DRUG STUDY

What is a DRUG? - it is a chemical substance that is introduced into the body that causes changes. What is a MEDICATION? - It is a therapeutic drugs used in the prevention or treatment of diseases.

LACTULOSE

RANITIDINE

MANNITOL

DOPAMINE

CLOPIDOGREL SULFATE

EPINEPHRINE

FUROSEMIDE

ENALAPRIL CLONIDINE RIFAMPICIN

LOSARTAN

ASPIRIN

CHLORPROMAZINE

HALOPERIDOL

HEPARIN

METFORMIN

DIAZEPAM

STREPTOMYCIN

ALLOPURINOL
MORPHINE SULFATE

METHYLENERGOVINE MALEATE

PHENYTOIN

PARACETAMOL

REG. INSULIN

LITHIUM

ACETYLCESTEINE

METRONIDAZOL E

DIGOXIN

MEBENDAZOLE

CIPROFLOXACIN

LACTULOSE
Duphalac, Cephulac, Cholac, Chronulac, Constulose, Enulose, Generlac, Kristalose

Laxative

Indication:
For constipation To prevent and treat encephalopathy, including hepatic pre-coma & coma in patients with severe hepatic dse To induce bowel evacuation after a barium meal examination To restore bowel movements after hemorrhoidectomy

Action:
Producing osmotic effects in colon, resulting distention promotes peristalsis. Decrease blood ammonia build-up that causes ammonia hepatic encepalopathy.

Contraindication:
Low-galactose diet Children with chronic constipation

Special precaution: Patients with diabetes mellitus Pregnant women- Breastfeeding women Elderly patients (more susceptible to hyponatremia

Side effects/Adverse reactions:

Side effects: Abdominal cramps, belching, diarrhea, distention, flatulence Adverse Reaction: Nausea, vomiting

Dosage/Availability:
Dosage: (Adults) 10-20 g (15-30 ml) P.O. daily, increase to 60 ml/day if needed Available forms: Crystals for reconstitution: 10g/packet, 20g/packet Solution: 10g/15ml, 3.33g/ml

Nursing Responsibility:
Assess patients condition before starting therapy, & regularly thereafter to monitor the drugs effectiveness. Be alert for adverse reactions & drug interactions. Replace fluid loss

RANITIDINE
Zantac

Anti-ulcerative

Indication:
Short term treatment of active benign gastric ulcer.
Gastroesophageal reflux dse. Erosive esophagitis For occasional heartburn, acid ingestion & sour stomach

Action:
Inhibits action of H2 at receptor sites of parietal cells, decreasing gastric acid
dysfunction.

Contraindication:
Patients hypersensitive to drugs or any of its components.

Special precaution:
Use cautiously in patients having hepatic dysfunction
Use cautiously in pregnant and lactating women

Side effects/Adverse reactions:

Side effects: Blurred vision, vertigo, malaise, jaundice, burning or itching at injection site Adverse Reaction: Angioedema, anaphylaxis, reversible leukopenia

Dosage/Availability:
Dosage:(Adults)150 mg twice a day or 300 mg after every meal or at bedtime Available forms: Capsules: 150 mg, 300 mg Tablets: 75 mg, 150 mg,300 mg Syrup: 15 mg/ml Granules (effervescent): 150 mg

Nursing Responsibility:
Be alert for adverse reactions and drug interactions. Assess patients GI condition before starting therapy and regularly thereafter monitor the drugs effectiveness. Instruct client to take drug with or without food.

MANNITOL
Osmitrol

Diuretic, Osmotic

Indication:
Diuretic to prevent or treat the oliguric phase of acute renal failure before irreversible renal failure occurs To reduce intraocular or intracranial pressure

Action:
Increases osmotic pressure of glomerular filtrate, inhibiting tubular re-absorption of water and electrolytes. This elevates blood osmolarity, enhancing water & sodium flow into extracellular fluid.

Contraindication:
Those with anuria, pulmonary edema, severe dehydration, progressive heart failure or pulmonary congestion after mannitol therapy.

Special precaution:
Use cautiously in pregnant and lactating women

Side effects/Adverse reactions:

Side effects: Headache, confusion, circulatory overload, heart failure, tachycardia Adverse Reaction: Seizures, Water intoxication

Dosage/Availability:
Dosage: (Adults & children 12 up) 50-100 g IV of a 15 % 25 % solution (Adults) 1.5-2 g/kg as a 15-25% solution, infused over 30-60 min. Available forms: Injection: 5%,10%,15%,20%, 25%

Nursing Responsibility:
Asses patients condition before therapy and regularly thereafter to monitor the drugs
effectiveness. Monitor vital signs, central venous pressure and fluid intake & output hourly. Insert urethral catheter in comatose or incontinent patient because therapy is based on strict evaluation of fluid intake & output.

DOPAMINE
Intropine, Revimine

Adrenergic, Inotropic, Vasopressor

Indication:
To increase cardiac output To treat shock and correct hemodynamic imbalances To improve perfusion to vital organs

Action:
Inhibits dopaminergic, alpha-adrenergic and beta-adrenergic receptors in sympathetic nervous system.

Contraindication:
Patients with tachyarythmias, ventricular fibrillation

Special precaution:
Use with caution during lactation se cautiously in patients with occlusive vascular disease, cold injuries, diabetic endarteritis, arterial embolism

Side effects/Adverse reactions:

Side effects:Headache, vasoconstriction, nausea, vomiting, dyspnea
Adverse Reaction:Bradychardia, hypotension, asthma attacks, anaphylaxis

Dosage/Availability:
Dosage: shock (Initial) 2-5 mcg /kg/min: then, increase in increments of 1-4 mcg/kg/min at 10-30-min intervals until desired response is obtain. severely ill (Initial) 5 mcg/kg/min: then increase in increments of 5-10 mcg/kg/min up to 20-50 mcg/kg/min as needed Available forms: Injection: 40mg/ml, 80 mg/ml, 160 mg/ml as concentrate for IV infusion

Nursing Responsibility:
Obtain history of patients underlying condition before therapy. During infusion, frequently monitor ECG, blood pressure and cardiac output. Must be diluted before use.

CLOPIDOGRIL BISULFATE
Plavix

Antiplatelet

Indication:
Reduce atherosclerotic events in patients with atherosclerosis
documented by recent stroke, MI, or peripheral arterial dse. Reduce atherosclerotic events in patients with acute coronary syndrome, including those managed medically and those who are to be vention or coronary artery bypass graft.

Action:
Inhibits binding of ADP to its platelet receptor, which inhibits ADPmediated activation and subsequent platelet aggregation. Because drugs acts by irreversibly modifying the platelet ADP receptor, platelet exposed to drug are affected for their lifetime.

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components, and in those with pathologic bleeding, such as peptic ulcer or intracranial hemorrhage.

Special precaution:
Use cautiously in patients with hepatic impairment and in those at risk from increased bleeding from trauma, surgery or other conditions.

Side effects/Adverse reactions:

Side effects: depression, fatigue, headache, pain, chest pain, edema, hypertension, epistaxis, rhinitis, pain, constipation, diarrhea, dyspepsia, gastritis, Hemorrhage, ulcers, UTI, purpura, arthralgia, back pain. bronchitis, cough, dyspnea. Upper respirator tract infection, rash, pruritus

Dosage/Availability:
Dosage: Adults: 75 mg P.O. daily. Adults: start therapy with a single 300-mg PO loading dose, and then continue at 75-mg PO daily. Available forms: Tablets: 75 mg

Nursing Responsibility:
Assess current use of OTC drugs, such as aspirin or NSAIDs, and herbal remedies Asses patient for increased bleeding or bruising tendencies before and during drug therapy. Dont give drug to patient with hepatic impairment or an increased risk of bleeding from trauma, surgery, or other pathologic condition. Inform patient that drug may be taken with or without food.

EPINEPHRINE
Adrenalin, Bronkaid Mistometer, MicroNefrin, Nephron, Primatene Mist

Bronchodilator, Vasopressor, Cardiac stimulant, Topical antihemmorhagic

Indication:
Brochospasms, hypersensitivity reactions, anaphylaxis, Acute asthma attacks. Hemostasis Prolonging local anesthetic effect, restoring cardiac rhythm in cardiac arrest.

Action:
Stimulates alpha and beta receptors in sympathetic nervous system.

Contraindication:
Contraindicated in patient with angle closure glaucoma, shock (other than anaphylaxis) organic brain damage, cardiac dilation. Arrhythmias. Coronary insufficiency or cerebral arteriosclerosis. Some commercial products contain sulfides and are contraindicated in patents with sulfites allergies except when drug is used for serious allergic reaction and in other emergency situations. In conjunction with local anesthetics, epinephrine is contraindicated for use in fingers, toes, ears, nose or genitalia. A pregnant woman in labor is contraindicated. Also with breastfeeding women.

Special precaution:
Use cautiously in patients with long standing bronchial asthma or emphysema who have developed degenerative heart dse. And in those with hyperthyroidism, CV dse, hypertension, psychoneurosis and diabetes. In pregnant women not in labor, in children, in elderly patients use cautiously.

Side effects/Adverse reactions:

Side effects: Nervousness, tremors, euphoria, anxiety, cold limbs, vertigo, headache drowsiness, diaphoresis, disorientation, agitation, fear, weakness, cerebra; hemmorhage, increased rigidity and tremors in patients with Parkinsons dse. Stroke, palpitations, widened pulse pressure, hypertension, tachycardia, ventricular fibrillation, shock, anginal pain, ECG changes, nausea, vomiting, hyperglyscemia, glycosuria, dyspnea, urticaria,

Dosage/Availability:
Dosage: Adults: 0.1 to 0.5 ml of 1:1,000 SQ or IM Children: 0.01 ml of 1:1,000/kg SQ; repeat q 20 min to 4 hrs, prn. Available forms: Aerosol inhaler: 220 mcg/metered spray Injection: 0.01 mg/ml Nebulizer inhaler:1% (1:100) Parenteral: 5mg/ml

Nursing Responsibility:
Briskly massage site o SC or IM injection to hasten drug action.
Discard solution if reddish brown and after expiration date. Do not use topical preparation in children under 6 years of age

FUROSEMIDE
Lasix, Novosemide, Uritol

Diuretic, Antihypertensive

Indication:
Acute pulmonary edema Edema associated with CHF, nephrotic syndrome, hepatic cirrhosis, and ascites PO to treat hypertension in con junction with spironolactone, triamterene, and other diuretics except ethacrynic acid.

Action:
Inhibits the reabsorption of sodium and dichloride in the proximal and distal tubulesas well as the ascending loop of Henle; this results in the excretion of sodium, chloride, and, to a lesser degree, potassium and bicarbonate ions.

Contraindication:
Never use with ethacrynic acid. hypersensitivity to drug, severe renal disease associated with azotemia and oliguria, hepatic coma associated with electrolyte depletion Lactating women

Special precaution:
Use with caution in premature infants and neonates due to prolonged half-life in these clients Geriatric clients may be more sensitive to the usual adult dose. Use cautiously in patients with hepatic cirrhosis

Side effects/Adverse reactions:

Side effects: Jaundice, tinnitus, hearing impairment, hypotension, water/electrolyte depletion, pancreatitis, abdominal pain, dizziness, anemia Adverse Reaction: Aplastic anemia, cardiac arrest

Dosage/Availability:
Dosage: (Adults) initial: 2080 mg/day as a single dose. For resistant cases, dosage can be increased by 2040 mg q 68 hr until desired diuretic response is attained. Maximum daily dose should not exceed600 mg. Available forms: Injection: 10 mg /mL; Oral Solution: 10 mg/mL, 40 mg/5 mL; Tablets: 20 mg, 40 mg, 80 mg.

Nsg. Responsibility:
Slight discoloration resulting from light does not affect potency. However, do not
dispense discolored tablets or injection. Give 24 days per week. Food decreases bioavailability of furosemide and ultimately the degree of diuresis.

CLONIDINE
Antihypertensive

Catapres, Catapres-TTS-1, -2, and -3, Duraclon

Indication:
Hypertension, used alone or as part of combination therapy. Treatment of severe pain in cancer patients in combination with opiates; epidural more effective with neuropathic pain

Action:
Stimulates alpha-adrenergic receptors of the CNS, resulting in inhibition of the sympathetic vasomotor center and decreased nerve impulses. Thus, bradycardia and a fall in both SBP and DBP occur.

Contraindication:
Contraindicated with hypersensitivity to clonidine or any adhesive layer components of the transdermal system. Injectable form is contraindicated in patients receiving anticoagulation therapy and patients with a bleeding diathesis or injection-site infection.

Special precaution:
Use with caution during lactation and in the presence of severe coronary in sufficiency, recent MI, cerebrovascular disease, or chronic renal failure Safe use in children not establish

Side effects/Adverse reactions:

Side effects: Dry mouth, drowsiness, dizziness, sedation, constipation Adverse Reaction: cardiac conduction defects, arrhythmias

Dosage/Availability:
Dosage: (Initial) 0.1 mg twice a day; then, increase by 0.10.2 mg/day until desired response is attained Available forms: Tablets: 0.1 mg, 0.2 mg, 0.3 mg Injection: 0.1 mg/mL, 0.5 mg/mL

Nsg. Responsibility:
If drug to be discontinued, do so gradually over a period of 24 days.
Do not use preservative when given epidurally. Store injection at controlled room temperature. Discard any unused portion.

RIFAMPICIN
Rifadin, Rifadin IV, Rimactane, Rimycin, Rofac

Antituberculotic

Indication:

Pulmonary Tuberculosis. Meningococcal carriers. Prophylaxis of Haemophilus influenzae type B. Leprosy

Action:
Kills bacteria by inhibiting DNA-dependent RNA polymerase, thus impairing RNA synthesis.

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components.

Special precaution:
Use cautiously and under strict medical supervision in patients with liver dse. In breastfeeding women use cautiously. Its unknown of the drug appears in breast milk.

Side effects/Adverse reactions:

Side effects: ataxia, behavioural changes, confusion, dizziness, fatigue, headache, drowsiness, generalized numbness, visual disturbances, exudative conjunctivitis, epigastric distress, anorexia, nausea, vomiting, abdominal pain, diarrhea, flatulence, sore mouth and tongue, hemoglobinuria, hematuria, menstrual disturbances, eosinophilia, hemolytic anemia, worsening of porphyria, osteomalacia, shortness of breath, wheezing, Rash, pruritus, urticaria, flu-like syndrome. Adverse reaction: Shock, pseudomembrabous colitis, pancreatitis, acute renal failure, transient leukopenia. Thrombocytopenia, hepatotoxicity,

Dosage/Availability:
Dosage: 10mg/kg PO or IV daily in single dose. Maximum, 600 mg daily. Available forms: Capsules: 150 mg, 300 mg Injection: 600mg

Nursing Responsibility:
Assess patients condition before starting therapy, and regularly thereafter to monitor the drugs effectiveness. Monitor liver function, CBC, and uric acid levels. Advise patient not to take alcohol while taking drug. Warn patient about drowsiness and red-orange urine, feces, saliva, sweat, sputum and tears.

ENALAPRIL
Enalaprilat, Vasotec, Amprace

Antihypertensive , ACE inhibitor

Indication:
treatment of hypertension Heart failure Symptomatic left ventricular dysfunction.

Action:
Inhibit angiotensin-converting enzyme resulting in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion.

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components and in those with a history a angioedema from ACE inhibitor.

Special precaution:
Cause cautiously in patients with renal impairment, especially those with bilateral renal artery stenosis or unilateral renal artery stenosis in a single functioning kidney. Use with caution during lactation Safety and effectiveness have not been determined in children.

Side effects/Adverse reactions:

Side effects: Dizziness, headache, hypotension, syncope, chest pain, fatigue, diarrhea, cough Adverse Reaction: cardiac arrest, pulmonary edema

Dosage/Availability:
Dosage: Antihypertensive in clients not taking diuretics Initial: 5 mg/day; then, adjust dosage according to response Hypertension in children. Initial: 0.08 mg/kg, up to 5 mg, once daily. Adjust dose depending on response Available forms: Injection: 1.25 mg/mL (as enalaprilat); Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg.

Nursing Responsibilities:
Use lower dose if receiving diuretics or impaired renal function. Note reasons for therapy, presenting symptoms, other agents trialed, outcome. Record ECG, VS, and weight. A 1 mg/mL suspension may be prepared for use in children.

LOSARTAN
Cozaar

Antihypertensive

Indication:
Hypertension reduce risk of stroke in clients with hypertension and left ventricular hypertrophy nephropathy in type 2 diabetics

Action:
Blocks the angiotensin AT1 receptor located in vascular smooth muscle and the adrenal glands, thus blocking the vasoconstrictor and aldosterone-secreting effects of angiotensin II. Thus, BP is reduced,

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components.

Special precaution:
Use cautiously in patients with pulmonary impairment. Use oral forms cautiously in patients with renal or hepatic impairment. Also use cautiously and at a reduced dosage in acutely ill or delibitated patients. Hepatic insufficiency In severe CHF there is a risk of oliguria and/or progressive azotemia with acute renal failure and/or death

Side effects/Adverse reactions:

Side effects: URTI, dizziness, cough, diarrhea, sinus disorder, nasal congestion, dyspepsia/heartburn, pain Adverse Reaction: ventricular tachycardia, ventricular fibrillation

Dosage and availability:

Dosage: (Adults) 50 mg once daily with or without food Hypertensives with left ventricular hypertrophy Initial: 50 mg once daily. Available forms: Tablets: 25 mg, 50 mg, 100 mg

Nursing Responsibilities:
List reasons for therapy, onset, other agents used, other related conditions (diabetes, low EF), outcome. Monitor CBC, microalbumin, renal and LFTs. When pregnancy is detected, discontinue as soon as possible.

CHLORPROMAZINE
Thorazine, Largactil

Antipsychotic, antiemetic

Indication:
Preanesthetic to relieve restlessness & apprehension Adjunct to treat tetanus severe behavioural problem in children 1-12 years old marked by combativeness and or explosive hyper-excitable behaviour

Action:
May block postsynaptic dopamine receptors in brain and inhibit medullary chemoreceptor trigger stone. Contraindicated in patients hypersensitive to drug and in patients with CNS depressions, bone marrow suppression, subcortical damage and coma.

Contraindication:

Special precaution:
Use cautiously in debilitated patients and in those with hepatic or renal disease, severe CV disease. In acutely ill or dehydrated children and elderly , use cautiously

Side effects/Adverse reactions:

Side effects: Constipation, drowsiness, blurred vision, decreased sweating, difficulty urinating, dark urine, swollen breasts Adverse Reaction: tremor, seizures, neuroleptic malignant syndrome, thrombocytopenia

Dosage and availability:

Dosage: (Adults) 10 mg3-4 times a day or 25 mg 2-3 times a day (Children) 1 mg/kg (0.5mg/lb) q 6-8 hours as needed Available forms: Injection: 25 mg/ml Oral concentrate: 100 mg/ml Suppository, rectal: 100mg Syrup: 10mg/5ml Tablets: 10 mg, 25 mg, 50 mg, 100mg, 200 mg

Nursing Responsibilities:
The maximum daily P.O. and parenteral dose for adults and adolescents should be 1 gram of the base. Solutions may cause contact dermatitis: avoid contact with hands or clothing. The oral concentrate is light sensitive: protect from light and dispense in amber glass bottle.

ASPIRIN
ZORpin, Easprin, Ancasal, Arthrinol, Astrin, Solprin, Supasa

Nonsteroidal anti-inflammatory drug, analgesic, antipyretic

Indication:
Pain from integumentary structure, mild pain or fever, prevention of thrombosis, Prophylaxis for transient ischemic attack. Arthritis

Action:
Antipyretic is due to an action on the hypothalamus, resulting to heat loss by vasodilation of peripheral blood vessels and promoting sweating. Anti-inflammatory effects are probably mediated through inhibition of cyclo-oxygenase, which results in a decrease in prostaglandin synthesis and other mediators of the pain

Contraindication:
Contraindicated in patients hypersensitive to drug and in patients with G6PD deficiency; bleeding disorders such as hemophilia, von Willebrands disease and tellangiectasia and NSAID induced sensitivity reactions. Children or teenagers with chicken-pox or flu due to possibility of development of Reyes syndrome

Special precaution:
Use cautiously in patients with GI lesions, impaired renal function, hyperthrombonemia, Vitamin K deficiency, thrombocytopenia or severe hepatic impairment.

Side effects/Adverse reactions:

Side effects: Dyspepsia, nausea, epigastric discomfort Adverse Reaction: Massive GI bleeding, potentiation of peptic ulcer, bronchospasm, asthma like symptoms, anaphylaxis

Dosage and availability:

Dosage: (Adults) 325-500 mg q 3 hr, 325-600mg q 4 hr. Or 650-1000 mg q 6 hr .(Pediatrics, 2-3 years): 162 mg q 4 hr as needed Available forms: Tablets: 325mg, 500 mg Tablets, Chewable: 81 mg Suppositories: 120 mg, 200 mg, 300 mg, 600 mg Gum: 227.5 mg Tablets, Enteric coated: 81 mg, 165 mg, 325 mg, 500 mg, 650 mg, 975 mg

Nursing Responsibilities:
Note any asthma, nasal polyps, hay fever or ulcer dse. Note effectiveness of Aspirin if previously used for pain and dose used. Document age: drug discouraged in those under 12. Assess for chickenpox or the flu.

HEPARIN
Hepalean, Heopatin Leo, Hepari Lock flush solution, Hep-lock, Uniparin

Anticoagulant

Indication:
Deep vein thrombosis, pulmonary embolism Embolism prevention Open-heart surgery DIC Maintaining patency of I.V indwelling catheters unstable angina Post MI, cerebral thrombosis in evolving stroke , left ventricular thrombi, heart failure, history of embolism, and atrial fibrillation

Action:
Accelerates formulation of anti-thrombineIII-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin

Contraindication:
Contraindicated in patients hypersensitive to the drug or any of its components.

Special Precaution:
Use very cautiously in patients with active bleeding; blood dyscrasia; bleeding tendencies such as hemophilia, thrombocytopenia, or hepatitis disease with hypoprothrombinemia.

Side effects/Adverse reactions:

Side effects: Fever, rhinitis, conjunctivitis, lacrimation, overly prolonged clotting time, irritation, mild pain; hematoma, ulceration, pruritus, urticaria, cutaneous or subcutaneous necrosis. Adverse reaction: hemorrhage, thrombocytopenia, white clot syndrome, hypersensitivity reactions, anaphylaxis.

Dosage and availability:

Dosage: Adults: (total body perfusion) 150-400 units/kg continuous I.V infusion. Available forms: Carpuject: 5000 units/ml -unit-dose Ampule: 1000units/ml; 5000 units/ml, 10000 units/ml Vials: 1000units/ml; 2500 units/ml; 5000units/ml; 7500 units/ml Disposable syringes: 10 units/ml, 100 units/ml

Nursing Responsibilities:
Be alert for adverse reactions and drug interactions. Monitor platelet counts regularly. Thrombocytopenia caused by heparin may be linked to s type of arterial thrombosis known as white clot syndrome.

HALOPERIDOL
Haldol, Novo-Peridol, Peridol, Serenace

Antipsychotic

Indication:
Psychotic orders Tourette syndrome Delirium severe behaviour problem in children short term treatment of hyperactive children who show excessive motor activity

Action:
Blocks dopamine receptors in the tuberoinfundibular system to cause sedation. Also causes alpha-adrenergic blockade, decreases release of growth hormone, and increases prolactin release by pituitary.

Contraindication:
Contraindicated in lactating women and in clients with Parkinsonism

Special Precaution:
PO dosage has not been determined in children, older adult or debilitated patient Glaucoma

Side effects/Adverse reactions:

Side effects: Drowsiness, dizziness, blurred vision, GI upset, salivation, dry mouth Adverse Reaction: Seizures, tardive dyskinesia

Dosage and availability:

Dosage: (Adults) 0.5-2 mg 2-3 times per day for severe symptoms (Children 3-12 years or 15-40 kg) 0.05-0.075 mg/kd/day Available forms: Tablets: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg

Nursing Responsibilities:
Store tablets from 15-30 C (59-86 F). Assess CBC, electrolytes, liver and renal function. Instruct client or family to avoid alcohol and activities that require mental alertness until drug effects realized.

DIAZEPAM
Diastat, Diazepam Intensol, Valium

Anxiolytic, skeletal muscle relaxant, anticonvulsant, sedative-hypnotic

Indication:
Management of anxiety disorders or for short-term relief of symptoms of anxiety Adjunct therapy in convulsive disorder Tetanus

Action:
Reduces anxiety by increasing or facilitating the inhibitory neurotransmitteractivity of GABA. The skeletal muscle relaxant effect may be due to enhancement of GABAmediated presynaptic inhibitionat the spinal level as well as in the brain stem reticular formation.

Contraindication:
Contraindicated within 14 days of Mao inhibitor therapy.

Special Precaution:
Use IV diazepam with extreme caution in the elderly, in very ill clients, and in those with limited pulmonary reserve as apnea or cardiac arrest may occur

Side effects/Adverse reactions:

Side effects: Drowsiness (transient), ataxia, confusion, depression, fainting, headache, insomnia, lethargy, pain, psychosis, restlessness, slurred speech, urine retention, repiratory depression, constipation Adverse reactions: Bradycardia, CV collapse

Dosage and availability:

Dosage: Adults: 210 mg 2 to 4 times per day. Children, initial: 12.5 mg 34 times per day Available forms: Injection: 5 mg/mL Oral Solution: 1 mg/mL Rectal Gel: 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg Solution, Intensol: 5 mg/mL Tablets: 2 mg, 5 mg, 10 mg

Nursing Responsibilities:
Identify reasons for therapy, characteristics of S&S, time for anticipated results. Monitor CBC, renal, and LFTs. Review anxiety level; identify contributing factors.

METFORMIN
Fortamet, Glucophage, Glumetza, Riomet

Antidiabetic

Indication:
Improve glycemic control in clients with type 2 diabetes Extended-Release form used to treat type 2 diabetes as initial therapy

Action:
Decreases hepatic glucose production, decreases intestinal absorption of glucose, and increases peripheral uptake and utilization of glucose.

Contraindication:
Acute or chronic metabolic acidosis Abnormal hepatic function Dehydration and lactation

Special Precaution:
Metformin should be promptly withheld in the presence of any condition associated with hypoexmia, dehydration, or sepsis. hepatic disease Lactic acidosis

Side effects/Adverse reactions:

Side effects: Hypoglycemia, diarrhea, N&V, asthenia, flatulence, headache, abdominal pain/discomfort. Adverse Reaction: Lactic acidosis

Dosage and availability:

Dosage: (Adults and adolescents over 16 years of age) Up to2,550 mg/day; (Children, 1016 years of age) up to 2,000 mg/day Available forms: Oral solution: 500 mg/5 ml Tablets: 500 mg, 850 mg, 1000 mg Tablets, Extended-Release: 500 mg, 750 mg, 1000 mg

Nursing Responsibilities:
Individualize dosage based on tolerance and effectiveness. Give with meals starting at a low dose with gradual escalation. Inform client that it may cause a metallic taste; should subside.

ALLOPURINOL
Allorin, Apo-Allopurinol, Capurate, Zyloprim

Anti-gout drug

Indication:
Gout To prevent acute gouty attacks. Hyperuricemias secondary to malignancies. Recurrent calcium oxalate calculi.

Action:
Reduce uric acid production by inhibiting the necessary biochemical reaction.

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components.

Special Precaution:
In pregnant and Breast feeding women use cautiously.

Side effects/Adverse reactions:

Side effects: headache, drowsiness, cataracts, retinopathy, nausea, vomiting, abdominal pain, diarrhea, uremia, anemia, Rash, pruritus, urticarial and pulpuric lesions, ichthyosis, severe furunculosis of nose Adverse Reaction: Renal failure,.agranulocytosis, aplastic anemia, Thrombocytopenia. Hepatitis, exfoliative lesions, erythema multiforme, toxic epidermal necrolysis

Dosage and availability:

Dosage: Adults: mild gout, 200 to 300 mg PO daily; severe gout with large tophi, 400 to 600 mg PO daily. Dosage varies with severity of dse and can be given as single dose or in divided doses, doses larger than 300mg should be divided. Maximum dosage, 800 mg daily. Available forms: Capsules: 100 mg, 300 mg Tablets: 100 mg, 2000, mg 300 mg Injection: 500m/30-ml vial (Allopurinol sodium)

Nursing Responsibilities:
Assess patients history. Gout may be secondary to dse. Such as acute or chronic leukaemia, polycythemia vera, multiple myeloma, and psoriasis. Be alert for adverse reactions and drug interactions. Give drug with or immediately after meals to minimize adverse GI reactions. Have patients drink plenty of fluids while taking drug, unless contraindicated. Advise patient not to take alcohol while taking drug.

STREPTOMYCIN SULFATE
Antibiotic

Indication:
Streptococcal endocarditis. Primary and adjunct treatment in tuberculosis. Enterococcal endocarditis. Tularemia

Action:
Inhibits protein synthesis by binding directly to 30S ribosomal subunit.

Contraindication:
Contraindicated in patients hypersensitive to drug or other aminoglycoside in patients with labyrinthine dse. In pregnant women, drug is contraindicated.

Special Precaution:
Use cautiously in patients with impaired kidney function or neuromuscular dse. In breastfeeding women and elderly, use cautiously.

Side effects/Adverse reactions:

Side effects: Ototoxicity, nausea, vomiting, eosinophilia, exfoliative dermatitis, hypersensitivity reaction, Adverse effect: neuromuscular blockade, nephrotoxicity leukopenia. Thrombocytopenia, apnea, angioedema, anaphylaxis.

Dosage and availability:

Dosage: Adults: 1g IM q 12 hours for 1 week, and then 500 mg q 12 hours for 1 week, given with penicillin. Available forms: Injection: 400mg/ml, 1 g/2.5-ml

Nursing Responsibilities:
Assess patients infection before starting therapy, and regularly thereafter to monitor the drugs effectiveness. Obtain specimen for culture and sensitivity test before first dose except when treating tuberculosis. Start therapy pending test result. Be alert for adverse reactions and drug interactions. Protect hands while preparing the drug because drug is irritating. Instruct patient to report hearing loss, roaring noises, or fullness in ears and dizziness immediately.

MORPHINE SULFATE
Avinza, Astramorph PF, Duramorph, Infumorph 200 and 500, Oramorph SR

Narcotic analgesic

Indication:
severe pain preoperatively for sedation and to reduce apprehension supplement to anesthesia control postoperative pain

Action:
Decreased permeability of the cell membrane tosodium, which results in diminished transmission of pain impulses and therefore analgesia.

Contraindication:
Heart failure secondary to chronic lung disease cardiac arrhythmias brain tumor acute alcoholism-delirium tremens -convulsive statescardiac arrhythmias

Special Precaution:
clients with known seizure disorders use with extreme caution in aged or debilitated clients

Side effects/Adverse reactions:

Side effects: N&V, constipation, somnolence, headache Adverse Reaction: Respiratory Depression, Bradycardia, shock, cardiac arrest, thrombocytopenia, respiratory arrest

Dosage and availability:

Dosage: Oral solution; Tablets; Tablets, Soluble530 mg (solution or tablets) on a regularly scheduled basis q 4 hr at the lowest dosage level that will achieve adequate analgesia Available forms: Capsules, Extended- Capsules, Sustained-Release Pellets: 20 mg, 30 mg, 50 mg, 60 mg, 100 mg Injection: 0.5 mg/mL, to 50 mg/mL Tablets, Controlled-Release: 15 mg, 30 mg,

Nursing Responsibilities:
List other agents prescribed, outcome. Note any seizure disorder or head trauma. Monitor VS and respiratory status. Help client practice cough and deep-breathing exercises and incentive spirometry to decrease risk of atelectasis.

METHYLENORGOVINE MALEATE
Methergine

Oxytocin

Indication:
For post partum hemorrhage

Action:
Inhibits motor activities of the uterus, shorten the third stage of labor and increases sensitivity to insulin.

Contraindication:
Pregnant patients who are sensitive to ergot preparation and in patients with hypertension or toxemia

Special Precaution:
Patients with sepsis Obliterative vascular disease Hepatic renal disease during at last stage of labor

Side effects/Adverse reactions:

Side effects: seizure, stroke, hallucination, headache, leg cramps and diaphoresis

Dosage and availability:

Dosage: adults: 0.2 mg IM q2-4 hours to a maximum of 5 doses Available forms: Injection: 0.2 mg/ml in 1 ml ampule Tablets: 0.2 mg

Nursing Responsibilities:
Monitor VS and respiratory status.

PARACETAMOL
Abenol, Acephen, Aceta, Aceta-Elixir, Dymadon, Panadol, Tempra, Tylenol

Nonopioid analgesic, antipyretic

Indication:
Mild pain or fever. Osteoarthritis.

Action:
May produce analgesic effect by blocking pain impulses, by inhibiting prostaglandin or pain receptor sensitizers. May relieve fever by acting in hypothalamic heat-regulating center.

Contraindication:
Contraindicated in patients hypersensitive to drug.

Special Precaution:
Use cautiously in patients with history of chronic alcohol abuse because hepatoxicity may occur after therapeutic doses. In pregnant and breastfeeding women, use cautiously.

Side effects/Adverse reactions:

Side effects: hemolytic anemia jaundice. Rash, urticaria Adverse Reaction: Thrombocytopenia, neotropenia, leukopenia, pancytopenia, liver damage, hypoglycaemia.

Dosage and availability:

Dosage: Adult and children older than age 12: 325 to 650 mg PO or PR q 4 hours prn or 1 g PO tid or qid, prn. Alternatively, 2 extended release caplets Po q 8 hours. Maximum, 4 g daily. Dosage for long term therapy shouldnt exceed 2.6 g daily unless monitored by prescriber.

Available forms: Infant drops: 80mg/0.8 ml Capsules: 150 mg, 300 mg Injection: 600mgSolution: 80mg/1.66ml Sprinkles: 80mg/capsules Suppositories: 80 mg, 120 mg Tablets: 160 mg, 325 mg, 500 mg Tablets (chewable); 80 mg, 160 mg

Nursing Responsibilities:
Assess patient's pain or temperature before and during therapy. be alert for adverse reactions and drug interactions Give liquid form to children and other patients who have trouble swallowing

LITHIUM
Lithotabs, Lithobid, Lithonate,

Antipsychotic , Antimanic

Indication:
control of mania in manic-depressive clients premenstrual tension alcoholism accompanied by depression Tardive dyskinesia Bulimia

Action:
A decrease in cyclic AMP levels caused by lithium which decreases sensitivity of hormonal sensitive adenyl cyclase receptors

Contraindication:
cardiovascular or renal dse. brain damage and lactation dehydration clients receiving diuretics

Special Precaution:
safety and efficacy have not been established for children less than 12 years of age use with caution in geriatric clients because lithium is more toxic to the CNS in these clients

Side effects/Adverse reactions:

Side effects: Due to initial therapy: Fine hand tremor,polyuria, thirst, transient and mild nausea, general discomfort Adverse Reaction: peripheral circulatory collapse, severe bradycardia causing syncope, coma

Dosage and availability:

Dosage: Acute mania.Capsules; Syrup; Tablets; Tablets, Extendederelease(Adults)300600 mg 3 times per day or 600900 mg twice per day of slowrelease form(Elderly and debilitated clients) 0.61.2 grams/day in three doses Available forms: Lithium carbonate Capsules: 150 mg, 300 mg, 600 mg; Tablets: 300 mg; Tablets,Extended-Release: 300 mg, 450 mg.Lithium citrate Syrup: 300 mg/5 mL

Nursing Responsibilities:
Monitor lithium levels, kidney and thyroid function studies; assess for decreased function. With arthritic conditions, document anti-inflammatory agent(s) used. Document mental status, CV function, VS, chemistry, thyroid function, urinalysis, weight, and ECG.

METRONIDAZOLE
Flagyl I.V., Flagyl 375, Flagyl ER, MetroGel, MetroLotion, Vandazole Trichomonacide, amebicide

Indication:
serious infections due to susceptible anaerobic bacteria Peritonitis skin structure infections due to Bacteroides species including B. fragilis group, Clostridium species and Peptococcus niger

Action:
Inhibits growth of trichomonae and amoebae by binding to DNA, resulting in loss of helical structure, strand breakage, inhibition of nucleic acid synthesis, and cell death.

Contraindication:
blood dyscrasias active organic disease of the CNS Trichomoniasis during the first trimester of pregnancy lactation

Special Precaution:
use with caution in those with evidence or history of blood dyscrasias or in those with impaired hepatic function

Side effects/Adverse reactions:

Side effects: Following systemic use: Headache, vaginitis, nausea, metallic taste, genital pruritus, bacterial infection, flu-like symptoms Adverse Reaction: seizures, bone marrow aplasia

Dosage and availability:

Dosage: Amebiasis: Acute amebic dysentery or amebic liver abscess Available forms: Capsules: 375 mg Cream: 0.75 %, 1% Gel (Topical): 0.75%, 1% Injection: 5 mg/ 1 mL (ready-to-use) Injection, Lyophilized: 500 mg Lotion: 0.75% Tablets: 250 mg, 500 mg Tablets, Extended-Release: 750 mg Vaginal Gel/Jelly: 0.75%.

Nursing Responsibilities:
Reduce dose in those with hepatic dse. Do not use syringes with Al needles or hubs. Document indications for therapy and symptom characteristics. Monitor CBC, LFTs, and cultures.

MEBENDAZOLE
Vermox

Anti-helmenthic

Indication:
Whipworm Pinworm Roundworm common and American hookworm

Action:
Blocks the glucose uptake of the organisms, thereby reducing their energy until death results

Contraindication:
Hypersensitivity to mebendazole and its component

Special Precaution:
Use with caution in children under 2 years old and during lactation

Side effects/Adverse reactions:

Side effects: Transient abdominal pain, diarrhea

Dosage and availability:

Dosage: Whipworm, roundworm, and hookworm Tablets, Chewable:(Adults and children) 1 tablet morning and evening on 3 consecutive daysPinworm1 tablet, one time Available forms: Tablets, Chewable 100 mg

Nursing Responsibilities:
Note clinical confirmation of organism, onset and characteristics of S&S, and any contributory factors. Identify all persons in contact and potentially affected. Tablets may be chewed, swallowed, or crushed with food. Teach client to practice personal hygiene and wash hands regularly.

REGULAR INSULIN
Humulin R, Novolin R, Velosulin

Antidiabetic

Indication:
diabetic coma Mild diabetic ketoacidosis clients suffering from labile diabetes

Action:
Increases synthesis of glycogen in the liver.

Contraindication:
Contraindicated in hypoglycaemia and in patients hypersensitivity to insulin or any of its ingredients.

Special Precaution:
Pregnant diabetic clients inhibits milk production

Side effects/Adverse reactions:

Side effects: hypokalemia, injection site reactionpruritus, rash, lipoatrophy, hypersensitivity reactions, lipohypertrophy Adverse reaction: Hypoglycemia, anphylaxis

Dosage and availability:

Dosage: SC (Adults) 5-10 units (Pediatric) 2-4 units. Injection is given 15-30 mi before meals and at bedtime. Available forms: Injection: 100 units/ml

Nursing Responsibilities:
Note dse. Onset, level of control/ understanding of dse. Previous agents trialed, outcome. Monitor VS, CBC, HbA1c, U/A: microalbumin, renal and LFTs. Tell client to report adverse effect or lack or sugar control. Continue diet, exercise and weight control.

ACETYLCESTEINE
Acetadote, Mucomyst

Mucolytic, antidote for acitamenophen overdose

Indication:
Chronic emphysema Emphysema with bronchitis Tuberculosis Chronic asthmatic Acetaminophen toxicity To prevent acute renal failure related to radiographic contrast media

Action:
Reduces the viscosity of purulent and nonpurulent pulmonary secretions and facilitates their removal by splitting disulfide bonds. Restores glutathione in liver to treat acitaminophen toxicity.

Contraindication:
Contraindicated in patients hypersensitive to drug.

Special Precaution:
Use cautiously in debilitated patients with severe respiratory insufficiency. In patients with asthma or a history of bronchospasm, use IV formulation cautiously. In pregnant and breastfeeding women and elderly patients with severe respiratory insufficiency use cautiously.

Side effects/Adverse reactions:

Side effects: Bronchial/tracheal irritation, N&V, rash, stomatitis Adverse effects: Bronchospasms

Dosage and availability:

Dosage: Direct instillation into tracheostomy1-2 ml of 10% or 20% solution every 1-4 hours Closed tent or croupette Up to 300 ml of 10% or 20% solution per treatment. Available forms: Injection: 20% Oral Solution (as sodium): 10%, 20%

Nursing Responsibilities:
Use non-reactive plastic, glass, or stainless steel for administration. After prolonged nebulization, dilute that last fourth of the medication with sterile water to prevent drug concentration. Note pulmonary findings: determine when spasm occur.

DIGOXIN
Lanoxin, Digitek, Digoxin, Lanoxicaps

Inotropic, anti-arrythmic

Indication:
Heart failure, paroxysmal supraventricular tachycardia atrial fibrillation and flutter.

Action:
Inhibits sodium-potassium-activated adenosine triphosphatase, thereby promoting movement of calcium from extra cellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through SA and AV nodes and providing Antiarrythmic effect.

Contraindication:
Contraindicated in patients hypersensitive to drug or any of its components and in those with digitalis induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.

Special Precaution:
Use cautiously in patients with acute MI, incomplete AV block, sinus bradychardia, PVCs Chronic onstrictive pericarditis, hypertrophic cardiomyopathy, renal insuffiency, severe pulmonary disease, or hyperthyroidism.

Side effects/Adverse reactions:

Side effects: Agitation, dizziness, fatigue, generalized muscle weakness, hallucination, headache, malaise, paresthesia, stupor, vertigo. Adverse reactions: Arryythmias, heart failure

Dosage and availability:

Dosage: Adults: for rapid digitalization, give 0.75 to 1.25 mg PO over 24 hours in two or more divided doses q6 to 8 hours. Available forms: Capsules: 0.5 mg, 0.1 mg, 0.2 mg Elixir: 0.05 mg/ml Injection: 0.05 mg/ml Tablets; 0.125 mg, 0.25 mg

Nursing Responsibilities:
Monitor potassium level carefully. Look for adverse reaction and drug interaction, Tell patient to eat potassium rich food. Administer IV doses slowly over 5 minutes. Do not double up with missed doses.

CIPROFLOXACIN
Ciloxan Ophthalmic, Cipro, Proquin XR

Antibiotic, fluoroquinolone

Indication:
Mild to moderate UTI. Severe or complicated UTI; mild to moderate bone and joint infections, mild to moderate: respiratory tract infection, skin and skin-structure infections, acute sinusitis due to Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis- Chronic bacterial prostatitis due to E. coli or Proteus mirabilis. Infectious diarrhea; intra-abdominal pain.

Action:
Interferes with DNA gyrase and topoisomeraseIV. DNA gyrase is an enzyme needed for replication, transcription, and repair of bacterial DNA.

Contraindication:
Hypersensitivity to fluroquinolones. Breastfeeding is contraindicated.

Special Precaution:
Use cautiously in patients with CNS disorders and pregnant women. Safety and effectiveness of ophthalmic, PO, or IV use have not been determined in children Possible antibiotic resistance when used to treat Pseudomonas aeruginosa infections.

Side effects/Adverse reactions:

Side effects: After systemic use: Headache, N&V, diarrhea, restlessness, rash After ophthalmic use: Irritation, burning, stinging, itching, inflammation Adverse Reaction: Intestinal perforation, toxic epidermal necrolysis

Dosage and availability:

Dosage: Pyelonephritis, acute uncomplicated(Adults)1,000 mg once daily of extended-release tablets for 714 days. Available forms: Injection: 200 mg, 400 mg Ophthalmic Ointment: 3.33 mg/g (equivalent to 3 mg base) Tablets: 100 mg, 250 mg, 500 mg, 750 mg Tablets, Extended-Release: 500 mg, 1,000 mg

Nursing Responsibilities:
Although food delays drug absorption, it may be taken with/without meals; recommended dosing time is 2 hr after a meal. Note reasons for therapy; S&S and obtain cultures. Store vials for IV use from 530C (4186F). Protect from light, excessive heat, and freezing.

PHENYTOIN
Dilantin, Infatab, Dilantin-125

Anticonvulsant

Indication:
Chronic epilepsy control seizures during neurosurgery Severe preeclampsia

Action:
Acts in the motor cortex of the brain to reduce the spread of electrical discharges from the rapidly firing epileptic foci in this area.

Contraindication:
Hypersensitivity to hydantoins Exfoliative dermatitis Sinus bradycardia Lactating women

Special Precaution:
Acute, intermittent porphyria clients with a history of asthma or other allergies Impaired renal or hepatic function Heart disease (hypotension, severe myocardial insufficiency)

Side effects/Adverse reactions:

Side effects: Ataxia, drowsiness, slurred speech, confusion, N&V, rash, constipation/ diarrhea, gingival hyperplasia Adverse Reaction: Increased seizures, toxic epidermal necrolysis, toxic hepatitis

Dosage and availability:

Dosage: (Adults, initial) 100 mg (125 mg of the suspension) 3 times per day; adjust dos age at 7- to 10-day intervals until seizures are controlled (Pediatric, initial) 5 mg/kg/day in two to three divided doses Available forms: Tablets, Chewable: 50 mg Oral Suspension: 125 mg/5 mL

Nursing Responsibilities:
List reasons for therapy, onset, characteristics of S&S, clinical presentation, blood levels, other agents trialled, outcome. Note history and nature of seizures, addressing location, frequency, duration, causes/characteristics, triggers and EEG findings. Do not substitute products or exchange brands; bioavailability of phenytoin may vary .