Icu&Er Drugs

....
Commonly !"# #$%! &n

'm"$%"n(y ) *C+
,-./
0000000000000000001 2345 000000000000000
6oon l&%78
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@$!&n% Ao(8o$
BCB1 DEEF
0

G7H$mH(olo%y,
- It is a Latin word meaning drug knowledge.
- Pharmacou = drug.
- Ology = science or knowledge.
A$%, is defined by the United States food and drug administration as a substance or
agent used in diagnosis cure !re"ention mitigation or treatment of a disease of
condition.#
@Hm&n% oI #$%!,J
$. %eneric name& 'chemical name( defines the chemical structure.
). *rade name& is gi"en by s!ecific !harmaceutical com!any.
K$"%nHn(y (H8"%o$y
+ system of classifying drugs according to their established risks for use during !regnancy.
CH8"%o$y L, ,ontrolled human studies ha"e demonstrated no fetal risk. CH8"%o$y M, +nimal
studies indicate no fetal risk but no human studies- or ad"erse effects in animals but not in well.
controlled human studies. CH8"%o$y C, /o ade0uate human or animal studies- or ad"erse fetal
effects in animal studies but no a"ailable human data. CH8"%o$y A, 1"idence of fetal risk but
benefits outweigh risks. CH8"%o$y N, 1"idence of fetal risk. 2isks outweigh any benefits
OCommonly !"# HPP$"Q&H8&on! O
23 = symbol for a !rescri!tion
a.c. = before meals mg = milligram
alt. hor. = e"ery other hour mcg =microgram
+.4.or a.m. = morning 4e0=milliegui"alent
+0 = water ml = milliliter
a.u. = each ear both ears /% = /asogastric
a.d. = right ear ng = nanogram
a. l. = left ear /PO = nothing by mouth
b.i.d. =two times a day o.d. = e"ery day
5U/ = blood urea nitrogen O.6. = right eye
c = with o.h. = e"ery hour
,a!s = ca!sules o.s. o.L. = left eye
,78 = congesti"e heart failure os =mouth
$
cm = centimeter o.u. = each eye both eyes
o9. = once d. = day
!.c. = after meals : = right
dc = discontinue !.o. = by mouth
dl = deciliter P.2. = by rectum
dr = dram !er = by through
eli3. = eli3ir !rn = when necessary
g 'gm( = gram 0 = e"ery
gr = grain 0.d. = e"ery day
gtt = a dro! dro!s 0.h. = e"ery bour
%U = genitourinary 0hs = e"ery night
7 hr = hour 0)h = e"ery ) hours
h.s. = at bed time 0id = ; times daily
I.4. = intramuscular 0od = e"ery other day
I.<. = intra"enous =g = kilogram
L = liter s = without
4in = minute SS = one. half
Sc = subcutaneous Syr = syru!
SL = sublingual stat = immediately
SOS = if necessary once only tab. = tablet
Sol = solution t.i.d. = > times daily
4g = microgram U = unit
<.O. = "erbal order
OR"&%78! ) 6"H!$"! O O$ teas!oonful = about ? ml
$ tables!oonful = about $? ml @$ !ound 'lb( = ;?; gram
$ dro! = $ minim @$ kg = ).) lebra 'lb(
$ gm = $? grains @$ ml = $? minims
)
A$% GH%" A$% GH%"
$. +cetamino!hen
?
). +cetylsalicylic +cid A
>. +cti"ated ,harcoal B
;. +drenaline
C
?. +llumag
$0
A. +llo!urinol
$$
D. +mikacin
$)
B. +mino!hylline
$>
C. +miodarone
$;
$0.+m!icillin
$A
$$. +m!hotercin
$D
$).+tenolol
$B
$>.+tor"astatin
$C
$;.+tracrium
)0
$?.+tro!ine
)$
$A.5iso!rolol
))
$D.,alcium
)>
$B.,a!to!ril
)?
$C.,ar"edilol
)D
)0.,efa9olin
)B
)$.,efota3ime E ,laforan F
)C
)).,efta9idime F 8ortum F
>0
)>.,eftria3one E 2oce!hin F
>$
>
);.,efuro3ime E Ginacef E
>)
)?.,hloram!henicol
>;
)A.,hlor!roma9ine
>?
)D.,i!roflo3acin
>A
)B.,lindamycin
>D
)C.,lo3acilin
>C
>0.6e3amethasone
;0
>$.6ia9e!am F+ssi"al
;)
>).6iclofenac Sodium
;>
>>.6igo3in
;?
>;.6iltia9im
;A
>?.6obutamine
;B
>A.6o!amine
?0
>D.6o3ycyclin
?)
>B.1nala!ril
??
>C. 1no3a!arin F,le3aneF
?D
;0.1!hdrine
?C
;$.1rythromycin
A)
;).1some!ra9ole
AD
;>.8entanyl
AC
;;.8luma9enil F +ne3ateF D$
;?.8urosemiade
D>
;A.%entamycin
D?
;D.%libenclamide E 6aonil E DA
;B.%lucagon
DD
;C.7alo!eridol
DB
?0.7e!arin
B$
?$.7uman +lbumin B>
?).7ydrocortisone
B;
?>.7ydrala9ine
BD
?;.7yoscine 5utyl!romide
BB
??.I!rtro!ium 5romide BC
?A.Iso!roterenol
C$
?D.=etamine
C>
;
?B.Lidocaine
C;
?C.4agnesium Sul!hate CA
A0.4annitol
CD
A$.4e!eridine F Pethidine F CC
A).4etformin
$0$
A>.4ethyl!rednisolone
$0)
A;.4etoclo!ramide
$0;
A?.4etronida9ole
$0?
AA.4ida9olam
$0D
AD.4or!hine
$0B
AB./.acetylcystine
$$0
AC./alo3ane
$$$
D0./efidi!ine
$$)
D$./eostigmine
$$;
D)./itrates
$$?
D>./itro!russide
$$A
D;./oradrenaline
$$B
D?.Ome!ra9ole
$)0
DA.Octreotide F SandostatinE $)$
DD. O3ytocin
$)>
DB.Pancuronium
$);
DC.Penicillin %
$)?
B0.Phenobar!itol
$)A
B$.Phenytoin
$)B
B).Potassium ,hloride
$)C
B>.Prednisolone
$>0
B;.Prometha9ine
$>>
B?.Pro!ofol
$>;
BA.Pro!ranolol
$>A
BD.Protamine Sul!hate $>D
BB.Huinidine Sul!hate $>B
BC.2anitidine
$;0
C0.2egular Insulin $;$
C$.Salbutamol E <entolin E )C
C).Sodium 5icarbonate
$;;
?
C>.S!ironolactone
$;A
C;.Stre!tokinase
$;D
C?.Succinyl ,holine
$;B
CA.*hio!ental Sodium E
PentothalE$;C
CD.*hyro3ine E 1ltro3inE $?$
CB.*rane3amic acid E $?>
CC. <al!roate Fsodium E $?;
$00. <ancomycin $?A
$0$. <era!amil
$?D
$0). <itamin k
$?B
$0>. Iarfarin
$?C
A
Commonly !"# #$%! &n 'm"$%"n(y Hn# *C+
S. GH$H("8Hmol T , T L("8Hm&noK7"n
U$H#" nHm"!& acamol !anadol
ClH!!, anti!yretic non o!ioid analgesic Para.amino!henol ty!e.
G$"%nHn(y, ',ategory 5(
L(8&on, +cetamino!hen decrease fe"er by an effect on hy!othalamus
leading to sweating J "asodilatation.
It also inhibits the effect of !yrogens on the heat.regulating
,enter on the hy!othalamus.
It may cause analgesia by inhibiting ,/S !rostaglandin syntheses
So it has no anti.inflammatory effect.
It doesnKt manifest any anticoagulant effect or any ulceration of %I*.
+!"!,
Pain due to 7eadache dysmenorrhea arthralgia myalgia muscluoskletal !ain
immuni9ation teething tonsillectomy.
*o reduce fe"er due to bacterial J "iral infection.
+s a substitute for as!irin when contraindicated.
Con8$H&n#&(H8&on!,
2enal insufficiency anemia.
V&#" "II"(8!,
,hronic J e"en acute to3icity can occur after long sym!tom.free usage.
7emolytic anemia neutro!nea thrombocyto!enia
Skin rashes fe"er Laundice and hy!oglycemia.
Sym!toms of o"er dosage&
7e!atic to3icity general malaise delirium de!ression sei9ures
,oma J death nausea "omiting fe"er and "ascular colla!se.
U$"H8m"n8 oI oQ"$#o!",
$. Induction of emesis.
). %astric la"age.
>. +cti"ated charcoal.
;. Oral /.acetyleystine 'mucomyst( is said to reduce or !re"ent he!atic damage
by inacti"ating acetamino!hen metabolites which cause li"er effects.
Ao!", by mouth 0.?M$ g e"ery ;MA hours to a ma3. Of ; g daily-
D
C7&l#,
) months A0 mg for !ost.immuni9ation !yre3ia-
Otherwise under > months 'on doctorEs ad"ice only( $0 mgNkg
'? mgNkg if Laundiced(-
> monthsM$ year A0M$)0 mg
$M? years $)0M)?0 mg
AM$) years )?0M?00 mg-
*hese doses may be re!eated e"ery ;MA hours when necessary
'4a3. of ; doses in ); hours(
@$!&n% (on!&#"$H8&on!,
$. Su!!ositories should be stored below )D,.
). Li"er function studies for long term thera!y.
>. /ote signs of met.hemoglobinemia& bluish discoloration of gum J fingernails.
;. 7a"e mucomyst a"ailable for signs of to3icity.
?. *each !atient signs of to3icity to be re!orted immediately.
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D. L("8yl!Hl&(yl&( L(&# W L!K&$&n W ,
U$H#" nHm", +s!irin
ClH!!&I&(H8&on,
/on.narcotic analgesic anti!yretic anti.inflammatory antirhumatic ant !latelet
/S+I6.
G$"%nHn(y, ',ategory ,(
L(8&on,
*he anti!yretic effect is due to an action on the hy!othalamus that results in heat
loss by "asodilatation of !eri!heral blood "essels J !romoting sweating.
*he anti.inflammatory effects !robably by decreasing !rostaglandin synthesis J
other mediators of the !ain res!onse.
*he analgesic action is not fully known but may be due to im!ro"ement of the
inflammatory condition .
@.M.& +s!irin also !roduces inhibition of !latelet aggregation.
+!"!,
. Pain . 4yalgia
. +rthralgia . 7eadache
. 6ysmenorrhea . +nti!yretic 'reduce fe"er(
B
. +nti.inflammatory 'arthritis gout rheumatic fe"er(
- *o reduce the risk of recurrent ischemic attacks J strokes in men.
- 2eduction of risk of death or nonfatal 4I in !atients with history of
infarction or unstable angina !ectoris.
Ao!",
+s Fant !lateletF + single dose of as!irin $?0M>00 mg is gi"en
+s soon as !ossible after an ischemic e"ent !referably
6is!ersed in water or chewed.
*he initial dose is followed by maintenance treatment with
+s!irin D?M$?0 mg daily.
+nti.inflammatory& 0.>M$ g e"ery ; hours after food- ma3.
In acute conditions B g daily- ,7IL6 Lu"enile arthritis u!
to B0 mgNkg daily in ?MA di"ided doses after food
Increased in acute e3acerbations to $>0 mgNkg
/ote& 7igh doses of as!irin are "ery rarely re0uired and are now
%i"en under s!ecialist su!er"ision only and with !lasma
4onitoring 'es!ecially in children(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to salicylates.
+sthma in conLunction with anticoagulant thera!y.
<itamin deficiency 'risk for bleeding increase with <itamin = deficiency(.
,hicken!o3 or influen9a '!otential risk for 2eyeKs syndrome among children
and teenagers(.
Pregnancy and lactation.
One week before J after surgery.
Patients recei"ing anticoagulants.
Patients with bleeding disorders 'ie hemo!hilia(
%I bleeding or hemorrhage from other sites.
7istory of %I ulcers.
V&#" "II"(8!,
,hildren e chicken !o3 'rays syndrome(.
7eartburn nausea anore3ia occult blood loss..
%I bleeding !otentation of !e!tic ulcer.
5ronchos!asm.
C
+na!hyla3is
Skin rashes.
Increase bleeding time.
VHl&(ylH8" 8oX&(&8y
- Salicylism& nausea "omiting di99iness tinnitus difficulty hearing diarrhea
mental confusion.
- +cute as!irin !oisoning& 2es!iratory alkalosis hy!er!nea tach!nea
hemorrhage confusion !ulmonary edema con"ulsion tetany metabolic
acidosis.
A$% &n8"$H(8&on!,
2isk for bleeding increase if taken with other anticoagulants.
2isk of %I bleeding increase if taken with steroids alcohol or other /S+I/6s.
Increased risk for salicylate to3icity if taken with frusimide 'lasi3(
7y!otension may occur if taken with nitroglycerin.
@$!&n% (on!&#"$H8&on!,
$.*ake drug with or after food or with milk to decrease %I irritation.
).+ssess for history of asthma and history of hy!ersensiti"ity.
>.6o not use with other anticoagulants.
;./ote any history of !e!tic ulcer.
?.2e!ort signs of side effect e.g. gastric irritation if occurs.
A.+s!irin is not gi"en $ week before J after surgery to !re"ent bleeding.
D. If !atient is diabetic discuss the !ossibility of hy!oglycemia occurring Patients
should monitor their blood glucose le"el fre0uently.
B. *eaches !atient about the to3ic sym!toms
'ringing in the ears( di99iness mental confusion.etc( and
ask himNher to re!ort it to !hysician.
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@
Y. L(8&QH8"# C7H$(oHl ,
U$H#" nHm", 1ucarbon
L(8&on& adsorbents

+!"!& used as adsorbent in cases of organo!hos!hourous !oisoning
$0
Ao!" , the first dose of $00 g is gi"en with a la3ati"e
'1.g. magnesium sul!hate( followed by acti"ated
charcoal ?0 g e"ery ; hours 'or more fre0uently if
tolerated( until the charcoal is seen in the stool.
@$!&n% (on!&#"$H8&on!,
13!lain the !rocedure to !atient because it always gi"en "ia /%* es!ecially if the
!atient is conscious and you want to insert /%*
Iear glo"es when dealing with this drug because the !owder form discolor e"ery
thing to black color when touching it
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Z. L#$"nHl&n" W 'K&n"K7$&n" T , VymKH87om&m"8&(!
U$H#" nHm", +drenaline
ClH!!& 6irect acting.adrenergic agent.
L(8&on,
+ natural hormone !roduced from adrenal medulla- induce marked stimulation of al!ha O$ P O)
rece!tors causing cardiac stimulation bronchodilation J decongestion.
+!"!,
$. 2elief of res!iratory distress due to bronchos!asm.
). 2a!id relief of hy!ersensiti"ity reactions.
>. ,ardiac arrest.
;. O!en. angle glaucoma.
?. *o !rolong the action of anesthesia.
A. *o!ically to sto! bleeding.
Ao!",
+"ailable in am!oules of $ml containing $ mg adrenaline
,an be gi"en by I.4 inLection. I.<. J S.,.
In ,P2 F+ systole and P1+F&
$ in $0 000 '$00 microgramsNmL( is recommended in a dose of $0 mL by intra"enous
inLection !referably through a central line.
If inLected through a !eri!heral line the drug must be flushed with at least )0 mL
sodium chloride 0.CQ inLection 'to aid entry into the central circulation(.
In +cute ana!hyla3is&
5y intramuscular inLection '!referably mid!oint in anterolateral thigh( 'or by subcutaneous
inLection F not generally recommended E ( of $ in $000 '$ mgNmL( solution F when there
$$
is doubt as to the ade0uacy of the circulation by slow intra"enous inLection of $ in $0 000
'$00 microgramsNmL( solution 'e3treme caution(
Ao!",
I<& $0 microgramsNkg F $ in $0 000 F as indicated& e"ery >.? minF
If endotracheal route&
*he used dose should be >.$0 times I< dose and diluted.
I4 inLection
+dult 0.? mg may be re!eated se"eral times if necessary at ?. minute inter"als
according to blood !ressure !ulse and res!iratory function
Infusion& ).$0 micNmin titrated to res!onse.
Con8$H&n#&(H8&on!,
/arrow angle glaucoma.
Shock
Lactation.
*achycardia
6uring labor 'it may delay the )
nd
B loge do labor(.
V&#" "II"(8!,
8atal "entricular fibrillation.
,erebral hemorrhage
urinary retention
headache
necroses at inLection side
5lurring of "ision !hoto!hobia.
@$!&n% (on!&#"$H8&on!,
/e"er administer $& $00 solutions I<. Use $& $000 mg sol. 8or I.<. use.
Use tuberculin '$cc( syringe to measure adrenaline.
+dminister adrenaline using !iggyback set to adLust the rate of infusion.
+dminister infusion by electronic infusion de"ice for safety J accuracy.
,losely monitor !atients recei"ing I.<. adrenaline infusion.
/ote the client for signs of shock loss of consciousness clammy cold skin
cyanosisR. etc.(.
5riskly massage site of S.,. or I.4. inLection to hasten the action of the drug.
$)
[. Llm&n&m 7y#$oX&#" Hn# mH%n"!&m 7y#$oX&#" ,
U$H#" nHm", WW LllmH%T
ClH!!& +ntacids
L(8&on& neutrali9ing or reducing gastric acidity thus increasing the !7 of the stomach and relie"ing
hy!eracidity. If the !7 is increased to ; the acti"ity of !e!sin is inhibited.
+!"!,
a. *reatment of hy!eracidity. '7eart. burns(.
b. Pe!tic ulcer
c. 6uodenal ulcer.
d. %astroeso!haged reflu3.
e. hiatus hernia
Ao!"& $0 mL > or ; times daily of li0uid magnesiumMaluminum antacids. +ntacids are best gi"en
when sym!toms occur or are e3!ected usually between meals and at
bedtime ; or more times daily- additional doses may be re0uired u! to
once an hour.
Con8$H&n#&(H8&on!,
Pregnancy
,hildren less than A years of age.
,hronic use of aluminum containing antacids may contribute to de"elo!ment of
+l9heimerKs disease.
V&#" "II"(8!,
,onsti!ation intestinal obstruction bone !ain muscle weakness.
@$!&n% (on!&#"$H8&on!,
It is recommended that most antacids be taken at > hours after meals J at bed M time.
*ablets should be thoroughly chewed before swallowing J followed by a glass of milk or
water.
Shake li0uid sus!ensions thoroughly before !ouring the medication .
,lientKs taking aluminum or calcium containing antacids should take )?00.>000 cc of fluids
to !re"ent consti!ation.
+d"ise clients to re!ort !ersistent diarrhea or consti!ation !hysician.
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\. LlloK$&nol , ]ylo$&(
U$H#" nHm", Gyloric
ClH!!& +nti.gout +gents

L(8&on, Is a !otent 3anthine o3idase inhibitor which reduces both serum and urinary uric acid
le"els by inhibiting the formation of uric acid without disru!ting the biosynthesis of "ital !urines.
$>
+!"!,
Is the drug of choice for chronic gouty arthritis 'not useful for treatment of acute
gout(.
7y!eruricemia associated with blood diseases renal diseases.
Pro!hylasis in hy!eruricemia in !atients with neo!lastic conditions.
*reatment of !atients with recurrent uric stone formation.
Ao!"
initially $00 mg daily !referably after food then adLusted according
to !lasma or urinary uric acid concentration- usual maintenance dose in mild conditions $00M
)00 mg daily in moderately se"ere conditions >00MA00 mg daily in se"ere conditions D00MC00 mg
daily- doses o"er >00 mg daily gi"en in di"ided doses- ,7IL6 under $?years 'in neo!lastic
conditions en9yme disorders( $0M)0 mgNkg daily 'ma3. ;00 mg daily(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
Lactation.
7emochromatosis.
,hildren e3ce!t for those with neo!lastie diseases.
V&#" "II"(8!,
Skin rash alo!ecia fe"er leuko!nea arthralgia nausea "omiting.
@$!&n% (on!&#"$H8&on!,
+dminister with food or immediately after meal to lessen gastric irritation.
+t least $0.$) eight. ounce glasses of fluid should be taken each day.
=ee! urine alkaline to !re"ent the formation of uric acid stones.
*ake com!lete drug history.
4onitor the ,5, li"er J renal function J serum uric acid on routine bases.
If skin rash a!!ear re!ort to !hysician.
+"oid e3cessi"e intake of "itamin , which lead to the !otential for the
formation of kidney stones.
+d"ice clients not to take iron salts with allo!urinol since high iron
concentration may occur in the li"er.
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^. Lm&_H(&n VlIH8",
U$H#" nHm", amikin
ClH!!& +ntibiotic F+mino glycosidesF
L(8&on, inhibit !rotein synthesis by binding irre"ersibly to ribosome which leads to !roduction of
nonfunctional !rotein. *hey are usually bactericidal as a result of disru!tion of bacterial
cyto!lasmic membrane.
+!"!,
5one and Loint infections.
2es!iratory tract infections.
$;
Se!ticemia 'including neonatal se!sis(.
Urinary tract infection 'UI*(.
Post o!erati"e infections.
Intra Mabdominal infections 'as !eritonitis( .
Skin infections 'including burns(
Ao!" & by intramuscular or by slow intra"enous inLection or by infusion $? mgNkg daily
in ) di"ided doses increased to )).? mgNkg daily in > di"ided doses in se"ere infections-
ma3. $.? g daily for u! to $0 days 'ma3. cumulati"e dose $? g(- child $? mgNkg daily in )
di"ided doses- neonate loading dose of $0 mgNkg then $? mgNkg daily in ) di"ided doses.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to amino glycosides.
Long Mterm thera!y.
8or !atients with im!aired renal function or !re.e3isting hearing im!airment.
V&#" "II"(8!,
Ototo3icity& tinnitus hearing im!airment ata3ia J di99iness.
2enal im!airment '/e!hroto3icity( hematuria !roteinuriaR
/euroto3icity& headache tremor lethargy numbness burning of face.
Others& nausea "omiting skin rash J su!er infection.
@$!&n% (on!&#"$H8&on!,
I.4. admin. InLect dee! into muscle to minimi9e !ain.
+dmin. 8or only D.$0 days.
+ssess history of hy!ersensiti"ity.
Obtain lab. Studies for renal function.
,ontinue to monitor for ototo3icity.
6iscuss with the client N family the im!ortance of taking medications at the
a!!ro!riate !rescribed time inter"als.
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F. Lm&noK7yll&n",
ClH!!& +ntiasthmatic bronchodilator
L(8&on& 2ela3es smooth muscles of bronchi causing bronchodilation and increasing "ital ca!acity
of the lungs
+!"!,
Pro!hyla3is and treatment of bronchial asthma.
2e"ersible bronchos!asm associated with ,.O.P.6.

Ao!" ,
5y mouth $00M>00 mg >M; times daily after food
$?
slow intra"enous inLection& o"er at least )0 minutesF not !re"iously treated with
theo!hyllineF 'with close monitoring( '? mgNkg(
Intra"enous infusion& 0.> M 0.D mgNkgNhour
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
7y!otension
,oronary artery disease 'angina !ectoris(.
V&#" "II"(8!,
/ausea "omiting e!igastric !ain.
2ectal irritation following use of su!!ositories.
7eadache di99iness 7y!otension arrhythmias ' tachycardia(
+mino!hylline gi"en by ra!id I.<. may !roduce hy!otension flushing !recordial !ain
7eadache J di99iness.
@$!&n% (on!&#"$H8&on!,
6ilute drugs J maintain !ro!er infusion rate.
+ssess client for any history of hy!ersensiti"ity.
Obtain baseline blood !ressure and !ulse !rior to starting thera!y monitor 5.P. J !ulse
closely during thera!y.
Obser"e closely for signs of to3icity.
*o a"oid e!igastric !ain 'when administered orally( gi"e the medication with meals.
4onitor for serum le"el of theo!hylline.
Instruct the client to increase intake of fluids to li0uefy secretions.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`. Lm&o#H$on",
U$H#" nHm", ,ordarone Pacerone
ClH!!& +ntiarrhythmic agent

L(8&on, +miodarone is categori9ed as a class III antiarrhythmic agent and !rolongs !hase > of the
cardiac action !otential. It has numerous other effects howe"er including actions that are similar to
those of antiarrhythmic classes I II and I<.
+!"!,
<entricular fibrillation
<entricular tachycardia
+trial fibrillation
Ao!" & by mouth )00 mg > times daily for $ week reduced to )00 mg twice daily for a
further week- maintenance usually )00 mg daily or the minimum re0uired to control the
arrhythmia
by intra"enous infusion& initially ? mgNkg o"er )0M$)0 minutes with 1,% monitoring-
$A
subse0uent infusion gi"en if necessary according to res!onse u! to ma3. $.) g in ); hours FC00 mg
o"er )> hours E.
<entricular fibrillation or !ulseless "entricular tachycardia& by intra"enous inLection o"er at
least > minutes >00 mg
Con8$H&n#&(H8&on!,
allergic reaction
Pregnant and lactation.
It is contraindicated in indi"iduals with sinus nodal bradycardia atrio"entricular
block and second or third degree heart block who do not ha"e an artificial
!acemaker.
Indi"iduals with baseline de!ressed lung function should be monitored closely if
amiodarone thera!y is to be initiated.
*he neonates.
V&#" "II"(8!,
,ardio"ascular
,ardiac arrhythmias ,78 S+ node dysfunction '$Q to >Q(- hy!otension
sinus arrest '!ostmarketing(.
,/S
+bnormal gaitNata3ia di99iness fatigue lack of coordination malaise
!aresthesias tremorNabnormal in"oluntary mo"ement ';Q to CQ(-
decreased libido headache insomnia slee! disturbances '$Q to >Q(-
confessional states delirium disorientation hallucinations !seudotumor
cerebri '!ostmarketing(.
6ermatologic
Photosensiti"ityNSolar dermatitis ';Q to CQ(- flushing '$Q to >Q(-
erythema multiform e3foliati"e dermatitis !ruritus skin cancer Ste"ens.
Sohnson syndrome to3ic e!idermal necrolysis "asculitis '!ostmarketing(.
11/*
<isual disturbances ';Q to CQ(- abnormal smell sensation '$Q to
>Q(.
%I
/ausea "omiting '$0Q to >>Q(- anore3ia consti!ation ';Q to
CQ(- abdominal !ain abnormal sali"ation abnormal taste '$Q to
>Q(- !ancreatitis '!ostmarketing(.
@$!&n% (on!&#"$H8&on!,
6uring I< infusion carefully monitor blood !ressure and
Slow the infusion if significant hy!otension occurs.
$D
5radycardia should be treated by slowing the infusion or discontinuing it if
necessary. Sustained monitoring is essential because drug has an unusually long
half.life.
2e!ort ad"erse reactions !rom!tly. 5ear in mind that long
1limination half.life means that drug effects will !ersist long
after dosage adLustments are made or drug is discontinued.
5e alert to signs of !ulmonary to3icity& !rogressi"e dys!nea
fatigue cough !leuritic !ain fe"er.
+uscultate chest !eriodically or when !atient com!lains of
res!iratory sym!toms. ,heck for diminished breath sounds rales !leuritic friction
rub- obser"e breathing !attern. 6rug induced !ulmonary function !roblems must be
distinguished from ,78 or !neumonia. =ee! your medical direction !hysician
informed.
4onitor heart rate and rhythm and 5P until drug res!onse
has stabili9ed. 2e!ort !rom!tly sym!tomatic bradycardia.
Patients already recei"ing antidysrhythmic thera!y when
+miodarone is started must be closely obser"ed for ad"erse
effects !articularly conduction disturbances and e3acerbation of dysrhythmias.
6osage of !re"ious agent should be
reduced by >0T?0Q se"eral days after amiodarone thera!y is started
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O
SE. LmK&(&ll&n,
U$H#" nHm", Penbritin
ClH!!& +ntibiotic F5road.s!ectrum !enicillinE

L(8&on, Inhibit cell wall synthesis some act by binding to !enicillin binding !rotein in the
cyto!lasmic membrane of the bacteria.
+!"!,
2es!iratory urinary J %I tract infections J other infection due to
am!icillin sensiti"e organisms.
4eningitis caused by /eisseria meningitidis.
Ao!"
$B
5y mouth 0.)?M$ g e"ery A hours at least >0 minutes before food-
,7IL6 under $0 years half adult dose.
Urinary.tract infections ?00 mg e"ery B hours-
,7IL6 under $0 years half adult dose.
5y intramuscular inLection or intra"enous inLection or infusion ?00 mg e"ery ;MA
hours- ,7IL6 under $0 years half adult dose
Listerial meningitis 'in combination with another antibiotic( by
intra"enous infusion ) g e"ery ; hours for $0M$; days- I/8+/* under $
month ?0 mgNkg e"ery A hours- $M> months ?0M$00 mgNkg e"ery A hours-
child > monthsM$) years $00 mgNkg e"ery A hours 'ma3. $) g daily(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to !enicillins.
Use cautiously with renal disorders.
V&#" "II"(8!,
+llergic& skin rashes !ruritis whee9ing fe"erR. .
6iarrhea abdominal cram! !ain nausea "omiting.
Psendomembranous colitis thrombocyto!enia leuko!nea
*hrombo!hlebitis P 1lectrolytes imbalance following I.<. use.
7e!atoto3icity.
I.4. inLection may cause !ain at the inLection site.
@$!&n% (on!&#"$H8&on!,
+fter reconstitution for I.4. I.<. administration the solution must be used
within the hour.
I.<. administration should be gi"en slowly within >.? minutes or by infusion.
I.4. inLections are made dee!ly into the gluteal muscle.
+ssess regularly for allergic reactions. If reaction occurs the drug must be discontinued
immediately 1!ine!hrine UO)K antihistamines P corticosteroids must be immediately
a"ailable.
6etain client in an ambulatory care site for at least )0 min after administering Penicillin.
+fter inLection because rate of absor!tion should not be increased.
,om!lete entire !rescribed course of thera!y.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
SS. LmK7o8"$(&n,
$C
U$H#" nHm", +m!hocin 8ungi9one
ClH!!& +ntibiotic antifungal
L(8&on, am!hotericin associates with ergosterol a membrane chemical of fungi forming a !ore
that leads to =P leakage and fungal cell death
+!"!,
+ntifungal infection
Ao!" , by mouth intestinal candidiasis $00M)00 mg e"ery A hours- Infant and child $00 mg
; times daily
Pro!hyla3is /eonate $00 mg once daily
My &n8$HQ"no! &nI!&on systemic fungal infections initial test dose of $ mg o"er )0M>0
minutes then )?0 microgramsNkg daily gradually increased if tolerated to $ mgNkg daily- ma3.
'se"ere infection( $.? mgNkg daily or on alternate days
Con8$H&n#&(H8&on!,
+llergic reaction to am!hotericin
V&#" "II"(8!,
5urning itching redness or other sign of irritation not !resent before use of
this medicine Skin rash 6ryness of skin.
/ausea "omiting diarrhea melena abd. ,ram!s.
8e"er headache thrombo!hlebitis bone marrow de!ression !ancyto!nea.
+na!hyla3is.
@$!&n% (on!&#"$H8&on!,
*he drug is to3ic and should be used only for !atients under close medical su!er"ision
with a relati"ely certain diagnosis of dee! mycotic infections.
I.<. adm. usually reser"ed for life threatening diseases because it is to3ic.
*reatment should be continued for at least ;B hr after clinical cure has been
achie"ed to !re"ent rela!se.
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SD. L8"nolol ,
U$H#" nHm", /ormatin
ClH!!& 5eta.adrenergic blocking agent

L(8&on& 5eta.adrenoce!tor blocking F anti hy!ertensi"e anti anginalF
)0
+!"!,
7y!ertension.
+ngina !ectoris.
Ao!"& by mouth 7y!ertension ?0 mg daily 'higher doses rarely necessary(
+ngina $00 mg daily in $ or ) doses
+rrhythmias ?0M$00 mg daily
5y intra"enous inLection arrhythmias ).? mg at a rate of
$ mgNminute re!eated at ?.minute inter"als to a ma3. Of $0 mg
Con8$H&n#&(H8&on!,
5radycardia ,.7.8. cardiogenic shock diabetes thyroto3icosis chronic bronchitis
asthma bronchos!asm em!hysema.
V&#" "II"(8!,
5radycardia ,.7.8. hy!otension cold e3tremities 'due to !eri!heral "asoconstriction(
edema dys!nia shortness of breath nausea "omiting he!atomegaly and
bronchos!asm.
@$!&n% (on!&#"$H8&on!,
8or I< use the drug may be diluted in sodium chloride de3trose on de3trose saline.
Instruct !atientNfamily to take blood !ressure and !ulse.
Pro"ide written instructions as when to call !hysician 'e.g. 72 below ?0 beatNmin(.
Instruct !atient to dress warmly during cold weather.
6iabetic !atient should be "ery careful about sym!toms of hy!oglycemia.
2e!ort any asthma.like sym!toms.
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SY. L8o$QH!8H8&n,
U$H#" nHm", Li!itor
ClH!!& +ntihy!erli!idemic Statins
G$"%nHn(y, ',ategory V(
L(8&on, lowers the le"el of cholesterol in the blood by reducing the !roduction of cholesterol
by the li"er.
+!"!,
Pre"enting and treating atherosclerosis.
Ao!"
)$
Primary hy!ercholesterolemia and combined hy!erli!idaemia usually
$0 mg once daily
8amilial hy!ercholesterolemia initially $0 mg daily increased at
inter"als of at least ; weeks to ;0 mg once daily- if necessary further
increased to ma3. B0 mg once daily
Con8$H&n#&(H8&on!,
+llergy to ator"astatin fungal by!roducts acti"e li"er disease or une3!lained and
!ersistent ele"ations of transaminase le"els !regnancy lactation.
Use cautiously with im!aired endocrine function
V&#" "II"(8!,
,/S& 7eadache asthenia
%I& 8latulence abdominal !ain cram!s consti!ation nausea dys!e!sia
heartburn li"er failure
2es!iratory& Sinusitis !haryngitis.
Other& 2habdomyolysis with acute renal failure arthralgia myalgia
@$!&n% (on!&#"$H8&on!,
Obtain li"er function tests as a baseline and !eriodically during thera!y.
Iithhold ator"astatin in any acute serious condition 'se"ere infection hy!otension maLor
surgery trauma se"ere metabolic or endocrine disorder sei9ures(
1nsure that !atient has tried cholesterol.lowering diet regimen for >...A mo before
beginning thera!y.
+dminister drug without regard to food but at same time each day.
,onsult dietitian regarding low.cholesterol diets.
1nsure that !atient is not !regnant and has a!!ro!riate contrace!ti"es a"ailable during
thera!y- serious fetal damage has been associated with this drug.
SZ. L8$H($&m,
U$H#" nHm", U$H($&m
L(8&on, muscle rela3ant
+!"!,
))
It is used as an adLunct to general anesthesia or sedation in the intensi"e care unit
'I,U( to rela3 skeletal muscles and to facilitate tracheal intubations and mechanical
"entilation.
Ao!" , intra"enous inLection& 0.>M0.A mgNkg
4aintenanceF intra"enous infusionF '0.>M0.A mgNkg hour(
Con8$H&n#&(H8&on!,
7y!ersensiti"e to atracurium cisatracurium or ben9enesulfonic acid.
V&#" "II"(8!,
Skin flushing mild reduction in blood !ressure and difficulty in breathing.
<ery rarely ana!hyla3is a se"ere allergic reaction can occur when gi"en with one or
more anesthetic agents. *here ha"e been rare re!orts of sei9ures 'fits( in I,U
!atients who usually also had a medical condition that makes them !redis!osed to
ha"ing fits e.g. head inLury or brain disease.
@$!&n% (on!&#"$H8&on!,
+lways assess !ast history of surgeries and res!onse to anesthesia
+ssess !ast history allergies and medications.
+ssess use of alcohol illicit drugs and o!ioids.
,lose and fre0uent obser"ation of the !atient and all body systems
monitor "ital signs +5,s.
4onitor for cardio"ascular de!ression res!iratory de!ression and com!lications of
anesthesia.
Im!lement safety measures.
S[. L8$oK&n" !lIH8",
U$H#" nHm", atro!ine
ClH!!& ,holinergic blocking agent

L(8&on, It is a !arasym!atholytic agent which cause rela3ation of smooth muscles J inhibition
of secretary glands
+!"!,
+dLunct in !e!tic ulcer treatment.
Irritable bowel syndrome.
*reatment of s!astic disorders of biliary tract.
)>
6uring anesthesia to control sali"ation J bronchial secretions.
Parkinsonism.
+nti.arrhythmic '!ro!hyla3is(.
Pro!hyla3is and treatment of to3icity due to cholinesterase inhibitor including
organo!hos!hate !esticides.
O!hthalmologic treatment of u"eitis.
Ao!"
5radydysrhythmia &+dult 0.?.$ mg I< may re!eated at ? min inter"als
until desired rate achie"ed F ma3 0.0>. 0.0; mg N kg F Pediatric 0.0) mgNkg F min dose 0.$
mg ma3 single dose 0.? mg for a child and $ mg for an
adolescent.
+systole J P1+& +dult $ mg I< may re!eated e"ery >.? min Fma3
0.0>. 0.0; mg N kg com!lete "agal blockF
Pediatric unknown efficacy.
1ndotracheal route& >0 micNkg diluted in ? ml /S
+nticholinesterase !oisoning& +dult $.) mg !ush e"ery ?.$?
minutes to dry secretions no ma3 dose
Pediatric 0.0? mgNkgNdose e"ery ?.$? min
@M
Possible !arado3ical bradycardia when !ushed slowly or when used at
doses less than 0.? mg
Con8$H&n#&(H8&on!,
%laucoma tachycardia myocardial ischemia.
Prostate hy!ertro!hy myasthenia gra"is !aralytic ileus.
4ental im!airment lactation he!atic disease.
V&#" "II"(8!,
/ausea "omiting dry mouth consti!ation heartburn
di99iness drowsiness headache insomnia blurring of "ision
Photo!hobia flashing eu!horia hallucination flushing of the skin.
@$!&n% (on!&#"$H8&on!,
,heck dosage J measure the drug e3actly.
+ssess for history of asthma glaucoma ulcer... etc.
6etermine the age of the client.
);
8re0uent mouth care.
+ssess client for change in !ulse rate.
In case of blurring of "ision assist on ambulating J gi"e safety measures.
S\. M&!oK$olol ImH$H8",
U$H#" nHm", Gebeta
ClH!!& 5eta.adrenoce!tor blocking drugs
L(8&on&
5locks adrenergic rece!tors of the sym!athetic ner"ous system in the heart and
Lu3taglomerular a!!aratus 'kidney( thus decreasing the e3citability of the heart.
6ecreasing cardiac out!ut and o3ygen consum!tion decreasing the release of rennin
from the kidney and lowering blood !ressure.
+!"!,
4anagement of hy!ertension
used alone or with other antihy!ertensi"e agents
Ao!"
Hypertension and angina usually $0 mg once daily '? mg may be
ade0uate in some !atients(- ma3. )0 mg daily
Adjunct in stable moderate to severe heart failure initially $.)? mg once
daily 'in the morning( for $ week then if well tolerated increased to
).? mg once daily for $ week then >.D? mg once daily for $ week then ? mg
once daily for ; weeks then D.? mg once daily for ; weeks then $0 mg
once daily- ma3. $0 mg daily
Con8$H&n#&(H8&on!,
Sinus bradycardia second. or third.degree heart block cardiogenic shock ,78.
Use cautiously with renal failure diabetes or thyroto3icosis 'biso!rolol can mask the
usual cardiac signs of hy!oglycemia and thyroto3icosis( lactation.
V&#" "II"(8!,
,/S& 6i99iness !aresthesias slee! disturbances hallucinations disorientation
memory loss slurred s!eech .
%I& %astric !ain flatulence consti!ation diarrhea nausea "omiting anore3ia
ischemic colitis retro!eritoneal fibrosis he!atomegaly acute !ancreatitis.
)?
,<& 5radycardia ,78 cardiac arrhythmias sinoatrial or +< nodal block
tachycardia !eri!heral "ascular insufficiency claudicating ,<+ !ulmonary
edema hy!otension
2es!iratory& 5ronchos!asm dys!nea cough bronchial obstruction nasal
stuffiness rhinitis !haryngitis.
%U& Im!otence decreased libido PeyronieEs disease dysuria nocturia fre0uent
urination.
4usculoskeletal& Soint !ain arthralgia muscle cram!
11/*& 1ye irritation dry eyes conLuncti"itis blurred "ision
Other& 6ecreased e3ercise tolerance de"elo!ment of antinuclear antibodies
hy!erglycemia or hy!oglycemia ele"ated serum transaminase alkaline
!hos!hatase and L67
@$!&n% (on!&#"$H8&on!,
6o not discontinue drug abru!tly after chronic thera!y 'hy!ersensiti"ity to catecholamine
may ha"e de"elo!ed causing e3acerbation of angina 4I and "entricular arrhythmias(.
*a!er drug gradually o"er ) wk with monitoring.
,onsult with !hysician about withdrawing drug if !atient is to undergo surgery
'withdrawal is contro"ersial(.
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S^. CHl(&m,
U$H#" nHm", ,alciday ,altrate
ClH!!& 1lectrolyte mineral ,alcium Salts
L(8&on&
It is essential for maintenance of normal function of ner"es muscles skeletal
system J !ermeability of cell membranes J ca!illaries.
/ecessary for acti"ation of many en9ymes contraction of cardiac skeletal J smooth
muscles ne"er im!ulses res!iration and blood coagulation.
+!"!,
@ I.<&
+cute hy!ocalcemic tetany secondary to &
)A
2enal failure
7y!o!arathyroidism.
Premature infants.
*o treat de!letion of electrolytes.
6uring cardiac resuscitation.
@ I.4. or I.<&
*o reduce s!asm 'renal J intestinal(.
*o relief sensiti"ity reactions of insect bites.
@@ P.O&
,hronic hy!o!arathyroidism.
Osteo!orosis
Osteomalacia.
2ickets
4yasthenia gra"is
Su!!lement for !regnant women.

Ao!"
In hy!ocalcaemic tetany an initial intra"enous inLection of $0 mL ').)? mmol( of
calcium gluconate inLection $0Q should be followed by the continuous infusion of
about ;0 mL 'C mmol( daily but !lasma calcium should be monitored.
*his regimen can also be used immediately to tem!orarily reduce the to3ic effects of
hy!erkalaemia.
4aintenance& calcium gluconate $M) g daily.
Con8$H&n#&(H8&on!,
6igiti9ed !atients.
Some renal J cardiac !atients.
,ancer with bone metastasis.
V&#" "II"(8!,
7y!ercalceia characteri9ed by lassitude M fatigue skeletal muscle
weakness confusion J consti!ation.
2enal calculi bradycardia arrhythmias J renal im!airment.
2a!id I.<. administration. 4ay result in "asodilatation decreased 5.P. J
7.2. cardiac arrhythmias synco!e and cardiac arrest.
)D
@$!&n% (on!&#"$H8&on!,
Oral&
administer $.$.? hr after meals alkalis J large amounts of fat
decrease the absor!tion of calcium.
If the client has difficulty swallowing large tablets obtain a calcium in water
sus!ension by diluting the calcium in hot water then cooled by administration.
I.<&
+dminister slowly.
Obser"e "ital signs closely for e"idence of bradycardia J hy!otension.
Pre"ent any leakage of medication into the tissue since it is e3tremely irritating.
I.4&
2otate the inLection sites.
Obtain baseline renal function.
In case of hy!ocalcemic tetany !ro"ide safety !recautions to !re"ent inLury.
$ @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
SF. CHK8oK$&l,
U$H#" nHm", ,a!otin nhabace
ClH!!& antihy!ertensi"e inhibitor of angiotensin synthesis.

L(8&on,
,a!to!ril is a highly s!ecific com!etiti"e inhibitor of angiotensin I ,on"erting
en9yme.
*he en9yme is res!onsible for the con"ersion of angiotensin I to angiotensin II
which decrease 5P.
2educe !eri!heral arterial resistance.
6ecrease aldosterone secretion which works to increase le"el of serum
!otassium.
+!"!,
7y!ertension.
In combination with diuretics and digitalis in the treatment of ,78.
Ao!"
hypertension used alone initially $).? mg twice daily- if used in addition to diuretic or
in elderly initially A.)? mg twice daily 'first dose at bedtime(- usual maintenance dose )? mg
twice daily- ma3. ?0 mg twice daily 'rarely > times daily in se"ere hy!ertension(
)B
Heart failure 'adLunct( initially A.)?M$).? mg under close medical su!er"ision-
usual maintenance dose )? mg )M> times daily- usual ma3. $?0 mg daily
Prophylaxis after infarction in clinically stable !atients with asym!tomatic
or sym!tomatic left "entricular dysfunction initially A.)? mg starting as early as > days after
infarction then increased o"er se"eral weeks to $?0 mg daily 'if tolerated( in di"ided doses .
Con8$H&n#&(H8&on!,
7y!ersensiti"ity 2eno "ascular disease and !regnancy.
V&#" "II"(8!,
Skin rash loss of taste neutro!nea nausea "omiting
7y!otension !roteinuria renal failure and hy!erkalemia.
@$!&n% (on!&#"$H8&on!,
In case of o"erdose gi"e normal saline to restore 5P.
Should not be discontinued without 6r. Instructions.
Obtain baseline hematological studies li"er J renal functions tests !rior to
beginning the treatment.
6etermine client understands of the thera!y and if heNshe takes other medications.
Obser"e client closely for hy!otension > hours after the initial dose.
In case of hy!otension !lace client in su!ine !osition and gi"e I< saline infusion.
Iithhold !otassium s!aring diuretics and consult with !hysician 'hy!erkalemia
may occur(.
*ake ca!to!ril $ hour before meal or on an em!ty stomach.
2e!ort skin rash heartburn and chest !ain to !hysician.
13!lain to client that he may de"elo! loss of taste for ).> months if it !ersists
notify the !hysician.
S`. CH$Q"#&lol,
U$H#" nHm", ,orega 6ilatrend.
ClH!!& antihy!ertensi"e, beta blockers.

L(8&on,
)C
5locks stimulation of beta$ 'myocardial( and beta) '!ulmonary "ascular and
uterine( .adrenergic rece!tor sites
+lso has al!ha$ blocking acti"ity which may result in orthostatic hy!otension.
+!"!,
4anagement of hy!ertension.
4anagement of ,78 'due to ischemia or cardiomyo!athy( with digo3in
diuretics and +,1 inhibitors.
Ao!"
7y!ertension initially $).? mg once daily increased after ) days to usual dose of )? mg
once daily- if necessary may be further increased at inter"als of at least ) weeks to ma3.
?0 mg daily in single or di"ided doses; ELDEL! initial dose of $).? mg daily may !ro"ide
satisfactory control +ngina initially $).? mg twice daily increased after ) days to )? mg
twice daily
+dLunct in heart failure initially >.$)? mg twice daily 'with food( dose increased at
inter"als of at least ) weeks to A.)? mg twice daily then to $).? mg twice daily then to
)? mg twice daily- increase to highest dose tolerated ma3. )? mg twice daily in !atients
with se"ere heart failure or body.weight less than B? kg and ?0 mg twice daily in !atients
o"er B? kg
Con8$H&n#&(H8&on!,
Uncom!ensated ,78.
Pulmonary edema.
,ardiogenic shock.
5radycardia or heart block.
Se"ere he!atic im!airment or bronchial asthmaNbronchos!asm.
V&#" "II"(8!,
,ar"edilol may cause hy!erglycemia tiredness weakness
lightheadedness di99iness headache
diarrhea nausea "omiting "ision changes Loint !ain difficulty falling
aslee! or staying aslee!
,ough dry eyes numbness burning or tingling in the arms or legs
@$!&n% (on!&#"$H8&on!,
*each !atient and family how to check !ulse and blood !ressure.
>0
4ay cause drowsiness or di99iness. ,aution !atients to a"oid dri"ing or other
acti"ities that re0uire alertness until res!onse to the drug is known.
Patients with diabetes should closely monitor blood sugar
+d"ise !atient to notify health care !rofessional if slow !ulse difficulty breathing
whee9ing cold hands and feet di99iness confusion de!ression rash fe"er sore
throat unusual bleeding or bruising occurs.
7y!ertension& 2einforce the need to continue additional thera!ies for hy!ertension
'weight loss sodium restriction stress reduction regular e3ercise moderation of
alcohol consum!tion and smoking cessation(.
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O
DE. C"IHbol&n,
U$H#" nHm", +ncef =ef9ol.
ClH!!& +ntibiotic Fce!halos!orinesF 8I2S* %1/12+*IO/

L(8&on, 5ind to bacterial cell wall membrane causing cell death.
+!"!,
*reatment of&
Skin and skin structure infections 'including burn wounds(
Pneumonia.
Otitis media.
Urinary tract infections.
5one and Loint infections.
Se!ticemia 'including endocarditic( caused by susce!tible organisms.
Perio!erati"e !ro!hyla3is.
Ao!"
5y intramuscular inLection or intra"enous inLection or infusion 0.?M$ g e"ery AM$)
hours- ,7IL6 )?M?0 mgNkg daily 'in di"ided doses( increased to $00 mgNkg daily in se"ere
infections
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure Pregnancy Lactation.
>$
V&#" "II"(8!,
/ausea "omiting diarrhea anore3ia abdominal !ain flatulence skin rashes
su!er.infection heartburn sore mouth bone marrow de!ression& '6ecrease
I5, decreased !latelets decreased 7ct( /e!hroto3icity '!ain abscess at
inLection site !hlebitis and inflammation at I< site.
@$!&n% (on!&#"$H8&on!,
Infuse o"er >0 minutes unless otherwise indicated.
*hera!y should be continued for at least ).> days after sym!toms of infection ha"e
disa!!eared.
+ssess client with a history of hy!ersensiti"ity reaction. for !enicillin or ce!halos!orin.#
+ssess client financial status. *hese drugs are usually e3!ensi"e.
If %I u!set occurs administer. 6rugs with meals. Should be administered on em!ty
stomach#.
Obtain li"er J renal studies.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
DS. C"Io8HX&m" ,
U$H#" nHm", claforan.
ClH!!& +ntibiotic Fce!halos!orines F'third generation(.

+!"!,
Pneumonia M %U tract infections . meningitis Peritonitis se!ticemia !el"ic
cellulitis M endometritis.
Ao!"
by intramuscular or intra"enous inLection or by intra"enous infusion $ g e"ery $)
hours increased in se"ere infections 'e.g. meningitis( to B g daily in ; di"ided doses- higher doses
'u! to $) g daily in >M; di"ided doses( may be re0uired- /1O/+*1 ?0 mgNkg daily in )M; di"ided
doses increased to $?0M)00 mgNkg daily in se"ere infections- ,7IL6 $00M$?0 mgNkg daily in )M;
di"ided doses increased u! to )00 mgNkg daily in "ery se"ere infections
%onorrhea ?00 mg as a single dose
>)
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin.
V&#" "II"(8!,
,/S& sei9ures 'high doses(.
%I& !seudomembraneous colitis diarrhea nausea "omiting cram!s
!seudolithiasis 'ceftria3one(.
6erm& rashes urticaria.
7emat& bleeding 'increased with cefo!era9one( blood dyscrasias hemolytic
anemia.
Local& !ain at I4 site !hlebitis at I< site.
4isc& allergic reactions including ana!hyla3is and serum sickness su!er infection.
@$!&n% (on!&#"$H8&on!,
Should not be mi3ed with amino glycosides. ' each should be gi"en se!arately(
8or I.<. use should be mi3ed with $0 ml sterile water J administer o"er >.? minutes.
DD. C"I8Hb&#&m" ,
U$H#" nHm", ,e!ta9 8ortum *a9icef *a9idime
ClH!!& +ntibiotic Fce!halos!orinesF third"generation

L(8&on , 5ind to bacterial cell wall membrane causing cell death.
+!"!,
,efta9idime eliminates bacteria that cause many kinds of infections including lung skin
bone Loint stomach blood gynecological and urinary tract infections
Ao!"
by dee! intramuscular inLection or intra"enous inLection or infusion $ g e"ery
B hours or ) g e"ery $) hours- ) g e"ery BM$) hours or > g e"ery $) hours in se"ere
infections- single doses o"er $ g intra"enous route only- elderly usual ma3. > g daily- child
u! to ) months )?MA0 mgNkg daily in ) di"ided doses o"er ) months >0M$00 mgNkg daily
in )M> di"ided doses- u! to $?0 mgNkg daily 'ma3. A g daily( in > di"ided doses if immuno.
com!romised or meningitis- intra"enous route recommended for children
Urinary.tract and less serious infections 0.?M$ g e"ery $) hours
Pseudomonal lung infection in cystic fibrosis adult $00M$?0 mgNkg daily in >
di"ided doses- child u! to $?0 mgNkg daily 'ma3. A g daily( in >di"ided doses- intra"enous
route recommended for children
>>
Surgical !ro!hyla3is !rostatic surgery $ g at induction of anesthesia re!eated if necessary
when catheter remo"ed
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin
V&#" "II"(8!,
6iarrhea stomach !ain u!set stomach "omiting.
@$!&n% (on!&#"$H8&on!,
Infuse o"er >0 minutes unless otherwise indicated.
*hera!y should be continued for at least ).> days after sym!toms of infection ha"e
disa!!eared.
+ssess client with a history of hy!ersensiti"ity reaction. for !enicillin or
ce!halos!orin.#
+ssess client financial status. *hese drugs are usually e3!ensi"e.
Obtain li"er J renal studies.
DY. C"I8$&HXon",
U$H#" nHm", 2oce!hin
ClH!!& +ntibiotic Fce!halos!orinesF third"generation

+!"!,
Pneumonia U*I infections of skin bone J abdomen. 4eningitis bacterial
se!ticemia !re.o!. !ro!hyla3is.
Ao!"
by dee! intramuscular inLection or by intra"enous inLection o"er at least )M; minutes or by
intra"enous infusion $ g daily- )M; g daily in se"ere infections- intramuscular doses o"er
$ g di"ided between more than one site /eonate by intra"enous infusion o"er A0 minutes
)0M?0 mgNkg daily 'ma3. ?0 mgNkg daily( Infant and child under ?0 kg by dee!
intramuscular inLection or by intra"enous inLection o"er )M; minutes or by intra"enous
infusion )0M?0 mgNkg daily- u! to B0 mgNkg daily in se"ere infections- doses of ?0 mgNkg
and o"er by intra"enous infusion only- ?0 kg and o"er adult dose
Uncom!licated gonorrhea by dee! intramuscular inLection )?0 mg as a single dose.
>;
Surgical !ro!hyla3is by dee! intramuscular inLection or by intra"enous
inLection o"er at least )M; minutes $ g at induction- colorectal surgery by dee!
intramuscular inLection or by intra"enous inLection o"er at least )M; minutes or by
intra"enous infusion ) g at induction- intramuscular doses o"er $ g di"ided between more
than one site
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure
V&#" "II"(8!,
/ausea "omiting diarrhea anore3ia abdominal !ain flatulence skin rashes
su!er.infection heartburn sore mouth bone marrow de!ression.
@$!&n% (on!&#"$H8&on!,
I.4. inLection should be dee! into the body of large muscle.
I.<. inLection should be diluted.
8or stability of solution the !ackage insert should be checked carefully.
6osage should be maintained for at least ) days after sym!toms of infection ha"e
disa!!eared 'usual course is ;.$; days(.
O
DZ. C"I$oX&m" ,
U$H#" nHm", Ginacef
ClH!!& +ntibiotic Fce!halos!orinesF 'second generation(
+!"!,
Pharyngitis tonsillitis Otitis media Lower res!iratory tract infections U*Is
6ermatologic infections *reatment of early Lyme disease Lower res!iratory tract
infections influen9a Se!ticemia 4eningitis 5one and Loint infections
Perio!erati"e !ro!hyla3is .
Ao!" & by mouth 'as cefuro3ime a3etil( )?0 mg twice daily in most infections
including mild to moderate lower res!iratory.tract infections 'e.g. bronchitis(- doubled
for more se"ere lower res!iratory.tract infections or if !neumonia sus!ected
Urinary.tract infection $)? mg twice daily doubled in !yelone!hritis
%onorrhea $ g as a single dose
>?
,hild o"er > months $)? mg twice daily if necessary doubled in child o"er ) years
with otitis media
Lyme disease adult and child o"er $) years ?00 mg twice daily for )0 days 5y intramuscular
inLection or intra"enous inLection or infusion D?0 mg e"ery AMB hours- $.? g e"ery AMB hours in
se"ere infections- single doses o"er D?0 mg intra"enous route only
,hild usual dose A0 mgNkg daily 'range >0M$00 mgNkg daily( in >M; di"ided doses ')M
> di"ided doses in neonates(
%onorrhea $.? g as a single dose by intramuscular inLection 'di"ided between ) sites(
Surgical !ro!hyla3is $.? g by intra"enous inLection at induction- u! to > further doses of
D?0 mg may be gi"en by intramuscular or intra"enous inLection e"ery B hours for high.risk
!rocedures
4eningitis > g intra"enously e"ery B hours- ,hild )00M);0 mgNkg daily 'in >M; di"ided
doses( reduced to $00 mgNkg daily after > days or on clinical im!ro"ement- /eonate $00 mgNkg
daily reduced to ?0 mgNkg daily
Con8$H&n#&(H8&on!,
+llergy to ce!halos!orin or !enicillins renal failure lactation !regnancy
V&#" "II"(8!,
,/S& 7eadache di99iness lethargy !aresthesias
%I& /ausea "omiting diarrhea anore3ia abdominal !ain flatulence !seudo
membranous colitis li"er to3icity
7ematologic& 5one marrow de!ression& decreased I5, decreased !latelets
decreased 7ct.
%U& /e!hroto3icity
7y!ersensiti"ity& 2anging from rash to fe"er to ana!hyla3is serum sickness
reaction.
@$!&n% (on!&#"$H8&on!,
,ulture infection arrange for sensiti"ity tests before and during thera!y if e3!ected
res!onse is not seen.
%i"e oral drug with food to decrease %I u!set and enhance absor!tion.
%i"e oral drug to children who can swallow tablets- crushing the drug results in a bitter
un!leasant taste.
7a"e "itamin = a"ailable in case hy!o!rothrombinemia occurs.
6iscontinue if hy!ersensiti"ity reaction occurs.
>A
D[. C7lo$HmK7"n&(ol ,
U$H#" nHm", ,hloromycetin
ClH!!& antibiotic

L(8&on& it inhibits !rotein synthesis in bacteria by binding to ribosome.
+!"!,
/ot to be used for tri"ial infections as !ro!hyla3is of infection
,old throat infections or flu.
*reatment of choice for ty!hoid fe"er 'not for carrier state(.
4eningitis due to hemo!hilus influen9a !neumocoeoi or
4iningococei.
Skin infections 'to!ically(.
5rain abscesses.
Ao!" & by mouth or by intra"enous inLection or infusion ?0 mgNkg daily in ; di"ided
doses 'e3ce!tionally can be doubled for se"ere infections such as se!ticemia and
meningitis !ro"iding high doses reduced as soon as clinically indicated(- ,hild
haemo!hilus e!iglottitis and !yogenic meningitis ?0M$00 mgNkg daily in di"ided doses
'high dosages decreased as soon as clinically indicated(- Infants under ) weeks )? mgNkg
daily 'in ; di"ided doses(
) weeksM$ year ?0 mgNkg daily 'in ; di"ided doses(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to chloram!henicol.
Pregnancy
/ursing mothers.
2enal and he!atic failure.
V&#" "II"(8!,
+ !lastic anemia !ancyto!nea nausea "omiting abdominal distention !rogressi"e !allid
cyanoses ashen gray color tachy!nea "asomotor colla!se J death# %ray syndrome in
infants su!er infections.
@$!&n% (on!&#"$H8&on!,
+dminister I.<. as $0Q solution o"er at least $ min.
/ote any history of hy!ersensiti"ity J other contraindications J if
,lient takes antidiabetic or other medications that cause bone marrow de!ression.
>D
/eonates should be obser"ed closely 'greater ha9ards of to3icity(.
+rrange for further hematologic studies to be conducted e"ery ) days to detect early signs
of bone marrow de!ression.
*he drug should be taken at regular inter"als to be most effecti"e.
*he drug should be taken $ hr before or ) hr after meals ' if %I u!set
Occurs it could be taken with the food(.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
D\. C7lo$K$omHb&n",
U$H#" nHm", Largactil
ClH!!& +nti!sychotic !henothia9ine

L(8&on& +ct by blocking do!amine rece!tors. It has significant antiemetic effect hy!oteinsi"e
sedati"e J anticholenergic effect.
+!"!,
+cute J chronic !sychosis 'such as schi9o!hrenia mania J manic
6e!ression.
Preanasthetic.
Intractable hiccoughs.
/ausea J "omiting.

Ao!" , by mouth !sychomotor agitation e3citement and "iolent or dangerously im!ulsi"e
beha"ior initially )? mg > times daily 'or D? mg at night( adLusted according to res!onse to
usual maintenance dose of D?M>00 mg daily
Intractable hiccu! oral )?M?0 mg >M; times daily
5y dee! intramuscular inLection 'for relief of acute sym!toms )?M?0 mg e"ery AMB hours- ,hild
$M? years 0.? mgNkg e"ery AMB hours 'ma3. ;0 mg daily(- AM$) years 0.? mgNkg e"ery AMB hours
'ma3. D? mg daily(
Induction of hy!othermia 'to !re"ent shi"ering( by dee! intramuscular inLection )?M?0 mg
e"ery AMB hours- ,hild $M$) years initially 0.?M$ mgNkg followed by maintenance 0.? mgNkg
e"ery ;MA hours.
Con8$H&n#&(H8&on!,
Se"er de!ression coma.
5one marrow de!ression.
>B
Patients with history of sei9ures J on anticon"ulsant thera!y.
7e!atic J renal diseases.
Prostatic hy!ertro!hy.
6ehydration . glaucoma measles.
V&#" "II"(8!,
6e!ression di99iness sei9ures gynecomastia. Orthostatic hy!otension bronchos!asm
larlynyos!asm tardi"e dyskinesia !hotosensiti"ity leuko!nea a!lastic anemia and dry
mouth.
@$!&n% (on!&#"$H8&on!,
ShouldnKt be used to treat nausea J "omiting in children less than A months of age.
Should a"oid getting solution on hands or clothing 'it will cause dermatitis(.
Solutions with marked discoloration should be discarded.
/ote any history of sei9ures.
*ake li"er J kidney function test !eriodically.
6ocument J rotate inLection sites.
2e!ort side effects immediately.
6etermine age of male !atients J assess for !rostatic hy!ertro!hy.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
D^. C&K$oIloXH(&n cy#$o(7lo$&#",
U$H#" nHm", ci!ro3in
ClH!!& +ntibacterial 0uinolone deri"ati"e

L(8&on, is a synthetic 0uinolone with broad. s!ectrum bactericidal acti"ity inhibits the
synthesis of bacterial 6/+ by inhibiting the en9yme 6/+ gyrase.
+!"!,
UI* infectious diarrhea
Infection of lower res!iratory tract bone Loints J skin.
Ao!" , by mouth res!iratory.tract infections )?0MD?0 mg
*wice daily Urinary.tract infections )?0M?00 mg twice
6aily '$00 mg twice daily for > days in acute
>C
uncom!licated cystitis in women(
,hronic !rostatitis ?00 mg twice daily for )B days
%onorrhea ?00 mg as a single dose
Pseudomonal lower res!iratory.tract infection in cystic fibrosis D?0 mg twice
daily- ,7IL6 ?M$D years u! to )0 mgNkg twice daily 'ma3. $.? g daily(
4ost other infections ?00MD?0 mg twice daily
Surgical !ro!hyla3is D?0 mg A0MC0 minutes before !rocedure
Pro!hyla3is of meningococcal meningitis Wnot licensed for this indicationX
?00 mg as a single dose- ,hild ?M$) years )?0 mg
5y intra"enous infusion 'o"er >0MA0 minutes- ;00 mg o"er A0 minutes( )00M
;00 mg twice daily ,hild )0 mgNkg daily in ) di"ided doses
Pseudomonal lower res!iratory.tract infection in cystic fibrosis ;00 mg twice
daily- ,7IL6 ?M$D years u! to $0 mgNkg > times daily 'ma3. $.) g daily(
,hild not recommended but where benefit outweighs risk by mouth $0M>0 mgNkg
daily in ) di"ided doses or by intra"enous infusion BM$A mgNkg daily in ) di"ided
doses
+nthra3 'treatment and !ost.e3!osure !ro!hyla3is see notes abo"e( by mouth
?00 mg twice daily- child >0 mgNkg daily in ) di"ided doses 'ma3. $g daily(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity . children . lactation.
V&#" "II"(8!,
/ausea "omiting. 6ys!hasia crystalluria
7ematuria 2ashes bad taste %I bleeding
7eadache insomnia.
@$!&n% (on!&#"$H8&on!,
%i"e medication ) hr after meals.
Stress im!ortance of drinking increased amounts of fluids to kee! urine acidic J to
minimi9e the risk of crystalluria.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
DF. Cl&n#Hmy(&n K7o!K7H8",
U$H#" nHm", 6alacin
ClH!!& antibiotic clindamycin
;0
L(8&on, su!!ress !rotein synthesis by microorganisms by binding to ribosomes. It is both
bacteriostatic J bactericidal.
+!"!,
Serious res!iratory tract infections. 'lung abscess !neumonia(.
Serious skin infections.
Se!ticemia.
Osteomyelitis caused by sta!hylococci.
Used to!ically for inflammatory acne "ulgaris .
Ao!" & by mouth $?0M>00 mg e"ery A hours- u! to ;?0 mg e"ery A hours in se"ere infections-
,7IL6 >MA mgNkg e"ery A hours
/.5
Patients should discontinue immediately and contact doctor if diarrhea de"elo!s- ca!sules should
be swallowed with a glass of water.
5y dee! intramuscular inLection or by intra"enous infusion 0.AM).D g daily 'in )M; di"ided
doses(- life.threatening infection u! to ;.B g daily- single doses abo"e A00 mg by intra"enous
infusion only- single doses by intra"enous infusion not to e3ceed $.) g
,7IL6 o"er $ month $?M;0 mgNkg daily in >M; di"ided doses- se"ere infections at least
>00 mg daily regardless of weight.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
4inor bacterial infections.
Pregnancy.
V&#" "II"(8!,
/ausea "omiting diarrhea abdominal !ain tenesmus.
Loss of weight !seudo membranous colitis skin rashes.
7y!otension.
*hrombo!hlebitis following I.<. use.
@$!&n% (on!&#"$H8&on!,
%i"e !arenteral drug to hos!itali9ed client only.
6ilute I.<. inLections. If I.4. inLect medication dee!ly.
6onKt refrigerate solution 'because it becomes thick( .
5efore use take full history J not signs of allergy.
;$
5e !re!ared to manage colitis which can occur ).C days or se"eral weeks after initiation of
thera!y. Ihich includes& fluids electrolytes Protein su!!lement corticosteroids and
<ancomycin 'as ordered(.
6uring I.<. administration obser"e for signs of hy!otension.
+dminister only on an em!ty stomach. 'Iith a full glass of water to !re"ent eso!hageal
ulceration(.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
D`. CloXH(&ll&n,
U$H#" nHm", Orbenin
ClH!!& antibiotic F!enicillinase.resistant !enicillinsF
L(8&on, Inhibit bacterial cell wall synthesis.
+!"!,
Infections caused by !enicillinase. !roducing sta!hylococci stre!tococci
!neumococci.
Osteomylitis
!neumonia
infected wounds J burns
Se!tic arthritis.
Ao!" , by mouth )?0M?00 mg e"ery A hours at least >0 minutes before food- ,hild under
) years 0uarter adult dose- )M$0 years half adult dose
5y intramuscular inLection )?0M?00 mg e"ery A hours- ,hild under ) years 0uarter adult
dose- )M$0 years half adult dose
5y slow intra"enous inLection or by intra"enous infusion 0.)?M) g e"ery A hours- ,hild
under ) years 0uarter adult dose- )M$0 years half adult dose
1ndocarditis $) g daily in A di"ided doses for ; weeks
Osteomyelitis u! to B g daily in >M; di"ided doses
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to !enicillins J ce!halos!orin.
V&#" "II"(8!,
;)
+llergic& skin rashes !ruritis whee9ing fe"erR. .
6iarrhea abdominal cram!s !ain nausea "omiting.
Psendomembranous colitis thrombocyto!enia leuco!enia
7e!atoto3icity.
@$!&n% (on!&#"$H8&on!,
+dminister on an em!ty stomach.
2efrigerate reconstituted solution J discard remaining amount after $; days.
/.5.& *o !re!are oral sus!ension add amount of water stated on label and
shake well.
Shake the bottle well before each use.
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YE. A"XHm"87H!on",
U$H#" nHm", de3acort
ClH!!& adrenocorticosteroid Msynthetic glucocorticoid ty!e
G$"%nHn(y, ',ategory ,N6 if used in $st trimester(
L(8&on,
*hey are a grou! of natural hormones !roduced by the adrenal corte3.
*hey are used for a "ariety of thera!eutic !ur!oses.
4any slightly modified synthetic "ariants are a"ailable today.
Some !atients res!ond better to one substance than to another.
*hese hormones influence many metabolic !athways J all organ systems J are essential
for sur"i"al.
*he release of corticosteroids is controlled by hormones such as corticotro!in. releasing
factor !roduced by the hy!othalamus J +,*7 !roduced by the anterior !ituitary.
+!"!,
2e!lacement thera!y& adrenal insufficiency '+ddisonKs disease( .
2heumatic disorders& rheumatoid arthritis J osteoarthritis.
,ollagen diseases& systemic la!us erythematosus rheumatic cardiac.
+llergic diseases& drug hy!ersensiti"ity urticarial transfusion reaction.
2es!iratory diseases& bronchial asthma rhinitis.
Ocular diseases & allergic J inflammatory conLuncti"itis keratitis R
;>
6ermatological diseases& !soriasis contact dermatitis urticaria.
6iseases of the %I*& ulcerati"e colitis.
/er"ous system& 4yasthenia gra"is.
4alignancies& leukemia lym!homa.
/e!hrotic syndrome.
7ematologic diseases& hemolytic anemia thrombocyto!enic !ur!ura.
4iscellaneous& se!tic shock li"er cirrhosis stimulation of surfactant
Production !re"ention of organ reLection.

Ao!"
My mo87 usual range 0.?M$0 mg daily-
Py &n8$Hm!(lH$ &nd"(8&on or slow intra"enous inLection or infusion 'as
de3amethasone !hos!hate( initially 0.?M)0 mg- ,7IL6
)00M?00 microgramsNkg daily
,erebral edema 'as de3amethasone !hos!hate( by intra"enous inLection
$0 mg initially then ; mg by intramuscular inLection e"ery A hours as re0uired for )M$0
days
Shock 'as de3amethasone !hos!hate( by intra"enous inLection or infusion
)MA mgNkg re!eated if necessary after )MA hours
/ote. 6e3amethasone $ mg = de3amethasone !hos!hate $.) mg =
de3amethasone sodium !hos!hate $.> mg
Con8$H&n#&(H8&on!,
If infection is sus!ected '4ask signs J sym!toms(.
Pe!tic ulcer.
+cute glomerulone!hritis.
,ushingKs syndrome.
,ongesti"e heart failure.
7y!ertension.
7y!erli!idemia.
V&#" "II"(8!,
1dema alkalosis hy!okalemia hy!ertension ,78 muscle wasting weakness
osteo!orosis nausea J "omiting.
;;
7eadache hy!ercholesterolemia hirsutism amenorrhea de!ression.
2edistribution of body fats& thin e3tremities and fat trunk moon.like face buffalo hum!.
@$!&n% (on!&#"$H8&on!,
+dminister oral forms with food to minimi9e ulcerogenic effect.
8or chronic use gi"e the smallest dose !ossible.
,orticosteroids should be discontinued gradually if used chronically.
6ocument baseline weight 5.P. Pulse J tem!erature.
8re0uently take 5P monitor body weight 'signs of /aP J 7)O retention(.
Periodic serum electrolytes blood sugar monitoring.
2e!ort signs J sym!toms of side effects ',ushing.like syndrome(.
6iscuss with female client !otentials of menstrual difficulties.
Instruct the client to take diet high in !rotein J !otassium.
Instruct the client to a"oid falls J accidents 'osteo!orosis causes
Pathological fracture(.
2emind the client to carry a card identifying the drug being used.
Stress the need for regular medical su!er"ision.
+d"ice the client to delay any "accination while taking these medications
'Ieakened immunity(.
13!lain the need to maintain general hygiene J cleanliness to !re"ent Infection.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YS. A&Hb"KHm ,
U$H#" nHm", <alium assi"al.
ClH!!& anti Mcon"ulsant sedati"e an3iolytic agent ben9odia9e!ine
L(8&on,
*he an3iolytic effect is belie"ed to be mediated through the action of ben9odia9e!ine to
increase the inhibitory action of %+5+ %amma amino butyric acid# inhibit ,/S
neurotransmitter.
*he drug is metaboli9ed in the li"er J e3creted through urine.
+!"!,
Sym!tomatic relief of an3iety J tension.
+lcohol withdrawal.
;?
4uscle rela3ant.
+nticon"ulsi"e.
Preo!erati"ely.
5efore gastresco!y or eso!hagosco!y.
*reatment of status e!ile!ticus.
2elief of facial muscle s!asm.
Ao!"
5y intra"enous inLection $0M)0 mg at a rate of 0.? mL ').? mg( !er >0 seconds re!eated
if necessary after >0MA0 minutes- may be followed by intra"enous infusion to ma3.
> mgNkg o"er ); hours-
,hild 0.).0.> mgNkg or $ mg !er year of age
by rectum as rectal solution +dult and ,hild o"er $0 kg 0.? mgNkg- 1lderly 0.)?mgNkg
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
+cute narrow angle glaucoma.
Pregnancy.
Shock coma.
+lcoholic into3ication 'to a"oid res!iratory of de!ression(.
V&#" "II"(8!,
6rowsiness fatigue
ata3ia
hy!otension
"isual disturbances headache
Phlebitis at inLection site.
@$!&n% (on!&#"$H8&on!,
Stress that drug may reduce !tKs ability to handle dangerous e0ui!ment.
+"oid alcohol ingestion.
6onKt sto! taking the medication suddenly withdraw drug gradually.
4onitor 5.P. before J after administration.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YD. A&(loI"nH( Vo#&m,
U$H#" nHm"&
6iclofenac sodium& <oltaren 2ufenal /o"o.6ifenac ',+/( /u.6iclo
;A
',+/( <oltaren O!htha ',+/( <oltaren.V2
6iclofenac !otassium& ,ataflam <oltaren 2a!id ',+/(
A$% (lH!!"!
+nalgesic 'non.narcotic(
+nti!yretic
+nti.inflammatory agent
/onsteroidal anti.inflammatory drug '/S+I6(
G$"%nHn(y, ',ategory 5 N6 if used in >rd trimester or near deli"ery.X
L(8&on, Inhibits !rostaglandin synthetase to cause anti!yretic and anti.
Inflammatory effects- the e3act mechanism is unknown.
+!"!,
2heumatoid arthritis
Osteoarthritis.
+cute or long.term treatment of mild to moderate !ain including
dysmenorrheal
+nkylating s!ondylitis
Other musculoskeletal diseases.
6ental !ain
Strains J s!rains.
Ao!" by mouth, D?M$?0 mg daily in )M> di"ided doses
5y dee! intramuscular inLection into the gluteal muscle acute e3acerbations of !ain and
!osto!erati"e !ain D? mg once daily 'twice daily in se"ere cases( for ma3. Of ) days
Ureteric colic D? mg then a further D? mg after >0 minutes if necessary
by intra"enous infusion 'in hos!ital setting( D? mg re!eated if necessary after ;MA hours for ma3. )
days
Pre"ention of !osto!erati"e !ain initially after surgery )?M?0 mg o"er $?MA0 minutes then
? mgNhour for ma3. ) days
by rectum in su!!ositories D?M$?0 mg daily in di"ided doses
4a3. *otal daily dose by any route $?0 mg
,hild $M$) years Lu"enile arthritis by mouth or by rectum $M> mgNkg daily in di"ided doses
')? mg eNc tablets $).? mg and )? mg su!!ositories only(
Con8$H&n#&(H8&on!,
$. ,hildren less than$; years of age.
;D
). Lactation.
>. 7y!ersensiti"ity 'asthma rashes rhinitis(.
;. Uses with caution in !atients with a history of %I disease J reduced renal
functions.
V&#" "II"(8!,
,/S& 7eadache di99iness somnolence insomnia fatigue tiredness
di99iness tinnitus o!hthalmologic effects
%I& /ausea dys!e!sia %I !ain diarrhea "omiting consti!ation flatulence
7ematologic& 5leeding !latelet inhibition with higher doses
%U& 6ysuria renal im!airment
6ermatologic& 2ash !ruritus sweating dry mucous membranes stomatitis
Other& Peri!heral edema ana!hylactoid reactions to fatal ana!hylactic shock
@$!&n% (on!&#"$H8&on!,
%i"e on full stomach to a"oid %I* irritation.
Ihen gi"en I4 %i"e it dee! into a large muscle because drug is "ery irritant.
/ote any history of allergic res!onses to as!irin or nonsteroidal anti.inflammatory
agents. Y/S.+I6.Z
/ote the age of the client.
6etermine if !atient is taking oral hy!oglycemic or insulin and document it.
*ake these agents with milk or meal or antacids as !rescribed.
1ncourage !atient to take drug regularly.
2e!ort signs of %I irritation sore throat fe"er rash itching weight gain swelling
in ankles or fingers changes in "ision- black tarry stools tinnitus and rashes M etc.
6i99iness drowsiness can occur 'a"oid dri"ing or using dangerous machinery while
on this drug(.
If the client has 6iabetes 4ellitus e3!lain the !ossible in increasing hy!oglycemic
effect of the drugs to test urine J blood for glucose. *o adLust dose of these agents.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YY. A&%oX&n ,
U$H#" nHm"& Lano3ica!s Lano3in /o"o.6igo3in ',+/(
A$% (lH!!"!,
,ardiac glycoside
,ardiotonic agent
;B
U7"$HK"8&( H(8&on!
Increases intracellular calcium and allows more calcium to enter the myocardial cell during
de!olari9ation "ia a sodium...!otassium !um! mechanism- this increases force of contraction
'!ositi"e inotro!ic effect( increases renal !erfusion 'seen as diuretic effect in !atients with
,78( decreases heart rate 'negati"e chronotro!ic effect( and decreases +< node conduction
"elocity.
*n#&(H8&on!
,78
+trial fibrillation
+trial flutter
Paro3ysmal atrial tachycardia
Ao!"
by mouth ra!id digitali9ation $M$.? mg in di"ided doses o"er ); hours- less urgent
digitali9ation )?0M?00 micrograms daily 'higher dose may be di"ided( 4aintenance
A).?M?00 micrograms daily 'higher dose may be di"ided( according to renal function and
in atrial fibrillation on heart.rate res!onse- usual range $)?M)?0 micrograms daily
'lower dose may be a!!ro!riate in elderly(
1mergency loading dose by intra"enous infusion 0.D?M$ mg o"er at least ) hours then
maintenance dose by mouth on the following day
Con8$H&n#&(H8&on!,
,ontraindications& allergy to digitalis !re!arations "entricular tachycardia "entricular
fibrillation heart block sick sinus syndrome I7SS acute 4I renal insufficiency and
electrolyte abnormalities 'decreased =
P
decreased 4g
PP
increased ,a
PP
(.
Use cautiously with !regnancy and lactation.
V&#" "II"(8!,
,/S& 7eadache weakness drowsiness "isual disturbances
%I& %I u!set anore3ia
,<& +rrhythmias
@$!&n% Con!&#"$H8&on!
;C
4onitor a!ical !ulse for $ min before administering- hold dose if !ulse [A0 in adult or [C0
in infant retake !ulse in $ h. If adult !ulse remains [A0 or infant [C0 hold drug and notify
!rescriber. /ote any change from baseline rhythm or rate.
,heck dosage and !re!aration carefully.
+"oid I4 inLections which may be "ery !ainful.
8ollow diluting instructions carefully and use diluted solution !rom!tly.
+"oid gi"ing with meals- this will delay absor!tion.
7a"e emergency e0ui!ment ready- ha"e =P salts lidocaine !henytoin atro!ine and
cardiac monitor on standby in case to3icity de"elo!s.
4onitor for thera!eutic drug le"els& 0.?...) ngNmL.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YZ. AH&l8&Hb"m 7y#$o(7lo$&#" ,
U$H#" nHm"& +lti.6iltia9em +!o.6iltia9 ,ardi9em 6ilacor V2
%en.6iltia9em /o"o.6ilta9em /u.6iltia9 *iamate *ia9ac
A$% (lH!!"!
,alcium channel.blocker
+ntianginal agent
+ntihy!ertensi"e
L(8&on, ,alcium.channel blockers Fanti anginal antihy!ertensi"eF
Inhibits the mo"ement of calcium ions across the membranes of cardiac and arterial muscle
cells resulting in the de!ression of im!ulse formation in s!eciali9ed cardiac !acemaker
cells slowing of the "elocity of conduction of the cardiac im!ulse de!ression of
myocardial contractility and dilation of coronary arteries and arterioles and !eri!heral
arterioles- these effects lead to decreased cardiac work decreased cardiac energy
consum!tion and in !atients with "asos!astic 'Prin9metalEs( angina increased deli"ery of
o3ygen to myocardial cells.
*n#&(H8&on!
+ngina !ectoris due to coronary artery s!asm 'Prin9metalEs "ariant angina(
1ffort.associated angina- chronic stable angina in !atients not controlled by O.
adrenergic blockers nitrates
1ssential hy!ertension 'sustained release(
?0
*reatment of hy!ertension 'sustained release *iamate(
Paro3ysmal su!ra"entricular tachycardia '!arenteral(
Ao!"
+"ailable 8orms& *ablets..>0 A0 C0 $)0 mg- S2 ca!sules..A0 C0 $)0 $B0 );0 >00 mg-
inLection..)? ?0 mg as ? mgNmL
1"aluate !atient carefully to determine the a!!ro!riate dose of this drug.
+ngina A0 mg > times daily 'elderly initially twice daily(- increased if
necessary to >A0 mg daily
Pediatric& Safety and efficacy not established.
Con8$H&n#&(H8&on!e(H8&on!
+llergy to diltia9em
im!aired he!atic or renal function
sick sinus syndrome hy!otension
!ulmonary congestion and 4I
heart block 'second or third degree( and
lactation
V&#" "II"(8!
,/S& 6i99iness light.headedness headache asthenia fatigue
%I& /ausea he!atic inLury
,<& Peri!heral edema hy!otension arrhythmias bradycardia +< block asystole
6ermatologic& 8lushing rash
Cl&n&(Hlly &mKo$8Hn8 &n8"$H(8&on!
6rug.drug
o Increased serum le"els and to3icity of cyclos!orine if taken concurrently with
diltia9em
@$!&n% Con!&#"$H8&on!
4onitor !atient carefully '5P cardiac rhythm and out!ut( while drug is being titrated to
thera!eutic dose- dosage may be increased more ra!idly in hos!itali9ed !atients under close
su!er"ision.
4onitor 5P carefully if !atient is on concurrent doses of nitrates.
4onitor cardiac rhythm regularly during stabili9ation of dosage and !eriodically during
long.term thera!y.
?$
2e!ort irregular heart beat shortness of breath swelling of the hands or feet !ronounced
di99iness consti!ation.
O
Y[. AoP8Hm&n" 7y#$o(7lo$&#",
U$H#" nHm"& 6obutre3
A$% (lH!!"!,
Sym!athomimetic
O
$
.selecti"e adrenergic agonist
U7"$HK"8&( H(8&on!,
Positi"e inotro!ic effects are mediated by O
$
. adrenergic rece!tors in the heart- increases the force
of myocardial contraction with relati"ely minor effects on heart rate arrhythmogenesis- has minor
effects on blood "essels.
*n#&(H8&on!
8or inotro!ic su!!ort in the short.term treatment of adults with cardiac decom!ensation
due to de!ressed contractility resulting from either organic heart disease or from
cardiac surgical !rocedures
In"estigational use in children with congenital heart disease undergoing diagnostic
cardiac catheteri9ation to augment ,< function
Ao!H%"
+"ailable 8orms& InLection $).? mgNmL.
+dminister only by I< infusion.
*itrate on the basis of the !atientEs homodynamicNrenal res!onse.
,lose monitoring is necessary.
L#l8,
).?...$? \gNkgNmin I< is usual rate to increase cardiac out!ut- rarely rates u! to ;0 \gNkg
!er minute are needed.
*f IH(8!
G$"KH$H8&on, 2econstitute by adding $0 mL Sterile Iater for InLection or ?Q 6e3trose
InLection to )?0.mg "ial. If material is not com!letely dissol"ed add $0 mL of diluent.
?)
8urther dilute to at least ?0 mL with ?Q 6e3trose InLection 0.CQ Sodium ,hloride
InLection or Sodium Lactate InLection. Store reconstituted solution under refrigeration for
;B h or at room tem!erature for A h. Store final diluted solution in glass or "ia fle3 container
at room tem!erature. Stable for ); h. 6o not free9e. '/ote& drug solutions may e3hibit a
color that increases with time- this indicates o3idation of the drug not a loss of !otency.(
*nI!&on, 4ay be administered through common I< tubing with do!amine lidocaine
tobramycin nitro!russide !otassium chloride or !rotamine sulfate. *itrate rate based on
!atient res!onse..P 5P rhythm- use of an infusion !um! is suggested.
*n(omKH8&P&l&8&"!, 6o not mi3 drug with alkaline solutions such as ?Q Sodium
5icarbonate InLection- do not mi3 with hydrocortisone sodium succinate cefa9olin
cefamandole neutral ce!halothin !enicillin sodium ethacrynate- sodium he!arin.
gJ!&8" *n(omKH8&P&l&8&"!, 6o not mi3 with acyclo"ir alte!lase amino!hylline foscarnet.
L#Q"$!" "II"(8!
,/S& 7eadache
%I& /ausea
,<& Increase in heart rate increase in systolic blood !ressure increase in "entricular
ecto!ic beats 'P<,s( anginal !ain !al!itations shortness of breath
6rug.drug
Increased effects with *,+s 'eg imi!ramine( fura9olidone methyldo!a
2isk of se"ere hy!ertension with O.blockers
6ecreased effects of guanethidine with dobutamine
@$!&n% Con!&#"$H8&on!
+rrange to digitali9e !atients who ha"e atrial fibrillation with a ra!id "entricular
rate before gi"ing dobutamine..dobutamine facilitates +< conduction.
4onitor urine flow cardiac out!ut !ulmonary wedge !ressure 1,% and 5P
closely during infusion- adLust doseNrate accordingly.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
Y\. AoKHm&n" cy#$o(7lo$&#",
U$H#" nHm"!& Intro!in docard
?>
ClH!!& 6irect J indirect acting adrenergic agent.
@.M.& +"ailable for hos!ital use only on ? ml am!oules containing )00 mg 6o!arninc
hydrochloride.
L(8&on,
It is the immediate !recursor of e!ine!hrine in the body.
It !roduces direct stimulation of O$ rece!tors resulting in increasing myocardial
contraction cardiac out!ut as well as increase renal blood flow J sodium
e3cretion.
It e3erts little effect on diastolic 5.P. J induce fewer arrhythrrias that seen on other
adrenergic.
+l!ha rece!tors which are stimulated by higher doses of do!amine e3erts
"asodilatation effects which can o"erride the "asodilating effect.
In higher doses it stimulates al!ha rece!tors leading to !eri!heral "asoconstriction.
*n#&(H8&on!,
,ardiogenic shocks es!ecially in 4.I. associated with se"er ,.7.8
7y!otension due to !oor cardiac out !ut.
Shock associated with se!ticemia trauma heart surgery renal failure J
,.7.8.
,ardiomyo!athy.
In lower doses '$.? 4cgNkgNmin( used in renal failure.
Con8$H&n#&(H8&on!,
Pheochromocytoma uncorrected tachycardia arrhythmias.
7y!o"olemia.
Safety and efficacy is not established in children.
V&#" "II"(8!,
%I& /ausea and "omiting.
,<& 1cto!ic heart.beats tachycardia or bradycardia anginal !ain !al!itation
hy!otension or hy!ertension dys!nea wide H2S com!le3.
Others& headache.
Ao!H%" Hn# H#m&n&!8$H8&on,
/.5.& *his is a !otent drug.
It must be diluted before administration to the !atient.
?;
Suggested dilution&
*ransfer contents of one am!oule '?ml containing )00 mg of do!amine( by ase!tic
techni0ue to either )?0 or ?00 ml bottle of sterile I.<. solution 'saline de3trose ?Q or
ringer lactate(. *hese dilutions will yield a final concentration for administration as
follows.
- )?0 ml dilution contains B00 mcg]ml of do!amine.
- ?00 ml dilution contains ;00 mcg]ml of do!amine.
/.5.&
$. Solution stable after dilution for ); hours.
). 6onKt add do!amine to /a7,O> or other alkaline I.<. solutions since the
drug is inacti"ated in alkaline solution.
2ate of administration.
*hrough a suitable I.<. needle or a catheter J through an electronic infusion
!um! rate is regulated according to re0uired dose.
Ao!",
2enal dose& $.? 4cg]kg]minute.
,ardiac dose& start initially of ? 4cgNkgNmin then increase by increments u! to a
rate of )0.?0 4cgNkgNmin.
@$!&n% (on!&#"$H8&on!,
+dminister only by I< I/8USIO/ '/ot I< bolus nor I4(
6rug must be diluted before use.
+dminister drug through a central line or a big "ein '"ein in the anticu!ital fossa is
!referred o"er those in the hand(.
Sto! the drug by small increments.
Solution is stable for ); hrs !rotect it from light.
4onitor 5.P. J 1,% continuously during drug administration.
4onitor intake J out !ut.
4onitor !atient for occurrence of side effects.
,heck I.<. site for sighs of e3tra"asations.
6rug should be administered through electronic infusion de"ice.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Y^. AoXy(y(l&n ,
U$H#" nHm"!& 6o3ylin 6o3y!al 6o3y!harm 6o3acylin. +!o.
6o3y 6ory3 6o3y.,a!s 6o3ycin
??
6o3ychel 7yclate 6o3ytec /o"o.6o3ylin /u.
6o3ycycline <ibra.*abs <ibramycin
ClH!!, +ntibiotic tetracycline.
U7"$HK"8&( H(8&on!
5acteriostatic& inhibits !rotein synthesis of susce!tible bacteria causing cell death
*n#&(H8&on!
Infections caused by rickettsiae- 4. !neumoniae- agents of !sittacosis ornithosis
lym!hogranuloma "enereum and granuloma inguinale- 5. recurrentis- 7. ducreyi- P. !estis-
P. tularensis- 5. bacilliformis- 5acteroides- <. comma- <. fetus- 5rucella- 1. coli- 1.
aerogenes- Shigella- +. calcoaceticus- 7. influen9a- =lebsiella- 6. !neumoniae- S. aureus
Ihen !enicillin is contraindicated infections caused by /. gonorrhoeae *. !allidum *.
!ertenue L. monocytogenes ,lostridium 5. anthracis- adLunct to amebicides in acute
intestinal amebiasis
Oral tetracyclines used for acne uncom!licated adult urethral endocer"ical or rectal
infections caused by ,. trachomatis
Unlabeled use& !re"ention of Ftra"elerEs diarrheaF commonly caused by enteroto3igenic 1.
coli
+llergy to tetracyclines
renal or he!atic dysfunction
!regnancy and
Lactation.

Ao!H%" Io$m,
+"ailable 8orms& *ablets..$00 mg- !owder for oral sus!ension..)? mg- syru!..?0
mg- !owder for inLection..$00 )00 mg
Ao!"&
)00 mg on first day then $00 mg daily- se"ere infections 'including refractory
urinary.tract infections( )00 mg daily
1arly sy!hilis $00 mg twice daily for $; days- late latent sy!hilis )00 mg twice
daily for )B days
?A
Uncom!licated genital ,hlamydia non.gonococcal urethritis $00 mg twice daily
for D days '$; days in !el"ic inflammatory disease
+nthra3 'treatment or !ost.e3!osure !ro!hyla3is $00 mg twice daily-
,hild 'only if alternati"e antibacterial cannot be gi"en( Wunlicensed doseX ? mgNkg
daily in ) di"ided doses 'ma3. )00 mg daily(
%eriatric or 2enal 8ailure Patients&
I< doses of do3ycycline are not as to3ic as other tetracyclines in these !atients.
L#Q"$!" "II"(8!
%I& 8atty li"er li"er failure anore3ia nausea "omiting diarrhea glossitis dys!hagia
enterocolitis eso!hageal ulcer
7ematologic& 7emolytic anemia thrombocyto!enia neutro!enia eosino!hilia
leukocytosis leuko!enia
6ermatologic& Phototo3ic reactions rash e3foliati"e dermatitis 'more fre0uent and more
se"ere with this tetracycline than with any others(
6ental& 6iscoloring and inade0uate calcification of !rimary teeth of fetus if used by
!regnant women discoloring and inade0uate calcification of !ermanent teeth if used during
!eriod of dental de"elo!ment
Local& Local irritation at inLection site
Other& Su!er infections ne!hrogenic diabetes insi!idus syndrome
6rug.drug
6ecreased absor!tion with antacids iron alkali
6ecreased thera!eutic effects with barbiturates carbama9e!ine !henytoins
Increased digo3in to3icity with do3ycycline
Increased ne!hroto3icity with metho3yflurane
6ecreased acti"ity of !enicillins
6rug.food
6ecreased effecti"eness of do3ycycline if taken with food dairy !roducts
6rug.lab test
?D
Interference with culture studies for se"eral days following thera!y
@$!&n% (on!&#"$H8&on,
+dminister the oral medication without regard to food or meals- if %I u!set occurs
gi"e with meals.
6o not gi"e with antacid milk or any !roduct that contains ,alcium Gink
aluminum magnesium and ferrous salts because these !roducts decrease the
absor!tion of the drug.
Protect !atient from light and sun e3!osure.
2e!ort rash itching- difficulty breathing- dark urine or light.colored stools- !ain at
inLection site
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
YF. 'nHlHK$&l T ConQ"$8&n W ,
U$H#" nHm"!& 1nala!rilat ,on"ertin
A$% (lH!!"!
+ntihy!ertensi"e
+,1 inhibitor
G$"%nHn(y, ',ategory ,N 6 if used in the )nd or >rd trimesters.X
U7"$HK"8&( H(8&on!
2enin synthesi9ed by the kidneys is released into the circulation where it acts on a
!lasma !recursor to !roduce angiotensin I which is con"erted by angiotensin.
con"erting en9yme to angiotensin II a !otent "asoconstrictor that also causes
release of aldosterone from the adrenals- both of these actions increase 5P. 1nala!ril
blocks the con"ersion of angiotensin I to angiotensin II decreasing 5P decreasing
aldosterone secretion slightly increasing serum =
P
le"els and causing /a
P
and fluid
loss- increased !rostaglandin synthesis also may be in"ol"ed in the antihy!ertensi"e
action.
*n#&(H8&on!
*reatment of hy!ertension alone or in combination with thia9ide.ty!e diuretics
*reatment of acute and chronic ,78
?B
*reatment of asym!tomatic left "entricular dysfunction 'L<6(
*reatment of acute hy!ertension..I<
,ontraindication& allergy to enala!ril.
Use cautiously with im!aired renal function- saltN"olume de!letion..hy!otension may
occur- lactation
Ao!"
7y!ertension used alone initially ? mg once daily-
if used in addition to diuretic in elderly !atients or in renal im!airment
initially ).? mg daily-
Usual maintenance dose $0M)0 mg once daily-
In se"ere hy!ertension may be increased to ma3. ;0 mg once daily
7eart failure 'adLunct( asym!tomatic left "entricular dysfunction initially
).? mg daily under close medical su!er"ision- usual maintenance dose )0 mg
daily in $M) di"ided doses
L#Q"$!" "II"(8!
,/S& Headache, di##iness, fatigue insomnia !aresthesias
%I& %astric irritation nausea "omiting diarrhea abdominal !ain dys!e!sia ele"ated li"er
en9ymes
,<& Synco!e chest !ain !al!itations hy!otension in saltN"olume de!leted !atients
7ematologic& 6ecreased hematocrit and hemoglobin
%U& Proteinuria renal insufficiency renal failure !olyuria oliguria urinary fre0uency
im!otence
Other& ,ough muscle cram!s hy!erhidrosis
6rug.drug
6ecreased hy!otensi"e effect if taken concurrently with indomethacin
rifam!in
@$!&n% Con!&#"$H8&on!
If !t undergoes any ty!es of surgery alert surgeon and mark !atientEs chart with notice that
enala!ril is being taken- the angiotensin II formation subse0uent to com!ensatory renin
?C
release during surgery will be blocked- hy!otension may be re"ersed with "olume
e3!ansion.
4onitor !atients on diuretic thera!y for e3cessi"e hy!otension following the first few doses
of enala!ril.
4onitor !atient closely in any situation that may lead to a fall in 5P secondary to reduced
fluid "olume 'e3cessi"e !ers!iration and dehydration "omiting diarrhea( because
e3cessi"e hy!otension may occur.
+rrange for reduced dosage in !atients with im!aired renal function.
4onitor !atient carefully because !eak effect may not be seen for ; h. 6o not administer
second dose until checking 5P.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO

Y`. 'noXHKH$&n TCl"XHn" W ,
U$H#" nHm", Lo"eno3
A$% (lH!!"!
Low.molecular.weight he!arin
+ntithrombotic agent
U7"$HK"8&( H(8&on!
Low molecular weight he!arin that inhibits thrombus and clot formation by blocking factor
Va factor IIa !re"enting the formation of clots.
*n#&(H8&on!
Pre"ention of dee! "ein thrombosis which may lead to !ulmonary embolism
following hi! re!lacement knee re!lacement surgery abdominal surgery
Pre"ention of ischemic com!lications of unstable angina and non...H.wa"e 4I
*reatment of dee! "ein thrombosis '6<*( !ulmonary embolus with warfarin
,ontraindications& hy!ersensiti"ity to eno3a!arin he!arin !ork !roducts- se"ere
thrombocyto!enia- uncontrolled bleeding.
Use cautiously with !regnancy or lactation history of %I bleeding.
A0
Ao!"
Pro!hyla3is of dee!."ein thrombosis in medical !atients by subcutaneous inLection ;0 mg
';000 units( e"ery ); hours for at least A days until !atient ambulant 'ma3. $; days(
*reatment of dee!."ein thrombosis or !ulmonary embolism by subcutaneous inLection
$.? mgNkg '$?0 unitsNkg( e"ery ); hours usually for at least ? days 'and until ade0uate oral
anticoagulation established(
Unstable angina and non.S*.segment.ele"ation myocardial infarction by subcutaneous
inLection $ mgNkg '$00 unitsNkg( e"ery $) hours usually for )MB days 'minimum ) days(
L#Q"$!" "II"(8!
7ematologic& 7emorrhage- bruising- thrombocyto!enia- ele"ated +S* +L* le"els-
hy!erkalemia
7y!ersensiti"ity& ,hills fe"er urticaria asthma
Other& 8e"er- !ain- local irritation hematoma erythema at site of inLection
6rug.drug
Increased bleeding tendencies with oral anticoagulants salicylates !enicillins
ce!halos!orins
6rug.lab test
Increased +S* +L* le"els
6rug.alternati"e thera!y
Increased risk of bleeding if combined with chamomile garlic ginger gingko
and ginseng thera!y
@$!&n% Con!&#"$H8&on!
%i"e drug as soon as !ossible after hi! surgery.
%i"e dee! S, inLections- do not gi"e eno3a!arin by I4 inLection.
+dminister by dee! S, inLection- !atient should be lying down. +lternate between the left
and right anterolateral and !osterolateral abdominal wall. Introduce the whole length of the
needle into a skin fold held between the thumb and forefinger- hold the skin fold throughout
the inLection.
A$
+!!ly !ressure to all inLection sites after needle is withdrawn- ins!ect inLection sites for
signs of hematoma- do not massage inLection sites.
6o not mi3 with other inLections or infusions.
Store at room tem!erature- fluid should be clear colorless to !ale yellow.
Pro"ide for safety measures 'electric ra9or soft toothbrush( to !re"ent inLury to !atient who
is at risk for bleeding.
,heck !atient for signs of bleeding- monitor blood tests.
+lert all health care !ro"iders that !atient is on eno3a!arin.
6iscontinue and initiate a!!ro!riate thera!y if thromboembolic e!isode occurs des!ite
eno3a!arin thera!y.
7a"e !rotamine sulfate 'eno3a!arin antidote( on standby in case of o"erdose.
*reat o"erdose as follows& Protamine sulfate '$Q solution(. 1ach mg of !rotamine
neutrali9es $ mg eno3a!arin. %i"e "ery slowly I< o"er $0 min.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
ZE. 'K7"#$&n" !lIH8"
U$H#" nHm", /asal decongestant& Pret9.6
A$% (lH!!"!
Sym!athomimetic drug
<aso!ressor
5ronchodilator drug
/asal decongestant
U7"$HK"8&( H(8&on!
Peri!heral effects are mediated by rece!tors in target organs and are due in !art to the release of
nore!ine!hrine from ner"e terminals. 1ffects mediated by these rece!tors include "asoconstriction
'increased 5P decreased nasal congestion ^ rece!tors(- cardiac stimulation 'O
$
( and
bronchodilation 'O
)
(. Longer acting but less !otent than e!ine!hrine- also has ,/S stimulant
!ro!erties.
A)
*n#&(H8&on!
*reatment of hy!otensi"e states es!ecially those associated with s!inal anesthesia- Stokes.
+dams syndrome with com!lete heart block- ,/S stimulant in narcole!sy and de!ressi"e
states- acute bronchos!asm '!arenteral(
Pressor agent in hy!otensi"e states following sym!athectomy o"er dosage with ganglionic.
blocking agents antiadrenergic agents or other drugs used for lowering 5P '!arenteral(
2elief of acute bronchos!asm '!arenteral- e!ine!hrine is the !referred drug(
*reatment of allergic disorders such as bronchial asthma and local treatment of nasal
congestion in acute cory9a "asomotor rhinitis acute sinusitis hay fe"er 'oral(
Sym!tomatic relief of nasal and naso!haryngeal mucosal congestion due to the common
cold hay fe"er or other res!iratory allergies 'to!ical(
+dLuncti"e thera!y of middle ear infections by decreasing congestion around the eustachian
ostia 'to!ical(
,ontraindications& allergy to e!hedrine angle.closure glaucoma anesthesia with
cyclo!ro!ane or halothane thyroto3icosis diabetes hy!ertension ,< disorders women in
labor whose 5P [ $>0NB0.
Use cautiously with angina arrhythmias !rostatic hy!ertro!hy unstable "asomotor
syndrome lactation.
Ao!H%"
L#l8
Hypotensive episodes, allergic disorders, asthma:
)?...?0 mg I4 'fast absor!tion( S, 'slower absor!tion( or I< 'emergency administration(.
Labor:
*itrate !arenteral doses to maintain 5P at or below $>0NB0.
Acute asthma:
+dminister the smallest effecti"e dose '0.)?...0.? mL or $).?...)? mg(.
Maintenance dosage--allergic disorders, asthma:
)?...?0 mg PO 0>...;h as necessary.
Topical nasal decongestant:
A>
Instill solution in each nostril 0;h. 6o not use longer than >...; consecuti"e days.
G"#&H8$&(,
)?...$00 mgNm
)
I4 or S, di"ided into ; to A doses- > mgNkg !er day or $00 mgNm
)
!er day di"ided
into ; to A doses PO S, or I< for bronchodilation.
Topical nasal decongestant (> 6 y:
Instill solution in each nostril 0;h. 6o not use for longer than >...; consecuti"e d. 6o not use in
children [A y unless directed by !hysician.
h"$&H8$&(,
4ore likely to e3!erience ad"erse reactions- use with caution.
L#Q"$!" "II"(8!
Systemic effects are less likely with to!ical administration but can take !lace and should be
considered.
,/S& $ear, anxiety, tenseness, restlessness, headache, light"headedness, di##iness
drowsiness tremor insomnia hallucinations !sychological disturbances con"ulsions ,/S
de!ression weakness blurred "ision ocular irritation tearing !hoto!hobia sym!toms of
!aranoid schi9o!hrenia
%I& %ausea "omiting anore3ia
,<& +rrhythmias hy!ertension resulting in intracranial hemorrhage ,< colla!se with
hy!otension !al!itations tachycardia !recordial !ain in !atients with ischemic heart
disease
%U& ,onstriction of renal blood "essels and decreased urine formation 'initial !arenteral
administration( dysuria, vesical sphincter spasm resulting in difficult and !ainful urination
urinary retention in males with !rostatism
Local& ebound congestion with to!ical nasal a!!lication
Other& Pallor res!iratory difficulty orofacial dystonia sweating
6rug.drug
o Se"ere hy!ertension with 4+O.inhibitors *,+s fura9olidone
o +dditi"e effects and increased risk of to3icity with urinary alkalini9ers
o 6ecreased "aso!ressor res!onse with reser!ine methyldo!a urinary acidifiers
A;
o 6ecreased hy!otensi"e action of guanethidine with e!hedrine
@$!&n% Con!&#"$H8&on!
Protect solution from light- gi"e only if clear- discard any unused !ortion.
4onitor urine out!ut with !arenteral administration- initially renal blood "essels may be
constricted and urine formation decreased.
6o not use nasal decongestant for longer than >...? d.
+"oid !rolonged use of systemic e!hedrine 'a syndrome resembling an an3iety effect may
occur(- tem!orary cessation of the drug usually re"erses this syndrome.
4onitor ,< effects carefully- !atients with hy!ertension may e3!erience changes in 5P
because of the additional "asoconstriction. If a nasal decongestant is needed gi"e
!seudoe!hedrine.
ZS. '$y87$omy(&n ,
U$H#" nHm"!, 1ramycin 1rythrocin
A$% (lH!!, 4acrolide antibiotic
U7"$HK"8&( H(8&on!
Inhibits !rotein synthesis of microorganisms by binding to ribosome.
It is effecti"e only against ra!idly multi!lying organisms.
+bsorbed readily from the u!!er %I* 'small intestine(.
+re manufactured in enteric Mcoated or film.coated forms to !re"ent destruction
by gastric acid diffuse !oorly to ,.S.8. J !rimarily e3creted in bile.
*n#&(H8&on!
!ystemic Administration
+cute infections caused by sensiti"e strains of &treptococcus pneumoniae, 'ycoplasma
pneumoniae, Listeria monocytogenes, Legionella pneumophila
U2Is L2Is skin and soft.tissue infections caused by grou! + O.hemolytic stre!tococci
when oral treatment is !referred to inLectable ben9athine !enicillin
PI6 caused by %( gonorrhoeae in !atients allergic to !enicillin
In conLunction with sulfonamides in U2Is caused by Haemophilus influen#ae
+s an adLunct to antito3in in infections caused by )orynebacterium diphtheriae and
)orynebacterium minutissimum
A?
Pro!hyla3is against ^.hemolytic stre!tococcal endocarditis before dental or other
!rocedures in !atients allergic to !enicillin who ha"e "al"ular heart disease
"ral #rythromycin
*reatment of intestinal amebiasis caused by Entamoeba histolytica- infections in the
newborn and in !regnancy that are caused by )hlamydia trachomatis and in adult
chlamydial infections when tetracycline cannot be used- !rimary sy!hilis '*reponema
pallidum( in !enicillin.allergic !atients- eliminating +ordetella pertussis organisms from
the naso!haryn3 of infected indi"iduals and as !ro!hyla3is in e3!osed and susce!tible
indi"iduals.
Unlabeled uses& erythromycin base is used with neomycin before colorectal surgery to
reduce wound infection- treatment of se"ere diarrhea associated with )ampylobacter
enteritis or enterocolitis- treatment of genital inguinal or anorectal lym!hogranuloma
"enereum infection- treatment of Haemophilus ducreyi 'chancroid(
"phthalmic "intment
*reatment of su!erficial ocular infections caused by susce!tible strains of microorganisms-
!ro!hyla3is of o!hthalmia neonatorum caused by %( gonorrhoeae or )( trachomatis
Topical $ermatologic !olutions %or Acne
*reatment of acne "ulgaris
Topical $ermatologic "intment
Pro!hyla3is against infection in minor skin abrasions
*reatment of skin infections caused by sensiti"e microorganisms
,ontraindication& allergy to erythromycin.
Use cautiously with he!atic dysfunction lactation 'secreted and may be concentrated in
breast milk- may modify bowel flora of nursing infant and interfere with fe"er worku!s(.
"phthalmic "intment
,ontraindications& allergy to erythromycin- "iral fungal mycobacterial infections of the
eye.
AA
Ao!H%"
+"ailable 8orms& 5ase& *ablets..)?0 >>> ?00 mg- 62 ca!sules..)?0 mg- o!hthalmic ointment..?
mgNg. 1stolate& *ablets..?00 mg- ca!sules..)?0 mg- sus!ension..$)? )?0 mgN? mL. Stearate&
*ablets..)00 ;00 mg- sus!ension..)00 ;00 mgN? mL $00 mgN)...? mL- !owder for sus!ension..
)00 mgN? mL- granules for sus!ension..;00 mgN? mL- to!ical solution..$.?Q )Q- to!ical gel
ointment..)Q.
Systemic administration&
Oral !re!arations of the different erythromycin salts differ in !harmacokinetics& ;00 mg
erythromycin ethylsuccinate !roduces the same free erythromycin serum le"els as )?0 mg of
erythromycin base sterate or estolate.
Adult:
$?...)0 mgNkg !er day in continuous I< infusion or u! to ; gNd in di"ided doses 0Ah- )?0 mg ';00
mg of ethylsuccinate( 0Ah PO or ?00 mg 0$)h PO or >>> mg 0Bh PO u! to ; gNd de!ending on
the se"erity of the infection.
Stre!tococcal infections&
)0...?0 mgNkg !er day PO in di"ided doses 'for grou! + O.hemolytic stre!tococcal infections
continue thera!y for at least $0 d(.
LegionnaireEs disease&
$...; gNd PO or I< in di"ided doses 'ethylsuccinate $.A gNd- o!timal doses not established(.
6ysenteric amebiasis&
)?0 mg ';00 mg of ethylsuccinate( PO 0id or >>> mg 0Bh for $0...$; d.
+cute !el"ic inflammatory disease '/. gonorrhoeae(&
?00 mg of lactobionate or gluce!tate I< 0Ah for > d and then )?0 mg stearate or base PO 0Ah or
>>> mg 0Bh for D d.
Pertussis&
;0...?0 mgNkg !er day PO in di"ided doses for ?...$; d 'o!timal dosage not established(.
Pro!hyla3is against bacterial endocarditis before dental or u!!er res!iratory !rocedures& $ g '$.A g
of ethylsuccinate( A h later.
,hlamydial infections&
AD
Urogenital infections during !regnancy& ?00 mg PO 0id or AAA mg 0Bh for at least D d $N) this
dose 0Bh for at least $; d if intolerant to first regimen. Urethritis in males& B00 mg of
ethylsuccinate PO tid for D d.
Primary sy!hilis&
>0...;0 g ';B...A; g of ethylsuccinate( in di"ided doses o"er $0...$? d.
,6, recommendations for S*6s&
?00 mg PO 0id for D...>0 d de!ending on the infection.
&ediatric:
>0...?0 mgNkg !er day PO in di"ided doses. S!ecific dosage determined by se"erity of infection
age and weight.
6ysenteric amebiasis&
>0...?0 mgNkg !er day in di"ided doses for $0...$; d.
Pro!hyla3is against bacterial endocarditis&
)0 mgNkg before !rocedure and then $0 mgNkg A h later.
,hlamydial infections&
?0 mgNkg !er day PO in di"ided doses for at least ) 'conLuncti"itis of newborn( or > '!neumonia
of infancy( wk.
O!hthalmic ointment&
$N).in ribbon instilled into conLuncti"al sac of affected eye two to si3 times !er day de!ending on
se"erity of infection.
*o!ical dermatologic solution for acne&
+!!ly to affected areas morning and e"ening.
*o!ical dermatologic ointment&
+!!ly to affected area $...? _Nd.
L#Q"$!" "II"(8!
Systemic +dministration
,/S& 2e"ersible hearing loss confusion uncontrollable emotions abnormal thinking
AB
%I& +bdominal cram!ing anore3ia diarrhea "omiting !seudomembranous colitis
he!atoto3icity
7y!ersensiti"ity& +llergic reactions ranging from rash to ana!hyla3is
Other& Su!er infections
O!hthalmic Ointment
6ermatologic& 1dema utricaria dermatitis angioneurotic edema
Local& Irritation burning itching at site of a!!lication
*o!ical 6ermatologic Pre!arations
Local& Su!er infections !articularly with long.term use
6rug.drug
Increased serum le"els of digo3in
Increased effects of oral anticoagulants theo!hyllines carbama9e!ine
Increased thera!eutic and to3ic effects of corticosteroids
Increased le"els of cyclos!orine and risk of renal to3icity
*o!ical 6ermatologic Solution for +cne
6rug.drug
Increased irritant effects with !eeling des0uamating or abrasi"e agents
6rug.lab test
Interferes with fluorometric determination of urinary catecholamines
6ecreased urinary estriol le"els due to inhibition of hydrolysis of steroids in the
gut
@$!&n% Con!&#"$H8&on,
AC
,ulture site of infection before thera!y.
+dminister oral erythromycin base or stearate on an em!ty stomach $ h before or )...> h
after meals with a full glass of water 'oral erythromycin estolate ethylsuccinate and
certain enteric.coated tablets Wsee manufacturerEs instructionsX may be gi"en without regard
to meals(.
+dminister around the clock to ma3imi9e effect- adLust schedule to minimi9e slee!
disru!tion.
4onitor li"er function in !atients on !rolonged thera!y.
%i"e some !re!arations 'see abo"e( with meals or substitute one of these !re!arations if
%I u!set occurs with oral thera!y.
Topical $ermatologic !olution %or Acne
Iash affected area rinse well and dry before a!!lication.
"phthalmic and Topical $ermatologic &reparation
Use to!ical !roducts only when needed. Sensiti9ation !roduced by the to!ical use of an
antibiotic may !reclude its later systemic use in serious infections. *o!ical antibiotic
!re!arations not normally used systemically are best.
,ulture site before beginning thera!y.
,o"er the affected area with a sterile bandage if needed 'to!ical(.
ZD. '!om"K$Hbol",
U$H#" nHm"!, /e3ium
ClH!!, Proton !um! inhibitors antinuclear agents
L(8&on,
5inds to an en9yme on gastric !arietal cells in the !resence of acidic gastric !7 !re"enting
the final trans!ort of hydrogen ions into the gastric lumen.
U7"$HK"8&( 'II"(8!,
o 6iminished accumulation of acid in the gastric lumen with lessened
gastroeso!hageal reflu3
o 7ealing of duodenal ulcers.
D0
+!"!,
*reatment of %126 including&
o 7ealing of erosi"e eso!hagitis
o 4aintenance of healing of erosi"e eso!hagitis
o *reatment of sym!tomatic %126
In combination with amo3icillin and clarithromycin for the eradication of 7elicobacter
!ylori in !atients with duodenal ulcer disease or a history of duodenal ulcer disease.
'Information on cucurrent use with amo3icillin and clarithromycin can be found in 6a"isEs
6rug %uide for /urses.
Ao!",
%astro.oeso!hageal reflu3 disease ;0 mg once daily for ; weeks followed by a further ;
weeks if not fully healed or sym!toms !ersist- maintenance )0 mg daily-
sym!tomatic treatment in the absence of oeso!hagitis )0 mg daily for u! to ;
weeks followed by )0 mg daily when re0uired
,7IL6 & not recommended
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
Lactation 'not recommended(.
V&#" "II"(8!,
,/S& headache.
%I& abdominal !ain consti!ation diarrhea dry mouth flatulence nausea.
@$!&n% (on!&#"$H8&on!,
/1VIU4 should be taken at least one hour before meals.
8or !atients who ha"e a nasogastric or gastric tube in !lace /1VIU4 8or 6elayed.2elease
Oral Sus!ension can be administered as follows&
+dd $? mL of water to a catheter ti!!ed syringe and then add the contents of a $0 mg
)0 mg or ;0 mg /1VIU4 !acket. It is im!ortant to only use a catheter ti!!ed syringe
when administering /1VIU4 through a nasogastric tube or gastric tube.
Immediately shake the syringe and lea"e ) to > minutes to thicken.
Shake the syringe and inLect through the nasogastric or gastric tube 8rench si9e A or
larger into the stomach within >0 minutes.
2efill the syringe with $? mL of water.
D$
Shake and flush any remaining contents from the nasogastric or gastric tube into the
stomach.
/1VIU4 8or 6elayed.2elease Oral Sus!ension should be administered as follows&
1m!ty the contents of a $0 mg )0 mg or ;0 mg !acket into a container containing $
tables!oon '$? mL( of water.
Stir.
Lea"e ) to > minutes to thicken.
Stir and drink within >0 minutes.
If any material remains after drinking add more water stir and drink immediately.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
ZY. i"n8Hnyl,
U$H#" nHm"!, +cti0 6uragesic 8entanyl Oralet 8entanyl
*ransdermal 8entanyl *ransmucosal Sublima9e
A$% (lH!!
/arcotic agonist analgesic
G$"%nHn(y, ',ategory ,N 6 if used for !rolonged !eriods or in high doses at term(
U7"$HK"8&( H(8&on!
+cts at s!ecific o!ioid rece!tors causing analgesia res!iratory de!ression !hysical
de!ression eu!horia.
*n#&(H8&on!
+nalgesic action of short duration during anesthesia and immediate !osto! !eriod
+nalgesic su!!lement in general or regional anesthesia
+dministration with a neurole!tic as an anesthetic !remeditation for induction of
anesthesia and as an adLunct in maintenance of general and regional anesthesia
8or use as an anesthetic agent with o3ygen in selected high.risk !atients
*ransdermal system& management of chronic !ain in !atients re0uiring o!ioid analgesia
*reatment of breakthrough !ain in cancer !atients being treated with narcotics
,ontraindications& hy!ersensiti"ity to narcotics diarrhea caused by !oisoning acute
bronchial asthma u!!er airway obstruction !regnancy.
Use cautiously with bradycardia history of sei9ures lactation.
D)
Ao!"
by intravenous injection with s!ontaneous res!iration ?0M)00 micrograms then ?0 micrograms as
re0uired- ,7IL6 >M? microgramsNkg then $ microgramNkg as re0uired
Iith assisted "entilation 0.>M>.? mg then $00M)00 micrograms as re0uired-
,hild& $? microgramsNkg then $M> microgramsNkg as re0uired
+y intravenous infusion ,n ,)-. /(0 1 2 microgramsNkg3 hour
L#Q"$!" "II"(8!
,/S& Sedation clamminess sweating headache "ertigo floating feeling di99iness
lethargy confusion light.headedness ner"ousness unusual dreams agitation eu!horia
hallucinations delirium insomnia an3iety fear disorientation im!aired mental and
!hysical !erformance coma mood changes weakness headache tremor con"ulsions
%I& /ausea "omiting dry mouth anore3ia consti!ation biliary tract s!asm
,<& Pal!itation increase or decrease in 5P circulatory de!ression cardiac arrest shock
tachycardia bradycardia arrhythmia !al!itations
2es!iratory& Slow shallow res!iration a!nea su!!ression of cough refle3 laryngos!asm
bronchos!asm
%U& Ureteral s!asm s!asm of "esical s!hincters urinary retention or hesitancy oliguria
antidiuretic effect reduced libido or !otency
11/*& 6i!lo!ia blurred "ision
6ermatologic& 2ash hi"es !ruritus flushing warmth sensiti"ity to cold
Local& Phlebitis following I< inLection !ain at inLection site- tissue irritation and induration
'S, inLection(
Other& Physical tolerance and de!endence !sychological de!endence- local skin irritation
with transdermal system
6rug.drug
o Potentiation of effects when gi"en with barbiturate anesthetics- decrease dose of
fentanyl when coadministering
6rug.lab test
o 1le"ated biliary tract !ressure may cause increases in !lasma amylase li!ase-
determinations of these le"els may be unreliable for ); h after administration of
narcotics
D>
@$!&n% Con!&#"$H8&on!
+dminister to women who are nursing a baby ;...A h before the ne3t scheduled
feeding to minimi9e the amount in milk.
Pro"ide narcotic antagonist facilities for assisted or controlled res!iration on
standby during !arenteral administration.
Pre!are site by cli!!ing 'not sha"ing( hair at site- do not use soa! oils lotions
alcohol- allow skin to dry com!letely before a!!lication. +!!ly immediately
after remo"al from the sealed !ackage- firmly !ress the transdermal system in
!lace with the !alm of the hand for $0...)0 sec making sure the contact is
com!lete. 4ust be worn continually for D) h.
Use caution with +cti0 form to kee! this drug out of the reach of children 'looks
like a lolli!o!( and follow the distribution restrictions in !lace with this drug
"ery carefully.
ZZ. ilmHb"n&l T Ln"XH8"T ,
U$H#" nHm"!, +ne3ate
A$% (lH!!, 5en9odia9e!ine antagonist- re"erses sedati"e effects of
ben9odia9e!ines used in conscious sedation and general anesthesia- treatment
of ben9odia9e!ine o"erdose
U7"$HK"8&( H(8&on!
,om!etiti"ely inhibits the acti"ity at the ben9odia9e!ine recognition site on
the %+5+Nben9odia9e!ine rece!tor com!le3. 8luma9enil does not antagoni9e
the ,/S effect of drugs affecting %+5+.ergic neurons by means other than
the ben9odia9e!ine rece!tor 'ethanol barbiturates general anesthetics( and
does not re"erse the effects of o!ioids
Ao!",
5y intra"enous inLection 0.BM) mg re!eated at inter"als of )M> minutes to
a ma3. of $0 mg if res!iratory function does not im!ro"e 'then 0uestion
diagnosis(- ,7IL6 $0 microgramsNkg- subse0uent dose of
$00 microgramsNkg if no res!onse
5y subcutaneous or intramuscular inLection as intra"enous inLection but
only if intra"enous route not feasible 'onset of action slower(
D;
5y continuous intra"enous infusion using an infusion !um! $0 mg diluted
in ?0 mL intra"enous infusion solution at a rate adLusted according to the
res!onse
L#Q"$!" j"H(8&on!
`$0Q
%astrointestinal& <omiting nausea
$Q to $0Q&
,ardio"ascular& Pal!itations
,entral ner"ous system& 7eadache an3iety ner"ousness insomnia abnormal crying
eu!horia de!ression agitation di99iness emotional lability ata3ia de!ersonali9ation
tears increased dys!horia !aranoia fatigue "ertigo
1ndocrine J metabolic& 7ot flashes
%astrointestinal& Verostomia
Local& Pain at inLection site
/euromuscular J skeletal& *remor weakness !aresthesia
Ocular& +bnormal "ision blurred "ision
2es!iratory& 6ys!nea hy!er"entilation
4iscellaneous& 6ia!horesis
[$Q& +bnormal hearing altered blood !ressure 'increases and decreases( confusion
sensation of coldness bradycardia chest !ain generali9ed con"ulsions hiccu!s
hy!ertension Lunctional tachycardia shi"ering somnolence tachycardia thick tongue
"entricular tachycardia withdrawal syndrome
Postmarketing andNor case re!orts& 8ear !anic attacks
kQ"$#o!H%"eUoX&(olo%y
13cessi"ely high doses may cause an3iety agitation increased muscle tone hy!eresthesia
and sei9ures.
D?
@$!&n% *mKl&(H8&on!
Parenteral& 8or I.<. use only-
administer "ia freely running I.<. infusion into larger "ein to decrease chance of
!ain !hlebitis
GH8&"n8 '#(H8&on
8luma9enil does not consistently re"erse amnesia. 6o not engage in acti"ities
re0uiring alertness for $B.); hours after discharge.
+"oid alcohol or O*, medications for ); hours after recei"ing this medication
unless a!!ro"ed by !rescriber.
2esedation may occur in !atients on long.acting ben9odia9e!ines 'such as
dia9e!am(.
PregnancyNbreast.feeding !recautions& Should Inform !hysician if you she is or
intend to become !regnant and ,onsult him if she is a breast.feeding.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Z[. i$o!"m&H#" T lH!&X T ,
U$H#" nHm"!, +!o.8urosemide Lasi3
A$% (lH!!, Loo! diuretics
G$"%nHn(y, ',ategory ,N 6 if used in !regnancy.induced hy!ertension.X
U7"$HK"8&( H(8&on!
Inhibits the reabsor!tion of sodium and chloride from the !ro3imal and
distal renal tubules and the loo! of 7enle leading to a sodium.rich diuresis.
*n#&(H8&on!
1dema associated with ,78 cirrhosis renal disease 'oral I<(
+cute !ulmonary edema 'I<(
7y!ertension 'oral(
,ontraindications& allergy to furosemide sulfonamides- allergy to tartra9ine 'in oral
solution(- electrolyte de!letion- anuria se"ere renal failure- he!atic coma- !regnancy-
lactation.
Use cautiously with SL1 gout diabetes mellitus.
Ao!"
DA
by mouth oedema initially ;0 mg in the morning- maintenance )0M;0 mg daily
increased in resistant oedema to B0 mg daily or more-
,7IL6 $M> mgNkg daily ma3. ;0 mg daily
Oliguria initially )?0 mg daily- if necessary larger doses increasing in ste!s of
)?0 mg may be gi"en e"ery ;MA hours to a ma3. Of a single dose of ) g 'rarely
used(
5y intramuscular inLection or slow intra"enous inLection initially )0M?0 mg-
,7IL6 0.?M$.? mgNkg to a ma3. daily dose of )0 mg
5y intra"enous infusion 'by syringe !um! if necessary( in oliguria initially
)?0 mg o"er $ hour 'rate not e3ceeding ; mgNminute( if satisfactory urine out!ut
not obtained in the subse0uent hour further ?00 mg o"er ) hours then if no
satisfactory res!onse within subse0uent hour further $ g o"er ; hours if no
res!onse obtained dialysis !robably re0uired- effecti"e dose 'u! to $ g( can be
re!eated e"ery ); hours
L#Q"$!" "II"(8!
,/S& Di##iness, vertigo, paresthesias, xanthopsia, 4ea5ness headache drowsiness fatigue
blurred "ision tinnitus irre"ersible hearing loss
%I& %ausea, anorexia, vomiting, oral and gastric irritation, constipation diarrhea acute
!ancreatitis Laundice
,<& 6rthostatic hypotension "olume de!letion cardiac arrhythmias thrombophlebitis
7ematologic& Leu5openia, anemia, thrombocytopenia fluid and electrolyte imbalances
%U& Polyuria nocturia glycosuria, urinary bladder spasm
6ermatologic& Photosensitivity, rash, pruritus, urticaria !ur!ura e3foliati"e dermatitis
erythema multiforme
Other& 'uscle cramps and muscle spasms
6rug.drug
Increased risk of cardiac arrhythmias with digitalis glycosides 'due to electrolyte
imbalance(
Increased risk of ototo3icity with aminoglycoside antibiotics cis!latin
6ecreased absor!tion of furosemide with !henytoin
6ecreased natriuretic and antihy!ertensi"e effects with indomethacin ibu!rofen
other /S+I6s
DD
6ecreased %I absor!tion with charcoal
@$!&n% Con!&#"$H8&on!
+dminister with food or milk to !re"ent %I u!set.
2educe dosage if gi"en with other antihy!ertensi"e- readLust dosages gradually as 5P
res!onds.
%i"e early in the day so that increased urination will not disturb slee!.
+"oid I< use if oral use is at all !ossible.
6o not mi3 !arenteral solution with highly acidic solutions with !7 below >.?.
6o not e3!ose to light may discolor tablets or solution- do not use discolored drug or
solutions.
6iscard diluted solution after ); h.
2efrigerate oral solution.
4easure and record weight to monitor fluid changes.
+rrange to monitor serum electrolytes hydration and li"er function.
+rrange for !otassium.rich diet or su!!lemental !otassium as needed.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Z\. h"n8Hmy(&n ,
U$H#" nHm", %aramyein.
ClH!!, J antibiotic aminoglycoside.
*n#&(H8&on,
It is the drug of choice for hos!ital. ac0uired gram negati"e
se!sis including neonatal se!sis.
Serious sta!hylococcal infections.
V&#" "II"(8!
blood !ressure alo!ecia
,/S& ototo3icity tinnitus di99iness ringing in the ears "ertigo.
%I& nausea "omiting anore3ia weight loss increased sali"ation.
,.<.& !al!itation hy!otension or hy!ertension.
7ematologic& 6ecrease number of blood cells.
%U& ne!hroto3icity
Local& Pain and irritation at I4 inLection site.
DB
io$mlH8&on,J
<ial ) ml containing )0 mg.
+m!oule ) ml containing B0 mg.
Ao!H%",J
I.4. 'usual(. I.<. adults > mg]kg 0 B hr u! to ? mg]kg daily.
,hildren ).).? mg]kg 0 B hr.
/ewborns ).? mg] kg 0 $) hr.
O!hthalmic solution 0.>Q $.) dro!s 0 $?.>0 minutes.
*o!ical ointment 0.$Q $.? times daily to the affected area.
Stre!tococcal or enterococcal endocarditis in combination with other drugs B0 mg twice
daily.
@.M.,J
Should not be mi3ed with other drugs for !arenteral use.
@$!&n% &mKl&(H8&on,
Ihen gi"en I4 gi"e it slowly and dee! in the muscle.
6ilute dose when gi"en I<.
4onitor for kidney function tests com!lete blood count when used for more
than D days. ,onsult with 6r. accordingly.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
Z^. hl&P"n(lHm&#" W AHon&l W ,
U$H#" nHm", daonil.
ClH!!, 8irst generation sulfonylurea.
*n#&(H8&on,
/on. insulin de!endent diabetes mellitus '/I664( 'ty!e II(.
Patients should be subLected to a D day thera!eutic trial.
6ecrease in blood sugar decrease in glucosuria J disa!!earance of Polyuria
!olydi!sia J !oly!hagia indicate that !atient can be managed on oral
antidiabetic agents.
Con8$H&n#&(H8&on!,
*y!e I of 6.4.
2enal J li"er disease.
6iabetes com!licated by recurrent e!isodes of ketoacidosis.
Ao!",
DC
Initially a .$ tablet '?mg( daily increased by ).? M ? mg weekly to achie"e the desired
res!onse. ma3. $? mg daily.
V&#" "II"(8!,
7y!oglycemia 'most common(.
/ausea heartburn diarrhea
7eadache di99iness general weakness.
Pancyto!nea.
,hronic use increases risk of cardio"ascular mortality.
,holestatic Laundice 'rare(.
@$!&n% (on!&#"$H8&on!,
6rugs may be taken with food to minimi9e %I u!set.
Sto! the medication if signs of side.effects or ketoacidosis a!!ear
13!lain the im!ortance of carrying candy or sugar at all times to counteract
hy!oglycemia should it occur.
Pro"ide the client J family with a !rinted chart e3!laining sym!toms of
hy!oglycemia hy!erglycemia J instructions concerning what to do for
each.
13!lain the im!ortance of e3ercise J adhering to the !rescribed diet.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
ZF. hl(H%on ,
U$H#" nHm", %lucagon
ClH!!, 8irst generation sulfonylurea
L(8&on, mobilising glycogen stored in the li"er
+!"!& %lucagon is a hormone that causes the li"er to release glucose into the blood. It is
used to 0uickly increase blood sugar le"els in diabetics with low blood sugar
'hy!oglycemia(. *his medication may also be used during certain medical tests.
Ao!"
by subcutaneous intramuscular or intra"enous inLection +dult and
,hild o"er B years 'or body.weight o"er )? kg( $ mg-
,hild under B years 'or body.weight under )? kg( ?00 micrograms-
if no res!onse within $0 minutes intra"enous glucose must be gi"en
V&#" 'II"(8!,
B0
/ausea and "omiting may occur but are also signs of low blood sugar.
+llergy sym!toms such as skin rash and breathing trouble ha"e been re!orted
with this medication.
@$!&n% (on!&#"$H8&on!,
5e aware of sym!toms of hy!oglycemia . stomach !ain an3ious feeling chills cold
sweats confusion cool skin difficulty in concentrating drowsiness hunger ra!id heart
rate headache nausea "omiting shakiness unsteadiness "ision changes or weakness. Pt
should instructed to eat or drink a source of sugar if he e3!eriences these sym!toms.
+fter inLection of %lucagon the !atient must be turned on their side to a"oid choking.
%lucagon is only effecti"e for C0 minutes and is to be used only until the !atient is able to
swallow.
*he blood sugar should be checked hourly for > to ; hours after regaining consciousness.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
Z`. cHloK"$&#ol #"(HnoH8" ,
U$H#" nHm", +!o.7alo!eridol 7aldol 7aldol 6ecanoate 7aldol /o"o.Peridol Peridol
P4S.7alo!eridol.
A$% (lH!!"!
6o!aminergic blocking drug
+nti!sychotic drug
5utyro!henone 'not a !henothia9ine(
L(8&on,
4echanism not fully understood& anti!sychotic drugs block !ostsyna!tic do!amine
rece!tors in the brain de!ress the 2+S including those !arts of the brain in"ol"ed with
wakefulness and emesis- chemically resembles the !henothia9ines.
*n#&(H8&on!
4anagement of manifestations of !sychotic disorders
,ontrol of tics and "ocali9ations in %illes de la *ouretteEs syndrome in adults and
children
Short.term treatment of hy!eracti"e children who also show im!ulsi"ity difficulty
sustaining attention aggressi"ity mood lability or !oor frustration tolerance
Prolonged !arenteral thera!y of chronic schi9o!hrenia 'halo!eridol decanoate(
B$
Unlabeled uses& control of nausea and "omiting control of acute !sychiatric situations
'I< use(
,ontraindications& coma or se"ere ,/S de!ression bone marrow de!ression blood
dyscrasia circulatory colla!se subcortical brain damage ParkinsonEs disease li"er damage
cerebral arteriosclerosis coronary disease se"ere hy!otension or hy!ertension.
Use cautiously with res!iratory disorders 'Fsilent !neumoniaF(- glaucoma !rostatic
hy!ertro!hy 'anticholinergic effects may e3acerbate glaucoma and urinary retention(-
e!ile!sy or history of e!ile!sy 'drug lowers sei9ure threshold(- breast cancer 'ele"ations in
!rolactin may stimulate a !rolactin.de!endent tumor(- thyroto3icosis- !e!tic ulcer
decreased renal function- myelogra!hy within !re"ious ); h or scheduled within ;B h-
e3!osure to heat or !hos!horous insecticides- lactation- children younger than $) y
es!ecially those with chicken!o3 ,/S infections 'children are es!ecially susce!tible to
dystonias that may confound the diagnosis of 2eyeEs syndrome(- allergy to as!irin if gi"ing
the $. ). ?. and $0.mg tablets 'these tablets contain tartra9ine(.
Ao!",
by mouth short.term adLuncti"e management of !sychomotor agitation
e3citement and "iolent or dangerously im!ulsi"e beha"ior initially $.?M> mg )M>
times daily or >M? mg )M> times daily in se"erely affected or resistant !atients-
adLusted according to res!onse to lowest effecti"e maintenance dose 'as low as ?M
$0 mg daily(- 1lderly 'or debilitated( initially half adult dose- ,hild initially )?M
?0 microgramsNkg daily 'in ) di"ided doses( to ma3. $0 mg
+gitation and restlessness in the elderly initially 0.?M$.? mg once or twice daily
Short.term adLuncti"e management of se"ere an3iety ?00 micrograms twice daily-
,7IL6 not recommended
Intractable hiccu! $.? mg > times daily adLusted according to res!onse- ,7IL6
not recommended
/ausea and "omiting $ mg daily
5y intramuscular or by intra"enous inLection initially )M$0 mg then e"ery ;MB
hours according to res!onse to total ma3. $B mg daily- se"erely disturbed !atients
may re0uire initial dose of u! to $B mg- elderly 'or debilitated( initially half adult
dose- ,7IL6 not recommended
/ausea and "omiting 0.?M) mg
B)
L#Q"$!" "II"(8!
/ot all effects ha"e been re!orted with halo!eridol- howe"er because halo!eridol has certain
!harmacologic similarities to the !henothia9ine class of anti!sychotic drugs all ad"erse effects
associated with !henothia9ine thera!y should be ke!t in mind when halo!eridol is used.
,/S& 6rowsiness insomnia "ertigo headache weakness tremor ata3ia slurring cerebral
edema sei9ures e3acerbation of !sychotic sym!toms e3tra!yramidal syndromes..
!seudo!arkinsonism- dystonias- akathisia tardi"e dyskinesias !otentially irre"ersible 'no
known treatment( neurole!tic malignant syndrome..e3tra!yramidal sym!toms
hy!erthermia autonomic disturbances
,<& 7y!otension orthostatic hy!otension hy!ertension tachycardia bradycardia cardiac
arrest ,78 cardiomegaly refractory arrhythmias 'some fatal( !ulmonary edema
2es!iratory& 5ronchos!asm laryngos!asm 6ys!nea- su!!ression of cough refle3 and
!otential for as!iration
7ematologic& 1osino!hilia leuko!enia leukocytosis anemia- a!lastic anemia- hemolytic
anemia- thrombocyto!enic or nonthrombocyto!enic !ur!ura- Pancyto!nea
7y!ersensiti"ity& Saundice urticaria angioneurotic edema laryngeal edema
!hotosensiti"ity ec9ema asthma ana!hylactoid reactions e3foliati"e dermatitis
1ndocrine& Lactation breast engorgement in females galactorrhea- SI+67- amenorrhea
menstrual irregularities- gynecomastia in males- changes in libido- hy!erglycemia or
hy!oglycemia- glycosuria- hy!onatremia- !ituitary tumor with hy!er!rolactinemia-
inhibition of o"ulation infertility !seudo!regnancy
+utonomic& 6ry mouth sali"ation nasal congestion nausea "omiting anore3ia fe"er
!allor flushed faces sweating consti!ation !aralytic ileus urinary retention incontinence
Polyuria enuresis !ria!ism eLaculation inhibition
@$!&n% Con!&#"$H8&on!
6o not gi"e children I4 inLections.
6o not use halo!eridol decanoate for I< inLections.
%radually withdraw drug when !atient has been on maintenance thera!y to a"oid
withdrawal.emergent dyskinesias.
6iscontinue drug if serum creatinine 5U/ become abnormal or if I5, count is
de!ressed.
4onitor elderly !atients for dehydration- institute remedial measures !rom!tly- sedation
and decreased thirst related to ,/S effects can lead to se"ere dehydration.
B>
,onsult !hysician regarding a!!ro!riate warning of !atient or !atientEs guardian about
tardi"e dyskinesias.
,onsult !hysician about dosage reduction use of anticholinergic anti!arkinsonism drugs
'contro"ersial( if e3tra!yramidal effects occur.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
[E. c"KH$&n !o#&m &nd"(8&on,
U$H#" nHm"!,
7e!alean 7e!arin Leo
7e!arin sodium and 0.CQ sodium chloride
7e!alean.Lok 7e!arin Lock 8lush 7e!.Lock
A$% (lH!!
+nticoagulant
ClH!!, anticoagulant
L(8&on,
+nticoagulant
Potentiate the inhibitory action of antithrombin III
on "arious coagulation factors.
Inacti"ate thrombin and !re"ent the con"ersion of fibrinogen to fibrin.
+!"!,
*o !re"ent e3tension of clots.
*o !re"ent thrombi and emboli from recurring.
Pro!hylactic from thromboembolic diseases.
+fter some ty!es of surgery 'cardiac J "ascular(.
Pre"ent clotting during hemodialysis.
*reatment of 6I, 'disseminated intra"ascular coagulation( coronary
occlusion after 4I.
Con8$H&n#&(H8&on!,
5lood disorders with bleeding tendencies 'hemo!hilia(.
Sus!ected intracranial hemorrhage.
O!en wounds.
6uring surgery of the eyes brain and s!inal cord.
4enstruation.
B;
+bortion.
V&#" "II"(8!,
7emorrhage.
kQ"$#o!",
/ose bleeds
7ematuria
Petechiae and
*arry stool.
Ln8&#o8",

Protamin sulfate.
Ao!",
I< or S., measured in units according to
5leeding J clotting time
treatment of dee!."ein thrombosis and !ulmonary embolism by intra"enous
inLection loading dose of ?000 units '$0 000 units in se"ere !ulmonary
embolism( followed by continuous infusion of $?M)? unitsNkgNhour or
treatment of dee!."ein thrombosis by subcutaneous inLection of
$? 000 units e"ery $) hours 'laboratory monitoring essentialb!referably on
a daily basis and dose adLusted accordingly(
S4+LL +6UL* O2 ,7IL6 lower loading dose then $?M
)? unitsNkgNhour by intra"enous infusion or )?0 unitsNkg e"ery $) hours by
subcutaneous inLection
Unstable angina acute !eri!heral arterial occlusion as intra"enous
regimen for dee!."ein thrombosis and !ulmonary embolism
Pro!hyla3is in general surgery by subcutaneous inLection ?000 units )
hours before surgery then e"ery BM$) hours for D days or until !atient is
ambulant 'monitoring not needed(- during !regnancy 'with monitoring(
?000M$0 000 units e"ery $) hours 'im!ortant& not intended to co"er
!re"ention of !rosthetic heart "al"e thrombosis in !regnancy which calls for
se!arate s!ecialist management(
4yocardial Infarction& 8or the !re"ention of coronary re.occlusion after
*hrombolysis he!arin is used in a "ariety of regimens according to locally
agreed !rotocols
8or the !re"ention of mural thrombosis he!arin is considered effecti"e
B?
when gi"en by subcutaneous inLection of $) ?00 units e"ery $) hours for at least
$0 days
@$!&n% (on!&#"$H8&on!,
Should not be administered I4 administer by dee! sc to minimi9e
local irritation and to !rolong the action of drug.
6onKt massage before and after inLection.
,hange site of administration.
Instruct and stress the im!ortance of re!orting any signs of acti"e
bleeding.
Use electric ra9or for sha"ing soft bristle tooth brush to decrease gum
irritation.
Patient should be hos!itali9ed for I< thera!y.
,lotting time P** should be done before the start of thera!y each dose
of drug then daily.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
[S. cmHn LlPm&n ,
U$H#" nHm"!& 7uman albumin )0Q 5iotest low salt content
ClH!!, 5lood "olume e3!ander !lasma !rotein fraction
L(8&on,
Plasma substitute
It contribute to oncotic !ressure of the blood and trans!ort function
+lbumin stabili9es circulating blood "olume and is a carrier of hormones
en9ymes medicinal !roducts
+!"!,
shock !ost surgery
/e!hrotic syndrome
burns
coma
li"er cirrhosis
!remature infants and
7y!er bilirubinemia.
Ao!",
BA
7y!oalbuminemia $ g Nkg Nday I< infusion o"er $.) hours
V&#" "II"(8!,
4ild reactions such as flush urticaria fe"er and nausea
@$!&n% (on!&#"$H8&on!,
6o not use the solutions which are cloudy or ha"e de!osits
*his means that the protein is unstable or that the solution becomes contaminated(
If large amount of solution used the bottle should be warmed to the room
tem!erature or body tem!erature before use
4onitor for side effects or any reactions.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
[D. cy#$o(o$8&!on" ,
U$H#" nHm"!, hydrocortisone butyrate
ClH!!,
,orticosteroid short acting
%lucocorticoid
4ineralocorticoid
+drenal cortical hormone 'hydrocortisone(
7ormonal agent
G$"%nHn(y, ',ategory ,N 6 if used in $st trimester(
L(8&on, 1nters target cells and binds to cyto!lasmic rece!tors- initiates many com!le3
reactions that are res!onsible for its anti.inflammatory immunosu!!ressi"e
'glucocorticoid( and salt.retaining '4ineralocorticoid( actions. Some actions may be
undesirable de!ending on drug use.
*n#&(H8&on!
2e!lacement thera!y in adrenal cortical insufficiency
7y!ocalcaemia associated with cancer
Short.term inflammatory and allergic disorders such as rheumatoid arthritis
collagen diseases 'SL1( dermatologic diseases '!em!higus( status asthmaticus
and autoimmune disorders
7ematologic disorders..thrombocyto!enic !ur!ura erythroblasto!enia
*richinosis with neurologic or myocardial in"ol"ement
BD
Ulcerati"e colitis acute e3acerbations of multi!le sclerosis and !alliation in
some leukemia and lym!homas
Intra.articular or soft.tissue administration& +rthritis !soriatic !la0ues
2etention enema& 8or ulcerati"e colitis !roctitis
6ermatologic !re!arations& *o relie"e inflammatory and !ruritic manifestations
of dermatoses that are steroid res!onsi"e
+norectal cream su!!ositories& *o relie"e discomfort of hemorrhoids and
!erianal itching or irritation
Systemic administration& infections es!ecially tuberculosis fungal infections
amebiasis he!atitis 5 "accinia or "aricella and antibiotic.resistant infections-
kidney disease 'risk to edema(- li"er disease cirrhosis hy!othyroidism-
ulcerati"e colitis with im!ending !erforation- di"erticulitis- recent %I surgery-
acti"e or latent !e!tic ulcer- inflammatory bowel disease 'risks e3acerbations or
bowel !erforation(- hy!ertension ,78- thromboembolitic tendencies
thrombo!hlebitis osteo!orosis con"ulsi"e disorders metastatic carcinoma
diabetes mellitus- lactation.
2etention enemas intrarectal foam& systemic fungal infections recent intestinal
surgery e3tensi"e fistulas.
*o!ical dermatologic administration& fungal tubercular her!es sim!le3 skin
infections- "accinia "aricella- ear a!!lication when eardrum is !erforated-
lactation.
Ao!",
by mouth re!lacement thera!y )0M>0 mg daily in di"ided doses
,7IL6 $0M>0 mg
5y intramuscular inLection or slow intra"enous inLection or infusion
$00M?00 mg >M; times in ); hours or as re0uired- ,7IL6 by slow
intra"enous inLection u! to $ year )? mg $M? years ?0 mg AM$) years
$00 mg
L#Q"$!" "II"(8!
!ystemic
,/S& <ertigo headache !aresthesias insomnia con"ulsions !sychosis
BB
%I& Pe!tic or eso!hageal ulcer !ancreatitis abdominal distention nausea "omiting
increased a!!etite and weight gain 'long.term thera!y(
,<& 7y!otension shock hy!ertension and ,78 secondary to fluid retention
thromboembolism thrombo!hlebitis fat embolism cardiac arrhythmias secondary to
electrolyte disturbances
7ematologic& /aP and fluid retention hy!okalemia hy!ocalcaemia increased blood sugar
increased serum cholesterol decreased serum *> and *; le"els
4usculoskeletal& 4uscle weakness steroid myo!athy and loss of muscle mass
osteo!orosis s!ontaneous fractures 'long.term thera!y(
11/*& ,ataracts glaucoma 'long.term thera!y( increased intraocular !ressure
6ermatologic& *hin fragile skin- Petechiae- ecchymoses- !ur!ura- striae- subcutaneous fat
atro!hy
7y!ersensiti"ity& +na!hylactoid or hy!ersensiti"ity reactions
1ndocrine& +menorrhea irregular menses growth retardation decreased carbohydrate
tolerance and diabetes mellitus cushingoid state 'long.term thera!y( hy!othalamic.
!ituitary.adrenal '7P+( su!!ression systemic with thera!y longer than ? d
Other& Immunosu!!ression aggra"ation or masking of infections im!aired wound healing
L#Q"$!" 'II"(8! j"lH8"# 8o VK"(&I&( jo8"! oI L#m&n&!8$H8&on
I4 re!ository inLections& +tro!hy at inLection site
2etention enema& Local !ain burning- rectal bleeding- systemic absor!tion and ad"erse
effects 'abo"e(
Intra.articular& Osteonecrosis tendon ru!ture infection
Intras!inal& 4eningitis adhesi"e arachnoiditis conus medullaris syndrome
Intralesional thera!y head and neck& 5lindness 'rare(
Intrathecal administration& +rachnoiditis
*o!ical dermatologic ointments creams s!rays& Local burning irritation acneiform
lesions striae skin atro!hy
@$!&n% Con!&#"$H8&on!
%i"e daily before C +4 to mimic normal !eak diurnal corticosteroid le"els and
minimi9e 7P+ su!!ression.
S!ace multi!le doses e"enly throughout the day.
6o not gi"e I4 inLections if !atient has thrombocyto!enic !ur!ura.
BC
2otate sites of I4 re!ository inLections to a"oid local atro!hy.
Use minimal doses for minimal duration to minimi9e ad"erse effects.
*a!er doses when discontinuing high.dose or long.term thera!y.
+rrange for increased dosage when !atient is subLect to unusual stress.
Use alternate.day maintenance thera!y with short.acting corticosteroids whene"er
!ossible.
6o not gi"e li"e "irus "accines with immunosu!!ressi"e doses of hydrocortisone.
Pro"ide antacids between meals to hel! a"oid !e!tic ulcer.
Topical $ermatologic Administration
Use caution with occlusi"e dressings- tight or !lastic dia!ers o"er affected area can
increase systemic absor!tion.
+"oid !rolonged use es!ecially near eyes in genital and rectal areas on face and
in skin creases.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
[Y. cy#$HlHb&n" 7y#$o(7lo$&#" ,
U$H#" nHm"!, +!resoline
ClH!!,
+ntihy!ertensi"e direct action on "ascular
Smooth muscles.

L(8&on,J
6irectly affect smooth muscles "asodilatation
,ardiac out!ut and finally blood flow to the brain and kidneys.
+!"!,J
Used with combination thera!y to treat hy!ertension.
%i"en !arenterally in hy!ertension emergencies.
Con8$H&n#&(H8&on!,J
+ngina !ectoris.
2heumatic heart disease.
C0
,hronic glomerulone!hritis.
Systemic lu!us erythrmatosus 'S.L.1.(
V&#" "II"(8!,J
Orthostatic hy!otension tachycardia nausea "omiting.
7eadache di99iness consti!ation and male im!otence.
Ao!H%",J
*abs. & initially $0 mg 0id for ).; days then )? mg bid
I.< I.4&.?0 mg 'I< slowly( re!eated as necessary. '4ay decrease 5! in ? minutes.(
Ao!" ,
5y mouth hy!ertension )? mg twice daily increased to usual ma3. ?0 mg
twice daily
7eart failure 'initiated in hos!ital( )? mg >M; times daily increased e"ery )
days if necessary- usual maintenance dose ?0MD? mg ; times daily
5y slow intra"enous inLection hy!ertension with renal com!lications and
hy!ertensi"e crisis ?M$0 mg diluted with $0 mL sodium chloride 0.CQ-
may be re!eated after )0M>0 minutes
5y intra"enous infusion hy!ertension with renal com!lications and
hy!ertensi"e crisis initially )00M>00 microgramsNminute- maintenance
usually ?0M$?0 microgramsNminute
@$!&n% (on!&#"$H8&on!,J
+"oid acti"ities that need mental awareness such as dri"ing.
+d"ise !t. to rise from the bed slowly.
Instruct !t. about re!ortable Signs J Sym!toms
+d"ise client to carry a card detailing current medication
2egimens always.
[Z. cyo!(&n" M8ylK$om&#" ,
U$H#" nHm"!, E Scobutyl E&
ClH!!, +ntimuscarinic
L(8&on, +ntis!asmodics
C$
7yoscine works by !re"enting certain chemicals !roduced by the body from interacting with
the muscarinic rece!tors located on the smooth muscle of the gut. *his causes the gut muscle to
rela3 remo"ing the !ain of colic resulting from the gut muscle contraction and s!asm.
*n#&(H8&on!,
+bdominal !ain associated with menstrual !eriods
+bdominal !ain which comes and goes 'colic(
Irritable 5owel Syndrome
Con8$H&n#&(H8&on!,
+bnormal muscle weakness
1nlarged !rostate
8ailure of function of !art of the gut causing an obstruction '!aralytic ileus(
%laucoma
Life long inherited blood diseases which can cause a "ariety of sym!toms
including mental health !roblems '!or!hyrias(
/arrowing of the outlet of the stomach making it difficult for food to !ass into
the intestines '!yloric stenosis(
Ao!",
by mouth )0 mg ; times daily- ,7IL6 AM$) years $0 mg > times daily Irritable
bowel syndrome $0 mg > times daily increased if re0uired u! to )0 mg ; times
daily
5y intramuscular or intra"enous inLection acute s!asm and s!asm in diagnostic
!rocedures )0 mg re!eated after >0 minutes if necessary 'may be re!eated more
fre0uently in endosco!y(- ,7IL6 not recommended
V&#" "II"(8!,
*achycardia
Urgency
5lurred "ision
6ry mouth
,onsti!ation
Urinary retention
@$!&n% (on!&#"$H8&on!,J
7a"e !atient "oid before taking medication if urinary retention is a !roblem.
4onitor for signs and sym!toms of allergy to drug
C)
[[. *K$8$oK&m M$om&#",
U$H#" nHm"!, +tro"ent
L(8&on, +ntimuscarinic bronchodilators
A$% (lH!!"!
+nticholinergic
+ntimuscarinic agent
Parasym!atholytic
U7"$HK"8&( H(8&on!
+nticholinergic chemically related to atro!ine which blocks "agally mediated refle3es
by antagoni9ing the action of acetylcholine.
*n#&(H8&on!
5ronchodilator for maintenance treatment of bronchos!asm associated with ,OP6
'solution aerosol(
Sym!tomatic relief of rhinorrhea associated with !erennial rhinitis common cold 'nasal
s!ray(
,ontraindications& hy!ersensiti"ity to atro!ine or its deri"ati"es acute e!isodes of
bronchos!asm.
Use cautiously with narrow.angle glaucoma !rostatic hy!ertro!hy bladder neck
obstruction !regnancy lactation.
Ao!",
5y inhalation of nebulised solution $00M?00 micrograms u! to ; times
daily-
,7IL6 $ monthM> years A).?M)?0 micrograms u! to > times daily
WunlicensedX-
>M$; years $00M?00 micrograms u! to > times daily.
L#Q"$!" "II"(8!
,/S& /er"ousness di99iness headache fatigue insomnia blurred "ision
%I& /ausea %I distress dry mouth
2es!iratory& ,ough e3acerbation of sym!toms hoarseness
C>
Other& Pal!itations rash
@$!&n% Con!&#"$H8&on!
Protect solution for inhalation from light. Store unused "ials in foil !ouch.
1nsure ade0uate hydration- !ro"ide en"ironmental control 'tem!erature( to
!re"ent hy!er!yre3ia.
7a"e !atient "oid before taking medication to a"oid urinary retention.
*each !atient !ro!er use of inhalator.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
[\. *!oK$o8"$"nol ,
U$H#" nHm"!, Isu!rel
ClH!!: Sym!athomimetic
L(8&on&
Iso!roterenol is a synthetic catecholamine that stimulates both beta$ and beta)
adrenergic rece!tors
'/o al!ha rece!tor ca!abilities(.
Inotro!ic Sym!athomimetic E non selecti"e beta agonist E
*he drug affects the heart by increasing Inotro!ic and chronotro!ic acti"ity.
In addition iso!roterenol causes arterial and bronchial dilation and is sometimes
administered "ia aerosoli9ation as a bronchodilator to treat bronchial asthma and
bronchos!asm.
*n#&(H8&on!
7emodynamically significant bradycardia unres!onsi"e to atro!ine *,P do!amine
and e!ine!hrine.
4anagement of torsades de !ointes. 'it refers to a s!ecific "ariety of "entricular
tachycardia that e3hibits distinct characteristics on the electrocardiogram(.
C;
Con8$H&n#&(H8&on!
7y!otension 'non.rate related(.
,ardiac arrest.
Ischemic heart disease.
L#Q"$!" j"H(8&on!
6ysrhythmias
7y!otension
Preci!itation of angina
8acial flushing
A$% *n8"$H(8&on!
4+O inhibitors and bretylium !otentiate the effects of catecholamine.
5eta adrenergic antagonists may blunt Inotro!ic res!onse.
Sym!athomimetic and !hos!hodiesterase inhibitors may e3acerbate dysrhythmia
res!onse.
Ao!",
L#l8
Infusion& ).$0 mcgNmin titrated to increase 72 and !erfusion. *y!ical !re!aration& dilute $
mg in )?0 ml for a concentration of ;mcgNml(
G"#&H8$&(
Infusion& 0.? mcgNkgNmin titrated to increased 72 and !erfusion. *y!ical !re!aration& dilute
0.A mgNkg to create $00 ml solution.
@$!&n% Con!&#"$H8&on!
Iso!roterenol increases myocardial o3ygen demand and can induce serious dysrhythmia
'including <* and <8(. So deal with it with caution and monitor always for ad"erse effects.
+dminister "ia infusion !um! to ensure !recise flow rates.
C?
4ay e3acerbate tachydysrhythmias due to digitalis to3icity or hy!okalemia.
/ewer Inotro!ic agents ha"e re!laced iso!roterenol in most clinical settings.
If electronic !acing is a"ailable it should be used instead of iso!roterenol or as soon as
!ossible after the drug has been initiated.
[\J m"8Hm&n" ,
U$H#" nHm"!, =etamin =etalar
ClH!!& short.acting anesthetic
L(8&on& inhibit the action of the /.methyl d.as!artate rece!tor '/46+2(.
+!"!,
=etamine is fre0uently described as Euni0ue drugE because it has hy!notic' slee!
!roducing( analgesic' !ain relie"ing( and amnesic ' short term memory loss(
effects no other drug used in clinical !ractice combines the three im!ortant
features.
=etamine used as a anesthetic howe"er due to the se"ere hallucinations caused by
ketamine there are better anesthetics for "ictims with unknown medical history.
=etamine can be used in !odiatry and other minor surgery and occasionally for
the treatment of migraine.
*here is ongoing research into the drugEs usefulness in !ain thera!y de!ression
su!!ression and for the treatment of alcoholism and heroin addiction.
Ao!",
by intramuscular inLection short !rocedures initially A.?M$> mgNkg '$0 mgNkg
usually !roduces $)M)? minutes of surgical anesthesia(.
5y intra"enous inLection o"er at least A0 seconds short !rocedures initially $M
;.? mgNkg ') mgNkg usually !roduces ?M$0 minutes of surgical anesthesia(.
5y intra"enous infusion of a solution containing $ mgNmL longer !rocedures
induction total dose of 0.?M) mgNkg- maintenance 'using micro dri! infusion( $0M
;? microgramsNkgNminute rate adLusted according to res!onse
CA
Con8$H&n#&(H8&on!,
allergic to any ingredient in =etamine
ha"e a condition in which a large increase in blood !ressure would be harmful
V&#" "II"(8!,
increased heart rate
slurred s!eech
!araly9ed feeling
nausea
unable to mo"e
hallucination
numbness
im!aired attention memory and learning ability
delirium amnesia im!aired motor function high blood !ressure de!ression
and !otentially fatal res!iratory !roblems at higher doses
VymK8om! oI m"8Hm&n" oQ"$#o!"
=etamine can induce unconsciousness and failure of the cardio"ascular system leading to
death. *here are at least se"en =etamine related deaths known nationally.
@$!&n% (on!&#"$H8&on!,
if =etamine is administered ra!idly by I< inLection it often causes res!iratory
de!ression so it gi"en only under se"ere !recautions.
In the maLority of !eo!le it increase the heart workload resulting in increase of 5P and
Pulse so close monitoring of "ital signs is "ery im!ortant.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
[^J l&#o(H&n" cy#$o(7lo$&#",
U$H#" nHm"!, 3ylocaine 1sracain
ClH!!: Local anesthesia anti arrhythmic
L(8&on,
*y!e $ antiarrhythmic& decreases diastolic de!olari9ation decreasing automaticity of
"entricular cells- increases "entricular fibrillation threshold.
CD
Local anesthetic& blocks the generation and conduction of action !otentials in sensory
ner"es by reducing sodium !ermeability reducing height and rate of rise of the action
!otential increasing e3citation threshold and slowing conduction "elocity.
+!"!,
+s antiarrhythmic& 4anagement of acute "entricular arrhythmias during cardiac
surgery and 4I 'I< use(. Use I4 when I< administration is not !ossible or when
1,% monitoring is not a"ailable and the danger of "entricular arrhythmias is great
'single.dose I4 use for e3am!le by !aramedics in a mobile coronary care unit(.
+s anesthetic& Infiltration anesthesia !eri!heral and sym!athetic ner"e blocks central
ner"e blocks s!inal and caudal anesthesia retrobulbar and transtracheal inLection-
to!ical anesthetic for skin disorders and accessible mucous membranes
Ao!",
by intra"enous inLection in !atients without gross circulatory im!airment $00 mg as a bolus
o"er a few minutes '?0 mg in lighter !atients or those whose circulation is se"erely im!aired(
followed immediately by infusion of ; mgNminute for >0 minutes ) mgNminute for ) hours
then $ mgNminute- reduce concentration further if infusion continued beyond ); hours '1,%
monitoring and s!ecialist ad"ice for infusion(
/.5
8ollowing intra"enous inLection lidocaine has a short duration of action 'lasting for $?M)0
minutes(. If an intra"enous infusion is not immediately a"ailable the initial intra"enous
inLection of ?0M$00 mg can be re!eated if necessary once or twice at inter"als of not less than
$0 minutes
Con8$H&n#&(H8&on!,
allergy to lidocaine or amide.ty!e local anesthetics ,78 cardiogenic shock
second. or third.degree heart block.
V&#" "II"(8!,
,/S& 6i99inessNlight.headedness fatigue drowsiness unconsciousness tremors
twitching "ision changes- may !rogress to sei9ures con"ulsions
%I& /ausea "omiting
,<& ,ardiac arrhythmias cardiac arrest "asodilatation hy!otension
2es!iratory& 2es!iratory de!ression and arrest
7y!ersensiti"ity& 2ash ana!hylactoid reactions
Other& 4alignant hy!erthermia
CB
@$!&n% (on!&#"$H8&on!,
6onKt add lidocain to blood transfusion assembly.
4ake certain that "ials state for cardiac arrhythmias#.
Use ?Q de3trose solution to !re!are drug 'stable for ); hours(.
+ssess for history of hy!ersensiti"ity.
Use electronic infusion de"ice to regulate the infusion of the
drug.
Obtain 5.P. Pulse 2es!. rate to use as baseline data to e"aluate
res!onse to treatment.
6rug should be gi"en in a monitored en"ironment.
+ssess 5.P. fre0uently during administration.
+ssess for res!iratory de!ression.
If +d"erse reactions occur discontinue infusion J !re!are for
emergency management.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
[FJ 6H%n"!&m !lIH8" ,
U$H#" nHm"!, 4agnesium sulfate
ClH!!: +nticon"ulsant electrolyte saline la3ati"e
L(8&on,
It is an im!ortant cation !resent in the e3tracelular fluid.
It is an essential electrolyte for muscle contraction certain
en9yme system J ne"er transmissions.
4agnesium de!resses ,/S J control con"ulsion by blocking the
release of acetylcholine at the myoneural Lunction.
+!"!,
Sei9ures associated with to3emia of !regnancy.
1!ile!sy
la3ati"e
7y!omagnesaemia
In total !arenteral nutrition
Ao!",
CC
7y!omagnesaemia &neonate I< )?.?0mgNkg e"ery B.$) hours for ).> days ,hildren
I4I< )?.?0 mgNkgNdose e"ery ;.A hours for >.; days maintenance >0.A0mgNkgNday
+dult I4I< $ g e"ery A hours for ; doses
4aintenance electrolyte re0uirement )?.?0 mgNkgNday
Pre"ention of sei9ure recurrence in eclam!sia initially ; g by intra"enous inLection o"er
?M$? minutes followed by intra"enous infusion $ gNhour for at least ); hours after last
sei9ure
Con8$H&n#&(H8&on!,
In the !resence of heart block.
In the !resence of myocardial damage.
V&#" "II"(8!,
4agnesium into3ication de!ression flushing hy!otension res!iratory
!aralysis muscle !aralysis res!iratory failure .
@.M.
Su!!ression of knee.Serk refle3 can be used to determine to3icity
2es!iratory failure may result if drug is gi"en after disa!!earance of this refle3.
U$"H8m"n8 oI 6H%n"!&m &n8oX&(H8&on,
Use artificial "entilation immediately.
7a"e calcium glutinate readily a"ailable for I.<. use.
@$!&n% (on!&#"$H8&on!,
8or I.<. administer. only $.? ml of $0Q solution]minute.
8or I.4. inLect the drug dee! into the muscle using ?0Q solution.
+s a la3ati"e dissol"e in a glass of ice water or other fluid to lessen disagreeable
taste.
Obtain baseline 4g le"el.
Obtain history of kidney disease.
,heck with the !hysician before administering magnesium if any of the following
conditions e3ist&
+bsent !atellar or knee Lerk refle3.
2.2. less than $A]m
$00
Urinary out !ut less than $00 ml]; hrs .
Patient has a history of heart block or myocardial damage.
7a"e a"ailable I.<. ,alcium gluconate .
6onKt administer drug ) hrs !receding deli"ery of the baby.
If mother has recei"ed I.<. thera!y of this drug ); hours !rior to deli"ery assess the
newborn for neurologic J res!iratory de!ression.
[`J 6Hnn&8ol ,
U$H#" nHm"!, Osmitrol
ClH!!: Osmotic diuretics
L(8&on&
Increase the osmolarity of the glomerular filtrate which decrease the reabsor!tion of
water while increasing the e3cretion of sodium and chloride.
+!"!,
+cute rend failure
,erebral edema
*o decrease intracranial !ressure
%laucoma
Ao!",
,erebral edema $ gNkg I< infusion followed by 0.)? gNkg e"ery A hours for ); hours
Con8$H&n#&(H8&on!,
+nemia
6ehydration
!ulmonary edema
Progressi"e heart failure or !ulmonary congestion after mannitol thera!y#.
V&#" "II"(8!,
7y!ernatremia electrolyte imbalance acidosis
6ehydration dry mouth thirst edema hy!otension J hy!ertension blurring of
"ision headache di99iness.
$0$
@$!&n% (on!&#"$H8&on!,
4annitol should not be added to other I.<. solutions nor should it be mi3ed with other
medications .
If blood is to be administered at the sometime add )0 m10 of sodium chloride to each
liter of mannitol to !re"ent !seudo agglutination.
4onitor J record "ital signs .
Obser"e for signs of electrolyte imbalance or dehydration.
Obser"e for signs J sym!toms of !ulmonary edema 'dys!nea cyanosis frothy
s!utum(.
Slow the rate J notify the !hysician#.
\EJ 6"K"$&#&n" 7y#$o(7lo$&#" n G"87"#&n" 7y#$o(7lo$&#"o ,
U$H#" nHm"!, 6emerol
ClH!!: /arcotic analgesic synthetic.
G$"%nHn(y, ',ategory 5 N 6 if used for !rolonged !eriods or in high doses at term(
L(8&on&
It has no antitussi"e effect.
*he duration of action is less than that of o!ium.
+!"!,
Se"er !ain.
2enal J he!atic colic.
Obstetric Preanasthetic medication.
In minor surgeries.
S!asm of %I tract uterus.
Prior some diagnostic !rocedures e.g. cystosco!e.
Post o!erati"e !ain.
Ao!",
$0)
+cute !ain 5y subcutaneous or intramuscular inLection )?M$00 mg re!eated after ;
hours- ,7IL6 by intramuscular inLection 0.?M) mgNkg
5y slow intra"enous inLection )?M?0 mg re!eated after ; hours
Obstetric analgesia by subcutaneous or intramuscular inLection
?0M$00 mg re!eated $M> hours later if necessary- ma3. ;00 mg in
); hours
Premedication by intramuscular inLection )?M$00 mg $ hour before o!eration- ,7IL6
0.?M) mgNkg
Posto!erati"e !ain by subcutaneous or intramuscular inLection )?M$00 mg e"ery )M>
hours if necessary- ,7IL6 by intramuscular inLection 0.?M) mgNkg
@o8".
In the !osto!erati"e !eriod the !atient should be closely monitored for !ain relief as well
as for side.effects es!ecially res!iratory de!ression
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
,on"ulsi"e states.
,hildren less than A months.
7ead inLuries.
6iabetic acidosis.
V&#" "II"(8!,
2es!iratory de!ression a!nea di99iness eu!horia headache mental clouding
insomnia nausea "omiting consti!ation dry mouth skin rashes laryngos!asm urinary
retention and decreased libido.
@$!&n% (on!&#"$H8&on!,
Use su!!orti"e nursing measures as rela3ation techni0ues to relie"e !ain before
using narcotics.
13!lore the source of !ain use non.narcotic analgesia if !ossible.
+dminister the medication when needed !rolonging the medication administration
will decrease the effect of the medication.
4onitor "ital signs J mental status.
$0>
4onitor 2es!iratory rate 'drug may lead to res!iratory de!ression(.
4onitor blood !ressure ' hy!otension may occur(
4onitor !ulse rare 'if A0]m withhold the drug(.
Iatch for constricted !u!ils. 6ocument it and notify the !hysician.
4onitor bowel function since drug may cause consti!ation .
1ncourage client to em!ty bladder e"ery >.; hrs 'since drug may cause urinary
retention(.
If client is bed ridden use side rails.
Inform the client]family that the drug may become habit forming and leading to
addiction.
6ocument any history of asthma or other contraindications.
7a"e emergency e0ui!ment and narcotic antagonist a"ailable .
\SJ 6"8Io$m&n ,
U$H#" nHm"!, %luco!hage
ClH!!: antidiabetics ,biguanides
L(8&on&
6ecreases he!atic !roduction of glucose
6ecreases intestinal absor!tion of glucose
Increases sensiti"ity to insulin.
+!"!,
+dLuncti"e management ty!e ) diabetes mellitus. 4ay be used with diet andNor
sulfonylurea oral hy!oglycemic agents.
Ao!",
initially ?00 mg with breakfast for at least $ week
$0;
then ?00 mg with breakfast and e"ening meal for at least $ week
then ?00 mg with breakfast lunch and e"ening meal-
ma3. > g daily in di"ided doses but most !hysicians limit this to ) g daily
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
4etabolic acidosis of any cause
6ehydration se!sis hy!o3emia im!aired he!atic function e3cessi"e alcohol
ingestion 'acute or chronic(
Underlying renal dysfunction 'serum creatinine `$.? mgNdl in men or `$.;
mgNdl in women(
,oncurrent radiogra!hic studies re0uiring I< administration of iodinated
contrast media 'tem!orarily withhold metformin(
,78 re0uiring !harmacologic treatment.
V&#" "II"(8!,
%I& abdominal bloating diarrhea nausea "omiting un!leasant metallic taste.
1ndo& hy!oglycemia.
8 and 1& L+,*I, +,I6OSIS.
4isc& decreased "itamin 5$) le"els.
@$!&n% (on!&#"$H8&on!,
6rugs may be taken with food to minimi9e %I u!set.
Sto! the medication if signs of side.effects or ketoacidosis a!!ear.
,heck for early sym!toms of hy!oglycemia.
+ssess diabetic more closely for infection or emotional disturbances that may
increase insulin re0uirements.
13!lain the necessity for close regular medical su!er"ision.
13!lain to !atient how to test the urine for sugar J acetone.
13!lain the use J care of e0ui!ment J the storage of medication.
Pro"ide the client J family with a !rinted chart e3!laining sym!toms of
hy!oglycemia hy!erglycemia J instructions concerning what to do for each.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
\DJ 6"87ylK$"#n&!olon" ,
U$H#" nHm"!, Solumedrol
$0?
ClH!!: ,orticosteroids F%lucocorticoid thera!y E anti inflammatory
L(8&on,
In !harmacologic doses all agents su!!ress inflammation and the normal
immune res!onse
+ll agents ha"e numerous intense metabolic effects 'see +d"erse 2eactions
and Side 1ffects(
Su!!ress adrenal function 7a"e negligible mineralocorticoid acti"ity
+!"!,
su!!ression of inflammation ' rheumatoid arthritis systemic lu!us
erythematosus acute gouty arthritis !soriatic arthritis ulcerati"e colitis and
,rohnEs disease(.
Se"ere allergic conditions that fail con"entional treatment 'bronchial asthma
allergic rhinitis drugMinduced dermatitis and contact and ato!ic dermatitis(.
,hronic skin conditions ' dermatitis her!etiformis !em!higus se"ere
!soriasis and se"ere seborrheic dermatitis(.
,hronic allergic and inflammatory conditions of the u"ea iris conLuncti"a
and o!tic ner"es of the eyes .
Ao!",
by mouth usual range )M;0 mg daily-
5y intramuscular inLection or slow intra"enous inLection or infusion initially
$0M?00 mg- graft reLection u! to $ g daily by intra"enous infusion for u! to >
days
Con8$H&n#&(H8&on!,
+cti"e untreated infections 'may be used in !atients being treated for some
forms of meningitis(
Lactation 'a"oid chronic use(
=nown alcohol bisulfite or tartra9ine hy!ersensiti"ity or intolerance 'some
!roducts contain these and should be a"oided in susce!tible !atients(.
V&#" "II"(8!,
,/S& de!ression eu!horia headache increased intracranial !ressure 'children
only( !ersonality changes !sychoses restlessness.
11/*& cataracts increased intraocular !ressure.
$0A
,<& hy!ertension.
%I& P1P*I, UL,12+*IO/ anore3ia nausea "omiting.
6erm& acne decreased wound healing ecchymoses fragility hirsutism
!etechiae.
1ndo& adrenal su!!ression hy!erglycemia.
8 and 1& fluid retention 'long.term high doses( hy!okalemia hy!okalemic
alkalosis.
7emat& *72O45O145OLIS4 thrombo!hlebitis.
4etab& weight gain weight loss.
4S& muscle wasting osteo!orosis ase!tic necrosis of Loints muscle !ain.
4isc& cushingoid a!!earance 'moon face buffalo hum!( increased
susce!tibility to infection.
@$!&n% (on!&#"$H8&on!,
2e!ort signs J sym!toms of side effects 'cushing.like syndrome(.
!athological fracture(.
+d"ise the client to delay any "accination while taking these medications
'weakened immunity(.
13!lain the need to maintain general hygiene J cleanliness to !re"ent
infection.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
\YJ 6"8o(loK$Hm&#" cCl,
U$H#" nHm"!, Pramin
$0D
ClH!!: +nti.emetics
L(8&on&
It is do!amine rece!tor antagonist acts both centrally J !eri!herally
centrally due to the effect in the ,*G ' inhibition( Peri!herally it
stimulate the motility of the u!!er %I* without affecting gastric J
biliary or !ancreatic secretions. It rela3es the !yloric s!hincter J
increases the !eristalsis of the duodenum resulting in accelerated
gastric em!tying J intestinal transit
+!"!,
6igesti"e disorders leading to relief %I* !ain 6ys!e!sia J regurgitation in !e!tic ulcer
reflu3 eso!hagitis J !ostanasthetic "omiting.
/ausea J "omiting as in chemothera!y.
8acilitate diagnostic !rocedure e.g. barium meal.
Ao!",
by mouth or by intramuscular inLection or by intra"enous inLection o"er $M) minutes
$0 mg '? mg in young adults $?M$C years under A0 kg( > times daily- ,7IL6 u! to $ year
'u! to $0 kg( $ mg twice daily $M> years '$0M$; kg( $ mg )M> times daily >M? years '$?M
$C kg( ) mg )M> times daily ?MC years ')0M)C kg( ) mg > times daily CM$; years '>0 kg
and o"er( ? mg > times daily
/ote. 6aily dose of metoclo!ramide should not normally e3ceed ?00 microgramsNkg
!articularly for children and young adults.
Con8$H&n#&(H8&on!,
Sei9ure 'e!ile!sy(
Pheochromocytoma J
Intestinal obstruction.
V&#" "II"(8!,
%I disturbances
transient hy!ertension
$0B
su!ra"entricular tachycardia
di99iness J
e3tra!yramidal effect con"ulsion#.
@$!&n% (on!&#"$H8&on!,
6onKt gi"e !ramin to !atients with e!ile!sy !heochromocytomes or !atients with
intestinal obstruction.
+dminister oral medication >0 minutes before meal J at bed time .
+dminister I.<. inLection slowly o"er $.) minutes.
5e aware of the e3tra!yramidal sym!toms s!ecially in children
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
\ZJ 6"8$on&#Hbol" ,
U$H#" nHm"!, 8lagyl
ClH!!, systemic trichomonocide amebicide
L(8&on,
1ffecti"e against anaerobic bacteria J !roto9oa.
Inhibit growth of trichomona J amebae by binding to 6/+ J inhibit nucleic acid
synthesis cell death .
Iell absorbed from %I* J widely distributed in tissues.
1liminated in urine ' !rimarily( )0Q unchanged red brown discoloration in
urine following P.O. or I.<. use .
+!"!,
L J Vy!8"m&(,
$. amebiasis trichomoniasis.
). amebic dysentery.
>. amebic li"er abscess.
;. se!ticemia
?. 1ndocarditis
A. %iardiosis
D. to anaerobic infections of the abdomen following colorectal surgery
hysterectomy emergency a!!endectomy.
M. UoK&(Hl ,
$. Inflammatory !a!ules J !ustules.
$0C
Ao!",
anaerobic infections 'usually treated for D days and for $0 days in antibiotic.associated
colitis( by mouth either B00 mg initially then ;00 mg e"ery B hours or ?00 mg e"ery B
hours ,7IL6 D.? mgNkg e"ery B hours-
by rectum $ g e"ery B hours for > days then $ g e"ery $) hours ,7IL6 e"ery B hours
for > days then e"ery $) hours age u! to $ year $)? mg $M? years )?0 mg ?M$0 years
?00 mg o"er $0 years adult dose-
by intra"enous infusion o"er )0 minutes ?00 mg e"ery B hours-
,7IL6 D.? mgNkg e"ery B hours
high.risk !rocedures- child D.? mgNkg at induction- u! to > further doses of D.? mgNkg
may be gi"en e"ery B hours for high.risk !rocedures
,ontraindications&
+cti"e organic disease of ,/S.
5lood disorders
Lactation.
$
st
trimester of !regnancy.
*o!ical 7y!ersensiti"ity.
V&#" "II"(8!,
6ry mouth metallic taste diarrhea di99iness abdominal discomfort furry tongue
ata3ia "ertigo J leuco!enia.
@$!&n% (on!&#"$H8&on!,
If used I< drug should not be gi"en by I< bolus.
If a !rimary I< fluid setu! is used discontinue the !rimary solution during infusion
of metronida9ole.
2e!ort any sym!toms of ,/S to3icity immediately e.g. ata3ia or tremor which
necessitate withdrawal of drug.
*he drug may turn urine brown.
13!lain for the male !artner the necessity to ha"e thera!y.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
\[J 6&#Hbolm ,
U$H#" nHm"!, 6ormicum
$$0
ClH!!, +n3iolyticssedati"e and anticon"ulsant
L(8&on,
Like other ben9odia9e!ines mida9olam acts on the ben9odia9e!ine binding site of %+5++
rece!tors. Ihen bound it enhances the binding of %+5+ to the %+5++ rece!tor which results in
inhibitory effects on the central ner"ous system.W$X
+!"!,
!roduce slee!iness or drowsiness and to relie"e an3iety before surgery or certain
!rocedures.
Ao!",
conscious sedation by slow intra"enous inLection 'a!!ro3. ) mgNminute( initially )M).? mg
'1L612Lc 0.?M$ mg( increased if necessary in ste!s of $ mg '1L612Lc 0.?M$ mg(-
usual range >.?MD.? mg 1L612Lc ma3. >.? mg- ,7IL6 by intra"enous inLection o"er )M>
minutes A monthsM? years initially ?0M$00 microgramsNkg
5y intramuscular inLection ?0M$?0 microgramsNkg- ma3. $0 mg
Premedication by dee! intramuscular inLection D0M$00 microgramsNkg '1L612Lc )?M
?0 microgramsNkg( )0MA0 minutes before induction usual dose )M> mg- ,7IL6 $M$? years
B0M)00 microgramsNkg
Sedation of !atients recei"ing intensi"e care by intra"enous infusion )0.?0 microgram
NkgNhour
Con8$H&n#&(H8&on!, 4ost are relati"e contraindications.
7y!ersensiti"ity
acute narrow angle glaucoma
shock hy!otension head inLury and drug or alcohol use.
V&#" "II"(8!,
2esidual Ehango"erE effects after nighttime administration of mida9olam such as
slee!iness im!aired !sychomotor and cogniti"e functions may !ersist into the ne3t day
which may im!air the ability of users to dri"e safely and increase risks of falls and hi!
fractures.
@$!&n% (on!&#"$H8&on!,
Prior to the intra"enous administration of mida9olam in any dose the immediate
a"ailability of o3ygen resuscitati"e drugs age. and si9e.a!!ro!riate e0ui!ment for
$$$
bagN"al"eNmask "entilation and intubation and skilled !ersonnel for the maintenance of a
!atent airway and su!!ort of "entilation should be ensured.
Patients should be continuously monitored with some means of detection for early signs of
hy!o"entilation airway obstruction or a!nea ie !ulse o3imetry. 7y!o"entilation airway
obstruction and a!nea can lead to hy!o3ia andNor cardiac arrest unless effecti"e
countermeasures are taken immediately.
*he immediate a"ailability of s!ecific re"ersal agents 'fluma9enil( is highly recommended.
<ital signs should continue to be monitored during the reco"ery !eriod. 5ecause
intra"enous mida9olam de!resses res!iration
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\\J 6o$K7&n" !lIH8" ,
U$H#" nHm"!, 2o3anol
ClH!!, /arcotic analgesic mor!hine ty!e.
G$"%nHn(y, ',ategory , N 6 if used for !rolonged !eriods or in high doses at term(
L(8&on,
/arcotic analgesics attach to s!ecific rece!tor in the ,/S resulting in analgesia. action
+ction e3actly is unknown but may be by decreasing cell membrane !ermeability to
sodium transmission of !ain im!ulses.
+!"!,
Intrathecally e!idurally orally or I.<. infusion for acute or chronic !ain.
Preo!erati"e medication.
*o facilitate induction of anesthesia or to decrease the dose of anesthesia.
Ao!",
acute !ain by intramuscular inLection $0 mg e"ery ; hours if necessary '$? mg for
hea"ier well.muscled !atients(- ,7IL6 u! to $ month $?0 microgramsNkg $M$)
months )00 microgramsNkg $M? years ).?M? mg AM$) years ?M$0 mg.5y slow
intra"enous inLection 0uarter to half corres!onding intramuscular dose
Premedication by subcutaneous or intramuscular inLection u! to $0 mg A0MC0 minutes
before o!eration- ,7IL6 by intramuscular inLection $?0 microgramsNkg
4yocardial infarction by slow intra"enous inLection ') mgNminute( $0 mg followed by
a further ?M$0 mg if necessary- elderly or frail !atients reduce dose by half
$$)
+cute !ulmonary edema by slow intra"enous inLection ') mgNminute( ?M$0 mg
Con8$H&n#&(H8&on!,
It is gi"en e!idural or intrathecal if infection is !resent at inLection site.
In !atients on anticoagulant thera!y .
5leeding disorders.
If !atients ha"e recei"ed !arenteral corticosteroids within the !ast ) weeks.
V&#" "II"(8!,
2es!iratory de!ression a!nea di99iness eu!horia headache mental clouding insomnia
nausea "omiting consti!ation dry mouth skin rashes laryngos!asm urinary retention
and decreased libido.
@$!&n% (on!&#"$H8&on!,
Use su!!orti"e nursing measures as rela3ation techni0ues to relie"e !ain before using
narcotics.
13!lore the source of !ain use non.narcotic analgesia if !ossible.
+dminister the medication when needed !rolonging the medication administration will
decrease the effect of the medication.
4onitor "ital signs J mental status.
4onitor 2es!iratory rate 'drug may lead to res!iratory de!ression(.
4onitor blood !ressure ' hy!otension may occur(
4onitor !ulse rare 'if A0]m withhold the drug(.
Iatch for constricted !u!ils. 6ocument it and notify the !hysician.
4onitor bowel function since drug may cause consti!ation .
1ncourage client to em!ty bladder e"ery >.; hrs 'since drug may cause urinary retention(.
If client is bed ridden use side rails.
Inform the client]family that the drug may become habit forming and leading to addiction.
6ocument any history of asthma or other contraindications.
7a"e emergency e0ui!ment and narcotic antagonist a"ailable .
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\^J L("8yl(y!8&n" ,
U$H#" nHm"!, /.acetylcystine 4ucomyst
ClH!!, Antidotes (%or acetaminophen, mucolytic
$$>

L(8&on,
PO& 6ecreases the buildu! of a he!atoto3ic metabolite in acetamino!hen o"erdosage
Inhal& 6egrades mucus allowing easier mobili9ation and e3!ectoration.
+!"!,
PO& 1mergency 'within ); hr( management of !otentially he!atoto3ic o"erdosage of
acetamino!hen
Inhal& 4ucolytic in the management of conditions associated with thick "iscid mucous
secretions.
Ao!",
I< infusion $?0 mgNkg in )00 ml of 6 ?Q o"er $? min then ?0mg Nkg
in ?00 ml of 6 ?Q o"er ; hours then $00 mgNkgN $A hours in $ L of 6?Q .
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
V&#" "II"(8!,
,/S& drowsiness.
11/*& rhinorrhea.
2es!& bronchialNtracheal irritation bronchoconstriction chest tightness
increased secretions.
%I& nausea "omiting stomatitis.
6erm& clamminess urticaria.
4isc& chills fe"er.
@$!&n% (on!&#"$H8&on!,
Iith the administration of 4U,O4cS* the !atient may obser"e initially a slight disagreeable
odor that is soon not noticeable. Iith a face mask there may be stickiness on the face after
nebuli9ation. *his is easily remo"ed by washing with water.
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\FJ @HloXHn" ,
U$H#" nHm"!, /arcan
$$;
ClH!!, /arcotic antagonist.
L(8&on,
5lock the action of narcotic analgesic by dis!lacing !re"iously gi"en narcotics from their
rece!tor sites or !re"enting them from attaching to o!iate rece!tors.
*he duration of action of nalo3one is shorter than that of the narcotic analgesic so the
res!iratory de!ression may return when the narcotic antagonist has washed off the body.
+!"!,
2es!iratory de!ression induced by narcotics.
6rug of choice when the de!ressant drug is unknown.
6iagnosis of acute o!iate o"erdose.
Ao!",
5y intra"enous inLection $00M)00 micrograms '$.?M> microgramsNkg(- if res!onse
inade0uate increments of $00 micrograms e"ery ) minutes- further doses by
intramuscular inLection after $M) hours if re0uired
,7IL6 by intra"enous inLection $0 microgramsNkg- subse0uent dose of
$00 microgramsNkg if no res!onse- if intra"enous route not !ossible may be gi"en
in di"ided doses by intramuscular or subcutaneous inLection
/1O/+*1 by subcutaneous intramuscular or intra"enous inLection
$0 microgramsNkg re!eated e"ery ) to > minutes or by intramuscular inLection
)00 micrograms 'A0 microgramsNkg( as a single dose at birth 'onset of action
slower(
Con8$H&n#&(H8&on!,
Sensiti"ity to drug.
/arcotic addicts since it will cause se"er withdrawal sym!toms.
/eonates.
V&#" "II"(8!,
. /ausea "omiting sweating hy!ertension tremors.
. If used !osto!erati"ely& tachycardia !ulmonary edema hy!o or
hy!ertension.
@$!&n% (on!&#"$H8&on!,
6etermine the etiology of res!iratory de!ression.
$$?
+ssess J obtain baseline "ital signs.
4onitor res!iration closely after the duration of action.
7a"e emergency drugs J e0ui!ment a"ailable.
If the !atient is comatosed turn him to his side to a"oid as!iration.
4aintain safe en"ironment 'side rails J soft su!!ort(.
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\`J @"I&#&K&n" ,
U$H#" nHm"!, Pressolat +dalat
ClH!!, calcium channel blocking agent 'anti.angina antihy!ertensi"e(.
L(8&on,
*hese agents inhibit the influ3 of calcium through the cell membrane resulting in a
de!ression of automatically and conduction "elocity in both smooth and cardiac muscles
leading to&
$. 4yocardial contractility. .
). Inhibit s!asm of coronary arteries dilatation.
>. Peri!heral "asodilatation !eri!heral resistance.
;. S. +. node automatically and conduction heart rate.
+!"!,
"asos!astic angina essential hy!ertension
Ao!",
2aynaudEs !henomenon initially ? mg > times daily adLusted according to res!onse to )0 mg >
times daily angina !ro!hyla3is not recommended 7y!ertension not recommended modified
release & hy!ertension )0M>0 mg once daily increased if necessary- ma3. C0 mg once daily
+ngina !ro!hyla3is >0 mg once daily increased if necessary- ma3. C0 mg once daily
Con8$H&n#&(H8&on!,
hy!ersensiti"ity lactation
Side effects&
!ulmonary and !eri!heral edema
hy!otension
headache
u!set stomach
$$A
di99iness or lightheadedness
e3cessi"e tiredness
flushing 'feeling of warmth(
heartburn
*achycardia
muscle cram!s
enlargement of gum tissue around teeth
consti!ation
nasal congestion
cough
decreased se3ual ability
@$!&n% (on!&#"$H8&on!,
6iscuss with the !atientNfamily the goals of thera!y.
*each them how to take !ulse and blood !ressure. 7old the medication in case of
hy!otension or bradycardia and consult the treating 6r.
Instruct the client to re!ort any untoward sings as di99iness.
In case of !ostural hy!otension ad"ise the client to change !osition.
+d"ise client to sit down immediately if fainting occurs.
,alcium antagonists should be taken with meals to %I irritation.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
^EJ @"o!8&%m&n" 6"87yl!lIH8"
U$H#" nHm"!, /eostigmine
ClH!!, +nticholinesterase E re"ersal of muscle rela3ant
L(8&on,
$$D
re"erse cholinesterase inhibitor. 5y interfering with the breakdown of acetylcholine /eostigmine
indirectly stimulates both nicotinic and muscarinic rece!tors
+!"!,
*he sym!tomatic control of myasthenia gra"is when oral thera!y is im!ractical.
*he !re"ention and treatment of !osto!erati"e distention and urinary retention after
mechanical obstruction has been e3cluded.
2e"ersal of effects of nonde!olari9ing neuromuscular blocking agents 'e.g. tubocuranne
metocurine gallamine or !ancuronium( after surgery.
Ao!",
re"ersal of non.de!olarising neuromuscular blockade by intra"enous inLection o"er $
minute ?0MD0 microgramsNkg 'ma3. ? mg( after or with atro!ine sulfate 0.AM$.) mg
Con8$H&n#&(H8&on!,
/eostigmine 4ethylsulfate InLection is contraindicated in !atients with known
hy!ersensiti"ity to the drug. It is also contraindicated in !atients with !eritonitis or
mechanical obstruction of the intestinal or urinary tract.
V&#" "II"(8!,
6i99iness con"ulsions loss of consciousness drowsiness headache dysarthria
miosis and "isual changes.
,ardiac arrhythmias .
2ash and urticaria.
/ausea emesis flatulence and increased !eristalsis.
6ia!horesis flushing and weakness.
@$!&n% (on!&#"$H8&on!,
/eostigmine 4ethylsulfate InLection should be used with caution in !atients with
e!ile!sy bronchial asthma bradycardia recent coronary occlusion "agotonia
hy!erthyroidism cardiac arrhythmias or !e!tic ulcer.
Ihen large doses of /eostigmine 4ethylsulfate InLection are administered the
!rior or simultaneous inLection of atro!ine sulfate may be ad"isable.
Se!arate syringes should be used for the neostigmine methylsulfate and atro!ine.
5ecause of the !ossibility of hy!ersensiti"ity in an occasional !atient atro!ine and
antishock medication should always be readily a"ailable.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
^SJ @&8$H8"! , *!o!o$P&#" 6onon&8$H8"
$$B
U$H#" nHm"!, Isoral ,ordil Isotard
ClH!!, coronary "asodilating effect
L(8&on,
*he !rinci!al !harmacological action of isosorbide dinitrate is rela3ation of "ascular smooth
muscle and conse0uent dilatation of !eri!heral arteries and "eins es!ecially the latter.
6ilatation of the "eins !romotes !eri!heral !ooling of blood and decreases "enous return to the
heart thereby reducing left "entricular end. diastolic !ressure and !ulmonary ca!illary wedge
!ressure '!reload(.
+rteriolar rela3ation reduces systemic "ascular resistance systolic arterial !ressure and mean
arterial !ressure 'afterload(.
6ilatation of the coronary arteries also occurs
+!"!,
Pro!hyla3is and treatment of acute angina !ectoris.
*reatment of chronic angina !ectoris.
*estament of hy!ertension associated with 4I or ,78.
/itroglycerin ointment for treatment of 2aynaudKs disease.
Ao!",
Isosorbide 4ononitrate & initially )0 mg )M> times daily or ;0 mg twice daily '$0 mg twice daily in
those who ha"e not !re"iously recei"ed nitrates(- u! to $)0 mg daily in di"ided doses if re0uired
Isosorbide 6initrate 5y mouth daily in di"ided doses angina >0M$)0 mg left "entricular failure
;0M$A0 mg u! to );0 mg if re0uired
5y intra"enous infusion )M$0 mgNhour- higher doses u! to )0 mgNhour may be re0uired
Con8$H&n#&(H8&on!,
Sensiti"ity to nitrates 7y!otension.
Se"er anemia.
7y!otension.
7ead trauma.
$$C
,erebral hemorrhage.
V&#" "II"(8!,
$. 7eadache synco!e di99iness.
). Postural hy!otension transient flushing and !al!itation.
>. *o!ical a!!lication may lead to dermatitis.
A$% &n8"$H(8&on, +ntihy!ertensi"e agents 5eta.adrenergic blocking agents and
calcium.channel blocking agent 'they may lead to additi"e hy!otension.
@$!&n% (on!&#"$H8&on!,
medications should be taken on an em!ty stomach.
,arry sublingual tablets in a glass bottle tightly ca!!ed.
If anginal !ain is not relie"ed in ? minutes by first sublingual tablet to take u! to ) more
tablets at ? minutes inter"al. If !ain has not subsided ? minutes after the >
rd
tablet client
should be taken to the emergency room.
*ake sublingual tablets ?.$? minutes !rior to any situation likely to cause anginal !ain such
as climbing stairs.
*ake sublingual tablets while sitting to a"oid !ostural hy!otension.
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^DJ @&8$oK$!!&#" !o#&m ,
U$H#" nHm"!, /itro!ress
ClH!!, <asodilator antihy!ertensi"e drugs
L(8&on,
Its mechanism of action a!!ears to be liberation of nitric o3ide '/O( con"erting 7emoglobin to
cyanomethaemaglobin. /itro!russide also releases cyanide ions which are con"erted in the li"er to
thiocyanate by the en9yme rhodanase a reaction which re0uires a sulfur donor such as thiosulfate.
*hiocyanate is then e3creted by the kidney. In the absence of sufficient thiosulfate cyanide ions
can 0uickly reach to3ic le"els.
$)0
*he half.life of nitro!russide is less than $0 minutes although thiocyanate has an e3cretion half life
of se"eral days. *he duration of treatment should not e3ceed D) hours and thiocyanate !lasma
concentrations should be monitored.
+!"!,
immediate reduction of blood !ressure of !atients in hy!ertensi"e crises.
!roducing controlled hy!otension in order to reduce bleeding during surgery.
treatment of acute congesti"e heart failure.
Ao!",
7y!ertensi"e crisis by intra"enous infusion initially 0.?M
$.? microgramsNkgNminute then increased in ste!s of 0.? micrograms NkgNminute
e"ery ? minutes within range 0.?MB microgramsNkgNminute 'lower doses in !atients
already recei"ing other antihy!ertensi"es(- sto! if res!onse unsatisfactory with ma3.
dose in $0 minutes
4aintenance of blood !ressure at >0M;0Q lower than !retreatment diastolic
blood !ressure )0M;00 microgramsNminute 'lower doses for !atients being
treated with other antihy!ertensi"es(
Con8$H&n#&(H8&on!,
should not be used in the treatment of com!ensatory hy!ertension where the
!rimary homodynamic lesion is aortic coarctation or arterio"enous shunting.
should not be used to !roduce hy!otension during surgery in !atients with known
inade0uate cerebral circulation or in moribund !atients '+.S.+. ,lass ?1( coming to
emergency surgery.
Patients with congenital 'LeberEs( o!tic atro!hy or with tobacco amblyo!ia ha"e
unusually high cyanided thiocyanate ratios.
Sodium nitro!russide should not be used for the treatment of acute congesti"e heart
failure associated with reduced !eri!heral "ascular resistance such as high.out!ut
heart failure that may be seen in endoto3ic se!sis.
V&#" "II"(8!,
allergic reaction& hi"es- difficulty breathing- swelling of face li!s tongue or
throat.
feeling e3tremely light.headed e"en while lying down-
confusion ringing in your ears-
fainting breathing that sto!s-
$)$
gas!ing or struggling to breathe-
di99iness with nausea and "omiting confusion ra!id breathing and sei9ure-
tremors chills bowel or bladder urgency-
fast slow or une"en heart rate-
easy bruising or bleeding- or muscle !ain or weakness numb or cold feeling in
your arms and legs.
@$!&n% (on!&#"$H8&on!,
*his drug can cause "ery large decreases in blood !ressure so !ro!er monitoring serious inLury
or death could result.
/itro!russide es!ecially in larger.than.recommended doses might cause cyanide !oisoning.
*herefore be sure not to e3ceed the recommended dose instructed by the doctors es!ecially if
the !atient has kidney !roblems.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
^YJ @o$H#$"nHl&n" ,
U$H#" nHm"!, /ore!ine!hrine
ClH!!, <asoconstrictor sym!athomimetics
L(8&on,
/oradrenalin '/ore!ine!hrine( tartrate is a substance released naturally by the ner"e cells. It
!roduces wide ranging effects on many areas of the body and is often referred to as a Efight or
flightE chemical as it is res!onsible for the bodyEs reaction to stressful situations.
+!"!,
Sudden life threatening low blood !ressure 'acute hy!otension(
Use with caution in&
+ se"ere form of angina !ectoris not caused by e3ertion 'Prin9metalEs angina(
+bnormally high amount of carbon dio3ide in the blood 'hy!ercabnia(
5lood clot in one of the blood "essels in the e3tremities '!eri!heral "ascular
thrombosis(
5lood clot in the artery which su!!lies blood to the heart 'coronary thrombosis(
$))
5lood clot in the artery which su!!lies blood to the intestines 'mesenteric
thrombosis(
Low blood !ressure following a heart attack
Low le"els of o3ygen in the tissues 'hy!o3ia(
Ao!",
+cute hy!otension by intra"enous infusion "ia central "enous catheter of a solution containing
noradrenaline acid tartrate B0 microgramsNmL 'e0ui"alent to noradrenaline base
;0 microgramsNmL( at an initial rate of 0.$AM0.>> mLNminute adLusted according to res!onse
Con8$H&n#&(H8&on!,
,hildren.
+llergy.
V&#" "II"(8!,
7eadache
Slow heart rate 'bradycardia(
7igh blood !ressure 'hy!ertension(
Inade0uate blood flow leading to low le"els of o3ygen in the tissues of the
e3tremities '!eri!heral ischemia( which may lead to gangrene
@$!&n% (on!&#"$H8&on!,
*he infusion must be changed e"ery ); hours e
4onitor urine out!ut hourly and check distal !ulses e
4onitor serum glucose.
%i"e "ia "olumetric !um! to regulate flow.
6uring infusion monitor 1,%5P ,O ,<P P+IP 72 urine out!ut color and
tem!erature of e3tremities initially e"ery ) minutes.
,heck infusion site fre0uently for signs of e3tra"asation If occurs sto! infusion
immediately infiltrate the area with ? . $0 mg Phentolamine'al!ha blocker( diluted
in $0 . $? ml 0.C Q normal saline subcutaneously and liberally
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@
$)>

^ZJ km"K$Hbol" ,
U$H#" nHm"!, Prilosec
ClH!!, Proton Pum! Inhibitors F Ulcer.healing drugs
L(8&on,
5inds to an en9yme on gastric !arietal cells in the !resence of acidic gastric !7 !re"enting
the final trans!ort of hydrogen ions into the gastric lumen.
*hera!eutic 1ffects&
o 6iminished accumulation of acid in the gastric lumen with lessened
gastroeso!hageal reflu3
o 7ealing of duodenal ulcers.
+!"!,
4anagement of %126
4anagement of duodenal ulcers 'with or without anti.infecti"e for 7. !ylori(
*reatment of !athologic hy!ersecretory conditions including Gollinger.1llison syndrome.
Ao!",
by mouth !ro!hyla3is against stress ulcer )0 mgN$) hours
/S+I6.associated duodenal or gastric ulcer and gastroduodenal erosions )0 mg once daily
for ; weeks followed by a further ; weeks if not fully healed- !ro!hyla3is in !atients with a
history of /S+I6.associated duodenal or gastric ulcers gastroduodenal lesions or
dys!e!tic sym!toms who re0uire continued /S+I6 treatment )0 mg once daily
%astric acid reduction during general anaesthesia '!ro!hyla3is of acid as!iration( ;0 mg
on the !receding e"ening then ;0 mg )MA hours before surgery
,7IL6 o"er ) years se"ere ulcerating reflu3 oeso!hagitis 0.DM$.; mgNkg daily for ;M$)
weeks- ma3. ;0 mg daily 'to be initiated by hos!ital !aediatrician(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
+!" CH8&o!ly &n,
$);
Li"er disease 'dosage reduction may be necessary(
Pregnancy lactation or children 'safety not established(.
V&#" "II"(8!,
,/S& di99iness drowsiness fatigue headache weakness.
,<& chest !ain.
%I& abdominal !ain acid regurgitation consti!ation diarrhea flatulence nausea
"omiting.
6erm& itching rash.
4isc& allergic reactions.
@$!&n% (on!&#"$H8&on!,
/urse should instruct the !t to take each dose of Prilosec with a full glass 'B
ounces( of water.
Prilosec is usually taken before eating.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
D?. Octreotide &
U$H#" nHm"!, Sandostatin
ClH!!, Antidiarrheals, hormones
L(8&on,
Su!!resses secretion of serotonin and gastroenterohe!atic !e!tides
Increases absor!tion of fluid and electrolytes from the %I tract and increases transit time
6ecreases le"els of serotonin metabolites
+lso su!!resses growth hormone insulin and glucagon.
o ,ontrol of se"ere flushing and diarrhea associated with %I endocrine tumors.
+!"!,
*reatment of se"ere diarrhea and flushing e!isodes in !atients with %I endocrine tumors
including metastatic carcinoid tumors and "asoacti"e intestinal !e!tide tumors '<IPomas(.
Unlabelled Uses&
o 2elief of sym!toms and su!!ressed tumor growth in !atients with !ituitary tumors
associated with acromegaly
o 4anagement of diarrhea in +I6S !atients or !atients with fistulas.
$)?
Ao!",
!ro!hyla3is following !ancreatic trauma or surgery subcutaneous e"ery B hours
$00 micNkg
In eso!hageal "arices ?0.$00 mic I< inLection then infusion of )? M ?0 micNhour
for ).> days
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
+!" CH8&o!ly &n,
%allbladder disease 'increased risk of stone formation(
2enal im!airment 'dosage reduction may be necessary(
7y!erglycemia or hy!oglycemia 'changes in blood sugar may occur(
8at malabsor!tion 'may be aggra"ated(
Pregnancy or lactation 'safety not established(.
V&#" "II"(8!,
,/S& di99iness drowsiness fatigue headache weakness.
11/*& "isual disturbances.
,<& edema orthostatic hy!otension !al!itations.
%I& abdominal !ain cholelithiasis diarrhea fat malabsor!tion nausea
"omiting.
6erm& flushing.
1ndo& hy!erglycemia hy!oglycemia.
Local& inLection site !ain.
@$!&n% (on!&#"$H8&on!,
Sandostatin am!oules and multi.dose "ials should be stored at refrigerated
tem!eratures ).Bf, '>A.;Af8( and !rotected from light.
5ecause the drug may result in hy!oglycemia or hy!erglycemia monitor
blood glucose le"el for the !t.
,ardiac conduction abnormalities ha"e also occurred during treatment with
Sandostatin so the nurse should monitor the !tEs "ital signs 1,%Retc.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
^\J kXy8o(&n ,
$)A
U$H#" nHm"!, Pitocin Syntocinon
ClH!!, Labor inducer F induce uterine contractions F o3ytocic agent.
L(8&on,
It has uterine stimulant "aso!ressi"e J antidiuretic !ro!erties.
4imics uterine contractions of normal labor.
8acilitates eLection of milk from the breasts by stimulating smooth muscles.
+!"!,
+nte!artum induction or stimulation of labor.
Uterine inertia 'hy!otonic contractions(.
8or induction of labor in case of !reeclam!sia eclam!sia maternal diabetes J other
conditions.
*o hasten uterine in"olution .
Intranasally for !ost!artum hemorrhage J uterine atony.
Ao!",
8or Pre"ention and treatment of hemorrhage
Pre"ention of !ost!artum hemorrhage after deli"ery of !lacenta by slow intra"enous inLection
? units 'if infusion used for induction or enhancement of labor increase rate during third stage and
for ne3t few hours(
@o8",
4ay be gi"en in a dose of $0 units by intramuscular inLection Wunlicensed routeX instead of
o3ytocin with ergometrine
*reatment of !ost!artum hemorrhage by slow intra"enous inLection ?M$0 units followed in se"ere
cases by intra"enous infusion of ?M>0 units in ?00 mL infusion fluid at a rate sufficient to control
uterine atony.
*mKo$8Hn8
+"oid ra!id intra"enous inLection 'may cause short.lasting dro! in blood !ressure(.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
ce!halo!el"ic dis!ro!ortion ',.P.6. (
$)D
4al!reresentation
undilated cer"i3
7istory of cesarean deli"ery.
V&#" "II"(8!,
*etanic uterine contraction ru!ture uterus 7y!ertension tachycardia.
*o 8etus &. it may cause death intracranial hemorrhage brady or tachycardia
@$!&n% (on!&#"$H8&on!,
$. *he !hysician should be a"ailable during administration of the drug.
). Use c.tubing for I.<. administration 'one bottle contain o3ytocin J another free( .
>. /ote any history of hy!ersensiti"ity J other contraindications.
;. ,heck for cer"ical dilation J uterine contractions !atterns.
?. 2emain with the client throughout the administration of medication.
A. 4onitor fetal heart rate at least e"ery $0 minutes.
D. ,heck "ital signs e"ery $?minutes.
B. Pre"ent uterine ru!ture J fetal damage by clam!ing off I.<. o3ytocin start
medication M 8ree fluid !ro"ide O) J notify the !hysician in case of hy!ertonic
uterine contraction J abnormal fetal heart rate !atterns.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
^^J GHn($on&m ,
U$H#" nHm"!, Pa"ulon
ClH!!, /on.de!olari9ing muscle rela3ants
L(8&on,
Pancuronium is a non.de!olari9ing neuromuscular blocking agent that com!etes with
acetylcholine for cholino. ce!ti"e sites at the !ostLunctional membrane and thereby blocks
com!etiti"ely the transmitter action of acetylcholine resulting in muscle !aralysis.
+!"!,
Pancuronium bromide is indicated as an adLunct to general anesthesia to facilitate tracheal
intubation and to !ro"ide skeletal muscle rela3ation during surgery or mechanical
"entilation.
$)B
Ao!",
by intra"enous inLection initially for intubation ?0M$00 microgramsNkg then $0M
)0 microgramsNkg as re0uired- ,7IL6 initially A0M$00 microgramsNkg then $0M
)0 microgramsNkg /eonate >0M;0 micNkg initially then $0M)0 microgramsNkg
Intensi"e care by intra"enous inLection A0 micNkg e"ery A0MC0 minutes
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
V&#" "II"(8!,
chest !ain
fe"er
!ain redness swelling or irritation at the inLection site
shortness of breath whee9ing
unusual muscle weakness or tiredness
flushing 'reddening of skin(
rash itching
@$!&n% (on!&#"$H8&on!,
4ay administered undiluted by ra!id I.< inLection as re0uested.
4onitor !arameters ' 7eart rate blood !ressure assisted "entilation status cardiac
monitor and "entilated re0uired.
/urse should not alter the !tEs state of unconsciousness
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
^FJ G"n&(&ll&n h !o#&m,
U$H#" nHm"!, ,rystalline Penicillin
ClH!!, +ntibiotic F 5road.s!ectrum !enicillin E
L(8&on,
Inhibit bacterial cell wall synthesis
+!"!,
%ram P<e cocci stre!tococci meningococci !neumococeiF
Subacute bacterial endocarditis caused by grou! + stre!tococci.
%onorrhea due to gonococci.
$)C
6i!htheria tetanus anthra3 gas gangrene.
Pro!hyla3is for rheumatic fe"er.
Ao!",
$00 000 .>00 000 unitNkgNday in di"ided doses ;.A hours
Con8$H&n#&(H8&on!,
7y!ersensiti"ity .
V&#" "II"(8!,
2a!id I.<. administration may cause hy!erkalemia J cardiac arrhythmias.
6iarrhea abdominal cram!s ]!ain nausea "omiting.
Psendomembranous colitis thrombocyto!enia leuco!enia
7e!atoto3icity.
@$!&n% (on!&#"$H8&on!,
I.4. is !referred minimi9e discomfort by using solution of u! to $00000 units ]ml.
4onitor intake J out!ut 'I J O( .
Solution may be stored at room tem!. for ); hr or in refrigerator for $ week.
Use $Q . )Q lidocaine as a diluent for I.4. use to decrease !ain at inLection site.
/ote the !enicillin % should not be mi3ed during I.<. administration with the
following drugs& amino!hylline gentamycin he!arin "ancomycin J sodium
bicarbonate.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
^`J G7"noPH$K&8ol ,
U$H#" nHm"!, Luminal
ClH!!, sedati"e. anticon"ulsant. barbiturate.
L(8&on,
Long.acting barbiturate. act as a sedati"e. hy!notic and anticon"ulsant by
!roducing ,/S de!ression.
It increase the inhibitory acti"ity of the on ner"e syna!ses.
+!"!,
$>0
Preanasthetic medication.
Sedation
7y!notic
1!ile!sy
in tetanus J eclam!sia ' as anticon"ulsant( .
Ao!",
by mouth A0M$B0 mg at night- ,7IL6 ?MB mgNkg daily
,ontrol of acute sei9ures by intramuscular inLection )00 mg re!eated after A hours if
necessary- ,7IL6 $? mgNkg as a single dose
Status e!ile!ticus by intra"enous inLection 'dilute inLection $ in $0 with water for
inLections( $0 mgNkg at a rate of not more than $00 mgNminute- ma3. $ g
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
V&#" "II"(8!,
7eadache
fe"er
megaloblastic anemia
di99iness
hy!otension
nausea and
"omiting e!igastric !ain.
*reatment of o"erdose to3icity&
4aintain J assist res!iration as indicated.
Su!!ort circulation by "aso!ressor J I.<. fluids as re0uired.
+s!irate stomach content take care to a"oid !ulmonary as!iration.
6iuretics may be gi"en as ordered.
Intake J out!ut measurement.
6ialysis if indicated.
@$!&n% (on!&#"$H8&on!,
$. If gi"en I.< closely monitor the rate of flow. 2a!id administration may lead to
res!iratory de!ression.
). 4onitor the site of I.<. for soft of e3tra"asation which cause se"er !ain ner"e
damage J necrosis.
$>$
>. +"oid the use of alcoholic be"erages.
;. Instruct the client not to dri"e a car or o!erate other ha9ardous machinery after
taking the medication .
?. *ake the medication only as !rescribed.
A. If used for hy!notic effect gi"e a hr before bedtime.
D. *each !atient about sings and sym!toms of to3icity and instruct !atient to re!ort
them to treating !hysician.
B. If taken for B weeks or more instruct !atient not to sto! it suddenly to a"oid
withdrawal sym!toms as con"ulsion.
C. =ee! the drug out of reach of the children.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FEJ G7"ny8o&n ,
U$H#" nHm"!, 1!anutin 6ilantin
ClH!!, anticon"ulsant antiarrhythmic
L(8&on,
acts in the motor corte3 of the brain to reduce the s!read of electrical
discharges from the ra!idly firing e!ile!tic foci in this area. +lso acti"ity of centers in the brain
stem res!onsible for the tonic !hase of grand mal sei9ures
+!"!,
,hronic e!ile!sy.
Premature "entricular contractions.
*achycardia.
Ao!",
by mouth initially >M; mgNkg daily or $?0M>00 mg daily 'as a single dose or in ) di"ided
doses( increased gradually as necessary- usual dose )00M?00 mg daily- ,7IL6 initially
? mgNkg daily in ) di"ided doses usual dose range ;MB mgNkg daily 'ma3. >00 mg(
5y intra"enous inLection & status e!ile!ticus $? mgNkg at a rate not e3ceeding ?0 mg !er
minute as a loading dose- maintenance doses of about $00 mg should be gi"en thereafter at
inter"als of e"ery AMB hours- rate and dose reduced according to weight- ,7IL6 $? mgNkg
as a loading dose 'neonate $?M)0 mgNkg at rate of $M> mgNkgNminute(
$>)
Pro!hyla3is of con"ulsion & ;.D mgNkgNday di"ided into ) doses.
<entricular arrhythmias by intra"enous inLection "ia ca"al catheter F ,entral LineF
>.?M? mgNkg at a rate not e3ceeding ?0 mgNminute with blood !ressure and 1,%
monitoring- re!eat once if necessary.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
V&#" "II"(8!,
6rowsiness
ata3ia
di99iness
measles.like rash
gingi"al hy!er!lasia
7irsutism 'e3cessi"e hair growth( and
hy!oglycemia.
@.M ,
2a!id I.<. administration 7y!otension J arrhythmia.
@$!&n% (on!&#"$H8&on!,
I.<. !henytoin may forms a !reci!itate so flush tubing by saline 'not de3trose(
before J after administration.
+ssess for hy!ersensiti"ity.
If a !regnant woman takes this drug tell her not to breast.feed her baby.
Obtain li"er J kidney function studies.
4onitor serum drug le"els on a routine basis.
6uring I.<. thera!y monitor 5.P. for signs of hy!otension .
*ake e food to minimi9e %I u!set.
If the !atient is diabetic monitor for signs of hy!oglycemia.
Oral hygiene to minimi9e bleeding from the gum.
2e!ort any e3cessi"e growth of hair.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FSJ Go8H!!&m C7lo$&#",
U$H#" nHm"!& =,L for I< !re!aration
G$"%nHn(y, ',ategory +(
$>>
ClH!!, 1lectrolyte mineral.
L(8&on,
+!"!,
Patients recei"ing high doses of !otent diuretics.
Patients ha"ing secondary hy!eraldosteronism.
Ihen there is e3cessi"e loss of !otassium in feces.
Ihen !otassium intake is not ade0uate 'es!ecially in elderly(.
Ao!",
by slow intra"enous infusion de!ending on the deficit or the daily maintenance
re0uirements F usually $.) m10NkgNday F
Con8$H&n#&(H8&on!,
Se"ere renal failure.
If serum !otassium le"el is o"er ? mmolNliter.
V&#" "II"(8!,
7y!erkalemia
Phlebitis at inLection site.
7eart to3icity if infused ra!idly.
Iith oral tablet& 6ys!e!sia nausea and "omiting eso!hageal or bowel ulceration.
@$!&n% (on!&#"$H8&on!,
4i3 solution well.
+dminister solution slowly '?00 4L of solution o"er ).> hours(
4onitor serum !otassium le"el.
+ssess insertion site for signs of !hlebitis.
%i"e oral !re!aration on full stomach
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FDJ G$"#n&!on" ,
U$H#" nHm"!, deltasone
ClH!!, ,orticosteroids F%lucocorticoid thera!y E anti inflammatory
G$"%nHn(y, ',ategory ,N 6 if used in $st trimester (
L(8&on,
$>;
*hey are a grou! of natural hormones !roduced by the adrenal corte3.
- *hey are used for a "ariety of thera!eutic !ur!oses.
- 4any slightly modified synthetic "ariants are a"ailable today.
- Some !atients res!ond better to one substance than to another.
- *hese hormones influence many metabolic !athways J all organ systems J are
essential for sur"i"al.
- *he release of corticosteroids is controlled by hormones such as corticotro!in.
releasing factor !roduced by the hy!othalamus J +,*7 !roduced by the anterior
!ituitary.
+!"!,
2e!lacement thera!y & adrenal insufficiency '+ddisonKs disease( .
2heumatic disorders & rheumatoid arthritis J osteoarthritis.
,ollagen diseases& systemic lu!us erythromatosus rheumatic cardiac.
+llergic diseases& drug hy!ersensiti"ity urticarial transfusion reaction.
2es!iratory diseases& bronchial asthma rhinitis.
Ocular diseases & allergic J inflammatory conLuncti"itis keratitis
6ermatological diseases& !soriasis contact dermatitis urticaria.
6iseases of the %I*& ulcerati"e colitis.
/er"ous system & 4yasthenia gra"is.
4alignancies& leukemia lym!homa.
/e!hrotic syndrome.
7ematologic diseases& hemolytic anemia thrombocyto!enic !ur!ura.
4iscellaneous& se!tic shock li"er cirrhosis stimulation of surfactant
!roduction !re"ention of organ reLection.
Ao!",
by mouth initially u! to $0M)0 mg daily 'se"ere disease u! to A0 mg daily( !referably taken
in the morning after breakfast- can often be reduced within a few days but may need to be
continued for se"eral weeks or months
4aintenance usual range ).?M$? mg daily but higher doses may be needed- cushingoid side.
effects increasingly likely with doses abo"e D.? mg daily
5y intramuscular inLection !rednisolone acetate )?M$00 mg once or twice weekly
Con8$H&n#&(H8&on!,
If infection is sus!ected '4ask signs J sym!toms(.
$>?
Pe!tic ulcer.
+cute glomerulone!hritis.
,ushingKs syndrome .
,ongesti"e heart failure.
7y!ertension.
7y!erli!idemia.
V&#" "II"(8!,
Prolonged thera!y may cause ,ushing.like syndrome J atro!hy of the adrenal corte3 J
subse0uent adrenocortical insufficiency.
@.M,
Steroid withdrawal syndrome may lead to & anore3ia nausea "omiting weight loss
headache myalgia J hy!otension.
V&#" "II"(8! &n(l#",
1dema alkalosis hy!okalemia hy!ertension ,78 muscle wasting weakness
osteo!orosis nausea J "omiting.
7eadache hy!ercholesterolemia hirsutism amenorrhea de!ression.
2edistribution of body fats& thin e3tremities and fat trunk moon.like face buffalo hum!.
@$!&n% (on!&#"$H8&on!,
2e!ort signs J sym!toms of side effects 'cushing.like syndrome(.
!athological fracture(.
$>A
+d"ise the client to delay any "accination while taking these medications 'weakened
immunity(.
13!lain the need to maintain general hygiene J cleanliness to !re"ent infection.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FYJ G$om"87Hb&n",
U$H#" nHm"!, !henergan !rothia9ine
ClH!!, +ntihistamines
L(8&on,
It may cause se"er drowsiness.
It also !ro"ides antiemetic effect
'it affects the chemo rece!tor trigger 9one (.
It also has a sedati"e action effecti"e in "ertigo
<estibular a!!aratus
+!"!,
4otion sickness.
/ausea J "omiting due to anesthesia.
Ao!",
by mouth )? mg at night increased to )? mg twice daily if necessary or $0M)0 mg )M>
times daily- ,7IL6 under ) years not recommended )M? years ?M$? mg daily in $M)
di"ided doses ?M$0 years $0M)? mg daily in $M) di"ided doses Premedication ,7IL6
under ) years not recommended )M? years $?M)0 mg ?M$0 years )0M)? mg
$>D
5y dee! intramuscular inLection )?M?0 mg- ma3. $00 mg- ,7IL6 ?M$0 years A.)?M
$).? mg Premedication )?M?0 mg $ hour before o!eration- ,7IL6 ?M$0 years A.)?M
$).? mg 5y slow intra"enous inLection in emergencies )?M?0 mg as a solution containing
).? mgNmL in water for inLections- ma3. $00 mg
,ontraindications&
7y!ersensiti"ity.
Pregnancy.
%laucoma
Prostatic hy!ertro!hy
,/S de!ression '!henothia9ine ty!e(.
5one marrow de!ression
,omatose !atients.
V&#" "II"(8!,
Sedation . dee! slee! . 6i99iness . 7eadache . muscle weakness . disturbed
coordination . e!igastric distress . dry mouth . nausea . "omiting . urinary fre0uency
anemia ' !ancyto!nea( .
Parado3ical e3citation 'es!ecially in children J elderly( 2estlessness irritability
insomnia hysteria tremors eu!horia ner"ousness hallucinations disorientation J
con"ulsion.
Usually caused by o"erdose 'acute to3icity(.
@$!&n% (on!&#"$H8&on!,
InLect I.4. !re!arations dee! into muscles.
Oral !re!arations may cause gastric irritation so gi"e drug with meals.
/ote if the client has any medical history of ulcer glaucoma J if the client is
!regnant.
Obtain a baseline 5.P. Pulse J res!iration .
/ote signs of ,/S de!ression 'signs of o"erdose so induce "omiting(.
If in hos!ital use side rails 'safety measures(.
+d"ice client to re!ort signs of side effects immediately.
Instruct client to a"oid undue e3!osure to sun.
If the drug is being used for motion sickness it should be taken >0 minutes before
trans!orting.
,aution the client not to dri"e a car or o!erate other machinery.
$>B
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FZJ G$oKoIol ,
U$H#" nHm"!, 6i!ri"an
ClH!!, short.acting Intra"enous anesthetic
L(8&on,
Produces sedationNhy!nosis ra!idly 'within ;0 sec( and smoothly with minimal e3citation-
decreases IOP and systemic "ascular resistance- rarely is associated with malignant hy!erthermia
and histamine release- su!!resses cardiac out!ut and res!iratory dri"e.
+!"!,
Induction and maintenance of anesthesia in adults- induction anesthesia in children at
least > yr of age- maintenance anesthesia in children at least ) mo of age- initiation and
maintenance of monitored anesthesia care sedation in adults- sedation in intubated or
res!iratory.controlled adult I,U !atients.
Ao!",
Induction of anesthesia by intra"enous inLection or infusion $.?M).? mgNkg 'less in those o"er ??
years( at a rate of )0M;0 mg e"ery $0 seconds- ,7IL6 o"er $ month administer slowly until
res!onse 'usual dose in child o"er B years ).? mgNkg may need more in younger child
4aintenance of anesthesia by intra"enous inLection )?M?0 mg re!eated according to res!onse
or by intra"enous infusion ;M$) mgNkgNhour- ,7IL6 o"er > years by intra"enous inLection or
infusion CM$? mgNkgNhour
Sedation in intensi"e care by intra"enous infusion adult o"er $D years 0.>M; mgNkgNhour
Con8$H&n#&(H8&on!,
Situations in which general anesthesia or sedation are contraindicated.
V&#" "II"(8!,
difficulty breathing whee9ing swelling of the throat
fast heartbeat !al!itations
lightheadedness or fainting s!ells
numbness or tingling in the hands or feet
$>C
sei9ure 'con"ulsion(
skin rash flushing 'redness( or itching
swelling or e3treme !ain at the inLection site
uncontrollable muscle s!asm
@$!&n% (on!&#"$H8&on!,
Should be administered only by !ersonnel who are trained in administration of general
anesthesia and familiar with drug.
+dminister only in settings in which resuscitation e0ui!ment is immediately a"ailable.
Shake well before use. 6o not use if there is e"idence of se!aration of !hases of
emulsion.
4aintain strict ase!tic techni0ue in handling- ra!id growth of organisms may occur if
contaminated.
6ilute with de3trose ?Q inLection but do not dilute to concentration less than ) mgNmL.
6rug is com!atible with de3trose ?Q- lactated 2ingerEs inLection- lactated 2ingerEs and
de3trose ?Q inLection- de3trose ?Q and sodium chloride 0.;?Q inLection- de3trose ?Q
and sodium chloride 0.)Q InLection.
4inimi9e !ain associated with administration by infusing into larger "eins.
6iscard any unused !ortions of drug or solution at end of anesthetic !rocedure- do not
kee! for more than A h.
In I,U sedation discard after $) h if administered directly from "ial or after A h if
transferred to syringe or other container.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
F[J G$oK$Hnolol cCl,
U$H#" nHm"!, 6eralin Inderal
ClH!!, beta.adrenergic blacking agent antiarryhthmic.
G$"%nHn(y, ',ategory , N 6 if used in )nd or >rd trimesters(
L(8&on,
manifests both beta$ and beta ) adrenergic blocking acti"ity.
+!"!,
+ngina !ectoris.
7y!ertension.
$;0
,ardiac arrhythmias.
Pro!hyla3is of migrin.
Pro!hyla3is of 4I.
Pheochromocytoma
Ao!",
by mouth hy!ertension initially B0 mg twice daily increased at weekly inter"als as
re0uired- maintenance $A0M>)0 mg daily
+ngina initially ;0 mg )M> times daily- maintenance $)0M);0 mg daily
+rrhythmias hy!ertro!hic obstructi"e cardiomyo!athy an3iety tachycardia and
thyroto3icosis 'adLunct( $0M;0 mg >M; times daily
+n3iety with sym!toms such as !al!itations sweating tremor ;0 mg once daily
increased to ;0 mg > times daily if necessary
Pro!hyla3is after myocardial infarction ;0 mg ; times daily for )M> days then
B0 mg twice daily beginning ? to )$ days after infarction
4igraine !ro!hyla3is and essential tremor initially ;0 mg )M> times daily-
maintenance B0M$A0 mg daily
5y intra"enous inLection arrhythmias and thyroto3ic crisis $ mg o"er $ minute- if
necessary re!eat at ).minute inter"als- ma3. $0 mg '? mg in anesthesia(
Con8$H&n#&(H8&on!,
5radycardia ,.7.8. cardiogenic shock diabetes thyroto3icosis chronic bronchitis asthma
bronchos!asm em!hysema.
V&#" "II"(8!,
5radycardia ,.7.8. hy!otension cold e3tremities 'due to !eri!heral "asoconstriction( edema
dys!nia shortness of breath nausea "omiting he!atomegaly and bronchos!asm.
@$!&n% (on!&#"$H8&on!,
Instruct !atientNfamily to take blood !ressure and !ulse.
Pro"ide written instructions as when to call !hysician 'e.g. 72 below ?0
beatNmin(.
,onsult the !hysician before interru!ting the thera!y.
Some drugs lead to blurring of "ision so that tell !atients not to engage in
acti"ities need mental alertness.
Instruct !atient to dress warmly during cold weather.
6iabetic !atient should be "ery careful about sym!toms of hy!oglycemia.
$;$
2e!ort any asthma.like sym!toms.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
F\J G$o8Hm&n" VlK7H8" ,
U$H#" nHm"!, !rosulf
ClH!!, he!arin antidote
L(8&on,
It binds to he!arin to form a stable ion !air which does not ha"e anticoagulant acti"ity.
+!"!,
Protamine sulfate is usually administered to re"erse the large dose of he!arin
administered during certain surgeries es!ecially heart surgery. It is also used in gene
transfer and !rotein !urification.
Ao!",
by intra"enous inLection o"er a!!ro3. $0 minutes $ mg neutralises B0M$00 units he!arin
when gi"en within $? minutes of he!arin- if longer time less !rotamine re0uired as he!arin
ra!idly e3creted- ma3. ?0 mg
Con8$H&n#&(H8&on!,
Patients who ha"e shown !re"ious intolerance to the drug.
V&#" "II"(8!,
I.<. inLections of !rotamine may cause a sudden fall in blood !ressure bradycardia
!ulmonary hy!ertension dys!nea or transitory flushing and a feeling of warmth. *here
ha"e been re!orts of ana!hyla3is that resulted in res!iratory embarrassment 'see
Precautions(. Other re!orted ad"erse reactions include systemic hy!ertension nausea
"omiting and lassitude. 5ack !ain has been re!orted rarely in conscious !atients
undergoing such !rocedures as cardiac catheteri9ation.
@$!&n% (on!&#"$H8&on!,
$;)
If gi"en too 0uickly may cause a se"ere dro! in blood !ressure and se"ere allergic
reaction.
8acilities for resuscitation and treatment of shock should be a"ailable.
Patients should be carefully monitored using either the acti"ated !artial thrombo!lastin
time or the acti"ated coagulation time carried out ?.$? minutes after !rotamine sul!hate
administration.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
F^J p&n&#&n" !lK7H8",
U$H#" nHm"!, +!o.Huinidine- 5i0uin 6urules- ,ardio0uin- /o"o0uinidin- Huin.2elease-
Huinaglute 6ura.tabs- Huinate- Huinide3 13tentabs.
ClH!!, +ntiarrhythmic F class g F
L(8&on,
Huinidine works by decreasing the sensiti"ity of heart muscle cells to electrical im!ulses
therefore slowing the electrical conduction in the heart muscle.
Huinidine is used to treat two forms of arrhythmia . "entricular and su!ra"entricular
arrhythmias.
+!"!,
Irregular heart beats 'arrhythmias(
Use with caution in
+llergic reaction to one of the acti"e ingredients
Ao!",
by mouth 0uinidine sul!hate )00M;00 mg >M; times daily
Con8$H&n#&(H8&on!,
6efect of the heartEs electrical message !athways resulting in decreased function of the
heart 'heart block(
*his medicine should not be used if you are allergic to one or any of its ingredients.
,ertain medicines should not be used during !regnancy or breastfeeding.
V&#" "II"(8!,
2ash
$;>
Inability of the heart to !um! blood efficiently 'heart failure(
5lood disorders
6isturbances of the gut such as diarrhea consti!ation nausea "omiting or abdominal
!ain
Irregular heart beat '"entricular arrhythmias(
8e"er '!yre3ia(
Lu!us syndrome
6ecreased electrical im!ulses within the heart 'myocardial de!ression(
@$!&n% (on!&#"$H8&on!,
+ test dose of a single tablet of 0uinidine sulfate ')00 mg( by mouth should be gi"en
initially in order to ascertain any !ossible hy!ersensiti"ity to 0uinidine. 7y!ersensiti"ity
to 0uinidine although rare should be constantly considered es!ecially during the first
week of thera!y.
,ontinuous 1,% monitoring is recommended in all cases in which 0uinidine is used in
large doses.
%astrointestinal sym!toms such as nausea "omiting diarrhea and colic may be
minimi9ed by gi"ing the drug with food.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
FFJ jHn&8&#&n" cCl ,
U$H#" nHm"!, Gantac 2andine
ClH!!, ulcer healing drug F7).rece!tor antagonists F
L(8&on,
It com!etiti"ely inhibits gastric acid secretion by blocking the effect of
histamine on histamine 7).rece!tors.
+!"!,
Short.term 'u! to B wks( J maintenance treatment of duodenal ulcer J
treatment of benign gastric ulcer .
4anagement of hy!ersecretion of gastric acid .
2eflu3 eso!hagitis.
$;;
Ao!",
by mouth $?0 mg twice daily or >00 mg at night
Pro!hyla3is of /S+I6.induced duodenal ulcer $?0 mg twice daily
2eflu3 oeso!hagitis $?0 mg twice daily or >00 mg at night for u! to B weeks 5y
intramuscular inLection ?0 mg e"ery AMB hours
5y slow intra"enous inLection ?0 mg diluted to )0 mL and gi"en o"er at least ) minutes-
may be re!eated e"ery AMB hours
Pro!hyla3is of stress ulceration initial slow intra"enous inLection of ?0 mg then
continuous infusion $)?M)?0 microgramsNkg !er hour
Con8$H&n#&(H8&on!,
Li"er cirrhosis im!aired renal J he!atic function .
V&#" "II"(8!,
,onsti!ation nausea "omiting diarrhea headache
6i99iness malaise "ertigo bradycardia or tachycardia
Pancyto!nea rashes bronchos!asm alo!ecia.
@$!&n% (on!&#"$H8&on!,
6ilute for I.<. use ' ?0 mg in )0 ml of 0.CQ /acl( .
/ote any e"idence of renal or li"er disease.
Obtain baseline li"er J kidney function.
/ote for signs of infection .
+de0uate hydration for !roblem of diarrhea.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
F`J j"%lH$ *n!l&n,
U$H#" nHm"!, 7umulin 2 Insulin.*oronto /o"olin 2 Iletin II 2egular <elosulin 52
ClH!!, Short.acting insulin
Pregnancy& ',ategory 5(
L(8&on,
Lower blood glucose by increasing trans!ort into cells and !romoting the con"ersion of
glucose to glycogen
Promote the con"ersion of amino acids to !roteins in muscle and stimulate triglyceride
formation
$;?
Inhibit the release of free fatty acids
Sources include !ork beefN!ork combinations semisynthetic biosynthetic and
recombinant 6/+.
o ,ontrol of blood sugar in diabetic !atients.
+!"!,
*reatment of insulin.de!endent diabetes mellitus 'I664 ty!e $(
4anagement of nonMinsulin.de!endent diabetes mellitus '/I664 ty!e )( unres!onsi"e to
treatment with diet andNor oral hy!oglycemic agents
,oncentrated insulin U.?00& Only for use in !atients with insulin re0uirements `)00
unitsNday.
Ao!",
by subcutaneous intramuscular or intra"enous inLection or intra"enous infusion
according to re0uirements F usually bolus 0.$ unitNkg followed by infusion 0.0?.0.$ unitNkgNhour
Con8$H&n#&(H8&on!,
+llergy or hy!ersensiti"ity to a !articular ty!e of insulin !reser"ati"es or other additi"es.
V&#" "II"(8!,
6erm& urticaria.
1ndo& 7y!oglycemia rebound hy!erglycemia 'Somogyi effect(.
Local& li!odystro!hy itching li!ohy!ertro!hy redness swelling.
4isc& allergic reactions including +na!hyla3is.
@$!&n% (on!&#"$H8&on!,
2ead the !roduct information J any im!ortant notes inserted into the !ackage.
2efrigerate stock su!!ly of insulin but a"oid free9ing.
8ollow the guidelines with res!ect to mi3ing the "arious ty!es of insulin.
In"ert the "ial se"eral times to mi3 before the material is withdrawn a"oid "igorous
shaking#.
+ssist !atient for self.administration of insulin.
2otate the sites of S.,. inLections to !re"ent the !roblem of hy!ertro!hy or atro!hy at
inLection site.
$;A
+llow insulin to remain at room tem!erature $ hour before administration.
+!!ly !ressure for $ minute donKt massage since it may interfere with rate of
absor!tion.
If breakfast must be delayed delay the administration of morning dose of insulin.
Obtain a thorough nursing history from the client N family.
If the client has sym!toms of hy!erglycemia reaction&
7a"e regular insulin a"ailable for administration.
4onitor client closely after administration.
,heck blood glucose urine glucose and acetone.
,heck for early sym!toms of hy!oglycemia.
+ssess diabetic more closely for infection or emotional disturbances that
may increase insulin re0uirements.
13!lain the necessity for close regular medical su!er"ision.
13!lain to !atient how to test the urine for sugar J acetone.
13!lain the use J care of e0ui!ment J the storage of medication.
Pro"ide the client J family with a !rinted chart e3!laining sym!toms of hy!oglycemia
hy!erglycemia J instructions concerning what to do for each.
Instruct client that blurring of "ision will subside within A.B weeks.
+d"ise client to check "ials of insulin carefully before each dose. 2egular
insulin should be clear where as other forms may be cloudy.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`EJ VHlP8omol ,LlP8"$ol,
U$H#" nHm"!, <entolin
ClH!!, sym!athomimetic agent bronchodilator
L(8&on, stimulate O ) rece!tors of the bronchi leading to bronchodilation.
+!"!,
5ronchial asthma.
$;D
5ronchos!asm due to bronchitis or em!hysema.
Parenteral for treatment of status asthmaticus.
Ao!",
by mouth ; mg 'elderly and sensiti"e !atients initially ) mg( >M; times daily- ma3. single dose
B mg- ,7IL6 under ) years $00 microgramsNkg ; times daily WunlicensedX- )MA years $M) mg
>M; times daily AM$) years ) mg >M; times daily
5y subcutaneous or intramuscular inLection ?00 micrograms re!eated e"ery ; hours if
necessary
5y slow intra"enous inLection )?0 micrograms re!eated if necessary
5y intra"enous infusion initially ? microgramsNminute adLusted according to res!onse and
heart.rate usually in range >M)0 microgramsNminute or more if necessary- ,7IL6 $ monthM$)
years 0.$M$ microgramNkgNminute WunlicensedX
5y inhalation of nebulised solution chronic bronchos!asm unres!onsi"e to con"entional
thera!y and se"ere acute asthma +6UL* and ,7IL6 o"er $B months ).? mg re!eated u! to ;
times daily- may be increased to ? mg if necessary but medical assessment should be
considered since alternati"e thera!y may be indicated- ,7IL6 under $B months WunlicensedX
'transient hy!o3aemia may occurbconsider su!!lemental o3ygen( $.)?M).? mg u! to ; times
daily but more fre0uent administration may be needed in se"ere cases
Con8$H&n#&(H8&on!,
hy!ersensiti"ity
V&#" "II"(8!,
*achycardia arrhythmias anginal !ain.
/ausea "omiting.
6i99iness sweating flushing.
7eadache weakness "ertigo and insomnia.
@$!&n% (on!&#"$H8&on!,
6onKt e3ceed the recommended dose.
*he contents of the container are under !ressure donKt store near heat or o!en flames.
Ihen gi"en by neubili9ation use facemask or mouth.!iece.
,om!ress O) or air at A M $0 L]min for ?.$? minutes.
Obser"e client for e"idence of allergic res!onse.
/1<12 gi"e the solution !re!ared to be gi"en as inhalation by the I< route. It may
cause se"ere tachycardia.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
$;B
`SJ Vo#&m M&(H$PonH8" ,
U$H#" nHm"!, /eut
ClH!!, +lkali
L(8&on,
Sodium bicarbonate is a systemic alkali9ing agent which when gi"en intra"enously will increase
!lasma bicarbonate buffers e3cess hydrogen ion concentration raises blood !7 and re"erses the
clinical manifestations of acidosis.
+!"!,
Sodium bicarbonate is used as an alkalini9ing agent in the treatment of metabolic acidosis which
may occur in many conditions including diabetes star"ation he!atitis cardiac arrest shock se"ere
dehydration renal insufficiency se"ere diarrhea +ddisonEs disease or administration of acidifying
salts 'e.g. e3cessi"e sodium chloride calcium chloride ammonium chloride(.
Sodium bicarbonate is also used to increase urinary !7 in order to increase the solubility of certain
weak acids 'e.g. cystine sul!honamides uric acid( and in the treatment of certain into3ications
'e.g. methanol !henobarbitone salicylates( to decrease renal absor!tion of the drug or to correct
acidosis.
Sodium bicarbonate reduces stomach acids and can make the urine less acidic. It is used
as an antacid to treat heartburn indigestion and other stomach disorders. It is also used to
treat "arious kidney disorders and to increase the effecti"eness of sulfonamides.
Ao!",
by slow intra"enous inLection a strong solution 'u! to B.;Q( or by continuous intra"enous
infusion a weaker solution 'usually $.)AQ( an amount a!!ro!riate to the body base deficit F
usually $.) m10Nkg F
Con8$H&n#&(H8&on!,
Sodium 5icarbonate InLection USP is contraindicated in !atients who are losing chloride
by "omiting or from continuous gastrointestinal suction and in !atients recei"ing
diuretics known to !roduce a hy!ochloremic alkalosis.
V&#" "II"(8!,
nausea or "omiting-
headache-
$;C
se"er mood changes-
muscle !ain-
swelling of feet ankles or legs
decreased a!!etite-
unusual tiredness-
consti!ation-
dry mouth or increased thirst- or
increased urination.
kQ"$#o!H%"
Sym!toms
4etabolic alkalosis which may be accom!anied com!ensatory hy!er"entilation !arado3ical
acidosis of the cerebros!inal fluid se"ere hy!okalaemia hy!erirritability or tetany.
*reatment
*he bicarbonate should be sto!!ed and the !atient managed according to the degree of alkalosis
!resent. *o control the sym!toms of alkalosis the !atient should rebreathe e3!ired air. Sodium
chloride inLection 0.CQ may be gi"en intra"enously !otassium chloride also may be indicated if
there is hy!okalaemia.
,alcium gluconate may be used to control hy!erirritability and tetany which can occur in se"ere
alkalosis. +mmonium chloride may also be indicated as an acidifying agent in se"ere cases.
@$!&n% (on!&#"$H8&on!,
Laboratory determination of the !atientEs acid base status is recommended before and
during treatment to minimi9e the !ossibility of o"erdosage and resultant metabolic
alkalosis.
*he use of scal! "eins should be a"oided.
6o not use the inLection if it contains !reci!itate. 6o not use unless the solution is clear and
the container and seal are intact. 6iscard any unused !ortion
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`DJ VK&$onolH(8on" ,
U$H#" nHm"!, +ldacton
$?0
ClH!!, Potassium.s!aring diuretics
G$"%nHn(y, ',ategory ,N 6 if used in !regnancy.induced hy!ertension(
L(8&on,
Is a mild diuretic that acts on the distal tubule to inhibit sodium e3change for !otassium
which results in increased secretion of sodium and water J conser"ation of !otassium .
It is also aldosterone antagonist.
It has slight antihy!ertensi"e effect .
+!"!,
1dema due to congesti"e heart failure
li"er cirrhosis.
/e!hrotic syndrome .
1ssential hy!ertension.
Primary hy!eraldosteronism.
7y!okalemia 'as in ,78( .
Ao!",
$00M)00 mg daily increased to ;00 mg if re0uired- ,7IL6 initially > mgNkg
daily in di"ided doses
7eart failure low doses of s!ironolactone 'usually )? mg( daily F already
recei"ing an +,1 inhibitor and a diuretic F
Con8$H&n#&(H8&on!,
+cute renal insufficiency .
Progressi"e renal failure .
Patients recei"ing !otassium su!!lement.
7y!erkalemia.
V&#" "II"(8!,
7y!erkalemia hy!onatremia ' dry mouth lethargy thirst J easy fatigability(.
<omiting diarrhea cram!s.
4enstrual irregularities gynecomastia hirsutism J dee!ing of "oice im!otence.
Skis rashes J breast carcinoma .
@$!&n% (on!&#"$H8&on!,
$?$
!rotect drug from light.
8ood may increase absor!tion of aldactone.
Obtain serum electrolyte le"els !rior to starting thera!y.
2ecord "ital signs intake J out !ut J body weight.
+d"ise the client to a"oid food high in !otassium.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`YJ V8$"K8o_&nH!" ,
U$H#" nHm"!, stre!tase
ClH!!, *hrombolytic agent.
L(8&on,
+cts with !lasminogen to !roduce an acti"ator com!le3 which enhance the con"ersion of
!lasminogen to !lasmin which breaks down fibrinogen fibrin clot J other !lasma !roteins.
+!"!,
6ee! "enous thrombosis '6<*(
4yocardial infarction '4I(
*o clear occluded arterio"enous or I< canula .
Ao!",
myocardial infarction $ ?00 000 units o"er A0 minutes
6ee!."ein thrombosis !ulmonary embolism acute arterial thromboembolism central retinal
"enous or arterial thrombosis by intra"enous infusion )?0 000 units o"er >0 minutes then
$00 000 units e"ery hour for u! to $)MD) hours according to condition with monitoring of
clotting !arameters
Con8$H&n#&(H8&on!,
7emorrhage.
V&#" "II"(8!,
5leeding
nausea and
headache.
@$!&n% (on!&#"$H8&on!,
5efore using Stre!tase Stre!tokinase an attem!t should be made to clear the
cannula by careful syringe techni0ue using he!arini9ed saline solution. If
ade0uate flow is not re.established Stre!tokinase may be em!loyed
$?)
,lam! off cannula limb's( for ) hours. Obser"e the !atient closely for !ossible
ad"erse effects.
+fter treatment as!irate contents of infused cannula limb's( flush with saline
reconnect cannula.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`ZJ V((&nyl C7ol&n" ,
U$H#" nHm"!, Scoline
ClH!!, 6e!olarising muscle rela3ants
L(8&on,
+n ultra short.acting de!olari9ing skeletal muscle rela3ant Succinyl ,holine bonds with
motor end!late cholinergic rece!tors to !roduce de!olari9ation '!ercei"ed as
fasciculation(. *he neuromuscular block remains as long as sufficient 0uantities of
Succinyl ,holine remain and is characteri9ed by a flaccid !aralysis.
+!"!,
Succinyl ,holine chloride is indicated as an adLunct to general anesthesia to facilitate
tracheal intubation and to !ro"ide skeletal muscle rela3ation during surgery or
mechanical "entilation and to reduce the intensity of muscle contractions associated with
electro. or !harmacological. induced con"ulsions.
Ao!",
by intra"enous inLection initially $ mgNkg- maintenance usually 0.?M$ mgNkg at
?M$0 minute inter"als- ma3. ?00 mgNhour- neonate and infant ) mgNkg- child
$ mgNkg
5y intra"enous infusion of a solution containing $M) mgNmL ).?M; mgNminute-
ma3. ?00 mgNhour-
5y intramuscular inLection I/8+/* u! to ;M? mgNkg- ,7IL6 u! to ; mgNkg-
ma3. $?0 mg
Con8$H&n#&(H8&on!,
Succinyl ,holine is contraindicated in !ersons with !ersonal or familial history of
malignant hy!erthermia skeletal muscle myo!athies and known hy!ersensiti"ity to the
drug.
V&#" "II"(8!,
$?>
+d"erse reactions to Succinyl ,holine consist !rimarily of an e3tension of its
!harmacological actions. Succinyl ,holine causes !rofound muscle rela3ation resulting in
res!iratory de!ression to the !oint of a!nea- this effect may be !rolonged.
7y!ersensiti"ity reactions including ana!hyla3is may occur in rare instances. *he
following additional ad"erse reactions ha"e been re!orted& cardiac arrest malignant
hy!erthermia arrhythmias bradycardia tachycardia hy!ertension hy!otension
hy!erkalemia !rolonged res!iratory de!ression or a!nea increased intraocular !ressure
muscle fasciculation Law rigidity !osto!erati"e muscle !ain rhabdomyolysis with
!ossible myoglobinuric acute renal failure e3cessi"e sali"ation and rash.
@$!&n% (on!&#"$H8&on!,
Succinylcholine should not be used if organo!hos!hate agents ha"e been gi"en or
a!!lied recently.
Succinylcholine chloride does not ha"e analgesic effects- and should be used with
a!!ro!riate analgesicNsedati"eNanesthetic agents.
5e !re!ared to administer o3ygen and artificial res!iration.
8acilities for resuscitation and treatment of shock should be a"ailable.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`[J U7&oK"n8Hl Vo#&m ,
U$H#" nHm"!, Pentothal
ClH!!, 5arbiturates F Intra"enous anesthetic F
L(8&on,
*hio!entone is a "ery short acting I.< 5arbiturate used as an anesthetic agent. It has !oor analgesic
and muscle rela3ing !ro!erties.
+!"!,
as the sole anesthetic agent for brief '$? minute( !rocedures
for induction of anesthesia !rior to administration of other anesthetic agents
to su!!lement regional anesthesia
to !ro"ide hy!nosis during balanced anesthesia with other agents for analgesia or
muscle rela3ation
$?;
for the control of con"ulsi"e states during or following inhalation anesthesia local
anesthesia or other causes
in neurosurgical !atients with increased intracranial !ressure if ade0uate
"entilation is !ro"ided and
for narcoanalysis and narcosynthesis in !sychiatric disorders.
Ao!",
induction of general anaesthesia by intra"enous inLection as a ).?Q ')? mgNmL( solution
induction >.? mgNkg in fit !remedicated adults initially $00M$?0 mg 'reduced in elderly or
debilitated( o"er $0M$? seconds 'longer in elderly or debilitated( followed by further 0uantity
if necessary according to res!onse after >0MA0 seconds- or u! to ; mgNkg- ,7IL6 induction
)MD mgNkg
2aised intracranial !ressure by intra"enous inLection $.?M> mgNkgNhour
Con8$H&n#&(H8&on!,
+bsence of suitable "eins for intra"enous administration
hy!ersensiti"ity 'allergy( to barbiturates and
"ariegate !or!hyria 'South +frican( or acute intermittent !or!hyria.
V&#" "II"(8!,
+d"erse reactions include
res!iratory de!ression
myocardial de!ression
cardiac arrhythmias
!rolonged somnolence and reco"ery
snee9ing
coughing
bronchos!asm
laryngos!asm and shi"ering.
+na!hylactic and ana!hylactoid reactions to Pentothal '*hio!ental Sodium
for InLection USP( ha"e been re!orted. Sym!toms e.g. urticaria
bronchos!asm "asodilatation and edema should be managed by
con"entional means.
@$!&n% (on!&#"$H8&on!,
$??
5arbiturate anesthetics should be administered only by indi"iduals familiar with
their use and skilled in airway management. +ge. and si9e.a!!ro!riate resuscitati"e
and endotracheal intubation e0ui!ment o3ygen and medications for !re"ention and
treatment of anesthetic emergencies must be immediately a"ailable. +irway !atency
must be maintained at all times
,are should be taken to a"oid e3tra"asation or intra.arterial inLection of barbiturate
anesthetics.
13tra"ascular inLection may cause !ain swelling ulceration and necrosis. Intra.
arterial inLection may !roduce arteritis followed by "asos!asm edema thrombosis
and gangrene of an e3tremity.
Sterile water for inLection ?Q de3trose inLection or 0.CQ sodium chloride inLection
may be used as diluents. 5acteriostatic diluents and lactated 2ingerEs inLection
should not be used as diluents because they tend to cause !reci!itation
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
@
`\J U7y$oX&n ,
U$H#" nHm"!, 1ltro3in
ClH!!, *hyroid hormones
G$"%nHn(y, ',ategory +(
L(8&on,
Princi!al effect is increasing metabolic rate of body tissues&
Promote gluconeogenesis
Increase utili9ation and mobili9ation of glycogen stores
Stimulate !rotein synthesis
Promote cell growth and differentiation
+id in the de"elo!ment of the brain and ,/S
,ontain *
>
'triiodothyronine( and *
;
'thyro3in( acti"ity.
2e!lacement in deficiency states with restoration of normal hormonal balance
Su!!ression of thyrotro!in.de!endent thyroid cancers.
$?A
+!"!,
2e!lacement or substitution thera!y in diminished or absent thyroid function of many
causes
*reatment of some ty!es of thyroid cancer.
Ao!",
+6UL* initially ?0M$00 micrograms '?0 micrograms for those o"er ?0 years( daily
!referably before breakfast adLusted in ste!s of ?0 micrograms e"ery >M; weeks until normal
metabolism maintained 'usually $00M)00 micrograms daily(- where there is cardiac disease
initially )? micrograms daily or ?0 micrograms on alternate days adLusted in ste!s of
)? micrograms e"ery ; weeks
,ongenital hy!othyroidism and Lu"enile my3oedema ,7IL6 u! to $ month initially ?M
$0 microgramsNkg daily o"er $ month initially ? microgramsNkg daily adLusted in ste!s of
)? micrograms e"ery )M; weeks until mild to3ic sym!toms a!!ear then reduce dose slightly
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
2ecent 4I
*hyroto3icosis
=nown alcohol intolerance 'liothyronine inLection only(
7y!ersensiti"ity to beef '*hyrar !roduct(.
V&#" "II"(8!,
,/S& insomnia irritability ner"ousness headache.
,<& ,+26IO<+S,UL+2 ,OLL+PS1 arrhythmias tachycardia angina
!ectoris hy!otension increased blood !ressure increased cardiac out!ut.
%I& cram!s diarrhea "omiting.
6erm& hair loss 'in children( increased sweating.
1ndo& hy!erthyroidism menstrual irregularities.
4etab& weight loss heat intolerance.
4S& accelerated bone maturation in children.
@$!&n% (on!&#"$H8&on!,
*he treatment is initiated slowly 'with small doses( J gradually increased.
Store medications in cool dark !lace.
$?D
*ake com!lete nursing history .
/ote if the client is taking antidiabetics drugs J document .
*ake baseline 1,%. then at regular inter"als.
4onitor thyroid function closely.
Obser"e client for side effects.
4onitor P* J P** closely since the drug increases hy!o!rothrombinemia.
4onitor 72 J 5.P. closely for cardiac !atients.
Instruct the client to re!ort side effects e.g. weight loss J ner"ousness to !hysician.
7a"e dietitian counsel clients regarding diet according to the energy demands.
8emale client should record menstrual irregularities .
1ncourage the client to kee! follow.u! "isits.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
`^J U$Hn"XHm&( L(&# ,
U$H#" nHm"!, ,ykloka!ron 7e3aca!ron
ClH!!, +ntifibrinolytic drugs and haemostatic
L(8&on,
*rane3amic acid is an +ntifibrinolytic that com!etiti"ely inhibits the acti"ation of !lasminogen to
!lasmin.
+!"!,
*his medication is used for short.term control of bleeding in hemo!hiliacs including dental
e3traction !rocedures.
Ao!",
by mouth local fibrinolysis $?M)? mgNkg )M> times daily
4enorrhagia 'initiated when menstruation has started( $ g > times daily for u! to
; days- ma3. ; g daily
7ereditary angioedema $M$.? g )M> times daily
5y slow intra"enous inLection local fibrinolysis 0.?M$ g > times daily F $0 mg
Nkg F
$?B
Con8$H&n#&(H8&on!,
In !atients with ac0uired defecti"e color "ision since this !rohibits
measuring one end!oint that should be followed as a measure of to3icity.
In !atients with subarachnoid hemorrhage. +necdotal e3!erience indicates
that cerebral edema and cerebral infarction may be caused by
,c=LO=+P2O/ in such !atients.
In !atients with acti"e intra"ascular clotting.
V&#" "II"(8!,
/ausea "omiting diarrhea might occur. If these !ersist or worsen notify your doctor
!rom!tly. <ery unlikely but re!ort !rom!tly& "ision changes di99iness.
@$!&n% (on!&#"$H8&on!,
8or intra"enous infusion ,c=LO=+P2O/ InLection may be mi3ed with most solutions
for infusion such as electrolyte solutions carbohydrate solutions amino acid solutions
and 6e3tran solutions.
*he mi3ture should be !re!ared the same day the solution is to be used.
,c=LO=+P2O/ InLection should /O* be mi3ed with blood.
*he drug is a synthetic amino acid and should /O* be mi3ed with solutions containing
!enicillin.
`FJ fHlK$o&( L(&# L(&#,
U$H#" nHm"!& 6e!akene 6e!akine Sodium "al!roate <al!arin
ClH!!, anticon"ulsants "ascular headache su!!ressants
L(8&on,
Increase le"els of %+5+ an inhibitory neurotransmitter in the ,/S.
Su!!ression of absence sei9ures
6ecreased manic beha"ior
6ecreased fre0uency of migraine headaches.
+!"!,
Sim!le and com!le3 absence sei9ures
$?C
Partial sei9ures with com!le3 sym!tomatology
6i"al!roe3 only&
4anic e!isodes associated with bi!olar disorder 'delayed.release only(
Pre"ention of migraine headache 'delayed and e3tended release(.
Unlabelled Uses&
I<& *reatment of migraine headache.
Ao!",
by mouth initially A00 mg daily gi"en in ) di"ided doses !referably after food
increasing by )00 mgNday at >.day inter"als to a ma3. of ).? g daily in di"ided
doses usual maintenance $M) g daily ')0M>0 mgNkg daily(-
,7IL6 u! to )0 kg initially )0 mgNkg daily in di"ided doses may be increased
!ro"ided !lasma concentrations monitored 'abo"e ;0 mgNkg daily also monitor
clinical chemistry and haematological !arameters(-
o"er )0 kg initially ;00 mg daily in di"ided doses increased until control 'usually
in range of )0M>0 mgNkg daily(- ma3. >? mgNkg daily
5y intra"enous inLection 'o"er >M? minutes( or by intra"enous infusion
continuation of "al!roate treatment when oral thera!y not !ossible same as
current dose by oral route.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
7e!atic im!airment
Some !roducts contain tartra9ine- a"oid in !atients with known hy!ersensiti"ity.
V&#" "II"(8!,
,/S& confusion di99iness headache sedation.
11/*& "isual disturbances.
%I& 71P+*O*OVI,I*c indigestion nausea "omiting anore3ia
consti!ation diarrhea hy!ersali"ation increased a!!etite !ancreatitis.
6erm& rashes.
7emat& leuco!enia !rolonged bleeding time thrombocyto!enia.
4etab& hy!erammonemia.
$A0
/euro& ata3ia !aresthesia.
@$!&n% (on!&#"$H8&on!,
<al!roic acid may cause an u!set stomach. Instruct the !t to take it with food
and to drink !lenty of water and not to take the li0uid with carbonated
be"erages.
If you gi"e this drug to a child obser"e and kee! a record of the childEs moods
beha"ior attention s!an hand.eye coordination and ability to sol"e !roblems
and !erform tasks re0uiring thought. +sk the childEs teacher to kee! a similar
record.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
``J fHn(omy(&n ,
U$H#" nHm"!, "ancocin
ClH!!, antibiotic miscellaneous
L(8&on,
It is deri"ed from stre!tomyces orientalis it a!!ears to bind to bacterial cell wall
arresting itKs synthesis and lysing the cyto!lasmic membrane by a mechanism that is
different from that of !enicillin. It is bactericidal for most organisms and bactereostatic
for enterococci.
+!"!,
drug should be reser"ed for treatment of life threatening infections when other
treatment ha"e been ineffecti"e .
Patients with se"er sta!hylococcal infections resistant or allergic to !enicillin or
ce!halos!orin such as&
@ 1ndocarditis @ Osteomylitis
@ Pneumonia @ Se!ticemia
Oral administration is useful in treatment of&
1nterocolitis @Pseudomemgranous ,olitis
Ao!",
$A$
by mouth antibiotic.associated colitis $)? mg e"ery A hours for DM$0 days see
notes abo"e- ,7IL6 ? mgNkg e"ery A hours o"er ? years half adult dose
5y intra"enous infusion ?00 mg e"ery A hours or $ g e"ery $) hours- 1L612Lc
o"er A? years ?00 mg e"ery $) hours or $ g once daily- /1O/+*1 u! to $ week
$? mgNkg initially then $0 mgNkg e"ery $) hours- I/8+/* $M; weeks $? mgNkg
initially then $0 mgNkg e"ery B hours- ,7IL6 o"er $ month $0 mgNkg e"ery A
hours
Con8$H&n#&(H8&on!,
@ 7y!ersensiti"ity @ 4inor infectious.
V&#" "II"(8!,
Ototo3icity deafness
/e!hroto3icity uremia
2ed./eck syndrome& chills errythema of neck and back fe"er#.
Skin rashes 6rug fe"er
7y!otension 'due to ra!id administration( .
*hrombo!hlebitis at the site of inLection.
@$!&n% (on!&#"$H8&on!,
4i3 as indicated on !ackage insert.
Intermittent infusion is the !referred route.
+"oid ra!id I.<. administration nausea J hy!otension.
+"oid e3tra"asations during inLections .
4onitor "ital signs intake of out!ut.
SEEJ f"$HKHm&l ,
U$H#" nHm"!, Ikacore ,alan ,o"era Iso!tin and <erelan
ClH!!, ,alcium.channel blockers F anti.arrhythmic F
G$"%nHn(y, nCH8"%o$y Co
L(8&on,
<era!amil rela3es 'widens( blood "essels '"eins and arteries( which makes it easier for
the heart to !um! and reduces its workload.
+!"!,
P.O&
$A)
angina !ectoris.
arrhythmia 'a trial fibrillation and flutter(.
1ssential hy!ertension.
I<& Su!ra"entricular tachycardia.
Ao!",
by mouth su!ra"entricular arrhythmias ;0M$)0 mg > times daily
+ngina B0M$)0 mg > times daily
7y!ertension );0M;B0 mg daily in )M> di"ided doses 5y slow intra"enous
inLection o"er ) minutes '> minutes in elderly( ?M$0 mg '!referably with 1,%
monitoring(- in !aro3ysmal tachyarrhythmia a further ? mg after ?M$0 minutes
if re0uired
Con8$H&n#&(H8&on!,
hy!otension cardiac shock and 4I.
V&#" "II"(8!,
+< block bradycardia headache di99iness abdominal cram!s blurring of "ision and
edema.
@$!&n% (on!&#"$H8&on!,
6iscuss with the !atientNfamily the goals of thera!y.
*each them how to take !ulse and blood !ressure. 7old the medication in
case of hy!otension or bradycardia and consult the treating 6r.
Instruct the client to re!ort any untoward sings as di99iness.
In case of !ostural hy!otension ad"ise the client to change !osition.
+d"ise client to sit down immediately if fainting occurs.
,alcium antagonists should be taken with meals to %I irritation.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
SESJ f&8Hm&n m ,
U$H#" nHm"!, +0ua.4e!hyton <itamin =
ClH!!, <itamin = is a fat.soluble "itamin
$A>
L(8&on, necessary for the !roduction of blood clotting factors
+!"!,
<itamin = is a fat soluble "itamin which !lays an im!ortant role in blood clotting. *his
medication is used to !re"ent and treat hy!o!rothrombinemia 'low blood clot factor
le"els( caused by "itamin = deficiency.
Ao!",
warfarin o"erdose F if I/2 ` B F and maLor bleeding $0 mg by slow intra"enous
inLection
4aintenance in *P/ $0 mg slow intra"enous inLection twice weekly
In li"er failure $0 mg Ndaily for > days.
Con8$H&n#&(H8&on!,
7emolytic +nemia from Pyru"ate =inase and %AP6 6eficiencies
V&#" "II"(8!,
an allergic reaction 'difficulty breathing- closing of the throat- swelling of the li!s tongue or face-
or hi"es(-
di99iness- fast or irregular heartbeats- or increased sweating.
@$!&n% (on!&#"$H8&on!,
4onitor for allergy or side effects
7igh intake of "itamin = is not recommended for indi"iduals taking anticoagulant
medications such as Iarfarin 'coumadin(.
Instruct the !t about the normal nutritional resources& cow milk broccoli 5russels
s!routs cabbage cauliflower kale s!inach and soybeans.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
SEDJ qH$IH$&n !o#&m ,
U$H#" nHm"!, coumadine
ClH!!, Oral anticoagulant
G$"%nHn(y, ',ategory 6N V according to manufacturerb6uPont Pharma )000.X
L(8&on,
!re"ent the formation of factors II <II I V and V in the li"er.
$A;
+!"!,
!ro!hyla3is and treatment of dee! "enous thrombosis.
*hromboembolison . *hrombo!hlebitis.
Pro!hyla3is from myocardial infarction.
Ao!",
*he usual adult induction dose of warfarin is $0 mg
daily for ) days 'higher doses no longer recommended(. *he subse0uent maintenance dose
de!ends u!on the !rothrombin time re!orted as I/2 'international normalised ratio(. *he
daily maintenance dose of warfarin is usually > to C mg 'taken at the same time each day(
Ihene"er !ossible the base.line !rothrombin time should be determined but the initial dose
should not be delayed whilst awaiting the result.
Con8$H&n#&(H8&on!,
7emorrhagic tendencies . 5lood disorders.
Ulcerati"e lesion of %I*.
Im!aired renal and he!atic function.
Se"ere hy!ertension.
*hrombocyto!enia.
V&#" "II"(8!,
hemorrhagic accidents.
@$!&n% (on!&#"$H8&on!,
6aily monitoring of !rothrombin time is recommended.
Instruct clients to take the drug before meal.
2emind clients to wear identification band that states that they are on
anticoagulant thera!y.
+d"ise client to a"oid acti"ities that may cause inLury.
<itamin = should by a"ailable
8ood rich in "itamin = should by a"oided.
$A?
j"!o$("!
)00$ Li!!incott /ursing 6rug %uide +my 4.=arch ,o!yright h )00$ by
Li!!incott Iilliams J Iilkins
Pharmacology of ,ritical ,are ,linic Ste"en S. 4artin and Sose!h 8. 6asta 6
)00A 1lse"ier Inc. ')00A(.
,ritical ,are 4edication +dministration Lucile Packard ,hildrenEs Stanford
6e!artment of Pharmacology.
6rug and 6rugs& + Practical %uide to the Safe Use of ,ommon 6rugs in +dult
Peter 7amilton and 6a"id 7ui )
nd
1dition')00>(.
Vom" "l"(8$on&( !&8"! $"!o$("!,
htt!&NNwww.medicinenet.comNmedicationsNarticle.htm
htt!&NNwww.druglib.comNdruginde3NnameNaN
htt!&NNwww.medguides.medicines.org.ukNdefault.as!3
htt!&NNen.wiki!edia

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