DRUG STUDY: LIDOCAINE

Drug Name Drug Classification Mechanism of Action and Drug Action Drug Effects Interactions
Indications (Serious/Common)
Generic Name: Pharmacologic: Mechanism of Action: Pharmacokinetics Side effects (common by Drug – Drug
A: Well absorbed after system):
Lidocaine administration into the
Sodium channel blocker; IV, IM: Suppresses Increase cardiac depression
amide automaticity and spontaneous deltoid muscle; some CNS: confusion, and toxicity with phenytoin,
depolarization of the absorption follows local use. amiodarone, quinidine,
drowsiness, agitation,
Therapeutic: ventricles during diastole by blurred vision, dizziness, procainamide, or
Trade Name: D: Widely distributed. slurred speech. propranolol.
altering the flux of sodium
Concentrates in adipose EENT: mucosal use—
Anesthetics ions across cell membranes
Dilocaine, tissue. Crosses the blood- decrease or absent gag Propranolol may decrease
(Topical/Local) with little or no effect on brain barrier and placenta;
Xylocaine, reflex. metabolism and increase risk
Antiarrhythmics heart rate. enters breast milk. of toxicity.
Solarcaine CV: arrhythmias,
(Class IB) Local: Produces local bradycardia, heart block,
anesthesia by inhibiting M: Mostly metabolized Lidocaine may increase levels
hypotension.
transport of ions across by the liver. of calcium channel blockers,
Dosage: Half-life: Biphasic—initial nausea, vomiting. certain benzodiazepines,
neuronal membranes, thereby Resp: bronchospasm.
Recommended: phase, 7–30 min; terminal cyclosporine, fluoxetine,
IV (Adults): 1–1.5 mg/kg
preventing initiation and phase, 90–120 min; increase Hemat: lovastatin, simvastatin,
bolus; may repeat doses of
conduction of normal nerve in HF and liver impairment. methemoglobinemia. mirtazapine, paroxetine,
impulses. Local: stinging, burning,
0.5–0.75 mg/kg q 5–10 ritonavir, tacrolimus,
contact dermatitis,
Therapeutic Effects: E: <10% excreted in urine theophylline, tricyclic
min up to a total dose of 3 erythema.
Control of ventricular as unchanged drug. MS: chondrolysis.
antidepressants, and
mg/kg; may then start venlafaxine.
arrhythmias. Local anesthesia. Neuro: paresthesia,
continuous infusion of 1–4 Pharmacodynamics
tremor.
mg/min. Indication(s): Route: IV Effects of lidocaine may be
Misc: allergic reactions,
Onset: Immediate decrease by carbamazepine,
Peak: Immediate

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 1
 Endotracheal (Adults): IV: Ventricular arrhythmias. Duration: 10–20 min (up Adverse Reactions phenobarbital, phenytoin,
Give 2–2.5 times the IV IM: Self-injected or when to several hours after (Serious, life threatening) and rifampin.
loading dose down the IV unavailable (during continuous infusion) Life-threatening:
endotracheal tube, followed transport to hospital CNS: Seizures Drug – Food
Route: IM
by a 10 mL saline flush. facilities). CV: Cardiac Arrest
Onset: 5-15 minutes
Local: Misc: Anaphylaxis Drug – Laboratory
Peak: 20 – 30 minutes
IM (Adults and Children Infiltration/mucosal/topical Duration: 60 – 90 minutes Creatine kinase: increased
>50 kg): 300 mg (4.5 mg/ anesthetic. Contraindication level (with I.M. use)
kg) Transdermal: Route: Local ▪ Hypersensitivity to
Pain due to post-herpetic Onset: Rapid drug, its components, Treatment of Overdose/
Peak: Unknown Antidote (if any)
Local: neuralgia. or other amide local
Duration: 1 – 3 hours Toxicity and Overdose:
Infiltration (Adults and anesthetics.
Children): Infiltrate ▪ Monitor serum lidocaine
affected area as needed ▪ Heart failure, levels periodically during
(increased amount and cardiogenic shock, prolonged or high-dose IV
frequency of use increases second- or third-degree therapy. Therapeutic serum
likelihood of systemic heart block, lidocaine levels range from
absorption and adverse intraventricular block 1.5 to 5 mcg/mL.
reactions). in absence of a
pacemaker. ▪ Signs and symptoms of
Topical (Adults): Apply toxicity include confusion,
to affected area 2–3 times ▪ Wolff-Parkinson-White excitation, blurred or double
daily. or Adams-Stokes vision, nausea, vomiting,
syndrome ringing in ears, tremors,
Mucosal (Adults): twitching, seizures,
For anesthetizing oral ▪ Severe hemorrhage, difficulty breathing, severe
surfaces—20 mg as 2 shock, or heart block dizziness or fainting, and
sprays/quadrant (not to unusually slow heart rate.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 2
 exceed 30 mg/ quadrant) (lidocaine with
may be used. 15 mL of the dextrose) ▪ If symptoms of overdose
viscous solution may be occur, stop infusion and
used q 3 hr for oral or ▪ Local infection at monitor patient closely.
pharyngeal pain. puncture site (lidocaine
For anesthetizing the with dextrose)
female urethra—3–5 mL
of the jelly or 20 mg as 2% ▪ Septicemia (lidocaine
solution may be used. with dextrose)
For anesthetizing the
male urethra—5–10 mL
of the jelly or 5–15 mL of
2% solution may be used
before catheterization or
30 mL of jelly before
cystoscopy or similar
procedures.

Patch (Adults): Up to 3
patches may be applied
once for up to 12 hr in any
24-hr period; consider
smaller areas of
application in geriatric or
debilitated patients.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 3
Nursing Process: Lidocaine

Assessment Nursing Diagnoses Planning Nursing Interventions with Appropriate Patient Evaluation/ Expected
(Priority Problems) Rationale (Italic) Teaching/Education Outcomes of Care
Baseline assessment prior ▪ Disturbed sensory The patient will: ▪ Prepare emergency equipment ▪ Discuss reason for drug ▪ Monitor patient
to administration: perception related to ▪ Experience therapeutic to maintain airway and therapy with patient and response to therapy
▪ Know that I.V. local anesthetic effect effects (e.g., numbness provide mechanical family, when appropriate. (loss of feeling in
lidocaine is a high alert
in the local or regional ventilation if needed. designated area).
drug.
▪ Impaired skin area). ▪ Explain that patient will be
▪ Make sure resuscitation ▪ Monitor for adverse
equipment and oxygen integrity related to ▪ Ensure that patients receiving monitored continuously
effects (e.g.
are available before immobility caused by ▪ Be free from, or spinal anesthesia or epidural during therapy.
respiratory depression,
giving I.V. lidocaine. action of drugs experience minimal, anesthesia are well hydrated
▪ Dilute injection in blood pressure
adverse effects. and remain lying down for up ▪ Instruct patient to promptly
additive syringe and ▪ Risk for injury related changes, arrhythmias,
to 12 hours after the anesthesia report discomfort at I.V.
single-use vial to loss of sensation GI upset, skin
and mobility ▪ Verbalize an to minimize headache. site as well as adverse
according to breakdown, injury,
manufacturer’s understanding of the ▪ Provide skin care to site of effects, especially
CNS alterations, etc).
instructions before drug’s use, adverse administration to reduce risk cardiovascular, respiratory,
administering as I.V. effects, and required or neurologic problems or ▪ Evaluate patient
of skin breakdown.
infusion. precautions. allergic reactions. understanding on drug
▪ Anesthetic: Assess ▪ Provide comfort measures to therapy by asking
degree of numbness of ▪ Demonstrate proper help patient tolerate drug ▪ Advise patient to telephone patient to name the
affected part. effects.
self-administration of health care professional drug, its indication,
▪ Asses topical site for
adverse reaction. the medication (e.g., ▪ Provide safety measures (e.g. immediately if symptoms of and adverse effects to
dose, timing, when to adequate lighting, raised side a heart attack occur. Do not watch for.
Assessment throughout notify provider). administer unless instructed
rails, etc.) to prevent injuries. ▪ Monitor patient
administration: by health care professional.
compliance to drug
▪ Antiarrhythmic: ▪ Caution women to consult
Monitor ECG therapy.
health care professional
continuously and BP

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 4
 and respiratory status ▪ Educate client on drug therapy before using a topical
frequently during to promote understanding and anesthetic for a
administration. compliance. mammogram or other
▪ Transdermal: Monitor
procedures.
for pain intensity in
affected area
periodically during ▪ Caution parents that oral
therapy. lidocaine causes numbness
▪ Serum electrolyte and may impair
levels should be swallowing; do not
monitored periodically administer food and/or
during prolonged
chewing gum for at least 60
therapy.
▪ Monitor serum min after administration.
lidocaine levels
periodically during
prolonged or high-dose
IV therapy. Therapeutic
serum lidocaine levels
range from 1.5 to 5
mcg/mL.
▪ Evaluate level of
consciousness closely.
▪ Watch for adverse
reactions, particularly
anaphylaxis.
▪ Stay alert for seizures.
▪ Monitor neurologic
status for lower spinal
segment deficits.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 5
▪ Give supportive oxygen
therapy, as indicated
and prescribed.
▪ Monitor electrolyte,
blood urea nitrogen,
and creatinine levels.

Janeirah Q. Manalundong
Faculty, College of Health Sciences NSG 105: PHARMACOLOGY DRUG STUDY 6