NAME OF THE DRUG Generic Name: epinephrine Brand Name: Injection, Adrenalin Chloride

DOSAGE/ ROUTE 3cc IV

ACTION/ CLASSIFICATION Action: Stimulates beta receptors in lung. Relaxes bronchial smooth muscle. Increases vital capacity BP, HR, PR Decreases airway resistance. Classification: Beta2 Adrenergic Agonists

INDICATIONS/ CONTRAINDICATIONS Indications: o Asthma o Bronchitis o Emphysema o All cardiac arrest, anaphylaxis o Used for symptomatic bradycardia. o Relief of bronchospasm occurring during anesthesia o Exercised-induced bronchospasm Contraindications: Contraindicate in patients with angle-closure glaucoma, shock (other than anaphylactic shock), organic brain damage, cardiac dilation, arrhythmias, coronary insufficiency, or cerebral arteriosclerosis. Also contraindicated in patient receiving general anesthesia with halogenated hydrocarbons or cyclopropane and in patients in labor (may delay second stage)

ADVERSE EFFECTS y y y y y Nervousness tremor, vertigo, pain, widened pulse pressure, y hypertension y nausea

NURSING RESPONSIBILITIES y Monitor V/S. and check for cardiac dysrhythmias y Drug increases rigidity and tremor in patients with Parkinsons disease y Epinephrine therapy interferes with tests for urinary catecholamine y Avoid IM use of parenteral suspension into buttocks. Gas gangrene may occur y Massage site after IM injection to counteract possible vasoconstriction. y Observe patient closely for adverse reactions. Notify doctor if adverse reaction develop y If blood pressure increases sharply, rapid-acting vasodilators such as nitrates or alpha blockers can be given to counteract

Some products containing sulfites and are contraindicated in patients with sulfite allergies except when drug is used for serious allergic reactions or in other emergency situations. Use cautiously with longstanding bronchial asthma and emphysema, who have developed degenerative heart disease and in those with hyperthyroidism, CV disease, hypertension, psychoneurosis, or diabetes.

DRUG NAME

DOSAGE/ ROUTE Neb q6

ACTION / CLASSIFICATION Action:

INDICATION/ CONTRAINDICATION y y y y y y y y

ADVERSE EFFECT Nausea and y vomiting Heart burn y Unusual or bad taste in mouth Repiratory difficulties Pulmonary edema y Coughing Bronchospasm Paradoxical airway ressitance with repeated, execessive use of inhalation preparations y

NURSING RESPONSIBILITY Observe 10 rights in giving medications. Use minimal doses for minimal periods; drug tolerance can occur with prolonged used. Maintain a adrenergic blocker ( cardioselective beta blocker, such as atenolol, should be use with respiratory distress ) on standby in case cardiac arrhythmias occur. Prepare solution for inhalation by diluting 0.5 ml 0.5% solution with 2.5 ml normal saline ; deliver over 5 15 minuts by nebulization. Do not exceed the recommended dosage; administer pressurized inhalation drug forms during second half of inspiration, because the airways are open wider and the aerosol

Brand name: Salbutamol Neb Generic Name: Albuterol Sulfate

Indication y Relief and prevention In low doses, acts of brochospasm in relatively selectively at patients with reversible beta 2 adrenergic obstructive airway receptors to cause disease. bronchodilation and y Inhalation: treatment vasodilation; at higher of acute attacks of doses, beta 2 brochospasm. selectivity is lost, and y Prevention of exercisethe drug acts at beta 2 induced brochospasm. receptors to cause y Unlabeled use: adjunct typical in treating serious sympathomimetic hyperkalemia in cardiac effect. dialysis patients; seems to lower Classification: potassium Antasthmatic concentration when inhaled by patients on hemodialysis. Contraindication y Contraindicated with hypersensitivity to albuterol; tachyarrhythmias, tachycardia cause by digitalis intoxication. y Use cautiously with diabetes mellitus;

hyperthyroidism, history of seizure disorders.:

distribution is more extensive.

NAME OF THE DRUG

DOSAGE/ ROUTE

INDICATION/ CLASSIFICATION

ACTION/ CONTRAINDICATION

ADVERSE REACTION

NURSING CONSIDERATION

Generic Name: DIAZEPAM Brand name: Valium

5mg IV

Indication: Symptomatic relief of anxiety, agitation, tension Classification: Anticonvulsant/ hypnotics/sedative/an xiolytics

Action: Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep Contraindication: Hypersensitivity. Dependence, withdrawal symptoms

y y y y y y y y y y y y y y

Dizziness, fatigue, blurred vision, dependence, withdrawal reactions, constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, phlebitis and thrombosis at IV injection sites.

y inform pt. that drug may be taken with food y advice pt. not to abruptly discontinue drug after long term use y advice pt. to avoid driving and activities that require alertness bec, drug can cause drowsiness y inform pt. that smoking may decrease effect y monitor EEG in patients treated for status epilipticus; seizure may recur after initially control, presumably because of short duration of that effect. y carefully monitor blood pressure, pulse rate, respiration during IV administration

NAME OF THE DRUG Generic Name Hydrocortiso ne Trade Name Cortef, SoluCortef, Hydrocorton e, Cortenema

DOSAGE/ ROUTE 2OOmg IV

ACTION/ CLASSIFICATION Action: Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its anti-inflammatory, immunosuppressive (glucocorticoid), and salt-retaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use. Classification: Pharmacologic Class Adrenal cortical steroid Corticosteroid Glucocorticoid Therapeutic Class Hormone

INDICATION/ CONTRAINDICATION Indication: -Replacement therapy in adrenal cortical insufficiency - Allergic states severe or incapacitating allergic conditions - Hematologic disorders - Ulcerative colitis Contraindication: Concentrations - Allergy to any component of the drug - Fungal infections - Amebiasis - Hepatitis B - Vaccinia or varicella - Antibiotic-resistant infections - Immunosuppression

ADVERSE REACTION y y y y y y Vertigo headache insomnia Hypotension shock, HPN and heart failure secondary to fluid retention, Thin, fragile skin, petechiae, ecchymosis Amenorrhea irregular mens, nausea, vomiting, increased appetite and weight gain Muscle weakness, , spontaneous fractures

NURSING RESPONSIBILITIES Before - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration. During - Give daily before 9am to mimic normal peak diurnal corticosteroid levels. - Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse effects. - Do not give IM injections if patient has thrombocytopenic purpura. - Taper doses when discontinuing high-dose or long-term therapy. After

y y y y y y y y

- Monitor client for at least 30 minutes. - Educate client on the side effects of the medication and what to expect. - Instruct client to report pain at injection site. - Instruct client to take drug exactly as prescribed. - Dispose of used materials properly. - Document that drug has been given.

NAME OF THE DRUG Generic Name: Sodium Bicarbonate Brand Name: Arm and Hammer Pure Baking Soda, Citrocarbonate, Soda Mint

DOSAGE/ ROUTE 50mg

ACTION/ CLASSIFICATION Action: Neutralizes gastric acid Decrease pepsin activity Classification: Alkalizing Agent, Buffer, Antacid, electrolyte

INDICATION/ CONTRAINDICATION Indications: o Hyperacidity o Peptic ulcer o Hyperkalemia o Tricyclic antidepressant OD o Shock associated with severe diarrhea, dehydration, uncontrolled DM o Reflux esophagitis Contraindications: Contraindicated in patients with metabolic or respiratory alkalosis; patients who are losing chlorides from vomiting or continuous GI suction; patients taking diuretics known to produce and patients with hypocalcemia in which alkalosis may produce tetany, hypertension, seizures, or heart failure.

ADVERSE EFFECT Adverse Effects: y Gastric distention, y belching, y flatulence. y metabolic alkalosis, y hypernatremia, y hypokalemia, y hyperosmolarity (with overdose). y Pain and irritation at injection site.

NURSING RESPONSIBILITIES y Monitor urinary pH, calcium, electrolytes and phosphate levels. y Record amount and consistency of stools. y Clients on lowsodium diets should evaluate sodium contents of antacids. y Monitor Arterial blood gasses, and calculate base deficit when administering parenteral sodium bicarbonate. y Monitor cardiac rhythm carefully during IV insertion y Do not give oral sodium bicarbonate within 1-2hrs. of other oral drugs to reduce risk of drug interruption.

NAME OF THE DRUG Generic Name Magnesium Sulfate Trade Name Martham

DOSAGE/ ROUTE

ACTION/ INDICATION/ CLASSIFICATION CONTRAINDICATION Action: Cofactor of many enzyme systems involved in neurochemical transmission and muscular excitability; prevents or controls seizures by locking the neuromuscular transmission; attracts and retains the water in the intestinal lumen and distends the bowel to promote mass movement and relieve constipation. Indications: - Constipation - Torsades de pointes - Muscle stimulating effects of barium poisoning - Reduction of cerebral oedema. - Hypomagnesaemia - Seizures associated with epilepsy, glomerulonephritis or hypothyroidism. - Toxemias of pregnancy - Boils and carbuncles Contraindications: Concentrations - Allergy to magnesium products - Abdominal pain - Nausea - Vomiting - Acute surgical abdomen - Fecal impaction - Intestinal and biliary tract obstruction - Hepatitis - Myocardial damage - Heart blocks - 2 hr preceding delivery

Adverse Reaction

Nursing Responsibilities

500 mg IV q6 x 4 doses

y y y y y y y y y y y

Weakness, drowsiness, dizziness, fainting, sweating Decreased respiratory rate Palpitations Excessive bowel activity, perianal irritation Magnesium intoxication, hypocalcemia with tetany

Before - Assess for contraindicated conditions. - Monitor knee-jerk reflex before repeated parenteral administration. - Give as laxative as temporary measure. - Reserve IV use in eclampsia for life-threatening situations. - Observe the 15 rights in drug administration. During - Give IM route by deep IM injection. - Monitor serum magnesium levels. - Do not give oral MgSO4 with abdominal pain, nausea, or vomiting. - Do not administer if knee-jerk reflexes are suppressed - Monitor bowel function. After - Arrange to discontinue administration as soon as levels are within normal limits and desired clinical response is obtained. - Discontinue if diarrhea or

Classification: Pharmacologic Class Mineral, Electrolyte Therapeutic Class Antiepileptic, Laxative; Mineral, electrolyte replacement

Precaution - Renal insufficiency Drug interaction Drug to drug - Potentiation of neuromuscular blockade produced by nondepolarizing neuromuscular relaxants Drug to food - none reported

cramping occurs. - Arrange for dietary measures, exercise and environmental control to return to normal bowel activity. - Report sweating, flushing, muscle tremors or twitching, inability to move extremities. - Maintain urine output at a level of 100 mL every 4 hr during parenteral administration.

NAME OF THE DRUG Generic name: Amoxicillin Brand name: Coamoxiclav

DOSAGE/ ROUTE

ACTION/ INDICATION/ CLASSIFICATION CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES

312.5/5ml

Action: Inhibits enzymes involved in formation of peptidoglycan layer of bacterial cell wall No effect on human cell walls Bactericidal; only works on dividing bacteria Well absorbed enterally Clavulanic acid inhibits bacterial lactamase

Indication: Lower resp tract infections, otitis media, sinusitis, skin & soft tissue infections, UTI, pre & post-surgical procedures, bone & joint, O & G infections, dental infections. Contraindication: History of penicillin hypersensitivity. Superinfections involving Pseudomonas or candida. Pregnancy & lactation

Allergic reactions itching, rashes, fever Hepatitis Diarrhea Vomiting Anemia

Classification Antibiotic

y Obtain patients history of allergy y Assess for signs and symptoms of infection y Monitor swallowing of oral administration medication y Monitor vital signs of patient y Assess for allergic reactions during treatment: rash, urticaria, pruritus, chills, fever, joint pains y Monitor signs of nephrotoxicity: oliguria, proteinuria, increased BUN, and creatinine y Assess for bowel patterns and signs of dehydration y Monitor for bleeding