NUR 210 Exam 1 : Pharmacologic Drug Class Overview and Implications
Pharmacologic Drug Class Action Drug Examples Indication Adverse Side Effects Nursing Implications &
(Areas of Use) Reactions Patient Education
Close monitoring of V/S, Resp. Status, and
LOC
Complete drug history – both prescribed and
OTC/herbal; Safety Precautions
Drowsiness Cautions/Contraindications:
Lorazepam Anxiety/Substance
Increase the action of the Hypotension
Older adults; Patients with renal impairment;
abuse withdrawal
Benzodiazepine inhibitory neurotransmitter (ETOH) – PO/IV/IM
Decreased VS Patients on other CNS depressants; Pregnant
women
gamma-aminobutyric acid Respiratory depression
Review Nursing (GABA) to the GABA Diazepam Acute seizures (status
Dizziness Patients with sleep apnea, respiratory
depression, hypotension, alcohol intoxication,
Process on receptors. epilepticus) – PO/PR Dependency
Memory or sedation.
pg. 210-211 & Neuron excitability is Alprazolam Anxiety - PO Seizures
Impairment
Patient Teaching (Pages 210-211):
Prototype on pg. 210 reduced.
Conscious Sedation for Depression
Blurred Vision Change positions slowly. Safety precautions.
No driving. Avoid ETOH or other CNS
Midazolam minor procedures - IV
CNS Depression Headache depressants (OTC herbs or medications).
Report a decrease in blood pressure, or
excessive dizziness and drowsiness. Report any
plans for pregnancy or if you become pregnant.
Do not discontinue abruptly/taper if coming off.
Not indicated for long-term use.
Cautions:
Renal impairment; Liver impairment; Benzodiazepine
Drowsiness/ allergy; Pregnant women – women in general;
Non-Benzodiazepine Physiological
Hangover Older adults; Children; Patients with depression
Review Prototype on CNS depression, dependency
Dizziness Patient Teaching (Page 213):
neurotransmitter inhibition Zolpidem Avoid ETOH or other CNS depressants. Educated RE
pg. 212 & Nursing Tartrate
Insomnia Vivid
Memory
complex sleep behavior – instruct family to monitor.
Administer at bedtime – ensure you allow 6-8 hrs. for
Dreams/Nightmares
Process on CNS Depression impairment sleep. If taking for a long period of time – do not
discontinue abruptly. Encourage sleep hygiene – no
Respiratory Depression
pg. 212-213 Complex Sleep caffeine, limiting screentime, avoiding stimulating
activities, and developing a sleep routine. Do not take
Behaviors/Amnesia
more than prescribed. Indicated for short-term use
only (<10 days). Safety precautions.
Monitor for loss of sensation.
Local Anesthetics Local anesthetics block pain at
the site where the drug is Topical Anesthesia, Assess for tissue damage if immobile.
Lidocaine Prolonged loss of
Review Nursing administered by preventing
conduction of nerve impulses. Hydrochloride
infiltrate or nerve Local skin reactions sensation Patient Teaching: May feel numb.
block
Process on pg. 217 Blocks Pain Sensations Remove patch after 12 hours.
Hypotension Anticipate loss of sensation.
Spinal Anesthesia Local anesthetics block pain at
the site where the drug is Lidocaine Respiratory Monitor vital signs, urine output and LOC
Epidural, and spinal Headache
Review Nursing administered by preventing
conduction of nerve impulses. Hydrochloride anesthesia
Depression (Spinal & Epidural) Caution: Narcotic Administration or other CNS
Process on pg. 217 CNS Depression (Spinal & Epidural) Depressants
, Pharmacologic Drug Class Action Drug Examples Indication Adverse Side Effects Nursing Implications &
(Areas of Use) Reactions Patient Education
Monitor vital signs and for signs of bleeding.
Monitor H/H.
Complete drug history – both prescribed and
OTC/herbal.
Pain assessment.
COX-1:
Tinnitus Cautions:
Stops bleeding
NSAID Protects Stomach Anti-inflammatory Bleeding – GI/Ulcers
GI Upset
Bleeding disorders, peptic ulcer disease;
Hepatic or Renal Impairment; Pregnancy
Asthma; Patients on anticoagulant therapy; 5Gs
Review Prototype on COX-2: Ibuprofen
Fever Reduction Anemia
Dizziness
Causes pain and inflammation (non-selective) Bruising Patient Teaching (Page 287):
pg. 286 & Nursing (vasodilation) Peripheral Edema Take with food – decreases GI upset. Report s/s of GI
Pain Control Anaphylaxis bleeding – tarry stool, coffee-ground emesis, severe GI
Process on pg. 287 Inhibit or block both
pain, bleeding gums, petechia, ecchymosis. etc.
Renal Failure Bleeding prevention – soft toothbrush, electric razor.
COX-1 and COX-2. NO ETOH. Do not take if pregnant. Notify provider
prior to surgery. Edema management – elevate leg,
compression stockings. Avoid during menstruation to
minimize excessive bleeding. Avoid the 5Gs, other
NSAIDs, ASA, and Anticoagulants. Do not take if you
have kidney failure.
COX-2: Bleeding Monitor vital signs
Used to treat
NSAID Causes pain and
Osteoarthritis, Hypertension
Headache Cautions:
inflammation Dizziness Patients with chronic hepatic or renal impairment;
Review Prototype (vasodilation)
Celecoxib Rheumatoid,
Stroke/MI
GI Upset Patients with cardiac history;
Moderate to severe Peripheral Edema Patients on anticoagulant therapy
pg. 288 Inhibits COX-2 only
pain
Nephrotoxicity Patient Teaching: Report edema and BP monitoring.
Monitor for bleeding and salicylism
Inhibits prostaglandin Bleeding
Salicylates synthesis, hypothalamic
Pain Relief Cautions:
Patients on antiplatelet or anticoagulant therapy; 5Gs,
Hearing loss Bruising
Review Prototype on heat regulator center, and
Fever Reduction GI Upset
Children under the age of 16
(Do not give for fever reduction) – Reyes Syndrome
platelet aggregation
pg. 284 & Nursing Aspirin Tinnitus Drowsiness
Headache
(vomiting, lethargy, delirium & coma); Pregnant
women (last trimester); Bleeding disorders.
Block Inflammation
process on Decreases inflammation,
fevers, pain, and blood
GI ulceration Patient Teaching (Page 285):
pg. 285
Report ringing in the ears – s/s salicylism. Take w/food to decrease GI
Antiplatelet
clotting. Reye’s Syndrome upset. Bleeding prevention. s/s of GI bleeding or excessive bleeding.
Avoiding 5 Gs. Stop prior to surgery. Avoid if taking anticoagulants. Do not
(children) combine w/NSAIDs – read OTC labels. Avoid during pregnancy and
menstruation. Do not give to children.
Monitor patients with renal disease, and hepatic
disorder. Uric Acid levels. Pain assessment.
(Monitor ALT, AST, Liver enzymes, BUN/Crt &
Increases uric acid Elevated liver enzymes UOP)
Anti-Gout excretion in the urine and
Prophylactic
GI Upset
Patient Teaching (Page 293):
block uric acid production Elevated BUN and
Review Nursing Allopurinol treatment of gout & Creatinine
ABD Discomfort Educate RE dietary restriction (avoid purines –
shellfish, organ meats, ETOH, etc.). Increase fluid
hyperuricemia
Process on pg. 293 Prevents uric acid crystal
formation in the joints. Stevens-Johnsons
Blurred Vision intake. Take w/food to decrease GI upset. Take daily
as prescribed (lifetime therapy). s/s kidney failure –
Syndrome (SJS) decreasing UOP. s/s liver failure – jaundice, itchy skin
or rash, ABD pain and tenderness. Yearly eye exams –
vision changes.
Pharmacologic Drug Class Action Drug Examples Indication Adverse Side Effects Nursing Implications &
(Areas of Use) Reactions Patient Education
Close monitoring of V/S, Resp. Status, and
LOC
Complete drug history – both prescribed and
OTC/herbal; Safety Precautions
Drowsiness Cautions/Contraindications:
Lorazepam Anxiety/Substance
Increase the action of the Hypotension
Older adults; Patients with renal impairment;
abuse withdrawal
Benzodiazepine inhibitory neurotransmitter (ETOH) – PO/IV/IM
Decreased VS Patients on other CNS depressants; Pregnant
women
gamma-aminobutyric acid Respiratory depression
Review Nursing (GABA) to the GABA Diazepam Acute seizures (status
Dizziness Patients with sleep apnea, respiratory
depression, hypotension, alcohol intoxication,
Process on receptors. epilepticus) – PO/PR Dependency
Memory or sedation.
pg. 210-211 & Neuron excitability is Alprazolam Anxiety - PO Seizures
Impairment
Patient Teaching (Pages 210-211):
Prototype on pg. 210 reduced.
Conscious Sedation for Depression
Blurred Vision Change positions slowly. Safety precautions.
No driving. Avoid ETOH or other CNS
Midazolam minor procedures - IV
CNS Depression Headache depressants (OTC herbs or medications).
Report a decrease in blood pressure, or
excessive dizziness and drowsiness. Report any
plans for pregnancy or if you become pregnant.
Do not discontinue abruptly/taper if coming off.
Not indicated for long-term use.
Cautions:
Renal impairment; Liver impairment; Benzodiazepine
Drowsiness/ allergy; Pregnant women – women in general;
Non-Benzodiazepine Physiological
Hangover Older adults; Children; Patients with depression
Review Prototype on CNS depression, dependency
Dizziness Patient Teaching (Page 213):
neurotransmitter inhibition Zolpidem Avoid ETOH or other CNS depressants. Educated RE
pg. 212 & Nursing Tartrate
Insomnia Vivid
Memory
complex sleep behavior – instruct family to monitor.
Administer at bedtime – ensure you allow 6-8 hrs. for
Dreams/Nightmares
Process on CNS Depression impairment sleep. If taking for a long period of time – do not
discontinue abruptly. Encourage sleep hygiene – no
Respiratory Depression
pg. 212-213 Complex Sleep caffeine, limiting screentime, avoiding stimulating
activities, and developing a sleep routine. Do not take
Behaviors/Amnesia
more than prescribed. Indicated for short-term use
only (<10 days). Safety precautions.
Monitor for loss of sensation.
Local Anesthetics Local anesthetics block pain at
the site where the drug is Topical Anesthesia, Assess for tissue damage if immobile.
Lidocaine Prolonged loss of
Review Nursing administered by preventing
conduction of nerve impulses. Hydrochloride
infiltrate or nerve Local skin reactions sensation Patient Teaching: May feel numb.
block
Process on pg. 217 Blocks Pain Sensations Remove patch after 12 hours.
Hypotension Anticipate loss of sensation.
Spinal Anesthesia Local anesthetics block pain at
the site where the drug is Lidocaine Respiratory Monitor vital signs, urine output and LOC
Epidural, and spinal Headache
Review Nursing administered by preventing
conduction of nerve impulses. Hydrochloride anesthesia
Depression (Spinal & Epidural) Caution: Narcotic Administration or other CNS
Process on pg. 217 CNS Depression (Spinal & Epidural) Depressants
, Pharmacologic Drug Class Action Drug Examples Indication Adverse Side Effects Nursing Implications &
(Areas of Use) Reactions Patient Education
Monitor vital signs and for signs of bleeding.
Monitor H/H.
Complete drug history – both prescribed and
OTC/herbal.
Pain assessment.
COX-1:
Tinnitus Cautions:
Stops bleeding
NSAID Protects Stomach Anti-inflammatory Bleeding – GI/Ulcers
GI Upset
Bleeding disorders, peptic ulcer disease;
Hepatic or Renal Impairment; Pregnancy
Asthma; Patients on anticoagulant therapy; 5Gs
Review Prototype on COX-2: Ibuprofen
Fever Reduction Anemia
Dizziness
Causes pain and inflammation (non-selective) Bruising Patient Teaching (Page 287):
pg. 286 & Nursing (vasodilation) Peripheral Edema Take with food – decreases GI upset. Report s/s of GI
Pain Control Anaphylaxis bleeding – tarry stool, coffee-ground emesis, severe GI
Process on pg. 287 Inhibit or block both
pain, bleeding gums, petechia, ecchymosis. etc.
Renal Failure Bleeding prevention – soft toothbrush, electric razor.
COX-1 and COX-2. NO ETOH. Do not take if pregnant. Notify provider
prior to surgery. Edema management – elevate leg,
compression stockings. Avoid during menstruation to
minimize excessive bleeding. Avoid the 5Gs, other
NSAIDs, ASA, and Anticoagulants. Do not take if you
have kidney failure.
COX-2: Bleeding Monitor vital signs
Used to treat
NSAID Causes pain and
Osteoarthritis, Hypertension
Headache Cautions:
inflammation Dizziness Patients with chronic hepatic or renal impairment;
Review Prototype (vasodilation)
Celecoxib Rheumatoid,
Stroke/MI
GI Upset Patients with cardiac history;
Moderate to severe Peripheral Edema Patients on anticoagulant therapy
pg. 288 Inhibits COX-2 only
pain
Nephrotoxicity Patient Teaching: Report edema and BP monitoring.
Monitor for bleeding and salicylism
Inhibits prostaglandin Bleeding
Salicylates synthesis, hypothalamic
Pain Relief Cautions:
Patients on antiplatelet or anticoagulant therapy; 5Gs,
Hearing loss Bruising
Review Prototype on heat regulator center, and
Fever Reduction GI Upset
Children under the age of 16
(Do not give for fever reduction) – Reyes Syndrome
platelet aggregation
pg. 284 & Nursing Aspirin Tinnitus Drowsiness
Headache
(vomiting, lethargy, delirium & coma); Pregnant
women (last trimester); Bleeding disorders.
Block Inflammation
process on Decreases inflammation,
fevers, pain, and blood
GI ulceration Patient Teaching (Page 285):
pg. 285
Report ringing in the ears – s/s salicylism. Take w/food to decrease GI
Antiplatelet
clotting. Reye’s Syndrome upset. Bleeding prevention. s/s of GI bleeding or excessive bleeding.
Avoiding 5 Gs. Stop prior to surgery. Avoid if taking anticoagulants. Do not
(children) combine w/NSAIDs – read OTC labels. Avoid during pregnancy and
menstruation. Do not give to children.
Monitor patients with renal disease, and hepatic
disorder. Uric Acid levels. Pain assessment.
(Monitor ALT, AST, Liver enzymes, BUN/Crt &
Increases uric acid Elevated liver enzymes UOP)
Anti-Gout excretion in the urine and
Prophylactic
GI Upset
Patient Teaching (Page 293):
block uric acid production Elevated BUN and
Review Nursing Allopurinol treatment of gout & Creatinine
ABD Discomfort Educate RE dietary restriction (avoid purines –
shellfish, organ meats, ETOH, etc.). Increase fluid
hyperuricemia
Process on pg. 293 Prevents uric acid crystal
formation in the joints. Stevens-Johnsons
Blurred Vision intake. Take w/food to decrease GI upset. Take daily
as prescribed (lifetime therapy). s/s kidney failure –
Syndrome (SJS) decreasing UOP. s/s liver failure – jaundice, itchy skin
or rash, ABD pain and tenderness. Yearly eye exams –
vision changes.
