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 |