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Ivanne D'Laureil I. Hisoler BSN III-A Drug Data Generic Name Lidocaine HCl Trade Name Xylocaine Minimum Dose 50 mg at a rate of 25 mg/min Maximum Dose 300 mg

Classification Pharmacologic Class Amide-type Local Anesthetic Therapeutic Class Antiarrhythmic, Local Anesthetic Pregnancy Risk Factor B

Contents Lidocaine HCl

Indication

Contraindications

Adverse Reaction

Nursing Responsibilities

General Indications - Management of acute ventricular arrhythmias during cardiac surgery and MI. - Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection, topical anesthetic for skin disorders and accessible mucous membranes - As local analgesia before venipuncture or peripheral IV cannulation when applied to intact skin in children 3-18 yr

Concentrations - Allergy to lidocaine or amide-type local anesthetics - Heart failure - Cardiogenic shock - Second or third degree heart block - Stokes-Adams syndrome - Wolff-ParkinsonWhite syndrome

Antiarrhythmic with systemic administration CNS: Dizziness or lightheadedness, fatigue. Drowsiness, unconsciousness, tremors, twitching, vision changes, may progress to seizures CV: Cardiac arrhythmias, cardiac arrest, vasodilation, hypotension Hypersensitivity: Rash, anaphylactoid reactions Respiratory: Respiratory depression, respiratory arrest Other: Malignant hyperthermia, fever, local injection site reaction

Before - Check drug concentration carefully. - Reduce dosage with hepatic or renal failure. - Keep life-support equipment and vasopressors readily available in case severe adverse reaction occurs. - Instruct about side effects of drug. - Keep in mind that amount used should be as small as possible. - Observe the 15 rights of drug administration.

Pharmacokinetics

Availability and color

A: Lidocaine is also well-absorbed from the GIT, although little intact drug appears in the circulation because of biotransformation in the liver. D: Lidocaine crosses the bloodbrain and placental barriers, presumably by passive diffusion. M: Hepatic E: Urine

- Direct injection- 10, 20 mg/mL - IV injection- 40, 100, 200 mg/mL - IV infusion- 2, 4 ,8 mg/mL - IM injection- 300 mg/mL - Topical liquid- 2.5% - Topical ointment- 5% - Topical cream- 0.5% Topical gel- 0.5%, 2%, 2.5%, 4%, 5% - Topical spray- 0.5%, 10% - Topical solution- 2%, 4% - Injection- 0.5%, 1%, 1.5%, 2%, 4%, 5% - Transdermal system0.5mg

Route Onset Peak Duration IM 5-10 min 5-15 min 2 hr IV Immedi-ate Immedi-ate 10-20 min

Routes of administration Intramuscular Intravenous Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

Mechanism of Action Type 1 antiarrhythmic: Decreases diastolic depolarization, decreasing automacity of ventricular cells; increases ventricular fibrillation threshold Local anesthetic: Blocks the generation and conduction of action potentials in sensory nerves by reducing sodium permeability, reducing height and rate of rise of the action potential, increasing excitation threshold, and slowing conduction velocity

Precaution - Impaired renal and hepatic function - Inflammation or sepsis in the region of injection - Labor and delivery (may prolong second stage of labor) - Lactation Drug interaction Drug to drug - Increased lidocaine levels with beta blockers, cimetidine, ranitidine - Prolonged apnea with succinylcholine Drug to food - none reported

Drug Half Life 10 min, then 1.5-3 hr

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693696

Injectable local anesthetic for epidural or caudal anesthesia CNS: Headache, backache, septic meningitis, persistent sensory, motor or autonomic deficit of lower spinal segments, sometimes with incomplete recovery CV: Hypotension due to sympathetic block Dermatologic: Urticaria, pruritus, erythema, edema GU: Urinary retention, urinary or fecal incontinence Topical local anesthetic Dermatologic: Contact dermatitis, urticaria, cutaneous lesions Hypersensitivity: anaphylactoid reactions Local: Burning, stinging, tenderness, swelling, tissue irritation, tissue sloughing, necrosis Other: Methemoglobinemia, seizures (children)

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

During - Continuously monitor response when used as antiarrhythmic or injected as local anesthetic. - Titrate dose to minimum needed for cardiac stability. - Make sure that such solutions are used only to produce locale anesthesia. - Apply lidocaine ointments or creams to a gauze or bandage before applying to the skin. - Establish safety precautions if CNS changes occur. After - Educate client about side effects of drug. - Instruct to report to physician if adverse reactions occur. - Monitor for malignant hyperthermia. - Monitor fluid load carefully. - Have patients who have received lidocaine as spinal anesthetic remain lying flat for 6-12 hr afterward. - Ensure adequate hydration to minimize risk of headache. - Do not give food or drink for 1 hr after use of oral anesthetic. - Do proper documentation. Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 693-696

Drug Data

Classification

Generic Name D5LR (5% Dextrose in Lactated Ringer's Solution)

Pharmacologic Class Hypertonic solution

Trade Name Braun D5LR, LVP D5LR

Pregnancy Risk Factor C

Mechanism of Action Hypertonic solution has a greater concentration of solutes than plasma. H2O draws out of a cell causing the cell to shrink.

Indication General Indications - Replacement therapy particularly in extracellular fluid deficit accompanied by acidosis - Used to treat losses for lower GI tract and burns

Minimum Dose KVO IV Maximum Dose Fast drip IV

Contraindications Concentrations - Renal failure - Liver dysfunction - Diabetes Mellitus - Lactic acidosis - Alkalosis Precaution - Pediatric patients - Congestive Heart Failure - Severe renal insufficiency - Metabolic or respiratory alkalosis

Adverse Reaction CV: Vein damage Respiratory: Coughing, sneezing, dyspnea Other: Allergic reaction Skin: Generalized urticaria, pruritus, facial edema

During - Do not administer unless solution is clear and seal is intact. - Prepare medication site. Puncture medication part and inject using syringe with 19 to 22 gauge needle. - Maintain sterility of needle or catheter. - Explain importance of IVF to patient. - Regulate the flow properly. - Monitor the patient closely for first 15-20 minutes.

Contents Per 100 mL dextrose Na lactated sol'n.: manohydrate 50% 620 mg; NaCl 600 mg, Kcl 30 mg, CaCl2 200 mg Availability and color - Infusion solution (clear): 500 mL and 1000 mL

After - Watch for adverse reactions. - Encourage patient to report signs of adverse reactions. - If an adverse reaction does occur, discontinue infusion. - Check patency of IV line everyday. - Monitor for fluid overload. - Assess for signs of thrombosis or phlebitis. - Document that infusion has been started.

Routes of administration Intravenous

Source: http://www.rxlist.com/lacta ted-ringers-in-5-dextrosedrug.htm

Nursing Responsibilities Before - Obtain vital signs for baseline data. - Check physician's order. - Assess lab values. - Check for minute leaks by squeezing inner bag firmly. - Attach administration set. Refer to complete directions accompanying set. - Check patency of IV line.

Source: http://www.rxlist.com/lacta ted-ringers-in-5-dextrosedrug.htm

Source: http://www.rxlist.com/lactated-ringers-in-5dextrose-drug.htm

Source: http://www.rxlist.com/lactatedringers-in-5-dextrose-drug.htm

Source: http://www.rxlist.com/lactatedringers-in-5-dextrose-drug.htm

Source: http://www.rxlist.com/lactated-ringers-in-5dextrose-drug.htm

Source: http://www.rxlist.com/lactated-ringers-in-5dextrose-drug.htm

Classification

Mechanism of Action

Generic Name Methotrexate

Drug Data

Pharmacologic Class Folic acid antagonist

Trade Name Folex

Therapeutic Class Antimetabolite. Antineoplastic, Antipsoriatic, Antirheumatic

Inhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication; selectively affects the most rapidly dividing cells (neoplastic and psoriatic cells)

Minimum Dose 7.5 mg 1 tab BID Maximum Dose 15 mg 1 tab q6˚ Contents Methotrexate Availability and color - Tablets- 2.5, 5, 7.5 10, 15mg - Powder for injection- 20 mg, 1 g per vial - Injection- 25 mg/mL Routes of administration Oral Intramuscular Intravenous

Pregnancy Risk Factor X

Pharmacokinetics A: Rapidly absorbed from the GI tract at low doses, higher doses are less well absorbed. Rapidly and completely absorbed after IM doses. D: Tissues and extracellular fluids; crosses the blood-brain barrier and placenta; enters breast milk. Small amounts in saliva and breast milk. 50% bound to plasma proteins. Bound as polyglutamate conjugates, bound drug may remain in the body for several mth, particularly in the liver. M: Partly by intestinal flora. Does not undergo significant metabolism at low dose therapy; 7-hydroxy metabolite is detected at high-doses. E: Primarily via urine; small amounts in bile, feces. Route Onset Peak Duration Oral Varies 1-2 hr Unknown IM Rapid 0.5-1 hr Unknown IV Rapid 0.5-1 hr Unknown

Drug Half Life 3-15 hr

Indication General Indications - Burkitt's lymphoma - Acute lymphoblastic leukaemia - Choriocarcinoma - Mycosis fungoides - Psoriasis - Rheumatoid arthritis - Crohn's disease - Osteosarcoma - Breast cancer - Advanced lymphosarcoma - Acute lymphoblastic leukaemia - Choriocarcinoma - Acute lymphoblastic leukaemia - Mycosis fungoides - Crohn's disease - Psoriasis - Meningeal leukaemia - Hydatidiform mole

Contraindications Concentrations - Pregnancy - Lactation - Alcoholism - Chronic liver disease - Immune deficiencies - Blood dyscrasias - Hypersensitivity Precaution - Renal disease - Infection - Peptic ulcer - Ulcerative colitis - Debility Drug interaction Drug to drug - Potentially serious to fatal reactions when given with NSAID’s - Risk for toxicity with alcohol - Increased risk of toxicity with salicylates, probenecid, sulfonamides - Decreased serum levels and therapeutic effects of digoxin - May decrease theophylline clearance Drug to food - none reported

Adverse Reaction

Nursing Responsibilities

CNS: Headache, drowsiness, blurred vision, aphasia, hemiparesis, paresis, seizures, fatigue, malaise, dizziness

Before - Observe 15 rights of drug administration. - Assess for hypersensitivity to drug. - Assess for contraindications of the drug. - Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests, and chest X-ray before therapy. - Ensure that patient is not pregnant before administering. - Prepare a calendar of treatment days.

Dermatologic: Erythematous rashes, pruritus, urticaria, photosensitivity, depigmentation, alopecia, ecchymosis, telangiectasia, acne, furunculosis GI: Ulcerative stomatitis, gingivitis, pharyngitis, anorexia, nausea, vomiting, diarrhea, hematemesis, melena, GI ulceration, bleeding, enteritis, hepatic toxicity GU: Renal failure, effects on fertility Hematologic: Severe bone marrow depression, increased susceptibility to infection Hypersensitivity: Anaphylaxis, sudden death Respiratory: Interstitial pneumonitis, chronic interstitial obstructive pulmonary disease Other: Chills and fever, metabolic changes, cancer

During - Do not administer any other medications containing alcohol. - Arrange for adequate hydration during therapy to reduce risk of hyperuricemia. - Arrange to have leucovrin readily available as antidote for methotrexate overdose. - Instruct to use contraceptives during therapy. - Avoid contact with needles for parenteral administration. After - Arrange for tests to evaluate CBC, urinalysis, renal and liver function tests, and chest X-ray several weeks after therapy. - Instruct to report black tarry stools, fever, chills, sore throat, unusual bleeding or bruising, cough or shortness of breath, darkened or bloody urine, abdominal, flank or joint pain, jaundice symptoms, mouth sores. - Reduce dosage or discontinue if renal failure occurs. - Arrange for frequent, regular medical check-ups. - Document that drug has been given.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 767-768

Source: http://www.keele.ac.uk/ Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 767

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 768

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 769

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 769

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 769

Drug Data Generic Name Hydralazine

Classification Pharmacologic Class Vasodilator

Trade Name Apresoline, NovoHylazin

Therapeutic Class Antihypertensive

Minimum Dose 5 mg/hr by IV infusion

Pregnancy Risk Factor C

Mechanism of Action Acts directly on vascular smooth muscle to cause vasodilation, primarily arteriolar, decreasing peripheral resistance; maintains or increases renal and cerebral flow.

Indication General Indications - Hypertension - Eclampsia

Pharmacokinetics

Maximum Dose 10 mg by IV infusion Contents Hydralazine HCl Availability and color - Tablets- 10, 25, 50, 100 mg - Injection- 20 mg/mL

A: Rapidly absorbed from the GI tract after oral administration. D: About 90% bound to plasma proteins. M: Undergoes considerable firstpass metabolism by acetylation in the GI mucosa and liver. E: Mainly excreted in urine as metabolites. Route Onset Peak Duration Oral Rapid 1-2 hr 6-12 hr IM Rapid 10-20 min 2-4 hr IV Rapid 10-20 min 2-4 hr

Routes of administration Oral Intramuscular Intravenous

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 588

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 588

Source: http://mims.com.ph/

Adverse Reaction CNS: Headache, peripheral neuritis, dizziness, tremors, psychotic reactions, characterized by depression, disorientation, anxiety

Precaution - with CAV’s - increased intracranial pressure - severe hypertension with uremia - advanced renal damage - slow acetylators - lactation - pregnancy - pulmonary hypertension

CV: Palpitations, tachycardia, angina pectoris, hypotension, paradoxical pressor response, orthostatic hypotension

Drug interaction Drug to drug - Increased pharmacologic effects of beta-adrenergic blockers and hydralazine when given concomitantly

Hypersensitivity: Rash, urticaria, pruritus, fever, chills, arthralgia, eosinophilia; rarely, hepatits, obstructive jaundice

Drug to food - Increased bioavailability of oral hydralazine given with food.

Drug Half Life 3-7 hr

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 588

Contraindications Concentrations - Hypersensitivity - CAD - mitral valvular rheumatic heart disease

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 589

GI: Anorexia, nausea, vomiting, diarrhea, constipation, paralytic ileus GU: Difficult micturition, impotence Hematologic: Blood dyscrasias

Other: Nasal congestion, flushing, edema, muscle cramps, lymphadenopathy, splenomegaly, dyspnea, lupus-like syndrome, possible carcinogenesis, lacrimation, conjunctivitis

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 589

Nursing Responsibilities Before - Check blood pressure. - Arrange for CBC, LE cell preparations, and ANA titers before therapy. - Assess for contraindicated conditions. - Observe the 15 rights of drug administration. - Assess bowel sounds. - Assess voiding pattern. During - Give oral drug with food. - Use parenteral drug immediately after opening ampule. - Discard discolored solutions. - Arrange for CBC, LE cell preparations, and ANA titers during prolonged therapy. - Instruct to take drug exactly as prescribed. After - Withdraw drug gradually. - Discontinue if blood dyscrasias occur. - Arrange for pyridoxine therapy if patient develops symptoms of peripheral neuritis. - Monitor for orthostatic hypotension. - Report persistent or severe constipation, unexplained fever or malaise, muscle or joint aching, chest pain, rash, numbness, tingling. - Do proper documentation. Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 589-590

Classification

Mechanism of Action

Indication

Contraindications

Generic Name Magnesium Sulfate

Drug Data

Pharmacologic Class Mineral, Electrolyte

Trade Name Martham

Therapeutic Class Antiepileptic, Laxative; Mineral, electrolyte replacement

Cofactor of many enzyme systems involved in neurochemical transmission and muscular excitability; prevents or controls seizures by locking the neuromuscular transmission; attracts and retains the water in the intestinal lumen and distends the bowel to promote mass movement and relieve constipation.

General Indications - Constipation - Torsades de pointes - Muscle stimulating effects of barium poisoning - Reduction of cerebral oedema. - Hypomagnesaemia - Seizures associated with epilepsy, glomerulonephritis or hypothyroidism. - Toxemias of pregnancy - Boils and carbuncles

Concentrations - Allergy to magnesium products - Abdominal pain - Nausea - Vomiting - Acute surgical abdomen - Fecal impaction - Intestinal and biliary tract obstruction - Hepatitis - Myocardial damage - Heart blocks - 2 hr preceding delivery

Minimum Dose 1-2 g qH by IV infusion Maximum Dose 4-6 g qH by IV infusion

Pregnancy Risk Factor A B (Laxative)

Contents Magnesium sulfate Availability and color - Granules- 40 mEq/5 g - Injection- 0.325, 0.65, 1, 4 mEq/mL

Pharmacokinetics A: Following administration, 30-50% of the dose is absorbed from the small intestine. D: Crosses the placenta and small amounts enter the breast milk. M: Unknown E: Via urine and feces.

Respiratory: Decreased respiratory rate CV: Palpitations GI: Excessive bowel activity, perianal irritation Metabolic: Magnesium intoxication, hypocalcemia with tetany

Drug interaction Drug to drug - Potentiation of neuromuscular blockade produced by nondepolarizing neuromuscular relaxants

Route Onset Peak Duration Oral 1-2 hr Unknown 3-4 hr IM 60 min Unknown 3-4 hr IV Immediate Unknown 30 min

Routes of administration Oral Intramuscular Intravenous

Precaution - Renal insufficiency

Adverse Reaction CNS: Weakness, drowsiness, dizziness, fainting, sweating

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 724

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 724725

Drug to food - none reported

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 724725

During - Give IM route by deep IM injection. - Monitor serum magnesium levels. - Do not give oral MgSO4 with abdominal pain, nausea, or vomiting. - Do not administer if knee-jerk reflexes are suppressed - Monitor bowel function. After - Arrange to discontinue administration as soon as levels are within normal limits and desired clinical response is obtained. - Discontinue if diarrhea or cramping occurs. - Arrange for dietary measures, exercise and environmental control to return to normal bowel activity. - Report sweating, flushing, muscle tremors or twitching, inability to move extremities. - Maintain urine output at a level of 100 mL every 4 hr during parenteral administration. - Do proper documentation.

Drug Half Life Unknown

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 724

Nursing Responsibilities Before - Assess for contraindicated conditions. - Monitor knee-jerk reflex before repeated parenteral administration. - Give as laxative as temporary measure. - Reserve IV use in eclampsia for lifethreatening situations. - Observe the 15 rights of drug administration.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 725

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 725-726

Drug Data Generic Name Diazepam Trade Name Valium Minimum Dose 2mg/day Maximum Dose 60mg/day

Classification Pharmacologic Class Benzodiazepine Therapeutic Class Antiepileptic, Anxiolytic, Skeletal muscle relaxant Pregnancy Risk Factor D

Contents Diazepam Availability and color - Tablets-2, 5, 10 mg - Oral solution1mg/mL, 5mg/mL - Rectal pediatric gel- 2.5, 5, 10mg - Injection5mg/mL Routes of administration Oral Intramuscular Intravenous Rectal

Mechanism of Action

Indication

Contraindications

Adverse Reaction

Nursing Responsibilities

It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilization.

General Indications - Short-term management of anxiety - Insomnia associated with anxiety - Sleepwalking - Night terrors - Premedication before anaesthesia - Adjunct in the management of seizures - Muscle spasms - Acute symptoms of alcohol withdrawal - Premedication before anaesthesia

Concentrations - Hypersensitivity - Preexisting CNS depression or coma - Respiratory depression - Acute pulmonary insufficiency or sleep apnea - Severe hepatic impairment - Acute narrow angle glaucoma - Children < 6 mth - Pregnancy and lactation.

CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, disorientation, restlessness, confusion, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, mild paradoxical excitatory reactions, extrapyramidal symptoms, visual and auditory disturbances CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, edema Dependence: Drug dependence with withdrawal syndrome Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, elevation in blood enzymes, hepatic impairment GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis, thrombosis, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia, pain, burning, redness after IM injection

Before - Discuss risk of fetal abnormalities with patients desiring to become pregnant. - Instruct about side effects of drug: Drowsiness, dizziness, GI upset, dreams, difficulty concentrating, fatigue, nervousness, crying. - Assess for hypersensitivity. - Reduce dose of opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated. - Instruct not to stop taking the drug without consulting the health care provider. - Observe the 15 rights of drug administration.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Pharmacokinetics A: Readily and completely absorbed from the GI tract, peak plasma concentrations after 30-90 min (oral). Rapidly absorbed, peak plasma concentrations after 10-30 min (rectal). D: Readily crosses the blood-brain barrier; redistributed into fat depots and tissues. Protein-binding: 98-99%. M: Extensively hepatic; converted to desmethyldiazepam, oxazepam and temazepam. E: Urine (as free or conjugated metabolites)

Precaution - Impaired renal and hepatic function - Chronic pulmonary insufficiency - Organic cerebral changes; elderly - History of alcohol or drug addiction. Drug interaction Drug to drug - Increased CNS depression with alcohol, omeperazole - Increased pharmacologic effects of diazepam if combined with cimetidine, disulfiram, hormonal contraceptives - Decreased effects of diazepam with theophyllines, ranitidine

Route Onset Peak Duration Oral 30-60 min 1-2 hr 3 hr IM 15-30 min 30-45 min 3 hr IV 1-5 min 30 min 15-60 min Rectal Rapid 1.5 hr 3 hr

Drug to food - none reported

During - Do not administer intrarterially; may produce arteriospasm, gangrene. - Carefully monitor P. BP, respiration during IV administration. - Change from IV therapy to oral therapy as soon as possible. - Do not use small veins for IV injection. - Instruct to take drug exactly as prescribed. After - Maintain patients receiving parenteral benzodiazepines in bed for 3 hours. - Do not permit ambulatory patients to operate a vehicle following an injection. - Instruct patient to report adverse reactions. - Monitor EEG in patients treated for status epilepticus, seizures may recur after initial control. - Monitor liver and renal function, CBC during long term therapy. - Taper dosage gradually after long-term therapy. - Document that drug has been given.

Drug Half Life 20-80 hr Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 374-376

Source: http://mims.com.ph/

Source: http://mims.com.ph/

Drug Data Generic Name Insulin Trade Name Humulin R Minimum Dose 0.05 unit/kg/hr Maximum Dose 1.2 units/kg/hr

Classification Pharmacologic Class Hormone Therapeutic Class Antidiabetic Pregnancy Risk Factor B

Mechanism of Action Insulin is a hormone secreted by beta cells of the pancreas that, by receptor-mediated effects, promotes the storage of the body’s fuels, facilitating the transport of metabolites and ions through cell membranes and stimulating the synthesis of glycogen from glucose of fats from lipids, and proteins from amino acids.

Indication General Indications - Diabetes mellitus - Diabetic ketoacidosis - Diabetic coma - Basal insulin control

Precaution - Lactation - Pregnancy Drug interaction Drug to drug - Increased hypoglycaemic effects of insulin with MAOI’s, beta blockers, salicylates, alcohol - Delayed recovery from hypoglycaemic episodes and masked signs and symptoms of hypoglycaemia if taken with beta adrenergic blockers. - Decreased effectiveness of insulin with corticosteroids, diuretics, atypical antipsychotics

Pharmacokinetics Contents 70% Human Insulin Isophane Suspension and 30% Human Insulin Injection (rDNA origin)

A: Inactivated (oral); fairly rapid (SC); rapid (IM); increased by exercise. D: Crosses placenta, does not enter breast milk M: Mainly in liver, also in kidneys and muscle tissue. E: Small amount excreted as unchanged drug in urine.

Availability and color - Injection- 100 units/mL, 500 units/mL - Prefilled cartridges and pens- 100 units/mL

Route Onset Peak Duration Parenteral 30-60 min 2-3 hr 6-12 hr

Routes of administration Intramuscular Subcutaneous Intravenous

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 626

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 626-627

Adverse Reaction Hypersensitivity: Rash, anaphylaxis, angioedema Respiratory: Decline in pulmonary function Local: Allergy, lipodystrophy, pruritus Metabolic: Hypoglycemia, ketoacidosis

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 626627

Nursing Responsibilities Before - Observe the 15 rights of drug administration. - Ensure uniform dispersion of insulin suspensions. - Use caution when mixing two types of insulin. - Double check, or have a colleague check dosage for pediatric patients. - Keep life support equipment and glucose readily available. - Use the same type and brand of insulin to avoid dosage errors. During - Give maintenance doses subcutaneously. - Monitor patients receiving insulin IV carefully. - Do not give insulin injection concentrated IV. - Do not change the order of mixing insulins. - Avoid alcohol upon administration. After - Store insulin in a cool place away from direct sunlight, do not freeze. - Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. - Monitor insulin needs during times of trauma or severe stress. - Arrange for proper disposal of syringes. - Rotate injection sites regularly. - Document that drug has been given.

Drug to food - none reported

Drug Half Life Varies with preparation

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 626

Contraindications Concentrations - Allergy to pork products - History of smoking or lung disease

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 627

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 627-628

Drug Data Generic Name Glucagon Trade Name GlucaGen Minimum Dose 5 mg/hr

Classification Pharmacologic Class Hormone Therapeutic Class Diagnostic agent, Glucose-elevating drug

Mechanism of Action Accelerates the breakdown of glycogen to glucose in the liver, causing an increase in blood glucose level; relaxes the smooth muscle of the GI tract and increases the force of contraction of the heart.

Indication General Indications - Severe hypoglycaemia - As a diagnostic aid in the radiologic exam of GI tract - Treatment of beta blocker and calcium channel blocker overdose

Pharmacokinetics Maximum Dose 0.02 mg/kg

Pregnancy Risk Factor B

Contents Glucagon Availability and color - Powder for injection- 1 mg Routes of administration Intramuscular Intravenous Subcutaneous

Precaution - Pregnancy - Lactation - Insulinoma Drug interaction Drug to drug - Increased anticoagulant effect and risk of bleeding with oral anticoagulants.

A: Glucagon binds to the glucagon receptor, a G protein-coupled receptor located in the plasma membrane D: Enters breast milk and crosses placenta. M: Mainly hepatic; some inactivation in kidneys and plasma. E: Urine, bile

IM 8-10 min 20-30 min 19-32 min IV 1 min 15 min 9-20 min

Contraindications Concentrations - Hypersensitivity - Pheochromocytoma - Insulinoma

Adverse Reaction CV: Hypotension, hypertension, tachycardia Hypersensitivity: Anaphylaxis, urticaria, respiratory distress, hypotension GI: Nausea, vomiting Hematologic: Hypokalemia in overdose

Drug to food - none reported

Route Onset Peak Duration

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 568

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 568-569

During - For parenteral administration, avoid contact with needles. - Teach patient signs and symptoms of hypoglycemia. - Position client on side until fully alert. - Assess for nausea and vomiting. - Adjust insulin dosage as needed. - Instruct patient to take oral glucose as soon as symptoms of hypoglycaemia occur. After - Arouse hypoglycemic patient as soon as possible after drug injection. - Provide supplemental carbohydrates. - Arrange for evaluation of insulin dosage. - Monitor for signs of nausea and vomiting. - Instruct to notify health care provider in case of hypoglycemia. - Document that drug has been given.

Drug Half Life 3-10 Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 568

Nursing Responsibilities Before - Observe 15 rights of drug administration. - Teach administration of drug subcutaneously. - Assess for contraindicated conditions. - Assess nutritional status. - Assess bowel sounds; blood and urine glucose.

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 569

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 569

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 569

Drug Data Generic Name Heparin Trade Name Hepalean Minimum Dose 150 mg 1 tab q24˚ Maximum Dose 150 mg 1 tab q6˚

Classification Pharmacologic Class Anticoagulant Therapeutic Class Antithrombotic Pregnancy Risk Factor C

Mechanism of Action

Indication

Contraindications

Heparin inactivates factor XA, therefore inhibiting thrombus and clot formation by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin, the final steps of the clotting process. Heparin also inhibits the activation of factor XIII, thrombin-induced activation of factors V and VIII.

General Indications - Prevention and treatment of venous thrombosis, pulmonary embolism, and peripheral arterial embolism - Atrial fibrillation with embolization - Diagnosis and treatment of DIC - Prevention of clotting in blood samples and heparin lock sets and during dialysis procedures

Concentrations - Hypersensitivity to heparin - Severe thrombocytopenia - Uncontrolled bleeding - Patients who cannot be monitored regularly with blood coagulation tests - Labor and immediate postpartum period

Pharmacokinetics A: Absorbed from systemic circulation. D: Reticuloendothelial system. Protein-binding: Extensive. M: Does not cross placenta, does not enter breast milk, broken down in liver. E: Urine

Contents Ranitidine HCl Availability and color - Injection- 1,000, 2,000, 2,500, 5,000, 7,500, 10,000, 12,500, 20,000, 40,000 units/mL - Single-dose and unit dose forms - Lock flush solution- 10, 100 units/mL

SubQ 20-60 min 2-4 hr 8-12 hr IV Immediate Minutes 2-6 hr

Routes of administration Subcutaneous Intravenous

Precaution - Women older than 60 yr - Pregnancy - Recent surgery or injury

Adverse Reaction Dermatologic: Loss of hair Hematologic: Hemorrhage, bruising, thrombocytopenia, elevated AST, ALT levels, hyperkalemia Hypersensitivity: Chills, fever, urticaria, asthma Other: Osteoporosis, suppression of renal function, white clot syndrome

Drug interaction Drug to drug - Increased bleeding tendencies with oral anticoagulants, salicylates, penicillins, cephalosporins, lowmolecular weight heparins, platelet inhibitors - Decreased anticoagulation effects of taken concurrently with nitroglycerin

Route Onset Peak Duration

Drug Half Life 30-180 min

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 574

Source: http://mims.com.ph/, Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 574

Source: http://mims.com.ph/

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 574575

During - Use heparin lock needle to avoid repeated injections. - Give deep subcutaneous injections, not IM. - Apply pressure to all injection sites after needle is withdrawn. - Mix well when adding heparin to IV infusion. - Do not add heparin to infusion lines of other drugs; do not piggyback other drugs into heparin line. After - Inspect injection sites for signs of hematoma, do not massage injection sites. - Provide safety measures. - Check for signs of bleeding, monitor blood tests. - Alert all health care providers of heparin use. - Instruct to be careful to avoid injury. - Do proper documentation.

Drug to food - none reported

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 574

Nursing Responsibilities Before - Observe 15 rights in drug administration. - Assess for contraindicated conditions. - Adjust dose according to coagulation test results performed just before injection. - Always check compatibilities with other IV solutions. - Have protamine sulfate readily available in case of overdose.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, p. 575

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 575-576

Drug Data

Classification

Generic Name Penicillin G Benzathine

Pharmacologic Classification Penicillin

Trade Name Penadur

Therapeutic Class Anti-infective, Antibiotic

Minimum Dose 300,000 units IM Maximum Dose 2.4 million units IM weekly for 3 weeks

Pregnancy Risk Factor B

Mechanism of Action Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria. Pharmacokinetics D: Crosses placenta; enters breast milk M: Hepatic E: Urine

Indication

Contraindications

General Indications - Severe infections caused by sensitive organisms (streptococci) - URTI caused by sensitive streptococci - Treatment of syphilis, bejel, congenital syphilis, pinta, yaws - Prophylaxis of rheumatic fever and chorea

Concentrations - Allergies to penicillins, cephalosporins, or other allergens

Route Onset Peak Duration

Contents Benzathine benzylpenicillin IM Slow 12-24 hr Days

Availability and color

- Injection: 600,000, 1.2 million, 2.4 million units/dose

Drug Half Life 30-60 min

Precaution - Renal disorders - Pregnancy - Lactation Drug interaction Drug to drug - Decreased effectiveness with tetracyclines - Inactivation of parenteral aminoglycosides (amikacin, gentamicin, kanamycin, neomycin, tobramycin) Drug to food - none reported

Routes of administration Intramuscular

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 929

Adverse Reaction CNS: Lethargy, hallucinations, seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black “hairy” tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding itme Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site, Jarisch-Herxheimer reaction when used to treat syphilis Other: Superinfections, sodium overload leading to heart failure

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 929

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 929, http://www.merck.com/mmpe/print/lexicomp/ penicillin%20g%20benzathine.html

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 929

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 929

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 930

Nursing Responsibilities Before - Observe 15 rights of drug administration. - Reduce dosage with hepatic or renal failure. - Assess for hypersensitivity to drug. - Assess for any contraindications to the drug. - Educate about side effects of drug. During - Drug is not for IV use. Do not inject or mix with other IV solutions. - Give IM injection in upper outer quadrant of the buttock. - Avoid contact with the needle. - Withdraw needle as quickly as possible to avoid discomfort. - Stay with patient throughout whole duration of administration. After - Monitor client for at least 30 minutes. - Arrange for regular follow-up, including blood tests, to evaluate effects. - Instruct to report difficulty breathing, rashes, severe pain at injection site, mouth sores, unusual bleeding or bruising. - Instruct to take medication as directed for the full course of therapy, even if feeling better. - Do proper documentation.

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 930

Drug Data Generic Name Terbutaline sulfate Trade Name Brethine Minimum Dose 5 mg at 6-hr intervals tid Maximum Dose 15 mg/day Contents Terbutaline sulfate

Classification Pharmacologic Class Beta2-selective adrenergic antagonist Therapeutic Class Antasthmatic, Bronchodilator, Sympathomimetic, Tocolytic drug Pregnancy Risk Factor B

Mechanism of Action

Indication

Contraindications

Adverse Reaction

Nursing Responsibilities

In low doses, acts relatively selectively at beta2-adrenergic receptors to cause bronchodilation and relax the pregnant uterus; At higher doses, beta2 selectively is lost and the drug acts at beta1 receptors to cause typical sympathomimetic cardiac effects.

General Indications - Prophylaxis and treatment of bronchial asthma and reversible bronchospasm that may occur with bronchitis and emphysema, in patients 12 yr and older - Unlabeled use: Tocolytic to prevent preterm labor

Concentrations - Hypersensitivity to terbutaline - Tachyarrhythmias, tachycardia caused by digitalis intoxication - General anesthesia with halogenated hydrocarbons or cyclopropane - Unstable vasomotor system disorders - Labor and delivery - Lactation

CNS: Restlessness, apprehension, anxiety, fear, CNS stimulation, hyperkinesia, insomnia, tremor, drowsiness, irritability, weakness, vertigo, headache, seizures

Before - Observe 15 rights of drug administration. - Reduce dosage with hepatic or renal failure. - Assess for hypersensitivity to drug. - Assess for any contraindications to the drug. - Educate about side effects of drug.

Pharmacokinetics D: May cross placenta; enters breast milk M: Tissue E: Urine

Availability and color

Precaution - Diabetes, Coronary insufficiency, CAD, History of CVA, COPD patient, Hyperthyroidism, History of seizure disorder, Psychoneurotic individuals, Hypertension

Route Onset Peak Duration

- Tablets: 2.5, 5 mg - Injection: 1 mg/mL

Oral 30 min 2-3 hr 4-8 hr SubQ 5-15 min 30-60 min 1.5-4 hr

Routes of administration Oral Subcutaneous

CV: Cardiac arrhythmias, palpitations, angina pain, changes in BP and ECG GI: Nausea, vomiting, heartburn, unusual or bad taste in mouth Respiratory: Respiratory difficulties, pulmonary edema, coughing, bronchospasm Other: Sweating, pallor, flushing, muscle cramps, elevated LFTs

After - Monitor client for at least 30 minutes. - Arrange for regular follow-up, including blood tests, to evaluate effects. - Instruct to report chest pain, dizziness, insomnia, weakness, tremor or irregular heartbeat, failure to respond to usual dosage. - Instruct to take medication as directed for the full course of therapy, even if feeling better. - Do not double dose. - Do proper documentation.

Drug interaction Drug to drug - Increased likelihood of cardiac arrhythmias with halogenated hydrocarbon anesthetics - Risk of bronchospasms if combined with diuretics - Increased risk of hypokalemia and ECG changes with MAOIs and TCAs

Drug Half Life 2-4 hr

During - Use minimal doses for minimal periods of time, drug tolerance can occur with prolonged use. - Keep a beta-blocker, such as atenolol, readily available in case cardiac dysrhythmias occur. - For oral forms, administer with water to facilitate swallowing. - For parenteral forms, avoid contact with the needle. - Stay with patient throughout whole duration of administration.

Drug to food - none reported Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1125-1126

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1125

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1125-1126

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1126

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1126

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1126

Source: Karch, Amy: 2009 Lippincott’s Nursing Drug Guide, pp. 1127