Unit 2 - Pharmacologic Drug Classes

Benzodiazepines

• Action: Increase inhibitory neurotransmitter GABA action, reducing neuron excitability and causing CNS depression.
• Examples: Lorazepam, Diazepam, Alprazolam, Midazolam.
• Indications: Anxiety, seizures, substance abuse withdrawal, acute seizures, conscious sedation.
• Adverse Reactions: Hypotension, respiratory depression, dependency, seizures, depression.
• Side Effects: Drowsiness, dizziness, memory impairment, blurred vision, headache, decreased VS.
• Nursing Implications & Patient Education:
  • Monitor V/S, respiratory status, and LOC.
  • Complete drug history (prescribed and OTC/herbal)
  • Patient teaching includes no alcohol, no driving, change positions slowly, gradual discontinuation advised, not for long-term use.
  • Contraindications include older adults, renal impairment, pregnancy, on other CNS depressants.

Non-Benzodiazepines

• Action: CNS depression and neurotransmitter inhibition.
• Example: Zolpidem, Tartrate
• Indication: Insomnia.
• Adverse Reactions: Physiological dependency, vivid dreams, respiratory depression.
• Side Effects: Drowsiness, dizziness, hangover, memory impairment, complex sleep behaviors/amnesia
• Patient Education:
  • Avoid alcohol, monitor sleep behavior.
  • Administer at bedtime, maintain sleep hygiene.
  • Short-term use only (<10 days), gradual discontinuation.
• Cautions/Contraindications
  • Renal/liver impairment
  • benzodiazepine allergy, pregnancy, depression
  • women, children, older adults

Local Anesthetics

• Action: Local anesthetics block pain at the site where the drug is administered by preventing conduction of nerve impulses.
• Example: Lidocaine, Hydrochloride.
• Indications: Topical anesthesia, nerve blocks.
• Side Effects: Local skin reactions, prolonged loss of sensation.
• Nursing Implications:
  • Monitor sensation and tissue damage.
  • Educate on numbness and patch removal after 12 hours.

Spinal Anesthesia

• Action: Similar to local anesthetics, with broader applications like epidural, CNS depression.
• Example: Lidocaine, Hydrochloride.
• Adverse Reactions: Hypotension, respiratory depression, headache.
• Nursing Implications:
  • Monitor V/S, urine output, LOC.
  • Caution with narcotics or CNS depressants.

NSAIDs

Non-selective (e.g., Ibuprofen)

• Action: Inhibit COX-1 (stops bleeding/protects stomach) and COX-2 enzymes (causes pain/inflammation/vasodilation).
• Indications: Inflammation, pain, fever.
• Adverse Reactions: Tinnitus, bleeding - GI/ulcers, renal failure, anemia, anaphylaxis.
• Side Effects: GI upset, dizziness, bruising, peripheral edema
• Patient Education:
  • Take with food; avoid alcohol.
  • Monitor for GI bleeding. -Cautions/Contradictions
  • Bleeding disorders, peptic ulcer disease, hepatic/renal impairment
  • Pregnancy, asthma, anticoagulant therapy, 5Gs

Selective COX-2 Inhibitors (e.g., Celecoxib)

• Indications: Osteoarthritis, rheumatoid arthritis.
• Adverse Reactions: Bleeding, hypertension, nephrotoxicity.
• Nursing Implications:
  • Monitor edema and BP.

Salicylates (e.g., Aspirin)

• Action: Inhibit prostaglandin synthesis, reduces inflammation and clotting.
• Indications: Pain, fever, anti-inflammatory, antiplatelet.
• Adverse Reactions: Bleeding, tinnitus, Reye's syndrome.
• Patient Education:
  • Report signs of salicylism and bleeding.
  • Avoid in children and pregnant women.

Anti-Gout (e.g., Allopurinol)

• Action: Increase uric acid excretion, prevent crystal formation.
• Indications: Gout, hyperuricemia.
• Adverse Reactions: Elevated liver enzymes, SJS.
• Patient Education:
  • Dietary restrictions, increased fluid intake.

Non-Opioid Analgesic (e.g., Acetaminophen)

• Action: Weakly inhibits prostaglandin, reduces pain/temperature.
• Adverse Reactions: Hepatotoxicity.
• Patient Education:
  • Dosage guidelines and liver monitoring.

Opioids (e.g., Morphine)

• Action: CNS and pain impulse depression.
• Adverse Reactions: Hypotension, respiratory depression.
• Patient Education:
  • Monitor for dependency and respiratory status.

Opioid Antagonists (e.g., Naloxone)

• Action: Displaces opioids, reverses effects.
• Indications: Opioid overdose.
• Adverse Reactions: Tachycardia, hypertension.
• Nursing Implications:
  • Monitor for withdrawal and bleeding.

Anti-migraine Agents (e.g., Sumatriptan)

• Action: Vasoconstriction of cranial arteries.
• Indications: Migraines, cluster headaches.
• Adverse Reactions: BP changes, thromboembolism.
• Patient Education:
  • Use at migraine onset, monitor BP, maintain a migraine diary.