NALBUPHINE HYDROCHLORIDE

NUBAINE

Drug Class:
Narcotic agonist-antagonist analgesic

Therapeutic Actions:

Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce

analgesia, sedation but also acts to cause hallucinations and is an antagonist at µ
receptors

Indications:
 Relief of moderate to severe pain
 Preoperative analgesia, as a supplement to surgical anesthesia, and for
obstetric analgesia during labor and delivery.

Contraindications/cautions:

 Contraindications: hypersensitivity to nalbuphine, sulfites; lactation.

 Use cautiously with emotionally unstable clients or those with a history of
narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial
asthma, COPD, respiratory depression, anoxia, increased intracranial
pressure, acute MI when nausea and vomiting are present, biliary tract
surgery.

Dosages:
Available Forms:
Injection – 10 mg/ml, 20mg/ml
Adults:
Usual dose is 10 mg/70kg, SC, IM or IV q 3-6h as necessary.
Individualize dosage. In nontolerant patients, the recommended single
maximum dose is 20mg, with a maximum total daily dose of 160mg.
Patients dependent on narcotics may experience withdrawal symptoms.

Pediatric patients < 18 yr : Not recommended

Geriatric patients or patients with renal or hepatic impairment: Reduce dosage

Pharmacokinetics:

Route Onset Peak Duration

IV 2-3 min 15-20 min 3-6 hr
SC/IM < 15 min 30-60 min 3-6 hr

Metabolism: hepatic, T ½: 5 hr
Distribution: Crosses placenta, enters breast milk
Excretion: Urine

IV facts
 Preparation: No additional preparation is required.

Infusion: Administer by direct injection or into the tubing of a running IV, each 10
mg over 3-5 min.

V-site incompatibilities: Do not give with nafcillin

Adverse Effects:

CNS: Sedation. Clamminess, sweating headache, nervousness, restlessness,

depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations,
euphoria, dysphoria, unreality, dizziness, vertigo, floating feeling, feeling of heaviness,
numbness, tingling, flushing, warmth, blurred vision.

CV: Hypotension, Hypertension, bradycardia, tachycardia

DERMATOLOGIC: Itching, burning, urticaria

GI: Nausea, vomiting, cramps, dyspepsia, bitter taste, dry mouth

GU: Urinary urgency

RESPIRATORY: Respiratory depression, dyspnea, asthma

PROMETHAZINE HYDROCHLORIDE
PHENERGAN

Drug class:

Phenothiazine, Dopaminergic bloking agent, Antihistamine, Antiemetic, Anti-

motion sickness agent, Sedative/hypnotic.

Therapeutic Actions:

Selectively blocks H1 receptors, diminishing the effects of histamine on cells of

the upper respiratory tract and eyes and decreasing the sneezing, mucus production,
itching and tearing that accompany allergic reactions in sensitized people exposed to
antigens; blocks cholinergic receptors in the vomiting center that are believed to mediate
nausea and vomiting caused by gastric irritation, by input from the chemoreceptor trigger
zone; depress the RAS, including the parts of the brain involves in wakefulness.

Indications:

 Symptomatic relief of perennial and seasonal allergic rhinitis, vasomotor

rhinitis, allergic conjunctivitis; mild, uncomplicated urticaria and
angioedema; amelioration of allergic reactions to blood or plasma;
dermatographism, adjunctive theraphy.
 Treatment and prevention of motion sickness; prevention and control of
nausea and vomiting associated with anesthesia and surgery.
  Preoperative, postoperative or obstetric sedation.
 Adjunct to analgesics to control postoperative pain.
 Adjunctive IV therapy with reduced amounts of meperidine or other
narcotic analgesics in special surgical situations, such as repeated
bronchoscopy, ophthalmic surgery or in poor-risk patients

Contraindications/cautions:
 Contraindications: hypersensitivity to antihistamines or phenothiazines,
coma or severe CNS depression, bone marrow depression, vomiting of
unknown cause, concomitant therapy with MAOIs, lactation.
 Use cautiously with lower respiratory tract disorders, glaucoma, prostatic
hypertrophy, CV disease or hypertension, breast cancer, thyrotoxicosis,
pregnancy, children, a child with history of sleep apnea, a family history of
SIDS, or Reye’s syndrome, the elderly,.

Dosages:
Available Forms:
Tablets – 12.5,25,50 mg;
Syrup – 6.25,25mg/5ml
Suppositories – 12.5,25,50 mg
Injection- 25,50 mg/ml

Adults:
Allergy – Average dose is 25 mg PO or by rectal suppository, preferably
hs. If necessary,12.5 mg PO before meals and hs; 25 mg IM or IV for
serious reaction.May repeat within 2 hr if necessary.

Motion sickness – 25mg PO bid. Initial doses should be scheduled ½-1hr

before travel; repeat in 8-12 hr if necessary. Thereafter, give 25 mg on
arising and before evening meal.

Nausea and vomiting – 25mg PO; repeat doses of 12.5-25mg as needed,

q4-6hr. give rectally or parenterally if oral dosage is not tolerated. 12.5-25
mg IM or IV, not to be repeated more frequently than q4-6hr.

Sedation: 25-50 mg PO, IM, IV.

Preoperative use: 50 mg PO the night before, or 50mg with an equal dose

of meperidine and the required amount of belladonna alkaloid.

Postoperative sedation and adjunctive use with analgesics: 25-50 mg PO,

IM or IV.

Labor: 50mg IM or IV in early stages. When labor is established, 25-75

mg with a reduced dose of narcotic. May repeat once or twice at 4-hr
intervals. Maximum dose within 24 hr is 100 mg.
Pharmacokinetics

Duration
Route Onset
Oral 20 min 12 hr
IM 20 min 12 hr
IV 3-5 min 12 hr

Metabolism: Hepatic, T 1/2 : unknown

Distribution: Crosses placenta, enters breast milk
Excretion: urine

Adverse Effects:

CNS: Dizziness, Drowsiness, poor coordination, confusion, restlessness, excitation,

convulsions, tremors, headache, blurred vision, diplopia, vertigo, tinnitur

CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles

DERMATOLOGIC: Urticaria, rash, photosensitivity, chills.

GI: Epigastric distress, nausea, vomiting, diarrhea, constipation

GU: Urinary frequency, dysuria, urinary retention, decreased libido, impotence

HEMATOLOGIC: Hemolytic anemia, hypoplastic anemia, thrombocytopenia,

leucopenia, agranulocytosis, pancytopenia.

RESPIRATORY: Thickening of brochial secretions, chest tightness, dry mouth,

suppression of cough reflex, potential for aspiration.

OTHER: Tingling, heaviness and wetness of hands.