ER DRUGS 5 column

Name of DrugClassificationMechanism of ActionIndicationSide EffectsNursing Consideration

Sodium BicarbonateElectrolytesSodium bicarbonate raises blood and urinary pH by dissociation to provide bicarbonate ions, which neutralizes the hydrogen ion concentration. It also neutralizes gastric acid via production of carbon dioxide.

Urine alkalinisation.To prevent development of uric-acidrenal calculiin the initial stages of uricosuric therapy forhyperuricaemiain chronic gout.

Metabolic alkalosis; mood changes, tiredness, shortness of breath, muscle weakness, irregular heartbeat; muscle hypertonicity, twitching, tetany; hypernatraemia, hyperosmolality, hypocalcaemia, hypokalaemia; stomach cramps, flatulence. Tissue necrosis at inj site.

- Assess the clients fluid balance throughout the therapy. Thisassessmentincludes intake and output, daily weight, edema and lung sounds.

- Symptoms of fluid overload should be reported such ashypertension, edema, difficulty breathing or dyspnea, rales or crackles and frothy sputum.

- IV sites should be observed closely. Extravasation should be avoided as tissue irritation or cellulitis may occur when taking sodium bicarbonate.


GentamycinTopical Antibiotics/Anti Infectives & AntisepticsGentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis, thus rendering the bacterial cell membrane defective.

Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.

Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. Neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses); arachnoiditis (intrathecal use). Hypotension orhypertension, Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly

- Draw blood specimens for peak serum gentamicin concentration 30 min1h after IM administration, and 30 min after completion of a 3060 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use no heparinized tubes to collect blood.


SalbutamolBronchodilator

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.

To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder

NervousnessRestlessnessTremorHeadacheInsomniaChest painPalpitationsAnginaArrhythmiasHypertensionNausea and vomitingHyperglycemiaHypokalemia

- Assess lung sounds, PR and BP before drug administration and during peak of medication.

- Observe for paradoxical spasm and withhold medication and notify physician if condition occurs.

- Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.Inform the patient that Albuterol may cause an unusual or bad taste.


DiazepamCentral Nervous System Agent, Anti - ConvulsantPsychotherapeutic agent related to chlordiazepoxide; reportedly superior in antianxiety and anticonvulsant activity, with somewhat shorter duration of action. Like chlordiazepoxide, it appears to act at both limbic and subcortical levels of CNS

Drug of choice for status epilepticus. Management of anxiety disorders, for short-term relief ofanxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs.

Psychological and physical dependence with withdrawal syndrome, fatigue, drowsiness, sedation, ataxia, vertigo, confusion, depression, GI disturbances, changes in salivation, amnesia, jaundice, paradoxical excitation, elevated liver enzyme values; muscle weakness, visual disturbances, headache, slurring of speech and dysarthria, mental changes, incontinence, constipation, hypotension, tachycardia, changes in libido, pain. - Monitor V/S Frequently prior to therapy and frequently during IV therapy

- Assess IV site frequently during administration, Diazepam may cause phlebitis and Venous Thrombosis


NalbuphineAnalgesicsNalbuphine is a phenanthrene derivative opioid analgesic with mixed opioid agonist and antagonist activity. It inhibits the ascending pain pathways, altering the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalized CNS depression.

Relief of Moderate to severe pain.

Preoperative analgesia, as a supplement to surgical anesthesia.Sedation, dizziness, vertigo, miosis, headache; nausea, vomiting, dry mouth; itching, burning, urticaria. Respiratory depression, dyspnoea, asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth; clamminess.

- Give diretct IV undiluted 10mg or less over 3-5 mins or more


MethergineDrugs acting on the UterusStimulates smooth muscles

Produces sustained contractionsActive management of the 3rd stage of labor.Headache, HTN, skin eruptions, abdominal pain, Dizziness, convulsions, chest pain, hypotension, nausea, vomiting, hyperrhidosis, Bradycardia, tachycardia - Be alert for drug interactions and side effects

- Use drug carefully due to potent vasoconstrictor action


PhenobarbitalAnti- ConvulsantsPhenobarbitone is a short-acting barbiturate. It depresses the sensory cortex, reduces motor activity, changes cerebellar function, and produces drowsiness, sedation and hypnosis. Its anticonvulsant property is exhibited at high doses.

Sedative treatment of generalized tonic- clonic and cortical focal seizures

Emergency control of certain acute seizuresBradycardia, hypotension, syncope; drowsiness, lethargy, CNS excitation or depression, impaired judgment, hangover effect, confusion, somnolence, agitation, hyperkinesia, ataxia, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness; rash, exfoliative dermatitis; nausea, vomiting, constipation; agranulocytosis, thrombocytopenia.

- Check the doctors order

- Check V/S

- Check drug history for hypersensitivity and condition of patient if not contraindicated

- Watch out for Patients with acute pain and depressive disorders


EpinephreneCardiac DrugsEpinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimetic. It stimulates - and -adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity.

Temporary relief of bronchospasm, acute asthmatic attack, mucosal congestion, hypersensitivity and anaphylactic reactions, syncope due to heart block or carotid sinus hypersensitivity, and to restore cardiac rhythm in cardiac arrest. Ophthalmic preparation is used in management of simple (open-angle) glaucoma, generally as an adjunct to topical miotics and oral carbonic anhydrase inhibitors.

epigastric pain; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing, when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.

- Watch out for palpitations, and other Side effects

- Instruct patient for any anaphylactic reaction

- Instruct patient on proper administration technique, depending on formulation used

DrugMode of ActionIndicationsSide effectsNursing Considerations

Tetanus toxoid

GENERIC NAME: Anti-tetanus serum

BRAND NAME: Tetanus Toxoid

GENERAL CLASSIFICATION:

EPI vaccine, Anti-tetanusTetanus toxoid adsorbed induces active immunity to tetanus antigen by stimulating the immune system to produce specific antitoxinIndications:Prophylaxis and treatment of tetanus.

Contraindications:Hypersensitivity reaction to the serum globulin or any of its components, a hypersensitivity reaction to a test dose, and any condition that will contraindicate intramuscular injection such as thrombocytopenia.

Redness Edema urticarial Malaise transient fever pain hypotension nausea arthralgiaObserve 10 rights in giving medications:oRight PatientoRight DrugoRight DoseoRight TimeoRight RouteoRight to refuseoRight AssessmentoRight EducationoRight DocumentationoRight EvaluationAsk for any history of allergy to the drugAssess site for administrationMonitor for any occurrence of side effectsPerform skin testing before administration

DRUG ORDER MECHANISM OF ACTIONINDICATIONSADVERSE EFFECTS OF THE DRUGNURSING RESPONSIBILITIES/

Generic Name:Purified Verocell vaccine, rabies (PVRV)

Brand Name:verorab

Classification:Anti-rabies, Vaccine, antisera & immunologicalsUsed in a postexposure prophylaxis regimen that includesactiveimmunization with rabies vaccine andpassiveimmunization with RIG. RIG provides immediate, temporary rabies virus-neutralizing antibodies until the patient has an immunologic response to active immunization with rabies vaccine and produces virus-neutralizing antibodies.For the prevention of rabies in subjects at a high risk of exposure. All subjects at a permanent risk eg, diagnostic, research and production laboratory staff working on rabies virus, should be vaccinated. A serological test is recommended every 6 monthsContraindications:Severe febrile infection, acute disease, progressive chronic disease (it is preferable to postpone vaccination); known hypersensitivity to any of the ingredients of Verorab.Post-Exposure: Due to the fatal progression of declared rabies infection, there are no contraindications to curative vaccination.If there is any doubt, it is essential to consult the doctor or pharmacist.Use in pregnancy & lactation:Verorab has not been the subject of animal teratogenicity studies Minor local reactions (pain, erythema, edema, pruritus and induration at the injection point); systemic reactions (moderate fever, shivering, faintness, asthenia, headaches, dizziness, arthralgia, myalgia, gastrointestinal disorders [nausea, abdominal pains]); exceptionally, anaphylactoid reactions, urticaria and rash.

Favirab must only be administered in a rabies control center, under medical supervision.Do not administer Favirab IV (due to the risk of shock ie, sudden collapse with drop in blood pressure). Consequently, make sure that the needle has not penetrated a blood vessel.Favirab should not be administered in repeated doses.

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ER DRUGS 5 column