Transcript Sedative- Hypnotics

Chapter 14
Sedative-Hypnotics
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 14
Lesson 14.1
Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
Objectives
• Differentiate among the terms sedative and
hypnotic; initial, intermittent, and terminal
insomnia; and rebound sleep and paradoxical
excitement
• Identify alterations found in the sleep pattern
when hypnotics are discontinued
• Cite nursing interventions that can be
implemented as an alternative to
administering a sedative-hypnotic
• Compare the effects of barbiturates and
benzodiazepines on the central nervous
system
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Slide 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 and NREM
 REM sleep associated with dreaming
 NREM sleep divided into four stages
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Slide 4
Four Stages of NREM
Sleep
• I
Transition from wakefulness to sleep;
2% to 5% of sleep time
• II Experienced as drifting, floating; 50% of
sleep time
• III Transition from lighter to deeper sleep
• IV Delta sleep – deep, dreamless, restful;
10% to 15% of sleep time in healthy
young adults
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Slide 5
The Sleep Cycle
• A healthy young adult cycles through NREM
and REM in a 90-minute period
• Stage I → Stage II → Stage III → Stage IV →
Stage III → Stage II → REM
• Many sleep disorders can be traced to
specific abnormalities in this sleep cycle.
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Slide 6
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
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Slide 7
Sedative-Hypnotic Agents
• 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 II and IV
• Decrease number of REM cycles and amount
of REM sleep
• May cause REM rebound when drug
use is stopped
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Slide 8
Sedative-Hypnotic Agents (cont’d)
• 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
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Slide 9
for Sedative-Hypnotic
Therapy
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Take baseline assessments
Note sleep disruption patterns
Determine activities done just before bed
Ask about patient stressors
Identify caffeine sources in dietary history
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Slide 10
Nursing Interventions for
Sedative-Hypnotic Therapy (cont’d)
• Before administering a sedative-hypnotic,
determine the actual need for it
• Patients with a history of sleep apnea or
respiratory difficulties are at higher risk for
respiratory depression if sedative-hypnotics
are taken
• Older adults may react paradoxically
• Sleep patterns change when hypnotics are
discontinued
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Slide 11
Nursing Responsibilities
for Sedative-Hypnotic Therapy
• Perform ongoing monitoring for therapeutic
and adverse effects
• Document findings
• Verify the written standards that provide for
safe care
• Follow policies and procedures of the
organization
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Slide 12
Chapter 14
Lesson 14.2
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Slide 13
Objectives
• Explain the major benefits of administering
benzodiazepines rather than barbiturates
• Identify the antidote drug used in the
management of benzodiazepine overdose
• Identify laboratory tests that should be
monitored when benzodiazepines or
barbiturates are administered over an
extended period
• Develop a plan for patient education for a
patient receiving a hypnotic
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Slide 14
Drugs Used
for Treatment of Insomnia
• Classes of sedative-hypnotics

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Barbiturates
Benzodiazepines
Nonbarbiturate, nonbenzodiazepines
Miscellaneous agents
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Slide 15
Drug Class: Barbiturates
• Actions
 Reversibly depress excitable tissues,
suppress REM and stage III/IV sleep patterns
when used for hypnosis
• Uses
 Anticonvulsant, general anesthetic
(ultra short acting), sedation before a
diagnostic procedure (short acting)
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Slide 16
Drug Class: Barbiturates (cont’d)
• Common adverse effects
 Hangover, blurred vision, transient
hypotension on arising, sedation, decreased
alertness, lethargy
• Serious adverse effects
 Excessive use or abuse, paradoxical
response, hypersensitivity (hives, rash,
pruritus), blood dyscrasias
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Slide 17
Nursing Interventions
for Barbiturate Therapy
• Perform a baseline assessment, including:
 Vital signs – blood pressure, pulse,
respirations and pain rating
 Degree of alertness
 State of arousal
 Motor function
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Slide 18
Drug Class:
Benzodiazepines
• Wide safety margin
• More than 200 derivatives
• Difficult to describe as a class, but include:
 Anticonvulsants
 Antianxiety agents
 Sedative-hypnotic agents
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Slide 19
Drug Class: Benzodiazepines (cont’d)
• 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
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Slide 20
Nursing Interventions
for Benzodiazepine Therapy
• Check vital signs, especially blood pressure,
while the patient is sitting and lying down
before administration
• Monitor laboratory results for hepatic
dysfunction or blood abnormalities
• Flumazenil is used as an antidote for
benzodiazepine reversal and overdoses
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Slide 21
Drug Class: Nonbarbiturates,
Nonbenzodiazepines
• Actions
 Variable effects on REM sleep
• Uses
 Sedative and hypnotic effects
• Common adverse effects:
 Hangover, sedation, lethargy, decreased level
of alertness, transient hypotension on arising,
restlessness, anxiety
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Slide 22
Nursing Interventions for Miscellaneous
Sedative-Hypnotic Therapy
• Assess vital signs, especially blood pressure,
while the patient is sitting and lying down
before administration
• Monitor laboratory results for hepatic
dysfunction or blood abnormalities
• Patient teaching
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Slide 23
Patient Education/Health Promotion
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Encourage standard bedtime
Avoid late, heavy meals
Limit caffeine and alcohol intake
Control sleep environment
Promote stress-reducing techniques
Discuss benefits of medication compliance
and nonpharmacologic interventions
• Encourage patient use of self-assessment
form
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Slide 24