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Chapter 27
Central Nervous System
Sedatives and
Hypnotics REVIEW
Sedatives and Hypnotics

Classifications




Barbiturates
Benzodiazepines
Nonbarbiturates
Miscellaneous
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Barbiturates
Act on the reticular
formation area




Reduce nerve impulses
to the cerebral cortex
Inhibit nerve impulse
transmission by
potentiating an inhibitory
amino acid known as
gamma-aminobutyric
acid (GABA)
Effects are dose related
In low doses act as
sedatives
In higher doses act as
hypnotics
Barbiturates raise the
seizure threshold




Reduce seizures


Used for treatment of
status epilepticus,
tetanus, and druginduced convulsions
A select few are used
as prophylaxis for
epileptic seizures.
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Duration of Barbiturates


Ultra short-acting
are used primarily
as IV injectable
anesthetics, usually
in combo with
inhalation agents.
(surgery)
Short and
intermediate-acting
treats insomnia (no
hang over feeling)

Long-acting are
used for convulsive
disorders (constant
blood level
throughout the day)
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(continued)
Barbiturates: Side Effects

Main side effects

Excessive central nervous system
depression




Drowsiness, lethargy, dizziness, hangover
Hypersensitivity reactions
Paradoxical restlessness or excitement
Depression of the REM sleep cycle
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Barbiturates: Rebound
Phenomenon

When barbiturates are discontinued,
a rebound phenomenon can occur


Increase in REM sleep
Dreams often become nightmares
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Benzodiazepines


Affect the
hypothalamic,
thalamic, and limbic
systems of the brain
and depress the
CNS
Receptors resemble
the GABA receptors






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Useful hypnotic agents
Have a calming effect
on the CNS
Control agitation and
anxiety
Relaxes skeletal
muscle
Does not affect the
REM sleep cycle
Used in the treatment
of alcohol withdrawal
(continues)
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(continued)
Benzodiazepines
Nursing
Considerations
when using as
hypnotics agents




Monitor for
dizziness,
oversedation,
vertigo..
Children and
elderely ASE’s more
common..
Suicidal pts monitor
closely..
An overdose results in
somnolence, confusion,
coma, and diminished
reflexes




Treatment is syrup of
Ipecac
Activated charcoal with
gastric lavage
Treatment is flumazenil
(Romazicon)

Reverses the sedative
effects of
benzodiazepines
27 - 8
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Alcohol


A potent CNS depressant
Used to assist a person in relaxing and
becoming more social
27 - 9
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Other Sedatives
Chloral Hydrate
(Noctec)

Zolpidem tartrate
(Ambien)




A nonbarbiturate,
nonbenzodiazepine
hypnotic agent
Produces an effect
similar to the
benzodiazepines,
but without
producing muscle
relaxation
Used frequently in
the elderly





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A nonbarbiturate,
nonbenzodiazepine
hypnotic agent
Does not affect the REM
sleep cycle.
Good for short term use
(10 days)
No alcohol : MickeyFinn knockout drps)
causes rapid loss of
consciousness 18961903
Also used for conscious
sedation.
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Safety Precautions



All patients should have
side rails up to prevent
falls during the night.
Avoid operating heavy
equipment, driving or
other activities which
require alertness.
May cause excitement
instead of sedation in
some individuals






Assist or monitor
ambulation closely.
Monitor for ASE’s or
over dosage
Discontinue gradually
to avoid sz
Institute 1:1 supervision
for suicidal patients
Know drug interactions.
Do not mix with ETOH
or antihistamines
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Drug Interactions/Toxicity


Impairs action of
Coumadin and
Dilantin
Do not mix
Barbituate drugs
with Demerol the
salts interfere with
chemical action
(give in separate
syringes).

Confusion,
excitement, heavy
sleep to coma state,
pupillary constriction
to dilation (terminal),
cyanosis, clammy
skin, hyptension.
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