Adiel Joy P.

Calsa (BSN2 – Travelbee B) March 13, 2022

DRUG TABULATION (WEEK 8 ACTIVITY)

Midazolam – Intramuscular (IM)

NAME OF DOSAGE / CONTRAINDICAT NURSING

MECHANISM OF ACTION INDICATION ADVERSE EFFECT
DRUG FREQUENCY/ TIMING ION RESPONSIBILITIES

GENERIC Adult: 0.07-0.1 mg/kg Midazolam binds to stereospecific benzodiazepine For IM administration, it is indicated Acute narrow- Significant: Anterograde amnesia, CNS Baseline assessment
NAME: (approx 5 mg) via IM inj, receptors on the postsynaptic GABA neuron at various as premedication in surgery or for angle glaucoma, depression, hypotension, paradoxical • Resuscitative equipment,
Midazolam given 20-60 minutes sites within the CNS, including limbic system and preop sedation. severe respiratory reactions (e.g. hyperactive or oxygen must be available.
before surgery. reticular formation. Enhancement of the inhibitory effect insufficiency, aggressive behavior), suicidal ideation, • Obtain vital signs before
BRAND Alternatively, 1-2 mg of GABA on neuronal excitability results by increased severe respiratory withdrawal symptoms. administration.
NAME: via IV inj, repeated if neuronal membrane permeability to Cl ions, which failure, acute • Assess level of
Midazolam necessary, given 5-30 results in hyperpolarization and stabilization. respiratory Cardiac disorders: Bradycardia, consciousness.
Injection, Apo- minutes before surgery. depression, tachycardia.
Midzaolam, Onset: Approx 15 minutes; 3-5 minutes (IV); 10-20 myasthenia gravis, Intervention/evaluation
Dormid, Child: 1-15 years 0.08- minutes (oral). sleep apnoea GI disorders: Nausea, vomiting, • Monitor respiratory rate
Dormizol, 0.2 mg/kg via IM inj syndrome; severe constipation, dry mouth, hiccups. and oxygen saturation
Sedoz, given 15-30 minutes Duration: Up to 6 hours (IM); <2 hours (IV: single dose). hepatic continuously during
Midazolex, before surgery. impairment (oral). General disorders and administration parenteral administration
Hypozam, Pharmacokinetics Concomitant use site conditions: Fatigue, inj site for underventilation or
Dormicum Elderly: 0.025-0.05 Well absorbed after IM administration. Protein binding: with CYP3A4 reactions (e.g. erythema, pain, phlebitis, apnea.
mg/kg given approx 20- 97%. Metabolized in inhibitors. thrombosis). • Monitor vital signs, level of
CLASSIFICATI 60 minutes before liver. Primarily excreted in urine. Not removed by sedation q3–5min during
ON: surgery via IM inj. hemodialysis. Injury, poisoning and procedural recovery period.
Alternatively, 0.5 mg Half-life: 1–5 complications: Falls, fractures. • Assess level of
Pharmacothera given IV 5-30 minutes consciousness for
-peutic: before procedure, Absorption: Rapidly absorbed. Bioavailability: 40-50% Musculoskeletal and connective tissue effectiveness.
Benzodiazepin repeated slowly if (oral); >90% (IM). Time to peak plasma concentration: disorders: Muscle weakness.
e required. 0.5-1 hour (IM); 0.17-2.65 hours (oral). Patient/family teaching
Nervous system disorders: Sedation • Educate and inform the
Clinical: Premedication in Distribution: Widely distributed in the body, including (prolonged and post-operative), patient, family members,
Sedative, surgery: CSF. Crosses the placenta and enters the breastmilk. decreased alertness, somnolence, and significant others that
anxiolytic Dose reduction may be Volume of distribution: 1-3.1 L/kg, increased in females, headache, dizziness, drowsiness, ataxia this drug may cause
necessary. elderly and obesity. Plasma protein binding: Approx . sedation, amnesia,
Pregnancy 97%, mainly albumin. Psychiatric disorders: Confusion, impaired concentration,
category: Dosage in Renal euphoric mood, depression, and muscular function.
Category D Impairment Metabolism: Extensively metabolised in the liver by hallucinations, physical drug
• If affected, do not drive or
No dose adjustment. CYP3A isoenzyme; 60-70% of biotransformed dependence, withdrawal syndrome.
operate machinery.
midazolam is 1-hyrdoxy-midazolam or α-
Dosage in Hepatic hydroxymidazolam (active metabolite). Respiratory, thoracic and mediastinal
Impairment disorders: Dyspnoea, laryngospasm,
Use caution. Excretion: Oral: Via urine (approx 90% within 24 hours; bronchospasm, cough.
mainly as glucuronide conjugates [60-70%]; <3% as Skin and subcutaneous tissue
unchanged drug); faeces (approx 2-10% over 5 days). disorders: Rash, urticaria, pruritus.
Elimination half-life: 3 hours; 4.2±1.87 hours (IM); <1
hour (active metabolite). Potentially Fatal: Cardiorespiratory
effects (e.g. respiratory depression,
Action respiratory arrest, apnoea, cardiac
• Enhances action of gamma-aminobutyric acid arrest).
• Therapeutic Effect: Produces anxiolytic, hypnotic,
anticonvulsant, muscle relaxant, amnestic effects.
Deferoxamine – Intramuscular (IM)
DOSAGE / FREQUENCY/
NAME OF DRUG
TIMING
GENERIC NAME: Diagnosis of iron storage
Deferoxamine disease
mesylate Adult: 500 mg as a single dose.
To estimate the excretion of Fe in
BRAND NAME: urine over the next 6 hr. An
excretion of >1 g suggests Fe
CLASSIFICATION: storage disease and >1.5 g
suggests a pathological cause.
Pharmacotherapeutic:
Iron chelator Chronic iron overload
Adult: If given via IM inj, initial
Chemical class: dose: 0.5-1 g daily as 1 or 2
Iron chelator injections; maintenance dose is
determined by response.
Pregnancy category:
Category C Acute iron poisoning
Adult: It can also be given via IM
Inj as a single dose of 2 g.
Child: Given via IM injection: 1 g
as a single dose.
MECHANISM OF ACTION
Binds iron by forming a stable
complex with it. This prevents iron
from entering into further chemical
reactions. The chelate then passes
through the kidneys and out of the
body in urine, thereby decreasing
the
iron level in the body.
Duration:
Pharmacokinetics
Absorption: Poorly absorbed from
the GI tract.
Metabolism: Metabolised mainly in
the plasma.
Excretion: Chelates with metal
ions, which are then excreted in the
urine.
INDICATION CONTRAINDICATION ADVERSE EFFECT
Used for the Anuria, hypersensitivity CNS: Dizziness, exacerbation or
diagnosis of iron to deferoxamine or its precipitation of aluminum-related dialysis
storage disease, to components, and severe encephalopathy, fever, headache,
treat acute iron renal disease. paresthesias, peripheral neuropathy,
intoxication and to seizures
treat chronic iron
overload. CV: Hypotension, shock, tachycardia
EENT: Blurred vision, cataracts, decreased
acuity, dyschromatopsia, high-frequency
sensorineural hearing loss, loss of vision,
night blindness, optic neuritis, retinopathy,
scotoma, tinnitus, visual field defects
GI: Abdominal discomfort, diarrhea, hepatic
dysfunction, increased liver enzymes,
nausea, vomiting
GU: Acute renal failure, dysuria, increased
serum creatinine, renal tubular disorder
HEME: Leukopenia, thrombocytopenia
MS: Arthralgia, growth retardation,
metaphyseal dysplasia, myalgia
RESP: Acute respiratory distress
syndrome, asthma
SKIN: Rash, urticaria
Other: Anaphylaxis; angioedema; infections
with Yersinia or Mucormycosis; injection-
site reactions such as localized irritation,
pain, burning, swelling, induration,
infiltration, pruritus, erythema, wheal
formation, eschar crust, vesicles, or local
edema
NURSING RESPONSIBILITIES
Baseline assessment
• Monitor patient closely for changes in
hearing or vision, especially in patients
receiving deferoxamine over prolonged
periods of time, or at high doses, or in
patients who have low ferritin levels.
• Monitor patient’s serum creatinine level
and assess patient for symptoms of
renal dysfunction.
• Assess children regularly for growth
retardation, especially if high doses are
being administered.
• Monitor patient, especially children,
closely for signs and symptoms of
respiratory distress.
• Assess patient regularly for infections.
Intervention/evaluation
• Expect to administer other supportive
measures, as ordered, when treating
acute iron intoxication with
deferoxamine because acute respiratory
distress syndrome may occur.
• Reconstitute drug according to how the
drug will be administered
Patient/family teaching
• Inform patient that deferoxamine therapy
is an adjunct to, and not a substitute for,
standard measures used to treat acute
iron intoxication.
• Advise patient not to exceed the
recommended dose of daily vitamin C
therapy prescribed.
• Caution patient not to perform
hazardous activities such as driving until
CNS, visual, and auditory adverse
effects are known.
• Inform patient that his urine may have a
reddish discoloration because of
deferoxamine therapy.
Insulin – Subcutaneous (SubQ)

NAME OF DRUG DOSAGE / FREQUENCY/ TIMING MECHANISM OF ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

GENERIC NAME: Diabetes mellitus Onset: 0.5-1 hr (short-acting e.g. Treatment of type 1 Hypersensitivity to Severe hypoglycemia, Baseline assessment
Insulin Adult: Administer according to soluble insulin); 2 hr (intermediate- diabetes (insulin insulin and use during insulin resistance, • Obtain serum glucose level, Hgb A1c.
requirements; inject into thighs, acting e.g. biphasic insulin, isophane dependent) and type 2 episodes of lipoatrophy, • Discuss lifestyle to determine extent of learning,
BRAND NAME: upper arms, buttocks, or abdomen. insulin, amorphous insulin zinc diabetes (non–insulin- hypoglycemia; hypokalemia, blurred emotional needs.
Scilin R, Novolin R, suspensions); 2-3 hr (mixed-insulin dependent) to improve vision. • If given IV, obtain serum chemistries (esp. serum
Basaglar Lantus, Type 1 Diabetes Zn suspension); 4 hr (long-acting e.g. glycemic control. potassium).
Humulin N • Multiple daily injections, insulin zinc suspensions, protamine
guided by glucose monitoring zinc insulins). Intervention/evaluation
CLASSIFICATION: or continuous SQ insulin • Assess for hypoglycemia: cool, wet skin, tremors,
infusions, is standard of care. Duration: 6-8 hr (short-acting e.g. dizziness, headache, anxiety, tachycardia, numbness
Pharmacotherapeutic: • Usual initial dose: 0.4–0.5 soluble insulin); 24 hr (intermediate- in mouth, hunger, diplopia.
Exogenous insulin unit/kg/ day in divided doses. acting e.g. biphasic insulin, isophane • Assess sleeping pt for restlessness, diaphoresis.
• Usual maintenance: 0.4–1 insulin, amorphous insulin zinc • Check for hyperglycemia: polyuria, polyphagia,
Clinical: units/kg/day in divided doses. suspensions); 30 hr (mixed-insulin Zn polydipsia, nausea or vomiting, dim vision, fatigue,
Antidiabetic suspension); 36 hr (long-acting e.g. deep and rapid breathing
Type 2 Diabetes insulin zinc suspensions, protamine • Be alert to conditions altering glucose requirements:
Pregnancy category: • Initially, 4–6 units or 0.1–0.2 zinc insulins). fever, trauma, increased activity/stress, surgical
Category B units/ kg given before largest procedure.
meal of day. Pharmacokinetics
• Adjust dose by 2 units q3days Patient/family teaching
Absorption: Fairly rapid (SC);
to reach fasting glucose target • Instruct on proper technique for drug administration,
(while avoiding increased by exercise.
testing of glucose, signs/symptoms of hypoglycemia
hypoglycemia). and hyperglycemia.
Metabolism: Mainly in liver, also in
• Diet and exercise are essential parts of treatment; do
Renal Impairment and Hepatic kidneys and muscle tissue.
not skip/delay meals.
Impairment • Carry candy, sugar packets, other sugar supplements
• Dose adjustments may be Excretion: Small amount excreted
as unchanged drug in urine. for immediate response to hypoglycemia.
needed. • Wear or carry medical alert identification.
.
• Check with physician when insulin demands are
Actions altered (e.g., fever, infection, trauma, stress, heavy
• Acts via specific receptor to physical activity).
regulate metabolism of • Do not take other medication without consulting
carbohydrates, protein, and fats. physician.
• Acts on liver, skeletal muscle, • Weight control, exercise, hygiene (including foot
and adipose tissue. care), not smoking are integral parts of therapy.
➢ Liver: Stimulates • Protect skin, limit sun exposure.
hepatic glycogen • Inform dentist, physician, surgeon of medication
synthesis, synthesis before any treatment is given.
of fatty acids.
➢ Muscle: Increases
protein, glycogen
synthesis.
➢ Adipose tissue:
Stimulates
lipoproteins to provide
free fatty acids,
triglyceride synthesis.
• Therapeutic Effect: Controls
serum glucose levels.
Heparin – Subcutaneous (SubQ)

DOSAGE /
NAME OF DRUG MECHANISM OF ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES
FREQUENCY/ TIMING

GENERIC NAME: Thromboembolic Heparin potentiates the action of Prophylaxis and Current or history of Hypersensitivity reactions Baseline assessment
Heparin sodium Prophylaxis antithrombin III, thereby inactivates treatment of heparin-induced (e.g. chills, fever, urticaria, • Obtain CBC, PT/INR, aPTT.
SQ: ADULTS, thrombin as well as activated coagulation thromboembolic thrombocytopenia; asthma, rhinitis); painful, • Cross-check dose with co-worker.
BRAND NAME: ELDERLY: 5,000 U factors IX, X, XI, XII and plasmin, and disorders and generalized or local ischemic and cyanosed • Assess for bleeding risk.
Hepalean Leo, given 2 hr before inhibits the conversion of fibrinogen to thromboembolic hemorrhagic tendency, limbs; osteoporosis (in long- • Question history of recent trauma, head injuries, GI/GU
Sakarin, Heprin, surgery then 8-12 hrly fibrin. It also stimulates release of complications including uncontrolled term admin), suppression of bleeding.
Bruhep 5000, Nuparin for 7 days or until the lipoprotein lipase which hydrolyses associated with severe HTN, severe liver aldosterone synthesis leading • Ensure that pt has not received spinal anesthesia,
patient is ambulant. triglycerides to glycerol and free fatty acids. atrial fibrillation; insufficiency, active peptic to hyperkaliemia, cutaneous spinal procedures.
CLASSIFICATION: anticoagulant for ulcer, acute or subacute necrosis, delayed transient
Venous Onset: Approx 20-30 min (SC). extracorporeal septic endocarditis, alopecia, priapism, rebound Intervention/evaluation
Pharmacotherapeutic: thromboembolism and dialysis intracranial hemorrhage hyperlipemia; increased • Monitor CBC, PT/INR daily.
Blood modifiet Adult: 15,000-20,000 Pharmacokinetics procedures; or injuries and operations serum concentrations of AST • Obtain aPTT 6 hrs after initiation or any change in
U 12 hrly or 8,000- Well absorbed following subcutaneous maintain patency on the CNS, eyes and and ALT, prolonged dosage (or per clinical standards) until maintenance
Clinical: 10,000 U 8 hrly. administration. Protein binding: Very high. of IV devices. ears, and in women w/ prothrombin time; local dose is established, then check aPTT q24hrs (or
Anticoagulant Child: 250 U/kg bid. Metabolized in liver. Removed from abortus imminens; irritation, erythema, mild pain, clinical standards).
Elderly: Lower circulation via uptake by reticuloendothelial epidural anesthesia hematoma or ulceration on inj
• In long-term therapy, monitor 1–2 times/mo.
Pregnancy category: dosages may be system. Primarily excreted in urine. Not during birth; locoregional site.
• Diligently assess for bleeding.
Category C required. removed by hemodialysis. anesthesia in elective
surgical procedures (in Potentially Fatal: Heparin- • If platelet count decreases more than 50% from
Dosage in Absorption: Absorbed from systemic patients receiving heparin induced thrombocytopenia w/ baseline, obtain stat HIT antibody test.
Renal/Hepatic circulation. for treatment rather than or w/out thrombosis, severe • If HIT antibody positive, discontinue heparin and
Impairment prophylaxis). hemorrhage. consider treatment with direct thrombin inhibitor (e.g.,
No dose adjustment. Distribution: Plasma protein binding: argatroban); avoid all heparin products and place
Extensive. heparin allergy on chart.
• Monitor urine and stool for occult blood. Assess for
Metabolism: Partially metabolised in the decrease in B/P, increase in pulse rate, complaint of
liver to uroheparin (partially desulfated abdominal/back pain, severe headache (may be
heparin); appears to be removed from the evidence of hemorrhage).
circulation mainly by the reticuloendothelial • Question for increase in amount of discharge during
system and may localise on arterial venous menses.
endothelium. • Assess peripheral pulses; skin for ecchymosis,
petechiae.
Excretion: Via urine (as metabolites, or up • Check for excessive bleeding from minor cuts,
to 50% as unchanged drug after admin of scratches.
large doses). • Assess gums for erythema, gingival bleeding.
• Assess urine output for hematuria.
Half-life: 1–6 hrs. • Avoid IM injections due to potential for hematomas.
• When converting to warfarin (Coumadin) therapy,
Actions monitor PT/INR results (will be 10%–20% higher while
heparin is given concurrently).
• Interferes with blood coagulation by
blocking conversion of prothrombin to
Patient/family teaching
thrombin and fibrinogen to fibrin.
• Use electric razor, soft toothbrush to prevent bleeding.
• Therapeutic Effect: Prevents further
extension of existing thrombi or new • Report red or dark urine, black or red stool, coffee-
clot formation. No effect on existing ground vomitus, blood-tinged mucus from cough, signs
clots. of stroke, nosebleeds, or increase in menstruation.
• Do not use any OTC medication without physician
approval (may interfere with platelet aggregation).
• Wear or carry identification that notes anticoagulant
therapy.
• Inform dentist, other physicians of heparin therapy.
• Limit alcohol.
Phentolamine – Intradermal (ID)

NURSING
NAME OF DRUG DOSAGE / FREQUENCY/ TIMING MECHANISM OF ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT
RESPONSIBILITIES

GENERIC NAME: Dermal necrosis associated with Blocks the actions of circulating To treat dermal necrosis or sloughing Existing or history of MI, Significant: Tachycardia, Baseline assessment
Phentolamine norepinephrine IV infusion epinephrine and norepinephrine by after extravasation of I.V. coronary insufficiency, cardiac arrhythmias. • Assess blood pressure
mesylate ADULT: As phentolamine mesilate: antagonizing alpha 1 and alpha 2 norepinephrine angina, other evidence with readings every 10
Prevention: 10 mg is added to each receptors. Phentolamine causes suggestive of coronary Gastrointestinal minutes for at least 30
BRAND NAME: litre of solution containing peripheral vasodilation through direct artery disease, and disorders: Vomiting, diarrhea, minutes
norepinephrine. Treatment of relaxation of vascular smooth muscle hypersensitivity to nausea
extravasation of norepinephrine: 5- and alpha blockade. Positive phentolamine or its Intervention/evaluation
CLASSIFICATION: 10 mg (diluted in 10 mL 0.9% NaCl) chronotropic and inotropic effects components. General disorders and • Reconstitute each 5-mg
is injected intradermally into the increase cardiac output. A positive administration site vial phentolamine with 1
Chemical Class: affected area within 12 hours. inotropic effect primarily raises blood conditions: Weakness. ml sterile water for
Imidazoline pressure, but in larger doses, injection.
phentolamine causes peripheral Nervous system • Use reconstituted solution
Therapeutic Class: vasodilation and can reduce blood disorders: Dizziness immediately; don’t store
Antihypertensive, pressure. unused portion.
diagnostic aid, Respiratory, thoracic and
vasodilator Onset: 1-2 minutes (IV); 15-20 mediastinal disorders: Nasal Patient/family teaching
minutes (IM). stuffiness. • Instruct patient to move
Pregnancy slowly after phentolamine
category: Duration: 10-30 minutes (IV); 30-45 Vascular disorders: Acute and administration to minimize
Category C minutes (IM). prolonged hypotensive dizziness and avoid falls.
episodes, orthostatic
Pharmacokinetics hypotension, flushing,
. arrhythmia, angina
Metabolism: Extensively
metabolized in the liver. Skin: Flushing

Excretion: Via urine (approx 13% as Potentially Fatal: MI,

unchanged drug). Elimination half-life: cerebrovascular spasm or
19 minutes (IV). occlusion.
BCG Vaccine – Intradermal (ID)

NURSING
NAME OF DRUG DOSAGE / FREQUENCY/ TIMING MECHANISM OF ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT
RESPONSIBILITIES

GENERIC NAME: Active immunization against BCG vaccine is an attenuated strain Indicated for the prevention of Hypersensitivity. Significant: Risk of bladder Baseline assessment
Bacillus Calmette- tuberculosis of bacillus Calmette-Guérin tuberculosis in persons not previously contracture (intravesical), • Assess possible allergic
Guerin Vaccine Adult: 0.1 mL via slow injection into Mycobacterium bovis used as infected with M. tuberculosis who are Impaired immune response, malaise, fever and chills, flu- reactions.
the deltoid muscle. biologic response modifier. It is also at high risk for exposure. congenital or acquired like symptoms.
BRAND NAME: Child: <12 months 0.05 mL via slow used as an active immunotherapy for immune deficiencies (e.g. Intervention/evaluation
TICE BCG injection into the deltoid muscle. the treatment of bladder carcinoma in HIV-infection, leukemia, Blood and lymphatic system • Inquire about the health
situ by causing a local, chronic lymphoma, cancer therapy, disorders: Anemia. status of the patient
CLASSIFICATION: inflammatory response involving Hodgkin’s disease), active • Reduce dose by one half
macrophage and leukocyte infiltration tuberculosis, acute severe Gastrointestinal disorders: by using 2 mL of sterile
Pharmacologic of the bladder, resulting in the febrile illness, generalized Abdominal pain, nausea, water for injection when
classification: destruction of superficial tumor cells infected skin conditions, diarrhea. reconstituting.
Biological response of the urothelium. current or previous evidence General disorders and • Administer intradermally
Modifier of BCG infection, urinary administration site conditions: on the deltoid area.
tract infection, gross Rigors. • Observe sterility in
Therapeutic hematuria, <14 days of administering the
classification: biopsy, TUR, or traumatic Musculoskeletal and medication.
Antituberculotic catheterization. connective tissue disorders:
Arthralgia, arthritis, myalgia. Patient/family teaching
Concomitant therapy with • Instruct the parent,
immunosuppressive agents, Renal and urinary disorders: guardian, family
bone marrow depressants, Cystitis, dysuria, pollakiuria, members, or significant
antibiotics, radiation therapy. hematuria, UTI, urinary others to keep the
incontinence. vaccination site clean until
local reaction has
Respiratory, thoracic, and subsided.
mediastinal disorders:
Pneumonitis.

Potentially Fatal: Rarely,

systemic granulomatous
illness.