GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE NURSING RESPONSIBILITY

REACTION
Norepinephrine At more than 4 mcg/min, inhibits CNS: Anxiety, dizziness, Observe the 14 Rights in
adenyl cyclase and directly stimulates headache, insomnia, preparing and administering
alpha-adrenergic receptors, which nervousness, tremor, weakness medication.
inhibits cAMP production. Inhibition of
cAMP constricts arteries and veins and CV: Angina, bradycardia, Dilute norepinephrine
increases peripheral vascular resistance ECG changes, edema, concentrate for infusion by
and systolic blood pressure. hypertension, hypotension, adding a 4 ml ampule (contains
palpitations, peripheral 4 mg) of drug to 1,000 ml of a
vascular insufficiency 5% dextrose-containing
BRAND NAME: INDICATION:
(including gangrene), PVCs, solution. Each ml of this
sinus tachycardia dilution contains 4 mcg of the
Levophed To manage blood pressure in acute base of the drug.
hypotensive states such as blood GI: Nausea, vomiting
DRUG ILLUSTRATION: transfusion, drug adverse effect, Make sure solution contains no
myocardial infarction, GU: Decreased renal perfusion particles and isn’t discolored
pheochromocytomectomy, before administering.
poliomyelitis, spinal anesthesia, and RESP: Apnea, dyspnea
sympathectomy reactions; adjunct in Give drug with a flow-control
treatment of cardiac arrest and SKIN: Pallor device.
profound hypotension.
Other: Infusion-site sloughing Check blood pressure every 2
and tissue necrosis, metabolic to 3 minutes, preferably by
acidosis direct intra-arterial monitoring,
until stabilized and then every
5 minutes.

WARNING Because
extravasation can cause severe
tissue damage and necrosis,
expect prescriber to give
CLASSIFICATION: CONTRAINDICATION: multiple subcutaneous
injections of phentolamine (5
Pharmacologic class: Concurrent use of cyclopropane and to 10 mg diluted in 10 to 15 ml
normal saline solution) around
Sympathomimetic hydrocarbon inhalation anesthetics,
extravasated infusion site.
Therapeutic class: Vasopressor hypersensitivity to norepinephrine or its
components, hypovolemia (except as
If blanching occurs along vein,
DOSAGE/FREQUENCY/ROUTE: an emergency measure), mesenteric or
change infusion site and notify
peripheral vascular thrombosis (except prescriber at once.
Route: IV as an emergency measure), profound
Onset: Rapid hypercarbia or hypoxia. Monitor continuous ECG
Peak: Unknown during therapy.
Duration: 1-2 min
PATIENT TEACHING
Adults. Initial average dose: 8 to
12 mcg/min of base. Then titrated Urge patient to immediately
to maintain systolic blood report burning, leaking, or
pressure between 80 to 100 mm tingling around I.V. site.
Hg in patients previously not
hypertensive and 40 mm Hg
below preexisting systolic blood
pressure in patients previously
hypertensive. Maintenance: 2 to
4 mcg/min of base. Initial high
dose: Highly individualized but
may require enormous daily
doses as high as 68 mg of base if
patient remains hypotensive.
 GENERIC NAME: MECHANISM OF ACTION: SIDE EFFECTS/ADVERSE NURSING RESPONSIBILITY
Binds to intracellular glucocorticoid REACTION
Hydrocortisone receptors and suppresses inflammatory CNS: Ataxia, behavioral Observe the 14 Rights in
and immune responses by: changes, depression, dizziness, preparing and administering
epidural lipomatosis, euphoria, medication.
 Inhibiting monocyte and neutrophil fatigue, headache, increased
accumulation at inflammation site intracranial pressure with Know that systemic
and suppressing their bactericidal papilledema, insomnia, hydrocortisone shouldn’t be
malaise, mood changes, given to immunocompromised
and phagocytic activity
paresthesia, seizures, steroid patients, such as those with
psychosis, syncope, vertigo fungal and other infections,
 Stabilizing lysosomal membranes
including amebiasis, hepatitis
CV: Arrhythmias, fat B, tuberculosis, vaccinia, and
 Suppressing antigen response of embolism, heart failure, varicella.
helper T cells and macrophages hypertension, hypotension,
thromboembolism, Give daily dose of
 Inhibiting synthesis of cellular thrombophlebitis hydrocortisone in morning to
mediators of inflammatory mimic normal peak in
response, such as cytokines, EENT: Central serous adrenocortical secretion of
interleukins, and prostaglandins. chorioretinopathy, corticosteroids.
exophthalmos, glaucoma,
BRAND NAME: INDICATION: increased intraocular pressure, Don’t give acetate injectable
nystagmus, posterior suspension by I.V. route.
subcapsular cataracts
Solu-Cortef To treat severe inflammation or acute
Give hydrocortisone sodium
adrenal insufficiency
ENDO: Adrenal insufficiency succinate as a direct I.V.
DRUG ILLUSTRATION:
during stress, cushingoid injection over 30 seconds to
symptoms (buffalo hump, several minutes, or as an
central obesity, moon face, intermittent or a continuous
CLASSIFICATION: CONTRAINDICATION: supraclavicular fat pad infusion. For infusion, dilute to
enlargement), diabetes 1 mg/ml or less with D5W,
Hypersensitivity to hydrocortisone or its mellitus, growth suppression in normal saline solution, or
components, idiopathic children, hyperglycemia, dextrose 5% in normal saline
thrombocytopenic purpura (I.M.), negative nitrogen balance from solution.
intestinal conditions prohibiting protein catabolism
intrarectal steroids (P.R.), systemic Inject I.M. form deep into
fungal infection GI: Abdominal distention; gluteal muscle, and rotate
hiccups; increased appetite; injection sites to prevent
nausea; pancreatitis; muscle atrophy. Subcutaneous
injection may cause atrophy
peptic ulcer; rectal and sterile abscess.
Pharmacologic class: abnormalities, such as
Glucocorticoid bleeding, blistering, burning, Shake foam container
itching, or pain (rectal form); vigorously for 5 to 10 seconds
Therapeutic class: ulcerative esophagitis; before each use. Gently
Adrenocorticoid replacement, vomiting withdraw applicator plunger
anti-inflammatory past the fill line on the
GU: Amenorrhea, glycosuria, applicator barrel while
DOSAGE/FREQUENCY/ROUTE: menstrual irregularities, container is upright on a level
perineal burning or tingling surface. Administer rectal foam
only with provided applicator.
I.V. INFUSION OR I.V., I.M., OR
HEME: Easy bruising, After each use, wash
SUBCUTANEOUS INJECTION
leukocytosis applicator, container cap, and
(HYDROCORTISONE SODIUM underlying tip with warm
PHOSPHATE); I.M. INJECTION MS: Arthralgia; aseptic water.
(HYDROCORTISONE) necrosis of femoral and
humeral heads; compression Be aware that high-dose
Adults. 15 (20 mg hydrocortisone) fractures; muscle atrophy, therapy shouldn’t be given for
to 240 mg daily as a single dose or twitching, or weakness; longer than 48 hours. Be alert
in divided doses. For I.V. infusion, myalgia; osteoporosis; for depression and psychotic
give over 20 to 30 min. For I.V. spontaneous fractures; steroid
injection, give over 30 sec to 10 myopathy; tendon rupture episodes.
min depending on dose. DOSAGE
ADJUSTMENT Dosage increased SKIN: Acne; altered skin Monitor blood pressure,
to more than 240 mg daily if pigmentation; diaphoresis; electrolyte levels, and weight
needed to treat acute disease. erythema; hirsutism; regularly during therapy.
necrotizing vasculitis;
petechiae; purpura; rash; Expect hydrocortisone to
scarring; sterile abscess; striae; worsen infections or mask
subcutaneous fat atrophy; thin, signs and symptoms.
fragile skin; urticaria
Monitor blood glucose level in
Other: Anaphylaxis, diabetic patients, and increase
hypocalcemia, hypokalemia, insulin or oral antidiabetic drug
hypokalemic alkalosis, dosage, as prescribed.
impaired wound healing,
masking of signs of infection, Know that elderly patients are
metabolic alkalosis, at high risk for osteoporosis
pheochromocytoma crisis (in during long-term therapy.
presence of
pheochromocytoma), Anticipate the possibility of
suppressed skin test reaction, acute adrenal insufficiency
weight gain with stress, such as emotional
upset, fever, surgery, or
trauma. Increase
hydrocortisone dosage, as
prescribed.

WARNING Avoid
withdrawing drug suddenly
after long-term therapy because
adrenal crisis can result. Expect
to reduce dosage gradually and
monitor response.

PATIENT TEACHING

Advise patient to take daily

dose of hydrocortisone at 9
a.m.

Instruct patient to take tablets

with food or milk.

Teach patient how to use

enema form or foam, if
prescribed.

Caution patient not to stop drug

abruptly without first
consulting prescriber.

Instruct patient to report early

evidence of adrenal
insufficiency: anorexia,
difficulty breathing,

Dizziness, fainting, fatigue,

joint pain, muscle weakness,
and nausea.

Inform patient that he may

bruise easily.

Advise patient on long-term

therapy to have periodic eye
examinations.

If patient receives long-term

therapy, urge him to carry or
wear medical identification.

Caution patient to avoid people

with infections because drug
 can suppress immune system,
increasing risk of infection. If
patient comes into contact with
chickenpox or measles, instruct
him to call prescriber because
he may need prophylactic care.
References:

Bs, R. K. J., RPh, & Ccrn, H. K. R. B. (2018). Saunders Nursing Drug Handbook 2019 (1 st ed.). Saunders.
Jones & Bartlett Learning. (2020). 2021 Nurse’s Drug Handbook (20 th ed.). Jones & Bartlett Learning.