BSN3A, GR 4

Drug Name and Indications Contraindications Action/Mechanism

Classification of Action
1. Diphenhydramine
It is indicated to patients  Diphenhydramine acts
with:  Documented as an inverse agonist
Brand Name: hypersensitivity to
Benadryl at the H1 receptor,
 Sedation diphenhydramine thereby reversing the
Generic Name:  Premature infants
 Allergic Rhinitis effects of histamine on
Diphenhydramine and neonates capillaries, reducing
 Dystonic reactions
 Motion Sickness  Breastfeeding allergic reaction
Classification:  Allergic Reactions mothers symptoms.
Diphenhydramine is in
a class of medications
called antihistamines.
It works by blocking the
action of histamine, a
substance in the body
that causes allergic
symptoms.
2. Promethazine
It is indicated to patients  Hypersensitivity  a phenothiazine
with:  Newborn/premature (antipsychotic)
Brand Name:
infants less than 2 derivative with very
Phenergan, years old (risk of
 Sedation weak dopamine
Phenadoz  Antihistamine potentially receptor antagonism,
Generic Name:  Nausea and fatal respiratory that also blocks H1
Promethazine Vomiting depression) receptors. It produces
 Motion Sickness  SC or intra-arterial clinically useful anti-
Classification: administration emetic and sedative
Promethazine is in a class  Coma effects.
of medications  Treatment of lower
called phenothiazines. It respiratory tract
works by blocking the symptoms,
action of a certain natural including asthma
substance in the body.
Promethazine is in a class
of medications
called phenothiazines. It
works by blocking the
action of a certain natural
substance in the body.

Route and Dosage Nursing Considerations Side Effects and Adverse Patient Education
Effects
 Diphenhydramine
can be given by Assessment These side effects may Teaching points
tablet, capsule, or History: Allergy to any occur:  Take as prescribed;
solution by mouth; antihistamines, narrow- avoid excessive
by intramuscular (IM) angle glaucoma, stenosing Dizziness, sedation, dosage.
or intravenous (IV) peptic ulcer, symptomatic drowsiness (use caution  Take with food if GI
injection; or topically. prostatic hypertrophy, driving or performing upset occurs.
25 to 50 mg by asthmatic attack, bladder tasks requiring alertness);  Avoid alcohol;
mouth/IM/IV every 4 neck obstruction, epigastric distress, serious sedation
to 6 hours as pyloroduodenal diarrhea or constipation could occur.
needed. obstruction, third trimester (take drug with meals);  Report difficulty
of pregnancy, lactation dry mouth (use frequent breathing,
ADULTS mouth care, suck hallucinations,
Oral Physical: Skin color, sugarless lozenges); tremors, loss of
 25–50 mg q 4–8 hr lesions, texture; thickening of bronchial coordination,
PO. orientation, reflexes, secretions, dryness of unusual bleeding or
 Motion sickness: Give affect; vision examination; nasal mucosa (use a bruising, visual
full dose P, BP; R, adventitious humidifier). disturbances,
prophylactically 30 sounds; bowel sounds; irregular heartbeat.
min before exposure prostate palpation; CBC
to motion, and with differential
repeat before meals
and at bedtime. Interventions
 Nighttime sleep aid:
 25–50 mg PO at  Administer with food
bedtime. if GI upset occurs.
 Cough suppression:  Administer syrup
25 mg q 4 hr PO, not form if patient is
to exceed 150 mg in unable to take
24 hr. tablets.
 Monitor patient
Parenteral response, and
 10–50 mg IV or deep arrange for
IM or up to 100 mg if adjustment of
required. Maximum dosage to lowest
daily dose is 400 mg. possible effective
dose.
PEDIATRIC PATIENTS >
10 KG OR 20 LB
Oral

 12.5–25 mg tid–qid
PO or 5 mg/kg/day
PO or 150 mg/m2 per
day PO. Maximum
daily dose 300 mg.
Motion sickness: Give full
dose prophylactically 30
min before exposure to
motion and repeat before
meals and at bedtime.

Cough suppression:
 2–6 yr: 6.25 mg q 4
hr, not to exceed 25
mg in 24 hr.
 6–12 yr: 12.5 mg q 4
hr PO, not to exceed
75 mg in 24 hr.
Parenteral
 5 mg/kg/day or 150
mg/m2 per day IV or
by deep IM injection.
Maximum daily dose
is 300 mg divided
into four doses.

 Promethazine has
several routes of Assessment Teaching points
administration, History: Hypersensitivity  CNS depression,  Take drug exactly as
including oral, rectal, to antihistamines or  Paradoxical excitation in prescribed.
intramuscular, and phenothiazines, severe children  Avoid using alcohol.
intravenous. CNS depression, bone  Dryness of mouth,  Avoid driving or
 The tablets, marrow depression, blurring of vision, engaging in other
solutions, and vomiting of unknown retention of urine, dangerous activities
suppository dosage cause, concomitant constipation, glaucoma, if dizziness,
are generally 12.5 therapy with MAOIs, drowsiness, or
tachycardia, headache,
mg to 50 mg. lactation, lower respiratory vision changes
hypotension, tinnitus.
tract disorders, glaucoma, occur.
prostatic hypertrophy, CV  Avoid prolonged
disease or hypertension, exposure to sun, or
breast cancer, use a sunscreen or
thyrotoxicosis, pregnancy, covering garments.
history of sleep apnea or a  Maintain fluid
family history of SIDS, child intake, and use
with Reye’s syndrome precautions against
heat stroke in hot
Physical: Weight, T; weather.
reflexes, orientation, IOP;  Report sore throat,
P, BP, orthostatic BP; R, fever, unusual
adventitious sounds; bowel bleeding or
sounds and normal output, bruising, rash,
liver evaluation; urinary weakness, tremors,
output, prostate size; CBC; impaired vision,
urinalysis; LFTs, renal and dark urine, pale
thyroid function tests stools, yellowing of
the skin or eyes.

Interventions
BLACK BOX WARNING:
Do not give tablets OR
rectal suppositories to
children < 2 yr.
Give IM injections deep
into muscle.
Do not administer
subcutaneously; tissue
necrosis may occur.

WARNING: Do not
administer intra-arterially;
arteriospasm and
gangrene of the limb may
result.

WARNING: Reduce dosage

of barbiturates given
concurrently with
promethazine by at least
half; arrange for dosage
reduction of opioid
analgesics given
concomitantly by one-
fourth to one-half.
 References:

 Diphenhydramine hydrochloride. (n.d.). https://www.nursingpath.in/2022/01/diphenhydramine-hydrochloride.html#:~:text=NURSING

%20CONSIDERATIONS&text=Administer%20with%20food%20if%20GI,to%20lowest%20possible%20effective%20dose.

 Promethazine: generic, uses, side effects, dosages, interactions & warnings. (2021, August 13). RxList.

https://www.rxlist.com/promethazine/generic-drug.htm

 Rnpedia. (2019). promethazine hydrochloride Nursing Considerations & Management. RNpedia. https://www.rnpedia.com/nursing-

notes/pharmacology-drug-study-notes/promethazine-hydrochloride/

 Promethazine: Uses, interactions, mechanism of action | DrugBank Online. (n.d.). DrugBank. https://go.drugbank.com/drugs/DB01069