DIAZEPAM

 5 mg IV BID

Pharmacologic class: benzodiazepine

Therapeutic class: anxiolytic, skeletal muscle relaxant, anticonvulsant, sedative-hypnotic
Pregnancy category D

Indications
 Anxiety
 Acute alcohol withdrawal
 Muscle spasm
 Preoperative sedation
 Cardioversion
 Adjunct in seizure disorders
 Status epilepticus

Contraindications
 contraindicated in patients hypersensitive to the drug and any of its components
and in those with angle-closure glaucoma, shock, coma, or acute alcohol intoxication

Adverse reactions

CNS: ataxia, Drowsiness, hanover, lethargy, pain, tremors

CV: bradycardia, CV collapse
GI: contstipation, diarrhea, dry mouth
Respiratory: respiratory depression
Other: acute withdrawal syndrome

Pharmacokinetics

Distribution: wide. About 85% to 95% bound to plasma protein

Metabolism: in liver toa active metabolite, desmethyldiazepam
Excretion: urine

Route Onset Peak Duration

PO 30 min ½-2 hour 3-8 hour
IV 1-5 min 15 min 15-60 min
IM Unknown 2 hour unkown

Action
Chemical: may depresses CNS at limbic and subcortical levels of brain; suppresses spread
of seizure activity produced by epileptogenic foci cortex, thalamus, and limbic system
Therapeutic: relieves anxiety, muscle spasms, and seizures.

Nursing considerations
  obtain history of patients underlying condition before therapy, and reassess
regularly thereafter
 periodically monitor liver, kidney, and hemapoietic function studies in patient
receiving repeated therapy
 Do not administer intra-arterially; may produce arteriospasm, gangrene
 Do not use small veins (dorsum of hand or wrist) for IV injection.
 Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by
at least one-third or eliminated
 Carefully monitor P, BP, respiration during IV administration
 Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not
permit ambulatory patients to operate a vehicle following an injection
 Monitor liver and kidney function, CBC during long-term therapy
 Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions,
palpitations, swelling of the ankles, visual or hearing disturbances, difficulty
voiding.

ATROPINE
 1 amp IV x 4 dose

Pharmacologic class: anticholinergic, belladonna alkaloid

Therapeutic class: antiarrhythmic, vagolytic
Pregnancy category C

Indications
 Symptomatic bradycardia, bradyarrhythmia
 Anticholinestaerase insecticide poisoning
 Preoperatively for decreasing secretions and blocking cardiac vagal reflexes
 Adjunct in peptic ulcer disease; functional GI disorders such as irritable bowel
syndrome

Contraindications
 Contraindicated with hypersensitivity to anticholinergic drugs.
 Contraindicated with glaucoma; adhesions between iris and lens; stenosing peptic ulcer;
pyloroduodenal obstruction; paralytic ileus; intestinal atony; severe ulcerative colitis;
toxic megacolon; symptomatic prostatic hypertrophy; bladder neck obstruction; bronchial
asthma; COPD; cardiac arrhythmias; tachycardia; myocardial ischemia; impaired
metabolic, liver, or kidney function; myasthenia gravis.

Adverse reactions
 CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache,
flushing, nervousness, weakness, dizziness, insomnia, mental confusion or excitement
(after even small doses in the elderly), nasal congestion
 CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)
 GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn,
constipation, bloated feeling, paralytic ileus, gastroesophageal reflux
  GU: Urinary hesitancy and retention; impotence
 Other: Decreased sweating and predisposition to heat prostration, suppression of
lactation
Pharmacokinetics

Route Onset Peak Duration

IM 30 min 1- ½ hour 4 hr
IV Immediate 2–4 min 4 hr
SC Unknown unkown 4 hr
Topical 5–10 min 30–40 min 7–14 days

 Metabolism: Hepatic; T1/2: 2.5 hr

 Distribution: throughout the body, including CNS
 Excretion: Urine, feces, and expired air

Action
Chemical: inhibits acetylcholine at parasympathetic neuroeffector junction, blocking vagal
effects on SA node, enhancing conduction through AV node, and speeding heart rate
Therapeutic: increases heart rate, decreases secretions, and slows GI motility. Antidote for
anticholinesterase insecticide poisoning

Nursing considerations

 Obtain history of patients underlying condition

 Monitor patients, especially those receiving doses of 0.4 to 0.6 mg, for paradoxical
initial bradycardia, which is caused by a drug effect in CNS and usually disappears
within 2 minutes
 Watch for tachycardia in cardiac patients because in may cause ventricular
fibrillation
 Give with or without food
 If ECG disturbances occur, withhold drug, obtain a rhythm strip, and notify
prescriber
 Have emergency equipment and drugs on hand to treat arrhythmias.
 Use physostigmine salicylate as antidote for atropine overdose
 Ensure adequate hydration; provide environmental control (temperature) to prevent
hyperpyrexia.
 Have patient void before taking medication if urinary retention is a problem
 Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination;
irregular heartbeat, palpitations; headache; abdominal distention; hallucinations; severe
or persistent dry mouth; difficulty swallowing; difficulty in urination; constipation;
sensitivity to light.
EPINEPHRINE
 1 amp IV one dose

Pharmacologic class: adrenergic

Therapeutic class: bronchodilator, vasopressor, cardiac stimulant, topical antihemorrhagic
Pregnancy category C

Indications
 Bronchospasm, hypersensitivity reactions, anaphylaxis
 Hemostasis
 Prolonging local anesthetic effect
 Restoring cardiac rhythm in cardiac arrest

Contraindications
 Contraindicated with allergy or hypersensitivity to epinephrine or components of
preparation (many of the inhalant and ophthalmic products contain sulfites: sodium
bisulfite, sodium or potassium metabisulfite; check label before using any of these
products in a sulfite-sensitive patient); 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; hypertension; renal
dysfunction (drug may initially decrease renal blood flow); COPD patients who have
developed degenerative heart disease; diabetes mellitus; hyperthyroidism; lactation.
Opthalmic preparations are contraindicated for those wearing contact lenses (drug may
discolor the contact lens), aphakic patients (maculopathy with decreased visual acuity
may occur).

Adverse reactions
 CNS: Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness,
drowsiness, tremor, insomnia, hallucinations, psychological disturbances, seizures, CNS
depression, weakness, blurred vision, ocular irritation, tearing, photophobia, symptoms of
paranoid schizophrenia
 CV: Arrhythmias, hypertension resulting in intracranial hemorrhage, palpitations,
tachycardia, precordial pain in patients with ischemic heart disease
 GI: Nausea, vomiting, anorexia
 GU: Constriction of renal blood vessels and decreased urine formation (initial parenteral
administration), dysuria, vesical sphincter spasm resulting in difficult and painful
urination, urinary retention in males with prostatism
 Other: Pallor, respiratory difficulty, orofacial dystonia, sweating
Pharmacokinetics

Route Onset Peak Duration

SC 5–10 min 30 min 1-4 hour
IM Varies Unkown 1-4 hour
IV immediate 5 min 1-4 hour

Metabolism: metabolize at sympathetic nerve endings, liver, other tissues

Distribution: wide, throughout body
Excretion: urine

Action

Chemical effect: stimulates alpha and beta receptors in sympathetic nervous system
Therapeutic effect: relaxes bronchial smooth muscle, causes cardiac stimulation, relieves
allergic signs and symptoms, helps stop local bleeding, and decreases pain sensation

Nursing considerations

 Obtain history of patient’s underlying condition and reassess regularly

 When giving drug IV, monitor blood pressure, heart rate, and ECG when therapy
starts and frequently thereafter
 Use extreme caution when calculating and preparing doses; epinephrine is a very potent
drug; small errors in dosage can cause serious adverse effects. Double-check pediatric
dosage.
 Use minimal doses for minimal periods of time; "epinephrine-fastness" (a form of drug
tolerance) can occur with prolonged use.
 Protect drug solutions from light, extreme heat, and freezing; do not use pink or brown
solutions. Drug solutions should be clear and colorless (does not apply to suspension for
injection).
 Shake the suspension for injection well before withdrawing the dose.
 Rotate SC injection sites to prevent necrosis; monitor injection sites frequently.
 Keep a rapidly acting alpha-adrenergic blocker (phentolamine) or a vasodilator (a nitrate)
readily available in case of excessive hypertensive reaction.
 Have an alpha-adrenergic blocker or facilities for intermittent positive pressure breathing
readily available in case pulmonary edema occurs.
 Keep a beta-adrenergic blocker (propranolol; a cardioselective beta-blocker, such as
atenolol, should be used in patients with respiratory distress) readily available in case
cardiac arrhythmias occur.
 Do not exceed recommended dosage of inhalation products; administer pressurized
inhalation drug forms during second half of inspiration, because the airways are open
wider and the aerosol distribution is more extensive. If a second inhalation is needed,
administer at peak effect of previous dose, 3–5 min.
 Use topical nasal solutions only for acute states; do not use for longer than 3–5 days, and
do not exceed recommended dosage. Rebound nasal congestion can occur after
vasoconstriction subsides.
  Report chest pain, dizziness, insomnia, weakness, tremor or irregular heart beat
(respiratory inhalant, nasal solution), difficulty breathing, productive cough, failure to
respond to usual dosage (respiratory inhalant), decrease in visual acuity (ophthalmic).

LEVOPHED(norepinephrine bitartrate)
 4 ml + 90 cc D5W x 30 ugtts/min

Pharmacologic class: adrenergic

Therapeutic class: vasopressor
Pregnancy category C

Indications
 To restore blood pressure in severe hypotension, shock, and during cardiac arrest
 GI bleeding

Contraindications
 Contraindicated in patients receiving cyclopropane or halothane anesthesia and in patients
with mesenteric or peripheral vascular thrombosis, profound hypoxia, hypercapnia, or
hypotension caused by blood volume deficits.

Adverse reactions
 CNS: anxiety, dizziness, fever, headache, insomnia, restlessness, tremor, weakness
 CV: arrhythmias, bradycardia, decreased cardiac output, severe hypertension
 GU: decreased urine output
 Metabolic: metabolic acidosis
 Respiratory: asthmatic episodes
 Other: anaphylaxis

Pharmacokinetics

Route Onset Peak Duration

IV Immediate Immediate 1-2 min

Distribution: localizes in sympathetic nerve tissues

Metabolism: metabolized in liver and other tissues to inactive compounds
Excretion: urine

Action

Chemical effect: stimulates alpha- and beta1- adrenergic receptors in sympathetic nervous system
Therapeutic effect: raises blood pressure

Nursing considerations

 Assess patient’s condition before starting therapy

 During infusion, frequently monitor ECG, cardiac output, CVP, pulse rate, urine output,
and color and temperature of the limbs.
  Check blood pressure every 2 minutes until stabilized, then check every 5 minutes
 Drug isn’t substitute for blood or fluid volume deficits. If deficits exists, replaced fluid
before giving vasopressors
 Keep emergency drugs on hand to reverse effects of epinephrine: atropine for reflex
bradycardia, phentolamine for extravasation, and propanolol for arrhythmias
 Immediately report to the prescriber any decreased urine output
 When stopping drug, gradually slow infusion rate and report sudden drop in blood
pressure
 Tell patient to immediately report discomfort at infusion site or difficulty breathing

DOPAMINE

Pharmacologic class: adrenergic

Therapeutic class: inotropic, vasopressor
Pregnancy category C

Indications
 to treat shock and correct hemodynamic imbalances; to improve perfusion to vital organs;
to increase cardiac output; to correct hypotension

Contraindications
 contraindicated in patients with uncorrected tachyarrhythmias, pheochromocytoma, or
ventricular fibrillation

Adverse reactions
 CV: Hypotension, ectopic beats, tachycardia, anginal pain, palpitation, vasoconstriction
(indicated by disproportionate rise in diastolic pressure), cold extremities; less frequent:
aberrant conduction, bradycardia, widening of QRS complex, elevated blood pressure.
 GI: Nausea, vomiting
 CNS: Headache.
 Skin: Necrosis, tissue sloughing with extravasation, gangrene, piloerection.
 Other: Azotemia, dyspnea, dilated pupils (high doses).

Pharmacokinetics

Route Onset Peak Duration

IV 5 min Unknown 10 min

Distribution: wide; doesn’t cross blood brain barrier

Metabolism: to inactive compounds in liver, kidneys, and plasma
Excretion: urine

Action

Chemical effect: stimulates dopaminergic, beta-adrenergic, alpha-adrenergic receptors of

sympathetic nervous system
Therapeutic effect: increases cardiac output, blood pressure, and renal perfusion
Nursing considerations

 Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed
by physician. Precise measurements are essential for accurate titration of dosage.
 Report the following indicators promptly to physician for use in decreasing or temporarily
suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia;
dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure);
signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of tenderness,
pain, numbness, or burning sensation).
 Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow,
other indices of adequate dosage and perfusion of vital organs include loss of pallor, increase
in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or
comatose state.
 Emphasize importance of reporting discomfort at IV site immediately

KEPTRIX
 1 g OD

Pharmacologic class: third generation cephalosporin

Therapeutic class: antibiotic
Pregnancy category B

Indications

 Uncomplicated gonococcal vulvovaginitis

 UTI; lower respiratory tract, gynecologic, bone or joint, intra-abdominal, skin, or skin structure infection;
septicemia

 Meningitis

 Perioperative prevention

 Acute bacterial otitis media

 Neurologic complications, carditis, and arthritis from penicillin G-refractory Lyme disease

Contraindications
 Contraindicated in patients hypersensitive to the drug or other cephalosporins

Adverse reactions
 CNS: fever, headache, dizziness
 CV: phlebitis,
 GI: diarrhea, pseudomembranous colitis
  GU: genital pruritus, candidiasis
 Hema: thrombocytosis, eosinophilia, leukopenia
 Skin: pain, induration, tenderness at injection site, rash, pruritus
 Other: hypersensitivity reactions, serum sickness, anaphylaxis, chills

Pharmacokinetics

Route Onset Peak Duration

IV Immediate Immediate Unknown
IM Unknown 1-4 hour Unknown

Distribution: wide. Good CSF penetration

Metabolism: partial
Excretion: urine, bile

Action

Chemical effect: inhibits cell wall synthesis, promoting osmotic instability

Therapeutic effect: hinders or kills susceptible bacteria

Nursing considerations

 Before giving drug, ask patient if he is allergic to penicillins or cephalosporin.

 Obtain specimen for culture and sensitivity tests before giving first dose
 If adverse GI reactions occur, monitor patient’s hydration
 Inject deep into large muscle mass, such as gluteus maximus
 Tell patient to promptly report adverse reactions and signs and symptoms of superinfection

FLUIMUCIL
 1/2 amp + 1 cc NSS q 12 hrs

Pharmacologic class: amino acid derivative

Therapeutic class: mucolytic, antidote for paracetamol toxicity
Pregnancy category B

Indications
 > Adjunct in the treatment of chronic emphysema, emphysema with bronchitis, chronic asthmatic
bronchitis, tuberculosis, bronchiectasis, primary amyloidosis of lung, acute bronchopulmonary disease
(bronchitis, pneumonia, tracheobronchitis

Contraindications
 Contraindicated to patients hypersensitivity to drugs.
Adverse reactions


 Respiratory: rhonchi, bronchospasm, cough, dyspnea.
 CV: tachycardia, hypotension, hypertension, flushing, chest tightness.
 CNS: fever, drowsiness, abnormal thinking, giat disturbances.
 GI: N&V, stomatitis.
 Other: Rashes, drowsiness, rhinorrhea.

Pharmacokinetics

Route Onset Peak Duration

IV, PO, Unknown Unknown Unknown
inhalation

Absorption: most inhaled acetylceisteine acts directly on mucus in lungs

Metabolism: in liver

Action
Chemical effect: increases respiratory tract fluid to help liquefy tenacious secretions. Restores glutathione in
liver to treat acetaminophen toxicity
Therapeutic effect: thins respiratory secretions and reverses toxic effects of acetaminophen

Nursing considerations

 Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization. Hand-bulb
nebulizers aren’t recommended because output is too small and particle size too large.
 Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate, amphotericin
B, and ampicillin sodium. If given by aerosol inhalation, nebulize these drugs separately
 Before aerosol administration, have patient clear airway by coughing
 Have suction equipment available
 Alert prescriber if patient’s respiratory secretion thicken or become purulent or if bronchospasm occurs
 Inform patient that drug may have a foul taste or smell
 Instruct patient to rinse mouth with water after nebulizer because it may leave sticky coating

PARACETAMOL(ACETAMINOPHEN)
 1 amp IV q 4 hours PRN

Pharmacologic class: para- aminophenol derivative

Therapeutic class: nonopioid analgesic, antipyretic
Pregnancy category B

Indications

 Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses,

upper GI disease, gouty arthritis
 Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant
antirheumatic and anti-inflammatory effects)
  Common cold, flu, other viral and bacterial infections with pain and fever

Contraindications
 Contraindicated with allergy to acetaminophen.
 Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation

Adverse reactions

 CNS: Headache
 CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for
several weeks or when doses of 4 g/day are ingested for 1 yr
 GI: Hepatic toxicity and failure, jaundice
 GU: Acute kidney failure, renal tubular necrosis
 Hematologic: Methemoglobinemia—cyanosis; hemolytic anemia—hematuria, anuria;
neutropenia, leucopenia, pancytopenia, thrombocytopenia, hypoglycemia
 Hypersensitivity: Rash, fever

Pharmacokinetics

Route Onset Peak Duration

PO, PR Unknown 10-60 min 4-6 hour

Absorption: rapid and complete

Metabolism: 90 to 95 % in liver
Excretion: urine

Action

Chemical effect: blocks pain impulses, probably by inhibiting prostaglandin or pain receptor
sensitizers. May relieve fever by acting in hypothalamic heat-regulating center

Therapeutic effect: relieves pain and reduces fever

Nursing considerations

 Monitor liver function studies; may cause hepatic toxicity at doses >4g/day
 Monitor renal function studies; albumin indicates nephritis
 Monitor blood studies, especially CBC and pro-time if patient is on long-term therapy
 Check I&O ratio; decreasing output may indicate renal failure.
 Assess hepatotoxicity: dark urine, clay-colored stools
 Assess allergic reactions: rash, urticaria
 Tell patient not to use the drug for fever that’s higher than 39.5 C, lasts longer than 3 days

CITICOLINE
 4 g IV OD

Classification
 Belongs to the class of other agents used as CNS stimulant
Indication

 Cerebrovascular accident in acute recovery phase, symptoms and signs of cerebral insufficiency
such as dizziness, memory loss, poor concentration, disorientation and recent cranial
traumatism and their sequelae.

Contraindication

 Must not be administered to patients with hypertonia of the parasympathetic

Adverse reactions

 Gastrointestinal disorders
 Fleeting and discrete hypotensive effect
 Elevated body temperature
 Restlessness

Action

It increases the neurotransmission levels because it favors the synthesis and production speed of
dopamine in the striatum, acting then as a dopaminergic agonist thru the inhibition of tyrosine-
hydroxylase.

Nursing considerations

 May be taken with or without food

 Should be administered slowly for patients with intracranial hemorrhage
 Monitor vital signs specifically the BP
 Provide frequent rest periods

PREDNISONE
 50 mg 1 tab OD

Pharmacologic class: adrenocorticoid

Therapeutic class: anti-inflammatory, immunosuppressant
Pregnancy category C

Indications
 Severe inflammation or immunosuppression
 Acute exacerbations of multiple sclerosis

Contraindications
 Systemic fungal infections and known hypersensitivity
Adverse reactions
 CNS: Euphoria, headache, insomnia, confusion, psychosis.
 CV: CHF, edema
 GI:Nausea, vomiting, peptic ulcer.
 Musculoskeletal: Muscle weakness, delayed woundhealing, muscle wasting, osteoporosis,
aseptic necrosis of bone, spontaneous fractures
 Endocrine: Cushingoid features, growth suppression in children, carbohydrateintolerance,
hyperglycemia.
 Metabolic: Hypokalemia.

Pharmacokinetics

Route Onset Peak Duration

PO Varies Varies Varies

Distribution: to muscle, liver, skin, intestine, and kidney

Metabolism: in liver
Excretion: in urine and feces

Action
Chemical effect: not clearly defined; decreases inflammation, suppresses immune response, stimulates
bone marrow, and influences protein, fat, and carbohydrate metabolism
Therapeutic effect: relieves inflammation and induces immunosuppression

Nursing considerations
 Establish baseline and continuing data regarding BP, I&O ratio and pattern,weight, and sleep
pattern. Start flow chart as reference for planning individualizedpharmacotherapeutic patient
care
 Check and record BP during dose stabilization period at least 2 times daily.Report an ascending
pattern
 Monitor patient for evidence of HPA axis suppression during long-term therapyby determining
plasma cortisol levels at weekly intervals
 Be aware that older adult patients and patients with low serum albumin areespecially
susceptible to adverse effects because of excess circulating freeglucocorticoids
 Be alert to signs of hypocalcemia. Patients with hypocalcemiahave increased
requirements for pyridoxine, vitamins C and D, andfolates
 Be alert to possibility of masked infection and delayed healing (antiinflammatoryand
immunosuppressive actions). Prednisone suppresses early classic signs of inflammation.
When patient is on an extended therapy regimen, incidence of oral Candida infection is
high. Inspect mouth daily for symptoms: white patches,black furry tongue, painful
membranes and tongue.
 Be aware that a slight weight gain with improved appetite is expected, but after dosage is
stabilized, a sudden slow but steady weight increase [2 kg (5 lb) per wk]should be reported to
physician
 Avoid or minimize alcohol and caffeine may contribute to steroid-ulcer development in long-
term therapy
  Report symptoms of GI distress to physician and do not self-medicate to find relief
 Do not use aspirin or other OTC drugs unless they are prescribed specifically bythe
physician.
 Report slow healing, any vague feeling of being sick, or return of pretreatmentsymptoms
 If patient has diabetes, urge him to inspect is skin closely for ulcer formation

MEFENAMIC ACID
 100 mg 1 tab now

Classification: NSAID

Indication
 Mild to moderate pain, inflammation, stiffness, swelling, or tendernessncaused by
headache, athralgia, myalgia, neuralgia, dysmenorrhea.

Contraindication
 Contraindicated with hypersensitivity to mefenamic acid, aspirin allergy, and as
treatment of perioperative pain with coronary artery bypass

Adverse reactions
 CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus,
ophthalmic effect
 Dermatologic: Rash, pruritus, sweating, dry mucous membrane, stomatitis
 GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence
 Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia,
eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis,
granulocytopenia, aplastic anemmia, decreasedHgb or Gct, bone marrow
depression, hemorrhage
 Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis

Pharmacokinetics

Route Onset Peak Duration

PO Varies 2-3 hours 6 hours

Nursing considerations
 Take drug with food; take only the prescribed dosage;
 Discontinue drug and consult your health care provider if rash or diarrhea occur
 Reportsore throat, fever, rash, itching,weight gain, swelling in ankles or fingers,changes in
vision,severe diarrhea
 Watch for bronchospasm in patients with aspirin hypersensitivity, rhinitis or nasal polyps, and
asthma.
KETOROLAC
 35 mg IV now then q 6 hours per pain

Pharmacologic class: NSAID

Therapeutic class: analgesic, anti-inflammatory
Pregnancy category C

Indications
 Short-term management of pain
 Ocular itching caused by seasonal allergic rhinitis
 Post operative inflammation
 Pain and burning or stinging sensation following surgery

Contraindications
 Hypersensitivity to ketorolac, aspirin, other NSAIDs, or any component of the formulation;
patients who have developed nasal polyps, angioedema, or bronchospastic reactions to other
NSAIDs; active or history of peptic ulcer disease; recent or history of GI bleeding or perforation;
patients with advanced renal disease or risk of renal failure.

Adverse reactions
 CNS: dizziness, drowsiness, headache, insomnia, syncope
 CV: edema, hypertension, palpitations
 EENT: corneal edema, keratitis, ocular irritation, transient stinging and burning
 GI: diarrhea, dyspepsia, GI pain, nausea
 GU: hematuria, polyuria, renal failure
 Skin: sweating

Pharmacokinetics

Route Onset Peak Duration

PO 30-60 min 30-60 min 6-8 hours
IV Immediate Immediate 8 hours
IM 30 min 1-2 hours 6-8 hours

Absorption: completely after IM

Distribution: more than 99.9 pct protein-bound
Metabolism: mainly in liver
Excretion: urine and feces

Action

Chemical effect: may inhibit prostaglandin synthesis

Therapeutic effect: relieves pain and inflammation

Nursing considerations
  Instruct client to avoid alcohol and maintain adequate hydration (2-3L/day of fluids) unless
instructed to restrict fluid intake.
 If pain persists or worsens, notify prescriber
 Monitor for signs of pain relief, such as an increased appetite and activity
 Instruct client to avoid taking ketorolac with aspirin or other NSAIDs such as ibuprofen (Motrin,
Advil), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etc.
 Teach patient to recognize and immediately report signs and symptoms of GI bleeding

LEVETIRACETAM

Pharmacologic class: pyrrolidine derivative

Therapeutic class: anticonvulsant
Pregnancy category C

Indications

 Adjunctive treatment of partial-onset seizures in epilepsy

 Adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients with
idiopathic generalized epilepsy
 Adjunctive treatment of myoclonic seizures in juvenile myoclonic epilepsy

Contraindications

 Contraindicated in patients hypersensitive to the drug

 Use cautiously in immunocompromised patients and in those with poor renal function

Adverse reactions

 CNS: asthenia, dizziness, headache, somnolence

 EENT: diplopia, pharyngitis, rhinitis, sinusitis
 GI: anorexia
 Hematologic: leukopenia, neutropenia
 Respiratory: cough

Pharmacokinetics:

Route Onset Peak Duration

PO, IV 1 hour 1 hour 12 hour

Absorption: rapid. Level peaks in about 1 hour

Distribution: minimally protein-bound
Metabolism: no active metabolites

Action
Chemical effect: may inhibit kindling in hippocampus, preventing simultaneous neuronal firing that leads
to seizures
Therapeutic effect: prevents seizures

Nursing considerations:

 Obtain history of patient’s underlying condition before starting therapy, and reassess regularly
to monitor drug effectiveness
 Assess renal function
 Monitor for dizziness, which may lead to falls
 Drug can be taken with or without food
 Taper drug to reduce risk of seizures
 Warn patient that drug may cause dizziness and somnolence and to use extra care when rising
to a sitting or standing position