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25.01 Sedatives-Hypnotics

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Overview

  1. CNS depressants used for insomnia, anxiety, apprehension. Should only be used for short-term therapy.
  2. May also be used for sedation/anesthesia

Nursing Points

Nursing Considerations

  1. Use lowest dose necessary to achieve desired effects
  2. Use extreme caution if patient has a history of substance abuse (does benefit outweigh risk?)
  3. Avoid driving, ETOH
  4. Use caution in patients at risk for suicide
  5. For sleep
    1. Take approximately 30 min before desired effect
    2. Ensure patient has a full 8 hours available to sleep
    3. May continue to feel effects after awakening
    4. Diprivan – prevents REM sleep
  6. Tolerance may develop; use caution
    1. Require higher and higher doses
  7. Watch for overdose, withdrawal
  8. Should taper down; don’t abruptly D/C

Examples

  1. Barbiturates
    1. Phenobarbital
    2. Pentobarbital
  2. Anesthetic
    1. Diprivan
  3. NMDA Antagonist
    1. Ketamine
Study Tools

Video Transcript

In this lesson we’re going to cover the important points for medications known as sedatives or hypnotics.

These medications are central nervous system depressants that are usually used for insomnia anxiety or anesthesia and are usually considered short-term medications. Examples are barbiturates like phenobarbital or pentobarbital, diprivan also known as propofol, and ketamine. Each of these is a different chemical drug class but they tend to have the same effect on patients so we’re going to cover some general nursing considerations for all of them and I’ll give a few specific points

Anytime you’re using a sedative you always want to use the lowest dose necessary to achieve your desired results. This is kind of like a form of titration. If you can achieve appropriate sleep or sedation with a dose of 2 mg for example, there’s no need to increase that dose to 5 mg. With medications like these we always want to use caution in any client with a history of substance abuse or suicidal behavior because of the risk for misuse and the dangerous effects that can have. Obviously these medications have a sedative effect so client should be cautious or simply not use this medication at the same time as drinking alcohol. They should also make sure that they know how their dose affects them before they start driving. Similar to most of our mental health medications it’s important that we taper these down slowly when it is time to stop because there’s a risk for withdrawal symptoms. And of course there’s always a risk for overdose or toxicity so make sure that you’re watching your client closely and assessing their level of consciousness and their ability to protect their own airway, which is usually the number one killer in an overdose of medications like these.

Some of these medications are used for insomnia, so it’s important that we educate our patients on appropriate use to help them sleep. They should be taking the medication about 30 minutes before they want to be asleep to give it a chance to work. they should also make sure that they have a full 8 hours available to sleep. These medications should not be used for quick cat naps in the afternoon. Now, even if they sleep for a full 9 or 10 hours, patients may still feel some of the effects of the medication when they wake up in the morning. Almost like a hangover. Now I bet you’re wondering why there’s a picture of Michael Jackson on this slide. In the last 2 months of his life Michael Jackson struggled with insomnia severely and was actually being dosed with diprivan or propofol to help him sleep. here’s the thing about Propofol… I personally had propofol during an endoscopy once after I had been awake all night at a night shift. they gave me propofol for the procedure and I was only out for maybe 15 minutes, but I felt like I had had a full night’s sleep when I woke up. The problem was that within an hour or so I was exhausted again because it wasn’t true sleep. Propofol actually prevents you from achieving rapid eye movement or REM sleep which is the most restorative form of sleep. So some experts have said that Michael Jackson went nearly two months without REM sleep and that even if he hadn’t unfortunately been overdosed with Propofol that the lack of sleep might have killed him anyway. So it’s important to understand that these medications are not for long-term solutions they are only for short term help. This is especially true because patients can develop a tolerance to the medications and require higher and higher doses for the same effect. So if you see someone who’s on one of these medications for an extended period of time, you need to advocate for them to be on a more long-term medication.

So remember that sedatives and hypnotics are central nervous system depressant used for insomnia anxiety and anesthesia for short-term Solutions. It’s always important to weigh the risks versus benefits. we want to be cautious in the elderly who might react stronger to the same dose or those using alcohol because of the interaction. We also want to be extremely cautious in those with history of substance abuse or suicidal Behavior because of the risk of misuse of these medications. We always want to keep safety first because of those sedative effects they would be at risk for Falls they need to be cautious before they drive and of course we need to watch their Airway in the case of overdose or oversedation. And again always just consider your dosing make sure you’re using the least dose possible to get the desired result watch for overdose withdrawal and tolerance and advocate for more long-term medications if necessary.

So those are the important points for sedatives and hypnotics. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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