Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. ALLERGY AND RESPIRATORY MEDICATIONS SURGICAL PATIENT - PHARMACOLOGY

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint

of Elsevier Inc.

ALLERGY AND RESPIRATORY MEDICATIONS

SURGICAL PATIENT - PHARMACOLOGY

1

RESPIRATORY SYSTEM

• Upper Respiratory System- filters and humidifies air that is inhaled• Oral and nasal cavity, sinuses, pharynx,

larynx, and trachea• Lower Respiratory System- exchange

oxygen and carbon dioxide between alveoli/blood• Right and left bronchi, right and left

lungs, bronchioles, and alveoliCopyright © 2013, 2010, 2006, 2003,

2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

2

CHAP 11 -ANTIHISTAMINES

• Action – histamine- chemical the body produces that causes an inflammatory response• Compete with histamine for H1 receptor sites to

limit its effect on body organs and structures• Limits vasodilation, capillary permeability, and

swelling• Limits acetylcholine release, which dries

secretions in the bronchioles and gastrointestinal system

• Sedative effect on the CNSCopyright © 2013, 2010, 2006, 2003,


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ANTIHISTAMINES (CONT.)

• Uses• Seasonal allergic rhinitis (SAR)• Perennial allergic rhinitis (PAR)• Perennial nonallergic rhinitis (PNAR)• Relieve symptoms of allergic disorders• Adjunctive therapy for anaphylaxis• Sedation


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ANTIHISTAMINES (CONT.)

• Adverse Reactions• Changes in blood pressure, blurred vision• Tachycardia, insomnia, dry mouth,

nausea• Restlessness, excitability, sedation,

tinnitus• Drug Interactions (CNS depressants –

hypnotics, sedatives, depressant analgesics, alcohol increase the effect. )


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ANTIHISTAMINES

Life span considerations• Pediatrics:

• Infants and young children often have anticholinergic side/adverse effects

• Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability

• Elderly• More likely to develop side effects such as

dizziness, syncope (fainting), confusion, and extrapyramidal reactions

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ANTI-HISTAMINE DRUGS

• First Generation – usually OTC, crosses blood-brain barrier, sedative effect• Dimetapp, Chlor-Trimeton, Benadryl, Banophen,

PhernerganSecond Generation – most available by

prescription, some OTC, rapid onset, do not cross blood-brain barrier, do not cause excessive sedationZyrtec, Periactin, Allegra, Allergra D, Claritin, Claritin D


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CHAPTER 16 -ANTIEMETICS

ActionInhibit cholinergic nerve impulses to the vomiting center of the brain

• Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center

Uses• Prevent and treat motion sickness or the

nausea and vomiting that occur with surgery, anesthesia, and cancer treatment


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ANTIEMETIC-ANTIVERTIGO AGENTS (CONT.)

Adverse Reactions • Drowsiness and drug tolerance with long-

term therapy• Anticholinergic reactions – dry mouth,

stuffy nose, blurred vision, constipations, urinary retention

Drug Interactions• CNS depressants increase the sedative

effect of antiemetic medications.Copyright © 2013, 2010, 2006, 2003,


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ANTIEMETIC-ANTIVERTIGO AGENTS (CONT.)

Lifespan considerations –Pediatric patients with acute illnesses are at special risk for adverse reactions (Reye syndrome)

Assessment – find out hx of allergies and medicationsDiagnosis – what other considerations vomiting may indicate – nutrition, electrolyte imbalancePlanning – educate patient on sedation effect


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ANTIEMETIC/ANTIVERTIGO AGENTS

CompazineReglanDramamineBenadrylAntivertMarinolScopolamine transdermal patchZofran

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SEDATIVE-HYPNOTIC MEDICATIONS

Action and Uses• Sedative agent: relaxes the patient and

reduces anxiety and MAY lead to sleep• Hypnotic agent produces sleep in the patient• They are used to relax patients and induce

sleep before medical testing and surgical procedures; used to treat insomnia caused by mental and physical stress

Lorzepam (Ativan), Temazepam (Restoril), Phenobarbital

Schedule IV controlled substancesCopyright © 2013, 2010, 2006, 2003,


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SEDATIVE-HYPNOTIC MEDICATIONS

• Adverse Reactions – “hangover” effect, impaired coordination, headache, muscle or joint pain

• Drug Interactions- increase sedative effects of CNS depressants, analgesics, anesthetics, tranquilizers


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GASTRO-INTESTINAL ANTI-CHOLINGERGICS

• Three major types of GI medications: restore and maintain the lining of the GI tract; decrease acidity and motility; exert laxative action on the colon

• Pre operative Medication – Tagamet Histamine 2 recepter antagonist decreases gastric acidity and volume


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Ch 17 – Analgesics Opiod & Non-Narcotic

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OPIOIDS

Two Forms• Natural: from opium (morphine and codeine)• Synthetic: man-made in the hope they would

not be as additive – useful for pain mgt and reversal effects of opiods – (hydrocodone, oxycodone)Synthetic: man-made mad


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OPIOIDS (CONT.)

Agonist• Binds with the receptor(s) to activate and

produce the maximum response of the individual receptor

Partial agonist• Produces a partial responseAgonist-antagonist• Acts as an agonist at one type of receptor and

as a competitive antagonist at another type of receptor


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OPIOIDS (CONT.)

Morphine • Uses

• Acute care• Hospice

Codeine, hydrocodone, oxycodone• Uses

• Office or clinical settingHydromorphone• Uses

• Severe pain unrelieved by morphine


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WONG-BAKER FACES PAIN RATING SCALE


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PAIN (CONT.)

Tolerance• The same amount of a drug produces a

decreased effect over timeDependence• A state in which the body will show withdrawal

symptoms if the drug is stopped or reducedAddiction• The uncontrollable need to have and use a drug

for nonmedical reasons


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NARCOTIC AGONIST ANALGESICS

Action• Prevent pain perception in the central nervous

system• Produce analgesia, sleepiness, euphoria,

unclear thinking, slow breathing, produce miosis, decreased peristalsis, reduced cough reflex, and hypotension

Uses• Treat moderate to severe pain


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NARCOTIC AGONIST ANALGESICS (CONT.)

Adverse Reactions• Bradycardia, slowed breathing• Hypotension, fainting• Anorexia, constipation• Confusion, euphoria• Dry mouth, vomiting• Pruritus, skin rash


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PATIENT-CONTROLLED ANALGESIA

• Used when a continuous infusion of opioids is required

• Pump is calibrated to ordered dose and frequency

• Patient is able to self-administer pain medication by pushing control button

• Pump can be programmed to deliver an hourly rate


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NARCOTIC AGONIST ANALGESICS (CONT.)

Drug Interactions• Many drugs increase or decrease effectsNursing ImplicationsPatient Teaching


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NARCOTIC AGONIST-ANTAGONISTANALGESICS

Action• Act on chemicals at specific nerve sites in the

CNS, possibly in the limbic system• Produce analgesia, euphoria, and respiratory

and physical depressionUses• Relief of moderate to severe pain• Presurgical anesthesia• Active labor


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NARCOTIC AGONIST-ANTAGONIST ANALGESICS (CONT.)

Adverse Reactions• Bradycardia or tachycardia• Hypertension or hypotension• Changes in mood, confusion, nervousness• Blurred vision, dizziness, headache• Weakness, nystagmus, syncope, tingling• Tinnitus, tremor, unusual dreams• Nausea, vomiting, dry mouth, constipation


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NARCOTIC AGONIST-ANTAGONIST ANALGESICS (CONT.)

Drug Interactions• Caution with alcohol and CNS depressants• Nursing Implications• Patient Teaching


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NONNARCOTIC CENTRALLY ACTING ANALGESICS

Action• Act at the level of the brain to control mild or

moderate painUses• Mild to moderate pain• Used in combination products for pain alone or

when pain and fever are present


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NONNARCOTIC CENTRALLY ACTING ANALGESICS (CONT.)

Adverse Reactions• Postural hypotension, dizziness • Disorientation, euphoria, headache• Light-headedness, minor visual disturbances• Sleepiness, slurring of speech, weakness• Skin rashes, stomach or abdominal pain• Dry mouth, nausea, vomiting, chills• Difficulty urinating, stuffy nose


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NONNARCOTIC CENTRALLY ACTING ANALGESICS (CONT.)

• Drug Interactions• Nursing Implications• Patient Teaching


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SKELETAL MUSCLE RELAXANTS

• Action: reduce muscle tone and involuntary movement without loss of voluntary motor function• Centrally acting or direct myotropic blocking

• Uses: relief of pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation; relief of spasticity in chronic conditions

• Table 18-2


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SKELETAL MUSCLE RELAXANTS (CONT.)

• Adverse reactions: symptoms • Drug interactions: sedatives, narcotic

analgesics, antianxiety agents, hypnotics, alcohol, general anesthetics, MAOIs, and tricyclics• Cyclobenzaprine and orphenadrine: anticholinergic

effects that interfere with antihypertensive activity of alpha-adrenergic blockers


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SKELETAL MUSCLE RELAXANTS (CONT.)

• Nursing implications: assessment, diagnosis, planning, implementation, and evaluation

• Patient and family teaching: administration considerations; avoiding activities requiring alertness; drug interactions; missed dosages; when to contact the health care provider; HS administration; storage and safety


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Documents

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. ALLERGY AND RESPIRATORY MEDICATIONS SURGICAL PATIENT - PHARMACOLOGY