NAME/

CLASSIFICATION

OMEPRAZOLE
Classification:
Proton-pump inhibitor

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

A
gastric-pump
inhibitor.
Suppress
gastric acid secretion
by specific inhibition of
the
hydrogenpotassium
ATPase
enzyme system at
secretory surface of
the gastric parietal
cells; blocks the final
step
of
acid
production.

Reduce risk of upper

G.I
bleeding
in
critically ill-patient.

Contraindicated with
hypersensitivity
to
omeprazole or its
components.

Cns:
Headache,
dizziness, fatigue,
G.I:
Diarrhea,
abdominal
pain
nausea, mild transient
increases in liver
function tests.
Urogenital:
Hematuria,
proteinuria
Skin: Rash

NURSING
RESPONSIBILITIES

-Dosage adjustment
may be necessary in
patients with hepatic
impairment.
-Advise patient that
the
drug
doesnt
intended to treat
infrequent heartburn
or for those who want
immediate relief of
heartburn.
-Instruct patient to
continue
prescribed
regimen to ensure
complete healing.

53

NAME/
CLASSIFICATION
KETOROLAC
Classification:
Non steroidal anti
inflammatory agent

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

- Inhibits prostaglandin
synthesis, producing
peripherally mediated
analgesia
- Also has antipyretic
and anti-inflammatory
properties.
Therapeutic
effect:Decreased pain

Short
term
management of pain

-Contraindicated
in
patients
hypersensitive to drug
and those with active
peptic ulcer disease,
recent G.I. bleeding or
perforation, advanced
renal impairment, for
volume
depletion,
suspected
or
confirmed
cerebrovascular
bleeding
bleeding,
hemorrhagis diathesis,
incomplete
hemostasis, or high
risk of bleeding

CNS:
drowsiness,
abnormal
thinking,
dizziness,
euphoria,
headache
RESP: asthma, dyspnea
CV: edema, pallor,
vasodilation
GI:
GI
Bleeding,
abnormal
taste,
diarrhea, dry mouth,
dyspepsia, GI pain,
nausea
GU: oliguria,
renal
toxicity,
urinary
frequency,
DERM:
pruritis,
purpura
sweating
urticaria
HEMAT:
prolonged
bleeding
time
LOCAL:
injection site pain
NEURO:
paresthesia
MISC:
allergic
reaction,
anaphylaxis

NURSING
RESPONSIBILITIES
-Hypersensitivity
reactions. Assess for
rhinitis, asthma, and
urticaria.
- Assess pain (note
type, location, and
intensity) prior to and
1-2
hr
following
administration.
- Ketorolac therapy
should always be given
initially by the IM or IV
route. Oral therapy
should be used only as
a continuation of
parenteral
therapy.
- Caution patient to
avoid concurrent use
of alcohol, aspirin,
NSAIDs,
acetaminophen,
or
other OTC medications
without
consulting
health
care
professional.
- Advise patient to
consult if rash, itching,
visual
disturbances,
tinnitus, weight gain,
edema, black stools,
persistent headache.

54

NAME/
CLASSIFICATION

ACTION

INDICATION

TRAMADOL
HYDROCHLORIDE

Binds
mu-opiod
receptors.
Inhibits
reuptake of Serotonin
and Norepinephrine in
the CNS

Moderate
moderately
pain

Classification:
Analgesic

to
severe

CONTRAINDICATION

ADVERSE EFFECT

NURSING
RESPONSIBILITIES

Hypersensitivity, pts.
who are intoxicated
with alcohol

CNS:
Dizziness,
headache,
malaise,
sleep
disorder,
weakness
GI:
Constipation,
nausea,
abdominal
pain,
flatulence,
vomiting
GU: Urinary retention
DERM: Sweating

-Assess type, location

and intensity of pain
before and 2-3 hours
after administered.
-Assess Bp and RR
before and periodically
during administration.
-Assess bowel function
routinely. Prevention
of constipation should
be instituted with
increased intake of
fluid and bulk and with
laxatives to minimize
constipation effect.

55

NAME/
CLASSIFICATION
NICARDIPINE
Classification:
Anti anginals

ACTION
A Calcium channel
blocker that inhibits
calcium ion influx
across cardiac and
smooth-muscle cells,
decreasing myocardial
contractility
and
oxygen demand. Also
dilates
coronary
arteries
and
arterioles.

INDICATION
Management
Hypertension

of

CONTRAINDICATION

ADVERSE EFFECT

-Contraindicated
in
patients
hypersensitive to drug
and in those with
advanced
aortic
stenosis.
-Use cautiously in
patients
with
hypotension,
heart
failure, or impaired
hepatic and renal
function

CNS: Dizziness, light

headedness,
head
ache, asthenia
CV: Peripheral edema,
palpitation,
angina,
tachycardia, flushing
GI: Nausea, abdominal
discomfort, dry mouth
SKIN: Rash

NURSING
RESPONSIBILITIES
-Measure
Blood
pressure
frequently
during initial theraphy
-Advise patient to
report chest pain
immediately.
Some
patients
may
experience increased
frequency, severity, or
duration of chest pain
at
beginning
of
therapy or during
dosage adjustments
-Inform patient to get
up from a sitting or
lying position slowly to
avoid dizziness caused
by a decreased in
blood pressure.

56

NAME/
CLASSIFICATION

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

NURSING
RESPONSIBILITIES

CELECOXIB

Thought to inhibit
prostaglandin
synthesis, primarily via
inhibition
of
cyclooxygenase2(COX-2),
thereby
producing
antiinflammatory,
analgesics,
and
antipyretic effects.

-Adjunctive treatment
for
familial
adenomatous
polyposis to reduce
the
number
of
adenomatous
colorectal polyps.

-Contraindicated
in
patients
hypersensitive to drug,
sulfonamide, aspirin,
or other NSAIDs
-Contraindicated
in
those with severe
hepatic impairment
-Use cautiously in
elderly or debilitated
patients.

-CNS:
Dizziness,
headache, insomnia
-CV: Peripheral edema
-EENT:
Pharyngitis,
rhinitis, sinusitis
-G.I:
Abdominal
pain,diarrhea,
dyspepsia, flatulence,
-METABOLIC:
Hyperchloremia
-MUSCULOSKELETAL:
Back pain
-Respiratory:
upper
respiratory
tract
infection

-Assess pts history

of allergic reaction to
the drug
-Instruct patient to
take drug with food or
milk
-Advise patient to
immediately report
bloody stools, blood in
vomit, or signs or
symptoms of liver
damage(nausea,
fatigue,
lethargy,
pruritus, yellowing of
eyes or skin, tenderness
on upper right side
of abdomen, or flulike
symptoms).

Classification:
Non steroidal anti
inflammatory drug

57

NAME/
CLASSIFICATION

METRONIDAZOLE
Classification:
Anti-infectives,
Anti-protozoals

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

-Disrupts DNA and

protein synthesis in
susceptible organisms
Bactericidal,
or
amebicidal action

-Amebicide in the
management
of
amebic dysentery

-Contraindicated with
hypersensitivity
to
Metronidazole
-Use cautiously in
patient with renal
disease

CNS:
seizures,
dizziness, headache
GI: abdominal pain,
anorexia,
nausea,
diarrhea, dry mouth,
glossitis, unpleasant
taste, vomiting
Hematologic:
leukopenia
Skin: rashes, urticaria

NURSING
RESPONSIBILITIES

- Inform patient that

medication may cause
urine to turn dark.
-If local reactions
occur, advise patient
to stop using it.
- Advise patient to
consult health care
professional if no
improvement in a few
days or if signs and
symptoms of super
infection.

58

NAME/
CLASSIFICATION
MORPHIN SULFATE
Classification:
Opoiod
agonistantagonist analgesic

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

Act as agonist at
specific opiod receptor
in the CNS to produce
analgesia, euphoria,
sedation.

-Relief of moderate to
severe and chronic
pain.
-Preoperative
medication to sedate
and
allay
apprehension,
facilitate induction of
anesthesia, and reduce
anesthetic dosage
-Intraspinal use with
microinfusion devices
for the relief of
intractable pain.

- Hypersensitivity to
opiates; upper airway
obstruction;
acute
asthma;
diarrhea
caused by poisoning or
toxins.

CNS:Light headedness,
dizziness,
euphoria,
dysphoria,
delirium,
insomnia,
agitation,
anxiety, fear, mood
changes,
weakness,
tremor,
visual
disturbances,
suppression of cough
reflex.
CV:Facial
flushing,
peripheral circulatory
collapse, tachycardia,
arrhythmia,
palpitations,
hypertension
G.I:Nausea, vomiting,
dry mouth, anorexia,
constipation,
G.U:Oliguria,
antidiuretic
effect,
reduced libido, spasm
of vesical sphincter.

NURSING
RESPONSIBILITIES
- Explain that full
effectiveness of drug
may not occur for 30 to
60 min after
administration.
Emphasize that drug is
more effective if taken
regularly to prevent
pain rather than to
treat pain after it
occurs.
- Explain that physical
dependency may occur
with long-term therapy
and that dosage will be
tapered slowly before
stopping to prevent
withdrawal symptoms
(nausea, vomiting,
cramps, fever,
faintness, anorexia).
- Inform patient that
drug may cause
constipation. Stool
softener, fiber laxative,
increased fluid intake
and bulk in diet may
help alleviate problem.
- Advise patient that
drug may cause
drowsiness, blurred

59

vision and to use

caution while driving or
performing other tasks
requiring mental
alertness.

60

NAME/
CLASSIFICATION
NALBUPHINE
Classification:
Opiod
agonistantagonist analgesic

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

Agonist at specific
opiod receptors in the
CNS
to
produce
analgesia
and
sedation but also acts
to cause hallucination
and is an antagonist at
mureceptors

-Relief moderate to
severe pain
-Preoperative
analgesia,
as
a
supplement to surgical
anesthesia

-Contraindicated with
hypersensitivity
to
nalbuphine, sulfites
-Use cautiously with
emotionally unstable
patients or those with
a history of opiod
abuse,
respiratory
depression,
anoxia,
increased intracranial
pressure, biliary tract
surgery

Cns:
Sedation,
clamminess, sweating,
headache,
nervousness,
restlessness,
depression,
crying,
confusion, faintness,
hostility,
unusual
dreams, hallucinations,
euphoria, dysphoria,
dizziness, vertigo, ,
feeling of heaviness,
numbness,
tingling,
flushing,
warmth,
blurred vision
Cv:
Hypotension,,
bradycardia,
Gi:Nausea, vomiting,
cramps,
dyspepsia,
asthma
Gu:Urinary urgency
Respiratory:
Respiratory
depression, dyspnea,
asthma

NURSING
RESPONSIBILITIES
-Taper dosage when
discontinuing
after
prolonged use to avoid
withdrawal symptoms.
-Reassure
patient
about
addiction
liability; most patients
who receive opiates
for medical reasons do
not
develop
dependence
syndromes.

61

NAME/
CLASSIFICATION

METOPROLOL
Classification:
Beta1-selective
adrenergic
blocker,
Antihypertensive

ACTION

Competitively blocks
beta-adrenergic
receptors in the heart
and
glomerular
apparatus, decreasing
the influence of the
sympathetic nervous
system
on
these
tissues
and
the
excitability of the
heart,
decreasing
cardiac output and the
release of renin, and
lowering BP; acts in
the CNS to reduce
sympathetic outflow
and
vasoconstrictor
tone.

INDICATION

Hypertension, alone
or with other drugs,
especially diuretics.

CONTRAINDICATION

Contraindicated
with sinus bradycardia
(HR < 45 beats/min),
secondor
thirddegree heart block (PR
interval > 0.24 sec),
cardiogenic
shock,
CHF, systolic BP < 100
mm Hg

ADVERSE EFFECT

NURSING
RESPONSIBILITIES

CNS: Dizziness, vertigo,

tinnitus,
fatigue,
emotional depression,
paresthesias,
sleep
disturbances,
,
disorientation, slurred
speech.
CV:CHF,
cardiac
arrhythmias,
peripheral
vascular
insufficiency,
claudication,
CVA,
pulmonary
edema,
hypotension.
SKIN: Rash, pruritus,
sweating, dry skin
G.I: Gastric pain,
flatulence,
constipation, diarrhea,
nausea,
vomiting,
anorexia,
ischemic
colitis,
renal
and
mesenteric
arterial
thrombosis,
retroperitoneal
fibrosis,
hepatomegaly, acute
pancreatitis

-Do not discontinue

drug abruptly after
long-term
therapy
(hypersensitivity
to
catecholamines may
have
developed,
causing exacerbation
of angina, MI, and
ventricular
arrhythmias).
Taper
drug gradually over 2
wk with monitoring.
- Ensure that patient
swallows the tablets
whole; do not cut,
crush, or chew.
-Consult
physician
about
withdrawing
drug if patient is to
undergo surgery
-Give oral drug with
food
to
facilitate
absorption.

62

63