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exam 3 pharm

ch 21

nonpharm methods to promote sleep get up at specific time in morning take few or no naps avoid caffeine and etoh 6 hrs prior to bedtime no smoking 6 hrs before HS avoid heavy meals and exercise before HS take a warm bath, listen to music, soothing activities before HS avoid drinking too much before HS drink warm milk
the mildest form of CNS depression is sedation
hypnotic effect not hypnosis but a form of natural sleep
REM rebound vivid dreams and nightmares that occur after taking a hypnotic for a prolonged period and then abruptly stopping, it can also occur after taking only one dose
who should avoid hypnotics ☺pts with severe respiratory disorders ☻pregnancy ♥ramelteon (Rozerem) - only hypnotic approved for long term use
barbiturates ☺long acting - phenobarbital and mephobarbital, used for seizures ☻intermediate acting - butabarbital (Butisol) - sleep sustainers, not for pts who have trouble falling asleep - take 1 hr before HS ♥short-acting - secobarbital (Seconal), pentobarbital (Nembutal) - preop sedation, closely monitor VS ♦ultrashort acting - thiopental sodium - general anesthetic ♠should be restricted to short term use (2 wks or less)
benzodiazepines ☺inducing sleep
NC benzos ☺hx of resp depression and HoTN ☻baseline VS, esp RR and BP ♥assess renal function, urine output should be 1500 mL/day, renal impairment could prolong action of drug ♦use bed alarm - confusion might occur in elderly ♣examine skin for rashes ♠teaching: use nonpharm method for sleep, report cognitive changes and paradoxical reactions, gradually d/c to avoid withdrawal symptoms (tremors, twitching)
herbal alert with sedatives ☺kava kava - ↑ sedative effect ☻valerian - ↑sedative effect
benzos ☺can suppress stage 4 of NREM sleep ☻to avoid REM rebound, do not use for more than 3-4 weeks
Triazolam (Halcion) ☺short acting ☻memory loss with long term use
antidote for benzos flumazenil (Romazicon)
nonbenzos zolpidem (Ambien) ☺short term (less than 10 days) tx of insomnia
melatonin agonists ramelteon (Rozerem) ☺not a controlled substance ☻been shown to ↓REM sleep ♥a/e: drowsiness, dizziness, fatigue, HA, nausea, SI ♦also used for antianxiety
sedatives and hypnotics for older adult ☺use nonpharm methods first ☻barbits ↑CNS dpression and confusion and should not be used for sleep ♥Prosom, restoril, and Halcion are safer than barbits ♦avoid doral and valium ♣main sleep problem is nighttime awakening ♠if insomnia is caused by discomfort or pain use NSAIDs
NC nonbenzos ☺baseline vs ☻AST, ALT, bilirubin labs ♥use bed alarm ♦observe pt for s/e ♣teach: nonpharm ways first, take before HS, alprazolam takes effect within 15-30 min, urinate before taking to prevent nocturia, ♠s/e: hangover
zolpidem tartrate ☺nonbenzo ☻CI: resp depression, lactation, ♥caution: renal/liver dysf, mental depression, SI, pregnancy, children, older adults, debilitated pts ♦use: insomnia ♠s/e: drowsiness, HA, hot flashes, hangover, irritable, ataxia, visual disturb, anxiety, depression, n/v, erectile dysf ♣ a/e: tolerance, dependence, sleep-related behaviors, HoTN, angioedema, dysrhythmia, SI
NC anesthetics ☺monitor post op state, report if pt remains excessively nonresponsive or confused ☻observe preop and postop urine output, report deficit of hourly or 8 hr urine output ♥give analgesic or narcotic with caution
balanced anesthesia ☺hypnotic given the night before ☻premedication (versed) 1 hr before ♥short acting barbit pentothal ♦inhaled gas, No2 or O2 ♣muscle relaxant
stages of anesthesia 1. analgesia 2. excitement or delirium 3. surgical 4. medullary paralysis - toxic stage of anesthesia, resp are lost, circulatory collapse, vent assistance is necessary
spinal anesthesia ☺HA may be result of decreased pressure or leak of CSF ☻pt is to remain flat and increase fluid intake reduces risk of HA ♥monitor BP for HoTN
Created by: nursingTSJC2013



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