Lactated Ringer’s Solution with 5%Dextrose(D5LR)

Classification: Hypertonic- Nonpyrogenic, parenteralfluid,electrolyteand nutrientreplenisher

Contents: Electrolytes in 1000ml: Sodium-130mmol, Potassium-4 mmol, Calcium-1.4mmol, Chloride – 109mmol, Lactate-28 mmol

MOA: Osmolarity is higher than serum; When infused, it initially increases the osmolarity, causing the fluid to be pulled from the interstitial
and intracellular compartments into the blood vessels (intravascular space).

Indications: Treatment for persons needing extra calories who cannot tolerate fluid overload. Treatment of shock.
Contraindications: Hypersensitivity to any of the components, Renal failure, Liver dysfunction, Diabetes Mellitus, Lactic acidosis, Alkalosis,
Hyperkalemia

Side Effects: Allergic reactions or anaphylactoid symptoms such as localized or generalized urticaria and pruritis; periorbital, facial,
and/or laryngeal edema, coughing, sneezing, and/or difficulty with breathing

Dose: 1L @30gtts/min
Nursing Responsibilities:
 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
PLAIN NSS (0.9% Sodium Chloride Solution)
Classification: Isotonic volume expander; Electrolyte replacement

MOA:
Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment.
It contains no antimicrobial agents.
The pH is 5.0 (4.5 to 7.0).
It contains 9 g/L Sodium Chloride with an osmolarity of 308 mOsmol/L.
It contains 154 mEq/L Sodium and Chloride.

Indications: It is indicated as a source of water and electrolytes.

-In general, intravenous lines should not be started unless the patient currently, or may soon need either fluid replenishment or medication
administration.

Contraindications: Patients at risk for increased I.C.P., Patients who have an acute neurological dysfunction, Hypovolemic states, Patients at
risk for third-space fluidshifts, Elevated blood glucoseconcentrations, heart problems (e.g., congestiveheart failure), kidney problems,fluid
balance problems (e.g.,hypovolemia),low levels of potassium(hypokalemia),vitamin B deficiencies, swelling (edema).

Adverse reactions: febrile response, infection at the site of injection, venous thrombosis, or phlebitis extending from the site of injection,
extravasation, and hypervolemia.
• If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and
save remainder of the fluid for examination if deemed necessary.
Precautions: If administering a fluid bolus check BP and lung sounds every 250cc. Discontinue bolus if pulmonary edema is discovered, or once
BP is in therapeutic range (generally SBP above 90 mm/Hg). Avoid hypervolemia.
-It should be used with great care, if at all, in patients with congestive heart failure, severe renal insufficiency and in clinical states in which
there exists edema with sodium retention.

-In patients with diminished renal function, administration of Normal Saline may result in sodium retention.

Nursing Responsibilities:

1. Do not administer quantity in excess of that required to keep vein open or administerappropriate dose of medication.
2. Do not use solution if outdated, cloudy or theseal is not intact, as with all IV solutions.
3. Monitor E.C.G. continuously.
4. Monitor blood pressure, pulse rate andrespiratory rate frequently.
Plain Lactated Ringer Solution
Classification: Isotonic Solution

Content:

Each 100 mL of Lactated Ringer's Injection USP contains:

Sodium Chloride USP 0.6 g; Sodium Lactate 0.31 g
Potassium Chloride USP 0.03 g; Calcium Chloride Dihydrate USP 0.02 g

MOA: Lactated Ringer's is a sterile solution for fluid and electrolyte replenishment. It restores fluid and electrolyte balances, produces
diuresis, and acts as alkalizing agent (reduces acidity).

Indications:
- for balancing fluid and electrolytes and as an alkalizing agent.
-Lactated Ringer's Injection, USP is indicated as a source of water and electrolytes or as directed by a physician. Dosage is dependent upon the
age, weight and clinical condition of the patient as well as laboratory determinations.

Contraindications
-This solution is contraindicated where the administration of sodium, potassium, calcium, lactate, or chloride could be clinically detrimental.
-Lactate administration is contraindicated in severe metabolic acidosis or alkalosis, and in severe liver disease or anoxic states which affect
lactate metabolism.

Side Effects: Side effects of Lactated Ringer's solution are chest pain, abnormal heart rate, decreased blood pressure, troubled
breathing, cough, sneezing, rash, itching, and headache. Infection at the site of injection, venous thrombosis or phlebitis at the site of injection,
extravasation, and increased fluid volume (hypervolemia) may also occur.
Storage: Store Lactated Ringer's solution at room temperature of 25 C, avoiding excessive heat. Brief exposure to up to 40 C does not affect
the product.

Nursing Responsibilities:
-This solution should be used with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or frank
cardiac decompensation.
-Extraordinary electrolytes losses such as may occur during protracted nasogastric suction, vomiting, diarrhea or gastrointestinal fistula
drainage may necessitate additional electrolyte supplementation.
-Additional essential electrolytes, minerals and vitamins should be supplied as needed.
-Sodium-containing solutions should be administered with caution to patients receiving corticosteroids or corticotropin, or to other salt-
retaining patients.
Atropine Sulfate
Brand Name: AtroPen, Minims (CAN), Sal-Tropine, Atropine Sulfate S.O.P., Isopto Atropine Ophthalmic
Classification:Anticholinergic,Antimuscarinic,Parasympatholytic,Antiparkinsonian,Antidote,Diagnostic agent (ophthalmic preparations)

MOA: Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic
postganglionic impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on the heart, relaxing the
GI and GU tracts, inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye (mydriatic effect), and preventing accommodation
for near vision (cycloplegic effect); also blocks the effects of acetylcholine in the CNS.

Indication: Antisialagogue for preanesthetic medication to prevent or reduce respiratory tract secretions
 Treatment of parkinsonism; relieves tremor and rigidity
 Restoration of cardiac rate and arterial pressure during anesthesia when vagal stimulation produced by intra-abdominal traction causes a
decrease in pulse rate, lessening the degree of AV block when increased vagal tone is a factor (eg, some cases due to digitalis)
 Relief of bradycardia and syncope due to hyperactive carotid sinus reflex
 Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
 Relaxation of the spasm of biliary and ureteral colic and bronchospasm
 Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of urinary tract conditions
 Control of crying and laughing episodes in patients with brain lesions
 Treatment of closed head injuries that cause acetylcholine release into CSF, EEG abnormalities, stupor, neurologic signs
 Relaxation of uterine hypertonicity
 Management of peptic ulcer
 Control of rhinorrhea of acute rhinitis or hay fever
 Antidote (with external cardiac massage) for CV collapse from overdose of parasympathomimetic (cholinergic) drugs (choline esters,
pilocarpine), or cholinesterase inhibitors (eg, physostigmine, isoflurophate, organophosphorus insecticides)
 Antidote for poisoning by certain species of mushroom (eg, Amanita muscaria)
Contraindication:
 Contraindicated with hypersensitivity to anticholinergic drugs.
Systemic administration
 Contraindicated with glaucoma; adhesions between iris and lens; stenosing peptic ulcer; pyloroduodenal obstruction; paralytic ileus;
intestinal atony; severe ulcerative colitis; toxic megacolon; symptomatic prostatic hypertrophy; bladder neck obstruction; bronchial
asthma; COPD; cardiac arrhythmias; tachycardia; myocardial ischemia; impaired metabolic, hepatic, or renal function; myasthenia gravis.
 Use cautiously with Down syndrome, brain damage, spasticity, hypertension, hyperthyroidism, lactation.
Ophthalmic solution
 Contraindicated with glaucoma or tendency to glaucoma.

DOSAGE:
SYSTEMIC ADMINISTRATION
0.4–0.6 MG PO, IM, IV, OR SUBCUTANEOUSLY .
 H Y P O T O N I C R A D I O G R A P H Y : 1 mg IM.
 S U R G E R Y : 0.5 mg (0.4–0.6 mg) IM (or subcutaneously or IV) prior to induction of anesthesia; during surgery, give IV; reduce dose to < 0.4
mg with cyclopropane anesthesia.
 B R A D Y A R R H Y T H M I A S : 0.4–1 mg (up to 2 mg) IV every 1–2 hr as needed.
 A N T I D O T E : For poisoning due to cholinesterase inhibitor insecticides, give large doses of at least 2–3 mg parenterally, and repeat until
signs of atropine intoxication appear; for rapid type of mushroom poisoning, give in doses sufficient to control parasympathetic signs
before coma and CV collapse intervene. Auto-injector provides rapid administration.
OPHTHALMIC SOLUTION
 F O R R E F R A C T I O N : Instill 1–2 drops into eye 1 hr before refracting.
 F O R U V E I T I S : Instill 1–2 drops into eye qid.
Side Effects:
Systemic administration
 CNS: blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache, flushing, nervousness, weakness, dizziness, insomnia,
mental confusion or excitement (after even small doses in the elderly), nasal congestion
 CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)
 GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn, constipation, bloated feeling, paralytic ileus
 GU: Urinary hesitancy and retention; impotence
 Other: Decreased sweating and predisposition to heat prostration, suppression of lactation
OPHTHALMIC PREPARATIONS
Local: Transient stinging

Nursing Responsibilities:

 Ensure adequate hydration; provide environmental control (temperature) to prevent hyperpyrexia.

 Have patient void before taking medication if urinary retention is a problem.

Teaching Points:
- When used preoperatively or in other acute situations, incorporate teaching about the drug with teaching about the procedure; the
ophthalmic solution is mainly used acutely and will not be self-administered by the patient; the following apply to oral medication for
outpatients:

 Take as prescribed, 30 minutes before meals; avoid excessive dosage.

 Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur.
 Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular heartbeat, palpitations; headache; abdominal
distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in urination; constipation; sensitivity to light.
Paracetamol
Brand Name: Tempra, Biogesic
Classification: Analgesics, Non-Narcotic; Antipyretics

MOA: Acetaminophen is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-
1, COX-2, and COX-3 enzymes involved in prostaglandin (PG) synthesis. Unlike NSAIDs, acetaminophen does not inhibit cyclooxygenase in
peripheral tissues and, thus, has no peripheral anti-inflammatory affects. While aspirin acts as an irreversible inhibitor of COX and directly
blocks the enzyme's active site, studies have found that acetaminophen indirectly blocks COX, and that this blockade is ineffective in the
presence of peroxides.

Indications: For temporary relief of fever, minor aches, and pains.

Contraindications: Liver Failure, Liver Problems, Overdose of the Drug Acetaminophen, Habit of Drinking Too Much Alcohol

Dosage: 500mg per 1 tab every 4hours for temp. >38.5

Side Effects: headache, chest pain, dyspnea, jaundice,hematuria, leucopenia, rash, fever

Nursing Responsibilities:
1. Make sure the patient is not taking any other medication that contains paracetamol.
2. Monitor therapeutic response. The likelihood to overdose is more prevalent in people who drink alcohol.
3. Give drug with food if GI upset occurs.
 Diazepam

BRAND NAME: Valium

CLASSIFICATION: Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal muscle relaxants (centrally acting)
MOA: - Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.
- Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.
- Has anticonvul-sant properties due to enhanced presynaptic inhibi-tion.

INDICATION: -Adjunct in the management of: Anxiety, Preoperative sedation, Conscious sedation, Provides light anesthesia and anterograde
amnesia, Treatment of status epilepticus/ uncontrolled seizures, Skeletal muscle relaxant, Management of the symptoms of alcohol
withdrawal
CONTRAINDICATIONS: - Hypersensitivity, Cross-sensitivity with other benzodiazepines may occurs ,Comatose patients ,Pre-existing CNS
depression

Side Effects: Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face,
lips, tongue, or throat.
Stop using diazepam and call your doctor at once if you have a serious side effect such as:
 confusion, hallucinations, unusual thoughts or behavior;
 unusual risk-taking behavior, decreased inhibitions, no fear of danger;
 depressed mood, thoughts of suicide or hurting yourself;
 hyperactivity, agitation, aggression, hostility;
 new or worsening seizures;
 weak or shallow breathing;
 feeling like you might pass out;
 muscle twitching, tremor;
 loss of bladder control; or
 urinating less than usual or not at all.
NURSING IMPLICATIONS/RESPONSIBILITIES:
- Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.
- Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis. - Prolonged high-dose therapy may
lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal
tendencies.
- Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after
administration.
- IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption.
- Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. - Effectiveness of therapy can be
demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.
Hyoscine-N-butylbromide

Brand Name: Buscopan

Classification: Antispasmodics Availability: Tablet 10 mg,Ampule 20mg

MOA: The mechanism of action of Buscopan is that it blocks the muscarinic receptors found on the smooth muscle walls which means its
blocks the action of acetylcholine on the receptors found within the smooth muscle of the gastrointestinal and urinary tract and thus reduces
the spasms and contractions. This relaxes the muscle and thus reduced the pain from the cramps and spasms.

Indication: 1. Spasm in the genitourinary tract 2. Spasm in the gastrointestinal tract 3. Spasm in the biliary tract 4. Colic Contraindications:
Myasthenia gravies, megacolon, hypersensitivity to drug contents, narrow angle glaucoma, prostate hypertrophy with urinary retention,
mechanical stenosis in the GI tract, tachycardia.

Route & Dosage: Ampule Colic Pain Adult and adolescent >12 y/o 1-2 amp IV/IM/SC several times daily. Maximum dose: 100mg/day Infant
and young children 0.3-0.6 mg/kg/body weight by slow IV/IM/SC several times daily. Maximum dose: 1.5 mg/kg/body weight.

Side Effects: Constipation, decreased sweating, mouth, skin, eye dryness, blurred feeling, bloating, dysuria, nausea or vomiting,
lightheadedness, headache, weakness

Drug Interaction: Potassium chloride, Metoclopramide, MAO inhibitors, Beta-agonists, Anticholinergics, Antacids, Droperidol
Nursing Responsibilities:
1. Instruct patient to take this drug 30 minutes to 1 hour before meals
2. Teach patient that Buscopan will potentiate the effect of alcohol and other CNS depressants.
3. Advice patient not take antacids and antidiarrheal 2 to 3 hours prior to raking this drug.
4. It is not necessary to take the medication if patient is not in pain.
5. Caution the patient to avoid driving or operating machinery after parenteral dose.
Sodium Bicarbonate
Brand Name: Sodium Bicarbonate
Classifications: gastrointestinal agent; antacid; fluid and electrolyte balance agent

MOA: Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to form sodium chloride, carbon dioxide, and water. After
absorption of sodium bicarbonate, plasma alkali reserve is increased and excess sodium and bicarbonate ions are excreted in urine, thus
rendering urine less acid. Not suitable for treatment of peptic ulcer because it is short-acting, high in sodium, and may cause, gastric,
distention, systemic, alkalosis, and possibly acid-rebound.

Therapeutic effects: Shortacting, potent systemic antacid; rapidly neutralizes gastric acid or systemic acidosis.
Indications: Systemic alkalinizer to correct metabolic acidosis (as occurs in diabetes mellitus, shock, cardiac arrest, or vascular collapse), to
minimize uric acid crystallization associated with uricosuric agents, to increase the solubility of sulfonamides, and to enhance renal excretion of
barbiturate and salicylate overdosage. Commonly used as home remedy for relief of occasional heartburn, indigestion, or sour stomach. Used
topically as paste, bath, or soak to relieve itching and minor skin irritations such as sunburn, insect bites, prickly heat, poison ivy, sumac, or oak.
Sterile solutions are used to buffer acidic parenteral solutions to prevent acidosis. Also as a buffering agent in many commercial products (e.g.,
mouthwashes, douches, enemas, ophthalmic solutions).

Contraindications: Prolonged therapy with sodium bicarbonate; patients losing chloride (as from vomiting, GI suction, diuresis); heart disease,
hypertension; renal insufficiency; peptic ulcer; pregnancy (category C). Cautious use: Edema, sodium-retaining disorders; lactation; older adults
patients.

Adverse effects: Belching, gastric distention, flatulence,Metabolic alkalosis; electrolyte imbalance: sodium overload (pulmonary edema),
hypocalcemia (tetany), hypokalemia, milk-alkali syndrome, dehydration.
Nursing responsibilities:
Assessment & Drug Effects
 Be aware that long-term use of oral preparation with milk or calcium can cause milk-alkali syndrome: Anorexia, nausea, vomiting, headache,
mental confusion, hypercalcemia, hypophosphatemia, soft tissue calcification, renal and ureteral calculi, renal insufficiency, metabolic
alkalosis.
 Lab tests: Urinary alkalinization: Monitor urinary pH as a guide to dosage (pH testing with nitrazine paper may be done at intervals
throughout the day and dosage adjustments made accordingly).
 Lab tests: Metabolic acidosis: Monitor patient closely by observations of clinical condition; measurements of acid-base status (blood pH,
Po2, Pco2, Hco3-, and other electrolytes, are usually made several times daily during acute period).
 Observe for signs of alkalosis (over treatment)
 Observe for and report S&S of improvement or reversal of metabolic acidosis.

Patient & Family Education

 Do not use sodium bicarbonate as antacid. A nonabsorbable OTC alternative for repeated use is safer.
 Do not take antacids longer than 2 wk except under advice and supervision of a physician. Self-medication with routine doses of sodium
bicarbonate or soda mints may cause sodium retention and alkalosis, especially when kidney function is impaired.
 Be aware that commonly used OTC antacid products contain sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon.
 Do not breast feed while taking this drug without consulting physician.
Metoclopramide

Brand Name:Clopra, Emex , Maxeran , Maxolon, Reglan

Classifications: gastrointestinal agent; prokinetic agent (gi stimulant); autonomic nervous system agent; direct-acting cholinergic
(parasympathomimetic); antiemetic
Availability:5 mg/mL injection

MOA: Potent central dopamine receptor antagonist. Structurally related to procainamide but has little antiarrhythmic or anesthetic activity.
Exact mechanism of action not clear but appears to sensitize GI smooth muscle to effects of acetylcholine by direct action.

Therapeutic effects: Increases resting tone of esophageal sphincter, and tone and amplitude of upper GI contractions. As a result, gastric
emptying and intestinal transit are accelerated with little effect, if any, on gastric, biliary, or pancreatic secretions. Antiemetic action results
from drug-induced elevation of CTZ threshold and enhanced gastric emptying. In diabetic gastroparesis, indicated by relief of anorexia, nausea,
vomiting, persistent fullness after meals.

Indications: Management of diabetic gastric stasis (gastroparesis); to prevent nausea and vomiting associated with emetogenic cancer
chemotherapy (e.g., cisplatin, dacarbazine); to facilitate intubation of small bowel; symptomatic treatment of gastroesophageal reflux.

Contraindicatons: Sensitivity or intolerance to metoclopramide; allergy to sulfiting agents; history of seizure disorders; concurrent use of drugs
that can cause extrapyramidal symptoms; pheochromocytoma; mechanical GI obstruction or perforation; history of breast cancer. Safety
during pregnancy (category B) or lactation is not established.

Cautious Use: CHF; hypokalemia; kidney dysfunction; GI hemorrhage; history of intermittent porphyria.

Adverse effects: restlessness,drowsiness,fatigue,insomia,dizziness,anxiety, tansient hypertension, nausea and diarrhea

Nursing Responsibilities:

Assessment & Drug Effects

 Report immediately the onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors. Extrapyramidal symptoms are
most likely to occur in children, young adults, and the older adult and with high-dose treatment of vomiting associated with cancer
chemotherapy. Symptoms can take months to regress.
 Be aware that during early treatment period, serum aldosterone may be elevated; after prolonged administration periods, it returns to
pretreatment level.
 Lab tests: Periodic serum electrolyte.
 Monitor for possible hypernatremia and hypokalemia, especially if patient has CHF or cirrhosis.
 Adverse reactions associated with increased serum prolactin concentration (galactorrhea, menstrual disorders, gynecomastia) usually
disappear within a few weeks or months after drug treatment is stopped.

Patient & Family Education

 Avoid driving and other potentially hazardous activities for a few hours after drug administration.
 Avoid alcohol and other CNS depressants.
 Report S&S of acute dystonia, such as trembling hands and facial grimacing,immediately.
 Do not breast feed while taking this drug without consulting physician.
Salbutamol

Generic Name: Albuterol

Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol, Proventil HFA, Gen-salbutamol, Ventodisk, Ventolin HFA,
Volmax, VoSpira ER
Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)

MOA: It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal
congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.
1. First, it binds to the beta2-adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl
cyclase and increased levels of cyclic- 3’5’-adenosine monophosphate (cAMP).
2. When cAMP increases, kinases are activated.
3. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.
4. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.

Indications
1. To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
2. Quick relief for bronchospasm
3. For the prevention of exercise-induced bronchospasm
4. Long-term control agent for patients with chronic or persistent bronchospasm

Contraindications
1. Hypersensitivity to adrenergic amines
2. Hypersensitivity to fluorocarbons

Precaution: Cardiac disease including coronary insufficiency, a history of stroke,coronary artery disease and cardiac arrhythmias, Hypertension,
Hyperthyroidism, Diabetes, Glaucoma, Geriatric patients – older individuals are at higher risk for adverse reactions and may require lower
dosage, Pregnancy especially near term, Lactation, Children less than 2 years of age because safety of its use has not been established, Excess
inhaler use which may lead to tolerance and paradoxical bronchospasm
Side Effects and Adverse Reactions: Nervousness, Restlessness, Tremor, Headache, Insomnia, Chest pain, Palpitations, Angina, Arrhythmias,
Hypertension, Nausea and vomiting, Hyperglycemia, Hypokalemia

Route and Dosage:

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mg of extended dose tablets twice a day.
PO (Geriatric Patients): initial dose should not exceed 2 mg 3-4 times a day and may be increased carefully up to 32 mg/day
PO (Children 6-12 years old): 2 mg 3-4 times a day or 4 mg as extended-release tablets twice a day; may be carefully increased as needed but
not to exceed 24 mg/day
PO (Children 2-6 years old): 0.1 mg/kg 3 times a day
Inhalation (Adults and children more than 4 years of age): 2 inhalations every 4-6 hours
Inhalation (Children 2-12 years old): 0.1-0.15 mg/kg/dose 3-4 times a day

Nursing Interventions
1. Assess lung sounds, PR and BP before drug administration and during peak of medication.
2. Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.
3. Administer PO medications with 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 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.
Chlorphenamine

Brand Name: Antamin

Classification: Antihistamines & Antiallergics
MOA: Chlorphenamine is an H1-receptor antagonist which competetively blocks H1-receptor sites on tissues.

Indication: Food & drug allergy, bronchial asthma, vasomotor rhinitis, dermatoses of allergic etiology, urticaria, drug sensitization, serum
sickness, anaphylactic shock, insect bites, hay fever & angioneurotic edema.

Contraindication: Lower resp tract disease. Newborn or premature infants

Adverse effects: Sedation, lassitude, elation or depression, irritability, paranoid psychosis, delusion, hallucination. Muscular weakness,
incoordination. GIT disturbances. Headache, tinnitus. Difficulty in micturition. CV effects. Allergic reactions.

Nursing responsibilities:
 Ensure patients are warned that this medication may cause drowsiness and that if they are affected they should not drive or operate
machinery.
 Advise patients to avoid alcohol as this may increase the medication's sedative effects.
 Drowsiness may improve after a few days of treatment.
 In allergy management patients should also be advised to limit exposure to the allergen.
 Patients should be made aware that many over-the- counter medications may contain chlorphenamine.
 This medication can be safely stopped when symptoms have shown signs of improvement.
Dopamine Hydrochloride

Brand Name: Intropin

Classification: Therapeutic: inotropics, vasopressors; Pharmacologic: adrenergics

MOA: Stimulates beta-1 receptors in the heart, causing more complete and forceful contractions (inotropy). Also acts on alpha receptors (dose
dependent) and has dopaminergic effects.

Indication: Adjunct to standard measures to improve: BP, Cardiac output, Urine output in treatment of shock unresponsive to fluid
replacement, Increased cardiac output, increased BP, and improved renal blood flow.

Contraindication: Hypersensitivity, Tachyarrhythmias, Pheochromocytoma

Adverse effects:
 CNS: headache.
 EENT: mydriasis (high dose).
 Resp: dyspnea.
 CV: arrhythmias, hypotension, angina, ECG change, palpitations, vasoconstriction.
 GI: nausea, vomiting

Nursing responsibilities:
 Monitor BP, heart rate, pulse pressure, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output
continuously during administration.
 Monitor urine output frequently throughout administration. Report decreases in urine output promptly.
 Toxicity and Overdose: If excessive hypertension occurs, rate of infusion should be decreased or temporarily discontinued until BP is
decreased.
Dobutamine

Brand Name: Dobutrex

Classification: Therapeutic: inotropics; Pharmacologic: adrenergics
MOA: Stimulates beta1(myocardial)-adrenergic receptors with relatively minor effect on heart rate or peripheral blood vessels.

Indication: Short-term (_48 hr) management of heart failure caused by depressed contractility from organic heart disease or surgical
procedures.

Contraindication: Hypersensitivity to dobutamine or bisulfites; Idiopathic hypertrophic subaortic stenosis.

Adverse effects:
CNS: headache.
Resp: shortness of breath.
CV: hypertension, increased heart rate, premature ventricular contractions, angina pectoris, arrhythmias, hypotension, palpitations.
GI: nausea, vomiting.

Nursing responsibilities:
 Monitor BP, heart rate, pulse pressure, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output
continuously during administration.
 Monitor urine output frequently throughout administration. Report decreases in urine output promptly.
 Toxicity and Overdose: If excessive hypertension occurs, rate of infusion should be decreased or temporarily discontinued until BP is
decreased.
A SP I R I N

B R A N D N A M E S : A P O - A S A ( C A N ) , A S P E R G U M , B A Y E R , E A S P R I N , E C O T R I N , E M P I R I N , E N T R O A S P H E N ( C A N) , G E N P R I N , H A L F P R I N 8 1 ,
1 / 2 H A L F P R I N , H E A R T L I N E , N O R W I C H , N O V A S E N ( C A N ) , P M S - A S A ( C A N) , Z O R P R I N

CLASSIFICATION: ANTIPYRETIC, ANALGESIC (NONOPIOID ), ANTI-INFLAMMATORY, ANTIRHEUMATIC , ANTIPLATELET, SALICYLATE,

NSAID

M O A:
Analgesic and antirheumatic effects are attributable to aspirin’s ability to inhibit the synthesis of prostaglandins, important mediators of
inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to
block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable
to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at
low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of
platelet aggregation.

INDICATIONS:

 Mild to moderate pain

 Fever
 Inflammatory conditions—rheumatic fever, RA, osteoarthritis
 Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli
 Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris
 MI prophylaxis
 Unlabeled use: Prophylaxis against cataract formation with long-term use
DOSAGE & ROUTE

 Available in oral and suppository forms. Also available as chewable tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin
is not recommended for antipyresis, short-term analgesia, or children < 12 yr.)
ADULTS
 M I N O R A C H E S A N D P A I N S : 325–650 mg q 4 hr.
 A R T H R I T I S A N D R H E U M A T I C C O N D I T I O N S : 3.2–6 g/day in divided doses.
 A C U T E R H E U M A T I C F E V E R : 5–8 g/day; modify to maintain serum salicylate level of 15–30 mg/dL.
 T I A S I N M E N : 1,300 mg/day in divided doses (650 mg bid or 325 mg qid).
 M I P R O P H Y L A X I S : 75–325 mg/day.

ADVERSE EFFECTS:

 Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema,
seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related, 20–25 g in adults, 4 g in children)
 Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis)
 GI: 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, lassitude (dose related)

CONTRAINDICATIONS

Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-
sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K
deficiency (increased risk of bleeding)
 Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye’s syndrome in children and teenagers); children with fever
accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage,
prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of
aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial
hemorrhage, stillbirths, neonatal death); lactation.

NURSING RESPONSIBILITIES:

Interventions
 BLACK BOX WARNING: Do not use in children and teenagers to treat chickenpox or flu symptoms without review for Reye’s syndrome, a
rare but fatal disorder.
 Give drug with food or after meals if GI upset occurs.
 Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.
 Do not crush, and ensure that patient does not chew SR preparations.
 Do not use aspirin that has a strong vinegar-like odor.
 WARNING: Institute emergency proedures if overdose occurs: Gastric lavage, induction of emesis, activated charcoal, supportive therapy.

Teaching Points
 Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.
 Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these
drugs contain aspirin, and serious overdose can occur.
 Take the drug with food or after meals if GI upset occurs.
 Do not cut, crush, or chew sustained-release products.
 Over-the-counter aspirins are equivalent. Price does not reflect effectiveness.
 You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to
aspirin’s effects on blood clotting).
 Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools.
Dantrolene

Brand name: Dantrium

Classification: skeletal muscle relaxants (Direct-acting)

MOA: Acts directly on skeletal muscle causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. Prevents
intense catabolic process associated with malignant hyperthermia

Indication: Treatment of spasticity associated with: Spinal cord injury, Stroke, Cerebral palsy, Multiple sclerosis. Prophylaxis of malignant
hyperthermia

Contraindications: No contraindications to IV formin treatment of hyperthermia; Pregnancy and lactation; Situations in which spasticity is used
to maintain posture or balance.

Adverse Effects:

CNS: drowsiness, muscle weakness, confusion, dizziness, headache, insomnia, malaise, nervousness
EENT: excessive lacrimation, visual disturbances.
Resp: pleural effusions.
CV: changes in BP, tachycardia.
GI: HEPATOTOXICITY, diarrhea, anorexia, cramps, dysphagia, GI bleeding, vomiting.
GU: crystalluria, dysuria, frequency, erectile dysfunction, incontinence, nocturia.
Derm: pruritus, sweating, urticaria.
Hemat: eosinophilia.
Local: irritation at IV site, phlebitis.
MS:myalgia.
Misc: chills, drooling, fever
Dosage:
 PO (Adults): Spasticity—25mg/day initially; increase by 25mg/day q 4–7 days until desired response or total of 100 mg 4 times
daily is reached. Prevention of malignant hyperthermia—4–8mg/kg/day in 3–4 divided doses for 1–2 days before procedure, last
dose 3–4 hr preop. Post-hyperthermic crisis follow-up—4–8 mg/kg/day in 3–4 divided doses for 1–3 days after IV treatment
 PO (Children >5 yr): Spasticity—0.5 mg/kg twice daily; increase by 0.5 mg/kg/day q 4–7 days until desired response is obtained
or dosage of 3mg/kg 4 times daily is reached (not to exceed 400 mg/day). Prevention of malignant hyperthermia—4–
8mg/kg/day in 3–4 divided doses for 1–2 days before procedure, last dose 3–4 hr preop. Post-hyperthermic crisis follow-up—4–
8mg/kg/day in 3–4 divided doses for 1–3 days after IV treatment
 IV (Adults and Children): Treatment of malignant hyperthermia—at least 1mg/kg (up to 3mg/kg), continued until symptoms
decrease or a cumulative dose of 10 mg/kg has been given. If symptoms reappear, dose may be repeated. Prevention of
malignant hyperthermia—2.5 mg/kg before anesthesia.

Nursing responsibilities:
 Assess bowel function periodically. Persistent diarrhea may warrant discontinuation of therapy.
 Muscle Spasticity: Assess neuromuscular status and muscle spasticity before initiating therapy and periodically during its course to
determine response to therapy
 Malignant Hyperthermia: Assess previous anesthesia history of all surgical patients. Also assess for family history of reactions to
anesthesia (malignant hyperthermia or perioperative death).
 Monitor ECG, vital signs, electrolytes, and urine output continuously when administering IV for malignant hyperthermia
 Monitor patient for difficulty swallowing and choking during meals on the day of administration.
 If gastric irritation becomes a problem, may be administered with food. Oral suspensions may be made by opening capsules and adding
them to fruit juices or other liquid. Drink immediately after mixing.
 Aminophylline

Brand Name: Phyllocontin, Truphylline

Classification: bronchodilators (xanthines)
MOA: Inhibit phosphodiesterase, producing increased tissue concentrations of cyclic adenosine monophosphate (cAMP). Increased levels of
cAMP result in: Bronchodilation, CNS stimulation, Positive inotropic and chronotropic effects, Diuresis, Gastric acid secretion.
Indications: Long-term control of reversible airway obstruction caused by asthma or COPD, increases diaphragmatic contractility.

Contraindications: Hypersensitivity
Adverse Reactions:
CNS: SEIZURES, anxiety, headache, insomnia, irritability
CV: ARRHYTHMIAS, tachycardia, angina, palpitations
GI: nausea, vomiting, anorexia.
Neuro: tremor.
Derm: rashes.

Dosage:
PO (Adults and Children): See theophylline for oral doses.
IV (Adults): Loading dose—6mg/kg (4.7mg/kg of theophylline) given over 20–30min, followed by 0.7mg/kg/hr (0.56mg/kg/hr of
theophylline) via continuous infusion (non-smokers); an infusion rate of 0.9mg/kg/hr (0.72mg/kg/hr of theophylline) should be
used for smokers.
Nursing Responsibilities:
 Assess blood pressure, pulse, respiratory status (rate, lung sounds, use of accessory muscles, number and severity of apnea spells in
infants) before and throughout therapy. Ensure that oxygen therapy is correctly instituted during acute asthma attacks.
 Patients with a history of cardiovascular problems should be monitored for chest pain and ECG changes (PACs, supraventricular
tachycardia, PVCs, ventricular tachycardia).
 Monitor intake and output ratios for an increase in diuresis or fluid overload.
 Monitor pulmonary function tests before and periodically during therapy to determine therapeutic efficacy in patients with chronic
bronchitis or emphysema.
 PO: Administer oral preparations with food or a full glass of water to minimize GI irritation. Food slows, but does not reduce, the extent of
absorption. May be administered 1 hr before or 2 hr after meals for more rapid absorption. Swallow tablets whole; do not crush, break, or
chew enteric-coated or ex tended-release tablets (extended-release tablets may be broken if scored). Pedi: Use calibrated measuring
device to ensure accurate dose of liquid preparations
 Hydrocortisone

Generic name: hydrocortisone

Brand name: A-hydroCort, Cortef, Solu-Cortef
Classification: corticosteroids (systemic)

MOA: replace endogenous cortisol in deficiency states. Have potent mineralocorticoid (sodium-retaining) activity. Suppress normal immune
response and inflammation.
Indications: Management of adrenocortical insufficiency. Used systemically and locally in a wide variety of chronic diseases including:
Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders.

Contraindications: Active untreated infections (may be used in patients being treated for some forms of meningitis); Lactation (avoid chronic
use); Known alcohol, bisulfite, or tartrazine hypersensitivity or intolerance (some products contain these and should be avoided in susceptible
patients); Administration of live virus vaccines.

Adverse Reactions:
 CNS: dizziness depression, euphoria, headache, increased intracranial pressure (children only), personality changes, psychoses,
restlessness.
 EENT: cataracts, increased intraocular pressure
 CV: hypertension
 GI: PEPTIC ULCERATION, anorexia, nausea, vomiting..
 Derm: acne, decreased wound healing, ecchymoses, fragility, hirsutism, petechiae
 Endo: adrenal suppression, hyperglycemia
 F and E: fluid retention (long-term high doses), hypokalemia, hypokalemic alkalosis
 Hemat: THROMBOEMBOLISM, thrombophlebitis.
 Metab: weight gain.
 MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: cushingoid appearance (moon face, buffalo hump),
increased susceptibility to infection.
Dosage:
 PO (Adults): 20–240mg/day in 1–4 divided doses
 IM, IV (Adults): 100–500 mg q 2–6 hr (range 100–8000 mg/day).

Nursing Responsibilities:
 Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion,
restlessness) before and periodically during therapy.
 Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or
dyspnea. Notify health care professional if these occur.
 Suppress reactions to allergy skin tests.
 PO: Administer with meals to minimize GI irritation
 Tablets may be crushed and administered with food or fluids for patients with difficulty swallowing. Capsules should be swallowed
whole; do not crush, break, or chew.
 Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue,
dyspnea, hypotension, hypoglycemia).
 Corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known
contagious illnesses and to report possible infections immediately.
D5IMB (Balanced Multiple Maintenace Solution with 5% dextrose)
Classification: Hypertonic Solution

Content::
 Formulation: Each 100 mL contains—
Dextrose monohydrate = 5 g, Sodium Acetate, Anhydrate= 189 mg, Potassium Chloride=141mg, Sodium Phophate Monobasic=21.4 mg, Magnesium Chloride
Hexahydrase = 30.5 mg, Monopotassium Phophate= 15 mg, Eectrolytes in 1000 mL:, Sodium= 25 mmol, Potassium= 20 mmol, Magnesium= 1.5 mmol, Acetate=
23 mmol, Chloride= 22 mmol, Phophate= 3 mmol, Osmolarity= 350 mmolpH= 4-6.5

MOA: Contains a high concentration of soluterelative to anothersolution (e.g. the cell'scytoplasm). When a cellis placed in a
hypertonicsolution, the waterdiffuses out of the cell,causing the cell toshrivel

Indications: low administration essential to preventoverload (100 mL/hr) ; Water intoxication ; Severe sodiumdepletion
Contraindication: phlebitis, peripheraledema, cellulardehydration

Nursing Considerations:
 Do not administer unless solution is clearand container isundamaged.
 Caution must be exercised in the administration ofparenteral fluids,especially those containing sodium ions to patients
receivingcorticosteroids 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 subclinicalor overt diabetes mellitus.
 Discard unusedportion.
 In very low birth weight infants,excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage.