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Sedative hypnotic by sanjana


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Sedative hypnotic by sanjana

  2. 2. • Definition • Introduction • Classification • Effect on the Body • Sedative Hypnotic intoxification • Sedative Hypnotic withdrawal • Sedative Hypnotic therapeutic use • NURSING Management
  3. 3. Sedative A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement.
  4. 4. Hypnotics 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.
  5. 5. Barbiturates 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 and psychological.
  6. 6. 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
  7. 7. 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 and death. 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
  8. 8. 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.
  9. 9. Categories
  10. 10. BARBITURATES 1. Pentobarbital (Nembutal) 2. Secobarbital (seconal) 3. Amobarbital (amytal) 4. Secobarbital / Amobarbital ( tuinal) 5. Phenobarbital 6. Butabarbital
  11. 11. Non – barbiturate hypnotics:- 1. Chloral hydrate (noctec) 2. Triazolam (halicon) 3. Flurazepam (Dalmana) 4. Temazepam ( restoril) 5. Quazepam ( doral)
  12. 12. Anti – Anxiety Agents:- 1. Diazepam (valium) 2. Chlordiazepoxide (zibrium) 3. Meprobamate ( miltown) 4. Oxazepam (serax) 5. Alprazolam (xanan) 6. Lorazepam (ativan) 7. Chlorazepate (tranexene) 8. Flumitrazepam (rohypnol)
  13. 13. Effects On The Body
  14. 14. 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 used.
  15. 15. A Continuum of the CNS depressant effects is presented to demonstrate how increasing doses of sedative hypnotic drugs affect behavioral depression. Norma l Relief from anxiety Disinhibh ition Sedation, Hypnosis, General anesthesia COMA; DEATH
  16. 16. 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.
  17. 17. Respiratory Depression 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 situation.
  18. 18. • 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 contractibility.
  19. 19. 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.
  20. 20. Hepatic Effects 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.
  21. 21. High doses of barbiturates can greatly decrease body temperature. It is not significantly altered with normal dosage levels.
  22. 22. SEXUAL FUNCTIONING 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.
  23. 23. • 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 functioning. • Other Symptoms that may develop with excessive use of sedatives, hypnotics includes
  24. 24. • 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 withdrawing. • 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
  25. 25. • 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.
  26. 26. 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 (chloral hydrate).
  27. 27. Contraindication o/r PRECAUTIONs
  28. 28. 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 respiratory insufficiency. They should be used with caution in clients who may be suicidal or who may have been addicted to drugs
  29. 29. NURSING DIAGNOSIS • 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.
  30. 30. 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 and delirium. 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 suicides.
  31. 31. 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 the physician. 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 immediately.
  32. 32. Client and family education
  33. 33. The client should: 1. Not drive or operate machinery if he feels drowsy. 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( including alcohol).
  34. 34. 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.
  35. 35. The following criteria may be used for evaluatin the effectiveness of therapy with sedative hypnotics medication: 1.Demonstrate a reduction in anxiety, tension and restless activity. 2. Falls alseep within 30 mins. Of taking medication and remains asleep for 6-8 hours without interruptions 3. Is able to participate in usual activites without residual sedation.
  36. 36. 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.
  37. 37. Thank you