sevoflurane (Sevorane) CLAS CLASSI SIFI FICA CATI TION ON
General Anesthetics Functional General Anesthetics
Induction Adult & childn Up to 8%, w/ or w/o O2 or O2/N2O. Maintenance Adult & childn 0.5-3% w/ or w/o concomitant N2O.
MECH MECHAN ANIS ISM M OF ACTION
INDI INDICA CATI TION ON
CONT CONTRA RAIN INDI DICA CATI TION ON
SIDE SIDE EFFE EFFECT CTS S
NURS NURSIN ING G RESP RESPON ONSI SIBI BILI LITI TIES ES
induces a state in which which the CNS is altered so that varying varying degrees degrees of pan reli relief ef,, depr depres essi sion on of consciousness, skelet skeletal al muscl musclee rela relaxa xati tion on and and reflex reflex reductio reduction n are produced
induction and maintenance of general anesthesia
>hypersensitive >history of malignant hyperpyrexia
> agitation > dizziness > drowsiness > increased cough > increased saliva >lightheadedness > nausea > shivering > vomiting
> Check the name of the patient and the time of administration. administration. > Monitor vital signs. > Monitor all the body systems. > Continuous monitoring of pulse oximetry. > Postural BP should be taken. > Take note of that time that the drug has expired.
Adverse Effect: >Anaphylaxis >Irregular heartbeat >Seizure >Yellowing of the skin or eyes >Hypotension
>Stop durg immediately, administer oxygen >Start rapid fluid resuscitation resuscitation >Make sure client is well ventilated >Seizure precation >Administer epinephrine
tetracaine hydrochloride (Pontocaine) CLASSIFICATION
MECHANISM OF ACTION
Tetracaine acts by preventing the generation Functional and transmission Local anesthetics; of impulses Topical anesthetics; along nerve Spinal anesthetics fibres and at nerve endings; depolarisation Subarachnoid Spinal anaesthesia and ionAdult: 1% solution exchange are diluted with an equal inhibited. In volume of CSF general, loss of immediately prior to pain occurs admin or 5 mg of before loss of powder dissolved in 1 sensory, ml of CSF and admin autonomic and slowly at a rate of 1 motor functions. ml/5 sec. Elderly: Dose reduction may be needed. Ophthalmic Anaesthesia of the eye Adult: Instil 0.5-1% tetracaine solution or 0.5% ointment. General Anesthetics
INDICATION
CONTRAINDICATION
SIDE EFFECTS
NURSING RESPONSIBILITIES
>Spinal anesthesia >Topical anesthesia
>Hypersensitivity to p> Mild erythema aminobenzoic acid or its at the application derivatives, local site, anaesthesia of the ester >slight oedema or type. >Low plasma pruritus, cholinesterase >blistering of the concentrations, skin, >Complete heart block >stinging >Bronchoscopy or sensation cytoscopy >Application to inflamed traumatised or highly vascular surfaces >Instillation into the middle ear.
> Check the name of the patient and the time of administration. > Check labs for low plasmasholinesterase concentration > Do not administer to inflamed or traumatized surfaces > Do not instill into the middle ear
Adverse Effects:
>Anaphylaxis > Eye irritation >Watering >Increased sensitivity to light
>Stop durg immediately, administer oxygen >Start rapid fluid resuscitation >Make sure client is well ventilated >Administer epinephrine >Advise patient to keep out of light and dim room if sensitivity to light occurs
ketorolac tromethamine (Toradol) CLASSIFICATION
General NSAIDS Functional Analgesic Adult: PO Moderate to severe pain 10 mg 4-6 hrly. Max: 40 mg/day. Max duration: 7 days. IV/IM Moderate to severe pain 60 mg via IM inj or 30 mg via IV inj. Ophth Ocular itching As 0.5% soln: Instill 1 drop 4 times/day. Post-op eye inflammation As 0.5% soln: Instill 1 drop 4 times/day for 2 wk, starting 24 hr after surgery for 2 wk.
MECHANISM OF ACTION
May inhibit prostaglandin synthesis. Posesses antiinflammatory analgesic and antipyretic effects
INDICATION
PO: short term (up to ) five days management of severe acute pain that requires analgesia at the opiate level IM/IV: Use with morphine and meperidine shows an oploid-sharing effect, combination can be used for break through pain Opthalmic: Releive itching caused by seasonal allergic conjunctivitis post-operative inflammation
CONTRAINDICATION
SIDE EFFECTS
NURSING RESPONSIBILITIES
>Hypersensitivity
CV: Vasodilation, Pallor
> Shortening the dosing interval recommended will lead to an increased frequency and duration of side effects
>History of nasal polyps >Angioedema >Bronchospastic activity >Allergic renal impairement
GI: GI-pain, peptic ulcer, nausea, dyspepsia, flatulence, G.I. Bleeding
> Correct hypovolemia prior to administering > Determine any liver or renal dysfunction > Assess hydration
>Advance renal impairement >Incomplete hemostatis use with aspirin
CNS: Headache, nervousness, abnormal thinking depression, euphoria Miscellaneous: Purpura, asthma, abnormal vision, abnormal liver function
> Drug may cause drowsiness, dizziness, avoid activities that require mental alertness > Avoid alcohol, NSAIDs, ASA without approval
Cystoid macular oedema As 0.5% soln: Instill 1-2 drops 6-8 hrly starting 24 hr before surgery, continue for 3-4 wk after surgery. Pain and photophobia after incisional refractive surgery As 0.5% soln: Instill 1 drop 4 times/day for up to 3 days after surgery.
following cataract surgery.
Adverse Effects:
GI: Perfuration, Hypersensitivity: Bronchospasm, Anaphylaxis
> Administer after ANST > Stop drug immediately, administer oxygen, start rapid fluid resuscitation make sure the client is well ventilated, administer epinephrine
ephedrine sulfate (Pretz-D) CLASSIFICATION
MECHANISM OF ACTION
INDICATION
Releases norepinephrine from synaptic Functional storage sites. Has Nasal Decongestant direct effects on alpha, beta-1 and beta -2 receptors, Adult: PO Diabetic causing neuropathic oedema increased BP due 30-60 mg 3 to arteriolar times/day. constriction and cardiac IV Reversal of stimulation, spinal or epidural bronchodilation, anesth-induced relaxation of GI hypotension tract smooth As 3 mg/mL soln: 3-6 muscle and nasal mg, up to 9 mg, may decongestion, repeat every 3-4 mins mydriasis and if needed. increase tone of the bladder trigone and vesicle sphincter
PO: Temporarily relieves the shortness of breath, tightness of chest and wheezing due to bronchial asthma
General Sympathomimetic
Parenteral: Allergic disorders, Vasopressor in shock Nasal: Nasal congestion due to common sold, sinusitis sinus drainage
CONTRAINDICATION
SIDE EFFECTS
>Angle closure glaucoma, CNS: >anesthesia with Nervousness, cyclopropane or halothane shakiness, >thyrotoxicosis, confusion, >diabetes, delirium >lactation CV: Precordial pain GU: Difficult and painful urination
NURSING RESPONSIBILITIES
> Asses mental status and pulmonary functions > Notify provider if SOB is unrelieved by medication and is accompanied by chest pain, dizziness or palpitations > With males, report any difficulty or pain when voiding
Miscellaneous: Pallor, respiratory difficulty, hypersensitivity reaction Adverse Effects:
CV: Excessive dose may cause hypertension sufficent to result in cerebral hemorrhage
> monitor blood pressure regularly
lidocaine hydrochloride (Xylocaine) CLASSIFICATION
MECHANISM OF ACTION
INDICATION
CONTRAINDICATION
SIDE EFFECTS
IV: Acute ventricular arrhytmias
>Hypersensitivy to amidetype local anesthetics
Body as a whole: Malignant hyeprthermia characterized by tachycardia; tachypnea, labile BP, metabolic acidosis
NURSING RESPONSIBILITIES
> Document CNS status General Anesthesia Functional Antiarryhtmic Surface anesth For pain: As 2% soln: 300 mg, not more often than 3 hrly.Regional anesth 50-300 mg (0.5% soln w/o adrenaline). Max: 4 mg/dose Epidural anesth 2-3 mL soln for each dermatome to be anaesthesized. Lumbar epidural: 250-300 mg (1% soln) for analgesia and 225-300 mg (1.5% soln) or 200300 mg (2% soln) for anesth and thoracic epidural: 200-300 mg (1% soln). In obstetric caudal
Shortens the refractory period and suppresses the automaticity of ectopi foci without affecting conduction of impulses through cardiac tissue, increase electrical stimulation threshold
Infiltration or regional anesthesia Buccal mucosal anesthesia
>Stokes Adams Syndrome >Wolff-Parkinson-White syndrome >Severe SA, AV or intraventricular block >Lactation >Presence of liver or kidney disease
CV: Precipitation or aggravation of arrythmias, hypotension CNS: Dizziness, apprehension, euphoria, lightheadednes, nervouseness, drowsiness Allergic: Rash, Edema
> Report sudden mental status changes > Symptoms such as dizziness, visual disturbances twitching and tremors may preclude convulsion
analgesia, up to 300 mg (0.5 or 1% soln).
Adverse Effect:
For surgical caudal analgesia: 225-300 mg (1.5% soln).
CV: Bradycardia possible cardiac arrest
Intraspinal Spinal anesth Normal vag delivery: 50 mg (5% hyperbaric soln) or 915 mg (1.5% hyperbaric soln). Caesarean operation : Up to 75 mg (5% hyperbaric soln). Other surgical procedures : 75-100 mg.
CNS: Convulsions Respiratory: Respiratory depression or arrest
> Note any hypersensitivity to amide-type local anesthesia > Those with hepatic or renal diseas will be watched closely for adverse effects > Note pulmonary functions >Asses for respiratory depression > Monitor for hypertension
Other: Venousthrombosi s, phlebitis
neostigmin methylsufate (Prostigmin) CLASSIFICATION
General Cholinergic Stimulant Functional Aminoglycosides, anticholinergic, antidepressant Reversal of neuromuscular blockade Adult 0.5-2.5 mg (0.050.07 mg/kg) neostigmine methylsulphate w/ atropine sulphate 0.61.2 mg (0.02-0.03 mg/kg). Max: 5 mg. Childn 0.05 mg/kg neostigmine methylsulphate w/ atropine sulphate 0.02 mg/kg. Max: 2.5 mg. Doses to be given by slow IV inj simultaneously in separate syringes over 1 min.
MECHANISM OF ACTION
Inhibits destruction of acetylcholine, which increases concentration at sites where acetylcholine is released, this facilitates transmission of impulses across the myoneural junction
INDICATION
>Myasthenia gravis >nondepolarizin g neuromuscular blocker >antagonist >bladder distention >post-operative ileus
CONTRAINDICATION
SIDE EFFECTS
NURSING RESPONSIBILITIES
>Obstruction of intestine, renal system >Bromide sensitivity >Peritonitis >urinary tract obstruction ileus
CNS: Dizziness, headache, sweating, weakness, drowsiness
>Monitor V/S respiration during rest
Precaution >Pregnancy C >Bradycardia >Hypotension >Seizure disorders >Bronchial asthma >Coronary occlusion
CV: Tachycardia, bradycardia, hypotension, Av block, ECG changes EENT: Miosis, blurred vision, lacrimation, visual changes GI: Nausea, diarrhea, vomiting, cramps GU: Frequency, incontinence, urgency
>Administer on empty stomach for better absorption >Give only with atropine sulfate available for cholinergic crisis
Myasthenia gravis Adult 1-2.5 mg IM/SC at intervals throughout the day if needed (eg mornings & before meals), giving a total dose of 5-20 mg. Childn 0.2-0.5 mg inj as required. Neonate 0.05-0.25 mg IM every 2-4 hr, ½ hr before feeding. Treatment is not usually required >8 wk of age.
INTEG: Rach, urticaria, flushing Adverse Effects:
CNS: Seizures, paralysis CV: Dysrythmias, cardiac arrest
>Monitor for bradycardia, hypotension, bronchospasm, headache, dizziness, seizure, respiratory depression >Discontinue if toxicity occurs >Seizure precaution
RESP: Respiratiory depression, bronchospasm, constriction, laryngospasm, respiratory arrest, dyspnea
>O2 ready at bedside >Have atropine sulfate available if toxicity occurs
