Drug Study

ANALGESICS

Generic name: Paracetamol

Brand name: Biogesic, Panadol, Tylenol
Pregnancy Category: B
Classification: Non-narcotic analgesic,
Analgesics, Muscle Relaxants

 Mode of action:
Decreases fever by a hypothalamic effect
leading to sweating and vasodilation
Inhibits pyrogen effect on the hypothalamicheat-regulating centers
Inhibits CNS prostaglandin synthesis with
minimal effects on peripheral prostaglandin
synthesis
Does not cause ulceration of the GI tract and
causes no anticoagulant action.
Suggested Dose: 1-2 tablets thrice daily
Ordered Dose: 500 mg tab q4

 Indications: Pain
Contraindication: Renal Insufficiency,
Anemia, Hypersensitivity
Side effects: drowsiness, nausea, vomiting,
abdominal pain, hepatotoxicity, hepatic
seizure, Jaundice, Glissitis, Drowsiness ,Liver
Damage
Adverse reaction: Allergic skin reactions &
GI disturbances.
Drug Interaction: Anticonvulsants, aspirin,
Phenothiazine, alcohol

 Nursing Interventions:
1. Monitor Vital Sign
2. Do TSB, if fever occurs
3. Do not exceed 4gm/24hr. in adults and 75mg/kg/day in
children.
4. Do not take for >5days for pain in children, 10 days for pain
in adults, or more than 3 days for fever in adults.
5. Monitor CBC, liver and renal functions.
6. Assess for fecal occult blood and nephritis.
7. Report N&V. cyanosis, shortness of breath and abdominal
pain as these are signs of toxicity.
8. Report paleness, weakness and heart beat skips
9. Report abdominal pain, jaundice, dark urine, itchiness or
clay-colored stools.
10.Phenmacetin may cause urine to become dark brown or
wine-colored.

ANTACIDS

Generic name: Calcium Carbonate

Brand name: Dicarbosil, Rolaids,
Titralac, Tums
Classification: Antacids
Mode of action: Rapid-acting antacid with high
neutralizing capacity and relatively prolonged duration of
action. Decreases gastric acidity, thereby inhibiting
proteolytic action of pepsin on gastric mucosa. Also
increases lower esophageal sphincter tone. Although
classified as a nonsystemic antacid, a slight to moderate
alkalosis usually develops with prolonged therapy. Acid
rebound, which may follow even low doses, is thought to
be caused by release of gastrin triggered by action of
calcium in small intestines.

 Suggested Dose: 1 to 1.2 g given daily in

2 or 4 divided doses with meals.
Ordered Dose: 500 mg tab T.I.D
Indications:
Fast relief of acid
indigestion, heartburn, sour & upset
stomach associated w/ these symptoms.
Calcium supplement & as an adjunct in
the treatment of osteoporosis.
Contraindication:
hypercalcemia,
hypercalciuria, or on a low-phosphate diet.

 Contraindication: hypercalcemia, hypercalciuria, or on a lowphosphate diet.

Side effects: Constipation, headache, rash, itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble
breathing.
Adverse reaction:
GI: Constipation or laxative effect, acid rebound, nausea,
eructation, flatulence, vomiting, fecal concretions.
Metabolic: Hypercalcemia with alkalosis, metastatic calcinosis,
hypercalciuria, hypomagnesemia, hypophosphatemia (when
phosphate intake is low).
CNS: Mood and mental changes.
Urogenital: Polyuria, renal calculi.
Drug Interaction:
Drug: May
enhance
inotropic
and
toxic
effects
of digoxin; magnesium may compete for GI absorption; decreases
absorption of TETRACYCLINES, QUINOLONES (ciprofloxacin).

 Nursing Interventions:
1. Monitor Vital Sign
2. Note number and consistency of stools. If constipation is a problem, physician may prescribe
alternate or combination therapy with a magnesium antacid or advice patient to take a laxative
or stool softener as necessary.
3. Lab tests: Determine serum and urine calcium weekly in patients receiving prolonged therapy
and in patients with renal dysfunction.
4. Record amelioration of symptoms of hypocalcemia (see Signs & Symptoms, Appendix F).
5. Observe for S&S of hypercalcemia in patients receiving frequent or high doses, or who have
impaired renal function (see Appendix F).
6. o not continue this medication beyond 12 wk, since it may cause acid rebound, which
generally occurs after repeated use for 1 or 2 wk and leads to chronic use. It is potentially
dangerous to self-medicate. Do not take antacids longer than 2 wk without medical
supervision.
7. Avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine
with calcium carbonate to form insoluble, nonabsorbable compounds.
8. Do not use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium
bicarbonate, as it may cause milk-alkali syndrome: hypercalcemia, distaste for food, headache,
confusion, nausea, vomiting, abdominal pain, metabolic alkalosis, hypercalciuria, polyuria, soft
tissue calcification (calcinosis), hyperphosphatemia and renal insufficiency. Predisposing
factors include renal dysfunction, dehydration, electrolyte imbalance, and hypertension.
9. Instruct patient to Increase fluid intake
10.Report severe headache, worsening of symptoms, fever, chills.

ANTIBACTERIAL

Generic name: cefuroxime

Brand name: Kefox
Pregnancy Category: B
Classification: Cephalosporins, antibacterial
Mode of action: Cefuroxime binds to one or
more of the penicillin-binding proteins (PBPs)
which inhibits the final transpeptidation step of
peptidoglycan synthesis in bacterial cell wall,
thus inhibiting biosynthesis and arresting cell
wall assembly resulting in bacterial cell death.

 Suggested Dose: 30-100g/kg/day in 3 or

4 divided doses
Ordered Dose: 750 mg IVTT q8
Indications:
Respiratory Tract, ENT,
urinary tract, skin & soft tissue, O&G, bone
& joint infections, surgical prophylaxis.
Contraindication:
hypersensitivity
to
cephalosporin. Acute porphyria.
Side effects: Glossitis, nausea, vomiting,
diarrhea, gastric pyrosis, abdominal pain.
Very seldom urticarial or cutaneous rash,
pruritus & arthralgia.

 Adverse reaction:
CNS: Headache, dizziness, lethargy, paresthesias
GI: Nausea, vomiting, diarrhea, anorexia, abdominal
pain, flatulence, pseudomembranous colitis, liver toxicity
Hematologic: Bone
marrow
depression: decreased
WBC, decreased platelets, decreased Hct
GU: Nephrotoxicity
Hypersensitivity: Ranging
from
rash
to
fever to anaphylaxis, serum sickness reaction
Local: Pain, abscess at injection site; phlebitis,
inflammation at IV site
Other: Superinfections, disulfiram-like reaction with
alcohol

 Drug Interaction:
Drug-drug
Increased nephrotoxicity with aminoglycosides
Increased bleeding effects with oral anticoagulants
Disulfiram-like reaction may occur if alcohol is taken
within 72 h after cefuroxime administration.
Drug-lab test
Possibility of false results on tests of urine glucose
using
Benedict's
solution,
Fehling's
solution, Clinitest tablets; urinary 17-ketosteroids; direct
Coombs' test.

 Nursing Interventions:
1. Determine history of hypersensitivity reactions to cephalosporins, penicillins, and
history of allergies, particularly to drugs, before therapy is initiated.
2. Lab tests: Perform culture and sensitivity tests before initiation of therapy and
periodically during therapy if indicated. Therapy may be instituted pending test
results. Monitor periodically BUN and creatinine clearance.
3. Inspect IV injection sites frequently for signs of phlebitis.
4. Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see
Signs & Symptoms, rarely occurs, this potentially life-threatening complication
should be ruled out as the cause of diarrhea during and after antibiotic therapy.
5. Monitor for manifestations of hypersensitivity .Discontinue drug and report their
appearance promptly.
6. Monitor I&O rates and pattern: Especially important in severely ill patients receiving
high doses. Report any significant changes.
7. Report loose stools or diarrhea promptly.
8. Report any signs or symptoms of hypersensitivity.
9. Have regular medical follow-up visits.
10.Instruct patient or watcher to report unusualities.

ANTIHISTAMINE

 Generic name: Benadryl

Brand name: diphenhydramine
Classification:
Antihistamine
Anti-motion sickness agent
Sedative-hypnotic
Antiparkinsonian
Cough suppressant
Mode of action: It stimulates changes within the cells that
lead to the release of chemicals that cause sneezing, itching,
and increased mucus production. Antihistamines compete
with histamine for cell receptors and bind to the receptors
without stimulating the cells. In addition, they prevent
histamine from binding and stimulating the cells.

 Suggested Dose: Capsules: 20- 50 mg every 4-6 hours

Ordered Dose: 30mg 1 cap, OD
Indications:
Relief of symptoms associated with perennial and seasonal
allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild,
uncomplicated urticaria and angioedema; amelioration of allergic
reactions to blood or plasma; dermatographism; adjunctive
therapy in anaphylactic reactions
Active and prophylactic treatment of motion sickness
Nighttime sleep aid
Parkinsonism (including drug-induced parkinsonism and
extrapyramidal reactions), in the elderly intolerant of more potent
agents, for milder forms of the disorder in other age groups, and
in combination with centrally acting anticholinergic
antiparkinsonian drugs
Syrup formulation: Suppression of cough due to colds or allergy

 Contraindication: Lower respiratory tract symptoms including

asthma. Hypersensitivity
Side effects: Urticaria, drug rash, anaphylactic shock,
photosensitivity, excessive perspiration, chills, dry mouth, nose &
throat. Hypotension, palpitations, sedation, sleepiness, disturbed
coordination. Hallucination, convulsions or death (overdosage)
Adverse reaction:
CNS: headache, fatigue, anxiety, tremors, vertigo, confusion,
depression, seizures, hallucinations
CV: tachycardia, palpitations, orthostaic hypotension, heart failure
EENT: blurred vision
GI: dry mouth, nausea, vomiting, constipation, flatulence
GU: urinary hesitancy or frequency, urine retention
Hematologic: leukopenia
Skin: photosensitivity, dermatitis
Drug Interaction: Alcohol & other central nervous system
depressants.

 Nursing Interventions:
1. Monitor Vital Sign
2. Raise railing, dizziness or drowsiness may occur.
3. Caution the client that the medication may cause drowsiness, creating
difficulties or hazards or other activities that require alertness.
4. Tell the client to take the medication with food to decrease GI upset.
5. Explain to the client that arising quickly form a lying or sitting position
may cause orthostatic hypotension.
6. When taking these medications, the client needs to have blood cells
counts, renal function, hepatic function, and blood pressure
monitored.
7. Adverse effects of these drugs occur more commonly in elderly
clients.
8. Explain to the client that use of these drugs in warm weather may
increase the likelihood of heatstroke.
9. Have regular medical follow-up visits.
10. Instruct patient or watcher to report unusualities.

Generic name: Kestine

Brand name: Ebastine
Pregnancy Category: C
Classification: Antihistamines
Mode of action: In vitro studies with human liver microsomes
show that ebastine is metabolised to carebastine predominantly
via the CYP3A4 pathway. Concurrent administration of ebastine
with ketoconazole or erythromycin (both CYP3A4 inhibitors) to
healthy volunteers was associated with significantly increased
plasma concentration and elimination half-life of ebastine and
carebastine. With ketoconazole the Cmax and AUC were 15
times and 40 times respectively increased, with erythromycin
the values were doubled.

 Suggested Dose: 10-20 mg once daily

Ordered Dose: 10 mg tab T.I.D
Indications: Ebastine is indicated for the
symptomatic treatment of:
Seasonal and perennial allergic rhinitis
Idiopathic chronic urticaria
Contraindication: hypersensitivity

 Side effects: headache, dry mouth and drowsiness,

pharyngitis, abdominal pain, dyspepsia, asthenia,
epistaxis, rhinitis, sinusitis, nausea and insomnia.
Adverse reaction:
CNS (central nervous system) may headache,
drowsiness, rarely - asthenia (weakness), and insomnia.
Digestive system: dry mouth, rarely - abdominal pain,
dyspepsia (violation of gastric digestion), nausea
(vomiting).
Other reactions and symptoms: rarely - rhinitis, sinusitis.
Drug
Interaction:
Claromycin,
Erythromycin
,Itraconazole, Ketoconazole

 Nursing Interventions:
1. Monitor Vital Signs.
2. Instruct patient to Increase fluid intake.
3. Raise railing , if patient is drowsy and dizziness occurs.
4. Monitor weight at least weekly.
5. Discontinued slowly after systemic use of <=1 wk. Abrupt withdrawal,
especially following high doses or prolonged use, can cause
dizziness, nausea, vomiting, fever, muscle and joint pain, weakness.
6. Instruct patient to report the sign and symptoms such as headache,
dry mouth and drowsiness, pharyngitis, abdominal pain.
7. Monitor I&O rates and pattern: Especially important in severely ill
patients receiving high doses. Report immediately if significant
changes.
8. Have regular medical follow-up visits.
9. Report severe headache, worsening of symptoms, fever, chills.
10.Instruct patient or watcher to report unusualities.

COUGH AND COLD

Generic name: Ambroxol

Brand name: Mucosolvan and Mucoangin
Pregnancy Category: C
Classification: cough & cold preparations
Mode of action: Ambroxol is the active metabolite of
bromhexine. Ambroxol causes an increase in secretion
in the respiratory tract. It promotes production and
stimulates ciliary activity. These effects assist the flow of
mucus and its removal (mucociliary clearance).An
improvement in mucociliary clearance was demonstrated
in clinical pharmacological studies. The increase in
secretion
and
mucociliary
clearance
facilitate
expectoration and reduce the cough.

 Suggested Dose: Ambroxol (as hydrochloride) (Ambrolex) 30mg

Tablet tablet 3 times daily
Ordered Dose: 30 mg tab B.I.D
Indications:
For the treatment of:
Acute respiratory tract diseases with impaired formation of secretions,
particularly in acute exacerbations of chronic bronchitis, asthmatic
bronchitis, bronchial asthma and bronchiectasis.
The following additional indications are also present in some local
markets:
Treatment of respiratory disorders associated with viscid mucus such
as: pneumonia, otitis media, sinusitis, nasopharyngitis.
Secretolytic therapy for relieving cough in acute and chronic disorders
of the respiratory tract associated with pathologically thickened mucus
and impaired mucus transport.

Contraindication: Ambroxol is contraindicated in: hypersensitivity

to ambroxol or any of the excipients.
Side effects: Mild gastrointestinal effects, runny nose and allergic
reactions.
Adverse reaction:
Respiratory, thoracic and mediastinal disorders
Rare: rhinorrhoea
Gastrointestinal disorders
Common: diarrhoea
Uncommon: nausea, vomiting, other mild gastrointestinal symptoms
Rare: hypersalivation, heartburn, constipation
Skin and subcutaneous tissue disorders

 Very rare: severe skin damage such as Stevens-Johnson syndrome

and Lyells syndrome (see Section Warnings and Precautions).
Not known: skin rashes, urticaria, angioedema
Renal and urinary disorders
Rare: dysuria
Drug Interaction:
Antitussives:
Concomitant administration of antitussives may impair the
expectoration of liquefied bronchial mucus due to inhibition of the
cough reflex and cause congestion of secretions.
Antibiotics:
After using ambroxol the concentrations of the antibiotics amoxicillin,
cefuroxime and erythromycin in bronchial secretions and sputum are
increased.

 Rare: hypersalivation, heartburn, constipation

Skin and subcutaneous tissue disorders
Very rare: severe skin damage such as
Stevens-Johnson syndrome and Lyells
syndrome (see Section Warnings and
Precautions).
Not known: skin rashes, urticaria, angioedema
Renal and urinary disorders
Rare: dysuria

 Nursing Interventions:
1. Monitor Vital Signs
2. Raise Railings, if dizziness may occur.
3. Monitor for S&S of aspiration of excess secretions, and for bronchospasm
(unpredictable); withhold drug and notify physician immediately if either occur.
4.Lab tests: Monitor ABGs, pulmonary functions and pulseoximetry as
indicated.
5. Have suction apparatus immediately available. Increased volume of
respiratory tract fluid may be liberated; suction or endotracheal aspiration
may be necessary to establish and maintain an open airway.
6. Instruct watcher report difficulty with clearing the airway or any other
respiratory distress.
7. Instruct patient to do breathing exercise.
8. If sign and symptoms occurs such as runny nose and allergic reactions
report immediately.
9. Monitor I&O rates and pattern: Especially important in severely ill patients
receiving high doses. Report immediately if significant changes.
10. Inspect IM and I V injection sites frequently for signs of phlebitis.

HYPERTONIC SOLUTION

Generic Name: Lactated Ringers

Solution with 5%Dextros (D5LR)
Brand Name: Euro-med 5% Dextrose
in lactated Ringer;s solution, Vis IV
Pregnancy Category: C
Classification: Nonpyrogenic, parenteral fluid, electrolyte
and nutrient replenisher
Mode of action: Hypertonic solutions are those that have
an effective osmolarity greater than the body fluids. These
solutions draw fluid out of the intracellular and interstitial
compartments into the vascular compartment, expanding
vascular volume. It raises intravascular osmotic pressure
and provides fluid, electrolytes and calories for energy

Suggested Dose: 1L @ 30gtts/min

Ordered Dose: 1L @ 120cc/ hr
Indications:
Replacement therapy particularly in extracellular fluid deficit
accompanied by acidosis
Treatment of shock
Persons needing extra calories who cannot tolerate fluid overload
Contraindication:
Hypersensitivity to any of the components.
Contains potassium, do not use with renal failure
patients/Hyperkalemia
Liver Dysfunction
Side effects: Increased serum osmolality, Hypernatremia,
Hypokalemia, Altered thermoregulation, pulmonaryedema,
cardiovascular overload

 Adverse reaction:
Reactions which may occur because of the solution or the technique
of administration includes:
Febrile response; infection at the site of injection; venous thrombosis
or phlebitis extending from the site of injection, extravasation:
hypervolemia.
Integ: Allergic reaction or anaphylactoid symptoms such as localized
or generalized urticarial and pruritus;periorbital, facial ,and/or
laryngeal edema;
Respi: Coughing, sneezing and/or difficulty with breathing
Drug Interaction:
Should not be used with phenytoin (Dilantin) or amrinone (Inocor)
Increase risk of sodium and fluid retention; corticosteroids
Renal clearance of acidic drugs such as solicyeates and barbiturates
Increase risk of hyperkalemia; increase renal clearance of lithium;
decrease renal clearance of alkaline drug

 Nursing Interventions:
1. Do not administer unless solution is clear and container is undamaged.
2. Caution must be exercised in the administration of parenteral fluids,
especially those containing sodium ions to patients receiving
corticosteroids or corticotrophin.
3. Solution containing acetate should be used with caution as excess
administration may result in metabolic alkalosis.
4. Solution containing dextrose should be used with caution in patients with
known subclinical or overt diabetes mellitus.
5. Check vital signs frequently; Report adverse reactions.
6. Monitor fluid intake and output.
7. In very low birth weight infants or children, excessive or rapid
administration of dextrose injection may result in increased serum
osmolality and possible intracerebral hemorrhage.
8. Properly label the IV Fluid
9. Observe aseptic technique when changing IV fluid.
10.Dont give concentrated solutions IM or subcutaneously.

Generic name: D5NSS

(Normal Saline Solution/
0.9% NaCl)
Brand Name: Euro-med 5%
Dextrose in Normal Saline solution
Classification: Hypertonic
Mode of action: Hypertonic solutions contain a
high concentration of solute relative to another
solution when a cell is placed in a hypertonic
solution, the water diffuses out of the
cell,causing the cell to shrivel.

 Suggested Dose: D5NSS 500-1000cc/hr

Ordered Dose: D5NSS 500cc/hr
Indications: Forreplacement ormaintenance of
fluidandelectrolytes
Contraindication: Hypersensitivity to any
of thecomponents.
Side effects:hypotension due tohypovolemia.Vomiting,
Shock, Hyperkalaemia
Adverse reaction: febrile response, infection at the site
of injection, venous thrombosisor phlebitisextending
from thesite of injection,-extravasation,-and
hypervolemia.
Drug Interaction: No known drug interactions.

 Nursing Responsibilities:
1. Monitor patient frequently for Signs of
infiltration/sluggish flow.
2. Monitor patient frequently for signs of phlebitis/infection.
3. Give the Correct solution, medication and volume.
4. Check and regulate the drop rate.
5. Check Vital Sign frequently
6. monitor fluid intake and output
7. Observe aseptic technique when changing IV fluid.
8. Properly label the IV Fluid
9. Dont give concentrated solutions IM or subcutaneously
10.Instruct patient or watcher to report unusualities.

HYPOPROTHROMBINE
MIA

Generic name: Vitamin K

Brand name: Phytomenadione
Pregnancy Category: C
Classification: Hypoprothrombinemia Therapy
Mode of action: Anticoagulant-induced
prothrombin deficiency; prophylaxis & therapy
of hemorrhagic disease of the newborn & it
may also given to the mother before delivery;
hypoprothrombinemia due to oral antibacterial
therapy; hypoprothrombinemia.

 Suggested Dose: 1 to 2 mg IV, IM or subcutaneously may

be administered.
Ordered Dose: 10 mg in 1 hour
Indications:
Phytonadione is used in the prevention and treatment of
hypoprothrombinemia caused by vitamin K deficiency, oral
anticoagulants, or other factors which impair the absorption
or synthesis of vitamin K. Phytonadione is also used in the
prevention and treatment of hemorrhagic disease of the
newborn.
Phytonadione may have a role in restoring normal clotting
time in patients with hypoprothrombinemia induced by
salicylates, sulfonamides, quinidine, quinine or broadspectrum antibiotics, when interference with vitamin K activity
is clearly the cause.

 Contraindication: Hypersensitivity
Side effects: Anaphylaxis, difficulty in breathing,
cyanosis, pain, swelling, vein inflammation at the
injection site, increased sweating, dizziness, low blood
pressure, allergic reactions after SC and IM injection.
Adverse reaction:
Transient flushing sensations, peculiar sensations of
taste dizziness, rapid and weak pulse, profuse
sweating, brief hypotension, dyspnea, cyanosis,
Bronchospasm, shock, cardiac and/or respiratory
arrest ,Pain, swelling, and tenderness at the injection
site may occur. allergic sensitivity (i.e., rash, urticaria),
including an anaphylactoid reaction.
Drug Interaction: Anticoagulants (coumarin)

Nursing Interventions:
1. Monitor Vital Signs
2. Instruct Patient to increase oral intake
3. Assess for bleeding or bruising: hematuria, black tarry
stools, hematemesis
4. Teach patient not to take other supplements unless directed
by prescriber
5. Teach patient necessary foods in Vit K to be included in diet.
6. Advise patient to avoid IM inj., hard toothbrush, flossing until
treatment is terminated.
7. Instruct patient to raise railings, dizziness may occur.
8. Monitor I&O rates and pattern: Especially important in
severely ill patients receiving high doses. Report immediately if
significant changes.
9. Have regular medical follow-up visits.
10. Instruct patient or watcher to report unusualities.

HYPOTONIC SOLUTION

Generic name: D5W

(Dextrose 5% Water) IV Fluid
Brand name: EUROSOL-M IN D5 WATER
Classification:
Isotonic then hypotonic
Nonpyrogenic
Parenteral fluid
Electrolyte
Nutrient replenisher
Mode of action: Dextrose provides a source of calories.
Dextrose is readily metabolized, may decrease losses of
body protein and nitrogen, promotes glycogen deposition
and decreases or prevents ketosis if sufficient doses are
provided

 Suggested Dose: 1 Liter

Ordered Dose: 20cc x 1 hr
Indications: Maintenance therapy in dehydration. Fluid&
electrolyte maintenance. Used in the treatment of diarrhea.
Contraindication: solutions containing dextrose may be
contraindicated in patients with knownallergy to corn or corn
products.
Side effects: severe burning, pain, or swelling around the IV
needle; warmth, redness, oozing, or bleeding where the IV
was placed; fever, ongoing cough;

Adverse reaction: Hyperkalemia,hypernatremia or

hyperchloremia & conditions arising from them eg.edema,
certain cardiac diseases. Rarely, hypermagnesemia or
hyperphosphatemia.
Drug Interaction: Amrinone lactate


1.
2.
3.
4.
5.
6.

Nursing Responsibilities:

Monitor Vital sign

Monitor I and O every shift.
Suspend container from eyelet support.
Remove plastic protector from outlet port at bottom of container.
Attach administration set. Refer to complete directions accompanying set
Clinical evaluation and periodic laboratory determinations are necessary to
monitor changes in fluid balance, electrolyte concentrations, and acid base
balance during prolonged parenteral therapy or whenever the condition of
the patient warrants such evaluation.
7. Lactated Ringers and 5% Dextrose Injection, USP should be used with
caution. Excess administration may result in metabolic alkalosis.
8. Caution must be exercised in the administration of parenteral fluids,
especially those containing sodium ions to patients receiving
corticosteroids or corticotrophin.
9. Solution containing acetate should be used with caution as excess
administration may result in metabolic alkalosis.
10. If an adverse reaction does occur, discontinue the infusion, evaluate the
patient, and institute appropriate therapeutic countermeasures.

MOTILIUM

Generic name: Doperidone

Brand name: Motilium
Classification: Prokinetic Drugs &Antiflatulents
Mode of action: Domperidone is a dopamine antagonist
with antiemetic properties. Domperidone does not readily
cross the blood-brain barrier. It seldom causes
extrapyramidal side effects, but does cause a rise in
prolactin levels. Its antiemetic effect may be due to a
combination of peripheral (gastrokinetic) effects and
antagonism of central dopamine receptors in the
chemoreceptor trigger zone which lies in the area
postrema and is regarded as being outside the bloodbrain barrier.

 Suggested Dose: 0.25-0.5 mg/kg three to four times per day with a
maximum daily dose of 2.4 mg/kg
Ordered Dose: 10 mg tab , 1 tab, PRN
Indications: Dyspeptic symptom complex assoc w/ delayed gastric
emptying, gastroesophageal reflux & esophagitis. Nausea & vomiting of
functional, organic infections, or dietetic origin or induced by radiotherapy
or drug therapy especially dopamine agonists as used in Parkinson
disease.
Contraindication: Hypersensitivity, prolactinoma, GI hemorrhage,
mechanical obstruction or perforation, moderate or severe hepatic
impairment.
Side effects: Gitation, nervousness, anaphylactic shock, extrapyramidal
disorder, convulsion, sudden cardiac death, serious ventricular
arrhythmias, angioedema, urticaria , urinary retention, gynecomastia,
amenorrhea, liver function test abnormal, blood prolactin incrd.

 Adverse reaction:
CNS: dry mouth ,headache/migraine,insomnia, nervousness,
dizziness, thirst, lethargy,irritability
Gastrointestinal ,abdominal cramps, diarrhea,regurgitation,
changes inappetite, nausea, heartburn,constipation .
Endocrinological :hot flushes, mastalgia,galactorrhea,
gynecomastia,menstrual irregularities.
Mucocutaneous :rash, pruritus, urticaria,stomatitis, conjunctivitis.
Urinary :urinaryfrequency, dysuria
Cardiovascular: edema, palpitations.
Musculoskeletal: leg cramps, asthenia.
Miscellaneous: drug intolerance.
Drug Interaction: Antacids &antisecretory drugs CYP3A4
inhibitors, oral ketoconazole or oral erythromycin.

Nursing Interventions:

1. Monitor Vital Signs.

2. Instruct patient to increase oral fluid
3. Position the patient in semi fowlers if vomiting occurs to prevent
aspiration
4. Instruct patient to eat Ice chips or crackers to relieve sensation of
nausea.
5. Report severe headache, dizziness, thirst, lethargy, irritability.
6. Monitor I&O rates and pattern: Especially important in severely ill
patients receiving high doses. Report immediately if significant
changes.
7. Have regular medical follow-up visits.
8. Instruct patient or watcher to report unusualities.
9. Instruct Proper dosing: Missed dose: Take as soon as possible; not
taking if almost time for next scheduled dose; not doubling doses.
10. Obtaining medical attention if fainting, dizziness, irregular heartbeat
or pulse, or other unusual symptoms occur.

PROTON PUMP INHIBITORS

 Generic name: omeprazole

Brand Names: Prilosec,
Prilosec OTC, Zegerid
Pregnancy Category: C
Classification: Proton Pump Inhibitors (PPIs),
gastrointestinal agent
Mode of action: An antisecretory compound
that is a gastric acid pump inhibitor. Suppresses
gastric acid secretion by inhibiting the H+, K+ATPase enzyme system [the acid (proton H+)
pump] in the parietal cells.Suppresses gastric
acid secretion relieving gastrointestinal distress
and promoting ulcer healing.

 Suggested Dose: 40 mg IVTT for 20-30 min period

in 100 l of NaCI 0.9 %
Ordered Dose: 40 mg IVTT O.D
Indications: Drug-drug
WARNING: Increased serum levels and potential
increase
in
toxicity
of
benzodiazepines, phenytoin, warfarin;
if
these
combinations are used, monitor patient very closely
Decreased absorption with sucralfate; give these
drugs at least 30 min apart.
Contraindication: Hypersensitivity

 Side effects: Headache, diarrhea, constipation,

abdominal pain, nausea, vomiting, dizziness, rash.
Adverse reaction:
CNS: Headache, dizziness, fatigue.
GI: Diarrhea, abdominal pain, nausea, mild transient
increases in liver function tests.
Urogenital: Hematuria, proteinuria.
Skin: Rash.
Drug Interaction:Warfarin, phenytoin, cyclosporine,
disulfiram, benzodiazepines, ketoconazole, ampicillin
esters, iron salts.

Nursing Interventions:

1. Monitor Initial vital signs.

2. Report any changes in urinary elimination such as pain or discomfort associated with urination,
or blood in urine.
3. Report severe diarrhea; drug may need to be discontinued.
4. Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush them. If
using the oral suspension, empty packet into a small cup containing 2 tbsp of water. Stir and
drink immediately; fill cup with water and drink this water. Do not use any other liquid or food to
dissolve the packet. This drug will need to be taken for up to 8 wk (short-term therapy) or for a
prolonged period (> 5 yr in some cases).
5. Have regular medical follow-up visits.
6. You may experience these side effects: Dizziness; headache (request medications); nausea,
vomiting, diarrhea (maintain proper nutrition); symptoms of URI, cough (do not self-medicate;
consult with your health care provider if uncomfortable).
7. Report severe headache, worsening of symptoms, fever, chills.
8. Instruct patient to increase oral fluid.
9. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high
doses. Report immediately if significant changes.
10. Instruct patient or watcher to report unusualities.