Brand Name: PLASIL CLASSIFICATIONS Therapeutic: Antiemetics ACTIONS Physiologic Mechanism Decreased nausea and vomiting.

. Decreased symptoms of gastric stasis. Pharmacologic Mechanism Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying. INDICATION Management of esophageal reflux Treatment and prevention of postoperative nausea and vomiting NURSING CONSIDERATIONS Assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after administration. May cause drowsiness. Advise patient to avoid concurrent use of alcohol and other CNS depressant while taking this medication. Advise patient to notify health care professional immediately if involuntary movement of eyes, face or limbs occurs.

Generic Name: Hyoscine ButylBromide Brand Name: Buscopan Classification: Belladona alkaloid, antimuscarinic Indication & Dosages: Spastic states

Adults: 0.4 to 0.8 mg P.O. Delirium, preanesthetic sedation and obstetric amnesia with analgesics

Adults: 0.3 to 0.65 mg I.V., I.M., or subcutaneously. Dilute solution with sterile water for injection before giving I.V.

Children: 0.006mg/kg I.V., I.M., or subcutaneously. Maximum dose, 0.3 mg. Dilute solution with sterile water for solution before giving I.V. To prevent nausea and vomiting from motion sickness

Adults: One Transderm-Scop, formulated to deliver 1mg scopolamine over 3 days, applied to the skin behing the ear at least 4 hours before antiemetic is needed. Or, 0.3 to 0.65 mg hydrobromide I.V., I.M. or subcutaneously. Or, 0.25 to 0.8 mg P.O. 1 hour before exposure to motion. Further doses of 0.25 to 0.8 mg may be given t.i.d., p.r.n. Children: 6 mcg/k or 200 mcg hydrobromide I.V., I.m., or subcutaneously Mode of Action: Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by postganglionic cholinergic neurons. May effect neural pathways originating in the inner ear to inhibit nausea and vomiting.

Contraindication: Contraindicated in patients with angleclosure glaucoma, obstructive uropathy, obstructive disease of the GI tract, asthma, chronic pulmonary disease, myasthenia gravis, paralytic ileus, intestinal atony, unstable CV status in acute hemorrhage, tachycardia from cardiac insufficiency, or toxic megacolon. Contraindicated in patients with hypersensitive to belladonna or barbiturates. Use cautiously in patients with autonomicneuropathy, hyperthyroidism, coronary artery disease, arrhythmias, heart failure, hypertension, hiatal hernia with ferlux esophagitis, hepatc or renal disease, known as suspected GI infection, or ulcerative colitis. Use cautiously in children. Use cautiously in patients in hot or humid environments; drug can cause heat stroke.

Side Effects: Frequent: Dry mouth (sometimes severe), decreased sweating, constipation. Occasional: Blurred vision; bloated feeling; urinary hesitancy; somnolence (with high dosage); headache; intolerance to light; loss of taste; nervousness; flushing; insomnia; impotence; mental confusion or excitement (particularly in the elderly and children); temporary light-headedness (parenteral form); local irritation(with parenteral form).

Adverse Reaction: Overdose may produce temporary paralysis of ciliary muscle; papillary dilation; tachycardia; palpitations; hot, dry, or flushed skin; absence of bowel sounds; hyperthermia; increased respiratory rate; EKG abnormalities; nausea; vomiting; rash over face or upper trunk; CNSstimulations; and psychosis (marked by agitation, restlessness, rambling speech, visual hallucinations, paranoid behavior, and delusions, followed by depression).

Nursing Responsibilities: Advise patient to apply patch the night before a planned trip. Transdermal method releases a controlled therapeutic amount of drug. Transderm-Scop is effective if applied 2 or 3 hours before experiencing motion but is more effective if applied 12 hours before. Instruct patient to remove one patch before applying another

Instruct patient to wash and dry hands thoroughly before and after applying the transdermal patch (on dry skin behind the ear) and before touching the eye because pupil may dilate. Tell patient to discard patch after removing it and to wash application site thoroughly. Tell patient that if patch becomes displaced, he should remove it and apply another patch on a fresh skin site behind the ear. Alert patient to possible withdrawal signs or symptoms (nausea, vomiting, headache, dizziness) when transdermal system is used for longer than 72 hours. Advice patient that eyes may be ore sensitive to light while wearing patch. Advice patient to wear sunglasses for comfort Urge patient to report urinary hesitancy or urine retention.

Indications for Furosemide Treatment of edema associated with congestive heart failure, chronic renal failure, hepatic cirrhosis, and acute pulmonary edema. It is also used for treatment of hypertension, alone or in combination with other hypertensives. Can also be used for treatment of hypercalcemia. Routes and Dosage of Furosemide Edema and Hypertension PO: ADULTS, ELDERLY: Initially, 20-80 mg/dose; may increase by 20-40 mg/dose at 6-8 hour intervals. May titrate up to 600 mg/day in severe edematous state, CHILDREN: 1-6 mg/kg/day in divided doses q6-12 hours. IM/IV: ADULTS, ELDERLY: 20-40 mg/dose; may repeat in 1-2 hours and increase by 20 mg/dose. CHILDREN: 1-2 mg/kg/dose q6-12 hours. NEONATES: 1-2 mg/kg/dose q12-24 hours. IV infusion: ADULTS, ELDERLY: Bolus of 0.1 mg/kg, then 0.1 mg/kg/hour; may double q2hours. Maximum: 0.4 mg/kg/hour. CHILDREN: 0.05 mg/kg/hour, titrate to desired effect. Action of Furosemide Enhances excretion of sodium, chloride, potassium by direct action at ascending limb of loop of Henle and produces a diuretic effect. Side Effects and Adverse Reactions of Furosemide Side Effects of Furosemide Increase in urinary frequency or volume Nausea Gastric upset with cramping Diarrhea or constipation Electrolyte disturbances Dizziness or light headedness Headache Blurred Vision Paresthesia Photosensitivity Rash

Weakness Bladder spasm Restlessness Diaphoresis Flank or loin pain

Adverse Reactions of Furosemide Excessive diuresis may lead to increased water loss and electrolyte depletion resulting to hypokalemia, hyponatremia, and dehydration. Sudden volume depletion may result in increased risk f thrombosis, circulatory collapse, or sudden death. Acute hypotensive episodes may occur, sometimes several days after beginning of therapy. Ototoxicity manifested as deafness, vertigo, and tinnitus may occur especially in patients with severe renal impairment. It can exacerbate diabetes mellitus, systemic lupus erthematosus, gout, and pancreatitis. Blood dyscrasias have been reported.

Nursing Consideration for Clients Taking Furosemide Give with food to avoid gastroinestinal upset, preferably with breakfast (to prevent nocturia). If given IM, temporary pain at injection site may be noted. Check vital signs especially blood pressure for hypotension prior to administration. Assess baseline electrolyte, particularly check for low potassium. Assess edema, skin turgor, and mucous membranes for hydration status. Assess muscle strength and mental status. Obtain baseline weight. Initiate Input and Output monitoring. Note extent of diuresis.

ndication for Digoxin Digoxin is used as a prophylactic management and treatment of CHF, control of ventricular rate in patients with atrial fibrillation. It is also used in the treatment and prevention of recurrent paroxysmal atrial tachycardia. Routes and Dosage of Digoxin Dosage should be adjusted in elderly patients with renal dysfunction. Larger doses often required for adequate control of ventricular rate in patients with atrial fibrillation or flutter. Administer loading dosage in several doses at 4 to 8 hour intervals. Usual Dosage for Adults (Rapid Loading Dosage) IV: ADULTS, ELDERLY: 0.6-1 mg PO: ADULTS, ELDERLY: Initially 0.5-0.75 mg, additional doses of 0.125-0.375 mg at 6 to 8 hour intervals. RANGE: 0.75-1.25 mg Usual Dosage for Adults (Maintenance Dosage) PO/IV: ADULTS, ELDERLY: 0.125-0.375 mg/day Usual Dosage for Children (Rapid Loading Dosage)

IV: Children >10 years: 8-12 mcg/kg; 5-10 years: 15-30 mcg/kg; 2-5 years: 25-35 mcg/kg; 1-24 mos: 30-50 mcg/kg; FULL-Term: 20-30 mcg/kg; PREMATURE: 15-25 mcg/kg PO: Children >10 years: 10-15 mcg/kg; 5-10 years: 20-35 mcg/kg; 2-5 years: 30-40 mcg/kg; 1-24 mos: 30-50 mcg/kg; FULL-TERM: 25-35 mcg/kg; PREMATURE: 20-30 mcg/kg Usual Dosage for Children (Maintenance Dosage) PO/IV: CHILDREN: 25%-35% loading dose (20%-30% for premature). Dosage in Renal Impairment Total digitalizing dose should decrease by 50% in end-stage renal disease. If creatinine clearance is 10-50 mg/min, dosage should be 25%-75% normal. If creatinine clearance is <10ml/min, dosage should be 10%-25% normal. Action of Digoxin Digoxin increases the influx of calcium from extracellular to intracellular cytoplasm. It potentiates the activity of the contractile heart muscle fibers and increases the force of myocardial contraction. Decreases conduction through the SA and AV nodes. Side Effects and Adverse Reactions of Digoxin Side Effects of Digoxin None known; however, there is a very narrow margin of safety between a therapeutic and toxic result.

Adverse Reactions of Digoxin GI disturbances (anorexia, nausea, vomiting) Neurologic abnormalities (fatigue, headache, depression, weakness, drowsiness, confusion, nightmares) Facial pain Personality changes Ocular disturbances (photo phobia, light flashes, halos around bright objects, yellow or green color perception) may be noted

Nursing Considerations for Clients Taking Digoxin Assess apical pulse for 60 secs (30 secs if on maintenance therapy). If pulse is <60/min (<70min for children), withhold drug, contact physician. Blood samples are best taken 6-8 hours after dose or just before next dose. May be given without regard to meals. Tablets may be crushed. Monitor pulse for bradycardia, EKG for arrhythmias for 1-2 hours after administration (excessive slowing of pulse may be a first clinical sign of toxicity). Assess for GI disturbances, neurologic abnormalities (signs of toxicity) every 2-4 hours during digitalization (daily during maintenance). Monitor serum potassium, magnesium levels.