DRUG NAME Brand Name: LANOXIN Generic Name: Digoxin Drug Class: Antiarrhythmics, inotropics

MODE OF ACTION Increases the force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect).

INDICATION Cardiac failure accompanied by atrial fibrillation; management of chronic cardiac failure where systolic dysfunction or ventricular dilatation is dominant; management of certain supraventricular arrhythmias, particularly chronic atrial flutter & fibrillation.

ADVERSE DRUG REACTION CNS disturbances, dizziness; visual disturbances (blurred or yellowish vision); arrhythmia, conduction disturbances, bigeminy, trigeminy, PR prolongation, sinus bradycardia; nausea, vomiting, diarrhea; urticarial or scarlatiniform w/ eosinophilia.

NURSING CONSIDERATION  Monitor apical pulse before administering.  Monitor blood pressure periodically in patients receiving IV dogoxin.  Monitor intake and output ratios and daily weights.  Observe patient for signs and symptoms of toxicity.  Oral preparations can be administered without regard to meals.  Before administering initial loading dose, determine whether patient has taken any digitalis preparations in the preceding 23 wk.

CONTRAINDICATIO N

Intermittent complete heart block or 2nd degree AV block esp if there is a history of Stokes-Adams attacks; arrhythmia caused by cardiac glycoside intoxication, supraventricular arrhythmia caused by Wolff-ParkinsonWhite syndrome; ventricular tachycardia or fibrillation; hypertrophic obstructive cardiomyopathy. Hypersensitivity to other digitalis glycosides.

Generic Name: TELMISARTAN Brand Name: Micardis Drug Class: Angiotensin II Antagonists / Diuretics

Telmisartan (Teli marketed by cadila pharma) is an Angiotensin Receptor Blocker (ARB) that shows high affinity for the angiotensin II type 1 (AT1) receptors, has a long duration of action, and has the longest half-life of any ARB. In addition to blocking the Renin-Angiotensin System (RAS), telmisartan acts as a selective modulator of Peroxisome proliferator-activated receptor gamma (PPAR-γ), a central regulator of insulin and glucose metabolism. It is believed that telmisartan’s dual mode of action may provide protective benefits against the vascular and renal damage caused by diabetes and cardiovascular disease (CVD). Telmisartan has binding affinity 3000 times greater for AT1 than AT2 receptors. Telmisartan also has the longest half life (24

Treatment for essential hypertension. Blocks vasoconstricting.

Telmisartan: Headache, upper respiratory tract infection, dizziness. Hydrochlorothiazide: Anorexia, gastric irritation, muscle spasm, sleep disturbances.

 Monitor client for hypotension after starting drug. Place client supine if hypotension occurs, and give IV normal saline, if needed.  For patient whose renal function may depend on the activity of the rennin angiotensin aldosterone system (such as those with severe heart failure) treatment with ACE inhibitors and angiotensin receptors antagonist has caused oliguria or progressive azotemia and acute renal failure or death.

Pregnancy & lactation. Cholestasis & biliary obstructive disorders. Severe hepatic & renal impairment (CrCl <30 mL/min). Refractory hypokalemia, hypercalcemia.

Generic Name: Warfarin Brand Names: Coumadin. The signs and symptoms will vary according to the  Use cautiously with divertiticulitis. Antireflux Agents & Antiulcerants hrs) of all angiotensin II type 1 receptor antagonists.and mild or moderate hypertension. nausea. abdominal pain. Nexium(esomeprazole) is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of H+/K+ATPase in the gastric parietal cell. Short term maintenace of hemostasis & prevention of rebleeding in patients following therapeutic endoscopy for acute bleeding of gastric or duodenal ulcers. Nexium blocks the final step in acid production. Hypersensitivity to substituted benzimidazoles.  Tell the patient to take drug at least 1 hour before a meal. pulmonary embolism. flatulence. adjunct in prophylaxis of systemic embolism Potential adverse reactions to Coumadin may include: Hemorrhage from any tissue or organ. Pharmacology: Coumadin and other coumarin anticoagulants act by inhibiting the synthesis of vitamin Kdependent coagulation factors. thus reducing gastric acidity.  Advise patient that antacids can be used while taking drugs unless otherwise directed by prescriber. colitis. This effect is dose-related up to a daily dose of 20–40 mg and leads to inhibition of gastric acid secretion.Generic Name: Esomeprazole Brand Name: Nexium Dug Class: Antacids. or mild or moderate hepatic or renal Anticoagulation is contraindicated in any localized or general physical condition or personal circumstance in which the hazard of hemorrhage might be greater than its potential clinical . atrial fibrillation w/ embolization. Headache. Antiplatelets & Fibrinolytics (Thrombolytics) Anticoagulant. Injection site reaction. Children. This is a consequence of the anticoagulant effect. vomiting. Jantoven Drug Class: Anticoagulants. constipation. By acting specifically on the proton pump. The resultant Prophylaxis & treatment of venous thrombosis. diarrhea.  Instruct patient to take drug exactly as prescribed. Treatment of GERD as an alternative to oral therapy in patients when oral therapy is not appropriate.

Other adverse reactions are infrequent and disease. Necrosis of skin and other tissues (see Warnings). location and degree or extent of the bleeding. or unexplained shock. IX. including dorsal midline dysplasia characterized by agenesis of the corpus callosum. the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis.  I. The degree of depression is dependent upon the dosage administered. Hemorrhagic complications may present as paralysis. An anticoagulant effect generally occurs within 24 hrs. benefits eg: Pregnancy: Women who are or may become pregnant because the drug passes through the placental barrier and may cause fatal hemorrhage to the fetus in utero. or in conditions that increase risk of hemorrhage. DandyWalker malformation. Ventral midline dysplasia. Furthermore. Bleeding which occurs when the PT is within the therapeutic range warrants diagnostic investigation since it may unmask a previously unsuspected lesion eg. Therefore. and maximal plasma concentrations are reached in 1-9 hrs. joint or other pain. Anticoagulants have no direct effect on an established thrombus. chest. difficult breathing or swallowing. . unexplained swelling. shortness of breath. ulcer.M administration isn’t recommended. abdomen.  Tell the patient to eat a daily. Pharmacokinetics: After oral administration of Coumadin. with regional or lumbar bock anesthesia. Approximately 97% is bound to albumin within the plasma. once a thrombus has occurred. absorption is essentially complete. consistent amount of leafy green vegetable containing vitamin K. X and II activities. However. headache. also use cautiously in breastfeeding women.  Tell patient to report adverse reactions promptly. and midline cerebellar atrophy. nor do they reverse ischemic tissue damage. there have been reports of birth malformations in children born to mothers who have been treated with warfarin during pregnancy. with drainage tubes in any orifice.in vivo effect is a sequential depression of Factors VII. etc. tumor. Bleeding during anticoagulant therapy does not always correlate with prothrombin activity (see Treatment under Overdosage). Embryopathy characterized by nasal hypoplasia with or without stippled epiphyses (chondrodysplasia punctata) has been reported in pregnant women exposed to warfarin during the 1st trimester. However. Central nervous system abnormalities also have been reported. the goal of anticoagulant treatment is to prevent further extension of the formed clot and prevent secondary thromboembolic complications which may result in serious and possible fatal sequelae. peak anticoagulant effect after MI.

and other central nervous system abnormalities have been reported in association with 2nd and 3rd trimester exposure. deformities of toes. Priapism has been associated with anticoagulant administration. Coumadin is a potent drug with a half-life of 2½ days. asplenia. hydrocephalus. a causal relationship has not been established. however. anencephaly. Mental retardation. consist of alopecia. reabsorbed and excreted into the urine. cholestatic hepatic injury and hypersensitivity reactions. Coumadin is metabolized by hepatic microsomal enzymes to inactive metabolites that are excreted into the bile. cardiac defects and congenital heart disease. dermatitis. teratogenic reports following in utero exposure to warfarin include urinary tract anomalies eg. characterized by optic atrophy. long-lasting response curve. polydactyly. therefore its effects may become more pronounced as daily maintenance doses overlap. and eye abnormalities have been observed. Women of childbearing potential who are candidates for anticoagulant therapy should be carefully . blindness. Spontaneous abortion and stillbirth are known to occur and a higher risk of fetal mortality is associated with the use of warfarin. thus producing a smooth. and corneal leukoma. diarrhea. cranial nerve palsy. diaphragmatic hernia. fever. systemic cholesterol microembolization.may be delayed 72-96 hrs and its duration of action may persist for 4-5 days. abdominal cramping. purple toes syndrome. spina bifida. single kidney. nausea. urticaria. Although rare.

Hemorrhagic tendencies or blood dyscrasias. pericardial effusions and bacterial endocarditis. aneurysms-cerebral.evaluated and the indications critically reviewed with the patient. she should be apprised of the potential risks to the fetus. or traumatic surgery resulting in large open surfaces. and the possibility of termination of the pregnancy should be discussed in light of those risks. genitourinary or respiratory tracts. Bleeding tendencies associated with active ulceration or overt bleeding of the gastrointestinal. Threatened abortion. dissecting aorta. eye. eclampsia and . If the patient becomes pregnant while taking this drug. Recent or contemplated surgery of the central nervous system. cerebrovascular hemorrhage. pericarditis.

 Follow instructions regarding dilution. >Severe renal impairment > severe hemolytic reactions > acute dehydration >heat cramps >hyperkalemia Cautious use in: >cardiac or renal disease. psychosis or lack of patient cooperation. Administer while patient is sitting up or standing (never in recumbent position) to prevent druginduced esophagus.Generic name: Potassium Chloride Brand Name: Kalium Durule Drug Class: Electrolytes and minerals Supplemental potassium in the form of high potassium food or potassium chloride may be able to restore normal potassium levels. prolonged diuresis and diabetic acidosis. deficit secondary to diuretics or corticosteroid therapy. Miscellaneous: Major regional. is depleted by severe vomiting. Spinal puncture and other diagnostic or therapeutic procedures with potential for uncontrollable bleeding.        renal insufficiency hyperkalemia nausea vomiting irritability muscle weakness difficulty in swallowing  Some patients find it difficult to swallow the large sized KCl tablet. systematic acidosis . Inadequate laboratory facilities or unsupervised senility.  For hypokalemia  As prophylaxis during treatment with diuretics  To prevent and treat potassium. alcoholism.  Also indicated when potassium. lumbar block anesthesia and malignant hypertension.  Color in some commercial oral solutions fades with exposure preeclampsia.

nausea. the nephrotic syndrome. Body as a whole: asthenia. malaise. The combination results in an additive diuretic effect since both drugs will increase sodium and water excretion by acting in different parts of the renal tubule. Reproductive disorders: breast disorders. gastrointestinal disturbance. Psychiatric disorders: impotence. monitor I and O ratios and daily weight. Neoplasm: breast neoplasm. menstrual disorders. vomiting. anuria. potassium-excreting hormone. oedema and ascites of congestive heart failure. Spironolactone acts in the distal portion of the renal tube by competitive inhibition of aldosterone.  Diuretic effect may be delayed 2-3 days and maximum hypertensive may be delayed 2-3weeks. pruritis. hyperkalemia or sensitivity to spironolactone. Other Antihypertensives Spironolactone promotes diuresis in patients with oedema or ascites. a sodium-retaining. The combination of spironolactone and isobutylhydrochlorothi azide provides an effective treatment for many patients who would not respond to either drug alone. cirrhosis of the liver. Nervous system disorders: dizziness. headache. Na) and renal function. serum electrolyte s (K. fever. . Metabolic and nutritional disorders: electrolyte disturbances. Acute renal insufficiency. Gastro-intestinal disorders: abdominal pain. photosensitivity.  Take with meals. thiazide diuretics or to other sulfonamidederived drugs. avoid excessive ingestion of food high in potassium or use of salts substitutes.  Educate to avoid hazardous activity such driving untl response to drug is known. anaphylactoid reaction. paraesthesia. dermatitis. idiopathic oedema. Essential hypertension.sulfonamidederived medicines. Skin and appendages: rash.Generic Name: Spironolactone Brand Name: Aldazide Drug Class : Diuretics. Haematological disorders: thrombocytopenia to light but drug effectiveness is reportedly not altered. Isobutylhydrochlorothi azide promotes sodium and water excretion by inhibiting sodium and chloride reabsorption in the kidney tubule. diarrhoea. including malignancy. BP. significant impairment of renal function.

  . Headache. nervousness. dizziness). Nootropil is virtually nontoxic and has no stimulating.  Administer the drug in IV form if the client can not take it orally. Ask the patients name Always observe aseptic technique  During: Explain the procedure to the patient/SO. It increases the energy output of the brain cell and activates its neurophysiological potentialities. attention disorders & lack of drive. vomiting. depression. chest tightness. Patients with parasympathetic hypertonia. trouble breathing. dizziness. After: Cerebral hemorrhage. Treatment of cerebrovascular accident in acute and recovery phase. Ped treatment for dyslexia in Hyperkinesia. It increases the energy output of the brain cell and activates its neurophysiological potentialities. Nootropil is virtually nontoxic and has no stimulating. Pharmacology: Piracetam acts selectively upon the telencephalon by improving its associative function. alone or in combination. sedative or neurovegetative activities. impaired balance. insomnia. disorientation. Huntington's chorea.upper abdominal pain. anaphylactoid reaction. vomiting. Allergic reaction: Itching or hives. or diarrhea (loose BMs)  Verify the doctor’s order. vertigo & associated disorders of balance. cortical myoclonus.  Do not use rug if the ptient is pregnant (use contraceptives). Low blood pressure (faintness. symptoms and signs of cerebral insufficiency eg. w/ the exception of dizziness of vasomotor or psychic origin. memory loss.Generic name: Citicoline Brand name: Zynapse Drug Class: Neuroprotective. ataxia. headache. poor concentration. aggravated epilepsy. Generic Name: Piracetam Brand Names: Nootropil Drug Class Nootropics & Neurotonics Treatment of post stroke sequelae ie aphasia. wt gain. Explain what is the general action of the drug to the body. swelling or tingling in your mouth or throat. Pharmacology: Piracetam acts selectively upon the telencephalon by improving its associative function. vertigo.  Document the procedure. end stage renal disease.  Assess allergy to warfarin. especially in deficit conditions. especially in deficit conditions. Symptomatic treatment of the psycho-organic syndrome whose features are memory loss. somnolence.nausea. CNS Drugs & Agents for ADHD Neurovascular enhancer. Pregnancy & lactation. swelling in your face or hands. Nausea.  Monitor closely PT ratio and INR.  Prior to:   Wash hands thoroughly. recent cranial trauma and their sequelae. sedative or neurovegetative activities. skin & subcutaneous tissue disorders. or rash. Slow or fast heart beat.diarrhea. asthenia. Gastrointestinal disorders.

Parenteral: Pain. fall in hematocrit or blood pressure. guaiac-positive stools). and heparin-like products.  Observe the patients for possible untoward reaction. nosebleed. Antiplatelets & Fibrinolytics (Thrombolytics) See available brands of sulodexide Sulodexide is a heparinoid consisting of 80% fast moving heparin and 20% dermatan sulfate.  Hypersensitivity to sulodexide. Diathesis. Oral: Nausea. fever. Instruct to take the medication exactly as directed. vomiting. hematuria. urticaria). It is hypolipidaemic and antithrombotic and has been administered by mouth and parenterally for peripheral vascular disease and cerebrovascular disease. Monitor platelet  Generic Name: Sulodexide Brand Name: Vessel Due F Drug Class : Anticoagulants. burning and haematoma at injection site. tarry stools. Assess patients for signs of bleeding and hemorrhage (bleeding gums. heparin. Record the drug after its administration (charting). Report signs to physician. epigastric pain. unusual bruising.combination w/ appropriate measures eg speech therapy.   . haemorrhagic conditions. Notify physician if these occur. Pregnancy. Sulodexide differs from heparin by having a longer halflife and a decreased effect on systemic clotting and bleeding. As admin of heparin and low molecular wt heparin results in a Antithromb otic. It is also included in topical preparations for local vascular inflammation and soft tissue disorders. Monitor patient for hypersensitivity reactions (chills. black.

5-6 hr. Reduction in intracerebral pressure: around 15 min. Miscellaneous Mannitol increases urinary output by inhibiting tubular reabsorption of water and electrolytes. urticaria and hypotension or hypertension. 1 mg of sulodexide is equivalent to 10 LSU. It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues. Absorption: Small amounts are absorbed from the GI tract. Edema Fluid and electrolyte imbalance. severe dehydration. chest pain. thrombophloebitis. Promotion of diuresis in the prevention or treatment of the oliguric phase of acute renal failure before irreversible renal failure becomes established. thirst. the activity of sulodexide is expressed as Lipoprotein lipase Releasing Units (LSU). anuria due to severe renal disease. skin necrosis. count every 2-3 days throughout therapy. blurred vision. . It does not penetrate the blood-brain barrier nor the eye. headache.  Shift of sodium-free intracellular fluid into the extracellular compartment following mannitol infusion may lower serum sodium concentration and aggravate Pulmonary congestion or oedema. Reduction of intracranial pressure and brain mass. May cause mild thrombocytope nia. CHF. which appears on the 4th day and resolves despite continued heparin therapy. vomiting. Resctisol Drug Class : Diuretics.release of lipoprotein lipase. Promotion of urinary excretion of toxic materials. Generic Name: Mannitol Brand name: Osmitrol. acute renal failure. acidosis (with high doses). metabolic oedema with abnormal capillary fragility. Distribution: Concentrated in extracellular compartments. chills. Reduction of high intraocular pressure when the pressure cannot be lowered by other means. tachycardia. convulsions. intracranial bleeding. fever.  The cardiovascular status of the patient should be carefully evaluated before rapidly administering mannitol since sudden expansion of the extracellular fluid may lead to fulminating congestive heart failure. Nausea. Metabolism: Minimal hepatic metabolism. dizziness. Onset: Diuresis: 1-3 hr. Duration: Reduction in intracerebral pressure: 1.

converted to glycogen. mannitol administration may obscure and intensify inadequate hydration or hypovolemia. If it is essential that blood be given simultaneously. Excretion: Urine via the kidneys (unchanged drug). at least 20 mEq of sodium chloride should be added to each liter of mannitol solution to avoid pseudoagglutin ation. If crystals are observed.  Electrolyte-free mannitol solutions should not be given conjointly with blood.  When exposed to low temperatures.  By sustaining diuresis. the container should be . solutions of mannitol may crystalize. pre-existing hyponatremia.

See NOTE under how supplied. CHF. Do not administer Mannitol 25% if the Fliptop vial seal is not intact. pulmonary Essential hypertension. the administration set should include a filter. chronic bronchitis. then cooled to body temperature before administering. Generic Name: Carvedilol Brand Name: Dilatrend Drug Class: Antihypertensive Decreased heart rate and pulse pressure. Do not infuse mannitol solution if crystals are present. When infusing 20% or 25% mannitol concentrations.  Take apical Diseases that constrict the respiratory tract (bronchial asthma.warmed to redissolve.     Fatigue Dizziness Bradycardia CHF  Monitor BP and pulse prior and throughout therapy. . Discard unused portion.  Do not administer unless solution is clear and container is undamaged.

shock. metabolic acidosis. 2nd & 3rd degree AV block. uterine tube contraction and ovarian cyclic AMP and progesterone formation in animal models. Ponstan also inhibits the action of exogenous prostaglandins on uterine muscle. SA block. Children <14 yr.  Advise patient for proper diet. MI w/ complications. vomiting or abdominal pain  Headache  Dizziness  Drowsiness  Skin rashes  Visual disturbances  Retention of water in the body tissues (fluid retention). sinus node syndrome. Pregnancy. swelling of the laryngeal mucosa. anti-inflammatory and anti-pyretic properties. constipation. Patient & Family Education  Discontinue emphysema). Pharmacokinetics and Metabolism: Mefenamic acid is well absorbed from the Relief of pain including muscular. or simultaneous MAOI therapy. rheumatic. Assessment & Drug Effects  Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance. severe liver dysfunction. withhold medication and notify physician. if less than 50 bpm. regular exercise. headache & in childn w/ fever & juvenile RA. nausea.  Diabetics should closely monitor blood sugar.  Disturbances of the gut such as indigestion. post-op & postpartum pain.  Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts. Also for the relief of primary dysmenorrhea. diarrhoea. and kidney function tests. and lifestyle modification. . traumatic. Generic name: Mefenamic acid Brand Name: Ponstan Drug Class: Anti-pyretic or antipyretic and anti-inflammatory analgesics Ponstan has analgesic. Hct and Hgb. The pharmacological activity of Ponstan may be due in part to its ability to inhibit the synthesis of prostaglandins. resulting in swelling (oedema)  Awareness of your heartbeat (palpitations)  Ulceration of the stomach or Ulceration in the upper or lower intestinal tract. dental. too slow heart rate. allergic rhinitis.    Pulmonary edema Hypotension Constipation Impotence pulse.

fever. Peak plasma concentrations occur in about 2 to 4 hours. epistaxis. or malaise occur. It may cause dizziness and drowsiness. sore throat. Plasma levels are proportional to dose. IV: Fluid and electrolyte imbalance.gastro-intestinal tract. Notify physician if persistent GI discomfort. Rashes. dark stools. following multiple doses. Do not drive or engage in potentially hazardous activities until response to drug is known. Contact physician. with a half-life of 2 to 4 hours. or rash occur and do not use again. Do not breast feed while taking this drug without consulting physician. Over 50% of the dose may be recovered in the urine as unchanged drug or conjugated metabolites. intestines  Bleeding from the stomach or intestines  Inflammation of the pancreas (pancreatitis)  Allergic reactions such as severe skin rashes. tongue and throat (angioedema) or narrowing of the airways (bronchospasm)  Kidney. Mefenamic acid is extensively bound to plasma proteins. Generic Name: Furosemide Furosemide inhibits reabsorption of Na and  Oral. with no drug accumulation. ecchymoses. liver or blood disorders     drug promptly if diarrhea. hematemesis. . Monitor blood glucose for loss of glycemic control if diabetic.  Administer Severe sodium and water depletion. swelling of the lips.

hypotension. Potentially Fatal: Rarely. with food or milk to prevent GI upset. Addison's disease. analgesic. It increases plasma-renin levels and secondary hyperaldosteronism may result. nausea. Pyrexia of unknown origin.Drug Class : Diuretics See available brands of furosemide Generic Name: Paracetamol Brand Name: Aeknil Drug Class : Analgesics (NonOpioid) & Antipyretics chloride mainly in the medullary portion of the ascending Loop of Henle. Absorption: Fairly rapidly absorbed from the GI tract (oral). renal disease  IV: Acute pulmonary edema  Oral: Hypertensio n photosensitivity.  Give early in the day so that increased urination will not disturb sleep. ototoxicity. headache. anuria or renal failure. Excretion: Via urine (as unchanged). diarrhoea. It also reduces pulmonary oedema before diuresis has set in. cirrhosis.  Avoid IV use if oral use is at all possible. precomatose states associated with liver cirrhosis. Antipyretic. Hyperglycaemia. glycosuria. upper resp tract infections post- Paracetamol has rarely been found to produce any adverse effects in therapeutic doses and is usually well tolerated by aspirin-sensitive patients. hypersensitivity to sulphonamides and furosemide. sudden death and cardiac arrest. Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. hepatic dysfunction.  Have plenty of water when taking this drug. Distribution: Crosses the placenta and enters breast milk. Fever & pain associated w/ common childhood disorders. blurred vision. Nephropathy. tonsillitis. dizziness. 2 hr (elimination half-life). . hyponatraemia. Toxicity may result from  Instruct the patient to take with meals. Proteinbinding: 99%. may be prolonged in neonates and renal and hepatic impairment. Furosemide reduces BP in hypertensives as well as in normotensives. Hypokalaemia and magnesium depletion can cause cardiac arrhythmias. hypokalaemia. readjust dosage gradually as BP responds. Pharmacology: Paracetamol produces analgesia by raising the threshold of the pain center in the brain and by obstructing Edema associated with CHF. Bone marrow depression (rare).  Reduce dosage if given with other antihyperte nsives.

mercapturate and unchanged drug. immunization reactions. sinusitis. Headache. hematological toxicity eg. Pharmacokinetics: Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Following oral administration.impulses at the painmediating chemoreceptors. cold. Approximately 85% of a dose of paracetamol is excreted in the urine within 24 hrs after administration. Paracetamol is excreted in the urine primarily as the glucuronide and smaller amounts as the sulfate. heat dissipation is increased as a result of vasodilation and increased peripheral blood flow. The drug produces antipyresis by an action on the hypothalamus. a single toxic dose of the drug or from chronic ingestion. arthritis & toothache. renal damage can result. methemoglobinaemia which can result in cyanosis. peak plasma levels are attained in 10 min to 1 hr and the half-life is 75 min to 3 hrs. Prevention of febrile convulsion. and on longterm use. thrombocytopenia and leucopenia. Distribution of paracetamol to most body tissues and fluids is both rapid and uniform. muscle pain. . The following adverse reactions have been reported: Skin eruption. after tonsillectomy & other conditions.

Analgesics (Opioid) Pharmacology: Nalbuphine HCl is a potent analgesic. .  Note general client condition. GI upsets. 10 mg of which is comparable in analgesic potency to 810 mg of morphine sulfate. allergic reactions. type/ onset of symptoms & anticipated. analgesia may be longer lasting than from comparable doses of morphine. whether administered IV. The onset of action occurs within 2-3 min after IV administration of nalbuphine HCl and in <10 min following SC or IM injection. for obstet analgesia during labor & relief of pain following MI. headache. The t½ of nalbuphine is 5 hrs. as a supplement to balanced anesth. Clinical experience suggests that in some patients. Infrequently sweating. vertigo.  Document indications for therapy.Generic Name: NALBUPHINE HYDROCHLORIDE Brand Name: Nubain Class : Anaesthetics . Pre-op analgesia. Post-op somatic & visceral pain. effects having been observed in acute and chronic pain for 3-8 hrs. SC or IM.Local & General.  Monitor V/S & I&O. dry mouth. Sedation. dizziness. Hemodynamic studies in patients with severe arteriosclerotic heart Relief of moderate to severe pain. Patients who are hypersensitive to nalbuphine HCl. Nalbuphine HCl has the effect of lowering the cardiac work load and can be used immediately in myocardial infarction (use with caution where emesis is involved). surgical anesth.

history of ventricular arrhythmias. QT interval prolongation. chest pain. store at 15-30 C. Before:  Do not expose premixed single-dose product to excessive heat. selective inhibitor of phosphodiesterase-III (PDE-III). nausea. diarrhoea. peripheral oedema. ecchymosis and skin rash. palpitations. cardiac index. pain. which augments the cAMP-elevating effect of PDE-III inhibition. Nalbuphine HCl antagonist activity is ¼ as potent as nalorphine and approximately 1/40 that of naloxone. Increase in cAMP in platelets and blood vessels leads to inhibition of platelet aggregation and vasodilation. a minimal decrease in oxygen consumption. Generic Name: Cilostazol Brand Name: Pletal Drug Class : Anticoagulants. vomiting. pharyngitis. Peripheral vascular disease Headache. known predisposition to bleeding. thereby suppressing cyclic adenosine monophosphate (cAMP) degradation. dizziness. severe renal impairment. other cardiac arrhythmias. extent of abdominal pain. stool/ gastric aspirate.  Assess location. . Absorption: Absorbed from the GI tract after oral admin. abnormal stools. rhinitis.  List drugs prescribed to ensure none interact unfavorably. infection. note blood in emesis. left ventricular end diastolic pressure and cardiac work. Antiplatelets & Fibrinolytics (Thrombolytics) Cilostazol is a reversible.changes reveal that nalbuphine HCl has circulatory effects similar to those of morphine ie. During:  Administer PO medication with meals & with a Heart failure. moderate to severe hepatic impairment. Cilostazol also inhibits adenosine uptake into cells. characteristics.

vomiting. K-Tab. Klotrix. remainder excreted in the faece Generic Name: Potassium Chloride Brand Name: K-Dur. It plays an active role in the conduction of nerve impulses in the heart.  For IM use. Oral: Nausea. Ten-K.Distribution: 95-98% bound to plasma proteins. mainly CYP3A4. . brain and skeletal muscle. hyperkalaemia.  Monitor plasma potassium levels  Monitoring of acid-base balance. snack at bedtime. After:  Note general client condition. give undiluted. Absorption: Well absorbed from the Prevention of hypokalaemia GI ulceration (sometimes with haemorrhage and perforation or with late formation of strictures) following the use of enteric-coated K chloride preparation. acid-base balance. and ECG is recommended. type/ onset of symptoms & anticipated. cardiac toxicity. Kaon CL. severe renal or adrenal insufficiency. IV: Pain or phloebitis. potassium levels. Metabolism: Extensively metabolised hepatically by CYP450 isoenzymes. Klorvess. Slow-K. carbohydrate metabolism and gastric secretion.  In renal dysfunction.  Document indications for therapy. KLyte CL Drug Class : Electrolytes Potassium chloride is a major cation of the intracellular fluid. a dose of 300 mg PO/ IV g 12 hr. diarrhoea and abdominal cramps. contraction of cardiac skeletal and smooth muscles.  Monitor V/S & I&O. Excretion: Mainly excreted in the urine. may be necessary. maintenance of normal renal function. Hyperchloraemia. K-Lor.

. Excretion: Mainly via the urine with small amounts via the sweat and feces. Distribution: Active transport mechanism allows K chloride to enter cells from the extracellular fluid.upper GI tract.