IX.

PHARMACOLOGICAL MANAGEMENT Generic Brand Classification: Calciumchannelblocker; Antianginal; Antihypertensive Mode of Action: Blocks the transport of calcium into the smooth musclecells lining the coronary arteries and other arteries of the body. Sincecalcium is important in muscle contraction, blocking calcium transportrelaxes artery muscles and dilates coronary arteries and other arteriesof the body. By relaxing coronary arteries, amlodipine is useful inpreventing chest pain (angina) resulting from coronary artery spasm.Relaxing the muscles lining the arteries of the rest of the body lowersthe blood pressure, which reduces the burden on the heart as it pumpsblood to the body. Reducing heart burden lessens the heart muscle'sdemand for oxygen, and further helps to prevent angina in patientswith coronary artery disease. Dosage: Lopicard 5mg tab OD Indication: Hypertension Contraindication: Hypersensitivity to amlodipine, impaired hepatic orrenal function, sick sinus syndrome, heart block (second or thirddegree), lactation Side Effects: dizziness, light-headedness, headache, fatigue, edema ofthe lower extremities, flushing, nausea, vomiting, palpitations,stomach pain, drowsiness, muscle cramps, abdominal discomforts Adverse Effects: asthenia, arrhythmias, chest pain, yellowing of theeyes or skin, difficulty breathing Drug - Drug Interaction: Risk of congestive heart failure with beta-adrenergic blockers.Increased antihypertensive effects with otherantihypertensives.Possible increased serum levels and toxicity ofcyclosporine if takenconcurrently. Nursing 1.Assess 2.Assess patient for for baseline Responsibilities: contraindication. data. Name: Name: Amlodipine besylate Lopicard

3.Administer drug without regard to meals. 4. Monitor patients vital signs carefully while adjusting drug totherapeutic dose. 5.Instruct patient to take drug with meals if stomach upsetoccurs.

6.Instruct him to take drug exactly as prescribed by hisphysician. 7.Tell patient that he may experience some side effects broughtupon by the drug. 8.Instruct him to report intolerable side effects so managementcan be done. 9.Instruct him to eat frequent small meals if vomiting occurs.

10.Oral care if patient vomits. 11.Instruct him to adjust lighting, noise and temperature if heexperiences headache and report if it is intolerable so thatmedication may be given. 12.Instruct him to report any adverse effects that he may experience.

Generic BRAND CLASSIFICATION:

Name: NAME: Fat

Vitamin

K Aqua-Mephyton

soluble

vitamin

MECHANISM OF ACTION: Vitamin K is essential for the hepaticsynthesis of factors II, VII, IX, and X, all of which are essential for bloodclotting. Vitamin K deficiency causes an increase in bleeding tendency,demonstrated by ecchymoses, epistaxis, hematuria, GI bleeding. DOSAGE: Vitamin K 10g IV OD INDICATION: Prevention of bleeding, Vitamin K malabsoption,hypoprothrombinemia CONTRAINDICATION: Hypersensitivity, severe hepatic disease, last fewwk of pregnancy SIDE EFFECTS: Dizziness, flushing, transient hypotension after IV administration, rapid and weak pulse, diaphoresis, erythema, pain swelling and hematoma at injection site ADVERSE REACTION: Anaphylaxis or anaphylactoid reactions, usuallyafter rapid IV administration DRUG INTERACTION: al oil: may inhibit Gi absorption of vitaminK

NURSING 1.Assess 2.Assess for

RESPONSIBILITIES for baseline

: contraindication. data.

3.Monitorprotime during treatment; monitor for bleeding,pulse and BP. 4.Teach patient not to take other supplements, unlessdirected by prescriber, to take this medication as directed. 5.Tell patient that he may experience side effects brought about by the drug and to report intolerable ones so as prompt interventions be done. 6.Instruct patient to report symptoms of bleeding: bruising,nosebleeds, bleack tarry stools, hematuria. 7.Stress the need for periodic lab tests to monitorcoagulation level. 8.Instruct patient to report adverse effect that he mayexperience.

Generic Brand Classification: Anticonvulsant

Name: Name: Benzodiazepine

Midazolam

HCl Dormicum CNSdepressant;

(short-acting);Anxiolytic;

Mode of Action: Acts mainly at the limbic system and reticularformation; potentiates the effects of gamma amino butyric acid(GABA), an inhibitory neurotransmitter; anxiolytic and amnesia effectsoccur at doses below those needed to cause sedation, ataxia; has littleeffect on cortical function. Dosage: Midazolam 15mg 1tab tab at 12nn with 30cc of water Indication: Sedation, anxiolysis, and amnesia prior to surgery Contraindication: Hypersensitivity to benzodiazepines;psychoses,acute marrowangle glaucoma, shock, coma, acute alcoholicintoxication, pregnancy (cleft lip or palate, inguinal hernia, cardiacdefects, microencephaly, pyloric stenosis have been reported whenused in the first trimester; neonatal withdrawal syndrome reported ininfants); neonates Side Effects: Drowsiness, dizziness, GI upset, difficulty concentrating,fatigue, nervousness, crying, dreams, hiccups, diaphoresis,incontinence, nausea, vomiting, diarrhea, constipation, dry mouth,salivation, headache, light-headedness Adverse Effects: Lethargy, apathy, disorientation, delirium, stupor,dysarthria, dystonia, tremor, rigidity, vertigo, euphoria, vivid dreams,psychomotor retardartion, extrapyramidal symptoms, nystagmus,bradycardia, tachycardia, urticaria, gastric disorder, jaundice, hepaticdysfunction, paresthesias, gynecomastia, bronchospam, laryngospam,drug dependence, respiratory depression, respiratory arrest Drug Drug Interaction:

other sedatives and anaesthetics.

benzodiazepines.

erythromycin, clarithromycin, diltiazem, verapamil,ketoconazole and itraconazole, antiretroviral agents, quinupristinwithdalfopristin.

ytoin,carbamazepine, rifampicin.

phenobarbital,

Nursing 1.Assess patient for

Responsibilities: contraindication.

2.Assess for baseline data. 3.Monitor level of consciousness before, during and for at least 2 6hours after administration. 4.Carefully monitor VS during administration. 5. Keep patient on bed for 3hours, not to permit ambulationupon administration. 6.Teach him that the drug helps him to relax and will make himsleep, and the drug is a potent amnesiac and he will notremember what has happened on him. 7.Instruct him to take the drug exactly as prescribed. 8. Instruct him to avoid alcohol, or sleep inducing, or OTCdrugs before receiving the drug. 9.Tell patient that he may experience side effects brought uponby the drug. 10.Instruct patient to report adverse effects that he mayexperience.

Generic Brand

Name:

Cefoperazone Name:

Na

g,

Sulbactam

Na

0.5

g [vial]

Sulperazone Cephalosporin,

Classification:

antibiotic

Mode of Action: Inhibits bacterial cell wall synthesis causing cellulardeath

Dosage:

Sulperazone

1.5g

q8

IVTT

Indication: Treatment of respiratory infection caused by S. pneumoniae,H. parainfluenzae, S. aureus, E. coli, Klebsiella, H. influenzae, S.pyrogenes; Perioperative prophylaxis; Post operative prophylaxis Contraindication: Hypersensitivity to cephalosporin or penicillin, orrenal failure Side Effects: diarrhea, nausea, vomiting, headache, dizziness, hypotension, abdominal pain, pain at injectionsite, inflammation at IV site, rash Adverse Effects: paresthesia, seizure, liver toxicity, nephrotoxicity, bone marrow depression, leukopenia, anaphylaxis, hematuria, vasculitis, shock Drug Drug Interaction: des

-like reaction may occur if alcohol is taken 72hrsafter drug administration Nursing 1.Assess 2.Assess 3.Inject slowly for over for baseline 3-5 Responsibilities: contraindication. data. minutes.

4.Have vitamin K injection readily available in case ofhypoprothrombinemia. 5.Tell patient that he may experience side effects that arebrought about by the drug. 6.Instruct him to report intolerable side effects so managementcan be done. 7.Instruct 8.Oral him to eat frequent if small meals if vomiting occurs. vomits.

care

patient

9.Minimize stimuli (adjust temperature, lighting and avoidnoise) if headache occurs and if intolerable pain medicationmay be given as ordered. 10.Instruct patient to avoid alcohol because severe reactionscould occur. 11.Tell patient to report any adverse effects that he mayexperience.

Generic Brand Classification:

Name: Name: Antibiotic;

Cefoxitin

Sodium Monowell

Cephalosporin

(second

generation)

Mode of Action: Bactericidal: inhibits synthesis of bacterial cell wall,causing cell death. Dosage: Indication: Contraindication: Hypersensitivity Cefoxitin 1 amp IVTT Surgical to cephalosporins or ANST now prior to OR

prophylaxis penicillins.

Side Effects: Nausea, vomiting, diarrhea, flatulence, anorexia,headache, phlebitis, rash, fever, pain on injection site, dizziness,stomach upset Adverse Effects: Lethargy, pseudomembranous colitis, paresthesias, liver toxicity, nephrotoxicity, convulsion, leukopenia, decreased hematocrit, decreased platelet, anaphylaxis, superinfection, Drug Drug Interaction:

-like reaction may occur if alcohol is taken within72hours after drug administration

Nursing 1.Assess patient for

Responsibilities: contraindication.

2.Assess for baseline data. 3. HavevitaminKreadilyavailableincaseofhypoprothrombinemia occurs. 4.Instruct patient to avoid alcohol for 3days after drugadministration because serious reactions often occur. 5.Tell patient that he may experience some side effects broughtupon by the drug. 6.Instruct him to report intolerable side effects so managementcan be done. 7.Instruct him to eat frequent small meals if vomiting occurs.

8.Oral care if patient vomits. 9.Instruct him to report any adverse effects that he mayexperience.

Generic Brand Name:

Name: Octamide PFS,

Metoclopramide Reglan

Classification: GI stimulant, antiemetic, dopaminergic blocker Mode of Action: Stimulates the muscles of the gastrointestinal tractincluding the muscles of the lower esophageal sphincter, stomach, andsmall intestine by interacting with receptors for acetylcholine anddopamine on gastrointestinal muscles and nerves; decreases the refluxof stomach acid by strengthening the muscle of the lower esophagealsphincter; stimulates the muscles of the stomach and thereby hastensemptying of solid and liquid meals from the stomach and into theintestines; interacts with the dopamine receptors in the brain and canbe effective in treating nausea. Dosage: Metoclopramide 1amp IVTT @ 6am Indication: Stimulation of gastric emptying prior to surgery Contraindication: Hypersensitivity to metoclopramide, GI hemorrhage,mechanical obstruction or perforation; pheochromocytoma (may causehypertensive crisis); epilepsy Side Effects: drowsiness, restlessness, fatigue, anxiety, insomnia,depression, sedation, nausea, diarrhea, urinary frequency Adverse Effects: parkinsonm-like reactions, involuntary musclemovements, facial grimacing, dystonic reactions resembling tetanus,transient hypertension, tardive dyskinesia, myoclonus Drug Drug Interaction

bioavailability or absorption of acetaminophen,cyclosporine, ethanol, levodopa, tetracycline

levodopa nsmitters with MAOIs for example, isocarboxazid(Marplan), phenelzine (Nardil),

tranylcypromine (Parnate),selegiline (Eldepryl), and procarbazine (Matulane) Nursing 1.Assess 2.Assess patient for for baseline Responsibilities: contraindication. data.

3.Give

direct

IV

dose

slowly

(over

to

minutes).

4.Monitor BP carefully during IV administration. 5.Monitor for extrapyramidal reactions, and consult physician ifthey occur. 6.Keep diphenhydramine injection readily available incase ofextrapyramidal reactions. 7. Have phentolamine readily available in case of

hypertensivecrisis(mostlikelytooccurwithundiagnosedpheochromocytoma). 8.Tell patient that he may experience side effects brought uponby the drug. 9. Instruct patient to report involuntary movement of the face,eyes or limbs, severe depression, severe diarrhea. 10.Provide a safe environment if restlessness, involuntary musclemovement occur.

Generic Brand Classification:

Name: Name: Histamine 2

Ranitidine Zantac antagonist

Mode of Action: Competitively inhibits the action of histamine at the H2receptors of the parietal cells f the stomach, inhibiting basal gastricacid secretion and gastric acid secretion that is stimulated by food,insulin, histamine, cholinergic agonist, gastrin, and Dosage: Indication: Post Ranitidine surgery antacid 50mg to prevent q8 ulcer pentagastrin. IVTT formation

Contraindication: Hypersensitivity to ranitidine, lactation. Side Effects: headache, rash, dizziness, vertigo, constipation, diarrhea,nausea, vomiting, abdominal discomforts, local burning or itching at IVsite Adverse Effects: malaise, insomnia, somnolence, urticaria,

tachycardia,bradycardia,leukopenia,pancytopenia,thrombocytopenia,gynecomastia, impotence, hepatitis Drug Drug Interaction: Increased effects of warfarin, tricyclicantidepressants Nursing 1.Assess 2.Assess patient for for baseline Responsibilities: contraindication. data.

3.Tell patient that he may experience side effects brought aboutby the drug. 4.Instruct patient to take his meal if nausea or vomiting occurs.

5.Oral care if vomiting occurs. 6.Adjust lighting and temperature and avoid noise if heexperiences headache and instruct him to report if it isintolerable so that medication may be given. 7. Instruct him to report intolerable side effects so as promptintervention could be done. 8.Instruct him to report adverse effects that he may experience Generic Brand Classification: Anesthesia Mode of Action: Block the generation and the conduction of nerveimpulses, presumably by increasing the threshold for electricalexcitation in the nerve, by Name: Name: Bupivacaine Bupican

slowing the propagation of the nerveimpulse, and by reducing the rate of rise of the action potential. Theanalgesic effects of Bupivacaine are thought to be due to its binding tothe prostaglandin E2 receptors, subtype EP1 (PGE2EP1), which inhibitsthe production of prostaglandins, thereby reducing fever,inflammation, and hyperalgesia Dosage: Indication: Bupivacaine Local or 0.25% regional 10cc anesthesia; + 0.25MSO4 for OD surgery

analgesia

Contraindication: Hypersensitivity to bupivacaine or other localanesthesia e.g. lignocaine, blood clotting disorder, low blood pressure, Side Effects: nervousness, tingling around the mouth, tinnitus, tremor,dizziness, blurred vision, ringing of the ears, feeling of disorientation,nausea, vomiting, drowsiness, numbness of tongue, lightheadedness Adverse Effect: convulsion, seizures, unconsciousness, arrhythmias,tachycardia, bradycardia, cardiac arrest, hypotensive shock,respiratory arrest, myocardial depression, Drug Drug Interaction: Additive effects when used withantiarrhythmic drugs Nursing 1.Assess 2.Assess for baseline data. 3. Monitor vital signs carefully, drug depresses the pulmonaryand cardiac system. 4.Monitor for side effects. 5.Tell patient that he may experience side effects brought aboutby the drug and if such is/are intolerable he must report themso as prompt interventions be done. 6.Oral care if vomiting occurs. 7.Monitor for occurrence of adverse effects, report to theanesthesiologist any signs and symptoms of adverse effects. 8.Continue to monitor patient following discontinuation ofanesthesia for Responsibilities: contraindication.

Generic Brand

Name:

Magnesium

Sulfate Name:

Classification: Electrolyte, Antiepilecptic, Antihypertensive, Laxative Mode of Action: An important cofactor for enzymatic reactions andplays an important role in neurochemical transmission and muscularexcitability; prevents or controls convulsions by blockingneuromuscular transmission and decreasing the amount ofacetylcholine liberated at the end plate by the motor nerve impulse;attracts and retains water in the intestinal lumen and distends thebowel to promote mass movement and relieve constipation; actsperipherally to produce vasodilation; larger doses cause lowering ofblood pressure. Dosage: Bupivacaine 0.25% 10cc + 0.25MSO4 OD Indication: Parenteral anticonvulsant for the prevention and control ofseizures, lowers BP while in surgery Contraindication: Hypersensitivity to magnesium sulfate, heart block,myocardial damage; abdominal pain, appendicitis, fecal impactation,hepatitis, intestinal and biliary tract obstruction Side Effects: weakness, dizziness, excessive bowel movement,sweating, flushing, headache, nausea, vomiting, palpitations Adverse Effects: fainting, magnesium intoxication, hypotension,depressed reflexes, flaccid, paralysis, hypothermia, circulatorycollapse, cardiac and CNS depression, hypocalcemia, tetany Drug Drug Interaction: uced bynondepolarizingneuromuscularrelaxants(tubocurarine,atracurium, vecuronium) pancuronium,

antagonized by calcium. andtobramycin when given together. Nursing 1.Assess 2.Assess for baseline data. for Responsibilities: contraindication.

3. Do not administer unless solution is clear and container isundamaged. Discard unused portion. 4.Monitor knee-jer reflex before repeated parenteraladministration. If it is suppressed, do not administer the drugfor it may cause respiratory center failure. 5.Administer with caution if flushing and sweating occurs. 6.Have calcium gluconate readily available if signs andsymptoms of

hypermagnesemia occur. 7.Tell patient that he may experience some side effects broughtabout by the drug and instruct him to report intolerable sideeffects so as prompt intervention be done. 8.Oral care when vomiting occurs.