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Pharmacological and Parenteral Therapies 4

      1. Hypnotics

        1. action: depress CNS

        2. examples

          1. barbiturates: pentobarbital (Nembutal), secobarbital (Seconal): physical dependency may result with long term use

          2. acetylinic alcohol: ethchlorvynol (Placidyl)

          3. chloral derivatives: chloral hydrate (Noctec)

        3. uses: insomnia, sedation

        4. adverse reaftions

          1. respiratory depression

          2. hypotension

          3. barbiturate toxicity: hypotension, pulmonary constriction, cold and clammy skin, cyanosis of lips, insomnia, hallucinations, delirium

        5. contraindications

          1. hypersensitivity

          2. pregnancy

        6. nursing interventions

          1. monitor client response to medication

          2. teach client

            • take medication exactly as prescribed

            • avoid alcohol and other depressant use

            • avoid driving and other hazardous activities while under the influence

      1. Antianxiety (Anxiolytic)

        1. action: depress CNS

        2. examples

          1. benzodiazepines: alprazolam (Xanax), chlordiazepoxide (Librium):physical dependency and withdrawl finsings after long term use

          2. azapirones: buspirone (Buspar)

        3. uses: anxiety, sleep disorders, alcohol withdrawl

        4. adverse reactions

          1. CNS disturbances: dizziness drowsiness, lethargy, orthostatic hypotension

          2. skin rash

          3. blood dyscrasias

        5. contraindications

          1. hypersensitivity

          2. acute narrow angle glaucoma

          3. liver disease

        6. nursing interventions

          1. notify health care provider if systolic BP drops 20mm Hg

          2. administer with food or milk

          3. 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

      1. General anesthetics

        1. action: depresses the CNS through a progressive sequence  

        2. examples

          1. inhalation anesthetics: cyclopropane, enflurane (Ethrane), ether, nitrous oxide

          2. IV barbiturates: thiopental sodium (Pentothal), methohexital sodium (Brevital)

          3. IV and IM nonbarbiturates: midazolam HCL (Versed), ketamine HCL (Ketaject)

        3. use: used in combination for surgical anesthesia

        4. adverse effects

          1. inhalation anesthetics: excitement and restlessness, nausea and vomiting, respiratory distress

          2. IV barbiturates: respiratory depression, hypotension, tachycardia, laryngospasm

          3. IV and IM nonbarbiturates: respiratory failure, hyper/hypotension, rigidity, psychiatric disturbances

        5. contraindications

          1. CVA

          2. increased intracranial pressure

          3. severe hypertension

          4. cardiac decompensation

        6. nursing interventions

          1. have oxygen and emergency treatment available

          2. monitor vital signs

          3. use precautions if agent flammable

          4. use safety precautions when client induced

      1. Local anesthetics

        1. action: decreases nerve membrane permeability to sodium ion influx

        2. examples

          1. topical: benzocaine, cocaine, lidocaine HCL (Xylocaine)

          2. spinal: dibucaine (Nupercaine), procaine HCL (Novocaine)

          3. nerve block: bupivacaine HCL (Marcaine), mepivacaine HCL (Carbocaine)

        3. use: pain control while client is conscious

        4. adverse effects

          1. allergic reactions

          2. respiratory arrest

          3. arrhythmias, cardiac arrest

          4. convulsions

          5. hypotension

        5. nursing interventions

          1. have oxygen and emergency equipment available

          2. monitor vital signs during local anesthesia

          3. if spinal anesthesia, keep client flat for 6-12 hours to prevent headaches

    1. Managing musculoskeletal conditions



  1. Skeletal muscle relaxants

  1. NSAIDs

  1. Antigout agents

      1. Skeletal muscle relaxants

        1. use: relax muscles, treat spasm disorders

      1. Nonsteroidal antinflammatory drugs (NSAIDS)

        1. action: interferes with prostaglandin synthesis

        2. examples: ibuprofen (Motrin), indomethacin (Indocin)

          1. first generation (COX-1 inhibitor) - salicylates (aspirin - Bayer, Ecotrin), ibuprofen(Motrin, Advil), naproxen (Naprosyn)

          2. second generation (COX-2 inhibitor)- celecoxib (Celebrex)

        3. use: rheumatoid arthritis, osteoarthritis, dysmenorrhea

        4. adverse effects

          1. gastric disturbances- lessened with administration of COX-2 inhibitors

          2. skin rash

          3. blood dyscrasias/bleeding

          4. CNS disturbances

          5. nephrotoxicity

        5. contraindications

          1. hypersensitivity

          2. asthma

          3. renal disease

          4. liver disease

        6. nursing interventions

          1. administer one hour before or two hours after meals

          2. monitor blood work, vital signs

          3. monitor response to medication

      1. Antigout agents

        1. action: increases excretion of uric acid and decreases uric acid formation

        2. examples

          1. allopurinol (Zyloprim)

          2. colchicine (Novocolchine)

          3. probenecid (Benemid)

        3. use: prevent gout attacks

        4. adverse effects

          1. gastric effects: nausea and vomiting, indigestion

          2. blood dyscrasias

          3. liver damage

          4. skin rash

          5. gi disturbances

        5. contraindications: hypersensitivity

        6. nursing interventions

          1. increase fluid intake to prevent renal calculi

          2. monitor fluid intake and output

          3. administer with meals

          4. monitor blood work, including serum uric levels, and electrolyte levels

          5. instruct client

            • lose weight if needed

            • avoid high purine foods (organ meats, sardines, shellfish, etc.)

            • avoid fermented beverages such as beer, ale, wine

    1. Managing integumentary conditions



  1. Scabicides / pediculicides

  1. Anti-pruritics

  1. Anti-infectives

  1. Antiinflammatory steroids

      1. Scabicides/pediculicides (illustration 1   illustration 2 )

          1. action: targets the parasite's nerve-cell membrane

          2. examples

            1. permethrin (Nix, Elimite)

            2. lindane (Kwell)

          3. use: treat parasitic arthropods: itch mites (scabies) and lice

          4. adverse reaction: skin irritation

          5. contraindications: hypersensitivity

          6. nursing interventions

            1. use precautions to prevent spread of parasites (for example, use gown and gloves, keep infected linen separate, etc.)

            2. keep medication away from eyes and mucous membranes

            3. monitor for skin irritation

            4. determine source of contamination

            5. evaluate effectiveness of treatment

        1. Antipruritics

          1. action: inhibits conduction of nerve impulses to sensory endings

          2. examples -

            1. benzocaine (Solarcaine)

            2. lidocaine HCL (Xylocaine)

          3. use: temporary relief of skin problems such as minor burns, insect bites, sunburn

          4. adverse reactions - skin irritation

          5. nursing interventions

            1. monitor effect of treatment

            2. avoid contact with eyes

      1. Anti-infectives

        1. action: interfere with essential metabolic actions of microbial cells

        2. examples

          1. silver sulfadiazine (Silvadene)

          2. silver nitrate 0.1%-0.5% solution

        3. uses

          1. ophthalmic solutions: treat ophthalmic infections

          2. bladder and urethra irrigations

        4. adverse effects

          1. silver sulfadiazine: skin irritation

          2. silver nitrate

            • electrolyte imbalance

            • brownish black discoloration produced on contact

        5. nursing interventions

          1. monitor client's condition during treatment

          2. for eyes, use only silver nitrate in ophthalmic solution

          3. handle silver nitrate with care: solutions stain skin and clothing

          4. silver sulfadiazine: use aseptic technique when applying

      1. Antiinflammatory (steroids, glucocorticoids)

        1. action: stabilize leukocyte lysosomal membranes, inhibit phagocytosis and release of allergic substances

        2. examples

          1. hydrocortisone sodium succinate (Solu-Cortef)

          2. hydrocortisone sodium phosphate (Hydrocortone)

        3. use: to suppress inflammatory or immune responses

        4. adverse reactions

          1. sodium and fluid retention

          2. nausea, acne, impaired wound healing

          3. anaphylactic reaction

          4. masking of infection

          5. behavior changes

        5. contraindications

          1. hypersensitivity

          2. systemic fungal infections

        6. nursing interventions

          1. establish baseline of vital signs, I/O ratio, weight

          2. monitor blood pressure during stabilization period

          3. assess client's response to treatment

          4. 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

    1. Managing gastrointestinal conditions



  1. Antiemetics

  1. Antacids

  1. Antiulcers

  1. Antidiarrheals

  1. Laxatives

  1. Pancreatic enzymes

      1. Antiemetics

        1. 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

        2. examples

          1. antihistamines: dimenhydrinate (Dramamine), promethazine (Phenergan)

          2. anticholinergic: scopolamine (Transderm- Scop)

          3. phenothiazines;chlorprimazine (Thorazine), prochlorperazine (Compazine)

          4. seratonin (5-HT3) receptor antagonist; granisetron (Kytril), odansetron (Zofran)

        3. use: prevent nausea and vomiting; cause must be identified to prevent masking a serious problem

        4. adverse reactions

          1. tachycardia, hypotension

          2. dry mouth and eyes, blurred vision, constipation

          3. sedation, drowsiness

        5. contraindications

          1. narrow-angle glaucoma

          2. liver disease

          3. intestinal obstrucion

          4. depression

        6. nursing interventions

          1. use nonpharmacologic measures first (tea, crackers, dry toast)

          2. monitor vital signs

          3. monitor for signs and symptoms of shock if vomiting severe

          4. monitor bowel sounds

          5. provide mouth care after vomiting

          6. 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