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DRUG MECHANISMOF ACTION

INDICATIONS/CONTRAINDICATI

ONS

SIDEEFFECTS/ADVE

RSEREACTIONS

NURSINGRESPONIBILIT

IES

Generic name:epinephrine(adrenaline),

epinephrinebitartrate,epinephrineborate,epinephrinehydrochloride

Trade name:Aerosol:Primatene Mist

Ophthalmicsolution: Epinal

Injection, OTCnasal solution:

AdrenalinChloride

Insect-stingemergencies:EpiPen Auto-Injector

(delivers 0.3 mgIM adult dose),EpiPen Jr. Auto-Injector(delivers 0.15mg IM forchildren)

OTC solutionsfor nebulization:

AsthmaNefrin,

microNefrin,Nephron, S2

Classification:Sympathomimetic, Alpha-adrenergicagonist, Beta1-and beta2-adrenergicagonist, Cardiac

stimulant,Vasopressor,Bronchodilator,

Antasthmatic,Nasaldecongestant,Mydriatic

Dosage:Epinephrine

Epinephrine,an activeprinciple of the

adrenalmedulla, is adirect-actingsympathomimetic. Itstimulates -and -adrenergicreceptorsresulting inrelaxation ofsmooth muscleof thebronchial tree,cardiacstimulation anddilation ofskeletal musclevasculature. Itis frequentlyadded to localanaesthetics toretard diffusion

and limitabsorption, toprolong theduration ofeffect and tolessen thedanger oftoxicity.

IndicationsIV: In ventricular

standstill after allother measureshave failed torestorecirculation, givenby trainedpersonnel byintracardiacpuncture andintramyocardialinjection;treatment andprophylaxis ofcardiac arrestand attacks oftransitory AVheart block withsyncopal seizures(Stokes-Adamssyndrome);syncope due tocarotid sinussyndrome; acute

hypersensitivity(anaphylactoid)reactions, serumsickness,urticaria,angioneuroticedema; in acuteasthmatic attacksto relievebronchospasmnot controlled byinhalation orsubcutaneousinjection;relaxation ofuterinemusculature;additive to localanestheticsolutions forinjection toprolong theirduration of action

and limit systemicabsorption

Injection: Relieffrom respiratorydistress ofbronchial asthma,chronicbronchitis,

CNS effects;GIdisturbances;

epigastricpain; CVdisorders;difficulty inmicturitionwith urinaryretention;dyspnoea;hyperglycaemia; sweating;hypersalivation; weakness,tremors;coldness ofextremities;hypokalaemia.Gangrene,tissue necrosisand sloughing(extravasation) when usedin addition tolocal

anaesthetics.Eye drops:Severesmarting,blurred vision,photophobia;naso-lachrymalductsobstruction.Oedema,hyperaemiaandinflammationof the eyeswith repeatedadministration.

WARNING:Use extremecaution when

calculatingandpreparingdoses;epinephrineis a verypotent drug;small errorsin dosage cancause seriousadverseeffects.Double-checkpediatricdosage.

Use minimaldoses forminimalperiods oftime;"epinephrine-fastness" (aform of drug

tolerance)can occurwithprolongeduse.

Protect drugsolutionsfrom light,extremeheat, andfreezing; donot use pinkor brownsolutions.Drugsolutionsshould beclear andcolorless(does notapply tosuspensionfor injection).

Shake thesuspensionfor injectionwell beforewithdrawingthe dose.

Rotatesubcutaneousinjection sites

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injection

Cardiacarrest: 0.51mg (510mL of1:10,000

solution) IVor byintracardiacinjection intoleftventricularchamber;duringresuscitation, 0.5 mg q 5min.

Intraspinal

0.20.4 mL of a1:1,000 solutionadded to anestheticspinal fluid mixture.

Other usewith localanesthetic:Concentratio

ns of1:100,0001:20,000 areusually used.

1:1,000 solution

Respiratorydistress:0.30.5 mLof 1:1,000

solution(0.30.5mg),subcutaneously or IM, q20 min for 4hr.

1:200 suspension(for subcutaneousadministration only)

Respiratorydistress:0.10.3 mL(0.51.5mg)subcutaneously.

Inhalation

emphysema,other COPDs

Aerosols andsolutions fornebulization:Temporary relief

from acuteattacks ofbronchial asthma,COPD

Topical nasalsolution:Temporary relieffrom nasal andnasopharyngealmucosalcongestion due toa cold, sinusitis,hay fever, orother upperrespiratoryallergies;adjunctivetherapy in middleear infections bydecreasingcongestionaround

eustachian ostia

0.1% ophthalmicsolution:Conjunctivitis,during eyesurgery to controlbleeding, toproducemydriasis

Contraindications:Pre-existinghypertension;occlusive vasculardisease; angle-closure glaucoma(eye drops);hypersensitivity;cardiacarrhythmias or

tachycardia.When used inaddition to localanaesthetics:Proceduresinvolving digits,ears, nose, penisor scrotum.

to preventnecrosis;monitorinjection sitesfrequently.

WARNING:Keep a

rapidly actingalpha-adrenergicblocker(phentolamine) or avasodilator (anitrate)readilyavailable incase ofexcessivehypertensivereaction.

WARNING:Have analpha-adrenergicblocker orfacilities forintermittentpositivepressure

breathingreadilyavailable incasepulmonaryedemaoccurs.

WARNING:Keep a beta-adrenergicblocker(propranolol;acardioselective beta-adrenergicblocker, suchas atenolol,should beused inpatients withrespiratorydistress)

readilyavailable incase cardiacarrhythmiasoccur.

Do notexceedrecommended dosage of

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(aerosol)

Begintreatment atfirstsymptoms ofbronchospas

m.Individualizedosage. Wait15 minbetweeninhalationsto avoidoverdose.

Inhalation(nebulization)

Place 815drops intothe nebulizerreservoir.Placenebulizernozzle intopartiallyopenedmouth.Patient

inhalesdeeply whilebulb issqueezedone to threetimes. If norelief in 5min, give 23 additionalinhalations.Use four tosix times perday usuallymaintainscomfort.

Topical nasalsolution

Apply locallyas drops orspray orwith a sterile

swab, asrequired.

Ophthalmicsolution

Vasoconstriction,mydriasis:

inhalationproducts;administerpressurizedinhalationdrug formsduring

second halfof inspiration,because theairways areopen widerand theaerosoldistribution ismoreextensive. Ifa secondinhalation isneeded,administer atpeak effect ofpreviousdose, 35min.

Use topicalnasalsolutions onlyfor acutestates; do not

use forlonger than35 days,and do notexceedrecommended dosage.Reboundnasalcongestioncan occuraftervasoconstriction

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Instill 12drops intothe eye oreyes; repeatonce ifnecessary.

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DRUG MECHANISMOF ACTION

INDICATIONS/CONTRAINDICATIO

NS

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:Prednisone

Trade name:Apo-Prednisone(CAN),Deltasone,Liquid Pred,Meticorten,Novo-Prednisone(CAN),Orasone,Panasol-S,Prednicen-M,Prednisone-Intensol,SterapredDS, Winpred(CAN)

Classification:

Corticosteroid(intermediate acting),Glucocorticoid, Hormone

Dosage,frequencyand route:40-60 mgdaily for 3-10 days;give assingle or in2 divideddoses PO

Prednisone is aglucocorticoidreceptoragonist. It is

firstmetabolized inthe liver to itsactive form,prednisolone.Prednisolonecrosses cellmembranesand binds withhigh affinity tospecificcytoplasmicreceptors. Theresult includesinhibition ofleukocyteinfiltration atthe site ofinflammation,interference inthe function ofmediators ofinflammatory

response,suppression ofhumoralimmuneresponses, andreduction inedema or scartissue. Theantiinflammatory actions ofcorticosteroidsare thought toinvolvephospholipase

A2 inhibitoryproteins,lipocortins,which controlthebiosynthesis ofpotentmediators ofinflammation

such asprostaglandinsandleukotrienes.

Indications- Replacement therapy

in adrenal cortical

insufficiency

Hypercalcemia

associated with cancer

Short-term

management of

various inflammatory

and allergic disorders,

such as rheumatoid

arthritis, collagen

diseases (eg, SLE),

dermatologic diseases(eg, pemphigus),

status asthmaticus,

and autoimmune

disorders

Hematologic

disorders:

thrombocytopenia

purpura,

erythroblastopenia

Ulcerative colitis,acute exacerbations of

multiple sclerosis and

palliation in some

leukemias and

lymphomas

Trichinosis with

neurologic or

myocardial

involvement

Contraindications:Contraindicatedwith infections,especiallytuberculosis, fungalinfections,amebiasis, vacciniaand varicella, andantibiotic-resistantinfections;lactation

Vertigo, headache,

paresthesias,

insomnia,

convulsions,psychosis,

cataracts,

increased

intraocular

pressure, glaucoma

(long-term

therapy)

Hypotension,

shock,

hypertension andCHF secondary to

fluid retention,

thromboembolism,

thrombophlebitis,

fat embolism,

cardiac

arrhythmias

Administer once-

a-day doses

before 9 AM to

mimic normalpeak

corticosteroid

blood levels.

Increase dosage

when patient is

subject to stress.

Taper doses

when

discontinuing

high-dose or long-term therapy.

Do not give live

virus vaccines with

immunosuppressiv

e doses of

corticosteroids.

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DRUG MECHANISMOF ACTION

INDICATIONS/CONTRAINDICATIO

NS

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:Methimazole

Tradename:

Tapozole

Classification:

Antithyroidagent

Dosage:20mg

Frequency:BID

Route:PO

Inhibits thesynthesis ofthyroidhormones.

Indicated forpalliativetreatment ofhyperthyroidism.

IndicationsMethimazole isindicated in the

medical treatment ofhyperthyroidism. Long-term therapy may leadto remission of thedisease. Methimazolemay be used toamelioratehyperthyroidism inpreparation forsubtotal thyroidectomyor radioactive iodinetherapy. Methimazoleis also used whenthyroidectomy iscontraindicated or notadvisable.

Contraindications:Hepatitis caused byDrugs, AbnormalLiver FunctionTests, Pregnancy,

UnderactiveThyroid, AcquiredDecrease of AllCells in the Blood,Decreased Functionof Bone Marrow,Decrease in theBlood-ClottingProteinProthrombin,Decreased BloodPlatelets,Deficiency ofGranulocytes aType of WhiteBlood Cell,Decreased WhiteBlood Cells

fever, chills,sore throat,body aches, flusymptoms;

easy bruisingor bleeding,unusualweakness;

blood in yoururine or stools;

severeblistering,peeling, andred skin rash;or

nausea,stomach pain,low fever, lossof appetite,dark urine,clay-coloredstools,

jaundice(yellowing ofthe skin oreyes).

Less serious sideeffects ofmethimazole mayinclude:

headache,drowsiness,dizziness;

mild nausea,vomiting, orstomachupset;

itching, minorskin rash; muscle, joint,

or nerve pain; swelling; or hair loss.

Assess patient forhypersensitivity.

Use cautiously in

patients 40 yearsold and above.Drug may causeagranulocytosis

Monitor patients

vital signs

If the patientmisses to take thedrug, ask thepatient to take itas soon asremembered

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICATION

S

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:

Amikacin

Trade name:Amikacide

Classification:

Antibioticaminoglycosi

de

Dosage:200mg

Route:Intravenous

Inhibitsprotein

synthesis bybindingdirectly tothe 30Sribosomalsub unit;bactericidal.

Indication:

Serious infectioncause bysensitiverestrains ofPseudomonasaeruginusa,E.coli, Proteus,Klebsiella,staphylococcus

UncomplicatedUTI caused byorganism

susceptible toless toxic drugs.

Activetuberculosis, withotherantituberculoticsMycobacteriumavium complex(MAC) infection.

Contraindication:Renal insufficiency,anemia.

Clients withcardiac andpulmonarydiseases aremore susceptibletoacetaminophentoxicity

Tinnitus,hearing

impairment,renalimpairment,headache,tremor,lethargy,rashes, fever,

joint pain.

Obtainspecimen

for cultureandsensitivitytest beforegiving firstdose.Therapymay beginwhileawaitingthe results.

Evaluatepatientshearingbefore andduringtherapy ifhe will bereceivingdrug forlongerthan 2weeks.

Notifyprescriberif patienthastinnitus,vertigo, orhearingloss.

Weighpatientand reviewrenal

functionstudiesbeforetherapybegins.

Correctdehydration beforetherapybecause ofincrease

risk oftoxicity.

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICATION

S

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:

Doxycycline

Tradename:

Periostat

Classification:

Tertacycline

Dosage:250mg

Route:PO

To inhibitbacterialproteinsynthesis at

level or 30Sand 50Sbacterialribosomesand to altercytoplasmicmembrane ofsusceptibleorganisms

Indication:

To reduce thedevelopment of

drug-resistantbacteria andmaintain theeffectiveness ofSumycin 250 andSumycin 500

Tablets (TetracyclineHydrochlorideTablets) and otherantibacterial drugs,Sum- ycin 250 andSumycin 500Tablets (TetracyclineHydrochlorideTablets) should beused only to treat orprevent infectionsthat are proven orstrongly suspectedto be caused bysusceptible bacteria.When culture andsusceptibility

information areavailable, theyshould beconsidered inselecting ormodifyingantibacterialtherapy. In theabsence of suchdata, localepidemiology andsusceptibilitypatterns maycontribute to theempiric selection oftherapy.

Contraindication:

Contraindicatedin patientshypersensitive todrug or

Use cautiously inpatients withimpaired renalfunction orneuromusculardisorders, inneonates andinfants and inelderly patients

anorexia,epigastricdistress,nausea,

vomiting,diarrhea,bulkyloose stools,stomatitis,sorethroat,glossitis,blackhairytongue,dysphagia,hoarseness,enterocolitis,andinflammatorylesions (withcandidalovergrowth) inthe anogenitalregion,includingproctitis andpruritus ani.Rare instancesofesophagitisand

esophagealulceration havebeen reportedin patientsreceivingparticularly thecapsule andalso the tabletforms oftetracyclines

Monitor fors/s of superinfectionand

hypersensitivityreaction.

With long-term use,monitorCBC, liverfunctiontests, andbonegrowth

Assessneurologicstatus, stayalert firbenignintra cranialhypertension

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICATIO

NS

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Generic name:Azithromycin

Trade name:Zithromax

Classification:Macrolide

Dosage:300mg

Frequency:OD

Route:PO

Azithromycinblocks

transpeptidation by bindingto 50sribosomalsubunit ofsusceptibleorganismsanddisruptingRNA-dependentprotein

synthesis atthe chainelongationstep.

Indication: Treatment of

lower respiratoryinfections: Acutebacterialexacerbations ofCOPD due toHaemophilusinfluenzae,Moraxellacatarrhalis,Streptococcuspneumoniae;community-

acquiredpneumonia due toS. pneumoniae, H.influenzae

Treatment oflowerrespiratoryinfections:Streptococcalpharyngitis

and tonsillitisdue toStreptococcuspyogenes inthose whocannot takepenicillins

Treatment ofuncomplicatedskin infectionsdue toStaphylococcus aureus, S.pyogenes,Streptococcusagalactiae

Treatment ofnongonococcalurethritis andcervicitis dueto Chlamydiatrachomatis;treatment of

PID Treatment of

acute sinusitis

Contraindication Contraindicated

withhypersensitivity toazithromycin,

Mild tomoderate

nausea,vomiting,abdominalpain,dyspepsia,flatulence,diarrhoea,cramping;angioedema,cholestatic

jaundice;dizziness,

headache,vertigo,somnolence;transientelevations ofliver enzymevalues.

Culture siteof infection

beforetherapy.

Administeron anemptystomach 1hr beforeor 23 hraftermeals.Foodaffects the

absorptionof thisdrug.

PrepareZmax byadding 60mL waterto bottle,shake well.

Counselpatients

beingtreated forSTDs aboutappropriateprecautionsandadditionaltherapy.

Teaching points

Take thefull courseprescribed.Do nottake withantacids.Tablets andoralsuspensioncan betaken withor without

food. Prepare

Zmax byadding 60milliliters(1/4 cup)water tobottle

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DRUG MECHANIS

M OFACTION

INDICATIONS/CONTRAINDICATIO

NS

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Generic name:Dexamethorp

han

Trade name:Mucubron

Classification:Antitussives

Dosage:Adult: 15mlPedia: 5-10 ml

Frequency:BID

Route:PO

Supressescough reflexby direct

action on thecough centerin the medulla

Indication:

Relief ofcough due tominor throat &bronchialirritation asmay occurwith thecommon cold,bronchitis orinhaledirritants

Contraindication:

Should not be taken

for persistent/chronic

cough

-Whencoughingaccompaniedby excessivesecretions

Nausea,drowsiness,dizziness

-Obtain patient

history of cough

before therapy

and reassess after

giving the drug

-Assess cough:type, frequency,character includingsputum

Instruct patient to

follow exactly the

direction on

medication

-Advice medical

consultation for

persistent cough

more than 7 days

-Suggest sugarlesslozenges todecrease throatirritation andcough.

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICATION

S

SIDEEFFECTS/ADVERSE REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:

Calcium

Carbonate

Tradename:

Calci-aid

Classification:

Calciumpreparationdrugs

Dosage:Adult: 1-2capsules

Pedia: 1-2tablets

Route:PO

Decreasestotal acidload of GItract.

Increaseesophagealsphinctertone

Indication:

Antacid, calciumsupplement,

osteoporosis

Contraindication:

Hypercalcemia,bone tremors,severe renalfailure,hypersensitivity

PRECAUTION:History of stoneformation,pregnancy

ADVERSE RXN Constipation,

flatulence,diarrhea, renaldysfunction,acid rebound

administer asantacid 1 hr ftermeal and at bedtime

>administer assupplement 1 hrs after meal andat bed time>advice pt toincrease fluids to2L unlesscontraindicated

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICATIO

NS

SIDEEFFECTS/ADVERS

E REACTIONS

NURSINGRESPONIBILITI

ES

Genericname:

Digoxin

Tradename:

Lanoxin

Classification:

Cardiotonic-inotropicagents

Dosage:80 mg

Route:PO

Makes theheart beatslower butstronger;

improves thepumpingability of theheart;increases theforce ofheartscontraction

Indication:

Congestve HeartFailure

Atrial flutter

Atrial fibrillation

Contraindication:

bsence of UrineFormation,Pancreatitis,HearingProblem, Heart

Attack, BloodPressure DropUpon Standing,

Abnormally LowBlood Pressure,Blockage ofUrinary Bladder,EnlargedProstate,Systemic LupusErythematosus,

BloodCirculationFailure due toSerious HeartCondition, High

Amount of UricAcid in theBlood,

Azotemia,DecreasedBlood Volume,

Acid BaseImbalance ofthe BloodToward theBasic Side,Diabetes, Gout,Low Amount ofMagnesium inthe Blood, Low

Amount ofCalcium in theBlood, Low

Amount ofSodium in theBlood, Low

Amount ofPotassium inthe Blood, Low

Amount ofChloride in theBlood

inging inyour ears,hearing loss;

feeling verythirsty orhot, beingunable tourinate,heavysweating, orhot and dryskin;

painful ordifficulturination;

pale skin,unusualbleeding(nose,mouth,vagina, orrectum),purple or redpinpointspots underyour skin;

Hyponatraemia,

hypokalaemia,hypomagnesaemia.

- Hypochloraemicalkalosis.

- Increasedcalciumexcretion.

- Hypotension.

- Nausea.

- Dizziness.

Furosemide is

often given inconjunction with

a potassium

supplement or apotassium-sparing diuretic

to counteractpotassium loss.

- The medication

has a rapidonset of effect of

about one hourwhen taken

orally and fiveminutes by

injection.

- Duration of

action is about

six hours so it ispossible to use atwice daily doseif necessary.

PATIENT

TEACHING- Explain to

patients that

furosemidecontrols highblood pressure

but does notcure it and

therefore theyneed to continue

with themedication even

if they feel well.

- Advise patientsnot to stop

takingfurosemide

withoutconsulting the

prescribing

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health care

professional.

- Health

education shouldbe givenregarding diet

and exercise.

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DRUG MECHANISM OF

ACTION

INDICATIONS/CONTRAINDICAT

IONS

SIDEEFFECTS/ADV

ERSEREACTIONS

NURSINGRESPONIBILITIES

Genericname:

Isorbidenitrate

Tradename:

Imdur Classifica

tion:

Nitrates

Dosage:60mg

Route:PO

Nitratesare drugsthat

act directlyon thesmoothmuscletocauserelaxationandtodepressmuscletone.

Indication:

Prevention and

treatment of AnginaPectoris in Adults

Contraindication:

The presence ofany allergiestonitrates. Thesedrugs arealsocontraindicated inthe followingconditions: Severeanemia, head traumaorhemorrhage, pregnancy andlactation.

CNS)Headache,dizziness,an

dmyasthenia.(GI) N &

Vandincontinence. (CV) Hypotension.(SKIN)Flushintg pallor sweatingandincreasedperspiration

Instruct patient totakemedication asdirected,even if feeling better.

Takemissed doses as soonasremembered; dosesofisosorbide dinitrateshould betaken at least 2 hr apart (6hrwith extended-releasepreparations);dailydosesof isosorbidemononitrateshould betaken 7 hr apart.Donot double doses. DonotdiscontinueabruptlyCaution patient tomake positionchangesslowly tominimizeorthostatichypotension

Norjetalexis M Cabrera

ADZU BSN III B