Common Medications in OR-DR

1. Common Medications in OR-DR Prepared by: Ryan Matira, RN

2. Overview • The extent of anxiety appears to be associated with the particular procedure being performed to the patient. • Primary goals for premedication : • Anxiolytic effects • Reduction in preoperative pain • Amnesia • Reduction in secretion • Increase in gastric fluid pH with a decrease in gastric fluid volume • Reduction of autonomic nervous system reflex responses

3. Reduction in required anesthetic amounts • Prophylaxis with respect to allergic reaction • Reduced cardiac activity • Reduction/avoidance of postoperative nausea and vomiting • Postoperative analgesia

4. Factors that influence the choice those drugs for premedications and associated dosages: • Whether the surgery is classified as "inpatient" or "outpatient" • Whether the surgery is being performed as an elective or emergency procedure • Concerns about the ability of the patient to tolerate the drug • Patient age & weight & physical status • Anxiety level of the patient-Recall that an anxious patient is likely to have elevation of circulating catecholamines which may cause a suboptimal cardiovascular preoperative state • Whether the patient has had an adverse response to the particular medication during a previous procedure

5. Benzodiazepines • Most commonly used sedative/anxiolytic • These agents may also cause some degree of retrograde amnesia as well like midazolam (Dormicum) and lorazepam (Ativan) • may also be used the night before schedule surgery in management of pre-surgical insomnia • Adverse Effects: Major adverse effects • Respiratory depression - cautious use in view of possible respiratory depression leading to inadequate oxygenation. • Reduction in cognitive & motor function

6. Nursing Considerations: • Avoid alcohol & hazardous activities that requires alertness • Instruct patient to avoid standing after taking the drug • Check RR • Monitor BP, PR, RR during IV – medical equipment should be nearby

7. Opioids • Advantages for use in preoperative medication: • Absence of myocardial depressant effects • Alleviate the preoperative pain • Management of discomfort associated with invasive monitor insertion • Management of pain which may be associated with establishing regional anesthesia • Commonly used opioids: • Morphine • Meperidine (Demerol)

8. Adverse Effects: • Respiratory depression • Orthostatic hypotension • Nausea & vomiting • Delayed gastric emptying • may also cause smooth muscle constriction • pinpoint pupils • Nursing Considerations: • Check BP at least not less than 90/60 mmhg • Check RR not > 12 CPM • Check Urine output >30 cc/hr – Monitor I&O • Monitor LOC • Increase bulk & fluids in diet • May be given by PCA pump in terminal illness • Place Naloxone (Narcan) at Bedside

9. Antihistamines • Purpose of premedication: prevention of intraoperative allergic reactions • Example: Diphenhydramine (Benadryl) • Common S/E: • Dizziness; drowsiness; dry mouth, throat, nose, thickening of mucus in nose or throat, photosensitivity, excessive perspiration, thickening of bronchial secretions, tightness of chest and wheezing • Nursing Considerations: • Assess respiratory status, rate and rhythm, increase in bronchial secretions, chest tightness & wheezing • caution when driving, operating machinery, or performing other hazardous activities. • caution in patients with a history of lower respiratory disease including asthma

10. H2 Receptors Antagonists • reduction of gastric acid secretion • premedication for patients with aspiration pneumonia risk • Specific medications: • Cimetidine (Tagamet) • Ranitidine (Zantac) • Famotidine (Pepcid) • Nizatidine (Axid) • Nursing Considerations: • Assess abdominal pain, acute presence of blood in emesis, stool or gastric aspirate • Take at bedtime for best effect • May be taken with or without meals • Avoid smoking

11. Anticholinergics • Purposes: • use to dry up secretion in preparation for awake intubation • for operative procedure that requires upper airway topical anesthesia or for bronchoscopies • to reduce/prevent reflex bradycardia secondary to: • laryngospasm • laryngeal stimulation • hypoxia • Examples: Atropine, Glycopyrolate, Scopolamine

12. Nursing considerations: • Watch for tachycardia – may lead to ventricular fibrillation • Use sunglasses – potential sensitivity to the sun • The drug will make the patient sweat less (Sweat glands are normally innervated by sympathetic cholinergic fibers), causing the body temperature to increase. not to become overheated during exercise or hot weather • may cause some people to have blurred vision instruct patient to avoid driving or operating a machine if he or she is not able to see well • may cause some people to become dizzy or drowsy • For temporary relief of mouth dryness, use sugarless candy or gum, melt bits of ice in your mouth

13. Antiemetic drugs • Antiemetic agents are included in anesthetic premedication with the objective decreasing postoperative nausea and vomiting incidence. • Drug used for prophylaxis against postoperative nausea and vomiting: • Gastrointestinal prokinetic agents: metoclopramide (Reglan) • not be given to patients who are taking dopamine antagonists, tricyclic antidepressants, sympathomimetic agents, or monoamine oxidase inhibitors (metoclopramide (Reglan) may cause hypertensive crises in patients with pheochromocytoma).

14. Nursing Considerattions: • Assess GI complaints: N/V, anorexia, constipation, abdominal distension before & after administration • Assess involuntary movements and inform physician • Avoid driving/ operating hazardous machines or alcohol intake because the drug has a sedating effect • Administer very slow IV

15. Antibiotics • Antibiotics are considered for administration immediately before surgery for "contaminated, potentially contaminated, or dirty surgical wounds.“ • The reason that the anesthesia provider is involved in antibiotic administration is that the antibiotics will be administered immediately preceding the surgical procedure-just before potential contamination could occur • Examples: Cefazolin, Penicillin Na, Vancomycin

16. Side effects and complications may occur with antibiotic administration. • Allergic reaction • Hypotension • Bronchospasm • Nephrotoxicity • Nursing Considerations: • Do ANST prior to administer the drug • Always administer at the right time and right length of time • Assess any allergic reaction if ANST is not prescribed by the Physician

17. Anesthesia: • Types of anesthesia • Local anesthesia • An anesthetic drug (which can be given as a shot, spray, or ointment) numbs only a small, specific area of the body (for example, a foot, hand, or patch of skin). • a person is awake or sedated, depending on what is needed • It lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day)

18. Regional anesthesia • An anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist, like epidurals given to women in labor). • It is generally used to make a person more comfortable during and after the surgical procedure. Regional and general anesthesia are often combined.

19. Two common types of regional anesthesia include: • Epidural anesthesia - The anesthesiologist injects the medicine into the lower back in the area surrounding the spine. • Spinal anesthesia - goes directly into the spinal canal and it also causes you to lose feeling in the lower part of your body.

21. General anesthesia • The goal is to make and keep a person completely unconscious (or "asleep") during the operation, with no awareness or memory of the surgery. • General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube. • Example: Lidocaine, Procaine, Tetracaine

22. Risks from any type of anesthesia include: • Allergic reaction to the medicines used • Breathing problems • Risks from local and regional anesthesia include: • Bleeding and infection (rare) • Long-term nerve damage (very rare) • Temporary weakness or paralysis in the area that received the anesthesia • Risks from general anesthesia may include: • Irregular heartbeat • Heart attack (rare) • Nausea and vomiting • Stroke (rare) • Temporary mental confusion (delirium)

23. Nursing Considerations: • Monitor VS q 15 mins after induction of the anesthesia • Administer prescribed anticholinergic drug preoperatively • Medical equipment should be placed nearby • Provide quite environment for recovery to decrease psychotic symptoms • Place in flat position at least 8 hrs postoperatively • Minimize sudden movement • Place basin for emesis at bedside

24. Labor & Delivery Medications

25. Metoclopramide (Reglan/Plasil):

26. Terbutaline (Brecanyl)/ Ritrodine (yutopar): • Used most commonly to treat asthma, terbutaline is thought to relax the muscles of the uterus • Nursing precautions: • A racing heartbeat or palpitations. These medications should not be used for women with known heart condition because it can cause increase in heartbeat and palpitation • Aspiration precaution can cause nausea & vomiting • Not given to pt with poorly controlled DM can cause increase Blood glucose • Can decrease potassium level: caution to pt w/ heart problem & muscle spasm may occur

28. Indomethacin (Indocin): • NSAID • Given as a suppository in the short term. • Delays premature labor by reducing uterine contractions through inhibition of prostaglandins. • Nursing Precautions: • Avoid operating machine/vehicle may cause drowsiness • Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells.

29. Magnesium sulfate: • Usually given for eclamptic pt. • Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end plate by the motor nerve impulse • Antidote: Ca Gluconate- injectable calcium salt should be immediately available to counteract the potential hazards of Magnesium intoxication in eclampsia • Nursing checks: • Knee jerk reflex • BP≥ 90/60mmHG • RR≥ 16CPM • Take ECG • Serum K determination

30. Glucocorticoids: • Administered, often in two doses, to stimulate growth in the lungs of the fetus. • Example: Decadron • Nursing precaution: • Avoid contact with people who have colds or infections. • Take adequate calcium and vitamin D supplements. • Check blood sugar levels closely.

31. Mesoprostol (Cervidil and Cytotec): • Both are administered as vaginal suppositories to ripen the cervix prior to delivery. • This is the first step in preparing the cervix to respond to contractions. • Cytotec, while very effective, has been implicated in some uterine ruptures and should not be used under certain circumstances. • Misoprostol has been shown to produce uterine contractions that may endanger pregnancy

32. Nursing Considerations: • Assess dilatation and effacement of the cervix & fetal heart tones • Monitor for N/V & Diarrhea • Misoprostol can cause abortion (sometimes incomplete which could lead to dangerous bleeding and require hospitalization and surgery), premature birth, or birth defects • Remain in supine 2 hrs after administration

33. Pitocin: • The synthetic form of oxytocin, which is a natural hormone produced by a woman's body, Pitocin is used to start or improve contractions and control postpartum bleeding. • Pitocin, when given for induction of labor or augmentation of uterine activity, should be administered only by the intravenous route and with adequate medical supervision in a hospital. • Overstimulation of the uterus by improper administration can be hazardous to both mother and fetus.

34. Nursing consideration • Assess labor and contraction, FHT • Turn pt to left side to increase oxygen to the fetus • Assess for water retention • Watch for fetal distress • Monitor VS & I&O