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Generic name: Captopril

Brand name: Apo-Capto, capoten, Novo-captopril, Nu-

Classification: ACE inhibitor, Antihypertensive
Mode of Action:
Blocks ACE from converting angiotensin I to angiotensin II, a powerful
vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a
small increase in serum potassium levels, and sodium and fluid loss;
increased prostaglandin synthesis also may be involved in the
antihypertensive action.
• Treatment of hypertension alone or in combination with thiazide-type
• Treatment of CHF in patients unresponsive to conventional therapy;
used with diuretics and digitalis
• Treatment of diabetic nephropathy
• Treatment of left ventricular dysfunction after MI
• Unlabeled uses: Management of hypertensive crises; treatment of
rheumatoid arthritis; diagnosis of anatomic renal artery stenosis,
hypertension related to scleroderma renal crisis; diagnosis of primary
aldosteronism, idiopathic edema; Bartter's syndrome; Raynaud's
• Contraindicated with allergy to captopril, history of angiodema, second
or third trimester of pregnancy.
• Use cautiously with impaired renal function; CHF; salt or volume
Adverse effects
• CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF,
hypotension in salt- or volume-depleted patients
• Dermatologic: Rash, pruritus, scalded mouth sensation, pemphigoid-
like reaction, exfoliative dermatitis, alopecia, photosensitivity
• GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia,
cholestatic jaundice, hepatocellular injury, anorexia, constipation
• GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria,
urinary frequency
• Hematologic: Neutropenia, agranulocytosis, thrombocytopenia,
hemolytic anemia, pancytopenia
• Other: Cough, malaise, dry mouth, lymphadenopathy
• Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted
within 1–2 wk, increase dosage to 50 mg bid–tid; usual range is 25–
150 mg bid–tid PO with a mild thiazide diuretic. Do not exceed
450 mg/day.
• CHF: 6.25–12.5 mg PO tid in patients who may be salt or volume
depleted. Usual initial dose, 25 mg PO tid; maintenance dose, 50–
100 mg PO tid. Do not exceed 450 mg/day. Use in conjunction with
diuretic and digitalis therapy.
• Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as
3 days post-MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing
slowly to 50 mg tid.
• Diabetic nephropathy: 25 mg PO tid.
Nursing Responsibilty
• Take drug 1 hour before meals; do not take with food. Do not stop
without consulting your health care provider.
• Be careful of drop in blood pressure (occurs most often with diarrhea,
sweating, vomiting, dehydration); if light-headedness or dizziness
occurs, consult your health care provider.
• Severe fetal damage can occur if captopril is taken during pregnancy.
Use of contraceptives is advised; if pregnancy should occur, stop drug
and notify your health care provider.
• Avoid over-the-counter medications, especially cough, cold, allergy
medications that may contain ingredients that will interact with ACE
inhibitors. Consult your health care provider.
• You may experience these side effects: GI upset, loss of appetite,
change in taste perception (limited effects, will pass); mouth sores
(frequent mouth care may help); rash; fast heart rate; dizziness, light-
headedness (usually passes after the first few days; change position
slowly, and limit your activities to those that do not require alertness
and precision).
• Report mouth sores; sore throat, fever, chills; swelling of the hands,
feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips,
tongue, difficulty breathing.
Generic name: Furosemide
Brand name: Lasix Apo-furosemide
Classification: Loop diuretic
Mode of Action:
Inhibits the reabsorption of sodium and chloride from the ascending
limb of the loop of Henle, leading to a sodium-rich diuresis.
• Oral, IV: Edema associated with CHF, cirrhosis, renal disease
• IV: Acute pulmonary edema
• Oral: Hypertension
• Contraindicated with allergy to furosemide, sulfonamides; allergy to
tartrazine (in oral solution); anuria, severe renal failure; hepatic coma;
pregnancy; lactation.
• Use cautiously with SLE, gout, diabetes mellitus.
Adverse Effect/ Side effect:
Dizziness, lightheadedness, or fainting when sitting up or standing; fast
heartbeat; flushing of face and neck; headache; irritation at site of patch;
nausea; vomiting.
• CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness,
headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible
hearing loss
• CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias,
• Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura,
exfoliative dermatitis, erythema multiforme
• GI: Nausea, anorexia, vomiting, oral and gastric irritation,
constipation, diarrhea, acute pancreatitis, jaundice
• GU: Polyuria, nocturia, glycosuria, urinary bladder spasm
• Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and
electrolyte imbalances, hyperglycemia, hyperuricemia
• Other: Muscle cramps and muscle spasms
• Edema: Initially, 20–80 mg/day PO as a single dose. If needed, a
second dose may be given in 6–8 hr. If response is unsatisfactory, dose
may be increased in 20- to 40-mg increments at 6- to 8-hr intervals. Up
to 600 mg/day may be given. Intermittent dosage schedule (2–4
consecutive days/wk) is preferred for maintenance, or 20–40 mg IM or
IV (slow IV injection over 1–2 min). May increase dose in increments of
20 mg in 2 hr. High-dose therapy should be given as infusion at rate
not exceeding 4 mg/min.
• Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to
80 mg IV given over 1–2 min if response is unsatisfactory after 1 hr.
• Hypertension: 40 mg bid PO. If needed, additional antihypertensive
agents may be added.
Nursing Resposibilty:
• Administer with food or milk to prevent GI upset.
• Reduce dosage if given with other antihypertensives; readjust dosage
gradually as BP responds.
• Give early in the day so that increased urination will not disturb sleep.
• Avoid IV use if oral use is at all possible.
• WARNING: Do not mix parenteral solution with highly acidic solutions
with pH below 3.5.
• Do not expose to light, may discolor tablets or solution; do not use
discolored drug or solutions.
• Discard diluted solution after 24 hr.
• Refrigerate oral solution.
• Measure and record weight to monitor fluid changes.
• Arrange to monitor serum electrolytes, hydration, liver and renal
• Arrange for potassium-rich diet or supplemental potassium as needed.
• Weigh yourself on a regular basis, at the same time and in the same
clothing, and record the weight on your calendar.
• Blood glucose levels may become temporarily elevated in patients with
diabetes after starting this drug.
• You may experience these side effects: Increased volume and
frequency of urination; dizziness, feeling faint on arising, drowsiness
(avoid rapid position changes; hazardous activities, like driving; and
consumption of alcohol); sensitivity to sunlight (use sunglasses, wear
protective clothing, or use a sunscreen); increased thirst (suck on
sugarless lozenges; use frequent mouth care); loss of body potassium
(a potassium-rich diet or potassium supplement will be needed).
• Report loss or gain of more than 3 pounds in 1 day, swelling in your
ankles or fingers, unusual bleeding or bruising, dizziness, trembling,
numbness, fatigue, muscle weakness or cramps.

Generic name: Phenytoin

Brand name: Dilantin
Classification: Anti convulsant
Mode of Action:
Limit seizure propagation by altering ion transport. Antiarryhythmic
poperties as a result of improvement I AV conduction. May also decrease
synaptic transmission.
Treatment/prevention of tonic clonic (grand mal) seizures and complex
partial seizure.
• As an antiarrhythmic, particularly for arrhythmias associated with
cardiac glycoside toxicity. Management of painful syndromes, including
trigeminal neuralagia.
• Hypersensitivity
• Alcohol intolerance
• Sinus bradycadia
• Heart block
• Stroke syndrome
Side Effect:
• drowsiness , difficulty focusing (vision), unsteady gate, tiredness,
abnormal involuntary movements, nausea, vomiting, constipation,
abdominal pain, loss of appetite, Dizziness
IV adults: 50-100 mg q 10-15 min until arrythmias is abolished. 15 mg/kg
have been given, or toxic occurs.
PO adults: 200-600 mg/day in divided doses.

Nursing Resposibilty:
• Seizure: assess location, duration, frequency and characteristics of
seizure activity.
• Arrythmias: Monitor ECG contiously during treatment of arrythmias
• Assess patient for phenytoin hypersensitivity syndrome( fever, skin
rash, lymphopathy). Rash usually occurs within the first 2 weeks of
• Assess oral hygiene. Vigorous oral cleaning beginning within 10 days of
initiation of phenytoin therapy may help control gingival hyperplasia.
• May cause increase serum alkaline phosphates,GTT and glucose level.

Generic name: Nitroglycerin Transdrmal patch

Brand name: Nitro-bid, Minitran, Nitrogard, Nitro par,
Classification: Anti anginal
Mode of Action:
Nitroglycerin Patch is a nitrate vasodilator. It works by relaxing blood
vessels in the body, which allows them to widen (dilate). This allows more
blood to flow through the blood vessels easier, which reduces the workload
on the heart.
• Prophylactic management of anginal pectoris
• For acute angina attack
• Acute myocardial infarction
• Hypersensitive to drug or adhesive
• Close-anginal glausonma
• Orthostatic hypotension
• Allergy on Transdermal patch
Side Effect:
• Dizziness
• lightheadedness, or fainting when sitting up or standing
• fast heartbeat
• flushing of face and neck
• headache; irritation at site of patch
• nausea
• vomiting
Nursing Resposibilty:

• Remove patch from foil pouch immediately prior to application.

• Remove protective liner from patch and apply to any area of the
body except the extremities below the knee or elbow; the chest is
preferred site. Press the patch on the skin and smooth down.
• Apply only to area that is clean, dry, and hairless. If hair is likely to
interfere with patch adherence, clip, do not shave, the area before
• Do not apply patch to skin areas with cuts or irritation or
immediately after showering or bathing.
• If the patch becomes dislodged, discard it and put a new one on at
a different skin site.
• Do not discharge cardioverter/defribrillator through paddle
electrode that overlies a transdermal patch. May cause current
arching that can damage the paddles and burn the patient.
• Nitroglycerin Patch may give you daily headaches. This should
become less noticeable with time.
• Nitroglycerin Patch takes about 1 to 2 hours to start working and
should not be used for a sudden chest pain attack.
• Use Nitroglycerin Patch with caution in the ELDERLY because they
may be more sensitive to its effects.
• Nitroglycerin Patch is not recommended for use in CHILDREN; safety
and effectiveness have not been confirmed.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss
with your doctor the benefits and risks of using Nitroglycerin Patch
during pregnancy. It is unknown if Nitroglycerin Patch is excreted in
breast milk. Do not breast-feed while taking Nitroglycerin Patch.

Generic name: Ranitidine

Brand name: Zantac
Classification: Anti ulcer drug
Mode of Action:
Inhibits the action of histamine at the H2 receptor site located
primarily in gastric parietal cells, resulting in inhibition of gastric acid
• Prevention and treatment of self stress induce upper GI bleeding in
critically ill patient.
• Short term treatment of active duodenal ulcers and benign ulcer.
• Prophylaxis of duodenal ulcer.
• Management of GERD.
• Prevention and treatment of heartburn, acid ingeston and sour
• Porphyria, Hypersensitivity, Renal impairement, Some products of
alcohol must be avoided, Some products contains as partame and
should be avoided I patients with phenylketonuria
Side effect:
• headache (may be severe); drowsiness, dizziness; sleep problems
(insomnia); decreased sex drive, impotence, or difficulty having an
orgasm; or swollen or tender breasts (in men); nausea, vomiting,
stomach pain; or Diarrhea or constipation. drowsiness, dizziness;
decreased sex drive, impotence, or difficulty having an orgasm; or
swollen or tender breasts (in men); nausea, vomiting, stomach pain; or
Diarrhea or constipation


IM,IV adultd: 50 g q 6-8 hrs ( no to exceed 400 mg/day). Continuous IV

infusion 6.25 mg/hr. gastric hypersecretory condition-1mg/kg/hr; may be
increase by 0.5 mg/kg/hr ( not to exceed 2.5 mg/kg/hr).

Nursing Resposibilty:
• Assess for epigastric pain or abdominal pain and frank or occult blood
in the stool, emesis or gastric aspirate.
• Antagonize effects of pentagstrin and histamine during gastric acid
secretion testing
• May cause uncrease in serum transaminase and serum creatinine
• Ranitidine may cause false positive results for urine protein, test with
sulfosalicylic acid.
• Instruct the patient to take the medication as directed for the full
course of therapy, even if feeling better.
• Inform the patient that smoking interferes with the action of histamine
• Advise the patient to avoid alcohol products containing to avoid aspirin
or NSAIDS, and foods that may cause increase in GI irritation.
• Inform the patient that increase fluid and fiber intake and exercise may
minimize constipation.

Generic name: Ketolac

Brand name: Remopain, Acular
Classification: Nonsteroidal Anti-inflammatory Drug (NSAID
Mode of Action:
It acts on cyclooxigenase route, inhibits prostaglandins synthesis and
may be considered a strong analgesic, both peripherally and centrally,
besides having anti-inflammatory and antipyretic effects. Ketorolac reduce
the mild to severe pain at emergency cases, musculosceletal pain, post
minor or major operative, renal cholic & pain in cancer at adults or children.
Ketorolac has analgesic efficacy equivalent to morphine or pethidin. Initial
analgesic effects of ketorolac may be slower, but the duration longer than
• ::: Ketorolac is indicated for the short-term (≤ 5 days) management of
moderate and severe acute pain that requires analgesia at the opioid
• Ketorolac tromethamine or in patients in whom aspirin or other NSAIDS
induce serious allergic manifestations
• patients with recent gastrointestinal bleeding or perforation and in
patients with a history of peptic ulcer disease or gastrointestinal
• Patients with severe renal impairment or patients at high risk of renal
failure.In labor and delivery, it may adversely affect fetal circulation
and inhibit uterine contraindications, thus increasing the risk of uterine
• Nursing mother because of the potential adverse effects of
prostaglandin inhibiting drugs on neonates
Adverse Effect:
Central nervous system: Headache (17%)
Gastrointestinal: Gastrointestinal pain (13%), dyspepsia (12%), nausea (12%)
>1% to 10%:
Cardiovascular: Edema (4%), hypertension
Central nervous system: Dizziness (7%), drowsiness (6%)
Dermatologic: Pruritus, purpura, rash
Gastrointestinal: Diarrhea (7%), constipation, flatulence, GI bleeding, GI
fullness, GI perforation, GI ulcer, heartburn, stomatitis, vomiting
Hematologic: Anemia, bleeding time increased
Hepatic: Liver enzymes increased
Local: Injection site pain (2%)
Renal: Renal function abnormal

I.V.: Initial dose: 0.5 mg/kg, followed by 0.25-1 mg/kg every 6 hours for up to
48 hours (maximum daily dose: 90 mg) Oral: 0.25 mg/kg every 6 hours

Nursing Resposibilty:
• Monitor response (pain, range of motion, grip strength, mobility, ADL
• Should be used cautiously in patients receiving anticoagulant therapy
and patients with hemophilia.
• Haematological effects : Ketorolac inhibits thrombocyte aggregation
and prolong bleeding time. Because of that ketorolac should not be
used before surgery and use with caution if there is hemostasis
• Should be used with caution in patients with cardiac decompensation,
acute renal failure, hypertension or other conditions associated with
fluid retention.
• Ketorolac tromethamine should be used with caution in patients with
impaired hepatic function or patients with history of hepatic desease.
• Hepatic effects : Ketorolac therapy increases hepatic enzymes and in
hepatic disease patients, severe hepatic risk reaction may occur.
Administration of ketorolac should be discontinued if abnormality of
hepatic function test occurs after ketorolac administration.
• Ketorolac tromethamine is not recommended for children under 16
years (Safety and efficacy have not been established).
Generic name: Co amoxiclav
Brand name: amoxcil
Classification: Antibiotics
Mode of Action:

Co-amoxiclav is an antibiotic that is a combination of a penicillin

(amoxicillin)and a substance called clavulanic acid. It kills bacteria, by
interfering with their ability to form cell walls. The bacteria therefore break
up and die.

• Abdominal infections
• Animal bites
• Infections of the organs associated with breathing, including nasal
passages, sinuses, windpipe and lungs (respiratory tract)
• Infections of the sex organs and organs associated with urination
(genito-urinary infections)
• Inflammation of connective tissue, commonly the skin (cellulitis)


• History of allergies, Severe hepatic impairment, Geriatric patient,

Aortic stenosis, Pregnancy, lactation, Liver disease

Side Effect:
• Diarrhea, Vomiting, Jaundice, Fever, Pseudomembranous colitis,
Angina, Bradycardia, Flushing, Nausea, Gingival hyperplasia

• Standard adult dosages for respiratory tract, urinary, abdominal and
dental infections as well as cellulitis and animal bites is co-amoxiclav
250/125 (one tablet Augmentin 250) taken every 8 hours, which may
be doubled in severe infections (as a single tablet of co-amoxiclav
500/125 Augmentin 500, but not as two co-amoxiclav 250/125 tablets
which would double the maximum recommended dose of clavulanic
Nursing Resposibilty:
• Assess for infection
• Obtain specimens for culture and sensitivity prior to therapy. First dose
may be given before receiving the result
• Monitor bow function
• Instruct the patient to take the medication around the cock and to
finish the drug completely as directed.
• Review use and preparation of tablets for oral suspension
• Instruct female patients taking oral contraceptives to use an alternate
or additional non-hormonal method contraception during therapy with
amoxicillin and until next menstrual period.
• Advise the patient to report signs of superinfection ( furry overgrowth
on the tongue, vagina itching or discharge, foul-smelling stools.and

Generic Name: Paracetamol

Brand Name: Biogesic
Classification: AntipyreticAnalgesic (nonopioid)
Mode of Action:
Reduces fever by acting directll on the hypothalamic heat regulating
center to cause vasodilation and sweating, which helps dissipate heat.
Indication: for mild pain and fever

Analgesic-anipyretic in patients with aspirin allergy, hemostatic

disturbances, bleeding diatheses, upper GI disease, gouty arthritis. Arthritis
and rheumatic disorders involving musculoskeletal pain (but l acks clinically
significant antirheumatic and anti-inflammatory effects)Common cold, flu,
other viral and bacterial infections with pain and fever Unlabeled use:
Prophylactic for children receiving DPT vaccination to reduce incidence of
fever and pain .


Contraindicated with allergy to acetaminophen.Use cautiously with

impaired hepatic function, chronic alcoholism, pregnancy, lactation
Ordered Dose: 500mg prn for fever
Drug Interaction:
Increased toxicity with long-term, excessive ethanol ingestion.
Increased hypoprothrombinemic effect of oral anticoagulants. Increased risk
of hepatotoxicity and possible decreased therapeutic effects with
barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone. Possible
delayed or decreased effectiveness with anticholinergics. Possible reduced
absorption of acetaminophen with activated charcoal
Possible decreased effectiveness of zidovudine
Side Effects:
Headache, Chest pain, dyspnea,
Adverse Effects: Rash, fever Methemoglobinemia—cyanosis; hemolytic
anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia,
thrombocytopenia, hypoglycemia Acute kidney failure, renal tubular necrosis
*Hepatic toxicity and failure, jaundice, myocardial damage when doses of 5–
8 g/day are ingested daily for several weeks or when doses of 4 g/day are
ingested for 1 yr
Nursing Responsibilities:
• Do not exceed the recommended dosage.
• Consult physician if needed for children < 3 yr; if needed for longer
than 10 days; if continued fever, severe or recurrent pain occurs
(possible serious illness).
• Avoid using multiple preparations containing acetaminophen. Carefully
check all OTC products.
• Give drug with food if GI upset occurs.
• Discontinue drug if hypersensitivity reactions occur.
• Treatment of overdose: Monitor serum levels regularly, N-
acetylcysteine should be available as a specific antidote; basic life
support measures may be necessary.
• Do not exceed recommended dose; do not take for longer than 10
• Take the drug only for complaints indicated; it is not an anti-
inflammatory agent.
• Avoid the use of other over-the-counter preparations. They may
contain acetaminophen, and serious overdosage can occur. If you need
an over-the-counter preparation, consult your health care provider.
• Report rash, unusual bleeding or bruising, yellowing of skin or eyes,
changes in voiding patterns.

Generic Name: Potassium chloride

Brand Name: Kalium Durule
Classification: Electrolyte
Mode of Action:

Principal intracellular cation of most body tissues, participates in a

number of physiologic processes—maintaining intracellular tonicity,
transmission of nerve impulses, contraction of cardiac, skeletal, and smooth
muscle, maintenance of normal renal function; also plays a role in
carbohydrate metabolism and various enzymatic reactions.

Prevention and correction of potassium deficiency; when associated with
alkalosis, use potassium chloride; when associated with acidosis, use
potassium acetate, bicarbonate, citrate, or gluconate. IV: Treatment of
cardiac arrhythmias due to cardiac glycosides


Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in

some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment
with oliguria, anuria, azotemia; untreated Addison's disease; hyperkalemia;
adynamia episodica hereditaria; acute dehydration; heat cramps; GI
disorders that delay passage in the GI tract. Use cautiously with cardiac
disorders, especially if treated with digitalis, pregnancy, lactation.

Drug Interaction:


Increased risk of hyperkalemia with potassium-sparing diuretics,

salt substitutes using potassium

Side Effects & Adverse Effects:

Dermatologic: Rash

GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction,

GI bleeding, GI ulceration or perforation

Hematologic: Hyperkalemia—increased serum K+, ECG changes

(peaking of T waves, loss of P waves, depression of ST segment,
prolongation of QTc interval)

Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm

with injection
Nursing Responsibilities:

• Arrange for serial serum potassium levels before and during therapy.
• Administer liquid form to any patient with delayed GI emptying.
• Administer oral drug after meals or with food and a full glass of water
to decrease GI upset.
• Caution patient not to chew or crush tablets; have patient swallow
tablet whole.
• Mix or dissolve oral liquids, soluble powders, and effervescent tablets
completely in 3–8 oz of cold water, juice, or other suitable beverage,
and have patient drink it slowly.
• Arrange for further dilution or dose reduction if GI effects are severe.
• Agitate prepared IV solution to prevent "layering" of potassium; do not
add potassium to an IV bottle in the hanging position.
• Monitor IV injection sites regularly for necrosis, tissue sloughing,
• Monitor cardiac rhythm carefully during IV administration.
• Caution patient that expended wax matrix capsules will be found in the
• Caution patient not to use salt substitutes.
• Take drug after meals or with food and a full glass of water to decrease
GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or
dissolve oral liquids, soluble powders, and effervescent tablets
completely in 3–8 ounces of cold water, juice, or other suitable
beverage, and drink it slowly. Take the drug as prescribed; do not take
more than prescribed.
• Do not use salt substitutes.
• You may find wax matrix capsules in the stool. The wax matrix is not
absorbed in the GI tract.
• Have periodic blood tests and medical evaluation.
• You may experience these side effects: Nausea, vomiting, diarrhea
(taking the drugs with meals, diluting them further may help).
• Report tingling of the hands or feet, unusual tiredness or weakness,
feeling of heaviness in the legs, severe nausea, vomiting, abdominal
pain, black or tarry stools, pain at IV injection site.

Generic name: Citicoline

Brand name: Zynapse
Drug Class:
• Neuroprotective
• CNS Drugs & Agents for ADHD
Treatment of cerebrovascular accident in acute and recovery phase,
symptoms and signs of cerebral insufficiency eg, dizziness, memory loss,
poor concentration, disorientation, recent cranial trauma and their sequelae.
Therapeutic Action:
Pharmacology: Somazine contains as its single active component,
cytidine-5-diphosphate choline. CDP-choline is a biologic product. It is found
in the body and takes part in the biosynthesis of phospholipids which
integrate into the structures of the nervous system especially in the
membranes of the neurons. The formation of phospholipids is needed for the
re-structuring of cell membranes by the damaged neurons.

Citicoline is an interneuronal communication enhancer. It increases the

neurotransmission levels because it favors the synthesis and production
speed of dopamine in the striatum, acting then as a dopaminergic agonist
thru the inhibition of tyrosine-hydroxylase. Citicoline acts as a presynaptic
cholinergic agent which favors the synthesis of acetylcholine. It also
decreases the release of serotonin. Citicoline improves neuronal metabolism
in those cases where there is a neuronal deterioration due to degenerative,
toxic or ischemic cause. The cause of poor neuronal metabolism is brought
about by a decrease in neuronal activity which makes the astrocytes swell.
Swelling is due to electrolyte imbalance. Active neurons release potassium
ions. These are taken up by astrocytes (K+ buffers) and distributed to regions
with less K+. When neuronal activity decreases, less K+ is released,
astrocytes take up Na+ instead of K+. The hydrated Na+ is larger than the
hydrated K+ and so the astrocyte swells. Improvement of neurometabolism is
demonstrated by citicoline's ability of restoring the activity of mitochondrial
ATPase and of membranal Na+/K+ ATPase. Citicoline also increases glucose
incorporation aside from metabolism while at the same time decreasing
lactate accumulation in the brain. Citicoline makes the neurons more active,
causing the astrocytes to loosen their grip on the capillaries, thus improving
microcirculation. By virtue of this action, citicoline has an indirect effect on
microcirculation. It has the ability to slightly increase cerebral blood flow and
exerts an anti-aggregation effect on platelets.

Ordered dose: 1 grm. IV q 12 hrs. / 5 ml TID
Patients with parasympathetic hypertonia.
Somazine must not be administered along with medicaments containing
Somazine potentiates the effects of L-dopa. Incompatibilities: Somazine must
not be administered with products containing meclofenoxate (clophenoxate)

Side Effects:

Gastrointestinal disorders. Allergic reaction: Itching or hives, swelling in your

face or hands, swelling or tingling in your mouth or throat, chest tightness,
trouble breathing, or rash, Low blood pressure (faintness, dizziness), Slow or
fast heart beat, Headache, Nausea, vomiting, or diarrhea (loose BMs)
Generic name: Mannitol
Brand name: Osmitrol, Resctisol
Classification: Osmotic diuretic
Mode of Action:
Increase the osmotic pressure of the glomerular filtrate, therapy
inhibiting reabsorbtion of water and electrolytes. Cause excretion of water,
sodium, potassium, chloride, calcium, phosphorus, Magnessium, Urea and
uric acid.


• Promotion of diuresis in the prevention or treatment of the oliguric phase

of acute renal failure before irreversible renal failure becomes established.
• Reduction of intracranial pressure and brain mass.
• Reduction of high intraocular pressure when the pressure cannot be
lowered by other means.
• Promotion of urinary excretion of toxic materials.
• Eddema

• Well established anuria due to severe renal disease.
• Severe pulmonary congestion or frank pulmonary edema.
• Active intracranial bleeding except during craniotomy.
• Severe dehydration.
• Progressive renal damage or dysfunction after institution of mannitol
therapy, including increasing oliguria and azotemia.
• Progressive heart failure or pulmonary congestion after institution of
mannitol therapy. Do not administer to patients with a known
hypersensitivity to mannitol

Adverse Effect/side effect:

• Pulmonary congestion, fluid and electrolyte imbalance, acidosis,
electrolyte loss, dryness of mouth thirst, marked dieresis, urinary
retention, edema, headache, blurred vision, convulsions, nausea,
vomiting, rhinitis, arm pain, skin necrosis, thrombophlebitis
chills, dizziness, urticaria, dehydration, hypotension, tachycardia,
fever, angina-like chest pains.
Nursing Responsibility:

• The cardiovascular status of the patient should be carefully evaluated

before rapidly administering mannitol since sudden expansion of the
extracellular fluid may lead to fulminating congestive heart failure.
• Shift of sodium-free intracellular fluid into the extracellular compartment
following mannitol infusion may lower serum sodium concentration and
aggravate pre-existing hyponatremia.
• By sustaining diuresis, mannitol administration may obscure and intensify
inadequate hydration or hypovolemia.
• Electrolyte-free mannitol solutions should not be given conjointly with
blood. If it is essential that blood be given simultaneously, at least 20 mEq
of sodium chloride should be added to each liter of mannitol solution to
avoid pseudoagglutination.
• When exposed to low temperatures, solutions of mannitol may crystalize.
If crystals are observed, the container should be warmed to redissolve,
then cooled to body temperature before administering. See NOTE under
how supplied. When infusing 20% or 25% mannitol concentrations, the
administration set should include a filter. Do not infuse mannitol solution if
crystals are present.
• Do not administer unless solution is clear and container is undamaged.
Discard unused portion. Do not administer Mannitol 25% if the Fliptop vial
seal is not intact.

Generic name: Magnesium Sulfate

Brand name: Epsom salt
Classification: electrolytes, antiepileptic, laxative
Mode of Action:
Cofactor of many enzyme system involve in
neurochemical transmission and muscular excitability. Prevent or control
seizure by blocking neuromuscular transmission. Attracts and retain water in
intestinal lumen and distends the bowel to promote mass movement and
relieve constipation.

Intramuscular: Adults and older children: For severe hypomagnesemia, 1 to

5 g (2 to 10 mLof 50% solution) daily in divided doses; administration is
repeated daily until serum levels have returned to normal. If deficiency is not
severe, 1 g (2 mL of 50% solution) can be given once or twice daily. Serum
magnesium levels should serve as a guide to continued dosage.

Intravenous: 1 to 4 g magnesium sulfate may be given intravenously in 10%

to 20% solution, but only with great caution; the rate should not exceed 1.5
mL of 10% solution or equivalent per minute until relaxation is obtained.
Intravenous Infusion: 4 g in 250 mL of 5% Dextrose Injection at a rate not
exceeding 3 mL per minute.

Usual Dose Range: 1 to 40 g daily.

Electrolyte Replenisher: Intramuscular 1 to 2 g in 50% solution four times a

day until serum magnesium is within normal limits.

Usual Pediatric Dose: Intramuscular 20 to 40 mg per kg of body weight in a

20% solution repeated as necessary.

For Eclampsia: Initially 1 to 2 g in 25% or 50% solution is given

intramuscularly. Subsequently, 1 g is given every 30 minutes until relief is
obtained. The blood pressure should be monitored after each injection.

Parenteral drug products should be inspected visually for particulate matter

and discoloration prior to administration, whenever solution and container


Convulsions (treatment) - Intravenous magnesium sulfate is indicated for

immediate control of life-threatening convulsions in the treatment of severe
toxemias (pre-eclampsia and eclampsia) of pregnancy and in the treatment
of acute nephritis in children.

Hypomagnesemia (prophylaxis and treatment) - Magnesium sulfate is

indicated for replacement therapy in magnesium deficiency, especially in
acute hypomagnesemia accompanied by signs of tetany similar to those of

Magnesium sulfate is also used to prevent or treat magnesium deficiency in

patients receiving total parenteral nutrition.

Tetany, uterine (treatment) - Magnesium sulfate is indicated in uterine tetany

as a myometrial relaxant.

Magnesium sulfate should not be administered parenterally in patients
with heart block or myocardial damage.
Adverse Effect/side effect:
Flushing, sweating, sharply lowered blood pressure, hypothermia, stupor and
ultimately, respiratory depression.

When barbiturates, narcotics, or other hypnotics (or systemic anesthetics)

are to be given in conjunction with magnesium, their dosage should be
adjusted with caution because of the additive central depressive effects of

Pregnancy - Teratogenic effects: Pregnancy category C. Animal reproduction

studies have not been conducted with Magnesium Sulfate Injection, USP
50%. It is also not known whether Magnesium Sulfate Injection, USP 50% can
cause fetal harm when administered to a pregnant woman or can affect
reproduction capacity. Magnesium Sulfate Injection, USP 50% should be
given to a pregnant woman only if clearly needed.

Nursing Responsibility:

• Use only as a temporary measure to relieve constipation. Do not take if

abdominal pain, nausea, or vomiting.
• You nay experience diarrhea with oral use. If this occurs, discontinue
drug and consultant your health provider.
• Report sweating, flushing, muscle tremors or twitching, inability to
• Reserve Iv use in eclampsia for immediate life threatening situation
• Do not give oral magnesium sulfate with abdominal pain, nausea or
• Monitor bowel function; if diarrhea and cramping occurs, discontinue
oral drugs.
• Maintain urine out put at the level of 100 ml q 4 hr. during parenteral