LOCAL ANESTHETICS

MECHANISM OF INDICATIONS & ADVERSE

DRUG NAME CONTRAINDICATIONS NURSING RESPONSIBILITIES
ACTION EFFECTS
Generic Name:  When administered Indications: Common 1. When Lidocaine is administered as an antiarrhythmic the nurse should
Lidocaine intramuscularly or  Intravenous – o Drowsiness monitor the ECG continuously. Blood pressure and respiratory status
intravenously, Lidocaine ventricular o Dizziness should be monitored frequently during the drug administration.
Brand Name: suppresses the arrhythmias o Nervousness 2. When administered as an anesthetic, the numbness of the affected part
Xylocaine automaticity and  Intramuscular – self- o (mucosal use) should be assessed.
spontaneous depolarization injected or when IV is decreased or 3. Serum Lidocaine levels should be monitored frequently during
Classification: of the ventricles during unavailable during absent gag reflex prolonged use. Therapeutic serum lidocaine levels range from 1.5 to 5
 Local or diastole by altering the flux transport to local o Bradycardia mcg/ml.
Topical of sodium ions across the facilities o Hypotension 4. If signs of overdose occur (listed above), stop the infusion immediately
Anesthetics cell membrane with little or  Local – infiltration or o Burning and monitor the patient closely.
 Anti- no effect on the heart. mucosal or topical sensation 5. For throat sprays, make sure that the patient’s gag reflex is intact
arrhythmic Locally, it produces local anesthetic before allowing the patient to eat or drink.
anesthesia effect by  Patch – used when Signs and symptoms of 6. When IM injections are used, the medication should be administered
inhibiting the transport of pain is present due to toxicity and overdose in the deltoid muscle only while frequently aspirating to prevent IV
ions across the neural post-herpetic of Lidocaine: injection.
membranes. Thus, neuralgia 7. For direct IV injection only 1% and 2% solutions are used.
initiation and conduction of o Confusion 8. Undiluted IV loading dose of Lidocaine is administered at 1 mg/kg at a
normal nerve impulses is Contraindications: o Excitation rate of 25 to 50 mg over 1 minute. The dose may be repeated after 5
prevented.  Hypersensitivity o Blurred or double minutes.
 Advanced AV block vision
Used cautiously in o Nausea and
patients with: vomiting References:
 Liver diseases o Ringing in the ears https://www.drugs.com/cons/lidocaine.html
 Congenital heart failure o Tremors
 Patient weighing less o Twitching
than 50 kilograms o Seizures
 Geriatric patients o Difficulty
 Respiratory depression breathing
 Shock o Severe dizziness
 Heart block and fainting
 Pregnancy and lactation o Unusually low
heart rate

Czarina Isabela P. Tuazon - BSN 4A

LOCAL ANESTHETICS

MECHANISM OF INDICATIONS & ADVERSE

DRUG NAME CONTRAINDICATIONS NURSING RESPONSIBILITIES
ACTION EFFECTS
Generic Name:  Mepivacaine is a local Indications: Common 1. Instruct patient mepivacaine may cause dizziness,
Mepivacaine anesthetic. It works by  CARBOCAINE o Abnormal skin sensations; drowsiness, or blurred vision. Do not drive, operate
preventing nerves from (mepivacaine) is o Anxiety machinery, or do anything else that could be dangerous until
Brand Name: transmitting painful indicated for o backache; you know how you react to mepivacaine. Using mepivacaine
Carbocaine impulses to the brain, production of local or o changes in speech patterns; alone, with certain other medicines, or with alcohol may
Polocaine which creates regional analgesia o chills; lessen your ability to drive or perform other potentially
temporary anesthesia and anesthesia by o constricted pupils; dangerous tasks.
Classification: (lack of feeling or local infiltration, o depression; 2. Position patient comfortably if they are conscious, this will
 Local numbness). peripheral nerve o headache; be sitting up.
Anesthetics block techniques, and o inability to urinate or defecate; 3. Be reassuring to the patient and administer oxygen.
central neural o lightheadedness; Seizure can occur with local anesthetic overdose,
techniques including o metallic taste; numbness and administering oxygen is useful in raising the seizure
epidural and caudal tingling of the mouth and lips; threshold in the brain.
blocks. o numbness in the legs and feet; 4. BLS as needed
 Causing numbness o ringing in the ears; 5. Monitor Vital Signs, especially for signs of respiratory
during surgical o sexual dysfunction; depression or hypotension.
procedures, labor, or o twitching; 6. Allow the biotransformation of the drug to occur and the
delivery o weakness. patient should recover quickly. If not, activate EMS.

Contraindications: Severe:
 Mepivacaine is o Severe allergic reactions (rash;
contraindicated in hives; difficulty breathing;
patients with a tightness in the chest; swelling
known of the mouth, face, lips, or
hypersensitivity to tongue)
amide-type local o blurred vision;
anesthetics. o changes in hearing;
o chest pain;
o convulsions;
o dizziness;
o drowsiness;
o excessive sweating;
o excitement;
o fainting;
o increased body temperature;
o increased heartbeat;
o interrupted References:
o breathing; https://www.drugs.com/pro/mepivacaine.html
o irregular heartbeat; http://www.rxlist.com/carbocaine-drug.html
o itching;
o lightheadedness;

Czarina Isabela P. Tuazon - BSN 4A

LOCAL ANESTHETICS
MECHANISM INDICATIONS &
DRUG NAME CONTRAINDICATIONS ADVERSE EFFECTS NURSING RESPONSIBILITIES
OF ACTION
Generic Name:  Anesthetic of the Indications Body as a Whole: 1. Monitor for signs of inadvertent intravascular
Bupivacaine amide type.  Infiltration anesthesia; o Hypersensitivity [cutaneous lesions, injection, which can produce a transient
hydrochloride Decreases peripheral, sympathetic urticaria, sneezing, diaphoresis, "epinephrine response" (increased heart rate or
sodium flux into nerve, and epidural syncope, hyperthermia, angioneurotic systolic BP or both, circumoral pallor, palpitations,
Brand Name: nerve cell, (including caudal) block edema (including laryngeal edema), nervousness) within 45 seconds in the unsedated
Marcaine, inhibiting initial anesthesia; 0.75% anaphylaxis, anaphylactoid reaction]. patient and an increase by 20 bpm or more in heart
Sensorcaine depolarization, bupivacaine solution in CNS: rate for at least 15 seconds in sedated patient.
and prevents dextrose is used for o Nervousness, 2. Vasoconstrictor-containing solution should be
Classification: propagation and spinal anesthesia. o unusual anxiety, administered cautiously, if at all, to areas with end
 Central conduction of o excitement, arteries (e.g., digits, penis) or to areas that have a
nervous the nerve Contraindications: o dizziness, compromised blood supply; ischemia and gangrene
system agent impulse.  Known sensitivity to o drowsiness, can result. Inspect areas for evidence of reduced
 Local Progression of bupivacaine, local o tremors, perfusion because of vasospasm: pale, cold, sensitive
anesthetic anesthesia, anesthetics, other amide- o convulsions, skin.
(amide-type) related to type anesthetics. o unconsciousness, 3. Note: Systemic reactions (toxicity) are more apt to
diameter,  Parabens, or metabisulfites; o respiratory arrest. occur in children or older adults and may develop
myelination, and acidosis; heart block; severe o Special Senses: rapidly or be delayed for as long as 30 min after
conduction hemorrhage; hypotension o Pupillary administration.
velocity of and shock; hypertension, o constriction; 4. Monitor for toxicity: CNS stimulation (unusual
affected fibers is cerebrospinal diseases; o blurred or double vision; tinnitus. anxiety, excitement, restlessness) usually occurs first,
manifested obstetrical paracervical GI: followed by CNS depression (drowsiness,
clinically as anesthesia or spinal o Nausea, vomiting. unconsciousness, respiratory arrest). However,
sequential loss anesthesia in septicemia; Other: because stimulation is apt to be transient or absent,
of nerve topical or IV regional o Inflammation or sepsis at injection site, drowsiness may be the first sign in some patients
function. May anesthesia; o chills, (especially children and older adults).
stimulate or o pupillary constriction. Associated with 5. Monitor BP and fetal heart rate continuously during
depress the CNS
 intercurrent use with Epidural labor because maternal hypotension may accompany
chloroprocaine; history of
or do both. Anesthesia, Body as a Whole: regional anesthesia. Place mother on left side with
malignant hyperthermia.
o Total spinal block, legs elevated.
 Safety during pregnancy o persistent analgesia, 6. Monitor cardiac and respiratory status continuously
(category C) other than o paresthesia. in patients receiving retrobulbar and dental blocks.
during labor, lactation, or Urogenital:
children <12 y is not o Urinary retention, Patient & Family Education
established. o fecal incontinence,
o loss of perineal sensation and sexual 1. After spinal anesthesia, sensation to lower
Cautious Use function. extremities may not return for 2.5–3.5 h.
Older adults or debilitated Other:
patients; hepatic or renal o Slowing of labor,
disease; known drug allergies o increased incidence of forceps Reference:
and sensitivities; dysrhythmias; delivery, http://www.robholland.com/Nursing/Drug_Guide/da
children >12 y; obstetrical o cranial nerve palsies (with inadvertent ta/monographframes/B045
delivery. intrathecal injection).

Czarina Isabela P. Tuazon - BSN 4A

LOCAL ANESTHETICS
MECHANISM OF INDICATIONS &
DRUG NAME
ACTION CONTRAINDICATIONS
Generic Name:  Duranest (etidocaine Indications:
Etidocaine HCL hcl) injections for Etidocaine is used in the
infiltration and nerve prevention of:
Brand Name: block should be  Pain
Duranest employed only by  Postoperative
clinicians who are well  Duranest (Etidocaine HCl)
Classification: versed in diagnosis Injections are indicated for
 Local anesthetic  Inhibits sodium fluxes infiltration anesthesia,
(amide-type) into nerve cell required peripheral nerve blocks
for initial (e.g., brachial plexus,
depolarization, intercostal, retrobulbar,
propagation, and ulnar, inferior alveolar), and
conduction of nerve central neural block (i.e.,
impulse lumbar or caudal epidural
 Amide-type local blocks).
anesthetic similar to
bupivacaine in action Contraindications:
and uses.  Known sensitivity to amide-
type anesthetics, parabens,
bisulfites; acidosis, heart
block, severe hemorrhage,
severe hypotension,
hypertension; cerebrospinal
deformities or disease;
spinal block, epidural
anesthesia in vaginal
delivery; injection into
inflamed or infected area.
Safety during pregnancy
(category B) (except during
labor), lactation, or in
children <14 y is not
established
ADVERSE EFFECTS
The signs and symptoms that
are produced after the acute
overdosage of Etidocaine
include
 Bradycardia,
 Hypotension,
 CNS stimulation,
 myocardial depression.
The symptomatic adverse
reactions produced by
Etidocaine are more or less
tolerable and if they become
severe, they can be treated
symptomatically, these
include
 Dizziness,
 Restlessness,
 Nervousness,
 Nausea and vomiting,
Hypersensitivity
reactions,
 Excitation,
 Nervousness,
 Dizziness.
NURSING RESPONSIBILITIES
1. Note: When used for peridural analgesia, drug
produces a profound degree of motor blockade
and abdominal relaxation.
2. Monitor patient's CV and respiratory status
continuously during administration.
3. Administer oxygen at first sign of CNS toxicity.
Early warning S&S: Restlessness, anxiety,
tinnitus, dizziness, blurred vision, tremors, and
drowsiness.
4. Note: Etidocaine may trigger familial malignant
hyperthermia. Early unexplained signs of
tachycardia, tachypnea, labile BP, metabolic
acidosis, and skeletal muscle rigidity may
precede temperature elevation.
Patient & Family Education
1. Do not to chew solid foods or test the
anesthetized region by biting or probing before
anesthesia wears off to prevent traumatizing
tongue, lip, and buccal mucosa.
2. Note: Patient may experience temporary loss of
sensation and motor activity, usually in the lower
part of the body, after proper administration of
epidural anesthesia.
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/E055.html
Czarina Isabela P. Tuazon - BSN 4A
LOCAL ANESTHETICS
MECHANISM OF INDICATIONS &
DRUG NAME
ACTION CONTRAINDICATIONS
Generic Name:  Decreases sodium flux Indications:
Procaine Hydrochloride into nerve cell, thus  Spinal anesthesia and
depressing initial epidural and peripheral
Brand Name: depolarization and nerve block by injection and
Novocain preventing propagation infiltration methods.
and conduction of the
Classifications: nerve impulse. Contraindications:
 Central Nervous  Local anesthetic action  Known hypersensitivity to
System agent produces loss of procaine or to other drugs of
 Local anesthetic sensation and motor similar chemical structure,
(ester-type) activity in to PABA, and to parabens;
circumscribed areas of generalized septicemia,
the body close to the inflammation, or sepsis at
injection or application proposed injection site;
site. cerebrospinal diseases (e.g.,
meningitis, syphilis); heart
block, hypotension,
hypertension; bowel
pathology, GI hemorrhage.
Safety during early
pregnancy (category C) or
lactation is not established.
Cautious Use
 Debilitated, older adults, or
acutely ill patients; obstetric
delivery; increased
intraabdominal pressure;
known drug allergies and
sensitivities, dysrhythmias;
shock.
ADVERSE EFFECTS
CNS:
o Anxiety,
o nervousness,
o dizziness,
o circumoral paresthesia,
o tremors,
o drowsiness,
o sedation,
o convulsions,
o respiratory arrest.
With spinal anesthesia:
o postspinal headache,
o arachnoiditis,
o palsies,
o spinal nerve paralysis,
o meningism.
Special Senses:
o Tinnitus,
o blurred vision.
CV:
o Myocardial depression,
o arrhythmias including
bradycardia (also fetal
bradycardia);
o hypotension.
GI:
o Nausea & vomiting.
Skin:
o Cutaneous lesions of
delayed onset,
urticaria, pruritus,
angioneurotic edema,
sweating, syncope,
anaphylactoid reaction.
Urogenital:
o Urinary retention, fecal
or urinary
incontinence, loss of
perineal sensation and
sexual function,
slowing of labor
NURSING RESPONSIBILITIES
1. Be aware that reactions during dental procedure
are usually mild, transient, and produced by
epinephrine added to local anesthetic (e.g.,
headache, palpitation, tachycardia, hypertension,
dizziness).
2. Use procaine with epinephrine with caution in
body areas with limited blood supply (e.g.,
fingers, toes, ears, nose). If used, inspect
particular area for evidence of reduced perfusion
(vasospasm): Pale, cold, sensitive skin.
3. Hypotension is the most important complication
of spinal anesthesia. Risk period is during first 30
min after induction and is intensified by changes
in position that promote decreased venous
return, or by preexisting hypertension,
pregnancy, old age, or hypovolemia.
Patient & Family Education
1. Understand that that there will be temporary
loss of sensation in the area of the injection.
2. Do not consume hot liquids or foods until
sensation returns when drug used for dental
procedure.
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/P079.html
Czarina Isabela P. Tuazon - BSN 4A
ANTI-CHOLINERGICS
MECHANISM OF
DRUG NAME
ACTION
Generic Name:  Synthetic centrally acting
Benztropine Mesylate anticholinergic
(antimuscarinic) agent.
Brand Name: Acts by diminishing
Apo-Benztropine excess cholinergic effect
Bensylate associated with dopamine
Cogentin deficiency.
PMS Benztropine  Benztropine works by
blocking chemicals in
Classifications: your body that cause the
 Autonomic Nervous symptoms of
System Agent parkinsonism or drug-
 Anticholinergic induced movement
(parasympatholytic) disorders. This results in
 Anti-parkinsonism decreased tremors,
agent muscle spasms, and
stiffness, and better
muscle control.
INDICATIONS & ADVERSE
NURSING RESPONSIBILITY
CONTAINDICATIONS EFFECTS
Indications: CNS: 1. Assess therapeutic effectiveness. Clinical
 Suppresses tremor and o Sedation improvement may not be evident for 2–3 d after oral
rigidity; does not alleviate o Drowsiness drug is started.
tardive dyskinesia. o Dizziness 2. Monitor I&O ratio and pattern. Advise patient to
 Symptomatic treatment of o Paresthesias report difficulty in urination or infrequent voiding.
all forms of parkinsonism o Agitation Dosage reduction may be indicated.
(arteriosclerotic, o Irritability 3. Closely monitor for appearance of S&S of onset of
idiopathic, o Restlessness paralytic ileus including intermittent constipation,
postencephalitic) and to o Nervousness abdominal pain, diminution of bowel sounds on
relieve extrapyramidal o Insomnia auscultation, and distention.
symptoms associated with o Hallucinations 4. Monitor for and report muscle weakness or inability
neuroleptic drugs, e.g., o Delirium to move certain muscle groups. Dosage reduction may
haloperidol (Haldol), o mental be needed.
phenothiazines, confusion 5. Supervise ambulation and use bed side rails as
thiothixene (Navane). o toxic psychosis necessary.
Commonly used as o muscular 6. Report immediately S&S of CNS depression or
supplement with weakness stimulation. These usually require interruption of
trihexyphenidyl, carbidopa, o Ataxia drug therapy.
or levodopa therapy. o Inability to move
certain muscle Patient & Family Education
Contraindications: groups. 1. Do not drive or engage in potentially hazardous
 Narrow angle glaucoma CV: activities until response to drug is known. Seek help
 myasthenia gravis o Palpitation walking as necessary.
 obstructive diseases of GU o Tachycardia 2. Avoid alcohol and other CNS depressants because
and GI tracts o Flushing they may cause additive drowsiness. Do not take OTC
 tendency to tachycardia Special Senses: cold, cough, or hay fever remedies unless approved by
 tardive dyskinesia o Blurred vision physician.
 children <3 y. Safety during o Mydriasis 3. Sugarless gum, hard candy, and rinsing mouth with
pregnancy (category C) or o Photophobia tepid water will help dry mouth.
lactation is not established. GI: 4. Avoid doing manual labor or strenuous exercise in hot
o Nausea & weather; diminished sweating may require dose
Cautious Use Vomiting adjustments because of possibility of heat stroke. This
 Older children, older adults o Constipation condition is most apt to occur in the older adults.
or debilitated patients, o Dry mouth 5. Do not breast feed while taking this drug without
patients with poor mental o Distention consulting physician.
outlook, mental disorders; o Paralytic ileus
enlarged prostate; Urogenital:
hypertension; history of o Dysuria Referemce:
renal or hepatic disease. http://www.robholland.com/Nursing/Drug_Guide/
data/monographframes/B016.html
Czarina Isabela P. Tuazon - BSN 4A
ANTI-CHOLINERGICS

MECHANISM OF INDICATIONS & ADVERSE

DRUG NAME NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS EFFECTS
Generic Name:  Acts by selectively Indications CNS: 1. Monitor vital signs. HR is a sensitive indicator of
Atropine Sulfate blocking all muscarinic  Adjunct in symptomatic treatment o Headache patient's response to atropine. Be alert to changes
responses to of GI disorders (e.g., peptic ulcer, o Ataxia in quality, rate, and rhythm of HR and respiration
Brand Name: acetylcholine (ACh), pylorospasm, GI hypermotility, o Dizziness ,Excitement and to changes in BP and temperature.
Atropair whether excitatory or irritable bowel syndrome) and spastic o Irritability 2. Initial paradoxical bradycardia following IV
Atropisol inhibitory. Selective disorders of biliary tract. Relaxes o Convulsions atropine usually lasts only 1–2 min; it most
Isopto depression of CNS upper GI tract and colon during o Drowsiness, Fatigue likely occurs when IV is administered slowly
Atropine relieves rigidity and hypotonic radiography. o Weakness (more than 1 min) or when small doses (less than
tremor of Parkinson's  Ophthalmic Use: To produce o Mental depression 0.5 mg) are used. Postural hypotension occurs
Classifications syndrome. mydriasis and cycloplegia before o Confusion when patient ambulates too soon after parenteral
 Autonomic Antisecretory action refraction and for treatment of o Disorientation administration.
Nervous (vagolytic effect) anterior uveitis and iritis. o Hallucinations 3. Monitor I&O, especially in older adults and
System suppresses sweating,  Preoperative Use: To suppress CV: patients who have had surgery (drug may
Agent lacrimation, salivation, salivation, perspiration, and o Hypertension or contribute to urinary retention). Palpate lower
 Anticholiner and secretions from respiratory tract secretions; to reduce hypotension abdomen for distention. Have patient void before
gic (para- nose, mouth, pharynx, incidence of laryngospasm, reflex o ventricular giving atropine.
sympatholyti and bronchi. Blocks bradycardia arrhythmia, and tachycardia 4. Monitor CNS status. Older adults and debilitated
c) vagal impulses to heart hypotension during general anesthesia. palpitation patients sometimes manifest drowsiness or CNS
 Anti- with resulting decrease  Cardiac Uses: For sinus bradycardia o paradoxical stimulation (excitement, agitation, confusion) with
muscarinic in AV conduction time, or asystole during CPR or that is bradycardia AV usual doses of drug or other belladonna alkaloids.
increase in heart rate induced by drugs or toxic substances dissociation In addition to dosage adjustment, side rails and
and cardiac output, and (e.g., pilocarpine, beta-adrenergic o atrial or ventricular supervision of ambulation may be indicated..
shortened PR interval. blockers, organophosphate pesticides, fibrillation Patient & Family Education
 Atropine is a potent and Amanita mushroom poisoning GI: 1. Follow measures to relieve dry mouth: adequate
bronchodilator when Contraindications: o Dry mouth with hydration; small, frequent mouth rinses with tepid
bronchoconstriction  Hypersensitivity to belladonna thirst water; meticulous mouth and dental hygiene; gum
has been induced by alkaloids; synechiae; angle-closure o Dysphagia , Loss of chewing or sucking sugarless sourballs.
parasympathomimetics. glaucoma; parotitis; obstructive taste 2. Note: Drug causes drowsiness, sensitivity to light,
Produces mydriasis uropathy, e.g., bladder neck o Nausea & Vomiting, blurring of near vision, and temporarily impairs
(dilation of pupils) and obstruction caused by prostatic o Constipation ability to judge distance. Avoid driving and other
cycloplegia (paralysis of hypertrophy; intestinal atony, paralytic Skin: activities requiring visual acuity and mental
accommodation) by ileus, obstructive diseases of GI tract, o Flushed & Dry skin alertness.
blocking responses of severe ulcerative colitis, toxic o Rash ,Urticarial. 3. Discontinue ophthalmic preparations and notify
iris sphincter muscle megacolon; tachycardia secondary to Special Senses physician if eye pain, conjunctivitis, palpitation,
and ciliary muscle of cardiac insufficiency or thyrotoxicosis; o Mydriasis & Blurred rapid pulse, or dizziness occurs.
lens to cholinergic acute hemorrhage; myasthenia gravis. vision 4. Do not breast feed while taking this drug without
stimulation. Safety during pregnancy (category C) o Photophobia consulting physician.
or lactation is not established. o Increased intraocular
Cautious Use pressure
 Myocardial infarction, hypertension, o Cycloplegia Reference:
hypotension; coronary artery disease, o Eye dryness http://www.robholland.com/Nursing/Drug_Guide
CHF, tachy-arrhythmias o Local redness. /data/monographframes/A084.html

Czarina Isabela P. Tuazon - BSN 4A

ANTI-CHOLINERGICS
MECHANISM OF
DRUG NAME
ACTION
Generic Name:  Synthetic tertiary
Trihexyphenidyl amine anticholinergic
Hydrochloride agent similar to
atropine. Thought to act
Brand Name: by blocking excess of
Aparkane acetylcholine at certain
Apo-Trihex cerebral synaptic sites.
Novohexidyl Relaxes smooth muscle
Trihexy by direct effect and by
atropinelike blocking
Classifications: action on the
 Autonomic Nervous parasympathetic
System Agent nervous system.
 Anticholinergic  Anticholinergic agent
(parasympatholytic) diminishes the
 Anti-parkinsonism characteristic tremor of
agent Parkinson's disease.
 Anti-muscarinic Antispasmodic action
 Antispasmodic appears to be one-half
that of atropine.
INDICATIONS &
CONTAINDICATIONS
Indications:
 Symptomatic treatment
of all forms of
Parkinsonism
(arteriosclerotic,
idiopathic, post
encephalitic). Also to
prevent or control drug-
induced extrapyramidal
disorders.
Contraindications:
 Narrow-angle glaucoma.
Safety during pregnancy
(category C), lactation, or
in children is not
established.
Cautious Use
 History of drug
hypersensitivities;
arteriosclerosis;
hypertension; cardiac
disease, kidney or liver
disorders; obstructive
diseases of GI or
genitourinary tracts;
older adults with
prostatic hypertrophy.
ADVERSE EFFECTS NURSING RESPONSIBILITY
GI: 1. Be aware that incidence and severity of adverse
o Dry mouth effects are usually dose related and may be
o Nausea minimized by dosage reduction. Older adults appear
o Constipation more sensitive to usual adult doses.
o Special Senses: 2. Monitor vital signs. Pulse is a particularly sensitive
o Blurred vision indicator of response to drug. Report tachycardia,
o Mydriasis palpitations, paradoxical bradycardia, or fall in BP.
o Photophobia 3. Assess for and report severe CNS stimulation (see
o Angle-closure ADVERSE EFFECTS) that occurs with high doses, and
glaucoma in patients with arteriosclerosis, or those with
Urogenital: history of hypersensitivity to other drugs.
o Urinary hesitancy or 4. In patients with severe rigidity, tremors may appear
retention. to be accentuated during therapy as rigidity
CNS: diminishes.
o Dizziness 5. Monitor daily I&O if patient develops urinary
o Nervousness hesitancy or retention. Voiding before taking drug
o Insomnia may relieve problem.
o Drowsiness 6. Check for abdominal distention and bowel sounds if
o Confusion constipation is a problem.
o Agitation 7. Monitor intraocular pressure at regular intervals.
o Delirium 8. Provide close follow-up care. Tolerance may
o Psychotic develop, necessitating dosage adjustment or use of
manifestations combination therapy. Patients 60 y frequently
o Euphoria develop sensitivity to drug action.
CV:
o Tachycardia Patient & Family Education
o Palpitations 1. Learn measures to relieve drug-induced dry mouth;
o Hypotension rinse mouth frequently with water and suck ice
o Orthostatic chips, sugarless gum, or hard candy. Maintain
hypotension adequate total daily fluid intake.
Body as a Whole: 2. Avoid excessive heat because drug suppresses
o Hypersensitivity perspiration and, therefore, heat loss.
reactions 3. Do not to engage in potentially hazardous activities
requiring alertness and skill. Drug causes dizziness,
drowsiness, and blurred vision. Help walking may be
indicated.
4. Do not breast feed while taking this drug without
consulting physician.
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/T077.html
Czarina Isabela P. Tuazon - BSN 4A
ANTI-CHOLINERGICS
MECHANISM OF
DRUG NAME
Generic Name:  Quaternary
Ipratropium Bromide
Brand Name:
Atrovent
Atrovent HFA
Classifications:
 Autonomic Nervous
System Agent
 Anticholinergic
(parasympatholytic)
 Antimuscarinic
 Bronchodilator  Bronchodilation
INDICATIONS & ADVERSE
NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS EFFECTS
Indications: Special Senses: 1. Monitor respiratory status; auscultate lungs before
compound, chemically  Maintenance therapy in o Blurred vision and after inhalation.
related to atropine, COPD including chronic (especially if 2. Report treatment failure (exacerbation of respiratory
with low solubility; bronchitis and sprayed into eye) symptoms) to physician
does not cross blood– emphysema; nasal spray o Difficulty in
brain barrier. for perennial rhinitis and accommodation Patient & Family Education
Produces local, site- symptomatic relief of o Acute eye pain 1. Note: This medication is not an emergency agent
specific effects on the rhinorrhea associated with o Worsening of because of its delayed onset and the time required to
larger central airways the common cold. narrow-angle reach peak bronchodilation.
including glaucoma 2. Review patient information sheet on proper use of
bronchodilation and Contraindications: GI: nasal spray.
prevention of  Use as primary treatment o Bitter taste 3. Allow 30–60 sec between puffs for optimum results.
bronchospasms. for acute episodes; o Dry oropharyngeal Do not let medication contact your eyes.
hypersensitivity to membranes 4. Wait 5 min between this and other inhaled
inhibits acetylcholine atropine or derivatives. With higher doses: medications. Check with physician about sequence of
at its receptor sites, Safe use in children 3 y is o Nausea administration.
thereby blocking not established. o Constipation 5. Take medication only as directed, noting some
cholinergic Broncho Respiratory: leniency in number of puffs within 24 h. Supervise
motor tone Cautious Use: o Cough child's administration until certain all of dose is being
(bronchoconstriction);  Pregnancy (category B), o Hoarseness administered.
also abolishes vagally lactation o Exacerbation of 6. Rinse mouth after medication puffs to reduce bitter
mediated reflex  Narrow-angle glaucoma symptoms taste.
bronchospasm  Prostatic hypertrophy o Drying of 7. Discuss changes in normal urinary pattern with the
triggered by such  Bladder neck obstruction. bronchial physician (more common in older adults).
nonspecific agents as secretions 8. Call physician if you note changes in sputum color or
cigarette smoke, inert o Mucosal ulcers amount, ankle edema, or significant weight gain.
dusts, cold air, and a o Epistaxis 9. Do not breast feed while taking this drug without
range of inflammatory o Nasal dryness consulting physician.
mediators (e.g., Skin:
histamine). o Rash
o Hives
Urogenital:
o Urinary retention
CNS:
o Headache.
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/I038.html
Czarina Isabela P. Tuazon - BSN 4A
ANTI-CHOLINERGICS
DRUG NAME
Generic Name:
Oxybutynin Chloride
Brand Name
Ditropan
Ditropan XL
Oxytrol
Classifications:
 Autonomic Nervous System
Agent
 Anticholinergic
(parasympatholytic)
 Anti-muscarinic
 Antispasmodic
MECHANISM OF INDICATIONS &
ACTION CONTAINDICATIONS
 Synthetic tertiary Indications:
amine that exerts  To relieve symptoms
direct associated with voiding in
antispasmodic patients with uninhibited
action and inhibits neurogenic bladder and
muscarinic effects reflex neurogenic bladder.
of acetylcholine on Also has been used to
smooth muscle. relieve pain of bladder
 Prominent spasm following
antispasmodic transurethral surgical
activity. procedures.
Contraindications:
 Hypersensitivity of
oxybutynin; narrow angle
glaucoma, myasthenia
gravis, partial or complete
GI obstruction, gastric
retention, paralytic ileus,
intestinal atony
(especially older adult or
debilitated patients),
megacolon, severe colitis,
GU obstruction, urinary
retention, unstable
cardiovascular status.
Cautious Use:
 Older adults; autonomic
neuropathy, hiatus hernia
with reflex esophagitis;
hepatic or renal
dysfunction; urinary
infection;
hyperthyroidism; CHF,
coronary artery disease,
hypertension; prostatic
hypertrophy; pregnancy
(category B), children
<18, lactation.
ADVERSE EFFECTS NURSING RESPONSIBILITY
Body as a Whole: Severe 1. Periodic interruptions of therapy are
allergic reactions recommended to determine patient's need for
including continued treatment. Tolerance has occurred in
o Urticaria some patients.
o skin rashes 2. Keep physician informed of expected responses to
o suppression of drug therapy (e.g., effect on urinary frequency,
lactation urgency, urge incontinence, nocturia,
o decreased sweating completeness of bladder emptying).
o fever 3. Monitor patients with colostomy or ileostomy
CNS: closely; abdominal distension and the onset of
o Drowsiness diarrhea in these patients may be early signs of
o Dizziness intestinal obstruction or of toxic megacolon.
o Weakness
o Insomnia Patient & Family Education
o Restlessness psychotic 1. Do not drive or engage in potentially hazardous
behavior (overdosage) activities until response to drug is known.
CV: 2. Exercise caution in hot environments. By
o Palpitations suppressing sweating, oxybutynin can cause fever
o Tachycardia and heat stroke.
o Flushing 3. Do not breast feed while taking this drug without
o Special Senses: consulting physician.
Mydriasis
o blurred vision,
Cycloplegia
o Increased ocular
tension
GI:
o Dry mouth
o Nausea & vomiting
o Constipation,
o Bloated feeling
Skin:
o Pruritus at application
site
o Rash
o application site vesicle
o erythema
Urogenital: Reference:
o Urinary hesitancy or http://www.robholland.com/Nursing/Drug_Guide
retention, impotence. /data/monographframes/O025.html
Czarina Isabela P. Tuazon - BSN 4A
SEDATIVES & INDUCTION AGENTS

MECHANISM OF INDICATIONS & ADVERSE

DRUG NAME NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS EFFECTS
Generic Name:  Most potent of the Indications: Body as a Whole: 1. Have equipment for maintaining patent airway
Lorazepam available  Management of anxiety o Usually disappear immediately available before starting IV administration.
benzodiazepines. disorders and for short-term with continued 2. IM or IV lorazepam injection of 2–4 mg is usually
Brand Name: Effects (anxiolytic, relief of symptoms of medication or with followed by a depth of drowsiness or sleepiness that
Ativan sedative, hypnotic, anxiety. Also used for reduced dosage. permits patient to respond to simple instructions
and skeletal muscle preanesthetic medication to CNS: whether patient appears to be asleep or awake.
Classifications: relaxant) are produce sedation and to o Anterograde 3. Supervise ambulation of older adult patients for at least
 Central Nervous mediated by the reduce anxiety and recall of amnesia 8 h after lorazepam injection to prevent falling and
System Agent inhibitory events related to day of o Drowsiness injury.
 Anxiolytic neurotransmitter surgery; for management of o Sedation 4. Lab tests: Assess CBC and liver function tests
 Sedative-hypnotic GABA. Action sites: status epilepticus. o Dizziness periodically for patients on long-term therapy.
 Benzodiazepine thalamic, o Weakness 5. Supervise patient who exhibits depression with anxiety
hypothalamic, and Contraindications: o Unsteadiness closely; the possibility of suicide exists, particularly
limbic levels of CNS  Known sensitivity to o Disorientation when there is apparent improvement in mood.
 Antianxiety agent benzodiazepines; acute o Depression
that also causes mild narrow-angle glaucoma; o Sleep disturbance Patient & Family Education
suppression of REM primary depressive restlessness 1. Do not drive or engage in other hazardous activities for
sleep, while disorders or psychosis; o Confusion a least 24–48 h after receiving IM injection of
increasing total sleep children <12 y (PO o Hallucinations. lorazepam.
time. preparation); coma, shock, CV: 2. Do not drink large volumes of coffee. Anxiolytic effects
acute alcohol intoxication; o Hypertension or of lorazepam can significantly be altered by caffeine.
pregnancy (category D), and hypotension 3. Do not consume alcoholic beverages for at least 24–48 h
lactation. o Special Senses: after an injection and avoid when taking an oral
o Blurred vision regimen.
Cautious Use: o Diplopia 4. Notify physician if daytime psychomotor function is
 Renal or hepatic o depressed hearing impaired; a change in regimen or drug may be needed.
impairment; organic brain GI: 5. Terminate regimen gradually over a period of several
syndrome; myasthenia o Nausea & vomiting, days. Do not stop long-term therapy abruptly;
gravis; narrow-angle o abdominal withdrawal may be induced with feelings of panic,
glaucoma; suicidal tendency; discomfort tonic–clonic seizures, tremors, abdominal and muscle
GI disorders; older adult and o anorexia cramps, sweating, vomiting.
debilitated patients; limited 6. Do not self-medicate with OTC drugs; seek physician
pulmonary reserve. guidance.
7. Discuss discontinuation of drug with physician if you
wish to become pregnant.
8. Do not breast feed while taking this drug.

Reference:
http://www.robholland.com/Nursing/Drug_Guide/
data/monographframes/L041.html

Czarina Isabela P. Tuazon - BSN 4A

SEDATIVES & INDUCTION AGENTS
MECHANISM OF INDICATIONS &
DRUG NAME
ACTION CONTAINDICATIONS
Generic Name:  Psychotherapeutic Indications:
Diazepam agent related to  Drug of choice for status
chlordiazepoxide; epilepticus. Management of
Brand Name: reportedly superior anxiety disorders, for short-
Valium in antianxiety and term relief of anxiety
Diastat anticonvulsant symptoms, to allay anxiety and
activity, with tension prior to surgery,
Classifications: somewhat shorter cardioversion and endoscopic
 Central duration of action. procedures, as an amnesic, and
Nervous Like treatment for restless legs. Also
System Agent chlordiazepoxide, it used to alleviate acute
 Benzodiazepine appears to act at withdrawal symptoms of
 Anticonvulsant both limbic and alcoholism, voiding problems in
 Anxiolytic subcortical levels of older adults, and adjunctively
CNS. for relief of skeletal muscle
 Shortens REM and spasm associated with cerebral
stage 4 sleep but palsy, paraplegia, athetosis,
increases total sleep stiff-man syndrome, tetanus.
time. Antianxiety
and anticonvulsant Contraindications:
agent.  Injectable form: Shock, coma,
acute alcohol intoxication,
depressed vital signs,
obstetrical patients, infants <30
d of age. Tablet form: Infants <6
mo of age, acute narrow-angle
glaucoma, untreated open-
angle glaucoma; during or
within 14 d of MAO inhibitor
therapy. Safe use during
pregnancy (category D) and
lactation is not established.
Cautious Use
 Epilepsy, psychoses, mental
depression; myasthenia gravis;
impaired hepatic or renal
function; drug abuse, addiction-
prone individuals. Injectable
diazepam used with extreme
caution in older adults, the very
ill, and patients with COPD.
ADVERSE EFFECTS NURSING RESPONSIBILITY
Body as a Whole: 1. Monitor for adverse reactions. Most are dose related.
o Throat and chest pain. Physician will rely on accurate observation and reports
CNS: of patient response to the drug to determine lowest
o Drowsiness, fatigue effective maintenance dose.
o Ataxia 2. Monitor for therapeutic effectiveness. Maximum effect
o Confusion ,Paradoxical may require 1–2 wk; patient tolerance to therapeutic
rage effects may develop after 4 wk of treatment.
o Dizziness ,Vertigo 3. Observe necessary preventive precautions for suicidal
o Amnesia tendencies that may be present in anxiety states
o Vivid dreams ,Headache accompanied by depression.
o Slurred speech ,tremor 4. Observe patient closely and monitor vital signs when
o EEG changes diazepam is given parenterally; hypotension, muscular
o tardive dyskinesia weakness, tachycardia, and respiratory depression may
CV: occur.
o Hypotension 5. Lab tests: Periodic CBC and liver function tests during
o Tachycardia prolonged therapy.
o Edema, Cardiovascular 6. Supervise ambulation. Adverse reactions such as
collapse. drowsiness and ataxia are more likely to occur in older
Special Senses: adults and debilitated or those receiving larger doses.
o Blurred vision Dosage adjustment may be necessary.
o Diplopia 7. Monitor I&O ratio, including urinary and bowel
o Nystagmus elimination.
GI: 8. Note: Smoking increases metabolism of diazepam;
o Xerostomia lowering clinical effectiveness. Heavy smokers may need
o Nausea ,Constipation a higher dose than the nonsmoker.
o Hepatic dysfunction 9. Note: Psychic and physical dependence may occur in
Urogenital: patients on long-term high dosage therapy, in those with
o Incontinence histories of alcohol or drug addiction, or in those who
o Urinary retention self-medicate.
o Gynecomastia Patient & Family Education
(prolonged use) 1. Avoid alcohol and other CNS depressants during
o Menstrual irregularities therapy unless otherwise advised by physician.
& Ovulation failure Concomitant use of these agents can cause severe
Respiratory: drowsiness, respiratory depression, and apnea.
o Hiccups & coughing 2. Do not drive or engage in other potentially hazardous
o Laryngospasm activities or those requiring mental precision until
Other: reaction to drug is known.
o Pain 3. Do not breast feed while taking this drug without
o Venous thrombosis consulting physician.
o Phlebitis at injection
site. Reference:
http://www.robholland.com/Nursing/Drug_Guide/
data/monographframes/D033.html
Czarina Isabela P. Tuazon - BSN 4A
SEDATIVES & INDUCTION AGENTS

MECHANISM OF INDICATIONS &

DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name:  Long-acting Indications: Body as a Whole: 1. Observe patients receiving large doses closely for at least
Phenobarbital barbiturate.  Long-term management of o Myalgia 30 min to ensure that sedation is not excessive.
Sedative and tonic-clonic (grand mal) o Neuralgia 2. Keep patient under constant observation when drug is
Brand Name: hypnotic effects of seizures and partial o CNS Depression administered IV, and record vital signs at least every hour
Luminal barbiturates appear seizures; status epilepticus, o Coma, and death. or more often if indicated.
to be due primarily eclampsia, febrile CNS: 3. Monitor serum drug levels. Serum concentrations >50
Classifications: to interference with convulsions in young o Somnolence, nightmares, mcg/mL may cause coma. Therapeutic serum
 Central impulse children. Also used as a insomnia, "hangover," concentrations of 15–40 mcg/mL produce anticonvulsant
Nervous transmission of sedative in anxiety or headache, anxiety, activity in most patients. These values are usually attained
System Agent cerebral cortex by tension states; in pediatrics thinking abnormalities, after 2 or 3 wk of therapy with a dose of 100–200 mg/d.
 Anticonvulsant inhibition of as preoperative and dizziness, nystagmus, 4. Expect barbiturates to produce restlessness when given to
 Sedative- reticular activating postoperative sedation and irritability, paradoxic patients in pain because these drugs do not have analgesic
hypnotic system. CNS to treat pylorospasm in excitement and action.
 Barbiturate depression may infants. exacerbation of 5. Be prepared for paradoxical responses and report
range from mild hyperkinetic behavior (in promptly in older adult or debilitated patient and children
sedation to coma, Contraindications: children); confusion or [i.e., irritability, marked excitement (inappropriate
depending on  Sensitivity to barbiturates; depression or marked tearfulness and aggression in children), depression, and
dosage, route of manifest hepatic or familial excitement (older adult or confusion].
administration, history of porphyria; debilitated patients); 6. Monitor for drug interactions. Barbiturates increase the
degree of nervous severe respiratory or ataxia. metabolism of many drugs, leading to decreased
system excitability, kidney disease; history of CV: pharmacologic effects of those drugs. Whenever a
and drug tolerance. previous addiction to o Bradycardia, syncope, barbiturate is added to an established regimen of another
Initially, sedative hypnotics; hypotension. GI: Nausea, drug, observe for changes in effectiveness of the first drug
barbiturates uncontrolled pain; vomiting, constipation, at least during early phase of barbiturate use.
suppress REM sleep, pregnancy (particularly diarrhea, epigastric pain, 7. Monitor for and report chronic toxicity symptoms (e.g.,
but with chronic early pregnancy) (category liver damage. ataxia, slurred speech, irritability, poor judgment, slight
therapy REM sleep D), lactation; sustained Hematologic: dysarthria, nystagmus on vertical gaze, confusion,
returns to normal. release formulation for Megaloblastic anemia, insomnia, somatic complaints).
 Produces sedative children <12 y of age. agranulocytosis, Patient & Family Education
and hypnotic effects thrombocytopenia. 1. Be aware that anticonvulsant therapy may cause
with no analgesic Cautious Use Metabolic: Hypocalcemia, drowsiness during first few weeks of treatment, but this
properties, and  Impaired liver, kidney, osteomalacia, rickets. usually diminishes with continued use.
small doses may cardiac, or respiratory Musculoskeletal: 2. Do not consume alcohol in any amount when taking a
increase reaction to function; history of o Folic acid deficiency, barbiturate; it may severely impair judgment and abilities.
painful stimuli. allergies; older adult or vitamin D deficiency. 3. Increase vitamin D-fortified foods (e.g., milk products)
Phenobarbital limits debilitated patients; Respiratory: Respiratory because drug increases vitamin D metabolism. A vitamin D
spread of seizure patients with fever; depression. supplement may be prescribed.
activity by hyperthyroidism; diabetes Skin: 4. Do not stop taking drug abruptly because of danger of
increasing threshold mellitus or severe anemia; o Mild maculopapular, withdrawal symptoms (8–12 h after last dose), which can
for motor cortex during labor and delivery; morbilliform rash; be fatal.
stimuli. Barbiturates patient with borderline erythema multiforme, 5. Do not breast feed while taking this drug.
are habit forming. hypoadrenal function. Stevens-Johnson Reference:
syndrome, exfoliative http://www.robholland.com/Nursing/Drug_Guide
dermatitis (rare). /data/monographframes/P037.html

Czarina Isabela P. Tuazon - BSN 4A

SEDATIVES & INDUCTION AGENTS
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name:  Synthetic, water- Indications: Body as a Whole: 1. Start flow charts to record maternal BP and other
Oxytocin soluble  To initiate or improve uterine contraction o Fetal trauma from too vital signs, I&O ratio, weight, strength, duration,
polypeptide at term only in carefully selected patients rapid propulsion and frequency of contractions, as well as fetal
Brand Name: consisting of eight and only after cervix is dilated and through pelvis, fetal heart tone and rate, before instituting treatment.
Pitocin amino acids, presentation of fetus has occurred; used to death, anaphylactic 2. Monitor fetal heart rate and maternal BP and
Syntocinon identical stimulate letdown reflex in nursing reactions, postpartum pulse at least q15min during infusion period;
pharmacologically mother and to relieve pain from breast hemorrhage, evaluate tonus of myometrium during and
Classifications: to the oxytocic engorgement. Uses include management precordial pain, between contractions and record on flow chart.
 Hormones principle of of inevitable, incomplete, or missed edema, cyanosis or Report change in rate and rhythm immediately.
and synthetic posterior abortion; stimulation of uterine redness of skin. 3. Stop infusion to prevent fetal anoxia, turn patient
substitutes pituitary. contractions during third stage of labor; CV: on her side, and notify physician if contractions
 Oxytocic  By direct action stimulation to overcome uterine inertia; o Fetal bradycardia and are prolonged (occurring at less than 2-min
on myofibrils, control of postpartum hemorrhage and arrhythmias, maternal intervals) and if monitor records contractions
produces phasic promotion of postpartum uterine cardiac arrhythmias, about 50 mm Hg or if contractions last 90 seconds
contractions involution. Also used to induce labor in hypertensive episodes, or longer. Stimulation will wane rapidly within 2–
characteristic of cases of maternal diabetes, preeclampsia, subarachnoid 3 min. Oxygen administration may be necessary.
normal delivery. eclampsia, and erythroblastosis fetalis. hemorrhage, 4. If local or regional (caudal, spinal) anesthesia is
Promotes milk increased blood flow, being given to the patient receiving oxytocin, be
ejection Contraindications: fatal afibrinogenemia, alert to the possibility of hypertensive crisis
(letdown) reflex  Hypersensitivity to oxytocin; significant ECG changes, PVCs, (sudden intense occipital headache, palpitation,
in nursing cephalopelvic disproportion, unfavorable cardiovascular spasm marked hypertension, stiff neck, nausea, vomiting,
mother, thereby fetal position or presentations that are and collapse. sweating, fever, photophobia, dilated pupils,
increasing flow undeliverable without conversion before GI: bradycardia or tachycardia, constricting chest
(not volume) of delivery, obstetric emergencies in which o Neonatal jaundice, pain).
milk; also benefit-to-risk ratio for mother or fetus maternal nausea, 5. Monitor I&O during labor. If patient is receiving
facilitates flow of favors surgical intervention, fetal distress vomiting. Endocrine: drug by prolonged IV infusion, watch for
milk during in which delivery is not imminent, ADH effects leading symptoms of water intoxication (drowsiness,
period of breast prematurity, placenta previa, prolonged to severe water listlessness, headache, confusion, anuria, weight
engorgement. use in severe toxemia or uterine inertia, intoxication and gain). Report changes in alertness and orientation
Uterine sensitivity hypertonic uterine patterns, previous hyponatremia, and changes in I&O ratio (i.e., marked decrease in
to oxytocin surgery of uterus or cervix including hypotension. output with excessive intake).
increases during cesarean section, conditions predisposing CNS: 6. Check fundus frequently during the first few
gestation period to thromboplastin or amniotic fluid o Fetal intracranial postpartum hours and several times daily
and peaks sharply embolism (dead fetus, abruptio hemorrhage, anxiety. thereafter.
before placentae), grand multiparity, invasive Respiratory: Fetal Patient & Family Education
parturition. Not cervical carcinoma, primipara >35 y of hypoxia, maternal 1. Be aware of purpose and anticipated effect of
used for elective age, past history of uterine sepsis or of dyspnea. oxytocin.
induction of labor. traumatic delivery, intranasal route during Urogenital: 2. Report sudden, severe headache immediately to
labor, simultaneous administration of o Uterine hypertonicity, healthcare providers.
drug by two routes. tetanic contractions,
uterine rupture, pelvic
Cautious Use: hematoma. Reference:
 Concomitant use with cyclopropane http://www.robholland.com/Nursing/Drug_Guide
anesthesia or vasoconstrictive drugs. /data/monographframes/O031.html

Czarina Isabela P. Tuazon - BSN 4A

SEDATIVES & INDUCTION AGENTS

MECHANISM OF INDICATIONS &

DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name:  Synthetically Indications: CNS: 1. Observe patient carefully, after insertion of the drug.
Dinoprostone prepared member To terminate pregnancy from o Headache, Rupture of the membranes is not a contraindication to
of the twelfth week through second o Tremor, drug, but be aware that profuse bleeding may result in
Brand Name: prostaglandin E2 trimester as calculated from o Tension. expulsion of the suppository. Report wheezing, chest pain,
Cervidil series that appears first day of last regular CV: dyspnea, and significant changes in BP and pulse to the
Prepidil to act directly on menstrual period; to evacuate o Transient physician.
myometrium and uterine contents in o Hypotension, 2. Monitor uterine contractions and observe for and report
Classifications: on gastrointestinal, management of missed o Flushing, excessive vaginal bleeding and cramping pain. Keep pad
 Hormones and bronchial, and abortion or intrauterine fetal o Cardiac arrhythmias. count. Save all clots and tissues for physician inspection
Synthetic vascular smooth death up to 28 wk gestational GI: and laboratory analysis.
substitutes muscle. age; to manage benign o Nausea, 3. Abortion usually occurs within 30 h. When used in
 Prostaglandin Stimulation of hydatidform mole; cervical o Vomiting, conjunction with oxytocin, time may be shortened to 12–
 Oxytocic gravid uterus in ripening prior to labor o Diarrhea. 14 h.
early weeks of induction. Urogenital: 4. Monitor vital signs. Fever is a physiologic response of the
gestation is more o Vaginal pain, hypothalamus to use of dinoprostone and occurs within
potent than that of Contraindications o Endometritis, 15–45 min after insertion of suppository. Temperature
oxytocin.  Acute pelvic inflammatory o Uterine rupture. returns to normal within 2–6 h after discontinuation of
 Contractions are disease, history of pelvic Respiratory: medication.
qualitatively surgery, uterine fibroids, o Dyspnea,
similar to those cervical stenosis, active o Cough, Patient & Family Education
that occur during cardiac, pulmonary, renal, o Hiccups. 1. Continue taking your temperature (late afternoon) for a
term labor. Has or hepatic disease, Body as a Whole: few days after discharge. Contact physician with onset of
high success rate pregnancy (category C). o Chills fever, bleeding, abdominal cramps, abnormal or foul-
when used as o Fever smelling vaginal discharge.
abortifacient Cautious Use o Dehydration, 2. Avoid douches, tampons, intercourse, and tub baths for at
before twentieth  History of hypertension, o Diaphoresis, rash. least 2 wk. Clarify with physician.
week and for hypotension, asthma, 3. Note: Dinoprostone may exacerbate joint pain and
stimulation of epilepsy, anemia, diabetes limitation due to its effect on the inflammatory process.
labor in cases of mellitus; jaundice, history
intrauterine fetal of hepatic, renal, or
death. cardiovascular disease;
cervicitis, acute vaginitis,
infected endo-cervical
lesion.

Reference:
http://www.robholland.com/Nursing/Drug_Guide/data/m
onographframes/D053.html

Czarina Isabela P. Tuazon - BSN 4A