Pharmacologic Profile

General Use

Sedatives are used to provide sedation, usually prior to procedures. Hypnotics are used to manage insomnia. Selected agents are useful as anticonvulsants (clorazepate, diazepam, phenobarbital), skeletal muscle relaxants (diazepam), adjuncts in the management of alcohol withdrawal syndrome (chlordiazepoxide, diazepam, oxazepam), adjuncts in general anesthesia (droperidol), or as amnestics (midazolam, diazepam).

General Action and Information

Cause generalized CNS depression. May produce tolerance with chronic use and have potential for psychological or physical dependence. These agents have NO analgesic properties.

Contraindications

Hypersensitivity. Should not be used in comatose patients or in those with pre-existing CNS depression. Should not be used in patients with uncontrolled severe pain. Avoid use during pregnancy or lactation.

Precautions

Use cautiously in patients with hepatic impairment, severe renal impairment, or severe underlying pulmonary disease. Use with caution in patients who may be suicidal or who may have had previous drug addictions. Hypnotic use should be short-term. Geriatric patients may be more sensitive to CNS depressant effects; dosage ↓ may be required.

Interactions

Additive CNS depression with alcohol, antihistamines, some antidepressants, opioid analgesics, or phenothiazines. Barbiturates induce hepatic drug-metabolizing enzymes and can ↓ the effectiveness of drugs metabolized by the liver, including oral contraceptives. Should not be used with MAO inhibitors.

Nursing Implications

Assessment

• Monitor BP, pulse, and respiratory status frequently throughout IV administration. Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict the amount of drug available to patient, especially if patient is depressed, suicidal, or has a history of addiction.
• Assess sleep patterns before and periodically throughout course of therapy.
• Observe and record intensity, duration, and characteristics of seizure activity. Institute seizure precautions.
• Assess muscle spasms, associated pain, and limitation of movement before and throughout therapy.
• Assess patient experiencing alcohol withdrawal for tremors, agitation, delirium, and hallucinations. Protect patient from injury.

Potential Nursing Diagnoses

• Insomnia (Indications)
• Risk for injury (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Supervise ambulation and transfer of patients following administration of hypnotic doses. Remove cigarettes. Side rails should be raised and call bell within reach at all times. Keep bed in low position.

Patient/Family Teaching

• Discuss the importance of preparing the environment for sleep (dark room, quiet, avoidance of nicotine and caffeine). If less effective after a few weeks, consult health care professional; do not ↑ dose. Gradual withdrawal may be required to prevent reactions following prolonged therapy.
• May cause daytime drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Advise patient to avoid the use of alcohol and other CNS depressants concurrently with these medications.
• Advise patient to inform health care professional if pregnancy is planned or suspected.

Evaluation/Desired Outcomes

• Improvement in sleep patterns.
• Control of seizures.
• Decrease in muscle spasms.
• Decreased tremulousness.
• More rational ideation when used for alcohol withdrawal.