DRUG STUDY Floriza D.

Batiancila BSN3-2 Name of drug Generic: ketorolac Brand name: Toradol Form: Route: IV Dose: 30mg Frequency: q6 x 3 doses CLASSIFICATION: Nonsteroidal antiinflammatory agents, nonopioid analagesics Indications Short term manag ement of pain (not to exceed 5 days total for all routes combined) Action - Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and antiinflammatory properties. - Therapeutic effect:Decrea sed pain Contraindication Contraindicated withsignificant renalimpairment , during labor and deliver y, lactation,aspiri n allergy, recent GI bleed or perforationUs e cautiously withimpaired hearing;allergies ; hepaticcondition Side effects Headache Abdominal pain (or stomach pain) Nausea Heartburn or indigestion Diarrhea Dizziness Drowsiness Swelling. Adverse effects GI ulcer, bleeding and perforation, drowsiness, rash, bronchospasm, hypotension, psychosis, dry mouth, fever, bradycardia, chest pain, dizziness, headache, sweating, oedema, pallor, liver function changes. Transient stinging and local irritation (ophthalmic). Potentially Fatal: Anaphylaxis . Severe skin reactions. MI, stroke, GI bleeding. Nursing Management PRE 1. Assess for renal impairment ,impaired hearing, allergies, hepatic,lactation, pregnancy 2. Physical: skin color and lesions ,orientation, reflexes, peripheral sensation,clotting times, CBC, adventitious sounds Inttra: 1. Be aware that patient may be atrisk for CV events ,GI bleeding, renal toxicity, monitor accordingly. 2. Do not use during abor, delivery, or while nursing. 3. Keep emergency equipment readily available at time of initial dose, in caseof severe hypersensitivity reaction 4. Protect drug vials from light. 5. Administer every6 hrs to maintainserum levels andcontrol pain. Post: 1.Instruct patient on how and when to ask for pain medication. 2. May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is

known. 3.Caution patient to avoid the concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. 4.Advise patient to inform health care professional of medication regimen prior to treatment or surgery. 5.Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain) occurs

DRUG STUDY Floriza D. Batiancila BSN3-2 Name of drug Generic:nifedinine Brand name: Form: Route Dose: 5mg Frequency: now Classification: antihypertensive Indications Action Contraindicati on hypersensitivi ty to nifedipine or any other calcium channel blocker and adenosine. Side effects Adverse effects Dizziness; Lighteadedness; Flushing; Heat sensation; Hypotension Nursing Management Pre: 1.Assess for Allergy to nifedipine; pregnancy; lactation Physical: Skin lesions, color, edema; orientation, reflexes; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, normal GI output; liver function tests Intra 1.Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being adjusted to therapeutic dose; the dosage may be increased more rapidly in hospitalized patients under close supervision. Do not exceed 30 mg/dose increases. 2.Ensure that patients do not chew or divide sustained-release tablets

Treatment Inhibits Calcium for ion from entering hypertension the slow channels or selectvoltagesensitive areas of v ascular smooth m uscle and myocard ium duringdepolar ization, producing a relaxa tion of coronary va scular smooth mus cle andcoronary va sodilation; increas es myocardial oxyg en delivery in pati ents withvasospati c angina.

water retention, fatigue, nausea, muscle cramps, tremors (uncontrollable shaking), impotence, headaches, constipation, dizziness, dry Use mouth and becoming cautiously with lactation, lightheaded. pregnancy.

3.Taper dosage of beta-blockers before nifedipine therapy. 4.Protect drug from light and moisture. Post: 1.Do not chew, cut, or crush sustained-release tablets. Swallow whole. 2.These side effects may occur: Nausea, vomiting (eat frequent small meals); dizziness, light-headedness, vertigo (avoid driving, operating dangerous machinery; take special precautions to avoid falling); muscle cramps, joint stiffness, sweating, sexual difficulties (reversible). 3.Report irregular heartbeat, shortness of breath, swelling of the hands or feet,pronounced dizziness, constipation.

DRUG STUDY Floriza D. Batiancila BSN3-2 Name of drug Generic:Bisacodyl Brand name: Form: supposository Route: rectal Dose: Frequency: Indications Temporary relief of acute constipatio n and for evacuati on of colon before surgery, proctoscopi c, sigmoidosc opic, and radiologic examinatio ns. Also used to cleanse colon befor e delivery and to relieve constipatio n in patients with spinal cord damage. Action Expands intestinal fluid volume by increasing epithelial permeability. Contraindication Acute surgical abdomen, nausea, vomiting, abdominal cramps, intestin al obstruction, fecal impaction; use of rectal suppository in presence of anal or rectal fissures, ulcerated hemor rhoids, proctitis. Safety during pregnancy (category C), lactation, or in children is not established. Side effects Rectal irritation/burni ng/itching, mild abdominal discomfort/cra mps, or nausea Adverse effects Systemic effects not reported. Mild cramping, nausea, diarrhea, fluid and electrolyte disturbances (especially potassium and calcium). Nursing Management 1.Evaluate periodically patients need for continued use of drug; bisacodyl usually produces 1 or 2 soft formed stools daily. 2.Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in decreased absorption of vitamin K. Post: 1.Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. 2.Adequate fluid intake includes at least 68 glasses/d. 3.Do not breast feed while taking this drug without consulting physician

DRUG STUDY Floriza D. Batiancila BSN3-2 Name of drug Generic: Dipenhydramine Brand name: Form: Route: IV Dose: 50mg Frequency: PRN Classification: Anti histamine, Indications Relief of symptoms associated with perennial and seasonal allergic rhinitis Action Diphenhydram ine blocks histamine H1receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action. Contraindicati on Hypersensitivi ty ; neonates, lactation. Side effects Orthostatic hypotension Palpitations Drowsiness Sedation Disturbed coordination Adverse effects CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias. Nursing Management PRE: 1. Assess for Allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation 2.Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; P, BP; R, adventitious sounds; bowel sounds; prostate palpation; CBC with differential Intra: 1.Administer with food if GI upset occurs.n 2.Administer syrup form if patient is unable to take tablets. 3.Monitor patient response, and arrange for adjustment of dosage to lowest possible effective dose. POST: 1.Take as prescribed; avoid excessive dosage. 2.Take with food if GI upset occurs. 3.Avoid alcohol; serious sedation could occur. 4.These side effects may occur: Dizziness, sedation, drowsiness (use

caution driving or performing tasks requiring alertness); epigastric distress, diarrhea or constipation (take drug with meals); dry mouth (use frequent mouth care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier). 5.Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.

NAME: Dextrose 5% in Water (D5W) raises total fluid volume it is also helpful in rehydrating and excretory purposes.

INDICATION Lactated Ringers and 5% Dextrose Injection, is indicated as a source of water, electrolytes and calories or as an alkalinizing agent.

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

CONTRAINDICATION solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.

Nursing Responsibilities 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. Lactated Ringers and 5% Dextrose Injection, USP should be used with caution. Excess administration may result in metabolic alkalosis. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures

Type of Solution Dextrose 5% Water Isotonic then hypotonic (once inside the body) Contents Dextrose Hydrous 50gm/L Classifcation Isotonic then hypotonic Nonpyrogenic Parenteral fluid Electrolyte Nutrient replenisher

NAME Dextrose 5% in Normosol M Solution (D5NM) is a hypertonic solution that is nonpyrogenic and is a nutrient replenisher.

INDICATION

ACTION Mechanism of Action When administered intravenously, Normosol-M and 5% Dextrose Injection provides water and electrolytes (with dextrose as a readily available source of carbohydrate) for maintenance of daily fluid and electrolyte requirements, plus minimal carbohydrate calories. The electrolyte composition approaches that of the principal ions of normal plasma (extracellular fluid). The electrolyte concentration is hypotonic (112 mOsmol/liter) in relation to the extracellular fluid (280 mOsmol/liter). One liter provides approximately one-third of the average adult daily requirement for water and principal electrolytes in balanced proportions, with acetate as a bircarbonate alternate,plus 170 calories from dextrose.

D5NM is indicated for parenteral maintenance of routine daily fluid and electrolyte Type of Solution Dextrose 5% in requirements with Normosol M Solution Hypertonic minimal solution of balanced carbohydrate maintenance electrolytes and 5% calories from dextrose injection in water for dextrose. injection Magnesium in the formula may help to Classification Hypertonic prevent iatrogenic Nonpyrogenic Parenteral fluid magnesium Electrolyte Nutrient replenisher deficiency in Contents Each 1000 mL contains patients receiving 5g of Dextrose Monohydrate, 234 prolonged mg of sodium chloride 128 mg of parenteral therapy. potassium acetate tetrahydrate and 30mg (approximately 1.6 mmol/L) of sodium Metabisulfate.

CONTRAINDI CATION Hypersensitivi ty to any of the components.

NURSING RESPONSIBILTY Do not administer unless solution is clear and container is undamaged. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus. Discard unused portion. In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage. Properly label the IV Fluid Observe aseptic technique when changing IV fluid

Dosage D5NM is supplied in single-dose 500 and 1000 mL flexible plastic containers. 1000 mL @ 30 gtts/min.