CLEXANE

Brand Name: Clexane

Generic Name: Enoxaparin sodium

Indications: Prevent pulmonary embolism and deep vein thrombosis after hip or knee
replacement surgery, abdominal surgery, patients with acute illness who are at
increased risk because of decreased mobility. To prevent ischemic complications
of unstable angina and non-Q-wave MI with oral aspirin theraphy.

Drug Classification:Anticoagulants

Mechanism of Action: A low moleculer weight heparin derivative that accelerates

formation of anti-thrombin III-thrombin complex and deactivates thrombin,
preventing conversion of fibrinogen to fibrin. Has higher anti-factor Xa to
antifactor IIa activity ratio.

Dosage:Initially at 40mg SC q8 for 10 days.

Special Precaution: History of Heparin induced thrombocytopenia with or without

thrombosis. Do not administer by IM route. Renal or hepatic insufficiency,
History of hepatic ulcer, arterial hypertension, diabetic retinophaty, shortly after
neuro or ophth surgery.

Pregnancy Risk: B

Adverse Reaction: Hemorrhage. Thrombocytopenia. Local reactions (Small local

hematoma). Exceptional cases of skin necrosis. Rarely cutaneous or systemic
allergic reaction. Increase liver enzymes.

Contraindications: Conditions with high risk of uncontrolled hemorrhage including

major bleeding disorders.
Form: Ampules 30mg/0.3 ml, Syringes (prefilled) 30mg/0.3 ml, 40mg/0.4 ml, Vial
300mg/3ml

Nursing Responsibilities:
 Monitor pregnant women using the drug
 Instruct patient and family to watch for signs of bleeding or abnormal bruising
and to notify prescriber immediately if any occur.
 Tell patient to avoid OTC drugs containing aspirin or other salicylates unles
ordered by physician.
 DIAZEPAM

Classifications: CENTRAL NERVOUS SYSTEM AGENT; BENZODIAZEPINE

ANTICONVULSANT; ANXIOLYTIC

Pregnancy Category:D

Controlled Substance: Schedule IV

Availability
2 mg, 5 mg, 10 mg tablets; 1 mg/mL, 5 mg/mL, 5 mg/5 mL oral solution; 5 mg/mL
injection; 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg rectal gel

Actions
Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety
and anticonvulsant activity, with somewhat shorter duration of action. Like
chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS.

Therapeutic Effects
Shortens REM and stage 4 sleep but increases total sleep time. Antianxiety and
anticonvulsant agent.

Uses
Drug of choice for status epilepticus. Management of anxiety disorders, for short-term
relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion
and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to
alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults,
and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy,
paraplegia, athetosis, stiff-man syndrome, tetanus.

Contraindications
Injectable form: Shock, coma, acute alcohol intoxication, depressed vital signs,
obstetrical patients, infants <30 d of age. Tablet form: Infants <6 mo of age, acute
narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 d ofMAO
inhibitor therapy. Safe use during pregnancy (category D) and lactation is not established.

Cautious Use
Epilepsy, psychoses, mental depression; myasthenia gravis; impaired hepatic or renal
function; drug abuse, addiction-prone individuals. Injectable diazepam used with extreme
caution in older adults, the very ill, and patients with COPD.

Adverse Effects

Body as a Whole: Throat and chest pain. CNS:Dr ows ines s , fatigue, ataxia, confusion,
paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech,
tremor; EEG changes, tardive dyskinesia.CV: Hypotension, tachycardia, edema,
cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus.GI :
Xerostomia, nausea, constipation, hepatic dysfunction.Ur ogeni t al : Incontinence,
urinary
retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure.
Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis
at injection site

Interactions
Drug:A lcoh ol, CNS DEPRESSANTS,ANTIC ONVULS ANTS potentiate CNS
depression;
cimetidine increases diazepam plasma levels, increases toxicity; may decrease
antiparkinson effects oflevod op a; may increaseph en ytoin levels; smoking decreases
sedative and antianxiety effects.Her bal : Kava kava, valerian may potentiate sedation.

Pharmacokinetics
Absorption: Readily absorbed from GI tract; erratic IM absorption. Onset: 30–60 min
PO; 15–30 min IM; 1–5 min IV.Peak: 1–2 h PO.Dur at i on: 15 min–1 h IV; up to 3 h
PO.Di str i but i on: Crosses blood–brain barrier and placenta; distributed into breast
milk.
Metabolism: Metabolized in liver to active metabolites. Elimination: Excreted primarily
in urine.Hal f - Lif e: 20–50 h.

NURSING IMPLICATIONS
Assessment & Drug Effects
Monitor for adverse reactions. Most are dose related. Physician will rely on
accurate observation and reports of patient response to the drug to determine
lowest effective maintenance dose.
•
Monitor for therapeutic effectiveness. Maximum effect may require 1–2 wk;
patient tolerance to therapeutic effects may develop after 4 wk of treatment.
•
Observe necessary preventive precautions for suicidal tendencies that may be
present in anxiety states accompanied by depression.
•
Observe patient closely and monitor vital signs when diazepam is given
parenterally; hypotension, muscular weakness, tachycardia, and respiratory
depression may occur.
•
Lab tests: Periodic CBC and liver function tests during prolonged therapy.
•
Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more
likely to occur in older adults and debilitated or those receiving larger doses.
Dosage adjustment may be necessary.
•
Monitor I&O ratio, including urinary and bowel elimination.
•
Note: Smoking increases metabolism of diazepam; lowering clinical
effectiveness. Heavy smokers may need a higher dose than the nonsmoker.
•
Note: Psychic and physical dependence may occur in patients on long-term high
dosage therapy, in those with histories of alcohol or drug addiction, or in those
who self-medicate.

Patient & Family Education

•
Avoid alcohol and other CNS depressants during therapy unless otherwise
advised by physician. Concomitant use of these agents can cause severe
drowsiness, respiratory depression, and apnea.
Do not drive or engage in other potentially hazardous activities or those requiring
mental precision until reaction to drug is known.
•
Tell physician if you become or intend to become pregnant during therapy; drug
may need to be discontinued.
•
Take drug as prescribed; do not change dose or dose intervals.
Check with physician before taking any OTC drugs.
•
Do not breast feed while taking this drug without consulting physician.

PLASIL

Brand name: Plasil

Generic name:Metoclopramide
Indication: prevention of chemotherapy-induced emesis, treatment of postsurgical and
diabetic gastric stasis, facilitation of small bowel intubations in radiographic procedures,
management of esophageal reflux, treatment and prevention of postoperative nausea and
vomiting when nasogastric suctioning is undesirable

Drug classification:Anti-emetics

Mechanism of action: it blocks dopamine receptors and makes the GI cells more
sensitive to acetylcholine, leading to increased GI activity and rapid movement
of food through the upper GI tract.

Dosage: Tab Adult: 1tab tid, Syr Adult: 10ml tid, Children: 5-14 yr 2.5-5mg tid, 3-5 yr
2mg bid-tid 1-3yr 1mg bid-tid <1 yr 1mg bid
Special precaution: patients with history of depression, diabetic patients, pregnancy and
lactation, children and geriatric patients

Pregnancy risk category:B

Adverse reaction: CNS: drowsiness, extrapyramidal reactions, restlessness, anxiety,

depression, irritability, tardive dyskinesia CV: arrhythmias, hypertension,
hypotension GI : constipation, diarrhea, dry mouth, nausea Endo: gynecomastia

Contraindicated to: hypersensitivity, possible obstruction or hemorrhage, history of

seizure disorders, pheochromocytoma, Parkinson’s disease
Form: solution (oral concentrate), syrup (sugar free), tablet, ampule
Nursing responsibilities:

 Assess client for abdominal pain distention, bowel sound

 Assess client for extrapyramidal reactions
 Monitor for tardive dyskinesian

LANOXIN

Brand Name: Lanoxin

Generic Name: Digoxin
Indications:
Treatment of CHF, Tachyarrhythmias, atrial fibrillation and atrial flutter, Paroxysmal
atrial tachycardia.
Drug Classification: Antiarrhythmics, inotropics
Mechanism of Action:
Increases the force of myocardial contraction. Prolongs refractory period of the AV
node. Decreases conduction through the SA and AV nodes. Increased cardiac output
(positive inotropic effect) and slowing of the heart rate (negative chronotropic effect).

Dosage:
(IV)Adult:
Digitilizing Dose –
I0.6-1 mg (10-15 mcg/kg) given as 50% of the dose initially and additional fractions
given at 4-8 hr interval.(PO)Adult:
Digitalizing dose
– 0.75-1.25 mg (10-15 mg/kg) given as 50% of the dose initially and additional fractions
given at 4-8 hr intervals.
Maintenance dose –
0.063-0.5 mg/day as tablets or 0.350-0.5 mg/day as gelatin capsules, depending on
patient’s lean body weight, renal function, and serum level.

Special Precautions:
Electrolyte abnormalities ( hypokalemia, hypercalcemia, and hypomagnesemia may
predispose to toxicity),Geriatric patients, MI,Renal impairement, Obese patients,
Pregnancy, and Lactation,
Pregnancy Risk Category: C
Adverse Reactions:
CNS: fatigue, headache, weakness EENT: blurred vision, yellow vision CV:
Arrhythmias, bradycardia, ECG changes GI: anorexia, nausea, vomiting, diarrhea
Endo: gynecomastia Hemat: thrombocytopenia
Contraindications:
Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic
hypertrophic subaortic stenosis, constrictive pericarditis, known alcohol intolerance
(elixir only)..
Forms:
Tablets-0.125 mg, 0.25 mg,0.5 mg; Capsules-0.05 mg, 0.2 mg; Pediatric elixir-0.05
mg/ml; Injection-0.25 mg/ml

Nursing Responsibilities:

Monitor apical pulse before administering.

Monitor blood pressure periodically in patients receiving IV dogoxin.

Monitor intake and output ratios and daily weights.

Observe patient for signs and symptoms of toxicity.

Oral preparations can be administered without regard to meals.

Before administering initial loading dose, determine whether patient has taken any
digitalis preparations in the preceding 2-3 wk.
DRUG MECHANISM OF INDICATION CONTRAINDI ADVERS NURSING
NAME ACTION CATION E RESPONSIBILITI
EFFECT ES
GENERIC Digoxin increases the LANOXIN is Digitalis Diarrhea; • Monitor
NAME: strength and vigor of indicated for the glycosides are nausea. apical
Digoxin heart contractions, and treatment of mild contraindicated pulse
is useful in the to moderate heart in patients with before
BRAND treatment of heart failure. LANOXIN ventricular administer
NAME: failure. It is extracted increases left fibrillation or in ing.
Lanoxin from the leaves of a ventricular ejection patients with a • Monitor
plant called digitalis fraction and known blood
lanata. Digoxin improves heart hypersensitivity pressure
increases the force of failure symptoms to digoxin. A periodicall
contraction of the as evidenced by hypersensitivity y in
muscle of the heart by exercise capacity reaction to patients
inhibiting the activity of and heart failure- other digitalis receiving
an enzyme (ATPase) related preparations IV
that controls movement hospitalizations usually dogoxin.
of calcium, sodium and and emergency constitutes a • Monitor
potassium into heart care, while having contraindicatio intake and
muscle. Calcium no effect on n to digoxin. output
controls the force of mortality. Where ratios and
contraction. Inhibiting possible, daily
ATPase increases LANOXIN should weights.
calcium in heart muscle be used with a • Observe
and therefore increases diuretic and an patient for
the force of heart angiotensin- signs and
contractions. Digoxin converting enzyme symptoms
also slows electrical inhibitor, but an of toxicity.
conduction between the optimal order for • Oral
atria and the ventricles starting these preparatio
of the heart and is three drugs cannot ns can be
useful in treating be specified. administer
abnormally rapid atrial ed without
rhythms such as atrial regard to
fibrillation, atrial flutter, meals.
and atrial tachycardia.
(Abnormally rapid atrial
rhythms can be caused
by heart attacks,
excessive thyroid
hormones, alcoholism,
infections, and many
other conditions.)
During rapid atrial
rhythms, electrical
signals from the atria
cause rapid
contractions of the
ventricles.