sleeping medications
TRANSCRIPT
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SLEEPING MEDS
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BARBITURATES
First introduced into clinical use in 1903
Prescribed for sedative, hypnotic,and antiseizure effects & wasmainstay of treatment for anxietyand insomnia
Now rarely prescribed for anxiety and insomnia due to side effects andavailability of more effective medications
Chemically they are derivatives of barbituric acid
They are habit forming and have a narrow therapeutic index
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BARBITURATES
Effects:
In low doses, acts as sedative.
Increasing the dose produces hypnotic effect decreasingrespiratory rate Stimulate enzymes in liver responsible for metabolism of drugstherefore drugs have faster onset of action and shorter duration of effect.Side Effects: Main side effects affect CNS
Drowsiness Lethargy
Dizziness Hangover Paradoxical restlessness or excitement
Chronic effects on sleep architecture can be detrimental d/t decreased REM sleep;withdrawal causes nightmares d/t increased REM with rebound effect
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BARBITURATES
Toxicity:
Respiratory depression
Intentional overdoses
Phenobarbital coma
CNS depression ranging from sleep to profound coma and death
Respiratory depressions progresses to hypoventilation and cyanosis
Signs of overdose:
Cold, clammy skin, may be hypothermic
Later can exhibit fever, areflexia, tachycardia, and hypotension
Pupils usually slightly constricted, but may be dilated in the event of severe poisoning
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BENZODIAZEPINES
Most frequently prescribed sedative-hypnotic agents and one ofthe most commonly prescribed classes of drugs.
Favorable side effect profiles, efficacy, and safety. Classified as anxiolytic or sedative-hypnotic, depending on primaryusage.
All 15 have same side effects and adverse reactions
Produce considerably less physical dependence and result in lesstolerance than barbiturates
May be abused recreationally
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BENZODIAZEPINES
Action:
Bind to GABA, a natural inhibitory neurotransmitter in brain
Metabolized in liver to active metabolites and excreted primarily in urine
Do NOT produce life-threatening respiratory depression or coma in excessive amounts,
however, will still cause rapid CNS and respiratory depression when given IV- monitor closely
Indications:
Drug of choice for short term treatment of insomnia caused by anxiety
Shorten length of time to fall asleep
Reduce frequency of interrupted sleep Increase total sleep time, but reduce stage 4 and some REM
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BENZODIAZEPINES
Nursing Considerations:
Monitor condition and provide education
Assess symptoms and need for medication Use with caution if suicidal or has sleep apnea Contraindicatedin narrow-angle glaucoma & organic brain disease Use cautiously in presence of
Liver or renal impairment Impaired respiratory function
Pregnancy category D Not recommended for pregnant or nursing moms Crosses placenta and excreted in breast milk
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BENZODIAZEPINES
Side Effects:
Drowsiness
Dizziness
Risk for injury
For overdose, Flumazenil (Romazicon) used to acutely reverse
effectscompetes for binding at receptor sites
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MUSCULOSKELETAL RELAXANTS
Most are central-acting: All central-acting have potential tocause sedation
Mechanism of action not fully knownBelieved to inhibit upper motor neuron activity
Causes sedation
Alters simple reflexes
Most effective in conjunction with rest and PT
Enhanced CNS depression results from co-ingestionof ETOH, opioids, or other CNS depressants
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MUSCULOSKELETAL
RELAXANTS
Nursing Considerations:
Food and drug allergies
Contraindicated if hypersensitive to protein-based foods
History of uncontrolled hypertension
Drug can raise BP to dangerously high levels
Vital signs
Baseline lab tests
Especially CBC
Use with caution in pregnant and lactating women (pregnancy category C)
Monitor for early signs of heart attack or stroke Increases risk of thromboembolic disease May need increased doses of heparin
Monitor for side effects of nausea, vomiting, constipation, medication site reaction, & headache