DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

mannitol

BRAND NAME Osmitrol

DOSAGE 75 cc Q8

Increases osmotic pressure of plasma in glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes (including sodium and potassium). These actions enhance water flow from various tissues and ultimately decrease intracranial and intraocular pressures

-Prevention and treatment of the oliguric phase of renal failure. -Reduction of intracranial pressure and treatment of cerebral edema; of elevated IOP when the pressure cannot be lowered by other means. -Promotion of the urinary excretion of toxic substances

-Contraindicated with anuria due to severe renal disease -Use cautiously with pulmonary congestion, active intracranial bleeding, dehydration, pregnancy and lactation.

ROUTE Intravenous

CLASSIFICATION Osmotic Diuretic

ADVERSE REACTION -dizziness -headache -blurred vision -hypotension -hypertension -tachycardia -edema -chest pain -urticaria -nausea -anorexia -dry mouth -thirst -diuresis -urine retention -fluid and electrolyte imbalances

NURSING RESPONSIBILITIES - Do not expose solutions to low temperatures; crystallization may occur. If crystals are seen, warm bottle in a hot water bath, then cool to body temperature before administering. -Monitor serum electrolytes periodically.

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CONTRAINDICATION

ADVERSE REACTION -Rash -Nausea -vomiting -Diarrhea -abdominal discomfort -GI obstruction -GI perforation -Hyperkalemia

NURSING RESPONSIBILITIES -Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician. Lab test: Frequent serum electrolytes are warranted. -Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis). Be alert for potassium intoxication. -Take drug with food and a full glass of water to decrease GI upset.

kalium durule

Essential for maintenance of intracellular isotonicity, transmission of nerve BRAND NAME impulses, contraction of Potassium cardiac, skeletal, and Chloride smooth muscles, maintenance of normal kidney function, and for DOSAGE enzyme activity. Plays a 500 mg, 595 mg prominent role in both tablets; formation and correction of imbalances in acid base metabolism. ROUTE Oral

-Prevention and correction of potassium deficiency. -IV treatment of cardiac dysrhytmmias due to cardiac glycosides

-contraindicated with allergy to tatrazine, aspirin therapy with potassium sparing diuretics or aldosteroneinhibiting agents; severe renal impairment with oliguria, anuria, azotemia. -Use catiously with cardiac disorders, especially if treated with cardiac glycosides, pregnancy and lactation.

CLASSIFICATION electrolytic and water balance agent

DRUG NAME

ACTION

INDICATION

CONTRAINDICATIO N

ADVERSE REACTION - Hypoglycemia -lactic acidosis -Anorexia -nausea &vomiting -epigastric discomfort -heartburn -diarrhea -eczema -pruritus -erythema -urticaria

NURSING RESPONSIBILITIES -Monitor urine or serum glucose levels frequently to determine effectiveness of drug and dosage. -Arrange for transfer to insulin therapy during periods of high stress (infections, surgery, trauma). -Use IV glucose if severe hypoglycemia occurs as a result of overdose

metformin hydrochloride

BRAND NAME Glucophage

DOSAGE 500 mg OD

Exact mechanism is not understood; possibly increases peripheral utilization of glucose,increases production of insulin, decreases hepatic glucose production and alters intestinalabsorption of glucose.

-Adjunct to diet to lower -Hypersensitivity blood glucose with type 2 (non\u2013insulindependent) diabetes mellitus in patients > 10 yr; extended release in patients > 17 yr -As part of combination therapy with a sulfonylurea or insulin when either drug alone cannot control glucose levels in patients with type 2 diabetes mellitus

ROUTE CLASSIFICATION Oral Antidiabetic

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES -Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate. -Avoid IM injections, which may be very painful -Report unusually slow pulse, irregular pulse, rapid weight gain, loss of appetite, nausea, diarrhea, vomiting, blurred or yellow vision, unusual tiredness and weakness, swelling of the ankles, legs or fingers, difficulty breathing.

digoxin

BRAND NAME Lanoxin

DOSAGE 0.1250.25 mg/day

It has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity.

-CHF -Atrial fibrillation

-Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive cardiomyopathy. -Arrhythmias due to accessory pathways (e.g. Wolff-Parkinson-White syndrome).

-anorexia -nausea & vomiting. -Diarrhea in elderly -dizziness -drowsiness -restlessness -nervousness -agitation -visual disturbances -Potentially Fatal: Cardiac arrhythmias in combination with heart block.

ROUTE Oral

CLASSIFICATION -Cardiac glycoside,

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION - Dizziness -fainting. -palpitations -bowel activity (griping, diarrhea, nausea, vomiting) -Perianal irritation -Bloating -Flatulence -Abdominal cramping -Sweating weakness -Suppositories may cause proctitis and inflammation with long-term use.

NURSING RESPONSIBILITIES -Assess stools for frequency and consistency. -Monitor patient for electrolyte imbalances and dehydration. -Instruct patient to swallow (not chew) enteric-coated tablets no sooner than 1 hour before or after ingesting antacids or dairy products. - As appropriate, review all other significant and lifethreatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

bisacodyl BRAND NAME Dulcolax

DOSAGE 10 mg HS

Bisacodyl works by stimulating enteric nerves to cause colonic mass movements. It is also a contact laxative; it increases fluid and NaCl secretion. Action of bisacodyl on small intestine is negligible; stimulant laxatives mainly promote evacuation of the colon.

Short-term treatment of constipation; evacuation of colon for rectal and bowel evaluations; preparation for delivery or surgery.

-Nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen; fecal impaction; intestinal obstruction; undiagnosed abdominal pain; ulcerative lesions of colon; rectal fissures; ulcerative hemorrhoids.

ROUTE Suppository

CLASSIFICATION Stimulant Laxative

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION -Dizziness -insomnia -nervousness -fatigue -somnolence -ataxia - diplopia -tremor -Pruritus -abrasion -Dyspepsia -vomiting -nausea -constipation -dry mouth -diarrhea -Rhinitis -pharyngitis -Weight gain -facial edema

NURSING RESPONSIBILITIES -Be aware that patient may be at increased risk for suicidality; monitor accordingly. -Take this drug exactly as prescribed; do not discontinue abruptly or change dosage, except on the advice of your health care provider. - Report severe headache, sleepwalking, rash, severe vomiting, chills, fever, difficulty breathing, thoughts of suicide.

gabapentin

BRAND NAME Neurontin

Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block post tetanic potentiation.

- Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in adults and children 3 12 yr with epilepsy - Orphan drug use: Treatment of amyotrophic lateral sclerosis - Management of postherpetic neuralgia or pain in the area affected by herpes zoster after the disease has been treated - Unlabeled uses: Hot flashes, neuropathic pain

Contraindicated with hypersensitivity to gabapentin. Use cautiously with pregnancy, lactation.

DOSAGE 600 mg tab BID

ROUTE Oral

CLASSIFICATION Antiepileptic

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION -Abdominal discomfort associated with flatulence and intestinal cramps. Nausea, vomiting, diarrhea on prolonged use.

NURSING RESPONSIBILITIES -Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness -Monitor pt for any adverse GI reactions nausea, vomiting, diarrhea -For pt. with hepatic encelopathy: regularly assessmental condition -monitor I & O -monitor for increase glucose level in diabetic patients.

LACTULOSE BRAND NAME duphalac

Inhibits bacterial DNA gyrase thus preventing replication insusceptible bacteria.

-Constipation, salmonellosis. Treatmentof hepaticencephalopathy

-Galactosemia deficiency -Intestinal obstruction.

DOSAGE 30cc BID CLASSIFICATION ROUTE Oral Gastrointestinal Agent

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION CNS: headache, dizziness, fatigue CV: peripheral edema, angina, bradycardia, hypotension, palpitations GI: gingival hyperplasia, nausea DERM: flushing

Amlodipine BRAND NAME Norvasc

DOSAGE 5mg/tab OD ROUTE Oral

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in the inhibition of excitation contraction coupling and subsequent contraction. Therapeutic effects: systemic vasodilation resulting in the decreased blood pressure. Coronary vasodilation resulting in decreased frequency and severity attacks of angina.

Alone or with other agents in the management of hypertension, angina pectoris and vasospastic angina.

Hypersensitivity. Blood pressure less than 90 mmHg. Use cautiously in: sever hepatic impairment, history of CHF, aortic Stenosis.

NURSING RESPONSIBILITIES *Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Monitor ECG during prolonged therapy. *Monitor intake and output ratios and daily weight. Assess for signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain and jugular venous distention0 *Lab test considerations: Total serum calcium are not affected by calcium channel blockers.

CLASSIFICATION Calcium channel blockers

DRUG NAME

ACTION

INDICATION

ADVERSE REACTION

CONTRAINDICATIONS

NURSING RESPONSIBILITIES -Check for doctors order -Monitor blood pressure and pulse rate before and after giving the meds. -Notify prescribing signs of heart failure such as swelling of hands and feet or SOB. - Advise patient of the side effects of the drug.

trimetazidine BRAND NAME Vestar

DOSAGE 35mg BID ROUTE: Oral

Trimetazidine is a cellular acting antiischaemic agent. It has 3 main properties by which it acts as a cytoprotective agent. It inhibits the anaerobic glycolysis and fatty acid metabolism, thus allowing only aerobic glycolysis. This action helps to restore the energy balance in the cell. It inhibits acidosis and free radical accumulation in the cell. All these action help the cell to restore the normal ionic and metabolic balance.

Angina pectoris & GI disturbances ischemia if (nausea and neurosensorial tissues vomiting) as in Menieres disease.

Pregnancy and lactation; hypersensitivity

CLASSIFICATION: Anti- angina drug

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES

Generic Name: ISMN Brand Name: Imdur

DOSAGE: 30mg/tab ODHS ROUTE: Oral

The Imdur product is an oral extended-release formulation of ISMN, the major active metabolite of isosorbide dinitrate; most of the clinical activity of the dinitrate is attributable to the mononitrate.

Prophylactic treatment of angina pectoris

Headache, hypotension with dizziness and nausea. tachycardia

Shock, Constrictive -Check the doctors cardiomyopathy, order pericarditis, -Headache may be a marker for drug activity; do not try to avoid by altering treatment schedule; aspirin or acetaminophen may be used for relief -Dissolve SL tablets under tongue; do not crush, chew, or swallow -Do not crush chewable tablets before administering -Avoid alcohol -Make changes in position slowly to prevent fainting

CLASSIFICATION: Anti- anginal drug

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION -Dizziness -headache -fatigue -paresthesia -fever - chills -confusion -Diarrhea -nausea &vomiting -anorexia -bleeding -abdominalpain -loose stools -flatulence -heartburn -stomach cramps - jaundice

NURSING RESPONSIBILITIES -Assess patient for signs and symptoms of infection. -Assess for anaohylaxis: rash, urticaria, chills, fever, dyspnea -Identify urine output -Assess bowel pattern daily -Monitor for bleeding

cefuroxime BRAND NAME Ceftin

Inhibits bacterial wall synthesis, rendering cell wall osmotically unstable, leading to cell death by binding to cell wall membrane

Urinary tract infections Otitis media Severe infections

Sensitivity to cephalosporins

DOSAGE 750 mg Q8

ROUTE Intravenously

CLASSIFICATION Anti Infective

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ACTION

INDICATION

CONTRAINDICATION

simvastatin BRAND NAME Vidastat

DOSAGE 40mg/ OD at hs

Inhibits HMG-Co Areductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

-Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol a nd other nonpharmacologic measures -To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, MI and reduction in need for bypass surgery and angionplasty in patients with coronary heart disease and hypercholesterolemia

Contraindicated with allergy to simvastatin, fungal byproducts, pregnancy, lactation

ADVERSE REACTION -Headache -asthenia -sleep disturbances -Flatulence -diarrhea -abdominal pain -constipation -nausea -dyspepsia -heartburn -liver failure -Sinusitis

NURSING RESPONSIBILITIES -Take drug in the evening. Do not drink grapefruit juice while using this drug. -Have periodic blood tests. -Repot GI upset, changes in vision, unusual bleeding or bruising,, dark urine or light colored stools, fever, musclepain or soreness.

ROUTE Oral CLASSIFICATION Anti Lipidemics

DRUG NAME

ACTION

INDICATION

CONTRAINDICAT IONS

ADVERSE REACTION CNS:Headache, dizziness,weakness, syncope, flushing CV: Hypertension, edema Dermatologic:Ras h, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other:Increased bleeding risk

NURSING RESPONSIBILITIES Assess for symptoms of stroke, MI during Treatment Monitor liver function studies: AST, ALT,bilirubin, creatinine if patient is on long-term therapy Monitor blood studies: CBC,Hgb, Hct, protime,cholesterol if the patient is on long-term therapy; thrombocytopeni a andneutropenia may occur. Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy

Clopidogrel BRAND NAME Plavix

DOSAGE

Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

75mg OD CLASSIFICATION: antiplatelet agent ROTE Oral

Treatment of patients at Contraindicated with risk for allergy to clopidogrel, ischemic events active pathological history of MI, bleeding such as ischemic stroke, peptic ulcer or peripheral artery intracranial disease hemorrhage, lactation Treatment of patients with acute coronary syndrome

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION -Dizziness -vertigo -tinnitus -fatigue -orthostatic hypertension -gastric pain -flatulence -constipation -diarrhea -rhinitis

NURSING RESPONSIBILITIES - Do not discontinue drug abruptly after chronic; taper drug gradually over 2wk with monitoring. -Take drug with meals. -Do not stop taking drug unless instructed to do so by a healthcare provider. -Avoid use of over-thecounter medications. -Advise the diabetic patient to promptly report changes in glucose

Carvedilol BRAND NAME Coreg DOSAGE 625 mg/tab BID

It causes vasodilation by blocking the activity of blockers, mainly at alpha1receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment.

-Hypertension, alone or with other oral drugs, especially diuretics -Treatment of mild to severe CHF of ischemic with digitalis, diuretics, ACE inhibitors -Left ventricular dysfunction (LVD)after MI

Hypersensitivity; severe chronic, heart failure, bronchial asthma; severe hepatic impairement; lactation and pregnancy

ROUTE CLASSIFICATION Oral Antihypertensive

DRUG NAME

ACTION

INDICATION

CONTRAINDICATI ON MAO inhibitor therap y within 14 days initiat ing therapy; severehyp ertension; severe. Cor onary artery disease, h ypersensitivity to pseu doedephrine,acrivastin e or any component; renal impairment.

ADVERSE REACTION Hypersensitivity reacti ons have been reporte d in patients receiving acetylcysteine, including bronchospasm, angioedema, rashes and pruritus, may occur. Other adverse effects reported include nausea and vomiting, fever, syncope, sweating, arthralgia, blurred vision, disturbances of liver function.

NURSING RESPONSIBILITIES Monitor effectiveness o f therapy and advent of adverse/allergic effects. Instruct patient in appropriate use and adverse effects to report.

Acetylcysteine BRAND NAME Fluimucil DOSAGE 600 mg/tab OD in glass of H2O ROUTE Oral

Exerts mucolytic action through its free sulfhydryl group which opens up the disulfide bonds in th e mucoproteins thus loweri ng mucous viscosity. The e xactmechanism of action in acetaminophen toxicity is unknown. It is thought to act by providing substrate for conjugation with the toxic metabolite. CLASSIFICATION Mucolytic Agent

Treatment of respiratory affections characterized by thick and viscoushyp ersecretions: acute bronc hitis, chronic bronchitis and its exacerbations; pu lmonaryemphysema, mucoviscidosis and bronchiectasis.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATI ON Hypersensitivity to drug

ADVERSE REACTION -dizziness -nausea -vomiting -seizures

NURSING RESPONSIBILITIES -provide safety of the patient.-advise patient notto drive and to usemachinery.-give hard candiesand ice chips-frequent oral care-advise patient tosmall frequentserving of food.-Provide safety of the patient-raise side rails-put tongue guardor towel into thepatient mouth toavoid aspiration.

ampicillin BRAND NAME Ampimax DOSAGE

Destroys bacteriaby Treatment forrespiratory inhibitingbacterial celltractinfections, wallsynthesis andsurgicalinfections. duringmicrobialmultiplicati on CLASSIFICATION Anti Infective

ROUTE

DRUG NAME

ACTION

INDICATION

CONTRAINDICATI ON Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.

ADVERSE REACTION - Lethargy -hallucinations -seizures -stomatitis -gastritis -soremouth -nausea -vomiting -diarrhea -abdominal pain -loody -Enterocolitis -pseudomembranous colitis -rash -fever -wheezing -pain

NURSING RESPONSIBILITIES -Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs)at beginning and throughout therapy. -Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative historyof penicillin sensitivity may still have anallergic response. Other:Superinfectionsy mptoms of anaphylaxis (rash,pruritus,laryngeal edema,wheezing).Disc ontinue thedrug and notifythe physicianimmediately if these occur.

ampicillin sulbactam BRAND NAME Silgram

DOSAGE 750mg tab BID

Bactericidal action. Binds tobacteria cell wall,resulting in cell death,spectrum is broaderthan that of penicillin.Addition of sulbactamincreases resistanceto betalactamase,enzymes produced bybacteria that mayinactivate ampicillin.

-Treatment of infections caused by susceptible strains of Shigella, Salmonella, E.Coli, Haemophilus influenzae, S.typhosa, N.Gonorrhea, enterococci,gram positive organisms -Meningitis causedby Neisseriameningitides

ROUTE Oral

CLASSIFICATION Anti Infective

DRUG NAME

ACTION

INDICATION

CONTRAINDICATI ON Hypersensitivity to drug

ADVERSE REACTION -dizziness -nausea -vomiting -seizures

NURSING RESPONSIBILITIES -provide safety of the patient.-advise patient notto drive and to usemachinery.-give hard candiesand ice chips-frequent oral care-advise patient tosmall frequentserving of food.-Provide safety of the patient-raise side rails-put tongue guardor towel into thepatient mouth toavoid aspiration.

ampicillin BRAND NAME Ampimax DOSAGE

Destroys bacteriaby Treatment forrespiratory inhibitingbacterial celltractinfections, wallsynthesis andsurgicalinfections. duringmicrobialmultiplicati on CLASSIFICATION Anti Infective

125 mg ROUTE Intravenous