drugsss

Generic Name: phytonadione

Brand Name: Vitamin K

Classification: Antidote, Vitamins

Date Ordered: july, 30

Ordered Dose: 1 amp IVTT now @ 9pm

Suggested Dose: 120 micrograms per day

Mechanism of Action: Promotes liver synthesis of clotting factors (II, VII, IX, X); however, the

exact mechanism as to this stimulation is unknown. Menadiol is a water soluble form of vitamin

K; phytonadione has a more rapid and prolonged effect than menadione; menadiol sodium

diphosphate (K4) is half as potent as menadione (K3).

Indication: coagulation disorders

Contraindication: hypersensitivity, hereditary hypoprothrombinemia, overanticoagulants due to

heparin, caution to neonates and elderly patients.

Drug Interactions:

Mineral oil. May decrease serum concentration of Phytonadione.

Orlistat. May decrease serum concentration of Vitamin K

Side Effects:

CV: cyanosis, flushing, hypotension

CNS: dizziness

META: hyperbilirubinemia

GI: abnormal taste

RESPI: dyspnea

MISC: anaphylactic reactions, diaphoresis, hypersensitivity

Nursing Responsibilities:

Assessment:

1. Monitor for frank and occult bleeding.

2. Monitor pulse and blood frequently.

3. Monitor prothrombin time prior to and throughout the therapy.

4. Inform physician for bleeding tendency to prevent further trauma.

Patient/Family Teaching:

1. Instruct patient to take medication as directed.

2. Advise patient to report any unusual bleeding or bruises.

3. Advise patient to inform health care professional of treatment regimen prior to

treatment or surgery.

Generic Name: acetylcysteine

Brand Name: fluimucil

Drug class: Mucolytic, antidote

Date Ordered: august 24,2012

Ordered Dosage: 600mg 1tab PO BID

Mode of Action:

Mucolytic activity: splits link in the mucoproteins contained in respiratory mucus secretions,

decreasing the viscosity of the mucus.

Antidote to acetaminophen hepatoxicity: Protects liver cells by maintaining cell function and

detoxifying acetaminophen metabolites.

Indications:

1. Mucolytic adjuvant therapy for abnormal, viscid, or inpissated mucus secretions in acute and

chronic broncopulmonary disease, in pulmonary complications of cystic fibrosis, and in

tracheostomy care; pulmonary complications associated with surgery; anesthesia, posttraumatic

chest conditions; diagnostic bronchial studies.

2. To prevent or lessen hepatic injury that may occur after ingestion of a potentially hepatotoxic

dose of acetaminophen; treatment must start as soon as possible; most effective if administered

within 8 hr of ingestion, but can be given within 24 hr or longer after ingestion.

Contraindications:

Contraindicated with hypersensitivity to acetylcysteine; use caution and discontinue immediately

if bronchospasm occurs.

Side Effects:

Increased productive cough, nausea, GI upset

Adverse effects:

GI: nausea, stomatitis

Hypersensitivity: urticaria

Respiratory: bronchospasm, especially in patients with asthma

Other: rhinorrhea

Nursing Responsibilities:

1. dilute the 20% acetylcysteine solution with either normal saline or sterile water for injection;

use the 10% solution undiluted. Refrigerate unused, undiluted solution, and use within 96 hour

drug solution in the opened bottle, may change color, but this does not alter safety or efficacy.

2. use water to remove residual drug solution on the patient’s face after administration by face

mask.

3. inform patient that nebulization may produce an initial disagreeable odor, but the odor will

soon disappear

4. monitor nebulizer for buildup of drug from evaporation; dilute with sterile water for injection to

prevent concentrate from impending nebulization and drug delivery.

Generic Name: senna, sennosides

Brand Name: Black Draught, Dr. Caldwell

Dosalax, Fletcher’s Castoria,

Senokot, Senolax

Classification: Laxative-stimulant

Date Ordered: july 30,2012

Ordered Dose: 2 tabs OD @ HS

Suggested Dose: 1-8 tabs/day or ½ to 4 tsp of granules (1tsp-4mL) added to water or juice

Mechanism of Action: stimulates peristalsis by action on Auerbach’s plexus; softens feces by

increasing water, electrolytes in large intestine

Indication: acute constipations, bowel preparation for surgery or examination

Contraindication: hypersensitivity, GI bleeding, obstruction, CHF, lactation, abdominal pain,

nausea/vomiting, appendicitis, acute surgical abdomen

Drug Interactions:

Do not use with disulfiram (Ant-abuse)

Side Effects:

GI: nausea, vomiting, cramps, diarrhea, flatulence

GU: pink, red, brown, or black urine

META: enteropathy

Adverse Effects:

GI: anorexia

META: hypocalcemia, alkalosis, hypokalemia, tetany

Nursing Responsibilities:

Assess:

1. Stool: color, consistency, amount

2. Blood, urine electrolytes if drug is used often

3. I&O ratio to identify fluid loss

4. Cause of constipation; fluids, bulk, exercise missing, constipating drugs

5. Cramping, rectal bleeding, nausea, vomiting; drug should be discontinued

Administer:

1. In morning or evening (oral dose) with full glass of water

2. Dissolve granules in water or juice before administration

3. On empty stomach for more rapid results

4. Shake oral sol before giving

Evaluate:

1. Therapeutic response: decrease in constipation

Teach Patient/Family:

1. That urine, feces may turn yellow-brown to red

2. Not to use laxatives for long-term therapy; bowel tone will be lost

3. That normal bowel movements do not always occur daily

4. Not to use in presence of abdominal pain, nausea, vomiting

5. To notify prescriber if constipation unrelieved or of symptoms of electrolyte imbalance:

muscle cramps, pain, weakness, dizziness, excessive thirst

Generic name: albumin

Brand name: Albuminar; Albutein; Plasbumin.

Classification: Volume expanders

Date ordered: august 21, 2012

Ordered Dose: Albumin 20% 50 cc IVTT q12 for 4hrs

Suggested dose: Dosage is highly individualized and

depends on condition being treated. For shock – 5%; IV

(adults) 500 ml, may be repeated within 30 min; IV (children) 50 ml; IV (infants and neonates)

10-20 ml/kg as a 5% solution.

Ordered dose: Albumin 20% to run at 4 hours OD, 6PM

Indications: Expansion of plasma volume and maintenance of cardiac output in situations

associated with fluid volume deficit, including shock, hemorrhage, and burns. Temporary

replacement of albumin in diseases associated with low levels of plasma proteins, such as

nephritic syndrome or end-stage renal disease, resulting in relief or reduction of associated

edema.

Contraindications: Allergic reaction to albumin, severe anemia, CHF, normal or increased

intravascular volume.

Mode of action: Provides colloidal oncotic pressure, which serves to mobilize fluid from

extravascular tissues back into the intravascular space. Require concurrent administration of

appropriate crystalloid.

Side/adverse effects: headache, pulmonary edema, fluid overload, hypertension, hypotension,

tachycardia, increased salivation, nausea, vomiting, rash, urticaria, back pain, chills, fever,

flushing.

Drug/food interaction: non-significant

Nursing responsibilities:

Monitor vital signs frequently throughout the therapy.

Monitor intake and output throughout the therapy.

Assess for signs of vascular overload (elevated CVP, rales/crackles, dyspnea,

hypertension, jugular vein distension) during and after the therapy.

Monitor serum sodium levels – may cause increased concentration during therapy.

Monitor hemoglobin and hematocrit levels – these values may decrease because of

hemodilution (watch out for bleeding/hemorrhage)

Follow physician’s order of administration promptly.

Make sure to use large gauge of needles when going to administer (at least gauge 20)

Watch out for side/adverse effects of the drugs.

Withhold infusion if fever, tachycardia, or hypotension occurs – notify physician

immediately

Generic Name: Furosemide

Brand Name: Lasix

Drug Class: Loop diuretic

Date Ordered: august 23,2012

Ordered Dosage: 40 mg IVTT post albumin drip

Mode of action:

Inhibits reabsorption of sodium and chloride from the

proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich

dieresis.

Indications:

1. Edema associated with CHF, cirrhosis, renal disease

2. Acute pulmonary edema

3. Hypertension

Contraindications:

Contraindicated with allergy to furosemide, sulfonamides, allergy to tartrazine; anuria, severe

renal failure, hepatic coma; pregnancy, lactation

Side Effects:

Increased volume and frequency of urination, dizziness, feeling faint on arising, drowsiness,

sensitivity to sunlight, increased thirst

Adverse Effects:

CNS: dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue,

blurred vision, tinnitus, irreversible hearing loss

CV: orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis

Dermatologic: photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema

multiforme

GI: nausea, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis,

jaundice

GU: polyuria, nocturia, glycosuria, urinary bladder spasm

Hematologic: leucopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances,

hyperglycemia, hyperuricemia

Other: Muscle cramps and spasms

Drug-Drug Interactions:

>increased risk of cardiac arrhythmias with digitalis glycosides

> increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin

> decreased absorption of furosemide with phenytoin

> Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other

NSAIDs

> decreased GI absorption with charcoal

> May reduce effect of insulin or oral antidiabetes because blood glucose levels can become

elevated

Nursing Responsibilities:

1. Administer with food or milk to prevent GI upset

2. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP

respond

3. Give early in the day so that increased urination will not disturb sleep

4. Measure and record weight to monitor fluid changes

5. Refrigerate oral solution

Generic Name: Cefuroxime

Brand Name: Ceftin

Classification: Cephalosporins

Ordered Dose: 500mg 1 tab q12 PO

Suggested Dose:

Uncomplicated urinary tract infections. Adult: 125 mg bid. 

Respiratory tract infections. Adult: 250-500 mg bid.

Child: >3 mth: 125 mg bid or 10 mg/kg bid. Max dose: 250 mg daily.

Uncomplicated gonorrhoea. Adult: 1 g as a single dose. 1 g oral probenecid may be

given concurrently. 

Otitis media . Child: >2 yr: 250 mg bid or 15 mg/kg bid up to 500 mg daily. 

Intravenous

Meningitis. Adult: 3 g every 8 hr.

Child: 200-240 mg/kg/day in 3-4 divided doses.

Renal impairment:  750-mg bid.

Mode of Action: Act by inhibiting bacterial cell wall synthesis, causing rapid cell destruction.

Their sites of action are enzymes known as penicillin-binding proteins.

Therapeutic Effects: Hinders or kills susceptible bacteria, including many gram-positive

organism and enteric gram-negative bacilli.

Indications:

Uncomplicated urinary tract infections

Respiratory tract infections

Uncomplicated gonorrhoea

Otitis media

Meningitis

Renal impairment

Contraindications: Hypersensitive to cephalosporins.

Drug Interactions:

Drug-Drug. Diuretics. May increase risk of adverse renal reactions.

Probenecid. May inhibit excretion and increase level of cefuroxime.

Drug-Food. Any food: May increase absorption and bioavailability of suspension.

Side Effects: Nausea, vomiting, diarrhoea, GI disturbance

Adverse Effects: Cerebral irritation and convulsions, Stevens-Johnson syndrome, epidermal

necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis.

Nursing Interventions:

1. Asses patient’s condition before therapy and regularly thereafter.

2. Obtain culture and sensitivity specimen before giving first dose; check test results

periodically to assess drug’s effectiveness.

3. Monitor BUN and creatinine levels and urine output for significant changes for patients

with decreased renal function.

4. Monitor PT and platelet count, and assess patient for signs of hypoprothrombinemia

commonly in elderly, debilitated, malnourished, or immunocompromised.

5. Should be taken with food.

6. Use cautiously among patients with severe renal impairment, pregnancy, lactation,

hypersensitivity to penicillins.

7. Observe patient for adverse reactions.

8. Notify physician for any serious or persistent adverse reactions.

9. Instruct patient to take it exactly as prescribed because excessive use can lead to

dependence.

10. Assess patient’s and family’s knowledge of the drug therapy.

Generic Name: ipratropium bromide + albuterol

Brand Name: Combivent

Classification: Antiasthmatics, COPD preparations

Ordered Dose: q 4 hours

Suggested Dose: Two inhalations q.i.d.

Mode of Action: Selectively activates beta2-adrenergic receptors, which results in

bronchodilation, and blocks release of allergic mediators from mast cells in respiratory tract.

Therapeutic Effects:

Improves breathing ability.

Reduces inflammation in the lungs.

Indications: Bronchospasm with COPD in patients who require more than a single

bronchodilator.

Contraindications:

Hypertrophic obstructive cardiomyopathy or tachyarrhythmia.

History of hypersensitivity to soya lecithin or related food products

Drug Interactions:

Drug-Drug. Altizide, althiazide, aminophylline, amphotericin: May add toxicity. Avoid

using together.

Side Effects: Palpitations, headache, dizziness, nervousness, dry mouth, throat irritation.

Adverse Effects: Fine tremor of skeletal muscle, palpitations, urinary retention.

Nursing Interventions:

1. Asses patient’s respiratory condition before therapy and regularly thereafter.

2. Use cautiously among patients who have insufficiently controlled diabetes mellitus,

recent MI, severe organic heart or vascular disorders, hyperthyroidism,

phaeochromocytoma, risk of narrow-angle glaucoma, prostatic hypertrophy or

bladder-neck obstruction; cystic fibrosis. 

3. Observe patient for adverse reactions.

4. Notify physician for any serious or persistent adverse reactions.

5. Evaluate drug effectiveness at regular intervals.

6. Assess patient’s and family’s knowledge of the drug therapy.

Generic Name: fenoterol + ipratropium

Brand Name: Berodual

Classification: Antiasthmatic, COPD Preparations

Ordered Dose: 1neb q8

Suggested Dose: Adult & childn >6 yr : 2 puff for

prompt relief. 

Mode of Action: Selectively activates beta2-adrenergic receptors, which results in

bronchodilation, and blocks release of allergic mediators from mast cells in respiratory tract.

Therapeutic Effects:

Improves breathing ability.

Reduces inflammation in the lungs.

Indications: Prevention & treatment of symptoms in chronic obstructive airway disorders w/

reversible bronchospasm especially with or without chronic bronchitis or emphysema.

Contraindications:

Hypertrophic obstructive cardiomyopathy,

Tachyarrhythmias.

Hypersensitivity to atropine-like substances or soya lecithin or related food products.

Drug Interactions:

Drug-Drug. Altizide, althiazide, aminophylline, amphotericin: May add toxicity. Avoid

using together.

Side Effects: Restlessness, palpitations, dizziness, headache, dry mouth, throat irritation or

allergic reaction, cough.

Adverse Effects: Fine tremor of skeletal muscles, nervousness, paradoxical bronchoconstriction

(rare), urinary retention may occur in patients w/ pre-existing outflow tract obstruction.

Nursing Interventions:

1. Asses patient’s respiratory condition before therapy and regularly thereafter.

2. Use cautiously among patients who are diabetic patients w/ unstable metabolism,

recent MI, severe organic heart or vascular disorders, narrow-angle glaucoma,

hyperthyroidism, pheochromocytoma, prostatic hypertrophy or bladder-neck

obstruction, cystic fibrosis, pregnancy and lactation.

3. Observe patient for adverse reactions.

4. Notify physician for any serious or persistent adverse reactions.

5. Evaluate drug effectiveness at regular intervals.

6. Assess patient’s and family’s knowledge of the drug therapy.

Brand name: Pantoloc, Protonix, Protonix I.V

Generic name: Pantoprazole

Classification: anti-ulcer: proton-pump inhibitor

Ordered dose: 40 mg 1tab OD BID ac

Suggested dose: PO/IV: 30mg daily for 8weeks, then 15 mg daily. 40mg once daily; gastric

hypersecretory conditions – 40mg twice daily up to 120mg twice daily.

Mode of action: binds to an enzyme in the presence of acidic gastric pH, preventing the final

transport of hydrogen ions to gastric lumen.

Drug interaction: may decrease theophylline levels: sucral ate decreases pantoprazole

bioavailability: may interfere with absorption of ampicillin, ketoconazole, digoxin. Food

decreases peak levels.

Indication: to treat peptic and duodenal ulcers, GERD, erosive esophagitis and H. pylori.

Suppresses gastric acid secretion.

Contraindication: hypersensitivity, pregnancy, lactation.

Side effects: headache, dizziness, fatigue, thirst, increase appetite, anorexia, nausea,

diarrhea, constipation, rash.

Adverse reaction: elevated AST, ALT.

Nursing responsibilities:

1. Check the chart for the order.

2. Follow strictly the 10 rules in administering medications.

3. Determine client’s renal function. Report urine output of <600ml ml/d or <25ml/h

4. Assess for fluid and electrolyte imbalances.

5. Measure gastic pH (>5 is desired).

6. Administer drug on an empty stomach.

7. Administer antacid 30minutes before or after sucralfate. Allow 1 to 2 hours to elapse

between sucralfate and other prescribed drugs.

8. Instruct client in the use of relaxation techniques.

9. Monitor for severe, persistent constipation.

10. Teach client to avoid liquids and foods that can cause gastric irritation: alcohol, certain

fats and spices.

Brand Name: Vastarel MR 

Generic Nam: Trimetazidine

Drug Classification: Anti-Anginal Drugs

Ordered dose:35 mg 1tab BID

Suggested dose: Tablets : 10 mg, 20mg

Tablets(extended-release) :30mg, 60mg,120mg

Indication: Long treatment of coronary insufficiency, angina pectoris.

 Adjunctive treatment to heart failure.

 Diffuse esophageal spasm with gastroesophageal reflux.

Mechanism of Act ion :  acts by direct ly  counteract ing al l the major

metabol ic  disorders occurr ingwithin  the ischemic cel l . The act ions of

tr imetazidine  include  l imitat ion of   intracel lular  acidosis, correction of disturbances of

transmembrane ion exchanges, and prevention

of e x c e s s i v e   p r o d u c t i o n   o f   f r e e   r a d i c a l s . d e c r e a s e   m y o c a r d i a l   o x y g e n  

r e q u i r e m e n t   b y d e c r e a s i n g   t h e   h e a r t   r a t e ,   v e n t r i c u l a r   v o l u m e ,   b l o o d  

p r e s s u r e   a n d   c o n t r a c t i l i t y .   I n some cases, myocardial oxygen del ivery is

increased thru reversing coronaryarterial spasm. May reduce cardiac oxygen demand by

decreasing left ventricular end diastolic pressure (preload) and to a lesser extent systemic

vascular resistance(afterload). May increase bloodflow through collateral coronary vessels.

Relieves angina.

Side effects:

CNS: dizziness, headache, weakness.

CV:  ankle edema, fainting, flushing, orthostatic, hypontension, palpitations, tachycardia.

GI: nausea, vomiting

Skin:  cutaneous vasodilation

Others: hypersensitivity, reactions, sublingual burning.

Drug Interaction:

Antihypertensives: May increase hypotensive effects. Monitor patient closely during initial

therapy.

Sildefanil, tadalafil, vardenafil: may increase hypotensive effect. Avoid use together.

Contraindications

: MAOI’s (monoamine oxidase inhibitors)

Nursing responsibilities:

1. Assess patient’s condition before and regularly during therapy.

2. Monitor blood pressure, heart rate and rhythm and intensity and duration of drug

response.

3. Be alert for adverse and drug interactions.

4. To know the drug effectiveness and reaction in the body.

5. To obtain baseline data of the patient.

6. To establish management for possible drug effects.

7. Promote proper guidance and information.

8. Administer crushed tablet on empty stomach either 30 minutes before or 1 to 2 hours

after mealsof feeding

Generic name: Digoxin

Brand Name Digitek, Lanoxicaps, Lanoxin

Classification Cardiac glycoside, Cardiotonic Pregnancy Category C

Ordered dose: 0.25 mg IVTT q12 x 2 days

Suggested dose: Loading dose, 0.75–1.25 mg PO or 0.125–0.25 mg IV. Maintenance dose,

0.125–0.25 mg/day PO. Lanoxicaps capsules Loading dose, 0.4–0.6 mg PO. Maintenance

dose, 0.1 –0.3 mg/day PO.

Mode of action:

Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase

in the force of myocardial contraction. It also reduces the conductivity of the heart through the

atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and

indirect effects mediated primarily by the autonomic nervous system and an increase in vagal

activity.

This medication works by blocking a specific enzyme in the body (known as sodium-potassium

ATPase). This enzyme controls the amount of sodium and potassium that enters the cells.

Blocking this enzyme increases the amount of calcium and potassium inside heart cells. This

helps the heart contract more forcefully with each heartbeat, making it more efficient at pumping

blood throughout the body. It also slows down the rate at which the heart beat

Indications : CHF, Atrial fibrillation

Contraindications:

Side effects:

Get emergency medical help if you have any of these signs of an allergic reaction to Lanoxin:

hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

fast, slow, or uneven heart rate;

bloody or black, tarry stools;

blurred vision, yellowed vision; or

confusion, hallucinations, unusual thoughts or behavior.

Less serious Lanoxin side effects may include:

nausea, vomiting, diarrhea, loss of appetite;

feeling weak or dizzy;

headache, anxiety, depression;

enlarged breasts in men; or

mild skin rash.

Drug interactions:

Many drugs can interact with Lanoxin. Below is just a partial list. Tell your doctor if you are

using:

an antacid, or Kaopectate;

alprazolam (Xanax);

cancer medications;

clonidine (Catapres);

supplements or medications that contain calcium;

a diuretic (water pill), such as spironolactone (Aldactone, Aldactazide);

amphotericin B (Fungizone, AmBisome, Abelcet);

cholestyramine (Questran, Prevalite);

epinephrine (EpiPen);

indomethacin (Indocin);

isoproterenol (Isuprel);

itraconazole (Sporanox);

levothyroxine (Synthroid, Levothroid, and others);

metoclopramide (Reglan);

neomycin (Mycifradin, Neo-Fradin, Neo-Tab);

rifampin (Rifadin, Rifater, Rifamate);

sulfasalazine (Azulfidine); or

an antibiotic such as erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), clarithromycin

(Biaxin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap);

heart or blood pressure medicine such as amlodipine (Norvasc, Caduet, Exforge, Lotrel,

Tekamlo, Tribenzor, Twynsta, Amturnide), carvedilol (Coreg), diltiazem (Cardizem,

Cartia, Dilacor, Diltia, Diltzac, Taztia, Tiazac), metoprolol (Dutoprol, Lopressor, Toprol),

nebivolol (Bystolic), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin,

Verelan, Tarka), and others;

decongestant cold or allergy medicine, or nasal sprays such as Afrin, Duramist, Neo-

Synephrine, Tysine Nasal, and others;

a heart rhythm medication such as amiodarone (Cordarone, Pacerone), propafenone

(Rythmol), or quinidine (Quin-G); or

steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex),

dexamethasone (Decadron, Hexadrol) and others.

Nursing responsibilities:

WARNING: Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult

or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and

notify prescriber. Note any change from baseline rhythm or rate. Take care to differentiate

Lanoxicaps from Lanoxin; dosage is very different Check dosage and preparation carefully.

Avoid IM injections, which may be very painful. Follow diluting instructions carefully, and use

diluted solution promptly. Avoid giving with meals; this will delay absorption. Have emergency

equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor readily

available in case toxicity develops.

WARNING: Monitor for therapeutic drug levels: 0.5–2 ng/mL.

Nursing responsibilities:

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.

Observe patients closely when being transferred from one preparation (tablet, elixir, or

parenteral) to another; when tablet is replaced by elixir potential for toxicity increases

since  30% of drug is absorbed.

Patient & Family Education

Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats

or other changes in rhythm, when digoxin is prescribed for atrial fibrillation.

Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea,

vomiting, diarrhea, or visual disturbances.

Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.

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.

Generic Name: Potassium Chloride

Brand Name: Kalium® [durule]

Classification: Electrolytes

Ordred dose: 1tab TID x3

Mode of action: Supplemental potassium in the form of high potassium food or potassium

chloride may be able to restore normal potassium levels. Provides a direct replacement of

potassium in the body.

Indication: Hypokalemia. Prophylaxis during treatment w/ diuretics.

Contraindication:

Renal insufficiency, hyperkalemia, untreated Addison'sdisease, constriction of the esophagus

&/or obstructive changes in thealimentary tract.

Side/ Adverse Effect: Diarrhea, nausea, stomach pain, discomfort or gas vomiting

Drug interactions: Hyperkalemia with potassium phosphate IV and products containing calcium

or magnesium; potassium-sparing diuretics, or other potassium products, ACEinhibitor

Nursing Responsibilities:

Watch out for levels of potassium electrolyte level to prevent hyperkalemia.

Observe 10 rights of giving medication.

Assess:

1.ECG for peaking T waves, lowered R, depressed RST, prolonged P-Rinterval, widening QRS

complex, hyperkalemia; drug should be reducedor discontinued

2.Potassium level during treatment (3.5 – 5 mg/dl is normal level)

3.I&O ratio: watch for decreased urinary output; notify prescriber immediately

4.Cardiac status: rate, rhythm, CVP, PWP, PAWP, if being monitored directly

Administer:

1.If PO: with meal or pc; DO NOT GIVE IM, OR SQ

2.IV route: through large-bore needle to decrease vein inflammation; checkfor extravasation

3.IV route: after diluting in large volume of IV solution and give as aninfusion, slowly by IV

infusion to prevent toxicity, never

give as an IVbolus or IMPerform/Provide:

1.Storage at room temperatureEvaluate:

1.Therapeutic response: absence of fatigue, muscle weakness, decreasedthirst and

urinary output, cardiac changes

.

To avoid OTC products: antacids, salt substitutes, analgesics, vitaminpreparations, unless

specifically directed by prescriber

2.To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea,vomiting, fainting,

decreased output) or continued hypokalemia symptoms(fatigue, weakness, polyuria, polydipsia,

cardiac changes)

3.To dissolve powder or tablet completely in at least 120 mL water or juice

Generic Name: propranolol hydrochloride

Brand Name: inderal

Ordered dose: 10 mg 1tab q8

Mode of action:

The mechanism of the antihypertensive effect of propranolol has not been established. Factors

that may contribute to the antihypertensive action include: (1) decreased cardiac output, (2)

inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow

from vasomotor centers in the brain. Although total peripheral resistance may increase initially, it

readjusts to or below the pretreatment level with chronic use of propranolol. Effects of

propranolol on plasma volume appear to be minor and somewhat variable.

In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any

given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic

blood pressure, and the velocity and extent of myocardial contraction. Propranolol may increase

oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and

systolic ejection period. The net physiologic effect of beta-adrenergic blockade is usually

advantageous and is manifested during exercise by delayed onset of pain and increased work

capacity.

Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic

blockade, and this appears to be its principal antiarrhythmic mechanism of action. In dosages

greater than required for beta-blockade, propranolol also exerts a quinidine-like or anesthetic-

like membrane action, which affects the cardiac action potential. The significance of the

membrane action in the treatment of arrhythmias is uncertain.

The mechanism of the antimigraine effect of propranolol has not been established. Beta-

adrenergic receptors have been demonstrated in the pial vessels of the brain.

The specific mechanism of propranolol's antitremor effects has not been established, but beta-2

(noncardiac) receptors may be involved. A central effect is also possible. Clinical studies have

demonstrated that propranolol hydrochloride is of benefit in exaggerated physiological and

essential (familial) tremor. The mechanism of the antihypertensive effect of propranolol has not

been established. Factors that may contribute to the antihypertensive action include: (1)

decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of

tonic sympathetic nerve outflow from vasomotor centers in the brain. Although total peripheral

resistance may increase initially, it readjusts to or below the pretreatment level with chronic use

of propranolol. Effects of propranolol on plasma volume appear to be minor and somewhat

variable.

Indications:

Inderide is indicated in the management of hypertension.

This fixed combination is not indicated for initial therapy of hypertension. Hypertension requires

therapy titrated to the individual patient. If the fixed combination represents the dosage so

determined, its use may be more convenient in patient management.

Contraindication:

Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than

first degree block; 3) bronchial asthma; and 4) in patients with known hypersensitivity to

propranolol hydrochloride.

Side effects:

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult

breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

fast, slow, or uneven heartbeats

feeling light-headed, fainting

feeling short of breath, even with mild exertion

swelling of your ankles or feet

nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools,

jaundice (yellowing of the skin or eyes)

cold feeling in your hands and feet

depression, confusion, hallucinations; or

severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your

eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face

or upper body) and causes blistering and peeling

Less serious side effects may include:

nausea, vomiting, diarrhea, constipation, stomach cramps

decreased sex drive, impotence, or difficulty having an orgasm

sleep problems (insomnia); or

tired feeling

Drug interactions:

CYP1A2, 2C18, 2C19, and 2D6 enzyme substrate

Alpha-blockers (prazosin, terazosin): Concurrent use of beta-blockers may increase risk of

orthostasis.

Cimetidine increases the plasma concentration of propranolol and its pharmacodynamic effects

may be increased.

Clonidine: Hypertensive crisis after or during withdrawal of either agent.

Drugs which slow AV conduction (digoxin): Effects may be additive with beta-blockers.

Epinephrine (including local anesthetics with epinephrine): Propranolol may cause hypertension.

Flecainide: Pharmacological activity of both agents may be increased when used concurrently.

Fluoxetine may inhibit the metabolism of propranolol, resulting in cardiac toxicity.

Glucagon: Propranolol may blunt hyperglycemic action.

Haloperidol: Hypotensive effects may be potentiated.

Hydralazine: The bioavailability propranolol (rapid release) and hydralazine may be enhanced

with concurrent dosing.

Insulin: Propranolol inhibits recovery and may cause hypertension and bradycardia following

insulin-induced hypoglycemia. Also masks the tachycardia that usually accompanies insulin-

induced hypoglycemia.

NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam) may reduce the antihypertensive

effects of beta-blockers.

Salicylates may reduce the antihypertensive effects of beta-blockers.

Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents.

Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken

concurrently with beta-blockers; avoid concurrent I.V. use of both.

Nursing responsibilities:

1. Patient's therapeutic response may be evaluated by looking at blood pressure, apical

and radial pulses, fluid I & O, daily weight, respirations, and circulation in extremities

before and during therapy

2. Take exactly as directed; do not increase, decrease, or discontinue without consulting

prescriber. Take at the same time each day. Tablets may be crushed and taken with

liquids.

3. Do not alter dietary intake of protein or carbohydrates without consulting prescriber.

4. Watch out for nausea, vomiting, or stomach discomfort (small frequent meals, frequent

mouth care, chewing gum, or sucking lozenges may help);

5. If diabetic, monitor serum glucose closely.

6. Report unusual swelling of extremities, difficulty breathing, unresolved cough, or unusual

weight gain, cold extremities, persistent diarrhea, confusion, hallucinations, headache,

nervousness, lack of improvement, or worsening of condition.

Generic: Spironolactone

Brand: Aldizide, Aldactone

Classification: potassium-sparring diuretic

Ordered dose: 25mg OD

Mode of Action

Competes with aldosterone at receptor sites at distal tubules, resulting in excretion of Sodium

Chloride, water, retention of Potassium and phosphate.

Indications:

Edema of congestive heart failure, hypertension, diuretic induced hypokalemia, primary

hyperaldosteronism, edema of nephrotic syndrome, liver cirrhosis with ascites

Why is it indicated to the client? Client has ascites as a result of congestive heart failure. Also,

the ultrasound of the whole abdomen revealed that client has cirrhosis.

Contraindications:

Pregnancy, hypersensitivity, anuria, severe renal disease, hyperkalemia

Drug/food interaction:

• Decreased effect of anticoagulant,

• Increase action of antihypertensives, digitalis

• Increase hyperkalemia; Potassium-sparing diuretics, potassium products, ACE inhibitors

• Decrease effect of spironolactone; ASA

• Increase effect; cucumber, licorice, pumpkin

Adverse Effects:

headache, drowsiness, lethargy, confusion, ataxia

GastrointestinaI: diarrhea, gastric bleeding, ulceration, cramping, gastritis, vomiting, diarrhea

Genito-Urinary: impotence, menstrual disturbance

electrolytes: hyperkalemia, hyponatremia, mild acidosis, dehydration

integumentary: urticaria, hirsutism, maculopapular eruptions, erythematus rash

OTHER: drug fever, gynecomastia, breast soreness, anaphylaxis, angioedema

Nursing Responsibilities:

1. Monitor electrolyte, Sodium, Calcium, Potassium, BUN, serum creatinine, ABGs and CBC

2. Weigh patient daily, monitor intake and output to determine fluid loss

3. Assess for signs of metabolic acidosis such as drowsiness and restlessness

4. Watch out for rashes and increase in temperature (drug fever)

5. instruct clients to avoid food with high potassium content such as bananas, oranges, dried

apricots

6. instruct patient to notify presciber should he feel cramps, diarrhea, lethargy, headache, skin

rashes, deepening voice, and breast enlargement

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin

Generic name: Tranexamic acid

Classification: Anti-fibrinolytic, antihemorrhagic

Ordered dose: 500 g IVTT q8

Mechanism of Action:

Tranexamic acid is a 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. The plasminogen-plasmin enzyme system is known to cause

coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By

inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive

breakdown of fibrin and effect physiological hemostasis.

Indications:

CYKLOKAPRON (tranexamic acid) Injection is indicated in patients with hemophilia for short-

term use (two to eight days) to reduce or prevent hemorrhage and reduce the need for

replacement therapy during and following tooth extraction

Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical

and clinical areas:

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.

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.

Contraindications

1. Allergic reaction to the drug or hypersensitivity

2. Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are

at risk for blood clots

3. Current administration of factor IX complex concentrates or anti-inhibitor coagulant

concentrates

CYKLOKAPRON (tranexamic acid) Injection is contraindicated:

1. In patients with acquired defective color vision, since this prohibits measuring one endpoint

that should be followed as a measure of toxicity (see WARNINGS).

2. In patients with subarachnoid hemorrhage. Anecdotal experience indicates thatcerebral

edema and cerebral infarction may be caused by CYKLOKAPRON (tranexamic acid) in such

patients.

3. In patients with active intravascular clotting.

Side effects:

Applies to: compounding powder; intravenous solution; oral tablet

Gastrointestinal

Gastrointestinal side effects have frequently included nausea, vomiting, and diarrhea.

Abdominal pain has also been reported.

Nervous system

Nervous system side effects have included giddiness, dizziness, headache, tension headache,

and migraine.

Hematologic

Hematologic side effects have included thromboembolic events (e.g., deep vein thrombosis,

pulmonary embolism, cerebral thrombosis, acute renal cortical necrosis, and central retinal

artery and vein obstruction) and anemia.

Hypersensitivity

Hypersensitivity side effects have included allergic skin reactions, anaphylactic shock and

anaphylactoid reactions.

A case of severe allergic reaction to tranexamic acid was reported involving a subject on her

fourth cycle of treatment who experienced dyspnea, tightening of her throat, and facial flushing

that required emergency medical treatment.

Ocular

Ocular side effects have rarely included disturbances of color vision and retinal artery occlusion.

Musculoskeletal

Musculoskeletal side effects have included back pain, musculoskeletal pain, muscle cramps

and spasms, myalgia, and arthralgia including joint stiffness and swelling.

Respiratory

Respiratory side effects have included nasal and sinus symptoms including nasal, respiratory

tract and sinus congestion, sinusitis, acute sinusitis, sinus headache, and allergic sinusitis and

sinus pain.

Cardiovascular

Cardiovascular side effects have included hypotension when intravenous administration

exceeded 1 mL per minute.

Genitourinary

Genitourinary side effects have included ureteral obstruction due to clot formation in patients

with upper urinary tract bleeding.

Drug interactions:

Tranexamic acid causes additive toxicity with retinoic acid

Tranexamic acid causes additive toxicity with tretinoin

Tranexamic acid causes additive toxicity with tretinoin tocoferil

Increased risk of thrombus formation with estrogens, Factor IX complexconcentrates or anti-

inhibitor coagulant concentrates. Increased risk of fatalthrombotic complications withtretinoinin

acute promyelocytic leukaemia

Nursing Responsibilities

1. Unusual change in bleeding pattern should be immediately reported to the physician.

2. For women who are taking Tranexamic acid to control heavy bleeding, the medication

should only be taken during the menstrual period.

3. 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.

4. The medication can be taken with or without meals.

5. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew

before swallowing.

6. 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.

7. Inform the client that he/she should inform the physician immediately if the following

severe side effects occur:

Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest,

swelling of the mouth, face, lips or tongue

Calf pain, swelling or tenderness

Chest pain

Confusion

Coughing up blood

Decreased urination

Severe or persistent headache

Severe or persistent body malaise

Shortness of breath

Slurred speech

Slurred speech

Vision changes

GENERIC NAME: amiodarone

BRAND NAME: Cordarone

Classification: anti-arrhythmic

Ordered dose: 150mg IV in 10 mis now

Suggested dose:

The recommended dosing schedule is an initial loading dose of 800-1600 mg daily for 1 to 3

weeks, followed by 600-800 mg daily for 1 month, then 400 mg daily for maintenance.

Response should be closely monitored and dosing is individualized for each patient.

Amiodarone may be administered once daily or given twice daily with meals to minimize

stomach upset which is seen more frequently with higher doses.

Mode of action:

Amiodarone is an oral and injectable drug that is used to correct abnormal rhythms of the heart.

(It is an antiarrhythmic medication.) Although amiodarone has many side effects, some of which

are severe and potentially fatal, it has been successful in treating many arrhythmias when other

antiarrhythmic drugs have failed. Amiodarone is considered a "broad spectrum" antiarrhythmic

medication, that is, it has multiple and complex effects on the electrical activity of the heart

which is responsible for the heart's rhythm. Among its most important electrical effects are:

a delay in the rate at which the heart's electrical system "recharges" after the

heart contracts (repolarization);

a prolongation in the electrical phase during which the heart's muscle cells are

electrically stimulated (action potential);

a slowing of the speed of electrical conduction (how fast each individual impulse

is conducted through the heart's electrical system);

a reduction in the rapidity of firing of the normal generator of electrical impulses

in the heart (the heart's pacemaker);

a slowing of conduction through various specialized electrical pathways (called

accessory pathways) which can be responsible for arrhythmias.

In addition to being an antiarrhythmic medication, amiodarone also causes blood vessels to

dilate (enlarge). This effect can result in a drop in blood pressure. Because of this effect, it also

may be of benefit in patients with congestive heart failure.

Indication:

Cordarone is indicated only for the treatment of the following documented, life-threatening

recurrent ventricular arrhythmias when these have not responded to documented adequate

doses of other available antiarrhythmics or when alternative agents could not be tolerated.

1. Recurrent ventricular fibrillation.

2. Recurrent hemodynamically unstable ventricular tachycardia.

As is the case for other antiarrhythmic agents, there is no evidence from controlled trials that

the use of Cordarone Tablets favorably affects survival.

Cordarone should be used only by physicians familiar with and with access to (directly or

through referral) the use of all available modalities for treating recurrent life-threatening

ventricular arrhythmias, and who have access to appropriate monitoring facilities, including in-

hospital and ambulatory continuous electrocardiographic monitoring and electrophysiologic

techniques. Because of the life-threatening nature of the arrhythmias treated, potential

interactions with prior therapy, and potential exacerbation of the arrhythmia, initiation of therapy

with Cordarone should be carried out in the hospital.

Contraindication:

Cordarone is contraindicated in patients with cardiogenic shock; severe sinus-node

dysfunction, causing marked sinus bradycardia; second- or third-degree atrioventricular block;

and when episodes of bradycardia have caused syncope (except when used in conjunction with

a pacemaker).

Cordarone is contraindicated in patients with a known hypersensitivity to the drug or to any of its

components, including iodine.

DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your

medications work or increase your risk for serious side effects. This document does not contain

all possible drug interactions. Keep a list of all the products you use (including

prescription/nonprescription drugs and herbal products) and share it with your doctor and

pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's

approval.A product that may interact with this drug is: fingolimod.Many drugs besides

amiodarone may affect the heart rhythm (QT prolongation), including dofetilide, pimozide,

procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), quinolone

antibiotics (such as levofloxacin), among others. (See also Precautions section.)Other

medications can affect the removal of amiodarone from your body, which may affect how

amiodarone works. Examples include azole antifungals (such as itraconazole), cimetidine,

protease inhibitors (such as indinavir), rifamycins (such as rifampin), St. John's wort, among

others.Amiodarone can slow down the removal of other medications from your body, which may

affect how they work. Examples of affected drugs include beta blockers (such as propranolol),

calcium channel blockers (such as diltiazem, verapamil), clopidogrel, cyclosporine, digoxin,

phenytoin, certain "statin" drugs (atorvastatin, lovastatin, simvastatin), trazodone, warfarin,

among others.

Sid effects:

Side effects that you should report to your doctor or health care professional as soon as

possible:

allergic reactions  like skin rash, itching or hives, swelling of the face, lips, or tongue

breathing problems

chest pain

dark urine

fast, irregular heartbeat

feeling faint or light-headed

intolerance to heat  or cold

nausea or vomiting

pain and swelling of the scrotum

pain, tingling, numbness in feet, hands

spitting up blood

stomach pain

sweating

unusual or uncontrolled movements of body

unusually weak or tired

weight gain or loss

yellowing of the eyes or skin

nursing rsponsibilities:

Injection

1. For IV infusion only; initial infusion rate should not exceed 30 mg/min.

2. Administer by volumetric infusion pump using polyvinyl chloride tubing and an in-line

filter.

3. Prepare infusions that will exceed 2 h in glass or polyolefin bottles containing 5%

dextrose in water. Do not use evacuated glass containers because incompatibility of

amiodarone with a buffer in container may cause precipitation.

4. Injection solution (50 mg/mL): To prepare first rapid loading infusion, add 3 mL (150 mg)

of IV amiodarone to 100 mL of 5% dextrose in water (concentration = 1.5 mg/mL).

5. Injection solution (50 mg/mL): To prepare 6 h slow loading infusion and 18 h initial

maintenance infusion, add 18 mL (900 mg) of IV amiodarone to 500 mL of 5% dextrose

in water (concentration = 1.8 mg/mL)

6. Injection solution (50 mg/mL): For maintenance infusions after first 24 h, use infusion

solutions containing 1 to 6 mg/mL.

7. Administer concentrations greater than 2 mg/mL via central venous catheter.

8. Premix injection: Administer 1.5 mg/mL strength for first rapid loading infusion, followed

by 1.8 mg/mL strength.

9. Solution should be clear and may have a pale yellow coloration. Do not administer if

solution is discolored or cloudy, or contains particulate matter.

10. Amiodarone should not be combined with any product in the same IV line or premixed

container.

11. The premix container is for single-use only, discard any unused portion. No further

dilution is required. Do not combine with any product in the same IV line or premixed

container.

12. IV loading infusions at much higher concentrations and rates of infusion much faster

than recommended have resulted in hepatocellular necrosis and acute renal failure

leading to death.

13. Amiodarone has been found to leach out plasticizers, including diethylhexyl phthalate

from IV tubing (including polyvinyl chloride tubing).

14. Tablets

15. Administer consistently either with food or on an empty stomach. Administer with food if

GI upset occurs. Administer doses greater than 1,000 mg in divided doses with food.

16. Administer maintenance doses as a single daily dose or, in patients with severe GI

intolerance, divide into 2 daily doses.

17. The loading phase should be performed in a hospital setting.

18. Upon starting therapy, attempt to gradually discontinue prior antiarrhythmic drugs.

MONITOR

Monitor effectiveness in long-term prevention of ventricular tachycardia and ventricular

fibrillation using ambulatory monitoring, programmed electrical stimulation, or a combination

of these, as appropriate. Monitor for hypotension, especially during the first few hours of IV

infusion. Close perioperative monitoring is recommended in patients undergoing general

anesthesia. Closely monitor FiO 2 and the determinants of oxygen delivery to the tissues

(eg, SaO 2 , PaO 2 ). Close clinical monitoring is recommended during the loading phase.

Generic Name:rebamipide

Brand Name:Mucosta

Classification:antiulcerant, cytoprotective

Ordered dose: 100g 1tab TID

Suggested Dose:1 tab tid, to be taken in the morning, evening & before bedtime

Mode of Action:It works by enhancing mucosal defense, scavenging free radicals,and

temporarily activating genes encodingcyclooxygenase-2

Indication:acute gastritis, acute exacerbation of chronic gastritis, PUD

Contraindication:lactation

Drug Interaction:

1.Rebamipide has shown no remarkable interaction with other drugs

Side Effects:

GI: nausea, vomiting, constipation, diarrhea

INTEG: rash

Adverse Effects:

INTEG: pruritus

Nursing Responsibilities:

Assess:

1.Gastric pH (>5 should be maintained)

2.Blood in stools, Hematemesis

3.Side Effects: n/v, pruritus, constipation, diarrhea; drug may have to bediscontinued

Administer

On an empty stomach, 1 hour before meals and at bedtime

Do not crush or chew tablets; it can be broken or dissolved in water;

donot take antacids 30 minutes before or after taking the drug3.With full glass of water to

maintain adequate hydration

Evaluate:

1. Therapeutic response: absence of pain

Teach patient/family:

1.To take on an empty stomach

2.To avoid antacids within ½ hours of taking the drug

Generic name: piperacillin Tazobactam

Brand name: Zosyn

Classification: antibiotic

Ordered dose: 4.5 g IVTT (-) ANST

Mode of action:

PIPERACILLIN; TAZOBACTAM (pi PER a sil in; ta zoe BAK tam) is a penicillin

antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or

other viral infections. Piperacillin is a penicillin-type antibiotic that works by stopping the growth

of bacteria. Tazobactam is an enzyme inhibitor (beta-lactamase inhibitor) that helps the

piperacillin work better.

Indication:

used to treat many different infections caused by bacteria, such as urinary tract

infections, bone and joint infections, severe vaginal infections, stomach infections, skin

infections, and pneumonia. It is a combination of two antibiotics.

Contraindication:

allergic to either of the drugs; or to penicillin, cephalosporin, or beta-lactam antibiotics; or

to other beta-lactamase inhibitors such as sulbactam; or if you have any other allergies.

This product may contain inactive ingredients, which can cause allergic reactions or

other problems.

Before using this medication, tell your doctor or pharmacist your medical history,

especially of: bleeding problems, cystic fibrosis, kidney disease, seizures.

This medication contains sodium. Consult your doctor or pharmacist if you are on a salt-

restricted diet or if you have a condition that could be worsened by an increase in salt

intake (e.g., congestive heart failure, high blood pressure).

Before having surgery, tell your doctor or dentist that you are using this medication.

Kidney function declines as you grow older. This medication is removed by the kidneys.

Therefore, elderly people may be at greater risk for side effects while using this drug,

especially salt retention.

Side effects:

swelling, redness, pain, or soreness at the injection site. Dizziness, trouble sleeping,

nausea, vomiting, diarrhea, or headache may also occur.

Drug interactions:

Potentiated by probenecid. May potentiate non-depolarizing muscle relaxants (eg,

vecuronium). Monitor methotrexate, heparin, anticoagulants. False (+) Clinitest or Coomb's test.

Some products that may interact with this drug include: "blood thinners" (e.g.,

enoxaparin, heparin, warfarin), live bacterial vaccines, cancer chemotherapy, lithium,

methotrexate, probenecid, tetracyclines, "water pills" (diuretics such as furosemide,

hydrochlorothiazide)

Nursing responsibilities:

1. Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to

administration.

2. Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor

hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and

platelet count).

3. Monitor patient carefully during the first 30 min after initiation of the infusion for signs of

hypersensitivity (see Appendix F).

4. Check for rash, itching, or other signs of hypersensitivity immediately.

5. Report loose stools or diarrhea as these may indicate pseudomembranous colitis.

6. Check the injection site for redness,pain, signs of infection.

Generic name: Carbimazole

Brand name: Neomercazole

Classification: Anti-thyroid agent

Ordered dose: 20 mg 1tab q12

Suggested dose:

The initial dose is in the range of 20-60 mg and should be titrated against thyorid

function until the patient is euthyorid in order to reduce the risk of over-treatment and resultant

hypothyoridism. Subsequent therapy may then be administered in one of two ways:

Maintenance regimen: Final dosage is usually in the range of 5-15 mg per day, which may be

taken as a single daily dose. Therpay should be continued for at least six, and up to 18 months.

Serial thyroid function monitoring is recommended, together with appropriate dosage

modification in order to maintain an euthyorid state.

Blocking-replacement regimen: Dosage is maintained at the intial level, i.e. 20-60 mg per day,

and supplemental l-thyorxine, 50-150 mcg per day, is administered concomitantly, in order to

prevent hypothyoridism. Therapy should be continued for at least six months and up to eighteen

months.

Where a single dosage of less than 20 mg is recommended, it is intended that NeoMercazole 5

should be taken.

Elderly

No special dosage regimen is required, but care should be taken to observe the

contraindications and warnings as it has been reported that the risk of a fatal outcome to

neutrophil dycrasia may be greater in the elderly (aged 65 or over).

Children

The usual intial daily dose is 15 mg per day.

Mode of action:

Neo-Mercazole works by decreasing the amount of thyroid hormones produced by the

thyroid gland. Iodine is a chemical used by the thyroid gland in the formation of thyroid

hormones. Iodine must be converted in the body to a useable form before it may be combined

with other components to form thyroid hormones. Neo-Mercazole acts to prevent the conversion

of iodine to its usable form. It also acts to block the combination of converted iodine with other

components to form thyroid hormones. This therefore results in decreased production of thyroid

hormones. As a result, Neo-Mercazole is useful in the treatment of conditions where excessive

amounts of thyroid hormones are being produced (hyperthyroidism).

Indication:

Neo-Mercazole is a medicine used to decrease the amount of thyroid hormones

produced by the thyroid gland. It is used to treat conditions resulting in an overactive thyroid

gland (hyperthyroidism )

Indicated to conditions where reduction of thyroid function is required, such as:

Hyperthyroidism

Preparation for thyoridectomy in hyperthyoridism

Therapy prior to and post radio-iodine treatment

Contraindication:

contrainidicated in patients with a previous history of adverse reactions to carbimazole or

to any of the excipients in the composition. Serious, pre-existing hematological conditions,

severe hepatic insufficiency.

Side effects:

Adverse reactions usually occur in the first eight weeks of treatment. The most

frequently occuring reactions are nausea, headacha, arthralgia, mild gastric distress, skin

rashes and pruritus. These reactions are usually self-limiting and may not require withdrawal of

the drug.

Blood and Lymphatic System Disorders

Bone marrow depression including neutropenia, eosinophilia, leukopenia,

agranulocytosis has been reported. Fatalities with carbimaole-induced

agranulocytosis have been reported. Rare cases of pancytopenia/aplastic

anemia and isolated thrombocytopenia have also been reported. Additionally,

very rare cases of hemolytic anemia have been reported.

Patients should always be warned about the onset of sore throats, bruising or

bleeding, mouth ulcers, fever, malaise and should be instructed to stop the drug

and to seek medical advice immediately. In such patients, blood cell counts

should be performed immediately, particularly where there is any clinical

evidence of infection.

Nervous System Disorders

Headache.

Gastrointestinal System Disorders

Nausea, mild gastric distress. Loss of the sense of taste has been observed.

General Disorders and Administration Site Conditions

Fever, malaise.

Hepatobiliary System Disorders

Hepatic disorders, including abnormal liver function tests, hepatitis, cholestatic hepatitis,

cholestatic jaundice and most commonly jaundice, have been reproted; in these cases

carbimazole should be withdrawn.

Injury, Poisoning and Procedural Complicatons

Bruising.

Skin and Subcutaneous Tissue Disorders

Skin rashes, pruritus, urticaria. Hair loss has been occasionally reported.

Musculoskeletal System Disorders

Isolated cases of myopathy have been reported. Patients experiencing mylagia after the

intake of NeoMercazole should have their creatine phosphokinase levels monitored.

Hypersensitivity and Allergic Raections

Angioedema and multi-system hypersensitivity reactions such as cutaneous vasculitis,

liver, lung and renal effects occur.

Vascular Disorders

Bleeding.

Drug interactions:

ittle is known about interactions.

Particular care is required in case of concurrent administration of medication capable of

inducing agranulocytosis. Since carbimazole is a vitamin K antagonist, the effect of

anticoagulants could be intensified.

The serum levels of theophylline can increase and toxicity may develop if hyperthyroidic

patients are treated with anti-thyroid medications without reducing the theophylline dosage.

Nursing responsibilities:

Generic name: Dabigatran etexilate

Brand name: Pradaxa

Classification: blood thinners

Ordered dose: 110 mg 1tab OD

Suggested dose: Swallow whole. CrCl>30mL/min: 150mg twice daily. Severe renal impairment

(CrCl 15–30mL/min): 75mg twice daily; CrCl<15mL/min or on dialysis: not recommended.

Moderate renal impairment (CrCl 30–50mL/min) with concomitant dronedarone or systemic

ketoconazole: consider reducing dose to 75mg twice daily. Severe renal impairment (CrCl 15–

30mL/min) with concomitant P-gp inhibitors: avoid. Converting from warfarin, other

anticoagulants: see literature. Take missed dose as soon as possible on same day; skip dose if

it cannot be taken at least 6 hours before the next scheduled dose; do not double doses

For patients with creatinine clearance (CrCl) >30 mL/min, the recommended dose of

Pradaxa is 150 mg taken orally, twice daily, with or without food. For patients with severe renal

impairment (CrCl 15-30 mL/min), the recommended dose of Pradaxa is 75 mg twice daily

Mode of action:

Pradaxa (dabigatran etexilate mesylate) is a competitive, direct thrombin inhibitor.

Because thrombin (serine protease) enables the conversion of fibrinogen into fibrin during the

coagulation cascade, its inhibition prevents the development of a thrombus. Both free and clot-

bound thrombin, and thrombin-induced platelet aggregation are inhibited by the active moieties

Pradaxa (dabigatran etexilate mesylate) is a competitive, direct thrombin inhibitor.

Because thrombin (serine protease) enables the conversion of fibrinogen into fibrin during the

coagulation cascade, its inhibition prevents the development of a thrombus. Both free and clot-

bound thrombin, and thrombin-induced platelet aggregation are inhibited by the active

moieties.Pradaxa is specifically indicated to reduce the risk of stroke and systemic embolism in

patients with non-valvular atrial fibrillation.

Indication:

indicated to reduce the risk of stroke and systemic embolism in patients with non-

valvular atrial fibrillation.

Contraindication:

Pradaxa is contraindicated in patients with:

Active pathological bleeding

History of a serious hypersensitivity reaction to Pradaxa (e.g., anaphylactic reaction or

anaphylactic shock)

Side effects:

o bleeding

gastrointestinal events (dyspepsia, nausea, upper abdominal pain, gastrointestinal

hemorrhage, and diarrhea)

Drug interactions:

o The concomitant use of PRADAXA with P-gp inducers (e.g., rifampin) reduces

exposure to dabigatran and should generally be avoided [see CLINICAL

PHARMACOLOGY].

o P-gp inhibition and impaired renal function are the major independent factors that

result in increased exposure to dabigatran [see CLINICAL PHARMACOLOGY].

Concomitant use of P-gp inhibitors in patients with renal impairment is expected

to produce increased exposure of dabigatran compared to that seen with either

factor alone.

o In patients with moderate renal impairment (CrCl 30-50 mL/min), consider

reducing the dose of PRADAXA to 75 mg twice daily when administered

concomitantly with the P-gp inhibitor dronedarone or systemic ketoconazole. The

use of P-gp inhibitors (verapamil, amiodarone, quinidine, and clarithromycin)

does not require a dose adjustment of PRADAXA. These results should not be

extrapolated to other P-gp inhibitors

o The concomitant use of PRADAXA and P-gp inhibitors in patients with severe

renal impairment (CrCl 15-30 mL/min) should be avoided

Nursing responsibilities:

1. Monitor symptoms of bleeding:

unexpected bleeding or bleeding that lasts a long time, such as:

unusual bleeding from the gums

nose bleeds that happen often

menstrual bleeding or vaginal bleeding that is heavier than normal

bleeding that is severe or you cannot control

pink or brown urine

red or black stools (looks like tar)

bruises that happen without a known cause or get larger

cough up blood or blood clots

vomit blood or your vomit looks like “coffee grounds”

unexpected pain, swelling, or joint pain

headaches, feeling dizzy or weak

Generic name: Acetazolamide

Brand name: Diamox, Dazamide, Diamox Sequels, Storzolamide, Acetazolam, Apo-

Acetazolamide

Ordered dose: 250mg 1tab TID

Classification:

Pharmacologic Classification: Carbonic Anhydrase Inhibitor

Therapeutic Classification: antiglaucoma, diuretics, ocular hypotensive agents, anticonvulsants

Suggested dose:

PO (adults)

Glaucoma: 250-1000 mg/day in 1-4 divided doses (up to 250 mg every 4 hours)

Epilepsy: 4-30 mg/kg/day in 1-4 divided doses

Altitude sickness: 250 mg 2-4 times a day started 24-48 hours before ascent, continued for 48

hours or longer to control symptoms.

PO (Children)

Glaucoma: 8-30 mg/kg/day in 3 divided doses

IM, IV (Adults): 250-500 mg, may repeat in 2-4 hours

IM, IV (children): 5-10 mg/kg every 6 hours

Mode of action:

Acetazolamide is a potent carbonic anhydrase inhibitor, effective in the control of fluid

secretion, in the treatment of certain convulsive disorders and in the promotion of diuresis in

instances of abnormal fluid retention. Acetazolamide is not a mercurial diuretic. Rather, it is a

nonbacteriostatic sulfonamide possessing a chemical structure and pharmacological activity

distinctly different from the bacteriostatic sulfonamides. The anticonvulsant activity of

Acetazolamide may depend on a direct inhibition of carbonic anhydrase in the CNS, which

decreases carbon dioxide tension in the pulmonary alveoli, thus increasing arterial oxygen

tension. The diuretic effect depends on the inhibition of carbonic anhydrase, causing a reduction

in the availability of hydrogen ions for active transport in the renal tubule lumen. This leads to

alkaline urine and an increase in the excretion of bicarbonate, sodium, potassium, and water.

Indication:

Glaucoma (lowers intraocular pressure in the treatment of glaucoma)

Epilepsy

Congestive heart failure

Drug-induced edema

Altitude sickness (mountain sickness)

Contraindication:

Hypersensitivity to carbonic anhydrase inhibitor

Hypersensitivity to sulfonamides

Depressed levels of serum potassium and sodium

Marked kidney and liver disease

Suprarenal grand failure

Hyperchloremic disease

First trimester of pregnancy

Concurrent use of ophthalmic carbonic anhydrase inhibitors (brinzolamide, dorzolamide)

Adrenal gland failure (Addison’s disease)

Sickle cell anemia

Chronic non-congestive glaucoma

Side effects:

Depression

Tiredness

Body malaise

Drowsiness and confusion

Transient nearsightedness

Anorexia

Metallic taste

Nausea and vomiting

Crystalluria

Renal calculi

Rashes

Hyperglycemia

Hyperchloremic acidosis

Hypokalemia

Aplastic anemia

Hemolytic anemia

Leucopenia

Weight loss

Paresthesias

Tingling feeling of the extremities

Polyuria

Polydipsia

Blushing

Headache

Irritability

Photosensitivity (rare)

Drug interactions:

Acetazolamide can decrease excretion of dextroamphetamine, anticholinergics,

mecamylamine, ephedrine, mexiletine, or quinidine because carbonic anhydrase inhibitors

increase the alkalinity of the urine, thereby increasing the amount of nonionized drug available

for renal tubular reabsorption. The effects of these drugs can be prolonged or enhanced.

Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde,

which is the active bacteriostatic form. Concurrent use of methenamine and acetazolamide is

not recommended. Acetazolamide produces alkaline urine and can increase the rate of

excretion of weakly acidic drugs including barbiturates and salicylates. Large or regular dosing

with aspirin and other salicylates should be avoided as acetazolamide can potentiate salicylate

toxicity by causing metabolic acidosis and enhancing the penetration of the salicylate into

tissues. In addition, salicylates decrease the elimination of acetazolamide, which could result in

CNS toxicity.

Acetazolamide can induce osteomalacia in patients being concomitantly treated with

carbamazepine, primidone, or phenytoin. Potential mechanisms for this interaction include an

acetazolamide-induced increase in the urinary excretion of calcium and effects resulting from

metabolic acidosis.

Nursing responsibilities:

1. . Monitor individuals taking acetazolamide with primidone and carbamazepine. 

Acetazolamide may increase the blood levels of carbamazepine and quinidine and may

decrease the blood levels of primidone.

2. Instruct the patient to avoid taking aspirin with Acetazolamide. Increase in side effects

such as drowsiness, confusion, lethargy, hyperventilation and ringing in the ears when

acetazolamide is taken with aspirin.

3. Monitor electrolyte levels

4.  Do not share your medicine with others and do not take anyone else's medicine.

5. • Keep all medicine out of the reach of children and pets.

6. • Keep a list of all your medicines (prescription, natural products, supplements, vitamins,

over-the-counter) with you. Give this list to healthcare provider (doctor, nurse, nurse

practitioner, pharmacist, physician assistant).

7. • Call your doctor for medical advice about side effects

Generic name: Ivabradine HCL

Brand name: Coralan

Classification: Anti - anginal

Ordered dose: 5 mg 1tab q12

Suggested dose:

The usual recommended dose is 5 mg twice daily. The dose may be

increased after 2 to 4 weeks to 7.5 mg twice daily, if necessary. If the heart rate decreases

below 50 bpm at rest or if the patient experiences symptoms related to bradycardia, the dose

should be reduced to 2.5 mg twice daily. Treatment should be stopped if the heart rate remains

below 50 bpm or if symptoms of bradycardia persist. Adults over the age of 75 years should

start treatment with a lower dose i.e. 2.5 mg twice daily

Mode of action:

Ivabradine is a heart rate lowering agent. It acts by selective and

specific inhibition of the cardiac pacemaker, current, an important ionic current that usually

controls spontaneous diastolic depolarisation in the sinus node and thereby regulates heart rate.

The cardiac effects of ivabradine are specific to the sinus node and ivabradine has no effect on

intra-atrial, atrioventricular or intraventricular conduction times, myocardial contractility or

ventricular repolarisation. An elevated heart rate increases myocardial oxygen demand and

limits tissue perfusion, the latter by reducing the duration of diastole, during which most

myocardial perfusion occurs. Therefore, a pure reduction in heart rate can reduce myocardial

ischaemia and prevent angina pectoris.

Indication:

Ivabradine is indicated for the symptomatic treatment of chronic stable

angina pectoris in patients with normal sinus rhythm who are intolerant to beta-blockers or in

whom these agents are contraindicated.

Contraindication:

Ivabradine is contraindicated in patients with cardiac dysrhythmias, unstable angina

pectoris, acute coronary syndrome, class lll to lV heart failure, 3 rd degree AV block, cardiogenic

shock, those with a pacemaker, a resting heart rate below 60 bpm or severe hypotension (<

90/50 mm Hg). Ivabradine is not recommended for use in patients with liver dysfunction and is

contraindicated in patients with severe liver dysfunction.

Side effects:

Luminous phenomena (phosphenes) i.e. enhanced brightness in the

visual field, have been reported in 14.5% of patients. These effects usually resolve

spontaneously during treatment. Other common side effects include bradycardia, AV 1st

degree heart block, ventricular extrasystoles, headache and dizziness.

Drug interactions:

The concurrent use of ivabradine with St John’s Wort, strong cytochrome P450 inhibitors

(such as the azole antifungals, macrolides, HIV protease inhibitors and nefazodone) is

contraindicated. The concomitant use of medicines that prolong the QT intervals should be

avoided since QT prolongation may be exacerbated by

heart rate reduction. The concomitant use of ivabradine with heart rate reducing calcium

channel blockers such as verapamil or diltiazem is not recommended.

Nursing responsibilities:

1. Ivabradine should be taken twice daily – in the morning and in the

evening.

2. The tablets should be swallowed with a little water and taken with

some food.

3. Changes in vision may occur, but usually resolve with continued

treatment.

4. Do not give this medicine to anyone else, even if their symptoms seem similar to

your

5. Keep CORALAN in a cool dry place where the temperature stays below 30°C,

but not in the fridge or freezer.

6. Do not store it, or any other medicine, in a bathroom or near a sink. Do not leave

it in the car or on window sills.

7. Keep your tablets in their blister pack until it is time to take them.

8. If you take the tablets out of the box or the blister pack they may not keep well.