DRUG NAME Generic Name: Ketorolac Brand Name: Toradol Classification: Nonsteroidal antiinflammatory agents/ nonopioid analagesics Dosage:

IM: 10-30 mg, q6 IV: 10-30 mg, 1 amp, q6

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

INDICATION/ CONTRAINDICATIONS Indication: Short term management of pain (not to exceed 5 days total for all routes combined)

ADVERSE EFFECTS CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache RESP: asthma, dyspnea

Contraindication: Hypersensitivity Cross-sensitivity with other NSAIDs may exist Pre- or perioperative use Known alcohol intolerance. Use cautiously in: 1) History of GI bleeding 2) Renal impairment (dosage reduction may be required) 3) Cardiovascular disease

CV: edema, pallor, vasodilation GI: GI Bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea RENAL: oliguria, renal toxicity, urinary frequency DERM: pruritis, purpura, sweating urticaria HEMAT: prolonged bleeding time LOCAL: injection site pain NEURO: paresthesia MISC: allergic reaction,

NURSING CONSIDERATIONS Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing 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 headche, or influenza-

anaphylaxis

like syndromes (chills, fever, muscles aches, pain) occur. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

DRUG NAME Generic Name: Ranitidine Brand Name: Zantac Classification: Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists Dosage: IM: 50 mg, q8 IV: 50 mg, 1 amp, q8

INDICATION/ CONTRAINDICATIONS Inhibits the action Indication: of histamine at the Treatment and prevention H2 receptor site of heartburn, acid located primarily indigestion, and sour in gastric parietal stomach. cells, resulting in inhibition of Contraindication: gastric acid Hypersensitivity secretion. Cross-sensitivity In addition, may occur; some ranitidine bismuth oral liquids contain citrate has some alcohol and should antibacterial be avoided in action against H. patients with pylori. known intolerance. Use Cautiously in: 1) Renal impairment 2) Geriatric patients (more susceptible to adverse CNS reactions) 3) Pregnancy or Lactation

DRUG ACTION

ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea RENAL: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

NURSING CONSIDERATIONS Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

DRUG NAME Generic Name: Hyoscine-NButylbromide Brand Name: Buscopan Classification: Antispasmodic

DRUG ACTION Quaternary ammonium antimuscarinic agent Does not readily pass the bloodbrain barrier A competitive antagonist of the actions of acetylcholine and other muscarinic agonists. The receptors affected are those of peripheral structures that are either stimulated or inhibited by muscarine, ie. exocrine glands, smooth and cardiac muscle.

INDICATION/ CONTRAINDICATIONS Indication: relief of smooth muscle spasm of the gastrointestinal and genitourinary systems Contraindication: Hypersensitivity Porphyria Myasthenia gravis Prostatic enlargement, paralytic ileus or pyloric stenosis and fever Closed angle glaucoma, or narrow angle between the iris and cornea, as hyoscine increases intraocular pressure Pregnant and lactating mothers

ADVERSE EFFECTS GI: dry mucous membranes (including in the mouth and nose), abdominal distension, nausea and vomiting, constipation RENAL: urinary retention. VISION: mydriasis, paresis of accommodation, blurred vision, increased intraocular pressure. CV: palpitations, tachycardia, increased blood pressure CNS and PNS: dizziness, headache, nervousness, weakness, ataxia, speech disorder, agitation or confusion (most often in the elderly), loss of memory or amnesia (for prolonged use in elderly patients, especially who had previously impaired memory), sleep disturbance (insomnia or drowsiness)

NURSING CONSIDERATIONS Be alert for adverse reactions and drug interactions. Assess for eye pain Assess for urinary hesitancy Assess for constipation Monitor urine output Encourage patient to void. Monitor BP for possible hypertension. For pregnant women, monitor cervical effacement and dilatation.

Dosage: PO: 1-2 tabs, TID IV: 20mg, 1 amp, q8 SC, IM: 1-2 amp

MISC: Allergic reactions: hives or other skin manifestations, reduction of potency, decrease sweating, reddening of the skin at the injection site

DRUG NAME Generic Name: Cefuroxime Brand Name: Xorimax Classification: 2nd generation cephalosporin Dosage: PO: 250 mg, 1 tab, BID IV: 750 mg, 1 vial, q8

DRUG ACTION Inhibits cell wall synthesis promoting osmotic instability usually bactericidal

INDICATION/ CONTRAINDICATIONS Indication: Infections of the airways including throat and ear, infections of the kidneys and/or the urinary tract, infections of the skin and soft tissues. Contraindication: Hypersensitivity. Cross-sensitivity with other beta lactam antibiotics

ADVERSE EFFECTS CNS: Headache CV: phlebitis, thrombophlebitis GI: diarrhea, anorexia, nausea, vomiting HEMAT: hemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia LOCAL: injection site pain MISC: Hypersensitivity reactions

NURSING CONSIDERATIONS Before giving drug. ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose. absorption of oral drug is induced

FARENAS, MAE CLARE B. BSN III-3 PLM SN Batch 2013