DRUGS
Generic Name:
Metoclopramide
Brand Name: Reglan
Drug Class:
PHARMACOTHERAPEUTIC:
Dopamine-2 receptor
antagonist
CLINICAL: Antiemetic, upper
GI stimulant
Date Ordered: October. 12,
2022 7:00 AM
Date Discontinued:
October. 15, 2022 3:00 PM
MECHANISM OF ACTION
Antagonizes the inhibitory
effect of dopamine on GI
smooth muscle. This causes
gastric contraction, which
promotes gastric emptying
and peristalsis, and also
reduces
gastroesophageal reflux.
Metoclopramide also blocks
dopaminergic receptors in the
chemoreceptor trigger zone,
preventing nausea and
vomiting.
Therapeutic Effect:
Accelerates
intestinal transit, promotes
gastric emptying.
Relieves nausea, vomiting.
INDICATION
- Prevent or treat nausea or
vomiting after a surgery.
CONTRAINDICATION SIDE/ ADVERSE EFFECTS NURSING CONSIDERATION
Contraindications: Side Effects: Baseline Assessment:
- Hypersensitivity to Frequent: - Assess for nausea, vomiting,
metoclopramide. Drowsiness, restlessness, abdominal distention,
fatigue, lethargy. bowel sounds.
- Concurrent use of
medications Occasional: Intervention/ Evaluation:
likely to produce Dizziness, anxiety, headache, - Monitor for anxiety,
extrapyramidal insomnia, breast tenderness, restlessness, extrapyramidal
reactions. altered menstruation, symptoms (EPS) during IV
- Situations in which GI constipation, rash, dry mouth, administration.
motility may be galactorrhea,
dangerous (e.g., GI gynecomastia. -Monitor daily pattern of
hemorrhage, GI bowel activity, stool
perforation/ Rare: consistency.
obstruction) Hypotension, hypertension,
- history of seizure tachycardia. -Assess skin for rash.
disorder,
pheochromocytoma. -Evaluate for therapeutic
response
Cautions: from gastroparesis (nausea,
Renal impairment, Heart vomiting,
Failure, cirrhosis, bloating).
hypertension,
depression, Parkinson’s - Monitor renal function, B/P,
disease, elderly. heart rate.
Family Teaching:
- Avoid tasks that require
alertness, motor
skills until response to drug is
established.
-Report involuntary eye,
facial, limb movement

DRUGS
Generic Name: Ketorolac
Brand Name: Toradol
Drug Class:
PHARMACOTHERAPEUTIC:
NSAID
CLINICAL: Analgesic,
Intraocular anti-
inflammatory.
Dosage: (4 doses) 30mg, IV,
q8
Date Ordered: October. 14,
2022 2:00 PM
Date Discontinued:
October. 15, 2022 2:00 PM
(extrapyramidal reaction).
MECHANISM OF INDICATION CONTRAINDICATION SIDE/ ADVERSE NURSING
ACTION EFFECTS CONSIDERATION
Blocks cyclooxygenase, - To treat moderate to - Patients with Side Effects: Baseline Assessment:
an enzyme needed to severe pain that previously history of Frequent (17%–12%): - Assess onset, type,
synthesize requires analgesia at peptic ulcers and or GI - Headache location, duration of
prostaglandins. the opioid level bleeding. - nausea, pain.
Prostaglandins usually in a - abdominal cramps or
mediate inflammatory postoperative setting. pain - Obtain baseline
response and cause - dyspepsia. renal/hepatic function
local vasodilation, pain, tests.
and swelling. They also Occasional (9%–3%):
promote pain - Diarrhea. Intervention/
transmission from Evaluation:
periphery to spinal Adverse Effect: - Monitor renal function,
cord. By blocking - Peptic ulcer, GI LFT, urinary output.
cyclooxygenase and bleeding, gastritis, severe - Monitor daily pattern
inhibiting hepatic reaction of bowel activity, stool
prostaglandins, this (cholestasis, jaundice) consistency.
NSAID reduces occur rarely.
inflammation and - Observe for occult
relieves pain. - Nephrotoxicity blood loss.
(glomerular nephritis,
Therapeutic Effect: interstitial nephritis, - Assess for therapeutic
Produces analgesic, nephrotic syndrome) response: relief of pain,
antipyretic, anti- may occur in pts with stiffness, swelling;
inflammatory effect; preexisting renal increased joint mobility;
reduces intraocular impairment. reduced joint
inflammation. tenderness; improved
-Acute hypersensitivity grip strength.
reaction (fever, chills,
joint pain) occurs rarely. - Monitor for bleeding
(may also occur with
DRUGS MECHANISM OF ACTION
Generic Name: Lidocaine Combines with fast sodium
channels in myocardial cell
Brand Name: Lidoderm membranes, which inhibits
sodium influx
Drug Class: into cells and decreases
PHARMACOTHERAPEUTIC: ventricular depolarization,
Amide anesthetic. as well as automaticity and
excitability
CLINICAL: Class 1B anti- during diastole. Lidocaine
arrhythmic, anesthetic. also blocks nerve impulses
by decreasing the
Dosage: permeability of
neuronal membranes to
sodium, which produces
Date Ordered: October. 14, local anesthesia.
2022 8:45 AM
Therapeutic Effect:
Date Discontinued: Causes temporary loss of
feeling/sensation.
Stimulates protein
synthesis.
INDICATION
- To treat ventricular
arrhythmias occurring
during cardiac
manipulations; to treat
life-threatening ventricular
arrhythmias
- relief of pain associated
with post-herpetic
neuralgia.
CONTRAINDICATION SIDE/ ADVERSE EFFECTS NURSING
CONSIDERATION
- Adams–Stokes Side Effects: Baseline Assessment:
syndrome - CNS effects generally dose- -- Question for
related and of short duration. hypersensitivity to
- Hypersensitivity to lidocaine, amide
lidocaine, amide Occasional: anesthetics.
anesthetics, or their - Infiltration/ nerve block
components - Pain at injection site. - Obtain baseline B/P,
pulse, respiratory rate,
Adverse Effects: ECG, serum electrolytes.
Serious adverse reactions to
lidocaine Intervention/ Evaluation:
are uncommon, but high - Monitor ECG, vital signs
dosage by any closely during and
route may produce following drug
- cardiovascular depression, administration for cardiac
- bradycardia, performance. If ECG
- hypotension, shows arrhythmias,
- arrhythmias, prolongation of PR interval
- heart block, or QRS complex, inform
- cardiovascular collapse, - physician immediately.
cardiac arrest.
- Assess pulse for rhythm,
rate, quality. Assess B/P
for evidence of
hypotension.
- Monitor for therapeutic
serum level (1.5–6
mcg/mL). For lidocaine
given by all routes,
monitor vital signs, LOC.
- Drowsiness should be
considered a warning sign
of high serum
levels of lidocaine.
Therapeutic serum
level: 1.5–6 mcg/mL;
 Toxic serum level:
greater than 6 mcg/mL

Family Teaching:
- Due to loss of feeling/
sensation, protective
measures may be
needed until anesthetic
wears off (no ambulation,
including special positions
for
some regional
anesthesia).

DRUGS MECHANISM OF ACTION INDICATION CONTRAINDICATIONS EFFECTS NURSING CONSIDERATION

Generic Name: Action: Prevention or reduction Hypersensitivity; Active Adverse effects/toxic ● Monitor blood pressure, pulse,
Tranexamic Acid Inhibits activation of of hemorrhage intravascular clotting; reactions: and respiratory status as indicated
plasminogen, thereby Acquired defective color seizures, headaches, by severity of bleeding.
Brand Name: preventing the vision; Subarachnoid backache, abdominal pain, ● Monitor for overt bleeding every
Hemostan conversion of hemorrhage. nausea, vomiting, diarrhea, 15–30 min.
plasminogen to plasmin. fatigue, pulmonary ● Monitor neurologic status (pupils,
Drug Class: embolism, deep vein level of consciousness, motor
Therapeutic Class: Therapeutic Effects: thrombosis, anaphylaxis, activity) in patients with
hemostatic agents ↓ bleeding following impaired color vision, and subarachnoid hemorrhage.
Pharmacologic Class: surgery other visual disturbances ● Assess for thromboembolic
antifibrinolytics, plasminogen complications.(especially in patients
inactivators with history). Notify physician of
positive Homans’ sign, leg pain
Doctor’s Order: hemorrhage, edema, hemoptysis,
15mg/kg 20 mins ā surgery dyspnea, or chest pain.
● Monitor platelet count and
Date Given: clotting factors prior to and
March 13, 2023 periodically throughout therapy in
patients with systemic fibrinolysis.
Date Discontinued: ● Stabilize IV catheter to minimize
March 13, 2023 thrombophlebitis. Monitor site
closely.
● Instruct patient to notify the
nurse immediately if bleeding recurs
or if thromboembolic symptoms
develop.
● Caution patient to make position
changes slowly to avoid orthostatic
hypotension.
DRUGS MECHANISM OF ACTION INDICATION CONTRAINDICATIONS EFFECTS NURSING CONSIDERATION
Generic Name: Action: Preop to inhibit Hypersensitivity to Side effects: ● Determine if patient is sensitive to
Atropine Competes with salivation/secretions s atropine. Narrow-angle Frequent: Dry mouth, nose, atropine, homatropine, scopolamine.
acetylcholine for glaucoma, pyloric throat (may be severe); ● Monitor changes in B/P, pulse,
Brand Name: common binding sites on stenosis, prostatic decreased sweating; temperature. ● Observe for
Atropan muscarinic receptors hypertrophy. constipation; irritation at tachycardia if pt has cardiac
located on exocrine subcutaneous or IM injection abnormalities.
Drug Class: glands, cardiac and site. Occasional: Dysphagia, ● Assess skin turgor, mucous
Therapeutic Class: smooth muscle ganglia, blurred vision, bloated membranes to evaluate
Antiarrhythmic, antispasmodic, intramural neurons. feeling, impotence, urinary hydration status (encourage
antidote, cycloplegic, hesitancy. adequate fluid intake unless NPO for
antisecretory, anticholinergic Therapeutic Effect: Rare: Allergic reaction, surgery), bowel sounds for
Pharmacologic Class: Decreases GI motility, including rash, urticaria; peristalsis.
Acetylcholine antagonist secretory activity, GU mental confusion or ● Be alert for fever (increased risk of
muscle tone (ureter, excitement, particularly in hyperthermia).
Doctor’s Order: bladder); abolishes children; fatigue. ● Monitor I&O, palpate bladder for
0.6mg IV 45 mins before various types of reflex urinary retention.
anesthesia vagal cardiac slowing or Adverse effects/toxic ● Monitor daily pattern of bowel
asystole. reactions: activity, stool consistency.
Date Given: Overdose may produce ● For preop use, explain that warm
March 13, 2023 tachycardia, palpitations, flushing feeling may occur.
hot/dry/flushed skin,
Date Discontinued: absence of bowel sounds,
March 13, 2023 increased respiratory rate,
nausea, vomiting, confusion,
drowsiness, slurred speech,
dizziness, CNS stimulation.
Overdose may also produce
psychosis as evidenced by
agitation, restlessness,
rambling speech, visual
hallucinations, paranoid
behavior, delusions, followed
by depression. Ophthalmic
form may rarely produce
increased IOP.

DRUGS MECHANISM OF INDICATION CONTRAINDICATIONS EFFECTS NURSING CONSIDERATION

 ACTION
Generic Name: Action: Management of ● Contraindicated in Side effects: ● Assess onset, type, location, duration of pain.
Tramadol Binds to mu-opioid moderate to patients hypersensitive Frequent: Dizziness, Assess drug history, esp. carBAMazepine, analgesics,
receptors, inhibits moderately severe to drug or opioids, in vertigo, nausea, CNS depressants, MAOIs.
Brand Name: reuptake of pain. patients with severe constipation, headache, ● Review past medical history, esp. epilepsy,
Ambidol norepinephrine, renal or hepatic drowsiness. seizures.
serotonin, inhibiting impairment, suicidal Occasional: Vomiting, ● Assess renal function, LFT.
Drug Class: ascending and patients, and in those pruritus, CNS stimulation ● Monitor pulse, B/P, renal/hepatic function.
Therapeutic Class: descending pain with acute intoxication (e.g., nervousness, anxiety, ● Assist with ambulation if dizziness, vertigo occurs.
Analgesics pathways. from alcohol, hypnotics, agitation, tremor, ● Palpate bladder for urinary retention.
Pharmacologic Class: Therapeutic Effect: centrally acting euphoria, mood swings, ● Monitor daily pattern of bowel activity, stool
Synthetic centrally active Reduces pain. analgesics, opioids, or hallucinations), asthenia, consistency.
analgesics psychotropic drugs. diaphoresis, dyspepsia, dry ● Assess for clinical improvement, record onset of
● Contraindicated in mouth, diarrhea. relief of pain.
Doctor’s Order: patients with GI Rare: Malaise, ● Inform patient that drug may cause drowsiness,
Tramadol 100 mg loading obstruction, including vasodilation, anorexia, dizziness, blurred vision.
(give at 5:30 pm) then 50 paralytic ileus. flatulence, rash, blurred ● Inform patient to avoid tasks requiring alertness,
mg IV q8 x 3 doses then ● Contraindicated with vision, urinary motor skills until response to drug is established.
PRN for moderate to concomitant use or retention/frequency, ● Inform patient to report severe constipation,
severe pain. within 14 days of MAO menopausal symptoms. difficulty breathing, excessive sedation, seizures,
inhibitor therapy. muscle weakness, tremors, chest pain, palpitations.
Date Given: March 13, ● Contraindicated in Adverse effects/toxic
2023 patients with significant reactions:
respiratory depression Seizures reported in pts
Date Discontinued: March or acute or severe receiving the drug within
13, 2023 bronchial asthma or recommended dosage
hypercapnia in range. May have
unmonitored settings or prolonged duration of
where resuscitative action, cumulative effect in
equipment isn't pts with hepatic/renal
available. impairment, serotonin
syndrome (agitation,
hallucinations,
tachycardia,
hyperreflexia). May cause
suicidal ideation and
behavior.

DRUGS MECHANISM OF INDICATION CONTRAINDICATIONS EFFECTS NURSING CONSIDERATION

ACTION
Generic Name: Action: To reverse the ● Hypersensitivity to Side effects: ● Before giving, ensure that atropine sulfate is
Neostigmine Inhibits the neuromuscular cholinergic or bromide Rare: Hypersensitivity available to treat cholinergic crisis.
breakdown of blockade during the ● Mechanical reaction. ● Know that atropine may be combined with usual
Brand Name: acetylcholine so that it administration of obstruction of GI or neostigmine dose to decrease risk of adverse
Prostigmin accumulates and has a anesthesia to urinary tract Adverse effects/toxic reactions.
prolonged effect. patients undergoing ● Peritonitis reactions: ● Administer I.V. dose undiluted directly into vein or
Drug Class: Therapeutic Effect: surgery that require Seizures, dizziness, I.V. line. Give 0.5-mg dose slowly over 1 minute.
Therapeutic Class: Muscle Reversal of muscle relaxation bronchospasm, ● Keep resuscitation equipment nearby.
stimulant nondepolarizing bradycardia, hypotension, ● Monitor vital signs. Assess patient for hypotension,
neuromuscular weakness bradycardia or tachycardia, AV block, and evidence
Pharmacologic Class: blockers of impending cardiac arrest.
Anticholinesterase ● Evaluate respiratory and neurologic status.
Doctor’s Order: ● Tell patient drug may alter his respiratory and
0.03 mg/kg IV cardiac status. Teach him to recognize and
immediately report warning signs.
Date Given:
March 13, 2023

Date Discontinued:
March 13, 2023

DRUGS MECHANISM OF ACTION INDICATION CONTRAINDICATIONS EFFECTS NURSING CONSIDERATION

Generic Name: Unclear. Decreases To reduce the risk of ● Hypersensitivity to drug, Side effects: ● Monitor hemoglobin and
Dexamethasone inflammation, mainly by nausea, vomiting, benzyl alcohol, bisulfites, Rare: stomach upset, potassium levels.
stabilizing leukocyte fatigue, and pain after EDTA, creatinine, headache, dizziness, acne, ● Assess for occult blood loss.
Brand Name: lysosomal membranes; surgery polysorbate 80, or skin rash, increased hair ● Instruct patient to
Metacort suppresses immune methylparaben growth, irregular immediately report sudden
response; stimulates ● Systemic fungal menstruation, trouble weight gain, swelling of face or
Drug Class: bone marrow; and infections sleeping, increased appetite, limbs, excessive nervousness
Therapeutic Class: influences protein, fat, weight gain, easy bruising, or sleep disturbances,
Anti-inflammatory and carbohydrate anxiety, or depression excessive body hair growth,
Pharmacologic Class: metabolism. vision changes, difficulty
Glucocorticoid Adverse effects/toxic breathing, muscle weakness,
Doctor’s Order: reactions: persistent abdominal pain, or
4mg IV push over 2 min GI bleeding, increased change in stool color.
susceptibility to many types ●Tell patient to take oral drug
Date Given: of infections, swelling with or after meals.
March 13, 2023 ● Advise patient to report
vision changes.
Date Discontinued: ● Inform patient that drug
March 13, 2023 makes him/her more
susceptible to infection.