NAME : Tiffany Luv B.
Adrias Year/Section: BSN II - Orlando
Category/Drug Actions/Indications
Nonnarcotic Analgesics
NSAIDs NSAIDs block cyclooxygenase-2
(COX-2), an enzyme that causes pain
Suffix: -profen (fenoprofen, and inflammation
ibuprofen, ketoprofen)
COX-2 inhibitors selectively block
Suffix: -fenac (bromfenac, the COX-2 enzyme and therefore
diclofenac, nepafenac) have a lower risk of causing stomach
or intestine ulcers than
Examples: other NSAIDs
Acetic acids: indomethacin These drugs inhibit the production
(Indocin), sulindac (Clinoril); of prostaglandins
Fenamates (Ponstel);
celecoxib (Celebrex);
oxicams (Feldene); Ketorolac tromethamine (Toradol) is
similar to morphine and is used for
Propionic acids: naproxen short-term
(Naprosyn); ketorolac
tromethamine (Toradol) management of moderately severe
acute pain
NOTE: The antidote for narcotics is naloxone (Narcan), which is used to reverse respiratory depression.
Demerol (meperidine) Acts as an agonist at specific opioid
receptors in the central nervous
system (CNS) to produce analgesia,
euphoria, and sedation
Fentanyl Buccal form is used to treat
“breakthrough” cancer pain that is
not controlled by other medications;
also used as a pain reliever and
anesthetic in pre-procedures
Morphine Indicated for the relief of pain in
patients who require opioid
analgesics for more than a few days;
interacts predominantly with the
opioid mu-receptor; also produces
respiratory depression by direct
action on the brainstem respiratory
centers.
Oxycodone (OxyContin) Decreases pain by binding to the
opiate receptors in the CNS
Corticosteroids
Examples: Betamethasone, Steroids have a wide range of uses
prednisone, Solu-Cortef IV, reflecting their anti- inflammatory
Solu-Medrol IV and immunosuppressive properties
(methylprednisolone), Individual agents may be available in
dexamethasone several different preparations (i.e.,
Adverse Effects Nursing Considerations
 Nausea NOTE: NSAIDs carry the risk of
 Vomiting myocardial infarction and stroke.
 Diarrhea
 Constipation  Fenamates (e.g., Ponstel) are
 Rash used to treat rheumatoid
 Dizziness arthritis
 Ketorolac (Toradol) is the
only NSAID that is available
for administration orally,
intramuscularly (IM),
intravenously (IV), or
topically
 Ketorolac is contraindicated
in patients with a patent
ductus arteriosus, renal or
hepatic impairment, anemia,
myocardial infarction, or
stroke
 Mood changes (e.g.,  Give the smallest effective
euphoria, dysphoria) dose for the shortest period
 Weakness of time
 Headache
 Agitation
 Tremor and involuntary
muscle movements
 Drowsiness  Fentanyl is 100 times
 Lightheadedness stronger than morphine
 Weakness and fatigue
 Respiratory depression  Contraindicated in patients
 Bradycardia with pancreatitis as
 Seizure (convulsions) morphine induces “spasm”
 May also cause itching of in the sphincter of Oddi
the face, mouth, and eyes,
which can be treated with
promethazine
 Respiratory depression  Monitor the patient’s
 Flushing response closely, especially
 Physical and psychological when giving sustained-
dependence release preparations
 Dizziness  Administer with meals
 Mood swings
 Hyperglycemia
 Weight gain
 Electrolyte imbalance NOTE: When discontinuing these
 Extreme fatigue
Category/Drug Actions/Indications Adverse Effects Nursing Considerations

oral, IV, topical)  Unusual bleeding drugs, gradually decrease the dosage
 Black stools to prevent adrenal crisis.
Betamethasone accelerates fetal  Swelling
lung maturity and reduces  Leukocytosis
 immune suppression
intracranial hemorrhage in
increases the risk of
premature infants
infections (especially
fungal)
Prednisone suppresses the normal  Prednisone toxicity results
immune response in Cushing’s syndrome
(buffalo hump, moon face,
Dexamethasone is used primarily in high glucose levels, and
the treatment of brain edema hypertension)

Anesthetics and Other Drugs Given During Surgery

Anesthetics are drugs that cause a reversible loss of sensation. Most anesthetics can cause respiratory depression, hypotension,
and arrhythmias. A less common, but important and potentially fatal adverse reaction is malignant hyperthermia. As the result of an
inherited condition, susceptible individuals develop hyperthermia, rhabdomyolysis, and muscle rigidity following administration of
certain anesthetics. Without prompt treatment with dantrolene, death often occurs.

Keep in mind that, when an anesthetic is administered to induce paralysis, a sedative should always be administered first

Category/Drug Actions/Indications Adverse Effects Nursing Considerations

Anesthetics

Etomidate Short-acting IV anesthetic used for  Injection site pain  Unlike many other anesthetics, this
short-term procedures or to induce  Eye movements drug does not cause hypotension
general anesthesia  Skeletal movements

Ketamine Used to induce and maintain general  Hallucinations  Closely monitor of vital signs during
anesthesia in children  Respiratory depression administration
 Cardiovascular side
effects

Pancuronium Competitive acetylcholine antagonist  Skeletal muscle weakness  This drug does not induce sleep; when
bromide used as a muscle relaxant for  Respiratory insufficiency administered with other anesthetic
(Pavulon) intubation or for quick-onset surgery  Apnea drugs, an additive effect occurs
 Use caution when administering to
patients with myasthenia gravis
 Antidote: The effects of this drug can
be partially reversed by
administration of an
anticholinesterase drug, such as
neostigmine and pyridostigmine

Propofol Used for sedation and hypnosis  Metabolic acidosis  Use aseptic technique when
 Hyperlipidemia administering this drug
 Change the IV tubing used to
administer the drug every 12 hours

Succinylcholine Binds to the nicotinic M receptors for
(Anectine) acetylcholine; used for relaxing
muscles during surgery or when on a
ventilator; also used during anesthesia
for tube insertion
 Hypotension  Because this drug increases
 Bradycardia intraocular pressure, it should not be
 Respiratory paralysis used in patients with penetrating eye
 Dystonia injuries
 Akathisia  Other contraindications include
 Malignant hyperthermia glaucoma, blood electrolyte
 Increased intraocular abnormalities, malignant
pressure hyperthermia, or kidney or liver
disease

Thiopental Acts on the gamma aminobutyric acid  Cardiovascular depression  Contraindications include liver
sodium (GABA) receptor in the brain and  Respiratory depression disease, Addison’s disease,
(pentothal spinal cord; a rapid-onset, short-acting myxedema, and heart disease
sodium) barbiturate general anesthetic

Antimuscarinic agents

Glycopyrrolate Given preoperatively to reduce  Dry mouth (xerostomia)  Contraindications include glaucoma,
[Robinul]) respiratory and gastric secretions  Urinary retention
Category/Drug Actions/Indications Adverse Effects Nursing Considerations

 Blurred vision and asthma, and prostatic hypertrophy

photophobia (due to
dilation of pupils
[mydriasis])
 Increased ocular tension
 Tachycardia