Generic /Brand name

TRAMADOL (9/20/10)

Classification
Analgesics

Dosage, Timing, Route

50mg IVTT q 8hrs

Indication
Moderate to moderately severe pain

Mechanism of Action
Binds to mu-opioid receptors. Inhibits reuptake of serotonin and

Adverse reaction
nausea, vomiting, sweating and constipation. Drowsiness is reported, although it is less of an issue than for nonsynthetic opioids. Patients prescribed tramadol for general pain relief with or without other agents have reported withdrawal symptoms including uncontrollable nervous tremors, muscle contracture, and 'thrashing' in bed (similar to restless leg syndrome.

Nursing responsibilities
Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess bowel function routinely. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Monitor patient for seizures. May occur within recommended dose range. Risk increased with

Contraindication

norepinephrine in the CNS

Health professionals have not yet fully endorsed of its use on a large scale for these disorders, although it may be used when other treatments have failed (under the supervision of a psychiatrist).

higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

DRUG STUDY

Generic /Brand name

Classification

Dosage, Timing, Route

Indication

Mechanism of Action
sodium is the major

Adverse reaction
hypernatremia, hypopotassemia, acidosis. Fluid and solute overload leading to dilution of serum electrolyte level, CHF, overhydration, acute pulmonary edem

Nursing responsibilities
a.Monitor electrolytes, ECG, liver and renal function studies b.Note level of consciousness c.Assess the heart and lung sounds d.Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema e.Monitor VS and I&O f.Assess urine specific gravity and serum sodium level

Sodium Chloride 9/20/10

Electrolytes

50ml vial slow IVTT

prophylaxis of heat prostration or muscle cramps; chloride deficiency due to dieresis or salt restrictions; prevention or treatment of extracellular volume depleti Contraindication congestive heart failure, severely impaired renal function, hypernatremia, fluid retention

cation of the body extracellular fluid. It plays a crucial role in maintaining the fluid and balance. electrolyte Excess

retention of sodium results in

overhydration(edema , hypervolemia),

which is often treated with diuretics.

Abnormally low levels of sodium result

indehydration. Normally, the plasma contains mEq/L and 136-145 98-1-6

mEq chloride/L. the averagedaily requirement of salt is approximately 5g

DRUG STUDY

Generic /Brand name

Classification

Dosage, Timing, Route

Indication

Mechanism of Action

Adverse reaction
GI irritation; soft-tissue

Nursing responsibilities
Make sure prescriber specifies form of calcium to be given; crash carts may contain by both calcium gluconate and calcium chloride. Tell patient to take oral calcium 1 to 11/2 hours after meals if GI upset occurs. Give I.M. injection in gluteal region in adults and in lateral thigh in infants. Use I.M. route only in emergencies when no I.V. route is

diluted and Calcium Gluconate 9/20/10 Electrolytes 1 ampule IVTT now in 30min administered as a continuous IV infusion. Antidote in severe hypermagnesaemia; Severe hyperkalaemia 10 mL of 10% soln, repeat every 10 mins if needed replaces Calcium and maintains Calcium level

calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised anorexia,

nausea,

vomiting, constipation, abdominal muscle weakness,mental disturbances, polydipsia, polyuria, pain,

nephrocalcinosis, Patients with calcium renal calculi or history of Contraindicat renal calculi. Conditions ion associated with hypercalcaemia and hypercalciuria. renal calculi; chalky taste, hot flushes and peripheralvasodilation . Potentially Fatal:

Cardiac and coma

arrhythmias

available bec. of irritation of tissue by calcium salts. Tell patient to take oral calcium with a full glass of water. Monitor calcium levels frequently. Hypercalcemia may result after large doses in chronic renal failure. Report abnormalities

DRUG STUDY

Generic /Brand name

Classification

Dosage, Timing, Route

Indication

Mechanism of Action
itamin K is discussed in terms of a new carbanion model that mimics the proton abstraction from the gamma position of protein-bound glutamate. This is the essential step leading to carboxylation and activation of the blood-clotting proteins. The model comprises an oxygenation that is coupled to carboncarbon bond formation, as is the oxygenation of vitamin K hydroquinone to vitamin K oxide. The model hypothesis is also supported by the mechanism of inhibition of the carboxylase by HCN, which acts as an acid-base inhibitor rather than a metal-complexing inhibitor. The new

Adverse reaction
Transient"flush ing sensations" and "peculiar" sensations of taste have been observed, as well as rare instances of dizziness, rapid and weak pulse, profuse sweating, brief hypotension, dyspnea, and cyanosis. Pain, swelling, and tenderness at the injection site may occur. The possibility of allergic sensitivity including an

Nursing responsibilities

hypoprothrombine Vitamine K Dose fat soluble vitamins 1 ampule IVTT q 8hrs mia secondary to factors limiting absorption or synthesis of vitamin K, e.g., obstructive jaundice, biliary fistula, sprue, ulcerative coilitis, celiac disease, intestinal resection, cystic fibrosis of the pancreas,

Contraindicat ion
Hypersensitivity to any component of this medication.

model postulates a dioxetane intermediate that explains the presence of a second atom of 18O (from 18O2) incorporated into vitamin K oxide in the course of the enzymatic carboxylation. Finally, the chemistry developed here has been used to define the active site of vitamin K hydroquinone as the carbon-carbon bond adjacent to the methyl group.

anaphylactoid reaction