Name of Drug Generic Name: Hydralazine DRUG STUDY Mechanism of Action Route and Dosage Brand Name: Apresoline Essential hypertension Adults: Initially, 10 mg P.O. q.i.d.; gradually increase over 2 weeks to 50 mg q.i.d., based on patient tolerance and response. Recommended range is 12.5 to 50 mg b.i.d. Children: Initially, 0.75 mg/kg or 200 mg daily. Maximum first P.O. dose is 25 mg. Severe essential hypertension Adults: 20 to 40 mg I.M. or I.V.; repeat as needed. Switch to oral form as soon as possible. Children: 1.7 to 3.5 mg/kg/day I.M. or I.V. divided into four to six doses. Adverse Reaction acts directly on vascular smooth CNS: headache, peripheral neuritis, muscle to cause vasodilation and dizziness. CV: angina pectoris, palpitations, drop of blood pressure does not inhibit cardiovascular tachycardia, orthostatic hypotension, reflexes and tachycardia edema, flushing. renin release will occur. EENT: nasal congestion. GI: nausea, vomiting, diarrhea, anorexia, conatipation. Hematologic: neutropenia, leukopenia, agranulocytopenia, agranulocytosis, thrombocytopenia with or without purpura. Skin: rash Other: lupus like syndrome Nursing Consideration Monitor patient's BP, pulse rate, and body weight frequently. Drug may be given with dieuretics and beta blockers to decrease sodium retention amd tachycardia and to prevent angina attacks. Elderly patients may be more sensitive to drug's hypotensive effects. Obtain CBC, lopus erythematosus cell preparation, and ANA titer determination before therapy and periodically during long term therapy. ALERT: Monitor patient closely for signs and symptoms of lopuslike syndrome (sore throat, fever, fever, muscle and joint aches, rash), and notify prescriber immediately if they develop. Improve patient compliance by giving drug b.i.d. Check with prescriber . • Look alike-sound alike: Don't confuse hydralazine with hydroxyzine Name of Drug Generic Name: Nicardipine Brand Name: Cardene Route and Dosage DRUG STUDY Mechanism of Action Adverse Reaction Side drip of 90cc D5LR 3NaCl + I amp A caldium channel blocker that CNS: headache, dizziness, anxiety, nicardine @ 50 cc/hr parenteral inhibits calcium ion influx across depression, confusion, paresthesia, cardiac and smooth muscle cells but is somnolence more selective to vascular muscle. CV: edema, bradycardia, hypotension, Also dilates coronary arteries and palpitation pulmonary edema, chest arterioles. pain, tachycardia, increased angina. GI: nausea, vomiting, gastric upset, constipation, hepatitis abdominal cramps GU: nocturia, polyuria INTEG: rash MISC: blurred vision, flushing, sweating, shortness of breath Nursing Consideration Monitor for CHF; weight gain, rates, jugular venous distension, dyspnea Monitor BP and pulse Assess surgical pain intensity, location, duration, alleviating factors Monitor potasssium, liver function test, renal studies periodically Assess fluid volume (I&O ration) & records weight Name of Drug Generic Name: Adenosine Route and Dosage Dose: 6 mg rapid push over 1-3 seconds. After 1-2 min if no Brand Name: Adenocard/Adenoscan resolution, give 12 mg over 1-3 sec Route: IVP (slam) Frequency: Rationale for client: Conversion of PSVT/SVT to NSR Onset: Immediate Peak: Unknown Duration: 1-2 Minutes DRUG STUDY Mechanism of Action Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in pt. with paroxysmal supraventricular tachycardia (PSVT) Therapeutic Effect: Restoration of normal sinus rhythm Adverse Reaction Side-Effects: CNS: light headedness dizziness, arm tingling, numbness, apprehension, headache CV: Chest pain, pressure, atrial tach dysrhythmias, sweating, palpitations, hypotension, facial flushing GI: Nausea, metallic taste, throat tightness, groin pressure RESP: Dyspnea, chest pressure, hyperventilation EENT: blurred vision, Contraindications: 2nd or 3rd degrees heart block, AV Block, atrial flutter, afib Nursing Consideration Cardiopulmonary status: B/P, pulse, RR, ECG RR Status, rate, rhythm, lung fields for crackles in CHF, watch for RR depression CNS effects; dizziness, confusion convulsionsdiscontinue restarts the heart. Name of Drug Brand Name: Antitet Generic Name: Tetanus Antitoxin (ATS) DRUG STUDY Mechanism of Action Route and Dosage Prophylactic Use Adult: 1500 I.U.5000 I.U SQ/IM 5,000 iu ANST Provides passive immunity towards tetanus by supplying antibodies to neutralize the free form of toxins produced by Clostridium tetani. Prophylaxis against tetanus following injury in patients whose immunization is incomplete or uncertain. To those who have not had previous Tetanus Toxoid injection or without a clear history of immunization, both antitoxins should be given for prophylaxis and permanent immunity Adverse Reaction CNS: Increased body temperature Local: Local soreness/soreness at injection site, pain at injection site, tenderness at injection site <1%, postmarketing, and/or case reports: Anaphylactic shock, angioedema, nephrotic syndrome Nursing Consideration Patient/Family Teaching Educate patient on what the medication is used for Inform patients and parents of potential and reportable side effects of immunization. Notify health care professional if patient develops fever higher than 39.4 C (103 F); difficulty breathing; hives; itching; swelling of eyes, face, or inside of nose; sudden, severe tiredness or weakness; or convulsions. Inform patient of short term pain Evaluation Prevention of diseases through active immunity. Name of Drug Generic name: Hydrocortisone Brand name: SoluCortef DRUG STUDY Mechanism of Action Route and Dosage Route: Intravenous Dosage Range: A: 1-2 mg/kgevery 6 hours initially for 24 hours; maintenance : 0.5-1 mg/kg every 6 hours. P: 1-2 mg/kg every 6 hours for 24 hours; not to exceed 250 mg Reduce airway inflammation, improve airway responsiveness, and shorten the duration of the exacerbation. Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediator. Adverse Reaction Concurrent administration of live virus vaccine Systemic fungal infections Concurrent use of other immunosuppressa nt corticosteroids Nursing Consideration Monitor the temperature of the patient and provide plenty of water to avoid dehydration. Elevate the head of the bed by propping up on pillows and gargle/drink warm liquids to soothe the throat. Encourage increased fluid intake to decrease the viscosity of secretions. Monitor the patient for any sign of respiratory infection; continued use of steroids during acute infection can lead to serious complications related to the depression of the inflammatory and immune responses. Encourage the patient to keep the skin clean, dry, and well lubricated to reduce skin trauma and risk for infection. Name of Drug Brand Name: Adacel Generic Name: Tetanus Toxoid DRUG STUDY Mechanism of Action Route and Dosage Primary Immunization: Adult - 0.5 mL IM 3 or 4 doses Booster: Adult: 0.5 mL IM q 10 years Prophylaxis: 1 emergency dose of 0.5 mL IM Adverse Reaction For those who have either Significant: Syncope. Blood and received fewer than three doses lymphatic system disorders: of tetanus toxoid previously or in Lymphadenopathy. Musculoskeletal whom the number of previous and connective tissue disorders: doses is unknown. Arthralgia, myalgia. For individuals who have Nervous system disorders: Neuritis, sustained a wound that is more headache, dizziness. severe than a clean and minor Skin and subcutaneous tissue wound. disorders: Rash. For active booster immunization Vascular disorders: Hypotension. for the prevention of tetanus. Potentially Fatal: Anaphylactoid or hypersensitivity reactions. Nursing Consideration Assess previous immunization history and history of hypersensitivity. Assess for history of latex allergy. Some prefilled syringes may use latex components and should be avoided in those with hypersensitivity. Inform patients and parents of potential and reportable side effects of immunization. Notify health care professional if patient develops fever higher than 39.4 C (103 F); difficulty breathing; hives; itching; swelling of eyes, face, or inside of nose; sudden, severe tiredness or weakness; or convulsions. Evaluation Prevention of diseases through active immunity Name of Drug Route and Dosage Brand Name: Protonix, Protonix IV, Erosive Esophagitis Adult: PO 40 mg Pantoloc q.d. times 8– 16 wk IV 40 mg q.d. times 7–10 d Generic Name: Pantoprazole Administration Oral Do not crush or break in half. Must be swallowed whole. Note: Therapy beyond 16 wk is not recommended. Store preferably at 20°– 25° C (66°–77° F), but room temperature permitted. Intravenous PREPARE: IV Infusion: Two-min infusion: Reconstitute each 40 mg vial with 10 mL NS. Fifteenmin infusion: Reconstitute as for 2-min infusion, then further dilute with 100 mL of D5W, NS, or RL to yield 0.4 mg/mL. ADMINISTER: IV Infusion: Give through a dedicated line or flushed IV line before and after each dose with D5W, NS, or RL. Two-min infusion: Give over at least 2 min. Fifteen-min infusion: Infuse over 15 min at a rate of 6 mg/min (7 mL/min). DRUG STUDY Mechanism of Action Adverse Reaction Gastric acid pump inhibitor; belongs GI: Diarrhea, flatulence, abdominal to a class of antisecretory pain. compounds. Gastric acid secretion is CNS: Headache, insomnia. Skin: Rash. decreased by inhibiting the H+ , K+ATPase enzyme system responsible for acid production. Therapeutic Effects Specifically, suppresses gastric acid secretion by inhibiting the acid (proton H+) pump in the parietal cells. Nursing Consideration Assess underlying conditions before therapy and thereafter to monitor drug effectiveness Assess GI symptoms: epigastric or abdominal pain, bleeding and anorexia. Monitor for possible drug induced adverse reaction. Monitor for and immediately report S&S of angioedema or a severe skin reaction. Lab tests: Urea breath test 4–6 wk after completion of therapy. Contact physician promptly if any of the following occur: Peeling, blistering, or loosening of skin; skin rash, hives, or itching; swelling of the face, tongue, or lips; difficulty breathing or swallowing. Do not breast feed while taking this drug without consulting a physician. Name of Drug Generic Name: Fondaparinux sodium Brand Name: Axtra Route and Dosage DRUG STUDY Mechanism of Action The recommended dose of Arixtra is The antithrombotic activity of 2.5 mg administered by subcutaneous fondaparinux sodium is the result of injection. antithrombin III (ATIII)- mediated selective inhibition of Factor Xa. By selectively binding to ATIII, fondaparinux sodium potentiates (about 300 times) the innate neutralization of Factor Xa by ATIII. Neutralization of Factor Xa interrupts the blood coagulation cascade and thus inhibits thrombin formation and thrombus development. Adverse Reaction Severe renal impairment (creatinine clearance [CrCl] <30 mL/min) Active major bleeding. Bacterial endocarditis. Thrombocytopenia associated with a positive in vitro test for anti-platelet antibody in the presence of fondaparinux sodium. Body weight <50 kg (venous thromboembolism [VTE] prophylaxis only) . History of serious hypersensitivity reaction (e.g., angioedema, anaphylactoid/anaphylactic reactions) to ARIXTRA. Nursing Consideration Monitor and report unusual muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia). monitor any wounds or suture lines for increased drainage or bleeding. Report prolonged or excessive wound drainage to the physician Name of Drug Generic Name: Budesonide Brand Name: Pulmicort Respules Route and Dosage DRUG STUDY Mechanism of Action Usual adult dose 180–360 mcg twice Potent, locally acting daily (not to exceed 720 mcg twice antiinflammatory and immune daily) Onset Inhalin: within 24 hr modifier. Nebulizer: 2-8 days Peak Inhalin: 14wk Nebulizer: 4-6 wk Duration Inhalin: unknown Nebulizer: unknown Adverse Reaction Anaphylaxis Nursing Consideration Monitor respiratory status and lung sounds. Assess pulmonary function tests periodically during and for several months following a transfer from systemic to inhalation corticosteroids. Assess patients changing from systemic corticosteroids to inhalation corticosteroids for signs of adrenal insufficiency (anorexia, nausea, weakness, fatigue, hypotension, hypoglycemia) during initial therapy and periods of stress. If these signs appear, notify health care professional immediately; condition may be lifethreatening. Monitor for withdrawal symptoms (fatigue, weakness, nausea, vomiting, hypotension, joint or muscular pain, lassitude, depression) during withdrawal from oral corticosteroids. Monitor growth rates in children receiving chronic therapy; lowest possible dose should be used. May cause ↑ serum and urine glucose concentrations if significant absorption occurs. Name of Drug Generic name: Aspirin Brand name: Aspergum, Bayer, Easprin, Ecotrin, Empirin, Genprin, Halfprin, Norwich DRUG STUDY Mechanism of Action Route and Dosage Adults: 325-650 mg orally/rectally once every 4-6 hours as needed Children under 12 years: 10-15 mg/kg orally once every 4 hours, up to 60-80 mg/kg/day Children 12 years and older: 325-650 mg orally/rectally once every 4-6 hours as needed Analgesic and antirheumaticinhibits prostaglandin (an inflammatory mediator) synthesis Antipyretic effect – this action is not fully understood but drug study of aspirin is correlated with the ability of the drug to act in the thermoregulatory center of the hypothalamus by blocking the endogenous pyrogen through inhibiting synthesis of prostaglandin intermediary. Antiplatelet – aspirin drug study reveals the ability of the drug to inhibit thromboxame A2 (a potent vasoconstrictor and inducer of platelet aggregation) synthesis Adverse Reaction Acute aspirin toxicity – respiratory alkalosis, hemorrhage, tachypnea, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, renal and respiratory failure Aspirin intolerance – exacerbation of bronchospasm, rhinitis Gastrointestinal: nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity Hematologic: occult blood loss, hemostatic defects Hypersensitivity: anaphylactoid reactions to anaphylactic shock Salicylism: dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion Nursing Consideration Assess patient’s orientation to time and place as the drug may cause dizziness and confusion. Give drug with food or after meal if GI upset occurs. Assess skin color and presence of lesions as this may indicate hepatotoxicity, allergy, bleeding, and other complications. Observe patient for signs and symptoms of bleeding such as easy bruising, bleeding in the gums, and nosebleeds. Monitor vital signs. Instruct to avoid OTC drugs as many of those contain aspirin so serious overdose can occur. Encourage client to increase oral fluid intake to facilitate excretion of drug. Name of Drug Brand Name: Electral, Enerlyte, Gastrolyte Generic Name: Oral Rehydration Salt Route and Dosage ORS sachet 1 sachet in 200 cc water for vol/vol replacement Mechanism of Action The central principle of oral rehydration therapy (ORT) is the utilization of sodiumglucose coTherapeutic Dosage: Infants: One liter transport in the small intestine, a over a period of 24 hours. 1 to 1.5 phenomenon that remains largely times their usual feed volume. unaffected during acute infectious Administer with care to infants diarrhea. The key constituents of ORS are sodium and glucose. The central principle of oral rehydration therapy (ORT) is the utilization of sodiumglucose cotransport in the small intestine, a phenomenon that remains largely unaffected during acute infectious diarrhea. Thus the success of ORT is largely dependent on glucosedriven sodium absorption (transcellular route) leading to passive absorption of water by the paracellular route. The clinical result is usually rapid rehydration and correction of acidosis Adverse Reaction Vomiting Convulsions Dizziness Tachycardia High blood pressure Irratability Muscle twitching Restlessness Swelling of feet or lower legs along with puffy eyelids Weakness Puffy eyelids Nursing Consideration Remind the patient to take this product by mouth as directed by his/her doctor, or follow all directions on the product package Instruct the patient to not mix with water or other liquids. The liquid form is a suspension, shake the bottle well before each dose. Instruct patient not to heat this product unless the product package states that it is okay to do so. Instruct the patient not to drink fruit juices or eat foods with added salt while taking this product unless directed by your doctor. Monitor the patient's intake and output. Observe the physical properties. Name of Drug Generic Name: omeprazole Brand Name: Omebloc-20 Route and Dosage Dosage: 20mg Route: PO Mechanism of Action Omeprazole is a substituted benzimidazole gastric antisecretory agent and is also known as proton pump inhibitor (PPI). It blocks the final step in gastric acid secretion by specific inhibition of adenosine triphosphatase (ATPase) enzyme system present on the secretory surface of the gastric parietal cell. Both basal and stimulated acid are inhibited. Adverse Reaction CNS: paresthesia, vertigo GI: carcinoma, SLE, hypomagnesemia General: hypersensitivity reactions, anaphylactic reactions Nursing Consideration Assess vital signs before and after administration Assess client history for any contraindications Assess for any hypersensitivity to any component of the drug Assess drugs already being taken for any adverse drug interactions Explain the side effects that may occur and also danger signs for adverse reactions to Administer drug with a whole glass of water Administer drug before meals
