DRUGS ACTING ON THE CENTRAL AND Benzodiazepines
PERIPHERAL NERVOUSE SYSTEM
Anxiolytic and Hypnotic Drugs
Sedative
A drug that reduces excitement, clams
the patient (without inducing sleep)
Sedatives in therapeutic doses are
anxiolytic agents
Most sedatives in larger doses produce
hypnosis (trans like state in which
subject becomes passive and highly
suggestible)
Site of action is on the limbic system
which regulates thought and mental
function
Hypnotic
A drug which produces sleep
resembling natural sleep
They are used for initiation and/pr
maintenance of sleep
Hypnotics in higher doses produce Adverse Effects
General anaesthesia
• Drowsiness and confusion
Site of action is on the midbrain and
ascending RAS which maintain • Ataxia occurs at high doses
wakefulness
• Cognitive impairment (decreased long-
States Affected by Anxiolytic and Hypnotic Drugs: term recall and retention of new
knowledge)
Anxiety – is a feeling of tension, nervousness,
apprehension, or fear that usually involves • Used cautiously in patients with liver
unpleasant reactions to a stimulus, whether disease
actual or unknown.
• Alcohol and CNS depressants enhance
Sedation - the loss of awareness and reaction to the sedative-hypnotic effects
environmental stimuli
• Administration in 3rd trimester can
Hypnosis – extreme sedation results in further result in “floppy-infant syndrome”
central nervous system (CNS) depression and
sleep,
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; Barbiturates
3. Sleep disorders Barbiturates used as anxiolytic–hypnotics
include:
4. midazolam: Facilitate amnesia while
causing sedation prior to anesthesia • amobarbital (Amytal Sodium)
5. lorazepam and diazepam: drug of • butabarbital (Butisol),
choice in terminating status epilepticus
• mephobarbital (Mebaral)
6. diazepam: Muscular disorders or
• pentobarbital (Nembutal)
spasticity from degenerative disorders
such as multiple sclerosis and cerebral • phenobarbital (Luminal)
palsy
• secobarbital (Seconal)
Nursing Implementation
Barbiturates are general CNS depressants that
1. Do not mix intravenous (IV) drugs in inhibit neuronal impulse conduction in the
solution with any other drugs to avoid ascending RAS, depress the cerebral cortex,
potential drug–drug interactions. alter cerebellar function, and depress motor
output.
2. Give parenteral forms only if oral forms
are not feasible or available and switch Can cause sedation, hypnosis, anesthesia, and,
to oral forms, which are safer and less in extreme cases, coma
likely to cause adverse effects, as soon
as possible. Indicated for the relief of the signs and
symptoms of anxiety and for sedation,
3. Give IV drugs slowly because these insomnia, preanesthesia, and the treatment of
agents have been associated with seizures
hypotension, bradycardia, and cardiac
arrest CNS effects:
4. Arrange to reduce the dose of narcotic drowsiness, somnolence, lethargy, ataxia,
analgesics in patients receiving a vertigo, a feeling of a “hangover,” thinking
benzodiazepine to decrease abnormalities, paradoxical excitement, anxiety,
potentiated effects and sedation. and hallucinations
5. Maintain patients who receive GI effects:
parenteral benzodiazepines in bed for a nausea, vomiting, constipation, diarrhea, and
period of at least 3 hours. Do not epigastric pain may occur
permit ambulatory patients to operate
a motor vehicle after an injection to Nursing Implementation
ensure patient safety. 1. Give parenteral forms only if oral forms
6. Taper dose gradually after long-term are not feasible or available, and switch
therapy, especially in epileptic patients. to oral forms as soon as possible to
Acute withdrawal could precipitate avoid serious reactions or adverse
seizures in these patients. It may also effects.
cause withdrawal syndrome. 2. Give IV medications slowly because
7. Provide comfort measures to help rapid administration may cause cardiac
patients tolerate drug effects, such as problems.
having them void before dosing, 3. Provide standby life-support facilities in
instituting a bowel program as needed, case of severe respiratory depression or
giving food with the drug if GI upset is hypersensitivity reactions.
severe, providing environmental control
(lighting, temperature, stimulation), 4. Taper dose gradually after long-term
taking safety precautions (use of side therapy, especially in patients with
rails, assistance with ambulation), and epilepsy. Acute withdrawal may
aiding 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
