Generic Name drugs

8/13/2019 Generic Name drugs

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Generic Name: Atropine Sulfate Cholinergic Blocking Drug

Brand Name/s: Atropair, AtroPen, International Apex

Action/ Kinetics: Blocks acetylcholine effects on post-ganglionic cholinergic receptors insmooth muscle, cardiac

muscle, exocrine glands, urinary bladder, and the AV and SA nodes in the heart.

Ophthalmologically, blocks acetylcholine effects on the sphincter muscle of the iris and the

accommodative muscle of the ciliary body. This results in dilation of the pupil (mydriasis) and

paralysis of the muscles required to accommodate for close vision (cyclopegia).

Indication/s: Reduces secretions eg gastric and intestinal motility and is used in the treatment ofsmooth muscle

spasm in conditions eg pylorospasm in infants, renal and biliary colic and bronchospasm.

Contraindications: Ophthalmic use: Infants less than 3 months of age, primary glaucoma or atendency towardglaucoma, adhesions between the iris and the lens, geria`tric clients and others whereundiagnosed glaucoma or excessive pressure in the eye may be presne, in children who have had

a previous severe systemic reaction to atropine.

Nursing Responsibilities:

1.Document indications for therapy, onset and characteristics of signs and symptoms.2.Chech for any history of glaucoma before ophthalmic administration; may precipitate an acute

crisis.

3.Obtain vital signs and ECG; monitor cardiovascular status during IV therapy4.When used in the eye, vision will be temporarily impaired. Close work, operating machinery,

or driving a car should be avoided until drug effects have worn off.

5.Do not blink excessively; wait 5 minutes before instilling other drops. Stop eye drops andreport if ee pain, conjunctivitis, rapid pulse/ palpitations or dizziness occurs.

6.Drug impairs heat regulation; avoid strenuous activity in hot environments; wear sunglasses7.Males with BPH may experience urinary retention and hesitancy.8.Increase fluids and add bulk to diet to diminish constipating effects.9.Drug inhibits salivation; use sugarless candies and gums to decrease dry mouth symptoms.


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Generic Name: Epinephrine Hydrochloride Sympathomimetic Drugs, Bronchodilator

Brand Name/s: Glaucon, Adrenalin Chloride, Vaponefrin

Action/ Kinetics: Causes marked stimulation of alpha, beta-1, and beta-2 receptors, causeingsympathomimetic

stimulation, pressor effects, cardiac stimulation, bronchodilation, and decongestion. It crosses the

placenta but not the blood-brain barrier.

Indication/s: Inhalation:

10. Temporary relief of shortness of breath, tightness of chest, and wheezing due to bronchialasthma.

11. Postintubation and infectious croup.12. MicroNefrein is used for chronic obstructive lung disease, chronic bronchitis,

broncheolitis, bronchial asthma, and other peripheral airway diseases.

Injection:

1.Relieve respiratory distress in bronchial asthma, during acute asthma attacks, and forreversible bronchospasm in chronic bronchitis, emphysema, and other obstructive

pulmonary diseases.

2.Severe acute anaphylactic reactions, including anaphylactic shock and cardiac arrest, to restorecardiac rhythm.

3.Allergic reactions caused by bees, wasps, hornets, yellow jackets, bumble bees, and fire ants;severe allergic reactions or anaphylaxis caused by allergy injections; allergic reactions

due to exposure to pollens, dusts, molds, foods, drugs, and exercise.

4.Severe, life-threatening asthma attacks with wheezing, dyspnea, and inability to breathe.5.Vasopressor in shock.6.Infiltration of tissue to delay absorption of drugs, including local anesthetics.Topical: Control bleeding.

Contraindications:Narrow-angle glaucoma. Use when wearing soft contact lenses (maydiscolor lenses). Aphakia.

Lactation.


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1.Briskly massage site of subcutaneous or intramuscular injection to hasten drug action. Do notexpose drug to heat, light, or air, as this causes deterioration.

2.For direct IV administration to adults, the drug must be well diluted; note response (BP andpulse). Dose may be repeated several times if necessary.

3.Assess for sulfite sensitivity.4.Document indications for therapy; describe type/onset of symptoms and anticipated results.5.Assess cardiopulmonary function.6.Note any symptoms of shock such as cold, clammy skin, cyanosis, and loss of consciousness.


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Generic Name: Digoxin Cardiac GlycosideBrand Name/s: Digitek, Lanoxicaps, Lanoxin

Action/ Kinetics: Digoxin increases the force and velocity of myocardial contraction (positiveinotropic effect) by

increasing the refractory period of the AV node and increasing total peripheral resistance. This

effect is due to inhibition of sodium/potassium-ATPase in the sarcolemmal membrane, which

alters excitation- contraction coupling. Inhibiting sodium/potassium-ATPase results in increased

calcium influx and increased release of free calcium ions within the myocardial cells, which thenpotentiate the contractility of cardiac muscle fibers. Digoxin also decreases the rate of

conduction and increases the refractory period of the AV node due to an increase in

parasympathetic tone. Clinical effects are not seen until steady-state plasma levels are reached.

The initial dose of digoxin is larger (loading dose) and is traditionally referred to as thedigitalizing dose; subsequent doses are referred to as maintenance doses.

Indication/s:

13. Congestive Heart Failure (CHF), including that due to venous congestion, edema,dyspnea, orthopnea, and cardiac arrhythmia. May be drug of choice for CHG because

of rapid onset, relatively short duration, and ability to be administered PO or IV.

14. Control of rapid ventricular contraction rate in clients with atrial fibrillation or flutter.15. Slow heart rate in sinus tachycardia due to CHF.16. Supraventricular tachycardia.17. Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal

AV junctional rhythm.

18. Cardiogenic shock (value not established).Contraindications: Ventricular fibrillation or tachycardia (unless congestive failure supervenesafter protracted episode

not due to digitalis), in presence of digoxin toxicity, hypersensitivity to cardiac glycosides,

beriberi heart disease, certain cases of hypersensitive carotid sinus syndrome.


7.Obtain written parameters indicating the pulse rates, both high and low, at which cardiacglycosides are to be held; changes in rate or rhythm may indicate toxicity.

8.Protect from light.


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9.Give IV injections over 5 minutes (or longer) either undiluted or diluted fourfold or greaterwith sterile water for injection, 0.9% NaCl, RL injection, or D5W.

10. Document type, onset, and characteristics of symptoms. If administered for heart failure,note causes; ensure that failure not solely related to diastolic dysfunction as drgs

positive inotropic effect may increase cardiac outflow obstruction with hypertrophiccardiomyopathy.

11. Obtain ECG; note rhythm/ rate.12. Elderly clients must be observed for early signs and symptoms of toxicity.


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Hydrocortisome-hycortil

Hydrocortisone 21-(sodium succinate)


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Isoket-penodex

dexamethasone(dex ameth'a sone)dexamethasone

Oral, topical dermatologic aerosol and gel, ophthalmic suspension:Aeroseb-Dex, Decadron, Dexameth, Dexasone (CAN), Dexone, Hexadrol,Maxidex Ophthalmicdexamethasone acetateIM, intra-articular, or soft-tissue injection:Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA,Solurex LAdexamethasone sodium phosphateIV, IM, intra-articular, intralesional injection; respiratory inhalant; intranasal steroid;ophthalmic solution and ointment; topical dermatologic cream:Cortastat, Dalalone, Decadron Phosphate, Decadron Phosphate Ophthalmic,Decadron Phosphate Turbinaire, Decaject, Dexasone, Dexone,

Hexadrol Phosphate,Solurex

Pregnancy Category CDrug classesCorticosteroidGlucocorticoidHormone Therapeutic actionsEnters target cells and binds to specific receptors, initiating many complex reactionsthatare responsible for its antiinflammatory and immunosuppressive effects.Indications\u2022

Hypercalcemia associated with cancer\u2022Short-term management of various inflammatory and allergic disorders, suchasrheumatoid arthritis, collagen diseases (SLE), dermatologic diseases(pemphigus),status asthmaticus, and autoimmune disorders\u2022Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia\u2022Trichinosis with neurologic or myocardial involvement\u2022Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in someleukemias and lymphomas\u2022Cerebral edema associated with brain tumor, craniotomy, or head injury\u2022Testing adrenocortical hyperfunction\u2022Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis ofDepression


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Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques\u2022Respiratory inhalant: Control of bronchial asthma requiring corticosteroids inconjunction with other therapy

\u2022

Intranasal: Relief of symptoms of seasonal or perennial rhinitis that respondspoorly to other treatments\u2022Dermatologic preparations: Relief of inflammatory and pruritic manifestations ofdermatoses that are steroid-responsive

\u2022Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globeContraindications and cautions\u2022Contraindicated with infections, especially tuberculosis, fungal infections,amebiasis,vaccinia and varicella, and antibiotic-resistant infections, allergy to anycomponent of

the preparation used.\u2022Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitiswithimpending perforation; diverticulitis; active or latent peptic ulcer;inflammatory boweldisease; CHF, hypertension, thromboembolic disorders;osteoporosis; seizuredisorders; diabetes mellitus; lactation.

Available formsTablets\u20140.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir\u20140.5 mg/5 mL; oralsolution\u20140.5 mg/5mL; injection\u20148 mg/mL, 16 mg/mL, 4 mg/mL, 10 mg/mL,20 mg/mL, 24 mg/mL;aerosol\u201484 mcg/actuation; ophthalmicsolution\u20140.1%; ophthalmic suspension\u20140.1%;ophthalmicointment\u20140.05%; topical ointment\u20140.05%; topical cream\u20140.05%,0.1%;topical aerosol\u20140.01%, 0.04%Dosages

ADULTSSystemic administrationIndividualize dosage based on severity of condition and response. Give daily dosebefore9 AM to minimize adrenal suppression. If long-term therapy is needed,alternate-daytherapy with a short-acting steroid should be considered. After long-termtherapy,withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy,reduceinitial dose in small increments at intervals until the lowest clinically satisfactorydose isreached.Oral (dexamethasone, oral)0.75\u20139 mg/day.\u2022Suppression tests for Cushing's syndrome:1 mg at 11 PM; assay plasma cortisolat 8 PM the next day. For greater accuracy, give 0.5 mg q 6 hr for 48 hr, and collect 24-hr urine to determine 17-OH-corticosteroid excretion.\u2022Suppression test to distinguish Cushing's syndrome due to ACTH excess from that


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resulting from other causes:2 mg q 6 hr for 48 hr. Collect 24-hr urine todetermine 17-OH-corticosteroid excretion.IM (dexamethasone acetate)8\u201316 mg; may repeat in 1\u20133 wk. Dexamethasone phosphate: 0.5\u20130.9mg/day; usual dose

range is one-third to one-half the oral dose.IV (dexamethasone sodium phosphate) Adverse effectsAdverse effects depend on dose, route, and duration of therapy. The first list isprimarilyassociated with absorption; the list following is related to specific routesofadministration.Systemic administrationCNS:Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia,mood swings, depression,psychosis, intracerebral hemorrhage, reversible cerebralatrophy in infants, cataracts, increased IOP, glaucoma

CV:Hypertension,CHF,necrotizingangiitisEndocrine:Growth retardation, decreased carbohydrate tolerance, diabetesmellitus, cushingoid state,secondary adrenocortical and pituitaryunresponsivenessGI:Peptic or esophageal ulcer, pancreatitis, abdominal distentionGU:Amenorrhea, irregular mensesHematologic:Fluid and electrolyte disturbances, negative nitrogen balance,

increased blood sugar, glycosuria, increased serum cholesterol, decreased serumT3and T4levelsHypersensitivity:Anaphylactoid or hypersensitivity reactionsMusculoskeletal:Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fracturesOther:Impaired wound healing; petechiae; ecchymoses; increased sweating;thin and fragile skin; acne; immunosuppression and masking of signs of infection;activation of latent infections, including TB, fungal, and viral eye infections; pneumonia; abscess; septic infection; GI and GU infectionsIntra-articularMusculoskeletal:Osteonecrosis, tendon rupture, infectionIntralesional therapyCNS:Blindness (when used on face and headrare)Respiratory inhalant


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Endocrine:Suppression of HPA function due to systemic absorptionRespiratory:Oral, laryngeal, pharyngeal irritation

Other:Fungal infectionsIntranasalCNS:Headach eDermatologic:Urtic ariaEndocrine:Suppression of HPA function due to systemic absorptionGI:Nausea

Respiratory:Nasal irritation, fungal infections, epistaxis, rebound congestion,perforation of the nasal septum, anosmiaTopical dermatologic ointments, creams, spraysInterventionsFor systemic administration, do not give drug to nursing mothers; drug is secretedin breast milk.Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels.Increase dosage when patient is subject to stress.

Taper doses when discontinuing high-dose or long-term therapy.Do not give live virus vaccines with immunosuppressive doses of corticosteroids.For respiratory inhalant, intranasal preparation, do not use respiratory inhalantduring an acute asthmatic attack or to manage status asthmaticus.

Do not use intranasal product with untreated local nasal infections, epistaxis,nasal trauma, septal ulcers, or recent nasal surgery.Taper systemic steroids carefully during transfer to inhalational steroids; adrenalinsufficiency deaths have occurred.For topical dermatologic preparations, use caution when occlusive dressings, tight


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diapers cover affected area; these can increase systemic absorption.Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.Teaching pointsSystemic administration

Do not stop taking the oral drug without consulting health care provider.Avoid exposure to infection.Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarrystools, fever, prolonged sore throat, colds or other infections, worsening of this disorder.Intra-articular administrationDo not overuse joint after therapy, even if pain is gone.Respiratory inhalant, intranasal preparation

Do not use more often than prescribed.Do not stop using this drug without consulting health care provider.Use the inhalational bronchodilator drug before using the oral inhalant productwhen using both.Administer decongestant nose drops first if nasal passages are blocked.Topical

Apply the drug sparingly.

Avoid contact with eyes.Report any irritation or infection at the site of application.Ophthalmic

Administer as follows: Lie down or tilt head backward and look at ceiling. Warmtube ofointment in hand for several minutes. Apply one-fourth to one-half inch ofointment, ordrop suspension inside lower eyelid while looking up. After applyingointment, closeeyelids and roll eyeball in all directions. After instilling eye drops,release lower lid, butdo not blink for at least 30 sec; apply gentle pressure to theinside corner of the eye for1 min. Do not close eyes tightly, and try not to blinkmore often than usual; do not touchointment tube or dropper to eye, fingers, orany surface.Wait at least 10 min before using any other eye preparations. Eyes will become more sensitive to light (use sunglasses).


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Report worsening of the condition, pain, itching, swelling of the eye, failure of thecondition to improve after 1 w

Generic Name: Sodium Bicarbonate Alkalinizing agent, Antacid, Electrolyte


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Brand Name/s: Neut, Soda Mint Action/ Kinetics:

The antacid action is due to neutralization of hydro chloric acid by forming sodium chloride andcarbon dioxide. Provides temporary relief of peptic ulcer pain and of discomfort associated with

indigestion. Sodium bicarbonate is rarely prescribed as an antacid because of its high sodium

content, short duration of action, and ability to cause alkalosis. Is also a systemic and urinaryalkalinizer by increasing plasma and urinary bicarbonate.

Indication/s:

19. Treatment of hyperacidity20. Severe diarrhea (where there is oss of bicarbonate)21. Alkalization of the urine to treat drug toxicity22.

Treatment of acute mild to moderate metabolic acidosis due to shock, severe dehydration,anoxia, uncontrolled diabetes, renal disease, cardiac arrest, extracorporeal circulation of

blood, severe primary lactic acidosis.

23. Prophylaxis of renal calculi in gout.24. During sulfonamide therapy to prevent renal calculi and nephrotoxicity.25. Neutralizing additive solution to decrease chemical phlebitis and client discomfort due to

vein irritation at or near the site of infusion of IV acid solutions.

Contraindications:

Chloride loss due to vomiting or from continuous GI suction. With diuretics known to produce a

hypochloremic alkalosis. Metabolic and respiratory alkalosis. Hypocalcemia in which alkalosismay cause tetany. Hypertension, convulsion, CHF, and other situations where administration of

sodium can be dangerous. As a systemic alkinizer when used as a neutralizing additive solution.

As an antidote for strong mineral acids because carbon dioxide is formed, which may cause

discomfort and even perforation.


13. Note indications for therapy and any history of renal impairment or CHF.14. If on low continuous or intermittent NG suctioning or vomiting, assess for evidence of

excessive chloride loss.

15. Record I&O. Observe for dry skin and mucous membranes, polydipsia, polyuria, and airhunger; may indicate a reversal of metabolic acidosis. With acidosis, assess for the

relief of dyspnea and hyperpnea.


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16. If prescribed to counteract metabolic acidosis, monitor electrolytes and ABGs. test urineperiodically with nitrazine paper to determine if becoming alkaline.

17. Chew tablets thoroughly and take only as prescribed. Follow with a full glass of water.18. If routinely taking excessive PO preparations of sodium bicarbonate to relieve gastricdistress, a rebound reaction may occur, resulting either in an increased acid secretion or

systemic alkalosis. Persistent symptoms of gastric distress especially with chest pain,

SOB, diarrhea or dark tarry BMs require medical intervention.

19. Continuous, routine ingestion of sodium bicarbonate may cause formation of phosphatecrystals in the kidney and fluid retention.

20. Consuming sodium bicarbonate with milk or calcium may result in a milk- alkalisyndrome. Report immediately if anorexia, N&V, or mental confusion occurs.

21. Avoid OTC preparations that contain sodium bicarbonate, such as Alka/ Bromo- Selter,Gaviscon, or Fizrin.

Generic Name: Aminophylline Antiasthmatic, Bronchodilator

Brand Name/s: Endure Medical Aminophylline, Phil Pharmawealth/ Atlantic Aminophylline


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Action/ Kinetics:

Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, whichhas been impaired by bronchospasm and air trapping; in higher concentration, it also inhibits the

release of slow-reacting substance of anaphylaxis (SRS-A) and histamine.

Indication/s: Symptomatic treatment of bronchial asthma, bronchitis, bronchospasm and statusasthmaticus.

Relieve periodic apnea. Adjunct in treatment of pulmonary edema and paroxysmal nocturnal

dyspnea

caused by left heart failure. Contraindications:

MI, hypersensitivity to ehtylenediamine. Nursing Responsibilities:

y Administer to pregnant patients only when clearly needed2neonatal tachycardia, jitteriness, and

withdrawal apnea observed when mothers received xanthines up until delivery.

y Caution patient not to chew or crush enteric-coated timed-release forms. y Give immediate-release, liquid dosage forms with food if GI effects occur. y Do not give timed-release formswith food; these should be given on an empty stomach 1 hr before or

2 hr after meals. y Maintain adequate hydration. y Monitor results of serum theophyllinelevels carefully, and arrange for reduced dosage if serum levels

exceed therapeutic range of 1020 mcg/mL. y Take serum samples to determine peaktheophylline concentration drawn 1530 min after an IV

loading dose. y Monitor for clinical signs of adverse effects, particularly if serum theophyllinelevels are not

available. y Take this drug exactly as prescribed; if a timed-release product is prescribed, takethis drug on an

empty stomach, 1 hr before or 2 hr after meals. Do not to chew or crush timed-release

preparations. y Administer rectal solution or suppositories after emptying the rectum. y It maybe necessary to take this drug around the clock for adequate control of asthma attacks. y Avoidexcessive intake of coffee, tea, cocoa, cola beverages, chocolate. Smoking cigarettes or other

tobacco products impacts the drug's effectiveness. Try not to smoke. Notify the care provider if

smoking habits change while taking this drug. y Frequent blood tests may be necessary tomonitor the effect of this drug and to ensure safe and

effective dosage; keep all appointments for blood tests and other monitoring. y These sideeffects may occur: Nausea, loss of appetite (taking this drug with food may help if taking

the immediate-release or liquid dosage forms); difficulty sleeping, depression, emotional lability


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(reversible). y Report nausea, vomiting, severe GI pain, restlessness, seizures, irregularheartbeat.

Nicardepine HCL- Cardepine

screenshot


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Generic Name: Dopamine Hydrochloride Sympathomimetic, direct- and indirect-acting

Brand Name/s: Intropin


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Action/ Kinetics: Dopamine is the immediate precursor of epinephrine in the body.Exogenously administered,

itproduces direct stimulation of beta-1 receptors and variable (dose-dependent) stimulation of

alpha receptors (peripheral vasoconstriction) will cause a release of norepinephrine from its

storage sites. These actions result in increased myocardial contraction, cardiac output, and strokevolume, as well as increased renal blood flow and sodium excretion. Exerts little effect on

diastolic BP and induces fewer arrhythmias than are seen with isoproterenol.

Indication/s: Cardiogenic shock due to MI, trauma, endotoxic septicemia, open heart surgery,renal failure, and

chronic cardiac decompensation (as in CHF). Clients most likely to respond include those in

whom urine flow, myocardial function, and BP have not deteriorated significantly. Best

responses are observed when the time is short between onset of symptoms of shock and initiationof dopamine and volume correction.

Contraindications: Pheochromocytoma, uncorrected tachycardia, ventricular fibrillation, orarrhythmias. Pediatric

clients.


26. To prevent fluid overload, may use more concentrated solutions with higher doses.27. When discontinuing, gradually decrease dose; sudden cessation may cause marked

hypotension.

28. Note indications for therapy; ensure adequate hydration prior to infusion.29. Monitor vital signs, I&O, and ECG; titrate infusion to maintain systolic BP as ordered.30. Be prepared to monitor central venous pressure and pulmonary artery wedge pressure.

Report ectopy, palpitations, angina pain, or vasoconstriction.

31. Report any chest pain, increased shortness of breath, headaches, or IV site pain.

amiodarone hydrochloride(a meeo'da rone)Cordarone, Pacerone


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Pregnancy Category DDrug classes

AntiarrhythmicAdrenergic blocker (not used as sympatholytic agent)Therapeutic actions

Type III antiarrhythmic: Acts directly on cardiac cell membrane; prolongsrepolarizationand refractory period; increases ventricular fibrillation threshold; acts onperipheralsmooth muscle to decrease peripheral resistanceIndications\u2022Only for treatment of the following documented life-threatening recurrentventriculararrhythmias that do not respond to other antiarrhythmics or whenalternative agentsare not tolerated: Recurrent ventricular fibrillation, recurrenthemodynamically unstableventricular tachycardia. Serious and even fatal toxicityhas been reported with thisdrug; use alternative agents first; very closely monitorpatient receiving this drug. \u2022

Unlabeled uses: Treatment of refractory sustained or paroxysmal atrial fibrillationand paroxysmal supraventricular tachycardia; treatment ofsymptomatic atrialflutter.Contraindications and cautions\u2022Contraindicated with hypersensitivity to amiodarone, sinus node dysfunction,heart block, severe bradycardia, hypokalemia, lactation.\u2022Use cautiously with thyroid dysfunction, pregnancy.

Available formsTablets\u2014200, 400 mg; injection\u201450 mg/mLDosagesCareful patient assessment and evaluation with continual monitoring of cardiacresponseare necessary for titrating the dosage. Therapy should begin in the hospitalwith continualmonitoring and emergency equipment on standby. The following is aguide to usualdosage.

ADULTSPOLoading dose: 800\u20131,600 mg/day PO in divided doses, for 1\u20133 wk; reducedose to 600\u2013800 mg/day in divided doses for 1 mo; if rhythm is stable, reducedose to 400 mg/day inone to two divided doses for maintenance dose. Adjust to thelowest possible dose to limitside effects.IV

nterventions\u2022Monitor cardiac rhythm continuously.

\u2022Monitor for an extended period when dosage adjustments are made.

\u2022Monitor for safe and effective serum levels (0.5\u20132.5 mcg/mL).

\u2022


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Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need tobe reduced one-third to one-half when amiodarone is started.

\u2022Give drug with meals to decrease GI problems.

\u2022

Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy.\u2022Arrange for periodic chest x-ray to evaluate pulmonary status (every 3\u20136 mo).

\u2022Arrange for regular periodic blood tests for liver enzymes, thyroid hormonelevels.Teaching points

\u2022Drug dosage will be changed in relation to response of arrhythmias; you will need to behospitalized during initiation of drug therapy; you will be closely monitored when dosageis changed.

\u2022Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eyeexam, blood tests.

\u2022These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light;wear sunglasses, monitor light exposure); nausea, vomiting, loss of appetite (take withmeals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or protectiveclothing when outdoors); constipation (a laxative may be ordered); tremors, twitching,dizziness, loss of coordination (do not drive, operate dangerous machinery, orundertake tasks that require coordination until drug effects stabilize and your bodyadjusts to it).

\u2022Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortnessof breath, difficulty breathing, cough; swelling of ankles or fingers; palpitations; difficultywith vision.


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Generic Name: Phenytoin Hydantoin AnticonvulsantBrand Name/s: Dilantin Action/ Kinetics:

Acts in the motor cortex of the brain to reduce the effect of electrical discharges from the rapidly

firing epileptic foci in this area. This is accomplished by stabilizing hyperexcitable cells possibly

by affectingsodium efflux. Also, phenytoin decreases activity of centers in the brain stem

responsible for the tonic phase of grand mal seizures. Has few sedative effects.

Indication/s: Chronic epilepsy, especially of the tonic- clonic, psychomotor type. Not effectiveagainst absence seizures and may even increase the frequency of the seizures in this disorder.

Contraindications: Hypersensitivity to hydantoins, exfoliative dermatitis, sinus bradycardia,second and third- degree AV block, clients with Adams- Strokes Syndrome, SA block. Lactation


32. Document indication for therapy, onset, characteristics of symptoms, other agents trialed,and outcome.

33. Note history and nature of seizures, addressing location, frequency, duration, causes, andcharacteristics.

34. Determine if hypersensitive to hydantoins or has exfoliative dermatitis. Considerfrosphenytoin in those unable to tolerate phenytoin. Do not beast-feed following

delivery.

35. Monitor ECG, CBC, liver and renal function studies. May lower serum Mg, folate,calcium and Vitamin D.

36. During IV administration, monitor for hypotension.37. May take food to minimize GI upset. Do not take antacids within 1 hr of ingestion. Do

not chew or crush; take tablets whole.

38. Use care when performing tasks that require mental alertness. Drug may causedrowsiness, dizziness and blurred vision.


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39. Do not take any other agents. Avoid alcohol in any form and CNS depressants.40. With diabetes, monitor FS and report changes; may have to adjust insulin dosage and or

diet.

41. May cause urine to appear pink, red, or brown; do not be alarmed.42. Practice good oral hygiene to minimize bleeding of gums and hyperplasia.43. Practice good skin care, may develop acne. If rashes or excessive hair growth on the face

and trunk appear, or any discoloration, refer to dermatologist.

44. Complaints of weakness, ease of fatigue, headaches, or feeling faint may be signs of folicacid deficiency or megaloblastic anemia. Refer to dietitian.

45. Report for lab studies as ordered, including CBC, drug levels, and renal and liverfunction results. If thyroid studies are conducted, for ensured accuracy, they should be

repeated 10 days after therapy has been discontinued.

46. Do not stop abruptly. Report all bothersome side effects because these may be dose-related.


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Adenosine- cardiovert

A short acting agent that depresses sinus node and Av node function

Hal lie: 5 seconds

Indication- to treat supraventricular tachycardia (stv)

Dose and how to give- initiate bolus of 6m iven rapidly over 1-3 seconds followed by

normal saline bolus of 20cc by attaching both syringe to the IV port closest to patient, then

elevate the extremity

Repeat dose of 12m in 1-2 min if needed

A 3rddose of 12m may be needed

Side effect:

Transient lushin

Chest pain or tightness

Brief period of asystoel or bradycardia

HypotensionBronchospasm therefore should not be given to patient with case of asthma


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Generic Name: Mannitol Osmotic Diuretic

Brand Name/s: Resectisol, Osmitrol

Action/ Kinetics: Increases the osmolarity of the glomerular filtrate, which decreases thereabsorption of water and

increases excretion of sodium and chloride. It also increases the osmolarity of the plasma, whichcauses enhaced flow of water from tissues in the interstitial fluid and plasma. Thus, cerebraledema, increased ICP, and CSF volume and pressure are decreased.

Indication/s: Diuretic to prevent or treat the oliguric phase of acute renal failure beforeirreversible renal failure

occurs. Decrease ICP and cerebral edema by decreasing brain mass. Decrease elevated

intraocular pressure when the pressure cannot be lowered by other means. To promote urinary

excretion of toxic substances. As a urinary irrigant to prevent hemolysis and hemoglobin build-

up during transurethral prostatic resection or other transurethral surgical procedures.

Contraindications: Anuria, pulmonary edema, severe dehydration, active intracranial bleedingexcept during craniotomy,

progressive heart failure or pulmonary congestion after mannitol therapy, progressive renaldamage following mannitol therapy.


47. Document indications of therapy, type and onset of symptoms.48. List other medications prescribed to ensure none alter drug effects.49. Document neurologic findings50. When used to reduce ICP and brain mass, evaluate the circulatory and renal reserve, fluid

and electrolyte balance, body weight, and total I&O before and after infusion.

51. Assess for S&S of electrolyte imbalances and dehydration; replace as needed. If renal


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failure or oliguria present, perform test dose.

52. Monitor VS and I&O. slow infusion and report S&S of pulmonary edema manifested bydyspnea, cyanosis, rales or frothy sputum.

D50 50 mL

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