Republic of the Philippines Region I COMMISSION ON HIGHER EDUCATION UNIVERSITY OF NORTHERN PHILIPPINES COLLEGE OF NURSING FUNDAMENTALS IN NURSING PRACTICE (SKILLS LABORATORY) COMMON MEDICATIONS IN THE HOSPITAL (Ampules and Vials) Jewel R. Galinato BSN-1A Mrs. Marichu Naira Umayam SUBJECT TEACHER 2021 ➢ 5 Medications on ampules with their indications and common side effects with pictures 1. PARACETAMOL AMPULE INDICATIONS ➢ Paracetamol, a para-aminophenol derivative, has analgesic and antipyretic properties and weak anti-inflammatory activity. Paracetamol id given by mouth or as a rectal suppository for mild to moderate pain and for fever. Paracetamol is often the analgesic or antipyretic of choice especially in patients in whom salicylates or other NSAIDs are contraindicated. Such patents include asthmatics or those with a history of peptic ulcer, or children in whom salicylates are contra- indicated because of the risk of Reye’s syndrome. SIDE EFFECTS ➢ Side effects of paracetamol are rare and usually mild, although haematological reactions including thrombocytopenia, leucopenia, pancytopenia, and agranulocytocis have been reported. Overdosage with paracetamol, can result in severe liver damage and sometimes acute renal tubular necrosis. Severe Liver Damage 2. EPINEPHRINE INDICATIONS ➢ IV: In ventricular standstill after all other measures have failed to restore circulation, given by trained personnel by intracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (StokesAdams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous injection; relaxation of uterine musculature; additive to local anesthetic solutions for injection to prolong their duration of action and limit systemic absorption. ➢ Injection: Relief from respiratory distress of bronchial asthma ➢ Aerosols and solutions for nebulization: Temporary relief from acute attacks of bronchial asthma, COPD ➢ Topical nasal solution: Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, sinusitis, hay fever, or other upper respiratory allergies; adjunctive therapy in middle ear infections by decreasing congestion around eustachian ostia ➢ 0.1% ophthalmic solution: Conjunctivitis, during eye surgery to control bleeding, to produce mydriasis SIDE EFFECTS Systemic administration ➢ CNS: Fear, anxiety, tenseness, restlessness, headache, lightheadedness, dizziness, drowsiness, tremor, insomnia, hallucinations, psychological disturbances, seizures, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, symptoms of paranoid schizophrenia ➢ CV: Arrhythmias, hypertension resulting in intracranial hemorrhage, CV collapse with hypotension, palpitations, tachycardia, precordial pain in patients with ischemic heart disease. ➢ GI: Nausea, vomiting, anorexia ➢ GU: Constriction of renal blood vessels decreased urine formation (initial parental administration), dysuria, vesical sphincter spasm resulting in difficult and painful urination, urinary retention in males with prostatism ➢ Other: Pallor, respiratory difficulty, orofacial dystonia, sweating Local injection ➢ Local: Necrosis at sites of repeat injections (due to intense vasoconstriction) Nasal solution ➢ Local: Rebound congestion, local burning and stinging Ophthalmic solutions: ➢ CNS: Headache, brow ache, blurred vision, photophobia, difficulty with night vision, pigmentary (adrenochrome) deposits in the cornea, conjunctiva, or lids with prolonged use. Local: Transitory stinging on initial instillation, eye pain or ache, conjunctival hyperemia ➢ Anxiety, Stress, Sweating, Headache, Palpitation 3. VITAMIN B-COMPLEX AMPULE INDICATIONS In disorders requiring parenteral administration of vitamins, i.e., pre- and postoperative treatment, when requirements are increased as in fever, severe burns, increased metabolism, pregnancy, gastrointestinal disorders interfering with intake or absorption of vitamins, prolonged or wasting diseases, alcoholism and where other deficiencies exist. SIDE EFFECTS Mild transient diarrhea, polycythemia vera, peripheral vascular thrombosis, itching transitory exanthema, feeling of swelling of entire body, anaphylactic shock and death. Sensitivity to the ingredients listed may occur (see WARNINGS). Use should be discontinued upon observance of any untoward reaction. Pain upon intramuscular injection may be noted. Mild transient diarrhea 4. CLINDAMYCIN PHOSPHATE INDICATIONS It is mainly bacteriostatic drug used in the treatment of serious anaerobic infections, notably due to Bacteroides fragilis. It is also used for Grand-positive infections due to pneumococci, staphylococci, streptococci such as liver abscess, actinomycosis, biliary-tract infections, staphylococcal bone and joint infections, the carrier state of diphtheria endophthalmitis, gas gangrene, various gynaecological infections including bacterial vaginosis, endometritis and pelvic inflammatory disease, intra-abdominal infections, including emphysema and pneumonia, septicaemia, and skin and soft tissue infections involving heavy colonization with streptococci or anaerobes such as necrotising fasciitis. SIDE EFFECTS Gastrointestinal: Abdominal pain, nausea, vomiting and diarrhea and esophagitis Hypersensitivity reactions: Maculopapular rash and urticaria Liver: Jaundice and abnormalities in liver function tests Skin and mucous membranes: Pruritus, vaginitis and rare instances of exfoliative and vesiculobullous dermatitis Hematopoietic: Transient neutropenia (leukopenia) and eosinophilia Local reactions: Pain, in duration stress abscess have been seen with IM injection. Thrombophlebitis has been reported with IV injection. These reactions can be minimized by deep IM injection and avoidance of indwelling intravenous catheters. Musculoskeletal: Rare instances of polyarthritis Nausea, diarrhea, vomiting & stomach pain 5. DICLOFENAC AMPULE INDICATIONS ➢ Acute or long-term treatment of mild to moderate pain, including dysmenorrhea ➢ Rheumatoid arthritis ➢ Osteoarthritis ➢ Ankylosing spondylitis ➢ Treatment of actinic keratosis in conjunction with sun avoidance ➢ Topical treatment of acute pain due to minor strains, sprains, contusions (Flector) ➢ Ophthalmic: Postoperative inflammation from cataract extraction SIDE EFFECTS ➢ CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmic effects ➢ Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis ➢ GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, GI bleed ➢ GU: Dysuria, renal impairment ➢ Hematologic: Bleeding, platelet inhibition with higher doses ➢ Other: Peripheral edema, anaphylactoid reactions to fatal anaphylactic shock. Constipation, Nausea, and Vommiting ➢ 5 Medications on vials with their indications and common side effects with pictures 1. CIPROFLOXACIN INDICATIONS Ciprofloxacin is used for the treatment of severe infections of the urinary and gastro- intestinal tracts including Campylobacter jejuni, Shigella or Salmonella; for susceptible sexually transmitted diseases; eg., gonococcal (including penicillinresistant) and non- gonococcal (chlamydial urethritis); for osteomyelitis/septicemia caused by susceptible organisms including bacteria resistant to beta-lactam. It is also used for the treatment of severe infections of the respiratory tract due to susceptible Gram-negative infections including Pseudomonas aeruginosa; for the multi-drug resistant tuberculosis in combination with other drugs; and for multi-drug resistant typhoid fever. It is also used as a post-exposure prophylaxis for meningococcal disease and anthrax in adults. SIDE EFFECTS The most frequently reported adverse event are nausea and vomiting, diarrhea, abdominal pain or discomfort, headache, restlessness and skin rash. Less frequent adverse events occurring in 1% of patients taking ciprofloxacin include: Cardiovascular- palpitation, atrial flutter, ventricular ectopy, syncope, hypertension, angina pectoris, myocardial infarction, cerebral thrombosis, thrombophlebitis; Central Nervous System- dizziness, light-headedness, insomnia, nightmares, hallucinations, manic reaction, irritability, tremor, ataxia, convulsive seizures, lethargy, drowsiness, weakness, malaise, anorexia, phobia, depersonalization, depression, paresthesia; Gastrointestinal- painful oral mucosa, oral candidiasis, dysphagia, intestinal perforation, gastrointestinal bleeding, cholestatic, jaundices ALT and AST elevation, bilirubinemia; Musculoskeletal- arthralgia or back pain, joint stiffness, flare up to gout; Renal- intestinal nephritis, renal failure, polyuria, urinary retention, urethral bleeding, vaginitis; Respiratory- dyspnea, epistaxis, pulmonary and laryngeal edema, hiccups, hemoptysis, bronchospasm, pulmonary embolism; Hematologiceosinophilia, leukopenia, anemia, thrombocytopenia, thrombocytosis, altered prothrombin time; Skin/ hypersensitivity- pruritus, urticaria, photosensitivity, flushing, fever, chill, angioedema, edema of the face, neck, lips, conjunctiva or hands, cutaneous candidiasis, hyperpigmentation, erythema nodosum, Stevens-Johnson Syndrome; Senses- blurred vision, decreased visual activity, diplopia, eye pain, tinnitus, deafness, taste perversion; Most of the aforementioned adverse events reported were described as mild or moderate in severity and abated with discontinuation of the drug. Dizziness, Drowsiness, Unusual Tiredness, Vomiting 2. AMPICILLIN SODIUM + SULBACTAM SODIUM (AMPI-SUL) INDICATIONS Ampicillin Na + Sulbactam Na is indicated for the treatment of infections due to susceptible strains of the designated microorganisms in the conditions listed. Skin and skin structure infections caused by beta-lactamase producing strains of Staphylococcus aureus, Escherichia coli, Klebsiella spp. (including K, pneumoniae), Proteus mirabilis, Bacteroides fragilis, Enterobacter spp., and Acinetobacter calcoaceticus. Intra-Abdominal infections caused by beta-lactamase producing strains of Escherichia coli, Klebsiella spp. (including K, pneumoniae), Bacteroids spp. (including B. fragilis), and Enterobacter spp. Gynecological infections caused by beta-lactamase producing strains of Escherichia coli, and Bacteroids spp. (including B. fragilis). SIDE EFFECTS ➢ Gastrointestinal: diarrhea, gastritis, pseudomembranous colitis ➢ Skin: rash, itching ➢ Cardiovascular: Thrombophlebitis ➢ Local: Pain at the injection site ➢ Hypersensitivity: Urticaria, erythema multiforme, anaphylactic reaction ➢ Hematologic: agranulocytosis ➢ Nausea, vomiting, candidiasis, fatigue, malaise, headache, chest pain, edema Rash and Itching, Vomiting, Nausea, Fatigue and Headache 3. CEFTRIAXONE SODIUM INDICATIONS Ceftriaxone Sodium is used for the treatment of susceptible infections. They include Chancroid, Gastro-enteritis (invasive salmonellosis; shigellosis), Gonorrhoea, Lyme disease, Meningitis, Septicaemia, Surgical infection (prophylaxis), Syphilis, Typhoid fever, and Whipple’s disease. SIDE EFFECTS ➢ Thrombocytopenia ➢ Eosinophilia ➢ Leukopenia ➢ Hypersensitivity reactions ➢ Gastro-intestinal effects ➢ Anaphylactic shock (rare) Vomiting, Diarrhea, and Constipation 4. PIPERACILLIN SODIUM + TAZOBACTAM SODIUM (PIP-TAZ) INDICATIONS Piperacillin sodium and Tazobactam sodium injection is indicated for the treatment of patients with moderate to severe infections caused by piperacillin-resistant, piperacillin/tazobactam-susceptible, β-lactamase producing strains of the designated microorganisms in the specified conditions listed below: ➢ Appendicitis (complicated by rupture or abscess) and peritonitis caused by piperacillin-resistant, β-lactamase producing strains of Escherichia coli or the following members of the Bacteroids fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus. Uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by piperacillin-resistant, βlactamase producing strains of Staphylococcus aureus. ➢ Postpartum endometritis or pelvic inflammatory disease caused by piperacillin- resistant, β-lactamase producing strains of Escherichia coli. ➢ Community-acquired pneumonia (moderate severity only) caused by piperacillin- resistant, β-lactamase producing strains of Haemophilus influenzae. ➢ Nosocomial pneumonia (moderate to severe) caused by piperacillinresistant, β- lactamase producing strains of Staphylococcus aureus and by piperacillin/tazobactam-susceptible Acinetobacter baumannii, Haemophilus influenzae, Klebsiella pneumoniae, and Pseudomona aeruginosa (Nosocomial pneumonia caused by P. aeruginosa should be treated in combination with an aminoglycoside). SIDE EFFECTS Of the studies reported, including that of nosocomial lower respiratory tract infections in which a higher dose of piperacillin and tazobactam injection was used in combination with an aminoglycoside, changes in laboratory parameters, without regard to drug relationship, include: ➢ Hematological decreases in hemoglobin and hematocrit, thrombocytopenia, increases in platelet count, eosinophilia, leucopenia, neutropenia. The leukopenia/neutropenia associated with Piperacillin/ tazobactam sodium injection administration appears to be reversible and most frequently associated with prolonged administration, i.e, >21 days of therapy. ➢ Coagulation, positive direct Coombs’ test, prolonged prothrombin time, prolonged partial thromboplastin time. ➢ Hepatic transient elevations of AST (SGOT), ALT (SGPT), alkaline phosphatase, bilirubin ➢ Renal increases in serum creatinine, blood urea nitrogen ➢ Urinalysis proteinuria, hematuria, pyuria ➢ Additional laboratory events include abnormalities in electrolytes (i.e., increases and decreases sodium, potassium, and calcium), hyperglycemia, decreases in total protein or albumin, blood glucose decreased, gammaglutamyltransferase increased, hypokalemia, and bleeding time prolonged. The following adverse reaction has also been for sterile piperacillin sodium: ➢ Skeletal prolonged muscle relaxation. ➢ Piperacillin therapy has been associated with an increased incidence of fever and rash in cystic fibrosis patients. Agitation, Nausea and Vomiting 5. MEROPENEM INDICATIONS Meropenem is indicated for treatment of the following infections in adults and children over 3 months of age: ➢ Severe pneumonia, including hospital and ventilator-associated pneumonia ➢ Broncho-pulmonary infections in cystic fibrosis ➢ Complicated urinary tract infections ➢ Complicated intra-abdominal infections ➢ Intra- and post-partum infections ➢ Complicated skin and soft tissue infections ➢ Acute bacterial meningitis Treatment of patients with bacteraemia that occurs in association with, or is suspected to be associated with, any of the infections listed above. Meropenem may be used in the management of neutropenic patients with fever that is suspected to be due to a bacterial infection. Consideration should be given to official guidance on the appropriate use of antibacterial agents. SIDE EFFECTS ➢ Meropenem-related adverse reactions most frequently reported were diarrhea (2.3%), rash (1.4%), nausea/vomiting (1.4%) and injection site inflammation (1.1%). The most commonly reported meropenem-related laboratory adverse events were thrombocytosis (1.6%) and increased hepatic enzymes (1.5-4.3%). Tabulated risk of adverse reactions In the table below all adverse reactions are listed by system organ class and frequency; very common (> 1/10); common (> 1/100 to < 1/10); uncommon (> 1/ 1, 000 to <1/100); rare (> 1/10, 000 to <1/1, 000); very rare (> 1/10, 000 to <1/10, 000) Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Table 1 System Organ Class Infections and infestations Blood and lymphatic system Uncommon Event Oral and vaginal candidiasis Thrombocythemia Eosinophilia, Thrombocytopenia, Leucopenia, neutropenia, Agranulocytosis, haemolytic anaemia Angioedema, anaphylaxis system Common headache Gastrointestinal disorders Uncommon Rare Common Hepatobiliary disorders Uncommon Common Paraesthesia convulsions Diarrhea, vomiting, nausea, abdominal pain Antibiotic-associated colitis Transaminases increased; blood alkaline phosphatase increased blood lactate dehydrogenase increased Blood bilirubin increased Rash, pruritis Urticarial, toxic epidermal necrolysis, Stevens Johnson syndrome, erythema multiforme Blood creatinine increased; blood urea increased Inflammation, pain Immune disorders Nervous disorders Frequency Uncommon Common Uncommon Uncommon Common Skin and subcutaneous tissue Uncommon disorders Renal and Urinary Disorders General disorders administration site conditions Uncommon and Common Uncommon Thrombophlebitis, pain at the injection site Skin Rash, Diarrhea, Injection site inflammation References: 2010 LIPPINCOTT’S Nursing Drug Guide, Amy M. 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