Pharmacology: Sedation and Sleep Drugs

Drugs Used for Sedation and Sleep

• The chapter covers drugs used for sedation and sleep.
• The text differentiates between sedatives and hypnotics.
• Sedatives relax, while hypnotics induce sleep.
• Insomnia is categorized as initial, intermittent, terminal, transient, short-term, and chronic.
• Rebound sleep is also discussed.
• Nursing interventions as alternatives to medication are also addressed.
• The chapter analyzes benzodiazepines and nonbenzodiazepines' effects on the central nervous system.
• Flumazenil is identified as the antidote for benzodiazepine overdose.
• Laboratory tests to monitor during extended benzodiazepine use are outlined.
• Sleep is described as a state of unconsciousness.
• Sleep is necessary for maintaining psychiatric equilibrium and strengthening the immune system.
• REM sleep is associated with dreaming.
• NREM sleep is divided into four stages.
• A healthy young adult sleep cycle typically runs through NREM and REM phases in a 90-minute period. The stages progression follows Stage 1, then 2, 3, and 4 then back to 3, 2 and lastly REM.
• Stage 2 accounts for the largest proportion of sleep time in adults.
• Insomnia is the most frequent sleep disorder, usually mild and short-lived.
• Common causes of Insomnia include lifestyle changes, pain, illness, anxiety, high caffeine intake, and large meals before bedtime.
• Insomnia is categorized into initial, intermittent, and terminal.
• Initial insomnia is characterized by difficulty falling asleep, while intermittent insomnia involves difficulty maintaining sleep.
• Terminal insomnia is defined by waking up and struggling to return to sleep.
• Sedative-hypnotic therapy is used for temporary insomnia treatment, alleviating anxiety, and/or inducing sleep before procedures.
• 7 to 8 hours of sleep is considered optimal for good health.
• Nursing implications for sedative-hypnotic therapy include monitoring central nervous system function, vital signs, sleep patterns, anxiety levels, environmental factors, nutritional needs, alcohol intake, exercise and respiratory status.
• The nurse should obtain vital signs periodically, and administer preoperative medications at the correctly scheduled time.
• As-needed medications should be reviewed with the patient to gauge effectiveness of the therapy. A repeat dose may be necessary if the attending medical professional prescribes it.
• Patient education should include information about bedtime routines, avoiding heavy meals before sleep, promoting personal comfort, encouraging environmental control, recommending activity and exercise, teaching stress management techniques, fostering health maintenance, and patient self-assessment.
• Anxiety about an upcoming procedure is often associated with insomnia; in this case, a hypnotic medication is the most recommended therapy.
• A low-dose sedative-hypnotic can be prescribed for insomnia, dizziness, combative behavior, or hallucinations.
• Benzodiazepines are widely used sedative-hypnotic agents.
• Benzodiazepines are known for having a wide safety margin and over 2000 derivatives; however, it is difficult to classify as a class. Antianxiety agents, Anticonvulsants, and Sedative-hypnotic agents are derivatives in this class.
• Benzodiazepines act by affecting type 1 and type 2 GABA receptors. This leads to stimulating the release of GABA which has sedative and conscious sedation effects.
• Common adverse effects include drowsiness, hangover, sedation, lethargy, and a reduced level of alertness.
• Serious adverse effects include confusion, agitation, amnesia, and hepatotoxicity and Flumazenil manages intentional or accidental overdose.
• Common adverse effects during benzodiazepine use include neurologic symptoms (drowsiness etc.), cardiovascular symptoms (transient hypotension), psychological symptoms (confusion etc).
• Excessive use or abuse of benzodiazepines may lead to blood dyscrasias or hepatotoxicity.
• Non-benzodiazepine sedative-hypnotic medications act by variable effects on REM sleep, for use in sedatives and hypnotics.
• Common adverse effects include hangover, sedation, lethargy, decreased alertness, transient hypotension upon arising, restlessness, and anxiety.
• Concerning non-benzodiazepine sedative-hypnotic agents, nursing implications involve premedication assessments, reviewing availability, dosage, and administration, knowledge of common adverse effects (neurological, cardiovascular, and psychological), and being aware of potential drug interactions especially with fluvoxamine, rifampin, and food.
• Newer non-benzodiazepine medications for insomnia are preferred due to less interference with natural sleep cycles and safer for long-term use.

This quiz explores the pharmacology of drugs used for sedation and sleep. It highlights the differences between sedatives and hypnotics, and discusses insomnia types and nursing interventions. Additionally, it covers benzodiazepines, nonbenzodiazepines, sleep stages, and the significance of sleep for health.