Drug Study Cardinal (1)

8/13/2019 Drug Study Cardinal (1)

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Name of the

drug

Classification Indications Dosage Side /

AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Epinephrine Bronchodilator/ Autonomic

Nervous

System Agent /

Alpha and

Beta

Adrenergic

Agonist

- It increases heart rate,

contracts blood vessels,

dilates air passages and

participates in the fight-or-

flight response of the

sympathetic nervous

system.

A. Initial Resuscitation

Management (bolus)

-Cardiac Arrest

a. Vasopressin may be

used instead in someprotocols

b. Symptomatic

-Bradycardia

a. Unresponsive to

Oxygenation

b. Ventilation

-Hypotension

not related to volume

depletion

B. Post-Resuscitation

Stabilization (Infusion)-Poor systemic perfusion

or Hypotension despite

a. Intravascular volume

replacement AND

b. Stable rhythm

-Significant Bradycardia

The effects of

epinephrine

may wear off

after 10 or 20

minutes. The

patient may

need to

receive further

treatment and

observation.

For adults:

Injection,solution

1:10,000 (0.1

mg/mL) as

hydrochloride

Recommende

d that

epinephrine

doses not

exceed 0.07

mg/kg.

Less serious

side effects

may include:

-sweating

-nausea and

vomiting

-pale skin

-feeling short

of breath

-dizziness

-weakness/

tremors-headache

-feeling

nervous or

anxious.

-Before using thismedication, check

if the patient has

heart disease or

high blood

pressure, a heart

rhythm disorder,

coronary artery

disease,

Parkinson's

disease, diabetes,

or a thyroid

disorder.

-Before using

epinephrine a

second time, call

the doctor if the

first injection

caused a serious

side effect such as

increased

breathing

difficulty, ordangerously high

blood pressure.

-Use extreme cautionwhen preparing.

Epinephrine is a very

potent drug; small errorsin dosage can cause

serious adverse effects.

- Monitor BP, pulse,

respirations, and urinary

output and observe

patient closely following

IV administration.

-Epinephrine may widen

pulse pressure. If

disturbances in cardiac

rhythm occur, withhold

epinephrine and notify

physician immediately.

Keep physician

informed of any

changes in intake-

output ratio.

Check BP repeatedly

when epinephrine isadministered IV

during first 5 min, then

q3 – 5min until

stabilized.

Monitor blood

glucose & HbA1c for

loss of glycemic

control if diabetic.

http://www.fpnotebook.com/ER/Exam/CrdplmnryRsctn.htm

http://www.fpnotebook.com/CV/EKG/Asystl.htm



http://www.fpnotebook.com/CV/EKG/Brdycrd.htm

http://www.fpnotebook.com/CV/Exam/Hyptnsn.htm













Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Tramadol /

Tramal

Analgesic Tramadol is a narcotic like

pain reliever. It is used to

treat moderate to severe

pain. Its extended-release

is used to treat moderate

to severe chronic pain

when treatment is

needed around the

clock.It inhibits reuptake

of norepinephrine,

serotonin and enhances

serotonin release. It alters

perception and responseto pain by binding to mu-

opiate receptors in the

CNS.

PO Moderate

to severe pain

50-100 mg 4-6

hourly.

Max: 400

mg/day

Extended

release: 50-

100mg/day

Max: 300

mg/day

IV/IM

Moderate to

severe pain 50-

100mg 4-6

hourly.

Get

emergency

medical help

if you have

any of these

signs of an

allergic

reaction:

-DOB

welling of

your face, lips,

tongue, or

throat.-Stop using

tramadol and

call the

doctor at

once if

patient has of

these serious

side effects:

hallucinations,

fever,tachycardia

overactive

reflexes, N&V

diarrhea, loss

of

coordination,

fainting

seizure

(convulsions)

- Tramadol can be

taken with or

without food, but

take it the same

way each time.

-Do not crush,

chew, or break a

tramadol tablet.

Swallow it whole.

-Breaking the pill

may cause toomuch of the drug

to be released at

one time.

-This medicine is for

oral (by mouth)

use only. Powder

from a crushed

tablet should not

be inhaled or

diluted with liquidand injected into

the body.

-Using this

medicine by

inhalation or

injection can

cause life-

threatening side

effects, overdose.

- May be taken with or

without food

- Watch out for

overdosage

-Monitor pain scale as

necessary

- Be aware that

tramadol shouldn’t be

given to patients with

a history ofanaphylactoid

reactions to codein or

other opiods.

- Avoid giving

tramadol to patients

with acute abdominal

conditions because it

may mask evidence

and disrupt

assessment of theabdomen.

- If patient has

respiratory depression,

assess respiratory

status often, and

expect to give non

opiod analgesic – not

tramadol.



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

KetorolacTromethamine /

Toradol

Chemicalclass: Acetic

acid derivative

Therapeutic

class:

Analgesic, Anti

inflammatory

Ketorolac is in a group of

drugs called non-steroidal

anti-inflammatory drugs

(NSAIDs).

It works by reducing

hormones that cause

inflammation and pain in

the body.

-Used for short-term (5

days or less) to treat

moderate to severe pain.

Adults ages to

16 to 64. Initial

20 mg dose,

followed by 10

mg every 4 to

6 hours prn, up

to 4 times a

day.

Patients age ≥

65, renally

impaired,

and/or weight< 50 kg (110

lbs): 10 mg PO

once followed

by 10 mg q4-6

hours prn not >

40 mg/day

Stop taking

ketorolac and

seek medical

attention or

call your

doctor if

patient have

any of these

serious side

effects:

chest pain,

weakness,shortness of

breath, slurred

speech,

problems with

vision or

balance

black, bloody,

or tarry stools

coughing up

blood or

vomit thatlooks like

coffee

grounds

swelling or

rapid weight

gain.

Use the lowest

effective dose for

the shortest duration

consistent with

individual patient

treatment goals.

Take the medicationexactly as it was

prescribed for you.

Do not take themedication in larger

amounts, or take it

for longer thanrecommended by

your doctor.

Ketorolac is not for

treating minor achesand pains.

Ketorolac is usually

given first as an

injection, and then

as an oral (by

mouth) medicine.

Ketorolac injection is

given through a

needle into a muscle

or a vein.

Store ketorolac

tablets at room

temperature away

from moisture and

heat.

Read Ketorolac labelcarefully. Don’t use IM

form for I.V. Route.

Know that ketorolac

isn’t for intrathecal or

epidural use.

- Inject IM ketorolac

slowly, deep into a

large muscle mass.

Monitor site for

bleeding, bruising or

hematoma.

- Give I.V. injection

over at least 15

seconds.

- Notify prescriber if

pain relief is

inadequate or if break

through pain occursbetween doses

because

supplemental doses of

an opiod analgesic

may required.



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Metoclopramide

hydrochloride

/ Plasil

Chemical

class:

Benzamide

Therapeutic

class: Anti

emetic, upper

GI stimulant

Metoclopramide

increases muscle

contractions in the upper

digestive tract. This speeds

up the rate at which the

stomach empties into the

intestines.

It is used for short-term to

treat heartburn caused by

gastroesophageal reflux in

people who have used

other medications withoutrelief of symptoms.

It also used to treat slow

gastric emptying in

people with diabetes

(also called diabetic

gastroparesis), which can

cause nausea, vomiting,

heartburn, loss of

appetite, and a feeling of

fullness after meals.

Metocloprami

de is not

approved by

the FDA for

postoperative

nausea and

vomiting in

pediatric

patients;

however, the

following doses

have been

studied:

DOSAGE

Adult:

10mg3x/day

Pedia:

15-20yrs

5-10mg 3x/day

5-14yrs:

2.5-5mg3x/day3-4yrs:

3mg 2-3x/day

1-2yrs:

1mg 2-3x/day

Under 1 yr:

1mg2x/day

SIGNS OF A

SERIOUS

MOVEMENT

DISORDER:

-tremors or

shaking in

your arms or

legs

uncontrolled

muscle

movements in

your face(chewing, lip

smacking,

frowning,

tongue

movement,

blinking or

eye

movement);

or

any new or

unusualmuscle

movements

you cannot

control.

Keep the tablet in

its bottle or blister

pack until the

patient is ready to

take the medicine.

Make sure your

hands are dry

before handling a

tablet. If the tablet

breaks or melts in

your hand, throw it

away and use a

new tablet.

Place the tablet

on the patient’s

tongue. It will

begin to melt right

away. Do not let

the client swallow

the tablet whole.

Allow it to melt in

the mouth without

chewing.

-Advice pt. to avoid

alcohol and other CNS

depressant that

enhance sedating

properties of this drug.

-Use metoclopramide

cautiously in patients

with hypertension

because it may

increase

catecholamine levels.

- Assess patients for

signs of intestinal

obstruction, such as

abnormal bowel

sounds, vomiting.

-For IV use you need

not dilute doses of 10

mg or less. Give drug

over 1 to 2 minutes.

For doses larger than10 mg, dilute in 50 ml

normal saline solution,

half normal (0.45)

saline solution.



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Bupivacaine

(Sensorcaine)

Amide Local

Anaesthesia

Bupivacaine is an

anesthetic (numbing

medicine) that blocks the

nerve impulses that send

pain signals to your brain.

Is used as a local (in only

one area) anesthetic for a

spinal block.

It may also be used for

purposes other than those

listed in this medicationguide.

For the production of

local or regional

anesthesia or analgesia

for surgery, for oral surgery

procedures, for diagnostic

and therapeutic

procedures, and for

obstetrical procedures.

During

epidural

administration

of Bupivacaine

Hydrochloride,

0.5% and 0.75%

solutions should

be

administered

in incremental

doses of 3 mL

to 5 mL with

sufficient timebetween doses

to detect toxic

manifestations

of

unintentional

intravascular or

intrathecal

injection.

Mild dizziness

or drowsiness.

Severe

allergic

reactions

(rash; hives;

itching;

difficulty

breathing;

tightness in

the chest;

swelling of the

mouth, face,lips, or

tongue);

blurred vision;

changes in

hearing; chest

pain;

excitement;

irregular

heartbeat;

nausea;

numbnessthat lasts for

more than a

few hours;

tremors;

vomiting.

Injections should

be made slowly,

with frequent

aspirations before

and during the

injection to avoid

intravascular

injection.

Sensorcaine

(bupivacaine HCl)

is contraindicated

in obstetricalparacervical block

anesthesia. Its use

by this technique

has resulted in

fetal bradycardia

and death.

Sensorcaine is

contraindicated in

patients with a

knownhypersensitivity to

it or to any local

anesthetic agent

of the amide type

or to other

components of

bupivacaine

solutions.

-When appropriate,

patients should be

informed in advance

that they may

experience temporary

loss of sensation and

motor activity, usually

in the lower half of the

body following proper

administration of

caudal or lumbar

epidural anesthesia.

Also, the physician

should discuss other

information including

adverse reactions in

the Sensorcaine

package insert.

Inform the patient

before using this

medication, to tell

his/her doctor orpharmacist of all

prescription and

nonprescription/herba

l products he/she may

use. Do not start or

stop any medicine

without doctor or

pharmacist approval.



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Promethazine

HCL / Phenergan

Anti-emetics,

Antihistamines,

Sedative/hypn

otics

Promethazine works by

changing the actions of

chemicals in your brain.

It also acts as an

antihistamine. It blocks the

effects of the naturally

occurring chemical

histamine in your body.

It is used to treat allergy

symptoms such as itching,

runny nose, sneezing,itchy or watery eyes,

hives, and itchy skin

rashes.

Also to prevents motion

sickness, and treats

nausea and vomiting or

pain after surgery. It is also

used as a sedative or

sleep aid.

Nausea and

Vomiting

Adults: One

25mg tablet

every 4 to 6

hours to a

maximum daily

dose of

four 25mg

tablets.

Children 6-12

years: One10mg

tablet or 10mL

of the elixir,

every 4

to 6 hours to a

maximum daily

dose

of two 10mg

tablets or 25mL

of the

elixir.

Children 2-5

years: 5mL of

elixir

every 4 to 6

hours to a

maximum

daily dose of

15mL.

Phenergan

may have

unwanted

side

effects in

some people.

Stop using

promethazine

and call your

doctor at

once if you

have any of

these seriousside effects: twitching, or

uncontrollabl

e movements

of your eyes,

lips, tongue,

face, arms, or

legs

tremor

(uncontrolled

shaking),

drooling,

trouble

swallowing,

problems with

balance or

walking

feeling

restless.

Promethazine can

be taken with or

without food or

milk.

Measure liquid

medicine with a

marked measuring

spoon or medicine

cup, not with a

regular table

spoon. If you do

not have a dose-measuring device,

ask the pharmacist

for one.

This medication

can cause to have

unusual results with

certain medical

tests.

Store thismedication at

room temperature

away from

moisture, heat,

and light.

-Monitor BP, pulse and

respiratory rate

frequently.

-Assess level of

sedation after

administration.

-Assess patient for

nausea and vomiting

before and after

administration.

-Administer each

25mg slowly over at

least 1 hr.

-Do not administer SQ,

tissue necrosis may

occur

-Arteriospasms and

gangrene of artery

may occur whenadministered intra-

arterially.

-Reduce dosage of

barbiturates given

concurrently within

promethazine by least

half.



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Succinylcholine

Anectine Neuromuscular

blocker,

depolarizing

ANECTINE (succinylcholine

chloride) is an ultra short-

acting depolarizing-type,

skeletal muscle relaxant

for intravenous (IV)

administration.

Succinylcholine chloride is

indicated as an adjunct

to general anesthesia, to

facilitate tracheal

intubation, and to provide

skeletal muscle relaxationduring surgery or

mechanical ventilation.

Normally given

slow IV push.

Continuous

infusion:

2.5 mg/min

(0.5 to 10

mg/min).

Dilute to 1-2

mg/ml.

Diluents: D5W,

NS

Supplied: 20

and 50 mg/ml-

10ml vial. 100

mg/ml-

5,10,20ml vial.

Dosing:

Adults: 0.6

mg/kg (0.3 to

1.1) over 10-30

seconds, up to150mg total

dose.

Maintenance:

0.04 to 0.07

mg/kg q5-

10min prn.

The average

dose required

Adverse

reactions to

succinylcholin

e consist

primarily of an

extension of

its

pharmacologi

cal actions.

Succinylcholin

e causes

profoundmuscle

relaxation

resulting in

respiratory

depression to

the point

of apnea; this

effect may be

prolonged.

Hypersensitivit

y reactions,including ana

phylaxis, may

occur in rare

instances. The

following

additional

adverse

reactions

have been

Depolarizing

skeletal muscle

blocker

procedures of

short duration such

as endotracheal

intubation.

Succinycholine

should be used

only by those

skilled in the

management ofartificial respiration

and only when

facilities are

instantly available

for tracheal

intubation and for

providing

intubation

adequate

ventilation of the

patient. Includingthe administration

of oxygen under

positive pressure

and elimination of

carbon dioxide

To avoid distress to

the patient,

succinylcholine

Anectine

(succinylcholine) is a

rapid acting agent

(within 1 minute) with

a short

duration of action (3

to 10 minutes)

depending on the

amount given

· Contraindicated in

patients with

hypersensitivity to drug

and in those with

abnormally

low plasma

pseudocholinesterase,

angle-closure

glaucoma, malignant

hyperthermia or

penetrating eye

Injuries

· Succinylcholineshould be sued only

by personnel skilled in

airway management

· Keep airway clear.

Have emergency

respiratory support

equipment

immediately

http://www.rxlist.com/script/main/art.asp?articlekey=2309








to produce

neuromuscular

blockade and

to facilitate

tracheal

intubation is 0.6mg/kg

ANECTINE

Injection given

intravenously.

The optimum

dose will vary

among

individuals and

may be from

0.3 to 1.1

mg/kg foradults.

Following

administration

of doses in this

range,

neuromuscular

blockade

develops in

about 1

minute;

maximum

blockade may

persist for

about 2

minutes, after

which recovery

takes place

within 4 to 6

minutes.

reported:

cardiac

arrest,

malignant

hyperthermia,

arrhythmias,bradycardia,

tachycardia,

hypertension,

hypotension,

hyperkalemia,

prolonged

respiratory

depression or

apnea,

increased intr

aocularpressure,

muscle

fasciculation,

jaw rigidity,

postoperative

muscle

pain,rhabdom

yolysis with

possible

myoglobinuric

acute renal

failure,

excessive

salivation,

and rash.

should not be

administered

before

unconsciousness

has been induced.

available.

· Frequently

administered prior to

intubation, and can

be given either by

bolus injection

or continuous drip

infusion when longer

periods of muscle

relaxation are required

· Do not use reversal

agents.

Use immediately after

reconstitution Do not

mix with alkaline

solutions (thiopental

sodium, sodium

bicarbonate, or

barbiturates)





























Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Diprivan /

Propofol

General

anesthesia Propofol slows the activityof your brain and nervous

system.

It is used to help you relax

before and during

general anesthesia for

surgery or other medical

procedure. Propofol is also

used in critically ill patientswho require a breathing

tube connected to a

ventilator (a machine that

moves air in and out of

the lungs when a person

cannot breathe on their

own).

It may be used for otherpurposes not listed in this

medication guide.

Initial Bolus:

0.8-1.2 mg/kg

(1-2 minutes

after fentanyl)

Infusion:

Start at 140-200

ug/kg/min

At 10 minutes:

100-140

ug/kg/min

After 2 hours:80-120

ug/kg/min

Turm off

propofol

infusion about

5-10 minutes

prior to the

desired time of

emergence.

Give 1-2 ccboluses as

needed to

keep patient

asleep until the

desired time of

emeregence.

Get

emergency

medical help

if you have

any of these

signs of

an allergic

reaction:

hives; difficulty

breathing;

swelling of

your face, lips,

tongue, orthroat.

Serious side

effect such

as:

pain,

swelling,

blisters, or skin

changeswhere the

medicine

was injected,

seizure

(convulsions)

During

maintenance of

anesthesia or

sedation, the rate

of DIPRIVAN

(propofol)

Injectable

Emulsion

administration

should be

adjusted

according to thedesired level of

anesthesia or

sedation and may

be reduced in the

presence of

supplemental

analgesic agents

(e.g., nitrous oxide

or opioids).

Contraindicated in

patients egg lecithin,

soybean oil or when

general anesthesia or

sedation is

contraindicated.

· Propofol can support

the growth of

microorganisms.

· Discard tubing and

unused portions ofdrug after 12 hours.

· Drug should be

administered by

trained personnel that

are not involved in the

surgical

or diagnostic

procedure.

http://www.emedicinehealth.com/script/main/art.asp?ArticleKey=59357








Name of the

drugGeneric/Brand


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Nalbuphine HCL /

Nubain

Opioid agonist-

antagonist

analgesic;

Antihistamine

>Treatment and prevention of

motion sickness; prevention

and control of nausea and

vomiting associated with

anesthesia and surgery.

>Symptomatic relief of

perennial and seasonal

allergic rhinitis,

vasomotor rhinitis, allergic

conjunctivitis;

mild, uncomplicated

urticaria and angioedema;amelioration of allergic

reactions to blood or

plasma;dermatographism,

adjunctive therapy.

>Preoperative, postoperative

or obstetric sedation.

>Adjunct to analgesics to

control postoperative pain.

>Adjunctive IV therapy withreduced amounts of

meperidine or other narcotic

analgesics in special surgical

situations.

The usual

recommended

adult dose is 10

mg for a 70 kg

individual,

administered

subcutaneousl

y,

intramuscularly

or

intravenously;

this dose may

be repeatedevery 3 to 6

hours as

necessary.

Dosage should

be adjusted

according to

the severity of

the pain,

physical status

of the patient,

and othermedications

which the

patient may

be receiving.

CNS effects:

Nervousness

Depression

Restlessness

Crying,

euphoria,

floating,

hostility,

unusual

dreams,

confusion,

faintness,

hallucinations,dysphoria,

feeling

of heaviness,

numbness,

tingling,

Unreality.

The incidence

of psychotomi

metic effects,

such asunreality,

depersonaliza

tion, delusions,

dysphoria and

hallucinations

has been

shown to be

less than that

which occurs

Contraindicated

with

Hypersensitivity to

nalbuphine or any

component

including sulfites;

pregnancy

(prolonged use or

high dosages at

term)

>Keep opioids

antagonist and

facilities for assisted

or controlled

respiration readily

available in case

of respiratory

depression.

>Assess the patient for

history of drug

addiction.

>Reassure patient

about addiction

liability; most patients

who receive opiates

for medical reasons

do not develop

dependence

syndrome.

>Taper dosage when

discontinuing afterprolonged use to

avoid withdrawal

symptoms.

>Reassess patient’s

level of pain at least

15 and 30 minutes

after parenteral

administration.



with

pentazocine.

Cardiovascul

ar:

Hypertension,hypotension,

bradycardia,

tachycardia

Pulmonary

edema.

Gastrointestin

al:

Cramps,

dyspepsia,

Bitter taste.Respiration:

Depression,

Dyspnea,

Asthma.

Dermatologic

al:

Itching

Burning

Urticaria

GU:

Urinary urgency

RESPIRATORY:

Respiratory

depression,

Dyspnea

Asthma

>Assess the patient for

hypersensitivity

reaction to Nalbuphine

>Assess for anyadverse reactions

>Assess the patient

and family’s

knowledge of drug

therapy

>Instruct the patient

not to drink alcohol

while you are using this

medication. Alcoholcan increase some of

the side effects of

nalbuphine.

>Use cautiously if the

patient is emotionally

unstable or twith a history

of narcotic abuse;

bronchial asthma, COPD,

respiratory depression,

anoxia, increased

intracranial pressure,

acute MI when nausea

and vomiting are present,

biliary tract surgery.



Name of the

drugGeneric / Brand


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Atropine Sulfate /

Atropair ,

Atropisol,Isopto

Atropine

Autonomic

Nervous System

Agent; Anti-

cholinergic

Preoperative Use:

To suppress salivation,perspiration, and

respiratory tract

secretions; to reduce

incidence of laryngo

spasm, reflex bradycardia

arrhythmia, and

hypotension during

general anesthesia.

Preanesthesia

Adult:

IV/IM/SC

0.2 – 1 mg 30 –

60min

beforesurgery

Child:

IV/IM/SC

< 5 kg

, 0.02mg/kg; > 5 kg

,0.01 – 0.02

mg/kg30 – 60

min before

surgery

CNS:

Headache,

ataxia,

dizziness, excit

ement,

irritability,

convulsions,

drowsiness,

fatigue,

weakness;

mental

depression,

confusion,disorientation,

hallucinations GI:

Dry mouth

with thirst,

dysphagia,

loss of taste;

nausea,

vomiting,

constipation,delayed

gastric

emptying,

antral stasis,

paralytic ileus.

Hypersensitivity to

belladonna

alkaloids;

synechiae; angle-

closure glaucoma;

parotitis;

obstructiveuropath

y, e.g., bladder

neck obstruction

caused by

prostatic

hypertrophy;

intestinal atony,paralytic ileus,

obstructive

diseases of GI tract,

severe ulcerative

colitis, toxic mega

colon;

tachycardia

secondary to

cardiac

insufficiency

orthyrotoxicosis;acute

hemorrhage;

myasthenia gravis.

Safety during

pregnancy

(category C)or

lactation is note

stablished.

>Monitor vital signs. HR

is a sensitive indicator

of patient's response

to atropine. Be alert to

changes in quality,

rate, and rhythm of HR

and respiration and to

changes in BP and

temperature.

>Initial paradoxical

bradycardia following

IV atropine usuallylasts only 1 – 2 min; it

most likely occurs

when IV

is administered slowly

(more than 1 min) or

when small doses (less

than0.5 mg) are used.

Postural hypotension

occurs when patient

ambulates too soon

after parenteraladministration

Note: Frequent and

continued use of eye

preparations, as well

as over dosage, can

have systemic effects.

Some atropine deaths

have resulted from



CV:

Hypertension

orhypotension

, ventricular

tachycardia,palpitation,

paradoxical

bradycardia,

AV

dissociation,

atrial or

ventricular

fibrillation.

systemic absorption

following ocular

administration in

infants and children



Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Neostigmine /

Prostigmin,

Prostigmin

Bromide

Anticholinester

ase agent

> Neostigmine is used for

the symptomatictreatment of myasthenia

gravis by improving

muscle tone.

> Is a cholinesterase

inhibitor used in the

treatment of myasthenia

gravis and to reverse the

effects of muscle relaxants

such as gallamine and

tubocurarine.Neostigmine, unlike

physostigmine, does not

cross the blood-brain

barrier. By inhibiting

acetylcholinesterase,

more acetylcholine is

available in the synapse,

therefore, more of it can

bind to the fewer

receptors present in

myasthenia gravis andcan better trigger

muscular contraction.

Myasthenia

gravis:Diagnosis: I.M.:

Children: 0.04

mg/kg as a

single dose

Adults: 0.02

mg/kg as a

single dose

>Increased

salivation andsweating,

nausea and

vomiting,

abdominal

cramps,

diarrhoea,

allergic

reactions, rash

(bromide salt),

miosis,

increasedbronchial

secretions,

bradycardia,

bronchospas

m, weakness,

muscle

cramps,

fasciculation,

hypotension.

PotentiallyFatal:

Anaphylaxis.

>Mechanical GI or

urinary tractobstruction,

peritonitis.

> Hypersensitivity

to

anticholinesterases

and bromides;

mechanical

intestinal or urinary

obstruction;

peritonitis.

> Administer as

prescribed. Size ofdose (eg, number of

tablets) and

frequency of

administration will be

adjusted to provide

max relief of

myasthenia gravis

symptoms.

> In the diagnosis of

myasthenia gravis, allanticholinesterase

medications should be

discontinued for at

least 8 hours before

administering

neostigmine

> Administer without

regard to meals.

Administer with food if

GI upset occurs.

> Ensure that

parenteral atropine is

available for

emergency treatment

of cholinergic crisis.

http://www.drugs.com/cdi/prostigmin.html

http://www.drugs.com/mtm/prostigmin-bromide.html




http://www.drugs.com/cdi/prostigmin.html



Name of the

drugGeneric / Brand


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Calan/

Verapamil

Calcium

ChanelBlockers

> Is a calcium ion influx

inhibitor (calcium entryblocker or calcium ion

antagonist). The

mechanism of the

antianginal and

antiarrhythmic effects of

verapamil is believed to

be related to its specific

cellular action of

selectively inhibiting

transmembrane influx of

calcium in cardiacmuscle, coronary and

systemic arteries and in

cells of the intracardiac

conduction system. >This

results in a reduction of

free calcium ions

available within cells of

the above tissues.

Adult dose is

80 mg 3 timesa day. If

required, the

dose may be

increased up

to 160 mg 3

times a day. A

maximum daily

dose of 480 mg

should not be

exceeded.

Cardiovascul

ar: Hypotension,

edema;

CHF/pulmona

ry edema 1;

bradycardia;

AV block,

total (first,

second and

third degree)

or second

and thirddegree

CNS:

Dizziness,

headache,

fatigue

Gastrointestin

al:

Constipation,

nausea

Cardiovascul

ar: Flushing,

angina

pectoris,

atrioventricula

r dissociation,

chest pain,

claudication,

myocardial

infarction,

> Acute

myocardialinfarction; severe

congestive heart

failure and/or

severe left

ventricular

dysfunction (unless

secondary to a

supraventricular

tachycardia

amenable to oral

verapamiltherapy);

cardiogenic

shock; severe

hypotension;

second or third

degree AV block;

sick sinus syndrome

(see Warnings);

marked

bradycardia;

hypersensitivity to

the drug; patients

with atrial flutter or

atrial fibrillation

and an accessory

bypass tract (e.g.

Wolff-Parkinson-

White, Lown-

Ganong-Levine

syndromes)

>Monitor patient

carefully (BP, cardiacrhythm, and output)

while drug is being

titrated to therapeutic

dose. Dosage may be

increased more

rapidly in hospitalized

patients under close

supervision.

> Ensure that patient

swallows SR tabletswhole: do not cut,

crush, or chew.

>Monitor BP very

carefully with

concurrent doses of

anti-hypertensives.

>Monitor cardiac

rhythm regularly

during stabilization ofdosage and

periodically during

long-term therapy.

>Administer sustained-

release form in the

morning with food to

decrease GI upset.



palpitations,

purpura,

syncope

CNS:

Cerebrovascu

lar accident,confusion,

equilibrium

disorders,

insomnia,

muscle

cramps,

paresthesia,

psychotic

symptoms,

shakiness,

somnolence,excitation,

depression,

Gastrointestin

al:

Diarrhea, dry

mouth,

gastrointestin

al distress

Respiratory:

Dyspnea,

bronchospas

m.Urogenital:

Gynecomasti

a, increased

frequency of

urination,

spotty

menstruation,

>Protect IV solution

from light.

>Monitor patients with

renal or hepatic

impairment carefullyfor possible drug

accumulation and

adverse reactions.



Name of the

drugGeneric / Brand


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Terbutaline/

Brethaire

Adrenergic

inhalants,

selective beta-

2-

adrenorecept

or agonists

> Beta-

adrenergic receptor block ing agents not only block

the pulmonary effect of

beta-agonists, such as

terbutaline, but may

produce severe

bronchospasm

in asthmatic patients

> Terbutaline sulfate

injection is indicated for

the prevention andreversal of bronchospasm

in patients 12 years of age

and older

with asthma and

reversible bronchospasm

associated

with bronchitis and emphy

sema.

Acute broncho

spasm Adult: Initially,

2.5 or 3 mg tid

increased to 5

mg tid if

necessary; as

modified-

release tablet:

7.5 mg bid.

Child: 75

mcg/kg tid;

usual dose for>7 yr: 2.5 mg

bid-tid.

Intravenous

Severe

bronchospasm

Adult: 250-500

mcg SC, IM or

slow IV Inj up to

4 times daily, or

by IV infusion 3-

5 mcg/ml runat a infusion

rate of 0.5-1

mL/min.

Child: >2 yrs: 10

mcg/kg by SC,

IM or slow IV

injection. Max

total dose:

300mcg.

Central

NervousSystem

Tremor,

Nervousness,

Dizziness,

Headache,

Drowsiness

Cardiovascul

ar

Palpitations,

Tachycardia

Respiratory

Dyspnea,

Chest

discomfort

Gastrointestin

al

Nausea/vomi

ting

Systemic

Weakness,

Flushed

feeling,

Sweating,

Pain at

injection site

> Terbutaline

sulfate injection iscontraindicated in

patients known to

be hypersensitive

to

sympathomimetic

amines or any

component of this

drug product.

> Terbutaline

sulfate iscontraindicated in

patients known to

be hypersensitive

to

sympathomimetic

amines or any

component of this

drug product.

>Monitor BP and HR.

> Parenteral form is

only for S.C. use.

Before using, the

inhaler must be

shaken well; assess

lung sounds, pulse,

and blood pressure

before administration

and during peak of

medication; observe

patient for wheezingafter administration, if

this occurs, call

physician








http://www.mims.com/USA/diagnoses/info/339














Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Diphenhydramine

/ Benadryl

Narcotic

antitussive,Anticholinergic

, Nonselective

ethanolamine

Symptomatic relief of

perennial and seasonalallergic rhinitis, vasomotor

rhinitis and allergic

conjunctivitis; temporary

relief of runny nose and

sneezing caused by

common cold;

dermatographism;

treatment of urticaria and

angioedema;

amelioration of allergic

reactions to blood orplasma; adjunct to

epinephrine and other

standard measures in

anaphylaxis; relief of

uncomplicated allergic

conditions of immediate

type when oral therapy is

impossible or

contraindicated

(parenteral form);

treatment andprophylactic treatment of

motion sickness (injection

only)

Cough

Suppressant(Syrup, Strips)

Adults

PO 25 mg

every 4 h (max,

150 mg per 24

h).

Hypersensitivity

Reactions,

Type1/Antiparkinso

nism/Motion

Sickness

Adults

PO 25 to 50 mg

every 4 to 6 h

(max, 300

mg/day). IV/IM

10 to 50 mg IV

at a rate not

exceeding 25

mg/min or 100

mg deep IM if

required (max,

400 mg/day).

CNS: drowsine

ss, dizziness,headache,

paradoxical

excitation

(increased in

children).

EENT: blurred

vision, tinnitus.

CV: hypotensi

on,

palpitations.

GI: anorexia,dry mouth,

constipation,

nausea.

GU: dysuria,

frequency,

urinary

retention.

Derm: photos

ensitivity.

Resp: chest

tightness,thickened

bronchial

secretions,

wheezing.

Local: pain at

IM site.

Hypersensitivity to

antihistamines;asthmatic attack;

MAO inhibitor

therapy; history of

sleep apnea; use

in newborn or

premature infants

and in nursing

women; use as a

local anesthetic.

Caution the clientthat the

medication may

cause drowsiness,

creating difficulties

or hazards or other

activities that

require alertness.

Adverse effects of

these drugs occur

more commonly inelderly clients.

Give cautiously to

older adults who are

taking other

medications.

Monitor side effects,

excessive sedation,

dizziness, palpitations

or urinary retentions.

Encourage a fluid

intake of 2500-

3500ml/day unlesscontraindicated.

Give Benadryl before

blood transfusion, or

diagnostic test that

uses contrast media as

ordered.



Name of the

drugGeneric / Brand


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Suprane /

DesfluraneGeneral

inhalation

anesthetic. SUPRANE (desflurane, USP)

is indicated as an

inhalation agent for

induction and/or

maintenance of

anesthesia for inpatient

and outpatient surgery in

adults (see PRECAUTIONS).

SUPRANE (desflurane, USP)

is not recommended for

induction of anesthesia inpediatric patients

because of a high

incidence of moderate to

severe upper airway

adverse events (see

WARNINGS). After

induction of anesthesia

with agents other than

SUPRANE, and tracheal

intubation, SUPRANE is

indicated formaintenance of

anesthesia in infants and

children.

Induction and

maintenanceof general

anaesthesia

Adult: Induction

: 4-11% v/v,

usually

produces

surgical anaest

hesia within 2-4

minutes,

maintenance:

2-6% v/v with

nitrous oxide or2.5-8.5% v/v in

O2 or oxygen-

enriched air.

Concentrations

>17% v/v

Renal

impairment: Re

commended

dosage in

chronic

impairment: 1-

4% v/v in nitrousoxide/O2.Hepatic

impairment: Re

commended

dosage in

chronic

impairment: 1-

4% v/v in nitrous

oxide/O2.

Hypotension,

respiratorydepression,

arrhythmias,

nausea and

vomiting; may

provoke

breath

holding,

apnoea,

coughing,

increased

salivation,laryngospasm;

rarely,

malignant

hyperthermia.

Induction of

anaesthesia inchildren. Known or

suspected

susceptibility to

malignant

hyperthermia.

•Monitor heart rate

and arterial bloodpressure remained

within 20% of

preinduction baseline

values during

administration of

Suprane (desflurane,

USP) 0.5-7.7%

(average 3.6%) with

50-60% N2O.

•Monitor for increased

incidence ofrespiratory adverse

reactions, including

coughing,

laryngospasm and

secretions

•Monitor for

cardiovascular

arryhtmia, bigeminy

abnormal

eclectrocardiogram,

myocardial ischemia,vasodilation, agitation,

dizziness, asthma,

dyspnea and hypoxia












Name of the

drug


AdverseEffects

Contraindication

and Precaution

Nursing

Responsibilities

Sevoflurane /

Sevorane

Halogenated

hydrocarbons,General

anesthetics.

Used for induction and

maintenance of generalanesthesia in adult and

pediatric patients for

inpatient and outpatient

surgery. Often,

sevoflurane is used with

other medications to

induce or supplement

anesthesia

CNS:

Electroencep

halogram

(EEG):

Sevoflurane

causes a

dose-

dependent

decrease in

EEG activity.

Neuromuscul

ar effects: Sevoflurane

impairs

neuromuscula

r conduction

and

decreases

muscle

contractility.

Respiratory

systemeffects:

Respiration:

Sevoflurane

depresses

ventilation in

a dose-

dependent

manner, with

apnea.

-Previously had

any problems with

a general

anaesthetic.

-Malignant

hyperthermia (a

rare type of severe

fever).

-general

anaesthetic, or

had more than

one general

anaesthetic over a

short period of

time

-You have had

Sevorane before

and experiencedan allergic

reaction.

-Growths or

abnormalities in

your brain

•Check the name of the

patient andthe timeof administration.

• Monitor vital signs.

•Monitor all the body

systems.

Continuous monitoring of

pulseoximetry.



Documents

Drug Study Cardinal (1)