Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from Generic name:

Ciprofloxacin

Brand name:

Classification:Anti-infectives

Antibiotic Class:Fluoroquinolones

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase.

Ciprofloxacin is used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria.

It is also frequently used to

Contraindicated in hypersensitivity, cross-sensitivity among agents may occur.

Use cautiously in

CNS: Seizures, dizziness, drowsiness, headache, insomnia, acute psychoses, agitation, confusion, hallucinations, increased intracranial pressure, tremors.GI: pseudomembranous colitis,

-Assess for infection prior to and during therapy.

-Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving

Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from

Antibiotic Class:Fluoroquinolones

Therapeutic Effects: Death of susceptible bacteria.

Spectrum: Broad

treat urinary infections caused by bacteria such as E. coli.

It is effective in treating infectious diarrheas caused by E. coli, Campylobacter

underlying CNS pathology, renal impairment, cirrhosis.

abdominal pain, diarrhea, nausea, altered tasteGU: interstitial cystitis, vaginitisDerm: rashEndo: hyperglycemia, hypoglycaemiaLocal: phlebitis at IV site

results. To prevent development of resistant bacteria, therapy should only be used to treat infections that are proven or strongly suspected to be caused by susceptible bacteria.

Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from activity includes

many gram-positive pathogens.

jejuni, and Shigella bacteria. MS: tendinitis, tendon ruptureMisc: hypersensitivity reactions including anaphylaxis, Stevens-Johnson syndrome, lymphadenopathy

-Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician immediately if these

Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from problems occur. Keep

epinephrine and resuscitation equipment close by in case of an anaphylactic reaction.

-Encourage patient to maintain a fluid intake of at

Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from least 1500-2000 ml/day to

prevent crystalluria.

-Advise patients that antacids or medications containing iron or zinc will decrease absorption and should not be

Name of DrugClassification/

ActionIndication

Contra Indication

Side Effects/Adverse Reaction

Nursing Responsibilities/Gener

al Considerations

lidocaine hydrochloride(lye' doe kane)

lidocaine HCl in 5% dextrose

lidocaine HCl without preservativesAntiarrhythmic preparations:Xylocaine HCl IV for Cardiac ArrhythmiasLocal anesthetic preparations:Octocaine, Xylocaine HCl (injectable)Topical for mucous membranes:Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-LTopical dermatologic:Lidoderm, Numby Stuff, Xylocaine

Available formsDirect injection—10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion—2, 4, 8 mg/mL; topical liquid—2.5%, 5%; topical ointment—2.5%, 5%; topical cream—0.5%; topical gel—0.5%, 2.5%; topical spray—0.5%, 10%; topical solution—2%, 4%; topical jelly—2%; injection—0.5%, 1%, 1.5%, 2%, 4%, 5%; patch—varies

DosagesADULTSIM

·        Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus·        Arrhythmia: Use

only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 20–50 mg/min. One-third to one-half

Drug classesAntiarrhythmicLocal anesthetic

Therapeutic actionsType 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; increases ventricular fibrillation threshold.Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity.

As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit) As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes

Contraindicated with allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block (if no artificial pacemaker), Wolff-Parkinson-White syndrome, Stokes-Adams syndrome. Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection (local anesthetic), labor and delivery (epidural anesthesia may prolong the second stage of labor; monitor for fetal and neonatal CV and CNS toxicity), and lactation.

Adverse effectsAntiarrhythmic with systemic administration

·        CNS: Dizziness or light-headedness, fatigue, drowsiness, unconsciousness, tremors, twitching, vision changes; may progress to seizures

·        CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension

·        GI: Nausea, vomiting·        Hypersensitivity: Rash, anaphylactoi

d reactions·        Respiratory: Respiratory depression

and arrest·        Other: Malignant hyperthermia, fever,

local injection site reactionInjectable local anesthetic for epidural or caudal anesthesia

·        CNS: Headache, backache, septic meningitis, persistent sensory, motor, or autonomic deficit of lower spinal segments, sometimes with incomplete recovery

·        CV: Hypotension due to sympathetic block

·        Dermatologic: Urticaria, pruritus, erythema, edema

·        GU: Urinary retention, urinary or fecal incontinence

Topical local anesthetic·        Dermatologic: Contact

dermatitis, urticaria, cutaneous lesions·        Hypersensitivity: Anaphylactoid reacti

ons·        Local: Burning, stinging, tenderness,

swelling, tissue irritation, tissue sloughing and necrosis

·        Other: Methemoglobinemia, seizures (children)

InteractionsDrug-drug

·        Increased lidocaine levels with beta

WARNING: Check drug concentration carefully; many concentrations are available.

Reduce dosage with hepatic or renal failure.

Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.

WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.

WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.

WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.

Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.

Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.

Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.

Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.

WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from taken.

-Caution patient that this may cause dizziness and drowsiness