SITI WAN NURAINATASA BINTI NAZRI WAN

ACETYLSALICYLIC ACID

ADENOSINE

ALPROSTADIL

AMINOPHYLLINE

AMIODARONE

AMLODIPINE

AMPICILLIN SODIUM

ATROPINE SULPHATE

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SITI WAN NURAINATASA BINTI NAZRI WAN

ASPIRIN / CARDIPRIN 100

(Nonsteroidal Anti-Inflammatory Drug)

Indications:
Transient ischaemic attacks, secondary prevention of MI. Platelet aggregation inhibitor for
prophylaxis against stroke, vascular occlusion & DVT. Prevention of graft occlusion in patients
following aortocoronary bypass surgery.
Available Dose:
Aspirin 100 mg, glycine 45 mg
Recommended dosage:
Adult
1 tab daily or as required. Dissolve on tongue or take with a glass of water.
Route Of Administration:
Oral
Mode Of Action:
Antiplatelet, antithrombotic. After oral administration of aspirin-glycine, aspirin is generally well
absorbed from the gastrointestinal tract, partly from the stomach and mainly from the small
intestine. Metabolism of arachidonic acid via the enzyme cyclooxygenase produces mainly
thromboxane (TxA2) in platelets and prostacyclin (PGI2) in the vascular endothelium.
TxA2 causes vasoconstriction and induces platelet aggregation and PGI 2 causes vasodilation
and has a platelet anti-aggregatory effect.
Special Warnings:
Patients suffering from active peptic ulceration or haemophilia or known to be allergic to
aspirin. There is clinical and epidemiological evidence of the safety of aspirin in pregnancy,
but it may prolong labour and contribute to maternal and neonatal bleeding and is best
avoided in the last trimester of pregnancy. Elderly patients do not tolerate aspirin as well as
younger patients. They may experience tinnitus, nausea, anorexia and gastrointestinal irritation
though this would be less likely at the doses recommended for antiplatelet action.

Possible Side Effects:

1. Apnoea
2. Haemorrhage
3. Bradycardia
4. Nausea
5. Congestive heart failure
6. Cortical proliferation of long bones
7. Diarrhoea
8. Disseminated intravascular coagulation
9. Edema
10. Vomiting

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Acetylsalicylic Acid is
a very potent drug; small errors in dosage can cause serious adverse effects.
Double-check paediatric dosage.
2. Protect drug from light, extreme heat, and freezing; do not use pink or brown colour
tablet.

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3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,

apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to avoid smoking and driving.

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ADENOSINE / MYODEEN

(Antiarrhythmic Agent)

Indications:
Rapid conversion to a normal sinus rhythm of paroxysmal supraventricular tachycardia
including those associated w/ accessory bypass tracts (Wolff-Parkinson-White syndrome). Aid
to diagnosis of broad or narrow complex supraventricular tachycardia. Sensitization of
intracavitary electrophysiological investigations.
Available Dose:
2 ml x 1’s
Recommended dosage:
Myocardial Imaging
140 mcg/kg/min for 6 minutes as a continuous infusion via infusion pump (total dose: 0.84
mg/kg). The radionuclide is injected at midpoint (after 3 minutes) of infusion.
Paroxysmal Supraventricular Tachycardia
Adult
Initially, 3 mg via rapid injection into a central or large peripheral vein over 2 seconds; 6 mg
may be given after 1-2 minutes, if necessary, then 12 mg after a further 1-2 minutes.
Alternatively, an initial dose of 6 mg, followed by 2 further doses of 12 mg, if necessary, at 1–2-
minute intervals. Follow each dose with normal saline flush.
Child
<50 kg: Initially, 50-100 mcg/kg as rapid bolus, may be increased by 50-100 mcg/kg increments
at 1–2-minute intervals until sinus rhythm is established. Max: 300 mcg/kg. Alternatively, an initial
dose of 100 mcg/kg (Max: 6 mg), followed by 200 mcg/kg (Max: 12 mg) if necessary; ≥50 kg:
Differential Diagnosis of Supraventricular Tachycardias
Initially, 3 mg via rapid injection into a central or large peripheral vein over 2 seconds; 6 mg
may be given after 1-2 minutes, if necessary, then 12 mg after a further 1-2 minutes.
Route Of Administration:
Intravenous
Mode Of Action:
Adenosine is an endogenous purine nucleoside that is involved in numerous biological
processes. It stimulates A1 receptors to slow conduction time through the AV node; and
A2 receptors to produce peripheral and coronary vasodilation, thus, increasing blood flow in
normal arteries w/ little to no increase in stenotic arteries.
Special Warnings:
Patients w/ transplanted heart; Patients receiving dipyridamole or carbamazepine; Admin via
central line: Use regimen w/ initial dose of 3 mg. Patient w/ QT prolongation, emphysema,
bronchitis, autonomic dysfunction, pericarditis, pericardial effusion, left main coronary stenosis,
stenotic valvular heart disease, stenotic carotid artery disease (w/ cerebrovascular
insufficiency), uncorrected hypovolemia, left to right shunt, recent MI or heart transplant,
severe heart failure, minor conduction defects (e.g. 1st degree AV block, bundle branch
block), atrial fibrillation/flutter, history of convulsion/seizure. Pregnancy and lactation.

Possible Side Effects:

1. Nausea
2. Diarrhea
3. Vomiting

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4. Sudden wheeziness, difficulty in breathing, swelling of the eyelids, face or lips, rash or
itching (especially affecting your whole body).
5. Headache
6. Dizziness
7. Feelings of anxiety or fear or restlessness
8. Insomnia, confusion, irritability
9. Dry mouth or producing too much saliva
10. Weakness or sweating
Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Adenosine is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Protect drug solutions from light, extreme heat, and freezing; do not use pink or
brown solutions. Drug solutions should be clear and colourless (does not apply to
suspension for injection).
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to avoid smoking and driving.

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SITI WAN NURAINATASA BINTI NAZRI WAN

ALPROSTADIL / CAVERJECT

(Vasodilator Prostaglandin)

Indications:
Erectile dysfunction in adult males due to neurogenic, vasculogenic, psychogenic or mixed
aetiology. Adjunct to other diagnostic tests in the diagnosis of erectile dysfunction.
Available Dose:
20 Micrograms
Recommended dosage:
Erectile dysfunction of neurogenic origin secondary to spinal cord injury
Initially 1.25 mcg, then 2.5 mcg as 2nd dose, followed by 5 mcg as 3rd dose. May be increased
in increments of 5 mcg until optimal dose is achieved.
Erectile dysfunction of vasculogenic, psychogenic or mixed aetiology
Initially 2.5 mcg, then 5 mcg as 2nd dose for partial response & 7.5 mcg if no response. May be
increased in increments of 5-10 mcg until optimal dose is achieved. Max therapy: Not >once
daily & not >3 times wkly.
Aid to aetiology diagnosis Subject w/o evidence of neurological dysfunction
20 mcg.
Subject w/ evidence of neurological dysfunction
Initially 5 mcg, not to exceed 10 mcg.
Route Of Administration:
Intracavernosal
Mode Of Action:
Alprostadil induces erection by relaxation of trabecular smooth muscle and by dilation of
cavernosal arteries.
Special Warnings:
Patient w/ bleeding tendencies, blood-borne and pulmonary diseases, transient ischaemic
attacks, CHD, CHF, history of psychiatric disorder or addiction. Pregnancy (use condom barrier
if female partner is or may be pregnant).
Possible Side Effects:
1. Accidental injury (Muse only)
2. Apnea
3. Bleeding of Cerebral and Urethral
4. Bradycardia
5. Cardiac arrest
6. Congestive heart failure
7. Cortical proliferation of long bones
8. Diarrhea
9. Disseminated intravascular coagulation
10. Edema
Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; prostaglandin is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-check
paediatric dosage.
2. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown
solutions.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue, apprehension
(use caution if driving or performing tasks that require alertness); anxiety, emotional

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changes; nausea, vomiting, change in taste (eat frequent small meals); fast heart rate.
Nasal solution may cause burning or stinging when first used (transient). Ophthalmic
solution may cause slight stinging when first used (transient); headache or brow ache
(only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac rhythm
and blood pressure.
5. Advice patient to avoid smoking and driving.

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ALPROSTADIL / PROSTIN VR

(Vasodilator Prostaglandin)

Indications:
Palliative, not definitive, therapy to temporarily maintain ductus arteriosus patency until
corrective or palliative surgery can be performed in neonates who have congenital heart
defects & who depend upon patent ductus for survival.
Available Dose:
I ml x 5 x 1’s
Recommended dosage:
Initially 0.05-0.1 mcg/kg/min by continuous IV infusion
Route Of Administration:
Intravenous. (PROSTIN VR PEDIATRIC may be administered through an umbilical artery catheter
placed at the ductal opening)
Mode Of Action:
In infants with restricted systemic blood flow, alprostadil often increased pH in those having
acidosis, increased systemic blood pressure, and decreased the ratio of pulmonary artery
pressure to aortic pressure.
Special Warnings:
Not be used in neonates w/ respiratory distress syndrome. Cortical proliferation of long bones.
Monitor respiratory status & arterial pressure throughout treatment. Long-term use. Neonates
w/ bleeding tendencies.
Preclinical safety data: Carcinogenesis, mutagenesis, impairment of fertility: Long-term
carcinogenicity studies and fertility studies have not been done. The Amesand Alkaline Elution
assays reveal no potential for mutagenesis.
Possible Side Effects:
1. Apnea
2. Fever
3. Seizures
4. Flushing
5. Bradycardia
6. Hypotension
7. Tachycardia
8. Cardiac arrest
9. Edema
10. Diarrhoea
Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; prostaglandin is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-check
paediatric dosage.
2. Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown
solutions. Drug solutions should be clear and colourless (does not apply to suspension
for injection).
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue, apprehension
(use caution if driving or performing tasks that require alertness); anxiety, emotional
changes; nausea, vomiting, change in taste (eat frequent small meals); fast heart rate.
Nasal solution may cause burning or stinging when first used (transient). Ophthalmic

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solution may cause slight stinging when first used (transient); headache or brow ache
(only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac rhythm
and blood pressure.
5. Advice patient to avoid smoking and driving.

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AMINOPHYLLINE

(Bronchodilator)

Indications:
Intravenous aminophylline can be used for acute exacerbation of symptoms and reversible
airway obstruction in asthma and other chronic lung disease such as COPD, emphysema and
chronic bronchitis. It is used as an adjunct to inhaled beta-2 selective agonists and
systemically administered corticosteroids.
Available Dose:
25 mg/ml
Recommended dosage:
Acute Severe Bronchospasm
Adult
In patients who are not currently receiving theophylline preparations: Loading dose: As
aminophylline: 250-500 mg or up to 5 mg/kg via slow inj or infusion over 20-30 minutes. As
aminophylline hydrate: Loading dose: 6 mg/kg via slow inj or infusion. Max rate: 25 mg/minute.
In patients who are already receiving theophylline: Loading dose must be deferred until serum
theophylline levels are determined, or if necessary, dose must be selected based on potential
benefits and risks.
Elderly
Maintenance: As aminophylline: 0.3 mg/kg/hour. As aminophylline hydrate: 0.6 mg/kg/hour,
decreasing to 0.3 mg/kg/hour after 12 hours.
Child
In patients who are not currently receiving theophylline preparations: Loading dose: Same as
adult dose. Maintenance: 6 months to 9 years a
s aminophylline: 1 mg/kg/hour. As aminophylline hydrate: 1.2 mg/kg/hour, decreasing to 1
mg/kg/hour after 12 hours; 10-16 years as aminophylline: 0.8 mg/kg/hour. As aminophylline
hydrate: 1 mg/kg/hour, decreasing to 0.8 mg/kg/hour after 12 hours.
Route Of Administration:
Intravenous
Mode Of Action:
Aminophylline, a xanthine derivative, is a complex of theophylline and ethylenediamine that
readily liberates theophylline in the body. Theophylline has 2 distinct actions; bronchodilation,
which may be mediated by inhibition of phosphodiesterase (PDE) isoenzymes (PDE III, and to
a lesser extent, PDE IV), and non-bronchodilation effects, which may be mediated through
other molecular mechanisms. It increases the force of contraction of diaphragmatic muscles
by increasing the Ca uptake through adenosine-mediated channels.
Special Warnings:
Patient with history of seizure, active influenza infection or undergoing influenza immunisation,
acute febrile illness, cardiac arrhythmias or other CV disease, chronic alcoholism, active or
history of peptic ulcer, thyroid disorder, glaucoma, diabetes mellitus, severe hypoxaemia,
sepsis with multiorgan failure, shock, hypertension, cystic fibrosis, acute pulmonary oedema,
cor pulmonale, compromised circulatory function. Simultaneous administration by >1
route/preparation. Not recommended for infants <6 months. Avoid extravasation (IV).
Smokers. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.

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Possible Side Effects:

1.
Tremors
2.
Palpitation
3.
Vomiting
4.
Sudden wheeziness, difficulty in breathing, swelling of the eyelids, face or lips, rash or
itching (especially affecting your whole body).
5. Irregular Heartbeat
6. Dizziness
7. Feelings of anxiety or fear or restlessness
8. Insomnia, confusion, irritability
9. Dry mouth or producing too much saliva
10. Abdominal pain
Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Aminophylline is a
very potent drug; small errors in dosage can cause serious adverse effects. Double-
check the dosage.
2. Protect drug solutions from light, extreme heat, and freezing; do not use pink or
brown solutions. Drug solutions should be clear and colourless.
3. Educate the patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Encourage patient to drink sufficient fluid to maintain adequate hydration.

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AMIODARONE/ CORDORONE

(Antiarrhythmic)

Indications:
Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types
of cardiac dysrhythmias. This includes ventricular tachycardia (VT), ventricular fibrillation (VF),
and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular
tachycardia.
Available Dose:
200 mg per tab
50 mg/ml
Recommended dosage:
Supraventricular Arrhythmias, Ventricular Arrhythmias
Adult
Initially, 200 mg tid for 1 week then reduced to 200 mg bid for another week. Maintenance:
≤200 mg daily based on patient response.
Elderly
Use minimum effective dose
Supraventricular Arrhythmias, Ventricular Arrhythmias
Adult
Initially, 5 mg/kg via infusion over a period of 20-120 minutes, may repeat infusion up to 1,200
mg (approx 15 mg/kg) per 24 hours, with a rate of infusion adjusted based on clinical response.
For emergency cases: 150-300 mg via slow inj over ≥3 minutes, may be repeated at least 15
minutes after the first dose.
Elderly
Use the minimum effective dose.
Route Of Administration:
Oral and Intravenous
Mode Of Action:
Amiodarone is a class III antiarrhythmic agent but exhibits characteristics of all Vaughn-Williams
classes. Its main effect is to lengthen the action potential and refractory period in the
myocardial tissue. It blocks the Na, K, and Ca channels resulting in slowing of the conduction
and prolongation of refractoriness. It produces negative chronotropic effect in nodal tissues
similar to class IV.
Special Warnings:
Patient with latent or manifest heart failure, implantable cardioverter defibrillator or
pacemaker, decompensated cardiomyopathy, hypotension. Patient undergoing surgery.
Elderly. Pregnancy.

Possible Side Effects:

1. Malaise
2. Hypotension
3. Vomiting
4. Wheeziness
5. Headache
6. Sleep Disturbance
7. Photo sensitivity

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8. Loss of appetite
9. Hyper Thyroidism
10. Weakness or sweating

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Amiodarone is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Arrange for ophthalmic exam to evaluate signs of optic neuropathy.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to avoid sun when takin drug to prevent bluish discolouration of skin.

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AMLODIPINE BESILATE/ NORVASC

(Anti-Angina & Anti-Hypertension)

Indications:
1st-line treatment of Hypertension & myocardial ischemia whether due to fixed obstruction
(stable angina) &/or vasospasm/vasoconstriction (Prinz metals or variant angina) of coronary
vasculature. Monotherapy or in combination w/ other antianginal drugs in patient’s w/ angina
refractory to nitrates &/or β-blockers.
Available Dose:
5mg per tab
10 mg per tab
Recommended dosage:
Use in the Elderly
Normal dosage regimens are recommended 5mg-10mg. Amlodipine, used at similar doses in
the elderly or younger patients, is equally well tolerated.
Use in Children
Children and adolescents with hypertension from 6 years to 17 years of age. The
recommended antihypertensive oral dose in paediatric patients aged 6-17 years is 2.5 mg
once daily as a starting dose, up-titrated to 5 mg once daily if blood pressure goal is not
achieved after 4 weeks. Doses in excess of 5 mg daily have not been studied in paediatric
patients.
Use in Patients with Renal Failure
Amlodipine may be used at normal doses in patients with renal failure. Changes in amlodipine
plasma concentrations are not correlated with the degree of renal impairment. Amlodipine is
not dialyzable.
Route Of Administration:
Oral
Mode Of Action:
Amlodipine is a calcium ion influx inhibitor (slow channel blocker or calcium ion antagonist)
and inhibits the transmembrane influx of calcium ions into cardiac and vascular smooth
muscle.
Special Warnings:
Patient with glandular fever, spirochaete infections (particularly syphilis). Not recommended
in patients suspected with or with infectious mononucleosis, acute and chronic lymphatic
leukaemia, or cytomegalovirus infection. Renal impairment. Pregnancy and lactation.

Possible Side Effects:

1. Edema
2. Palpitation
3. Vomiting
4. Wheeziness
5. Headache
6. Muscle Cramps
7. Skin Rash
8. Loss of appetite
9. Dizziness
10. Weakness or sweating

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Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Amlodipine is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Monitor Blood pressure regularly to prevent complications.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Ensure patient is assisted when ambulating to prevent fall.

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AMPICILLIN SODIUM/ OMNIPEN

(Antibiotic)

Indications:
Ampicillin is an antibiotic. It is used to treat bacterial infections of the ear, nose, throat, lungs,
skin, bladder, and genitals.
Available Dose:
500 mg/ml
Recommended dosage:
Bacterial meningitis, Septicaemia
Adult
Dosage is individualised based on the type or severity of the infection, the age, and renal
function of the patient. Usual dose range: 8,000-14,000 mg daily or 150-200 mg/kg daily in
divided doses 3-4 hourly. May give initial treatment via slow IV injection for at least 3 days and
continued with deep IM inj. Dosing recommendations may vary among individual products
and between countries (refer to specific product guidelines).
Child
Usual dose range: 100-200 mg/kg daily in divided doses 3-4 hourly; may give initial treatment
via IV for 3 days and continue with IM inj. Dosing recommendations may vary among individual
products and between countries (refer to specific product guidelines).
Endocarditis, Intra-abdominal infections, Peritonitis, Respiratory tract infections
Adult
Dosage is individualised based on the type or severity of the infection, the age, and renal
function of the patient. Usual dose range: 500 mg 4-6 hourly via slow IV inj or IV infusion, or via
deep IM injection; may give higher doses in severe cases. Dosing recommendations may vary
among individual products and between countries (refer to specific product guidelines).
Child
Usual dose range: ≤40 kg: 25-50 mg/kg daily in divided doses 6 hourly; >40 kg: Same as adult
dose. Treatment and dosing recommendations may vary among individual products and
between countries (refer to specific product guidelines).
Gastrointestinal infections
Adult
Dosage is individualised based on the type or severity of the infection, the age, and renal
function of the patient. Usual dose range: 500 mg 6 hourly via slow IV injection or IV infusion, or
via deep IM injection, may give higher doses in severe cases. Dosing recommendations may
vary among individual products and between countries (refer to specific product guidelines).
Child
Usual dose range: ≤40 kg: 50-100 mg/kg daily in divided doses 6 hourly via slow IV injection or
IV infusion, or via deep IM injection; >40 kg: Same as adult dose. Dosing recommendations
may vary among individual products and between countries (refer to specific product
guidelines).
Route Of Administration:
Intramuscular and Intravenous
Mode Of Action:
Ampicillin prevents bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding
proteins resulting in the inhibition of the final transpeptidation step of peptidoglycan synthesis
in the bacterial cell walls.

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Special Warnings:
Patient with glandular fever, spirochaete infections (particularly syphilis). Not recommended
in patients suspected with or with infectious mononucleosis, acute and chronic lymphatic
leukaemia, or cytomegalovirus infection. Renal impairment. Pregnancy and lactation.

Possible Side Effects:

1. Rashes
2. Hives
3. Vomiting
4. Wheeziness
5. Headache
6. Redness of skin
7. Seizure
8. Loss of appetite
9. Diarrhoea
10. Weakness or sweating

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Ampicillin is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Advice patient to finish the drug to prevent development of bacterial resistance.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient do not take the drug with fruit juice or soft drink to ensure the stability
of the drug.

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ATROPINE SULPHATE/ ATROPEN

(Anti-Cholinergic & Anti-Spasmodic)

Indications:
Pre-anaesthesia medication in conjugation w/ morphine sulphate. Reverse effects of non-
depolarising muscle relaxants in conjugation w/ neostigmine methyl sulphate. Smooth muscle
spasm in conditions e.g., renal & biliary colic. Management of arrhythmias & treatment of
bradycardia or asystole due to overdosage w/ parasympathomimetic agents. Suppression of
GI motility in the treatment of peptic ulcer. Diagnosis of colicky pain. Antidote in carbamate
& w/ pralidoxime in organophosphorus insecticide poisoning.
Available Dose:
1mg/ml
Recommended dosage:
Management of Arrhythmias
400 mcg-1 mg, repeat as needed to total dose: 2 mg. SC/IM/IV
Bradycardia or Asystole Due to Overdosage W/ Parasympathomimetic Agents
1-2 mg. IV/IM
Anticholinesterase Poisoning
Initially 1-2 mg for mild poisoning; 6 mg as often as every 5 min for severe poisoning. SC/IM/IV
Adult GI Anticholinergic Effect
400-600 mcg qds.
Pre-Anaesthesia Medication
300-600 mcg 1 hr before induction. SC Childn 10 mcg/kg every 4-6 hr; reduce dose on hot
days or for febrile child.
Route Of Administration:
Intravenous, Intramuscular, Subcutaneous
Mode Of Action:
Atropine is an anticholinergic agent which competitively blocks the binding of acetylcholine
to muscarinic receptors at the parasympathetic sites in the CNS and peripheral tissues such as
the heart, intestines, bronchial muscles, iris and secretory glands. Atropine abolishes
bradycardia by diminishing vagal activity thereby increasing heart rate. It promotes
bronchodilation by inhibiting secretions in the respiratory tract and relaxing the bronchial
smooth muscles. Topical atropine onto the eyes induces mydriasis and cycloplegia by
inhibiting circular pupillary sphincter muscle contraction and paralysing the ciliary muscles
responsible for accommodation respectively.
Special Warnings:
Patients with Down’s syndrome, brain damage, autonomic neuropathy, increased intraocular
pressure, spastic paralysis, hiatal hernia, hyperthyroidism, gastric ulcers, GERD, diarrhoea,
COPD, heart failure, myocardial ischaemia, hypertension, and cardiac surgery. Patients with
fever or those exposed to high ambient temperature. Hepatic and renal impairment. Children.
Pregnancy and lactation.

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Possible Side Effects:

1. Blurred Vision
2. Constipation
3. Vomiting
4. Wheeziness
5. Headache
6. Muscle Cramps
7. Photo Sensitivity
8. Irregular Heart Beat
9. Dizziness
10. Weakness or sweating

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Atropine is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
3. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
4. Ensure patient is assisted when ambulating to prevent fall.
5. Encourage patient to drink sufficient fluid to maintain adequate hydration.

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