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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