Diazepam

Diazepam (Valium) is an anxiolytic, benzodiazepine and an antiepileptic.

Generic Name: diazepam
Brand Names: Valium
Pregnancy Category D
Controlled Substance C-IV

Drug classes
Benzodiazepine
Anxiolytic
Antiepileptic
Skeletal muscle relaxant (centrally acting)
Therapeutic actions
Exact mechanisms of action not understood; acts mainly at the limbic
system and reticular formation; may act in spinal cord and
at supraspinal sites to produce skeletal muscle relaxation; potentiates the
effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at
doses well below those necessary to cause sedation, ataxia; has little effect
on cortical function.

Indications
Management of anxiety disorders or for short-term relief of symptoms of
anxiety
Acute alcohol withdrawal; may be useful in symptomatic relief of acute
agitation, tremor, delirium tremens, hallucinosis
Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to
local pathology (inflammation of muscles or joints) or secondary to trauma;
spasticity caused by upper motor neuron disorders (cerebral palsy and
paraplegia); athetosis, stiff-man syndrome
Parenteral: Treatment of tetanus
Antiepileptic: Adjunct in status epilepticus and severe recurrent convulsive
seizures (parenteral); adjunct in seizure disorders (oral)
Preoperative (parenteral): Relief of anxiety and tension and to lessen recall in
patients prior to surgical procedures, cardioversion,
and endoscopic procedures
Rectal: Management of selected, refractory patients with epilepsy who
require intermittent use to control bouts of increased seizure activity
Unlabeled use: Treatment of panic attacks
Contraindications and cautions
Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute
narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy
(cleft lip or palate, inguinal hernia, cardiac defects, microcephaly,

pyloric stenosis when used in first trimester; neonatal withdrawal syndrome

reported in newborns); lactation.
Use cautiously with elderly or debilitated patients; impaired liver or renal
function; and in patients with a history of substance abuse.
Available forms
Tablets2, 5, 10 mg; SR capsule15 mg; oral solution1mg/mL, 5 mg/5 mL;
rectal pediatric gel2.5, 5, 10 mg; rectal adult gel10, 15, 20 mg; injection
5 mg/mL

Adverse effects
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy,
apathy, fatigue, light-headedness, disorientation, restlessness, confusion,
crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity,
tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration,
vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild
paradoxical excitatory reactions, during first 2 wk of treatment, visual and
auditory disturbances, diplopia, nystagmus, depressed hearing, nasal
congestion
CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension,
palpitations, edema
Dependence: Drug dependence with withdrawal syndrome when drug is
discontinued (common with abrupt discontinuation of higher dosage used for
longer than 4 mo); IV diazepam: 1.7% incidence of fatalities; oral
benzodiazepines ingested alone; no well-documented fatal overdoses
Dermatologic: Urticaria, pruritus, skin rash, dermatitis
GI: Constipation; diarrhea, dry mouth; salivation; nausea; anorexia; vomiting;
difficulty in swallowing; gastric disorders; elevations of blood enzymesLDH,
alkaline phosphatase, AST, ALT; hepatic impairment; jaundice
GU: Incontinence, urinary retention, changes in libido, menstrual
irregularities
Hematologic: Decreased hematocrit, blood dyscrasias
Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever,
diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain,
burning, and redness after IM injection

Interactions
Drug-drug
Increased CNS depression with alcohol, omeprazole
Increased pharmacologic effects of diazepam if combined
with cimetidine, disulfiram, hormonal contraceptives
Decreased effects of diazepam with theophyllines, ranitidine

Nursing considerations
Assessment
History: Hypersensitivity to benzodiazepines; psychoses, acute narrow-angle

glaucoma, shock, coma, acute alcoholic intoxication; elderly or debilitated

patients; impaired liver or renal function; pregnancy, lactation
Physical: Weight; skin color, lesions; orientation, affect, reflexes, sensory
nerve function, ophthalmologic examination; P, BP; R, adventitious sounds;
bowel sounds, normal output, liver evaluation; normal output; LFTs, renal
function tests, CBC
Interventions
WARNING: Do not administer intra-arterially; may produce arteriospasm,
gangrene.[/sws_red_box]
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 opioid analgesics with IV diazepam; dose should be reduced
by at least one-third or eliminated.
Carefully monitor P, BP, respiration during IV administration.
WARNING: 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 renal 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.
Teaching points
Take this drug exactly as prescribed. Do not stop taking this drug (long-term
therapy, antiepileptic therapy) without consulting your health care provider.
Caregiver should learn to assess seizures, administer rectal form, and
monitor patient.
Use of barrier contraceptives is advised while using this drug; if you become
or wish to become pregnant, consult with your health care provider.
It is advisable to wear a medical alert ID indicating your diagnosis and
treatment (as antiepileptic).
1. You may experience these side effects: Drowsiness, dizziness (may
lessen; avoid driving or engaging in other dangerous activities); GI
upset (take drug with food); dreams, difficulty concentrating, fatigue,
nervousness, crying (reversible).
Drug Name

Dosage & Route

Action

Indication

Adverse Effects

Co

PHENOBARBITAL
SODIUM
Luminal Sodium
Classifications: CENTRAL
NERVOUS SYSTEM AGENT;
ANTICONVULSANT;
SEDATIVE-HYPNOTIC;
BARBITURATE

Anticonvulsant
Adult: PO 100300
mg/d IV/IM 200600
mg up to 20 mg/kg
Child: PO/IV 38 mg/kg
or 125 mg/m2/d
Neonate: PO/IV 34
mg/kg/d (max: 5
mg/kg/d)
Status Epilepticus
Adult/Child: IV 1518
mg/kg in single or
divided doses (max: 20
mg/kg)
Neonate: IV 1520
mg/kg in single or
divided doses
Sedative
Adult: PO 30120
mg/d IV/IM 100200
mg/d
Child: PO 6 mg/kg/d or
180 mg/m2 in 3 divided
doses IV/IM 16100
mg/d (13 mg/kg)

Drug Name

Dosage & Route

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.

Action

Long-term
management of tonicclonic (grand mal)
seizures and partial
seizures; status
epilepticus,
eclampsia, febrile
convulsions in young
children. Also used as
a sedative in anxiety
or tension states; in
pediatrics as
preoperative and
postoperative
sedation and to treat
pylorospasm in
infants.

Indication

Body as a Whole:
Myalgia, neuralgia, CNS
depression, coma, and
death. CNS:
Somnolence, nightmares,
insomnia, "hangover,"
headache, anxiety,
thinking abnormalities,
dizziness, nystagmus,
irritability, paradoxic
excitement and
exacerbation of
hyperkinetic behavior (in
children); confusion or
depression or marked
excitement (older adult
or debilitated patients);
ataxia. CV: Bradycardia,
syncope, hypotension.
GI: Nausea, vomiting,
constipation, diarrhea,
epigastric pain, liver
damage. Hematologic:
Megaloblastic anemia,
agranulocytosis,
thrombocytopenia.
Metabolic:
Hypocalcemia,
osteomalacia, rickets.
Musculoskeletal: Folic
acid deficiency, vitamin
D deficiency.
Respiratory:
Respiratory depression.
Skin: Mild
maculopapular,
morbilliform rash;
erythema multiforme,
Stevens-Johnson
syndrome, exfoliative
dermatitis (rare). .

Contraindication

Sensitiv
manifes
history
respirat
history
sedativ
uncontr
(particu
(catego
sustaine
for chil

AMINOPHYLLINE
(theophylline
ethylenediamide)
(am-in-off'i-lin)
Corophyllin , Paladron ,
Phyllocontin,
Somophyllin,
Somophyllin-DF,
Truphylline
Classifications:
BRONCHODILATOR
(RESPIRATORY SMOOTH
MUSCLE RELAXANT);
XANTHINE

Bronchospasm
Adult: IV Loading
Dose 6 mg/kg over 30
min IV Maintenance
Dose nonsmoker, 0.5
mg/kg/h; smoker, 0.75
mg/kg/h; CHF or
cirrhosis, 0.25
mg/kg/h PO
nonsmoker, 0.5
mg/kg/h times 24 h in
4 divided doses;
smoker, 0.75 mg/kg/h
times 24 h in 4 divided
doses; CHF or
cirrhosis, 0.25 mg/kg/h
times 24 h in 4 divided
doses
Child: IV Loading
Dose 6 mg/kg IV over
30 min IV
Maintenance Dose
19 y, 1 mg/kg/h; >9
y, 0.75 mg/kg/h PO 1
9 y, 1 mg/kg/h times
24 h in 4 divided
doses; >9 y, 0.75
mg/kg/h times 24 h in
4 divided doses
Infant: PO/IV 611 mo,
0.87 g/kg/h; 26 mo,
0.5 mg/kg/h
Neonate: PO/IV 0.16
mg/kg/h
Neonatal Apnea
Neonate: PO/IV
Loading Dose 5
mg/kg PO/IV
Maintenance Dose 5
mg/kg/d divided q12h

Aminophylline is a salt
of theophylline with
effects similar to those
of other xanthines (e.g.,
caffeine and
theobromine). Action is
dependent on
theophylline content
(approximately 80%)
and is measured as
theophylline in the
serum.

To prevent and relieve

symptoms of acute
bronchial asthma and
treatment of
bronchospasm
associated with chronic
bronchitis and
emphysema.

Hypersensitivity to xanthine
derivatives or to
ethylenediamine component;
cardiac arrhythmias. Safety
during pregnancy (category C)
or lactation is not established.

CN
res
de
irri
diz
hy
con
Ca
tac
IV)
che
hy
arr
vom
he
dia
pa

Ampicillin

Generic name: ampicillin sodium

Oral: Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), NuAmpi (CAN), Penbritin (CAN), Principen
Pregnancy Category B

Drug classes
Antibiotic
Penicillin
Therapeutic actions
Bactericidal action against sensitive organisms; inhibits synthesis of bacterial
cell wall, causing cell death.
Indications
Treatment of infections caused by susceptible strains of Shigella, Salmonella,
Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria
gonorrhoeae, enterococci, gram-positive organisms (penicillin Gsensitive
staphylococci, streptococci, pneumococci)
Meningitis caused by Neisseria meningitidis
Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients
Adverse effects
CNS: Lethargy, hallucinations, seizures
CV: CHF
GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy
tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea,
enterocolitis, pseudomembranous colitis, nonspecific hepatitis
GU: Nephritis
Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia,
prolonged bleeding time
Hypersensitivity: Rash, fever, wheezing, anaphylaxis
Local: Pain, phlebitis, thrombosis at injection site (parenteral)
Other: Superinfectionsoral and rectal moniliasis, vaginitis
Contraindications and cautions
Contraindicated with allergies to penicillins, cephalosporins, or other
allergens.
Use cautiously with renal disorders.
Nursing considerations
Assessment
History: Allergies to penicillins, cephalosporins, or other allergens; renal
disorders; lactation
Physical: Culture infected area; skin color, lesion; R, adventitious sounds;
bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct,
urinalysis

Interventions
Culture infected area before treatment; reculture area if response is not as
expected.
Check IV site carefully for signs of thrombosis or drug reaction.
Do not give IM injections in the same site; atrophy can occur. Monitor
injection sites.
Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals
with a full glass of water; do not give with fruit juice or soft drinks.
Teaching points
Take this drug around-the-clock.
Take the full course of therapy; do not stop taking the drug if you feel better.
Take the oral drug on an empty stomach, 1 hour before or 2 hours after
meals; do not take with fruit juice or soft drinks; the oral solution is stable for
7 days at room temperature or 14 days refrigerated.
This antibiotic is specific to your problem and should not be used to self-treat
other infections.
You may experience these side effects: Nausea, vomiting, GI upset (eat
frequent small meals), diarrhea.
Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores,
rash, hives, fever, itching, severe diarrhea, difficulty breathing.

Salbutamol

Generic Name: Albuterol

Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, NovoSalbutamol, Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA, Volmax,
VoSpira ER
Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)

Indications
To control and prevent reversible airway obstruction caused by asthma or
chronic obstructive pulmonary disorder (COPD)
Quick relief for bronchospasm
For the prevention of exercise-induced bronchospasm
Long-term control agent for patients with chronic or persistent bronchospasm

Mechanism of Action
It relieves nasal congestion and reversible bronchospasm by relaxing the
smooth muscles of the bronchioles. The relief from nasal congestion and
bronchospasm is made possible by the following mechanism that takes place
when Salbutamol is administered.
First, it binds to the beta2-adrenergic receptors in the airway of the smooth

muscle which then leads to the activation of the adenyl cyclase and
increased levels of cyclic- 35-adenosine monophosphate (cAMP).
When cAMP increases, kinases are activated.
Kinases inhibit the phosphorylation of myosin and decrease intracellular
calcium.
Decreased in intracellular calcium will result to the relaxation of the smooth
muscle airways.
Contraindications
Hypersensitivity to adrenergic amines
Hypersensitivity to fluorocarbons
Precaution
Cardiac disease including coronary insufficiency, a history of stroke, coronary
artery disease and cardiac arrhythmias
Hypertension
Hyperthyroidism
Diabetes
Glaucoma
Geriatric patients older individuals are at higher risk for adverse reactions
and may require lower dosage
Pregnancy especially near term
Lactation
Children less than 2 years of age because safety of its use has not been
established
Excess inhaler use which may lead to tolerance and paradoxical
bronchospasm
Side Effects and Adverse Reactions
Nervousness
Restlessness
Tremor
Headache
Insomnia
Chest pain
Palpitations
Angina
Arrhythmias
Hypertension
Nausea and vomiting
Hyperglycemia
Hypokalemia
Nursing Interventions
Assess lung sounds, PR and BP before drug administration and during peak
of medication.

Observe fore paradoxical spasm and withhold medication and notify

physician if condition occurs.
Administer PO medications with meals to minimize gastric irritation.
Extended-release tablet should be swallowed-whole. It should not be crushed
or chewed.
If administering medication through inhalation, allow at least 1 minute
between inhalation of aerosol medication.
Advise the patient to rinse mouth with water after each inhalation to
minimize dry mouth.
Inform the patient that Albuterol may cause an unusual or bad taste.

Amikacin

Generic Name: amikacin sulfate

Brand Name: Amikin
Classifications: Anti-infective; Aminoglycoside
Pregnancy Category: C

Availability
250 mg/mL, 50 mg/mL injection
Actions
Semisynthetic derivative of kanamycin with broad range of antimicrobial
activity that includes many strains resistant to other aminoglycosides.
Pharmacologic properties are essentially the same as those of gentamicin.
Appears to inhibit protein synthesis in bacterial cell and is usually
bactericidal.
Therapeutic Effects
Effective against a wide variety of gram-negative bacteria including
Escherichia coli, Enterobacter, Klebsiella pneumoniae, most strains of
Pseudomonas aeruginosa, and many strains of Proteus species, Serratia,
Providencia stuartii, Citrobacter freundii, Acinetobacter. Also effective against
penicillinase- and non-penicillinase-producing Staphylococcus species, and
against Mycobacterium tuberculosis and atypical mycobacteria.
Uses
Primarily for short-term treatment of serious infections of respiratory tract,
bones, joints, skin, and soft tissue, CNS (including meningitis), peritonitis
burns, recurrent urinary tract infections (UTIs).
Unlabeled Uses: Intrathecal or intraventricular administration, in
conjunction with IM or IV dosage.
Contraindications

History of hypersensitivity or toxic reaction with an aminoglycoside

antibiotic.
Safety during pregnancy (category C), lactation, neonates and infants, or use
period exceeding 14 years old is not established.
Cautious Use
Impaired renal function; eighth cranial (auditory) nerve impairment;
preexisting vertigo or dizziness, tinnitus, or dehydration; fever; older adults,
premature infants, neonates
Adverse Effects (1%)
CNS: Neurotoxicity: drowsiness, unsteady gait, weakness, clumsiness,
paresthesias, tremors, convulsions, peripheral neuritis.
Special Senses: Auditoryototoxicity, high-frequency hearing loss, complete
hearing loss (occasionally permanent); tinnitus; ringing or buzzing in ears;
Vestibular: dizziness, ataxia.
GI: Nausea, vomiting, hepatotoxicity.
Metabolic: Hypokalemia, hypomagnesemia.
Skin: Skin rash, urticaria, pruritus, redness.
Urogenital: Oliguria, urinary frequency, hematuria, tubular necrosis,
azotemia.
Other: Superinfections.
Interactions
Drug: ANESTHETICS, SKELETAL MUSCLE RELAXANTS have additive
neuromuscular blocking effects; acyclovir, amphotericin B, bacitracin,
capreomycin, cephalosporins, colistin, cisplatin, carboplatin, methoxyflurane,
polymyxin B, vancomycin, furosemide, ethacrynic acid increase risk of
ototoxicity and nephrotoxicity.
Pharmacokinetics
Peak: 30 min IV; 45 min to 2 h IM.
Distribution: Does not cross bloodbrain barrier; crosses placenta;
accumulates in renal cortex.
Elimination: 94%98% excreted renally in 24 h, remainder in 1030 d.
Half-Life: 23 h in adults, 48 h in neonates.
Nursing Considerations
Assessment & Drug Effects
Baseline tests: Before initial dose, C&S; renal function and
vestibulocochlear nerve function (and at regular intervals during therapy;
closely monitor in the older adult, patients with documented ear problems,
renal impairment, or during high dose or prolonged therapy).
Monitor peak and trough amikacin blood levels: Draw blood 1 h after IM or
immediately after completion of IV infusion; draw trough levels immediately
before the next IM or IV dose.

Lab tests: Periodic serum creatinine and BUN, complete urinalysis. With
treatment over 10 d, daily tests of renal function, weekly audiograms, and
vestibular tests are strongly advised.
Monitor serum creatinine or creatinine clearance (generally preferred) more
often, in the presence of impaired renal function, in neonates, and in the
older adult; note that prolonged high trough (>8 mg/mL) or peak (>3035
mg/mL) levels are associated with toxicity.
Monitor S&S of ototoxicity (primarily involves the cochlear (auditory) branch;
high-frequency deafness usually appears first and can be detected only by
audiometer); indicators of declining renal function; respiratory tract
infections and other symptoms indicative of superinfections and notify
physician should they occur.
Monitor for and report auditory symptoms (tinnitus, roaring noises, sensation
of fullness in ears, hearing loss) and vestibular disturbances (dizziness or
vertigo, nystagmus, ataxia).
Monitor & report any changes in I&O, oliguria, hematuria, or cloudy urine.
Keeping patient well hydrated reduces risk of nephrotoxicity; consult
physician regarding optimum fluid intake.
Patient & Family Education
Report immediately any changes in hearing or unexplained ringing/roaring
noises or dizziness, and problems with balance or coordination.
Do not breast feed while taking this drug without consulting physician.

Metronidazole

Generic Name: Metronidazole

Brand Name: Flagyl, Metric 21, Noritade, Protostat, MetroGel-Vaginal
Classification: Antibiotic, Antibacterial, Amebicide, Antiprotozoal
Patients Dose:
Metronidazole 500mg1 tab TID PO
Minimum Dose:
PO: 250mg TID IV : 100mg /mL
Maximum Dose:
PO: 750 mg TID 6-10days IV :100mg/mL
Availability:
Capsules: 375 mg
Injection: 5mg/mL
Oral suspension: 200mg/5ml
Tablets: 200mg, 250mg, 400mg, 500mg
Topical gel: 0.75 %,1%
Routes of Administration
PO, IV, Topical
Pharmacologic Class:
Nitroimidazole
Therapeutic Class:
Antibacterial Antiprotozoal
Pharmacokinetics Onset:
PO: unknown IV: immediate Topical: unknown
Peak
PO: 1-2 hrs IV: immediate Topical: 6-10hrs
Duration:
PO, IV, Topical: unknown
Therapeutic Effects:
Hinders growth of selected organisms, including most anaerobic bacteria and
protozoa

General Indications
Amoebic hepatic abscess

Intestinal amebiasis
Trichomoniasis
Retractory trichomoniasis
Bacterial infection caused by anaerobic microorganisms
To prevent postoperative infection in contaminated colorectal surgery
Pelvic inflammatory disease
Contraindications
Contraindicated with hypersensitivity to metronidazole; pregnancy (do not
use for trichomoniasis in first trimester).
Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis),
blood dyscrasias, lactation.
Adverse Effects
Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures,
peripheral neuropathy, fatigue
Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset,
cramps
Dysuria, incontinence, darkening of the urine
Thrombophlebitis (IV); redness, burning, dryness, and skin irritation (topical)
Severe, disulfiram-like interaction with alcohol, candidiasis (superinfection)
Nursing Responsibilities
Before
Assess pt. Infection
Watch carefully for edema because it may cause sodium retention
Assess skin for severity areas of local adverse reactions
Record number and character of stools
Assess pt.s and familys knowledge of drug therapy
During
Give drug with meals to minimize GI distress
To treat trichomoniasis, give drug for 7 days instead of 2-g single dose
Use only after T.vaginalis has been confirmed by wet smear
Tablets may be crushed for pts. with difficult swallowing
Do not use aluminium needles or hubs, color will turn orange/rust
After
Tell pt. that metallic taste and dark or red brown urine may occur
Instruct pt. to take oral form with meals to minimize reactions
Instruct to complete full course of therapy
Tell pt. not to use alcohol or drugs that contain alcohol.
May cause dizziness/ light headedness
Reference:
Nursing 2008 Drug Handbook: Lippincott Williams & Wilkins