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Fentanyl is a synthetic opioid preferred for critically ill patients with hemodynamic instability or morphine allergy. It is a lipid-soluble agent that has a more rapid onset than morphine and a shorter duration.The metabolites of fentanyl are largely inactive and nontoxic, which makes it an effective and safe opioid. The use of fentanyl in the critical care unit is growing in popularity, and it is the preferred agent for acutely distressed patients. Fentanyl or hydromorphone are also recommended in hemodynamically unstable or renal impaired patients in the SCCM guidelines.It is available in intravenous, intraspinal, and transdermal forms. The transdermal form is commonly referred to as the Duragesic patchor the 72-hour patch.Because the side effects of fentanyl are similar to those of morphine, the nurse must monitor carefully the hemodynamic and respiratory response. When fentanyl is given by rapid administration and at higher doses, it has been associated with the additional hazard of bradycardia and rigidity in the chest wall muscles.[22,]The use of transdermal fentanyl is indicated rarely in the critically ill patient. The customary use of the “fentanyl patch” is for those experiencing chronic pain or cancer pain, and in critical care, it is used for the patient who requires extended pain control. Transdermal delivery requires 12 to 16 hours for onset of action, and it has a duration of 72 hours.If this delivery method is used, the patient will require other opioid management until the transdermal fentanyl takes effect.Nimodipine (Nimotop); Subarachnoid bleeding: calcium channel blocker used to decrease cerebral blood vessel spasm.
Actonel: drink water, don’t lay down, heathburnAntihypertensiveAricept: AlzheimerFlagyl: sexual transmitted diseaseViagraMuscarinicAldosteroneGlucagon: TestosteroneCNS agentsLeukotrienesParkinson’s pharmacology: dopamine(Osmitrol)Indications: Mannitol is used to treat cerebral edema, to reduce intraocular pressure, to increase the urinary excretion of toxic substances (salicylates, barbiturates, lithium, bromides), as an irrigating preparation to prevent hemolysis and hemoglobin accumulation during transurethral prostatic resection, and as an adjunct to other therapies in the treatment of edema in acute renal failure. Pharmacokinetics/Dosing: Very little if any mannitol is metabolized in the liver. See Table 33-1for the pharmacokinetics and dosages of the osmotic diuretics. Adverse EffectsThe adverse effects of mannitol include nausea, vomiting, dry mouth, headache, increased urination, and weakness. Mannitol may also cause visual disturbances, dizziness, and rash.(Diamox, Acetazolam, Apo-Acetazolamide)Acetazolamide is widely used as an antiglaucoma agent because it lowers intraocular pressure by decreasinaqueous humor by more than 50% (see Chapter 42for further discussion).IndicationsAcetazolamide is used to treat open-angle glaucoma and is also used as adjunct treatment with antiepileptic drug