Class: Benzodiazepines Complication: Nursing action for CNS effects: Class: Non-Benzodiazepines
Diazepam for anxiety CNS suppression: prevention fall/injuries Zolpidem: short-term management of
disorder and also treats: Dizziness, drowsiness, lethargy assess memory insomnia
Skeletal muscle spasm and Impaired recall/memory (amnesia) watch for paradoxical reaction, esp. in older MOA: enhance GABA’s inhibitory effect in the
spasticity in high dose or with alcohol adults. CNS but not function as antianxiety, muscle
Seizure and emergency t/x Paradoxical reaction: confusion Nursing action for tolerance/dependence/withdrawal relaxant, or antiepileptic agents. Low risk of
for epilepsy and anxiety (↑ risk in older adults) Assess tolerance/dependence, (recommend tolerance, substance use disorder, and
Acute alcohol withdrawal Sedative effects (often go away short-term use, increase dose if tolerance dependence compared to benzodiazepines, so
Anesthetic agent during within 7-10 days) develops) still monitor
moderate sedation Tolerance & dependence as long-term Watch for withdrawal manifestation. If d/c, taper Adverse effects:
Short-term use treatment. And withdrawal symptom dose slowly (1-2wks) to prevent withdrawal Daytime sleepiness and lightheadedness,
recommended due to due to abruptly d/c symptoms. headache
potential dependence, ***withdrawal symptoms: insomnia, Nursing action for overdose or toxicity o Take on empty stomach just before
tolerance, withdrawal anxiety, tremors, diaphoresis, Monitor V/S, especially when giving IV slowly bedtime for more rapid absorption
symptoms. dizziness, panic, HTN, seizures, and have emergency resuscitation equipment o Allow 8hours of sleep
paranoid, muscle twitching, and even nearby
MOA: CNS depression hallucinations*** Overdose give IV flumazenil to reserve Additional important to know:
enhance GABA’s inhibitory Overdose cause toxicity sedation but closely monitor for seizure in pt Oral or sublingual route
effects in the CNS. Provide rapid Rare in oral, common in IV with h/x of seizure disorder or pt taking tricyclic Tell patient to avoid alcohol and other CNS
relief of anxiety attack following hypotension, tachycardia and antidepressant depressants (barbiturates, opioids)
administration. respiratory depression Always check the patency of the IV line prior to Not safe during pregnancy and lactation
GABA: gamma aminobutyric But oral can cause life-threatening IV administration and assess IV site frequently cause respiratory depression in neonates
acid sedation, hypotension, respiratory risk for phlebitis and venous thrombosis. after birth, neonatal flaccidity and
depression and cardiac arrest withdrawal
Administration: Educate patient to: Caution in older adult, impaired kidney,
Diazepam: oral, IM, IV, rectal Contra in: Glaucoma, coma or shock. Careful about ambulation, driving, activities liver, or respiratory function.
IM and IV emergency use Neonates, during labor and delivery required mental alertness.
due to severe respiratory (teratogenic med, so no to Pregnant No alcohol and other CNS depressants
arrest and lactation too) (opioid/other benzodiazepine) during therapy
Be aware IV diazepam Cautiously use in older adults, cause severe sedation and respiratory
precipitates in solution with children under 18, Renal or hepatic depression
some diluents or medication impairment, Mental health disorders, No misuse and d/c abruptly to prevent
don’t administer IM which suicidal ideation, chronic respiratory withdrawal symptoms
may result in inconsistent disorders, or neuromuscular disorders Notify CNS effects and tolerance if occur
absorption (or if IM, do it
slowly into large muscle)
, Selective serotonin Side effects and Intervention: Class: Mood stabilizing med (lithium) Intervention:
Reuptake inhibitors Common: insomnia, nervousness, headache, Lithium carbonate is used to: Monitor for early and transient
(SSRIs) sexual dysfunction (decreased libido, impotence) Control acute mania and acute manic adverse effects
Fluoxetine – o Monitor for insomnia, nervousness, headache episodes associated with bipolar Differentiate transient from toxic
antidepressant agent decrease dosage disorder effects by monitoring lithium level
Pharmacology Action: o If sexual dysfunction reported decrease prevent recurrence of mania or (keep it below 1.5mEq/L)
Selectively block dosage or switch to another antidepressant for depression. Monitor I&O, electrolyte imbalance
reuptake of serotonin complete resolution Pharmacology Action: (low Na cause toxicity)
allow more serotonin o Tell patient to take med with food to minimize GI Change the sodium ion transport in the Watch out for s/x of hypothyroidism
available to the brain effect and in the morning due to insomnia, nerve cells alter metabolism of and plan monitor thyroid function
produce CNS o Tell them to take OTC acetaminophen for catecholamines, the fight-or-flight tests once a year
excitation headache (but avoid ibuprofen due to risk for GI hormones released by the adrenal Recognize early sign of toxicity
SSRI is used to treat: bleeding) glands to response to stress (nausea and muscle weakness)
major depression, Long-term use cause weight gain (especially in Also prevent neuronal atrophy and to prevent severe toxic effect
bipolar disorder, panic older adult and those taking diuretics) promotes neuronal growth o Give prescribed Beta blockers
disorder, obsessive o Monitor weight weekly during therapy Side effects: to decrease fine tremor but if
compulsive disorder o Tell them to eat healthy and exercise to combat GI effects subside with time tremor still worsening notify
(OCD), premenstrual CNS effects: transient fatigue, o Monitor Kidney function
weight gain
dysphoric disorder headache, confusion, muscle (creatinine >1.3 and urine
Increased ADH secretion leading to hyponatremia
(PMDD), and bulimia weakness, memory impairment <30ml/hr. = kidney distress)
o Closely monitor for low sodium level and watch
nervosa (overeating Polyuria (lithium inhibit ADH) Educate patient to:
for lethargy, abdominal cramps, diarrhea, and
disorder). Goiter or hypothyroidism (lithium Report any effects do not subside
nausea to prevent seizure, coma, cerebral
SSRI oral only, take decreases thyroid hormone) or become worse
edema (increased ICP)
4-6 weeks to reach Toxicity due to narrow range: Report signs of hypothyroidism +
Suicide risk, particularly in children and young
effectiveness o Muscle hyperirritability, a fine hand neck swelling
adults.
Cautiously use in: tremor progressing to coarse Careful about ambulation, driving,
o Closely monitor for depression and suicidal
Older adult tremor, ECG changes, activities required mental alertness
DM risk for ideation initiate suicide precautions when
incoordination, ataxia, blurred Drink 2-3L/day to stay hydrated
hypoglycemia need appropriate
vision, seizures, significant Avoid caffeine and stressors that
to adjust dose of High dose Serotonin syndrome: confusion,
hypotension and coma death increase tremor + report worsening
antidiabetic meds difficulty concentrating, incoordination, anxiety,
can occur tremor to prevent severe toxicity.
liver disease, peptic hallucinations, agitation, hyperreflexia, fever,
o Lithium toxicity can cause renal Increase sodium intake (contra in
ulcer disease diaphoresis, and tremors (all s/x are overactive)
failure dehydration and low sodium)
hyponatremia, existing ***Dangerous complication of serotonin syndrome is muscle
🚨Safety Alert: reach toxic level quickly
cardiac disease, h/x of breakdown (Rhabdomyolysis) from hyperreflexia due to narrow therapeutic range (0.8-
suicidal tendencies. releases toxins damage kidneys****
o Monitor for serotonin manifestation & stop the 1.2 mEq/L). Range may increase to up
Avoid MAOIs, St. John’s 1.5mEq/L during acute manic episode
Wort, grapefruit due to risk med if present.
keep the range below 1.5mEq/L and
for serotonin syndrome o Tell patient to recognize serotonin syndrome +
observe for manifestation of toxicity.
stop med and report provider if serotonin
syndrome occurs.
Diazepam for anxiety CNS suppression: prevention fall/injuries Zolpidem: short-term management of
disorder and also treats: Dizziness, drowsiness, lethargy assess memory insomnia
Skeletal muscle spasm and Impaired recall/memory (amnesia) watch for paradoxical reaction, esp. in older MOA: enhance GABA’s inhibitory effect in the
spasticity in high dose or with alcohol adults. CNS but not function as antianxiety, muscle
Seizure and emergency t/x Paradoxical reaction: confusion Nursing action for tolerance/dependence/withdrawal relaxant, or antiepileptic agents. Low risk of
for epilepsy and anxiety (↑ risk in older adults) Assess tolerance/dependence, (recommend tolerance, substance use disorder, and
Acute alcohol withdrawal Sedative effects (often go away short-term use, increase dose if tolerance dependence compared to benzodiazepines, so
Anesthetic agent during within 7-10 days) develops) still monitor
moderate sedation Tolerance & dependence as long-term Watch for withdrawal manifestation. If d/c, taper Adverse effects:
Short-term use treatment. And withdrawal symptom dose slowly (1-2wks) to prevent withdrawal Daytime sleepiness and lightheadedness,
recommended due to due to abruptly d/c symptoms. headache
potential dependence, ***withdrawal symptoms: insomnia, Nursing action for overdose or toxicity o Take on empty stomach just before
tolerance, withdrawal anxiety, tremors, diaphoresis, Monitor V/S, especially when giving IV slowly bedtime for more rapid absorption
symptoms. dizziness, panic, HTN, seizures, and have emergency resuscitation equipment o Allow 8hours of sleep
paranoid, muscle twitching, and even nearby
MOA: CNS depression hallucinations*** Overdose give IV flumazenil to reserve Additional important to know:
enhance GABA’s inhibitory Overdose cause toxicity sedation but closely monitor for seizure in pt Oral or sublingual route
effects in the CNS. Provide rapid Rare in oral, common in IV with h/x of seizure disorder or pt taking tricyclic Tell patient to avoid alcohol and other CNS
relief of anxiety attack following hypotension, tachycardia and antidepressant depressants (barbiturates, opioids)
administration. respiratory depression Always check the patency of the IV line prior to Not safe during pregnancy and lactation
GABA: gamma aminobutyric But oral can cause life-threatening IV administration and assess IV site frequently cause respiratory depression in neonates
acid sedation, hypotension, respiratory risk for phlebitis and venous thrombosis. after birth, neonatal flaccidity and
depression and cardiac arrest withdrawal
Administration: Educate patient to: Caution in older adult, impaired kidney,
Diazepam: oral, IM, IV, rectal Contra in: Glaucoma, coma or shock. Careful about ambulation, driving, activities liver, or respiratory function.
IM and IV emergency use Neonates, during labor and delivery required mental alertness.
due to severe respiratory (teratogenic med, so no to Pregnant No alcohol and other CNS depressants
arrest and lactation too) (opioid/other benzodiazepine) during therapy
Be aware IV diazepam Cautiously use in older adults, cause severe sedation and respiratory
precipitates in solution with children under 18, Renal or hepatic depression
some diluents or medication impairment, Mental health disorders, No misuse and d/c abruptly to prevent
don’t administer IM which suicidal ideation, chronic respiratory withdrawal symptoms
may result in inconsistent disorders, or neuromuscular disorders Notify CNS effects and tolerance if occur
absorption (or if IM, do it
slowly into large muscle)
, Selective serotonin Side effects and Intervention: Class: Mood stabilizing med (lithium) Intervention:
Reuptake inhibitors Common: insomnia, nervousness, headache, Lithium carbonate is used to: Monitor for early and transient
(SSRIs) sexual dysfunction (decreased libido, impotence) Control acute mania and acute manic adverse effects
Fluoxetine – o Monitor for insomnia, nervousness, headache episodes associated with bipolar Differentiate transient from toxic
antidepressant agent decrease dosage disorder effects by monitoring lithium level
Pharmacology Action: o If sexual dysfunction reported decrease prevent recurrence of mania or (keep it below 1.5mEq/L)
Selectively block dosage or switch to another antidepressant for depression. Monitor I&O, electrolyte imbalance
reuptake of serotonin complete resolution Pharmacology Action: (low Na cause toxicity)
allow more serotonin o Tell patient to take med with food to minimize GI Change the sodium ion transport in the Watch out for s/x of hypothyroidism
available to the brain effect and in the morning due to insomnia, nerve cells alter metabolism of and plan monitor thyroid function
produce CNS o Tell them to take OTC acetaminophen for catecholamines, the fight-or-flight tests once a year
excitation headache (but avoid ibuprofen due to risk for GI hormones released by the adrenal Recognize early sign of toxicity
SSRI is used to treat: bleeding) glands to response to stress (nausea and muscle weakness)
major depression, Long-term use cause weight gain (especially in Also prevent neuronal atrophy and to prevent severe toxic effect
bipolar disorder, panic older adult and those taking diuretics) promotes neuronal growth o Give prescribed Beta blockers
disorder, obsessive o Monitor weight weekly during therapy Side effects: to decrease fine tremor but if
compulsive disorder o Tell them to eat healthy and exercise to combat GI effects subside with time tremor still worsening notify
(OCD), premenstrual CNS effects: transient fatigue, o Monitor Kidney function
weight gain
dysphoric disorder headache, confusion, muscle (creatinine >1.3 and urine
Increased ADH secretion leading to hyponatremia
(PMDD), and bulimia weakness, memory impairment <30ml/hr. = kidney distress)
o Closely monitor for low sodium level and watch
nervosa (overeating Polyuria (lithium inhibit ADH) Educate patient to:
for lethargy, abdominal cramps, diarrhea, and
disorder). Goiter or hypothyroidism (lithium Report any effects do not subside
nausea to prevent seizure, coma, cerebral
SSRI oral only, take decreases thyroid hormone) or become worse
edema (increased ICP)
4-6 weeks to reach Toxicity due to narrow range: Report signs of hypothyroidism +
Suicide risk, particularly in children and young
effectiveness o Muscle hyperirritability, a fine hand neck swelling
adults.
Cautiously use in: tremor progressing to coarse Careful about ambulation, driving,
o Closely monitor for depression and suicidal
Older adult tremor, ECG changes, activities required mental alertness
DM risk for ideation initiate suicide precautions when
incoordination, ataxia, blurred Drink 2-3L/day to stay hydrated
hypoglycemia need appropriate
vision, seizures, significant Avoid caffeine and stressors that
to adjust dose of High dose Serotonin syndrome: confusion,
hypotension and coma death increase tremor + report worsening
antidiabetic meds difficulty concentrating, incoordination, anxiety,
can occur tremor to prevent severe toxicity.
liver disease, peptic hallucinations, agitation, hyperreflexia, fever,
o Lithium toxicity can cause renal Increase sodium intake (contra in
ulcer disease diaphoresis, and tremors (all s/x are overactive)
failure dehydration and low sodium)
hyponatremia, existing ***Dangerous complication of serotonin syndrome is muscle
🚨Safety Alert: reach toxic level quickly
cardiac disease, h/x of breakdown (Rhabdomyolysis) from hyperreflexia due to narrow therapeutic range (0.8-
suicidal tendencies. releases toxins damage kidneys****
o Monitor for serotonin manifestation & stop the 1.2 mEq/L). Range may increase to up
Avoid MAOIs, St. John’s 1.5mEq/L during acute manic episode
Wort, grapefruit due to risk med if present.
keep the range below 1.5mEq/L and
for serotonin syndrome o Tell patient to recognize serotonin syndrome +
observe for manifestation of toxicity.
stop med and report provider if serotonin
syndrome occurs.
