1.

KETEROLAX TROMETAMOL Classification: nonsteroidal anti-inflamatory drug

DOSAGE

USES AND ACTION

Ketorolac tablets and injection are used to treat pain straight after an operation.

PHARMACOKINETICS

CONTRAINDICATION

SIDE-EFFECTS

NURSING RESPONSIBILITIES
Should be taken with food. To prevent GI upsets.

IM administration is rapidly and Hypersensitivity to the drug or allergic Diarrhea

completely absorbed. A mean peak plasma concentration of 2.2g/ml occurred an average of 50 minutes after a single 30mg dose.
symptoms to aspirin or other NSAIDs. Headache Active or history peptic ulcer disease, recent GI bleeding or perforation. Advanced renal impairment and in those at risk for renal failure due to volume of depletion. Feeling dizzy, lightheaded or sleepy Nausea Dyspepsia Epigastric pain/ GI pain Edema

Oral For Adult: 10mg every 4-6hr. Max: 40mg/day. Max duration: 7 days. For Elderly: 10mg every 6-8hr. Max: 40mg/day. Max duration: 7 days.

Ketorolac eye drops are used to prevent and reduce inflammation (swelling, redness and heat) and pain of the eye after eye surgery.

Avoid alcohol, aspirin and all OTC against w/o approval.

Parenteral For Adult: 10mg IM/IV followed by 10-30 mg every 4-6 hr if necessary. Max: 90 mg/day (60mg/day in patients wt. <50 kg). For Elderly: Max: 60 mg/day.

It is used to block the action of prostaglandins, which are produced by the pain in response to injury and disease and cause swelling, pain and inflammation.

IV administration of single 10mg dose of ketorolac resulted in a mean peak plasma concentration of 2.4g/ml at an average of 5.4 minutes after dosing. The terminal plasma elimination halflife was 5.1 hours, average volume of distribution 0.15 l/kg, and total plasma clearance 0.35ml/min/kg.

Report any unusual bruising/bleeding, weight gain, SOB chest pain, increased joint pain and change in urine pattern

Suspected or confirmed with a high risk of bleeding.

Women attempting to conceive

2. TRAMADOL HYDROCLORIDE Classification: analgesic, centrally acting

DOSAGE
IMMEDIATE-RELEASE For rapid onset: 50-100mg every 46hr. But not to exceed 400mg.

USES AND ACTION

Management of moderate to moderately severe pain in adults.

PHARMACOKINETICS
Rapidly and almost completely absorbed after oral administration of 50 mg capsules following a mean absorption delay of approximately thirty minutes.

CONTRAINDICATION
Hypersensitivity to tramadol, opioids, or any component of the formulation;

SIDE-EFFECTS
Nausea Constipation, Dizziness Sweating, Dry mouth Diarrhea Itching Somnolence Anorexia Insomnia

NURSING RESPONSIBILITIES

Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Monitor patient for seizures. May occur within recommended dose range. Overdose may cause respiratory depression and seizures. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

For moderate to moderately severe chronic pain : Initial dose: 25 mg every morning Titration: increase in 25 mg increments as separate doses every 3 days to reach 100 mg per day taken as 25 mg 4 times per day. Then the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg per day taken as 50 mg 4 times per day. Maintenance: After titration, 50 mg to 100 mg can be administered as needed for pain relief every 4 to 6 hours not to exceed 400 mg per day

Binds to opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of nor epinephrine and serotonin, which also modifies the ascending pain pathway.

opioid-dependent patients;

Onset: 1 hr Peak effect: 2-3hr Peak plasma level: 2 hr

acute intoxication with alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic drugs

use in children less than 16 y/o, safety and efficacy have not been determined

EXTENDED-RELEASE Initial dose: 100 mg once daily Titration: 100 mg increments every 5 days to relief of pain and individualized according to patient need and tolerability. Maximum dose: 300 mg per day

1. DOXYCYLINE CAPSULES Classification: Anti-biotic, Tetracycline

DOSAGE
PO

USES AND ACTION

A tetracycline antibiotic that fights bacteria in the body.

PHARMACOKINETICS
More slowly absorbed, and thus more persistent, than other tetracycline. Preferred for clients with impaired renal function for treating infections outside the urinary tract.

CONTRAINDICATION
Hypersensitivity tetracycline. to any of the

SIDE-EFFECTS
Most Common:

NURSING RESPONSIBILITIES
Should be taken with full glass of water to prevent esophageal ulceration and remain upright for 45 mins.

For Adults: The usual dose is 200 mg on the first day of treatment (administered 100 mg every 12 hours or 50 mg every 6 hours) followed by a maintenance dose of 100 mg/day.

Prophylaxis of malaria in pregnant individuals and in children less than 8 y/o Lactation

Anorexia Nausea Vomiting Diarrhea Dizziness Headache Rashes Avoid excessive sunlight or artificial ultraviolet light while receiving Doxycycline and to discontinue therapy if phototoxicity occurs. Sunscreen or sun block should be considered Should not be taken with aluminum, calcium, or magnesium, and iron-containing preparations. Absorption of tetracyclines is impaired by antacids.

For children: if weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days.

Use to treat bacterial infections caused by gram-negative organisms, Rickettsiae, Mycoplasma Pneumoniae, Chlamydia trachomatis, Chlamydia psittaci, Ureaplasma urealyticum, Borrelia recurrentis.

High lipid solubility

Plasma protein binding: from 80=90%

Doxycycline might increase the incidence of vaginal candidiasis.

1. ERYTHROMYCIN STEARATE (film-tablets) Classification: anti-biotic, macrolide

DOSAGE
PO

USES AND ACTION

It is known as a macrolide antibiotic. It works by stopping the growth of bacteria. Used to treat or prevent a wide variety of bacterial infections caused by Streptococcus pyogenes , Streptococcus pneumoniae, Listeria monocytogenes, Mycoplasma pneumonia, Bordetella pertussis, Corynebacterium diphtheriae, Corynebacterium minutissimum, and Neisseria gonorrhoeae The drugs are effective only against rapidly multiplying organisms.

PHARMACOKINETICS
Absorbed from the upper part of the small intestine. Those for PO use are manufactured in enteric coated or filmcoated forms to prevent destruction by gastric acid.

CONTRAINDICATION
Hypersensitivity to erythromycin

SIDE-EFFECTS
Most Common:

NURSING RESPONSIBILITIES
Should be taken with empty stomach. Food decrease absorption.

For Adults: 250 mg every 6 hours; or 500 mg every 12 hours. Dosage may be increased up to 4 g per day according to the severity of the infection.

Hepatic impairment Achieves concentrations in the body tissues about 40% of those in plasma.

Use with terfenadine, astemizole, cisapride, or pimozide

For children: 30 to 50 mg/kg/day, in equally divided doses. For more severe infections this dosage may be doubled but should not exceed 4 g per day.

Diffuse poorly into spinal fluid, although penetration is increased in meningitis.

Abdominal pain Headache Nausea Diarrhea Rash Vomiting Dyspepsia Flatulence Pain Pruritus

Consume up to 8 oz of water with each dose and ensure a fluid intake of 2.5 L/day

Report any supernfection

Report hearing loss Alkalinization of urine increases the gram-negative anti-bacterial action.

Peak serum level: 1-4 hrs

Plasma protein binding: app. 70%

DOSAGE
Initial dosage varies from 0.5 to 9 mg a day depending on the disease being treated. In less severe diseases doses lower than 0.5 mg may suffice, while in severe diseases doses higher than 9 mg may be required. .

USES AND ACTION

Is a corticosteroid hormone (glucocorticoid). Used to treat various conditions such as severe allergic reactions, arthritis, blood diseases, breathing problems, certain cancers, eye diseases, intestinal disorders, and skin diseases. It is also used to test for an adrenal gland disorder (Cushing's syndrome) Rapid onset and short duration of action.

PHARMACOKINETICS
Rapid onset and short duration of action.

CONTRAINDICATION
Acute infections persistent positive sputum cultures of Candida Albicans

SIDE-EFFECTS
Stomach upset headache dizziness

NURSING RESPONSIBILITIES
Monitor BP, weight, mental status, serum glucose, electrolytes.

Use during pregnancy only if benefits outweighs risk. Lactation

nausea menstrual period changes trouble sleeping increased appetite weight gain pain/redness/swelling at the injection site may occur.

Do not exceed dose

May take with food to reduce stomach upset.

Report adverse reactions: lack/loss of response, worsening the symptoms, excessive thirst and urinary frequency.

Avoid exposure to chickenpox or measles.

1. DEXAMETHASONE SODUIM PHOSPHATE Classification: Glucocorticoid