MEDICATION MOA RT LABS TO REVIEW

SIDE EFFECTS

NURSING RESPONSIBILITIES

Misoprostol

(Cytotec)

Stage 3(Also used in first trimester to terminate pregnancy)

ActionReplaces protective prostaglandins consumed with prostaglandin-inhibiting therapies (e.g., NSAIDs).

Therapeutic Effect:Reduces acid secretion from gastric parietal cells, stimulates bicarbonate production from gastric/duodenal mucosa.

UsesPrevention of NSAID-induced gastric ulcers and in pts at high risk for developing gastric ulcer/gastric ulcer complicationsChemical termination of pregnancy (in conjunction with mifepristone)

PO BUN, Hematocrit,

CBCALT, AST,

Hgb, Creatinine

Frequent Abdominal painDiarrheaOccasional Nausea, FlatulenceDyspepsiaHeadache

Baseline assessmentQuestion for possibility of pregnancy before initiating therapy (Pregnancy Category X)

Bicitra

 (Cytra-2, Liqui-Dual Citra, Oracit)GI System (electrolyte modifier)

Stage 1 (prior to epidural)

ActionThis medication is used to make the urine less acidic. This medication can also prevent and treat certain metabolic problems (acidosis) caused by kidney disease.Citric acid and citrate salts (which contain potassium and sodium)

PO sodium levelspH (acidity)

of your urine blood

electrolyte bicarbonate

levels

Nausea, vomiting, diarrhea, and stomach pain

During pregnancy, this medication should be used only when clearly needed. This medication may worsen high blood pressure during pregnancy (toxemia of pregnancy).

Methergine

(Methylergonovine)

Stage 2(, given after delivery, shortens 3rd stage of labor)

ActionStimulates alpha-adrenergic, serotonin receptors, producing arterial vasoconstrictionCauses vasospasm of coronary arteriesDirectly stimulates uterine muscle.

PO calcium levels

Nausea, uterine cramping, vomiting

Baseline assessmentDetermine baseline serum calcium level, B/P, pulse. Assess for any evidence of bleeding before administration.

Intervention/evaluationMonitor uterine tone, bleeding, B/P, pulse q15min until stable (about 1–2 hrs)Assess extremities for color, warmth, movement, pain. Report chest pain promptlyProvide support with ambulation if dizziness occurs.

Magnesium

Sulfate

(Epsom Salt)Stage 1

ActionEssential for enzyme activity, nerve conduction, muscle contractionMaintains and restores magnesium levels. Anticonvulsant: Blocks neuromuscular transmission, amount of acetylcholine released at motor end plate. Produces seizure control

UsesTreatment/prevention of hypomagnesemiaPrevention and treatment of seizures in eclampsia; Torsade de pointes (atypical ventricular tachycardia); Treatment of arrhythmias due to hypomagnesemia (ventricular tachycardia/ventricular fibrillation)

IVIMPO

Mg, electrolytes

Common

Muscle WeaknessLack of EnergyBlurry VisionSlurred SpeechHeadacheNausea and VomitingFlushing

Baseline assessmentAssess if pt is sensitive to magnesium. Antacid: Assess GI pain (duration, location, quality, time of occurrence, relief with food, causative/excacerbative factors). Laxative: Assess for weight loss, nausea, vomiting, and history of recent abdominal surgery.Systemic: Assess renal function, serum magnesium.

Intervention/evaluationAntacid: Assess for relief of gastric distress. Monitor renal function (esp. if dosing is long term or frequent). Laxative: Monitor daily pattern of bowel activity, stool consistency. Maintain adequate fluid intake. Systemic: Monitor renal function, magnesium levels, EKG for cardiac function. Test patellar reflexes (knee jerk reflexes) before giving repeat parenteral doses (used as indication of CNS depression; suppressed reflexes may be sign of impending respiratory arrest). Patellar reflex must be present, respiratory rate should be 16/min or over before each parenteral dose. Initiate seizure precautions.

Oxytocin

(Pitocin, Syntocinon)Endocrine system (pituitary drug)

(Stage 1 & 3)

UsesInduction of labor at term, control of post-partum bleeding. Adjunct in management of abortion.

IV electrolytes Occasional: Tachycardia, premature ventricular contractions, hypotension, nausea, vomiting. Rare: Nasal: Lacrimation/tearing, nasal irritation, rhinorrhea, unexpected uterine bleeding/contractions.

Baseline assessment Assess baselines for vital signs, B/P, fetal heart rate. Determine frequency, duration, strength of contractions. Intervention/evaluation Monitor B/P, pulse, respirations, fetal heart rate, intrauterine pressure, contractions (duration, strength, frequency) q15min. Notify physician of contractions that last longer than 1 min, occur more frequently than every 2 min, or stop. Maintain careful I&O; be alert to potential water intoxication. Check for blood loss.

Terbutaline(Brethine)(Bricanyl)

(CNS system. Stimulant)

(Stage 2)

ActionStimulates beta2-adrenergic receptors, resulting in relaxation of uterine, bronchial smooth muscle

Therapeutic Effect:Inhibits uterine contractionsRelieves bronchospasm, reduces airway resistance.

UsesSymptomatic relief of reversible bronchospasm due to bronchial asthma, bronchitis, emphysemaDelays premature labor in pregnancies between 20 and 34 wks

IVPO

Frequent (38%–23%):Tremor, anxietyOccasional (11%–10%):Drowsiness, headache, nausea, heartburn, dizziness

Baseline assessmentBronchospasm: Offer emotional support (high incidence of anxiety due to difficulty in breathing, Sympathomimetics response to drug). Preterm labor: Assess baseline maternal pulse, B/P, frequency and duration of contractions, fetal heart rate.

Intervention/evaluationBronchospasm: Monitor rate, depth, rhythm, type of respiration; quality, rate of pulse. Assess lung sounds for rhonchi, wheezing, and rales. Monitor ABGs. Observe lips, fingernails for cyanosis (blue or dusky color in light-skinned pts; gray in dark-skinned pts). Observe for clavicular retractions, hand tremor. Evaluate for clinical improvement (quieter, slower respirations, relaxed facial expression, and cessation of clavicular retractions). Preterm labor: Monitor for frequency, duration, strength of contractions. Diligently monitor fetal heart rate.

Penicillin

G benzathine

(Stage 2)

ActionInhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins of bacteria. Therapeutic Effect: Bactericidal. Uses Treatment of mild to moderate severe infections caused by organisms susceptible to low concentrations of penicillin including streptococcal (Group A) upper respiratory infections, syphilis, yaws. Prophylaxis of infections caused by susceptible organisms (e.g., rheumatic fever prophylaxis).

IM CBC, urinalysis,

renal function

tests.

Occasional: Lethargy, fever, dizziness, rash, pain at injection site. Rare: Seizures, interstitial nephritis.

Baseline assessment Question for history of allergies, particularly penicillins, cephalosporins.

Penicillin G

potassium

(Stage 2)

Action Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins of bacteria.

Therapeutic Effect:Bactericidal.

UsesTreatment of susceptible infections due to gram-positive organisms, gram-negative organisms, actinomycosis, clostridium, diphtheria, Listeria, N. meningitidis, pasteurella including anthrax, endocarditis, respiratory tract infections, meningitis, neurosyphilis, skin/skin structure infections.

IV CBC, urinalysis,

renal function

tests.

Occasional: Lethargy, fever, dizziness, rash, pain at injection site. Rare: Seizures, interstitial nephritis.

Baseline assessment Question for history of allergies, particularly penicillins, cephalosporins.

Penicillin V

potassium

(Stage 3)

ActionInhibits cell wall synthesis by binding to bacterial cell membranes.

Therapeutic Effect:Bactericidal.

UsesTreatment of mild to moderate infections of respiratory tract, skin/skin structure, otitis media, necrotizing ulcerative gingivitis; prophylaxis for rheumatic fever, dental procedures.

PO Hgb levels Frequent:Mild hypersensitivity reaction (chills, fever, rash), nausea, vomiting, diarrhea.

Rare:Bleeding, allergic reaction.

Baseline assessmentQuestion for history of allergies,

particularly penicillins, cephalosporins.

Intervention/evaluationHold medication, promptly report rash (hypersensitivity), diarrhea (with fever, abdominal pain, mucus or blood in stool may indicate antibiotic-associated colitis). Monitor I&O, urinalysis, renal function tests for nephrotoxicity. Be alert for superinfection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal change (ulceration, pain, and erythema). Review Hgb levels; check for bleeding (overt bleeding, ecchymosis, swelling of tissue).

Betamethasone Action: IM Calcium Frequent: Baseline assessment

(Celestone,

Celestone

Phosphate,

Celestone

Soluspan)

(Stage 3)

Controls rate of protein synthesis, depresses migration of polymorphonuclear leukocytes/fibroblasts, reverses capillary permeability, prevents or controls inflammation.

Therapeutic Effect:Decreases tissue response to inflammatory process.

UsesSystemic:

Anti-inflammatory, immunosuppressant, corticosteroid replacement therapy.

Topical:Relief of inflammatory and pruritic dermatoses. Foam: Relief of inflammation, itching associated with dermatosis.

POTOPICAL

levels, Hematocrit,

Hgb, RBC, PT, PTT

Systemic:Increased appetite, abdominal distention, nervousness, insomnia, false sense of well-being.

Topical:Burning, stinging, pruritus.

Question for hypersensitivity to any corticosteroid, sulfite. Obtain baseline values for height, weight, B/P, serum glucose, electrolytes. Obtain baseline results of initial tests (tuberculosis [TB] skin test, X-rays, EKG).

Intervention/evaluationMonitor B/P, blood glucose, electrolytes. Apply topical preparation sparingly. Do not use on broken skin or in areas of infection. Do not apply to wet skin, face, and inguinal areas.

Ropivacaine

(Naropin,

Naropin

Polyamp,

Naropin SDV,

Naropin

Novaplus)

ActionMost local anesthetics fall into one of two groups: esters or amides. Both provide anesthesia and analgesia by reversibly binding to and blocking sodium (Na) channels. This slows the rate of depolarization of the nerve action potential; thus, propagation of the electrical impulses needed for nerve conduction is prevented.

UsesLocal anesthetics suppress pain by blocking impulses along axons. Suppression of pain does not cause generalized depression of the entire nervous system. Local anesthetics may be given topically and by injection (local infiltration, peripheral nerve block [axillary], IV regional [Bier block], epidural, and spinal).

Nerve block

Hypotension, bradycardia, headache, pruritus, nausea, vomiting, dizziness, anxiety, tinnitus, dyspnea, cardiac arrest, arrhythmias, seizures, syncope, chills

Baseline assessmentPt should be in recumbent position before drug is administered by parenteral route. Assess onset, type, location, duration of pain. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Effect of medication is reduced if full pain recurs before next dose.

Intervention/evaluationMonitor vital signs 15–30 min after subcutaneous/IM dose, 5–10 min after IV dose (monitor for hypotension, change in rate/quality of pulse). Monitor pain level, sedation response. Monitor daily pattern of bowel activity, stool consistency; avoid constipation. Check for adequate voiding. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Therapeutic serum level: 100–550 ng/ml; toxic serum level: greater than 1,000 ng/ml.

Demerol Action IV plasma Frequent: Baseline assessment

(meperidine)(Isonipecaine)(Pethidine)(Neperdine)

Analgesic

NARCAN is antidote

Binds to opioid receptors within CNS. Therapeutic Effect: Alters pain perception, emotional response to pain.

UsesRelief of moderate to severe pain.

IMPO

amylase & lipase

concentration

Sedation, hypotension (including orthostatic hypotension), diaphoresis, facial flushing, dizziness, nausea, vomiting, constipation.

Pt should be in recumbent position before drug is administered by parenteral route. Assess onset, type, location, duration of pain. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Effect of medication is reduced if full pain recurs before next dose.

Intervention/evaluationMonitor vital signs 15–30 min after subcutaneous/IM dose, 5–10 min after IV dose (monitor for hypotension, change in rate/quality of pulse). Monitor pain level, sedation response. Monitor daily pattern of bowel activity, stool consistency; avoid constipation. Check for adequate voiding. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Therapeutic serum level: 100–550 ng/ml; toxic serum level: greater than 1,000 ng/ml.

Morphine

sulfate

(Avinza, Kadian,

Morphine IR, MS

Contin, MSIR,

Oramorph SR,

Roxanol)NARCAN is antidote

ActionBinds with opioid receptors within CNSTherapeutic Effect: Alters pain perception, emotional response to pain

UsesRelief of moderate to severe, acute, or chronic pain; analgesia during laborDrug of choice for pain due to MI, dyspnea from pulmonary edema not resulting from chemical respiratory irritantDepoDur: Epidural (lumbar) single dose management of surgical pain. Infumorph: Use in devices for managing intractable chronic pain

IV plasma amylase &

lipase concentration

Ambulatory pts, that not in severe pain may experience nausea, vomiting more frequently than those in supine position or who have severe pain.

Frequent:Sedation, decreased B/P (including orthostatic hypotension), diaphoresis, facial flushing, constipation, dizziness, drowsiness, nausea, vomiting..

Baseline assessmentPt should be in recumbent position before drug is given by parenteral route. Assess onset, type, location, duration of pain. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Effect of medication is reduced if full pain recurs before next dose.

Intervention/evaluationMonitor vital signs 5–10 min after IV administration, 15–30 min after subcutaneous, IM. Be alert for decreased respirations, B/P. Check for adequate voiding. Monitor daily pattern of bowel activity and stool consistency.

ketorolac

(Toradol)

Immune system drug, Anti-inflammatory & Disease-modulating Agent

Action Inhibits prostaglandin synthesis, reduces prostaglandin levels in aqueous humor. Therapeutic Effect: Reduces intensity of pain stimulus, reduces intraocular inflammation.Uses PO, injection: Short-term (5 days or less) relief of mild to moderate pain. Ophthalmic: Relief of ocular itching due to seasonal allergic conjunctivitis. Treatment postop for inflammation following cataract extraction, pain following incisional refractive surgery.

IVIMPO

BUN, serum creatine, CBC

with diff, electrolytes,

bleeding time, & liver

function tests

Frequent (17%–12%): Headache, nausea, abdominal cramps/pain, dyspepsia (heartburn, indigestion, epigastric pain).

Baseline assessmentAssess onset, type, location, duration of pain. Obtain baseline renal/hepatic function tests.

Intervention/evaluationMonitor renal/hepatic function tests, urinary output. Monitor daily pattern of bowel activity, stool consistency. Observe for occult blood loss. Assess for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility, reduced joint tenderness, improved grip strength. Be alert to signs of bleeding (may also occur with ophthalmic route due to systemic absorption).

Hydralazine

(Apresoline)

ActionCompetes with histamine for receptor sites in GI tract, blood vessels, respiratory tractDiminishes vestibular stimulation, depresses labyrinthine function.

Therapeutic Effect:Produces anxiolytic, anticholinergic, antihistaminic, analgesic effects; relaxes skeletal muscle; controls nausea, vomiting.

UsesTreatment of anxiety, preop sedation, antipruitic

POIM

None significant

Frequent: Drowsiness, dry mouth, marked discomfort with IM injection. Occasional: Dizziness, ataxia, asthenia (loss of strength, energy), slurred speech, headache, agitation, increased anxiety.

Baseline assessmentAnxiety: Offer emotional support to anxious pt. Assess motor responses (agitation, trembling, tension), autonomic responses (cold/clammy hands, diaphoresis). Antiemetic: Assess for dehydration (poor skin turgor, dry mucous membranes, and longitudinal furrows in tongue).

Intervention/evaluationFor those on long-term therapy, hepatic/renal function tests, blood counts should be performed periodically. Monitor lung sounds for signs of hypersensitivity reaction. Monitor serum electrolytes in pts with severe vomiting. Assess for paradoxical reaction, particularly during early therapy. Assist with ambulation if drowsiness, light-headedness occur.

Nubain

(Nalbuphine )

Short acting

ActionBinds with opioid receptors within CNS. May displace opioid agonists, competitively inhibiting their action; may precipitate withdrawal symptoms. Therapeutic Effect: Alters pain perception, emotional response to pain.

UsesRelief of moderate to severe pain, preop analgesia, obstetric analgesia, adjunct to anesthesia. OFF-LABEL: Opioid-induced pruritus.

IVIM

plasma amylase &

lipase concentration

Frequent Sedation. Occasional Diaphoresis, cold/clammy skin, nausea, vomiting, dizziness, vertigo, dry mouth, headache.

Baseline assessmentObtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Low abuse potential.

Intervention/evaluationMonitor for change in respirations, B/P, rate/quality of pulse. Monitor daily pattern of bowel activity and stool consistency. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Assess for clinical improvement, record onset of relief of pain. Consult physician if pain relief is not adequate.

Ritodrine

used to stop premature labor

ActionInhibits HIV-1 and HIV-2 proteases, rendering these enzymes incapable of processing polypeptide precursors leading to production of noninfectious, immature HIV particles. Therapeutic Effect: Slows HIV replication, reducing progression of HIV infection.Uses Treatment of HIV infection in combination with other antiretroviral agents.

PO Frequent:GI disturbances (abdominal pain, anorexia, diarrhea, nausea, vomiting), circumoral and peripheral paresthesias, altered taste, headache, dizziness, fatigue, asthenia (loss of strength, energy).

Baseline assessmentPts beginning combination therapy with ritonavir and nucleosides may promote GI tolerance by beginning ritonavir alone and subsequently adding nucleosides before completing 2 wks of ritonavir monotherapy. Obtain baseline laboratory testing, esp. serum hepatic function tests, triglycerides before beginning ritonavir therapy and at periodic intervals during therapy. Offer emotional support to pt/family. Intervention/evaluation Closely monitor for evidence of GI disturbances, neurologic abnormalities (particularly paresthesias). Monitor serum hepatic function tests, serum glucose, CD4 cell count, plasma levels of HIV RNA.

Calcium

Gluconate

(Tums)

GI Drug, electrolyte modifier

Therapeutic Effect:

Replaces calcium in deficiency states; controls hyperphosphatemia in end-stage renal disease, relieves heartburn, indigestion.

Action:Essential for function, integrity of nervous, muscular, skeletal systems. Plays an important role in normal cardiac/renal function, respiration, blood coagulation, cell membrane and capillary permeability. Assists in regulating release/storage of neurotransmitters/hormones. Neutralizes/reduces gastric acid (increases pH). Calcium acetate: Combines with dietary phosphate, forming insoluble calcium phosphate.

Uses:Parenteral: Acute hypocalcemia (e.g., neonatal hypocalcemia tetany, alkalosis), electrolyte depletion, cardiac arrest (strengthens myocardial contractions), hyperkalemia (reverses cardiac depression), Hypermagnesemia (aids in reversing CNS depression).

IV electrolytes, serum Mg, Ph, & K concentrations

Frequent:PO: Chalky taste. Parenteral: Pain, rash, redness, burning at injection site, flushing, feeling of warmth, nausea, vomiting, diaphoresis, hypotension

Baseline assessment AssessB/P, EKG and cardiac rhythm, renal function, serum magnesium, phosphate, potassium concentrations.

Intervention/evaluationMonitor B/P, EKG, cardiac rhythm, serum magnesium, phosphate, potassium, renal function. Monitor serum, urine calcium concentrations. Monitor for signs of hypercalcemia.

Stadol

(Butorphanol)

Short acting

ActionBinds to opiate receptor sites in CNS. Reduces intensity of pain stimuli incoming from sensory nerve endings. Therapeutic Effect: Alters pain perception, emotional response to pain

UsesManagement of pain (including postop pain). Nasal: Management of moderate to severe pain, including migraine headache pain. Parenteral: Preop, preanesthetic medication, supplement balanced anesthesia, relief of pain during labor.

IVNasal Spray

(Stadol NS):

10 mg/ml.

.

plasma amylase &

lipase concentration

Frequent: Parenteral: Drowsiness, dizziness. Nasal: Nasal congestion

Baseline assessmentObtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Protect from falls. During labor, assess fetal heart tones, uterine contractions. Intervention/evaluation Monitor for change in respirations, B/P, rate/quality of pulse. Initiate deep breathing, coughing exercises, particularly in those with pulmonary impairment. Change pt’s position q2–4h. Assess for clinical improvement, record onset of relief of pain.

Phytonadione

Aqua

(Vitamin K 1)

stage 2

First hour after

birth

Cardiovascular Drug, Affecting coagulation

Antidote for WARFARIN

ActionPromotes hepatic formation of coagulation factors II, VII, IX, X. Therapeutic Effect:Essential for normal clotting of blood.

UsesPrevention, treatment of hemorrhagic states in neonates; antidote for hemorrhage induced by oral anticoagulants, hypoprothrombinemic states due to vitamin K deficiency. Will not counteract anticoagulation effect of heparin.

IMIVPO

PTIR

Occasional: Pain, soreness, swelling at IM injection site, pruritic erythema (with repeated injections), facial flushing, altered taste.

Intervention/evaluationMonitor PT, international normalized ratio (INR) routinely in those taking anticoagulants. Assess skin for ecchymoses, petechiae. Assess gums for gingival bleeding, erythema. Assess urine for hematuria. Assess Hct, platelet count, urine/stool culture for occult blood. Assess for decrease in B/P, increase in pulse rate, complaint of abdominal/back pain, severe headache (may be evidence of hemorrhage). Question for increase in amount of discharge during menses. Assess peripheral pulses. Check for excessive bleeding from minor cuts, scratches.

PNV Prenatal vitamins are used to provide the additional vitamins needed during pregnancy. Minerals may also be contained in prenatal multivitamins.

PO Nonesignificant

Upset stomach;headache; orUnusual or unpleasant taste in your mouth.

Avoid taking any other multivitamin product within 2 hours before or after you take your prenatal vitamins. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.Avoid the regular use of salt substitutes in your diet if your multivitamin contains potassium. If you are on a low-salt diet, ask your doctor before taking a vitamin or mineral supplement.

Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the prenatal vitamin.

Iron Sulfate

(ferrous sulfate)

UsesFerrous sulfate provides the iron needed by the body to produce red blood cells.

It is used to treat or prevent iron-deficiency anemia, a condition that occurs when the body has too few red blood cells because of pregnancy, poor diet, excess bleeding, or other medical problems.

PO Serum iron, total iron-binding capacity, reticulocyte count, Hgb, ferritin.

ConstipationStomach Upset

Although symptoms of iron deficiency usually improve within a few days, you may have to take ferrous sulfate for 6 months if you have severe iron deficiency.This medication should be taken on an empty stomach, at least 1 hour before or 2 hours after eating.Ferrous sulfate drops come with a special dropper for measuring the dose. Ask your pharmacist to show you how to use it. The drops may be placed directly in the mouth or mixed with water or fruit juice (not with milk).

Ducolax

GI system, Laxative/ bowel preps/ Anitflatulents

Action Direct effect on colonic smooth musculature by stimulating intramural nerve plexi. Therapeutic Effect: Promotes fluid and ion accumulation in colon increasing peristalsis, producing laxative effect.Uses Treatment of constipation, colonic evacuation before examinations or procedures.

PO electrolytes Frequent: Some degree of abdominal discomfort, nausea, mild cramps, faintness. Occasional: Rectal administration: burning of rectal mucosa, mild proctitis.

Intervention/evaluation Encourage adequate fluid intake. Assess bowel sounds for peristalsis. Monitor daily pattern of bowel activity and stool consistency; record time of evacuation. Assess for abdominal disturbances. Monitor serum electrolytes in those exposed to prolonged, frequent, or excessive use of medication.

(Reglan(Metoclopramide)Routes

ActionStimulates motility of upper GI tract Decreases reflux into esophagus. Raises threshold activity in chemoreceptor trigger zoneTherapeutic Effect: Accelerates intestinal transit, gastric emptying. Relieves nausea, vomiting.

UsesFacilitates placement of enteral feeding tubes; stimulates gastric emptying, intestinal transit in conjunction with radiography; treatment of gastroparesis, gastroesophogeal reflux disease (GERD); prevents or treats cancer chemotherapy-induced nausea, vomiting; prevents or treats postop nausea, vomiting. Orally-Disintegrating Tablets: Treatment of gastroparesis, GERD.

IVPO

◀ ALERT ▶ Doses of 2 mg/kg or greater, or increased length of therapy, may result in a greater incidence of side effects. Frequent (10%):Drowsiness, restlessness, fatigue, lethargy

Baseline assessmentAntiemetic: Assess for dehydration (poor skin turgor, dry mucous membranes, and longitudinal furrows in tongue). Assess for nausea, vomiting, abdominal distention, and bowel sounds.

Intervention/evaluationMonitor for anxiety, restlessness, extrapyramidal symptoms (EPS) during IV administration. Monitor daily pattern of bowel activity and stool consistency. Assess skin for rash. Evaluate for therapeutic response from gastroparesis (nausea, vomiting, bloating). Monitor renal function, B/P, heart rate.

Methyldopa

(Aldomet)

Lowers blood pressure by decreasing the levels of certain chemicals in your blood. This allows your blood vessels (veins and arteries) to relax (widen) and your heart to beat more slowly and easily.

Methyldopa is used to treat hypertension (high blood pressure).

ORAL slow heart rate;pale or yellowed skin, fever, confusion or weakness;nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);skin rash, bruising, severe tingling, numbness, pain, muscle weakness;feeling short of breath, even with mild exertion;swelling in your hands, ankles, or feet;easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; orMuscle movements you cannot control.

You should not take this medication if you are allergic to methyldopa, or if you have liver disease (especially cirrhosis), or a history of liver problems caused by taking methyldopa. Do not use methyldopa if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

Procardia

(Nifedipine)Cardiovascular system, Affecting contractility/ rhythm/ circulating blood volume

ActionInhibits calcium ion movement across cell membranes, depressing contraction of cardiac, vascular smooth muscle

Therapeutic Effect:Increases heart rate, cardiac outputDecreases systemic vascular resistance, B/P

UsesTreatment of angina due to coronary artery spasm (Prinzmetal’s variant angina), chronic stable angina (effort-associated angina) Extended-releaseTreatment of essential hypertension

POSUB

LINGUAL

LFT, RFT, CBC, serum glucose, K

Frequent Peripheral edema, headache, flushed skin, dizziness.

Occasional Nausea, shakiness, muscle cramps/pain, drowsiness, palpitations, nasal congestion, cough, dyspnea, wheezing.

Baseline assessmentConcurrent therapy of sublingual nitroglycerin may be used for relief of anginal painRecord onset, type (sharp, dull, squeezing), radiation, location, intensity, duration of anginal pain; precipitating factors (exertion, emotional stress)Check B/P for hypotension immediately before giving medication.

Intervention/evaluationAssist with ambulation if light-headedness, dizziness occursAssess for peripheral edema. Assess skin for flushing. Monitor serum hepatic enzymes, signs/symptoms of CHF.

Bupivacaine(Marcaine HCl, Marcaine Spinal, Sensorcaine, Sensorcaine-MPF, Sensorcaine-MPF Spinal)

Inducing spinal anesthesia for certain medical or surgical procedures.

Bupivacaine Solution is an anesthetic. It works by blocking the generation and conduction of nerve impulses.

Nerve block

Mild dizziness or drowsiness.

Baseline assessmentPt should be in recumbent position before drug is administered by parenteral route. Assess onset, type, location, duration of pain. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Effect of medication is reduced if full pain recurs before next dose.

Intervention/evaluationMonitor vital signs 15–30 min after subcutaneous/IM dose, 5–10 min after IV dose (monitor for hypotension, change in rate/quality of pulse). Monitor pain level, sedation response. Monitor daily pattern of bowel activity, stool consistency; avoid constipation. Check for adequate voiding. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Therapeutic serum level: 100–550 ng/ml; toxic serum level: greater than 1,000 ng/ml.

Fentanyl

( Fentora,

Onsolis)CNS, Analgesics

NARCAN is antidote

ActionBinds to opioid receptors in CNS, reducing stimuli from sensory nerve endings, inhibits ascending pain pathways. Therapeutic Effect: Alters pain reception, increases pain threshold.

UsesFor sedation, pain relief, preop medication; adjunct to general or regional anesthesia. Duragesic: Management of chronic pain (transdermal). Actiq: Treatment of breakthrough pain in chronic cancer or AIDS-related pain. Fentora: Breakthrough pain in pts on chronic opioids. Onsolis: Breakthrough pain in pts with cancer currently receiving opioids and tolerant to opioid therapy.

IVIM BUCAL

plasma amylase & lipase

Frequent:IV: Postop drowsiness, nausea, vomiting. Transdermal (10%–3%): Headache, pruritus, nausea, vomiting, diaphoresis, dyspnea, confusion, dizziness, drowsiness, diarrhea, constipation, decreased appetite. Occasional: IV: Postop confusion, blurred vision, chills, orthostatic hypotension, constipation, difficulty urinating. Transdermal (3%–1%): Chest pain, arrhythmias, erythema, pruritus, syncope, agitation, skin irritations.

Baseline assessment Resuscitative equipment, opiate antagonist (naloxone 0.5 mcg/kg) must be available. Establish baseline B/P, respirations. Assess type, location, intensity, duration of pain. Intervention/evaluation Assist with ambulation. Encourage post-op pt to turn, cough, deep breathe q2h. Monitor respiratory rate, B/P, heart rate, oxygen saturation. Assess for relief of pain.

Phenergan

(Promethazine)GI System, Antiemetics/ Antihistamine

ActionAntihistamine: Inhibits histamine at histamine receptor sites. Antiemetic: Diminishes vestibular stimulationDepresses labyrinthine functionActs on chemoreceptor trigger zoneSedative-hypnotic:Produces CNS depression by decreasing stimulation to brain stem reticular formation

Therapeutic Effect:Prevents allergic responses mediated by histamine (urticaria, pruritus). Prevents, relieves nausea/vomitingProduces mild sedative effect

UsesTreatment of allergic conditions, Motion sickness, Nausea VomitingMay be used as mild sedative

POIV

Serum electrolytes,

serum bilirubin, AST, ALT

Expected:Drowsiness, disorientation; hypotension, confusion, syncope in elderly

Frequent:Dry mouth, nose, throat; urinary retention; thickening of bronchial secretions

Baseline assessmentAssess allergy symptoms. Assess B/P, pulse for bradycardia, tachycardia if pt is given parenteral form. If used as antiemetic, assess for dehydration (poor skin turgor, dry mucous membranes, and longitudinal furrows in tongue).

Intervention/evaluationMonitor serum electrolytes in pts with severe vomiting. Assist with ambulation if drowsiness, light-headedness occurs. Monitor for relief of nausea, vomiting, allergic symptoms

RhoGAM Action IV CNS: dizziness, Assessment

(RHo (D) immune globulin)

Prevent production of anti-Rh(D) antibodies in Rh(D)-negative patients who were exposed to Rh(D)-positive blood. Increase platelet counts in patients with ITP. Therapeutic Effects: Prevention of antibody response and hemolytic disease of the newborn (erythroblastosis fetalis) in future pregnancies of women who have conceived a Rh (D)-positive fetus. Prevention of Rh(D) sensitization following transfusion accident. Decreased bleeding in patients with ITP.

IM headache. CV: hypertension, hypotension. Derm: rash. GI: diarrhea, nausea, vomiting. Hemat: ITP: anemia, intravascular hemolysis. MS: arthralgia, myalgia. Local: pain at injection site. Misc: fever.

IV: Assess vital signs periodically during therapy in patients receiving IV Rh(D) immune globulin .ITP: Monitor patient for signs and symptoms of intravascular hemolysis (IVH) (back pain, shaking chills, fever, hemoglobinuria), anemia, and renal insufficiency. If transfusions are required, use Rh(D) negative packed red blood cells to prevent exacerbation of IVH.Lab Test Considerations: Pregnancy: Type and crossmatch of mother and newborns cord blood must be performed to determine need for medication. Mother must be Rh (D)-negative and Du-negative. Infant must be Rh(D)-positive. If there is doubt regarding infants blood type or if father is Rh(D)-positive, medication should be given. An infant born to a woman treated with Rh(D) immune globulin antepartum may have a weakly positive direct Coombs test result on cord or infant blood.ITP: Monitor platelet counts, RBC counts, hemoglobin, and reticulocyte levels to determine effectiveness of therapy .

Zofran(Ondansetron)

GI System, Antiemetics/ Antihistamine

ActionBlocks serotonin, both peripherally on vagal nerve terminals and centrally in chemoreceptor trigger zone

Therapeutic Effect:Prevents nausea/vomiting

UsesPrevention/treatment of nausea/vomiting due to cancer chemotherapy (including high-dose cisplatin)Prevention of postop nausea, vomiting. Prevention of radiation-induced nausea, vomiting. Treatment of postop nausea, vomiting.

OFF-LABEL:Postanesthetic shivering, vomiting due to viral illnessTreatment of early-onset alcoholism, Hyperemesis gravidarum

IVPO

Serum electrolytes, serum bilirubin, AST, ALT

Frequent(13%–5%): Anxiety, dizziness, drowsiness, headache, fatigue, constipation, diarrhea, hypoxia, urinary retention.

Occasional (4%–2%):

Abdominal pain, xerostomia, fever, feeling of cold, redness/pain at injection site, paresthesia, asthenia (lack of strength, energy)

Rare (1%):Hypersensitivity reaction (rash, pruritus), blurred vision

Baseline assessmentAssess degree of nausea, vomiting. Assess for dehydration if excessive vomiting occurs (poor skin turgor, dry mucous membranes, and longitudinal furrows in tongue). Provide emotional support.

Intervention/evaluationMonitor pt in environment. Assess bowel sounds for peristalsis. Provide supportive measures. Assess mental status. Monitor daily pattern of bowel activity and stool consistency. Record time of evacuation

Motrin Action PO Serum, Occasional: Baseline assessment

(DiphenhydramineIbuprofen )

Inhibits prostaglandin synthesis. Produces vasodilation acting on heat-regulating center of hypothalamus. Therapeutic Effect: Produces analgesic, anti-inflammation effects, decreases fever.

UsesTreatment of fever, juvenile rheumatoid arthritis (JRA), osteoarthritis, minor pain, mild to moderate pain, primary dysmenorrheal. NeoProfen: Closes clinically significant patent ductus arteriosus (PDA) in premature infants weighing between 500 and 1,500 g who are no more than 32 wks gestational age when usual medical management is ineffective.

plasma,URINE

Nausea with or without vomiting, dyspepsia, dizziness, rash. Rare (less than 3%): Diarrhea or constipation, flatulence, abdominal cramps or pain, pruritus.

Assess onset, type, location, duration of pain, inflammation. Inspect appearance of affected joints for immobility, deformities, skin condition. Assess temperature.

Intervention/evaluationMonitor for evidence of nausea, dyspepsia. Monitor CBC, hepatic/renal function tests, occult blood loss. Monitor daily pattern of bowel activity and stool consistency. Assess skin for rash. Observe for bleeding, bruising. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increased joint mobility; reduced joint tenderness; improved grip strength. Monitor temperature for fever.

Zantac

(ranitidine)

ActionInhibits histamine action at histamine 2 receptors of gastric parietal cells. Therapeutic Effect: Inhibits gastric acid secretion (fasting, nocturnal, when stimulated by food, caffeine, insulin). Reduces volume, hydrogen ion concentration of gastric juice.

UsesShort-term treatment of active duodenal ulcer. Prevention of duodenal ulcer recurrence. Treatment of active benign gastric ulcer, pathologic GI hypersecretory conditions, acute gastroesophageal reflux disease (GERD), includes erosive esophagitis. Maintenance of healed erosive esophagitis. Part of regimen for H. pylori eradication to reduce risk of duodenal ulcer recurrence. OTC: Relieve heartburn, acid indigestion, sour stomach.

POIMIV

serum AST, ALT levels, creatinine, BUN

Occasional (2%): Diarrhea. Rare (1%): Constipation, headache (may be severe).

.

Baseline assessmentObtain history of epigastric/abdominal pain. Obtain baseline hepatic/renal function tests.

Intervention/evaluationMonitor. Assess mental status in elderly. Question present abdominal pain, GI distress

Pepcid Action PO Occasional Baseline assessment

(Famotidine, calcium, and magnesium)

Inhibits histamine action H2 receptors of parietal cells. Therapeutic Effect: Inhibits gastric acid secretion (fasting, nocturnal, or stimulated by food, caffeine, insulin).

UsesShort-term treatment of active duodenal ulcer. Prevention, maintenance of duodenal ulcer recurrence. Treatment of active benign gastric ulcer, pathologic GI hypersecretory conditions. Short-term treatment of gastroesophageal reflux disease (GERD), including erosive esophagitis. OTC formulation for relief of heartburn, acid indigestion, sour stomach.

IMIV

(5%): Headache.

Assess epigastric/abdominal pain. Intervention/evaluation Monitor daily pattern of bowel activity and stool consistency. Monitor for diarrhea, constipation, and headache. Assess confusion in elderly.

Beractant

(Survanta)

ActionLowers alveolar surface tension during respiration, stabilizing alveoli. Therapeutic Effect: Improves lung compliance, respiratory gas exchange.

UsesPrevention and treatment (rescue therapy) of respiratory distress syndrome (RDS—hyaline membrane disease) in premature infants. Prevention: Body weight less than 1,250 g in infants at risk for developing or with evidence of surfactant deficiency (give within 15 min of birth). Rescue Therapy: Treatment of infants with RDS confirmed by X-ray, requiring mechanical ventilation (give within 8 hrs of birth).

Intratracheal

Frequent:Transient bradycardia, oxygen (O2) desaturation, increased carbon dioxide (CO2) retention.

Occasional:Endotracheal tube reflux.

Baseline assessmentDrug must be administered in highly supervised setting. Clinicians caring for neonate must be experienced with intubation, ventilator management. Offer emotional support to parents.

Intervention/evaluationMonitor infant with arterial or transcutaneous measurement of systemic O2, CO2. Assess for adventitious breath sounds (rales, rhonchi).

Erythromycin 1% Action PO Frequent: Baseline assessment

stage 2First hour after birth

Penetrates bacterial cell membranes, reversibly binds to bacterial ribosomes, inhibiting protein synthesis. Therapeutic Effect: Bacteriostatic.

UsesTreatment of susceptible infections due to S. pyogenes, S. pneumoniae, S. aureus, M. pneumoniae, Legionella, diphtheria, pertussis, chancroid, Chlamydia, N. gonorrheae, E. histolytica, syphilis, nongonococcal urethritis, Campylobacter gastroenteritis. Topical: Treatment of acne vulgaris. Ophthalmic: Prevention of gonococcal ophthalmia neonatorum, superficial ocular infections.

OFF-LABEL:Systemic: Treatment of acne vulgaris, chancroid, Campylobacter enteritis, gastroparesis, Lyme disease, preoperative gut sterilization. Topical: Treatment of minor bacterial skin infections. Ophthalmic: Treatment of blepharitis, conjunctivitis, keratitis, chlamydial trachoma.

TOPICAL IV: Abdominal cramping/discomfort, phlebitis/thrombophlebitis. Topical: Dry skin (50%).

Occasional:Nausea, vomiting, diarrhea, rash, urticaria. Rare: Ophthalmic: Sensitivity reaction with increased irritation, burning, itching, inflammation. Topical: Urticaria.

Question for history of allergies (particularly erythromycins), hepatitis.

Intervention/evaluationMonitor daily pattern of bowel activity and stool consistency. Assess skin for rash. Assess for hepatotoxicity (malaise, fever, abdominal pain, GI disturbances). Be alert for superinfection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema). Check for phlebitis (heat, pain, red streaking over vein). Monitor for high-dose hearing loss.

.

Narcan

(Naloxone)

CNS Drug,

Opioid Reversal

Agent

ActionDisplaces opioids at opioid-occupied receptor sites in CNS. Therapeutic Effect: Reverses opioid-induced sleep/sedation, increases respiratory rate, raises B/P to normal range.

UsesComplete or partial reversal of opioid depression including respiratory depression. Diagnosis of suspected opioid tolerance or acute opioid overdose. Neonatal opiate depression. Coma of unknown origin

IVIM

None known; little or no pharmacologic effect in absence of narcotics.

Baseline assessmentMaintain clear airway. Obtain weight of children to calculate drug dosage.

Intervention/evaluationMonitor vital signs, esp. rate, depth, rhythm of respiration, during and frequently following administration. Carefully observe pt after satisfactory response (duration of opiate may exceed duration of naloxone, resulting in recurrence of respiratory depression). Assess for increased pain with reversal of opiate.

Benadryl Action IV Frequent: Baseline assessment

(Diphenhydramine)

Respiratory System, Anti-allergy/ Anti-inflammatory Agent

Competitively blocks effects of histamine at peripheral H1 receptor sites. Therapeutic Effect: Produces anticholinergic, antipruritic, antitussive, antiemetic, antidyskinetic, sedative effects.

UsesTreatment of allergic reactions, parkinsonism; prevention/treatment of nausea, vomiting, vertigo due to motion sickness; antitussive; short-term management of insomnia. Topical form used for relief of pruritus, insect bites, skin irritations.

IMPO

Drowsiness, dizziness, muscle weakness, hypotension, urinary retention, thickening of bronchial secretions, dry mouth, nose, throat, lips; in elderly: sedation, dizziness, hypotension.

Occasional:Epigastric distress, flushing, visual/hearing disturbances, paresthesia, diaphoresis, chills.

If pt is having acute allergic reaction, obtain history of recently ingested foods, drugs, environmental exposure, and emotional stress. Monitor B/P rate, depth, rhythm, type of respiration; quality, rate of pulse. Assess lung sounds for rhonchi, wheezing, and rales.

Intervention/evaluationMonitor B/P, esp. in elderly (increased risk of hypotension). Monitor children closely for paradoxical reaction.

Percocet

(

Acetaminophen/

Oxycodone)

Action Binds with opioid receptors within CNS. Therapeutic Effect: Alters perception of and emotional response to pain.

Uses Relief of mild to moderately severe pain.

PO May increase serum amylase, lipase.

◀ ALERT ▶ Effects are dependent on dosage amount. Ambulatory pts, those not in severe pains may experience dizziness, nausea, vomiting, and hypotension more frequently than those in supine position or having severe pain. Frequent: Drowsiness, dizziness, hypotension (including orthostatic hypotension), anorexia.

Baseline assessment Assess onset, type, location, duration of pain. Effect of medication is reduced if full pain recurs before next dose. Obtain vital signs before giving medication. If respirations are 12/min or less (20/min or less in children), withhold medication, contact physician. Intervention/evaluation Palpate bladder for urinary retention. Monitor daily pattern of bowel activity and stool consistency. Initiate deep breathing, coughing exercises, esp. in pts with pulmonary impairment. Monitor pain relief, respiratory rate, mental status, B/P.