Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

University Town, Northern Samar

COLLEGE of NURSING and ALLIED HEALTH SCIENCES

DRUG ANALYSIS
OF PREOPERATIVE MEDICATIONS

Submitted by:
HAGUTIN, ZAIRENE KYLE M.
I. Sedatives and Hypnotics

DRUG MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING

DATA M OF N ON INTERACTIO REACTION RESPONSIBILITI
ACTION N ES
pentobarbit Depresses Pentobarbital Barbiturate sensitivity, Pentobarbital Nervous Nursing
al sodium sensory cortex is a porphyria liver disease, has no known system: Considerations
(Nembutal) & decreases medication severe respiratory severe Agitation, 1.High doses can
motor activity; used to disease. interactions confusion, cause death.
produces manage and with other hyperkinesia, 2.Monitor
sedation, treat several drugs. ataxia, CNS Hemodynamics
drowsiness, medical depression, Respiratory status
and hypnosis. conditions, nightmares, Mechanical
Pentobarbital such as a pre- nervousness, ventilation
works in the anesthetic in psychiatric 3. Avoid use in
central the operating disturbance, geriatric patients.
nervous room. Acts as hallucinations, Use caution,
system by a depressant, insomnia, Depression, Hepatic
binding to or sedative, anxiety, impairment, Renal
gamma- used short- dizziness, impairment
aminobutyric term to treat thinking
acid (GABA) A insomnia. abnormality.
subtype Nembutal is
receptors. also used as Respiratory
This action an emergency system:
induces a treatment for Hypoventilatio
change in the seizures, and n, apnea.
chloride to cause
transport patients to Cardiovascular
receptor, fall asleep for system:
leading to an surgery. Bradycardia,
increase in the hypotension,
duration that syncope.
the chloride
channels Digestive
remain open, system:
hence Nausea,
potentiating vomiting,
GABA effects constipation.

Other reported
reactions:
Headache,
injection site
reactions,
hypersensitivit
y reactions
(angioedema,
skin rashes,
exfoliative
dermatitis),
fever, liver
damage,
megaloblastic
anemia
following
chronic
phenobarbital
use.
 DRUG MECHANIS INDICATIO CONTRAINDICATIO DRUG ADVERSE NURSING
DATA M OF N N INTERACTIO REACTION RESPONSIBILITI
ACTION N ES
secobarbital Inhibits This History of manifest or CNS CNS: Anxiety, 1. Be aware that
sodium upward medication is latent porphyria; depressants: clumsiness, prolonged use of
(Secobarbitol conduction of used to calm hypersensitivity to Additive confusion, secobarbital may
) nerve you just secobarbital, other depressant depression, lead to tolerance and
impulses to before barbiturates, or their effects dizziness, physical and
Pharmacologi the reticular surgery. components; severe corticosteroids, drowsiness, psychological
c class: formation of Secobarbital hepatic or respiratory oral hangover, dependence.
Barbiturate the brain, belongs to a impairment in which anticoagulants: headache, 2. Assess patient for
Therapeutic thereby class of drugs dyspnea or obstruction Decreased insomnia, signs and symptoms
class: disrupting known as is evident plasma levels of irritability, of barbiturate
Sedative- impulse barbiturate these drugs lethargy, toxicity, including
hypnotic transmission hypnotics. It with decreased nervousness, dyspnea, severe
Controlled to the cortex. works by effectiveness nightmares, confusion, and
substance This action affecting doxycycline: paradoxical severe drowsiness.
schedule: II depresses the certain parts Shortened half- stimulation, Notify prescriber
CNS, of the brain life by syncope CV: immediately if they
producing to calm you. secobarbital for Hypotension appear because
drowsiness, Secobarbital as long as 2 EENT: barbiturate toxicity
hypnosis, and is used on a weeks after Laryngospasm may be life-
sedation. short-term barbiturate GI: Anorexia, threatening.
basis to treat therapy is constipation, 3. Expect the
insomnia. It is discontinued nausea, prescriber to provide
also used to estradiol, vomiting MS: patient with the least
relieve estone, Arthralgia, possible quantity of
anxiety progesterone, muscle secobarbital to
before and other weakness minimize the risk of
surgery. steroidal RESP: Apnea, acute or chronic
hormones: bronchospas overdosage. For
Decreased m, respiratory patients who are
effectiveness of depression depressed, drug-
these drugs SKIN: dependent, or
griseofulvin: Jaundice suicidal or who have
Interference Other: Drug a history of drug
with the dependence, abuse, institute
absorption of weight loss precautions to
oral griseofulvin prevent drug
MAO inhibitors: hoarding and
Prolonged overdosage.
effect of
secobarbital
increasing risk
of adverse
reactions
phenytoin:
Effects on the
metabolism of
phenytoin
variable
requiring close
monitoring
sodium
valproate,
 valproic acid:
Increased
secobarbital
serum levels

DRUG MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING

DATA M OF N ON INTERACTION REACTION RESPONSIBILITI
ACTION ES
chloral Chloral Hydrate Chloral Chloral hydrate is Enhanced sedative Significant: 1.Give capsules with
hydrat is a hypnotic hydrate, a contraindicated in effect w/ opiates, Gastric a full glass of liquid;
e and sedative sedative, is patients with marked barbiturates, TCAs, irritation (e.g. ensure that patient
with CNS used in the hepatic or renal antipsychotics, nausea, swallows capsules
depressant short-term impairment and in antihistamines, and vomiting, whole; give syrup in
properties treatment of patients with severe other sedatives. May diarrhoea), half glass of water,
similar to insomnia (to cardiac disease. Oral cause hot flushes, abdominal fruit juice, or ginger
barbiturates. help you fall dosage forms of chloral sweating, and HTN distention, ale.
Its exact asleep and hydrate are w/ IV furosemide. flatulence, 2. Supervise dose
mechanism of stay asleep contraindicated in the May cause delirium tolerance, and amount of drug
action is for a proper presence of gastritis. w/ anticholinergics dependence. prescribed for
unknown, rest) and to or psychotropics. Nervous: patients who are
however, it is relieve May produce a Drowsiness, addiction prone or
believed that anxiety and transient increase in light- alcoholic; give least
its CNS induce sleep hypoprothrombine headedness, amount feasible to
depressant before mic response to headache, patients who are
effects are due surgery. It is warfarin. paradoxical depressed or
to its active also used excitement, suicidal.
metabolite, After surgery hallucination, 3. Withdraw
trichloroethan for pain and nightmares, gradually over 2 wk if
ol. to treat confusion, patient has been
alcohol ataxia. maintained on high
withdrawal. GI: Gastritis, doses for weeks or
unpleasant months; if patient
taste. has built up high
Genitourinary: tolerance,
Ketonuria, withdrawal should
parenchymato occur in a hospital,
us renal injury. using supportive
Dermatologic: therapy similar to
Erythema that for barbiturate
multiforme, withdrawal; fatal
Stevens- withdrawal reactions
Johnson have occurred.
syndrome. 4. Reevaluate
Potentially patients with
Fatal: Delirium prolonged insomnia;
tremens. therapy for the
underlying cause (eg,
 pain, depression) is
preferable to
prolonged use of
sedative–hypnotic
drugs.

ii. tranquilizers
 DRUG MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING
DATA M OF N ON INTERACTI REACTION RESPONSIBILITI
ACTION ON ES
chlorpromazi Depresses To manage Comatose states; anticonvulsant CNS: Drowsiness, 1. Don’t open or
ne brain areas symptoms of hypersensitivity to s: Possibly extrapyramidal crush E.R. capsules.
hydrochlorid that control psychotic chlorpromazine, lowered reactions (such as 2. Know that
e (Thorazine) activity and disorders or phenothiazines, or convulsive dystonia, fever, chlorpromazine
aggression, control their components; use threshold CNS motor shouldn’t be used
including the manic of large amounts of depressants restlessness, to treat dementia-
Pharmacologi cerebral manifestatio CNS depressants such as pseudoparkinsonis related psychosis in
c class: cortex, ns of manic- anesthetics, m, and tardive the elderly
Phenothiazin hypothalamu depression in barbiturates, dyskinesia), because of an
e Therapeutic s, and limbic outpatients narcotics: neuroleptic increased risk of
class: system, by an Prolonged and malignant death.
Antiemetic, unknown intensified CNS syndrome, 3. Use
antipsychotic, mechanism. depression seizures CV: ECG chlorpromazine
tranquilizer Prevents metrizamide: changes, such as cautiously in
nausea and Possibly nonspecific, patients (especially
vomiting by lowered usually reversible children) with
inhibiting or seizure Q- and T-wave chronic respiratory
blocking threshold oral changes; disorders
dopamine anticoagulants: orthostatic (such as severe
receptors in Decreased hypotension; asthma or
the medullary anti- tachycardia EENT: emphysema) or
chemorecept coagulation Blurred vision, dry acute respiratory
or trigger propranolol: mouth, nasal tract infections
zone and Increased congestion, ocular because drug has
peripherally plasma levels changes (fine CNS
by blocking of both drugs particle deposits depressant effect.
the vagus thiazide in lens and Also use cautiously
nerve in the diuretics: cornea) with long- in patients with
GI tract Possibly term therapy cardiovascular,
increased ENDO: hepatic, or renal
orthostatic Gynecomastia, disease
hypotension hyperglycemia, because of
hypoglycemia, increased risk of
lactation, developing
moderate breast arrhythmias, heart
engorgement GI: failure, and
Constipation, hypotension.
ileus, nausea GU: 4. Know that
Amenorrhea, because of
ejaculation chlorpromazine’s
disorders, anticholinergic
impotence, effects, use it
priapism, urine cautiously in
retention HEME: patients with
Agranulocytosis, glaucoma. Also use
aplastic anemia, it cautiously in
eosinophilia, those who are
hemolytic anemia, exposed to extreme
leukopenia, heat or
pancytopenia, organophosphate
thrombocytopenic insecticides and
purpura SKIN: those receiving
Exfoliative atropine or related
dermatitis, drugs.
photosensitivity, 5. Protect
tissue necrosis, concentrate from
urticaria light. Refrigeration
isn’t required.
6. Dilute
concentrate in at
least 60 ml of
diluent just before
administering it.
Use a carbonated
beverage,
coffee, milk, orange
syrup, pudding and
soup, semisolid
food, simple syrup,
tea, tomato or fruit
juice,
or water.
7. Protect
parenteral solution
from light. Solution
should be clear and
colorless to pale
yellow. Discard
markedly discolored
solution.
8. Don’t inject drug
by subcutaneous
route because it can
cause severe tissue
necrosis.
9. Wear gloves
when working with
liquid or injectable
form because
parenteral solution
may cause
contact dermatitis.
For I.V. injection,
dilute
chlorpromazine
with sodium
chloride to a
concentration of 1
mg/ml.
10. Give I.M.
injection slowly and
deep into upper
outer quadrant of
buttocks, such as in
the gluteus
maximus. To
minimize
hypotensive effects,
keep patient lying
flat and monitor
blood pressure for
30
minutes after
injection.
11. Monitor patient
for increased
sensitivity to drug’s
CNS effects if
patient has a history
of hepatic
encephalopathy
from cirrhosis.
 DRUG MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING
DATA M OF N ON INTERACTION REACTION RESPONSIBILITI
ACTION ES
hydroxyzine Competes To relieve Contraindications antibiotics such as CNS: 1. Use hydroxyzine
hydrochlori with anxiety and Early pregnancy; azithromycin, Drowsiness, cautiously in
de (Vistaril) histamine for tension hypersensitivity to erythromycin, hallucinations patients with risk
 histamine1 associated cetirizine, hydroxyzine, clarithromycin, , headache, factors for QT
receptor sites with levocetirizine or their gatifloxacin, or involuntary prolongation such
Pharmacolo on surfaces of psychoneuros components; moxifloxacin; motor as concomitant
gic class: effector cells. is; adjunct in prolonged QT interval. antidepressants activity, arrhythmogenic
Piperazine This organic such as citalopram seizures, drug use,
derivative suppresses disease states or fluoxetine; tremor CV: electrolyte
Therapeutic results of in which antipsychotics such Prolonged QT imbalance, or
class: histaminic anxiety is as chlorpromazine, interval, preexisting heart
Anxiolytic, activity, manifested clozapine, torsades de disease. Also use
Antiemetic, including iloperidone, pointes EENT: cautiously in
antihistamin edema, flare, quetiapine, or Dry mouth patients with
e, sedative- and pruritus. ziprasidone; class IA SKIN: Fixed bradyarrhythmias,
hypnotic Sedative antiarrhythmics drug congenital or family
actions occur such as eruptions, history of long QT
at subcortical procainamide or pruritus, rash, syndrome, other
level of CNS quinidine; class III urticaria conditions that
and are dose antiarrhythmics Other: predispose patient
related. such as amiodarone Hypersensitivi to QT prolongation
or sotalol; ty reactions, and ventricular
droperidol; injection-site arrhythmia, recent
methadone; pain MI, or
ondansetron; uncompensated
pentamidine:Increa heart failure.
sed risk of QT 2. Don’t give
prolongation CNS hydroxyzine by
depressants: subcutaneous or I.V.
Increased CNS route because
depression tissue necrosis may
occur. 3. Inject I.M.
form deep into
large muscle, using
Z-track method.
4. Observe for
oversedation if
patient takes
another CNS
depressant.
DRUG MECHANISM INDICATIO CONTRAINDICATIO DRUG ADVERSE NURSING
DATA OF ACTION N N INTERACTIO REACTION RESPONSIBILITI
N ES
diazepa It is indicated Contraindications: Interactions
m Depresses all for the Hypersensitivity DRUG: Alcohol, IV route may 1.Assess B/P, pulse,
(Valium) levels of CNS by management to CNS produce pain, respirations
enhancing of anxiety diazepam. depressants swelling, immediately before
action of disorders or (e.g., thrombophlebitis administration.
gamma- for the short- Acute gabapentin, , carpal tunnel 2.Assess autonomic
aminobutyric term relief of morphine, syndrome. response (cold,
acid the symptoms narrow-angle zolpidem) clammy hands;
of anxiety. may increase Abrupt or too- diaphoresis), motor
(GABA), a major glaucoma, untreated CNS depression. rapid withdrawal response
inhibitory open-angle glaucoma, CYP3A4 may result in (agitation, trembling,
neurotransmitt severe respiratory inducers (e.g., pronounced tension).
er in the brain. depression, severe carBAMazepine, restlessness, Musculoskeletal
Therapeutic rifAMPin) spasm:
Effect: hepatic insufficiency, may irritability, 3.Record onset, type,
sleep apnea syndrome, insomnia, hand location, duration of
Produces myasthenia gravis. decrease tremor, pain. Check for
anxiolytic Children abdominal/muscl immobility, stiffness,
effect, elevates concentration. e cramps, swelling.
seizure younger than 6 mos diaphoresis, 4.Review history of
threshold, (oral). CYP3A4 seizure disorder
produces vomiting, (length, intensity,
skeletal muscle inhibitors seizures. Abrupt frequency, duration,
 withdrawal in pts LOC).
relaxation (e.g., with epilepsy 5.Observe frequently
may produce for recurrence of
itraconazole, increase seizure activity.
ketoconazole) in 6. heart rate,
may increase frequency/severi respiratory rate, B/P,
concentration ty of seizures. mental status. Assess
Overdose results children, elderly
in drowsiness, for paradoxical
confusion, reaction, particularly
during early therapy.
diminished 7.Evaluate for
reflexes, CNS therapeutic response
depression, (decrease in
coma. intensity/frequency
of seizures; calm
facial
expression,
decreased
restlessness;
decreased intensity
of skeletal muscle
pain).
8. Therapeutic serum
level: 0.5–2 mcg/mL;
toxic serum level:
greater than 3
mcg/mL.
iii. opioid analgesics

DRUG MECHANIS INDICATIO CONTRAINDICATIO DRUG ADVERSE NURSING

DATA M OF N N INTERACTIO REACTION RESPONSIBILITI
ACTION N ES
meperidine Binds with To relieve Acute or severe 5-HT3 receptor CNS: 1. Be aware that
hydrochlorid opiate pain severe bronchial asthma in an antagonists, Agitation, excessive use of
e (Demerol) receptors in enough to unmonitored setting or drugs that affect confusion, opioids like
the spinal cord require opioid in the absence of the serotonin delirium, meperidine may lead
Pharmacologi and higher treatment resuscitative neurotransmitte depression, to abuse, addiction,
c class: levels of the and for which equipment; r system dizziness, misuse, overdose,
Opioid CNS. In this alternative hypersensitivity to (mirtazapine, drowsiness, and possibly death.
Therapeutic way, treatment meperidone or its tramadol, headache, Because of this, a
class: Opioid meperidine options such components; known or trazodone), increased Risk Evaluation and
analgesic stimulates as nonopioid suspected MAO inhibitors intracranial Mitigation Strategy
Controlled kappa and mu analgesics or gastrointestinal including I.V. pressure, lack (REMS) is required.
substance receptors, opioid obstruction, including methylene blue of Monitor patient’s
schedule: II which alters combination paralytic ileus; and linezolid, coordination, intake of drug closely
the perception products are significant respiratory selected muscle malaise, and for evidence of
of and inadequate or depression; use within relaxants mood physical dependence.
emotional not tolerated 14 days of MAO (cyclobenzaprin changes, 2. Know that chronic
response to inhibitor therapy e, metaxalone), nervousness, maternal use of
pain. selective nightmares, meperidine during
serotonin restlessness, pregnancy can result
reuptake seizures, in neonatal opioid
inhibitors syncope, withdrawal
(SSRIs), transient syndrome (NOWS),
serotonin and hallucination which may be life-
norepinephrine s or threatening if not
reuptake disorientatio recognized and
inhibitors n, tremor, treated
(SNRIs), tricyclic weakness CV: appropriately. NOWS
antidepressants, Hypotension, occurs when a
triptans: orthostatic newborn has been
Increased risk of hypotension, exposed to opioid
serontonin tachycardia drugs like meperidine
syndrome EENT: for a prolonged
Blurred period while in utero.
vision, 3. Use meperidine
diplopia, dry with extreme caution
mouth in patients with acute
ENDO: abdominal
Adrenal conditions, hepatic or
insufficiency renal disorders,
GI: hypothyroidism,
Abdominal prostatic hyperplasia,
cramps or seizures, or
pain, supraventricular
anorexia, tachycardia.
constipation, 4. Use cautiously in
ileus, nausea, debilitated patients
vomiting GU: or patients with
Decreased adrenocortical
libido, insufficiency,
dysuria, pheochromocytoma,
erectile sickle cell anemia,
dysfunction, toxic psychosis, and
impotence, any other condition
infertility, that might worsen
lack of with CNS depression,
menstruation such as acute
, urinary alcoholism.
frequency, 5. Be aware that
urine meperidine should
retention only be used
MS: concomitantly with
Involuntary benzodiazepine and
muscle other CNS
movements depressants therapy
RESP: in patients for whom
Dyspnea, other treatment
respiratory options are
arrest or inadequate. If
depression, prescribed together,
wheezing expect dosing and
SKIN: duration of
Diaphoresis, meperidine to be
flushing, limited. Monitor
pruritus, patient closely for
rash, signs and symptoms
urticaria of a decrease in
Other: consciousness,
Anaphylaxis; including coma,
injection-site profound sedation,
pain, and significant
redness, or respiratory
swelling; depression. Notify
physical and prescriber
psychological immediately and
dependence provide emergency
supportive care, as
death may occur.
6. .Be aware that
dosing errors related
to confusion
between milligrams
(mg) and milliliters
(ml) and different
concentrations of
oral solutions can
result in accidental
overdose and death.
Check dosage and
concentration of oral
solution very
carefully before
administering. 7.
Dilute meperidine
syrup with water
before use to
minimize local
anesthetic effect.
8.Give I.V. dose
slowly by direct
injection or as a slow
continuous infusion.
Mix with D5W,
normal saline
solution, or Ringer’s
or lactated Ringer’s
solution.
9. Keep naloxone
available when giving
I.V. meperidine.
10.Be aware that
subcutaneous
injection is painful
and isn’t
recommended unless
no other route can
be used.
11. Be aware that
oral form of
meperidine is less
than half as effective
as parenteral
meperidine.
12. Give I.M. form
when possible, and
expect to increase
dosage when
switching patient to
oral form.
13. Monitor patient’s
bowel function to
detect constipation,
and assess the need
for stool softeners.
14. Know that
prolonged use may
increase risk of
toxicity exhibited by
seizures from the
accumulation of the
meperidine
metabolite,
normeperidine.
15. Expect
withdrawal
symptoms to occur if
drug is abruptly
withdrawn after
long-term use.
16. Be aware that
concomitant use with
CYP3A4 inhibitors or
discontinuation of
CYP3A4 inducers can
result in fatal
overdose of
meperidine.
 DRUG MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING
DATA M OF N ON INTERACTIO REACTION RESPONSIBILITI
ACTION N ES
morphine Binds with To relieve For all forms: Acute or 5-HT3 receptor CNS: Agitation, 1. Be aware that
sulfate and activates pain severe severe bronchial antagonists; amnesia, morphine can lead
opioid enough to asthma in an cyclobenzaprin anxiety, ataxia, to abuse, addiction,
Pharmacolog receptors require unmonitored setting or e; linezolid; chills, coma, and misuse. To
ic class: (mainly mu opioid in the absence of methylene confusion, ensure that benefits
Opioid receptors) in treatment resuscitative blue; selected decreased of morphine therapy
Therapeutic the brain and and for which equipment; psychiatric concentration, outweigh risks, a
class: Opioid spinal cord to alternative gastrointestinal drugs such as delirium, Risk Evaluation and
analgesic produce treatment obstruction, including amoxapine, delusions, Mitigation Strategy
Controlled analgesia and options such paralytic ileus; buspirone, depression, (REMS) is required.
substance euphoria. as nonopioid hypersensitivity to lithium, dizziness, dream 2. Use cautiously in
schedule: II analgesics or morphine sulfate or its mirtazapine, abnormalities, patients about to
opioid components; nefazodone, drowsiness, undergo surgery of
combination significant respiratory trazodone, edema, the biliary tract and
products are depression; use of vilazodone; euphoria, fever, patients with acute
inadequate MAO inhibitors within selective gait disturbance, pancreatitis
or not past 14 days; For serotonin hallucinations, secondary to biliary
tolerated neuraxial reuptake headache, tract disease
administration: inhibitors; increased because morphine
Concomitant serontonin- intracranial may cause spasm of
anticoagulant therapy, norepinephrine pressure, the sphincter of
infection at the reuptake insomnia, Oddi.
injection microinfusion inhibitors; St. lethargy, light- 3. Be aware that
site, presence of any John’s wort; headedness, MorphaBond ER
other concomitant tricyclic malaise, mood formulation has an
therapy or medical antidepressants alterations, added abuse
condition which would ; tramadol; psychosis, deterrent property
render epidural or triptans; restlessness, that makes it
intrathecal tryptophan: rigidity, difficult to break,
administration of Increased risk sedation, crush, or cut the
morphine especially of serotonin seizures, tablet. It also resists
hazardous syndrome syncope, extraction and forms
anticholinergics thinking a viscous liquid
: Possibly disturbances, when physically
severe tremor, compromised and
constipation uncoordinated placed in a liquid.
leading to ileus, muscle This abuse deterrent
urine retention movements, helps prevent abuse
antipsychotics, unresponsivenes when attempts are
anxiolytics, s, vertigo, made to administer
benzodiazepine weakness CV: it intranasally or by
s, cimetidine, Bradycardia, injection.
CNS cardiac arrest, 4. Store morphine at
depressants, edema, room temperature.
general hypertension, Ensure that before
anesthetics, hypotension, giving morphine,
muscle orthostatic opioid antagonist
relaxants other hypotension, and equipment for
opioids, P- palpitations, oxygen delivery and
glycoprotein shock, respiration are
inhibitors, tachycardia, available.
sedating vasodilation 5. Assess patient’s
antihistamines, EENT: drug use, including
tranquilizers, Amblyopia, all prescription and
tricyclic blurred vision, OTC drugs before
antidepressants diplopia, dry therapy begins.
: Increased mouth, eye pain, 6. Expect prescriber
additive effects hiccup, laryngeal to usually start
increasing risk edema or patient who has
of coma, laryngospasm never received
hypotension, (allergic), miosis, opioids on
profound nystagmus, immediate-release
sedation, rhinitis, taste or form and then
respiratory voice alteration switch to E.R. form if
depression, ENDO: Adrenal therapy must last
death diuretics: insufficiency longer than a few
Decreased (rare), days.
diuretic efficacy hypogonadism 7. Keep in mind that
MAO inhibitors: GI: Abdominal when morphine is
Increased risk cramps or pain, given by epidural
of opioid anorexia, biliary route, dosage must
toxicity (coma, tract spasm, be individualized
respiratory constipation, according to
depression) or diarrhea, patient’s age, body
serotonin dysphagia, mass, physical
syndrome elevated liver status, previous
mixed agonist- enzymes, experience with
antagonist and gastroenteritis, opioids, risk factors
partial agonist gastroesophage for respiratory
analgesics such al reflux, depression, and
as butorphanol, hiccups, ileus (in drugs to be
buprenorphine, patients with coadministered
nalbuphine, inflammatory before or during
pentazocine: bowel disease), surgery.
Possibly toxic megacolon 8. Give oral form
withdrawal (in patients with with food or milk to
symptoms or inflammatory minimize adverse GI
reduced bowel disease), reactions, if needed.
analgesic effect indigestion, Solution can be
oral P2Y12 intestinal mixed with fruit
inhibitors: obstruction, juice to improve
Decreased nausea, taste.
absorption and vomiting GU: 9. Open E.R.
peak Decreased capsules and
concentration ejaculate sprinkle contents on
of oral P2Y12 potency, applesauce (at room
inhibitors and decreased temperature or
delay onset of libido, difficult cooler) just before
antiplatelet ejaculation, giving to patient, if
effect when dysuria, needed.
given with impotence, 10. Make sure
intravenous infertility, patient doesn’t
morphine menstrual chew or crush
sulfate irregularities, capsules or dissolve
oliguria, capsule’s pellets in
prolonged labor, his mouth.
urinary 11. Be aware that
hesitancy, urine E.R. forms of
retention HEME: morphine aren’t
Anemia, interchangeable.
leukopenia, 12. Discard injection
thrombocytopen solution that is
ia MS: discolored or darker
Arthralgia, than pale yellow or
decreased bone that contains
mineral density, precipitates that
skeletal muscle don’t dissolve with
rigidity RESP: shaking.
Apnea, asthma 13. Avoid I.M. route
exacerbation, for long-term
atelectasis, therapy because of
bronchospasm, injection-site
depressed cough irritation.
reflex, 14. During
hypoventilation, subcutaneous
pulmonary injection, take care
edema, to avoid injecting
respiratory drug intradermally.
arrest and 15. For intrathecal
depression, injection, expect
wheezing SKIN: prescriber to give no
Diaphoresis, more than 2 ml of
dryness, 0.5-mg/ml solution
flushing, pallor, or 1 ml of 1-mg/ml
pruritus, rash, solution.
urticaria Other: 16. Expect
Allergic reaction; intrathecal dosage
anaphylaxis; to be about one-
angioedema; tenth of epidural
injection-site dosage. Keep in
edema, pain, mind if rectal
rash, or redness; suppository is too
physical and soft to insert,
psychological refrigerate for 30
dependence; minutes or run
weight loss; wrapped
withdrawal suppository under
symptoms cold tap water.
DRUG DATA MECHANIS INDICATIO CONTRAINDICATI DRUG ADVERSE NURSING
M OF N ON INTERACTION REACTION RESPONSIBILITI
ACTION ES
hydromorpho May bind with To relieve Acute asthma (in an 5-HT3 receptor CNS: Anxiety, 1. Be aware that
ne opioid pain severe unmonitored setting or antagonists, CNS hydromorphone
hydrochloride receptors in enough to in the absence of drugs that affect depression, therapy increases
(Dilaudid) the spinal cord require resuscitative the serotonin confusion, risk of abuse,
and higher opioid equipment); history of neurotransmitter dizziness, addiction, and
Pharmacologic levels in the treatment narrowing of the GI system drowsiness, misuse. A Risk
class: Opioid CNS. In this and for which tract or presence of (mirtazapine, euphoria, Evaluation and
Therapeutic way, alternative blind loops in the GI trazodone, hallucination Mitigation Strategy
class: Opioid hydromorpho treatment tract, or GI obstruction, tramadol), s, headache, (REMS) is required.
analgesic ne is believed options such including paralytic linezolid, nervousness, 2. Monitor patient
Controlled to stimulate as nonopioid ileus; hypersensitivity methylene blue restlessness, closely throughout
substance kappa and mu analgesics or to hydromorphone, (I.V.), selective sedation, therapy for abuse,
schedule: II receptors, opioid hydromorphone salts, serotonin somnolence, addiction, or misuse.
thus altering combination sulfite-containing reuptake tremor, 3. Know that chronic
the perception products are drugs, or their inhibitors, weakness maternal use of
of and inadequate components; opioid serotonin and CV: hydromorphone
emotional or not nontolerant patients norepinephrine Hypertension during pregnancy
response to tolerated (Dilaudid HP, Exalgo); reuptake , orthostatic can result in
pain. paralytic ileus; severe inhibitors, hypotension, neonatal opioid
respiratory depression tricyclic palpitations, withdrawal
antidepressants tachycardia syndrome (NOWS),
triptans, EENT: which may be life-
tryptophan: Blurred threatening, if not
Increased risk of vision, recognized and
serotonin diplopia, dry treated
syndrome mouth, appropriately.
anticholinergics: laryngeal NOWS occurs when
Increased risk of edema, a newborn has been
ileus, severe laryngeal exposed to opioid
constipation, or spasms, drugs for a
urine retention nystagmus, prolonged period
anxiolytics, tinnitus while in utero. 4.Use
antipsychotics, ENDO: extreme caution
benzodiazepines Adrenal when administering
and other CNS insufficiency hydromorphone to
depressants, GI: patients with cor
general Abdominal pulmonale or
anesthetics, cramps, significant chronic
muscle relaxants, anorexia, obstructive
other opioids and biliary tract pulmonary disease,
sedative/hyponti spasm, and in patients
cs, sedating constipation, having a
antihistamines, hepatotoxicit substantially
tranquilizers, y, nausea, decreased
tricyclic vomiting GU: respiratory reserve,
antidepressants: Decreased hypercapnia,
Increased risk of libido, hypoxia, or
coma, dysuria, preexisting
hypotension, erectile respiratory
profound dysfunction, depression,
sedation, and impotence, especially when
severe infertility, initiating and
respiratory lack of titrating therapy.
depression menstruation These patients may
, urine develop respiratory
retention depression, even
RESP: with usual
Dyspnea, therapeutic doses,
respiratory because
depression, hydromorphone
wheezing may decrease the
SKIN: patient’s respiratory
Diaphoresis, drive to the point of
flushing apnea. Use
Other: hydromorphone
Injection-site cautiously in,
pain, cachectic,
redness, and debilitated, or
swelling; elderly patients,
physical and especially when
psychological initiating and
dependence titrating therapy, as
they are at
increased risk for
adverse effects,
especially
respiratory
depression.
5. Use
hydromorphone
cautiously in
patients whose
ability to maintain a
normal blood
pressure is already
compromised by a
reduced blood
volume or
concurrent
administration of
certain CNS
depressant drugs;
the drug may cause
severe hypotension
in these patients,
especially when
initiating or titrating
the dose of
hydromorphone.
6. Be aware that
hydromorphone
should only be used
concomitantly with
benzodiazepines
and other CNS
depressants in
patients for whom
other treatment
options are
inadequate. If
prescribed together,
expect dosing and
duration of
hydromorphone to
be limited.
7. Monitor patient
closely for signs and
symptoms of
decrease in
consciousness,
including coma,
profound sedation,
and significant
respiratory
depression. Notify
prescriber
immediately, expect
drug to be
discontinued, and
provide emergency
supportive care, as
death may occur. Be
aware that to
improve analgesic
action, give
hydromorphone
before pain
becomes intense.
8. Give I.V. form by
direct injection over
at least 2 minutes.
For infusion, mix
drug with D5W,
normal saline
solution, or Ringer’s
solution.
9. Be aware that all
other around-the-
clock opioid
analgesics should be
stopped when E.R.
tablets are
prescribed. Expect
to give immediate-
release nonopioid
analgesics for
exacerbation of pain
and for preventing
pain during certain
activities.
10. Know that E.R.
tablets may be
visible on abdominal
X-rays under certain
circumstances,
especially when
digital enhancing
techniques are
utilized, because the
tablet is
nondeformable and
does not change
much in shape in the
GI tract.
11. Expect to taper
dosages of
hydromorphone
that have been
administered for an
extended period of
time to the opioid-
tolerant patient
gradually by 25 to
50% every 2 to 3
days, down to a
dose of 8 mg before
the drug is
discontinued. This
will help prevent
signs and symptoms
of withdrawal.
DRUG DATA MECHANISM OF INDICATION CONTRAINDICATION DRUG ADVERSE NURSING
MECHANISM INTERCATION REACTION RESPONSIBILITIES
OFACTION
Atroprine Competitively -As an anti- Atropine generally Antihistamine, Anti-muscarinic Monitor apical
Sulphate blocks effects of sialogue contraindicated in disopyramide, effects (dryness pulse prior to
acetylcholine, when patients with tricylic anti- of the mouth, administration.
Pharmacologica including excess reduction of glaucoma, pyloric depressants; blurred vision, Cardiac monitor
l class: acetycholine due secretions of stenosis, increased adverse photophobia, should be used
Anticholinergic, to the thyrotoxicosis, effects. tachycardia), on patients
antispasmodic organophosphorus respiratory fever, urinary tract hypersensitivity receiving
agents. poisoning, at tract are obstruction and Metocholopromide, reactions, atropine IV
muscarinic needed. ileus. domperidone: palpitation, boluses
cholinergic Antagonism. dilated pupils,
receptors on -To difficulty in
smooth muscle, temporarily Ketoconazole: swallowing, hot
cardiac muscle, increase Affects absorption. dry skin, thirst,
secretory gland heart rate or dizziness,
cells, and in decrease AV- restlessness,
peripheral block until tremor, fatigue
autonomic ganglia definitive and ataxia.
and the central intervention Toxic doses
nervous system. can take lead to
place in hallucinations,
bradychardi delirium and
a or AV- coma.
block.

IV. ANTICHOLINERGIC
DRUG DATA MECHANISM INDICATION CONTRAINDICATIO DRUG ADVERSE NURSING
OF ACTION N INTERCATION REACTION RESPONSIBILITIES
Scopolomine An Postoperative Contraindicated Decreased Ophthalmic. Be alert for
(Hycosine) anatagonist at nausea and with the patients effects of decreased sweating
muscarinic vomiting with closed-angle acetaminophen, Ocular: local and increased body
Pharmacologica acetyhcholone (PONV) glaucoma because levodopa, irritation, temperature
l class: receptors associate the drug can include keteconazole, increased (hyperthermia),
Antimuscarinics. (M1). with recovery cyclopegia and digoxin, intraocular especially during
from mydriasis, which riboflavin, pressure. exercise. Notify
naesthasia, would result in potassium Respiratory: physician of a
Blocking opiate increased chloride in wax Congestion. prolonged or
acetylcholine analgesia, intraocular matrix persistent elevation
from binding and surgery. pressure. preparations. Dermatologic: in body
to the Dry skin. temperature.
receptor Nausea and Monitor any
blocks vomiting Gastrointestinal: improvements in
acetycholine associated Constipation, symptoms (nausea,
mediated with motion xerostomia, dry vomiting,
nerve suckness. throat. dizziness)to help
impulses from document the
traveling effects of this drug.
through the
body.
V. RECEPTOR ANTAGONISTS

DRUG MECHANISM INDICATION CONTRAINDICATIO DRUG ADVERSE NURSING

DATA OF ACTION N INTERCATION REACTION RESPONSIBILITIES
Cimetidine Competitively A drug with an Any patient Emerged as one Cimetidine Monitor signs of
(tagamel) blocks indication of hypersensitive to of its major has serious hypersensitivity
histamine peptic ulcer the drug or its adverse effects. interactions reactions,
from disease, components. Cross- Clinincally with at including
stimulating gastroesophageal sensitivity in this important least 143 pulmonary
the H2- reflux disease, class of compounds interactions different symptoms
receptors and for has been observed, with warfarin, drugs. (tightness in the
located on dermatological so cimetidine phenytoin, throat or chest,
the gastric conditions should be diazepam, Cimetidine wheezing, cough,
parietal cells including warts, administered with chlormethiazole, has dyspnea) or skin
(these cells urticaria, caution to patients propranolol, miderate reactions (rash,
are mastocytosis, with a history of H2- lidocaine, and a intercations pruritus,
responsible and blocker number of other with at urticaria).
for erythropoietic hypersensitivity. drugs have been least 193
hydrochloric protoporphyria. reported. different
acid This medication drugs.
secretion and is an H2 receptor
secretion of antagonist. Cimetidine
the intrinsic has mild
factor). interactions
with at
least 169
different
drugs.
DRUG DATA MECHANISM INDICATION CONTRAINDICATION DRUG ADVERSE NURSING
OF ACTION INTERCATION REACTION RESPONSIBILITIES
Ranitidien Competitive Active General Serious Severe: Report balance
hydrochlorid inhibitor of duodenal or information, H2- interaction: problems and
e (zantac) histamine H2- benign blocker Atazanavir, Pancreatitis, functional
receptors in gastric ulcer. hypersensitivity, dasatinib, hemolytic anemia, limitations to the
gastric Maintenance gastric delaviridine. aplastic anemia, physician and
parietal cells of healing of cancer,hepatic agranulocytosi, nursing staff, and
results in a duodenal or disease, pregnancy, Mild pancytopenia, caution the
reduction in gastric ulcer. children, infants, interactions: anaphylactoid patient and
both gastric neonates, Alendronate, reactios. family caregivers
acid volume premature blessed thistle, to guard against
and neonates, ceftibuten, Moderate: falls and trauma.
concentration. breastfeeding, renal cyanocobalamin
disease, renal . Constipation,
failure, renal jaundice, hepatitis,
impairment, neutropenia,
porphyria, tobacco thrombocytopenia.
smoking,
bradychardia, Mild:
cardiac disease,
Headache, nausea,
geriatric.
dizziness,
infection, diarrhea,
abdominal pain,
vomiting.
DRUG MECHANISM INDICATION CONTRAINDICATION DRUG ADVERSE NURSING
DATA OF ACTION INTERCATIO REACTION RESPONSIBILITIES
N
Famotidine Competitively - Short term Hypersensitivity, No known - It effects - Take
(pepcid) blocks treatment of lactation. severe on the antacid
histamine active interaction s cardiovasc exactly as
H2-receptors duodenal with any ular prescribed,
thus reducing ulcer. drugs. system. being
basal, - Short term - Effects on careful of
nocturnal treatment of the the time of
and benign gastric endocrine administra
simulated ulcer. system. tion.
gastric acid - Treatment of - It effects - Have
secretion. pathologic on the regular
Pepsin hypersecretor nervous medical
secretion is y conditions system. follow-up
reduced (zollinger- while on
resulting in ellison). thus drug
decreased to evaluate
peptic your
activity. It reaction.
effectively - Take over
heals the
duodenal and counter
gastric ulcers drug 1
and prevents hour
recurrence. before
eating to
prevent
indigestion
. Do not
intake
more than
two per
day.
VI. ANTICEMETICES

DRUG DATA MECHANISM OF INDICATION CONTRAINDICATION DRUG ADVERSE NURSING

ACTION INTERCATI REACTION RESPONSIBI
ON LITIES
Metochlopra - Metocholopra - N/V - GI bleeding or Gastrointes - Extrapyram -Assess the
mide mide and - Gastropar obstruction, tinal idal extrapyrami
(reglan) domperidone esis heart failure, motility are reaction, dal
are dopamine liver disease. antagonize fatigue, symptoms
Pharmacolo D2 receptor - Epilepsy, by headache, and tardive
gical class: antagonists. Parkinson’s anticholiner dizziness. dyskinesia
Prokinetic - Within the disease, renal gics drugs - Bradychard (more likely
agents gastrointestin failure. and ia, AV in older
al tract - Pheochromocy narcotic blocks, patients).
activation of toma analgesics. N/V.
D2 receptors Additive -Assess for
block sedative gastrointesti
cholinergic effects can nal
smooth occur when complaints,
muscle metoclopra such as
stimulation. mide is nausea,
- Blocking D2 given with vomiting
will unblock alcohol, and
the sedatives, constipation
cholinergic hypnotics, . In oral
smooth narcitics, or administrati
muscle tranquilizer on, for
stimulation. s. better
absorption
allow 30
minutes to
one hour
before
eating.
DRUG DATA MECHANISM INDICATION CONTRAINDICATIO DRUG ADVERSE NURSING
OF ACTION N INTERCATION REACTION RESPONSIBILITIES
Droperidol The exact Reduce the Hypersensitivity to Any drug The most - Assess heart rate,
(inapsine) mechanism of incidence droperidol or to any known to common ECG, and heart
action is of nausea of the excipients. have the behavioral sounds, especially
Pharmacologica unknown, and potential to adverse during exercise.
l class: however, vomiting prolong the effects of - Report any rhythm
Antiemetic droperidol associated QT interval inapsine disturbances or
agents causes a CNS with should not (droperidol) symptoms of
depression at surgical and be used include increased
subcortical diagnostic together with dysphoria, arrhythmias,
levels of the procedures. the inapsine postoperative including
brain, (droperidol). drowsiness, palpations, chest
midbrain, and restlessness, discomfort,
brainstem hyperactivity shortness of
reticular and anxiety, breath, fainting,
formation. It which can and
may antagonize either be the fatigue/weakness.
the actions of result of an - Assess the motor
glutamic acid inadequate function, and be
within the dosage (lack alert for
extrapyramidal. of adequate extrapyramidal
treatment symptoms.
effect) or of
an adverse
drug reaction
 (part of the
symptom
complex of
akathisia).

DRUG DATA MECHANISM INDICATION CONTRAINDICATION DRUG ADVERSE NURSING

OF ACTION INTERCATION REACTION RESPONSIBILITIES
Promethazine An Treat rhinitis, Patients with Promethazine Sedation, - Assess dizziness
hydrochloride antagonist of allergic hypersensitivity to can confusion, and drowsiness
( Phenergan) histamine conjunctivitis, the drug potentially and that might
H1, post- allergic components, o interact with disorientation, affect gait,
Pharmacologica sypnatic reactions to other a number of which may balance, and
l class: mesolimbic blood or phenothiazines. It is other impair other functional
Phenothiazines dopamine, plasma, contraindicated in medications. physical and activities.
alpha dermographism children under two Taking mental
adrenergic, , anaphylactic years of age due to promethazine abilities. - Report balance
muscarinic, reactions, the risk of with certain However, in problems and
and NMDA sedation, potentially fatal medications some cases functional
receptors. nausea, respiratory can decrease promethazine limitations to
The vomiting, pain depression. the may the physician
antihistamine motion Promethazine eefctiveness paradoxically and nursing
action is used sickness, and contraindicated for of either drug cause staff, and
to treat allergic subcutaneous or or increase a excitability, caution the
allergic reactions. intra-arterial patient’s risk restlessness, patient and
reactions. administration due of unwanted or rare family/caregive
Antagonism to the risk of tissue side effects. seizures. rs to guard
of muscarinic damage. against falls and
and NMDA trauma.
receptors
contribute to
it is use as
sleep aid, as
well as for
anxiety and
tension.