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DRUG

1.Methylergonov ine maleate (Methergin)

DRUG CLASSIFI CATION Oxytocic

MODE OF ACTION -

INDICATION

CONTRAINDICATION -

SIDE EFFECTS & ADVERSE EFFECTS CNS: Dizziness, headache, tinnitus, diaphoresis CV: Hypertension, palpations, chest pain, dyspnea GI: Nausea, vomiting -

NURSING INTERVENTIONS

Increases motor activity of the uterus by direct stimulation of the smooth muscle, rd shortening the 3 stage of labor, and reducing blood loss

2. Amoxicillin (Amoxil, Amoxil Pediatric Drops, Apo-Amoxi (CAN), DisperMox, GenAmoxicillin (CAN), Moxatag, Novamoxin (CAN), Nu-Amoxi (CAN), Trimox)

Antibiotic

Bactericidal; Inhibits synthesis of cell wall of sensitive organisms, causing cell death

Routine management after delivery of the placenta Treatment of postpartum atony and hemorrhage; sub involution of the uterus Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder, under strict medical supervision Treatment of tonsillitis and pharyngitis caused by Streptococcus pyogenes Infections due to susceptible strains of Haemophilus influenza, Escherichia coli, Proteus mirabilis, Neisseria gonorrhoeae, Streptococcus pneumonia, Enterococcus faecalis, streptococci, nonpenicillinaseproducing staphylococci

Contraindicated with allergy to methylergonovine, hypertension, toxemia, lactation, pregnancy. Use cautiously with sepsis, obliterative vascular disease, hepatic or renal impairment

Administer by IM injection Monitor postpartum women for BP changes and amount and character of vaginal bleeding Discontinue if signs of toxicity occur Avoid prolonged use of the drug. Be alert for adverse reactions and drug interactions -Never give oxytocin simultaneously by more than one route. Monitor I/O. Antidiuretic effect may lead to fulud overload, seizures, and coma

Contraindicated with allergies to penicillins, cephalosporins, or other allergens Use cautiously with renal disorders, lactation

CNS: Lethargic, hallucinations, seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, Thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing anaphylaxis

Culture infected area prior to treatment, reculture area if response is not as expected. Give in oral preparations only, amoxicillin is not affected by food Continue therapy for at least 2 days after signs of infection have disappeared; continuation for 10 full days is recommended. Use corticosteroids or antihistamines for skin reactions Tell patient to take entire quantity of drug exactly as prescribed even after feeling better Instruct patient to take drug with food to prevent GI upset. If hes taking the oral suspension, tell him to keep drug refrigerated, to shake wit well before taking it, and to discard remaining drug after 10 days. Tell patient to call prescriber if a rash

3. Cefuroxime (Cefuroxime axetil Ceftin, cefuroxime sodium Zinacef)

Antibiotic Cephalosp orin

Bactericidal: Inhibits synthesis of bacterial cell wall; causing cell death

Helicobacter pylori infection in combination with other agents - Postexposure prophylaxis against Bacillus antbracis - Unlabeled use: Chlamydia trachomatis in pregnancy, mild to moderate otitis media in children Oral (cefuroxime Axetil) - Pharyngitis, tonsillitis caused by Streptococcus pyogenes - Otitis media caused by Streptococcus pneumonia, S. pyogenes, Haemophilus influenza, Moraxella catarrhalis - Acute bacterial maxillary sinusitis caused by S. pneumonia, Haemophilus parainfluenzae, H. Influenzae - UTIs caused by Escherichia coli, Klebsiella pneumonia - Uncomplicated gonorrhea (urethral and endocervical - Skin and skin

occurs because a rash is a sign of an allergic reaction.

Contraindicated with allergy to cephalosporins or penicillins. Use cautiously with renal failure, lactation, pregnancy.

CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepatotoxicity GU: Nephrotoxicity Hematologic: Bone marrow depression Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction Local: Pain, abscess at injection site, phlebitis, inflammation at IV site

Tell patient to take drug as prescribed,even after he feels better. Tell patient to notify presciber about loose stools or diarrhea. Culture infection site, and arrange for sensitivity tests before and during therapy if expected response is not seen Give oral drug with food to decrease GI upset and enhance absorption Give oral tablets to children who can swallow tablets, crushing the drug results in a bitter, unpleasant taste. Use solution for children who cannot swallow tablets. Have vitamin K available in case hypoprothrombinemia occurs. Discontinue if hypersensitivity reaction occurs

structure infections, including impetigo caused by Streptococcus aureus, S. pyogenes Treatment of early Lyme disease

Parenteral (cefuroxime sodium) - Lower respiratory infections caused by S. pneumonia, S. aureus, E. coli, Klebsiella pneuemoniae, H. influenza, S. pyogenes - Dermatologic infections caused by S.aureus, S pyogenes, E.coli, K pneuemoniae, Enterobacter - UTIs caused by E.coli, K. pneuemoniae - Uncomplicated disseminated gonorrhea caused by N. gonorrhoeae - Septicemia caused by S. pneumonia, S. aureus, E. coli, K. pneumonia, H. influenza - Meningitis caused by S. pneumonia, H. influenza, S. aureus, N. meningitides

4. Ranitidine (Apo-Ranitidine (CAN), GenRanitidine (CAN), Novo-Ranidine, (CAN), Nu-Ranit (CAN), PMSRanitidine (CAN), ratio-Ranitidine (CAN), Zantac, Zantac EFFERdose, Zantac Geldose, Zantac 75, Zantac 150)

Histamine2 (H2) antagonist

Competitively inhibits the actions of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin

5. Mefenamic Acid

NSAID

Anti- inflammatory, analgesic, and antipyretic activites related to inhibition of prostaglandin synthesis, esact mechanisms of action are not known

Bone and joint infections due to S. aureus Perioperative prohylaxis Treatment of acute bacterial maxillary sinusitis in patients 3mo- 12yrs Short-term treatment of active duodenal ulcer Maintenance therapy for duodenal ulcer at reduced dosage Short-term treatment and maintenance therapy of active, benign gastric ulcer Short-term treatment of GERD Pathologic hypersecretory conditions Treatment of erosive esophagitis Treatment of heartburn, acid indigestion, Sour stomach Relief of moderate pain when therapy will not exceed 1 wk Treatment of primary dysmenorrea

Contraindicated with allergy to ranitidine, lactation. Use cautiously with impaired renal or hepatic function, pregnancy

CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo CV: Tachycardia, bradycardia, PVCs Dermatologic: rash, alopecia GI: constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels GU: Gynecomastia, impotence or decreased libido Hematologic: Leukopenia, grenulocytopenia, thrombocytopenia, pancytopenia Local: Pain at IM site, local burning or itching Other: Arthralgias CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmic effects Dermatologic: Rash, pruritus, sweating, dry mucous, stomatitis GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence,

Urge patient to avoid cigarette smoking because this may increase gastric acid secretion and worsen disease. Instruct patient on proper use of OTC preparation, as indicated. Advise patient to report abdominal pain and blood in stool or emesis Administer oral drug with meals and at bedtime Decrease doses in renal and liver failure Provide concurrent antacid therapy to relieve pain

Contraindicated with hypersensitivity to mefenamic acid, aspirin allergy, and as treatment of perioperative pain with coronary artery bypass grafting. Use catiously with asthma, renal or

Give with milk or food to decrease GI upset Arrange for periodic ophthalmologic examinations during long-term therapy If patient have had a stomach ulcer or bleeding, tell healthcare provider. Instruct patient to avoid alcohol (includes wine, beer, and liquor) when taking this medicine since it can cause increases in stomach irritation.

hepatic impairment, peptic ulcer disease, GI bleeding, hypertension, heart failure, pregnancy, lactation

6. Metoclopramide (Apo-Metoclop, Clopra, Maxeran, Maxolon, Octamide PFS, Pramin, Reglan)

Antiemetic Dopaminer gic blocker

Stimulates motility of GI tract,increases lower esophageal sphincter tone,and blocks dopamine receptors at the chemoreceptor trigger zone

To prevent or reduce postoperative nausea and vomiting Adults: 10-20 mg I.M. near end of surgical procedure;repeat q 4 to 6 hours,p.r.n.

Contraindicated in patients hypersensitive to drug and in those with pheochromocytoma or seizure disorders Contraindicated in patients for whom stimulation of GI motility might be dangerous Use cautiously in patients with history of depression,Parkinso ns disease,or hypertension

ulcers, GI bleed GU: dysuria, Renal Impairment Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock CNS: restlessness,anxiety,drowsin ess,fatigue,lassitude,fever,de pression,akathisia,insomnia,c onfusion,suicide ideation,seizures,neuroleptic malignant syndrome,hallucinations,hea dache,dizziness,extrapyrami dal symptoms,tardive dyskinesia,dystonic reactions CV: transient hypertension,hypotension,su praventricular tachycardia,bradycardia GI:nausea,bowel disorders,diarrhea GU: urinary frequency,incontinence Hematologic:

Use caution if the patient has a weakened heart. It may cause increased shortness of breath or weight gain. Then recommend to talk with healthcare provider or its own physician. Avoid aspirin, aspirin-containing products, other pain medicines, other blood thinners (warfarin, ticlopidine, clopidogrel), garlic, ginseng, ginkgo, and vitamin E while taking. Talk with healthcare provider. If patient is allergic to any medicine, especially aspirin, or have asthma. Make sure to tell about the allergy and how it affected the patient by consulting its attending physician.

Monitor bowel sounds Safety and effectiveness of drug havent been established for therapy lasting longer than 12 weeks. Tell patient to avoid activities that require alertness for 2 hours after doses Urge patient to report persistent or serious adverse reactions promptly Advise patient not to drink alcohol during therapy

7. Tramadol (Ryzolt, Ultram, Ultram ER)

- Analgesic - Opioid analgesic

Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin causes many effects similar to the opioids dizziness, somnolence, nausea, constipation but does not have the respiratory depressant effects.

Relief of moderate to moderately severe pain Relief of moderate to severe chronic pain in adults who need around the clock treatment for extended periods Unlabled uses: premature ejaculation; restless leg syndrome

8. Ketorolac (Acular LS, Acular PF)

Antipyretic NSAID Nonopioid analgesic

Anti-Inflamamatory and analgesic activity; inhibits prostaglandins and leukotriene synthesis

Short-term management of pain Opthalmic: relief of ocular itching due to seasonal conjunctivitis and relief of postoperative inflammation after cataract surgery

Contraindicated with allergy to tramadol or opiods or acute intoxication with alcohol, opioids, or psychoactive drugs Use cautiously with pregnancy, lactation; seizuresl concomitant use of CNS depressants, MAOIs, SSRIs, TCAs; renal impairment; hepatic impairment. Contraindicated with significant renal impairment, during labor and delivery, lactation, patients wearing soft contact lenses; aspirin allergy; concurrent use of NSAIDs, active peptic ulcer disease, recent GI blood or perforation, history of peptic ulcer disease or GI bleeding hypersensitivity to ketorolac; as prophylactic analgesic before major surgery; treatment of

neutropenia,agranulocytosis Skin: rash,urticartia Other: prolactin secretion,loss of libido CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, enxiety, seizures CV: Hypotension, tachycardia, bradycardia Dermatologic: Sweating pruritus, rash, pallor, urticarial GI: Nausea, vomiting, dry mouth, constipation, flatulence

Control environment if sweating or CNS effects occur. Ensure that patient does not cut, crush, or chew ER tablets Reassess patients level of pain at least 30 minutes after administration Monitor blader and bowel function.Anticpate need for laxative For better alagesic effect,give drug before onset of intense pain Monitor patient for drug dependence. Withdrawal symptoms may occur if drug is stopped abruptly. Reduce dosage gradually Be aware that patient ay be at increased risk for CV events, Gi bleeding, renal toxicity; monitor accordingly Do not use during labor, delivery, or while nursing; serious adverse effects to the fetus or baby are possible. May increase risk of bleeding. Do not use with high risk of bleeding or prophylactically before surgery There is increased risk of severe hypersensitivity with known hypersensitivity to aspirin, NSAIDs, Contraindicated for use with aspirin or NSAIDs because of risk of serious cumulative NSAID effects Protect drug vials from light Administer every 6hr to maintain serum levels and control pain Keep emergency equipment readily available at time of initial dose, in case

CNS: Headache, dizziness, somnolence, insomnia, fatigue, tinnitus, ophthalmologic effects Dermatologic: Rash, pruritus, sweating dry mucous membranes GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, gastric or duodenal ulcers GU: Dysuria, renal impairment Hematologic: Bleeding platelet inhibition with higher doses, neutropenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow

9. Diclofenac (Potassuim Cataflam, Sodium Fenac, Voltaren, Volteran-XR, Voltaren Rapide, Voltaren SR)

Analgesic( nonopioid) Antiinflammato ry Antipyretic NSAID

Unknown.May inhibit prostaglandin synthesis,to produce antiinflammatory,analgesi c,and antipyretic effects.

Analgesia,primary dysmenorrhea Adults: 50 mg diclofenac potassium P.O.t.i.d.For some patients,the first dose may be 100 mg,followed by 50 nd rd mg for the 2 and 3 doses;maximum dose for first day is 200 mg.Dont exceed 50 mg daily after the first day

perioperative pain in CABG; suspected or confirmed cerebrovascular bleeding; hemorrhagic diathesis, incomplete hemostasis, high rish of bleeding; use with probenecid, pentoxyphylline Use cautiously with impaired hearing, allergies, hepatic, CV and GI conditions contraindicated in patients hypersensitive to drug and in those wth hepatic porphyria or history of asthma,urticarial,or other allergic reactions after taking aspirin or other NSAIDS. -Drug isnt recommended for use during late pregnancy or breastfeeding. -Use cautiously in patients wth history of peptic ulcer disease,hepatic dysfunction,cardiac deisease,hypertensio n,fluid retention,or impaired renal

depression, menorrhagia Respiratory: dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis

of sever hypersensitivity reaction

CNS: anxiety,depression,dizziness, drowsiness,insomnia,irritabilit y,headache,aseptic meningitis CV: heart failure,hypertension,edema,fl uid retention EENT: tinnitus,laryngeal edema,swelling of the lips and tongue,blurred vision.eye pain,night blindnss,epistaxis,reversible hearing loss GI: abdominal pain/crams,constipation,diarr hea,indigestion,nausea,abdo minal distention,flatulence,taste disorder,peptic ulceration,bleeding,melena,bl oody diarrhea,appetite change,colitis GU proteinuria,acute renal -

Tell patient to take drug with milk,meals,or antacids to minimize GI distress. Instruct patient not to crush,break,or chew enteric-coated tablets. Advise patient not to take this drug with any other diclofenac-containing products(such as Athrotec) Teach patient sings and symptoms of GI bleeding,including blood in vomit,urine,stool;coffee-ground vomit; and black tarry stool. Tell him to notify prescriber immediately if an of these occurs. Teach patient signs and symptoms of damge to the liver,including nausea,fatigue,lethargy,itching,yellowe rd skin or eyes,right upper quadrant tenderness,and flulike symptoms. Advise patient to avoid consuming alcohol or aspirin during drug therapy. Tell patient to wear sunscreen or protective clothing because drug may cause sensitivity to sunlight. Warn patient to avoid hazardous

function.

10. Methyldopa (Aldopren, ApoMethyldopa, Dopamet, Hydopa, NovoMedopa, NuMedopa)

Antihypert ensive Symphatol ytic(central ly acting)

May inhibit the central vasomotor centers,decreasing sympathetic outflow to the heart,kidneys,and peripheral vasculature.

-Hypertension,hypertensive crisis Adults: Initially,250 mg P.O. b.i.d. to t.i.d. in first 48 hours. Increase p.r.n. q 2 days. May give entire daily dose in evening or at bedtime. Adjust dosages if other antihypertensives are added to or delted from therapy. Maintenance dosage is 500 mg to 2 g daily in 2-4 divided doses. Maximum recommended daily dose is 3 g. Or,250 -500 mg I.V. q 6 hours.Maximum dosage is 1 g q 6 hours. Switch to oral antihypertensives as soon as possible

-Contraindicates in patients hypersensitive to drug and in those with active hepatic disease(such as acute hepatitis)or active cirrhosis. -Contraindicated in those whose previous methyldopa therapy caused live problems and in those taking MAO inhibitors. -Use cautiously in patients with history of impaired hepatic function or sulfite

failure, oliguria.interstitialnephritis,pa pillary necrosis, nephrotic syndrome,fluid retention Hepatic: jaundice,hepatitis,hepatotoxi city Metabolic: hypoglycemia,hyperglycemia Musculoskeletal: back,leg,or join pain Respiratory: Asthma Skin: rash,pruritus,urticarial,eczem a,dermatitis,alopecia,photose nsitivity reactions,bulous eruption,Stevens-Johnson syndrome,allergic purpura Other: anaphylaxis,anaphylactoid reactions,angioedema CNS: sedation,headache,weaknes s,dizziness,decreased mental acuity,paresthesia,parkinsoni sm,involuntary choreoathetoid movements,psychic disturbances,depression,nigh tmares. CV: bradycardia,orthostatic hypotension,aggravated angina,myocarditis,edema EENT: nasal congestion GI: nausea,vomiting,diarrhea,pa ncreatic,dry mouth,constipation GU: galactorrgea

activities that require alertness until its known whether the drug causes CNS symptoms. Tell pregnant woman to avoid use of drug last trimester. Advise patient that use of OTC NSAIDs and diclofenac may increase the risk of GI toxicity.

Tell patient not to suddenly stop taking drug,but to notify presciber if unpleasant adverse reactions occur Instruct patient to report signs and symptoms of infection Tell patient to check his weight daily and to notify prescriber if he gains more than 5lb. Sodium and water retention may occur but can be delivered with diuretics Warn patient that,particularly at the start of therapy,drug may impair ability to perform tasks that require mental alertness.A once-daily dose at bedtime minimizes daytime drowsiness. Inform patient that low blood pressure and dizziness upon rising can be minimized by rising slowly and avoiding sudden position changes and

sensitivity and in breast-feeding women.

Hematologic: hemolytic anemia,thrombocytopenia,le ukopenia,bone marrow,depression. Hepatic: hepatic necrosis,hepatitis Musculoskeletal: arthralgia Skin: rash Other: drug-induced fever,gynecomastia

that dry mouth can be relieved by chewing gum or sucking on hard candy or ice chips. Tell patient that urine may turn dark if left sing in toilet bowl or if toilet bowl has been treated with bleach.

Name Generic Brand Available Drug classification Mode of action Indication Contraindications Side effects & Adverse Effects Interventions (7)