Introduction to Clinical Pharmacology Chapter 18 Antidementia Drugs PDF

Introduction to Clinical Pharmacology Chapter 18 Antidementia Drugs Copyright © 2022 Wolters Kluwer · All Rights Reserved Learning Objectives 1. Compare and contrast the clinical manifestations of Alzheimer disease (AD). 2. Explain the uses, general drug actions, general adverse reactions, contrai...

Introduction to Clinical Pharmacology Chapter 18 Antidementia Drugs Copyright © 2022 Wolters Kluwer · All Rights Reserved Learning Objectives 1. Compare and contrast the clinical manifestations of Alzheimer disease (AD). 2. Explain the uses, general drug actions, general adverse reactions, contraindications, precautions, and interactions associated with the administration of antidementia drugs. 3. Distinguish important preadministration and ongoing assessment activities the nurse should perform with the client taking an antidementia drug. 4. List nursing diagnoses particular to a client taking an antidementia drug. 5. Examine ways to promote an optimal response to therapy, how to manage common adverse reactions, and important points to keep in mind when educating clients about the use of antidementia drugs. Copyright © 2022 Wolters Kluwer · All Rights Reserved What Is Dementia? ❖ Dementia—a general term used for a variety of diseases and conditions that involve decrease in cognitive functioning (i.e., memory, attention, language, communication, and problem-solving) ❖ Alzheimer disease—type of dementia with amyloid plaques and tangled nerve bundles which slow or block transmission within the brain Copyright © 2022 Wolters Kluwer · All Rights Reserved Continuum of Alzheimer Disease Progression ❖Preclinical ❖Mild cognitive impairment ❖Mild ❖Moderate ❖Severe Copyright © 2022 Wolters Kluwer · All Rights Reserved Dementia versus Delirium Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Actions #1 ❖Cholinesterase Inhibitors oIncrease the levels of acetylcholine in the central nervous system by inhibiting its breakdown and slowing neural destruction oSlow but do not stop the progress of the disease oExample: donepezil Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Actions #2 ❖NMDA Receptor Antagonist o Decreases the excitability of neurotransmission caused by an excess of the amino acid glutamate in the central nervous system o NDMA blocker attaches to the nerve cell receptors and helps prevent cell damage o Example: memantine Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Uses ❖To treat early and moderate stages of dementia associated with Alzheimer disease ❖Investigational use for severe cognitive decline associated with vascular or Parkinson dementia ❖Drugs are best used early as they slow the progression of AD Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Adverse Reactions General Adverse Reactions: Anorexia Confusion Nausea Vomiting Diarrhea Dizziness Headache Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Contraindications and Precautions Contraindicated in clients with: known hypersensitivity to the drugs pregnancy and lactation confusion from delirium Use cautiously in clients with:  renal disease, bladder obstruction  seizure disorders  sick sinus syndrome  GI bleeding  asthma  a history of ulcer disease Copyright © 2022 Wolters Kluwer · All Rights Reserved Antidementia Drugs—Interactions Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #1 Preadministration Assessment Objective Data Description of general appearance, orientation to person, place, and time Observation of behavior during interview (e.g., inappropriate answers to questions) Obtain body weight & vital signs Cognitive screen (e.g., Mini-Mental Status Examination) Other cognitive and functional ability testing Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #2 Pre-administration Assessment Subjective Data Current history of symptoms Comparison of client and family member report of ability to perform activities of daily living and self-care Unusual activity, wandering, angry outbursts Review the chart for drugs that may cause changes in mental health Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #3 Ongoing Assessment Includes both mental and physical assessment, often using standardized assessment tools or instruments Initial assessments will be compared with ongoing assessments to monitor client’s improvement after taking antidementia drugs Effects of antidementia drugs may take several weeks Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #4 Nursing Diagnoses Malnutrition: Less Than Body Requirements related to anorexia, nausea, or vomiting Injury Risk related to dizziness, syncope, clumsiness, or the disease process Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #5 Planning Expected client outcomes may include: Optimal response to therapy Management of common adverse drug reactions Absence of injury Confidence in an understanding of the prescribed medication regimen Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #6 Implementation Promoting Optimal Response to Therapy When drugs are no longer successful at slowing the progression of the disease, environmental factors may need to change If the client is hospitalized, monitor vitals signs and complete other assessments to determine if the changes in cognition are due to delirium rather than dementia Continue cholinesterase inhibitors during hospitalization. If therapy is discontinued, the client loses any benefit they received over the prior 6 weeks of treatment Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #7 Implementation Promoting Optimal Response to Therapy Apply transdermal forms of antidementia drugs to a new, clean, dry, hairless area of the body that the client cannot easily reach The same site should not be used more than once every 2 weeks; document the location of application and track for 14 days—teach caregivers Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #8 Implementation Monitoring and Managing Client Needs Malnutrition: Less Than Body Requirements Attention to dosing of medications can be helpful to decrease adverse GI reactions and promote nutrition (especially with rivastigmine) Remove oral dosing syringe provided in protective container when rivastigmine is administered as oral solution The use of namzaric (combined cholinesterase inhibitor and NMDA receptor antagonist) is taken only once daily and may be easier to take for some clients with dementia Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #9 Implementation Monitoring and Managing Client Needs Malnutrition: Less Than Body Requirements Keep mealtime simple and calm; offer client well-balanced foods that are easy to chew and digest Offer frequent small meals and a variety of different foods (consistency and flavor) Encourage fluids Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #10 Implementation Monitoring and Managing Client Needs Injury Risk Provide the client with appropriate assistive devices for ambulation and offer assistance with ambulation Provide a controlled and safe environment (e.g., bed alarms, bed in low position, night lights, and frequent monitoring) Client should always wear a medical identification bracelet Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #11 Implementation—Educating the Client and Family Develop a teaching plan for the client and family to include: Keep all appointments with primary care provider—dose changes may be needed to achieve best results Report any adverse effects Take the drug exactly as prescribed; correct and routine administration is key to effectiveness Do not drive or perform other hazardous tasks while drowsy—consider referral for driving evaluation consultation with provider Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #12  Implementation—Educating the Client and Family Develop a teaching plan for the client and family to include: Talk to primary health care provider before taking any nonprescription medications Track the administration of the drug Notify primary health care provider if client has a history of ulcers, feels faint, experiences stomach pains, vomits blood or substance that looks like coffee grounds, or has bloody or black stool Remember that the antidementia drugs slow the progression of the disease but do not cure the dementia Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antidementia Drug #13 Evaluation Was the therapeutic effect achieved? Has cognitive function maintained? Were adverse reactions: identified, reported, and managed? Client maintains an adequate nutritional status No injury is evident Did client (if able) and family express confidence and demonstrate understanding of drug regimen? Copyright © 2022 Wolters Kluwer · All Rights Reserved Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #1 In the following stage of Alzheimer disease, there are brain changes detectable on an MRI but no cognitive changes. Which stage of the disease is being described? a)Stage 1 b)Stage 2 c)Stage 3 Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #2 A client with dementia also may have delirium. Which of the following signs indicate a cognitive problem is due to delirium and not dementia? Select all that apply. a)Sudden onset b)Client feels itchy c)Placing oxygen may resolve it d)Progressive changes e)Irreversible Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #3 A client with moderate dementia of the Alzheimer type repeatedly spits out pills. They are being changed to a transdermal patch. Where should the nurse place a cholinesterase inhibitor transdermal patch so the client can’t easily remove it? a)Upper arm b)Side of thigh c)Chest d)Lower back Copyright © 2022 Wolters Kluwer · All Rights Reserved Introduction to Clinical Pharmacology Chapter 19 Antianxiety Drugs Copyright © 2022 Wolters Kluwer · All Rights Reserved Learning Objectives 1.Explain the uses, general drug actions, general adverse reactions, contraindications, precautions, and interactions associated with the administration of antianxiety drugs. 2.Distinguish important preadministration and ongoing assessment activities the nurse should perform on the client taking an antianxiety drug. 3.List nursing diagnoses particular to a client taking an antianxiety drug. 4.Examine ways to promote an optimal response to therapy, how to manage common adverse reactions, and important points to keep in mind when educating clients about the use of antianxiety drugs. Copyright © 2022 Wolters Kluwer · All Rights Reserved What Is Anxiety? ❖Anxiety—feeling of apprehension, worry, or uneasiness; can be normal; sometimes needs to be treated when it interferes with activities of daily living ❖Antianxiety medications or “anxiolytics” are used to treat anxiety Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drug—Actions ❖Anxiolytic drugs block neurotransmitter receptor sites preventing neurotransmission of the anxious perception and body’s physical reaction to anxiety ❖Benzodiazepines—potentiating effects of gamma aminobutyric acid (GABA) ❖Nonbenzodiazepines act in many ways oBuspirone—acts on serotonin receptors oHydroxyzine—acts on hypothalamus and brainstem reticular formation Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drug—Uses ❖Isolated episodes of intense anxiety ❖Temporary use with severe functional impairment ❖Preanesthetic sedation and muscle relaxation ❖Convulsions or seizures ❖Alcohol withdrawal Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Adverse Reactions #1 Frequent Early Adverse Reactions: ◦Mild drowsiness and sedation ◦Lightheadedness or dizziness ◦Headache Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Adverse Reactions #2 Other Adverse Reactions: ◦Lethargy, apathy, fatigue ◦Constipation (slowed intestinal transit time) ◦Disorientation ◦Anger ◦Restlessness ◦Nausea, dry mouth ◦Visual disturbances Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Dependence Long-term use of benzodiazepines can result in physical dependence and tolerance Should never be discontinued abruptly Withdrawal symptoms can occur Tapering—gradually decreasing dosage when stopping a benzodiazepine Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Symptoms of Benzodiazepine Withdrawal Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs-Contraindications Contraindicated in clients with: ◦known hypersensitivity to the drugs, psychosis, and acute narrow-angle glaucoma ◦pregnancy and labor due to floppy infant syndrome ◦lactation ◦coma or shock ◦acute alcoholic intoxication with abnormally low vital signs Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Contraindications and Precautions Use cautiously in: ◦elderly clients ◦ clients with impaired liver or kidney function ◦ clients with debilitation Copyright © 2022 Wolters Kluwer · All Rights Reserved Antianxiety Drugs—Interactions Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #1 Preadministration Assessment Objective Data ◦Description of general appearance, watch for cool or pale skin ◦Vital signs and weight ◦Observation of behavior during the interview Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #2 Pre-administration Assessment Subjective Data ◦ Rating of anxiety level ◦ Current history of symptoms, description of how the client reacts to stress ◦ Self-report compared to family members for episodes of behavioral change or escalation of symptoms ◦ Coping mechanisms used to deal with anxiety ◦ Medical, social, and health history ◦ Review chart for drugs that may cause changes in mental health ◦ Ask client about drug/alcohol use ◦ Inquire if breastfeeding mother is taking any antianxiety medications Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #3 Ongoing Assessment ◦Check blood pressure before drug administration (Blood pressure may increase with anxiety) ◦Periodically monitor mental status and anxiety level and compare to baseline ◦Ask client or family about adverse effects of drug ◦Assess for and document improvement or decline of client’s outward behavior, complaints, or problems ◦Monitor for adverse reactions Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #4 Nursing Diagnoses ◦ Injury Risk related to dizziness, hypotension, and gait problems ◦ Impaired Comfort related to dryness of gastrointestinal tract from medication ◦ Coping Impairment related to situation causing anxiety Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #5 Planning ◦Expected client outcomes may include: ◦Optimal response to therapy ◦Management of adverse drug reactions ◦Confidence in an understanding of the prescribed medication regimen Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #6 Implementation ◦Promoting Optimal Response to Therapy ◦ During initial therapy, the nurse observes for adverse drug reactions ◦ The antianxiety drugs are not recommended for long-term use ◦ If used for short periods (1 to 2 weeks), tolerance, withdrawal, and dependence do not usually develop ◦ Report the client needing larger doses or complaints of increased anxiety or agitation to the primary health care provider Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #7 Implementation ◦ Monitoring and Managing Client Needs ◦ Injury Risk ◦ During outpatient therapy the nurse should instruct the family and client about adverse reactions—risk for falls ◦ During inpatient therapy the nurse should instruct the client to ask for assistance getting out of bed; monitor vital signs ◦ Gerontologic alert: benzodiazepines—increased risk of adverse reactions and toxicity ◦ Buspirone is better choice for elderly clients Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #8 Implementation ◦Monitoring and Managing Client Needs ◦Injury Risk ◦ After parenteral administration of an antianxiety drug, the client should be kept lying down 30 minutes to 3 hours ◦ Resuscitative equipment should be readily available when administering antianxiety drugs parenterally to elderly clients ◦ Benzodiazepine toxicity risk—flumazenil is the antidote (antagonist) Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #9 Implementation ◦Monitoring and Managing Client Needs ◦Impaired Comfort ◦ Assess swallowing and encourage fluids especially in older/institutionalized clients ◦ Offer client sugarless gum or hard candy (decrease dry mouth) ◦ Administer antianxiety drugs with food or meals (decrease GI upset) ◦ Provide meals that include fiber, fruits, and vegetables (prevent constipation) Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #10 Implementation ◦Monitoring and Managing Client Needs ◦Coping Impairment ◦Outpatient: the nurse observes the client for response to therapy at time of each clinic visit ◦Question about response to therapy; use open-ended questions ◦Once anxiety reduced, the nurse may be able to help client identify precipitation of panic/cause of anxiety Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #11 Implementation—Educating the Client and Family ◦Develop a teaching plan for the client and family to include: ◦ Evaluation of the client’s ability to assume responsibility for taking the drugs at home ◦ Explanation of the adverse effects of specific drugs and encourage the client and family to contact primary health care provider if serious adverse effects occur ◦ Instructions to contact the primary health care provider if anxiety persists Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #12 Implementation—Educating the Client and Family ◦ Develop a teaching plan for the client and family to include: ◦ Take drug as directed ◦ Avoid performing hazardous tasks, drinking alcohol ◦ Do not discontinue drugs abruptly; instruct patient if discontinuing medication to gradually decrease dosage over time ◦ Do not take nonprescription drugs or supplements without consulting primary health care provider ◦ Inform dentist, physicians, and health care providers of your therapy Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #13 Implementation—Educating the Client and Family ◦Develop a teaching plan for the client and family to include: ◦ If dizziness occurs, rise slowly when getting out of a bed or chair ◦ If dry mouth occurs, take frequent sips of water or suck on hard candies or gum (sugarless) ◦ Preventing constipation by eating high-fiber foods and drinking adequate fluids ◦ Keep all appointments with primary health care provider and report any adverse effects/unusual changes Copyright © 2022 Wolters Kluwer · All Rights Reserved Nursing Process—Client Receiving an Antianxiety Drug #14 Evaluation ◦ Was the therapeutic effect achieved? Does the client report a decrease in feelings of anxiety? ◦ Were adverse reactions: identified, reported, and managed? ◦ No injury is evident ◦ Client reports comfort without increased GI distress ◦ Client manages coping effectively ◦ Did client and family express confidence and demonstrate understanding of drug regimen? Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #1 A client on benzodiazepine therapy for 4 weeks comes to an adult day health facility. The EHR indicates the drug was stopped abruptly. The nurse should monitor for which of the following? a)Increased RBC count b)Decreased pulse rate c)Increased anxiety d)Increased appetite Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #2 A client visits a neighborhood clinic with symptoms of anxiety. The primary health care provider has prescribed hydroxyzine. Which of the following conditions should the nurse flag for possible contraindication or complications when administering hydroxyzine? Select all that apply. a)Impaired liver function b)Impaired pancreas function c)Bone marrow depression d)Clients with debilitation Copyright © 2022 Wolters Kluwer · All Rights Reserved Pharmacology in Practice Exercise #3 An adult family home client is prescribed chlordiazepoxide for anxiety. Which of the following dietary changes should the nurse instruct the caregivers to perform to prevent the occurrence of constipation in the client? a)Provide vitamin supplements b)Restrict the client’s diet to fluids only c)Provide the client with a fiber-rich diet and plenty of fluids d)Restrict client to a strict vegetarian diet Copyright © 2022 Wolters Kluwer · All Rights Reserved INTRODUCTION TO CLINICAL PHARMACOLOGY CHAPTER 20 SEDATIVES AND HYPNOTICS Copyright © 2022 Wolters Kluwer · All Rights Reserved LEARNING OBJECTIVES 1.DIFFERENTIATE BETWEEN A SEDATIVE AND A HYPNOTIC. 2.EXPLAIN THE USES, GENERAL DRUG ACTIONS, ADVERSE REACTIONS, CONTRAINDICATIONS, PRECAUTIONS, AND INTERACTIONS OF SEDATIVES AND HYPNOTICS. 3.DISTINGUISH IMPORTANT PREADMINISTRATION AND ONGOING ASSESSMENT ACTIVITIES THE NURSE SHOULD PERFORM WITH THE CLIENT TAKING A SEDATIVE OR HYPNOTIC. 4.LIST NURSING DIAGNOSES PARTICULAR TO A CLIENT TAKING A SEDATIVE OR HYPNOTIC. 5.EXAMINE WAYS TO PROMOTE AN OPTIMAL RESPONSE TO THERAPY, HOW TO MANAGE COMMON ADVERSE REACTIONS, AND IMPORTANT POINTS TO KEEP IN MIND WHEN EDUCATING CLIENTS ABOUT THE USE OF SEDATIVES OR HYPNOTICS. Copyright © 2022 Wolters Kluwer · All Rights Reserved WHAT IS INSOMNIA? ❖INSOMNIA CRITERIA—DIFFICULTY FALLING ASLEEP; WAKING OFTEN & HAVING TROUBLE FALLING BACK TO SLEEP; WAKING TOO EARLY; FEELING TIRED UPON WAKING ❖CAUSES: LIFESTYLE CHANGES; NEW JOB; JET LAG; CHRONIC PAIN; HEADACHE; STRESS; ANXIETY Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS ❖TWO CLASSES: BARBITURATES; NONBARBITURATES ❖BARBITURATES HAVE HARSH SIDE EFFECTS AND ARE NOW ONLY USED FOR DEEP, NONWAKING SLEEP (ASSISTED SUICIDE) ❖CLASSIFICATION OF NONBARBITURATES: ❖BENZODIAZEPINES AND NONBENZODIAZEPINES ❖EXAMPLES OF BENZODIAZEPINES: ❖TEMAZEPAM; TRIAZOLAM ❖EXAMPLES OF NONBENZODIAZEPINES: ❖ESZOPICLONE; ZOLPIDEM Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS—ACTIONS ❖BARBITURATES—CNS DEPRESSION AND MOOD ALTERATIONS (MILD EXCITATION, MILD SEDATION, HYPNOSIS, AND DEEP COMA); RESPIRATORY DEPRESSANTS ❖BENZODIAZEPINES—CNS DEPRESSION; EFFECT ON GAMMA-AMINOBUTYRIC ACID (GABA) TO POTENTIATE NEURAL INHIBITION; LESSER EFFECT ON RESPIRATORY RATE; INDUCTION OF SLEEP ❖NONBENZODIAZEPINE—GROUP OF UNRELATED DRUGS THAT ALL PROVIDE SOME LEVEL OF CNS DEPRESSION; EFFECTS DIMINISH AFTER ABOUT 2 WEEKS; POTENTIAL FOR PHYSICAL TOLERANCE, DEPENDENCE, AND WITHDRAWAL Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS—USES ❖INSOMNIA ❖CONVULSIONS OR SEIZURES ❖PREOPERATIVE SEDATION ❖CONSCIOUS SEDATION Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS—ADVERSE REACTIONS • ADVERSE REACTIONS: • NERVOUS SYSTEM REACTIONS SUCH AS DIZZINESS, DROWSINESS, AND HEADACHE • GI SYSTEM REACTION— NAUSEA, HEARTBURN Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS— CONTRAINDICATIONS • CONTRAINDICATED IN CLIENTS WITH: • KNOWN HYPERSENSITIVITY TO SEDATIVES OR HYPNOTICS • COMA • SEVERE RESPIRATORY PROBLEMS • A HISTORY OF HABITUAL DRUG AND ALCOHOL USE • PREGNANCY OR LACTATION Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS— PRECAUTIONS • USE CAUTIOUSLY IN CLIENTS WITH: • LACTATION • HEPATIC OR RENAL IMPAIRMENT • HABITUAL ALCOHOL USE • MENTAL HEALTH PROBLEMS Copyright © 2022 Wolters Kluwer · All Rights Reserved SEDATIVES AND HYPNOTICS— INTERACTIONS Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #1 • PREADMINISTRATION ASSESSMENT • OBJECTIVE DATA • VITAL SIGNS—LOW BLOOD PRESSURE • LEVEL OF CONSCIOUSNESS • OBSERVATION OF BEHAVIOR DURING THE INTERVIEW • OBSERVATIONS OF THE ENVIRONMENT THAT MAY CAUSE INSOMNIA Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #2 • PRE-ADMINISTRATION ASSESSMENT • SUBJECTIVE DATA • CURRENT HISTORY OF SYMPTOMS, DESCRIPTION OF TYPICAL SLEEP PATTERNS, BEDTIME, WAKE-UP TIME • METHODS USED TO DEAL WITH INSOMNIA (SELFMEDICATION, HERBAL REMEDIES, ALCOHOL, DRUGS) • MEDICAL, SOCIAL, AND MENTAL HEALTH HISTORY • MEDICAL, SOCIAL, AND HEALTH HISTORY • REVIEW CHART FOR DRUGS THAT MAY CAUSE CHANGES IN SLEEP PATTERNS (CAFFEINE-CAUSES WAKEFULNESS) Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #3 • ONGOING ASSESSMENT • FOCUS ASSESSMENT ON WHY CLIENT CAN NOT GET ADEQUATE SLEEP • ASSESS THE VITAL SIGNS AND LEVEL OF CONSCIOUSNESS EACH TIME BEFORE ADMINISTERING THE DRUG (NOTIFY PRIMARY HEALTH CARE PROVIDER IF RESPIRATORY RATE IS LESS THAN 10 BREATHS/MIN) • CHECK IF DRUG HELPED CLIENT SLEEP ON PREVIOUS NIGHTS • CONSULT PRIMARY HEALTH CARE PROVIDER REGARDING TIME INTERVAL BETWEEN ADMINISTRATION OF DRUGS Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #4 • NURSING DIAGNOSES • INJURY RISK RELATED TO IMPAIRED MEMORY • ALTERED BREATHING PATTERN RELATED TO RESPIRATORY DEPRESSION • COPING IMPAIRMENT RELATED TO EXCESSIVE USE OF MEDICATION Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #5 • PLANNING • EXPECTED CLIENT OUTCOMES DEPEND ON THE REASON FOR ADMINISTRATION OF THE SEDATIVE OR HYPNOTIC BUT MAY INCLUDE: • OPTIMAL RESPONSE TO THERAPY • MANAGEMENT OF ADVERSE DRUG REACTIONS • CONFIDENCE IN AN UNDERSTANDING OF THE PRESCRIBED MEDICATION REGIMEN Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #6 • IMPLEMENTATION • PROMOTING OPTIMAL RESPONSE TO THERAPY • PROVIDE SUPPORTIVE CARE (BACK RUBS, NIGHT LIGHTS, DARKENED ROOM, QUIET ATMOSPHERE) • DISALLOW CONSUMPTION OF BEVERAGES CONTAINING CAFFEINE • DO NOT LEAVE SEDATIVES AND HYPNOTICS UNATTENDED NEAR CLIENT’S BEDSIDE OR IN HALLWAY OR OTHER AREAS • SOME SEDATIVES AND HYPNOTICS SHOULD ONLY BE TAKEN WHEN A PERSON PLANS FOR 7 TO 8 HOURS OF SLEEP DUE TO ADVERSE REACTIONS OF MEMORY LOSS OR AMNESIA Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #7 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • INJURY RISK • OBSERVE CLIENT FOR ADVERSE DRUG REACTIONS AND REPORT TO PRIMARY HEALTH CARE PROVIDER • PROTECT CLIENT FROM HARM AND PROVIDE SUPPORTIVE CARE AND SAFE ENVIRONMENT • ASSESS CLIENT AND DETERMINE SAFETY MEASURES TO BE TAKEN • ASSIST THE CLIENT TO RISE SLOWLY FROM SITTING TO STANDING; ASSIST THE CLIENT TO AMBULATE IF NEEDED Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #8 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • INJURY RISK • RAISE THE SIDE RAILS OF THE BED; ADVISE CLIENT TO ASK FOR ASSISTANCE TO GET OUT OF BED • ASSESS CLIENT EVERY 1 TO 2 HOURS AFTER THE DRUG IS GIVEN TO EVALUATE EFFECT OF DRUG • REPORT EXCESSIVE DROWSINESS AND HEADACHE THE MORNING AFTER ADMINISTRATION OF THE DRUG TO THE PRIMARY HEALTH CARE PROVIDER Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #9 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • INJURY RISK • OUTPATIENT SETTING: CLIENT SHOULD BE TAUGHT NOT TO OPERATE MACHINERY OR COMPLETE POTENTIALLY HAZARDOUS TASKS • OLDER ADULT IS AT GREATER RISK FOR OVERSEDATION, DIZZINESS, CONFUSION, ATAXIA, AND PARADOXICAL REACTION—MONITOR MORE FREQUENTLY AS OFTEN AS 5 TO 10 MINUTES IF EXCITEMENT OR CONFUSION OCCURS Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #10 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • ALTERED BREATHING PATTERN • ASSESS THE RESPIRATORY FUNCTION BEFORE AND FREQUENTLY AFTER ADMINISTERING THE SEDATIVE (30 MINUTES TO 1 HOUR AFTER ADMINISTRATION) • INSTRUCT NOT TO DRINK ALCOHOL DUE TO THE ADDITIVE EFFECT AND INCREASE IN CNS DEPRESSION, WHICH COULD RESULT IN DEATH Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #11 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • COPING IMPAIRMENT • ADMINISTER PRESCRIBED DRUGS FOR NO MORE THAN 2 WEEKS • EMPHASIZE IMPORTANCE OF NOT INCREASING OR DECREASING DOSE AND NOT REPEATING DOSES DURING THE NIGHT IF SEEP IS INTERRUPTED • LONG-TERM USE CAUSES DEPENDENCY Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #12 • IMPLEMENTATION • MONITORING AND MANAGING CLIENT NEEDS • COPING IMPAIRMENT • DECREASE THE DRUG DOSAGE GRADUALLY • SYMPTOMS OF WITHDRAWAL: • RESTLESSNESS; EXCITEMENT; EUPHORIA; • CONFUSION Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #13 • IMPLEMENTATION—EDUCATING THE CLIENT AND FAMILY • DEVELOP A TEACHING PLAN FOR THE CLIENT AND FAMILY TO INCLUDE: • SHORT-TERM USE ONLY • CONTACT PRIMARY HEALTH CARE PROVIDER FOR INEFFECTIVENESS OR ADVERSE REACTIONS • NOT TO DRINK ALCOHOLIC BEVERAGES 2 HOURS BEFORE, WITH, OR 8 HOURS AFTER TAKING THE DRUG • DO NOT DRIVE OR OPERATE MACHINERY Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #14 • IMPLEMENTATION—EDUCATING THE CLIENT AND FAMILY • DEVELOP A TEACHING PLAN FOR THE CLIENT AND FAMILY TO INCLUDE: • BE CAREFUL WHEN GETTING OUT OF BED AT NIGHT, DIMLY LIT ROOM, REMOVE OBSTACLES • DO NOT TAKE TRIAZOLAM OR ZALEPLON WITH GRAPEFRUIT JUICE, OTHER DIRECTIONS ABOUT TAKING MEDICATIONS WITH OR WITHOUT FOOD OR FLUID • TAKE ZOLPIDEM ON AN EMPTY STOMACH • MOST OFTEN ADMINISTERED A BEDTIME Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #15 • IMPLEMENTATION—EDUCATING THE CLIENT AND FAMILY • DEVELOP A TEACHING PLAN FOR THE CLIENT AND FAMILY TO INCLUDE: • NOT TO TAKE THESE DRUGS IF PREGNANT, PLANNING ON BECOMING PREGNANT, OR BREASTFEEDING • NOT TO TAKE OTC COLD, COUGH, OR ALLERGY DRUGS WITH A SEDATIVE OR HYPNOTIC UNLESS PRESCRIBED BY THE PRIMARY HEALTH CARE PROVIDER Copyright © 2022 Wolters Kluwer · All Rights Reserved NURSING PROCESS—CLIENT RECEIVING A SEDATIVE OR HYPNOTIC #16 • EVALUATION • WAS THE THERAPEUTIC EFFECT ACHIEVED? IS THE CLIENT CALM AND RELAXED FOR THE PROCEDURE? • WERE ADVERSE REACTIONS: IDENTIFIED, REPORTED, AND MANAGED? • NO INJURY IS EVIDENT • AN ADEQUATE BREATHING PATTERN IS MAINTAINED • CLIENT MANAGES COPING EFFECTIVELY • DID CLIENT AND FAMILY EXPRESS CONFIDENCE AND DEMONSTRATE UNDERSTANDING OF DRUG REGIMEN? Copyright © 2022 Wolters Kluwer · All Rights Reserved PHARMACOLOGY IN PRACTICE EXERCISE#1 • WHICH OF THE FOLLOWING DRUGS PURPOSELY INDUCES DROWSINESS? a)ANXIOLYTIC b)SEDATIVE c)HYPNOTIC d)OPIOID Copyright © 2022 Wolters Kluwer · All Rights Reserved PHARMACOLOGY IN PRACTICE EXERCISE#2 • A CLIENT UNDERGOING TREATMENT FOR AN ALLERGY IS PRESCRIBED SEDATIVES FOR ANXIETY. WHICH OF THE FOLLOWING MAY BE A POSSIBLE EFFECT OF THE INTERACTION BETWEEN ANTIHISTAMINES AND SEDATIVES? a)RESTLESSNESS b)INCREASED SEDATION c)HEADACHE d)CHRONIC PAIN Copyright © 2022 Wolters Kluwer · All Rights Reserved PHARMACOLOGY IN PRACTICE EXERCISE#3 • A NURSE IS CARING FOR A CLIENT WHO IS PRESCRIBED A SEDATIVE. WHICH OF THE FOLLOWING MEASURES CAN ENSURE AN OPTIMAL RESPONSE TO HYPNOTIC THERAPY? SELECT ALL THAT APPLY. a)BACK RUBS b)ALCOHOL INTAKE c)NIGHT LIGHTS d)DARKENED ROOM e)BEDTIME COFFEE Copyright © 2022 Wolters Kluwer · All Rights Reserved