Hydroxyzine

INTRODUCTION

Indications

Treatment of anxiety. Preoperative sedation. Antiemetic. Antipruritic. May be combined with opioid analgesics.

Action

Acts as a CNS depressant at the subcortical level of the CNS. Has anticholinergic, antihistaminic, and antiemetic properties. Blocks histamine 1 receptors. Therapeutic Effects: Sedation. Relief of anxiety. Decreased nausea and vomiting. Decreased allergic symptoms associated with release of histamine, including pruritus.

Adverse Reactions/Side Effects

CNS: drowsiness, agitation, ataxia, dizziness, headache, weakness. Resp: wheezing. GI: dry mouth, bitter taste, constipation, nausea. GU: urinary retention. Derm: flushing. Local: pain at IM site, abscesses at IM sites. Misc: chest tightness.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor any respiratory problems, including wheezing or tightness in the chest and throat. Report severe or prolonged respiratory symptoms to the physician.

• Be alert for increased anxiety or agitation, especially during the initial period of drug therapy. Notify physician about any problematic changes in mood or behavior.

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

• Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall- prevention strategies, especially in older adults or if balance is impaired (See Appendix E).

• Help patient explore nonpharmacologic methods to reduce anxiety, such as relaxation techniques, exercise, counseling, support groups, and so forth.

Patient/Client-Related Instruction

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. These problems can be severe in certain people. Use care if driving or in other activities that require quick reactions and strong concentration.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, urinary retention, skin redness/warmth, or GI problems (constipation, nausea, dry mouth, bitter taste).

Pharmacokinetics

Absorption: Well absorbed following PO/IM administration.

Distribution: Unknown.

Metabolism and Excretion: Completely metabolized by the liver; eliminated in the feces via biliary excretion.

Half-life: 3 hr.