DRUG STUDY

HYDROXYZINE BRAND NAMES: Atarax; Vistaril DRUG CLASS AND MECHANISM: Hydroxyzine is an antihistamine with anticholinergic (drying) and sedative properties that is used to treat allergic reactions. The body releases histamine during several types of allergic reactions and--to a lesser extent--during some viral infections, such as the common cold. When histamine binds to its receptors on cells, it causes the cells to release chemical messengers that lead to sneezing, itching, and increased mucus production. Antihistamines, like histamine, binds to the histamine receptors, but when they bind to the receptors they do not stimulate the cells to release chemical messengers. In addition, they prevent histamine from binding and stimulating the cells. Hydroxyzine itself has no activity. After ingestion, it is converted to its active form. The active form of hydroxyzine is a drug called cetirizine (Zyrtec). Although, both hydroxyzine and cetirizine act as antihistamines, hydroxyzine causes more sedation than cetirizine. PRESCRIBED FOR: Hydroxyzine is used for the relief of pruritus (itching) caused by various allergic conditions. Hydroxyzine is also used for treating anxiety and tension, and inducing sedation prior to or after anesthesia. DRUG INTERACTIONS:

Hydroxyzine adds to (exaggerates) the sedating effects of alcohol and other drugs that can cause sedation such as the benzodiazepine class of anti-anxiety drugs [for example, diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax)], the narcotic class of pain medications and its derivatives [for example, oxycodone and acetaminophen (Percocet), hydrocodone/acetaminophen (Vicodin), guaifenesin (Dilaudid), Codeine, propoxyphene (Darvon)], the tricyclic class of antidepressants [for example, amitriptyline (Elavil), imipramine (Tofranil), desipramine (Norpramin)], and certain antihypertensive medications [for example, clonidine (Catapres), propranolol (Inderal)]. Hydroxyzine can also intensify the drying effects of other medications with anticholinergic properties [for example, dicyclomine (Bentyl), bethanechol (Urecholine), Probanthine, amitriptyline (Elavil), chlorpromazine (Thorazine)]. When using these drugs, the dose of hydroxyzine may require reduction, therefore. SIDE EFFECTS:

Hydroxyzine can commonly cause sedation, tiredness, sleepiness, dizziness, disturbed coordination, drying and thickening of oral and other respiratory secretions, and stomach distress. Hydroxyzine may also cause confusion, nervousness, irritability, blurred vision, double vision, tremor, loss or appetite, or nausea. Hydroxyzine should be used with caution (if at all) in

persons with narrow-angle glaucoma, prostatic hypertrophy (enlarged prostate gland), hyperthyroidism, cardiovascular disease, hypertension, and asthma. INTERVENTIONS

Determine and treat underlying cause of vomiting. Drug may mask signs and symptoms of serious conditions, such as brain tumor, intestinal obstruction, appendicitis. Do not administer parenteral solution SC, IV, or intra-arterially; tissue necrosis has occurred with SC and intra-arterial injection, hemolysis with IV injection. Give IM injections deep into a large muscle. In adults, use upper outer quadrant of buttocks or midlateral thigh; in children use midlateral thigh muscles; use deltoid area only if well developed. MIDAZOLAM BrandName:MIDAZOLAM CLASSIFICATIONS Therapeutic: Anti-anxiety agents, sedative/hypnotics Pharmacologic: benzodiazepines ACTIONS Physiologic Mechanism

Short-term sedation Postoperative amnesia Pharmacologic Mechanism Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter. INDICATION

 Preprocedural sedation. Aids in the induction of anesthesia and as part of balanced anesthesia.

NURSING CONSIDERATIONS

Assess level of sedation and level of consciousness throughout and for 2-6 hr following administration. Monitor BP, pulse and respiration continuously during IV administration. Oxygen and resuscitative equipment should be immediately available. If overdose occurs, monitor pulse, respiration , and BP continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning and vasopressors. The effects of midazolam can be reversed with flumazenil (Romazicon). SIDE EFFECTS

Blurred vision; changes in blood pressure, breathing, and heartbeats; coughing; dizziness; drowsiness; dry mouth; headache; hiccups; low blood pressure (children); nausea; pain during injection; pain, redness, or tenderness at the injection site; short-term memory loss; slurred speech; vomiting.

METHERGINE This medication is used after childbirth to help stop bleeding from the uterus. Methylergonovine belongs to a class of drugs known as ergot alkaloids. It works by increasing the rate and strength of contractions and the stiffness of the uterus muscles. These effects help to decrease bleeding. How to use Methergine Oral

Take this medication by mouth with or without food, usually 3 to 4 times daily for up to 1 week after delivery or as directed by your doctor. Dosage is based on your medical condition and response to treatment. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor instructs you otherwise. Grapefruit can increase the amount of this medication in your bloodstream. Consult your doctor or pharmacist for more details. Tell your doctor if your condition persists or worsens. Side Effects

Headache, nausea, vomiting, or dizziness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these rare but serious side effects occur: fast/slow heartbeat, shortness of breath, cold hands/feet, pain/redness/swelling of arms or legs. Seek immediate medical attention if any of these rare but serious side effects occur: chest pain, vision changes, confusion, seizures. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. Precautions

Before taking methylergonovine, tell your doctor or pharmacist if you are allergic to it; or to similar ergot alkaloids (such as ergonovine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, high blood pressure, heart disease (such as venoatrial shunts, mitral valve stenosis), blood vessel disease (such as Raynaud's disease), complications during pregnancy (such as preeclampsia, eclampsia). This drug may make you dizzy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. This medication must not be used during pregnancy. It may harm an unborn baby. Consult your doctor for more details.

This medication passes into breast milk, but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. Interactions

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring. To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval. Some products that may interact with this drug include: other ergot alkaloids (such as ergotamine, dihydroergotamine), "triptan" migraine medications (such as eletriptan, rizatriptan, sumatriptan). Other medications can affect the removal of methylergonovine from your body, which may affect how methylergonovine works. Examples include azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as erythromycin, clarithromycin), HIV protease inhibitors (such as ritonavir), HIV NNRTI's (such as delavirdine, efavirenz), among others. For women in their childbearing years, the chances of having a miscarriage can range from 1025%, and in most healthy women the average is about a 15-20% chance.

An increase in maternal age affects the chances of miscarriage Women under the age of 35 yrs old have about a 15% chance of miscarriage Women who are 35-45 yrs old have a 20-35% chance of miscarriage Women over the age of 45 can have up to a 50% chance of miscarriage A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)