Anesthesia
Used for surgery; Widespread CNS depression
Adverse Effects: Decreased pulse; Hypotension; Suppressed respirations; Decreased GI activity (nausea and vomiting are common after recovery)
Have emergency equipment to maintain airway readily available (when not able to maintain respirations d/t CNS depression);
Monitor V/S continually during and frequent after (assess systemic response to CNS depression and provide support as needed)
General Anesthesia
Used to cause paralysis to facilitate mechanical
ventilation
Given as an IV push bolus prior to intubation
Rapid onset and short duration; Creates muscular contraction
Adverse effects: respiratory depression/apnea, muscle soreness
The nurse must be prepared to ventilate the client with a resuscitation bag
Succinylcholine
Used for pain; also sedation, adjuncts to anesthesia to produce rapid analgesia, sedation, and respiratory depression; Works through CNS to alter the way pain impulses are processed that arrive from peripheral nerves
Adverse Effects: Respiratory depression resulting in apnea leading to cardiac arrest; Orthostatic hypotension; Nausea, vomiting, constipation; Lightheadedness, dizziness, pupil constriction
Analgesics
Treatment of cardiogenic shock related to progressive heart failure; treatment for heart failure
Increases myocardial contractility therefore increasing cardiac output and increasing blood pressure
Nursing:Monitor HR/rhythm, BP, urine output
dobutamine
used to restore the appropriate oxygen delivery to the cardiac muscle; This is accomplished by dilating vessels and decreasing venous return (preload)
antianginals
Used for minor surgical/medical procedures
diagnostic, therpeutic, and endoscopic procedures
Drug-induced depression of consciousness-respond
purposefully to verbal commands/light stimulation
Adverse Effects: Decreased pulse; Hypotension; Suppressed respirations
Moderate Sedation
Given as an IV push bolus prior to intubation
Slower onset and longer duration
Adverse effects: respiratory depression/apnea,
pressure ulcers from prolonged paralysis
The nurse must be prepared to ventilate the client with a resuscitation bag
vecuronium/rocuronium/pancuronium:
for analgesia before, during, or after surgery; control of breakthrough pain;
available in transdermal patch for management of chronic pain
fentanyl:
Treatment of shock- dilates renal vessels stimulating a sympathetic response causing vasoconstriction
positive chronotrope & positive inotrope
Adverse effects: tachycardia, chest pain, SOB, N/V, tissue necrosis due to extravasation of IV site- central line preferred
Nursing: Monitor HR/rhythm, BP, urine output; Monitor IV site for extravasation; phentolamine for treatment
dopamine
used for treatment of mild to moderate HF by controlling heart rate and increasing cardiac muscle contraction
cardiac glycosides
Benzodiazepine class that has amnesia effect
Can be used to induce anesthesia, moderate sedation, and/or to
provide continuous sedation for intubated and ventilated clients.
Rapid onset, peak effectiveness 30-60 min
Can cause respiratory depression/arrest
Have resuscitative equipment available
midazolam
Treatment of acute life-threatening ventricular dysrhythmias; treatment for refractory dysrhythmias
Adverse effects: toxicity, CNS effects (dizziness, fatigue, slurred speech, respiratory arrest, vison changes, twitching leading to seizures), heart blocks
Nursing: Monitor lidocaine level; Typically used for no more than 24 hours; Monitor BP, HR/rhythm, and CNS depression
lidocaine
Used for opioid overdose, or reversal of opioid effects
Monitor for withdrawal symptoms in opioid-dependent clients; Half-life is often shorter than opioid, continued monitoring is needed for re-sedation.
naloxone
Treatment of shock hypotension through vasoconstriction; emergency anaphylactic shock
positive inotrope, positive chronotrope, increases cardiac output, improves tissue perfusion
Adverse effects: hypertensive crisis, dysrhythmias, tissue necrosis of IV site
Nursing: Monitor HR/rhythm, BP, urine output; Monitor IV site for extravasation; phentolamine for treatment
epinephrine
drugs that affect the action potential of cardiac cells and are used to restore normal rate/rhythm
antidysrhythmics
Can be used as general anesthesia, moderate sedation, and/or to provide continuous sedation for intubated and ventilated clients.
Onset within 1 minute, rapid recovery within 3-5 minutes
During recovery, many client experience myoclonic and tonic movements, as well as nausea & vomiting
Can cause hallucinations, dreams and psychotic episodes
Etomidate
Treatment of life-threatening ventricular dysrhythmias refractory to other treatments; preferred antiarrhythmic in Advanced Cardiac Life Support protocol; treatment in atrial fibrillation for rate control and maintenance
Adverse effects: highly toxic to lungs and liver (need baseline chest x-ray,pulmonary function test, liver function test), arrhythmias, N/V, weakness
Nursing: Monitor BP, HR/rhythm; Monitor for side effects; Monitor labs
amiodarone
Used for symptomatic bradycardia; to decrease secretions
Adverse effects: tachycardia, blurred vision, mydriasis, dry mouth, urinary hesitancy
Nursing:Monitor HR/rhythm, BP, urine output, pupillary response
atropine
Treatment of acute hypotensive states associated with shock through vasoconstriction
Adverse effects: hypertensive crisis, dysrhythmias, tissue necrosis of IV site
Nursing: Monitor HR/rhythm, BP, urine output; Monitor IV site for extravasation; phentolamine for treatment
norepinephrine
nitrate of choice for acute angina attacks; Can be used in the acute care setting and at home
Different routes: sublingual, topical, transdermal, IV
Educate on proper use for at-home routes (1 SL tab every 5 min x 3)
Acute care settings: titrate to effective pain management with least adverse effects
Adverse effects (related to vasodilation and decreased blood pressure): hypotension, headache, dizzy, weak
Drug-Drug interaction: phosphodiesterase type 5 inhibitors (ED drugs)
Teach client to stand slowly
nitroglycerin
Client can appear awake, but are unconscious and cannot feel pain
Causes sympathetic stimulation with increases in BP and HR, may be helpful in situations when cardiac depression is dangerous
Onset within 30 seconds and a slow recovery (45 min); May enhance paralytics therefore may require prolonged respiratory support when both are used
Ketamine
tachycardia
Adverse effects: related to vasodilation- causing bradycardia, hypotension and negative inotropic effects, AV block, dizziness, lightheadedness, headache
Nursing: Monitor BP, HR/rhythm; Monitor for side effects; Titrate off, don’t stop abruptly
diltiazem
Treatment of supraventricular tachycardia (SVT)
Negative chronotropic, and negative dromotropic
Duration of action is only 15 seconds
Give RAPIDLY IV push to antecubital IV site and flush immediately behind with minimum 20ml of normal saline; Continuous cardiac monitoring during
Adverse effects: flushing,shortness of breath, feeling of impending doom
adenosine
Treatment of hypotensive states associated with shock through vasoconstriction; (PO: cold and allergy medicines )
Adverse effects: hypertension, decreased urine output, nausea, anxiety
Nursing:Monitor HR/rhythm, BP, urine output
phenylephrine
Used for heart failure; and controlling heart rate in atrial fibrillation
Positive inotropic and negative chronotropic
Adverse effects: bradycardia, headache, weakness, vision changes (yellow halos around objects), toxicity (anorexia, N/V, heart block, V-tach)
Nursing: Check apical pulse rate and assess rhythm before administering- Hold if less than 60bpm; Monitor digoxin level and potassium level; Monitor for toxicity- anorexia is the first manifestation
Digoxin