Unit 2 Table Summer 2024 Completed PDF

Unit 2 Pharmacologic Drug Class Benzodiazepine Review Nursing Process on pg. 210-211 & Prototype on pg. 210 Action Increase the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to the GABA receptors. Neuron excitability is reduced. CNS Depression Non-Benzodiazepine Review Pro...

Unit 2 Pharmacologic Drug Class Benzodiazepine Review Nursing Process on pg. 210-211 & Prototype on pg. 210 Action Increase the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to the GABA receptors. Neuron excitability is reduced. CNS Depression Non-Benzodiazepine Review Prototype on pg. 212 & Nursing Process on pg. 212-213 Drug Examples Lorazepam Diazepam Alprazolam Midazolam Indication (Areas of Use) Substance abuse withdrawal (ETOH) – PO/IV/IM Acute seizures (status epilepticus) – PO/PR Anxiety - PO Conscious Sedation for minor procedures - IV Adverse Reactions Drowsiness Hypotension Tachycardia Respiratory depression Dependency Seizures Zolpidem Tartrate Hypotension Insomnia CNS Depression Fatigue Decreased VS Dizziness Memory Impairment Blurred Vision Headache Physiological dependency CNS depression, neurotransmitter inhibition Side Effects Angioedema Renal failure Drowsiness Hangover Decreased BP/HR Complex Sleep Behaviors Vision Changes Vivid Dreams Local Anesthetics Review Nursing Process on pg. 217 NSAID Review Prototype on pg. 286 & Nursing Process on pg. 287 Local anesthetics block pain at the site where the drug is administered by preventing conduction of nerve impulses. Inhibit or block both COX-1 and COX-2. COX-1: Stops bleeding Protects Stomach COX-2: Causes pain and inflammation (vasodilation) Lidocaine Hydrochloride For nerve block, infiltration, epidural, and spinal anesthesia. Allergic reaction (rarely ever seen) Dizziness Restlessness Euphoria Drowsiness Metallic Taste Nursing Implications & Patient Education Close monitoring of Vitals and Respiratory Status and LOC Cautions: Older adult; Patients with renal impairment; Patient on other CNS depressants; Pregnant women Patients with sleep apnea; Patients with respiratory depression, Hypotension, or alcoholism, sedation Patient Teaching: No ETOH or other CNS depressants (includes OTC meds and herbs). No driving or any activities that require alertness. Change positions slowly. Do not discontinue abruptly. Monitor BP, report difficulty breathing. Fall precautions. Notify provider of changes in vision, excessive drowsiness and changes in cognition. Not intended for long-term use. Do not use if pregnant. Cautions: Renal impairment; Liver impairment; Pregnant women – women in general; Older adults Patients with depression Patient Teaching: Allow 6-8 hrs for sleep. Take at bedtime. Indicated for short-term use only. Avoid ETOH and other CNS depressants. Do not take more than prescribed. Educate family about complex behaviors. Change positions slowly. Report any hangover feelings. Take on an empty stomach. Encourage proper “sleep hygiene” – no caffeine, avoid stimulating activities etc. Monitor vital signs and LOC; Cardiac enzymes; liver enzymes Assess for tissue damage if immobile. Patient Teaching: May feel numb. Monitor vital signs and for signs of bleeding. Hearing loss Ibuprofen (non-selective) Anti-inflammatory Fever Reduction Pain Control Bleeding - GI Anemia Anaphylaxis Renal Failure GI Upset Dizziness Headache Bruising Tinnitus Rash Stomach Ulcers Blood Abnormalities Cautions: Bleeding disorders, peptic ulcer disease; Hepatic or Renal Impairment Asthma; Patients on anticoagulant therapy Patient Teaching: Take w/food; Avoid ASA or other NSAIDS. Read labels of OTC meds. Report signs of bleeding: changes in stool (dark/tarry), ABD pain, bleeding gums, excessive bruising. Report ringing in the ears. Avoid the 4Gs. Avoid during 3rd trimester of pregnancy. Avoid during menses. Inform provider if taking anticoagulants. Increase fluid intake – kidney protection. Stop prior to surgical procedures (7 days). Pharmacologic Drug Class Action Drug Examples Indication (Areas of Use) Adverse Reactions Side Effects Nursing Implications & Patient Education Monitor vital signs NSAID Review Prototype pg. 288 Inhibits COX-2 only COX-2: Causes pain and inflammation (vasodilation) Celecoxib Salicylates Review Prototype on pg. 284 & Nursing process on pg. 285 Anti-Gout Review Nursing Process on pg. 293 Non-Opioid Analgesic Review Prototype on pg. 298 & Nursing Process pg. 299 Used to treat Osteoarthritis, Rheumatoid, Moderate to severe pain Pain Relief Inhibits prostaglandin synthesis, hypothalamic heat regulator center, and platelet aggregation Aspirin Fever Reduction Block Inflammation Antiplatelet Increases uric acid excretion in the urine and block uric acid production Weakly inhibits prostaglandin synthesis, which decreases pain sensation. No impact on inflammation or coagulation. Allopurinol Treat gout & hyperuricemia Bleeding Hypertension Headache Dizziness GI Upset Stroke/MI Peripheral edema Bleeding Hearing loss Tinnitus Patient Teaching: Report edema and BP monitoring. Monitor for bleeding and salicylism Bleeding Bruising GI Upset Drowsiness Dyspepsia GI ulceration Elevated liver enzymes Elevated BUN and Creatinine Cautions: Patients with chronic hepatic or renal impairment; Patients with cardiac history; Patients on anticoagulant therapy GI Upset ABD Discomfort Cautions: Patients on antiplatelet or anticoagulant therapy; Children under the age of 16 (Do not give for fever reduction) – Reyes Syndrome; Pregnant women; Bleeding disorders. Patient Teaching: Do not give to children. Bleeding precautions (electric razor, avoid injury, soft toothbrush). Take with food. Report ringing in the ears – s/s salicylism. Report increased bleeding and bruising. Avoid during pregnancy. Notify providers if taking anticoagulants. Stop prior to surgeries (7 days). Read labels of OTC meds; avoid the 4 Gs. Do not combine with NSAIDs. Avoid during menstruation. Monitor patients with renal disease, and hepatic disorder. (Monitor ALT, AST, Liver enzymes, BUN, and Creatinine) Patient Teaching: Educate on dietary restrictions (avoid purines – ETOH, shellfish, organ meat etc.) Increase fluid intake. Take w/food to decrease GI upset. Take daily as prescribed (lifetime therapy). s/s liver failure – jaundice; ABD pain; skin rashes, fluid retention. Yearly eye exams. Monitor for s/s liver failure (LFTs) & dosing. Cautions: Patients with liver disease; a history of alcoholism; Patients with renal impairment Oliguria Acetaminophen Used to treat pain and fever. Elevated Liver Enzymes Hepatotoxicity Constipation Anorexia Rash N/V When acetaminophen toxicity occurs: Acetylcysteine is the antidote. Patient Teaching: Dosing guidelines – 4 grams/day if healthy; 2 grams/day if frail, elderly or taking numerous others. Avoid ETOH. Read labels of OTC meds. Notify prescriber if pain persists for longer than 10 days. s/s of hepatotoxicity – See above. Report changes in urine output. Pharmacologic Drug Class Action Drug Examples Indication (Areas of Use) Adverse Reactions Side Effects Nursing Implications & Patient Education Monitor for tolerance vs dependence. Close monitoring of Respiratory Status and vitals and LOC; Monitoring GI and GU Function Safety Precautions Opioids Review Prototype on pg. 301 & Nursing process pg. 302 Depression of the CNS; depression of pain impulses by binding with opiate receptors in the CNS Hypotension Morphine Used to treat moderate to severe pain Respiratory depression Dependency Seizures CNS Depression Hypotension Decreased RR Drowsiness Dizziness Sedation Euphoria GI Upset Constipation Blurred Vision Confusion Urinary Retention Pruritis Cautions: Patients with CNS depression - ICP; Elderly – Confusion and sedation; Respiratory depression and renal or hepatic impairment; Breastfeeding and pregnancy ****Naloxone is the antidote for opioid overdose*** Monitor for narcotic abstinence syndrome: HTN; Tachycardia; Increased Pain Patient Teaching: Avoid ETOH or other CNS depressants. Educate on risks long-term use: addiction, changes in bowel pattern, resp and urinary functions. Report urinary retention. Constipation prevention – increase fiber, fluids and activity. Monitor vitals, report changes in respirations. Avoid during pregnancy and while breastfeeding. No driving or participating in activities that require alertness. Do not discontinue abruptly. Take as prescribed. Take w/food to manage GI upset. Monitor Vitals and s/s migraines; Complete medication history and medical exam prior prescribing. Hypotension, Hypertension, Bradycardia, Anti-migraine 5-HT receptor Agonist Review Prototype pg. 309 Causes vasoconstriction of cranial arteries to relieve migraine attacks Sumatriptan Used to treat migraines or cluster headaches Elevated hepatic enzymes, Thromboembolism, Seizures; CVA; MI Hearing Loss N/V Flushing Drowsiness Dizziness Pruritis Paresthesia Fatigue Cautions: Hypersensitivity, CAD, peripheral vascular disease, hypertension, cerebrovascular disease; Renal or hepatic dysfunction, obesity, DM, smoking, seizures, older adults Patient: Take at the first sign of a migraine or when you develop an aura (sensitivity to light or sound; GI upset). Avoid triggers – caffeine, dehydration, specific, lack of sleep, etc. No driving, avoid CNS depressants – due to drowsiness. Report increasing need for use. Report changes in hearing. Keep migraine diary. Monitor for changes in BP and HR.