Cns Depressants & anesthetics Flashcards
Understanding of Sleep: 2 types.
daydreaming
4 stages
Intervals time:
REM & NREM rapid eye movement, non rapid eye movement
REM = daydreaming
NREM = 4 stages
Stage 1: wakefulness to sleep ( you can feel someone come in your room);
2% to 5% sleep time
Stage 2: drifting, floating; 50% sleep time
Stage 3: lighter to deeper sleep
Stage 4: delta sleep. deep, dreamless, restful; 10% to 15% sleep
Interval: 90 mins
8 hours of sleep is about 48mins of sleep
Insomnia
Inability to fall asleep or stay asleep
More common in females (b/c of hormones)
↑ with age
Treatment: sedative-hypnotics
*sedative: calms you down
Hypnotics: puts you to sleep
Barbiturates vs Benzodiazepines
** remember they work in your CNS
Barbs are the older sisters, have a lot of side effects
Benzo are our little sister, are the lams and pams
Barbiturates type
Long acting: seizure
Intermediate acting: allow for sleep sustainers
Short acting: procedures sedation
Ultrashort acting: general anesthesia
Restricted to short term use 2 weeks or less b/c drug tolerances ( drug no longer produces an effect)
Benzodiazepines (lam and pam)
For sleep disorder and anxiety- mainly use lorazepam and diazepam
Barbiturates v Benzodiazepines
Action, use, nursing implication and patient teaching
** drug work on the medulla also
Action:interacts with neurotransmitter GABA to reduce neuron excitability
*GABA is an inhibitor
* increase of GABA blocks calcium which block excitability, decrease electrical impulse
Use: reduce anxiety, treat insomnia
(Extra)S/E: residual drowsiness, vivid dreams, nightmares, drug dependence, drug intolerance, excessive depression, respiratory depression, hypersensitivity
Implication: monitor vital signs especially respiratory and BP, assess renal and liver function, use bed alarm SAFETY, pt can become CONFUSED examine pt skin for rashes
P/T: AVOID alcohol, antidepressant, antipsychotic,and opioid drugs Anne NOT TO DRIVE
Nonbenzodiazepines
- zolpidem
- melatonin agonists
Drug interaction
Intervention
- alcohol, CNS depressants
- FIRST USE NONPHARMACOLOGIC METHODS
- SAFETY
Take 15 to 45 mixture before bedtime
Report hangover effect
Monitor BP, RR
Withdraw gradually (rebound, without draw s/s, hypersensitivity
Pop quiz
1) Hangover -what types of SHD cause hangover effects?
2) REM rebound -what causes REM rebound?
3) Dependence -how longs does it take to relieve?
4) Tolerance -why does tolerance occur?
5) Excessive depression -why does excess depression occur?
6) Respiratory depression -what part of the brain is suppressed ?
7) Hypersensitivity -what are signs of this?
1) drowsiness and Down
2) taking hypnotic for a long time and stoping abruptly. Pt should taper off
3) depends on withdraw its individualize ( physically and psychological dependence)
4) when the drug is used repeatedly and the body adapts to the drug, so you’ll increase dosage or taper off slowly
5) CNS is being affected
6) medulla
7) rashes, urticaria itchy welt
Sleep aids in older adults:
Use nonpharm methods first. Then,
Use short to intermediate acting benzos like estazolam (ProSom), temazepam (Restoril), triazolam (Halcion).
Patient teaching use short to intermediate benzos like temazepam
Implications avoid flurazepam, quazepam (Doral), diazepam (Valium) or use 4x/week.
BUTABARBITAL (BUTISOL)
S/eE implication contraindication
Intermediate acting barb. For maintaining long periods of sleep. to manage anxiety, sedation induction, insomnia.
SE : ataxia, drowsiness, confusion, agitation, bradycardia, hypotension, headache, nightmares, depression, angioedema
Implications :monitor vitals
Alcohol, narcotics, & other sedative-hypnotics used in combo will ↓ CNS
Contraindications no longer accepted for older adults or debilitated adults
TEMAZEPAM (RESTORIL)
S/e. Nursing intervention
Benzo
Treat insomnia
SE tolerance, drowsiness, dizziness, confusion, palpitations, hypotension, dependence, withdrawal, anterograde amnesia
nursing implications monitor vitals, RR & BP. examine skin for rashes
Anesthetics
- Different types and routes
Type
General: depress CNS, alleviate pain, cause loss of consciousness
Local: analgesia to local (limited) area
Routes inhalation IV topical local spinal
Stages of anesthesia
Stage 1: Analgesia (loss of consciousness )
Stage 2: Excitement or delirium (concern w/ safety)
Stage 3: Surgical (pt is totally under, Respiration become shallow, RR increase, checking O2 levels)
Stage 4: Medullary paralysis ( toxic stage, respiration is loss and circulatory collapse occur, ventilator is need)
Balanced anesthesia
a combination of drugs frequently used in general anesthesia. Balanced anesthesia may include the following:
- A hypnotic given the night before
- Premedication with an opioid analgesic or benzodiazepine (e.g., midazolam) plus an anticholinergic (e.g., atropine) given about 1 hour before surgery to decrease secretions
- A short-acting nonbarbiturate such as propofol
- An inhaled gas, often a combination of an inhalation anesthetic, nitrous oxide, and oxygen
- A muscle relaxant given as needed
Balanced anesthesia minimizes cardiovascular problems, decreases the amount of general anesthetic needed, reduces possible postanesthesia nausea and vomiting, minimizes the disturbance of organ function, and decreases pain. Because the patient does not receive large doses of general anesthetics, fewer adverse reactions occur; and recovery is enhanced by allowing quicker mobility.
Topical anesthetics
Use
Role
Use: a mucous membranes, broken or unbroken skin surfaces, and burns
Role is to decreases the sensitivity of nerve endings of the affected area
Local anesthetics
Role & use
Role is to block pain at the site where the drug is given
Consciousness is maintained
Use
Dental procedures
Suturing skin lacerations
Short term surgery at local area
Blocking never impulses below the insertion of a spinal anesthetic
Diagnostic procedures such a lumbar puncture and thoracentesis
Regional blocks
Spinal nerve blocking
Spinal block
Epidural ( in the outer covering of the spinal cord or dura mater)
Caudual block ( near the sacrum)
Saddle block: end of the spinal Column to block the perineal area
