Sleep

• Benzodiazepines

  • diazepam (Valium)
  • temazepam (Restoril)
  • alprazolam (Xanax) 
• Benzodiazepines used for

  anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, seizure disorders, insomnia, and preoperative relief of anxiety and tension to aid in balanced anesthesia
• Benzodiazepines Contraindications

  Known allergies, pregnancy, and breast feeding
• Adverse effects of benzodiazepines

  dry mouth, constipation, nausea, vomiting, and elevated liver enzymes, sedation, drowsiness, depression, lethargy, blurred vision, “sleep driving” and other complex behaviors, headaches, apathy, light-headedness, amnesia, and confusion hypotension, hypertension, arrhythmias, palpitations, and respiratory difficulties, blood dyscrasias and anemia are possible, urinary retention and hesitancy, loss of libido, and changes in sexual functioning
• Interactions of benzodiazepines


  CNS depression increases if benzodiazepines are taken with alcohol or other CNS depressants such as opioids, taken with cimetidine, oral contraceptives, or disulfiram,
• Nursing Implications of benzodiazepines


  Before starting therapy, assess for contraindications like known allergies to benzodiazepines, impaired liver or kidney function, conditions exacerbated by depressant effects, pregnancy, lactation, and use of opioids. Check baseline status for potential adverse effects, including temperature, weight, skin color, and respiratory rate. Perform laboratory tests, including renal and liver function tests and CBC.
• Non- benzodiazepines 

  zolpidem (Ambien)

  zaleplon (Sonata)
• Non-benzodiazepines Use

  are used for the short-term treatment of insomnia
• Non-benzodiazepines Contraindication


  allergies, liver diease, taking any other drugs and natural products use for sleep
• Non-benzodiazepines Adverse Effects

  • Feeling dizzy, tired, or weak.
  • Feeling sleepy the next day.
  • Headache.
  • Upset stomach.
  • Diarrhea.
• Interactions of Non-benzodiazepines

  CNS depressants, Heavy meals, high-fat foods, Alcohol use
• Nursing Implications of Non-benzodiazepines

  Monitor respiratory depression
• Antidepressants

  • mirtazapine (Remeron),
  • trazodone (Desyrel)
• Antidepressants use


  which blocks 5HT and some 5HT precursor reuptake, is effective in some forms of depression
• Contraindication of Antidepressants

  hypersensitive, Drug may increase risk of suicidality in children, adolescents, and young adults with MDD or other psychiatric disorders, patients with CV or cerebrovascular disease, seizure disorders, suicidality, liver or kidney impairment, or history of mania or hypomania,
• Adverse Effects of Antidepressants

  dizziness, asthenia, abnormal dreams, abnormal thinking, tremors, confusion, drowsiness, agitation, amnesia, anxiety, apathy, depression, hypoesthesia, malaise, myasthenia, thirst, paresthesia, twitching, vertigo, edema,angle-closure glaucoma anorexia, constipation, abdominal pain, weakness, flulike syndrom
• Interactions of Antidepressants


  CNS depressants, MAO inhibitors, St. John’s wort and Alcohol use
• Nursing Implications for Antidepressants


  Monitor for serotonin syndrome, Monitor patient for distressing restlessness and need to move, Monitor for hypersensitivity reactions, including severe skin reactions.
• Antihistamines

  diphenhydramine (Benadryl)
• Antihistamines used for

  Relieves symptoms of seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema; amelioration of allergic reactions; relieves discomfort associated with dermographism; also used as adjunctive therapy in anaphylactic reactions, as a sleeping aid, and for parkinsonism
• Contraindication of Antihistamines

  hypersensitive, pregnancy or lactation
• Adverse Effects of Antihistamines

  drowsiness and sedation drying of the respiratory and GI mucous membranes, GI upset and nausea, arrhythmias, dysuria, urinary hesitancy, and skin eruption and itching associated with dryness
• Interactions of Antihistamines 


  CNS depressants, MAO inhibitors,Alcohol use, Sun exposure
• Nursing Implications of Antihistamines

  • Stop drug 4 days before diagnostic skin testing, or as directed.
  • Be aware that dizziness, excessive sedation, syncope, toxicity, paradoxical stimulation, and hypotension are more likely to occur in an older adult.