DRUG STUDY

Name of drug 1.MAGNESIU M SULFATE BRAND NAME: Therapeutic actions Cofactor of may enzyme systems involved in neurochemical transmission and muscular excitability; Prevents, controls seizures by blocking the neuromascular transmission; Attracts and retains water in the intestinal lumen and distends the bowel to promote mass movement and relieve constipation. Indication Acute nephritis (children), to control hypertension IV or IM: preeclampsia or eclampsia PO: evacuation of the colon or rectal and bowel examinations Unlabelled Uses: Inhibition of premature labor (parenteral), adjunct treatment of exacerbations of acute asthma; treatment atypical ventricular arrhythmias Contraindications Contraindicated with allergy to magnesium products; heart block, myocardial damage, abdominal pain, nausea, vomiting or other symptoms of appendicitis; Acute surgical abdomen, fecal impaction, intestinal and biliary tract obstruction hepatitis. Do not give during 2 hour preceding delivery because of the risk of magnesium toxicity in the neonate. Use cautiously with renal insufficiency. Adverse effects CNS: Weakness, dizziness, fainting, sweating CV: Palpitation GI: Excessive bowel activity, perianal irritation Magnesium intoxication (flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depressionparenteral); hypocalcemia with tetany (secondary to treatment of eclampsiaparenteral) Drug to drug interaction Potentiation of neuromascular blockade produced by nondepolarizing neuromascular relaxants (tubocurarin, atracurium, pancuronium, vecuronium Nursing responsibilities Reserve IV use in eclampsia for immediate life threatening situations. Give IM route by deep IM injection of the undiluted (50%) solution for adults, dilute to a 20% solution for children. Do not give oral Magnesium Sulfate with abdominal pain, nausea and vomiting. Monitor bowel function; if diarrhea and cramping occur, discontinue oral drug. Maintain urine output at a level of 100ml every 4H during parenteral administration.

CLASS: Antiepileptic Electrolyte Laxative

2.MIDOZALA M HCL

Acts mainly at the limbic system and BRAND reticular NAME: formation; Apo potentiates the Midozalam effect of GABA, an inhibitory CLASS: neurotransmitt Benzodiazepin er, anxiolytic e (short and amnesia acting) effects occur at CNS doses below Depressant those needed to cause sedation, ataxia; has little effect on cortical function.

IV or IM: Sedation, anxiolysis and amnesia prior to diagnostic, therapeutic or endoscopic procedures or surgery Induction of general anesthesia Continuous sedation of intubated and mechanically ventilated patients as component of anesthesia or during treatment in critical care settings Unlabelled Uses: Treatment of epileptic, seizure or refractory status epilepticus.

Contraindicated with hypersensitivity to benzodiazepines, allergy to cherries (syrup), psychoses, acute narrow-angled glaucoma, shock, coma, acute alcoholic intoxication, pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in the first trimester, neonatal withdrawal syndrome reported in infants) and in neonates.

CNS: Weakness, dizziness, fainting, sweating CV: Palpitation GI: Excessive bowel activity, perianal irritation Metabolic: Magnesium intoxication (flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depressionparenteral); hypocalcemia with tetany (secondary to treatment of eclampsiaparenteral)

Risk for increase CNS depression if combined with alcohol, antihistamine. Opiods, other sedatives; protase inhibitors, decrease midozalam dose by up to 50% if any of these combinations are used. Decreased effectiveness if given with carbazepines, phenytoin, rifampicin, rifabutin, Phenobarbital; monitor patients response carefully.

Do not administer intra arterially, which may produce arteriospasm or gangrene Do not use in small veins for IV injection. Monitor IV injection site. Monitor LOC before, during and after giving midozalam at least 2-3H.

3.MORPHINE SULFATE BRAND NAME: Astramorph CLASS: Opiod agonist analgesic

Principal opium alkaloid; acts as agonist at Specific opiod receptors in the CNS to produce analgesia, euphoria, sedation, the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opiods.

Relief of moderate to severe acute and chronic pain. Preoperative medication to sedate and alley apprehension facilitate induction of anesthesia and reduce anesthetic dosage. Analgesic adjunct during anesthesia. Treatment of pain following major surgery. Relief pain associated with MI.

Contraindicated with hypersensitivity to opiods; during labor and delivery of a premature infant; after biliary tract surgery or surgical anastomosis ; with pregnancy labor.

CNS: light headedness dizziness, sedation CV: facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, palpitations, orthostatic hypotension GI: nausea and vomiting, dry mouth, constipation, biliary tract spasm, GU: uteral spasm, urine retention and hesitancy, oliguria, antidiuretic effect, reduced libido, potency Local: tissue irritation and induration. Major Hazards: respiratory depression, apnea, circulatory depressions respiratory arrest, shock, cardiac arrest.

Increase likelihood of respiratory depression, hypotension, profound sedation, or coma in patients receiving barbiturate general anesthetic. Risk for toxicity if combined with alcohol.

Caution patient not to chew or crush CR, ER, SR preparations and ensure appropriate use of these forms Dilute and administer slowly IV to minimize likelihood of adverse effects,

4.NALBUPHIN E HCL BRAND NAME: Nubain CLASS: Opiod agonistantagonist analgesic

Nalbuphine acts as an agonist at specific opiod receptors in the CNS to produce analgesia and sedation but also acts to cause hallucinations and is and antagonist at MU receptors.

Relief of moderate to severe pain Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery.

Contraindicated to hypersensitivity to nabuphines, sulfites.

CNS: sedation, clamminess, sweating, headache CV: hypotension, hypertension, bradycardia, tachycardia GI: nausea and vomiting, cramps, dyspepsia, bitter taste, dry mouth GU: Urinary urgency Respiratory: respiratory depression, dyspnesa, asthma.

Potentaition of effects with barbiturates anesthetics or other CNS depressants.

Taper dosage when discontinuing after prolong use to avoid withdrawal symptoms. Keep Opiod antagonist and facilities assisted or controlled respiration available in case of respiratory depression.

5.PROMETHA ZINE HCL BRAND NAME: Phenadoz CLASS: Antiemetic Antihistamine Phenothiazine Sedativehypnotic

Promethazine is an H1 receptor blo cking agent. In addition to its antihistaminic action, it provides clinically useful sedative and antiemetic effects.

Preoperative, p ostoperative, or obstetric sedation. Prevention and control of nausea and vomiting associated with certain types of anesthesia an d surgery. Therapy adjunctive to meperidine or other analgesics for control of postoperative pain. Antiemetic therapy in postoperative patients.

Contraindicated with hypersensitivity to antihistamines, coma or severe CNS depressions, bone marrow depression, vomiting of unknown cause, concomitant therapy with MAOIs.

CNS: Drowsiness Sedation,somnolenc e, blurred vision, dizziness; confusion, disorientation, and extrapyramidal symptoms such as oculogyric crisis, torticollis, and tongueprotrusio n; lassitude, tinnitus , incoordination, fatig ue, euphoria, nervousness,diplopi a, insomnia, tremors, convulsive seizures, excitation, catatonic-like states, hysteria. CV: Increased or decreased blood pressure, tachycardi a,bradycardia, faintness. Respiratory: Asthma, nasal stuffi ness, respiratory depressi on (potentially fatal) and apnea (potentia lly fatal).

CNS DepressantsPromethazine hydrochloride tablets may increase, prolong, or intensify the sedative acti on of other central-nervoussystem depressants, such as alcohol, sedatives/hypno tics (including barbiturates), narcotics, narco ticanalgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore, such agents should be avoided or administered in reduced dosage to patients receiving promethazine HCl.

Promethazine hydrochloride tablets may impair the mental and/or physical abilities required for the performance of potentially hazardous tasks, such as driving a vehicle or operating machinery. The impairment may be amplified by concomitant use of other centralnervous-system depressants such as alcohol, sedatives/hypnotics (including barbiturates), narcotics, narcotic analgesics, general anesthetics, tricyclic antidepressants, and tranquilizers; therefore such agents should either be eliminated or given in reduced dosage in the presence of promethazine HCl

6.BIPUVICAIN E BRAND NAME: Sensorcaine mpf Sensorcaine CLASS: Anesthetics

Local anesthetics block the generation and the conduction of nerve impuls es, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. In general, the progression of anesthesia is related to the diameter, myeli nation and conduction velocity of affected nerve fibers. Clinically, the order of loss of nerve function is as follows:

Indicated for local anaesthesia including infiltration, nerv e block, epidural, and intrathecal anaesthesia.

Bupivacaine is contraindicated for IV regional anaesthesia (IVRA) because of potential risk of tourniquet failure and systemic absorption of the drug.

Systemic exposure to excessive quantities of bupivacaine mainly result in central nervous system (CNS) and cardiovascular e ffects CNS effects usually occur at lower blood plasma concentratio ns and additional cardiovascular effects present at higher concentrations, though cardiovascular collapse may also occur with low concentrations. CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision,seizures) followed by depression (drowsiness, loss of consciousness, respi

The administration of local anesthetic solutions containing epine phrine or norepinephrine to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension.

Local anesthetics should only be employed by clinicians who are well versed in diagnosis and management of dose-related toxicity and other acute emergencies which might arise from the block to be employed, and then only after insuring the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies. (see also adverse reactions, precautions, and overdosage.) Delay in proper

(1) pain, (2) temperature, (3) touch, (4) propriocepti on, and (5) skeletal muscle tone.

ratory depression and apn ea). Cardiovascular effects include hypotension ,bradycardia, arrhyt hmias, and/or cardiac arrest some of which may be due to hypoxemia secon dary to respiratory depression.

management of dose-related toxicity, underventilation from any cause and/or altered sensitivity may lead to the development of acidosis, cardiac arrest and, possibly, death.