Medication Portfolio (1)

Drug Classification General Anesthetic

Generic Name etomidate injection
Brand name Amidate
Prescribed dosage 0.2-0.6 mg/kg
Route of Administration IVP
Frequency of Medication over 30-60 sec

Mechanism of Action: Etomidate acts on the CNS to stimulate gamma-aminobutyric acid (GABA)
receptors and, in doing so, depresses the reticular activating system. The electroencephalogram (EEG)
changes are similar to those produced by barbiturates as the patient passes rapidly through light to
deep levels of surgical anesthesia.

Indication: General Anesthesia Induction. Intravenous etomidate is also indicated for the
supplementation of subpotentanesthetic agents, such as nitrous oxide in oxygen, during maintenance of
anesthesia for short operative procedures such as dilation and curettage or cervical conization.

Adverse Reaction: Transient injection site pain, Skeletal muscle movements, mainly myoclonic,
Opsoclonus (20%), Adrenal suppression; Hiccups, <1%: Apnea (duration: 5-90 seconds) Arrhythmias,
Hyperventilation, HTN, Hypotension, Hypoventilation, Laryngospasm, Nausea/vomiting, Oxygen
desaturation, Snoring (may be associated with partial upper airway obstruction)

Nursing Responsibilities: Monitor postoperative respiration and notify physician or nursing staff
immediately if patient exhibits any interruption in respiratory rate (apnea) or wheezing, coughing,
tightness in chest, or shortness of breath that might indicate laryngospasm.

Pharmacokinetics
A:
D:

M: rapidly metabolized in the liver; Half-life: 75 minutes.

E: urinary excretion

Pharmacodynamics

Route:

Onset:

Peak:

Duration:
 Medication Portfolio (2)

Drug Classification Typical antipsychotic

Generic Name Droperidol
Brand name Inapsine
Prescribed dosage 2.5 mg
Route of Administration IM/IV slow
Frequency of Medication PRN

Mechanism of Action: The exact mechanism of action is unknown, however, droperidol causes a CNS
depression at subcortical levels of the brain, midbrain, and brainstem reticular formation. It may
antagonize the actions of glutamic acid within the extrapyramidal system. It may also inhibit
cathecolamine receptors and the reuptake of neurotransmiters and has strong central antidopaminergic
action and weak central anticholinergic action. It can also produce ganglionic blockade and reduced
affective response. The main actions seem to stem from its potent Dopamine(2) receptor antagonism
with minor antagonistic effects on alpha-1 adrenergic receptors as well.

Indication: To reduce the incidence of nausea and vomiting associated with surgical and diagnostic
procedures

Adverse Reaction: dysphoria, postoperative drowsiness, restlessness, hyperactivity and anxiety,

Nursing Responsibilities: Assess heart rate, ECG, and heart sounds, especially during exercise (See
Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including
palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness. Assess motor
function, and be alert for extrapyramidal symptoms.

Medication Portfolio (3)

Drug Classification Anticoagulants

Generic Name enoxaparin sodium injection
Brand name Lovenox
Prescribed dosage 40 mg
Route of Administration SQ
Frequency of Medication Once a day for 7 to 10 days

Mechanism of Action: Lovenox is a blood thinner containing a low molecular weight heparin. The drug
binds and accelerates the activity of antithrombin III, an enzyme which causes blood to clot by acting on
a blood protein called fibrinogen. It also inhibits coagulation factors Xa and IIa.

Indication: Prophylaxis of Deep Vein Thrombosis

Adverse Reaction: Spinal/Epidural Hematoma, Increased risk for hemorrhage, Thrombocytopenia (drug
should be held if platelet count falls below 100,00)

Nursing Responsibilities: Document the time, dose, site, and patient response to the injection. Instruct
the patient not to rub the injection site and to report any bleeding, bruising, or pain. Tell her that
bleeding may take longer than usual to stop. During therapy, monitor the patient for signs and
symptoms of overt or occult bleeding.

Medication Portfolio (4)

Drug Classification Local Anesthetics

Generic Name bupivacaine
Brand name Marcaine HCl
Prescribed dosage 10-20 ml
Route of Administration Epidural
Frequency of Medication PRN

Mechanism of Action: like other local anesthetics reduces the flow of sodium in and out of nerves. This
decreases the initiation and transfer of nerve signals in the area in which the drug is applied. This
blockage leads first to a loss of sensation of pain, then temperature, touch, deep pressure, and muscle
control.

Indication: to produce local or regional anesthesia or analgesia for surgery, for oral surgery procedures,
for diagnostic and therapeutic procedures, and for obstetrical procedures.

Adverse Reaction: Seizures and Cardiovascular collapse

Nursing Responsibilities: Nurse should focus on safely administering analgesia, achieving optimal pain
control, and identifying and managing adverse reactions or complications.

Medication Portfolio (5)

Drug Classification Neuromuscular Blockers

Generic Name rocuronium bromide injection
Brand name Zamuron
Prescribed dosage 0.6-1.2 mg/kg
Route of Administration IV
Frequency of Medication PRN

Mechanism of Action: A short acting, non-depolarizing neuromuscular blocking agent that directly
competes with acetylcholine on the neuromuscular receptors. Indications: Used for rapid and smooth
endotracheal intubation when succinylcholine is contraindicated or unavailable.

Indication: For inpatients and outpatients as an adjunct to general anesthesia to facilitate both rapid
sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or
mechanical ventilation.

Adverse Reaction: Transient hypotension, Hypertension, Dose-related tachycardia, Apnea, Abnormal

ECG, Injection site edema, Hiccups, Pruritus, Nausea, Wheezing, Residual muscle weakness, Allergic or
idiosyncratic hypersensitivity reactions

Nursing Responsibilities: Monitor ECG, heart rate, and BP throughout administration. Observe the
patient for residual muscle weakness and respiratory distress during the recovery period. Monitor
infusion site frequently. If signs of tissue irritation or extravasation occur, discontinue, and restart in
another vein.

Medication Portfolio (6)

Drug Classification Analgesics, Opioid Combos

Generic Name hydrocodone bitartrate and acetaminophen
tablets
Brand name Lortab 10
Prescribed dosage 500mg
Route of Administration PO
Frequency of Medication q4h – q6h PRN

Mechanism of Action: inhibits pain signaling in both the spinal cord and brain. Its actions in the brain
also produce euphoria, respiratory depression, and sedation.

Indication: for the relief of moderate to moderately severe pain.

Adverse Reaction: confusion, dizziness, sedation, hypotension, constipation, dyspepsia, nausea,

Nursing Responsibilities: Determining the dose of the analgesic medication to administer if a range is
prescribed. Evaluating the effectiveness of the analgesic. Assessing for and managing side effects of the
medication. Determining why the analgesic was ineffective, if applicable.

Medication Portfolio (7)

Drug Classification NSAIDs

Generic Name Diflunisal
Brand name Dolobid
Prescribed dosage 500mg
Route of Administration PO
Frequency of Medication q8h to q12h

Mechanism of Action: Inhibits cyclooxygenase-1 (COX-1) & -2 (COX-2), thereby inhibiting prostaglandin
synthesis

Indication: relieve mild to moderate pain

Adverse Reaction: nausea, vomiting, dyspepsia, gastrointestinal pain, diarrhea, constipation, and
flatulence.

Nursing Responsibilities: Monitor for therapeutic effectiveness: Full anti-inflammatory effect for arthritis
may not occur until 8 d to several weeks into therapy. Discontinue if patient presents signs of hepatic
toxicity (see Appendix F). Note: Although the antipyretic effect is mild, chronic or high doses may mask
fever in some patients.

Medication Portfolio (8)

Drug Classification NSAID

 Generic Name Diclofenac Sodium
Brand name Voltaren
Prescribed dosage 50 mg
Route of Administration PO
Frequency of Medication Qid

Mechanism of Action: Inhibits an enzyme needed for prostaglandin synthesis resulting in decreased
levels.

Indication: Pain and inflammation in rheumatic disease, musculoskeletal disorders, acute gout and
following surgery.

Adverse Reaction: Gastric upset, renal impairment, elevation of serum aminotransferase, salt and water
retention.

Nursing Responsibilities: Evaluate therapeutic response by assessing pain, joint stiffness, joint swelling
and mobility. Assess any worsening of asthma in appropriate patients. Regular full dosage has both
lasting analgesic and anti-inflammatory effects, making it useful for continuous pain associated with
inflammation. Nurses should refer to manufacturer’s summary of product characteristics and to
appropriate local guidelines.

Medication Portfolio (9)

Drug Classification Opioid Analgesics; Synthetic, Opioids

Generic Name Sufentanil
Brand name Dsuvia, Sufenta, Zalviso
Prescribed dosage 1-2 mcg/kg THEN 10-50 mcg
Route of Administration IV
Frequency of Medication PRN

Mechanism of Action: May open K+ channels and inhibit Ca++ channels, causing an increase in pain
threshold and alteration in pain perception. It also inhibits ascending pain pathways

Indication: As an analgesic adjunct in the maintenance of balanced general anesthesia in patients who
are intubated and ventilated. As a primary anesthetic agent for the induction and maintenance of
anesthesia.

Adverse Reaction: Bloody urine.blue lips, fingernails, or skin.burning feeling in the chest or
stomach.burning, crawling, itching, numbness, prickling, "pins and needles", or tingling
feelings.decreased frequency or amount of urine.decreased urine output.difficult or troubled breathing.
difficulty in passing urine (dribbling)

Nursing Responsibilities: Assess respiration, and notify physician immediately if patient exhibits any
interruption in respiratory rate (apnea) or signs of respiratory depression. Continually monitor for signs
of cardiac arrest. Monitor signs of laryngeal spasm and allergic bronchospasm. Be alert for other signs of
allergic reactions and anaphylaxis. Be alert for excessive sedation or changes in mood and behavior.
Assess blood pressure periodically and compare to normal values. Be alert for residual muscle rigidity
and decreased thoracic and limb movements. ...

Medication Portfolio (10)

Drug Classification Neuromuscular Blockers, Nondepolarizing

Generic Name cisatracurium (Rx)
Brand name Nimbex
Prescribed dosage 0.15-0.2 mg/kg
Route of Administration IV bolus
Frequency of Medication PRN

Mechanism of Action: Non-depolarizing skeletal muscle relaxant; cholinergic receptor antagonist; a cis-
isomer of atracurium

Indication: adjunct to general anesthesia to facilitate tracheal intubation. Also indicated for skeletal
muscle relaxation during surgical procedures or mechanical ventilation in ICU settings

Adverse Reaction: Bronchospasm, Bradycardia, Flushing, Pruritus, Myositis ossificans, Hypotension, Rash

Nursing Responsibilities: Monitor ECG, heart rate, and BP throughout administration. Observe the
patient for residual muscle weakness and respiratory distress during the recovery period. Monitor
infusion site frequently. If signs of tissue irritation or extravasation occur, discontinue and restart in
another vein.

 Analgesic- also called painkillers, are medications that relieve different types of pain — from
headaches to injuries to arthritis.
 Antibiotics- also known as anti-bacterials, are medications that destroy or slow down the
growth of bacteria.
 Pharmacology lessons
 Board types exam
 What is pharmacokinetics- is the study of the time course of drug absorption, distribution,
metabo- lism, and excretion. It is the study of how the body interacts with administered
substances for the entire duration of exposure. It is evident that drug molecules have to pass
many structural and metabolic barriers.
 Pharmacodynamics- is the response of the body to the drug. It refers to the relationship
between drug concentration at the site of action and any resulting effects namely, the intensity
and time course of the effect and adversee effects. (Route, Onset, peak and Duration)
 Assessing pain- Measuring pain enables the nurse to assess the amount of pain the patient is
experiencing. Patients' self-reporting (expression) of their pain is regarded as the gold standard
of pain assessment measurement as it provides the most valid measurement of pain. The three
most utilized tools to quantify pain intensity include verbal rating scales, numeric rating scales,
and visual analogue scales.