propofol (Diprivan) 

class

nonbarbiturate hypnotic agent; “milk of anesthesia”

propofol (Diprivan)

indication 

induction and maintenance of general anesthesia,

maintenance of ICU sedation,

refractory status epilepticus

propofol (Diprivan)

MOA 

unknown, thought to be mediator of GABA receptors, action immediate and short-lived

propofol (Diprivan)

pharmacokinetics 

IV, rapid distribution, loss of consciousness <40 seconds,  duration 3-5 minutes

propofol (Diprivan)

contraindictions/precautions 

• hypersensitivity to drug or ingredients of emulsion; 
• pregnancy/lactation;
• caution w/ cardiac, PVD, CVA, DM, hyperlipids and pancreatitis.

propofol (Diprivan)-

adverse effects 

• N/V; 
• involuntary muscle movement, 
• hypotension, 
• APNEA in 50-84% pts.  
• Note that long term use causes bright green urine.    

propofol (Diprivan)-

drug interactions 

• potentiated effects with other CNS drugs

propofol (Diprivan)-

nursing interventions 

• MUST be in critical care environment; 
• CONTINUOUS MONITORING of BP, CO, pulm cap wedge pressure, respiratory system.  
• Turn q2h and assess skin. 
• Check lipid levels q3-7 days.  
• Discard preparation if discoloration or particulate matter or emulsion separated d/t risk of bacterial growth.

• Lidocaine

• indications

local, regional and nerve blocks

Lidocaine

MOA

reversible nerve conduction blockade, diminishes nerve membrane permeability to sodium

Lidocaine

Pharmcokinetics

topical, oral, SQ, ID, submucosally, IV;

topical lasts 30-40 min;  SQ lasts 1-3 hrs

Lidocaine

Contraindications/Precautions

hypersensitivity, infection/inflammation at topical site

*if epinephrine is added will decrease systemic effect but pt will have adverse effects from epinephrine and think its specifically just the lidocaine

Lidocaine

Adverse Effects

• allergic reactions (hives to anaphylactic shock);
• topical may cause erythema.
• Oral and mucosal may interfere w/ swallowing ASPIRATION RISK!

Lidocaine

Nursing Interventions

• Assess for sensitivity.  
• Do not apply to denuded (raw) skin.  
• Assess swallowing before eating/drinking. 
• Restrict food/fluids 1 hours after viscous preparation.

vecuronium (Norcuron)

Class

• Nondepolarizing-keep muscle relaxed

vecuronium (Norcuron)

indications

Skeletal muscle relaxant used as an adjunct to general anesthetics or in ICU to decrease patient movement.

vecuronium (Norcuron)

MOA

vecuronium (Norcuron)

Pharmacokinetics

Administered: IV.

Onset: 2-4 minutes. Peak: 3-5 minutes. Duration 30-60 minutes.

vecuronium (Norcuron)

Contraindications/Precautions

vecuronium (Norcuron)

Adverse Effects

vecuronium (Norcuron)

Drug interactions

• Decrease: carbamazepine
• Increase: antibiotics, inhalation anesthetics, magnesium salts, quinine derivatives, and verapamil

vecuronium (Norcuron)

Health Status

• Assess for history of hypersensitivity and chronic conditions.

vecuronium (Norcuron)

Environment

vecuronium (Norcuron)

Max therapeutic effects

• Help patients understand the reason for the therapy.
• Monitor patients carefully for pain or distress.

vecuronium (Norcuron)

min adverse effects

• Have resuscitation equipment at the bedside.
• Evaluate the depth of paralysis by use of a stimulator.
• Change the patient’s position frequently.

vecuronium (Norcuron)

Pt and family education

• Before administration, explain to patients and families that the drug will paralyze muscles.
• Advise patients that adverse effects may occur after administration.

vecuronium (Norcuron)

ongoing assessment and evaluation

• Monitor the respiratory and cardiac status of the patient.
• Conscious patients should be monitored for any sign of distress. d verapamil

Succinylcholine (Anectine)

Class

• Depolarizing-muscle contracts and unable to go

into a relaxed state

Succinylcholine (Anectine)

Indications

• Used primarily for rapid endotracheal intubation and endoscopic procedures.

Succinylcholine (Anectine)

Pharmacokinetics

• Administered: IV or IM. Onset & duration: vary with route.

Succinylcholine (Anectine)

MOA

• Agonist at the cholinergic nicotinic receptors of the motor end plate.

Succinylcholine (Anectine)

contraindications/precautions

• Hypersensitivity or patient/family history of malignant hyperthermia

Succinylcholine (Anectine)

Adverse Effects

• Adverse effects are associated with muscle paralysis
• Can cause histamine release

Succinylcholine (Anectine)

Drug Interactions

• Aminoglycosides, anticholinesterases, procaine, and trimethaphan

Succinylcholine (Anectine)

Life spand and gender

• Pregnancy category C- should not be given

Succinylcholine (Anectine)

Environment

• Be aware of the environment in which the drug will be given- monitored in high intensity areas

Succinylcholine (Anectine)

max therapeutic effects

Help the patient understand the rationale for the therapy.

Succinylcholine (Anectine)

min adverse effects

• To decrease muscle fasciculations: give a small dose of a nondepolarizing NMJ blocker.

• A muscle spasm is a sudden, violent involuntary contraction of a muscle or group of muscles.
• Spasms are related to a localized skeletal muscle injury or an imbalance in electrolytes.
• Tonic spasm is characterized by an unusually prolonged and strong muscular contraction

• Spasticity is a condition in which certain muscles are continuously contracted.
• This contraction causes stiffness or tightness of the muscles. 
• Spasticity may be associated with spinal cord injury.

cyclobenzaprine (Flexeril)

indications 

• Manages muscle spasms associated with acute musculoskeletal disorders
• short term whule injury heals

cyclobenzaprine (Flexeril)

pharmacokinetics

• Administered: oral. Metabolism: liver. Excreted: urine and bile. Onset: 1 hour. Duration: 12-24 hours.
• mostly excreted in bile in feces so does not depend on renal function

cyclobenzaprine (Flexeril)

MOA

• Relieves muscle spasms through a central action

cyclobenzaprine (Flexeril)

Contraindications and precautions

• Hyperthyroidism
• 14 days within use of MAOIs

cyclobenzaprine (Flexeril)

Adverse Effects

• CNS depression and anticholinergic activity
• Arrhythmias, seizures, and MIs**

cyclobenzaprine (Flexeril)

• Tramadol, guanethidine, MAOIs, histamine-1 blocking agents, and various herbal remedies

cyclobenzaprine (Flexeril)

Assess past medical history and drug allergies- cardiovascular hx most important

cyclobenzaprine (Flexeril)

life span and gender

• Pregnancy category B
• Use precaution in administration to elderly

cyclobenzaprine (Flexeril)

lifestyle, diet, habits

Avoid alcohol and other CNS depressant use (pain meds)

assess ability to drive

cyclobenzaprine (Flexeril)

max therapeutic effects

• Take with full glass of water at evenly spaced intervals (once when waking up, once before bed, and sometime exactly inbtwn)
• Coordinate physical therapies with administration

cyclobenzaprine (Flexeril)

min adverse effects

• Assess for excessive sedation
• Caution the patient about the potential for orthostatic hypotension (elderly get up slowly)

cyclobenzaprine (Flexeril)

pt and family education

• Take medication as prescribed
• Explain adverse effects- know what to report
• Do not take with other OTC medications- ask HCP

baclofen (Lioresal)

class

Centrally Acting Spasmolytics

baclofen (Lioresal)

indications

Relieves some components of spinal spasticity- allows pt to participate in PT  

baclofen (Lioresal)

pharmacokinetics

• Administered: oral. Distribution: crosses blood–brain barrier. 
• Metabolism: liver. Excreted: urine and bile. Peaks: 2–3 hours.

baclofen (Lioresal)

MOA 

• Acts specifically at the spinal end of the upper motor neurons at GABA_B receptors to cause hyperpolarization

baclofen (Lioresal)

Contra/precautions

Hypersensitivity and spasticity of cerebral origin (not used in parkinsons or strokes)

baclofen (Lioresal)

adverse effects

• Drowsiness, 
• weakness, 
• dizziness and lightheadedness, 
• headache, 
• nausea and vomiting, 
• hypotension, constipation,
• lethargy and fatigue, 
• confusion, 
• insomnia, 
• and increased urinary frequency

baclofen (Lioresal)

drug interactions

CNS depressants (monitor I &O) or TCAs (these also cause muscle weakness and loss of muscle tone)

baclofen (Lioresal)

health status

• Assess past medical history and allergies
• Perform physical assessment

baclofen (Lioresal)

life span and gender

Older patients are more susceptible to sedation 

baclofen (Lioresal)

lifestyle, diet, habits

• Caution the patient about the concurrent use of alcohol

baclofen (Lioresal)

max therapeutic effects

• Take with full glass of water at evenly spaced intervals
• If GI distress occurs, coordinate with meals

baclofen (Lioresal)

min adverse effects

• Ensure patient safety
• Do not abruptly stop medication 

baclofen (Lioresal)

ongoing assessment and evaluation

• Monitor for the emergence of hallucinations or psychotic episodes
• Assess for improved symptoms of spasticity 

methotrexate (Rheumatrex)

class

Disease-Modifying Antirheumatic Drugs (DMARDs): 

methotrexate (Rheumatrex)

indications

• Folate antimetabolite used in treating various malignancies and rheumatoid arthritis.

methotrexate (Rheumatrex)

pharmacokinetics

• Administered: orally or parenterally. Metabolized in the liver, excreted in the kidneys.

methotrexate (Rheumatrex)

MOA

• Exerts immunosuppressive effects by inhibiting the replication and function of T lymphocytes that stimulate the production of cytokines.

methotrexate (Rheumatrex)

contra/ precautions

• Immunosuppression, blood dyscrasia, 
• pregnancy category X, and lactation (must be off for 3 months, both men and women)

methotrexate (Rheumatrex)

adverse effects

• Rash, headache, nausea and vomiting, diarrhea, stomatitis, alopecia, suppression of bone marrow

methotrexate (Rheumatrex)

drug interactions

methotrexate (Rheumatrex)

Life span and gender-

• Give with caution to the young and elderly.
• evaulate nutrition due to immunosuppression
• caution with comorbidities

methotrexate (Rheumatrex)

max therapeutics effects

• Administer medication as ordered.
• Drink plenty of water to prevent nephrotoxicity.

methotrexate (Rheumatrex)

min adverse effects

• Folic acid will interfere with effectiveness of drug. ???? check this
• Can cause photosensitivity.

methotrexate (Rheumatrex)

pt and family teaching

• Instruct patient how to administer medication properly.
• Teach adverse effects to report to physician.

methotrexate (Rheumatrex)

ongoing assessment and evaluation

• Monitor patients for signs of blood dyscrasias, suppressed bone marrow function, pulmonary changes, and hepatic or renal dysfunction.
• Effective treatment should show improved symptoms. (3-6 weeks)

Etanercept (Enbrel)

class

Tumor Necrosis Factor Inhibitors

Etanercept (Enbrel)

indications

• Used in managing RA, psoriasis, ankylosing spondylitis

Etanercept (Enbrel)

pharmacokinetics

• Weekly subcutaneous injection. Its onset is slow and duration is uncertain.   

Etanercept (Enbrel)

MOA

• Binds specifically to circulating TNF, prevents it from binding to TNF receptors on the cell membranes, and prevents the TNF-mediated cellular response

Etanercept (Enbrel)

contra/precautions

• Hypersensitivity
• Current infections or malignancy (high risk of infections)

Etanercept (Enbrel)

Adverse Effects

• Injection-site reactions, 
• upper respiratory infections, 
• headache, nausea, and rhinitis.
•  Serious effects: induction of demyelinating diseases, and blood dyscrasias
• INFECTION!

Etanercept (Enbrel)

lifespan and gender

• Pregnancy category B.
• Can be given >4 yo but they can not have vaccines

Etanercept (Enbrel)

lifestyle, diet and habits

• Evaluate nutritional status.

Etanercept (Enbrel)

max therapeutic effects

• Administer weekly as prescribed.
• Rotate the injection sites. (dont give within 1 inch of each other or on tender or hardened areas)

Etanercept (Enbrel)

min adverse effects

• Use aseptic technique when administering. 
• Do not administer if the drug solution is discolored or cloudy or contains particles.
• Do not administer live-virus vaccines.

Etanercept (Enbrel)

pt and family teaching

• Teach symptoms to report.
• Teach proper preparation and administration of drug.
• Stress importance of avoiding others who are ill.

Etanercept (Enbrel)

ongoing assessment and evaluation

• Assess for improved range of motion, decreased early morning stiffness, and painful/swollen joints. (the drug is working)  
• Coordinate laboratory testing for CBC, C-reactive protein levels, and Erythrocyte Sedimintation Rate. Review aseptic technique at each visit.

Colchicine

indications

• Treating acute gout and as presurgical prophylaxis to prevent gout.

Colchicine

pharmacokinetics

• Administered: Oral or IV. Metabolism: liver. Excreted: feces.
• can admin to pt with renal defiences

Colchicine

MOA

• Inhibits the activity of leukocytes by decreasing their migration into the affected area.

Colchicine

Contra/precautions

• Cardiac disease, hepatic disease, and renal disease

Colchicine

Adverse Effects

• Nausea, vomiting, diarrhea, abdominal pain, and paralytic ileus

Colchicine

drug interactions

• Radiation therapy, drugs that depress bone marrow function and cyanocobalamin
• will effect B 12 vitamin, pts will stay anemic

Colchicine

health status

Assess for conditions that are contraindicated in therapy.

Baseline CBC and good assessment of joint 

Colchicine

life span and gender

Colchicine

Lifestyle, diet and habits

Colchicine

max therapeutic effects

• Administer with a full glass of water at evenly spaced intervals throughout the day.
• Adherence to diet and alcohol restrictions decreases hyperuricemia.
• take 1 tab q2h until diarrhea starts then STOP med

Colchicine

min adverse effects

• Monitor pre-existing medical conditions.
• Start medications at the first sign of an attack. (kind of PRN)

Colchicine

pt and family education

• Discuss importance of dietary restrictions.
• Discuss side effects of therapy.

Colchicine

ongoing assessment and evaluation

• Monitor for hematopoietic and renal toxicity, joint involvement, deformity, and range of motion.
• Therapy is considered effective if the patient reports decreased frequency of acute gout attacks and remains free of adverse effects.

Allopurinol (Zyloprim)

indications

• Management of chronic gout, recurrent calcium renal stones, and hyperuricemia.

Allopurinol (Zyloprim)

pharmacokinetics

• Administered: oral or IV. Metabolism: liver. 

Allopurinol (Zyloprim)

MOA

• Decreases the production of uric acid by inhibiting the action of xanthine oxidase.

Allopurinol (Zyloprim)

Adverse effects

• Pruritus, maculopapular rash, nausea and vomiting, elevated LFTs, and acute gout symptoms

Allopurinol (Zyloprim)

lifespan and gender

Pregnancy category C.

Allopurinol (Zyloprim)

health status

Allopurinol (Zyloprim)

drug interactions

Allopurinol (Zyloprim)

lifestyle, diet, habits

Allopurinol (Zyloprim)

max therapeutic effects

• Administer allopurinol in conjunction with colchicine.
• Assist the patient to develop meal plans that limit uric acid production.

Allopurinol (Zyloprim)

min adverse effects

• Fluid intake should range between 2.5 and 3 L/day.
• Titrate drug based on uric acid levels.

Allopurinol (Zyloprim)

pt and family education

• Take medication as prescribed.
• Teach adverse effects and when to notify provider.
• Teach importance of fluid intake.

Allopurinol (Zyloprim)

ongoing assessment and evaluation

• Therapy is considered effective when the patient reports reduced pain and inflammation and remains free of adverse effects.