DRUG STUDY

Classification: ANTI-INFECTIVES-Quinolones

KARLEEN L. JARO

GENERIC NAME Ciprofloxaci n BRAND NAME Ciprobay DOSAGE 250-500mg BID

INDICATION Infections of the resp. tract, middle ear,paranas al sinuses, eyes, kidneys, urinary tract

ACTION Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria

CONTRAINDICATIO N Drugs that inhibit peristalsis. Infants and children, growing adolescents. Pregnancy and lactation

PRECAUTION/ ADVERSE REACTION PRECAUTION Severe and persistent diarrhea during and after treatment ADVERSE RXN Common:Nausea, diarrhea, vomiting, rash Uncommon: Anorexia, headache,dizzine ss, fever, GI and abdominal pain, flatulence, confusion, vertigo

NURSING CONSIDERATIO N >Assess pt for previous sensitivity reaction >Assess pt for any s/s of infection before & during treatment >Assess for adverse reactions >assess pt. & family’s knowledge of drug therapy

Classification: GASTROINTESTINAL DRUGS-Laxatives

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

LACTULOSE BRAND NAME duphalac DOSAGE Infants: 5 ml Children: 1-6 y/o- 510ml 7-14y/o15ml 15-45y/o- 1530ml. Dose given in 3 days

Constipatio n, salmonello sis. Treatment of hepatic encephalo pathy

Inhibits bacterial DNA gyrase thus preventin g replicatio n in susceptib le bacteria

Pt who require a low lactose diet. Galactosemia deficiency. Intestinal obstruction.

PRECAUTION: Lactose intolerance, diabetes Adverse Rxn: Abdominal discomfort associated with flatulence and intestinal cramps. Nausea, vomiting, diarrhea on prolonged use.

>Assess condition before therapy and reassess regularly thereafter to monitor drug’s effectiveness >Monitor pt for any adverse GI reactions, nausea,vomiting,diarr hea, >Assess for adverse reactions >for pt. with hepatic encelopathy: regularly assess mental condition >monitor I & O >monitor for Inc. glucose level in diabetic pts

Classification: ANTI-ALLERGICS_Anti-histamine

KARLEEN L. JARO

GENERIC NAME levocetirizin e BRAND NAME Xyzal

INDICATION Treatment of symptoms associated with allergic conditions (including ocular symptoms)

ACTION Longacting nonsedating antihistami ne that selectively inhibits peripheral HI receptors

CONTRAINDICATIO N Pts with severe renal impairment, pts with rare problems of galactose intolerance

PRECAUTION/ ADVERSE REACTION PRECAUTION Adjustment of dose is recommended in elderly pts w/ compromised renal function. Lactation. ADVERSE RXN Dry mouth, headache, fatigue, rhinitis, abdominal pain, migraine

DOSAGE Adult and adolescents more than 12 yrs- 1 tab/day Pedia: 6-12 yrs- 1 tab/ day Classification: ANTI-INFECTIVES-Penicillins

NURSING CONSIDERATIO N >obtain pt hx inc. drug hx and any unkown allergies >monitor pulse, BP, respiration > observe dizziness and excessive sedation

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Amoxicillin BRAND NAME Amoxil DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/d ay divided dosage given every 8 hrs

Infections of the resp. tract, skin & skin structures,paran asal sinuses, genitourinary tract, otitis media, sinusitis, meningitis,septic emia

Prevents bacterial cell wall synthesis during replication .

Hypersensitivity to penicillins, cephalosporins. Not used to treat pneumonia, bacteremia pericarditis during acute stage.

PRECAUTION: Hypersensitivit y: rxn range from mild to life threatening ADVERSE RXN: Dizziness, fatigue, insomnia, skin rashes, itchy eyes, sore or dry mouth, abnormal taste sensation, diarrhea, rectal bleeding

>obtain pt’s hx of allergy >Assess pt for any s/s of infection >Assess for pt’s sensitivity to penicillin ot other cepalosporins >assess for allergic rxn during therapy >Assess for bowel pattern, if diarrheashld be discontinue

Classification: CARDIOVASCULAR DRUGS-Calcium Antagonist

KARLEEN L. JARO

GENERIC NAME felodipine BRAND NAME Plendil DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/da y divided dosage given every 8 hrs

INDICATION Treatment of hypertensio n

ACTION Inhibits calcium ion influx across cell membrane, resulting in inhibition of excitation/ contraction.

CONTRAINDICATION Sick sinus syndrome, second or third-degree Av block except with functioning pacemaker, hypotension with systolic BP<90mmHg

PRECAUTION/ ADVERSE REACTION ADVERSE RXN: Peripheral edema, hypotension, syncope, MI, angina, tachycardia, headache, dizziness, lightheadedness, nausea, vomiting, sinusitis, wheezing cough, sneezing

NURSING CONSIDERATION >assess fluid volume status, adequacy of pulses, pitting edema, dehydration, hypotension, dry mouth >monitor cardiac status: BP, pulse, respiration >Assess for angina pain: duration,intensity, aggravating factors

Classification: CARDIOVASCULAR DRUGS-Angiotensin II Antagonist

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

TELMISART AN BRAND NAME Pritor DOSAGE Adult: 2080mg daily, usual starting dose 40mg daily

Treatment of hypertension

Blocks the vasoconstricti ve ans aldosteroneone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the ATI receptor in many tissues

Hypersensitivity, pregnancy, lactation. Severe hepatic or renal impairment

PRECAUTION: Can cause death to the fetus if used on the 2nd trimester, safety in children not yet established ADVERSE RXN Diarrhea and angioedema. Sinusitis, pharyngitis, upper resp. tract infection, back pain

>assess pt’s condition before therapy >Assess for heart failure >Assess for obstructive jaundice >monitor for possible drug induced adverse rxn >close monitoring of BP and pulse

Classification: ANTI-DIARRHEALS

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Loperamide HCl BRAND NAME IMODIUM DOSAGE Adult: initially 2 cap; subsequent dose a cap after every stool

Symptomati c control of acute and chronic diarrhea

Acts on the nerve endings &/or intramural ganglia of the intestinal wall to decrease intestinal motility, resulting to prolonged retention of feces in the intestines

Those in whom constipation must be avoided, children less than 1 yr, hypersensitivity, abdominal distention

PRECAUTION: Hepatic dysfunction, chronic diarrhea, dehydration ADVERSE RXN Hypersensitivit y reactions, flatulence, abdominal pain, distention or discomfort, nausea and vomiting

>assess pt’s bowel pattern >check response after 48 hrs >Assess hydration >assess for abdominal distention >inform pt. that dry mouth may be relieved by frequent sips of water, hard candy or sugarless gum

KARLEEN L. JARO

Classification: CENTRAL NERVOUS SYSTEM DRUGS-Anti-anxiety ( Anticonvulsant/Hypnotics/Sedatives/Anxiolytics)
GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

DIAZEPAM BRAND NAME Valium DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/da y divided dosage given every 8 hrs

Symptomatic relief of anxiety, agitation, tension

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Hypersensitivity. Dependence, withdrawal symptoms

PRECAUTION: Hypersensitivi ty: cardiorespirat ory insufficiency, pregnancy, lactation ADVERSE RXN Dizziness, fatigue, blurred vision, dependence, withdrawal reactions

> inform pt. that drug may be taken with food >advice pt. not to abruptly discontinue drug after long term use >advice pt. to avoid driving and activities that require alertness bec, drug can cause drowsiness >inform pt. that smoking may decrease effect

KARLEEN L. JARO

Classification: DIETARY/NUTRITIONAL DRUGS-Vitamins and Minerals
GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Calcium carbonate BRAND NAME Calci-Aid DOSAGE Adult: 1-2 capsules daily Pedia: 1-2 tablets daily

Antacid, calcium supplement, osteoporosis

Decreases total acid load of GI tract. Increase esophageal sphincter tone

Hypercalcemia, bone tremors, severe renal failure,hypersensit ivity

PRECAUTION: History of stone formation, pregnancy ADVERSE RXN Constipation, flatulence, diarrhea, renal dysfunction, acid rebound

> administer as antacid 1 hr fter meal and at bed time >administer as supplement 1 ½ hrs after meal and at bed time >advice pt to increase fluids to 2L unless contraindicate d

Classification: ANTI-ASTHMA
GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Salbutamol BRAND NAME Ventolin vilmax DOSAGE Adult: 8mg tablet BID Pedia: 3-12 yrs 4mg tab BID

Reversible airway obstruction including bronchial asthma, chronic bronchitis

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Hypersensitivity

PRECAUTION: Hyperthyroidism ,DM, cardiovascular disease ADVERSE RXN Fine tremor of skeletal muscle, feeling of tension, a compensory small increase in heart rate, headache, muscle cramps

> drug may be decrese sensitivity of spirometry used for diagnosis of asthma >syrup may be taken as young as age 2 >monitor for evidence of allergic rxn

Classification: CARDIAC DRUGS-Centrally-acting Drugs
GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

orlistat BRAND NAME Xenical DOSAGE Adult: 1 cap with each main meal

Long-term treatmentof obese and overweight patients with risk factors and comorbiditi, associated with obesity including hypercholesterolemia, NIDD, impaired glusoce tolerance, hypertension and reduction of visceral fat

Inhibits the absorptio n of dietary fat

Chronic malabsorption syndrome

PRECAUTION: Children <18 yrs, pregnancy, lactation, shld be given with caution to diabetic pt. ADVERSE RXN Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation. Fecal incontinence

> assess effectiveness of other medications pt may be taking (esp. anticoagulant) >pt. may experience dizziness or lightheadedness >advice pt to report persistens back pain, muscle, or joint pain, signs of resp. tract infection

Classification: ANALGESICS
GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATIO N

KARLEEN L. JARO

Mefenamic acid BRAND NAME Dolfenal DOSAGE Adult: start with 75150mcg BID Severe HPN 300mg BID

Relief of pain including muscular, rheumatic, traumatic, dental, postop and postpartum pain, headache, migraine, fever, dysmenorrhe a

Aspirin-like drug that has analgesic,antipyr etic, & antiinflammatory activities

Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs

PRECAUTION: If rash occurs, administration should be stopped, asthmatics, Hx of liver and kidney disease ADVERSE RXN GI discomfort, diarrhea or constipation, gas pain, nausea, vomiting, drowsiness

> assess pt.’s pain before therapy >monitor for possible drug induced adverse reactions >advice pt. not to take drug for more than 7 days >advice pt. to report immediately persistence or failure to relieve pain

Classification: ANTI-INFECTIVES
GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

chloroquine BRAND NAME chlorofoz DOSAGE Adult: initially four 250mg tablet followed by 2 tab after 6-8 hrs, then2 tab daily for 2 days

Antacid, calcium suppleme nt, osteoporo sis

Inhibits the perioxidativ e activity of heme, and disrupt its nonenzyma tic polymerizat ion to hemozin

Presence of retinal or visual field changes

PRECAUTION: Hepatic disease, alcoholism, monitor complete blood count ADVERSE RXN Headache, nausea, vomiting, diarrhea, skin eruptions

>advice pt that compliance with dosage schedule & duration of tx are necessary >caution pt to avoid alcohol while taking drug >assess hepatic status (dec. appetite,jaundice, dark urine >instruct pt to use sunglasses in bright sunlight

Classification: GASTROINTESTINAL DRUGS-LAXATIVES
GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

bisacodyl BRAND NAME Dulcolax DOSAGE Adult: 2 tab at bedtime or 30 mins before breakfast, max 4 tabs Pedia: greater than 4 yrs- 1 tab Suppository: Pedia – 5mg Adult- 10mg

Constipatio n, relief of evacuation in hemorrhoid s, prep for barium enema, pre and post-op

Increases peristalsis & motor activity of the small intestines by acting directly on the smooth muscles.

Nausea, vomiting or other symptoms of appendicitis, acute surgical abdomen, abdominal pain, ulcerative lesions of colon

PRECAUTION: Caution is advised during 1st 3 mos of pregnancy as well as administration to children < 4 yrs ADVERSE RXN Occasional abdominal discomfort, soreness in anal region

> monitor frequency & character of stool >monitor occurrence of adverse rxn >swallow the tablet whole, do not crush or chew

Classification: RESPIRATORY DRUGS- MUCOKINETICS/EXPECTORANTS
GENERIC NAME INDICATION ACTION CONTRAINDICATI ON PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Carbocisteine BRAND NAME Loviscol DOSAGE Capsule: Adult: 250mg 2 caps, 500mg 1 cap TID Suspension: Adult – 15ml; Pedia: 612yrs: 5ml, 2-5 yrs: 1.252.5 ml Syr: 6-12yrs: 10ml 2-5 yrs: 2.5ml Drops: 12-24mos: 1.25ml, 911mos: 1ml, 6-8mos: 0.75ml, 3-5mos: .50ml, <3mos: 0.25ml All doses 3-4x/ day

Acute/chro nic disorders of the upper & lower respiratory tract associated with the secretion & formation of excessive and viscid mucus

Reduces the viscosity of bronchial secretions & facilitate expectoration

active peptic ulcer. Hypersensitivit y to carbocisteine

PRECAUTION: Hx of peptic ulcer, hypothyroidis m ADVERSE RXN Nausea, headache, vomiting, anorexia, gastric discomfort, diarrhea, GI bleeding

>assess cough: type, frequency, character > advice medical consultation for persistent cough of more than 7 days >advice pt. to avoid smoking >suggest sugarless lozenges to decrease throat irritation and cough

Classification: CARDIOVASCULAR DRUGS- ANTI-ARRYTHMICS
GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTIO N/ NURSING CONSIDERATION

KARLEEN L. JARO

ADVERSE REACTION

Amiodarone Hcl BRAND NAME Cordarone DOSAGE
Tab: initially 3 tab/day maintenance: 1-2 tab/day

Cardiac arrhythmias, ventricular rhythm disorders

Blocks sodium channels at rapid pacing frequencies, prolonging myocardial cell action potential and refractory period

Sinus bradycardia,. SA and AV blocks, pregnancy, hypersensitivity

PRECAUTI ON: Goiter, CHF, respirator y disease ADVERSE RXN Bradycard ia, heart block, sinus arrest, flushing, fatigue, insomnia, headache

>assess cardiovascular status before therapy > loading dose with food to decrease nausea >instruct pt. that skin discoloration is reversible >advice pt. to wear sunglasses for photophobia, protective clothing to prevent burning

Classification: GASTROINTESTINAL DRUGS- ANTI-FLATULENTS

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

metoclopramide BRAND NAME Plasil DOSAGE Adult 10mg 3x/day pedia: 15-20yrs 5-10mg 3x/day 5-14yrs: 2.5-5mg 3x/day 3-4yrs: 3mg 23x/day 1-2yrs: 1mg 23x/day Under 1 yr: 1mg 2x/day

Gastrointestinal motility, nausea, vomiting of central and peripheral origin assoc. with surgery

Dopamine antagonist that acts by increasing receptor sensitivity and response of upper GIT tissues to acetylcholine

GI hemorrhage, epileptics, hypersensitivity, lactation, pts. With breast cancer

PRECAUTIO N: Activities requiring mental alertness, elderly, lactation ADVERSE RXN Restlessnes s, drowsiness, fatigue, insomnia, headache, dizziness, nausea

>give 30 mins before meals and at bed time > assess mental status during treatment >tell pt. To avoid driving & other hazardous activities for at least 2 hrs >advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug

Classification: CARDIOVASCULAR DRUGS- BETA-BLOCKERS
GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE NURSING CONSIDERATION

KARLEEN L. JARO

REACTION

metropolol BRAND NAME Neobloc DOSAGE
Adult : 50mg BID or 100 mg OD

Hypertensi on, chronic angina pectoris

Exerts mainly beta-1 adrenergic blocking activity but also blocks beta-2 receptors at high doses

AV blocks, cardiogenic shock, sinus bradycardia

PRECAUTION: Slowing of heart rate, occasionally severe bradycardia may lead to vertigo ADVERSE RXN Occasionally fatigue, dizziness, headache, GI disturbance, skin rashes nausea

>tablet may be crashed or swallowed whole > instruct pt to take with meals >inform the pt that drug only controls but does not cure the disorder >tell the pt. not to discontinue drug abruptly can worsen angina

Classification: CNS DRUGS- HYPNOTICS/ SEDATIVES

KARLEEN L. JARO

GENERIC NAME

INDICATIO N

ACTION

CONTRAINDICATIO N

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

phenobarbit al BRAND NAME luminal DOSAGE
100-320mg. max 600mg daily

Shortterm treatment of insomnia, long- term treatment of generalize d toniclonic seizures

Depressant and anticonvulsant effects may be related to its ability to increase the inhibitory activity of GABA on nerve impulses

Hypersensitivity to barbiturates, pregnancy, severe renal, hepatic, resp. impairment

PRECAUTION: Impaired renal, hepatic cardiac or resp. functions ADVERSE RXN Dizziness, headache, hangover, confusion in elderly, GI disturbances, allergic reactions, sedation and depression may occur

>instruct pt. to avoid alcohol and other CNS depressant to prevent inc. depression > withdrawal insomnia may occur after short-term use, insomnia improves in 1-3 nights >on empty stomach, 30-60 mins before bedtime for expected sleeplessness >advice pt to change positions slowly to prevent orthostatic hypotension

Classification: CARDIOVASCULAR DRUGS- ANTI-INFECTIVE ( ANTI-FUNGALS)

KARLEEN L. JARO

GENERIC NAME

INDICATIO N

ACTION

CONTRAINDICATIO N

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Nystatin BRAND NAME Mycostatin DOSAGE 4-6ml susp 4x/day or 12 tabs 3x/day Infants: 2ml pedia susp 4x/day

Antifungal antibiotic used for prophylax is and treatment of candidiasi s of the skin and mucous membran es

Interferes with fungal DNA replication: binds sterols in fungal cell membrane, w/c increases permeability, resulting in leaking of cell nutrients

hypersensitivity

PRECAUTION: Discontinue if sensitization occurs ADVERSE RXN Diarrhea, GI distress, nausea, vomiting

>oral suspension, shake well before using > report persistent nausea and vomiting, diarrhea or if condition worsens >inform physician if pt is pregnant

Classification: Anticholinergic

KARLEEN L. JARO

GENERIC NAME
Atropine SO4 BRAND NAME Dose/Route: 0.5-1.0 mg IVP Q3-5min max of 0.04mg/kg (ETT 2-2.5 x dosage) OPP: 2-5mg Q1015 min (Peds 0.05mg/kg) Pediatric: 0.02mg/kg (minimum 0.1mg

INDICATION

ACTION
Helps to reduce saliva and fluid in the respiratory tract. May also be used to treat a slow heartbeat or insecticide or mushroom poisoning

CONTRAINDICATION
Contraindicated in patients with glaucoma, pyloric stenosis or prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication.

SIDE EFFECTS
Can cause blurred vision, dilated pupils, dry mouth, palpitations urinary retention, tachycardia drowsiness, and confusion • • • •

NURSING CONSIDERATION
monitor level of consciousness do not sit up or stand up quickly advise patient to stay out of bright light chew sugarless gums and suck hard candies to avoid mouth dryness use lubricating drops is wearing contact lenses avoid extreme heat

- Antidote to overdosage with cholinergic substances (nerve gases, poisonous mushroom) - Pre-op medication to reduce salivary and resp. tract secretions.

Classification: Andrenergics

KARLEEN L. JARO

GENERIC NAME Dobutamin e HCL

INDICATION
Increased cardiac output in short-term treat ment of cardiac decompensati on caused by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery

ACTION
Stimulates heart’s beta1 receptors to increase myocardial contractility and stoke volume. At dosages, drug increases cardiac output by decreasing peripheral vascular resistance, Zeducing ventricular filling pressure and facilitating AV node therapeutic conduction

CONTRAINDICATI ON
Contra indicated in patients hypersensitive to drug and in those with idiopathic hypertrophic subaortic stenosis Use cautiously in patients with history of hypertension because drug may increase pressor response Use cautiously in patients with history of sulfite sensitivity .

SIDE EFFECTS

NURSING CONSIDERATION
Before starting dobutamine therapy: (1) give a plasma volume expander to correct hypovolemia (2) give cardiac glycoside • Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output • Monitor Electrolyte levels. Drug may lower potassium level • Do not confuse with Dopamine • Tell patient to report adverse reactions promptly, especially labored breathing and drug-induced headache Instruct patient to report discomfort at IV insertion

BRAND NAME
Dobutrex

Infusion rate: 2.5-10 mcg/kg/min

Increased heart rate, hypertension, Angina, phlebitis, nonspecific chest pain, palpitations, hypotension, nausea, vomiting, shortness of breath, hypersensitivit y reactions

KARLEEN L. JARO

site

Classification: Antihistamine/ anti allergic GENERIC NAME INDICATION ACTION CONTRAINDICATI ON SIDE EFFECTS NURSING CONSIDERATION

KARLEEN L. JARO

Diphenhydra mine HCl BRAND NAME Benadryl
DOSAGE Capule/syrup Adult: 50 mg tid-qid. Children >20 lb: 12.5-25 mg tidqid

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

Antihistami ne that reduces allergic reactions, motion sickness and vertigo (dizziness and loss of balance), and Parkinson's disease

• Premature & newborn infants; asthma attack; lactation • • •

CV & CNS effects Blood disorders GI disturbances Antimuscarini c effects Allergic reactions

Special precaution for • • • Narrow-angle glaucoma stenosing peptic ulcer pyloroduodenal obstruction • symptoms of prostatic hypertrophy or bladderneck obstruction • History of bronchial asthma • increased intraocular pressure • hyperthyroidism • CV disease or hypertension. • Pregnancy. Avoid operating vehicles or machinery

Classification: Antagonist and antidotes
GENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS/ ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Naloxone hydrocholori de BRAND NAME Narcan
DOSAGE Adult : 0.4 -2 mg IV q2 to 3 mins. p.r.n.

Displaces Known previously suspected administer narcotic ed induced narcotic respiratory analgesics depression from their including that receptors. cause by Has no pentazocine pharmacol and ogic propaxyphene activity of its own

Patient known to be hypersensitive to naloxone hydrochloride

Tachycardia Hypertension Nausea Vomiting Tremors

Safest drug to use when cause respiratory depression is uncertain. Monitor respiratory depth and rate. Be prepared to provide O2, ventilation and resuscitative measures. Also been shown to improve circulation in refractory shock

Classification: Antispasmodic

KARLEEN L. JARO

GENERIC NAME

INDICATION indicated for the control of abdominal pain (colic) associated with spasmodic colic, flatulent colic

ACTION Relieve cramps or spasms of the stomach,in testines, and bladder

CONTRAINDICATION Myasthenia gravis, megacolon. Parenteral Untreated narrowangle glaucoma, prostate hypertrophy w/ urinary retention, mechanical stenosis of GIT, tachycardia
• • •

SIDE EFFECTS/ ADVERSE REACTION
xerostomia tachycardia urinary retention • allergic & skin reactions • rarely dyspnea (in patients w/ history of bronchial asthma or allergy) • parenteral visual accommodation disturbance infrequently inj site pain (after IM inj), rarely anaphylactoid reactions & anaphylactic shock

NURSING CONSIDERATION • Drug compatibility should be monitored closely in patients requiring adjunctive therapy • Avoid driving & operating machinery after parenteral administration Avoid strict heat

Hyoscine-Nbutylbromide
BRAND NAME

Buscopan

DOSAGE Adult & childn >6 yr 1-2 tab 3-5 times daily. Amp Acute attacks of colicky pain Adolescent >12 yr 12 amp IV, IM or SC several times daily. Max: 100 mg aily. Infant & young childn Severe cases: 0.3-0.6 mg/kg body wt by slow IV, IM or SC several times daily. Max: 1.5 mg/kg body

KARLEEN L. JARO

wt/day.

Classification: CNS stimulant CONTRAINDICATI ON SIDE EFFECTS/ ADVERSE REACTION NURSING CONSIDERATION

GENERIC NAME

INDICATION

ACTION

KARLEEN L. JARO

Citicoline
BRAND NAME Somazine amp DOSAGE 125 mg/mL 12 inj/day. 250 mg/mL 1 inj/day

CVD in acute & recovery phase, symptoms & signs of cerebral insufficiency (dizziness, memory loss, poor concentration, disorientation, recent cranial trauma & their sequelae.)

- Citicoline is an interneuronal communication enhancer. It increases the neurotransmission levels because it favors the synthesis and production speed of dopamine in the striatum, acting then as a dopaminergic agonist thru the inhibition of tyrosinehydroxylase.

Parasympathetic hypertonia

Gastrointestinal disorders

•Somazine must not be administered along with medicaments containing meclophenoxate

Classification: Loop Diuretic

KARLEEN L. JARO

GENERIC NAME Furosemide
BRAND NAME Lasix DOSAGE
Adult: Initially 1/2-1-2 tab/day Maintenance: 1/2-1 tab/day 20-40 mg IV/IM Children: 2 mg/kg body/wt

INDICATION
acute pulmonary edema edema hypertension

ACTION
inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

CONTRAINDICATI ON
• • Anuria hepatic coma & precoma • severe hypokalemia &/or hyponatremia • hypovolemia w/ or w/o hypotension Hypersensitivity to furosemide or sulfonamides

SIDE EFFECTS
• vertigo, dizziness, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, hypokalemia, anemia muscle spasm

NURSING CONSIDERATION
To prevent nocturia, give preparation in the morning and early in the afternoon • Watch for signs of hpokalemia • do not confuse with Torsemide or Lasix with Lonox • advise patient to take drug with food to prevent GI upset inform patient of possible need for potassium or magnesium supplements

Classification: Anri- ulcer

KARLEEN L. JARO

GENERIC NAME Ranitidine HCL
BRAND NAME Xantac DOSAGE 50 mg by slow IV then 0.1250.25 mg/kg/hr as continuous IV infusion

INDICATION
•Duodenal and gastric ulcers •Maintenance therapy for gastric and duodenal ulcer •GERD •Erosive esophagitis •Heartburn

ACTION
Completely inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretions

CONTRAINDICATI ON
Contraindicated in patients hypersensitive to drug and those with porphyria •Use cautiously in patients with hepatic dysfunction. Adjust dose in patients with impaired renal function

SIDE EFFECTS
• Vertigo, malaise, headache, blurred vision, jaundice, burning and itching at injection site

NURSING CONSIDERATION
•Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate •Ranitidine may be added to total parenteral nutrition solution •Instruct patient on proper use of OTC preparation as indicated. •Remind patient to take once daily prescription drug at bedtime for best results •Instruct patient to take without regard to meals because absorption isn’t affected by food

KARLEEN L. JARO

Classification: Nutrional Agents (Calorics) GENERIC NAME Dextrose
BRAND NAME DOSAGE Dosage depends on fluid and caloric requirements

INDICATION
Fluid replacement and caloric supplementati on in patient who can’t maintain adequate oral intake or who is restricted from doing so.

ACTION
Minimize glyconeogenesi s and promotes anabolism in patients who can’t receive sufficient oral caloric intake.

CONTRAINDICATI ON
Hyperglycemia, diabetic coma, intracranial or intra spinal hemorrhage or delirium tremens. •

SIDE EFFECTS
Mental confusion, unconsciou sness in hyperosmol ar nonketotic syndrome. Pulmonary edema Glycosuria, osmotic diuresis Metabolic: hyperglyce mia, hypervolem ia Rapid termination after long term infusion •

NURSING CONSIDERATION
Use cautiously in cardiac or pulmonary disease, hypertension, renal insufficiency urinary obstruction and hypovolemia. • Never infuse concentrated solutions rapidly, may cause hyperglycemia and fluid shift. Monitor glucose level carefully. Prolonged therapy can cause depletion of pancreatic insulin production and secretion.

• • •

KARLEEN L. JARO

may cause hypoglyce mia rebound hyperinsuli nemia. Sloughing and tissue necrosis

Classification: Electrolytes and replacement solutions
GENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

KARLEEN L. JARO

Calcium gluconate
BRAND NAME

Hypocalcemia, hypocalcemic tetany, magnesium toxicity, hypoparathyroidism

Replaces and maintains calcium

Hypercalcemia, ventricular fibrillation, renal canaliculi

Kalcinate
DOSAGE Tablets 500 mg, 650 mg, 975 mg, 1 g (contains 90 mg elemental calcium/g)

GI irritation hemorrhage constipation vomiting thirst renal canaliculi hypercalcemia polyuria

Use cautiously in patients with sarcoidosis and renal or cardiac disease and in digitalized patients. monitor blood calcium level frequently.

Classification: Non narcotic /analgesics and antipyretic/ antiplatelet
GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Mild pain/fever

Aspirin (acetylsalicylic acid)

Arthritis Reduce risk of heart attack in patient with previous MI or unstable angina

BRAND NAME
Aspilet

Produces analgesia by an ill defined effect on the hypothalamus and by blocking generation of pain impulses (peripheral action)

• •

• GI ulcer • GI bleeding Patients with bleeding disorders Aspirin hypersensitivity Vit.K deficiency

• • • • • • • • •

DOSAGE
Fever/mild pain: 325-650 mg P.O q4 hours; p.r..n unstable angina: 325 P.O once/daily
Also impedes clotting by blocking prostaglandin synthesis which prevents formation of plateletaggregating substances.

Prolonged bleeding time Tinnitus Hearing loss Nausea,vomiti ng GI distress Occult bleeding Abnormal liver function Rash Bruising Hypersensitivity manifested by asthma and anaphylaxis

Give milk, food antacid or large glass of water to reduce GI adverse reactions. • Warn patients taking prescription drugs to check with doctor before taking OTC combination containing aspirin. • Watch out for petechiae, bleeding gums, signs of GI bleeding. • Maintain adequate fluid intake. Obtain hemoglobin and prothrombin test periodically.

Classification: Antihypertensives
GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Clonidine hydrochloride BRAND NAME Catapres DOSAGE
01-02 mg P.O B.

Essential renal and malignant hypertension

Inhibits central vasomotor centers, thereby decreasing sympatheric outflow.

Patient hypersensitive to clonidine

• • • • • • • • • • •

• •

drowsiness dizziness fatigue sedation nervousness headache orthostatic hypotension bradycardia urine retetion impotence transient glucose intolerance (after large dose) constipation pruritis dermatitis

Monitor blood pressure and pulse rate. • May be given rapidly lower blood pressure in some hypertensive emergencies. • Rising slowly and avoid sudden position change to prevent orthostatic hypotension. Remove patch before defribrillation to prevent arcing

Classification: Antianginals
GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

KARLEEN L. JARO

Nifedipine BRAND NAME Adalat DOSAGE
Adults: Initial: 10-30mg PO TID Maximum: 120180mg Hypertension: 30-60mg PO

•Vasospastic angina, classic chronic stable angina pectoris •Hypertension

Thought to • inhibit calcium ion influx across cardiac and • smooth-muscle • cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole •

•Contraindicated in patients hypersensitive to drug •Use cautiously in patients with heart failure or hypotension and in elderly patients. Use extended-release tablets cautiously in patients with severe GI narrowing

Dizziness, lightheadedness, headache, weakness, peripheral edema, flushing, nausea, Syncope, nervousness, hypotension, palpitations, nasal congestion, diarrhea, constipation, abdominal discomfort, muscle cramps, dyspnea, pulmonary edema, cough, rash, puritus

Don’t give immediate-release form within 1 week of acute MI or in acute coronary syndrome Alert: despite the previously widespread SL use nifedipine capsule, avoid this route of administration. Excessive hypotension, MI, and death may result Monitor blood pressure regularly, especially in patients who take beta blockers or antihypertensive Watch for symptoms of heart failure

Classification: Antianginals

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

SIDE EFFECTS

NURSING CONSIDERATION

Nicardipine BRAND NAME
Cardipine

Chronic stable angina

DOSAGE
Initially 20 mg P.O Tid hypertension 20 to 40 mg P.O t.i.d increase dosage depends on the patients response

Inhibits calcium ion influx across cardiac and smooth muscle cells, thus decreasing myocardial contractility and oxygen demand and coronary arteries and arterioles.

Patient who are hypersensitive to nicardipine

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Dizziness Headache Paresthesis Drowsiness Peripheral edema Palpitations Tachycardia Nausea Dry mouth Abdominal discomfort Rash Flushing

Patients with hepatic impairment should receive lower dose Monitor blood pressure. Allow atleast 3 days between dosage adjustment to achieve steady plasma levels. Advise patient to report immediately if experiencing chest pain

Classification: Corticosteroids

KARLEEN L. JARO

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION
Patient had an allergic reaction previously. Have an active peptic ulcer Have an active herpes simplex fungal or mycobacterial infection ot the eye, ear infection

SIDE EFFECTS
Increased appetite Weight gain Water retention Increased WBC Hypokalemia Skin rash Dizziness Insomia Headache

NURSING CONSIDERATION
Stop drug and notify doctor if patient develops signs of systemic absorption. Before applying, gently wash skin to prevent damage to skin rub medication gently. Treatment should be continued for a few days after clearing of lesions to prevent recurrence

Dexamethasone BRAND NAME Dexon DOSAGE
The initial dosage varies from 0.75 to 9 mg a day depending on the disease being treated

Inflammation of corticosteroidresponsive dermatoses

Diffuses across cell membrane and complexes with specific cytoplasmic receptors

antiinflammatory effects in disorders of many organ systems

Active tuberculosis Have psychoneurosis or psychosis

KARLEEN L. JARO

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