1. Introduction to Clinical Pharmacology Chapter 21 Sedatives and Hypnotics

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

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

23. 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.

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

25. 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.

26. 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.

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