Chemical structure of hydroxyzine.
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Hydroxyzine

Hydroxyzine is a piperazine derivative that is used as an antihistamine (especially for itches), anti-emetic (nausea reducing), and anxiolytic (anxiety reducing) drug. It can also be used as an adjunct to pre- and post-operative medication and it also possesses a weak analgesic effect. Hydroxyzine is sold under brand names such as Atarax, Serecid and Vistaril. more...

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Mode of action

Hydroxyzine is not a cortical depressant, but its effects on the central nervous system may be due to suppression of certain regions of the subcortical areas. The antihistamine effect is due to one of its metabolites cetirizine, which is a potent H1-antagonist.

Pharmacokinetics

Hydroxyzine can be administered orally as hydroxyzine hydrochloride or hydroxyzine embonate or as an intramuscular injection as hydroxyzine hydrochloride. When given orally, hydroxyzine is rapidly absorbed from the gastro-intestinal tract. The effect of hydroxyzine is notable in 30 minutes. Hydroxyzine is diffused throughout the body, but higher concentrations can be found in the skin than in the plasma. It is metabolised in the liver, and the main metabolite (45%), through oxidation of the alcohol moiety to a carboxylic acid, is cetirizine. Hydroxyzine's half-life is on average 14 hours for adults, but it can be as low as 5 hours for small children and over 30 hours for elderly people. Hydroxyzine is excreted into the urine almost wholly as metabolites.

Side effects

The side effects of hydroxyzine are usually mild, and include drowsiness and dry mouth, which is due to slight anticholinergic action. In rare cases muscle tremor and convulsions may occur.

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Hospital pharmacy computer systems may be unreliable
From AORN Journal, 11/1/05

A survey conducted by the Institute for Safe Medication Practices (ISMP) shows that many hospital pharmacy computer systems may not be detecting and correcting prescription errors or pharmacy order entry errors reliably, according to an Aug 30, 2005, news release from the ISMP. To field test when safety warnings appeared, survey participants were asked to create a test patient in their medication order entry system used by pharmacists and place a series of orders associated with actual errors or hazards reported to the ISMP.

Of the 182 systems tested, only four were able to detect all of the unsafe orders, and fewer than half were able to detect orders for medications that exceeded a safe maximum dose. Only one in five computer systems was able to intercept the entry of a contraindicated medication based on the patient's diagnosis or condition (ie, pregnancy), and only one in four was able to detect a clinically significant interaction between 'medications and herbal supplements. When unsafe orders were detected, approximately nine in 10 systems allowed the user to override serious warnings, often by simply pressing a function key.

Most systems were able to provide reports of medication warning overrides and permitted staff members to build alerts for serious error-prone situations. Only half of the systems tested, however, allowed the use of tail man Letters to differentiate look-alike medication names (eg, hydrOXYzine, hydrALAzine), and only 9% allowed users to change the font and color to highlight look-alike medication name pairs.

The poor field test results may be a result of failure to update technology or software. More than half (ie, 56%) of the survey participants were using a system that was at Least five years old with no, recent upgrades, and 38% had been using the same system for eight years or more without upgrades. Certain' types of warnings may be omitted if a medication information providers software vendor deems them unimportant, and important alerts may not appear if the software content is not current or adequate.

Computer Weaknesses Compromise Medication Safety (news release, Huntingdon Valley, Pa: Institute for Safe Medication Practices, Aug 30, 2005) http://www.ismp .org/PR/PR20050830.pdf (accessed 22 Sept 2005).

COPYRIGHT 2005 Association of Operating Room Nurses, Inc.
COPYRIGHT 2005 Gale Group

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