sevoflurane (Sevorane

)
CLASSIFICATION MECHANISM OF ACTION induces a state in which the CNS is altered so that varying degrees of pan relief, depression of consciousness, skeletal muscle relaxation and reflex reduction are produced INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

General Anesthetics Functional General Anesthetics Induction Adult & childn Up to 8%, w/ or w/o O2 or O2/N2O. Maintenance Adult & childn 0.5-3% w/ or w/o concomitant N2O.

induction and maintenance of general anesthesia

>hypersensitive >history of malignant hyperpyrexia

> agitation > dizziness > drowsiness > increased cough > increased saliva >lightheadedness > nausea > shivering > vomiting

> Check the name of the patient and the time of administration. > Monitor vital signs. > Monitor all the body systems. > Continuous monitoring of pulse oximetry. > Postural BP should be taken. > Take note of that time that the drug has expired.

Adverse Effect: >Anaphylaxis >Irregular heartbeat >Seizure >Yellowing of the skin or eyes >Hypotension

>Stop durg immediately, administer oxygen >Start rapid fluid resuscitation >Make sure client is well ventilated >Seizure precation >Administer epinephrine

tetracaine hydrochloride (Pontocaine)
CLASSIFICATION MECHANISM OF ACTION Tetracaine acts by preventing the generation and transmission of impulses along nerve fibres and at nerve endings; depolarisation and ionexchange are inhibited. In general, loss of pain occurs before loss of sensory, autonomic and motor functions. INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

General Anesthetics Functional Local anesthetics; Topical anesthetics; Spinal anesthetics Subarachnoid Spinal anaesthesia Adult: 1% solution diluted with an equal volume of CSF immediately prior to admin or 5 mg of powder dissolved in 1 ml of CSF and admin slowly at a rate of 1 ml/5 sec. Elderly: Dose reduction may be needed. Ophthalmic Anaesthesia of the eye Adult: Instil 0.5-1% tetracaine solution or 0.5% ointment.

>Spinal anesthesia >Topical anesthesia

>Hypersensitivity to paminobenzoic acid or its derivatives, local anaesthesia of the ester type. >Low plasmacholinesterase concentrations, >Complete heart block >Bronchoscopy or cytoscopy >Application to inflamed traumatised or highly vascular surfaces >Instillation into the middle ear.

> Mild erythema at the application site, >slight oedema or pruritus, >blistering of the skin, >stinging sensation

> Check the name of the patient and the time of administration. > Check labs for low plasmasholinesterase concentration > Do not administer to inflamed or traumatized surfaces > Do not instill into the middle ear

Adverse Effects: >Anaphylaxis > Eye irritation >Watering >Increased sensitivity to light >Stop durg immediately, administer oxygen >Start rapid fluid resuscitation >Make sure client is well ventilated >Administer epinephrine >Advise patient to keep out of light and dim room if sensitivity to light occurs

ketorolac tromethamine (Toradol)
CLASSIFICATION MECHANISM OF ACTION May inhibit prostaglandin synthesis. Posesses antiinflammatory analgesic and antipyretic effects INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES > Shortening the dosing interval recommended will lead to an increased frequency and duration of side effects > Correct hypovolemia prior to administering > Determine any liver or renal dysfunction > Assess hydration >Advance renal impairement >Incomplete hemostatis use with aspirin CNS: Headache, nervousness, abnormal thinking depression, euphoria Miscellaneous: Purpura, asthma, abnormal vision, abnormal liver function > Drug may cause drowsiness, dizziness, avoid activities that require mental alertness > Avoid alcohol, NSAIDs, ASA without approval

General NSAIDS Functional Analgesic Adult: PO Moderate to severe pain 10 mg 4-6 hrly. Max: 40 mg/day. Max duration: 7 days. IV/IM Moderate to severe pain 60 mg via IM inj or 30 mg via IV inj. Ophth Ocular itching As 0.5% soln: Instill 1 drop 4 times/day. Post-op eye inflammation As 0.5% soln: Instill 1 drop 4 times/day for 2 wk, starting 24 hr after surgery for 2 wk.

PO: short term (up to ) five days management of severe acute pain that requires analgesia at the opiate level IM/IV: Use with morphine and meperidine shows an oploid-sharing effect, combination can be used for break through pain Opthalmic: Releive itching caused by seasonal allergic conjunctivitis post-operative inflammation

>Hypersensitivity >History of nasal polyps >Angioedema >Bronchospastic activity >Allergic renal impairement

CV: Vasodilation, Pallor GI: GI-pain, peptic ulcer, nausea, dyspepsia, flatulence, G.I. Bleeding

Cystoid macular oedema As 0.5% soln: Instill 1-2 drops 6-8 hrly starting 24 hr before surgery, continue for 3-4 wk after surgery. Pain and photophobia after incisional refractive surgery As 0.5% soln: Instill 1 drop 4 times/day for up to 3 days after surgery.

following cataract surgery.

Adverse Effects: GI: Perfuration, Hypersensitivity: Bronchospasm, Anaphylaxis > Administer after ANST > Stop drug immediately, administer oxygen, start rapid fluid resuscitation make sure the client is well ventilated, administer epinephrine

ephedrine sulfate (Pretz-D)
CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

General Sympathomimetic

Releases norepinephrine from synaptic Functional storage sites. Has Nasal Decongestant direct effects on alpha, beta-1 and Adult: beta -2 receptors, PO Diabetic causing neuropathic oedema increased BP due 30-60 mg 3 to arteriolar times/day. constriction and cardiac IV Reversal of stimulation, spinal or epidural bronchodilation, anesth-induced relaxation of GI hypotension tract smooth As 3 mg/mL soln: 3-6 muscle and nasal mg, up to 9 mg, may decongestion, repeat every 3-4 mins mydriasis and if needed. increase tone of the bladder trigone and vesicle sphincter

PO: Temporarily relieves the shortness of breath, tightness of chest and wheezing due to bronchial asthma Parenteral: Allergic disorders, Vasopressor in shock Nasal: Nasal congestion due to common sold, sinusitis sinus drainage

>Angle closure glaucoma, >anesthesia with cyclopropane or halothane >thyrotoxicosis, >diabetes, >lactation

CNS: Nervousness, shakiness, confusion, delirium CV: Precordial pain GU: Difficult and painful urination Miscellaneous: Pallor, respiratory difficulty, hypersensitivity reaction Adverse Effects: CV: Excessive dose may cause hypertension sufficent to result in cerebral hemorrhage

> Asses mental status and pulmonary functions > Notify provider if SOB is unrelieved by medication and is accompanied by chest pain, dizziness or palpitations > With males, report any difficulty or pain when voiding

> monitor blood pressure regularly

lidocaine hydrochloride (Xylocaine)
CLASSIFICATION MECHANISM OF ACTION Shortens the refractory period and suppresses the automaticity of ectopi foci without affecting conduction of impulses through cardiac tissue, increase electrical stimulation threshold INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES > Document CNS status General Anesthesia Functional Antiarryhtmic Surface anesth For pain: As 2% soln: 300 mg, not more often than 3 hrly.Regional anesth 50-300 mg (0.5% soln w/o adrenaline). Max: 4 mg/dose Epidural anesth 2-3 mL soln for each dermatome to be anaesthesized. Lumbar epidural: 250-300 mg (1% soln) for analgesia and 225-300 mg (1.5% soln) or 200300 mg (2% soln) for anesth and thoracic epidural: 200-300 mg (1% soln). In obstetric caudal IV: Acute ventricular arrhytmias Infiltration or regional anesthesia Buccal mucosal anesthesia >Hypersensitivy to amide- Body as a whole: type local anesthetics Malignant hyeprthermia >Stokes Adams Syndrome characterized by tachycardia; tachypnea, labile >Wolff-Parkinson-White BP, metabolic syndrome acidosis >Severe SA, AV or CV: intraventricular block Precipitation or aggravation of >Lactation arrythmias, hypotension >Presence of liver or kidney disease CNS: Dizziness, apprehension, euphoria, lightheadednes, nervouseness, drowsiness Allergic: Rash, Edema > Report sudden mental status changes > Symptoms such as dizziness, visual disturbances twitching and tremors may preclude convulsion

analgesia, up to 300 mg (0.5 or 1% soln). For surgical caudal analgesia: 225-300 mg (1.5% soln). Intraspinal Spinal anesth Normal vag delivery: 50 mg (5% hyperbaric soln) or 915 mg (1.5% hyperbaric soln). Caesarean operation: Up to 75 mg (5% hyperbaric soln). Other surgical procedures: 75-100 mg.

Adverse Effect: CV: Bradycardia possible cardiac arrest CNS: Convulsions Respiratory: Respiratory depression or arrest Other: Venousthrombosi s, phlebitis > Note any hypersensitivity to amide-type local anesthesia > Those with hepatic or renal diseas will be watched closely for adverse effects > Note pulmonary functions >Asses for respiratory depression > Monitor for hypertension

neostigmin methylsufate (Prostigmin)
CLASSIFICATION MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

General Inhibits Cholinergic Stimulant destruction of acetylcholine, Functional which increases Aminoglycosides, concentration at anticholinergic, sites where antidepressant acetylcholine is released, this Reversal of facilitates neuromuscular transmission of blockade impulses across Adult the myoneural 0.5-2.5 mg (0.05junction 0.07 mg/kg) neostigmine methylsulphate w/ atropine sulphate 0.61.2 mg (0.02-0.03 mg/kg). Max: 5 mg. Childn 0.05 mg/kg neostigmine methylsulphate w/ atropine sulphate 0.02 mg/kg. Max: 2.5 mg. Doses to be given by slow IV inj simultaneously in separate syringes over 1 min.

>Myasthenia gravis >nondepolarizin g neuromuscular blocker >antagonist >bladder distention >post-operative ileus

>Obstruction of intestine, renal system >Bromide sensitivity >Peritonitis >urinary tract obstruction ileus Precaution >Pregnancy C >Bradycardia >Hypotension >Seizure disorders >Bronchial asthma >Coronary occlusion

CNS: Dizziness, headache, sweating, weakness, drowsiness CV: Tachycardia, bradycardia, hypotension, Av block, ECG changes EENT: Miosis, blurred vision, lacrimation, visual changes GI: Nausea, diarrhea, vomiting, cramps GU: Frequency, incontinence, urgency

>Monitor V/S respiration during rest >Administer on empty stomach for better absorption >Give only with atropine sulfate available for cholinergic crisis

Myasthenia gravis Adult 1-2.5 mg IM/SC at intervals throughout the day if needed (eg mornings & before meals), giving a total dose of 5-20 mg. Childn 0.2-0.5 mg inj as required. Neonate 0.05-0.25 mg IM every 2-4 hr, ½ hr before feeding. Treatment is not usually required >8 wk of age.

INTEG: Rach, urticaria, flushing Adverse Effects: CNS: Seizures, paralysis CV: Dysrythmias, cardiac arrest RESP: Respiratiory depression, bronchospasm, constriction, laryngospasm, respiratory arrest, dyspnea >Monitor for bradycardia, hypotension, bronchospasm, headache, dizziness, seizure, respiratory depression >Discontinue if toxicity occurs >Seizure precaution >O2 ready at bedside >Have atropine sulfate available if toxicity occurs

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