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Brand name:

Rotexmedica [Commerz]

Generic Name:

Comxytocin

Classification of the drug:

Oxytocin

Order Dose:

Caesarian Section 5 iu by slow IV inj immediately after delivery.

Mode of Action:

Oxytocin induces rhythmic uterine contraction which increases throughout the


pregnancy, reaching the max at term by proliferating oxytocin receptors. It
increases the tone and amplitude of the uterine contractions at small doses.
Onset: Uterine contractions: IM: 3-5 minutes; IV: approx 1 minute.
Duration: IM: 2-3 hr; IV: 1 hr.
Absorption: Steady state is reached normally 40 minutes after parenteral admin.
Distribution: Distribution throughout extracellular fluid, small amounts reach
foetus.
Metabolism: Rapidly via the liver and plasma (by oxytocinase); some metabolism
via mammary gland.
Excretion: Elimination half-life: 1-5 minutes; excreted via urine.

Indication:

Induction or stimulation of labor in hypotonic uterine inertia. Prevention & treatment


of postpartum uterine atony & hemorrhage. Early stages of pregnancy as an
adjunctive therapy for the management of incomplete, inevitable or missed
abortion.

Contraindications:

hypertonic uterine contraction, mechanical obstruction to delivery, fetal distress.


Significant cephalopelvic disproportion, fetal malpresentation, placenta previa,
placenta abruption, cord presentation or prolapsed, overdistension or impaired
resistance of the uterus to rupture as in multiparity & in uterine scar. Do not use for
prolonged period in patients w/ oxytocin-resistant uterine ineria, severe pre-
eclamptic toxemia or severe disorder.

Drug interaction:
Prostaglandin, inhalation anesthetics eg cyclopropane or halothane,
sympathomimetic vasoconstrictor agent.

Side Effects:

• chest pain or difficulty breathing


• confusion
• fast or irregular heartbeat
• severe headache
• irritation at the injection site

Adverse reaction:

Uterine spasm in low doses. High doses may result in uterine overstimulation that
may cause fetal distress, asphyxia & death, or may lead to hyperonicity, tetanic
contractions, soft tissue damage or rupture of the uterus. Rapid IV bolus inj may
cause short-lasting hypotension accompanied with flushing & reflex tachycardia.

Nursing responsibilities:

• oxytocin infusion involves careful titration of the drug to the maternal fetal
response

• Uterine hyperstimulation occurs the oxytocin is discontinued

• If oxytocin is discontinued for less than 20-30mins, the FHR is reassuring and
contraction frequency and duration are normal, the oxytocin can be restarted
at lower rate.

• However if discontinued for 30-40mins most of the exogenous oxytocin is


metabolized and plasma levels is similar to a woman without IV of oxytocin.
Suggested protocol includes restarting the oxytocin at or near initial dose
ordered.

Brand name:

Generic Name:

ampicillin

Classification of the drug:

Antibacterial

Order Dose:
ap 250-500 mg tid-qid. IM/IV Adult & childn >20 kg 250-500 mg 6 hrly, <20 kg 100-200 mg/kg/day in
divided doses 6 hrly. Infant >7 days 75 mg/kg/day in divided doses 8 hrly, <7 days 50 mg/kg/day in
divided doses 12 hrly.

Mode of Action:

Ampicillin exerts bactericidal action on both gm+ve and gm-ve organisms. Its
spectrum includes gm+ve organisms eg, S pneumoniae and other Streptococci, L
monocytogenes and gm-ve bacteria eg, M catarrhalis, N gonorrhoea, N meningitidis,
E coli, P mirabilis, Salmonella, Shigella, and H influenzae. Ampicillin exerts its action
by inhibiting the synthesis of bacterial cell wall.
Absorption: Relatively well absorbed from the GI tract with peak plasma
concentrations after 1-2 hr (oral); may be altered in the presence of food.
Distribution: Widely distributed into the ascitic, pleural and joint fluids
(therapeutic concentrations), CSF (small amounts except when the meninges are
inflamed), bile (high concentrations); crosses the placenta and enters the breast
milk (small amounts). Protein-binding: 20%.
Metabolism: Converted to some extent to penicilloic acid; undergoes
enterohepatic recycling.
Excretion: Via the urine by glomerular filtration and tubular secretion; via the
faeces. May be removed by haemodialysis.

Indication:

Resp, GIT, GUT, skin & soft tissue infections caused by susceptible gm+ve & gm-ve
organisms.

Contraindications:

Hypersensitivity to penicillins; infectious mononucleosis.

Drug interaction:

Simultaneous use with oral contraceptives may lead to increased risk of


breakthrough bleeding and reduced efficacy of the contraceptive. Skin rash
increased with allopurinol. Probenecid increases blood levels. Synergism with β-
lactamase inhibitors, clavulanic acid or sulbactam, penicillinase-stable drugs eg,
cloxacillin or flucloxacillin and aminoglycosides.

Side Effects:

Side effects of Ampicillin may include upset stomach, diarrhea, nausea, vomiting,
anxiety, colitis, confusion, convulsions, dizziness, hives, liver problems and
jaundice, fungal infections, rash, tooth discoloration in children, and appetite loss.

Adverse reaction:
GI upset, nausea, vomiting, diarrhoea; blood dyscrasias; urticaria, exfoliative
dermatitis, rash; fever, seizures; interstitial nephritis.
Potentially Fatal: Anaphylactic shock; pseudomembranous colitis; neuromuscular
hypersensitivity; electrolyte imbalance.

Nursing responsibilities:

• Assess patient for infection (vital signs, wound appearance, sputum, urine, stool,
and WBCs) at beginning and throughout therapy.
• Obtain a history before initiating therapy to determine previous use of and
reactions to penicillins or cephalosporins. Persons with a negative history of
penicillin sensitivity may still have an allergic response.
• Obtain specimens for culture and sensitivity before therapy. First dose may be
given before receiving results.
• Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
edema, wheezing). Discontinue the drug and notify the physician immediately if
these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close
by in the event of an anaphylactic reaction.
• Caution patient to notify physician if fever and diarrhea occur, especially if stool
contains blood, pus, or mucus. Advise patient not to treat diarrhea without
consulting health care professional. May occur up to several weeks after
discontinuation of medication.
•Instruct patient to notify physician if symptoms do not improve.

Brand name:

Ranitidine

Generic Name:

Zantac

Classification of the drug:

Antacids, Antireflux Agents & Antiulcerants

Order Dose:

The usual dose of ranitidine by IM or IV injection is 50 mg which may be repeated


every 6-8 hrs, the IV injection should be given slowly over not be less than 2 min
and should be diluted to contain 50 mg in 20 mL.

Mode of Action:
H2-receptor antagonist.

Pharmacology: Ranitidine is a specific rapidly acting histamine H2-antagonist. It inhibits basal


and stimulated secretion of gastric acid, reducing both the volume and the acid and pepsin
content of the secretion. Ranitidine has a long duration of action and a single 75-mg dose
suppresses gastric acid secretion for up to 12 hrs.

Clinical studies have shown that ranitidine can relieve the symptoms of excess acid production
for up to 12 hrs.

Pharmacokinetics: Serum concentrations necessary to inhibit 50% of stimulated gastric acid


secretion are estimated to be 36-94 ng/mL. Following single IV or IM 50-mg doses, serum
concentrations of ranitidine HCl are in this range for 6-8 hrs.

Following IV injection, approximately 70% of the dose is recovered in the urine as unchanged
drug. Renal clearance averages 530 mL/min, with a total clearance of 760 mL/min. The volume
of distribution is 1.4 L/kg and the elimination half-life is 2-2.5 hrs.

Ranitidine HCl is absorbed very rapidly after IM injection. Mean peak levels of 576 ng/mL occur
within 15 min or less following a 50-mg IM dose. Absorption from IM sites is virtually
complete, with a bioavailability of 90-100% compared with IV administration. Following oral
administration, the relative bioavailability of ranitidine HCl tablets is 50%.

In humans, the N-oxide is the principal metabolite in the urine; however, this amounts to <4% of
the dose. Other metabolites are the S-oxide (1%) and the desmethyl ranitidine (1%). The
remainder of the administered dose is found in the stool.

Studies in patients with hepatic dysfunction (compensated cirrhosis) indicate that there are
minor, but clinically insignificant, alterations in ranitidine half-life, distribution, clearance, and
bioavailability. Serum protein binding averages 15%.

Indication:

Treatment for hospitalized patients with pathological hypersecretory conditions or intractable


duodenal ulcers, or as an alternative to the oral dosage form for short-term use in patients who
are unable to take oral medication.

Short-term treatment of active duodenal ulcer.

Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers.

Treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome and


systemic mastocytosis).

Short-term treatment of active, benign gastric ulcer.


Maintenance therapy for gastric ulcer patients at reduced dosage after healing of acute ulcers.

Treatment of Gastroesophageal reflux disease and endoscopically diagnosed erosive esophagitis.

Maintenance of healing of erosive esophagitis.

Contraindications:

•Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and
should be avoided in patients with known intolerance.

Drug interaction:

Although ranitidine has been reported to bind weakly to cytochrome P-450 in vitro,
recommended doses of the drug do not inhibit the action of the cytochrome P-450-linked
oxygenase enzymes in the liver. However, ranitidine may affect the bioavailability of certain
drugs by some mechanism.

Increased or decreased prothrombin times have been reported during concurrent use of ranitidine
and warfarin. However, in human pharmacokinetic studies with dosages of ranitidine up to 400
mg/day, no interaction occurred; ranitidine had no effect on warfarin clearance or prothrombin
time.

Reduced gastric acidity due to ranitidine may result in an increase in the availability of triazolam,
when used concurrently. The clinical significance of triazolam and ranitidine pharmacokinetic
interaction is unknown.

Side Effects:

CNS:
Confusion, dizziness, drowsiness, hallucinations, headache

• CV:
Arrhythmias

• GI:
Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea

• GU:
Decreased sperm count, impotence

• ENDO:
Gynecomastia

• HEMAT:
Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia
• LOCAL:
Pain at IM site

• MISC:
Hypersensitivity reactions, vasculitis

Adverse reaction:

Transient and reversible changes in liver function tests can occur. There have been occasional
reports of reversible hepatitis (hepatocellular, hepatocanalicular or mixed) with or without
jaundice.

Leukopenia and thrombocytopenia have occurred rarely in patients. These are usually reversible.

Rare cases of agranulocytosis or of pancytopenia, sometimes with marrow hypoplasia, or aplasia


have been reported.

Hypersensitivity reactions (urticaria, angioneurotic edema, fever, bronchospasm, hypotension,


anaphylactic shock) have been seen rarely following oral administration of ranitidine. These
reactions have occasionally occurred after a single dose.

As with other H2-receptor antagonists there have been rare reports of bradycardia and A-V block.

Headache, sometimes severe and dizziness have been reported in a very small proportion of
patients. Rare cases of reversible mental confusion, depression and hallucinations have been
reported, predominantly in severely ill and elderly patients.

Skin rash has been reported, including rare cases suggestive of mild erythema multiforme. Rare
cases of vasculitis and alopecia have been reported rarely.

Reversible impotence has been reported rarely.

Musculoskeletal symptoms eg, arthralgia and myalgia have been reported rarely.

There have been a few reports of breast symptoms (swelling and/or discomfort) in men taking
ranitidine; some cases have resolved on continued ranitidine treatment.

Nursing responsibilities:
• Assess patient for epigastric or abdominal pain and frank or occult blood in the
stool, emesis, or gastric aspirate.
• Nurse should know that it may cause false-positive results for urine protein; test
with sulfosalicylic acid.
• Inform patient that it may cause drowsiness or dizziness.
• Inform patient that increased fluid and fiber intake may minimize constipation.
• Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea;
dizziness; rash; confusion; or hallucinations to health car professional promptly.
• Inform patient that medication may temporarily cause stools and tongue to
appear gray black.

Brand name:

Plasil

Generic Name:

metoclopramide

Classification of the drug:

CARDIOVASCULAR DRUGS- BETA-BLOCKERS

Order Dose:

Adult 10mg 3x/day pedia: 15-20yrs 5-10mg 3x/day5-14yrs: 2.5-5mg 3x/day3-4yrs:


3mg 2-3x/day1-2yrs: 1mg 2-3x/dayUnder 1 yr: 1mg 2x/day

Mode of Action:

Dopamine antagonist that acts by increasing receptor sensitivity and response of


upper GIT tissues to acetylcholine

Indication:

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


with surgery

Resp, GIT, GUT, skin & soft tissue infections caused by susceptible gm+ve & gm-ve
organisms.

Contraindications:

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

Drug interaction:
Additive effects w/ alcohol, sedatives, hypnotics, narcotics or tranquillizers. Digoxin.
Acetaminophen, tetracycline, levodopa, ethanol.

Side Effects:

Agranulocytosis,

Hypertension
Tachycardia
extrapyramidal effects, dystonic
extrapyramidal effects, parkinsonian
tardive dyskinesia
Agitation
panic-like sensation
restless legs syndrome
Diarrhea
Drowsiness
Restlessness
unusual tiredness or weakness
Breast tenderness and swelling
changes in menstruation
Constipation
Dizziness
Headache
Insomnia

Adverse reaction:

Restlessness, drowsiness, fatigue, insomnia, headache, dizziness, nausea

Nursing responsibilities:

>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
• Assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after
administration.

• May cause drowsiness.