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Chapter 28 Drug therapy for Insomnia
Terms in this set (40)
is the inability to go to sleep or remain asleep through the night
Symptoms include: difficulty falling asleep, waking often during the night or early morning, and not feeling rested after sleep.
Failing to get enough sleep because of insomnia causes..
sleep deprivation, which is a shortage of quality undisturbed sleep that reduces physical and mental well- being.
Coordination, judgement, reaction time, and social function are all impaired by lack of sleep.
Sleep deprivation decreases?
immune function and increases the risk for infection.
The most commonly prescribed sleep drugs are?
sedatives are a broad group of drugs that promote sleep by acting on signals in the central nervous system to produce calm and ease agitation.
Benzodiazepine Receptors agonists
Skeletal muscle relaxants
Benzodiazepine receptors agonists (Non- benzodiazepine sedative-hypnotics)
class of drugs that interact with the same receptor site that benzodiazepine drugs do, turning on the receptors to induce sleep.
Drugs from this class are now the first- line sleep aids to treat insomnia.
- less likely to be addictive
drugs that depress the central nervous system by binding to gamma aminobutyric acid (GABA) receptors, resulting in hypnotic and sedating effects.
GABA is in inhibitory rather than excitatory neurotransmitter in the brain. When increased amounts of GABA are present or GABA receptors are stimulated CNS activity is reduced.
Although benzodiazepines are mainly used to treat anxiety or stress, a few are used as a short term treatment of insomnia.
They can be habit forming when uses for prolonged periods of time ( 2-4 weeks) and are no longer the first line drugs for insomnia.
drugs formed from barbituric acid that induce a general depression over all CNS functions along with inducing sedation.
Although rarely used for general insomnia, the barbiturates may be prescribed short-term when other drugs for insomnia have not been SUCCESSFUL.
**** MOST BARBITURATES INCLUDING THOSE USED FOR SLEEP ARE CATEGORIZED AS SCHEDULE II controlled substances with a high potential for abuse and dependence.
In addition, because all CHS functions are depressed, overdoses with the barbiturates are serious and can lead to death.
These drugs are more commonly used to induce sedation and reduce anxiety before surgery. Some are used as part o seizure control management with epilepsy.
What barbiturate drugs are rarely used for insomnia because they are classified as schedule II controlled substances with a high potential for abuse and addiction?
pentobarbital and secobarbital
Drugs used to treat allergies and allergic reactions. Some such as diphenhydramine (Allerdryl Benadryl) have sedating effects and are available over the counter.
Also have some effects for insomnia, especially trazodone, amitriptyline and doxepin
Skeletal muscle relaxants
another group of drugs that are used at time for insomnia. The most common ones used for this purpose are the carbamates and the cyclobenzaprines.
Drugs used for Insomnia intended response
Insomnia is relived, and sleep is improved
Person is sedated, and sleep is induced
Length of time to fall asleep is decreased
Sleep duration is increased
A concerning side effect of the benzodiazepine receptor agonists is what?
the possibility of sleepwalking, sleep eating, and sleep driving, with the patient having no recollection of these actions.
Do not give flumazenil (Romazicon) to anyone who has what disorder?
To better monitor for side effects assess the level of what before giving a drug for insomnia?
Assess level of consciousness
Teach patients taking benzodiazepine receptor agonists to...
go to bed immediately after taking a dose of these drugs.
Teach patients to be sure that there is adequate time (4-8) hours) for sleep...
before taking a drug for insomnia.
Teach patients taking an insomnia drug to avoid what?
Alcohol and other CNS depressing substances because of the risk for over sedation.
All drugs to relive insomnia cause what?
Some degree of central nervous system depression
Psychologic and physical dependence can develop within
a few weeks or months of regular or repeated use of many drugs for insomnia.
A family member should be taught to watch the patient taking what class of drugs for sleep walking?
Benzodiazepine receptor agonists
Warn patients to avoid operating any heavy equipment, driving a car, or making critical decisions while under the influences of?
Any CNS depressant drug
With which drug for Insomnia should you warn the patient about the side effect of sleepwalking, sleep eating or sleep driving?
What should you instruct the patient to do immediately after taking a benzodiazepine receptor agonist?
Go to bed within 5 to 10 minutes after taking the drug
Which drugs belong to all the benzodiazepine receptor agonists class?
Which drug for insomnia is rarely used now because it is a schedule II drug with a high potential for abuse and dependence?
Why should a patient taking a CNS depressant avoid drinking alcohol?
Alcohol can potentiate the sedating effect of these drugs
What is the reversal agent for a benzodiazepine overdose?
Which statement made by a person prescribed to take zolpidem (Ambien) indicates a need for more teaching?
I am so glad that this drug is so safe and has no potential for dependence
The nurse is caring for a patient who has a history of insomnia. The nurse knows that drugs to relieve insomnia can cause some degree of depression of what system?
Central nervous system
A nurse is caring for a patient with a history of sleep deprivation. The nurse knows that an important outcome of sleep deprivation is related to what problem?
Heightened risk for infection
The prescriber just ordered eszopiclone (Lunesta) for a patient for insomnia. Before giving the drug, what is the most important assessment the nurse should do?
Assess the patient's present mental status.
The nurse is discharging a patient with a prescription for an insomnia medication. What statement about insomnia medications is true and should be included in patient teaching?
Insomnia medication can cause traveler's amnesia.
Warn patients not to take these drugs on overnight airplane flights of less than 7 to 8 hours because they may experience transient memory loss called traveler's amnesia. Remind them that the amnesia side effect can be reduced or avoided if they are able to get 4 or more hours of sleep after taking the drug. Tremors and diarrhea are side effects of drugs for narcolepsy. Insomnia medication should never be doubled. Insomnia medications should be taken only for short periods of time (2 to 4 weeks) and only when needed.
A nurse in a residential setting for older adults is giving a patient zolpidem (Ambien) for insomnia for the first time. Besides assessing the patient's level of consciousness, what is the most important follow-up care the nurse should check for this patient?
Check the patient's vital signs
For patients in an acute care or residential setting who are taking a drug for insomnia for the first time, besides assessing the level of consciousness, check the patient's vital signs. Watch for changes in heart rate, blood pressure, and level of consciousness.
The nurse is discharging a patient with a new prescription for benzodiazepine receptor agonists. What is the most important instruction the nurse needs to give to the patient?
Have another person with you the first night you take the drug to see if sleepwalking will be a problem.
The emergency department (ED) nurse has been ordered to give romazicon (Flumazenil) intravenously to a patient who overdosed on a benzodiazepine. The nurse knows that this drug should not be given to anyone with a history of what type of disorder?
A pediatric nurse knows that children receiving any sedating drug need to be watched for unusual or paradoxical responses. What is a paradoxical response?
One that is opposite of what is expected.
The evening shift nurse is about to administer a sedative to a patient. The nurse knows that what types of drugs are considered sedatives. (select all that apply)
Skeletal muscle relaxants
Benzodiazepine receptor agonists
THIS SET IS OFTEN IN FOLDERS WITH...
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