Methergine drug study

CONTRAINDICATION

PRECAUTIONS

DRUG

ACTION

INDICATION

Adverse Reactions

NURSING CONSIDERATION

Methergine Act (methylergometrine directly maleate) at the

Postpartum hemorrhage and uterine atony, subinvolution.

Hypertension. Toxemia. Pregnancy (Cat.C).

Sepsis. Obliterative vascular disorders. Hepatic or renal disease. 2nd stage of labor. Nursing mothers.

Hyper- or hypotension, nausea, vomiting, chest pain, dyspnea, headache, hematuria, thrombophlebitis, water intoxication, hallucinations, leg cramps, dizziness, tinnitus, nasal congestion, diarrhea, diaphoresis, palpitations, foul taste.

Name of the Drug Generic Morphine Sulfate Brand Immediate-release tablets: MSIR Timed-release: Kadian, M-Eslon (CAN), MS Contin, Oramorph SR Oral solution: MSIR, Rescudose, Roxanol, Roxanol T Rectal suppositories: RMS Injection: Astramorph PF, Duramorph, Epimorph (CAN) Preservative-free concentrate for microinfusion devices for intraspinal use: Infumorph

Dosage/Route ADULTS Oral One-third to one-sixth as effective as parenteral administration because of first-pass metabolism; 1030 mg q 4 hr PO. Controlledrelease: 30 mg q 812 hr PO or as directed by physician; Kadian: 20 100 mg PO daily24hr release system; MS Contin: 200 mg PO q 12 hr. SC and IM 10 mg (520 mg)/70 kg q 4 hr or as directed by physician. IV 2.515 mg/70 kg of body weight in 45 mL water for injection administered over 45 min, or as directed by physician. Continuous IV infusion: 0.1 1 mg/mL in 5% dextrose in water by controlled infusion device. Rectal 1030 mg q 4 hr or as directed by physician.

Action/Classification Action Principal opium alkaloid; acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Indication/ Contraindications Indication Relief of moderate to severe acute and chronic pain Preoperative medication to sedate and allay apprehension, facilitate induction of anesthesia, and reduce anesthetic dosage Analgesic adjunct during anesthesia

Classification Opioid agonist analgesic

Component of most preparations that are referred to as Brompton's cocktail or mixture, an oral alcoholic solution that is used for chronic severe pain, especially in terminal cancer patients Intraspinal use with microinfusion devices for the relief of intractable pain Unlabeled use: Dyspnea associated with acute left ventricular failure and pulmonary edema Contraindication

Adverse Effects/ Side Effects Adverse Effect CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances, suppression of cough reflex CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope Dermatologic: Pruritus, urticaria, Respiratory: laryngospasm, bronchospasm, edema GI: Nausea, vomiting, anorexia, biliary tract spasm; increased

Nursing Responsibilities Assessment History: Hypersensitivity to opioids; diarrhea caused by poisoning; labor or delivery of a premature infant; biliary tract surgery or surgical anastomosis; head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression; acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction; pregnancy; lactation Physical: T; skin color,

Epidural Initial injection of 5 mg in the lumbar region may provide pain relief for up to 24 hr. If adequate pain relief is not achieved within 1 hr, incremental doses of 12 mg may be given at intervals sufficient to assess effectiveness, up to 10 mg/24 hr. For continuous infusion, initial dose of 24 mg/24 hr is recommended. Further doses of 12 mg may be given if pain relief is not achieved initially. Intrathecal Dosage is usually onetenth that of epidural dosage; a single injection of 0.21 mg may provide satisfactory pain relief for up to 24 hr. Do not inject > 2 mL of the 5 mg/10 mL ampule or > 1 mL of the 10 mg/10 mL ampule. Use only in the lumbar area. Repeated intrathecal injections are not recommended;

Contraindicated with hypersensitivity to opioids; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature blood brain barrier more readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor). Use cautiously with head injury and increased intracranial pressure; acute asthma, COPD, cor pulmonale, preexisting respiratory depression, hypoxia, hypercapnia (may decrease respiratory drive and increase airway resistance); lactation (wait 46 hr after administration to nurse the baby); acute abdominal conditions, CV disease, supraventricular tachycardias, myxedema, seizure disorders, acute

colonic motility in patients with chronic ulcerative colitis GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency Respiratory: Respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest Side Effects GI: dry mouth, constipation. Skin: Tissue irritation and induration (SC injection). Other: sweating,physical tolerance and dependence, psychological dependence

texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, normal output; urinary frequency, voiding pattern, normal output; ECG; EEG; thyroid, liver, kidney function tests Interventions Caution patient not to chew or crush controlled-release preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Tell patient to lie down during IV administration. Keep opioid antagonist and facilities for assisted or controlled respiration readily available during IV administration.

use other routes if pain recurs. For epidural or intrathecal dosing, use preservative-free morphine preparations only. PEDIATRIC PATIENTS Do not use in premature infants. SC or IM 0.050.2 mg/kg (up to 15 mg per dose) q 4 hr or as directed by physician. GERIATRIC PATIENTS OR IMPAIRED ADULTS Use caution. Respiratory depression may occur in the elderly, the very ill, those with respiratory problems. Reduced dosage may be necessary. Epidural Use extreme caution; injection of < 5 mg in the lumbar region may provide adequate pain relief for up to 24 hr. Intrathecal Use lower dosages

alcoholism, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, kyphoscoliosis, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction.

Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patients that they are unlikely to become addicted; most patients who receive opioids for medical reasons do not develop dependence syndromes Teaching points Take this drug exactly as prescribed. Avoid alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs. Swallow controlledrelease preparation (MS Contin, Oramorph SR) whole; do not cut, crush, or chew them. Do not take leftover medication for other disorders, and do not let

than recommended for adults above.

anyone else take your prescription. These side effects may occur: Nausea, loss of appetite (take with food, lie quietly); constipation (use laxative); dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness and visual acuity). Report severe nausea, vomiting, constipation, shortness of breath or difficulty breathing, rash.

Drug Drug name

Dosage/ Route

Classification

Indication

Contraindication

Side Effects Adverse Effect CNS: restlessness, drowsiness, fatigue, insomnia, dizziness, anxiety CV: transient hypertension GI: nausea, diarrhea

Nursing Responsibilities Nursing Consideration -monitor BP carefully during IV administration -keep diphenhydramine injection readily available in case extrapyramidal reactions occur -have phenotolamine readily available in case of hypertensive crisis -take drug exactly as prescribed -use of alcohol, sleep remedies, or sedatives can cause serious sedation. -report involuntary movement of the face, eyes, and limbs

Classification Antiemetic GI stimulant

Generic name: Metoclopramide Brand name: Plasil, Maxolon, Reglan

Availability: -Tablets -Injections

Mechanism of Action Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit, little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin.

Indication -relief of symptoms of acute and recurrent diabetic gastroparesis -short- term therapy for adults with GERD -parenteral: prevention of nausea and vomiting -prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable -treatment of nausea and vomiting of a variety of etiologies

Contraindication -contraindicated with allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, epilepsy. -use cautiously with previously detected breast cancer, lactation, pregnancy

TRADE NAME: Oxytocin

Available Forms: 10 units/ml in 1ml ampule, vial or syringe in compatible IV solution.

Pharmacologic -to induce or Class: stimulate labor Posterior pituitary hormone Therpeutic Class: Uterine-active agent

-hypersensitive to drug when vaginal delivery is advised - cephalopelvic disproportion is present -when delivery requires conversion as in transverse lie

CV: Hypertension, increased heart rate, systemic venous return, cardiac output GI: Nausea, vomiting RESPIRATORY: Anoxia, asphyxia OTHERS: Low APGAR score at 5 mins.

Continuously monitor contractions, fetal and maternal heart rate, and maternal blood pressure and ECG. Discontinue infusion if uterine hyperactivity occurs. Monitor patient extremely closely during first and second stages of labor because of risk of cervical laceration, uterine rupture and maternal and fetal death. Assess fluid intake and output. Watch for signs and symptoms of water intoxication.

DRUG

ACTIO N

CONTRAINDICATION

INDICATION

PRECAUTI Adverse ONS Reactions

NURSING CONSIDERA TION

NALBUPHIN E HYDROCHLO RIDE NUBAINE Drug Class: Narcoti c agonistantagonist analgesic

Act direc tly at the CNS

y

Symptomatic relief of perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis; mild, uncomplicate d urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatograp hism, adjunctive theraphy.

y

y

Contraindications : hypersensitivity to antihistamines or phenothiazines, coma or severe CNS depression, bone marrow depression, vomiting of unknown cause, concomitant therapy with MAOIs, lactation. Use cautiously with lower respiratory tract disorders, glaucoma, prostatic hypertrophy, CV disease or hypertension, breast cancer,

Sepsis. Obliterativ e vascular disorders. Hepatic or renal disease. 2nd stage of labor. Nursing mothers.

CNS: Dizziness, Drowsiness, poor coordination, confusion, restlessness, excitation, convulsions, tremors, headache, blurred vision, diplopia, vertigo, tinnitur CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles DERMATOL

y

Treatment and prevention of motion sickness; prevention and control of nausea and vomiting associated with anesthesia and surgery.

thyrotoxicosis, pregnancy, children, a child with history of sleep apnea, a family history of SIDS, or Reyes syndrome, the elderly,.

OGIC: Urticaria, rash, photosensitivi ty, chills. GI: Epigastric distress, nausea, vomiting, diarrhea, constipation GU: Urinary frequency, dysuria, urinary retention, decreased libido, impotence HEMATOLO GIC: Hemolytic anemia, hypoplastic anemia, thrombocytop enia, leucopenia, agranulocytos is, pancytopenia.

RESPIRATO RY: Thickening of brochial secretions, chest tightness, dry mouth, suppression of cough reflex, potential for aspiration. OTHER: Tingling, heaviness and wetness of hands.

Drug Data Generic Name Promethazine HCl Trade Name Phenergan Minimum Dose 25 mg 1 tab q 4-6, Maximum Dose 50 mg 1 tab q 4 Contents Promethazine HCl Availability and color - Tablets: 12.5, 25, 50 mg - Syrup: 6.25, 25 mg/5mL - Suppositories: 12.5, 25, 50 mg - Injection: 25, 50 mg/mL Routes of administration Oral Intramuscular Intravenous

Classification Pharmacologic Class Phenothiazine Therapeutic Class Antiemetic, Antihistamine, Sedative, Hypnotic Pregnancy Risk Factor C

Mechanism of Action Selectively blocks the H1 receptors, diminishing the effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions in sensitized people exposed to antigens; blocks cholinergic receptors in the vomiting centre that are believed to mediate the nausea and vomiting caused by gastric irritation, by input from the vestibular apparatus, and by input from the chemoreceptor trigger zone; depresses the RAS, including the parts of the brain involved with wakefulness. Pharmacokinetics A: Well absorbed (Oral, IM); peak plasma concentrations after 2-3 hr. D: Widely distributed: Brain, crosses the placenta, enters breast milk. Protein-binding: 76-93%. M: Extensive hepatic 1st-pass metabolism; converted to promethazine sulfoxide, Ndesmethylpromethazine. E: Via urine and bile (as metabolites) Drug Half Life 9-16 hr

Indication General Indications - Prevention and treatment of nausea and vomiting associated with labyrinthitis - Prevention of motion sickness - Short-term management of insomnia - Symptomatic relief of perennial and seasonal allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria and angioedema - Amelioration of allergic reactions to blood or plasma - Dermatographism, adjunctive therapy in anaphylactic reactions - Preoperative, postoperative, or obstetric sedation - Adjunct to analgesics to control postoperative pain - Adjunctive IV therapy with reduced amounts of meperidine or other opioid analgesics in special surgical

ContraindicationsConcentrations - Hypersensitivity to antihistamines or phenothiazines - Comatose patients - Severe CNS depression - Bone marrow depression - Vomiting of unknown cause - Concomitant therapy with MAOIs - Lactation Precaution - Lower respiratory tract disorders - Glaucoma - Prosthatic hypertrophy - CV disease, hypertension - Breast cancer - Thyrotoxicosis - Children - Child with history of sleep apnea - A family history of SIDS - Reyes syndrome - Elderly - Pregnancy Drug interaction Drug to drug - Additive anticholinergic effects with anticholinergic drugs - Increased frequency and severity of neuromuscular excitation and hypotension with methohexital, thiamylal, Phenobarbital anesthetic, thiopental - Enhanced CNS depression with alcohol

Adverse Reaction CNS: Dizziness, drowsiness, poor coordination, confusion, restlessness, excitation, seizures, tremors, headache, blurred vision, diplopia, vertigo, tinnitus CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles Dermatologic: Urticaria, rash, photosensitivity, chills GI: Epigastric distress, nausea, vomiting, diarrhea, constipation GU: Urinary frequency, dysuria, urinary retention, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia Local: Thickening of bronchial secretions, chest tightness, dry mouth, nose and throat; respiratory depression, suppression of cough reflex, potential of aspiration Other: Tingling, heaviness and wetness

Nursing

Before - Observe 15 righ - Assess for hype contraindications. - Reduce dosage impairment. - Reduce dosage concurrently with a half. - Arrange for dos analgesics given fourth to one-half.

During - Do not give table to children young - Give IM injection - Do not administe necrosis may occ - Do not administe arteriospasm and may result. - Instruct to take d prescribed.

After - Instruct to avoid - Instruct to avoid other dangerous a drowsiness or vis - Educate about a exposure to the s or covering garme - Maintain fluid int against heatstrok - Report sore thro bleeding or bruisi weakness, tremor urine, pale stools, eyes.

conditions

Drug to food - none reported

of hands

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 999

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 999

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 999-1000

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 999-1000

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 1000

Source: Karch, Amy: 2009 Lip pp. 1000-1001