Ten Rights On Drug Administration

Right drug Right route Right dose Right time Right patient Right assessment Right to patient s education Right to refuse Right documentation Right evaluation

COMMON AND EMERGENCY DRUGS IN MEDICAL WARD

COMMON DRUGS

Angiotensin-Converting Enzyme Inhibitors

Hypertension, heart failure , left ventricular dysfunction, MI, and diabetic nephropathy.

These drugs work by inhibiting conversion of angiotensin I to angiotensin II, potent vasoconstrictor. Thus promoting dilatation of peripheral blood vessels that leads to decreasing blood pressure and afterload.

Examples: Captopril (Capoten) Enalapril (Vasotec)

Contraindications: Impaired Renal Function

Adverse effect: Hypotension, Hacking cough, Nausea/vomiting, Rashes

Nursing responsibility:
Assess vital signs, especially pulse and monitor blood pressure in standing and supine position positions during therapy. Monitor urinary output during initial titration Instruct client to: follow a low-sodium diet; eat foods in B-complex vitamins; change positions slowly; continue to take medication as prescribed because therapy is usually for life; report occurnce of any side effects to physician; avoid engaging in hazardous activities when initially placed on antihypertensive drug therapy

Antacids
For hyperacidity and treatment for ulcers. Neutralizes gastric acid in the GI tract and elevate gastric PH to reduce pepsin activity. They also strengthen the gastric mucosal barrier and increase esophageal sphincter tone.

Examples: aluminum hydroxide gel (Amphojel) aluminum and magnesium hydroxides (Maalox) sodium bicarbonate

Contraindications: Calcium carbonate and magnesium oxide are contraindicated in patients with severe renal disease. Sodium bicarbonate is contraindicated in patients with hypertension and sodium restricted sodium diet.

Adverse effect: Constipation (aluminum compounds) delays passage of stool in GI tract. Sodium bicarbonate is contraindicated in patients with hypertension and sodium restricted sodium diet. Alkalosis (systemic antacids) can cause absorption of alkaline compound into the circulation. Calcium carbonate and magnesium oxide are contraindicated in patients with severe renal disease

Nursing responsibility:
Instruct client regarding the : Prevention of overuse of antacids, which can cause rebound hyperacidity. Need for continued supervision Dietary restriction related to gastric distress. Foods high in calcium Caution client on sodium-restricted diet that many antacids contain sodium. Shake oral suspensions well before administration Administer with small amount of water of ensure passage to stomach.

Antibiotic
Used to destroy bacteria or inhibit bacteria or inhibit bacterial reproduction to control infection. Antibiotic are classified: Penicillins: interfere with bacterial cell wall synthesis; eg., broad spectrum amoxicillin (Amoxil) and penicillin G potassium (Pentids). Indicated for wide range of infections; penicillin used forstreptococcal infections, syphilis, and Lyme disease.

Cephalosphorins: interefere with bacterial cell wall synthesis; eg., broad spectrum cefazolin sodium (Ancef, Kefzol) and cephalexin monohydrate ( Keflex). (First generation) - Good coverage against Gram positive infections. (Second generation) - Less gram positive cover, improved gram negative cover. (Third generation) - improved coverage of Gram negative organisms.

Erythromycins: inhibit mRNA synthesis of bacterial protein; e.g., clindamycin HCL (Cleocin), azithromycin( Zithromax), erythromycin (E-mycin) Tetracyclines: inhibit bacterial protein synthesis by blocking tRNA attachment to ribosomes; eg., broad spectrum doxycycline (Vibramycin) and tetracycline (Achromycin, Sumycin). For syphilis, chlamydial infections, Lyme disease, mycoplasmal infections, acnerickettsial infections,

Aminoglycosides: disrupt bacterial protein synthesis by providing a substitute for essential nucleotide required to mRNA; e.g., broad spectrum gentamicin sulfate (Garamycin), neomycin sulfate ( Mycifradin), streptomycin sulfate. Used for infections caused by Gram-negative bacteria, such as Escherichia coli and Klebsiella particularly Pseudomonas aeruginosa. Effective against Aerobic bacteria Quinolones: interefere with DNA gyrase, an enzyme necessary for the synthesis of bacterial DNA (e.g., broad spectrum ciprofloxacin (Ciprol) and levofloxacin (Levaquin). Indicated urinary tract infections, bacterial prostatitis, communityacquired pneumonia, bacterial diarrhea, mycoplasmal infections,gonorrhea

y Polymyxin group: decreases bacterial cell membrane permeability; e.g., polymyxin B sulfate (Aerosporin). y Vancomycin: inhibits bacterial cell wall synthesis (e.g., Lyphocin and Vancocin) y Macrolides:Streptococcal infections, syphilis, upper respiratory tract infections, lower respiratory tract infections, mycoplasmal infections,Lyme disease y Sulfonamides for urinary tract infections (except sulfacetamide, used for eye infections, and mafenide and silver sulfadiazine, used topically for burns

Contraindications: Hypersensitivity, with renal and hepatic impairment, history of GI Disease or allergy to penicillin Adverse effect:
o Depressed appetite (altered taste sensitivity) o Nausea, vomiting ( Normal flora imbalance) o Suppressed absorption of a variety of nutrients including fat; protein; lactose; vitamins A, D, K, and B12 ; and the minerals calcium, iron, and potassium (normal flora imbalance) o Increased excretion of water-soluble vitamins and minerals (normal flora imbalance) o Allergic reactions, anaphylaxis ( hypersensitivity) o Nephrotoxicity (direct kidney toxic effect)

o o o o

o o o o o o

Tetracycline Hepatoxicity (direct liver toxic effect) Phototoxicity (degradation to toxic products by ultraviolet rays) Hyperuricemia (impaired kidney function) Enamel hypoplsia , dental caries, and bone defects in children under 8 years old (drug binds to calcium in tissue) o Aminoglycosides Ototoxicity(direct auditory (eight cranial) nerve toxic effect) Leucopenia (decreased WBC synthesis) Thrombocytopenia (decreased platelet synthesis) Headache, confusion (neurotoxicity) Peripheral neuropathy (neurotoxicity) Nephrotoxicity (direct kidney toxic effect)

o Respiratory paralysis (neuromascular blockade)

Vancomycin : Ototoxicity (hearing loss)

oNephrotoxicity ( kidney damage Nursing responsibility:

Give drug at least one hour before bacteriostatic antibiotic Follow manufacturers direction for reconstitution, dilution, and storage of drugs; check expiration date Give IM dose deep into gluteal muscle mass or in the mid-lateral thigh; rotate injection site Advise patient to take drug with food.

Warn patient not top ingest of any alcohol within 3 days of treatment Tetracyclines: o Avoid use during last half of pregnancy or by children younger than 8 yrs old o Teach client to avoid direct sunlight o Advise client avoid dairy products, antacids, or iron preparations because they reduce effectiveness

Antidiarrheal
For alleviation of diarrhea Promote the formation of formed stools Examples:
Fluid adsorbent: decrease the fluid content of stool: bismuth subcarbonate; kaolin and pectin (Kaopectate) Enteric bacteria replacements enhance production of lactic acid from carbohydrates in intestinal lumen; acidity suppresses pathogenic bacterial overgrowth; lactobacillus acidophilus (Bacid); Lactobacillus Bulgaricus (Lactinex) Motility suppressants: decrease GI tract motility so that more water will be absorbed from the large intestine: diphenoxylate HCL (Lomotil); loperamide HCL (Imodium)

Contraindications: Hypersensitivity to antidiarrheals Adverse effect: Bismuth preparations may cause temporary darkening of tongue and stools. Kaolin and pectin mixture may cause constipation and fecal impaction or ulceration. Opium preparations may cause dizziness, light headedness, nausea and vomiting, physical dependence.

Nursing responsibility:
Monitor bowel movements for color, characteristics and frequency Assess for fluid/electrolyte imbalance Assess and eliminate cause of diarrhea Warn patient to avoid hazardous activities that require alertness if CNS depression occur

Antiviral
Used to provide prophylaxis when exposure to viral infection has occurred; prevent entrance of the virus into host cells. Like antibiotics for bacteria, specific antiviral are used for specific viruses. These drugs are also used to treat herpetic lesions (HSV-1, HSV-2), varicella infections (chickenpox), herpes zoster (shingles), herpes simplex (fever blisters), encephalitis, cytomegalovirus (CMV), and respiratory syncytial virus (RSV. They inhibit viral growth by inhibiting an enzyme within the virus.

Examples: Acyclovir (Zovirax), amantadine HCL (Symmetrel) and vidarabine (Vira-A)

Contraindications: Contraindicated with allergy to drug, seizures, heart failure, renal disease and lactation.

Adverse effect:
(CNS) stimulation (direct CNS effect) Orthostatic hypotension ( depressed cardiovascular system) Dizziness (hypotension) Constipation (decreased peristalsis) Nephrotoxicity (direct kidney toxic effect) Local irritation (direct local tissue effect

Nursing responsibility: Ensure patient is well hydrated with IV or PO fluids Provide support and encouragement to deal with the disease Provide frequent small meals and high-fiber if systemic therapy causes GI upset Provide skin care for rash if needed Support natural defense mechanism of client; encourage intake of foods rich in the immunestimulating nutrients, such as vitamins A,C, and E, and the minerals selenium and zinc Monitor disease symptoms and laboratory data Evaluate client s response to medication

Histamine-2 Antagonists
These drugs are used in the treatment of gastroesophageal reflux disease (GERD), acid reflux, and gastric ulcers. They inhibit histamine 2 (H2) release in the gastric parietal cells, therefore inhibiting gastric acids. Examples: Rantidine (Zantac), famotidine (Pepcid)

Contraindications: Use cautiously with renal failure

Adverse effect: CNS disturbances (decreased metabolism of drug because of liver or kidney impairment) Blood dyscrasias (decreased RBCs, WBCs. Platelet synthesis Skin rash (hypersensitivity) Nursing responsibility: Periodically monitor the CBC and renal function. Give antacids at least 1 hour before or after H2 receptor antagonist. Antacids can decreased drug absorption. Adjust the dose with the patient having renal impairment. Administration should not exceed 8 weeks without medical supervision.

Cathartics/ Laxatives
Used for constipation and promote passageway of stools Laxative promotes movement of intestinal contents through the colon and rectum in several ways, bulkforming, emollient, hyperosmolar, and stimulant. Examples: Intestinal lubricants decrease dehydration of lubricants: feces; lubricate intestinal tract; mineral oil; olive oil Fecal softeners: lower surface tension of feces, allowing water and fats to penetrate; docusate calcium (Surfak); docusate sodium (Colace)

Bulk-forming laxatives: increase bulk in intestinal lumen, which stimulates propulsive movements by pressure on mucosal lining;e.g., methyl-cellulose (Cellthyl); psyllium hydrophilic mucilloid (Metamucil) Colon irritants: stimulate peristalsis by reflexive response to irritation of intestinal lumen; bisacodyl (Dulcolax); senna (Senokot) Saline cathartics: increase osmotis pressure within intestine, drawingfluid from the blood and bowel wall, thus increasing bulk and stimulating peristalsis. Effervescent sodium phosphate ( Fleet PhosphoSoda); magnesium citrate solution; milk of magnesia

Contraindications: With GI obstruction or perforation, toxic colitis, megacolon, nausea and vomiting, or acute surgical abdomen, with large hemorrhoids. Adverse effect: All laxative can cause flatulence, diarrhea, abdominal discomfort, weakness, and dependence. Bulk forming laxative may cause intestinal obstruction, impaction, or esophageal obstruction. Emolient Laxative may cause bitter taste or throat irritation. Hyperosmolar laxative may cause fluid and electrolyte imbalance. Stimulant laxative cause urine discoloration, malabsorption, and weight loss.

Nursing responsibility: Obtain baseline assessment of patient s bowel patterns and GI history before giving the drug Monitor bowel sounds and color and consistency of stools. Monitor fluid and electrolyte status Advice patient that therapy should be short term Point out that abuse or prolonged use can cause nutritional imbalance Tell patient that stool softeners and bulk-forming laxatives may take several days to achieve result. Encourage to drink plenty of fluids especially taking bulk-forming laxative. Explain that stimulant laxative may cause harmless urine discoloration Encourage to eat high fiber diet

Mucolytic
Designed to help loosen and clear the mucus from the airways by breaking up the sputum. Increased production of respiratory tract fluids to help liquefy and reduce viscosity of tenacious secretions. Thins respiratory secretions.

Examples: Guiafenesin (robitussin) Carbocysteine(mucodyne) Acetylcysteine(Mucomyst) Contraindications: patient with hypersensitivity to drugs.

Adverse effect: EENT: rhinorrhea, hemoptysis GI: stomatitis,nausea and vomiting Respiratory: bronchospasm Nursing responsibility: Instruct the patient to follow directions on drug label exactly. Inform patient that drug may have foul taste or smell. Encourage patient to increase fluid intake

Non-steroidal Anti-inflammatory Drugs

For mild to moderate pain, inflammation, stiffness, swelling, or tenderness caused by headache, arthralgia, myalgia, neuralgia, dysmennorhea, rheumatoid arthritis, juvenile arthritis, osteoarthritis. Analgesic effects: may result from interference of prostaglandins involving in pain. Prostaglandins appear to sensitized pain receptors to mechanical stimulation or other chemical mediators. NSAID inhibits synthesis of prostaglandins peripherally and centrally. Anti-inflammatory effect that may result in part from inhibition of prostaglandin synthesis and release during inflammation

Anti- pyretic effect: directly react into the hypothalamus which is the thermo-regulating center of the body Examples: acetylsalicylic acid (aspirin), ibuprofen (Motrin, Advil), naproxen (Naprosyn) Contraindications: Patients with ulcers and gastritis Use cautiously in patient with head injury and ICP. Adverse effect: Respiratory and circulatory depression. CNS: Dizziness, visual disturbances, mental clouding, depression, sedation, coma, euphoria, dysphoria, weakness, faintness, agitation, restlessness, nervousness, and seizures

GI: nausea and vomiting, erosion of the gastric mucosa, the most common symptoms are dyspepsia, heart burn, epigastric distress, and abdominal pain.

Nursing responsibility: Instruct patient to take drug with food Monitor patients for signs and symptoms of bleeding Monitor CBC, platelet count, PT, and hepatic and renal function studies to detect abnormalities.

EMERGENCY DRUGS

EMERGENCY DRUGS

Antidyrhythmics To treat abnormal variations in cardiac rate and rhythm; also prevent dyrhythmia Act at specific sites to alter the action potential of cardiac cells and interfere with the electrical excitability of the heart. Most of these drugs may cause new or worsened arrhythmias (proarrythmic effect) and must be used with caution and with continual cardiac monitoring and patient evaluation. Examples: Calcium ion antagonist- control atrial dysrhytmia by decreasing cardiac automaticity and impulse conduction: diltiazem (Cardizem),nifedipine (Procardia), verapamil (Calan)

Beta-adrenergic blockers control supraventricular dysrhythmias by decreasing cardiac impulse conduction through a blocking action; propanolol (Inderal), metoprolol (Lopressor) Disopyramide phosphate (Norpace): controls ventricular dysrhythmias by decreasing the rate of diastolic depolarization Lidocaine HCL: controls ventricular irritability by shortening the refractory period and suppressing ectopic foci. Procainamide HCL (Pronestyl): controls atrial and ventricular and atrial dysrhythmias by prolonging the refractory period and slowing conduction of cardiac impulses.

Quinidine preparations: control atrial dysrhythmias by prolonging the effective refractory period and slowing depolarization. Amiodarone (Cordarone): controls ventricular dysrhythmias by prolonging action potential and refractory period; slows the sinus rate.

Contraindications: Use cautiously during pregnancy or lactation Adverse effect: CNS: Lightheadedness, speech disorder, weakness, rigors, somnolence, confusion

CV: hypotension, pallor, arrhythmias GI: Taste perversion GU: urine retention Local: inflammation, edema, erythema, buring at the site of infusion Other: fever, ronchi, flushing Nursing responsibility: Assess vital signs during the course of therapy: monitor drug blood levels Use cardiac monitoring during IV administration; ensure follow-up ECGS. Use infusion-control device for continous IV administration Administer oral preparations with meals to reduce GI irritation.

Use safety precautions ( supervise ambulation, side rails up (CNS) effects are manifested Instruct client to: notify physician of any side effects; report any changes in heart rate or rhythm to physician (irregular beats, increased or decreased rate)

Antianginals
For moderate to severe angina (beta blockers); classic ,effort induced (calcium channel blockers ); recurrent angina (long acting nitrates and topical, transderrmal, transmucusal, and oral extendedrelease nitro glycerin); acute angina (SL nitroglycerin and SL chewable Isosorbide Dynitrate); unstable angina (IV nitroglycerin )

Examples:
Beta blockers decreased catecholamineinduced increases in heart rate, blood pressure, and myocardial contraction.

Calcium Channel Blockers: inhibit the influx of the calcium ion across the cell membrane during depolarization of the cardiac and vascular smooth muscle : nifedipine (Procardia), verapamil Hydrochloride( Calan, Isoptin) Nitrates:act directly at receptors in smooth muscles causing vasodilation, which decreases the preload, thus decreasing cardiac workload. (sublingual) )- isosorbide dinitrate (Isordil, Sorbitrate); nitroglycerine (oral) - isosorbide dinitrate (Isordil, Sorbitrate) (topical)- Transdermal(Nitro-Dur, Transderm-Nitro) Ointment-( Nitro-Bid;Nitrol)

Contraindications: Contraindications:
Beta- Blockers - hypersensitivity and patient with cardiogenic shock, sinus bradycardia, heart block greater than fist degree, bronchial asthma, or heart failure and unless failure result from tahcyarrythmia that is tretable with propanolol. Calcium Channel Blockers - severe hypotension or heart block greater than First Degree (except with functional pacemaker ) Nitrates are contraindicated with severe anemia cerebral hemorrhage, head trauma, glaucoma, hyperthyroidism.

Adverse effect: Beta Blockers - Bradycardia, heart failure, cough, diaarhea, disturbing dreams, dizziness , dyspnea, fatigue, fever, hypotension, lethargy, nausea, peripheral edema, and wheezing . Calcium channel blockers bradycardia, confusion, constipation, depression, diarrhea, dizziness, edema, elevated liver enzyme, fatigue, flushing, headache, hypotension, insomnia, nervousness, and rash. Nitrates flushing, headache, orthostatic hypotension, reflex tachycardia, rash, syncope, and vomiting.

Nursing responsibility: responsibility: Take the pulse rate before receiving or taking calcium channel blockers or beta blockers the pulse rate must not below 60 bpm. Monitor the vital signs every 5 to 15 minutes. Instruct the patient not to stop the medication abruptly. Take sublingual preparation before anginaproducing activities; note slight stinging, burning, tingling under the tongue that indicate potency of the drug; avoid placing the drug in heat, light moisture, o plastic; store in original glass container; obtain a new supply every 3 to 4 months; take SL preparations every 5 minutes, not to exceed in 3 in 15 minutes for chest pain; if pain persist, get emergency care.

Anticoagulants
Used for pulmonary emboli, deep vein thrombosis, blood clotting, DIC, unstable angina, MI, arterial fibrillation. Heparin derivatives accelerate formation of anantrombin III- thrombin complex. It inactivates thrombin and prevents conversion of fibrinogen to fibrin. The coumarin derivative, warfarin, inhibits Vit. K Dependent activation of clotting factor II, VII, IX and X. This is form in the liver. Thrombin inhibitors directly bind to thrombin and inhibits its action. Examples: Parenteral-heparin sodium (Calciparine);enoxaparin (Lovenox) Oral- warfarin sodium (Coumadin)

Contraindications: o Patients with aneurysm, active bleeding, CV hemorrhage, hemorrhagic blood dyscrasia, hemophilia, sever hypertension, pericardial effusions, or pericarditis; and in patients undoing major surgeries (neurosurgeries). Adverse effect: fever,chills (hypersensitivity); skin rash (hypersensitivity); hemorrhage (interference with clotting mechanisms); diarrhea (GI irritation)

Subcutaneous heparin is generally administered in the abdomen; the nurse does not aspirate or massage the area o Monitor blood work during course of therapy, especially coagulation studies; international normative ratio (INR),PT (for warfarin derivatives) and PTT (for heparin therapy), blood platelets; PT and PTT Values would be 1.5 to 2 times normal values; INR values would be 2.0 to 3.5. o Bleeding and may cause hypersensitivity reaction. Warfarin may cause agranulocytosis, alopecia, anorexia, dermatitis, fever, nausea, vomiting, tissue necrosis or gangrene, uticaria.

o Heparin derivatives may cause thrombocytopenia and increase liver enzyme levels. o Have appropriate antidote available: vitamin K for warfarin; protamine sulfate for heparin o Avoid aspirin

Cardiac glycosides Effective in treating congestive heart failure and atrial flutter and fibrillation Produce a positive inotropic effect (increased force of contraction) increasing permeability of cardiac muscle membranes to the calcium and sodium ions required for contraction of muscle fibrils. Produce a negative chonotropic effect (decreased rate of contraction) by an action mediated through the vagus nerve, which slows firing of the SA node and impulse transmission at the AV node.

Available in oral and parenteral (IM, IV) preparations Initially, loading dose is administered to digitalize the client; after the desired effect is achieved, the dosage is lowered to a maintenance level, which replaces the amount of drug metabolized and excreted each day. Examples: digitalis; digoxin (Lanoxin) Contraindications: Hypersensitivity; Uncontrolled ventricular arrhythmias; AV block; Idiopathic hypertrophic subaortic stenosis; constrictive pericarditis; Known alcohol intolerance

Adverse effect: diarrhea (local effect), malabsorption pf all nutrients (nausea, vomiting, diarrhea); bradycardia (increased vagal tone at AV node) digitalis toxicity: premature ventricular beats (increased spontaneous rate of ventricular depolarization); xanthopsia/ yellow vision (effect on visual cones); muscle weakness (CNS effect, neurotoxicity, hypokalemia) blurred vision (CNS effect); anorexia, vomiting (local effect stimulates chemoreceptor zone in medulla). A resting pulse rate of less than 60 bpm in an adult client, less than 80 bpm in a child, and less than 100 bpm in a neonatal client should alert the nurse to the possibility of toxicity.

Nursing responsibility: Check apical pulse before administration: in adults if pulse is below 60 or over 120 withhold dose and notify physician Treatment for digitalis toxicity includes checking the potassium level because hypokalemia can contribute to digitalis toxicity. ECG will indicate depressed Twaves with hypokalemia. Judicious monitoring of the digoxin (Digitalis) blood levels is an important factor in the care of the client. The therapeutic level for digoxin (Digitalis) is 0.92.0 ng/mL. Administer oral preparation with meals to reduce GI irritation Assess for signs of impending toxicity (anorexia, nausea, vomiting, dysrhythmias, xanthopsia)

Bronchodilators Use to prevent bronchospasm in patient with obstructed airway disease. Act by stimulating beta-adrenergic sympathetic nervous system receptors, relaxing bronchial smooth muscle. Examples: adrenergics: act at beta-adrenergic receptors in bronchus to relax smooth muscle and increase respiratory volume: albuterol (Proventil); epinephrine HCL (Adrenalin; Sus-Phrine); metaproterenol sulfate (Alupent); salmeterol (Serevent)

xanthenes: act directly on bronchial smooth muscle, decreasing spasm, relaxing smooth muscle of the vasculature: aminophylline; theophylline (Elixophyllin; TheoDur) anticholinergics: inhibit action of acetylcholine at receptor sites on the bronchial smooth muscle: ipratropium (Atrovent) steroids: exert anti-inflammatory effect on nasal passages: fluticasone (Flovent); beclomethasone leukotriene receptor antagonist: block action of leukotriene to reduce bronchoconstrition and inflammation associated with asthma; montelukast sodium (Singulair), zafirlukast (Accolate)

Contraindications: Hypersensitivity Adverse effect: CNS: tremor, insomnia, headache CV: tachycardia, palpitation, and hypertension EENT: drying and irritation of nose and throat GI: nausea and vomiting, heartburn Metabolic: hypokalemia, and weight loss Respiraory: bronchospasm Nursing responsibility: Check pulse before and after using bronchodilator. Advise patient to wait at least 2 mins before repeating procedure if more than 1 inhalation is ordered

Administer during waking hours Administer with food Warn patient to avoid accidental spraying of inhalation form into eyes which may blur vision temporarily.

Opioid acts as agonists at specific opiate receptor binding site in the CNS and other tissues, altering the patient s perception of an emotional response to pain Examples: Morphine sulfate Codeine phosphate Fentanyl citrate Meperidine hydrochloride Contraindications: Patient taking MAOIs, patients with acute or sever bronchial asthma or respiratory depression. Use cautiously in patient with head injury, increased ICP, and hepatic and renal dysfunction.

Adverse effect: Respiratory and circulatory depressions are the major hazards of opioids. CNS: dizziness, visual disturbances, depression, sedation, seizure, nervousness, restlessness, and coma GI: nausea and vomiting, constipation, urine retention or hypersensitivity Nursing responsibility: Assess for respiratory status before giving the drug. Keep resuscitatative equipment and opioid antagonist (naloxone). Give IV drug by slow injection.

Give oral forms with food Give drug IM or SC cautiously to a patient with decrease platelet and to the patient who is hypovolemic or in shock. Rotate injection site to avoid indurations Don t stop taking drug abruptly

Diuretics Iincrease urine output urine output, which reduces hypervolemia ; decreases preload and afterload . Interefere with sodium absorption in the kidney Examples: Thiazides: chlorothiazide (Diuril); hydrochlorothiazaide (HydroDIURIL); interefere with the sodium ion transport at the loop of henle and inhibit carbonic anhydrase activity at distal tubule sites. Potassium-sparers: spironolactone (Aldoctone);triamterine (dyrenium); interefere with aldosterone- induce reabsorption of sodium ions at distal nephron sites increase sodium chloride excretion and decrease potassium ion loss.

Loop diuretics: Furosemide (Lasix) Loop diuretics act on the Na+-K+-2Cl- symporter (co-transporter) in the thick ascending limb of the loop of Henle to inhibit sodium and chloride reabsorption. This is achieved by competing for the Cl- binding site. Contraindication: With anuria, hepatic coma and with severe electrolyte depletion, use cautiously in clients with severe hypersensitivity with sulfonamides. Impaired hepatic function

Adverse effects: Major effects: Frequent urination, Arrhythmia (abnormal heart rhythm), Electrolyte abnormalities, Extreme tiredness or weakness, muscle cramps or weakness, Dizziness , lightheadedness, Blurred vision, confusion, headache, increased perspiration (sweating), and restlessness, include dizziness, extreme thirst, excessive dryness Dehydration. Signs of the mouth, decreased urine output, dark-colored
urine, or constipation. All diuretics except potassium sparers: hypokalemia (increased K+ excretion);increased urinary excretion of magnesium and zinc

Potassium-sparers: hypokalemia (rabsorption of potassium at the kidney tubule); hypomagnesemia (increased excretion of magnesium at kidney tubule); increased urinary excretion of calcium. Furosemide (Lasix) competes with aspirin for renal excretion sites and can cause aspirin toxicity Thiazide and loop diuretics: may cause hyperglycemia in clients with diabetes.

Anticonvulsants
y Diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an anticonvulsant is to suppress the rapid and excessive firing of neurons that start a seizure. y Stabilization of the cell membrane by altering cation transport (sodium, potassium, calcium) either by increasing sodium efflux or decreasing.

y Main Pharmacologic effects are: o To increase motor cortex threshold to reduce its response to incoming electric or chemical stimulation. o To depress or reduce the spread of a seizure discharge from its focus (origin) by depressing synaptic transport or decreasing nerve conduction.
1 Examples of drugs o Hydantoins-phenytoin(Dilantin),mephenytoin(Mesantoin) o Barbiturates-phenobarbital o Succinimides-ethosuximide(Zarontin) o Benzodiazepines - diazepam (Valium)

Contraindications o Use cautiously with renal failure and lactation and pregnancy.

Adverse effects
o CNS: Headache, dizziness, lethargy, paresthesias o GI: nausea, vomiting diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis o GU: nephrotoxicity o Hematologic: bone marrow depression o Hypersencitivity: ranging from rash to fever to anaphylaxis; serum sickness reaction o Local:pain, abcess at injection site, phlebitis, inflammation at IV site o Other: superinfections

Nursing responsibilities o Check for therapeutic drug levels o Check results of EEG o Check results of liver function studies o Use IV for emergency use. o Administer daily dose at bedtime to overcome the sedation effect. o Do not stop meds without consulting doctor o Store drugs properly - out of reach of children. o Keep a daily record of seizures