Lidocaine hydrochloride

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A Drug Study Presented to

the Faculty of the Nursing Department
Mrs. Rodeliza Faith B. Guillermo RN., MN.

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In Partial Fulfillment of
The Requirements NCM 212-RLE
Oxygenation/Fluids and Electrolytes Nursing Rotation

By

Clarissa S. Torres
BSN-3D Group 1 Subgroup 4

November 7, 2020
Brand Name: Xylocaine, Xylocard

Generic Name: lidocaine hydrochloride

Classification: Antiarrhythmics class IB, amide

derivatives (Local anesthetic) - Pregnancy Category
B

Mode of Action: A class IB antiarrhythmic that decreases the depolarization,

automaticity, and excitability in the ventricles during the diastolic phase by direct action
on the tissues, especially the Purkinje network.

Dose and Route:

Ventricular Arrhythmias

• Adult: IV 50–100 mg bolus at a rate of 20–50 mg/min, may repeat in 5 min, then
start infusion of 1–4 mg/min immediately after first bolus IM/SC 200–300 mg IM,
may repeat once after 60–90 min
• Child: IV 0.5–1 mg/kg bolus dose, then 10–50 mcg/kg/min infusion

Anesthetic Uses

• Adult: Infiltration 0.5–1% solution Nerve Block 1–2% solution Epidural 1–2%
solution Caudal 1–1.5% solution Spinal 5% with glucose Saddle Block 1.5% with
dextrose Topical 2.5–5% jelly, ointment, cream, or solution

Post-Herpetic Neuralgia

• Adult: Topical Apply up to 3 patches over intact skin in most painful areas once
for up to 12 h per 24 h period

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Indication:

• As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac

surgery and MI (IV use). Use IM when IV administration is not possible or when
ECG monitoring is not available and the danger of ventricular arrhythmias is
great (single-dose IM use, for example, by paramedics in a mobile coronary care
unit)
• As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks,
central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal
injection; topical anesthetic for skin disorders and accessible mucous
membranes.

Contraindication:

• Contraindicated in patients hypersensitive to amide-type local anesthetics,

Stokes-Adams syndrome, Wolff-Parkinson-White syndrome, and severe degrees
of SA, AV, or intraventricular block in absence of artificial pacemaker.
• Also contraindicated in patients with inflammation or infection in puncture region,
septicemia, severe hypertension, spinal deformities, and neurologic disorders.
• Use cautiously in geriatric patients; in patients with renal or hepatic disease,
complete or second-degree heart block, sinus bradycardia, or heart failure; and
in those who weigh less than 110 lb.

Side Effects:

• CNS: anxiety, nervousness, lethargy, somnolence, paresthesia, muscle

twitching; confusion, tremor, stupor, restlessness, light-headedness,
hallucinations; apprehension, unconsciousness, confusion, tremors, stupor,
restlessness, slurred speech, euphoria, depression, light-headedness.
• CV: hypotension, myocardial depression, edema.
• EENT: tinnitus, blurred or double vision
• GI: nausea, vomiting
• Skin: dermatologic reactions, sensitization; diaphoresis, rash
• Other: soreness at injection site, sensation of cold

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Adverse effects:

• CNS: seizures
• CV: bradycardia, cardiac arrest, new or worsened arrhythmias (with systemic
form), asystole
• Respiratory: respiratory arrest, status asthmaticus
• Other: anaphylaxis

Drug Interaction:

✓ Drug-drug
• Atenolol, metoprolol, nadolol, pindolol, propranolol: may reduce hepatic
metabolism of lidocaine, increasing the risk of toxicity.
• Cimetidine: may decrease clearance of lidocaine, increasing the risk of
toxicity.
• Ergot-type oxytocic drugs: may cause severe, persistent HTN or stroke. Avoid
using together.
• Mexiletine: may increase pharmacologic effects. Avoid using together
• Phenytoin, procainamide, propranolol, quinidine: may increase cardiac
depressant effects.
• Succinylcholine: may prolong neuromuscular blockade.
• High-dose lidocaine, succinylcholine: May increase neuromuscular effects of
succinylcholine. Use together cautiously.
• Cyclic antidepressants, MAO inhibitors: Causes prolonged and severe
hypertension when lidocaine with epinephrine is used. Avoid use together.
✓ Drug-herb
• Pareira: May add to or potentiate neuromuscular blockade. Discourage use
together.

Nursing Responsibilities:

1. Assess respiratory and neurologic status frequently.

Rationale: To avoid potential overdosage, toxicity, complications and accidents.

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2. Monitor patient for toxicity or overdose. If signs of toxicity occur (excitation,
confusion, blurred or double vision, nausea and vomiting, ringing in the ears,
tremors, twitching, seizures, dyspnea, severe dizziness and fainting), stop the
drug or infusion at once and notify prescriber.
Rationale: To prevent further complications and accidents.
3. Monitor patient’s vital signs especially blood pressure and respiratory status.
Rationale: To provide a baseline data, and monitor for unusualities or
improvements. Also, this drug can cause hypotension and myocardial depression
as its side effects, and several adverse effects related to cardiovascular and
respiratory system.
4. Establish safety precautions such as raising the side rails.
Rationale: Lidocaine hydrochloride may cause blurriness or double vision and
other CNS side effects and adverse effects. Thus, safety precautions must be
observed to prevent accidents and injury.
5. When Lidocaine is administered as an antiarrhythmic, monitor the ECG
continuously. Stop infusion immediately if ECG indicates excessive cardiac
depression.
Rationale: To monitor infusion precisely, reduce risk of toxicity by early detection
of changes or abnormalities in the ECG, and prevent further complications. Also,
there are conditions that may affect drug metabolism, excretion, or distribution
volume, predisposing patient to drug toxicity.
6. Tell patient receiving lidocaine I.M. that drug may cause soreness at injection
site.
Rationale: To inform patient on possible side effects
7. Prepare emergency equipment.
Rationale: To maintain airway and provide mechanical ventilation if needed
8. Provide skin care to site of administration
Rationale: To reduce risk of skin breakdown.
9. Advise patient to do NOT ingest food within 60 min after drug application;
especially pediatric, geriatric, or debilitated patients. Do not chew gum while
buccal and throat membranes are anesthetized to prevent biting trauma.

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 Rationale: Oral topical anesthetics (e.g., Xylocaine Viscous) may interfere with
swallowing reflex.
10. Instruct patient to do not breast feed while taking this drug without consulting
physician.
Rationale: This medication should be used only when clearly needed, for small
amounts of lidocaine are secreted into breast milk and an allergic reaction in the
infant may be possible.

References:
Antipuesto,D. (n.d.). Lidocaine Nursing Responsibilities. Retrieved: November 5, 2020
from: https://nursingcrib.com/drug-study/lidocaine-nursing-responsibilities/
Lidocaine hydrochloride (n.d.). LIDOCAINE HYDROCHLORIDE. Retrieved: November
5, 2020 from:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/L026.ht
ml
Prescriber’s Digital Reference (2020). lidocaine hydrochloride - Drug Summary.
Retrieved: November 5, 2020 from: https://www.pdr.net/drug-
summary/Lidocaine-Hydrochloride-Injection-lidocaine-hydrochloride-3301
Wolters Kluwer (2020). Amitriptyline. Nursing 2020 Drug Handbook Philippine Edition.
Wolters Kluwer Health,Inc. Volume I pages 116-118.