1.emergency drugs group9b

8/8/2019 1.Emergency Drugs Group9b

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EMERGENCYDRUGS


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Table of Contents

AmlodipineAspirinAtropine Sulfate

BricanylBupivacaineBuscopanButorphanol Tartrate

Calcium GluconateCapotenCatapresCefurosimeCelecoxibClindamycinClopidogrelCo- amoxiclav

DemerolDiamicronDiazepamDigoxinDiphenhydramineDobutamineDopamineDynastat

Epinephrine

Ephedrine

FamotidineFelodipine

Gentamycin

HeparinHydroxyzineHyperstat

Ketorolac

Lidocaine HCl

MannitolMethergineMethylergonovine MaleateMetronidazoleMidazolamMorphine Sulfate

Nalbuphine HClNifedipineNitroglycerineNorvascNubaine

OmeprazoleOsmofundinOxytocin

PhenerganPilocarpine HClPlasilPotassium Chloride

SalbutamolSimvastatinSodium BicarbonateSolu- CortefSomazineSpiriva

ToradolTramadol HClTranexamic Acid

ValiumVentolin

Zantac


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BSN IV Group 9B


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Marzan, Kristy M.

o Atropine Sulfate

o ButorphanolTartrateo Bupivacaineo Famotidineo Methergineo Norvasco Pilocarpine HCl

Nacion, Arriane C.

o Calcium Gluconateo Diazepamo Diphenhydramineo Epinephrineo Ephedrineo Phenergano Potassium Chlorideo Valiumo Ventolin

Noriega, Mark Anthony F.

o Capoteno Hyperstato Ketorolaco Lidocaine HClo Methylergonovine

Maleateo Metronidazoleo Midazolamo Omeprazoleo Plasil

Ortega, Michelle A.

o Amlodipineo Aspirino Bricanylo Celecoxibo Heparino Morphine Sulfateo Nalbuphine HClo Oxytocino Tramadol HCl

Patron, Arra Mariz U.

o Buscopano Clopidogrelo Demerolo Digoxino Dynastato Mannitolo Nubaineo Toradolo Tranexamic Acid

Peralta, Marichu A.

o Catapreso Dobutamineo Dopamineo Gentamycino Nifedipineo Nitroglycerineo Salbutamolo Sodium Bicarbonateo Solu- Cortef

Vergara, Rhenalyn V.

o Cefurosimeo Clindamycino Co- amoxiclavo Diamicrono Felodipineo Hydroxyzineo Osmofundino Simvastatino Zantac

Drugs Action Indication Contraindication Adverse ReactionNursing

Consideration

Amlodipine(Norvasc)

Possible slightdecrease in

Hypertensionalone or in

Use withgrapefruit juice.

CNS: Headache,fatigue, lethargy.

Check BPbefore giving the


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ClassificationCalcium channel

blocker

Dosage, Route,Frequency:10mg 1tab OD

myocardialcontractility. COis increased;

moderatedecrease inperipheralvascularresistance.

combination withotherantihypertensives.

Chronic stableangina alone or incombination withother antianginaldrugs.

Vasospasticangina alone or incombination with

other antianginaldrugs.

GI: Nausea,abdominal

discomfort, cramps

CV: Peripheraledema, palpitations

Dermatologic:Dermatitis, rash,pruritus

Musculoskeletal:

Muscle cramps painor inflammation.

GU: Polyuria,dysuria

Respiratory:Nasal or chestcongestion,sinusitis, rhinitis.

medications.

Monitor Vital

Signs.

Take withfoods to helpdecreasestomach upset.

Instruct thepatient to reportany symptoms of

chest pain, SOB,dizziness,swelling ofextremities,irregular pulse, oraltered visionimmediately.


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Drugs Action Indication Contraindication Adverse Reaction NursingConsideration

Aspirin(Aspilets)

Classification:Nonsteroidalanti-inflamatorydrug,antipyretic,analgesic.

Relieves painand reducesinflammationby inhibition ofperipheralprostaglandinsynthesis. Italso inhibitsthe synthesis

or action ofothermediators ofinflammation.Its acts onhypothalamicheat relatingcenter torelieve fever.Also

decreasesplateletaggregartionby preventingformation ofthromboxaneA.

Treatmentof mild tomoderate pain.

Fever

Variousinflammatoryconditions

Reductionof risk of dealthin patients withpreviousinfarctionrecurrenttransientischemiaattacks or

stroke in menwho have hadtransient brainischemiacaused byplatelet emboli.

Hypersensitivity to salicylatesor NSAIDS

Hemophilia

Bleedingulcers orhemorrhagic

state

Pregnancy

EENT: Dizziness,tinnitus

GI: Nausea,dyspepsia, heartburn,bleeding

Hematology:Increase bleeding

times, anemia,decrease ironconcentration

Others:Hypersensitivityreactions may include,urticaria, hives,rashes, angioedema,and anaphylactic

shock.

Assess pain

Assess for allergicreactions

Assess forototoxicity

Administer topatient crushed orwhole

Give with food ormilk

Advise patient toavoid alcoholingestion.

Name of theDrug

Action Indication Contraindications Adverse Effects/Side Effects

NursingResponsibilities

Generic

Atrophine Sulfate

BrandIsopto Atropine

ClassificationAnticholinergics

Actioncholinergicreceptor sites so

response toacetylcholine isdecreased

IndicationAs an anti-sialagogue for

preanestheticmedication toprevent or reducesecretions of therespiratory tract

To restore

cardiac rate andarterial pressureduring

anesthesia, whenvagal

To lessen thedegree ofatrioventricular(A-V) heart blockwhen increasedvagal tone is amajor factor in

the conductiondefect, as insome cases dueto digitalis

To overcomesevere carotidsinus reflexAntidote forcardiovascularcollapse from theinjudicious use ofa cholinergicdrug.

ContraindicationContraindicated inpatients

hypersensitive todrug and those withacute angle closureglaucoma,obstructiveuropathy,obstructive diseaseof GI tract, paralyticelius, toxicmagacolon,

intestinal atony,unstable CV statusin acutehemorrhage,asthma, ormyasthenia gravis.Also contraindicatedin pregnant women.

Adverse EffectsCNS:restlessness,

ataxia,disorientation,hallucinations,delirium, coma,insomnia,agitation,confusion.CV: tachycardia,angina,arrhythmias,

flushing.EENT:photophobia,blurred vision,mydriasis.GI: dry moth,constipation,vomiting.GU: urineretention.

Hematologic:leukocytosisOther:anaphylaxis

Side EffectsCNS: headache,excitement.CV: palpitationsGI: thirst,nausea.

Monitor VS.

Report HR

Monitor forconstipation,oliguria.Atrophine couldresult in CNSstimulation(confusion,excitement) or

drowsiness Instruct to take 30mins before meals

Eat foods high infiber and drinkplenty fluids.Avoid OTC

antihistamines. Instruct client not todrive a motorvehicle orparticipate inactivities requiringalertness.

Advise to use hard

candy, ice chips,etc. for dry mouth.


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Terbutaline(Bricanyl)

Classification:Sympathomimetic, direct-acting

Specific beta2 adrenergicreceptorstimulant,resulting tobronchopdilation andrelaxation ofperipheralvasculature. It

also causesrelaxation ofuterinesmoothmuscles andhas minimalbeta 1 activity.

Terbutalineis given as thesulfate for itsbronchodilatingproperties inreversibleairwaysobstruction, asoccurs inasthma and in

some patientswith chronicpulmonarydisease. It alsodecreasesuterinecontractilityand may beused to arrestpremature

labor.

Hypersensitivity

Thyrotoxicosis

Pregnancy

Cardiacarrhytmias

associated withtachycardia.

Palpitations

Tachycardia

Chest discomfortor pain

Arrhythmias

CNS stimulation

Tremor

Dizziness

nervousness

drowsiness

headache

weakness

nausea andvomiting

flushing

Assess patientscondition beforetherpy.

Assess respirations

Assess forparadoxicalbronchospasm

Monitor for allergicreactions and possibledrug induced adversereactions.

Give oraladministrations withmeals.

Store in lightresistant container.

Advise patient toavoid smoking.


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DRUG NAME MECHANISMOF ACTION

INDICATIONS CONTRAINDI-CATION

ADVERSEEFFECTS

NURSINGRESPONSIBILITIES

Generic Name:Bupicavacaine

Brand Name:Marcaine

Classification:Local anesthetic,analgesic, anti-inflammatoryagents

Reversibleinhibits nerveconduction byblocking sodiuminflux.

With or withoutepinephrine: caudalor lumbar nerveblock

With epinephrine:dental infiltration ornerve block.

With dextrose:

subarachnoid block.

Contraindicated topatientshypersensitive tothe drug and itscomponent.

CV: prolongedcardiovasculardepression and

arrhythmias

Asses for allergicreaction

Assess BP,pulse, level ofconsciousnessand mental statusto check for CNStoxicity.

Do not use if

solution isdiscolored orcontainsprecipitate.

Discard unusedportions ofpreparation thatdo not contain apreservative.

Dont chew gum

Provide safetyprecautions.


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DRUGS ACTION INDICATION CONTRAINDICATION ADVERSE

REACTION

NURSING

CONSIDERATION

Generic Name:Buscopan

Brand Name:Hyoscine-N-butylbromide

Classification:

Antispasmodics

Relievecramps orspasms ofthestomach,intestines,andbladde

indicated forthe control ofabdominalpain (colic)associatedwithspasmodiccolic, flatulentcolic

Tab Myasthenia gravis& megacolon. Shouldnot be used in patientswho have priorsensitivity to hyosinen-butyl bromide or anycomponent ofbuscopan. AmpUntreated narrow-

angle glaucoma,prostate hypertrophyw/ urinary retention,mechanical stenosis inthe GIT, tachycardia,megacolon,myasthenia gravis. IMinj in patients onanticoagulants.

Urinary retention,allergic & skinreactions, rarelydyspnea (inpatients w/history ofbronchial asthmaor allergy).ParenteralVisual

accommodationdisturbance,infrequently injsite pain (after IMinj), rarelyanaphylactoidreactions &anaphylacticshock.

Drug

compatibility

should be

monitored

closely in

patients

requiring

adjunctive

therapy

Avoid driving &

operating

machinery after

parenteral

administration

Avoid strict heat


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Name of theDrug

Action/Classification

Indication Contraindications Adverse Effects/Side Effects


GenericbutorphanolBrandButorphanolTartrate

Class: Opioid agonist-antagonist analgesic

Indication

Management ofpain when use ofan opioidanalgesic isappropriate(parenteral/nasal); preoperative orpreanestheticmedication, as asupplement tobalancedanesthesia, andfor relief of painduring labor(parenteral).

Contraindication

Hypersensitivity tothis medication orthe preservativebenzethoniumchloride.

Cardiovascular

Palpitations

Dermatologic

Pruritus,sweating/clamminess

EENT

Nasal congestion

(nasal spray; 13%);blurred vision, earpain, pharyngitis,rhinitis, tinnitus,unpleasant taste (atleast 1%).

GI

Nausea, vomiting

anorexia,constipation, drymouth, stomach pain

When giving byIM route, use deep,slow injection. If accidentalskin contactoccurs, washexposed area withcool water. Do notadminister ifsolution isdiscolored, cloudy,or containsparticulate matter.

Nasal Pump reservoirmust be primedprior to initial use;pump sprayerfirmly and quicklyuntil a fine sprayappears (up to 7 to8 strokes).

Pump reservoirmust be reprimed(1 or 2 strokes) ifnot used for 48 hor longer).


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Generic name Action Indication Contraindication Adverse Reaction NursingConsideration

Calcium

gluconateBrand name

Harson

Classification

Electrolyte

Replaces

calcium andmaintainscalcium level.

Hypocalcemic

emergency Hypocalcemic

tetany

Adjunctivetreatment ofmanagementintoxication

Duringexchangetransfusions

Hyperphosphatemia

Dietarysupplement

Hyperkalemiawith secondarycardiac toxicity

Contraindicated in

cancer patientswith bonemetastases andin those withventricularfibrillation,hypercalcemia,hypophosphatemia,or renalcalculi.

CNS: tingling

sensations, senseof oppression orheart waves withI.V. use, syncopewith rapid I.V.use.

CV: bradycardia,arrhythmia

GI: constipation

GU: renal calculi

Metabolic:hypercalemia

Skin: necrosis,cellulitis

Use all calcium

products withextreme caution indigitalized patientsand patients withsarcoidosis andrenal or cardiacdisease. Usecalcium chloridecautiously inpatients with cor

pulmonale,respiratory acidosisor respiratoryfailure.

Signs andsymptoms ofseverehypercalcemia mayinclude stupor,confusion, delirium

and coma. Signsand symptoms ofmild hypercalcemiamay includeanorexia, nausea,and vomiting.


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Drug Action Indication Contraindication AdverseReaction

Nursing Consideration

Generic

Name:Captopril

Brand Name:Capoten

Classification:ACEinhibitors

Captopril competes

with angiotensin I forbinding at theangiotensin-converting enzyme,blocking theconversion ofangiotensin I toangiotensin II. Asangiotensin II is avasoconstrictor and

a negative feedbackmediator for reninactivity, lowerangiotensin II levelsresults in a decreasein blood pressure,an increase in reninactivity, andstimulation ofbaroreceptor reflex

mechanisms.Kininase II, anenzyme whichdegrades thevasodilatorbradykinin

o Hypertension

o congestive heartfailure

o renal syndromes

such as diabeticnephropathy andscleroderma.

o History of ACEI-

associated orotherangioedema.

o Pregnancy

o light-headed

o urinating moreor less thanusual

o fever

o chills

o pale skin

o fast, pounding,

or unevenheartbeats

o chest pain

o rapid weight

gaino cough

o loss of appetite

o nausea

o diarrhea

constipationo drowsiness

o dizziness

o dry mouth

Take each dose with a

full glass of water.

Capoten is usuallytaken 1 hour beforemeals.

If you need to have anytype of surgery, tell thesurgeon ahead of timethat you are taking

Capoten.

To be sure thismedication is helpingyour condition, yourblood pressure will needto be checked on aregular basis.

Take Capoten exactly

as it was prescribed foryou. Do not take themedication in largeramounts, or take it forlonger thanrecommended by yourdoctor.


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controlling drugsreadily available.

Reevaluatetherapy if clonidinetolerance occurs;giving concomitantdiuretic increases theantihypertensiveefficacy ofclonidine.

Monitor BPcarefully whendiscontinuingclonidine;hypertensionusually returnswithin 48 hr.


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Drugs Mechanismof Action

Indication Contraindication

AdverseReaction

NursingConsiderations

Cefuroxime

Classification:Anti-infective;antibiotic

Broad-

spectrumcephalosporinantibioticresistant tobeta-lactamase. Ithas beenproposed forinfectionswith gram-

negative andgram-positiveorganisms,gonorrhea,andhaemophilus.

It is effective for the

treatment ofpenicillinase-producing Neisseriagonorrhoea(PPNG). Effectivelytreats bone and jointinfections,bronchitis,meningitis,gonorrhea, otitis

media,pharyngitis/tonsillitis, sinusitis, lowerrespiratory tractinfections, skin andsoft tissueinfections, urinarytract infections, andis used for surgicalprophylaxis,reducing oreliminating infection.

Hypersensitivity

tocephalosporinsand relatedantibiotics;pregnancy(category B),lactation

. GI:

Diarrhea,nausea,antibiotic-associatedcolitis.

Skin:Rash,pruritus,urticaria.

Urogenital

: Increasedserumcreatinineand BUN,decreasedcreatinineclearance.

Determine historyof hypersensitivityreactions tocephalosporins,penicillins, andhistory of allergies,particularly todrugs, beforetherapy is initiated.

Inspect

IM and IV injectionsites frequently forsigns of phlebitis.

Report onset ofloose stools ordiarrhea. Althoughpseudomembranous colitis.

Monitor I&O

rates and pattern:Especiallyimportant inseverely ill patientsreceiving highdoses. Report anysignificantchanges.


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Celecoxib(Celebrex)

Classification:Nonsteroidal anti-inflammatorydrug, COX-2inhibitor

Inhibitsprostaglandinsynthesis,primarily byinhibiting cyclo-oxygenase-2; itdoes not inhibitthecyclooxygenase-1 isoenzyme.

Does not affectplateletaggregation;renal effectssimilar to otherNSAIDS.

Relief of signsand symptoms ofrheumatoidarthritis andosteoarthritis inadults.

Acute painand primarydysmenorrhea in

adults.

Reduce thenumber ofadenomatouscolorectal polypsin familialadenolatouspolyposis.

Use in severehepaticimpairement, inthose who haveshown an allergicreaction tosulfonamides, orthose who haveexperiencedasthma, urticaria,

or allergic typereactions aftertaking aspirin orother NSAIDS.

GI: Dyspepsia,diarrhea,abdominal pain.

Respiratory:URI, sinusitis,pharyngitis, rhinitis,bronchitis

Infections:

Bacterial, fungal, orviral infection.

Dermatologic:Rash, ecchymosis,alopecia, dermatitis,nail disorder.

Assess forrenal and liverdysfunction.

Do notconsumealcoholicbeverages whileon this drug.

May take withfood to decreaseGI upset.

Report weightgain, swelling ofankles, chest painor SOB.


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DRUGS ACTION INDICATION CONTRAINDICATION ADVERSEREACTION

NURSINGCONSIDERATION

Generic Name:

Clopidogrel

Brand Name:Plavix

Classification:Anticoagulants,Anti-platelets &Antifibrinolytics,

Clopidogrel

inhibitsadenosinediphosphate(ADP) frombinding to itsreceptor siteson the plateletsand subsequentactivation ofglycoprotein GP

IIb/IIIa complexthus preventingfibrinogenbinding, plateletadhesion andaggregation.

Prophylaxis

ofthromboembolic events daily. Acutecoronarysyndrome For ST-elevationmyocardialinfarction: W/aspirin:

Forunstableangina, non-ST-elevationmyocardialinfarction:Initial:

Hypersensitivity.

Active pathologicalbleeding. adminwithin 7 days after MIand ischaemic stroke,coagulationdisorders. Lactation.

Dyspepsia,

abdominalpain, nausea,vomiting,flatulence,constipation,gastritis,gastric andduodenalulcers. GIupset,

diarrhoea,paraesthesia,vertigo,headache,dizziness,pruritus andrashes.PotentiallyFatal: Bleeding disorders

including GIandintracranialhaemorrhage.Blooddyscrasias.

1.Provide small,

frequent meals ifGI upset occurs(not as common aswith aspirin).

2.Provide comfortmeasures andarrange foranalgesics ifheadache occurs.

3.Take daily asprescribed. May betaken with meals.

4.These sideeffects may occur:Dizziness, light-headedness

5.Report skin rash,chest pain, fainting,severe headache,abnormal bleeding
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Drug Mechanism of Action

Indication Contraindication

Side effect Nursing Consideration

Generic Name:

CoAmoxiclavBrand Name:Amoxicillin

Classification:Anti-infectives

Dosage:Adult: Oraladministration

250 to 500 mgevery 8 hours.Children: Oraladministration 20to 40mg/kg/dayin divided dosesgiven in every 8hours.

-Prevents

bacterial cellwall synthesisduringreplication

-Bactericidal

Treatment of

infections ofrespiratorytract, skin andskin structures,otitis media,meningitis,septicemia,sinusitis,bacterialendocarditis

prophylaxis.

-hypersensitivity

to penicillin,cephalosporins oremipenem.

-Not used to treatseverepneumoniaempyema,bacteremia,pericarditis,

meningitis andpurulent or septicarthritis duringacute stage.

-Dizziness, fatigue,

insomnia, reversiblehyperacidity,urticaria, skin rashes, itchyeyes, glossitis, drymouth, abnormaltaste sensation,anorexia, nauseaand vomiting,abdominal pain ,diarrhea, rectal

bleeding, vaginitis,anemia.

-reduced hemoglobinand hematocrit.

-prolonged bleedingand prothrombintime, increased ordecreased

lymphocyte count.

- Obtain pt. history of

allergy.-Assess pt. for previoussensitivity reaction topenicillin or othercephalosporins.-Monitor for bleding-Instruct pt. to takeentire quantity of drugexactly as prescribedeven after feeling better

and not to double dose.-Advise pt. to watch andreport signs of infectionlike vaginal itching,loose foul smelling stoolor furry tongue.-Teach pt to report sorethroat, joint pain andbloody diarrhea whichmay indicate blood

dyscrasias andpseudomembranouscolitis respectively.


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Generic Name:

Meperidine

Brand Name:Demerolhydrochloride

Classification:

Anaesthetics-Local and

General

DEMEROL

containsmeperidine, amu-agonistopioid with anabuse liabilitysimilar tomorphine andis a Schedule IIcontrolledsubstance.

Meperidine, likemorphine andother opioidsused inanalgesia, canbe abused andis subject tocriminaldiversion

Relief of

moderate tosevere pain,pre-opmedication,support ofanesth & obstetanalgesia.

respiratory depression

lightheadedness,dizziness, sedation,nausea, vomiting, andsweating

NervousSystem: Euphoria,dysphoria, weakness,headache, agitation,tremor, uncoordinated

muscle movements (e.g.muscle twitches,myoclonus), severeconvulsions, transienthallucinations anddisorientation, visualdisturbances.

Gastrointestinal: Drymouth, constipation,

biliary tract spasm.

Cardiovascular: Flushing of the face,tachycardia,bradycardia, palpitation,hypotension (seeWARNINGS), syncope.

Resp depression,

circulatorydepression, resparrest, shock,cardiac arrest. GIdisturbance.Lightheadedness,dizziness,sedation, nausea,vomiting,sweating.

Euphoria,dysphoria,weakness,headache,tremor, agitation,uncoordinatedmusclemovements,severeconvulsions,

transienthallucinations &disorientation,visualdisturbance.Flushing,tachycardia,bradycardia,palpitation,

1. Administer to

lactating women46 hr beforethe next feedingto minimize theamountin milk.

2.Providenarcoticantagonist,

facilities forassisted orcontrolledrespiration onstandbyduringparenteraladministration.

3. Use caution

when injectingSC into chilledareas of thebody or inpatients withhypotension orin shock;impairedperfusion may
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Genitourinary: Urinaryretention.

Allergic: Pruritus,urticaria, other skinrashes, wheal and flareover the vein withintravenous injection.Hypersensitivityreactions includinganaphylaxis.

hypotension,syncope,phlebitis. Urinary

retention. Allergicreactions. Pain atinj site, localtissue irritation.

delayabsorption; withrepeated doses,

an excessiveamount may beabsorbed whencirculation isrestored.

4. Reducedosage ofmeperidine by25%50% in

patientsreceivingphenothiazinesorothertranquilizers

5.Give eachdose of the oralsyrup in half

glass of water. Iftaken undiluted,it may exert aslight localanestheticeffect onmucousmembranes. Reassure


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patient aboutaddictionliability; most

patients whoreceive opiatesfor medicalreasons do notdevelopdependencesyndromes.

Name ofDrug

ClassificationMechanismof Action

Indication ContraindicationAdverseReaction

Nursing Responsibilities

Gliclazide(Diamicron)

Dosage:80 mg 1 tabOD

Anti Diabetic Drug

PharmacokineticsAbsorption:Effectively absorbedin the GITDistribution: highlybound to plasmaproteins (94%)

Metabolism: liverExcretion: Urine,feces (10-20%)Half life: 10.4 hrs

PharmacodynamicsOnset: unknownPeak: 4-6 hrsDuration: unknown

Stimulatesinsulinrelease frompancreaticbeta cells.

Non-insulindependentdiabetesmellitus(NIDDM).

Type I diabetes;diabetescomplicated withketosis andacidosis;pregnancy,diabetics under-going surgery,hypersensitivity to

sulfonylureas.

Hypoglycemia,GIdisturbances,dermatologicalreactions,biochemicalabnormalities,headache.

Asses forhypoglycemic/hyperglycemicreactions.

Monitor CBC, glycosylatedhemoglobin duringtreatment.

Monitor liver and renal

function test periodically.

Assess for hypersensitivity ofthe patient to medications.


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DiazepamBrand name

Diazepam

Classification

Benzodiazepine

Abenzodiazepine thatprobablypotentiatesthe effectsof GABA,depressesthe CNS,

Anxiety Acute

alcoholwithdrawal

Beforeendoscopicprocedures

Musclespasm

Diastat rectalgel iscontraindicated in patientswith acuteangle- closureglaucoma.

Use cautiouslyin patients

CNS:drowsiness,dysarthria,slurred speech.

CV: CVcollapse,bradycardia.

EENT:diplopia, blurred

Use Diastatrectal gel totreat no morethan fiveepisodes permonth and nomore than oneepisode every 5days because


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andsuppresses the

spread ofseizureactivity.

Preoperativesedation

Cardioversio

n

with liver orrenalimpairment,

depression orchronic openangle-glaucoma.Use cautiouslyin elderly anddebilitatedpatients.

vision,nystagmus.

GI: nausea,

constipation. GU:incontinence,urine retention.

Hematologic:neutropenia

tolerance maydevelop.

Monitor elderly

patients fordizziness,ataxia, mentalstatus changes.Patients are atan increasedrisk for falls.


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DRUGS ACTION INDICATION CONTRAINDICATION

ADVERSEREACTION

NURSINGCONSIDERATIONS

GenericName:Digoxin

Brand Name:Lanoxin

Classification:Cardiac Drugs

Digoxin is acardiac glycosidewhich has positiveinotropic activitycharacterized byan increase in theforce ofmyocardialcontraction.

Digoxin alsoexerts directaction on vascularsmooth muscleand indirecteffects mediatedprimarily by theautonomicnervous systemand an increase invagal activity.

OralHeart failure he useof digoxin in heartproblemsduring sinusrhythm was oncestandard, but is nowcontroversial.

Digoxin is no longerthe first choiceforcongestive heartfailure, but can stillbe useful in patientswho remainsymptomatic despiteproperdiuretic.

Digitalistoxicity,ventriculartachycardia/fibrillation,obstructivecardiomyopathy.Arrhythmiasdue toaccessorypathways(e.g. Wolff-Parkinson-Whitesyndrome).

Extra beats,anorexia, nauseaand vomiting.

Diarrhea in elderly,confusion,dizziness,drowsiness,restlessness,nervousness,agitation andamnesia, visualdisturbances,gynecomastia, localirritation (IM/SC inj),rapidIV admin may leadto vasoconstrictionand transienthypertension.

Potentially Fatal:Cardiac arrhythmiasin combination withheart block.

1. Measure liquidprecisely, using acalibrated dropper orsyringe.obtain writtenparameters.

2. obtain writtenparameters indicatingthe pulse rate, bothhigh and low, atwhich cardiacglycosides are to beheld

3. protection fromlight

4. give IV injectionsover 5 min (or longer)either undiluted ordiluted fourfold orgreater with sterilewater for injection,0.9% NaCl. RLinjection or D5W
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Diphenhy

draminehydrochloride

Brand name

BenadrylClassific

ation

Ethanolaminederivative

Competes

with histaminefor H1-receptor sites.Prevents, butdoesntreverse,histamine-mediatedresponses,particularly

those of thebronchialtubes, GI tract,uterus, andblood vessels.

Rhinitis,

allergysymptoms,motionsickness,Parkinsondisease

Sedation

Nighttimesleep aid

Nonproducti

ve cough(syrup only)

Avoid use in

patients takingMAOinhibitors.

Use withcaution inpatients withprostatichyperplasia,asthma,COPD,

increasedintraocularpressure,hyperthyroidism, CVdisease, andhypertension.

CNS: seizures,

drowsiness,sedation

CV:palpitations,hypotension, tachycardia

EENT: diplopia,blurred vision,nasal congestion,tinnitus.

GI: dry mouth,

nausea, epigastricdistress.

GU: dysuria, urineretention, urinefrequency.

Hematologic:thrombocytopenia,agranulocytosis.

Respiratory:thickening of

bronchialsecretions.

Skin: urticaria

Other:anaphylacticshock.

Stop drug 4

days beforediagnostictesting.

Dizziness,excessivesedation,syncope, toxicity,paradoxicalstimulation, andhypotension are

more likely tooccur in theelderly.


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DRUG ACTION INDICATION CONTRAINDICATION ADVERSEREACTION


Generic Name:

Dobutamine

Brand Names:DobujectDobutrex

Classification:Sympathomimetic( CardiovascularDrugs)

Direct-acting

inotropic agentwhose primaryactivity resultsfrom stimulationof the b-receptors of theheart whileproducing lessmarkedchronotropic,

hypertensive,arrhythmogenicor vasodilatoryeffects.Dobutamine,unlikedopamine, doesnot cause therelease ofendogenous

norepinephrine.No specificeffect on therenalvasculature wasobserved.

Treatment of

cardiacdecompensationdue to depressedcontractilityresulting fromorganic heartdisease orfollowing cardiacsurgicalprocedures in

which parenteraltherapy isnecessary forinotropic support.Myocardialperfusionimaging.

Patients with known

hypersensitivity to thedrug or with idiopathichypertropic subaorticstenosis (IHSS). Theinjectable formulationcontains sodiumbisulfite as apreservative whichhas been documentedto cause allergic-type

reactions in somehuman patients..

Tachycardia,

increase inprematureventricularbeats, transientbigeminy,angina,elevation inblood pressure.

Observe IV

site closely andavoidextravasation.Dobutamine cancauseinflammatoryresponse andtissueischaemia. Monitor for

adversereactions Continuousblood pressuremonitoring Continuouscardiorespiratorymonitoring Documentvital signs hourly

and PRN Monitor fluidbalance


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GenericName:Dopamine

BrandNames:DopamineHCl

Classificatio

n:Cardiovascular Drugs

Immediateprecursor ofepinephrine in thebody, exogenousadministrationproduces directeffect of beta-1receptors andvariablestimulation of

alpha receptors,will cause releaseof norepinephrinefrom storage site.These actionsresult in increasedmyocardialcontraction andcardiac output,systemic

vasoconstrictionas well asincrease renalblood flow andsodium excretion.

Correction ofhemodynamicimbalancespresent inthe shocksyndrome due tomyocardialinfarctions, trauma,endotoxicseptic

emia, openheart surgery,renal failure,and chroniccardiacdecompensation as incongestivefailure.

Should not be used inpatients withphaechromocytoma orhyperthyroidism, nor inthe presence ofuncorrectedtachyarrhythmias orventricular fibrillation.

Ectopic beats;tachycardia;angina pain;palpitation;vasoconstriction;ventriculararrhythmias (athigh doses);hypertension.Headache;

anxiety. Dilatedpupils. Nausea;vomiting.Decreased urineoutput. Dyspnea.Gangrene ofextremities.

Explain topatient/family thereasons formedication,expected results,reason for allmonitoring andprocedures done. Advise patientto be aware and to

report all identifiedadverse reactions. Emphasize theimportance ofreporting discomfortat IV site.
http://www.rxlist.com/script/main/art.asp?articlekey=5477http://www.rxlist.com/script/main/art.asp?articlekey=5613http://www.rxlist.com/script/main/art.asp?articlekey=5613http://www.rxlist.com/script/main/art.asp?articlekey=8171http://www.rxlist.com/script/main/art.asp?articlekey=8171http://www.rxlist.com/script/main/art.asp?articlekey=15917http://www.rxlist.com/script/main/art.asp?articlekey=15917http://www.rxlist.com/script/main/art.asp?articlekey=19211http://www.rxlist.com/script/main/art.asp?articlekey=19211http://www.rxlist.com/script/main/art.asp?articlekey=2728http://www.rxlist.com/script/main/art.asp?articlekey=2628http://www.rxlist.com/script/main/art.asp?articlekey=2628http://www.rxlist.com/script/main/art.asp?articlekey=5477http://www.rxlist.com/script/main/art.asp?articlekey=5613http://www.rxlist.com/script/main/art.asp?articlekey=5613http://www.rxlist.com/script/main/art.asp?articlekey=8171http://www.rxlist.com/script/main/art.asp?articlekey=8171http://www.rxlist.com/script/main/art.asp?articlekey=15917http://www.rxlist.com/script/main/art.asp?articlekey=15917http://www.rxlist.com/script/main/art.asp?articlekey=19211http://www.rxlist.com/script/main/art.asp?articlekey=19211http://www.rxlist.com/script/main/art.asp?articlekey=2728http://www.rxlist.com/script/main/art.asp?articlekey=2628http://www.rxlist.com/script/main/art.asp?articlekey=2628


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Generic Name:Parecoxib

Brand Name:Dynastat

Classification:Non-SteroidalAnti-inflammatoryDrugs (NSAIDs)

The mechanismof action ofvaldecoxib is byinhibition ofcyclooxygenase-2 (COX-2)-mediatedprostaglandinsynthesis.Cyclooxygenase

is responsible forgeneration ofprostaglandins.Two isoforms,COX-1 and COX-2, have beenidentified. COX-2is the isoform ofthe enzyme thathas been shown

to be induced bypro-inflammatorystimuli and hasbeen postulatedto be primarilyresponsible forthe synthesis ofprostanoidmediators of pain,

Management ofacute pain. Itmay be usedpreoperatively toprevent orreducepostoperativepain and canreduce opioidrequirements

when they areusedconcomitantly.

Hypersensitivity toparecoxib or to anyother ingredient ofDynastat. Patientswho havedemonstrated allergic-type reactions tosulfonamides,acetylsalicylic acid(aspirin) or

nonsteroidal anti-inflammatory drugs(NSAIDS) includingother cyclooxygenase-2 (COX-2) specificinhibitors; asthma andurticaria.

Clinical Trials:The followingadverse eventswere reported atan incidencerate of 0.5%and greater thanor equal toplacebo inpatients who

receivedparecoxib in 13controlledgeneral and oralsurgery trials:EventsOccurring 1%and


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inflammation andfever.

System: Alveolarosteitis (drysocket),

constipation andflatulence.Platelet,Bleeding andClotting:Ecchymosis.Psychiatric:Agitation andinsomnia. Skinand

Appendages:

inhibition which isreversible in 24-48hours.


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Generic name Action Indication Contraindication Adverse Reaction Nursing Management

EpinephrineBrand name

AdrenalineClassificatio

n

Adrenergic

Relaxesbronchialsmoothmuscle bystimulatingbeta2receptors andalpha andbeta receptorsin the

sympatheticnervoussystem.

Bronchospasm,hypersensitivityreactions,anaphlaxis

Hemostasis

Acuteasthma attacks

To prolonganeasthetic

effect To restorecardiac rhythmin cardiacarrest

Contraindicated for use infingers, toesears, nose, orgenitalia whenused with localanesthetig.

Use cautiouslyin patients withlong- standing

bronchial astmaay emphysemawho havedevelopeddegenerativeheart disease.

CNS:drowsiness,headache,nervousness

CV:palpitations,ventricularfibrillation

GI: nauseaand vomiting

Respiratory:dyspnea

In patient withParkinsondisease, drugincreasesrigidity andtremor.

Drug interfereswith tests forurinarycatecholamines.


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EphedrineBrand nameHarson

Classification

Vasoconstrictors

Itincreasescardiacoutput,inducesperipheralvasoconstriction,bronchodil

ation,reducesintestinaltone andmotility,andrelaxes thebladderwhilecontracting

thespinchtermuscle.

Diabeticneurophaticedema.

Reversal ofspinal orepiduralanesthesia-inducedhypotension.

Hypersensitivity,

Hypertention

Lactation

Anxiety

Tachycardia

Dry mouth

Insomnia

tremor

1.Report anydisturbing orunusual side effectsto your doctor.

2. Look for e sideeffects of thedrug;like headache,dizziness, anxiety,

restlessness,insomnia andstomach upset.3. the side effectsare severe enoughto makediscontinuing thedrug necessary, butthey are usuallyonly a nuisance.

4. It is indicated forshort term use only.


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GENERIC

NAME(BRANDNAME)

MECHANISMOF ACTION

INDICATION

CONTRA-INDICATION

SIDE EFFECTS/ADVERSEEFFECTS

NURSING IMPLICATIONS/RESPOSIBLITIES

famotidine(Pepcid)

ClassificationH2-receptorantagonist,antiscretory

Competitivelyblocks theaction ofhistamine atthe H2receptors ofthe parietalcells of thestomach;inhibits basalgastric acidsecretion andchemicallyinducedgastric acidsecretions.

Intractableulcerationsor hypersecretoryconditions.

Contraindicated in patientwith sensitivityto drug or anyof itscomponents.

CNS: dizziness,headache, confusion,depression.GI: constipation,diarrhea.SKIN: rash, acne,pruritus, dry skin,flushing.

Assess creatinine clearancebefore treatment.

Assess patient GI disorder beforestarting therapy and reassess

regularly. Be alert for adverse reactions.

Give daily doses or last dose ofthe day at bedtime.

Take drug with food tell patient/SOtaking 20mg BID to take one doseHS.

Avoid over the counter drugs totreat heartburns.


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Name of

Drug

ClassificationMechanism

of Action

IndicationContraindicatio

n

Adverse

Reaction

Nursing

Responsibilities

Felodipine

Dosage:50 mg 1 tabOD

Antihypertensive -Calcium ChannelBlocker

PharmacokineticsAbsorption: wellabsorbedDistribution:

unknownMetabolism: liverExcretion: kidneysHalf life: 11-16 hrs.

PharmacodynamicsOnset: 2-3 hrs.Peak: 2 -5 hrs.Duration: less than24 hrs.

Inhibit calciumion influxacross cellmembrane,resulting ininhibition ofexcitation/contraction.

Relaxes thesmoothmuscles of thevessel walland reducingincidence andseverity of thespasm.

Neurologicfunction isimproved andfurtherdeteriorationfrom ischemiais prevented.

Treatment ofhypertension.

Used to treat orpreventcerebralvasospasmfollowing a SA

hemorrhage,which usuallyoccurs 4-14days after astroke, inhibitsblood flow to thearea, andworsensischemia.

Hypotensionwith systolic BP


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GenericName:Gentamicin

BrandNames:Garamycin

Classification:

AntibioticTopicalagent

A wide spectrumantibioticprovides highlyeffective topicaltreatment inprimary andsecondarybacterialinfections of theskin. This

product mayclear infectionsthat have notresponded toother topicalantibiotic agents.In impetigocontagiosa andother primaryskin infections,

treatment with asmallamount of GENTAMICIN OINTMENT ANDCREAM three tofour times dailyusually clears

Used to treatinfectionscaused byaerobic gram-negativebacteria.Gentamicin incombination withpenicillin hassynergetic

antibacterialeffects againstgram positivecocci.Gentamicin hasa narrowtherapeuticrange and maycause sideeffects of earloss andnephrotoxic. It ismostly useful inlifethreateninginfections, whichmakes itcompulsory forthe use of

Patients that havereported allergicreactions to previousgentamicin exposure,or otheraminoglycoside use.This is due to thepatient cross-sensitivityto these drugs.

Gentamicin canhave effects onthe CNS,specifically theeigth cranialnerve which canlead toirreversiblehearing loss,especially in

patients withrenal impairmentor in patients onhigh doses forprolongedduration oftherapy.Additionally, theCNS effects canpresent asdizziness,vertigo, ataxia,tinnitus, androaring in theears. There havealso beenreports ofperipheralneuropathy and

Give by IMroute if at allpossible; give bydeep IM injection.

Cultureinfected areabefore therapy.

Use 2 mg/mL

intrathecalpreparationwithoutpreservatives, forintrathecal use.

Avoid long-term therapiesbecause ofincreased risk oftoxicities.Reduction in dose may beclinically indicated.

Patients withedema or ascitesmay have lowerpeak
http://www.medindia.net/drugs/drug_toxicity/gentamicin.htmhttp://www.medindia.net/drugs/drug_toxicity/gentamicin.htmhttp://www.medindia.net/drugs/drug_toxicity/gentamicin.htmhttp://www.medindia.net/drugs/drug_toxicity/gentamicin.htmhttp://www.medindia.net/drugs/drug_toxicity/gentamicin.htmhttp://www.medindia.net/drugs/drug_toxicity/gentamicin.htm


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the lesionspromptly. Insecondary skin

infections, theproductfacilitates thetreatment of theunderlyingdermatosis bycontrolling theinfection.Bacteriasusceptible to

the action of GENTAMICIN include sensitivestrains of streptococci (group Abeta-hemolytic,alpha-hemolytic), Staphylococcusaureus (coagula

se positive,coagulasenegative, andsomepenicillinase-producingstrains), and thegram-negative

gentamicin.Effective levelsof gentamicin

can be achievedwithoutoverdosage.

encephalopathy.Another seriousside effect of

gentamicin isnephrotoxicity,which is alsoassociated withhigh drug doses,prolongedtherapy, orconcurrent useof othernephrotoxicagents. Patientsmay experienceGI effects, otherCNS effectssuch as lethargyand confusion,rashes, transientenlargement ofthe liver orspleen, andhypertension orhypotension.

concentrationsdue to expanded

extracellular fluidvolume.

Cleanse areabefore applicationof dermatologicpreparations.

Ensureadequatehydration ofpatient before andduring therapy.

Monitor renalfunction tests,CBCs, serum druglevels during long-term therapy. Consult withprescriber toadjust dosage


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bacteria


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Drugs Action Indication Contraindication

Adverse Reaction NursingConsideration

Heparin(Heparin Leo)

Classification:Anticoagulant

Acceleratesformation ofantithrombinlllthrombincomplex anddeactivatesthrombintopreentconversion offibrinogen to

fibrin.

Prophylaxisand treatment oftromboemboliticdisorder.

Prevention ofthromboemboliccomplications

Hypersensitivity to Heparin

Actual orpotentialhemorrhagicstates

Pregnancy

Threatenedabortion,subacutebacterialebdocarditis,severehypertension,gastric orduodenalulcers,

advanced renalor hepaticdisease duringor immediatelyafter spinal ormajor surgery.

Hemorrhage

Allergic andanaphylactic reactions

Delayed onsetthrombocytopenia,skin necrosis at theinjection site

Alopecia,diarrhea,osteoporosis.

Assess patientscondition beforetherapy.

Monitor allergic andadverse reaction

Monitor plateletcount regularly.

Instruct patient andfamily to watch for andreport signs ofbleeding.

Caution patient touse soft bristletoothbrush to avoidbleeding gums.

Instruct patient tocarry emergency IDwith information aboutdrug being taken andcondition beingtreated.


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Drug Action Indication Contraindication Adverse Reaction NursingConsideration

Generic

Name:Diazoxide

Brand Name:Hyperstat

Classification:Anti-hypertensive

Potassium channel

activator, whichcauses localrelaxation insmooth muscle byincreasingmembranepermeability topotassium ions.This switches offvoltage-gatedcalcium ionchannels whichinhibits thegeneration of anaction potential.

o Hypertensive

Emergencyo Hypoglycemia

o Insulinoma

o compensatory

hypertension,such as thatassociated withaortic coarctationor arteriovenousshunt

o hypersensitive to

diazoxide, otherthiazides, or othersulfonamide-

derived drugs.

o Nausea

o

Vomitingo Anorexia

o Abdominal

discomforto Dry Mouth

o Costipation

o Diarrhea

o Cerebral

ischemiao Unconsciousnes

so Convulsions

o Paralysis

o Confusion

o Sodium and

water retentionafter repeatedinjections

Caution must be

observed whenreducing severelyelevated bloodpressure.

Do not used for routinetreatment ofchronichypertension.

Blood glucosedeterminations arerecommended atperiodic intervals afterparenteraladministration tomonitor hyperglycemia.

Care must be taken toavoid extravasationduring intravenousadministration sincecellulitis and pain (butnot necrosis) mayresult.
http://en.wikipedia.org/wiki/Potassium_channelhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Semipermeable_membranehttp://en.wikipedia.org/wiki/Ionhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Action_potentialhttp://www.everydayhealth.com/drugs/c/hypertensive-emergencyhttp://www.everydayhealth.com/drugs/c/hypertensive-emergencyhttp://www.everydayhealth.com/drugs/c/hypoglycemiahttp://www.everydayhealth.com/drugs/c/insulinomahttp://highbloodpressure.about.com/od/highbloodpressure101/a/intro_art.htmhttp://highbloodpressure.about.com/od/highbloodpressure101/a/intro_art.htmhttp://en.wikipedia.org/wiki/Potassium_channelhttp://en.wikipedia.org/wiki/Smooth_musclehttp://en.wikipedia.org/wiki/Semipermeable_membranehttp://en.wikipedia.org/wiki/Ionhttp://en.wikipedia.org/wiki/Calciumhttp://en.wikipedia.org/wiki/Action_potentialhttp://www.everydayhealth.com/drugs/c/hypertensive-emergencyhttp://www.everydayhealth.com/drugs/c/hypertensive-emergencyhttp://www.everydayhealth.com/drugs/c/hypoglycemiahttp://www.everydayhealth.com/drugs/c/insulinomahttp://highbloodpressure.about.com/od/highbloodpressure101/a/intro_art.htmhttp://highbloodpressure.about.com/od/highbloodpressure101/a/intro_art.htm


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Generic

Name:Ketorolac

Brand Name:Toradol

Classification:Anti-Pyretic,NSAIDs

Responsible for

ketorolac's anti-inflammatory,antipyretic andanalgesic effects isthe inhibition ofprostaglandinsynthesis bycompetitive blockingof the enzymecyclooxygenase(COX). Like mostNSAIDs, ketorolac isa non-selective COXinhibitor.

o Short term

management ofpain(up to 5 days)o Mild to moderate

pain.o Opthalmic: relief of

ocular itching dueto seasonalconjunctivitis andrelief of postoperative

inflammation aftercataract.

o Renal impairment

o

Labor and deliveryo Lactation

o Aspirin allergy

o Recent GI

bleeding orperforation

o Allergies

o Edema

o

Rasho Heartburn

o GI irritation or

hemorrhageo urinating less

than usual ornot at all

o nausea

o sore throat

Remember, keep this

and all other medicinesout of the reach ofchildren, never shareyour medicines withothers, and use thismedication only for theindication prescribed.

Take this medicine bymouth with a full glassof water.

Do not take yourmedicine more oftenthan directed.
http://en.wikipedia.org/wiki/Enzymehttp://en.wikipedia.org/wiki/Cyclooxygenasehttp://en.wikipedia.org/wiki/Enzymehttp://en.wikipedia.org/wiki/Cyclooxygenase


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GenericName:LidocaneHydrochloride

Brand Name:Xylocaine

Classification:Antiarrhythmic agent;Localanesthetic

Lidocaine HClstabilizes theneuronal membraneby inhibiting theionic fluxes requiredfor the initiation andconduction ofimpulses, therebyeffecting localanesthetic action.

o Acute management

of ventriculararrhythmias

o topical anesthesia

in local skindisorders

o local anesthesia of

accessible mucousmembranes

o topical anesthesia

prior tovenipuncture orperipheral IVcannulation

o Hypersensitivity to

amide localanesthetics

o Stokes-Adams

syndromeo Wolff-Parkinson-

White syndromeo Severe degrees of

sinoatrial, AV, orintraventricular

block in absenceof pacemaker.

o Edema

o Erythema

o Petechiae

o Confusion

o Convulsion

o Drowsiness

o Diziness

o Respiratory

Arrest

Use IM route foremergency situations(eg, no IV access, noECG monitoring) only.

Do not use around theeyes, on body orifices,or on mucousmembranes.

For Im injection, deltoidmuscle is preferred IMsite. Switch to IV routeas soon as possible.

Use only lidocainespecifically labeled forIV use (withoutpreservatives orepinephrine). Do notadminister with otheragents.

Advise patient that drugmay cause dizziness ordrowsiness and to avoidgetting out of bed orwalking withoutassistance.


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Generic Name:Mannitol

Brand Name:Osmitrol

Classification:Diuretics

Mannitolincreasesurinary output byinhibiting tubularreabsorption ofwater andelectrolytes.

It raises theosmotic

pressure of theplasma allowingwater to bedrawn out ofbody tissues.

Oliguric phase ofrenal failure,raisedintracranialpressure, raisedintraocularpressure,cerebral edema,transurethralprostatic

resection

Pulmonary congestionor edema;

intracranial bleeding;

CHF;

metabolic oedemawith abnormalcapillary fragility;

anuria due to severerenal disease;

severe dehydration.

Fluid andelectrolyteimbalance;acidosis (withhigh doses).Nausea, vomiting,thirst; headache,dizziness,convulsions,chills, fever;

tachycardia, chestpain; blurredvision; urticariaand hypotensionor hypertension;acute renalfailure; skinnecrosis;thrombophloebitis

1.Take care toavoidextravasation.Observeinjection sitefor signs ofinflammationor edema

2.check for signs

of fluid andelectrolyteimbalance

3.measure I&Oaccurately andrecord toachieve properfluid balance

4.monitor vitalsigns closely.Reportsignificantchanges in BPand signs ofCHF


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Generic Name(Brand Name)

Mechanismof Action

Indication Adverse Reaction Contraindication

Nursing Responsibility

Methergine(methylergonovinemaleate)

Methergin

Stimulatesuterinesmoothmuscles

producingsustained

contractions

therebyshortens thethird stage of

labor

Indication:Preventionand treatmentof postpartumandpostabortionhemorrhagecaused byuterine atonyorsubinvolution

Cardiovascular:hypertension,temporary chestpain, palpitation

CNSHallucinations,dizziness, seizure,headache

Gastrointestinal:Nausea, vomiting,diarrhea, foul taste

Local:Thrombophlebitis

Otic: Tinnitus

Renal: Hematuria

Respiratory:Dyspnea, nasalcongestionMiscellaneous:Diaphoresis

> contraindicatedin patientshypersensitive tomethylergonovineor anycomponent of theformulation.

>ergot alkaloidsarecontraindicated

with potentinhibitors ofCYP3A4(includesproteaseinhibitors, azoleantifungals, andsome macrolideantibiotics);hypertension;

toxemia;pregnancy

>Be alert for adverse reactionsand drug interactions.

>This drug should be usedextremely carefully because ofit's potent vasoconstrictoraction. I.V. use may inducesudden hypertension andcerebrovascular accidents. As alast resort, give I.V. slowly overseveral minutes and monitor

blood pressure closely.


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NursingConsideration

Generic Name:MethylergonovineMaleate

Brand Name:Methergine

Classification:Alkaloids

o Directly

stimulates theuterine muscleto increaseforce andfrequency ofcontractions.

o Produces

arterialvasoconstriction

by stimulation ofalpha-adrenergic andserotoninreceptors andinhibition ofendothelial-derivedrelaxation factorrelease.

o Hemorrhage,

postpartum andpostabortal(prophylaxis andtreatment)

o prevention or

treatment ofpostpartum orpostabortal uterinebleeding due to

uterine atony orsubinvolution.o In cases of

incompleteabortion,methylergonovinemay be used tohasten expulsionof uterinecontents.

o Pregnancy

o Labor and

deliveryo Lactation

o Hypersensitivity

o

o increased

blood pressure(severeheadache,blurred vision)

o seizure

(convulsions)o feeling light-

headed,fainting

o

poundingheartbeato chest pain or

heavy feeling,pain spreadingto the arm orshoulder,nausea,sweating,general ill

feelingo hallucinations

o unpleasant

taste in yourmouth

o ringing in your

ears

Frequent monitoring ofvital signs, arterialblood gases, andelectrolytes.

Electrocardiogrammonitoring to assesscardiac function andperfusion.

May includemaintaining an openairway and breathing,maintaining properfluid and electrolytebalance, correctinghypertension, andcontrolling seizures.

Notify physician ifinfection develops,since infection maycause increasedsensitivity tomedication.


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GenericName:Metronidazole

Brand Name:Flagyl

Classification:Antibiotic

Metronidazole,taken up bydiffusion, isselectively absorbedby anaerobicbacteria andsensitive protozoa.Once taken up byanaerobes, it is non-enzymaticallyreduced by reactingwith reducedferredoxin, which isgenerated bypyruvate oxido-reductase. Thisreduction causes theproduction of toxicproducts toanaerobic cells, andallows for selectiveaccumulation inanaerobes.

o It is prescribed in

the treatment of avariety ofinfections, includingamebiasis,trichomoniasis,anaerobicinfections,antibiotic-inducedinfections, pseudo-membranouscolitis, and bacterialvaginosis.

o First trimester of

pregnancyo blood dyscrasias

o organic disease

o central nervous

system disorders,or knownhypersensitivity tothis drug prohibits

its use.o It is

contraindicated innursing mothers.

o severe GI

distresso dizziness

o neutropenia

o neurologic

disturbanceso nausea

o stomach pain

o diarrhea

o headacheo vaginal itching

or dischargeo A metallic

taste in themouth iscommonlynoted.

Administer with food ormilk to minimize GIirritation.

Do not skip doses ordouble up on misseddoses. If a dose ismissed, take as soon asremembered if notalmost time for nextdose.

Inform patient thatmedication may causean unpleasant metallictaste.

Advise patient toconsult health careprofessional if noimprovement in a fewdays or if signs andsymptoms ofsuperinfection (blackfurry overgrowth ontongue; loose or foul-smelling stoolsdevelop).
http://en.wikipedia.org/wiki/Anaerobic_bacteriahttp://en.wikipedia.org/wiki/Anaerobic_bacteriahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Ferredoxinhttp://en.wikipedia.org/wiki/Anaerobic_bacteriahttp://en.wikipedia.org/wiki/Anaerobic_bacteriahttp://en.wikipedia.org/wiki/Protozoahttp://en.wikipedia.org/wiki/Ferredoxin


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GenericName:MidazolamHCl

Brand Name:Midazolam

Classification:Antianxiety;Sedative orhypnotics(Benzo-diazepine)

Actions aremediated throughthe inhibitoryneurotransmittergamma-aminobutyric acid(GABA), which isone of the majorinhibitoryneurotransmitters inthe brain.Benzodiazepinesincrease the activityof GABA, therebyproducing a calmingeffect, relaxingskeletal muscles,and inducing sleep.Benzodiazepines actas agonists at the

benzodiazepinereceptors, whichform a component ofthe benzodiazepine-GABA receptor-chloride ionophorecomplex.

o Preprocedural

sedation.o Aids in the

induction ofanesthesia and aspart of balancedanesthesia.

o Pregnancy

especially in thethird trimester

o Long term use

o Hypersensitivity

o Acute narrow

angle glaucomao

o Ataxia

o Dysarthria

o Nystagmus

o Slurred speech

o Somnolence

(difficultystaying awake)

o Mental

confusion

o Hypotensiono Respiratory

arresto Vasomotor

collapseo Headache

Assess level of sedationand level ofconsciousnessthroughout and for 2-6hr followingadministration.

Monitor BP, pulse andrespiration continuouslyduring IV administration.

If overdose occurs,monitor pulse,respiration , and BPcontinuously.

If hypotension occurs,treatment includes IVfluids, repositioning andvasopressors.

The effects ofmidazolam can bereversed with flumazenil(Romazicon).
http://en.wikipedia.org/wiki/Ataxiahttp://en.wikipedia.org/wiki/Dysarthriahttp://en.wikipedia.org/wiki/Nystagmushttp://en.wikipedia.org/wiki/Somnolencehttp://en.wikipedia.org/wiki/Hypotensionhttp://en.wikipedia.org/wiki/Respiratory_arresthttp://en.wikipedia.org/wiki/Respiratory_arresthttp://en.wikipedia.org/wiki/Respiratory_arresthttp://en.wikipedia.org/wiki/Vasomotorhttp://en.wikipedia.org/wiki/Ataxiahttp://en.wikipedia.org/wiki/Dysarthriahttp://en.wikipedia.org/wiki/Nystagmushttp://en.wikipedia.org/wiki/Somnolencehttp://en.wikipedia.org/wiki/Hypotensionhttp://en.wikipedia.org/wiki/Respiratory_arresthttp://en.wikipedia.org/wiki/Respiratory_arresthttp://en.wikipedia.org/wiki/Vasomotor


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MorphineSulfate (HizonMorphineSulfate

Classification:Narcoticanalgesic

Binds withopoidreceptors inthe CNScausingalteration ofbothperception ofand emotionalresponse topain throughunknownmechanism.

Relief ofmoderate tosevere acuteand chronicpain.

Renalintestinal colic.

Cancer

MyocardialInfarction

Pilmonaryedema todecreasepulmonarycongestion.

Antitussive

Narcotic,hypnotic,sedative.

Knownhypersensitivityto morphine or toone of the otherexcipients,existing intestinalobstruction andpregnancy.

Asthma,

shortage ofbreathing, braindamage,epilepsy,simultaneoustreatment withantidepressants,chronic alcoholabuse,immediatelyafterbile duct surgery,anastomoses,severeobstruction ofthe gut.

Allergic reactions.

Gastrointestinaldisturbances

Urinary retention

Depression,delirium andconvulsion.

Nausea,xerostomia, emesis, anorexia,dysguesia, facialflushing.

Assess pain.

Monitor for allergicreactions

Monitor forrespiratorydepression.

Monitor for input

output ratio.

Give withantiemetic if nauseaoccurred.

Administer whenpain is beginning toreturn.

Withdrawmedication slowlyafter long term use.

Give with food ormilk.


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NAlbuphineHydrocloride(Nubain)

Classification:Analgesics,Musclerelaxants

Binds withopiatereceptors inthe CNS:ascendingpain pathwaysin limbicsystem,thalamus,midbrain,hypothalamus, alteringperception ofand emotionalresponse topain. Relievespain.

Relief ofmoderate tosevere pain

For pre-operativeanalgesia,supplement tobalancedamesthesia.

Hypersensitivity

Pregnancy.

Sedation

Drowsiness

Sweating

Nausea

Dry mouth

Dizziness

Headache

vomiting

Assess patientsunderlying conditionbefore therapy.

Monitor allergicreactions.

Give only withresuscitativeequipment available.

Advice patient torefrain from takingCNS depressants.

Teach patient toturn, cough, breathedeeply after surgery toprevent atelectasis.


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ointment by applyingthe ointment over a 6 6 inch area in athin, uniform layerusing the applicator.Cover area withplastic wrap held inplace by adhesivetape. Rotate sites ofapplication todecrease the chanceof inflammation andsensitization; closetube tightly when

finished. Administer transder

mal systems to skinsite free of hair andnot subject to muchmovement. Shaveareas that have a lotof hair. Do not applyto distal extremities.Change sites slightly

to decrease thechance of localirritation andsensitization.Remove transdermalsystem beforeattemptingdefibrillation


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or cardioversion. Administer transmu

cosal tablets byplacing them betweenthe lip and gumabove the incisors orbetween the cheekand gum. Encouragepatient not to swallowand not to chew thetablet.

Administerthe translingual spraydirectly onto the oral

mucosa; preparationis not to be inhaled.

WARNING: Arrange to withdraw druggradually. 46 wk isthe recommendedwithdrawal period forthe transdermal preparations.


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DRUGS ACTION INDICATION CONTRAINDICATION

ADVERSEREACTION


GenericName:Nalbuphine

asynthetic opioid agonist-antagonistan

NUBAIN isindicated for therelief of moderateto severe pain.

NUBAIN shouldnot beadministered topatients who are

CNSEffects: Nervousness,depression,restlessness,

1. Reassess patientslevel ofpain at least 15 and 30minutes after parenteral
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Hydrochloride

Brand Name:Nubain

Classification:Analgesics

algesic of thephenanthrene series. It ischemically

related toboth thewidely usedopioid antagonist, naloxone, and thepotent opioidanalgesic,oxymorphone.

NUBAIN can alsobe used as asupplement tobalanced anesth

esia,forpreoperativeandpostoperativeanalgesia, andfor obstetricalanalgesia duringlabor anddelivery.

hypersensitive tonalbuphinehydrochloride, orto any of the

other ingredientsin NUBAIN.

crying, euphoria,floating, hostility,unusual dreams,confusion, faintness,

hallucinations, dysphoria, feeling ofheaviness, numbness,tingling, unreality.

Cardiovascular: Hypertension, hypotension, bradycardia, tachycardia.

Gastrointestinal: Cramps, dyspepsia, bittertaste.

Respiratory: Depression, dyspnea, asthma.

Dermatologic: Itching, burning, urticaria.

Miscellaneous: Speech difficulty, urinaryurgency, blurredvision, flushing andwarmth.

administration

2. Nalbuphine acts asan

opioid antagonist andmaycause withdrawalsyndrome. For patientswhohave received log-termopioids, give 25% of theusual dose initially.Watchfor sings of withdrawal.

3. Alert: Drug causesrespiratory depression,which at 10mg is equaltorespiratory depressionproduced by 10 mg ofmorphine

4.Monitor circulatory

andrespiratory status,bladderand bowel function. Ifrespirations are shalloworrate is below 12breaths/minute, withhold
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AllergicReactions: Anaphylactic/anaphylactoid andother serious

hypersensitivityreactions have beenreported following theuse of nalbuphine andmay requireimmediate, supportivemedical treatment.

dose and notifyprescriber


NursingConsideration

Generic Name:Omeprazole

Reduces gastricacid secretion and

o Gastroesophageal

reflux disease

o Hypersensitivity

o frequent chest

CNS: dizziness,headache,

Check for abdominalpain, emesis,


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Brand Name:Losec

Classification:Proton pumpinhibitor

increases gastricmucus andbicarbonateproduction,

creating protectivecoating on gastricmucosa and easingdiscomfort fromexcess gastric acid

o Erosive

esophagitiso Short-term

treatment of activeduodenal ulcer

o Gastric ulcers

o Pathologic

hypersecretoryconditions

o Frequent heartburn

paino unexplained

weight losso vomit that looks

like blood or coffeegrounds

o stomach pain

asthenia

GI: nausea,vomiting,

diarrhea,constipation,abdominal pain

Musculoskeletal:back pain

Respiratory:cough, upperrespiratory tract

infection

Skin: rash

diarrhea, orconstipation.

Evaluate fluid I&O.

Tell patient to take30 to 60 minutesbefore a meal,preferably inmorning.

Instruct patient toswallow capsules ortablets whole and not

to chew or crushthem

Caution patient toavoid driving andother hazardousactivities until heknows how drugaffects concentrationand alertness.

Name of Drug ClassificationMechanismof Action

IndicationContraindicatio

nAdverse

ReactionsNursing

Responsibilities


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Mannitol(Osmofundin)

Dosage:75 cc

Diuretics -Osmotic Diuretic

PharmacokineticsAbsorption:Complete (IVadministration)Metabolism: 15-100 minsDistribution:crosses placenta;may enter

breastmilkExcretion: urine

PharmacodynamicsOnset: -1 hourPeak: 1 hrDuration: 6-8 hrs.

Increases theosmoticpressure of

glomerularfiltrate, whichinhibits tubularreabsorptionof water andelectrolytesand increasesurinary output.

Reduction ofincreaseintracranial

pressureassociatedwith cerebraledema;promotion ofdieresis in theprevention ortreatment ofoliguria oranuria due to

acute renalfailure;promotingurinaryexcretion oftoxicsubstances.

Hypersensitivity.Severe renaldisease, severe

dehydration,pulmonarycongestion.Renaldysfunction aftermannitoladministrationseverepulmonaryedema.

Dizziness,headache,convulsion,

reboundincreased ICP,confusion,seizures, andfever.Edema,thrombophlebitis, hypotension,hypertension,heart failure,

tachycardia,angina likechest pain,vascularoverload.Blurred vision,rhinitis, loss ofhearing,decreased IOP.Nausea,

vomiting, drymouth,diarrhea, thirst.Urine retention.

Assess patientscondition before therapyand regularly thereafter

to monitor drugeffectiveness.

Assess fluid volumestatus, hypovolemia orhypervolemia, urineoutput, skin turgor, neckveins, peripheraledema, breath sounds,peripheral pulses and

mucous membranes,thirst and hypotension.

Monitor manifestation ofelectrolyte imbalance:hypokalemia andhyponatremia.

Assess BP before andduring therapy with

patient lying, standing,and sitting, orthostatichypotension.


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Oxytocin(Syntocinon)

Classification:Oxytocic drugs

Acts directlyononmyofibrils,producinguterinecontractions:stimulate milkejection bythe breast

Initiation orimprovementof uterinecontractions toachieve earlyvaginaldelivery formaternal orfetal reasons

Management of inevitableor incompleteabortion

Control ofpostpartumbleeding orhemorrhage

Stimulationof uterine

contractionduring thirdstage of labor

Preganacy

Hypersensitivity

Pregnacy-inducedhypertension,cephalopelvicdisproportion,fetal distress,hypertonicuterus.

Seizures

Titaniccontractions

Hypertension/hypotension

Dysrhythmias

Intracranialhemorrhage

Anorexia

Vomiting

Rush

Asphyxia

Prematureventricular contraction

Jaundice

Hypoxia

Monitor BP andfluid intake and output

Assess laborcontractions

Assess signs ofwater intoxication

Watch for fetal

distress, acceleration,deceleration, fetalpresentation, pelvicdimensions.

Instruct patienttoreport increased bloodloss, abdominalcramps, increasedtemp or foul-smelling

lochia.

Advise patient thatcontractions will besimilar to menstrualcramps, graduallyincreasing in intensity.


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GenericName(BrandName)

Mechanism ofAction

Indication AdverseReaction

Contraindication Nursing Responsibility

Generic

Name:Pilocarpinehydrochloride

ClassificationMiotics

Directly

stimulatescholinergicreceptors,resulting inmuscarinicand nicotiniceffects.

Pilocarpine

HydrochlorideTablets areindicated for 1)the treatment ofsymptoms ofdry mouth fromsalivary glandhypofunctioncaused byradiotherapy for

cancer of thehead and neck;and 2) thetreatment ofsymptoms ofdry mouth inpatients withSjogren'sSyndrome.

Body as a whole:

body odor,hypothermia, mucousmembraneabnormality

Cardiovascular:bradycardia, ECGabnormality,palpitations, syncope

Digestive: anorexia,increased appetite,esophagitis,gastrointestinaldisorder, tonguedisorder

Hematologic:leukopenia,lymphadenopathy

Nervous: anxiety,confusion,depression, abnormaldreams, hyperkinesia,hypesthesia,nervousness,paresthesias.

Pilocarpine

HydrochlorideTablets arecontraindicated inpatients withuncontrolledasthma, knownhypersensitivity toPilocarpine, andwhen miosis isundesirable, e.g.,

in acute iritis and innarrow angle(angle closure)glaucoma.

Importance of

learning and adhering toproper administrationtechniques to avoidcontamination of thesolution or gel container.

Importance ofremoving soft contactlenses beforeadministration (since

pilocarpine may beabsorbed by orpreservatives inpreparations may havea deleterious effect onthe lenses)

Caution advised ifdriving at night orperforming hazardous

tasks in dim light.

Importance ofinforming clinicians ofexisting or contemplatedconcomitant therapy,including prescriptionand OTC drugs.


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Generic name Action Indication Contraindication Adverse Reaction NursingManagement

PromethazinehydrochlorideBrand name

PhenerganClassification

Phenotiazinederivative

Phenotiazine

derinativethatcompeteswithhistamine forH1- receptorsites oneffectorcells.Prevents,

but doesntreverse,histamine-mediatedresponses.At highdoses, drugalso haslocalanesthetic

effects.

Monitorsickness

Nausea andvomiting

Nighttimesedation

Contraindicated

in patientshypersensitiveto drug, thosewho haveexperiencedadversereactions tophenothiazines,breast- feedingwomen,

childrenyounger thanage 2, andacutel ill ordehydratedchildren.

CNS:drowsiness,sedation,coneusion.

CV:hypotension,hypertension

EENT: drymouth

Hematologic:leukopenia

Monitorpatient forneurolepticmalignantsyndrome:alteredmentalstatus,autonomicinstability,muscle

rigidity,andhyperpyrexia.


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Drug Action Indication Contraindication Adverse

Reaction


GenericName:Meto-clopramide

Brand Name:Plasil

Classification

:Antiemetic

o Blocks dopamine

receptors inchemoreceptortrigger zone ofthe CNS.

o Stimulates

motility of theupper GI tractand acceleratesgastric emptying.

o Gastroparesis

o GERD

o Migraine

o Nausea/Vomiting

o Nausea/Vomiting,

ChemotherapyInduced

o Nausea/Vomiting,

Postoperativeo Radiographic Exam

o Small Intestine

Intubation

o bleeding or

blockage in yourstomach orintestines;

o a perforation

(hole) in yourstomach orintestines;

o epilepsy or other

seizure disorder;or

o an adrenal gland

tumor(pheochromocytoma).

o tremors, or

restlessmusclemovements inyour eyes,tongue, jaw, orneck;

o mask-like

appearance ofthe face;

o very stiff (rigid)

muscles, highfever,confusion, fastor unevenheartbeats,tremors,

o fluid retention;

o jaundice

(yellowing ofyour skin oreyes); or

o seizure

(convulsions)

Assess patient fornausea, vomiting,abdominal distention,and bowel soundsbefore and afteradministration.

May cause drowsiness.

Advise patient to avoidconcurrent use ofalcohol and other CNSdepressant while takingthis medication.

Advise patient to notifyhealth care professionalimmediately ifinvoluntary movement

of eyes, face or limbsoccurs.
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Potassiu

mChloride

Brand name

KaliumDulures

Classification

Potassium salt

Replace

potassium andmaintainspotassiumlevel.

To prevent

hypokalemia Hypokalemia

Severehypiokalemia

Acute MI

Use

cautiouslyin patientwithcardiacdisease orrenalimpairment.

CNS:

paresthesia oflimbs, flaccidparalysis

CV: heartblock,cardiacarrest

Metabolic:hyperkalemia

Make sure

powders arecompletely dissolvedbefore giving.

Many adversereactions may reflecthyperkalemia.


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GenericName:Salbutamol

Brand Name:Ventolin

Albuterol

Classification:Bronchodilator

Relaxesbronchial andvascularsmoothmuscle bystimulating

beta2receptors.

Relief of severebronchospasmassociated withacuteexacerbations ofchronic

bronchitis andbronchialasthma.Treatment ofstatusasthmaticus. Inpatientsrefractory tosalbutamolrespiratory

solution

Eclampsia and severepre-eclampsia; intra-uterine infection, intra-uterine foetal death,antepartumhaemorrhage, placenta

praevia and cordcompression,threatened miscarriage,cardiac disease.

Tremor,nervousness,headache,hyperactivity,tachycardia,palpitations,

nausea, vomiting,bronchospasm,hypersensitivityreactions.

Use cautiously inpatients withcardiovasculardisorders. Syrup is availablefor children as young

as age 2. Inhaler may beused 15 minutesbefore exercise toprevent exercise-inducedbronchospasm. Patient may usetablets and inhaler atthe same time. Monitor

for toxicity. Warn the patientabout the risk ofparadoxicalbronchospasm and if itoccurs, stop drugimmediately. Teach patient to


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use the inhalercorrectly: Shake it,clear the throat, expelas much air as

possible from thelungs, inhale deeplywhile releasing thedrug from the inhaler,hold breath for severalseconds. Use of a spacermay improve delivery. Wait for 2 minutesbetween puffs of

inhaler. If the patient isalso using a steroidinhaler, use thebronchodilator first,then wait 5 minutesbefore using thesteroid. Wash the canisterwith warm water and

soap at least once aweek.

Classification Mechanism Indication Contraindicatio Adverse Nursing


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GenericName:

SodiumBicarbonate

Brand Name:B. Braun 8.4% SodiumBicarbonate

ClassificationElectrolyte-

alkalinizer

It raisesblood andurinary pH bydissociationto providebicarbonateions, whichneutralisesthe hydrogenionconcentration. It alsoneutralisesgastric acidviaproduction ofcarbondioxide.

treatmentof

metabolicacidosis

asalkalinizingagent incardiopulmonaryresuscitation and inthe

treatmentof certaindrugintoxicants

Metabolic orrespiratory alkalosis;hypernatraemia,severe pulmonaryoedema;hypocalcaemia,hypochlorhydria.

Metabolicalkalosis; moodchanges,tiredness,shortness of breath, muscleweakness,irregularheartbeat;musclehypertonicity,twitching,tetany;hypernatraemia,hyperosmolality,hypocalcaemia,hypokalaemia;stomachcramps,flatulence.Tissue necrosisat inj site.

Instruct patientto chew antacid

tab and drink 8 oz.of water.

Inform patientthat renal calculimay develop ifantacid is takenwith milk.

Instruct thepatient not to useantacid for morethan two weeksexcept undersupervision of thephysician.

Advice patientnot to take sodiumbicarbonate onroutine or longterm basis.

Advise patientto notify physicianif indigestion isaccompanied bychest pain:dyspnea; diarrhea;dark, tarry stools.

Teach patientabout sodium-


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restricted diet; toavoid use ofbaking soda forindigestion.

Cautionpatient toimmediately reportto physician ifsymptoms such asnausea, vomitingand anorexiaoccurs.


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Name ofDrug

ClassificationMechanism of

ActionIndication

Contraindication

AdverseReactions


Citicoline(Somazine)

Dosage:1 gm IV q 12

CNS Stimulants/Neurotonics

PharmacokineticsAbsorption: almostcompletelyabsorbedDistribution:disperse widelythroughout the

body: cross bloodbrain barrierMetabolism:unknownExcretion: unknownHalf life: unknown

PharmacodynamicsOnset: unknown

Peak: UnknownDuration: unknown

Citicoline is aderivative ofcholine andcytidine involvein thebiosynthesis oflecithin. It isclaimed toincreaseblood flow

and oxygenconsumptionin the brain.

CVA in acuteand recoveryphase.Symptomsand signs ofcerebralinsufficiency(i.e.,dizziness,headache,

poorconcentration,memory loss,disorientation).

Hypertonia oftheparasympatheticnervous system.

Shock,hypersensitivity,hypotension,insomnia,excitement.

Evaluate patient medicalhistory.

Assess patientscondition.

Monitor BP, pulse andheart rate.

Assess allergic reaction

like gastro intestinaldisturbances.

Must not be administeredto patient with hypertoniaof the parasympatheticnervous system.


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DRUG NAME

MECHANISM

OF ACTION

INDICATION

CONTRAINDICATI

ON

ADVERSE EFFECTS

NURSING

CONSIDERATION

BRAND NAME:

Spiriva

GENERIC

NAME:Tiotropiu

m bromide

CLASSIFICATI

ON:

Anticholinergic

Dosage:

18mcg/cap OD

Long-acting

antimuscarinic

(anticholinergic

). In the

airways it

inhibits

muscarinic M3

receptors at the

smooth muscle,leading to

bronchodilation

. Since the drug

is inhaled, the

majority is

deposited in

the GI tract

and, to a lesser

extent, the

lungs (site ofaction). The

portion

metabolized is

through the

CYP2D6 and

CYP3A4

enzyme

Long-term,

once daily,

maintenance

treatment of

bronchospas

m associated

with COPD,

including

chronicbronchitis and

emphysema.

History of

hypersensitivity to

atropine or its

derivatives, including

ipratropium. Use for

initial treatment of

acute episodes of

bronchospasm

(rescue therapy).Use with other

anticholinergics

(e.g., ipratropium).

GI: Dry mouth, dyspepsia,

abdominal pain, constipation,

vomiting, gastroesophageal

reflux, GI disorder, stomatitis

(including

ulcerative).CNS:Depression,

dysphonia,

paresthesia.Respiratory:URTI,

sinusitis, pharyngitis, rhinitis,epistaxis, coughing,

laryngitis. CV:Angina pectoris

(including aggravated angina

pectoris), atrial fibrillation,

supraventricular tachycardia,

palpitation.Musculoskeletal:Art

1.emergency drugs group9b

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