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;
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/E055.html
LOCAL ANESTHETICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITIES
ACTION CONTRAINDICATIONS
Generic Name: Decreases sodium flux Indications: CNS: 1. Be aware that reactions during dental procedure
Procaine Hydrochloride into nerve cell, thus Spinal anesthesia and o Anxiety, are usually mild, transient, and produced by
depressing initial epidural and peripheral o nervousness, epinephrine added to local anesthetic (e.g.,
Brand Name: depolarization and nerve block by injection and o dizziness, headache, palpitation, tachycardia, hypertension,
Novocain preventing propagation infiltration methods. o circumoral paresthesia, dizziness).
and conduction of the o tremors, 2. Use procaine with epinephrine with caution in
Classifications: nerve impulse. Contraindications: o drowsiness, body areas with limited blood supply (e.g.,
Central Nervous Local anesthetic action Known hypersensitivity to o sedation, fingers, toes, ears, nose). If used, inspect
System agent produces loss of procaine or to other drugs of o convulsions, particular area for evidence of reduced perfusion
Local anesthetic sensation and motor similar chemical structure, o respiratory arrest. (vasospasm): Pale, cold, sensitive skin.
(ester-type) activity in to PABA, and to parabens; With spinal anesthesia: 3. Hypotension is the most important complication
circumscribed areas of generalized septicemia, o postspinal headache, of spinal anesthesia. Risk period is during first 30
the body close to the inflammation, or sepsis at o arachnoiditis, min after induction and is intensified by changes
injection or application proposed injection site; o palsies, in position that promote decreased venous
site. cerebrospinal diseases (e.g., o spinal nerve paralysis, return, or by preexisting hypertension,
meningitis, syphilis); heart o meningism. pregnancy, old age, or hypovolemia.
block, hypotension, Special Senses:
hypertension; bowel o Tinnitus, Patient & Family Education
pathology, GI hemorrhage. o blurred vision. 1. Understand that that there will be temporary
Safety during early CV: loss of sensation in the area of the injection.
pregnancy (category C) or o Myocardial depression, 2. Do not consume hot liquids or foods until
lactation is not established. o arrhythmias including sensation returns when drug used for dental
bradycardia (also fetal procedure.
Cautious Use bradycardia);
Debilitated, older adults, or o hypotension.
acutely ill patients; obstetric GI:
delivery; increased o Nausea & vomiting.
intraabdominal pressure; Skin:
known drug allergies and o Cutaneous lesions of
sensitivities, dysrhythmias; delayed onset,
shock. urticaria, pruritus,
angioneurotic edema, Reference:
sweating, syncope, http://www.robholland.com/Nursing/Drug_Guide
anaphylactoid reaction. /data/monographframes/P079.html
Urogenital:
o Urinary retention, fecal
or urinary
incontinence, loss of
perineal sensation and
sexual function,
slowing of labor
ANTI-CHOLINERGICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name: Synthetic tertiary Indications: GI: 1. Be aware that incidence and severity of adverse
Trihexyphenidyl amine anticholinergic Symptomatic treatment o Dry mouth effects are usually dose related and may be
Hydrochloride agent similar to of all forms of o Nausea minimized by dosage reduction. Older adults appear
atropine. Thought to act Parkinsonism o Constipation more sensitive to usual adult doses.
Brand Name: by blocking excess of (arteriosclerotic, o Special Senses: 2. Monitor vital signs. Pulse is a particularly sensitive
Aparkane acetylcholine at certain idiopathic, post o Blurred vision indicator of response to drug. Report tachycardia,
Apo-Trihex cerebral synaptic sites. encephalitic). Also to o Mydriasis palpitations, paradoxical bradycardia, or fall in BP.
Novohexidyl Relaxes smooth muscle prevent or control drug- o Photophobia 3. Assess for and report severe CNS stimulation (see
Trihexy by direct effect and by induced extrapyramidal o Angle-closure ADVERSE EFFECTS) that occurs with high doses, and
atropinelike blocking disorders. glaucoma in patients with arteriosclerosis, or those with
Classifications: action on the Urogenital: history of hypersensitivity to other drugs.
Autonomic Nervous parasympathetic Contraindications: o Urinary hesitancy or 4. In patients with severe rigidity, tremors may appear
System Agent nervous system. Narrow-angle glaucoma. retention. to be accentuated during therapy as rigidity
Anticholinergic Anticholinergic agent Safety during pregnancy CNS: diminishes.
(parasympatholytic) diminishes the (category C), lactation, or o Dizziness 5. Monitor daily I&O if patient develops urinary
Anti-parkinsonism characteristic tremor of in children is not o Nervousness hesitancy or retention. Voiding before taking drug
agent Parkinson's disease. established. o Insomnia may relieve problem.
Anti-muscarinic Antispasmodic action o Drowsiness 6. Check for abdominal distention and bowel sounds if
Antispasmodic appears to be one-half Cautious Use o Confusion constipation is a problem.
that of atropine. History of drug o Agitation 7. Monitor intraocular pressure at regular intervals.
hypersensitivities; o Delirium 8. Provide close follow-up care. Tolerance may
arteriosclerosis; o Psychotic develop, necessitating dosage adjustment or use of
hypertension; cardiac manifestations combination therapy. Patients 60 y frequently
disease, kidney or liver o Euphoria develop sensitivity to drug action.
disorders; obstructive CV:
diseases of GI or o Tachycardia Patient & Family Education
genitourinary tracts; o Palpitations 1. Learn measures to relieve drug-induced dry mouth;
older adults with o Hypotension rinse mouth frequently with water and suck ice
prostatic hypertrophy. 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
Reference:
http://www.robholland.com/Nursing/Drug_Guide
/data/monographframes/I038.html
ANTI-CHOLINERGICS
Czarina Isabela P. Tuazon - BSN 4A
MECHANISM OF INDICATIONS &
DRUG NAME ADVERSE EFFECTS NURSING RESPONSIBILITY
ACTION CONTAINDICATIONS
Generic Name: Synthetic tertiary Indications: Body as a Whole: Severe 1. Periodic interruptions of therapy are
Oxybutynin Chloride amine that exerts To relieve symptoms allergic reactions recommended to determine patient's need for
direct associated with voiding in including continued treatment. Tolerance has occurred in
Brand Name antispasmodic patients with uninhibited o Urticaria some patients.
Ditropan action and inhibits neurogenic bladder and o skin rashes 2. Keep physician informed of expected responses to
Ditropan XL muscarinic effects reflex neurogenic bladder. o suppression of drug therapy (e.g., effect on urinary frequency,
Oxytrol of acetylcholine on Also has been used to lactation urgency, urge incontinence, nocturia,
smooth muscle. relieve pain of bladder o decreased sweating completeness of bladder emptying).
Classifications: Prominent spasm following o fever 3. Monitor patients with colostomy or ileostomy
Autonomic Nervous System antispasmodic transurethral surgical CNS: closely; abdominal distension and the onset of
Agent activity. procedures. o Drowsiness diarrhea in these patients may be early signs of
Anticholinergic o Dizziness intestinal obstruction or of toxic megacolon.
(parasympatholytic) Contraindications: o Weakness
Anti-muscarinic Hypersensitivity of o Insomnia Patient & Family Education
Antispasmodic oxybutynin; narrow angle o Restlessness psychotic 1. Do not drive or engage in potentially hazardous
glaucoma, myasthenia behavior (overdosage) activities until response to drug is known.
gravis, partial or complete CV: 2. Exercise caution in hot environments. By
GI obstruction, gastric o Palpitations suppressing sweating, oxybutynin can cause fever
retention, paralytic ileus, o Tachycardia and heat stroke.
intestinal atony o Flushing 3. Do not breast feed while taking this drug without
(especially older adult or o Special Senses: consulting physician.
debilitated patients), Mydriasis
megacolon, severe colitis, o blurred vision,
GU obstruction, urinary Cycloplegia
retention, unstable o Increased ocular
cardiovascular status. tension
GI:
Cautious Use: o Dry mouth
Older adults; autonomic o Nausea & vomiting
neuropathy, hiatus hernia o Constipation,
with reflex esophagitis; o Bloated feeling
hepatic or renal Skin:
dysfunction; urinary o Pruritus at application
infection; site
hyperthyroidism; CHF, o Rash
coronary artery disease, o application site vesicle
hypertension; prostatic o erythema
hypertrophy; pregnancy Urogenital: Reference:
(category B), children o Urinary hesitancy or http://www.robholland.com/Nursing/Drug_Guide
<18, lactation. retention, impotence. /data/monographframes/O025.html
Reference:
http://www.robholland.com/Nursing/Drug_Guide/
data/monographframes/L041.html
Reference:
http://www.robholland.com/Nursing/Drug_Guide/data/m
onographframes/D053.html