NICARDIPINE (Cardene)

Classification:

Therapeutic: antianginals, antihypertensives;

Pharmacologic: calcium channel blockers.
Indications

Management of: Hypertension, Angina pectoris, Vasospastic

(Prinzmetals) angina.Unlabeled uses: Management of CHF.
Mechanism of Action

Inhibits the transport of calcium into myocardial and vascular

smooth muscle cells, resulting in inhibition of excitation-contraction
coupling and subsequent contraction. Therapeutic Effects: Systemic
vasodilation resulting in decreased blood pressure. Coronary
vasodilation resulting in decreased frequency and severity of attacks of
angina.
Contraindications/Precautions

Contraindicated in: Hypersensitivity; Sick sinus syndrome; 2nd- or

3rd-degree AV block (unless an artificial pacemaker is in place); BP
<90mmHg; Advanced aortic stenosis. Use Cautiously in: Severe hepatic
impairment (dose reduction recommended); Geri: Geriatric patients (dose
reduction/slower IV infusion rates recommended formost agents; increased
risk of hypotension); Severe renal impairment (dose reduction may be
necessary); History of serious ventricular arrhythmias or CHF; OB,
Lactation, Pedi: Pregnancy, lactation, or children (safety not established).
Adverse Reactions/Side Effects

CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness,

headache, jitteriness, nervousness, psychiatric disturbances,
weakness. EENT: blurred vision, disturbed equilibrium, epistaxis,
tinnitus.
Resp: cough, dyspnea, shortness of breath.
CV: ARRHYTHMIAS, CHF, peripheral edema, bradycardia, chest
pain, hypotension, palpitations, syncope, tachycardia.

GI: abnormal results in liver function studies, anorexia,

constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea,
vomiting.
GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary
frequency. Derm: dermatitis, erythemamultiforme, flushing,
increased sweating, photosensitivity, pruritus/urticaria, rash.
Endo: gynecomastia, hyperglycemia.
Hemat: anemia, leukopenia, thrombocytopenia.
Metab: weight gain.
MS: joint stiffness, muscle cramps.
Neuro: paresthesia, tremor.
Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.

Nursing Management

1. Advise patient to take medication exactly as directed, even if

feeling well. Take missed doses as soon as possible unless almost
time for next dose; do not double doses. May need to be
discontinued gradually.
2. Instruct patient on technique for monitoring pulse. Instruct
patient to contact health care professional if heart rate is <50 bpm.
3. Advise patient to avoid grapefruit and grapefruit juice during
therapy.
4. Caution patient to change positions slowly to minimize
orthostatic hypotension.
5. May cause drowsiness or dizziness. Advise patient to avoid
driving or other activities requiring alertness until response to the
medication is known.
6. Instruct patient to avoid concurrent use of alcohol or OTC
medications, especially cold preparations, without consulting
health care professional.
7. Advise patient to notify health care professional if irregular
heartbeat, dyspnea, swelling of hands and feet, pronounced

dizziness nausea, constipation, or hypotension occurs or if

headache is severe or persistent.
8. Caution patient to wear protective clothing and to use sunscreen
to prevent photosensitivity reactions.
9. Angina: Instruct patient on concurrent nitrate or beta-blocker
therapy to continue taking both medications as directed and to use
SL nitroglycerin as needed for anginal attacks.
10. Advise patient to contact health care professional if chest pain
does not improve, worsens after therapy, or occurs with
diaphoresis; if shortness of breath; or if persistent head ache occurs.

Side Effects/ Adverse Effects:

CNS: drowsiness, abnormal thinking, dizziness,euphoria,headache,

RESP: asthma, dyspnea
CV: Edema,pallor,vasodilation
GI:GI Bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia,GI pain,
nausea
GU: oliguria,renal toxicity, urinary frequency
DERM:pruritis, purpura, sweating, urticarial
HEMAT:prolonged bleeding time
LOCAL:injection site pain
NEURO:paresthesia
MISC: allergic reaction, anaphylaxis
Nursing Implications/Responsibilities:

KETOROLAC (Toradol)
Classification:

Nonsteroidal anti-inflammatory agents, nonopioid analagesics

DOSAGE:
30mg/amp1 amp IM

Mechanism Of Action:

- Inhibits prostaglandin synthesis, producing peripherally

mediated analgesia
- Also has antipyretic and anti-inflammatory properties.
- Therapeutic effect:Decreased pain

Indication:

Short term management of pain (not to exceed 5 days total for all
routes combined)

Contraindications:

- Hypersensitivity
- Cross-sensitivity with other NSAIDs may existPre- or
perioperative use
- Known alcohol intoleranceUse cautiously in:
1) History of GI bleeding
2) Renal impair-ment (dosage reduction may be required)
3) Cardiovascular disease

- Patients who have asthma, aspirin-induced allergy, and nasal polyps are
at increased risk for developing hypersensitivity reactions. Assess for
rhinitis, asthma, and urticaria.
- Assess pain (note type, location, and intensity) prior to and 1-2 hr
following administration.
- Ketorolac therapy should always be given initially by the IM or IV route.
Oral therapy should be used only as a continuation of parenteral therapy.
- Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs,
acetaminophen, or other OTC medications without consulting health care
professional.
- Advise patient to consult if rash, itching, visual disturbances, tinnitus,
weight gain, edema, black stools, persistent headche, or influenza-like
syndromes (chills,fever,muscles aches, pain) occur.
- Effectiveness of therapy can be demonstrated by decrease in severity of
pain. Patients who do not respond to one NSAIDs may respond to another.

OMEPRAZOLE (Losec,Prilosec)
Drug class

Gastrointestinal agent; proton pump inhibitor

Pregnancy Category C

Therapeutic effects

Suppresses gastric acid secretion relieving gastrointestinal

distress and promoting ulcer healing.

Indications

Duodenal and gastric ulcer. Gastroesophageal reflux disease

including severe erosive esophagitis (4 to 8 wk treatment). Longterm treatment of pathologic hypersecretory conditions such as
Zollinger-Ellison syndrome, multiple endocrine adenomas, and
systemic mastocytosis. In combination with clarithromycin to
treat duodenal ulcers associated with Helicobacter pylori.

Contraindications

Long-term use for gastroesophageal reflux disease, duodenal

ulcers.

Side effects

CNS:Headache, dizziness, fatigue.

GI:Diarrhea, abdominal pain, nausea, mild transient increases in
liver function tests.
Urogenital:Hematuria, proteinuria.
Skin:Rash

Nursing implications

Ampicillin Sulbactam (Unasyn)

Drug class

Therapeutic effects

Lab tests: Monitor urinalysis for hematuria and proteinuria.

Periodic liver function tests with prolonged use.

Patient & Family Education

Report any changes in urinary elimination such as pain or

discomfort associated with urination, or blood in urine.
Report severe diarrhea; drug may need to be discontinued.

Bactericidal action against sensitive organisms; inhibits

synthesis of bacterial cell wall, causing cell death.

Indications

Treatment of skin and skin structure, intra-abdominal, and

gynecologic infections caused by susceptible
microorganisms.

Contraindications

Hypersensitivity to penicillins.

Side effects

Assessment & Drug Effects

antibacterial
Pregnancy Category: B

Dermatologic: Rash (less than 2%); erythema multiforme,

exfoliative dermatitis, urticaria.
GI: Diarrhea (3%); black, hairy tongue; Clostridium difficile
associated diarrhea; enterocolitis; gastritis; pseudomembranous
colitis; stomatitis.
Genitourinary: Increased BUN and creatinine; presence of RBCs
and hyaline casts in urine.
Hematologic: Agranulocytosis; decreased Hct, Hgb, lymphocytes,
neutrophils, RBC, platelets, and WBC; increased basophils,
eosinophils, lymphocytes, monocytes, and platelets; positive direct
Coombs tests.
Hypersensitivity: Hypersensitivity (anaphylactic) reactions
(sometimes fatal).
Local: Pain at IM injection site (16%); pain at IV injection site,
thrombophlebitis at injection site (3%).
Metabolic: Elevated serum alkaline phosphatase, ALT, AST, and
LDH; reduced serum albumin and total proteins.

Nursing implications

Side effects

Assessment

History: Allergies to penicillins, cephalosporins, or other

allergens; renal disorders; lactation
Physical: Culture infected area; skin color, lesion; R, adventitious
sounds; bowel sounds; CBC, LFTs, renal function tests, serum
electrolytes, Hct, urinalysis

Take this drug around-the-clock.

Take the full course of therapy; do not stop taking the drug if you
feel better.
This antibiotic is specific to your problem and should not be used
to self-treat other infections.
You may experience these side effects: Nausea, vomiting, GI upset
(eat frequent small meals), diarrhea.
Report pain or discomfort at sites, unusual bleeding or bruising,
mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty
breathing.

Pain, phlebitis at injection site

Hyperglycemia and glycosuria
Fluid overload

Special Considerations

Teaching points

Rapid rates of administration predisposes the patient to pain and

may cause phlebitis if aperipheral vein is used; to minimize this
effect administer slowly
Excessive IV administration may cause fluid overload, water
intoxication, +/or CHF
D50W and Thiamine 100 mg IV (mini bag or IVP) should be given
together when alcoholism or malnutrition are suspected

Teaching points

D5050
Drug class

Caloric Agent

Therapeutic effects

Rapidly increases blood glucose levels

Transient osmotic diuretic

Indications

Documented hypoglycemia
Seizures of unknown etiology
Cerebral/meningeal edema related to eclampsia

Contraindications

No significant contraindications in the emergency setting

Do not stop taking this drug without notifying your health care
provider.
Take pulse rate before administering.
Do not start taking any prescription or over-the-counter
products without talking to your health care provider. Some
combinations may increase the risk of digoxin toxicity and may
put you at risk of adverse reactions.
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.

Epinephrine (Adrenaline)
Drug class

Alpha-adrenergic agonist
Cardiac stimulant
Antasthmatic drug

Mechanism of Action

Epinephrine acts by binding to a variety of adrenergic

receptors.

Adrenergic receptor binding triggers glucagon secretion in

the pancreas, increased adrenocorticotropic hormone
(ACTH) secretion by the pituitary gland, and increased
lipolysis by adipose tissue. Together these effects lead to
increased blood glucose and fatty acids, providing substrates
for energy production within cells throughout the body.

Indications

Treatment and prohylaxis of cardiac arrest and attacks of transitory

AV heart block with syncopal seizures; syncope due to carotid sinus
syndrome, acute hypersensitivity reactions
Injection: relief from respiratory distress of bronchial asthma,
chronic bronchitis, emphysema, other COPDs
Temporary relief from acute attacks of bronchial asthma,
COPD

Contraindications

Contraindicated with allergy or hypersensitivity to epinephrine or

components of preparation; narrow-angle glaucoma; shock other
than anaphylactic shock; hypovolemia; general anesthesia with
halogenated hydrocarbons; organic brain damage; cerebral
arteriosclerosis; cardiac dilation and coronary insufficiency;
tachyarrhythmia; ischemic heart disease; hypertension; renal
dysfunction; COPD patients who have developed degenerative
heart disease; diabetes mellitus; hyperthyroidism; lactation.

Side effects

CNS: fear, anxiety, tenseness, restlessness, headache, dizziness,

drowsiness, tremor, insomnia, hallucinations, seizures
CNS depression, weakness, blurred vision, tearing, photophbia
CV: Arrhythmias, hypertension resulting in intracranial
hemorrhage
CV collapse with hypotension, palpitations, tachycardia, precordial
pain
GI: Nausea, vomiting, anorexia
GU: Constriction of blood vessels and decreased urine formation,
dysuria, urinary retention in males with prostatism

OTHER: pallor, respiratory difficulty, orofactial dystonia,

sweating.

Nursing implications

Rotate SC injection sites to prevent necrosis; monitor sites

frequently
Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug.
Protect drug solutions from light, extreme heat and freezing.
Shake the suspension for injection well before withdrawing
the dose.

Lidocaine (Xylocaine)
Drug class

Anesthetic topical or local, Antiarrythmics

Mechanism of Action
When administered intramuscularly or intravenously,

Lidocaine suppresses the automaticity and spontaneous

depolarization of the ventricles during diastole by altering the
flux of sodium ions across the cell membrane with little or no
effect on the heart. Locally, it produces local anesthesia
effect by inhibiting the transport of ions across the neural
membranes. Thus, initiation and conduction of normal nerve
impulses is prevented.
Indications

Intravenous ventricular arrhythmias

Intramuscular self-injected or when IV is unavailable
during transport to local facilities
Local infiltration or mucosal or topical anesthetic
Patch used when pain is present due to post-herpetic
neuralgia

Contraindications

Hypersensitivity

Advanced AV block

Side effects

Drowsiness
Dizziness
Nervousness
(mucosal use) decreased or absent gag reflex
Bradycardia
Hypotension
Burning sensation

Magnesium sulfate
Drug class

Therapeutic effects

Nursing implications

When Lidocaine is administered as an antiarrhythmic the

nurse should monitor the ECG continuously. Blood pressure
and respiratory status should be monitored frequently during
the drug administration.
When administered as an anesthetic, the numbness of the
affected part should be assessed.
Serum Lidocaine levels should be monitored frequently
during prolonged use. Therapeutic serum lidocaine levels
range from 1.5 to 5 mcg/ml.
If signs of overdose occur (listed above), stop the infusion
immediately and monitor the patient closely.
For throat sprays, make sure that the patients gag reflex is
intact before allowing the patient to eat or drink.
When IM injections are used, the medication should be
administered in the deltoid muscle only while frequently
aspirating to prevent IV injection.
For direct IV injection only 1% and 2% solutions are used.
Undiluted IV loading dose of Lidocaine is administered at 1
mg/kg at a rate of 25 to 50 mg over 1 minute. The dose may
be repeated after 5 minutes.

Replacement in deficiency states. Resolution of eclampsia.

Indications

Anticonvulsant

Treatment/prevention of
hypomagnesemia. Treatment
of
hypertension. Anticonvulsant associated with severe eclampsia,
pre-eclampsia, or acute nephritis. Unlabeled uses: Preterm labor.
Treatment of Torsade de pointes. Adjunctive treatment for
bronchodilation in moderate to severe acute asthma.

Contraindications

Hypermagnesemia; Hypocalcemia; Anuria; Heart block; Active

labor or within 2 hr of delivery (unless used for preterm labor).

Side effects

CNS: drowsiness.
Resp: decreased respiratory rate.
CV: arrhythmias, bradycardia, hypotension.
GI: diarrhea.
MS:muscle weakness.
Derm: flushing, sweating.
Metab: hypothermia.

Nursing implications

Hypomagnesemia/Anticonvulsant: Monitor pulse, blood

pressure, respirations, and ECG frequently throughout
administration of parenteral magnesium sulfate.
Respirations should be at least 16/min before each dose.
Monitor neurologic status before and throughout therapy.
Institute seizure precautions. Patellar reflex (knee jerk)
should be tested before each parenteral dose of

magnesium sulfate. If response is absent, no additional doses

should be administered until positive response is obtained.
Monitor intake and output ratios. Urine out put should be
maintained at a level of at least 100 ml/4 hr.
Explain purpose of medication to patient and family.

Atropine sulfate (AtroPen)

Drug class

Anticholinergic
Antimuscarinic
Parasympatholytic
Antiparkinsonian
Antidote
Diagnostic agent (ophthalmic preparations)
Belladonna alkaloid

Therapeutic effects
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.

Indications

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 disorders

Contraindications

Contraindicated with hypersensitivity to anticholinergic drugs.

Side effects

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, gastroesophageal reflux
GU: Urinary hesitancy and retention; impotence
Other: Decreased sweating and predisposition to heat
prostration, suppression of lactation

Nursing implications

Interventions
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.
You may experience these side effects: Dizziness, confusion
(use caution driving or performing hazardous tasks);
constipation (ensure adequate fluid intake, proper diet); dry
mouth (sugarless lozenges, frequent mouth care may help;
may be transient); blurred vision, sensitivity to light
(reversible; avoid tasks that require acute vision; wear
sunglasses in bright light); impotence (reversible); difficulty
in urination (empty the bladder prior to taking drug).
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.

DOPAMINE HYDROCHLORIDE (Dopastat)

Drug class

AUTONOMIC NERVOUS SYSTEM AGENT; ALPHA- AND

BETA-ADRENERGIC AGONIST (SYMPATHOMIMETIC)

Therapeutic effects
Positive inotropic effect on myocardium increases cardiac

output with increase in systolic and pulse pressure and little

or no effect on diastolic pressure. Improves circulation to
renal vascular bed by decreasing renal vascular resistance
with resulting increase in glomerular filtration rate and
urinary output.

Indications

Correction of hemodynamic imbalances present in shock syndrome

after MI, trauma, endotoxic septicemia, open heart surgery, and
renal failure or chronic cardiac decompensation (eg, CHF).

Contraindications

Pheochromocytoma; tachyarrhythmias or ventricular fibrillation.

Safe use during pregnancy (category C), lactation, or children is not
established.

Side effects

CV: Hypotension, ectopic

beats, tachycardia, anginal
pain,
palpitation, vasoconstriction (indicated by disproportionate rise in
diastolic pressure), cold extremities; less frequent: aberrant
conduction, bradycardia, widening of QRS complex, elevated
blood pressure.
GI: Nausea, vomiting.
CNS: Headache. Skin: Necrosis,
tissue
sloughing
with
extravasation, gangrene, piloerection.
Other: Azotemia, dyspnea, dilated pupils (high doses).

Nursing implications

Assessment & Drug Effects

Monitor blood pressure, pulse, peripheral pulses, and

urinary output at intervals prescribed by physician.
Precise measurements are essential for accurate titration
of dosage.
Report the following indicators promptly to physician
for use in decreasing or temporarily suspending dose:
Reduced urine flow rate in absence of hypotension;
ascending tachycardia; dysrhythmias; disproportionate
rise in diastolic pressure (marked decrease in pulse
pressure); signs of peripheral ischemia (pallor, cyanosis,
mottling, coldness, complaints of tenderness, pain,
numbness, or burning sensation).

Monitor therapeutic effectiveness. In addition to

improvement in vital signs and urine flow, other indices
of adequate dosage and perfusion of vital organs include
loss of pallor, increase in toe temperature, adequacy of
nail bed capillary filling, and reversal of confusion or
comatose state.

Clonidine Hydrochloride (catapres)

Drug class

cardiovascular agent;
central-acting anti-hypertensive
analgesic

Therapeutic effects
Clonidine stimulates alpha-2receptors in brainstem which

results in reduced sympathetic outflow from the CNS and

decrease in peripheral resistance leading to reduced BP and
pulse rate. It does not alter normal hemodynamic response to
exercise at recommended dosages
Indications

Step 2 drug in stepped-care approach to treatment of hypertension,

either alone or with diuretic or other antihypertensive agents.
Epidural administration as adjunct therapy for severe pain.

Contraindications

Nursing implications

Assessment & Drug Effects

Pregnancy (category C),lactation. Use of clonidine patch in

polyarteritis nodosa, scleroderma, SLE

Side effects

CV: Hypotension (epidural),postural hypotension

(mild),peripheral edema, ECG changes, tachycardia, bradycardia,
flushing, rapid increase in BP with abrupt withdrawal.

GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction

of large bowel, altered taste, nausea, vomiting, hepatitis,
hyperbilirubinemia, weight gain(sodium retention).
CNS: Drowsiness, sedation, dizziness, headache, fatigue,
weakness, sluggishness, dyspnea, vivid dreams, nightmares,
insomnia, behavior changes, agitation, hallucination, nervousness,
restlessness, anxiety, mental depression.
Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis;
with transdermal patch: hyperpigmentation, recurrent herpes
simplex, skin irritation, contact dermatitis, mild erythema.
Special Senses: Dry eyes.
Urogenital: Impotence, loss of libido

Monitor BR closely. Determine positional changes (supine,

sitting, standing).
With epidural administration, frequently monitor BP and HR.
Hypotension is a common side effect that may require
intervention.
Monitor BP closely whenever drug is added to or withdrawn from
therapeutic regimen.
Monitor I&O during period of dosage adjustment. Report change
in I&O ratio or change in voiding pattern.
Determine weight daily. Patients not receiving concomitant
diuretic agent may gain weight, particularly during first 3 or 4 d of
therapy, because of marked sodium and water retention.
Supervise closely patients with history of mental depression, as
they may be subject to further depressive episodes

Hydralazine Hydrochloride (Apresoline)

Drug class

Antihypertensive, Vasodilator

Therapeutic effects
Acts directly on vascular smoothmuscle to cause

vasodilation,primarily arteriolar, decreasingperipheral

resistance; maintains or increases renal and cerebral flow.
Indications

Moderate to severe hypertension (with a diuretic). Lowering high

blood pressure helps prevent strokes, heart attacks, and kidney
problems.

CHF unresponsive to conventional therapy with Digoxin and

diuretics

Contraindications

Hypersensitivity, Severe tachycardia, Dissecting aortic aneurysm,

Heart failure with high cardiac output, Cor pulmonale,Myocardial
insufficiency due to mechanical obstruction, Coronary artery
disease, Idiopathic SLE, Patients with recent MI

Side effects

CNS: Headache, peripheral neuritis, dizziness, tremors, psychotic

reactions, characterized by depression, disorientation, anxiety
CV: Palpitations, tachycardia, angina pectoris, hypotension,
paradoxical pressor response, orthostatic hypotension
GI: Anorexia, nausea, vomiting, diarrhea, constipation, paralytic
ileus
GU: Difficult micturition, impotence
Hematologic: Blood dyscrasias
Hypersensitivity: Rash, urticaria, pruritus, fever, chills, arthralgia,
eosinophilia; rarely, hepatitis, obstructive jaundice
Other: Nasal congestion, flushing, edema, muscle cramps,
lymphadenopathy, splenomegaly, dyspnea, lupus-like syndrome,
possible carcinogenesis, lacrimation, conjunctivitis

Nursing implications

Monitor the clients blood pressure and pulse frequently during

initial dosage adjustment and periodically throughout therapy.
Report significant changes to the physician.

Monitor frequency of prescription refills to determine adherence.

Prior to and periodically during prolonged therapy the following
lab values should be monitored: CBC, electrolytes, LE Cell Prep
and ANA titer.
The nurse must be aware that Hydralazine may cause a positive
direct Coombs test result.
IM or IV route should be used only when the drug cannot be given
orally.
Hydralazine may be administered concurrently with diuretics or
beta blockers to permit lower doses and minimize side effects.
Instruct the patient not to let anyone else take his or her
medication.
Inform the patient to take hydralazine with meals or a snack.
Instruct the patient to take this medication exactly as prescribed
by the doctor. He or she should not take it in larger amounts or for
longer than recommended. Directions on the prescription label
should be followed.
It is important to remind the patient to keep using Hydralazine as
directed, even if he or she feels well. High blood blood pressure
often has no symptoms, so you may not know when your blood
pressure is high.
STORAGE: Store hydralazine at room temperature away from
moisture and heat.
In cases where the patient missed a dose he or she should take the
missed dose as soon as he or she remembers. If it is almost time for
the next dose, wait until then to take the medicine and skip the
missed dose. Do not take extra medicine to make up the missed
dose.
Instruct the patient to call the physician immediately if he or she
experiences the following symptoms: Fainting, Joint or muscle
pain, unexplained fever, Rapid heartbeat, Chest pain, swollen
ankles or feet, Numbing or tingling in hands or feet.

SALBUTAMOL (Ventolin)

FUROSEMIDE (Lasix)

Drug class

Therapeutic effects

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.

Therapeutic effects

Indications

Treatment & prevention of bronchial asthma, bronchitis,

emphysema w/ associated reversible airway obstruction.

Contraindications

Hypersensitivity to adrenergic amines

Hypersensitivity to fluorocarbons

Side effects

Nervousness, Restlessness, Tremor, Headache, Insomnia,

Chest pain, Palpitations, Angina, Arrhythmias, Hypertension,
Nausea and vomiting, Hyperglycemia, Hypokalemia

Nursing implications

Auscultate lungs for presence of adventitious breath sounds

that may signal pulmonary edema, airway resistance or
bronchospasm.
Inspect clients nail bed and oral mucosa for pallor.
Place client in position of comfort to facilitate optimum rest
and sleep.
Assess pulse for rhythm.
Provide oral care or let patient gurgle after inhalation to get
rid of the unpleasant aftertaste of the inhalation.

Loop diuretic
Pregnancy Category C
Furosemide inhibits reabsorption of Na and chloride mainly
in the medullary portion of the ascending Loop of Henle.
Excretion of potassium and ammonia is also increased while
uric acid excretion is reduced. It increases plasma-renin levels
and secondary hyperaldosteronism may result. Furosemide
reduces BP in hypertensives as well as in normotensives. It
also reduces pulmonary oedema before diuresis has set in.

Indications

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema
Oral: Hypertension

Contraindications

Severe sodium and water depletion, hypersensitivity to

sulphonamides and furosemide, hypokalaemia, hyponatraemia,
precomatose states associated with liver cirrhosis, anuria or renal
failure.
Addisons disease.

Side effects

Fluid and electrolyte imbalance.

Rashes, photosensitivity, nausea, diarrhoea, blurred
vision, dizziness, headache, hypotension. Bone marrow
depression (rare), hepatic dysfunction.
Hyperglycaemia, glycosuria, ototoxicity.
Potentially Fatal: Rarely, sudden death and cardiac arrest.
Hypokalaemia and magnesium depletion can cause
cardiac arrhythmias.

Nursing implications

Assessment

History: Allergy to furosemide, sulfonamides, tartrazine;

electrolyte depletion anuria, severe renal failure; hepatic coma; SLE;
gout; diabetes mellitus; lactation, pregnancy
Physical: Skin color, lesions, edema; orientation, reflexes, hearing;
pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern,
adventitious sounds; liver evaluation, bowel sounds; urinary
output patterns; CBC, serum electrolytes (including calcium),
blood sugar, LFTs, renal function tests, uric acid, urinalysis, weight

Therapeutic effects

Indications

Teaching points

Record intermittent therapy on a calendar or dated envelopes.

When possible, take the drug early so increased urination will not
disturb sleep. Take with food or meals to prevent GI upset.
Weigh yourself on a regular basis, at the same time and in the same
clothing, and record the weight on your calendar.
Blood glucose levels may become temporarily elevated in patients
with diabetes after starting this drug.
You may experience these side effects: Increased volume and
frequency of urination; dizziness, feeling faint on arising,
drowsiness (avoid rapid position changes; hazardous activities,
like driving; and consumption of alcohol); sensitivity to sunlight
(use sunglasses, wear protective clothing, or use a sunscreen);
increased thirst (suck on sugarless lozenges; use frequent mouth
care); loss of body potassium (a potassium-rich diet or potassium
supplement will be needed).
Report loss or gain of more than 3 pounds in 1 day, swelling in your
ankles or fingers, unusual bleeding or bruising, dizziness,
trembling, numbness, fatigue, muscle weakness or cramps.

Paracetamol may cause analgesia by inhibiting CNS

prostaglandin synthesis. The mechanism of morphine is
believed to involve decreased permeability of the cell
membrane to sodium, which results in diminished
transmission of pain impulses therefore analgesia.

Temporary relief of pain and discomfort from headache, fever,

cold, flu, minor muscular aches, overexertion, menstrual
cramps, toothache, minor arthritic pain.

Contraindications

Intravenous acetaminophen is contraindicated in patients

with severe hepatic impairment or patients with a known
hypersensitivity to acetaminophen or its excipients
(mannitol, cysteine hydrochloride, dibasic sodium phosphate,
hydrochloric acid, or sodium hydroxide). It should be used
with caution in patients with active hepatic disease,
alcoholism, chronic malnutrition, severe hypovolemia, or
severe renal impairment.

Side effects

Hematologic: hemolytic anemia, leukopenia, neutropenia,

pancytopenia, thrombocytopenia.
Hepatic: liver damage, jaundice
Metabolic: hypoglycemia
Skin: rash, urticuria

Nursing implications

Assessment & Drug Effects

PARACETAMOL (Tylenol)
Drug class

Analgesics ( Non-opioid), Antipyretics

1. Assess patients pain or temperature before therapy and

regularly thereafter.
2, Asses patients drug history and calculate total daily
dosage accordingly.

3. Be alert for signs of reactions

and drug interactions.
4. Assess patients and familys knowledge of drug therapy.

Patient & Family Education

Warn patient that high doses or unsupervised long-term use can
cause liver damage.
Tell patient to keep track of daily drug intake, including OTC
and prescription medications.
Tell a breast-feeding woman that drug appears in breast milk in
levels less than 1% of dose.