Introduction to Clinical Pharmacology Chapter 21- Sedatives and Hypnotics

1. Introduction to Clinical PharmacologyChapter 21-Sedatives and Hypnotics

2. Introduction to Sedatives and Hypnotics • *Used to treat insomnia, convulsions/seizures • Causes: Lifestyle changes; new job; jet lag; chronic pain; headache; stress; anxiety • Two classes: Barbiturates; nonbarbiturates • Classifynonbarbiturates: Benzodiazepines; miscellaneous sedatives and hypnotics

3. Introduction to Sedatives and Hypnotics • See drug table pg. 187 • Example of benzodiazepines : • Estazolam; Flurazepam; Quazepam • Example of miscellaneous sedatives and Hypnotics : • Eszopiclone; Zaleplon; Zolpidem

4. Sedatives and Hypnotics: Actions and Uses • Actions: Nervous system depression; mood alteration; hypnosis; deep coma • Treats: Insomnia and convulsions • Used as: Adjuncts for anesthesia; preoperative sedation; conscious sedation

5. Sedatives and Hypnotics: Adverse Reactions • Nervous system reactions: • Dizziness; drowsiness; and headache • Gastrointestinal (GI) reaction: • Nausea

6. Sedatives and Hypnotics: Contraindications and Precautions • Contraindicated in clients: • With a known hypersensitivity to the sedatives or hypnotics ; during pregnancy; comatose patients; patients with severe respiratory problem; patients with a history of drug and alcohol habitual use, heartburn • Used cautiously in patients: • Hepatic or renal impairment; lactating patients; alcohol use; mental health conditions • See supplement alert pg. 188

7. Sedatives and Hypnotics: Interactions

8. Nursing Process: Assessment • Preadministration assessment: • Identify and record vital signs and assess the patient’sneeds • Hypnotics-Ask-is it too early to receive the drug?, is it being administered correctly? • Sedatives-Ask –is the sedative for surgeries and adminstered at the correct time?, has the consent form been signed prior to medication adminstration? • Do not administer barbiturates if: • Client has pain and cannot sleep –may cause restlessness, excitement and delirium

9. Nursing Process: Assessment (cont’d) • Ongoing assessment: • Assess the vital signs and level of consciousness each time before administering the drug. • Checks if drug helped patient sleep on previous nights • HOLD the drug if one or more v/s vary from the database, if RR 10 or less

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 • Promoting an optimal response therapy: • Provide supportive care-back rubs, quiet atmosphere • Disallow consumption of beverages containing caffeine • Do not leave sedatives and hypnotics near client bedside or in hallway or in other areas

13. Nursing Process: Implementation • Monitoring and managing patient’s need: • 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 • Monitoring and managing patient’sneed (cont’d): • Risk for injury (cont’d) : • Raise the side rails of patient’sbed • 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

15. Geriatrics • See Lifespan Alert-pg. 190

16. Nursing Process: Implementation • Educating the patient and family • Develop a teaching plan • Explain the prescribed drug and dosage regimen • Explain the situations that should be avoided • Explain necessity of contacting primary health care provider immediately if symptoms occur

17. Nursing Process: Evaluation • The therapeutic effect is achieved; sleep pattern improved • Adverse reactions are identified, reported, and managed • Patientverbalizes an understanding of what to avoid while taking drug