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LOCAL ANESTHETICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM INDICATIONS &
DRUG NAME CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES
OF ACTION
Generic Name: MECHANISM
Anesthetic of the OF INDICATIONS &
Indications ADVERSE
Body as a Whole: 1. Monitor for signs of inadvertent intravascular
DRUG NAME
Bupivacaine amide type. CONTRAINDICATIONS o Hypersensitivity [cutaneous lesions, NURSING
injection, which RESPONSIBILITIES
can produce a transient
ACTION Infiltration anesthesia; EFFECTS
hydrochloride Decreases urticaria, sneezing, diaphoresis, "epinephrine response" (increased heart rate or
Generic Name: Mepivacaine is a local peripheral, sympathetic
Indications: Common 1. Instruct patient mepivacaine may cause dizziness,
sodium flux into nerve, and epidural syncope, hyperthermia, angioneurotic systolic BP or both, circumoral pallor, palpitations,
Mepivacaine anesthetic. It works by CARBOCAINE o Abnormal skin sensations; drowsiness, or blurred vision. Do not drive, operate
Brand Name: nerve cell, edema (including laryngeal edema), nervousness) within 45 seconds in the unsedated
preventing nerves from (including caudal) block
(mepivacaine) is o Anxiety machinery, or do anything else that could be dangerous until
Marcaine, inhibiting initial anesthesia; 0.75% anaphylaxis, anaphylactoid reaction]. patient and an increase by 20 bpm or more in heart
Brand Name: transmitting painful indicated for o backache; you know how you react to mepivacaine. Using mepivacaine
Sensorcaine depolarization, CNS: rate for at least 15 seconds in sedated patient.
Carbocaine impulses to the brain, bupivacaine solution
production in or
of local o changes in speech patterns; alone, with certain other medicines, or with alcohol may
and prevents dextrose is usedanalgesia
for o Nervousness, 2. Vasoconstrictor-containing solution should be
Polocaine which creates regional o chills; lessen your ability to drive or perform other potentially
Classification: propagation and o unusual anxiety, administered cautiously, if at all, to areas with end
temporary anesthesia spinal anesthesia.
and anesthesia by o constricted pupils; dangerous tasks.
Central conduction of o excitement, arteries (e.g., digits, penis) or to areas that have a
Classification: (lack of feeling or local infiltration, o depression; 2. Position patient comfortably if they are conscious, this will
nervous the nerve Contraindications: o dizziness, compromised blood supply; ischemia and gangrene
Local numbness). peripheral nerve o headache; be sitting up.
system agent impulse. Knownblock sensitivity to o drowsiness, can result. Inspect areas for evidence of reduced
Anesthetics techniques, and o inability to urinate or defecate; 3. Be reassuring to the patient and administer oxygen.
Local Progression of bupivacaine, local o tremors, perfusion because of vasospasm: pale, cold, sensitive
central neural o lightheadedness; Seizure can occur with local anesthetic overdose,
anesthetic anesthesia, anesthetics, other amide- o convulsions, skin.
techniques including o metallic taste; numbness and administering oxygen is useful in raising the seizure
(amide-type) related to type anesthetics. o unconsciousness, 3. Note: Systemic reactions (toxicity) are more apt to
epidural and caudal tingling of the mouth and lips; threshold in the brain.
diameter, Parabens, or metabisulfites; o respiratory arrest. occur in children or older adults and may develop
blocks. o numbness in the legs and feet; 4. BLS as needed
myelination, and acidosis; heart block; severe o Special Senses: rapidly or be delayed for as long as 30 min after
Causing numbness o ringing in the ears; 5. Monitor Vital Signs, especially for signs of respiratory
conduction hemorrhage; o Pupillary administration.
duringhypotension
surgical o sexual dysfunction; depression or hypotension.
velocity of and shock; hypertension, o constriction; 4. Monitor for toxicity: CNS stimulation (unusual
procedures, labor, or o twitching; 6. Allow the biotransformation of the drug to occur and the
affected fibers is cerebrospinal o blurred or double vision; tinnitus. anxiety, excitement, restlessness) usually occurs first,
deliverydiseases; o weakness. patient should recover quickly. If not, activate EMS.
manifested obstetrical paracervical GI: followed by CNS depression (drowsiness,
clinically as anesthesia or spinal o Nausea, vomiting. unconsciousness, respiratory arrest). However,
Contraindications: Severe:
sequential loss anesthesia in septicemia; Other: because stimulation is apt to be transient or absent,
Mepivacaine is o Severe allergic reactions (rash;
of nerve topical contraindicated
or IV regional in o Inflammation or sepsis at injection site, drowsiness may be the first sign in some patients
hives; difficulty breathing;
function. May anesthesia; o chills, (especially children and older adults).
patients with a tightness in the chest; swelling
stimulate or o pupillary constriction. Associated with 5. Monitor BP and fetal heart rate continuously during
depress the CNS
intercurrent
knownuse with of the mouth, face, lips, or
Epidural labor because maternal hypotension may accompany
chloroprocaine; history to
hypersensitivity of tongue)
or do both. Anesthesia, Body as a Whole: regional anesthesia. Place mother on left side with
malignant hyperthermia.
amide-type local o blurred vision;
o Total spinal block, legs elevated.
Safety during pregnancy
anesthetics. o changes in hearing;
o persistent analgesia, 6. Monitor cardiac and respiratory status continuously
(category C) other than o chest pain;
o paresthesia. in patients receiving retrobulbar and dental blocks.
during labor, lactation, or o convulsions;
Urogenital:
children <12 y is not o dizziness;
o Urinary retention, Patient & Family Education
established. o drowsiness;
o fecal incontinence,
o excessive sweating;
o loss of perineal sensation and sexual 1. After spinal anesthesia, sensation to lower
Cautious Use o excitement;
function. extremities may not return for 2.5–3.5 h.
Older adults or debilitated o fainting;
Other:
patients; hepatic or renal o increased body temperature;
o Slowing of labor,
disease; known drug allergies o increased heartbeat;
o increased incidence of forceps Reference:
and sensitivities; dysrhythmias; o interrupted References:
delivery, http://www.robholland.com/Nursing/Drug_Guide/da
children >12 y; obstetrical o breathing; https://www.drugs.com/pro/mepivacaine.html
o cranial nerve palsies (with inadvertent ta/monographframes/B045
delivery. o irregular heartbeat; http://www.rxlist.com/carbocaine-drug.html
intrathecal injection).
o itching;
o lightheadedness;
LOCAL ANESTHETICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION CONTRAINDICATIONS
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/E055.html
LOCAL ANESTHETICS
LOCAL ANESTHETICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS & ADVERSE
DRUG NAME MECHANISM OF INDICATIONS & ADVERSE NURSING RESPONSIBILITY
DRUG NAME ACTION CONTAINDICATIONS EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS EFFECTS
Generic Name: Synthetic centrally acting Indications: CNS: 1. Assess therapeutic effectiveness. Clinical
Generic Name:
Benztropine Mesylate Acts by selectively
anticholinergic Indications Suppresses tremor and CNS:
o Sedation 1.improvement
Monitor vital maysigns.
not beHR is a sensitive
evident for 2–3 indicator
d after oralof
Atropine Sulfate blocking all(antimuscarinic)
muscarinic Adjunct in symptomatic
agent. rigidity; doestreatment
not alleviate oo Headache
Drowsiness patient's
drug is started.response to atropine. Be alert to changes
Brand Name: responses Acts
to by diminishing of GI disorders (e.g.,dyskinesia.
tardive peptic ulcer, oo Ataxia
Dizziness in quality,
2. Monitor rate,and
I&O ratio andpattern.
rhythm Advise
of HR and respiration
patient to
Brand Name:
Apo-Benztropine acetylcholine
excess(ACh), pylorospasm,
cholinergic effect GI hypermotility,
Symptomatic treatment of oo Dizziness ,Excitement
Paresthesias anddifficulty
report to changes in BP and or
in urination temperature.
infrequent voiding.
Atropair
Bensylate whether excitatory or
associated with dopamine irritable bowel
all syndrome) and spastic
forms of parkinsonism oo Irritability
Agitation 2.Dosage
Initial paradoxical
reduction may be bradycardia
indicated. following IV
Atropisol
Cogentin inhibitory.deficiency.
Selective disorders of biliary tract. Relaxes
(arteriosclerotic, oo Convulsions
Irritability atropine
3. Closely monitor usually lasts onlyof
for appearance 1–2
S&Smin; it most
of onset of
Isopto
PMS Benztropine depression of CNS
Benztropine works byupper GI tractidiopathic,
and colon during oo Drowsiness,
Restlessness Fatigue likely occurs when IV is administered
paralytic ileus including intermittent constipation, slowly
Atropine relieves rigidity
blockingandchemicals inhypotonic radiography.
postencephalitic) and to oo Weakness
Nervousness (more than
abdominal pain,1diminution
min) or when small doses
of bowel sounds(less
on than
Classifications: tremor of Parkinson's
your body that cause Ophthalmic
the Use: Toextrapyramidal
relieve produce oo Mental depression
Insomnia 0.5 mg) are
auscultation, andused. Postural hypotension occurs
distention.
Classifications
Autonomic Nervous syndrome. symptoms of mydriasis and cycloplegia before with
symptoms associated oo Confusion
Hallucinations whenfor
4. Monitor patient ambulates
and report muscle tooweakness
soon afterorparenteral
inability
Autonomic
System Agent Antisecretory action
parkinsonism refraction and
or drug- for treatment
neuroleptic of e.g.,
drugs, oo Disorientation
Delirium administration.
to move certain muscle groups. Dosage reduction may
Nervous
Anticholinergic (vagolytic effect)
induced movement anterior uveitis and iritis.(Haldol),
haloperidol oo Hallucinations
mental 3.be needed.
Monitor I&O, especially in older adults and
System
(parasympatholytic) suppressesdisorders.
sweating,This results
Preoperative
in Use: To suppress
phenothiazines, CV: confusion patients
5. Supervise who have and
ambulation had use
surgery (drugrails
bed side mayas
Agent
Anti-parkinsonism lacrimation, salivation,
decreased tremors, salivation, perspiration,
thiothixeneand (Navane). oo Hypertension
toxic psychosisor contribute to urinary retention). Palpate lower
necessary.
Anticholiner
agent and secretions
muscle fromspasms, and respiratory tract secretions;
Commonly usedtoasreduce o hypotension
muscular abdomen
6. Report for distention.
immediately S&S of CNSHavedepression
patient voidor before
gic (para- nose, mouth, pharynx,
stiffness, and better incidence of laryngospasm,
supplement with reflex o ventricular
weakness giving atropine.
stimulation. These usually require interruption of
sympatholyti and bronchi. Blocks
muscle control. bradycardia arrhythmia,
trihexyphenidyl, and carbidopa, o tachycardia
Ataxia 4.drug
Monitor
therapy.CNS status. Older adults and debilitated
c) vagal impulses to heart hypotension or during general
levodopa anesthesia.
therapy. palpitation
o Inability to move patients sometimes manifest drowsiness or CNS
Anti- with resulting decrease Cardiac Uses: For sinus bradycardia o paradoxical
certain muscle Patient stimulation (excitement, agitation, confusion) with
& Family Education
muscarinic in AV conduction time, or asystole during CPR or that is
Contraindications: bradycardia
groups. AV usual
1. Do not doses
drive or of drug in
engage or potentially
other belladonna alkaloids.
hazardous
increase in heart rate induced by drugs
Narrow or toxic
anglesubstances
glaucoma CV: dissociation activities until response to drug is known. Seekand
In addition to dosage adjustment, side rails help
and cardiac output, and (e.g., pilocarpine,
myastheniabeta-adrenergic
gravis oo atrial or ventricular
Palpitation supervision
walking of ambulation may be indicated..
as necessary.
shortened PR interval. blockers,organophosphate
obstructive diseasespesticides,
of GU o fibrillation
Tachycardia 2. Patient & Family
Avoid alcohol andEducation
other CNS depressants because
Atropine is a potent and Amanita and mushroom
GI tracts poisoning GI:
o Flushing 1. Follow measures
they may cause additive to relieve dry mouth:
drowsiness. Do notadequate
take OTC
bronchodilator when Contraindications:
tendency to tachycardia Dry mouth
oSpecial Senses: with cold,hydration;
cough, or small, frequent
hay fever remediesmouth rinses
unless with tepid
approved by
bronchoconstriction Hypersensitivity
tardive to belladonna
dyskinesia o thirst
Blurred vision water; meticulous mouth and dental hygiene; gum
physician.
has been induced by alkaloids; childrenangle-closure
synechiae; <3 y. Safety during oo Dysphagia
Mydriasis, Loss of 3. Sugarless
chewing or sucking
gum, sugarless
hard candy, sourballs.
and rinsing mouth with
parasympathomimetics. glaucoma; parotitis;
pregnancy obstructive
(category C) or o taste
Photophobia 2.tepid
Note: Drug
water willcauses drowsiness,
help dry mouth. sensitivity to light,
Produces mydriasis uropathy, e.g.,lactation
bladderisneck not established. oGI: Nausea & Vomiting, 4. Avoid blurring
doing of near vision,
manual labor or and temporarily
strenuous impairs
exercise in hot
(dilation of pupils) and obstruction caused by prostatic oo Constipation
Nausea & abilitydiminished
weather; to judge distance.
sweating Avoid
maydriving
requireanddoseother
cycloplegia (paralysis of hypertrophy; intestinal
Cautious Use atony, paralytic Skin: Vomiting activities because
adjustments requiringofvisual acuityofand
possibility heatmental
stroke. This
accommodation) by ileus, obstructive diseases
Older children, ofolder
GI tract,
adults oo Flushed & Dry
Constipation skin alertness.
condition is most apt to occur in the older adults.
blocking responses of severe ulcerative colitis, toxic
or debilitated patients, oo Rash
Dry ,Urticarial.
mouth 5. 3.Do not
Discontinue
breast feed ophthalmic
while takingpreparations and notify
this drug without
iris sphincter muscle megacolon; tachycardia
patients with secondary
poor mentalto Special Senses
o Distention physician
consulting if eye pain, conjunctivitis, palpitation,
physician.
and ciliary muscle of cardiac insufficiency or thyrotoxicosis;
outlook, mental disorders; oo Mydriasis
Paralytic & Blurred
ileus rapid pulse, or dizziness occurs.
lens to cholinergic acute hemorrhage;
enlarged myasthenia
prostate; gravis. vision
Urogenital: 4. Do not breast feed while taking this drug without
stimulation. Safety duringhypertension;
pregnancy (category
history C)of oo Photophobia
Dysuria consulting physician.
Referemce:
or lactation isrenal
not established.
or hepatic disease. o Increased intraocularhttp://www.robholland.com/Nursing/Drug_Guide/
Cautious Use pressure data/monographframes/B016.html
Myocardial infarction, hypertension, o Cycloplegia Reference:
hypotension; coronary artery disease, o Eye dryness http://www.robholland.com/Nursing/Drug_Guide
ANTI-CHOLINERGICS CHF, tachy-arrhythmias o Local redness. /data/monographframes/A084.html
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/T077.html
ANTI-CHOLINERGICS
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/I038.html
ANTI-CHOLINERGICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name: Synthetic tertiary Indications: Body as a Whole: Severe 1. Periodic interruptions of therapy are
Oxybutynin Chloride amine that exerts To relieve symptoms allergic reactions recommended to determine patient's need for
direct associated with voiding in including continued treatment. Tolerance has occurred in
Brand Name antispasmodic patients with uninhibited o Urticaria some patients.
Ditropan action and inhibits neurogenic bladder and o skin rashes 2. Keep physician informed of expected responses to
Ditropan XL muscarinic effects reflex neurogenic bladder. o suppression of drug therapy (e.g., effect on urinary frequency,
Oxytrol of acetylcholine on Also has been used to lactation urgency, urge incontinence, nocturia,
smooth muscle. relieve pain of bladder o decreased sweating completeness of bladder emptying).
Classifications: Prominent spasm following o fever 3. Monitor patients with colostomy or ileostomy
Autonomic Nervous System antispasmodic transurethral surgical CNS: closely; abdominal distension and the onset of
Agent activity. procedures. o Drowsiness diarrhea in these patients may be early signs of
Anticholinergic o Dizziness intestinal obstruction or of toxic megacolon.
(parasympatholytic) Contraindications: o Weakness
Anti-muscarinic Hypersensitivity of o Insomnia Patient & Family Education
Antispasmodic oxybutynin; narrow angle o Restlessness psychotic 1. Do not drive or engage in potentially hazardous
glaucoma, myasthenia behavior (overdosage) activities until response to drug is known.
gravis, partial or complete CV: 2. Exercise caution in hot environments. By
GI obstruction, gastric o Palpitations suppressing sweating, oxybutynin can cause fever
retention, paralytic ileus, o Tachycardia and heat stroke.
intestinal atony o Flushing 3. Do not breast feed while taking this drug without
(especially older adult or o Special Senses: consulting physician.
debilitated patients), Mydriasis
megacolon, severe colitis, o blurred vision,
GU obstruction, urinary Cycloplegia
retention, unstable o Increased ocular
cardiovascular status. tension
GI:
Cautious Use: o Dry mouth
Older adults; autonomic o Nausea & vomiting
neuropathy, hiatus hernia o Constipation,
with reflex esophagitis; o Bloated feeling
hepatic or renal Skin:
dysfunction; urinary o Pruritus at application
infection; site
hyperthyroidism; CHF, o Rash
coronary artery disease, o application site vesicle
hypertension; prostatic o erythema
hypertrophy; pregnancy Urogenital: Reference:
(category B), children o Urinary hesitancy or http://www.robholland.com/Nursing/Drug_Guide
<18, lactation. retention, impotence. /data/monographframes/O025.html
Reference:
http://www.robholland.com/Nursing/Drug_Guide/
data/monographframes/L041.html
Reference:
http://www.robholland.com/Nursing/Drug_Guide/data/m
onographframes/D053.html