A.

Benzodiazepine
1. Midazolam Hydrochloride (Versed) Classification:
Sedative

Mechanism of action

Depresses all levels of CNS, including limbic and reticular formation, probably through increased action of GABA, which is major inhibitory neurotransmitter in brain.

Indications: Preoperative sedation induction of general anesthesia

Adverse / Side Effects: CNS: headache, involuntary movements, amnesia CV: Variations in BP (hypotension) and pulse rate, cardiac arrest GI: nausea, vomiting, hiccups Respi: decreased respiratory rate, apnea Other: pain

Nursing Responsibilities:
Monitor

BP, heart rate and rhythm, respirations, airway integrity, and arterial oxygen saturation during procedure. Have oxygen and resuscitation equipment available in case of severe respiratory depression.

2. Diazepam (Valium)

Mechanism of Action:

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter, Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways, Has anticonvulsant properties due to enhanced presynaptic inhibition.

Indications:

management of anxiety, preoperative sedation, conscious sedation, Provides light anesthesia

Adverse/Side Effects:

CNS: dizziness, drowsiness, lethargy, depression, hangover, headache Resp: respiratory depression CV: hypotension (IV only) GI: constipation, diarrhea), nausea, vomiting; Derm: rashes; Local: pain (IM), phlebitis (IV), venous thrombosis

Nursing Responsibilities:
Monitor blood pressure, pulse, and respiratory rate prior to and periodically throughout therapy and frequently during IV therapy Assess IV site frequently during administration; diazepam may cause phlebitis and venous thrombosis; Anxiety: Assess degree of anxiety and level of sedation (ataxia, dizziness, slurred speech) prior to and periodically throughout therapy Muscle Spasms: Assess muscle spasm, associated pain, and limitation of movement prior to and throughout therapy

3 . Lorazepam (Ativan)

Mechanism of Action
Potentiates action of GABA, resulting in increased neuronal inhibition and CNS depression

Anxiolytic, Sedative-hypnotic

Indications
Anxiety Insomnia preoperative drug

Adverse effect/Side effect CNS: drowsiness, lethargy, hangover, fainting, anterogade amnesia, restlessness, psychosis CV: transient hypotension GI: Dry mouth, abdominal discomfort GU: Urinary Retention, incontinence.

Nursing Responsibilities

Warn patient to avoid hazardous activities until the drugs CNS effects are known Tell patient not to drink alcohol or smoke during therapy

1. Secobarbital Sodium Mechanism of Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis. Sedative-hypnotic, anti-convulsant

Indications

Preoperative sedation Insomnia

Adverse effect/Side effect CNS: drowsiness, lethargy, hangover, paradoxical excitement in geriatric patients RESP: Respiratory depression G.I: Nausea and vomiting.

Nursing Responsibilities

Warn patient to avoid activities that require mental alertness or physical coordination. For inpatient, supervise walking and raise side rails. Inform patient that morning hangover is common after hypnotic dose, which suppresses REM sleep.

2. Pentobarbital

Mechanism of Action Depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation and hypnosis.

Anticonvulsant, sedative-hypnotic

Indications

Preoperative sedation

Adverse/Side Effects: CNS: drowsiness, lethargy, hangover GI: nausea, vomiting Respi: respiratory depression

Nursing Responsibilities
Warn patient to avoid activities that require mental alertness or physical coordination. For inpatient, supervise walking and raise side rails. Inform patient that morning hangover is common after hypnotic dose, which suppresses REM sleep.

C. H2 Receptor Blocking Agents

1. Ranitidine (Zantac) Mechanism of Action: Reversibly and competitively blocks histamine at H2 receptors, particularly those in gastric parietal cells, leading to inhibition of gastric acid secretion.
Antiulcerative

Indications:

Duodenal and gastric ulcer.

Adverse/Side Effect: CNS: vertigo, malaise EENT: blurred vision Hepatic: jaundice.

Nursing Responsibilities:
Dont use aluminum-based needles or equipment when mixing or giving drug parenterally because drug is incompatible with aluminum. Remind patient taking drugs once daily to take it h.s. Instruct patient to take drug drug with or without food. Instruct patient not to smoke. Smoking may increase gastric secretion and worsen disease.

2. Cimetidine (Tagamet)

Mechanism of action Reversibly and competitively blocks histamine at H2 receptors, particularly those in gastric parietal cells, leading to inhibition of gastric acid secretion. Antiulcerative

Indications
Duodenal

and gastric ulcer

Adverse/Side Effects:
CNS: confusion, dizziness, headaches GI: mild and transient diarrhea CV: bradycardia Hematologic: thrombocytopenia, aplastic anemia; Hepatic: Jaundice; Musculoskeletal: Muscle pains.

Nursing implications

Give medications with meals Remind patient not to take antacid within 1 hour of taking drug. Instruct patient to immediately report black tarry stools, diarrhea, confusion, or rash.

D. Inhalation Gases

1. Oxygen

2. Nitrous Oxide

3. Desflurane (Suprane)

Mechanism of Action causes general anesthesia (loss of consciousness) before and during surgery. It is breathed in (inhaled). Although desflurane can be used by itself, combinations of anesthetics are often used together. This helps produce more effective anesthesia in some patients.

Indication

Anesthetic

Adverse/Side Effects More common Coughing nausea or vomiting

Less common or rare Dizziness headache irritated or red eyes nervousness and restlessness sore throat

Nursing implications
General anesthetics may cause some people to feel drowsy, tired, or weak for a while after they have been given. They may also cause problems with coordination and one's ability to think. Therefore, for about 24 hours (or longer if necessary) after receiving a general anesthetic, do not drive, use machines, or do anything else that could be dangerous if you are not alert. Unless otherwise directed by your doctor or dentist, do not drink alcoholic beverages or take other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness) for about 24 hours after you have received a general anesthetic. To do so may add to the effects of the anesthetic. Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; other sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; and muscle relaxants.

4. Halothane (Fluothane)
Mechanism of Action

Inducing general anesthesia and with other medications to provide anesthesia during short surgeries.

Indications

Halothane is indicated for the induction and maintenance of general anesthesia.

Adverse reactions/side effects

Hepatic necrosis cardiac arrest hypotension respiratory arrest cardiac arrhythmias Hyperpyrexia Shivering nausea and emesis.

Nursing Implication

The uterine relaxation obtained with Halothane, unless carefully controlled, may fail to respond to ergot derivatives and oxytocic posterior pituitary extract (oxytocin injection). Halothane increases cerebrospinal fluid pressure. Therefore, in patients with markedly raised intracranial pressure, if Halothane is indicated, administration should be preceded by measures ordinarily used to reduce cerebrospinal fluid pressure. Ventilation should be carefully assessed, and it may be necessary to assist or control ventilation to insure adequate oxygenation and carbon dioxide removal. The patient should be closely observed for signs of overdosage, i.e., depression of blood pressure, pulse rate and ventilation, particularly during assisted or controlled ventilation.

5. Isoflurane (Florane)

Mechanism of Action

Inducing general anesthesia and with other medications to provide anesthesia during short surgeries.

Indications

Isoflurane, may be used for induction and maintenance of general anesthesia

Adverse Reactions/Side Effects

Respiratory depression hypotension and arrhythmias Shivering Nausea vomiting hyperkalemia

Nursing Implications

If side effects occur, discontinuance of triggering agents (e.g., Isoflurane), administration of intravenous dantrolene sodium, and application of supportive therapy. Such therapy includes vigorous efforts to restore body temperature to normal, respiratory and circulatory support as indicated, and management of electrolyte-fluid-acid-base derangements.

E. Intravenous Anesthetics

1. Etomidate
Mechanism of Action

Inducing general anesthesia and with other medications to provide anesthesia during short surgeries. It may also be used for other conditions as determined by your doctor.

Indications

Anesthetic

Adverse Reactions/Side Effects Brief pain in the veins coughing; drowsiness hiccups; nausea temporary uncontrollable muscle movements vomiting.

Nursing Implications
Etomidate may cause drowsiness for up to 24 hours. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Etomidate. Using Etomidate alone, with certain other medicines, or with alcohol may lessen your ability to drive or to perform other potentially dangerous tasks. Do not drink alcohol for 24 hours after using Etomidate. Use Etomidate with caution in the ELDERLY, especially those with high blood pressure, because they may be more sensitive to its effects on the heart. Etomidate is not recommended for use in CHILDREN younger than 10 years of age. Safety and effectiveness in this age group have not been confirmed.

F. Antiemetics

1. Prochlorperazine (Compazine)
Mechanism of Action Acts on chemoreceptor trigger zone to inhibit nausea and vomiting. Relieves nausea and vomiting, singns and symptoms of psychosis, and anxiety.

INDICATIONS
mild to severe nausea and vomiting. Antipsychotic, antiemetic, anxiolytic

ADVERSE REACTIONS/SIDE EFFECTS

CNS: sedation, dizzines G.I: dry mouth, constipation EENT: blurred vision.

Nursing responsiblities:

Advise patient to wear protective clothing when exposed to sunlight.

2. Droperidol (Inapsine)

Mechanism of Action: Droperidol is used to reduce nausea and vomiting caused by surgery or other medical procedures. sedative, tranquilizer, and anti-nausea medication.

Indication: mild to severe nausea and vomiting

Adverse Effect: dizziness, fainting, fast or pounding heartbeat, fever, stiff muscles, confusion, sweating, fast or uneven heartbeats, tremor (uncontrolled shaking), confusion, hallucinations.

Nursing Responsibilities: Before receiving droperidol, asses patient if he/she has: heart disease; heart rhythm disorder; congestive heart failure; high blood pressure; an electrolyte imbalance (such as low potassium); liver or kidney disease; a history of alcohol abuse.

3. Promethazine Hydrochloride (Phenergan)

Mechanism of Action

Blocks the effect of histamine. Has inhibitory effect on the chemoreceptor trigger zone in the medulla, resulting in antiemetic properties. Alters the effects of dopamine in the CNS. Possesses significant anticholinergic activity. Produces CNS depression by indirectly decreased stimulation of the CNS reticular system.

Indication:

Treatment of various allergic conditions and motion sickness. Preoperative sedation. Treatment and prevention of nausea and vomiting. Adjunct to anesthesia and analgesia.

Adverse Effect: CNS: confusion, disorientation, sedation, dizziness, insomnia, fatigue, nervousness, CV: bradycardia, hypertension, hypotension, tachycardia GI: constipation, dry mouth, nausea and vomiting GU: urinary retention

Nursing Responsibility:
Monitor BP, PR, RR frequently in patients receiving

IV doses. Assess patient for nausea and vomiting before and after administration. If administered IV, assess for burning and pain at IV site. If pain occurs, discontinue administration immediately. When administering Promethazine concurrently with opiod analgesics, supervise ambulation closely to prevent injury from increased sedation. To minimize GI irritation, administer PO meds with food, water, or milk. IM injection is the preferred parenteral route of administration. Inject deep IM into large muscle mass.

1. Heparin
Mechanism of Action Accelerates formation of antithrombin IIIthrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fribrin Decrease ability to clot.

Indication Treatment of various allergic conditions and motion sickness. Preoperative sedation. Treatment and prevention of nausea and vomiting.

Adverse Effect: CNS: fever EENT: rhinitis, conjunctivitis, lacrimation SKIN: irritation, mild pain, hematoma
Nursing Responsibility: Monitor PTT values. Monitor platelet counts regularly Instruct patient and family to watch for signs of bleeding and to immediately notify physician. Tell patient to avoid OTC medications containing aspirin, or any drugs that may interact with heparin.

Analgesic
Morphine Sulfate Narcotic Analgesic Mechanism of action

Relieves pain by stimulating opiate receptors in CNS

Indication
relief of moderate to severe acute and chronic pain adjunct to anesthesia

Adverse effects CV: Hypotension CNS: Lightheadedness; dizziness SKIN: Sweating EENT: Blurred vision GI: Nausea; vomiting

Nursing Responsibilities Assess type, location and intensity of pain before and 3060 min after administration. Assess vital signs before and periodically during therapy. Assist patient with ambulation. Keep siderails up and call bell within reach. Evaluate therapeutic response. Prolonged use may lead to physical dependence and tolerance. Progressively higher doses may be necessary to control pain in patients receiving long-term therapy.

Anti-inflammatory/ Immunosuppressant
Hydrocortisone (Solu-cortef)

Mechanism of action Short-acting glucocorticoid that depresses formation, release, and activity of endogenous mediators of inflammation including prostaglandins, kinins, histamine, liposomal enzymes, and complement system. Also modifies body's immune response.

Indications dermatologic diseases allergic and inflammatory ophthalmic processes tuberculous meningitis

Adverse effects CNS: Convulsionsvertigo; headache DERM: Impaired wound healing; thin, fragile skin EENT: increased IOP; glaucoma; exophthalmos GI: nausea; vomiting

Nursing responsibilities

Monitor for covert infections. If local irritation occurs with topical use, discontinue and notify health care provider. Following dosage reduction or therapy withdrawal, monitor for signs of adrenal insufficiency, including fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness or low blood sugar. Notify health care provider of weight gain, swelling, muscle weakness, black tarry stools, hematemesis, facial puffiness, menstrual irregularities, prolonged sore throat, fever, cold or signs of infection.

Emergency Drugs

Epinephrine Hydrochloride (Vasopressor) Stimulates both alpha-and betareceptors (alpha-receptors at high doses; beta1 - and beta2 -receptors at moderate doses) within sympathetic nervous system. Relaxes smooth muscle of bronchi and iris and is antagonist of histamine.

Indication treatment and prophylaxis of cardiac arrest relief of bronchial asthma life-threatening asthma attacks characterized by wheezing, dysypena, and inability to breathe

Adverse effects CV: Cardiac arrhythmias and excessive hypertension; palpitations CNS: Anxiety; headache; restlessness; tremor; weakness GI: Nausea; vomiting RESPIRATORY: Shortness of breath

Nursing responsibilities

Monitor vital signs frequently. Assess lung sounds for wheezes. Monitor ECG, skin color, tremors, nervousness, and agitation.

Atropine Sulfate (Anticholinergic/antispasmodic)

Mechanism of action Promotes peripheral anticholinergic/antispasmodic action (decreases GI motility); provides mild sedation.

Indications Possibly effective for treatment of irritable bowel syndrome and acute enterocolitis as adjunctive therapy for duodenal ulcer.

Adverse effects CV: Palpitations; bradycardia; tachycardia; CNS: Headache; nervousness; drowsiness SKIN: Urticaria and other dermal manifestations of allergic reaction EENT: Blurred vision GI: nausea; vomiting;

Nursing responsibilities
Monitor vital signs and LOC. Note any signs of hyperactivity or sedation. Monitor I&O and bowel sounds. Notify physician of abdominal distention. In patient with chronic lung disease, monitor lung sounds and effectiveness of cough.