Drug Name Furosemide Lasix 40mg OD y

Action Potent loop diuretics that inhibit NaCl reabsorption at the proximal and distal tubules and ascending loop of henle. Promotes water and sodium excretion. y y

Indication Edema Hypercalemia y

Contraindication Contraindicated in patient with hypersensitivity to drug or any of its componentsin those with anuria. Use continuosly in patients with hepatic cirrhosis. Patient with allergy to sulphonamides may also be allergic to furosemide.

Side Effects CNS: Fever, vertigo, headech, dizziness, weaknkess CV: Orthostatic hypotension, thrombophlebitis, volume depletion and dehydration. EENT: transient deafness (with too rapid IV injection) blurred or yellow vision. GI: pancreatitis, anorexia, abd l discomfort, diarrhea, nausea and vomiting, constipation. GU: azotemia, nocturia, polyuria, frequent urination, oliguria. METABOLIC: asymptomatic hyperuvicemia, hyperglycemia and glucose intolerance, hypochloremic alkalosis, hypokalemia, F & C imbalance. y Hyponatremia y Hypocalcemia y Hypomagnesemia Musculoskeletal: Muscle spasm Skin: Dermatitis, purpura, photosensitivity

Nursing responsibility 1. Advise patient to stand slowly to prevent dizziness, not to drink alcohol, and to minimize strenuous exercise in hot weather. Instruct patient to report ringing in ears, severe abdominal pain, or sore throat and fever because they may indicate toxicity. Give P.O. or I.M. dose in the morning to prevent nocturia. Store tablet in light resistant container to prevent discoloration. Don t use yellow injectable preparation. If oliguria or azotemia develops or increase, notify prescriber.

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Drug Name Lactulose Rilax 30cc HS y y

Action Disaccharide laxative Produce osmotic effects on colon. Resulting distension promote peristalsis. Decreases blood ammonia build up that cause hepatic encephalopathy, probably as result of b acterial degradation which lowers PH of colon contents. y

Indication Constipation; prevent and treat hepatic encephalopathy, including hepatic precoma and coma in patient and severe hepatic disorder. To induce bowel movement evacuation in geriatric patient the colonic retention of barium and severe constipation after a barium meal examination. To restore bowel movements after hemorhoidectom y. y

Contraindication Contraindicated to patient with low galactose diet. Use cautiously in patient with DM because drug contains lactose, galactose & other sugars.

Side Effects GI: Abdominal cramps, belching, diarrhea, distention, flactulose, nausea, vomiting.

Nursing responsibility 1. Assess patients condition before starting their therapy and regularly after to monitor the drugs effectiveness. If patient has hepatic encephalopathy, assess mental condition. Monitor electrolyte levels potassium with long term use. Monitor ammonia levels in patient with hepatic disease. Replacement of fluid loss. To minimize sweet taste, dilute with water or fruit juice or give with food. Diarrhea may indicate overdose. Store at room temperature, 30oC DON T freeze.

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Drug Name Spironolactone Aldactone 25mg tab OD y y

Action Potassium sparing diuretic. Antagonize aldosterone in distal tubule. Promotes water and sodium excretion and hinders potassium excretion, lowers BP and helps to diagnose primary hyperaldosteronism. y

Indication Essenital HPN, edema, CHF, liver cirrhosis, nephritic syndrome, idiopathic edema. y

Contraindication Adult renal insufficiency, significant renal impairment, anuria, hyperkalemia. Use cautiously in patient with fluid and electrolyte imbalance, impaired kidney function, or hepatic disease.

Side Effects CNS: headache, drowsiness,, lethargy, confusion, ataxia. GI: diarrhea, gastric bleeding, ulceration, caramping, gastritis, vomiting. GU: Impotence, menstrual disturbance HEMA: Agranulocytosis METABOLISM: Hyperkalemia, hyponatremia, mild acidosis, dehydration SKIN: uticaria, hirsutism, maculopapular eruptions, edematous rash.

Nursing responsibility 1. Monitor electrolyte levels, fluid I&O, weight, and BP. Give drug with meals to enhance absorption. Warn patient not to eat large amounts of potassium rich foods and not tonuse potassium containing salt substitute or use potassium supplements to prevent serious hyperkalemia. Give drug in the morning to avoid nocturia. Protect drug from light. Inform laboratory that patient is taking spironolactone because it may interfere with some laboratory tests that measure digoxin level.

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Drug Name Propanolol Hydrochloride 10mg BID y

Action Beta-blocker; antihypertensive , anti-anginal, antiarrhythmic Reduces cardiac O2 demand by blocking catecholamineinduced increases in heart rate, blood pressure, and force of myocardial contraction. Depresses rennin secretion and prevents vasodilation of cerebral arteries. y

Indication Angina pectoris, mortality reduction after M.I.; supraventricular, ventricular and atrial arrhythmias; tachyarhythmias caused by excessive catecholamine action during anesthesia. HPN Prevention of frequent, severe uncontrollable, or disabling migraine or vascular headache. Essential tremor. Hypertrophic subaortic stenosis. y

Contraindication Patient with bronchial asthma; sinus bradycardia, heart block greater than 1st degree, cardiogenic shock, overt cardiac failure. Use continuously in patients taking other hypertensive and in those with renal impairment, non allergic bronchospastic disease.

Side Effects CNS:fatigue; lethargy, vivid dreams, fever, hallucinations, menal depression, dizziness. CV: bradycardia, hypotension, heart failure, intermittent cloudication. GI: Nausea, vomiting, diarrhea,constipation. Hematologic: Agranulocytosis. Musculoskeletal: Orthralgia. Respi: Increased airway resistance. Skin: Rash.

Nursing responsibility 1. Check patients apical pulse before therapy. If extreme decrease in pulse rate occur, don t give the drug and immediately call the prescriber. Give oral drug with meals. Food may increase absorption. Double check dose and route. IV doses are much smaller than oral doses.

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Drug Name Ceftriaxone Sodium

Action 3rd generation cephalosporin; antibiotic. Inhibits cell wall synthesis promoting osmotic instability, usually bactericidal.

Indication Treatment of susceptible infection; chancroid, endocarditis and surgical infection and gonorrhoea.

Contraindication History of shock; hypersensitivity to cephalosporins, penicillins, onilide local anesthesia.

Side Effects CNS: headache, dizziness, fever GI: pseudomembranoous colitis, nausea, vomiting, diarrhea, dysguesia. CU: genital pruritus and candidiasis. Hematologic: Eosinophilia, thromocytosis, leukopenia. Skin: Phlebitis, rash.

Nursing responsibility 1. Ask patient about previous reaction to cephalosporins or penicillin before giving the dose. Be alert for adverse reaction; if adverse GI reactions occurs, monitor patient s hydration. Instruct patient to report pain at the IV site.

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Drug Name Tramadol Hydrochloride 50mg q80

Action

Indication

Contraindication

Side Effects CNS: dizziness, vertigo, headache, somnolence, CNS stimulation, asthenia, anxiety, confusion, coordination disturbance, malaise, euphoria, nervousness, sleep disorder, seizures. CV: vasodilation EENT: visual disturbance GI: nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, abdominal pain, anorexia, flatulence GU: urine distention, urinary frequency, menopausal syndrome Skin: pruritus, sweating, rash 1. 2.

Nursing responsibility Monitor CV and respiratory status. If respiratory rate decreases or falls below 12bpm, withhold dose and notify prescriber. Assess patients pain before starting therapy and regularly thereafter to monitor the drug s effectiveness. Closely monitor patient risk for seizure; drug has been reported to reduce seizure threshold. Monitor patient for drug dependence; tramadol can produce dependence similar to that of codein or dextropropoxyphene and thus has potential to be abused. For better effect, give drug before onset of intense pain. Because constipation is a common adverse effect, anticipate need for laxative.

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Opioid against analgesic Centrtally acting synthetic analgesic compound not chemically r/t opioid that is thought to bind to opioid receptors and inhibit reuptake of norepinephrine and serotonin. Relieves pain.

Moderate to severe pain.

Contraindicated to patients hypersensitive to the drug or any of its components and in those and acute intoxication from alcohol, hypnotics, centrally acting analgesics, opioids, or psychotrophic drugs. Use cautiously in patients risk for seizures or respiratory depression, patient with increase ICP or head injury, acute abdominal conditions, or renal hepatic impairment, and patients physically dependent to opioids.

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Drug Name Phytonadione (Vit. K) 1amp q8o y

Action Synthetic analysis of vitamin K. Blood coagulation modifier. An antihemorrhagic factor that promotes hepatic formation of active prothrombin. Controls abnormal bleeding. y

Indication Hyperprothromb in secondary to vitamin K malabsorption, drug therapy, or excessive vitamin A. Hypoprothrombi nemia secondary to effect of oral anti coagulants. Prevents hemorrhagic disease in newborns. y

Contraindication Contraindicated in patients with hypersensitivity to the drug or any of its components.

Side Effects CNS: dizziness, seizure like movements CV: flushing, trancient hypotension after IV administration, rapid and weak pulse, cardiac irregularities. Skin: diaphoresis, erythema

Nursing responsibility 1. Monitor patient to determine dosage effectiveness. Check brand name labels for administration route restrictions. SC is the preferred route for administration.

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Drug Name Metronidazole 500mg IV q6o y

Action Antibacterial, antiprorozoal, amebecide. Direct acting trichomonacide and amebicide that works at both intestinal and extraintestinal site. Hinders growth of selected organiz=sms including most aerobic bacteria and protozoa. y

Indication Amebic hepatic abscess; intestinal y

Contraindication Contraindicated in patients hypersensitive to the drug or other nitroimidazole derivatives. Use cautiously in patient receiving hepatotoxic drugs and in patient with history of blood dyscrasia or CVS disorder. y

Side Effects Nausea, headache, anorexia, occasionally vomiting, diarrhea, epigastric cramping, constipation, leukopenia.

Nursing responsibility 1. Watch carefully for edema, especially in patient also receiving corticosteroids, because flagyl IV PTU may cause Na retention. Tell patient that metallic taste and dark or red urine may occur. Give with meals to minimize GI distress. Flagyl ER at least 1o before or 2o after meals.

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Drug Name Kalium Durule 1durule TID y y

Action Hypokalemia Prophylaxis during treatment of diuretics Prevent and treat potassium deficit secondary to diuretics y

Indication Supplemental potassium in the form of high KCL may be able to restore normal potassium levels. y

Contraindication Renal insufficiency, hyperkalemia, unrelated addisons, constriction of the esophagus and/or destructive changes in the alimentary tract. y y y y y

Side Effects Hyperkalemia Nausea and vomiting Irritability Muscle weakness Dysphagia

Nursing responsibility 1. 2. Monitor BP and PR. This medicine must be completey dissolved in at least glass of cold water to reduce its possible stomach irritating/ laxative effects. Don t use salt substance, eat low salt diet. Monitor color of stools blackish stoolsmay indicate stomach/intestin al bleeding.

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