Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Anxiolytic and Hypnotic Agents

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
    • Cause sleep
  • 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
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
Use of Anxiolytic and Hypnotic Agents Across the Lifespan

Prototype Benzodiazepines Agent

Prototype Benzodiazepines Agent
Prototype Benzodiazepines Agent

Prototype Barbiturates 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
Categories
Chemotherapeutic Agents Nursing Pharmacology

Antibiotics

Antibiotics

Antibiotics

  • Antibiotics are defined as:
    • Chemicals that inhibit specific bacteria

Types of Antibiotics

  • Bacteriostatic
    • Substances that prevent the growth of bacteria
  • Bactericidal
    • Substances that kill bacteria directly

Signs of Infection

  • Fever
  • Lethargy
  • Slow-wave sleep induction
  • Classic signs of inflammation (redness, swelling, heat, and pain)

Goal of Antibiotic Therapy

  • Decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invaders

Selecting Treatment

  • Identification of the causative organism
  • Based on the culture report, an antibiotic is chosen that is known to be effective at treating the invading organism

Bacteria Classification

  • Gram-positive
    • The cell wall retains a stain or resists decolorization with alcohol
  • Gram-negative
    • The cell wall loses a stain or is decolorized by alcohol
  • Aerobic
    • Depend on oxygen for survival
  • Anaerobic
    • Do not use oxygen

Aminoglycosides

  • A group of powerful antibiotics used to treat serious infections caused by gram-negative aerobic bacilli
  • Common medications:
    • Amikacin (Amikin)
    • Gentamicin (Garamycin)
    • Kanamycin (Kantrex)
    • Neomycin (Mycifradin)
    • Streptomycin
    • Tobramycin (Nebcin, Tobrex)
  • Bactericidal
  • Indications: treatment of serious infections caused by susceptible bacteria
  • Action: inhibit protein synthesis in susceptible strains of gram-negative bacteria causing cell death
  • Pharmacokinetics
    • Poorly absorbed from the GI tract but rapidly absorbed after IM injection, reaching peak levels within 1 hour
    • Widely distributed throughout the body, crossing the placenta and entering breast milk
    • Excreted unchanged in the urine and have an average half-life of 2 to 3 hours
    • Depend on the kidney for excretion and are toxic to the kidney
  • Contraindications
    • Known allergies, renal or hepatic disease, and hearing loss
  • Adverse effects
    • Ototoxicity and nephrotoxicity are the most significant
  • Drug-to-drug interactions
  • Diuretics and neuromuscular blockers

Cephalosporins

  • Similar to penicillin in structure and activity
  • Action
    • Interfere with the cell-wall–building ability of bacteria when they divide
  • Indication
    • Treatment of infection caused by susceptible bacteria
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver, excreted in the urine
  • Contraindications
    • Allergies to cephalosporins or penicillin
  • Adverse effect
    • GI tract
  • Drug-to-drug interactions
    • Aminoglycosides, oral anticoagulants, and ETOH

Fluoroquinolones

  • Relatively new class of antibiotics with a broad spectrum of activity
  • Indications: treat infections caused by susceptible strains of gram-negative bacteria, including urinary tract, respiratory tract, and skin infections
  • Actions: interferes with DNA replication in susceptible gram-negative bacteria, preventing cell reproduction
  • Pharmacokinetics
    • Absorbed in the GI tract
    • Metabolized in the liver
    • Excreted in the urine and feces
  • Contraindications
    • Known allergy, pregnancy, and lactation
  • Adverse effects
    • Headache, dizziness, and GI upset
  • Drug-to-drug interactions
    • Antacids, quinidine, and theophylline

Macrolides

  • Antibiotics that interfere with protein synthesis in susceptible bacteria
  • Indications: treatment of respiratory, dermatologic, urinary tract, and GI infections caused by susceptible strains of bacteria
  • Actions: bind to cell membranes causing a change in protein function and cell death; can be bacteriostatic or bactericidal
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Metabolized in the liver, excreted in the bile to feces
  • Contraindications
    • Allergy and hepatic dysfunction
  • Adverse effects
    • GI symptoms
  • Drug-to-drug interactions
    • Digoxin, oral anticoagulants, theophylline, and corticosteroids

Lincosamides

  • Similar to macrolides but more toxic
  • Action
    • Similar to macrolides
  • Indications
    • Severe infections
  • Pharmacokinetics
    • Well absorbed from the GI tract or IM
    • Metabolized in the liver and excreted in the urine and feces
  • Contraindications
    • Hepatic or renal impairment
  • Adverse effects
    • GI reactions

Monobactams

  • Unique structure with little cross-resistance
  • Action
    • Disrupts bacteria cell wall synthesis, which promotes the leakage of cellular content and cell death
  • Indications
    • Treatment of infections caused by susceptible bacteria; UTI, skin, intra-abdominal, and gynecologic infections
  • Pharmacokinetics
    • Well absorbed from the IM injection
    • Excreted unchanged in the urine
  • Contraindications
    • Allergy
  • Adverse effects
    • GI and hepatic enzyme elevation

Penicillins

  • First antibiotics introduced for clinical use
  • Action
    • Inhibit synthesis of the cell wall in susceptible bacteria, causing cell death
  • Indications
    • Treatment of infections caused by streptococcal, pneumococcal, staphylococcal, and other susceptible bacteria
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Excreted unchanged in the urine
  • Contraindications
    • Allergy
    • Caution in patients with renal disease
  • Adverse effects
    • GI effects
  • Drug-to-drug interactions
    • Tetracyclines and aminoglycosides

Sulfonamides

  • Drugs that inhibit folic acid synthesis
  • Action
    • Interfere with the cell-wall–building ability of dividing bacteria
  • Indications
    • Treatment of infections caused by gram-negative and gram positive-bacteria
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver and excreted in the urine
  • Contraindications
    • Allergy and pregnancy
  • Adverse effects
    • GI symptoms and renal effects related to the filtration of the drug
  • Drug-to-drug interactions
    • Cross sensitivity with thiazide diuretics
    • Sulfonylureas

Tetracyclines

  • Developed as semisynthetic antibiotics based on the structure of a common soil mold
  • Action
    • Inhibit protein synthesis in susceptible bacteria, preventing cell replication
  • Indications
    • Treatment of various infections caused by susceptible strains of bacteria and acne, and when penicillin is contraindicated for eradication of susceptible organisms
  • Pharmacokinetics
    • Adequately absorbed from the GI tract
    • Concentrated in the liver and excreted unchanged in the urine
  • Contraindications
    • Allergy, pregnancy, and lactation
  • Adverse effects
    • GI, skeletal: damage to bones and teeth
  • Drug-to-drug interactions
    • Penicillin G, oral contraceptive therapy, methoxyflurane, and digoxin

Antimycobacterials

  • Contain pathogens causing tuberculosis and leprosy
  • Action
    • Act on the DNA of the bacteria, leading to lack of growth and eventual bacterial death
  • Indication
    • Treatment of acid-fast bacteria
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver and excreted in the urine
  • Contraindications
    • Allergy and renal or hepatic failure
  • Adverse effects
    • CNS effects and GI irritation
  • Drug-to-drug interactions
    • Rifampin and INH can cause liver toxicity

Antibiotic Use Across the Lifespan

  • Pediatric population
  • Adult population
  • Geriatric population

Comparison of Prototype Antibiotics

Drug/ Classification Indication Action Route Onset Peak Pharmacokinetics Adverse Effects
Gentamicin/ Aminoglycosides Treatment of serious infections caused by susceptible bacteria Inhibits protein synthesis in susceptible strains of gram negative bacteria IM Rapid 30-90 min T½  – 2-3 h Sinusitis, dizziness, rash, fever, risk of nephrotoxicity
IV Metabolized in the liver,
excreted in the urine
Cefaclor/ Cephalosporins Treatment of respiratory, dermatological, urinary tract, and middle ear infections Inhibits synthesis of bacteria cell wall Oral 30-60 min 8-10 h T ½ 30-60 min Nausea, vomiting, diarrhea, rash, superinfections, bone marrow suppression, risk for pseudomembranous colitis
Excreted unchanged in the urine
Ciprofloxacin/ Fluoroquinolones Treatment of respiratory, dermatological, urinary tract, ear, eye, bone, and joint infections Interferes with DNA replication in susceptible gram negative bacteria Oral Varies 4-5 h T ½  – 3.5-4 h Headache, dizziness, hypotension, nausea, vomiting, diarrhea, fever, and rash
IV 10 min 4-5 h Metabolized in the liver,
excreted in bile and urine
Erythromycin/ Macrolides Treatment of respiratory, dermatological, urinary tract, and GI infections Binds to cell membrane causing change in protein function and cell death Oral 1-2 h 1-4 h T ½ – 3-5 h Abdominal cramping, vomiting, diarrhea, rash, superinfections, liver toxicity, potential for hearing loss
IV Rapid 1h Metabolized in the liver, CONTINUED ON NEXT SLIDE
excreted in bile and urine
Treatment of serious infections caused by susceptible strains of bacteria Inhibits protein synthesis in susceptible bacteria Oral Varies 1-2 h T ½ – 2-3 hours Nausea, vomiting, diarrhea, pseudomembranous colitis, bone marrow suppression, hypotension, cardiac arrest
IV Immed. Min Metabolized in the liver, excreted in bile and urine
IM 20-30 min 1-3 h
Aztreonam/ Treatment of lower respiratory, dermatological, urinary tract, intra-abdominal, and GYN infections Interferes with bacterial cell wall synthesis IM Varies 60-90 min T ½ – 1.5-2 h Nausea, vomiting, diarrhea, rash, superinfections, anaphylaxis, local discomfort at injection site
Monobactams IV Immed. 30 min Excreted in unchanged urine
Amoxicillin/ Treatment of infections caused by susceptible strains of bacteria Inhibits synthesis of the cell wall, causing cell death Oral Varies 1 h T ½  – 1-1.4 h Nausea, vomiting, diarrhea, glossitis, stomatitis, bone marrow suppression, rash, fever, lethargy
Penicillins Excreted unchanged in urine
Sulfasalazine/ Treatment of rheumatoid arthritis, arthritis, and ulcerative colitis Clindamycin/ Oral Varies 1.5-6 h T ½ – 5-10 h Nausea, vomiting, hepatocellular necrosis, hematuria, Stevens-Johnson syndrome, rash, photophobia, fever
Sulfonamides Lincosamides 6-24 h – metab. Metabolized in the liver, excreted in urine
Tetracycline/ Treatment of various infections caused by susceptible bacteria Inhibits protein synthesis in susceptible bacteria Oral Varies 2-4 h T ½ – 6-12 h Nausea, vomiting, diarrhea, discoloration of teeth, bone marrow suppression, photosensitivity
Tetracyclines Excreted unchanged in urine
Isoniazid/ Treatment of tuberculosis Interferes with lipid and nucleic acid synthesis in actively growing tubercle bacilli Oral Varies 1-2 h T ½  – 1-4 h Peripheral neuropathies, nausea, vomiting, hepatitis, bone marrow suppression, fever, gynecomatia, lupus syndrome
Antimycobacterials Metabolized in the liver, excreted in urine

Nursing Considerations—Aminoglycosides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Cephalosporins

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Fluoroquinolones

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations— Macrolides & Lincosamides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Monobactam

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Penicillins

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Sulfonamides

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Tetracyclines

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations—Antimycobacterials

  • Assessment and history
  • Nursing diagnosis
  • Implementation
  • Evaluation