152 Questions
Which of the following medications is useful in the acute treatment of alcohol withdrawal?
Diazepam
What is a contraindication for the use of benzodiazepines?
Pregnancy
What is a common adverse effect of benzodiazepines?
Headache
What is the antidote used to treat benzodiazepine overdose?
Flumazenil
What is the purpose of diazepam in procedural sedation and anesthesia?
Sedation
What is a benefit of buspirone over benzodiazepines?
No sedative action or risk of dependence
What is a possible cause of insomnia?
Anxiety and stress
What are the two basic elements of sleep architecture?
REM and non-REM sleep
What is the primary difference between sedatives and hypnotics?
Sedatives reduce nervousness, while hypnotics cause sleep
What is the main mechanism of action of benzodiazepines?
Increasing the action of gamma-aminobutyric acid (GABA)
What is a common indication for the use of benzodiazepines?
Relief of anxiety
What is the name of the system that benzodiazepines affect in the brain?
Limbic system
What is the definition of anxiety?
An unpleasant state of mind characterized by a sense of dread and fear
What are the three main chemical classifications of sedative-hypnotics?
Barbiturates, benzodiazepines, and miscellaneous drugs
What is a common side effect of benzodiazepines?
Amnesia
What is the primary difference between anxiolytic drugs and sedative-hypnotics?
Anxiolytic drugs are used for anxiety, while sedative-hypnotics are used for sleep disorders
What is the result of REM interference caused by prolonged sedative-hypnotic use?
Daytime fatigue
Which of the following drugs is classified as a sedative-hypnotic and anxiolytic depending on the dosage and patient sensitivity?
Benzodiazepines
What is the primary advantage of Zolpidem compared to Benzodiazepines?
Lower incidence of daytime sleepiness
What is the mechanism of action of Barbiturates?
Potentiating the action of inhibitory neurotransmitter GABA
What is the primary indication for Ramelteon usage?
Patients who have difficulty with sleep onset
What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?
Abnormally large amount of REM sleep
What is the characteristic of Barbiturates that makes them habit-forming?
Low therapeutic index
What is the brain region primarily affected by Barbiturates?
Reticular formation
What is the primary use of ultra short-acting barbiturates?
Anesthesia for short surgical procedures
What is a contraindication for the use of barbiturates?
Pregnancy
What is a common adverse effect of barbiturates on the central nervous system?
Drowsiness
Why should patients avoid taking other medications with barbiturates?
To prevent drug interactions
What is a nursing implication for administering hypnotics?
Give hypnotics 30 to 60 minutes before bedtime
Why should elderly patients be cautioned when using benzodiazepines?
They may experience REM rebound and a tired feeling
What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?
Rebound insomnia
Why is it important to keep side rails up or use bed alarms when administering hypnotics?
To prevent falls and injuries
What is the primary benefit of using diazepam in anxiety treatment?
versatility in administration forms
What is a unique characteristic of buspirone compared to benzodiazepines?
no sedative action or risk of dependence
What is a common cause of insomnia?
all of the above
What is the primary function of Flumazenil?
antidote for benzodiazepine overdose
What is a characteristic of non-rapid eye movement (non-REM) sleep?
decreased consciousness
What is a possible consequence of benzodiazepine toxicity?
diminished reflexes and coma
What is a benefit of using diazepam in procedural sedation and anesthesia?
skeletal muscle relaxation
What is a common adverse effect of benzodiazepines in elderly patients?
fall hazard
What is the result of prolonged sedative-hypnotic use on REM sleep?
Reduced REM sleep
What is the primary action of zolpidem compared to benzodiazepines?
Shorter duration of action
What is the mechanism of action of ramelteon?
Acting as a melatonin agonist
What is a characteristic of barbiturates?
Low therapeutic index and habit-forming
What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?
Abnormally large amount of REM sleep
What is the primary indication for ramelteon usage?
Insomnia related to difficulty with sleep onset
What is the effect of barbiturates on the brain?
Reduction of nerve impulses in the brainstem
What is the advantage of zaleplon and zolpidem compared to benzodiazepines?
Lower incidence of daytime sleepiness
What is the primary effect of anxiolytic drugs on the central nervous system (CNS)?
Depress activity
What is the main characteristic of hypnotics compared to sedatives?
More potent effect on the CNS
What is the primary mechanism of action of benzodiazepines?
Increasing the action of GABA
What is a common indication for the use of benzodiazepines?
All of the above
What is the classification of drugs that can act as either a sedative or a hypnotic depending on the dose and patient responsiveness?
Sedative-hypnotics
Which of the following is NOT a classification of sedative-hypnotics?
Opioids
What is the primary characteristic of anxiety?
A sense of dread and fear
What is a common use of benzodiazepines in addition to anxiety relief?
Skeletal muscle relaxation
What is the primary use of ultra short-acting barbiturates like thiopental?
Anesthesia for short surgical procedures
What is a significant respiratory difficulty that is a contraindication for the use of barbiturates?
Significant respiratory difficulties
What is a common adverse effect of barbiturates on the central nervous system?
Mental depression
Why should patients avoid taking other medications with barbiturates?
Because they are enzyme inducers
What is the recommended time to administer hypnotics before bedtime for maximum effectiveness?
30 to 60 minutes
Why should elderly patients be cautioned when using benzodiazepines?
Because they can cause REM rebound and a tired feeling the next day
What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?
Rebound insomnia
Why is it important to keep side rails up or use bed alarms when administering hypnotics?
To ensure patient safety
What is the primary purpose of benzodiazepines in the treatment of alcohol withdrawal?
To reduce the risk of withdrawal-related seizures
What is a common symptom of benzodiazepine overdose?
Somnolence
What is the benefit of using buspirone over benzodiazepines?
It has no sedative action or risk of dependence
What is the primary difference between REM and non-REM sleep?
REM sleep is characterized by rapid eye movement, while non-REM sleep is not
What is the primary mechanism of action of Flumazenil?
It is an antidote for benzodiazepine overdose
What is a common cause of insomnia?
All of the above
What is the primary purpose of using diazepam in skeletal muscle relaxation?
To relieve muscle spasms
What is the primary effect of benzodiazepines on the elderly?
They increase the risk of falls
What is the primary indication for ultra-short acting barbiturates?
Anesthesia for short surgical procedures
What is a common adverse effect of barbiturates on the central nervous system?
Mental depression
Why should patients avoid taking other medications with barbiturates?
Because barbiturates induce enzymes in the liver, shortening the duration of action of many drugs
What is a contraindication for the use of barbiturates?
All of the above
What is the primary benefit of giving hypnotics 30 to 60 minutes before bedtime?
To improve the quality of sleep
What is a potential consequence of discontinuing a 3- to 4-week regimen of hypnotics?
Rebound insomnia
Why is it important to keep side rails up or use bed alarms when administering hypnotics?
To prevent falls and injuries
What is a nursing implication for administering hypnotics?
Give hypnotics 30 to 60 minutes before bedtime
What is the consequence of prolonged sedative-hypnotic use on REM sleep?
Reduced REM sleep
What is the primary mechanism of action of barbiturates?
Potentiating the action of inhibitory neurotransmitter GABA
Which of the following medications is a melatonin agonist?
Ramelteon
What is the primary benefit of zolpidem compared to benzodiazepines?
Lower incidence of daytime sleepiness
What is the primary indication for ramelteon usage?
Patients with difficulty falling asleep
What is the characteristic of barbiturates that makes them habit-forming?
Low therapeutic index
What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?
Increased REM sleep
What is the primary effect of zaleplon and zolpidem on the brain?
Inhibition of the cerebral cortex
What is the primary effect of anxiolytic drugs on the central nervous system (CNS)?
Decrease activity in the brainstem and limbic system
What is the main characteristic of hypnotics compared to sedatives?
Hypnotics have a more potent effect on the CNS
Which of the following is a common indication for the use of benzodiazepines?
Treatment of seizure disorders
What is the mechanism of action of benzodiazepines?
Increasing GABA activity
What is the main difference between anxiolytic drugs and sedative-hypnotics?
Anxiolytic drugs are used to treat anxiety, while sedative-hypnotics are used to treat insomnia
What is anxiety?
A normal physiologic emotion
What is the primary effect of sedative-hypnotics on the CNS?
Decrease activity in the CNS
What is a common side effect of benzodiazepines?
Amnesia
What is the primary function of anxiolytic drugs?
To reduce anxiety
What is a characteristic of benzodiazepines?
They are used to treat seizure disorders
What is the effect of benzodiazepines on the brain?
They decrease activity in the brainstem and limbic system
What is a characteristic of sedative-hypnotics?
They can act as either a sedative or a hypnotic
What is a common indication for the use of benzodiazepines?
Relief of anxiety
What is the difference between sedatives and hypnotics?
Sedatives reduce anxiety, while hypnotics cause sleep
What is the mechanism of action of benzodiazepines?
They increase the action of GABA
What is the classification of sedative-hypnotics?
Barbiturates, benzodiazepines, and miscellaneous drugs
What is the primary use of ultra short-acting barbiturates?
Anesthesia for short surgical procedures
What is a contraindication for the use of barbiturates?
All of the above
What is a common adverse effect of barbiturates on the central nervous system?
Lethargy
Why should patients avoid taking other medications with barbiturates?
All of the above
What is a nursing implication for administering hypnotics?
Give hypnotics 30 to 60 minutes before bedtime
What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?
Rebound insomnia
Why is it important to keep side rails up or use bed alarms when administering hypnotics?
To prevent falls
What is a unique characteristic of barbiturates?
They are habit-forming
What is the primary benefit of using benzodiazepines in the acute treatment of alcohol withdrawal?
Reducing the risk of withdrawal-related seizures
What is a common adverse effect of benzodiazepines that can be a significant fall hazard in elderly patients?
Dizziness or vertigo
What is the primary difference between diazepam and buspirone?
Buspirone has no sedative action or risk of dependence
What is the primary function of Flumazenil?
Reversing benzodiazepine toxicity
What is the primary characteristic of non-rapid eye movement (non-REM) sleep?
Decreased physical activity and consciousness
What is the primary consequence of benzodiazepine toxicity?
Somnolence, confusion, and coma
What is the primary benefit of using diazepam in procedural sedation and anesthesia?
Producing skeletal muscle relaxation
What is the primary characteristic of sleep architecture?
A cyclic pattern of REM and non-REM sleep
What is the result of prolonged sedative-hypnotic use on REM sleep?
Reduced REM sleep
What is the primary mechanism of action of barbiturates?
Potentiating the action of inhibitory neurotransmitter GABA
What is the primary advantage of zolpidem compared to benzodiazepines?
Lower incidence of daytime sleepiness
What is the primary indication for ramelteon usage?
Sleep onset
What is the consequence of REM rebound after discontinuing a sedative-hypnotic drug?
Frequent and vivid dreams
What is the characteristic of barbiturates that makes them habit-forming?
Low therapeutic index
What is the primary effect of ramelteon on the body?
Regulating day-night sleep cycles
What is the primary difference between benzodiazepines and zaleplon/zolpidem?
Chemical structure
What is a unique characteristic of isoflurane compared to enflurane?
It has a more rapid onset of action
What is a common adverse effect of ketamine?
Hallucinations
What is a characteristic of propofol?
It is used for maintenance of general anesthesia
What is the primary purpose of local anesthetics?
To reduce pain sensations
What is a characteristic of sevoflurane?
It has a rapid onset and rapid elimination
What is the primary mechanism of action of local anesthetics?
They interfere with nerve transmission
What is a common use of propofol?
For general anesthesia and sedation
What is a characteristic of ketamine?
It is highly lipid soluble
What is the initial effect of general anesthesia on the senses?
Loss of senses of sight, touch, taste, smell, and hearing
What is a potential fatal adverse effect of general anesthesia?
Malignant hyperthermia
What determines the dose of any anesthetic?
The complexity of the surgical procedure and the physical characteristics of the patient
What is the main difference between adjunct anesthetics and general anesthetics?
Their use complements the use of other drugs
What is the primary function of anticholinergics in anesthesia?
Preventing secretions
What is the role of opioid analgesics in balanced anesthesia?
Pain relief
What is the term for the simultaneous use of both general anesthetics and adjunct drugs?
Balanced anesthesia
What is a characteristic of fat-soluble drugs?
They are strong anesthetics
What is the primary goal of moderate sedation?
To allow the patient to relax, yet still maintain their own open airway
What is the difference between general anesthesia and local anesthesia?
General anesthesia causes complete loss of consciousness, while local anesthesia does not
What is the main characteristic of inhalational anesthetics?
They are volatile liquids or gases that are vaporized or mixed with oxygen
What is the purpose of parenteral anesthetics?
To induce anesthesia and/or maintain anesthesia, induce amnesia, and as adjuncts to inhalation anesthetics
What is the advantage of using a synergistic combination of drugs in general anesthesia?
It allows for better control of the patient's anesthetized state
What is the primary difference between moderate sedation and general anesthesia?
Moderate sedation does not cause respiratory arrest, while general anesthesia does
What is the main characteristic of local anesthesia?
It is used to numb a specific area of the body
What is the primary effect of general anesthesia on the body?
It eliminates pain and other sensations throughout the entire body
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.
Learn about the effects of anxiolytic, sedative, and hypnotic drugs on the central nervous system, including their differences and uses.
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