San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. 4BCN Group 6A March 03, 2011 Trade Name: Demerol Hydrochloride Pregnancy Category: C
Adverse Reactions Transient hallucinati ons Transient hypotensi on in high doses Visual disturban ces Active metabolit e may accumula te in renal dysfunctio n, leading to an increased risk of CNS toxicity Drug Interactions Drug-Drug: Protease Inhibitors: Avoid combination Sibutramine: Possibility of lifethreatening serotonin syndrome Tricyclic Antidepressant s: Additive anticholinergic side effects Cimetidine: Increase respiratory and CNS depression Hydantoins: Decrease meperidine effect r/t increased liver breakdown Nursing Considerations Meperidine for IV use is incompatible with: Aminophylline, barbiturates, heparin, iodide, methicillin, Morphine SO4, phenytoin, NaHCO3, sulfadiazine, sulfisoxazole. For repeated doses, IM administration is preferred over SC use More effective when given parenterally than when given PO If used concomitantly with phenothiazines or antianxiety agents, reduce dose by 2025% Health Teachings Drug causes dizziness and drowsiness; do not engage in activities that require mental alertness Take drug within ordered intervals to prevent pain recurring; report pain levels and lack of effectiveness Due to low BP effects, rise slowly and do not change positions abruptly Increase fluid intake and bulk; report constipation if evident Avoid alcohol and other CNS depressant Store safely away from bedside; record dose and time of administration. Drug causes dependence

Generic Name: Meperidine Hydrochloride (Pethidine HCl) Route of Administration: Parenteral

Drug Class Narcotic Analgesic Mode of Action During pregnancy, meperidine is preferred to morphine because it doesnt diminish uterine contractions and cause less neonatal respiratory depression; causes less constipation and urinary retention One-tenth as potent an analgesic as morphine. Its analgesic effect is only when given PO rather than parenterally. Has no antitussive effects and doesnt produce miosis. Less smooth muscle spasm, constipation, and antitussive effect than equianalgesic Indications/ Contraindications Indications: Preoperative medication Adjunct to anesthesia Obstetrical analgesia Contraindications: Chronic pain, severe liver dysfunction, sickle cell disease, history of seizure, severe Coronary Artery Disease (CAD), those with cardiac dysrhythmias; hypersensitivity to drug, tetanus and strychnine poisoning, children under 6 months, diabetic acidosis, head injuries, shock, respiratory

doses of morphine. Produces both psychologic and physical dependence; overdosage causes respiratory depression.

depression, increased ICP, and before labor during pregnancy.

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. Generic Name: Oxytocin Route of Administration: Parenteral
Drug Class Oxytocic Drug Mode of Action Oxytocin stimulates rhythmic contractions of the uterus, increases the frequency of existing contractions, and raises the tone of uterine musculature. Acts on the smooth muscle of the uterus to stimulate contractions; response depends on the uterine Indications/ Contraindications Indications: To induce or augment labor contractions To treat uterine atony To hasten uterine involution To treat postpartum and post-abortion hemorrhage Contraindications: Fetal Intolrance of labor, anticipated non-vaginal delivery; Hypersensitivity to drug; Cephalopelvic disproportion (CPD), unfavorable fetal positions or presentations that are Adverse Reactions Seizure Water intoxicatio n if given in electrolyte free solution Intracrania l hemorrha ge Cardiac dysrhythm ia Asphyxia Drug Interactions Drug-Drug: Sympathom imetic Amines: severe hypertension and possible stroke Vasoconstri ctors/ Caudal block anesthesia: severe hypertension possible

4BCN

Group 6A

March 03, 2011 Trade Name: Syntocinon Pregnancy Category: X

Nursing Considerations Oxytocin is rapidly broken down by sodium bisulfate. Have Magnesium S04 immediately available to relax the uterus in case of tetanic uterine contractions. Do not confuse oxytocin with oxycontin (a narcotic analgesic) To reconstitute add 1 ml (10 units) to 1000ml of 0.9% NaCl or Ringers Lactate. Solution contains 10 milliunits/ml (0.01 Health Teachings Cramps will feel like strong menstrual cramps but will continue to increase in intensity. Report increased blood/fluid loss, severe headaches, fever, foul smelling drainage, or severe abdominal cramps Drug is uterine stimulant. It works by causing uterine contractions by changing calcium concentration in the uterine muscle cells

threshold of excitability.Is selective for the uterus, especially towards the end of pregnancy, during labor, and immediately following delivery.

undeliverable without conversion prior to delivery, Fetal distress where delivery is not imminent, cord prolapse, total placenta previa, genital herpes

Fetus: Hypoxia, Jaundice

units/ml) Use Y tubing system, with one bottle containing IV solution and oxytocin, and the other containing only the IV solution.

Review potential adverse effects associated with this therapy

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. 4BCN Group 6A March 03, 2011 Trade Name: Phenergan Pregnancy Category: C
Adverse Reactions Excitation Fatigue Drowsiness Dizziness Confusion Blurred Vision Tinnitus Photosensit ivity Drug Interactions CNS depression increases when promethazine is taken with alcohol, narcotics, sedative-hypnotics and general anesthetics Anticholinergic effects increase Nursing Considerations The extrapyramidal symptoms that can occur secondary to promethazine administration may be confused with the CNS signs of undiagnosed primary disease (e.g. encephalopathy, Reye syndrome). Avoid promethazine in such Health Teachings Avoid activities requiring mental alertness until drug effects realized; may cause sedation Drug may alter skin testing; stop 72hours before testing Consume

Generic Name: Promethazine Hydrochloride Route of Administration: Parenteral

Drug Class Antihistamin e, first generation, phenothiazi ne Mode of Action Blocks post synaptic mesolimbic dopaminergic receptors in the brain; exhibits a strong alphaadrenergic blocking effect and depresses Indications/ Contraindications Indications: Prophyaxis and control of N&V d/t anesthesia or surgery (also postoperatively) Preoperative, postoperative or obstetric sedation. Relief of apprehension and production of light sleep Adjunct to analgesic for

the release of hypothalamic and hypophyseal hormones; competes with histamine for the H1 receptor

postoperative pain Contraindications: Previous phenothiazine idiosyncrasy or hypersensitivity, SC or intraarterial use d/t tissue necrosis and gangrene, use in the treatment of lower respiratory symptoms, including asthma Lactation, comatose clients, CNS depression due to drugs (including barbiturates, general anesthetics, tranquilizers, alcohol, narcotics)

Incoordinati on Euphoria Seizure Extrapyram idal symptoms

when promethazine is combined with antihistamines, anticholinergics such as atropine and other phenothiazines Promethazine may interfere with urinary pregnancy tests leading to falseresults

situation Do not confuse promethazine with chlorpromazine or with prochlorperazine, both of which are antipsychotics Decrease dosage in dehydrated or oliguric clients Ampules may contain sulfite. Inject IM deep into large muscle mass rotating sites. Not for SC or intra-arterial administration; may cause tissue necrosis

adequate fluids to prevent dehydration; use caution in hot weather to prevent heat stroke Report any involuntary muscle movement. Keep all F/U appointments

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. 4BCN Group 6A March 03, 2011 Trade Name: Methergine Pregnancy Category: C
Adverse Reactions Hallucinat ions Drug Interactions Drug-Drug: Nursing Considerations Document fundal tone and non-phasic Health Teachings Report any signs and symptoms of

Generic Name: Methylergonovine Maleate Route of Administration: Parenteral

Drug Class Oxytocic Mode of Action Acts directly on the uterine Indications/ Contraindications Indications: Management and

Drug

smooth muscle to stimulate the rate, tone and amplitude of uterine contractions. It induces a rapid, sustained tetanic uterotonic effect that shortens the third stage of labor and reduces blood loss. The uterus becomes more sensitive to the drug toward the end of pregnancy

prevention of postpartal and postabortal hemorrhage by producing firm uterine contractions and decreasing uterine bleeding During the second stage of labor following delivery of the anterior shoulder, but only under full obstetric observation

Contraindications: To induce labor or threatened spontaneous abortions. Administration before delivery of the placenta. Use with CYP3A4 inhibitors (e.g. protease inhibitors, macrolide antibiotics, azole antifungal drugs) Pregnancy, toxemia, Hypertension. Ergot hypersensitivity.

Seizure HTN associate d with seizure or headache Acute MI Thrombophlebitis Palpitatio n Dizziness H/a Tinnitus

Azole antifungals: Increase risk of vasospasm leading to cerebral ischemia and/or ischemia of the extremities; do not use together Clarithromycin: Increase risk of vasospasm leading to cerebral ischemia and ischemia of the extremities Sympathomimeti cs: HTN r/t additive vasoconstriction Protease Inhibitors: Increase risk of vasospasm leading to cerebral ischemia and ischemia of the extremities

contracture; massage to check for relaxation or severe cramping Administer slowly over 1 minute and check for VS for evidence of shock or HTN after IV administration. Have emergency drugs available Give only if solution is clear and colorless; discard ampoules if discolored Monitor baseline calcium; correct if low to improve drug effectiveness; Monitor prolactin levels; assess for decreased milk production With post partum bleeding, report frequency, amount, color, and any associated S&S.

ergotism (cold, numb finer/toes, N&V, headache, muscle or chest pain, weakness) or infection Take only as directed; do not exceed dosage Avoid smoking; nicotine constricts blood vessels Abdominal cramps may be experienced; report any severe cramping, increased bleeding or adverse effects. Follow up with provider to ensure no complications

San Beda College

College of Nursing
Drug Study

Name/Section: GARCIA, Jan Isaiah S.

4BCN

Group 6A

March 03, 2011 Trade Name: Buscopan Pregnancy Category: C

Generic Name: Hyoscine N-Butyl Bromide Route of Administration: Parenteral

Drug Class Anticholinerg ic, Antispasmodi c Butylscopola mine (Belongs to the class of belladonna alkaloids, semisyntheti c, quaternary ammonium compounds. Used in the treatment of functional gastrointesti nal disorders. ) Mode of Action Hyoscine Nbutyl bromide (HBB) acts by inhibiting cholinergic transmission in the abdominopelvic parasympathe tic ganglia, thus relieving spasm in the smooth muscles of gastrointestina l, biliary, urinary tract and female genital organs, especially the cervico-uterine plexus and aiding cervical dilatation Indications/ Contraindications Indications: Parenterally also as an aid in diagnostic & therapeutic procedures eg gastroduodenal endoscopy, radiology. Acute GI, biliary & genitourinary spasm, including biliary & renal coic. Contraindications: Untreated narrowangle glaucoma, prostate hypertrophy w/ urinary retention, mechanical stenosis in the GIT, tachycardia, megacolon, myasthenia gravis. IM inj in patients on anticoagulants. Myasthenia gravis & megacolon. Should not be used in patients who have prior sensitivity to hyosine N-butyl bromide or any component of Adverse Reactions Visual accommodat ion disturbance, Infrequently injection site pain (after IM inj), Xerostomia, tachycardia, urinary retention, allergic & skin reactions, rarely dyspnea (in patients w/ history of bronchial asthma or allergy). rarely anaphylactoi d reactions & anaphylactic shock. Drug Interactions Intensifies anticholinergic effects of tricyclic antidepressant s, antihistamines , quinidine, amantadine dispyramide & other anticholinergic s (eg tiotropium, ipratropium). Enhanced tachycardiac effects of adrenergic agents. Dopamine antagonists reduce effects of both drugs on GIT.

Nursing Considerations

Buscopan should be used with caution in conditions characterised by tachycardia such as thyrotoxicosis, cardiac insufficiency or failure and in cardiac surgery where it may further accelerate the heart rate. Due to the risk of anticholinergic complications, caution should be used in patients susceptible to intestinal or urinary outlet obstructions. Because of the possibility that anticholinergics may reduce sweating, Buscopan should be administered with caution to patients with pyrexia. Elevation of intraocular pressure may be produced by the administration of anticholinergic agents such as Buscopan in patients with undiagnosed and therefore untreated narrow angle glaucoma.

Health Teachings Advise client to report signs and symptoms of adverse reactions such as allergic skin reactions, DOB, visual disturbance Caution patient to avoid alcohol because it may increase CNS depression.

buscopan.

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. 4BCN Group 6A March 03, 2011 Trade Name: Xylocaine Pregnancy Category: B
Adverse Reactions Mental/ mood changes, tinnitus vision changes, tremors, numbnes s, fever, unusually fast or slow pulse, trouble breathing , seizures, chest pain Drug Interactions Aminoglycosid es neuromuscular blockade Betaadrenergic blockers lidocaine levels with possible toxicity Cimetidine clearance of lidocaine with possible toxicity Phenytoin excessive cardiac depression Nursing Considerations Check drug concentrations carefully Establish safety precautions if CNS changes occur Teach client to report difficulty speaking, thick tongue, numbness, tingling,difficulty breathing, pain or numbness at site, swelling or pain at site Observe for untoward reactions such as drowsiness, depressed Health Teachings Nausea may occur. If this effect persists or worsens, contact your doctor or pharmacist promptly. Tell your doctor immediately if any of these unlikely but serious side effects occur: drowsiness, mental/mood changes, ringing in the ears, dizziness, vision changes, tremors, numbness, headache backache. Tell your doctor immediately if any of these highly unlikely but very serious side effects occur: fever,

Generic Name: Lidocaine Hydrochloride Route of Administration: Parenteral

Drug Class Antiarrythmi c, Local Anesthetics Mode of Action Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity Indications/ Contraindications Indications: Used as a local anesthesia for Cesarean section Used to numb an area before surgery or before another medical procedure. Injected prior to normal spontaneous delivery to anesthetize the area of the perineum to be used for episiotomy. Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia Contraindications: Contraindicated with allergy to lidocaine or amide-type local

anesthetics, CHF cardiogenic shock, 2nd or 3rd degree AV blocks] Hypovolemia Heartblock Other Conduction Disturbances

Procainamide additive cardio depressant effect

respiration, or seizures.

unusually fast or slow pulse, trouble breathing, seizures, chest pain.

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. Generic Name: Diazepam Route of Administration: Parenteral
Drug Class Benzodiazepi ne Mode of Action It provides anxiolytic, sedative, anticonvulsant, central muscle relaxant effect. The mechanism of action is associated with increased inhibitory effect of GABA in the Indications/ Contraindications Indications: It is used in: relief labor, premature birth, abruptio placenta, tetanus Premedication before anesthesia as a component of combined anesthesia Contraindications: Adverse Reactions Muscle weakness After IV injection is sometimes seen a hiccup When administer ed parenteral may be some fall Drug Interactions

4BCN

Group 6A

March 03, 2011 Trade Name: Anxionil Pregnancy Category: D

Nursing Considerations When used in obstetrics doses recommended to facilitate childbirth, newborns (most preterm) it is possible temporary muscular hypotonia, hypothermia, respiratory failure. Diazepam should Health Teachings

Theophylline at low doses changes a sedative effect of diazepam. Cimetidine, omeprazole, disulfiram may increase the intensity and duration of action of diazepam. Simultaneous

Advise patient to report signs and symptoms of diazepam toxicity:CNS depression of varying severity (from lethargy to coma): severe drowsiness, lethargy, weakness, decreased muscle tone, ataxia, prolonged confusion, depression of reflexes, coma; perhaps

CNS. Muscle relaxant effect is also due to the inhibition of spinal reflexes. This medication may cause anticholinergic effects.

Specifying a history of alcohol or drug dependence (except for acute withdrawal). Hypersensitivity to diazepam and other benzodiazepines. Myasthenia gravis, severe chronic hypercapnia.

in blood pressure. When administer ed parenteral in single cases respiratory disorders

administration with paracetamol may decrease excretion of diazepam and its metabolite desmethyldiazepam; with risperidone described the cases of NMS. Simultaneous administration with muscle relaxants the action of muscle relaxants increases, also increases the risk of apnea.

not be used in the I trimester of pregnancy, except in cases of extreme necessity. Diazepam taking during pregnancy may significantly change fetal heart rate.

hypotension, respiratory depression.

San Beda College

College of Nursing
Drug Study Name/Section: GARCIA, Jan Isaiah S. Generic Name: Metoclopramide Route of Administration: Parenteral
Drug Class Antiemetics, Gastrointestin al Stimulant Mode of Action Dopamine antagonists that acts by increasing sensitivity to acetylcholine; Indications/ Contraindications Indications: It is used in treatment of postoperative emesis Adverse Reactions Extrapyra midal symptoms Restlessne ss Depression Drug Interactions

4BCN

Group 6A

March 03, 2011 Trade Name: Plasil Pregnancy Category: B

Nursing Considerations Do not confuse metoclopramide with metoprolol (a beta adrenergic blocker)or with metolazone (a Health Teachings Drug increases the movements or contractions of the stomach and the intestines Report lack of

Acetaminophen: increase acetaminophen absorption Anticholinergics:

results in increased motility of the upper GIT and relaxation of the pyloric sphincter and duodenal bulb. Gastric emptying time and GI transit time are shortened. No effect on gastric, biliary or pancreatic secretions; Facilitates intubation of the small bowel and speeds transit of barium meal. Produces sedation, includes release of prolactin, increases circulating aldosterone levels, an antiemetic

Vomiting during pregnancy and labor To improve lactation

Seizure Neurolepti c Malignant syndrome

Contraindications: GI hemorrhage, obstruction or perforation Epilepsy Clients taking drugs likely to cause extrapyramidal symptoms such as phenothiazines Pheochromocytoma

decrease metoclopramide effects CNS depressants: additive sedative effects Digoxin: decrease digoxin effect r/t decrease GI absorption Narcotic analgesic: decrease metoclopramide effect Tetracyclines: increase tetracyclines GI absorption

thiazide diuretic) Metoclopramide is physically/chemica lly incompatible with with number of drugs; check package insert if drug is to be admixed Asses abdomen for bowel sounds, distention N&V

response, persistent side effects so they can be properly evaluated and counteracted Avoid alcohol and CNS depressants Extrapyramidal effects ( trembling hands, facial grimacing) should be reported; may be treated with parenteral diphenhydramine