Drug Oxytoxin

Classification Oxytocic

Pharmakokinetics Absorption: Well absorbed from the nasal mucosa Distribution: Widely distributed in extracellular fluid. Small amounts reach fetal circulation. Metabolism and Excretion: Rapidly metabolized by liver and kidneys Half-life: 39min. TIME/ACTION PROFILE (IV = uterine contractions; intranasal = milk letdown)

Indication y To stimulate uterine contraction and improve uterine tonus in induction of labour y Treatment of postpartum hemorrhage y Termination of pregnancy during the second trimester y Treatment of uterine atony following abortion

Side Effects y Anaphylactic reaction y Postpartum hemorrh age y Cardiac arrhythmia y Fatal y Afibrinogenemia y Hypertensive episod e y Nausea y Vomiting y Premature ventricula r contractions y Pelvic hematoma y Subarachnoid hemorrhage y Hypertensive episodes y Rupture of the uterus y y y y y y y y Constipation Dizziness Drowsiness Headache mild nervousness nausea trouble sleeping vomiting.

Nursing Responsibilities y Monitor the duration and intensity of contractions y Monitor blood pressure and pulse, fetal heart rate y Advise the prescriber if nausea and vomiting happens.

Phenytoin

Anticonvulsantantiarrhythmic diphenyl hydantoin

Absorption: Well absorbed following IM administration. Distribution: Unknown. Metabolism and Excretion: 10% excreted unchanged by kidneys Half-life: Unknown.

y Treatment of status epilepticus, and control /prevention of seizures y Treatment of ventricular arrhythmias due to digoxin in persons refractory or hypersensitive to conventional therapy

y Patient should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, drowsiness, or confusion. y This drug may decrease effectiveness of oral contraceptives with concurrent use. Recommend additional form of birth

control. y This drug may cause constipation, gingival hyperplasia, nausea. Vomiting, atxia, choreoathetosis, slurred speech and nervousness. y Tell patient to report signs and symptoms of pancytopenia, nephrotoxicity, hepatotoxicity, or systematic lupus erythamatosus. y Patient should report signs and symptoms of a severe skin reaction such as Stevens-Johnson syndrome (flu-like symptoms, spreading red rash, or skin/mucous membrane blistering) or toxic epidermal necrolysis (widespread peeling/blistering of skin) y Patient should not drink alcohol while taking this drug, as this may affect the blood level of phenytoin. Phenobarbital Anticonvulsant, Sedative/ Hypnotics Absorption: Absorption is slow but relatively complete (7090%). y Anticonvulsant in tonicclonic (grandmal), partial, and febrile y Somnolence y Syncope y Erythroderma y Patient should avoid activities requiring mental alertness or

Distribution: Unknown. Metabolism and Excretion: 75% metablized by the liver, 25% excreted unchanged by the kidneys. Half-life: Neonates: 1.8 8.3 days; Infants: 0.8 5.5 days; Children: 1.5 3 days; Adults: 26 days.

seizures in children. Preoperative sedative and in other situations in which sedation may be required. Hypnotic (short term). Unlabeled uses: Prevention/treatment of hyperbilirubinemia in neonates.

y Megaloblastic anemia y Liver damage y Immune hypersensitivity reaction y Hallucinations y Barbiturate withdrawal

coordination until drug effects are realized, as drug may cause dizziness, light headedness, or somnolence. y Instruct patient to report sign and symptoms of withdrawal upon dose reduction or discontinuation y Patients should not increase phenobarbital dose unless instructed by health care professional y Advise patient against sudden discontinuation of drug. y Patient should avoid activities requiring mental alertness or coordination until drug effects are realized. y Elderly and debilitated patients are especially sensitive to adverse effects. y Patients receiving extended diazepam therapy should avoid abrupt discontinuation of drug in order to prevent withdrawal symptoms. y Patients should not

Diazepam

Antianxiety agents, anticonvulsant, sedative/hypnot ics, skeletal muscle relaxants (centrally acting)

Absorption: Rapidly absorbed from the GI tract. Absorption from IM sites may be slow and unpredictable. Well absorbed (90%) from rectal mucosa Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta; enters breast milk. Metabolism and Excretion: Highly

y Adjunct in the management of: Anxiety Disorder, Athetosis, Anxiety relief prior to cardioversion (injection), Stiffman Syndrome, Preoperative sedation, Conscious sedation (provides light anesthesia and anterograde amnesia). Treatment of status epilepticus/uncontrolled seizures (injection). Skeletal muscle relaxant. Management of the symptoms of alcohol

y y y y y y y y y

Hypotension Rash Diarrhea Muscle weakness Ataxia, incoordination Euphoria Respiratory depression Fatigue Neutropenia

metabolized by the liver. Some products of metabolism are active as CNS depressants. Half-life: Neonates: 50 95 hr; Infants 1 month 2 yr: 4050 hr; Children 212 yr: 15-21 hr; Children 1216 yr: 18 20 hr; Adults: 2050 hr (up to 100 hr for metabolites). Midazolam antianxiety agents, sedative/hypnot ics Absorption: Rapidly absorbed following oral and nasal administration; undergoes substantial intestinal and first-pass hepatic metabolism. Well absorbed following IM administration; IV administration results in complete bioavailability. Distribution: Crosses the blood-brain barrier and placenta. Protein Binding: 97%. Metabolism and Excretion: Almost exclusively metabolized by the liver, resulting in conversion to hydroxymidazolam, an active metabolite, and 2 other inactive

withdrawal. Unlabeled uses: Anxiety associated with acute myocardial infarction, insomnia

drink alcohol while taking this drug.

y PO: Preprocedural sedation and anxiolysis in pediatric patients. y IM, IV: Preoperative sedation/anxiolysis/amn esia. y IV: Provides sedation/anxiolysis/amn esia during therapeutic, diagnostic, or radiographic procedures (conscious sedation). Aids in the induction of anesthesia and as part of balanced anesthesia. As a continuous infusion, provides sedation of mechanically ventilated patients during anesthesia or in a critical care setting, Status epilepticus.

y Excessive somnolence y Headache y Hiccoughs y Cardiac arrest y Involuntary movement y Agitation y Apnea

y Advise patient not to drive for 24 to 48 hours after receiving this drug, as there may be residual sedative and amnestic effects. y Review postprocedure instructions with patients family and give a copy in writing, as transient amnestic effects may occur even if patient seems alert. y Instruct patient to avoid alcohol or other CNS depressants until at least 24 hours after drug therapy, as concomitant use increase risk of sedation or respiratory depression.

metabolites(metabolized by cytochrome P450 3A4 enzyme system); metabolites are excreted in urine. Half-life: Pretermneonates: 2.6 17.7 hr; Neonates: 412 hr; Children: 37 hr; Adults: 26 hr (increased in renal impairment, CHF, or cirrhosis). Morphine Opioid analgesics Absorption: Variably absorbed (about 30%) following oral administration. More reliably absorbed from rectal, subcut, and IM sites. Following epidural administration, systemic absorption and absorption into the intrathecal space via the meninges occurs. Distribution: Widely distributed. Crosses the placenta; enters breast milk in small amounts. Protein Binding: Premature infants: <20%; Adults: 35%. Metabolism and Excretion: Mostly metabolized by the liver. Severe pain. Pulmonary edema. Pain associated with MI. y y y y y y y y y y y y y y y y y y Peripheral edema Pruritus Sweating Abdominal pain Constipation Loss of appetite Nausea and vomiting Xerostomia Liver function test abnormal Backache Dizziness Insomnia Paresthesia Somnolence Anxiety Urinary retention Fever Hiccoughs y Patient should avoid activities requiring mental alertness or coordination until drug effects are realized. y Tell patient to report signs and symptoms of respiratory depression, ineffective pain control, excessive sedation, hypotension, constipation, or urinary retention. y Advise patient using morphine for long periods of time against sudden discontinuation of drug. y Patient should not use additional CNS depressants while taking this drug.

Active metabolites excreted renally Half-life: Premature neonates: 1020 hr; Neonates: 7.6 hr; Infants 13 mo: 6.2 hr; Children 6mo2.5 yr: 2.9 hr; Children 36 yr: 12 hr; Children 619 yr with sickle cell disease: 1.3 hr; Adults: 24 hr. Nalbuphine Opioid analgesics Absorption: Well absorbed after IM and subcut administration. Distribution: Probably crosses the placenta and enters breast milk. Metabolism and Excretion: Mostly metabolized by the liver and eliminated in the feces via biliary excretion. Minimal amounts excreted unchanged by the kidneys. Half-life: 5 hr. y Moderate to severe pain. Also provides: Analgesia during labor, Sedation before surgery, Supplement to balanced anesthesia. y Diaphoresis y Nausea and vomiting y Xerostomia y Dizziness y Headache y Vertigo y Immune hypersensitivity reaction y Loss of consciousness y Seizure y Pulmonary edema y Respiratory depression y Patient should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness or sedation. y Patient should report depression y Advise patient against sudden discontinuation of drug. y If self-administered, teach patient proper technique and placement of injections. y Advise patient to rotate injection sites y Patient should not use alcohol or other CNS depressants s y Instruct patient to take extra care to avoid injury of body areas that are numbed by

Lidocaine Polyampule

Anesthetics topical/local, anti arrhythmics

Absorption: Well absorbed after administration into the deltoid muscle;

y IV: Ventricular arrhythmias. y IM: Self-injected or when IV unavailable (during

y CNS: SEIZURES, confusion, drowsiness, blurred vision, dizziness,

some absorption follows local use. Distribution: Widely distributed. Concentrates in adipose tissue. Crosses the blood-brain barrier and placenta; enters breast milk Metabolism and Excretion: Mostly metabolized by the liver; <10% excreted in urine as unchanged drugs. Half-life: Biphasic initial phase, 730min; terminal phase, 90120 min; increased in CHF and liver impairment.

transport to hospital facilities). y Local: Infiltration/mucosal/topic al anesthetic. y Patch: Pain due to posther-petic neuralgia.

y y y

nervousness, slurred speech tremor. EENT: mucosal use decreased or absent gag reflex. CV: CARDIAC ARREST, arrhythmias, bradycardia, heart block, hypotension GI: nausea, vomiting. Resp: bronchospasm. Local: stinging, burning, contact dermatitis, erythema. Misc: allergic reactions, including AN PHYLAXIS.

lidocaine. Patient should avoid scratching, rubbing, or applying extreme temperatures until body area sensation returns. y Instruct patients to report signs/symptoms of lidocaine or prilocaine toxicity, seizures, difficulty breathing, coma, or cardiac dysrhythmia