In: Nursing
•Discuss the actions, side effects, contraindications and nursing considerations of the following medications:
•Ceftriaxone
oVancomycin hydrochloride
oFentanylcitrate
oMidazolam hydrochloride
oDiazepam
oLidocaine/Prilocaine topical cream
1) CEFTRIAXONE
ACTIONS :-
Ceftriaxone selectively and irreversibly inhibits bacterial cell
wall synthesis by binding to transpeptidases, also called
transamidases, which are penicillin binding proteins (PBPs) that
catalyze the cross linking of the peptidoglycan polymers forming
the bacterial cell wall.
SIDE EFFECTS :- Rashes, bloody, or watery stools, stomach cramps,
or fever during treatment or for up to two or more months after
stopping treatment.Stomach tenderness, pain or bloating, nausea and
vomiting, heart burn and chest pain.
CONTRAINDICATIONS :-
diarrhea from an infection with Clostridium difficile
bacteria.
a type of blood disorder where the red blood cells burst called
hemolytic anemia.
liver problems.
disease of the gallbladder.
severe renal impairment.
yellowing of the skin in a newborn child.
NURSING CONSIDERATIONS :-
Watch for seizures; notify physician immediately if patient
develops or increases seizure activity.
Monitor signs of pseudomembranous colitis, including diarrhea,
abdominal pain, fever, pus or mucus in stools, and other severe or
prolonged GI problems (nausea, vomiting, heartburn).
2) VANCOMYCIN HYDROCHLORIDE
ACTIONS :- When taken by mouth it fights bacteria in the
intestines. Vancomycin is used to treat an infection of the
intestines caused by Clostridium difficile, which can cause watery
or bloody diarrhea. It is also used to treat staph infections that
can cause inflammation of the colon and small intestines.
SIDE EFFECTS :- Serious allergic reactions (anaphylactoid
reactions), including low blood pressure, wheezing, indigestion,
hives, or itching. Rapid infusion of Vancomycin may also cause
flushing of the upper body (called "red neck" or "red man
syndrome"),dizziness,
CONTRAINDICATIONS :-
Vancomycin is contraindicated in patients with known
hypersensitivity to this antibiotic. Solutions containing dextrose
may be contraindicated in patients with known allergy to corn or
corn products.
NURSING CONSIDERATIONS :-Advise patient to report signs of
nephrotoxicity (blood or pus in urine, decreased urine output,
weight gain from fluid retention, fatigue). Instruct patient and
family/caregivers to report other troublesome side effects such as
severe or prolonged fever, chills, skin rashes, or GI problems
(nausea, vomiting).
3) FENTANYL CITRATE :-
ACTIONS :- Fentanyl is a strong agonist at mu- and kappa-opiate
receptors, which have been reclassified by an International Union
of Pharmacology subcommittee as OP2 (kappa) and OP3 (mu). These
receptors are coupled with G-protein (guanine-nucleotide-binding
protein) receptors and function as modulators, both positive and
negative, of synaptic transmission via G-proteins that activate
effector proteins. Opioid-G-protein systems include adenylyl
cyclase-cyclic adenosine monophosphate (cAMP) and phospholipase3 C
(PLC)-intositol 1,4,5 triphosphate.
SIDE EFFECTS :- Addiction, Abuse, and Misuse , life-threatening
Respiratory depression,interactions with benzodiazepines or other
CNS depressants,serotonin syndrome,severe cardiovascular
epression,gastrointestinal adverse Reactions,seizures.
CONTRAINDICATIONS :-
Respiratory depression, apnea, skeletal muscle rigidity,
bradycardia (may be severe); severe hypotension, syncope.
NURSING CONSIDERATIONS :-
Assess IV site closely for signs of extravasation.
Assess for signs of adverse reactions.
Continuous cardiorespiratory and blood pressure monitoring.
Monitor oxygen saturations.
Monitor respiratory status carefully. Effect on respiration is longer acting that analgesic effect.
Ensure naloxone and resuscitation equipment is readily available.
Monitor urinary and bladder function.
Drug documentation.
Record balance discarded out of the narcotic register.Two nurses must witness the discarding of the unused drug, syringes and ampoules into the sharps container.Two nurses must sign FBC when discarding any unused drugs from a continuous IV infusion.
4) Midazolam hydrochloride binds to the GABA receptor but does
not displace GABA; rather, it enhances the affinity of GABA for its
receptor site on the same receptor complex. The pharmacodynamic
consequences of benzodiazepine agonist actions include antianxiety
effects, sedation, and reduction of seizure activity.
Side effects-Nausea, vomiting,dizziness, or drowsinessmay occur. If
any of these effects persist or worsen, notify the doctor or
pharmacist promptly.
Contraindications-
closed angle glaucoma.
chronic heart failure.
constriction of blood vessels of the extremities.
obstructive pulmonary disease.
hardening of the liver.
acute kidney failure.
coma.
a condition where the body is unable to maintain adequate blood
flow called shock.
Nursing Implications
Assessment & Drug Effects
Inspect insertion site for redness, pain, swelling, and other
signs of extravasation during IV infusion.
Monitor for hypotension, especially if the patient is premedicated
with a narcotic agonist analgesic.
Monitor vital signs for entire recovery period. In obese patient,
half-life is prolonged during IV infusion; therefore, duration of
effects is prolonged (i.e., amnesia, postoperative recovery).
Be aware that overdose symptoms include somnolence, confusion,
sedation, diminished reflexes, coma, and untoward effects on vital
signs.
Patient & Family Education
Do not drive or engage in potentially hazardous activities until
response to drug is known. You may feel drowsy, weak, or tired for
1–2 d after drug has been given.
Be prepared for amnesia to prevent an upsetting postoperative
period.
Review written instructions to assure future understanding and
compliance. Patient teaching during amnestic period may not be
remembered. Even if dose is small and depth of amnesia is unclear,
relearn information.
5)Diazepam is used to treat anxiety, alcohol withdrawal, and
seizures. It is also used to relieve muscle spasms and to provide
sedation before medical procedures. This medication works by
calming the brain and nerves.Diazepam belongs to a class of drugs
known as benzodiazepines.
Side effects-
drowsiness,
tired feeling,
dizziness,
spinning sensation,
fatigue
constipation,
ataxia (loss of balance),
memory problems,
restlessness,
irritability,
muscle weakness,
nausea,
drooling,
dry mouth,
slurred speech,
blurred or double vision,
skin rash,
itching, or
loss of interest in sex.
Contraindications:-Contraindications to diazepam include patients
with severe respiratory insufficiency, myasthenia gravis, sleep
apnea syndrome, and severe hepatic insufficiency. It is permissible
in patients with open-angle glaucomawho are receiving appropriate
therapy but is contraindicated in acute narrow-angle
glaucoma.
NURSING CONSIDERATIONS
- Assess blood pressure, pulse and respiration if IV
administration. - Provide frequent sips of water for dry mouth. -
Provide fluids and fibre for constipation. - Evaluate therapeutic
response, mental state and physical dependency after long-term
use.
6)Lidocaine is a local anesthetic (numbing medication). It works by
blocking nerve signals in your body.Lidocaine topical (for use on
the skin) is used to reduce pain or discomfort caused by skin
irritations such as sunburn, insect bites, poison ivy, poison oak,
poison sumac, and minor cuts, scratches, or burns.
Lidocaine is an antiarrhythmic medication of the class Ib type.
This means it works by blocking sodium channels and thus decreasing
the rate of contractions of the heart. When it is used locally as a
numbing agent, local neurons cannot signal the brain.
Side effects:-Common Side effects of Lidocaine include:
Low blood pressure(hypotension)
Swelling (edema)
Redness at injection site
Small red or purple spots on skin
Skin irritation
Constipation
Nausea
Vomiting
Confusion
Dizziness
Headache
Numbness and tingling
Drowsiness
Tremor
Irritation symptoms (topicalproducts); i.e., redness,
swelling
Serious side effects of lidocaine include:
Cardiac arrest
Abnormal heartbeat
Methemoglobinemia
Seizures
Severe allergic reactions (anaphylaxis)
Malignant hyperthermia
This document does not contain all possible side effects and others
may occur. Check with your physician for additional information
about side effects.
Contraindications-
-Heart block, second or third degree (without pacemaker)
-Severe sinoatrial block (without pacemaker)
-Serious adverse drug reaction to lidocaine or amide local
anesthetics.
Nursing consideration-Reduce dosage with hepatic or renal failure.
Continuously monitor response when used as antiarrhythmic or
injected as local anesthetic. WARNING: Keep life-support equipment
and vasopressors readily available in case severe adverse reaction
(CNS, CV, or respiratory) occurs when lidocaine is
injected.