5 er drug study

8/3/2019 5 Er Drug Study

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Generic

Name

Brand Name Classification Action Indication Dose Nursing Responsibilities

Diazepam Valium Antianxiety

agents,anticonvulsants,sedative/hyptonics,skeletal musclerelaxants (centrallyacting)

- Depress the CNS,

probably bypotentiating GABA,an inhibitoryneurotransmitter.- Produces skeletalmuscle relaxation byinhibiting spinal

polysynaptic afferentpathways.- Has anticonvul-sant

properties due to

enhanced presynapticinhibi-tion.Therapeuticeffects:(1) Relief of Anxiety(2) Sedation

(3) Amnesia(4) Skeletal muscle

relaxant(5) Decreased seizure

activity

-Adjunct in the management

of:1) Anxiety2) Preoperative sedation3) Conscious sedation- Provides light anesthesiaand anterograde amnesia- Treatment of statusepilepticus/ uncontrolledseizures- Skeletal muscle relaxant- Management of the

symptoms of alcoholwithdrawal

CONTRAINDICATIONS:

- Hypersensitivity- Cross-sensitivity withother benzodiazepines mayoccurs- Comatose patients- Pre-existing CNS

depression- Uncontrolled severe

painUse cautiously in:1) Hepatic dysfunction

2) Severe renal impairment3) History of suicide

attempt or drug dependence

10 mg

IM

- Monitor BP, PR,RR

prior to periodicallythroughout therapy andfrequently during IVtherapy.- Assess IV sitefrequently duringadministration,diazepam may cause

phlebitis and venousthrombosis.- Prolonged high-dose

therapy may lead topsychological orphysical dependence.Restrict amount of drugavailable to patient.Observe depressed

patients closely forsuicidal tendencies.

- Observe and recordintensity, duration and

location of seizure

activity. The initialdose of diazepam offersseizure control for 15-20 min afteradministration.- IM injections are

painful and erraticallyabsorbed. If IM route isused, inject deeply into


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deltoid muscle formaximum absorption.- Caution patient to

avoid taking alcohol orother CNS depressantsconcurrently with thismedication.- Effectiveness oftherapy can bedemonstrated bydecrease anxiety level;control of seizures;decreasedtremulousness.


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Generic Name Brand Name Classification Action Indication Dose Nursing

Responsibilities

diphenhydramine Benadryl Antihistamine,

anticholinergicantiparkinsonagent

Antagonizes the

effect of histamine atH1 receptor sites;does not bind orinactivate histamine,Antihistamines

prevent thephysiological actionsof histamine by

preventinghistamines fromreaching H1- and

H2-receptor sites.Antihistamines

provide short-livedbenefits and provideonly symptomaticrelief. Antihistamine

is specific forconditions in which

histamine excess ispresent (for examle,

acute urticaria) but is

adjunctive therapy inthe treatment ofanaphylactic shock

because epinephrineis more effenctive.Antihistamines arequite specific forreversingextrapyramidal

parkinsonism or

drug-inducedextrapyramidaleffects,Symptomatic reliefof allergiesAllergic reactionsAnaphylaxisAcute dystonicreactions

Contraindications

Lower respiratorydiseases such asastma attacksPatients takingMAOIsHypersensitivity

Narrow-angleglaucome

Tablet: 25, 50

mgCapsule: 25, 50mgElixir: 12.5 mg/5mlParenteral: 10,50 mg/ml vials,

prefilled syringeAdult:

The standard

dose ofdiphenhydramineis 25-50 mg,either IM or IV.

Pediatric: 5

mg/kg/24 hr q 6hr PO. 2-5

mg/kg IV or IM.

Onset &Duration

Onset: Maximaleffects 1-3 hrDuration: 6-12hr

Caution the client that

the medication maycause drowsiness,creating difficulties orhazards or otheractivities that requirealertness. Tell the client to takethe medication withfood to decrease GIupset. Explain to the client

that arising quicklyform a lying or sitting

position may causeorthostatichypotension. When taking these

medications, the clientneeds to have blood

cells counts, renalfunction, hepatic

function, and blood

pressure monitored. Adverse effects ofthese drugs occurmore commonly inelderly clients. Explain to the clientthat use of these drugsin warm weather mayincrease the likelihood


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reactions and areprobably efficaciousas drying agents in

upper respiratoryand sinus conditions

of heatstroke.

Generic Name Brand

Name

Classification Action Indication Dose Nursing

Responsibilities

NALBUPHINE

HYDROCHLORIDE

Nubaine Narcoticagonist-antagonistanalgesic,

Opioid Agonist-Antagonist

Nalbuphine actsas an agonist atspecific opioidreceptors in the

CNS to produceanalgesia,

sedation but alsoacts to cause

hallucinationsand is an

antagonist at receptors

Relief of moderate tosevere pain

Preoperative

analgesia, as asupplement to surgical

anesthesia, and forobstetric analgesia

during labor anddelivery.

Contraindications:

hypersensitivity tonalbuphine, sulfites;lactation.

Use cautiously withemotionally unstableclients or those with ahistory of narcoticabuse; pregnancy

prior to labor, labor ordelivery, bronchialasthma, COPD,respiratory depression,

Available Forms:

Injection 10

mg/ml, 20mg/ml

Adults:

Usual dose is 10

mg/70kg, SC, IM

or IV q 3-6h as

necessary.

Individualize

dosage. In

nontolerant

patients, therecommended

single maximum

dose is 20mg,

with a maximum

total daily dose of

160mg. Patients

dependent on

Reassess patientslevel of pain at least15 and 30 minutesafter parenteraladministration

Nalbuphine acts asan opioid antagonistand may causewithdrawalsyndrome. Forpatients who havereceived log-termopioids, give 25% ofthe usual doseinitially. Watch forsings of withdrawal.

Alert: Drug causesrespiratorydepression, whichat 10mg is equal torespiratorydepressionproduced by 10 mg


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anoxia, increasedintracranial pressure,acute MI when nausea

and vomiting arepresent, biliary tractsurgery.

narcotics may

experience

withdrawal

symptoms.

Pediatric patients

< 18 yr : Not

recommended

Geriatric patientsor patients withrenal or hepatic

impairment:Reduce dosage

AdultsSubcutaneous /IM / IV 10 mgper 70 kg q 3to 6 h asneeded.Individualizedosage. Innontolerantpatients, do notexceed 20mg/dose or160 mg/day

of morphine

Monitorcirculatory and

respiratory status,bladder and bowelfunction. Ifrespirations areshallow or rate isbelow 12breaths/minute,withhold dose andnotify prescriber

Constipation isoften severe with

maintenancetherapy. Make surestool softener orother laxative isordered.

Psychological andphysicaldependence mayoccur withprolonged use.

Remind patientnot to confuseNubain withNavane.


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Generic Name Brand

Name


Responsibilities

CLONIDINE

HYDROCHLORIDE

Catapres,

Catapres-TTS,Dixaril ,Duraclon

cardiovascular

agent; central-actingantihypertensive;analgesic

Centrally acting

antiadrenergicderivative.

Stimulates

alpha2-

adrenergic

receptors in

CNS to inhibit

sympathetic

vasomotor

centers. Central

actions reduce

plasma

concentrations

of

norepinephrine.

It decreases

systolic and

diastolic BP and

heart rate.

Orthostaticeffects tend to

be mild and

occur

infrequently.

Also inhibits

renin release

from kidneys.

Step 2 drug in

stepped-care approachto treatment ofhypertension, eitheralone or with diureticor otherantihypertensiveagents. Epiduraladministration asadjunct therapy forsevere pain.

CONTRAINDICATION

Pregnancy (categoryC), lactation. Use ofclonidine patch in

polyarteritis nodosa,

scleroderma, SLE

Hypertension

Adult: PO 0.1 mg b.i.d. or t.i.d.,may increase by0.10.2 mg/duntil desiredresponse isachieved (max:2.4mg/d) Transdermal 0.1 mg patchonce q7d, may

increase by 0.1mg q12 wk Geriatric: POStart with 0.1 mgonce dailyChild: PO 510

mcg/kg/d dividedq812h, may

increase to 525mcg/kg/d divided

q6h (max: 0.9

mg/d)

Severe Pain

Adult: Epiduralstart infusion at30 mcg/h andtitrate toresponse. Userates >40 mcg/h

Assessment & Drug

Effects

Monitor BR

closely.

Determine

positional

changes (supine,

sitting, standing).

With epidural

administration,frequently monitor BPand HR. Hypotensionis a common sideeffect that may requireintervention.

Monitor BP closelywhenever a drug isadded to or withdrawnfrom therapeutic

regimen.

Monitor I&O duringperiod of dosageadjustment. Reportchange in I&O ratio orchange in voiding


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with cautionChild: Epiduralstart infusion at

0.5 mcg/kg/h andtitrate to response

ADDH

Child: PO 5mcg/kg/d in 4divided doses(average dose,0.150.2mg/d) Transdermal 0.20.3 mg/d

q57d

pattern.

Determine weightdaily. Patients notreceiving a

concomitant diureticagent may gain weight,

particularly during first3 or 4 d of therapy,

because of markedsodium and water

retention.

Supervise closelypatients with history ofmental depression, as

they may be subject tofurther depressive

episodes.

Generic Name Brand Name Classification Action Indication Dose Nursing Responsibilities

FUROSEMIDE LasixElectrolytic

and water

balance

agent;

loop

Rapid-acting potentsulfonamide loopdiuretic andantihypertensive with

pharmacologic effectsand uses almost

Treatment ofedema associatedwith CHF,cirrhosis of liver,and kidneydisease, including

Tablets:20, 40,and80mg.Oralsolution:

Observe patientsreceiving parenteral

drug carefully;closely monitor BP

and vital signs.Sudden death from


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diureticidentical to those ofethacrynic acid. Exactmode of action not

clearly defined;decreases renal vascularresistance and mayincrease renal bloodflow.

nephroticsyndrome. May

be used for

management ofhypertension,alone or incombination withotherantihypertensiveagents, and fortreatment ofhypercalcemia.Has been usedconcomitantly

with mannitol fortreatment of

severe cerebraledema,

particularly inmeningitis.

10mg/ml,40 mg/5

ml.Injection:10 mg/ml

cardiac arrest hasbeen reported.

Monitor BP during

periods of diuresisand through periodof dosageadjustment.

Observe older adultsclosely during periodof brisk diuresis.Sudden alteration influid and electrolyte

balance mayprecipitate

significant adversereactions. Reportsymptoms to

physician. Lab tests: Obtain

frequent bloodcount, serum and

urine electrolytes,CO2, BUN, blood

sugar, and uric acidvalues during first

few months oftherapy and

periodicallythereafter.

Monitor for S&S ofhypokalemia (seeAppendix F).

Monitor I&O ratio

and pattern. Report


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decrease or unusualincrease in output.Excessive diuresis

can result indehydration andhypovolemia,circulatory collapse,and hypotension.Weigh patient dailyunder standardconditions.

Monitor urine andblood glucose &

HbA1C closely in

diabetics andpatients withdecompensatedhepatic cirrhosis.Drug may causehyperglycemia.

Note: Excessivedehydration is mostlikely to occur inolder adults, thosewith chronic cardiac

disease on prolongedsalt restriction, orthose receiving

sympatholyticagents.


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Generic Name Brand

Name


Responsibilities

DOPAMINE

HYDROCHLORIDE

Dopastat,

Intropin,

Revimine

autonomic nervous

system agent;

alpha- and beta-

adrenergic agonist

(sympathomimetic

)

Naturallyoccurring

neurotransmitterand immediate

precursor ofnorepinephrine.

Majorcardiovascular

effects producedby direct action on

alpha- and beta-adrenergicreceptors and onspecificdopaminergicreceptors inmesenteric andrenal vascular

beds.

To correcthemodynamic

imbalance in shocksyndrome due to MI

(cardiogenic shock),trauma, endotoxic

septicemia (septicshock), open heart

surgery, and CHF.

Contraindication:

Pheochromocytoma; tachyarrhythmias

or ventricularfibrillation. Safe use

during pregnancy(category C),

lactation, orchildren is notestablished.

Shock

Adult/Child:IV 25mcg/kg/min

increasedgradually up to

2050mcg/kg/min if

necessary

Renal Failure

Adult:IV 25mcg/kg/min

Dopamine

Calculation:

Drip Rate=

[(orders) x

(kg) x (drip

set)] /

concentration

in 1 mL

Assessment & Drug

Effects

Monitor blood

pressure, pulse,peripheral pulses,

and urinary outputat intervals

prescribed byphysician. Precise

measurements areessential foraccurate titration ofdosage. Report thefollowingindicators promptly

to physician for usein decreasing ortemporarilysuspending dose:Reduced urine flowrate in absence of

hypotension;ascending

tachycardia;


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Conversion

factor:1mg=1000mc

g

1kg=2.2lbs

dysrhythmias;disproportionaterise in diastolic

pressure (markeddecrease in pulsepressure); signs ofperipheral ischemia(pallor, cyanosis,mottling, coldness,complaints oftenderness, pain,numbness, or

burning sensation).

Monitor therapeuticeffectiveness. Inaddition toimprovement invital signs and urineflow, other indicesof adequate dosageand perfusion ofvital organs includeloss of pallor,increase in toe

temperature,adequacy of nail

bed capillary filling,and reversal of

confusion orcomatose state.


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Generic

Name


Nicardipine Cardene Calcium

channelblocker(dihydropyridine).

Inhibits calcium

ion influx acrosscardiac andsmooth musclecells, thusdecreasingmyocardialcontractility andoxygen demandand coronararteries andarterioles.

Chronic stable

angina

Contraindication:

Patient whoarehypersensitivetonicardipine

Initially

20 mg P.O

Tid

hypertension20 to 40mg P.Ot.i.dincreasedosage

dependson thepatientsresponse

Patients with

hepatic

impairment should

receive lower dose

Monitor bloodpressure.

Allow atleast 3

days

between dosage

adjustment toachieve

steady plasma

levels.

Advise patient toreportimmediately ifexperiencing chestpa

Generic

Name


Mannitol Osmitrol,

Resectisol

Diuretic It raises the

osmotic

1. Acute

oliguric

Adult Assessment Monitor the


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pressure of theplasma

allowing water to bedrawn out of body

tissues

In the oliguric phase

of acute renal

failure, Mannitol

increases osmotic

pressure (pressure

needed to stop the

absorption of

something or

osmosis) of the

glumerular filtrate,

thereby, promoting

diuresis (treating

the oliguric phase of

renal failure) and

excretes toxic

materials

(management for

toxic overdose).

It also elevatesblood plasma

renal failure2. Toxic

overdose

3. Edema4. Increasedintracranial

pressure(ICP)

5. Intraocularpressure

6. (IOP)7. Pulmonary

congestion

or oedema;

intracranial

bleeding;

CHF; metabolicedema withabnormalcapillaryfragility; anuria

due to severerenal disease;severedehydration.

Oliguria: 50-100 g as a5-25% solution.

Intracranial/Intraocular pressure: 0.25-2 g/kg

as 15-25% solutionadministered for 30-60

minutes.

Children

Oliguria: 0.25-2 g/kgas a 15-20% solution

for 2-6 hours

Intracranial/Intraocular pressure: 1-2 g/kg asa 15-20% solutionadministered for 30-60minutes.

following:

1. 1. Vital signs

2. 2. Intake and output3. 3. Central venouspressure

4. Pulmonary arterypressure

5. Signs and symptoms ofdehydration (e.g. poorskin turgor, dry skin,

fever, thirst)6. Signs of electrolyte

imbalance/deficit (e.g.

muscular weakness,paresthesia, numbness,confusion, tinglingsensation of extremityand excessive thirst)

7. (for increase ICP)Neurologic status andintracranial pressurereadings.

8. (for increase IOP)Elevating eye pain or

decreased visualacuity.

Laboratory Tests

1. Renal function (BUNand Creatinine)

2. Serum Electrolyte


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osmolality thus,inhibiting the

reabsorption of

water and

electrolytes (forrelief of edema) andmobilizing fluids in

the cerebral and

ocular spaces

(lowers intracranialor intraocular

pressure).

(Sodium andPotassium)

Precaution

Pregnancy and lactation

(safe use during theseconditions is not

established)

Interventions

1. Observe the IV siteregularly for

infiltration.2. Administration rate

for oliguria shouldbe titrated to producea urine output. (about30-50 ml/hr in adultand 2-6 hours inchildren)

Generic

Name

Brand Name Classification Action Indication

/Dose

Active Duodenal Ulcer

Adults: PO 150mg b.i.d. or300 mg at bedtime.

Maintenance dose is 150 mgat bedtime.

Nursing Responsibilities

RanitidineHCL

Zantac GASTROINTESTINAL AGENT;ANTISECRETORY(H2-RECEPTORANTAGONIST)

Completely inhibitsaction of histamineon the H2 atreceptor sites ofparietal cells,

Instruct patient onproper use of OTCpreparation as indicated.

Instruct patient onproper use of OTC


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decreasing gastricacid secretions

IM/IV/Intermittent IV 50 mgevery 6 to 8 h.

Children 1 mon -16 y/o: PO 2

to 4 mg/kg twice daily (max,300 mg/day).

Maintenance therapy for

Duodenal and Gastric UlcersAdults: 150mg P.O at bedtime

Children 1 mon -16 y/o: PO 2to 4 mg/kg daily up to 150mgdaily

Pathologic HypersecretoryConditionsAdults: PO 150 mg twicedaily. Individualize.

GERD and ErosiveEsophagitisAdults: PO 150mg b.i.d.

Children 1 mon -16 y/o: PO 5to 10 mg/kg daily usuallygiven in 2 divided doses.

Erosive Esophagitis:Maintenance dosage is 150mgP.O. q.i.d.

Heartburn

Adults and Children 1 mon

-12 y/o and older: 75mg of

preparation as indicated.

Assess patient forabdominal pain. Note

presence of blood inemesis, stool, or gastricaspirate

Ranitidine may beadded to total parenteralnutrition solution

Remind patient to takeonce daily prescriptiondrug at bedtime for bestresults

Instruct patient to takewithout regard to mealsbecause absorption isntaffected by food

Remind patient not toconfuse ranitidine withrimantadine: dontconfuse Zantac withXanax or Zyrtec


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Zantac 75 P.O. as symptoms

occur, up to 150mg daily, not

to exceed 2 weeks of

continuous treatment.

CONTRAINDICATION

Contraindicated in patientshypersensitive to drug andthose with porphyria

Use cautiously in patients

with hepatic dysfunction.Adjust dose in patients with

impaired renal function

Generic

Name


Calcium

Gluconate

Calciumsupplements

Calcium is essentialfor the functionalintegrity of thenervous, muscular,and skeletal systems.It plays a role innormal cardiac

Parenteraladministration ofcalcium is indicatedwhere thepharmacologicalaction of a highcalcium ion


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function, renalfunction, respiration,blood coagulation,and cell membraneand capillarypermeability. Also,calcium helps toregulate the releaseand storage ofneurotransmittersand hormones, theuptake and binding ofamino acids,absorption of vitaminB 12, and gastrinsecretion. The majorfraction (99%) ofcalcium is in theskeletal structureprimarily ashydroxyapatite, Ca10(PO 4) 6(OH) 2;small amounts ofcalcium carbonateand amorphouscalcium phosphatesare also present.

concentration isrequired, as forexample, in acutehypocalcaemia,cardiac resuscitationand some cases ofneonatal tetany.Intravenousinjections of calciumhave been used inthe treatment of theacute colic of leadpoisoning, and as anadjunct in thetreatment of acutefluoride poisoning.Also, for theprevention ofhypocalcaemia inexchangetransfusions

Contraindication :

Hypercalcaemia

(e.g. in

hyperparathyroidism,hypervitaminosis D,

neoplastic disease

with decalcification

of bone), severe

hypercalciuria,

severe renal failure,


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patients receiving

cardiac glycosides.

Adverse Reactions:

If Calcium Gluconate

Injections is

administered too

rapidly, nausea,

vomiting, hot

flushes, sweating,

hypotension and

vasomotor collapse,possibly fatal, may

occur. Soft tissue

calcification due to

extravasation of

calcium solutions

has been reported

Generic

Name


Potassium

Chloride

Electrolyte Potassium chloride is

used to prevent or to

treat low blood levels

of potassium

(hypokalemia).

Potassium

deficiency.


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Potassium levels can

be low as a result of a

disease or from taking

certain medicines, orafter a prolonged

illness with diarrhea

or vomiting.

Contraindication:

Excess of

potassium ions

producesdepression of

the heart and

may cause

cardiac arrest.

Poisoning may

occur from the

intravenous

injection of even

small doses of

potassium ions

when excretion

is delayed, as in

the presence of

renal

insufficiency.

Adverse

Reactions:nausea,

vomiting,

diarrhea,

stomach ache,

and flatulence.


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Generic

Name

Brand Name Classification Action Indication Dose Nursing

Responsibilities

Aluminum

magnesiumhydroxide

Maalox peptic, gastric,

duodenal ulcers,hyperphosphatemia

in chronic failure,reflux esophagitis,

hyperacidity, heart

burn, GERD

ADULT-

suspension 5-10 ml1 hr after meal at

bedtimeORAL

Administration: 600

mg 1 hr after mealat bedtime, chewed

with milk or water.GI bleeding:

Infant: Oral

administration 2-5ml/ dose every 1-2

hrs.Children Oral

Administration: 5-15 ml/dose every 1-

2 hours.

hyperphosphatemia

in renal failure:Adult: suspension

500 mg- 2 2x- 4x a

dayPharmacodynamics:

Onset: Varies

Peak: Unknown


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Duration: 20- 60

minutes (Fasting)

3 hours( taken 1 hour aftermeal)

Generic

Name

Brand Name Classification Action Indication Dose Nursing

Responsibilities

Atropine

sulfate

atropine

sulfate

administration

prior toanesthesia to

reduce or

preventsecretions of

respiratorytract; teratment

of

parkinsonism;irritation or

inflammation ofstomach;

treatment ofalcohol

withdrawal

symptoms;relief of motion

sickness;shorttreatment

For IV administration

ADULT 0.4-0.6 mgevery 4-6 hrs.

PEDIA 0.1-0.6 mg

depending on weightAs Antidote 1-2 mg

every 20-30 mins untilthe skin is flushed

and dry, the pupils are

dilated and tachycardiahas developed

ADULT by subQinjection 0.5 mg 4-6

hrly.PEDIA < 12 yrs, subQ

0.01 mg/kg body-

weightREFRACTION; adult

1-2 drpos 1 hr beforerefracting


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has and

prevention ofbronchospasm

associated withchronicbronchial

asthma,bronchitis and

COPD. therapyfor certain

bradycardias

and heartblocks.

Generic

Name


Magnesium

Sulfate

Elin

magnesiumsulfate

used as anti-

convulsan, lowersintracranial

pressure,prevention and

control of seizures

in toxemia, acutenephritis in

children and otherconditions like

epilepsy,glomerulonephritis

or

hypothyroidism,

Magnesium

deficiency2 ml

injectionIM.

Pre-

eclampsia8-10 ml

added into250 ml of 5

% dextroseor 0.9%

sodium

chloride


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also use for

arrythmias such asatypical

ventriculartachycardia.

injectionPedia

Depressionof Seizures0.08-

0.16ml/kgBW of

25%solution IM

Generic Name Brand Name Classification Action Indication Dose Nursing ResponsibilitiesPHENOBARBITAL SODIUM

Luminal Sodium central nervoussystem agent;anticonvulsant;sedative-hypnotic;barbiturate

Long-acting barbiturate.

Sedative and hypnotic

effects of barbiturates

appear to be due

primarily to interference

with impulse

transmission of cerebral

cortex by inhibition of

reticular activating

system. CNS depression

may range from mild

sedation to coma,

depending on dosage,

route of administration,degree of nervous

system excitability, and

drug tolerance. Initially,

barbiturates suppress

REM sleep, but with

chronic therapy REM

sleep returns to normal.

Long-termmanagement oftonic-clonic (grandmal) seizures andpartial seizures;status epilepticus,eclampsia, febrileconvulsions inyoung children.Also used as asedative in anxietyor tension states; inpediatrics aspreoperative andpostoperativesedation and totreat pylorospasmin infants

CONTRAINDICATION:

Sensitivity to

barbiturates;

manifest hepatic or

AnticonvulsantAdult:PO 100300 mg/d IV/IM200600 mgup to 20mg/kgChild:PO/IV 38 mg/kg or125 mg/m2/dNeonate:

PO/IV 34mg/kg/d (max:5 mg/kg/d)

StatusEpilepticusAdult/Child:IV1518 mg/kgin single ordivided doses(max: 20mg/kg)Neonate:IV1520 mg/kg

Assessment & Drug Effects

Observe patientsreceiving large dosesclosely for at least 30 min toensure that sedation is notexcessive.

Keep patient underconstant observation whendrug is administered IV, andrecord vital signs at leastevery hour or more often ifindicated.

Lab tests: Obtain liverfunction and hematologytests and determinations ofserum folate and vitamin Dlevels during prolongedtherapy.

Monitor serum druglevels. Serumconcentrations >50 mcg/mLmay cause coma.

Therapeutic serum


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familial history of

porphyria; severe

respiratory or

kidney disease;

history of previous

addiction to

sedative hypnotics;

uncontrolled pain;

pregnancy

(particularly early

pregnancy)

(category D),

lactation; sustained

release formulation

for children


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Ophthalmic solution:Epifrin, Glaucon

Insect stingemergencies:EpiPen Auto-Injector

(delivers 0.3 mg IM

adult dose), EpiPen Jr.

Auto-Injector (delivers

0.15 mg IM for

children)

OTC solutions for

nebulization:AsthmaNefrin,

microNefrin, Nephron,S2

Anaphylaxis:

0.1- 1 mg SQ or

IM of 1:1000

solution.

Asthma: 0.1-0.3

mg SQ or IM of

1:10,000 solution

Refractorybradycardiaand

hypotension: 2-

10ug/min

Increases vital

capacity

BP, HR, PR

Decreases airway

resistance.

Classification:

Beta2 Adrenergic

Agonists

bradycardia.o Relief of

bronchospasmoccurring

duringanesthesia

o Exercised-

inducedbronchospasm

Contraindications:

Contraindicate in

patients with angle-

closure glaucoma,

shock (other than

anaphylactic shock),

organic brain damage,

cardiac dilation,

arrhythmias, coronary

insufficiency, or

cerebral

arteriosclerosis. Also

contraindicated in

patient receiving

general anesthesiawith halogenated

hydrocarbons or

cyclopropane and in

patients in labor (may

delay second stage)

hypertension

nausea

Side Effects:

headache

Parkinsons

disease

Epinephrine

therapy interferes

with tests for

urinary

catecholamine

Avoid IM use of

parenteral

suspension into

buttocks. Gas

gangrene mayoccur

Massage site

after IM injection to

counteract possible

vasoconstriction.

Observe

patient closely for

adverse reactions.

Notify doctor if

adverse reaction

develop

If blood

pressure increases

sharply, rapid-


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Some products

containing sulfites and

are contraindicated in

patients with sulfite

allergies except when

drug is used for

serious allergic

reactions or in other

emergency situations.

In conjunction with

local anesthesia,

epinephrine is

contraindicated for

use in finger, toes,

ears, nose, and

genitalia.

Use cautiously with

long-standing

bronchial asthma and

emphysema, who

have developed

degenerative heart

disease and in those

with hyperthyroidism,

CV disease,

acting vasodilators

such as nitrates or

alpha blockers can

be given tocounteract


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hypertension,

psychoneurosis, or

diabetes.

In pregnant woman,

drug is

contraindicated.

In breast feeding do

not use the drug or

stop breast feeding.

Name of the

Drug

Dosage/Route Action/Classificati

on

Indication/

Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic Name:

Sodium

Bicarbonate

Brand Name:

Arm and Hammer

Pure Baking Soda,

Citrocarbonate,

Soda Mint

1 mEq/kg IVP,

may repeat 0.5

mEq/kg 10 min.

Action:

Neutralizes gastric

acid

Decrease pepsin

activity

Indications:

o Hyperacidity

o Peptic ulcer

o Hyperkalemiao Tricyclic

antidepressantOD

o Shock

associated withseverediarrhea,

Adverse Effects:

GI: Gastric

distention,

belching,

flatulence.

Metabolic:

metabolic

alkalosis,

hypernatremia,

Monitor urinary

pH, calcium,

electrolytes and

phosphate levels.

Record amount

and consistency of

stools.


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Classification:

Alkalizing Agent,

Buffer, Antacid,

electrolyte

dehydration,uncontrolledDM

o Reflux

esophagitis

Contraindications:

Contraindicated in

patients with

metabolic or

respiratory alkalosis;

patients who are

losing chlorides from

vomiting or continuousGI suction; patients

taking diuretics known

to produce

hypochloremia

alkalosis; and patients

with hypocalcemia in

which alkalosis may

produce tetany,

hypertension, seizures,

or heart failure. Oral

sodium bicarbonate is

contraindicated in

patients with acute

ingestion of strong

mineral acids.

hypokalemia,

hyperosmolarity

(with overdose).

Other: Pain andirritation at

injection site.

Clients on low-

sodium diets

should evaluatesodium contents

of antacids.


30/40

Name of the

Drug

Dosage/Route/Timi

ng

Action/Classificati

on

Indication/

Contraindications

Adverse

Effects/ Side

Effects

Nursing

Responsibilities

Generic

Nitroglycerin

Brand

Nitrostat

0.3-0.4 mg SL q 5

min, max 3 doses.

Action:

Relaxes the vascular

smooth system

Myocardialoxygen consumption

left ventricularworkload

arterial BP

venous return

Classification

Antianginal, Nitrate,

Vasodilator,

Coronary

Indication:

Angina pectoris

CHF associated

with AMI

Cardiac load

reducing agent

Hypertensive Crisis

Contraindication:

Contraindicated in

patientshypersensitive to

nitrates and in

those with early MI.

(S.L. form), severe

anemia, increase

ICP angle-closure

glaucoma, IV

Adverse Effects

CV: orthostatic

hypotension,

flushing, fainting.

EENT: sublingual

burning.

Skin: Cutaneousvasodilation,

contact

dermatitis (patch)

Side Effects

CNS: headache,

throbbing,

dizziness,

weakness.

GI: nausea,

vomiting.

Skin: Rash

Record

characteristics and

precipitating

factors of anginal

pain.

Monitor BP and

apical pulse before

administration and

periodically after

dose.

Have client sit or

lie down if taking

drug for the first

time.

Client must have

continuing EKG

monitoring for IV


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nitroglycerine is

contraindicated in

patients with

hypovolemia,

hypotension,

orthostatic

hypotension,

cardiac tamponade

restrictive

cardiomyopathy,

constrictive

pericarditis.

administration

Cardioverter/defibrillator must

not be discharged

through paddle

electrode overlying

Nitro-Bid ointment

or the Transderm-

Nitro Patch. Assist

with ambulating if

dizzy.

Instruct to take at

first sign of anginal

pain.

May be repeated

q 5 minutes to

max. of 3 doses.

If the client

doesnt experience

relief, advise to

seek medical


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assistance

immediately.

Name of the

Drug


on

Indication/

Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic

Atrophine Sulfate

Brand

Isopto Atropine

Bradycardia: 0.5

-1 mg IV (may give

via ETT at double

dose) q 3-5 min,

max 0.04 mg/kg

Cardiac arrest: 1

mg q 3-5 min, max0.04 mg/kg

Nerve gas and

organophosphate

symptoms, may

repeat in 2 mg

increments q 3 min

tiltrated to relief

symptoms.

Action

cholinergic receptor

sites so response to

acetylcholine is

decreased

Classification

Anticholinergics

Indication

As an anti-

sialagogue for

preanesthetic

medication to

prevent or reduce

secretions of therespiratory tract

To restore cardiac

rate and arterial

pressure during

anesthesia, when

vagal

stimulation

produced by intra-

abdominal surgical

traction causes a

sudden decrease in

pulse rate and

Adverse Effects

CNS: restlessness,

ataxia,

disorientation,

hallucinations,

delirium, coma,

insomnia,agitation,

confusion.

CV: tachycardia,

angina,

arrhythmias,

flushing.

EENT:

photophobia,

blurred vision,mydriasis.

GI: dry moth,

constipation,

vomiting.

GU: urine

Monitor VS.

Report HR

Monitor for

constipation,oliguria.

Atrophine could

result in CNS

stimulation

(confusion,

excitement) or

drowsiness

Instruct to take 30

mins before meals

Eat foods high in


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cardiac action

To lessen thedegree of

atrioventricular (A-

V) heart block when

increased vagal

tone is a major

factor in the

conduction defect,

as in some cases

due to digitalis

To overcome

severe carotid sinus

reflex

Antidote for

cardiovascular

collapse from the

injudicious use of a

cholinergic drug.

Contraindication

Contraindicated in

patients

hypersensitive to

retention.

Hematologic:

leukocytosis

Other: anaphylaxis

Side Effects

CNS: headache,

excitement.

CV: palpitations

GI: thirst, nausea.

fiber and drink

plenty fluids.

Avoid OTCantihistamines.

Instruct client not

to drive a motor

vehicle or

participate in

activities requiring

alertness.

Advise to use hard

candy, ice chips,

etc. for dry mouth.


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drug and those with

acute angle closure

glaucoma,

obstructive

uropathy,

obstructive disease

of GI tract, paralytic

elius, toxic

magacolon,

intestinal atony,

unstable CV status

in acute

hemorrhage,

asthma, or

myasthenia gravis.Also

contraindicated in

pregnant women.

Name of the

Drug


on

Indication/

Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic

Morphine Sulfate

Brand

ADULTS

Oral

One-third to one-sixth

as effective as

parenteral

administration because

of first-pass

metabolism; 1030 mg

Action

Principal opium alkaloid;

acts as agonist at specific

opioid receptors in the

CNS to produce

analgesia, euphoria,

sedation; the receptors

Indication

Relief of moderate to

severe acute and chronic

pain

Preoperative medication

to sedate and allay

Adverse Effect

CNS:Light-headedness,dizziness, sedation,euphoria, dysphoria,

delirium, insomnia,

agitation, anxiety, fear,

hallucinations,

Assessment

History:

Hypersensitivity to

opioids; diarrhea caused

by poisoning; labor or

delivery of a premature

infant; biliary tract

surgery or surgical


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Immediate-releasetablets:MSIR

Timed-release:

Kadian, M-Eslon(CAN), MS Contin,

Oramorph SR

Oral solution:MSIR, Rescudose,

Roxanol, Roxanol T

Rectal suppositories:RMS

Injection:Astramorph PF,

Duramorph, Epimorph

(CAN)

Preservative-freeconcentrate formicroinfusion devicesfor intraspinal use:Infumorph

q 4 hr PO. Controlled-

release: 30 mg q 812

hr PO or as directed by

physician;Kadian: 20

100 mg PO daily24-hrrelease system; MSContin: 200 mg PO q12 hr.

SC and IM

10 mg (520 mg)/70

kg q 4 hr or as directed

by physician.

IV

2.515 mg/70 kg of

body weight in 45 mL

water for injection

administered over 45min, or as directed by

physician. Continuous

IV infusion: 0.1

1 mg/mL in 5%

dextrose in water by

controlled infusion

device.

Rectal

1030 mg q 4 hr or as

directed by physician.

Epidural

Initial injection of5 mg in the lumbar

region may provide

pain relief for up to 24

hr. If adequate pain

relief is not achieved

within 1 hr,

incremental doses of

12 mg may be given

mediating these effects

are thought to be the same

as those mediating the

effects of endogenous

opioids (enkephalins,endorphins).

Classification

Opioid agonist analgesic

apprehension, facilitate

induction of anesthesia,

and reduce anesthetic

dosage

Analgesic adjunct during

anesthesia

Component of most

preparations that are

referred to as

Brompton's cocktail or

mixture, an oral

alcoholic solution that is

used for chronic severe

pain, especially in

terminal cancer patients

Intraspinal use with

microinfusion devices

for the relief of

intractable pain

Unlabeled use: Dyspnea

associated with acute left

ventricular failure and

pulmonary edema

Contraindication

Contraindicated with

hypersensitivity to

opioids; diarrhea caused

by poisoning until toxins

are eliminated; during

disorientation,

drowsiness, lethargy,

impaired mental and

physical performance,

coma, mood changes,weakness, headache,

tremor, seizures, miosis,

visual disturbances,

suppression of cough

reflex

CV: Facial flushing,

peripheral circulatory

collapse, tachycardia,

bradycardia, arrhythmia,

palpitations, chest wall

rigidity, hypertension,hypotension, orthostatic

hypotension, syncope

Dermatologic: Pruritus,

urticaria, Respiratory:

laryngospasm,

bronchospasm, edema

GI:Nausea, vomiting,anorexia, biliary tract

spasm; increased colonic

motility in patients withchronic ulcerative colitis

GU: Ureteral spasm,

spasm of vesical

sphincters, urinary

retention or hesitancy,

oliguria, antidiuretic

effect, reduced libido or

anastomosis; head

injury and increased

intracranial pressure;

acute asthma, COPD,

cor pulmonale,preexisting respiratory

depression; acute

abdominal conditions,

CV disease,

supraventricular

tachycardias,

myxedema, seizure

disorders, acute

alcoholism, delirium

tremens, cerebral

arteriosclerosis,

ulcerative colitis, fever,kyphoscoliosis,

Addison's disease,

prostatic hypertrophy,

urethral stricture, recent

GI or GU surgery, toxic

psychosis, renal or

hepatic dysfunction;

pregnancy; lactation

Physical: T; skin color,

texture, lesions;

orientation, reflexes,bilateral grip strength,

affect; P, auscultation,

BP, orthostatic BP,

perfusion; R,

adventitious sounds;

bowel sounds, normal

output; urinary

frequency, voiding


36/40

at intervals sufficient to

assess effectiveness, up

to 10 mg/24 hr. For

continuous infusion,

initial dose of 24mg/24 hr is

recommended. Further

doses of 12 mg may

be given if pain relief

is not achieved

initially.

Intrathecal

Dosage is usually one-

tenth that of epidural

dosage; a single

injection of 0.21 mg

may providesatisfactory pain relief

for up to 24 hr. Do not

inject > 2 mL of the

5 mg/10 mL ampule or

> 1 mL of the

10 mg/10 mL ampule.

Use only in the lumbar

area. Repeated

intrathecal injections

are not recommended;

use other routes if pain

recurs. For epidural orintrathecal dosing, use

preservative-free

morphine preparations

only.

PEDIATRIC

PATIENTS

Do not use in

labor or delivery of a

premature infant (may

cross immature blood

brain barrier more

readily); after biliarytract surgery or

following surgical

anastomosis; pregnancy;

labor (respiratory

depression in neonate;

may prolong labor).

Use cautiously with head

injury and increased

intracranial pressure;

acute asthma, COPD,

cor pulmonale,preexisting respiratory

depression, hypoxia,

hypercapnia (may

decrease respiratory

drive and increase

airway resistance);

lactation (wait 46 hr

after administration to

nurse the baby); acute

abdominal conditions,

CV disease,

supraventriculartachycardias,

myxedema, seizure

disorders, acute

alcoholism, delirium

tremens, cerebral

arteriosclerosis,

ulcerative colitis, fever,

kyphoscoliosis,

potency

Respiratory:

Respiratory

depression, apnea,circulatory

depression,

respiratory arrest,

shock, cardiac arrest

Side Effects

GI: dry mouth,

constipation.

Skin: Tissueirritation and

induration (SC

injection).

Other:sweating,physicaltolerance and

dependence,

psychological

dependence

pattern, normal output;

ECG; EEG; thyroid,

liver, kidney function

tests

Interventions

Caution patient not to

chew or crush

controlled-release

preparations.

Dilute and administer

slowly IV to minimize

likelihood of adverse

effects.

Tell patient to lie downduring IV

administration.

Keep opioid antagonist

and facilities for

assisted or controlled

respiration readily

available during IV

administration.

Use caution when

injecting SC or IM intochilled areas or in

patients with

hypotension or in

shock; impaired

perfusion may delay

absorption; with

repeated doses, an

excessive amount may


37/40

premature infants.

SC or IM

0.050.2 mg/kg (up to

15 mg per dose) q 4 hr

or as directed byphysician.

GERIATRIC

PATIENTS OR

IMPAIRED ADULTS

Use caution.

Respiratory depression

may occur in the

elderly, the very ill,

those with respiratory

problems. Reduced

dosage may benecessary.

Epidural

Use extreme caution;

injection of < 5 mg in

the lumbar region may

provide adequate pain

relief for up to 24 hr.

Intrathecal

Use lower dosages than

recommended for

adults above.

Addison's disease,

prostatic hypertrophy,

urethral stricture, recent

GI or GU surgery, toxic

psychosis, renal orhepatic dysfunction.

be absorbed when

circulation is restored.

Reassure patients

that they are

unlikely to becomeaddicted; most

patients who

receive opioids for

medical reasons do

not develop

dependence

syndromes

Teaching points

Take this drug exactly

as prescribed. Avoid

alcohol, antihistamines,

sedatives, tranquilizers,

over-the-counter drugs.

Swallow controlled-

release preparation (MSContin, Oramorph SR)whole; do not cut,

crush, or chew them.

Do not take leftover

medication for other

disorders, and do not let

anyone else take your

prescription.
http://opt/scribd/conversion/tmp/scratch2530/morphine_sulfate_tp.htmhttp://opt/scribd/conversion/tmp/scratch2530/morphine_sulfate_tp.htm


38/40

These side effects may

occur: Nausea, loss of

appetite (take with food,

lie quietly); constipation

(use laxative);dizziness, sedation,

drowsiness, impaired

visual acuity (avoid

driving or performing

tasks that require

alertness and visual

acuity).

Report severe nausea,

vomiting, constipation,

shortness of breath or

difficulty breathing,rash.

Generic

Name


Omeprazole

Tansinel Antisecretorydrug

Gastric-acidpumpinhibitor:suppressesgastric acid

secretion byspecificinhibition ofthehydrogenpotassiumATPase

Short-termtreatment ofactiveduodenalcancer

Short-termtreatment ofactive benigngastric ulcerEradicationofHelicobacter

20 mg1 capfortwoweeks

Assessment:1. History:hypersensitivity toomeprazole or any ofits components;

pregnancy, lactation2. Physical: skinlesions; reflexes;urinary output;abdominalexamination;respiratory


39/40

enzymesystem atthe

secretorysurface ofthe gastricparietal cells;blocksthe finalstep of acidproduction.

PyloriFirst-linetherapy for

treatment ofheartburn orsymptoms ofGERD.

auscultationInterventions:1. Administer before

meals.2. Administerantacids with, ifneeded.3. Have regularmedical follow-upvisits.4. Report severeheadache, worseningof symptoms, fever,

chills.

Generic

Name



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Generic

Name


Generic

Name


Generic

Name


Generic

Name


Generic

Name


LACAMPUINGAN, JOEMAR M.ADAMSON UNIVERSITYCollege of NursingBLOCK 403

5 er drug study

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