Far Eastern University Drug Study

8/2/2019 Far Eastern University Drug Study

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Far Eastern University

Institute of Nursing

Dr. Nicanor Reyes st. Sampaloc, Manila

S.Y. 2011-2012

Carandang, Jonathan C. February 24, 2012

BSN215/ Group 57b

DRUG STUDY:

1. Sodium Bicarbonate 2. Isosorbide Dinitrate 3. Hydrocortisone4. Lidocaine 5. Dipenhydramine Hydrochloride 6. Phenobarbital

Name of the Drug Dosage/Route Action/Classification Indication/

Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic Name:

SODIUM

BICARBONATE

Brand Name:Arm

and HammerPureBaking Soda,

Citrocarbonate,Soda Mint

1 mEq/kg IVP,may repeat 0.5

mEq/kg 10 min.

Action:Neutralizes gastric

acid

Decrease pepsinactivity

Classification:

Alkalizing Agent,Buffer, Antacid,

electrolyte

Indications:

o Hyperacidityo Peptic ulcero Hyperkalemiao Tricyclic

antidepressant

OD

o Shock associatedwith severediarrhea,

dehydration,uncontrolled DM

Adverse Effects:

GI:Gastric

distention,belching,

flatulence.Metabolic:

metabolicalkalosis,

hypernatremia,hypokalemia,

hyperosmolarity(with overdose).

Monitor urinarypH, calcium,

electrolytes andphosphate levels.

Record amount

and consistency ofstools.

Clients on low-

sodium dietsshould evaluate


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o Refluxesophagitis

Contraindications:

Contraindicated in

patients with metabolicor respiratory alkalosis;

patients who are losingchlorides from vomiting

or continuousGI

suction; patients takingdiuretics known toproduce hypochloremia

alkalosis; and patientswith hypocalcemia in

which alkalosis mayproduce tetany,

hypertension, seizures,or heart failure. Oralsodium bicarbonate is

contraindicated inpatients with acute

ingestion ofstrongmineral acids.

Other:Pain and

irritation at

injection site.

sodium contents

of antacids.


Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic Name: Action Indications: Side Effects: Monitor BP and


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ISOSORBIDE

DINITRATE

Brand Name:

Isoket IV

IV amp 10 mg/

10 mL

Isosorbide dinitrate

is a smooth muscle

relaxant. It isparticularly effectiveon vascular and

bronchial smoothmuscle. Its systemic

cardiovasculareffects are mainly

due to a decrease in

venous return(pooling of blood inthe peripheral

venous system).Consequently,

ventricular end-diastolic pressure

and volume arediminished, thusreducing cardiac

work and implicitlymyocardial oxygen

requirements. Thearterial vessels are

dilated as well,

though to a lesserdegree. This resultsin a slight drop in

aortic and systemic blood pressure

relieving themyocardium from a

part of its afterload.

o Hyperacidityo Peptic ulcero Hyperkalemiao Tricyclic

antidepressant

ODo Shock associated

with severediarrhea,

dehydration,

uncontrolled DMo Reflux

esophagitis

Contraindications:

Contraindicated inpatients with metabolic

or respiratory alkalosis;patients who are losingchlorides from vomiting

or continuousGIsuction; patients taking

diuretics known toproduce hypochloremia

alkalosis; and patients

with hypocalcemia inwhich alkalosis mayproduce tetany,

hypertension, seizures,or heart failure. Oral

sodium bicarbonate iscontraindicated in

patients with acute

unresponsive

left ventricular

failuresecondary toacute MI, severe

or unstableangina pectoris

Adverse Effects:

GI:Gastricdistention,belching,

flatulence.Metabolic:

metabolicalkalosis,

hypernatremia,hypokalemia,hyperosmolarity

(with overdose).Other:Pain and

irritation atinjection site.

heart rate.

Assess location,

duration, intensity,and precipitatingfactors of anginal

pain.


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These nitrate-

induced changes

account for both theantianginal effects ofisosorbide dinitrate

and for its beneficialeffects in the

treatment ofcongestive heart

failure.

Classification: anti

anginal drug

ingestion ofstrong

mineral acids.


Contraindications

Adverse Effects/

Side Effects

Nursing

Responsibilities

Generic Name:

HYDROCORTISONE

Brand Name:A

-hydroCort, Solu-Cortef

100 mg/ 2 mL,250 mg/ 2 mL

Action Decreasesinflammation,

mainly bystabilizing

leukocytelysosomal

membranes,suppresses immune

response, stimulates bone marrow and

influences protein,fat, and

Indications:endocrine,

hematologic,rheumatic &

collagen disorders,dermatologic,

ophth, GI, resp &neoplastic diseases,

edematousstates,control ofsevere

incapacitatingallergic conditions,

Adverse Effects:

fluid and

electrolytedisturbances,

decreasedcarbohydrate

tolerance,impaired wound

healing, thinfragile skin,

muscleweakness,

Give daily before

9 AM to mimic

normal peak

diurnal

corticosteroid

levels and

minimize HPA

suppression.

Space multiple

doses evenly


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carbohydrate

metabolism

Classification:corticosteroid

hormones

TB meningitis w/

subarachnoid block

or impending blockwhen usedconcurrently with

appropriate anti-TBchemotherapy,

shocksecondary toadrenocortical

insufficiency or

shock unresponsiveto conventionaltherapy when

adrenocorticalinsufficiency may

be presentContraindications:

Contraindicatedin patients withsuppresses

immune response,stimulates bone

marrow andinfluences

protein, fat, and

carbohydratemetabolism

steroid

myopathy,

osteoporosis,aseptic necrosis,peptic ulceration

w/ possibleperforation,

cataracts,increased

intraocular and

intracranialpressure, growthretardation,

Cushingoidstate, protein

catabolism,psychic

derangements,exophthalmos,masking of

infections,gasping

syndrome,seizures,

menstrual

irregularities.

throughout the

day.

Do not give IM

injections if

patient has

thrombocytopeni

c purpura.

Rotate sites of

IM repository

injections to

avoid local

atrophy.

Use minimal

doses for

minimal duration

to minimizeadverse effects.

Taper doses

when

discontinuing

high-dose or

long-term

therapy.Arrange for

increased dosage

when patient is

subject to

unusual stress.

Use alternate-day


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maintenance

therapy with

short-acting

corticosteroids

whenever

possible.

Do not give live

virus vaccines

with

immunosuppress

ive doses of

hydrocortisone.

Provide antacids

between meals to

help avoid peptic

ulcer.


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Name of theDrug

Dosage/Route Action/Classification Indication/Contraindications

Adverse Effects/Side Effects

NursingResponsibilities

Generic Name:

lidocane

Brand Name:

Xylocaine

1-1.5 mg/kg IVP or

ETT (double doseif giving via ET

tube), may repeat q5-10 min. max

3 mg/kg;If

conversionsuccessful start aninfusion of 2-4

mg/min

Action:

Decrease cardiac

excitability, cardiac

contraction is delayed

in the atrium and

ventricle

Classification:

Antiarrythmic and

Anesthetic

Indications:

Decrease cardiacexcitability, cardiac

contraction is delayedin the atrium and

ventricle

Contraindications:

Contraindicated in

patientshypersensitive to

amide-type localanesthetics and in

those with Adams Stoke syndrome.

Wolff-Parkinsons-White Syndrome, or

severe degrees of SA,AV, or

intraventricular blockin the absence of

pacemaker.

Adverse Effects:

CNS: Confusion,

tremor, lethargy,

somnolence,

stupor, restlessness

anxiety,

hallucinations,

nervousness,

seizure. CV:

hypotension,

bradychardia, new

or worsened

arrhythmias EENT:

tinnitus, blurred ordouble vision.

Respiratory:

Respiratory

depression and

arrest

Skin:soreness at

injection site

Other: anaphylaxis,

Side Effects:

sensation of cold,

vomiting

Monitor EKG, BP,

pulse, rhythm,continuously.

Monitorserum

lidocaine levels

throughouttheraphy;therapreutic range

1.5-5 mcg/ml

Monitor intake andoutput

Do not mix in the

same syringe withamphoterin B or

cefazolin

Administer

Lidocaine TIV.

In case of

circulatory

depression have

dopamine available


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Contraindications

Adverse

Effects/ Side

Effects

Nursing

Responsibilities

Generic Name:DIPENHYDRAMINE

HYDROCHLORIDE

Brand Name:

Benadryl

50mg/ml Action:prevents histamine

mediated responses,drug provides local

anesthesia andsuppresses cough

reflex

Classification:

antihistamine

Indications:Hay fever,urticaria,

vasomotor rhinitis,angioneurotic

edema, drugsensitization,

serum & penicillinreaction, contact

dermatitis, atopiceczema, other

allergicdermatoses,

pruritus, foodsensitivity,

parkinsonism,motion sickness.

Contraindications:

Contraindicated inpatients with blood

disorders, and GIdisturbances.

AdverseEffects:

CV and CNS

effects, blood

disorders, GI

disturbances,

anti-muscarinic

effects andallergic

reactions.

Side Effects:

HA, vomiting

Monitor

carefully, assess

for confusion,

delirium, other

anticholinergic

side effects and

fall risk.Institute

measures to

prevent falls.

Assess

movement

disorder before

and after

administration.Caution patient

not to use oral

OTC

diphenhydramin

e products with

any other


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product

containing

diphenhydramine, including

products used

topically.

It can cause

excitation in

children.

Caution parents

or caregivers

about proper

dose calculation;

overdosage,

especially in

infants andchildren, can

cause

hallucinations,

seizures or death

Inform patient

that this drug

may cause drymouth. Frequent

oral rinses, good

oral hygiene, and

sugarless gum or

candy may

minimize this


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effect. Notify

dentist if dry

mouth persistsfor more than 2

weeks.

Name of theDrug

Dosage/Route Action/Classification

Indication/Contraindications

Adverse Effects/ SideEffects

NursingResponsibilities

Generic

Name:

phenobarbita

l

ADULTS

Oral

y Sedation:30120 mg/day

Action:

General CNSdepressant;

barbiturates inhibitimpulse conduction

Indications:

y Oral orparenteral:

Sedative

y Oral or

Adverse Effects:

y CNS:Somnolence,agitation,

confusion,

y Monitorpatientresponses,

bloodlevels (as


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Brand Name:

Barbilixir

(CAN),Barbita

(CAN),

Bellatal,

Solfoton

Luminal

Sodium

phenobarbita

l sodium

in 23

divided

doses.Nomore than400 mg per

24 hr.

y Hypnotic:100200 mg

hs.

y Antiepileptic: 60100 mg/day.

IM orIV

y Sedation:30120 mg/day

IM orIV in23 divided

doses.

y Preoperativesedation:

100200 mgIM, 6090

min beforesurgery.

y Hypnotic:100320 mgIM orIV.

y Acuteseizures:200320 mg

IM orIVrepeated in 6

in the ascending

RAS, depress the

cerebral cortex, altercerebellar function,depress motor

output, and canproduce excitation,

sedation, hypnosis,anesthesia, and deep

coma; at subhypnotic

doses, has antiseizureactivity, making itsuitable for long-

term use as anantiepileptic.

Classification:

Barbiturate (longacting)Sedative

HypnoticAntiepileptic

parenteral:

Hypnotic,

treatment ofinsomnia forup to 2 wk

y Oral:Long-term treatmentof generalized

tonic-clonicand cortical

focal seizuresy Oral:

Emergency

control ofcertain acute

seizures (eg,those

associated withstatus

epilepticus,eclampsia,

meningitis,tetanus, and

toxic reactionsto strychnine

or localanesthetics)

y Parenteral:Preanesthetic

y Parenteral:Treatment of

generalizedtonic-clonic

hyperkinesia,

ataxia, vertigo,

CNS depression,nightmares,lethargy,

residual sedation(hangover),

paradoxicalexcitement,

nervousness,

psychiatricdisturbance,hallucinations,

insomnia,anxiety,

dizziness,thinking

abnormality

y CV:Bradycardia,

hypotension,syncope

y GI:Nausea,vomiting,constipation,

diarrh

ea,epigastric pain

y Hypersensitivity: Rashes,angioneurotic

edema, serumsickness,

morbiliform rash,

appropriat

e) if any

interactingdrugslisted

above aregiven with

phenobarbital;

suggest

alternativemeans ofcontracept

ion towomen

usinghormonal

contracept

ives.y Do not

administerintra-

arterially;may

producearteriospas

m,thrombosi

s,gangrene.

y AdministerIV dosesslowly.


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hr if

necessary.

and cortical

focal seizures

y Parenteral:Emergencycontrol ofacute seizures

(tetanus,eclampsia,

epilepticus)

Contraindications:y Contraindicate

d with

hypersensitivity to

barbiturates,manifest or

latentporphyria;

marked liverimpairment;

nephritis;severe

respiratorydistress;

previousaddiction to

sedative-hypnotic drugs

(may beineffective and

may contributeto further

urticaria; rarely,

exfoliative

dermatitis,Stevens-

Johnson

syndrome

y Local: Pain,tissue necrosis at

injection site,gangrene; arterial

spasm withinadvertent intra-

arterial injection;thrombophlebitis

; permanentneurologic deficit

if injected near anerve

y Respiratory:Hypoventilation,apnea,

respiratorydepression,

laryngospasm,

bronchospasm,

circulatorycollapse

y Other:Tolerance,psychological

and physicaldependence,

withdrawal

y AdministerIM doses

deep in alarge

musclemass

(gluteusmaximus,

vastuslateralis)

or otherareas

wherethere is

little riskof

encountering a nerve

trunk ormajor

artery.

y Monitorinjection

sitescarefully

forirritation,

extravasation (IV

use).Solutions

arealkaline


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addiction);

pregnancy

(fetal damage,neonatalwithdrawal

syndrome).

y Use cautiouslywith acute or

chronic pain(drug may

causeparadoxical

excitement ormask

importantsymptoms);

seizuredisorders

(abruptdiscontinuation

of daily dosescan result in

statusepilepticus);

lactation(secreted in

breast milk;drowsiness in

nursinginfants); fever,

hyperthyroidism, diabetes

mellitus,

syndrome

Side Effects:HA, vomiting

and very

irritating

to thetissues.

y MonitorP,BP,

respirationcarefully

during IVadministra

tion.y Arrange

for

periodiclab tests of

hematopoietic, renal,

and

hepaticsystemsduring

long-termtherapy.

y Taperdosage

graduallyafterrepeated

use,especially

in patientswith

epilepsy.


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severe anemia,

pulmonary or

cardiacdisease, statusasthmaticus,

shock, uremia;impaired liver

or kidneyfunction,

debilitation.

When

changing

from oneantiepileptic drug to

another,taper

dosage ofthe drug

being

discontinued whileincreasing

the dosageof the

replacement drug.

Far Eastern University Drug Study

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