pharm- ch 34 sedative hypnotic drugs

A nurse is discussing the use of benzodiazepines as sedative-hypnotic agents with a group of nursing students. A student asks about the actions of these drugs in the central nervous system. The nurse makes which correct statement?

"Benzodiazepines affect the hippocampus and the cerebral cortex to cause anterograde amnesia."

10. A patient with a new-onset seizure disorder receives a prescription for phenobarbital. The patient reports being concerned about the sedative side effects of this drug. Which response by the nurse is correct?

"Phenobarbital doses for seizures are nonsedating."

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan?

"When it is time to discontinue this drug, you will need to taper it off slowly." Correct

3. A hospitalized patient who is given one dose of flurazepam continues to show drowsiness the next day. A nursing student asks the nurse the reason for this, because the drug's half-life is only 2 to 3 hours. Which response by the nurse is correct?

"When this drug is metabolized, the resulting compound has longer-lasting effects." explanation: Flurazepam has a half-life of 2 to 3 hours; however, its metabolite has a long half-life, so giving the drug results in long-lasting effects. Barbiturates, not benzodiazepines, are commonly associated with residual, or hangover, effects. A paradoxical reaction to a sedative would manifest as insomnia, euphoria, and excitation, not drowsiness. Tolerance means that the patient would need increased amounts of a drug to get the desired effects and would not have prolonged effects of the medication.

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct?

"Yes, there is a medication that works with your body's melatonin and is not a controlled substance." Correct

When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.)

- Benzodiazepines have a high safety profile. Correct - Benzodiazepines have a low ability to cause tolerance. Correct - Benzodiazepines have a low abuse potential. Correct

what is a side effect from benzo

- CNS depression - anterograde amnesia -sleep driving - paradoxical effects ( opposite effect of what the medicine is suppose to do) - respiratory depression

benzodiazepines drugs

- Diazepam ( Valium) / Lorazepam and alprazolam (most prescribed drug)

Which statements about zaleplon [Sonata] does the nurse identify as true? (Select all that apply.)

- Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. Correct - Zaleplon [Sonata] interacts with the neurotransmitter GABA explanation:

what are the other drugs used for treatment of insomnia

- antidepressant ( Trazodone- Oleptro) - is used a lot for alchoholics

other drugs used for treatment of insomnia

- antihistamines -Diphenhydramine-benedryl - Doxylamine -melatonin

what are sedative hypnotic drugs

- benzoiazepines - benzodiazepine like drugs - barbituates

what is the mechanism of action for barbituates

- binds to the GABA receptor chloride channel complez

what are sedative-hypnotic drugs

- drugs that depress the CNS function - treats anxiety/ insomnia - are antianxiety agents/ anxiolytics -antianxiety and hypnotic effects are often a matter of dosage

what are benzodiazepines and benzodiazepine receptor agonists

- drugs to treat insomnia and anxiety - is used to induce general anesthesia - manages seizure disorders, muscle spasms, panic disorders and withdrawal from alcohol - safer then general CNS depressant -low potential for abuse -fewer drug interactions

ramelteonL metalonin agonist

- for patients who dont wake up - rapid onset - 30 minutes

benzo like drugs: Zaleplon (Sonata)

- new class of hypnotics, pyrazolopyridimines - shrt term management of insomnia - side effects: headache, nausea, drowsiness, dizziness, myalgia, and abdominal pain

benzo like drugs: Zolpidem ( Ambien)

- sedative hypnotic - shrt term management of insomnia - side eff: daytime drowsiness and dizziness

benzo like drugs: Eszoplicone (lunesta)

- the S-isomer of zopliclone - trtment of insomnia

the nurse teaches a patient about eszopliclone ( lunesta). which statement by the patient indicates the teaching has been effective

- the drug may leave a bitter taste in my mouth

what is the ultrashort acting barbituate

- thiopental

what are barbituates

- used for sedation. anti seizure - causes tolerance and dependance - high abuse potential - powerful respiratory depressant that can be fatal with overdose - are used much less now due to new and safer drugs like benzo

what is Doxepin used for

-antidepressant with strong sedative effects - used to treat patients who have trouble staying asleep

what is the treatment for barbituate overdose

-removal with activated charcoal - maintenence with O2 supply to the brain

what are the sleep phases

1. REM ( Rapid Eye movement) 2. NREM ( Non rapid Eye movement)

5. A patient takes temazepam [Restoril] for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?

Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient?

Flumazenil [Romazicon]

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam?

Flumazenil [Romazicon] Correct explanation: Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol]

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter?

Gamma-aminobutyric acid (GABA) Correct

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential?

Phenobarbital [Luminal Sodium] explanation: Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.

6. A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?

Suspect a possible paradoxical reaction to the clorazepate. explanation: Patients taking benzodiazepines for anxiety sometimes develop paradoxical responses to the drug, which include insomnia, excitation, euphoria, heightened anxiety, and rage. A missed dose would trigger withdrawal symptoms, which would include anxiety, insomnia, sweating, tremors, and dizziness. Because this is a paradoxical reaction to the drug, a longer-acting drug would make the symptoms worse. This is not caused by overdose, which would manifest as drowsiness, lethargy, and confusion, so a drug level is not warranted.

9. A patient who travels frequently for business reports occasional instances of being unable to fall asleep. The patient tells the nurse that job demands require staying up late and then getting up early for meetings. The nurse expects that the provider will prescribe which medication for this patient?

Zaleplon [Sonata] explanation: Zaleplon [Sonata] works well for people who have trouble falling asleep and, because of its short duration of action, can be taken late at night without causing a hangover or next-day sedation early in the morning. Zolpidem [Ambien] has a longer duration and is a good choice for patients who have difficulty maintaining sleep. Flurazepam has a long duration of action. Trazodone causes daytime grogginess.

Which agent is most likely to be prescribed today for short-term management of insomnia?

Zolpidem [Ambien] Correct

8. A patient is brought to the emergency department by friends, who say that they were at a party where alcohol and a mix of barbiturates and benzodiazepines were all available. They tell the nurse that the patient was among the first to arrive at the party, which started several hours ago. The patient is nonresponsive and has pinpoint pupils and respirations of 6 breaths per minute. After oxygen has been administered, the nurse should prepare the patient for which intervention?

maintaining adequate O2 to the brain explanation: Because time has elapsed, enough medication is present in the system to warrant treatment for systemic effects. A central nervous system stimulant is contraindicated, and intravenous fluids do not address the overdose. Although activated charcoal may assist in absorption of medication in the gut, flumazenil will be effective only for the benzodiazepines. Naloxone, a narcotic antagonist, is not effective for barbiturates and benzodiazepines.

what is the long acting barbituate

phenobarbital

A patient who has been using secobarbital for several months to treat insomnia tells the nurse that the prescriber has said the prescription will be changed to temazepam [Restoril] because it is safer. The patient asks why this agent is safer. The nurse is correct in telling the patient that temazepam:

potentiates endogenous gamma-aminobutyric acid (GABA) producing a finite CNS depression. explanation: Benzodiazepines potentiate the actions of GABA, and because the amount of GABA in the CNS is finite, these drugs' depressive effect on the CNS is limited. Benzodiazepines depress the CNS but not to the extent that barbiturates do. Benzodiazepines are weak respiratory depressants at therapeutic doses and moderate respiratory depressants at toxic doses. Barbiturates mimic GABA; therefore, because they produce CNS depression, this effect is limited only by the amount of barbiturate administered.

7. A patient in the emergency department is given intravenous diazepam [Valium] for seizures. When the seizures stop, the nurse notes that the patient is lethargic and confused and has a respiratory rate of 10 breaths per minute. The nurse will expect to administer which of the following?

respiratory support

what is the short to immediate acting barbituate

secobarbital

The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug?

sedation explanation: The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).

what are the stages of sleep

stage 1 and II= light sleep stage III and IV= deep sleep

A patient who is experiencing alcohol withdrawal is given a benzodiazepine. The nurse understands that this drug is effective because:

the patient has a cross-dependence to the benzodiazepine. explanation: Benzodiazepines are given to ease withdrawal from alcohol because of cross-dependence with these drugs and alcohol, enabling the benzodiazepine to suppress withdrawal symptoms. Alcohol and benzodiazepines can potentiate one another. The benzodiazepine does not potentiate withdrawal symptoms. Benzodiazepines relieve muscle spasms, but this is not why they are given for alcohol withdrawal.

how do you reverse acute toxicity from benzodiazepines

treatment with flumazenil ** - is a receptor antagonist - reverses sedative effects but will not reverse respiratory depression