Older adults who take long-acting sedatives or hypnotics are likely to experience:
|
Sei J. Lee, MD, MAS Ariel R. Green, MD, MPH, PhD Q: What are sedative-hypnotic drugs and why are they prescribed? A: Sedatives and hypnotics are two classes of prescription drugs that are commonly called “tranquilizers,” “sleeping pills,” or “sedatives.” They affect your central nervous system – your brain and spinal cord – and have a relaxing, calming effect. They are often prescribed to older adults for problems including anxiety and difficulty sleeping. Research has shown that sedative-hypnotic medication, even in small doses, is not a safe long-term treatment for anxiety or insomnia, especially for people 65 and older. Q: What are some commonly prescribed sedative-hypnotic drugs? A: There are two main types of sedative-hypnotics – benzodiazepines and Z-drugs. Common benzodiazepines include Xanax (alprazolam), Librium (chlordiazepoxide), Valium (diazepam), and Ativan (lorazepam). Common Z-drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). They are often prescribed for patients with anxiety and difficulty sleeping. Q: Are these medications a good choice for older people with anxiety or insomnia? A: Studies suggest they are not. They find that people who take benzodiazepines and Z-drugs are five times more likely to have memory problems, four times more likely to feel drowsy during the day, two times more likely to experience falls and fractures (such as hip fractures), and two times more likely to have a motor vehicle crash. These side effects can lead to hospitalizations and death among older adults. Research suggests that Z-drugs are not a safer alternative for older adults. Medicines stay in the body longer with aging and are more likely to cause harmful side effects. Benzodiazepines and Z-drugs are also highly addictive. The body becomes used to them over time, which causes them to stop working. For these reasons, benzodiazepines and Z-drugs should be avoided by older patients, except in rare cases.The AGS Updated Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is one of the leading sources of information about safe prescribing for older adults. The Criteria suggests that older adults avoid benzodiazepines because of the substantial risks associated with them. The Criteria also recommend that the Z drugs should not be prescribed for long-term use because they may cause similar side effects and have limited value in improving sleep. Q: Are there non-drug alternatives that will help older adults sleep? A: There are a number of effective, non-drug approaches people can take to get better sleep, including avoiding caffeine, exercising, and maintaining a healthy bedtime routine. (See the Caregiver Guide on Sleep Problems for more information.) Q: Are there non-drug alternatives that may help prevent or treat anxiety? A: Yes, there are a number of alternatives. Getting regular exercise can be very helpful. A type of talk therapy called cognitive-behavioral therapy is also very good for treating anxiety disorders. (For more information see the Anxiety topic.) Q: Can people safely stop benzodiazepines and Z-drugs on their own? A: Please talk with your doctor, nurse, or pharmacist before stopping these medicines. It’s important to reduce the dose gradually because stopping these medicines suddenly can cause uncomfortable withdrawal effects. Last Updated July 2019
More NCLEX questions can be found on nclexonline.com. Answer the following questions for the NCLEX topic: Sleep 1. To validate the suspicion that a married male client has sleep apnea the nurse first: a. asks the client if he experiences apnea in the middle of the night 2. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about: a. Nonsteroidal antiinflammatory drugs (NSAIDs) 3. The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is: a. Asking the client what he or she is doing and call for help 4. The nurse is sure to implement strategies to reduce noise on the unit particularly on the ______ night of admission, when the client is especially sensitive to hospital noises. a. 1st 5. Which of the following medications are the safest to administer to adults needing assistance in falling asleep? a. Sedatives 6. To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.) a. Drinking a glass of wine just before retiring to bed 7. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply): a. Extended time to fall asleep 8. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply): a. Prone 9. When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: a. Headache 10. The nurse understands that the most vivid dreaming occurs during: a. REM sleep 11. A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as: a. Nocturia 12. Narcolepsy can be best explained as: a. A sudden muscle weakness during exercise 13. A nursing measure to promote sleep in school-age children is to: a. Make sure the room is dark and quiet 14. A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep. Check all that apply. a. Eat a heavy snack before bedtime 15. A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder. Select all that apply: a. Chronic stress 16. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care? a. Monitor
apical heart rate every 2 hours 17. Select all that apply to the use of barbiturates in treating insomnia: a. Barbiturates deprive people of NREM sleep 18. Select all that apply that is appropriate when there is a benzodiazepine overdose: a. Administration of syrup of ipecac 19. A patient is admitted to the emergency department with an overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart? a. naloxone (Narcan) 20. Older adults who take long-acting sedatives or hypnotics are likely to experience: a. Hallucinations Answers and Rationale can be found here. Which of the following is an important nursing action for the administration of benzodiazepine as a sedative hypnotic agent?Which of the following is an important nursing action for the administration of a benzodiazepine as a sedative-hypnotic agent? Monitor geriatric patients for the common occurrence of paradoxical reactions.
When a client is deprived of sleep the nurse might assess such symptoms as?[1] A patient who lacks adequate sleep will commonly endorse symptoms of sleep loss, such as excessive daytime sleepiness, poor concentration, fatigue, moodiness, and decreased libido, among other symptoms.
Which measure helps promote sleep in older adults?Effective behavioral strategies to promote sleep include encouraging a bedtime routine with a consistent retiring and arising time. Elders with a routine, such as watching television or reading before going to bed, report fewer sleep complaints than those without one.
When assessing a patient for obstructive sleep apnea OSA The nurse understands the most common symptom is?The 2 most common symptoms of OSA are snoring and excessive daytime sleepiness.
|
