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exam 3 pharm
ch 21
Question | Answer |
---|---|
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 |