Generic Name: Mechanism of Action
Nursing Responsibilities
Nicardipine Hydrochloride Inhibits calcium ion influx across
cardiac and smooth muscle cells
Brand Name: Cardene IV but is more selective to vascular
smooth muscle than cardiac
Drug Illustration
muscle. Drug also dilates coronary
arteries and arterioles.
Indication
To prevent hypertension and
chronic stable angina.
Contraindication
Drug Classification  Contraindicated in patients
hypersensitive to drug and
Pharmacologic: in those with advance aortic
Calcium Channel Blockers stenosis.
Therapeutic:  Use cautiously in patients
Antihypertensives, with hypotension when
Antianginals administering drug to
patients who have sustained
an acute cerebral infarction
Dose/Frequency/Route or hemorrhage.
 Consider lower dosages and
10mg + 90 NSS Drip/ 10 cc closely monitoring
per hour responses in patient with
hepatic impairment.
 Titrate gradually in patient
with renal impairment.
Side Effects/
Adverse Reactions
CNS: headache, dizziness,
light-headedness, asthenia,
drowsiness, paresthesia,
somnolence.
CV: angina, peripheral edema,
palpitations, flushing,
hypotension, tachycardia.
GI: nausea, vomiting,
abdominal discomfort, dry
mouth, dyspepsia.
Musculoskeletal: myalgia and
weakness.
Skin: rash, diaphoresis,
injection-site reaction.
Nursing Consideration
 Closely monitor BP and HR. Drug can cause symptomatic
hypotension or tachycardia.
 Measure BP frequently during initial therapy. Maximal
response occurs in about 1 hour.
 Check for orthostatic hypotension, because large swings in
BP may occur based on drug level, assess antihypertensive
effect 8 hours after dosing.
 To reduce risk of venous thrombosis, phlebitis, and vascular
impairment, don’t use small veins, such as those on the
dorsum of the hand and wrist. Use extreme care to avoid
intra-arterial administration or extraversion.
 Don’t confuse nicardipine with niacinamide, nifedipine or
nimodipine. Don’t confuse Cardene with Cardura, Cardizem,
or Codeine.
Patient & Family Education
 Advise the patient to report chest pain immediately. Some
patient increased frequency, severity, or duration of chest pain
at beginning of therapy or dosage adjustment.
 Tell patient to get up from sitting or lying position slowly to
avoid dizziness caused by a decrease in BP.
 Tell patient drug may be taken with or without food but
shouldn’t be taken with high-fat food or grapefruit products.
 Generic Name: Mechanism of Action
Amlodipine Besylate Mechanism of action on blood
Brand Name: Norvasc pressure, considered a peripheral
arterial vasodilator that exerts its
action directly on vascular smooth
Drug Illustration muscle to lead to a reduction in
peripheral vascular resistance,
causing a decrease in blood
pressure. It inhibits the influx of
calcium ions into both vascular
smooth muscle and cardiac muscle.
Indication
Indicated for patients with
hypertension, coronary artery
disease, chronic stable angina, and
vasospastic angina
Contraindication
Drug Classification  Contraindicated in patients
hypersensitive to drug.
Pharmacologic:  Patients with cardiogenic
Calcium Channel Blockers shock, severe aortic
Therapeutic: stenosis, unstable angina,
Antihypertensives, severe hypotension, heart
Antianginals failure, and hepatic
impairment.
Dose/Frequency/Route
10 mg/ OD / PO
Side Effects/ Nursing Responsibilities
Adverse Reactions
Common side effects: Nursing Consideration
- swelling of your legs or ankles
-tiredness  Monitor patient carefully (BP, cardiac rhythm, and output)
-feeling sleepy while adjusting drug to therapeutic dose; use special caution
-abdominal pain if patient has CHF.
-nausea  Monitor BP very carefully if patient is also on nitrates.
-dizziness  Monitor cardiac rhythm regularly during stabilization of
-hot or warm feeling in your face dosage and periodically during long-term therapy.
(flushing)  Administer drug without regard to meals.
-very fast heart rate
(palpitations)
Low blood pressure. Symptoms Patient & Family Education
can include:
-severe dizziness  Take with meals if upset stomach occurs.
-lightheadedness  You may experience these side effects: Nausea, vomiting (eat
-fainting frequent small meals); headache (adjust lighting, noise, and
temperature; medication may be ordered).
More chest pain or a heart  Report irregular heartbeat, shortness of breath, swelling of the
attack. Symptoms can include: hands or feet, pronounced dizziness, constipation.
-chest pain or discomfort
-upper body discomfort
-shortness of breath
-breaking out in a cold sweat
-unusual tiredness
-nausea
-lightheadedness
 Generic Name: Mechanism of Action
Tramadol + Paracetamol Unknown. Thought to inhibits
Brand Name: Dolcet reuptake of norepinephrine,
serotonin and enhances serotonin
release. It alters perception and
Drug Illustration response to pain by binding to mu-
opiate receptors in the CNS.
Indication
Relief of moderate to moderately
severe pain.
Contraindication
Drug Classification  Contraindicated in patients
hypersensitive to drug
Pharmacologic:  in patients suffering from
Synthetic centrally active acute intoxication with
analgesic alcohol, hypnotics,
Therapeutic: analgesics, opioids, or
Analgesics psychotropic medicinal
products.
 in patients who are
Dose/Frequency/Route receiving monoamine
oxidase (MAO) inhibitors
 in patients with epilepsy
50mg per tab/ q8h / PO  for use in narcotic
withdrawal treatment.
Side Effects/
Adverse Reactions
CNS: dizziness, headache,
somnolence, vertigo, anxiety,
confusion, sleep disorder
CV: HTN, peripheral edema.
EENT: visual disturbances,
nasopharyngitis, pharyngitis,
rhinitis, sinusitis.
GI: constipation, nausea
vomiting, abdominal pain,
anorexia, diarrhea, dry mouth,
dyspepsia, flatulence.
GU: menopausal symptoms,
proteinuria, urinary retention,
pelvic pain, UTI, prostate
disorder.
Metabolic: weight loss.
Musculoskeletal: hypertonia,
arthralgia, neck pain, myalgia.
Respiratory: bronchitis
Nursing Responsibilities
Nursing Consideration
 History: Hypersensitivity to tramadol; pregnancy; acute
intoxication with alcohol, opioids, psychotropic drugs or
other centrally acting analgesics; lactation; seizures;
concomitant use of CNS depressants or MAOIs; renal or
hepatic impairment; past or present history of opioid
addiction
 Physical: Skin color, texture, lesions; orientation, reflexes,
bilateral grip strength, affect; P, auscultation, BP; bowel
sounds, normal output; LFTs, renal function tests
 Control environment (temperature, lighting) if sweating or
CNS effects occur.
 WARNING: Limit use in patients with past or present history
of addiction to or dependence on opioids.
Patient & Family Education
 You may experience these side effects: Dizziness, sedation,
drowsiness, impaired visual acuity (avoid driving or
performing tasks that require alertness); nausea, loss of
appetite (lie quietly, eat frequent small meals).
 Report severe nausea, dizziness, severe constipation.
 Generic Name: Mechanism of Action
Metronidazole Direct acting trichomonacide and
Brand Name: amebicide that works inside and
Flagyl IV RTU outside the intestine. It’s thought to
enter the cells of microorganism
Drug Illustration that contain nitro-reductase,
forming unstable compounds that
bind to DNA and inhibit synthesis,
causing cell death.
Indication
t's used to treat skin infections,
rosacea and mouth infections,
including infected gums and dental
abscesses. It's also used to treat
conditions such as bacterial
vaginosis and pelvic inflammatory
disease.
Contraindication
Drug Classification  Contraindicated in patients
hypersensitive to drug or
Pharmacologic: other nitroimidazole
Nitroimidazoles derivatives.
 Pregnancy (1st trimester)
Therapeutic: and lactation.
Antibiotic, Antibacterial,
Amebicide, Antiprotozoal
Side Effects/
Adverse Reactions
GI: nausea, unpleasant metallic
taste, vomiting, diarrhea or
constipation. Furred tongue,
glossitis, and stomatitis due to
overgrowth of Candida. Rarely,
antibiotic-associated colitis.
CNS: Weakness, dizziness,
ataxia, headache, drowsiness,
insomnia, changes in mood or
mental state. Numbness or
tingling in the extremities,
epileptiform seizures (high doses
or prolonged treatment).
Hematologic: Transient
leucopenia and
thrombocytopenia.
GU: Urethral discomfort and
darkening of urine.
Hepatic: Raised liver enzyme
values, cholestatic hepatitis,
jaundice.
Thrombophlebitis (IV).
Potentially Fatal: Anaphylaxis.
Nursing Responsibilities
Nursing Consideration
 History: CNS or hepatic disease; candidiasis (moniliasis);
blood dyscrasias; pregnancy; lactation
 Physical: Reflexes, affect; skin lesions, color (with topical
application); abdominal examination, liver palpation;
urinalysis, CBC, LFTs
 Avoid use unless necessary. It may be carcinogenic.
 Administer oral doses with food.
 Apply topically (MetroGel) after cleansing the area. Advise
patient that cosmetics may be used over the area after
application.
 Reduce dosage in hepatic disease.
Patient & Family Education
 Take full course of drug therapy; take the drug with food if GI
upset occurs.
 Do not drink alcohol (beverages or preparations containing
alcohol, cough syrups); severe reactions may occur.
 Your urine may be a darker color than usual; this is expected.
 Refrain from sexual intercourse during treatment for
trichomoniasis, unless partner wears a condom.
 Apply the topical preparation by cleansing the area and then
rubbing a thin film into the affected area. Avoid contact with
the eyes.
 Frequent mouth care, sucking sugarless candies may help; eat
frequent small meals.
 Report severe GI upset, dizziness, unusual fatigue or
weakness, fever, chills.
 Generic Name: Side Effects/
Mechanism of Action Nursing Responsibilities
Ceftriaxone Adverse Reactions
Inhibits cell-wall synthesis,
Brand Name: promoting osmotic instability; Nursing Consideration
Ceftrisol Plus and Rocephin usually bactericidal. Hematologic: eosinophilia,
 Assess for the mentioned cautions and contraindications to
Drug Illustration thrombocytosis, leukopenia.
prevent any untoward complications.
 Perform a thorough physical assessment (other medications
GI: pseudomembranous colitis,
taken, CNS, skin, respirations, and laboratory tests like renal
Indication diarrhea
functions tests and complete blood count or CBC) to establish
Third generation cephalosporins are baseline data before drug therapy begins, to determine
effective against all of the strains in effectiveness of therapy, and to evaluate for occurrence of any
lower generation. They are Skin: rash, pain, induration,
adverse effects associated with drug therapy.
relatively weak against gram- tenderness at injection site
 Perform culture and sensitivity tests at the site of infection to
positive bacteria but are more CNS: headache, dizziness,
ensure appropriate use of the drug.
potent against gram-negative lethargy, paresthesia
 Conduct orientation and reflex assessment, as well as auditory
bacilli. testing to evaluate any CNS effects of the drug.
Nephrotoxicity in patients who
 Monitor infection site and presenting signs and sympoms
have predisposing renal
Drug Classification throughout course of drug therapy because failure of these
insufficiency.
manifestations to resolve may indicate the need to reculture
Pharmacologic: the site.
Superinfections
Third Generation  Provide safety measures to protect the patient if CNS effects
Contraindication
Cephalosporins (e.g. confusion, disorientation, numbness) occur.
 Known allergy to Phlebitis and local abscess at the
Therapeutic:  Educate client on drug therapy to promote understanding and
cephalosporins and beta site of IV administration.
Antibiotics compliance.
lactams. Cross-reactions are
common. Others: hypersensitivity
Patient & Family Education
 Hepatic or renal reaction, serum sickness,
impairment. anaphylaxis
 Report any adverse reaction and discomfort.
Dose/Frequency/Route  Pregnancy and lactation.
 Notify physician about loose stool or diarrhea
1g/ q12h/ IV
 Generic Name: Mechanism of Action Side Effects/ Nursing Responsibilities
Regular Insulin Insulin lowers blood glucose levels. Adverse Reactions
Brand Name: Humulin R It regulates carbohydrate, protein, CV: peripheral edema Nursing Consideration
and fat metabolism by inhibiting
hepatic glucose production and Metabolic; hypoglycemia,  Ensure uniform dispersion of insulin suspensions by rolling
Drug Illustration lipolysis and enhancing peripheral hypokalemia, weight gain the vial gently between hands; avoid vigorous shaking.
glucose disposal.  Obtain baseline and periodic PFTs for patient using inhaled
Skin: injection site reaction, insulin; carefully monitor glucose levels when converting
lipodystrophy, pruritus from subcutaneous to inhaled insulin.
 Monitor patients receiving insulin IV carefully.
Indication Other: allergic reaction,  Carefully monitor patients being switched from one type of
Treatment of type 1 & 2 diabetes anaphylaxis, insulin antibody insulin to another; dosage adjustments are often needed.
mellitus that cannot be controlled production  Store insulin in a cool place away from direct sunlight.
by diet or oral drugs  Monitor urine or serum glucose levels frequently to determine
Treatment of severe ketoacidosis or effectiveness of drug and dosage. Patients can learn to adjust
diabetic coma. insulin dosage on a sliding scale based on test results.
Contraindication  Monitor insulin needs during times of trauma or severe stress;
Drug Classification  Contraindicated in patients dosage adjustments may be needed.
hypersensitive to drug.
Pharmacologic:  During episode of Patient & Family Education
Insulin hypoglycemia
Therapeutic:  Store drug in the refrigerator or in a cool place out of direct
Antidiabetic sunlight; do not freeze insulin.
 Monitor your urine or blood levels for glucose and ketones as
prescribed.
Dose/Frequency/Route  Wear a medical alert tag stating that you have diabetes and
are taking insulin so that emergency medical personnel will
6 ‘u’ SQ PRN per CBG >180 take proper care of you.
mg/dl  Avoid alcohol; serious reactions can occur.
 Report fever, sore throat, vomiting, hypoglycemic or
hyperglycemic reactions, rash.