Post on 14-Jul-2016
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ST. PAUL UNIVERSITY DUMAGUETE(St. Paul University System)
P.O. Box 126200 Dumaguete City
Philippines
As Partial Fulfillment for the Degree of
Master of Arts in Nursing
Submitted to:
Dr. Richard Pascua M.A.NProfessor
Submitted by:
Ms. Joralyn A. Pacres, RN
1
ST. PAUL UNIVERSITY DUMAGUETE(St. Paul University System)
P.O. Box 126200 Dumaguete City
PhilippinesDrug Order
(Generic Name, Brand Name, Classification,
Dosage, Route, Frequency)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name: Furosemide
Brand Name: Lasix
Classification: Loop Diuretic
Dosage:Tablet – 20, 40, 80 mg;Oral Solution – 10mg/ml; injection 10mg/ml
Inhibits reabsorption of sodium and water in the ascending limb of the loop of henle by interfering with the chloride binding site. Loop diuretics increase the rate of delivery of tubular fluid and electrolytes to the distal sites of hydrogen and potassium ion secretion, while plasma volume contraction increases aldosterone production. The increased delivery and high aldosterone levels promote sodium reabsorption at the distal tubules, thus increasing the loss of potassium and hydrogen ions.
Indicated to patient’s with edema associated with CHF, cirrhosis, renal disease
Hypertension
Severe Sodium and water depletion
Hypersensitivity to sulphonamides and furosemide, hypokalemia, hyponatremia, precomatose states associated with liver cirrhosis, anuria or renal failure
Addison’s Disease
Low blood pressure Fluid and Electrolyte
Imbalance Rashes,
photosensitivity, nausea, diarrhea, blurred vision, dizziness, headache, hypotension
Hyperglycemia, glycosuria, ototoxicity
Assess patient’s underlying condition before starting therapy.
Monitor for renal, cardiac, neurologic, GI manifestation
Assess fluid volume status
2
Drug Order(Generic Name, Brand Name,
Classification, Dosage, Route, Frequency)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Mannitol
Brand Name:Osmitrol
Classification:Osmotic diuretic
Dosage:15% to 25% solution IV infusion
Increases osmotic pressure of plasma in glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes (including sodium and potassium). These actions enhance water flow from various tissues and ultimately decrease intracranial and intraocular pressures.
It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues.
Active intracranial bleeding, anuria secondary to severe renal disease, progressive heart failure, pulmonary congestion, renal damage, severe dehydration
CNS: dizziness, headache, seizures
CV: chest pain, hypotension, tachycardia
GI: nausea and omitting, diarrhea
GU: polyuria, urinary retention
METABOLIC: dehydration, water intoxication, hypernatremia, hyponatremia, hypokalemia, metabolic acidosis
Assess skin turgor, mucous membranes and mental status before administering the drug
Assess signs of electrolyte imbalance
Monitor iv site carefully to avoid extravasations and tissue necrosis
Do not add to other IV solutions or mix with other medications.
Watch for excessive fluid loss and signs and symptoms of hypovolemia and dehydration
Assess for evidence of circulatory overload, including pulmonary edema and heart failure.
Drug Order(Generic Name, Brand
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
3
Name, Classification, Dosage, Route, )
Generic Name:Hydralazine hcl
Brand Name:apresoline
Classification:vasodilator
Dosage: 5 or 10mg by iv infusion
Routeintravenous
Acts directly on vascular smooth muscle to cause vasodilation, primarily anteriolar, decreasing peripheral resistance; maintains or increase renal and cerebral flow
Hypertension Manage
hypertensive emergencies related to pregnancy
Manage severe heart failure
Contraindicated in patients hypersensitive to the drug and its components and those with coronary artery disease or mitral valvular rheumatic heart disease.
CNS: headache, dizziness, tremors
CV: palpitations, tachycardia, hypotension
GI: nausea and vomiting, diarrhea, constipation
Urticarial, pruritus
Check blood pressure before administering the drug
Inform patient that orthostatic hypotension can be minimized by rising slowly and not changing position suddenly.
4
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:hydrocortisone
Brand Name:Solu-cortef
Classification:steroid
Dosage:20-240mg
Route:IV, oral
Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its anti- inflammatory, immunosuppressive, and salt retaining actions.
Replacement therapy in adrenal cortical insufficiency.
Allergic states – severe or incapacitating allergic conditions.
Hematologic disorders
Allergy to any components of the drug
CNS: vertigo, headache, insomnia, siezures
CV: hypotensions, shock, heart failure secondary to fluid retention
GI: peptic ulcer, nausea and vomiting, abdominal distention
Assess for contraindications
Monitor vital signs
5
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:digoxin
Brand Name:Lanoxin
Classification:Inotropic, antiarrhythmic cardiac glycoside
Dosage:0.75-1.25mg PO0.125mg-0.25mg IV
Route:Oral, IV
Inhibits sodium-potassium activated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts to CNS to enhance vagal tone, slowing conduction through the SA and AV nodes.
Heart failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter.
Contraindicated in patients hypersensitive to drugs and in those with digitalis- induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.
CNS: fatigue, generalized muscle weakness, agitation, hallucinations.
CV: arrhythmias, heart block
EENT: yellow green halos around visual images, blurred vision, light flashes, photophobia
GI: anorexia, nausea
Before giving loading dose, obtain baseline data and ask patient about use of cardiac glycosides within the previous 2 to 3 weeks.
Before giving drug, take apical-radial pulse for 1minute. Record and notif prescriber of significant changes (sudden increase or decrease in pulse rate, irregular beats). If these occur, check blood pressure and obtain a 12 leads ECG.
Monitor potassium level carefully. Take corrective action before hypokalemia occurs. Hyperkalemia may results from digoxin toxicity.
6
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:diphenhydramine
Brand Name:benadryl
Classification:antihistamine
Dosage:25-50mg PO
Route: PO, Im, IV
Action on blood vessel, GI, respiratory tract by antagonizing the effects of histamine for H1 receptors site decrease allergic response by blocking histamine caused increased heart rate, vasodilation secretions.
Histamine H1 receptor antagonist of effector cells in respiratory tract, blood vessels, and GI smooth muscle.
It is used for symptomatic relief of allergic conditions including urticarial and angioedema. It is used for abtimiscarinic properties in the control of parkinsonism and drug-induced extrapyramidal disorders.
Hypersensitivity to drugs and its components.
CNS: sedation, confusion, nervousness, restlessness, convulsion
CV: tachycardia, hypotension, palpitation,
Euphoria Anorexia Urinary retention Tinnitus Diplopia Orthostatic
hypotension Palpitations Drowsiness Sedation
Assess respiratory status, rate, rhythm and increase In bronchial secretions, wheezing and chest tightness.
Instruct patients not to take Benadryl when driving.
7
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Epinephrine hydrochloride
Brand Name:adrenaline
Classification:Beta2 adrenergic agonists
Dosage:1mg IV,
Route: IM, IV
Stimulates alpha and beta receptors in sympathetic nervous system
Relaxes bronchial smooth muscles, causes cardiac stimulation, relieves allergic signs and symptoms, helps stop local bleeding, and decreases pain sensation.
Bronchospasm, hypersensitivity reactions, anaphylaxis
Hemostasis Prolonging local
anesthetic effect Restoring cardiac
rhythm in cardiac arrest.
Asthma
Cardiac dysrhythmias, angle-closure glaucoma, local anesthetic of fingers and toes
General anesthesia with halocarbons or cyclopropane, organic brain damage, labor coronary insufficiency.
CNS: anxiety, dizziness, fear, headache, hemiplegia, subarachnoid hemorrhage, tremors, weakness, restlessness
CV: angina pain, dysrhythmias, palpitations
GI: nausea and vomiting
Urinary retention Respiratory diffiulty
Monitor vital signs and check for cardiac dysrhythmias.
Avoid IM use of parenteral suspensions into buttocks. Gas gangrene may occur.
Massage site after IM injection to counteract possible vasoconstriction.
If blood pressure increases sharply, rapid-actiong vasodilators such as nitrates or alpha blockers can be given to counteract.
8
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Adenosine
Brand Name:Adenocard
Classification:Antidysrhythmics
Dosage and route: 3mg/ml140mcg/kg IV infusion6mg IVP
PSVT: slow conduction through AV node and interrupts AV reentry pathways, which restore normal sinus symptoms.
Stress testing: A2A adenosine receptor agonist; activation of the A2A adenosine receptor produces coronary vasodilation and increases coronary blood flow.
Indicated as adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately.
Sustained ventricular tachycardia
Hypersensitivity to drugs
Broncho constrictive or bronchospastic lung disease (eg. Asthma)
Dyspnea Chest pain Headache Lightheadedness Dizziness Numbness Nausea Hypotension Palpitations Blurred vision Bradycardia Seizure
Monitor vital signs
Check for hypersensitivity reactions
Do not refrigerate; possible crystal formation
9
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:aminophylline
Brand Name:paladron
Classification:bronchodilator
Dosage:6mg over 3ominutes
Route: IV
Directly relaxes smooth muscles of respiratory tract.
To prevent and relieve symptoms of acute bronchial asthma and treatment of bronchospasm associated with chronic bronchitis and emphysema
Hypersensitivity to xanthine deratives.
CNS: nervousness, restlessness, depression, insomnia, headache,
CV: cardiac arrhythmias, tachycardia
GI: nausea and vomiting, anorexia, diarrhea, epigastric pain
Monitor vital signs and I&O, a sudden, sharp unexplained rise in heart rate may indicate toxicity.
10
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Amiodarone
Brand Name:Cordarone
Classification:Antidysrhythmics
Dosage:50mg/ml100mg-400mg/tab
Route:IV, oral
Class III antiarrhythmic agent, which inhibits adrenergic stimulation; affect sodium, potassium, and calcium channels; markedly prolongs action potential and repolarization; decreases AV conduction and sinus node function.
Indicated only for life threatening arrhythmias because of risk for substantial toxicity;
Hypersensitivity to the drugs.
Severe sinus node dysfunction
Cardiogenic shock Avoid during
breastfeeding
Hypotension Dizziness Headache Malaise Ataxia Fatigue Impaired memory Involuntary
movement Sleep disturbance Photosensitivity Hypothyroidism Constipation Anorexia Bradycardia GI: hepatitis,
cirrhosis, pancreatitis, dry mouth
Nephrology: renal impairment, acute renal failure
Avoid excessive exposure to sunlight, may cause photosensitivity
Check for blood pressure: hypotension is the most common adverse reaction in some cases.
Assess for electrolyte imbalance
11
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Atropine sulfate
Brand Name:AtroPen, Saltropine
Classification:Anticholinergic, antimuscarinic, parasympatholytic, antiparkinsonian
Dosage:Bradycardia: 0.5mg IVCardiac arrest: 1mg
Route:
Chemical effect: inhibits acetylcholine at parasympathetic neuroeffector junction, blocking vagal effects on SA node, enhancing conduction through AV node
Therapeutic effect: increases heart rate, decreases secretions and slow GI motility. Antidote for anticholinesterase insecticide poisoning.
Sympatomatic bradycardia, bradyarrhythmia
Anticholinesterase insecticide poisoning
Preoperatively for decreasing secretions and blocking cardiac vagal reflexes
Adjunct in peptic ulcer disease; functional GI disorders such as irritable bowel syndrome.
Contraindicated in patients with hypersensitivity to the drug and its components
Those with acute angle closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, asthma, myasthenia gravis
CNS: agitation, ataxia, coma, confusion, disorientation, dizziness, hallucination, headache, insomnia, restlessness
CV: angina, arrhythmias, palpitations, tachycardia
GI: nausea and vomiting
Ensure adequate hydration
Have patient void before taking medication if urinary retention is the problem
Monitor vital signs
Instruct to take 30 minutes before meals
12
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Calcium Gluconate
Brand Name:gluconate
Classification:Antidote, calcium salts
Dosage:100mg/ml IV50-650mg tablet500mg capsule
Route:Oral, IV
Bone mineral component; cofoactor in enzymatic reactions, essential for neurotransmission, muscle contraction, and many signal transduction pathways
Treatment for hypocalcemia
Cardiac arrest Hyperkalemia Hypermagnesemia
Contraindicated to hypersensitivity to drugs
Hypercalcemia
Bradycardia Hypotension Headache Constipation Diarrhea Flatulence Nausea Vomiting Hypomagnesemia Hypophosphatemia
Monitor vital signs
Assess for electrolyte imbalance
13
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Dexamethasone
Brand Name:Decadron, solurex
Classification:Corticosteroids, anti-inflammatory agents
Dosage and route:Tablet: 0.5 mg – 6mgInjectables: 4mg/ml10mg/ml
Decreases inflammation by sippressing migration of polymorphonuclear leukocytes (PMNs) and reducing capillary permeability; stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, and inhibits prostaglandin and proinflammatory cytokines; suppresses lymphocytes proliferation through direct cytolysis, inhibits mitosis, breaks down granulocytes aggregates, and improves pulmonary microcirculation.
Inflammation Cerebral edema Shock Allergic
condition
Hypersensitivity to drug
Systemic fungal infection
Cerebral malaria
Bradycardia Depression Diaphoresis Euphoria Insomnia Rash Seizure Vertigo Weight gain Urticarial Moon face
Monitor vital signs Check for
hypersensitivity reaction
Drug Order(Generic Name, Brand
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
14
Name, Classification, Dosage, Route)
Generic Name:Diazepam
Brand Name:Valium
Classification:Anticonvulsants, skeletal muscle relaxant
Dosage and Route:Tablet: 2mg, 5mg, 10mgIV: 5mg/mlIM: 5mg/ml
Modulates postsynaptic effects of GABA-A transmission, resulting in an increase in presynaptic inhibition. Appears to act on part of the limbic system, as well as on the thalamus and hypothalamus, to induce a calming effect.
Anxiety Alcohol
withdrawal Muscle spasm Seizure disorder Status epilepticus
Contraindicated in patient with hypersensitivity to drugs
Sleep apnea Breastfeeding Children below
6months Severe respiratory
depression
Hypotension Fatigue Muscle weakness Respiratory
depression Urinary retention Depression Blurred vision Headache Skin rash
Monitor vital signs Check for respiration
15
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Dopamine hcl
Brand Name:decocard
Classification:Sympathomimetic
Dosage:2.5mcg
Route:Iv infusion
Sympathomimetic chemical precursor to norepinephrine. It has differing effects on the vascular and cardiac systems.
Correction of hemodynamic imbalances present in shock after myocardial infarction, trauma, surgery and renal failure or imbalance in condition or chronic refractory cardiac decompensation.
Should not be used in patient with phaechromocytoma or hyperthyroidism, nor the presence of uncorrected tachyarrhythmias or ventricular fibrillation.
CNS: headache, anxiety
CV: ectopic beats, tachycardia, angina pain, palpitations, hypotension, dyspnea, bradycardia
GI: nausea and vomiting
Monitor vital signs, cardiac output, and urinary output. Report significant changes.
Assess for containdication
Advise patient to inform NOD immediately if chest pain, dyspnea, numbness, tingling or burning of extremities occurs.
16
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Nicardipine
Brand Name:cardene
Classification:Calcium channel blockers
Dosage and route:Capsule: 20mg, 30mg, 60mgInfusion: 20mg/200mlInjectable: 2.5mg/ml
Calcium channel blocker; inhibits transmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentration; this inhibits cardiac and vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries.
Hypertension Chronic stable
angina
Hypersensitivity to drug
Advanced aortic stenosis
Headache Peripheral edema Hypotension Nausea Dizziness Polyuria Facial edema Tachycardia
Monitor blood pressure
Check for peripheral edema; it may occur
Check for hypersensitivity reaction.
Monitor vital signs
17
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Norepinephrine
Brand Name:Levophed
Classification:Alpha/beta adrenergic agonists
Dosage and route: Injectables: 1mg/ml
Strong beta1 and alpha adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and PVR, and cause variable BP effects.
Acute hypotension Cardiac arrest Sepsis/septic shock
Hypersensitivity to drug
Hypotension due to blood volume deficit
Peripheral vascular thrombosis
Bradycardia Hypertension Arrhythmias Confusion Anxiety Dyspnea Headache Nausea and vomiting Sweating Tremors Restlessness Urinary retention gangrene
monitor blood pressure and heart rate
monitor intake and output
check cause of hypotension
18
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Phenobarbital
Brand Name:No brand
Classification:Anticonvulsants, barbiturates
Dosage and route:Tablet: 15mg-100mgIV: 20mg/5ml
Depresses sensory and motor cortex, cerebellum.
Anti-seizures activity occurs primarily where GABA mediates neurotransmission
Hypnotic effect of barbiturates result from activity of GABA receptor in the polysynaptic midbrain reticular formation ( control CNS arousal)
Status epilepticus Seizures Sedation Insomnia
Hypersensitivity Porphyria COPD Dyspnea Pregnancy
Respiratory depression
Ataxia Dizziness Drowsiness Fatigue Headache Irritability Vertigo Constipation Diarrhea Nausea Vomiting
Monitor vital signs
Let patient lie down, do not take when driving
Check for hypersensitivity
Monitor heart rate
19
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Phenytoin sodium
Brand Name:dilantin
Classification:anticonvulsant
Dosage:
Route:
Produces a voltage and frequency dependent blockage of sodium channels in rapidly discharging nerve cells. Thus, it stops sustained repetitive firing such as that occurring during a seizure.
Control of generalized tonic-clonic (grand-mal)and complex partial seizures
Preventin and treatment of seizures occurring during or following neurosurgery
Status epelipticus
Contraindicated in patients who are hypersensitive to phenytoin or other hydantoins
SA block adams-stroke syndrome
CNS: ataxia, confusion, dizziness, headache, slurred speech, twitching
CV: hypotension GI: nausea and
vomiting HEMATOLOGIC:
anemia, lecopenia METABOLIC:
hyperglycemia
Patients taking phenytoin should be advised of the importance of adhering strictly to the prescribed dosage regimen, and of informing the physician of any clinical condition in which it is not possible to take the drug orally as prescribed.
The importance of good dental hygiene should be stressed in order to minimize the development of gingival hyperplasia and its complications.
20
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Isosorbide Dinitrate
Brand Name:Isoket
Classification:Nitrates, angina
Dosage and route:PO: 5mg-40mg
Vasodilating agent; relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce bot preload and afterload, as well as myocardial oxygen demand; also improves coronary collateral circulation, lowering blood pressure, increasing heart rate, and causing occasional paradoxical bradycardia.
Angina pectoris Hypersensitivity Severe anemia Recent use (within
several days) of PDE-5 inhibitors (eg. Avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time courses of the interaction appear to be related to the PDE-5 inhibitor half-life.
Cardiovascular: rebound hypertension, syncope, unstable angina flushing, hypotension/ orthostatic hypotension, lightheadedness, palpitation
CNS: dizziness, headache, restlessness, weakness
GI: nausea HEMATOLOGIC:
methemoglobinemia
Monitor vital signs (blood pressure)
Check for hypersensitivity reaction
21
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Magnesium sulfate
Brand Name:
Classification:Antidysrhythmics, electrolytes
Dosage and route:Injectables: 40mg/ml
Depresses CNS, blocks peripheral neuromuscular transmission produces anticonvulsants effects; decreases amount of acetylcholine released at end-plate by motor nerve impulses.
Hypomagnesemia Indicated to prevent
seizures associated with pre-eclampsia, and for control of seizures with eclampsia
Torsades de pointes
Hypersensitivity to drugs
Hypothermia Hypotension Drowsiness Diaphoresis Hypocalcemia Hyperkalemia Visual changes
Monitor vital signs
Check for electrolytes imbalance
22
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Midazolam
Brand Name:Versed
Classification:Antianxiety, anxiolytics, benzodiazepines
Dosage and route:Oral: 2mg/mlIM: 70-80mcg/kgIV: 0.5-1mg
Binds receptors at several sites within the CNS, including the limbic system and reticular formation; effects may be mediated through GABA receptor system; increase in neuronal membrane permeability to chloride ions enhances the inhibitory effects of GABA; the shift in chloride ions causes hyperpolarization (less excitability) and stabilization of neuronal membrane.
Hypersensitivity to drug
Drowsiness Nausea and
vomiting Cough Headache Sedation Delirium Euphoria Hypotension Seizures activity apnea
Monitor vital signs
Do not administer by rapid IV injection in neonates (hypotension and seizures reported, especially when used concomitantly with fentanyl)
23
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Morphine sulfate
Brand Name:
Classification:Opioid agonists analgesic
Dosage:Oral: 10-30mg q4SC and IM: 10mgIV: 2.5-15mg
Route:
Acts as agonists at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation.
Relief of moderate to severe acute and chronic pain
Preoperative medications
Analgesic adjunct during anesthesia
Intraspinal use with microinfusion devices for the relief of intractable pain
Hypersensitivity to opioid
Diarrhea caused by poisoning until toxins are eliminated
During labor or delivery of premature infant
Pregnancy
CNS: light-headedness, dizziness, sedation, euphoria, insomnia, agitation, anxiety, fear
CV: facial flushing, tachycardia, bradycardia, palpitations, hypertension, hypotension
GI: dry mouth, nausea and vomiting constipation
SKIN: tissue irritation and induration
OTHER: sweating, physical tolerance, psychological dependence.
Dilute and administer slowly
Tell patient to lie down during IV administration
Keep opioid antagonists and facilities for assisted or controlled respiration readily available during IV administration
Use caution when injections SC or IM onto chilled areas in patients with hypotension or in shock
24
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Esomeprazole
Brand Name:Nexium
Classification:Proton pump inhibitor
Dosage and route:PO: 20mg -40mg
S-isomer of omeprazole; PPI: binds to H+/K+ - xchanging ATPase (proton pump) in gastric parietal cells, resulting in blockage of acid secretion.
GERD without erosive esophagitis
NSAID-induced gastric Ulcer
Zollinger-Ellison Syndrome
Gastric and Duodenal Ulcer
Frequent heartburn
Hypersensitivity to esomeprazole or other proton pump inhibitor
Headache Flatulence Nausea Abdominal pain Diarrhea Dizziness Constipation Stomatitis Hypomagnesimia Muscle weakness bronchospasm
Monitor vital signs
Let patient take the drug before meals
Check for electrolyte imbalance: hypomagnesemia may occur with prolonged use.
25
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Methotrexate
Brand Name:trexall
Classification:Immunosuppressants, antineoplastics, antimetabolites
Dosage and route:25mg/mlSC: 10mg/0.4mlPO: 2.5mg
Inhibits dihydrofolic acid reductase; inhibits purine and thymidylic acid synthesis; which in turn interferes with DNA synthesis, repair, and cellular replication; cell cycle specific for S phase of cycle.
Osteosarcoma Rheumatoid
arthritis Psoriasis Treatment of
myasthenia gravis
Hypersensitivity to drug
Pregnancy: do not use due to potential for fetal death and teratogenic effects.
Immunodeficiency syndromes
Reddening of skin Hyperurecemia Nausea and
vomiting Diarrhea Anorexia Leukopenia Renal failure Alopecia Rash Fatigue Chills, fever
Monitor vital signs
Monitor closely elderly patient for early signs of hepatic and bone marrow.
Monitor intake and output; may cause renal damage leading to acute renal failure.
26
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:streptokinase
Brand Name:Streptase
Classification:Thrombolytic agent
Converts endogenous plasminogen to plasmin which breaks down fibrin clots, fibrinogen, and other plasma proteins; lysis thrombi and emboli
Coronary artery thrombosis; management of acute evoving transmural MI; lysis of pulmonary embolic; treatment of DVT arterial thrombosis, and embolism; opening of occluded arteriovenous cannula
Hypersensitivity to drug
Headache Angioneurotic Edema Hypotension Skin rash Bleeding Pain Fever Anaphylactic shock
Monitor vital signs
Check for bleeding
27
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Ranitidine
Brand Name:Zantac
Classification:Histamine H2 Antagonist
Dosage and route:25mg/ml
H2-receptors antagonist; blocks H2 receptors of gastric parietal cells, leading to inhibition of gastric secreation.
Gastroesophageal reflux disease
Gastric ulcer, Benign Erosive Esophagitis Hypersecretory
Conditions
Hypersensitivity to ranitidine or components of the formulation
Abdominal pain Diarrhea Constipation Dizziness Hypersensitivity
reaction Nausea Vomiting
Use caution in hepatic impairment
Monitor for adverse effects.
28
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Tranexamic acid
Brand Name:hemostan
Classification:Antihemophilic agent
Dosage:250-500mg
Route: IV, oral
Forms a reversible complex that displaces plasminogen from fibrin resulting in inhibition of fibrinolysis, it also inhibits the proteolytic activity of plasmin.
Antihemorrhagic and antifibrinolytic for effective hemostasis in various surgical and clinical cases, in traumatic injuries.
Treating heavy menstrual bleeding
Allergy reaction to drug
Presents of blood clots, have history of blood clots or are at risk for blood clots
Renal function impairment
Hematuria of upper urinary tract
Unsual changes in bleeding pattern should be immediately reported to the physician.
It can be taken with or without meals
Inform the patients to notify physician immediately if the following severe side effects occur.
29
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Metoclopramide
Brand Name:Reglan
Classification:Antiemetic agents, Prokinetic agents
Dosage and route:5mg/ml injectable solution
Blocks dopamine receptors (at high dose) and serotonin receptors in chemoreceptor trigger zone of CNS; and sensitizes tissues to acetylcholine; increases lower GI motility but not secretions; increases lower esophageal sphincter tone
Chemotherapy-Induced Nausea and Vomiting
Diabetic Gastroparesis
Small bowel intubation/Radiologic examination of Upper GI Tract
Gastroesophageal reflux disease
Post-operative Nausea and Vomiting
Hypersensitivity to metoclopramide or procainamide
Patient with GI hemorrhage, mechanical obstruction, perforation, history of seizures, pheochromocytoma.
Fatigue Restlessness Sedation Headache Dizziness
Discontinue with signs and symptoms of tardive dyskinesia
Use caution in patient with hypertension, CHF, renal impairment, cirrhosis
30
Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Dobutamine
Brand Name:
Classification:Inotropic Agents
Dosage and route:200ng/100ml
Strong beta 1 and weak beta2 effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance
Cardiac decompensation
Low cardiac output
Hypersensitivity Idiopathic
hypertrophic subaortic stenosis
Hypertension Premature
ventricular beats Dyspnea Headache Nausea
Monitor vital signs
Caution in patient with Myocardial Infarction
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Drug Order(Generic Name, Brand Name, Classification,
Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Hetastarch
Brand Name:Hespan
Classification:Volume expanders
Dosage and route:500-1000ml injectable solution
Ethoxylated amylopectins; colloidally expands plasma volume
Hypovolemia Leukapheresis Renal impairment
Hypersensitivity Severe bleeding
disorders, severe CHF, severe renal failure
Hypertension Premature
ventricular beats Dyspnea Headache Nausea
Discontinue use at first sign of renal injury
Do not use in critically ill adult including those with sepsis, and those admitted to the ICU
Cautions to patient with allergy to corn, liver disease, renal impairment, thrombocytopenia
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Drug Order(Generic Name, Brand Name,
Classification, Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:Sodium bicarbonate
Brand Name:No brands
Classification:Alkalinizing agents
Dosage and route:Injectable: 4.2%5%Tablet: 325mg, 650mgIV: 50 mEq
Bicarbonate reacts with H+ ions to form water and carbon dioxide. It acts as a buffer against acidosis by raising blood pH.
Metabolic acidosis Cardiac arrest
Hypersensitivity to drugs
Hypercarbic acidosis Metabolic or
respiratory alkalosis hypocalcemia
aggravated CHF edema hypernatremia hypokalemia tetany metabolic alkalosis
monitor vital signs
check for extravasation
check for electrolyte imbalance
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Drug Order(Generic Name, Brand Name,
Classification, Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:enoxaparine
Brand Name:Lovenox
Classification:Anticoagulants
Dosage and route:Prefilled syringe: 30mg/0.3mL150mg/mL
Antithrombotic that inhibits factor Xa by increasing inhibition rate of clotting proteases that are activated by antithrombin III.
Prevent occurrence of pulmonary embolism in patients at risk for thromboembolic complications who are undergoing abdominal surgery or hip or knee replacement surgery.
Acute STEMI Renal impairement
Active major bleeding, thrombocytopenia with antiplatelet antibody in presence of enoxaparin or heparin.
Hypersensitivity to enoxaparin, heparin, pork products
Thrombocytopenia Nausea Anemia Heart failure Pneumonia Pulmonary edema Hyperkalemia Headache
Monitor vital signs
Check for signs and symptoms of neurologic impairment.
Monitor patents for bleeding
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Drug Order(Generic Name, Brand Name,
Classification, Dosage, Route)
Mechanism Of Action Indication contraindication Adverse Effects Nursing Considerations
Generic Name:fondaparinux
Brand Name:arixtra
Classification:Anticoagulants
Antithrombotic agent; inhibits factor Xa, which interrupts blood coagulation cascade and inhibits thrombin formation and thrombus development; generally does not increases prothrombin time (PT) or partial thromboplastin time (PTT).
Deep vein thrombosis
Acute pulmonary embolism treatment
Severe renal impairment
Active major bleeding
Bacterial endocarditis
Hypersensitivity to drugs
Anemia Fever Nausea Dizziness Confusion Diarrhea Edema Headache Hypokalemia Hypotension Insomnia Thrombocytopenia Urinary retention vomiting
monitor vital signs
check for bleeding
monitor inatake and output
check for electrolyte imbalance
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