Depressants

Question 1

REM

Answer 1

Rapid eye movement
Occur cyclically during sleep at about 90-minute intervals.

The period of REM sleep episodes becomes longer during the sleep process.
It is difficult to rouse a person during REM sleep.

Most of recallable dreams are experienced during the REM sleep.

If a person is roused from REM sleep, frequently, a vivid, bizarre dream may be recalled.

Individuals perform better during their waking hours if they experience all types and stages of sleep.

Question 2

NREM

Answer 2

Nonrapid eye movement
Occur cyclically during sleep at about 90-minute intervals.
If sleep is interrupted the cycle begins again with stage 1 of NREM sleep

Question 3

Sleep Disorders

Answer 3

Insomnia:
More common in female patients

Treatment: sedative-hypnotics.

Nonpharmacologic management:
Arise at specific hour in morning
Limit daytime naps
Avoid caffeine, alcohol, and nicotine 6 hr before bedtime
Avoid heavy meals, large amounts of fluids, loud noise, and strenuous exercise before bedtime
Take warm bath, read, listen to quiet music, or drink warm milk before bedtime

Question 4

Sedative-Hypnotics

Answer 4

Sedatives:
Treat sleep disorders.

Sedative-hypnotics:

1. )Barbiturates
2. )Benzodiazepines
3. )Nonbenzodiazepines

Question 5

Sedative-Hypnotics Side Effects

Answer 5

Residual drowsiness (hangover)
Vivid dreams, nightmares
Drug dependence
Drug tolerance
Excessive depression
Respiratory depression
Hypersensitivity

Question 6

Barbiturates

Answer 6

Long-intermediate-short-ultrashort-acting.

Restrict to short-term use because of side effects, including drug tolerance (limit use to 2 weeks or less).

Question 7

Barbiturates Interactions

Answer 7

Alcohol, opioids, other sedative-hypnotics.

Decreases effects of oral anticoagulants, glucocorticoids, tricyclic antidepressants, quinidine.

Question 8

Examples of

Benzodiazepines drugs as hypnotics.

Answer 8

Flurazepam
Alprazolam (niravam,Xanax)
Temazepam
Triazolam 
Estazolam 
Quazepam

Question 9

Examples of Benzodiazepines drugs for sleep disorders and Anxiety.

Answer 9

Lorazepam (Ativan)
Diazepam (valium)

Action: Interacts with neurotransmitter GABA to reduce neuron excitability

Use:Interacts with neurotransmitter GABA to reduce neuron excitability

Question 10

Nursing Process: Benzodiazepines

Answer 10

Assessment:
Determine whether the patient has a history of insomnia or anxiety disorders.

Nursing diagnosis:
Sleep deprivation related to adverse effect of insomnia.

Planning:
Patient will receive adequate sleep when taking benzodiazepines

Nursing interventions:
Observe the patient for adverse reactions, especially an older or debilitated patient.
Teach patient to use nonpharmacologic methods to induce sleep.
Advise patients to report adverse reactions.
Teach patient that benzodiazepines should be gradually withdrawn.
Evaluation

Question 11

Examples of Nonbenzodiazepines as hypnotics.

Answer 11

Zolpidem

Action: Neurotransmitter inhibition.
Duration of action is 6 to 8 hours.

Use: Treat short-term (less than 10 days) insomnia

Question 12

Sedatives and Hypnotics for Older Adults.

Answer 12

Sedatives and hypnotics for older adults:

Use nonpharmacologic methods first.

Short- to intermediate-acting benzodiazepines such as Estazolam, temazepam, and triazolam
are considered safer for older adults.

Avoid benzodiazepines such as flurazepam, quazepam, and diazepam
or use four times/week or less.

Question 13

Melatonin Agonists

Answer 13

Ramelteon

First FDA-approved hypnotic not classified as a controlled substance. Prescription needed.

Selectively targets melatonin receptors to regulate circadian rhythm to treat insomnia.

Not been shown to decrease REM sleep.

Question 14

Melatonin Agonist Adverse effects

Answer 14

Drowsiness
Dizziness
Fatigue
Headache
Nausea
Suicidal ideation

Question 15

Nursing Process: Sedative-Hypnotics (Non-Benzodiazepines)

Answer 15

Assessment:
Ascertain the patient’s problem with sleep disturbance.

Nursing diagnosis:
Sleep deprivation related to anxiety
Fatigue related to anxiety

Planning:
Patient will remain asleep for 6 to 8 hours.

Nursing interventions:
Observe patient for side effects of nonbenzodiazepines such as hangover, dizziness, or confusion.
Encourage patients to avoid alcohol, antidepressants, antipsychotics, and opioids while taking nonbenzodiazepines.
Evaluation

Question 16

Anesthetics Types.

Answer 16

General :
Depresses the CNS
Alleviates pain
Causes a loss of consciousness.

Local:
Pain relief in limited area

Question 17

Anesthetics Routes.

Answer 17

Inhalation
IV
Topical
Local
Spinal

Question 18

Balanced Anesthesia

Answer 18

Balanced anesthesia may include:
Hypnotic is usually given the night before surgery to ensure adequate rest.
Preoperative medication is usually given approximately 1 hour before surgery.

Preoperative medications include an opioid analgesic and anticholinergic to decrease secretions.

Premedication:
With an opioid analgesic or benzodiazepine
Example: midazolam (Versed)

With an anticholinergic
Example: atropine given about 1 hour before surgery to decrease secretions.

A short-acting barbiturate
Example: Propofol.

An inhaled gas
Often a combination of nitrous oxide and oxygen
A muscle relaxant given as needed.

Question 19

Stages of General Anesthesia

Answer 19

Stage 1: Analgesia
Stage 2: Excitement or delirium.
Stage 3: Surgical.
Stage 4: Medullary paralysis

Question 20

Inhalation Anesthetics

Answer 20

Inhalation anesthetics:
Halothane
Methoxyflurane
Enflurane 
Isoflurane
Desflurane
Sevoflurane 

Provides smooth induction.
Usually combined with:
A nonbarbiturate such as Propofol 
A strong analgesic such as morphine 
A muscle relaxant such as pancuronium.

Question 21

Inhalation Anesthetics Adverse effects

Answer 21

Respiratory depression Hypotension
Dysrhythmias
Hepatic dysfunction
Malignant hyperthermia.

Consciousness usually reoccurs minutes to an hour upon discontinuation

Question 22

Intravenous Anesthetics

Answer 22

Droperidol
Etomidate
Ketamine
(Rapid onsets and short durations of action)

Midazolam
Propofol
( Induction and maintenance of anesthesia or conscious sedation for minor surgery or procedures such as mechanical ventilation or intubation. Patients are sedated and relaxed but responsive to commands)

Question 23

Intravenous anesthetic Adverse Effects.

Answer 23

Respiratory and Cardiovascular depression.

Infection.

Question 24

Topical Anesthetics

Answer 24

Use:
Mucous membranes, broken or unbroken skin surfaces, and burns.

Forms:
Solution, liquid spray, ointment, cream, gel, and powder
Decreases the sensitivity of nerve endings of the affected area

Question 25

Local Anesthetics

Answer 25

Block pain at the site where the drug is given
Consciousness is maintained.

Use:
Dental procedures, suturing skin lacerations
Short-term (minor) surgery at a localized area
Blocking nerve impulses (nerve block) below the insertion of a spinal anesthetic
Diagnostic procedures such as lumbar puncture and thoracentesis
Regional blocks

Question 26

Local anesthetics Two groups ?

Answer 26

1.)Esters
2.)Amides
Amides have a very low incidence of allergic reaction.
Procaine hydrochloride.
Lidocaine hydrochloride
(Rapid onset, longer duration of action
Causes fewer hypersensitivity reactions than procaine).

Question 27

Spinal Anesthesia

Answer 27

Local anesthetic injected in the subarachnoid space.
Adults—below first lumbar space
Children—below third lumbar space

Question 28

Spinal Anesthesia Side Effects

Answer 28

Respiratory distress
Headache
Hypotension

Question 29

Spinal Column Nerve Blocks

Answer 29

Spinal block:
Penetration of the anesthetic into the subarachnoid membrane between the pia mater and arachnoid membrane.

Epidural block:
Placement of the local anesthetic in the epidural space posterior to the spinal cord or dura mater.

Caudal block:
Placed through the sacral hiatus.

Saddle block:
Placed at the lower end of the spinal column to block the perineal area

Question 30

Nursing Process: Anesthetics

Answer 30

Assessment:
Obtain a drug and health history, noting drugs that affect the cardiopulmonary system.

Nursing diagnosis:
Pain, acute related to injury
Breathing pattern, ineffective related to CNS depression.

Planning:
Patient will participate in preoperative preparation and will understand postoperative care.

Nursing interventions:
Monitor the postoperative state of sensorium.
Observe preoperative and postoperative urine output.
Monitor vital signs following general and local anesthesia for hypotension and respiratory depression.
Administer an analgesic with caution until the patient fully recovers from the anesthetic.
Evaluation

Question 31

Which nursing intervention would be most appropriate for a patient taking temazepam?

Answer 31

Tell patient to ask for help before standing.

Question 32

What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching?

Answer 32

The patient requests a cup of kava tea to help her get to sleep faster.

Question 33

An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue?

Answer 33

“Drink warm milk or chamomile tea before bedtime.”

Question 34

A patient is taking a hypnotic nightly to enhance sleep. The patient experiences vivid dreams and nightmares. This may be associated with

Answer 34

REM rebound.

Question 35

The most serious adverse effect of spinal anesthesia is

Answer 35

respiratory distress.

Question 36

Which drug is commonly used for conscious sedation?

Answer 36

Midazolam