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Local anesthetic
Lidocaine w/o epi
- Classification: Therapeutic: anesthetics (topical/local), anti-arrhythmics
- Indications: IV-ventricular arrhythmias, IM: self injected or when IV unavailable, Local: infiltration/mucosal/topical anesthetic, patch: pain due to post-herpetic neuralgia
- Action: Suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes w/ little or no effect on the heart.
- Contraindications/Precautions: Hypersensitivity, cross sensitivity, third degree heart block
- Adverse Reactions/Side Effects:Routes: CNS: seizures, confusion, dizziness, EENT: mucosal use decrease or absent gag reflex, CV: cardiac arrest, bradycardia, hypertension, LOCAL: stinging, anaphylaxis
- Nursing Implications/Priorities: Monitor ECG, assess degree of numbness, monitor for pain intensity, serum electrolyte leves should be monitored
- Toxicity: confusion, excitation, blurred or double vision, nausea, vomiting, ringing in ears, tremors
- Desired Outcomes: local anesthesia
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Reversal agents
Naloxone
- Classification: Therapeutic: antidotes (for opiods) Pharmacologic- opiod antagonists
- Indications: Reversal of CNS depression and respiratory depression because of suspetced opiod overdose.
- Action: Competitively blocks the effects of opioids, including CNS and respiratory depression w/o inducing any agonist effects
- Contraindications/Precautions: hypersensitivity, use cautiously in cardiovascular disease
- Adverse Reactions/Side Effects: CV: ventricular arrhythmias, hypertension, hypotension, GI: nausea, vomiting
- Routes: IV, IM, subcut
- Nursing Implications/Priorities: manages respiratory rate, rhythm, depth and pulse
- Desired Outcomes: adequate ventilation, alertness w/o significant pain or withdrawal symptoms.
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Reversal agents
Flumazenil (Anexate, Romazicon)
- Classification: Therapeutic: antidotes, Pharmacologic: benzodiazepines
- Indications: Complete/partial reversal of effects of benzodiazepines uses as general anesthetics, or during diagnostic or thereaptuetic procedures.
- Action: a benzodiazepine derivative that antagonizes the CNS depressant effects of benzodiazepine compounds, no effects on CNS depression
- Contraindications/Precautions: Hypersensitivity to flumazenilor benzodiazepines, patients receiving benzodiazepines for life threatening medical problems should not be given flumazenil.
- Adverse Reactions/Side Effects: CNS: dizziness, headache, CV, chf, arrhythmias, hypertension, GI: anorexia, stroke, Endo: adrenal suppression, weight gain, F and E: hypokalemia, hypokalemic episodes, Misc: hypersensitivity reactions
- Routes: PO
- Nursing Implications/Priorities: monitor blood pressure, monitor for fluid retention, monitor patients with addison's disease
- Desired Outcomes: normalization of fluid and electrolyte balance w/o the development of hypokalemia or hypertension
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Local Anesthetics
Bupivacaine (Marcaine, sensorcaine)
- Classification: Therapeutic: Epidural local anesthetic, anesthetic (topical/local)
- Indications: Local or regional anesthesia or analgesia for surgical, obsteric, or diagnostic procedures
- Action: Local anesthetics inhibit initiation and conduction of sensoy nerve impulses by altering the influx of sodium and efflux of potassium in neurons, slowing or stopping pain transmission.
- Contraindications/Precautions:
- Adverse Reactions/Side Effects:Routes:Nursing Implications/Priorities: monitor sensation, assess toxicity (tingling, numbness, ringing in ears, metallic taste, dizziness, monitor bp, heart rate, and respiratory rate, hypotension, bradycardia
- Desired Outcomes: Decrease in postoperative pain w/o unwanted sensory or motor deficits
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Inhalational anesthetics
Halothane, Isoflurane, Nitrous oxide
- Classification:
- Indications: induction and maintenance of general anesthesia
- Action: Acts as an inhalation anesthetic. Induction and recovery are rapid and depth of anesthesia can be rapidly altered. Reduces blood pressure, and frequently decreases pulse rate. More concentration, the more evidence of these changes.
- Contraindications/Precautions: Not recommended for obsterical anesthesia, expect when uterine relaxation is required.
- Adverse Reactions/Side Effects: hepatic necrosis,cardiac arrest, hypotension, respiratory arrest, cardiac arrhythmias, hyperpyrexia, shivering, nausea and emesis.
- Routes: nonrebreathing, partial rebreathing, or closed technique. Inhalation
- Nursing Implications/Priorities: monitor, bp, pulse, cardiac arrhythmias
- Desired Outcomes: Induce general anesthesia
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Intravenous anesthetics
Diazepam
- Classification: Therapeutic: anti-anxiety agents, anticonvulsants, sedative/hypnotic, skeletal muscle relaxant
- Pharmacologic: benzodiazepines
- Indications: Adjunct in the management of anxiety disorder, athetosis, anxiety relief prior to cardioversion (injection), stiffman syndrome, preoperative sedation, conscious sedation, treatment of uncontrolled seizrues.
- Action:Contraindications/Precautions:Adverse Reactions/Side Effects:Routes: CNS: dizziness, drowsiness, leathargy, EENT: blurred vision, RESP: respiratory depression, CV: hypotension, GI: constipation, diarreah
- Nursing Implications/Priorities: monitor bp, pulse and respiratory rate prior to and periodically throuhgout therapy. Prolonged therapy may lead to independence restrict amount given to pt. seizures, anxiety, muscle spasms, alchohol withdrawal.
- Desired Outcomes: Decrease anxiety level, decreased recall of surgery or diagnostic procedures, control of seizures, decrease muscle spasms decreased termbolousness.
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Intravenous anesthetic
Midazolam
- Classification: Therapeutic: antianxiety agents, sedative/hypnotic
- Pharmacologic: benzodiazepines
- Indications: Preprocedural sedation and anxiolysis in pediatric patients, IM, IV preoperative sedation/anxiolysis/amnesia
- Action: acts at many levels of the CNS to produce generalized depression
- Contraindications/Precautions: Hypersensitivity; cross-sensitivity w/ other benzodiazepines may occur; shock; comatose patients or those with pre-existing CNS depression, uncontrolled severe pain
- Adverse Reactions/Side Effects:Routes: CNS: agitation, drowsiness, excess sedation, headache EENT: Blurred vision, RESP: apnea, laryngospasm, respiratory depression, bronchospasm, coughing, CV: cardiac arrest, arrhythmias, GI: hiccups, nausea, vomiting, DERM: rashes LOCAL: Phlebitis at IV site, pain at IM site
- Nursing Implications/Priorities: assess level of sedation and consciousness for 2-6 hours after admin. monitor bp, pulse, respiration, continuously during IV admin, toxicity monitor bp, pulse, respirations, maintain airway ventilation prn.
- Desired Outcomes: Sedation during and amnesia following surgical, diagnostic and radiologic procedures, sedation and amnesia for mechanically ventilated patients in a critical care setting.
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Intravenous anesthetic
Propofol
- Classification: Therapeutic: general anesthetic
- Indications: Induction of general anesthesia in children >3yr and adults. Maintenance of balanced anesthesia when used with other agents in children >2mo and adults. Initiation and maintenance of monitored anesthesia care.
- Action: short acting hypnotic, mechanism of action is unknown. Produces amnesia, has no analgesic properties.
- Contraindications/Precautions: hypersensitivity, soybean oil, egg lecithin, or glycerol, OB crosses placenta; may cause neonatal depression, enters breast milk
- Adverse Reactions/Side Effects: CNS: dizziness, headache, Resp: apnea, cough CV: bradycardia, hypotension, hypertension GI: abdominal cramping, hiccups, nausea, vomiting, DERM: flushing LOCAL: burning pain, stinging, coldness, numb, MS: involuntary muscle movements, GU: discoloration of urine
- Routes:Nursing Implications/Priorities: Assess respiratory status, pulse and blood pressure, assess level of sedation and level of consciousness, watch for metabolic acidosis, hyperkalemia, lipemia, rhabdyomyolysis, renal failure
- Desired Outcomes: Induction and maintenance of anesthesia, amnesia, sedation in mechanically ventilated patients in an intesive care setting.
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Opioid
Morphine, hydromorphone, oxycodone, fentanyl
- Classification: Therapeutic: opiod analgesic, Pharmacologic: opioid agonists
- Indications: Severe pain, pulmonary edema, pain associated with MI
- Action: Binds to opiate receptors in the CNS. Alters the perception of an response to painful stimuli while producing generalized CNS depression.
- Contraindications/Precautions: hypersensitivity; some products contain tartazine, bisulfites, or alcohol and should be avoided in patients with hypersensitivity
- Adverse Reactions/Side Effects: CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams ENT: blurred vision, diplopia, miosis, CV: hypotension bradycardia GI: constipation, nausea vomiting, GU: urinary retention, flushing, itching, sweating.
- Routes: PO, IM, subcut, rect, IV, epidural
- Nursing Implications/Priorities: assess type, location and intesity of pain prior to and 1 hr following PO, subcut, IM pt. should have bolus dose, long term use may lead to dependence.
- Desired Outcomes: Decrease in severity of pain w/o a significant alteration in level of consciousness or respiratory status, decrease in symptoms of pulmonary edema
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Opioid
Hydrocodone
- Classification: Therapeutic: allergy, cough and cold remedies, opioid analgesic, opioid agonist/ nonopioid analgesic
- Indications: used mainly in combination with nonopioid analgesics in the management of moderate to severe pain, in the management of moderate to severe pain.
- Action: Binds to opiate receptors in the CNS. Alters the reception of and response to painful stimuli, while producing generalized CNS depression
- Contraindications/Precautions: hypersensitivity to hydrocodone/ acetaminophen/ibuprofen, should be avoided in patients with severe hepatic and renal disease
- Adverse Reactions/Side Effects: CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache, unusual dreams, EENT: blurred vision, diplopia, miosis RESP: respiratory depression. CV: hypotension, bradycardia GI: constipation, dyspepsia, nausea, vomiting GU: urinary retention DERM: sweating MISC: physical dependence, psychological dependence, tolerance
- Routes: PO
- Nursing Implications/Priorities: Assess bp, pulse, and respirations before and preiodically during admin. assess geriatric and pediatric pts often. assess bowel function routinely, assess type, location and intesity of pain
- Desired Outcomes: Decrease in severity of pain without a significant alteration in level of consciousness or respiratory status, suppression of cough
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Neuromuscular blockers
Succinylcholine
- Classification: Neuromuscular blocking agent
- Indications: relaxing muscles during surgery or when using a ventilator. Also used to induce anesthesia
- Action: Depolarizing muscle relaxant. Works by keeping muscles from contracting, which cause paralysis of the muscles in the face, and those used to breathe and move.
- Contraindications/Precautions: hypersensitive to succinylcholine, had recent burn, trauma, nerve damage, family hisotry of muscel disease or malignant hyperthermia
- Adverse Reactions/Side Effects: Increased saliva, muscle pain, muscle twitching, dizziness, headache, slowed breathing
- Routes: IM?
- Nursing Implications/Priorities: assess bp, pulse, respirations,
- Desired Outcomes: relax muscles
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Neuromuscular blocker
Vecuronium
- Classification: neuromuscular blocker
- Indications: adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
- Action: competes for cholinergic receptors at the motor end plate. Nondepolarizing neuromuscular blocking agent.
- Contraindications/Precautions:
- Adverse Reactions/Side Effects: slowed gi tract, fatigue
- Routes: IV
- Nursing Implications/Priorities:
- Desired Outcomes:
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