Drug

General Action

Mechanism of action Bloc(s acet)lcholine effects on prostaganglionic receptors in smooth muscle, cardiac muscle, e*ocrine glands, urinar) 'ladder, and the A+ and SA nodes of the heart. Ophthalmologicall) 'loc(s acet)lcholine effects n the sphincter muscle of the iris and the accommodati,e muscle of the ciliar) 'od). -his results in dilation of the pupil and paral)sis f the muscles re#uired to accommodate for close ,ision

Contraindica tions .nfants less than 3 months of age, primar) glaucoma or a tendenc) to/ard glaucoma, adhesions 'et/een the iris and the lens, geriatric clients and others /here undiagnosed glaucoma or e*cessi,e pressure in the e)e ma) 'e present, in children /ho ha,e had a pre,ious se,ere s)stemic reaction to atropine

Indications

Side effect

Nursing responsibilities !. Do not use 3 Atro0en in1ections unless under super,ision of trained medical pro,ider ". note indications for therap) 3.chec( for glaucoma 'efore ophthalmic administration $. o'tain +S and 2&G3 monitor &+ status during the therap). 4.use the A-ropen auto in1ector as soon as s)mptoms of organosphosphorus or car'amate poisoning appear. %. After instillation of ophthalmic ointment, compress the lacrimal sac ') digital pressure for ! 3 min to decrease s)stemic effects.

Generic Name: Atropine Sulfate Band name: Atropen, Atropair, atropine sulfate ophthalmic, Route of administration: Oral, parenteral, ophthalmic Dosage: 0.3 !." mg # $ % hr

&holirgenic 'loc(ing drug

0eptic ulcer treatments, p)lorospasm, 'iliar) and ureteral colic spasm and 'ronchial spasms, preanesthetic to control sali,ation and 'ronchial secretions, restoration of &R during anesthesia, decrease degree of A+ heart 'loc(, se,ere 'rad)cardia and s)ncope,

dr) mouth, urinar) hesitanc), headache, flushing, constipation, heart'urn, 'lurred ,ision, stinging, increased intraocular pressure,

Drug

General Action

Mechanism of action

Contraindicatio ns 0ree*isting h)pertension3 occlusi,e ,ascular disease3 angle closure glaucoma 7e)e drops83 h)persensiti,it)3 cardiac arrh)thmias or tach)cardia. 9hen used in addition to local anaesthetics: 0rocedures in,ol,ing digits, ears, nose, penis or scrotum.

Indications

Side effect

Nursing responsibilities !. note indications for therap), onset, characteristics of signs and s)mptoms. ". monitor ,:s 3. document disease onset, su't)pe, other agents trialed and outcome. $. ta(e e*tra precaution on the patients /ith follo/ing conditions: &+ diseases3 h)perth)roidism3 D;3 0ar(inson<s disease3 elderl)3 pregnanc), lactation.

Generic Name: 2pinephrine Brand Name: epinephrine Amp, adrenin amp,

2pinephrine, an Antiglaucoma acti,e principle of preparations the adrenal medulla, is a direct acting s)mpathomimetic. .t stimulates 5 and 6 adrenergic receptors resulting in rela*ation of smooth muscle of the 'ronchial tree, cardiac stimulation and dilation of s(eletal muscle ,asculature. .t is fre#uentl) added to local anaesthetics to retard diffusion and limit a'sorption, to prolong the duration of effect and to lessen the danger of to*icit).

Ad,anced cardiac life support, anaph)lactic shoc(, ocular h)pertension, open angle glaucoma, asthmatic attac(s

epigastric pain3 &+ disorders3 difficult) in micturition /ith urinar) retention3 d)spnoea3 h)pergl)caemia3 s/eating3 h)persali,ation3 /ea(ness, tremors3 coldness of e*tremities3 h)po(alaemia. Gangrene, tissue necrosis and sloughing 7e*tra,asation8 /hen used in addition to local anaesthetics. 2)e drops: Se,ere smarting, 'lurred ,ision, photopho'ia3 naso lachr)mal ducts o'struction. Oedema, h)peraemia and inflammation of the e)es /ith repeated administration.

Drug

General Action Nonsteroidal anti inflammator)

Mechanism of action 0osseses anti inflammato), analgesic, and antip)retic effects

Contraindications

Indications

Side Effects

Nursing Responsibilities !. use as a part of a regular analgesic schedule rather than on an as needed 'asis ". if gi,en p.r.n, 'asis, 'ase si?e of repeat dose. .f pain returns /ithin 3 4 hr, the en*t dose can 'e increased ') up to 40 percent 3. shortening the dosing inter,als recommended /ill lead to an increased fre#uenc) and duation of side effects.

Generic Name: =etorolac tromethamine Brand Name: Acular Route of Administration .;, .+, 0O, ophthalmic Dosage: %0 mg for less than %4 )ears old, .; 30 mg for .+ %0 mg 0O !gtt $* a da) for ophthalmic route

>)persensti,t) to the drug or allergic s)mtpms to aspirin or other NSA.Ds. Acti,e peptic ulcer disease, recent G. 'leeding or perforatin, histor) of peptic ulcer disease, ad,anced renal impairment and in those at ris( for renal failure due to ,olume depletion, suspected or confirmed cere'ro,a*cula 'leeding, hemorrhagic diathesis, or incomplete hemostasis and in those /ith high ris( of 'leeding.

Se,ere, acute pain in adults, itching caus?ed ') seasonal allergic con1uncti,itis, , post operati,e inflammation follo/ing cataract surger), reduce ocular pain, 'urining and stinging after corneal refracti,e surger), reduction of ocular pain and photopho'ia follo/ing incisional refracti,e surger),

>eadache, di??iness, rdro/siness, diarrhea, nausea, d)spepsia, indigestion, epigastric pain, edema, transient 'urning stinging upon administration, ocular irritation,

Drug

General Action

Mechanism of Action -he analgesic effect is onl) partiall) antagoni?ed ') the antagonist nalo*one. &auses significantl) lesss respirator) depression than morphine. .n contrast to morphine, tramadol does not cause release of histamine. 0roduces dependence of the mu opioid t)pe ho/ e,er there is little e,idence of a'use. -olerance occurs 'ut is relati,el) mild3 the /ithdra/al s)ndrome is not as se,ere as /ith other opiates

Contraindications

Indications

Side Effects

Nursing responsibilities !.do not confuse @ltram /ith @ltrase ". Aist easons for theap), location, onset, trigges, characteristics of S and S. use a pin rating scale to rate pain. 3. Assess for histor) of drug addiction, allerg) to opiates or codeine, sei?ures3 drug ma) increase the ris( of con,ulsions $. ;onitor +S, .and O, renal and AB-s, reduce dose /ith d)sfunction and if o,er C4 )ears old.

Generic Name: -ramadol h)drochloride Brand name: @ltram, @ltram 2R Route of administration: Oral Dosage: 40 !00mg # $ % hr prn

Analgesic

>)persensiti,it) to tramadol, in acute into*ication /ith alcohol, h)pnotics, centrall) acting analgesics, opiates or ps)chotropic drugs. @se in cleitns /ith past r resent addictin or opiate dependence or in those /ith a prior histor) of allerg) to codeine or opiates. @se for o'stetric preoperati,e medicatin of postdeli,er) analgesia .n nursing mothers.

;oderate to moderatel) se,ere pain.

Di??iness, headache, &NS stimulation, ata*ia, sedation, ,ertigo, itching, constipation, nausea, sei?ures, paresthesia, cogniti,e d)sfunction, hallucinations, tremor, amnesia, concentration difficult), a'normal gait, migraine, nausea, constipation, ,omiting, d)spepsia, dr) mouth, diarrhea, anore*ia

Drug

General action

Generic Name: antihistamine Diphenh)drami ne >&l Brand Name: Benadr)l Route of administration: Oral, .+ or .; Dosage: Cap Adult & childn 12 yr "4 40 mg tid #id. Syr Adult & childn 12 yr !".4 "4 mg #id. Childn 6 yr-<12 yr !".4 mg #id, 2-<6 yr %."4 mg #id.

Mechanism of Action >igh sedati,e, anticholinergic, and antiemetic effects

Contraindication 0remature D ne/'orn infants3 asthma attac(3 lactation.

Indication >a) fe,er, urticaria, ,asomotor rhinitis, angioneurotic edema, drug sensiti?ation, serum D penicillin reaction, contact dermatitis, atopic ec?ema, other allergic dermatoses, pruritus, food sensiti,it), par(insonism, motion sic(ness.

Side Effect &+ D &NS effects. Blood disorders. G. distur'ances. Antimuscarinic effects. Allergic reactions. Dro/siness, constipation, diarrhea, di??iness, dr) mouth, nose, throat, headache, anore*ia, an*iet), G. upset, asthenia

Nursing responsibilities !. note reasons fo therap), signs and s)mptoms of charactgeristics, other agents trialed, triggers, outcome ". do not confuse diphenh)dramine /ith desipramine /ith dimenh)drinate 3. ta(e 30 minutes 'efore tra,el $. use sugarless gum, cand) to diminish dr) mouth effects. 4. a,oid alcohol and an) other &NS depressants unless prescri,ed %. Stop therap) C" E% hour 'efore s(in testing

Drug Generic Name: .sosor'ide dinitrate Brand Name: .sordil Route of administration: Su'lingual, oral Dosage: Oral 4 30 mg #id. Sublingual 4 !0 mg " 3 hrl). Acute CHF Oral !0 $0 mg #id. Sublingual 4 !0 mg " hrl). Chronic CHF .nitiall) 4 !0 mg:da) " hrl) su'linguall). ;aintenance: "0 $0 mg #id orall).

General action Anti angina, coronar) ,asodlator

Mechanism of Action Rela*es ,ascular smooth muscle ') stimulatng production of intracellular c)clic guanosine monophosphate. Dilation of post capillar) ,essels decreases ,enous return to the heart due to pooling of 'lood3 thus A+ end diastolic pressure is educed. 2la*ation of arteriololes results in a decreased s)stemic ,ascular resistance and arterial pressure.

Contraindication @se to a'ort anginal attac(s

Indication Angina pectoris, acute and chronic &>B

Side effect >eadache, ,ascular headache, lightheadedness, h)potension.

Nursing responsibilities !.note reasons fo therap)3 include onset, location, characteristics of chest pain3 pain le,els ".assess +S and 2&G-3 note stress thallium, catheteri?ation, or .+@S findins as /ell as &AD histor):inter,ention s. 3. store at room temperature protected from light. =eep 'ottles tighl) closed. Dipense in alight resistant tight contaainer

Drug

General Action &alcium channel 'loc(er

Generic Name: Nifedipine Brand Name: &alci'loc Route of administration: Oral Dosage: &apsules: !0 "0 mg 3* a da) -a'lets: 30 %0 mg per da)

Mechanism of action . .t 'loc(s the calcium or Fslo/F channels and inhi'its entr) of calcium ions into ,ascular smooth muscles particularl) of resistance ,essels and coronar) arteries. dilates coronar) and peripheral arteries, as /ell as ,eins. &oronar) arterial ,asodilation increases coronar) 'lood flo/ in the ischemic post stenotic areas, /hile dilation of the peripheral arteries lo/ers arterial 'lood pressure and reduces left ,entricular afterload. Some renal arter) dilatation ma) stimulate mild diuresis.

Contraindicatio ns &ardio,ascular shoc(, se,ere aortic stenosis or in patients (no/n to 'e h)persensiti,e to nifedipine. &are is needed in patients /ith ,er) lo/ 'lood pressure 7se,ere h)potension /ith s)stolic pressure GE0 mm>g8 or decompensated heart failure.

Indications All forms of h)pertension, primar) or secondar). Nifedipine is most effecti,e for mild to moderate degrees of h)pertension 'ut the capsule ma) 'e 'itten and s/allo/ed for more rapid effects as in h)pertensi,e crises. >)pertension in pregnanc) 7at an) term of pregnanc)8. &oronar) insufficienc) /ith or /ithout angina. +asospastic angina 70rin?metal<s angina8. -o increase heart rate in patients /ith sinus 'rad)cardia and sic( sinus s)ndrome.

Side Effects Side effects are mild, transient and relati,el) infre#uent. -hese include flushing, nausea, di??iness, headache, tiredness, sedation, leg edema and other manifestations of peripheral ,asodilation.

Nursing Responsibilities !. dot not confuse nifedipine /ith nicardipine ". do not e*ceed a single dose 3. 'efore increasing dose, carefull) monitor B0 $. use onl) the sustained release ta'lets to treat h)pertension 4. concomitant therap) /ith 'eta renergic 'loc(ing agents ma) 'e used %. clients /ithdra/n from 'eta 'loc(ers ma) manifest s)mptoms of increased angina /hich cannot 'e pre,ented ') nifedipine3 in fact nifedipine ma) increase the se,erit) of angina situation