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Anti-emetics

1. Ondansetron
• Action: these block serotonin receptors in
the central nervous system and
gastrointestinal tract. As such, they can be
used to treat post-operative and cytotoxic
drug nausea & vomiting.

• Routes: Oral, IV, IM


• Dosage: 4 – 8 mg
• Side effects: Headache, constipation, and
dizziness are the most commonly reported
side effects associated with its use.
2.Domperidone
• Action: this blocks the action of dopamine. It
has strong affinities for the dopamine receptors,
which are found in the chemoreceptor trigger
zone, located just outside the blood brain
barrier, which - among others - regulates
nausea and vomiting.

Routes: Oral.
Dosage: 10mg
Side effects: Headache, dizziness, dry mouth,
nervousness, flushing, or irritability
3.Metoclopramide
•Action: is a potent dopamine receptor
antagonist used for its antiemetic properties.
Thus it is primarily used to treat nausea and
vomiting, and to facilitate gastric emptying in
patients with gastroparesis.
•Routes: Oral, IV.
•Dosage: 10mg – 20mg

•Side effects: restlessness, drowsiness,


dizziness, lassitude, and or dystonic reactions.
NURSING INTERVENTIONS:
•Monitor vital signs. If vomiting is severe,
dehydration may occur. Monitor for sign and
symptoms of dehydration.
•Monitor bowel sounds for hypoactivity or
hyperactivity.
•Provide mouth care after vomiting. Encourage
the client to maintain oral hygiene.
•Administer medication by mouth as prescribed
usually 30 minutes before meals and at
bedtime.
• Client Teaching:
• Instruct the client to store drug in tight, light
resistant container.
• Instruct the client to avoid over-the-counter
preparations.
• Instruct the client not to consume alcohol while
taking antiemetics.
• Advise pregnant women to avoid antiemetics
during the first trimester.
Antacid
Common antacids:
1.Aluminium hydroxide (Amphojel, AlternaGEL)
2.Magnesium hydroxide (Phillips’ Milk of Magnesia)
3.Aluminum hydroxide with magnesium hydroxide
(Maalox, Mylanta)
4.Calcium carbonate.

• Action Antacids perform a neutralization reaction,


i.e. they buffer gastric acid, raising the pH to
reduce acidity in the stomach.
• Routes: Oral.
• Side effects
Carbonate: regular high doses may
cause alkalosis, kidney stones. gastric
distension.
Aluminum hydroxide:
hypophosphatemia and osteomalacia.
constipation.
Magnesium hydroxide: has laxative
properties. Magnesium may accumulate
in patients with renal failure leading to
hypermagnesemia.
• NURSING INTERVENTIONS:
• Avoid administering antacids with other oral
drugs, because antacids can delay their
absorption. An antacid should definitely not be
given with tetracycline, digoxin or quinidine
because it binds with and inactivates most of
the drug.
• Antacids should be given 1-2 hours after other
medications.
• Shake suspension well before administering;
follow with water.
•Monitor electrolytes and urinary pH, calcium,
and phosphate levels
Client teaching:
•Instruct the client to report pain, coughing, or
vomiting of blood.
•Encourage the client to drink 2 oz of water
after antacid to ensure that the drug reaches
the stomach.
•Advise the client to take the antacid 1 to 3
hours after meals and at bedtime. Do not take
antacid at mealtime; they slow gastric emptying
time.
•Advise the client to notify the health care
provider if constipation or diarrhea occurs.
• Advise the client to avoid taking antacid with
milk or foods high in Vitamin D
• Alert the client to consult with the health care
provider before taking self prescribed antacids
for a longer than 2 weeks.
Laxatives
)
(or purgatives)
•Laxatives (or purgatives) are foods,
compounds, or drugs taken to induce bowel
movements or to loosen the stool, most often
taken to treat constipation
1.Bulk-producing agents
• Site of Action: Small and large intestine
• Onset of Action: 12 - 72 hours
• Examples: psyllium husk (Metamucil),
methylcellulose (Citrucel),, dietary fiber, apples
• Action: Bulking agents or roughage, these
include dietary fiber. Bulk-producing agents
cause the stool to be bulkier and to retain more
water, as well as forming an emollient gel,
making it easier for peristaltic action to move it
along. They should be taken with plenty of
water. Bulk-producing agents have the gentlest
of effects among laxatives and can be taken
just for maintaining regular bowel movements.
2.Stool softeners / Surfactants
•Site of Action: Small and large intestine
•Onset of Action: 12 - 72 hours
•Examples: docusate (Colace, Diocto)
•Action: These cause water and fats to
penetrate the stool, making it easier to move
along. Many of these quickly produce a
tolerance effect and so become ineffective
with prolonged use. They can be used for
patients with occasional constipation or those
with anorectal conditions for whom passage of
a firm stool is painful.
3.Lubricants / Emollient
Site of Action: Colon
Onset of Action: 6 - 8 hours
• Action:
• These simply make the stool slippery, so that it
slides through the intestine more easily. An
example is mineral oil, which also retards
colonic absorption of water, softening the stool.
Mineral oil may decrease the absorption of fat-
soluble vitamins and minerals.
• Side effects: nausea, vomiting, diarrhea, and
abdominal cramping
4.Hydrating agents (osmotic)
These cause the intestines to hold more water
within, softening the stool. There are two
principal types, saline and hyperosmotic.
a) Saline
•Site of Action: Small and large intestine
•Onset of Action: 0.5 - 6 hours
•Examples: magnesium citrate, magnesium
hydroxide (Milk of magnesia), magnesium
sulfate (which is Epsom salt).
•Action:
Saline laxatives attract and retain water in the
intestinal lumen, increasing intraluminal
pressure and thus softening the stool.
•Side effects: drowsiness, weakness, paralysis,
hypotension, flush and respiratory depression.
• b) Hyperosmotic agents
• Site of Action: Colon
• Onset of Action: 0.5 - 3 hours
• Examples: Glycerin suppositories, Sorbitol,
Lactulose
Action:Lactulose works by the osmotic effect,
which retains water in the colon, lowering the pH
and increasing colonic peristalsis.. Glycerin
suppositories work mostly by hyperosmotic action,
but also the sodium stearate in the preparation
causes local irritation to the colon.
Side effects: nausea, vomiting, flatulence,
diarrhea, abdominal cramps.
5.Stimulant / Irritant
•Site of Action: Colon
•Onset of Action: 6 - 10 hours- Dulcolax
2 - 6 hours-Castor oil
(Small intestine)
15 min - 1 hour- Dulcolax suppository
These stimulate peristaltic action and can be
dangerous under certain circumstances. Long
term use can lead to 'cathartic colon'.
Stimulant laxatives act on the intestinal
mucosa, or nerve plexus; they also alter water
and electrolyte secretion.
They are the most severe among laxatives and
should be used only in extreme conditions.
Castor oil may be preferred when more
complete evacuation is required.

NURSING INTERVENTION:
•Monitor fluid intake and output. Note signs and
symptoms of fluid and electrolyte imbalances that
may result from watery stools.

•Habitual use of laxative can cause fluid volume


deficit and electrolyte losses.

In addition,it can cause a loss of urge to


•Monitor bowel sounds.
•Identify the cause of constipation.
Client teaching:
•Instruct the client to mix drug with water
immediately before use.
•Instruct the client not to swallow the drug in
dry form.
•Instruct the client to increase water intake,
drink at least 8 glasses of fluids per day, if not
contraindicated, which will decrease hard,dry
stools.
•Advise the client to avoid overuse of laxatives,
which can lead to fluid and electrolyte
imbalances and drug dependence.
Instruct client not to chew tablets; swallow them
whole.
•Advise the client to store suppositories at <86
degree F (30 C).
•Advise the client to take the drug only with
water to increase absorption
•Instruct the client not to take drug within 1 hour
of any other drugs.
•Remind the client that drug is not for long-term
use; tone of bowel may be lost.
• Instruct the client to time administration of drug
so as not to interfere with activities or sleep.
• Instruct the client to discontinue use if rectal
bleeding, nausea, vomiting, or cramping
occurs.
ANTIULCER
1.Ranitidine
Action: An H2-receptor antagonist used to block
the action of histamine on parietal cells in the
stomach, decreasing acid production by these
cells.
•Side Effects: headache, tiredness, dizziness,
confusion, diarrhea, constipation, and skin
rash, pruritus.
•Routes: Oral, IV.
•Dosage: 50 – 150 mg
2.Omeprazole
•Action :Proton pump inhibitors are a group of
drugs whose main action is pronounced and
long-lasting reduction of gastric acid
production.
• Routes: Oral,IV.
• Dosage: 20mg
• Side Effects: headache, diarrhea, abdominal
pain, nausea and dizziness.
NURSING INTERVENTIONS
Administer drug just before meals to decrease
food induced acid secretion or at bedtime.
Be alert that reduced doses of drug are needed
by older adults, who have less gastric acid.
Administer drug iv in 20 to 100 ml of solution.
Client Teaching
•Instruct the client to report pain, coughing or
vomiting of blood.
•Advise client to avoid smoking because it can
hamper the effectiveness of the drug.
•Remind the client that the drug must be taken
exactly as prescribed to be effective.
•Instruct the client to separate ranitidine and
antacid dosage by at least 1 hour, if possible.
•Advise client to avoid foods and liquids that
can cause gastric irritation, such as caffeine
containing beverages, alcohol, and spices.
Muscle relaxant
Antispasmodic
1.Dicyclomine
• Action: is used to treat , the symptoms of
Irritable Bowel Syndrome (IBS) (also known
as spastic colon). It relieves muscle spasms
and cramping in the gastrointestinal tract by
blocking the activity of acetylcholine on
cholinergic (or muscarinic) receptors on the
surface of muscle cells. It is a smooth
muscle relaxant.
• Routes: oral
• Side effects: dry mouth, blurred
vision, confusion, agitation, increased
heart rate, heart palpitations,
constipation, difficulty urinating, and
occasionally seizures can occur.
2.Methocarbamol (trade names Robaxin,)
Action: is a central muscle relaxant used to
treat skeletal muscle spasms.
Routes: oral
Side effects: drowsiness ,dizziness ,nausea,
vomiting, blurred vision, fever.
3.Metaxalone (brand name Skelaxin)
Action: is a muscle relaxant used to relax
muscles and relieve pain caused by strains,
sprains, and other musculoskeletal conditions. Its
exact mechanism of action is not known, but it
may be due to general central nervous system
depression.
Routes: oral
Side effects: nausea, vomiting, drowsiness and
CNS side effects such as dizziness, headache,
and irritability.
NURSING INTERVENTIONS:
•Monitor vital signs. Report abnormal results.
•Observe for dizziness.
•Administer muscle relaxants with food to
decrease gastrointestinal upset.
Client Teaching
•Inform the client that the muscle relaxant
should not be abruptly stopped.
Drug should be tapered over 1 week to avoid
rebound spasms.
•Advise the client not to drive when taking
muscle relaxants.
• Advise the client to avoid alcohol and CNS
depressants.
• Inform the client that these drugs are
contraindicated for pregnant women or nursing
mothers.
• Instruct the client to report side effects of
muscle relaxant such as drowsiness
,dizziness ,nausea, vomiting, blurred vision,
fever. Diuretics
1.Furosemide /Lasix (loop diuretics)
•Action: inhibits reabsorption of sodium and
chloride from the proximal and the distal renal
tubules and the loop of Henle, leading to a
sodium rich diuresis.
• Route of administration: Orally or IV
• Dosage: 20,40, 80mg
• Side effects: dehydration and electrolyte imbalance,
including loss of potassium, calcium, sodium, and
magnesium.
• NURSING INTERVENTIONS
• Administer drug in the morning and not in the evening to
prevent sleep disturbance and nocturia.
• Monitor urinary output to determine body fluid gain or
loss. Urinary output should be at least 25ml/h
• If drug is given IV , the urine output should increase in 5
to 20 minutes. If urine output does not increase, notify
the doctor.
•Check the client’s weight to determine fluid
loss or gain.
•Monitor vital signs,. Be alert for marked
decrease in blood pressure.
•Administer IV lasix slowly; hearing loss may
occur if rapidly injected.
•Observe for sign and symptoms of
hypokalemia such as muscle weakness,
abdominal distention, leg cramps, and cardiac
dysrhythmias
• Check serum potassium levels, especially
when the client is taking digoxin. Hypokalemia
enhances the action of digitalis, causing
digitalis toxicity.
• Instruct the client to arise slowly to prevent
dizziness resulting from fluid loss.
2.Spironolactone (Potassium-sparing
diuretics)
Action: increases the excretion of water and
sodium, while decreasing the excretion of
potassium.
Route of administration: Orally
Dosage: 25mg, 100mg
•Side effects: anorexia, nausea, vomiting,
increased risk of bleeding from the stomach
and duodenum, gynecomastia, menstrual
irregularities, drowsiness and rashes.
NURSING INTERVENTIONS
•Monitor urinary output. Urinary output should
increase. Report if urine output is <30ml/h.
•Monitor vital signs. Report abnormal changes.
•Observe for signs and symptoms of
hyperkalemia, such as nausea, diarrhea,
abdominal cramps, tachycardia and later
bradycardia, or oliguria.
•To avoid nocturia, administer drug in the
Client Teaching
•Instruct the client to take the drug with or after
meals to avoid nausea.
•Do not discontinue drug
•Instruct the client to avoid exposure to direct
sunlight because the drug can cause
photosensitivity.
•Advise the client to report possible side
effects of the drug, such as a rash, dizziness,
or weakness.
•Advise client to avoid foods rich in potassium
when taking potassium sparing diuretics.
3.Mannitol (Osmotic diuretics)
Action: is used as an osmotic diuretic agent. It
pulls water into the renal tubule without sodium
loss.
Uses: to reduce acutely raised intracranial
pressure.
Route of administration: Orally or IV
• Dosage: 50 – 100g
• Side effects:: Headache, nausea, diarrhea, vomiting, dry
mouth, angina, seizures ,changes in blood pressure, and
irritation/pain/swelling at the injection site.
NURSING INTERVENTIONS
•Monitor urinary output.
•Observe for signs and symptoms of fluid and
electrolyte imbalance.
•Monitor vital signs. Be alert for marked
decrease in blood pressure.
•Crystallization of mannitol in the vial may
occur when the drug is exposed to a low
temperature. The vial should be warmed to
dissolve the crystals. The mannitol solution
should not be used for IV infusion if crystals
are present and have not been dissolved.
4.Hydrochlorothiazide,
•Action: it acts by inhibiting the kidneys ability to
retain water. This reduces the volume of the
blood, decreasing blood return to the heart and
thus cardiac output and, by other mechanisms, is
believed to lower peripheral vascular resistance.
•Route of administration: Oral (capsules,
tablets, solution)
•Dosage: 12.5mg
•Side effects: Hypokalemia, Hypomagnesaemia,
Hyperuricemia and gout. High blood sugar,
Hypercalcemia, Headache Nausea/vomiting.
• NURSING INTERVENTIONS
• Monitor vital signs and serum electrolyte.
• Observe for signs and symptoms of
hypokalemia, such as muscle weakness, leg
cramps, and cardiac dysrhythmais.
• Check client’s weight daily at a specific time.
• Monitor urine output to determine fluid loss or
retention.
Digitalis
Digoxin
• Action: It decrease the conduction of electrical
impulses through the AV node. It increase the force of
contraction via inhibition of the Na+/K+ ATPase pump.
• Side effects: loss of appetite, nausea, vomiting,
diarrhea, blurred vision, visual disturbances (yellow-
green halos), confusion, drowsiness, dizziness,
nightmares, agitation, and/or depression.
• Route of administration: Orally or IV
• Dosage: 0.125 – 1mg
NURSING INTERVENTIONS
•Do not confuse Digoxin (Rapid-Acting Digitalis)
with Digitoxin (Long-Acting Digitalis). Read the
drug label carefully.
•Check the apical pulse rate before
administering Digoxin. Do not administer if
pulse rate is <60bpm.
•Check the signs of peripheral and pulmonary
edema.
•Check serum potassium level and report if
hypokalemia (<3.5mEq/L) is present.
•Check the serum Digoxin level. The normal
therapeutic drug range is 0.5 to 2.0 ng/ml. A
• Client Teaching
• Explain to the client the importance of
compliance with the drug therapy.
• Advise the client not to take over the counter
drugs without first consulting the doctor to avoid
adverse drug interactions.
Instruct the client how to check pulse rate before
taking the drug and not to take the drug if pulse
rate is <60bpm
Instruct the client to report side effects such as a
pulse rate
<60bpm, nausea, vomiting headache, and visual
disturbances, including diplopia.
•Advise the client to eat foods rich in potassium
such as fresh and dried fruits, fruit juices and
vegetables, including potatoes.
ANTIHYPERTENSIVE
A. Beta blockers
1.Propranolol
Action:. Propranolol blocks the action of the
sympathetic nervous system. The sympathetic
nervous system stimulates the pace of the heart
beat. By blocking the action of these nerves,
propranolol reduces the heart rate. Propranolol
also reduces the force of heart muscle
contraction and lowers blood pressure.
Route of administration: Orally
Dosage: 20- 80mg
Side effects: nausea, diarrhea, bronchospasm,
dyspnea, cold extremities,, bradycardia,
hypotension, heart failure, heart block, fatigue,
dizziness, abnormal vision, decreased
concentration, hallucinations, insomnia,
nightmares.
2. Metoprolol
Action: reduces the force of contraction of
heart muscle and thereby lowers blood
pressure. By reducing the heart rate and the
force of muscle contraction, it also reduces the
need for oxygen by heart muscle.
• Route of administration: Orally or IV
• Dosage 50- 100mg
Side effects: abdominal cramps, diarrhea,
constipation, fatigue, insomnia, nausea,,
memory loss, fever, impotence,
lightheadedness, slow heart rate, low blood
pressure, cold extremities, sore throat, and
shortness of breath or wheezing.
NURSING INTERVENTION
Monitor vital signs, especially blood pressure
and pulse.
Monitor laboratory results, especially BUN,
serum creatinine.
Client’s Teaching
•Instruct the client to comply with drug regimen:
abrupt discontinuation of the antihypertensive
drug may cause rebound hypertension.
•Suggest that the client avoid over the counter
drugs.
•Suggest that the client carry a card indicating the
health problem and prescribed drugs.

•Advise the client that antihypertensive may


cause dizziness resulting from orthostatic
hypotension. Instruct the client to remain in a
sitting position after getting up from the bed for
several minutes before standing
•Instruct client to report dizziness, slow pulse
rate, changes in blood pressure, heart
palpitation, confusion or GI upset to the health
care provider.
B. Calcium Blocker
1.Amlodipine
Action : It acts by relaxing the smooth muscle
in the arterial wall, decreasing peripheral
resistance and hence reducing blood pressure;
in angina it increases blood flow to the heart
muscle.
Route of administration: Orally (tablets)
Dosage: 5 10mg
Side effects: headache, edema, fatigue, nausea,
flushing, palpitations and dizziness. Vomiting and
abdominal pain have occurred.
2.Nifedipine
Action: It relaxes the blood vessels so the heart
does not have to pump as hard. It also increases
the supply of blood and oxygen to the heart to
control chest pain (angina).
Route of administration: Orally, Sublingual.
Dosage: 10-20mg
Side effects: headache, upset stomach,
dizziness or lightheadedness, excessive
tiredness, flushing, heartburn, fast heartbeat,
muscle cramps, constipation, nasal congestion,
Client Teaching
• Instruct the client that nifedipine capsules may
be taken with or without food.
•The tablet should be taken on an empty
stomach, either 1 hour before or 2 hours after a
meal, and should be swallowed whole.
Instruct not chew, divide, or crush the tablet.
•Advise the client to avoid drinking grapefruit
juice or eating grapefruit while taking nifedipine.
•Advise the client to avoid drinking alcoholic
beverages while taking this medication
•Instruct client to take nifedipine exactly as
directed.
•Instruct client to continue to take nifedipine
even if they feel well and not to stop taking
nifedipine without consulting the doctor.
•Instruct the client to take the missed dose as
soon as he/she remember it. However, if it is
almost time for the next dose, skip the missed
dose and continue with the regular dosing
schedule. Do not take a double dose to make
up for a missed one.
•Instruct client to report immediately if
swelling of the face, eyes, lips, tongue, arms,
or legs is present, difficulty breathing or
swallowing, fainting, rash, yellowing of the
skin or eyes, increase in frequency or severity
of chest pain (angina).
C. Angiotensin Converting Enzyme
Inhibitor
1.Captopril ACE (angiotensin converting
enzyme) inhibitor
Action: it is an ACE inhibitor. ACE is an
enzyme in the body which is important for the
formation of angiotensin II.
•Angiotensin II causes constriction of arteries in
the body, thereby elevating blood pressure.
• ACE inhibitors such as captopril lower blood
pressure by inhibiting the formation of
angiotensin II, thus relaxing the arteries.
• Relaxing the arteries not only lowers blood
pressure, but also improves the pumping
efficiency of a failing heart and improves
cardiac output in patients with heart failure.
Route of administration: Orally,
Dosage: tablets: 12.5 mg, 25 mg, 50 mg, 100
mg.
Side effects: A dry, persistent cough,
abdominal pain, constipation, diarrhea,
dizziness, fatigue, headache, loss of taste,
loss of appetite, nausea and vomiting, easy
bruising or bleeding, chest pain, chills,
difficulty breathing, severe dizziness or
fainting.

2.Lisinopril
Action: is an angiotensin converting enzyme
(ACE) inhibitor.
Route of administration: Orally,
Dosage: 2.5, 5, 10, 20, and 40 mg oral
tablets.
Side effects: First doses of lisinopril can cause
dizziness due to a drop in blood pressure.
Lisinopril can cause nausea, headaches,
anxiety, insomnia, drowsiness, and nasal
congestion.
NURSING INTERVENTIONS
Monitor laboratory tests related to renal function
(BUN, creatinine, protein) and blood glucose
levels. Watch for hypoglycemic reaction in clients
with diabetes mellitus.
Report to the health care provider occurrences of
bruising, petechiae, and/ or bleeding. These may
indicate a severe reaction to the Angiotensin
• NURSING INTERVENTIONS
• Monitor laboratory tests related to renal
function (BUN, creatinine, protein) and blood
glucose levels. Watch for hypoglycemic
reaction in clients with diabetes mellitus.
• Report to the health care provider occurrences
of bruising, petechiae, and/ or bleeding. These
may indicate a severe reaction to the
Angiotensin Antagonist Inhibitors such as
captopril.
Client Teaching
•Instruct the client not to abruptly discontinue
use of captopril without notifying the health
care provider.
•Inform the client to avoid over the counter
drugs.
•Teach the client how to take and record
his/her own blood pressure. A blood pressure
chart should be established, and blood
pressure changes should be reported.
•Explain to the client that dizziness may occur
during the first week of captopril therapy. If
dizziness persist, inform the health care
provider.
Instruct the client to take captopril 20minutes to
1 hour before a meal. Food decreases captopril
absorption.
D. Alpha-1 blocker
1.Prazosin (Minipress)

Action : Prazosin relaxes and expands blood


vessels. It is used to treat high blood pressure
(hypertension).
Route of administration: Orally,
Dosage: 1mg, 2mg
Side effects: drowsiness, headache,
constipation, loss of appetite, nausea, vomiting,
fatigue, nasal congestion or dry eyes.
• NURSING INTERVENTIONS-.
• Monitor vital signs. The desired therapeutic
effect of prazosin may not fully occur for 4
weeks. A sudden marked decrease of blood
pressure should be reported.
• Check daily for fluid retention in the extremities.
Prazosin may cause sodium water and water
retention.
Client Teaching
Instruct client to comply with drug regimen.
Inform the client that orthostatic hypotension may
occur.
Explain that before rising, the client should sit
•Instruct the client or family member how to
take blood pressure reading. A record for daily
blood pressures should be kept.
•Caution the client that dizziness, and
drowsiness may occur, especially when the
drug is first prescribed.
•Instruct client to report if edema is present in
the morning.
•Instruct the client not to take cold, cough, or
allergy over the counter medications.
•Encourage the client to decrease salt intake
Anticoagulant
1.Heparin
• Action: It is an anticoagulant which prevents the blood
from clotting. It is used to prevent and treat venous
thrombosis, pulmonary embolism and other conditions
of blood clotting.
• Route of administration: IV,SC
• Available Dosage: 5000iu/ml in 5ml
• Side effects: irritation, pain, redness or swelling at the
injection site. Bleeding indicate the dose is too high.
Clients should be monitored closely for signs of
bleeding like petechiae, ecchymosis, hematemesis,
nose bleed, dark and tarry stools, and blood in urine.
Action of parenteral anticoagulant
Heparin
Heparin
Step I
Binds with  Step II
Inactivates

Antithrombin III Thrombin



  Step III

Inhibits conversion of
Fibrinogen to Fibrin
Step IV

Clot prevented.
2.Warfarin (Coumadin)
Action: Coumadin is an oral anticoagulant that
inhibits the synthesis of clotting factors, thus
preventing blood clot formation.
Route of administration: Orally
Dosage: tablets (1mg, 2mg, 2.5mg, 5mg, 7.5mg,
10mg)
Side effects: The two most serious side effects
are bleeding and necrosis of the skin.
Bleeding around the brain can cause severe
headache and paralysis, joints can cause joint
pain and swelling, stomach or intestines can
cause weakness, fainting spells, black tarry
stools, vomiting of blood, or coffee ground
material, kidneys can cause back pain and blood
in urine.
• Signs of overdose include bleeding gums,
bruising, nosebleeds, heavy menstrual
bleeding, and prolonged bleeding from cuts.
NURSING INTERVENTIONS
•Monitor vital signs. an increased pulse rate
followed by a decrease systolic
•Pressure can indicate a fluid volume deficit
resulting from external or internal bleeding.
•Check for bleeding from the mouth, nose
(epistaxis), urine (hematuria), and skin
(petechiae, purpura).
•Check stools periodically for occult blood.
•Monitor older adults closely for bleeding.
•Keep anticoagulant antagonists ( protamine for
heparin and vitamin K for warfarin) available
when drug dose is increased or there are
indications of frank bleeding.
• Client Teaching
• Instruct the client to inform the dentist when
taking an anticoagulant.
• Instruct the client to use a soft toothbrush to
prevent the gums from bleeding.

•Instruct the client to shave with an electric


razor. Bleeding fromshaving cuts may be difficult
to control.
•Advise the client to have laboratory tests such
as PT performed as ordered by health care
provider. Warfarin dose is regulated according to
the INR derived from the PT.
•Instruct the client to carry a medical ID card
that lists the person’s name, telephone
number, and drug name.
•Encourage the client not to smoke. Smoking
increases drug metabolism.
•Aspirin should not be taken with warfarin
because aspirin
intensifies its action and bleeding is apt to
occur.
• Teach the client to control external hemorrhage
from accidentsor injuries by applying firm, direct
pressure for at least 5 to 10 minutes with a
clean, dry absorbent material.
• Advise client to report bleeding , such as
petechiae, epistaxis, ecchymosis, tarry stools,
bleeding gums, or expectoration of blood.
Analgesics
1.Aspirin
Action: Inhibition of prostaglandin synthesis, inhibition of
hypothalamic heat-regulator center. Aspirin is a
nonsteroidal anti-inflammatory drug (NSAID) effective in
treating fever, pain, inflammation in the body; inhibits
platelet aggregation.
• Route of administration: Oral, rectal
• Dosage: tablets 325mg, 500mg; enteric coated (safety
coated) tablets: 325mg, 500mg
• Side effects: anorexia, nausea, vomiting, diarrhea,
dizziness, confusion, hearing loss, heartburn, rash,
stomach pain, drowsiness.
NURSING INTERVENTIONS
•Observe the client for signs of bleeding, such
as black stools, bleeding gums, petechiae,
ecchymosis, and purpura when the client takes
high doses of asprin.
Client teaching
•Advise client not to take asprin with alcohol or
drugs that are highly protein bound, such as the
anticoagulant warfarin.
•Suggest that the client inform the dentist before
a dental visit if taking high doses of asprin.
•Instruct the client to take aspirin with food, at
mealtime, or with plenty of fluids to reduce GI
upset.
•Enteric coated aspirin avoids GI disturbances.
• Instruct client to report side effects such as
drowsiness, tinnitus, headache, flushing, GI
symptoms (heartburn, bleeding), visual
changes and seizures.
• Keep the asprin bottle out of the reach of
children.
2.Diclofenac
Action: The exact mechanism of action is not
entirely known, but it is thought that the primary
mechanism responsible for its anti-
inflammatory / antipyretic / analgesic action is
inhibition of prostaglandin synthesis.
Route of administration: Oral, IM, Topical
Available Dosage: 25, 50, 100mg
Side effects: Nausea, vomiting, bloating, gas,
dizziness, drowsiness, blurred vision, loss of
appetite. The development of ulceration and/or
GI bleeding requires immediate termination of
treatment with diclofenac.

3. Ibuprofen
Action: Inhibition of prostaglandin synthesis,
thus relieving pain and inflammation.
Route of administration: Oral, Topical
Available Dosage: 200mg, 400mg
Side effects: anorexia, nausea, vomiting,
diarrhea, edema, rash, purpura,tinnitus, fatigue,
dizziness, anxiety, confusion.

NURSING INTERVENTION
•Observe the client for bleeding gums,
petechiae, ecchymoses, or black stools.
bleeding time can be prolonged when NSAIDs
are taken, especially anticoagulant.
•Administer the NSAIDs at mealtime or with
food to prevent GI upset.
•Monitor vital signs and check peripheral
edema, especially in the morning.
• Client teaching
• Instruct the client not to take asprin and
paracetamol with NSAIDs. Taking an NSAIDs
with asprin could cause GI upset and possible
GI bleeding.
• Instruct the client to avoid alcohol when taking
NSAIDs. GI upset or gastric ulcer may result.
•Advise the client to inform the dentist or
surgeon before a procedure when taking
Ibuprofen or other NSAIDs for a
continuous period.
•Advise women not to take NSAIDs 1 to 2 days
before menstruation to avoid heavy menstrual
flow.
•Instruct the client to take NSAIDs with meals
or food to reduce GI upset.
ANTIPYRETIC
Paracetamol
Action: Analgesic and Antipyretic. Inhibition of
prostaglandin synthesis, inhibition of
hypothalamic heat regulating center.
Route of administration: Oral, Rectal, IM
Dosage: 500mg.
Side effects: anorexia, nausea, vomiting, rash.
Hemorrhage, Hepatotoxicity,thrombocytopenia,
ANTIDIABETICS
• 1. Metformin
• Action: Inhibits hepatic glucose production and
increases sensitivity of peripheral tissue to
insulin.
• Route of administration: oral
• Available dose: 500mg
• Side effects: headache, weakness, lactic
acidosis, diarrhea, nausea, vomiting,
thrombocytopenia
• NURSING INTERVENTIONS
• Assess hypoglycemic reaction (sweating,
weakness, dizziness, anxiety, tremors, and
hunger)
• Assess for lactic acidosis (malaise,
myalgia, abdominal distress, chills)
• Administer PO, do not break or crush
tablet
• Evaluate therapeutic response
• Client teaching
– Teach client lactic acidosis symptoms; to
notify doctor immediately if occur
– Instruct client to use regular self monitoring
of blood glucose using blood glucose meter
– Teach client about symptom of hypo/
hyperglycemia, what to do about each
– Instruct client that drug must be continued
on daily basis and not to stop drug abruptly.
2. Insulin

INSULINS

INTERMEDIATE
RAPID ACTING LONG ACTING MIXTURES
ACTING
• Action: decreases blood glucose; by transport of
glucose into cells and conversion of glucose to
glycogen.
• Route: subcutaneous
• Side effects: blurred vision, dry mouth, rash,
urticaria, lipodystrophy, swelling, redness,
hypoglycemia
• NURSING INTERVENTIONS
• Assess fasting blood glucose
• Assess for hypoglycemic reaction that can occur
during peak time (sweating, weakness, dizziness,
chills, confusion, headache, nausea, rapid weak
pulse, slurred speech, anxiety, tremors and hunger)
•Assess for hyperglycemia: acetone breath,
polyuria, polydipsia, dry skin, lethargy
• Administer oral antidiabetic 30 min before
meals
• Administer insulin after warming to room
temperature by rotating in palms to prevent
lipodystrophy from injecting cold insulin.
• Administer subcutaneous route, rotate site of
injection
• Store insulin at room temperature
• Keep food ready before administering insulin or
antidiabetic agents
• Client teaching
– Instruct client to keep insulin,
equipment available at all times;
carry candy or lump sugar to treat
hypoglycemia
– Inform client that the drug does not
cure diabetes but control symptoms
– Instruct client to carry emergency ID
as diabetic
– Teach client to recognize
hypoglycemia reaction: headache,
tremors, fatigue, and weakness
– Teach client to recognize
hyperglycemia reaction: frequent
urination, thirst, fatigue, hunger
– Instruct patient about blood glucose
testing; make sure patient is able to
determine glucose level
– Instruct client about dosage, route, if
any diet restrictions
– Obtain yearly eye examination
ANTICONVULSANT
• Phenytoin (Dilantin)
– Action: Inhibits spread of seizure activity in
motor cortex by altering ion transport.
– Route of administration: oral/ IV
– Dosage: 200mg – 600mg
– Side effects: drowsiness, dizziness,
insomnia, depression, headache, confusion,
slurred speech, ventricular fibrillation,
blurred vision, nausea, vomiting,
constipation, hepatitis, leucopenia.
• NURSING INTERVENTIONS:
• Assess for phenytoin hypersensitivity syndrome
• Assess drug level; toxic level 30-50 mcg/ml
• Assess for seizures: duration, type, intensity,
precipitating factors
• Assess for mental status: mood, sensorium,
memory
• Assess for respiratory depression
• Administer after diluting with diluent provided
• Client teaching:
– Instruct client that if diabetic, urine glucose
should be monitored
– Inform client that urine may turn pink
– Teach client not to discontinue drug abruptly;
seizures may occur
– Instruct client proper brushing of teeth using
a soft toothbrush to prevent gingival
hyperplasia; need to see dentist frequently
– Instruct client to avoid hazardous activities
until stabilized on drug
– To carry emergency ID stating drug use.
Narcotic analgesic
Morphine
• Action: acts directly on the central nervous system (CNS); depression of
pain impulses by binding with opiate receptor in the CNS, to relieve pain.
• Route of administration: Oral, subcutaneous, IV, IM
• Dosage:
• Side effects: anorexia, nausea, vomiting, constipation, drowsiness,
dizziness, sedation, urinary retention, flushing.
NURSING INTERVENTIONS:
Administer the narcotic before pain reaches its peak.
NURSING INTERVENTIONS:
•Administer the narcotic before pain reaches its
peak.

•Check respiratory rate before administering


morphine. If RR is <
Classes of Antibiotics
• Bactericidal antibiotics kill bacteria.
• Bacteriostatic antibiotics only slow their
growth or reproduction.

CLASSIFICATIONS OF BACTERIA
• Gram-positive
• Gram-negative
• Aerobic: depend on oxygen for survival
• Anaerobic: do not use oxygen
Aminoglycosides
Generic Name Common Uses Side Effects Mechanism of
action
•Amikacin Infections •Hearing loss Inhibition of
•Gentamicin caused by •Vertigo, bacterial
Gram-negative •rash protein
•Streptomycin bacteria, such synthesis;
as Escherichia •Nausea, bactericidal
coli and •Vomiting effect
Klebsiella. •Anorexia
Effective against •Tremors
Aerobic bacteria.
•Tinnitus
•Muscle cramps
•Nephrotoxicity
NURSING INTERVENTIONS:
AMINOGLYCOSIDES.
•Monitor intake and output. Inform immediately if
urine output is decreased.
•Check hearing loss. aminoglycosides can
cause ototoxicity.
•Monitor vital signs. Note if body temperature
has decreased.
•For IV use, dilute the aminoglycosides in 50 –
200ml of normal saline or D5w solution and
administer in 30 to 60 minutes.
•Monitor for signs and symptoms of
superinfection such as stomatitis, genital
discharge.
• Client teaching
• Unless fluids are restricted, encourage the
client to increase fluid intake.
• Instruct the client never to take leftover
antibiotics.
• Instruct client to report side effects including
hearing loss,
• nausea, vomiting, anorexia, tremors, tinnitus,
muscle cramps.
Cephalosporins (First generation)
Generic Common Uses Possible Mechanism of
Name Side Effects action
•Cefazolin Bactericidal for •diarrhea Interfere with
•Cefalexin both Gram- •stomach cell wall-
positive and pain building ability of
Gram-negative •upset bacteria when
organisms and they divide.
stomach
therefore useful
for broad- •vomiting
spectrum •rash
antibacterial
coverage
Cephalosporins (Second generation)

Generic Common Uses Possible Side Mechanism of


Name Effects action
Cefaclor Same effectiveness •diarrhea, Interfere with
as the first •vomiting, cell wall-
Cefuroxime generation. These •headache, building ability
antibiotics possess of bacteria
a broader spectrum •migraines, when they
against other gram •dizziness and divide
negative bacteria •abdominal
and several pain.
anaerobic
organisms.
Cephalosporins (Third generation)
Generic Name Common Uses Possible Side Mechanism of
Effects action
•Ceftriaxone Same •Gastro- Interfere with cell
•Cefixime effectiveness as Intestinal wall- building
the first and ability of bacteria
•Cefotaxime upset and
second when they divide
generations. Also •Diarrhea
effective against • Nausea (if
gram negative alcohol taken
bacteria. Less concurrently)
effective against
gram positive •Allergic
bacteria reactions
Cephalosporins (Fourth generation)
Generic Common Uses Possible Side Mechanism of
Name Effects action
Cefepime It has a greater •Gastro- Interfere with
activity against both Intestinal cell wall-
Gram-negative and upset and building ability
Gram-positive of bacteria
organisms than third- •Diarrhea when they
generation agents • Nausea (if divide
alcohol taken
concurrently)
•Allergic
reactions
NURSING INTERVENTIONS:
CEPHALOSPORINS
•Culture the infected area before
cephalosporin therapy is started.
•Check for sign and symptoms of
superinfection, especially if the client takes
high doses of a cephalosporin product for a
prolonged period.
•Refrigerate oral suspensions. For intravenous
dilute in an appropriate amount of IV fluids.
•Monitor vital signs, urine output and
laboratory results.
• Client teaching
• Instruct the client to report signs of superinfection,
such as mouth ulcers, or discharge from the anal
or genital area.
• Advise the client to ingest yogurt to prevent
superinfection of the intestinal flora with long term
use of a cephalosporin.
• Instruct the client to take the complete course of
medication even when the symptoms of infection
have ceased.
• Advise the client to take medication with food to
prevent gastric irritation.
Penicillins
Amoxicillin
• Action: inhibition of the enzyme in cell wall
synthesis; bactericidal effect.
• Route of administration: oral , parenrtal.
• Available dosage: 250 – 500 mg.
• Side effects: nausea, vomiting, diarrhea, rash,
edema, stomatitis.

Penicillin
• Action: disrupt the synthesis of the peptidoglycan
layer of bacterial cell walls.
• Route of administration:oral
• Available dosage:250 mg,q 4-8 h.
• Side effects: diarrhea, hypersensitivity,
nausea, rash, neurotoxicity urticaria, and/or
superinfection (including candidiasis).
NURSING INTERVENTIONS: PENICILLIN
•Test dose should be given to the client before
administering IV penicillin.
•Check the client for allergic reaction to the
penicillin product,especially after the first and
second dose.
•Have epinephrine available to counteract a
severe allergic reaction.
•Do not mix aminoglycoside with a high doses of
penicillin because this combination may
inactivate the aminoglycoside.
•Monitor body temperature
•Dilute the antibiotic for IV use.
Client teaching
•Instruct the client to take all the prescribed
penicillin product such as amoxicillin until the
bottle is empty.
•Advise the client who is allergic to penicillin to
carry a card that indicates the allergy. The client
should notify the health care provider of any
allergy to penicillin when recording the health
history.
•Encourage the client to increase fluid intake;
fluids aids in
•excreting the drug.
•Advise the client to take oral penicillin 1 hour
before or 2 hours after meals to avoid in delay
in drug absorption.
Macrolides
Erythromycin
Action: inhibition of the steps of protein
synthesis; bacteriostatic or bactericidal effect
Route of administration:oral , parentral.
Available dosage: 250 mg.
• Side effects: anorexia, nausea, vomiting,
diarrhea, tinnitus, abdominal cramps, pruritus,
rash.
Quinolones
Ciprofloxacin
Action: interference with the enzyme DNA
gyrase, which is needed for bacterial DNA
synthesis; bactericidal effects
Route of administration:
Available dosage: oral tablets (250, 500, 750,
and 1000 mg), infusion bottles (200 and 400 mg).
Side effects: nausea, vomiting, diarrhea,
tinnitus, abdominal cramps, headache, fatigue,
dizziness ,insomnia, restlessness.
.
NURSING INTERVENTIONS:
•Obtain specimen from infected site before
drug therapy.
•Monitor intake and output.
•Monitor vital signs.
•Administer ciprofloxacin 1 hour before or 2
hours after meals.
•Dilute IV ciprofloxacin in an appropriate
amount of solution as indicated in the drug
circular. Infuse over 60 minutes.
•Check for signs and symptoms of
superinfection
Sulfonamides
Co-trimoxazole (Bactrim)
• Action: inhibition of protein synthesis of
nucleic acids; bactericidal effect
• Available dosage:400 mg.
• Routes: oral , parenteral
• Side effects: Anorexia, nausea, vomiting, and
diarrhea Allergy (including skin rashes),
Crystals in urine, stomatitis, headache,
photosensitivity.
NURSING INTERVENTIONS:
•Administer sulfonamides with a full glass of
water. extra fluid intake can prevent kidney
stone formation.
•Monitor the client’s intake and output. urine
output should be atleast 1200ml/day.
•Monitor vital signs. Note if the client’s
temperature has decreased.
•Observe the client for hematologic reaction
that may lead to life- threatening anemias.
•Check for signs and symptoms of
superinfection.
• Client teaching
• Instruct the client to drink several glasses of
fluid daily while taking sulfonamides to avoid
the complication of kidney stone formation.
• Instruct the client not to take antacids with
sulfonamides because antacids decrease the
absorption rate. instruct the client to take the
1 hour before or 2 hours after meals with a full
glass of water.
Antihistamine
Cetirizine
• Action: Antihistamines block the effects of histamines.
Histamines cause symptoms of allergy when released by
allergic reactions in the body. Antihistamines block the
ability of histamine to promote the allergy symptoms.
• Route of administration: oral
• Available dosage: 5- 10mg
• Side effects: drowsiness, headache, excessive
tiredness, Sleepiness, dry mouth, nausea, diarrhea,
vomiting
Piriton
•Action: it is an antihistamine that blocks allergic
reactions.
•Route of administration: oral, IV, IM
•Available dosage: 4mg
•Side effects: drowsiness, difficulty
concentrating; blurred vision; loss of appetite,
indigestion or upset stomach.
NURSING INTERVENTION:
•Administer the medication with food to
decrease gastric distress.
•Administer intramuscularly in large muscle.
• Client Teaching
• Instruct client to avoid driving and performing
other dangerous activities if drowsiness
occurs..
• Avoid alcohol and other CNS depressants.
• For temporary relief of mouth dryness, suggest
Hypnotic
using gum or ice chips.
Benzodiazepine
1.Nitrazepam
Action: induce sleep , used in the treatment of
insomnia and in surgical anesthesia
Route of administration: oral
Dosage: 2.5mg to 10mg, taken at bedtime
• Side effects: dizziness, depressed mood,
violence, fatigue, headache, impairment of
memory, hangover feeling in the morning,
slurred speech, reduced alertness, muscle
weakness.
• 2.Flurazepam
• Action: Depression of the CNS,
Neurotransmitter inhibition
• Dosage: 15 to 30 mg
• Route of administration: oral
Side effects: drowsiness, lethargy, hangover,
dizziness, lightheadedness, confusion, nausea,
vomiting, diarrhea.
.NURSING INTERVENTIONS:
•Monitor vital signs. check for signs of
respiratory distress, such as slow, irregular
breathing patterns.
•Raise bedside rails, confusion may occur,
and injury may result.
•Observe the client for side effects, such
hangover, dizziness,
•lightheadedness, confusion.
• Client teaching
• Instruct the client to avoid alcohol and
antidepressant while taking these drugs
• Advise client to take the medication
before bedtime.
• Suggest the client urinate before taking
the medication, to prevent sleep
disruption.
• Instruct the client to report adverse
reactions to the health care provider.
Sedative-hypnotic (tranquilizers)
Barbiturate
Pentobarbital sodium
• Action: depresses the central nervous system resulting
in calmness, relaxation, reduction of anxiety,
sleepiness, and slowed breathing, and possibly - at
higher doses - slurred speech, staggering gait, poor
judgment, and slow, uncertain reflexes.
• Route of administration: oral, IV, IM
• Dosage: 20mg – 100mg.
• Side effects: drowsiness, hangover, dizziness,
nystagmus and ataxia.
NURSING INTERVENTION:
•Monitor vital signs, especially respirations and
blood pressure.
•Raised bedside rails.
•Observe skin rashes.
•Administer IV at the rate of less than
50mg/min.
•IM injection should be given in large muscle
such as the gluteus muscle.