Drugs

DRUGS INDICATION ACTION NURSING CONSIDERATIONSAminophyll

ineTo prevent and relieve symptoms of acute bronchial asthma and treatment of bronchospasm associated with chronic bronchitis and emphysema.

Aminophylline is a saltof theophylline witheffects similar to thoseof other xanthines (e.g.,caffeine andtheobromine). Action isdependent ontheophylline content(approximately 80%)and is measured astheophylline in theserum

Administer to pregnant patients only when clearly needed—neonatal tachycardia, jitteriness, and withdrawalapnea observed when mothers received xanthines up until delivery.•Caution patient not to chew or crush enteric-coated timed-release forms.•Give immediate-release, liquid dosage forms with food if GI effects occur.•Do not give timed-release forms with food; these should be given on an empty stomach 1 hr before or 2 hr after meals.•Maintain adequate hydration.•Monitor results of serum theophylline levels carefully, and arrange for reduced dosage if serum levels exceedtherapeutic range of 10–20 mcg/mL.•Take serum samples to determine peak theophylline concentration drawn 15–30 min after an IV loading dose.•Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available.•Ensure that diazepam is readily available to treat seizures.•Take this drug exactly as prescribed; if a timed-

release product is prescribed, take this drug on an empty stomach,1 hr before or 2 hr after meals.•Do not to chew or crush timed-release preparations.•Administer rectal solution or suppositories after emptying the rectum.•It may be necessary to take this drug around the clock for adequate control of asthma attacks.•Avoid excessive intake of coffee, tea, cocoa, cola beverages, chocolate.•Smoking cigarettes or other tobacco products impacts the drug's effectiveness. Try not to smoke. Notify the careprovider if smoking habits change while taking this drug.•Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage;keep all appointments for blood tests and other monitoring.•These side effects may occur: Nausea, loss of appetite (taking this drug with food may help if taking theimmediate-release or liquid dosage forms); difficulty sleeping, depression, emotional lability (reversible).•Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat

terbutaline

prevention and reversal of bronchospasm in patients 12 years of age and older with asthma and reversible bronchospasm associated with bronchitis and emphysema.

a direct-acting sympathomimetic which relaxes bronchial smooth muscle by selective action on β2 receptors. It also decreases uterine contractility.

Parenteral form is only for S.C. use. Before using, the inhaler must be shaken well; assess lung sounds, pulse, and blood pressure before administration and during peak of medication; observe patient for wheezing after administration, if this occurs, call physician

AtROPINE SULFATE

Adjunct in symptomatictreatment of GIdisorders (e.g., pepticulcer, pylorospasm, GIhypermotility, irritablebowel syndrome) andspastic disorders of biliary tract. Relaxesupper GI tract andcolon during hypotonicradiography.Ophthalmic Use:Toproduce mydriasis andcycloplegia beforerefraction and fortreatment of anterioruveitis and iritis.Preoperative Use:Tosuppress salivation,perspiration, andrespiratory tractsecretions; to reduceincidence of laryngospasm, reflexbradycardiaarrhythmia, andhypotension duringgeneral anesthesia.Cardiac Uses:For sinusbradycardia or asystoleduring CPR or

Acts by selectivelyblocking all muscarinicresponses toacetylcholine (ACh),whether excitatory orinhibitory. Selectivedepression of CNSrelieves rigidity andtremor of Parkinson'ssyndrome.Antisecretory action(vagolytic effect)suppresses sweating,lacrimation, salivation,and secretions fromnose, mouth, pharynx,and bronchi. Blocksvagal impulses to heartwith resulting decreasein AV conduction time,increase in heart rateand cardiac output, andshortened PR interva

Monitor vital signs. HR is asensitive indicator of patient's response toatropine. Be alert to changesin quality, rate, and rhythmof HR and respiration and tochanges in BP andtemperature.•Initial paradoxicalbradycardia following IVatropine usually lasts only 1–2 min; it most likely occurswhen IV is administeredslowly (more than 1 min) orwhen small doses (less than0.5 mg) are used. Posturalhypotension occurs whenpatient ambulates too soonafter parenteraladministration.•Note: Frequent andcontinued use of eyepreparations, as well asoverdosage, can havesystemic effects. Someatropine deaths haveresulted from systemicabsorption following ocularadministration in infants andchildren.Monitor I&O, especially inolder adults and patients whohave had surgery (drug maycontribute to urinaryretention). Palpate lowerabdomen for distention. Havepatient void before givingatropine

that isinduced by drugs ortoxic substances (e.g.,pilocarpine, beta-adrenergic blockers,organophosphatepesticides, and Amanitamushroompoisoning); formanagement of selected patients withsymptomatic sinusbradycardia andassociated hypotensionand ventricularirritability; for diagnosisof sinus nodedysfunction and inevaluation of coronaryartery disease duringatrial pacing

Omeprazole Short-term treatment of activeduodenal ulcer; First-linetherapy in treatment of heartburn or symptoms of gastroesophageal refluxdisease (GERD); Short-termtreatment of active benigngastric ulcer; GERD, severeerosive esophagitis,

Gastricacid-pumpinhibitor:Suppresses gastricacidsecretionby specificinhibition of thehydrogen-potassiumATPaseenzymesystem atthesecretorysurface of the gastricparietalcells;blocks thefinal step

Administer before meals. Caution patient toswallow capsules whole—not to open, chew, or crush them.Arrange for further evaluation of patient after 8 wkof therapy for gastroreflux disorders; not intendedfor maintenance therapy. Symptomaticimprovement does not rule out gastric cancer,which did occur in preclinical studies.Administer antacids with omeprazole, if needed.Teaching pointsTake the drug before meals. Swallow thecapsules whole; do not chew, open, or crushthem. This drug will need to be taken for up to 8wk (short-term therapy) or for a prolonged period(> 5 yr in some cases).Have regular medical follow-up

poorlyresponsive symptomatic GERD;Long-term therapy: Treatmentof pathologic hypersecretoryconditions (Zollinger-Ellisonsyndrome, multiple adenomas,systemic mastocytosis);Eradication of H. pylori withamoxicillin or metronidazole andclarithromycin;Prilosec OTC: Treatment of frequent heartburn(2 or more days per wk);Unlabeled use: Posterior laryngitis; enhance efficacy of pancreatin for the treatment of steatorrhea in cystic fibrosis

of acidproduction visits.These side effects may occur: Dizziness (avoiddriving or performing hazardous tasks);headache (request medications); nausea,vomiting, diarrhea (maintain proper nutrition);symptoms of upper respiratory tract infection,cough (do not self-medicate; consult with your health care provider if uncomfortable).Report severe headache, worsening of symptoms, fever, chills

Ranitidine Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in

Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.• Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.

inhibition of gastric acid secretion.

• Inform patient that it may cause drowsiness or dizziness.• Inform patient that increased fluid and fiber intake may minimize constipation.• Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly.• Inform patient that medication may temporarily cause stools and tongue to appear gray black.

Furosemide

Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

Rapid-acting potent sulfonamide “loop” diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. decreases renal vascular resistance and may increase renal blood flow.

Give with food to avoid gastroinestinal upset, preferably with breakfast (to prevent nocturia).

If given IM, temporary pain at injection site may be noted.

Check vital signs especially blood pressure for hypotension prior to administration.

Assess baseline electrolyte, particularly check for low potassium.

Assess edema, skin turgor, and mucous membranes for hydration status.

Assess muscle strength and mental status. Obtain baseline weight. Initiate Input and Output monitoring. Note extent of diuresis.

Solu-Cortef

Steroid-responsive disorders when oral therapy not feasible. Allergic statesDermatologic diseasesEndocrine disordersGastrointestinal diseasesHematologic disordersNeoplastic diseasesNervous SystemOphthalmic diseasesRenal diseases

Corticosteroids are hormones produced naturally by the adrenal glands which have many important functions on every organ system. Corticosteroids affect the heart and its response to natural chemicals that affect heart rate. They also affect water and salt balance in the body and allow the body to cope with stress

Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose.

Lab tests: Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC with differential.

Monitor for adverse effects. Older adults and patients with low serum albumin are especially susceptible to adverse effects.

Be alert to signs of hypocalcemia (see Appendix F).

Ophthalmoscopic examinations are recommended every 2–3 mo, especially if patient is receiving ophthalmic steroid therapy.

Monitor for persistent backache or chest pain; compression and spontaneous fractures of long bones and vertebrae present hazards.

Monitor for and report changes in mood and behavior, emotional instability, or psychomotor activity, especially with long-term therapy.

Be alert to possibility of masked infection and delayed healing (antiinflammatory and immunosuppressive actions).

Note: Dose adjustment may be required if patient is subjected to severe stress (serious infection, surgery, or injury).

Note: Single doses of corticosteroids or use for a short period (<1 wk) do not produce withdrawal symptoms when discontinued, even with moderately large doses.

Meropenem

To reduce the development of drug-resistant bacteria and maintain the effectiveness of MERREM I.V. and other antibacterial drugs, MERREM I.V. should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

a carbapenem that works by inhibiting the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls by binding to one or more of the penicillin-binding proteins (PBPs), thus inhibiting cell wall biosynthesis resulting to bacterial lysis.

Lab tests: Perform C&S tests prior to therapy. Monitor periodically liver and kidney function.

Determine history of hypersensitivity reactions to other beta-lactams, cephalosporins, penicillins, or other drugs.

Discontinue drug and immediately report S&S of hypersensitivity (see Appendix F).

Report S&S of superinfection or pseudomembranous colitis (see Appendix F).

Monitor for seizures especially in older adults and those with renal insufficiency.

Patient & Family Education

Learn S&S of hypersensitivity, superinfection, and pseudomembranous colitis; report any of these to physician promptly.

Do not breast feed while using this drug.

ampicillin

Treatment of respiratory infections

Bactericidal action. Active against: Streptococci, Penumococci, Enterococci, Haemophilus influenzae, Binds to bacteria cell wall, resulting in cell death, spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to beta-lactamase, enzymes produced by bacteria that may inactivate ampicillin.

Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy.• Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.• Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results.• Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.• Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.•Instruct patient to notify physician if symptoms do not improve.

Gentamicin

Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.

Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea. Action is usually bacteriocidal.

Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.

Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.

Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4– 10 g/mL, and trough concentrations of 1–2 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity.

Draw blood specimens for peak serum gentamicin concentration 30 min–1h after IM administration, and 30 min after completion of a 30–60 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

Amikacin

short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, species of indole-positive and indole-negative Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter (Mima-Herellea) species.

inhibitsproduction of bacterialprotein, causingbacterial celldeath.

Patients shouldbe counseled thatantibacterialdrugs includingAmikacin shouldonly be used totreat bacterialinfections.➢Patients shouldbe told thatalthough it iscommon to feelbetter early in thecourse of therapy,the medicationshould be takenexactly asdirected.➢Skipping doses ornot completingthe full course of therapy may (1)decrease theeffectiveness of the immediatetreatment and (2)increase thelikelihood thatbacteria willdevelopresistance and will not betreatable byAmikacin or otherantibacterialdrugs in thefuture.

cefuroxime ♦ Perioperative prevention

Lesssusceptibleto betalactamaseand havegreateractivityagainstHaemophilusInfluenzae,gonorrheaand Lymedisease

Inhibits cell wall synthesis promoting osmotic instability usually bactericidal

♦ Before giving dug. ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose. absorption of oral drug is induced.

cefotaxime Susceptible bacteremia, septicemia, lower respiratory and genitourinary tracts, skin and skin structure, bone and joint, gynecologic, CNS (e.g., meningitis),

The bactericidal activity of cefotaxime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs).

1. Observe site closely for extravasation during administration.

2. Observe for signs of adverse effects, especially those suggesting a superinfection.

3. Observe for signs of renal, hepatic or haematological dysfunction during prolonged therapy.

intraabdominal infections. Surgical prophylaxis.

Cefotaxime shows high affinity for penicillin-binding proteins in the cell wall including PBP Ib and PBP III.

Chloramphenicol

Serious infections for which no other antibiotic is effective, acute infection that is caused by salmonella typhi and cystic fibrosis regimen.

Bacteriostatic effect against susceptible bacteria; prevents cell replication

- Assess culture infection before beginning therapy

- Monitor hematologic data

- Monitor serum levels periodically

- Advice watchers that she may experience side effects such as nausea, vomiting , diarrhea, headache

- Advice to report sore throat, tiredness, unusual bleeding, numbness, tingling, pain in extremities.

benzylPenicillin

Mild to moderately severe infections caused by sensitive organisms--streptococci, pneumococci, staphylococci, fusospirochetes

· Prophylaxis against bacterial endocarditis in patients with valvular heart disease undergoing dental or upper respiratory tract surgery

· Unlabeled uses: prophylactic treatment of children with sickle cell anemia, mild to moderate anaerobic infections, Lyme disease

Bactericidal: inhibits cell wall synthesis of sensitive organisms, causing cell death.

Culture infection before beginning treatment; reculture if response is not as expected.

· Continue therapy for at least 2 days after infection has disappeared, usually 7–10 days.

· Do not administer oral drug with milk, fruit juices, or soft drinks; a full glass of water is preferred; this oral penicillin is less affected by food than other penicillins.

METRONIDAZOLE

Acute infection with susceptible anaerobic bacteria

· Acute intestinal amebiasis

· Amebic liver abscess

· Trichomoniasis (acute and partners of patients with acute infection)

· Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal surgery

· Topical application in the treatment of inflammatory papules, pustules, and erythema of rosacea

· Unlabeled uses: prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's

Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoal-trichomonacidal, amebicidal: biochemical mechanism of action is not known.

Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).

Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary.

Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF.

Monitor patients on lithium for elevated lithium levels.

Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly.

Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated.

Do not drink alcohol during therapy; may induce a disulfiram-type reaction (see Appendix F). Avoid alcohol or alcohol-containing medications for at least 48 h after treatment is completed.

Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance.

disease; antibiotic-associated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC)

Tranexamic Acid

Treating heavy menstrual bleeding

Hemorrhage following dental and/or oral surgery in patients with hemophilia

Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures.

Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.

synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots

Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing.

If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia

Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage

Effective in promoting hemostasis in traumatic injuries.

Preventing hemorrhage after orthopedic surgeries.

Lanoxin Mild-to-moderate heart failure (with a diuretic and an ACE inhibitor when possible). Control of ventricular response rate in chronic atrial fibrillation.

Digoxin acts by increasing the force the heart muscle contracts with increasing the effectiveness of its pumping mechanism.It also slows the electrical conduction through the heart, which helps to prevent abnormal heart rhythms.

Be familiar with patient’s baseline data (e.g., quality of peripheral pulses, blood pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a foundation for making assessments.

Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Notify physician of abnormal values. Draw blood samples for determining plasma digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dose. Therapeutic range of serum digoxin is 0.8–2 ng/mL; toxic levels are >2 ng/mL.

Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If changes are noted, withhold digoxin, take rhythm strip if patient is on ECG monitor, notify physician promptly.

Withhold medication and notify physician if apical pulse falls below ordered parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children).

Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.

Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate chest for rales.

Monitor serum digoxin levels closely during concurrent antibiotic–digoxin therapy, which can precipitate toxicity because of altered intestinal

flora.

Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day. Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician. Continue with brand originally prescribed unless otherwise directed by physician. Do not breast feed while taking this drug without consulting physician.

Paracetamol

Fever, Relief of mild to moderate pain like headaches, muscular aches and pain, toothache, colds, earache, fever due to tonsillectomy, inoculations, and vaccinations.

Inhibits prostaglandin synthesis in the CNS and blocks the pain impulse through a peripheral action. It acts on the hypothalamic heat-regulating center, producing peripheral vasodilation. It results in antipyresis and produces analgesic effect.

If to be given as analgesia, assess onset, type, location, duration of pain.

Can be given without regards to meals. Tablets can be crushed. Assess temperature directly before and 1 hour

after giving medication. If respirations are <12/min (<20/min in children),

withhold the medication and contact the physician. Evaluate for therapeutic response: relief of pain,

stiffness, swelling; increasing in joint mobility; reduced joint tenderness; improve grip strength.

Therapeutic blood serum level: 10-30 mcg/mL; toxic serum level: >200 mcg/mL.

Patient Teaching for Clients Taking Paracetamol

Consult physician for use in children less than 2 years old; oral use more than 5 days for children, more than 10 days for adults, or fever more than 3 days.

Do not crush or chew sustained-release or enteric-coated form.

Report ringing in ears and persistent GI pain. Severe, recurrent pain or high continuous fever

may indicate serious illness.

PLASIL

Management of esophageal reflux

• Treatment and prevention of postoperative nausea

Physiologic Mechanism

• Decreased nausea and vomiting.

• Decreased symptoms

• Assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after administration.

• May cause drowsiness.

and vomiting of gastric stasis.

Pharmacologic Mechanism

• Blocks dopamine receptors in chemoreceptor trigger zone of the CNS.

• Stimulates motility of the upper GI tract and accelerates gastric emptying.

• Advise patient to avoid concurrent use of alcohol and other CNS depressant while taking this medication.

• Advise patient to notify health care professional immediately if involuntary movement of eyes, face or limbs occurs.

Lidocaine

Intravenous – ventricular arrhythmias

Intramuscular – self-injected or when IV is unavailable during transport to local facilities

Local – infiltration or mucosal or topical anesthetic

Patch – used when pain is present due to post-herpetic neuralgia

suppresses the automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across the cell membrane with little or no effect on the heart. Locally, it produces local anesthesia effect by inhibiting the transport of ions across the neural membranes. Thus, initiation and conduction of normal nerve impulses is prevented.

When Lidocaine is administered as an antiarrhythmic the nurse should monitor the ECG continuously. Blood pressure and respiratory status should be monitored frequently during the drug administration. When administered as an anesthetic, the numbness of the affected part should be assessed. Serum Lidocaine levels should be monitored frequently during prolonged use. Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/ml. If signs of overdose occur (listed above), stop the infusion immediately and monitor the patient closely. For throat sprays, make sure that the patient’s gag reflex is intact before allowing the patient to eat or drink. When IM injections are used, the medication should be administered in the deltoid muscle only while frequently aspirating to prevent IV injection. For direct IV injection only 1% and 2% solutions are used.

Undiluted IV loading dose of Lidocaine is administered at 1 mg/kg at a rate of 25 to 50 mg over 1 minute. The dose may be repeated after 5 minutes

nifedipine

treatment of angina due to coronary artery spasm (Prinzmetal’s variant angina), chronic stable angina (Effort-associated angina). It is also used in the treatment of essential hypertension. Nifedipine can also be used in the treatment of Raynaud’s phenomena.

inhibits calcium ion movement across cell membrane, depressing contraction of cardiac or vascular smooth muscle. It also increases heart rate and cardiac output. Nifedipine decreases systemic vascular resistance and blood pressure.

Monitor BP carefully during titration period. Patient may become severely hypotensive, especially if also taking other drugs known to lower BP. Withhold drug and notify physician if systolic BP <90.

Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties.

Monitor for gingival hyperplasia and report promptly. This is a rare but serious adverse effect (similar to phenytoin-induced hyperplasia).

Rise slowly from lying to sitting position, dangle legs from bed before standing to reduce hypotensive effect.

Contact physician or nurse if irregular heartbeat, shortness of breath, pronounced dizziness, or nausea occurs.

Avoid alcohol and grapefruit juice use

Sodium Bicarbonate

1. Management of metabolic acidosis

2. Used to alkalinize urine and promote excretion of certain drugs in over dosage situations

3. Used as an antacid

acts as an alkalinizing agent by releasing bicarbonate ions. Following oral administration of this medication, it releases bicarbonate which is capable of neutralizing gastric acid.

1. Assess the client’s fluid balance throughout the therapy. This assessment includes intake and output, daily weight, edema and lung sounds.

2. Symptoms of fluid overload should be reported such as hypertension, edema, difficulty breathing or dyspnea, rales or crackles and frothy sputum.

3. Sigs of acidosis should be assessed such as disorientation, headache, weakness, dyspnea and hyperventilation.

4. Assess for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany and altered breathing pattern.

5. Hypernatremia clinical manifestations should be assessed and monitored which includes: edema, weight gain, hypertension, tachycardia, fever, flushed skin and mental irritability.

6. Hypokalemia should also be assessed by monitoring signs and symptoms such as: weakness, fatigue, U wave on ECG, arrhythmias, polyuria and polydipsia.

7. IV sites should be observed closely. Extravasation should be avoided as tissue irritation or cellulitis may occur when taking sodium bicarbonate.

8. If infiltration occurs, the physician should be notified immediately. Confer with the doctor or other health care staff regarding warm compresses and infiltration site with lidocaine or hyaluronidase.

9. Monitor the client’s serum calcium, sodium, potassium, bicarbonate concentrations, serum osmolarity, acid-base balance and renal function before and throughout the therapy.

10. Tablets must be taken with a full glass of

water.11. For clients taking the medication as a

treatment for peptic ulcers it may be administered 1 and 3 hours after meals and at bedtime.

Epinephrine

Temporary relief of bronchospasm, acute asthmatic attack, mucosal congestion, hypersensitivity and anaphylactic reactions, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest. Ophthalmic preparation is used in management of simple (open-angle) glaucoma, generally as an adjunct to topical miotics and oral carbonic anhydrase inhibitors; also used as ophthalmic decongestant. Relaxes myometrium and inhibits uterine contractions; prolongs action and delays systemic absorption of local and intraspinal anesthetics. Used topically to control superficial bleeding.

Naturally occurring catecholamine obtained from animal adrenal glands; also prepared synthetically. Acts directly on both alpha and beta receptors; the most potent activator of alpha receptors. Strengthens myocardial contraction; increases systolic but may decrease diastolic blood pressure; increases cardiac rate and cardiac output.

Monitor BP, pulse, respirations, and urinary output and observe patient closely following IV administration. Epinephrine may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold epinephrine and notify physician immediately.

Keep physician informed of any changes in intake-output ratio.

Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart immediately available.

Check BP repeatedly when epinephrine is administered IV during first 5 min, then q3–5min until stabilized.

Advise patient to report to physician if symptoms are not relieved in 20 min or if they become worse following inhalation.

Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage should be reduced.

Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.

Patient & Family Education

Be aware intranasal application may sting slightly.

Administer ophthalmic drug at bedtime or following prescribed miotic to minimize mydriasis, with blurred vision and sensitivity to light (possible in some patients being treated for glaucoma).

Transitory stinging may follow initial ophthalmic administration and that headache and browache

occur frequently at first but usually subside with continued use. Notify physician if symptoms persist.

Discontinue epinephrine eye drops and consult a physician if signs of hypersensitivity develop (edema of lids, itching, discharge, crusting eyelids).

Learn how to administer epinephrine subcutaneously. Keep medication and equipment available for home emergency. Confer with physician.

Note: Inhalation epinephrine reduces bronchial secretions and thus may make mucous plugs more difficult to dislodge.

Report tolerance to physician; may occur with repeated or prolonged use. Continued use of epinephrine in the presence of tolerance can be dangerous.

Take medication only as prescribed and immediately notify physician of onset of systemic effects of epinephrine.

Discard discolored or precipitated solutions. Do not breast feed while taking this drug without

consulting physician.

Benadryl

parkinsonism or drug-induced extrapyramidal effects

Antagonizes the effect of histamine at H1 receptor sites; does not bind or inactivate histamine

• Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness.• Tell the client to take the medication with food to decrease GI upset.• Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension.• When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored.• Adverse effects of these drugs occur more commonly in elderly clients.• Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke.

Diazepam

Adjunct in the management of:1) Anxiety2) Preoperative sedation3) Conscious sedation- Provides light anesthesia and anterograde amnesia- Treatment of status epilepticus/ uncontrolled seizures- Skeletal muscle relaxant- Management of the symptoms of alcohol withdrawal

- Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.- Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.- Has anticonvul-sant properties due to enhanced presynaptic inhibi-tion.Therapeutic effects:(1) Relief of Anxiety(2) Sedation(3) Amnesia(4) Skeletal muscle relaxant(5) Decreased seizure activity

- Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.- Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis.- Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies.- Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after administration.- IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption.- Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.- Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

Calcium Gluconate

Calcium gluconate is used to treat conditions arising from calcium deficiencies such as hypocalcaemia tetany and to relieve muscle cramping.

Replaces calcium and maintains calcium level

- Assess for cutaneous burning sensations and peripheral vasodilation, with moderate fall in BP, during direct IV injection.

- Monitor ECG during IV administration to detect evidence of hypercalcemia: decreased QT interval associated with inverted T wave.

- Observe IV site closely. Extravasation may result in tissue irritation and necrosis.

- Monitor for hypocalcemia and hypercalcemia (see Signs & Symptoms, Appendix F).

Lab tests: Determine levels of calcium and phosphorus (tend to vary inversely) and magnesium frequently, during sustained therapy. Deficiencies in other ions, particularly magnesium, frequently coexist with calcium ion depletion

POTASSIUM CHLORIDE

Hypokalemia Replaces and maintains potassium level.

use cautiously in patients with cardiac disease and in those with renal impairment

Alert: IV use: Give by infusion only; never give IV push or IM. give slowly as dilute solution; potentially fatal hyperkalemia may result from too-rapid infusion

Give oral potassium supplements with extreme caution because different forms deliver varying

amounts of potassium. Never switch products without a doctor’s order.

Give oral potassium supplements with extreme caution because different forms deliver varying amounts of potassium. Never switch products without doctor’s order.

make sure powders are completely dissolved before administering

Know that enteric-coated tablets are not recommended because of increased potential for GI bleeding and small bowel ulcerations.

Know that drug is often used orally with potassium-wasting diuretics to maintain potassium levels.

Be aware that sugar free liquid is available; use if tablet or capsule passage is likely to be delayed, such as GI obstruction. Have patients sip slowly to minimize GI irritation.

magnesium sulfate

magnesium sulfate is indicated for the treatment of acute hypomagnesemia accompanied by signs of

inhibits convulsion by acting at the myoneural junction to prevent release of acetylcholine and to

Monitor pulse, blood pressure, repirations and ECG frequently throughout administration of parenteral magnesium sulfate.

o Respirations should be at least 16/min before

tetany, to control hypertension, encephalopathy and convulsions and for the prevention and control of convulsions in patients with pre-eclampsia or eclampsia. It is also used to prevent hypomagnesemia in patients receiving total parenteral nutrition (TPN).

decrease the motor and plate potential. It inhibits the contraction of the uterus by directly acting on the myometrial cells and enhancing uterine blood flow.

administering.

o Monitor neurologic status before and throughout therapy.

o Institute seizure precaution.

o Patellar reflex should be tested before administering, if absent, no additional doses should be administered until positive response is obtained.

o Monitor intake and output ratios. Urine output should be maintained at a level of at least 100ml/4hr.

transdermal patch

clonidine Hypertension, used alone or as part of combination therapy •

Stimulates CNS alpha2-adrenergic receptors, inhibits sympathetic cardioaccelerator and

    WARNING: Do not discontinue abruptly; discontinue therapy by reducing the dosage gradually over 2–4 days to avoid rebound hypertension, tachycardia, flushing, nausea,

Treatment of severe pain in cancer patients in combination with opiates; epidural more effective with neuropathic pain (Duraclon) •

Unlabeled uses: Tourette's syndrome; migraine, decreases severity and frequency;menopausal flushing, decreases severity and frequency of episodes; chronicmethadone detoxification; rapid opiate detoxification (in doses up to 17mcg/kg/day); alcohol and benzodiazepine withdrawal treatment; management ofhypertensive "urgencies"; (oral clonidine "loading" is used; initial dose of 0.2 mgthen 0.1 mg every hour

vasoconstrictor centers, and decreases sympathetic outflow from the CNS

vomiting, cardiac arrhythmias (hypertensive encephalopathy and death have occurred after abrupt cessation of clonidine).

        Do not discontinue prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs readily available.

        Store epidural injection at room temperature; discard any unused portions.

        Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic increases the antihypertensive efficacy of clonidine.

        Monitor BP carefully when discontinuing clonidine; hypertension usually returns within 48 hr.

        WARNING: Remove transdermal patch before defibrillation to prevent arcing.

        Assess compliance with drug regimen in a supportive manner with pill counts, or other methods.

Teaching points

        Take this drug exactly as prescribed. Do not miss doses. Do not discontinue the drug unless so instructed. Do not discontinue abruptly; life-

until a dose of 0.7 mg is reached or until BP is controlled)

threatening adverse effects may occur. If you travel, take an adequate supply of drug.

        Use the transdermal system as prescribed; refer to directions in package insert, or contact your health care provider with questions. Be sure to remove old systems before applying new ones.

        Attempt lifestyle changes that will reduce your blood pressure: Stop smoking and using alcohol; lose weight; restrict intake of sodium (salt); exercise regularly.

        Use caution with alcohol. Your sensitivity may increase while using this drug.

        You may experienc these side effects: Drowsiness, dizziness, light-headedness, headache, weakness (often transient; observe caution driving or performing other tasks that require alertness or physical dexterity); dry mouth (sucking on sugarless lozenges or ice chips may help); GI upset (eat frequent small meals); dreams, nightmares (reversible); dizziness, light-headedness when you change position (get up slowly; use caution climbing stairs); impotence, other sexual dysfunction, decreased libido (discuss with care providers); breast enlargement, sore breasts; palpitations.

        Report urinary retention, changes in

vision, blanching of fingers, rash.

Capoten Hypertension; in conjunction with digitalis and diuretics in CHF, diabetic nephropathy.

Lowers blood pressure by specific inhibition of the angiotensin-converting enzyme (ACE)

1. Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy. (for patients treated with hypertension)

2. For patients treated with CHF, monitor weight and assess patient routinely for resolution of fluid overload. Signs of fluid overload are: peripheral edema, rales or crackles, dyspnea, weight gain and jugular vein distention.

3. The nurse should keep in mind that Captopril may cause false-positive result for urine acetone.

4. The drug should be administered 1 hour before or 2 hours after meals. It may be crushed if the patient has difficulty swallowing.

5. Keep this medication in the container it came in, tightly closed, and out of reach of children.

6. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

7. Throw away any medication that is outdated or no longer needed.

8. Inform the patient that Captopril tablets may have a slight sulfur odor (like rotten eggs).

9. Instruct the patient to notify the physician immediately when the following manifestations are experienced:

chest pain

swelling of the face, eyes, lips, tongue, arms, or legs

difficulty breathing or swallowing fainting rash

salbutamol

For symptomatic relief and prevention of bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchopulmonary disorders such as COPD.

beta 2 adrenoceptor agonist. It binds therefore to Beta 2 receptors found particularly in the bronchioles of the respiratory system

* Use cautiously in patients with cardiovascular disorders. * Syrup is available for children as young as age 2. * Inhaler may be used 15 minutes before exercise to prevent exercise-induced bronchospasm. * Patient may use tablets and inhaler at the same time. Monitor for toxicity. * Warn the patient about the risk of paradoxical bronchospasm and if it occurs, stop drug immediately. * Teach patient to use the inhaler correctly: Shake it, clear the throat, expel as much air as possible from the lungs, inhale deeply while releasing the drug from the inhaler, hold breath for several seconds. * Use of a spacer may improve delivery. * Wait for 2 minutes between puffs of inhaler. * If the patient is also using a steroid inhaler, use the bronchodilator first, then wait 5 minutes before using the steroid. * Wash the canister with warm water and soap at least once a week.

budesonide Management of symptoms of seasonal or perennial allergic

Budesonide controls the rate of protein synthesis,

Inhalation

BLACK BOX WARNING: Taper systemic steroids carefully during transfer to inhalational

rhinitis in adults and children; nonallergic perennial rhinitis in adults

Turbuhaler: Maintenance treatment of asthma as prophylactic therapy in adults and children > 6 yr and for patients requiring corticosteroids for asthma

Inhalation suspension: Maintenance treatment and prophylaxis therapy of asthma in children 12 mo–8 yr

Oral: Treatment and maintenance of clinical remission for up to 3 mo of mild to moderate active Crohn's disease involving the ileum or ascending colon

depresses the migration of polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability and lysosomal stabilisation at the cellular level to prevent or control inflammation.

steroids; deaths from adrenal insufficiency have occurred.

Arrange for use of decongestant nose drops to facilitate penetration if edema, excessive secretions are present.

Prime unit before use for Pulmicort Turbuhaler; have patient rinse mouth after each use.

Use aerosol within 6 mo of opening. Shake well before each use.

Store Respules upright and protected from light; gently shake before use; open envelopes should be discarded after 2 wk.

Nasal inhalation

Prime pump eight times before first use. If not used for 2 consecutive days, reprime with 1 spray or until fine mist appears. If not used for more than 14 days, rinse applicator and reprime with 2 sprays or until fine mist appears.

Oral

Make sure patient does not cut, crush, or chew capsules; they must be swallowed whole.

Administer the drug once each day, in the morning; do not administer with grapefruit juice.

Encourage patient to complete full 8 wk of drug therapy.

WARNING: Monitor patient for signs of hypercorticism—acne, bruising, moon face, swollen ankles, hirsutism, skin striae, buffalo hump—which

could indicate need to decrease dosage.

Teaching points

Inhalation

Do not use more often than prescribed; do not stop without consulting your health care provider.

It may take several days to achieve good effects; do not stop if effects are not immediate.

Use decongestant nose drops first if nasal passages are blocked.

Prime unit before use for Pulmicort Turbuhaler; rinse mouth after each use.

Store Respules upright, protect from light; discard open envelopes after 2 weeks; gently shake before use.

You may experience these side effects: Local irritation (use your device correctly), dry mouth (suck sugarless lozenges).

Report sore mouth, sore throat, worsening of symptoms, severe sneezing, exposure to chickenpox or measles, eye infections.

Oral

Take the drug once a day in the morning. Do not cut, crush, or chew the capsules, they must be swallowed whole.

If you miss a day, take the capsules as soon as you remember them. Take the next day's capsules at the regular time. Do not take more than three capsules in a day.

Take the full course of the drug therapy (8 weeks in most cases).

Do not take this drug with grapefruit juice; avoid grapefruit juice entirely while using this drug.

Store Respules upright, protected from light; discard open envelopes after 2 weeks. Shake before use.

You may experience these side effects: Dizziness, headache (avoid driving or operating dangerous machinery if these effects occur); nausea, flatulence (small, frequent meals may help; try to maintain your fluid and food intake).

Report chest pain, ankle swelling, respiratory infections, increased bruising.

COMBIVENT indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator.

anticholinergic (parasympatholytic) agent which, based on animal studies, appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung. Anticholinergics prevent the increases in intracellular

Check inhaler technique.

- Ensure that patients are able to correctly use the delivery device for their medication and consider use of a space if appropriate.

- If administering by nebulisers use a mouthpiece rather than face mask.

- If administered by nebuliser the dilution of the solution should be adjusted according to equipment and length of administration.

- Paradoxical bronchospasm has occurred with nebulised solution, therefore first dose should be used under medical supervision.

concentration of Ca++ which is caused by interaction of acetylcholine with the muscarinic receptors on bronchial smooth muscle.

- Caution should be taken not to confuse Atrovent with Alupent.

- Evaluate therapeutic response.

Patient teaching- Advise patients not to exceed the prescribed dose.

- Rinse mouth after each use of the inhaler.

- Frequent drinks and the use of sugar-free gum can help with dry mouth.

- Seek medical attention if more than the usual dosage is required.

- Keep delivery devices clean and dry.

- Take a missed dose as soon as remembered unless it is almost time for the next dose. Do not take a double dose.

- Avoid getting in eyes.

Flixotideused to treat persistent asthma in adults and children older than one year. Used regularly, it acts as a preventative medication. Nebuliser forms (discussed as a separate topic) can be used in the management of acute asthma attacks.

reduces the swelling and irritation in the air passages associated with asthma. This will help improve your asthmatic symtoms and make breathing easier

Advice patient thatdrug is for long termmaintenance.Tell the patient not tostop oral or inhaledlong acting betaagonist.Instruct patient on the proper way of druginhalation and not toexceed dose under anycircumstances.Instruct to rinse mouthafter inhalation

Mesna

Prevention of ifosfamide-induced hemorrhagic cystitis (syndrome of bleeding and irritation of the bladder).

Prevention of high-dose cyclophosphamide-induced hemorrhagic cystitis.Note:  If a drug has been approved for one use, physicians may elect to use this

rophylactic agent to reduce the risk of hemorrhagic cystitis induced by ifosfamide.

Monitor urine for hematuria. Be aware that a false-positive test for urinary

ketones may arise in patients treated with mesna. In this test, a red-violet color develops that, with the addition of glacial acetic acid, will turn to violet.

About 6% of patients treated with mesna along with ifosfamide still develop hematuria.

Patient & Family Education

Mesna prevents ifosfamide-induced hemorrhagic cystitis; it will not prevent or alleviate other adverse reactions or toxicities associated with ifosfamide therapy.

Report any unusual or allergic reactions to physician.

Check with physician before using any new

same drug for other problems if they believe it may be helpful.

prescription or OTC medicine.

NALOXONE indicated for the complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids including propoxyphene, methadone, and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol and cyclazocine. Naloxone hydrochloride is also indicated for the diagnosis of suspected or known acute opioid overdosage.

Displacespreviouslyadministerednarcoticanalgesicsfrom theirreceptors.Has nopharmacologicactivity of its own

Safest drug to usewhen causerespiratorydepression isuncertain.Monitor respiratorydepth and rate. Beprepared to provideO2, ventilation andresuscitativemeasures.Also been shown toimprove circulationin refractory shock