309 Central Nervous System Depressants

What is sleep?

A time of bodily rest, the brain remains active

What are the two phases of sleep?

•No rapid eye movements (NREM)

•Rapid eye movements (REM)

+Active dreaming

Physiologic effects of sleep:

Growth, energy, metabolic hormones

Amount of sleep needed varies:

•infants requiring the most

•adults requiring the least.

How many people do sleep disorders affect?

Affect 50-70 million American adults

List different sleep disorders.

•Narcolepsy (sleep attacks)

•Sleep apnea

•Sleepwalking

•Night terrors

•Excessive daytime sedation

•Insomnia

What are drugs for sleep

Hypnotics

What are Benzodiazepines indicated for?

High-anxiety periods, night before surgery, etc.

How long should Benzodiazepines be used for?

Short-term use (3-4 weeks)

What pregnancy category are Benzodiazepines?

Pregnancy category X (when used to promote sleep)

Possibly unsafe when breastfeeding

What are the prototype drugs for Nonbenzodiazepines?

Zaleplon, Zolpedim

Indications of Nonbenzodiazepines:

(Zaleplon, Zolpedim)

Short-term treatment of insomnia

Contraindications/precautions of Nonbenzodiazepines:

(Zaleplon, Zolpedim)

•Hypersensitivity, pregnancy

•Caution: aspirin allergy

Adverse effects of Nonbenzodiazepines:

(Zaleplon, Zolpedim)

Drowsiness, cognitive impairment, excessive daytime sleepiness, ataxia ·Paradoxical excitation ·Rebound insomnia ·Increased risk for falls ·tolerance and dependence

Interactions of Nonbenzodiazepines:

(Zaleplon, Zolpedim)

Other CNS depressants

How long should Zolpidem use be limited to?

short-term 7 to 10 days

What does Zolpidem do?

induces sleep RAPIDLY

CAUTIONS!!! of Zolpidem!!!!

Amnesia: sleep walking, sleep driving(!), sleep eating (aspiration), sleep cooking…

with no memory of activity the next day!!!

What type of drug is Ramelton?

Nonbenzodiazepines

MOA of Ramelteon:

Melatonin receptor agonists

How long is the duration of Ramelton?

Short duration

What is Ramelton useful for?

Useful for sleep onset

Why is Ramelton a good drug to use? (just pros to it idk)

Less next-day drowsiness

•No withdrawal, no dependence, no rebound insomnia

What type of drug is Trazodone?

Non-benzodiazepine

atypical antidepressant

What is an adverse effect of Trazodone?

Significant sedation is an adverse effect

What is Trazodone most commonly used for? What is it used in combination with?

Most commonly used to promote sleep.

Often used in combination with antidepressants that cause insomnia.

Major AEs/Warnings of Trazodone:

suicidality in children, adolescents, young adults with major depression or other psychiatric disorders

What were Barbiturates used for? What are they used for now?

Previously used to induce sleep.

Now used primarily to treat convulsive disorders.

What classes are OTC hypnotics?

Diphenhydramine (Sominex)

Doxylamine (Unisom)

What are OTC hypnotics often used in combination with?

Often in combination with an analgesic

•Tylenol PM, Advil PM

•Look for the PM in the name!

What may OTC hypnotics cause?

OTC hypnotics may cause cognitive impairment and increased falls risk in older adults.

Nursing Implications: Assess

•Sleep patterns, VS, PE, mental status, allergies, medication history, alcohol, drugs, OTCs

•Occupation, environment, safety issues

Nursing Implications: Diagnose/plan

Sleep/rest, safety

Nursing Implications: Implement

•Non-pharmacologic sleep measures – first!

•Safety precautions!

•Empty stomach if tolerated

•Administer at bedtime

+Patient should be in bed for the night

•Dose no later than midnight

+Will cause next-day drowsiness

What measures should be implemented first to induce sleep?

non pharmacologic

Should OTC hypnotics be taken with or without food?

Empty stomach if tolerated

When should OTC hypnotics be administered? (where should the pt be?

Administer at bedtime

Patient should be in bed for the night

What time should OTC hypnotics be taken by? Why?

Dose no later than midnight

•Will cause next-day drowsiness

Nursing Implications: Evaluate

Therapeutic effects

•Time to fall asleep, total # hours of sleep, sleep quality

Adverse effects

•Drowsiness, confusion, ataxia

Nursing Implications: Educate

•Non-pharmacologic measures (Box 12-1)

•Purpose, dosing, administration

•Adhere to dosing duration (short-term use)

•Avoid alcohol and other CNS depressants

•Caution with OTC meds

•Sleep diary

Non-pharmacologic Sleep Interventions:

Regular sleep/wake pattern

•Sleep only as much as you need - Too much sleep may lead to fragmented sleep patterns.

•Avoid tobacco at bedtime.

•Avoid daytime napping.

•Avoid exercise late in the evening.

•Avoid alcohol in the evening – leads to fragmented sleep.

•Keep bedroom temperatures moderate.

•Avoid caffeine within 6 hours of bedtime.

•Decrease loud noises.

•Relax before bedtime.

•Reduce screen time. No TV in the bedroom.

•The bed is for sleep and sexual activity only.

What leads to fragmented sleep?

too much sleep and alcohol in the evening