okay guys so this is unit 10 that we are going to be going over so i'm just going to scroll up really quick so just make sure that you are reviewing the information from these chapters as we're covering it um this particular unit goes over the central nervous system unit 11 is a continuation on with the peripheral nervous system but we're just going to be covering unit 10 right now all right so sedatives and hypnotics this starts in chapter 12 on page 183 so a comparison sedatives these are drugs that have an inhibitory effect on the cns so they're going to depress the central nervous system they help induce relaxation decreases anxiety so we call it an anxiolytic so they decrease anxiety and nervousness and then they also can um cause sedation at higher doses hypnotics actually cause sleep they're much more potent um or have a much more potent effect than sedatives do so this would be the upper end of sedation and then induces sleep um and coma so precautions we really want to be careful about the patient's level of consciousness because they're going to have a change in level of consciousness and then we also have to be concerned about respiratory insufficiency because it can depress their respiratory their respiratory drive and then risk for injury so if they have a change in level of consciousness hopefully it makes sense to you as to why they would be more at risk for injury or say a fall so nursing actions in general we want to assess for therapeutic and side effects we have to monitor their level of consciousness their respiratory function even their blood pressure because it can cause them to become hypotensive and then make sure we ensure safety so these aren't medications that you would want to administer and then walk away with your side rails down right so you want to make sure your side rails up the call light's in reach ensuring that your patient is safety and are is safe and that they know to call for help if they need to get up out of bed patient education so um educating the patient about the drug information the drug levels there are certain drugs we actually will assess or draw a therapeutic drug level on and we'll get to those shortly and then potential issues so opioids can cause severe low blood pressure they can depress the respiratory rate and they can change the patient's level of consciousness so those are just some things to think about okay depending on what exact class of drug that we're talking about physical and psychological dependence can actually occur and then they could actually have withdrawal symptoms if they were to stop the medications so they might have psychological disturbances such as anxiety or insomnia and then other withdrawal symptoms should be or would be fever tachycardia and increase or decrease in blood pressure so the classes we see here are the first we're going to talk about is barbiturates this starts on page 194. therapeutic effects and indications so these are very potent uh central nervous system depressants they decrease nerve transmission and they increase the seizure threshold so when we're saying they it increases the seizure threshold what we're saying is it decreases how susceptible a person is to seizure so if their threshold is high that means they're not as susceptible to having a seizure okay um dose dependent action and so depending on the dose that's what lets us know its action so in low doses we can give it as anti-anxiety we can give it for it may cause drowsiness or sedation in moderate doses we can use it for anti-seizure activity and then for high doses it can be used for anesthesia or to induce coma important to remember for barbiturates barbiturates are no longer recommended for sleep induction very important that you remember that okay no longer recommended for sleep induction what it does is it actually deprives the patient of rem sleep and rem sleep is really important that is the sleep phase that's the restorative part of our sleep cycle it helps restore brain chemistry uh lack of rent sleep rem sleep can also cause psychosis so just important that we no longer use barbiturates for or it's not recommended for the use for sleep induction side effects we're going to have decreased respiratory rate blood pressure and lethargy and then these are also notorious enzyme inducers so what this does is it increases metabolism of certain drugs by the liver so barbiturates are known to cause medications to actually metabolize more quickly so what happens is it shortens the duration of action and then it may actually even require increased doses of certain medications to be given in order to achieve therapeutic effect so increases metabolism of certain drugs by the liver nursing actions we have to know the narrow therapeutic range some of these drugs we draw levels on so we needed other side effects and what the appropriate or normal drug levels are okay because they have such a very narrow therapeutic range so examples of drugs nicer that you see the only one starred you need to know is phenobarbital it is a barbiturate and we call it phenobarbital and you need to know that the therapeutic drug level is 10 to 40 micrograms per milliliter okay important that you remember that drug level um also what is very important to remember about that particular drug is that alcohol can increase the sedative effects so the patient's going to have increased lethargy right alcohol can increase the sedative effects that's another important fact to remember benzodiazepines benzodiazepines are cns depressants um therapeutic effects and indications they are the drug of choice for patients with anxiety we can give it for some sedation um patients who have insomnia and we can even use it as a skeletal muscle relaxant so those are some um reasons as we would as to why we would give that class of drug so some of the side effects are headache they can feel very drowsy they might even have a hangover effect so again important to avoid the use of alcohol with this particular drug class and then paradoxical excitement or nervousness so we say paradoxical we're saying that's not the norm or usual effect um but they can have that excitement or nervousness from it nursing action we need to make sure we're assessing the appropriate use educating our patients appropriately especially about safety and then reversal agent reversal agents really important for you guys to remember okay so your reversal agent is flumazanil flamazanil is the antidote for benzodiazepine overdose okay important to remember also important to remember are that benzodiazepines affect the sleep cycle right so patients could have daytime drowsiness because of it it affects the sleep cycle causing daytime drowsiness examples you see lorazepam is your froze first prototype important fact to remember about lorazepam is this particular drug is excellent for panic attacks for treating anxiety and for treating seizures so good for panic attacks anxiety and seizure the other prototypes listed there are clonazepam temazepam midazolam important about midazolam is it has an amnesiac effect okay so we use that the trade name is versed so midazolam we use in outpatient procedures so patients are going to go for outpatient procedures we will give this because it has an amnesiac effect to it so they might or should not really remember the procedure itself and then alprazolam is the other prototype so the nice thing about all those medications is they have pretty similar suffix so hopefully they're easier for you to remember non-benzodiazepines non-benzos work very similar to benzos however they cause less disruption of normal sleep and then they lack that sedative and dependency potential so they work similar but again don't disrupt the sleep as much and then they lack that sedative and dependency potential so therapeutic effects and indications so we can use it for an anxiolytic so we're going to decrease anxiety and then we can also use it to help induce sleep it's going to treat insomnia so some of the side effects and these are more specific to the actual medication so the zolpidem or you see ambien listed there as a trade name patients typically will sleep walk um sleep eat sleep drive all those things can happen i know scary and then number two there is busparone um buspar is the trade name that's listed there with that particular drug grapefruit juice increases the drug concentration so those are just specific to those particular drugs so nursing actions we want to talk about safety with ambien which is your zolpidem and dietary guidelines with the buspirone which is the boost bar you see listed there so examples um the zolpidem aids in sleep induction and then the busparone we can give for patients to help decrease anxiety and the nice thing about it is we can decrease their anxiety and then they'll have less drowsy effects they don't have all that sleepiness that they would get from taking a benzodiazepine so if you have somebody maybe who likes the way a benzodiazepine works but they're kind of suffering from the drowsy effects or hangover effect from the drug we might be able to prescribe them or not us but the provider would be able to prescribe them a non-benzodiazepine such as the abuseverone to help decrease their anxiety levels with the less drowsy effects