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SEDATIVE-HYPNOTICS
Joy N Bautista, RN, MPH, DRDM
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Review of Sleep Physiology
Sleep cycle
Stage 1 between wakefulness and drowsiness
Stage 2 feeling of drifting or floating
Stage 3 between light and deep sleep
Stage 4 deep sleep; dreamless, very restful, decreased
physiologic processes
Stage 5 REM sleep; dreams, increased physiologic processes;
associated with subconscious mitigation of anxieties
Issues
Initial insomnia inability to fall asleep when desired
Intermittent insomnia inability to stay asleep
Terminal insomnia early awakening with inability to fall asleep
again
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Sedative-Hypnotics
Sedative quiets the patient and gives a feeling of
relaxation and rest
Hypnotic produces sleep
Good sedative-hypnotic increase stage 2 and stage 4
sleep time
Actions
Produce relaxation and rest
Induce sleep
Classifications
Barbiturates
Benzodiazepines
Miscellaneous agents


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Barbiturates
Action reversible depression of all
excitable tissues (esp the brain)
depending on
Dose
Route
Tolerance
Degree of CNS excitability
Patient condition
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Barbiturates
Ultra-short-acting methohexital, thiopental as GA
Short-acting
Pentobarbital pre-anesthesia, daytime sedative, bedtime
hypnotic
Secobarbital - daytime sedative, bedtime hypnotic, not used >14
days
Intermediate acting
Amobarbital pre-anesthesia or during labor
Butabarbital daytime sedative and bedtime hypnotic
Long acting
Mephobarbital anticonvulsant, daytime sedative
Phenobarbital anticonvulsant, pre-anesthesia, daytime
sedative, bedtime hypnotic
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Benzodiazepines
Actions CNS depression but with more
selective action at receptor sites
variable uses
Uses
Mild sedation
Short-term use to produce sleep
Preoperative sedation with amnesia
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Benzodiazepines
Short-acting
Diazepam for insomnia use, preoperative anxiety
Midazolam onset 15 minutes (IM) 3-5 mins (IV), duration 30-60
min (IM) 2-6 hrs (IV), causes amnesia in most patients
Triazolam for insomnia use < 2 weeks, no morning hangover
Intermediate-acting
Estrazolam used for insomnia, minimal morning hangover
Temazepam - used for insomnia, minimal morning hangover
Long-acting
Flurazepam short term tx of insomnia up to 4 wks, significant
morning hangover
Lorazepam preoperative anxiety, insomnia
Quazepam insomnia, significant morning hangover
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Miscellaneous Sedative-
Hypnotics
Chloral hydrate
Bedtime hypnotic, preoperative sedative
Take with full glass of water, do not chew
Ethchlorvynol short term insomnia < 1wk
Glutethimide short term insomnia < 3-7 days
Paraldehyde
Administer with milk or juice to mask taste and odor
Dispense only in glass container, not plastic spoon or container
Sedative for delirium tremens
Bad breath 24 hours after
Zolpidem bedtime hypnosis