Short-term management of insomnia in patients unable to get at least 4 hr of sleep; especially useful in sleep initiation disorders.
Produces CNS depression by binding to gamma-aminobutyric acid (GABA) receptors in the CNS. Has no analgesic properties. Therapeutic Effects: Sedation and induction of sleep.
Adverse Reactions/Side Effects
CNS: abnormal thinking, amnesia, anxiety, behavior changes, depersonalization, dizziness, drowsiness, hallucinations, headache, impaired memory (briefly following dose), impaired psychomotor function (briefly following dose), malaise, sleep driving, vertigo, weakness. EENT: abnormal vision, ear pain, epistaxis, hearing sensitivity, ocular pain, altered sense of smell. CV: peripheral edema. GI: abdominal pain, anorexia, colitis, dyspepsia, nausea. GU: dysmenorrhea. Derm: photosensitivity. Neuro: hyperesthesia, paresthesia, tremor. Misc: fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor daytime drowsiness, anxiety, behavior changes, short-term memory deficits, hallucinations, and “drugged” feelings. Repeated or excessive symptoms may require change in dose or medication.
Assess dizziness and vertigo that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.
Assess signs of paresthesia (numbness, tingling), tremor, or abnormal sensitivity to touch or temperature (hyperesthesia). Perform objective tests, including electroneuromyography and sensory testing, to document any drug-related neuropathic changes.
Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.
Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).
Help patient explore nonpharmacologic methods to improve sleep, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.
Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.
Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal after 2 or more weeks of use may result in fatigue, nausea, flushing, light-headedness, uncontrolled crying, vomiting, GI upset, panic attack, or nervousness.
Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.
Caution patient and family/caregivers that “sleepwalking” and other complex activities, including driving a car (sleep driving), may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor vehicles while under the influence of this drug....
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