are not useful as analgesics (pain-killers). The effect of a small dose is to produce
sedation, a state of calmness in which the client tends to be less active and less
responsive and possibly even sleepy. With a slightly greater dose, he tends to lose
feelings of anxiety and inhibition, and lose some muscular coordination. His eyes may
begin to move irregularly. If the dose is large enough, he will go to sleep. With a very
large dose, he may enter a state similar to surgical anesthesia or die of respiratory
depression. If large, but nonlethal doses are regularly given to a client for an extended
period of time and then administration of the drug is discontinued, the client is likely to
experience a withdrawal state in which he is hyperexcited and may even go into
convulsions. Thus, sedative-hypnotics can cause physical dependence. There is a
possibility of habituation (psychological dependence) with either small or large doses.
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USES OF SEDATIVE-HYPNOTICS
a. Situational Anxiety. Anxiety is sometimes a normal response to a particular
situation. If the situation is one in which a high level of physical or mental performance
is necessary, a sedative--hypnotic may produce in the client a generalized feeling that
he is performing well although his proficiency is, in fact, impaired. Nevertheless, there
are situations in which sedative-hypnotics are valuable for reducing anxiety. One
frequently recurring example is the use of a sedative-hypnotic to prepare a client for an
unpleasant or painful medical or dental procedure.
b. Neurotic Anxiety. Neurotic anxiety is anxiety in which there is not an
external situation sufficient to account for the dread and fear felt by the client. This
anxiety is manifested in some clients as obsessive behavior, phobias (abnormal fears),
depression, or excessive fatigability. Though sedative-hypnotics are useful in treating
the symptoms of neurotic anxiety, they should never be used as a substitute for
psychotherapy, where the client will not associate the administration of the drug too
closely with relief of his anxiety, it is a good idea to use a longer-acting drug, such as
phenobarbital, which does not have to be administered as frequently as some sedative-
hypnotics. This helps reduce the likelihood of habituation, or psychological
dependence.
c. Induction of Sleep. The pattern of a client's insomnia is important to the
physician in determining how it should be treated. If the client has trouble only in going
to sleep, a rapidly acting hypnotic which lasts only for a short time is desirable. A client
who has trouble only in staying asleep or who has trouble in both going to sleep and
staying asleep may be given an intermediate-acting hypnotic, or he may be given a
short-acting hypnotic with instructions to take a second dose upon awakening. The
intermediate-acting hypnotic carries with it the possibility of a hangover the next
morning. (Sedative--hypnotics cannot be expected to induce sleep in clients
experiencing severe pain.)
d. Other Uses. Some drugs, such as epinephrine, and some maladies, such as
hyperthyroidism, cause excitement or hyperactivity that can be reduced by the use of
sedative-hypnotics. Sedative-hypnotics are sometimes desirable to reduce the activity
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