Generic Name: ATROPINE SULFATE Brand name: Atro-Pen, Sal-Tropine Drug Classification: Antidysrhythmic, anticholinergic parasympatholytic, mydriatic Mechanism

of Action: Blocks acetylcholine and parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretion, decrease sweating, salivation in low doses, mydriasis, increased heart rate and cycloplegia occur at moderate doses, motility of GI, GU systems at high dose. Indications: Bradycardia, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU and biliary surgery, bronchodilator; ophthalmically for cycloplegia mydriasis Contraindications: Hypersensitivity to belladonna alkaloids,angle closure glaucoma, GI obstructions, myasthenia gravis, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia, asthma, acute hemorrhage, hepatic disease, myocardial ischemia

Side Effects: CNS: Headache, dizziness, involuntary movement, confusion, psychosis, anxiety, coma, flushing, drowsiness, insomnia, weakness, delirium (elderly) CV: Hypotension, paradoxic bradycardia, angina, PVCs, hypertension, tachycardia, ectopic vebtricular beats EENT: Blurred vision, photophobia, glaucoma, eye pain, pupil dilation, nasal congestion GI: Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation, paralytic ileus, abdominal distention, altered taste GU: Retetion, hesitancy, impotence, dysuria INTEG: Rash, urticaria, contact dermatitis, dry skin, flushing MISC: Suppression of lactation, decreased sweating

Nursing Considerations: Monitor I & O ratio, check for urinary retention and daily output in elderly and post-operative patients; Monitor ECG for ectopic ventricular beats, PVC, tachycardia in cardiac patients; Monitor for bowel sounds, check for constipation, abdominal distention and constipation may occur; Monitor respiratory status: rate, rhythm, cyanosi,wheezing, dyspnea, engorged neck veins; Monitor for increasedintraoccular pressure: eye pain, nausea, vomiting, blurred vision, increased tearing, discontinue use if pain occur (optic); Monitor cardiac rate: rhythm, character, BP continuously; Monitor allergic reactions:rash, urticaria

Client Teaching: Advise patient not to perform strenuous activity in high temperature, heat stroke may occur; Instruct patient to take as prescribed, not skip doses; Instruct patient to report change in vision; Caution patient not to use machinery if drowsiness occurs; Advise patient not to take OTC products without approval of physician

Generic Name: EPINEPHRINE Drug Classification: Bronchodilator, non-selective adrenergic agonist, cardiac stimulant, vasopressor Mechanism of Action: Stimulates alpha-, beta1-, and beta2-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation, and dilation of skeletal muscle vasculature; small doses can cause vasodilation via beta2-vascular receptors; large doses may produce constriction of skeletal and vascular smooth muscle; decreases production of aqueous humor and increases aqueous outflow; dilates the pupil by contracting the dilator muscle. Indications: Bronchospasms, anaphylactic reactions, cardiac arrest, management of open-angle (chronic simple) glaucoma; added to local anesthetics to decrease systemic absorption, increase duration of action, and decrease toxicity of the local anesthetic

Side Effects: Cardiovascular: Tachycardia (parenteral), pounding heartbeat, flushing, hypertension, pallor, chest pain, increased myocardial oxygen consumption, cardiac arrhythmia, sudden death, angina, vasoconstriction CNS: Nervousness, anxiety, restlessness, headache, dizziness, lightheadedness, insomnia GI: Nausea, vomiting, xerostomia,dry throat GU: Acute urinary retention in patients with bladder outflow obstruction Neuromuscular & skeletal: Weakness, trembling Ocular: Precipitation or exacerbation of narrow-angle glaucoma, transient stinging, burning, eye pain, allergic lid reaction, ocular irritation Renal: Decreased renal and splanchnic blood flow Respiratory: Wheezing, dyspnea Miscellaneous: Diaphoresis (increased)

Nursing Considerations: Use extreme caution when calculation and preparing the doses because it is a very potent drug, double check pediatric doses; Rotate injection sites to prevent necrosis and monitor these sites frequently; Assess for allergy, V/S, breath sounds and orientation

Generic Name: CLONIDINE Brand Name: Catapres Indications: Essential and renal hypertension, Pheochromocytoma diagnosis, Migraine prophylaxis, Dysmenorrhea, Vasomotor symptoms of menopause, Opiate dependence, Alcohol dependence, Smoking cessation, Attention deficit hyperactivity disorder Mechanism of Action: Unknown. Thought to stimulate alpha2 receptors and inhibit the central vasomotor centers, decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature, and lowering peripheral vascular resistance, blood pressure, and heart rate. Side Effects: CNS: drowsiness, dizziness, fatigue, sedation, weakness, malaise, agitation, depression. CV: orthostatic hypotension, bradycardia, severe rebound hypertension. GI: constipation, dry mouth, nausea, vomiting, anorexia. GU: urine retention, impotence. Metabolic: weight gain. Skin: pruritus, dermatitis with transdermal patch, rash. Other: loss of libido. Contraindications: Contraindicated in patients hypersensitive to drug; Transdermal form is contraindicated in patients hypersensitive to any component of the adhesive layer of transdermal system; Epidural form is contraindicated in patients receiving anticoagulant therapy, in those with bleeding diathesis, in those with an injection site infection, and in those who are hemodynamically unstable or have severe CV disease; Use cautiously in patients with severe coronary insufficiency, conduction disturbances, recent MI, cerebrovascular disease, chronic renal failure, or impaired liver function. Nursing considerations: Drug may be given to lower blood pressure rapidly in some hypertensive emergencies. ; Monitor blood pressure and pulse rate frequently. Dosage is usually adjusted to patient's blood pressure and tolerance. ; Elderly patients may be more sensitive than younger ones to drug's hypotensive effects. ; Observe patient for tolerance to drug's therapeutic effects, which may require increased dosage. ; Noticeable antihypertensive effects of transdermal clonidine may take 2 to 3 days. Oral antihypertensive therapy may have to be continued in the interim. ; Alert: Remove transdermal patch before defibrillation to prevent arcing. ; Stop drug gradually by reducing dosage over 2 to 4 days to avoid rapid rise in blood pressure, agitation, headache, and tremor. When stopping therapy in patients receiving both clonidine and a beta blocker, gradually withdraw the beta blocker several days before gradually stopping clonidine to minimize adverse reactions. Don't stop drug before surgery. Look alike-sound alike: Don't confuse clonidine with quinidine or clomiphene; or Catapres with Cetapred or Combipres. Alert: The injection form is for epidural use only. The injection form concentrate containing 500 mcg/ml must be diluted before use in normal saline injection to yield 100 mcg/ml. When drug is given epidurally, carefully monitor infusion pump, and inspect catheter tubing for obstruction or dislodgment.

Patient teaching: Advise patient that stopping drug abruptly may cause severe rebound high blood pressure. Tell him dosage must be reduced gradually over 2 to 4 days as instructed by prescriber. Tell patient to take the last dose immediately before bedtime. Reassure patient that the transdermal patch usually remains attached despite showering and other routine daily activities. Instruct him on the use of the adhesive overlay to provide additional skin adherence, if needed. Also tell him to place patch at a different site each week. Caution patient that drug may cause drowsiness but that this adverse effect usually diminishes over 4 to 6 weeks. Inform patient that dizziness upon standing can be minimized by rising slowly from a sitting or lying position and avoiding sudden position changes.

Generic Name: VERAPAMIL Brand Name: Isoptin, Verapamil Drug Classification: Calcium channel blocker Mechanism of Action: A calcium channel blocker that inhibits calcium ion influx across cardiac and smooth-muscle cells, thus decreasing myocardial contractility and oxygen demand; it also dilates coronary arteries and arterioles. Indications: Vasospastic angina (Prinzmetal's or variant angina); classic chronic, stable angina pectoris; chronic atrial fibrillation, to prevent paroxysmal supraventricular tachycardia, Contraindications: This form is contraindicated in patients receiving I.V. beta blockers and in those with ventricular tachycardia, Contraindicated in patients hypersensitive to drug and in those with severe left ventricular dysfunction, cardiogenic shock, second- or third-degree AV block or sick sinus syndrome except in presence of functioning pacemaker, atrial flutter or fibrillation and accessory bypass tract syndrome, severe heart failure (unless secondary to therapy), and severe hypotension. I.V. form is contraindicated in patients receiving I.V. beta blockers and in those with ventricular tachycardia. Use cautiously in elderly patients and in those with increased intracranial pressure or hepatic or renal disease. Side Effects: CNS: dizziness, headache, asthenia, fatigue, sleep disturbances. CV: transient hypotension, heart failure, pulmonary edema, bradycardia, AV block, ventricular asystole, ventricular fibrillation, peripheral edema. GI: constipation, nausea, diarrhea, dyspepsia. Respiratory: dyspnea, pharyngitis, rhinitis, sinusitis, upper respiratory infection. Skin: rash. Nursing Considerations: Monitor ECG and blood pressure continuously, Pellet-filled capsules may be given by carefully opening the capsule and sprinkling the pellets on a spoonful of applesauce. This should be swallowed immediately without chewing, followed by a glass of cool water to ensure all the pellets are swallowed. Patients with severely compromised cardiac function or those receiving beta blockers should receive lower doses of this drug. Monitor these patients closely. For supraventricular tachycardia, have the patient perform vagal maneuvers after receiving drug. Monitor blood pressure at the start of therapy and during dosage adjustments. Assist patient with walking because dizziness may occur. If signs and symptoms of heart failure occur, such as swelling of hands and feet and shortness of breath, notify prescriber. Monitor liver function test results during prolonged treatment. Look alike-sound alike: Don't confuse Verelan with Vivarin, Voltaren, or Virilon.

Client Teaching: Instruct patient to take oral form of drug exactly as prescribed. Tell patient that long-acting forms shouldn't be crushed or chewed. Caution patient against abruptly stopping drug. If patient continues nitrate therapy during oral verapamil dosage adjustment, urge continued compliance. S.L. nitroglycerin may be taken, as needed, for acute chest pain. Encourage patient to increase fluid and fiber intake to combat constipation. Give a stool softener. Drug significantly inhibits alcohol elimination. Advise patient to avoid or severely limit alcohol use. Inform patient taking Covera-HS that the outer shell of the drug may be excreted in feces.

Generic Name: DIAZEPAM Brand name: Antenex, Apo-Diazepam, Diastat, Diazemuls, Diazepam Intensol, Ducene, Novo-Dipam, PMS-Diazepam, Valium, Vivol Drug Classification: Benzodiazepine, anxiolytic, skeletal muscle relaxant, amnesic, anticonvulsant, sedative-hypnotic Mechanism of Action: A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity. Indications: Anxiety, Muscle spasm, Preoperative sedation, Cardioversion, Status epilepticus, Patients on stable regimens of antiepileptic drugs who need diazepam intermittently to control bouts of increased seizure activity severe recurrent seizures

Side Effects: CNS: drowsiness, dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucinations, minor changes in EEG patterns. CV: hypotension, CV collapse, bradycardia. EENT: diplopia, blurred vision, nystagmus. GI: nausea, constipation, diarrhea with rectal form. GU: incontinence, urine retention. Hematologic: neutropenia. Hepatic: jaundice. Respiratory: respiratory depression, apnea. Skin: rash. Other: altered libido, physical or psychological dependence, pain, phlebitis at injection site.

Nursing Considerations: Contraindicated in patients hypersensitive to drug or soy protein; in patients experiencing shock, coma, or acute alcohol intoxication (parenteral form); in pregnant women, especially in first trimester; and in children younger than age 6 months (oral form). Diastat rectal gel is contraindicated in patients with acute angle-closure glaucoma. Use cautiously in patients with liver or renal impairment, depression, or chronic open-angle glaucoma. Use cautiously in elderly and debilitated patients.

Client Teaching: Warn patient to avoid activities that require alertness and good coordination until effects of drug are known. Tell patient to avoid alcohol while taking drug. Notify patient that smoking may decrease drug's effectiveness. Warn patient not to abruptly stop drug because withdrawal symptoms may occur. Warn woman to avoid use during pregnancy. Instruct patient's caregiver on the proper use of Diastat rectal gel.

Generic Name; POTASSIUM CHLORIDE Brand name: Cena K, K+Care, K-10, K-Dur, K-Lor, K-Norm, K-Tab, Kaochlor, Kaon-CI, Kato, Kay Ciel, Klor-Con, Klorvess, Klotrix, Micro-K, Slow-K, Ten-K Mechanism of Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance. Indications: Prevention and treatment of hypokalemia Contraindications: Rena disease (severe), severe hemolytic disease, Addisons disease, hyperkalemia, acute dehydration, extensive tissue breakdown Side Effects: CNS: confusion CV: bradycardia, cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged PR interval, widened QRS complex Nursing Considerations: Assess ECG for peaking T waves, lowered R, depressed RST, prolonged P interval, widening QRS complex, hyperkalemia, drug should be reduced or discontinued Client Teaching: Teach patient to eat foods rich in potassium after medication is discontinued; Advise patient to avoid OTC products; Advise patient to report hyperkalemia symptoms or continued hypokalemia symptoms; Tell patient to take cap with full glass of liquid. To dissolve powder or tab completely in at least 120 ml of water or juice; Emphasize importance of regular follow-up.

Generic Name: FUROSEMIDE Brand Name: Apo-Furosemide, Furosemide Special IV, Furoside, Lasix*, Drug Class: loop diuretic; antihypertensive Indications & dosages Acute pulmonary edema Adults: 40 mg I.V. injected slowly over 1 to 2 minutes; then 80 mg I.V. in 60 to 90 minutes if needed. Edema Adults: 20 to 80 mg P.O. daily in the morning. If response is inadequate, give a second dose, and each succeeding dose, q 6 to 8 hours. Carefully increase dose in 20- to 40-mg increments up to 600 mg daily. Once effective dose is attained, may give once or twice daily. Or, 20 to 40 mg I.V. or I.M., increased by 20 mg q 2 hours until desired effect achieved. Infants and children: 2 mg/kg P.O. daily, increased by 1 to 2 mg/kg in 6 to 8 hours if needed; carefully adjusted up to 6 mg/kg daily if needed. Hypertension Adults: 40 mg P.O. b.i.d. Dosage adjusted based on response. May be used as adjunct to other antihypertensives if needed. Children: 0.5 to 2 mg/kg P.O. once or twice daily. Increase dose p.r.n. up to 6 mg/kg daily. Mechanism of Action A potent drug that inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle.

Side Effects: CNS: vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever. CV: orthostatic hypotension, thrombophlebitis with I.V. administration. EENT: transient deafness, blurred or yellowed vision, tinnitus. GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation, pancreatitis. GU: nocturia, polyuria, frequent urination, oliguria. Hematologic: agranulocytosis, leukopenia, thrombocytopenia, azotemia, anemia, aplastic anemia. Hepatic: hepatic dysfunction, jaundice. Metabolic: volume depletion and dehydration, asymptomatic hyperuricemia, impaired glucose tolerance, hypokalemia, hypochloremic alkalosis, hyperglycemia, dilutional hyponatremia, hypocalcemia, hypomagnesemia. Musculoskeletal: muscle spasm. Skin: dermatitis, purpura, photosensitivity reactions, transient pain at I.M. injection site. Other: gout.

Contraindications & cautions Contraindicated in patients hypersensitive to drug and in those with anuria. Use cautiously in patients with hepatic cirrhosis and in those allergic to sulfonamides. Use during pregnancy only if potential benefits to mother clearly outweigh risks to fetus.

Nursing considerations To prevent nocturia, give P.O. and I.M. preparations in the morning. Give second dose in early afternoon. Alert: Monitor weight, blood pressure, and pulse rate routinely with long-term use and during rapid diuresis. Use can lead to profound water and electrolyte depletion. If oliguria or azotemia develops or increases, drug may need to be stopped. Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide levels frequently. Watch for signs of hypokalemia, such as muscle weakness and cramps. Consult prescriber and dietitian about a high-potassium diet or potassium supplements. Foods rich in potassium include citrus fruits, tomatoes, bananas, dates, and apricots. Monitor glucose level in diabetic patients. Drug may not be well absorbed orally in patient with severe heart failure. Drug may need to be given I.V. even if patient is taking other oral drugs. Monitor uric acid level, especially in patients with a history of gout. Monitor elderly patients, who are especially susceptible to excessive diuresis, because circulatory collapse and thromboembolic complications are possible. Store tablets in light-resistant container to prevent discoloration (doesn't affect potency). Refrigerate oral solution to ensure drug stability. Look alike-sound alike: Don't confuse furosemide with torsemide or Lasix with Lonox, Lidex, or Luvox.

Patient teaching Advise patient to take drug with food to prevent GI upset, and to take drug in morning to prevent need to urinate at night. If patient needs second dose, tell him to take it in early afternoon, 6 to 8 hours after morning dose. Inform patient of possible need for potassium or magnesium supplements. Instruct patient to stand slowly to prevent dizziness and to limit alcohol intake and strenuous exercise in hot weather to avoid worsening dizziness upon standing quickly.

Advise patient to immediately report ringing in ears, severe abdominal pain, or sore throat and fever; these symptoms may indicate toxicity. Alert: Discourage patient from storing different types of drugs in the same container, increasing the risk of drug errors. The most popular strengths of this drug and digoxin are white tablets about equal in size. Tell patient to check with prescriber or pharmacist before taking OTC drugs. Teach patient to avoid direct sunlight and to use protective clothing and a sunblock because of risk of photosensitivity reactions. *Liquid contains alcohol. Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING.

Generic Name: SODIUM BICARBONATE Brand name: Soda mint, Citrocarbonate, Neut Drug Classification: Alkalinizer, antacid Mechanism of Action: Orally neutralizes gastric acid, which forms water, NaCl,CO2; increases plasma bicarbonate, which buffers hydrogen ion concentration, reverses acidosis Uses: Metabolic acidosis, cardiac arrest, alkalinization (system/urinary); antacid (PO) Contraindications: Hypertension, peptic ulcer, renal disease, hypocalcemia Side Effects: CNS: irritability, headache, confusion, stimulation, tremors, twitching, hyperreflexia, tetany, weakness, seizures caused by alklosis CV: irregular pulse, cardiac arrest, water retention, edema, weight gain GI: flatulence, belching, distention, paralytic ileus, acid rebound GU: calculi META: alkalosis RESP: shallow, slow respirations, cyanosis, apnea Nursing Considerations: Assess respiratory and pulse rate, rhythm, depth, lung sounds; Assess for carbon dioxide in GI tract; Monitor fluid balance; Monitor electrolytes, blood pH, PO2, HCO3 during beginning of treatment; Monitor urine pH; Assess for alkalosis; Monitor manifestations of hypokalemia; Monitor for manifestations of hyponatremia; Assess for milk-alkali syndrome Client Teaching: Instruct patient to chew antacid tab and drink 8 oz of water, not to take antacid with milk; Notify prescriber if indigestion is accompanied by chest pain, dyspnea, diarrhea, dark and tarry stool; teach patient about sodium-restricted diet

Generic Name: DIGOXIN Brand Name: Lanoxin Pharmacologic Class: cardiac glycoside Therapeutic Class: inotropic antiarrhythmic Indications: Heart failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter; Mechanism of Action; Inhibits sodium-potassium-activated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Also acts on CNS to enhance vagal tone, slowing conduction through the SA and AV nodes.

Adverse reactions: CNS: fatigue, generalized muscle weakness, agitation, hallucinations, headache, malaise, dizziness, vertigo, stupor, paresthesia. CV: arrhythmias, heart block.

EENT: yellow-green halos around visual images, blurred vision, light flashes, photophobia, diplopia. GI: anorexia, nausea, vomiting, diarrhea. Effects on lab test results: May prolong PR interval or depress ST segment. Contraindications & cautions: Contraindicated in patients hypersensitive to drug and in those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure. Don't use in patients with Wolff-Parkinson-White syndrome unless the conduction accessory pathway has been pharmacologically or surgically disabled. Use with extreme caution in elderly patients and in those with acute MI, incomplete AV block, sinus bradycardia, PVCs, chronic constrictive pericarditis, hypertrophic cardiomyopathy, renal insufficiency, severe pulmonary disease, or hypothyroidism.

Nursing considerations: Drug-induced arrhythmias may increase the severity of heart failure and hypotension. In children, cardiac arrhythmias, including sinus bradycardia, are usually early signs of toxicity. Patients with hypothyroidism are extremely sensitive to cardiac glycosides and may need lower doses. Before giving loading dose, obtain baseline data (heart rate and rhythm, blood pressure, and electrolytes) and ask patient about use of cardiac glycosides within the previous 2 to 3 weeks. Loading dose is usually divided over the first 24 hours with approximately half the loading dose given in the first dose. Before giving drug, take apical-radial pulse for 1 minute. Record and notify prescriber of significant changes (sudden increase or decrease in pulse rate, pulse deficit, irregular beats and, particularly, regularization of a previously irregular rhythm). If these occur, check blood pressure and obtain a 12-lead ECG. Toxic effects on the heart may be life-threatening and require immediate attention. Absorption of digoxin from liquid-filled capsules is superior to absorption from tablets or elixir. Expect dosage reduction of 20% to 25% when changing from tablets or elixir to liquid-filled capsules or parenteral therapy. Monitor digoxin level. Therapeutic level ranges from 0.8 to 2 ng/ml. Obtain blood for digoxin level at least 6 to 8 hours after last oral dose, preferably just before next scheduled dose. Alert: Excessively slow pulse rate (60 beats/minute or less) may be a sign of digitalis toxicity. Withhold drug and notify prescriber. Monitor potassium level carefully. Take corrective action before hypokalemia occurs. Hyperkalemia may result from digoxin toxicity. Reduce drug dose for 1 or 2 days before elective cardioversion. Adjust dosage after cardioversion. Look alike-sound alike: Don't confuse digoxin with doxepin.

Patient teaching Teach patient and a responsible family member about drug action, dosage regimen, how to take pulse, reportable signs, and follow-up care. Tell patient to report pulse less than 60 beats/minute or more than 110 beats/minute, or skipped beats or other rhythm changes. Instruct patient to report adverse reactions promptly. Nausea, vomiting, diarrhea, appetite loss, and visual disturbances may be indicators of toxicity.

Encourage patient to eat potassium-rich foods. Tell patient not to substitute one brand for another. Advise patient to avoid the use of herbal drugs or to consult his prescriber before taking one.

Generic name: ISOSORBIDE DINITRATE Brand names: Isordil, Isordil Titradose Pharmacologic Class: nitrate Therapeutic Class: antianginal, vasodilator Indications: Acute anginal attacks (S.L. isosorbide dinitrate only); to prevent situations that may cause anginal attacks Mechanism of Action: -Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood flow through the collateral coronary vessels. -Isosorbide dinitrate relaxes vascular smooth muscles by stimulating cyclic-GMP. It decreases left ventricular pressure (preload) and arterial resistance (afterload).

Adverse reactions: CNS: headache, dizziness, weakness. CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing. EENT: S.L. burning. GI: nausea, vomiting. Skin: cutaneous vasodilation, rash. Contraindications & cautions: -Contraindicated in patients with hypersensitivity or idiosyncrasy to nitrates and in those with severe hypotension, angle-closure glaucoma, increased intracranial pressure, shock, or acute MI with low left ventricular filling pressure. -Use cautiously in patients with blood volume depletion (such as from diuretic therapy) or mild hypotension. Nursing considerations: -To prevent tolerance, a nitrate-free interval of 10 to 14 hours per day is recommended. The regimen for isosorbide mononitrate (1 tablet on awakening with the second dose in 7 hours, or 1 extended-release tablet daily) is intended to minimize nitrate tolerance by providing a substantial nitrate-free interval. -Monitor blood pressure and intensity and duration of drug response. -Drug may cause headaches, especially at beginning of therapy. Dosage may be reduced temporarily, but tolerance usually develops. Treat headache with aspirin or acetaminophen. -Methemoglobinemia has been seen with nitrates. Symptoms are those of impaired oxygen delivery despite adequate cardiac output and adequate arterial partial pressure of oxygen. -Look alike-sound alike: Don't confuse Isordil with Isuprel or Inderal.

Patient teaching: -Caution patient to take drug regularly, as prescribed, and to keep it accessible at all times. -Alert: Advise patient that stopping drug abruptly may cause spasm of the coronary arteries with increased angina symptoms and potential risk of heart attack. -Tell patient to take S.L. tablet at first sign of attack. He should wet tablet with saliva and place under his tongue until absorbed; he should sit down and rest. Dose may be repeated every 10 to 15 minutes for a maximum of three doses. If drug doesn't provide relief, tell patient to seek medical help promptly. -Advise patient who complains of tingling sensation with S.L. drug to try holding tablet in cheek. -Warn patient not to confuse S.L. with P.O. form. -Advise patient taking P.O. form of isosorbide dinitrate to take oral tablet on an empty stomach either 30 minutes before or 1 to 2 hours after meals and to swallow oral tablets whole. -Tell patient to minimize dizziness upon standing up by changing to upright position slowly. Advise him to go up and down stairs carefully and to lie down at first sign of dizziness. -Caution patient to avoid alcohol because it may worsen low blood pressure effects. -Advise patient that use of sildenafil, tadalafil, or vardenafil with any nitrate may cause severe low blood pressure. Patient should talk to his prescriber before using these drugs together. -Instruct patient to store drug in a cool place, in a tightly closed container, and away from light.

Generic name: CAPTOPRIL Brand name: Acenorm, Capoten, Enzace, Novo-Captoril Pharmacologic Class: ACE inhibitor Therapeutic Class: antihypertensive Indications & dosages: Hypertension ; Diabetic nephropathy ; Heart failure ;Left ventricular dysfunction after acute MI Mechanism of Action: Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure. Adverse reactions: CNS: dizziness, fainting, headache, malaise, fatigue, fever. CV: tachycardia, hypotension, angina pectoris. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting. Hematologic: leukopenia, agranulocytosis, pancytopenia, anemia, thrombocytopenia. Metabolic: hyperkalemia. Respiratory: dyspnea, dry, persistent, nonproductive cough. Skin: urticarial rash, maculopapular rash, pruritus, alopecia. Other: angioedema.

Contraindications & cautions: -Contraindicated in patients hypersensitive to drug or other ACE inhibitors. -Use cautiously in patients with impaired renal function or serious autoimmune disease, especially systemic lupus erythematosus, and in those who have been exposed to other drugs that affect WBC counts or immune response.

Nursing considerations: -Monitor patient's blood pressure and pulse rate frequently. -Alert: Elderly patients may be more sensitive to drug's hypotensive effects. -Assess patient for signs of angioedema. -Drug causes the most frequent occurrence of cough, compared with other ACE inhibitors. -In patients with impaired renal function or collagen vascular disease, monitor WBC and differential counts before starting treatment, every 2 weeks for the first 3 months of therapy, and periodically thereafter. -Look alike-sound alike: Don't confuse captopril with Capitrol.

Patient teaching: -Instruct patient to take drug 1 hour before meals; food in the GI tract may reduce absorption. -Inform patient that light-headedness is possible, especially during first few days of therapy. Tell him to rise slowly to minimize this effect and to report occurrence to prescriber. If fainting occurs, he should stop drug and call prescriber immediately. -Tell patient to use caution in hot weather and during exercise. Lack of fluids, vomiting, diarrhea, and excessive perspiration can lead to lightheadedness and syncope. -Advise patient to report signs and symptoms of infection, such as fever and sore throat. -Tell women to notify prescriber if pregnancy occurs. Drug will need to be stopped. -Urge patient to promptly report swelling of the face, lips, or mouth; or difficulty breathing.

Generic name: METOCLOPRAMIDE HCL Brand name: plasil Pharmacologic Class: dopamine antagonist Indications: Disturbances of gastrointestinal motility, including gastroesophageal reflux and diabetic gastroparesis (diabetic gastric stasis). Nausea and vomiting of central and peripheral origin associated with surgery, metabolic diseases, infectious diseases, migraine headache, or drugs including cancer chemotherapy. To facilitate small bowel intubation and radiological procedures of gastrointestinal tract. Mechanism of Action: -Pharmacology: Metoclopramide, a dopamine antagonist, stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. The effect of metoclopramide on motility is not dependent on intact vagal innervation but it can be abolished by anticholinergic drugs. Metoclopramide increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenum and jejunum, resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower esophageal sphincter. -Pharmacokinetics: Peak plasma levels are reached 30-60 min following an oral dose. Excretion is primarily in the urine. The plasma half-life is about 3 hrs. Metoclopramide undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal.

Adverse reactions: The most frequent adverse reactions to metoclopramide are restlessness, drowsiness, fatigue and lassitude which occur in approximately 10% of patients. Less frequently, extrapyramidal symptoms, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, rash including urticaria, or bowel disturbances may occur. Contraindications & cautions: -Contraindicated in patients hypersensitive to drug or and in those with pheochromocytoma or seizure disorders -Contraindicated in patients for whom stimulation of GI mobility might be dangerous (those with hemorrhage, obstruction, or perforation) -Use cautiously in patients with history of depression, Parkinsons disease, or hypertension

Nursing considerations: -Monitor bowel sounds -Alert: Use 2.5 mg. diphenhydramine IV to counteract extrapyramidal adverse effects from high doses -Safety and effectiveness of drug havent been established for therapy lasting longer than 12 weeks

Patient teaching: -Tell patient to avoid activities that require alertness 2 hours after doses -Urge patient to report persistent or serious adverse reactions promptly -Advise patient not to drink alcohol during therapy Generic name: SALBUTAMOL Brand name: Activent, Aero-vent, Airomir, Ventolin Pharmacologic Class: Bronchodilator Administration: Should be taken on an empty stomach (i.e. At least one hour before food or four hours after food). (Take 1 hr before or 2 hr after meals.) Indications: Acute bronchospasm ; Uncomplicated premature Labor Severe bronchospasm ; Acute bronchospasm ; Acute severe asthma ; Severe or unresponsive Bronchospasm Mechanism of Action:

Salbutamol is a direct-acting sympathomimetic with b-adrenergic activity and selective action on b2 receptors, producing bronchodilating effects. It also decreases uterine contractility. Onset: Inhalation: 5-15 min; oral: 30 min. Duration: Inhalation: 3-6 hr; oral: 8 hr; modified-release preparation: 12 hr.

Adverse reactions: CNS: dizziness, fainting, headache, malaise, fatigue, fever. CV: tachycardia, hypotension, angina pectoris. GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting. Hematologic: leukopenia, agranulocytosis, pancytopenia, anemia, thrombocytopenia. Metabolic: hyperkalemia. Respiratory: dyspnea, dry, persistent, nonproductive cough. Skin: urticarial rash, maculopapular rash, pruritus, alopecia. Other: angioedema.

Contraindications & cautions: -Contraindicated with patients with eclampsia and severe pre-eclampsia; intra-uterine infection, intra-uterine foetal death, antepartum haemorrhage, placenta praevia and cord compression, threatened miscarriage, cardiac disease. -Use cautiously in patients with pregnancy; mild to moderate pre-eclampsia. Arrhythmias, hyperthyroidism, hypertension, DM, myocardial insufficiency, susceptibility to QT-interval prolongation. Monitor serum potassium levels. In women treated for premature labour, monitor hydration status, cardiac and respiratory function. Minimise volume of infusion fluid. Discontinue treatment if patient develops signs of pulmonary oedema. Nursing considerations and Patient teaching: -Use cautiously in patients with cardiovascular disorders. -Syrup is available for children as young as age 2. -Inhaler may be used 15 minutes before exercise to prevent exercise-induced bronchospasm. -Patient may use tablets and inhaler at the same time. Monitor for toxicity. -Warn the patient about the risk of paradoxical bronchospasm and if it occurs, stop drug immediately. -Teach patient to use the inhaler correctly: Shake it, clear the throat, expel as much air as possible from the lungs, inhale deeply while releasing the drug from the inhaler, hold breath for several seconds. -Use of a spacer may improve delivery. -Wait for 2 minutes between puffs of inhaler. -If the patient is also using a steroid inhaler, use the bronchodilator first, then wait 5 minutes before using the steroid. -Wash the canister with warm water and soap at least once a week. Generic name: DIPHENHYDRAMINE HCl Brand name: Benadryl, Allerdryl, Nervine Pharmacologic Class: ethanolamine-derivative Therapeutic Class: antihistamine Indications & dosages: Rhinitis, allergy symptoms, motion sickness, Parkinson disease ; Sedation Nighttime sleep aid ; Nonproductive cough (syrup only) Mechanism of Action: -Competes with histamine for H1-receptor sites. Prevents, but doesnt reverse, histamine-mediated responses, particularly those of the bronchial tubes, GI tract, uterus, and blood vessels. Structurally related to local anesthetics, drug provides local anesthesia and suppresses cough reflex - Diphenhydramine blocks histamine H1-receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action.

Adverse reactions: CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias. Contraindications & cautions: -Contraindicated in patients who has hypersensitivity ; neonates, lactation.. -Use cautiously in patients with epilepsy; elderly; performing tasks which require mental alertness; angle-closure glaucoma; pyroduodenal obstruction; urinary tract obstruction; hyperthyroidism; raised intraocular pressure; CV disease; acute asthma; pregnancy.

Nursing considerations: -Stop drug 4 days before diagnostic skin testing -Alternate injections sites to prevent irritation. Give I.M. injection deep into large muscle -Dizziness, excessive sedation, syncope, toxicity, paradoxical stimulation, and hypotension are more likely to occur in the elderly -Look alike-sound alike: Don't confuse diphenhydramine with diphenhydraminate; dont confuse Benadryl with Bentyl or benazepril

Patient teaching:

-Warn patient not to take this drug with any other products that contain diphenhydramine (including topical therapy) because of increased adverse reactions -Instruct patient to take drug 30 minutes before travel to prevent motion sickness -Tell patient to take diphenhydramine with food or mild to reduce GI distress -Warn patient to avoid alcohol and hazardous activities that require alertness until CNS effects of drug are known -Tell patient that coffee or tea may reduce drowsiness. Urge caution if palpitations develop -Inform patient that sugarless gum, hard candy, or ice chips may relieve dry mouth -Tell patient to notify prescriber if tolerance develops because a different anthistamine may need to be prescribed -Drugs is in many OTC sleep and cold products. Advise patient to consult prescriber before using these products -Warn patient of possible photosensitivity reactions. Advise use of sunblock. Generic name: BUDESONIDE Brand names: Entocort EC, budecort Pharmacologic Class: glucocorticoids Therapeutic Class: anti-inflammatory Indications Inflammatory bowel disease ; Prophylaxis and treatment of rhinitis ; Nasal polyps; asthma Mechanism of Action -Significant glucocorticoid effects caused by drug's high affinity for glucocorticoid receptors. - Budesonide controls the rate of protein synthesis, depresses the migration of polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability and lysosomal stabilisation at the cellular level to prevent or control inflammation.

Adverse reactions CNS: headache, dizziness, asthenia, hyperkinesia, paresthesia, tremor, vertigo, fatigue, malaise, agitation, confusion, insomnia, nervousness, somnolence. CV: chest pain, hypertension, palpitations, tachycardia, flushing. EENT: facial edema, ear infection, eye abnormality, abnormal vision, sinusitis. GI: nausea, diarrhea, dyspepsia, abdominal pain, flatulence, vomiting, anal disorder, aggravated Crohn disease, enteritis, epigastric pain, fistula, glossitis, hemorrhoids, intestinal obstruction, tongue edema, tooth disorder, increased appetite. GU: dysuria, micturition frequency, nocturia, intermenstrual bleeding, menstrual disorder, hematuria, pyuria. Hematologic: leukocytosis, anemia. Metabolic: hypercorticism, dependent edema, hypokalemia, increased weight. Musculoskeletal: back pain, aggravated arthritis, cramps, arthralgia, myalgia. Respiratory: respiratory tract infection, bronchitis, dyspnea. Skin: acne, alopecia, dermatitis, eczema, skin disorder, increased sweating. Other: flulike disorder, sleep disorder, candidiasis, viral infection, pain.

Contraindications & cautions -Contraindicated in patients hypersensitive to drug. -Use cautiously in patients with tuberculosis, hypertension, diabetes mellitus, osteoporosis, peptic ulcer disease, glaucoma, or cataracts; those with a family history of diabetes or glaucoma; and those with any other condition in which glucocorticosteroids may have unwanted effects. -Glucocorticoids appear in breast milk, and infants may have adverse reactions. Use cautiously in breast-feeding women only if benefits outweigh risks.

Nursing considerations: -Reduced liver function affects elimination of this drug; systemic availability of drug may increase in patients with liver cirrhosis. -Patients undergoing surgery or other stressful situations may need systemic glucocorticoid supplementation in addition to budesonide therapy. -Carefully monitor patients transferred from systemic glucocorticoid therapy to budesonide for signs and symptoms of corticosteroid withdrawal. Watch for immunosuppression, especially in patients who haven't had diseases, such as chickenpox or measles; these can be fatal in patients who are immunosuppressed or receiving glucocorticoids. -Replacement of systemic glucocorticoids with this drug may unmask allergies, such as eczema and rhinitis, which were previously controlled by systemic drug. -Long-term use of drug may cause hypercorticism and adrenal suppression.

Patient teaching: -Tell patient to swallow capsules whole and not to chew or break them. -Advise patient to avoid grapefruit juice while taking drug. -Tell patient to notify prescriber immediately if he is exposed to or develops chickenpox or measles.

Generic name: LIDOCAINE HYDROCHLORIDE Brand names: Lidopen Autoinjector, Xylocaine Pharmacologic Class: amide derivative Therapeutic Class: antiarrhythmics Indications VENTRICULAR ARRHYTHMIAS IN ADVANCED CARDIAC LIFE SUPPORT FOR CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION AND PULSELESS VENTRICULAR TACHYCARDIA ; INTRAVENOUS REGIONAL ANAESTHESIA ; VENTRICULAR ARRHYTHMIAS IN STABLE PATIENTS; EMERGENCY TREATMENT OF VENTRICULAR ARRHYTHMIAS ; SYMPATHETIC NERVE BLOCK; INFILTRATION ANAESTHESIA; PERIPHERAL NERVE BLOCK ; HAEMORRHOIDS ; SURFACE ANAESTHESIA ; PERIANAL PAIN AND ITCHING ; EPIDURAL ANAESTHESIA ; PUPIL DILATATION DURING PHACOEMULSIFICATION CATARACT SURGERY ; SPINAL ANAESTHESIA Mechanism of Action -Lidocaine is an amide type local anaesthetic. It stabilises the neuronal membrane and inhibits sodium ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces phase 4 depolarisation and automaticity. Duration of action potential and effective refractory period are also reduced. -A class IB antiarrhythmic that decreases the depolarization, automacity, and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the Purkinje network

Adverse reactions Dizziness, paraesthesia, drowsiness, confusion, respiratory depression and convulsions. Contraindications & cautions -Contraindicated in patients hypersensitive to drug; to patients with hypovolaemia; heart block or other conduction disturbances. -Use cautiously in patients with hepatic or renal impairment; CHF and following cardiac surgery; bradycardia; respiratory depression; porphyria; elderly or debilitated patients; pregnancy.

Nursing considerations: -Give IM injections in the deltoid muscle only -Monitor isoenzymes when using IM drug for suspected MI. A patient who has received IM lidocaine will show a sevenfold increase in CK level. Such an increase originates in the skeletal muscle, not the heart -Monitor drug level. Therpeutic levels are 2 to 5 mcg/mL -Alert: Monitor patient for toxicity. In many severly ill patients, seizueres may be the first sign of toxicity, but sever reactions are usually preceded by somnolence, confusion, tremors, and paresthesia. If signs of toxicity occur, stop drug at once and notify prescriber. Contuining it may lead to seizures and coma. Give oxygen through nasal cannula if not contraindicated. Keep oxygen and cpr equipment available. -Monitor patients response, esp bp and electrolytes, BUN and crea levels -If arrhytmias worsen or ECG changes, stop infusion and notify prescriber

Patient teaching: -For IM form, tell patient that drug may cause soreness at injection site. Tell him to report discomfort at the site -Tell patient to report adverse reactions promptly because toxicity can occur

GENERIC NAME: KETOROLAC Pharmacologic Class: Analgesics (Non-Opioid) & Antipyretics, Other Eye Preparations Indications & dosages Short-term management of moderate to severe pain Mechanism of Action Ketorolac inhibits prostaglandin synthesis by decreasing the activity of the cyclooxygenase enzyme. Onset: 30-60 min (oral); 10 min (IM). Duration: 6-8 hr (oral/IM).

Adverse reactions -GI ulcer, bleeding and perforation, drowsiness, rash, bronchospasm, hypotension, psychosis, dry mouth, fever, bradycardia, chest pain, dizziness, headache, sweating, oedema, pallor, liver function changes. -Transient stinging and local irritation (ophthalmic). Contraindications -Hypersensitivity to aspirin or other NSAIDs, asthma. Hypovolaemia or dehydration. Do not give postoperatively to patients with high risk of haemorrhage. History of peptic ulcer or coagulation disorders. Nasal polyps, angioedema, bronchospasm. Labour. Moderate to severe renal impairment. GI bleeding, cerebrovascular bleeding. As prophylactic analgesic before surgery. Pregnancy, lactation.

Nursing considerations -Elderly, patients weighing <50 kg, hepatic dysfunction, heart failure, predisposition to reduced blood volume or renal blood flow. Mild renal impairment; monitor renal function closely.

GENERIC NAME: ACETYLSALYCILIC ACID Brand Name: aspirin Pharmacologic Class: Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics), Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Administration: Should be taken with food. Mechanism of Action Aspirin is an analgesic, anti-inflammatory and antipyretic. It inhibits cyclooxygenase, which is responsible for the synthesis of prostaglandin and thromboxane. It also inhibits platelet aggregation.

Indications & dosages MILD TO MODERATE PAIN AND FEVER Adult: 325-650 mg repeated every 4-6 hr according to response. Max: 4 g/day. May also be given rectally. Max Dosage: ACUTE AND CHRONIC MUSCULOSKELETAL CONDITIONS AND RHEUMATIC DISORDERS Adult: Initial: 2.4-3.6 g/day in divided doses. Usual maintenance: 3.6-5.4 g/day. Monitor serum concentrations.

Adverse reactions - GI disturbances; prolonged bleeding time, rhinitis, urticaria and epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm. Nursing considerations - History of peptic ulcer or those prone to dyspepsia and those with gastric mucosal lesion; asthma or allergic disorders; dehydrated patients; uncontrolled hypertension; impaired renal or hepatic function; elderly.

Generic Name: AMIODARONE HCl Brand Name: Aratac, Cordarone, Pharmacologic Class: benzofuran derivative Therapeutic Class: antiarrhythmic Indications: Life-threatening recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia unresponsive to adequate doses of other antiarrhythmics or when alternative drugs can't be tolerated Mechanism of Action Effects result from blockade of potassium chloride leading to a prolongation of action potential duration. Adverse reactions

CNS: peripheral neuropathy, ataxia, paresthesia, tremor, insomnia, sleep disturbances, headache, malaise, fatigue. CV: bradycardia, hypotension, arrhythmias, heart failure, heart block, sinus arrest, edema. EENT: asymptomatic corneal microdeposits, optic neuropathy or neuritis resulting in visual impairment, abnormal smell, visual disturbances. GI: abnormal taste, anorexia, nausea, vomiting, constipation, abdominal pain. Hematologic: coagulation abnormalities. Hepatic: hepatic dysfunction, hepatic failure. Metabolic: hypothyroidism, hyperthyroidism. Respiratory: acute respiratory distress syndrome, SEVERE PULMONARY TOXICITY. Skin: photosensitivity, solar dermatitis, blue-gray skin. Contraindications & cautions Contraindicated in patients hypersensitive to drug or to iodine.. Contraindicated in those with cardiogenic shock, second- or third-degree AV block, severe SA node disease resulting in bradycardia unless an artificial pacemaker is present, and in those for whom bradycardia has caused syncope. Use cautiously in patients receiving other antiarrhythmics. Use cautiously in patients with pulmonary, hepatic, or thyroid disease.

Nursing considerations Be aware of the high risk of adverse reactions. Obtain baseline pulmonary, liver, and thyroid function test results and baseline chest X-ray. Give loading doses in a hospital setting and with continuous ECG monitoring because of the slow onset of antiarrhythmic effect and the risk of lifethreatening arrhythmias. Divide oral loading dose into two or three equal doses and give with meals to decrease GI intolerance. Give maintenance dose once daily or divide into two doses, with meals to decrease GI intolerance. Alert: Drug may pose life-threatening management problems in patients at risk for sudden death. Use only in patients with life-threatening, recurrent ventricular arrhythmias unresponsive to or intolerant of other antiarrhythmics or alternative drugs. Amiodarone can cause fatal toxicities, including hepatic and pulmonary toxicity. Alert: Drug is highly toxic. Watch carefully for pulmonary toxicity. Risk increases in patients receiving doses over 400 mg/day. Watch for evidence of pneumonitis, exertional dyspnea, nonproductive cough, and pleuritic chest pain. Monitor pulmonary function tests and chest X-ray. Monitor liver and thyroid function test results and electrolyte, particularly potassium and magnesium, levels. Monitor PT and INR if patient takes warfarin and digoxin level if he takes digoxin. Instill methylcellulose ophthalmic solution during amiodarone therapy to minimize corneal microdeposits. About 1 to 4 months after starting amiodarone, most patients develop corneal microdeposits, although 10% or less have vision disturbances. Regular ophthalmic examinations are advised. Monitor blood pressure and heart rate and rhythm frequently. Perform continuous ECG monitoring when starting or changing dosage. Notify prescriber of significant change in assessment results. Life-threatening gasping syndrome may occur in neonates given I.V. solutions containing benzyl alcohol. Look alike-sound alike: Don't confuse amiodarone with amiloride.

Patient teaching

Advise patient to wear sunscreen or protective clothing to prevent sensitivity reaction to the sun. Monitor patient for skin burning or tingling, followed by redness and blistering. Exposed skin may turn blue-gray. Tell patient to take oral drug with food if GI reactions occur. Inform patient that adverse effects of drug are more common at high doses and become more frequent with treatment lasting longer than 6 months, but are generally reversible when drug is stopped. Resolution of adverse reactions may take up to 4 months.

Generic Name: MANNITOL Brand Name: Osmitrol Pharmacologic Class: Osmotic diuretic Indications: Test dose for marked oliguria or suspected inadequate renal function; Oliguria; To prevent oliguria or acute renal failure; To reduce intraocular or intracranial pressure; Diuresis in drug intoxication; Irrigating solution during transurethral resection of prostate gland Mechanism of Action Increases osmotic pressure of glomerular filtrate, inhibiting tubular reabsorption of water and electrolytes; drug elevates plasma osmolarity, increasing water flow into ECF Adverse reactions CNS: seizures, dizziness, headache, fever CV: edema, thrombophlebitis, hypotension, hypertension, heart failure, tachycardia, angina-like chest pain, vascular overload EENT: blurred vision, rhinitis GI: thirst, dry mouth, nausea, vomiting, diarrhea Metabolic: dehydration Skin: local pain, urticaria Other: chills Contraindications & cautions Contraindicated in patients hypersensitive to drug or to iodine.. Contraindicated in those with anuria; severe pulmonary congestion; frank pulmonary edema; active intracranial bleeding; sever dehydration; metabolic edema; previous progressive renal disease

Nursing considerations Monitor vital signs, including central venous pressure and fluid intake and output hourly; report increasing oliguria. In comttose or incontinent patient, use urinary catheter because therapy is based on strict evaluation of fluid intake and output Drug can be used to measure GFR To relieve thirst, give frequent mouth care of fluids Dont give electrolyte free solutions with blood

Patient teaching Tell patient that he may feel thirsty or have dry mouth and emphasize importance of drinking only the amount of fluids ordered Instruct patient to promptly report adverse reactions and discomfort at IV site.

Generic Name: NALBUPHINE HCl Brand Name: Nubain Pharmacologic Class: opiod agonist-antagonis, opioid partial agonist Indications: Moderate to severe pain; adjunct to balance anesthesia Mechanism of Action Unknown. Binds with opiate receptors in the CNS, altering perception of and emotional response to pain Adverse reactions CNS: dizziness, headache, sedation, vertigo, confusion, crying, delusions, depression, euphoria, hallucinations, hostility, nervousness, restlessness, speech disorders, unusual dreams CV: bradycardia, hypertension, hypotension, tachycardia EENT: blurred vision, dry mouth GI: biliary tract spasms, constipation, cramps, dyspepsia, nausea, vomiting GU: urinary urgency Respiratory: respiratory depression, asthma, dyspnea, pulmonary edema Skin: burning, clamminess, diaphoresis, pruritus, urticaria Contraindications & cautions Contraindicated in patients hypersensitive to drug or to iodine.. Use cautiously in patients with history of drug abuse 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

Nursing considerations Reassess patients level of pain at least 15 to 30 minutes after parenteral administration Drug actis as an opioid antagonist and may cause withdrawal syndrome Monitory circulatory and respiratory status and bladder and bowel function. Constipation is often sever with maintenance therapy Psychological and physical dependence my occur with prolonged use

Patient teaching Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other hazardous activities that require mental alertness until drugs CNS effects are known Teach patient how to manage troublesome adverse effects such as constipation

Generic Name: TERBUTALINE SULFATE Brand Name: Brethien Pharmacologic Class: Beta2 agonist Indications: Bronchospasm in patients with reversible obstructive airway disease Mechanism of Action Relaxes bronchial smooth muscle by stimulating beta2 receptors Adverse reactions CNS: nervousness, tremor, drowsiness, dizziness, headache, weakness CV: palpitations, arrhythmias, tachycardia, flushing GI: nausea, vomiting, heartburn Metabolic: hypokalemia Skin: diaphoresis

Contraindications & cautions Contraindicated in patients hypersensitive to drug or to iodine.. Use cautiously in patients with CV disorders, hyperthyroidism, diabetes, or seizure disorder

Nursing considerations Give subcutaneous injections in the side of the deltoid\ Protect drug from light. Dont use if discolored Drug may reduce the sensitivity of spirometry for the diagnosis of bronchospasm

Patient teaching Make sure patient and caregivers understand why drug is given Remind patient to separate oral doses by 6 hours

Generic Name: DOPAMINE HCl Brand Name: Intropin Pharmacologic Class: adrenergic Indications: To treat shock and correct hemodynamic imbalances; to improve perfusion to vital organs; to increase cardiac output; to correct hypotension Mechanism of Action Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system resulting in a positive inotropic effect and increased cardiac output. Action is dose-related; large doses cause mainly alpha stimulation Adverse reactions CNS: headache, anxiety CV: hypotension, ventricular arrhytmias, ectopic beats, tachycardia, angina, palpitations, vasoconstriction GI: nausea, vomiting Metabolic: azotemia, hyperglycemia Respiratory: asthmatic episodes, dyspnea Skin: necrosis and tissue sloughing with extravasation, piloerection Other: anaphylactic reactions Contraindications & cautions

Contraindicated in patients hypersensitive to drug or to iodine.. Contraindicated in patients having uncorrected tachyarrhythmias, pheochromocytoma, or ventricular fibrillation

Nursing considerations Drug isnt a substitute for blood or fluid volume deficit. If deficit exists, replace fluid before giving vasopressors During infusion, frequently monitor ECG, BP, CO, CVP, PAWP, PR, U/O, and color and temperature or the limbs Observe patient closely for adverse reaction; dosage may need to be adjusted or drug stopped Check urine output often. If urine flow decreases without hypotension, notify prescriber because dosage may need to be reduced Acidosis decreases effectiveness of drug

Patient teaching Tell patient to report adverse reactions promptly Instruct patient to report any discomfort at IV insertion site

Generic Name: SODIUM BICARBONATE Brand Name: Soda Mint, Neut Pharmacologic Class: Alkalinizer Indications: Metabolic acidosis, Systemic or urinary alkalinization, antacid, cardiac arrest Mechanism of Action Restores buffering capacity of the body and neutralizes excess acid Adverse reactions CNS: tetany CV: edema GI: gastric distention, belching, flatulence Metabolic: hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose Skin: pain and irritation at injection site Contraindications & cautions Contraindicated in patients with metabolic or respiratory alkalosis and in those with hypocalcemia Contraindicated in patients losing chloride because of vomiting or continuous GI suction and in those receiving diuretics that produce hypochloremic alkalosis Use with caution in patients with renal insufficiency, heart failure, or other edematous or sodium-retaining condtion.

Nursing considerations To avoid risk of alkalosis, obtain blood pH, parial pressure of arterial oxygen, partial pressure of CO2, and electrolyte levels. Tell prescriber laboratory results Oral products may contain 27% sodium

Patient teaching Tell patient not to take drug with milk because doing so may cause high levels of calcium in the blood, abnormally high alkalinity in tissues and fluids, or kidney stones.

Generic Name: CITICOLINE Brand Name: Zynapse, Cholinerv Pharmacologic Class: antispasmodic; Nootropics & Neurotonics Indications: Cerebrovascular disorders and head injury; parkinsonism Mechanism of Action Citicoline increases blood flow and O2 consumption in the brain. It is also involved in the biosynthesis of lecithin. Adverse reactions CNS: tetany CV: edema GI: gastric distention, belching, flatulence Metabolic: hypokalemia, metabolic alkalosis, hypernatremia, hyperosmolarity with overdose Skin: pain and irritation at injection site Administration: May be taken with or without food. (Take w/ or between meals.) Nursing considerations Ensure clients safety Monitor vital signs Patient teaching Tell patient not to engage into any activity that require alertness

Generic Name: TRANEXAMIC ACID Brand Name: Pantrex, Cyclotrax, Hemostan Pharmacologic Class: antifibrinolytic agent ; hemostat Indications: Short-term management of hemorrhage; long-term management of hereditary angioedema Mechanism of Action Tranexamic acid is an antifibrinolytic agent that competitively inhibits breakdown of fibrin clots. It blocks binding of plasminogen and plasmin to fibrin, thereby preventing haemostatic plug dissolution. Adverse reactions Diarrhoea, nausea, vomiting, disturbances in colour vision, giddiness, hypotension (after rapid IV inj), thromboembolic events. Contraindications & cautions Severe renal failure, active intravascular clotting, thromboembolic disease, colour vision disorders, subarachnoid bleeding. Increased risk of thrombus formation with estrogens, Factor IX complex concentrates or anti-inhibitor coagulant concentrates. Increased risk of fatal thrombotic complications with tretinoin in acute promyelocytic leukaemia. Nursing considerations Ensure clients safety Monitor vital signs Monitro tendencies of bleeding Check platelet count, bleeding time and prothrombin time Patient teaching Tell patient not to engage into any activity that require alertness

NASAL CANNULA used to administer oxygen GAS MASK used to deliver oxygen in higher concentrations that the nasal cannula SUCTION CATHETER used to suction drainages from the respiratory system INDWELLING FOLEY CATHETER used to resolve urinary retention and prepare the client pre-operatively STRAGHT CATHETER used to resolve urinary retention, distended bladder and to acquire urine specimen SOLU-SET used to measure exact dosages of IV meds during infusion HOSPICE BAG for urine collection connected to the IFC PEDIA URINE COLLECTOR for urine collection of pedriatric urine IV INFUSION SET used to deliver IV fluids directly to the venous system BOTTLES OF DISTILLED WATER used to dilute medications GLASS SLIDES used for placing specimens for laboratory evaluation MICROPORE used to hold IV cannulas, sponges and gauze in place BATTERIES used in providing energy in the laryngoscope LARYNGOSCOPE Instrument used in viewing the lower repiratory tract, in placing the endotracheal tube and gaining access to the GIT system GUIDE WIRE used in guiding the ET tube down the larynx, trachea and the lower airways KY JELLY for lubrication of instruments (ie. catheters) and the fingers during examination SYRINGES used for injection and aspiration of medication

MICROHEMATOCRIT TUBES used for blood collection for laboratory evaluation MEASURING TAPE

 used to measure body proportions during physical examination WITHDRAWAL CANNULA used to withdraw large amounts of IV fluid during emergency (ie. mannitol and dextrose) NASOGASTRIC TUBE used in gaining access to the GI system directly to the stomach when the patient is unable to take food p.o. ASEPTOSYRINGES used to aspirate fluid for cleansing wound and NGT feeding AMBU Bag - used to deliver O2 manually in cases of arrest

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