DRUG NAME AND DOSAGE ROUTE OF MECHANISM OF SIDE EFFECTS NURSE RESPONSIBILITY

GENERIC NAME ADMINISTRATIO ACTION

N
Assessment:
Pharmacological class -The average Oral Administration Pyridostigmine inhibits Cardiovascular:
Acetylcholinesterase dose is ten 60 acetylcholinesterase in Arrhythmias  Report increasing
inhibitor mg regular the synaptic cleft by (especially muscular weakness,
release tablets or competing with bradycardia), AV cramps, or
ten 5-ml acetylcholine for block, cardiac arrest, fasciculations. Failure
Pyridostigmine
teaspoonful (600 -I.M. or slow I.V attachment to decreased carbon of patient to show
Bromide mg). acetylcholinesterase, monoxide, flushing, improvement may
Chemically,3-hydroxy-1- Push: To supplement thus slowing down the hypotension, nodal reflect either
methylpyridinium bromide -In mild disease, oral dosage pre- and hydrolysis of rhythm, nonspecific underdosage or
dimethylcarbamate 1 to 6 ( 1 dose= postoperatively during acetylcholine, and ECG changes, overdosage.
60 mg) doses labor and postpartum, thereby increases syncope, tachycardia  Observe patient closely
may be during myasthenic efficiency of Central nervous if atropine is used to
sufficient. crisis, or when oral cholinergic transmission system: Convulsions, abolish GI adverse
therapy is in the neuromuscular dizziness, drowsiness, effects or other
-Severe disease, impractical): ~1/30th junction and prolonges dysphonia, headache, muscarinic adverse
25 doses (1 dose of oral dose; observe the effects of loss of consciousness effects because it may
= 60 mg regular patient closely for acetylcholine. Dermatologic: Skin mask signs of
release tablet or cholinergic reactions rash, overdosage (cholinergic
Brand name 5 ml syrup) -I.V. infusion: Indication: thrombophlebitis crisis): Increasing
Mestinon (I.V.), urticaria muscle weakness,
-Timespan To supplement oral -To improve muscle Gastrointestinal: which through
tablets, one to dosage pre- and strength in patients with Abdominal pain, involvement of
three 180 mg postoperatively, a certain muscle disease diarrhea, dysphagia, respiratory muscles can
tablets (180 to during labor and myasthenia gravis flatulence, lead to death.
540 mg) once or postpartum, during hyperperistalsis,
twice daily myasthenic crisis, or -Reversal of non- nausea, salivation,  Monitor vital signs
when oral therapy is depolarizing muscle stomach cramps, frequently, especially
-pediatric impractical): Initial: 2 relaxant vomiting respiratory rate.
dosage neonate- mg/hour with gradual Genitourinary:
titration in increments  Observe for signs of
5 mg PO 4-6 Recover may require Urinary urgency cholinergic reactions,
hourly or 0.05- of 0.5-1 mg/hour, up more than 30 mint. Neuromuscular &
to a maximum rate of particularly when drug
0.15 mg/kg Contraindication skeletal: Arthralgia, is administered IV.
IV/IM 4 mg/hour -Reversal dysarthria,
of nondepolarizing  Observe neonates of
 muscle relaxants: I.V.: Known hypertensive, fasciculations, muscle myasthenic mothers,
Children-7 0.1-0.25 peritonitis or cramps, myalgia, who have received
mg/kg PO, 4 mechanical obstruction spasms, pyridostigmine, closely
hourly Recover may of intestinal or urinary weakness for difficulty in
-Each tablet tract Ocular: Amblyopia, breathing, swallowing,
contains lactose, lacrimation, small or sucking.
silicon dioxide pupils  Observe patient
and stearic acid. Respiratory: continuously when used
Bronchial secretions as muscle relaxant
Storage at 15°– increased, bronchiolar antagonist. Airway and
30° C (59°–86° constriction, respiratory assistance
F). Protect from bronchospasm, must be maintained
light and dyspnea,
moisture. laryngospasm, Patient & Family Education
respiratory arrest,
respiratory  Be aware that duration
depression, of drug action may vary
respiratory muscle with physical and
paralysis emotional stress, as well
Miscellaneous: as with severity of
Allergic reactions, disease.
anaphylaxis,  Report onset of rash to
diaphoresis increased physician. Drug may be
discontinued.
 Sustained release tablets
may become mottled in
appearance; this does
not affect their potency.
 Do not breast feed
while taking this drug
without consulting
physician.

DRUG NAME DOSAGE ROUTE MECHANISM OF SIDE EFFECTS NURSE IMPLICATIONS

AND GENERIC ACTION
NAME
The initial dosage 5 Oral route Decreased CNS: euphoria, • Determine if patient is sensitive to
Corticosteroids mg to 60 mg per day Parenteral vasodilation and insomnia, psychotic behaviour, other corticosteroids.
prednisolone route permeability of pseudotumor cerebri, vertigo, • Use only prednisolone sodium
Syrup: 5 mg/ml, 15 capillaries, as well as headache, paraesthesia, seizure. phosphate for I.V. administration. When
Prednisolone
mg/5 ml decreased leukocyte CV: heart failure, administering as direct injection, inject
Tablets: 5 mg migration to sites of thromboembolism, hypertensio undiluted over at least 1 minute. When
prednisolone inflammation. n, edema, arrhythmias, thromb- administering as intermittent or
acetate Corticosteroids ophlebitis. continuous infusion, dilute solution
Injection: 25 mg/ml, binding to the ENT: cataracts, glaucoma. according to manufacturer’s instructions.
50 mg/ml suspension glucocorticoid GI: peptic ulceration, GI Use D5W or normal saline solution as
prednisolone receptor mediates irritation, increased diluent for I.V. infusion.
sodium phosphate changes in gene appetite, pancreatitis, nausea, • Always adjust to lowest effective dose.
Injection: 20 mg/ml expression that lead vomiting. • Monitor patient’s weight, blood
solution to multiple GU: menstrual irregularities. pressure, and serum electrolyte levels.
Oral liquid: 5 mg/5 downstream effects. Metabolic: hypokalemia, • Monitor patient for cushingoid effects,
ml, 15 mg/5 ml hyperglycemia, carbohydrate including moonface, buffalo hump,
prednisolone Glucocorticoids intolerance. central obesity, thinning hair,
tebutate inhibit neutrophil Musculoskeletal: muscle hypertension, and increased
Injection: 20 mg/ml apoptosis and weakness, osteoporosis, growth susceptibility to infection.
suspension demargination; they suppression in children. • Drug may be used for alternate-day
inhibit Skin: delayed wound healing, therapy.
Multiple Sclerosis phospholipase A2, acne, various skin eruptions, • Give oral dose with food when possible
acute exacerbations which decreases the hirsutism. to reduce GI irritation. Patient may need
of multiple sclerosis, formation of Other: susceptibility to medication to prevent GI irritation.
daily doses of 200 arachidonic acid infections; acute adrenal • Give I.M. injection deeply into gluteal
mg of prednisolone derivatives; they insufficiency cushingoid state muscle. Rotate injection sites to prevent
for a week followed inhibit NF-Kappa B (moonface, buffalo hump, muscle atrophy. Avoid S.C. injection
by and other central obesity). because atrophy and sterile abscesses
80 mg every other inflammatory • Most adverse reactions to may occur.
day for one month transcription factors; corticosteroids are dose- or • Prednisolone acetate and tebutate aren’t
they promote anti- duration-dependent. for I.V. use.
inflammatory genes • Unless contraindicated, give low-
like interleukin-10. sodium diet that’s high in potassium and
ALERT: After abrupt protein. Administer potassium
Contains Lower doses of withdrawal, patient may supplements as needed.
Prednisolone Tablets corticosteroids experience rebound • Gradually reduce dosage after long-
USP 5 mg contain provide an anti- inflammation, fatigue, term therapy
the following inflammatory effect, weakness, arthralgia, fever, ALERT Don’t confuse prednisolone
inactive ingredients: while higher doses dizziness, lethargy, depression, with prednisone.
anhydrous lactose, are fainting, orthostatic • Prednisolone suppresses reactions to
colloidal silicon immunosuppressive hypotension, dyspnea, skin tests; causes false-negative results in
dioxide, High doses of anorexia, hypoglycemia. After the nitroblue tetrazolium test for
crospovidone, D&C glucocorticoids for prolonged use, sudden systemic bacterial infections.
Yellow No.10, an extended period withdrawal may cause acute • Watch for depression or psychotic
docusate sodium, bind to the adrenal insufficiency and episodes, especially during high-dose
FD&C Yellow No. mineralocorticoid death. therapy.
6, magnesium receptor, raising • Diabetic patient may need increased
stearate and sodium sodium levels and ALERT After abrupt insulin. Monitor blood glucose levels.
benzoate. decreasing withdrawal, patient may
potassium levels. experience rebound Patient education
inflammation, fatigue, • Tell patient not to stop drug abruptly or
Prednisone is a weakness, arthralgia, fever, without medical approval.
prodrug to dizziness, lethargy, depression, • Instruct patient to take oral form of
prednisolone, which fainting, orthostatic drug with food or milk.
mediates its hypotension, dyspnea, • Tell patient symptoms of early adrenal
glucocorticoid anorexia, hypoglycemia. After insufficiency: fatigue, muscle weakness,
effects. Prednisone is prolonged use, sudden joint pain, fever, anorexia, nausea,
a synthetic withdrawal may cause acute dyspnea, dizziness, and fainting.
glucocorticoid that adrenal insufficiency and • Instruct patient to carry or wear
has both anti- death. medical identification indicating his need
inflammatory and for supplemental systemic
immunomodulating INDICATION: glucocorticoids during stress. It should
properties. Nervous System Conditions include prescriber’s name, name of drug,
• Acute exacerbations of and dosage taken.
After cell surface multiple sclerosis • Warn patient on long-term therapy
receptor attachment • Cerebral edema associated about cushingoid effects (moonface,
and entry into the with primary or metastatic buffalo hump) and the need to report
cell, prednisone brain tumor, craniotomy or sudden weight gain or swelling.
enters the nucleus head injury • Tell patient to report slow healing.
where it binds and • Advise patient receiving long-term
activates specific CONTRAINDICATION: therapy to consider exercise or physical
nuclear receptors, therapy. Advise him about vitamin D or
which result in  Untreated tuberculosis calcium supplement.
altered gene  an infection due to a • Instruct patient to avoid exposure to
expression and fungus infections and call if exposure occurs.
inhibition of  an infection • Tell patient to avoid immunizations
proinflammatory  a condition with low while taking drug.
cytokine production. thyroid hormone levels • Advise patient to be aware of signs of
This agent decreases  diabetes infection; some of these signs may be
the number of  insufficiency of the masked during drug use.
circulating hypothalamus and
lymphocytes, pituitary gland
inducing cell
 high cholesterol
differentiation, and
 low amount of
stimulates apoptosis
potassium in the blood
in sensitive tumor
cell populations.  a reduction in the body's
resistance to infection
The effects of  psychotic disorder
glucocorticoids are  brain injury
subject to mediation  a disease with shrinking
by mechanisms that and weaker muscles
alter DNA called myopathy
replication within  increased pressure in the
the nucleus. eye
 wide-angle glaucoma
 clouding of the lens of
the eye called cataracts
 high blood pressure
 chronic heart failure
 stomach irritation called
gastritis
 diverticulitis
 surgical joining of two
parts of the intestine
 hardening of the liver
 rupture of a tendon
 osteoporosis
 decreased calcification
 or density of bone
 seizures
 infection caused by the
varicella zoster virus
 the measles, muscle pain
or tenderness with
increase creatine kinase
 broken bone due to
disease or illness
 malaria affecting the
brain
 muscle wasting

DRUG NAME DOSAGE ROUTE MECHANISM OF ACTION SIDE EFFECTS NURSE RESPONSIBILITY
AND GENERIC
NAME
Anti- SINEMET is supplied as Oral route Crosses into the brain through More common Assessment & Drug Effects
parkinsonism tablets in three strengths: the "blood- brain barrier."
drug Once it crosses, it is converted Twitching, twisting,  Make accurate observations
SINEMET 25-100, to dopamine. The resulting uncontrolled and report promptly adverse
containing 25 mg of increase in brain dopamine repetitive reactions and therapeutic
Carbidopa carbidopa and 100 mg of concentrations is believed to movements of the effects. Rate of dosage
levodopa levodopa. improve nerve conduction and tongue, lips, face, increase is determined
assist the movement disorders arms, or legs primarily by patient's
Brand name SINEMET 10-100, in Parkinson disease. Less common tolerance and response to
Atamet, Sinemet. containing 10 mg of Carbidopa does not cross the levodopa.
carbidopa and 100 mg of blood-brain barrier. Carbidopa Bladder pain,  Monitor vital signs,
levodopa. is added to the levodopa to bloody or cloudy particularly during period of
prevent the breakdown of urine, dosage adjustment. Report
SINEMET 25-250, levodopa before it crosses into chest pain alterations in BP, pulse, and
containing 25 mg of the brain. The addition of confusion respiratory rate and rhythm.
carbidopa and 250 mg of carbidopa allows lower doses difficult, burning, or  Monitor all patients closely
levodopa. of levodopa to be used. This painful urination for behavior changes.
reduces the risk of side effects discouragement Patients in depression should
from levodopa such inability to move the
Immediate-release
Initial dose: 25 mg-100
mg orally three times a
day or 10 mg-100 mg
orally 3 or 4 times a day
Sustained-Release
Tablets (Sinemet CR):
-Initial dose (levodopa-
naive): 50 mg-200 mg
orally twice a day; initial
dosage should be given
at intervals of more than
6 hours
Extended-Release
Capsules
-Initial dose (levodopa-
naive): 23.75 mg-95 mg
orally 3 times a day for 3
days; on the fourth day,
may increase to 36.25
mg-145 mg 3 times a day
-Dosing interval may be
increased up to a
maximum of 5 times a
day, if tolerated
-Maximum daily dose:
612.5 mg-2450 mg
as nausea and vomiting. This
combination medicine was
approved by the FDA in 1988.
eyes be closely observed for
increased blinking or suicidal tendencies.
spasms of the eyelid  Monitor for changes in
irritability intraocular pressure in
lack of appetite patients with chronic wide-
loss of interest or angle glaucoma.
pleasure  Monitor patients with
Nervous system diabetes carefully for
Very common (10% alterations in diabetes
or more): Headache control. Frequent monitoring
(up to 17%), of blood sugar is advised.
dyskinesia (up to  Lab tests: Periodic blood
16.5%), dizziness glucose, hepatic and renal
(up to 12%) function tests, CBC with
differential, Hgb and Hct.
Common (1% to  Report promptly abnormal
10%): Confusion, involuntary movement such
dystonia, on-off as facial grimacing,
phenomena, exaggerated chewing,
hypoesthesia, protrusion of tongue,
polyneuropathy, rhythmic opening and
tremor, dysgeusia, closing of mouth, bobbing of
bradykinesia head, jerky arm and leg
movements, and exaggerated
Uncommon (0.1% respiration.
to 1%): Paresthesia,  Assess for "on-off"
ataxia, gait phenomenon: sudden,
disturbance, unpredictable loss of drug
convulsion effectiveness ("off" effect),
which lasts 1 min–1 h. This
Rare (less than is followed by an equally
0.1%): Malignant, abrupt return of function
neuroleptic ("on" effect). Sometimes
syndrome symptoms can be controlled
by increasing number of
doses per day.
 Monitor therapeutic effects.
 Some patients manifest
increase in bradykinesia
("leg freezing" or slow body
movement). The patient is
unable to start walking and
frequently falls. Reduction of
dosage may be indicated in
these patients.
 Patients who require more
frequent drug administration
are most likely to manifest
gradual return of
parkinsonian symptoms
toward the end of a dose
period.

Patient & Family Education

 Follow physician's directions

regarding continuation or
discontinuation of levodopa.
Both adverse reactions and
therapeutic effects occur
more rapidly with carbidopa-
levodopa combination than
with levodopa alone.
 Make positional changes
slowly and in stages,
particularly from recumbent
to upright position, dangle
your legs a few minutes
before standing, and walk in
place before ambulating, as
some patients experience
weakness, dizziness, and
faintness. Tolerance to this
effect usually develops
 within a few months of
therapy. Support stockings
may help. Consult physician.
 Report muscle twitching and
spasmodic winking
promptly, as these may be
early signs of overdosage.
 notice elevation of mood and
sense of well-being before
any objective improvement.
Resume activities gradually
and observe safety
precautions to avoid injury.
 Maintain prescribed drug
regimen. Abrupt withdrawal
can lead to parkinsonian
crisis with return of marked
muscle rigidity, akinesia,
tremor, hyperpyrexia, mental
changes.
 Avoid driving or other
hazardous activities until
reaction to drug is
determined.
 Levodopa may cause urine to
darken on standing and may
also cause sweat to be dark-
colored. This effect is not
clinically significant.
 Wear medical identification.
Inform all health care
providers that you are taking
carbidopa-levodopa.
 Do not breast feed while
taking this drug.