Download Post-Operative Care II

Common Peri-Operative
Medications
Respiratory Depression
 Sarah is a 35 year old female, who underwent GI
surgery this morning. She received 5 mg of
morphine IV in recovery and is now on your unit.
Twenty minutes after admission, you check on her
to find that she is unresponsive to verbal stimuli.
Her vitals are normal but breathing is 6 breaths per
minute. What do you do?
Treatment of Narcotic Overdose
 Try to awaken pt
Recount RR
 If conts to be low:
 Call MD(if no standing order)
 naloxone hydrochloride (Narcan)
 Repeat dosages as ordered
Naloxone hydrochloride
 Trade Name - Narcan
 Reverses all effects of narcotics
 How?
Atropine
 Now Sarah is fully awake and breathing normally. But
she complains to you that her mouth is very dry and
she is thirsty. Providing that she isn’t dehydrated,
what explanation would you give to Sarah?
.
 She was given Atropine prior to surgery
 It causes drying of the mouth
 How to treat:
 Mouth swabs
 Ice chips or wet cloth for mucus membranes
Atropine
 An anticholinergic drug
 Blocks effect of acetylcholine (ACH)
Acetylcholine
 Excreted by the
Parasympathetic system
 The caretaker system in
charge when all is quiet:





Heart beats slowly
GI tract is active
Bladder constricts
Pupils constrict
Digestive juices (think of
saliva)
 ACH = cholinergic.
 Drugs that prevent ACH from doing
it’s work are called “anticholinergics.”
(Atropine)
These drugs reverse the effect of
ACH
 Everyday functions are blocked:
 Heart beats faster
 GI tract slows down
 Bladder relaxes
 Pupils dilate
 Digestive juices 
Why Atropine Pre-Op?
 All of these effects help a patient to better tolerate
surgery:
 prevents slowing of heart
 dries secretions
 interferes with voiding, slows peristalsis, dilates bronchi
Case Study - Promethazine
Hydrochloride (Phenergan)
 Sarah appreciates all your explanations so far. But she
has one more thing to tell you – she is feeling
nauseated and it’s gotten worse since an hour ago.
Could she please have something for the nausea?
N & V triggered by:
 GI tract sends “irritation”
messages to the
“Vomiting Center”
 “dopamine” transmits
the “vomit stimulus” in
the vomiting center of
the medulla.
 Must block dopamine to
decrease N & V.
Phenergan:
• Blocks release of dopamine
 Is also an antihistamine –
 blocks H2 receptors in the stomach
 Result: Stims
__________
gastric acid
 Induces light sleep
 Decreases anxiety
Other Antiemetics
 Compazine (blocks dopamine)
 Metochlopramide - Reglan
 Zofran (selective
serotonin receptor
antagonist)




Serotonin released from
wall of small intestine
Stimulates vagal nerve
Initiates vomiting reflex
Used to prevent N/V in
post-op patients
Diazepam - Valium
 Tory is a 32 year old female undergoing surgery today
for a breast biopsy. When you enter the room with her
pre-op diazepam, 5 mg, po, she states, “My mother
was addicted to Valium, I’d rather not take it.” What
should be your response?
a. You are concerned about becoming addicted to
Valium.
b. Don’t be silly. Just because your mother was
addicted you think you’ll become addicted?
c. You can’t become addicted to Valium.
d. We really don’t have time to talk about this.
Diazepam - Valium
 Benzodiazepine family
 Used as a sedative or an antianxiety agent, status
epilepticus, muscle relaxation
 Also used for induction of anesthesia
Bethanechol - Urecholine
 Mr. Jones has undergone surgery for removal of
kidney stone today. As he returns from surgery you
note on the doctor’s orders an order for bethanechol.
Why would the doctor order this medication for Mr.
Jones?
Bethanechol (Urecholine)
 It increases ACH in
the body.
 Has the opposite
effect of Atropine
Bethanechol
 For urinary retention
 At normal doses, can cause excessive salivation,
increased secretion of gastric acid, abdominal cramps
and diarrhea
Meperidine - Demerol
 Narcotic used for pain
 Side effects:
 Respiratory depression
 Orthostatic hypotension
 Cough suppresant
 Constipation
 Urinary retention
 Epigastric distress
 ICP elevation