Discussion: Anxiolytic and hypnotic agents.
A graduate school nurse has to prepare a presentation for a freshman class of nursing students on anxiolytic and hypnotic agents. The learning objectives include a review of the states that are affected by anxiolytic and hypnotic agents and key nursing considerations for patients receiving these medications. (Learning Objectives 1, 2, and 5)
a.What are the definitions of the states affected by anxiolytic or hypnotic agents?
b.What are the key nursing implementation considerations for a patient receiving a benzodiazepine?
c.What should the nurse teach the students about the indications for zaleplon (Sonata) and zolpidem (Ambien)?
Case Study, Chapter 23, Antiseizure Agents
A patient had a tonic–clonic seizure and has been started on a phenytoin medication. The patient tells the nurse he is very upset about not being able to drive and has several questions about epilepsy. (Learning Objectives 1, 2, and 5)
a.What should be included in the patient teaching about the classification of generalized seizures?
a.How does phenytoin work?
c.What are the key implementation and rationale considerations for this patient who is receiving medication to treat generalized seizures?
Case Study, Chapter 26, Narcotics, Narcotic Antagonists, and Antimigraine Agents
A new graduate RN has been assigned to a medical–surgical unit. The new graduate RN is in the week of nursing orientation and is administering medications. The RN has to administer an antimigraine medication to an adult patient, a narcotic to an older adult in acute pain, and a narcotic antagonist to a third patient. (Learning Objectives 1, 2, 3, and 5)
a.What is the gate control theory of pain, and how does this block pain for a patient?
b.What are the key lifespan considerations for an older adult when administering narcotics?
c.What are the key nursing implementation considerations for a patient receiving a narcotic antagonist?
d.What are the key lifespan considerations for an adult when administering antimigraine medication?
Discussion: Anxiolytic and hypnotic agents.
Case Study, Chapter 30, Adrenergic Agonists
A patient is experiencing serious ventricular arrhythmias and shock following a heart transplant. The physician has ordered isoproterenol and dopamine to be administered to the patient. (Learning Objectives 2, 4, and 5)
a.What is the therapeutic action for isoproterenol?
b.What are the adverse effects of isoproterenol?
c.What is the therapeutic action for dopamine?
d.What are the adverse effects of dopamine?
e.What are the key nursing implementation considerations for patients receiving an adrenergic agent?
Case Study, Chapter 36, Adrenocortical Agents
A second-year nursing student has to prepare medication cards for clinical on adrenocortical agents. The specific medication cards that have to be prepared are for prednisone (Deltasone) and fludrocortisone (Florinef). Additionally, the student nurse has to prepare a patient teaching plan for mineralocorticoids. (Learning Objectives 1, 2, 4, and 5)
a.What are the physiological effects of the adrenocortical agents?
b.What are the key nursing implementation teaching points that need to be reviewed with a patient receiving an adrenocortical agent?
c.What are the most common adverse reactions for fludrocortisone (Florinef)?
d.What are the indications for prednisone (Deltasone)?
Anxiolytic and hypnotic agents are drugs that are used to relieve anxiety, as well as to induce sleep. Benzodiazepines (BZD) like diazepam (Valium) and lorazepam (Ativan), are most commonly used for treating anxiety disorders like panic disorder. However, they can also be used to treat insomnia or muscle spasms. Flurazepam is often used in the treatment of severe nausea and vomiting related to cancer chemotherapy; it has also been shown to be useful when treating short-term memory loss caused by alcohol withdrawal. Midazolam is an injectable form of diazepam that’s FDA approved for short-term use only as a sedative agent before surgery or childbirth.”
Benzodiazepines are a class of psychoactive drugs that are commonly used as sedatives, hypnotics, or anxiolytics. They can be used to treat anxiety disorders, panic attacks, insomnia and epilepsy. They have also been shown effective in the treatment of substance abuse disorders (e.g., alcoholism) and some eating disorders (e.g., bulimia nervosa).
The benzodiazepines include:
Flurazepam is a benzodiazepine, which means it’s a drug that binds to GABA receptors in the brain. This can cause sedation and relaxation, making it useful for treating insomnia.
Flurazepam also has hypnotic properties; in other words, it causes drowsiness so you may feel less alert while using the drug. It has a short half-life (about 7 hours), so you should take this medication before going to bed if you plan on using it as an anxiolytic—it will wear off before morning if not taken soon enough after taking your last dose of flurazepam.[1]
Lorazepam is a benzodiazepine that is used to treat anxiety, insomnia and seizures. It can cause sedation and memory loss.
Lorazepam should not be used in children because of the risk of life-threatening respiratory depression if given to them. It should also not be taken during pregnancy because it may cause birth defects or death of the baby if taken during early pregnancy.
Midazolam is a benzodiazepine, which means it has the same effects as valium and other drugs from this class. It’s used to treat anxiety and insomnia, but can also be used as an anaesthetic or procedural sedation (used for medical procedures).
Midazolam acts on the central nervous system by affecting GABA receptors. This makes it more effective at reducing anxiety than other drugs like Valium due to its similarity in effect to benzodiazepines such as diazepam (Valium).
Nitrazepam is a benzodiazepine. It’s not available at the pharmacy counter, but it can be ordered online. Nitrazepam has a short half-life and can be administered by injection or through an IV line.
Nitrazepam is used to treat insomnia, anxiety disorders and panic attacks; it may also be used as part of drug-dependence treatment programs for people who have abused alcohol or other drugs for many years.[1]
Nitrazolam is a benzodiazepine derivative that has sedative, hypnotic and anticonvulsant properties. It has a short half-life and is metabolized by the liver. It may be used to treat insomnia (difficulty falling asleep) or anxiety disorders such as generalized anxiety disorder (GAD), panic disorder and phobia.
Nitrazolam should not be taken with any other type of medicine including alcohol because they could lead to an overdose if taken together.
Clonazepam is a benzodiazepine that’s used to treat anxiety, insomnia and seizures. Temazepam is an antihistamine that’s also used to treat insomnia. Oxazepam is an opioid antagonist (a drug that blocks the effect of other opioids) and therefore should not be combined with any other opioid.
Carbamazepine (also known as Tegretol) is a medication used to treat epilepsy, trigeminal neuralgia, bipolar disorder, and agitation associated with Alzheimer’s disease. Carbamazepine was first marketed in 1970 under the brand name Tegretol XR and has since become one of the most widely prescribed antiepileptic drugs worldwide. Carbamazepine is also used for treating anxiety disorders such as posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder without agoraphobia or other anxiety disorders characterized by excessive worry about everyday life events that causes distress or impairment in social functioning.
Anxiolytic and hypnotic agents are drugs that can be used to treat anxiety, insomnia and other disorders. Some of the drugs listed in this article are not anxiolytic or hypnotic. Other classes of compounds may be included; for example, benzodiazepines are sometimes classified as both drugs.
The list is not exhaustive: there are many other types of medication available under these headings that have been used historically to treat these conditions (for example, amphetamine derivatives).
In conclusion, we have reviewed some of the drugs that are currently used to help you sleep. The most important thing to remember is that you should never take medication without consulting your doctor first. They will be able to tell you if it is right for your needs and give advice on side effects.
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