Drug Name Generic Name: Hydrocortisone Brand Name: Solu-Cortef Functional Name: Glucocorticoid

Dose 250 mg/ 2ml vial

Mechanism Of Action Glucocorticoid with anti- inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leukocytes, and fibroblasts at sites of inflammation, phagocytosis and lysosomal enzyme release. It can also cause the reversal of increased capillary permeability.

Indications and Contraindications Indications: Endocrine, rheumatic and hematologic disorders. Collagen, dermatologic, opth, GI, respiratory and neoplastic diseases. Allergies. Acute exacerbations of TB meningitis w/ subarachnoid block, trichinosis. Multiple sclerosis. Contraindications: Systemic fungal infections, administration of live/ live attenuated vaccine.

Side Effects and Adverse Reactions Side Effects: Dryness; itching, Difficulty sleeping; dizziness or lightheadedness; headache; increased appetite; increased sweating; indigestion

Nursing Considerations

Assessment: - Assess patients condition before starting therapy and reassess regularly. - Monitor patients weight, blood pressure, glucose and electrolyte levels. Adverse Reactions: - Monitor for possible drug induced adverse Severe allergic reactions, reactions. black, tarry stools; chest pain; - Assess mental status. eye pain or increased Planning: pressure in the eye; fever, - Give only sodium chills, or sore throat; joint or phosphate product IV. bone pain; mood or mental - Maybe given by changes; muscle pain or intermittent infusion in compatible solution. weakness; seizures; severe or - Give titrated dose; use persistent; stomach pain or lowest effective dosage. bloating; swelling of feet or Implementation; legs; unusual weight gain or - Advise patient to wear loss; vision changes emergency ID as steroid user. - Caution patient on use of OTC products that contain salicylates and alcohol

Drug Name Generic Name: Isosorbide Dinitrate Brand Name: Isoket Functional Class: Vasodilator

Dose 10 mg/1o ml amp

Mechanism Of Action Increases supply of oxygen to the heart by dilating both the arteries and veins which supply the heart itself.

Indications and Contraindications Indications: MI. unresponsive left ventricular failure, sever unstable angina pectoris, pulmonary hyprertension Contraindications: Very low BP, cardiogenic shock, acute circulatory failure, vascular prolapse

Side Effects and Adverse Reactions Side Effects: Orthostatic hypotension, tachycardia, headache, flushing, dizziness. Adverse Reactions: Hypoxemia, cerebral ischemia, erythema, paradoxical bradycardia

Nursing Considerations Assessment: - Assess pain; duration, time started, activity being performed, character, intensity - Monitor vital signs at baseline and during treatment Planning: - Give 1 hour before or 2 hours after meals with 8 oz of water - Sustained release tabletshould not be chewed, boken or crushed; tablet should be chewed thoroughly Implementation: - Warn patient to avoid alcohol and OTC medications - Warn patient to avoid driving and hazardous activities if dizziness occurs. - Caution patient to make position changesss slowly to prevent orthostatic hypotension.

Drug Name Generic Name: Norepinephrine Brand Name: Levophed Functional Class: Inotropic drug

Dose 4mg

Mechanism Of Action Powerful peripheral vasoconstrictorand as a potent inotropic stimulator of the heart and dilator of coronary arteries.

Indications and Contraindications Indications: Blood pressure control in certain acute hypotensive states. As an adjunct in the treatment of cardiac arrest and profound hypotension. Contraindications: Pregnancy

Side Effects and Adverse Reactions Side Effects: Bradycardia, respiratory difficulty, transient headache. Adverse reactions: Ischemic injury, arrythmias, extravasation necrosis at injection site, plasma volume depletion on prolonged administration.

Nursing Considerations Assessment: - Obtain baseline vital signs, neurological assessment, urine output and ECG - Monitor for cyanosis - Assess for signs of extravasation at injection site. Planning: - Administer by IV in D5w or D5 saline; do not prepare infusion with normal saline alone because it may cause degradation. - Use infusion pump and plastic catheter; enter antecubital or other large vein. - Do not discontinue abruptly - Discard solution after 24 hours. Implementation: - Inform patient the reason for drug administration - Advise patient to notify nurse if IV site feels cool or painful

Drug Name Generic Name: Labetalol Brand Name: Trandate Functional Class: Adrenergic receptor blocking agent

Dose 100 mg/20 ml vial

Mechanism Of Action Competitively inhibits the adrenergic stimulation of receptors within the myocardium, bronchial and vascular smooth muscle, and 1receptors within vascular smooth muscle. It also has some intrinsic 2agonist and membrane-stabilising activity

Indications and Contraindications Indications: Management of hypertension Contraindications: Bronchial asthma, overt cardiac failure, greater than first degree heart block, cardiogenic shock, severe bradycardia, other conditions associated with severe and prolonged hypotension, and in patients with a history of hypersensitivity to any component of the product

Side Effects and Adverse Nursing Considerations Reactions Side Effects: Assessment Dizziness; tingling of the scalp - History: Sinus or skin; Abdominal or bradycardia, second- or stomach pain, black, tarry third-degree heart block, stools, drowsiness, low cardiogenic shock, energy. CHF, asthma, pregnancy, lactation, diabetes or Adverse Reactions: hypoglycemia, Depression, chronic heart nonallergic failure, bronchospasm, bronchospasm, abnormal heart rhythm, joint pheochromocytoma pain, hallucination, - Physical: Weight, skin hypersensitivity condition, neurologic status, P, BP, ECG, respiratory status, kidney and thyroid function, blood and urine glucose. Planning: - Do not discontinue drug abruptly after long-term therapy. - Consult with physician about withdrawing the drug if the patient is to undergo surgery - Keep patient supine during parenteral therapy, and assist initial ambulation. - Position to decrease effects of edema.

Drug Name Generic Name: Lidocaine Brand Name: Xylocaine Functional Name: Anesthetic topical or local, Antiarrythmics

Dose 2% 50mL vial

Mechanism Of Action 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 and Contraindications Indications: Ventricular arrhythmias, self-injected or when IV is unavailable during transport to local facilities, infiltration or mucosal or topical anesthetic, used when pain is present due to post-herpetic neuralgia Contraindications: Hypersensitivity Advanced AV block

Side Effects and Adverse Reactions Side Effects: Drowsiness, dizziness, nervousness(mucosal use) decreased or absent gag reflex, bradycardia, hypotension, burning sensation Adverse Reactions: Confusion, excitation, blurred or double vision, nausea and vomiting, ringing in the ears, tremors, twitching, seizures, difficulty breathing, severe dizziness and fainting, unusually low heart rate

Nursing Considerations Assessment: - Monitor the ECG continuously. Blood pressure and respiratory status should be monitored frequently during the drug administration. - Serum Lidocaine levels should be monitored frequently during prolonged use. Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/ml. Planning: - 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.

Drug Name Generic Name: Magnesium Sulfate Brand Name: Sulfamag Functional Name: anticonvulsant

Dose

Mechanism Of Action

2500mg/10mL Inhibits convulsion by amp acting at the myoneural junction to prevent release of acetylcholine and to decrease the motor and plate potential. It inhibits the contraction of the uterus by directly acting on the myometrial cells and enhancing uterine blood flow.

Indications and Contraindications Indications: Acute hypomagnesemia accompanied by signs of tetany, to control hypertension, encephalopathy and convulsions and for the prevention and control of convulsions in patients with pre-eclampsia or eclampsia Contraindications: Patients with heart block or myocardial damage.

Side Effects and Adverse Reactions Side Effects: Breathing difficulties; poor reflexes, ow body temperature; severe headache; fainting; rash; vision problems;. Adverse Reactions: Flushing, sweating, hypotension, muscular weakness, sedation and confusion.

Nursing Considerations Assessment: - Assess for contraindicated conditions. - - Monitor knee-jerk reflex beforerepeated parenteral administration. - Give as laxative as temporarymeasure. Reserve IV use in eclampsia for lifethreatening situations. Observe the 15 rights in drug administration. Planning: - Give IM route by deep IM injection.- Monitor serum magnesium levels. - Do not give oral MgSO4 with abdominal pain, nausea, orvomiting. - Do not administer if knee-jerkreflexes are suppressed - Monitor bowel function

Drug Name Generic Name: Methylprednisolone Brand Name: Medrol Functional Name: Corticosteroid

Dose 125 mg/2mL vial

Mechanism Of Action Naturally-occurring chemicals produced by the adrenal glands located adjacent to the kidneys.Corticosteroids affect metabolism in various ways and modify the immune system. Corticosteroids also block inflammation and are used in a wide variety of inflammatory diseases affecting many organs.

Indications and Contraindications Indications: Suppression of inflammatory disorders, including rheumatoid arthritis, systemic lupus erythematosus, ulcerative colitis and Crohn's disease. Severe allergic conditions: bronchial asthma; allergic rhinitis; and contact and atopic dermatitis. Chronic skin conditions including dermatitis herpetiformis, severe psoriasis and severe seborrhoeic dermatitis. Cerebral oedema linked to malignancy. Contraindications: Systemic infection. Avoid live virus vaccines

Side Effects and Adverse Reactions Side Effects: Vertigo,headache, hypertension and CHF secondary to fluid retention, abdominal distention, nausea, vomiting, increased appetite, weight gain, muscle weakness Adverse Reactions: paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP,glaucoma,Hypotension, shock, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias, Na+ and fluid retention, hypokalemia, hypocalcemia , Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, Peptic or esophageal ulcer, pancreatitis, Anaphylactoid reactions

Nursing Considerations Assessment: - Assess for potassium depletion (fatigue, nausea, vomiting, depression, polyuria, dysrhythmia and weakness). - Assess for hypertension, oedema and cardiac symptoms. - Assess for mental status. Rotate sites in IM injection. Planning: - Increase potassium, calcium and protein intake. - Do not discontinue suddenly (can precipitate adrenal crisis). - Avoid OTC products unless cleared with prescriber. - Educate on symptoms of adrenal insufficiency (anorexia, dizziness, dyspnoea, fatigue, joint pain, nausea and weakness).