Brand Name: Proventil, Ventolin

Generic Name: Albuterol Sulfate

Action: It works in the airways by opening breathing passages and relaxing muscles.

Classification: Bronchodilators.

Indications:

 Exercise-Induced Bronchospasm Prevention

 Asthma Attack
 Bronchospasm Prevention
 Bronchospasm
 Chronic Obstructive Lung Disease

Contraindications:
Albuterol Inhalation Aerosol is contraindicated in patients with a history of hypersensitivity to albuterol or any of its components.

Route and Dosage: 2.5 Mg/0.5 Ml Solution For Nebulization

Side Effects: Nervousness, shaking (tremor), headache, nausea or dizziness may occur.

Drug Interaction: Albuterol is very similar to levalbuterol. Do not use medications containing levalbuterol while using albuterol.

Nursing Responsibilities:

 Do not drive, use machinery, or do anything that needs alertness.

 Limit alcoholic beverages.
Contraindications:
Albuterol Inhalation Aerosol is contraindicated in patients with a history of hypersensitivity to albuterol or any of its components.
Route and Dosage: 2.5 Mg/0.5 Ml Solution For Nebulization
Side Effects: Nervousness, shaking (tremor), headache, nausea or dizziness may occur.
Drug Interaction: Albuterol is very similar to levalbuterol. Do not use medications containing levalbuterol while using albuterol.
Nursing Responsibilities:
Do not drive, use machinery, or do anything that needs alertness.
Limit alcoholic beverages.
Brand Name: Bayer Aspirin, Easprin, Ecotrin

Generic Name: Aspirin

Action: It works by blocking a certain natural substance in the body to reduce pain and swelling.

Classification: Non-steroidal Anti-inflammatory drug (NSAID)/ Antithromboembolic

Indication

Usual adult use:

 Osteoarthritis
 Rheumatoid Arthritis
 Systemic Lupus Erythematosus
 Fever
 Pain
 Myocardial Infarction
 Ischemic Stroke
 Ischemic Stroke - Prophylaxis
 Angina Pectoris Prophylaxis
 Angina Pectoris
 Revascularization Procedures - Prophylaxis
 Ankylosing Spondylitis
 Myocardial Infarction - Prophylaxis
 Cardiovascular Risk Reduction
 Colorectal Cancer
 Usual Pediatric Use:

 Fever
 Pain
 Juvenile Rheumatoid Arthritis
 Kawasaki Disease
 Thrombotic/Thromboembolic Disorder

Contraindications:

 Patient is unable to chew or swallow, including GCS >15

 Allergy to aspirin, products containing aspirin, or aspirin-like products
 History of active bleeding disorder
 Recent or current ulcer or gastrointestinal bleeding
 Taken aspirin within the last 24 hours
 Patient prescribed anticoagulation therapy
 Possible aortic aneurysm

Route and Dosage:

Usual Pediatric Dose: 12 years or older: 300 to 650 mg orally every 4 to 6 hours as needed
Maximum dose: 4 g in 24 hours.

Usual Adult Dose: 3 g orally per day in divided doses.

Side Effects: Upset stomach and heartburn may occur.

Serious Side Effects: Easy bruising/bleeding, difficulty hearing, ringing in the ears, signs of kidney problems (such as change in the amount
of urine), persistent or severe nausea/vomiting, unexplained tiredness, dizziness, dark urine, yellowing eyes/skin.
Drug Interaction: Some products that may interact with this drug include: mifepristone, acetazolamide, "blood thinners" (such as warfarin,
heparin), corticosteroids (such as prednisone), methotrexate, valproic acid, herbal medications (such as ginkgo biloba).

Nursing Responsibilities:

 Before administering aspirin check any allergies to it or to other salicylates (such as choline salicylate) or to other pain relievers or
fever reducers (NSAIDs such as ibuprofen, naproxen).
 Limit alcoholic beverages, and stop smoking.
Brand Name: Atropine Sulfate

Generic Name: Atropine Sulfate

Action: Atropine is a muscarinic antagonist indicated for temporary blockade of severe or life threatening muscarinic effects.

Classification: Anticholinergic or antiparasympathetic/Anti-muscarinic

Indication: Atropine produces many effects in the body such as reducing muscle spasms and fluid secretions. Atropine is used to help reduce saliva, mucus, or
other secretions in your airway during a surgery. Atropine is also used to treat spasms in the stomach, intestines, bladder, or other organs.

Antidote for overdose of cholinergic drugs or mushroom poisoning.

Contraindications:

Atropine generally is contraindicated in patients with glaucoma, pyloric stenosis or prostatic hypertrophy, except in doses ordinarily used for preanesthetic
medication.

Route and Dosage: Intravenous, intramuscular, subcutaneous or endotracheal use.

0.5 mg to 1 mg (5 - 10 mL of the 0.1 mg/mL solution) for antisialagogue and other antivagal effects,

2 to 3 mg (20 - 30 mL of the 0.1 mg/mL solution) as an antidote for organophosporous or muscarinic mushroom poisoning.

Side Effects:
 dry mouth,
 blurred vision,
 sensitivity to light,
  lack of sweating,
 dizziness,
 nausea,
 loss of balance,
 hypersensitivity reactions (such as skin rash), and
 rapid heartbeat (tachycardia).

Drug Interaction:
 Belladonna (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop)
 Bronchodilators such as ipratropium (Atrovent, Combivent) or tiotropium (Spiriva)
 Digoxin (digitalis, Lanoxin)
 Glycopyrrolate (Robinul)
 Mepenzolate (Cantil)
 Bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin
(Vesicare)
 Irritable bowel medicines such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), or propantheline (Pro-Banthine)

Nursing Responsibilities:
 Do not administer unless solution is clear and seal is intact.
 Discard unused portion.
 Should be used with caution in all individuals over 40 years of age.
 Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased
hepatic, renal, or cardiac function, and of concomitant disease of other drug therapy.
Brand Name: Catapres

Generic Name: Clonidine - Oral

Action: Catapres (clonidine) lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels to relax and your
heart to beat more slowly and easily.

Classification: Alpha-agonist hypotensive agents.

Indication:

 Hypertension (high blood pressure)

 Treat attention deficit hyperactivity disorder (ADHD).

Contraindications:

 heart disease or severe coronary artery disease;

 heart rhythm disorder, slow heartbeats;
 low blood pressure, or a history of fainting spells;
 a history of heart attack or stroke;
 pheochromocytoma (tumor of the adrenal gland);
 kidney disease; or
 if you have ever had an allergic reaction to a Catapres TTS skin patch.
Route and Dosage: clonidine hydrochloride 0.100mg

Oral tablet.

Side Effects:

 Mental depression
 Swelling of the feet and lower legs.

Drug Interaction:

Common medications checked in combination with Catapres (clonidine):

 Adderall (amphetamine / dextroamphetamine)
 amlodipine
 Ativan (lorazepam)
 clonidine
 Coreg (carvedilol)
 Cymbalta (duloxetine)
 hydrochlorothiazide
 hydrocodone
 Klonopin (clonazepam)
 Lasix (furosemide)
 Lexapro (escitalopram)
 Lipitor (atorvastatin)
 lisinopril
 losartan
 metformin
 methadone
 metoprolol
  Neurontin (gabapentin)
 Norvasc (amlodipine)
 oxycodone
 Plavix (clopidogrel)
 Protonix (pantoprazole)
 Ritalin (methylphenidate)
 Seroquel (quetiapine)
 Synthroid (levothyroxine)
 Vitamin D3 (cholecalciferol)
 Xanax (alprazolam)
 Zoloft (sertraline)

Nursing Responsibilities:
 Administration of Catapres® (clonidine hydrochloride, USP) tablets should be continued to within 4 hours of surgery and resumed as soon as possible
thereafter.
 Blood pressure should be carefully monitored during surgery and additional measures to control blood pressure should be available if required.
 Patients should be cautioned against interruption of Catapres tablets therapy without their physician's advice.
 Inform patients that this sedative effect may be increased by concomitant use of alcohol, barbiturates, or other sedating drugs.
 Patients who wear contact lenses should be cautioned that treatment with Catapres tablets may cause dryness of eyes.

Brand Name: Cipro

Generic Name: Ciprofloxacin

Action: Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body. It is used to treat different types of bacterial infections.

Classification: Antibiotics

Indication:
 Treat a variety of bacterial infections.
 This antibiotic treats only bacterial infections.

Contraindications: Diabetes, heart problems (such as recent heart attack), joint/tendon problems (such as tendonitis, bursitis), kidney disease, liver disease,
mental/mood disorders (such as depression), myasthenia gravis, nerve problems (such as peripheral neuropathy), seizures, conditions that increase your risk of
seizures (such as brain/head injury, brain tumors, cerebral atherosclerosis).

Route and Dosage: IV: 400 mg IV every 12 hours

Oral: 500 mg orally every 12 hours

Side Effects: Nausea, diarrhea, dizziness, lightheadedness, headache, or trouble sleeping may occur.

Drug Interaction: acenocoumarol, warfarin, and strontium

Nursing Responsibilities:
 Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas), eating large amounts of chocolate, or taking over-the-counter products
that contain caffeine.
 Assist for allergic in any to other antibiotics.
 Check blood sugar regularly as directed especially in diabetic patients.
 Evaluate patients for side effects.
 Limit the time in the sun.
 Do not have any immunizations/vaccinations while using this medication unless prescribed by the doctor.

Brand Name: Benadryl

Generic Name: Diphenhydramine Hcl

Action: This medication works by blocking a certain natural substance (histamine) that the body makes during an allergic reaction.

Classification: Antihistamine

Indication: To relieve symptoms of allergy, hay fever, and the common cold.

Contraindications: Breathing problems (such as asthma, emphysema), high pressure in the eye (glaucoma), heart problems, high blood pressure, liver disease,
seizures, stomach/intestine problems (such as ulcers, blockage), overactive thyroid (hyperthyroidism), difficulty urinating (for example, due to enlarged prostate).

Route and Dosage:

Parenteral: 10 to 50 mg IV or IM as needed. May increase dose to 100 mg if required. Maximum daily dose 400 mg.

Oral: 25 to 50 mg orally every 6 to 8 hours.

Side Effects: Drowsiness, dizziness, constipation, stomach upset, blurred vision, or dry mouth/nose/throat may occur.

Drug Interaction: Antihistamines applied to the skin (such as diphenhydramine cream, ointment, spray).

Nursing Responsibilities:
 Assist for allergies in this medication.
 Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely.
 Avoid alcoholic beverages.

Brand Name: Intropin

Generic Name: Dopamine (injection)

Action: It works by improving the pumping strength of the heart and improves blood flow to the kidneys.

Classification: Symphatomimetic, natural catecholamine

Indication:
 It is used to treat heart failure (weak heart).
 It is used to treat low blood pressure.
 It may be given to you for other reasons.

Contraindications:
 Dopamine HCl should not be used in patients with pheochromocytoma.
 Dopamine HCl should not be administered to patients with uncorrected tachyarrhythmias or ventricular fibrillation.

Route and Dosage:

IV Infusion:

 80mg/100mL
 160mg/100mL
 320mg/100mL

Injectable solution:

 40mg/mL
 80mg/mL
 160mg/mL

Side Effects: Hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Drug Interaction:
 droperidol (Inapsine);
 epinephrine (EpiPen, Adrenaclick, Twinject, and others);
 haloperidol (Haldol);
 midodrine (ProAmatine);
 phenytoin (dilantin);
 vasopressin (Pitressin);
 a diuretic (water pill);
 an antidepressant such as amitriptyline (Elavil, Vanatrip, Limbitrol), doxepin (Sinequan, Silenor), nortriptyline (Pamelor), and others;
 a beta blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol),
nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others;

Nursing Responsibilities:
 Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician.
 Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose:
 Reduced urine flow rate in absence of hypotension;
 Ascending tachycardia;
 Dysrhythmias;
 Disproportionate rise in diastolic pressure (marked decrease in pulse pressure);
 Signs of peripheral ischemia (pallor, cyanosis).
 Monitor therapeutic effectiveness.

Brand Name: EpiPen

Generic Name: Epinephrine Injection

Action: It works by relaxing the muscles in the airways and tightening the blood vessels.

Classification: adrenergic bronchodilators

Indication:
 Adams-Stokes Syndrome
 Allergic Reactions
 Anaphylaxis
 Asthma, acute
 Asystole
 AV Heart Block
 Cardiac Arrest
 COPD, Acute
 Electromechanical Dissociation
 Oral Allergy Syndrome
 Pupillary Dilation
 Shock

Contraindications:
  None in cardiac arrest.
 Tachydysrhythmias.
 For severe asthma or allergic reactions, Epi should be used with extreme caution in patients
 Greater than age 40 or in patients with coronary artery disease since myocardial ischemia may be
precipitated.
 Use with extreme caution and only in life threatening emergencies.
 IV Epi should only be used if patients are in life-threatening extremis, otherwise use only
SQ.

Route and Dosage:

 Cardiac Arrest: 1 mg (1:10,000) IVP q 3 to 5 min.
 If using (1:1000) Epi, dilute with NS so that a total of 10 ml of solution is administered with
each dose.
 Severe Allergic Reaction and Severe Asthma: 0.3 to 0.5 mg (1:1,000) SQ based upon weight
and severity.
 Anaphylactic Shock: 0.1 mg (1:1,000) IVP, may be repeated q 5 min. for a total of 3 doses.
PEDIATRIC USAGE:
 Severe Asthma or Allergic Reaction: 0.01 mg/kg (1:1,000) SQ (max. dose is 0.3 mg).

Side Effects:
 skin redness, swelling, warmth, or tenderness at the site of injection
 difficulty breathing
 pounding, fast, or irregular heartbeat
 nausea
  vomiting
 sweating
 dizziness
 nervousness, anxiety, or restlessness
 weakness
 pale skin
 headache
 uncontrollable shaking of a part of your body

Drug Interaction:
Amiodarone, quinidine), beta-blockers (e.g., propranolol), digoxin, entacapone, ergot alkaloids (e.g., ergotamine), MAO inhibitors (isocarboxazid, linezolid,
methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine), phenothiazines (e.g., chlorpromazine), thyroid
hormones (e.g., levothyroxine), tricyclic antidepressants (e.g., amitriptyline, doxepin).

Nursing Responsibilities:
 Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV administration. Epinephrine may widen pulse pressure. If
disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately.
 Keep physician informed of any changes in intake-output ratio.
 Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately available.
 Check BP repeatedly when epinephrine is administered IV during first 5 min, then q3–5min until stabilized.
 Advise patient to report to physician if symptoms are not relieved in 20 min or if they become worse following inhalation.
 Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage should be reduced.
 Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.

Brand Name: Brevibloc

Generic Name: Esmolol

Action: A very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilizing activity at therapeutic dosages.

Classification: Beta1-selective (cardioselective) adrenergic receptor blocking agent/Antihypertensive

Indication:
 Supraventricular tachyarrhythmias (SVT) in perioperative and postoperative periods or in other critical situations
 Short-term treatment of noncompensating sinus tachycardia and in the control of heart rate for patients with MI.

Contraindications:
 Severe sinus bradycardia.
 Heart block greater than first degree
 Sick sinus syndrome
 Cardiogenic shock
 Pulmonary hypertension
 Hypersensitivity reactions, including anaphylaxis, to esmolol or any of the inactive ingredients of the product (cross-sensitivity between beta blockers is
possible).

Route and Dosage:

10 mg/mL, 250 mg/mL injection

Side Effects:
 Blurred vision
 confusion
 dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  increased sweating
 unusual tiredness or weakness

Drug Interaction:
 digoxin, digitalis;
 blood pressure medication;
 diet pills, stimulants, ADHD medication (Ritalin, Adderall, and others);
 insulin or oral diabetes medicine; or
 medicines to treat asthma, colds, or allergies.

Nursing Responsibilities:
 Monitor BP, pulse, ECG, during esmolol infusion. Hypotension may have its onset during the initial titration phase; thereafter the risk increases with
increasing doses. Usually the hypotension experienced during esmolol infusion is resolved within 30 min after infusion is reduced or discontinued.
 Change injection site if local reaction occurs. IV site reactions (burning, erythema) or diaphoresis may develop during infusion. Both reactions are
temporary. Blood chemistry abnormalities have not been reported.
 Overdose symptoms: Discontinue administration if the following symptoms occur: bradycardia, severe dizziness or drowsiness, dyspnea, bluish-colored
fingernails or palms of hands, seizures.

Brand Name: Flagyl

Generic Name: Metronidazole

Action: It works by stopping the growth of bacteria and protozoa.

Classification: Antibiotics/ Nitroimidazoles

Indication:
 Acute infection with susceptible anaerobic bacteria
  Acute intestinal amebiasis
 Amebic liver abscess
 Trichomoniasis (acute and partners of patients with acute infection)
 Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery
 Topical application: Treatment of inflammatory papules, pustules, and erythema of rosacea
 Unlabeled uses: Prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn’s disease; antibiotic-associated
pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC)

Contraindications:
 History of hypersensitivity to metronidazole or other nitroimidazole derivatives. Pregnancy (1st trimester) and lactation.

Route and Dosage:

Oral - Amebiasis: 750 mg/tid PO for 5–10 days. (In amebic dysentery, combine with iodoquinol 650 mg PO tid for 20 days.)
Antibiotic-associated pseudomembranous colitis: 1–2 g/day PO for 7–10 days.
Gardnerella vaginalis: 500 mg bid PO for 7 days.
Giardiasis: 250 mg tid PO for 7 days.
Trichomoniasis: 2 g PO in 1 day (1-day treatment) or 250 mg tid PO for 7 days.

IV - Anaerobic bacterial infection: 15 mg/kg IV infused over 1 hr; then 7.5 mg/kg infused over 1 hr q 6 hr for 7–10 days, not to exceed 4 g/day.

Prophylaxis: 15 mg/kg infused IV over 30–60 min and completed about 1 hr before surgery. Then 7.5 mg/kg infused over 30–60 min at 6- to 12-hr intervals after
initial dose during the day of surgery only.

Side Effects:
  stomach pain, diarrhea;
 dizziness, loss of balance;
 vaginal itching or discharge;
 dry mouth or unpleasant metallic taste;
 cough, sneezing, runny or stuffy nose; or.
 swollen or sore tongue.

Drug Interaction:
 May potentiate oral anticoagulants, and lithium.
 Avoid concomitant busulfan.
 May be antagonized by phenobarbital, phenytoin, other hepatic enzyme inducers.
 May interfere with serum chemistry tests.

Nursing Responsibilities:
 Avoid use unless necessary.
 Administer oral doses with food.
 Apply topically (MetroGel) after cleansing the area.
 Advise patient that cosmetics may be used over the area after application.
 Reduce dosage in hepatic disease.
 Take full course of drug therapy; take the drug with food if GI upset occurs.
 Do not drink alcohol (beverages or preparations containing alcohol, cough syrups); severe reactions may occur.
 Your urine may be a darker color than usual; this is expected.
 Refrain from sexual intercourse during treatment for trichomoniasis, unless partner wears a condom.
 Apply the topical preparation by cleansing the area and then rubbing a thin film into the affected area. Avoid contact with the eyes. Cosmetics may be
applied to the area after application.
 You may experience these side effects: Dry mouth with strange metallic taste (frequent mouth care, sucking sugarless candies may help); nausea, vomiting,
diarrhea (eat frequent small meals).
  Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

Brand Name: Haldol

Generic Name: Haloperidol

Action: Haloperidol blocks the effects of dopamine and increases its turnover rate; however, the precise mechanism of action is unknown.

Classification: Antipsychotic

Indication:
Indicated for the treatment of schizophrenic patients who require prolonged parenteral antipsychotic therapy.

Contraindications:
 Previous history of acute stroke or coma
 Severe intoxication with alcohol or any other drug that acts as a central nervous system depressant
 Allergy to haloperidol or other drugs of the butyrophene class
 Heart disease

Route and Dosage:

Adult-100 mg/day PO. 20 mg/day IM of haloperidol lactate.

Geriatric - 100 mg/day PO. 20 mg/day IM of haloperidol lactate.

Adolescents - weight more than 40 kg: 15 mg/day PO for Tourette's syndrome

Children - 3 to 12 years and weight 15 to 40 kg: 0.15 mg/kg/day PO for most indications; severely psychotic children may require higher doses (suggested Max: 6
mg/day PO for non-psychotic behaviors); 15 mg/day PO for Tourette's syndrome. Safe and effective use of haloperidol injections has not been established (adult
haloperidol lactate Max: 20 mg/day IM).

Side Effects:
 headache, dizziness, spinning sensation, drowsiness;
 sleep problems (insomnia);
 feeling restless or anxious;
 mild skin rash or itching;
 breast enlargement, irregular menstrual periods, loss of interest in sex; or.
 dry mouth, blurred vision, urinating less than usual.

Drug Interaction:
 Anticholinergic medications, such as scopolamine (Transderm-Scop) and lithium (Eskalith)
 Drugs for Parkinson's disease.
 Heart rhythm drugs.
 Antidepressants.
 Sleep medication.
 Anti-anxiety medication.
 Muscle relaxants.
 Psychiatric medications.

Nursing Responsibilities:
 Assess patient’s disorder and mental status before drug therapy and reassess regularly thereafter; affect, orientation, mood, behavior, sleep pattern, presence
and type of hallucinations.
 Monitor for possible adverse reactions:
 CNS: severe extrapyramidal reactions, tardive dyskinesia, sedation, seizures, neuroleptic malignant syndrome.
 Cardiovascular: tachycardia, ECG changes, hypotension, hypertension, bradycardia.
 EENT: blurred vision.
 GU: urine retention, menstrual irregularities.
 Hematologic: transient leukopenia and leukocytosis.
 Hepatic: jaundice.
 Skin: rash, gynecomastia.
 Monitor swallowing of oral administration medication and check for hoarding or giving of medication to other patients.
 Monitor vital signs during initial treatment (sitting, standing and lying blood pressure). Check for dizziness, faintness, palpitations, tachycardia on rising and
severe orthostatic hypotension. Obtain baseline ECG, Q-wave and T-wave changes.
 Assess for constipation and urinary retention daily. Monitor input-output ratio and palpate bladder if low urinary output s observed. Increase bulk and water
in the diet.
 Monitor CBC, liver function and bilirubin monthly.
 Assess for neuroleptic malignant syndrome (hyperpyrexia, muscle rigidity, CPK increase and altered mental status. If these occur, drug should be
discontinued.
 Assess for reflexes, gait, coordination and EPS including akathasia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of
the jaw, mouth, tongue, extremities), pseudoparkinsonism (ragged tremors, pill rolling, shuffling gait), for prescription of an antiparkinsonism drug.
 Assess patient’s and family’s knowledge of drug therapy.
Brand Name: Hep-Lock

Generic Name: Heparin sodium

Action: Used to stop the formation of blood clots.

Classification: Anticoagulant

Indication:
 Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
 -Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
 -Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
 -Prophylaxis and treatment of peripheral arterial embolism.

Contraindications:
Intravenous solutions with Heparin Sodium Injection are contraindicated in patients who are hypersensitive to heparin.

Route and Dosage:

Usual Adult Dose - Continuous IV infusion:

-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection - Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Side Effects:

 easy bleeding and bruising;

 pain, redness, warmth, irritation, or skin changes where the medicine was injected;
 itching of your feet; or.
 bluish-colored skin.e Effects:

Drug Interaction:
Drugs such as acetylsalicylic acid, dextran, phenylbutazone, ibuprofen, indomethacin, dipyridamole, hydroxychloroquine and others that interfere with platelet
aggregation reactions (the main hemostatic defense of heparinized patients) may induce bleeding and should be used with caution in patients receiving heparin
sodium.

Nursing Responsibilities:
 Lab tests: Baseline blood coagulation tests, Hct, Hgb, RBC, and platelet counts prior to initiation of therapy and at regular intervals throughout therapy.
 Monitor APTT levels closely.
 Note: In general, dosage is adjusted to keep APTT between 1.5–2.5 times normal control level.
 Draw blood for coagulation test 30 min before each scheduled SC or intermittent IV dose and approximately q4h for patients receiving continuous IV
heparin during dosage adjustment period. After dosage is established, tests may be done once daily.
 Patients vary widely in their reaction to heparin; risk of hemorrhage appears greatest in women, all patients >60 y, and patients with liver disease or renal
insufficiency.
 Monitor vital signs. Report fever, drop in BP, rapid pulse, and other S&S of hemorrhage.
 Observe all needle sites daily for hematoma and signs of inflammation (swelling, heat, redness, pain).
  Antidote: Have on hand protamine sulfate (1% solution), specific heparin antagonist.

Brand Name: Advil

Generic Name: Ibuprofen

Action: The analgesic, antipyretic, and anti-inflammatory activity of NSAIDs appears to operate mainly through inhibition of COX-2, which decreases the
synthesis of prostaglandins involved in mediating inflammation, pain, fever, and swelling.

Classification: NSAIDs

Indication:
 treatment of mild to moderate pain
 inflammation and fever caused by many and diverse diseases
 treating menstrual cramps (dysmenorrhea)
 osteoarthritis
 rheumatoid arthritis
 juvenile idiopathic arthritis

Contraindications:
Patient in whom urticaria, severe rhinitis, bronchospasm, angioedema, nasal polyps are precipitated by aspirin or other NSAIDs; active peptic ulcer, bleeding
abnormalities. Safe use during pregnancy (category B), lactation, or children <6 mo is not established.
Route and Dosage:
Inflammatory Disease
Adult: PO 400–800 mg t.i.d. or q.i.d. (max: 3200 mg/d)
Child: PO <20 kg, up to 400 mg/d in divided doses; 20–30 kg, up to 600 mg/d in divided doses; 30–40 kg, up to 800 mg/d in divided doses
Mild to Moderate Pain, Dysmenorrhea
Adult: PO 400 mg q4–6h up to 1200 mg/d
Fever
Adult: PO 200–400 mg t.i.d. or q.i.d. (max: 1200 mg/d)
Child: PO 6 mo–12 y, 5–10 mg/kg q4–6h up to 40 mg/kg/d

Side Effects:
 rash
 ringing in the ears
 headaches
 dizziness
 drowsiness
 abdominal pain
 nausea
 diarrhea
  constipation
 heartburn

Drug Interaction:
 When ibuprofen is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the
methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or
aminoglycoside-related side effects.
 Ibuprofen increases the negative effect of cyclosporine on kidney function.
 If aspirin is taken with ibuprofen there may be an increased risk for developing an ulcer.

 Combining SSRIs or selective serotonin reuptake inhibitors (for example, fluoxetine [Prozac], citalopram [Celexa], paroxetine [Paxil, Paxil CR, Pexeva)
with NSAIDs may increase the likelihood of upper gastrointestinal bleeding.

Nursing Responsibilities:
 Monitor for therapeutic effectiveness. Optimum response generally occurs within 2 wk (e.g., relief of pain, stiffness, or swelling; or improved joint flexion
and strength).
 Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema.
 Lab tests: Baseline and periodic evaluations of Hgb, renal and hepatic function, and auditory and ophthalmologic examinations are recommended in patients
receiving prolonged or high-dose therapy.
 Monitor for GI distress and S&S of GI bleeding.
 Note: Symptoms of acute toxicity in children include apnea, cyanosis, response only to painful stimuli, dizziness, and nystagmus.
Brand Name: Humulin R

Generic Name: INSULIN

Action: Short-acting, clear, colorless solution of exogenous unmodified insulin extracted from beta cells in pork pancreas or synthesized by recombinant DNA
technology (human). Enhances transmembrane passage of glucose across cell membranes of most body cells and by unknown mechanism may itself enter the cell to
activate selected intermediary metabolic processes. Promotes conversion of glucose to glycogen.

Classification: HORMONE AND SYNTHETIC SUBSTITUTE; ANTIDIABETIC AGENT; INSULIN

Indication:
 Emergency treatment of diabetic ketoacidosis or coma.
 To initiate therapy in patient with insulin-dependent diabetes mellitus
 Combination with intermediate-acting or long-acting insulin to provide better control of blood glucose concentrations in the diabetic patient.
 Used IV to stimulate growth hormone secretion (glucose counter regulatory hormone) to evaluate pituitary growth hormone reserve in patient with known or
suspected growth hormone deficiency.
 Promotion of intracellular shift of potassium in treatment of hyperkalemia (IV) and induction of hypoglycemic shock as therapy in psychiatry.

Contraindications: Hypersensitivity to insulin animal protein.

Route and Dosage:

Diabetes Mellitus
Adult: SC 5–10 U 15–30 min a.c. and h.s. (dose adjustments based on blood glucose determinations)
Child: SC 2–4 U 15–30 min a.c. and h.s. (dose adjustments based on blood glucose determinations)
Ketoacidosis
Adult: IV 2.4–7.2 U loading dose, followed by 2.4–7.2 U/h continuous infusion
Child: IV 0.1 U/kg loading dose, followed by 0.1 U/h continuous infusion

Side Effects: Hypoglycemia, or low blood sugar

Symptoms: nclude headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe
hypoglycemia can be fatal).

Drug Interaction:
Alcohol, ANABOLIC STEROIDS, MAO INHIBITORS, guanethidine, SALICYLATES may potentiate hypoglycemic effects; dextrothyroxine,
CORTICOSTEROIDS, epinephrine may antagonize hypoglycemic effects; furosemide, THIAZIDE DIURETICS increase serum glucose levels; propranolol and
other BETA BLOCKERS may mask symptoms of hypoglycemic reaction. Herbal: Garlic, ginseng may potentiate hypoglycemic effects.

Nursing Responsibilities:
 Note: Frequency of blood glucose monitoring is determined by the type of insulin regimen and health status of the patient.
 Lab tests: Periodic postprandial blood glucose, and HbA1C. Test urine for ketones in new, unstable, and type 1 diabetes; if patient has lost weight, exercises
vigorously, or has an illness; whenever blood glucose is substantially elevated.
 Notify physician promptly for presence of acetone with sugar in the urine; may indicate onset of ketoacidosis. Acetone without sugar in the urine usually
signifies insufficient carbohydrate intake.
 Monitor for hypoglycemia (see Appendix F) at time of peak action of insulin. Onset of hypoglycemia (blood sugar: 50–40 mg/dL) may be rapid and sudden.
 Check BP, I&O ratio, and blood glucose and ketones every hour during treatment for ketoacidosis with IV insulin.
 Give patients with severe hypoglycemia glucagon, epinephrine, or IV glucose 10–50%. As soon as patient is fully conscious, give oral carbohydrate (e.g.,
dilute corn syrup or orange juice with sugar, Gatorade, or Pedialyte) to prevent secondary hypoglycemia.
Brand Name: Kayexalate

Generic Name: Sodium Polystyrene Sulfonate

Action: Sulfonic cation-exchange resin that removes potassium from body by exchanging sodium ion for potassium, particularly in large intestine; potassium-
containing resin is then excreted. Small amounts of other cations such as calcium and magnesium may be lost during treatment.

Classification: Electrolytes and water balance agent

Indication: Hyperkalemia

Contraindications: Patients with hypokalemia; hypersensitivity to Kayexalate.

Route and Dosage:

Hyperkalemia

Adult: PO 15 g suspended in 70% sorbitol or 20–100 mL of other fluid 1–4 times/d PR 30–50 g/100 mL 70% sorbitol q6h as warm emulsion high into sigmoid
colon

Child: PO Calculate appropriate amount on exchange rate of 1 mEq of potassium per gram of resin and suspend in 70% sorbitol or other appropriate solution (Usual
dose: 1 g/kg q6h) PR 1 g/kg q2–6h

Side Effect:
GI: Constipation, fecal impaction (in older adults); anorexia, gastric irritation, nausea, vomiting, diarrhea (with sorbitol emulsions). Metabolic: Sodium retention,
hypocalcemia, hypokalemia, hypomagnesemia.
Drug Interaction:
ANTACIDS, LAXATIVES containing calcium or magnesium may decrease potassium exchange capability of the resin.

Nursing Responsibilities:
 Lab tests: Determine serum potassium levels daily throughout therapy. Monitor acid–base balance, electrolytes, and minerals in patients receiving repeated
doses.
 Serum potassium levels do not always reflect intracellular potassium deficiency. Observe patient closely for early clinical signs of severe hypokalemia (see
Appendix F). ECGs are also recommended.
 Consult physician about restricting sodium content from dietary and other sources since drug contains approximately 100 mg (4.1 mEq) of sodium per gram
(1 tsp, 15 mEq sodium).
Brand Name: Toradol

Generic Name: KETOROLAC TROMETHAMINE

Action: It inhibits synthesis of prostaglandins and is a peripherally acting analgesic. Ketorolac does not have any known effects on opiate receptors.

Classification: NSAID, ANALGESIC; ANTIPYRETIC

Indication: Short-term management of pain; ocular itching due to seasonal allergic conjunctivitis, reduction of post-operative pain and photophobia after
refractive surgery.

Contraindications: Hypersensitivity to ketorolac; individuals with complete or partial syndrome of nasal polyps, angioedema, and bronchospastic reaction to
aspirin or other NSAIDs; during labor and delivery; patients with severe renal impairment or at risk for renal failure due to volume depletion; patients with risk of
bleeding; active peptic ulcer disease; pre- or intraoperatively; intrathecal or epidural administration; in combination with other NSAIDs; lactation.

Route and Dosage:

Pain
Adult: IV Loading Dose 30 mg (15 mg <50 kg) IM 30–60 mg loading dose, then 15–30 mg q6h [max: 150 mg/d on first day, then 120 mg subsequent days (30 mg
load, then 15 mg q6h if <50 kg)] PO 10 mg q6h prn (max: 40 mg/d) max duration all routes 5 d
Geriatric: IV Loading Dose 15 mg IM 30 mg loading dose, then 15 mg q6h PO 5–10 mg q6h prn (max: 40 mg/d) max duration all routes 5 d
Pain after Refractive Surgery
Adult: Ophthalmic Acular LS only 1 drop in operative eye q.i.d. up to 4 d
Allergic Conjunctivitis
Adult: Ophthalmic 1 drop 0.5% solution q.i.d.

Side Effects: Drowsiness, dizziness, headache. GI: Nausea, dyspepsia, GI pain, hemorrhage. Other: Edema, sweating, pain at injection site.

Drug Interaction: May increase methotrexate levels and toxicity; may increase lithium levels and toxicity. Herbal: Feverfew, garlic, ginger, ginkgo increased
bleeding potential.

Nursing Responsibilities:
 Correct hypovolemia prior to administration of ketorolac.
 Lab tests: Periodic serum electrolytes and liver functions; urinalysis (for hematuria and proteinuria) with long-term use.
 Monitor urine output in older adults and patients with a history of cardiac decompensation, renal impairment, heart failure, or liver dysfunction as well as
those taking diuretics. Discontinuation of drug will return urine output to pretreatment level.
 Monitor for S&S of GI distress or bleeding including nausea, GI pain, diarrhea, melena, or hematemesis. GI ulceration with perforation can occur anytime
during treatment. Drug decreases platelet aggregation and thus may prolong bleeding time.
 Monitor for fluid retention and edema in patients with a history of CHF.
Brand Name: Xylocaine

Generic Name: LIDOCAINE HYDROCHLORIDE

Action: Similar to those of procainamide and quinidine, but has little effect on myocardial contractility, AV and intraventricular conduction, cardiac output, and
systolic arterial pressure in equivalent doses. Exerts antiarrhythmic action (Class IB) by suppressing automaticity in His-Purkinje system and by elevating electrical
stimulation threshold of ventricle during diastole. Action as local anesthetic is more prompt, more intense, and longer lasting than that of procaine.

Classification: Local Anesthetic

Indication: Rapid control of ventricular arrhythmias occurring during acute MI, cardiac surgery, and cardiac catheterization and those caused by digitalis
intoxication. Also as surface and infiltration anesthesia and for nerve block, including caudal and spinal block anesthesia and to relieve local discomfort of skin and
mucous membranes. Patch for relief of pain associated with post-herpetic neuralgia.

Contraindications: History of hypersensitivity to amide-type local anesthetics; application or injection of lidocaine anesthetic in presence of severe trauma or
sepsis, blood dyscrasias, supraventricular arrhythmias, Stokes-Adams syndrome, untreated sinus bradycardia, severe degrees of sinoatrial, atrioventricular, and
intraventricular heart block. Safe use during pregnancy (category B), lactation, or in children is not established.

Route and Dosage:

Ventricular Arrhythmias
Adult: IV 50–100 mg bolus at a rate of 20–50 mg/min, may repeat in 5 min, then start infusion of 1–4 mg/min immediately after first bolus IM/SC 200–300 mg IM,
may repeat once after 60–90 min
Child: IV 0.5–1 mg/kg bolus dose, then 10–50 mcg/kg/min infusion
Anesthetic Uses
Adult: Infiltration 0.5–1% solution Nerve Block 1–2% solution Epidural 1–2% solution Caudal 1–1.5% solution Spinal 5% with glucose Saddle Block 1.5% with
dextrose Topical 2.5–5% jelly, ointment, cream, or solution
Post-Herpetic Neuralgia
Adult: Topical Apply up to 3 patches over intact skin in most painful areas once for up to 12 h per 24 h period

Side Effects:
CNS -Drowsiness, dizziness, light-headedness, restlessness, confusion, disorientation, irritability, apprehension, euphoria, wild excitement, numbness of lips or
tongue and other paresthesias including sensations of heat and cold, chest heaviness, difficulty in speaking, difficulty in breathing or swallowing, muscular
twitching, tremors, psychosis. With high doses: convulsions, respiratory depression and arrest.

CV - With high doses, hypotension, bradycardia, conduction disorders including heart block, cardiovascular collapse, cardiac arrest. Special Senses: Tinnitus,
decreased hearing; blurred or double vision, impaired color perception.

Skin - Site of topical application may develop erythema, edema. GI: Anorexia, nausea, vomiting. Body as a Whole: Excessive perspiration, soreness at IM site, local
thrombophlebitis (with prolonged IV infusion), hypersensitivity reactions (urticaria, rash, edema, anaphylactoid reactions).

Drug Interaction:
Lidocaine patch may increase toxic effects of tocainide, mexiletine; BARBITURATES decrease lidocaine activity; cimetidine, BETA BLOCKERS, quinidine
increase pharmacologic effects of lidocaine; phenytoin increases cardiac depressant effects; procainamide compounds neurologic and cardiac effects.

Nursing Responsibilities:
 Stop infusion immediately if ECG indicates excessive cardiac depression (e.g., prolongation of PR interval or QRS complex and the appearance or
aggravation of arrhythmias).
 Monitor BP and ECG constantly; assess respiratory and neurologic status frequently to avoid potential overdosage and toxicity.
 Auscultate lungs for basilar rales, especially in patients who tend to metabolize the drug slowly (e.g., CHF, cardiogenic shock, hepatic dysfunction).
  Watch for neurotoxic effects (e.g., drowsiness, dizziness, confusion, paresthesias, visual disturbances, excitement, behavioral changes) in patients receiving
IV infusions or with high lidocaine blood levels.
 Note: Lidocaine blood levels of 1.5–6 mcg/mL are reported to provide "usually effective" antiarrhythmic activity. Blood levels greater than 7 mcg/mL are
potentially toxic.
 Patient & Family Education

Brand Name: Epsom Salt

Generic Name: Magnesium Sulfate

Action:

Classification:

Indication:

Contraindications:

Route and Dosage:

Side Effects:

Drug Interaction:

Nursing Responsibilities:
Brand Name:

Generic Name:

Action:

Classification:
Indication:

Contraindications:

Route and Dosage:

Side Effects:

Drug Interaction:

Nursing Responsibilities:

Brand Name:

Generic Name:

Action:
Classification:

Indication:

Contraindications:

Route and Dosage:

Side Effects:

Drug Interaction:

Nursing Responsibilities: