Professional Documents
Culture Documents
1) AMINOPHYLLINE
Brand Names: Phil Pharmawealth/Atlantic Aminophylline amp Theofil amp
Classification: Antiasthmatic & COPD Preparations
Dosage: Initial: 225-450 mg twice daily, increased if needed. IV Acute severe bronchospasm.
Loading dose: 5 mg/kg (ideal body wt). Maintenance: 0.5 mg/kg/hr. Rate should not exceed 25
mg/min.
Indication: PO Chronic bronchospasm as hydrate
Action: Increases the level of cAMP resulting in bronchodilation
Adverse Reactions: Nausea, vomiting, abdominal pain, diarrhea, headache, insomnia, dizziness,
anxiety, restlessness; tremor, palpitations. Potentially Fatal: Convulsions, cardiac arrhythmias,
hypotension and sudden death after too rapid IV injection.
Nursing Measures:
Administer to pregnant patients only when clearly neededneonatal tachycardia, jitteriness,
and withdrawal apnea observed when mothers received xanthines up until delivery.
Caution patient not to chew or crush enteric-coated timed-release forms.
Give immediate-release, liquid dosage forms with food if GI effects occur.
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 results of serum theophylline levels carefully, and arrange for reduced dosage if serum
levels exceed therapeutic range of 1020 mcg/mL.
Take serum samples to determine peak theophylline concentration drawn 1530 min after an IV
loading dose.
Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not
available.
Ensure that diazepam is readily available to treat seizures.
Take this drug exactly as prescribed; if a timed-release product is prescribed, take this drug on
an empty stomach, 1 hr before or 2 hr after meals.
Do not to chew or crush timed-release preparations.
Administer rectal solution or suppositories after emptying the rectum.
It may be necessary to take this drug around the clock for adequate control of asthma attacks.
Avoid excessive intake of coffee, tea, cocoa, cola beverages, chocolate.
Smoking cigarettes or other tobacco products impacts the drug's effectiveness. Try not to
smoke. Notify the care provider if smoking habits change while taking this drug.
Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and
effective dosage; keep all appointments for blood tests and other monitoring.
These side effects may occur: Nausea, loss of appetite (taking this drug with food may help if
taking the immediate-release or liquid dosage forms); difficulty sleeping, depression, emotional
lability (reversible).
3) ATROPINE SULFATE
Brand Names: Anespin amp Atropol amp Euro-Med Atropine Sulfate amp Isopto Atropine eye
drops Phil Pharmawealth/Atlantic Atropine amp
Classification: Other Cardiovascular Drugs, Muscle Relaxants, Mydriatic Drugs, Antidotes,
Detoxifying Agents & Drugs Used in Substance Dependence
Indication/Dosage: IV Bradycardia 500 mcg every 3-5 mins. Total: 3 mg. IV/IM
Organophosphorus poisoning 2 mg every 10-30 mins until muscarinic effects disappear or
atropine toxicity appears. IM/SC Premed in anesth 300-600 mcg 30-60 mins before anesth.
IV/IM/SC Overdosage w/ other compd having muscarinic actions 0.6-1 mg, repeat 2 hrly. Ophth
Inflammatory eye disorders As 0.5-1% soln: 1-2 drops 4 times/day. Eye refraction As 1% soln: 1
drop twice daily for 1-2 days before procedure.
Action: An anti-cholinergic that inhibits acetylcholine at the parasympathetic neuroeffector
junction, enhances the conduction of AV node and increases heart rate
Adverse Reactions: Dry mouth, dysphagia, constipation, flushing and dryness of skin,
tachycardia, palpitations, arrhythmias, mydriasis, photophobia, cycloplegia, raised intraocular
pressure. Toxic doses cause tachycardia, hyperpyrexia, restlessness, confusion, excitement,
hallucinations, delirium and may progress to circulatory failure and respiratory depression. Eye
drops: Systemic toxicity especially in children, on prolonged use may lead to irritation,
hyperemia, edema and conjunctivitis. Increased intraocular pressure. Inhalation: Dryness of
mouth, throat. Potentially Fatal: Atrial arrhythmias, AV dissociation, multiple ventricular
ectopics.
Nursing Measures:
Ensure adequate hydration; provide environmental control (temperature) to prevent
hyperpyrexia.
Have patient void before taking medication if urinary retention is a problem.
When used preoperatively or in other acute situations, incorporate teaching about the drug with
teaching about the procedure; the ophthalmic solution is used mainly acutely and will not be selfadministered by the patient; the following apply to oral medication for outpatients:
Take as prescribed, 30 min before meals; avoid excessive dosage.
Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur.
These side effects may occur: Dizziness, confusion (use caution driving or performing
hazardous tasks); constipation (ensure adequate fluid intake, proper diet); dry mouth (suck
sugarless lozenges; perform frequent mouth care; may be transient); blurred vision, sensitivity to
light (reversible; avoid tasks that require acute vision; wear sunglasses in bright light); impotence
(reversible); difficulty in urination (empty the bladder prior to taking drug).
Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular
heartbeat, palpitations; headache; abdominal distention; hallucinations; severe or persistent dry
mouth; difficulty swallowing; difficulty in urination; constipation; sensitivity to light.
4) BUMETANIDE
These side effects may occur: GI upset, loss of appetite, change in taste perception (limited
effects, will pass); mouth sores (perform frequent mouth care); rash; fast heart rate; dizziness,
light-headedness (usually passes after the first few days; change position slowly, and limit your
activities to those that do not require alertness and precision).
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat,
chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.
7) CLONIDINE
Brand Names: Catapin amp Catapres amp Catapres tab
Classification: Other Antihypertensives
Indication/Dosage: PO HTN Initial: 50-100 mcg 3 times/day. Max: 2,400 mcg/day. Menopausal
flushing; Migraine prophylaxis 50 mcg twice daily, up to 75 mg twice daily. IV Hypertensive
crisis 150-300 mcg via slow inj. Max: 750 mcg over 24 hr. Epidural Severe cancer pain Initial:
30 mcg/hr as continuous infusion in combination w/ an opioid. Transdermal HTN As patch
releasing 100-300 mcg clonidine base/day at constant rate: Apply once wkly.
Action: stimulates alpha 2 receptors and inhibits central vasomotor centers, lowers peripheral
vascular resistance, blood pressure, and heart rate
Adverse Reactions: Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid
dreams, urinary retention; dry, itching, burning sensation in the eye; fluid or electrolyte
imbalance, GI upset, paralytic ileus, orthostatic hypotension, weakness, sedation, pruritus,
myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI motility at times may
cause paralytic ileus. Potentially Fatal: Transient hypertension or profound hypotension,
respiratory depression, convulsion. Clonidine withdrawal syndrome could be life threatening.
Bradycardia, coma and disturbances in conduction (in individuals with preexisting diseases of
SA/AV nodes, overdose or on digitalis).
Nursing Measures:
Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting
your health care provider.
Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting,
dehydration); if light-headedness or dizziness occurs, consult your health care provider.
Avoid over-the-counter medications, especially cough, cold, allergy medications that may
contain ingredients that will interact with ACE inhibitors. Consult your health care provider.
These side effects may occur: GI upset, loss of appetite, change in taste perception (limited
effects, will pass); mouth sores (perform frequent mouth care); rash; fast heart rate; dizziness,
light-headedness (usually passes after the first few days; change position slowly, and limit your
activities to those that do not require alertness and precision).
Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat,
chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing.
Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless so
instructed. Do not discontinue abruptly; life-threatening adverse effects may occur. If you travel,
take an adequate supply of drug.
Use the transdermal system as prescribed; refer to directions in package insert, or contact your
health care provider with questions. Be sure to remove old systems before applying new ones.
Attempt lifestyle changes that will reduce your BP: stop smoking and using alcohol; lose
weight; restrict intake of sodium (salt); exercise regularly.
Use caution with alcohol. Your sensitivity may increase while using this drug.
These side effects may occur: Drowsiness, dizziness, light-headedness, headache, weakness
(often transient; observe caution driving or performing other tasks that require alertness or
physical dexterity); dry mouth (suck on sugarless lozenges or ice chips); GI upset (eat small,
frequent meals); dreams, nightmares (reversible); dizziness, light-headedness when you change
position (get up slowly; use caution climbing stairs); impotence, other sexual dysfunction,
decreased libido (discuss with care providers); breast enlargement, sore breasts; palpitations.
Report urinary retention, changes in vision, blanching of fingers, rash.
8) DIAZEPAM
Brand name: Valium
Classification: Anxiolytics
Dosage: 10mg/2ml
Indication: relief of anxiety, agitation & tension due to psychoneurotic states & transient
situational disturbances
Action: a benzodiazepine that probably potentiates the effects of GABA, depresses the CNS &
suppresses the spread of seizure activity
Adverse Reaction: drowsiness,dysarthria, slurred speech, tremor, transient amnesia, fatigue,
ataxia, headache, insomnia, paradoxical anxiety, hallucination
Nursing Measures:
Do not administer intra-arterially; may produce arteriospasm, gangrene.
Change from IV therapy to oral therapy as soon as possible.
Do not use small veins (dorsum of hand or wrist) for IV injection.
Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least onethird or eliminated.
Carefully monitor P, BP, respiration during IV administration.
Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit
ambulatory patients to operate a vehicle following an injection.
Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control,
presumably because of short duration of drug effect.
Monitor liver and kidney function, CBC during long-term therapy.
Taper dosage gradually after long-term therapy, especially in epileptic patients.
Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking
this medication.
Discuss risk of fetal abnormalities with patients desiring to become pregnant.
9) DIGOXIN
Brand name: Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)
Classification: Inotropics
Dosage: 5mg/2ml
Indication: Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac
failure where systolic dysfunction or ventricular dilatation is dominant; management of certain
supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation.
Action: inhibits sodium-potassium activated adenosine triphosphate, promoting movement of
calcium from extracellular to intra-cytoplasm and strengthening myocardial contraction, also acts
on CNS to enhance vagal tone
Adverse Reaction: nausea, vomiting, anorexia, headache, facial pain, fatigue, weakness,
dizziness, drowsiness, disorientation, mental confusion, bad dreams, convulsions
Nursing Measures:
Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in
infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify
prescriber. Note any change from baseline rhythm or rate.
Check dosage and preparation carefully.
Avoid IM injections, which may be very painful.
Follow diluting instructions carefully, and use diluted solution promptly.
Avoid giving with meals; this will delay absorption.
Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, cardiac
monitor on standby in case toxicity develops.
Monitor for therapeutic drug levels: 0.52 ng/mL.
10) DIPENHYDRAMINE
Brand name: Benadryl
Classification: antihistamine
Dosage: 50mg/ml
Indication: Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization,
serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses,
pruritus, food sensitivity, parkinsonism, motion sickness.
Action: prevents histamine mediated responses, drug provides local anesthesia and suppresses
cough reflex
Adverse Reaction: CV and CNS effects, blood disorders, GI disturbances, anti-muscarinic effects
and allergic reactions.
Nursing Measures:
Monitor carefully, assess for confusion, delirium, other anticholinergic side effects and fall risk.
Institute measures to prevent falls.
Assess movement disorder before and after administration.
Caution patient not to use oral OTC diphenhydramine products with any other product
containing diphenhydramine, including products used topically.
It can cause excitation in children. Caution parents or caregivers about proper dose calculation;
overdosage, especially in infants and children, can cause hallucinations, seizures or death Inform
patient that this drug may cause dry mouth. Frequent oral rinses, good oral hygiene, and
sugarless gum or candy may minimize this effect. Notify dentist if dry mouth persists for more
than 2 weeks.
11) EPINEPHRINE
Brand name:
Epinephrine Bitartrate
Aerosols: Primatene Mist
Epinephrine Borate
Ophthalmic solution: Epinal
Epinephrine Hydrochloride
Injection, OTC nasal solution: Adrenalin Chloride
Ophthalmic solution: Epifrin, Glaucon
Insect sting emergencies: EpiPen Auto-Injector (delivers 0.3 mg IM adult dose), EpiPen Jr. AutoInjector (delivers 0.15 mg IM for children)
OTC solutions for nebulization: AsthmaNefrin, microNefrin, Nephron, S2
Classification: Sympathomimetic, Alpha-adrenergic agonist, Beta1and beta2-adrenergic agonist,
Cardiac stimulant, Vasopressor, Bronchodilator, Antasthmatic drug, Nasal decongestant,
Mydriatic, Antiglaucoma drug
Dosage: 1mg/ml
Indication: Acute asthmatic attacks, Advanced cardiac life support
Action: Naturally occurring neurotransmitter, the effects of which are mediated by alpha or beta
receptors in target organs. Effects on alpha receptors include vasoconstriction, contraction of
dilator muscles of iris. Effects on beta receptors include positive chronotropic and inotropic
effects on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2
receptors); decreased production of aqueous humor.
Adverse Reaction: drowsiness, headache, nervousness, tremors, cerebral hemorrhage, dizziness,
weakness, vertigo, pain
Nursing Measures:
Monitor heart rate.
Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug;
small errors in dosage can cause serious adverse effects. Double-check pediatric dosage.
Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug
tolerance) can occur with prolonged use.
Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown
solutions. Drug solutions should be clear and colorless (does not apply to suspension for
injection).
Shake the suspension for injection well before withdrawing the dose.
Rotate SC injection sites to prevent necrosis; monitor injection sites frequently.
Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (a nitrate)
readily available in case of excessive hypertensive reaction.
Have an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing
readily available in case pulmonary edema occurs.
Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.
Discard diluted solution after 24 hr.
Refrigerate oral solution.
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.
13) HYDRALAZINE HYDROCHLORIDE
Brand name: Supres
Classification: antihypertension
Dosage: 20mg/ml
Indication: For hypertensive patient
Action: a direct acting peripheral vasodilator that relaxes arteriolar smooth muscles
Adverse Reaction: tachycardia, palpitation, angina pectoris, severe headache, dizziness, weight
gain, GI disturbances, pruritus, rashes, nausea and vomiting
Nursing Measures:
Give oral drug with food to increase bioavailability(drug should be given in a consistent
relationship ti ingestion of food for consistent response to therapy).
Drug may cause a syndrome resembling systemic lupus erythematosus (SLE). Arrange for
CBC, LE cell preparations, and ANA titers before and periodically during prolonged therapy,
even in the asymptomatic patient. Discontinue if blood dyscrasias occur. Reevaluate therapy if
ANA or LE tests are positive.
Arrange for pyridoxine if patient develops symptoms of peripheral neuritis.
Monitor patient for orthostatic hypotension which is most marked in the morning and in hot
weather, and with alcohol or exercise.
14) HYDROCORTISONE SODIUM SUCCINATE
Brand name: A-hydroCort, Solu-Cortef
Classification: corticosteroid hormones
Stock Dose:100 mg/ 2 mL, 250 mg/ 2 mL
Indication: endocrine, hematologic, rheumatic & collagen disorders, dermatologic, ophth, GI,
resp & neoplastic diseases, edematous states, control of severe incapacitating allergic conditions,
TB meningitis w/ subarachnoid block or impending block when used concurrently with
appropriate anti-TB chemotherapy, shock secondary to adrenocortical insufficiency or shock
unresponsive to conventional therapy when adrenocortical insufficiency may be present
Action: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes,
suppresses immune response, stimulates bone marrow and influences protein, fat, and
carbohydrate metabolism
Adverse Reactions: fluid and electrolyte disturbances, decreased carbohydrate tolerance,
impaired wound healing, thin fragile skin, muscle weakness, steroid myopathy, osteoporosis,
aseptic necrosis, peptic ulceration w/ possible perforation, cataracts, increased intraocular and
intracranial pressure, growth retardation, Cushingoid state, protein catabolism, psychic
derangements, exophthalmos, masking of infections, gasping syndrome, seizures, menstrual
irregularities.
Nursing Measures:
Give daily before 9 AM to mimic normal peak diurnal corticosteroid levels and minimize HPA
suppression.
Space multiple doses evenly throughout the day.
Do not give IM injections if patient has thrombocytopenic purpura.
Rotate sites of IM repository injections to avoid local atrophy.
Use minimal doses for minimal duration to minimize adverse effects.
Taper doses when discontinuing high-dose or long-term therapy.
Arrange for increased dosage when patient is subject to unusual stress.
Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible.
Do not give live virus vaccines with immunosuppressive doses of hydrocortisone.
Provide antacids between meals to help avoid peptic ulcer.
15) ISOSORBIDE-5- MONONITRATE
Brand name: Imdur
Classification: anti- anginal drug
Stock Dose: SL: 5 mg/mL ; Oral: 30 mg, 60 mg
Indication: prophylactic treatment of angina pectoris
Action: Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug
also may increase blood flow through the collateral coronary vessels
Adverse Reactions: headache, hypotension w/ dizziness and nausea, tachycardia
Nursing Measures:
Monitor BP and heart rate.
Assess location, duration, intensity, and precipitating factors of anginal pain.
16) ISOSORBIDE DINITRATE
Brand name: Isoket IV
Classification: anti anginal drug
Stock: IV amp 10 mg/ 10 mL
Dose: 10 mg/10mL
Indication: unresponsive left ventricular failure secondary to acute MI, severe or unstable angina
pectoris
Action: Isosorbide dinitrate is a smooth muscle relaxant. It is particularly effective on vascular
and bronchial smooth muscle. Its systemic cardiovascular effects are mainly due to a decrease in
venous return (pooling of blood in the peripheral venous system). Consequently, ventricular enddiastolic pressure and volume are diminished, thus reducing cardiac work and implicitly
myocardial oxygen requirements. The arterial vessels are dilated as well, though to a lesser
degree. This results in a slight drop in aortic and systemic blood pressure relieving the
myocardium from a part of its afterload. These nitrate-induced changes account for both the
antianginal effects of isosorbide dinitrate and for its beneficial effects in the treatment of
congestive heart failure.
Side effects/ adverse reactions: severe cerebral flow deficiency and decreased coronary perfusion
may develop, nitrate headache and nausea.
Nursing Measures:
Monitor BP and heart rate.
Assess location, duration, intensity, and precipitating factors of anginal pain.
17) MAGNESIUM SULFATE
Brand name: Elin Magnesium Sulfate
Classification: anticonvulsant
Dosage: 250 mg/10 mL
Indication: treatment of hypomagnesemia accompanied by signs of tetany, control of HTN,
encephalophathy & convulsions, prevention & control of convulsions in patients w/ preeclampsia
or eclampsia, prevention of hypomagnesemia in patients receiving TPN
Action: may decrease acetylcholine released by nerve impulses, but its anticonvulsant
mechanism is unknown
Adverse Reactions: flushing, sweating, hypotension, muscular weakness, sedation & confusion;
decreased deep tendon reflexes; resp. paralysis
Nursing Measures:
Monitor the following: I.V.: Rapid administration: ECG monitoring, vital signs, deep tendon
reflexes; magnesium, calcium, and potassium levels; renal function during administration.
Obstetrics: Patient status including vital signs, oxygen saturation, deep tendon reflexes, level of
consciousness, fetal heart rate, maternal uterine activity. Oral: Renal function; magnesium levels;
bowel movements.
18) MEPERIDINE HYDROCHLORIDE
Brand name: Demerol
Classification: antivertigo drug
Dosage: 100 mg/ 2mL
Indication: relief of moderate to severe pain, pre-op medication, support of anesth & obstet
analgesia
Action: binds with opiate receptors in the CNS, altering perception of and emotional response to
pain
Adverse Reactions: resp. depression, circulatory depression, resp arrest, shock, cardiac arrest, GI
disturbance, light headedness, dizziness, sedation, nausea, vomiting, sweating, euphoria,
dysphoria, weakness, headache, tremor, agitation, uncoordinated muscle movements, severe
convulsions, transient hallucinations & disorientation, visual disturbance, flushing, tachycardia,
bradycardia, palpitation, hypotension, syncope, phlebitis, urinary retention, allergic reactions,
pain at injection site and local tissue irritation.
Nursing Measures:
Make position changes slowly and in stages particularly from recumbent to upright posture. Lie
down immediately if light-headedness or dizziness occurs.
Lie down when feeling nauseated and to notify physician if this symptom persists. Nausea
appears to worsen with ambulation.
Avoid driving and other potentially hazardous activities until reaction to drug is known.
Codeine may impair ability to perform tasks requiring mental alertness and therefore to.
Do not take alcohol or other CNS depressants unless approved by physician.
Hyperactive cough may be lessened by avoiding irritants such as smoking, dust, fumes and
other air pollutants. Humidification of ambient air may provide some relief.
Do not breast feed while taking this drug.
19) METOCLOPRAMIDE
Brand name: Apo-Metoclop (CAN), Maxeran (CAN), Maxolon, Nu-Metoclopramide (CAN),
Octamide PFS, Reglan
Classification: antiemetic & anti-spasmodic
Dosage: 10 mg/ 2mL
Indication: disturbances of GI motility, nausea & vomiting of central & peripheral origin
associated w/ surgery, metabolic diseases, infectious & drug induced diseases, facilitate small
bowel intubation & radiological procedures of GIT
Action: stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and
blocks dopamine receptors at the chemoreceptor trigger zone
Adverse Reactions: extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety, less
frequently, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, bowel
disturbances.
Nursing Measures:
Monitor BP carefully during IV administration.
Monitor for extrapyramidal reactions, and consult physician if they occur.
Monitor diabetic patients, arrange for alteration in insulin dose or timing if diabetic control is
compromised by alterations in timing of food absorption.
Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50
mg IM).
Have phentolamine readily available in case of hypertensive crisis (most likely to occur with
undiagnosed pheochromocytoma).
20) MIDAZOLAM HYDROCHLORIDE
Brand name: Dormicum
Classification: hypnotics & sedatives
Dosage: 5mg/5mL
Indication: tab: disturbances of sleep rhythm, insomnia esp difficulty in falling asleep either
initially or after premature awakening, tab/inj: sedation in premed before surgical or diagnostic
Nursing Measures:
Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to
therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under close
supervision.
Ensure that patient swallows SR tablets whole: do not cut, crush, or chew them.
Monitor BP very carefully with concurrent doses of antihypertensives.
Monitor cardiac rhythm regularly during stabilization of dosage and periodically during longterm therapy.
Administer sustained-release form in the morning with food to decrease GI upset.
Protect IV solution from light.
Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and
adverse reactions.
28) IPRATROPIUM INHALATION
Brand name: Atrovent
Classification: Antiasthmatic & COPD Preparations, anticholinergics or antimuscarinics
Stock: 0.5 mg/2 mL
Dosage: Adult (including elderly) & adolescent >12 yr Acute attacks 1 vial, may repeat doses
until patient is stable. Maintenance: 1 vial tid-qid.
Indication: Bronchodilator for treatment of bronchospasm associated w/ COPD, including
chronic bronchitis, emphysema and asthma
Action: it works by binding to specific receptors (called muscarinic receptors) in the airway,
helping to relax the smooth muscle of the airway. When used to treat a runny nose, it works by
decreasing the production of fluid in the glands that line the nasal passages
Adverse Reaction: Headache, nausea, dry mouth, increased heart rate & palpitations, ocular
accommodation disturbances, GI motility disturbances, urinary retention, ocular side effects,
cough, local irritation, bronchoconstriction, skin rash, angioedema, urticaria, laryngospasm,
anaphylactic reactions.
Nursing Measures:
Protect solution for inhalation from light. Store unused vials in foil pouch.
Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.
Have patient void before taking medication to avoid urinary retention.
Teach patient proper use of inhalator.
29) FENOTEROL/IPRATROPIUM BROMIDE
Brand name: Berodual
Classification: Antiasthmatic & COPD Preparations
Dosage: Berodual inhalation soln Adult (including elderly) & adolescent >12 yr Treatment of 1
mL for immediate symptom relief. Intermittent & long-term treatment 1-2 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn 6-12
yr Treatment of attacks 0.5-1 mL. Intermittent & long-term treatment 0.5-1 mL for each
administration, up to qid. Moderate bronchospasm or w/ assisted ventilation 0.5 mL. Childn <6
yr (<22 kg body wt) Up to 0.5 mL up to tid. Berodual F UDV Adult & childn >12 yr Acute
asthma episodes 1 vial, in very severe cases, 2 vials are needed. Intermittent & long-term
treatment 1 vial up to qid.
Indication: prevention and treatment of symptoms in chronic obstructive airway disorders with
reversible bronchospasm
Action: for the prevention and treatment of reversible bronchospasm associated with bronchial
asthma and especially chronic bronchitis with or without emphysema
Adverse Reactions: Fine tremor of skeletal muscles, nervousness, restlessness, palpitations; less
frequently tachycardia, dizziness or headache. Dry mouth, throat irritation or allergic reactions,
cough, paradoxical bronchoconstriction (rare). Urinary retention may occur in particular, in
patients w/ preexisting outflow tract obstruction.
Nursing Measures:
Protect solution for inhalation from light. Store unused vials in foil pouch.
Use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of
narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
Ensure adequate hydration, control environmental temperature to prevent hyperpyrexia.
Have patient void before taking medication to avoid urinary retention.
Teach patient proper use of inhalator.
30) BUDESONIDE
Brand name: Symbicort
Classification: Corticosteroids
Dosage: 80/4.5 mcg x 60 doses; 160/4.5 mcg x 60 doses; 320/9 mcg x 60 doses
Indication: regular treatment of asthma where use of a combination (inhaled corticosteroid and
long acting beta 2 agonist) is appropriate
Action: work by reducing inflammation, which helps with several conditions ranging from
asthma to allergies toCrohns disease
Adverse Reactions: Abdominal pain, conjunctivitis (pinkeye), cough, diarrhea, ear infection or
inflammation, fever, fungal infection in mouth, headache, nasal or sinus inflammation,
nosebleed, pain, rash, respiratory infection, stomach or intestinal inflammation, throat
inflammation, viral infection, vomiting, wheezing
Nursing Measures:
Taper systemic steroids carefully during transfer to inhalational steroids; deaths from adrenal
insufficiency have occurred.
Arrange for use of decongestant nose drops to facilitate penetration if edema, excessive
secretions are present.
Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after each use.
Monitor pulmonary function tests before initiating therapy and periodically throughout course
to determine effectiveness of medication.
Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication
and notify physician or other health care professional immediately.
Instruct mother to take missed dose as soon as remembered, spacing remaining doses at regular
intervals. Do not double doses or increase the dose or frequency of doses.
Inform the mother not to smoke near the child and to avoid respiratory irritants.
Advise the mother to rinse the childs mouth with water after each inhalation dose to minimize
dry mouth.
33) TERBUTALINE SULFATE
Brand name: Pulmonyl
Classification: Antiasthmatic/ Brochodilator
Stock: 2.5 mg/ml
Dose: Adult 5-10 mg, Children 2-5mg
Indication: relief of bronchospasm in obstructive airway diseases
Action: It works by dilating (opening) the bronchioles of the lungs by relaxing the muscles
around them. This allows for easier airflow into and out of the lungs
Adverse Reactions: Headache, nausea, vomiting, palpitations, tachycardia, sweating &
drowsiness
Nursing Measures:
Use minimal periods of time; drug tolerance can occur with prolonged use.
Keep beta-adrenergic blocker readily available in case cardiac arrhythmias occur.
Do not recommended dosage.
34) HEPARIN SODIUM
Brand name: Britton Heparin Na
Classification: Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)
Dosage: 5000 iu/1 mL; 25000 iu/1 mL
Indication: treatment and prophylaxis of thromboembolic disorders
Action: Accelerates formation of antithrombin III-thrombin complex and deactivates thrombin,
preventing conversion of fibrinogen to fibrin
Adverse Reactions: Slight fever, headache, chills, nausea, vomiting, constipation, epistaxis,
bruising, slight haematuria, skin necrosis (SC inj), osteoporosis, alopecia. Hypersensitivity
reactions include urticaria, conjunctivitis, rhinitis, asthma, angioedema and anaphylactic shock.
Priapism. Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis;
bleeding
Nursing Measures:
Baseline blood coagulation tests, Hct, Hgb, RBC and platelet counts prior to initiation or
therapy and at regular intervals throughout therapy
Monitor APTT levels closely
Draw blood for coagulation tests 30 min before each scheduled SC or intermittent IV dose and
approximately q4h for pts receiving continuous IV heparin during dosage adjustments period.
After dosage is established, tests may be done once daily
Pts vary widely in their reaction to heparin; risk of hemorrhage appears greatest in women, all
patients > 60 y, and patients with liver disease or renal insufficiency.
Monitor vitals, report fever, drop in BP, rapid pulse and other S&S of hemorrhage
Observe all needle sites daily for hematoma and signs of inflammation
Have on hand protamine sulfate, specific heparin antagonist
35) ESMOLOL HYDROCHLORIDE
Brand name: Brevibloc
Classification: Beta blockers
Dosage: 100mg/10ml
Indication: supraventricular tachycardia; post-operative tachycardia or hypertension; noncompensatory sinus tachycardias; intra-operative tachycardia or hypertension; unstable angina,
non ST segment elevation MI
Action: A Class II antiarrythmic and ultra-short-acting selective beta blocker that decreases heart
rate, contractility and blood pressure
Adverse Reactions: Hypotension, bradycardia, heart failure, local irritation, diaphoresis,
peripheral ischaemia, dizziness, somnolence, confusion, fatigue, paraesthesia, peripheral
neuropathy, headache, weakness, irritability, dyspnoea, nausea, vomiting, blurred vision, urinary
retention, fever, rigor, muscular pain. Potentially Fatal: Profound bradycardia, AV block,
cardiogenic shock, asystole, bronchospasm.
Nursing Measures:
Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to
therapeutic dose. Dosage may be increased more rapidly in hospitalized patients under close
supervision.
Monitor cardiac rhythm regularly during stabilization of dosage and periodically during longterm therapy.
36) D 50-50
Brand name: Phil Pharmawealth/Atlantic 50% Dextrose
Classification: Intravenous & Other Sterile Solutions
Dosage: 50ml/vial
Indication: for hypoglycemia
Action: A simple water soluble sugar that minimizes glyconeogenesis and promotes anabolism in
patients whose oral caloric intake is limited
Adverse Reactions: Local pain, vein irritation, thrombophlebitis & tissue necrosis in the event of
extravasation. Fluid & electrolyte imbalance eg hypokalemia, hypomagnesemia &
hypophosphatemia; edema or water intoxication
Nursing Measures:
Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip. Infusion may result
in fluid overload.
Check IV site frequently and if infiltration is noted, turn off IV drip.
Watch out for signs of fluid overload (distended neck veins (JVD), rapid respirations, shallow
tidal volume, fine auscultatory crackles, dyspnea, and peripheral edema)
Watch out for signs of infiltration (swelling and pain around IV site).
37) POTASSIUM CHLORIDE
Brand name: Phil Pharmawealth/Atlantic Potassium Chloride
Classification: Electrolytes
Dosage: 40 meqs/20 ml
Indication: for hypokalemia, acute MI
Action: Replaces potassium and maintains potassium level
Adverse Reactions: GI ulceration (sometimes with haemorrhage and perforation or with late
formation of strictures) following the use of enteric-coated K chloride preparation;
hyperkalaemia. Oral: Nausea, vomiting, phlebiti and abdominal cramps. IV: Pain or phlebitis;
cardiac toxicity.
Nursing Measures:
Monitor serum potassium levels, renal function, and serum bicarbonate.
Explain to patient purpose of the medication and the need to take as directed,especially when
concurrent digoxin or diuretics are taken. A missed dose should be taken as soon as remembered
within 2 hr; if not, return to regular doseschedule. Do not double dose.
Emphasize correct method of administration. GI irritation or ulceration may result from
chewing enteric-coated tablets or insufficient dilution of liquid or powder forms. Some extendedrelease tablets are contained in a wax matrix that may be expelled in the stool. This occurrence is
not significant.
Instruct patient to avoid salt substitutes or low-salt milk or food unless approved by health care
professional.
Patient should be advised to read all labels to prevent excess potassium intake.
Advise patient regarding sources of dietary potassium.
Encourage compliance with recommended diet.
Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of
extremities.
Notify health care professional if nausea, vomiting, diarrhea, or stomach discomfort persists.
Dosage may require adjustment. Emphasize the importance of regular follow-up exams to
monitor serum levels and progress.
38) LIDOCAINE HYDROCHLORIDE
Brand name: Abbott Lidocaine
Classification: Anaesthetics - Local & General
Dosage: 50 ml/vial
40) DOPAMINE
Brand name: Intropin
Classification: Adrenergics (Sympathomimetics)
Dosage: 40 mg/Ml; 80mg/mL; 160 mg/mL
Indication : shock and hemodynamic imbalances, hypotension
Action: Stimulates dopaminergic and alpha beta receptors for the sympathetic nervous system
resulting in a positive inotropic effect and increased cardiac output. Action is dose-related; large
doses cause mainly alpha stimulation
Adverse Reaction: ectopic beats, tachycardia, anginal pain, palpitation, hypotension,
vasoconstriction, ventricular arrhythmias, hypertension, headache, anxiety, dilated pupils,
nausea, vomiting, decreased urine output, dyspnea
Nursing Measures:
Monitor vital signs and ECG closely throughout therapy.
Monitor I&O regularly; note decreases in urine output.
Monitor central venous pressure or pulmonary wedge pressure if possible during infusion.
Note significant changes in vital signs, ECG changes, deterioration of peripheral pulses, and/or
cold, mottled extremities
41) DOBUTAMINE
Brand name: Dobatrey
Classification: Adrenergics
Dosage: 12.5 mg/mL
Indication: increased cardiac output in short term treatment of cardiac decompensation caused by
depressed contractility
Action: Stimulates hearts beta1 receptors to increase myocardial contractility and stroke volume.
Increases cardiac output by decreasing peripheral vascular resistance, reducing ventricular filling
pressure, and facilitating AV node conduction
Adverse Reaction: increased systolic BP, increased heart rate, chest pain, increased number of
premature ventricular beats, headache, tingling sensations, paresthesia. nausea, vomiting,
dyspnea, phlebitis, local inflammation after infiltration, leg cramps
Nursing Measures:
Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure, central venous
pressure and urinary output carefully throughout infusion.
Monitor patency and placement of IV catheter to reduce risk of extravasation and phlebitis.
Watch out for symptoms of overdosage such as excessive hypertension, tachycardia, nausea,
vomiting, tremor, headache, chest pain
42) LIDOCAINE PREMIXED
Brand name: Xylocaine
Classification: Antiarrhythmic agent, Local anesthetic
Dosage: 0.2% (2mg/ml); 0.4% (4g/ml); 0.8% (8g/ml)
Indication: ventricular arrhythmias caused by MI, cardiac manipulation or cardiac glycosides
Action: Acts as an anesthetic by stabilizing the neuronal membrane by inhibiting the ionic fluxes
required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
Also acts as an antiarrhythmic by decreasing the depolarization, automaticity, and excitability in
the ventricles during the diastolic phase by a direct action on the tissues, especially the Purkinje
network, without involvement of the autonomic system. Neither contractility, systolic arterial
blood pressure, atrioventricular (AV) conduction velocity, nor absolute refractory period is
altered by usual therapeutic doses
Adverse Reaction: bradycardia, cardiac arrest, CV collapse, hypotension, apprehension,
confusion, dizziness, drowsiness, hallucinations, headache, light-headedness, mood changes,
nervousness, tremors, conjunctival hyperemia, corneal epithelial changes, diplopia, tinnitus,
visual disturbances, nausea, vomiting, erythema, petechiae, edema, injection-site reactions,
including bruising, burning, contusion, hemorrhage, local reactions, including soreness at IM
injection site, venous thrombosis or phlebitis, extravasation, burning, stinging, sloughing,
respiratory depression or arrest, hypersensitivity reactions
Nursing Measures:
Explain that adverse reactions related to the CNS (eg, drowsiness, confusion, paresthesias,
convulsions, respiratory arrest) can occur and are a result of CNS toxicity.
Advise patient that drug may cause dizziness or drowsiness and to avoid getting out of bed or
walking without assistance.
Advise patients that skin reactions, including erythema, petechiae, and edema, may occur with
intradermal injection.
Systemic effects can occur following topical use; use lowest possible dose to avoid serious
toxicity, shock, or heart block.
Do not use in patients with congenital or idiopathic methemoglobinemia or in infants younger
than 12mo of age who are receiving methemoglobin-inducing drugs.
Use with caution and in lower doses in patients with CHF, reduced cardiac output, digitalis
toxicity, and in elderly patients
43) MANNITOL
Brand name: Osmitrol
Classification: osmotic diuretic
Dosage: 5% , 10%, 15%, 20%, 25% in 500cc/1,000cc
Indication: test dose for marked oliguria or suspected inadequate renal function, oliguria, to
reduce intraocular or intracranial pressure, diuresis in drug intoxication
Action: Increases osmotic pressure of glomerular filtrate; drug elevates plasma osmolality
Adverse Reaction: Increased urination, nausea, runny nose, vomiting, severe allergic reactions
(rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips,
or tongue), blurred vision, chest pain, chills or fever, confusion, decreased alertness, difficulty
urinating, extreme dizziness, extreme thirst or dry mouth, fast or irregular heartbeat, headache,
muscle cramps, pain, redness, or swelling at the injection site, weakness
Nursing Measures:
Monitor vital signs, including CVP, and fluid intake and output.
Monitor weight, renal function, and serum sodium and potassium levels daily
Watch out for symptoms of overdosage such as excessive hypertension, tachycardia, nausea,
vomiting, tremor, headache, chest pain
To relieve thirst, give frequent mouth care and fluids
44) DEXTROSE 5% IN WATER (D5W) SOLUTION
Brand name: None
Classification: Isotonic/Hypotonic Solution
Dosage: 250ml bottles (5g dextrose/100ml water)
Indication: fluid replacement and caloric supplementation in patients who cant maintain
adequate oral intake or are restricted from doing so
Action: Provides some sugar for cellular metabolism and supplies body water
Adverse Reaction: Increases free water and may cause intracellular edema, fluid overload,
infiltration (swelling and pain at infusion site)
Nursing Measures:
Monitor infusion rate frequently; if signs of fluid overload, turn off IV drip. Infusion may result
in fluid overload.
Check IV site frequently and if infiltration is noted, turn off IV drip.
Watch out for signs of fluid overload (distended neck veins (JVD), rapid respirations, shallow
tidal volume, fine auscultatory crackles, dyspnea, and peripheral edema)
Watch out for signs of infiltration (swelling and pain around IV site).