Anticholinergics

Atropine Robinul (glycopyrrolate) scopolamine

Histamine Antagonists
Pepcid (famotidine) Tagamet (cimetidine) Zantac (ranitidine)

Sedative Hypnotics (Benzodiazepines)
Versed (midazolam) Ativan (lorazepam, Valium (diazepam)

Narcotic Analgesics (Opioid Analgesics)
Morphine, Dilaudid (hydromorphone), Demerol (meperidine)

Antibiotics
Ancef (cefazolin) Mefoxin (cefoxitin) Maxipime (cefepime)

Gastrokinetics
Reglan (metoclopramide)

Antiemetics
Phenergan (promethazine) Compazine (prochlorperazine edisylate) Zofran (odansetron)

Examples:

Bind to parasympatheti c nerve ending receptor sites, inhibiting action of actylcholine.

Action:

Overall effects:
preoperative clients include smooth muscle relaxation, decreased glandular secretions, and mydriasis (pupil dilation) Decreased oral and respiratory secretions to prevent aspiration pneumonitis.

Inhibit the action of histamine at the H2 receptor site located in gastric parietal cells, resulting in inhibition of gastric acid secretion

Potentiate the effects of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Bind to receptors of the brain & spinal cord, resulting in hypolarization (less response to excitatory neurotransmitters).

Bind to opioid receptor sites in the brain and spinal cord, resulting in CNS depression. Alters perception and emotional responses to painful stimuli.

Inhibit cell wall synthesis, cell division, and growth of rapidly dividing bacteria.

Blocks dopamine receptor in chemoreceptor trigger zone of CNS. Stimulates motility of upper GI tract and accelerates gastric emptying.

Inhibits the chemoreceptor trigger zone (CTX) decreasing nausea.

Indicatio n:

Prevent aspiration pneumonitis.

Preprocedural sedation, anxiolysis, amnesia. Aids in induction of anesthesia. Part of balanced anesthesia.

Treatment of moderate to severe pain. Part of balanced anesthesia.

Prevention of postoperative infection (prophylaxis) Prevent surgical site infection (SSI)

Prevent aspiration pneumonitis. Decrease nausea & vomiting

Prevention & treatment of nausea & vomiting.

urinary retention. Most common .Mydriasis. Diarrhea.Cardiovascular System ² Tachycardia. palpitations (at intermediate doses or when given IV. Central Nervous System ² tremors. hypotension (results in peripheral vasodilatation. diarrhea or constipation ( more likely to affect the elderly or those with renal disease. extrapyramidal reactions. constipation. abdominal cramping. confusion. phlebitis (IV administration) Less common ² Dry mouth. photophobia. restlessness. decreased tone & peristalsis in stomach and intestines (risk for constipation or paralytic ileus).Drowsiness. Effects less likely with Robinul. anxiety Restlessnessness. blurred vision Respiratory depression (due to depression of the respiratory center in medulla oblongata). dizziness. constipation (from decreased peristalsis and glandular secretions) nausea. vomiting. nausea/vomiting.) GI . thirst. blurred vision. thirst. headaches. restlessness. redness. May result in confusion. delirium (CNS stimulation followed by CNS depression). pruritis. . dry mouth. lethargy. Effects less likely with Robinul. hiccups (especially w/Versed). agitation. excessive sedation. decreased tone & peristalsis in stomach and intestines (risk for constipation or paralytic ileus). weakness. oral or vaginal candidasis (yeast) rash. Skin and mucous membranes ² Decreased sweating. GI . hallucinationsd .Dry mouth. Hazardous for clients with glaucoma ² due to increased ocular pressure. or edema. loss of dexterity. abdominal cramping. Side effects: Generally uncommon with one-time preoperative dose. Drowsiness. extrapyramidal reactions. Eye .Dry mouth.

. Phenergan (promethazine) can damage veins when given IV. Assess for signs of allergic reaction. Administer Narcan (naloxone) to reverse respiratory depression/over sedation. Avoid use of Demerol (meperidine) in elderly w/impaired renal/hepatic function (d/t production of CNS neurotoxic metabolite normeperidine in liver). Administer IM injections of sedative hypnotics deep into welldeveloped muscles.. NS and administer slowly over at least 30 minutes to minimize irritation. Morphine is the prototype. decreased tone & peristalsis in stomach and intestines (risk for constipation or paralytic ileus). Use cautiously for clients w/history of bleeding disorders.Additional Information: Administer flumazenil (Romazicon) to reverse oversedation/respiratory depression. Dilute in 20 mL.

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