College of Nursing & Health Sciences
School of Nursing
Nursing Lab 473
Mechanism of Action
Why is your pt. receiving the med?
Common Side Effects
Nursing Implications/Concerns and Pertinent Labs
Antihistamine, H1, Sedating
An ethanolamine that competitively blocks the effects of histamine at peripheral H1 receptor sites
Produces anticholinergic, antipruritic, antitussive, antiemetic, antidyskinetic, and sedative effects.
Decreases itching after receiving epidural or narcotic.
Somnolence, dizziness, muscle weakness, hypotension, urine retention, thickening of bronchial secretions, dry mouth, nose, throat, or lips
Overdose symptoms (CNS depression): sedations, apnea, hypotension, cardiovascular collapse, and death to severe paradoxical reactions, such as hallucinations, tremor, and seizures.
Alcohol, other CNS depressants: may increase depressant effect.
Anticholinergics: may increase anticholinergic effects
CYP2D6 substrates: levels of substrates may be increased
MAOIs: may increase anticholinergic and CNS depressant effects.
Crosses the placenta and appears in breast milk.
Not recommended for neonates or premature infants.
Monitor respiratory rate, depth, and rhythm; pulse rate and quality; blood pressure; and therapeutic response. Will suppress skin allergy testing.
Beta adrenergic agent
0.25mg SQ every 15 minutes for 45 minutes
PO dose 2.5-5mg
Relaxes smooth muscles, inhibiting uterine activity and causing bronchodilation
Used in pregnancy to stop preterm labor
Indicated as an antidote for Pitocin
Smooth muscle relaxant – the uterus is a smooth muscle so it will work almost instantly
Tachycardia, increased respirations, flushing, palpitations, tremors, headache, N/V, hypokalemia, ketonuria, altered glucose metabolism, fetal tachycardia
One on one patient care
Use subcutaneous pump if necessary for continuous subcutaneous therapy
Continuous monitoring of uterine activity and contractions and fetal heart monitoring.
SQ, small amount, potent (0.25mg=0.25mL)
Hold if heart rate is above 120BPM
Give does every 15 minutes x3 if contractions have not gone away – check HR between each dose
May send patient home on PO Brethine to maintain uterine relaxation, teach S/S of preterm labor.
An amide-type anesthetic that stabilizes neonatal membranes and prevents initiation and transmission of nerve impulses, thereby effecting local anesthetic actions.
Produces local analgesia
Indications: epidural analgesic, spinal anesthesia
Produces rapid pain relief by blocking the nerve thereby decreasing the perception of pain. Causes vasodilation, loss of motor control in lower extremities, and loss of bladder control.
CNS depression, Hypotension, bradycardia, palpitations, respiratory depression, dizziness, headache, N/V, restlessness, weakness, blurred vision, tinnitus, apnea.
Effects may last one hour postpartum
S/S of hypotension – nauseated, pale, diminished color, feel the need to vomit
Angiotensin-converting enzyme inhibitors: may increase risk of bradycardia and hypotension as well as loss of consciousness.
Beta blockers, MAOIs, TCAs, vasopressors: may increase the risk of bupivacaine toxicity.
Propofol: may increase hypnotic effect
Ropivicaine: may prolong effect of intrathecal bupivacaine.
Verapamil: may increase risk of heart block
No known diagnostic effects.
Only concentrations lower than 0.75% should be used for obstetrical anesthesia.
May cause severe disturbances of cardiac rhythm, shock, or heart block after spinal anesthesia.
Monitor for arrhythmias.
Fetal bradycardia frequently follows obstetrical paracervical block with some amide-type local anesthetics and may be associated with fetal acidosis.