METRONIDAZOLE

A. Drug classes
 Antibiotic
 Antibacterial
 Amebicide
 Antiprotozoal

B. Therapeutic actions
Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death;
antiprotozoal-trichomonacidal, amebicidal: biochemical mechanism of action is not known.

C. Indications
 Acute infection with susceptible anaerobic bacteria
 Acute intestinal amebiasis
 Amebic liver abscess
 Trichomoniasis (acute and partners of patients with acute infection)
 Preoperative, intraoperative, postoperative prophylaxis for patients undergoing colorectal
surgery
 Topical application in the treatment of inflammatory papules, pustules, and erythema of
rosacea
 Unlabeled uses: prophylaxis for patients undergoing gynecologic, abdominal surgery; hepatic
encephalopathy; Crohn's disease; antibiotic-associated pseudomembranous colitis; treatment
of Gardnerella vaginalis, giardiasis (use recommended by the CDC)

D. Contraindications/cautions
 Contraindications: hypersensitivity to metronidazole; pregnancy (do not use for
trichomoniasis in first trimester).
 Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrasias,
lactation.

E. Dosage
Available Forms: Tablets--250, 500 mg; ER tablets--750 mg; capsules--375 mg; powder for
injection--500 mg; injection--500 mg/100 ml; powder for injection--500 mg

1
 ADULT DOSE-
15mg/kg IV every 6 hours.
500mg/100 ml T.D.S. for 3-5 days.

F. Pharmacokinetics

Route Onset Peak

Oral Varies 1---2 h

IV Rapid 1---2 h

Topical Not generally absorbed systemically

G. Adverse effects
 CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral
neuropathy, fatigue
 GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps
 GU: Dysuria, incontinence, darkening of the urine
 Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation(topical)
 Other: Severe, disulfiram---like interaction with alcohol, candidiasis (superinfection)

NURSES RESPONSIBILITY

 Check vitals and close monitoring

 Monitor I&O ratio
 Monitor for hepatotoxicity
 Monitor allergic reaction
 Monitor elctrolyte balance
 Assess for central nervous system symptoms
 Assess for over growht of infection

2
 IBUPROFEN

A. Drug classes
 Nonsteroidal anti-inflammatory drug (NSAID)
 Analgesic (non-narcotic)
 Propionic acid derivative

B. Therapeutic actions
Anti-inflammatory, analgesic, and antipyretic activities largely related to inhibition of
prostaglandin synthesis; exact mechanisms of action are not known.

C. Indications
 Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
 Relief of mild to moderate pain
 Treatment of primary dysmenorrhea
 Fever reduction

D. Contraindications/cautions
 Contraindications: allergy to ibuprofen, salicylates, or other NSAIDs (more common in
patients with rhinitis, asthma, chronic urticaria, nasal polyps); CV dysfunction, hypertension;
peptic ulceration, GI bleeding; pregnancy; lactation.
 Use cautiously with impaired hepatic or renal function.

E. Dosage
Available Forms: Tablets--100, 200, 400, 600, 800 mg; chewable tablets--50, 100 mg;
capsules--200 mg; suspension--100 mg/2.5 mL, 100 mg/5mL; oral drops--40 mg/Ml. Do not
exceed 3200 mg/d.

ADULT DOSE-
400 mg every four hours as neded.

3
F. Adverse effects
 CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus,
ophthalmologic effects
 GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, GI bleeding
 Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis
 Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia,
leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic
anemia, decreased Hgb or Hct, bone marrow depression
 GU: Dysuria, renal impairment, menorrhagia
 Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
 Other: Peripheral edema, anaphylactoid reactions to fatal anaphylactic shock

NURSES RESPONSIBILITY

 Check vitals and close monitoring

 Monitor I&O ratio
 Monitor for hepatotoxicity
 Monitor allergic reaction
 Monitor elctrolyte balance
 Assess for central nervous system symptoms

4
 DIAZEPAM

A. Drug classes
 Benzodiazepine
 Anxiolytic
 Antiepileptic
 Skeletal muscle relaxant (centrally acting)

B. Therapeutic actions
Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation;
may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation; potentiates the
effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those
necessary to cause sedation, ataxia; has little effect on cortical function.

C. Indications
 Management of anxiety disorders or for short-term relief of symptoms of anxiety
 Acute alcohol withdrawal; may be useful in symptomatic relief of acute agitation, tremor,
delirium tremens, hallucinosis
 Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to local pathology
(inflammation of muscles or joints) or secondary to trauma; spasticity caused by upper
motoneuron disorders (cerebral palsy and paraplegia); athetosis, stiff-man syndrome
 Parenteral: Treatment of tetanus
 Antiepileptic: Adjunct in status epilepticus and severe recurrent convulsive seizures
(parenteral); adjunct in seizure disorders (oral)
 Preoperative (parenteral): Relief of anxiety and tension and to lessen recall in patients prior to
surgical procedures, cardioversion, and endoscopic procedures
 Rectal: Management of selected, refractory patients with epilepsy who require intermittent
use to control bouts of increased seizure activity
 Unlabeled use: Treatment of panic attacks

D. Contraindications and cautions

 Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle
glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal
hernia, cardiac defects, microcephaly, pyloric stenosis when used in first trimester; neonatal
withdrawal syndrome reported in newborns); lactation.

5
  Use cautiously with elderly or debilitated patients; impaired liver or renal function; and in
patients with a history of substance abuse.

E. Available forms
Tablets—2, 5, 10 mg; SR capsule—15 mg; oral solution—1 mg/mL, 5 mg/5 mL;
rectal pediatric gel—2.5, 5, 10 mg; rectal adult gel—10, 15, 20 mg; injection—5 mg/Ml

F. DOSAGE-
ADULT DOSE-
Oral: 2 to 10 mg 2 to 4 times a day.
IM or IV: 2 to 5 mg (moderate anxiety) or 5 to 10 mg (severe anxiety) for one dose.
May repeat in 3 to 4 hours, if necessary.

G. Pharmacokinetics
Route Onset Peak Duration
Oral 30–60 min 1–2 hr 3 hr
IM 15–30 min 30–45 min 3 hr
IV 1–5 min 30 min 15–60 min
Rectal Rapid 1.5 hr 3 hr

H. Adverse effects
 CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue,
light-headedness, disorientation, restlessness, confusion, crying, delirium, headache, slurred
speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness,
difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal
symptoms; mild paradoxical excitatory reactions, during first 2 wk of treatment, visual and
auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion

 CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations,

edema

 Dependence: Drug dependence with withdrawal syndrome when drug is discontinued

(common with abrupt discontinuation of higher dosage used for longer than 4 mo); IV

6
 diazepam: 1.7% incidence of fatalities; oral benzodiazepines ingested alone; no well-
documented fatal overdoses

 Dermatologic: Urticaria, pruritus, skin rash, dermatitis

 GI: Constipation; diarrhea, dry mouth; salivation; nausea; anorexia; vomiting; difficulty in
swallowing; gastric disorders; elevations of blood enzymes—LDH, alkaline phosphatase,
AST, ALT; hepatic dysfunction; jaundice

 GU: Incontinence, urinary retention, changes in libido, menstrual irregularities

 Hematologic: Decreased hematocrit, blood dyscrasias

Nursing responsibilities-
 Asses for contraindications
 Assess body weight, skin color, urinalysis, X-ray
 Arrange for increased dosage when patient is subject to unsual stress.
 Space multiple doses evenly throughout the day
 Use minimal doses for minimal duration to minimize adverse effects.
 Educate client on the side effects of medication and what ot expect
.

7
 GENTAMICIN SULFATE

A. Drug class: Aminoglycoside

B. Therapeutic actions
Bactericidal: Inhibits protein synthesis in susceptible strains of gram-negative
bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death.

C. Indications
1. Parenteral
 Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species,
Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus
species
 Serious infections when causative organisms are not known (often in conjunction with a
penicillin or cephalosporin)
 Unlabeled use: With clindamycin as alternative regimen in PID

2. Intrathecal
 Gram-negative infections
 Serious CNS infections, such as meningitis, ventriculitis, infections caused by susceptible
Pseudomonas species

3. Ophthalmic preparations
 Treatment of superficial ocular infections due to strains of microorganisms susceptible to
gentamicin

4. Topical dermatologic preparation

 Infection prophylaxis in minor skin abrasions and treatment of superficial infections of the
skin due to susceptible organisms amenable to local treatment

5. Gentamicin-impregnated PMAA beads on surgical wire

 Orphan drug use: Treatment of chronic osteomyelitis of posttraumatic, postoperative, or
hematogenous origin

8
 6. Gentamicin liposome injection
 Orphan drug use: Treatment of disseminated Myobacterium avium-intracellulare infection

D. Contraindications and cautions

 Contraindicated with allergy to any aminoglycosides.
 Use cautiously with renal or hepatic disease; preexisting hearing loss; active infection with
herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic
preparations); myasthenia gravis; parkinsonism; infant botulism; burn patients; lactation;
pregnancy.

E. Available forms
Injection—10, 40 mg/mL; ophthalmic solution—3 mg/mL; ophthalmic ointment—
3 mg/g; topical ointment—0.1%; topical cream—0.1%; ointment—1 mg; cream—1 mg

F. Dosage
ADULTS
3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four
equal doses in severe infections. For IV use, a loading dose of 1–2 mg/kg may be infused over
30–60 min, followed by a maintenance dose, usually for 7–10 days.

G. Pharmacokinetics
ROUTE ONSET PEAK
IM, IV Rapid 30–90 min

Metabolism: Hepatic; T1/2: 2–3 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts
Preparation: Dilute single dose in 50–200 mL of sterile isotonic saline or D 5W. Do not mix
in solution with any other drugs.
Infusion: Infuse over 30–120 min.
Incompatibilities: Do not mix in solution with any other drugs.

9
H. Adverse effects
 CNS: Ototoxicity—tinnitus, dizziness, vertigo, deafness (partially reversible to irreversible),
vestibular paralysis, confusion, disorientation, depression, lethargy, nystagmus, visual
disturbances, headache, numbness, tingling, tremor, paresthesias, muscle twitching, seizures,
muscular weakness, neuromuscular blockade
 CV: Palpitations, hypotension, hypertension
 GI: Hepatic toxicity, nausea, vomiting, anorexia, weight loss, stomatitis, increased salivation
 GU: Nephrotoxicity
 Hematologic: Leukemoid reaction, agranulocytosis, granulocytosis, leukopenia,
leukocytosis, thrombocytopenia, eosinophilia, pancytopenia, anemia, hemolytic anemia,
increased or decreased reticulocyte count, electrolyte disturbances
 Hypersensitivity: Purpura, rash, urticaria, exfoliative dermatitis, itching
 Local: Pain, irritation, arachnoiditis at IM injection sites
 Other: Fever, apnea, splenomegaly, joint pain, superinfections

Nursing responsibilities-
 Asses for contraindications
 Assess body weight, skin color, urinalysis, X-ray
 Arrange for increased dosage when patient is subject to unsual stress.
 Space multiple doses evenly throughout the day
 Use minimal doses for minimal duration to minimize adverse effects.
 Educate client on the side effects of medication and what ot expect
.

ONDANSETRON HYDROCHLORIDE
10
A. Drug class: Antiemetic

B. Therapeutic actions
Blocks specific receptor sites (5-HT 3), which are associated with nausea and vomiting in
the chemoreceptor trigger zone, centrally and at specific sites peripherally. It is not known
whether its antiemetic actions are from actions at the central, peripheral, or combined sites.

C. Indications
 Parenteral and oral: Prevention of nausea and vomiting associated with emetogenic cancer
chemotherapy in patients > 6 mo of age
 Prevention of postoperative nausea and vomiting—to prevent further episodes or, when
postoperative nausea and vomiting must be avoided (oral), prophylactically (parenteral) in
patients > 1 mo of age
 Prevention of nausea and vomiting associated with radiotherapy
 Unlabeled uses: Treatment of nausea and vomiting associated with acetaminophen poisoning,
prostacyclin therapy; treatment of acute levodopa-induced psychosis; reduction of episodes in
bulimia nervosa; treatment of spinal or epidural morphine-induced pruritus

D. Contraindications and cautions

 Contraindicated with allergy to ondansetron.
 Use cautiously with pregnancy, lactation.

E. Available forms
Tablets—4, 8, 24 mg; orally disintegrating tablets—4, 8 mg; oral solution—4 mg/5 mL;
injection—2 mg/mL, 32 mg/50 mL

F. DOSAGE-
ADULT DOSE
Parenteral:
1 month to 12 years: (Less than 40 kg):
-Recommended dose: 0.1 mg/kg IV over 2 to 5 minutes immediately.
(40 kg and greater):
-Recommended dose: 4 mg IV over 2 to 5 minutes immediately.

11
G. Pharmacokinetics
Route Onset Peak

Oral 30–60 min 1.7–2.2 hr

IV Immediate Immediate

H. Adverse effects
 CNS: Headache, dizziness, drowsiness, shivers, malaise, fatigue, weakness, myalgia
 CV: Chest pain, hypotension
 Dermatologic: Pruritus
 GI: Abdominal pain, constipation
 GU: Urinary retention
 Local: Pain at injection site

Nursing responsibilities-
 Teach the paitent take medication as directed
 Advise patient to notify health care professional immediately if involuntary movement of
eyes, face or limbs occur.

PANTOPRAZOLE

12
Drug classes
Antisecretory drug
Proton pump inhibitor

Therapeutic actions
Gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-
potassium ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the
final step of acid production.

Indications
 Oral: Short-term (< 8 wk) and long-term treatment of GERD
 Maintenance healing of erosive esophagitis
 Long-term treatment of pathological hypersecretory conditions
 IV: Short-term (7–10 days) treatment of GERD in patients unable to continue oral therapy
 Treatment of pathological hypersecretory conditions associated with Zollinger-Ellison
syndrome and other neoplastic conditions
 Unlabeled uses: Treatment of duodenal ulcer

Contraindications and cautions

 Contraindicated with hypersensitivity to any proton pump inhibitor or any drug components.
 Use cautiously with pregnancy, lactation.

Available forms
DR tablet—20, 40 mg; powder for injection—40 mg/vial

Dosages

ADULTS
40 mg PO daily for maintenance healing of erosive esophagitis for < 8 wk. 8-wk course may be
repeated if healing has not occurred; give continually for hypersecretory disoders; 40 mg/day IV for
7–10 days. Up to 240 mg/day PO or IV has been used for hypersecretory syndromes.

Pharmacokinetics
Route Onset Peak
Oral 1 hr 3–5 hr
IV Rapid 3–5 hr

Adverse effects
 CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream
abnormalities
13
  Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
 GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy
 Respiratory: URI symptoms, cough, epistaxis
 Other: Cancer in preclinical studies, back pain, fever

Adverse effects in Italic are most common; those in Bold are life-threatening.

NURSES RESPONSIBILITY

1. Check vitals and close monitoring

2. Monitor I&O ratio
3. Monitor for hepatotoxicity
4. Monitor allergic reaction
5. Monitor elctrolyte balance
6. Assess for central nervous system symptoms
7. Assess for over growht of infection

14
 RANITIDINE HYDROCHLORIDE

Novo-Ranidine, Zantac, Zantac 75, Zantac 150

Pregnancy Category B

Drug class
Histamine2 (H2) antagonist

Therapeutic actions
Competitively inhibits the action of histamine at the histamine2 (H2) receptors of the parietal cells of
the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by
food, insulin, histamine, cholinergic agonists, gastrin, and pentagastrin.

Indications
 Short-term treatment of active duodenal ulcer
 Maintenance therapy for duodenal ulcer at reduced dosage
 Short-term treatment of active, benign gastric ulcer
 Short-term treatment of GERD
 Pathologic hypersecretory conditions (eg, Zollinger-Ellison syndrome)
 Treatment of erosive esophagitis
 Treatment of heartburn, acid indigestion, sour stomach

Contraindications and cautions

 Contraindicated with allergy to ranitidine, lactation.
 Use cautiously with impaired renal or hepatic function, pregnancy.

Available forms
Tablets—75, 150, 300 mg; effervescent tablets and granules—25, 150 mg; syrup—15 mg/mL;
injection—1, 25 mg/mL

Dosages
ADULTS
 Active duodenal ulcer: 150 mg bid PO for 4–8 wk. Alternatively, 300 mg PO once daily hs or
50 mg IM or IV q 6–8 hr or by intermittent IV infusion, diluted to 100 mL and infused over
15–20 min. Do not exceed 400 mg/day.
 Maintenance therapy, duodenal ulcer: 150 mg PO hs.
 Active gastric ulcer: 150 mg bid PO or 50 mg IM or IV q 6–8 hr.
 Pathologic hypersecretory syndrome: 150 mg bid PO. Individualize dose with patient's
response. Do not exceed 6 g/day.
 GERD, esophagitis, benign gastric ulcer: 150 mg bid PO.
 Treatment of heartburn, acid indigestion: 75 mg PO as needed.

PEDIATRIC PATIENTS
Safety and efficacy not established.

GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION

15
For creatinine clearance < 50 mL/min, accumulation may occur; use lowest dose possible, 150 mg q
24 hr PO or 50 mg IM or IV q 18–24 hr. Dosing may be increased to q 12 hr if patient tolerates it and
blood levels are monitored.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–3 hr 8–12 hr
IM Rapid 15 min 8–12 hr
IV Immediate 5–10 min 8–12 hr

Metabolism: Hepatic; T1/2: 2–3 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

IV facts

Preparation: For IV injection, dilute 50 mg in 0.9% sodium chloride injection, 5% or 10% dextrose
injection, lactated Ringer's solution, 5% sodium bicarbonate injection to a volume of 20 mL; solution
is stable for 48 hr at room temperature. For intermittent IV, use as follows: Dilute 50 mg in 100 mL
of 5% dextrose injection or other compatible solution

Infusion: Inject over 5 min or more; for intermittent infusion, infuse over 15–20 min; continuous
infusion, 6.25 mg/hr

Incompatibilities: Do not mix with amphotericin B

Adverse effects
 CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo
 CV: Tachycardia, bradycardia, PVCs (rapid IV administration)
 Dermatologic: Rash, alopecia
 GI: Constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels
 GU: Gynecomastia, impotence or decreased libido
 Hematologic: Leukopenia, granulocytopenia, thrombocytopenia, pancytopenia
 Local: Pain at IM site, local burning or itching at IV site
 Other: Arthralgias

Interactions
Drug-drug
 Increased effects of warfarin, TCAs; monitor patient closely and adjust dosage as needed

Nursing considerations
Assessment
 History: Allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy
 Physical: Skin lesions; orientation, affect; pulse, baseline ECG; liver evaluation, abdominal
examination, normal output; CBC, LFTs, renal function tests

Interventions
 Administer oral drug with meals and hs.
 Decrease doses in renal and liver failure.
 Provide concurrent antacid therapy to relieve pain.
 Administer IM dose undiluted, deep into large muscle group.
 Arrange for regular follow-up, including blood tests, to evaluate effects.

16
NURSING RESPONSIBILITIES
 Take drug with meals and at bedtime. Therapy may continue for 4–6 weeks or longer.
 Have regular medical follow-up care to evaluate your response.
 Patient may experience side effects: Constipation or diarrhea (request aid from your health
care provider); nausea, vomiting (take drug with meals); enlargement of breasts, impotence or
decreased libido (reversible); headache (adjust lights and temperature and avoid noise).
 Report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, hallucinations,
dizziness, severe headache, muscle or joint pain.

17
 DICLOFENAC SODIUM

Diclofenac Sodium
Novo-Difenac, Vovaron, Voltaren.

Pregnancy Category B

Drug classes
Anti-inflammatory
NSAID

Therapeutic actions
Inhibits prostaglandin synthetase to cause antipyretic and anti-inflammatory effects; the exact
mechanism is unknown.

Indications
 Acute or long-term treatment of mild to moderate pain, including dysmenorrhea
 Rheumatoid arthritis
 Osteoarthritis
 Ankylosing spondylitis
 Treatment of actinic keratosis in conjunction with sun avoidance
 Ophthalmic: Postoperative inflammation from cataract extraction

Contraindications and cautions

 Contraindicated with allergy to NSAIDs, significant renal impairment, pregnancy, lactation.
 Use cautiously with impaired hearing, allergies, hepatic, CV, GI conditions, and in elderly
patients.

Available forms
Tablets—50 mg; DR tablets—25, 50, 75 mg; ER tablets—100 mg; topical gel—30 mg/g; ophthalmic
solution—0.1%

Dosages
ADULTS
Oral
 Pain, including dysmenorrhea: 50 mg tid PO; initial dose of 100 mg may help some patients
(Cataflam).
 Osteoarthritis: 100–150 mg/day PO in divided doses (Voltaren); 50 mg bid–tid PO
(Cataflam).
 Rheumatoid arthritis: 150–200 mg/day PO in divided doses (Voltaren); 50 mg bid–tid PO
(Cataflam).
 Ankylosing spondylitis: 100–125 mg/day PO. Give as 25 mg qid, with an extra 25-mg dose
hs (Voltaren); 25 mg qid PO with an additional 25 mg hs if needed (Cataflam).
Topical
 Actinic keratosis: Cover lesion with gel and smooth into skin; do not cover with dressings or
cosmetics (Solaraze).
Ophthalmic
1 drop to affected eye qid starting 24 hr after surgery for 2 wk

18
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak Duration
Oral (sodium) Varies 2–3 hr 12–15 hr
Oral Rapid 20–120 min 12–15 hr
(potassium)

Metabolism: Hepatic; T1/2: 1.5–2 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Feces, urine

Adverse effects
 CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthamologic
effects
 Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
 GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence
 GU: Dysuria, renal impairment
 Hematologic: Bleeding, platelet inhibition with higher doses
 Other: Peripheral edema, anaphylactoid reactions to fatal anaphylactic shock

Interactions
Drug-drug
 Increased serum levels and increased risk of lithium toxicity
 Increased risk of bleeding with anticoagulants; monitor patient closely

Nursing considerations

Assessment
 History: Renal impairment; impaired hearing; allergies; hepatic, CV, and GI conditions;
lactation, pregnancy
 Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric
evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC,
clotting times, LFTs, renal function tests; serum electrolytes, stool guaiac

Interventions
 Administer drug with food or after meals if GI upset occurs.
 Arrange for periodic ophthalmologic examination during long-term therapy.
 WARNING: Institute emergency procedures if overdose occurs (gastric lavage, induction of
emesis, supportive therapy).

ATROPIN SULPHATE
19
Therapeutic action-
Competitively blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the
effects of parasympathetic postganglionic impulses, depressing salivary and bronchial secretions,
dilating the bronchi, inhibiting vagal influences on the heart, relaxing the GI and GU tracts,
inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye (mydriatic effect), and
preventing accommodation for near vision (cycloplegic effect); also blocks the effects of
acetylcholine in the CNS.

Dose and Route-

Adults

Systemic administration

 0.4–0.6 mg PO, IM, IV, or subcutaneously.

Ophthalmic solution

 For refraction: Instill 1–2 drops into eye 1 hr before refracting.

 For uveitis: Instill 1–2 drops into eye qid.

pediatric patients

Weight Dose (mg)

7–16 lb (3.2–7.3 kg) 0.1
16–24 lb (7.3–10.9 kg) 0.15
24–40 lb (10.9–18.1 kg) 0.2
40–65 lb (18.1–29.5 kg) 0.3
65–90 lb (29.5–40.8 kg) 0.4
> 90 lb (> 40.8 kg) 0.4–0.6

Indication:

 For preanesthetic medication to prevent or reduce respiratory tract secretions

 Treatment of parkinsonism; relieves tremor and rigidity
 Restoration of cardiac rate and arterial pressure during anesthesia
 Relief of bradycardia and syncope due to hyperactive carotid sinus reflex
 Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility of the colon
 Relaxation of the spasm of biliary and ureteral colic and bronchospasm

20
  Relaxation of the tone of the detrusor muscle of the urinary bladder in the treatment of
urinary tract disorders
 Control of crying and laughing episodes in patients with brain lesions
 Treatment of closed head injuries that cause acetylcholine release into CSF, EEG
abnormalities, stupor, neurologic signs
 Relaxation of uterine hypertonicity
 Management of peptic ulcer
 Control of rhinorrhea of acute rhinitis or hay fever
 Antidote (with external cardiac massage) for CV collapse from overdose of
parasympathomimetic (cholinergic) drugs, or cholinesterase inhibitors (eg, physostigmine,
isoflurophate, organophosphorus insecticides)
 Antidote for poisoning by certain species of mushroom (eg, Amanita muscaria)

Ophthalmic preparations

 Diagnostically to produce mydriasis and cycloplegia-pupillary dilation in acute inflammatory

conditions of the iris and uveal tract

Adverse effect:
 Systemic administration

 CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP, headache,

flushing, nervousness, weakness, dizziness, insomnia, mental confusion or excitement (after
even small doses in the elderly), nasal congestion
 CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)
 GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia, heartburn,
constipation, bloated feeling, paralytic ileus, gastroesophageal reflux
 GU: Urinary hesitancy and retention; impotence
 Other: Decreased sweating and predisposition to heat prostration, suppression of lactation

 Ophthalmic preparations

 Local: Transient stinging

 Systemic: Systemic adverse effects, depending on amount absorbed

Contraindications of Atrophine

 Contraindicated with hypersensitivity to anticholinergic drugs.

 Contraindicated with glaucoma; adhesions between iris and lens; stenosing peptic ulcer

Ophthalmic solution

 Contraindicated with glaucoma or tendency to glaucoma.

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Nursing intervension:

 Ensure adequate hydration

 provide environmental control (temperature) to prevent hyperpyrexia.
 Have patient void before taking medication if urinary retention is a problem.
 Take as prescribed, 30 minutes before meals; avoid excessive dosage.
 Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur.

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 HYDROCORTISONE

Mechanism of action-
Enters larget cells and binds to cycloplasmic receptor, initiates many complex reaction that are
responsible for its anti-inflammatary (glucocorticoid) and salt – relating (mineralocorticoid) actions,
some action may be undesirable depending on drug use.

Dose and route-

ADULT DOSE
 20-240 mg/day in single dose or divided doses by oral, IV, IM route.
 Tablets; 5, 10, 20 mg

Indication:
 Replacement therapy in adrenal cortical insufficiency
 Allergic states- severe or incapacitating allergic conditions
 Hematologic disorders
 Ulcerative collitis

Contraindication-
 Allergy of the drug
 Fungal infection
 Amebiasis
 Hepatitis B
 Vaccine or varicella
 Antibiotic-resistant infection
 Immunosuppression

Precaution-
 Kidney disease
 Liver disease
 Cirrhosis
 Hypothyroidism
 Ulverative collitis
 Diverticulitis
 Heart failure
 Lactation

Adverse reaction-

CNS: vertigo, headache, insomnia, paresthesias, psychosis

CV: hypotension, shock, HPN, heart failure, fluid retention, thrombophlebitis, fat embolism.

Dermatologic: thin, fragile skin, petechiae, ecchomoses, purpura, fat atrophy

ENT: cataracts, glaucoma, increased ICP

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Endocrine: amenorrhea, irregular mens, growth retardation, decreased carbohydrate tolerance DM,
hyperglycemia

GI: peptic or esophagial ulcer, pancreatitis, abdominal distention, nausea vomiting, increased
appetite and weight.

Hematologic: sodium and water retention, hypocalcemia, increased blood sugar, decreased T3 and
T4

Hypersensitivity reactions

Musculoskeletal: muscle weakness, steroid myopathy, and loss of muscle mass

Other: immunosuppression, impaired wound healing.

Nursing responsibilities-
 Asses for contraindications
 Assess body weight, skin color, urinalysis, X-ray
 Arrange for increased dosage when patient is subject to unsual stress.
 Give daily before 9 a.m. to mimic normal peak diumal corticosteroid levels
 Space multiple doses evenly throughout the day
 Use minimal doses for minimal duration to minimize adverse effects.
 Do not give IM injection if patient has thrombocytopenic purpura
 Educate client on the side effects of medication and what ot expect
 Instruct client to report pain at injection site.

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