Sleeping Medications

8/10/2019 Sleeping Medications

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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

Sleeping Medications

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