1. Chapter 27 Central Nervous System Sedatives and Hypnotics

2. Sedatives and hypnotics p614 Sedatives: Reduce anxiety and nervousness, excitability and irritability. Also called anxiolytics. Hypnotics: sleeping pills

3. 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

4. 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

5. Barbiturates: Rebound Phenomenon When barbiturates are discontinued, a rebound REM phenomenon can occur – Increase in REM sleep – Dreams often become nightmares

6. Barbiturates continued p615-616 Examples: – Pentobarbital (Nembutal) – Phenobarbital (Luminal): anticonvulsant med – Secobarbital (Seconal)

7. Benzodiazepines Table 27-2 p617 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

8. Benzodiazepines p617 Side effects: – Vertigo – Dizziness – Oversedation – Retrograde amnesia with versed Examples: – Diazepam (Valium) – lorazepam (Ativan) – midazolam (Versed)

9. Benzodiazepines p617 An overdose symptoms: – somnolence – confusion – coma – diminished reflexes – CNS depression – respiratory depression – hypotension Reversal agent for benzodiazepines: flumazenil (Romazicon)

10. 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.

11. 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

12. 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.

13. 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

14. 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