Pharmacological and Parenteral Therapies 4
Hypnotics
action: depress CNS
examples
barbiturates: pentobarbital (Nembutal), secobarbital (Seconal): physical dependency may result with long term use
acetylinic alcohol: ethchlorvynol (Placidyl)
chloral derivatives: chloral hydrate (Noctec)
uses: insomnia, sedation
adverse reaftions
respiratory depression
hypotension
barbiturate toxicity: hypotension, pulmonary constriction, cold and clammy skin, cyanosis of lips, insomnia, hallucinations, delirium
contraindications
hypersensitivity
pregnancy
nursing interventions
monitor client response to medication
teach client
take medication exactly as prescribed
avoid alcohol and other depressant use
avoid driving and other hazardous activities while under the influence
Antianxiety (Anxiolytic)
action: depress CNS
examples
benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium):physical dependency and withdrawl finsings after long term use
azapirones: buspirone (Buspar)
uses: anxiety, sleep disorders, alcohol withdrawl
adverse reactions
CNS disturbances: dizziness drowsiness, lethargy, orthostatic hypotension
skin rash
blood dyscrasias
contraindications
hypersensitivity
acute narrow angle glaucoma
liver disease
nursing interventions
notify health care provider if systolic BP drops 20mm Hg
administer with food or milk
teach client
take medication as prescribed
do not take OTC medication without health care provider's approval
use caution when driving or hazardous activities
action potentiated with alcohol or sedatives
never abruptly stop taking benodiazepine
with chlordiazepoxide- avoid excessive sunlight
General anesthetics
action: depresses the CNS through a progressive sequence
examples
inhalation anesthetics: cyclopropane, enflurane (Ethrane), ether, nitrous oxide
IV barbiturates: thiopental sodium (Pentothal), methohexital sodium (Brevital)
IV and IM nonbarbiturates: midazolam HCL (Versed), ketamine HCL (Ketaject)
use: used in combination for surgical anesthesia
adverse effects
inhalation anesthetics: excitement and restlessness, nausea and vomiting, respiratory distress
IV barbiturates: respiratory depression, hypotension, tachycardia, laryngospasm
IV and IM nonbarbiturates: respiratory failure, hyper/hypotension, rigidity, psychiatric disturbances
contraindications
CVA
increased intracranial pressure
severe hypertension
cardiac decompensation
nursing interventions
have oxygen and emergency treatment available
monitor vital signs
use precautions if agent flammable
use safety precautions when client induced
Local anesthetics
action: decreases nerve membrane permeability to sodium ion influx
examples
topical: benzocaine, cocaine, lidocaine HCL (Xylocaine)
spinal: dibucaine (Nupercaine), procaine HCL (Novocaine)
nerve block: bupivacaine HCL (Marcaine), mepivacaine HCL (Carbocaine)
use: pain control while client is conscious
adverse effects
allergic reactions
respiratory arrest
arrhythmias, cardiac arrest
convulsions
hypotension
nursing interventions
have oxygen and emergency equipment available
monitor vital signs during local anesthesia
if spinal anesthesia, keep client flat for 6-12 hours to prevent headaches
Managing musculoskeletal conditions
Skeletal muscle relaxants
NSAIDs
Antigout agents
Skeletal muscle relaxants
use: relax muscles, treat spasm disorders
Nonsteroidal antinflammatory drugs (NSAIDS)
action: interferes with prostaglandin synthesis
examples: ibuprofen (Motrin), indomethacin (Indocin)
first generation (COX-1 inhibitor) - salicylates (aspirin - Bayer, Ecotrin), ibuprofen(Motrin, Advil), naproxen (Naprosyn)
second generation (COX-2 inhibitor)- celecoxib (Celebrex)
use: rheumatoid arthritis, osteoarthritis, dysmenorrhea
adverse effects
gastric disturbances- lessened with administration of COX-2 inhibitors
skin rash
blood dyscrasias/bleeding
CNS disturbances
nephrotoxicity
contraindications
hypersensitivity
asthma
renal disease
liver disease
nursing interventions
administer one hour before or two hours after meals
monitor blood work, vital signs
monitor response to medication
Antigout agents
action: increases excretion of uric acid and decreases uric acid formation
examples
allopurinol (Zyloprim)
colchicine (Novocolchine)
probenecid (Benemid)
use: prevent gout attacks
adverse effects
gastric effects: nausea and vomiting, indigestion
blood dyscrasias
liver damage
skin rash
gi disturbances
contraindications: hypersensitivity
nursing interventions
increase fluid intake to prevent renal calculi
monitor fluid intake and output
administer with meals
monitor blood work, including serum uric levels, and electrolyte levels
instruct client
lose weight if needed
avoid high purine foods (organ meats, sardines, shellfish, etc.)
avoid fermented beverages such as beer, ale, wine
Managing integumentary conditions
Scabicides / pediculicides
Anti-pruritics
Anti-infectives
Antiinflammatory steroids
Scabicides/pediculicides ( illustration 1 illustration 2 )
action: targets the parasite's nerve-cell membrane
examples
permethrin (Nix, Elimite)
lindane (Kwell)
use: treat parasitic arthropods: itch mites (scabies) and lice
adverse reaction: skin irritation
contraindications: hypersensitivity
nursing interventions
use precautions to prevent spread of parasites (for example, use gown and gloves, keep infected linen separate, etc.)
keep medication away from eyes and mucous membranes
monitor for skin irritation
determine source of contamination
evaluate effectiveness of treatment
Antipruritics
action: inhibits conduction of nerve impulses to sensory endings
examples -
benzocaine (Solarcaine)
lidocaine HCL (Xylocaine)
use: temporary relief of skin problems such as minor burns, insect bites, sunburn
adverse reactions - skin irritation
nursing interventions
monitor effect of treatment
avoid contact with eyes
Anti-infectives
action: interfere with essential metabolic actions of microbial cells
examples
silver sulfadiazine (Silvadene)
silver nitrate 0.1%-0.5% solution
uses
ophthalmic solutions: treat ophthalmic infections
bladder and urethra irrigations
adverse effects
silver sulfadiazine: skin irritation
silver nitrate
nursing interventions
monitor client's condition during treatment
for eyes, use only silver nitrate in ophthalmic solution
handle silver nitrate with care: solutions stain skin and clothing
silver sulfadiazine: use aseptic technique when applying
Antiinflammatory (steroids, glucocorticoids)
action: stabilize leukocyte lysosomal membranes, inhibit phagocytosis and release of allergic substances
examples
hydrocortisone sodium succinate (Solu-Cortef)
hydrocortisone sodium phosphate (Hydrocortone)
use: to suppress inflammatory or immune responses
adverse reactions
sodium and fluid retention
nausea, acne, impaired wound healing
anaphylactic reaction
masking of infection
behavior changes
contraindications
hypersensitivity
systemic fungal infections
nursing interventions
establish baseline of vital signs, I/O ratio, weight
monitor blood pressure during stabilization period
assess client's response to treatment
teach client
take oral steroid with food
take anti-inflammatories on schedule and don't stop abruptly
expect a slight weight gain
avoid alcohol and caffeine
do not use OTC medications unless approved by health care provider
report slow healing, vague feeling of being sick, or relapse
use medic alert jewelry or ID
Managing gastrointestinal conditions
Antiemetics
Antacids
Antiulcers
Antidiarrheals
Laxatives
Pancreatic enzymes
Antiemetics
action - prevent expulsion of stomach contents by decreasing stimulation of either the chemoreceptor trigger zone (CTZ), near the medulla, or the vomiting center in the medulla
examples
antihistamines: dimenhydrinate (Dramamine), promethazine (Phenergan)
anticholinergic: scopolamine (Transderm- Scop)
phenothiazines;chlorprimazine (Thorazine), prochlorperazine (Compazine)
seratonin (5-HT3) receptor antagonist; granisetron (Kytril), odansetron (Zofran)
use: prevent nausea and vomiting; cause must be identified to prevent masking a serious problem
adverse reactions
tachycardia, hypotension
dry mouth and eyes, blurred vision, constipation
sedation, drowsiness
contraindications
narrow-angle glaucoma
liver disease
intestinal obstrucion
depression
nursing interventions
use nonpharmacologic measures first (tea, crackers, dry toast)
monitor vital signs
monitor for signs and symptoms of shock if vomiting severe
monitor bowel sounds
provide mouth care after vomiting
teach client
store drug in tight, light resistant container
avoid OTC drugs
avoid alcohol because of cumulative sedative effects
avoid during first trimester of pregnancy