RESPECTED Ms. NITASHA MADAM
BSc. Nsg. IIIrd yr
ROLL No. 74
• Effect on the Body
• Sedative Hypnotic intoxification
• Sedative Hypnotic withdrawal
• Sedative Hypnotic therapeutic use
• NURSING Management
A sedative or tranquilizer is a substance that
induces sedation by reducing irritability or
Hypnotics (also called soporific) drugs are a class
of psycho actives whose primary function is to
induce sleep and to be used in the treatment
of insomnia and in surgical anesthesia.
Barbiturates are drugs that act as central
nervous system depressants, produces a wide
spectrum of effects from mild sedation to total
anesthesia. They are also effective as
anxiolytic, hypnotics, and anticonvulsants.
They have addiction potential both physical
Effects produced by these substances depends on
size of dose and potency of drug administered.
Several principles been identified that apply fairly
uniformly to all CNS depressants.
1. T h e e f f e c t o f C N S
d e p r e s s a n t s a r e
a d d i t i v e w i t h a n o t h e r
a n d w i t h t h e b e h a v i o r a l
s t a t e o f t h e u s e r . For
example, when these drugs are used in combination
with each other or in combination with alcohol, the
depressive effect are compounded. These intense
depressive effects are often unpredictable mentally
depressed or physically fatigued may have an
exaggerated response to a dose of the drug that would
only slightly affect a person in a normal or excited
2. C N S d e p r e s s a n t s a r e
c a p a b l e o f p r o d u c i n g
p h y s i o l o g i c a l
d e p e n d e n c y : if large doses of CNS
depressants are repeatedly administered over a
prolonged duration, period of hyper excitability
occurs on withdrawal of the drug. The response
can be quite severe even leading to convulsions
3. C N S d e p r e s s a n t s a r e
c a p a b l e o f p r o d u c i n g
p s y c h o l o g i c a l
d e p e n d e n c y : CNS depressants have
the potential to generate within the individual
and psychic drive for periodic or continuous
administration of drug to achieve a maximum
4. C r o s s t o l e r a n c e &
c r o s s d e p e n d e n c y
m a y e x i s t b e t w e e n
v a r i o u s C N S
d e p r e s s a n t s :
Cross tolerance is exhibited when one drug
results in a lessened response to another
drug. Cross dependence is a condition in
which one drug can prevent withdrawal
symptoms associated with physical
dependence on a different drug.
The sedative hypnotic compounds induce a general depressant
effects ; that is they depress the activity of he brain , nerves
, muscles & heart tissue. They reduce the rate of metabolism in
a variety of tissue throughout the body & in general they
depress any system that use energy.
Large scale doses require to produce these effects. In lower
doses, these drugs appear to be more selective in their
depressant actions. Specifically in lower doses these drugs
appear to exert their actions on the centers within the brain that
are concerned with arousal (e.g., the ascending reticular
activating system, in the reticular formation & the diffuse
thalamic projection system.)
As stated previously, the sedative hypnotics are capable of
producing all level of CNS depression from mild sedation to
death. The level is determined by dosage & potency of the drug
A Continuum of the CNS depressant effects is presented to demonstrate how
increasing doses of sedative hypnotic drugs affect behavioral depression.
Barbiturate use decreases the amount of sleep
time spent in dreaming. During drug
withdrawal, dreaming becomes vivid and
excessive. Rebound insomnia and increases
dreaming are not uncommon with abrupt
withdrawal from long term use of these drugs
are sleeping aids.
Barbiturates are capable of inhibiting the
reticular activating system, resulting in
respiratory depression. Additive effects can
occur with the concurrent use of other CNS
depressants, effecting a life threatening
• Hypotension may be a problem with large
doses. Only a slight decrease in blood pressure
is noted with normal oral dosage. High dosage
of barbiturates may result in decreased
cardiac output, decreased cerebral blood flow
and direct impairment of myocardial
In high doses barbiturates may suppress renal
function. At the usual sedative hypnotic
dosage, however , there is no evidence that
they have any direct action on the kidney.
The barbiturates may produce jaundice with
doses large enough to produce acute
intoxification. Barbiturates stimulate the
production of liver enzymes, resulting in a
decrease in the plasma levels of both the
barbiturates and other drugs metabolism in
the liver. Preexisting liver disease may
perdispose an individual to additional live
damage with excessive barbiturate use.
High doses of
It is not significantly
altered with normal
CNS depressants have a tendency to produce a
biphasic response. There is an initial response is
then followed by decrease in the ability to
maintain any erection.
• The DSM IV describes sedative, hypnotic
intoxification as the presence of clinically
significant maladaptive behavioral or
psychological changes that develop during , or
shortly after, use of one of these substances.
• These maladaptive changes may include
inappropriate sexual or aggressive behavior
mood liability, impaired judgment or impaired
judgment or impaired social or occupational
• Other Symptoms that may develop with
excessive use of sedatives, hypnotics includes
• Withdrawal from sedatives, hypnotics produce a
charcteristic syndrome of symptoms that
develops after a marked decreased in or
cessation of intake after a several week or more
of regular use. Onset of the individual is
• A short acting (e.g., Lorazepam or oxazepam)
may produce symptoms within 6-8 hrs of
decreasing blood levels, where withdrawal
symptoms from substances with longer half-lifes(
e.g., diazepam) may not develop for more than a
week, peak in intensity during the second week
and decrease markedly during the third or fourth
• Severe withdrawal is most likely to occur when a
substance has been used at high dosages for
prolonged period. However, withdrawal
symptoms associated with sedative hypnotics
include autonomic hyperactivity(e.g., sweating
or pulse rate greater than 100 ), increased hand
tremor, insomnia, nausea, vomiting, hallucinatio
n, illusion, psychomotor agitation anxiety or
grand mal seizures.
INDICATIONS: Sedative Hypnotics are used in the
short term management of various anxiety states
and to treat
(mephobarbital, pentobarbital, secobarbital) and to
reduce anxiety associated with drug withdrawal
Sedative hypnotics are contraindicated
in individuals with hypersensitivity to
the drug or to any drug within the
chemical class; in pregnancy (
exception may be made in certain
cases based on benefit to risk ratio);
location and in severe cases like
hypnotic, cardiac, respirator, or renal
disease. Caution should be used in
administering these drugs to client
with cardiac, hepatic, renal or
They should be used with caution in
clients who may be suicidal or who
may have been addicted to drugs
• Risk for injury related to abrupt withdrawal from
long term use of decreased mental alertness caused
by residual sedation.
• Insomnia related to situational crises, physical 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
medication on the central nervous system.
Planning / Implementation
The plan of care should include monitoring for the following side
effects from sedative hypnotics:
1. Drowsiness, confusion & lethargy: (most common side effect)
instruct the client not to drive or operate dangerous machinery
after taking medication.
2. Intolerance , physical & psychological dependence: instruct the
client on long-term therapy not to quit the drug taking abruptly.
Abrupt withdrawal can be life threatening. Symptoms include
depression, insomnia, tremors, vomiting, sweating, convulsions
3. Ability to potentiate the effect of other CNS depressant: instruct
the client not to drink alcohol or take other medications without
consultation that otherwise could depress the CNS .
4. Possibility for aggravating symptoms in depressed person: assess
the client’s mood daily. Take necessary precautions potential
Planning / Implementation
5.Orthostatic hypotension: monitor lying and standing blood
pressure and pulse at every nursing shift. Instruct the client to
arise slowly from the lying or sitting position.
6. Paradoxical excitement: client develop the symptoms opposite
of the medication’s desired effect. Withhold the drug and notify
7. Dry mouth: have the client taken frequent sips of water, suck on
ice chips or hard candy or chew sugarless gum.
8. Nausea and vomiting: check whether the client have taken drug
with food or milk or not.
9.Blood dyscrasias: symptoms of sore throat , fever, malaise, easy
bruising, or unusual bleeding should be reported to the physician
The client should:
1. Not drive or operate machinery if he feels
2. 2. not to stop taking drug abruptly, as this
may produce serious withdrawal
symptoms, such as, depression
, insomnia, anxiety, abdominal and muscle
cramps, tremors, vomiting
, sweating, convulsions, delerium.
3. Not to take non prescription medicines
without approval from physicians.
4. not to consume other CNS depressant(
5. Be aware of risk of taking drug during
pregnancy (congenital malformation have
been associated with use during the first
trimester). The client should notify the
physician of the desirability to discontinue
the drug if pregnancy is susupected.
6. Beaware of possible side effects. The client
should refer to written materials furnished by
healthcare providers regarding the correct
method of self adminitration.
7. Carry a card piece of paper at all time stating
the name of medication being taken.
The following criteria may be used for evaluatin the
effectiveness of therapy with sedative hypnotics
1.Demonstrate a reduction in anxiety, tension and
2. Falls alseep within 30 mins. Of taking medication
and remains asleep for 6-8 hours without
3. Is able to participate in usual activites without
4. Experiences no physical injury.
5. Exhibits no evidence of confusion.
6. Verbalizes understanding of taking the
medication on a short term basis.
7.Verbalizes understanding of potential for
development of tolerance and
dependence with long term use.