GENERIC NAME: Ketorolac BRAND NAME: Toradol CLASSIFICATION: Nonsteroidal anti-inflammatory agents, nonopioid analagesics DOSAGE: 30mg/amp1 amp

IM MECHANISM OF ACTION: - Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and anti-inflammatory properties. - Therapeutic effect:Decreased pain INDICATION: Short term management of pain (not to exceed 5 days total for all routes combined) CONTRAINDICATIONS: - Hypersensitivity - Cross-sensitivity with other NSAIDs may existPre- or perioperative use - Known alcohol intoleranceUse cautiously in: 1) History of GI bleeding 2) Renal impair-ment (dosage reduction may be required) 3) Cardiovascular disease SIDE EFFECTS/ ADVERSE EFFECTS: - CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP: 1) asthma 2) dyspnea - CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea 4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL: 1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis NURSING IMPLICATIONS/RESPONSIBILITIES: - Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. - Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches,

pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another. Brand Name: TRAMADOL CLASSIFICATIONS Therapeutic: Analgesics (centrally acting) ACTIONS Physiologic Mechanism Decreased pain. Pharmacologic Mechanism Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. INDICATION Moderate to moderately severe pain NURSING CONSIDERATIONS Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

Generic name: metronidazole Brand name: Flagyl Preparations: PO 7.5 mg/kg q6hr (not to exceed 4g/day) CLASSIFICATION: Anti-infectives, Anti-protozoals ACTION: Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action

INDICATION / USES: Amebicide in the management of amebic dysentery COMMON ADVERSE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria CONTRA-INDICATIONS: hypersensitivity NURSING CONSIDERATIONS: Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop). NURSING IMPLICATIONS Assessment & Drug Effects

Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities). Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary. Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF. Monitor patients on lithium for elevated lithium levels. Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly. Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated. Brand Name: UNASYN CLASSIFICATIONS Therapeutic: Anti-infectives

Pharmacologic: Aminopenicillins/ beta lactamase inhibitors ACTIONS Physiologic Mechanism Bactericidal action. Active against: Streptococci, Penumococci, Enterococci, Haemophilus influenzae, Use should be reserved for infections caused by beta-lactamase-producing strains. Pharmacologic Mechanism Binds to bacteria cell wall, resulting in cell death, spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to beta-lactamase, enzymes produced by bacteria that may inactivate ampicillin. INDICATION Treatment of respiratory infections NURSING CONSIDERATIONS Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.

NURSING IMPLICATIONS Assessment & Drug Effects

Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens prior to therapy. Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results.

Report promptly unexplained bleeding (e.g., epistaxis, purpura, ecchymoses). Monitor patient carefully during the first 30 min after initiation of IV therapy for signs of hypersensitivity and anaphylactoid reaction (see Appendix F). Serious anaphylactoid reactions require immediate use of emergency drugs and airway management. Observe for and report symptoms of superinfections (see Appendix F). Withhold drug and notify physician. Monitor I&O ratio and pattern. Report dysuria, urine retention, and hematuria.

Mefenamic Acid Written by admin Drug study Feb 4, 2011 Generic Name: Mefenamic Acid Brand Name: APO-Mefenamic Acid PMS-MEFENAMIC MEFENEMIC ACID PONSTAN, PONSTEL Drug classification: Anti inflammatory, Analgesic, Antipyretic activities related to inhibition of prostaglandin synthesis Mode of Action: anti-inflammatory, analgesic, and antipyretic activities related to inhibition of prostaglandin synthesis;exact mechanism of action are not known. Indications: relief of moderate pain when therapy will not exceed one week. Treatment of primary dysmenorrhea Contraindications: contraindicated with hypersensitivity with mefenamic acid Use cautiously with asthma, renal or liver dysfunction, peptic Ulcer disease, gastrointestinal bleeding, hypertension, CHF, pregnancy and lactation. Suggested dose: 500 mg PO q 6 hrs. Ordered dose: Capsule 250 mg; adults and patients 14 yr and above, initially, 500 mg PO followed by 250 mg q 6 hr as needed. Do not exceed one week of therapy. this is for acute pain. 5oomg PO then 250 mg q 6 hr starting with the onset of bleeding. Can be initiated at start of mense and should not necessary for two to three days. For primary dysmenorrheal. Patient below 14 are not given this meds. Adverse effects CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmic effects. Dermatologic: rash, prumitus, sweating,dry mucos membranes, stomatitis GI: dysuria, renal impairment Hematologic: bleeding, platelet inhibition in higher doses, neutropenia, eosinophilia, leucopenia, pancytonea, thrombocytopenia, agranalocytosis, granalucytopenia, aplastic anemia, decrease Hgb OR hCT, bone marrow depression,menorrhagia. Respiratory: dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Nursing responsibilities: 1. Give drugs with food or milk to decrease gastrointestinal upset. 2. Give prescribed dosage of drug to prevent Overdose or under dose administering of drug may result to trauma and further injury to the patients health. 3. Rendered health teaching such as: patient instructed to:

a. does not share medicine with other patient; b. report signs of allergies or any unusualities. c. discuss some adverse effect of drug 4. Stay at the patient bedside during drug intake to insure that the patient take the medicine, 5. Give exact dose of drug and administer drug in the appropriate route.

Nifedipine Generic Name: nifedipine (nye FED i peen) Brand names: Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia, Procardia XL, Adalat

Nifedipine side effects Get emergency medical help if you have any of these signs of an allergic reaction to nifedipine: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

worsening angina; feeling like you might pass out; feeling short of breath, swelling in your hands or feet; fast or pounding heartbeats; numbness or tingly feeling; jaundice (yellowing of the skin or eyes); or chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Nifedipine Dosing Information Usual Adult Dose for Hypertension: Initial dose: Nifedipine Extended release tablets: 30 to 60 mg orally once a day Dosage can be increased gradually every 7 to 14 days. Maximum dose: Adalat (R) CC: 90 mg/day Procardia XL (R): 120 mg/day NURSING IMPLICATIONS Assessment & Drug Effects

Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 69 h following oral doses. Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by weight gain; rarely, severe edema may cause discontinuation of drug. Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when additional antihypertensives or diuretics are added. Monitor heart rate; dose-related palpitations (more common in women) may occur. Mechanism of Action Inhibits calcium ion from entering the "slow channels" or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina

Vitamin C Vitamin C or Ascorbic Acid, has a wide range or use in the human body. It acts as an oxidant, a cofactor in enzymatic reactions, and other metabolic reactions. Common brand names are A-Cee, Ad-C, Alka-C, Cecon, Ceelin, Cenolate, Enervon, and Redoxon. Vitamin C is classified as a vitamin. Indication for Vitamin C Vitamin C is used for prevention and treatment of scurvy, acidification of urine, dietary supplement, prevention of and reduction in the severity of colds. Routes and Dosage of Vitamin C Dietary Supplement PO: ADULTS, ELDERLY: 45-60 mg/day. CHILDREN >4 years: 30-40 mg/day. Deficiency PO: ADULTS, ELDERLY: 75-150 mg/day. Scurvy PO: ADULTS, ELDERLY: 300mg 1g per day. Burns PO: ADULTS, ELDERLY: Up to 2g per day. Enhance Wound Healing PO: ADULTS, ELDERLY: 300-500 mg/day for 7-10 days. Action of Vitamin C Assists in collagen formation, tissue repair; involved in oxidation reduction reactions, other metabolic reactions. Vitamin C is involved in metabolism; carbohydrate utilization; synthesis of lipids, proteins, carnitine. It also preserves blood vessel integrity. Side Effects and Adverse Reactions of Vitamin C Side Effects of Vitamin C

Abdominal cramps Nausea Vomiting Diarrhea Increased urination with doses exceeding 1 gram Flushing Headache Dizziness Sleepiness or insomnia

Adverse Reactions of Vitamin C

Urine acidification that may lead to crystalluria

Nursing Considerations for Clients Taking Vitamin C May give without regard to food. Assess for clinical improvement (improved sense of well-being and sleep patterns). Observe for reversal of deficiency symptoms (gingivitis, bleeding gums, poor wound healing, digestive difficulties, joint pain). Generic:Ascorbic Acid Vit. C Brand Protexin Classification: Vitamincs sd Minerals

GENERIC NAME: Ranitidine BRAND NAME: Zantac CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists

DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach. CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence

 ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black. Cefalexin (cephalexin) Drug Class Description : Cephalosporins. Generic Name : Generic Cefalexin is a semi-synthetic first generation cephalosporin. Presentation : Capsules, cefalexin 250 mg , 500 mg . Available from APS, Cox, Generics UK, Greenfield, Hillcross, Kent, Lagap, Norton, Ranbaxy. Tablets, cefalexin 250 mg , 500 mg . Available from APS, Cox, Generics UK, Greenfield, Hillcross, Kent, Lagap, Norton, Ranbaxy. Oral suspension, cefalexin for reconstitution with water, 125 mg/5 mL , 250 mg/5 mL . Available from APS, Cox, Generics UK, Greenfield, Hillcross, Kent, Lagap, Norton, Ranbaxy. Indications : Urinary tract infections, respiratory tract, skin and soft tissue infections. tissue infections. Adult Dosage : 250mg every six hours or 500mg every 8 - 12 hours increased to 1 g twice daily. Severe infections, 1 g three times daily or 3 g twice daily. Prophylaxis UTI, 125 mg at night. Special Precautions : Renal impairment. Hypersensitivity to penicillins. Adverse Reactions : Hypersensitivity, GI upset, pseudomembranous colitis, neutropenia, rash. Drug Availability : (POM) Uses Consider potential benefits and risks of mefenamic acid therapy as well as alternative therapies before initiating therapy with the drug. Use lowest possible effective dosage and shortest duration of therapy consistent with patients treatment goals. Pain Relief of mild to moderate pain in patients 14 years of age when the duration of therapy 1 week. Dysmenorrhea Treatment of primary dysmenorrhea. Fever Has been used for reduction of fever associated with infection in children; routine use as an antipyretic not recommended because of potential adverse effects. Dosage and Administration General

Consider potential benefits and risks of mefenamic acid therapy as well as alternative therapies before initiating therapy with the drug.

Administration Oral Administration Administer orally. May be administered in divided doses up to 4 times daily. Dosage To minimize the potential risk of adverse cardiovascular and/or GI events, use lowest effective dosage and shortest duration of therapy consistent with the patients treatment goals. Adjust dosage based on individual requirements and response; attempt to titrate to the lowest effective dosage. Oral Therapy should not be necessary for more than 23 days. NURSING IMPLICATIONS Assessment & Drug Effects

Assess patients who develop severe diarrhea and vomiting for dehydration and electrolyte imbalance.

Lab tests: With long-term therapy (not recommended) obtain periodic complete blood counts, Hct and Hgb, and kidney function tests..

Ferrous sulfate or FeSO4 is used to fortify foods and treat iron-deficiency anemia. Common brand names are Ameciron, Appebon, Brisofer, Drexabion, Femina, Feosol, Ferglobin, Ferlin, Ferosal, Forlavit, Hemiron, Iberet, Sorbifer and Terraferron. Ferrous sulfate is classified as an Enzymatic mineral and Iron preparation. Indications for Ferrous Sulfate The prevention or treatment of iron deficiency anemia due to inadequate diet, malabsorption pregnancy, and blood loss. Routes and Dosage of Ferrous Sulfate Deficiency PO: ADULTS, ELDERLY: 2-3 mg/kg/day or 50-100mg elemental iron 2 time/day up to 100mg 4 time/day. CHILDREN: 3 mg/kg/day elemental iron in 1-3 divided doses. Prophylaxis PO: ADULTS, ELDERLY: 60-100 mg elemental iron/day. CHILDREN: 1-2 mg/kg/day elemental iron. Maximum: 15 mg elemental iron/day. Action of Ferrous Sulfate Ferrous Sulfate is an essential component in the formation of hemoglobin, myoglobin and enzymes. It is necessary for effective erythropoiesis and transport or utilization of oxygen. Side Effects of Ferrous Sulfate

Mild, transient nausea Heartburn Anorexia Constipation Diarrhea

Nursing Implications Assessment & Drug Effects

Lab tests: Monitor Hgb and reticulocyte values during therapy. Investigate the absence of satisfactory response after 3 wk of drug treatment. Continue iron therapy for 23 mo after the hemoglobin level has returned to normal (roughly twice the period required to normalize hemoglobin concentration). Monitor bowel movements as constipation is a common adverse effect.

What are the possible side effects of methylergonovine (Methergine)? Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

increased blood pressure (severe headache, blurred vision); seizure (convulsions); feeling light-headed, fainting; pounding heartbeat; chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or hallucinations.

Other less serious side effects are more likely to occur, such as:

nausea, vomiting, diarrhea;


Action

leg cramps; dizziness; ringing in your ears; stuffy nose; or unpleasant taste in your mouth.

Directly stimulates uterine and vascular smooth muscle. Route/Dosage PO (Adults): 200400 mcg (0.40.6 mg) q 612 hr for 27 days. IM, IV (Adults): 200 mcg (0.2 mg) q 24 hr for up to 5 doses. NURSING IMPLICATIONS Assessment

Monitor blood pressure, heart rate, and uterine response frequently during medication administration. Notify health care professional promptly if uterine relaxation becomes prolonged or if character of vaginal bleeding changes. Assess for signs of ergotism (cold, numb fingers and toes, chest pain, nausea, vomiting, headache, muscle pain, weakness). Lab Test Considerations: If no response to methylergonovine, calcium levels may need to be assessed. Effectiveness of medication is with hypocalcemia. May cause serum prolactin levels methylergonovine (meth-ill-er-goe-noe-veen) Methergine\Classification Therapeutic: Pharmacologic: ergot alkaloids