X.

DRUG STUDY
Date Ordered: July 5, 2013
Adverse
Drug

Drug Class

Dosage

Action

Indication

Contraindications

Epinephrine

Adrenergic

0.01mg/ml

- Relaxes bronchial smooth

muscle by stimulating beta2
receptors and alpha and
beta receptors in the
sympathetic nervous system

Bronchospasm,
hypersensitivity
reactions,
anaphylaxis

- Contraindicated to
pt. hypersensitive
to the drug

0.1mg/ml
0.5mg/ml
1mg/ml
5mg/ml

- Acute Asthma
attack
- To prolong
local anesthesia
effect
- to restore
cardiac rhythm
in cardiac arrest

- Contraindicated to
patients with
narrow-angle
glaucoma; shock
other than
anaphylactic shock;
hypovolemia;
general anesthesia
with halogenated
hydrocarbons or
cyclopropane;
organic brain
damage, cerebral
arteriosclerosis;
cardiac dilation and
coronary
insufficiency;
tachyarrhythmias;
ischemic heart
disease;

Effect
- ceerebral
hemorrhage
- stroke
- ventricular
fibrillation
- shock
nausea and
vomiting
- tachycardia
- palpitations

Nursing
Considerations
- drug interferes
with tests for
urinary
catecholamines
- drug of choice in
emergency
treatment of acute
anaphylactic
reactions
- observe patient
closely for
adverse reaction
- if blood pressure
increases sharply,
give rapid acting
vasodilators, such
as nitrates and
alpha blockers, to
counteract
marked pressor
effect of large

hypertension; renal
dysfunction
- Contraindicated
with patients
receiving general
anesthesia with
halogenated
hydrocarbons or
cyclopropane and
in patients in labor
- Contraindicated
for use in fingers,
toes, ears, nose ,
or genitalia when
used with local
anesthetic

doses
- when treating
patients with
reactions caused
by other drugs
given I.M. or
subcutaneously,
inject this drug
into the site where
the other drug
was given to
minimize further
absorption
- drug is rapidly
destroyed by
oxidizing
products, such as
iodine, chromates,
nitrites, oxygen
and salts of easily
reducible metals

Adverse
Drug

Drug Class

Dosage

Action

Indication

Contraindications

Effect

Tramadol

Opioid Analgesic

50mg

- A centrally acting
synthetic analgesic
compound not
chemically related to
opioids. Thought to bind
opioid receptors and
inhibit reuptake of
norepinephrine and
serotonin

- Indicated to
moderate to
moderately
severe pain

- Contraindicated to
pt. hypersensitive to
the drug and other
opioids. Pt. with
history of codeine
and other opioids
may be at risk

- seizures

- Use cautiously in
pt. at risk for
seizures or
respiratory
depression; pt. with
increased ICP or
head injury or renal
or hepatic
impairment

- nausea and
vomiting

-vasodilation
-respiratory
depression
- constipation

- urine
retention

Nursing
Considerations
- Assess pt.
level of pain at
least 30mins
after
administration
- Monitor bowel
and bladder
function
- Monitor pt. for
signs of drug
dependence

- Use cautiously in
pt. with physical
dependence on
opioids
Adverse
Drug

Drug Class

Dosage

Action

Indication

Contraindications

Effect

Nursing
Considerations

Dopamine

Adrenergic

40mg/ml
80mg/ml
160mg/
ml

-stimlates dopaminergic
and alpha and beta
receptors of the
symphathetic nervous
system resulting in a
positive inotropic effect
and increased cardiac
output. Action is doserelated; large dose
cause mainly alpha
stimulation

-to treat shock

and correct
hemodynamic
imbalances;
to improve
perfusion to
vital organs;to
increase
cardiac
output;to
correct
hypotension

- contraindicated in
patients with
uncorrected
tacharrhythmias,
pheochromocytoma,
or ventricular
fibrillation
- use cautiously in
patient with
occlusive vascular
diease, cold injuries,
biabetic endarteritis

- Tventricular
arrhythmias
- asthmatic
episodes
- exctopic
beats
palipations
- nausea and
vomiting

- drug isnt a
substitute for
blood or fluid
volume deficit
- during infusion,
monitor ECG,
BP, cardiac
output, CVP,
pulmonary
artery wedge
pressure, color
and temperature
of limbs

Adverse
Drug

Ranitidine

Drug Class

Dosage

Action

Indication

Contraindications

Effect

H2 receptor
antagonist

1mg/ml

-Competitively inhibits
action on histamine on
the H2 receptor sites of
parietal cells,
decreasing gastric acid
secretion

-active
duodenal and
gastric ulcer

- contraindicated if
patient has
hypersensitivity ot
drug

- headahe

- use cautiously in
patients with
hepatic dyfunction

- jaundice

25mg/ml
75mg
150 mg
300mg

- pathologic
hypersecretory
condition
Gastroesopha
geal reflux
Erosive
esophagitis
heartburn

- blurred
vision

- anaphylaxis
angioedema

Nursing
Considerations

- assess patient
for abdominal
pain. Note for
presence of
blood in emesis,
stool, or gastric
aspirate
- drug may be
added to total
parental
nutritional
soluions

Adverse
Drug

Tetanus
Toxoid

Drug Class

Dosage

Action

Indication

Contraindications

Effect

Toxoid

250
units vial
or
syringe

-provides passive
immunity to tetanus

- tetanus

- contraindicated in
patients with
thrombocytopenia or
other coagulation
disorders that would
contraindicate I.M.
injection unless
benefitsoutweight
risks

- slight fever

postexposure
prevention of
tetanus after
injurt, in
patients whoe
immunization
is incomplete
or unknown

- nephrotic
syndrome
- stiffenss
- erythema at
injection site
- anaphylaxis
angioedema

Nursing
Considerations

- obtain history
of injury
- last tetanus
toxoid
injectiontetanus
immune globulin
is used only if
wound is more
than 24 hours
old or patient
has had fewer
than two tetanus
toxoid injections

Adverse
Drug

Drug Class

Dosage

Action

Indication

Contraindications

Lidocaine
hydrochlori
de

Amide derivative

Injetion( fo
r direct IV
use): 1%
(10mg/ml,
2%(20mg/
ml)

A class 1B
antiarrhythmic that
decreases the
depolarization,
automaticity and
excitability in the
ventricles during
diastolic phase by
direct action on the
tissues specially the
purkinjie network

Ventriculat
arrhythmias
cause b MI,
cardiac
manipulation,
or cardiac
glycosides

- contraindicated to
patients with
hypersensitivity to
amide-type local
anesthesia

Injection(f
or IV
admixture
s):
4%(40mg/
ml),
10%(100
mg/ml),
20%(200
mg/ml)

- use cautiously and

at reduced dosages
in patients with
complete or seconddegree heart block
or sinus brady
cardia, heart failure
or renal or hepatic
disease, and in
those who weigh
less than 50kg

Effect

Seizure
Bradycardia
Arrhythmias
Respiratory
depression
or arrest
Anaphylaxis
Tremor
Tinnitus
Sensation of
cold

Nursing
Considerations

-give IM
injections in the
deltoid muscle
only
- Monitor drug
levels.
Therapeutic
levels are 2 to
5mcg/ml
- if arrhythmias
worse or ECG
changes, stop
infusion and
notify prescriber
- monitor patient
for toxicity.
Seizures may be
the first sign of
toxicity

Adverse
Drug

Drug Class

Dosage

Action

Tranexamic
Acid

Anti-fibrinolytic,
antihemorrhagic

Injetion( fo
r direct IV
use): 1%
(10mg/ml,
2%(20mg/
ml)

a synthetic derivative
of the amino acid
lysine. It exerts its
antifibrinolytic effect
through the reversible
blockade of lysinebinding sites on
plasminogen
molecules. Inhibits
endometrial
plasminogen activator
and thus prevents
fibrinolysis and the
breakdown of blood
clots. By inhibiting the
action of plasmin
(finronolysin) the antifibrinolytic agents
reduce excessive
breakdown of fibrin
and effect
physiological
hemostasis.

Injection(f
or IV
admixture
s):
4%(40mg/
ml),
10%(100
mg/ml),
20%(200
mg/ml)

Indication

Contraindications

used for the

prompt and
effective
control of
hemorrhage

- contraindicated to
patients with
hypersensitivity to
drug

- effective in
promoting
hemostasis is
traumatic
injuries
- epistaxis,
hemoptysis,
hematuria,
peptic ulcer
with
hemorrhage
and blood
dyscrasis with
hemorrhage

- presence of blood
clots, have a history
of blood clots or are
at risk for blood clots
- current
administration of
factor IX complex
concentrates or antiinhibitor coagulant
concentrates

Effect

Chest pain
Calf pain
Confusion
Coughing up
blood
Decreased
urination
Severe or
persistent
headache
Shortness of
breath
Slurred
speech
Vision
change

Adverse

Nursing

Nursing
Considerations

-unsual change
in bleeding
pattern should
be immediately
reported to the
physician
- tranexamic
achid should be
used with
extreme caution
in children
younger than
18y/o
medication can
be taken with or
without meals

Drug
Ketorolac

Drug Class
Nonsteroidal
antiinflammatory
drugs

Dosage
30mg/1
amp

Action

- May inhibit prostaglandin

synthesis, to produce antiinflammatory, analgesic,
and anti-pyretic effects.

Indication
- Short-term
management
of
moderately
severe,
acute pain

Contraindicati
ons

Effect

- Contraindicated to
pt. hypersensitive
to the drug

- drowsiness

- Use cautiously in
patient who are
elderly or have
hepatic or renal
impairment or
cardiac
decompensation

-headache

- euphoria

- edema
-dyspnea
-GI bleeding
- oliguria
-renal toxicity
-utricaria
-paresthesia
-prolonged
bleeding time

Consideration
s
Patients who
have asthma,
aspirininduced
allergy, and
nasal polyps
are at
increased risk
for developing
hypersensitivit
y reactions.
Assess for
rhinitis,
asthma, and
urticaria.
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,
acetaminophe
n, or other
OTC
medications
without
consulting
health care
professional.

Adverse
Drug

Drug Class

Dosage

Ampicillin

Antiinfective

250 mg,
500 mg
capsules;
125
mg/5 mL,
250 mg/5
mL oral
suspensi
on; 125
mg, 250
mg, 500
mg, 1
gm, 2 gm
vials

Action
A broad-spectrum
semisynthetic
aminopenicillin, is highly
bactericidal even at low
concentrations, but is
inactivated by
penicillinase (betalactamase).

Indication

Contraindications

Effect

Infections of
GU,
respiratory,
and GI tracts
and skin and
soft tissues;
also
gonococcal
infections,
bacterial
meningitis,
otitis media,
sinusitis, and
septicemia
and for
prophylaxis of
bacterial
endocarditis.
Used
parenterally
only for
moderately
severe to
severe
infections.

- Contraindicated to
pt. hypersensitive
to the drug

Lethargy

- Use cautiously in
patient with renal
disorder

Stomatitis

Glossitis

Abd pain
Nephritis
Anemia
Thrombocyto
penia
Rash
Fever
Phlebitis
super
infections

Nursing
Considerations
- asses for
allergies to
penicillins
- check Iv site
carefully for
signs of
thrombosis or
drug reaction
- do not give IM
injections in the
same site;
atrophy can
occur

Adverse
Drug

Drug Class

Dosage

Action

Indication

Contraindications

Lidocaine
hydrochlori
de

Amide
derivative

Injetion( for
direct IV use):
1% (10mg/ml,
2%(20mg/ml)

A class 1B
antiarrhythmic that
decreases the
depolarization,
automaticity and
excitability in the
ventricles during
diastolic phase by
direct action on the
tissues specially the
purkinjie network

Ventriculat
arrhythmias
cause b MI,
cardiac
manipulation,
or cardiac
glycosides

- contraindicated to
patients with
hypersensitivity to
amide-type local
anesthesia

Injection(for IV
admixtures):
4%(40mg/ml),
10%(100mg/ml
),
20%(200mg/ml
)

- use cautiously and

at reduced dosages
in patients with
complete or seconddegree heart block
or sinus brady
cardia, heart failure
or renal or hepatic
disease, and in
those who weigh
less than 50kg

Effect

Seizure
Bradycardia
Arrhythmias
Respiratory
depression
or arrest
Anaphylaxis
Tremor
Tinnitus
Sensation of
cold

Nursing
Considerations

-give IM
injections in the
deltoid muscle
only
- Monitor drug
levels.
Therapeutic
levels are 2 to
5mcg/ml
- if arrhythmias
worse or ECG
changes, stop
infusion and
notify prescriber
- monitor patient
for toxicity.
Seizures may be
the first sign of
toxicity

Adverse
Drug

Vitamin B
complex

Drug Class

Dosage

Vitamins
and mineral

100mcg/ml
1000mcg/ml

Action

A coenzyme that
stimulate
metabolic
function and is
needed for cell
replication,
hematopoiesis,
and nucleoprotein
and myelin
synthesis..

Indication

Contraindications

- vit.b12
deficiency
from
inadequate
diet, subtotal
gastrectomy,
or other
condition,
disorder, or
disease,
except
malaborption,
related to
pernicious
anemia or
other GI
disease

-------------

- pernicious
anemia or vit
b12
deficiency
- maintenance
therapy for
remission of

Effect

Peripheral
vascular
thrombosis
Heart failure
Transient
diarrhea
Pulmonary
edema
Anaphylaxis

Nursing
Considerations

Determine
reticulocyte
count, hct, Vit.
B12, iron,
folate levels
before
beginning
therapy
Dont give large
doses of vitamin
b12 routinely;
drug is lost
through
excretion
Protect b12 from
light. Dont
refrigerate or
freeze

pernicious
anemia after
IM vitamin
b12 therapy in
patients
without
nervous
system
involvement;d
ietary
deficiency,
malabsorption
disorders and
inadequate
secretion of
intrinsic factor
- shilling test
flushing dose