All Meds

what is the mechanism of action for local anesthetics?

blocks pain transmission in peripheral nerves

what is the prototype drug for local anesthetics?

lidocaine (Xylocaine)

what does lidocaine do?

• decrease local pain

• decrease sensation

• decrease local reflex

what are the adverse outcomes for lidocaine?

• local skin reaction

• systemic toxicity

what to monitor for local skin reactions?

erythema, pruritus, and warmth

what is the response for local skin reaction?

educate that this is normal and should abate

what to monitor for systemic toxicity?

CNS depression (agitation followed by low LOC) and CV depression (low HR, BP, cardiac arrest)

what is the response for systemic toxicity?

call RRT, call code blue, and notify provider

what is the mechanism of general anesthetics

enhance transmission at inhibitory synapses and inhibit transmission at excitatory synapses

what is the prototype drug of general anesthetics?

propofol, fentanyl, and benodiazepines

what does propofol, fentanyl, and benzodiazepines do?

• decrease

  • pain

  • agitation and anxiety

  • alertness

  • memory of event

  • reflexes

what are the adverse outcomes of propofol, fentanyl, and benzodiazepines?

• respiratory depression

• spinal headache

• Postoperative nausea and vomiting

• malignant hyperthermia

what to monitor for respiratory depression?

• low RR

• low SPO2

• cyanosis

what is the response for respiratory depression?

oxygen, sternal rub, ambu bag, bode blue, and notify provider

what to monitor for spinal headache?

onset of headache and particularly when the pt is upright

what is the response for spinal headaches?

• notify provider

• encourage hydration

• anticipate orders to administer analgesics

• anticipate orders for blood patch if conservative measures fall

what to monitor for postoperative nausea and vomiting?

report of nausea and emesis

what to response for postoperative nausea and vomiting?

• administer antiemetics

• ensure hydration

• provide comfort measures

what to monitor for malignant hyperthermia?

muscle rigidity, hyperthermia

what is the response for malignant hyperthermia?

• hold triggering agents

• notify provider

• anticipate orders to administer dantrolene

• cool the pt

what are the prototype drugs for centrally acting muscle relaxants?

• cyclobenzaprine (flexeril, Amrix)

• Baclofen (Gablofen, Lioresal)

what is the mechanism of action for cyclobenzaprine and baclofen ?

acts on the CNS to reduce muscle tone by decreasing the transmission of nerve impulses, thereby relieving muscle spasm

what does cyclobenzaprine and baclofen do?

• decrease muscle spasm or spasticity

• decrease muscle pain

• increase mobility

what are the adverse outcomes for cyclobenzaprine and baclofen?

• additive CNS depression

• gastrointestinal upset

• dizziness and hypotension

• drowsiness and muscle weakness

• dry mouth

• photosensitivity

• hepatotoxicity

what to monitor for additive CNS depression?

• decrease RR, SPO2

• concurrent use of other CNS depressants

what is the response for additive CNS depression?

do not take with ETOH, CNS depressants, accelerate as needed

what to monitor for gastrointestinal upset?

patient report of nausea

what is the response for gastrointestinal upset?

• encourage to tae with or after meal

• try ginger candy or capsules

• notify provider

what to monitor for dizziness and hypotension?

decrease BP and report of dizziness

what is the response for dizziness and hypotension?

• fall precautions

• advise rise slowly

• hold and notify provider

what to monitor for drowsiness and muscle weakness?

decrease LOC and report weakness

what is the response for drowsiness and muscle weakness

• advise patient to avoid activities requiring alertness

• assess safety needs

• hold med and notify provider

what to monitor for dry mouth?

report of dry mouth, oral examination

what is the response for dry mouth?

• provide sips of water

• sugar-free gum/lozenges

• humidified air

• notify provider

what to monitor for photosensitivity?

report light sensitivity, discomfort in bright light

what is the response for photosensitvity?

• educate pt on the use of sunscreen 

• protective clothing and sunglasses

• hold and notify

what to monitor for heptotoxicity?

• elevated liver function tests

• jaundice

what is the response for hepatotoxicity?

hold and notify

what to look out for cyclobenzaprine?

confusion and hallucinations

what to look out for with baclofen?

used in a pump but don’t discontinue abruptly

what is the prototype drug for direct acting muscle relaxants?

dantrolene 

what is the mechanism of action for dantrolene?

directly relaxes spastic muscle by interfering with the release of calcium ion in SR of skeletal muscle

what does dantrolene do?

• decrease muscle spasticity

• decrease muscle pain

• increase mobility

what to know about dantrolene?

more hepatotoxic than other muscle relaxants

what is the prototype drug of ICP-reducing agents?

mannitol

what is the mechanism of action for mannitol?

draw water and plasma into the intravascular space and shifting excess fluid out of the brain

what does mannitol do?

• decrease

  • ECF

  • ICP

• Increase

  • increase intravascular vol.

  • urine output

what are adverse outcomes for mannitol?

• pulmonary edema 

• hypotension and dizziness

• electrolyte imbalances

• dehydration and fatigue

what to monitor for pulmonary edema

SOB, crackles, in lungs, decrease SPO2

what is the response for pulmonary edema?

• hold and notify

• supplemental O2

• RRT if needed

what to monitor for hypotension and dizziness?

decrease BP, HR, and report dizziness

what is the response for hypotension and dizziness

hold and notify, ensure safety, and prevent falls

what to monitor for electrolyte imbalance

electrolyte levels: sodium and potassium

what is the response for electrolyte imbalance

hold and notify

what to monitor for dehydration and fatigue?

fluid balance (is and Os0

what is the response for dehydration and fatigue?

• educate on need to diuresis

• avoid over hydration which will increase ICP

what is the prototype drugs for antiseizure meds?

• phenytoin 

• levetiracetam

what does phenytoin and levetiracetam do?

decrease seizures and excitability

what to know about phentoin?

therapeutic range 10-20 mcg/dl, SE: gingival hyperplasia, vision tissues, GI upset, rash

what to know about levetiracetam?

behavioral effects in peds pts such as agitation, depression, and hostility

what are adverse reactions for phenytoin and levetiracetam?

• sedation and drowsiness

• hypotension and dizziness

• suicidal ideation and depression

• safety considerations

• discontinuation risk

• pregnancy and newborn risk

what to monitor for sedation and drowsiness?

LOC, confusion, disorientation, fall risk

what is the response for Sedation and drowsiness/

• expected in first 24 hrs

• hold and notify

• avoid other CNS depressants

• fall prevention

what to monitor for hypotension and dizziness?

decrease BP and report dizziness

what is the response of hypotension and dizziness?

• expected in first 24 hrs

• hold and notify

what to monitor for suicidal ideation and depression?

suicidal thoughts and mood

what is the response for suicidal ideation and depression?

ensure safety and notify

what to monitor for safety considerations

driving or need to alertness during tasks

what is the response for safety consideration?

pt should not drive until seizures are under control

what to monitor for discontinuation risk?

recurrence of seizures and status epilepticusw

what is the response for discontinuation risk?

instruct pt not discontinue med for risk of seizure return

what to monitor for pregnancy and newborn risk

birth control, chance of pregnancy, and breastfeeing

what is the response for pregnancy and newborn risk?

instruct pt to notify if they planning pregnancy or get positive test

what is the prototype drug for dopamine blockers

Haloperidol (first gen antipsychotic)

what is the mechanism of action for haloperidol?

blocks actions of dopamine

what does haloperidol do?

decrease: hallucinations, delusions, and agitation

what are adverse outcomes for haloperidol?

• extrapyramidal symptoms

• tardive dyskinesia

• Neuroleptic Malignant syndrome

• sedation

• anticholinergic effects

what to monitor for extrapyramidal symptoms?

• muscle stiffness

• tremors

• rigidity

• bradykinesia

• akathisia (restlessness)

• dystonia (sustained muscle contractions

what is the response for extrapyramidal symptoms?

hold and notify, anticipate order for anticholinergic

what to monitor for tardive dyskinesia?

involuntary movements of the face, tongue, or extremities, often irreversible

what is the response for tardive dyskinesia?

hold and notify

what to monitor for neuroleptic malignant syndrome?

• hyperthermia

• muscle rigidity

• altered mental status

• autonomic instability (tachycardia, BP changes)

what is the response for neuroleptic malignant syndrome

• hold and notify

• RRT

• anticipate order for dantrolene

what to monitor for sedation?

• excessive sleepiness

• drowsiness

• decrease LOC

what is the response for sedation?

hold and notify, educate taking at night

what to monitor for anticholinergic effects?

• dry mouth

• constipation

• urinary retention

• blurred vision

what is the response for anticholinergic effects

• provide symptomatic treatments

• monitor for severe complications like urinary retention

• notify provider

what are the prototype drugs for dopamine and serotonin blocker

• olanzapine

• aripiprazole

• risperidone

  • 2nd gen antipsychotics

what is the mechanism of action for olanzapine, aripiprazole, and risperidone

blocks actions of dopamine and seratonin

what does olanzapine, aripiprazole, and risperidone do?

decrease

• hallucinations

• delusions

• agitation

• negative symptoms of schizophrenia

what are adverse outcomes for olanzapine, aripiprazole, and risperidone

• metabolic syndrome 

• QT prolongation

• Extrapyramidal symptoms

what to monitor for metabolic syndrome

• weight

• blood glucose levels

• lipid profile

• waist circumference

what is the response for metabolic syndrome?

hold and notify

what to monitor for QT prolongation

• ECG for QT interval prolongation

• K+ and mag levels

what is the response for QT prolongation?

hold and notify

what to monitor for extrapyramidal symptoms?

• muscle stiffness, tremors, rigidity, bradykinesia

• akathisia (restlessness)

• dystonia (sustained muscle contractions)

what is the response for extrapyramidal symptoms?

• hold and notify

• anticipate order for anticholinergic

what is oxytocin for?

initiation or improvement of uterine contractions and to control bleeding/hemorrhage

what to assess for oxytocin?

• med appropariate?

• uterine contractions

• fetal health: FHR, gestational age

what to be cautious with while on oxytocin?

• contraindicated in pts who should not have a vaginal delivery

  • fetal malpresentation

  • history of major surgery to uterus or cervix

  • urgent fetal distress

  • active gential herpes

• antidiuretics side effect