Transcript Side effects

Chapter 27
Central Nervous System Sedatives
and Hypnotics
Sedatives and hypnotics p614
• Sedatives: Reduce anxiety and nervousness,
excitability and irritability. Also called
anxiolytics.
• Hypnotics: sleeping pills
Barbiturates p614
Table 27-1 p 615
Reduce nerve impulses to the cerebral cortex
• Effects are dose related
–In low doses act as sedatives
–In higher doses act as hypnotics
• Raise the seizure threshold
Barbiturates: Side Effects p615
• Side effects
– CNS depression
• Drowsiness, lethargy, dizziness, hangover
– Paradoxical restlessness or excitement
– Depression of the REM sleep
• Psychological and physical dependence
• Rapid drug withdrawal may cause convulsions
• SS of toxicity:
– Confusion, excitement, deep sleep, coma,
pupil constriction, cyanosis, clammy skin,
hypotension
Barbiturates: Rebound Phenomenon
• When barbiturates are discontinued, a
rebound REM phenomenon can occur
– Increase in REM sleep
– Dreams often become nightmares
Barbiturates continued p615-616
• Examples:
– Pentobarbital (Nembutal)
– Phenobarbital (Luminal): anticonvulsant med
– Secobarbital (Seconal)
Benzodiazepines
Table 27-2 p617
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Useful hypnotic agents (sleeping pills)
Have a calming effect on the CNS
Control agitation and anxiety
Does not affect the REM sleep cycle
Used in the treatment of alcohol withdrawal
Benzodiazepines p617
• Side effects:
– Vertigo
– Dizziness
– Oversedation
– Retrograde amnesia with versed
• Examples:
– Diazepam (Valium)
– lorazepam (Ativan)
– midazolam (Versed)
Benzodiazepines p617
• An overdose symptoms:
– somnolence
– confusion
– coma
– diminished reflexes
– CNS depression
– respiratory depression
– hypotension
• Reversal agent for benzodiazepines: flumazenil (Romazicon)
Alcohol p620
• CNS depressant
• Used to assist a person in relaxing and becoming more social
– Lose inhibitions
– Loss of judgment
– Impaired reaction time
• Liver processes alcohol first. Circulating drug levels will
increase while liver is processing alcohol.
• Alcohol causes dehydration. This leads to more concentrated
circulating levels of medication.
Other hypnotics p619
Table 27-3 p620
• Eszopiclone (Lunesta)
– Approved for longer term use
• Zaleplon (Sonata)
– Limited for 5 weeks use
• Zolpidem tartrate (Ambien)
– Produces an effect similar to the benzodiazepines
– Used frequently in the elderly
OTC sleep aids p621
• Contain an antihistamine, frequently
diphenhydramine
• Pt to avoid the use of alcohol or other CNS
depressant drugs
• Insomnia lasting over 2 weeks should be
evaluated by doctor.
Nursing considerations p622
• Assess nature of sleep disturbance
• Supportive nursing measures to encourage sleep:
– Encourage bedtime routine
– Avoid waking pt who has finally fallen asleep
Nursing considerations cont
• Priority for patient safety!!!
– Side rails up, assist with ambulation, fall
precautions
– Caution against driving a car or operating
dangerous machinery
– Devote 8 hours to sleep
– Hypnotics should be taken at bedtime