LIDOCAINE

Ther. class.
anesthetics topical local
antiarrhythmics

Indications

• IV: Ventricular arrhythmias

Action

• IV, IM: Suppresses automaticity and spontaneous depolarization of the ventricles

during diastole by altering the flux of sodium ions across cell membranes with little or
no effect on heart rate

Contraindicated in:

• Hypersensitivity; cross-sensitivity may occur

Adverse Reactions/Side Effects

Applies mainly to systemic use

CNS: SEIZURES, confusion, drowsiness, blurred vision, dizziness, nervousness,

slurred speech, tremor.

EENT: mucosal use—decreased or absent gag reflex.

CV: CARDIAC ARREST, arrhythmias, bradycardia, heart block, hypotension.

GI: nausea, vomiting.

Resp: bronchospasm.

Assessment

Antiarrhythmic

• Monitor ECG continuously and blood pressure and respiratory status frequently
during administration

Anesthetic

• Assess degree of numbness of affected part

Lab Test Considerations

• Serum electrolyte levels should be monitored periodically during prolonged therapy

» IM administration may cause ↑ CPK levels

ketorolac

Ther. class.
nonsteroidal anti inflammatory agents
nonopioid analgesics

Indications

Short-term management of pain (not to exceed 5 days total for all routes combined)

Contraindicated in:

• Hypersensitivity

• Cross-sensitivity with other NSAIDs may exist

Adverse Reactions/Side Effects

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache.

Resp: asthma, dyspnea.

CV: edema, pallor, vasodilation.

GI: GI BLEEDING, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea.

GU: oliguria, renal toxicity, urinary frequency.

Assessment

• Patients who have asthma, aspirin-induced allergy, and nasal polyps are at
increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma,
and urticaria

• Assess pain (note type, location, and intensity) prior to and 1–2 hr following
administration

Action

• Inhibits prostaglandin synthesis, producing peripherally mediated analgesia

• Also has antipyretic and anti-inflammatory properties

Patient/Family Teaching

• Instruct patient on how and when to ask for and take pain medication
• Instruct patient to take medication exactly as directed. Take missed doses as soon
as remembered if not almost time for next dose. Do not double doses. Do not take
more than prescribed or for longer than 5 days

» May cause drowsiness or dizziness. Advise patient to avoid driving or other

activities requiring alertness until response to the medication is known

ketamine

Ther. class.
general anesthetics

Indications

• Anesthesia for short-term diagnostic and surgical procedures

• As induction before the use of other anesthetics

Contraindicated in:

• Hypersensitivity

• Psychiatric disturbances

• Hypertension

• Elevated intracranial pressure

Action

• Blocks afferent impulses of pain perception

• Suppresses spinal cord activity

• Affects CNS transmitter systems

Adverse Reactions/Side Effects

CNS: emergence reactions, elevated intracranial pressure.

EENT: diplopia, increased intraocular pressure, nystagmus.

Resp: laryngospasm, respiratory depression and apnea (rapid IV administration of

large doses).

CV: hypertension, tachycardia, arrhythmias, bradycardia, hypotension.

GI: excessive salivation, nausea, vomiting.

Patient/Family Teaching
• Psychomotor impairment may last for 24 hr after anesthesia. Caution patient to
avoid driving or other activities requiring alertness until response to medication is
known

• Advise patient to avoid alcohol or other CNS depressants for 24 hr after anesthesia

propofol

Ther. class.
general anesthetics

Indications

• Induction of general anesthesia in children >3 yr and adults

• Maintenance of balanced anesthesia when used with other agents in children >2
months and adults

• Initiation and maintenance of monitored anesthesia care (MAC)

• Sedation of intubated, mechanically ventilated patients in intensive care units

(ICUs)

Contraindicated in:

• Hypersensitivity to propofol, soybean oil, egg lecithin, or glycerol

• OB: Labor and delivery

Action

• Short-acting hypnotic. Mechanism of action is unknown

Adverse Reactions/Side Effects

CNS: dizziness, headache.

Resp: APNEA, cough.

CV: bradycardia, hypotension, hypertension.

GI: abdominal cramping, hiccups, nausea, vomiting.

Patient/Family Teaching

• Inform patient that this medication will decrease mental recall of the procedure
• May cause drowsiness or dizziness. Advise patient to request assistance prior to
ambulation and transfer and to avoid driving or other activities requiring alertness for
24 hr following administration