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50 Cards in this Set
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diazepam (Valium)
Sedative Hypnotics/Benzodiazipines Indications for Use Mechanism of Action Contraindications |
Use: anxiety, seizures, muscle spasms, alcohol withdrawal, anesthesia induction or preanesthesia
MOA: Depresses CNS (potentiates GABA), skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways Contraindications: Hypersensitivity, OB, lactation, comatose patients, severe pulmonary impairment |
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diazepam (Valium)
Sedative Hypnotics/Benzodiazipines Adverse Effects Drug Interactions Nursing Considerations |
AE: Dizziness, drowsiness, lethargy
Oral Benzodiazipines are very weak respiratory depressants (an over dose with a PO has never been documented) DI: Alcohol, antidepressants, antihistamines, and opioid analgesics--concurrent use results in additive CNS depression NC: No alcohol, no babies, on Beer's list, monitor VS, prolonged use may lead to dependence |
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midazolam/Versed
Sedative Hypnotics/Benzodiazipines Indications for Use Mechanism of Action Contraindications |
Use: Anesthesia induction or preanesthesia
MOA: Acts at many levels of the CNS to produce generalized CNS depression (GABA). Contraindications: Hypersensitivity, OB, lactation, comatose, previous CNS depression |
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midazolam/Versed
Sedative Hypnotics/Benzodiazipines Adverse Effects Drug Interactions Nursing Considerations |
AE: apnea, laryngospasm, respiratory depression, cardiac arrest
DI: Alcohol, antidepressants, antihistamines, and opioid analgesics--concurrent use results in additive CNS depression, grapefruit juice NC: Assess sedation, no alcohol, no babies, monitor VS, causes amnesia, accidental OD from syrup in children (only administered by HCP), drowsiness/dizziness |
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Propofol (Diprovan)
General anesthesia Indications for Use Mechanism of Action Contraindications |
Use: general anesthesia as part of a balanced anesthesia technique
MOA: release of GABA, resulting in generalized CNS depression Contraindications: Hypersensitivity, soybean oil, egg lecithin, or glycerol, OB/lactation, children < 3 or for infants < 2 mo |
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Propofol (Diprovan)
General anesthesia Adverse Effects Drug Interactions Nursing Considerations |
AE: Pain at IV site, high risk of bacterial infection (soybean oil/egg lecithin/glycerol), profound resp. depression, apnea, hypotension
DI: Alcohol, antihistamines, opioid analgesics, and sedative/hypnotics (additive respiratory depression) NC: monitor VS, assess for infection at IV site, no alcohol, no babies, decreases mental recall, assess level of sedation |
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morphine
Opioid agonists Indications for Use Mechanism of Action Contraindications |
Use: relief of moderate to severe pain
MOA: mimicking the action of endogenous opioid peptides, primarily at the MU receptors Contraindications: caution in decreased respiratory reserve, OB, neonatal opioid dependency, head injury, infants and elderly, inflammatory bowel disease, liver impairment, hypotension, reduced blood volume, prostatic hypertrophy. |
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morphine
Opioid agonists Adverse Effects Drug Interactions Nursing Considerations |
AE:constipation, orthostatic hypotension, urinary retention, cough suppression, biliary colic, emesis, intracranial pressure, euphoria, dysphoria, sedation, Miosis (pupillary constriction) life threatening respiratory depression, birth defects, neurotoxicity
DI: CNS depressants, anticholinergic drugs, hypotensive drugs, monoamine oxidase inhibitors, opioids NC: pain assessment, vital signs (withhold if less then 12 breaths per minute), identify high risk patients, discontinue slowly, administer on fixed schedule, increase fiber/fluids/activity to decrease constipation, monitor I/O for urinary retention, antiemetics for N/V, instruct to cough at regular intervals |
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Fentanyl
Opioid agonist |
Same as morphine except:
may cause muscle rigidity which can interfere with induction of anesthesia patch should not be used for postoperative, intermettent pain, or pain that responds to a less powerful analgesic |
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clonidine (Duraclon)
Centrally acting alpha2-adrenergic agonist Indications for Use Mechanism of Action Contraindications |
Use: Treatment of hypertension and relief of severe pain.
MOA: Binds with the presynaptic and postsynaptic alpha 2 receptors in the spinal cord which blocks nerve traffic pathways. Contraindications: Due to risk of severe hypotension and bradycardia- epidural clonidine contrindicated for hemodynamically unstable, and for obstetric, postpartum, or surgical patients |
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clonidine (Duraclon)
Centrally acting alpha2-adrenergic agonist Adverse Effects Drug Interactions Nursing Considerations |
AE: Hypotension, Bradycardia, Rebound hypertension, Catheter-related infection, dry mouth N/V, constipation
DI: Alcohol, Antihistamines, opiod analgesics, and sedatives. NC: Monitor BP, pulse, pain level, and temperature, no babies |
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atropine
Anticholinergics/Muscarinic antagonist Indications for Use Mechanism of Action Contraindications |
Use: adjunct to inhalation anesthesia
MOA: Preoperative administration prevents bradycardia by blocking the activation of the cardiac muscarinic receptors. Also suppresses saliva (aspiration) Contraindications: Angle-closure glaucoma, acute hemorrhage, GI obstruction, tachycardia |
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atropine
Anticholinergics/Muscarinic antagonist Adverse Effects Drug Interactions Nursing Considerations |
AE: Dry Mouth, Blurred Vision, Urinary Retention, Constipation, anhidrosis (lack of sweating, lead to overheating)
DI: antihistamines, anticholinergics, antipsychotics, tricyclic antidepressants, phenothiazine NC: Assess VS and ECG, monitor I & Os, assess bowels |
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bethanechol
cholinergics/Muscarinic agonist Indications for Use Mechanism of Action Contraindications |
Use: Urinary retention
MOA: Stimulates cholinergic receptors of urinary tract Contraindications: low BP/low cardiac output |
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bethanechol
cholinergics/Muscarinic agonist Adverse Effects Drug Interactions Nursing Considerations |
AE: rare with oral dosing. hypotension, bradychardia, excesseive salvation, abdominal cramps, diarrhea, increased urinary pressure, increased asthma
DI: anticholinergics, quinidine, procainamide, cholinesterase inhibitors NC: Monitor VS, I & Os |
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scopolamine
Anticholinergics/Muscarinic antagonist |
Similar to atropine except:
Produces sedation Indications: Motion Sickness (transdermal), production of cycloplegia and mydriasis for ophthalmic procedures (lasik) (PO), and preanesthetic sedation (IV, IM) |
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ranitidine
Antihistamine/H2 receptor antagonist Indications for Use Mechanism of Action Contraindications |
Use: Due to anesthesia suppressing the glottal reflex during surgery, histamine-2 receptor antagonists are given to reduce gastric secretions and minimize the risk for aspiration pneumontitis
MOA: suppresses secretion of gastric acid by blocking H2 receptors on gastric parietal cells. Contraindications: hypersensitivity, alcohol intolerance |
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ranitidine
Antihistamine/H2 receptor antagonist Adverse Effects Drug Interactions Nursing Considerations |
AE: significant side effects are rare; the elevation of gastric pH may increase risk of bacterial pneumonia.
DI: weak inhibitor of hepatic drug-metabolizing enzymes; antacids have a small effect on ranitidine absorption. NC: may cause drowsiness/dizziness, report black tarry stools, fever, sore throat, diarrhea, rash, confusion |
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Lidocaine
Amides (bupivicain, prilocaine) Indications MOA |
use: regional anesthesia for procedures and surgery, frequently used in combination with vasoconstrictor to reduce blood flow and cause prolonged anesthesia. topical/injection. can also be used for dysrhythmia's
MOA: stops axonal conduction by blocking NA channels in axonal membrane |
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Lidocaine
Amides (bupivicain, prilocaine) Adverse effects Drug interactions Nursing considerations |
AE: CNS toxicity excitation followed by depression, headaches and urinary retention related to spinal admin, confusion, stinging, drowsiness, bradycardia, hypotension, arrhythmia's, cardiac arrest.
DI: possible increase in CNS depression when combined with sedatives, may increase calcium channel blockers NC: assess for headache, for hypotension trendelenburg position, ECG, not to be used in areas that are supplied by end arteries> loss of blood>gangrene |
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Procaine (benzocaine, tetracaine)
Esters Indications MOA |
Indications: suppression of pain without depression of entire nervous system, procain not effective topically must be injected
MOA: blocks sodium channels in axonal membrane resulting in block of impulse conduction along axons |
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Procaine (benzocaine, tetracaine)
Esters Adverse effects Drug interactions Nursing considerations |
AE: CNS toxicity excitation followed by depression, confusion, seizures, stinging, drowsiness, bradycardia, hypotension, arrhythmia's, cardiac arrest. Benzocain=methemoglobinemia
DI: not for children<2, sedatives can increase CNS depression NC: ECG |
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Lidocaine + prilocaine/EMLA
combination drug Indications MOA |
Indications: local anesthesia, topical use
MOA: inhibits transport of ions across neuronal membranes which prevents initiation and conduction of normal nerve impulses |
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Lidocaine + prilocaine/EMLA
combination drug Adverse effects Drug interactions Nursing considerations |
AE: usually only from systemic absorption
DI: possibly antiarrhythmics NC: assess application site |
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Thiopental/pentothal
short acting barbiturates IV anesthetics Indications MOA |
Indications: mainstay of anesthesia induction, less BP drop so preferred for Geri, cardi, neuro patients
MOA: CNS depressant, highly lipid soluble, rapid onset, short duration |
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Thiopental/pentothal
short acting barbiturates IV anesthetics Adverse effects Nursing considerations |
AE: respiratory depression, apnea,
NC: shivering and twitching may indicate pain, monitor respirations. |
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Midazolam, Versed
Benzodiazines Indications MOA |
Indications: prep use, induction of anesthesia, amnesia, conscious sedation, anti anxiety
MOA: when combined with short acting barbiturates causes induction of anesthesia |
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Midazolam, Versed
Benzodiazines Adverse effects Drug interactions Nursing considerations |
AE: dangerous cardiorespiratory; apnea, laryngospasms, respiratory depression, respiratory and cardiac arrest
caution in elderly DI: etoh, antihistamines, opioids, kava-kava, chamomile, valerian may all increase CNS depression. Grapfruit juice may increase toxicity NC: risk of phlebitis, inject slowly watch reaction/LOC before redosing, constant cardiac respiratory monitoring |
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Opioid agonist/analgesic
fentanyl/sublimaze Indications MOA |
indications: induction and maintenance of anesthesia, decrease pain
MOA: binds to opiate receptors, altering the response and perception of pain |
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Opioid agonist/analgesic
fentanyl/sublimaze Adverse effects Drug interactions Nursing considerations |
AE: respiratory depression, sedation, muscle rigidity (which can interfere with induction of anesthesia, circulatory depression. Caution in asthma
DI: CYP3A4 inhibitors, grapefruit juice, MAo inhibitors NC: constipation, N/V, urinary retention, cough deep breathe |
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Propofol
Indications MOA |
Indications: IV only, most widely used IV anesthetic, induction and maintenance
MOA: promotes release of GABA resulting in CNS depression |
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Propofol
Adverse effects Drug interactions Nursing considerations |
AE: profound respiratory depression and hypotension, bacterial infection, pain at site of IV, proposal infusion syndrome, bradycardia in children
DI: ETOH, antihistamines, opioids and sedatives cause increase CNS depression. NC: monitor for propofol infusion sydrome= metebolic acidosis, hyperkalemia, rhabdomyolosis, cardiac/renal failure, assess IV site |
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Ketamine/ketalar
Indications MOA |
Indications, dissociative anesthesia, sedation, immobility, analgesia, amnesia, resposivness to apin is lost, used in burn victims
MOA= depresses the CNS by blocking the effects of excitatory neurotransmitters, glutamic acid, at NMDA receptors. Cardivascular stimulant so increased HR, BP |
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Ketamine/ketalar
Adverse effects Drug interactions Nursing considerations |
AE: unpleasant psychological reactions, arrythmias, respiratory depression, not used in head injury
NC: caution in psych disorders, soothing environment |
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Neuroleptic opioid combination
Droperidol+Fentanyl Indications Adverse effects |
Indications: indifference to surroundings, insensitivity to pain, appears asleep but is not, can be used for major surgeries.
AE: prolongs QT interval, potential for fatal dysrhythmias hypotension, respiratory depression Not for patients with parkinsons (droperidol is an antipsychotic and blocks dopamine) |
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Halothane/fluothane,
Indications MOA |
indications: anesthetic, muscle relaxant
MOA: decreases rate of firing and neuronal activity, alters the lipid layer of cell membranes, causing structural alterations in ion channels |
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Halothane/fluothane,
Adverse effects |
AE: hypotension, respiratory depression, dysrhythmias, malignant hypothermia, hepatotoxicity (reason for its withdrawal)
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isoflurane/forane
Indications Adverse effects |
Indications: anesthisisa, muscle relaxant
AE: respiratory depression, hypotension but not associated with renal or hepatic toxicity may suppress uterine contractions |
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Nitrous oxide
gas inhalation anesthetics Indications MOA |
Indications: Never employed as a primary anesthetic, dental procedures supplemental to other anesthetics
MOA: appears to bind to NMDA resceptor and prevent receptor activation by NMDA |
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Nitrous oxide
gas inhalation anesthetics Adverse effects Nursing considerations |
AE: hypoxia, N/V, headache, apnea, hypotension, no babies
**does not trigger malignant hyperthermia NC: Deep breaths for maximum results |
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Ondansetron/Zofran
Serotonin antagonists Antiemetics Indications MOA |
Indications: prevent N/V after anastethia
MOA: blocks type 3 serotonin receptors in Chemo receptor zone and on afferent vagal nerves in upper GI |
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Ondansetron/Zofran
Serotonin antagonists adverse effects drug interactions nursing considerations |
AE: headache, diarrhea, and dizziness, prolongs QT interval= torsade de pointes
DI: apomorphine will increase hypotension and loss of consciousness NC: assess for N/V, abdominal distention, bowel sounds |
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promethazine/phenergan
phenothiazines dopamine antagonists indication MOA |
indications: N/V
MOA: blockes dopamine 2 receptors in chemo receptor zone |
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promethazine/phenergan
phenothiazines adverse effects drug interactions nursing considerations |
AE: extrapyrimidal reactions, anticholinergic effects, hypotension and sedation
DI: cns depressants NC: not for children<2, IV admin may cause severe burning, assess LOC, extrapyrimidal effects |
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succinoylcholine
neuromuscular blocking agent indications Mode of action |
indications: primarily for muscle relaxation during endotracheal intubation, electroconvulsion therapy, endoscopy
MOA: depolarizing neuromuscular blockade, binds nicotine receptors and maintains end plate constant depolarization=paralysis |
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succinoylcholine
neuromuscular blocking agent adverse effects drug interactions nursing interactions |
AE: postoperative muscle pain, prolonged apnea, malignant hyperthermia, dysrhythmias, bradycardia, junctional rhythms, sinus arrest
DI: cholinesterase inhibitor potentiate, antibiotics may intensify NC: watch what you say client can still hear, what to expect with paralysis |
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pancuronium
neuromuscluar blocking agents indications mode of actions |
indications: skeletal muscle paralysis and facilitation of intubation after indiction of anesthesia
MOA: prevents neuromuscular transmission by blocking the effects of acetylcholine at the myoneural junction. has no analgesic or anxiolytic properties |
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pancuronium
neuromuscluar blocking agents adverse effects drug interactions nursing considerations |
AE: bronchospasms, HTN, tachycardia, excessive salivation, rash, possible anaphylaxis
DI: antibiotics NC: monitor infusion site |
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Cocaine
ester indications mode of action |
indications= topical anesthetic, usually for ears nose and throat. unlike others causes vasoconstriction
MOA= blocks norepi uptake at sympathetic nerve terminals on blood vessels |
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cocaine
ester adverse effects drug interactions nursing considerations |
AE: excitation followed by CNS depression, seizures, respiratory arrest and death, reduced fatigue, tachycardia, dysrhythmias, HTN
DI: epinepherine, any vasoconstrictors NC: not for use in people with HTN, dysrhythmias, angina pectoris |
