Sedatives and Hypnotics
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Questions and Answers

Which of the following medications is useful in the acute treatment of alcohol withdrawal?

  • Buspirone
  • Antidepressants
  • Diazepam (correct)
  • Flumazenil

    • What is a contraindication for the use of benzodiazepines?

  • Pregnancy (correct)
  • Insomnia
  • Anxiety disorder
  • Skeletal muscle relaxation

    • What is a common adverse effect of benzodiazepines?

  • Hypertension
  • Headache (correct)
  • Nausea
  • Diarrhea

    • What is the antidote used to treat benzodiazepine overdose?

    <p>Flumazenil</p> Signup and view all the answers

    What is the purpose of diazepam in procedural sedation and anesthesia?

    <p>Sedation</p> Signup and view all the answers

    What is a benefit of buspirone over benzodiazepines?

    <p>No sedative action or risk of dependence</p> Signup and view all the answers

    What is a possible cause of insomnia?

    <p>Anxiety and stress</p> Signup and view all the answers

    What are the two basic elements of sleep architecture?

    <p>REM and non-REM sleep</p> Signup and view all the answers

    What is the primary difference between sedatives and hypnotics?

    <p>Sedatives reduce nervousness, while hypnotics cause sleep</p> Signup and view all the answers

    What is the main mechanism of action of benzodiazepines?

    <p>Increasing the action of gamma-aminobutyric acid (GABA)</p> Signup and view all the answers

    What is a common indication for the use of benzodiazepines?

    <p>Relief of anxiety</p> Signup and view all the answers

    What is the name of the system that benzodiazepines affect in the brain?

    <p>Limbic system</p> Signup and view all the answers

    What is the definition of anxiety?

    <p>An unpleasant state of mind characterized by a sense of dread and fear</p> Signup and view all the answers

    What are the three main chemical classifications of sedative-hypnotics?

    <p>Barbiturates, benzodiazepines, and miscellaneous drugs</p> Signup and view all the answers

    What is a common side effect of benzodiazepines?

    <p>Amnesia</p> Signup and view all the answers

    What is the primary difference between anxiolytic drugs and sedative-hypnotics?

    <p>Anxiolytic drugs are used for anxiety, while sedative-hypnotics are used for sleep disorders</p> Signup and view all the answers

    What is the result of REM interference caused by prolonged sedative-hypnotic use?

    <p>Daytime fatigue</p> Signup and view all the answers

    Which of the following drugs is classified as a sedative-hypnotic and anxiolytic depending on the dosage and patient sensitivity?

    <p>Benzodiazepines</p> Signup and view all the answers

    What is the primary advantage of Zolpidem compared to Benzodiazepines?

    <p>Lower incidence of daytime sleepiness</p> Signup and view all the answers

    What is the mechanism of action of Barbiturates?

    <p>Potentiating the action of inhibitory neurotransmitter GABA</p> Signup and view all the answers

    What is the primary indication for Ramelteon usage?

    <p>Patients who have difficulty with sleep onset</p> Signup and view all the answers

    What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?

    <p>Abnormally large amount of REM sleep</p> Signup and view all the answers

    What is the characteristic of Barbiturates that makes them habit-forming?

    <p>Low therapeutic index</p> Signup and view all the answers

    What is the brain region primarily affected by Barbiturates?

    <p>Reticular formation</p> Signup and view all the answers

    What is the primary use of ultra short-acting barbiturates?

    <p>Anesthesia for short surgical procedures</p> Signup and view all the answers

    What is a contraindication for the use of barbiturates?

    <p>Pregnancy</p> Signup and view all the answers

    What is a common adverse effect of barbiturates on the central nervous system?

    <p>Drowsiness</p> Signup and view all the answers

    Why should patients avoid taking other medications with barbiturates?

    <p>To prevent drug interactions</p> Signup and view all the answers

    What is a nursing implication for administering hypnotics?

    <p>Give hypnotics 30 to 60 minutes before bedtime</p> Signup and view all the answers

    Why should elderly patients be cautioned when using benzodiazepines?

    <p>They may experience REM rebound and a tired feeling</p> Signup and view all the answers

    What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?

    <p>Rebound insomnia</p> Signup and view all the answers

    Why is it important to keep side rails up or use bed alarms when administering hypnotics?

    <p>To prevent falls and injuries</p> Signup and view all the answers

    What is the primary benefit of using diazepam in anxiety treatment?

    <p>versatility in administration forms</p> Signup and view all the answers

    What is a unique characteristic of buspirone compared to benzodiazepines?

    <p>no sedative action or risk of dependence</p> Signup and view all the answers

    What is a common cause of insomnia?

    <p>all of the above</p> Signup and view all the answers

    What is the primary function of Flumazenil?

    <p>antidote for benzodiazepine overdose</p> Signup and view all the answers

    What is a characteristic of non-rapid eye movement (non-REM) sleep?

    <p>decreased consciousness</p> Signup and view all the answers

    What is a possible consequence of benzodiazepine toxicity?

    <p>diminished reflexes and coma</p> Signup and view all the answers

    What is a benefit of using diazepam in procedural sedation and anesthesia?

    <p>skeletal muscle relaxation</p> Signup and view all the answers

    What is a common adverse effect of benzodiazepines in elderly patients?

    <p>fall hazard</p> Signup and view all the answers

    What is the result of prolonged sedative-hypnotic use on REM sleep?

    <p>Reduced REM sleep</p> Signup and view all the answers

    What is the primary action of zolpidem compared to benzodiazepines?

    <p>Shorter duration of action</p> Signup and view all the answers

    What is the mechanism of action of ramelteon?

    <p>Acting as a melatonin agonist</p> Signup and view all the answers

    What is a characteristic of barbiturates?

    <p>Low therapeutic index and habit-forming</p> Signup and view all the answers

    What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?

    <p>Abnormally large amount of REM sleep</p> Signup and view all the answers

    What is the primary indication for ramelteon usage?

    <p>Insomnia related to difficulty with sleep onset</p> Signup and view all the answers

    What is the effect of barbiturates on the brain?

    <p>Reduction of nerve impulses in the brainstem</p> Signup and view all the answers

    What is the advantage of zaleplon and zolpidem compared to benzodiazepines?

    <p>Lower incidence of daytime sleepiness</p> Signup and view all the answers

    What is the primary effect of anxiolytic drugs on the central nervous system (CNS)?

    <p>Depress activity</p> Signup and view all the answers

    What is the main characteristic of hypnotics compared to sedatives?

    <p>More potent effect on the CNS</p> Signup and view all the answers

    What is the primary mechanism of action of benzodiazepines?

    <p>Increasing the action of GABA</p> Signup and view all the answers

    What is a common indication for the use of benzodiazepines?

    <p>All of the above</p> Signup and view all the answers

    What is the classification of drugs that can act as either a sedative or a hypnotic depending on the dose and patient responsiveness?

    <p>Sedative-hypnotics</p> Signup and view all the answers

    Which of the following is NOT a classification of sedative-hypnotics?

    <p>Opioids</p> Signup and view all the answers

    What is the primary characteristic of anxiety?

    <p>A sense of dread and fear</p> Signup and view all the answers

    What is a common use of benzodiazepines in addition to anxiety relief?

    <p>Skeletal muscle relaxation</p> Signup and view all the answers

    What is the primary use of ultra short-acting barbiturates like thiopental?

    <p>Anesthesia for short surgical procedures</p> Signup and view all the answers

    What is a significant respiratory difficulty that is a contraindication for the use of barbiturates?

    <p>Significant respiratory difficulties</p> Signup and view all the answers

    What is a common adverse effect of barbiturates on the central nervous system?

    <p>Mental depression</p> Signup and view all the answers

    Why should patients avoid taking other medications with barbiturates?

    <p>Because they are enzyme inducers</p> Signup and view all the answers

    What is the recommended time to administer hypnotics before bedtime for maximum effectiveness?

    <p>30 to 60 minutes</p> Signup and view all the answers

    Why should elderly patients be cautioned when using benzodiazepines?

    <p>Because they can cause REM rebound and a tired feeling the next day</p> Signup and view all the answers

    What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?

    <p>Rebound insomnia</p> Signup and view all the answers

    Why is it important to keep side rails up or use bed alarms when administering hypnotics?

    <p>To ensure patient safety</p> Signup and view all the answers

    What is the primary purpose of benzodiazepines in the treatment of alcohol withdrawal?

    <p>To reduce the risk of withdrawal-related seizures</p> Signup and view all the answers

    What is a common symptom of benzodiazepine overdose?

    <p>Somnolence</p> Signup and view all the answers

    What is the benefit of using buspirone over benzodiazepines?

    <p>It has no sedative action or risk of dependence</p> Signup and view all the answers

    What is the primary difference between REM and non-REM sleep?

    <p>REM sleep is characterized by rapid eye movement, while non-REM sleep is not</p> Signup and view all the answers

    What is the primary mechanism of action of Flumazenil?

    <p>It is an antidote for benzodiazepine overdose</p> Signup and view all the answers

    What is a common cause of insomnia?

    <p>All of the above</p> Signup and view all the answers

    What is the primary purpose of using diazepam in skeletal muscle relaxation?

    <p>To relieve muscle spasms</p> Signup and view all the answers

    What is the primary effect of benzodiazepines on the elderly?

    <p>They increase the risk of falls</p> Signup and view all the answers

    What is the primary indication for ultra-short acting barbiturates?

    <p>Anesthesia for short surgical procedures</p> Signup and view all the answers

    What is a common adverse effect of barbiturates on the central nervous system?

    <p>Mental depression</p> Signup and view all the answers

    Why should patients avoid taking other medications with barbiturates?

    <p>Because barbiturates induce enzymes in the liver, shortening the duration of action of many drugs</p> Signup and view all the answers

    What is a contraindication for the use of barbiturates?

    <p>All of the above</p> Signup and view all the answers

    What is the primary benefit of giving hypnotics 30 to 60 minutes before bedtime?

    <p>To improve the quality of sleep</p> Signup and view all the answers

    What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?

    <p>Rebound insomnia</p> Signup and view all the answers

    Why is it important to keep side rails up or use bed alarms when administering hypnotics?

    <p>To prevent falls and injuries</p> Signup and view all the answers

    What is a nursing implication for administering hypnotics?

    <p>Give hypnotics 30 to 60 minutes before bedtime</p> Signup and view all the answers

    What is the consequence of prolonged sedative-hypnotic use on REM sleep?

    <p>Reduced REM sleep</p> Signup and view all the answers

    What is the primary mechanism of action of barbiturates?

    <p>Potentiating the action of inhibitory neurotransmitter GABA</p> Signup and view all the answers

    Which of the following medications is a melatonin agonist?

    <p>Ramelteon</p> Signup and view all the answers

    What is the primary benefit of zolpidem compared to benzodiazepines?

    <p>Lower incidence of daytime sleepiness</p> Signup and view all the answers

    What is the primary indication for ramelteon usage?

    <p>Patients with difficulty falling asleep</p> Signup and view all the answers

    What is the characteristic of barbiturates that makes them habit-forming?

    <p>Low therapeutic index</p> Signup and view all the answers

    What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?

    <p>Increased REM sleep</p> Signup and view all the answers

    What is the primary effect of zaleplon and zolpidem on the brain?

    <p>Inhibition of the cerebral cortex</p> Signup and view all the answers

    What is the primary effect of anxiolytic drugs on the central nervous system (CNS)?

    <p>Decrease activity in the brainstem and limbic system</p> Signup and view all the answers

    What is the main characteristic of hypnotics compared to sedatives?

    <p>Hypnotics have a more potent effect on the CNS</p> Signup and view all the answers

    Which of the following is a common indication for the use of benzodiazepines?

    <p>Treatment of seizure disorders</p> Signup and view all the answers

    What is the mechanism of action of benzodiazepines?

    <p>Increasing GABA activity</p> Signup and view all the answers

    What is the main difference between anxiolytic drugs and sedative-hypnotics?

    <p>Anxiolytic drugs are used to treat anxiety, while sedative-hypnotics are used to treat insomnia</p> Signup and view all the answers

    What is anxiety?

    <p>A normal physiologic emotion</p> Signup and view all the answers

    What is the primary effect of sedative-hypnotics on the CNS?

    <p>Decrease activity in the CNS</p> Signup and view all the answers

    What is a common side effect of benzodiazepines?

    <p>Amnesia</p> Signup and view all the answers

    What is the primary function of anxiolytic drugs?

    <p>To reduce anxiety</p> Signup and view all the answers

    What is a characteristic of benzodiazepines?

    <p>They are used to treat seizure disorders</p> Signup and view all the answers

    What is the effect of benzodiazepines on the brain?

    <p>They decrease activity in the brainstem and limbic system</p> Signup and view all the answers

    What is a characteristic of sedative-hypnotics?

    <p>They can act as either a sedative or a hypnotic</p> Signup and view all the answers

    What is a common indication for the use of benzodiazepines?

    <p>Relief of anxiety</p> Signup and view all the answers

    What is the difference between sedatives and hypnotics?

    <p>Sedatives reduce anxiety, while hypnotics cause sleep</p> Signup and view all the answers

    What is the mechanism of action of benzodiazepines?

    <p>They increase the action of GABA</p> Signup and view all the answers

    What is the classification of sedative-hypnotics?

    <p>Barbiturates, benzodiazepines, and miscellaneous drugs</p> Signup and view all the answers

    What is the primary use of ultra short-acting barbiturates?

    <p>Anesthesia for short surgical procedures</p> Signup and view all the answers

    What is a contraindication for the use of barbiturates?

    <p>All of the above</p> Signup and view all the answers

    What is a common adverse effect of barbiturates on the central nervous system?

    <p>Lethargy</p> Signup and view all the answers

    Why should patients avoid taking other medications with barbiturates?

    <p>All of the above</p> Signup and view all the answers

    What is a nursing implication for administering hypnotics?

    <p>Give hypnotics 30 to 60 minutes before bedtime</p> Signup and view all the answers

    What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?

    <p>Rebound insomnia</p> Signup and view all the answers

    Why is it important to keep side rails up or use bed alarms when administering hypnotics?

    <p>To prevent falls</p> Signup and view all the answers

    What is a unique characteristic of barbiturates?

    <p>They are habit-forming</p> Signup and view all the answers

    What is the primary benefit of using benzodiazepines in the acute treatment of alcohol withdrawal?

    <p>Reducing the risk of withdrawal-related seizures</p> Signup and view all the answers

    What is a common adverse effect of benzodiazepines that can be a significant fall hazard in elderly patients?

    <p>Dizziness or vertigo</p> Signup and view all the answers

    What is the primary difference between diazepam and buspirone?

    <p>Buspirone has no sedative action or risk of dependence</p> Signup and view all the answers

    What is the primary function of Flumazenil?

    <p>Reversing benzodiazepine toxicity</p> Signup and view all the answers

    What is the primary characteristic of non-rapid eye movement (non-REM) sleep?

    <p>Decreased physical activity and consciousness</p> Signup and view all the answers

    What is the primary consequence of benzodiazepine toxicity?

    <p>Somnolence, confusion, and coma</p> Signup and view all the answers

    What is the primary benefit of using diazepam in procedural sedation and anesthesia?

    <p>Producing skeletal muscle relaxation</p> Signup and view all the answers

    What is the primary characteristic of sleep architecture?

    <p>A cyclic pattern of REM and non-REM sleep</p> Signup and view all the answers

    What is the result of prolonged sedative-hypnotic use on REM sleep?

    <p>Reduced REM sleep</p> Signup and view all the answers

    What is the primary mechanism of action of barbiturates?

    <p>Potentiating the action of inhibitory neurotransmitter GABA</p> Signup and view all the answers

    What is the primary advantage of zolpidem compared to benzodiazepines?

    <p>Lower incidence of daytime sleepiness</p> Signup and view all the answers

    What is the primary indication for ramelteon usage?

    <p>Sleep onset</p> Signup and view all the answers

    What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?

    <p>Frequent and vivid dreams</p> Signup and view all the answers

    What is the characteristic of barbiturates that makes them habit-forming?

    <p>Low therapeutic index</p> Signup and view all the answers

    What is the primary effect of ramelteon on the body?

    <p>Regulating day-night sleep cycles</p> Signup and view all the answers

    What is the primary difference between benzodiazepines and zaleplon/zolpidem?

    <p>Chemical structure</p> Signup and view all the answers

    What is a unique characteristic of isoflurane compared to enflurane?

    <p>It has a more rapid onset of action</p> Signup and view all the answers

    What is a common adverse effect of ketamine?

    <p>Hallucinations</p> Signup and view all the answers

    What is a characteristic of propofol?

    <p>It is used for maintenance of general anesthesia</p> Signup and view all the answers

    What is the primary purpose of local anesthetics?

    <p>To reduce pain sensations</p> Signup and view all the answers

    What is a characteristic of sevoflurane?

    <p>It has a rapid onset and rapid elimination</p> Signup and view all the answers

    What is the primary mechanism of action of local anesthetics?

    <p>They interfere with nerve transmission</p> Signup and view all the answers

    What is a common use of propofol?

    <p>For general anesthesia and sedation</p> Signup and view all the answers

    What is a characteristic of ketamine?

    <p>It is highly lipid soluble</p> Signup and view all the answers

    What is the initial effect of general anesthesia on the senses?

    <p>Loss of senses of sight, touch, taste, smell, and hearing</p> Signup and view all the answers

    What is a potential fatal adverse effect of general anesthesia?

    <p>Malignant hyperthermia</p> Signup and view all the answers

    What determines the dose of any anesthetic?

    <p>The complexity of the surgical procedure and the physical characteristics of the patient</p> Signup and view all the answers

    What is the main difference between adjunct anesthetics and general anesthetics?

    <p>Their use complements the use of other drugs</p> Signup and view all the answers

    What is the primary function of anticholinergics in anesthesia?

    <p>Preventing secretions</p> Signup and view all the answers

    What is the role of opioid analgesics in balanced anesthesia?

    <p>Pain relief</p> Signup and view all the answers

    What is the term for the simultaneous use of both general anesthetics and adjunct drugs?

    <p>Balanced anesthesia</p> Signup and view all the answers

    What is a characteristic of fat-soluble drugs?

    <p>They are strong anesthetics</p> Signup and view all the answers

    What is the primary goal of moderate sedation?

    <p>To allow the patient to relax, yet still maintain their own open airway</p> Signup and view all the answers

    What is the difference between general anesthesia and local anesthesia?

    <p>General anesthesia causes complete loss of consciousness, while local anesthesia does not</p> Signup and view all the answers

    What is the main characteristic of inhalational anesthetics?

    <p>They are volatile liquids or gases that are vaporized or mixed with oxygen</p> Signup and view all the answers

    What is the purpose of parenteral anesthetics?

    <p>To induce anesthesia and/or maintain anesthesia, induce amnesia, and as adjuncts to inhalation anesthetics</p> Signup and view all the answers

    What is the advantage of using a synergistic combination of drugs in general anesthesia?

    <p>It allows for better control of the patient's anesthetized state</p> Signup and view all the answers

    What is the primary difference between moderate sedation and general anesthesia?

    <p>Moderate sedation does not cause respiratory arrest, while general anesthesia does</p> Signup and view all the answers

    What is the main characteristic of local anesthesia?

    <p>It is used to numb a specific area of the body</p> Signup and view all the answers

    What is the primary effect of general anesthesia on the body?

    <p>It eliminates pain and other sensations throughout the entire body</p> Signup and view all the answers

    Study Notes

    Sedatives and Hypnotics

    Anxiolytics

    • Definition: Drugs used to depress the central nervous system (CNS) and prevent signs and symptoms of anxiety
    • Examples: Benzodiazepines, Buspirone, Beta-blockers, Antidepressants

    Benzodiazepines

    • Definition: Classified as sedatives-hypnotics or anxiolytics depending on primary usage
    • Mechanism of action: Decrease anxiety by reducing overactivity in the CNS, increasing the action of GABA
    • Indications:
      • Anxiety relief
      • Sleep disorders (short-term use recommended to avoid dependency)
      • Skeletal muscle relaxation
      • Treatment of seizure disorders
      • Amnesia
    • Examples: Diazepam, Lorazepam, Midazolam
    • Contraindications:
      • Known drug allergy
      • Narrow-angle glaucoma
      • Pregnancy
    • Adverse effects (mild):
      • Headache
      • Drowsiness
      • Paradoxical excitement or nervousness
      • Dizziness or vertigo
      • Cognitive impairment
      • Lethargy
      • Significant fall hazard in elderly patients
    • Toxicity and management of overdose:
      • Somnolence, confusion, coma, and diminished reflexes
      • Do not cause hypotension and respiratory depression unless taken with other CNS depressants
      • Treatment: Symptomatic and supportive, use Flumazenil as an antidote

    Other Sedatives and Hypnotics

    • Zaleplon and Zolpidem: Function similarly to benzodiazepines but are chemically distinct
    • Ramelteon: Newest prescription hypnotic, structurally like melatonin, regulates day-night sleep cycles
    • Barbiturates:
      • Introduced in 1903, standard drugs for treating insomnia and producing sedation
      • Habit-forming, low therapeutic index
      • Mechanism of action: Act on brainstem, reducing nerve impulses to cerebral cortex, potentiating GABA action
      • Contraindications:
        • Known drug allergy
        • Significant respiratory difficulties
        • Pregnancy
      • Adverse effects:
        • CNS: Drowsiness, lethargy, vertigo, mental depression
        • Respiratory: Respiratory depression, apnea, bronchospasms, cough
        • GI: Nausea, vomiting, diarrhea, constipation
        • Others: Agranulocytosis, hypotension, Stevens-Johnson syndrome

    Insomnia and Sleep

    • Definition: A transient, reversible, and periodic state of rest with decreased physical activity and consciousness

    • Patterns of sleep: REM sleep and non-REM sleep

    • Causes of insomnia:

      • Anxiety and stress
      • Depression
      • Physical illness
      • Pain### Sedatives and Hypnotics

    • Sedatives: reduce nervousness, excitability, and irritability without causing sleep

    • Hypnotics: cause sleep and have a much more potent effect on the CNS than sedatives

    • Many drugs are called sedative-hypnotics because they can act in the body as either a sedative or a hypnotic, depending on dose and patient responsiveness

    Classification of Sedative-Hypnotics

    • Barbiturates: introduced into clinical use in 1903, habit-forming, and have a low therapeutic index
    • Benzodiazepines: classified as either sedatives-hypnotics or anxiolytics depending on their primary usage
    • Miscellaneous drugs: include zaleplon, zolpidem, and ramelteon

    Barbiturates

    • Mechanism of action: act primarily on the brainstem in an area called the reticular formation
    • Drug effects: reduce nerve impulses traveling to the cerebral cortex, and inhibit nerve impulse transmission by potentiating the action of GABA

    Benzodiazepines

    • Mechanism of action: increase the action of GABA in the brain
    • Drug effects: decrease anxiety by reducing overactivity in the CNS, depress activity in the brainstem and limbic system
    • Indications: anxiety relief, sleep disorders, skeletal muscle relaxation, treatment of seizure disorders, amnesia, and treatment of alcohol withdrawal symptoms

    Other Sedative-Hypnotics

    • Zaleplon and zolpidem: function much like benzodiazepines but are chemically distinct from them
    • Ramelteon: structurally like the hormone melatonin, used as a hypnotic, lacks dependency effect, and has a shorter duration of action than other hypnotics

    Contraindications and Adverse Effects

    • Contraindications: known drug allergy, significant respiratory difficulties, pregnancy, and severe kidney or liver disease
    • Adverse effects: CNS (drowsiness, lethargy, vertigo, mental depression), respiratory (respiratory depression, apnea, bronchospasms, cough), GI (nausea, vomiting, diarrhea, constipation), and others (agranulocytosis, hypotension, Stevens-Johnson syndrome)

    Nursing Implications

    • Give hypnotics 30 to 60 minutes before bedtime for maximum effectiveness
    • Use with caution in the elderly, and instruct patients to avoid alcohol and other CNS depressants
    • Check with physician before taking any other medications, including over-the-counter medications
    • Rebound insomnia may occur for a few nights after a 3- to 4-week regimen has been discontinued
    • Safety is important: keep side rails up or use bed alarms, and assist patients with ambulation, especially the elderly

    Sedatives and Hypnotics

    • Anxiolytic: a drug used to depress the central nervous system (CNS); prevents signs and symptoms of anxiety.
    • Sedatives: reduce nervousness, excitability, and irritability without causing sleep.
    • Hypnotics: cause sleep and have a more potent effect on the CNS than sedatives.

    Classification of Sedative-Hypnotics

    • Barbiturates
    • Benzodiazepines
    • Miscellaneous drugs

    Anxiety

    • A normal physiologic emotion characterized by a sense of dread and fear.
    • Can occur due to various medical illnesses (e.g., cardiovascular or pulmonary disease, hypothyroidism, and hypoglycemia).
    • Clinically divided into several distinct disorders.

    Anxiolytic Drugs

    • Benzodiazepines
    • Buspirone
    • Beta-blockers
    • Antidepressants

    Benzodiazepines

    • Mechanism of action: decrease anxiety by reducing overactivity in the CNS.
    • Effects: depress activity in the brainstem and limbic system by increasing the action of GABA.
    • Indications: anxiety relief, sleep disorders, skeletal muscle relaxation, treatment of seizure disorders, amnesia, and treatment of alcohol withdrawal symptoms.
    • Contraindications: known drug allergy, narrow-angle glaucoma, pregnancy.
    • Adverse effects (mild): headache, drowsiness, paradoxical excitement or nervousness, dizziness or vertigo, cognitive impairment, lethargy, and fall hazard in elderly patients.

    Buspirone

    • An anxiolytic drug with no sedative action or risk of dependence.
    • Adverse effects: occasional nausea and headache.

    Insomnia

    • Can cause feelings of anxiety, inability to concentrate, and general debility.
    • Causes: anxiety and stress, depression, physical illness, and pain.
    • Physiology of sleep: defined as a transient, reversible, and periodic state of rest in which there is a decrease in physical activity and consciousness.

    Sleep Research

    • Study of sleep patterns, including REM sleep and non-REM sleep.
    • Prolonged sedative-hypnotic use may reduce cumulative REM sleep, leading to daytime fatigue.
    • REM rebound can occur on discontinuance of a sedative-hypnotic drug, resulting in frequent and vivid dreams.

    Other Sedative-Hypnotics

    • Zaleplon and zolpidem: function like benzodiazepines but are chemically distinct.
    • Ramelteon: a melatonin agonist, used as a hypnotic with a lack of dependency effect.
    • Barbiturates: habit-forming drugs with a low therapeutic index, used for anesthesia, sedation, and control of convulsions.

    Anesthesia

    • Anesthesia: a state of reduced neurologic function, causing complete or partial loss of sensation.
    • Moderate Sedation: also known as conscious sedation or procedural sedation, it does not cause complete loss of consciousness or respiratory arrest, and allows patients to relax and respond to verbal commands.

    Types of Anesthesia

    • General Anesthesia: involves complete loss of consciousness, loss of body reflexes, elimination of pain and sensations, and skeletal and smooth muscle paralysis.
    • Local Anesthesia (Regional Anesthetics): reduces pain sensations at the level of peripheral nerves, blocking nerve conduction only in the area where they are applied, without causing loss of consciousness.

    General Anesthetics

    • Inhalational Anesthetics: volatile liquids or gases that are vaporized or mixed with oxygen to induce anesthesia.
    • Parenteral Anesthetics: usually given IV, used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation anesthetics.

    Specific Anesthetics

    • Isoflurane: a fluorinated ether with rapid onset and little or no associated toxicity.
    • Sevoflurane: a fluorinated ether with rapid onset and elimination, making it useful in outpatient surgery settings.
    • Ketamine: can be used for both general anesthesia and moderate sedation, has a rapid onset of action and a low incidence of reduction of cardiovascular, respiratory, and bowel function.
    • Propofol (Diprivan): a parenteral general anesthetic used for induction and maintenance of general anesthesia, and for sedation for mechanical ventilation in ICU settings.

    Adjunct Anesthetics

    • Adjuncts: "helper drugs" used to complement the use of general anesthetics, for anesthesia induction, sedation, reduction of anxiety, and amnesia.
    • Examples: neuromuscular blocking agents, sedative hypnotics or anxiolytics, opioid analgesics, anticholinergics, and antiemetics.

    Mechanism of Action and Drug Effects

    • The overall effect of general anesthetics is a progressive reduction of sensory and motor CNS functions.
    • The degree and speed of this process varies with the anesthetics and adjuncts used, along with their dosages and routes of administration.

    Adverse Effects

    • Sites primarily affected: heart, peripheral circulation, liver, kidneys, and respiratory tract.
    • Malignant hyperthermia: an uncommon, but potentially fatal, condition that occurs during or after general anesthesia or use of the NMBC succinylcholine, characterized by sudden elevation in body temperature, tachypnea, tachycardia, muscle rigidity, and treated with dantrolene.

    Dosing of Anesthetics

    • The dose of any anesthetic depends on the complexity of the surgical procedure and the physical characteristics of the patient.

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