Revised Ppt on or Drugs

8/3/2019 Revised Ppt on or Drugs

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A. Benzodiazepine

1. Midazolam Hydrochloride (Versed)

Classification:

Sedative

Mechanism of action

Depresses all levels of CNS, includinglimbic and reticular formation, probably

through increased action of GABA,which is major inhibitory neurotransmitterin brain.


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Indications:

Preoperative sedation

induction of general anesthesia

Adverse / Side Effects:

CNS: headache, involuntary movements,amnesia

CV: Variations in BP (hypotension) andpulse rate, cardiac arrest

GI: nausea, vomiting, hiccups

Respi: decreased respiratory rate, apnea

Other: pain


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Nursing Responsibilities:

Monitor BP, heart rate and rhythm,respirations, airway integrity, andarterial oxygen saturation during

procedure. Have oxygen andresuscitation equipment available incase of severe respiratory depression.


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2. Diazepam (Valium)

Mechanism of Action:

Depresses the CNS, probably bypotentiating GABA, an inhibitoryneurotransmitter, Produces skeletalmuscle relaxation by inhibiting spinalpolysynaptic afferent pathways, Hasanticonvulsant properties due toenhanced presynaptic inhibition.


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Indications:

management of anxiety, preoperative sedation,

conscious sedation, Provides light anesthesia

Adverse/Side Effects:

CNS: dizziness, drowsiness, lethargy, depression,hangover, headache

Resp: respiratory depression CV: hypotension (IV only)

GI: constipation, diarrhea), nausea, vomiting; Derm: rashes; Local: pain (IM), phlebitis (IV), venous

thrombosis


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Monitor blood pressure, pulse, andrespiratory rate prior to and periodicallythroughout therapy and frequently during IVtherapy

Assess IV site frequently during

administration; diazepam may causephlebitis and venous thrombosis;

Anxiety: Assess degree of anxiety and levelof sedation (ataxia, dizziness, slurred speech)

prior to and periodically throughout therapy Muscle Spasms: Assess muscle spasm,

associated pain, and limitation ofmovement prior to and throughout therapy


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3 . Lorazepam(Ativan)

Mechanism of Action

Potentiates action of GABA, resulting inincreased neuronal inhibition and CNSdepression

Anxiolytic, Sedative-hypnotic


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Indications

Anxiety Insomnia

preoperative drug

Adverse effect/Side effect

CNS: drowsiness, lethargy, hangover,fainting, anterogade amnesia, restlessness,

psychosis CV: transient hypotension

GI: Dry mouth, abdominal discomfort

GU: Urinary Retention, incontinence.


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Nursing Responsibilities

Warn patient to avoid hazardous activities until thedrugs CNS effects are known

Tell patient not to drink alcohol or smoke duringtherapy


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1. Secobarbital Sodium

Mechanism of Action

Depresses sensory cortex, decreasesmotor activity, alters cerebellar functionand produces drowsiness, sedation and

hypnosis. Sedative-hypnotic, anti-convulsant


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Indications


Insomnia

Adverse effect/Side effect

CNS: drowsiness, lethargy, hangover,

paradoxical excitement in geriatric patients RESP:Respiratory depression

G.I: Nausea and vomiting.


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Warn patient to avoid activities thatrequire mental alertness or physical

coordination. For inpatient, supervisewalking and raise side rails.

Inform patient that morning hangover is

common after hypnotic dose, whichsuppresses REM sleep.


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2. Pentobarbital

Mechanism of Action

Depresses sensory cortex, decreasesmotor activity, alters cerebellar functionand produces drowsiness, sedation andhypnosis.

Anticonvulsant, sedative-hypnotic


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Indications



CNS: drowsiness, lethargy, hangover

GI: nausea, vomiting

Respi: respiratory depression


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Warn patient to avoid activities thatrequire mental alertness or physicalcoordination. For inpatient, supervise

walking and raise side rails. Inform patient that morning hangover is

common after hypnotic dose, which

suppresses REM sleep.


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Indications:

Duodenal and gastric ulcer.

Adverse/Side Effect:

CNS: vertigo, malaise

EENT: blurred vision Hepatic: jaundice.


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Dont use aluminum-based needles orequipment when mixing or giving drugparenterally because drug isincompatible with aluminum.

Remind patient taking drugs once dailyto take it h.s.

Instruct patient to take drug drug with or

without food. Instruct patient not to smoke. Smoking

may increase gastric secretion andworsen disease.


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2. Cimetidine (Tagamet)

Mechanism of action

Reversibly and competitively blocks

histamine at H2 receptors, particularlythose in gastric parietal cells, leading toinhibition of gastric acid secretion.

Antiulcerative


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Indications

Duodenal and gastric ulcer


CNS: confusion, dizziness, headaches

GI: mild and transient diarrhea

CV: bradycardia Hematologic: thrombocytopenia, aplastic

anemia; Hepatic: Jaundice;Musculoskeletal: Muscle pains.


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Nursing implications

Give medications with meals Remind patient not to take antacid within 1 hour of taking

drug.

Instruct patient to immediately report black tarry stools,diarrhea, confusion, or rash.


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D. Inhalation Gases

1. Oxygen


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2. Nitrous Oxide


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3. Desflurane (Suprane)

Mechanism of Action

causes general anesthesia (loss of

consciousness) before and during surgery.It is breathed in (inhaled). Althoughdesflurane can be used by itself,

combinations of anesthetics are oftenused together. This helps produce moreeffective anesthesia in some patients.


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Indication

Anesthetic

Adverse/Side Effects More common

Coughing

nausea or vomiting

Less common or rareDizziness

headacheirritated or red eyesnervousness and restlessnesssore throat


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Nursing implications

General anesthetics may cause some people to feel

drowsy, tired, or weak for a while after they have beengiven. They may also cause problems with coordinationand one's ability to think. Therefore, for about 24 hours (orlonger if necessary) after receiving a general anesthetic, donot drive, use machines, or do anything else that could bedangerous if you are not alert.

Unless otherwise directed by your doctor or dentist, do notdrink alcoholic beverages or take other CNS depressants(medicines that slow down the nervous system, possiblycausing drowsiness) for about 24 hours after you havereceived a general anesthetic. To do so may add to theeffects of the anesthetic. Some examples of CNSdepressants are antihistamines or medicine for hay fever,other allergies, or colds; other sedatives, tranquilizers, orsleeping medicine; prescription pain medicine or narcotics;barbiturates; medicine for seizures; and muscle relaxants.


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4. Halothane (Fluothane)

Mechanism of Action

Inducing general anesthesia and with

other medications to provide anesthesiaduring short surgeries.


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Indications

Halothane is indicated for the inductionand maintenance of general anesthesia.


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Adverse reactions/side effects

Hepatic necrosis

cardiac arrest

hypotension

respiratory arrest

cardiac arrhythmias

Hyperpyrexia Shivering

nausea and emesis.


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Nursing Implication

The uterine relaxation obtained with Halothane, unlesscarefully controlled, may fail to respond to ergotderivatives and oxytocic posterior pituitary extract(oxytocin injection).

Halothane increases cerebrospinal fluid pressure.

Therefore, in patients with markedly raised intracranialpressure, if Halothane is indicated, administrationshould be preceded by measures ordinarily used toreduce cerebrospinal fluid pressure. Ventilation shouldbe carefully assessed, and it may be necessary to assistor control ventilation to insure adequate oxygenationand carbon dioxide removal.

The patient should be closely observed for signs ofoverdosage, i.e., depression of blood pressure, pulserate and ventilation, particularly during assisted orcontrolled ventilation.


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Indications

Isoflurane, may be used for inductionand maintenance of general anesthesia


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Adverse Reactions/Side Effects

Respiratory depression hypotension and arrhythmias Shivering Nausea

vomiting hyperkalemia


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Nursing Implications

If side effects occur, discontinuance oftriggering agents (e.g., Isoflurane),administration of intravenous dantrolenesodium, and application of supportivetherapy. Such therapy includes vigorousefforts to restore body temperature tonormal, respiratory and circulatory

support as indicated, and managementof electrolyte-fluid-acid-basederangements.


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E. Intravenous Anesthetics

1. Etomidate

Mechanism of Action

Inducing general anesthesia and withother medications to provide anesthesia

during short surgeries. It may also be usedfor other conditions as determined byyour doctor.


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Indications

Anesthetic


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Adverse Reactions/Side Effects

Brief pain in the veins coughing; drowsiness

hiccups; nausea

temporary uncontrollable musclemovements

vomiting.


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Nursing Implications

Etomidate may cause drowsiness for up to 24 hours.

Do not drive, operate machinery, or do anythingelse that could be dangerous until you know howyou react to Etomidate. Using Etomidate alone, withcertain other medicines, or with alcohol may lessenyour ability to drive or to perform other potentiallydangerous tasks.

Do not drink alcohol for 24 hours after usingEtomidate.

Use Etomidate with caution in the ELDERLY,especially those with high blood pressure, becausethey may be more sensitive to its effects on theheart.

Etomidate is not recommended for use in CHILDRENyounger than 10 years of age. Safety andeffectiveness in this age group have not beenconfirmed.


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F. Antiemetics

1. Prochlorperazine (Compazine)

Mechanism of Action Acts on chemoreceptor trigger zone to

inhibit nausea and vomiting. Relieves

nausea and vomiting, singns andsymptoms of psychosis, and anxiety.


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INDICATIONS

mild to severe nausea and vomiting.

Antipsychotic, antiemetic, anxiolytic


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ADVERSE REACTIONS/SIDE EFFECTS

CNS: sedation, dizzines G.I: dry mouth, constipation

EENT: blurred vision.


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Nursing responsiblities:

Advise patient to wear protectiveclothing when exposed to sunlight.


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2. Droperidol (Inapsine)

Mechanism of Action:

Droperidol is used to reduce nausea and

vomiting caused by surgery or othermedical procedures.

sedative, tranquilizer, and anti-nausea

medication.


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Indication:

mild to severe nausea and vomiting

Adverse Effect:

dizziness, fainting, fast or pounding

heartbeat, fever, stiff muscles, confusion,sweating, fast or uneven heartbeats,tremor (uncontrolled shaking), confusion,hallucinations.


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Before receiving droperidol, asses patient if

he/she has:

heart disease;

heart rhythm disorder;

congestive heart failure;

high blood pressure;

an electrolyte imbalance (such as low

potassium);

liver or kidney disease;

a history of alcohol abuse.


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3. Promethazine Hydrochloride

(Phenergan)

Mechanism of Action

Blocks the effect of histamine. Has inhibitoryeffect on the chemoreceptor trigger zone inthe medulla, resulting in antiemeticproperties. Alters the effects of dopamine in

the CNS. Possesses significant anticholinergicactivity. Produces CNS depression byindirectly decreased stimulation of the CNSreticular system.


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Indication:

Treatment of various allergic conditionsand motion sickness. Preoperativesedation. Treatment and prevention ofnausea and vomiting. Adjunct toanesthesia and analgesia.


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Adverse Effect:

CNS: confusion, disorientation, sedation,

dizziness, insomnia, fatigue, nervousness, CV: bradycardia, hypertension,

hypotension, tachycardia

GI: constipation, dry mouth, nausea andvomiting

GU: urinary retention


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Nursing Responsibility:

Monitor BP, PR, RR frequently in patients receivingIV doses.

Assess patient for nausea and vomiting beforeand after administration.

If administered IV, assess for burning and pain atIV site. If pain occurs, discontinue administrationimmediately.

When administering Promethazine concurrentlywith opiod analgesics, supervise ambulationclosely to prevent injury from increased sedation.

To minimize GI irritation, administer PO meds with

food, water, or milk. IM injection is the preferred parenteral route of

administration. Inject deep IM into large musclemass.


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1. Heparin

Mechanism of Action

Accelerates formation of antithrombin III-thrombin complex and deactivates

thrombin, preventing conversion offibrinogen to fribrin

Decrease ability to clot.


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Indication

Treatment of various allergic conditions

and motion sickness. Preoperative sedation.

Treatment and prevention of nausea

and vomiting.


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Adverse Effect: CNS: fever EENT: rhinitis, conjunctivitis, lacrimation SKIN: irritation, mild pain, hematoma

Nursing Responsibility: Monitor PTT values.

Monitor platelet counts regularly

Instruct patient and family to watch for signs ofbleeding and to immediately notify physician. Tell patient to avoid OTC medications containing

aspirin, or any drugs that may interact with heparin.


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Analgesic

Morphine Sulfate

Narcotic Analgesic

Mechanism of action

Relieves pain by stimulating opiatereceptors in CNS


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Indication

relief of moderate to severe acute andchronic pain

adjunct to anesthesia


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Adverse effects

CV: Hypotension

CNS: Lightheadedness; dizziness

SKIN: Sweating

EENT: Blurred vision

GI: Nausea; vomiting


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Assess type, location and intensity of pain

before and 3060 min after administration.

Assess vital signs before and periodicallyduring therapy.

Assist patient with ambulation. Keepsiderails up and call bell within reach.

Evaluate therapeutic response. Prolongeduse may lead to physical dependence and

tolerance. Progressively higher doses maybe necessary to control pain in patientsreceiving long-term therapy.


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Anti-inflammatory/Immunosuppressant

Hydrocortisone (Solu-cortef)

Mechanism of action

Short-acting glucocorticoid that depressesformation, release, and activity of endogenousmediators of inflammation includingprostaglandins, kinins, histamine, liposomal

enzymes, and complement system. Alsomodifies body's immune response.


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Indications

dermatologic diseases

allergic and inflammatory ophthalmicprocesses

tuberculous meningitis


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Adverse effects

CNS: Convulsionsvertigo; headache

DERM: Impaired wound healing; thin,fragile skin

EENT: increased IOP; glaucoma;

exophthalmos GI: nausea; vomiting

Nursing responsibilities


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Monitor for covert infections. If local irritation occurs with topical use,

discontinue and notify health care provider. Following dosage reduction or therapy

withdrawal, monitor for signs of adrenal

insufficiency, including fatigue, anorexia,nausea, vomiting, diarrhea, weight loss,weakness, dizziness or low blood sugar.

Notify health care provider of weight gain,

swelling, muscle weakness, black tarrystools, hematemesis, facial puffiness,menstrual irregularities, prolonged sorethroat, fever, cold or signs of infection.


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Emergency Drugs

Epinephrine Hydrochloride (Vasopressor)

Stimulates both alpha-and beta-receptors (alpha-receptors at high

doses; beta1 - and beta2 -receptors atmoderate doses) within sympatheticnervous system. Relaxes smooth muscleof bronchi and iris and is antagonist ofhistamine.

di i


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Indication

treatment and prophylaxis of cardiac

arrest relief of bronchial asthma

life-threatening asthma attacks

characterized by wheezing, dysypena,and inability to breathe

Adverse effects


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Adverse effects

CV: Cardiac arrhythmias and excessive

hypertension; palpitations CNS: Anxiety; headache; restlessness;

tremor; weakness

GI: Nausea; vomiting RESPIRATORY: Shortness of breath


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Monitor vital signs frequently.

Assess lung sounds for wheezes.

Monitor ECG, skin color, tremors,

nervousness, and agitation.


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Atropine Sulfate(Anticholinergic/antispasmodic)

Mechanism of action

Promotes peripheral

anticholinergic/antispasmodic action(decreases GI motility); provides mildsedation.


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Indications

Possibly effective for treatment of

irritable bowel syndrome and acuteenterocolitis

as adjunctive therapy for duodenal

ulcer.


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Adverse effects

CV: Palpitations; bradycardia;

tachycardia; CNS: Headache;nervousness; drowsiness

SKIN: Urticaria and other dermal

manifestations of allergic reaction EENT: Blurred vision

GI: nausea; vomiting;


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Monitor vital signs and LOC. Note anysigns of hyperactivity or sedation.

Monitor I&O and bowel sounds. Notify

physician of abdominal distention. In patient with chronic lung disease,

monitor lung sounds and effectiveness of

cough.

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