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Anxiolytic and Hypnotic Agents
Types of Anxiolytic and Hypnotic Agents
- Anxiolytics
- Prevent feelings of tension or fear
- Sedatives
- Calm and make patients unaware of the environment
- Hypnotics
- Minor tranquilizers
- Produce a state of tranquility in anxious patients
States Affected by Anxiolytic and Hypnotic Drugs
- Anxiety
- –Feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
- Sedation
- –Loss of awareness and reaction to environmental stimuli
- Hypnosis
- –Extreme sedation resulting in further CNS depression and sleep
Sites of Action of Benzodiazepines and Barbiturates
Sites of Action of Benzodiazepines and Barbiturates
Benzodiazepines—Actions
- Act in the limbic system and the RAS
- Make GABA more effective
- Cause interference with neurons firing
- Lower doses cause anxiolytic effects
- Higher doses cause sedation and hypnosis
Benzodiazepines—Indications
- Anxiety disorders
- Alcohol withdrawal
- Hyperexcitability and agitation
- Preoperative relief of anxiety and tension
Benzodiazepines—Pharmacokinetics
- Well absorbed from the GI tract
- Peak levels achieved in 30 minutes to 2 hours
- Lipid soluble and well distributed throughout the body
- Cross placenta
- Enter breast milk
- Metabolized in the liver
- Excretion is primarily in the urine
Benzodiazepines—Contraindications & Cautions
- Allergy to benzodiazepines
- Psychosis
- Acute narrow angle glaucoma
- Shock
- Coma
- Acute alcohol intoxication
- Pregnancy
Benzodiazepines—Adverse Effects
- Sedation
- Drowsiness
- Depression
- Lethargy
- Blurred vision
- Confusion
- Dry mouth
- Constipation
- Nausea
- Vomiting
- Hypotension
- Urinary retention
Benzodiazepines—Drug-to-Drug Interactions
- Increase CNS depression when taken with alcohol
- Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
- Decrease in effect if given with theophylline or ranitidine
Barbiturates
- Act as a general CNS depressant
- Inhibit neuronal impulse conduction in the ascending RAS
- Depress the cerebral cortex
- Alter cerebellar function
- Depress motor output
Barbiturates—Actions
- CNS depressant
- Inhibit neuronal impulse conduction in the ascending RAS
- Depress cerebral cortex
- Depress motor output
- Cause sedation, hypnosis, anesthesia, and coma
Barbiturates—Indications
- Relief of the signs and symptoms of anxiety
- Sedation
- Insomnia
- Preanesthesia
- Seizures
Barbiturates—Pharmacokinetics
- Well absorbed
- Reach peak in 20 to 60 minutes
- Metabolized in the liver
- Excreted in the urine
Barbiturates—Contraindications & Cautions
- Allergy to any barbiturate
- Previous history of addiction to sedative–hypnotic drugs
- Latent or manifest porphyria
- Marked hepatic impairment or nephritis
- Respiratory distress or severe respiratory dysfunction
- Pregnancy
Barbiturates—Adverse Reactions
- CNS depression
- Physical dependency
- Drowsiness
- Somnolence
- Lethargy
- Ataxia
- Vertigo
- Nausea
- Vomiting
- Constipation
Barbiturates—Drug-to-Drug Interactions
- Increase CNS depression when given with alcohol, antihistamines, and other tranquilizers
- Alter response to phenytoin
- MAOs increase serum levels and effect
- Decrease effectiveness of the following drugs: anticoagulants, digoxin, tricyclic antidepressants, corticosteroids, and oral contraceptives
Other Anxiolytic and Hypnotic Drugs
- Paraldehyde (Paral): sedates patients with delirium tremens or psychiatric conditions characterized by extreme excitement
- Meprobamate (Miltown): manages acute anxiety for up to 4 months
- Chloral hydrate (Aquachloral): produces nocturnal sedation or preoperative sedation
- Glutethimide (generic), zaleplon (Sonata), and zolpidem (Ambien): short-term treatment of insomnia
- Antihistamines (promethazine [Phenergan], diphenhydramine [Benadryl]: preoperative medications, and postoperatively to decrease the need for narcotics
- Buspirone (BuSpar): reduces the signs and symptoms of anxiety without severe CNS and adverse effects
Use of Anxiolytic and Hypnotic Agents Across the Lifespan
Use of Anxiolytic and Hypnotic Agents Across the Lifespan
Prototype Benzodiazepines Agent
Prototype Benzodiazepines Agent
Prototype Barbiturates Agent
Prototype Barbiturates Agent
Nursing Considerations for Benzodiazepines
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
Nursing Considerations for Barbiturates
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
-
Tags
acute alcohol intoxication, acute narrow angle glaucoma, alcohol withdrawal, anxiety disorders, anxiolytic and hypnotic agents, anxious patients, benzodiazepines, breast milk, cause interference, cns depression, drug to drug interactions, excretion, gi tract, hypnotic drugs, limbic system, minor tranquilizers, narrow angle glaucoma, peak levels, unpleasant reactions, urinary retention
Immune Modulators
Sites of Actions of Immune Modulators
- Immune modulators
- Modify the actions of the immune system
- Immune stimulants
- Energize the immune system when it needs help fighting a specific pathogen
- Immune suppressants
- Block the normal effects of the immune system in organ transplantation and autoimmune disorders
Immune Stimulants
- Interferons
- Naturally released from human cells in response to viral invasion
- Interleukins
- Communicate between lymphocytes, stimulate cellular immunity, and inhibit tumor growth
- T and B cell modulator (levamisole)
- Restores immune function and activity
Interferon
- Actions
- Prevents virus particles from replicating inside other cells
- Stimulates interferon receptor sites on noninvaded cells to produce antiviral proteins
- Inhibits tumor growth and replication
- Pharmacokinetics
- Absorbed well after subcutaneous or intramuscular injection
- Broken down in the tissues
- Excreted in the kidneys
- May be teratogenic
- Contraindications
- Known allergy
- Pregnancy and lactation
- Use with caution in cardiac disease, myelosuppression, and with central nervous system dysfunction
- Adverse reactions
- Lethargy, myalgia, arthralgia, anorexia, nausea, headache, dizziness, and bone marrow depression
- Drug-to-drug interactions
Interleukins
- Definition
- Chemicals produced by T cells to communicate between leukocytes
- Types of preparations
- Aldesleukin (Proleukin)
- Human interleukin produced by recombinant DNA technology using Escherichia coli bacteria
- Oprelvekin (Neumega)
- A newer agent produced by DNA technology
- Actions
- Increase the number of natural killer cells and lymphocytes
- Activate cellular immunity and inhibit tumor growth
- Indications
- Aldesleukin: specific renal carcinomas and possible treatment of AIDS and AIDS-related disorders
- Oprelvekin: prevention of severe thrombocytopenia after myelosuppressive chemotherapy
- Pharmacokinetics
- Rapidly distributed after injection
- Cleared by the kidneys
- Teratogenic
- Contraindications
- Known allergy, pregnancy, and lactation
- Caution with renal, liver, or cardiovascular impairment
- Adverse reactions
- Lethargy, myalgia, arthralgia, fatigue, fever, and respiratory difficulties
T and B Cell Modulators
- Action/Indication
- Levamisole stimulates B cells which in turn stimulate antibody formation, enhancing T cell activity
- Used in the treatment of Duke’s stage C colon cancer
- Pharmacokinetics
- Absorbed from the GI tract
- Peaks in 1.5 to 2 hours
- Metabolized in the liver and excreted in the urine
- T½ of 16 hours
- Contraindications
- Known allergy, pregnancy, and lactation
- Adverse reactions
- Headache, dizziness, ataxia, nausea, vomiting, and diarrhea
- Drug-to-drug interactions
- Disulfiram-type reaction
- Increased phenytoin levels
Types of Immune Suppressants
- T and B cell suppressors
- An interleukin receptor antagonist
- Monoclonal antibodies
- Produced by a single clone of B cells that react with specific antigens
T and B Cell Suppressors
- Azathioprine (Imuran): prevents rejection in renal hemotransplants; treats rheumatoid arthritis
- Cyclosporine (Sandimmune): suppresses rejection in a variety of transplants; treats rheumatoid arthritis and psoriasis
- Glatiramer acetate (Copaxone): reduces number of relapses in multiple sclerosis in adults
- Mycophenolate mofetil (CellCept): prevents rejection after renal or heart transplant in adults
- Sirolimus (Rapamune): prevents rejection after renal transplantation
- Tacrolimus (Prograf): prevents rejection after liver transplantation
- Action
- Contraindications
- Known allergy, pregnancy, CNS disease, and hepatic disease
- Drug-to-drug interactions
T and B Cell Suppressor Adverse Effects
- Increased risk for infection and development of neoplasms
- Hepatotoxicity
- Renal toxicity and renal dysfunction
- Pulmonary edema
- Possible headache, tremors, and secondary infections such as acne, GI upset, diarrhea, and hypertension
Interleukin Receptor Antagonists
- Actions
- Used to treat rheumatoid arthritis
- Block activity of interleukin-1
- Pharmacokinetics
- Given subcutaneously
- Reach peak in 3 to 7 hours
- Metabolized in the tissues
- T½ of 4 to 6 hours
- Contraindications
- Known allergy, pregnancy, lactation, and renal impairment
- Adverse reactions
- Headache, sinusitis, nausea, and diarrhea
- Drug-to-drug interaction
- Etanercept may cause severe and even life- threatening infections
Monoclonal Antibodies
- Action
- Antibodies attach to specific receptors
- Pharmacokinetics
- Contraindications
- Known allergy and fluid overload
- Adverse reactions
- Pulmonary edema, fluid retention, flu-like symptoms
- Drug-to-drug interaction
- Severe immune suppression can occur
Use of Immune Modulators Across the Lifespan
Use of Immune Modulators Across the Lifespan
Prototype Immune Stimulants
Prototype Immune Stimulants
Prototype Interleukins
Prototype Interleukins
Prototype T and B Cell Suppressors
Prototype T and B Cell Suppressors
Prototype Monoclonal
Prototype Monoclonal
Nursing Considerations for Immune Stimulators
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
Nursing Considerations for Immune Suppressants
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
-
Tags
aldesleukin, cellular immunity, central nervous system, drug to drug interactions, escherichia coli bacteria, human cells, human interleukin, immune modulators, immune stimulants, interferon receptor, natural killer cells, neumega, organ transplantation, proleukin, recombinant dna technology, renal carcinomas, t cells, tumor growth, viral invasion, virus particles
Anti-inflammatory Agents
Inflammatory Response
- Protects the body from injury and pathogens
- Uses chemical mediators to produce the reaction that helps destroy pathogens and promote healing
Anti-inflammatory Agents
- Block or alter the chemical reactions associated with the inflammatory response
Types of Anti-inflammatory Agents
- Corticosteroids: used systemically to block the inflammatory and immune systems
- Antihistamines: block the release of histamine in the initiation of the inflammatory response
Salicylates
- Can block the inflammatory response
- Have antipyretic (fever-blocking) properties
- Have analgesic (pain-blocking) properties
NSAIDs
- Provide strong anti-inflammatory and analgesic effects
- Sold over the counter, which may lead to abuse
Common Salicylates
- Aspirin (Bayer,etc.): treats inflammatory conditions
- Balsalazide (Colazal): new drug that treats ulcerative colitis
- Choline magnesium trisalicylate (Trilisate): treats mild pain and fevers as well as arthritis
- Choline salicylate (Arthropan): treats mild pain and fevers as well as arthritis
- Mesalamine (Pentasa, etc.): treats inflammation of the large intestine
- Olsalazine (Dipentum): converted to mesalamine in the colon; has the same direct anti-inflammatory effects
- Salsalate (Argesic, etc.): treats pain, fever, and inflammation
- Sodium thiosalicylate (Rexolate): treats episodes of acute gout and muscular pain as well as rheumatic fever
Salicylates
- Action/indication
- Inhibit synthesis of prostaglandin; used to treat mild to moderate pain and fever
- Pharmacokinetics
- Absorbed from the stomach, peak in 5 to 30 min., metabolized in the liver, and excreted in the urine
- Contraindications
- Known allergy, bleeding abnormalities, and impaired renal function
- Drug-to-drug interactions
- Interact with other drugs by interfering with absorption
Salicylates—Adverse Effects
- GI irritation
- Nausea, dyspepsia, and heartburn
- Clotting system
- Blood loss and bleeding abnormalities
- Eighth cranial nerve stimulation
- Salicylism
- Ringing in the ears
- Acidosis
- Nausea, vomiting, and diarrhea
- Mental confusion and lassitude
Types of NSAIDs
- Propionic acids
- Acetic acids
- Fenamates
- Cyclooxygenase-2 inhibitors
NSAIDs Indications
- Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis
- Relief of mild to moderate pain
- Treatment of primary dysmenorrhea
- Fever reduction
Contraindications to NSAIDs
- Presence of allergy to any NSAID or salicylate
- Cardiovascular dysfunction or hypertension
- Peptic ulcer or known GI bleeding
- Pregnancy and lactation
- Caution with renal or hepatic dysfunction
Other Anti-inflammatory Agents
- Acetaminophen (Tylenol)
- Gold compounds
- Antiarthritic drugs
Acetaminophen
- Action/indications
- Acts directly on the thermoregulatory cells of the hypothalamus
- Mechanism of action related to analgesic effects is not certain
- Used to treat pain and fever
- Treatment of pain and fever associated with a variety of conditions, including influenza
- Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
- Relief of musculoskeletal pain associated with arthritis
- Pharmacokinetics
- Absorbed from the GI tract
- Peaks in ½ to 2 hours
- Metabolized in the liver
- Excreted in the urine
- T½ is about 2 hours
- Contraindications
- Known allergy
- Use with caution in pregnancy and lactation
- Adverse reactions
-
- Headache, hemolytic anemia, renal dysfunction, skin rash, fever, and hepatotoxicity
- Drug-to-drug interactions
- Oral anticoagulants increase bleeding
Gold Compounds
- Action
- Absorbed by macrophages, which results in inhibition of phagocytosis
- Indication
- Tissue destruction is decreased
- Pharmacokinetics
- Absorption varies based on the site of administration
- Widely distributed throughout the body
- Contraindications
-
- Known allergy
- Diabetes, CHF, and renal or hepatic impairment
- Adverse reactions
- Stomatitis, glossitis, gingivitis, bone marrow depression, and dermatitis
- Drug-to-drug interactions
- Penicillamine, antimalarials, cytotoxic drugs, and immunosuppressive agents
Other Antiarthritis Drugs
- Etanercept (Enbrel)
- Leflunomide (Arava)
- Penicillamine (Depen)
- Hyaluronidase derivative (Synvisc)
- Sodium hyaluronate (Hyalgan)
- Anakinra (Kineret)
Use of Anti-inflammatory Agents Across the Lifespan
Use of Anti-inflammatory Agents Across the Lifespan
Prototype Salicylates
Prototype Salicylates
Prototype NSAIDs
Prototype NSAIDs
Prototype Acetaminophen
Prototype Acetaminophen
Prototype Gold Compound
Prototype Gold Compound
Nursing Considerations for Salicylates
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
Nursing Considerations for NSAIDs
- Assessment (history and physical exam)
- Nursing diagnosis
- Implementation
- Evaluation
-
Tags
acute gout, analgesic effects, aspirin bayer, balsalazide, chemical mediators, choline magnesium trisalicylate, colazal, dipentum, drug to drug interactions, gi irritation, impaired renal function, inflammatory agents, large intestine, mild pain, pentasa, response types, rheumatic fever, salicylates aspirin, salsalate, trilisate
Nursing Management
Nursing Responsibility
- Assessment
- Administration of ordered medications and therapy
- Assessment of reaction/outcome to medications
- Teaching
- Evaluation of teaching effectiveness
Nursing Process
- Assessment
- Gather data: history and physical assessment
- Nursing diagnosis
- Draw a conclusion from the assessment data that was gathered
- Intervention
- Formulate a plan of care that includes actions to improve or maintain the patient’s health
- Evaluation
- Determine if the plan of care was effective at either maintaining or improving the patient’s health
Assessment
- History
- Medical
- Certain conditions prevent patients’ use of some medications
- Surgical
- May require new medications as a result of surgery
- Social
- Level of education, social support, financial means
- Medications
- Drug-to-drug interactions
- Allergies
- Patients may have cross-sensitivity to medications
Physical Assessment
- Head-to-toe assessment
- Weight
- Age
Nursing Diagnosis
- Based on the data collected in the assessment phase of the nursing process
- The nursing diagnosis is a statement of the patient’s status from the nursing perspective
- This statement is the basis for the care provided by the nurse
- Insert box 4.2
Interventions
- Nursing actions that guide the care provided to the patient by the nurse
- Interventions can be dependent, interdependent, or independent
Proper Drug Administration (The Rights)
- Drug
- Storage
- Route
- Dosage
- Preparation
- Timing
- Recording
Promoting Drug Therapy
- Placebo effect
- Managing adverse effect
- Lifestyle adjustment
Patient and Family Education
- Cornerstone of drug therapy
- Nurses are the primary educators about medications
Elements of Patient Teaching
- Name, dose, and action of drug
- Timing of administration
- Special storage and preparation instructions
- Specific OTC drugs or alternative therapies to avoid
- Special comfort or safety measures
- Specific points about drug toxicity
- Specific warnings about drug discontinuation
Patient History
- Chronic conditions
- Drug use
- Allergies
- Level of education
- Level of understanding of disease and therapy
- Social support
- Financial support
- Patterns of health care
Physical Assessment
- Weight
- Determine whether recommended dose is appropriate
- Age
- Extremes often require dosage adjustments
- Physical parameters related to disease or drug effects
- Provide a baseline level for future assessments
Medication Order—Hospital
- Date and time of order
- Patient name and identifiers (medical record number, date of birth)
- Drug
- Dosage
- Route
- Frequency
- Special administration instructions
Medication Order—Community
- Patient name
- Patient date of birth
- Drug
- Drug dosage
- Drug route
- Drug frequency
- Any special instructions
- Amount of medication to dispense
- Number of refills
Drug Administration
- Assessment of patient
- Includes history, allergies, physical assessment
- Assessment of drug
- Proper medication procedure
- Teaching
- Administration of medication
- Assessing for therapeutic or adverse effect
- Documentation
-
Tags
adverse effect, assessment administration, assessment data, assessment phase, drug storage, drug to drug interactions, family education, health assessment, health evaluation, INTERVENTIONS, nursing diagnosis, nursing management, nursing process, nursing responsibility, physical assessment, placebo effect, process assessment, teaching effectiveness, teaching evaluation, therapy assessment