Albuterol Sulfate (salbutamol) Classification: Bronchodilators Action: Relaxes Bronchial, Uterine, And

ALBUTEROL SULFATE (SALBUTAMOL) CLASSIFICATION: Bronchodilators ACTION: Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta2 receptors INDICATIONS: To prevent or treat bronchospasm in patients w/ reversible obstructive airway disease. CONTRAINDICATIONS: Use cautiously in patients w/ CV disorders, hyperthyroidism, or diabetes mellitus and in those who are unusually responsive to adrenergics. ADVERSE EFFECT: tremor, nervousness, dizziness, insomnia, headache, hyperactivity, weakness, CNS, stimulation, malaise. NURSING CONSIDERATIONS: Drug may decrease sensitivity of spirometry used for diagnosis of asthma. > when switching patient from regular to extended – release tablet, remember that a regular 2mg – tablet every 6 hrs is equivalent to an extended – release 4mg tablet every 12hrs. STOCK: Capsule for inhalation 200mcg Injection 1mg/1ml ALLOPURINOL (ALOPRIM, PURINOL) CLASSIFICATION: Antigout drug ACTION: Inhibits the enzyme responsible for the conversion of purines to uric acid thus reducing the production of uric acid w/ a decrease in serum and sometimes in urinary uric acid levels, relieving the signs & symptoms of gout. INDICATIONS: Management of patients w/ malignancies that result in evaluations of serum and urinary uric acid. CONTRAINDICATIONS: Contraindicated w/ allergy to allapurinol blood dyscrasias ADVERSE EFFECT: GI – nausea, vomiting, diarrhea, abdominal pain, cholestatic & jaundice. NURSING CONSIDERATIONS: Monitor fluid I & O daily, urine output at least 2L & maintenance of neutral or slightly alkaline urine are desirable > monitor uric acid level at evaluate drugs effectiveness STOCK: 100, 300mg, powder for injection – 500mg

ALPRAZOLAM (XANAX) CLASSIFICATION: Anxiolytics ACTION: Unknown. A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity INDICATIONS: Anxiety, panic disorders CONTRAINDICATIONS: Use cautiously in pts. w/ hepatic, renal and pulmonary disease. ADVERSE EFFECT: drowsiness, light-headedness, seduction, somnolence, hot flushes, chest pain, hypotension, diarrhea, vomiting, dyspepsia, nausea NURSING CONSIDERATIONS: Monitor hepatic, renal, and hematopoietic function periodically in pts. receiving repeated or prolonged therapy STOCK: Oral solution: 1mg/ml Tablets: 0.25mg, 0.5mg, 1mg, 2mg

AMIKACIN SULFATE (AMIKIN)

CLASSIFICATION: Aminoglycosides ACTION: Inhibits protein synthesis by binding directly to the 30S ribosomal, subunit; bactericidal INDICATIONS: Serious infections cause by sensitive strains of pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, or Staphylococcus CONTRAINDICATIONS: Contraindicated in patient hypersensitive to drugs or other aminoglycosides. > use cautiously in patients with impaired renal function or neuromuscular disorders, in neonates & infants, and in elderly patients. ADVERSE EFFECT: Neuromuscular blockade, apnea NURSING CONSIDERATIONS: Watch for signs and symptoms of super infection (especially of upper respiratory tract), such as continued fever, chills, and increased pulse rate. STOCK: INJECTION: 50mg/ml (pedia) 250mg/ml, 5mg/ml (500mg) in normal saline solution

AMOXICILLIN TRIHYDRATE (ALPHAMOX) CLASSIFICATION: PENICILLINS ACTION: Inhibits cell-wall synthesis during bacterial multiplication INDICATIONS: Mild to moderate infections of the ear, nose, & throat, skin and skin structure, or genitourinary tract. CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug or other penicillins > use cautiously in pts. w/ other drug allergies (especially to cephalosporins) bec. of possible cross-sensitivity. ADVERSE EFFECT: Lethargy, hallucinations, seizures, anxiety, confusion, agitation, depression, dizziness, fatigue. NURSING CONSIDERATIONS: Before giving ask patient about allergic rxns to penicillin. > Amoxicillin usually causes fewer cases of diarrhea than does ampicillin. STOCK: Capsules: 250mg, 500mg. Oral Suspension: 50mg/ml (pedia), 125mg/5ml, 200mg/5ml, 250mg/5ml, 400mg/5ml (after reconstitution) Vials: 1,000,000 iu, 5,000,000 iu - penicillins

AMPICILLIN (PENBRITIN, PRINCIPEN) CLASSIFICATION: PENICILLINS ACTION: Inhibits cell-wall synthesis during bacterial multiplication INDICATIONS: Respiratory tract or skin and skin structure infections CONTRAINDICATIONS: Give dry I.M. or I.V. only if prescribed and the infection is severe or if patient can’t take oral dose. > To prevent bacterial endocarditis in pts. At high risk, give drug w/ gentamicin ADVERSE EFFECT: Nausea, vomiting, diarrhea, glossitis, stomatitis, gastritis, abdominal pain, enterocolitis, pseudomembranocolitis, black hairy tongue. NURSING CONSIDERATIONS: Give drug 1-2 hours before or 23° p meals. When given orally, drug may cause GI disturbances. Food may interfere with absorption. STOCK: Capsules: 250mg, 500mg Injection: 250mg, 500mg, 1g, 2g Oral Suspension: 125mg/5ml, 250mg/5ml

ASPIRIN (Bayer) CLASSIFICATION: Antipyretic, Analgesic

ACTION: Analgesic and antirheumatic effects are attributable to aspirins ability to inhibit the synthesis of prostaglandins, impt. med’s of inflammation INDICATIONS: Mild to moderate pain, fever, MI prophylaxis, inflammatory conditions – rheumatic fever, rheumatoid, arthritis, osteothritis CONTRAINDICATIONS: Use cautiously in patients w/ GI lesions, impaired renal function hypoprothrombinemia, vit. K deficiency thrombocytopenia, thrombotic, thrombocytopenic ADVERSE EFFECT: Acute aspirin toxicity, aspirin intolerance, nausea, dyspepsia, heartburn NURSING CONSIDERATIONS: w/ pt. w/ swallowing difficulties, crush non enteric-coated aspirin and dissolve in soft food or liquid. > febrile dehydrated children can develop toxicity rapidly. STOCK: Suppositories – 120mg, 200mg Tablets – 325mg, 500mg ATENOLOL (APO-ATENOLOL, GEN-ATENOLOL, TENORMIN) CLASSIFICATION: Betal selective adrenergic blocker, Antianginal ACTION: Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus thus increasing the excitability of the heart INDICATIONS: Treatment of angima pectoris due to coronary atherosclerosis CONTRAINDICATIONS: Contraindicated w/ bradycardia, second or third degree heart block, cardiogenic shock, CHF, pregnancy ADVERSE EFFECT: Gastric pain, flatulence, constipation, nausea, vomiting, anorexia, ischemic colitis NURSING CONSIDERATIONS: Do not discontinue drug abruptly after long-term therapy STOCK: tablets – 25, 50, 100

ATROPINE SULFATE (SAL – TROPINE) CLASSIFICATION: Anti-arrythmics ACTION: An anticholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes, thereby enhancing conduction through the AV Nodes and increasing the heart rate. INDICATIONS: Symptomatic bradycardia, bradyarhytmia (junctional or escape rhythm) CONTRAINDICATIONS: Contraindicated in those w/ acute glaucoma, obstructive uropathy, obstructive dse. of G.I. tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, tachycardia, myocardial ischemia, asthma, or myasthenia gravis. ADVERSE EFFECT: Headaches, restlessness, ataxia, disorientation, hallucinations, delirium, insomnia, dizziness, excitement, agitation, confusion. NURSING CONSIDERATIONS: Many adverse rxn (such as dry mouth and constipation) vary with the dose. > Monitor fluid intake and urine output. Drug causes urine retention and urinary hesitancy. STOCK: INJECTION: 0.05mg/ml, 0.1mg/ml, 0.3mg/ml, 0.4mg/ml, 0.5mg/ml, 0.8mg/ml, 1mg/ml TABLETS: 0.4mg CIMETIDINE (TAGAMENT) CLASSIFICATION: Anti-ulcer drugs ACTION: Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion.

INDICATIONS: To prevent upper GI bleeding in critically ill patients. CONTRAINDICATIONS: Use cautiously in elderly or debilitated patients because they may be more susceptible to crimetidine – induced confusion. ADVERSE EFFECT: Confusion, dizziness, headache, peripheral neuropathy, somnolence, hallucinations. NURSING CONSIDERATIONS: Assess pt. for abdominal pain. Note blood in emesis, stool, or gastric aspirate. STOCK: Injection: 300mg/2ml, 300mg in 50ml normal saline solution, 300mg/2ml ADD-vantage-vial Tablets: 100mg, 200mg, 300mg, 400mg, 800mg CEFTRIAXONE SODIUM (ROCEPHIN) CLASSIFICATION: Anti-infectiveness ACTION: Third-generation cephalosporins that inhibits cell-wall synthesis, promoting osmotic instability, usually bactericidal. INDICATIONS: Pharyngitis, tonsillitis, infection of the urinary and lower respiratory tracts, and skin and skin structure infection caused by streptococcus pneumoniae and spyogenes, haemophilis influenzae, staphylococcus aureus, Escherichia coli, moravella contarrhalis, neisseria CONTRAINDICATIONS: Use cautiously in pts., hypersensitive to penicillin because of possibility, usually bactericidal ADVERSE EFFECT: Fever, headache, dizziness, phlebitis, genital pruritus, candidiasis. NURSING CONSIDERATIONS: Cefuroxime axely tablets maybe crushed, if absolutely necessary, for pt. who can’t swallow tablets, tablets maybe dissolved in small amounts of apple, orange, or grape juice or chocolate milk. STOCK: Injection: 250mg, 500mg, 1g, 2g CEFUROXIME (ZINACEF) CLASSIFICATION: Anti-infectives ACTION: Second generation cephalosporins that inhibits cell-wall synthesis, promoting osmotic instability, usually bactericidal INDICATIONS: Serious lower respiratory tract infections, UTI’s skin and skin – structure infections, bone and joint infections, septicemia, meningitis and gonorrhea CONTRAINDICATIONS: Use cautiously in patients hypersensitive to penicillin because of possibility of crosssensitivity w/ other beta-lactam antibiotics. ADVERSE EFFECT: Phlebitis, thromboplebitis, nausea, anorexia, vomiting, diarrhea, anemia, rashes NURSING CONSIDERATIONS: For IM administration, inject deep into a large muscle, such as the gluteus maximus or the lateral aspect of the thigh >Before administration, ask patient if he is allergic to penicillins. STOCK: Suspension: 125mg/5ml, 250mg/5ml Tablets: 125mg, 250g, 500mg Vials: 250mg, 750mg, 1.5 gms

CLONAZEPAM (KLONOPIN) CLASSIFICATION: Anti-convulsants ACTION: Unknown. A benzodiazepine that probably acts by facilitating the effects of the inhibitory neurotransmitter GABA. INDICATIONS: Lennox – Gastraut Syndrome, atypical absence seizures, akinetic and myoclonic seizures. CONTRAINDICATIONS: Use cautiously in children and in patients w/ chronic respiratory disease or open angle glaucoma.

ADVERSE EFFECT: Drowsiness, ataxia, behavioral disturbances, depression, palpitations, nystagmus, abnormal eye movements, dysuria, nocturia, diarrhea NURSING CONSIDERATIONS: Monitor pt. for oversedation > Monitor CBC and liver functions test. STOCK: Tablets: 0.rmg, 1mg, 2mg DIAZEPAM (ANXIONIL OR VALIUM) CLASSIFICATION: Central Nervous system drugs, Anxiolytics ACTION: Unknown. A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity. INDICATIONS: Anxiety, acute alcohol withdrawal, muscle spasm, cardioversion, adjunct treatment for seizure disorders. CONTRAINDICATIONS: Contraindicated in pts. hypersensitive to drugs or soy protein, in pts. experiencing shock, coma or acute alcohol intoxication, (parenteral form) in pregnant woman, especially in 1st trimester and in children younger than age 6 mos. ADVERSE EFFECT: Drowsiness, dysathria, slurred speech, tremor, transient, amnesia, fatigue, ataxia, headache, insomnia, paradoximal, anxiety, hallucinations, minor changes in EEG patterns. NURSING CONSIDERATIONS: Use distat rectal gel to treat no more than five episodes/mos. and no more than one episode every 5 days bec. tolerance may develop. STOCK: Capsules: 15mg Injection: 5mg/ml Tablets: 2mg/5mg, 10mg DEXAMETHASONE (MEXADROL) CLASSIFICATION: Corticosteroids, hormonal drugs ACTION: Decreased inflammatory, mainly by stabilizing leukocyte lysosomal membranes, suppresses immune system response, stimulates bone marrow, air influence protein, fat, and carbohydrate metabolism INDICATIONS: Cerebral edema, dexamethasone suppression test for cushing’s syndrome, shock, inflammatory conditions, allergic reactions neoplasia CONTRAINDICATIONS: Use cautiously in pts. w/ ulcer, seizure, heart failure, psychotic tendencies, hepatitis, seizures, lactation, myasthenia ADVERSE EFFECT: heart failure, cataracts, glaucoma, hypertension, edema, paresthesia NURSING CONSIDERATIONS: Monitor patients weight, blood pressure, and electrolyte levels. > Diabetic pt. may need increased insulin, monitor glucose levels STOCK: Elixir: 0.5mg/5ml Tablets: 0.25mg, 0.5mg. Amp: 5mg/ml Vial: 4mg/ml

DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL) CLASSIFICATION: Antihistamines ACTION: Competes w/ histamine for H1 – receptor sites on effector cells. Prevents but doesn’t reverse, histamine – mediated responses particularly those of the smooth muscle of the bronchial tubes, GI tract, uterus, and blood vessels. Structurally related to local anesthetics, di phenhydramine provides local anesthesia and suppresses cough reflex. INDICATIONS: Rhinitis, allergy symptoms, motion sickness, parkinson’s disease > Sedation, nighttime sleep aid, non productive cough

CONTRAINDICATIONS: Use with caution in patients w/ prostatic hyperplasia, asthma, COPD, increased intraocular pressure, hyperthyroidism, CV disease, and hypertension. ADVERSE EFFECT: Drowsiness, confusion, insomnia, headache, vertigo, sensation, sleepiness, dizziness, incoordination, fatigue, restlessness, tremor, nervousness, seizures. NURSING CONSIDERATIONS: Stop drug 4 days before diagnostic skin testing because antihistamines can prevent, reduce, or mask positive skin test response. STOCK: Capsules: 25mg Elixir: 12.5mg/5ml Injection: 10mg/ml EPINEPRINE (ADRENALINE) CLASSIFICATION: Bronchodilators ACTION: Relaxes bronchial smooth muscle by stimulating beta2 receptors and alpha and beta receptors in the sympathetic nervous system. INDICATIONS: Bronchospasm, hypersensitivity, rxn’s anaphylaxis, acute asthma attacks CONTRAINDICATIONS: Contraindicated in pts. w/ angle closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis, ADVERSE EFFECT: Nervousness, trmor, vertigo, pain, fear, dizziness, headache, disorientation, agitation, drowsiness, weakness, cerebral hemorrhage, CVA. NURSING CONSIDERATIONS: Epinephrine is drug of choice in emergency treatment of acute anaphylactic rxns. STOCK: Aerosol inhaler: 160mcg, 200mcg, 220mcg Nebulizer inhaler: 1%

FENTANYL CITRATE (SUBLIMAZE) CLASSIFICATION: Opioid Analgesics ACTION: Binds with opiate receptors in the CNS, altering perception of and emotional response to pain INDICATIONS: Adjunct to general anesthetic > To manage chronic pain CONTRAINDICATIONS: Don’t give transdermal fentanyl to patients younger than age 12 or those younger than age 18 who weightless than 110lls (50kg) or those for postoperative pain. ADVERSE EFFECT: Sedation, somnolence, clouded, sensorium, euphoria, dizziness, headache, confusion, asthenia, chest pain. NURSING CONSIDERATIONS: Monitor circulatory and respiratory status and urinary function carefully. Drug may cause respiratory depression, hypotension, urine retention, nausea, vomiting ileus, or altered level of consciousness no matter how it is given. STOCK: Injection: 50mcg/ml Transmucocal: 200mcg, 400mcg, 600mcg, 88mcg, 1,200mcg, 1,600mcg GENTAMICIN SULFATE (CIDOMYCIN, GARAMYCIN) CLASSIFICATION: Aminoglycosides ACTION: Inhibits protein synthesis by binding directly to the 30s ribosomal subunit, bactericidal. INDICATIONS: Serious infections caused by sensitive strains of pseudomonas aeruginosa, eschericia coli, proteus, klebsiella, or staphylococcus CONTRAINDICATIONS: Used cautiously in pts. hypersensitive to drugs, use cautiously in neonates, infants, elderly patients w/ impaired renal function or neuromuscular disorders.

ADVERSE EFFECT: Fever, headache, lethargy, encephalopathy, confusion, dizziness, seizures, numbness, peripheral neuropathy, vertigo, ataxia, tingling. NURSING CONSIDERATIONS: Weight patient & review renal function studies before therapy begins. STOCK: Injection: 40mg/ml, 10mg/ml I.V Infusion: 40mg, 60mg, 70mg, 80mg, 90mg, 100mg, 120mg, in normal saline solution. GUAIFENESIN (ROBITUSSIN) CLASSIFICATION: Expectorant ACTION: Enhances the output of respiratory tract fluid by reducing adhesiveness and surface tension, facilitating the removal of viscous mucus. INDICATIONS: Symptomatic relief of respiratory conditions characterized by dry, nonproductive cough and when there is mucus in the respiratory tract. CONTRAINDICATIONS: Contraindicated w/ allergy to guaifenesin, use cautiously w/ pregnancy, lactation & persistent cough. ADVERSE EFFECT: GI: nausea w/ pregnancy, lactation & vomiting, GI discomfort. NURSING CONSIDERATIONS: Monitor rxn to drug persistent cough for longer than 1 wk., fever, rash/persistent headache may indicate a more serious conditions. STOCK: Syrup: 100mg/5ml Tablets: 100, 200, 400mg

HYDROCORTISONE (AQUACORT) CLASSIFICATION: Hormonal Drugs, Corticosteroids ACTION: Decreased inflammation, mainly by stabilizing leukocyte, lysomal membranes, suppresses immune response, stimulates bone marrow, and influences protein, fat & carbohydrate metabolism. INDICATIONS: Severe inflammation, adrenal insufficiency shock, adjunct treatment for ulcerative colitis proctitis. CONTRAINDICATIONS: used cautiously in pts. w/ G.I ulcer, renal dse., hypertension, osteoporosis, diabetes mellitus, hypothyroidism, cirrhosis, diverticulitis, non-specific ulcerative, colitis, psychotic tendencies. ADVERSE EFFECT: Heart failure, hypertension, edema, glaucoma, easy bruising, skin eruptions, dizziness, lethargy, depression, anorexia. NURSING CONSIDERATIONS: Determine whether pt. is sensitive to other corticosteroids. STOCK: Tablets: 5mg, 10mg, 20mg Oral suspension: 2mg/ml

HYDRALAZINE HYDROCHLORIDE (ALPHAPRESS) CLASSIFICATION: Antihypertensives ACTION: Unknown. A direct – acting vasodilator that relaxes arteriolar smooth muscle. INDICATIONS: Essential hypertension (orally, alone w/ other antihypertensives), severe essential hypertension (parenterally, to lower blood pressure quickly). CONTRAINDICATIONS: Contraindicated in those w/ coronary artery disease or mitral valuular rheumatic heart dse. ADVERSE EFFECT: rash, tachycardia, nasal congestion, nausea, vomiting, diarrhea, anorexia, constipation. NURSING CONSIDERATIONS: Monitor pts. blood pressure, pulse rate, and body weight frequently, hydralazine may be given w/ diuretics and beta blockers to decrease sodium retention and tachycardia and to prevent angina attacks.

STOCK: Injection: 20mg/ml Tablets: 10mg, 25mg, 50mg, 100mg HYDROCORTISONE (CORTEF) CLASSIFICATION: Corticosteriods ACTION: Decreased inflammation, mainly by stabilizing leukocyte, lysosomal membranes, suppress immune response, stimulates bone marrow, and influences protein, fat & carbohydrate metabolism. INDICATIONS: Severe inflammation, adrenal insufficiency shock, adjunct treatment for ulcerative colitis and proctitis. CONTRAINDICATIONS: Use cautiously in patients w/ GI ulcer renal dse., hypertension, osteoporosis, diabetes mellitus, hypothyroidism, cirrhosis, diverticulitis, nonspecific ulcerative colitis, active hepatitis, lactation, recent intestinal anastomoses, thomboembolic disorders, seizures, myasthenia, gravis, heart failure, tuberculosis, ocular herpes simplex, emotional instability, and psychotic tendencies. ADVERSE EFFECT: Euphoria, insomnia, psychotic behavior, heart failure, pancreatitis, hypoglycemia. NURSING CONSIDERATIONS: For better results and less toxicity, give a once-daily dose in morning. > Inspect patient’s skin for petechiae. STOCK: Injection: 25mg/ml, 50mg/ml suspension KETOPROFEN (RHOVAIL) CLASSIFICATION: NSAIP, Non opioid analgesic ACTION: Anti-inflammatory & analgesic activity, inhibits prostaglandin & leukotriene, synthesis & has anti-bradykinin & lysosomal membrane stabilizing others action. INDICATIONS: Relief of mild to moderate pain, treatment of dysmenorrheal, reduction of fever (OTC indication), temporary relief of minor aches & pains. CONTRAINDICATIONS: w/ significant renal impairment, pregnancy, lactation, allergy to ketoprofen, aspirin. ADVERSE EFFECT: GI: nausea, dyspepsia, pain, diarrhea, vomiting, flatulence, constipation NURSING CONSIDERATIONS: Administer drug w/ food / after meals if GI upsent occurs. STOCK: Tablets: 12.5mg Capsules: 25-50

MEPERIDINE HYDROCHLORIDE (DEMEROL) CLASSIFICATION: Opiod Analgesics ACTION: Unknown. Binds w/ opiate receptors in the CNS, altering perception of and emotional response to pain. INDICATIONS: Moderate to severe pain, preoperative analgesia. CONTRAINDICATIONS: Contraindicated in pts. hypersensitive to drug and in those who have received MAO inhibitors w/in 14days. ADVERSE EFFECT: Physical dependence, sedation, somnolence, clouded, sensorium, euphoria, paradoximal anxiety, tremor, dizziness, seizures, headache, hallucinations, syncope, lightheadedness. NURSING CONSIDERATIONS: Active metabolite of meperidine may accumulate in pts. w/ renal dysfunction, causing increased adverse CNS rxn’s.

STOCK: Injection: 10mg/ml, 25mg/ml, 50mg/ml, 75mg/ml, 100mg/ml Syrup: 50mg/5ml Tablets: 500mg, 1000mg

METHYLERGONOVINE MALEATE (METHERGINE) CLASSIFICATION: Oxytocics ACTION: Increase motor activity of the uterus by direct stimulation of the smooth muscle, shortening the 3rd stage of labor, and reducing blood loss INDICATIONS: To prevent and treat postpartum hemorrhage caused by uterine atony or subinuolution. CONTRAINDICATIONS: Use cautiously in pts. w/ sepsis, oblilerative vascular dse. or hepatic or or renal dse. ADVERSE EFFECT: Dizziness, headache, hypertension, transient chest pain, leg cramps, dyspnea, diaphoresis. NURSING CONSIDERATIONS: Monitor and record blood pressure, pulse rate and uterine response, report, sudden change in vital signs, frequent periods of uterine relaxation, and character and amount of vaginal bleeding. STOCK: Injection: 0.2mg/ml Tablets: 0.2mg

MIDAZOLAM HYDROCHLORIDE (HYPNOVEL) CLASSIFICATION: Anxiolytics ACTION: Unknown. A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity. INDICATIONS: To induce sleepiness and amnesia and to relieve apprehension before anesthesia, or before and during procedures in children. CONTRAINDICATIONS: Use cautiously in pts. w/ uncompensated acute illness and in elderly or depiliated pts. ADVERSE EFFECT: CNS: headache, amnesia, drowsiness, excitement. GI: nausea, vomiting, apnea, hiccups NURSING CONSIDERATIONS: Monitor blood pressure, heart rate and rhythm, respirations, airway integrity, and arterial oxygen saturation during procedure. STOCK: Injection: 1mg/ml, 5m/ml Syrup: 2mg/ml

METOCLOPRAMIDE HYDROCHLORIDE (PLASIL) CLASSIFICATION: Antiemetics ACTION: Stimulates motility of upper GI tract, increases lower esophageal sphincter tone, and blocks dopamine receptors at the chestmoreceptor trigger zone. INDICATIONS: To prevent or reduce nausea and vomiting from anetogenic cancer chestmotherapy CONTRAINDICATIONS: Use cautiously in pts. w/ history of depression, parkinson’s dse. or hypertension. ADVERSE EFFECT: restlessness, anxiety, drowsiness, fatigue, lassitude, fever, depression, hallucination, headache, nausea, bowel disorders, diarrhea, rash, urticaria. NURSING CONSIDERATIONS: Monitor bowel sounds > When oral sol. Is used dilute in pudding, apple sauce just before using. STOCK: Injection: 5mg/ml Syrup: 5mg/5ml, 10mg/ml Tablets: 5mg, 10mg

METRONIDAZOLE

(NIDAZOL, PROTOSTAT) CLASSIFICATION: Amebicides and Antiprotozoals ACTION: Direct – acting trichomonacide and amebicide that works inside and outside the intestines. It’s thought to enter the cells of microorganisms that contain nitroreductase, forming unstable compounds that bind to DNA and inhibit synthesis, causing cell death. INDICATIONS: Amebic liver abscess, intestinal amebiasis, trichomoniasis. CONTRAINDICATIONS: Use cautiously in breast-feeding patients, its unknown if drug appears in breast milk. ADVERSE EFFECT: Fever, vertigo, headache, ataxia, dizziness, syncope, incoordination, confusion, irritability, sinusitis, nausea, vomiting, anorexia, diarrhea. NURSING CONSIDERATIONS: Give oral form w/ meals. > Record no. and character of stools when drug is used to treat amebiasis. Give metronidazole only after trichomonas vaginalis infection is confirmed by wet smear or culture or entameba hystolictica is identified. STOCK: Capsules: 375 mg. Injection: 500mg/100ml ready to use minibags

MANNITOL (OSMITROL) CLASSIFICATION: Diuretics ACTION: Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes, drug elevates plasma osmolality, increasing water flow into extracellular fluid. INDICATIONS: To prevent oliguria or acute renal failure > To reduce intraocular or intracranial pressure CONTRAINDICATIONS: Contraindicated in pts. w/ anuria, severe pulmonary congestion, frank pulmonary edema, severe heart failure, severe dehydration, metabolic edema, progressive renal dses. Or dysfunction, or active intracranial pressure. ADVERSE EFFECT: Seizures, dizziness, headache, fever, edema, blurred vision, rhinitis, nausea, vomiting. NURSING CONSIDERATIONS: Monitor vital signs, including central venous pressure and fluid intake and output hourly. Report increasing oliguria, check weight, renal fxn, fluid balance, and serum and urine sodium & potassium levels daily. STOCK: Injection: 5%, 10%, 15%, 20%, 25%

NALOXONE HYDROCHLORIDE (NARCAN) CLASSIFICATION: Miscellaneous antagonists & antidotes ACTION: Unknown. Thought to displace opioid analgesics from their receptors (competitive antagonism), drug has no pharmacologic actv. Of its own. INDICATIONS: Known or suspected opioid – induced respiratory depression, including that caused by pentazocine & propoxyphene. CONTRAINDICATIONS: Use cautiously in patients w/ cardiac irritability or opioid addiction. Abrupt reversal of opioid – induced CNS depression may result in nausea, vomiting, diaphoresis, tachycardia, CNS excitement, & increase blood pressure. ADVERSE EFFECT: Tremors, seizures, tachycardia, hypertensive w/ higher than recommended doses, hypotension, nausea, vomiting. NURSING CONSIDERATIONS: Monitor respiratory depth & rate. Be prepared to provide oxygen, ventilation, and other resuscitation measures. STOCK: Injection: 0.02mg/ml, 0.4mg/ml

NALBUPHINE HYDROCHLORIDE

(NUBAIN) CLASSIFICATION: Opiod Analgesics ACTION: Unknown. Binds w/ opiate receptors in the CNS, altering perception of and emotional response to pain. INDICATIONS: Moderate to severe pain Adjunct to balanced anesthesia CONTRAINDICATIONS: Use cautiously in patients w/ history of drug abuse and in those w/ emotional instability, head injury, increased intracranial pressure, impaired ventilation, MI encompanied by nausea and vomiting, upcoming biliary, surgery, and hepatic or renal disease. ADVERSE EFFECT: Headache, sedation, dizziness, vertigo, nervousness, depression, hallucination, vomiting, constipation, urinary, pruritis, burning, asthma. NURSING CONSIDERATIONS: Reassess patient’s level of pain at least 15 and 30mins after parenteral administration. > Monitor respiratory and circulatory status of the pt. and bladder vowel function. STOCK: Injection: 10mg/ml, 20mg/ml

NIFEDIPINE (PROCARDIA) CLASSIFICATION: Antianginals ACTION: Thought to inhibit calcium ion influx across cardiac and smooth muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles. INDICATIONS: Vasospastic angina, classic chronic stable angina pectoris. CONTRAINDICATIONS: Use cautiously in patients w/ heart failure or hypotension and in elderly patients. Use extended – release tablets cautiously in pts. w/ severe GI narrowing. ADVERSE EFFECT: Dizziness, light-headedness, somnolence, headache, weakness, syncope, nervousness, heart failure. NURSING CONSIDERATIONS: Don’t give immediate – release form w/in 1 week of acute MI or in acute coronary syndrome. > Monitor blood pressure regularly, especially in pts. who take beta blockers or antihypertensives. STOCK: Capsules: 10mg, 20mg Tablets: 30mg, 60mg, 90mg

PENICILLIN 6 POTASSIUM (PFIZERPEN) CLASSIFICATION: Anti-infectives ACTION: Inhibits cell-wall synthesis during bacterial multiplication. INDICATIONS: Moderate to severe systemic infection > Anthrax CONTRAINDICATIONS: Use cautiously in pts. w/ other drug allergies, especially to cephalosporins, because of possible crosssensitivity. ADVERSE EFFECT: Nausea, vomiting, enterocolitis, seizures, anxiety, dizziness, fatigue NURSING CONSIDERATIONS: Before giving drug, ask the patients hypersensitive to drug or other penicillins. STOCK: Injection: 1 million units, 5 million units, 20 million units. Tablets: 500,000 units

PHENYTOIN SODIUM (DILANTIN) CLASSIFICATION: Anticonvulsants ACTION: Unknown INDICATIONS: To control tonic-clonic (grand mal) & complex partial (temporal lobe) seizures

CONTRAINDICATIONS: Contraindicated in pts. hypersensitive to hydantoin and in those w/ sinus bradycardia, SA block, second or third degree AV block, or Adams-Strokes Syndrome. ADVERSE EFFECT: Gingival hyperplasia, nausea, vomiting, constipation NURSING CONSIDERATIONS: Use only clear solution for injection. A slight yellow color is acceptable. Don’t refrigerate. STOCK: Oral Suspension: 125mg/5ml Tablets: 50mg

PYREGABALIN (LYRICA) CLASSIFICATION: Calcium channel modulator, Analgesic, Antiepileptic ACTION: Binds to alpha2 - delta sites on the nerves in the CNS, w/c reduces the calcium influx into the cell and decreases the releases of neurotransmitters into the synaptic cleft, resulting in less stimulating of the nerve. INDICATIONS: Management of acute pain associated w/ diabetic peripheral neuropathy, postherpetic neuralgia. CONTRAINDICATIONS: Contraindicated w/ known hypersensitivity to pregabalin / any component of the drug lactation. ADVERSE EFFECT: GI: dry mouth, constipation, flatulence NURSING CONSIDERATIONS: Provide safety measure if dizziness, somnolence, changes in thinking occur. > Monitor weight gain & fluid retention, adjust treatment for diabetes, CHF accordingly. STOCK: Tablets: 50mg, 250mg Suspension: 250mg/5ml

RANITIDINE (ZANTAC) CLASSIFICATION: Anti-ulcer drugs ACTION: Competitively inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretion. INDICATIONS: Maintenance therapy for duodenal or gastric ulcer. CONTRAINDICATIONS: Use cautiously in pts. w/ hepatic dysfunction. Adjust dosage in pts. w/ impaired renal function. ADVERSE EFFECT: Vertigo, malaise, headache, jaundice. NURSING CONSIDERATIONS: Assess pt. for abdominal pain. Note presence of blood in emesis, stool or gastric aspirate. STOCK: Granules: 150mg. Injection: 25mg/ml Syrup: 15mg/ml Tablets: 75mg

RIFAMPICIN (ROFACT) CLASSIFICATION: Anti-tuberculotics and antileprotics ACTION: Inhibits DNA - dependent RNA polymerase, w/c impairs RNA Synthesis, bactericidal. INDICATIONS: Pulmonary tuberculosis, w/ other antituberculotics. CONTRAINDICATIONS: Use cautiously w/ patient hypersensitivity to rifampin. > Use cautiously in patient w/ liver disease.

ADVERSE EFFECT: Headache, fatigue, drowsiness, dizziness, numbness, ataxia, shock. NURSING CONSIDERATIONS: Give drug w/ at least one other antituberculotic. > Give P.O. doses 1 hr. before or 2 hrs. after meals for optimal absorption, if GI irritation occurs, may give w/ meals. STOCK: Capsules: 150mg, 300mg

ADVERSE EFFECT: GI: nausea, diarrhea NURSING CONSIDERATIONS: Administer drug 30mins before pt. is going to bed, encourage no other actv. After patient takes the drug. STOCK: Tablets: 60mg

RANIPRIL (ALTACE) PHENOBARBITAL (SOLFOTON) CLASSIFICATION: Anticonvulsants ACTION: As barbiturate, probably depresses CNS, and increases seizure threshold. As sedative, may interfere w/ transmission of impulses from thalamus to cortex of brain. INDICATIONS: Anti-convulsant, febrile seizures, status epilepticus. > Sedation, Insomnia, preoperative sedation CONTRAINDICATIONS: Use cautiously in patients with acute or renal chronic pain, depression, suicidal, tendencies, history of drug abuse, fever, hyperthyroidism, diabetes mellitus, severe anemia, blood pressure alterations, CV disease, shock, or uremia, and in elderly or debilitated patients. ADVERSE EFFECT: Drowsiness, lethargy, hangover, paradoxical, excitement in elderly patients, somnolence, changes in EEG patterns, physical and psychological dependence. NURSING CONSIDERATIONS: Give I.M injection deeply into large muscles. Superficial injection may cause pain, sterile abscess, and tissue sloughing. > Don’t stop drug abruptly because this may worsen seizures. Call prescriber immediately if adverse rxn’s develop. STOCK: Capsules: 16mg

CLASSIFICATION: Antihypertensive, ace inhibitor ACTION: Blocks Ace ffom converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decrease BP, decrease aldosterone secretion INDICATIONS: Treatment of hypertension alone or combination w/ thiazide-type diuretics treatment of CHF in stable patients in the 1st few days after MI. CONTRAINDICATIONS: Contraindicated w/ allergy to ranipril salt / volume depletion, lactation ADVERSE EFFECT: Gastric irritation, opthous ulcers, dysgeusia, hepatocellular, injury, anorexia. NURSING CONSIDERATIONS: Monitor patient closely or falling BP 2° to reduction in fluid volume because excessive hypotension may occur. STOCK: Capsule: 1.25mg, 2.5mg, 5mg, 10mg

SODIUM BICARBONATE PYRAZINAMIDE (TEBRAZID) CLASSIFICATION: Antituberculotic ACTION: Bacteriostatic or bacteriodical against mycobacterium tuberculosis mechanism of action is unknown. INDICATIONS: Initial treatment of active TB in adults & children when combined w/ other antituberculotics. CONTRAINDICATIONS: Contraindicated w/ allergy to pyrazinamide, acute hepatic dses., lactation, acute gout. ADVERSE EFFECT: GI: Hepatotoxicity, nausea, vomiting, diarrhea, anorexia NURSING CONSIDERATIONS: Administer only in conjunction w/ other antituberculotics > Administer once a day STOCK: Tablets: 500mg

ROMELTEON (ROZEREM) CLASSIFICATION: Melatonin receptor, agonist, sedative hypnotic. ACTION: Agonist at melatonin receptor sites believed to contribute to sleep promotion and though to be involved in the maintenance of circadian rhythm underlying the normal - wake cycle. INDICATIONS: Treatment of insomia characterized by difficulty w/ sleep onset. CONTRAINDICATIONS: Contraindicated w/ known hyper sensitivity to any component of the drug. > Severe sleep apnea, severe COPD.

CLASSIFICATION: Acidifiers and Alkalinizer ACTION: Restore buffering capacity of the body and neutralizes excess acid INDICATIONS: Metabolic acidosis, systemic or urinary alkalinization, antacid, cardiac arrest CONTRAINDICATIONS: Contraindicated in patients losing chloride because of vomiting or continuous GI suction and in those receiving diuretics that produce hypochloremic alkalosis. Oral sodium bicarbonate is contraindicated for acute ingestion of strong mineral acids. ADVERSE EFFECT: Tetany, edema, gastric distention, belching, flatulence. NURSING CONSIDERATIONS: To avoid risk of alkalosis, obtain blood pH, partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide and electrolyte levels. Tell prescriber laboratory results. STOCK: Injection: 4%, 5%, 1.5%, 8.4% Tablets: 325mg, 650mg

TIZANIDINE (ZANAFLEX) CLASSIFICATION: Antipasmodic, sympatholytic (centrally acting) ACTION: Centrally acting alpha, agonist, antispasmodic effect thought to be a result of indirect depression of poly synaptic reflexes by blocking the excretory actions of spinal intraneurons. INDICATIONS: Acute & intermittent management of increase muscle tone associated w/ spasticity. CONTRAINDICATIONS: Contraindicated w/ hypersensitively to tizanidine. ADVERSE EFFECT: GI: dry mouth, constipation, anorexia, malaise, nausea, vomiting.

NURSING CONSIDERATIONS: Adminster drug q 6-8° around the clock for the best effect. > Adjust drug doses slowly, w/c helps to decrease side effects. > Provide sugarless lozenges / ice chips, as appropriate, if dry mouth or altered taste occur. STOCK: Tablets: 2mg, 4mg Capsules: 2mg, 4mg, 6mg

THIETHYPERAZINE MALEATE (TORECAN, NORZINE) CLASSIFICATION: Antiemetic, Antivertigo drug ACTION: Mechanism of Action not fully understood, Acts directly on the CTZ and the vomiting center to suppress nausea and vomiting. INDICATIONS: Relief of nausea and vomiting CONTRAINDICATIONS: Contraindicated for IV use, and w/ allergy to phenothiazines, comatose, or severely CNS depressed states, pregnancy. ADVERSE EFFECT: GI: dry mouth, salivation, nausea, vomiting, anorexia. NURSING CONSIDERATIONS: Do not administer to pregnant patients, serious fetal harm can occur. > Keep the patient recumbent for 30 mins after injection to avoid orthostatic hypotension. STOCK: Injection: 5ml/ml

TRAMADOL HYDROCHLORIDE (ULTRAM) CLASSIFICATION: Analgesic, centrally acting ACTION: Binds to opioid receptors & inhibits the re up take of nonephineprine and serotonin, causes many effects similar to the opioids, dizziness, somnolence, nausea. INDICATIONS: Relief of moderate to moderately severe pain. CONTRAINDICATIONS: Contraindicated w/ allergy to tramadol / opioidsor acute intoxication w/ alcohol, opioids or psychoactive drugs. ADVERSE EFFECT: GI: nausea, vomiting, dry mouth. NURSING CONSIDERATIONS: Limit use in patients w/ past / present history of addiction to or depence or opioids. STOCK: Tablets: 50mg

VITAMIN C (ASCORBIC ACID) CLASSIFICATION: Vitamins and Minerals ACTION: Stimulates collagen formation and tissue repair, involved in oxidation – reduction reactions. INDICATIONS: RDA, to prevent Vit. C deficiency in pts. w/ poor nutritional habits or increased requirements. > To acidify urine CONTRAINDICATIONS: Contraindicated in pts. w/ an allergy to tartrazine or sulfites. > Contraindicated in large doses in pregnant pts. ADVERSE EFFECT: CNS: Faintness, dizziness, GI: diarrhea, heartburn, nausea, vomiting NURSING CONSIDERATIONS: When giving for urine acidification, check urine pH to ensure efficiency. > Protect solution from light, and refrigerate ampules. STOCK: Capsules: 250mg, 500mg

VALPROIC ACID (DEPAKENE) CLASSIFICATION: Anticonvulsants ACTION: Probably facilitates the effects of the inhibitory neurotransmitter INDICATIONS: Simple and complex absence, seizures, mixed seizure types, complex partial seizures, mania. > To prevent migraine headache CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug in those w/ hepatic disease or significant hepatic dysfunction and in patients w/ urea cycle disorder. ADVERSE EFFECT: Insomnia, nervousness, somnolence, abnormal thinking, amnesia, emotional upset, depression, tremor, ataxia, headache, dizziness, asthenia, fever NURSING CONSIDERATIONS: Obtain liver function test results, platelet count, and PT and INR before starting therapy, and monitor these values periodically. > Patients at high risk for heaptotoxicity include those w/ congenital metabolic disorders, mental retardation, or organic brain dses. STOCK: Injection: 100mg/ml Syrup: 250mg/5ml