Pharmacology and Nursing Care for Clinical Practice

Posted on May 4, 2026 in Airports

Sedative-Hypnotic Drug Classes

1. Barbiturates

Phenobarbital: Historically used for sleep; currently utilized as an anticonvulsant or for anesthesia.

  • Risks: High abuse potential, habit-forming, low therapeutic index (TI), and increased suicide risk.

2. Benzodiazepines

Considered safer than general CNS depressants with fewer drug interactions; classified as Schedule IV.

  • Examples: Diazepam (Valium) for acute seizures; Lorazepam (Ativan) for acute seizures and alcohol withdrawal; Alprazolam (Xanax) for anxiety; Midazolam (Versed) for pre-sedation in the operating room.
  • Uses: Insomnia, anxiety, conscious sedation, seizures, and alcohol withdrawal.
  • Side Effects: Anterograde amnesia, daytime sedation, lethargy, and confusion.
  • Nursing Interventions: Contraindicated in pregnancy; monitor fall risk; check respiratory rate (RR) and blood pressure (BP) before IV administration; do not stop abruptly.
  • Antidote: Flumazenil (Romazicon); always have oxygen and suction ready.

3. Non-benzodiazepines

Specifically targeted for sleep therapy.

  • Risks: Lower abuse risk due to targeted action mechanisms.
  • Zolpidem (Ambien): Targets short-term insomnia. Side effects include daytime sedation, confusion, and complex sleep-related behaviors. Nursing interventions include monitoring for severe fall risk and encouraging non-pharmacological therapies first.
  • Ramelteon (Rozerem): Rapid onset (30 minutes) for chronic insomnia. Not a controlled substance; no abuse potential or withdrawal risk. Side effects include drowsiness, dizziness, depression, and potential liver damage.

4. Over-the-Counter (OTC) Sleep Aids

  • Antihistamines: Diphenhydramine (Benadryl) causes daytime drowsiness and anticholinergic effects.
  • Hormones: Melatonin shows moderate effectiveness, especially for the elderly.

Epilepsy Management and Antiepileptic Drugs

Seizure Classifications

  • Epilepsy: A neurological disorder characterized by recurrent, compulsive seizures, sensory disturbances, or abnormal behavior.
  • Seizure: A disruption in the brain’s electrical function caused by an imbalance between excitation and inhibition.
  • Focal Seizures: Originating in a localized region of the brain.
  • Tonic-Clonic Seizures: Initial muscular contraction (tonic phase) followed by alternating contraction and relaxation (clonic phase).
  • Status Epilepticus: Repeated tonic-clonic convulsions; this is a medical emergency.

Antiepileptic Drug (AED) Therapy

1. Hydantoins: Phenytoin (Dilantin)

  • Side Effects: Nystagmus, ataxia, measles-like rash (Stevens-Johnson Syndrome), and teratogenic effects.
  • Nursing Interventions: Narrow therapeutic index (10-20 mcg/mL); highly protein-bound (check albumin); monitor drug interactions (e.g., warfarin). Maintain strict oral hygiene to prevent gingival hyperplasia (gum tissue overgrowth).
  • Administration: Irritating to tissues; use a large vein and dilute only with 0.9% Normal Saline (NS). Use a filter needle; maximum push rate is 50 mg/min to avoid dysrhythmias.

2. Valproic Acid (Depakote)

  • Side Effects: Hepatotoxicity, weight gain, GI upset, and dizziness.
  • Nursing Interventions: Check Liver Function Tests (LFTs); contraindicated in liver disease. Capsules may be sprinkled on food.

3. Levetiracetam (Keppra)

  • Side Effects: Hyperactivity and behavioral changes such as anxiety, hostility, and suicidal ideation.
  • Nursing Interventions: Obtain baseline LFT and renal assessments.

Patient Education for AEDs

  • Lifelong Therapy: Do not taper abruptly to avoid rebound seizures or status epilepticus.
  • Strict Timing: Take at the same time daily to maintain therapeutic blood levels.
  • Driving Laws: Patients must typically be seizure-free for 3 to 12 months to drive.
  • Family Planning: Discuss risks as many AEDs are teratogenic.

Muscle Tension and CNS Depressant Care

1. Muscle Spasms

A localized issue involving involuntary contraction of a specific muscle often caused by overuse, fatigue, dehydration, or electrolyte imbalance.

  • Treatment: Immobilization, cold compresses, physical therapy, NSAIDs, and local relaxants.
  • Cyclobenzaprine (Flexeril): A CNS depressant that reduces muscle hyperactivity. Side effects include drowsiness, dizziness, anticholinergic effects, and fall risk.

2. Spasticity

A CNS issue involving muscle hyperactivity, constant contraction, and pain, often caused by Multiple Sclerosis (MS), Cerebral Palsy (CP), CVA, or spinal cord injury.

  • Baclofen (Lioresal): Acts on spinal cord nerves to relieve pain and spasms.
  • Nursing Interventions: Taper off slowly to avoid seizures, paranoia, and hallucinations.

Neurodegenerative Disease Manifestations

Parkinson’s Disease

Characterized by decreased dopamine and increased acetylcholine (ACh).

  • Symptoms (TRAP): Tremor (pill-rolling), Rigidity (stiffness), Akinesia/Bradykinesia (slow movement), and Postural instability (shuffling gait).
  • Interventions: Carbidopa-levodopa (Sinemet) restores dopamine. Take 30 minutes before or 1 hour after protein; contraindicated in glaucoma.
  • Adjuncts: COMT inhibitors (Entacapone) may cause brownish-orange urine. MAO-B inhibitors (Rasagiline) require avoiding tyramine (the “cheese effect”) to prevent hypertensive crisis.

Alzheimer’s Disease

Characterized by decreased acetylcholine leading to diminished cognitive function.

  • Symptoms: Confusion, difficulty with ADLs, memory loss, and poor judgment.
  • Treatment: Acetylcholine inhibitors like Donepezil (Aricept). Goal: provide safety and increase independence.

Extrapyramidal Symptoms (EPS)

  1. Pseudo-Parkinsonism: Stooped posture, shuffling, and tremors.
  2. Acute Dystonia: Facial grimacing and laryngeal spasms.
  3. Akathisia: Restlessness and pacing.
  4. Tardive Dyskinesia: Protrusion of the tongue and involuntary body movements.

Psychiatric Disorders and Treatment

Anxiety and Depression

  • Anxiolytics: Benzodiazepines are used for rescue (PRN), while Buspirone is for maintenance (scheduled) as it lacks dependency risks.
  • Depression: Treated with SSRIs/SNRIs (Escitalopram, Fluoxetine). Note the 4-6 week onset and the Black Box Warning for suicidal ideation.

Schizophrenia and Bipolar Disorder

  • Schizophrenia: Positive symptoms (hallucinations) and negative symptoms (apathy). Haloperidol is used for acute psychosis, while Aripiprazole is for maintenance.
  • Bipolar Disorder: Managed with Lithium. Maintain hydration and sodium levels to avoid toxicity (levels > 1.2). Early toxicity signs include N/V/D and slurred speech.

Anemia Types and Clinical Interventions

Manifestations of Anemia

  • Symptoms: Pallor, fatigue, dyspnea, tachycardia, and brittle nails.
  • Iron-Deficiency Anemia: Caused by bleeding or poor nutrition. Treat with Ferrous Sulfate.
  • Pernicious Anemia: Lack of intrinsic factor or folic acid. Treat with Vitamin B12 or Folic Acid.

Blood Transfusion Protocols

  • Pre-transfusion: Verify informed consent, 3-way check of expiration and blood type, and 2-RN verification.
  • Administration: Use special filtered tubing (19g or larger catheter). Administer over 1-4 hours.
  • Reactions: Monitor for allergic, febrile, or hemolytic reactions (back pain, chills, hypotension). If a reaction occurs, stop the infusion immediately.

Oncology Nursing and Treatment Complications

Chemotherapy Side Effects

  • Bone Marrow Suppression: Leads to leukopenia (infection risk), thrombocytopenia (bleeding risk), and anemia.
  • Stomatitis: Mucosal breakdown. Rinse mouth every 2 hours with salt/baking soda solution; avoid alcohol-based mouthwashes and spicy foods.

IV Complications and the SLAP Protocol

  1. Phlebitis: Vein inflammation (redness, edema).
  2. Infiltration: Fluid leakage (cool skin, blanching).
  3. Extravasation: Vesicant leakage (necrosis). Follow SLAP: Stop infusion, Leave catheter in, Aspirate drug, Plan for antidote.

Rheumatoid Arthritis (RA)

  • Methotrexate: A non-biologic DMARD that delays joint degeneration. Administered weekly; often combined with Leucovorin.
  • Monoclonal Antibodies (-mab): Target specific inflammatory pathways. Pre-treat with acetaminophen and diphenhydramine to prevent hypersensitivity.