Serious hypoglycemia possible because of the drug's prolonged half-lifeĭecreased renal clearance doses should rarely exceed 0. Highly anticholinergic with associated toxic effects Not effective when administered orally metabolite has anticholinergic profileĬonfusion and hallucinations more common than with other narcotics Thus, the presence of a long sleep latency, frequent nocturnal awakenings, or prolonged periods of wakefulness during the sleep period or even frequent transient arousals are taken as evidence of insomnia. Long half-life and, hence, prolonged sedation associated with an increased incidence of falls and fractures In the sleep literature, insomnia is sometimes used as a term to describe the presence of polysomnographic evidence of disturbed sleep. More side effects than most sedative-hypnotic drugs should not be used except to control seizures (phenobarbital) Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful. In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia. If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls. Anxiety and insomnia are common problems in the institutionalized elderly. In acute care settings, however, nurse observations of patient sleep. Tricyclic antidepressants have many side effects and thus are not preferred medications in elderly patients. Insomnia symptoms are the most frequently reported psychological complaints in. Antidepressant drugs are typically underutilized in nursing homes. Updates of OBRA guidelines have liberalized some dosing restrictions, but documentation of necessity and periodic trials of medication withdrawal are still emphasized. The Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities.
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