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action of acetylcholine PHARMACOKINETICS Absorption: Varies widely; rarely administered intramuscularly (I.M.) or intravenously (I.V) because they would be subject to immediate breakdown by cholinesterases; usually given orally or subcutaneously (S.C.) Distribution: Widely distributed, binding primarily to muscarinic and nicotinic receptor sites, in the plasma, and in liver. Excretion: Excreted in the urine DRUG EXAMPLES Bethanechol chloride(Duvoid,Myotonachol),pilocarpine(Isoptocarpine,Pilocar) INDICATIONS Cholinergic agonists are used to treat glaucoma and to stimulate bladder and intestinal function Bethabechol is used to treat non-obstructive urine retention and neurogenic bladder Pilocarpine is used to treat glaucoma CONTRAINDICATIONS AND PRECAUTIONS Prostate enlargement, possible urinary or GI obstruction, hyperthyroidism, bradycardia or atrioventicular (AV) conduction defects, asthma, and pregnancy ADVERSE REACTIONS Hypotension, headache, flushing, sweating, increased salivation, abdominal cramps, nausea, vomiting, diarrhea, blurred vision, bronchial constriction INTERACTIONS Inhibits parasympathomimetic action when used with atropine-like drugs (antimuscarinics) and sympathomimetics Acetycholinesterase inhibitors and cholinergic agonists potentiate each other Causes additive effects when parasympatholytics are used with other anticholinergic Quinidine and procainamide may antagonize effects bethanedchol chloride NURSING RESPONSIBILITIES When administering bethanechol chloride: - Base patient evaluation on increased bladder tone and function - Assess the patient’s urinary status - Never give bethanechol chloride I.V. or I.M. (only give by mouth P.O. or S.C.) - Observe the patient for 20 to 60 minutes after S. C. administration
- Monitor the patient for signs and symptoms of drug toxicity, such as urinary urgency, excessive secretions, respiratory depression or spasm, bradycardia, abdominal cramping, and involuntary defecation - Administer atropine as the antidote for toxicity, as prescribed When administering pilocarpine: - base patient evaluation on decreased intraocular pressure - teach the patient how to instill the eyedrops PARASYMPATHOMIMETICS ACETYCHOLINESTERASE INHIBITORS MECHANISM OF ACTION Inhibit acetycholinesteras, the enzyme that inactivates acetylcholine, thereby stimulating cholinergic receptors and producing prolonged activation of the parasympathetic nervous system PHARMACOKINETICS Absorption. Absorbed readily in the GI tract, subcutaneous tissues, and mucous membranes, except for neostigmine, which is absorbed poorly if given orally Distribution: Only physostigmine readily penetrates the blood-brain barrier Metabolism: Most are metabolized by the plasma esterases Excretion: Excreted in the urine; half-life (of neostigmine)- oral,40 to 60 minutes; injection, 50 to 90 minutes DRUG EXAMPLES Ambenonium (mytelase), edrophonium (Enlon, Reversol, Tensilon), neostigmine, (Prostigmin), physostigmine (antilirium), pyridostigmine (Mestinon,regonol) INDICATIONS Acetycholinesterase inhibitors are used to treat myasthenia gravis and glaucoma and to prevent or treat postoperative paralytic ileus Edrophonium and neostigmine, are used to diagnose myasthenia gravis Ambenonium, neostigmine, and pyridostigmine promote muscle construction and are used to treat myasthenia gravis Neostigmine is used to prevent or treat postoperative ileus, prevent or treat postoperative distention, and treat non-obstructive urine retention Physostigmine is used to treat anticholinergic poisoning (including tricyclic antidepressant overdose) Edrophonium, neostigmine, and pyridostigmine are used to reverse the effects of nondepolarizing neuromuscular blockers CONTRAINDICATIONS AND PRECAUTIONS Possible urinary or GI obstruction ADVERSE REACTIONS Parasympathomimetic, or muscarinic adverse effects are common and include nausea, vomiting, diarrhea, increased salivation, bradycardia, hypotension, dyspnea, diaphoresis, blurred vision, and miosis Nicotinic adverse effects include muscle cramps, fatigue, weakness, paralysis, hypertension, and respiratory depression
INTERACTIONS Use of edrophonium, neostigmine, and pyridostigmine, with nondepolarizing neuromuscular blocker(for example, tubocurarine) antagonizes the effect of the neuromuscular blocker, decreasing the drug’s therapeutic effectiveness Neostigmine and pyridostigmine potentiate depolarizing muscle relaxants (for example, succinylcholine),prolonging muscle paralysis Use with cholinergic agonists(such as pilocarpine, bethanechol, and carbachol) will increase the effect of acetylcholine Use with anticholinergics (such as atropine and scopolamine) decreases the effect of the anticholinesterase and could mask signs of a cholinergic crisis NURSING RESPONSIBILITIES Asses the patient’s neuromuscular status, including gait, muscle strength, reflexes, and heart rate, before and during therapy Monitor the patient for signs and symptoms of toxicity, such as generalized weakness, dysphagia, and respiratory weakness, administer atropine as the antidote for toxicity, as prescribed Monitor the patient’s vital signs and auscultate for breath sounds at least once every 4 hours Take seizure precautions
PARASYMPATHOLYTICS: CHOLINERGIC BLOCKERS (ANTICHOLINERGICS) MECHANISM OF ACTION Block the action of acetycholine at muscarinic receptors in the parasympathetic nervous system PHARMACOKINETICS Absorption: Absorbed in the GI tract, mucous membranes, skin, and eyes Distribution: Belladonna alkaloids are distributed widely and readily cross the blood-brain barrier; the other drugs aren’t. Metabolism: Alkaloids are metabolized in the liver; the other drugs are hydrolyzed in the GI tract and the liver Excretion: Excreted in the feces and the urine DRUG EXAMPLES Atropine, belladonna, benztropine (Cogentin),gycopyrrolate (Robinul) propantheline (Pro-banthine),scopolamine (Scop, Transderm Scop), trihexyphenidyl hydropchloride(Artane) INDICATIONS Parasympatholytics are used to reduce salivation and gastric secretions, to reverse heart block, to induce mydriasis, and to treat Parkinson’s disease, GI spasms, motion sickness and enuresis Atropine and gycopyrrolate are used to treat bradyarrhythmias, arrhythmias, and sinus arrest
urinary or GI tract obstruction. or gum and to reduce constipation by exercising and increasing fiber and fluid intake Instruct the patient to consult a physician or pharmacist before taking nonprescription drugs to prevent adverse drug interactions Administer a cholinergic blocker 30 minutes before meals and at bedtime when used to reduce GI motility Monitor the patient’s intake and output. and urinary hesitancy or urine retention INTERACTIONS Use with various drugs (such as tricyclic antidepressants) may increase anticholinergic adverse effects Antacids decrease absorption of parasympatholytics NURSING RESPONSIBILITIES Assess the patient for relief of symptoms Monitor the patient fro adverse reactions Teach the patient to reduce dry mouth by using ice chips.feeding women ADVERSE REACTIONS Ophthalmic adverse effects with topical application of atropine include blurred vision. severe ulcerative colitis. extrapyramidal reactions. constipation. scopolamine. tachycardia caused by cardiac insufficiency or thyrotoxicosis. uncontrolled tachycardia. hard candy. and watch fro signs and symptoms of urine retention. or dopamine receptors activated by dopamine PHARMACOKINETICS Absorption: Varies widely with each drug Distribution: Varies widely with each drug Metabolism: Varies widely with each drug . or unstable cardiovascular status Also contraindicated in children and breast. such as urinary frequency with voiding of minimal amounts ADRENERGIC AGONISTS (SYMPATHOMIMETICS) MECHANISM OF ACTION Mimic sympathetic activity by activating or inhibiting alpha and beta receptors that normally are activated by the neurotransmitter norepinephrine. conjunctivitis. and photophobia Systematic adverse effects include tachycardia. hypersensitivity. and glycopyrrolate are used to decrease saliva and bronchial secretions before surgery CONTRAINDICATIONS AND PRECAUTIONS Contraindicated in angle-closure glaucoma. myasthenia gravis. dry mouth. acute or severe hemorrhage. Benztropine and trihexyphenidyl are used to treat dyskinesia. and parkinsonism Propantheline and glycopyrrolate are used to treat peptic ulcer and bowel spasms Scopolamine is used to prevent nausea and vomiting resulting from motion sickness Atropine also is used to induce mydriasis Atropine.
terburtaline ( Brethine. which increase cardiac output. are used to treat hypotension Beta1. Isoproterenol is used for cardiac stimulation and bronchodilation through stimulation of beta1 and beta2 receptors Norepinephrine is used to stimulate the heart in cardiac arrest and to increase blood pressure through vasoconstriction in acute hypotension and shock Dopamine is used in higher doses for increased blood pressure and cardiac output through positive inotropic action and in lower doses for increased renal and mesenteric blood flow through its action on alpha – adrenergic and beta1-adrenergic receptors Dobutamine is used for increased myocardial force and cardiac output through stimulation of beta1.adrenergic agonist. to produce local vasoconstriction . are used to treat asthma and allergy Dopamine agonist. isoproterenol (isuprel). and mydriasis.V. thereby decreasing blood flow to the site and prolonging anesthetic action. myocardial contractility. angina. epinephrine (Adrenalin. Bricanyl ) INDICATIONS Alpha –adrenergic agonist. Suldafed). dopamine (In tropin). urinary urgency or incontinence. tachycardia. pseudoephedrine (Novafed. metaproteronol sulfate (Alupent). are used to treat mild renal failure caused by decreased cardiac output Epinephrine is used for bronchodilation in asthma or allergic reactions. are used to treat heart failure Beta2. to treat severe hypotension or shock CONTRAINDICATIONS AND PRECAUTIONS Epinephrine is contraindicated in angle-closure glaucoma Dopamine and isoproterenol are contraindicated in patients with tachyarrhythmias ADVERSE REACTIONS Arrhythmias. cardiac stimulation in cardiac arrest. phenylephrine (Neosynephrine). dobutamine (Dobutrex). and heart rate and accelerate AV conduction. it’s also used to stimulate alpha. Ventolin). which increase blood pressure.and beta2 receptors and . overuse of nasal decongestants may result in rebound stuffiness .adrenergic agonist. restlessness. beta1.adrenergic receptors for patients with acute congestive heart failure and those undergoing cardiopulmonary bypass Albuterol and metaproterenol are used for bronchodilation Terbutaline is used for brochodilation and to delay delivery in preterm labor Psuedoephrine and phylephrine are used for nasal decongestion Phenylephrine is given I. noropinephedrine (Levophed). which cause peripheral vasodilatation and bronchodilation. which dilate renal arteries in low does. when combined with local anesthetics. susphrine). Excretion: Varies widely with each drug DRUG EXAMPLES Albuterol (Proventil.
Raynaud’s disease.muscle relaxants and vasodilators. and hemodynamics or on relief of bronchospasms without serious adverse effects ADRENERGETIC BLOCKERS (SYMPATHOLYTICS) ALPHA – ADRENERGETIC BLOCKERS MECHANISM OF ACTION Inhibition sympathetic activity by activating or inhibiting alpha-and betareceptors that normally are activated by norepinephrine . coronary insufficiency. phenoxybenzamine (Dibenzyline). as ordered.INTERACTIONS Antagonize the effects of beta blockers ( epinephrine. and urine output to prevent the adverse effects listed above Monitor the electrocardiogram and hemodynamic parameters for undesirable changes Correct hypovolemia before infusing dopamine or norepinephrine to ensure the drug’s effectiveness Administer drugs through a large vein to prevent extravasations. pregnant women . if extravasation occurs during infusion of dopamine or norepinepherine. and norepinephrine) NURSING RESPONSIBILITIES Explain to the patient the purpose of the drug Assess the patient’s vital signs. as appropriate Base patient evaluation on improved vital signs. pheochromocytoma) Phenoxybenzamine is used to treat Raynaud’s disease Phentolamine is used to diagnose and treat hypertension secondary to pheochromocytoma and treat extravasation of vasopressors Ergotamine is used to treat vascular headache CONTRAINDICATIONS AND PRECAUTIONS Patients who have had a myocardial infraction (MI). vascular headaches. phentolamine (Regitine) INDICATIONS As smooth. more rapidly and completely absorbed when administered sublingually Distribution: unknown Metabolism: Metabolized by the liver Excretion: Excreted in the feces with only traces in the urine DRUGS EXAMPLE Doxazosin mesylate (Cardura). ergotamine tartrate (Ergostat). Teach the patient how to administer the prescribed inhalation drug. infiltrate the skin with phentolamine (Regitine) and normal saline solution. or other evidence of coronary artery disease. used to treat peripheral vascular disorders. breath sounds. isoproterenol. urine output. ergotamine tartrate with caffeine (Cafergot). or dopamine receptors that are activated by dopamine PHARMACOKINETICS Absorption: Absorption is erratic when administered orally. and adrenergic excess (for example.
GI irritation. quiet room. found predominantly in the heart Nonselective beta blockers block both beta1 and beta2 receptors. tachycardia. characterized by numbness. Monitor the patient receiving ergotamine for signs and symptoms of vascular insufficiency due to ergotism. place the patient in resuscitation. ischemic extremities. as appropriate BETA. as ordered. arrhythmias. which may result in bronchospasm in individuals with asthma or obstructive lung disease PHARMACOKINETICS Absorption: Usually absorbed rapidly and well from the GI tract and some drugs are absorbed more completely than others. and cerebral ischemia) NURSING RESPONSIBILITIES When administering phenoxybenzamine or phentolamine. and blindness INTERACTIONS Use with antihypertensives (phenoxybenzamine) potentiates hypotensive effects Use of adrenergic agonists with other adrenergic causes additive effects Use with epinephrine or ephedrine will antagonize their vasoconstricting and hypertensive effects Use of ergotamine tartrate and caffeine suppository with potent CYP3 A4 inhibitors (such as macrolides and protease inhibitors) can cause ergot toxicity (vasospasms.ADRENERGIC BLOCKERS MECHANISM OF ACTION Reduce or block myocardial stimulation and cause vasodilatation.ADVERSE REACTIONS Phenoxybenzamine and phentolamine may cause nasal congestion. dizziness. and explain the test to the patient Instruct the patient to change positions slowly to minimize orthostatic hypotension. monitor blood pressure for signs of orthostatic hypotension If a phentolamine test is scheduled. Inform the patient that the intended effects of phenoxybenzamine may take 1 week to appear Instruct the patient with vascular headache and then lie down in a dark. such as numbness. orthostatic hypotension. tingling of fingers and toes. and miosis Ergotamine may cause ergotism (chronic poisoning from excessive ergot use). food may enhance absorption . weakness. tingling. or weakness in extremities Administer with milk or food to minimize gastric irritation If the patient experiences a shocklike state. withhold all antihypertensives. reducing glycogenolysis and bronchodilator effects Selective beta block beta1 and beta2 receptors.
Timolol (Blocarden) INDICATIONS Beta Blockers are used to treat hypertension. penbutolol. with highest concentrations in the heart. heart block ADVERSE REACTIONS Arrhythmias. apply pressure to the inner canthus of the eye for 1 minute to minimize systemic absorption Teach the patient to monitor pulse and blood pressure for adverse changes (for specific teaching tips(teaching about beta-adrenergic . withhold the drug and notify the physician if the rate is below 50 beats/minute (or according to hospital policy) After administering eyedrops. liver . esmolol. Labetalol (Ormodyne). diarrhea. usually metabolized in the liver Excretion: Excreted in feces. metipranolol. lungs.carvedilol. distributed widely in the body tissues. and timolol are used to treat hypertension Atenolol. Nadolol (Corgard). and propranolol are used to treat angina Acebutolol. bradycardia. and saliva Metabolism: Except for nadolol and atenolol. Carvedilol (Coreg). Trandate). and may mask signs and symptoms of hypoglycemia (such as tachycardia and sweating) NURSING RESPONSIBILITIES Assess the patient’s pulse rate. sotalol and propranolol are used to treat tachyarrhythmias Carvedilol is used to treat mild to severe heart failure and left ventricular dysfunction after MI Metoprolol. Atenolol (Tenormin). nausea.metaprolol.Propranolol (Inderal).atenolol. betaxolol (Betopti. urine. metoprolol. Kerlone). and tachyarrhythmias and to prevent migraine headache. and acute anxiety reaction Acebutolol. levobunolol (Betagan). propranolol. esmolol (Brevibloc).glaucoma. Pindolol (Visken). Penutolol (Levatol). Distribution: Somewhat protein. bronchospasm. Metipranolol (OptiPranolol). propranolol. angina. vomiting.betaxolol. may alter insulin requirements. nadolol.labetalol. and breast milk DRUGS EXAMPLES Acebutolol (Sectral). brochospasm. increased sensitivity to cold INTERACTIONS Use with drugs having similar effects(such as antiarrhythmics and calcium channel blockers) may cause additive myocardial depression and bradycardia Use with insulin or hypoglycemics increases the risk of hypoglycemia.bound. Sotalol (Betapace).carteolol. Carteolol (Artrol). MI. and timolol are used to treat glaucoma CONTRAINDICATIONS AND PRECAUTIONS Bradyarrhythmias. and timolol are used to prevent MI Propranolol is used to prevent vascular headache Betaxolol. Metoprolol (Lopressor). pindolol. lovobunolol. nadolol.
pancuronium bromide.) If appropriate.vecuronium bromide (Norcuron) Indications For prolonged or intermediate muscle relaxation during surgery or facilitation of endotracheal(ET) intubation For paralysis in patients who are insufficiently ventilated or who fight with the ET tube or ventilator Contraindications and precautions Contraindicated in patients hypersensitive to drug and in neonates because these drugs contain benzyl alcohol Use cautiously in pregnant and breast-feeding women Adverse reactions Apnea.cisatracurium besylate(Nimbex).skin reactions. therefore. encourage the patient to comply with other recommended antihypertensive interventions(such as weight reduction.such as antibiotics and anesthetics.they don’t alter consciousness or pain perception Metabolism:Partially metabolized in the liver Excretion:Most are excreted unchanged in the urine Drugs examples Atracurium besylate (Tacrium). moderation of alcohol consumption. regular exercise and stress management Instruct the patient to carry identification describing the disease and drug regimen Advise the patient who is receiving long-term therapy not to discontinue the drug suddenly because this may precipitate an IM or arrhythmias NEUROMUSCULAR BLOCKERS NONDEPOLARIZING DRUGS(COMPETITIVE OR STABILIZING DRUGS) Mechanism of action Comparison with acetycholine at the cholinergic receptor sites of the skeletal muscle membrane. dietary sodium restriction.thereby blocking acetylcholine transmitter action and preventing muscle membranes from depolarizing Pharmacokinetics Absorption:Absorb parenterally because they are poorly absorbed after oral administration Distribution: Distributed rapidly throughout the body but don’t cross bloodbrain barrier.excessive bronchial or salivary excretions Interactions Most drugs.smoking cessation.blockers –make sure to include the ff topics in your teaching plan for the patient receiving a beta-adrenergic blocker. that interact with a nondepolarizing blocker will have an additive effect .doxacurium chloride(Nuromax). bronchospasms. hypotension.
personal or family history of malignant hyperthermia. administration is the preferred route Distribution:Unknown Metabolism:hydrolyzed in the liver and plasma by pseudocholinesterase Excretion: Excreted in the urine:about 10% is excreted unchanged Drugs Succinylcholine chloride (Anectine. hand grip. myopathies associated with elevated creatine phosphokinase. head lift. especially apnea or bronchospasm. never turn off the ventilator alarm DEPOLARIZING DRUGS Mechanics of action Produce a biphasic effect at the skeletal muscle .V.The second phase is seen only in high doses Pharmacokinetics Absorption:Absorbed poorly in the GI tract.Quelicin) Indications For short-term muscle relaxation as an adjunct to general anesthesia to facilitate ET intubation To induce skeletal muscle relaxation during surgery or mechanical ventilation Contraindications and precautions Contraindicated in patients with a known hypersensitivity to the drug or its components. and ability to cough) Keep drugs refrigerated to maintain their potency Suction the patient as needed because the drug will suppress the cough reflex and increase respiratory secretions Frequently check the mechanical ventilator settings and functions to ensure that it’s working properly.pyridostigmine. as evidenced by increased muscle strength (peripheral nerve stimulation. and edrophonium) antagonistic and are used as antidotes to nondepolarizing blockers are Nursing responsibilities Monitor the patient for any adverse reactions. Anticholinesterases(neostigmine. during drug therapy Have oxygen and ET and suction equipment available at all times in case respiratory support is needed Monitor respirations frequently until the patient is fully recovered from the neuromuscular blockade.First phase : These drugs compete with acethycholine at the cholinergic receptors of the skeletal muscle membrane and depolarize that postsynaptic membrane of the muscle: NOT counteracted by antichonesterase causing persistent depolarization followed by muscle fasciculations and paralysis or flaccidity . or penetrating eye injuries . a genetic disorder of plasma pseudocholinesterase. I. acute angle-closure glaucoma. levels.
pemoline (Cylert.hepatic.pulmonary. and a diminished sense of fatigue Pharmacokinetics Absorption: Absorbed in the GI tract after oral administration Distribution: Varies with each drug Metabolism: Usually metabolized by the liver Excretion: Excreted in the urine Drug examples Dexmethyphenidate hydrochloride (Focalin). or renal disorders Adverse reactions Prolonged apnea and cardiovascular effects. dextroamphetamine(Dexedrine). signs of recovery include a renewed ability to cough.methylphenidate. methylphenidate hydrochloride (Concerta. and a return of previous levels of muscle strength on hand-grip and head-lift tests CNS STIMULANTS Mechanism of action Increase neurotransmitter levels in the CNS. possible muscle pain and increased intraocular pressure Interactions Anticholinesterases increase succinylcholine blockade Check the patient’s respiratory rate and pattern every 5 minutes during drug infusion Nursing Responsibilities Maintain a patent airway for the patient at all times Check the patient’s respiratory rate & pattern every 5 minutes during drug infusion Monitor the patient closely until recovery from the neuromuscular blockade is complete. Methylin.causing CNS and respiratory stimulation. pupil dilation. Use cautiously in pregnant or breast-feeding women.Ritalin). heightened mental alertness.doxapram (Dopram). Metadate.children. either by increasing neuronal discharge or by blocking an inhibitory neurotransmitter. brighter spirits. and patients with cardiovascular.metabolic. increased motor activity.and pemoline are used to treat narcolepsy and ADHD Doxapram is used to treat respiratory stimulation after anesthesia .PemADD) Indications To increase mental alertness and respiratory rate To treat hyperactivity in children Dexmethylphenidate hydrochloride effectively manages symptoms of attention deficit hyperactivity disorder(ADHD) at half the dose of Ritalin Dextroamphetamine.
insomnia.in the patient with ADHD. base evaluation on increased activity and alertness. and a prolonged attention span(these effects usually appear in 3 to 4 weeks) . and brighter spirits . assess the patient’s respiratory status(including lung sounds and rate and depth of respirations) and arterial blood gas(ABG) measurement for changes Keep in mind that most CNS stimulants are controlled substances and that amphetamines may cause dependence and abuse Instruct the patient to take the last daily dose at least 6 hours before bedtime to prevent insomnia Instruct the patient to avoid beverages containing caffeine to prevent added stimulation Base patient evaluation on the reason for using the drug .in the patient with narcolepsy. depression.decreased hyperactivity. tremor. irritability. irritability. and CV collapse Chronic adverse effects include marked weight loss.base evaluation on improved respiratory status and ABG measurements ANTICONVULSANTS HYDANTOINS Mechanism of action Inhibit seizure activity by promoting sodium outflow from the neurons. angina.Contraindications and precautions Contraindicated in patients with glaucoma and severe cardiovascular (CV)disease Use with caution in patients with psychosis and in pregnant and breastfeeding women Adverse reactions Acute adverse effects (toxicity) include restlessness. base evaluation on increased calmness. fatigue.thereby depressing abnormal neuronal stimulation and discharge Pharmacokinetics . hypotension.in the patient receiving doxapram to treat respiratory depression after anesthesia. and growth suppression (in children) Interactions Concurrent use with similar-acting drugs causes additive sympathomimetic effects Altered urine Ph may alter the effectiveness of CNS stimulants .diminished fatigue. arrhythmias.Urine acidification enhances renal excretion of the drug .Urine alkalinization enhances renal absorption of the drug Nursing responsibilities Assess the patient’s behavior to determine drug effectiveness Monitor growth in a child who is receiving long-term therapy When administering doxapram.
Phenytek) Indications To treat tonic-clonic (grand mal) seizures.). infuse no faster that 50 mg/minute Teach the patient about the importance of good oral hygiene and regular dental examinations to prevent gingival hyperplasia If GI upset occurs. and complex partial seizures Phenytoin also is used to treat arrhythmias and painful conditions. nystagmus. half-life varies and is dose-dependent Drug examples Ethotoin (Peganone). activity. cycloserine.nausea and vomiting Interactions Alcohol (long-term use). sulfamethizole and valproate may increase phenytoin. fosyphenytoin sodium (Cerebyx).influenza vaccine. and dysarthria). bioavailability varies among products. Distribution: Protein-bound . diplopia. oral anticoagulants.V.disulfiram.V).distributed in breast milk Metabolism: Metabolized in the liver Excretion: Excreted in the urine. such as trigeminal neuralgia Contraindications and precautions Contraindicated in patients hypersensitive to drug or its components Phenytoin is contraindicated in patients with sinus bradycardia. rare blood dyscrasias. coma. chloramphenicol. slurred speech. leading to phenytoin toxicity Oral tube feedings may interfere with absorption of oral phenytoin. may give drug with food . treatment for toxicity is nonspecific Monitor therapeutic hydantoin. or Adam-Stokes Syndrome Adverse Reactions Gingival hyperplasia. ataxia. second-and third. salicylates. or unresponsive pupils. feedings should be scheduled at least 1 hour before or 2 hours after phenytoin dose Phenytoin is incompatible with dextrose and any dextrose containing solutions Nursing responsibilities Monitor the patient for signs and symptoms of toxicity(ataxia. and folic acid may decrease phenytoin activity and diminish the drug’s effectiveness Amiodarone. hypotension. nystagmus. phenylbutazone. diazepam. status epilepticus (I. isoniazid. rifampin. Absorption: Usually slowly absorbed in the small intestines after oral administration. and liver enzyme levels to avoid or detect toxicity When administering phenytoin intravenously (I. drowsiness. antihistamines. dilute in normal saline solution (dextrose solutions cause a precipitate). diminishing the drug’s effectiveness. complete blood count. tremors.degree heart block. diazoxide.mephenytoin(Mesantoin). phenytoin(Dilantin.cimetidine. sinoatrial block.
in high doses. hypotension. Instruct the patient to consult the physician or pharmacist before changing drug brands because bioavailability may differ among brands (for specific teaching tips) BARBITURATES AND DEOXYBARTITURATES Mechanism of action Depress the sensory cortex and motor activity and alter cerebellar function. may be used as an emergency control for acute convulsive episodes Contraindications & Precautions * Barbiturates are contraindicated in patients who are sensitive to barbituarates & in pregnant & breast feeding women * Also contraindicated in patients with hepatic impairment or severe respiratory disease & in those who have had a previous addiction to a sedative or hypnotic * Intra-arterial & subcutaneous (SC) administrations are contraindicated Adverse Reactions Dizziness. and insomnia As adjuncts to anesthesia. primidone is also excreted in breast milk Drug examples Mephobarbital(Mebaral). and hypnosis. barbiturates may induce anesthesia Pharmacokinetics Absorption: Absorbed slowly in the GI tract. especially following prolonged use at high dose . blood dyscrasias Interactions Alcohol may cause additive CNS effects & death Phenobarbital toxicity can occur if primidone is given with Phenobarbital (primidone is metabolized in the liver to Phenobarbital) Barbiturates reduce the effectiveness of hormonal contraqceptives Nursing Responsibilities Assess patient’s respiratory status before & during drug therapy Discourage alcohol use during drug therapy Know that barbiturate3s maybe habit-forming.sedation.primidone (mysoline) Indications To treat tonic-clonic (grand mal)seizures. drowsiness.Phenobarbital(Luminal).causing drowsiness. rate of absorption increases if given on an empty stomach Distribution: Protein-bound and well distributed in body tissues Metabolism: Metabolized by the liver Excretion: Excreted in the urine. partial seizures. respiratory depression (with high doses). tolerance & psychological & physical dependence may occur.
under the skin during drug therapy. Monitor the patient for withdrawal symptoms Minor symptoms may appear 8 to 12 hours after the last dose &include anxiety. blood dyscrasias. weakness. muscle twitching. dizziness. drowsiness. unusual bleeding or bruising. mouth sores. or tiny broken blood vessels. or blurred vision develops Tell patient to avoid alcohol during therapy OXAZOLIDINEDIONES Mechanisms of actions Affect the brain and nervous system to change seizure patterns . bruising. give the drug with food or milk Monitor for adverse reactions Notify prescriber if rashes. drowsiness. Metabolized in the liver Excreted in the urine When to use succinimides Absence of seizures When not to use succinimides Hypersensitivity Adverse reaction to watch for Anorexia. nausea. and elevating the threshold of the CNS to convulsive stimuli. SUCCINIMIDES Mechanisms of Action Reduce epileptic attacks by suppressing paroxysmal three cycle per second spike and wave activity. joint pain. dizziness. vomiting. bleeding. Phensuximide Key nursing actions Don’t withdraw the drug abruptly If GI upset occurs. depressing the motor cortex. hematuria Drug examples Ethosuximide (Milonitn) (Zarontin). sore throat. sore throat. ataxia. dizziness. & nausea & vomiting Severe symptoms include convulsions & delirium within 16 hours of last dose & may last after 5 days after abrupt cessation of these drugs Notify doctor immediately if patient develops fever. Methosuximide (Celontin). hand & finger tremors. unexplained fever.
SULFONAMIDES Mechanism of action Raise the threshold for generalized seizures in rats Increase dopaminergic and serotonergic neurotransmission Block sodium channels Stabilize neuronal membranes Suppress neuronal hypersynchronization When to use Partial seizure related to epilepsy When not to use Hypersensitivity Renal failure Adverse reaction to watch for Somnolence. fatigue.When to use Absence seizures When not to use Hypersensitivity Pregnancy Breast-feeding Liver disease Renal disease Diseases affecting the bone marrow Optic or retinal diseases Adverse Reaction Dangerous levels of sedation. or drowsiness. dizziness. anorexia Drug examples Zonisamide (Zonegran) Key nursing actions Monitor adverse reactions . headache. agitation. dizziness. or visual disturbances develop. rash easy bruising. ataxia. photosensitivity reaction Drug Example Trimethadione (Tridione) Key Nursing Reaction Give drug with food if patient complains of GI upset Advise patient that extreme drowsiness and sedation may occur Notify prescriber immediately if ataxia. sore throat. fever.
contact prescriber if the patient develops fever. refractory absence seizure. gabapentin (neurontin). felabmate (felbatol). or oral ulcers MISCELLANEOUS ANTI CONVULSANT Mechanism of action Action largely unknown. easy bruising. may reduce polysynaptic responses and block posttetanic potentiation by blocking voltage-sensitive sodium channels Metabolize in the liver Excreted in the urine When to use Tonic-clonic seizures Simple and complex partial seizures Trigeminal neuralgia Neurogenic pain Absence seizure Postherpetic neuralgia When not to use Hypersensitivity Bone marrow suppression Within 14 days of MAO inhibitor therapy Pregnancy Breast-feeding Adverse reaction to watch for Sedation. tiagabine (gabitril). valproate sodium (Depakene). photophobia. Key nursing actions Assess seizure characteristics Implement seizure precautions as indicated Watch for signs and symptoms of anticonvulsive toxicity Instruct the patient not to discontinue the drug without consulting the prescriber Warn the patient not to consume alcohol during anticonvulsant therapy . oxcarbazepine (Trileptal). levetiracetam (Keppra). drowsiness. lamotrigine (lamictal). divalproex sodium (depakote). If rash or seizure worsen. blood dyscrasias Drug examples Carbamazepine (Tegretol). topiramate (topamax). sore throat.
mood changes. or fatigue develops. easy bruising or bleeding. agitation. bromocriptine [dopar]). sore throat. levodopa (L-dopa Key nursing actions Assess for signs and symptoms of parkinsonism Base patient evaluation on improvement in signs and symptoms of Parkinsonism without severe adverse effects. dry mouth. involuntary movements. orthostatic hypotension. nausea. thereby . oral ulcers. Instruct the patient to carry identification describing the disorder and drug regimen Notify prescriber if fever. altered tastes. periphery. ANTICHOLINERGICS (CHOLINERGIC BLOCKERS) Mechanism of Action Block muscarinic acetylcholine receptors suppressing acetylcholine activity Metabolism and excretion unknown When to use Parkinson’s disease Idiopathic parkinson’s disease in the CNS. confusion. and in the liver Excreted in the urine When to use Parkinson’s disease Influenza A Hyperprolactinemia Cocaine abuser When not use Angle-closure glaucoma Adverse reaction Dizziness. insomia. vomiting. hallucinations Drug examples Amantidine(symmetrel). ANTIPARKINSONIAN DOPAMINERGIC AGONIST Mechanism of Action Restore natural balance of acetycholine and dopamine in the CNS Decrease signs and symptoms of Parkinson’s disease Metabolized in the brain. levodopa-carbidopa (sinemet) (parlodel). tremors.
biperiden (Akineton). administer drug with foods CHOLINERGICS (ANTIMYASTHENICS) Mechanism of Action Relieve muscle weakness associated with myasthenia gravis by blocking acetylcholine breakdown at the neuromuscular junction Undergoes hydrolysis by cholinesterase or metabolize by the liver Excreted in the urine When to use Myasthenia gravis Myasthenic crisis When not to use Hypersensitivity Bromide allergy Adverse reaction Abdominal pain. nausea. increased salivation. Postencephalitic parkinson’s disease Acute dystonic reaction Drug-induced extrapyramidal reactions When not to use Angle-closure glaucoma Pyloric and duodenal obstruction Myasthenia gravis Stenosing peptic ulcer Achalasia Megacolon Prostatic hypertrophy Bladder neck obstructions Adverse reactions Blurred vision Constipation Dry mouth Urine retention Drug examples Benztropine mesylate (Cogentin). difficulty breathing . diarrhea. miosis. diphenhydramide hydrochloride (Benadryl) Key nursing action Assess bowel and urinary function for evidence of adverse effects Instruct patient to consult health care provider or pharmacist before taking nonprescription drugs If GI upset occurs. vomiting. sweating. increased bronchial secretions.
fever. nausea. and kidneys When to use Pain arthritis and osteoarthritis fever reduction inflammation reaction prevention of transient ischemic attacks and MI dysmenorrheal When not to use aspirin hypersensitivity bleeding disorders children GI ulcers pregnancy Adverse reactions GI pain and upset.S. aspirin (A. angioneurotic edema. laryngeal edema. breast milk. mucosal lesions. 2) inhibits prostaglandin synthesis in the CNS and stimulate peripheral vasodilation to reduce fever.Drug examples Edrophonium (mestinon) (tensilon). bronchospasm. dizziness. diarrhea. Metabolized in the liver Excreted in the urine. rash. heartburn. neostigmine (prostigmine). and shock Drug examples Salicylate analgesics. rhinitis.A) Key nursing action administer the drug before meals for a rapid effect and with meals for GI irritation reductions . tinnitus. vomiting. pyridostigmine Key nursing actions assess neuromuscular status monitor patient for signs and symptoms of drug overdose or underdose urge patient to carry identification describing the disease and drug regimen base patient evaluation on improvement of neuromuscular symptoms or strength without cholinergic signs or symptoms NONOPIOID ANALGESIC Mechanisms of action Act peripherally to prevent prostaglandin formation in inflamed tissues by two actions: 1) inhibits stimulation for pain receptors. headache.
vomiting. advise the patient that the CCD warns against giving salicylates to children or adolescents with influenza. or viral illness OPIOID ANTAGONIST Mechanisms of action completely blocks the effect of opioid without producing analgesic effects may cause withdrawal symptoms in patient with physical dependence on opioid metabolized in the liver excreted in the urine When to use opioid overdose adjunct to therapy in treating drug abuse Adverse reaction nausea. reversible CNS depression Drug examples Methohexital (brevital). varicella. naloxone (Narcan) Key nursing actions assess respiratory status.propofol Keys facts about rapid-acting hypnotics Stabilize neuronal membranes to produce progressive. arrhythmias. hypertension. hypotension. RAPID-ACTING HYPNOTICS Mechanics of action Stabilize neuronal membranes to produce progressive. tachycardia.thiopental sodium (Pentothal) hydrochloride(versed).midazolam (diprivan). hyperventilation and tremors Drug examples nalmefene (Revex). blood pressure. pulse and level of consciousness until the opioid wears off opioid dosage should be adjusted according to the patient’s pain level give only the amount required to reverse respiratory depression or increase mental alertness. reversible CNS depression Metabolized hepatically Renal or hepatic excretion Indications fro rapid-acting hypnotics Anesthesia induction and maintenance Anesthesia extension .
as prescribed . INJECTABLE ANALGESIC ANESTHETICS Mechanics of action Depress the CNS Metabolized by liver Excreted in feces When to use injectable analgesic anesthetics Rapid anesthesia or conscious sedation induction Pain Drug examples Alfentanil (Alfenta). keep the patient warm with extra blankets or heat and administer oxygen. etomidate. hypotension. muscle twitching. and renal status and level of consciousness before and after surgery INHALATION ANESTHETICS Mechanics of action Depress the CNS Metabolized in lungs and liver Excreted in urine When to use inhalation and anesthetics Promotion of loss of consciousness.memory loss Key nursing actions Keep atropine available at all times to reverse possible bradycardia Monitor the patient’s temperature frequently Shivering is normal during recovery. tachycardia.Adverse reactions Respiratory depression. respiratory. fentanyl (sublimaze) . arrhythmias. enflurane (ethrane)halothane Adverse reactions Exaggerated response to the normal dose(most common). to compensate for the increased oxygen demand. loss of responsiveness to sensory stimulation including pain. Assess CV. and muscle relaxation Anesthesia maintenance Drug examples Desflurane (suprane). tissue necrosis with extravasation Key nursing actions Determine if patient has allergies before the surgery. nausea and vomiting. if shivering occurs.agitation. tachycardia.postanesthesia nausea and vomiting. hypotension. confusion. apnea.
and shivering Key nursing reactions Continually assess respiratory status Only those experienced in endotracheal intubation should use these drugs NUEROLEPTANESTHETICS Mechanics of action Droperidol and ketamine produce dissociation from the environment during induction of anesthesia Droperidol-fentanyl produces pain relief and sedation by directly blocking subcortical receptors Metabolized in liver Excreted in feces When to use neuroleptanesthetics Analgesia induction When NOT to use neuroleptanesthetics Hypertension Cardiac decompensation History of cerebrovascular accidents Surgery of the pharynx. bradycardia. and torsade de pointes Key nursing actions In droperidol-fentanyl.When NOT to use injectable analgesic anesthetics Hypersensitivity Adverse reactions Respiratory depression. extrapyramidal signs and symptoms. asystole. seizures. larynx. cough. brochospasms. excessive salivation. laryngospasm. urine retention. shivering. respiratory depression. seizures. hypotension. skeletal and thoracic muscle rigidity. muscles rigidity. or brochial tree Adverse reaction Arrhythmias. disturbing dreams or hallucinations. arrhythmias. QT interval prolongation. all dose of analgesics and other CNS depressants must be reduces by one-third to one-half during recovery from anesthesia LOCAL ANESTHETICS Mechanics of action Provide analgesic relief by blocking the conduction of nerve impulses at the point of contract Metabolism varies Excreted in the urine . dry mouth.
hypersensitivity reactions drug example benzocaine (dermoplast). bradycardia. mioisis. during and after application Don’t apply a refrigerated topical anesthetic to broken skin or mucous membranes . bupivacaine hydrochloride (Marcaine) key nursing action Assess for return of motor function and sensation postoperatively Ensure that the gag reflex has returned before feeding a patient whose throat has been anesthesized. arrhythmias. including spinal and epidural when not to use drug hypersensitivity myasthenia gravis severe shock impaired cardiac conduction adverse reactions possible anxiety. chills. restlessness.When to use Pain anesthesia. hypotension. TOPICAL ANESTHETIC Mechanism of action block nerve impulse transmission stimulate the nerve endings and interfere with pain perception stimulate the cold sensation receptors and block the nerve endings in the frozen area metabolized in the blood and liver excreted in urine When to use topical anesthetics pain anesthesia surface numbing When NOT to use topical anesthetics Drug hypersensitivity Adverse reactions Hypersensitivity Key nursing actions Assess the area where topical anesthetic is to be applied before.tinnitus.
BARBITURATES Mechanism of action The exact mechanism of action of barbiturates is unknown The drugs are believed to cause generalized CNS depression by mimicking or enhancing the effects of GABA in the brain Drug examples Rapid-acting barbiturates include thiopental sodium Short-acting barbiturates include pentobarbital When to use barbiturates Anesthesia Insomnia Seizures When NOT to use Barbiturates Pregnancy Uncontrolled pain History of acute intermittent porphyria and CNS depression Adverse reactions to watch for Hangover feeling.speechm paradoxical excitement Key nursing reactions Assess patient’s sleep patterns Administer I. doses slowly Know that many sedative-hypnotics are controlled substances Limit amount of medication available to patient Know that long-term use of these drugs may cause physical and psychological dependence Monitor patient’s respiratory status.chlordiazepoxide hydrochloride (Librium).slurred.XanaxXR).V. BENZODIAZEPINES Mechanism of action Cause generalized CNS depression by mimicking or enhancing the effects of GABA Metabolized by the liver Excreted in the urine Drug examples Alprazolam(Xanax.diazepam When to use benzodiazepines Anxiety Alcohol withdrawal Preoperative sedation amnesia Insomnia Seizures . clorazepate (Tranxene).clonazepam(Klonopin).
Advise patient not to increase dosage unless instructed by physician NONBARBITURATES SEDATIVE-HYPNOTICS AND ANXIOLYTICS Mechanism of action Cause generalized CNS depression Metabolized by the liver Excreted in the feces Drug examples Buspirone(BuSpar). excitement.or hostility Key nursing action Administer I. doses slowly.diphenhydramine When to use nonbarbiturates sedative-hypnotics and anxiolytics Anxiety Insomnia Preoperative sedation As adjuncts to opioid analgesics General anesthesia When NOT to use nonbarbiturates sedative-hypnotics and anxiolytics Pregnancy Uncontrolled pain Preexisting CNS depression Adverse Reactions Drownsiness Respiratory depression Key nursing actions Use z-track method of injection(hydroxyzine) Administer after meals(Chloral hydrate) . ataxia. Instruct patient to notify physician if dose becomes ineffective after a few weeks. temporary memory impairments.Chloral hydrate(Noctec). Skeletal muscle relaxation When NOT to use benzodiazepines Pregnancy Uncontrolled pain Preexisting CNS depression Acute angle-closure glaucoma Adverse reactions Drowsiness.V. reactions of rage.
sedation. inhibiting transmission of neural impulses Inhibit the chemoreceptor trigger zone in the medulla of the brain Metabolized in the liver Excreted mostly in the urine Drug examples Chlorpromazine(thorazine).mesoriadazine When to use phenothiazines Psychosis.PHENOTHIAZINES Mechanism of action Block the neurotransmitter dopamine in the limbic system. blood dyscrasias. constipation. depression with psychotic features. haloperidol(Haldol) .inhibiting transmission of neural impulses(antipsychotic action) These drugs also inhibit the chemoreceptor trigger zone in the medulla of the brain Metabolized in the liver Excreted mostly in the urine Drug examples Droperidol(Inapsine). fluphenazine(prolixin). heat intolerance Key nursing actions Tell patient that phenothiazines may discolor urine to pink or redbrown Instruct patient to call physician before taking over-the-counter or herbal preparations Monitor QT interval in patient taking thioridazine BUTYROPHENONES Mechanism of action These drugs block the neurotransmitter in the limbic system.psychotic symptoms associated with organic brain symptoms associated with organic brain syndrome Nausea and vomiting When NOT to use phenothiazines Angle-closure glaucoma CNS depression Pregnancy (first trimester) Coma Risk of suicide Adverse reactions Extrapyramidal symptoms. photosensitivity reaction.schizophrenia. blurred vision.tardive dyskinesia. dry mouth.neuroleptic malignant syndrome.schizoaffective disorder. sunburn.
sunburn. neuroleptic malignant syndrome. constipation. hyperactivity in hyperactive children When NOT to use butyrophenones Angle-closure glaucoma CNS depression Adverse reaction Extrapyramidal symptoms.heat intolerance Key nursing action Tell patient to avoid driving or other hazardous activities until CNS effects of drug are known Advise patient to avoid alcohol and other CNS depressants during therapy ATYPICAL ANTIPSYCHOTICS Mechanism of actions Block the neurotransmitter dopamine in the limbic system.blurred vision.nueroleptic malignant syndrome. photosensitivity reaction. heat intolerance Drug example Clomipramine (anafranil). blood dyscrasias. blurred vision. tardive dyskinesia. behavioral problems in children with explosive hyperexcitability. inhibiting the transmission of the neural impulses. tardive dyskinesia. blood dyscrasias. dry mouth. clozapine (clorazil) Key nursing action assess the patient’s mental status . constipation. sedation. sunburn. Inhibit the chemoreceptor trigger zone in the medulla of the brain Metabolize by the liver Excreted in the urine When to use Psychotic disorders such as schizophrenia and schizoaffective disorders Obsessive-compulsive disorder Bipolar disorder Risk of suicidal behavior When not to use Angle-closure glaucoma CNS depression Adverse reaction Extrapyramidal symptoms. photosensitivity reaction. sedation.When to use butyrophenones Nausea and vomiting during surgery and diagnostic procedures As adjunct to anesthesia Psychosis. dry mouth. Tourette syndrome.
avoid driving and hazardous activities until CNS effects of drug are known . SECOND-GENERATION. thus increasing serotonin levels at the synapse Metabolized by the liver Tricyclic antidepressants excretion mostly in the urine as metabolites When to use Endogenous depression.avoid alcohol and other CNS depressant . seizures. nausea. anticholinergic effects Somnolence. episodes of major depression Enuresis Anxiety Neurogenic pain (unlabeled use) Generalized anxiety disorder Obsessive-compulsive disorder Depression Bulimia nervosa Smoking cessation Premenstrual dysphoric disorder When not to use MAO inhibitor therapy Active liver disease Drug example Tricyclic antidepressant include amitriptyline hydrochloride (Endep). or both through reuptake inhibition. asthenia. blurred vision. drowsiness. thus normalizing the receptor site associated with depression SSRI’s block the reuptake of serotonin into the presynactic cells. sexual disturbances . amoxapine (asendin). serotonin. fatigue. clomipramine(anafranil).comply with therapy . AND MISCELLANEOUS ANTIDEPRESSANTS AND SSRI’s Mechanism of Action tricyclic and second-generation antidepressants increase the amount of norepinephrine. tremor. imipramine (tofranil). monitor patient for orthostatic hypotension know that the patient receiving long term antipstchotic therapy should undergo regular evaluation of red and white blood counts don’t give antacids within 1 hour of administering these drugs know that the drug should be discontinued gradually teach the patient to: . rash. monitor patient for extrapyramidal symptoms and other adverse reaction if the patient is recovering from anesthesia with droperidol or fentanyl. exacerbation of heart failure or bundlebranch block Insomia. dry mouth.use sunscreen and wear protective clothing ANTIDEPRESSANTS TRICYCLIC. Adverse reaction Orthostatic hypotension. tachycardia. decrease opioid analgesic dosages to one-quarter to one third of normal after parenteral doses. constipation.
but to swallow them whole MONOAMINE OXIDASE (MAO) INHIBITORS Mechanism of action Impair inactivation of norepinephrine . liver disease or abnormal liver function test results.insomnia.tricyclic antidepressants. dry mouth. nausea. antihypertensives.drowsiness. hypertension. CNS depressants. renal impairment.serotonin. peripheral edema. or both.history of headaches With other MAO inhibitors.Key nursing action Know that these drug should be discontinued gradually Know that these drug may take several weeks to produce desired effects Teach patient to : o Avoid alcohol and nonprescription drugs o Avoid driving and other hazardous activities until CNS effects of drug are known o Take daily dose of tricylic antidepressants at bedtime o Take fluoxetine or paroxetine early in day o Not crush controlled-release tablets. thus prolonging their presence in CNS synapses and increasing their concentrations in the body Metabolized in the liver Excreteed mainly in the feces and partly in the urine When to use MAO inhibitors Depression Bulimia(Unlabeled use) Panic disorder with associated agoraphobia and globus hystericus syndrome (unlabeled use) When NOT to use MAO Inhibitors Hypersensitivity to MAO inhibitors or their components Pheochromocytomas.headache. constipation. anorexia. and vomiting Hypertensive crisis Key nursing action Don’t administer these drugs in the evening Assess patient’s mental status for mood changes and suicidal tendencies Know that it may take several weeks for these drugs to produce desired effects Be alert for suicide attempts when depression begins to lift and energy improves . caffeine. anesthetics. dizziness.cheeses or other foods high in tyramine Adverse reaction Restlessness. blurred vision. orthostatic hypotension.heart failure. confirmed or suspected cerebrovascular disease.
polydipsia.lithium citrate When to use lithium Mania Bipolar affective disorders When Not to use lithium Renal or cardiovascular disease Breast-feeding Severe dehydration Severe sodium depletion Severe debilitation Adverse reactions Hand tremors. mild thirst. polyuria. as necessary Assess patient for signs and symptoms of lithium toxicity. including vomiting. Teach patient to: o Drink 2 to 3 L of fluid daily.abdominal pains. and avoid activities that cause excess sodium loss o Avoid driving and other hazardous activities until CNS effects of drug are known . avoid excessive amounts of coffee. and twitching. hypertonia.nephrogenic diabetes insipidus Key nursing actions Know that tolerance for lithium is high in acute phase of mania and decreases as mania subsides Assess for suicidal tendencies and institute suicide precautions. maintain adequate salt intake.transient muscle weakness. decreased coordination. drowsiness. slurred speech.storage. vomiting. tea. Monitor patient for signs and symptoms of hypertensive crisis Teach patient to: o Avoid alcohol and foods containing tyramine o Carry identification describing disorder and drug regimen ANTIMANICS(LITHIUM) Mechanism of action Alters the sodium transport in nerve and muscle cells Affect synthesis. anorexia. bloating. muscle weakness. release and reuptake of central monoamine neurotransmitters Antimanic effects may result from increases in norepinephrine reuptake and serotonin sensitivity Excreted mostly in the urine Drug example Lithium carbonate. and cola. nausea. diarrhea. diarrhea.
o Consult physician before taking nonprescription drugs .
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