DRUG STUDY Name HYDROCORTISONE Classificat ion Corticoste roids Mechanism of Action reduce inflammation in the airways.

Hydrocortisone c omes from the outer part of our adrenal glands, called the 'cortex'. It is also partly an emergency hormone. Medicines which resemble it act slowly and make the lining of air tubes in asthma more normal Antacids, H2-receptor Antireflux antagonist. Agents & Ranitidine is a Antiulcera competitive nts inhibitor of histamine at histamine H2receptor sites, including receptors on the gastric cells. Ranitidine Indication Adrenocortical insufficiency, sho ck, hypersensitivity reactions. treat acute asthma attacks or very severe asthma. They may take a few hours or a few days to be fully effective. Contraindicati on Latent, healed & active TB, herpes simplex, chronic nephritis, acute psychosis, Cushing's syndrome, peptic ulcer & predisposition to thrombophlebi tis. Adverse Reaction Dosage Nursing Intervention 4-6 Assess contraindications for

Na & water retention Hydrocortisone w/ edema & HTN, mg/kg/dose IV hypokalemic acidosis, given q4-6h susceptibility to infections, increase in appetite, osteoporosis, muscle weakness, ocular changes, peptic ulcer, indigestion.

Monitor client for at least 30 minutes. Educate client on the side effects of the medication and what to expect Document that drug has been given.

RANITIDINE

Peptic Hypersensitivit ulcer, GERD, y to ranitidine. selected cases of persistent dyspe psia, ZollingerEllison syndrome, stress ulceration & in patients at risk of acid aspiration during anesth, reflux esophagitis.

In various short term and longer studies in the treatment of peptic ulcer, ranitidine has been well tolerated with side effects occurring only in a minority of patients. Minor side effects reported are usually confined to rash, headache,

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, IV infusion: 50 mg (2 mL) sore throat; diarrhea; IV Injection: 50 mg (2 mL) every 6-8 hrs. Dilute ranitidine injection 50 mg in 0.9% sodium chloride injection or other compatible IV solution to a total volume of 20 mL and inject over a period of not less than 5 months.

inhibits both day time and nocturnal basal gastric acid secretions as well as gastric secretion by food, histamine and pentagastin.

dizziness, diarrhea and tiredness. Rare cases or reversible mental confusion have been reported, especially in severely ill, elderly patients. Local pain, burning or itching has been reported at the site of injection.

SALBUTAMOL

Antiasthm aticSalbut amol ; Belongs to the class of adrenergi cs for systemic use, selective beta-2adrenorec eptor agonists. Used in the treatment of obstructiv e airway diseases.

Salbutamol is a direct-acting sympathomimeti c with adrenergic activity and selective action on 2 receptors, producing bronchodilating effects. It also decreases uterine contractility.

Relief Pregnancy. of bronchospasm blockers. in bronchial asthma, chronic bronchitis,emphy sema & other reversible obstructive pulmonary diseases.

- Fine skeletal muscle tremor especially hands, tachycardia, palpitations, muscle cramps, headache, paradoxical bronchospasm, angioedema, urticaria, hypotension and collapse. Potentially Fatal: Potentially serious hypokalaemia after large doses.

dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause The IV or IM injection is stools and tongue to indicated where oral appear gray black. treatment is inappropriate. Adult 10 mL. Childn >12 Advise patient to rinse yr 5-10 mL, 7-12 yr 5 mouth with water mL, 2-6 yr 2.5-5 mL. To after each inhalation dose to minimize dry be taken 6-8 hrly. mouth Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain

every 6-8 hrs. Dilute ranitidine 50 mg in 100 mL of 5% dextrose injection or other compatible IV solution at the rate of 25 mg/hr for 2 hrs.

CO-AMOXICLAV

Penicillins

Inhibits enzymes involved in formation of peptidoglycan layer of bacterial cell wall No effect on human cell walls Bactericidal; only works on dividing bacteria Well absorbed enterally Clavulanic acid inhibits bacterial -lactamase

Lower resp tract infections, otitis media, sinusitis, skin & soft tissue infections, UTI, pre & postsurgical procedures, bone & joint, O & G infections, dental infections.

Hypersensitivit y to penicillins & cephalosporins or other allergen, possible cross sensitivity w/ other lactams. History of penicillinassociated cholestatic jaundice/hepat ic dysfunction.

Diarrhea, indigestion, nausea, vomiting, candidiasis, rash. Rarely, pseudomembranous colitis, hepatitis, cholestatic jaundice, crystalluria, erythema multiforme, StevensJohnson syndrome, toxic epidermal necrolysis, reversible leukopenia, thrombocytopenia, hemolytic anaemia, CNS disturbances.

Dosage depends on the age, weight and renal function of the patient and the severity of the infection. Dosages are expressed throughout in terms of co-amoxiclav content except when doses are stated in terms of an individual component.

To minimize potential GI intolerance, administer at the start of a meal. The absorption of coamoxiclav is optimized when taken at the start of a meal. Treatment should not be extended beyond 14 days without review. Advise patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.

EPINEPHRINE

Epinephri ne ; Belongs to the class of topical sympatho mimetic agents used as nasal decongest ants.

Epinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimeti c. It stimulates and -adrenergic receptors resulting in relaxation of smooth muscle

Acute asthmaAs 1:1,000 soln: 0.30.5 mL. Ophth Openangle glaucoma; Ocular HTN As 0.5, 1 or 2% soln: Instill 1-2 times/day. Inhala tion Acute asthma Per metered dose

Preexisting hypertension; occlusive vascular disease; angleclosure glaucoma (eye drops); hypersensitivit y; cardiac arrhythmias or tachycardia.

CNS effects; GI disturbances; epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of

Bronchial asthma & bronchospasm 0.3-0.5 mL of 1:1000 dilution. Childn 10 mcg/kg body wt or 300 mcg/m2 body surface up to 500 mcg/dose, repeated as necessary up to 6 times a day.

Use extreme caution when calculating and preparing doses; epinephrine is a very potent drug. Protect drug solutions from light, extreme heat and freezing.

Autonomic nervous system agent; alpha and beta adrenergic agonist; bronchodilat or.

MIDAZOLAM

Anxiolytic s / Hypnot ics & Sedatives / Anticonv ulsants Midazola m ; Belongs to the class of benzodiaz epine derivative s. Used as hypnotics and

of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity. Midazolam has anxiolytic hypnotic, anticonvulsant, muscle relaxant and anterograde amnestic effects. The mechanism of action of midazolam is not clearly understood, however, it is probably similar to that of other benzodiazepines

from pressurised aerosols contains 160-275 mcg of epinephrine: 1-2 inhalations, repeat 3 hr later if needed.

When used in extremities; addition to hypokalaemia local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum.

Acute asthma Adult: Spray: Aqueous solution with an adrenaline co ntent equivalent to 1:100. Pressurised aerosols delivering metered doses equivalent to approximately 160-275 mcg: 1-2 inhalations, may repeat after 3 hr if necessary.

Acute narrowangle glaucoma; coma or patients in shock; acute alcohol intoxication; intrathecal and epidural admin. Acute pulmonary insufficiency

Physical and psychological dependence with withdrawal symptoms; decreased tidal volume and respiration rate; apnoea; headache; hiccup; nausea, increased appetite, vomiting; cough; oversedation; seizurelike activity (paediatrics); paradoxical reactions; kernicterus; nystagmus; skin rash,

Preoperative Sedative

Assess level of sedation and level of Adults consciousness IM 0.07 to 0.08 mg/kg throughout and for 2approximately 1 h before 6 hr following surgery. administration. C onscious Sedation Monitor BP, pulse and respiration Adults continuously during IV IV 1 to 2.5 mg as 1 mg/mL administration. dilution over 2 min. Increase by smallincrements to total Oxygen and dose of no more than 5 mg in resuscitative at least 2 min intervals; use equipment should be less if patient is premedicated immediately available. with other CNS depressants.

sedatives.

PENICILLIN G

Natural penicillin Penicillin G Potassium

Parenteral Acute asthma Adult: As 1:1,000 aqueous solution: 0.3-0.5 ml (300-500 mcg). Dose may be given via IM or SC inj. Child: As 1:1,000 aqueous solution: 0.01 ml/kg (10 mcg/kg). Max: 0.5 ml (500 mcg). Dose may be given via IM or SC inj. Intravenous Bactericidal: Penicillin G Inhibits synthesis Treatment of of cell wall of infections caused sensitive by susceptible organisms, microorganisms. causing cell death.

pruritus; reduced alertness, confusion, euphoria, hallucinations, fatigue, dizziness, ataxia, postoperative sedation, anterograde amnesia; jaundice; cardiac arrest, heart rate changes, thrombosis; anaphylaxis; laryngospasm, bronchospasm.

C hildren IM 0.1 to 0.15mg/kg. Doses up to 0.5 mg/kg have been used for moreanxious patients. Total dose usually does not exceed 10 mg.

If overdose occurs, monitor pulse, respiration , and BP continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning and vasopressors..

Hypersensitivit y to penicillins. Do not treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, and purulent or septic arthritis with oral penicillin G during acute

Dizziness; fatigue; insomnia; reversible hyperactivity; neurotoxicity (eg, lethargy, neuromuscular irritability, hallucinations, convulsions, seizures).Itchy eyes; gastritis; sore mouth or tongue; furry tongue; black hairy tongue; abnormal

M;IV,INFUSION (Continuous) Serious streptococcal infections (empyema, endocarditis, meningitis, pericarditis, pneumonia.) * Adults: 5-24 million units/day in divided doses q 4 to 6 hr. * Pediatric: 150,000 units/kg/day given in equal doses q 4 to 6 hr. * Infants over 7 days of

Assess the patient s history to allergy to penicillins, cephalosporins, imipenem, betalactamase inhibitors, other allergens, renal disease, lactation and pregnancy. Monitor intake and output. Dehydration decreases drug excretion and may raise blood level of

stage.

taste perception Interstitial nephritis (eg, oliguria, proteinuria, hematuria, hyaline casts, pyuria); nephropathy; increased BUN and creatinine.

age: 75,000 units/kg/day in divided doses q 8 hr. * Infants less than 7 days of age: 50,000 units/kg/day given in divided doses q 12 hr. For Group B streptococcus, give 100,000 units/kg/day.

penicillin G to dangerously high levels causing kidney damage. GI disturbances may lead to dehydration. Culture infection before beginning treatment; reculture if response is not as expected.. Monitor serum electrolytes and cardiac status if penicillin G is given by IV infusion. Sodium or potassium preparations have been associated with severe electrolyte imbalances. Keep epinephrine, IV fluids, vasopressors, bronchodiators, oxygen, and emergency equipment readily available in case of serious hypersensitivity reaction.

Instruct the patient to report any unusual bruising, bleeding, nausea and vomiting, sore mouth, diarrhea, rash, fever, difficulty breathing, adverse side effects, or lack of improvement. BUDESONIDE Belongs to the class of other inhalants used in the treatment of obstructiv e airway diseases, glucocorti coids. Budesonide is an antiinflammatory corticosteroid. The precise mechanism of action on inflammation is not known. Corticosteroids have been shown to have a wide range of inhibitory activities against multiple cell types (eg, mast cells, eosinophils, neutrophils, macrophages and lymphocytes) and mediators (eg, histamine Chronic control of signs and symptoms of bronchial asthma. Maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients. Primary treatment of status asthmaticus or other acute episodes of asthma where intensive measures are required. Hypersensitivit y to budesonide. Neck pain.Cough, respiratory infection, rhinitis, sinusitis, stridor. Gastroenteritis, oral candidiasis, abdominal pain, dry mouth, nausea, vomiting, dyspepsia.Weight gain.Insomnia, anorexia, emotional lability.Contact dermatitis, rash.: Taste perversion. In most studies, a volume fill of 4 mL in the nebulizer chamber, using sterile normal saline as diluent, is recommended to ensure a high aerosol output, small respirable particle size and acceptably short treatment time Encourage patient to complete drug therapy. Monitor patient for signs of hypercorticism acne, bruising, moon face, swollen ankles, hirsutism, skin striae, buffalo hump which could indicate need to decrease dosage. Teaching points Inhalation Do not use more often than prescribed; do not stop without consulting your health care provider.

eicosanoids, leukotrienes and cytokines) involved in allergic and nonallergic-mediated inflammation. These antiinflammatory actions may contribute to their efficacy in asthma.

It may take several days to achieve good effects; do not stop if effects are not immediate. Use decongestant nose drops first if nasal passages are blocked. These side effects may occur: Local irritation (use device correctly), dry mouth (use sugarless lozenges). Report sore mouth, sore throat, worsening of symptoms, severe sneezing, exposure to chickenpox or measles, eye infections.