Generic Name drugs
Content
Generic Name: Atropine Sulfate Cholinergic Blocking Drug Brand Name/s: Atropair, AtroPen, International Apex Action/ Kinetics:
Blocks acetylcholine effects on post-ganglionic cholinergic receptors in smooth 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 of smooth 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 a tendency toward glaucoma, adhesions between the iris and the lens, geria`tric clients and others where undiagnosed 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 therapy 4. 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 and report if ee
pain, conjunctivitis, rapid pulse/ palpitations or dizziness occurs. 6. Drug impairs heat regulation; avoid strenuous activity in hot environments; wear sunglasses 7. 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.
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, causeing sympathomimetic 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 bronchial asthma. Postintubation and infectious croup. MicroNefrein is used for chronic obstructive lung disease, chronic bronchitis, broncheolitis, bronchial asthma, and other peripheral airway diseases.
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Injection: 1. Relieve respiratory distress in bronchial asthma, during acute asthma attacks, and for reversible bronchospasm in chronic bronchitis, emphysema, and other obstructive pulmonary diseases. 2. Severe acute anaphylactic reactions, including anaphylactic shock and cardiac arrest, to restore cardiac 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 (may discolor lenses). Aphakia. Lactation.
Nursing Responsibilities: 1. Briskly massage site of subcutaneous or intramuscular injection to hasten drug action. Do not expose 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 and pulse). 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.
Generic Name: Digoxin Cardiac Glycoside Brand Name/s: Digitek, Lanoxicaps, Lanoxin Action/ Kinetics: Digoxin increases the force and velocity of myocardial contraction (positive inotropic 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 then potentiate 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 the digitalizing 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. Control of rapid ventricular contraction rate in clients with atrial fibrillation or flutter. Slow heart rate in sinus tachycardia due to CHF. Supraventricular tachycardia. Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm. Cardiogenic shock (value not established).
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Contraindications: Ventricular fibrillation or tachycardia (unless congestive failure supervenes after 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. Nursing Responsibilities: 7. Obtain written parameters indicating the pulse rates, both high and low, at which cardiac glycosides are to be held; changes in rate or rhythm may indicate toxicity. 8. Protect from light.
9. Give IV injections over 5 minutes (or longer) either undiluted or diluted fourfold or greater with 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 drg¶s positive inotropic effect may increase cardiac outflow obstruction with hypertrophic cardiomyopathy. Obtain ECG; note rhythm/ rate. Elderly clients must be observed for early signs and symptoms of toxicity.
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Hydrocortisome-hycortil Hydrocortisone 21-(sodium succinate)
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 Ophthalmic dexamethasone acetate IM, intra-articular, or soft-tissue injection: Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA, Solurex LA dexamethasone sodium phosphate IV, 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 PregnancyCategoryC Drugclasses Corticosteroid Glucocorticoid Hormone Therapeuticactions Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects. Indications \u2022 Hypercalcemia associated with cancer \u2022 Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders \u2022 Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia \u2022 Trichinosis with neurologic or myocardial involvement \u2022 Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas \u2022 Cerebral edema associated with brain tumor, craniotomy, or head injury \u2022 Testing adrenocortical hyperfunction \u2022 Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of Depression
Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques \u2022 Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy \u2022 Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments \u2022 Dermatologic preparations: Relief of inflammatory and pruritic manifestations of dermatoses that are steroid-responsive \u2022 Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe Contraindicationsandcautions \u2022 Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any component of the preparation used. \u2022 Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF, hypertension, thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation. Availableforms Tablets\u20140.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir\u20140.5 mg/5 mL; oral solution\u20140.5 mg/5 mL; injection\u20148 mg/mL, 16 mg/mL, 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL; aerosol\u201484 mcg/actuation; ophthalmic solution\u20140.1%; ophthalmic suspension\u20140.1%; ophthalmic ointment\u20140.05%; topical ointment\u20140.05%; topical cream\u20140.05%, 0.1%; topical aerosol\u20140.01%, 0.04% Dosages ADULTS Systemic administration Individualize dosage based on severity of condition and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy with a short-acting steroid should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until the lowest clinically satisfactory dose is reached. Oral (dexamethasone, oral) 0.75\u20139 mg/day. \u2022 Suppression tests for Cushing's syndrome: 1 mg at 11 PM; assay plasma cortisol at 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. \u2022 Suppression test to distinguish Cushing's syndrome due to ACTH excess from that
resulting from other causes: 2 mg q 6 hr for 48 hr. Collect 24-hr urine to determine 17-OH-corticosteroid excretion. IM (dexamethasone acetate) 8\u201316 mg; may repeat in 1\u20133 wk. Dexamethasone phosphate: 0.5\u20130.9 mg/day; usual dose range is one-third to one-half the oral dose. IV (dexamethasone sodium phosphate) Adverseeffects Adverse effects depend on dose, route, and duration of therapy. The first list is primarily associated with absorption; the list following is related to specific routes of administration. Systemic administration • CNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, cataracts, increased IOP, glaucoma • V a g z c F C , o i s n t r e p y H : • Endocrine: Growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state, secondary adrenocortical and pituitary unresponsiveness • GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention • GU: Amenorrhea, irregular menses • Hematologic: Fluid and electrolyte disturbances, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levels • Hypersensitivity: Anaphylactoid or hypersensitivity reactions • Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures • Other: 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 infections Intra-articular • Musculoskeletal: Osteonecrosis, tendon rupture, infection Intralesional therapy • CNS: Blindness (when used on face and head—rare) Respiratory inhalant
• Endocrine: Suppression of HPA function due to systemic absorption • Respiratory: Oral, laryngeal, pharyngeal irritation • Other: Fungal infections Intranasal • CNS:Headach e • Dermatologic:Urtic aria • Endocrine: Suppression of HPA function due to systemic absorption • GI:Nausea • Respiratory: Nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia Topical dermatologic ointments, creams, spraysInterventions • For systemic administration, do not give drug to nursing mothers; drug is secreted in 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 inhalant during 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; adrenal insufficiency deaths have occurred. • For topical dermatologic preparations, use caution when occlusive dressings, tight
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 points Systemic 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 tarry stools, fever, prolonged sore throat, colds or other infections, worsening of this disorder. Intra-articular administration • Do 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 product when using both. • Administer decongestant nose drops first if nasal passages are blocked. T o p c i a l • 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. Warm tube of ointment in hand for several minutes. Apply one-fourth to one-half inch of ointment, or drop suspension inside lower eyelid while looking up. After applying ointment, close eyelids and roll eyeball in all directions. After instilling eye drops, release lower lid, but do not blink for at least 30 sec; apply gentle pressure to the inside corner of the eye for 1 min. Do not close eyes tightly, and try not to blink more often than usual; do not touch ointment tube or dropper to eye, fingers, or any surface. • Wait at least 10 min before using any other eye preparations. • Eyes will become more sensitive to light (use sunglasses). •
Report worsening of the condition, pain, itching, swelling of the eye, failure of the condition to improve after 1 w
Generic Name: Sodium Bicarbonate Alkalinizing agent, Antacid, Electrolyte
Brand Name/s: Neut, Soda Mint Action/ Kinetics: The antacid action is due to neutralization of hydro chloric acid by forming sodium chloride and carbon 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 urinary alkalinizer by increasing plasma and urinary bicarbonate. Indication/s: 19. 20. 21. 22. Treatment of hyperacidity Severe diarrhea (where there is oss of bicarbonate) Alkalization of the urine to treat drug toxicity 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. Prophylaxis of renal calculi in gout. During sulfonamide therapy to prevent renal calculi and nephrotoxicity. 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.
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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 alkalosis may 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. Nursing Responsibilities: 13. 14. Note indications for therapy and any history of renal impairment or CHF. If on low continuous or intermittent NG suctioning or vomiting, assess for evidence of excessive chloride loss. Record I&O. Observe for dry skin and mucous membranes, polydipsia, polyuria, and air hunger; may indicate a reversal of metabolic acidosis. With acidosis, assess for the relief of dyspnea and hyperpnea.
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If prescribed to counteract metabolic acidosis, monitor electrolytes and ABG¶s. test urine periodically with nitrazine paper to determine if becoming alkaline. Chew tablets thoroughly and take only as prescribed. Follow with a full glass of water. If routinely taking excessive PO preparations of sodium bicarbonate to relieve gastric distress, 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. Continuous, routine ingestion of sodium bicarbonate may cause formation of phosphate crystals in the kidney and fluid retention. Consuming sodium bicarbonate with milk or calcium may result in a milk- alkali syndrome. Report immediately if anorexia, N&V, or mental confusion occurs. Avoid OTC preparations that contain sodium bicarbonate, such as Alka/ Bromo- Selter, Gaviscon, or Fizrin.
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Generic Name: Aminophylline Antiasthmatic, Bronchodilator Brand Name/s: Endure Medical Aminophylline, Phil Pharmawealth/ Atlantic Aminophylline
Action/ Kinetics: Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has 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 status asthmaticus. 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 immediaterelease, liquid dosage forms with food if GI effects occur. y Do not give timed-release forms with 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 theophylline levels carefully, and arrange for reduced dosage if serum levels exceed therapeutic range of 10±20 mcg/mL. y Take serum samples to determine peak theophylline concentration drawn 15±30 min after an IV loading dose. y Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available. y Take this drug exactly as prescribed; if a timed-release product is prescribed, take this 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 may be necessary to take this drug around the clock for adequate control of asthma attacks. y Avoid excessive 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 to monitor the effect of this drug and to ensure safe and effective dosage; keep all appointments for blood tests and other monitoring. y These side effects 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
(reversible). y Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.
Nicardepine HCL- Cardepine screenshot
Generic Name: Dopamine Hydrochloride Sympathomimetic, direct- and indirect-acting Brand Name/s: Intropin
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 stroke volume, 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 initiation of dopamine and volume correction. Contraindications: Pheochromocytoma, uncorrected tachycardia, ventricular fibrillation, or arrhythmias. Pediatric clients. Nursing Responsibilities: 26. 27. To prevent fluid overload, may use more concentrated solutions with higher doses. When discontinuing, gradually decrease dose; sudden cessation may cause marked hypotension. Note indications for therapy; ensure adequate hydration prior to infusion. Monitor vital signs, I&O, and ECG; titrate infusion to maintain systolic BP as ordered. Be prepared to monitor central venous pressure and pulmonary artery wedge pressure. Report ectopy, palpitations, angina pain, or vasoconstriction. Report any chest pain, increased shortness of breath, headaches, or IV site pain.
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amiodarone hydrochloride (a meeo' da rone) Cordarone, Pacerone
PregnancyCategoryD Drugclasses Antiarrhythmic Adrenergic blocker (not used as sympatholytic agent) Therapeuticactions Type III antiarrhythmic: Acts directly on cardiac cell membrane; prolongs repolarization and refractory period; increases ventricular fibrillation threshold; acts on peripheral smooth muscle to decrease peripheral resistance Indications \u2022 Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias that do not respond to other antiarrhythmics or when alternative agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug. \u2022 Unlabeleduses:Treatmentofrefractorysustainedorparoxysmalatrialfibrilation andparoxysmalsupraventriculartachycardia;treatmentof symptomaticatrial flutter . Contraindicationsandcautions \u2022 Contraindicated with hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation. \u2022 Use cautiously with thyroid dysfunction, pregnancy. Availableforms Tablets\u2014200, 400 mg; injection\u201450 mg/mL Dosages Careful patient assessment and evaluation with continual monitoring of cardiac response are necessary for titrating the dosage. Therapy should begin in the hospital with continual monitoring and emergency equipment on standby. The following is a guide to usual dosage. ADULTS PO Loading dose: 800\u20131,600 mg/day PO in divided doses, for 1\u20133 wk; reduce dose to 600\u2013 800 mg/day in divided doses for 1 mo; if rhythm is stable, reduce dose to 400 mg/day in one to two divided doses for maintenance dose. Adjust to the lowest possible dose to limit side effects. IV nterventions \u2022 Monitor cardiac rhythm continuously. \u2022 Monitor for an extended period when dosage adjustments are made. \u2022 Monitor for safe and effective serum levels (0.5\u20132.5 mcg/mL). \u2022
Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when amiodarone is started. \u2022 Give drug with meals to decrease GI problems. \u2022 Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy. \u2022 Arrange for periodic chest x-ray to evaluate pulmonary status (every 3\u20136 mo). \u2022 Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels. Teaching points \u2022 Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of drug therapy; you will be closely monitored when dosage is changed. \u2022 Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam, blood tests. \u2022 These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or protective clothing when outdoors); constipation (a laxative may be ordered); tremors, twitching, dizziness, loss of coordination (do not drive, operate dangerous machinery, or undertake tasks that require coordination until drug effects stabilize and your body adjusts to it). \u2022 Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortness of breath, difficulty breathing, cough; swelling of ankles or fingers; palpitations; difficulty with vision.
Generic Name: Phenytoin Hydantoin Anticonvulsant Brand 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 effective against 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 Nursing Responsibilities: 32. Document indication for therapy, onset, characteristics of symptoms, other agents trialed, and outcome. Note history and nature of seizures, addressing location, frequency, duration, causes, and characteristics. Determine if hypersensitive to hydantoins or has exfoliative dermatitis. Consider frosphenytoin in those unable to tolerate phenytoin. Do not beast-feed following delivery. Monitor ECG, CBC, liver and renal function studies. May lower serum Mg, folate, calcium and Vitamin D. During IV administration, monitor for hypotension. May take food to minimize GI upset. Do not take antacids within 1 hr of ingestion. Do not chew or crush; take tablets whole. Use care when performing tasks that require mental alertness. Drug may cause drowsiness, dizziness and blurred vision.
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Do not take any other agents. Avoid alcohol in any form and CNS depressants. With diabetes, monitor FS and report changes; may have to adjust insulin dosage and or diet. May cause urine to appear pink, red, or brown; do not be alarmed. Practice good oral hygiene to minimize bleeding of gums and hyperplasia. 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. Complaints of weakness, ease of fatigue, headaches, or feeling faint may be signs of folic acid deficiency or megaloblastic anemia. Refer to dietitian. Report for lab studies as ordered, including CBC, drug levels, and renal and liver function results. If thyroid studies are conducted, for ensured accuracy, they should be repeated 10 days after therapy has been discontinued. Do not stop abruptly. Report all bothersome side effects because these may be doserelated.
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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 3rd dose of 12m may be needed Side effect: Transient lushin Chest pain or tightness Brief period of asystoel or bradycardia Hypotension Bronchospasm therefore should not be given to patient with case of asthma
Generic Name: Mannitol Osmotic Diuretic Brand Name/s: Resectisol, Osmitrol Action/ Kinetics: Increases the osmolarity of the glomerular filtrate, which decreases the reabsorption of water and increases excretion of sodium and chloride. It also increases the osmolarity of the plasma, which causes enhaced flow of water from tissues in the interstitial fluid and plasma. Thus, cerebral edema, increased ICP, and CSF volume and pressure are decreased. Indication/s: Diuretic to prevent or treat the oliguric phase of acute renal failure before irreversible 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 buildup during transurethral prostatic resection or other transurethral surgical procedures. Contraindications: Anuria, pulmonary edema, severe dehydration, active intracranial bleeding except during craniotomy, progressive heart failure or pulmonary congestion after mannitol therapy, progressive renal damage following mannitol therapy. Nursing Responsibilities: 47. 48. 49. 50. Document indications of therapy, type and onset of symptoms. List other medications prescribed to ensure none alter drug effects. Document neurologic findings 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. 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 by dyspnea, cyanosis, rales or frothy sputum.
D50 50 mL
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, causeing sympathomimetic 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 bronchial asthma. Postintubation and infectious croup. MicroNefrein is used for chronic obstructive lung disease, chronic bronchitis, broncheolitis, bronchial asthma, and other peripheral airway diseases.
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Injection: 1. Relieve respiratory distress in bronchial asthma, during acute asthma attacks, and for reversible bronchospasm in chronic bronchitis, emphysema, and other obstructive pulmonary diseases. 2. Severe acute anaphylactic reactions, including anaphylactic shock and cardiac arrest, to restore cardiac 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 (may discolor lenses). Aphakia. Lactation.
Nursing Responsibilities: 1. Briskly massage site of subcutaneous or intramuscular injection to hasten drug action. Do not expose 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 and pulse). 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.
Generic Name: Digoxin Cardiac Glycoside Brand Name/s: Digitek, Lanoxicaps, Lanoxin Action/ Kinetics: Digoxin increases the force and velocity of myocardial contraction (positive inotropic 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 then potentiate 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 the digitalizing 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. Control of rapid ventricular contraction rate in clients with atrial fibrillation or flutter. Slow heart rate in sinus tachycardia due to CHF. Supraventricular tachycardia. Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm. Cardiogenic shock (value not established).
14. 15. 16. 17.
18.
Contraindications: Ventricular fibrillation or tachycardia (unless congestive failure supervenes after 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. Nursing Responsibilities: 7. Obtain written parameters indicating the pulse rates, both high and low, at which cardiac glycosides are to be held; changes in rate or rhythm may indicate toxicity. 8. Protect from light.
9. Give IV injections over 5 minutes (or longer) either undiluted or diluted fourfold or greater with 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 drg¶s positive inotropic effect may increase cardiac outflow obstruction with hypertrophic cardiomyopathy. Obtain ECG; note rhythm/ rate. Elderly clients must be observed for early signs and symptoms of toxicity.
11. 12.
Hydrocortisome-hycortil Hydrocortisone 21-(sodium succinate)
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 Ophthalmic dexamethasone acetate IM, intra-articular, or soft-tissue injection: Cortastat LA, Dalalone L.A., Decaject LA, Dexasone-L.A., Dexone LA, Solurex LA dexamethasone sodium phosphate IV, 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 PregnancyCategoryC Drugclasses Corticosteroid Glucocorticoid Hormone Therapeuticactions Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects. Indications \u2022 Hypercalcemia associated with cancer \u2022 Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders \u2022 Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia \u2022 Trichinosis with neurologic or myocardial involvement \u2022 Ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas \u2022 Cerebral edema associated with brain tumor, craniotomy, or head injury \u2022 Testing adrenocortical hyperfunction \u2022 Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of Depression
Intra-articular or soft-tissue administration: Arthritis, psoriatic plaques \u2022 Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy \u2022 Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments \u2022 Dermatologic preparations: Relief of inflammatory and pruritic manifestations of dermatoses that are steroid-responsive \u2022 Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe Contraindicationsandcautions \u2022 Contraindicated with infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any component of the preparation used. \u2022 Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis with impending perforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF, hypertension, thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation. Availableforms Tablets\u20140.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir\u20140.5 mg/5 mL; oral solution\u20140.5 mg/5 mL; injection\u20148 mg/mL, 16 mg/mL, 4 mg/mL, 10 mg/mL, 20 mg/mL, 24 mg/mL; aerosol\u201484 mcg/actuation; ophthalmic solution\u20140.1%; ophthalmic suspension\u20140.1%; ophthalmic ointment\u20140.05%; topical ointment\u20140.05%; topical cream\u20140.05%, 0.1%; topical aerosol\u20140.01%, 0.04% Dosages ADULTS Systemic administration Individualize dosage based on severity of condition and response. Give daily dose before 9 AM to minimize adrenal suppression. If long-term therapy is needed, alternate-day therapy with a short-acting steroid should be considered. After long-term therapy, withdraw drug slowly to avoid adrenal insufficiency. For maintenance therapy, reduce initial dose in small increments at intervals until the lowest clinically satisfactory dose is reached. Oral (dexamethasone, oral) 0.75\u20139 mg/day. \u2022 Suppression tests for Cushing's syndrome: 1 mg at 11 PM; assay plasma cortisol at 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. \u2022 Suppression test to distinguish Cushing's syndrome due to ACTH excess from that
resulting from other causes: 2 mg q 6 hr for 48 hr. Collect 24-hr urine to determine 17-OH-corticosteroid excretion. IM (dexamethasone acetate) 8\u201316 mg; may repeat in 1\u20133 wk. Dexamethasone phosphate: 0.5\u20130.9 mg/day; usual dose range is one-third to one-half the oral dose. IV (dexamethasone sodium phosphate) Adverseeffects Adverse effects depend on dose, route, and duration of therapy. The first list is primarily associated with absorption; the list following is related to specific routes of administration. Systemic administration • CNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, cataracts, increased IOP, glaucoma • V a g z c F C , o i s n t r e p y H : • Endocrine: Growth retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state, secondary adrenocortical and pituitary unresponsiveness • GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention • GU: Amenorrhea, irregular menses • Hematologic: Fluid and electrolyte disturbances, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levels • Hypersensitivity: Anaphylactoid or hypersensitivity reactions • Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures • Other: 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 infections Intra-articular • Musculoskeletal: Osteonecrosis, tendon rupture, infection Intralesional therapy • CNS: Blindness (when used on face and head—rare) Respiratory inhalant
• Endocrine: Suppression of HPA function due to systemic absorption • Respiratory: Oral, laryngeal, pharyngeal irritation • Other: Fungal infections Intranasal • CNS:Headach e • Dermatologic:Urtic aria • Endocrine: Suppression of HPA function due to systemic absorption • GI:Nausea • Respiratory: Nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia Topical dermatologic ointments, creams, spraysInterventions • For systemic administration, do not give drug to nursing mothers; drug is secreted in 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 inhalant during 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; adrenal insufficiency deaths have occurred. • For topical dermatologic preparations, use caution when occlusive dressings, tight
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 points Systemic 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 tarry stools, fever, prolonged sore throat, colds or other infections, worsening of this disorder. Intra-articular administration • Do 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 product when using both. • Administer decongestant nose drops first if nasal passages are blocked. T o p c i a l • 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. Warm tube of ointment in hand for several minutes. Apply one-fourth to one-half inch of ointment, or drop suspension inside lower eyelid while looking up. After applying ointment, close eyelids and roll eyeball in all directions. After instilling eye drops, release lower lid, but do not blink for at least 30 sec; apply gentle pressure to the inside corner of the eye for 1 min. Do not close eyes tightly, and try not to blink more often than usual; do not touch ointment tube or dropper to eye, fingers, or any surface. • Wait at least 10 min before using any other eye preparations. • Eyes will become more sensitive to light (use sunglasses). •
Report worsening of the condition, pain, itching, swelling of the eye, failure of the condition to improve after 1 w
Generic Name: Sodium Bicarbonate Alkalinizing agent, Antacid, Electrolyte
Brand Name/s: Neut, Soda Mint Action/ Kinetics: The antacid action is due to neutralization of hydro chloric acid by forming sodium chloride and carbon 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 urinary alkalinizer by increasing plasma and urinary bicarbonate. Indication/s: 19. 20. 21. 22. Treatment of hyperacidity Severe diarrhea (where there is oss of bicarbonate) Alkalization of the urine to treat drug toxicity 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. Prophylaxis of renal calculi in gout. During sulfonamide therapy to prevent renal calculi and nephrotoxicity. 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.
23. 24. 25.
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 alkalosis may 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. Nursing Responsibilities: 13. 14. Note indications for therapy and any history of renal impairment or CHF. If on low continuous or intermittent NG suctioning or vomiting, assess for evidence of excessive chloride loss. Record I&O. Observe for dry skin and mucous membranes, polydipsia, polyuria, and air hunger; may indicate a reversal of metabolic acidosis. With acidosis, assess for the relief of dyspnea and hyperpnea.
15.
16.
If prescribed to counteract metabolic acidosis, monitor electrolytes and ABG¶s. test urine periodically with nitrazine paper to determine if becoming alkaline. Chew tablets thoroughly and take only as prescribed. Follow with a full glass of water. If routinely taking excessive PO preparations of sodium bicarbonate to relieve gastric distress, 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. Continuous, routine ingestion of sodium bicarbonate may cause formation of phosphate crystals in the kidney and fluid retention. Consuming sodium bicarbonate with milk or calcium may result in a milk- alkali syndrome. Report immediately if anorexia, N&V, or mental confusion occurs. Avoid OTC preparations that contain sodium bicarbonate, such as Alka/ Bromo- Selter, Gaviscon, or Fizrin.
17. 18.
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Generic Name: Aminophylline Antiasthmatic, Bronchodilator Brand Name/s: Endure Medical Aminophylline, Phil Pharmawealth/ Atlantic Aminophylline
Action/ Kinetics: Relaxes bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has 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 status asthmaticus. 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 immediaterelease, liquid dosage forms with food if GI effects occur. y Do not give timed-release forms with 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 theophylline levels carefully, and arrange for reduced dosage if serum levels exceed therapeutic range of 10±20 mcg/mL. y Take serum samples to determine peak theophylline concentration drawn 15±30 min after an IV loading dose. y Monitor for clinical signs of adverse effects, particularly if serum theophylline levels are not available. y Take this drug exactly as prescribed; if a timed-release product is prescribed, take this 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 may be necessary to take this drug around the clock for adequate control of asthma attacks. y Avoid excessive 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 to monitor the effect of this drug and to ensure safe and effective dosage; keep all appointments for blood tests and other monitoring. y These side effects 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
(reversible). y Report nausea, vomiting, severe GI pain, restlessness, seizures, irregular heartbeat.
Nicardepine HCL- Cardepine screenshot
Generic Name: Dopamine Hydrochloride Sympathomimetic, direct- and indirect-acting Brand Name/s: Intropin
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 stroke volume, 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 initiation of dopamine and volume correction. Contraindications: Pheochromocytoma, uncorrected tachycardia, ventricular fibrillation, or arrhythmias. Pediatric clients. Nursing Responsibilities: 26. 27. To prevent fluid overload, may use more concentrated solutions with higher doses. When discontinuing, gradually decrease dose; sudden cessation may cause marked hypotension. Note indications for therapy; ensure adequate hydration prior to infusion. Monitor vital signs, I&O, and ECG; titrate infusion to maintain systolic BP as ordered. Be prepared to monitor central venous pressure and pulmonary artery wedge pressure. Report ectopy, palpitations, angina pain, or vasoconstriction. Report any chest pain, increased shortness of breath, headaches, or IV site pain.
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amiodarone hydrochloride (a meeo' da rone) Cordarone, Pacerone
PregnancyCategoryD Drugclasses Antiarrhythmic Adrenergic blocker (not used as sympatholytic agent) Therapeuticactions Type III antiarrhythmic: Acts directly on cardiac cell membrane; prolongs repolarization and refractory period; increases ventricular fibrillation threshold; acts on peripheral smooth muscle to decrease peripheral resistance Indications \u2022 Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias that do not respond to other antiarrhythmics or when alternative agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug. \u2022 Unlabeleduses:Treatmentofrefractorysustainedorparoxysmalatrialfibrilation andparoxysmalsupraventriculartachycardia;treatmentof symptomaticatrial flutter . Contraindicationsandcautions \u2022 Contraindicated with hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation. \u2022 Use cautiously with thyroid dysfunction, pregnancy. Availableforms Tablets\u2014200, 400 mg; injection\u201450 mg/mL Dosages Careful patient assessment and evaluation with continual monitoring of cardiac response are necessary for titrating the dosage. Therapy should begin in the hospital with continual monitoring and emergency equipment on standby. The following is a guide to usual dosage. ADULTS PO Loading dose: 800\u20131,600 mg/day PO in divided doses, for 1\u20133 wk; reduce dose to 600\u2013 800 mg/day in divided doses for 1 mo; if rhythm is stable, reduce dose to 400 mg/day in one to two divided doses for maintenance dose. Adjust to the lowest possible dose to limit side effects. IV nterventions \u2022 Monitor cardiac rhythm continuously. \u2022 Monitor for an extended period when dosage adjustments are made. \u2022 Monitor for safe and effective serum levels (0.5\u20132.5 mcg/mL). \u2022
Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when amiodarone is started. \u2022 Give drug with meals to decrease GI problems. \u2022 Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy. \u2022 Arrange for periodic chest x-ray to evaluate pulmonary status (every 3\u20136 mo). \u2022 Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels. Teaching points \u2022 Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of drug therapy; you will be closely monitored when dosage is changed. \u2022 Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye exam, blood tests. \u2022 These side effects may occur: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or protective clothing when outdoors); constipation (a laxative may be ordered); tremors, twitching, dizziness, loss of coordination (do not drive, operate dangerous machinery, or undertake tasks that require coordination until drug effects stabilize and your body adjusts to it). \u2022 Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortness of breath, difficulty breathing, cough; swelling of ankles or fingers; palpitations; difficulty with vision.
Generic Name: Phenytoin Hydantoin Anticonvulsant Brand 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 effective against 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 Nursing Responsibilities: 32. Document indication for therapy, onset, characteristics of symptoms, other agents trialed, and outcome. Note history and nature of seizures, addressing location, frequency, duration, causes, and characteristics. Determine if hypersensitive to hydantoins or has exfoliative dermatitis. Consider frosphenytoin in those unable to tolerate phenytoin. Do not beast-feed following delivery. Monitor ECG, CBC, liver and renal function studies. May lower serum Mg, folate, calcium and Vitamin D. During IV administration, monitor for hypotension. May take food to minimize GI upset. Do not take antacids within 1 hr of ingestion. Do not chew or crush; take tablets whole. Use care when performing tasks that require mental alertness. Drug may cause drowsiness, dizziness and blurred vision.
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34.
35.
36. 37.
38.
39. 40.
Do not take any other agents. Avoid alcohol in any form and CNS depressants. With diabetes, monitor FS and report changes; may have to adjust insulin dosage and or diet. May cause urine to appear pink, red, or brown; do not be alarmed. Practice good oral hygiene to minimize bleeding of gums and hyperplasia. 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. Complaints of weakness, ease of fatigue, headaches, or feeling faint may be signs of folic acid deficiency or megaloblastic anemia. Refer to dietitian. Report for lab studies as ordered, including CBC, drug levels, and renal and liver function results. If thyroid studies are conducted, for ensured accuracy, they should be repeated 10 days after therapy has been discontinued. Do not stop abruptly. Report all bothersome side effects because these may be doserelated.
41. 42. 43.
44.
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46.
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 3rd dose of 12m may be needed Side effect: Transient lushin Chest pain or tightness Brief period of asystoel or bradycardia Hypotension Bronchospasm therefore should not be given to patient with case of asthma
Generic Name: Mannitol Osmotic Diuretic Brand Name/s: Resectisol, Osmitrol Action/ Kinetics: Increases the osmolarity of the glomerular filtrate, which decreases the reabsorption of water and increases excretion of sodium and chloride. It also increases the osmolarity of the plasma, which causes enhaced flow of water from tissues in the interstitial fluid and plasma. Thus, cerebral edema, increased ICP, and CSF volume and pressure are decreased. Indication/s: Diuretic to prevent or treat the oliguric phase of acute renal failure before irreversible 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 buildup during transurethral prostatic resection or other transurethral surgical procedures. Contraindications: Anuria, pulmonary edema, severe dehydration, active intracranial bleeding except during craniotomy, progressive heart failure or pulmonary congestion after mannitol therapy, progressive renal damage following mannitol therapy. Nursing Responsibilities: 47. 48. 49. 50. Document indications of therapy, type and onset of symptoms. List other medications prescribed to ensure none alter drug effects. Document neurologic findings 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. Assess for S&S of electrolyte imbalances and dehydration; replace as needed. If renal
51.
failure or oliguria present, perform test dose. 52. Monitor VS and I&O. slow infusion and report S&S of pulmonary edema manifested by dyspnea, cyanosis, rales or frothy sputum.
D50 50 mL
