Sleep part 5

Question 1

• Hormone which regulates circadian clock
• Used for insomnia and jet lag
• OTC (over the counter)
• Produced by pineal gland
• Suppressed by light, stimulated by darkness
• Promotes sleep
• Low doses reset circadian clock
• Higher doses exert direct hypnotic effects
• not regulated by FDA

Answer 1

Melatonin

Question 2

What are the side effects of melatonin?

Answer 2

large doses– hang over, headache, nightmares, hypothermia, and transient depression

Question 3

What are the S/S of anxiety?

Answer 3

Sweating, fast heart rate, rapid breathing, and elevated blood pressure

Question 4

What are sedative-hypnotics used for?

Answer 4

anxiety and insomnia

Question 5

What are Bento’s used for?

Answer 5

Anxiety (sedative) and insomnia
Induce general anesthesia
Manage seizures
Muscle spasms
Withdraw from alcohol

Question 6

What do Bento’s act on?

Answer 6

• the RAS reticular activating system

- blocks the brains response to incoming stimuli

Question 7

Safe to use compared to other CNS depressants
Lower potential for abuse
Less tolerance and physical dependence
Long term, high dose use–> dependence can develop
Fewer drug interactions

Answer 7

Benzo’s

Question 8

Benzo’s depress actions within the CNS at what sites?

Answer 8

• limbic system
• cortical areas
• supraspinal motor areas, including the cerebellum

Question 9

With Bento’s what results from effects on the hippocampus and cerebral cortex?

Answer 9

confusion and anterograde amnesia

Question 10

What are the effects of Benzo’s on cardiovascular?

VERY IMPORTANT

Answer 10

-if given IV can cause profound hypotension and cardiac arrest

Question 11

When do Benzo’s cause respiratory depression?

Answer 11

-if combined with other CNS depressants (opioids, barbiturates, and alcohol)

Question 12

If you have COPD what will Benzo’s cause?

Answer 12

Hypoventilation and Hypoxemia

Question 13

If you have OSA with will Benzo’s do?

Answer 13

exacerbate apneic episodes

Question 14

Explain the absorption and distribution of Benzo’s?

Answer 14

• well absorbed
• lipid soluble crosses the BBB
• prolonged excretion and intensifying responses

Question 15

What medication do you give if a pt OD’s on Benzo’s?

Answer 15

Flumazenil (Romazicon)

Question 16

• Drowsiness, lightheadedness, incoordination, and difficulty concentrating
• Anterograde Amnesia
• Sleep Driving other Sleep-Related Behaviors
• Paradoxical Effects– insomnia, excitation, euphoria, heighten anxiety and rage

Answer 16

Benzodiazepines AE

Question 17

What is the risk for respiratory depression with benzo’s?

Answer 17

Low with Oral

High with IV

Question 18

Should you ever mix Benzo’s with other CNS depressants?

Answer 18

NO

Question 19

When administering Benzo’s to a pt with COPD, OSA, and snoring what should be the priority assessment?

Answer 19

• respiratory depression
• Although rare, Benzodiazepam may cause respiratory depression, especially with those who have underlying respiratory disorders.