- classification- Therapeutic: antidotes (for opiods)
- Pharmacologic: Opiod antagonists
Indications for use- Reversal of CNS depression and respiratory depression because of suspected opiod overdose.
Action- Competitively blocks the effects of opioids, including CNS respiratory depression, without producing any agonist (opioid-like) effects. Therapeutic- reversal of opioid excess.
Contraindications/precautions- Hypersensitivity. Use cautiously in cardiovascular disease, may cause severe withdrawal symptoms for patients physically dependent on opiods. OB: can cause acute withdrawal syndrome in mother and fetus PED: May cause acute withdrawal syndrome in neonates of opioid dependent mothers.
Life-threatening adverse reactions/most common side effects- CV- Ventricular arrhythmias, hypertension, hypotension GI- nausea, vomiting
- Classification- Therapeutic: Antidotes
- Pharmacologic: Benzodiazepines
Indications for use- Complete/partial reversal of effects of benzodiazepines used as general anesthetics, or during diagnostic or therapeutic procedures. Management of potential or accidental overdose of benzodiazepines.
Action- a benzodiazepine derivative that antagonizes the CNS depressant effects of benzodiazepine compounds. Has no effect on CNS depression from other causes, including opioids, alcohol, barbiturates, or general anesthetics. Therapeutic: reversal of benzodiazepine effects
Contraindications/precautions- Hypersensitivity, patients receiving benzodiazepines for life threatening medical problems, including status epilepticus or increased intracranial pressure, should not be given flumazenil; serious cyclic antidepressant overdose
Life-threatening adverse reactions/most common side effects- CNS: Seizures, dizziness, agitation, confusion, drowsiness, emotional lability, fatigue, headache, sleep disorders EENT: Abnormal hearing, abnormal and blurred vision GI: nausea, vomiting, hiccups DERM: flushing, sweating LOCAL: pain/injection site reactions phlebitis NEURO: paresthesia MISC: rigors, shivering
- Classification- Therapeutic: antianxiety agent anticonvulsants, sedative/hypnotic, skeletal muscle relaxant
- Pharmacology: benzodiazepines
Indications for use- Adjunt in the management of: anxiety disorder, athetosis, anxiety reelief prior to cardioversion (injection), stiffman syndrome, preoperative sedation, conscious sedation. Treatment of epilepticus/uncontrolled seizures. Skeletal muscle relaxant. Management of the symptoms of alcohol withdrawal.
Action- Depresses the CNS, probably by potentiating GABA, an inhibitor neurotransmitter. Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. Has anticonvulsant properties due to enhances presynaptic inhibition. Therapeutic- Relief of anxiety. Sedation. Amnesia, skeletal muscle relaxation. Decrease seizure activity
Contraindications/precautions- Hypersensitivity; cross sensitivity with other beonzodiazepines may occur; comatose patients; myasthenia gravis; severe pulmonary impairment; sleep apnea; severe hepatic dysfunction, pre-existing CNS depression, uncontrolled severe pain; angle closure glaucoma OB: increased risk of congenital malformations D/C drug if lactating or bottle feed, safety not established for pt. <6 mo.
Life-threatening adverse reactions/most common side effects- CNS: dizziness, drowsiness, lethargy, depression, hangover, ataxia, slurred speech, headache, paradoxical excitation. EENT: blurred vision RESP: respiratory depression CV: hypotension GI: constipation, diarrhea, nausea, vomiting, weight gain DERM: rashes LOCAL: pain IM, phlebitis IV, venous thrombosis. MISC: physical dependence, psycholoical dependence, tolerance.
- Classification- Therapeutic: antianixety agents, sedative/hypnotics
- Pharmacologic: benzodiazepines
Indications for use- PO: preprocedural sedation and anxiolysis in pediatric patients IM, IV: preoperative sedations/anxiolysis/amnesia IV: provides sedation/anxiolysis/amneisa during therapeutic, diagnositc, or radiographic procedures. (Conscious sedation) Aids as induction of anesthesia. As a continuous infusion, provides sedation for mechanically ventilated patients.
Action- Acts at many levels of the CNS to produce generalized CNS depression. Affects are mediated by GABA (an inhibitory neurotransmitter)
Contraindications/precautions- Hypersensitivity; cross sensitivity with other benzodiazepines may occur; shock; comatose patients or those with pre-exisiting CNS depression; uncontrolled severe pain; acute angle glaucoma OB: benzodiazepine durgs may increase risk of congenital malformations; If used in the last week of pregnancy can cause CNS depression of the neonate. Products contain benzyl alcohol should not be used in neonates. PEDI: hypotension and seizures occur with rapid injection especially fentanyl GERI: older pts. are more susceptible to cardiorespiratory depressant effects decrease dosage required.
Life-threatening adverse reactions/most common side effects CNS: agitation, drowsiness, excess sedation, headache EENT: blurred vision RESP: APNEA, LARYNGOSPASM, REPSIRATORY DEPRESSION, bronchospasm, coughing CV: cardiac arrest, arrhythmias GI: hiccups, nausea, vomiting DERM: rashes LOCAL: phlebitis and pain IM
Classification- Therapeutic: general anesthetics
Indications for use- Induction of general anesthesia in children >3yr and adults. Maintenance of balanced anesthesia when used with other agents in children >2mo and adults. Intitiation and mainteneance of monitored anestheis care (MAC). Sedation of intubated, mechanically ventilated patiens in intensive care units.
Action- Short-acting hypnotic. Mechanism of action is unknown. Produces amnesia. No analgesia properties. Therapeutic: induction and maintenance of anesthesia.
Contraindications/precautions- Hypersensitivity to propofol, soy bean oil, egg, lecithin, or glycerol OB: crosses placenta; may cause neonatal depression LACTATION: enters breast milk; effects on newborns unknown.
Life-threatening adverse reactions/most common side effects - CNS: dizziness, headache, RESP: apnea, coughing CV: bradycardia, hypotension, hypertension GI: abdominal cramping, hiccups, nausea, vomiting DERM: flushing LOCAL: buring, pain, stingin, coldess, numbnesss, tingling at IV site. MS: involuntary muscle movements, perioperative myoclonia GU: discoloration of urine (green) Misc- PROPOFOL INFUSION SYNDROME, fever
- Classification- Therapeutic: opiod analgesic
- Pharmacologic: opioid agonists
Indications for use- Sever pain, pulmonary edema. Associated with MI
Action- Binds to opiate receptors at CNS. Alters perception of and response to painful stimuli while producing generalized CNS depression. Therapeutic: decrease in severity of pain. Addition of naltrexone in Embeda product designed to prevent abuse or misuse by altering formulation. NALTREXONE has no effect unless capsule is crushed or chewed.
Contraindications/precautions- Hypersensitivity; some products contain tartazine, bisulfites, or alcohol and should be avoided in pts. with known hypersensitivity. Use cautiously with: head trauma, increased cranial pressure, severe renal, heptaic, or pulmonary disease; hypothyroidism. Adrenal insufficiency; history of abuse. GERI: dose reduction suggested; undiagnosed abd pain; prostatic hyperplasia, procedures that rapidly reduce pain, long acting agents should be d/c'd 24 hr before or replaced with short acting agents. OB: avoid chronic use PEDI: neonates and infants more susceptible to respiratory depression
Life-threatening adverse reactions/most common side effects- CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. RESP: RESPIRATORY DEPRESSION CV: hypotension, bradycardia GI: constipation, nausea, vomiting GU: urinary retention DERM: flushing, itching, sweating MISC: physical, psychological dependence tolerance.
- Classification- Therapeutic: Opioid analgesic
- Pharmacologic: Opioid agonists
Indications for use- Management of breakthrough cancer pain in patients with malignancies who are already receiving and are tolerant to opioid therapy for their underlying cancer pain.
Action- Binds to opiate receptors in the CNS, altering response to and perception of pain. Therapeutic- decreased pain.
Contraindications/precautions- hypersensitivity; management of acute or post op. pain; opioid naive (non tolerant) pts. Use cautiously in bradyarrhythmias; concurrent use of CNS active drugs; chronic pulmonary disease or predisposition to hypoventilation; hepatic or renal impairment OB/Lactation: short term use at lower doses may be acceptable PEDI: safety not established in children < 16 yr; GERI: elderly patients may be more sensitive to side effects. Extreme caution: increased intracranial pressure or altered consciousness.
Life-threatening adverse reactions/most common side effects- CNS: dizziness, drowsiness, abnormal thinking, confusion, hallucinations, headache, insomnia, nervousness, weakness. EENT: abnormal vision. RESP: RESPIRATORY DEPRESSION, dyspnea. CV: hypotension GI: nausea, constipation, dry mouth, vomiting. DERM: pruritus, rash, sweating NEURO: abnormal gait.
- Classification- Therapeutic: allergy, cold, and cough remedies (antitussives), opioid analgesics
- Pharmacologic: Opioid agonists
Indications for use- Moderate to severe pain (alone and in combination with nonopioid analgesics); extended release product for opioid-tolerant patients requiring around the clock management of persistent pain.
Action- Binds ot opiate receptors in the CNS. Alters the preception of and response to painful stimuli while producing generalized CNS depression. Suppresses the cough reflex via a direct central action. Therapeutic: decrease in moderate to severe pain. Suppression of cough.
Contraindications/precautions- Hypersensitivity to hydroxychloroquine or chloroquine; previous visual damage from hydroxychloroquine or chloroquine. Use cautiously in concurrent use of hepatotoxic drugs. History of liver disease or alcoholism or renal impairment, severe neurological disorders, severe blood disorders, retinal or visual field changes, psoriasis, bone marrow depression; obesity. OB, lactation: avoid use unless treating malaria or treating amebic abcess. PEDI: long term use may increase sensitivity.
Life-threatening adverse reactions/most common side effects - CNS: SEIZURES, aggressiveness, anxiety, apathy, confusion, fatigue, headache. EENT: keratopathy, ototoxicity, retinopathy, tinnitus, visual disturbances CV: ECG changes, hypotension GI: abd cramps, anorexia, diarrhea, epigastric discomfort, nausea, vomiting, hepatic failure. DERM: bleaching of hair, alopecia, hyperpigmentation, photosensitivity, steven johnsons syndrome HEMAT: AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thromocytopenia NEURO: neuromyopathy, peripheral neuritis.
- Classification- Therapeutic: Allergy, cold and cough remedies, antitussives, opioid analgesics
- Pharmacologic: Opioid agonists
Indications for use- Management of mild to moderate pain. Antitussive (in smaller doses) unlabeled: diarreah management.
Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Decreases cough reflex. Decreases GI motility. Therapeutic: decreases severity of pain, suppression of cough reflex and diarreah relief.
Contraindications/precautions- Hypersensitivity. Use cautiously in head trauma; increased intracranial pressure; severe renal, hepatic, pulmonary disease; hypothyroidism; adreanl insufficency; alcoholism GERI: Geriatric or debilitated patients dose reduction required more susceptible to CNS depression, constipation. OB: has been used during labor; respiratory depression may occur in newborn. OB, lactation: avoid chronic use.
Life-threatening adverse reactions/most common side effects - CNS: confusion, sedation, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams. EENT: blurred vision, diplopia, miosis. RESP: respiratory depression CV: hypotension, bradycardia, GI: constipation, nausea, vomiting. GU: urinary retention DERM: flusing, sweating, MISC: physical dependence, psychological dependence, tolerance.
- Classification- Therapeutic: allegy, cold and cough remedies (antitussive) opioid analgesic
- Pharmacologic: opioid agonists/nonopioid analgesic combinations.
Indications for use- Used mainly in combination with nonopioid analgesics (acetaminophen/ibuprofen) in the management of moderate to severe pain. Antitussive (usually in combination products with decongestants.)
Action- Bind to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression: suppress the cough reflex via a direct central action. Therapeutic: Decrease in severity of moderate pain. Suppression of the cough reflex.
Contraindications/precautions- Hypersenstivity to hydrocodone, acetaminophen/ibuproen; ibuprofen containt products should be avoided in pts. with bleeding disorders or thrombocytopenia; acetaminophen containing products should be avoided in pts. with severe hepatic or renal disease. OB, lactation: avoid chronic use. Alcohol, aspartame, sacharin, sugar, or tartazine should be avoided in pts with hypersensitivity. Use cautiously in increased head trauma, increased incranial pressure, severe renal, hepatic or pulmonary disease; cardiovascular disease, history of peptic ulcer disease GERI: decrease initial dosage, more prone to CNS depression, constipation. PEDI: children safety not established.
Life-threatening adverse reactions/most common side effects - CNS: confusion, dizziness, sedations, eupohria, hallucinations, headache, unusual dreams. EENT: bluured vision, diplopia, miosis RESP: respiratory depression CV: hypotension, bradycardia GU: urinary retention DERM: sweating. MISC: physical dependence, psychological dependence, tolerane.
- Classification- Therapeutic: opioid analgesic
- Pharmacologic: opioid agonist
Indications for use- moderate to severe pain.
Action- Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli, while producing generalized CNS depression. Therapeutic: decreased pain.
Contraindications/precautions- hypersensitivity; some products contain alcohol or bisulfites and should be avoided in patients with known intolerance or hypersensitivity. Use cautiously in: head trauma; increased intracranial pressure; severe renal, hepatic, or pulmonary disease, hypothyroidism; adrenal insufficiency; alcoholism; undiagnosed abd pain; prostatic hyperplasia OB: avoid chronic use; weigh maternal benefit against fetal risks. GERI: elderly or debilitated patients (Initial dose decreased recommended.
Life-threatening adverse reactions/most common side effects- CNS: confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headaches, unusual dreams EENT: blurred vision, diplopia, miosis RESP: RESPIRATORY DEPRESSION CV: orthostatic hypotension GI: constipation, dry mouth, nausea, vomiting. GU: urinary rention. DERM: flushing, sweating. MISC: physical dependence, psychological dependence, tolerance.
Classification- Therapeutic: neuromuscular blocking agents- depolarizing
Indications for use- Used during surgical procedures to produce skeletal muscle paralysis after induction of anesthesia and provision of opioid analgesics.
Action- Prevents neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Has agonist activity initially, producing fasciculation. Causes the realse of histamine. Has no analgesic or anxiolytic effects. Therapeutic: muscle paralysis.
Contraindications/precautions- Hypersensitivity to succinylcholine or parabens; plasma pseudocholinesterase deficiency; children and neonates (continuous infusions); personal history of malignant hyperthermia. Use cautiously in familial hisotry of malgnant hypethermia; hisotry of pulmonary disease, renal or liver impairment; major trauma, burns, or underlying myopathy. Glaucoma, electrolyte distrubances, pt's receiving digoxin; fractures, muscular spasm; myasthenia gravis or myasthenic syndromes; geriatric or debilitate patients; has been used in pregnant women undergoing cesarean section; neonateds and children.
Life-threatening adverse reactions/most common side effects - RESP: APNEA, bronchospasm CV: arhythmias, bradycardia, hypotension F and E: HYPERKALEMIA MS: RHABDOMYOLYSIS, muscle fasciculation MISC: MALIGNANT HYPERTHERMIA, myoglobinemia, myoglobinuria (children), tachyphylaxis.
Classification- Therapeutic: Neuromuscular blocking agent- nondepolarizing.
Indications for use- Induction of skeletal muscle paralysis and facilitation of intubation after induction of anesthesia in surgical procedures. Facilitation of compliance during mechanical ventilation.
Action- Prevent neuromuscular transmission by blocking the effect of acetylcholine at the myoneural junction. Have no analgesic or anxiolytic properties. Therapeutic: skeletal muscel paralysis.
Contraindications/precautions- Hypersensitivity to bromides (pancuronium, vecuronium only) PEDI: products containing benzyl alcohol should be avoided in neonates. Use cautiously in pts with underlying cardiovascular disease ( increase risk of arrhythmias; less with atracurium or vecuronium); dehydration or electrolyte abnormalities. Fractures or spasm; geriatric patients or patients with impaired renal function (slow onset to increase paralysis with cisatracurium; decreasae elimination of pancuronium) Extensive burns, low plasma pseudocholinesterase levels, severe liver disease, pregnancy, or hereditary predisposition. OB/lactation/PEDI: safety not established in some agents; most agents have been used safely in pregnant women undergoing cesarean section; selected agents have been used safely in children.
Life-threatening adverse reactions/most common side effects - RESP: bronchospasm CV: atracurium HYPOTENSION: pancuronium HYPERTENSION: atracurium, pancuronium: tachycardia GI: pancuronium: excessive salvation DERM: rash atracurium: skin flushing MISC: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS
Classification- Therapeutic: Skeletal muscle relaxants
Indications for use- PO: treatment of spasticity associated with spinal cord injury, stroke, cerebral palsy, multiple sclerosis. Prophylaxis of malignant hyperthermia. Unlabled: management of neuroleptic malignant syndrome.
- Action- Acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. presents intense catabolic process associated with malignant hyperthermia.
- Therapeutic- reduction in muscle spaticity. Prevention of malignant hyperthermia.
Contraindications/precautions- No contraindications to IV form in treatment of hyperthermia OB, Lactation: pregnancy and lactation; situations in which spasiticity is used to maintain posture or balance. Use cautiously in: cardiac, pulmonary, or previous liver disease.
Life-threatening adverse reactions/most common side effects - CNS: drowsiness, muscle weakness, confusion, dizziness, headache, insomnia, malaise, nervousness EENT: excessive lacrimation, visual disturbances RESP: pleural effusions. CV: changes in BP, tachycardia, GI: HEPATOTOXICITY, diarrhea, annorexia, cramps, dysphagia, GI bleeding, vomiting. GU: crystalluria, dysura, frequency, erectile dysfunction, incontinence, nocturia, DERM: pruritus, sweating, urticaria HEMAT: eosinophilia LOCAL: irritaiton at IV site, phlebitis MS: myalgia MISC: chills, drooling, fever
Classification- Therapeutic: general anesthetic, Barbiturate (systemic)
Indications for use (discontinued) Used for narcoanalysis, seizures with epilepsy. Off label: cerebral hypoxia, cerebral ischemia.
Action- Act by enhancing responses to GABA, diminishing glutamate responses, and directly depressing excitability by increasing membrane conductance, causing a net decrease in neuronal excitability to provide anesthetic action.
Contraindications/precautions- Should not be given in case of liver disease, addison's disease, myxedema, severe heart disease, severe hypotension, severe breathing disorder and porphyria.
Life-threatening adverse reactions/most common side effects- Cardiovascular and respiratory depression resulting in hypotension, apnea, and airway obstruction. Headache, agitated emergence, prolonged somnolence, and nausea.