D Generic name: Ciprofloxacin Brand name: Ciloxan, Cipro Availability: -tablets -injection -oral suspension -opthalmic ointment - otic

suspension

C Antibac terialbacteri cidal

MOA Interferes with DNA replication in susceptible bacteria preventing cell reproductio n

I treatment of UTIs caused by E.coli Otic: treatment of acute otitis externa oral: STDs caused by N. gonorrhea LRTI: caused by E.coli, Enterobacter species, S.pneumoniae effective in patient with cystic fibrosis who have pulmonary exacerbations.

CI -contraindicated with allergy to Ciprofloxacin , norfloxacin, or other fluoroquinolones, pregnancy, lactation. -use cautiously with renal dysfunction, tendinitis or tendon rupture associated with fluoroquinolones

AE CNS: headache, dizziness, insomnia, fatigue, blurred vision CV: arrhythmias, hypotension, angina GI: nausea, vomiting, dry mouth, diarrhea, abdominal pain Hematologic: elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase, decreased WBC, neutrophil count, Hct EENT:dry eye, eye pain Other: fever, rash

NC allergy to Ciprofloxacin arrange for culture and sensitivity test before beginning therapy. continue therapy for 2 days after signs and symptoms of infection are gone ensure that patient is well hydrated give antacids at least 2 hr after dosing monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity encourage Patient to complete full course of therapy.

D Generic name: Acetaminophen/Parac etamol Brand name: Biogesic Availability: -Suppositories, chewable tablet, caplet, gelcap, capsules, liquid , solution

C Antipy retic Analge sic

MOA Reduces fever by directly on the hypothalamic heatregulating center to cause vasodilation and sweating, which helps dissipate heat.

I -analgesic- antipyretic in patients with aspirin allery, hemostatic disturbances,upper GI disease -arthritis and rheumatic disorders involving musculoskeletal pain. -common cold, flu, other viral and bacterial infections with pain and fever. -prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain.

CI -contraindicated with allergy to acetaminophen -use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

AE CNS: headache CV: chest pain, dyspnea, myocardial damage when doses of 5-8 g/day are ingested daily for several weeks. GI: hepatic toxicity and failure, jaundice Hematologic: hemolytic anemia, neutropenia, leucopenia Hypersensitivity: fever, rash

NC allergy to acetaminophen do not exceed the recommended dosage. avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. give drug with foods if GI upsets occur

D Generic name: Metoclopra mide Brand name: Plasil, Maxolon,

C Antie metic GI stimu lant

MOA Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal

I relief of symptoms of acute and recurrent diabetic gastroparesis short- term therapy for adults with GERD parenteral: prevention of nausea and vomiting prophylaxis of postoperative nausea and vomiting when

CI -contraindicated with allergy to metoclopramide, GI hemorrhage, mechanical obstruction or perforation, epilepsy.

AE CNS: restlessnes s, drowsiness , fatigue, insomnia, dizziness, anxiety

NC monitor BP carefully during IV administration keep diphenhydramine injection readily available in case EPSl reactions occur have phenotolamine readily available in case of hypertensive crisis

Reglan Availabilit y: -Tablets -Injections

transit, little effect on gallbladder or nasogastric suction is colon motility; increases lower undesirable esophageal sphincter pressure; has treatment of nausea and sedative properties; induces vomiting of a variety of etiologies release of prolactin.

-use cautiously with previously detected breast cancer, lactation, pregnancy

CV: transient hypertensi on GI: nausea, diarrhea

take drug exactly as prescribed use of alcohol, sleep remedies, or sedatives can cause serious sedation. report involuntary movement of the face, eyes, and limbs

GN citich oline

BN Zyna pse

DOSAGE 500mg IV q8 Discontinue d on September 9, 2009

INDICATION Cerebrovascular Diseases, accelerates the recovery of consciousness and overcoming motor deficit.

MECHANISM OF ACTION Citicoline activates the biosynthesis of structural phospholipids in the neuronal membrane, increases cerebral metabolism and increases the level of various neurotransmitters, including acetylcholine and dopamine. Citicoline has shown neuroprotective effects in situations of hypoxia and ischemia.

CI hypertonia of the parasympath etic

AE citicoline may exert a stimulating action of the parasympathetic, as well as a fleeting and discrete hypotensor effect

NR Watch out for hypotensive effects Somazine must not be administered along with medicaments containing

GN
lactul ose

BN
Lilac

D 80cc HS

I Const ipatio n

MOA metabolism of lactulose by bacteria results in reduced colonic pH which stimulates peristalsis and decreases stool transit time. In turn, decreased water reabsorption from the feces further facilitates the passage of soft well-formed stools. And increased osmotic pressure of fecal material secondary to an increase in colonic organic acids results in accumulation of fluid from surrounding tissues, helping to soften stool mass. CI Pulmonary congestion or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration. MOA

CI Low galactose diet & intestinal obstruction

AE Abdominal discomfort associated w/ flatulence or cramps. Prolonged use or large doses may result in diarrhea w/ excessive loss of water & electrolytes

NR Do not administer if patient has already pass out stool especially if stool is liquid

GN Manni tol

D 100 cc IV

I Raised intracran ial pressure

MOA It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues.

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

NR Take care to avoid extravasation. Observe injection site for signs of inflammation or edema check for signs of fluid and electrolyte imbalance measure I&O accurately and record to achieve proper fluid balance monitor vital signs closely. Report significant changes in BP and signs of CHF

GN

BN

NR

Nimo dipin e

Nim oto p

30 mg / tab 2 tab sq 6

Prophylaxis and treatment of ischemic neurological deficits due to cerebral vasospasms after subarachnoid hemorrhage

Calcium channel blocking agent that is relatively selective for cerebral arteries compared with arteries elsewhere in the body. This may be attributed to the drugs high lipid solubility and specific binding to cerebral tissue. None

Severe BP lowering, GI disturbances, deterioration of renal function, disturbances of heart rhythm, phlebitis, increase of liver enzymes.

Take apical pulse prior to administering drug and hold it if pulse is below 60. notify the physician. Establish baseline data before treatment is started.BP, pulse and laboratory evaluations of liver and kidney function. Monitor frequently for adverse drug effects, including hypotension, peripheral edema, tachycardia, or skin rash. Monitor frequently for dizziness or lightheadedness in older adult, risk of hypotension is increased

GN Phen obarb ital

D 60 mg/ tab 1 tab HS

I Used as a sedat ive in anxie ty or tensi on state s.

MOA It depresses the sensory cortex, reduces motor activity, changes cerebellar function, and produces drowsiness, sedation and hypnosis. Its anticonvulsant property is exhibited at high doses.`

CI Severe renal and hepatic disorders. Severe respirator y depressio n, dyspnoea or airway obstructio n; porphyria. Pregnancy .

AE Bradycardia, hypotension, syncope; drowsiness, lethargy, CNS excitation or depression, impaired judgment, confusion, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness; rash, thrombocytopenia, megaloblastic anaemia; respiratory depression, apnoea (especially with rapid IV admin),

NR Observe patients receiving large doses closely for at least 30 mins to endure that sedation is not excessive. Keep patient under constant observation when drug is administered every hour or more often if indicated Monitor serum drug levels. Serum concentrations >50 mcg/ml may cause coma. Therapeutic serum concentrations of 15-40 mcg/ml produce anticonvulsant activity in most patients. Expect barbiturates to produce restlessness when given to patients in pain because these drugs do not have analgesic action Be prepared for paradoxical responses Monitor for drug interactions. Barbiturates increase the metabolism of many drugs, leading to decreased pharmacological effects of those drugs. Avoid administering with beta-blockers, calcium channel blockers, warfarin, oral contraceptives

GN Tra mad ol

BN Tra mal Dol cet

D 50 mg / cap 1 cap q8 RTC

I Moderate to severe acute or chronic pain and in painful diagnostic or therapeuti c

MOA Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and serotonin, suggesting both opiod and nonopioid mechanisms of pain relief. May produce opioid-like effects, but causes less respiratory depression

CI Hypersensitivity to tamadol or other opioid analgesics; patients on MAOI, patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs;

AE Drowsiness, dizziness, vertigo, fatigue, headache, restlessness, euphoria, confusion, anxiety, palpitations, vasodilation,

NR Assess for level of pain relief and administer dose as needed but not to exceed the recommended total daily dose. Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression. Discontinue drug and notify the physician if s/sx of hypersensitivity occur. Assess bowel and bladder function, report urinary frequency or retention. Take appropriate safety precautions. Discontinue drug and notify the physician if s/sx of

measures

than morphine

patients on obstetric preoperative medication, lactation.

nausea, constipation, urinary retention/frequen cy. AE Diarrhea, nausea, stomach pain, discomfort or gas vomiting.

hypersensitivity occur Take appropriate safety precautions. To be taken with food to avoid GI upset.

GN Pota ssiu m chlor ide GN Rani tidin e

BN
Kaliu m durul e

D 1 tab TID * 6 doses

I hypok alemia

MOA Provides a direct replacement of potassium in the body

CI Renal insufficiency, hyperkalemia, untreated Addisons disease, constriction of the esophagus and or obstructive changes in the alimentary tract. CI Safe use during pregnancy or lactation is not established

NR Watch out for levels of potassium electrolyte level to prevent hyperkalemia. Observe 10 rights of giving medication. Watch out for possible adverse reaction of the patient.

BN Zan tac

D 150 mg / tab q 12

I Prophylaxis of stress ulceration and recurrent hemorrhage from peptic ulcer

MOA Potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2receptor sites on parietal cells, thus blocking gastric acid secretion.

AE Headache, malaise, dizziness, mental confusion, agitation, depression, hallucinations in older adult. Constipation, nausea, abdominal pain

NR Potential toxicity results from decreased clearance (elimination) and therefore prolonged action; greatest in the older adult patients or those with hepatic or renal dysfunction. Be alert for early signs of hepatotoxicity; jaundice (dark urine, pruritus, yellow slera and skin) Long term therapy may lead to vitamin B12 deficiency.

GN met oprol ol

D 50 mg/tab BID

I Hypert ension

MOA Metoprolol selectively inhibits adrenergic receptors but has little or no effect on 2receptors except in high doses.

CI 2nd or 3rd degree AV block; decompensated heart failure; clinically relevant sinus bradycardia. Severe peripheral arterial circulatory disorders. Cardiogenic shock. Asthma. Phaeochromocytoma (without -blockade), systolic BP <100 mmHg. Metabolic acidosis. Pregnancy (2nd and 3rd trimesters).

AE Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, , palpitation, syncope, dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, rash, sexual dysfunction/impotence,; diarrhea, constipation, flatulence, GI pain, heartburn, nausea, Heart failure, heart block, bronchospasm.

NR Take apical pulse and BP before administering drug. Report to physician significant changes in rate, rhythm, or quality of pulse or variations in BP prior to administration. Monitor BP, HR, and ECG carefully during administration Expect maximal effect on BP after 1 week of therapy Observe hypertensive patients with CHF closely for impending heart failure. Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins. Monitor I&O, daily weight, auscultate daily for pulmonary rales.