Submitted by: APRIL F. SAROL DRUG STUDY submitted to: Mr.

Jericho Alicante

BSN 3Y2-20

MAGNESIUM SULFATE

Actions Uses Planning Implementation Evaluation Drug Interactions

Magnesium Magnesium Sulfate is used in Availability: Dosage and Side Effects to Central Nervous
Sulfate is an ion obstetrics primarily to inhibit Administration: Report: System
normally found premature labor. It may also be Injection: 4% Depressants.
in the blood in used to control seizure activity (0.325 • IM: Deep Tendon Central nervous
concentrations associated with preeclampsia mEq/mL); Intramuscu Reflexes. system depressants,
of 1.8 to or eclampsia. When used as an 12.5% (1 lar including
mEq/mL), and The
3mEq/L. When anticonvulsant or to inhibit injection is
50% (4 presence or barbiturates,
administered labor, blood levels should be extremely
mEq/mL) absence of patellar analgesics, general
parenterally in maintained at 4 to 8 mEq/L. painful.
solutions. reflex (knee-jerk anesthetics,
doses sufficient Avoid if
Patients maintained at a reflex), biceps tranquilizers, and
to produce levels possible,
magnesium serum level reflex, or radial alcohol, will
greater than 4 or potentiate the
between 3and 5 mEq/L rarely reflex are primary
mEq/L, The administer central nervous
show any side effects from monitoring
drug may in
hypermagnesemia. At levels parameters for system depressant
depress the conjunctio effects of
approximately 5 to 8 mEq/L, magnesium
central nervous n with a magnesium sulfate.
patients begin to show sulphate therapy.
system and local
block peripheral increasing signs of toxicity that anesthetic. The patellar Periodically
nerve correlate fairly well to serum reflex should be check orientation to
levels. Early signs of maternal • IV: It is make sure the
transmission, monitored hourly
toxicity are complaints of absolutely patient is not
producing if the patient is
“feeling hot all over” and essential suffering from
anticonvulsant receiving a
“being thirsty all the time”, that an magnesium
effects and continuous IV
smooth muscle flushed skin, and diaphoresis. infusion infusion or before toxicity.
relaxation. Patients may then become pump be every dose if being
hypotensive and have used to administered Neuromuscular
depressed patellar, radial, and help intermittently IM Blockade.
biceps reflexes, and flaccid control the or IV. If the reflex Concurrent use of
muscles. Later signs of infusion of is absent, further neuromuscular
hypermagnesemia are central the loading doses should be blockings agents
nervous system depression dose and withheld until it and magnesium
shown first by anxiety, then continuous returns. If the sulfate will further
confusion, lethargy, and drip. patellar reflex depress muscular
drowsiness. If serum levels cannot be used activity. Monitor
continue to increase, cardiac Anticonvulsant: because of epidural the patient closely
depression and respiratory anesthesia, the for depressed
• IM: reflexes and
paralysis may result. Loading biceps or radial
Magnesium sulfate should be respiration.
dose: 10g reflex may be
administered with extreme o 50% used.
caution to patients with solution
impaired renal function and Intake and
(20 mL) is Output.
whose urine output is less than divided
100 mL over the past 4 hours. Magnesium
into two toxicity is more
Therapeutic Outcomes doses of 5g likely to occur in
each patients with
The primary (10mL) reduced renal
therapeutic outcomes and is output. Report
associated with magnesium injected by urine outputs of
sulfate therapy are as follows: deep IM less than 30 mL
injection per hour or less
• Arrest of into each than 100 mL over
buttock;
 preterm labor. 1% 4 hours. Observe
lidocaine tha urine color, and
• Elimination of or procaine measure the
seizure may be specific gravity.
activity. added to
each Note any
Nursing Process for other fluid and
Magnesium Sulfate syringe to
reduce electrolyte loss
Premedication Assessment: pain on such as vaginal
injection. bleeding, diarrhea,
1. Obtain baseline vital signs, or vomiting.
The IM
especially blood pressure,
loading Vital Signs. Vital
pulse, and respirations.
dose is signs(Blood
2. Perform a mental status usually pressure, heart
examination: level of administer rate, and rhythm)
consciousness, orientation, and ed at the should be
anxiety level. same time measured every 15
that 4 to 5g to 30 minutes
3. Check deep tendon reflexes; of 50% when a patient is
report hyporeflexia or absence solution receiving a
of reflexes. (10mL) IM continuous IV
every 4 infusion. Take vital
4. Review intake and output
hours in signs before and
record; report declining output.
alternate after each
5. Have calcium gluconate or buttocks. administration for
calcium chloride and patients receiving
• IV:
equipment for IV intermittent
Loading
administration available if therapy.
dose: 4g of
needed.
6. Obtain baseline laboratory magnesiu The
values (e.g., serum magnesium m sulfate respiratory rate
level). is added to should be at least
250 mL of 16 breaths per
7. Monitor fetal heart rate and D5W and minute before the
uterine activity; report distress. infused administration of
slowly at a further doses of
rate of magnesium sulfate.
10mL per
minute. Do not
(The IV administer
loading additional doses if
dose is there is a reduced
usually respiratory rate, a
administer drop in blood
ed at the pressure, or fetal
same time heart rate, or other
as a 10g signs of fetal
IM loading distress.
dose.) Overdose. The
Maintenan antidote for
ce dose is magnesium
1 to 2g per intoxication
hour by(shown by
continuous respiratory
infusion. depression and
Preterm Labor. heart block) is
calcium gluconate.
IV: Loading dose: A 10% solution of
 4g of magnesium calcium gluconate
sulfate should be kept at
intravenously over the patient’s
15 to 20 minutes. bedside ready for
Maintenance dose: use. The dosage is
1 to 3 g per hour 5 to 10 mEq (10-
by continuous 20 mL) IV over 3
infusion. minutes.

NOTE: Deep Administer

tendon flexes, cardiopulmonary
intake and output, resuscitation until
vital signs, and the patient
orientation to the responds
environment must appropriately.
be monitored on a
regular, ongoing Neonates. Infants
basis. born of mothers
who receive
magnesium sulfate
must be monitored
for hypotension,
hyporeflexia, and
respiratory
depression.

CALCIUM GLUCONATE
Definition INDICATIONS DOSAGE AND DRUG WARNINGS PRECAUTIONS
ADMINISTR INTERAC
ATION TIONS
Calcium Calcium Calcium The For
Gluconate is the gluconate is used to Gluconate should be ionotropic andintravenous General
calcium salt of treat conditions administered toxic effects of use only.
gluconic acid, an arising from calcium intravenously either cardiac glycosides Subcutaneous To avoid
oxidation product of deficiencies such as directly or by infusion. and calcium are or undesirable
glucose, and contains hypocalcemic tetany, The dose is dependent synergistic andintramuscular reactions that may
9.3% calcium, which is hypocalcemia related upon the individual arrhythmias may injection may follow rapid
about one-third of the to requirements of the occur if these drugscause severe intravenous
calcium in strength of hypoparathyrodism patient. Calcium are given together necrosis and administration of
calcium chloride USP. and hypocalcemia Gluconate may also be (particularly when sloughing. calcium gluconate,
Since it is soluble to due to rapid growth administered by calcium is given This product the drug should be
the extent of only one or pregnancy. It is intermittent infusion at intravenously). contains given slowly, e.g.,
part in 30 parts of cold also used in the a rate not exceeding Intravenous aluminum that approximately 1.5
water, the 10% treatment of black 200 mg/min, or by administration of may be toxic. mL over a period
solution is widow spider bites to continuous infusion. calcium should be Aluminum of one minute.
supersaturated and is relieve muscle avoided in patients may reach When injected
stabilized by the cramping and as an SIDE EFFECTS receiving cardiac toxic levels intravenously,
addition of calcium adjunct in the glycosides; if
with calcium gluconate
saccharate tetrahydrate treatment of rickets, Patients may necessary, calcium prolonged should be injected
0.46% w/v (which osteomalacia, lead complain of tingling should be given parenteral through a small
supplies calcium colic and magnesium sensations, a sense of slowly in small administration needle into a large
6.2%). Each mL sulfate overdosage. oppression or heat amounts. if kidney vein in order to
contains 98 mg of Calcium gluconate waves and a calcium function is avoid too rapid
calcium has also been or chalky taste Calcium impaired. increase in serum
gluconatemonohydrate, employed to decrease following the complexes Premature calcium and
4.6 mg of calcium capillary intravenous tetracycline neonates are extravasation of
saccharate permeability in administration of antibiotics particularly at calcium solution
tetrahydrate, and Water allergic conditions, calcium gluconate. rendering them risk because into the
for Injection USP, q.s. nonthrombocytopenic inactive. The two their kidneys surrounding tissue
Each mL provides 9.3 purpura and Rapid drugs should not be are immature, with resultant
mg (0.465 exudative dermatoses and they
milliequivalents) of such as dermatitis intravenous injection given at the same require large necrosis.
calcium. herpetiformis and for of calcium salts may time orally nor amounts of
pruritus of eruptions cause vasodilation, should they be calcium and Rapid
caused by certain decreased blood mixed for phosphate injection of
drugs. In pressure, bradycardia, parenteral solutions, calcium gluconate
hyperkalemia, cardiac arrhythmias, administration. which contain may cause
calcium gluconate syncope and cardiac aluminum. vasodilation
may aid in arrest. Use in Calcium decreased blood
antagonizing the digitalized patients Gluconate Injection Resear pressure,
cardiac toxicity may precipitate has been reported ch indicates bradycardia,
provided the patient arrhythmias. to be incompatible that patients cardiac
is not receiving with intravenous with impaired arrhythmias,
digitalis therapy. Local necrosis solutions kidney syncope and
and abscess formation containing various function, cardiac arrest.
may occur with drugs. Published including
intramuscular data are too varied premature Because of
injection. and/or limited to neonates, who the danger involved
permit receive in simultaneous use
generalizations, parenteral of calcium salts and
and specialized levels of drugs of the
references should aluminum at digitalis group, a
be consulted for greater than 4 digitalized patient
specific to 5 should not receive
information. mcg/kg/day an intravenous
accumulate injection of a
aluminum at calcium compound
levels unless indications
associated are clearly defined.
with central
nervous Pregnancy
system and
bone toxicity.
Categor
Tissue loading yC
may occur at
even lower Animal
rates of reproduction
administration. studies have not
been conducted
with calcium
gluconate. It is also
not known whether
calcium gluconate
can cause fetal
harm when
administered to a
pregnant woman or
can affect
reproduction
capacity. Calcium
gluconate should
be given to a
pregnant woman
only if clearly
needed.

Nursing
Mothers

It is not
known whether this
drug is excreted in
human milk.
Because many
 drugs are excreted
in human milk,
caution should be
exercised when
calcium gluconate
is administered to a
nursing woman.

CONTRAINDICATIONS

Calcium salts are contraindicated in patients with ventricular fibrillation or hypercalcemia. Intravenous administration of
calcium is contraindicated when serum calcium levels are above normal.

USES: This medication is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets.
It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets),
decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in
certain patients to make sure they are getting enough calcium (e.g., women who are pregnant, nursing, or postmenopausal, people
taking certain medications such as phenytoin, phenobarbital, or prednisone).

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If
there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right
amount of calcium is important for building and keeping strong bones.

HOW TO USE: Take this medication by mouth with food. Follow all directions on the product package, or take as directed by your
doctor. For best absorption, if your daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If
you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using the chewable product, chew it well before swallowing.

If you are using the effervescent tablet, allow the tablet to fully dissolve in a glass of water before drinking it. Do not chew or
swallow the tablet whole.

If you are using the liquid product, measure the medication with a dose-measuring spoon or device to make sure you get the
correct dose. Do not use a household spoon. If the liquid product is a suspension, shake the bottle well before each dose.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit
from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.

If you think you may have a serious medical problem, seek immediate medical attention.
HYDRALAZINE
Actions
Hydralazine causes direct arteriolar smooth
muscle relaxation, resulting in reduced
peripheral vascular resistance. The
reduction in peripheral resistance causes a
reflex increase in heart rate, cardiac output
and rennin release with sodium and water
retention. Consequently, the hypotensive
effectiveness is reduced unless the patient
is also taking a sympathetic inhibitor and a
diuretic.
Uses Therapeutic Outcomes
This antihypertensive agent is used to treat The primary therapeutic outcome of
stage 2 hypertension and hypertension hydralazine is reduction in blood pressure.
associated with renal disease and toxaemia
of pregnancy. It may also be used to
provide symptomatic relief in patients with
heart failure by reducing resistance
(afterload) to left ventricular output.
Because of reflex increase in cardiac rate,
hydralazine is often used in combination
with a drug that inhibits tachycardia.
A combination product (BiDil) containing
hydralazine and isosorbide dinitrate has
recently been approved by the U.S. Food
and Drug Administration (FDA). This
combination has been shown to reduce
hospitalizations, improve quality of life,
and reduce mortality among Americans
with hypertension and heart failure.
Premedication Assessment Planning Implementation
Obtain baseline blood pressure Availability. Dosage and Administration
readings in the supine and
standing positions and apical PO: 10, 25,50, and 100 mg Adult: PO: Initially, 10 mg four
pulse. tablets; intramuscular (IM): 20 times daily for the first 2 to 4
mg/mL in 1-mL ampoules. days, then 25 mg four times
daily. The second week,
increase the dosage to 50 mg
four times daily as the patient
tolerates the dosage and the
blood pressure is brought under
control. IM, IV: 20 to 40
repeated as necessary. Monitor
blood pressure often. Results
usually become evident within
10 to 20 minutes.
Evaluation
Side Effects to Expect
Nausea, dizziness,
palpitations, tachycardia,
numbness and tingling in the
legs, nasal congestion.
Although these symptoms may
be anticipated, they require
monitoring. If severe, they
should be reported so that the
dosage can be adjusted
appropriately. Nasal congestion
can be treated with an
antihistamine, such as
chlorpheniramine.
Orthostatic Hypotension.
This may occur particularly
during initiation of theraphy.
Patients can usually avoid this
complication by rising slowly
from supine and sitting
positions.
Side Effects to Report
Fever, chills, joint and muscle
pain, skin eruptions.

Tell patients to report the

development of these
symptoms. Monitor laboratory
reports for leukocyte counts
and the antinuclear antibody
(ANA) titer.

Drug Interactions

Drugs That Enhance

Therapeutic and Toxic
Effects.

Diuretics, alcohol, beta-

adrenergic blocking agents and
other antihypertensive agents.
Monitor the blood pressure
response to the cumulative
effects of antihypertensive
agents. Take the blood pressure
in supine and standing
positions,

Monitor for an increase in

severity of side effects, such as
sedation, hypotension, and
bradycardia or tachycardia.