Muscle Relaxants, Substance Abuse and CNS Stimulants - PowerPoint PPT Presentation

Loading...

PPT – Muscle Relaxants, Substance Abuse and CNS Stimulants PowerPoint presentation | free to download - id: 26732f-NzFjM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Muscle Relaxants, Substance Abuse and CNS Stimulants

Description:

Spasms may be tonic (sustained) or clonic (alternating) ... Rohypnol (flunitrazepam) GHB (gamma hydroxybutyric acid) Dextromethorphan. THC. Absinthe ... – PowerPoint PPT presentation

Number of Views:327
Avg rating:3.0/5.0
Slides: 57
Provided by: Comput359
Learn more at: http://www.atu.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Muscle Relaxants, Substance Abuse and CNS Stimulants


1
Muscle Relaxants, Substance Abuse and CNS
Stimulants
  • By Linda Self

2
Muscle Relaxants
  • Used to decrease muscle spasms or the spasticity
    associated with certain neurologic and
    musculoskeletal disorders
  • Muscle spasmsudden, involuntary muscle
    contraction. Occurs with musculoskeletal trauma.
    Spasms may be tonic (sustained) or clonic
    (alternating)
  • Spasticityincreased muscle tone or contraction,
    stiff, awkward movements. Caused by nerve damage
    in spinal cord and brain

3
Mechanisms of Action
  • Centrally active except Dantrium
  • Cause general depression of the CNS
  • May block nerve impulses that cause increased
    muscle tone and contraction
  • Lioresal and Valium increase GABA
    (gamma-aminobutyric acid)
  • Dantrolene acts directly on muscles inhibiting
    the release of calcium in skeletal muscle cells

4
Indications
5
Indications
  • As adjuncts to other treatment measures such as
    physical therapy
  • Spastic disorders which cause severe pain or
    inability to tolerate physical therapy, perform
    ADLs
  • Dantrium in malignant hyperthermia

6
Skeletal Muscle Relaxants
  • Used in patients with low back problems or be
    associated with sprains (ligaments), strains
    (muscle/tendon) , or other musculoskeletal
    injuries

7
Contraindications
  • Caution in patients with liver or renal
    compromise
  • Caution if must be alert
  • Flexeril may have anticholinergic activity
    caution in BPH, glaucoma and cardiac dysrhythmias

8
General Considerations
  • No muscle relaxants are considered safe during
    pregnancy and lactation
  • Lioresal (baclofen) approved for spasticity in
    patients with multiple sclerosis
  • Flexeril (cyclobenzaprine) not recommended for
    more than three weeks

9
Age-Related Considerations
  • Safety and effectiveness in children not
    established
  • Caution in elderly because of anticholinergic
    effects and because of sedation

10
Individual Drugs
  • Lioresal (baclofen) used in MS and SCI. PO or
    intrathecal (spinal). Decrease dose in renal
    impairment. Taper over 1-2 weeks
  • Soma (carisoprodol) indicated for acute, painful,
    musculoskeletal disorders. Can cause physical
    dependence. Withdrawal s/s if stopped suddenly.
    Half-life is 8 hours.
  • Flexeril (cyclobenzaprine). Contraindicated in
    patients with CV disorders, recent MI and
    hyperthyroidism.

11
Individual Drugs
  • Dantrium (dantrolene)
  • Acts directly on skeletal muscle to inhibit
    muscle contraction. Used to relieve spasticity in
    neurologic disorders and in Tx of malignant
    hyperthermia.
  • Use 1-2 days before surgery in those w/documented
    MH
  • Oral preparation has slow onset of action, IV is
    rapid
  • Can cause fatal hepatitis if used on maintenance
    basis

12
Individual Drugs
  • Zanaflex (tizanidine)
  • Alpha 2 adrenergic agonist, similar to clonidine
  • Given orally
  • Can cause drowsiness, dizziness, constipation,
    dry mouth and hypotension
  • Can cause psychoses and hallucinations

13
Individual Drugs
  • Robaxin (methocarbamol)
  • May be indicated to be used in tetanus (IV)
  • Contraindicated with renal impairment
  • Causes urine to have a green, brown or black
    color
  • Skelaxin
  • Painful, musculoskeletal disorders
  • Contraindicated in anemias, renal or hepatic
    compromise

14
Interactions
  • Caution with other CNS depressants
  • MAOIs may potentiate effects by inhibiting
    metabolism of muscle relaxants
  • Caution with antihypertensives as may increase
    effects of BP lowering

15
(No Transcript)
16
Substance Abuse Disorders
  • Substance abuse is self-administration of a drug
    for prolonged periods or in excessive amounts
    resulting in physical and/or psychological
    dependence
  • Most drugs of abuse affect the CNS
  • Include alcohol, CNS depressants (narcotic
    analgesics), CNS stimulants (cocaine, ecstasy,
    methamphetamine, nicotine) and others (marijuana)

17
Dependence
  • Physical dependence whereby withdrawal symptoms
    will occur upon abrupt discontinuation
  • Includes a craving for the drug
  • Often will have unsuccessful attempts to decrease
    its use
  • Continued use despite disruption in life (job
    loss, impaired relationships)

18
Dependence cont.
  • Involves all socioeconomic levels
  • School aged children to elderly
  • Drug effects depend on the substance, route of
    administration, duration of use and phase of
    substance abuse
  • Abusers are not reliable sources of information
    on their abuse
  • Often will only present for medical care when
    situation mandates, e.g. withdrawal s/s or
    serious illness
  • Used for mind-altering effects

19
CNS Depressants--Alcohol
  • Considered to be most abused drug in the world
  • Induces drug metabolizing enzymes that accelerate
    metabolism .
  • Damages liver, increases production of lactate,
    decreases excretion of uric acid, increases
    production of lipids
  • Results in irreversible changes in liver
    (necrosis, inflammation, fibrous scar
    tissuecirrhosis)

20
Alcohol
  • Effects on CNS by enhancing activity of GABA
    (inhibitory) or inhibiting glutamate (excitatory)
  • Women have less enzyme activity than men so
    absorb 30 more alcohol than men given comparable
    amounts based on weight and size
  • Women become intoxicated more quickly from
    smaller amounts and develop cirrhosis earlier

21
Alcohol
  • Causes increased intestinal motility
  • Can damage intestinal mucosa resulting in
    nutritional deficienciesthiamine, folic acid
    and Vitamin B12
  • Damages myocardial cells resulting in
    cardiomyopathy
  • Can affect bone marrow w/ resultant anemia
  • May impair growth and development of fetus (fetal
    alcohol syndrome)
  • Osteoporosis 2ndary to hypocalcemia
  • myopathies

22
Alcohol and Drug Interactions
  • CNS depressants such as sedative-hypnotics,
    narcotic analgesics, antianxiety agents, general
    anesthetics
  • Potentiates CNS depression so can cause excessive
    sedation, respiratory depression. Can be lethal.

23
Alcohol
  • With antihypertensives, causes vasodilation and
    hypotensive effects
  • With oral antidiabetic drugs, potentiates
    hypoglycemia
  • With oral anticoagulants, variable depending on
    duration of alcohol ingestion

24
Alcohol
  • With Antabuse (disulfiram), produces distress.
    Causes flushing, tachycardia, bronchospasm,
    sweating, nausea and vomiting
  • Disulfiram-like reaction may also occur with
    Flagyl (metronidazole), Diabenese
    (chlorpropamide), Orinase (tolbutamide), others

25
Alcohol Dependence
  • Occurs to extent of psychological dependence,
    physical dependence and cross tolerance w/other
    CNS depressants
  • S/S of withdrawal include agitation, tremors,
    sweating, tachycardia, fever, nausea, delirium,
    and convulsions
  • Delirium Tremens
  • Intensity of withdrawal depends on duration and
    amount of ingestion

26
Treatment of Alcohol Dependence
  • Benzodiazepine antianxiety agents are drugs of
    choice for withdrawal syndromes
  • Valium (diazepam) or Librium (chlordiazepoxide)
  • Ativan (lorazepam) or Serax (oxazepam) better in
    elderly
  • Antiseizure medications not usually needed
    post-detox

27
Alcohol
  • Two drugs for maintenance of sobriety
  • Antabuse (disulfiram)interferes with metabolism
    of alcohol and allows accumulation of
    acetaldehyde. If alcohol ingested, acetaldehyde
    will cause n/v, syncope, hypotension, headache
    and confusion. Can affect cardiac functioning and
    even convulsions.
  • Caution in OTC meds that contain etoh.

28
Alcohol
  • Second drug used to maintain sobriety is ReVia
    (naltrexone).
  • Opiate antagonist that reduces craving for
    alcohol. Thought to be related to blockade of the
    endogenous opioid system which then decreases
    alcohol craving and consumption.
  • Adverse effects include anxiety, dizziness,
    drowsiness, headache, insomnia, and vomiting.

29
Alcohol
  • Key to abstinence is desire to stop drinking
  • Need support and psychiatric help
  • Antidepressants appear to decrease alcohol intake
    as well

30
Barbiturate and Benzodiazepine Dependence
  • Resembles alcohol dependence in symptoms of
    intoxication and withdrawal
  • Includes physical dependence, psychologic
    dependence, tolerance, and cross tolerance
  • Convulsions are more likely to occur during first
    48 hours of withdrawal
  • S/S of withdrawal are less severe with
    benzodiazepines than with barbiturates

31
Barbiturates
  • Barbiturates largely replaced by benzodiazepines
  • Examples Luminal (phenobarbital), Pentothal
    (thiopental), Nembutal (pentobarbital), Seconal
    (secobarbital)

32
Barbiturate Dependence
  • No antidote for overdose. Treatment is
    symptomatic and supportive.
  • Withdrawal can be life-threatening
  • May treat with gastric lavage if within 3 hours
    of ingestion
  • If comatose, mechanical ventilation necessary
  • Diuresis or hemodialysis clear the drug

33
Benzodiazepines
  • May need to treat supportively as well
  • Romazicon (flumazenil) is antidote, competes with
    benzodiazepine receptors
  • Treatment of withdrawal involves administering
    benzodiazepines or phenobarbital in gradually
    tapering doses

34
Benzodiazepines
  • Librium, Valium, Versed, Ativan, Xanax,
    Klonopin, Tranxene, ProSom, Serax, Restoril,
    Halcion
  • Atypical benzodiazepine receptor ligands
  • Sonata (zalepon) and Ambien (zolpidem)

35
Opiates
  • Commonly abused
  • Produce tolerance and high degrees of
    psychological and physical dependence
  • Not an issue when needed for pain management in
    terminal illnesses

36
Treatment of Opiate Dependence
  • Overdose will require supportive care
  • Giving narcotic antagonist can precipitate
    withdrawal s/s
  • Can achieve therapeutic withdrawal by gradually
    tapering dose

37
Treatment of Opiate Dependence
  • Methadone used in treatment
  • Blocks euphoria, acts longer and reduces
    preoccupation with drug use
  • LAAM (Orlaam) is synthetic, Schedule II narcotic
    used for treatment of opiate dependence. Can be
    given three times weekly (If M-W-F, Friday dosing
    needs to be larger to prevent withdrawal s/s over
    weekend)

38
LAAM
  • Can overdose if patient takes this medication and
    other opiates
  • Has prodysrhythmic effects so need baseline ECG.
  • Can use ReVia (naltrexone) but then have to give
    alternative non-narcotic analgesic. If undergoing
    elective surgery, must stop taking ReVia 72h
    before procedure

39
CNS Stimulants
  • Not recommended in children under 6 years of age
  • May affect growth
  • Ritalin (methylphenidate) is most commonly used
    drug for children with ADHD

40
Amphetamines
  • Increase amounts of norepinephrine, dopamine and
    serotonin
  • Are Schedule II drugs under Controlled Substances
    Act
  • High potential for addiction and abuse
  • Concerta, Focalin, Ritalin, Daytrana, Adderall,
    Metadate, Vyvanse

41
Amphetamine Dependence
  • Produce stimulation and euphoria
  • Effects are dose related
  • Small amounts cause mental alertness, wakefulness
    and increased energy
  • Large amounts can cause psychoses
  • Tolerance develops

42
Methamphetamine
  • Psychostimulant
  • Increases levels of norepinephrine, serotonin and
    dopamine
  • Extremely neurotoxiccan result in a secondary
    Parkinsonism. Causes dopaminergic degeneration.
  • Meth mouth
  • Patriot Act 2005 removed active ingredients,
    ephedrine or pseudoephedrine, were removed from
    regular OTC access

43
Xanthines
  • Caffeine
  • Stimulates cerebral cortex thus increasing
    alertness and decreasing fatigue
  • Cause myocardial stimulation, diuresis, and
    increased sescretion of pepsin and HCL,
    cerebrovascular constriction, bronchodilation
  • Can cause restlessness, nervousness, anxiety,
    agitation, insomnia, cardiac dysrhythmias and
    gastritis

44
Xanthines
  • Frequently ingested stimulant in form of coffee,
    tea, cola drinks
  • Develop tolerance and habituation
  • Combined with other medications to enhance
    absorption and work as an additive with ergots,
    oxycodone, OTC pain and cold remedies

45
Cocaine
  • Powerful CNS stimulant
  • Prevents reuptake of dopamine, norepinephrine and
    serotonin and prolongs neurotransmitter effects
  • Inhalation
  • Produces euphoria, increased energy and
    alertness, sexual arousal, tachycardia, increased
    blood pressure and restlessness

46
Cocaine
  • As drug wears off, patient will feel depressed,
    fatigued and drowsy
  • Can cause cardiac dysrhythmias, MI, convulsions,
    stroke and death
  • Not physically addictive but cause psychologic
    dependence
  • Crack cocaine highly addictive after first dose

47
Treatment
  • Treat with Haldol or other antipsychotics
  • Treat cardiac dysrhythmias with antidysrhythmics
  • Need detox and psychiatric counseling

48
Nicotine
  • Promotes compulsive use, abuse and dependence
  • Inhaling smoke from cigarrette delivers 1 mg of
    nicotine
  • Readily absorbed through the lungs, skin, mucous
    membranes
  • Metabolized by liver, excreted by kidneys
  • GI effects n/v, increases muscle tone and
    motility, aggravates GERD and PUD

49
Nicotine
  • Toxic effects include hypertension, cardiac
    dysrhythmias, convulsions, coma, respiratory
    arrest, paralysis of skeletal muscle
  • With chronic use, implicated in vascular disease
    and sudden cardiac death

50
Nicotine
  • Dependence is characterized by compulsive use and
    development of tolerance and physical dependence
  • Compulsion when nicotine levels become low
  • S/S of withdrawal include anxiety, irritability,
    difficulty concentrating, restlessness, headache,
    increased appetite, weight gain, and sleep
    disturbances

51
Treatment of Nicotine Addiction
  • Wellbutrin or Zyban (buproprion) OR
  • Nicotine replacement in form of patches or gum
    inhaler and nasal spray by prescription
  • Intended for use no longer than 3-6 months
  • Contraindicated in CAD
  • May use buproprion and nicotine in concert

52
MDMA
  • Psychoactive similar to methamphetamine
  • Stimulant and psychedelic, create energizing
    effect
  • Causes distortion in perception of time
  • Affects primarily serotonin
  • Neurotoxic
  • addictive

53
MDMA
  • Can affect with body temperature regulation
  • Cognitive impairment
  • Causes tachycardia, elevated BP, involuntary
    teeth clenching, chills or sweating

54
Analeptics
  • CNS stimulants
  • Provigil (modafinil) for narcolepsy
  • Mechanism of action unclear
  • Not recommended in patients with LVH or ischemic
    changes on ECG
  • Adverse effects include chest pain, dizziness,
    dyspnea, dysrhythmias, headache, nausea,
    nervousness, palpitations

55
Toxicity of CNS stimulants
  • s/s agitation, dysrhythmias, combativeness,
    confusion, hyperactivity, insomnia, irritability,
    nervousness, panic states, restlessness, tremors,
    seizures, coma, circulatory collapse and death
  • Tx is supportive. Gastric lavage within 4h of
    ingestion. Activated charcoal (1g/kg). IV Valium

56
Others
  • Ketamine
  • Rohypnol (flunitrazepam)
  • GHB (gamma hydroxybutyric acid)
  • Dextromethorphan
  • THC
  • Absinthe
About PowerShow.com