Pain management in elderly
Perioperative
5. Benzodiazepines ( Lorazepam/ Ativan)
Classification: anesthetic adjuncts, antianxiety agents, sedative hypnotics
Perioperative use: Decreases preoperative anxiety and provides amnesia.
Adverse reactions: APNEA, CARDIAC ARREST, bradycardia, hypotension.
Contraindications: Severe hypotension; Sleep apnea; OB, Lactation: Use in pregnancy and lactation may cause CNS depression. Do not use for pt. with seizure disorders.
Interactions: Additive CNS depression with other CNS depressants including alcohol, antihistamines, antidepressants, opioid analgesics, clozapine, and other sedative/hypnotics including other benzodiazepines. Smoking may metabolism and decrease effectiveness.
Nursing implications:
Anxiety: Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically throughout therapy.
Toxicity and Overdose: If overdose occurs, flumazenil (Romazicon) is the antidote
Hydroxyzine (Vistaril):
Classification: antiemetic, Anti-anxiety, antihistamine, sedative hypnotic
Perioperative use: control of nausea and vomiting as adjunct to analgesia pre-op and post-op, to allow decreased opioid dosage. (pg 466)
Adverse reactions: drowsiness, agitation, ataxia, dizziness, headache, weakness, wheezing, dry mouth, bitter taste, constipation, nausea, urinary retention, chest tightness.
Contraindications: Hypersensitivity; OB, Severe hepatic dysfunction, Geriatric patients are more susceptible to adverse reactions due to anticholinergic effects; dosage reduction recommended.
Interactions: Additive CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, and sedative/hypnotics.
Nursing implications:
Assess patient for profound sedation, Monitor for drowsiness, agitation, over sedation, and other systemic side effects. Assess falls risk and implement prevention strategies. Nausea and Vomiting: Assess degree of nausea and frequency and
5. Benzodiazepines ( Lorazepam/ Ativan)
Classification: anesthetic adjuncts, antianxiety agents, sedative hypnotics
Perioperative use: Decreases preoperative anxiety and provides amnesia.
Adverse reactions: APNEA, CARDIAC ARREST, bradycardia, hypotension.
Contraindications: Severe hypotension; Sleep apnea; OB, Lactation: Use in pregnancy and lactation may cause CNS depression. Do not use for pt. with seizure disorders.
Interactions: Additive CNS depression with other CNS depressants including alcohol, antihistamines, antidepressants, opioid analgesics, clozapine, and other sedative/hypnotics including other benzodiazepines. Smoking may metabolism and decrease effectiveness.
Nursing implications:
Anxiety: Assess degree and manifestations of anxiety and mental status (orientation, mood, behavior) prior to and periodically throughout therapy.
Toxicity and Overdose: If overdose occurs, flumazenil (Romazicon) is the antidote
Hydroxyzine (Vistaril):
Classification: antiemetic, Anti-anxiety, antihistamine, sedative hypnotic
Perioperative use: control of nausea and vomiting as adjunct to analgesia pre-op and post-op, to allow decreased opioid dosage. (pg 466)
Adverse reactions: drowsiness, agitation, ataxia, dizziness, headache, weakness, wheezing, dry mouth, bitter taste, constipation, nausea, urinary retention, chest tightness.
Contraindications: Hypersensitivity; OB, Severe hepatic dysfunction, Geriatric patients are more susceptible to adverse reactions due to anticholinergic effects; dosage reduction recommended.
Interactions: Additive CNS depression with other CNS depressants, including alcohol, antidepressants, antihistamines, opioid analgesics, and sedative/hypnotics.
Nursing implications:
Assess patient for profound sedation, Monitor for drowsiness, agitation, over sedation, and other systemic side effects. Assess falls risk and implement prevention strategies. Nausea and Vomiting: Assess degree of nausea and frequency and