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GENERIC: CLONIDINE HYDROCHLORIDE BRAND: catapres CLASSIFICATION cardiovascular agent; central-acting antihypertensive; analgesic
Mechanism of Action
Centrally acting antiadrenergic derivative. 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. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.
• Step 2 drug in steppedcare approach to treatment of hypertension, either alone or with diuretic or other antihypertens ive agents. Epidural administratio n as adjunct therapy for severe pain.
Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE
CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal. GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large bowel, altered taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain (sodium retention). CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation, hallucination, nervousness, restlessness, anxiety, mental depression. Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild erythema. Special Senses: Dry eyes. Urogenital: Impotence, loss of libido.
Monitor BR closely. Determine positional changes (supine, sitting, standing). With epidural administration, frequently monitor BP and HR. Hypotension is a common side effect that may require intervention. Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen. Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern. Determine weight daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention. Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes.
urticaria. vomiting. or amebicidal action • Indication Asymptomatic and symptomatic trichomoniasis in females and males. pyuria. to ensure that amebae have been eliminated. depression. proctitis. Anti-protozoals Mechanism of Action • Disrupts DNA and protein synthesis in susceptible organisms • Bactericidal. usually up to 3 mo. confusion. gynecologic infections. first trimester of pregnancy (category B). fever. active CNS disease. flushing). Lab tests: Obtain total and differential WBC counts before. fleeting joint pains. • • DOSAGE: 500mg iv q8 • • • • • • . Monitor patients on lithium for elevated lithium levels.stomatitis. acute intestinal amebiasis and amebic liver abscess. IV metronidazole is used for the treatment of serious infections caused by susceptible anaerobic bacteria in intra abdominal infections. abdominal cramps. Urogenital: Polyuria.Name of Drug GENERIC: metronidazole BRAND: cetaz CLASSIFICATION Anti-infectives. septicemia. overgrowth of Candida. Blood dyscrasias. incontinence CV: ECG changes (flattening of T wave). weakness. furry tongue) or its becoming more prominent with therapy to physician promptly. Nursing Consideration • Administer with food or milk to minimize GI irritation. epigastric distress. insomnia GI: Nausea. Discontinue therapy immediately if symptoms of CNS toxicity develop. and after therapy. Urine may appear dark or reddish brown (especially with higher than recommended doses). ataxia. Monitor for S&S of sodium retention.and postoperative prophylaxis Contraindication Adverse Effect Body as a Whole: hypersensitivity (rash. pruritus. This appears to have no clinical significance. numbness and paresthesia of extremities). lactation. especially in patients on corticosteroid therapy or with a history of CHF. dry mouth. Report appearance of candidiasis(milk-vaginal discharge. drowsiness. during. dysuria.. CNS: Vertigo. Monitor especially for seizures and peripheral neuropathy (e. anorexia. skin infections. especially if a second course is necessary. restlessness. diarrhea. Repeat feces examinations. and for both pre. irritability. metallic or bitter taste. Tablets may be crushed for patients with difficulty swallowing. headache. constipation.g.
Citrobacter. confusion. hypertension. E. muscular weakness. edema. obesity. lactation. tremor. therapy may begin pending test results. Proteus species. hypotension GI: hepatic toxicity. increased or decreased . Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy. leucopenia. KlebsiellaEnterobacterSerratia species. stomatitis. seizures. dizziness (reversible. such as: ringing in the ears. burn patients. visual disturbances. DOSAGE: 80mg iv q8 • CNS: tinnitus. vaccinia. lethargy. active infection with herpes. vestibular paralysis. causing cell death Indication Serious infections caused by susceptible strains of Pseudomonas aeruginosa. pre-existing hearing loss. Aminoglycoside antibiotic Mechanism of Action Bactericidal: inhibits protein synthesis in susceptible strains of gramnegative bacteria. agranulocytosis. Contra -indication allergy to any aminoglycosi des Use cautiously with renal or hepatic disease. muscle twitching. pancytopenia. and perform frequent mouth care) • . reevaluate therapy. • Repeat C&S if improvement does not occur in 3–5 days. loss of appetite (instructed the client toeat frequent small meals. headache. eosinophilia. anorexia. infant botulism. nausea. disorientation. coli. Staphylococcus species Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin). increased salivation GU: nephrotoxicity Hematologic: Leukemoid reaction. vomiting. leukocytosis. older adults. patients receiving high doses or therapy beyond 10 days. weight loss. particularly for patients with impaired renal function. hemolytic anemia. neuromuscular blockade CV: Palpitations. thrombocytopenia.Name of Drug GENERIC: gentamycin BRAND: garamycin CLASSIFICATION Antiinfective. fungal infections. myasthenia gravis. appears to disrupt functional integrity of bacterial cell membrane. parkinsonism. depression. tingling. pregnancy Adverse Effect Nursing Consideration • Client experiencing side effects. numbness. deafness (partially reversible to irreversible). use safety measures if severe) • In cases of nausea. sulfite sensitivity. patients with fever or extensive burns. Determine creatinine clearance and serum drug concentrations at frequent intervals. headache. vomiting. nystagmus. varicella. paresthesia. granulocytosis. vertigo. dizziness. anemia. infants (renal immaturity).
itching Local: pain. exfoliative dermatitis. superinfections .reticulocyte count. splenomegaly. joint pain. apnea. electrolyte disturbances Hypersensitivity: Purpura. rash. urticaria. arachnoiditis at IM injection sites Other: fever. irritation.
• Assess bowel function routinely. vomiting. • Assess BP & RR before and periodically during administration. concomitant use of CNS depressants or MAOIs. and intensity of pain before and 2-3 hr (peak) after administration. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. seizures • CV: Hypotension. opioids. This should not prevent patient from receiving adequate analgesia. anxiety. may cause opioid withdrawal symptoms. Respiratory depression has not occurred with recommended doses. pallor. flatulence • Other: Potential for abuse. • Prolonged use may lead to physical and psychological dependence and tolerance. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk. renal or hepatic impairment. sweating. • Monitor patient for seizures. urticaria • GI: Nausea. location. headache. bradycardia • Dermatologic: Sweating. constipation. Use cautiously with pregnancy. rash. tachycardia. pruritus. anaphylactoid reactions Interactions Drug-drug • Decreased effectiveness with carbamazepine Increased risk of tramadol toxicity with MAOIs Nursing Consideration • Assess type. or psychotropic drugs. changing to an opioid agonist may be required to relieve pain. Most patients who receive tramadol for pain do not develop psychological dependence. • Inhibits reuptake of serotonin and norepinephrine in the CNS. dizziness or vertigo. lactation. seizures.Name of Drug GENERIC: Tramadol hydrochloride BRAND: CLASSIFICATION Analgesic (centrally acting) DOSAGE: 50mg iv q8 Mechanism of Action Binds to muopioid receptors. Indication • Relief of moderate to moderate ly severe pain Contraindication • Contraindicat ed with allergy to tramadol or opioids or acute intoxication with alcohol. Adverse Effect CNS: Sedation. although these may be milder than with opioids. dry mouth. If tolerance develops. • Assess previous analgesic history. dreaming. May occur within recommended dose • . confusion.
or other durgs that decrese the seizure threshold.range. Naloxone (Narcan) may reverse some. opioid analgesics. but not all. Treatment should be symptomatic and supportive. or Mao inhibitors). • Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia. . Maintain adequate respiratory exchange. of the symptoms of overdose. • Overdose may cause respiratory depression and seizures. Risk increased with higher doses and inpatients taking antidepressants (SSRIs. tricyclics.
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