Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. ALLERGY AND RESPIRATORY MEDICATIONS SURGICAL PATIENT - PHARMACOLOGY 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 H 1 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 long- term 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

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Ch 17 – Analgesics Opiod & Non-Narcotic 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