A patient takes temazepam (Restoril) for insomnia. The patient ...

[amal]

A patient takes temazepam (Restoril) for insomnia. The patient tells the nurse that a recent telephone bill lists several calls to friends that the patient does not remember making. What will the nurse do?
 
  a. Ask the patient about any alcohol consumption in conjunction with the benzodiazepine.
  b. Contact the prescriber to request an order for a benzodiazepine with a shorter duration.
  c. Reassure the patient that this is most likely caused by a paradoxical reaction to the benzodiazepine.
  d. Tell the patient that this is an example of anterograde amnesia, which is an expected effect of benzodiazepine.

Question 2

A patient has been taking high doses of clorazepate (Tranxene) for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and anxious. What will the nurse do?
 
  a. Double-check the chart to make sure the last dose was given.
  b. Request an order for a longer acting benzodiazepine.
  c. Suspect a possible paradoxical reaction to the clorazepate.
  d. Withhold the next dose until a drug level can be drawn.

[ApricotDream]

Answer to Question 1

ANS: A
This patient is describing complex sleep-related behavior, which occurs when patients carry out complex behaviors while taking benzodiazepines but have no memory of their actions. These actions can occur with normal doses but are more likely with excessive doses or when benzodiazepines are combined with alcohol or other CNS depressants, so the nurse is correct in evaluating this possibility. The duration of the benzodiazepine does not contribute to this phenomenon. Paradoxical effects of benzodiazepines include insomnia, excitation, euphoria, anxiety, and rage. Anterograde amnesia occurs when patients have impaired recall of events that occur after dosing.

Answer to Question 2

ANS: C
Patients taking benzodiazepines for anxiety sometimes develop paradoxical responses to the drug, which include insomnia, excitation, euphoria, heightened anxiety, and rage. A missed dose would trigger withdrawal symptoms, which would include anxiety, insomnia, sweating, tremors, and dizziness. Because this is a paradoxical reaction to the drug, a longer acting drug would make the symptoms worse. This is not caused by overdose, which would manifest as drowsiness, lethargy, and confusion, so a drug level is not warranted.

[amal]

TYSM

[LVPMS]

Excellent