RESOURCE UNIT ON COMMON LR-DR DRUGS

Placement: NCM 102 RLE

Time Allotment: 2 hours

Topic: Common LR-DR Drugs

Topic Description: This topic focuses on common drugs used to clients experiencing the Labor/ Delivery process and their newborns. The
drugs presented according to trade names, generic names and other important drug information such as classification, mechanism of
action, indication, contraindication, adverse reactions, and dosage of specific drugs, giving emphasis on the nurses’ responsibilities when
administering these drugs.

Central Objectives: At the end of 2-hour ward class, the learners shall augment their knowledge, develop beginning skills and manifest
desirable attitude in the administration of LR-DR drugs.

SPECIFIC OBJECTIVES CONTENT T.A. T-L ACTIVITIES EVALUATION

Given the necessary I. Introduction 5 • Socialized • Active
information about LR-DR Clients with acute or chronic health min. discussion participation in
drugs and with adequate alterations restore or maintain their health the games
visual aids, at the end of the using a variety of strategies. A medication
2-hour ward class discussion, is a substance used in the diagnosis,
the learners shall: treatment, cure, relief, or prevention of
health alterations. In fact medications are
• Correctly define all the the primary treatment clients associate with
related terms. restoration of health. No matter where
clients receive their health care-hospitals,
• Enumerate correctly all clinics, or home-the nurse plays an essential
the different rights of role in medication preparation and
drug administration. administration, medication teaching, and
• State the exact generic evaluating client’s responses to
and brand name of all medications.
the drugs. Today we’re going to discuss to you the
• Cite the form and 18 common LR-DR drugs but we’re going to
dosage required for all start with the definition of terms and the 10 20 • Socialized • Active
the drugs correctly. rights of a client. min. discussion with participation in
visual aids the socialized
• State the classification II. Definition of terms discussion
of each drug correctly A.Drugs
• Enumerate at least 2 - Are chemical substance that have an
indications for each effect on living organisms.
drug B. Pharmacodynamics
• Discuss on adverse - The biochemical and physical effects
reaction and a side of drugs and the mechanisms of drug
effect for each drug. actions.
• Verbalize C. Pharmacokinetics
understanding on the - The study of how medications enter
importance of the the body, reach their site of action,
nurse’s role in giving are metabolized, and exit the body.
information to the D.Generic Name
patient about the - Or non-proprietary name, is an
drugs given. abbreviation of the chemical name
E. Brand Name
- Trade name or proprietary name is
selected by the drug company selling
the product. Trade names are
protected by copyright. The symbol
®after a trade name is registered by
or restricted to the drug
manufacturer.
F. Classification
- Groupings of drugs which has the
same characteristics or uses.
- Categorizing medications with similar
characteristics by their class.
G.Dosage
- The regimen governing the size,
amount, frequency and number of
doses of a therapeutic agent to be
administered to a patient.
H.Indication
- a reason to prescribe a medication or
perform a treatment.
I. Mechanism of Action
 - refers to the specific biochemical
interaction through which a drug
substance produces its
pharmacological effect.

J. Side Effects
- are the unintended, secondary
effects a medication predictably will
cause. It may be harmless or
injurious.
K.Adverse Reactions
- are generally considered severe
responses to medication.
L. Contraindications
- A factor that prohibits the
administration of a drug or
performance of an act or procedure
in the care of a specific patient.
M. Nursing Responsibilities
- Where the nurse is responsible for
evaluating the effects of the
medications on the client’s health
status, teaching clients about their
medications and their side effects,
ensuring the medication regimen,
and evaluating client technique when
the client administers medications
that are not given by mouth.
N.Analgesics
- Drug that relieves pain.
O.Anesthesia 10
- The absence of all sensation min. • Active
especially sensitivity to pain, as participation in
induced by an anesthetic substance the socialized
or by hypnosis or as occurs with discussion
traumatic or pathophysiologic
damage to nerve tissue.
 P. Agonist
- Drugs that produce a response
Q.Antagonist
- Drugs that block a response

III. Different rights of drug administration

A.Right client
*Is this their medication or it for
someone else?
*Never take someone else’s medication.
B. Right drug
*Is this the medication the ordered for
them?
C. Right dose
*How many do they take each day?
*How long do they continue to take the
medication?
D.Right time and frequency
*What time of day should the medication
be taken?
*Do they take it before a meal, after a
meal, or with a snack?
E. Right route
*Is it to be swallowed or chewed?
*Can it be crushed if necessary?
*Does it come in a liquid form?
*If it’s an injection, is it intramuscular or
subcutaneous?
*If it’s an IV medication and the patient
is self administering have they been
adequately instructed?
F. Right assessment
*requires that appropriate data collected
before administration of the drug.
G.Right documentation
*requires that the nurse immediately
record the appropriate information about
 the drug administered and protect
against legal liabilities.
H. Client’s right to education
*requires that the client receive accurate • Lecture
and thorough information about the 60 discussion with • Oral
medication and how it relates to his or min visual aids evaluation
her particular situation.
I. Right evaluation
*requires that the effectiveness of the
medication be determined by the client’s
response to the medication.
J. Client’s right to refuse
*Client’s can and do refuse to take a
medication. It is the nurse’s
responsibility to determine, when
possible, the reason for the refusal and
to take reasonable measures to facilitate
the client’s taking of medication.

IV.Common LRDR drugs

IV.A. Phenergan
IV.A.1. Generic Name
• Promethazine hydrochloride
IV.A.2. Brand Name
• Phenergan
IV.A.3 Classification
• gastrointestinal agent; antiemetic;
antivertigo agent; phenothiazine
IV.A.4 Dosage
• Nausea
Adult: PO/PR/IM/IV 12.5–25 mg q4–6h
pr
• Allergies
Adult: PO/PR/IM/IV 12.5 mg q.i.d. or
25 mg h.s.
• Sedation
Adult: PO/PR/IM/IV 25–50 mg
 preoperatively or h.s.
IV.A.5. Indication
• Symptomatic relief of various allergic
conditions, to ameliorate and prevent
reactions to blood and plasma, and in
prophylaxis and treatment of motion
sickness, nausea, and vomiting.
Preoperative, postoperative, and
obstetric sedation and as adjunct to
analgesics for control of pain.

IV.A.6. Mechanism of Action

• Long-acting derivative of
phenothiazine with marked
antihistamine activity and prominent
sedative, amnesic, antiemetic, and
anti-motion-sickness actions. Unlike
other phenothiazine derivatives,
relatively free of extrapyramidal
adverse effects; however, in high
doses it carries same potential for
toxicity.
IV.A.7. Side Effects/ Adverse Effects
• Body as a Whole: Deep sleep, coma,
convulsions, cardiorespiratory
symptoms, extrapyramidal reactions,
nightmares (in children), CNS
stimulation, abnormal movements.
• Respiratory: Irregular respirations,
respiratory depression, apnea.
• CNS: Sedation drowsiness, confusion,
dizziness, disturbed coordination,
restlessness, tremors.
• CV: Transient mild hypotension or
hypertension.
• GI: Anorexia, nausea, vomiting,
 constipation.
• Hematologic: Leukopenia,
agranulocytosis.
• Special Senses: Blurred vision, dry
mouth, nose, or throat.
• Skin: Photosensitivity.
• Urogenital: Urinary retention.
IV.A.8. Contraindication
• Hypersensitivity to phenothiazines;
narrow-angle glaucoma; stenosing
peptic ulcer, pyloroduodenal
obstruction; prostatic hypertrophy;
bladder neck obstruction; epilepsy;
bone marrow depression; comatose
or severely depressed states;
pregnancy (category C), lactation,
newborn or premature infants,
acutely ill or dehydrated children;
children <2 y; Reye's syndrome,
encephalopathy, hepatic diseases.
IV.A.9. Nursing Responsibilities

• Supervise ambulation.
Promethazine sometimes produces
marked sedation and dizziness.
• Be aware that antiemetic action
may mask symptoms of unrecognized
disease and signs of drug overdosage
as well as dizziness, vertigo, or
tinnitus associated with toxic doses of
aspirin or other ototoxic drugs.
• Patients in pain may develop
involuntary (athetoid) movements of
upper extremities following
parenteral administration. These
symptoms usually disappear after
 pain is controlled.
• Monitor respiratory function in
patients with respiratory problems,
particularly children. Drug may
suppress cough reflex and cause
thickening of bronchial secretions.

Patient & Family Education

• Do not take OTC medications

without physician's approval.
• Avoid alcohol and other CNS
depressants.
• Relieve dry mouth by frequent
rinses with water or by increasing
noncaloric fluid intake (if allowed),
chewing sugarless gum, or sucking
hard candy. If these measures fail,
add a saliva substitute (e.g., Moi-Stir,
Orex, Xero-Lube).
• Do not breast feed while taking
this drug.

IV.B. Demerol
IV.B.1. Generic Name
• Meperidine hydrochloride
IV.B.2. Brand Name
• Demerol
IV.B.3 Classification
• central nervous system agent;
narcotic (opiate) agonist analgesic
IV.B.4 Dosage
• Moderate to Severe Pain
Adult: PO/SC/IM/IV 50–150 mg q3–4h
prn
Child: PO/SC/IM/IV 1–1.5 mg/kg q3–4h
 (max: 100 mg q4h) prn
• Preoperative
Adult: IM/SC 50–150 mg 30–90 min
before surgery
Child: IM/SC 1–2.2 mg/kg 30–90 min
before surgery
• Obstetric Analgesia
Adult: IM/SC 50–100 mg when pains
become regular, may be repeated
q1–3h
IV.B.5. Indication
• Relief of moderate to severe pain, for
preoperative medication, for support
of anesthesia, and for obstetric
analgesia.
IV.B.6. Mechanism of Action
• Synthetic morphine-like compound.
Chemically dissimilar to morphine, but
in equianalgesic doses it is
qualitatively comparable. Usual doses
produce either no pupillary change or
slight miosis, but overdosage results
in marked miosis or mydriasis. Also,
unlike morphine, has little or no
antidiarrheic or antitussive action.
Produces CNS stimulation in toxic
doses.
IV.B.7. Side Effects/ Adverse Effects
• Body as a Whole: Allergic (Pruritus,
urticaria, skin rashes, wheal and flare
over IV site), profuse perspiration.
• CNS: Dizziness, weakness, euphoria,
dysphoria, sedation, headache,
uncoordinated muscle movements,
disorientation, decreased cough
reflex, miosis, corneal anesthesia,
respiratory depression.
 • Toxic doses: muscle twitching,
tremors, hyperactive reflexes,
excitement, hypersensitivity to
external stimuli, agitation, confusion,
hallucinations, dilated pupils,
convulsions.
• CV: Facial flushing, light-headedness,
hypotension, syncope, palpitation,
bradycardia, tachycardia,
cardiovascular collapse, cardiac
arrest (toxic doses).
• GI: Dry mouth, nausea, vomiting,
constipation, biliary tract spasm.
• Urogenital: Oliguria, urinary
retention.
• Respiratory: Respiratory depression
in newborn, bronchoconstriction
(large doses).
• Skin: Phlebitis (following IV use),
pain, tissue irritation and induration,
particularly following subcutaneous
injection.
• Metabolic: Increased levels of serum
amylase, BSP retention, bilirubin,
AST, ALT.
IV.B.8. Contraindication
• Hypersensitivity to meperidine;
convulsive disorders; acute
abdominal conditions prior to
diagnosis; pregnancy prior to labor
[(category B), at term (category D)],
lactation.

IV.B.9. Nursing Responsibilities

• Give narcotic analgesics in the

smallest effective dose and for the
least period of time compatible with
patient's needs.
• Assess patient's need for prn
medication. Record time of onset,
duration, and quality of pain.
• Note respiratory rate, depth, and
rhythm and size of pupils in patients
receiving repeated doses. If
respirations are 12/min or below and
pupils are constricted or dilated or
breathing is shallow, or if signs of
CNS hyperactivity are present,
consult physician before
administering drug.
• Monitor vital signs closely. Heart
rate may increase markedly, and
hypotension may occur. Meperidine
may cause severe hypotension in
postoperative patients and those with
depleted blood volume.
• Schedule deep breathing, coughing
(unless contraindicated), and
changes in position at intervals to
help to overcome respiratory
depressant effects.
• Chart patient's response to drug
and evaluate continued need.
• Repeated use can lead to
tolerance as well as psychic and
physical dependence of the morphine
type.
• Be aware that abrupt
discontinuation following repeated
use results in morphine-like
withdrawal symptoms. Symptoms
 develop more rapidly (within 3 h,
peaking in 8–12 h) and are of shorter
duration than with morphine. Nausea,
vomiting, diarrhea, and pupillary
dilatation are less prominent, but
muscle twitching, restlessness, and
nervousness are greater than
produced by morphine.

Patient & Family Education

• Do not smoke and walk without

assistance after receiving the drug.
Bed side rails may be advisable.
• Be aware nausea, vomiting,
dizziness, and faintness associated
with fall in BP are more pronounced
when walking than when lying down
(these symptoms may also occur in
patients without pain who are given
meperidine). Symptoms are
aggravated by the head-up position.
• Do not take other CNS depressants
or drink alcohol because of their
additive effects.
• Do not breast feed while using this
drug.

IV.C. Buscopan
IV.C.1. Generic Name
• Hyoscine butylbromide
IV.C.2. Brand Name
• Buscopan
IV.C.3 Classification
• anticholinergic (Oral route, Parenteral
route, Rectal route, Transdermal
 route)
IV.C.4 Dosage
• Typical dose is 10mg 3 times daily.
• Adult dose may be increased if
required up to to 20mg 4 times daily
(max 80mg/day).
IV.C.5. Indication
• This medication is used to relieve
bladder or intestinal spasms.
IV.C.6. Mechanism of Action
• Buscopan acts by interfering with the
transmission of nerve impulses by
acetylcholine in the parasympathetic
nervous system (specifically the
vomiting center).
IV.C.7. Side Effects/ Adverse Effects
• Constipation, dry mouth, trouble
urinating, or nausea could occur. If
these continue or are bothersome,
notify your doctor promptly. Very
unlikely but report: rash, itching,
swelling of the hands or feet, trouble
breathing, increased pulse, dizziness,
diarrhea, vision problems, eye pain. If
you notice other effects not listed
above, contact your doctor or
pharmacist.
IV.C.8. Contraindication
• Glaucoma, myasthenia gravis,
paralytic ileus, pyloric stenosis,
prostatic enlargement, porphyria
IV.C.9. Nursing Responsibilities
Certain medicines should not be
used during pregnancy or
breastfeeding. However, other
medicines may be safely used in
pregnancy or breastfeeding providing
 the benefits to the mother outweigh
the risks to the unborn baby.
• This medicine should be used with
caution during pregnancy, and only if
the expected benefit to the mother is
greater than the possible risk to the
foetus, particularly in the first
trimester. Seek medical advice from
your doctor.
• It is not known if this medicine
passes into breast milk. It should be
used with caution in nursing mothers,
and only if the benefits to the mother
outweigh any risks to the nursing
infant. Discuss this with your doctor.
• You should notify the doctor
immediately if the patient
experience any of the following while
using this medicine: red and painful
eye, possibly with headache, loss of
vision or blurred vision, or seeing
haloes around lights. These
symptoms may be caused by an
increase in pressure inside the
eyeball and require urgent
investigation by her doctor.

IV.D. Syntocinon
IV.D.1. Generic Name
• Oxytocin
IV.D.2. Brand Name
• Syntocinon
IV.D.3 Classification
• hormones and synthetic substitutes;
oxytocic
IV.D.4 Dosage
 • Antepartum
Adult: IV Start at 1 mU/min, may
increase by 1 mU/min q15min (max:
20 mU/min)
• Postpartum
Adult: IV Infuse a total of 10 U at a
rate of 20–40 mU/min after delivery
• To Promote Milk Ejection
Adult: Nasal 1 spray or 1 drop in 1 or
both nostrils 2–3 min before nursing
or pumping
IV.D.5. Indication
• To initiate or improve uterine
contraction at term only in carefully
selected patients and only after
cervix is dilated and presentation of
fetus has occurred; used to stimulate
letdown reflex in nursing mother and
to relieve pain from breast
engorgement. Uses include
management of inevitable,
incomplete, or missed abortion;
stimulation of uterine contractions
during third stage of labor;
stimulation to overcome uterine
inertia; control of postpartum
hemorrhage and promotion of
postpartum uterine involution. Also
used to induce labor in cases of
maternal diabetes, preeclampsia,
eclampsia, and erythroblastosis
fetalis.
IV.D.6. Mechanism of Action
• Synthetic, water-soluble
polypeptide consisting of eight amino
acids, identical pharmacologically to
the oxytocic principle of posterior
 pituitary.
IV.D.7. Side Effects/ Adverse Effects
• Body as a Whole: Fetal trauma from
too rapid propulsion through pelvis,
fetal death, anaphylactic reactions,
postpartum hemorrhage, precordial
pain, edema, cyanosis or redness of
skin.
• CV: Fetal bradycardia and arrhythmias,
maternal cardiac arrhythmias,
hypertensive episodes, subarachnoid
hemorrhage, increased blood flow,
fatal afibrinogenemia, ECG changes,
PVCs, cardiovascular spasm and
collapse.
• GI: Neonatal jaundice, maternal
nausea, vomiting.
• Endocrine: ADH effects leading to
severe water intoxication and
hyponatremia, hypotension.
• CNS: Fetal intracranial hemorrhage,
anxiety.
• Respiratory: Fetal hypoxia, maternal
dyspnea.
• Urogenital: Uterine hypertonicity,
tetanic contractions, uterine rupture,
pelvic hematoma.

IV.D.8. Contraindication
• Hypersensitivity to oxytocin;
significant cephalopelvic
disproportion, unfavorable fetal
position or presentations that are
undeliverable without conversion
before delivery, obstetric
emergencies in which benefit-to-risk
 ratio for mother or fetus favors
surgical intervention, fetal distress in
which delivery is not imminent,
prematurity, placenta previa,
prolonged use in severe toxemia or
uterine inertia, hypertonic uterine
patterns, previous surgery of uterus
or cervix including cesarean section,
conditions predisposing to
thromboplastin or amniotic fluid
embolism (dead fetus, abruptio
placentae), grand multiparity,
invasive cervical carcinoma,
primipara >35 y of age, past history
of uterine sepsis or of traumatic
delivery, intranasal route during
labor, simultaneous administration of
drug by two routes.
IV.D.9. Nursing Responsibilities

• Start flow charts to record

maternal BP and other vital signs,
I&O ratio, weight, strength, duration,
and frequency of contractions, as well
as fetal heart tone and rate, before
instituting treatment.
• Monitor fetal heart rate and
maternal BP and pulse at least
q15min during infusion period;
evaluate tonus of myometrium during
and between contractions and record
on flow chart. Report change in rate
and rhythm immediately.
• Stop infusion to prevent fetal
anoxia, turn patient on her side, and
notify physician if contractions are
prolonged (occurring at less than 2-
 min intervals) and if monitor records
contractions about 50 mm Hg or if
contractions last 90 seconds or
longer. Stimulation will wane rapidly
within 2–3 min. Oxygen
administration may be necessary.
• If local or regional (caudal, spinal)
anesthesia is being given to the
patient receiving oxytocin, be alert to
the possibility of hypertensive crisis
(sudden intense occipital headache,
palpitation, marked hypertension,
stiff neck, nausea, vomiting,
sweating, fever, photophobia, dilated
pupils, bradycardia or tachycardia,
constricting chest pain).
• Monitor I&O during labor. If patient
is receiving drug by prolonged IV
infusion, watch for symptoms of
water intoxication (drowsiness,
listlessness, headache, confusion,
anuria, weight gain). Report changes
in alertness and orientation and
changes in I&O ratio (i.e., marked
decrease in output with excessive
intake).
• Check fundus frequently during the
first few postpartum hours and
several times daily thereafter.
• Incidence of hypersensitivity or
allergic reactions is higher when
oxytocin is given by IM or IV injection
rather than by IV infusion (diluted
solution).

Patient & Family Education

 • Be aware of purpose and
anticipated effect of oxytocin.
• Report sudden, severe headache
immediately to healthcare providers.

IV.E. Methergine
IV.E.1. Generic Name
• Methylergonovine maleate
IV.E.2. Brand Name
• Methergine
IV.E.3 Classification
• autonomic nervous system agent;
adrenergic antagonist
(sympatholytic); ergot alkaloid;
oxytocic
IV.E.4 Dosage
• Postpartum Hemorrhage
Adult: PO 0.2–0.4 mg q6–12h until
danger of atony passes (2–7 d) IM/IV
0.2 mg q2–4h (max: 5 doses)
IV.E.5. Indication
• Routine management after delivery
of placenta and for postpartum
atony, subinvolution, and
hemorrhage. With full obstetric
supervision, may be used during
second stage of labor.
IV.E.6. Mechanism of Action
• Ergot alkaloid that induces rapid,
sustained tetanic uterine contraction
that shortens third stage of labor and
reduces blood loss.
IV.E.7. Side Effects/ Adverse Effects
• GI: Nausea, vomiting (especially with
IV doses).
 • CV: Severe hypertensive episodes,
bradycardia.
• Body as a Whole: Allergic phenomena
including shock, ergotism.

IV.E.8. Contraindication
• Hypersensitivity to ergot
preparations; to induce labor; use
prior to delivery of placenta;
threatened spontaneous abortion;
prolonged use; uterine sepsis;
hypertension; toxemia; lactation.
IV.E.9. Nursing Responsibilities

• Monitor vital signs (particularly BP)

and uterine response during and after
parenteral administration of
methylergonovine until partum period
is stabilized (about 1–2 h).
• Notify physician if BP suddenly
increases or if there are frequent
periods of uterine relaxation.

Patient & Family Education

• Report severe cramping for

increased bleeding.
• Report any of the following: Cold or
numb fingers or toes, nausea or
vomiting, chest or muscle pain.
• Do not breast feed while taking
this drug.

IV.F. Stadol
IV.F.1. Generic Name
• Butorphanol tartrate
IV.F.2. Brand Name
• Stadol
IV.F.3 Classification
• central nervous system agent;
analgesic; narcotic (opiate) agonist-
antagonist
IV.F.4 Dosage
• Pain Relief
Adult: IM 1–4 mg q3–4h as needed
(max: 4 mg/dose) IV 0.5–2 mg q3–4h
as needed
IV.F.5. Indication
• Relief of moderate to severe pain,
preoperative or preanesthetic
sedation and analgesia, obstetrical
analgesia during labor, cancer pain,
renal colic, burns.
IV.F.6. Mechanism of Action
• Synthetic, centrally acting analgesic
with mixed narcotic agonist and
antagonist actions. Acts as agonist
on one type of opioid receptor and as
a competitive antagonist at others.
Site of analgesic action believed to
be subcortical, possibly in the limbic
system. On a weight basis, analgesic
potency appears to be about 5 times
that of morphine, 40 times that of
meperidine, and 15–30 times that of
pentazocine. Narcotic antagonist
potential is approximately 30 times
that of pentazocine and 1/40 that of
naloxone. Respiratory depression
does not increase appreciably with
higher doses, as it does with
morphine, but duration of action
increases. Like pentazocine,
 analgesic doses may increase
pulmonary arterial pressure and
cardiac work load.
IV.F.7. Side Effects/ Adverse Effects
• CNS: Drowsiness, sedation,
headache, vertigo, dizziness, floating
feeling, weakness, lethargy,
confusion, light-headedness,
insomnia, nervousness, respiratory
depression.
• CV: Palpitation, bradycardia.
• GI: Nausea.
• Skin: Clammy skin, tingling
sensation, flushing and warmth,
cyanosis of extremities, diaphoresis,
sensitivity to cold, urticaria, pruritus.
• Genitourinary: Difficulty in urinating,
biliary spasm.
IV.F.8. Contraindication
• Narcotic-dependent patients. Safety
during pregnancy prior to labor
(category C), lactation, or in children
<8 y is not established.
IV.F.9. Nursing Responsibilities

• Monitor for respiratory depression.

Do not administer drug if respiratory
rate is <12 breaths/min.
• Monitor vital signs. Report marked
changes in BP or bradycardia.
• Note: If used during labor or
delivery, observe neonate for signs of
respiratory depression.
• Note: Drug can induce acute
withdrawal symptoms in opiate-
dependent patients.
 • Schedule gradual withdrawal
following chronic administration.
Abrupt withdrawal may produce
vomiting, loss of appetite,
restlessness, abdominal cramps,
increase in BP and temperature,
mydriasis, faintness. Withdrawal
symptoms peak 48 h after
discontinuation of drug.

Patient & Family Education

• Lie down to control drug-induced

nausea.
• Do not take alcohol or other CNS
depressants with this drug without
consulting physician because of
possible additive effects.
• Do not breast feed while taking
this drug without consulting
physician.

IV.G. Valium
IV.G.1. Generic Name
• Diazepam
IV.G.2. Brand Name
• Valium
IV.G.3 Classification
• central nervous system agent;
benzodiazepine anticonvulsant;
anxiolytic
IV.G.4 Dosage
• Anxiety, Muscle Spasm, Convulsions,
Alcohol Withdrawal
Adult: PO 2–10 mg b.i.d. to q.i.d. or
15–30 mg/d sustained release IV/IM
 2–10 mg, repeat if needed in 3–4 h
IV.G.5. Indication
• Management of anxiety disorders, for
short-term relief of anxiety
symptoms, to allay anxiety and
tension prior to surgery,
cardioversion and endoscopic
procedures, as an amnesic, and
treatment for restless legs. Also used
to alleviate acute withdrawal
symptoms of alcoholism, voiding
problems in older adults, and
adjunctively for relief of skeletal
muscle spasm associated with
cerebral palsy, paraplegia, athetosis,
stiff-man syndrome, tetanus.
IV.G.6. Mechanism of Action
• Psychotherapeutic agent related to
chlordiazepoxide; reportedly superior
in antianxiety and anticonvulsant
activity, with somewhat shorter
duration of action. Like
chlordiazepoxide, it appears to act at
both limbic and subcortical levels of
CNS.
IV.G.7. Side Effects/ Adverse Effects
• Body as a Whole: Throat and chest
pain.
• CNS: Drowsiness, fatigue, ataxia,
confusion, paradoxic rage, dizziness,
vertigo, amnesia, vivid dreams,
headache, slurred speech, tremor;
EEG changes, tardive dyskinesia.
• CV: Hypotension, tachycardia,
edema, cardiovascular collapse.
• Special Senses: Blurred vision,
diplopia, nystagmus.
 • GI: Xerostomia, nausea, constipation,
hepatic dysfunction.
• Urogenital: Incontinence, urinary
retention, gynecomastia (prolonged
use), menstrual irregularities,
ovulation failure.
• Respiratory: Hiccups, coughing,
laryngospasm.
• Other: Pain, venous thrombosis,
phlebitis at injection site.
IV.G.8. Contraindication
• Injectable form: Shock, coma,
acute alcohol intoxication, depressed
vital signs, obstetrical patients,
infants <30 d of age.
• Tablet form: Infants <6 mo of age,
acute narrow-angle glaucoma,
untreated open-angle glaucoma;
during or within 14 d of MAO inhibitor
therapy. Safe use during pregnancy
(category D) and lactation is not
established.
IV.G.9. Nursing Responsibilities

• Monitor for adverse reactions. Most

are dose related. Physician will rely
on accurate observation and reports
of patient response to the drug to
determine lowest effective
maintenance dose.
• Monitor for therapeutic
effectiveness. Maximum effect may
require 1–2 wk; patient tolerance to
therapeutic effects may develop after
4 wk of treatment.
• Observe necessary preventive
 precautions for suicidal tendencies
that may be present in anxiety states
accompanied by depression.
• Observe patient closely and
monitor vital signs when diazepam is
given parenterally; hypotension,
muscular weakness, tachycardia, and
respiratory depression may occur.
• Lab tests: Periodic CBC and liver
function tests during prolonged
therapy.
• Supervise ambulation. Adverse
reactions such as drowsiness and
ataxia are more likely to occur in
older adults and debilitated or those
receiving larger doses. Dosage
adjustment may be necessary.
• Monitor I&O ratio, including urinary
and bowel elimination.
• Note: Smoking increases
metabolism of diazepam; lowering
clinical effectiveness. Heavy smokers
may need a higher dose than the
nonsmoker.
• Note: Psychic and physical
dependence may occur in patients on
long-term high dosage therapy, in
those with histories of alcohol or drug
addiction, or in those who self-
medicate.

Patient & Family Education

• Avoid alcohol and other CNS

depressants during therapy unless
otherwise advised by physician.
Concomitant use of these agents can
 cause severe drowsiness, respiratory
depression, and apnea.
• Tell physician if you become or
intend to become pregnant during
therapy; drug may need to be
discontinued.
• Take drug as prescribed; do not
change dose or dose intervals.
• Check with physician before taking
any OTC drugs.
• Do not breast feed while taking
this drug without consulting
physician.

IV.H. Xylocaine/ Pontocaine

IV.G.1. Generic Name
• Lidocaine hydrochloride
IV.G.2. Brand Name
• Xylocaine/Pontocaine
IV.G.3 Classification
• cardiovascular agent; antiarrhythmic,
class ib; central nervous system
agent; local anesthetic (amide type)
IV.G.4 Dosage
• Ventricular Arrhythmias
Adult: IV 50–100 mg bolus at a rate
of 20–50 mg/min, may repeat in 5
min, then start infusion of 1–4
mg/min immediately after first
bolus IM/SC 200–300 mg IM, may
repeat once after 60–90 min
Child: IV 0.5–1 mg/kg bolus dose,
then 10–50 mcg/kg/min infusion
• Anesthetic Uses
Adult: Infiltration 0.5–1%
 solution Nerve Block 1–2%
solution Epidural 1–2%
solution Caudal 1–1.5%
solution Spinal 5% with
glucose Saddle Block 1.5% with
dextrose Topical 2.5–5% jelly,
ointment, cream, or solution
IV.G.5. Indication
• Rapid control of ventricular
arrhythmias occurring during acute
MI, cardiac surgery, and cardiac
catheterization and those caused by
digitalis intoxication. Also as surface
and infiltration anesthesia and for
nerve block, including caudal and
spinal block anesthesia and to relieve
local discomfort of skin and mucous
membranes. Patch for relief of pain
associated with post-herpetic
neuralgia.
IV.G.6. Mechanism of Action
• Similar to those of procainamide and
quinidine, but has little effect on
myocardial contractility, AV and
intraventricular conduction, cardiac
output, and systolic arterial pressure
in equivalent doses. Exerts
antiarrhythmic action (Class IB) by
suppressing automaticity in His-
Purkinje system and by elevating
electrical stimulation threshold of
ventricle during diastole. Action as
local anesthetic is more prompt,
more intense, and longer lasting than
that of procaine.
IV.G.7. Side Effects/ Adverse Effects
• CNS: Drowsiness, dizziness, light-
 headedness, restlessness, confusion,
disorientation, irritability,
apprehension, euphoria, wild
excitement, numbness of lips or
tongue and other paresthesias
including sensations of heat and cold,
chest heaviness, difficulty in
speaking, difficulty in breathing or
swallowing, muscular twitching,
tremors, psychosis. With high doses:
convulsions, respiratory depression
and arrest.
• CV: With high doses, hypotension,
bradycardia, conduction disorders
including heart block, cardiovascular
collapse, cardiac arrest.
• Special Senses: Tinnitus, decreased
hearing; blurred or double vision,
impaired color perception.
• Skin: Site of topical application may
develop erythema, edema.
• GI: Anorexia, nausea, vomiting.
• Body as a Whole: Excessive
perspiration, soreness at IM site, local
thrombophlebitis (with prolonged IV
infusion), hypersensitivity reactions
(urticaria, rash, edema,
anaphylactoid reactions).
IV.G.8. Contraindication
• History of hypersensitivity to amide-
type local anesthetics; application or
injection of lidocaine anesthetic in
presence of severe trauma or sepsis,
blood dyscrasias, supraventricular
arrhythmias, Stokes-Adams
syndrome, untreated sinus
bradycardia, severe degrees of
 sinoatrial, atrioventricular, and
intraventricular heart block. Safe use
during pregnancy (category B),
lactation, or in children is not
established.
IV.G.9. Nursing Responsibilities

• Stop infusion immediately if ECG

indicates excessive cardiac
depression (e.g., prolongation of PR
interval or QRS complex and the
appearance or aggravation of
arrhythmias).
• Monitor BP and ECG constantly;
assess respiratory and neurologic
status frequently to avoid potential
overdosage and toxicity.
• Auscultate lungs for basilar rales,
especially in patients who tend to
metabolize the drug slowly (e.g., CHF,
cardiogenic shock, hepatic
dysfunction).
• Watch for neurotoxic effects (e.g.,
drowsiness, dizziness, confusion,
paresthesias, visual disturbances,
excitement, behavioral changes) in
patients receiving IV infusions or with
high lidocaine blood levels.
• Note: Lidocaine blood levels of 1.5–
6 mcg/mL are reported to provide
"usually effective" antiarrhythmic
activity. Blood levels greater than 7
mcg/mL are potentially toxic.

Patient & Family Education

• Swish and spit out when using

 lidocaine solution for relief of mouth
discomfort; gargle for use in pharynx,
may be swallowed (as prescribed).
• Oral topical anesthetics (e.g.,
Xylocaine Viscous) may interfere with
swallowing reflex. Do NOT ingest food
within 60 min after drug application;
especially pediatric, geriatric, or
debilitated patients. Do not chew
gum while buccal and throat
membranes are anesthetized to
prevent biting trauma.
• Do not breast feed while taking
this drug without consulting
physician.

IV.I. Nubain
IV.I.1. Generic Name
• Nalbuphine hydrochloride
IV.I.2. Brand Name
• Nubain
IV.I.3 Classification
• central nervous system agent;
analgesic; narcotic (opiate) agonist-
antagonist

IV.I.4 Dosage
• Moderate to Severe Pain
Adult: IV/IM/SC 10–20 mg q3–6h prn
(max: 160 mg/d)
Child: IV/IM/SC 0.1–0.15 mg/kg q3–6h
prn
IV.I.5. Indication
• Symptomatic relief of moderate to
severe pain. Also preoperative
 sedation analgesia and as a
supplement to surgical anesthesia.
IV.I.6. Mechanism of Action
• Binds with opiate receptors in the
CNS, altering both perception of and
emotional response to pain.
• Relieves pain and enhances
anesthesia.

IV.I.7. Side Effects/ Adverse Effects

• CNS: headache, sedation,
dizziness, vertigo, nervousness,
depression, restlessness, crying
euphoria, hostility, confusion, unusual
dreams, hallucination, speech
disorder, delusion.
• CV: hypertension, hypotension,
tachycardia, bradycardia
• EENT: blurred vision, dry mouth
• GI: cramps, dyspepsia, bitter taste,
nausea, vomiting, constipation,
biliary tract spasms
• Respiratory: respiratory
depression, dyspnea, asthma,
pulmonary edema
• Skin: pruritus, burning, uticaria,
clammoness, diaphoresis.

IV.I.8. Contraindication
• Contraindicated in patients with
hypersensitive to drug.
• Use cautiously in substance
abusers, and in those with emotional
instability, head injury, increased
intracranial pressure, impaired
ventilation, MI accompanied by
 nausea and vomiting, upcoming
biliary surgery, and hepatic or renal
disease.
IV.I.9. Nursing Responsibilities

• Assess respiratory rate before drug

administration. Withhold drug and
notify physician if respiratory rate
falls below 12.
• Watch for allergic response in
persons with sulfite sensitivity.
• Administer with caution to patients
with hepatic or renal impairment.
• Monitor ambulatory patients;
nalbuphine may produce drowsiness.
• Watch for respiratory depression of
newborn if drug is used during labor
and delivery.
• Avoid abrupt termination of
nalbuphine following prolonged use,
which may result in symptoms
similar to narcotic withdrawal:
nausea, vomiting, abdominal
cramps, lacrimation, nasal
congestion, piloerection, fever,
restlessness, anxiety.

Patient & Family Education

• Avoid alcohol and other CNS

depressants.
• Do not breast feed while taking this
drug without consulting physician.

IV.J. Vitakay
IV.J.1. Generic Name
IV.J.2. Brand Name
 IV.J.3 Classification
IV.J.4 Dosage
IV.J.5. Indication
IV.J.6. Mechanism of Action
IV.J.7. Side Effects/ Adverse Effects
IV.J.8. Contraindication
IV.J.9. Nursing Responsibilities

IV.K. Terramycin Ointment

IV.K.1. Generic Name
IV.K.2. Brand Name
IV.K.3 Classification
IV.K.4 Dosage
IV.K.5. Indication
IV.K.6. Mechanism of Action
IV.K.7. Side Effects/ Adverse Effects
IV.K.8. Contraindication
IV.K.9. Nursing Responsibilities

IV.L. Aquamephyton
IV.L.1. Generic Name
IV.L.2. Brand Name
IV.L.3 Classification
IV.L.4 Dosage
IV.L.5. Indication
IV.L.6. Mechanism of Action
IV.L.7. Side Effects/ Adverse Effects
IV.L.8. Contraindication
IV.L.9. Nursing Responsibilities

IV.M. Magnesium Sulfate

IV.M.1. Generic Name
IV.M.2. Brand Name
IV.M.3 Classification
IV.M.4 Dosage
IV.M.5. Indication
IV.M.6. Mechanism of Action
 IV.M.7. Side Effects/ Adverse Effects
IV.M.8. Contraindication
IV.M.9. Nursing Responsibilities

IV.N. Apresoline
IV.N.1. Generic Name
IV.NJ.2. Brand Name
IV.N.3 Classification
IV.N.4 Dosage
IV.N.5. Indication
IV.N.6. Mechanism of Action
IV.N.7. Side Effects/ Adverse Effects
IV.N.8. Contraindication
IV.N.9. Nursing Responsibilities

IV.O. Kalcinate/ Calcium Gluconate

IV.O.1. Generic Name
IV.O.2. Brand Name
IV.O.3 Classification
IV.O.4 Dosage
IV.O.5. Indication
IV.O.6. Mechanism of Action
IV.O.7. Side Effects/ Adverse Effects
IV.O.8. Contraindication
IV.O.9. Nursing Responsibilities

IV.P.Yutopar
IV.P.1. Generic Name
IV.P.2. Brand Name
IV.P.3 Classification
IV.P.4 Dosage
IV.P.5. Indication
IV.P.6. Mechanism of Action
IV.P.7. Side Effects/ Adverse Effects
IV.P.8. Contraindication
IV.P.9. Nursing Responsibilities
 IV.Q. Bricanyl
IV.Q.1. Generic Name
IV.Q.2. Brand Name
IV.Q.3 Classification
IV.Q.4 Dosage
IV.Q.5. Indication
IV.Q.6. Mechanism of Action
IV.Q.7. Side Effects/ Adverse Effects
IV.Q.8. Contraindication
IV.Q.9. Nursing Responsibilities

IV.R. Hepatitis B. Vaccine

IV.R.1. Generic Name
IV.R.2. Brand Name
IV.R.3 Classification
IV.R.4 Dosage
IV.R.5. Indication
IV.R.6. Mechanism of Action
IV.R.7. Side Effects/ Adverse Effects
IV.R.8. Contraindication
IV.R.9. Nursing Responsibilities

References:

Books
• Potter & Perry (2005).Fundamental of nursing. 6th ed. Philippines: Elsevier (Singapore) PTE LTD.
 • Clayton & Stock (2001).Basic pharmacology for nurses. 12th ed. Philippines: Elsevier Science (Singapore) PTE LTD.

• Kee, J. L. & Hayes, E. R. (2003).Pharmacology: a nursing process approach. 4th ed. Philippines: Elsevier Science (Singapore) PTE
LTD.

• Nursing pharmacology made incredibly easy. (2005). Philadelphia: LWW.

• Karch, A. M. (2007). Lippincotts nursing drug guide. Philadelphia: LWW.

• Mosby’s pocket dictionary of medicine, nursing, & allied health. 4th ed. (2002). Philippines: Elsevier (Singapore) PTE LTD.

• Shanon, M. T. et. al.(2007). Prentice Hall Nurse's Drug Guide 2007. New Jersey: Prentice Hall.

Internet
• http://en.wikipedia.org/wiki/Mechanism_of_action
• http://www.drugs.com/cons/buscopan.html
• http://www.netdoctor.co.uk/medicines/100000395.html
• http://www.medicinenet.com/hyoscine_butylbromide-oral/article.htm
• http://www.flexyx.com/B/Buscopan.html