DRUG STUDY DRUG NAME

Generic Name: Epinephrine HCL Brand Name: Adrenalin Chloride, AsthmaNefrin, EpiPen, EpiPen Jr, MicroNefrin, Nepron, Sus-Phrine, Vaponefrin Classification: Bronchodilators How Supplied: Aerosol inhaler: 160mcg, 200mcg, 220 mcg. Injection:0.01 mg/ml, 0.1 mg/ml, 0.5mg/ml, 1mg/ml parenteral; 5mg.ml parenteral suspension. Nebulizer inhaler:1%, 1.25 %,2.25% (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619-620)

DOSAGE & FREQUENCY

1mg/ml stat

MECHANISM OF ACTION
It relaxes bronchial smooth muscle by stimulating beta2 receptors and alpha and beta receptors in the sympathetic nervous system. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619620)

INDICATION
*Fro Bronchospasm, hypersensitivity reactions, anaphylaxis. *For Hemostasis *Acute Asthma Attacks *To prolong local anesthetic effect. *To restore cardiac rhythm in cardiac arrest (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619-620)

CONTRAINDICATION
*Contraindicated in patients with angle closure glaucoma, shock other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebra; arteriosclerosis. *Contraindicated in patients receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage). *Commercial products containing sulfite allergies, except when epinephrine is being used to treat serious allergic reactions or other emergency situations. *Contraindicated for use in fingers, toes, ears, nose, or genitalia when used with local anesthetic. *Use cautiously in patients with long standing bronchial asthma or emphysema who have developed degenerative heart disease. *Use cautiously in elderly patients and in those with hyperthyroidism, CV disease, hypertension, psychoneurosis, and diabetes. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619-620)

SIDE EFFECTS
CNS: nervousness, tremor, vertigo, pain, headache, disorientation, agitation, drowsiness, fear, dizziness, weakness. CV: palpitations, widened pulse pressure, hypertension, tachycardia, anginal pain. GI:nausea, vomiting RESPIRATORY: dyspnea SKIN: urticaria, hemorrhage at injection site, pallor. OTHER: tissue necrosis (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619620)

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Teach patient to perform oral inhalation correctly. *If more than one inhalation is prescribed, advise patient to wait at least 2 minutes before repeating procedure. *If patients is also using a corticosteroid inhaler, instruct him to use the bronchodilators first and then to wait about 5 minutes before using corticosteroid. This lets the bronchodilators open the air passages for maximum effectiveness. *Instruct patient to remove canister and wash inhaler with warm, soapy water at least once weekly. *If patient has acute hypersensitivity reactions (such as to bee stings), you may need to teach him to self-inject epinephrine. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.619-620)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Atropine Sulfate Brand Name: Sal-Tropine Classification: Antiarrhythmics How Supplied: Injection: 0.05mg/ml, 0.1 mg/ml, 0.3 mg/ml, 0.4 mg/ml, 0.8 mg/ml, 1mg/ml Tablets:0.4 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239-240)

1mg/ml stat

An anticholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes, thereby enhancing conduction through the AV node and increasing the heart rate. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239240)

*For Symptomatic bradycardia, bradyarrhymia (juctional or escape rhythm) *For Antidote for anticholinesterase insecticide poisoning. *Preoperatively to diminish secretions and block cardiac vagal reflexes. *Adjunct treatment of peptic ulcer disease; functional GI disorder such as irritable bowel syndrome. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239-240)

*Contraindicated in patients hypersensitive to drug. *Contraindicated in those with acute angle-closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status in acute hemorrhage, tachycardia, myocardial ischemia, asthma, or myasthenia gravis. *Use cautiously in patients with Down Syndrome because they may be more sensitive to drug. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239-240)

CNS: headache, restlessness, ataxia, disorientation, hallucinations, delirium, insomnia, dizziness, excitement, agitation, confusion. CV: palpitations, tachycardia. EENT: photophobia, blurred vision, mydriasis. GI:dry mouth, thirst, constipation, nausea, vomiting GU: urine retention, impotence. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239240)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Teach patient receiving oral form of drug how to handle distressing anticholinergic effects. *Instruct patient to report serious or persistent adverse reactions promptly. *tell patient about potential for sensitivity of the eyes to the sun and suggest use of sunglasses. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.239-240)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Furosemide Brand Name: Lasix Classification: Diuretics How Supplied: Injection: 10mg/ml Oral solution:10mg/ml, 40mg/5ml Tablets:20 mg, 40 mg, 80 mg, 500 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850-852)

20mg/2ml stat

A potent loop diuretic that inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850852)

*Acute Pulmonary edema *Edema *Hypertension (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850-852)

*Contraindicated in patient hypersensitive to drug and in those with anuria. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850852)

CNS: headache, restlessness, dizziness, vertigo, paresthesia, weakness, restlessness CV: orthostatic hypotension, thrombophlebitis with I.V. administration. EENT: transient deafness blurred or yellowed vision. GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation. GU: nocturia, polyuria, frequent urination, oliguria. MUSCULOSKELETAL: muscle spasm SKIN: dermatitis, purpura, photosensitivity reactions, transiet pain at I.M. injection site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850-852)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check Blood pressure During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check again Blood pressure Health Teaching: *Advise patient to take drug with food to prevent GI upset, and take drug in morning to prevent need to urinate at night. *Inform patient of possible need for potassium or magnesium supplements. *Instruct patient to stand slowly to prevent dizziness and limit alcohol intake and strenuous exercise in hot weather to avoid worsening dizziness upon standing quickly. *Advise patient to immediately report ringing in ears, severe abdominal pain, or indicate furosemide toxicity. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.850-852)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Verapamil Brand Name: Isoptin Classification: Antianginals How Supplied: Tablets:40 mg, 80 mg, 120 mg Capsules (extendedreleased):100mg, 120mg, 180 mg, 200mg, 240mg, 300mg Capsules (sustainedreleased):120mg, 160mg,180mg,240mg, 360mg Injection:2.5mg/ml (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271-273)

5mg/2ml stat

Not clearly defined. A calcium channel blocker that inhibits calcium ion influx across cardiac and smooth-muscle cell, thus decreasing myocardial contractility and oxygen demand; it also dilates coronary arteries and arterioles. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271273)

*Vasospatic angina (Prinzmetals or variant angina); classic chronic, stable angina pectoris; chronic atrial fibrillation. *To prevent paroxysmal supraventricular tachycardia. *Supraventricular arrhythmias *Digitalized patients with chronic atrial fibrillation or flutter. *Hypertension (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271-273)

*Contraindicated in patient hypersensitive to drug and in those with severe left ventricular dysfunction, cardiogenic shock, secondor- third- degree Av block or sick sinus syndrome except in presence of functioning pacemaker, atrial flutter or fibrillation and accessory bypass tract syndrome, severe heart failure (unless secondary to verapamil therapy), severe hypotension. *IV verapamil is contraindicated in patients receiving IV beta blockers and in those with ventricular tachycardia. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271273)

CNS: headache, dizziness, asthenia CV: transient hypotension, pulmonary edema, peripheral edema GI: nausea, constipation. SKIN: rash (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271-273)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check Blood pressure During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Blood pressure again Health Teaching: *Instruct patient to take oral form of drugs exactly as prescribed. *Tell patient that long-acting forms shouldnt be crushed or chewed. *Advise patient to take drug with food. *Caution patient against abruptly stopping drug. *If patient continues nitrate therapy during oral verapamil dosage adjustment, urge continued compliance. S.L nitroglycerine may be taken, as needed, when chest pain is acute. *Encourage patient to increase fluid and fiber intake to combat constipation. Give a stool softener. *Advise patient to avoid or severely limit alcohol consumption. Verapamil significantly inhibits alcohol elimination. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.271-273)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Digoxin Brand Name: Lanoxin Classification: Inotropics How Supplied: Capsules: 0.05 mg, 0.1 mg, 0.2 mg Elixir: 0.05 mg/ml Injection:0.05 mg/ml, 0.1 mg/ml (pediatric) 0.25mg/ml Tablets:0.125 mg, 0.25mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231-232)

0.5 mg/2ml stat

Inhibits sodiumpotassiumactivated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through the SA and AV node. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231232)

*Heart failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231-232)

*Contraindicated in patient hypersensitive to drug and in those with digitalis induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. * Use with extreme caution in elderly patient and in those with acute MI, incomplete AV block, sinus bradycardia, PVCs chronic constrictive pericarditis, hypertropic cardiomyopathy, renal pulmonary disease, or hypothyroidism. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231232)

CNS: fatigue, generalized muscle weakness, agitation, hallucination, headache, malaise, dizziness, vertigo, stupor, paresthesia. GI: nausea, anorexia, vomiting, diarrhea. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231-232)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital signs (heart rate and rhythm) During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check vital signs again Health Teaching: *Teach patient and a responsible family member about drug action, dosage regimen, how to take pulse, reportable signs, and follow-up care. *Tell patient to report pulse less than 60beats/minute or more than 110 beats/minute, or skipped beats or other rhythm changes. *Instruct patient to report adverse reactions promptly. Nausea, vomiting, diarrhea, appetite loss, and visual disturbances may be early indicators of toxicity. *Encourage patient to eat potassium-rich foods. *Tell patient not to substitute one brand of digoxin for another. *Advise patient to avoid the use of herbal drugs or to consult his prescriber before taking one. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.231-232)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Terbutaline Sulfate Brand Name: Brethine Classification: Bronchodilators How Supplied: Injection: 1mg/ml Tablets: 2.5 mg, 5mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631-632)

0.5 mg/ml Relaxes bronchial smooth muscle by stimulating beta2 receptors. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631632) *Bronchospasm in patients with reversible obstructive airway disease. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631-632) *Contraindicated in patient hypersensitive to drug or sympathomimetic amines. *Use cautiously in patient with CV disorders, hyperthyroidism, diabetes, or seizure disorders. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631632) CNS: weakness, headache, dizziness, nervousness, tremor, drowsiness CV: palpitations, tachycardia, flushing GI: vomiting, nausea, heartburn. RESPIRATORY: dyspnea SKIN: diaphoresis (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631-632)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Make sure patient and caregivers understand why patient need drug. *Remind patient to separate oral doses by 6 hours intervals. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.631-632)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Diazepam Brand Name: Valium Classification: Anxiolytics How Supplied: Capsules (extended release):15mg Injection: 5mg/ml Oral Solution: 5mg/5ml, 5mg/ml Rectal gel twin packs:2.5 mg, 5mg, 10 mg, 15 mg, 20 mg Tablets: 2mg, 5mg, 10mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471-473)

10mg/2ml stat Unknown. A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471473) *Anxiety *Acute alcohol withdrawal *Before endoscopic procedures *Muscle spasm *Preoperative sedation *Cardioversion *Adjunct treatment for seizure disorders *Status epilepticus, severe recurrent seizures *Patient on stable regimens of antiepileptic drugs who need diazepam intermittently to control bouts of increased seizure activity. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471-473) *Diastat rectal gel is contraindicated in patients with acute angle-closure glaucoma. *Use cautiously in patients with liver or renal impairment, depression, or chronic open-angle glaucoma. Use cautiously in elderly and debilitated patients. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471473) GI: nausea, constipation, diarrhea with rectal form. GU: incontinence, urine retention Hepatic: Jaundice SKIN: rash OTHER: altered libido, physical or psychological dependence, pain, phlebitis at injection site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471-473) *Contraindicated in patient hypersensitive to drug or soy protein; in patients experiencing shock, coma, or acute alcohol intoxication (parenteral form); in pregnant women, especially in first trimester; and in children younger than age 6 months (oral form). CNS: drowsiness, dysarthria, slurred speech, tremor, transiet amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucinations, minor changes in EEG patterns. CV: hypotension

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Warm patient to avoid activities that require alertness and good coordination until effects of drug are known. *Tell patient to avoid alcohol while taking drug. *Notify patient that smoking may decrease drugs effectiveness. *Warm patient not to abruptly stop drug because withdrawal symptoms may occur. *Warn woman to avoid use during pregnancy. *instruct patients caregiver on the proper administration of Diastat rectal gel. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471-473)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Phenytoin Sodium (prompt) Brand Name: Dilantin Classification: Anticonvulsants How Supplied: Capsule:100mg (92 mg base) Injection:50mg/ml (46mg base) (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429-432)

100mg/2ml stat Unknown. A hydration derivative that probably stabilizes neuronal membranes and limits seizure activity by either increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429432) *To control tonicclonic (grand ma) and complex partial (temporal lobe) seizures. *For patient requiring a loading dose *To prevent and treat seizures occurring during and after surgery. *Status epilepticus (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429432) *Contraindicated in patient hypersensitive to hydantoin and in those with sinus bradycardia, SA block, second- or-third degree Av block, or Adams-Strokes syndrome. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429432) CNS: ataxia, slurred speech, dizziness, insomnia, nervousness, twitching, headache, mental confusion, decreased coordination. CV: periarteritis nodosa GI: gingival hyperplasia, nausea, vomiting, constipation. SKIN: scarlatiniform or morbiliform rash, bullous or purpuric dermatitis, exfoliative dermatitis, lupus erythematosus, photosensitivity reactions, discoloration of skin if given by I.V push in back of hand, hypertrichosis, pain, necrosis, inflammation at injection site. OTHER: altered libido, physical or psychological dependence, pain, phlebitis at injection site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471473)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient to notify prescriber if skin rash develops. *Advise patient to avoid driving and other potentially hazardous activities that require mental alertness until drugs CNS effects are known. *Dilantin capsules are the only oral form that can be given once daily. Toxic levels may result if any other brand or form is given once daily. *Tell patient not to use capsules that are discolored. *Advise patient to avoid alcohol. *Warn patient and parents not to stop drug abruptly. *Stress importance of good oral hygiene and regular dental examinations. Surgical removal of excess gum tissue may be needed periodically if dental hygiene is poor. *Caution patient that drug may color urine pink, red, or reddish brown. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.471-473)

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Dobutamine Hydrochloride Brand Name: Dobutrex Classification: Andrenergics (sympathomimetics) How Supplied: Injection:12.5 mg/ml in 20-ml vials (parenteral) (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574)

250mg/5ml stat Stimulates hearts beat1 receptors to increase myocardial contractility and stroke volume. At therapeutic dosages, drug increases cardiac output by decreasing peripheral vascular resistance, reducing ventricular filling pressure, and facilitating AV node conduction. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574) *Increased cardiac output in shortterm treatment of cardiac decompensation caused by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574) *Contraindicated in patient hypersensitive to hydantoin and in those with sinus bradycardia, SA block, second- or-third degree Av block, or Adams-Strokes syndrome. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429432) CNS: headache CV: increase heart rate, hypertension, PVCs, angina, phlebitis, nonspecific chest pain, palpitations, and hypotension. GI: nausea, vomiting, OTHER: hypersensitivity reactions. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429432) After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient to report adverse reactions promptly, especially labored breathing and drug-induced headache. *Instruct patient to report discomfort at I.V. insertion site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.429-432) Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds

DRUG STUDY
DRUG NAME DOSAGE & FREQUENCY MECHANISM OF ACTION INDICATION CONTRAINDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

Generic Name: Dopamine Hydrochloride Brand Name: Intropin Classification: Andrenergics (sympathomimetics) How Supplied: Injection:40mg/ml, 80 mg/ml, 160 mg/ml parenteral concentrated for injection for I.V. infusion; 0.8 mg/ml in D5W; 1.6 mg/ml in D5W; 3.2mg/ml in D5W parenteral injection for I.V. infusion (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574-575)

200mg/5ml stat Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is doerelated; large doses cause mainly alpha stimulation. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574575) *To treat shock and correct hemodynamic imbalances, to improve perfusion to vital organs, to increase cardiac output, vital organs, to increase cardiac output, to correct hypotension. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574575) *Contraindicated in patient with uncorrected tachyarrhythmias, pheochromocytoma, or ventricular fibrillation. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574575) CNS: headache CV: ectopic beats, tachycardia, angina, palpitations, hypotension GI: nausea, vomiting, Metabolic: azotemia, hyperglycemia Respiratory:dyspnea (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574575) During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check BP again Health Teaching: *Tell patient to report adverse reactions promptly. *Instruct patient to report discomfort at I.V. insertion site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.574-575) Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check BP

DRUG STUDY

DRUG NAME
Generic Name: Lidocaine hydrochloride Brand Name: Xylocard Classification: Antiarrhythmias How Supplied: Infusion (premixed): 2mg/ml, 4mg/ml, 8mg/ml Injection (IM): 300mg/3ml automatic injection device Injection (for I.V. admixtures):40mg/ml, 100mg/ml, 200mg/ml (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247-249)

DOSAGE & FREQUENCY

100mg.5ml stat

MECHANISM OF ACTION
A class IB antiarrhythmic that decrease the depolarization, automaticity, and excitability in the ventricle during the diastolic phase by direct action on the tissues, especially the Purkinje network. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247249)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*Ventricular arrhythmias caused by MI, cardiac manipulation, or cardiac glycosides. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247249)

*Contraindicated in patients hypersensitivity to the amide-type local anesthetics. *Contraindicated in those with Adams-Strokes syndrome, Wolff-ParkinsonWhite syndrome, and severe degrees of SA, Av or intraventricular block in the absence of an artificial pacemaker. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247249)

CNS: confusion, tremor, stupor, restlessness, lightheadedness. CV: hypotension EENT: tinnitus, blurred or double vision GI: vomiting, SKIN: soreness at injection site OTHER: sensation of cold (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247249)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient receiving lidocaine I.M. that drug may cause soreness at injection site. Tell him to report discomfort at the site. *Tell patient to report adverse reactions promptly because toxicity can occur. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.247-249)

DRUG STUDY

DRUG NAME
Generic Name: Metoclopramide Brand Name: Plasil Classification: GIT Regulators, Antiflatulents & Antiinflammatories Antiemetics & Antivertigo Drugs How Supplied: Ampule: 10mg/2mL Syrup: 5mg/5mL Tablet: 10mg (http://asia.mims.com/ mimsonline/drugdetail s.aspx? id=4383&dcname=Ph &SearchType=Brand)

DOSAGE & FREQUENCY

10mg/2ml stat

MECHANISM OF ACTION
Metoclopramide is a medicine that increases the movements or contractions of the stomach and intestines. When given by injection, it is used to help diagnose certain problems of the stomach and/or intestines. It is also used by injection to prevent the nausea and vomiting that may occur after treatment with anticancer medicines. Another medicine may be used with metoclopramide to prevent side effects that may occur when metoclopramide is used with anticancer medicines. (http://www.nlm.nih.gov/medli neplus/druginfo/uspdi/202364. html)

INDICATION
Disturbances of GI motility. Nausea & vomiting of central & peripheral origin associated w/ surgery, metabolic diseases, infectious & drug-induced diseases. Facilitate small bowel intubation & radiological procedures of GIT. (http://asia.mims.com /mimsonline/drugdet ails.aspx? id=4383&dcname=P h&SearchType=Bran d)

CONTRAINDICATION
GI hemorrhage, mechanical obstruction or perforation, pheochromocytoma, epileptics. (http://asia.mims.com/mims online/drugdetails.aspx? id=4383&dcname=Ph&Sea rchType=Brand)

SIDE EFFECTS
Extrapyramidal reactions, drowsiness, fatigue & lassitude, anxiety. Less frequently, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, bowel disturbances. (http://asia.mims.c om/mimsonline/dru gdetails.aspx? id=4383&dcname =Ph&SearchType =Brand)

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. Health Teaching: *Take this medicine 30 minutes before meals and at bedtime, unless otherwise directed by your doctor. *Take metoclopramide only as directed. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. *To take metoclopramide oral concentrate: This medicine should be mixed with another liquid, such as water, juices, soda or soda-like beverages, or with a semi-solid food, such as applesauce or pudding. * If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. (http://www.nlm.nih.gov/medlineplus/druginfo /uspdi/202364.html)

DRUG STUDY

DRUG NAME
Generic Name: Amiodarone Hydrochloride Brand Name: Cordarone Classification: Antiarrhythmics How Supplied: Injection : 50 mg/ml in 3 ampules, vials Tablets:100 mg, 200mg, 400 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236-239)

DOSAGE & FREQUENCY

150/3ml stat

MECHANISM OF ACTION
Effects result from blockage of potassium chloride leading to a prolongation of action potential duration. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236239)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*Life-threartening recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia unresponsive to adequate doses of other antiarrhytmics or when alternative drugs cant be tolerated. *Cardiac arrest, pulseless ventricular tachycardia, or ventricular fibrillation *Supraventricular arrhythmias *Ventricular and supraventricular arrhythmias *Short-term management of atrial fibrillation *Heart failure (impaired left ventricular ejection fraction, impaired exercise tolerance, and ventricular arrhythmias (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236-239)

*Contraindicated in patients hypersensitivity to drugs *Contraindicated in those with cardiogenic shock, second- or third-degree Av block, severe SA node an artificial pacemaker is present, and in those for whom bradycardia has caused syncope. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236239)

CNS: peripheral neuropathy, ataxia, paresthesia, tremor, insomnia, sleep disturbances, headache, malaise, fatigue. CV: hypotension, edema EENT: asymptomatic corneal microdeposits, optic neuropathy or neuritis resulting in visual impairment, abnormal smell, visual disturbances. GI: abnormal taste, anorexia, nausea, vomiting, constipation, abdominal pain. SKIN: photosensitivity, solar dermatitis, blue gray skin. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236239)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check vital signs again Health Teaching: *Advise patient to wear sunscreen or protective clothing to prevent sensitivity reaction to the sun. Monitor patient for skin burning or tingling, followed by redness and blistering. Exposed skin may turn blue-gray. *Tell patient to take oral drug with food if GI reactions occur. *Inform patient that adverse effect of drug are more common at high doses and become more frequent with treatment lasting longer than 6 months but are generally reversible when drug is stopped. Resolution of adverse reactions may take up 4 months. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.236-239)

DRUG STUDY

DRUG NAME
Generic Name: Aminophylline (theophylline ethylenediamine) Brand Name: Aminophylline Classification: Bronchodilators How Supplied: Injection : 250mg/10ml, 500mg/20ml, 100mg/100ml in halfnormal saline solution, 200 mg/100ml in halfnormal saline solution Oral liquids: 105mg/5ml Rectal Suppositories: 250 mg, 500mg Tablets:100mg, 200mg Tablets (extendedrelease); 350 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615-617)

DOSAGE & FREQUENCY

250mg/10ml stat

MECHANISM OF ACTION
Relaxes smooth muscle of bronchial airways and pulmonary blood vessels by inhibiting phosphodiesterase, the enzyme that degrades cAMP. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615617)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* Symptomatic relief of bronchospasm (aminophylline doses) *Chronic bronchial asthma (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615617)

*Contraindicated in patients hypersensitivity to xanthine compounds (caffeine, theobromine) and ethylenediamine and in those with active peptic ulcer disease and seizure disorders (unless they receive adequate convulsant therapy). *Rectal suppositories contraindicated in patients with irritation or infection of the rectum or lower colon. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615617)

CNS: fever, nervousness, restlessness, headache, insomnia, dizziness, confusions, psychosis. CV: palpitations, sinus tachycardia, extra systoles, flushing, marked hypotension GI: nausea, vomiting, diarrhea, epigastric pain, hematemesis, irritation with rectal suppositories, anorexia SKIN: urticaria OTHER: hypersensitivity reactions. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615617)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check vital signs again Health Teaching: *Provide dosage schedule and instructions for home use of prescribed form. Some patients may need an around-the-clock dosage schedule. *Warn elderly patient that dizziness is common at start of therapy. *Warn patient to check with prescribed before combining amionophylline with other drugs. Prescription or OTC remedies may contain ephedrine and theophylline salts; excessive CNS stimulation may result. *Caution patient not to switch brands without first checking with prescriber. *If patient smokes, tell him to notify prescriber if he quits. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.615-617)

DRUG STUDY

DRUG NAME
Generic Name: Calcium Gluconate Brand Name: Calcium Gluconate Classification: Electrolytes and Replacement Solutions How Supplied: Injection : 10% solution in 10-ml ampules and vials, 10ml or 50-ml vials Powder for oral suspension:3, 756/15ml Tablets:500mg, 650mg, 1g (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863-866)

DOSAGE & FREQUENCY

1gm/10ml stat

MECHANISM OF ACTION
Replaces calcium and maintains calcium level. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863866)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*Hypocalcemic emergency *Hypocalcemic tetany *Adjunctive treatment of magnesium toxicity *During exchange transfusions. *Hyperphosphatemia *Dietary Supplement *Hyperkalemia with secondary cardiac toxicity. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863866)

*Contraindicated in cancer patients with bone metastases and in patients with ventricular fibrillation, hypercalcemia, hypophosphatemia, or renal calculi. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863866)

CNS: tingling sensations, sense of oppression or heat waves with I.V. use, syncope with rapid I.V. injection CV: mild drop in blood pressure, vasodilatation. GI: irritation, constipation, chalky taste, hemorrhage, nausea, vomiting, thirst, abdominal pain. GU: polyuria, renal calculi SKIN: local reactions, including burning, necrosis, tissue sloughing, cellulites, soft-tissue calcification with I.M. use, pain, irritation at S.C. injection site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863866)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient to take oral calcium 1 to 1 hours after meals if GI upset occurs. *Tell patient to take oral calcium with a full glass of water. *Warn patient to avoid oxalic acid (in rhubarb and spinach), phytic acid (in bran and wholegrain cereals), and phosphorous (in dairy products) n the meal preceding calcium consumption; these substances may interfere with calcium absorption. *Inform patient that some products may contain phenylalanine. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.863-866)

DRUG STUDY

DRUG NAME
Generic Name: Magnesium Sulfate Brand Name: Magnesium Sulfate Classification: Electrolytes and Replacement Solutions How Supplied: Injection Solutions: 10%, 12.5%, 50% in 2ml, 5ml, 10ml, 20ml and 30 ml ampules, vials and prefilled syringes (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866-867)

DOSAGE & FREQUENCY

250mg/ml stat

MECHANISM OF ACTION
Replaces magnesium and maintains magnesium level; as an anticonvulsant, reduces muscle contractions by interfering with release of acetylcholine at myoneural junction. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866867)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*Mild hypomagnesemia *Symptomatic severe hypomagnesemia, with magnesium 0.8 mEq/L or less. *Magnesium supplement *Magnesium supplementation in total parenteral nutrition (TPN) *Seizures (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866867)

*Contraindicated in patient with myocardial damage or heart block and in pregnant women in actively progressing labor. *Use parenteral magnesium with caution in patients with impaired renal function. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866867)

CNS: toxicity, weak or absent deep tendon reflexes, flaccid paralysis, drowsiness, stupor. CV: slow, weak, pulse, hypotension, flushing. GI: diarrhea SKIN: diaphoresis OTHERS: hypothermia (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866867)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Explain use and administration of drug to patient and family. *Tell patient to report adverse effects. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.866-867)

DRUG STUDY

DRUG NAME
Generic Name: Sodium Bicarbonate Brand Name: Arm & Hammer Baking Soda, Bell/ans, Neut, Soda Mint Classification: Acidifiers and Alkalinizes How Supplied: Injection :2.4 mEq/5ml, 5mEq/10ml,297.5mEq /500ml,8.92mEq/10ml & 44.6mEq/50ml, 10mEq/10ml and 50mEq/50ml Tablets:325mg, 650 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873-874)

DOSAGE & FREQUENCY

50ml/vial stat

MECHANISM OF ACTION
Restore buffering capacity of the body and neutralizes excess acid. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873874)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*Metabolic Acidosis *Systemic or Urinary alkalinization *Antacid *Cardiac Arrest (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873874)

*Contraindicated in patient with metabolic or respiratory alkalosis and those with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure. *Contraindicated in patients losing chloride because of vomiting or continous GI suction and in those receiving diuretics that produce hypochloremic alkalosis. Oral sodium bicarbonate is contraindicated for acute ingestion of strong mineral acids. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873874)

CNS: tetany. CV: edema GI: gastric distention, belching, flatulence METABOLIC: hypokalemia, hypernatremia, hyperrosmolarity with overdose SKIN: pain and irritation at injection site (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873874)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient not to take drug with milk because doing so may cause high levels of calcium in blood, abnormally high levels of calcium in the blood, abnormally high alkalinity in tissues and fluid, or kidney stones. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.873-874)

DRUG STUDY

DRUG NAME
Generic Name: Potassium Chloride

DOSAGE & FREQUENCY

MECHANISM OF ACTION
Replaces potassium and maintains potassium level (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869870)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

40mEq/20ml stat Brand Name: Apo-K+ Classification: Electrolytes and Replacement Solutions How Supplied: Capsules (controlledrelease) 8mEq, 10mEq Injection concentrate: 1.5mEq/ml, 2mEq/ml Injection for I.V. infusion:0.1 mEq/ml, 0.2mEq/ml, 0.3mEq/ml, 0.4mEq/ml Powder for Oral Administration:15mEq /packet, 20mEq/packet, 25mEq/packet Tablets (controlledrelease):6.7mEq, 8mEq, 10mEq, 20mEq Tablets(extendedrelease)8mEq, 10mEq (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869-870)

*To prevent hypokalemia *Hypokalemia *Severe Hypokalemia *Acute MI (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869870)

*Contraindicated in patients with sever renal impairment with oliguria, anuria, or azotemia; with untreated Addisons Disease, or with acute dehydration, heat cramps, hyperkalemia, hyperkalemia form of familial periodic paralysis, or other conditions linked to extensive tissue breakdown. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869870)

CNS: paresthesia of limbs, listlessness, confusion, weakness or heaviness of limbs, flaccid paralysis. CV: ECG changes, hypotension, post infusion phlebitis GI: nausea, vomiting, abdominal pain, diarrhea (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869870)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Teach patient how to prepare (powder) and give drug form prescribed. Tell patient to take with or after meals with full glass of water or fruit juice to lessen GI distress. *Teach patient signs and symptoms of hyperkalemia, and tell patient to notify prescriber if they occur. *Tell patient to report discomfort at I..V. insertion site. *Warn patient not to use salt substitutes concurrently, except with prescribers permission. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.869-870)

DRUG STUDY

DRUG NAME
Generic Name: Methylprednisolone Sodium Succinate Brand Name: Solu-Medrol Classification: Corticosteroids How Supplied: Injection:40-mg vial, 125-mg vial, 500-mg vial, 1,000-mg vial, 2,000-mg vial (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725-727)

DOSAGE & FREQUENCY

500mg/vial stat

MECHANISM OF ACTION
Not clearly defined. Decreases inflammation, mainly but stabilizing leukocyte lysosomal membranes; suppresses immune response, stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725727)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient not to stop drug abruptly or without prescribers consent. *Instruct patient to take oral form of drug with milk or food. *Teach patient signs and symptoms of early adrenal insufficiency; fatigue, muscle weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness, and fainting. *Instruct patient to carry or wear medical identification indicating his need for supplemental systemic glucocorticoids during stress. This card should contain prescribers name of drug, and dosage taken. *Warn patient on long-term therapy about cushingoid effects (moon face, buffalo hump) and the need to notify prescriber about sudden weight gain or swelling. *Advise patient receiving on long-term therapy to consider exercise or physical therapy. Also, tell patient to ask prescriber about vitamin D and calcium supplement. *Instruct patient to avoid exposure to infections (such as chicken pox or measles) and to contact prescriber if such exposure occurs. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725-727)

*Severe inflammation or immunosupression *Shock (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725727)

*Contraindicated in patients hypersensitive to drug or its ingredients, in those with systemic fungal infections, in premature infants (acetate and succinate), and in patients receiving immunosuppressive doses together with live virus vaccines. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725727)

CNS: euphoria, insomnia, psychotic behavior, vertigo CV: hypertension, edema, thromphebitis EENT: cataracts, glaucoma GI: peptic ulceration, GI irritation, increased appetite, nausea and vomiting. GU:menstrual irregularities, increased urine calcium levels METABOLIC: hypokalemia, hyperglycemia, carbohydrate intolerance, hypercholesterolemia, hypocalcemia. MUSCULOSKLETAL: growth suppression in children, muscle weakness, osteoporosis. SKIN: hirsutism, delayed wound healing, acne, various skin eruptions. OTHER: cushingoid taste, susceptibility to infections. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.725727)

DRUG STUDY

DRUG NAME
Generic Name: Hydrocortisone Sodium succinate Brand Name: Solu-Cortef Classification: Corticosteroids How Supplied: Injection:100mg vial, 250 mg vial, 500 mg vial, 1,000 mg vial (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722-725)

DOSAGE & FREQUENCY

250mg/2ml 100mg/2ml stat

MECHANISM OF ACTION
Not clearly defined. Decrease inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response, stimulate bone marrow and influences protein, fat, and carbohydrate metabolism. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722725)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient not to stop drug abruptly or without prescribers consent. *Instruct patient to take oral form of drug with milk or food. *Teach patient signs and symptoms of early adrenal insufficiency; fatigue, muscle weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness, and fainting. *Instruct patient to carry or wear medical identification indicating his need for supplemental systemic glucocorticoids during stress. This card should contain prescribers name of drug, and dosage taken. *Warn patient about bruising. *Urge patient receiving long-term therapy to consider exercise or physical therapy. Also, tell him to ask prescriber about vitamin D or calcium supplement. *Advise patient receiving long-term therapy to have periodic eye examinations. **Instruct patient to avoid exposure to infections (such as chicken pox or measles) and to contact prescriber if such exposure occurs. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722-725)

* Severe inflammation, adrenal insufficiency *Shock *Adjunct treatment for ulcerative solitis and proctitis. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722725)

*Contraindicated in patients hypersensitive to drug or its ingredients, in those with systemic fungal infections, in those receiving immunosuppressive doses together with live virus vaccines, and in premature infants (succinate) (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722725)

CNS: euphoria, insomnia, psychotic behavior, vertigo CV: hypertension, edema, thromphebitis EENT: cataracts, glaucoma GI: peptic ulceration, GI irritation, increased appetite, nausea and vomiting. GU:menstrual irregularities, increased urine calcium levels METABOLIC: hypokalemia, hyperglycemia, carbohydrate intolerance, hypercholesterolemia, hypocalcemia. MUSCULOSKLETAL: growth suppression in children, muscle weakness, osteoporosis. SKIN: hirsutism, delayed wound healing, acne, various skin eruptions. OTHER: cushingoid taste, susceptibility to infections. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.722725)

DRUG STUDY

DRUG NAME
Generic Name: Isosorbide Dinitrate Brand Name: Isordil Titradose Classification: Antianginals How Supplied: Capsules (sustainedrelease):40mg Tablets:5mg, 10mg, 20mg, 30mg, 40mg Tablet (S.L.): 2.5mg, 5mg, 10mg Tablets (sustainedrelease):40mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263-264)

DOSAGE & FREQUENCY

5mg/tab stat

MECHANISM OF ACTION
Not completely known. Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood flow through the collateral coronary vessels. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263264)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: *Tell patient to take drug regularly, as prescribed, and keep it accessible at all times. *Advise patient that stopping drug abruptly may cause spasm of the coronary arteries with increased angina symptoms and potential risk of heart attack. *Advise patient taking P.O from to take oral tablets 30 minutes before or 1-3 hours after meal and to swallow oral tablets whole. *Tell patient to avoid alcohol because it may worsen low blood pressure effects. *Instruct patient to store drug in a cool place, in a tightly closed container, and away from light. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263-264)

* Acute anginal attacks (S.L. isosorbide dinitrate only); to prevent situations that may cause anginal attacks. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263264)

*Contraindicated in patients with hypersensitivity or idiosyncrasy to nitrates and in those with severe hypotension, angle glaucoma, increased intracranial pressure, shock, or acute MI with low left ventricular filling pressure. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263264)

CNS: headache, dizziness, weakness CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing EENT: S.L. burning GI: nausea and vomiting. GU:menstrual irregularities, increased urine calcium levels SKIN: cutaneous vasodilation, rash (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.263264)

DRUG STUDY

DRUG NAME
Generic Name: Nalbuphine Hydrochloride Brand Name: Nubain Classification: Opiods Analgesics How Supplied: Injection:10mg/ml, 20 mg/ml (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394-395)

DOSAGE & FREQUENCY

10mg stat

MECHANISM OF ACTION
Unknown. Binds with opiate receptors in the CNS, altering perception of and emotional response to pain. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394395)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital Signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Vital Signs again Health Teaching: *Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other hazardous activities that require mental alertness until drugs CNS effect are known. *Teach patient how to manage trouble some adverse effects such as constipation. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394-395)

* Moderate to Severe Pain *Adjunct to balanced anesthesia (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394395)

*Contraindicated in patients hypersensitive to drug. *Use cautiously in patients with history of drug abuse and in those with emotional instability, head injury, increased intracranial pressure, impaired ventilation, MI accompanied by nausea and vomiting, upcoming biliary surgery, and hepatic or renal disease. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394395)

CNS: headache, sedation, dizziness, vertigo CV: hypotension, hypertension, tachycardia EENT: blurred vision, dry mouth GI: cramps, dyspepsia, bitter taste, nausea, vomiting, constipation, biliary tract spasms. GU:urinary urgency SKIN: pruritus, burning, urticaria, clamminess, diaphoresis (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.394395)

DRUG STUDY

DRUG NAME
Generic Name: Tramadol Hydrochloride Brand Name: Tramal Classification: Centrally Acting Analgesic How Supplied: Tablets: 50 mg (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 1163-1164)

DOSAGE & FREQUENCY

50mg/2ml stat

MECHANISM OF ACTION
Binds to mu-opiod receptors and inhibits the reuptake of norepinephrine and serotonin (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 11631164)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds as ordered *Provide environment control (temp., lightning) After Administration: *Do after care *Do handwashing *Document the given medication. Health Teaching: *Tell patient to take drug as prescribed and not to increase dose or dosage interval unless ordered by prescriber. *Caution ambulatory patient to patient to be careful when rising and walking. Warn outpatient to avoid driving and other potentially hazardous activities that require mental alertness until drugs CNS effects are known. *Advise patient to check with prescriber before taking OTC drugs because drug interactions can occur. *Warn patient not to stop the drug abruptly. (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 1163-1164)

*Relief of moderate to moderately severe pain (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 1163-1164)

*Contraindicated with pregnancy allergy to tramadol, acute intoxication with alcohol opiods, psychotropic drug or other centrally acting analgesic lactation. (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 1163-1164)

CNS: sedation, dizziness/ vertigo, headache. CV: hypotension GI: nausea, vomiting (2004 Lippincotts Nursing Drug Guide by Amy M. Karch pp. 1163-1164)

DRUG STUDY

DRUG NAME
Generic Name: Ketorolac Trothemine Brand Name: Toradol Classification: Nonsteroid antiinflammatory drugs How Supplied: Injection: 15mg/ml, 30mg/ml Tablets:10mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368-369)

DOSAGE & FREQUENCY

30mg/2ml stat

MECHANISM OF ACTION
Unknown. May inhibit prostaglandin synthesis, to produce antiinflammatory, analgesics, and antipyretic effects. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368369)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES
Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital Signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Vital Signs again Health Teaching: * Warn patient receiving drug I.M. that pain may occur at injection site. *Teach patient signs and symptoms of GI bleeding, including blood in vomit, urine, or stool; coffee-ground vomit; and black, tarry stool. Tell him to notify prescriber immediately if any of these occurs (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368-369)

* Short-term management of moderately sever, acute pain for singledose treatment. *Short-term management of moderate severe, acute pain for multiple dose treatment. *Short-term management of moderate sever, acute pain when switching from parenteral to oral administration (oral therapy is indicated only as continuation of parenterally given drug and should never be given without patient first having received parenteral therapy. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368369)

*Contraindicated in patients hypersensitive to drug and in those with active peptic ulcer disease, recent GI bleeding or perforation, advanced renal impairment, cerebrovascular bleeding, hemorrhagic diathesis, or incomplete hemostasis from volume depletion or at risk of bleeding. *Contraindicated in children younger than age 2 and in patients with history of peptic ulcer disease or GI bleeding, past allergic reactions to aspirin or other NSAIDs and during labor and delivery or breastfeeding. *Contraindicated as prophylactic analgesics before major surgery or intraoperatively when hemostasis is critical; and in patients currently receiving aspirin, an NSAID, or probenecid. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368369)

CNS: headache, dizziness, drowsiness, sedation CV: hypertension, edema, palpitations GI: nausea, vomiting, GI pai, diarrhea, peptic ulceration, vomiting, constipation, flatulence, stomatitis HEMATOLOGIC: decreased platelet adhesion, purpura, and prolonged bleeding time. SKIN: pruritus, rash, diaphoresis. OTHER: pain at injection site (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.368369)

DRUG STUDY

DRUG NAME
Generic Name: Captopril Brand Name: Capoten Classification: Antihypertensives How Supplied: Tablets:12.5 mg, 25 mg, 50 mg, 100 mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279-281)

DOSAGE & FREQUENCY

25mg/tab stat

MECHANISM OF ACTION
Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279281)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* Hypertension *Diabetic nephropathy * Heart failure *Left ventricular dysfunction after acute MI (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279281)

*Contraindicated in patients hypersensitive to drug or other ACE inhibitors. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279281)

CNS: headache, dizziness, fainting, malaise, fever, fatigue CV: hypotension, tachycardia, angina pectoris GI: nausea, vomiting, abdominal pain, anorexia, constipation, dry mouth, dysgeusia METABOLIC: hyperkalemia SKIN: pruritus,alopecia, urticardial rash, maculopapular rash (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279281)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital Signs BPDuring Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Vital Signs again-BPHealth Teaching: * Instruct patient to take drug 1 hour before meals; food in the GI tract may reduce absorption. *Inform patient that light-headedness is possible, especially during first few days of therapy. Tell him to rise slowly to minimize this effect and to report occurrence to prescriber. If fainting occurs, he should stop drug and call prescriber immediately. *Tell patient to use caution in hot weather and during exercise. Lack of fluids, vomiting, diarrhea, and excessive perspiration can lead to light-headedness and syncope. *Advise patient to report signs and symptoms of infection, such as fever and sore throat. *Tell women to notify prescriber if pregnancy occurs. Drug will need to be stopped. *Urge patient to promptly reports swelling of the face, lips, or mouth, or difficulty breathing. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.279-281)

DRUG STUDY

DRUG NAME
Generic Name: Nifedipine Brand Name: Procardia Classification: Antianginals How Supplied: Capsules:10 mg, 20mg Tablets (extendedrelease); 30mg, 60mg, 90mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265-266)

DOSAGE & FREQUENCY

5mg/cap 10mg.tab stat

MECHANISM OF ACTION
Unknown. Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265266)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* Vasospatic angina (Prinzmetals or variant angina), classic chronic stable angina pectoris *Hypertension (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265266)

*Contraindicated in patients hypersensitive to drug. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265266)

CNS: light headness, dizziness, somnolence, headache, weakness, syncope, nervousness CV: peripheral edema, hypotension, palpitations, flushing GI: nausea, diarrhea, constipation, abdominal discomfort METABOLIC: muscle cramps SKIN: rash, pruritus (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265266)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital Signs BPDuring Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Vital Signs again-BPHealth Teaching: * If patient is kept on nitrate therapy while nifedipine dosage is being adjusted, urge continued compliance. Patient may take S.L. nitroglycerin, as needed, for acute chest pain. *Tell patient that chest pain may worsen briefly when beginning drug or when dosage is increased. *Advise patient to avoid taking drug with grapefruit juice. *Reassure patient taking the extended- release form that a wax-matrix ghost from the tablet may be passed in the stools. Drug is completely absorbed before this occurs. *Tell patient to protect capsules from direct light and moisture and to store at room temperature. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.265-266)

DRUG STUDY

DRUG NAME
Generic Name: Salbutamol Sulfate Brand Name: Ventolin Classification: Bronchodilators How Supplied: Capsules for inhalation:200mcg Injection:1mg/ml Solution for inhalation:0.083%, 0.5%, 0.63 mg/ml, 1.25mg/3ml Syrup:2mg/5ml Tablets:2mg, 4mg Tablets (extendedrelease): 4mg, 8mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613-615)

DOSAGE & FREQUENCY

2.5mg/neb stat

MECHANISM OF ACTION
Relaxes bronchia, uterine, and vascular smooth muscle by stimulating beta2 receptors. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613615)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* To prevent or treat bronchospasm in patient with reversible obstructive airway disease. *To prevent exerciseinduced bronchospasm (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613615)

*Contraindicated in patients hypersensitive to drug or its ingredients. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613615)

CNS: tremors, nervousness, dizziness, insomnia, headache, hyperactivity, weakness, CNS stimulation, malaise. CV: tachycardia, palpitations, hypertension. EENT: dry and irritated nose and throat with inhaled form, nasal congestion, and epistaxis. GI: Heartburn, nausea, vomiting, anorexia, altered taste, increased appetite. METABOLIC: hypokalemia MUSCULOSKELETAL: muscle cramps RESPIRATORY: cough, wheezing, dyspnea, bronchitis, increased sputum OTHER: hypersensitivity reactions. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613615)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check vital Signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects *Check Vital Signs again Health Teaching: * Warn patient about risk of paradoxical bronchospasm and to stop drug immediately if it occurs. *Teach patient to perform oral inhalation correctly. *If prescriber orders more than 1 inhalation, tell patient to wait at least 2 minutes before repeating procedure. *Tell patient that use of a spacer device may improve drug delivery to lungs. *If patient is also using a corticosteroids inhaler, instruct him to use the bronchodilators first and then wait about 5 minutes before using the corticosteroid. *tell patient to remove canister and wash inhaler with warm, soapy water at least once a week. *Advise patient not to chew or crush extendedrelease tablets or mix them with food. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.613-615)

DRUG STUDY

DRUG NAME
Generic Name: Naloxone Hydrochloride Brand Name: Narcan Classification: Miscellaneous antagonists and Antidotes How Supplied: Injection: 0.02mg/ml, 0.4mg/ml, 1mg/ml (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.1249-1250)

DOSAGE & FREQUENCY

0.4mg/ml stat

MECHANISM OF ACTION
Unknown. Thought to displace opioid an analgesics from their receptors (competitive antagonism); drug has no pharmacologic activity of its own. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.12491250)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* Known or suspected opioidinduced respiratory depression, including that caused by pentazocine and propoxyphene. *Postoperative opioid depression (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.12491250)

*Contraindicated in patients hypersensitive to drug. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.1249-1250)

CNS: tremors, seizures CV: tachycardia, hypertension with higher-thanrecommended doseshypotension. GI:nausea, vomiting RESPIRATORY: pulmonary edema SKIN: diaphoresis OTHER: withdrawal symptoms in opioid dependent patients with higher-thanrecommended doses. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.12491250)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects Health Teaching: * Inform patient about use and administration of drug. *Reassure family that patient will be monitored closely until effect of opioid resolve. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.1249-1250)

DRUG STUDY

DRUG NAME
Generic Name: Metoprolol Succinate Brand Name: Toprol- XL Classification: Antihypertensive How Supplied: Tablets (extendedrelease):25mg, 50mg, 100mg, 200mg (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301-303)

DOSAGE & FREQUENCY

5 mg slow IV at 5-minute intervals to total of 15 mg (http://www2.mc .duke.edu/9200b mt/ACLSdrugs.ht m)

MECHANISM OF ACTION
Unknown. A selective beta blocker that selectively blocks beta, receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses rennin secretion. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301303)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

* Hypertension *Early Intervention in Acute MI * Angina Pectoris *Stable symptomatic heart failure (New York Heart Association class II) resulting from ischemia, hypertension, or cardiomyopathy. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301303)

*Contraindicated in patients hypersensitive to drug or other beta blockers. *Contraindicated in patients with sinus bradycardia, greater than first9degree heart block, cardiogenic shock, or overt cardiac failure when used to treat hypertension or angina. When used to treat MI drug is contraindicated in patients with heart rate less than 45 beats/minute, greater than first-degree heart block, PR interval of 0.24 second or longer with first-degree heart block, systolic blood pressure less than 100 mmHg, or moderate to severe cardiac failure. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301303)

CNS: fatigue, dizziness, depression CV: hypotension GI:nausea, diarrhea RESPIRATORY: dyspnea SKIN: rash (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301303)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check Vital Signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects * Check again for Vital Signs Health Teaching: * Inform patient to take drug exactly as prescribed and to take it with meals. *Caution patient to avoid driving and other tasks requiring mental alertness until response to therapy has been established. *Advise patient to inform dentist or prescriber about use of this drug before procedures or surgery. *Tell patient to alert prescriber if shortness of breath occurs. *Instruct patient not to stop drug suddenly but to notify prescriber about unpleasant adverse reactions. Inform him that drug must be withdrawn gradually over 1 0r 2 weeks. *Inform patient that metoprolol isnt advised in breast-feeding women. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.301-303)

DRUG STUDY

DRUG NAME
Generic Name: Norepinephrine bitartrate Brand Name: Levophed Classification: Adrenergic (sympathomimetics ) How Supplied: Injection: 1mg/ml (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575-577)

DOSAGE & FREQUENCY

Start at 0.5-1.0 mcg/minute; titrate to 30 mcg/minute (http://www2.mc .duke.edu/9200b mt/ACLSdrugs.ht m)

MECHANISM OF ACTION
Stimulates alpha and beta, receptors in the sympathetic nervous system, causing vasoconstriction and cardiac stimulation. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575577)

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

*To restore blood pressure in acute hypotensive states. *Severe hypotension during cardiac arrest. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575577)

*Contraindicated in patients with mesenteric or peripheral vascular thrombosis, profound hypoxia, hypercarbia, or hypotension resulting from blood volume deficit. *Contraindicated during cyclopropane and halothane anesthesia (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575577)

CNS: headache, anxiety, weakness, dizziness, tremor, restlessness, insomnia. RESPIRATORY: respiratory difficulties SKIN: irrigation with extravasation, necrosis and gangrene secondary to extravasation. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575577)

Before Administration: *Do handwashing *Checked with Medication Ticket *3 times check on the medication. *Prepare the medications. *Check Vital Signs During Administration: *Give Meds After Administration: *Do after care *Do handwashing *Document the given medication. *Watch for adverse effects * Check again for Vital Signs Health Teaching: * Tell patient to report adverse reactions promptly. *Advise patient to report discomfort at I.V. insertion site. (26th edition Nursing Drug Handbook by Lippincott Williams & Wilkins pp.575-577)