Generic name: Acetaminophen Brand name: Tylenol

Action: May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis; does not possess anti-inflammatory properties; antipyretic action results from inhibition of prostaglandins in the CNS. Classification: Nonopioid analgesic (Pain medication for mild to moderate pain), antipyretic (prevent or reduce fever). Dosage and Routes: Adult and Child >12 yr: PO/RECT 325-650 mg q4-6hr prn, max 4g/day. Child 1-12yr: PO 10-15mg/kg q4-6hr, max 5 doses/24 hr. Child 1-12yr: RECT 10-20mg/kg/dose q4-6hr. Neonate: RECT 10-15mg/kg/dose q6-8hr. Indications (uses): Mild to moderate pain or fever, arthralgia (pain in a joint), dental pain, dysmenorrhea (painful menstruation or abdominal cramps), headache, myalgia (pain in a muscle), osteoarthritis. Contraindications: Hypersenstivity, intolerance to tartrazine, alcohol, table sugar, saccharin, depending on product.

Acetaminophen
Side effects: drowsiness, nausea, vomiting, abdominal pain, GI bleeding, seizure, renal failure, leukopenia, rash, hypersensitivity, cyanosis, jaundice, coma, death, CNS stimulation, delirium followed by vascular collapse. Nursing Considerations: Assess health status and alcohol usage before administering. Assess for pain (type and location), use pain scale. Allergic reactions like rash, if it occurs product may have to discontinued. Decreasing output may indicate renal failure. Monitor CBC and liver and renal function test. Teach patient and family not to use with alcohol, herbals without approval of prescriber.

Generic name: NIFEdipine Brand name: Adalat

Action: Relaxes coronary vascular smooth muscles; dilate coronary arteries, increases myocardial oxygen delivery in patients with vasospastic angina, dilates peripheral arteries. Classification: Calcium channel blocker, antianginal, antihypertensive. Dosage and routes: Adult: PO: 10 mg tid, max 180mg /24hr or single dose of 30mg. SUS REL: 30-60mg/day, may increase q7-14days, doses>120mg not recommended. HYPERTENSION Adult: PO EXT REF 30-60mg daily, max 90mg/day. Child/adolescent: PO EXT REF 0.25-0.5 mg/kg/day, max 3mg/kg/day. ACUTE HYPERTENSIVE EPISODES IN PEDIATRIC PATIENTS Adolescent/child/infant: PO 0.2-0.5mg/kg/dose up to 10mg total dose. MIGRANE: Adult: PO 30-180mg/day PRETERM LABOR: Pregnant female: PO Immediate release 30mg in loading dose then 10-20mg q4-6hr (monitor)

Adalat
Indications (uses): Chronic stable angina pectoris, vasospastic angina, hypertension. Contraindications: Hypersensitivity to this product, cardiogenic shock. Side effects: Headache, blurry vision, anxiety, edema, hypotension, tachycardia, nausea, vomiting. Nursing Considerations: Assess anginal pain, cardiac status and any rash. Assess potassium, renal hepatic studies. Teach patient and family to limit caffeine consumption, no alcohol products, avoid OTC product unless directed by prescriber, notify any changes in pattern, frequency/severity of angina.

Generic name: docusate sodium Brand name: Colace

Action: Increases water, fat penetration in intestine; allows for easier passage to stool. Classification: Laxative , emollient; stool softener. Dosages and routes: Adult: PO 50-300mg/day ENEMA 4ml Child>12yr: ENEMA 2ml Child 6-12yr: PO 40-150mg/day in divided doses Child 3-6yr: PO 20-60mg/day in divided doses Child<3yr: PO 10-40mg/day in divided doses Indications (uses): Prevention of dry or hard stools. Contraindication: Hypersensitivity, obstruction, fecal impaction, nausea/vomiting. Side effects: Bitter taste throat irritation, nausea, anorexia, cramps, diarrhea, rash.

Colace
Nursing considerations: Assess the cause of constipation. Cramping, rectal bleeding, nausea, vomiting; if these symptoms occur, product should be discontinued. Tell patient not to break, crush or chew tab only swallow. Oral sol can be diluted in milk or fruit juice to decrease bitter taste. Inform patient that product may take up to three days to soften stools. Teach patient to increase fluid intake unless on fluid restrictions. Teach patient to notify any imbalance occur; muscle cramps, pain, weakness, dizziness, excessive thirst and tell them not to use in presence of abdominal pain, nausea and vomiting.

Generic name: meperidine Brand name: Demerol

Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors. Classification: Opioid analgesic. Dosages and routes: Adult: PO/SUB/IM 50-150mg q3-4hr prn; IV 15-35mg/hr Geriatric: PO/SUB/IM start with 50mg, increase as needed q3-4hr Child: PO/SUB/IM 1-1.8 mg/kg q3-4hr prn, not to exceed 100mg q4hr LABOUR ANALGESIA Adult: SUBCUT/IM 50-100 mg when contractions are regularly spaced, repeat q1-3hr prn. PREOPERATIVELY Adult: IM/SUBCUT 50-100mg 30-90 min before surgery; dose should be reduced if given IV. Child: IM/SUBCUT 1-2.2mg/kg 30-90 min before surgery.

Demerol
Indications (uses): Moderate to severe pain, preoperatively, postoperatively. Contraindications: Hypersensitivity. Side effects: Headache, dizziness, increased intracranial pressure, seizures, bradycardia, change in BP, tachycardia, blurred vision, nausea, vomiting, anorexia, constipation, cramps, urinary retention, dysuria, rash, respiratory depression, anaphylaxis. Nursing Considerations: Assess for pain, renal function and respiratory dysfunction. Check for decreasing output, may indicate urinary retention.

Generic name: dimenhydrinate Brand name: Gravol

Action: Competes with histamine for H1 receptors in GI tract, blood vessels, respiratory tract; central anticholinergic activity which results in decreased vestibular stimulation and blockade of chemoreceptor trigger zone. Classification: Antiemetic, Antihistamine, Anticholinergic. Dosages and Routes: Adults: PO 50-100mg q4hr; IM/IV 50mg q4hr as needed. Child 6-12yr: PO 25-50mg q6-8hr prn; max 150mg/day. Child 2-5yr: PO 12.5-25mg q6-8hr, max 75mg/day. Indications (uses): Dimenhydrinate is used to prevent and treat nausea, vomiting, dizziness, and vertigo associated with motion sickness. Contraindications: Hypersensitivity, infants, neonates, tartrazine dye hypersensitivity. Side effects: drowsiness or dizziness; restlessness, excitation, nervousness, or insomnia; blurred or double vision; dry mouth, nose, or throat; decreased appetite, nausea, vomiting, or diarrhea; difficulty urinating; or an irregular or fast heartbeat.

Gravol
Nursing Considerations: Assess BP, observe for drowsiness and dizziness, Teach patient to avoid hazardous activities, activities requiring alertness, dizziness may occur, instruct patient to request assistance with ambulation. Tell patient to avoid alcohol and other CNS depressants.

Heparin
Action: Inhibits clotting factors Classification: Anticoagulant, antithrombotic. Dosages and routes: Adult: IV BOL 80 international units/kg. Child/infant/neonate: IV loading dose 75 international units/kg. Child> 1yr: 20 international units/kg/hr Infants/neonates<1yr: 28 international units/kg/hr as initial maintenance dose. Indications (uses): prevention of deep vain thrombosis and pulmonary embolism , open heart surgery, disseminated intravascular clotting syndrome, as an anticoagulant in transfusion and dialysis procedures. Contraindications: Allergy, active internal bleeding, severe hypertension, bleeding disorders, trauma, intracranial hemorrhage. Side effects: Bleeding and nausea.

Heparin
Nursing Considerations: Only have an effect as a prophylaxis (they do not work on clots that have already formed) Monitor blood work, values such as aPTT (heparin use) and INR (warfarin use) Check for bleeding especially in gums and stool Vitamin K is used to reverse effects of warfarin toxicity Heparin containing benzyl alcohol must not be given to neonates (fatal reactions have been reported) When warfarin is used, all care providers should be informed to avoid unnecessary physical trauma More likely to experience bleeding complications dalteparin and enoxaparin can cause renal failure

Insulins
Action: Insulin is a hormone. Acts on bets cells in pancreas. Helps to metabolize proteins, fats and carbohydrates. Helps to store glucose in the liver. Classification: Antidiabetic, pancreatic hormone. Dosages and Routes: Lantus (insulin glargine): Adult and child>6yr: SUBCUT 10 international units/day, range 2-100 international units/day. Lispro: Adult: SUBCUT 15 min before meals. Novolin 30/70 (insulin aspart): Adult/adolescent/child>6yr: INTERMITTENT SUBCUT. Total daily dose is given as 2-4 inj/day just prior to beginning to meal; in general, 50%-70% of total daily insulin may be given as insulin aspart, the remainder should be intermediate or long lasting indulin. Regular: Adult: IV 5-10units, then 5-10units/hr until desired response, then switch to SUBCUT dose; IV/INF 2-12units Child: IV 0.1units/kg Indications (uses): Type1 diabetes, Type2 diabetes. Contraindications: Allergy, hypoglycemia, Corticosteriods, Diuretics, Birth control. Side effects: Hypoglycemia.

Insulins
Nursing Considerations:Insulins differ in onset and duration of action Insulin can not be given orally; must be given subcutaneously or IV (regular insulin) Insulin can be stored at room temperature or in the fridge Injection sites can not be used more than once a month (must move at least inch from previous site) Effective management requires a consistent schedule of meals, snacks, exercise, injections and blood glucose monitoring Impaired vision may result in inaccurate dosages

Generic name: Digoxin Brand name: Lanoxin

Action: Increases myocardial contractility. Decreases the rate of electrical conduction and prolongs the refractory period in the conduction system . Classification: Cardiac glycoside, inotropic, antidysrhythmic. Routes: PO/IV Indications (uses): Congestive Heart Failure, Atrial Fibrillation, Tachycardia, Mitral Regurgitation Contraindications: + + + medications (most medications with either increase digoxins effects, or decrease the excretion of the medication). Hypersenstivity to digoxin, ventricular fibrillation, vantricular tachycardia, carotid sinus syndrome, 2nd or 3rd degree heart block. Side effects: Dysrhythmias, Nausea/vomiting, Visual disturbances (green blurry halos around lights; often suggests that concentration is above therapeutic limits), neonate toxicity starts with unexpected slowing of heart rate

Lanoxin
Nursing Considerations: Thorough cardiovascular assessment is required prior to administration Antacids decrease absorption Serum drug levels should be obtained regularly (toxicity occurs in about 20% of patients) Very small amounts are given risk of dosage errors Increased risk of accumulation r/t renal impairment

Generic name: Lorazepam Brand name: Ativan

Action: Potentiates the actions of GABA, especially in the limbic system and reticular formation. Classification: sedative, hypnotic, antianxiety. Dosages and Routes: ANAXIETY: Adult/adolescent: PO 2-3mg/day in divided doses and max of 10mg/day. Geriatric: PO 1-2mg/day in divided doses or 0.5-1 mg at bedtime. PREOPERATIVELY: Adult: IM 50mcg/kg 2 hr prior to surgery; IV 44mcg/kg 15-20 min prior to surgery, max 2mg 15-20 min prior to surgery Child> 12 yr: IV 0.05mg/kg. INSOMNIA: Adult: PO 2-4mg at bedtime; only minimally effective after 2wk continuous therapy. Geriatric: PO 0.5-1 mg initially. Indications (uses): Anxiety, irritability in psychiatric or organic disorders, preoperatively, insomnia. Contraindications: pregnancy, breastfeeding, hypersensitivity to benzodiazepines, closed angle glaucoma, psychosis, history of drug abuse, sleep apnea.

Ativan
Side effects: Dizziness, headache, anxiety, depression, weakness, ECG changes, tachycardia, hypotension, apnea, cardiac arrest, rash, acidosis, nausea. Nursing Considerations: Assess for anxiety, mood, sleeping, dizziness, suicidal tendencies, renal/heptic blood status, physical dependency, headache, nausea, vomiting. Perform assistance with ambulation. Check to see if PO meds has been swallowed. Teach pt to avoid OTC, driving, alcohol. Teach pt to rise slowly or fainting may occur and drowsiness may worsen at the starting of treatment.

Generic name: Metformin Brand name: Glucophage, Fortamet

Action: Acts by decreasing the hepatic production of glucose (gluconeogenesis). Helps to decrease intestinal absorption of glucose. Helps to improve insulin receptor sensitivity. Does not increase insulin secretion, thus does not cause hypoglycemia. Classification: Antidiabetic, oral. Dosages and Routes: Adult: PO 500mg bid. Geriatric: PO use lowest affective dose. Child 8-9yr: PO 825mg/day with dinner. Indications (uses): Type2 dibetes mellitus. Contraindications: Allergy, Hypoglycemia, Some antacids, Iodine containing contrast mediums.

Metformin
Side effects: Diarrhea, Nausea, Metallic taste in mouth, Anorexia Nursing Considerations: Must be taken with meals. Must stop medication 48 hours prior to iodine radiological studies

Generic name: Morphine Brand name: Avinza

Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors. Classification: Opioid analgesic. Dosages and Routes: Adult: SUBCUT/IM: 5-20mg q4hr prn; PO 10-30mg q4hr prn, IV 2.5-15mg diluted in 4-5ml H2O for inj, over 5min. Child: SUBCUT/IV 0.05-0.2 mg/kg max 15mg; PO 0.2-0.5 mg/kg q4-6hr (reg rel), q12hr (sus rel) Indications (uses): moderate to severe pain. Contraindications: Hypersensitivity, addiction, hemorrhage, bronchial asthma, increased intracranial pressure. Side effects: seizures, bradycardia, shock, cardiac arrest, thrombocytopenia, respiratory depression, respiratory arrest, apnea.

Morphine
Nursing Considerations: Assess for pain, BP, Bowel status, respiratory dysfunction, allergy like rash, Dizziness, drowsiness. Do not break, crush or chew controlled or sus rel products. Teach pt to report any allergic reactions and to avoid alcohol or CNS depressants. Assist with ambulation, safety measure like bed rails.