CENTRAL PHILIPPINE UNIVERSITY

COLLEGE OF NURSING
The First Nursing School in the Philippines, 1906
Iloilo City, Philippines 5000
RLE: OR (Qualimed)
NCM 4226

DRUG STUDY

GUILLERGAN, Elijah Dale A. BSN-4D 1/29/24

Submitted to: Prof. Joy Guadelupe

Generic Name: Bupivacaine HCL injections

Brand Name: Sensorcaine
SENSORCAINE
Classification: Local injectable anesthetics
Dosage: 0.25% 125mg per 50mL
Bupivacaine hydrochloride (SENSORCAINE) Spinal Heavy contains bupivacaine,
Mechanism of Action which is a long-acting local anaesthetic of the amide type. Bupivacaine
reversibly blocks impulse conduction in the nerves by inhibiting the transport of
sodium ions through the nerve membrane.
 Is indicated in adults for the production of local or regional anesthesia or
analgesia for surgery, dental and oral surgery procedures, diagnostic and
therapeutic procedures, and for obstetrical procedures.
Indications or
 Contraindicated in obstetrical paracervical block anesthesia. Its use in this
Contraindications
technique has resulted in fetal bradycardia and death.
 Contraindicated in patients with a known hypersensitivity to it or to any
local anesthetic agent of the amide-type or to other components of
bupivacaine solutions.
SE: nausea, vomiting, headache, back pain, dizziness, chills, shivering, or
problems with sexual function.

Side Effects or AE:

Adverse Effects Major cause of adverse reactions:
excessive plasma levels, which may be due to overdosage, unintentional
intravascular injection, or slow metabolic degradation.
CNS and cardiovascular including:
seizures, coma, arrhythmias, and death.
 Be alert for new seizures or increased seizure activity. Document the
number, duration, and severity of seizures, and report these findings
immediately to the physician.
 Monitor cardiac symptoms at rest and during exercise, and be alert for signs
Nursing of severe cardiac insufficiency due to cardiac arrest (cardiovascular
Responsibility collapse). Seek immediate medical assistance if symptoms of cardiac arrest
develop, including sudden chest pain, pain radiating into the arm or jaw,
shortness of breath, dizziness, sweating, anxiety, and nausea.
 Monitor signs of allergic reactions, including pulmonary symptoms
(laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin
reactions (rash, pruritus, urticaria). Notify physician or nursing staff
 immediately if these reactions occur.
 Instruct patient to tell his/her doctor if he/she have ever had an allergic
reaction to any type of numbing medicine.
 Inform patient that this drug may cause short-term loss of feeling and
Health Teaching
motor activity where it is given.
 Educate patients about the risks and symptoms of respiratory depression
and sedation.

Generic Name: Ropivacaine

Brand Name: Naropin
NAROPIN
Classification: Amide-type local anesthetic
Dosage: 0.2% 20mg per 10mL
Local anesthetics like Ropivacaine block the generation and conduction of nerve
impulses, presumably by increasing the threshold for electrical excitation in the
nerve, by slowing the propagation of the nerve impulse, and by reducing the
Mechanism of Action
rate of rise of the action potential. Specifically, they block the sodium channel
and decrease chances of depolarization and consequent action potentials. In
general, the progression of anesthesia is related to the diameter, myelination,
and conduction velocity of affected nerve fibers.
 FDA-approved for surgical anesthesia and acute pain management. It is
used in an epidural block for surgery—such as cesarean sections. It is also
used in major nerve blocks and local infiltration. In acute pain management,
ropivacaine is used in epidurals (continuous infusion or intermittent bolus)
Indications or for postoperative or labor pain control. More recently, ropivacaine’s use in
Contraindications chronic pain management has also been evaluated by researchers.
 Hypersensitivity to amide anesthetics, Infection at injection site, Intra-
articular continuous infusion, PTS
 Caution in elderly pts, acutely ill pts.
 Caution if hepatic impairment, renal disease, impaired cardiac function,
heart block, hypovolemia, hypotension.
SE:
Hypotension, nausea/vomiting, paresthesia, pain, non-specific bradycardia,
headache, fever, rigors, dizziness, injection site burning, pruritus, drowsiness,
Side Effects or restlessness, anxiety, blurred vision, tinnitus.
Adverse Effects
AE:
CNS toxicity, myocardial depression, seizures, unconsciousness, respiratory
arrest, heart block, hypotension, bradycardia, ventricular arrhythmias, cardiac
arrest, anaphylactoid reaction.
 Be alert for new seizures or increased seizure activity. Document the
number, duration, and severity of seizures, and report these findings to the
Nursing physician immediately.
Responsibility  Monitor signs of allergic reactions, including pulmonary symptoms
(laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin
reactions (rash, pruritus, urticaria). Notify physician or nursing staff
immediately if these reactions occur.
  Monitor and report any muscle weakness, aches, or cramps that might
indicate low potassium levels (hypokalemia).
 Assess signs of paresthesia (numbness, tingling) or numbness around the
mouth. Perform objective tests, including electroneuromyography and
sensory testing to document any drug-related neuropathic changes.
 Inform patient about the therapeutic effects of the drug such as decreased
Health Teaching pain or induction of anesthesia; low doses have minimal effect on sensory
or motor function; higher doses may produce complete motor blockade.

Generic Name: Suxamethonium Chloride

SUXAMETHONIUM Brand Name: Anektil
CHLORIDE (Anektil) Classification: Neuromuscular Blockers
Dosage: 400mg / 20mL (I.V.)
Anektil, also known as succinylcholine, is a drug used to induce muscle
relaxation, usually to make endotracheal intubation possible. Anektil is sold
under the trade names Anectine and Anektil.
Anektil acts as a depolarizing neuromuscular blocker. It imitates the action of
Mechanism of Action
acetylcholine at the neuromuscular junction, acting on muscle type nicotinic
receptors, but it is degraded not by acetylcholinesterase but by
butyrylcholinesterase, a plasma cholinesterase. This hydrolysis by
butyrylcholinesterase is much slower than that of acetylcholine by
acetylcholinesterase.
 Succinylcholine (Anektil chloride) is contraindicated in persons with
personal or familial history of malignant hyperthermia, skeletal muscle
myopathies and known hypersensitivity to the drug. It is also
contraindicated in patients after the acute phase of injury following major
burns, multiple trauma, extensive denervation of skeletal muscle, or upper
Indications or
motor neuron injury, because succinylcholine administered to such
Contraindications
individuals may result in severe hyperkalemia which may result in cardiac
arrest.
 The risk of hyperkalemia in these patients increases over time and usually
peaks at 7 to 10 days after the injury. The risk is dependent on the extent
and location of the injury. The precise time of onset and the duration of the
risk period are not known.
SE:
Side Effects or Malignant hyperthermia, Muscle pains, Acute rhabdomyolysis, Transient ocular,
Adverse Effects hypertension, Constipation, Changes in cardiac rhythm
AE:
Flushing, skin rash, bronchospasm, and shock have been reported.
 Assess respiration, and notify physician or nursing staff immediately if
patient exhibits any interruption in respiratory rate (apnea) or signs of
Nursing respiratory failure (rapid labored breathing, cyanosis, confusion, irritability,
Responsibility sleepiness, headache, oxygen desaturation).
 Monitor symptoms of high plasma potassium levels (hyperkalemia),
including bradycardia, fatigue, weakness, numbness, and tingling. Notify
physician or nursing staff immediately because severe cases can lead to life-
 threatening arrhythmias and paralysis.
 Be alert for a rapid rise in body temperature, especially if accompanied by
muscle rigidity and stiffness. These may be signs of malignant hyperthermia,
and the physician or nursing staff should be notified immediately.
 Assess any muscle pain, tenderness, or weakness, especially if accompanied
by fever, malaise, and dark-colored urine. These symptoms may indicate
myopathy that can progress to severe muscle damage (rhabdomyolysis).
Report any unexplained musculoskeletal symptoms to the physician or
nursing staff immediately.
 Assess symptoms of bronchospasm (wheezing, coughing, tightness in chest)
or decreased respiratory muscle function. Perform pulmonary function tests
to quantify suspected changes in ventilation and respiration.
 Instruct patient to report to the doctor if long-term paralysis and muscle
weakness have happened when this type of drug was given for a long time.
Health Teaching
 Repeated or continuous infusions aren’t advisable, they may cause reduced
response or prolonged muscle relaxation and apnea.

Generic Name: Tranexamic acid

TRANEXAMIC ACID Brand Name: Hemostan
(Hemostan) Classification: Antifibrinolytics
Dosage: 100mg/mL (500mg/5mL) solution for injection (I.M./I.V.)
TXA is a synthetic reversible competitive inhibitor to the lysine receptor found
on plasminogen. The binding of this receptor prevents plasmin (activated form
Mechanism of Action of plasminogen) from binding to and ultimately stabilizing the fibrin matrix.
TXA used for hereditary angioedema works by its indirect effect of reducing
complement activation. By reducing plasmin activity, it reduces the
consumption of C1 esterase inhibitors.
 Tranexamic acid inhibits fibrinolysis by blocking the binding of plasminogen
Indications or and plasmin to fibrin, thus preventing dissolution of the haemostatic plug.
Contraindications  Hypersensitivity. Active thromboembolic disease (e.g. DVT, pulmonary
embolism, cerebral thrombosis), history and risk of thrombosis or
thromboembolism. Patients with acquired color vision disturbances.
SE:
Nausea, diarrhea, stomach pain or discomfort, vomiting, chills, fever, severe
headache (throbbing), back or joint pain, muscle pain, muscle stiffness, difficulty
Side Effects or
moving, runny or stuffy nose
Adverse Effects
AE:
seizures, headaches, backache, abdominal pain, nausea, vomiting, diarrhea,
fatigue, pulmonary embolism, deep vein thrombosis, anaphylaxis, impaired
color vision, and other visual disturbances.
 Be alert for bleeding gums, nosebleeds, or other unusual bleeding or
bruising that might indicate inadequate drug effects. Report signs of
Nursing
bleeding to the physician immediately.
Responsibility
 Monitor increased blood coagulation, including venous thrombosis (lower
extremity swelling, warmth, erythema, tenderness) or arterial thrombosis
(extreme coldness in the hands and feet, cyanosis, muscle cramping).
  Watch for pulmonary embolism (shortness of breath, chest pain, cough,
bloody sputum) or arterial thrombosis that could lead to MI or stroke.
Notify physician immediately, and request objective tests (Doppler
ultrasound, others) if thrombosis is suspected.
 Assess blood pressure and compare to normal values (See Appendix F).
Report low blood pressure (hypotension), especially if patient develops
dizziness or syncope.
 Assess dizziness that might affect gait, balance, and other functional
activities (See Appendix C). Report balance problems and functional
limitations to the physician, and caution the patient and family/caregivers
to guard against falls and trauma.
 Instruct patient to report other troublesome side effects such as severe or
prolonged vision abnormalities or GI problems (nausea, vomiting, diarrhea).
 Instruct patient to notify the nurse immediately if bleeding recurs or if
Health Teaching
thromboembolic symptoms develop.
 Caution patient to make position changes slowly to avoid orthostatic
hypotension.

Generic Name: Nalbuphine

NALBUPHINE Brand Name: Nubain
(Nubain) Classification: Synthetic opioid agonist-antagonist
Dosage: 10-20 mg/70kg IV/IM/SC Q3-6hr PRN
The exact mechanism of action is unknown, but is believed to interact with an
opiate receptor site in the CNS (probably in or associated with the limbic
system). The opiate antagonistic effect may result from competitive inhibition
Mechanism of Action
at the opiate receptor, but may also be a result of other mechanisms.
Nalbuphine is thought primarily to be a kappa agonist. It is also a partial mu
antagonist analgesic, with some binding to the delta receptor and minimal
agonist activity at the sigma receptor.
Indications or Contraindicated in patients with: Significant respiratory depression. Severe or
Contraindications active bronchial asthma. Known or suspected gastrointestinal obstruction,
including ileus.
S.E.
sedation, sweating, nausea, vomiting, dizziness, vertigo, dry mouth, or a
headache
A.E.
 CNS: Nervousness, depression, restlessness, crying, euphoria, floating,
hostility, unusual dreams, confusion, faintness, hallucinations, dysphoria, a
Side Effects or
feeling of heaviness, numbness, tingling, or unreality.
Adverse Reactions
 Cardio: hypertension, hypotension, bradycardia, or tachycardia.
 Gastro: cramps, dyspepsia, or bitter taste.
 Resp: depression, dyspnea, or asthma.
 Derma: itching, burning, or urticaria.
 Allergic Reactions: anaphylactic, anaphylactoid, or severe hypersensitivity
reactions have been reported with nalbuphine use, and care should be
given providing immediate supportive medical treatment should they occur.
  Monitor pulse oximetry and perform pulmonary function tests to quantify
Nursing suspected changes in ventilation and respiratory function. Excessive
Responsibility respiratory depression requires emergency care.
 Be alert for excessive sedation or changes in mood and behavior (euphoria,
dysphoria, confusion, hallucinations).
 Encourage patient to report all medications being taken, including
prescription and OTC medications and supplements.
 Inform patient to report to the doctor if the medicine seems to stop
Health Teaching
working as well in relieving your pain. If you stop using nalbuphine suddenly
after long-term use, patient could have unpleasant withdrawal symptoms.
Ask doctor how to safely stop using this medicine.

References:
 Alvarellos ML, McDonagh EM, Patel S, McLeod HL, Altman RB, Klein TE: PharmGKB summary:
succinylcholine pathway, pharmacokinetics/pharmacodynamics. Pharmacogenet Genomics. 2015
Dec;25(12):622-30. doi: 10.1097/FPC.0000000000000170.
 Anektil Injection - Product - tabletwise.net. (2024). Retrieved January 29, 2024, from
https://www.tabletwise.net/philippines/anektil-injection
 Chauncey JM, Wieters JS. Tranexamic Acid. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK532909/
 Cunha, J. P. (2022, August 2). SENSORCAINE. RxList. Retrieved January 29, 2024, from
https://www.rxlist.com/sensorcaine-drug.htm#warnings
 FDA Approved Drug Products: Sensorcaine (bupivacaine hydrochloride, or bupivacaine
hydrochloride and epinephrine) solution for injection use
 Furtmuller R, Schlag MG, Berger M, Hopf R, Huck S, Sieghart W, Redl H: Tranexamic acid, a widely
used antifibrinolytic agent, causes convulsions by a gamma-aminobutyric acid(A) receptor
antagonistic effect. J Pharmacol Exp Ther. 2002 Apr;301(1):168-73. doi: 10.1124/jpet.301.1.168.
 George AM, Liu M. Ropivacaine. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532924/
 Hager HH, Burns B. Succinylcholine Chloride. [Updated 2023 Feb 20]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499984/
 Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in
Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012 Feb;147(2):113-9. [PubMed]
 Peng X, Knapp BI, Bidlack JM, Neumeyer JL: Pharmacological properties of bivalent ligands
containing butorphan linked to nalbuphine, naltrexone, and naloxone at mu, delta, and kappa opioid
receptors. J Med Chem. 2007 May 3;50(9):2254-8. Epub 2007 Apr 4.
 Simpson D, Curran MP, Oldfield V, Keating GM. Ropivacaine: a review of its use in regional
anaesthesia and acute pain management. Drugs. 2005;65(18):2675-717.