Drug Study MICU (1)

Generic Name / Brand Name

Mechanism of Action Indications Contraindications Adverse Reactions Nursing Responsibilities

calcium gluconate Cation needed for maintenance of nervous, muscular, skeletal systems, enzyme reactions, normal cardiac contractility, coagulation of blood; affects secretory activity of endocrine, exocrine glands.

Prevention and treatment of hypocalcemia, hypermagnesemia, hypoparathyroidism, cardiac toxicity caused by hyperkalemia, ;lead colic, hyperphosphatemia, calcium antagonist toxicity

-hypercalcemia-digitalis toxicity-ventricular fibrillation-renal calculi

-hypotension-bradycardia-dysrhythmias -nausea-constipation-lethargy-headache-polyuria

-monitor ECG, calcium levels-assess cardiac status, rhythm, CVP-provide seizure precautions: padded side rails; place airwasy suction equipment-patient should remain recumbent 30mins. After I dose.-adise patient to add food high in vitamin D

Magnesium sulfate Increases osmotic pressure, draws fluid into colon, neutralizes HCL.

-constipation-anticonvulsant-electrolyte-bowel prep

-hypersensitivity-abdominal pain-nausea/vomiting-obstruction-acute surgical abdomen-rectal bleeding

-nausea-vomiting-anorexia-cramps-muscle weakness-sweating-electrolyte, fluid imbalances

-assess I and O; check for decrease in urinary output.-assess cramping, rectal bleeding, nausea and vomiting-assess visual changes, edema-administer with food or milk to decrease gastric symptoms-inform patient to avoid alcohol intoxication



Potassium chloride Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance

-prevention treatment of hypokalemia

-renal disease (severe)-severe hemolytic disease-Addison’s disease-hyperkalemia-acute dehydration-extensive tissue breakdown.

-cardiac depression-nausea-vomiting-cramps-diarrhea

-assess ECG-monitor I and O ratio, potassium level, cardiac status-dilute in LARGE VOLUME OF IV SOLUTION, NEVER GIVE BOLUS.-tell patient to take cap with full glass of liquid (120ml)

Atropine sulfate Blocks acetylcholine at parasympatheticneurro affector sites; increases cardiac output, HR by blocking agal stimulation in heart; dries secretions, decrease sweating , mydriasis, increase HR at moderate dose; motility of GI, GU system

-bradycardia-bradydysrhythmia-insecticide poisoning-decreasing secretions before surgery-antispasmodic with GU and biliary surgery-bronchodilator-cyclopegia-mydriasis

-hypersensitiivty to belladonna alkaloids-

-nausea-vomiting-anorexia-cramps-muscle weakness-sweating-electrolyte, fluid imbalances

-assess I and O; check for decrease in urinary output.-assess cramping, rectal bleeding, nausea and vomiting-assess visual changes, edema-administer with food or milk to decrease gastric symptoms-inform patient to avoid alcohol intoxication



Lidocaine (xyloccine) Increases electrical stimulation threshold ofVentricle and his-purkinjeSystem w/c stabilizes cardiacMembrane and decrease automaticity; locally producesAnesthesia by preventing initiation and conduction of impulse

-Ventricular tachycadics-ventricular dysrhythmia during cardiac sx-Mi-digitalis toxicity-cardiac catheter-anesthesia locally

-hypersensitivity to amides-severe heart block-supraventricular dysrhythmias-adams-stroke syndrome-wolff-parkinson-white syndrome

-headache-dizziness-drowsiness-hypertension-bradycardia

-assess for oxygenation/perfusion deficit, respiratory status,Urinary retention-monitor I and O ration liver function studies, ECG, blood levels-give iv bolus undiluted(1%, 2% only); give long or less over 1min of using an iv line

Morphine sulfate Depresses pain impulse transmission at the spinal cord level by interacting opioid receptors, produces CNS depression

-severe pain-often given after or during MI

-hypersensitivity-addiction (opioid)-hemorrhage-bronchial asthma-increased ICP

-drowsiness-dizziness-confusion-sedation\-constipation

Assess pain; location, type, character, intensity-monitor I and O ratio, CNS changes, allergic reactions-assess respiratory dysfunction-withdraw medication slowly after long-term use to prevent withdrawal symptoms-caution patient to avoid CNS depressant24hrs after taking this drug-elevate side rails for patient safety



Epirephine levophed(adrenaline)

B1 and B2 agonist causing increased levels of cyclic AMP producing bronchodilation, cardiac and CNS stimulation; large doses can cause vasoconstriction via alpha receptors; small dose can cause vasodilation via b2 vascular receptors

-acute asthma attack-hemostasis-bronchospasm-anaphylaxis-allergic reactions-cardiac arrest-adjunct in anesthesia-shock

-hypersensitivity to symphatomimetics-narrow-angle glaucoma-organic brain and heart disease syndrome-local anesthesia of certain area-labor-cardiac dilation-coronary insufficiency-cerebral arteriosclerosis

-tremors-anxiety-palpitations-tachycardia-dysrhythmias-anorexia-dyspnea

-monitor respiratory function, ECG to prevent cerebral hemorrhage-monitor for evidence of allergic reactions, paradoxical bronchospasm-instruct patient to use this medication before other medications and allow at least 5 mins between each, to prevent overstimulation

Sodium bicarbonate Orally neutralizes gastric acid, which forms water, NaCl, CO2, increases plasma bicarbonate, which buffers h1 ion concentration, reverses acidosis

-acidosis-cardiac arrest-alkalinization-gastric acid neutralization/antacid

-hypertension-peptic ulcer-renal disease-hypocalcemia

-twitching-hypereflexia-belching-distention-alkalosis

-assess respiratory function and pulse rate, depth, lung sounds-assess for CO2 in GI tract-monitor fluid balance, electrolytes, blood PH, urine output-advise patient to notify MD if indigestion is accompanied with chest pain, dyspnea, diarrhea



Phenytoin (Dilantin) Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction to decrease dysrhythmias

-generalized tonic-clonic seizures -status epilepticus-migraine-bell’s palsy-non-epileptic seizure associated with Raye’s syndrome or head trauma

-hypersensitivity-psychiatric condition-bradycardia-stoke-adams syndrome-hepatic failure-acute intermittent porphyria

-headache-hypotension-gingival hyperplasia-nystagmus-diplopia-urine discoloration-hypocalcemia

-assess mental status, seizure activity, renal studies and blood studies-monitor hepatic stuches and WOF toxicity-give with meals to decrease GI upset-do not take antacid together with phenytoin-instruct patient in proper oral hygiene

Diazepam (Valium) Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety

-anxiety-acute alcohol withdrawal-adjunct in seizure disorders-pre op skeletal muscle relaxation

-hypersensitivity to benzodiazepines -narrow angle glaucoma-psychosis-respiratory depression-coma

-dizziness -drowsiness-orthostatic hypotension-blurred vision

-assess degree of anxiety-monitor BP with patient lying, standing-give with food/milk-use sugarless gum, hard candy frequent sips of water for dry mouth-advise patient that drug is not to be used for everyday stress-inform patient to avoid driving and to rise abruptly

Generic Name / Brand Mechanism of Action Indications Contraindications Adverse Reactions Nursing

Name ResponsibilitiesMidazolam (dormicum) Depresses subcortical

levels in CNS; may act on limbic system, reticular formation, may potentiate GABA by binding to specific benzodiazepine receptor

-pre op sedation-general anesthesia induction-sedation for diagnostic test-intubation

-hypersensitivity to benzodiazepines-shock-coma-alcohol intoxication-acute narrow angle glaucoma

-nausea-vomiting-coughing -dyspnea-loss of balance

-monitor BP, pulse-watch out for respiratory depression especially to elederly patient -caution patient to avoid CNS depressants including alcohol for 24hrs after taking this drug

Naloxone (Narcan) May displace opioid analgesics from their receptors to reduce its effects

-narcotic overdose -post op narcotic depression

-respiratory depression due to non-opioid drugs

-tachycardia-increase BP-seizures-cardiac arrest-pulmonary edema

-assess cardiac status -monitor VS -assess for pain, patient respiration-instruct patient to report adverse reaction


Name ResponsibilitiesPromethazine (Phenergan)

Acts on blood vessels, GI, respiratory system by competing with histamine for h1 receptor site; decreases allergic response by blocking histamine; also acts on chemo receptor trigger zone to decrease vomiting; increases CNS stimulation; has anticholinergic response

-motion sickness-rhinitis-allergy response-sedation-nausea-pre op and post op sedation-

-hypersensitivity to h1 receptor antagonist -sulfite allergy -child <2yr-acute asthma attack

-dizziness-drowsiness-constipation-urinary retention

-assess respiratory status, I and O-give 1hr before and 2hrs after meals to decrease GI upset-caution patient not to exceed recommended dose; dysrhythmia may occur

Hydrocortisone (solu-cortef)

Glucocorticoid with anti inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leucocytes and fibroblasts at sites of inflammation phagocytosis and lysomal enzyme release. It can also cause the reversal of increased capillary permeability

-allergic and inflammatory ophthalmic processes-GI disease ulceratic colitis-multiple sclerosis-treatment of synovitis of osteoarthritis-treatment of keloids -relief of discomfort associated with hemorrhoids perineal itching or irritation

-systemic fungal infection-acute glumeruloneprhitis-amoebiasis-AIDS--TB-nonasthmatic bronchial dse.

-depression-flushing-sweating-headache-mood changes-hypertension-diarrhea-nausea-vomiting-hemorrhage

-monitor patient’s weight, BP. Glucose and electrolyte levels.-assess for systemic absorption and irritation-advise patient to exercise and take vit. D and calcium supplements


Name ResponsibilitiesDexamethasone (Decadron)

Synthetic glucocorticoid with marked anti-inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leukocytes and fibroblasts at sites of inflammation, phagocytosis and lysosomal enzyme release

-inflammation-allergies-neoplasms-cerebral edema-septic shock-collagen disorders

-psychosis-hypersensitivity-idiopathic thrombocytopenia-amoebiasisnonasthmatic bronchial dse.

-depression-flushing-sweating-hypertesion-diarrhea-nausea-vomiting-abdominal distention-increased appetite

-assess infection; fever, potassium depletion, mental status-monitor weight daily -instruct patient to report signs of adverse reactions-advise patient to avoid exposure to persons with infection

Terbutaline (bricanyl) Relaxes bronchial snooth muscle by direct action on B2 adrenergic receptors through accumulation of cAMP at B-adrenergic receptor sites; results are bronchodilation, diuresis and CNs, heart stimulation; relaxes uterine smooth muscle.

-bronchospasm -hypersensitivity to symphatomimetics -narrow-angle glaucoma-tachydysrhythmias

-tremors-insomnia-headache-dizziness-palpitations-nuasea-vomiting

-monitor respiratory function -determine that patient has not received theophylline therapy before giving dose-monitor for evidence of allergic reactions-assess for paradoxical bronchospasm-should be given with meals-teach patient how to use inhaler; to avoid getting aerosol in eyes because blurring may result



Tranexemic acid (Hemostan)

Inhibits breakdown of fibrin clots. It acts primarily by blocking the binding of plasminogen and plamin to fibrin; direct inhibition of plasmin a\occurs only to a limited degree

-treatment and prophylaxis of hemorrhage associated with excessive fibrinolysis -prophylaxis for hereditary angioedema

-hypersensitivity-severe renal insufficiency-patient with microscopic hematuria

-nausea-vomiting-headache-hypotension

-assess patient if with active intravascular clotting; obtain prothrombin time of the patient-perform liver function test and blood tests-advise patient to report visual abnormalities to the physician.

Amiodarone (Cordarone)

Prolongs action potential duration and effective refractory period, slows sinus rate with increasing PR and QT intervals, non-competitive alpha and beta adrenergic inhibition; increase PR and QT intervals, decrease sinus rate and decreases PVR

-severe ventricular tachycardia-supraventricular tachycardia-ventricular fibrillation-atrial fibrillation not controlled by 1st line agents

-sinus node dysfunction-2nd or 3rd degree AV block-bradycardia-neonates, infants

-headache-dizziness-hypotension

-monitor I and O ratio, ECG-assess for CNS symptoms, sight and vision-instruct patient to report side effects immediately to the prescriptor and that skin discoloration is usually reversible-advise patient that dark glasses may be needed for photophobia-instruct patient to use sunscreen and protective clothing (photosensitivity)



Aminophylline (Truphylline)

Exact mechanism unknown; relaxes smooth muscle of respiratory system by blocking phosphodiesterase which increases cyclic AMP alters intracellular calcium ion movements

-bronchial asthma-emphysema-bradycardia

-hypersensitivity to xanthines-active peptic ulcer disease

-dizziness-palpitations-sinus tachycardia-nausea-vomiting

-monitor theophylline blood levels, I and O, respiratory rate-instruct patient to avoid hazardous activities-teach patient if GI upset occurs, take drug with 8oz of water-advise patient to increase fluid intake

Clonidine (Catapres) Inhibits sympathetic ve\asomotor center in CNS which reduce impulses in sympathetic nervous system; BP; pulse rate, CO decreased; prevents pain signal transmission in CNS by alpha adrenergic receptor stimulation of the spinal cord

-mild to moderate hypertension

-hypersensitivity-bleeding disorders-anticoagulants

-drowsiness-sedation-headache-fatigue-orthostatic hypertension-nocturia-palpitations-nausea-vomitng-dry mouth-malaise

-monitor BP/pulse-check for edema in feet and legs daily-monitor I and O-instruct patient not to discontinue drug abruptly-caution patient to change position slowly



Digoxin (Lanoxin) Inhibits sodium potassium ATPase which makes more calcium available for contractile proteins, resulting in increased cardiac output, force of contraction; decrease contraction, decrease HR and AV conduction speed

-rapid digitalization in acute and chronic CHF-atrial fibrillation -atrial flutter-atrial bradycardia-atrial tachycardia-cardionegic shock-paroxysmal atrial tachycardia

-hypersensitivity to digitalis-ventricular fibrillation-ventricular tachycardia-carotid sinus syndrome-2nd or 3rd degree block

-headache-drowsiness-hypotension-nausea-vomiting-anorexia

-assess apical pulse for 1 min-monitor cardiac status, ECG-advise patient to maintain a sodium-restricted diet as ordered -teach patient purpose of drug is to regulate the heart’s functioning

Verapamil (Isoptin) Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; peripheral vascular arteries. Increase myocardial oxygen delivery

-chronic stable vasospastic-unstable angina-dysrhythmias-hypertension-supraventricular tachycardia-atrial flutter or fibrillation

-sick sinus syndrome -2nd or 3rd degree heart block-hypotension-cardiogenic shock-severe CHF

-headache-drowsiness-edema-nausea-constipation

-assess fluid volume: I and O ratio and record-monitor BP and pulse, pulmobary capillary wedge pressure-assess for extravasation -advise patient to increase fluid intake to counteract constipation-advise patient to comply with medical regimen


Mechanism of Action Indications Contraindications Adverse Reactions

Nursing Responsibilities

Nalbuphine(nubain)Binds with opiate receptors in the CNS: ascending pain pathways in limbic system, thalamus, midbrain, hypothalamus, altering perception of end emotional response to pain. Relieves pain

-relief of moderate to severe pain-for pre-operatively analgesia-supplemental to balance anesthesia-surgical anesthesia-obstetrical anesthesia

-hypersensitivity -sedation-drowsiness-sweating-nausea-dry mouth-dizziness-headache-vomiting

-assess pain characteristics before administration and after tx-monitor VS after IV route-instruct px to change position slowly to prevent orthostatic hypotension and avoid getting up without assistance-advise Px to refrain taking CNS depressant for at least 2 hrs after taking the drug

Phenobarbital(luminal) Depresses activity in brain cells primarily in reticular activating system in brainstem, also selectively depresses neurons in posterior hypothalamus, limbic structure; decreases seizure and motor activity by inhibiting CNS impulses

-all forms of epilepsy-status epilepticus-febrile seizure-sedation-insomnia

-hypersensitivity to barbiturates-porphyria-hepatic disease-respiratory disease-nephritis -hypertension-DM

-paradoxic excitement-elderly-hang0ver headache-diarrhea-rash-local pain, swelling

assess mental status, respiratory dysfunction, ,toxicity and seizure activity-tell Px that hangover is common-teach Px to make position changes slowly-elevate side rails to promote safety



Diphenhydramine (benadryl)

Acts on blood vessels, GI, respiratory system by competing with histamine for the receptor site; decreases allergic response blocking histamine; causes increase HR,vasodilatio, secretion

-allergy symptoms-rhinitis-motion sickness-nighttime sedation-infant colic-non productive cough-anaphylaxis-nasal allergies-dystonic reaction -

-hypersensitivityto H1 receptor antagonist -acute asthma attack -lower respiratory tract disease

-dizziness-drowsiness-urinary retention

-assess respiratory status-provide 2L/day to decrease secretion thickness-monitor I&O ratio-instruct Px to use sunscreen to prevent photo sensitivity-elevate siderails to promote safety since dizziness may occur-instruct Px to request assistance with completion

Phytonadione (aquamephyton)

Needed for adequate blood clotting (factors II, VII, IX, X)

-vit. K malabsorption-hypoprothrombinemia-prevention of hemorrhagic disease of thje new born

-hypersensitivity-severe hepatic disease-last few week of pregnancy

-headache –nausea-uticaria

-monitor for bleeding or bruising-assess nutritional status-teach Px necessary foods high in vit. K to be induced in diet -advise Px to avoid IM inj, toothbrush, flossing; use electric razor until Tx is terminated.



Nifedipine (adalat)Inhibits calcium ioninflux across cell membrane during cardiac depolarization, produces relaxation of coronary vascular smooth muscle and peripheral vascular muscle, dilates coronary vascular arteries, increase myocardial oxygen delivery in Px with vasopatic angina

-Chronic stable angina pectoris-vasopatic angina-HPN

-hypersensitivity -headache-dizziness-light headedness-nausea-flushing of skin

-assess anginal pain, fluid vol. status and monitor K,LFT-instruct the Px to limit the caffeine consumption-advise Px to increase fluid intake to prevent constipation, teach Px to check for gingival hyperplasia and report promptly



dopamineAssess increase CO, beta 1 and alpha receptor, causing vasoconstriction, in blood vessel: when low doses are administered causes renal mesenteric vasodilatation; beta1 stimulation produce inotropic effects with increase cardiac output

-shock-to increase perfusion-hypotension

-hypersensitivity-ventricular fibrillation-tachydysrythmias-pheochromocytoma

-headache-palpitations-hypertension-nausea-vomiting-diarrhea

-monitor ECG, BP, and pulse q5 min if BP drops 30 mmHg, stop infusion, and call prescriber,-check for extravasation: change site q48-advise Px to report all S/E.

Isosorbide dinitrae (isoket, isordil)

Relaxation of vascular smooth muscle, which leads to decrease preload; afterload thus decreasing left ventricular end,diastolic pressure, systemic vascular resistance and reducing cardiac oxygen demand

Tx and prevention of chronic stable angina pectoris

-hypersensitivity to nitrates-severe anemia-increase ICP-cerebral hemorrhage-acute MI

-vascular headache -flushing-dizziness -postural hypotension

-asses for pain-monitor for orthostatic BP, pulse at baseline and during Tx-inform Px that drug may be taken before stressful activity-caution Px to change position slowly.

Documents

Drug Study MICU (1)