ACTIVATED CHARCOAL

antiflatulent/ antidote inactivates toxins and binds until excreted Adverse Effects: N/V black stool constipation diarrhea Contraindication: semiconsciousness cyanide poisoning gag reflex depression ethanol intoxication Nursing Considerations:

assess LOC give after inducing vomiting unless vomiting is contraindicated use laxative to promote elimination give through NGT if pt is unable to swallow

ALBUTEROL
bronchodilator, used in a nebulizer for asthma patients Typically a drop (0.5 mg) of albuterol is suspended in saline and nebulized with oxygen.

ASPIRIN
NSAID Common AE: Tinnitus hearing loss Nausea GI bleeding Leukopenia Thrombocytopenia Rashes Reyes syndrome Effect: may increase liver function test, decrease WBC & platelet count Nursing considerations:

dont give w/ chicken pox or flu-like symptoms increases the risk of Reyes syndrome If unable to swallow give it by rectum (watch out for rectal mucosal irritation or
bleeding

ATENOLOL

Stop aspirin 5-7 days prior to surgery Dont give to patient who is allergic to tartazine dye Take w/ meals to reduce GI unpleasant reaction (best time 1 hr after lunch or 1 hr pc) Dont crush or chew

beta-blocker similar to metoprolol

ATROPINE
It is used for several purposes, including inducing the heart to beat faster as well as an antidote anticholinesterase insecticide poisoning like organophosphate . It is sometimes used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory secretions during procedures. Nursing considerations:

Watch for tachycardia may lead to ventricular fibrillation Use sunglasses potential sensitivity to the sun BUDESONIDE
Anti-asthma Stock: Respule AE: oral candidiasis stomatitis pharyngitis Rhinitis repiratory tract infection Nursing considerations:

If bronchospasm results after using shift to bronchodilator Use inhaler for those who have no effect on acute asthma Rinse mouth after using inhaler & spit out the water to prevent developing oral
candidiasis

CAPTOPRIL
Antihypertensive Adverse Effect: Leukopenia Agranulocytosis Pancytopenia Anemia thrombocytopenia Nursing Considerations:

Check WBC & differental count before treatment every 2 wks for 3 months of therapy Check BP at least 90/60 mmHg Take 1 hr a.c. GI tract may reduce absorption Rise slowly to prevent orthostatic hypotension Report swelling of face sign of Angioedema

CLOPIDOGREL (PLAVIX)

 Thrombolytic agent AE: GI hemorrhage Effect: decreases platelet count Nursing consideration

Avoid activities that can cause trauma or bleeding Taken with or without meals DIAZEPAM (VALIUM)
is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant for patients with seizures use for alcohol withdrawal cocaine toxicity status epilepticus (i.e. uncontrolled seizures) may produce respiratory depression. Nursing consideration:

Do not drink alcohol or take other medications that can make you tired or drowsy while
you are taking Valium.

Avoid taking Valium with meals, because food may decrease the effect of Valium and
delay the time it takes to work in your body.

DIGOXIN
(a derivative of the Foxglove plant) is a cardiac drug Cardiac Glycoside use to slow conduction through the heart, especially in cases of atrial-fibrillation produce various dysrhythmias including ventricular fibrillation and aystole, nausea & vomiting, visual disturbances (yellow green halos around light, blurred vision, light flashes, photophobia & diplopia) Need normal K+ serum levels to prevent toxicity (K+ binds to the same receptor of Digoxin) Therapeutic level: 1-0.8 to 2ng/ml should be obtained at least 6-8 hrs after use Antidote: Digibind Nursing Checks:

Apical rate prior to administration Hold for <60 beats/minute Hold for change in rhythm
What to teach:

signs of toxicity monitor for rate and rhythm monitor for signs of hypokalemia increase K intake Avoid using herbal meds: plantain & st. johns wort may decrease effectiveness of digoxin siberian ginseng - may increase toxicity

DILTIAZEM(CARDIZEM)
calcium channel blocker , antianginal use to slow the heart down in patients with certain types of tachycardias such as atrial fibrillation Adverse Effect:

Headache Fatigue Drwosiness Edema N/V Photosensitivity Rhinitis dyspnea Treatment for overdose : atropine for AV block & vasopressor for hypoBP Nursing Considerations:

DOPAMINE

Assess fluid volume status Assess BP. PR, RR, ECG Monitor liver function tests; AST, ALT, bilirubin give with meals

is a mild vasopressor agent, Symphatomimetic drug is administered IV to produce vasoconstriction and raise a patients blood pressure, renal & mesenteric vasodilation Indication: treatment for heart failure & Increase renal perfusion Adverse Effects: Headache Tachycardia Hypertension Angina N/V Diarrhea Extravasation dyspnea Nursing Considerations:

Monitor ECG for dyspnea, ischemia during treatment Monitor BP & PR Check extravasation - change site q48hrs

Treatment for overdose: short acting A-blockers like Phentolamine (dilates peripheral blood vessels & lowering peripheral resistance)

EPINEPHRINE
is a natural substance produced by the adrenal gland (a.k.a. adrenaline) is used in emergencies to stimulate the heart or to dilate the bronchial tree Other indication: Mydriatic during eye surgery to control bleeding relief of Nasal & nasophrayngeal decongestion It is also mixed with lidocaine to prolong lidocaines effect and to control bleeding. Nursing considerations:

 Dont exceed 5 days for topical nasal solution rebound congestion may occur after
vasoconstriction subsides

May administer through ET route FUROSEMIDE (LASIX)

is a loop diuretic, which is given IV or PO produce more urine, thus decreasing the BP. given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or hypertension. Common AE: increase urination drowsiness sensitivity to sunlight increase thirst Nursing checks:

BP 90/60 mmHG Urine output at least 30cc/hr

Nursing considerations:

HEPARIN

Administer with foods to prevent GI upset Give in early day so that increased urinary will not disturb sleep. measure fluid and weight to monitor fluid changes Increase K intake

anticoagulant used to prevent blood from clotting It is used in patients suspected of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same reason. Antidote: Protamine SO4 Nursing Checks:

Signs of bleeding
Nursing Considerations:

Use heparin lock needles to avoid repeated injections Give SC injection, avoid IM & massaging the site may cause hematoma formation Apply pressure Avoid contact sports or other activities that can cause injury

KETOROLAC (TORADOL)
a powerful NSAID, nonopioid analgesic Uses: severe headaches musculo-skeletal pain kidney stones inflammation Adverse Effects: Drowsiness

Tinnitus hearing loss N/V GI bleeding taste change blood dyscrasia Hematoria Cramps dry mouth constipation Nursing Considerations:

Monitor blood count during therapy Assess for GI bleeeding: sputum, emesis, stool Give 30 mins AC or 2 hrs PC Caution when driving Caution pt when using soft contact lenses, the drug may cause eye burning sensation

LACTULOSE
Laxative, use for chronic constipation & portal-systemic encephalopathy with heaptic disease Disaccharides that are not absorbed from the digestive tract. They are thought to improve the generation of ammonia by bacteria, render the ammonia inabsorbable by converting it to ammonium (NH4), and increase transit of bowel content through the gut. Adverse effects: N/V Anorexia Diarrhea Flatulence distention belching abdominal cramps Nursing Considerations:

Assess abdominal cramping , rectal bleeding, N/V if these will occur the drug may be
discontinued by the prescriber

Monitor blood ammonia level: 30-70 mg/100ml, monitor LOC (increased LOC is the
expected outcome for pt with hepatic disease)

Avoid for long-term use bowel tone may be lost If diarrhea occurs it indicates overdosage LIDOCAINE
2 uses:

local anesthetic when injected subcutaneously (and it can be

used for a nerve block) Anesthetic preparations come in 2 forms: with and without epinephrine. The epinephrine is added to reduce absorption and prolong the effect. Toxic dose when used as a local anesthetic: 5mg/kg for lidocaine without epi, and 7mg/kg with epi.


dysrhythmias).

antidysrhythmic drug when injected IV (used to treat cardiac

LORAZEPAM
Sedative AE: drowsiness sedation decreases BP Effect: Increases Liver function test Nursing considerations:

Avoid alcohol & hazardous activities that requires alertness Instruct patient to avoid standing after taking the drug

MAGNESIUM SULFATE
Antiepiliptic, electrolyte, laxative Laxative attract water and retains water in the intestinal lumen and distend the bowel to promote mass movement & relieve constipation Usually given for eclamptic pt. Antidote: Ca Gluconate Nursing checks:

MANNITOL

Knee jerk reflex BP 90/60mmHG RR 16CPM Take ECG Serum K determination

Osmotic diuretic Decreases intracranial pressure, thus decreasing the pts BP Common AE: increased urination GI upset dry mouth headache blurred vision Nursing considerations:

Dont expose solution to low temperature crystallization may occur

If crystals are seen arm the bottle in a hot water bath, then cool the body temperature before adminstration

Take BP before adminstration, withhold if BP 90/60mmhg Check urine output at least 30cc/hr Assess for difficulty of breathing, chest pain, and pain in the IV site METOPROLOL

 Antihypertensive & antianginal beta-blocker use to slow down the heart and lower blood-pressure Common AE:

Fluid retention and worsening heart failure Fatigue Hypotension Bradycardia or heart block

Drowsiness Nursing Alert: are not typically used in asthmatics, as they can induce bronchoconstriction Treatment for overdose:

atropine bradycardia theophylline bronchospasm glucose hyperglycemia

Nursing Considerations:

Give with food to prevent GI upset Teach signs & symptoms of CHF Check BP & PR Hold if PR 60bpm, BP 90/60 mmHg

METRONIDAZOLE (FLAGYL)
is an antibiotic used against anaerobic bacteria and certain parasite ( Amebecide & Antiinfective) Given to patient with hepoencephalopathy : the rationale of their use was the fact that ammonia and other waste products are generated and converted by intestinal bacteria, and killing of these bacteria would reduce the generation of these waste products. Adverse Effects: Sore throat metallic taste stomatitis N/V Anorexia pseudomembranous colitis darkened urine nephrotoxicity decreased libido bone marrow depression leukopenia vaginal drynes Nursing considerations:

Assess signs of infections Asses urine output check for increased BUN & creatinine Instruct pt of metallic taste andt urine may turn dark

Avoid alcohol when taking this drug because it makes their stommach violently ill, may experience disulfiran (antabuse) reactions

MIDAZOLAM (VERSED)
a very powerful short acting benzodiazepine type of sedative is used to sedate patients for painful procedures (preoperative, endoscopic, intubation) Adverse effect: Retrograde amnesia Hypotension cardiac arrest N/V respiratory depression blurrred vision loss of balance Nursing Considerations:

Excessive dosing may produce respiration depression (when given i.v.) or coma. Grapefruit foods can increase midazolam effect Monitor BP, PR, RR during IV medical equipment should be nearby Dont give rapid bolus for IV route

MORPHINE SULFATE
a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer (i.e. analgesic) Adverse Effects: drowsiness confusion euphoria palpitation bradycardia cardiac arrest hypoBP blurred vision miosis N/V urinary retention respiratory depression constipation Antidote: Naloxone (Narcan) Nursing Considerations:

Check BP at least not less than 90/60 mmhg Check RR not > 12 CPM Check Urine output >30 cc/hr Monitor I&O Monitor LOC Increase bulk & fluids in diet May be given by PCA pump in terminal illness

NALOXONE (NARCAN)
antidote to opioids such as heroin or morphine

 It is very rapidly acting and competes with the opioid at the opioid receptor. Adverse effect: Drowsiness Nervousness ventricular tachycardia

increase sytolic BP (high doses) N/V

Hyperpnea Nursing considerations:

Assess cardiac status: tachycardia, hyperBP, ECG Monitor LOC Assess for signs of Opioids withdrawal: cramping, hypertension, vomiting these may
occur 2 hrs after administration

N-ACETYLCYSTEINE (MUCOMYST)
Mucomyst is given in cases of acetaminophen toxicity (e.g. Tylenol). Adverse effects: Drowsiness Hypotension Rhinorrhea Hepatotoxicity Bronchospasm chest tightness stomatitis Nursing Considerations:

Assess cough Assess cardiac status Frequent rinsing of mouth for dryness of oral cavity NITROGLYCERIN
Antianginal drug Treats Hypertension, acute heart failure, & anginal pain Nursing Considerations:

Abrupt stopping may cause sapsm of the artery Administer 1 tab SL q 5 mins. Maximum of 3 tablets can be taken by the pt
having anginal pain

Place in a Light protected cool & dark container , close tightly and remove cotton because it absorbs the drug If transdermal patch (Deponit) is used:

Tingling sensation w/ SL drug, hold tablet in cheek 30mins-2hrs p.c. swallow tablet dont chew Rise slowly prevent orthostatic hypotension

Remove the patch before defibrillation because aluminum backing may damage the
puddle and cause burns

 Apply in rotation & hairless site PREDNISONE

is a corticosteroid that is given for asthma and as an anti-inflammatory Prolonged use is Cushings syndrome and often you may see tremors. Adverse Effects: Depression Flushing Sweating Hypertension circulatory collapse, fungal infections increased IOP nausea thrombocytopenia poor wound healing hyperglycemia ecchymosis osteoporosis Nursing Considerations:

Monitor serum K, blood glucose, urine glucose may cause hypokalemia &
hyperglycemia

Monitor weight daily: notify physicain wt gain lbs 5 Monitor I&O: report for decreasing urinary output & increasing edema Monitor Bp: refer for chest pain Monitor plasma cortisol level (138-635 mmol/L measured at 8am Assess adrenal functions may suppress hypothalamic, pituitary & adrenal Assess infection, the drug masks inections symptoms May be given w/ food or milk to reduce GI symptoms Use emergency ID as steroid user Dont discontinue abruptly may cause adrenal crisis

PILOCARPINE
is dripped into the eyes to produce constriction of the pupil in patients with glaucoma

PHENOBARBITAL
is a barbiturate used either as a sedative and/or anticonvulsant medication. Adverse Effects:

Drowsiness hangover headache coma N/V stevens-johnson syndrome thrombophebitis

Nursing Considerations:

Assess mental status Assess respiratory dysfunctions hold drug if RR10/min or pupils are dilated Assess signs of drug toxicity:
Hypotension pulmonary constriction cold & clammy skin Cyanosis CNS depression

May crush or mix with food if difficulty of swallong Drug should be tapered before discontinuing Bruising & bleeding indicates blood dyscrasias Avoid driving & other activities that require alertness Overdose: Activated Charcoal

PENTOBARBITAL
Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an anticonvulsant medication and to treat severe alcohol withdrawal.

SODIUM BICARBONATE
The drug is given to correct Hyperkalemia, metabolic acidosis with bicarbonate loss, hypoxic lactic acidosis, as an antacid (symptomatic relief of GI upset) Nursing considerations: Check serum K levels risk of metabolic acidosis in increase state of hypokalemia

Hook pt to cardiac monitor while administering the drug Chew oral tablet follow with water dont take 1-2 hrs in any drug may decrease the effect

VALPROIC ACID (DEPAKENE)

is used as an anticonvulsant medication It is not typically used in the emergency treatment of seizures, but toxicity can often be seen with seizure patients who have taken too much. Effect: may cause positive result of ketones Nursing considerations:

Avoid withdrawing the drug immediately to prevent worsening of seizure Take with foods Dont not chew tablet form may cause irritation of the throat and mouth Dont mix with carbonated beverages

PHENYTOIN (DILANTIN)
is an anticonvulsant, antidysrhythmic when administered too fast, it can induce hypotension

Antidote: Acetylceisteine Adverse Effects: Drowsiness Confusion suicidal tendencies hypotension blurred vision hepatitis gingival hyperplasia anemia stevens-Johnson syndrome Nursing considerations:

Assess drug level: wait 1wk to determine the level

Therapeutic level 7.5-20mcg/ml Toxic level 30-50 mcg/ml

Assess mental status Assess beginning rash may lead to SJS Assess for blood dyscrasia: fever, sore, throat, bruising, rash, jaundice, epistaxis

Monitor for toxicity: bone marrow depression, N/V, CV collapse, slurred speech & confusion Monitor liver function test: ALT & AST, Bilirubin Give with meals Tablet: can be crushed or chewed Dont take antidiarrheal or antacid within 2-3 hrs of taking the drug Avoid driving or other activities that require mental alertness Taper off dosage over several week Proper oral hygiene or visit dentist toutinly gingival hyperplasia

RANITIDINE
Antiulcer Nursing considerations:

aspirate

Assess abdominal pain, acute presence of blood in emesis, stool or gastric Take at bedtime for best effect May be taken with or without meals Avoid smoking increase gastric acid secretions

SUCRALFATE

Antiulcer AE: Constipation Nausea dry mouth indegistion

Nursing considerations:

Take 1 hr ac or empty stomach & at bedtime Avoid smoking Antacid my be used while taking sucralfate by 30 mins apart

TOPIRAMATE (TOPAMAX)
Anticonvulsant It is also indicated to prevent migraine headache Effect: Sleepiness or concentration problems Nursing considerations:

VANCOMYCIN

Caution in hot weather may cause oligohydrosis or hyperthermia Increase oral fluid to prevent of forming kidney stones Dont break or crush casue bitter taste, swallow immediately without chewing

antibiotic, used for highly resistant bacteria It is fairly toxic to the patient, and often is a drug of choice to a septic, shocky patient. Adverse Effects: Cardiac Arrest Ototoxicity permanent deafness tinnitus nephrotoxicity increased BUN & creatinine wheezing & dyspnea

leukopenia
neutropenia anaphylaxis Nursing Considerations:

Report hematuria Report compromise renal system drug is slowly excreted in the renal system if pt experience ringing or roaring ear, the drug should be discontued

Have adrenalin, suction, tracheostomy set, endotracheal intubation equipment anaphylaxis may occur

50% DEXTROSE SOL.

Alternative: Glucagon Classification: Antihypoglycemic Indication: To treat hypoglycemia that results either from fasting or insulin use in a patient with diabetes mellitus.