Drugs Used for Sedation and Sleep PDF

Chapter 13 Drugs Used for Sedation and Sleep Clayton’s Basic Pharmacology for Nurses, 19th edition Michelle Willihnganz, MS, RN, CNE 1  Lesson 13.1 Drugs Used for Sedation and Sleep...

Chapter 13 Drugs Used for Sedation and Sleep Clayton’s Basic Pharmacology for Nurses, 19th edition Michelle Willihnganz, MS, RN, CNE 1  Lesson 13.1 Drugs Used for Sedation and Sleep (1 of 2) 1. Differentiate among the terms sedative and hypnotic; initial, intermittent, and terminal insomnia; transient, short-term, and chronic insomnia; and rebound sleep. 2. Discuss nursing interventions that can be implemented as an alternative to administering a sedative-hypnotic medication. 2  Lesson 13.1 Drugs Used for Sedation and Sleep (2 of 2) 3. Compare the effects of benzodiazepines and nonbenzodiazepines on the central nervous system. 4. Identify the antidote drug used for the management of benzodiazepine overdose. 5. Identify laboratory tests that should be monitored when benzodiazepines are administered for an extended period. 3  Sleep  State of unconsciousness from which a person can be aroused by appropriate stimulus  Needed to maintain psychiatric equilibrium and strengthen immune system  Two phases  REM sleep associated with dreaming  NREM sleep divided into four stages 4  Four Stages of NREM Sleep  1: Transition from wakefulness to sleep; 2% to 5% of sleep time  2: Experienced as drifting, floating; 50% of sleep time  3: Transition from lighter to deeper sleep  4: Delta sleep; deep, dreamless, restful; 10% to 15% of sleep time in healthy young adults 5  The Sleep Cycle  A healthy young adult cycles through NREM and REM in a 90-minute period  Stage 1 → Stage 2 → Stage 3 → Stage 4 → Stage 3 → Stage 2 → REM  Many sleep disorders can be traced to specific abnormalities in this sleep cycle 6  Audience Response Question 1  The non–rapid eye movement (NREM) phase of sleep is divided into four stages. Which stage accounts for the largest amount of normal sleep time for an adult? a) 1 b) 2 c) 3 d) 4 7  Insomnia  Most common sleep disorder, usually mild and short-lived  Common causes  Lifestyle or environmental changes  Pain, illness, anxiety  Large amounts of caffeine; large meals before bedtime  Three types  Initial: Difficulty falling asleep  Intermittent: Difficulty staying asleep  Terminal: Waking and an inability to fall back to sleep 8  Sedative-Hypnotic Therapy (1 of 2)  Hypnotic: Drug that produces sleep  Sedative: Drug that relaxes a patient but is not necessarily accompanied by sleep  Increase total sleeping time, mainly in stages 2 and 4  Decrease number of REM cycles and amount of REM sleep  May cause REM rebound when drug use is stopped 9  Sedative-Hypnotic Therapy (2 of 2)  Actions: Sedatives produce relaxation and rest; hypnotics produce sleep  Uses: Temporary treatment of insomnia, decrease anxiety and increase relaxation and/or sleep before diagnostic or operative procedures, anticonvulsive agents 10  Audience Response Question 2  How many hours of sleep per night are thought to be optimal for good health? a) 5 to 6 b) 6 to 7 c) 7 to 8 d) 8 to 9 11  Nursing Implications for Sedative-Hypnotic Therapy  Central nervous system function  Vital signs  Sleep patterns  Anxiety level  Environmental control  Nutritional needs  Alcohol intake  Exercise  Respiratory status 12  Nursing Implementation for Sedative-Hypnotic Therapy  Obtain vital signs periodically  Give patient preoperative medications at specified time  Monitor effects  As-needed medications  Ask patient about effectiveness of previously administered therapy  Sometimes necessary to repeat a medication if an order permits doing so 13  Patient Education for Sedative-Hypnotic Therapy  Bedtime  Nutrition  Avoiding heavy meals during the evening  Personal comfort  Environmental control  Activity and exercise  Stress management  Fostering health maintenance  Patient self-assessment 14  Audience Response Question 3  A patient is experiencing insomnia due to anxiety about an upcoming procedure in the morning. The patient is oriented and cooperative, but restless. The nurse has reassured the patient, explained what the patient can expect the next day, and provided a relaxing backrub. Which medication would be most effective for this patient? a) Sedative b) Hypnotic c) Narcotic d) Muscle relaxant 15  Audience Response Question 4  A low-dose sedative-hypnotic agent may be prescribed for a patient with which condition? a) Dizziness b) Combative behavior c) Hallucinations d) Inability to sleep 16  Drug Class: Benzodiazepines (1 of 2)  Wide safety margin  More than 2000 derivatives  Difficult to describe as a class, but include:  Anticonvulsants  Antianxiety agents  Sedative-hypnotic agents 17  Drug Class: Benzodiazepines (2 of 2)  Actions: Affect type 1 and type 2 GABA receptors; bind to the receptors to stimulate the release of GABA  Uses: Preoperative sedative, conscious sedation  Common adverse effects: Drowsiness, hangover, sedation, lethargy, decreased level of alertness  Serious adverse effects  Confusion, agitation, amnesia, hepatotoxicity  Flumazenil is used for the management of an intentional or accidental overdose of benzodiazepines 18 Nursing Implications for Benzodiazepines  Premedication assessment  Availability, dosage, and administration  Pregnancy and lactation  Common adverse effects  Neurologic (drowsiness, hangover, sedation, lethargy)  Cardiovascular (transient hypotension when arising)  Serious adverse effects  Psychological (confusion, agitation, hallucinations, amnesia)  Excessive use or abuse  Blood dyscrasias (routine lab studies should be run)  Hepatotoxicity (abnormal liver function tests) 19  Drug Class: Nonbenzodiazepine Sedative-Hypnotic Agents  Action: Variable effects on REM sleep  Use: Sedative and hypnotic effects  Common adverse effects: Hangover, sedation, lethargy, decreased level of alertness, transient hypotension on arising, restlessness, anxiety 20 Nursing Implications for Nonbenzodiazepine Sedative-Hypnotic Agents  Premedication assessment  Availability, dosage, and administration  Common adverse effects  Neurologic (hangover, sedation, lethargy)  Cardiovascular (transient hypotension when arising)  Psychological (restlessness; anxiety)  Drug interactions: Fluvoxamine, rifampin, food 21  Audience Response Question 5  Why are the newer, nonbenzodiazepine medications for insomnia preferred over older medications? a) They interfere less with natural sleep cycles. b) They can be used safely for long-term insomnia. c) They have a longer duration of action. d) They are less expensive. 22 Questions? 23