CITY OF MANILAUNIVERSIDAD DE MANILA

(Formerly City College of Manila)Mehan Gardens, Manila

College of Nursing

A Compilation of Anesthetic Drugs:A Drug Study

In Partial Fulfillment for the Requirements on the Medicaland Surgical Nursing(NCM106)- Related Learning

Experience (OPERATING ROOM)

Submitted by:Atawneh, Sarah YounesBAcani, Hannah Kaye

Baes, EdwardBalane, Fatima Grace

Barte, Jim BoyNR-42/ Group One

Submitted to:Mrs. Marie Chona Balce, RN, MAN

Date Submitted

The Anesthetic Drugs used at Ospital ng Maynila – Operating room:

Spinal:

NubainMidazolamBupivacaineTetracaine Meperidine HCL (Demerol) - optionalEpinephrine

GETA

NubainMidazolamTracriumPropofolelThipental NaAnectine (Succinylcholine chloride)FentanylAtropine Sulfate (Optional

GEN IV

NubainMidazolamProfololFentanylDemerol

GEN MASKO

GEN IV + Isoflurane or Sevoflurane

PNB

Bupivacaine IsobaricLidocaine twist topEpinephrine

Clea / CTEA

NubainMidazolamBupivacaine IsobaricLidocaine AmpuleEpinephrineDemerol (optional)

Anesthesia, or anaesthesia has traditionally meant the condition of having sensation

(including the feeling of pain) blocked. This allows patients to undergo surgery and other

procedures without the distress and pain they would otherwise experience. The word was

coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a “reversible lack of

awareness”, whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of

awareness of a part of a the body such as a spinal anaesthetic or another nerve block would

cause. Anesthesia differs from analgesia in blocking all sensation, not only pain.

Classification:

A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes

such as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness

centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain),

hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.

General anesthetics are usually administered by intravenous infusion or by inhalation of

gases through a mask or through an endotracheal tube inserted into the trachea.

Advantages:

1. Because the client is unconscious rather then awake and anxious, respiration and cardiac

function are readily regulated.

2. The anesthesia can be adjusted to the length of the operation and the client’s age and

physical status.

Disadvantage:

1. It depresses the respiratory and circulatory systems.

2. Some clients become more anxious about a general anesthetic that about the surgery

itself. Often this is because they fear losing the capacity to control their own bodies.

B. Regional Anesthesia - is the temporary interruption of the transmission of nerve impulses

to and from a specific area or region of the body. The client loss sensation in an area of the

body but remains conscious. Several techniques are used:

Conscious Sedation may be used alone or in conjuction with regional anesthesia for some

diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of

the level of consciousness in which the client retains the ability to maintain a patent airway

and respond appropriately to commands.

Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such

as diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain

conscious sedation. Conscious sedation increases the client’s pain threshold and induces a

degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal

activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses,

and even balloon angioplastymay be performed under conscious sedation.

Topical (surface) Anesthesia

Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most common used topical agents are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly.

Local Anesthesia (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a biopsy. Lidocaine or tetracaine 0.1% may be used.

Nerve Block Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Major blocks involve multiple nerves or a plexus (e.g. the brachial plexus anesthetizes the arm); minor blocks involve a single nerve (e.g. a facial nerve)

Intravenous block (Bier block)

Is used most often for procedures involving the arm, wrist and hand. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the involved extremity.

Spinal anesthesia (Subarachnoid block)

It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Categorized into Low Spinals(saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. Mild Spinals (below the level of the umbilicus – T10) can be used for hernia repairs or appendectomies. High Spinals (reaching the nipple line – T4) can be used for surgeries such as cesarean sections.

Epidural (peridural) anesthesia

Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.

Risk Factors for Complications During the Procedure:

Current or past health problems

Taking medications, supplements, or herbal remedies, blood thinners

Allergies (eg, food allergies, medication allergies, latex allergies)

Smoking

Drinking alcohol

Taking recreational drugs

Personal or family history of adverse reactions to anesthesia

Possible Complications:

Pain and tenderness around the injection site

Bruising, infection, or bleeding of the injection site

Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a

result of a broken blood vessel)

Spinal headache (a severe headache that may occur after spinal or epidural anesthesia)

Decrease in blood pressure

Nerve damage Medication mistakenly injected into a vein; symptoms include dizziness, rapid

heartbeat, and funny taste or numbness around the mouth

Horner’s syndrome (change of pupil size on one side) Ptosis (drooping of the eyelid) Pneumothorax (air trapped between the lung and rib cage)Call Your Doctor If Any of the Following Occurs: Signs of infection, including fever and chills Redness, swelling, increasing pain, or discharge from the injection site Tingling, numbness, or trouble moving around the affected area Headache Persistent coughing Chest pain Trouble breathing or shortness of breath Dizziness Heartbeat abnormalities Funny taste or numbness of the mouth Other worrisome symptoms

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication Nursing Responsibility

Patient Teaching

Generic Name: Nalbuphine

Brand Name: Nubain

Drug Classification: synthetic opioid agonist-antagonist analgesic

Indication:

-Relief of moderate to severe pain; for pre-operatively analgesia, supplement to balanced anesthesia, surgical anesthesia.

-Adult: 0.15-0.20mg/kg

-SC/IM/IV

-Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of and emotional response to pain.

-Sedation, drowsiness, sweating, nausea, dry mouth and dizziness, headache, and vomiting

Hypersensitivity to

nalbuphine,

sulfites; lactation.

-Use cautiously with emotionally unstable clients or those with a history ofnarcotic abuse; pregnancy prior to labor, labor or delivery, bronchialasthma, COPD, respiratory depression, anoxia, increased intracranialpressure, acute MI when nausea and vomiting are present, biliary tractsurgery.

Assess patient’s underlying condition before therapy obtain drug history.Monitor vital signs after parenteral routeMonitor allergic reactions: rash, pruritus and Urticaria

Discuss in detail all aspects of the drug therapy: reason for taking drug and expected results. Discuss with the patient that dizziness, drowsiness, confusion are common. Instruct patient to change position slowly to prevent orthostatic hypotension and avoid getting up without assistance.

Nubain

Midazolam

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Midazolan Hydrochloride

Brand Name:

Apo-Midazalon (CAN)

Drug Classification:

Benzodiazepine (short acting), CNS depressant

Indication:

. •IV or IM:Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or endoscopic or surgery.• Induction of general anesthesia•Continuous

sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting.

Injection-5mg/ml

IM, IV

Exact mechanism of action not understood; acts mainly at the limbic system and reticular formation; potentiates the effect of GABA, an inhibitory neurotransmitter, anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function.

•CNS: Transient, mild drowsiness(initially), sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, restlessness, confusion, crying, delirium, difficulty in concentration, vivid dreams, psychomotor retardation, extra pyramidal symptoms, and depressed hearing, nasal congestion.

•CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitation, edema.

•Dependence: drug dependence with withdrawal

. •Contraindicated with hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when use in first trimester; neonatal withdrawal syndrome reported in infants); neonates.

•Use cautiously in elderly or

Assessment:

History: Hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, elderly are debilitated patients, impaired liver or renal function, pregnancy lactation.

Physical: Weight skin color, lesions, orientation, affect, reflexes, and sensory nerve function, ophthalmologic examination, P, BP, R,

This drug will help you to relax and will make you go to sleep. This drug is a potent amnesiac and you will not remember what has happened to you.

Avoid using alcohol or sleep inducing or over-the-counter drugs before receiving this drug.

Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, visual or hearing disturbances, difficulty voiding.

•Unlabeled uses:

treatment of epileptic seizure of refractory status epilepticus.

syndrome when drug is discontinued (more common with abrupt discontinuation of higher dosage used for longer than 4 mo.)

•Dermatologic: Urticaria, pruritus, skin rush, dermatitis.

•GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevation of blood enzymes; LDH, alkaline phosphatase, AST, ALT, hepatic impairment.

•GU: incontinence, urine retention, changes in libido, menstrual irregularities.

•Hematologic: Decreased Hct,

debilitated patients; with impaired liver or renal function, lactation.

adventitious sounds.

blood dyscrasias

•Other: Phlebitis and thrombosis at IV injection site, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomasia, pain, burning.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route, Frequency

Mechanism of Action

Adverse Reaction Contraindication Nursing Responsibility Patient Teaching

Bupivacaine Heavy

Generic Name: Bupivacaine HCl

Brand Name:

Bupi Heavy

Drug Classification:

Local anesthetic

Indication:

peripheral nerve block, infiltration, sympathetic blockade, caudal, epidural, pudendal block

analgesia via the epidural route

spinal anaesthesia - route

Dosage:

Local injection:

Individualized, varying with the anesthetic procedure, the degree of anesthesia required and the patient's response.

Maximum single dose - 175 mg without epinephrine; 225 mg with epinephrine

dose may be repeated at intervals of not less than 3 hours

Maximum daily dose - 400 mg

PICRA

20mL of 0.25% solution injected directly into the nerve sheath, followed by a continuous infusion of 0.2% concentration to

Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction.

Reactions to Bupivacaine are characteristic of those associated with other amide-type local anaesthetics. The most commonly encountered acute adverse experiences which demand immediate countermeasures following the administration of spinal anaesthesia are hypotension due to loss of sympathetic tone and respiratory paralysis or under ventilation due to cephalic extension of the motor level of anaesthesia.

Contraindicated in patients with a known hypersensitivity to it or to any local anesthetic agent of the amide-type. The following conditions preclude the use of spinal anesthesia:

Severe hemorrhage

severe hypotension or shock and arrhythmias, such as complete heart block, which severely restrict cardiac output

Local infection at the site of proposed lumbar puncture

Septicemia

solutions containing epinephrine should not be used in the presence of peripheral vascular disease or in areas with limited blood supply i.e. digits, ears, nose, penisresuscitative equipment and drugs for treatment of adverse effects should be readily available when solutions containing epinephrine are used the usual cautions for epinephrine applycontraindicated if known allergy to local anesthetics of the amide type Epidural

This medication is given to reduce sensation in the injected area. You will experience decreased sensation to pain, heat, or cold in the area and/or decreased muscle strength; use necessary caution to reduce incidence of possible injury until full sensation returns. If used in mouth, do not eat or drink until full sensation returns. Immediately report chest pain or palpitations; increased

infuse at 120-240 mg/24 hours (maximum 400 mg/day)

continue for 72 hours or longer as necessary

Epidural (preservative free)

5-20 mL of a 0.125% to 0.25% solution with or without epinephrine; may be followed by continuous infusion of 5-10 mL/hr of a 0.0625% to 0.25% solution with or without epinephrine

Dosage: adjustments should be considered in patients with severe liver disease.

Route:

local injection - for

These may lead to cardiac arrest if untreated. In addition, dose-related convulsions and cardiovascular collapse may result from diminished tolerance, rapid absorption from the injection site or from unintentional intravascular injection of a local anaesthetic solution. Factors influencing plasma protein binding, such as acidosis, systemic diseases which alter protein production, or competition of other drugs for

monitoring parameters: heart rate, blood pressure PICRA monitoring parameters: pain level, sedation scale, motor function, blood pressure, respiratory rate, pulse, temperature

restlessness, anxiety, or dizziness; skeletal or muscle weakness; or respiratory difficulty.

regional and block anesthesia

post-operative infusion of continuous regional analgesia (PICRA) - continuous infusion

Frequency:

Depends on patient’s response

protein binding sites, may diminish individual tolerance.

Generic Name(Brand Name)

Drug Classification & Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Tetracaine HCl

Generic Name: Tetracaine HCl

Brand Name:

Pontocaine

Ak-T-Caine

Ak-Taine

Alcaine

Diocaine

Minims

Tetracaine

Ocu-Caine

Ophthaine

Ophthetic

Opticaine

Pontocaine

Spectro-Caine

Drug Classification:

Anesthetic, local (ophthalmic)

Indication:

Anesthesia, local—Proparacaine and tetracaine are indicated to produce local anesthesia of short duration for ophthalmic procedures including measurement of intraocular pressure (tonometry), removal of foreign bodies and sutures, and conjunctival and corneal scraping in diagnosis and

Anesthetic, local

Topical, to the lower conjunctival fornix, approximately 1.3 to 2.5 cm (approximately 1/2 to 1 inch) of a 0.5% ointment.

Topical, to the conjunctiva, 1 or 2 drops of a 0.5% or 1% solution.

After topical application to the eye, local anesthetics penetrate to sensory nerve endings in the corneal tissue. These medications block both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions. This reversibly stabilizes the membrane and inhibits depolarization, resulting in the failure of a propagated action potential and subsequent conduction blockade.

Localized

Erythema, blanching, edema, or abnormal sensation at the site

Allergic

Urticaria, angioedema, bronchospasm, and possible shock

Systemic Reactions CNS excitation and/or depression (light-headedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred

Contraindicated to patients with Hypersensitivity, low plasma cholinesterase concentrations, complete heart block, pyrogenic infection.

Caution to Patients sensitive to other ester-type local anesthetics (such as benzocaine, butacaine, butamben, chloroprocaine, procaine, or propoxycaine) or to aminobenzoic acid (para-aminobenzoic acid; PABA) or parabens may be sensitive to tetracaine also.

Monitor ECG, blood pressure and respiratory status frequently.

Assess degree of numbness of the affected part.

IM injections are recommended if ECG monitoring is not available.

Explain the purpose of the medication.

Notify Physician if adverse reaction occurs.

Report for signs of infection, including fever and chills, redness, swelling, increasing pain, or discharge from the injection site, tingling, numbness, or trouble moving around the affected area, headache, persistent coughing, chest pain, trouble breathing or shortness of breath, dizziness, heartbeat abnormalities, funny taste or numbness of the mouth or other worrisome symptoms

gonioscopy.

Proparacaine and tetracaine are also indicated to produce local anesthesia prior to surgical procedures such as cataract extraction and pterygium excision, usually as an adjunct to locally injected anesthetics.

Ophthalmic solutions used for intraocular procedures should be preservative-free. Preservatives may cause damage to the corneal epithelium if a

or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest).

Cardio Bradycardia, hypotension and cardiovascular collapse leading to arrest

significant quantity of solution enters the eye through the incision.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility Patient Teaching

Generic Name: Meperidine hydrochloride

Drug Classification:

Opioid agonist

Adult:

Relief of pain:

Acts as agonist at specific opioid receptors in the CNS to produce

CNS: dizziness, Lightheadedness, sedation,

Contraindicated with hypersensitivity to

Administer to lactating women 4-6 hrs before next feeding to minimize the amount

Take drug exactly as prescribedAvoid

Meperidine hydrochloride

Brand Name:

Demerol

analgesic

Indication:

Oral, parenteral: relief of moderate to severe painParenteral: Preoperative medication, support of anesthesia and obstetric analgesia.

individualize dosage; 50-150mg Im, SQ, or PO every 3-4 hours as needed

Preoperative medication:50-100 mg IM or SQ

Obstetric anesthesia: when contractions become regular, 50-100mg IM or SQ; every 1-3hrs.

analgesia, euphoria. Sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation

CV: facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, palpitations, chest wall rigidity

Derma: pruritus, urticaria, laryngospasm, edema

GI: Nausea, vomiting, dry mouth, anorexia, constipation

opioids, diarrhea caused by poisoning, BA, COPD, respiratory distress, anoxia, seizure.

Contraindicated to premature infants

Use cautiously with acute abdominal conditions, CV disease, myxedema, delirium tremens, ulcerative colitis.

of milkKeep opioid antagonist and facilities for assisted or controlled respiration readily available during parenteral administration.Use caution when injecting SQ into chilled areas of the body or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive when the circulation is restored.Reduce dose of meperidine by 25% - 50% in patients receiving phenothiazines or other tranquilizersGive each dose of the oral syrup in half glass of water. If taken undiluted, it amy exert a slight local anesthetics effect on mucous membranes.

alcohol, antihistamines, sedatives, tranquiliziers and OTC drugsDo not take leftover medication for other disorders, and do not let anyone else take this prescriptionReport severe nausea and vomiting, constipation, shortness of breath, or difficulty of breathingSide effects such as loss of appetite, constipation, dizziness, sedation, drowsiness, impaired

Major Hazards: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest

Reassure patient that addiction is unlikely; most patients who receive opiates for medical reasons do not develop dependence syndromesUse meperidine with extreme caution in patients with renal impairment or those requiring repeated dosing due to accumulation of normeperidine, a toxic metabolite that may cause seizures

visual acuity may experience.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Epinephrine

Brand Name:

Drug Classification: Sympathomimetic drug, Alpha-adrenergic agonist, Beta1 and beta2-

-IV Advanced cardiac life support As 1:10,000 soln: 10 mL, repeat every 2-3

-Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain,

-Sedation, drowsiness, sweating, nausea, dry mouth and dizziness, headache, and

Contraindicated with allergy or hypersensitivity to epinephrine or components of preparation narrow-angle

Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug; small

Instruct patient to take medication exactly as directed. If on

Epinephrine

epinephrine bitartrate

adrenergic agonist, Cardiac stimulant, Vasopressor, Bronchodilator,Antiasthmatic drug, Nasal decongestant, Mydriatic, Antiglaucoma drug

Indication:

- In ventricular standstill after other measures have failed to restore circulation, given by trained personnel byintracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus

mins if needed. Anaphylactic shock As 1:10,000 soln: 5 mL infused slowly until a response is achieved. IM Anaphylactic shock As 1:1,000 soln: 0.5 mL, repeat every 5 mins as needed. Acute asthmatic attacks As 1:1,000 soln: 0.3-0.5 mL.

-SC/IV

hypothalamus, altering perception of and emotional response to pain.

vomiting glaucoma; shock other than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or cyclopropane; organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary insufficiency;tachyarrhythmias; ischemic heart disease; hypertension; renal dysfunction (drug may initially decrease renal blood flow); COPD patients who have developed degenerative heart disease; diabetes mellitus; hyperthyroidis

errors in dosage can cause serious adverse effects. Double-check pediatric dosageUse minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with prolonged use.Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug solutions should be clear and colorless (does not apply to suspension for injection).Shake the suspension for injection well before withdrawing the dose.Rotate SC injecti

a scheduled dosing regimen, take a missed dose as soon as possible; space remaining doses at regular intervals. Do not double doses. Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm, or loss of effectiveness of medication

syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or SC injection; relaxation of uterine musculature; additive to local anesthetic solutions for injection to prolong their duration of action and limit systemic absorption- Relief from respiratory distress of bronchial asthma, chronic bronchitis, emphysema, other COPDs- Temporary relief from acute

m; lactation. on sites to prevent necrosis; monitor injection sites frequently.Maintain a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (a nitrate) on standby in case of excessive hypertensive reaction.Maintain an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing on standby in case pulmonary edema occurs.Maintain a beta-adrenergic blocker (propranolol; a cardioselectivebeta-blocker, such as atenolol, should be used in patients with respiratory

attacks of bronchial asthma, COPD-Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing congestion around eustachianostia-Management of open-angle (chronic simple) glaucoma, often in combination with miotics or other drugs-Conjunctivitis, during eye surgery to control bleeding, to produce mydriasis

distress) on standby in case cardiac arrhythmias occur.Do not exceed recommended dosage of inhalation products; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol distribution is more extensive. If a second inhalation is needed, administer at peak effect of previous dose, 3–5 min.Use topical nasal solutions only for acute states; do not use for longer than 3–5 days, and do not exceed

recommended dosage. Rebound nasal congestion can occur after vasoconstriction subsides.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Atracurium Besylate

Brand Name:

Tracrium

Drug Classification:

Analgesics, anesthesia anti psychotic, anti ulcer.

Indication:

For inpatients and outpatients as an adjunct to general

Injection:

10mg/ml; 2.5ml ampoule

Atracurium Besylate Preservative Free binds to the nicotinic acetycholine (cholinergic) receptors in the motor endplate and blocks access to the receptors. In the process of binding, the

Allergic reactions (anaphylactic or anaphylactoid responses) which, in rare instances, were severe (e.g., cardiac arrest)

Musculoskeleta

Contraindicated in patients known to have an allergic hypersensitivity to NIMBEX or other bis-benzylisoquinolinium agents. Use of NIMBEX from vials

Use in combination with agents that cause sedation/amnesia and analgesia; atracurium has no effect on level of consciousness or pain threshold. Dilute with D^sub 5^W or

Instruct patient to take a missed dose as soon as p[possible.Instruct patients to take the drug with meals. Emphasized importance of taking drugs as prescribed, even if patient is

Atracurium Besylate

anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation in the ICU.

receptor is actually activated - causing a process known as depolarization. Since it is not degraded in the neuromuscular junction, the depolarized membrane remains depolarized and unresponsive to any other impulse, causing muscle paralysis.

l:

Inadequate block, prolonged block

Cardiovascular:

Hypotension, vasodilatation (flushing), tachycardia, bradycardia

Respiratory: Dyspnea, bronchospasm, laryngospasm

Integumentary: Rash, urticaria, reaction at injection site

containing benzyl alcohol as a preservative is contraindicated in patients with a known hypersensitivity to benzyl alcohol.

0.9% sodium chloride solution. Don't use with lactated Ringer's solution, which can cause atracurium to degrade quickly, or with alkaline solutions, especially barbiturates, which can inactivate atracurium.Monitor the patient's response to blockade with peripheral nerve stimulation.To reverse neuromuscular blockade, administer an anticholinesterase agent such as neostigmine in combination with an anticholinergic agent such as glycopyrrolate.

Don't administer by intramuscular

feeling better.Warn patients to avoid hazardous activities when dizziness occurs.

injection; atracurium can cause tissue irritation.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route, Frequency

Mechanism of Action

Adverse Reaction

Contraindication Nursing Responsibility

Patient Teaching

Generic Name: Propofol

Brand Name:

Diprivan

Drug Classification:

General anesthetic

Indication:

Induction and maintenance

Dosage:AnesthesiaAdults younger than 55 yr of age

IV Induction 40 mg every 10 sec until onset. Usual dose is 2 to 2.5 mg/kg total. For maintenance infusion, titrate to 100 to 200

Produces sedation/hypnosis rapidly (within 40 sec) and smoothly with minimal excitation; decreases IOP and systemic vascular resistance;

Cardiovascular

Myocardial ischemia; hypotension; bradycardia; decreased cardiac output; hypertension (especially in

Propofol is contraindicated in patients hypersensitive to it or any of components of the product. It should not be used in patients where general anesthesia or sedation are

Monitor hemodynamic status and assess for dose-related hypotension.Take seizure precautions. Tonic-clonic seizures have occurred following

Advise patient that mental alertness, coordination, and physical dexterity may be impaired for some time after administration

Propofol

of anesthesia in adults; induction anesthesia in children at least 3 yr of age; maintenance anesthesia in children at least 2 mo of age; initiation and maintenance of monitored anesthesia care sedation in adults; sedation in intubated or respiratory-controlled adult ICU patients.

mcg/kg/min (6 to 12 mg/kg/h).

For maintenance intermittent bolus, use 25 to 50 mg increments, as needed.

Elderly, Debilitated, or ASA III/IV (American Society of Anesthesiologists classification of heart disease, cardiac function, angina, and physical status used to assign risk for anesthesia.) IV 20 mg every 10 sec until onset. Usual dose is 1 to 1.5 mg/kg.

For maintenance infusion, titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/h).Neurosurgical patients

IV Induction 20 mg every 10 sec until onset. Usual dose is 1 to 2 mg/kg.

rarely is associated with malignant hyperthermia and histamine release; suppresses cardiac output and respiratory drive.

children).

CNS

Amorous behavior; movement hypotonia; hallucinations; neuropathy; opisthotonos.

Dermatologic

Rash.

EENT

Conjunctival hyperemia; nystagmus.

Metabolic

Hyperlipidemia.

Respiratory

Apnea; cough; respiratory acidosis during weaning.

contraindicated. Propofol should only be used in facilities where sufficient monitoring and patient-support capabilities are available. Because patients who are in shock, under severe stress or have undergone trauma may be overly sensitive to the cardiovascular and respiratory depressant effects of propofol, it should be used with caution in these patients.

Patients with hypoproteinemia may be susceptible to untoward effects. Other general

general anesthesia with propafol.Be alert to the potential for drug induced excitation (e.g., twitching, tremor, hyperclonus) and take appropriate safety measures.Provide comfort measures; pain at the injection site is quite common especially when small veins are used.

.

For maintenance infusion, use 100 to 200 mcg/kg/min (6 to 12 mg/kg/h).

IV Induction 2.5 to 3.5 mg/kg over 20 to 30 sec. For maintenance infusion (at least 2 mo), use 200 to 300 mcg/kg/min immediately following the induction dose, then, after the first 30 min of maintenance, use infusion rates of 125 to 150 mcg/kg/min titrated to achieve the desired clinical effect, are typically needed.

SedationAdults younger than 55 yr of age

IV Initiation 100 to 150 mcg/kg/min (6 to 9 mg/kg/h) for 3 to 5 min (preferred method) or slow injection of 0.5 mg/kg over 3 to 5 min; follow by

Miscellaneous

Asthenia; burning, stinging, or pain at injection site; fever.

anesthetic agents may be a safer choice in these patients.

maintenance infusion.

For maintenance, use 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/h) (preferred method) or incremental bolus doses of 10 to 20 mg.

Elderly, Debilitated, or ASA III/IV

IV Initiation Same as adults; not as rapid bolus. For maintenance, use 20% reduction of adult dose; avoid rapid bolus doses.

ICU SedationAdults

IV Initiation 5 mcg/kg/min (0.3 mg/kg/h) for at least 5 min; increments of 5 to 10 mcg/kg/min (0.2 to 0.6 mg/kg/h) over 5 to 10 min may be used until desired level of sedation is achieved.

For maintenance, use 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; use minimum dose required for sedation.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Thiopental

sodium

Brand Name:

Pentothal- Powder for injection 2% (20 mg/mL)

Drug Classification:

Anesthesia

Barbiturate

Indication:

as anesthetic agent for brief (15 minute)

Adults:IV 25 to 75 mg; observe for 60 sec.

AnesthesiaAdults:IV 50 to 75 mg slowly every 20 to 40 sec until anesthesia is

Ultra short-acting barbiturate anesthetics depress the central nervous system (CNS) to produce hypnosis and anesthesia without analgesia.The exact mechanism by which barbiturate anesthetics

Cardiovascular:Myocardial depression; arrhythmias.

CNS: Delirium, headache; amnesia; seizures.DermatologicRash.

GI: Abdominal

Absolute Contraindications:

Absence of suitable veins for intravenous administration,

hypersensitivity (allergy) to

Avoid alcohol intake at least 24 hours without advice of the health care professional Inform patient that medication will decrease mental recall of the

Instruct patient to notify health care provider of any signs of hypersensitivitiy to barbiturates.Inform patient to avoid alcohol or other CNS

Thiopental Sodium

- Powder for injection 2.5%

(25 mg/mL)

procedures,for induction of anesthesia prior to administration of other anesthetic agents, to supplement regional anesthesia, to provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation,for the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other causes, in

established then 25 to 50 mg as needed or continuous infusion of 0.2% or 0.4%.

Preanesthetic Sedation:Adults:PR 1 g/34 kg (30 mg/kg).Basal NarcosisAdultsPR 1 g/22.5 kg (44 mg/kg) (max, 3 to 4 g for adults weighing over 90 kg).

produce general anesthesia is not completely understood. However, it has been proposed that they act by enhancing responses to gamma-aminobutyric acid (GABA), diminishing glutamate (GLU) responses, and directly depressing excitability by increasing membrane conductance (an effect reversed by the GABA antagonist picrotoxin), thereby producing a net decrease in neuronal excitability to provide anesthetic action.The mechanism by which thiopental reduces intracranial

pain; rectal irritation; diarrhea; cramping; rectal bleeding (rectal suspension).

Respiratory: Apnea; laryngospasm; bronchospasm; hiccoughs; sneezing; coughing.

Miscellaneous:Thrombophlebitis; pain at injection site; salivation; shivering.

barbiturates and (3) variegate porphyria (South African) or acute intermittent porphyria.

Relative Contraindications:

Severe cardiovascular disease

hypotension or shock,

conditions in which the hypnotic effect may be prolonged or potentiated — excessive premedication, Addison's disease, hepatic or renal dysfunction

procedure mood-altering drugs, or any other CNS depressant medicines for at least 24 hours without advice of the health care professional Aseptic technique is essential. Solution is capable of rapid growth of bacteria contaminants. Infections and subsequent dea6hs have been reportedMay cause drowsiness or dizziness. Advice patients to request assistance prior to ambulation and transfer to avoid driving or any kind of activities that

depressants for 24 h.Advise patient that drug can continue to impair abilities for 24 h following administration and caution patient to avoid driving or performing other tasks requiring mental alertness.

neurosurgical patients with increased intracranial pressure, if adequate ventilation is provided for narcoanalysis and narcosynthesis in psychiatric disorders.

pressure and protects the brain from cerebral ischemia and hypoxia is not completely understood. However, it is related to thiopental's anesthetic action and results in increased cerebral vascular resistance with a decrease in cerebral blood flow and cerebral blood volume, and decreased cerebral metabolic rate for oxygen. Various mechanisms of action have been proposed, including a reduction of cerebral metabolic rate, a decrease in the functional activity of the brain, an inhibition of the brain stem neurogenic

, myxedema, increased blood urea, severe anemia, asthma, myasthenia gravis, and status asthmaticus.

requires alertness until response to medication is known

mechanism of vasoparalysis, a sealing effect on membranes, and a scavenging of free oxygen radicals

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction

Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: succinylcholine chloride

Brand Name:

Anectine

Quelicin

Quelicin Preservative Free Sucostrin

Drug Classification:

Anesthetic, local (ophthalmic)

Indication:

Succinylcholine chloride is indicated as an adjunct to general anesthesia, to facilitate

The dosage of succinylcholine should be individualized and should always be determined by the clinician after careful assessment of the patient

For Short Surgical Procedures

The mechanism of action of Anectine involves what appears to be a "persistent" depolarization of the neuromuscular junction. This depolarization is caused by Anectine mimicking the effect of

General Malignant hyperthermia

Respiratory

prolonged respiratory depression or apnea

Cardio Cardiac arrest, arrhythmias, bradycardia, tachycardia,

Succinylcholine 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

Lab tests: Obtain baseline serum electrolytes. Electrolyte imbalance (particularly potassium, calcium, magnesium) can potentiate effects of neuromuscular blocking agents.

Be aware that

Patient may experience postprocedural muscle stiffness and pain (caused by initial fasciculations following injection) for as long as 24–30 h.

Be aware that hoarseness and sore throat are common even when pharyngeal

Succinylcholine chloride

tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Average dose required to produce neuromuscular blockade and to facilitate tracheal intubation is 0.6 mg/kg ANECTINE Injection given intravenously. The optimum dose will vary among individuals and may be from 0.3 to 1.1 mg/kg for adults.

For Long Surgical Procedures

The dose of succinylcholine administered by infusion depends upon the duration of the surgical procedure and the need for muscle

acetylcholine but without being rapidly hydrolysed by acetylcholinesterase. This depolarization leads to desensitization.

hypertension, hypotension, hyperkalemia,

Others

Increased intraocular pressure, muscle fasciculation, jaw rigidity, postoperative muscle pain, rhabdomyolysis with possible myoglobinuric acute renal failure, excessive salivation, and rash.

of injury following major burns, multiple trauma, extensive denervation of skeletal muscle, or upper motor neuron injury, because succinylcholine administered to such 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.

transient apnea usually occurs at time of maximal drug effect (1–2 min); spontaneous respiration should return in a few seconds or, at most, 3 or 4 min.

Have immediately available: Facilities for emergency endotracheal intubation, artificial respiration, and assisted or controlled respiration with oxygen.

Monitor vital signs and keep airway clear of secretions.

airway has not been used.

Report residual muscle weakness to physician.

Generic Name(Brand Name)

Drug Classification &

Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction Contraindication

Nursing Responsibility

Patient Teaching

Generic Name: Fentanyl

Brand Name: Actiq, Fentora, Onsolis,Duragesic

Drug Classification: Narcotic agonist analgesic

Indication:

- Analgesic action of short duration during anesthesia and immediatepostop period

· Analgesic

Premedication: 0.05–0.1 mg IM 30–60 min prior to surgery.

IM /Transderma

Acts at specific opioid receptors, causing analgesia, respiratory depression, physical depression, euphoria.

Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, light-headedness, nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental

- Contraindicated with hypersensitivity to narcotics, diarrhea caused by poisoning, acute bronchial asthma, upper airway obstruction, pregnancy.

Administer to women who are nursing a baby 4–6 hr before the next scheduled feeding to minimize the amount in milk.Provide narcotic antagonist, facilities for assisted or controlled respiration on standby during parenteral

These side effects may occur: dizziness, sedation, drowsiness, impaired visual acuity (ask for assistance if you need to move); nausea, loss of appetite (lie quietly, eat frequent

Fentanyl

supplement in general or regional anesthesia

· Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia

· For use as an anesthetic agent with oxygen in selected high-risk patients

· Transdermal system: management of chronic pain in patients requiring opioid analgesia

· Treatment of breakthrough pain in cancer

and physical performance, coma, mood changes, weakness, headache, tremor, convulsions

Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia, palpitations

Rash, hives, pruritus, flushing, warmth, sensitivity to cold

Diplopia, blurred vision

Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm

Ureteral spasm, spasm of vesical sphincter

administration.Prepare site for transdermal form by clipping (not shaving) hair at site; do not use soap, oils, lotions, alcohol; allow skin to dry completely before application. Apply immediately after removal from the sealed package; firmly press the transdermal system in place with the palm of the hand for 10–20 sec, making sure the contact is complete. Must be worn continually for 72 hr.Use caution with Actiq form to keep this drug out of the reach of children (looks like a lollipop) and follow the distribution restrictions in place with this drug very

small meals); constipation (a laxative may help).Do not drink grapefruit juice while on this drug.Report severe nausea, vomiting, palpitations, shortness of breath, or difficulty breathing.

patients being treated with narcotics (Actiq)

s, urinary retention or hesitancy,oliguria, antidiuretic effect, reduced libido or potency

carefully.

Generic Name(Brand Name)

Drug Classification & Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction Contraindication Nursing Responsibility

Patient Teaching

Generic Name: Atropine Sulfate

Brand Name:

AtroPen, Sal-Tropine

Drug Classification:

Anticholinergic, antidote, Antiparkinsonian, Belladonna alkaline

Indication:

•Antisialogogue for preanesthetic medication to prevent or reduce respiratory tract secretions.

Tablets-0.4 m, injection: 0.05, 0.1, 0.3, o.4, 0.5, 0.8 mg/ml;

IM,IV, SubQ, Topical

Ophthalmic ointment: %, ophthalmic solution:0.5%

Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic post ganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences in

•CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache flushing, nervousness, weakness, dizziness, insomnia, mental confusion, or excitement.

•CV: Palpitations,

•Contraindicated with hypersensitivity to anticholinergic drugs.

Systemic administration:

•Contraindicated with glaucoma, adhesions between iris and lens; stenosing peptic ulcer,

Assessment:•History: Hypersensitivity to anticholinergic; glaucoma; adhesions between iris and lens; stenosing peptic ulcer, paralytic ileus.• Physical: skin

color, lesions, texture, T; orientation, reflexes, bilateral grip strength, affect, ophthalmic

•Take as prescribed, 30 minutes before meals, avoid excessive dosage.

•Avoid hot environments you will be heat intolerant, and dangerous reactions may occur.

•Report rash, flushing, eye pain difficulty breathing tremors, loss of coordination, irregular heartbeat, palpitations,

Atropine sulphate

•Treatment of parkinsonism; relieves tremors and rigidity

•Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intra-abdominal traction causes a decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor.

•Relief of bradycardia and syncope due to hyperactive carotid sinuses reflex.

•Relief of pylorospasm, hyper tonicity of the small intestine, and hypermotility of the clon

•Relaxation of

the heart, relaxin the GI and GU tracts, inhibiting gastric acid secretion, ( high dose), relaxing the pupil of the eye, and preventing accommodation foe near vision, also blocks the effects of acetylcholine in the CNS.

bradycardia, ( low doses) tachycardia ( high doses)

•GI: Dry mouth, altered taste perception, N/V, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal reflux.

•GU: Urinary hesitancy and retention, impotence.

•Other: decreased sweating and predispositions, suppression of lactation.

•Local: transient stinging

•Systemic: systemic adverse effects, depending on amount

pyloroduodenal obstruction; paralytic ileus.

•Use cautiously with Down syndrome, brain damage, spasticity, hypertension, hyperthyroidism, lactation.

examination, P, BP, R adventitious sounds.

headache, abdominal distention, hallucinations, sever or persistent dry mouth.

the spasm of biliary and ureteral colic and bronchospasm.

•Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of the urinary tract disorder.

•Control of crying and laughing episodes in patients with brain lesions.

•Relaxation of uterine hyper tonicity.

•Management of peptic ulcer.

•Control of rhinorrhea of acute rhinitis or hay fever.

absorbed.

Generic Name(Brand Name)

Drug Classification & Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction Contraindication Nursing Responsibility

Patient Teaching

Isoflurane

Generic Name: Isoflurane

Brand Name:

Forane

Terrell

Aerrane

Ethane

Forane

Forene

Drug Classification:

Anesthetic

Indication:

Forane (isoflurane, USP) may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.

Inhalation induction:

initial 0.5 % v/v with

oxygen or oxygen and

nitrous oxide,

increase to 1.5- 3 % v/v

Maintenance:

1-2.5% v/v with oxygen only

Forane induces a reduction in junctional conductance by decreasing gap junction channel opening times and increasing gap junction channel closing times. Forane also activates calcium dependent ATPase in the sarcoplasmic reticulum by increasing the fluidity of the lipid membrane. Also appears to bind the D subunit of ATP synthase and NADH dehydogenase. Forane also binds to the GABA receptor, the large conductance Ca2+ activated potassium channel, the glutamate

General

Malignant hyperthermia and shivering

Hepatic

Rare reports of mild, moderate, and severe (sometimes fatal) postoperative hepatic dysfunction and hepatitis, hepatic failure and hepatic necrosis

Gastrointestinal Nausea, vomiting,

Respiratory Isoflurane can react with desiccated carbon dioxide (CO2) absorbents to

Contraindicated to patients with known sensitivity to Isoflurane, USP or to other halogenated agents and known or suspected genetic susceptibility to malignant hyperthermia.

Used with caution in patients with coronary artery disease

Monitor blood pressure and temperature to detect residual hypotension and the possibility of malignant hyperthermia

Must be given with a licensed anesthesiologist

Emergency kit must be made available

Monitor respiratory function (dosage may need to be reduced)

Advise patient to stop herbal medication 2-3 weeks prior to surgery

Report for signs of infection, including fever and chills, redness, swelling, increasing pain, or discharge from the injection site, tingling, numbness, or trouble moving around the affected area, headache, persistent coughing, chest pain, trouble breathing or shortness of breath, dizziness, heartbeat abnormalities, funny taste or numbness of the mouth or

receptor and the glycine receptor produce carbon

monoxide, which may result in elevated levels of carboxyhemoglobin in some patients.

Metabolic Hyperkalemia

Other Transient elevations in white blood count

Prepare to provide ventilator support

Document the use of these agents in the medical record

other worrisome symptoms

Generic Name(Brand Name)

Drug Classification & Indication

Dosage, Route,

Frequency

Mechanism of Action

Adverse Reaction Contraindication Nursing Responsibility

Patient Teaching

Generic Name: Lidocaine HCl

Drug Classification:

Local anesthesia: dosage

Local anesthetic: blocks the generation and

Injectable local anesthesia;

CNS: dizziness,

Contraindicated with allergy to lidocaine or amide-type

Check drug concentration carefully;

Dosage is changed frequently in

Lidocaine hydrochloride

Brand Name:

Lidocaine anesthetic prep:

Xylocaine HCl (inj.)

Octocaine

Local Anesthetic

Antiarrhythmic

Indication:

As anesthetic: infiltration anesthesia, peripheral and symphatetic nerve blocks, central nerve blocks. Spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthesia for skin disorders and accessible mucous membranesAs local anesthesia before venipuncture or peripheral IV cannulation

varies with the area to be anesthesized and te reason for the anesthesia; use the lowest dose possible.

Direct inj—10,20mg/mL

conduction 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.

Type 1 antiarrhythmic: decreases diastolic depolarization, decreasing automaticity of ventricular cells: increases ventricular fibrillation threshold.

HA, backache, septic meningitis, sometimes incomplete recovery

CV: Hypotension due to sympathetic block

Derma: pruritus, urticaria, edema

GU: urinary retention, urinary or fecal incontinence

Topical Local Anesthesia:

Derma: contact dermatitis, urticaria, cutaneous lesions

Hypersentitivity: anaphylactoid

local anesthetics, HF, cardiogenic shock, strokes-Adam syndrome

Use cautiously with hepatic or renal disease, inflammation or sepsis in the region of injection, labor and delivery and lactation.

many concentrations are available.Reduces dosage with hepatic or renal failure.Continuously monitor response when used as antiarrhythmic or injected as local anesthesia.Keep life-support equipment and vasopressors readily available in case severe adverse reaction occursMonitor for malignant hyperthermia; have-life support equipment

response to cardiac rhythm on monitor.Oral lidocaine can cause numbness of the tongue, cheeks, and throat. Do not eat or drink for 1 hour to prevent biting the inside of your mouth and tongue and chokingSide effects such as drowsiness, numbness, dizziness, burning, local irritation may experience.Report difficulty speaking, thick tongue, DOB, pain at the IV site

when applied to intact skin in children 3-18 years old.As antiarrhythmic: Mngt of 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.

reactions

Local: Burning, stinging, tenderness, swelling, tissue irritation, necrosis

and IV dantrolene readily availableReduce dose when treating arrhythmias in HF, digoxin toxicity with AV block, and geriatric patientsMonitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictionsLarge amount of anesthesia used during cosmetic procedures may result in severe, life- threatening adverse

effects.Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from the injection site. Make sure that solutions are use only to produce local anesthesiaUse caution to prepvent choking. Patient may have difficulty swallowing after using oral topical anesthetic. Do not give food or drink for 1 hour use of

oral anestheticMonitor for safe and effective serum drug concentrations (antiarrhythmic use: 1-5mcg/mL). Doses more than 6-10mcg/mL are usually toxic