ch 18 - depressants

what are the stages of sleep

1. rapid eye movement

2. non rapid eye movement

what happens during REM

the brain start to develop and create memories

what is an intervention to do when your patient has insomnia

assess why they cant sleep

what are nonpharmacologic ways to manage insomnia

1. limit daytime naps

2. avoid caffeine

3. avoid exercise

what are sedatives

mildest form of CNS depression

what classes belong to sedative hypnotics

1. barbituates

2. benzodiazepines

3. nonbenzodiazepines

general side effects of sedative hypnotics

1. residual drowsiness

2. respiratory depression

3. drug tolerance

what vital signs do i monitor while the pt is on a sedative hypnotic

respiratory rate (ABCs)

why do we not use barbituates as much

it has a high potential for mental/physical dependency

how long do we limit using barbituates to

2 weeks or less

what are benzodiazepines

creates sleep

important benzodiazepine to remember

alprazolam

benzodiazepine action

interacts with neurotransmitter GABA to reduce neuron excitability

reversal agent for benzodiazepine OD

flumazenil

benzodiazepine use

reduces anxiety and treats insomnia

why do we encourage pt to not use alcohol and depressants when taking benzodiazepines

helps avoid respiratory distress

what do we teach patients regarding benzodiazepines

it should be gradually withdrawn

how long should we use benzodiazepine for sleep

3-4 weeks

what are nonbenzodiazepines

hypnotics

what is zoldipem

activates benzodiazepine receptors

how long should we use nonbenzodiazepine

less than 10 days for insomnia

what are melotonin agonists used for

regulating circadian rhythm to treat insomnia

examples of balanced anesthesia

1. hypnotic the night before

2. premedication

3. short acting barbituate

4. inhaled gas

5. muscle relaxant

what are examples of premedication

1. opioid analgesic/benzodiazepine

2. anticholinergic

what is an example of a short acting barbituate

propofol

what is inhaled gas made of

nitrous oxide and oxygen

stages of general anesthesia

1. analgesia (speech is difficult)

2. excitement or delirium (losing consciousness)

3. surgical

4. medullary paralysis

routes for anesthesia

1. inhalation

2. IV

3. local

4. topical

5. spinal

examples of intravenous anesthetics

1. droperidol

2. etomidate

3. ketamine

what is the use of a topical anesthetic

decreases the sensitivity of nerve endings of the affected area

how long do i let the topical anesthetic sit for

20 minutes

for spinal anesthesia, where would i inject it

subarachnoid space

in adults, where exactly can i inject spinal anesthesia

below first lumbar space

in children, where exactly can i inject spinal anesthesia

below third lumbar space

side effects of spinal anesthesia

1. respiratory distress

2. headache

3. hypotension