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ANALGESICS/ANTIPYRETICS & MUSCLE RELAXANTS

GENERIC NAME 1. Aspirin, Acetylsalicyli c acid BRAND NAME Aspilets (TAB) CLASSIFICAT ION NSAIDs INDICATION Tx of mild to moderate pain, fever, inflammation SIDE EFFECTS/ADVERSE REACTIONS EENT: dizziness, tinnitus. GI: nausea, dyspepsia, heartburn, bleeding. HEMATOLOGY: bleeding times, anemia, iron concentration. OTHERS: hypersensitivity, urticaria, hives, rashes, angioedema, anaphylactic shock NURSING RESPONSIBILITIES >Instruct patient to take drug with food or after meals and with full glass of water. Explain that antacids should be avoided within 1 to 2 h after ingestion of enteric-coated tablets. >Tell patient to discard any aspirin that has a vinegar-like odor. >Instruct patient to report ringing in ears or unusual bleeding, bruising, or persistent GI pain. >Advise patient on long-term therapy to inform health care provider or dentist before seeking surgery or dental care. >Tell patient on sodium-restricted diet to limit use of effervescent or buffered aspirin preparations. >Caution parents to avoid giving aspirin to children or teenagers with flu-like symptoms or chickenpox without first consulting health care provider. >Instruct patient to avoid intake of alcoholic beverages or other CNS depressants. >Instruct patient to take drug with food, milk, or antacid if GI upset occurs. >Inform patient that drug is an NSAID and can cause serious side effects, such as GI bleeding. >Instruct patient to avoid alcohol, aspirin, and other NSAIDs. >Advise patient to inform dentist and other health care providers of drug therapy before any treatment or surgery. >Instruct patient to report the following symptoms to health care provider: black stools, edema, itching, persistent headache, skin rash, visual disturbances, or weight gain. >Advise patient that drug may cause drowsiness or dizziness and to use caution while driving or performing other tasks requiring mental alertness. >Instruct patient to take oral preparations with food or juice if GI upset occurs. >Tell patient not to crush or chew controlled-release tablets. >Explain that full effectiveness of drug may not occur for 30 to 60 min after administration. Emphasize that drug is more effective if taken regularly to prevent pain rather than to treat pain after it occurs. >If patient is to receive patient-controlled analgesia (PCA), instruct on use of PCA pump. >Explain that physical dependency may occur with longterm therapy and that dosage will be tapered slowly before stopping to prevent withdrawal symptoms (nausea, vomiting, cramps, fever, faintness, anorexia). >Encourage patient to turn, cough and breathe deeply every 2 h to prevent atelectasis. >Advise patient to consult with health care provider if excessive sedation occurs or if pain relief is inadequate. >Inform patient that drug may cause constipation. Stool softener, fiber laxative, increased fluid intake and bulk in diet may help alleviate problem. >Caution patient to avoid sudden position changes to prevent orthostatic hypotension. >Instruct patient to avoid intake of alcoholic beverages and other CNS depressants. >Advise patient that drug may cause drowsiness, dizziness or blurred vision and to use caution while driving or performing other tasks requiring mental alertness. >Advise patient or caregiver that medication will usually be

2. Ketorolac trometamol

Toradol (AMP)

NSAIDs

OPTHALMIC: Tx of allergic conjunctivitis, for prophylaxis and reduction of inflammation and associated symptoms following ocular surgery. SOLN FOR INJ: short term management of moderate to severe acute post-op pain

OPTHALMIC: transient stinging and burning on instillation, ocular irritation, allergic rxn, superficial ocular infection, superficial keratitis. INJ: GI ulceration, bleeding and perforation, post-op bleeding, ARF, anaphylactic and anaphylactoid rxns, liver failure. HPN, pruritis, rash, GI disturbances, nausea, dyspepsia, diarrhea, purpura, headache, drowsiness, dizziness, sweating, edema, injection site pain

3. Morphine sulfate

M-Dolor (AMP)

Opiates and antagonists

Relief of moderate to severe acute and chronic pain. Renal and intestinal colic. Cancer. MI. Pulmonary edema to pulmonary congestion. Antitussive. Narcotic, hypnotic, sedative

Allergic rxns. GI disturbances. Urinary retention. Depression, delirium, and convulsion. Nausea, xerostomia, emesis, anorexia, dysguesia, facial flushing, chills, palpitations, general asthenia, syncope, cardiac failure, respiratory depression, sedation, headache, vertigo, perspiration, mood swings, euphoria, insomnia, alterations in cognitive and sensory capability, perceptive disorders, hypersensitivity rxns

4.

Nubain (AMP)

Opiates and

Relief of moderate to severe pain

Sedation, drowsiness, sweating, nausea, dry mouth

Nalbuphine hydrochlorid e

antagonists

and dizziness, headache, vomiting

5. Paracetamol , Acetaminoph en

Aeknil (AMP), Biogesic (TAB)

Non-opioid analgesics

Relief of mild to moderate pain. Tx of fever

Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity, hepatic seizures (overdose), renal failure (high, prolonged doses), leukopenia, neutropenia, hemolytic anemia (long term use), thrombocytopenia, pancytopenia, rash, urticaria, hypersensitivity, cyanosis, anemia, jaundice, CNS stimulation, delirium, convulsions, coma, death CNS: headache, dizziness, drowsiness, paresthesia, somnolence. CV: peripheral edema. EENT: auditory disturbance. GI: epigastric pain, nausea, peptic ulceration, GI bleeding. GU: nephrotoxicity. HEMA: anemia, leucopenia, aplastic anemia, agranulocytosis, thrombocytopenia. METABOLIC: hyperkalemia, acidosis, dilutional hypernatremia. RESPI: bronchospasm

6. Piroxicam

Feldene/Feld ene Flash (TAB)

NSAIDs

Tx of acute use rheumatoid arthritis, relief of primary dysmenorrheal, juvenile rheumatoid arthritis

7. Tramadol hydrochlorid e

Tramal (AMP)

Opiates and antagonists

Tx for moderate to severe pain

CNS: stimulation, dizziness, vertigo, headache, somnolence, anxiety, confusion, coordination disturbance, malaise, euphoria, nervousness, sleep disorder, seizures. CV: vasodilatation. GI: nausea, vomiting, constipation, dyspepsia, diarrhea, abd. pain, anorexia, flatulence, dry mouth. GU: retention, frequency menopausal symptoms. MUSCULOSKELETAL: hypertonia. RESPI: respiratory depression. SKIN: pruritus, sweating, rash

prepared and administered by a health care provider in a health care setting. >Caution patient or caregiver that medication may be habit forming and, if used at home, to use exactly as prescribed and not to change the dose or discontinue therapy unless advised by health care provider. >Advise patient or caregiver to notify health care provider if medication does not adequately control pain. >Advise patient or caregiver that if medication needs to be discontinued after prolonged use that it will usually slowly be withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. >Advise patient or caregiver to notify health care provider if any of the following occur: excessive sedation or drowsiness; slow or shallow breathing; low BP; slow heart rate; severe constipation. >Instruct patient to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. >Advise patient to report dizziness with position changes to health care provider. >Caution patient that hot tubs and hot showers or baths may make dizziness worse. >Caution patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined. >Caution patient to avoid alcohol and other CNS depressant medications while using this medication. >Instruct family to consult health care provider for use in children younger than 3 yr of age and not to continue taking drug more than 5 days unless advised by health care provider. >Instruct adult patients not to continue taking drug more than 10 days for pain or 3 days for fever. >Instruct patient/family to contact health care provider if pain or fever (above 103F) persists for more than 3 days. >Advise diabetic patients to use sugar-free form of drug. >Explain that increased response may be seen after weeks of therapy. >Caution patient to avoid exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction. >Identify signs and symptoms patient should report to health care provider, including changes in how food tastes, nausea, vomiting, constipation, diarrhea, cramping, black or red stool, discolored urine, changes in urination, fever, rash, unusual bruising or bleeding. >Explain that taking medication with food will minimize GI distress. >Inform patient to avoid aspirin and alcohol during therapy. >Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness until the effects of the drug are known. >Encourage patient to maintain adequate fluid intake. >Instruct patient to take the prescribed dose at the recommended intervals. >Advise patient to swallow the ER tablet whole and not to break, cut, or crush the tablet. Instruct patient to report any serious side effects to health care provider. >Advise patient not to wait until pain level is high to selfmedicate; drug will not be as effective. >Advise patient to avoid using alcohol or other CNS

depressants (eg, sleeping pills). >Advise patient that this medication may cause drowsiness and to use caution while driving or using heavy equipment, or performing other tasks requiring mental alertness. >Advise patient not to abruptly discontinue this medication; when discontinuing treatment, taper the dose. >Advise patient to notify health care provider if pain is not relieved by the medication at prescribed dosage.

ANESTHETICS
GENERIC NAME 1. Atropine sulfate BRAND NAME EuroMed Atropin e Sulfate (AMP) CLASSIFICATI ON Anticholinergics (Adjuvants) Antidote Antispasmodic INDICATION Administration prior to anesthesia to reduce or prevent secretions of respiratory tract. Antidote to overdosage w/ cholinergic substances eg, organophosphate insecticides & nerve gases, & poisonous mushroom. Pre-operatively medication of anxious or tense patients SIDE EFFECTS/ADVERSE REACTIONS Bradycardia, tachycardia, cyanosis, wheezing, dyspnea, rash, urticaria, urinary retention, abd. distention, constipation, eye pain, nausea, vomiting, blurred vision, increased tearing NURSING RESPONSIBILITIES >Caution patient to have adequate oral intake. >Advise patient to include fiber in diet to prevent constipation. >Caution patient to limit exposure to high ambient temperatures. >Advise patient that dilated pupils may be experienced. >Warn patient that product may cause excitability or sedation. Remind patient not to drive or operate heavy machinery if sedation occurs. >Advise patient to notify health care provider if confusion, disorientation, ataxia, nausea, vomiting, diarrhea, abdominal distention, or elevated body temperature occurs. >Advise patient or caregiver to read the patient information leaflet before starting therapy and with each refill. >Advise patient that medication is usually started at a low dose and then gradually increased until maximum benefit is obtained. >Caution patient that medication may be habit forming, to take as prescribed, and not to stop taking or change the dose unless advised by health care provider. >Advise patient to take each dose without regard to meals but to take with food if stomach upset occurs. >Advise patient or caregiver using concentrated oral solution to measure prescribed dose using calibrated dropper and then add solution to a liquid (eg, juice, water, soda) or semisolid food (eg, applesauce, pudding); stir for a few seconds then immediately take (give) the entire mixture. Caution patient or caregiver not to prepare mixtures ahead of time and store. >Advise patient that if a dose is missed to skip that dose and take the next dose at the regularly scheduled time. Caution patient to never take 2 doses at the same time. >Advise patient if medication needs to be discontinued, it will be slowly withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. Instruct patient to avoid alcoholic beverages and other depressants while taking this medication.

2. Diazepam

Valium (AMP)

Anxiolytics and neuroleptics (Adjuvants)

CNS: drowsiness, lethargy, ataxia, fainting, depression, restlessness, anterograde amnesia, psychosis, slurred speech, tremors, headache, insomnia. CV: bradycardia, transient hypotension, CV collapse. GU: incontinence, urinary retention. RESPI: respiratory depression. SKIN: rash, urticaria, desquamation

>Advise patient with anxiety to take medication as needed and to seek alternative methods for controlling or preventing anxiety (eg, stress reduction, counseling). Instruct patient to contact health care provider if symptoms (eg, anxiety, panic attacks, seizures) do not appear to be getting better, are getting worse, or if bothersome adverse reactions (eg, drowsiness, memory impairment) occur. >Advise patient that drug may cause drowsiness or impair judgment, thinking, or reflexes and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined. >Encourage patient with seizure disorder to carry identification (eg, card, bracelet) indicating condition and medication being used to treat. *Injection >Advise patient or caregiver that medication will be prepared by a health care provider and administered in a health care setting under close observation, when oral therapy is not feasible. >Caution patient who receives parenteral therapy as an outpatient (eg, outpatient surgery) to use caution while ambulating, avoid ingestion of alcohol or other sedatives, and avoid driving or other hazardous activities for 24 to 48 h. >Advise patient or caregiver that medication will usually be prepared and administered by a health care provider in a health care setting. >Caution patient or caregiver that medication may be habit forming and, if used at home, to use exactly as prescribed and not to change the dose or discontinue therapy unless advised by health care provider. >Advise patient or caregiver to notify health care provider if medication does not adequately control pain. >Advise patient or caregiver that if medication needs to be discontinued after prolonged use that it will usually slowly be withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. >Advise patient or caregiver to notify health care provider if any of the following occur: excessive sedation or drowsiness; slow or shallow breathing; low BP; slow heart rate; severe constipation. >Instruct patient to get up slowly from lying or sitting position and to avoid sudden position changes to prevent postural hypotension. >Advise patient to report dizziness with position changes to health care provider. >Caution patient that hot tubs and hot showers or baths may make dizziness worse. >Caution patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness or coordination until tolerance is determined. >Caution patient to avoid alcohol and other CNS depressant medications while using this medication.

3. Nalbuphin e hydrochlor ide

Nubain (AMP)

Analgesics (Adjuvants), Local & General anesthesia

For pre-op analgesia, supplement to balanced anesthesia, surgical anesthesia, obstetrical analgesia

CNS: sedation, drowsiness, dizziness, headache, hallucinations, euphoria, restlessness. GI: dry mouth, vomiting. EENT: blurred vision. RESPI: respiratory depression

ANTIALLERGICS
GENERIC NAME 1. Diphenhydram ine hydrochloride BRAND NAME Nebrec on (AMP) CLASSIFICATIO N 1st generation antihistamines (Antihistamines) INDICATION For symptomatic relief of allergic conditions (urticaria, angioedema, rhinitis, conjunctivitis, pruritic disorders) SIDE EFFECTS/ADVERSE REACTIONS Orthostatic hypotension, palpitations, bradycardia, tachycardia, faintness, drowsiness, sedation, dizziness, disturbed coordination, nasal stiffness, dry mouth, epigastric distress, diarrhea, constipation, hemolytica anemia, thrombocytopenia, agranulocytosis, weight gain, chest tightness, wheezing, respiratory depression NURSING RESPONSIBILITIES >Caution patient using OTC product to read package label before using and not to exceed dose or frequency of administration instructions. Advise patient to take each dose without regard to meals but to take with food if stomach upset occurs. >Advise patient using diphenhydramine to prevent motion sickness to take first dose at least 30 min before exposure to motion and take subsequent doses after each meal and at bedtime for duration of journey. >Advise patient using diphenhydramine as a sleep aid to take dose at least 30 min before bedtime and not to use for more than 2 wk. Caution patient that if insomnia persists for more than 2 wk, it may be a symptom of a serious underlying illness and to inform health care provider. >Advise patient or caregiver using liquid, oral solution, elixir, or syrup to

measure and administer prescribed dose using dosing syringe, dosing spoon, or dosing cup. >Advise patient that if a dose is missed to take it as soon as possible unless it is nearing time for the next scheduled dose, then advise patient to skip the missed dose and take the next dose at the regularly scheduled time. Caution patient not to double the dose to catch up. >Advise patient that if allergy symptoms are not controlled not to increase the dose of medication or frequency of use but to inform their health care provider. Caution patient that larger doses or more frequent dosing does not increase effectiveness and may cause excessive drowsiness or other side effects. >Instruct patient to stop taking drug and immediately report any of these symptoms to health care provider: persistent dizziness; excessive drowsiness; severe dry mouth, nose, or throat; flushing; unexplained shortness of breath or difficulty breathing; unusual tiredness or weakness; sore throat, fever, or other signs of infection; bleeding or unusual bruising; fast or irregular heartbeat; excitability, confusion, or changes in thinking or behavior; chest tightness; difficulty urinating. >Advise patient that medication may cause drowsiness or dizziness and not to drive or perform other activities requiring mental alertness until tolerance is determined. >Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs. >Caution patient that alcohol and other CNS depressants (eg, sedatives) will have additional sedative effects if taken with diphenhydramine. >Caution patient not to take any OTC antihistamines or any other product containing diphenhydramine, including topical products, while taking this medication unless advised by health care provider. >Caution patient that medication may cause sensitivity to sunlight and to avoid excessive exposure to the sun or UV light (eg, tanning booths) and to wear protective clothing and use sunscreens until tolerance is determined. >If patient is to have allergy skin testing, advise patient not to take the medication for at least 4 days before the skin testing. *Injection >Advise patient or caregiver that injection is used when it is impractical to take diphenhydramine by mouth and that the medication will be prepared and administered by a health care professional in a medical setting.

CARDIOVASCULAR DRUGS
GENERIC NAME 1. Adenosine BRAND NAME Cardiov CLASSIFICATIO N Antiarrythmics INDICATION Conversion to sinus rhythm of SIDE EFFECTS/ADVERSE REACTIONS Facial flushing, headache, chest pain, NURSING RESPONSIBILITIES >Inform patient to report the following symptoms to health care

ert (AMP)

(Cardioactive drugs)

2. Amiodarone

Cordaro ne (AMP)

Antiarrythmics (Cardioactive drugs)

paroxysmal supraventricular tachycardia (PSVT), associated w/ Wolff-Parkinson-White syndrome. For CAD pxs. Used w/ BCNU for tx. Tx for recurrent ventricular arrhythmias (i.e. ventricular fibrillation/tachycardia)

hypotension, light-headedness, dizziness, tingling in arms, numbness, nausea, dyspnea, SOB, chest pressure CNS: confusion, psychosis, involuntary movements, paresthesias. RESPI: dyspnea, fatigue, cough, fever, chest pain, ARDS. THYROID: hypothyroidism, lethargy, dizziness, constipation, enlarged thyroid gland, edema of extremities, cool pale skin

provider: facial flushing, headache, shortness of breath, chest pressure, lightheadedness, dizziness, tingling in arms, numbness or nausea. >Advise patient or caregiver that injectable amiodarone will be prepared and administered by health care provider in a medical setting. >Advise patient or caregiver to read the Medication Guide carefully before starting therapy, and to read and check for new information each time the medication is refilled. >Advise patient to take each dose consistently either with or without food. >Advise patient to take with food if stomach upset occurs. >Instruct patient to avoid drinking grapefruit juice while taking amiodarone. >Instruct patient not to change the dose or stop taking unless advised by health care provider. >Advise patient that if medication is stopped because of side effects, side effects may persist for a long time because the amiodarone stays in the body for months after treatment is stopped. >Instruct patient to contact health care provider or seek medical assistance right away if any of the following occur: blurred vision, seeing halos, or eyes sensitive to sunlight; chest pain, coughing, or spitting up blood; difficulty breathing, unexplained shortness of breath, or wheezing; feeling light-headed or faint; feeling more tired than usual; feeling of pins and needles or numbness in hands, legs, or feet; heart pounding, skipping beats, beating very fast or very slowly; muscle weakness, uncontrolled movements, poor coordination, or trouble walking; passing brown or dark-colored urine; persistent nausea, stomach pain, or vomiting; yellowing of skin or eyes. >Advise patient to notify health care provider if any of the following occur: bluish discoloration of skin; changes in menstruation; heat or cold intolerance; restlessness; swelling or lump in neck; thinning hair; unexplained sweating; unexplained weight loss or gain; weakness; any other bothersome side effect or unexplained feelings. >Advise patient to avoid unnecessary exposure to direct and indirect sunlight or tanning lamps and to use sunscreen and wear protective clothing to avoid photosensitivity reactions during therapy. Advise patient to discontinue therapy and notify health care provider if any of the following occur following exposure to sunlight or artificial UV light (eg, sunlamp): blistering; itching; rash; redness; sensation of skin burning; swelling. >Caution women of childbearing potential to avoid becoming pregnant during treatment with amiodarone. >Instruct patient to take drug with food or after meals and with full glass of water. Explain that antacids should be avoided within 1 to 2 h after ingestion of enteric-coated tablets. >Tell patient to discard any aspirin that has a vinegar-like odor. >Instruct patient to report ringing in ears or unusual bleeding, bruising, or persistent GI pain. >Advise patient on long-term therapy to inform health care provider or dentist before seeking surgery or dental care. >Tell patient on sodium-restricted diet to limit use of effervescent or buffered aspirin preparations. >Caution parents to avoid giving aspirin to children or teenagers with flu-like symptoms or chickenpox without first consulting health care provider. >Instruct patient to avoid intake of alcoholic beverages or other CNS depressants. >Advise patient to take prescribed dose 1 h before or 2 h after meals because food can reduce absorption and benefits of medication. >Advise patient to try to take each dose at about the same time each day. >Inform hypertensive patient that drug controls, but does not cure,

3. Aspirin, Acetylsalicylic acid

Aspilets (TAB)

Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics)

Reduction of risk of death for MI pxs w/ previous infarction or unstable angina pectoris or recurrent TIAs or stroke in men

EENT: dizziness, tinnitus. GI: nausea, dyspepsia, heartburn, bleeding. HEMATOLOGY: bleeding times, anemia, iron concentration. OTHERS: hypersensitivity, urticaria, hives, rashes, angioedema, anaphylactic shock

4. Captopril

Capoten (TAB)

ACE inhibitors (Antihypertensive s)

HPN, CHF, left ventricular dysfunction after MI, diabetic nephropathy

Fever, chills, hypotension, postural hypotension, tachycardia, angina, impotence, dysuria, nocturia, proteinuria, nephritic syndrome, ARF, polyuria, oliguria, neutropenia, agranulocytosis,

pancytopenia, thrombocytopenia, anemia, rash, angioedema, hyperkalemia, bronchospasm, dyspnea, cough

5. Clonidine

Catapre s (TAB)

Centrally-acting drugs (Antihypertensive s)

HPN, migraine, relief of cancer pain

Skin irritation, drowsiness, dry mouth, dizziness, headache, constipation, depression, anxiety, fatigue, nausea, anorexia, parotid pain, sleep disturbances, vivid dream, impotence, urinary retention CNS: fatigue, generalized muscle weakness, agitation, hallucination, headache, malaise, dizziness, vertigo, stupor, paresthesia. CV: arrhythmia, heart failure, hypotension. ENT: blurred vision, light flashes, yellow-green halos around visual images, photophobia, diplopia. GI: anorexia, vomiting, diarrhea

6. Digoxin

Lanoxin (AMP)

Cardiac glycosides (Cardioactive drugs), Antiarrythmics

Chronic cardiac failure w/ atrial fibrillation, ventricular dilatation, supraventricular arrhythmias

hypertension and to continue taking drug as prescribed even when BP is not elevated. >Caution patient not to change the dose or stop taking unless advised by health care provider. >Instruct patient to continue taking other medications for the condition as prescribed by health care provider. >Instruct patient in BP and pulse measurement skills. >Advise patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit. >Caution patient to avoid sudden position changes to prevent orthostatic hypotension. >Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing. >Emphasize to hypertensive patient the importance of other modalities on BP control: weight control, regular exercise, smoking cessation, and moderate intake of alcohol and salt. >Emphasize to heart failure patient the importance of other modalities that can help control heart failure symptoms: weight control, progressive exercise program, smoking cessation, and moderate intake of alcohol and salt. >Advise heart failure patient to weigh daily, keep a record of daily weights, and notify health care provider if rapid weight gain (eg, 5 pounds in 1 wk) is noted or if edema or shortness of breath worsen. >Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting. >Advise patient that medication may cause dizziness or lightheadedness and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined. >Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light to avoid photosensitivity reaction. >Instruct patient to stop taking drug and immediately report any of the following symptoms to health care provider: sore throat, fever, irregular heartbeat, chest pains, fainting, signs or symptoms of angioedema (eg, swelling of the hands, feet, face, lips, eyelids, or tongue, hoarseness, difficulty swallowing or breathing). >Instruct patient to inform health care provider if a persistent cough or changes in taste develop while taking this medication. >Caution patient not to take any prescription or OTC medications, potassium-containing salt substitutes, potassium supplements, or dietary supplements unless advised by health care provider. >Patients should be cautioned against interruption of Clonidine hydrochloride therapy without their physicians advice. >Patients who engage in potentially hazardous activities, such as operating machinery or driving, should be advised of a possible sedative effect of Clonidine. They should also be informed that this sedative effect may be increased by concomitant use of alcohol, barbiturates, or other sedating drugs. >Instruct patient to take digoxin at same time each day to ensure steady-state dosing and to contact health care provider for instructions if dose is missed. >Teach patient and family name, action, administration, adverse reactions, and toxic effects of particular digoxin preparation. >Emphasize importance of regular follow-up exams to determine effectiveness and to monitor for toxicity. >Caution patient to avoid taking otc medications without consulting health care provider. Antacids and antidiarrheals, for example, slow absorption of digoxin. >Teach patient and family to take pulse and to seek health care provider's advice for rates less than 60bpm or more than 100 bpm (adults). >If patient is directed by health care provider, help identify ways to

7. Dobutamine hydrochloride

Dobujec t (AMP)

Inotropic agents (Cardioactive drugs) Vasopressor / Vasoconstrictor Adrenergic, Dopaminergic cardiac stimulants Vasopressor / Vasoconstrictor

the contractility of heart in acute heart failure, cardiogenic shock, MI, septic shock

8. Dopamine hydrochloride

Docard (AMP)

Correction of hemodynamic imbalances present in shock after MI, trauma, endotoxic septicemia, surgery and renal failure or imbalances in conditions of chronic refractory cardiac decompensation Tx for hypotension, cardiac arrest

9. Epinephrine hydrochloride, Adrenaline

Levoph ed (AMP)

Inotropic agents (Cardioactive drugs) Vasopressor / Vasoconstrictor

CNS: headache. CV: heart rate, HPN, PVCs, angina, nonspecific chest pain, phlebitis, hypotension. GI: nausea, vomiting. MUSCULOSKELETAL: cramps, tingling sensation. RESPI: SOB, asthma attacks CNS: headache. CV: arrhythmias, ectopic beats, tachycardia, anginal pain, palpitations, hypotension, bradycardia, wide QRS complex, conduction disturbance, vasoconstriction, HPN. GI: nausea, vomiting. GU: azotemia. RESPI: asthma attacks, dyspnea. SKIN: necrosis, tissue sloughing with extravasation, piloerection Ischemic injury, bradycardia, arrhythmias, anxiety, transient headache, respiratory difficulty, extravasation necrosis @ injection site, plasma volume depletion on prolonged administration

supplement potassium intake. >Instruct patient to report these symptoms to health care provider: pain or discomfort at IV site, any anginal pain.

>Instruct patient to inform health care provider immediately if these signs occur: chest pain, dyspnea, numbness, tingling or burning of extremities, and discomfort at IV site.

*Injection >Advise patient, family, or caregiver that medication (other than that delivered by auto-injector) will be prepared and administered by a health care provider in a medical setting. >Ensure patient using auto-injector understands how to store, prepare the auto-injector, administer the injection, and dispose of used equipment. >Ensure patient using auto-injector understands how and when to use oral medications for allergic reactions (eg, antihistamines, corticosteroids) if prescribed or recommended by health care provider. *Inhalation Solution and Aerosol >If using solution for inhalation, ensure patient or caregiver can prepare, use, and clean the nebulizer without difficulty. If using the aerosol, ensure patient understands how to store and use the inhaler properly. >Instruct patient not to mix with other nebulizer medications unless advised by health care provider. >Instruct patient not to exceed prescribed dose or frequency of use. Advise patient to contact health care provider if this medication no longer seems to control asthma symptoms or if increasing doses of the medicine are needed. This may indicate worsening asthma. >Advise patients using more than 1 inhaled medication to use this medication first if needed. Inhaled corticosteroids or other inhaled controller medications should be taken last. >Advise patient that if breathing symptoms worsen during or immediately after using this medication to stop using it and inform health care provider immediately. >Caution patient not to use solution if it is pinkish or darker than slightly yellow, or if it contains a precipitate. >Caution patient not to puncture canister, dispose of used aerosol canister in incinerator, or store canister near open flame or heat above 120F. *Topical Solution >Ensure patient or caregiver understands how and when to apply topical solution as drops, spray, or directly on mucosal surface with sterile swab, as directed. >Advise patient or caregiver not to increase the frequency of use if symptoms of congestion do not improve or worsen but to notify health care provider. *Injection >Advise patient or caregiver that injection is used when a rapid onset of diuresis is needed, when GI absorption is impaired, or when taking oral medications is not practical, and that conversion to oral therapy will be made as soon as possible. *Tablets and oral solution

10. Furosemide

Lasix (AMP)

Loop diuretics (Diuretics, Antihypertensive s)

Tx of edema associated w/ CHF, hepatic cirrhosis, renal disease. HPN.

Orthostatic hypotension, thrombophlebitis, chronic aortitis, vertigo, headache, dizziness, paresthesia, restlessness, fever, photosensitivity, urticaria, pruritus, necrotizing angitis, rash, blurred vision, xanthopsia, tinnitus, hearing impairment, anorexia, nausea, vomiting, diarrhea, oral

and gastric irritation, cramping, constipation, pancreatitis, urinary bladder spasm, interstitial nephritis, glycosuria, anemia, leucopenia, purpura, aplastic anemia, thrombocytopenia, agranulocytosis, jaundice, ischemic hepatitis, hyperuricemia, hyperglycemia, hypokalemia, metabolic alkalosis, muscle spasm, weakness

11. Isosorbide dinitrate/mononit rate, ISD/ISDN

Isoket (AMP)

Osmotic diuretics (Diuretics, Antihypertensive s) Organic nitrates/nitrites (Antianginal drugs, Cardioactive drugs) Vasodilator

Tx for angina pectoris/post MI angina. Tx of severe CHF in combination w/ cardiac glycosides, diuretics, ACE inhibitors, arterial vasodilators, pulmonary HPN

Transient hypoxemia, headache, hypotension, dizziness, weakness, nausea, vomiting, HR @ start of tx, cerebral ischemia

>Advise patient to take prescribed dose without regard to meals but to take with food if stomach upset occurs. >Advise patient or caregiver using oral solution to measure and administer prescribed dose using supplied dosing cup, calibrated dosing syringe, or calibrated dosing spoon. >Advise patient that medication will increase urination and not to take before bedtime or before activities in which increased urination would be a problem. >Instruct patient that if dose is delayed to take the dose later in the day to prevent interference with activities. Caution patient not to skip doses. >Caution patient not to change the dose or stop taking unless advised by health care provider. >Ensure patient understands how to implement fluid and salt restriction if prescribed as part of therapeutic regimen. >Instruct patient to lie or sit down if they experience dizziness or lightheadedness when standing. >Caution patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting can lead to excessive fall in BP resulting in lightheadedness or fainting. >Instruct diabetic patient to monitor blood glucose more frequently when drug is started or dose is changed and to inform health care provider of significant changes in readings. >Caution patient to avoid unnecessary exposure to UV light (sunlight, tanning booths) and to use sunscreen and wear protective clothing when exposed to UV light until tolerance is determined. >Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding. >Instruct patient to inform health care provider if any of the following occur: muscle pain, weakness, or cramps; persistent nausea or vomiting; diarrhea; excessive thirst; unexplained tiredness; drowsiness; dizziness or feeling of the room spinning; ringing in the ears or decreased hearing; confusion or changes in thinking; increased heart rate; unexplained joint pain; abnormal skin sensations. >Advise patient to review the patient information leaflet carefully before starting therapy and to read and check for new information each time the medication is refilled. >Review with patient and family the signs and symptoms of angina (eg, acute onset of pressure-like chest pain that may radiate down the left arm and/or into the neck or jaw, often associated with sweating and shortness of breath or difficulty breathing). >Instruct patient not to change from one brand of medicine to another without consulting health care provider. Products manufactured by different companies may not be equally effective. >Instruct patient using sublingual isosorbide for acute treatment of angina symptoms in proper use of drug: place tablet under the tongue and allow to dissolve; caution patient not to chew or crush sublingual tablets. >Instruct patient using extended-release tablets or capsules to swallow whole and not to crush, chew, break, or open. >Ensure patient using oral forms of isosorbide dinitrate has sublingual nitroglycerin available at all times. Ensure patient knows when and how to use sublingual nitroglycerin and what to do if angina pain worsens or fails to respond to sublingual nitroglycerin. >Caution patient that antianginal effectiveness of isosorbide is strongly related to the dosing regimen and not to change the dose or frequency of administration, or stop taking, unless advised by health care provider. >Advise patient that headaches are a common adverse reaction of therapy and are also a marker of antianginal effectiveness. Advise patient that acetaminophen can be used to relieve headache without reducing the medication's antianginal effectiveness. Caution patient not to reduce the dose or change the frequency of administration of isosorbide to avoid medication-induced headache. >Advise patient to notify health care provider if angina symptoms

12. Nicardipine hydrochloride

Cardepi ne (AMP)

Calcium antagonists (Antihypertensive s)

Tx of HPN, angina pectoris, vasospastic (Prinzmetals) angina. Management of CHF

Peripheral edema, headache, tachycardia, palpitations, localized thrombophlebitis and hypotension

13. Nifedipine

Calciblo c (TAB)

Calcium antagonists (Antihypertensive s)

Tx of vasospastic (Prinzmetals or variant) angina, chronic stable angina, HPN (sustainedrelease tabs only)

Dizziness, flushing, headache, hypotension, peripheral edema, tachycardia, palpitations, nausea, GI disturbance, increased micturition frequency, lethargy, eye pain, mental depression, gingival hyperplasia, rashes, fever

increase in frequency or severity, or if there is a sudden increase in the frequency of use of SL nitroglycerin. >Caution patient that medication may cause dizziness, lightheadedness, or fainting, especially if used while standing or following consumption of alcohol. >Caution patient to avoid sudden position changes to prevent orthostatic hypotension. >Instruct patient to notify health care provider if any of the following occur: frequent episodes of dizziness or light-headedness; fainting; intolerable headache; episodes of sweating, nausea, and/or vomiting; any unusual or unexplained feeling or sensation. >Instruct patient to swallow sustained-release capsules whole and not to crush or chew. >Caution patient that increased angina may occur initially when starting, changing dose, or stopping medication. >Advise patient not to stop taking drug abruptly. >Instruct patient to report the following symptoms to health care provider: any unusual bleeding, bruising, rash, palpitations, irregular heartbeat, shortness of breath, nausea, change in angina, constipation, changes in gums, dizziness, or swelling in hands or feet. >Advise patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness. >Notify health care provider if condition does not appear to be improving or is worsening, or if bothersome side effects are noted. >Advise patient that dose of medication may be adjusted to obtain max benefit. >Advise patient taking immediate-release capsules to take 3 to 4 times daily as prescribed. Advise patient to swallow whole, without regard to meals, and not to chew or puncture capsule. Advise patient to take with food if stomach upset occurs. >Advise patient taking extended-release tablets to take once daily as prescribed, on an empty stomach. Caution patient to swallow extended-release tablets whole and not to crush, chew, cut, or break. >Advise patient using extended-release tablets that empty tablets may be seen in the stool but that these are are the empty matrix that released the nifedipine for absorption. Advise patient not to be concerned as the active drug has already been absorbed. >Advise patient to try to take each dose at about the same time each day. Inform patient that drug controls, but does not cure, hypertension or angina and to continue taking as prescribed even when BP is not elevated or angina symptoms are not present. >Caution patient not to change the dose or stop taking unless advised by health care provider. >Instruct patient to continue taking other BP or angina medications as prescribed by health care provider. >Instruct patient being treated for angina to notify health care provider if frequency or severity of chest pain or need for sublingual nitroglycerin appears to be increasing. >Instruct patient in BP and pulse measurement skills. >Advise hypertensive patient to monitor and record BP and pulse at home and to inform health care provider if abnormal measurements are noted. Also advise patient to take record of BP and pulse to each follow-up visit. Instruct patient to lie or sit down if experiencing dizziness or lightheadedness when standing. >Advise patient to notify health care provider if any of the following occur: frequent episodes of dizziness when arising; swelling of lower legs or ankles; persistent fatigue; or any other unusual or unexplained symptom or sign. >Emphasize to hypertensive patient importance of other modalities on BP: weight control, regular exercise, smoking cessation, moderate intake of alcohol and salt.

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14. Nitroglycerin, Glyceril trinitrate

Nitrosta t (TAB)

Organic nitrates/nitrites (Antianginal drugs, Cardioactive drugs)

Tx of acute angina, prophylaxis of angina, control of BP in perioperative or intraoperative HPN, CHF associated w/ MI

Tachycardia, palpitations, hypotension, syncope, arrhythmias, headache, apprehension, weakness, vertigo, dizziness, agitation, insomnia, blurred vision, nausea, vomiting, diarrhea, dyspepsia, dysuria, urinary frequency, impotence, methemoglobinemia, hemolytic anemia, bronchitis, pneumonia, arthralgia, perspiration, pallor, cold sweat, edema

>Advise patient to carefully review the patient information leaflets and booklets supplied with each product before starting therapy, and to read and check for new information each time the medication is refilled. >Review with patient and family the signs and symptoms of angina (eg, acute onset of pressure-like chest pain that may radiate down the left arm and/or into the neck or jaw, often associated with sweating and shortness of breath or difficulty breathing). >Ensure patient using extended-release capsules, topical ointment, or transdermal nitroglycerin to prevent angina attacks has sublingual nitroglycerin tablets or translingual spray available at all times. Ensure patient knows when and how to use sublingual nitroglycerin or translingual spray and what to do if angina pain worsens or fails to respond to sublingual nitroglycerin. >Caution patient that antianginal effectiveness of nitroglycerin is strongly related to the dosing regimen and not to stop taking or change the dose or frequency of administration unless advised by health care provider. >Advise patient that headaches are a common adverse reaction of therapy and are also a marker of antianginal effectiveness. Advise patient that acetaminophen can be used to relieve headache without reducing the medications antianginal effectiveness. Caution patient not to reduce the dose or change the frequency of administration of isosorbide to avoid medication-induced headache. >Advise patient to notify health care provider if angina symptoms increase in frequency or severity, or if there is a sudden increase in the frequency of use of sublingual nitroglycerin or translingual spray. >Caution patient that medication may cause dizziness, lightheadedness, or fainting, especially while standing or following consumption of alcohol. >Caution patient to avoid sudden position changes to prevent orthostatic hypotension. >Instruct patient to notify health care provider if any of the following occur: frequent episodes of dizziness or lightheadedness; fainting; intolerable headache; episodes or sweating, nausea and/or vomiting; any unusual or unexplained feeling or sensation. *Sublingual tablets >Instruct patient to carry the tablets with them at all times and to keep the tablets in the original glass container and tightly capped. >Instruct patient to sit down and dissolve 1 tablet under the tongue or between the cheek and gum at the first sign of an anginal attack. If pain remains, dose may be repeated every 5 min until 3 tablets are taken. Instruct patient to go to a near hospital if pain becomes more intense or persists after a total of 3 tablets. >Caution patient not to crush, chew, or swallow sublingual tablets. Instruct patient to lie down if dizziness or lightheadedness occurs. >Advise patient that tablets may produce a burning or tingling sensation but that the ability to cause burning or tingling is not considered a reliable method for determining potency of the tablets. >Advise patient to discontinue nitroglycerin and notify health care provider if vision blurring or dry mouth occurs. *Translingual spray >Ensure patient knows when and how to use translingual spray: Sit down before using spray. Do not shake container before administering dose. Prime aerosol unit initially with 1 spray. Reprime with 1 spray if unit has not been used for 6 or more weeks. Hold container upright as close to open mouth as possible; press button firmly to release spray onto or under the tongue. >Caution patient not to inhale spray. Have patient avoid swallowing immediately after administering spray or expectorating or rinsing the mouth for 5 to 10 min following administration. If pain remains, dose may be repeated every 5 min until 3 sprays are taken. Instruct patient to call 911 if pain becomes

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more intense or persists after a total of 3 sprays. >Caution patient that aerosol spray contains alcohol and not to spray toward flames or forcefully open or burn container after use. >Advise patient to discard aerosol and replace with new unit when end of pump is no longer covered by fluid. *Transdermal systems >Ensure patient knows how to use transdermal system: remove patch from foil pouch immediately prior to application and remove protective liner from patch and apply to any area of the body except the extremities below the knee or elbow. Advise patient that the chest is preferred site. Press the patch on the skin and smooth down. >Advise patient to apply only to area that is clean, dry, and hairless. If hair is likely to interfere with patch adherence, instruct patient to clip, not shave, the area before application. >Caution patient not to apply patch to skin areas with cuts or irritation, or immediately after showering or bathing. >Advise patient that if the patch becomes dislodged, discard it and put a new one on at a different skin site. >Caution patient to remove and discard patch after 12 to 14 h, as instructed by health care provider, to provide nitroglycerin-free interval. *Topical ointment >Ensure patient knows how to use topical ointment: measure prescribed dose of ointment using measuring applicator supplied with tube by squeezing necessary amount of ointment onto applicator and placing applicator (ointment side down) on desired area of skin. Spread ointment using dose measuring applicator then tape applicator into place. Caution patient not to rub ointment into skin. >Advise patient to cover dose-measuring applicator with plastic kitchen wrap to prevent staining of clothing by ointment. >Instruct patient to remove first applicator 6 h after application and apply a second applicator. Instruct patient to remove second applicator after 6 h to provide nitrate-free dosing interval. *Extended-release capsules >Instruct patient using extended-release capsules to swallow whole and not to crush, chew, or open capsules. *Injection >Advise patient, family, or caregiver that medication will be prepared and administered by a health care professional in the intensive care center with close monitoring. >Explain that patient may experience temporary flushing sensations and peculiar sensations of taste. Rarely, dizziness, rapid weak pulse, profuse sweating, or difficulty breathing may occur. Another rare occurrence is pain, swelling, or tenderness at injection site. >Remind patients on anticoagulant and phytonadione therapy of importance of regular lab work to check PT. Anticoagulant effects are antagonized by vitamin K; therefore, temporary resistance to oral anticoagulants may result, especially when larger doses are used. >Instruct patient to report any symptoms of bleeding. >Should not be used in patients with active intravascular clotting. >Reduced dosage for children and patients with renal impairment. >Possibility for skin reaction such as a wide spread, patchy rash with associated blisters. >Advise patient to report visual abnormalities >Tell patient if dose is missed to take as soon as possible. If several hours have passed or if it is nearing time for next dose, tell patient not to double dose to catch up unless advised by health care provider. >If more than one dose is missed, tell patient to contact health care provider. >Caution patient not to change dose unless directed by health care

15. Phytomenadione, Vitamin K

Konakio n (AMP)

Blood modifier, Haemostatics

Tx and prevention of hemorrhage associated w/ vitamin K deficiency

CNS: dizziness, seizure like movements. CV: flushing, transient hypotension, rapid and weak pulse, cardiac irregularities. SKIN: diaphoresis, erythema. OTHERS: cramp like pain, anaphylaxis, anaphylactoid rxns, pain, swelling, hematoma @ injection site GI disturbances, hypotension, thrombotic complications, transient disturbance of colour vision Headache, ankle edema, hypotension, dizziness, flushing, fatigue, nausea, GI disturbances, gingival hyperplasia, rashes

16. Tranexamic acid

Hemost an (AMP) Isoptin (AMP)

Haemostatics, Antifibrinolytic, Antihemorrhagic Calcium antagonists (Antihypertensive s)

17. Verapamil

Tx and prophylaxis of hemorrhage associated w/ excessive fibrinolysis. Prophylaxis of hereditary angioedema Tx of angina pectoris and HPN, cardiac arrhythmias

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provider. >Advise patient not to suddenly stop taking medication. >Remind patient to brush and floss teeth and see dentist regularly. >Instruct patient to report any irregular heart beat, shortness of breath, swelling of hands and feet, pronounced dizziness, constipation, nausea, or hypotension. >Advise patient to avoid use of alcohol and OTC medications without consulting health care provider. >Instruct patient to limit caffeine consumption. >Advise patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness until effects of drug have stabilized. >Stress to patient the importance of compliance in all areas of treatment regimen: diet, exercise, stress reduction, drug therapy.

CENTRAL NERVOUS SYSTEM DRUGS


GENERIC NAME 1. Betahistine dihydrochlori de 2. Betahistine mesilate BRAND NAME Serc (TAB) CLASSIFICATI ON Antiemetic/anti vertigo INDICATION Meniere's disease, Meniere-like syndrome characterized by attacks of vertigo, tinnitus & sensorineural deafness, peripheral vertigo. Vertigo and dizziness associated with Meniere's disease, Meniere's syndrome and peripheral vertigo. SIDE EFFECTS/ADVERSE REACTIONS Mild gastric complaints have been reported. They can often be eliminated by reducing the dosage. Also, skin rashes have been reported. Adverse reactions were reported in 26 of 2254 patients treated with betahistine mesilate (1.2%). Gastrointestinal: Nausea or vomiting may occur in rare cases (0.4%). Hypersensitivity: Hypersensitivity reactions eg, rash, may occur in rare cases (0.1%). Effects on Laboratory Values: With respect to laboratory test values, no changes attributable to betahistine mesilate treatment have been observed. Somnolence & GI disturbances. Aggravation or appearance of extrapyramidal symptoms (prolonged use in elderly). Rarely, headache, dry mouth, wt gain, perspiration, allergic reactions. Very rarely, lichen planus & lupuslike symptoms. NURSING RESPONSIBILITIES

Merislon (TAB)

Antiemetic/anti vertigo

3. Cinnarizine

Stugero n forte (TAB)

Antiemetic/anti vertigo Cerebral/periph eral vasodilators

Maintenance therapy of labyrinthine disorders (vertigo, dizziness, tinnitus, nystagmus, nausea & vomiting), cerebrovascular origin (dizziness, ear buzzing, vascular headache, unsociability,

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4. Diazepam

Valium (AMP)

Benzodiazepin es (Anticonvulsant s) Benzodiazepin es (Hypnotics/sed atives) Anxiolytic (Psychotropic drugs)

irritability disorders, loss of memory & lack of conc), migraine. Prophylaxis of motion sickness; maintenance therapy for symptoms of peripheral circulatory disorders, including Raynaud's phenomenon, acrocyanosis, trophic disturbances, intermittent claudication, trophic & varicose ulcers, paraesthesia, nocturnal cramps, cold extremities. Relief of anxiety, agitation, tension due to psychoneurotic states and transient situational disturbances. For major mental and organic disorders, relief of reflex muscle spasm due to local trauma. Basal sedation, preoperatively medication of anxious or tense pxs. Tx of excitation states associated w/ acute anxiety and panic

CNS: drowsiness, lethargy, ataxia, fainting, depression, restlessness, anterograde amnesia, psychosis, slurred speech, tremors, headache, insomnia. CV: bradycardia, transient hypotension, CV collapse. GU: incontinence, urinary retention. RESPI: respiratory depression. SKIN: rash, urticaria, desquamation

>Advise patient or caregiver to read the patient information leaflet before starting therapy and with each refill. >Advise patient that medication is usually started at a low dose and then gradually increased until maximum benefit is obtained. >Caution patient that medication may be habit forming, to take as prescribed, and not to stop taking or change the dose unless advised by health care provider. >Advise patient to take each dose without regard to meals but to take with food if stomach upset occurs. >Advise patient or caregiver using concentrated oral solution to measure prescribed dose using calibrated dropper and then add solution to a liquid (eg, juice, water, soda) or semisolid food (eg, applesauce, pudding); stir for a few seconds then immediately take (give) the entire mixture. Caution patient or caregiver not to prepare mixtures ahead of time and store. >Advise patient that if a dose is missed to skip that dose and take the next dose at the regularly scheduled time. Caution patient to never take 2 doses at the same time. >Advise patient if medication needs to be discontinued, it will be slowly withdrawn unless safety concerns (eg, rash) require a more rapid withdrawal. Instruct patient to avoid alcoholic beverages and other depressants while taking this medication. >Advise patient with anxiety to take medication as needed and to seek alternative methods for controlling or preventing anxiety (eg, stress reduction, counseling). Instruct patient to contact health care provider if symptoms (eg, anxiety, panic attacks, seizures) do not appear to be getting better, are getting worse, or if bothersome adverse reactions (eg, drowsiness, memory impairment) occur. >Advise patient that drug may cause drowsiness or impair judgment, thinking, or reflexes and to use caution while driving or performing other tasks requiring mental alertness until tolerance is determined. >Encourage patient with seizure disorder to carry identification (eg, card, bracelet) indicating condition and medication being used to treat. *Injection >Advise patient or caregiver that medication will be prepared by a health care provider and administered in a health care setting under close observation, when oral therapy is not feasible. >Caution patient who receives parenteral therapy as an outpatient (eg, outpatient surgery) to use caution while ambulating, avoid ingestion of alcohol or other sedatives, and avoid driving or other hazardous activities for 24 to 48h. *Injection >Advise patient that medication will be prepared and administered by a health care professional in a hospital setting. *Oral >Advise patient to mix granules in at least a half-glass of water before swallowing and to follow with full glass of water. Advise patient to mix with ice chips or flavor with lemon or orange juice to make more

5. Magnesium sulfate

Elin magnes ium sulfate (VIAL)

Anticonvulsant s

Used as an anticonvulsant. Lowers ICP. For hypomagnesemia in pxs receiving TPN. Prevention and control of seizures in toxemia, acute nephritis in children, epilepsy, glomerulonephritis, hypothyroidism

CNS: drowsiness, depressed reflexes, flaccid paralysis, hypothermia. CV: hypotension, flushing, circulatory collapse, depressed cardiac function, heart block. METABOLIC: hypocalcemia. RESPI: paralysis SKIN: diaphoresis

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6. Phenobarbital

Luminal (AMP)

Barbiturates (Anticonvulsant s)

Antiepileptic to control partial & generalized tonic-clonic seizures, given parenterally as part of the management of acute seizures & for control of status epilepticus in adults.

Somnolence is the most common. Agitation, confusion, hyperkinesia, ataxia, CNS depression, nightmares, nervousness, psychiatric disturbances, hallucinations, insomnia, anxiety, dizziness, thinking abnormality. Hypoventilation, apnea. Bradycardia, hypotension, syncope. Nausea, vomiting & constipation. Headache, inj site reactions, hypersensitivity reactions, fever, liver damage, megaloblastic anemia following chronic phenobarb use.

7. Phenytoin, Phenytoin sodium, Diphenylhyda ntoin, DPH

Dilantin (AMP)

Hydantoins (Anticonvulsant s)

Tonic-clonic and psychomotor seizures, seizures occurring during or following neurosurgery

CNS: ataxia, slurred speech, confusion, dizziness, insomnia, nervousness, twitching, headache. CV: hypotension. EENT: nystagmus, diplopia, blurred vision, gingival hyperplasia. GI: nausea, vomiting. HEMATOLOGIC: thrombocytopenia, leucopenia, agranulocytosis, pancytopenia, macrocythemia, megaloblastic anemia, lymphadenopathy. HEPATIC: toxic hepatitits. METABOLIC: hyperglycemia. MUSCULOSKELETAL: osteomalacia. SKIN: rash, exfoliative or purpuric dermatitis, hirsutism, photosensitivity rxn, Stevens-Johnson syndrome, toxic epidermal necrolysis. OTHERS: periarteritis, lupus erythematosus

palatable. >Educate patient regarding other measures that may help prevent constipation (eg, dietary fiber, adequate fluid intake, regular exercise). >Caution patient that drug is for short-term laxative use only and that prolonged use can lead to dehydration and electrolyte imbalance. >Advise patient to discontinue use and notify health care provider of the following: unrelieved constipation, rectal bleeding, symptoms of electrolyte imbalance (eg, muscle cramps or pain, weakness, dizziness). >Advise patient to increase intake of vitamin D-fortified foods (eg, milk products) while taking this medication. >Explain the following importances of maintaining adequate intake of folic acid: fresh vegetables, fruits, whole grains, liver. >Instruct patient to report the following symptoms to health care provider: nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores or easy bleeding or bruising. >Caution patient to avoid intake of alcoholic beverages or other CNS depressants. >Warn patient that medication may be habit forming, and for that reason, it is important to take medicine as directed. >Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness. >Instruct patient not to stop taking medication abruptly without consulting health care provider. >Advise patient to take medication with food. >Teach patient to shake oral suspension well. >Instruct patient taking capsules not to use discolored ones. >Tell patient to notify health care provider if skin rash develops. >Instruct patient to report the following symptoms to health care provider: nystagmus, ataxia, drowsiness, severe nausea or vomiting, gingival hyperplasia, or jaundice. >Caution patient to consult with health care provider before using alcohol or taking any other drug including OTC medications. >Warn patient that stopping medication too quickly may precipitate seizures. Stress that dose should be changed only under health care provider's direction. Inform patient that it is important to maintain good oral hygiene and to inform dentist of phenytoin therapy. >Instruct diabetic patient that changes may occur in blood sugars and to monitor and report any abnormal results to health care provider. >Inform patient that urine may turn pink. >Advise patient to carry medical identification (eg, card, bracelet) that identifies illness and medication. >Warn patient to inform surgeon, health care provider, or dentist about this medication before any surgical, emergency, or dental procedure. >Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.

DIETARY/NUTRITIONAL DRUGS
GENERIC NAME 1. Vitamin C, Ascorbic acid BRAND NAME Benutrex C (AMP) CLASSIFICATI ON Vitamins and minerals INDICATION Enhance bodys natural immune fxn SIDE EFFECTS/ADVERSE REACTIONS Hypersensitivity reactions; anaphylaxis NURSING RESPONSIBILITIES >Explain that taking product with foods high in iron will enhance absorption of iron. >Explain to any patient scheduled for glucose studies that product should not be taken for at least 48 to 72 h before test. >Inform patient that abruptly stopping high-dose therapy may lead to loosening of teeth and bleeding gums.

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FLUIDS, ELECTROLYTES & HEMATOLOGICAL DRUGS


GENERIC NAME 1. Calcium gluconate BRAND NAME Phil Pharmawealth/Ha rson Calcium Gluconate (AMP) CLASSIFICATION Electrolytes, Antihyperkalemic, Antihypermagnesemic, Antihypocalcemic, Cardiotonic, Nutritional supplement, mineral INDICATION Treatment of Ca deficiencies due to tetany, hypoparathyroidism, rapid growth or pregnancy. Treatment of black widow spider bites; adjunct in treatment of rickets, osteomalacia, lead colic & Mg sulfate overdosage; decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura & exudative dermatoses; aid in antagonizing cardiac toxicity associated w/ hyperkalemia provided patient is not on digitalis. Hypokalemia. Prophylaxis during treatment w/ diuretics. Treatment of children & adults w/ dehydration due to diarrhea. Replaces fluid & electrolytes lost due to diarrhea & vomiting. SIDE EFFECTS/ADVERSE REACTIONS Tingling sensation, sense of oppression or heat waves, chalky taste. Rapid IV: Vasodilation, decreased BP, bradycardia, cardiac arrhythmias, syncope & cardiac arrest. IM inj: Local necrosis, abscess formation. NURSING RESPONSIBILITIES

2. Dextrose 50% hypertonic 3. Potassium chloride 4. Rehydration salts

(VIAL) Kalium durule (VIAL) Hydrite (TAB)

Electrolytes Electrolytes, Antihypokalemic Oral electrolytes/hydrating solutions (Miscellaneous fuids)

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GASTROINTESTINAL/HEPATOBILIARY DRUS
GENERIC NAME 1. Hyoscine-Nbutylbromide, Scopolamine BRAN D NAME Buscop an (AMP) CLASSIFICA TION Antispasmodi cs INDICATION Acute GI, biliary, and genitourinary spasm, include biliary and renal colic, dysmenorrheal SIDE EFFECTS/ADVERSE REACTIONS Xerostomia, tachycardia, urinary retention, visual accommodation disturbances, dizziness, agranulocytosis, pancytopenia, bronchospasm NURSING RESPONSIBILITES >Caution patient not to change the dose or stop taking it unless advised by health care provider. Advise patient to notify health care provider if symptoms do not improve or appear to worsen, or if bothersome side effects occur. >Instruct patient to stop taking the drug and notify health care provider immediately if any of the following occur: rash, flushing, eye pain, inability to urinate, confusion, disorientation, hallucinations, change in behavior. >Advise patient to avoid strenuous activity during periods of high temperature or humidity. >Advise patient to take sips of water, suck on ice chips or sugarless hard candy, or chew sugarless gum if dry mouth occurs. >Inform patient that medication may cause pupils to dilate, resulting in intolerance to bright lights or sunlight. Advise patient to wear dark glasses to make bright lights or sunlight tolerable. >Advise patient that drug may cause drowsiness, disorientation, or blurred vision and to use caution while driving or performing other tasks requiring mental alertness and coordination until tolerance is determined. *Transdermal system >Advise patient to read the patient information leaflet before using patch the first time and with each refill. >Caution patient to apply 1 patch at a time. >Instruct patient not to remove patch from foil wrapper until just prior to application. >Advise patient that in order to prevent motion sickness, the patch must be applied at least 4 h prior to expected motion. >Instruct patient to follow application instructions and apply to clean, hairless, dry area behind ear. Caution patient not to touch exposed adhesive area of patch and to wash hands thoroughly before and after application. >Instruct patient to change patch every 72 h if continuation of therapy is required and to rotate application sites. >Advise patient to wash hands and old application site thoroughly with soap and water after removing patch. >Advise patient that if patch becomes dislodged to discard patch and apply a fresh patch to hairless area behind other ear. *Oral >Advise patient to take prescribed dose 30 to 60 min before meals but to take with food if stomach upset occurs. >Advise patient that dose and/or frequency of use may be changed periodically to achieve max benefit. *Ophthalmic >Remind patient or caregiver that solution is for use in the eye only. >Teach patient or caregiver proper technique for instilling ophthalmic solution: wash hands; do not allow tip of dropper bottle to touch eye, eyelid, fingers, or any other surface. Tilt head back, look up; pull lower eyelid down to form pocket; place prescribed number of drops in the pocket; look downward before closing eye; compress lacrimal sac for 2 to 3 min after instillation complete. Caution patient not to rub eye(s). >Advise patient or caregiver that if more than 1 topical ophthalmic drug is being used, instill eye drops first, wait at least 5 min, and then instill ointment last. >Caution patient that blurred vision may occur and not to drive or engage in hazardous activities while pupil(s) are dilated. >Advise patient or caregiver to contact health care provider if eye drops cause

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intolerable stinging, if eye or eyelid inflammation is noted, or if eye symptoms do not improve or worsen. *Injection >Advise patient or caregiver that medication will be prepared and administered by a health care provider in a medical setting. >Instruct patient to take medication 30 min before meals. >Instruct patient to report the following symptoms to the health care provider: involuntary movement of eyes, face, or limbs. >Caution patient to avoid intake of alcoholic beverages. >Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.

2. Metoclopramid e

Plasil (AMP)

Prokinetic drugs/antiflat ulents Antidopamin ergic, GI stimulant, GIT regulators, Antiemetic

Disturbances of GI motility. Nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic diseases, infectious & druginduced diseases. Facilitate small bowel intubation & radiological procedures of GIT.

CNS: restlessness, anxiety, drowsiness, fatigue, fever, lassitude, insomnia, seizures, suicide ideation, headache, dizziness, dystonic rxns, extrapyramidal symptoms, tardive dyskinesia, sedation. CV: transient HPN. GI: nausea, bowel disturbance. HEMATOLOGIC: agranulocytosis, neutropenia. SKIN: rash. OTHERS: prolactin secretion, loss of libido

HORMONES & RELATED DRUGS


GENERIC NAME 1. Dexamethasone sodium phosphate BRAND NAME Scancorti n (AMP) CLASSIFICATIO N Adrenocorticoste roid hormones INDICATION Anaphylactic shock, severe allergic reactions, fulminating infections, cerebral edema. Intrathecally in painful joints & acute rheumatic disorders. SIDE EFFECTS/ADVERSE REACTIONS Fluid & electrolyte retention, increased susceptibility to infection; growth retardation; Cushingoid states; amenorrhea; hyperhydrosis, mental disturbances; intracranial hypertension; acute pancreatitis; aseptic osteonecrosis. NURSING RESPONSIBILITIES >Caution patient that stopping drug abruptly is dangerous and may cause adrenal insufficiency. >Explain rationale for tapering off medication when that time comes. >Instruct patient to avoid exposure to chickenpox or measles and to immediately notify health care provider if exposure occurs. >Teach patient or family procedures for correctly administering specific form of drug (eg, ophthalmic). >Caution patient against receiving immunizations while drug is being taken. >Advise patient on long-term therapy to carry medication identification (eg, card, bracelet). In case of emergency, this information is important for treatment. >Instruct patient to avoid people with infections, particularly respiratory. >Teach patient to take oral forms with meals or snacks if GI irritation occurs. >Review guidelines for missed doses of particular product with patient. >Teach patient on long-term therapy how to keep a weight record. >Instruct patient to inform other health care providers if taking a steroid. >Review signs of infection and remind patient that fever, swelling, and redness may be masked in infection. >Review possible adverse reactions of dexamethasone with patient and instruct patient to report these to health care provider. >Advise patient to take oral medication with food to

2.

Solu-

Adrenocorticoste

Endocrine, hematologic, rheumatic &

Fluid & electrolyte disturbances; decreased

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Hydrocortisone sodium succinate

Cortef (VIAL)

roid hormones

collagen disorders; dermatologic, ophth, GI, resp & neoplastic diseases; edematous states, control of severe incapacitating allergic conditions; TB meningitis w/ subarachnoid block or impending block when used concurrently w/ appropriate anti-TB chemotherapy; shock secondary to adrenocortical insufficiency or shock unresponsive to conventional therapy when adrenocortical insufficiency may be present.

carbohydrate tolerance; impaired wound healing, thin fragile skin; muscle weakness, steroid myopathy, osteoporosis, aseptic necrosis; peptic ulceration w/ possible perforation; cataracts, increased intraocular & intracranial pressure; growth retardation; Cushingoid state; protein catabolism; psychic derangements, exophthalmos, masking of infections, gasping syndrome, seizures, menstrual irregularities.

minimize GI upset. Warn patient not to stop taking drug abruptly. >Caution diabetic patients that insulin or oral hypoglycemic agent needs may increase. >Instruct elderly patient to have BP, blood glucose, and electrolytes monitored at least every 6 mo. >Advise patient that sunglasses may reduce sensitivity to sunlight that occurs with optic administration. >Caution against eye contact with topical agents. >Instruct patient to wash or soak areas for topical administration prior to administration to increase absorption. >Advise patient to apply topical agents sparingly, rubbing in lightly. >Caution against covering topically treated areas unless specifically prescribed by health care provider. >Advise against mixing topical agents with other products unless advised by health care provider. >Instruct patient if topical dose is missed to apply as soon as remembered, but not to double doses. >Teach patient using suppositories or other hemorrhoidal agents that appropriate diet, fluid intake, and adequate exercise are useful treatment adjuncts. >Remind patient to wear medical identification (eg, card, bracelet) while taking this medication. >Advise that temporary burning is common after administration of optic preparations. >Caution patient that systemic reactions may occur with topical applications.

RESPIRATORY DRUGS
GENERIC NAME 1. Albuterol, Salbutam ol BRAND NAME Ventolin nebule (AMP) CLASSIFICATION Antiasthmatic, COPD preparations INDICATION Treatment & prevention of bronchial asthma, bronchitis, emphysema w/ associated reversible airway obstruction. SIDE EFFECTS/ADVERSE REACTIONS Fine tremor of skeletal muscle, feelings of tension, peripheral vasodilation, a compensatory small increase in heart rate, headache, transient muscle cramps, hypersensitivity reactions, potentially serious hypokalaemia, hyperactivity in childn. Paradoxical bronchospasm, mouth & throat irritation (inhalers). Tachycardia. NURSING RESPONSIBILITES >Tell patient not to chew or crush capsules. >Teach patient correct method for using metered-dose inhaler. Have patient demonstrate proper technique, including timing between inhalations. >Instruct patient in home monitoring of pulse and BP. >Advise patient to maintain fluid intake of 2,000 mL/day and to rinse mouth after each complete dose. >Instruct patient not to use OTC inhalers without consulting health care provider. >Instruct patient to contact health care provider if symptoms are not relieved by normal dose. >Tell patient to report adverse reactions or side effects. >Instruct patient on proper use of inhaler. Explain value of using spacing device. >Instruct patient on proper sequencing and timing if using more than 1 inhaled agent. >Teach patient how to determine when canister is empty and needs to be replaced.

2. Ipratropiu m salbutam ol

Combive nt (AMP)

Bronchodilator, Sympathomimetic s (Drugs for asthma/COPD)

Acute exacerbations of COPD, relief of bronchospasm

CNS: nervousness, dizziness, headache. CV: palpitations. EENT: blurred vision, epistaxis. GI: nausea, GI distress, dry mouth. RESPI: cough, URTI, bronchitis, bronchospasm

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3. Terbutalin e sulfate

Bricanyl (AMP)

Bronchodilator, Sympathomimetic s (Drugs for asthma/COPD)

For airway obstruction in asthmatic pxs and COPD

CNS: nervousness, headache, drowsiness, dizziness, weakness. CV: palpitations, tachycardia, arrhythmia, flushing. GI: vomiting, nausea, heartburn. METABOLIC: hypokalemia. RESPI: paradoxical bronchospasm, dyspnea. SKIN: diaphoresis

>Teach patient how to properly use the nasal spray. >Caution patient not to rely on ipratropium for acute bronchospasm. >For relief of dry mouth, suggest use of saliva substitute, practice of good oral hygiene, rinsing of mouth after inhalation. Instruct patient to take sips of water frequently, suck on ice chips or sugarless hard candy, or chew sugarless gum. >Caution patient to avoid spraying aerosol in eyes; temporary blurred vision may result. >Advise patients using aerosol to seek immediate medical attention if recommended dosage does not provide relief or if symptoms worsen. >Advise patients not to use other inhaled drugs unless prescribed while taking ipratropium inhalation aerosol. >Use a nebulizer with a mouthpiece for the solution rather than a face mask to reduce the likelihood of the solution reaching the eyes. >Instruct patient to notify health care provider if condition worsens or if the following symptoms occur: dizziness, nausea, headache, palpitations, or cough. >Advise patient using nasal spray to avoid spraying in or around eyes. Patient should contact health care provider if experiencing eye pain, blurred vision, excessive nasal dryness, or nasal bleeding. >Advise patient that drug may cause dizziness and to use caution while driving or performing other tasks requiring mental alertness. >Instruct patient on proper technique for use of inhalers and evaluate return demonstration. >Demonstrate use of spacer or peak flow meter if prescribed. >Caution patient not to use inhaler form of medication more than 6times/day. >Advise patient to take tablets with food to avoid GI upset. >Inform patient that the drug can stop working over time. If this is noted or if the inhalation makes breathing worse, notify the health care provider at once. >Instruct patient to report these symptoms to health care provider: chest pain, dizziness or headache, persisting symptoms of asthma.

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