Doxapram

INTRODUCTION

Indications

Used in carefully selected short-term situations with other supportive measures to treat postoperative patients with respiratory depression secondary to anesthesia. Prevention of acute hypercapnia during administration of oxygen to patients with acute respiratory insufficiency due to COPD (short-term only—less than 2 hr). Treatment of mild-to-moderate respiratory and CNS depression due to drug overdosage.

Action

In low doses, stimulates breathing by activating carotid receptors. Larger doses directly stimulate the respiratory center in medulla as well as produce generalized CNS stimulation. Therapeutic Effects: Transient increase in tidal volume, small increase in respiratory rate. Oxygenation is not increased.

Adverse Reactions/Side Effects

CNS: SEIZURES, apprehension, disorientation, dizziness, headache. EENT: gagging, mydriasis. Resp: LARYNGOSPASM, bronchospasm, cough, dyspnea, hiccups, rebound hypoventilation, tachypnea. CV: arrhythmias, changes in heart rate, chest pain, hypertension, T-wave inversion. GI: diarrhea, nausea, vomiting. GU: albuminuria, perineal/genital burning sensation, spontaneous voiding, urinary retention. Derm: flushing, pruritus, sweating. Hemat: hemolysis. Local: phlebitis. MS: involuntary movement, muscle spasticity, skeletal muscle hyperactivity. Neuro: generalized clonus, paresthesia, positive bilateral Babinski's sign. Misc: fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician or nursing staff.

• Monitor signs of laryngeal spasm and bronchospasm such as wheezing, cough, dyspnea, and tightness in chest and throat. Notify physician or nursing staff immediately.

• Assess respiratory function using pulse oximetry and pulmonary function tests (see Appendix I) to help determine if drug therapy is successful in improving respiratory depression and normalizing blood gases.

• Assess heart rate, ECG, and heart sounds (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report a sustained increase in BP (hypertension).

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor and report other changes in mood and behavior, including apprehension or disorientation.

• Assess any muscle hyperactivity, spasticity, involuntary movements, or numbness and tingling. Report severe or prolonged neuromuscular symptoms.

• Assess injection site during and after IV administration, and report signs of phlebitis (local pain, swelling, inflammation).

Interventions

• Because of the risk of cardiac effects (arrhythmias, hypertension) and residual respiratory depression, use caution during therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately ...