Flashcards in ATI CH 16 Deck (19)
What are contraindications and precautions regarding benzodiazepines?
Theses medications are pregnancy category D; estazolam,quaxepam,triazolam & temazepam are pregnancy category X
These MEDS are contraindicated in those who have sleep apnea, respiratory depression, organic brain disease or who are breastfeeding
Use cautiously in clients who have a history of substance use disorder, liver dysfunction and kidney failure. Older adults need decreased dosages.
For a pt. Suffering from acute toxicity from a benzodiazepine what is a nursing intervention?
For oral toxicity, gastric lavage can be used, followed by the administration of activated charcoal or saline cathartics.
For IV toxicity, administer flumazenol (Romazicon) to counteract sedation and reverse side effects
Monitor vital signs, maintain patent airway provide fluids to maintain blood pressure
Have resuscitation equip avail.
Name some non benzodiazepines.
zaleplon ( Sonata)
trazadone ( Oleptro)
What is the action of non benzodiazepines?
Enhances the action of GABA in the CNS. This results in prolonged Sleep duration and decreased wakenings
Management of insomnia
What is a nursing consideration of those taking non benzodiazepines.
Advise clients to take med just before bed
Administer all agents by oral or sublingual route
Management of insomnia by activation of melatonin receptors.
What are adverse effects of melatonin agonists?
Sleepiness, dizziness, fatigue
Hormonal effects (amenorrhea, decreased libido, infertility, galactorrhea)
What is the prototype drug of melatonin agonists
ramelteon ( Rozerem)
What are contraindications and precautions of melatonin agonists
Contraindicated in pregnancy and lactation
In severe forms of liver disease
Apnea and COPD
What are medication and food interactions of melatonin agonists (ramelteon)
1.)High fat meals and grapefruit juice increase absotion- take med on an empty stomach
2.) concurrent use of fluvoxamine (Luvox) can increase levels of ramelteon.
3.) CNS depressants such as opiods, alcohol can cause additive CNS depression.
What are nursing considerations for administration of melatonin agonists ( ramelteon)
Administer by oral route
Instruct clients to take 30 min before bedtime
Instruct clients to take on an empty stomach
Intravenous non opioid agents
Barbituates: pentobarbital sodium ( Nembutal)
Benzodiazepines: midazolam, diazepam ( Valium)
Other medications: propofol ( Diprivan) ketamine( Ketalar)
Intravenous opiod agents
Fentanyl ( Sublimaze)
alfentanil ( Alfenta) sufentanil ( Sufenta)
What is the expected pharmacological action of intravenous anesthetics
These medications produce loss of consciousness and elimination of response to painful stimuli
Induction and maintenance of anesthesia
Moderate ( conscious) sedation ( usually an IV non opiod agent combined with an opioid agent.
Intubation and mechanical ventilation.
What are adverse effects of lorazepam?
What drug is used to reverse the effects of benzodiazepines
Is a competitive benzodiazepine antagonist used to reverse the sedation and other effects of benzodiazepines
What foods should a client avoid while taking ramelteon (Rozerem)
Grapefruit juice and high fat foods increase absorption of ramelteon.
A client is admitted to undergo a surgical procedure. The nurse should be aware that which of the following preexisting conditions may be a contraindication for the use of ketamine ( Ketalar) as an intravenous anesthetic for this client.
Ketamine can produce psychological effects such as hallucinations. Therefore, schizophrenia can be a contraindication for the use of ketamine.