are secondary (trauma, anoxia, infection, and cerebrovascular disorders
3. Non-epileptic causes (fever, hypoglycemia, electrolyte abnormalities, metabolic imbalances, ETOH/drug, and Pseudo seizures

Generalized MOA for anti seizure meds
1. Suppress NA+
2. Suppress Ca
3. induce GABA

Phenytoin (Dilantin)
Inhibits NA influx of motor cortex
– stabilizes cell membrane
– reduce repetitive neuronal firing

Phenytoin (Dilantin) Indication
Only Seizures

Phenytoin (Dilantin) Pharmacokinetics
1. slow GI absorption
2. Liver metabolized
3. Highly protein bound

Phenytoin (Dilantin) Admin.
1. Po/IV
2. IM not recommended b/c causes local tissue destruction
3. Target therapeutic range 10-20 mug/dl

Phenytoin (Dilantin) Side Effects
1. Teratogenic (harmful to baby)
2. Hypotension
3. Discoloration of urine
4. Dysrhythmias
5. Pancytopenia (deficiency of RBCs, WBCs, and platelets)
6. Gingival hyperplasia (gum enlargement)

Benzo’s in seizures
1. increased effectiveness for acute seizure management (petit mal, grand mal, and status epilepticus)
2. Ativan
3. Valium

Levetiracetam (Keppra)
inhibits calcium Ca & K currents
– rapid/complete oral absorption

Levetiracetam (Keppra) Adverse Reactions
1. Depression
2. Hostility
3. Aggressive behavior
4. Psychosis
5. Suicidality
6. Leukopenia
7. neutropenia
8. SJS

Keppra Nursing Implications
1. seizure precautions
2. nutritional status (ETOH, hypoglycemia, caffeine, hypontremia)
2. seizure precautions
3. Prego risk = risk of IUGR, minor fetal skeletal abnormalities, and decreased fetal wt.
4. Med. adherence
5. Cultural and religious believes – respect them and be sensitive to them

Other anti-convulsants
1. Divalproex (Depakote)
2. Lamotrigine (Lamictel)
3. Carbamazepine (tegretol)

Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), temazepam (Restoril) Notes – Benzodiazepine – schedule IV controlled substances Alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), temazepam (Restoril) Indications (Table 34-2) a. anxiety (drug of first choice) b. panic disorder c. insomnia d. seizures …

What is epilepsy? Group of disorders characterized by excessive excitability of neurons in the CNS. This abnormal neuronal activity can produce a variety of symptoms ranging from brief periods of unconsciousness to violent convulsions. Convulsion applies to abnormal movement (jerking …

What are the indications for Anti-Anxiety Benzodiazepines? Reduce anxiety, Induce sedation, Relax Muscles, Inhibit Convulsions, Treat A ETHOL and drug withdrawal symptoms, Safer than Sedative-Hypnotics What are the reactions for the Anti-Anxiety Benzodiazepines? Sedation, Drowsiness, Ataxia, Dizziness, Irritability, Blood dycrasias, …

Benzodiazepines alprazolam (Xanax), clonazepam (Klonipin), diazepam (Valium) (most common), loraepam (Ativan), midazolam (Versed) What are typical indications (uses) for diazepam (Valium) anxiety disorder, insomnia, athetosis (involuntary convoluted writhing movements of arms, legs, & neck), anxiety, panic disorders, stiffman syndrome, preoperative …

Central Nervous System Depressants Zolpidem Tartrate (Ambien) Alprazolam (Xanax) What the antagonist of Alprazolam (Xanax)? Flumazenil (Romazicon) WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample What type of CNS …

Lorazepram Classification Benzodiazipine For acute anxiety Lorazepram – Action MOA not fully understood; Acts mainly at sub corticoid levels in CNS; Acts in the limbic system; inhibitory neuro transmitter WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY …

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