Drug
Dosage/rou
te
Pre- Operative
Diprivan – IV
short acting
Opioids
Versed
0.5 -2 mg
slow IV
over 2-3
min. Onset
1-5
Valium
PO IM IV
RECT
Vistaril
Atropine
PO IM, IV
Post - Operative
Anzemet
Compazine
Phenergan
Reglan
Action
Side effects
General Anesthetic – short
acting hypnotic, absence of
sensation & consciousness
APNEA, Anaphylaxis, hypotension Frequently
causes apnea lasting ≥60 sec. Maintain patent airway and
adequate ventilation
Benzodiazepine - Sedative IV
APNEA, LARYNGOSPASM, RESPIRATORY
procedural sedation for
DEPRESSION, CARDIA ARREST - NURSING
lengthy procedures. (in
IMPLICAITONS Monitor blood pressure, pulse, and
respiration continuously during IV administration. Oxygen and
article) to alleviate anxiety
resuscitative equipment should be immediately available.
and decrease recall of events
Vomiting, Aspiration
related to surgery
Paradoxical excitation, confusion, pain at injection site.
Conscious Sedation – are not
dizziness, drowsiness, lethargy –
pain relieving. Used with
Hangover produced
analgesics/Opioids
Benzoidiazepine-like drug. Sedation/Relief of anxiety/decrease
nausea/vomiting
Muscarinic Antagonist – to
Cardiac Dysrhythmia, Drowsiness, blurred
decrease pulmonary and oral
vision, tachycardia, dry mouth, urinary
secretions and prevent
hesitancy Can effect CNS
laryngospasm
Antiemetic / Antihistamine–
decrease nausea/vomiting
Antiemetic /Phenothiazine–
decrease nausea/vomiting anxiety
Headache – has Antimuscarinic effects
Antimetic – Phenothiazine –
Dopamine blockage. (in
article)
Post-op patients with this were still
suffering from nausea and vomiting
Antimetic
agent
- Prokinetic GI
NEUROLEPTIC MALIGNANT SYNDROME,
AGRANULOCYTOSIS Monitor for development of neuroleptic
malignant syndrome (fever, respiratory distress, tachycardia,
seizures, diaphoresis, hypertension or hypotension, pallor,
tiredness, severe muscle stiffness, loss of bladder control). Notify
physician or other health care professional immediately if these
symptoms occur LAB CBC and liver function tests should be
evaluated periodically throughout course of therapy. May cause
blood dyscrasias, especially between wks 4 and 10 of therapy.
NEUROLEPTIC MALIGNANT SYNDROME, confusion,
disorientation, sedation
CNS: drowsiness, extrapyramidal reactions, restlessness,
NEUROLEPTIC MALIGNANT SYNDROME, Assessment Monitor for neuroleptic malignant syndrome (hyperthermia,
In addition, it is given to prevent nausea and
vomiting caused by cancer chemotherapy and
surgery.
muscle rigidity, altered consciousness, irregular pulse or blood
pressure, tachycardia, and diaphoresis.
Opioid Antagonists – decrease severity of pain
Phenanthrene – moderate to severe pain, pulmonary edema, MI
Phenylpiperidine – IM, patch, wide variation in client response avoid with
older adults
Diphenylheptane – dosing for maintenance of opioid dependence 20120mg/daily-avoid older
Adverse
effects/Side effects Nursing Implications/Labs/Assessments
Route/dose
Drug
Use with extreme caution in constipation RESPIRATORY DEPRESSION confusion, sedation,
Moderate to
Morphine
patients receiving MAO
hypotension,
severe pain
sulfate
inhibitors (may result in
For overdose – Narcan 0.4mg IV
unpredictable, severe, and
Constipation – increase water consumption 2000ml/daily, fiber in diet.
Class:
potentially fatal reactions-mobility
decrease initial dose to
Phenanthre
25% of usual dose).
ne
Nursing Implications High
Narcotic
Alert: Assess level of
Tylenol
analgesic – mild consciousness, blood
w/codeine to severe pain. pressure, pulse, and
respirations before and
(#3, 4)
Metabolizes to
periodically during
administration. If
Phenanthre morphine
respiratory rate is
ne
<10/min, assess level of
Dizziness, weakness, nausea – Narcan for overdose
sedation. Physical
Darvocet-N
stimulation may be
Diphenylhe
sufficient to prevent
significant hypoventilation.
ptane
Subsequent doses may
IV - Rate: High Alert:
SEIZURES, confusion, sedation hypotension, bradycardia.
need to be decreased by
Demerol
GI: constipation, nausea, vomiting RESPIRATORY DEPRESSION.
Administer slowly over at
25-50%.
Phenylpipe least 5 min. Rapid
Hypertension, muscle rigidity, coma, seizures, hyperpyrexia, death.
Implementation
administration may lead to
Avoid combinations
ridine
High Alert: Accidental
increased respiratory
Dilaudid
Also a
Antitussive
depression, hypotension,
and circulatory collapse
Rate: Administer slowly, at
a rate not to exceed 2 mg
over 3-5 min. High Alert:
Rapid administration may
lead to increased
over dosage of opioid
analgesics has resulted in
fatalities. Before
administering, clarify all
ambiguous orders; have
second practitioner
independently check
discontinue MAO inhibitors 2 wk prior to hydromorphone). Assessment
Assess blood pressure, pulse, and respirations before and periodically
during administration. If respiratory rate is <10/min, assess level of sedation.
Dose may need to be decreased by 25-50%. Initial drowsiness will diminish
with continued use
Phenanthre
ne
respiratory depression,
hypotension, and
circulatory collapse. Faster
acting, but shorter lasting
original order, dose
calculations, and infusion
pump settings.
Vicodin
Implementation Monitor daily
High Alert: Accidental overdosage of opioid analgesics has resulted in
fatalities. Before administering, clarify all ambiguous orders; have second
practitioner independently check original order and dose calculations.
RESPIRATORY DEPRESSION.
Assess blood pressure, pulse, and respirations before and periodically during
administration. If respiratory rate is <10/min, assess level of sedation.
Physical stimulation may be sufficient to prevent significant hypoventilation.
Dose may need to be decreased by 25-50%. Initial drowsiness will diminish
with continued use Narcan for overdose
Phenanthren
e
Percodan
Phenanthren
e
Percocet
Phenanthren
e
Fentanyl
Patch,
RESPIRATORY DEPRESSION, dizziness, drowsiness nausea Should not be
used within 14 days of MAO inhibitors because of possible severe and
unpredictable reactions
Toxicity and Overdose: naloxone (Narcan) is the antidote.
Phenylpiper
idine
Partial Opioids Agonist-Antagonists
Nubain
– less
On set 1-3
minutes IV
Opioid analgesics
- decrease pain
potent
analgesics,
lower
dependency
potential tan
opiods.
Use with extreme caution in patients receiving MAO inhibitors (may result in
unpredictable, severe reactions--reduce initial dose of nalbuphine to 25% of
usual dose).
Naloxone (Narcan) antidote overdose
Implementation
High Alert: Accidental overdose of opioid analgesics has resulted in
fatalities. Before administering, clarify all ambiguous orders; have second
practitioner independently check original order, dose calculations, and
infusion pump settings.
Opioid Antagonist
Narcan
Direct IV: Diluent: Administer undiluted for suspected
opioid overdose. For opioid-induced respiratory
depression, dilute with sterile water for injection
Antidote for opioids – reversal fo signs of
opioid overdose/excess
0.4mg IV is usually ordered
Opioid-like Drug
Ultram
Renal Impairment
PO (Adults): CCr <30
ml/min--increase dosing to
q 12 hr (not to exceed 200
mg/day).
Analgesics
(centrally
acting) –
inhibits reuptake
SEIZURES, dizziness, headache, somnolence constipation, nausea
Monitor patient for seizures. May occur within recommended dose range.
Risk is increased with higher doses and in patients taking antidepressants
(SSRIs, tricyclics, or MAO inhibitors), opioid analgesics, or other drugs that
decrease the seizure threshold.
Hepatic Impairment
PO (Adults):50mg q 12hr.
of serotonin and
norepinephrine in
cns. Decreased
pain
Narcan may reduce some, but not all symptoms of overdose
Analgesics
Tylenol
Non opioid Analgesics, antipyretic
– mild pain, fever
HEPATIC FAILURE, HEPATOTOXICITY (OVERDOSE).
Acetaminophen intake > 4 grams daily
What is a MAO? Antidepressants - MAO Inhibitors: When other antidepressants don't
work, some people find relief from an older class of medications - MAO inhibitors.
Monoamine oxidase inhibitors (MAOIs) were the first type of antidepressant to be
used, starting in the 1950s
Opioid Antagonist– binds to Opioids receptors and competitively displace the
Opioids analgesics from their receptor sites. Emergency Treatment.
Guedel’s Stages of Anesthesia
Stage
Stage 1: Analgesia
(administration to
LOC)
Stage 2: Excitement
(Vary depending on:
type/amount
premedication.
Anesthetic agent
used. Degree of
external stimuli)
Stage 3: Surgical
Anesthesia
Stage 4: Medullary
Paralysis
Alternative
Nomenclature
Induction
Plane 1
Plane 2
Plane 3
Plane 4
Toxicity
Key Features
Nursing Management
Analgesia/numbness
Loss of senses
Auditory/visual hallucinations
Exaggerated reflexes
Client may struggle
Periods of apnea
Vomiting or incontinence may occur
Reduced with use of balanced anesthesia
Maintain tranquil
environment
Eye movement stops
Partial intercostals paralysis
Divergent pupil dilation
Complete intercostals paralysis
Diaphragmatic paralysis
Respiratory arrest
Vasomotor collapse
Maintain airway
Protect against
aspiration
(Most surgical procedures happen here)
Maintain airway
Protect against
aspiration
Resuscitation