ch 21
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
nursingTSJC2013
Popular Pharmacology sets