Drug Calcium Gluconate

Class: Mineral

Actions Calcium is the fifth most abundant element in the body and is essential for maintenance of the functional integrity of nervous, muscular and skeletal systems and cell membrane an d capillary permeability. It is also an important activator in many enzymatic reactions and is essential to a number of physiologic processes including

Indications Calcium gluconate is used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyroid ism and hypocalcemia due to rapid growth or pregnancy. It is also used in the treatment of black widow spider bites to relieve muscle cramping and as an adjunct in the treatment of rickets, osteomalacia, lead colic and

Contraindications Calcium salts are contraindicated in patients with ventricular fibrillation or hypercalcemia. Intrave nous administration of calcium is contraindicated when serum calcium levels are above normal. If neonates are required, or expected to require, treatment with calciumcontaining IV solutions, including continuous calcium-containing infusions such as parenteral nutrition, ceftriaxone sodium injection is contraindicated because of the risk of precipitation of ceftriaxone-calcium

Adverse Effects Bradycardia Hypotension Headache Constipation Diarrhea Flatulence Nausea Vomiting Hypomagnesemia Hypophosphatemia Extravasation necrosis

Interventions Assess for cutaneous burning sensations and peripheral vasodilation, with moderate fall in BP, during direct IV injection. Monitor ECG during IV administration to detect evidence of hypercalcemia: decreased QT interval associated with inverted T wave. Observe IV site closely. Extravasation may result in tissue irritation and necrosis. Monitor for hypocalcemia and hypercalcemia. Lab tests: Determine levels of calcium and phosphorus (tend to vary inversely) and magnesium frequently, during

transmission of nerve impulses; contraction of cardiac, smooth and skeletal muscles; renal function; respiration and blood coagulation. Calcium also plays regulatory roles in the release and storage of neurotransmi tters and hormones, in the uptake and binding of amino acids, and in cyanocobala min (vitamin B12) absorption and gastrin secretion

magnesium sulfate overdosage. Cal cium gluconate has also been employed to decrease capillary permeability in allergic conditions, nonthrombocyto penic purpura and exudative dermatoses such as dermatitis herpetiformis and for pruritus of eruptions caused by certain drugs. In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity provided the patient is not receiving digitalis therapy

sustained therapy. Deficiencies in other ions, particularly magnesium, frequently coexist with calcium ion depletion

Drug Cefuroxime

Actions

Indications Susceptible bacterial septicemia, lower respiratory or urinary tract, skin and skin structure, meningitis and bone joint infection, gonorrhea. Surgical prophylaxis.

Contraindications

Adverse Effects

Interventions Before giving dug. Ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity test giving first dose. Absorption of oral drug is induced.

Cefuroxime is used to treat a wide variety of bacterial Class: infections. Cephalosporin This Antibiotic medication is known as a cephalosporin antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (e.g., commo n cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased

Cefuroxime >10% (cefuroxime Diarrhea (4-11%; (cefuroxime injection) depends on injection) for Injection duration) USP and Dextrose Injection USP 1-10% is contraindicated in Decreased patients with hemoglobin or known allergy to the hematocrit (10%) cephalosporin group of Eosinophilia (7%) antibiotics. Solutions Nausea or vomiting containing dextrose (3-7%) may be Vaginitis (<5%) contraindicated in Transient rise in patients with hepatic hypersensitivity to corn transaminases (2products. 4%) Diaper rash (3%) Increase in alkaline phosphatase (2%) Thrombophlebitis (2%) Increase in lactate dehydrogenase (1%) <1% Anemia

effectiveness.

Cholestasis Colitis Dyspnea Epidermal necrolysis

Drug Furosemide

Class: Loop diuretic

Indications For the Furosemide, a treatment of loop diuretic, edema inhibits water associated with reabsorption congestive heart in the failure, cirrhosis nephron by of the liver, and blocking the renal disease, sodiumincluding the potassiumnephrotic chloride syndrome. Also cotransporter for the (NKCC2) in treatment for the thick hypertension alo ascending ne or in limb of the combination loop of Henle. with other This is antihypertensive achieved agents. through competitive

Actions

Contraindications Documented hypersensitivity to furosemide or sulfonamides Anuria Concomitant ethacrynic acid therapy (increases risk of ototoxicity)

Adverse Effects Chest pain chills cough or hoarseness fever general feeling of tiredness or weakness headache lower back or side pain painful or difficult urination sore throat sores, ulcers, or

Interventions Furosemide is often given in conjunction with a potassium supplement or a potassium-sparing diuretic to counteract with potassium chloride.

The medication has a rapid onset of effect of about one hour when taken orally and five minutes by injection.

inhibition at the chloride binding site on the cotransporter , thus preventing the transport of sodium from the lumen of the loop of Henle into the basolateral interstitium. Consequently, the lumen becomes more hypertonic while the interstitium becomes less hypertonic, which in turn diminishes the osmotic gradient for water reabsorption throughout

white spots on the lips or in the mouth swollen or painful glands tightness in the chest unusual bleeding or bruising unusual tiredness or weakness wheezing

Duration of action is about six hours so it is possible to use a twice daily dose if necessary.

the nephron. Because the thick ascending limb is responsible for 25% of sodium reabsorption in the nephron, furosemide is a very potent diuretic..

Drug Lanoxin

Actions Increases force and velocity of myocardial contraction and prolongs refractory period of atrioventricul ar (AV) node by increasing calcium entry into myocardial cells. Slows conduction through sinoatrial and AV nodes and produces antiarrhythmi c effect.

Class: Cardiac glycoside

Indications LANOXIN is indicated for the treatment of mild to moderate heart failure in adults. LANOXIN increases left ventricular ejection fraction and improves heart failure symptoms as evidenced by improved exercise capacity and decreased heart failurerelated hospitalizations and emergency care, while having no effect on mortality. Where possible, LANOXIN should be used in combination with a diuretic and an

Contraindications Digitalis glycosides are contraindicated in patients with ventricular fibrillation or in patients with a known hypersensitivity to digoxin. A hypersensitivity reaction to other digitalis preparations usually constitutes a contraindication to digoxin.

Adverse Effects Black, tarry stools blood in the urine or stools bloody vomit pinpoint red spots on the skin rash with flat lesions or small raised lesions on the skin severe stomach pain unusual bleeding or bruising

Interventions 1. Digoxin preparations must be stored in tightly covered, light resistant containers at room temp. 2. FOLLOW CLOSELY (especially in patients receiving diuretics or amphotericin) for decreased serum potassium (K), magnesium (Mg), or thyroxine (T4) along with increased calcium (Ca) will increase digoxin toxicity at a given level. Initial hyperkalemia results from release of intracellular K and indicates serious acute toxicity. 3. Follow HR and rhythm closely 4. Take apical-radial pulse before giving Digoxin; determine

angiotensinconverting enzyme (ACE) inhibitor.

whether bradycardia exists individualized to patient; if so, notify H.O., check last level result and hold medication 5. Monitor for dysrhythmias; respiratory congestion; peripheral edema 6. Monitor daily weights and perform accurate I & O 7. Order must be taken off by two RNs 8. Obtain periodic EKGs to assess both desired effects and signs of toxicity

Drug Mannitol Class: Diuretics, Osmotic Agents

Actions

Mannitol draws free water out of tissues (including the brain) and into the intravascular space, and can transiently decrease cerebral edema (until excreted by the kidney)

Indications Used for the promotion of diuresis before irreversible renal failure becomes established, the reduction of intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic substances.

Contraindications Well established anuria due to severe renal disease. Severe pulmonary congestion or frank pulmonary edema. Active intracranial ble eding except during craniotomy. Severe dehydration. Progressive renal damage or dysfunction after institution of mannitol (mannitol (mannitol injection) injection) therapy, including increasing oliguria and azotemia. Progressive heart failure or pulmonary congestion after institution of mannitol (mannitol (mannitol injection) injection) therapy. Do not administer to patients with a

Adverse Effects Angina-like chest pains CHF Hypotension Phlebitis Convulsions Chills Dizziness Headache Acidosis Fluid/electrol yte imbalances Thirst Nausea Vomiting Blurred vision

Interventions History: Pulmonary congestion, active intracranial bleeding, dehydration, renal disease, CHF Physical: Skin color, lesions, edema, hydration; orientation, reflexes, muscle strength, pupils; pulses, BP, perfusion; R, pattern, adventitious sounds; urinary output patterns; CBC, serum electrolytes, urinalysis, renal function tests

known hypersensitivity to mannitol

Drug Paracetamol Class: Non-narcotic analgesic Antipyretic

Actions Decreases fever by a hypothalamic effect leading to sweating and vasodilation Inhibits pyrogen effect on the hypothalamicheat-regulating centers Inhibits CNS Prostglandin Synthesis with minimal effects on peripheral prostaglandin synthesis Does not cause ulceration of the GI tract and causes no anticoagulant action.

Indications Paracetamol is an analgesic and antipyretic drug.It is used for the relief of: Mild to moderate pain Fever Migraine Tension headaches

Contraindications Liver Failure Liver Problems Overdose of the Drug Acetaminoph en, Habit of Drinking Too Much Alcohol

Adverse Effects Minimal GI upset. Methemoglobine mia Hemolytic Anemia Neutropenia Thrombocytopeni a Pancytopenia Leukopenia Urticaria CNS stimulation Hypoglycemic coma Jaundice Glissitis Drowsiness Liver Damage

Interventions Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children. Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults. ExtendedRelease tablets are not to be chewed. Monitor CBC, liver and renal functions. Assess for fecal occult blood and nephritis. Avoid using OTC drugs with Acetaminophe n. Take with food or milk to minimize GI

upset. Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity. Report paleness, weakness and heart beat skips Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools. Phenmacetin may cause urine to become dark brown or winecolored. Report pain that persists for more than 3-5 days

Drug Phenobarbital

Class: Barbiturate (long acting), Sedative, Hypnotic, Anticonvulsan t, Antiepileptic agent

Actions General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at subhypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an antiepileptic.

Indications Long-term management of tonic-clonic (grand mal) seizures and partial seizures; status epilepticus, eclampsia, febrile convulsions in young children. Also used as a sedative in anxiety or tension states; in pediatrics as preoperative and postoperative sedation and to treat pylorospasm in infants

Contraindications Sensitivity to barbiturates; manifest hepatic or familial history of porphyria; severe respiratory or kidney disease; history of previous addiction to sedative hypnotics; uncontrolled pain; pregnancy (particularly early pregnancy) (category D), lactation; sustained release formulation for children < 12 y of age.

Adverse Effects

Interventions

Bradycardia, hypotension, syncope; drowsiness, lethargy, CNS excitation or depression, impaired judgment, hangover effect, confusion, somnolence, agitation, hyperkinesia, ataxia, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness; rash, exfoliative dermatitis; nausea, vomiting, constipation; agranulocytosis, thrombocytopeni a, megaloblastic

History: Hypers ensitivity to barbiturates, manifest or latent porphyria; marked liver impairment; nephritis; severe respiratory distress; previous addiction to sedativehypnotic drugs; pregnancy; acute or chronic pain; seizure disorders; lactation, fever; hyperthyroidis m; diabetes mellitus; severe anemia; cardiac

anaemia; pain at inj site, thrombophlebitis (IV); oliguria: laryngospasm, respiratory depression, apnoea (especially with rapid IV admin), hypoventilation. Potentially Fatal: Stevens-Johnson syndrome.

disease; shock; uremia; impaired liver or renal function; debilitation Physical: Weig ht; T; skin color, lesions; orientation, affect, reflexes; P, BP, orthostatic BP; R, adventitious sounds; bowel sounds, normal output, liver evaluation; LFTs, renal function tests, blood and urine glucose, BUN

Actions It relieves nasal Salbutamol congestion and reversible bronchospasm by relaxing the smooth Class: Bronchodilato muscles of the bronchioles. The relief r (therapeutic); from nasal congestion and bronchospasm is adrenergics (pharmacologi made possible by the following mechanism c) that takes place when Salbutamol is administered. First, it binds to the beta2adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 35adenosine monophosphate (cAMP). When cAMP

Drug

Indications Contraindications 1. Hypersensitivity to To control and adrenergic amines prevent reversible airway 2. Hypersensitivity to fluorocarbons obstruction caused by asthma or chronic obstractive pulmonary disord er (COPD) Quick relief for bronchospasm For the prevention of exercise-induced bronchospasm Long-term control agent for patients with chronic or persistent bronchospasm

Adverse Effects

Interventions

1. Nervousness 1. Assess lung sounds, 2. Restlessness PR and BP before 3. Tremor drug 4. Headache administration and 5. Insomnia during peak of 6. Chest pain medication. 7. Palpitations 2. Observe fore 8. Angina paradoxical spasm 9. Arrhythmias and withhold 10. Hypertension medication and 11. Nausea and notify physician if vomiting condition occurs. 12. Hyperglycemi 3. Administer PO a medications with 13. Hypokalemia meals to minimize gastric irritation. 4. Extended-release tablet should be swallowed-whole. It should not be crushed or chewed. 5. If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication. 6. Advise the patient

increases, kinases are activated. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways

to rinse mouth with water after each inhalation to minimize dry mouth. 7. Inform the patient that Albuterol may cause an unusual or bad taste.

Drug kalium durule (KCl) Class: Electrolyte

Actions Principal intracellular cation of most body tissues, participates in a no. of physiologic processesmaintaining intracellular tonicity; transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; maint. of normal renal fxn; also plays a role in CHO metabolism & various enzymatic reactions

Indications Prevention and correction of potassium deficiency; when associated w/ alkalosis, use KCl; when associated w/ acidosis use potassium acetate, bicarbonate, citrate, or gluconate

Contraindications Allergy to tartrazine, aspirin; therapy w/ potassium-sparing diuretics / aldosteroneinhibiting agents; severe renal impairment w/ oliguria, anuria, azotemia; hyperkalemia; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract; Use cautiously w/ cardiac disorders

Adverse Effects Dermatologic: Rash GI: nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction-bleedingulceration/perforation Hematologic: Hyperkalemia inc. serum potassium, ECG changes Local: tissue sloughing, local necrosis, local phlebitis, and venospasm w/ injection

Interventions Administer liquid form to any patient w/ delayed GI emptying Administer oral drug after meals or with food and a full glass of water to decrease GI upset, have patient swallow tablet whole Agitate prepared IV solution to prevent layering of potassium, do not add potassium to an IV bag in the hanging position Caution patient not to use salt substitutes and that expended wax matrix capsules will be found in the stool

Drug co-amoxiclav

Actions

Indications Respiratory tract infections caused by strep. Pneumoniae, Group A beta hemolytic strep. Skin and skin structure infections caused by staph., strep. Otitis media, bone infections, GU infections

Contraindications Allergy to cephalosporin or penicillin; use cautiously with renal failure, lactation, pregnancy

Adverse Effects Headache, nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, nephrotoxicity, bone marrow, depression, ranging from rash to fever

Interventions Arrange for culture and sensitivity tests of infection before and during therapy if infection does not resolve Give drug with meals, arrange for small frequent meals if GI complications occur

Bactericidal; inhibits synthesis Class: of bacterial cell Antibiotic, wall, causing cell Cephalosporin death (1st Gen)