Drug

Mechanism of action

Contraindicatio ns
-With

Indications

Side effect

Nursing responsibilities 1. note indications for therapy, onset, characteristics of signs and symptoms. 2. monitor v/s 3. document disease onset, subtype, other agents trialed and outcome. 4. take extra precaution on the patients with following conditions: CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.

Brand Name: Hizon epinephrine Generic Name: Epinephrine Classification Beta2 Adrenergic Agonists Dosage: 0.5 mL IM

Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity Increases BP, HR, PR Decreases airway resistance.

angleclosure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis -In conjunction with local anesthesia, epinephrine is contraindicated for use in finger, toes, ears, nose, and genitalia. -In pregnant woman, drug is contraindicated. -In breast feeding do not use the drug or stop breast feeding.

Advanced cardiac life support, anaphylactic shock, ocular hypertension, open-angle glaucoma, asthmatic attacks

epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.

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Mechanism of Action The analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly less respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of the mu-opioid type how ever there is little evidence of abuse. Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates

Contraindications

Indications

Side Effects

Nursing responsibilities

Brand name: Dolcet Generic Name: Tramadol hydrochloride Route of administration : Oral Classification : Analgesic Dosage: 50-100mg q 4-6 hrs. prn

Hypersensitivity to tramadol, in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opiates or psychotropic drugs. Use in cleitns with past r resent addictin or opiate dependence or in those with a prior history of allergy to codeine or opiates. Use for obstetric preoperative medicatin of postdelivery analgesia In nursing mothers.

Moderate to moderately severe pain.

Dizziness, headache, 1.do not confuse CNS stimulation, Ultram with Ultrase ataxia, sedation, 2. List reasons for vertigo, itching, therapy, location, constipation, nausea, onset, triggers, seizures, characteristics of S paresthesia, and S. use a pincognitive rating scale to rate dysfunction, pain. hallucinations, 3. Assess for history tremor, amnesia, of drug addiction, concentration allergy to opiates or difficulty, abnormal codeine, seizures; gait, migraine, drug may increase nausea, constipation, the risk of vomiting, dyspepsia, convulsions dry mouth, diarrhea, anorexia

Drug

Brand Name: Calcibloc Generic Name: Nifedipine Classification: Calcium channel blocker Route of administration : Oral Dosage: Capsules: 10-20 mg 3x a day Tablets: 30-60 mg per day

Mechanism of action . It blocks the calcium or "slow" channels and inhibits entry of calcium ions into vascular smooth muscles particularly of resistance vessels and coronary arteries. Dilates coronary and peripheral arteries, as well as veins. Coronary arterial vasodilation increases coronary blood flow in the ischemic poststenotic areas, while dilation of the peripheral arteries lowers arterial blood pressure and reduces left ventricular afterload. Some renal artery dilatation may stimulate mild diuresis.

Contraindicatio ns Cardiovascular shock, severe aortic stenosis or in patients known to be hypersensitive to nifedipine. Care is needed in patients with very low blood pressure (severe hypotension with systolic pressure <90 mmHg) or decompensated heart failure.

Indications Treatment of vasospastic angina, chronic stable angina, hypertension.

Side Effects Flushing, nausea, dizziness, headache, tiredness, sedation, leg edema and other manifestations of peripheral vasodilation.

Nursing Responsibilities 1. dot not confuse nifedipine with nicardipine 2. do not exceed a single dose 3. before increasing dose, carefully monitor BP 4. use only the sustained release tablets to treat hypertension 5. concomitant therapy with beta renergic blocking agents may be used 6. clients withdrawn from beta blockers may manifest symptoms of increased angina which cannot be prevented by nifedipine; in fact nifedipine may increase the severity of angina situation

Drug Data Brand Name Solu-Cortef Generic Name Hydrocortisone Dosage 20-240 mg/day in single dose or divided doses Classification : Adrenal cortical steroid Corticosteroid Glucocorticoid

Mechanism of Action Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its antiinflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions..

Indication -Replacement therapy in adrenal cortical insufficiency - Allergic states severe or incapacitating allergic conditions - Hematologic disorders - Ulcerative colitis

Contraindications Hepatitis B,Vaccinia or varicella,Antibioticresistant infections,Immunosu ppression Special Precaution - Kidney disease - Liver disease - Cirrhosis - Hypothyroidism - Ulcerative colitis with - Hypertension - Heart failure - Thromboembolic tendencies - Osteoporosis - Convulsive disorders - Metastatic carcinoma

Side Effects CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis, EENT: Cataracts, glaucoma, increased IOP Endocrine: Amenorrhea, irregular mens, growth retardation, decreased GI: Peptic or esophageal ulcer, pancreatitis, Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis.

Nursing Responsibilities - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration. .- Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse effects. - Do not give IM injections if patient has thrombocytopenic purpura.

Drug Brand Name: Zantac Generic Name: Ranitidine Classification : Anti-ulcer agents Dosage: 150 300 mg

Mechanism of action . Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

Contraindicatio ns Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Special Precaution:: Renal impairment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation

Indications Used in management of various gastro intestinal disorders such as dyspepsia, gastroesophageal reflux disease,peptic ulcer and ZollingerEllison syndrome.

Side Effects CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis .

Nursing Responsibilities 1. Use caution in presence of renal or hepatic impairment 2. Assess potential interactions with other pharmacologi cal agents patient maybe taking. 3. Monitor AST,ALT,ser um creatinine,wh en used to prevent stress-related GI bleeding

Drug Brand Name: Phyllocontin Generic Name: Aminophylline Classification : Bronchodilator Route of administration : IV,Oral Dosage: Tablets100, 200 mg; liquid 105 mg/5 mL; injection 250 mg/10 mL; suppositories 250, 500 mg

Mechanism of Contraindicatio Indications action ns -Contraindicated . Relaxes bronchial -Symptomatic relief with smooth muscle, causing or prevention of hypersensitivity bronchodilation and bronchial asthma to any xanthine increasing vital and reversible or to capacity, which has bronchospasm ethylenediamin been impaired by associated with e, peptic ulcer, bronchospasm and air chronic active gastritis; trapping; in higher bronchitis and rectal or colonic concentrations, it also emphysema irritation or inhibits the release of -Unlabeled uses: infection (use slow-reacting substance Respiratory rectal preparations). of anaphylaxis (SRSstimulant in -Use cautiously A) and histamine. Cheyne-Stokes with cardiac respiration; arrhythmias, treatment of acute apnea and myocardial bradycardia in injury, CHF, premature babies cor pulmonale,
severe hypertension, severe hypoxemia, renal or hepatic disease, hyperthyroidis m, alcoholism, labor, lactation.

Side Effects -CNS: Irritability (especially children); restlessness, dizziness, severe depression -CV: Palpitations, sinus tachycardia, ventricular tachycardia, life ,circulatory failure -GI: Loss of appetite, hematemesis, epigastric pain, gastroesophageal reflux during sleepGU: RBCs;urinary retention in men with prostate enlargement -Respiratory: Tachypnea, respiratory arrest

Nursing Responsibilities -Administer to pregnant patients only when clearly needed. -Caution patient not to chew or crush enteric-coated timed-release forms. -Give immediaterelease, liquid dosage forms with food if GI effects occur. -Maintain adequate hydration. -Monitor for clinical signs of adverse effects -Ensure that diazepam is readily available to treat seizures.

Drug . Brand Name: Voltaren Generic Name: Diclofenac sodium Classification : Antiinflammatory Route of administration : oral Dosage: 50 mg

Mechanism of action

Inhibits prostaglandin synthesis to cause antipyretic and antiinflammatory effects; the exact mechanism is unknown.

Contraindicatio ns Contraindicated with allergy to NSAIDs, significant renal impairment, pregnancy, lactation. Use cautiously with impaired hearing, allergies, hepatic, cardiovascular, and GI conditions

Indications . Acute or longterm treatment of mild to moderate pain, including dysmenorrhea Rheumatoid arthritis Osteoarthritis Ankylosing spondylitis Treatment of actinic keratosis in conjunction with sun avoidance Ophthalmic: Postoperative inflammation from cataract extraction

Side Effects . CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmologic effects Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitisGI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence GU: Dysuria, renal impairment Hematologic: Bleeding, platelet inhibition with higher doses

Nursing Responsibilities 1.Take drug with food or meals if GI upset occurs. 2.Take only the prescribed dosage. These side effects may occur: Dizziness, drowsiness (avoid driving or using dangerous machinery while using this drug). 3.Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision; black, tarry stools.

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Mechanism of action Depresses the CNS, probably by potentiating gammaaminobutyric acid, an inhibitory neurotransmitter, produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways, has anticonvulsant properties due to enhanced presynaptic inhibition. It also relieves anxiety. It is used also as sedative, skeletal muscle relaxation, cessation of seizure activity.

Contraindicatio ns Dependence on other substances including alcohol except in management of acute withdrawal reactions. Severe chronic hypercapnia.

Indications Management of anxiety, Preoperative sedation, light anesthesia, amnesia, treatment of status epilepticus, skeletal muscle relaxant Management of the symptoms of alcohol withdrawal. Special Precaution: Cardiorespi. insufficiency; pregnancy, lactation; myasthenia gravis

Side effect CNS: dizziness, drowsiness, lethargy, hangover, paradoxical excitation, mental depression, headache EENT: blurred vision Resp: respiratory depression CV: hypotension (IV only) GI: nausea, vomiting, diarrhea, constipation Derm: rashes Local: venous thrombosis, phlebitis (IV) Misc: tolerance, psychological dependence, physical dependence

Nursing responsibilities 1.Don't mix injectable diazepam with other drugs, and don't store parenteral solution in plastic syringes. 2. Avoid mixing with any other drugs or solutions, and avoid infusion sets or containers made from polyvinyl chloride.

Brand Name: Diazepam Generic Name: Valium Classification Anti-convulsant Dosage: Tab Adult 5-20 mg daily

Drug

Mechanism of action Ihibits sodium and chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water, together with sodium, chloride and potassium.

Contraindicatio ns . Hypersensitivity to sulfonyureas; Anuria

Special Precaution: Elderly patients, diabetes mellitus severe hepatic disease, pregnant or breastfeeding patients, neonates

Indications For acute pulmonary edema, Edema caused by heart failure, hepatic cirrhosis and renal disorder

Side effect CNS:dizziness,headac he,vertigo,weakness,le thargy,paresthesia CV: hypotension,lightheadedness,necrotizin g angiitis,thrombolebitis, arrythmias EENT: blurred vision,hearing loss,tinittus GI: acute pancreatitis GU: oliguria,intestinal nephritis HEMATOLOGIC: Leucopenia,thrombocy topenia,hemolytic anemia HEPATIC: jaundice MUCOSKELETAL: muscle pain,muscle cramps SKIN: erythema multiforme OTHER: fever,trancient pain

Nursing responsibilities 1.Avoid driving and other hazardous activities until he knows how drug effects concentration and alertness. 2.Caution the patient to stop to avoid alcohol and herbs while taking this drug. 3. Inform patient that he will regularly undergo blood testing therapy.

Brand Name: Lasix Generic Name: Furosemide Classification Diuretic, Antihypertensive Dosage: Injection 10 mg/dl Oral Solution10 mg/ml Tablet20 mg

Drug

Mechanism of action Paracetamol produces analgesia by raising threshold of the pain center of the brain and by obstructing imulpses at the pain-mediating chemoreceptors. The drug produces antipyresia by an action of hypothalamus ; heat dissipation,is increased as a result of vasodilation and peripheral blood flow

Contraindicatio ns Nephropathy .

Indications

Side effect

Nursing responsibilities

Brand Name: Aeknil Generic Name: Paracetamol Classification Analgesic , Antipyretic Dosage: 10 years old 1-2 ml Adult and children 10yr. 2-3 ml

For sympmtomatic relief of fever and pain Special associated with Precaution: Renal and hepatic common childhood failure disorders,tonsillit is,URTI,post immunization reactions

HEMATOLOGIC: luekopenia,thrombocyt 1. Instruct patient to openia take with meals. SKIN skin eruption 2. Have plenty of water when taking this drug.

Drug

Mechanism of action Competes with histamine for H 1receptor site on effector cells; decreases allergic response by blocking histamine.

Contraindicatio ns
. Newborn or premature infants, hyperthyroidism, hypertension. acute asthma attack, active peptic ulcer, tuberculosis Special Precaution: Liver disease,epilepsy,c hronic respiratory disorders, hepatic disease,pregnant or breastfeeding pts.

Indications Treatment for allergic disorders of allergic rhinitis, bronchial asthma, food and drug allergy, measles, asthma , pains, headaches, common cold, anaphylactic shock.

Side effect Dry mouth, constipation, blurred vision, delirium , agitation, jaundice, ventricular tachycardia, drowsiness, nasal stuffiness, cardiac arrhythmias, cardiac failure, skin rashes.

Nursing responsibilities 1Assess patients condition before after therapy and regularly after. 2. Assess for hypersensitivity reaction: fever, skin rash. 3. Tell patient to report adverse effect. 4. Advise patient that drug may cause photosensitivity. 5. Avoid driving and other hazardous activities because drowsiness may occur, observe until drugs effect are known.

Brand Name: Chlorphenamine Generic Name: Antamin Classification Antihistamines, Antiallergies Dosage: Adult: 1 tab/ 3x a day

Drug

Mechanism of action .Inhibits breakdown of fibrin clots.It acts primarily by blocking the binding of plasminogen and plasmin to fibrin; direct inhibition of plasmin occurs only to a limited degree.

Contraindicatio ns Hypersensitivity to drugs, patients with intravascular clotting because of the risk of thrombosis. Severe renal insuffiency , patients with microscopic hematuria.
Special Precaution: Patients with pre disposition to thrombosis, hematuria, renal impairment,pregna nt or breastfeeding pts.

Indications Treatment and prophylaxis of hemorrhage associated with excessive fibrinolysis.

Side effect .Gastrointestinal disturbances, hypotension, disturbance color vision, thrombotic complication.

Nursing responsibilities 1. Perform blood tests, liver function tests, eye examination, and obtain prothrombine time. 2. Reduced dosage for patients with renal impairment. 3. Advice patient to report visual abnormalities to the physician.

Brand Name: Hemostan Generic Name: Tranexamic acid Classification Haemostatics Dosage: Oral(15 to 25 mg) 2 to 4 x a day

Drug

Mechanism of action Causes an influx of fluid in the intestinal tract by increasing the osmotic pressure within the intestinal lumen.Bacterial metabolism of the drug to lactate and other acids which are only partially abvsorbed in the distal ileum and colon augments the osmotic effect of lactulose.

Contraindicatio ns .Patients who require to low lactose diet, galactosaemia or disaccharide deficiency , intestinal obstruction.
Special Precaution: Diabetes mellitus elderly,pregnant or breastfeeding pts. , do not use if presence of adominal pain , nausea,vomiting, fever,.

Indications Constipation, salmonellosis, treatment for hepatic encephalopathy.

Side effect Abdominal discomfort associated with flatulence and intestinal cramps, nausea, vomiting, diarrhea on prolonged use.

Nursing responsibilities 1..For patient with hepatic encephalopathy, regularly assess mental condition and ammonia level. 2. Monitor for possible GI reactions: nausea, vomiting, abdominal cramps, blenching, diarrhea , flatulence, and distention. 3. Monitor for increased glucose levels for diabetic patient.

Brand Name: Buscopan plus Generic Name: Hyoscine/ Paracetamol Classification Antispasmodic Dosage: Infants: 5 mL , initial dose TID Children: 1-6 yrs. 5-10 mL , initial dose TID Children: 7- 14 yrs. 15 mL, Initial dose TID Adult: 15-45 mL TID

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Mechanism of action Dopamine agonist that acts by increasing receptor sensitivity and response of upper GI tissues to acetycholine. This causes the contraction of gastric smooth muscles, relaxation of pyloric sphincter and duodenal bulb and increased peristalsis without stimulating gastric,biliary and pancreatic secretions.It also produces sedation and induces releases of prolactin.

Contraindicatio ns .Patients in whom increased GI might be dangerous ,hypersensitivity to drugs, children, lactation, patients with breast cancer, epileptic patients.
Special Precaution: Patients with Parkinsonism and history of mental illness,epileptics,el derly ,pregnant or breastfeeding pts.

Indications Gastrointestinal motility disturbances.Nau sea and vomitingof central and peripheral origin associated with surgery , metabolic diseases, infectious diseases, and drug induced.

Side effect Sedation, restlessness, fatigue diarrhea, insomnia, headache, dizziness, nervousness, menstrual disorders, drowsiness, bowel upsets.

Nursing responsibilities 1..Frequently monitor blood pressure of patients taking IV form of drug. 2. Assess mental status during treatment : depression,anxiety, irritability. 3. Assess patients and familys knowledge of drug therapy.

Brand Name: Plasil Generic Name: Metoclopera mide Classification Antiemetic, GI regulator, antiinflammatory, antiflatulents Route: IM, slow IV injection over 12 mins. Dosage: Pedia: 5 -10 mg TID Adult: 10 mg TID

Drug

Mechanism of action

Contraindicatio ns Acute myocardial infarction ; with low filling pressures , except in the intensive care unit with continuous haemodynamic monitoring; left heart failure with low filling pressures ; shock; very low blood pressure . .
Special Precaution: Pregnant or breastfeeding patients, acute myocardial infarction, constrictive pericarditis.

Indications .Preventive and long term treatment of angina pectoris, congestive heart failure, arterial vasodilators, pulmonary hypertension.

Side effect Transient hypoxemia,headache, blood pressure, pulse rate, dizziness and weakness, nausea,vomiting, allergic skin reactions.

Nursing responsibilities 1.Assess for pain: duration, time started, activity being performed, character, intensity. 2. Monitor B/.P, pulse at baseline and during treatment. 3. Caution pt. to make position changes slowly to prevent orthostatic hypotension. 4. Instruct pt. to swallow sustained released tablet whole, do not chew; SL tablet should be dissolved under the tongue ,do not swallow chewable tablet should be chewed thoroughly.

Brand Name: Isordil

Increases supply of oxygen to the heart by dilating both the Generic Name: arteries and veins Isosorbide which supply the dinitrate/mononit heart itself. rate Classification Anti- anginal Route: Oral Dosage: 40 mg OD

EMERGENCY DRUGS

Submitted by: Mary Anne E. Elepao BSN C Submitted to: Ms. Silgrid Villanueva Clinical Instructor