Transcript PowerPoint Chapter 11

SURGICAL PATIENT PHARMACOLOGY
ALLERGY AND RESPIRATORY MEDICATIONS
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
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 alveoli
Copyright © 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 CNS
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
3
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
4
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. )
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
5
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
6
ANTI-HISTAMINE DRUGS
• First Generation – usually OTC, crosses blood-brain
barrier, sedative effect
• Dimetapp, Chlor-Trimeton, Benadryl, Banophen,
Phernergan
Second Generation – most available by
prescription, some OTC, rapid onset, do not cross
blood-brain barrier, do not cause excessive
sedation
Zyrtec, Periactin, Allegra, Allergra D, Claritin,
Claritin D
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
7
CHAPTER 16 -ANTIEMETICS
Action
Inhibit 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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
8
ANTIEMETIC-ANTIVERTIGO AGENTS
(CONT.)
Adverse Reactions
• Drowsiness and drug tolerance with longterm 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,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
9
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
medications
Diagnosis – what other considerations vomiting
may indicate – nutrition, electrolyte imbalance
Planning – educate patient on sedation effect
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
10
ANTIEMETIC/ANTIVERTIGO AGENTS
Compazine
Reglan
Dramamine
Benadryl
Antivert
Marinol
Scopolamine transdermal patch
Zofran
11
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 substances
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
12
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
13
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
14
Ch 17 – Analgesics
Opiod & Non-Narcotic
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
15
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
16
OPIOIDS (CONT.)
Agonist
• Binds with the receptor(s) to activate and
produce the maximum response of the
individual receptor
Partial agonist
• Produces a partial response
Agonist-antagonist
• Acts as an agonist at one type of receptor and
as a competitive antagonist at another type of
receptor
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
17
OPIOIDS (CONT.)
Morphine
• Uses
• Acute care
• Hospice
Codeine, hydrocodone, oxycodone
• Uses
• Office or clinical setting
Hydromorphone
• Uses
• Severe pain unrelieved by morphine
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
18
WONG-BAKER FACES PAIN RATING
SCALE
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
19
PAIN (CONT.)
Tolerance
• The same amount of a drug produces a decreased
effect over time
Dependence
• A state in which the body will show withdrawal
symptoms if the drug is stopped or reduced
Addiction
• The uncontrollable need to have and use a drug
for nonmedical reasons
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
20
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
21
NARCOTIC AGONIST ANALGESICS
(CONT.)
Adverse Reactions
• Bradycardia, slowed breathing
• Hypotension, fainting
• Anorexia, constipation
• Confusion, euphoria
• Dry mouth, vomiting
• Pruritus, skin rash
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
22
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
23
NARCOTIC AGONIST ANALGESICS
(CONT.)
Drug Interactions
• Many drugs increase or decrease effects
Nursing Implications
Patient Teaching
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
24
NARCOTIC AGONIST-ANTAGONIST
ANALGESICS
Action
• Act on chemicals at specific nerve sites in the CNS,
possibly in the limbic system
• Produce analgesia, euphoria, and respiratory and
physical depression
Uses
• Relief of moderate to severe pain
• Presurgical anesthesia
• Active labor
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
25
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
26
NARCOTIC AGONIST-ANTAGONIST
ANALGESICS (CONT.)
Drug Interactions
• Caution with alcohol and CNS depressants
• Nursing Implications
• Patient Teaching
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
27
NONNARCOTIC CENTRALLY ACTING
ANALGESICS
Action
• Act at the level of the brain to control mild or
moderate pain
Uses
• Mild to moderate pain
• Used in combination products for pain alone or
when pain and fever are present
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
28
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
29
NONNARCOTIC CENTRALLY
ACTING ANALGESICS (CONT.)
• Drug Interactions
• Nursing Implications
• Patient Teaching
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
30
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
31
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
32
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
Copyright © 2013, 2010, 2006, 2003,
2000, 1995, 1991 by Mosby, an imprint
of Elsevier Inc.
33