Introduction to Clinical Pharmacology Chapter 21 Sedatives and Hypnotics

Introduction to Sedatives and Hypnotics #1 Used to treat insomnia-to help induce sleep; will be given at hour of sleep Causes: lifestyle changes such as hospitalization; new job; jet lag; chronic pain; headache; stress; anxiety Two classes: barbiturates; nonbarbiturates pentobarbital and secobarbital are examples of barbiturates and barbiturates are capable of CNS depression, hypnosis, deep comma, respiratory depression being reasons that they are not prescribed much Classification of nonbarbiturates: benzodiazepines and nonbenzodiazepines

Introduction to Sedatives and Hypnotics #2 Hypnotic drugs induce drowsiness or sleep Sedative drugs assist with keeping a client sleeping and aid in healing allow client to sleep Examples of benzodiazepines: temazepam; triazolam, estazolam; flurazepam Examples of nonbenzodiazepines: eszopiclone; zaleplon; zolpidem

Sedatives and Hypnotics: Actions and Uses Actions: nervous system depression; mood alteration; hypnosis; deep coma Treat insomnia and convulsions or seizures (status epilecpticus) Used as adjuncts for anesthesia; for preoperative sedation; for conscious sedation

Sedatives and Hypnotics: Adverse Reactions Nervous system reactions: Dizziness; drowsiness; headache; depression; palpitations Gastrointestinal (GI) reaction: Nausea, heartburn, vomiting Other adverse reactions: Rash, somnolence, weakness, and body and joint pain Nausea, heartburn

Sedatives and Hypnotics: Contraindications and Precautions Contraindicated in clients: With a known hypersensitivity to the sedatives or hypnotics; during pregnancy; who are comatose; with severe respiratory problems; with a history of drug and alcohol habitual use Used cautiously in patients: With hepatic or renal impairment; who are lactating; with alcohol use; with mental health conditions

Sedatives and Hypnotics: Interactions Interactant drug Effect of interaction Antidepressants Increased sedative effect Opioid analgesics Antihistamines Phenothiazines Cimetidine Alcohol

Nursing Process: Assessment #1 Preadministration assessment: Identify and record vital signs and assess the patient’s needs When being given for sedation need to assess if Is it for preparation for surgical procedure Is the time correct for administering Has consent been signed Do not administer barbiturates if: Client has pain or uncomfortable and cannot sleep Is there sufficient time between doses Consider the environment and if any stimulation Evaluate the patient’s level of consciousness and general mental state

Nursing Process: Assessment #2 Ongoing assessment: Assess the vital signs and level of consciousness each time before administering the drug Check if drug helped patient sleep on previous nights Consult primary health care provider regarding time interval between administration of drugs Elderly at greater risk for oversedation, dizziness, confusion, ataxia, and paradoxical reactions to sedative and hypnotic drugs

Nursing Process: Nursing Diagnosis Risk for Injury Ineffective Breathing Pattern Ineffective Individual Coping

Nursing Process: Planning The expected outcome includes an optimal response to therapy: Management of adverse drug reactions Understanding of and compliance with the prescribed treatment regimen

Nursing Process: Implementation #1 Promoting an optimal response to therapy: Provide supportive care Darkening the room, provide quiet atmosphere, may give back rub to help relax Disallow consumption of beverages containing caffeine Do not leave sedatives and hypnotics near client’s bedside or in hallway or other areas

Nursing Process: Implementation #2 Monitoring and managing patient needs: Risk for injury: Observe client for adverse drug reactions Protect client from harm and provide supportive care and safe environment Assess client and determine safety measures to be taken

Nursing Process: Implementation #3 Monitoring and managing patient needs (cont.) Risk for injury (cont.) Raise the side rails of patient’s bed Assess client every 1 to 2 hours after the drug is given to evaluate effect of drug Report any adverse drug reactions to the primary health care provider if respiratory rate below 10 breaths/min; blood pressure drops significantly; the client appears lethargic

Nursing Process: Implementation #4 Monitoring and managing patient needs (cont.) Ineffective breathing pattern Assess the respiratory function before and 30 to 60 minutes after administration and frequently after administering the sedative Instruct not to drink alcohol due to the additive effect and increase in CNS depression, which could result in death

Nursing Process: Implementation #5 Monitoring and managing patient needs (cont.) Ineffective individual coping: Administer prescribed drugs for no more than 2 weeks Emphasize importance of not increasing or decreasing dose Long-term use causes dependency

Nursing Process: Implementation #6 Monitoring and managing patient needs (cont.) Ineffective individual coping (cont.) Decrease the drug dosage gradually Symptoms of withdrawal: Restlessness; excitement; euphoria; confusion

Nursing Process: Implementation #7 Educating the patient and family Develop a teaching plan Explain the prescribed drug and dosage regimen Explain the situations that should be avoided Such as alcohol consumption Explain the necessity of contacting the primary health care provider immediately if symptoms occur

Nursing Alert When being given zolpidem to help with sleep client needs to realize that they need to have at least 7 to 8 hours of sleep. Valerian classified as “generally recognized as safe” taken approximately 1 hour before bedtime can be used in combination with other calming herbs, such as lemon balm or chamomile may take 2 to 4 weeks before the full therapeutic effect known to experience withdrawal symptoms when they stop taking valerian abruptly

Nursing Process: Evaluation The therapeutic effect is achieved; sleep pattern improved Adverse reactions are identified, reported, and managed Patient verbalizes an understanding of what to avoid while taking drug

Nursing Process: Evaluation The therapeutic effect is achieved; sleep pattern improved Adverse reactions are identified, reported, and managed Patient verbalizes an understanding of what to avoid while taking drug

Question #1 Is the following statement true or false? Sedatives produce sleep.

Answer to Question #1 False Sedatives produce a relaxing and calming effect. Hypnotic drugs produce sleep. These drugs work by depressing the CNS. Barbiturate use is lessening because of both dependency and harsh adverse reactions. The nonbarbiturates include both benzodiazepines and nonbenzodiazepines.

Question #2 Approximately how many people in the United States are affected by insomnia? 40 million 60 million 70 million 80 million

Answer to Question #2 A According to the National Sleep Foundation, insomnia affects approximately 30% to 50% of the population in the United States, this means about 40 million people suffer routinely with sleeping problems.

Question #3 Is the following statement true or false? Hypnotics are meant to treat insomnia for only a short period of time, such as 2 weeks.

Answer to Question #3 True Hypnotics are meant to treat insomnia for only a short period of time, such as 2 weeks.