SAFE MEDICATION ADMINISTRATION

Safe Medication Administration



Safe Medication Administration

Question 1

Description

Neostigmine is a quaternary ammonium anticholinesterase that acts by inhibiting the enzyme cholinesterase. The primary use in anesthetic practice is related to the reversal of neuromuscular blockade produced by non-depolarizing neuromuscular relaxants.

Drug Action

Mrs Lim is prescribed Neostigmine because it acts as a competitive inhibitor of acetylcholinesterase by a binding mechanism similar to that of the same acetylcholine. There is a subsequent transfer, however, the carbamate group of the molecule of neostigmine to the ester of acetylcholinesterase. Neostigmine, also thought to have a presynaptic action, produces an increased level of acetylcholine release. Both actions have similar results, as mentioned above. It acts as acetylcholine within the neuromuscular junction, the competitive mechanism for the cholinergic receptor eventually tilted in favor of acetylcholine rather than by non-depolarizing muscle relaxant (Ouellette, 2010).

Adverse Reactions

Adverse reactions are those, which relate to undesirable muscarinic effects of neostigmine, enumerardos, when used as an agent for reversing neuromuscular blockade. These are reduced by concomitant administration of anticholinergic drugs such as glycopyrrolate. It is also reported as side effects such as rash, urticaria, and nausea.

The anticholinesterase overdose can lead to uncontrolled muscarinic effects with the addition of nicotinic effects weakened skeletal muscles, cramps or paralysis. Large doses of CNS effects may include confusion, ataxia, seizures, coma and depression of ventilation. Treatment is with atropine 30-70 mg / kg IV every 3-10 minutes until muscarinic effects diminish.

Drug Interactions

The antagonism of neuromuscular blockade is decreased by the concomitant use of some antibiotics such as aminoglycosides. Combinations with other anticholinesterase neostigmine produce an additive effect of both drugs (Surhone, 2010). Anticholinesterase activity may also have other effects as changes in the metabolic, respiratory acidosis, hypokalemia and metabolic alkalosis.

Question 2

Mrs Lim is prescribed Amiodarone because of its interaction with warfarin as Mrs Lim suffers from atrial fibrillation. The drug in combination with warfarin can be significant in patients with atrial fibrillation. The drug belongs to class III antiarrhythmic drugs although, it has the properties of antiarrhythmic drugs in all four classes. The main electrophysiological effect of amiodarone is the lengthening of the potential action and, therefore, the refractory period due to the blockade of potassium channels.

Action

The drug causes a moderate blockade of sodium channels (class I effect), non-competitive?-Adrenergic blockade (Class II effect) and to some extent - a calcium channel blockade (class IV effect).

Administration of the Drug

Instruction recommends starting with a reception 1200-1600 mg / day divided in doses of 5 to 14 days (Foundation for a Drug-Free World, 2008). Then the daily dose of amiodarone reduces to 400-600 mg. After several weeks of therapy, the patient is transferred to a maintenance dose - 200-400 mg / day. Intravenous form of amiodarone is usually used to treat life-threatening arrhythmias.

Side Effects

Unfortunately, while taking amiodarone, it may develop a variety of side effects - from mild to life-threatening effects. In connection with the cumulation of even low doses can cause significant side effects, and the addition of new risk increases with duration of ...