Drug

Generic name:
MIDAZOLAM
HYDROCHLORIDE
Brand name: Dormicum
Classification: hypnotics &
sedatives
Dosage: 5mg/5mL

Generic Name:
NALBUPHINE
Brand name : Nubain
Classification: Opioid
agonist-antagonist analgesic

Indication
disturbances of sleep
rhythm, insomnia
esp difficulty in
falling asleep either
initially or after
premature
awakening, tab/inj:
sedation in premed
before surgical or
diagnostic
procedures,
induction &
maintenance of
anesth

Action
may potentiate the
effects of GABA,
depress the CNS, and
suppress the spread of
seizure activity

Adverse Reactions
rarely cardiorespiratory
adverse events, nausea,
vomiting, headache,
hiccoughs, laryngospasm,
dyspnoea, hallucination,
oversedation, drowsiness,
ataxia, rash, paradoxical
reactions, amnesic
episodes.

moderate to severe
pain
action: Nalbuphine
acts as anagonist at
specific
opioidreceptors in
the CNS toproduce
analgesia

Nalbuphine acts as an
agonist at specific
opioid receptors in the
CNS to
produceanalgesia,
sedation but also acts to
cause hallucinations
and is an antagonist at

Adverse reaction:
CNSeffects: Nervousness,
depression, restlessness,
crying, euphoria, floating,
hostility, unusual dreams,
confusion, faintness,
hallucinations, dysphoria,
feeling of heaviness

Nursing responsibilities
Do not administer intra-arterially, which may
produce arteriospasm or gangrene.
Do not use small veins (dorsum of hand or wrist)
for IV injection.
Administer IM injections deep into muscle.
Monitor IV injection site for extravasation.
Arrange to reduce dose of midazolam if patient is
also being given opioid analgesics; reduce dosage
by at least 50% and monitor patient closely.
Monitor level of consciousness prior to, during,
and for at least 26 hr after administration of
midazolam.
Carefully monitor P, BP, and respirations carefully
during administration.
Keep resuscitative facilities readily available;
have flumazenil available as antidote if overdose
should occur.
Keep patients in bed for 3 hr; do not permit
ambulatory patients to operate a vehicle following
an injection.
Arrange to monitor liver and kidney function and
CBC at intervals during long-term therapy.
Establish safety precautions if CNS changes occur
(use side rails, accompany ambulating patient).
Provide comfort measures and reassurance for
patients receiving diazepam for tetanus.
Arrange to taper dosage gradually after long-term
therapy.
Provide patient with written information
regarding recovery and follow-up care. Midazolam
is a potent amnesiac and memory may be altered.
Taper dosagewhen discontinuingafter
prolongeduse to avoidwithdrawalsymptoms.
Keep opioidsantagonist andfacilities for assisted or
controlledrespiration readilyavailable in case of
respiratorydepression.
Reassure patientabout addictionliability;
mostpatients whoreceive opiates for medical
reasonsdo not developdependencesyndrome

andsedation but also

acts tocause
hallucinations andits
antagonist at
mureceptors

receptors

,numbness,
tingling,unreality.
Theincidence of
psychotomimetic effects,
suchas
unreality,depersonalization,
delusions,dysphoria
andhallucinationshas
beenshown to beless than
thatwhich
occurswithpentazocine.
Cardiovascular:
Hypertension, hypotension,
bradycardia, tachycardia,
pulmonary edema.
Gastrointestinal: Cramps,
dyspepsia, bitter taste.
Respiration: Depression,
dyspnea, asthma.
Dermatological: Itching,
burning, urticaria

Drug
Generic Name:
PHENOBARBITAL
Brand name: Luminal
Sodium
Classification: Barbiturate
(long acting), Sedative,
Hypnotic, Anticonvulsant,
Antiepileptic agent

Indication
Sedative (oral or
parenteral)

Hypnotic,
short-term (up to 2
wk) treatment of
insomnia (oral or
parenteral)

Long-term
treatment of
generalized tonicclonic and cortical
focal seizures (oral)

Emergency
control of certain
acute convulsive
episodes (eg, those
associated with
status epilepticus,
eclampsia,
meningitis, tetanus,
and toxic reactions
to strychnine or
local anesthetics;
parenteral)

Preanesthetic
(parenteral)

Anticonvulsant
treatment of
generalized tonicclonic and cortical
focal seizures
(parenteral)

Action
General CNS
depressant; barbiturates
inhibit impulse
conduction in the
ascending RAS,
depress the cerebral
cortex, alter cerebellar
function, depress motor
output, and can produce
excitation, sedation,
hypnosis, anesthesia,
and deep coma; at
subhypnotic doses, has
anticonvulsant activity,
making it suitable for
long-term use as an
antiepileptic.

Adverse Reactions
Adverse reaction:
Somnolence, agitation,
confusion, hyperkinesia,
ataxia, vertigo, CNS
depression, nightmares,
lethargy, residual sedation
(hangover), paradoxical
excitement, nervousness,
psychiatric disturbance,
hallucinations, insomnia,
anxiety, dizziness, thinking
abnormality
Bradycardia, hypotension,
syncope
Nausea, vomiting,
constipation, diarrhea,
epigastric pain
Rashes, angioneurotic
edema, serum sickness,
morbiliform rash, urticaria;
rarely, exfoliative
dermatitis, Stevens-Johnson
syndrome
Pain, tissue necrosis at
injection site, gangrene;
arterial spasm with
inadvertent intra-arterial
injection; thrombophlebitis;
permanent neurologic
deficit if injected near a
nerve
Hypoventilation, apnea,

Nursing responsibilities
Monitor patient responses, blood levels (as
appropriate) if any of the above interacting
drugs are given with phenobarbital; suggest
alternative means of contraception to women
using hormonal contraceptives.
Do not administer intra-arterially; may
produce arteriospasm, thrombosis, gangrene.
Administer IV doses slowly.
Administer IM doses deep in a large muscle
mass (gluteus maximus, vastus lateralis) or
other areas where there is little risk of
encountering a nerve trunk or major artery.
Monitor injection sites carefully for irritation,
extravasation (IV use). Solutions are alkaline
and very irritating to the tissues.
Monitor P, BP, respiration carefully during IV
administration.
Arrange for periodic laboratory tests of
hematopoietic, renal, and hepatic systems
during long-term therapy.
Taper dosage gradually after repeated use,
especially in epileptic patients. When changing
from one antiepileptic drug to another, taper
dosage of the drug being discontinued while
increasing the dosage of the replacement drug.

respiratory depression,
laryngospasm,
bronchospasm, circulatory
collapse

Emergency
control of acute
convulsions
(tetanus, eclampsia,
epilepticus;
parenteral)
Generic name: DIAZEPAM
Brand name: Valium
Classification: Anxiolytics
Dosage: 10mg/2ml

relief of anxiety,
agitation & tension
due to
psychoneurotic
states & transient
situational
disturbances

a benzodiazepine that
probably potentiates the
effects of GABA,
depresses the CNS &
suppresses the spread
of seizure activity

Tolerance, psychological
and physical dependence,
withdrawal syndrome
drowsiness, dysarthria,
slurred speech, tremor,
transient amnesia, fatigue,
ataxia, headache, insomnia,
paradoxical anxiety,
hallucination

Do not administer intra-arterially; may produce

arteriospasm, gangrene.
Change from IV therapy to oral therapy as soon as
possible.
Do not use small veins (dorsum of hand or wrist)
for IV injection.
Reduce dose of narcotic analgesics with IV
diazepam; dose should be reduced by at least onethird or eliminated.
Carefully monitor P, BP, respiration during IV
administration.
Maintain patients receiving parenteral
benzodiazepines in bed for 3 hr; do not permit
ambulatory patients to operate a vehicle following
an injection.
Monitor EEG in patients treated for status
epilepticus; seizures may recur after initial control,
presumably because of short duration of drug
effect.
Monitor liver and kidney function, CBC during
long-term therapy.
Taper dosage gradually after long-term therapy,
especially in epileptic patients.
Arrange for epileptic patients to wear medical
alert ID indicating that they are epileptics taking
this medication.
Discuss risk of fetal abnormalities with patients
desiring to become pregnant.