Sedative Medications: Controversies, Challenges, and Nursing Practice

This essay critically discusses the controversial use of sedative medications in mental health, examining their impact on patient behavior and symptom management. It explores the complexities of psychotropic medication use, including the potential for dependency and addiction. The essay delves into the challenging aspects faced by registered nurses who administer these medications, particularly when managing patients who pose a risk of harm to themselves or others. It analyzes the role of nurses in promoting recovery-oriented practices while addressing the ethical considerations and legal frameworks surrounding the use of sedatives, including the balance between patient autonomy and the need for intervention. The essay highlights the importance of understanding both the benefits and potential adverse effects of sedative medications, as well as the need for evidence-based practices and adherence to established protocols. The discussion incorporates a review of contemporary literature to provide a comprehensive understanding of the issues involved, emphasizing the need for ongoing research and improved sedation management strategies in mental healthcare settings.

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Introduction:
Sedatives are a drug group, which slowdowns the brain function. Sedative
medications are effective in the management of anxiety and sleep disorders, which may
contribute to dependency or addiction to drugs. Such drugs are used primarily for psychiatric
disease and also for the issue that they are not approved for (Sie, 2010).
Seclusion and restriction are commonly approved strategies used in mental health
care programs to monitor or handle a person's behavior. Severe questions have been posed in
Australia about the usage of such seclusion and restriction at least since 1993. Consumers of
health care services and their allies have voiced their opinions on the damage such activities
have caused. Regardless of the potential negative consequences of the application of physical
and mechanical restraint, the mental health law regulates only mechanical control in any state
and jurisdiction. Consumer perceptions of physical restriction and seclusion are recorded to
be largely negative, correlated with acute worsening of anxiety and extreme emotions such as
depression, guilt, fear and rage (Brophy et al., 2016).
Discussion:
The use of Sedatives are a matter of controversy, as the specific classes of drugs are
associated with dependency and addiction. Dependency occurs when the body begins to be
opioid-addicted. It may happen without addiction, but it is highly associated with addiction.
When a patient is dependent on a medication, they will require a higher dosage to reach the
desired result or, if the treatment is discontinued, there may be a physical or psychological
impact. Addiction involves an obsessive compulsion to take a substance, particularly though
it has a negative impact on your professional or personal life (Fite et al., 2020).
The essay will be shed light on the impact of restrictive and coercive practice in
mental health, relevant significant factors, analyze the current issues or theories, and the

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significance of them. To analyze and evaluate the said topic, pertinent contemporary pieces
of literature will be reviewed as argument evidence.
Sedatives function by altering the signaling of the nerves to the brain in the central
nervous system. The medication calms the body in this situation by winding down the brain
function. A patient could be susceptible to having more adverse effects than usual, and
problems with communicating may make it challenging to diagnose adverse effects.
Proper utilization of sedatives may improve health treatment and lead to health
protection. Still, their usage is correlated with both short and long-term adverse effects for
patients, involving excessive artificial breathing and cognitive dysfunctions. Therefore, it is
necessary to identify the sedation signal because this will influence the sedative collection
and help to decide the target for sedative usage. In ICU settings, sedation guidelines are
prevalent and offer a formal system that directs sedative treatment and surveillance. Their
usage itself related to substantially better patient health results. Nurses, due to their more
frequent appearance at the bedside of the patient, are the most effective services for
administering sedation procedures, and protocol prescribed by nursing professionals have
been proven to increase patient satisfaction, as well as health outcomes. Primary features of
sedation procedures may consist of arousal testing devices, sedative dosing guidance,
spontaneous awakening measures related to spontaneous breathing exercises, and early
mobilization therapy (Sessler et al, 2013). Given research illustrating that intense sedation is
not needed in most ICU patients and also that moderate sedation targets are increasing
results, several hospitals have declined to adopt such procedures due to patient health issues
and the perception that patients will be more prone to experience long-term psychiatric
disorders without heavy sedation throughout their ICU treatment period. The amount of
sedation application days is linked to PTSD or post-traumatic stress disorder and depression.
It can be said that the painful memories of the period in ICU can lead to the psychological

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distress of the patient. PTSD is most commonly correlated with staying at the ICU,
possessing distorted and not realistic experiences. Due to their neurophysiological or
cognitive disorder. All the ICU must establish a local sedation protocol that takes into
consideration recent studies, patient preferences, and local facts or shreds of evidence
(Hughes, McGrane, & Pandharipande, 2012).
The perfect sedative should be simple, have limited respiratory disturbance, organ-
independent depletion, no active metabolite, and brief context-sensitive half-life. However,
none of the widely prescribed sedatives meet all such requirements, so when using a sedative
drug, physicians need to be conscious of their limits. Benzodiazepines, barbiturates, and other
sleeping drugs are widely used for depression and other sleep disorders. They are also often
used for agitation, or in panic attacks Propofol, dexmedetomidine, and benzodiazepines are
the widely recommended sedative drugs applied in the ICU, and certain substances such as
ketamine, volatile anesthetics, clonidine and neuromuscular inhibitors employed as associate
therapies (Smith et al., 2017). Benzodiazepines that are analogous to alcohol in the
mechanism of action and induce the inhibitory effects of gamma-aminobutyric acid (GABA)
in the GABA-A receptor complex. They are the most commonly prescribed sedatives,
primarily work by non-selectively binding to benzodiazepine subtype 1 and BZ2 receptors.
Benzodiazepines can induce euphoria in addition to decreasing distress and stimulating
relaxation and are often prone to misuse as recreational narcotics (Pek et al., 2017).
Flunitrazepam (Rohypnol) is a benzodiazepine with brief-acting effectiveness and about 10
times more effective than of diazepam. It has exploded in popularity among the criminals, as
a date-rape product for the unique property of it. It is colorless, miscible, and
odorless, increasing the sedative impacts. Sexual abusers are prone to add the drug to a
possible victim's cocktail and commit the ultimate sin. The intensity of euphoria depends
upon the different types of drugs and their time or duration of consumption (Weaver, 2015).

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Sedatives naming zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta) are
referred to as "z-drugs" and are approved by the U.S. Food and Drug Administration (FDA)
for treatment of insomnia (U.S. Food and Drug Administration, 2020). They have a
brief period of acting mechanism and half-life, not interfere with the overall sleep system,
and have less residual effects during the awake time, rendering them scientifically more
desirable than benzodiazepines. Adverse effects such as hallucinations and psychosis,
particularly with zolpidem, have been documented. Growing accounts of unusual and
complicated behavioral consequences from z-drugs led regulatory authorities to impose alerts
and prohibitions on the prescribing, dispensing, and usage of z-drugs (Kapil et al., 2014).
Barbiturates are categorized as sedatives based on their relaxing and sleep-enhancing
character on the central nervous system or CNS. Chemical restraint is employed to treat
clients of mental disorder problems committed to urgent medical or hospital facilities
for excessive violence, anger, or aggressive behaviors. Action implications reported the
involvement of post-chemical restriction harmful adverse effects as such deleterious may
influence on the physical wellbeing of an individual (Muir‐Cochrane et al., 2019)
Barbiturates are primary therapeutically uses as anticonvulsant and anesthetic
medicines. Prescription and unlawful abuse of Barbiturates— peaked in the 1970s
and towards the late 1980s barbiturates had been primarily replaced by anxiety and insomnia-
treated by benzodiazepines due to ensure safety-related issues of the consumers. Butalbital is
a quick-acting barbiturate coupled with caffeine and aspirin (Fiorinal) or acetaminophen
(Fioricet), widely used for pain relief. Constant over usage of butalbital, though, may
contribute to dependency and withdrawal syndrome that begins with headaches, contributing
to a prolonged loop of recurring headaches or medication-rebound headaches, which are only
relieved by repeated butalbital re-administration. Many people misuse barbiturates seem to
be familiar with certain other sedatives as well. Developing a barbiturate overdose itself is

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uncommon for an individual (Chen et al., 2014). Abusers may use a range of sedatives used
to relieve the adverse symptoms of addictive stimulants, alleviate distress, or cause euphoric
feelings. Many people use prescription medications that have been approved with certain
disorders, such as panic attack disorder sedatives, that provide specific benefits: stimulating
relaxation, minimizing distress related and traumatic life situations, elevating their mood
while stressed, or having extra strength. Such activity is a induce a condition of self-
medication, which is also known as "chemical coping" (Jiménez et al., 2013). Patients
engaging in drug coping may build immunity to the sedative's additional results rather rapidly
than to the medicinal impact it was intended for, contributing to dose elaboration. Increases in
emotional tension, family conflicts, work stresses, or financial concerns may enhance a
patient's vulnerability to symptoms of anxiety, contributing to an increased usage of
controlled drug therapies (Schepis, & McCabe, 2019).
Critical care nurses must administer sedatives mechanically to ventilated patients.
Multiple considerations have driven sedation management procedures, including specific
patient preferences, interpretation of scientific knowledge by clinicians, implementation of
standard practices, and diverse viewpoints in professional and personal experience. A recent
report stated that nurses had required more health service providers to enhance their sedation
control procedures along with more preparation, improved leadership methods, and sufficient
staffing. Patient with a respiratory disorder or respiratory insufficiency needs the support of
mechanical ventilation most of the time. The therapy induces patients with a multitude of
psychological and physical effects, including discomfort, dyspepsia, stress, anxiety,
depression, and agitation. It is a standard procedure for critical care nurses to prescribe
sedative and antidepressant medications to improve the condition, reducing the discomfort
burden in ventilated patients, and ease the symptoms. Sedative medicines could be required
to enhance patient satisfaction, comfort, facilitate synchronous ventilation, and ensure health

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safety. But prolonged usage of sedative medications may contribute to neurological
problems, delirium, higher mortality, and high ventilator time. Current Pain, Agitation, and
Delirium unit (PAD) guidelines allow physicians in the Intensive Care Unit (ICU) to restrict
the amount in sedative medications prescribed to ventilated patients in order to retain
moderate rates of sedation where necessary (Barr J, 2020). Varying commitment to protocol
standards remains a problem for critical care nurses due to various obstacles, including lack
of knowledge, confidence, consensus, perceived utility, and the impact of previously
established methods. Changing the perceptions of nurses towards sedation and the knowledge
of mechanical ventilation might be essential in order to improve the sedation procedures to
match the standards of clinical practice. Most respondents operated in units that implemented
specific sedation procedures and had strategies in effect that represented the latest up-to-date
guidance on sedation procedure, but few recorded appropriate enforcement (Hughes,
McGrane, & Pandharipande, 2012).
The concept of sedative medications is an area of interest for a long time, keeping on
mind the significance of them in mental health. The Human rights workers and government
formed effective laws concerning the sedative used in mental illness. According to Appendix
4-Medical Sedation Behavioral Health regulations, International law requires care of medical
and psychological crises for any un-arrested patient to preserve the health and/or well-being
and/or well-being of others (Health.qld.gov.au, 2020). No credential is required in case of a
file beyond the definition of the operation. However, without that permission of the patient,
professional attention can be provided to any individual who has no capacity to render or
withdraw approval. The legislation specifies the options below for people unable to agree or
deny therapy owing to psychiatric illness. The Mental Health (Care and Treatment)
(Scotland) Act 2003 allows drugs to be provided for the diagnosis of psychotic illness
(includes the severely unstable secondary activity of delirium and dementia) without and/or

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without patient permission. This Act, implemented in the case of saving the life of the patient,
prevent any violent behavior against anyone else or themselves, reduce acute suffering, and
prevent deterioration of patients’ condition (Legislation.gov.uk, 2020). The nurses’ faces
challenges to apply the sedatives on medical patients as the freedom to deny treatment is also
deemed a right of a patient to reject medicine. du Patients now have the right to deny to
undergo any treatment or medication until and unless ordered by the judge to take the drug
or in emerging cases, and immediately limit the use of those medications. The patients’ are
not always only concern about the side effects of the drug but intended to deny due to social
stigma of taking psychiatric treatments. In this type of events, the nurses can try to convince
the patient, but the ultimate decision maker is the patient. This events significantly challenge
the nursing job, interfereing with the quality of care (Barloon, 2003).
The use of sedatives is a tricky business. While it is beneficial and indeed needed in
treatment in ICU and some mental discomfort, as well as disorder, the misuse of some
sedatives leads to unwanted circumstances, inducing the authority to take legal steps to ban or
regulate the use of them. Propofol is such a drug. At the time Michael Jackson expired
suddenly, and Propofol was discovered in his house, nonanesthesiologists started scrutinizing
the usage of Propofol by regulatory bodies. The result is the immediate removal of Propofol
from the emergency Physician’s (EP) drug panel, including the addition of the drug
regulation under the Institutional Anesthesia Department. The result is the replacement of
Propofol by the other related drugs with similar effects and potentially lower adverse effects
(Pester et al., 2012).
Conclusion:
It is concluded from the report that the use of sedatives is crucial in the critical care
unit as well as the treatment of the patient with anxiety, depression, and sleep disorder.
However, the use of the sedatives is controversial as it produces a feeling of euphoria in

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patients. The overuse of the drugs leads to dependency or addiction to the drug, resulting in
substance abuse. The critical care nurses are responsible for the oral and mechanical
administration of medicines, including the application of sedatives to the patients. The
effective administration can be done by their professional and personal experiences, though
they face some difficulty chiefly related to sufficient staff and profound knowledge about the
drug and its application. The problem can be solved by the active involvement of several
stakeholders and government organizations. There are specific policies and acts to help the
health care professional in administrating the drug on the needing patient and to prevent the
misuse of certain sedatives. However, there is a vast area of research and implementation to
design a compelling balance between the mandatory use and inhibition of abuse of sedatives.

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