DRUG NAME

MODE OF ACTION

INDICATION

ADVERSE
DRUG REACTION

NURSING
CONSIDERATION

Brand Name: LANOXIN

Generic Name: Digoxin
Drug Class: Antiarrhythmics,
inotropics

Increases the force of

myocardial
contraction. Prolongs
refractory period of the
AV node. Decreases
conduction through the
SA and AV nodes.
Increased cardiac
output (positive
inotropic effect) and
slowing of the heart
rate (negative
chronotropic effect).

Cardiac failure
accompanied by
atrial fibrillation;
management of
chronic cardiac
failure where systolic
dysfunction or
ventricular dilatation
is dominant;
management of
certain
supraventricular
arrhythmias,
particularly chronic
atrial flutter &
fibrillation.

CNS disturbances,
dizziness; visual
disturbances (blurred or
yellowish vision);
arrhythmia, conduction
disturbances, bigeminy,
trigeminy, PR
prolongation, sinus
bradycardia; nausea,
vomiting, diarrhea;
urticarial or
scarlatiniform w/
eosinophilia.

Monitor apical
pulse
before
administering.
Monitor blood
pressure
periodically in
patients
receiving
IV
dogoxin.
Monitor intake
and
output
ratios and daily
weights.
Observe patient
for signs and
symptoms
of
toxicity.
Oral
preparations
can
be
administered
without regard
to meals.
Before
administering
initial loading
dose, determine
whether patient
has taken any
digitalis
preparations in
the preceding 23 wk.

CONTRAINDICATIO
N

Intermittent complete
heart block or 2nd
degree AV block esp if
there is a history of
Stokes-Adams attacks;
arrhythmia caused by
cardiac glycoside
intoxication,
supraventricular
arrhythmia caused by
Wolff-ParkinsonWhite syndrome;
ventricular tachycardia
or fibrillation;
hypertrophic
obstructive
cardiomyopathy.
Hypersensitivity to
other digitalis
glycosides.

Generic Name:
TELMISARTAN
Brand Name: Micardis
Drug Class: Angiotensin II
Antagonists /
Diuretics

Telmisartan (Teli
marketed by cadila
pharma) is an
Angiotensin Receptor
Blocker (ARB) that
shows high affinity for
the angiotensin II type
1 (AT1) receptors, has
a long duration of
action, and has the
longest half-life of any
ARB.
In addition to blocking
the Renin-Angiotensin
System (RAS),
telmisartan acts as a
selective modulator of
Peroxisome
proliferator-activated
receptor gamma
(PPAR-), a central
regulator of insulin and
glucose metabolism. It
is believed that
telmisartans dual
mode of action may
provide protective
benefits against the
vascular and renal
damage caused by
diabetes and
cardiovascular disease
(CVD).
Telmisartan has
binding affinity 3000
times greater for AT1
than AT2 receptors.
Telmisartan also has
the longest half life (24

Treatment for
essential
hypertension.
Blocks
vasoconstricting.

Telmisartan: Headache,
upper respiratory tract
infection, dizziness.
Hydrochlorothiazide:
Anorexia, gastric
irritation, muscle spasm,
sleep disturbances.

Monitor client
for hypotension
after starting
drug. Place
client supine if
hypotension
occurs, and
give IV normal
saline, if
needed.
For patient
whose renal
function may
depend on the
activity of the
rennin
angiotensin
aldosterone
system (such as
those with
severe heart
failure)
treatment with
ACE inhibitors
and angiotensin
receptors
antagonist has
caused oliguria
or progressive
azotemia and
acute renal
failure or death.

Pregnancy & lactation.

Cholestasis & biliary
obstructive disorders.
Severe hepatic & renal
impairment (CrCl <30
mL/min). Refractory
hypokalemia,
hypercalcemia.

Generic Name: Esomeprazole

Brand Name: Nexium
Dug Class:
Antacids, Antireflux Agents &
Antiulcerants

Generic Name: Warfarin

Brand Names: Coumadin,
Jantoven
Drug Class: Anticoagulants,
Antiplatelets & Fibrinolytics
(Thrombolytics)

hrs) of all angiotensin

II type 1 receptor
antagonists.
Nexium(esomeprazole)
is a proton pump
inhibitor that
suppresses gastric acid
secretion by specific
inhibition of H+/K+ATPase in the gastric
parietal cell. By acting
specifically on the
proton pump, Nexium
blocks the final step in
acid production, thus
reducing gastric
acidity. This effect is
dose-related up to a
daily dose of 2040
mg and leads to
inhibition of gastric
acid secretion.

Anticoagulant.
Pharmacology:
Coumadin and other
coumarin
anticoagulants act by
inhibiting the synthesis
of vitamin Kdependent coagulation
factors. The resultant

Treatment of GERD
as an alternative to
oral therapy in
patients when oral
therapy is not
appropriate. Short term maintenace of
hemostasis &
prevention of
rebleeding in patients
following therapeutic
endoscopy for acute
bleeding of gastric or
duodenal ulcers.

Headache, abdominal
pain, constipation,
diarrhea, flatulence,
nausea, vomiting.
Injection site reaction.

Instruct patient
to take drug
exactly as
prescribed.
Tell the patient
to take drug at
least 1 hour
before a meal.
Advise patient
that antacids
can be used
while taking
drugs unless
otherwise
directed by
prescriber.

Prophylaxis &
treatment of venous
thrombosis, atrial
fibrillation w/
embolization,
pulmonary
embolism, adjunct in
prophylaxis of
systemic embolism

Potential adverse
reactions to Coumadin
may include:
Hemorrhage from any
tissue or organ. This is a
consequence of the
anticoagulant effect. The
signs and symptoms will
vary according to the

Use cautiously
with
divertiticulitis,
colitis,and mild
or moderate
hypertension, or
mild or
moderate
hepatic or renal

Hypersensitivity to
substituted
benzimidazoles.
Children.

Anticoagulation is
contraindicated in any
localized or general
physical condition or
personal circumstance
in which the hazard of
hemorrhage might be
greater than its
potential clinical

in vivo effect is a
sequential depression
of Factors VII, IX, X
and II activities. The
degree of depression is
dependent upon the
dosage administered.
Anticoagulants have
no direct effect on an
established thrombus,
nor do they reverse
ischemic tissue
damage. However,
once a thrombus has
occurred, the goal of
anticoagulant treatment
is to prevent further
extension of the
formed clot and
prevent secondary
thromboembolic
complications which
may result in serious
and possible fatal
sequelae.
Pharmacokinetics:
After oral
administration of
Coumadin, absorption
is essentially complete,
and maximal plasma
concentrations are
reached in 1-9 hrs.
Approximately 97% is
bound to albumin
within the plasma. An
anticoagulant effect
generally occurs within
24 hrs. However, peak
anticoagulant effect

after MI.

location and degree or

extent of the bleeding.
Hemorrhagic
complications may
present as paralysis;
headache, chest,
abdomen, joint or other
pain; shortness of breath,
difficult breathing or
swallowing; unexplained
swelling; or unexplained
shock. Therefore, the
possibility of
hemorrhage should be
considered in evaluating
the condition of any
anticoagulated patient
with complaints which
do not indicate an
obvious diagnosis.
Bleeding during
anticoagulant therapy
does not always correlate
with prothrombin
activity (see Treatment
under Overdosage).
Bleeding which occurs
when the PT is within
the therapeutic range
warrants diagnostic
investigation since it
may unmask a
previously unsuspected
lesion eg, tumor, ulcer,
etc.
Necrosis of skin and
other tissues (see
Warnings).
Other adverse reactions
are infrequent and

disease; with
drainage tubes
in any orifice;
with regional or
lumbar bock
anesthesia; or in
conditions that
increase risk of
hemorrhage;
also use
cautiously in
breastfeeding
women.
I.M
administration
isnt
recommended.
Tell patient to
report adverse
reactions
promptly.
Tell the patient
to eat a daily,
consistent
amount of leafy
green vegetable
containing
vitamin K.

benefits eg: Pregnancy:

Women who are or
may become pregnant
because the drug
passes through the
placental barrier and
may cause fatal
hemorrhage to the
fetus in utero.
Furthermore, there
have been reports of
birth malformations in
children born to
mothers who have
been treated with
warfarin during
pregnancy.
Embryopathy
characterized by nasal
hypoplasia with or
without stippled
epiphyses
(chondrodysplasia
punctata) has been
reported in pregnant
women exposed to
warfarin during the 1st
trimester. Central
nervous system
abnormalities also
have been reported,
including dorsal
midline dysplasia
characterized by
agenesis of the corpus
callosum, DandyWalker malformation,
and midline cerebellar
atrophy. Ventral
midline dysplasia,

may be delayed 72-96

hrs and its duration of
action may persist for
4-5 days, thus
producing a smooth,
long-lasting response
curve. Coumadin is
metabolized by hepatic
microsomal enzymes
to inactive metabolites
that are excreted into
the bile, reabsorbed
and excreted into the
urine.
Coumadin is a potent
drug with a half-life of
2 days; therefore its
effects may become
more pronounced as
daily maintenance
doses overlap.

consist of alopecia,
urticaria, dermatitis,
fever, nausea, diarrhea,
abdominal cramping,
systemic cholesterol
microembolization,
purple toes syndrome,
cholestatic hepatic injury
and hypersensitivity
reactions.
Priapism has been
associated with
anticoagulant
administration; however,
a causal relationship has
not been established.

characterized by optic
atrophy, and eye
abnormalities have
been observed. Mental
retardation, blindness,
and other central
nervous system
abnormalities have
been reported in
association with 2nd
and 3rd trimester
exposure. Although
rare, teratogenic
reports following in
utero exposure to
warfarin include
urinary tract anomalies
eg, single kidney,
asplenia, anencephaly,
spina bifida, cranial
nerve palsy,
hydrocephalus, cardiac
defects and congenital
heart disease,
polydactyly,
deformities of toes,
diaphragmatic hernia,
and corneal leukoma.
Spontaneous abortion
and stillbirth are
known to occur and a
higher risk of fetal
mortality is associated
with the use of
warfarin.
Women of
childbearing potential
who are candidates for
anticoagulant therapy
should be carefully

evaluated and the

indications critically
reviewed with the
patient. If the patient
becomes pregnant
while taking this drug,
she should be apprised
of the potential risks to
the fetus, and the
possibility of
termination of the
pregnancy should be
discussed in light of
those risks.
Hemorrhagic
tendencies or blood
dyscrasias.
Recent or
contemplated surgery
of the central nervous
system, eye, or
traumatic surgery
resulting in large open
surfaces.
Bleeding tendencies
associated with active
ulceration or overt
bleeding of the
gastrointestinal,
genitourinary or
respiratory tracts;
cerebrovascular
hemorrhage;
aneurysms-cerebral,
dissecting aorta;
pericarditis, pericardial
effusions and bacterial
endocarditis.
Threatened abortion,
eclampsia and

Generic name: Potassium

Chloride
Brand Name: Kalium Durule
Drug Class: Electrolytes and
minerals

Supplemental
potassium in the form
of high potassium food
or potassium chloride
may be able to restore
normal potassium
levels.

For hypokalemia
As prophylaxis
during treatment
with diuretics
To prevent and
treat potassium,
deficit secondary
to diuretics or
corticosteroid
therapy.
Also indicated
when potassium,
is depleted by
severe vomiting,
prolonged
diuresis and
diabetic acidosis.

renal insufficiency
hyperkalemia
nausea
vomiting
irritability
muscle weakness
difficulty in
swallowing

Some patients
find it difficult
to swallow the
large sized KCl
tablet.
Administer
while patient is
sitting up or
standing (never
in recumbent
position) to
prevent druginduced
esophagus.
Follow
instructions
regarding
dilution.
Color in some
commercial oral
solutions fades
with exposure

preeclampsia.
Inadequate laboratory
facilities or
unsupervised senility,
alcoholism, psychosis
or lack of patient
cooperation.
Spinal puncture and
other diagnostic or
therapeutic procedures
with potential for
uncontrollable
bleeding.
Miscellaneous: Major
regional, lumbar block
anesthesia and
malignant
hypertension.
>Severe renal
impairment
> severe hemolytic
reactions
> acute dehydration
>heat cramps
>hyperkalemia
Cautious use in:
>cardiac or renal
disease; systematic
acidosis

Generic Name: Spironolactone

Brand Name: Aldazide
Drug Class : Diuretics, Other
Antihypertensives

Spironolactone
promotes diuresis in
patients with oedema
or ascites.
Spironolactone acts in
the distal portion of the
renal tube by
competitive inhibition
of aldosterone, a
sodium-retaining,
potassium-excreting
hormone.
Isobutylhydrochlorothi
azide promotes sodium
and water excretion by
inhibiting sodium and
chloride reabsorption
in the kidney tubule.
The combination of
spironolactone and
isobutylhydrochlorothi
azide provides an
effective treatment for
many patients who
would not respond to
either drug alone. The
combination results in
an additive diuretic
effect since both drugs
will increase sodium
and water excretion by
acting in different parts
of the renal tubule.

Essential
hypertension,
oedema and ascites
of congestive heart
failure, cirrhosis of
the liver, the
nephrotic syndrome,
idiopathic oedema.

Gastro-intestinal
disorders: abdominal
pain, vomiting, nausea,
diarrhoea, gastrointestinal disturbance.
Body as a whole:
asthenia, fever,
anaphylactoid reaction,
malaise.
Skin and appendages:
rash, pruritis, dermatitis,
photosensitivity.
Nervous system
disorders: dizziness,
headache, paraesthesia.
Psychiatric disorders:
impotence.
Neoplasm: breast
neoplasm, including
malignancy.
Metabolic and
nutritional disorders:
electrolyte disturbances.
Reproductive disorders:
breast disorders,
menstrual disorders.
Haematological
disorders:
thrombocytopenia

to light but drug

effectiveness is
reportedly not
altered.
Educate to
avoid hazardous
activity such
driving untl
response to
drug is known.
Take with
meals; avoid
excessive
ingestion of
food high in
potassium or
use of salts
substitutes.
Diuretic effect
may be delayed
2-3 days and
maximum
hypertensive
may be delayed
2-3weeks;
monitor I and O
ratios and daily
weight, BP,
serum
electrolyte s (K,
Na) and renal
function.

Acute renal
insufficiency,
significant impairment
of renal function,
anuria, hyperkalemia
or sensitivity to
spironolactone,
thiazide diuretics or to
other sulfonamidederived
drugs.sulfonamidederived medicines.

Generic name: Citicoline

Brand name: Zynapse
Drug Class:
Neuroprotective, CNS Drugs &
Agents for ADHD

Neurovascular
enhancer.
Pharmacology:
Piracetam acts
selectively upon the
telencephalon by
improving its
associative function. It
increases the energy
output of the brain cell
and activates its
neurophysiological
potentialities,
especially in deficit
conditions. Nootropil
is virtually nontoxic
and has no stimulating,
sedative or
neurovegetative
activities.

Treatment of
cerebrovascular
accident in acute and
recovery phase,
symptoms and signs
of cerebral
insufficiency eg,
dizziness, memory
loss, poor
concentration,
disorientation, recent
cranial trauma and
their sequelae.

Gastrointestinal
disorders.
Allergic
reaction:
Itching
or
hives, swelling in your
face or hands, swelling
or tingling in your mouth
or throat, chest tightness,
trouble breathing, or
rash, Low blood pressure
(faintness,
dizziness),
Slow or fast heart beat,
Headache,
Nausea,
vomiting, or diarrhea
(loose BMs)

Verify the
doctors order.
Assess allergy
to warfarin.
Do not use rug
if the ptient is
pregnant (use
contraceptives).
Monitor closely
PT ratio and
INR.
Administer the
drug in IV form
if the client can
not take it
orally.
Document the
procedure.

Generic Name: Piracetam

Brand Names: Nootropil
Drug Class
Nootropics & Neurotonics

Pharmacology:
Piracetam acts
selectively upon the
telencephalon by
improving its
associative function. It
increases the energy
output of the brain cell
and activates its
neurophysiological
potentialities,
especially in deficit
conditions. Nootropil
is virtually nontoxic
and has no stimulating,
sedative or
neurovegetative
activities.

Treatment of post
stroke sequelae ie
aphasia, cortical
myoclonus, alone or
in combination,
vertigo & associated
disorders of balance,
w/ the exception of
dizziness of
vasomotor or psychic
origin. Symptomatic
treatment of the
psycho-organic
syndrome whose
features are memory
loss, attention
disorders & lack of
drive. Ped treatment
for dyslexia in

Hyperkinesia, wt gain,
asthenia,
nervousness,
somnolence, depression,
vertigo,upper abdominal
pain,diarrhea,nausea,
vomiting, anaphylactoid
reaction, ataxia, impaired
balance,
aggravated
epilepsy,
headache,
insomnia,
skin
&
subcutaneous
tissue
disorders.

Prior to:

Wash hands
thoroughly.
Ask the patients
name
Always observe
aseptic
technique
During:
Explain the
procedure to the
patient/SO.
Explain what is
the general
action of the
drug to the
body.
After:

Patients with
parasympathetic
hypertonia.

Cerebral
hemorrhage,
end stage renal
disease,
Huntington's
chorea.
Pregnancy &
lactation.

combination w/
appropriate measures
eg speech therapy.

Record the drug

after its
administration
(charting).

Observe the

Generic Name:
Sulodexide
Brand Name: Vessel
Due F
Drug Class : Anticoagulants,
Antiplatelets & Fibrinolytics
(Thrombolytics)
See available brands of
sulodexide

Sulodexide is a
heparinoid consisting
of 80% fast moving
heparin and 20%
dermatan sulfate. It is
hypolipidaemic and
antithrombotic and has
been administered by
mouth and parenterally
for peripheral vascular
disease and
cerebrovascular
disease. It is also
included in topical
preparations for local
vascular inflammation
and soft tissue
disorders. Sulodexide
differs from heparin by
having a longer halflife and a decreased
effect on systemic
clotting and bleeding.
As admin of heparin
and low molecular wt
heparin results in a

Antithromb
otic.

Oral: Nausea, vomiting,

epigastric
pain.
Parenteral: Pain, burning
and
haematoma
at
injection site.

patients for
possible
untoward
reaction.
Instruct to take
the medication
exactly as
directed.
Assess patients
for signs of
bleeding and
hemorrhage
(bleeding gums;
nosebleed;
unusual
bruising; black,
tarry stools;
hematuria; fall
in hematocrit or
blood pressure;
guaiac-positive
stools). Notify
physician if
these occur.
Monitor patient
for
hypersensitivity
reactions
(chills, fever,
urticaria).
Report signs to
physician.
Monitor platelet

Hypersensitivity to
sulodexide, heparin,
and heparin-like
products. Diathesis,
haemorrhagic
conditions. Pregnancy.

release of lipoprotein
lipase, the activity of
sulodexide is
expressed as
Lipoprotein lipase
Releasing Units (LSU).
1 mg of sulodexide is
equivalent to 10 LSU.

Generic Name:
Mannitol
Brand name: Osmitrol,
Resctisol
Drug Class : Diuretics,
Miscellaneous

Mannitol increases
urinary output by
inhibiting tubular
reabsorption of water
and electrolytes. It
raises the osmotic
pressure of the plasma
allowing water to be
drawn out of body
tissues.
Onset: Diuresis: 1-3
hr. Reduction in
intracerebral pressure:
around 15 min.
Duration: Reduction
in intracerebral
pressure: 1.5-6 hr.
Absorption: Small
amounts are absorbed
from the GI tract.
Distribution:
Concentrated in
extracellular
compartments. It does
not penetrate the
blood-brain barrier nor
the eye.
Metabolism: Minimal
hepatic metabolism,

Promotion of diuresis
in the prevention or
treatment of the
oliguric phase of
acute renal failure
before irreversible
renal failure becomes
established.
Reduction of
intracranial pressure
and brain mass.
Reduction of high
intraocular pressure
when the pressure
cannot be lowered by
other means.
Promotion of
urinary
excretion of
toxic
materials.
Edema

Fluid and electrolyte

imbalance;
acidosis
(with
high
doses).
Nausea, vomiting, thirst;
headache,
dizziness,
convulsions,
chills,
fever; tachycardia, chest
pain; blurred vision;
urticaria and hypotension
or hypertension; acute
renal
failure;
skin
necrosis;
thrombophloebitis.

count every 2-3

days throughout
therapy. May
cause mild
thrombocytope
nia, which
appears on the
4th day and
resolves despite
continued
heparin therapy.
The
cardiovascular
status of the
patient should
be carefully
evaluated
before rapidly
administering
mannitol since
sudden
expansion of
the extracellular
fluid may lead
to fulminating
congestive heart
failure.
Shift of
sodium-free
intracellular
fluid into the
extracellular
compartment
following
mannitol
infusion may
lower serum
sodium
concentration
and aggravate

Pulmonary congestion
or oedema; intracranial
bleeding; CHF;
metabolic oedema with
abnormal capillary
fragility; anuria due to
severe renal disease;
severe dehydration.

converted to glycogen.
Excretion: Urine via
the kidneys
(unchanged drug).

pre-existing
hyponatremia.
By sustaining
diuresis,
mannitol
administration
may obscure
and intensify
inadequate
hydration or
hypovolemia.
Electrolyte-free
mannitol
solutions should
not be given
conjointly with
blood. If it is
essential that
blood be given
simultaneously,
at least 20 mEq
of sodium
chloride should
be added to
each liter of
mannitol
solution to
avoid
pseudoagglutin
ation.
When exposed
to low
temperatures,
solutions of
mannitol may
crystalize. If
crystals are
observed, the
container
should be

warmed to
redissolve, then
cooled to body
temperature
before
administering.
See NOTE
under how
supplied. When
infusing 20% or
25% mannitol
concentrations,
the
administration
set should
include a filter.
Do not infuse
mannitol
solution if
crystals are
present.
Do
not
administer
unless solution
is clear and
container
is
undamaged.
Discard unused
portion. Do not
administer
Mannitol 25%
if the Fliptop
vial seal is not
intact.
Generic Name: Carvedilol
Brand Name: Dilatrend
Drug Class: Antihypertensive

Decreased heart rate

and pulse pressure.

Essential
hypertension; CHF.

Fatigue
Dizziness
Bradycardia
CHF

Monitor BP and
pulse prior and
throughout
therapy.
Take
apical

Diseases that constrict

the respiratory tract
(bronchial asthma,
chronic bronchitis,
pulmonary

Generic name: Mefenamic acid

Brand Name: Ponstan
Drug Class: Anti-pyretic or antipyretic and anti-inflammatory
analgesics

Ponstan has analgesic,

anti-inflammatory and
anti-pyretic properties.
The pharmacological
activity of Ponstan
may be due in part to
its ability to inhibit the
synthesis of
prostaglandins.
Ponstan also inhibits
the action of
exogenous
prostaglandins on
uterine muscle, uterine
tube contraction and
ovarian cyclic AMP
and progesterone
formation in animal
models.
Pharmacokinetics and
Metabolism:
Mefenamic acid is well
absorbed from the

Relief of pain
including muscular,
rheumatic, traumatic,
dental, post-op &
postpartum pain,
headache & in childn
w/ fever & juvenile
RA. Also for the
relief of primary
dysmenorrhea.

Pulmonary edema
Hypotension
Constipation
Impotence

Disturbances of the
gut such as
indigestion,
diarrhoea,
constipation, nausea,
vomiting or
abdominal pain
Headache
Dizziness
Drowsiness
Skin rashes
Visual disturbances
Retention of water
in the body tissues
(fluid retention),
resulting in swelling
(oedema)
Awareness of your
heartbeat
(palpitations)
Ulceration of the
stomach or

pulse, if less
than 50 bpm,
withhold
medication and
notify
physician.
Advise patient
for proper diet,
regular
exercise,
and
lifestyle
modification.
Diabetics
should closely
monitor blood
sugar.

emphysema), allergic
rhinitis, swelling of the
laryngeal mucosa,
sinus node syndrome,
SA block, 2nd & 3rd
degree AV block, too
slow heart rate, shock,
MI w/ complications,
severe liver
dysfunction, metabolic
acidosis, or
simultaneous MAOI
therapy.

Assessment & Drug

Effects
Assess patients
who develop
severe diarrhea
and vomiting
for dehydration
and electrolyte
imbalance.
Lab tests: With
long-term
therapy (not
recommended)
obtain periodic
complete blood
counts, Hct and
Hgb, and
kidney function
tests.
Patient & Family
Education
Discontinue

Ulceration in the upper

or lower intestinal
tract. Children <14

yr. Pregnancy.

gastro-intestinal tract.
Peak plasma
concentrations occur in
about 2 to 4 hours,
with a half-life of 2 to
4 hours. Plasma levels
are proportional to
dose, following
multiple doses, with no
drug accumulation.
Mefenamic acid is
extensively bound to
plasma proteins. Over
50% of the dose may
be recovered in the
urine as unchanged
drug or conjugated
metabolites.

intestines
Bleeding from the
stomach or
intestines
Inflammation of the
pancreas
(pancreatitis)
Allergic reactions
such as severe skin
rashes, swelling of
the lips, tongue and
throat (angioedema)
or narrowing of the
airways
(bronchospasm)
Kidney, liver or
blood disorders

Generic Name:
Furosemide

Furosemide inhibits
reabsorption of Na and

Oral, IV:

Fluid and electrolyte

imbalance. Rashes,

drug promptly
if diarrhea, dark
stools,
hematemesis,
ecchymoses,
epistaxis, or
rash occur and
do not use
again. Contact
physician.
Notify
physician if
persistent GI
discomfort, sore
throat, fever, or
malaise occur.
Do not drive or
engage in
potentially
hazardous
activities until
response to
drug is known.
It may cause
dizziness and
drowsiness.
Monitor blood
glucose for loss
of glycemic
control if
diabetic.
Do not breast
feed while
taking this drug
without
consulting
physician.
Administer

Severe sodium and

water depletion,

Drug Class : Diuretics

See available brands of
furosemide

Generic Name: Paracetamol

Brand Name: Aeknil
Drug Class : Analgesics (NonOpioid) & Antipyretics

chloride mainly in the

medullary portion of
the ascending Loop of
Henle. Excretion of
potassium and
ammonia is also
increased while uric
acid excretion is
reduced. It increases
plasma-renin levels
and secondary
hyperaldosteronism
may result. Furosemide
reduces BP in
hypertensives as well
as in normotensives. It
also reduces
pulmonary oedema
before diuresis has set
in.
Absorption: Fairly
rapidly absorbed from
the GI tract (oral).
Distribution: Crosses
the placenta and enters
breast milk. Proteinbinding: 99%.
Excretion: Via urine
(as unchanged); 2 hr
(elimination half-life),
may be prolonged in
neonates and renal and
hepatic impairment.
Antipyretic, analgesic.
Pharmacology:
Paracetamol produces
analgesia by raising the
threshold of the pain
center in the brain and
by obstructing

Edema
associated
with CHF,
cirrhosis,
renal disease
IV: Acute
pulmonary
edema
Oral:
Hypertensio
n

Pyrexia of unknown
origin. Fever & pain
associated w/
common childhood
disorders, tonsillitis,
upper resp tract
infections post-

photosensitivity, nausea,
diarrhoea, blurred vision,
dizziness, headache,
hypotension. Bone
marrow depression
(rare), hepatic
dysfunction.
Hyperglycaemia,
glycosuria, ototoxicity.
Potentially Fatal:
Rarely, sudden death and
cardiac arrest.
Hypokalaemia and
magnesium depletion
can cause cardiac
arrhythmias.

with food
or milk to
prevent GI
upset.
Reduce
dosage if
given with
other
antihyperte
nsives;
readjust
dosage
gradually
as BP
responds.
Give early
in the day
so that
increased
urination
will not
disturb
sleep.
Avoid IV
use if oral
use is at all
possible.

Paracetamol has rarely

been found to produce
any adverse effects in
therapeutic doses and is
usually well tolerated by
aspirin-sensitive patients.
Toxicity may result from

Instruct the
patient to take
with meals.
Have plenty of
water when
taking this drug.

hypersensitivity to
sulphonamides and
furosemide,
hypokalaemia,
hyponatraemia,
precomatose states
associated with liver
cirrhosis, anuria or
renal failure. Addison's
disease.

Nephropathy.

impulses at the painmediating

chemoreceptors. The
drug produces
antipyresis by an
action on the
hypothalamus; heat
dissipation is increased
as a result of
vasodilation and
increased peripheral
blood flow.
Pharmacokinetics:
Paracetamol is rapidly
and almost completely
absorbed from the
gastrointestinal tract.
Following oral
administration, peak
plasma levels are
attained in 10 min to 1
hr and the half-life is
75 min to 3 hrs.
Distribution of
paracetamol to most
body tissues and fluids
is both rapid and
uniform.
Paracetamol is
excreted in the urine
primarily as the
glucuronide and
smaller amounts as the
sulfate, mercapturate
and unchanged drug.
Approximately 85% of
a dose of paracetamol
is excreted in the urine
within 24 hrs after
administration.

immunization
reactions, after
tonsillectomy &
other conditions.
Prevention of febrile
convulsion.
Headache, cold,
sinusitis, muscle
pain, arthritis &
toothache.

a single toxic dose of the

drug or from chronic
ingestion.
The following adverse
reactions have been
reported: Skin eruption,
hematological toxicity
eg, thrombocytopenia
and leucopenia,
methemoglobinaemia
which can result in
cyanosis, and on longterm use, renal damage
can result.

Generic Name: NALBUPHINE

HYDROCHLORIDE
Brand Name: Nubain
Class : Anaesthetics - Local &
General, Analgesics
(Opioid)

Pharmacology:
Nalbuphine HCl is a
potent analgesic, 10
mg of which is
comparable in
analgesic potency to 810 mg of morphine
sulfate, whether
administered IV, SC or
IM.
The onset of action
occurs within 2-3 min
after IV administration
of nalbuphine HCl and
in <10 min following
SC or IM injection.
Clinical experience
suggests that in some
patients, analgesia may
be longer lasting than
from comparable doses
of morphine, effects
having been observed
in acute and chronic
pain for 3-8 hrs. The
t of nalbuphine is 5
hrs.
Nalbuphine HCl has
the effect of lowering
the cardiac work load
and can be used
immediately in
myocardial infarction
(use with caution
where emesis is
involved).
Hemodynamic studies
in patients with severe
arteriosclerotic heart

Relief of moderate to
severe pain. Pre-op
analgesia, as a
supplement to
balanced anesth,
surgical anesth, for
obstet analgesia
during labor & relief
of pain following MI.
Post-op somatic &
visceral pain.

Sedation. Infrequently
sweating, GI upsets,
vertigo, dizziness; dry
mouth; headache,
allergic reactions.

Note general
client condition.
Document
indications for
therapy, type/
onset of
symptoms &
anticipated.
Monitor V/S &
I&O.

Patients who are

hypersensitive
to nalbuphine
HCl.

changes reveal that

nalbuphine HCl has
circulatory effects
similar to those of
morphine ie, a minimal
decrease in oxygen
consumption, cardiac
index, left ventricular
end diastolic pressure
and cardiac work.
Nalbuphine HCl
antagonist activity is
as potent as nalorphine
and approximately
1/40 that of naloxone.
Generic Name: Cilostazol
Brand Name: Pletal
Drug Class : Anticoagulants,
Antiplatelets &
Fibrinolytics
(Thrombolytics)

Cilostazol is a
reversible, selective
inhibitor of
phosphodiesterase-III
(PDE-III), thereby
suppressing cyclic
adenosine
monophosphate
(cAMP) degradation.
Increase in cAMP in
platelets and blood
vessels leads to
inhibition of platelet
aggregation and
vasodilation.
Cilostazol also inhibits
adenosine uptake into
cells, which augments
the cAMP-elevating
effect of PDE-III
inhibition.
Absorption: Absorbed
from the GI tract after
oral admin.

Peripheral vascular
disease

Headache, dizziness,
palpitations, diarrhoea,
abnormal stools; pain,
infection; peripheral
oedema, nausea,
vomiting, other cardiac
arrhythmias, chest pain,
rhinitis, pharyngitis,
ecchymosis and skin
rash.

Before:
Do not expose
premixed
single-dose
product to
excessive heat;
store at 15-30
C.
List drugs
prescribed to
ensure none
interact
unfavorably.
Assess location,
characteristics,
extent of
abdominal pain;
note blood in
emesis, stool/
gastric aspirate.
During:
Administer PO
medication with
meals & with a

Heart failure;
known
predisposition to
bleeding; history
of ventricular
arrhythmias; QT
interval
prolongation;
severe renal
impairment;
moderate to
severe hepatic
impairment.

Distribution: 95-98%
bound to plasma
proteins.
Metabolism:
Extensively
metabolised
hepatically by CYP450
isoenzymes, mainly
CYP3A4.
Excretion: Mainly
excreted in the urine,
remainder excreted in
the faece

Generic Name: Potassium

Chloride
Brand Name: K-Dur, K-Lor,
K-Tab, Kaon CL,
Klorvess, Slow-K,
Ten-K, Klotrix, KLyte CL
Drug Class : Electrolytes

Potassium chloride is a
major cation of the
intracellular fluid. It
plays an active role in
the conduction of
nerve impulses in the
heart, brain and
skeletal muscle;
contraction of cardiac
skeletal and smooth
muscles; maintenance
of normal renal
function, acid-base
balance, carbohydrate
metabolism and gastric
secretion.
Absorption: Well
absorbed from the

Prevention of
hypokalaemia

GI ulceration (sometimes
with haemorrhage and
perforation or with late
formation of strictures)
following the use of
enteric-coated K chloride
preparation;
hyperkalaemia. Oral:
Nausea, vomiting,
diarrhoea and abdominal
cramps. IV: Pain or
phloebitis; cardiac
toxicity.

snack at
bedtime.
In renal
dysfunction, a
dose of 300 mg
PO/ IV g 12 hr.
may be
necessary.
For IM use,
give undiluted.
After:
Note general
client condition.
Document
indications for
therapy, type/
onset of
symptoms &
anticipated.
Monitor V/S &
I&O.
Monitor plasma
potassium
levels
Monitoring of
acid-base
balance,
potassium
levels, and ECG
is
recommended.

Hyperchloraemia,
severe renal or adrenal
insufficiency.

upper GI tract.
Distribution: Active
transport mechanism
allows K chloride to
enter cells from the
extracellular fluid.
Excretion: Mainly via
the urine with small
amounts via the sweat
and feces.