2.4 Sedatives - Hypnotics (Barbiturates and Benzodiazepines)

Question 1

What is the purpose of sedatives?

Answer 1

Reduce nervousness, excitability, and irritability without causing sleep, but can be hypnotic if given in a large enough dose

Question 2

What is the purpose of hypnotics?

Answer 2

Cause sleep and have a much more potent effect on the CNS than sedatives.

Question 3

Many drugs act as either a sedative or a hypnotic, and so they are called what? What are the 3 classes?

Answer 3

Sedative-hypnotics

Barbiturates
Benzodiazepines
Miscellaneous agents

Question 4

Barbiturates are…

Answer 4

A class of drugs that are chemical derivatives of barbituric acid. They are used to induce sedation

Habit forming
Have a narrow therapeutic window

Question 5

Barbiturates were first introduced into clinical use in…

Answer 5

1903. They were used as the standard drug for treating insomnia and producing sedation

Only few in use today ie: phenobarbitAL or PentothAL

Question 6

What are the indications for Barbiturates?

Answer 6

Hypnotic
Sedative
Anticonvulsant - for seizures
Anesthetic for surgical procedures

Question 7

What 4 effects do Barbiturates have on the CNS?

Answer 7

Drowsiness, lethargy, vertigo, mental coma

Question 8

What 4 effects do Barbiturates have on the respiratory system?

Answer 8

Depression, apnea, bronchospasm, cough

Question 9

Signs of Barbiturate overdose include…

Answer 9

Respiratory depression and arrest
- Cheyne-stokes respirations
- Hypoventilation
- Cyanosis

CNS depression: sleep-coma-death

Question 10

How would we help a patient with uncontrollable seizures?

Answer 10

Therapeutic overdose AKA phenobarbital coma
Anesthetic induction
Seizures can be stopped until enough serum levels of anticonvulsant drugs are achieved

Question 11

What are Benzodiazepines? What are their uses?

Answer 11

The most commonly prescribed sedative-hypnotic drug or anxiolytic

Favourable side effect profile
Efficacy high
Safety

Question 12

Examples of long-acting benzos are…

Answer 12

chlordiaZEpoxide
fluraZEpam
cloraZEpate
diaZEpam

Question 13

Examples of intermediate-acting benzos are…

Answer 13

alprazolam
clonazepam
lorazepam
oxazepam

Question 14

Examples of short-acting benzos are…

Answer 14

midazolam
triazolam

Question 15

9 Indications for benzodiazepines include…

Answer 15

Sedation
Sleep induction(insomnia)
Skeletal muscle relaxation
Anxiety relief
Treatment of alcohol withdrawal
Agitation
Depression
Epilepsy
Balanced anesthesia

Question 16

Name 6 potential side effects of benzodiazepines

Answer 16

Headache
Drowsiness
Lethargy
Paradoxical excitement
Hangover effect

*Can be mild and frequent

Question 17

Benzodiazepines should be administered ___ to ___ minutes before sleep time

Answer 17

15-30

Question 18

Most benzodiazepines cause what? Which benzodiazepine is the exception?

Answer 18

REM rebound - tired next day
Flurazepam

Question 19

T/F clients can drink alcohol and other CNS depressants while on a benzodiazepine

Answer 19

False

Question 20

It may take how many weeks before noticing improved sleep on benzodiazepines?

Answer 20

2-3

Question 21

On discontinuation of benzodiazepines, what can happen?

Answer 21

Rebound insomnia

Question 22

Why should safety be taught to clients on benzodiazepines?

Answer 22

It can cause drowsiness and dizziness

Question 23

Nurses should monitor what for clients on benzodiazepines?

Answer 23

Monitor side effects and therapeutic effects

Question 24

Name 4 potential therapeutic effects of benzodiazepines

Answer 24

Increased ability to sleep
Fewer awakenings
Shorter sleep-induction times
Improved sense of well-being