| Drug and Dosage | Use | Action | Assessment: Side Effects |
|---|---|---|---|
| Chloral hydrate—PO 250 mg 3 times daily; hypnotic: PO 0.5–1.0 gm; rectal suppository 0.3–0.9 gm | Sedation for elderly; delirium tremens; pruritus; mania; barbiturate and alcohol withdrawal | Depresses sensorimotor areas of cerebral cortex | Nausea, vomiting, gastritis; pinpoint pupils; delirium; rash; decreased BP, pulse, respirations, temperature; hepatic damage |
| NURSING IMPLICATIONS: Caution: should not be taken in combination with alcohol; dependency is possible | |||
| Chlordiazepoxide HCl (Librium)—PO 5–10 mg; IM, IV 50–100 mg | Psychoneuroses; preoperative apprehension; chronic alcoholism; anxiety | CNS depressant resulting in mild sedation; appetite stimulant; anticonvulsant | Ataxia, fatigue; blurred vision, diplopia; lethargy; nightmares; confusion |
| NURSING IMPLICATIONS: Ensure anxiety relief by allowing client to verbalize feelings; advise client to avoid driving and alcoholic beverages | |||
| Diazepam (Valium)—PO 2–10 mg 3–4 times daily; IM, IV 2–10 mg q3–4h | Anxiety disorders; alcohol withdrawal; adjunctive therapy in seizure disorders; status epilepticus; eclamptic seizures; tetanus, preoperative or preprocedural sedation (also see Midazolam) | Induces calming effect on limbic system, thalamus, and hypothalamus | CNS depression—sedation or ataxia (dose related); dry mouth; blurred vision; mydriasis; constipation; urinary retention |
| NURSING IMPLICATIONS: Do not mix with other drugs; IM injection painful; observe for phlebitis; monitor response; measures to ensure client safety (e.g., falls); high potential for abuse; contraindicated in acute closed-angle glaucoma and porphyria | |||
| Flurazepam (Dalmane)—PO >15 yr, 30 mg at bedtime; elderly or debilitated, 15 mg at bedtime | Hypnotic | Fastest acting; see Diazepam | See Diazepam |
| NURSING IMPLICATIONS: See Diazepam | |||
| Hydroxyzine pamoate (Vistaril)—PO 25–100 mg 4 times daily | See Chlordiazepoxide (Librium); antiemetic in postoperative conditions; adjunctive therapy Obstetric use: prodromal labor | CNS relaxant with sedative effect on limbic system and thalamus Allows relaxation | Drowsiness; headache; itching; dry mouth; tremor |
| NURSING IMPLICATIONS: Give deep IM only; potentiates action of: warfarin (Coumadin), narcotics, and barbiturates | |||
| Lorazepam (Ativan)—PO 1–2 mg 2–3 times daily (up to 10 mg); 2–4 mg at bedtime; IM 4 mg max.; IV 2 mg max. | Anxiety disorders; insomnia; alternative to diazepam for status epilepticus; preanesthesia | See Diazepam | See Diazepam |
| NURSING IMPLICATIONS: See Diazepam | |||
| Meprobamate (Equanil, Miltown)—PO 400 mg 3–4 times daily | Anxiety; stress; absence seizures | See Hydroxyzine pamoate (Vistaril) | Voracious appetite; dryness of mouth; ataxia |
| NURSING IMPLICATIONS: Older clients prone to drowsiness and hypotension; observe for jaundice | |||
| Midazolam (Versed)—IM 0.05–0.08 mg/kg; IV 0.1–0.15 mg/kg | Preanesthesia; prediagnostic procedures; induction of general anesthesia | Penetrates blood-brain barrier to produce sedation and amnesia | Respiratory depression, apnea; disorientation, behavioral excitement |
| NURSING IMPLICATIONS: Monitor ventilatory status and oxygenation; prevent injuries from CNS depression; nonirritating to vein | |||
| Phenobarbital—sedative, PO 20–30 mg 3 times daily; hypnotic, PO 50–100 mg; IV, IM 100–300 mg; also butabarbital (Butisol), pentobarbital (Nembutal), secobarbital (Seconal) | Preoperative sedation; emergency control of convulsions; absence seizures | Depresses CNS, promoting drowsiness | Cough, hiccups; restlessness; pain; hangover; CNS and circulatory depression |
| NURSING IMPLICATIONS: Observe for hypotension during IV administration; put up side rails on bed of older clients; observe for increased tolerance | |||
| Promethazine (Phenergan)—IV, IM, PO 25–50 mg | Preoperative sedation; postoperative sedation | Antihistaminic; sedative, antiemetic, anti–motion sickness | Drowsiness; coma; hypotension; hypertension; leukopenia; photosensitivity; irregular respirations; blurred vision; urinary retention; dry mouth, nose, throat |
| NURSING IMPLICATIONS: Administer PO with food, milk; IM deep into large muscles, rotate sites; verify compatibility with other drugs; safety concerns due to sedative effect | |||
| Zolpidem (Ambien)—PO 5–10 mg at bedtime, limited to 7–10 days | Short-term treatment of insomnia | Nonbenzodiazepine hypnotic; preserves deep sleep (stages 3 and 4) | Headache on awakening; drowsiness, fatigue; confusion and falls in elderly; myalgia |
| NURSING IMPLICATIONS: Monitor for: compromised respiratory status, increased depression, cognitive impairment. Onset more rapid on empty stomach. Do not breastfeed while taking this medication | |||