11/21/09
SEDATIVE AND HYPNOTIC AGENTS
INTRODUCTION
Insomnia is a significant health care problem. It can create daytime fatigue, impaired social or occupational functioning, and reduced quality of life. Treating the secondary cause of insomnia may alleviate the sleep difficulty without the need to use sedative -hypnotic agents.
INDICATIONS
Sedative-hypnotics are used in the short term management of various anxiety states and to treat insomnia. Selected agents are used as anticonvulsants and preoperative sedatives. (Phenobarbital, secobarbital and pentobarbital) and to reduce anxiety associated with drug withdrawal (chloral hydrate).
ACTION
It causes generalized CNS depression. They may produce tolerance with chronic use and have the potential for psychological or physical dependence.
CLASSIFICATION
|
Chemical class |
Generic name |
Daily dose(mg) |
Half life( hour) |
|
Barbiturates |
Amo barbital Butabarbital Mephobarbital Pentobarbital Phenobarbital secobarbital |
60-200 45-120 32-200 60-100 30-200 100-200 |
16-40 66-140 11-67 15-50 53-118 15-40 |
|
Benzodiazepines |
Estrazolam Flurazepam Quazepam Temazepam Triazolam |
1-2 15-30 7.5-15 15-30 0.125-0.5 |
8-28 2-3 41 9-15 1.5-5.5 |
|
Miccelaneous |
Chloral hydrate Eszopiclone Zalpilon zolpidem |
500-1000 1-3 5-20 5-10 |
8-10 6 0.5-1.5 1.4-4 |
CONTRAINDICATION/ PRECAUTIONS
Sedative hypnotics are contraindicated in individuals with hypersensitivity to the drug or to any drug within the chemical class.
Caution should be used in administering thses drugs or clients with hepatic dysfunction or severe renal impairment. They should be used with caution in clients who may be suicidal or who may have been addicted to drugs previously. Hypnotic use should be short term. Elderly clients are more sensitive to CNS depressant effects , and dodge reduction may be required.
INTERACTIONS
Addictive CNS depression can occur when sedative-hypnotics are taken concomitantly with alcohol, antihistamines , antidepressants, phenothiazines, or any other CNS depressants . Barbiturate induces hepatic drug-metabolizing enzymes and can increase the effectiveness of drugs metabolized by the liver. Sedative hypnotics should not be used with MAOIs.
Disadvantage of barbiturates
Barbiturates and other older sedative hypnotic agents (alcohol,meprobamate,chloral hydrate) have many disadvantage that have led their greatly decreased use. It include the following
- Tolerance develops to their ant anxiety and sedative effects.
- They are very addictive.
- They cause serious even lethal ,withdrawal reactions
- They are dangerous in case of overdose.
- They cause CNS depression.
- They cause a variety of drug interactions, particularly when mixed with CNS depressants such as alcohol.
POSSIBLE NURSING DIAGNOSIS
- Risk for injury related to abrupt withdrawal from long term use or decreased mental alertness caused by residual sedation.
- Disturbed sleep pattern related to situational crises, physical condition or severe level of anxiety.
- Risk for activity intolerance related to side effects of lethargy, drowsiness, and dizziness.
- Risk for acute confusion related to action of the medication on the CNS.
CONCLUSION
Psychotropic medications are intended to be used as adjunctive therapy to individuals or group psychotherapy. Ant anxiety agents and sedative-hypnotics are CNS depressants and have a potential for physical and psychological dependence. Addiction and side effects are common to these drugs. So teaching has to be given regarding this.
