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ACTIVATED CHARCOAL InstaChar, SuperChar, Actidose, Liqui-Char

CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY Classification: Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence Cyanide, mineral acids, caustic alkalis, organic ACUTE ORAL POISONING solvents, iron, ethanol, methanol poisoning; Adult: 25-100 g as a single lithium, methionine; dose. For multiple-dose intestinal obstruction, Action: treatment: 50-100 g as an anatomically-broken GI Charcoal due to its large initial dose followed by not tract, haemorrhage or GI surface area, inhibits the GI perforation. Concomitant absorption of toxic substances <12.5 g every hr. Alternatively, 25 mg every 2 use of charcoal with or irritants ex., aromatic or hr or 50 mg every 4 hr. sorbitol: Patients with benzenoid-type substances fructose intolerance; through adsorption. As a Child: <1 yr: 1 g/kg/dose; 1- Children <1 yr. laxative, the addition of sorbitol provides hyperosmotic 12 yr: 25-50 g/dose. environment thus causing catharsis. Moreover, charcoal GI DISORDERS Adult: 0.9753.9 g tid. interferes with the enterohepatic circulation of bile acids resulting to a lower cholesterol level. Oral Vomiting, constipation, diarrhea, black stools, swelling of abdomen, bowel obstruction; platelet aggregation, charcoal embolism, thrombocytopenia, hemorrhage, hypoglycemia, hypocalcaemia, hypothermia, hypotension, blackening of teeth and mouth; hypernatraemia, hypokalaemia, hypermagnesemia (with concomitant admin with cathartics). -Alert: drug is commonly used for treating poisoning or overdose with acetaminophen, aspirin, atropine, barbiturates or antidepressant -Give after emesis complete because Activated charcoal absorbs and inactivates syrup. -Instruct patient to drink 6-8 glasses of liquid per day because It can cause constipation

FUROSEMIDE Apo- Furosemide, Furoside, Lasix, Myrosemide

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE NURSING RESPONSIBILITY EFFECT

Classification: Diuretics

Edema Adult: PO 20-80 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 20-40 mg in 1 or more divided doses up to 600 Action: mg/d. A potent loop diuretic that Child: PO 2 mg/kg, may be inhibits sodium and increased by 1-2 mg/kg q 6-8h chloride reabsorption at (max: 6 mg/kg/dose) IV/IM 1 the proximal and distal mg/kg, may be increased by 1 tubules and the mg/kg q 2h if needed (max: ascending loop of Henle mg/kg/dose) Neonate: PO 1-4 mg/kg q 12-24h IV/IM 1-2 mg/kg q 12-24h Hypertension Adult: PO 10-40 mg bid (max: 480 mg/d)

History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion state; hepatic coma; pregnancy category c, lactation.

-CV: postural hypotension, dizziness with excessive diuresis, Circulatory collapse -Metabolic: hypovolemia, dehydration, hyponatremia, hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia, glycosuria, elevated BUN, hyperuricemia -GI: nausea, vomiting, oral and gastric burning, -HEMA: anemia

- Administer with food or milk to prevent GI upset. - Reduce dosage if given with other antihypertensive; readjust dosage gradually as BP responds. - Give early in the day so that increased urination will not disturb sleep. - Measure and record weight to monitor fluid changes. - Arrange to monitor serum electrolytes, hydration, liver function. - Arrange for potassium-rich diet or supplemental potassium as needed.

NIFEDIPINE Adalat, , Apo-Nifed , Gen-Nifedipine, Nifedical, Novo-Nifedin , Procardia,

CLASSIFICATION AND MECHANISM OF ACTION Classification: -Calcium channel-blocker -Antianginal -Antihypertensive

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

CNS: Dizziness, lightheadedness, -Acute MI, cardiogenic headache, shock, acute unstable asthenia, fatigue, angina, treatment of nervousness, anginal attack in sleep Action: Initial dose, 10 mg tid chronic stable angina. disturbances, Inhibits the movement of calcium ions PO. Maintenance blurred vision across the membranes of cardiac and range, 1020 mg tid. -Contraindicated with CV: Peripheral edema, arterial muscle cells; inhibition of Higher doses (20 allergy to nifedipine angina, transmembrane calcium flow results in 30 mg tidqid) may be hypotension, the depression of impulse formation in required, depending arrhythmias, AV specialized cardiac pacemaker cells, in on patient response. block, asystole slowing of the velocity of conduction of Adjust over 714 Dermatologic: the cardiac impulse, in the depression of days. More than Flushing, rash, myocardial contractility, and in the 180 mg/day is not dermatitis, pruritus, dilation of coronary arteries and recommended.

Management of hypertension, Angina pectoris, interstitial cystitis

-Monitor blood pressure impulse before therapy, during dose titration and periodically during therapy. -Monitor intake and output ratio and daily weight. -Assess for signs of CHF (peripheral edema, rales/cracles, dyspnea, weight gain. -Caution patient to change position slowly to minimize orthostatic pressure -Instruct patient on importance of maintaining dental hygiene

arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac energy consumption, and increased deliver of oxygen to myocardial cells.

Sustained-release 3060 mg PO once daily. Adjust over 714 days. Usual maximum dose is 90 120 mg/day.

urticaria - Instruct patient not to chew, GI: Nausea, diarrhea, cut, or crush sustainedconstipation, release tablets. cramps, flatulence, Swallow whole. hepatic injury Other: Nasal congestion, cough, fever, chills, shortness of breath, muscle cramps, joint stiffness, sexual difficulties

SCOPOLAMINE BUTYLBROMIDE Hyoscine Butylbromide

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

PHARMACOLOGIC CLASS: anticholinergic THERAPEUTIC CLASS: antimuscarinic, antiemetic, antivertigo drug, antiparkinsonian A tion: Inhibits muscarinic actions of acetylcholine in the autonomic nervous system. It also may affect neural pathways originating in the labyrinth to inhibit nausea and vomiting. Relieves spasticity, nausea and vomiting, reduces secretions, and blocks cardiac vagal reflexes

SPASTIC STATES. Adults: 0.4 to 0.8mg Scopace PO daily. Or, 10 to 20mg scopolamine butylbromide SC, IM or IV tid or qid.

-Contraindicated in patients with angle-closure glaucoma, obstructive uropathy, obstructive disease of GI tract, asthma, CPD, myasthenia gravis, paralytic ileus, intestinal atony, unstable CV status in acute hemorrhage, or toxic megacolon.

CNS: disorientation, restlessness, irritability, dizziness CV: palpitations, tachycardia EENT: dilated pupils, blurred vision, photophobia, increased IOP, difficulty swallowing GI: constipation, dry mouth, nausea, vomiting GU: urinary hesitancy, urine retention RESPI: bronchial plugging, depressed respirations SKIN: rash, dryness

- Assess pts condition before therapy and regularly thereafter. - Be alert for adverse reactions and drug interactions. - Advise patient to refrain from activities that require alertness until drugs CNS effects are known. - Instruct patient to report signs of urinary hesitancy or urine retention. - Recommend use of sugarless gum or hard candy to help minimize dry mouth

CALCIUM GLUCONATE Calgonate

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classification: Calcium Salt, Electrolytes and Replacement solution Action: Calcium is essential for maintaining normal function of nerves, muscles, the skeletal system, and permeability of cell membranes and capillaries. The normal serum calcium concentration is 9-10.4 mg/dl. Calcium gluconate is used to prevent or treat negative calcium balance. It also helps facilitate nerve and muscle performance as well as normal cardiac function.

Hypocalcaemia and calcium deficiency states Adult: oral, 10-50 mmol daily, adjusted according to patient's needs Hypocalcaemic tetany Adult: 2.25 mmol by slow IV inj over 10 minutes, followed by 58-77 ml of 10% calcium gluconate solution in 0.5-1L of 5% dextrose solution as continuous IV infusion. Antidote in severe hypermagnesaemia Adult: 10 ml of 10% calcium gluconate solution over 2 minutes, repeated every 10 minutes if needed.

Contraindicated in patients with calcium renal calculi or history of renal calculi. Conditions associated with hypercalcemia and hypercalciuria.

GI irritation; soft-tissue calcification, skin sloughing Hypercalcemia characterized by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation.

-note indications for therapy, other agents trialed, serum levels and desired levels -monitor calcium levels and renal function; assess for renal or parathyroid disease. Vitamin D facilitates absorption. - IV rate should not exceed 0.5-2 ml/min - give by intermittent IV infusion at a rate not exceeding 200 mg/min - monitor any adverse effect

AMLODIPINE BESYLATE Norvasc

DIPHENHYDRAMINE HCL Allerin, Benadryl

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classification: antihistamine, antiemetic, antivertigo agent, antitussive, sedative hypnotic, antidyskinetic Action: *Histamine is released by the body during several types of allergic reactions and--to a lesser extent-during some viral infections, such as the common cold. When histamine binds to its receptors on cells, it stimulates changes within the cells that lead to sneezing, itching, and increased mucus production. Antihistamines compete with histamine for cell receptors

RHINITIS. Adults and children: 25-50 mg PO TID or QID maximum of 300mg PO daily

Contraindicated to patients hypersensitive to drug: newborn, premature neonates, breastfeeding woman

sedation, tiredness, sleepiness, dizziness, disturbed coordination, drying and thickening of oral and other respiratory secretions, and stomach distress

-Stop drug 4 days bebefore diadnostic skin testing -Warn pt. not to take this drug with any other products that contain dephenhydramine - May be taken with or without food -Intruct pt. to take 30mins before travel to prevent motion sickness

OXYTOCIN Pitocin

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classification: Oxytoxics Induction or stimulation of labor in hypotonic uterine inertia. Prevention & Action: treatment of postpartum Drugs Acting on the uterine atony & uterus hemorrhage. Early stages Causes potent and of pregnancy as an selective stimulation of adjunctive therapy for the uterine and mammary management of gland smooth muscle. incomplete, inevitable or Induces labor and milk missed abortion. ejection and reduces postpartum bleeding.

Hypertonic uterine contraction, mechanical obstruction to delivery, fetal distress. Significant cephalopelvic disproportion, fetal malpresentation, placenta previa, placental abruption, cord presentation or prolapse, overdistension or impaired resistance of the uterus to rupture as in multiple pregnancy, polyhydramnios, Initially 1 amp (10units) IV grand multiparity & in uterine scar. Do not use for prolonged in 1000ml of D5W, dextrose 5% in NSS at 1 period in patients w/ oxytocinresistant uterine inertia, severe 2 milliunits pre-eclamptic toxemia or severe CV disorder.

Maternal CNS: hemorrhage, hypertension, seizures. CV: hypertension, increased heart rate GI: nausea and vomiting GU:: titanic uterine contraction, abruption placenta, impaired uterine blood flow Fetal CV: bradycardia, tachycardia Respi: anoxia

- Assess patients condition before starting the therapy. - Monitor and record uterine contractions, heart rate, blood pressure. - be alert for adverse reactions and drug interactions. - Instruct patient to report unusual feelings. - Instruct patient to remain lying down during administration.

AMINOPHYLLIN (Theophylline ethylenediamine) Truphylline

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classification: Bronchodilator Xanthine Action: Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping; in higher concentrations, it also inhibits the release of slowreacting substance of anaphylaxis (SRS-A) and histamine.

Chronic bronchospasm Adult: As hydrate: Initially, 225-450 mg bid, increased if necessary. Child: >3 yr: As modified-release hydrate: 12 mg/kg daily increased to 24 mg/kg daily in 2 divided doses after 1 wk.

Contraindicated in patients hypersensitive to xanthine compounds (caffeine, theobromine) and ethylediamine and in those with active peptic ulcer disease and seizure disorder (unless they receive adequate anticonvulsant therapy). Rectal suppositories are contraindicated in patients who have an irritation or infection of the rectum or lower colon.

CNS: nervousness, restlessness, headache, insomia, seizures, muscle twitching CV: palpitation, sinus tachycardia, extrasystoles, flushing marked hypotension arrhythmias GI: nausea, vomiting, diarrhea, epigastric pain, hematemesis, irritation with rectal suppositories Metabolic: Hyperglycemia Respiratory: tachypnea, respiratory arrest Skin: urticaria Others: fever, hypersensitivity reactions.

- Administer to pregnant patients only when clearly needed neonatal tachycardia, jitteriness, and withdrawal apnea observed when mothers received xanthines up until delivery. - Caution patient not to chew or crush enteric-coated timedrelease forms. - Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals. - Maintain adequate hydration. - Monitor for clinical signs of adverse effects - Take this drug exactly as prescribed

STREPTOKINASE Streptase, Kabikinase CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

Classification: Thrombolytic Agents, Action: Convert plasmonogen to plasmin, which is then able to degrade fibrin present in clots. Streptokinase combines with plasmonogen to form activator complexes which then convert plasminogen to form activator complexes which then convert plasminogen to plasmin.

Acute myocardial infarction Adult: 1.5 million units as a single dose infused over 1 hr immediately after onset of symptoms. Pulmonary thromboembolism and other arteriovenous occlusions Adult: Loading dose: 250,000 units infused over 30 min. Maintenance: 100,000 units/hr for 24-72 hr depending on the condition to be treated.

- Active Internal bleeding. -History of cerebrovascular accident. -Recent CNS trauma, surgery, or neoplasm. -Severe uncontrolled hypertension. -Arteriovenous malformation. -Known bleeding tendencies. -Hypersensitivity; crosssensitivity with streptokinase may occur.

CNS: Intracranial hemorrhage, headache CV: Reperfusion arrhythmias, hypotension EENT: periorbital edema GI: GI bleeding, retroperitoneal bleeeding GU: GU tract bleeding RESPI: hemoptysis, bronchospasm SKIN: eccymoses, urticaria, flushing HEMAT: bleeding LOCAL: phlebitis at IV site MS: musculoskeletal pain MISC: allergic reactions including anaphylaxis, fever

-Monitor vital signs, including temperature, continuously for coronary thrombosis and at least every 4 hrs during therapy for other indications. Do not use lower extremities to monitor blood pressure. -Assess patient carefully for bleeding. Frank bleeding and internal bleeding may occur. If uncontrolled bleeding occurs, stop medication and notify physician. -Assess neurological status throughout therapy. Altered sensorium or neurological changes may be indicative of bleeding intracranial bleeding. -Explain need for bed rest and minimal handling during therapy to avoid injury.

THIAMINE HYDROCHLORIDE Vitamin B1, Betamin, Beta-Sol

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classifications Nutritional drugs:

RDA Beriberi

Contraindicated in patients hypersensitive

-CNS: restlessness, weakness

- Use parenteral route only when P.O. route is not feasible

Wet beriberi and myocardial failure - Wernickes Action: Combines with adenosine triphosphate to encephalopathy from coenzyme needed Dosage: Adult men: 1.2 for carbohydrate mg metabolism. Adult women: 1.1mg Children: .9mg

vitamins and minerals

to thiamine products.

-CV: cyanosis, CV collapse (with repeated I.V. injections) -EENT: tightness of throat - GI: nausea, hemorrhage - Respiratory: pulmonary Edema -Skin: feeling of warmth, pruritus, urticaria, diaphoresis -Others: angioedema

- Dont confuse thiamine with thorazine - In wernickes encephalopathy, give thiamine before dextrose - Thiamine malabsorption is most likely in alcoholism, cirrhosis and GI disease

IPECAC SYRUP

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

LABETALOL HYDROCHLORIDE Trandate, Normodyne

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Antihypertensives May be related to reduced peripheral vascular resistance as a result of alpha and beta blockade Hypertension (100mg ID with or without diuretic) - Severe hypertension, hypertension emergencies (200mg diluted in 160ml of D5W infused at 2mg/minute) - Patients with bronchial asthma, severe bradycardia - Use cautiously in patients with heart failure, hepatic failure, chronic bronchitis, emphysema, peripheral vascular disease CNS: dizziness, syncope CV: orthostatic hypotension, ventricular arrhythmias EENT: nasal congestion GI: nausea, vomiting GU: sexual dysfunction, urine retention Respiratory: bronchospasm Skin: rash - Monitor BP frequently - Monitor signs of shock for drug masks common signs and symptoms of shock - Monitor glucose level closely for diabetic patients - Tell patient that stopping drug abruptly can worsen chest pain and trigger an MI - Warn px that occasional harmless scalp tingling may occur

ISOSORBIDE DINITRATE Isobar

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Anti-Anginal Drugs Action:

Long-term prophylaxis of Marked anemia; head angina pectoris; as an trauma; cerebral adjunctive therapy in CHF. hemorrhage. Shock & hypotonic collapse. Avoid sildenafil, tadalafil, 5-30 mg qid. vardenafil. Precautions: Not recommended for childn. Monitor hemodynamics before & during treatment. May develop tolerance to other nitrates & nitrites.

Headache, flushing, dizziness, palpitations, orthostatic hypotension, tachycardia, vertigo, confusion, weakness.

1. Monitor Vital signs 2. Should be taken on an empty stomach (Take on an empty stomach 1/2 hr before meals.).

HYDROCORTISONE Cortin

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Corticosteroid Hormones

Acion: Decreases inflammation, mainly by stabilizing leukocytes lysosomial membrane, suppresses immune respose

Acute adrenocortical insufficiency, bilateral adrenalectomy, severe shock, acute hypersensitivity reactions, overwhelming infections w/ severe toxicity, SLE in relapse, aspiration pneumonitis Adult 100500 mg IV over a period of 1 to several mins. Childn & infant Reduce dose but should be >25 mg daily.

Latent, healed & active TB, herpes simplex, chronic nephritis, acute psychosis, Cushing's syndrome, peptic ulcer & predisposition to thrombophlebitis.

Fluid electrolyte, musculoskeletal, GI, dermatologic, neurological, endocrine, ophth, metabolic disturbances.

.inspect patients skin with petechiae; watch for depression or psychotic episodes; diabetic patient may need increased in insulin, monitor blood glucose; tell patient not to stop drug abruptly; Elderly patient may be more susceptible to osteoporosis with prolonged use; caution patient to avoid exposure to infections

BRETYLIUM TOSYLATE Bretylium Tosylate, , Bretylol CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

Action: Cardiac DrugS: Bretylium tosilate is a quarternary ammonium compound with class II and class III antiarrhythmic activities. It causes an early release of norepinephrine at the adrenergic postganglionic nerve terminals and subsequently inhibits release of norepinephrine in response to nerve stimulation.

Intravenous LIFE-THREATENING VENTRICULAR ARRHYTHMIAS Adult: Initially, 5 mg/kg as an undiluted solution via rapid IV inj. Max Dosage: Total dose: 30-35 mg/kg. Parenteral OTHER VENTRICULAR ARRHYTHMIAS Adult: Dose can be given via IM or IV admin. IM admin: Use undiluted bretylium tosilate inj. Initially, 5-10 mg/kg.

Hypersensitivity, pheochromocytoma, severe aortic stenosis, severe pulmonary hypertension. Not to be used when there is digitalis-induced arrhythmias. Precautions Pregnancy, lactation, elderly, child, renal impairment. Keep patients supine (postural hypotension common). Continuous cardiac and BP monitoring. Rapid IV admin may cause severe nausea and vomiting, and hypertensive crisis; infuse diluted solution over at least 8 minutes.

Transient initial hypertension; nausea, vomiting, local tissue necrosis after IM Inj (limit vol and vary site), bradycardia and renal impairment, dyspnea, chest pain, flushing, increase in premature ventricular contractions, nasal congestion, syncope.

1.keep patient supine until tolerance to hypotension develops 2.Monitor patient closely. 3. Monitor blood pressure, heart rate and rhythm contibuously. 4. Observe for increase anginal pain. 5. Dosage ajust may be necessary to patients with renal insufficientcy

EPINEPHRINE Glaucon, Epinal, Epifrin CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT SYSTEMIC ADMIN: CNS: Fear, anxiety, tenseness, restlessness, headache, lightheadedness, dizziness, CV: Arrhythmias, hypertension resulting in intracranial hemorrhage, CV collapse with hypotension, palpitations, tachycardia, precordial pain in patients with ischemic heart disease GI: N/V, anorexia NURSING RESPONSIBILITY

*Contraindicated with allergy or hypersensitivity Sympathomimetic to epinephrine or Alpha-adrenergic agonist components of Beta1- and beta2preparation; narrow-angle adrenergic agonist glaucoma; shock other Treatment and prophylaxis than anaphylactic shock; Cardiac stimulant Vasopressor of cardiac arrest and hypovolemia; general Bronchodilator attacks of transitory AV anesthesia with Antasthmatic heart block with syncopal halogenated hydrocarbons Nasal decongestant or cyclopropane; organic seizures; in acute Mydriatic brain damage, cerebral asthmatic attacks to Therapeutic actions: arteriosclerosis; cardiac relieve bronchospasm not Naturally occurring dilation and coronary neurotransmitter, the controlled by inhalation or insufficiency; effects of which are subcutaneous injection, tachyarrhythmias; mediated by alpha or beta Injection: ischemic heart disease; receptors in target organs. hypertension; renal Effects on alpha receptors impairment; include vasoconstriction, contraction of dilator muscles of iris.

injection: Relief from respiratory distress of bronchial asthma, other COPDs

- Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug tolerance) can occur with prolonged - Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown - WARNING: Keep a rapidly acting alphaadrenergic blocker (phentolamine) or a vasodilator (a nitrate) readily available in case of excessive hypertensive reaction.

PHENYTOIN SODIUM Dilantin

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Anticonvulsants Action:

Tonic-clonic & complex partial (psychomotor, temporal lobe), prevention & treatment of seizures occurring during or following neurosurgery.Adult Initially 100 mg tid. Maintenance: 300-400 mg daily. Childn 6 yr Initially 100 mg tid, subsequent dosage should be adjusted according to therapeutic response, <6 yr 30 mg bid, may be increased to 30 mg tid or qid. Pedia 5 mg/kg/day Initially in 2-3 equally divided doses. Max: 300 mg daily. Maintenance: 48 mg/kg/day.

History of hypersensitivity GI disturbances; ataxia, to phenytoin or other slurred speech; diplopia, hydantoins. nystagmus & mental confusion w/ headache, Precautions: dizziness, gingival hyperplasia, hirsutism, Severe myocardial hyperglycemia, insufficiency, hepatic osteomalacia. impairment, porphyria. Avoid abrupt w/drawal.

1.Elderly client tend to metabolize phenytoin slowly and may not need reduced dosage 2. Use clear solution for injection 3. Dont give Im ulless dosage adjustments are made. 4. divided doses given with or after meals may decrease adverse GI reactionsDont withdraw drug suddenly because seizures may worsen. Monitor blood levels of blood

MAGNESIUM SULFATE Epsom Salt CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

Pregnancy risk category A Central Nervous system drugs

Action:

Convulsions (treatment) Intravenous magnesium sulfate is indicated for immediate control of lifethreatening convulsions in the

Parenteral of drug contraindicated in patients with heart block or nyocardial damage. Dont give in toxemia of pregnancy during 2 hour

Muscle weakness, lack of energy, low blood pressure, n/v, stuffy nose, chest pain, pulmonary edema,

1.if used to treat seizure, take appropriate seizure precaution 2. check blood

May decrease acetylcholine released by nerve impulse, but its anticonvulsant mechanism is unknown

treatment of severe toxemias proceeding delivery (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,Tetany, uterine (treatment) - as a myometrial relaxant. IM: 1-5 g; IV: 1 to 4 g magnesium sulfate may be given intravenously in 10% t20% solution

blurry vision, blurred speech, flushing

magnesium level after repeated dose. 3. monitor fluid intake and output. 4. Review pptential adverse effects

DEXTROSE

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Nutritional drugs : caloric

Contraindicated in patients in diabetic coma while glucose level remains Action: excessively high. Use of concentrated solutions A simple water soluble contraindicated in patients sugar that minimizes the with intracranial or glyconeogenesis and intraspinal hemorrhage; in promotes anabolism in Dosage depends on fluid dehydrated patients with delirium tremens; and in patients whose oral caloric caloric requirement patients with severe intake is limited dehydration, anuria, I.V infusion of 2.5%, 5% or diabetic coma, or glucose10% used to treat galactose malabsorption hypoglycemia syndrome. Also contraindicated in patients with known allergy to corn or corn products.

-fluid replacement and caloric supplementation in patients who cant maintain adequate oral intake or who is restricted of doing so Dosage

CNS: confusion, unconscious CV: phlebitis, venous sclerosis, tissue necrosis, GU: glycosuria, osmotic diuresis Metabolic: Hyperglycemia, dehydration, hypervolemia Respiratory: pulmonary edema Others: fever

*Use cautiously in patients with cardiac or pulmonary disease, hypertension, renal insufficiency, urinary obstruction or hypovolemia. *Never stop hypertonic solution abruptly *Dont give concentrated solution subcutaneos or IM *Check vital signs frequently *Monitor glucose level *Monitor fluid intake and output and weigh patient carefully *Watch for signs and symptoms of fluid overload. *Monitor signs for confusion

CALCIUM CHLORIDE Calcium Chloride CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

PHARMACOLOGICAL CLASS: mineral, cardiotonic THERAPEUTIC CLASS: calcium supplement MOA: * Replaces calcium and maintain calcium level.

HYPOCALCEMIC EMERGENCY. Adults: 7 mEq to 14 meq calcium I.V. May given as 10% calcium gluconate solution HYPOCALCEMIC TETANY. Adults; 4.5 mEq to 7 mEq calcium I.V. Children: .5 to .7 mEq/kg calcium I.V TID to QID until tetany is controlled

*Contraindicated to cancer patients with bone metastases and in those with ventricular fibrillation, hypocalcaemia or renal calculi.

CNS: tingling sensation CV: bradycardia, milddrop in blood pressure GI: constipation GU:polyuria, renal calculi

*tell patient to take oral calcium 1-1.5 hours after meals if GI upset occurs. *tell patient to take oral calcium with full glass of water. *tell patient to report anorexia, N/V, abdominal pain. *inform patient that some products may containi phenyalanine or tatazine *watch any signs ot hypercalcemia such us stupor, confusioin,delirium

NITROGLYCERIN Nitrostat CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

PHARMACOLOGIC PREVENTION OF CHRONIC CLASS: nitrate ANGINAL ATTACKS. THERAPEUTIC CLASS: antianginal, vasodilator ACUTE ANGINA PECTORIS; TO PREVENT OR MINIMIZE MOA: ANGINAL ATTACKS WHEN *reduces cardiac oxygen TAKEN IMMEDIATELY demand by decreasing BEFORE STRESSFUL left ventricular end EVENTS.

*Contraindicated in patients hypersensitive to nitrates and in those with early MI, severe anemia, increased IOP, angleclosure glaucoma, orthostatic hypotension, and allergy to adhesives. IV nitroglycerin is contraindicated in patients

CNS: headache, sometimes with throbbing, dizziness, weakness CV: orthostatic hypotension, tachycardia, flushing, palpitations, fainting EENT: sublingual burning

*Assess pts condition before therapy and regularly thereafter. *Monitor v/s and drug response. Be particularly aware of BP. Excessive hypotension may worsen MI.. *Tell pt to swallow oral tablets whole and not to

diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). Also increases blood flow through collateral coronary vessels. *prevents or relieves acute angina, lowers BP, and helps minimize heart failure caused by MI.

HPN R/T SURGERY, HEART FAILURE LINKED TO MI; ANGINA PECTORIS IN ACUTE SITUATIONS; TO PRODUCE CONTROLLED HYPOTENSION DURING SURGERYHYPERTENSIVE CRISIS.

with cardiac tamponade, restrictive cardiomyopathy, constrictive pericarditis, or hypersensitivity to IV form. *Use cautiously in patients with hypotension or volume depletion.

GI: nausea, vomiting SKIN: cutaneous vasodilation, contact dermatitis, rash OTHER: hypersensitivity reactions

chew them. *Tell pt that stopping drug abruptly causes coronary vasospasm. *Advise pt to avoid alcohol during drug therapy. *Tell pt to change to upright position slowly. Advise him to go up and down stairs carefully and to lie down at first sign of dizziness.

DEXAMETHASONE Decadron, Dexamethasone Intensol CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

--Corticosteroids

Action: It is commonly used to treat inflammation of the skin, joints, lungs, and other organs. Common conditions treated include asthma, allergies, and arthritis. It is also used for other conditions, like blood disorders and diseases of the adrenal glands

-Shock: 4 to 8 mg intravenously initially, repeat if necessary to a total dose of 24 mg. -Autoimmune diseases and inflammations: longterm therapy with 0.5 to 1.5 mg oral per day. Avoid more than 1.5 mg daily, because serious side effects are more frequently encountered with higher doses. -Adjuvant to or part of chemotherapy: individual schedule -Diagnostic purposes: special schedule

-diabetes -Cushings syndrome -kidney dse -liver dse -osteoporosis

Osteoporosis under long term treatment, pathologic fractures (e.g., hip) Muscle atrophy, negative protein balance (catabolism) Elevated liver enzymes, fatty liver degeneration (usually reversible) Cushingoid (syndrome resembling hyperactive adrenal cortex with increase in adiposity, hypertension, bone demineralization, etc.) Depression of the adrenal gland is usually seen, if more than 1.5 mg daily are given for more than three weeks to a month. Hypertension, fluid and sodium retention, edema

-Dexamethasone may be given to women at risk of delivering prematurely in order to promote maturation of the fetus' lungs. This has been associated with low birth weight, although not with increased rates of neonatal death.

VERAPAMIL Isoptin, VErelan

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

--calcium channel blocker -hypertension

Action: It affects the amount of calcium found in your heart and muscle cells. This relaxes your blood vessels, which can reduce the amount of work the heart has to do. This medicine is used to lower high BP

-Severe left ventricular dysfunction (see -10-15 mg slow IVP9over WARNINGS) 2 min), repeat in 30 min -Hypotension (systolic pressure less than 90 mm Hg) or cardiogenic shock Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker) -Second- or third-degree AV block (except in patients with a functioning artificial ventricular pacemaker) Patients with atrial flutter or atrial fibrillation and an accessory bypass tract

-headaches - facial flushing -dizziness swelling,increased urination, -fatigue,nausea, ecchymosis, -lightheadedness,and constipation.

RETEPLASE Retavase CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

-Thrombolytic drug

Action: -used to treat heart

-Active internal bleedingHistory of cerebrovascular accident -Recent intracranial or intraspinal -10 units IV bolus over 2 -Intracranial neoplasm, min; after 10 arteriovenous min,administer 2nd 10 units -Known bleeding diathesis -Severe uncontrolled Iv bolus over 2 min

-Acute myocardial infarction -congestive heart failure

-BLEEDING -pericarditis -sinus bradycardia -dyspnea -hypotension

attacks by breaking up the clots that cause them. Reteplase is a recombinant nonglycosylated form of human tissue plasminogen activator, which has been modified to contain 357 of the 527 amino acids of the original protein. It is produced in the bacterium Escherichia coli.

hypertension

ADENOSINE Adenocard, Adenoscan

CLASSIFICATION AND MECHANISM OF ACTION Anti-arrthythmic

INDICATION AND DOSAGE Symptomatic supraventricular tachycardia

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT -headache, light headedness, dizziness -chest pain,palpitations, Hypotension -nausea, pressure in groin -hyperventilation, metallic taste

NURSING RESPONSIBILITY -Monitor heart rhythm for arrhythmias -Asses for chest pain,dyspnea & sweating -Monitor vital signs

-2nd or 3rd degree burn -hypersensitivity to drug -sinus node disease Action: -bronchoconstrictive lung Converts paroxysmal supraventricular tachycardia to normal sinus rhythm 6 mg rapid IVP, then disease resulting by slowing conduction 12 mg IV q1-2 minx2 through atrioventricular (AV)node & interrupting reentry pathway

ACTIVASE Reteplase

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Thrombolytic Agents

Fibrinolytic; treatment of acute developing myocardial infarction 15 mg IV bolus followed by infusion 0.75 mg/kg over next 20 mins. ,followed by infusion 0.5 mg/kg over next 60 minutes.

Action: Binds to fbrin in a thrombus and locally converts plasminogen to plasmin, which starts local firinolysis.

. -Drug may be given to - Contraindicated in -fever, cerebral menstruating women. patients with active hemorrhage internal bleeding, -arrhythmias, hypotension, -Monitor vital signs and neurologic status carefully. intracranial neoplasm, edema arteriovenous - GI bleeding, nausea and Keep patient on strict bed rest. malformation, vomiting -If uncontrollable bleeding aneurysm, sever -GU tract bleeding occurs, stop infusion (and uncontrolled - bleeding at puncture heparin) and notify hypertension, or history sites, cholesterol prescriber. or current evidence of embolization, intracranial hemorrhage, hypersensitivity reactions, -Anticoagulant and anti platelet therapy is suspicion of anaphylaxis commonly started during subarachnoid or after treatment, to hemorrhage, or seizure decrease risk of another at onset of CVA when thrombosis. used for acute ischemic CVA.

AMIODARONE Cordarone, Pacerone

CLASSIFICATION AND MECHANISM OF ACTION Anti-arrhythmic

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT -nausea, constipation, vomiting,abdo pain -cough, hypotension -photophobia, eye discomfort,tremor,halos -decreased libido -hypothyroidism -thrombocytopenia

NURSING RESPONSIBILITY -Monitor patient closely -Monitor ECG continuously -Assess for s/sx of lung inflammation -Monitor patients BP, pulse, heart rhythm.

Action: Prolongs duration & refractory period of action mg IV over 10 min; follow potential. Slows electrical with 1mg/min infusion conduction, electrical impulse generation from sinoatrial node, conduction through accessory pathways.

Persistent or recurrent VF -cardiogenic shock or pulseless VT -2nd/3rd degree burn -marked sinus bradycardia -breastfeeding/neonates Rapid infusion 150-300

BUSCOPAN Hyoscine butylbromide

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Anticholinergic

-Spastic states -Contraindicated to pt. with -Delirium and glaucoma,obstructive neuropathy and preanesthetic GI tract, asthma, CPD, unstable CV sedation status hyperthyroidism, CAD, heart Action: -To prevent failure, hiatal hernia with reflux Inhibits muscarinic actions of nausea and esophagitis, hepatic failure acetylcholine on automatic vomiting from -Use cautiously in children younger effectors innervated by motion sickness than 6 year old postganglionic cholinergic neurons 0.4 to 0.8 mg P.O. Onset: 1 hour Peak: 1-3 hours Duration: 4-6 hours

- disorientation, restlessness, headache, confusion, impaired memory

-raised side rails as precautions -advised patient that eyes may be more sensitive to light - urge patient to report - palpitations, urine retention tachycardia, flushing -reorient patient as needed - blurred vision, -warn patient to avoid photophobia, activities that require increased IOP, difficulty swallowing alertness - constipation, dry mouth epigastric distress - urine retention - depressed respirations - rash, dryness

ATROPINE Atropen

CLASSIFICATION AND INDICATION AND MECHANISM OF ACTION DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Cholinergic Blocking drug

Action: Blocks acetylcholine effects on postganglionic cholinergic receptors in smooth muscle, cardiac muscles, exocrine glands, urinary bladder, and AV and Sa nodes in the heart

Antidote to overdosage w/ cholinergic substances eg, organophosphate insecticides & nerve gases, & poisonous mushroom. Pre-op medication to reduce salivary & resp tract secretions. Severe bradycardia.

Glaucoma, unstable cardiac rhythm, prostatic hypertrophy, reflux esophagitis, severe coronary artery disease, paralytic ileus, obstructive GI disorders.

Dryness of the mouth associated w/ difficulty in swallowing, pupillary dilatation w/ loss of accommodation producing blurring of vision, flushed skin, tachycardia, urinary Precautions retention, constipation, agitation & restlesness, Infants, small childn, elderly & hyperthermia debilitated patients.

*Document indications for therapy, onset and characteristics of S & S *Check for any history of glaucoma before ophthalmic administration *Obtain VS and ECG, monitor CV status during IV therapy

Adult 0.4-0.6 mg every 46 hr.

DOBUTAMINE Dobutrex

CLASSIFICATION AND MECHANISM OF ACTION Inotropic

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT -headache,nausea, vomiting -hypotension,angina -dyspnea,tachycardia

NURSING RESPONSIBILITY -Monitor ECG & blood pressure continuously -Monitor fluid intake & output -Assess electrolyte levels -Monitor signs of hypovolemic shock

Action: Stimulates beta adrenergic receptors of heart,causing a positive inotropic effect that increase myocardial contractility & stroke volume

Short term management -idiopathic hypertropic of cardiac subaortic stenosis decompensation resulting -hypersensitivity to drug from depressed contractility Continuous IV infusion; usual dose is 2-20 mcg/kg/min IV, based on patient on patient response

SODIUM BICARBONATE Neut, Soda Mint

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Acidifiers and alkalinizers

Action: Restores the buffering capacity of the body and neutralizes excess acid. Onset: unknown Peak: unknown Duration: unknown

-Metabolic acidosis -Systemic or urinary alkalinization -Antacid Cardiac arrest

-Contraindicated in patient with metabolic or respiratory alkalosis and hypocalcemia -Contraindicated in patient with renal insufficiency, heart failure

-tetany - edema - gastric distention, flatulence - metabolic alkalosis - irritation at injection site

-Obtain blood pH, partial pressure of arterial oxygen and arterial carbon dioxide and electrolyte level -Tell pt. not to take drug with milk by doing so may cause rise in calcium in the blood

SOPROTERENOL HCL Isuprel

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Bronchodilators

Action: Relaxes bronchial smooth muscle by stimulating beta2 receptors. Onset: immediate Peak: unknown Duration: < 60 minutes

-Bronchospasm during anesthesia -Heart block, ventricular arrhythmias -Shock -Post-op patient with bradycardia IV 0.02-0.06, then 0.01-0.2mcg/min

-Used cautiously to patient with tachycardia or AV block, angina pectoris, glaucoma -Contraindicated when used with general anesthesia -Used cautiously with elderly patients

-headache, mild tremor, weakness, dizziness, anxiety, insomnia - palpitations, tachycardia, arrhythmias, cardiac arrest - nausea and vomiting -hyperglycemia - diaphoresis

-Tell pt. that drug isnt a substitute for fluid and blood volume deficit -Dont use solution if discolored -Discontinue if heart rate > 110 bpm and notify physician -Monitor pt. for adverse reaction -Tell patient to report chest pain, or fluttering of the chest

DOPAMINE Intropin,Revimine

CLASSIFICATION AND INDICATION AND MECHANISM OF ACTION DOSAGE Inotropic Hemodynamically significant hypotension in the absence of hypovolemia Continuous IV infusion:dose range:5-20 mcg/kg/min;begin infusion at mcg/kg/min;increase infusion rate according to BP & other clinical responses

CONTRAINDICATION -pheochromocytoma -tachyarrhythmias, ventricular fibrillation -hypersensitivity

SIDE EFFECT/ ADVERSE EFFECT -headache, palpitations -hypotension, vomiting -dyspnea, piloerection -mydriasis -tachycardia

NURSING RESPONSIBILITY -Monitor blood pressure, pulse -Monitor urinary output -Monitor color & temperature -Never stop infusion abruptly, because this may cause severe hypotension

Action: Causes norepinephrine release, leading to vasodilation of renal & mesenteric arteries,increases heart rate,blood flow, myocardial contractility & stroke volume

TERBUTALINE SULFATE Brethair, Brethine

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Bronchodilators

Action: Relaxes bronchial smooth muscle by stimulating beta2 receptors. Onset: 30 min Peak: 2-3 hours Duration: 4-8 hours

Bronchospasm in patients with reversible obstructive airway disease 2.5-5 mg P.O. tid

-Contraindicated to patient hypersensitive to the drug -Used cautiously in patient with CV disorder, hyperthyroidism, diabetes, seizure disorder

-nervousness, tremor, dizziness, headache - palpitations, tachycardia, arrhythmias, flushing - vomiting, nausea, heartburn -hypokalemia -dyspnea - diaphoresis

-protect med from light - terbutaline may reduce the sensitivity of spirometry for the Dx of bronchospasm - make the pt. understand the effects of the drug - remind pt. to separate oral dosages accordingly

DIAZEPAM Valium, Vivol

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Anti-convulsant

Seizures

Action: 5-10 mg IV q 10-15 min Produces anxiolytic effect prn, max 20 mg. & CNS depression by Administer slow IVP stimulating gamma aminobutyric acid receptors. Relaxes skeletal muscles of spine by inhibiting polysynaptic afferent pathways.

-Coma or CNS depression -dizziness, drowsiness, -Narrow-angle glaucoma tremor -bradycardia, nausea, Vomiting, diarrhea -pruritus, diaphoresis -muscle rigidity, rash -diplopia, dysarthria, restlessness -dystonia, increased salivation -hypotension, stupor

-Assist patient in ambulation -Monitor CBC & kidney & liver function test results -Tell patient to avoid sudden drug withdrawal

PROCAINAMIDE Pronestyl, Procanbid

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Anti arrhythmic Action: Decreases myocardial excitability by inhibiting conduction velocity,depresses myocardial contractility

Recurrent VF,VT,PVCs 20-30 mg/min,max=17 mg/kg or 500 mg

-complete heart block -torsades de pointes -lupus erythematosus -hypersensitivity to drug

-headache, dizziness, confusion,psychosis -hypotension,bradycardia -nausea, vomiting, diarrhea -rash, urticaria, pruritus -bitter taste, lupuslike syndrome,edema -asthenia,seizures

-Monitor electrolyte levels, CBC, &antinuclear antibody titers -Evaluate patient for s/sx of lupuslike syndrome -Monitor vital signs

MORPHINE SULFATE Roxanol, Statex

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Opioid analgesic

SEVERE PAIN.

MOA: * Unknown: binds with opiate receptors in the CNS, altering perception of and emotional response to pain

-hypersensitivity to morphine or in any situation where opioids are Adults: 5 to 20 mg contraindicated. This includes patients SQ or IM or 2.5 to with respiratory depression (in the 15 mg IV q 4 hours absence of resuscitative equipment or in unmonitored settings), and in patients PRN or 5-30 mg with acute or severe bronchial asthma or PO. hypercarbia.

-dizziness euphoria, light headedness, nightmare - bradycardia, cardiac arrest, shock - nausea, vomiting, anorexia

*Patients should be advised that Morphine Sulfate extended-release tablets contain morphine and should be taken only as directed. *Patients should be advised that Morphine Sulfate

1.

- urine retention

extended-release tablets were designed to work properly only if swallowed whole.

NITROUS OXIDE

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

MOA: Dissociative Anesthesia, weak anesthesia

A lungful of nitrous oxide results in temporary loss of motor control and dissociative psychological effect when sensation and perception becomes disconnected. Weak anesthetic gas permeates the membranes of the body.

-Blood clotting problems. -Heart and blood vessel problems. -Alcohol and other sedative stimulants.

Mild audio visual hallucinations , loss of H20 control, long lasting numbness of the extremities and other neurological problems, partial depressants of CV, nausea and analgesia.

-Monitor vital signs. -Dont use wool blanket in area. -Assess patients condition. -Watch for any adverse effects. -Help patient establish psychological balance.

LIDOCAINE HYDROCHLORIDE Xylocaine

CLASSIFICATION INDICATION AND DOSAGE AND MECHANISM OF ACTION

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

. Antiarrhythmics

- For ventricular arrhythmias caused by MI, cardiac MOA: manipulation, or - A class IB antiarrhythmics cardiac glycosides that decreases the Infusion depolarization, automaticity (premixed) 0.2% and excitability in the ventricles (2mg/ml), during the diastolic phase by 0.4%(4mg/ml), direction action on the tissue 0.8%(8mg.ml) Injection for direct IV use 1% (10mg/ml), 2% (20mg/ml) Injection for IM use: 300mg/3ml

Patient with Adams-Strokes syndrome, Wolff-ParkinsonWhite syndrome, severe degrees of SA, AV or intraventricular block in the absence of an artificial pacemaker - second-degree heart block or sinus bradycardia, -heart failure or renal or hepatic disease and weighing less than 50kg

- confusion, anxiety, hallucinations, somnolence, paresthesia, seizure -hypotension, bradycardia, cardiac arrest -tinnitus, blurred or double vision - vomiting Respiratory: respiratory depression and arrest - soreness at injection site

- Give IM injections in the deltoid muscle - Monitor isoenzymes when using IM drug for suspected MI - Monitor drug level therapeutic levels are 2.5 meq/ml - Monitor patient response esp. ECG, BP and electrolytes - Ensure safety of the patient

ALBUTEROL SULFATE Ventolin

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Bronchodilators

MOA: - Relaxes bronchial, uterine and vascular smooth muscle by stimulating beta2 receptors.

- To prevent or treat bronchospasm in patients with reversible obstructive airway disease (200 mcg inhaled q 4-6 hrs) - To prevent exerciseinduced bronchospasm (200 mcg for inhalation 15 minutes before exercise)

Use cautiously in px with CV disorders (hypertension), hyperthyroidism, DM

-tremor,dizziness, headache, - tachycardia, palpitations, hypertension - dry and irritated nose nasal congestion - heartburn, nausea, vomiting, increased appetite Musculoskeletal: muscle cramps - cough, wheezing, dyspnea,

- Warn px about risk of paradoxical bronchospasm and to stop drug immediately if occurs - Tell px to perform oral inhalation correctly - Tell px to remove canister and wash inhaler with warm, soapy water at least once a week

CAPTOPRIL Captopren

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

HYPERTENSION Adult: Initially, 12.5 mg bid or 6.25 mg bid in combination with a diuretic, at bedtime to avoid precipitous fall in BP Action: Blocks ACE from Maintenance: 25-50 mg converting angiotensin I to bid. Max: 50 mg tid. angiotensin II, a powerful Elderly: Initially, 6.25 mg vasoconstrictor, leading to bid. decreased blood pressure, decreased aldosterone HEART FAILURE secretion, a small increase Adult: Initially, 6.25-12.5 in serum potassium levels, mg bid-tid. Maintenance: and sodium and fluid loss; 25 mg bid-tid. Max: 50 mg increased prostaglandin tid. synthesis also may be involved in the antihypertensive action. Classification: Angiotensin-converting enzyme (ACE) inhibitor Antihypertensive

- Bilateral renal artery stenosis, hereditary angioedema; renal impairment; pregnancy.

-Hypotension, tachycardia -chest pain, palpitations -pruritus, hyperkalaemia. Proteinuria -angioedema, skin rashes; taste disturbance - nonproductive cough, headache.

-monitor partients blood pressure and pulse rate - Advise patient to report signs and symptoms - Administer 1 hr before or 2 hr after meals. - Reduce dosage in patients with impaired renal function.

RANITIDINE HYDROCHLORIDE Zantac CLASSIFICATION AND MECHANISM OF ACTION INDICATION AND DOSAGE CONTRAINDICATION SIDE EFFECT/ ADVERSE EFFECT NURSING RESPONSIBILITY

Antiulcer Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion.

-Duodenal and gastric ulcer (short-term treatment); pathologic hypersecretory conditions, such as Zollinger-Ellison syndrome. -Maintenance therapy for duodenal or gastric ulcers. -Gastroesophageal reflux disease. -Erosive esophagitis -Heartburn

-Contraindicated in patients hypersensitive to rug and those with acute porphyria. -Use cautiously in patients with hepatic dysfunction. Adjust dosage in patients with impaired renal failure.

- vertigo, malaise, headache - blurred vision flushing - jaundice - burning and itching at injection site, anaphylaxis, angioedema

-Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate. -Ranitidine may be added to total parenteral nutrition solutions

SUCCINYLCHOLINE CHLORIDE Scoline, Sucostrine

CLASSIFICATION AND INDICATION AND DOSAGE MECHANISM OF ACTION

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

PHARMACOLOGIC CLASS: depolarizing neuromuscular blocker THERAPEUTIC CLASS: skeletal muscle relaxant MOA: *prolongs depolarization of muscle end plate *relaxes skeletal muscle

Adjunct to anesthesia to relax skeletal muscles during short surgical procedures;endotracheal intubation with mechanical ventilation; electrically induced convulsive therapy Dosage depends on anesthetic used, individual needs and response.

Contraindicated in patients hypersensitive to drug and patients with abnormally low pseudocholinesterase level, angle-closure glaucoma, malignant hyperthermia, or penetrating eye injury.

- bradycardia, tachycardia, HPN, hypotension, arrhythmias, flushing, cardiac arrest - increased IOP -prolonged respiratory depression, apnea, bronchoconstriction - malignant hyperthermia, excessive salivation, allergic to idiosyncratic hypersensitivity reactions

-Monitor baseline electrolyte determinations and v/s (check RR q 5 to 10mins during infusion) *Monitor RR and pulse oximetery. -Keep airway clear. Have e respiratory support equipment immediately available. -Inform patient that postoperative stiffness is normal and will soon subside.

CALCIUM CHLORIDE

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Calcium supplement

* Replaces calcium and maintain calcium level.

HYPOCALCEMIC EMERGENCY. Adults: 7 mEq to 14 meq calcium I.V. May given as 10% calcium gluconate solution HYPOCALCEMIC TETANY. Adults; 4.5 mEq to 7 mEq calcium I.V. Children: .5 to .7 mEq/kg calcium I.V TID to QID until tetany is controlled

-Contraindicated to cancer patients with bone metastases -ventricular fibrillation -hypocalcaemia or renal calculi.

- tingling sensation - bradycardia, milddrop in blood pressure - constipation -polyuria, renal calculi

-tell patient to take oral calcium 1-1.5 hours after meals if GI upset occurs. -tell patient to take oral calcium with full glass of water. -tell patient to report anorexia, N/V, abdominal pain. -inform patient that some products may containi phenyalanine or tatazine -watch any signs ot hypercalcemia such us stupor, confusioin,delirium

DIGOXIN Lanoxicaps, Lanoxin

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Antidotes, Detoxifying Agents & Drugs Used in Substance Dependence

Reversal of CNS depression and respiratory depression because of suspected opioid overdosage IV (adults): 0.02-0.2mg q 2-3 min until response obtained; repeat q 1-2 hr if needed. IV (children): 5-10mcg; may repeat q 2-3 min until response obtained.

-Hypersensitivity to drugs. Use cautiously: -Cardiovascular dse; patient dependent on opioids; pregnancy

Nausea & vomiting, hypotension -HTN - cardiac arrhythmias -pulmonary edema - Seizures.

-the duration of the narcotic may exceed naloxone(the antagonist). Therefore, more than one dose may be necessary to counteract the effects of the narcotic. -monitor VS @ 5 min intervals, then every 30 mins once stabilized. -titrate to avoid interfering with pain control or readminister narcotic at a lower dosage to maintain pain control.

NOREPINEPHRINE Levofin amp

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

ACUTE HYPOTENSIVE STATES Adult: IV infusion of 4 mcg/ml in glucose 5%, or sodium Norepinephrine is a direct- chloride 0.9% and glucose 5% acting sympathomimetic at a rate of 2-3 ml/min (8-12 which stimulates 1- and - mcg/min). Adjust according to adrenergic receptors. Its - BP response. Average maintenance dose: 0.5-1 agonist effects cause ml/min (2-4 mcg/min). vasoconstriction, thereby raising systolic and diastolic Alternatively, 40 mcg/ml at an initial rate of 0.16-0.33 ml/min BP with reflex slowing of via a central venous catheter, heart rate. using a syringe pump or drip Onset: Rapid. counter. Duration: Short; stops Child: Administer at a rate of within 1-2 min after 2 mcg/min. Alternatively, 2 discontinuing the infusion. mcg/m2/min. Adjust rate according to BP response. Elderly: Initial dose should be at low end of dose range. Vasoconstrictors

Hypertension. Pregnancy. Patients with peripheral or mesenteric vascular thrombosis unless necessary as a life-saving procedure.

Hypertension, headache, peripheral ischaemia, bradycardia, arrhythmias, anxiety, skin necrosis (with extravasation), dyspnoea, respiratory difficulty.

Monitor IV flow rate diligently Assess EKG, BP continuously( be alert to precipitous BP drop Never leave patient alone during IV in fusion Be alert to patient complaint of headache

BAXTER HUMAN TETANUS IMMUNOGLOBULIN Tetanus Ig G

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Vaccines, Antisera & Immunologicals

prophylaxis in persons w/ recent injuries eg trauma & burns that might be contaminated w/ Clostridium tetani; those who did not receive tetanus vaccination in the last 10 yr or in whom the immune response is insufficient & when the status of immunization is unknown or when active immunization is contraindicated.

Must not be given IV as patient could develop shock. Should not be given in severe thrombocytopenia & in hemostasis.

-Chills,headache, fever, -nausea, vomiting, allergic reactions, dizziness -hypotension -arthralgia & moderate low back pain.

-observe history of allergies and reactions to immunization. -give drug soon after reconstitution. -dont give immune globulin for prophylaxis against hepatitis A after 6 weeks or more have elapsed since exposure or onset of clinical illness.

MANNITOL Osmitrol

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Classification: Diuretics

Oliguric phase of renal failure Action: Increases osmotic Adult: 50-100 g in a 24-hr period by IV infusion of a 5pressure of glomerular 25% solution. Adjust rate of filtrate, ihibiting tubular reabsorption of water and administration to maintain a electrolytes; drug elevates urine flow of at least 30-50 mL/hr. plasma osmolarity, increasing water flow into Child: 0.25-2 g/kg. extracellular fluid. Cerebral edema Adult: 0.25-2 g/kg by IV infusion of a 15-25% solution given over 30-60 minutes.

*Contraindicated in patients hypersensitive to drug. *Contraindicated in patients with anuria, severe pulmonary congestion, frank pulmonary edema, severe heart failure, severe dehydration, metabolic edema, progressive renal disease or dysfunction, or active intracranial bleeding (except during craniotomy).

CV: seizures, dizziness, headache, fever - edema, thrombophlebitis, hypotension, hypertension, heart failure, tachycardia, angina-like chest pain, vascular overload. -EENT: blurred vision, rhinitis -GI: thirst, dry, mouth, nausea, vomiting, diarrhea

*Monitor vital signs, including central venous pressure and fluid intake and output hourly. *Report increasing oliguria. Check weight, renal function, fluid balance, and serum and urine sodium and potassium levels daily. *Dont give electrolyte-free mannitol solutions with blood

PROPRANOLOL HYDROCHLORIDE Propanolol, Inderal

CLASSIFICATION AND MECHANISM OF ACTION

INDICATION AND DOSAGE

CONTRAINDICATION

SIDE EFFECT/ ADVERSE EFFECT

NURSING RESPONSIBILITY

Antianginals A nonselective beta blocker that reduces cardiac oxygen demand by blocking catecholamine-induced increases in HR, BP, force of myocardial contraction. Depresses renin secretion and prevents vasodilation of cerebral arteries.

- Angina pectoris ( total daily doses of 80-320mg PO when given BID, TID or QID) - To decrease risk of death after MI (180-240mg PO OD) - Supraventricular, ventricular, and atrial arrhythmias, tachyarrhythmias caused by excessive catecholamine during anesthesia, hyperthyroidism pr pheochromocytoma (1-3mg by slow IV push) - Hypertension (80 mg PO daily) - To prevent frequent severe, uncontrollable or disabling migraine or vascular headache (80mg PO daily) - Essential tremor (40mg PO BID) - Hypertrophic subaortic stenosis (20-40mg PO TID or QID) Adjunct therapy in pheochromocytoma (60mg PO OD)

Patients with bronchial asthma, sinus bradycardia Use cautiously in px with hepatic or renal impairment, hepatic disease.

CNS: fatigue, lethargy CV: bradycardia, heart failure, intensification of AV block GI: abdominal cramping, constipation, diarrhea, nausea, vomiting Hematologic: agranulocytosis Respiratory: bronchospasm Skin: rash

- Always check px. Apical pulse before giving drug - Give drug consistently with meals. - Caution px to continue taking this drug as prescribed even he feels better - Tell patient not to stop drug suddenly this can worsen chest pain and trigger a heart attack

Emergency Drugs

Submitted to: Mr. Christopher Taboada, R.N., M.A.N. Clinical Instructor

Submitted by : Tia, Charmaine V. USC-CN