Drug 3 | Allergy | Analgesic

B.

Pharmacologic Management Drug Name Generic Name Promethazi ne HCl Trade Name Phenergan Mechanism of Action Selectively blocks the H1 receptors, diminishing the effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions in sensitized people exposed to antigens; blocks cholinergic receptors in the vomiting centre that are believed to mediate the nausea and vomiting caused by gastric irritation, by input from the vestibular apparatus, and by input from the chemoreceptor trigger zone; depresses the RAS, including the parts of the brain involved with wakefulness. Pharmacokinetics A: Well absorbed (Oral, IM); peak plasma concentrations after 2-3 hr. D: Widely distributed: Brain, crosses the placenta, enters breast milk. Protein-binding: Indication General Indications - Prevention and treatment of nausea and vomiting associated with labyrinthitis - Prevention of motion sickness - Short-term management of insomnia - Symptomatic relief of perennial and seasonal allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria and angioedema - Amelioration of allergic reactions to blood or plasma Dermatographi Adverse Reaction Concentrations CNS: Dizziness, - Hypersensitivity to drowsiness, poor antihistamines or coordination, phenothiazines confusion, - Comatose patients restlessness, - Severe CNS excitation, depression seizures, tremors, - Bone marrow headache, blurred depression vision, diplopia, - Vomiting of unknown vertigo, tinnitus cause CV: Hypotension, - Concomitant therapy palpitations, with MAOI’s bradycardia, - Lactation tachycardia, extrasystoles Precaution Dermatologic: - Lower respiratory Urticaria, rash, tract disorders photosensitivity, - Glaucoma chills - Prosthatic GI: Epigastric hypertrophy distress, nausea, - CV disease, vomiting, hypertension diarrhea, - Breast cancer constipation - Thyrotoxicosis GU: Urinary - Children frequency, - Child with history of dysuria, urinary sleep apnea retention, - A family history of decreased libido, SIDS impotence - Reye’s syndrome Hematologic: - Elderly Hemolytic Contraindications Nursing Responsibilities Before - Observe 15 rights in drug administration. - Assess for hypersensitivity and other contraindications. - Reduce dosage for patients with hepatic impairment. - Reduce dosage of barbiturates given concurrently with promethazine by at least a half. - Arrange for dosage reduction of opioid analgesics given concomitantly by onefourth to one-half. During - Do not give tablets or rectal suppositories to children younger than 2 yr. - Give IM injections deep into muscle. - Do not administer subcutaneously, tissue necrosis may occur. - Do not administer intrarterially; arteriospasm and gangrene of the limb may result. - Instruct to take drug exactly as prescribed.

leukopenia.Instruct to avoid driving or engaging in other dangerous activities of dizziness. use precautions against heatstroke in hot weather.Adjunct to analgesics to control postoperative pain . N-desmethylpromethazine. agranulocytosis.Pregnancy Drug interaction Drug to drug . hypoplastic anemia. impaired vision.Instruct to avoid alcohol.Maintain fluid intake. rash.Additive anticholinergic effects with anticholinergic drugs . . thiopental .Educate about avoiding prolonged exposure to the sun. or using of sunscreen or covering garments. nose and throat.Enhanced CNS depression with alcohol Drug to food . converted to promethazine sulfoxide. pale stools. heaviness and wetness of hands After .Report sore throat. unusual bleeding or bruising. thiamylal. fever. or obstetric sedation .Adjunctive IV therapy with reduced amounts of meperidine or other opioid analgesics in special surgical conditions . weakness. chest tightness. respiratory depression. Phenobarbital anesthetic. M: Extensive hepatic 1stpass metabolism.Preoperative. . potential of aspiration Other: Tingling. E: Via urine and bile (as metabolites) Drug Half Life 9-16 hr sm. adjunctive therapy in anaphylactic reactions .none reported anemia.76-93%. fever. yellowing of the skin or eyes. suppression of cough reflex. . postoperative. pancytopenia Local: Thickening of bronchial secretions.Increased frequency and severity of neuromuscular excitation and hypotension with methohexital. . thrombocytopenia . dry mouth. drowsiness or vision changes occur. . dark urine. tremors.

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