Pharmacology
Exam 3
Drug categories · mechanisms · side effects · antidotes
nursing interventions · 125 NCLEX practice questions
Ch 14 · Anxiety & Insomnia 25 questions
Ch 15 · Seizures 25 questions
Ch 16 · Mood & ADHD 25 questions
Ch 39 · Rhinitis & Cold 25 questions
Ch 40 · Asthma & COPD 25 questions
Based on Adams, M. P., Holland, N., & Chang, S. (2023).
Pharmacology for Nurses: A Pathophysiologic Approach (7th ed.). Pearson Education (US).
,Chapter 14 — Drugs for Anxiety & Insomnia
Anxiety & sleep live in the limbic system + reticular activating system. Most anti-anxiety meds calm
the brain by boosting GABA (the brain’s "brakes").
Big picture: Benzos & barbiturates = boost GABA (sedate). SSRIs & buspirone = safer, slower, for
long-term anxiety. Z-drugs & ramelteon = short-term sleep.
Drug Categories
Benzodiazepines
See "-pam / -lam" think BENZO
Drugs: lorazepam (Ativan), diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax), flurazepam
(Dalmane)
Mechanism (MOA)
Intensify the effect of GABA CNS depression, sedation, muscle relaxation, less anxiety.
Top side effects
• Drowsiness, dizziness, ataxia (fall risk)
• Dependence & tolerance
• Respiratory depression (especially IV)
• Anterograde amnesia
Antidote: Flumazenil (Romazicon)
Give when
Short-term anxiety, insomnia, status epilepticus, alcohol withdrawal.
Hold / caution
Older adults (falls), pregnancy, sleep apnea, with alcohol/CNS depressants. Never stop abruptly
withdrawal seizures.
Nursing care
• Fall precautions; short-term use only
• Taper slowly, never stop cold-turkey
• Monitor respirations (esp. IV)
• No alcohol
Pharmacology Exam 3 Study Guide · page 2
,Ch 14 · Anxiety & Insomnia
Non-Benzo Sleep Meds ("Z-drugs")
See "Z" think SLEEP
Drugs: zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)
Mechanism (MOA)
Bind selectively to GABA receptors sleep, with less muscle-relaxant effect than benzos.
Top side effects
• Daytime drowsiness / next-day sedation
• Sleepwalking & complex sleep behaviors (driving, eating asleep)
• Dizziness
Give when
Short-term insomnia. Take right at bedtime, on an empty stomach (food delays onset).
Hold / caution
Pregnancy (Ambien); do not do activities after taking.
Nursing care
• Take immediately before getting in bed
• Safety for sleepwalking
• Separate from food
Pharmacology Exam 3 Study Guide · page 3
, Ch 14 · Anxiety & Insomnia
Melatonin Receptor Agonist
Sleep with NO dependence
Drug: ramelteon (Rozerem)
Mechanism (MOA)
Activates melatonin receptors promotes falling asleep.
Top side effects
Mild; rapid onset; no physical dependence.
Give when
Trouble falling asleep; safe choice with no abuse potential.
Nursing care
Short onset — take right before bed.
Barbiturates
Old, dangerous — rarely used now
Drugs: phenobarbital (Luminal), secobarbital
Mechanism (MOA)
Enhance GABA strong CNS depression.
Top side effects
Many serious adverse effects, respiratory depression, high dependence.
Why rarely used
Too many serious adverse effects; narrow safety margin. No true antidote (supportive care).
Pharmacology Exam 3 Study Guide · page 4
Exam 3
Drug categories · mechanisms · side effects · antidotes
nursing interventions · 125 NCLEX practice questions
Ch 14 · Anxiety & Insomnia 25 questions
Ch 15 · Seizures 25 questions
Ch 16 · Mood & ADHD 25 questions
Ch 39 · Rhinitis & Cold 25 questions
Ch 40 · Asthma & COPD 25 questions
Based on Adams, M. P., Holland, N., & Chang, S. (2023).
Pharmacology for Nurses: A Pathophysiologic Approach (7th ed.). Pearson Education (US).
,Chapter 14 — Drugs for Anxiety & Insomnia
Anxiety & sleep live in the limbic system + reticular activating system. Most anti-anxiety meds calm
the brain by boosting GABA (the brain’s "brakes").
Big picture: Benzos & barbiturates = boost GABA (sedate). SSRIs & buspirone = safer, slower, for
long-term anxiety. Z-drugs & ramelteon = short-term sleep.
Drug Categories
Benzodiazepines
See "-pam / -lam" think BENZO
Drugs: lorazepam (Ativan), diazepam (Valium), clonazepam (Klonopin), alprazolam (Xanax), flurazepam
(Dalmane)
Mechanism (MOA)
Intensify the effect of GABA CNS depression, sedation, muscle relaxation, less anxiety.
Top side effects
• Drowsiness, dizziness, ataxia (fall risk)
• Dependence & tolerance
• Respiratory depression (especially IV)
• Anterograde amnesia
Antidote: Flumazenil (Romazicon)
Give when
Short-term anxiety, insomnia, status epilepticus, alcohol withdrawal.
Hold / caution
Older adults (falls), pregnancy, sleep apnea, with alcohol/CNS depressants. Never stop abruptly
withdrawal seizures.
Nursing care
• Fall precautions; short-term use only
• Taper slowly, never stop cold-turkey
• Monitor respirations (esp. IV)
• No alcohol
Pharmacology Exam 3 Study Guide · page 2
,Ch 14 · Anxiety & Insomnia
Non-Benzo Sleep Meds ("Z-drugs")
See "Z" think SLEEP
Drugs: zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta)
Mechanism (MOA)
Bind selectively to GABA receptors sleep, with less muscle-relaxant effect than benzos.
Top side effects
• Daytime drowsiness / next-day sedation
• Sleepwalking & complex sleep behaviors (driving, eating asleep)
• Dizziness
Give when
Short-term insomnia. Take right at bedtime, on an empty stomach (food delays onset).
Hold / caution
Pregnancy (Ambien); do not do activities after taking.
Nursing care
• Take immediately before getting in bed
• Safety for sleepwalking
• Separate from food
Pharmacology Exam 3 Study Guide · page 3
, Ch 14 · Anxiety & Insomnia
Melatonin Receptor Agonist
Sleep with NO dependence
Drug: ramelteon (Rozerem)
Mechanism (MOA)
Activates melatonin receptors promotes falling asleep.
Top side effects
Mild; rapid onset; no physical dependence.
Give when
Trouble falling asleep; safe choice with no abuse potential.
Nursing care
Short onset — take right before bed.
Barbiturates
Old, dangerous — rarely used now
Drugs: phenobarbital (Luminal), secobarbital
Mechanism (MOA)
Enhance GABA strong CNS depression.
Top side effects
Many serious adverse effects, respiratory depression, high dependence.
Why rarely used
Too many serious adverse effects; narrow safety margin. No true antidote (supportive care).
Pharmacology Exam 3 Study Guide · page 4
