DRUG STUDY VELOSO, Roginette Louise F.

Patient: Diagnosis: DIPHENHYDRAMINE Drug classes Antihistamine Anti-motion sickness agent Sedative-hypnotic Antiparkinsonian Cough suppressant Ward: Bed:

Therapeutic actions Competitively blocks the effects of histamine at H1-receptor sites, has atropinelike, antipruritic, and sedative effects. Indications Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria andangioedema; amelioration of allergic reactions to

blood or plasma; dermatographism; adjunctive therapy in anaphylactic reactions Active and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism (including drug-induced parkinsonism and extrapyramidal reactions), in the elderly intolerant of more potent agents, for milder forms of the disorder in other age groups, and in combination with centrally acting anticholinergic antiparkinsonian drugs Syrup formulation: Suppression of cough due to colds or allergy Indication for the Patient: Contraindications and cautions Contraindicated with allergy to any antihistamines, third trimester of pregnancy, lactation. Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction,pyloroduodenal obstruction, pregnancy; elderly patients who may be sensitive to anticholinergic effects.

IV facts Preparation: No additional preparation required. Infusion: Administer slowly each 25 mg over 1 min by direct injection or into tubing of running IV. Incompatibilities: Do not combine with amobarbital, amphotericin B, cephalothin, hydrocortisone, phenobarbital, phenytoin, thiopental. Y-site incompatibilities: Do not mix with foscarnet. Adverse effects CNS: Drowsiness, sedation, dizziness, disturbed coordination, fatigue, confusion, restlessness, excitation, nervousness, tremor, headache, blurred vision,diplopia CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia

 Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat Other: Urticaria, rash, anaphylactic shock, photosensitivity, excessive perspiration Interactions Drug-drug Possible increased and prolonged anticholinergic effects with MAOIs

Nursing considerations Assessment History: Allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision exam; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential Interventions Administer with food if GI upset occurs. Administer syrup form if patient is unable to take tablets. Monitor patient response, and arrange for adjustment of dosage to lowest possible effective dose. Teaching points Take as prescribed; avoid excessive dosage. Take with food if GI upset occurs. Avoid alcohol; serious sedation could occur.

 These side effects may occur: Dizziness, sedation, drowsiness (use caution driving or performing tasks requiring alertness); epigastric distress, diarrhea or constipation (take drug with meals); dry mouth (use frequent mouth care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier). Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.