Er Drugs Study

NCM 106 RLE SY 2020-2021
EMERGENCY DRUGS
Acena, Jobelle C.
Union Christian College
DRUGS MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
ACTION RESPONSIBILITIES
Inhibits sodium and  Edema associated  Contraindicated to  Vertigo Monitor serum glucose,
Generic Name: chloride reabsorption at with CHF patients hypersensitive  Headache and electrolyte
FUROSEMIDE the proximal and distal to drug or any of its  Paresthesia
tubules and the  Cirrhosis with components and in  orthostatic Diet- K+ for all except
Brand Name: ascending loop of ascites or renal those with anuria. hypotension aldactone
Apo-Furosemide Henlen dysfunction  thrombophlebitis
Furoside  Use cautiously in  abdominal pain Intake and Output, daily
Lasix  For hypertension or patient with hepatic weight
 Hypokalemia
Lasix Speacial in combination with cirrhosis.  Anemia
Novosemide other Undesirable effects;
Uritol  muscle spasm Fluid and electrolyte
antihypertensive  Patients with allergies
medications. to sulfonamides may imbalance
Classification: also be allergic to
Loop Diuretics  ICP, nephritic furosemide. Review HR, BP and
syndrome, hepatic electrolytes
Dosage: cirrhosis  In pregnant woman, use
0.5-1 mg/kg slow IVP only if benefits Elderly-Careful
over 1-2 min, may outweighs the risk to
repeat once at 2 mg/kg the fetus. Take with or after meals
slow IVP over 1-2 mins. and in AM
 In breast feeding
woman, do not use Increase risk of
drug. orthostatic hypotension;
move slowly
Cancel alcohol
Acts as an anesthetic by Ventricular Contraindicated in patients CNS: Confusion,  Monitor EKG, BP, pulse,
Generic Name: stabilizing the neuronal arrhythmias caused by hypersensitive to amide-type tremor, lethargy, rhythm, continuously.
LIDOCANE membrane by inhibiting MI, cardiac local anesthetics and in those somnolence, stupor,
the ionic fluxes manipulation or with Adams –Stoke restlessness anxiety,  Monitor serum lidocaine
Brand Name: required for the cardiac glycosides syndrome. Wolff-Parkinsons- hallucinations, levels throughout theraphy;
Xylocaine initiation and White Syndrome, or severe nervousness, seizure. therapreutic range 1.5-5
conduction of impulses, degrees of SA, AV, or mcg/ml
Classification: thereby effecting local intraventricular block in the CV: hypotension,
Antiarrythmic and anesthetic action. Also absence of pacemaker. bradychardia, new or  Monitor intake and output
Anesthetic acts as an worsened arrhythmias
antiarrhythmic by  Do not mix in the same
Dosage: decreasing the EENT: tinnitus, syringe with amphoterin B
1-1.5 mg/kg IVP depolarization, blurred or double or cefazolin
or ETT (double automaticity, and vision.
dose if giving via excitability in the  Administer Lidocaine TIV.
ET tube), may ventricles during the Respiratory:
repeat q 5-10 min. diastolic phase by a Respiratory  In case of circulatory
max direct action on the depression and arrest depression have dopamine
3 mg/kg; If tissues, especially the available
conversion Purkinje network, Skin: soreness at
successful start an without involvement of injection site
infusion of 2-4 the autonomic system.
mg/min Neither contractility, Other: anaphylaxis,
systolic arterial blood
pressure,
atrioventricular (AV)
conduction velocity,
nor absolute refractory
period is altered by
usual therapeutic doses
Inhibits the sodium- V-fib, V-flutter, CHF, Contraindicated in patients CNS: hallucinations, Monitor K+, Mg++,
Generic Name: potassium ATP phase. pulmonary edema, atrial hypersensitive to the drug paresthesia, stupor, ECG, liver/renal function
DIGOXIN fibrillation and or flutter, or any of its components vertigo. tests, drug level
and paroxysmal atrial and in those with digitalis- CV: Arrythmias, heart (therapeutic level 0.5-2.0
Brand Name: contractions induced toxicity, failure, hypotension. mg/ml, toxicity is >2.0
Lanoxin, Digoxin, ventricular fibrillation, or EENT: blurred vision, mg/ml).
Lanoxicap ventricular tachycardia diplopia, light flashes,
unless caused by heart photophobia, yellow- Before each dose assess
Classification: failure. green halos around apical pulse for full
Cardiac Glycosides visual images. minute, record and report
Dosage: Use cautiously in patients GI: anorexia, diarrhea, changes in rate or
Adults: For rapid with acute MI, in complete nausea, vomiting. rhythm.
digitalization, give 0.4 Av block, sinus
to 0.6 mg I.V. initially, bradycardia, PVCs,, Withhold drug and
followed by 0.1 to 0.3 chronic constrictive contact provider if pulse
mg I.V. every 4 hours, pericarditis, hyperthropic is < 60/min. or >100
as needed and tolerated, cardiomyopathy, renal (adults) or < 110/minute
for 24 hours. insufficiency, severe (children)
pulmonary disease, or
Children: digitalizing hypothyroidism. Weigh daily
dose is based on child’s Monitor I&O and signs
age and is given in three of CHF
or more divided doses
over the first 24 hours.
First dose is 50% of
total dose; subsequent
dose are given q 4 to 8
hours as needed and
tolerated.
Children age 10 years

and older: For rapid
digitalization, give 8 to
12 mcg/kg I.V. over 24
hours, divided as above,
Maintenance dose is
25% to 35% of total
digitalizing dose, given
daily as a single dose.
Children ages 5 to 10:

For rapid digitalization,
give 15 to 30 mcg/kg
I.V. over 24 hours
divided as above.
Maintenance dose is
25% to 35% of total
digitalizing dose,
divided and given in two
or three equal portions
daily.
Children ages 2 to 5: For

rapid digitalization: give
25 to 35 mcg/kg I.V.
over 24 hours, divided
as above. Maintenance
dose is 25% to 35% of
total digitalizing dose,
daily.
Infants ages 1 month to

2 years: For rapid
digitalization. Give 30 to
hours, divided as above.
Maintenance dose is
25% to 35% of the total
digitalizing dose,
daily.
Neonates: for rapid

digitalization, give 20 to
hours, divided as above.
Maintenance dose is
25% to 30% of the total
digitalizing dose,
daily.
Premature Infants: For

rapid digitalization, give
15 to 25 mcg/kg I.V.
over 24 hours, divided
as above. Maintenance
dose is 20% to 30% of
the total digitalizing
dose, divided and given
into two or three equal
portions daily.
Neutralizes gastric acid o Hyperacidity Contraindicated in patients GI: Gastric distention, Monitor urinary pH,
Generic Name: o Peptic ulcer with metabolic or belching, flatulence. calcium, electrolytes
SODIUM Decrease pepsin activity o Hyperkalemia respiratory alkalosis; and phosphate levels.
BICARBONATE o Tricyclic patients who are losing Metabolic: metabolic
antidepressant OD chlorides from vomiting or alkalosis, Record amount and
Brand Name: o Shock associated continuous GI suction; hypernatremia, consistency of stools.
Arm and Hammer Pure with severe diarrhea, patients taking diuretics hypokalemia,
Baking Soda, dehydration, known to produce hyperosmolarity (with Clients on low-sodium
Citrocarbonate, Soda uncontrolled DM hypochloremia alkalosis; overdose). diets should evaluate
Mint o Reflux and patients with sodium contents of
hypocalcemia in which Other: Pain and antacids.
esophagitis
Classification: alkalosis may produce irritation at injection
Neutralizes gastric acid tetany, hypertension, site.
seizures, or heart failure.
Decrease pepsin activity Oral sodium bicarbonate is
contraindicated in patients
Dosage: with acute ingestion of
1 mEq/kg IVP, may strong mineral acids.
repeat 0.5 mEq/kg 10
min.
Stimulates dopaminergic To treat shock and Contraindicated in patient Cv: anginal pain, Blood is not a substitute
Generic Name: and alpha and beta correct hemodnamic with uncorrected arrythmias, bradycardia, for blood or fluid volume
DOPAMINE HCL. receptors of the imbalances, improve tachyarrhythmias, conduction disturbances deficit. If deficit occurs,
sympathetic nervous perfusion of vital pheocromocytoma, or ectopic replace fluid deficit first
Brand Name: system. Action is dose- organs, to increase ventricular fibrillation. breasts,hypertension, before giving meds.
Intropin; Revimine related; large doses can cardiac output, and to - Use cautiously in patients hypotension,
cause mainly alpha correct hypotension. with occlusive vascular palpitations, tachycardia, During infusion,
Classification: stimulation. disease, cold injuries, vasoconstriction, frequently monitor ECG,
Inotropic, vasopressor diabetic endarteritis, and widening of QRS BP, cardiac output, CVP,
arterial embolism; in complex. pulmonary artery wedge
Dosage: pregnant woman; with a pressure, pulse rate,
Adults: initially, 1 to 5 history of sulfite GI: vomiting. urine output, and color
mcg/kg/minute by I.V. sensitivity; and in those and temperature of the
infusion. Adjust dose to taking MAO inhibitor. GU: azotemia limbs.
desired hemodynamic or Respiratory: asthma
renal response, increase attacks, dyspnea If diastolic pressure rises
by 1 to 4 mcg/kg/minute disproportionately,
at 10 to 30-minute Skin: decrease perfusion rate
intervals. necrosis,piloerection, and watch out carefully
tissue sloughing with for further signs of
extravasation. vasoconstriction unless
such action is desired.
Other: anaphylaxis.
Observe for adverse
reaction.
Check for urine output.

If urine flow is decrease
without hypotension,
notify physician.
After drug is stopped,
Tamper dosage slowly to
evaluate stability of
blood pressure.
Acidosis decrease
effectiveness of
dopamine.
Relaxes the vascular Angina pectoris Contraindicated in patients CV: orthostatic Record characteristics
Generic Name smooth system CHF associated with hypersensitive to nitrates hypotension, flushing, and precipitating factors
NITROGLYCERIN AMI and in those with early MI. fainting. of anginal pain.
 Myocardial oxygen (S.L. form), severe anemia, EENT: sublingual
Brand Name consumption Cardiac load reducing increase ICP angle-closure burning. Monitor BP and apical
Nitrostat agent glaucoma, IV Skin: Cutaneous pulse before
 left ventricular nitroglycerine is vasodilation, contact administration and
Classification workload Hypertensive Crisis contraindicated in patients dermatitis (patch) periodically after dose.
Antianginal, Nitrate,  arterial BP with hypovolemia,
Vasodilator, Coronary hypotension, orthostatic Have client sit or lie
 venous return hypotension, cardiac down if taking drug for
Dosage: tamponade restrictive the first time.
0.3-0.4 mg SL q 5 min, cardiomyopathy,
max 3 doses. constrictive pericarditis. Client must have
continuing EKG
monitoring for IV
administration
Cardioverter/
defibrillator must not be
discharged through
paddle electrode
overlying
Nitro-Bid ointment or
the Transderm-Nitro
Patch. Assist with
ambulating if dizzy.
Instruct to take at first

sign of anginal pain.
May be repeated q 5
minutes to max. of 3
doses.
If the client doesn’t

experience relief, advise
to seek medical
assistance immediately.
cholinergic receptor  As an anti- Contraindicated in patients CNS: restlessness, Monitor VS.
Generic Name sites so response to sialagogue for hypersensitive to drug and ataxia, disorientation,
ATROPHINE acetylcholine is preanesthetic those with acute angle hallucinations, delirium, Report  HR
SULFATE decreased medication to closure glaucoma, coma, insomnia,
prevent or reduce obstructive uropathy, agitation, confusion. Monitor for constipation,
Brand Name secretions of the obstructive disease of GI CV: tachycardia, angina, oliguria.
Isopto Atropine respiratory tract tract, paralytic elius, toxic arrhythmias, flushing.
magacolon, intestinal EENT: photophobia, Atrophine could result in
Classification  To restore cardiac atony, unstable CV status blurred vision, CNS stimulation
Anticholinergics rate and arterial in acute hemorrhage, mydriasis. (confusion, excitement)
pressure during asthma, or myasthenia GI: dry mouth, or drowsiness
Dosage: anesthesia, when gravis. Also constipation, vomiting.
Bradycardia: 0.5 -1 mg vagal contraindicated in pregnant GU: urine retention. Instruct to take 30 mins
IV (may give via ETT at women. Hematologic: before meals
double dose) q 3-5 min,  stimulation leukocytosis
max 0.04 mg/kg produced by intra- Other: anaphylaxis Eat foods high in fiber
Cardiac arrest: 1 mg q abdominal surgical and drink plenty fluids.
3-5 min, max 0.04 traction causes a
mg/kg sudden decrease in Avoid OTC
pulse rate and antihistamines.
Nerve gas and cardiac action
organophosphate Instruct client not to
symptoms, may repeat  To lessen the degree drive a motor vehicle or
in 2 mg increments q 3 of atrioventricular participate in activities
min tiltrated to relief (A-V) heart block requiring alertness.
symptoms. when increased
vagal tone is a Advise to use hard
major factor in the candy, ice chips, etc. for
conduction defect, dry mouth.
as in some cases due
to digitalis
 To overcome severe
carotid sinus reflex
 Antidote for
cardiovascular
collapse from the
injudicious use of a
cholinergic drug.
Enhancing the force of Short term treatment of Contraindication in patients CV: angina, Monitor CVP to assess
Generic Name myocardial contraction cardiac decompensation hypersensitive to drug or hypertension, vascular volume and
DOBUTAMINE in organic heart disease any of its components and hypotension, increased cardiac pumping
HYDROCHLORIDE  HR,  CO, and  of cardiac surgical in those with idiopathic heart rate, nonspecific efficiency.
SV with minor effects to pressures. hypertrophic subaortic chest pain, phlebitis,
Brand Name HR. stenosis. PVCs. (Elevated CVP may
Dobutrex  elevated ventricular GI: nausea and indicate disruption on
filling pressure and vomiting. CO, as in pump failure or
Classification helps AV node Respiratory: asthma Pulmonary edma; low
Inotropic, Adrenergic conduction attacks, shortness of CVP may indicate
breath. hypovolemia)
Dosage Others: anaphylaxis.
Adults individualized: Monitor ECG and BP
2.5-15 mcg/kg/min. continuously during drug
administration
Rate of administration
and duration of therapy Record I&O
depend on the response
of client as determined Monitor glucose in
by HR, presence of diabetes patients
activity, BP and urine
flow Drug is administered IV
to improve cardiac
function thus increasing
BP and improving urine
output.
Report any chest pain,

increase SOB, headaches
or IV site pain.
Principal opium Relief of moderate to Contraindicated with CNS: Light-headedness, Assessment
Generic Name alkaloid; acts as agonist severe acute and chronic hypersensitivity to opioids; dizziness, sedation, History:
MORPHINE at specific opioid pain diarrhea caused by euphoria, dysphoria, Hypersensitivity to
SULFATE receptors in the CNS to poisoning until toxins are delirium, insomnia, opioids; diarrhea caused
produce analgesia, Preoperative medication eliminated; during labor or agitation, anxiety, fear, by poisoning; labor or
Brand Name euphoria, sedation; the to sedate and allay delivery of a premature hallucinations, delivery of a premature
Immediate-release receptors mediating apprehension, facilitate infant (may cross immature disorientation, infant; biliary tract
tablets: these effects are thought induction of anesthesia, blood–brain barrier more drowsiness, lethargy, surgery or surgical
MSIR to be the same as those and reduce anesthetic readily); after biliary tract impaired mental and anastomosis; head injury
Timed-release: mediating the effects of dosage surgery or following physical performance, and increased
Kadian, M-Eslon endogenous opioids surgical anastomosis; coma, mood changes, intracranial pressure;
(CAN), MS Contin, (enkephalins, Analgesic adjunct during pregnancy; labor weakness, headache, acute asthma, COPD, cor
Oramorph SR endorphins). anesthesia (respiratory depression in tremor, seizures, miosis, pulmonale, preexisting
Oral solution: neonate; may prolong visual disturbances, respiratory depression;
MSIR, Rescudose, Component of most labor). suppression of cough acute abdominal
Roxanol, Roxanol T preparations that are reflex conditions, CV disease,
Rectal suppositories: referred to as Use cautiously with head supraventricular
RMS Brompton's cocktail or injury and increased CV: Facial flushing, tachycardias, myxedema,
Injection: mixture, an oral intracranial pressure; acute peripheral circulatory seizure disorders, acute
Astramorph PF, alcoholic solution that is asthma, COPD, cor collapse, tachycardia, alcoholism, delirium
Duramorph, Epimorph used for chronic severe pulmonale, preexisting bradycardia, arrhythmia, tremens, cerebral
(CAN) pain, especially in respiratory depression, palpitations, chest wall arteriosclerosis,
Preservative-free terminal cancer patients hypoxia, hypercapnia (may rigidity, hypertension, ulcerative colitis, fever,
concentrate for decrease respiratory drive hypotension, orthostatic kyphoscoliosis,
microinfusion devices Intraspinal use with and increase airway hypotension, syncope Addison's disease,
for intraspinal use: microinfusion devices resistance); lactation (wait prostatic hypertrophy,
Infumorph for the relief of 4–6 hr after administration Dermatologic: Pruritus, urethral stricture, recent
intractable pain to nurse the baby); acute urticaria, Respiratory: GI or GU surgery, toxic
Classification abdominal conditions, CV laryngospasm, psychosis, renal or
Opioid agonist analgesic Unlabeled use: Dyspnea disease, supraventricular bronchospasm, edema hepatic dysfunction;
associated with acute tachycardias, myxedema, pregnancy; lactation
Dosage left ventricular failure seizure disorders, acute GI: Nausea, vomiting,
ADULTS and pulmonary edema alcoholism, delirium anorexia, biliary tract Physical: T; skin color,
Oral tremens, cerebral spasm; increased colonic texture, lesions;
One-third to one-sixth as arteriosclerosis, ulcerative motility in patients with orientation, reflexes,
effective as parenteral colitis, fever, chronic ulcerative colitis bilateral grip strength,
administration because kyphoscoliosis, Addison's affect; P, auscultation,
of first-pass metabolism; disease, prostatic GU: Ureteral spasm, BP, orthostatic BP,
10–30 mg q 4 hr PO. hypertrophy, urethral spasm of vesical perfusion; R,
Controlled-release: stricture, recent GI or GU sphincters, urinary adventitious sounds;
30 mg q 8–12 hr PO or surgery, toxic psychosis, retention or hesitancy, bowel sounds, normal
as directed by physician; renal or hepatic oliguria, antidiuretic output; urinary
Kadian: 20–100 mg PO dysfunction. effect, reduced libido or frequency, voiding
daily–24-hr release potency pattern, normal output;
system; MS Contin: ECG; EEG; thyroid,
200 mg PO q 12 hr. Respiratory: liver, kidney function
SC and IM Respiratory tests
10 mg (5–20 mg)/70 kg depression, apnea,
q 4 hr or as directed by circulatory Interventions
physician. depression, Caution patient not to
IV respiratory arrest, chew or crush
2.5–15 mg/70 kg of shock, cardiac arrest controlled-release
body weight in 4–5 mL preparations.
water for injection
administered over 4–5 Dilute and administer
min, or as directed by slowly IV to minimize
physician. Continuous likelihood of adverse
IV infusion: 0.1– effects.
1 mg/mL in 5% dextrose
in water by controlled Tell patient to lie down
infusion device. during IV administration.
Rectal
10–30 mg q 4 hr or as Keep opioid antagonist
directed by physician. and facilities for assisted
Epidural or controlled respiration
Initial injection of 5 mg readily available during
in the lumbar region IV administration.
may provide pain relief
for up to 24 hr. If Use caution when
adequate pain relief is injecting SC or IM into
not achieved within 1 hr, chilled areas or in
incremental doses of 1– patients with
2 mg may be given at hypotension or in shock;
intervals sufficient to impaired perfusion may
assess effectiveness, up delay absorption; with
to 10 mg/24 hr. For repeated doses, an
continuous infusion, excessive amount may
initial dose of 2–4 be absorbed when
mg/24 hr is circulation is restored.
recommended. Further Reassure patients that
doses of 1–2 mg may be they are unlikely to
given if pain relief is not become addicted; most
achieved initially. patients who receive
Intrathecal opioids for medical
Dosage is usually one- reasons do not develop
tenth that of epidural dependence syndromes
dosage; a single
injection of 0.2–1 mg Teaching points
may provide satisfactory
pain relief for up to 24 Take this drug exactly as
hr. Do not inject > 2 mL prescribed. Avoid
of the 5 mg/10 mL alcohol, antihistamines,
ampule or > 1 mL of the sedatives, tranquilizers,
10 mg/10 mL ampule. over-the-counter drugs.
Use only in the lumbar
area. Repeated Swallow controlled-
intrathecal injections are release preparation (MS
not recommended; use Contin, Oramorph SR)
other routes if pain whole; do not cut, crush,
recurs. For epidural or or chew them.
intrathecal dosing, use
preservative-free Do not take leftover
morphine preparations medication for other
only. disorders, and do not let
anyone else take your
PEDIATRIC prescription.
PATIENTS
Do not use in premature These side effects may
infants. occur: Nausea, loss of
SC or IM appetite (take with food,
0.05–0.2 mg/kg (up to lie quietly); constipation
15 mg per dose) q 4 hr (use laxative); dizziness,
or as directed by sedation, drowsiness,
physician. impaired visual acuity
(avoid driving or
GERIATRIC performing tasks that
PATIENTS OR require alertness and
IMPAIRED ADULTS visual acuity).
Use caution. Respiratory
depression may occur in Report severe nausea,
the elderly, the very ill, vomiting, and
those with respiratory constipation, shortness of
problems. Reduced breath or difficulty
dosage may be breathing, rash.
necessary.
Epidural
Use extreme caution;
injection of < 5 mg in
the lumbar region may
provide adequate pain
relief for up to 24 hr.
Intrathecal
Use lower dosages than
recommended for adults
above.
Blocks potassium Ventricular and Cardiogenic shock Blue-grey discoloration  Monitor cardiac
Generic Name chloride leading to supraventricular Severe sinus-node of skin, photosensitivity, rhythm continuously.
AMIODARONE HCL prolongation of action arrhythmias. dysfunction, causing peripheral neuropathy,  Monitor for an
potential duration. marked sinus bradycardia paraesthesia, myopathy, extended period when
Brand Name Second or third-degree ataxia, tremor, nausea, dosage adjustments
Cordarone atrioventricular block vomiting, metallic taste, are made.
Bradycardia, that has hypothyroidism,  Monitor for safe and
Classification caused syncope hyperthyroidism, effective serum levels
Cardiac drugs Known hypersensitivity to alopecia, sleep (0.5–2.5 mcg/mL).
the drug or to any of its disturbances, corneal  Doses of digoxin,
Dosage component including microdeposits, hot quinidine,
PO Initial: 200 mg 3 iodine. flushes, sweating. Heart procainamide,
times/day for 1 wk, block, bradycardia, sinus phenytoin, and
reduce to 200 mg twice arrest, hepatotoxicity, warfarin may need to
daily for a further wk. heart failure. Potentially be reduced one-third
Maintenance: 200 Fatal: Pulmonary to one-half when
mg/day or lowest toxicity including amiodarone is started.
effective dose. IV pulmonary fibrosis and  Give drug with meals
Initial: 5 mg/kg infusion interstitial pneumonitis, to decrease GI
via central venous hepatotoxicity, problems.
catheter. Max: 1.2 g/24 thyrotoxicity.  Arrange for
hr. Ventricular arrhythmias, ophthalmologic
pulmonary alveolitis, exams; reevaluate at
exacerbation of any sign of optic
arrhythmias and rare neuropathy.
serious liver injury.
 Arrange for periodic
Generally in patients
chest x-ray to
with high doses and
evaluate pulmonary
having preexisting
status (every 3–6
abnormalities of
mo).
diffusion capacity.
 Arrange for regular
periodic blood tests
for liver enzymes,
thyroid hormone
levels
 Drug dosage will be
changed in relation to
response of
arrhythmias; you will
need to be
hospitalized during
initiation of drug
therapy; you will be
closely monitored
when dosage is
changed.
 Have regular medical
follow-up, monitoring
of cardiac rhythm,
chest x-ray, eye
exam, blood tests.
 These side effects
may occur: Changes
in vision (halos, dry
eyes, sensitivity to
light; wear
sunglasses, monitor
light exposure);
nausea, vomiting, loss
of appetite (take with
meals; eat small,
frequent meals);
sensitivity to the sun
(use a sunscreen or
protective clothing
when outdoors);
constipation (a
laxative may be
ordered); tremors,
twitching, dizziness,
loss of coordination
(do not drive, operate
dangerous machinery,
or undertake tasks
that require
coordination until
drug effects stabilize
and your body adjusts
to it).
 Report unusual
bleeding or bruising;
fever, chills;
intolerance to heat or
cold; shortness of
breath, difficulty
breathing, cough;
swelling of ankles or
fingers; palpitations;
difficulty with vision.
DRUGS MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
replaces Calcium Hypocalcemia Hypophosphatemia or GI irritation; soft- Make sure prescriber specifies
Generic Name and maintains Osteoporosis and Hyperphosphatemia tissue calcification, form of calcium to be given;
CALCIUM Calcium level osteomalacia Hypothyroidism skin sloughing or crash carts may contain both
GLUCONATE Calcium carbonate is Too much calcium in blood necrosis after IM/SC calcium gluconate and calcium
used for treating inj. Hypercalcaemia chloride.
Brand Name hyperphosphatemia characterised by
Phil in chronic renal anorexia, nausea, Tell patient to take oral calcium 1
Pharmawealth/Harson failure vomiting, to 11/2 hours after meals if GI
Calcium Gluconate amp Calcium carbonate is constipation, upset occurs.
used as an antacid abdominal pain,
Classification Calcium chloride is muscle weakness, Give I.M. injection in gluteal
Electrolytes used to treat mental disturbances, region in adults and in lateral
hyperkalemia polydipsia, polyuria, thigh in infants. Use I.M. route
Dosage nephrocalcinosis, only in emergencies when no I.V.
PO Hypocalcaemia 10- renal calculi; chalky route is available bec. of irritation
50 mmol/day. IV taste, hot flushes and of tissue by calcium salts.
Hypocalcaemic tetany peripheral
2.25 mmol via slow inj , vasodilation. Tell patient to take oral calcium
then 58-77 mL of 10% Potentially Fatal: with a full glass of water.
soln diluted and Cardiac arrhythmias
administered as a and coma. Monitor calcium levels
continuous IV infusion. frequently. Hypercalcemia may
Antidote in severe result after large doses in chronic
hypermagnesaemia; renal failure. Report
Severe hyperkalaemia 10 abnormalities.
mL of 10% soln, repeat
every 10 mins if needed.
DRUGS MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE NURSING
ACTION EFFECT RESPONSIBILITIES
inhibits ACE, Hypertension Captopril is contraindicated Hypotension, Administer 1 hr before or 2 hr
Generic Name reduces Sodium and Congestive cardiac in patients who are tachycardia, chest after meals.
CAPTOPRIL water retention, failure hypersensitive to this product pain, palpitations, Alert surgeon and mark patient's
lowers blood or any angiotensin-converting pruritus, chart with notice that captopril
Brand Name pressure enzyme inhibitor. Avoid in hyperkalaemia. is being taken; the angiotensin
Ace-Bloc tab Capomed neonates, in volume depletion Proteinuria; II formation subsequent to
tab Capotec tab Capoten and renovascular disease angioedema, skin compensatory renin release
tab Captor tab Captril rashes; taste during surgery will be blocked;
tab Cardiovaz tab disturbance, hypotension may be reversed
Conamid tab Hartylox nonproductive with volume expansion.
tab Normil tab Phil cough, headache. Monitor patient closely for fall
Pharmawealth/Panion & Potentially Fatal: in BP secondary to reduction in
BF Captopril tab Prelat Neutropenia, usually fluid volume (excessive
tab Primace tab Retensin occurs within 3 mth perspiration and dehydration,
tab Spec-Ace tab of starting therapy vomiting, diarrhea); excessive
Tensoril tab Unihype tab especially in patients hypotension may occur.
Vasostad tab with renal Reduce dosage in patients with
dysfunction or impaired renal function.
Classification collagen diseases. Take drug 1 hr before or 2 hr
ACE Inhibitors Hyperkalaemia. after meals; do not take with
Anaphylactic food. Do not stop without
reactions. consulting your health care
Dosage provider.
O HTN Initial: 12.5 mg Be careful of drop in blood
twice daily. pressure (occurs most often
Maintenance: 25-50 mg with diarrhea, sweating,
twice daily. Max: 50 mg vomiting, dehydration); if light-
3 times/day. Heart headedness or dizziness occurs,
failure Initial: 6.25-12.5 consult your health care
mg 2-3 times/day. Max: provider.
50 mg 3 times/day. Post Avoid over-the-counter
MI Start 3 days after MI. medications, especially cough,
Initial: 6.25 mg/day, may cold, allergy medications that
increase after several wk may contain ingredients that
to 150 mg/day in divided will interact with ACE
doses if needed and inhibitors. Consult your health
tolerated. HTN in care provider.
diabetic nephropathy 75- These side effects may occur:
100 mg/day in divided GI upset, loss of appetite,
doses. change in taste perception
(limited effects, will pass);
mouth sores (perform frequent
mouth care); rash; fast heart
rate; dizziness, light-headedness
(usually passes after the first
few days; change position
slowly, and limit your activities
to those that do not require
alertness and precision).
Report mouth sores; sore throat,
fever, chills; swelling of the
hands, feet; irregular heartbeat,
chest pains; swelling of the
face, eyes, lips, tongue,
difficulty breathing.
DRUGS MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE NURSING
ACTION EFFECT RESPONSIBILITIES
prevents histamine Hay fever, urticaria,  overactive thyroid CV and CNS • Monitor carefully, assess for
Generic Name mediated responses, vasomotor rhinitis, gland effects, blood confusion, delirium, other
DIPENHYDRAMINE drug provides local angioneurotic edema,  increased pressure in disorders, GI anticholinergic side effects
anesthesia and drug sensitization, serum the eye disturbances, anti- and fall risk. Institute
Brand Name suppresses cough reflex & penicillin reaction,  closed angle glaucoma muscarinic effects measures to prevent falls.
Benadryl contact dermatitis,  high blood pressure and allergic • Assess movement disorder
atopic eczema, other  stenosing peptic ulcer reactions. before and after
Classification allergic dermatoses,  blockage of the urinary administration.
Antihistamine pruritus, food bladder • Caution patient not to use
sensitivity, oral OTC diphenhydramine
 enlarged prostate
Dosage parkinsonism, motion products with any other
 an inability to
50mg/ml sickness. product containing
completely empty the
diphenhydramine, including
bladder
products used topically.
 chronic idiopathic • It can cause excitation in
constipation children. Caution parents or
caregivers about proper dose
calculation; overdosage,
especially in infants and
children, can cause
hallucinations, seizures or
death Inform patient that this
drug may cause dry mouth.
Frequent oral rinses, good oral
hygiene, and sugarless gum or
candy may minimize this
effect. Notify dentist if dry
mouth persists for more than 2
weeks.
a direct acting Chronic hypertension Hypersensitivity to tachycardia, • Give oral drug with food to
Generic Name peripheral vasodilator Hypertensive crisis hydralazine; coronary artery palpitation, angina increase bioavailability(drug
HYDRALAZINE HCL that relaxes arteriolar Severe essential disease; mitral valvular pectoris, severe should be given in a consistent
smooth muscles hypertension rheumatic heart disease are headache, dizziness, relationship ti ingestion of
Brand Name contraindication for its use. weight gain, GI food for consistent response to
Supres disturbances, pruritus, therapy).
rashes, nausea and • Drug may cause a syndrome
Classification vomiting resembling systemic lupus
Antihypertensive erythematosus (SLE). Arrange
for CBC, LE cell preparations,
Dosage and ANA titers before and
20mg/ml periodically during prolonged
therapy, even in the
asymptomatic patient.
Discontinue if blood
dyscrasias occur. Reevaluate
therapy if ANA or LE tests are
positive.
• Arrange for pyridoxine if
patient develops symptoms of
peripheral neuritis.
• Monitor patient for
orthostatic hypotension which
is most marked in the morning
and in hot weather, and with
alcohol or exercise.
Decreases inflammation, endocrine, hematologic,  inactive tuberculosis fluid and electrolyte • Give daily before 9 AM
Generic Name mainly by stabilizing rheumatic & collagen  herpes simplex disturbances, decreased to mimic normal peak
HYDROCORTISONE leukocyte lysosomal disorders, dermatologic, infection of the eye carbohydrate tolerance, diurnal corticosteroid
SODIUM SUCCINATE membranes, suppresses ophth, GI, resp &  an infection due to a impaired wound levels and minimize
immune response, neoplastic diseases, fungus healing, thin fragile HPA suppression.
Brand Name stimulates bone marrow edematous states,  intestinal infection skin, muscle weakness, • Space multiple doses
A-hydroCort, Solu- and influences protein, control of severe caused by the steroid myopathy, evenly throughout the
Cortef fat, and carbohydrate incapacitating allergic roundworm osteoporosis, aseptic day.
metabolism conditions, TB Strongyloides necrosis, peptic • Do not give IM
Classification meningitis w/  pheochromocytoma ulceration w/ possible injections if patient has
corticosteroid hormones subarachnoid block or  a condition with low perforation, cataracts, thrombocytopenic
impending block when thyroid hormone levels increased intraocular purpura.
Dosage used concurrently with and intracranial • Rotate sites of IM
 diabetes
100 mg/ 2 mL, 250 mg/ appropriate anti-TB pressure, growth repository injections to
 insufficiency of the
2 mL chemotherapy, shock retardation, Cushingoid avoid local atrophy.
hypothalamus and
secondary to state, protein • Use minimal doses for
pituitary gland
adrenocortical catabolism, psychic minimal duration to
insufficiency or shock  low amount of derangements, minimize adverse
unresponsive to potassium in the blood exophthalmos, masking effects.
conventional therapy  psychotic disorder of infections, gasping • Taper doses when
when adrenocortical  brain injury syndrome, seizures, discontinuing high-dose
insufficiency may be  myasthenia gravis menstrual irregularities. or long-term therapy.
present  a skeletal muscle • Arrange for increased
disorder dosage when patient is
 a disease with subject to unusual stress.
shrinking and weaker • Use alternate-day
muscles called maintenance therapy
myopathy with short-acting
 increased pressure in corticosteroids whenever
the eye possible.
 wide-angle glaucoma • Do not give live virus
 clouding of the lens of vaccines with
the eye called cataracts immunosuppressive
 high blood pressure doses of hydrocortisone.
 chronic heart failure • Provide antacids
 an ulcer from too much between meals to help
stomach acid avoid peptic ulcer.
 diverticulitis
 surgical joining of two
parts of the intestine
 hardening of the liver
 decreased kidney
function
 osteoporosis
 a condition of weak
bones
 decreased calcification
or density of bone
 inherited deficiency of
argininosuccinate lyase
 inherited carbamoyl
phosphate synthetase
deficiency
 citrullinemia
 infection caused by the
varicella zoster virus
 measles
 ornithine
carbamoyltransferase
deficiency
 arginase deficiency
 exposure to the measles
 exposure to the
chickenpox
 broken bone due to
disease or illness
 malaria affecting the
brain
 hyperammonemia
associated with N-
acetylglutamate
synthase deficiency
It blocks the calcium or Treatment of vasospastic Cardiovascular shock, Flushing, nausea,  Do not confuse
Generic Name “slow” channels and angina, chronic stable severe aortic stenosis or in dizziness, headache, nifedipine with
NIFEDIPINE inhibits entry of calcium angina, hypertension patients known to be tiredness, sedation, leg nicardipine
ions into vascular hypertensive to nifedipine. edema and other  Do not exceed a
smooth muscles Care in in needed in manifestations of single dose
Brand Name particularly of resistance patients with very low peripheral vasodilation.  Before increasing
Calciboloc vessels and coronary blood pressure (severe dose, carefully
arteries. Dilates hypotension with systolic monitor BP
coronary and peripheral pressure < 90 mmHg) or  Use only the
Classification arteries, as well as veins. decompensated heart sustained release
Calcium Channel Coronary arterial failure. tablets to treat
blocker vasodilation increases hypertension
coronary blood flow in  Concomitant
the ischemic post- therapy with beta
Dosage stenotic areas, while adrenergic blocking
Capsules: 10-20 mg 3x a dilation of the peripheral agents may be used
day arteries lowers arterial  Clients
Tablets: 30-60 mg per blood pressure and withdrawn from beta
day reduces left ventricular blockers may
afterload. Some renal manifest symptoms
artery dilation may of increased angina
stimulate mild diuresis. which cannot be
prevented by
nifedipine may
increase the severity
of angina situation.
 Protect capsules
from light and
moisture; store at
room temperature in
original container.
 During initial
therapy and when
dosage increased,
may experience
increase in
frequency, duration,
or severity of angina.
 Food may
decrease rate but not
extent of absorption;
can be taken without
regard to meals.
DRUGS MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING RESPONSIBILITIES
OF ACTION
In therapeutic Management of Sinus bradycardia, greater CNS: Dizziness, vertigo, Assessment & Drug Effects
Generic Name doses, atenolol hypertension as a than first-degree AV heart light-headedness,
ATENOLOL selectively single agent or block, uncompensated heart syncope, fatigue or  Neonates born to mothers who
blocks beta1- concomitantly failure, cardiogenic shock, weakness, lethargy, are receiving atenolol at
Brand Name adrenergic with other peripheral vascular disease, drowsiness, insomnia, parturition or breast–feeding
Tenormin receptors located antihypertensive Raynaud's disease, mental changes, may be at risk for
chiefly in cardiac agents, especially hypotension; abrupt depression. CV: Bradyca hypoglycemia.
Classification muscle. With a diuretic, and in discontinuation, pulmonary rdia, hypotension,  Check apical pulse before
Autonomic nervous large doses, treatment of edema. Safety during CHF, cold extremities, giving oral drug, especially in
system agent; beta- preferential stable angina pregnancy (category D), or leg pains, patients receiving digitalis (both
adrenergic antagonist effect is lost and pectoris, MI. lactation is not established. dysrhythmias. GI: Nause drugs slow AV conduction). If
(sympatholytic, inhibition of a, vomiting, below 60 bpm (or other ordered
blocking beta2-adrenergic Cautions Use diarrhea. Respiratory: Pul parameter), withhold dose and
agent); antihypertensive receptors may Hypertensive patients with monary edema, consult physician.
agent lead to increased CHF controlled by digitalis dyspnea, bronchospasm.  Monitor apical pulse, BP,
airway and diuretics, vasospastic Other: May mask respirations, and peripheral
Dosage resistance, angina (Prinzmetal's symptoms of circulation throughout dosage
Hypertension, Angina especially in angina); asthma, bronchitis, hypoglycemia; decreased adjustment period. Consult
Adult: PO 25–50 mg/d, patients with emphysema, and COPD; sexual ability. physician for acceptable
may increase to 100 asthma or major depression; diabetes parameters.
mg/d COPD. mellitus; impaired renal
Child: PO 0.8–1.5 Mechanisms for function, dialysis; Patient & Family Education
mg/kg/d (max: 2 antihypertensive myasthenia gravis;
mg/kg/d) action include pheochromocytoma,  Adhere rigidly to dose regimen.
central effect hyperthyroidism, Sudden discontinuation of drug
MI leading to thyrotoxicosis; older adults. can exacerbate angina and
Adult: PO 10 min after decreased precipitate tachycardia or MI in
second IV dose, start sympathetic patients with coronary artery
50 mg/d IV 5 mg outflow to disease, and thyroid storm in
q5min times 2 doses, periphery, patients with hyperthyroidism.
then switch to PO reduction in  Make position changes slowly
renin activity and in stages, particularly from
with consequent recumbent to upright posture.
suppression of  Do not breast feed while taking
the renin- this drug.
angiotensin-
aldosterone
system, and
competitive
inhibition of
catecholamine
binding at beta-
adrenergic
receptor sites.
DRUGS MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE NURSING RESPONSIBILITIES
OF ACTION EFFECT
Potent anti-ulcer Short-term Hypersensitivity to ranitidine; CNS: Headache, Assessment & Drug Effects
Generic Name drug that treatment of acute porphyria; OTC malaise, dizziness,
RANITIDINE competitively and active duodenal administration in children somnolence,  Potential toxicity results from
reversibly inhibits ulcer; <12 y. insomnia, vertigo, decreased clearance (elimination)
Brand Name histamine action maintenance mental confusion, and therefore prolonged action;
Zantac, Zantac at H2-receptor therapy for Cautious Use agitation, depression, greatest in the older adult patients or
EFFERdose, Zantac sites on parietal duodenal ulcer hallucinations in those with hepatic or renal
GELdose, Zantac-75 cells, thus patient after Hypersensitivity to H2- older dysfunction.
blocking gastric healing of acute blockers; hepatic and renal adults. CV: Bradycar  Lab tests: Periodic liver functions.
Classification acid secretion. ulcer; treatment dysfunction; renal failure; dia (with rapid IV Monitor creatinine clearance if renal
GASTROINTESTINAL Indirectly reduces of PKU; pregnancy (category push). GI: Constipati dysfunction is present or suspected.
AGENT; ANTISECRET pepsin secretion gastroesophageal B), infants <1 mo, lactation. on, nausea, When clearance is <50 mL/min,
ORY (H2-RECEPTOR but appears to reflux disease; abdominal pain, manufacturer recommends
antagonist) have minimal short-term diarrhea. Skin: Rash. reduction of the dose to 150 mg
effect on fasting treatment of Hematologic: Revers once q24h with cautious and
Dosage and postprandial active, benign ible decrease in gradual reduction of the interval to
Duodenal Ulcer, Gastric serum gastrin gastric ulcer; WBC count, q12h or less, if necessary.
Ulcer, Gastroesophageal concentrations or treatment of thrombocytopenia. B  Be alert for early signs of
Reflux secretion of pathologic GI ody as a hepatotoxicity (though l ow and
Adult: PO 150 mg b.i.d. gastric intrinsic hypersecretory Whole: Hypersensiti thought to be a hypersensitivity
or 300 mg h.s. IV 50 mg factor or mucus. conditions (e.g., vity reaction): jaundice (dark urine,
q6–8h; 150–300 mg/24 h Zollinger-Ellison reactions, anaphylaxi pruritus, yellow sclera and skin),
by continuous infusion syndrome, s (rare). elevated transaminases (especially
Child: PO 4–5 mg/kg/d systemic ALT) and LDH.
divided q8–12h (max: 6 mastocytosis, and  Long-term therapy may lead to
mg/kg/d or 300 postoperative vitamin B12 deficiency.
mg/d) IM/IV 2–4 hypersecretion);
mg/kg/d divided q6–8h; heartburn. Patient & Family Education
0.1–0.125 mg/kg/h by
continuous infusion  Note: Long duration of action
Infant: PO <2 wk, 2
mg/kg/d divided provides ulcer pain relief that is
q12h IV 1.5 mg/kg/d maintained through the night as well
divided q12h or 0.04 as the day.
mg/kg/h by continuous  Be aware that even if symptomatic
infusion relief is provided by ranitidine, this
should not be interpreted as absence
Duodenal Ulcer, of gastric malignancy. Follow-up
Maintenance Therapy examinations will be scheduled
Adult: PO 150 mg h.s. after therapy is discontinued.
 Adhere to scheduled periodic
Pathologic laboratory checkups during
Hypersecretory ranitidine treatment.
Conditions  Do not supplement therapy with
Adult: PO 150 mg b.i.d. OTC remedies for gastric distress or
up to 6.3 g/d IV 50 mg pain without physician's advice
q6–8h (e.g., Mylanta II reduces ranitidine
absorption).
Heartburn  Do not smoke; research shows
Adult: PO 75–150 mg smoking decreases ranitidine
b.i.d. efficacy and adversely affects ulcer
healing.
 Do not breast feed while taking this
drug without consulting physician.
DRUGS MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING RESPONSIBILITIES
nACTION
Synthetic To relieve Pregnancy (category C), Body as a Assessment & Drug Effects
Generic Name sympathomimetic bronchospasm lactation. Use of oral syrup Whole: Hypersensitivit
ALBUTEROL amine and moderately associated with in children <2 y. y  Monitor therapeutic
selective beta2- acute or chronic reaction. CNS: Tremor, effectiveness which is
Brand Name adrenergic agonist asthma, Cautious Use anxiety, nervousness, indicated by significant
Accuneb, Novosalmol with comparatively bronchitis, or restlessness, subjective improvement in
, Proventil, Proventil long action. Acts more other reversible Cardiovascular disease, convulsions, weakness, pulmonary function within
HFA, Proventil prominently on obstructive hypertension, headache, 60–90 min after drug
Repetabs, Salbutamol, beta2 receptors airway diseases. hyperthyroidism, diabetes hallucinations. CV: Pal administration.
Ventolin, Ventolin (particularly smooth Also used to mellitus, hypersensitivity to pitation, hypertension,  Monitor for: S&S of fine
HFA, Volmax muscles of bronchi, prevent exercise- sympathomimetic amines or hypotension, tremor in fingers, which may
uterus, and vascular induced to fluorocarbon propellant bradycardia, reflex interfere with precision
Classification supply to skeletal bronchospasm. used in inhalation aerosols. tachycardia. Special handwork; CNS stimulation,
Autonomic nervous muscles) than on Senses: Blurred vision, particularly in children 2–6
system agent; beta- beta1 (heart) receptors. dilated y, (hyperactivity, excitement,
adrenergic agonist Inhibits histamine pupils. GI: Nausea, nervousness, insomnia),
(sympathomimetic); b release by mast cells. vomiting. Other: Muscl tachycardia, GI symptoms.
ronchodilator Produces e cramps, hoarseness. Report promptly to
(respiratory smooth bronchodilation, physician.
muscle relaxant) regardless of  Lab tests: Periodic ABGs,
administration route, pulmonary functions, and
Dosage by relaxing smooth pulse oximetry.
Bronchospasm muscles of bronchial  Consult physician about
Adult: PO 2–4 mg 3– tree. giving last albuterol dose
4 times/d, 4–8 mg several hours before
sustained release 2 bedtime, if drug-induced
times/d Inhaled 1–2 insomnia is a problem.
inhalations q4–6h
Child: PO 2–6 y, 0.1– Patient & Family Education
0.2 mg/kg t.i.d. (max:
4 mg/dose); 6–12 y, 2  Review directions for correct
mg 3–4
times/d Inhaled 6–12 use of medication and
y, 1–2 inhalations q4– inhaler
6h (see ADMINISTRATION).
 Avoid contact of inhalation
drug with eyes.
 Do not increase number or
frequency of inhalations
without advice of physician.
 Notify physician if albuterol
fails to provide relief
because this can signify
worsening of pulmonary
function and a reevaluation
of condition/therapy may be
indicated.
 Note: Albuterol can cause
dizziness or vertigo; take
necessary precautions.
 Do not use OTC drugs
without physician approval.
Many medications (e.g., cold
remedies) contain drugs that
may intensify albuterol
action.
 Do not breast feed while
taking this drug without
consulting physician.
DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
OF ACTION
Fat-soluble Drug of choice as Hypersensitivity to Hypersensitivity  Monitor patient constantly.
Generic Name: naphthoquinone antidote for AquaMEPHYTON; severe or anaphylaxis-like Severe reactions, including
PHYTONADIONE derivative overdosage of liver disease. reaction: facial flushing, fatalities, have occurred
(VITAMIN K1) chemically coumarin and cramp-like pains, during and immediately after
identical to and indandione oral convulsive movements, IV injection.
Brand Name: with similar anticoagulants. chills, fever,  Lab tests: Baseline and
AquaMEPHYTON activity as Also reverses diaphoresis, weakness, frequent PT/INR.
naturally hypoprothrombin dizziness,  Frequency, dose, and therapy
occurring vitamin emia secondary shock, cardiac arrest, duration are guided by
Classification K. Vitamin K is to administration Headache (after oral PT/INR clinical response.
Hormones and Synthetic essential for of oral dose), brain  Monitor therpeutic
Substitutes; Vitamin; hepatic antibiotics, damage, Gastric upset. effectiveness which is
Antidote biosynthesis of quinidine, Paradoxic indicated by shortened PT,
blood clotting quinine, hypoprothrombinemia INR, bleeding, and clotting
Dosage: Factors II, VII, salicylates, (patients with severe times, as well as decreased
Anticoagulant Overdose: IX, and X. sulfonamides, liver disease), severe hemorrhagic tendencies.
Adult: PO/SC/IM 2.5-10 excessive vitamin hemolytic anemia,  Be aware that patients on
mg; rarely up to 50 mg/d, A, and secondary Hyperbilirubinemia, large doses may develop
may repeat parenteral dose to inadequate kernicterus, temporary resistance to
after 6-8h if needed or PO . absorption and Bronchospasm, coumarin-type
dose after 6-8 h if needed synthesis of dyspnea, sensation of anticoagulants. If oral
or PO dose after 12-24 h vitamin K. chest anticoagulant is reinstituted,
IV Also, prophylaxis constriction, respiratory larger than former doses may
Emergency only: of and therapy for arrest, Pain at injection be needed. Some patients
10-15 mg at a rate of 1 neonatal site, hematoma, and may require change to
mg/min, may be repeated hemorrhagic nodule formation, heparin.
in 4 h if bleeding disease. erythematous skin
continues eruptions (with repeated
injections). Special
Senses: Peculiar taste
sensation.
DRUGS MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING RESPONSIBILITIES
OF ACTION
Major actions To relieve pain of History of hypersensitivity Body as a Assessment & Drug Effects
Generic Name appear to be low to moderate to salicylates including Whole: Hypersensitivi
ASPIRIN associated intensity. Also methyl salicylate (oil of ty  Monitor for loss of tolerance to
(ACETYLSALICYLIC primarily with for various wintergreen); sensitivity to (urticaria, bronchospa aspirin. The reaction is
ACID) inhibiting the inflammatory other NSAIDs; patients with sm, anaphylactic nonimmunologic; symptoms
formation of conditions, such "aspirin triad" (aspirin shock (laryngeal usually occur 15 min to 3 h after
Brand Name prostaglandins as acute sensitivity, nasal polyps, edema). ingestion: profuse rhinorrhea,
involved in the rheumatic fever, asthma); chronic rhinitis; erythema, nausea, vomiting,
production of Systemic Lupus, chronic urticaria; history of CNS: Dizziness, intestinal cramps, diarrhea.
Classification inflammation, rheumatoid GI ulceration, bleeding, or confusion,  Lab tests: frequent PT and IRN
Central nervous system pain, and fever. arthritis, other problems; drowsiness. with concurrent anticoagulant
agent; analgesic, osteoarthritis, hypoprothrombinemia, therapy; more frequent fasting
salicylate; antipyretic; a Anti- bursitis, and vitamin K deficiency, Special blood glucose levels with diabetes.
ntiplatelet inflammatory calcific hemophilia, or other Senses: Tinnitus,  Monitor the diabetic child
action: Inhibits tendonitis, and to bleeding disorders; CHF. Do hearing carefully for need to adjust insulin
Dosage prostaglandin reduce fever in not use aspirin during loss. GI: Nausea, dose. Children on high doses of
Mild to Moderate Pain, synthesis. As an selected febrile pregnancy (category D), vomiting, diarrhea, aspirin are particularly prone to
Fever anti- conditions. Used especially in third trimester; anorexia, heartburn, hypoglycemia (see Appendix F).
Adult: PO/PR 350–650 inflammatory to reduce lactation; or in prematures, stomach  Monitor for salicylate toxicity. In
mg q4h (max: 4 g/d) agent, aspirin recurrence of neonates, or children under 2 pains, ulceration, adults, a sensation of fullness in
Child: PO/PR 10–15 appears to be TIA due to fibrin y, except under advice and occult bleeding, GI the ears, tinnitus, and decreased or
mg/kg in 4–6 h (max: involved in platelet emboli supervision of physician. Do bleeding. muffled hearing are the most
3.6 g/d) enhancing and risk of stroke not use in children or frequent symptoms associated with
antigen removal in men; to teenagers with chickenpox Hematologic: Thromb chronic salicylate overdosage.
Arthritic Conditions and in reducing prevent or influenza-like illnesses ocytopenia, hemolytic  Monitor children closely because
Adult: PO 3.6–5.4 g/d the spread of recurrence of MI; because of possible anemia, prolonged salicylate toxicity is enhanced by
in 4–6 divided doses inflammation in as prophylaxis association with Reye's bleeding time. the dehydration that frequently
Child: PO 80–100 ground against MI in syndrome. accompanies fever or illness.
mg/kg/d in 4–6 divided substances. men with Skin: Petechiae, easy Children tend to manifest
doses; max 130 These anti- unstable angina. bruising, rash. salicylate toxicity by
mg/kg/d inflammatory Cautious Use hyperventilation, agitation, mental
actions also Urogenital: Impaired confusion, or other behavioral
Thromboembolic contribute to Unlabelled Uses Otic diseases; gout; children renal function. changes, drowsiness, lethargy,
Disorders analgesic with fever accompanied by sweating, and constipation.
Adult: PO 81–325 mg effects. As prophylactic dehydration; Other: Prolonged  Note: Potential for toxicity is high
qd against hyperthyroidism; cardiac pregnancy and labor in older adults and patients with
Analgesic thromboembolis disease; renal or hepatic with increased asthma, nasal polyps, perennial
TIA Prophylaxis action: Principa m; to prevent impairment; G6PD bleeding. vasomotor rhinitis, hay fever, or
Adult: PO 650 mg lly peripheral cataract and deficiency; anemia; chronic urticaria.
b.i.d. with limited progression of preoperatively; Hodgkin's
action in the diabetic disease. Patient & Family Education
MI Prophylaxis CNS, possibly retinopathy; and
Adult: PO 80–325 on the to control  Do not give aspirin to children or
mg/d hypothalamus; symptoms related teenagers with symptoms of
results in relief to gluten varicella (chickenpox) or
of mild to sensitivity. influenza-like illnesses because of
moderate pain. association of aspirin usage with
Reye's syndrome.
Antipyretic  Use enteric-coated tablets,
action: In extended release tablets, buffered
addition to aspirin, or aspirin administered
inhibiting with an antacid to reduce GI
prostaglandin disturbances.
synthesis,  Take aspirin 1–2 d before menses
aspirin lowers when prescribed for
body dysmenorrhea. When experiencing
temperature in heavy menstrual blood loss, take
fever by another analgesic, such as
indirectly acetaminophen, instead of aspirin.
causing  Discontinue aspirin therapy about
centrally 1 wk before surgery to reduce risk
mediated of bleeding. Do not use aspirin-
peripheral containing gum or gargles or chew
vasodilation and aspirin products for at least 1 wk
sweating. following oral surgery.
 Note: Chronic use of high-dose
Antiplatelet aspirin during the last 3 mo of
action: Aspirin pregnancy can prolong pregnancy
(but not other and labor, increase maternal
salicylates) bleeding before and after-delivery,
powerfully and cause weight increase and
inhibits platelet hemorrhage in the neonate.
aggregation.  Discontinue aspirin use with onset
High serum of ringing or buzzing in the ears,
salicylate impaired hearing, dizziness, GI
concentrations discomfort or bleeding, and report
can impair to physician.
hepatic  Do not use aspirin for self-
synthesis of medication of pain (adults) beyond
blood 5 d without consulting a physician.
coagulation Do not use aspirin longer than 3 d
factors VII, IX, for fever (adults and children),
and X, possibly never for fever over 38.9° C (102°
by inhibiting F) in older adults or 39.5° C (103°
action of F) in children and adults under 60
vitamin K. yrs or for recurrent fever without
medical direction.
 Consult physician before using
aspirin for any fever accompanied
by rash, severe headache, stiff
neck, marked irritability, or
confusion (all possible symptoms
of meningitis).
 Avoid alcohol when taking large
doses of aspirin.
 Observe and report signs of
bleeding (e.g., petechiae,
ecchymoses, bleeding gums,
bloody or black stools, cloudy or
bloody urine).
 Maintain adequate fluid intake
when taking repeated doses of
aspirin.
 Avoid other medications
containing aspirin unless directed
by physician, because of danger of
overdosing (there are more than
500 OTC aspirin-containing
compounds).
 Do not breast feed while taking
this drug.
DRUGS MECHANISM OF INDICATIONS CONTRAINDICATIONS ADVERSE NURSING RESPONSIBILITIES
ACTION EFFECT
Psychotherapeutic Drug of choice for Injectable form: Shock, Body as a Assessment & Drug Effects
Generic Name agent related to status epilepticus. coma, acute alcohol Whole: Throat and
DIAZEPAM chlordiazepoxide; Management of intoxication, depressed vital chest  Monitor for adverse reactions.
DIAZEPAM reportedly superior anxiety disorders, signs, obstetrical patients, pain. CNS: Drowsi Most are dose related. Physician
EMULSIFIED in antianxiety and for short-term relief infants <30 d of age. Tablet ness, fatigue, will rely on accurate observation
anticonvulsant of anxiety form: Infants <6 mo of age, ataxia, confusion, and reports of patient response to
Brand Name activity, with symptoms, to allay acute narrow-angle paradoxic rage, the drug to determine lowest
Valium, Diastat, somewhat shorter anxiety and tension glaucoma, untreated open- dizziness, vertigo, effective maintenance dose.
Diazemuls, Apo- duration of action. prior to surgery, angle glaucoma; during or amnesia, vivid  Monitor for therapeutic
Diazepam, E-Pam, Like cardioversion and within 14 d dreams, headache, effectiveness. Maximum effect
Meval, Novodipam chlordiazepoxide, it endoscopic of MAO inhibitor therapy. slurred speech, may require 1–2 wk; patient
Dizac appears to act at both procedures, as an Safe use during pregnancy tremor; EEG tolerance to therapeutic effects
limbic and amnesic, and (category D) and lactation is changes, tardive may develop after 4 wk of
Classification subcortical levels of treatment for not established. dyskinesia. CV: Hy treatment.
Central nervous CNS. restless legs. Also potension,  Observe necessary preventive
system used to alleviate Cautious Use tachycardia, precautions for suicidal
agent; benzodiazepine acute withdrawal edema, cardiovascu tendencies that may be present in
anticonvulsant; anxiol symptoms of Epilepsy, psychoses, mental lar anxiety states accompanied by
ytic alcoholism, voiding depression; myasthenia collapse. Special depression.
problems in older gravis; impaired hepatic or Senses: Blurred  Observe patient closely and
Dosage adults, and renal function; drug abuse, vision, diplopia, monitor vital signs when
Status Epilepticus adjunctively for addiction-prone individuals. nystagmus. GI: Xer diazepam is given parenterally;
Adult: IV/IM 5–10 relief of skeletal Injectable diazepam used ostomia, nausea, hypotension, muscular weakness,
mg, repeat if needed muscle spasm with extreme caution in constipation, tachycardia, and respiratory
at 10–15 min intervals associated with older adults, the very ill, and hepatic depression may occur.
up to 30 mg, then cerebral palsy, patients with COPD. dysfunction. Uroge  Lab tests: Periodic CBC and liver
repeat if needed q2– paraplegia, nital: Incontinence, function tests during prolonged
4h athetosis, stiff-man urinary retention, therapy.
Child: IV/IM <5 y, syndrome, tetanus. gynecomastia  Supervise ambulation. Adverse
0.2–0.5 mg slowly (prolonged use), reactions such as drowsiness and
q2–5min up to 5 mg; menstrual ataxia are more likely to occur in
>5 y, 1 mg slowly irregularities, older adults and debilitated or
q2–5min up to 10 mg, ovulation those receiving larger doses.
repeat if needed q2–4 failure. Respiratory Dosage adjustment may be
h : Hiccups, necessary.
coughing, laryngos  Monitor I&O ratio, including
Anxiety, Muscle pasm. Other: Pain, urinary and bowel elimination.
Spasm, Convulsions, venous thrombosis,  Note: Smoking increases
Alcohol Withdrawal phlebitis at metabolism of diazepam;
Adult: PO 2–10 mg injection site. lowering clinical effectiveness.
b.i.d. to q.i.d. or 15– Heavy smokers may need a
30 mg/d sustained higher dose than the nonsmoker.
release IV/IM 2–10  Note: Psychic and physical
mg, repeat if needed dependence may occur in patients
in 3–4 h on long-term high dosage
Geriatric: PO 1–2 mg therapy, in those with histories of
1–2 times/d (max: 10 alcohol or drug addiction, or in
mg/d) those who self-medicate.
Child: PO >6 mo, 1–
2.5 mg bid. or t.i.d. Patient & Family Education
 Avoid alcohol and other CNS

depressants during therapy unless
otherwise advised by physician.
Concomitant use of these agents
can cause severe drowsiness,
respiratory depression, and
apnea.
 Do not drive or engage in other
potentially hazardous activities or
those requiring mental precision
until reaction to drug is known.
 Tell physician if you become or
intend to become pregnant during
therapy; drug may need to be
discontinued.
 Take drug as prescribed; do not
change dose or dose intervals.
 Check with physician before
taking any OTC drugs.
this drug without consulting
physician.
ACTION EFFECT
Produces analgesia It provides Hypersensitivity to Body as a Assessment & Drug Effects
Generic Name by unknown temporary acetaminophen or phenacetin; Whole: Negligib
ACETAMINOPHEN mechanism, perhaps analgesia for mild use with alcohol. le with  Monitor for S&S of:
by action on to moderate pain. recommended hepatotoxicity, even with moderate
Brand Name peripheral nervous In addition, Cautious Use dosage; acetaminophen doses, especially in
Tempra, Tylenol, Valado system. Reduces acetaminophen rash. Acute individuals with poor nutrition or
l fever by direct lowers body Children <3 y unless directed poisoning: Anor who have ingested alcohol over
action on temperature in by a physician; repeated exia, nausea, prolonged periods; poisoning, usually
Classification hypothalamus heat- individuals with a administration to patients vomiting, from accidental ingestion or suicide
Central nervous system regulating center fever. with anemia or hepatic dizziness, attempts; potential abuse from
agent; nonnarcotic with consequent disease; arthritic or lethargy, psychological dependence
analgesic, antipyretic peripheral rheumatoid conditions diaphoresis, (withdrawal has been associated with
vasodilation, affecting children <12 y; chills, epigastric restless and excited responses).
Dosage sweating, and alcoholism; malnutrition; or abdominal
Mild to Moderate Pain, dissipation of heat. thrombocytopenia. Safety pain, diarrhea; Patient & Family Education
Fever Unlike aspirin, during pregnancy (category onset
Adult: PO 325–650 mg acetaminophen has B) or lactation is not of hepatotoxicit  Do not take other medications
q4–6h (max: 4 little effect on established. y—elevation of (e.g., cold preparations)
g/d) PR 650 mg q4–6h platelet aggregation, serum containing acetaminophen
(max: 4 g/d) does not affect transaminases without medical advice;
Child: PO 10–15 mg/kg bleeding time, and (ALT, AST) and overdosing and chronic use can
q4–6h PR 2–5 y, 120 mg generally produces bilirubin; cause liver damage and other
q4–6h (max: 720 no gastric bleeding. hypoglycemia, h toxic effects.
mg/d); 6–12 y, 325 mg epatic coma,  Do not self-medicate adults for
q4–6h (max: 2.6 g/d) acute renal pain more than 10 d (5 d in
Neonate: PO 10–15 failure (rare). Ch children) without consulting a
mg/kg q6–8h ronic physician.
ingestion: Neutr  Do not use this medication
openia, without medical direction for:
pancytopenia, fever persisting longer than 3 d,
leukopenia, fever over 39.5° C (103° F), or
thrombocytopen recurrent fever.
ic  Do not give children more than 5
purpura, hepatot doses in 24 h unless prescribed
oxicity in by physician.
alcoholics, renal  Do not breast feed while taking
damage. this drug without consulting
physician.
DRUGS MECHANISM INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
OF ACTION RESPONSIBILITIES
Residue from General purpose Reportedly not effective GI: Vomiting (rapid Assessment & Drug
Generic Name destructive emergency antidote in the for poisonings by cyanide, ingestion of high doses), Effects
ACTIVATED distillation of treatment of poisonings by mineral acids, caustic constipation, diarrhea
CHARCOAL (LIQUID organic materials most drugs and chemicals, alkalis, organic solvents, (from sorbitol).  Record
ANTIDOTE) treated to reduce e.g., acetaminophen, iron, ethanol, methanol. appearance,
particle size, which aspirin, atropine, color,
Brand Name increases surface barbiturates, digitalis consistency,
Actidose, CharcoAid, area and adsorptive glycosides, phenytoin, Cautious Use frequency, and
Charcocaps, Charcodote, power. Activated propoxyphene, strychnine, relative amount
Insta-Char charcoal (carbon) is tricyclic antidepressants, Pregnancy (category C); of stools. Inform
a chemically inert, among many others. lactation. patient that
Classification odorless, tasteless, Gastric dialysis (repetitive activated
Antidote, Adsorbent fine black powder doses) in uremia to adsorb charcoal will
with wide spectrum various waste products color feces black.
Dosage of adsorptive from GI tract; severe acute
Acute Poisonings activity. Acts by poisoning. Has been used Patient & Family
Adult: PO 30–100 g in at binding (adsorbing) to adsorb intestinal gases Education
least 180–240 mL (6–8 oz) toxic substances, in treatment of dyspepsia,
of water or 1 g/kg thereby inhibiting flatulence, and distension  Do not breast
Child 1–12 y : PO 1–2 g/kg their GI absorption, (value in these conditions feed while taking
or 15–30 g in at least 6–8 enterohepatic not established). this drug without
oz of water circulation, and Sometimes used topically consulting
Infant <1 y : PO 1 g/kg thus ioavailability. as a deodorant for foul- physician.
smelling wounds and
Gastric Dialysis ulcers.
Adult: PO 20–40 g q6h for
1 or 2 d
GI Disturbances
Adult: PO 520–975 mg p.c.
up to 5 g/d
ACTION EFFECT
Aminophylline is a To prevent and Hypersensitivity to xanthine CNS: Nervousnes Assessment & Drug Effects
Generic Name salt of theophylline relieve symptoms derivatives or to s, restlessness,
AMINOPHYLLINE with effects similar of acute bronchial ethylenediamine depression,  Monitor for S&S of toxicity
(theophylline to those of other asthma and component; cardiac insomnia, (generally related to
ethylenediamide) xanthines (e.g., treatment of arrhythmias. Safety during irritability, theophylline serum levels over
caffeine and bronchospasm pregnancy (category C) or headache, 20 mg/mL). Observe patients
Brand Name theobromine). associated with lactation is not established. dizziness, muscle receiving parenteral drug
Phyllocontin, Somophyllin, Action is dependent chronic bronchitis hyperactivity, closely for signs of
Somophyllin-DF, on theophylline and emphysema. Cautious Use convulsions. CV: hypotension, arrhythmias, and
Truphylline, Corophyllin, content Cardiac convulsions until serum
Paladron (approximately 80%) Unlabeled Uses Severe hypertension, arrhythmias, theophylline stabilizes within
and is measured as cardiac disease, tachycardia (with the therapeutic range.
Classification theophylline in the As a respiratory arrhythmias; impaired rapid IV),  Note: High incidence of
Bronchodilator (respiratory serum. stimulant in hepatic function; diabetes hyperventilation, toxicity is associated with
smooth muscle Cheyne-Stokes mellitus; hyperthyroidism; chest pain, severe rectal suppository use due to
relaxant); xanthine respiration; for glaucoma; prostatic hypotension, erratic rate of absorption.
treatment of hypertrophy; fibrocystic cardiac  Monitor & record vital signs
Dosage apnea and breast disease; history of arrest. GI: Nausea and I&O. A sudden, sharp,
Bronchospasm bradycardia in peptic ulcer; neonates and , vomiting, unexplained rise in heart rate
Adult: IV Loading Dose 6 premature infants; young children, patients anorexia, may indicate toxicity.
mg/kg over 30 min IV as cardiac over 55 y; COPD, acute hematemesis,  Lab tests: Monitor serum
Maintenance stimulant and influenza or patients diarrhea, theophylline levels.
Dose nonsmoker, 0.5 diuretic in receiving influenza epigastric pain.  Note: Older adults, acutely ill,
mg/kg/h; smoker, 0.75 treatment of CHF. immunization. and patients with severe
mg/kg/h; CHF or cirrhosis, respiratory problems, liver
0.25 dysfunction, or pulmonary
mg/kg/h PO nonsmoker, 0.5 edema are at greater risk of
mg/kg/h times 24 h in 4 toxicity due to reduced drug
divided doses; smoker, 0.75 clearance.
mg/kg/h times 24 h in 4  Note: Children appear more
divided doses; CHF or susceptible to CNS
cirrhosis, 0.25 mg/kg/h stimulating effects of
times 24 h in 4 divided xanthines (nervousness,
doses restlessness, insomnia,
Child: IV Loading Dose 6 hyperactive reflexes,
mg/kg IV over 30 min IV twitching, convulsions).
Maintenance Dose 1–9 y, 1 Dosage reduction may be
mg/kg/h; >9 y, 0.75 indicated.
mg/kg/h PO 1–9 y, 1
mg/kg/h times 24 h in 4 Patient & Family Education
divided doses; >9 y, 0.75
mg/kg/h times 24 h in 4  Note: Use of tobacco tends to
divided doses increase elimination of this
Infant: PO/IV 6–11 drug (shortens half-life),
mo, 0.87 g/kg/h; 2–6 necessitating higher dosage or
mo, 0.5 mg/kg/h shorter intervals than in
Neonate: PO/IV 0.16 nonsmokers.
mg/kg/h  Report excessive nervousness
or insomnia. Dosage reduction
Neonatal Apnea may be indicated.
Neonate: PO/IV Loading  Note: Dizziness is a relatively
Dose 5 mg/kg PO/IV common side effect,
Maintenance Dose 5 particularly in older adults;
mg/kg/d divided q12h take necessary safety
precautions.
 Do not take OTC remedies for
treatment of asthma or cough
unless approved by physician.
taking this drug without
ACTION EFFECT
Analog of Narcotic overdosage; Respiratory depression due Body as a Assessment & Drug Effects
Generic Name oxymorphone. A complete or partial to nonopioid drugs. Safety Whole: Reversal of
NALOXONE HCL "pure" narcotic reversal of narcotic during pregnancy (other analgesia, tremors,  Observe patient closely;
antagonist, essentially depression including than labor) (category B) or hyperventilation, duration of action of some
Brand Name free of agonistic respiratory depression lactation is not established. slight drowsiness, narcotics may exceed that of
Narcan (morphine-like) induced by natural sweating. CV: Incr naloxone. Keep physician
properties. Thus, it and synthetic Cautious Use eased BP, informed; repeat naloxone
Classification produces no narcotics and by tachycardia. GI: Na dose may be necessary.
Central nervous significant analgesia, pentazocine and Neonates and children; usea,  May precipitate opiate
system agent; narcotic respiratory propoxyphene. Drug known or suspected vomiting. Hematol withdrawal if administered to
(opiate) antagonist depression, of choice when nature narcotic dependence; ogic: Elevated a patient who is opiate
psychotomimetic of depressant drug is cardiac irritability. partial dependent.
Dosage effects, or miosis not known and for thromboplastin  Note: Narcotic abstinence
Opiate Overdose when administered in diagnosis of suspected time. symptoms induced by
Adult: IV 0.4–2 mg, the absence of acute opioid naloxone generally start to
may be repeated q2– narcotics and overdosage. diminish 20–40 min after
3min up to 10 mg if possesses more potent administration and usually
necessary narcotic antagonist Unlabeled Uses disappear within 90 min.
Child: IV 0.01 mg/kg, action.  Monitor respirations and other
may be repeated q2– Shock and to reverse vital signs.
3min up to 10 mg if alcohol-induced or  Monitor surgical and obstetric
necessary clonidine-induced patients closely for bleeding.
coma or respiratory Naloxone has been associated
Postoperative Opiate depression. with abnormal coagulation test
Depression results. Also observe for
Adult: IV 0.1–0.2 mg, reversal of analgesia, which
may be repeated q2– may be manifested by nausea,
3min for up to 3 doses vomiting, sweating,
if necessary tachycardia.
Child: IV 0.005–0.01
mg/kg, may be
repeated q2–3min up
to 3 doses if necessary Patient & Family Education
Asphyxia  Report postoperative pain that

Neonatorum emerges after administration
Child: IV 0.01 mg/kg of this drug to physician.
into umbilical vein,
may be repeated q2–
3min up to 3 doses if
necessary
ACTION EFFECT
Produced by reaction Prevention and Hypersensitivity to other Body as a Assessment & Drug Effects
Generic Name of silver nitrate with treatment of sulfonamides; G6PD Whole: Pain
SILVER sulfadiazine. sepsis in second- deficiency; pregnancy (occasionally),  Observe for and report
SULFADIAZINE Mechanism of action and third-degree (category C), pregnant burning, itching, hypersensitivity reaction: Rash,
differs from that of burns. women at term, lactation, rash, reversible itching, or burning sensation in
Brand Name either component. premature infants and leukopenia. unburned areas.
Silvadene Silver salt is released neonates <2 mo. Potential for  Lab tests: Obtain serum sulfa
slowly and exerts toxicity as for concentrations, urinalysis, and
Classification bactericidal effect Cautious Use other kidney function tests when drug
ANTIINFECTIVE only on bacterial cell sulfonamides if is applied to extensive areas.
SULFONAMIDE membrane and wall, Impaired kidney or liver applied to Significant quantities of drug
rather than by function; impaired extensive areas may be absorbed.
Dosage inhibiting folic acid respiratory function. of the body  Observe patient for reactions
Burn Wound Treatment synthesis; surface. attributed to sulfonamides.
Adult/Child: Topical Apply antibacterial activity  Note: Analgesic may be required.
1% cream 1–2 times/d to is not inhibited by p- Occasionally, pain is experienced
thickness of approximately aminobenzoic acid on application; intensity and
1.5 mm (1/6 in) (PABA). Contact duration depend on depth of
with sodium chloride burn.
in body tissues and  Continue treatment until
fluids results in slow satisfactory healing or burn site is
release of ready for grafting, unless adverse
sulfadiazine, which reactions occur.
may be systemically
absorbed from Patient & Family Education
application site.
this drug.
DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION
Hyperglycemic; Documented, Increased intracranial or Pain, phlebitis or tissue  Obtain history of the
Generic Name: rapidly increases suspected or known intraspinal hemorrhage, necrosis at injection site patient’s fluid and electrolyte
DEXTROSE circulating blood hypoglycemia (BS Delirium Tremens, if infiltration occurs status before therapy.
glucose levels <80mg/dL) Glucose-Galactose Hyperglycemia and  Before giving the bottle,
Brand Name: malabsorption glycosuria check for the correct patient
D50W, DGlucose, To transient osmotic Seizure of unknown Fluid overload; may to be administered.
Glucose diuretic etiology aggravate HTN and  Monitor patient frequently
CHF on:
Classification: Onset: < 1 minute Cerebral / Meningeal  Signs of infiltration/ sluggish
Caloric Agent; Peak: depends on edema related to flow or phlebitis/ infection.
Nutritive Agent / degree of eclampsia  Well time of catheter and
Carbohydrate hypoglycemia need to be replaced.
Duration: Depends Coma of unknown  Condition of catheter
Dosage: on degree of origin dressing.
Adult: 12.5 – 25 gm Hypoglycemia  Check the level of the IVF.
D50W slow IV,  Correct solution, medication
repeat PRN x 1 and volume.
 Check and regulate the drop
Pediatric: 0.5 gm/kg . rate.
D25W slow IV to a  Change the IVF solution if
maximum of 25gm needed.
(dilute D50W 1:1  Safety and comfort measures.
with NS), repeat
PRN x 1
Alert!
Neonates: (Birth to  Rapid rates of administration
30 days): predispose the patient to pain
2.5-5ml/kg of 12.5% and may cause phlebitis if a
Dextrose in Water peripheral vein is used; to
minimize this effect
Infants (30 days to 1 administer slowly
year): 1-2ml/kg of  Excessive IV administration
25% dextrose in may cause fluid overload,
water water intoxication, +/or CHF
 D50W and Thiamine 100 mg
Children (>1 year): IV (mini bag or IVP) should
0.5-1ml/kg of 50% be given together when
dextrose in Water alcoholism or malnutrition is
suspected
ACTION
By direct action on To initiate or Hypersensitivity to Fetal trauma from too  Start flow charts to record
Generic Name: myofibrils, produces improve uterine oxytocin; significant rapid propulsion maternal BP and other vital
OXYTOCIN phasic contractions contraction at term cephalopelvic through pelvis, signs, I&O ratio, weight,
characteristic of only in carefully disproportion, unfavorable fetal death, anaphylactic strength, duration, and
Brand Name: normal delivery. selected patients and fetal position or reactions, postpartum frequency of contractions, as
Pitocin, Syntocinon Promotes milk only after cervix is presentations that are hemorrhage, precordial well as fetal heart tone and
ejection (letdown) dilated and undeliverable without pain, edema, cyanosis rate, before instituting
Classification: reflex in nursing presentation of fetus conversion before delivery, or redness of skin. treatment.
Uterine Active mother, thereby has occurred; used to obstetric emergencies in  Monitor fetal heart rate and
Agents increasing flow (not stimulate letdown which benefit-to-risk ratio Fetal bradycardia and maternal BP and pulse at least
volume) of milk; reflex in nursing for mother or fetus favors arrhythmias, maternal q15min during infusion
Dosage: also facilitates flow mother and to relieve surgical intervention, fetal cardiac arrhythmias, period; evaluate tonus of
10 units/ml in 1m of milk during pain from breast distress in which delivery hypertensive myometrium during and
ampule period of breast engorgement. Uses is not imminent, episodes, subarachnoid between contractions and
engorgement. include management prematurity, placenta hemorrhage, increased record on flow chart. Report
Uterine sensitivity of inevitable, previa, prolonged use in blood flow, fatal change in rate and rhythm
to oxytocin incomplete, or severe toxemia or uterine afibrinogenemia, ECG immediately.
increases during missed abortion; inertia, hypertonic uterine changes,  Stop infusion to prevent fetal
gestation period and stimulation of uterine patterns, previous surgery PVCs, cardiovascular anoxia, turn patient on her
peaks sharply before contractions during of uterus or cervix spasm and collapse, side, and notify physician if
parturition. Not used third stage of labor; including cesarean section, Neonatal jaundice, contractions are prolonged
for elective stimulation to conditions predisposing to maternal nausea, and if monitor records
induction of labor. overcome uterine thromboplastin or amniotic vomiting, ADH effects contractions about 50 mm Hg
inertia; control of fluid embolism (dead fetus, leading to severe water or if contractions last 90
postpartum abruptio placentae), grand intoxication and seconds or longer.
hemorrhage and multiparity, invasive hyponatremia, Stimulation will wane rapidly
promotion of cervical carcinoma, hypotension, within 2–3 min. Oxygen
. postpartum uterine primipara >35 y of age, Fetal intracranial administration may be
involution. Also used past history of uterine hemorrhage, anxiety, necessary.
to induce labor in sepsis or of traumatic Fetal hypoxia, maternal  If local or regional anesthesia
cases of maternal delivery, intranasal route dyspnea, Uterine is being given to the patient
diabetes, during labor, simultaneous hypertonicity, tetanic receiving oxytocin, be alert to
preeclampsia, administration of drug by contractions, uterine the possibility of hypertensive
eclampsia, and two routes. rupture, pelvic crisis.
erythroblastosis hematoma.  Monitor I&O during labor. If
fetalis. patient is receiving drug by
prolonged IV infusion, watch
for symptoms of water
intoxication. Report changes
in alertness and orientation
and changes in I&O ratio.
 Check fundus frequently
during the first few
postpartum hours and several
times daily thereafter.
 Incidence of hypersensitivity
or allergic reactions is higher
when oxytocin is given by IM
or IV injection rather than by
IV infusion (diluted solution).
ACTION
Potent, long-acting Management of Parkinson's disease, Extrapyramidal  Assess mental status prior to
Generic Name: butyrophenone manifestations of parkinsonism, seizure symptoms such as and periodically during
HALOPERIDOL derivative with psychotic disorders disorders, coma; muscle rigidity or therapy
pharmacologic and for control of alcoholism; severe mental spasm,  Monitor BP and pulse prior to
Brand Name: actions similar to tics and vocal depression, CNS Posture learning and frequently during the
Haldol, Peridol those of piperazine utterances of Gilles depression; thyrotoxicosis. forward, period of dosage adjustment.
phenothiazines but de la Tourette's Safe use during pregnancy Masklike facial May cause QT interval
Classification: with higher syndrome; for (category C), lactation, or appearance, changes on ECG.
Central Nervous incidence of treatment of agitated in children <3 y is not Blurred vision,  Observe patient carefully
System Agent, extrapyramidal states in acute and established. Urinary frequency, when administering
Antipsychotic, effects and less chronic psychoses. anemia, medication to ensure that
Psychotherapeutic hypotensive and Used for short-term Photosensitivity, dry medication is actually taken
relatively low treatment of mouth, nausea and and not hoarded.
Dosage: sedative activity. hyperactive children vomiting, anorexia,  Monitor I & O ratios daily.
Psychosis: and for severe decreased serum Assess patient for signs and
Adult: PO 0.2-5 mg behavior problems in cholesterol symptoms of dehydration.
b.i.d or t.i.d, IM 2-5 children of  Monitor for development of
mg repeated q 4h combative, explosive neuroleptic malignant
prn; hyperexcitability. syndrome (fever, respiratory
Decanoate: 50- distress, tachycardia, seizures,
100mg q 4wk diaphoresis, hypertension.
Child: PO: 0.5 mg/d  Be alert for behavioral
in 2-3 divided doses, changes in patients who are
may be increased by concurrently receiving
0.5 mg q5-7 to 0.05- antiparkinson drugs.
0.15 mg/kd/d  Monitor for exacerbation of
seizure activity.
Severe Psychosis:  Observe patients closely for
Adult: PO 3-5 mg rapid mood shift to
b.i.d ot t.i.d., may depression when haloperidol
need up to 100 is used to control mania or
mg/d, cyclic disorders. Depression
IM: 2-5 mg, may may represent a drug adverse
repeat q.h. prn; effect or reversion from a
Decanoate: 50-100 manic state.
mg q 4 week  Avoid use of alcohol during
therapy.
Child: PO 0.005-  Do not drive or engage in
0.15 mg/kg/d in 2-3 other potentially hazardous
divided doses activities until response to
drug is known.
Dementia:  Discuss oral hygiene with
Geriatric: PO 0.25- health care provider; dry
0.05 mg 1-2 times mouth may promote dental
daily, may increase problems. Drink adequate
every 4-7 d (max: 4 fluids.
mg/d in 2-3 divided  Avoid overexposure to sun or
doses) sunlamp and use a sunscreen;
drug can cause a
Tourette’s Disorder photosensitivity reaction.
Adult: PO 0.05-  Do not breast feed while
0.075 mg/kg/d in 2- taking this drug without
3 divided doses consulting physician
OF ACTION
Interferes with Treatment of Hay fever, urticarial, Lethargy,  Assess patient’s condition
Generic Name: bacterial cell wall respiratory affections vasomotor rhinitis, hallucinations, seizures, before after therapy and
ACETYLCYSTEINE synthesis during characterized by angioneurotic edema, drug Glossitis, stomatitis, regularly after
active thick & vicious sensitization, serum & gastritis, sore mouth,  Instruct patient to follow
Brand Name: multiplication, hypersecretions; penicillin reaction, contact furry tongue, black directions exactly.
Acetimax, Solmucol causing cell wall acute and chronic dermatitis, atopic eczema, “hairy” tongue, nausea,  Explain the importance of
death and resultant bronchitis & its other allergic dermatoses, vomiting, diarrhea, using drug as directed.
Classification: bactericidal exacerbation, pruritus, food sensitivity, abdominal pain, bloody  Patients suffering from
Mucolytic activity against pulmonary parkinsonism, motion diarrhea, enterocolitis, bronchial asthma must be
susceptible emphysema, sickness. pseudomembranous strictly monitored during the
Dosage: bacteria mucoviscidosis & colitis, nonspecific therapy. If bronchospasm
600 mg/ tab @ HS bronchiectasis. hepatitis, Nephritis occur, the treatment must be
. Antidote in Anemia, suspended immediately.
poisoning caused by thrombocytopenia,  It should be used with caution
. paracetamol, carbon leukopenia, in asthmatic patients and
tetrachloride, arsenic, neutropenia, prolonged patients with a history of
metallic mercury bleeding time peptic ulceration.
inhalation, yellow Rash, fever, wheezing,  The possible presence of a
phosphorus & for anaphylaxis sulfur-like odor does not
cyclophosphamide Pain, phlebitis, indicate an alteration of the
induced hemorrhagic thrombosis at injection product but is a characteristic
cystitis. site, Jarisch- of the active ingredient
Herxheimer reaction contained in the preparation.
when used to treat  It is preferred not to mix
syphilis, Super other drugs with the
infections, sodium Acetylcysteine solution.
overload leading to
heart failure
OF ACTION
Long-acting Adrenal Systemic fungal infection, Nasal irritation, dryness,  Monitor and report S&S of
Generic Name: synthetic insufficiency acute infections, active or epistaxis, rebound Cushing's syndrome or other
DEXAMETHASONE adrenocorticoid concomitantly with a resting tuberculosis, congestion, bronchial systemic adverse effects.
with intense mineralocorticoid; vaccinia, varicella, asthma, anosomia,  Monitor neonates born to a
Brand Name: antiinflammatory inflammatory administration of live virus perforation of nasal mother who has been
Dexamethasone (glucocorticoid) conditions, allergic vaccines (to patient, family septum Euphoria, receiving a corticosteroid
Acetate, activity and states, collagen members), latent or active insomnia, convulsions, during pregnancy for
Dalalone D.P., minimal diseases, amebiasis. increased ICP, vertigo, symptoms of
Decadron-LA mineralocorticoid hematologic headache, psychic hypoadrenocorticism.
activity. disorders, cerebral Ophthalmic use: disturbances, CHF,  Monitor for S&S of a
Classification: edema, and Primary open-angle hypertension, edema, hypersensitivity reaction. The
Antiinflammatory Anti- addisonian shock. glaucoma, eye infections, Menstrual acetate and sodium phosphate
Gluccorticoid inflammatory Also, palliative superficial ocular herpes irregularities, hyperglyc formulations may contain
action: Prevents treatment of simplex, keratitis and emia; cushingoid state; bisulfites, parabens, or both;
Route of accumulation of neoplastic disease, as tuberculosis of eye. Safe growth suppression in these inactive ingredients are
Administration: inflammatory adjunctive short-term use during pregnancy children; hirsutism. allergenic to some
IV cells at sites of therapy in acute (category C), lactation, or Posterior subcapsular individuals.
infection; inhibits rheumatic disorders in children is not cataract, increased IOP,
Dosage: phagocytosis, and GI diseases, and established. glaucoma, Patient & Family Education
1.8 mg q6 lysosomal as a diagnostic test exophthalmos. Peptic  Take drug exactly as
enzyme release, for Cushing's ulcer with possible prescribed.
and synthesis of syndrome and for Cautious Use perforation, abdominal  Report lack of response to
selected chemical differential diagnosis Stromal herpes simplex, distension, nausea, medication or malaise,
mediators of of adrenal keratitis, GI ulceration, increased appetite, orthostatic hypotension,
inflammation; hyperplasia and renal disease, diabetes heartburn, dyspepsia, muscular weakness and pain,
reduces capillary adrenal adenoma. mellitus, hypothyroidism, pancreatitis, bowel nausea, vomiting, anorexia,
dilation and myasthenia gravis, CHF, perforation, oral hypoglycemic reactions or
permeability. cirrhosis, psychic candidiasis, tendon mental depression to
disorders, seizures. rupture, Acne, impaired physician. These symptoms
Immunosuppressi wound may signal
on: healing, petechiae, hypoadrenocorticism.
Not clearly ecchymoses,  Report changes in appearance
understood, but diaphoresis, allergic and easy bruising to
may be due to dermatitis, hypo- or physician. These symptoms
prevention or hyperpigmentation, SC may signal
suppression of and cutaneous atrophy, hyperadrenocorticism.
delayed burning and tingling in
hypersensitivity perineal area (following
immune reaction. IV injection).
.
OF ACTION
Short-acting, clear, Moderate to severe Contraindicated in Profuse  Note: Frequency of blood
Generic Name: colorless solution diabetic hypoglycemia and in sweating, hunger, glucose monitoring is
INSULIN of exogenous ketoacidosis or patient’s hypertensive to headache, nausea, determined by the type of
(REGULAR) unmodified insulin hyperglycemia, insulin or its ingredients. tremulousness, tremors, insulin regimen and health
extracted from beta mild diabetic Drug-drug: AIDS palpitation, tachycardia, status of the patient.
Brand Name: cells in pork ketoacidosis, antireretrovirals, weakness, fatigue,  Lab tests: Periodic
Humulin R, Novolin R pancreas or newly diagnosed corticosteroids, nystagmus, circumoral postprandial blood glucose,
synthesized by diabetes mellitus to dextrothyroxine, pallor; numb mouth, and HbA1C. Test urine for
Classification: recombinant DNA control epinephrine, thiazide tongue, and other ketones in new, unstable, and
Anti-diabetic Agent; technology hyperglycemia. diuretics may increase paresthesias; visual type 1 diabetes; if patient has
Hormone & Synthetic (human). Enhances insulin response. Beta disturbances (diplopia, lost weight, exercises
Substitute transmembrane blockers may conceal signs blurred vision, vigorously, or has an illness;
passage of glucose of hypoglycemia. mydriasis), staring whenever blood glucose is
Dosage: across cell Hormonal contraceptives expression, confusion, substantially elevated.
Diabetes Mellitus: membranes of most may decrease glucose personality changes,  Notify physician promptly for
Adult: sc 5-10 U 15- 30 body cells and by tolerance, monitor glucose ataxia, incoherent presence of acetone with
min a.c. and h.s (dose unknown level and adjust insulin speech, apprehension, sugar in the urine; may
adjustments based on mechanism may dosage carefully. irritability, inability to indicate onset of ketoacidosis.
blood glucose itself enter the cell concentrate, personality Acetone without sugar in the
determinations) to activate selected changes, uncontrolled urine usually signifies
Child: sc 2-4 U 15-30 intermediary yawning, loss of insufficient carbohydrate
min a.c. and h.s. (dose metabolic consciousness, delirium, intake.
blood glucose processes. hypothermia,  Monitor for hypoglycemia at
determinations) Promotes convulsions, Babinski time of peak action of insulin.
conversion of reflex, coma. (Urine Onset of hypoglycemia
Ketoacidosis glucose to glucose tests will be (blood sugar: 50–40 mg/dL)
Adult: IV 2.4- 7.2 U glycogen. negatives). may be rapid and sudden.
loading dose, followed With overdose  Check BP, I&O ratio, and
by 2.4- 7.2 U/h . psychic disturbances blood glucose and ketones
continuous infusion (i.e., aphasia, every hour during treatment
Adult: IV 0.1 U/kg . personality changes, for ketoacidosis with IV
loading dose, followed maniacal behavior). insulin.
by 0.1/h continuous Metabolic  Give patients with severe
infusion Posthypoglycemia or hypoglycemia glucagon,
rebound hyperglycemia epinephrine, or IV glucose
(Somogyi effect), 10–50%. As soon as patient is
lipoatrophy and fully conscious, give oral
lipohypertrophy of carbohydrate to prevent
injection sites; insulin secondary hypoglycemia.
resistance.
Skin Patient & Family Education
Localized allergic  Learn correct injection
reactions at injection technique.
site; generalized  Inject insulin into the
urticaria or bullae, abdomen rather than a near
lymphadenopathy. muscle that will be heavily
taxed, if engaged in active
sports.
 Notify physician of local
reactions at injection site;
may develop 1–3 wk after
therapy starts and last several
hours to days, usually
disappear with continued use.
 Do not change prescription
lenses during early period of
dosage regulation; vision
stabilizes, usually 3–6 wk.
 Note: Hypoglycemia can
result from excess insulin,
insufficient food intake,
vomiting, diarrhea,
unaccustomed exercise,
infection, illness, nervous or
emotional tension, or
overindulgence in alcohol.
 Carry some form of fast-
acting carbohydrate (e.g.,
lump sugar, Life-Savers or
other candy) at all times to
treat hypoglycemia.
 Check blood glucose
regularly during menstrual
period; loss of diabetes
control (hyperglycemia or
hypoglycemia) is common;
adjust insulin dosage
accordingly, as prescribed by
physician.
ACTION
UNKNOWN. To control tonic- Hypersensitivity to Usually dose-related:  Continuously monitor vital
Generic Name: Hydantoin clonic (grand mal) hydantoin products; rash; Nystagmus, drowsiness, signs and symptoms during
PHENYTOIN derivative seizures, seizures due to ataxia, dizziness, mental IV infusion and for an hour
chemically related psychomotor and hypoglycemia; sinus confusion, tremors, afterward. Watch for
Brand Name: to phenobarbital. nonepileptic seizures bradycardia, complete or insomnia, headache, respiratory depression.
Dilantin Infatab, Precise mechanism (e.g., Reye's incomplete heart block; seizures, Bradycardia, Constant observation and a
Dilantin 125 of anticonvulsant syndrome, after head Adams-Stokes syndrome; hypotension, cardiovasc cardiac monitor are necessary
action is not known, trauma). Also used to pregnancy (category D), ular collapse, with older adults or patients
Classification: but drug use is prevent or treat lactation. ventricular fibrillation, with cardiac disease. Margin
Central Nervous accompanied by seizures occurring phlebitis, Photophobia, between toxic and therapeutic
System agent; reduced voltage, during or after conjunctivitis, diplopia, IV doses is relatively small.
anticonvulsant; frequency, and neurosurgery. Is not blurred vision, Gingival  Be aware of therapeutic
Hydantoin spread of electrical effective for absence hyperplasia, nausea, serum concentration: 10–20
discharges within seizures. vomiting, constipation, mcg/mL; toxic level: 30–50
Dosage: the motor cortex. epigastric pain, mcg/mL; lethal level: 100
Adults: initially, 100 Class IB dysphagia, loss of taste, mcg/mL. Steady-state
mg PO, TID antiarrhythmic weight loss, hepatitis, therapeutic levels are not
Children: 5 mg/kg properties similar to Unlabeled Uses liver necrosis, achieved for at least 7–10 d.
0r 250 mg/m2 PO those of lidocaine Antiarrhythmic agent Thrombocytopenia,  Lab tests: Periodic serum
divided BID or TID. and tocainide (also (phenytoin IV) leukopenia, phenytoin concentration;
Maximum daily class IB agents). especially in leukocytosis, agranuloc CBC with differential,
dose is 300 mg Has class IB treatment of ytosis, pancytopenia, platelet count, and Hct and
antiarrhythmic digitalis-induced eosinophilia; Hgb; serum glucose, serum
properties. arrhythmias; megaloblastic, calcium, and serum
treatment of hemolytic, or aplastic magnesium; and liver funtion
trigeminal neuralgia anemias, Fever, tests.
(tic douloureux). hyperglycemia,  Observe patient closely for
glycosuria, weight gain, neurologic adverse effects
edema, transient following IV administration.
increase in serum Have on hand oxygen,
thyrotropic (TSH) level, atropine, vasopressor,
osteomalacia or rickets assisted ventilation, seizure
associated with precaution equipment (mouth
hypocalcemia and gag, nonmetal airway, suction
elevated alkaline apparatus).
phosphatase activity.  Be aware that gingival
Alopecia, hirsutism hyperplasia appears most
(especially in young commonly in children and
female); rash: adolescents and never occurs
scarlatiniform, in patients without teeth.
maculopapular,  Make sure patients on
urticaria, prolonged therapy have
morbilliform; bullous, adequate intake of vitamin D-
exfoliative, or purpuric containing foods and
dermatitis; Stevens- sufficient exposure to
Johnson syndrome, sunlight.
toxic epidermal  Monitor diabetics for loss of
necrolysis, keratosis, glycemic control.
neonatal hemorrhage  Observe for symptoms of
folic acid deficiency:
neuropathy, mental
dysfunction.
 Be alert to symptoms of
hypomagnesemia
neuromuscular symptoms:
tetany, positive Chvostek's
and Trousseau's signs,
seizures, tremors, ataxia,
vertigo, nystagmus, muscular
fasciculations.
Patient & Family Education

 Be aware that drug may make
urine pink or red to red-
brown.
 Report symptoms of fatigue,
dry skin, deepening voice
when receiving long-term
therapy because phenytoin
can unmask a low thyroid
reserve.
 Do not to request/accept
change in drug brand when
refilling prescription without
 Discontinue drug
immediately if a measles-like
skin rash or jaundice appears
and notify physician.
OF ACTION
It inhibits synthesis Short-term Hypersensitivity to Drowsiness, dizziness,  Correct hypovolemia prior to
Generic Name: of prostaglandins management of ketorolac; individuals with headache, administration of ketorolac.
KETOROLAC and is a moderate to complete or partial Nausea, dyspepsia, GI  Lab tests: Periodic serum
TROMETHAMINE peripherally acting severe pain. syndrome of nasal polyps, pain, hemorrhage, electrolytes and liver
analgesic. angioedema, and sweating, pain at functions; urinalysis (for
Brand Name: Ketorolac does not bronchospastic reaction to injection site. hematuria and proteinuria)
Acular have any known aspirin or other NSAIDs; with long-term use.
effects on opiate during labor and delivery;  Monitor urine output in older
Classification: receptors. patients with severe renal adults and patients with a
Nonsteroidal Anti- impairment or at risk for history of cardiac
Inflammatory Drugs renal failure due to volume decompensation, renal
(NSAIDS); Central depletion; patients with impairment, heart failure, or
Nervous Agent risk of bleeding; active liver dysfunction as well as
peptic ulcer disease; pre- or those taking diuretics.
Dosage: intraoperatively; Discontinuation of drug will
60 mg less than 65 years intrathecal or epidural return urine output to
old, IM administration; in pretreatment level.
combination with  Monitor for S&S of GI
30 mg for IV other NSAIDs; lactation. distress or bleeding including
nausea, GI pain, diarrhea,
60 mg PO melena, or hematemesis. GI
ulceration with perforation
1 gtts 4x a day for can occur anytime during
ophthalmic route treatment. Drug decreases
platelet aggregation and thus
may prolong bleeding time.
 Monitor for fluid retention
and edema in patients with a
history of CHF.
Patient & Family Education
 Watch for S&S of GI

ulceration and bleeding (e.g.,
bloody emesis, black tarry
stools) during long-term
therapy.
 Note: Possible CNS adverse
effects (e.g., light-
headedness, dizziness,
drowsiness).
 Do not drive or engage in
potentially hazardous
activities until response to
drug is known.
 Do not use other NSAIDs
while taking this drug.
taking this drug.
ACTION
Organic nitrate with Relief of acute Hypersensitivity to nitrates Hypersensitivity  Do not confused between
Generic Name: pharmacologic anginal attacks and or nitrites; severe anemia; reaction, paradoxical Isordil (Isosorbide) and
ISOSORBIDE actions similar to for management of head trauma; increased increase in anginal pain, Plendil (felodipine); USE
DINITRATE/ those of long-term angina intracranial pressure. Safe methemoglobinemia CAUTION.
MONONITRATE nitroglycerin. pectoris. use during pregnancy (overdose), Headache,  Assess for allergy to nitrates,
Relaxes vascular (category C) or lactation is dizziness, severe anemia, GI
Brand Name: smooth muscle with not established. weakness, lightheadedn hypermobility, head trauma,
Isordil resulting ess, restlessness, cerebral hemorrhage,
vasodilation. Palpitation, postural Hypertropic cardiomyopathy,
Classification: Dilation of hypotension, pregnancy, lactation.
Anti - Anginal peripheral blood tachycardia, Nausea,  Assess for pain: duration,
vessels tends to vomiting, time started, activity being
Dosage: cause peripheral Flushing, pallor, performed, character,
40 mg OD pooling of blood, perspiration, rash, intensity.
decreased venous exfoliative dermatitis.  Monitor B/P, pulse at
return to heart, and baseline and during
decreased left treatment.
ventricular end-  Caution patient to make
diastolic pressure, position changes slowly to
with consequent prevent orthostatic
reduction in hypotension.
myocardial oxygen  Instruct patient to swallow
consumption sustained released tablet
whole, do not chew; SL tablet
. should be dissolved under the
tongue, do not swallow
chewable tablet should be
chewed thoroughly.
 WARNING: Keep life
support equipment readily
available if overdose occurs
or cardiac conditions
worsens.
 WARNING: Gradually
reduce dose if anginal
treatment is being terminated;
rapid discontinuation can lead
to problems of withdrawal.
ACTION
Purified mixture of Antidote for heparin Hemorrhage not induced Abrupt drop in BP (with  Do not use protamine if only
Generic Name: simple, low- calcium or heparin by heparin overdosage; rapid IV infusion), minor bleeding occurs during
PROTAMINE molecular-weight sodium overdosage pregnancy (category C). bradycardia, heparin therapy because
SULFATE proteins obtained (after heparin has Urticaria, angioedema, withdrawal of heparin will
from sperm or testes been discontinued). pulmonary usually correct minor
Brand Name: of suitable fish edema, anaphylaxis, bleeding within a few hours.
Protamine Sulfate species. dyspnea, lassitude;  Monitor BP and pulse q15–
Anticoagulant effect transient flushing and 30min, or more often if
Classification: when used alone. feeling of warmth, indicated. Continue for at
Antidote Nausea, vomiting, least 2–3 h after each dose, or
Protamine overdose or longer as dictated by patient's
Dosage: "heparin rebound" condition. Be prepared to
Antidote for (hyperheparinemia). treat patient for shock as well
Heparin Overdose: as hemorrhage.
Adult/Child: V 1  Lab tests: Monitor effect of
mg for every 100 protamine in neutralizing
units of heparin to heparin by aPTT or ACT
be neutralized give values. Coagulation tests are
at first 25-50 mg by usually performed 5–15 min
slow direct IV and after administration of
the rest over 2-3 h. protamine, and again in 2–8 h
if desirable.
 Observe patients undergoing
extracorporeal dialysis or
patients who have had cardiac
surgery carefully for bleeding
(heparin rebound). Even with
apparent adequate
neutralization of heparin by
protamine, bleeding may
occur 30 min to 18 h after
surgery. Monitor vital signs
closely. Additional protamine
may be required in these
patients.
ACTION
A reduced form of Folate-deficient Undiagnosed anemia, Allergic sensitization  Monitor neurologic status.
Generic Name: folic acid; unlike megaloblastic pernicious anemia, or other (urticaria, pruritus, rash, Use of leucovorin alone in
folic acid, it does not anemias due to megaloblastic anemias wheezing). treatment of pernicious
LEUCOVORIN
require enzymatic sprue, pregnancy, secondary to vitamin Thrombocytosis anemia or other megaloblastic
CALCIUM reduction and and nutritional B12 deficiency. Safe use anemias associated with
therefore is readily deficiency when oral during pregnancy vitamin B12 deficiency can
Brand Name: available to therapy is not (category C) or lactation is result in an apparent
Calcium Folinade, participate in feasible. Also to not established. hematological remission
Wellcovorin reactions. prevent or diminish while allowing already
toxicity of present neurologic damage to
Classification: antineoplastic folic progress.
Antiemetic, acid antagonists,  Lab tests: Do
Antidote particularly Clcr determinations prior to
methotrexate; and as initiation of leucovorin, urine
adjunct with antifols pH prior to and about every 6
Route of (e.g., h throughout therapy; daily
Administration & pyrimethamine) in serum creatinine levels are
Dosage: pneumocystosis or recommended to detect onset
Megablastic toxoplasmosis to of kidney function
Anemia prevent significant impairment
Adult/Child: IV/IM bone marrow
No more than 1 toxicity.
mg/d
Leucovorin Rescue
for Methotrexate
Toxicity
Adult/Child:
PO/IM/IV 10mg/m
followed by 10
mg/m followed by
10 mg/m q6h for 72
h, further doses
based on serum
methotrexate
concentrations
Leucovorin Rescue
for other Folate
Antagonist Toxicity
Adult/Child:
PO/IM/IV 5-15
mg/dl
ACTION
Although its exact Analgesic and Hypersensitivity to Headache, dizziness,  Monitor for therapeutic
Generic Name: mechanism of action antipyretic effects in diclofenac, patients in somnolence, insomnia, effectiveness. Up to 3 wks
has not been fully symptomatic treatment whom asthma, urticaria, fatigue, tiredness, may be needed for beneficial
DICLOFENAC
elucidated, it appears of rheumatoid arthritis, angioedema, tinnitus, effects with rheumatoid
SODIUM to be a potent osteoarthritis, and bronchospasm, severe ophthalmologic arthritis or osteoarthritis.
inhibitor of ankylosing spondylitis. rhinitis, shock, or other effects, Rash, pruritus,  Observe and report signs of
Brand Name: cyclooxygenase, Also, acute gout; sensitivity reaction is sweating, dry mucous bleeding (e.g., petechiae,
Voltaren thereby decreasing juvenile rheumatoid precipitated by aspirin or membranes, stomatitis, ecchymoses, bleeding gums,
the synthesis of arthritis; various other NSAIDS, pregnancy Nausea, dyspepsia, GI bloody or black stools, cloudy
Classification: prostaglandins. rheumatic conditions (category B), lactation. Pain, diarrhea, or bloody urine).
Anti-inflammatory . including bursitis, vomiting, constipation,  Monitor BP for hypertension
myalgia, sciatica, and flatulence. Dysuria, and blood sugar for
Dosage: tendinitis; acute soft renal impairment, hyperglycemia.
50 mg tissue injuries Bleeding, platelet  Monitor diabetics closely for
including sprains and inhibition with higher loss of diabetic control.
strains; dysmenorrhea; doses  Monitor for increased serum
headache, migraine, sodium and potassium in
and dental, minor patients receiving potassium-
surgical, and sparing diuretics.
postpartum pain; and  Monitor weight and report
renal or biliary colic. gains greater than 1 kg.
Ophthalmic: Cataract  Monitor for signs and
surgery; photophobia symptoms of GI irritation and
associated with ulceration.
refractive
surgery. Topical: Treat
ment of actinic
keratosis.
ACTION
Stimulates beta o Asthma Contraindicate in patients  Nervousness  Monitor V/S. and check for
Generic Name: receptors in lung. o Bronchitis with angle-closure  Tremor cardiac dysrhythmias
EPINEPHRINE o Emphysema glaucoma, shock (other  Vertigo  Drug increases rigidity and
Relaxes bronchial o All cardiac than anaphylactic shock),  Pain tremor in patients with
smooth muscle. arrest, organic brain damage,  Widened pulse Parkinson’s disease
Brand Name: anaphylaxis cardiac dilation, pressure  Epinephrine therapy interferes
Injection, OTC Increases vital o Used for arrhythmias, coronary  Hypertension with tests for urinary
nasal solution: capacity insufficiency, or cerebral catecholamine
symptomatic  nausea
Adrenaline  BP,  HR,  PR bradycardia. arteriosclerosis. Also  Avoid IM use of parenteral
Chloride o Relief of contraindicated in patient suspension into buttocks. Gas
Decreases airway receiving general gangrene may occur
bronchospasm
Ophthalmic resistance. anesthesia with  Massage site after IM injection to
occurring during
solution: halogenated hydrocarbons counteract possible
anesthesia
Epifrin, Glaucon or cyclopropane and in vasoconstriction.
o Exercised-
patients in labor (may  Observe patient closely for
induced
Insect sting delay second stage) adverse reactions. Notify doctor
bronchospasm
emergencies: if adverse reaction develop
 EpiPen Auto- Some products containing
 If blood pressure increases
Injector sulfites and are
sharply, rapid-acting vasodilators
(delivers contraindicated in patients
such as nitrates or alpha blockers
0.3 mg IM with sulfite allergies
can be given to counteract
adult dose) except when drug is used
 EpiPen Jr. for serious allergic
Auto-Injector reactions or in other
(delivers emergency situations.
0.15 mg IM for
children) In conjunction with local
anesthesia, epinephrine is
OTC solutions for contraindicated for use in
nebulization: finger, toes, ears, nose, and
AsthmaNefrin, genitalia.
microNefrin,
Nephron, S2 Use cautiously with long-
standing bronchial asthma
Classification: and emphysema, who have
Sympathomimetic developed degenerative
Beta2 Adrenergic heart disease and in those
Agonists with hyperthyroidism, CV
disease, hypertension,
Dosage: psychoneurosis, or
Cardiac arrest: diabetes.
1 mg IV of 1:10,000
solution q 3-5 min; In pregnant woman, drug
double dose if is contraindicated.
administering
via ET tube In breast feeding do not
use the drug or stop breast
Anaphylaxis: 0.1- 1 feeding.
mg SQ or IM of
1:1000 solution.
Asthma: 0.1-0.3 mg
SQ or IM of
1:10,000 solution
Refractory
bradycardia and
hypotension: 2-
10ug/min

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NCM 106 RLE SY 2020-2021

Children age 10 years

Children ages 5 to 10:

Children ages 2 to 5: For

Infants ages 1 month to

Neonates: for rapid

Premature Infants: For

Check for urine output.

Instruct to take at first

If the client doesn’t

Report any chest pain,

 Avoid alcohol and other CNS

Asphyxia  Report postoperative pain that

Patient & Family Education

 Watch for S&S of GI

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