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Isoflurane details
USE: induction and maintenance of general anesthesia.
ROUTE: inhalation
ADVERSE EFFECTS: CV and respiratory depression, malignant hyperthermia
CONTRAINDICATIONS: if theres a family history of malignant hyperthermia or personal history of PONV
NURSING IMPLICATIONS: drug has an odor. be assessing for symptoms of malignant hyperthermia
Propofol details
USE: sedation (induction and maintenance of general anesthesia)
ROUTE: intravenous
ADVERSE: pain and burning at IV site
CONTRA: soy and egg allergy. Lipid metabolism disorders
Ketamine details
USE: maintains low BP and HR, often used in critically ill patients bc of this
ADVERSE: BBW for delirium, hallucinations, unpleasant dreams.
ROUTE: IV
Vecuronium details
Neuromuscular blocking agent.
USE: skeletal muscle paralysis for operations (including mechanical ventilation and intubation)
MOA: suspends nerve impulses at the neuromuscular junction
ADVERSE: skin irritation like urticaria and erythema
NURSING IMPLICATIONS: hella interactions. recurarization monitoring
Succinylcholine details
USE: paralysis for tracheal intubation
MOA: the only depolarizing neuromuscular blocking agent
ADVERSE:BBW for sudden cardiac arrest
CONTRAINDICATIONS: history of malignant hyperthermia, preexisting hyperkalemia.
name the two neuromuscular blocking agents
Vecuronium and Succinylcholine
Midazolam/ Benzodiazepine details
USE: adjunct for all types of anesthesia
ROUTE: IV, oral syrup available for peds
BBW: respiratory depression
REVERSAL AGENT: Flumazenil
Fentanyl details
OPIOD
used as supplemental sedation and general anesthesia.
ADVERSE: respiratory depression, N/V, urinary retention
NURSING IMPLICATIONS: Naloxone is reversal agent
Naproxen details
CLASS: NSAID
MOA: COX 1 and 2 inhibitor.
USE: reduce pain from acute migraine
ADVERSE: BBW for CV events and GI bleed.
CONTRAINDICATIONS: pregnancy, lactation
normally not taken more than twice a day
What are COX 1 and 2?
enzymes that play a role in producing prostaglandins. prostaglandins are inflammatory molecules involved in pain, inflammation, and fever
Acetaminophen, Aspirin, and caffeine details
MOA: analgesia, anti inflammatory, vascular constriction
USE: reduce pain related to migraine or tension headache
ADVERSE: Hepatotoxicity, GI effects, hypertension, palpitations
CONTRAINDICATIONS: hepatic disease, alcoholism, diabetes, pregnancy
Ergotamine Tartrate details
CLASS: ergotamine alkaloids
MOA: constrict cranial and peripheral blood vessels
USE: prevents or stops migraine, cluster, or vascular headaches.
ADVERSE: gangrene, fibrosis. N/V abdominal pain, numerous vascular side effects
CONTRAINDICATIONS: BBW for use with CYP3A4 inhibitors
ROUTE: sublingual
Sumatriptan details
MOA: binds to serotonin receptors to provide cranial vasoconstriction and relief of migraine symptoms.
ADVERSE: CV effects
Sumatriptan and Naproxen details
used to treat acute migraines and decrease photophobia
TWO BBW: cardiovascular risk (heart attack and stroke) and GI risk
ADMIN: do not crush/chew/divide tablets
Adverse effects of Opiod agonists?
CNS depression, respiratory depression, constipation
Morphine Sulfate hydromophone details/ hydrocodone details
CLASS: opioid agonists
MOA: binds to receptors in CNS to block pain transmission
USE: prevent/treat severe/chronic pain.
HYDROCODONE: also an antitussive!
contraindications of opioid agonists?
pregnancy and hypersensitivity.
nursing implications for opioid agonists?
pruritus or urticaria can be a sign of allergic reaction.
Butorphanol details
MOA: an agonist for kappa and mu, antagonist at other receptors.
USE: moderate-severe pain relief not managed with alternate options
ADVERSE: CNS depression, respiratory depression, constipation
CONTRAINDICATIONS: BBW for neonatal withdrawal syndrome, respiratory depression
IMPLICATIONS: less potential for abuse but normally is considered a 2nd line option. CEILING EFFECT
Naloxone details
MOA: competes with and blocks opioids at receptor sites
USE: reverse opioid overdose, given to neonates if mom had analgesia.
ADVERSE: tremors, drowsiness, tachycardia, sweating, HTN, N/V.
CONTRAINDICATIONS: hypersensitivity, pregnancy, presence of narcotic abuse
IMPLICATIONS: IV and nasal spray formulations. may cause opioid withdrawal.
Lidocaine details
MOA: blocks conduction of pain impulses to the area.
USES: local anesthesia.
ADVERSE: LAST (local anesthetic systemic toxicity). Allergic reactions (rash, itching, hives)
CONTRAINDICATIONS: hypersensitivity, severe trauma, sepsis, cardiac abnormalities
Bupivacaine details
MOA: blocks conduction of pain impulses to the area, but longer and more potent than lidocaine.
USE: local anesthetics
CONTRAINDICATIONS: BBW for epidural in pregnant women- can cause cardiac arrest and difficult resuscitation.
ADMINISTRATION- test dose given before full dosage
Aspirin details
MOA: inhibits prostaglandin
USES: mild moderate pain relief. adults only can take this. osteoarthritis. risk reduction for cardiac events.
ADVERSE: GI bleeding, GI upset-take with food. toxicity.
CONTRAINDICATIONS: do not take 2 weeks before or after surgery. children and teenagers cannot take. pt should not be taking anticoagulants.
Acetaminophen details
CLASS: nonnarcotic analgesic
MOA: acts on hypothalamus directly
USES: reduce fever, mild pain relief. MAXIMUM dosage 4g a day
ADVERSE: hepatoxicity and renal failure.
CONTRAINDICATIONS: hypersensitivity, renal/hepatic impairment
IMPLICATIONS: overdose caution. for people who abuse alcohol, normally safe doses can be dangerous.
used as an alternative to NSAIDS due to lack of GI effects
Ibuprofen details
CLASS: NSAIDS
USES: mild/moderate pain relief, fever reduction, treat inflammation from arthritis, treat initial gout attacks
ADVERSE: increased risk for cardiovascular events
all NSAIDs BBW
increased risk for cardiovascular events
Naproxen details
USES: prototype NSAID for migraine treatment.
Stays active in the body longer, so this drug is normally only taken twice daily.
All NSAIDS MOA
Block COX-1 and COX-2
Meloxicam details
CLASS: NSAIDS
USES: osteoarthritis and rheumatoid arthritis
CONTRAINDICATIONS: known aspirin allergy, past GI bleed
ADVERSE: GI bleeding, cardiovascular events
Indomethacin details
USES: arthritis and gout pain. can be used IV to close patent ductus arteriosus in premature infants.
ADVERSE: CV risk, GI bleeding, CNS effects, renal impairment
CONTRAINDICATIONS: salicylate hypersensitivity. past GI BLEED
Ketorolac details
CLASS: NSAID
CONTRAINDICATIONS: high risk of bleeding.
ADMIN: IV NSAID. provides a high pain relief but is limited to five days due to increased bleeding risk
Celecoxib details
CLASS: NSAID
MOA: only selective COX-2 inhibitor in the US
less risk of a GI bleed, but still a concern.
symptoms indicative of a cardiac event (to monitor for NSAIDS)
chest pain, shortness of breath, confusion, numbness of extremities
colchicine details
USE: acute treatment and prevention of gout.
MOA: decreases inflammatory. stops WBC movement into areas with urate crystals
ADVERSE: N/V, pain, hepatotoxicity.
INTRACTIONS: do not take with grapefruits/alcohol. decrease vitamin b12 absorption
Allopurinol details
MOA: reduces uric acid production
USE: gout treatment and cancers that result in higher uric acid levels
ADVERSE: uric acid kidney stones
TEACHINGS: keep hydrated to decrease risk of kidney stones
