DRUG STUDY

DOSAGE / ROUTE / FREQUENCY

MECHANIS M OF ACTION

INDICATIONS

CONTRAINDICATION S

SIDE EFFECTS

NURSING CONSIDERATIONS

Generic Name: Bisacodyl

10mg 2 tabs Oral OD - HS

Brand Name: Dulcolax

Increases peristalsis & motor activity of the small intestines by acting directly on the smooth muscles.

Constipation Evacuation of bowel before radiologic studies or surgery

Acute surgical abdomen or intestinal obstruction severe dehydration fecal impaction chronic use.

Abdominal cramps (colic, cramps) Nausea Diarrhea Hypokalemia Muscle weakness

Assess bowel sounds Do not give if patient ahs abdominal pain Teach the patient: short-term therapy only increase fluid intake bulk up the diet normal bowel habits may vary from 3 times/day to 3 times/we ek

Classification: laxatives

DRUG

DOSAGE / ROUTE / FREQUENCY 750mg IV q 8 hrs

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

NURSING SIDE CONSIDERATIONS EFFECTS 1. Check for doctors order 2. Perform ANST prior to admission 3. Should not be given if positive skin test 4. Slow IV push 5. Inform the patient about the possible side effect of the drug 6. Advise patient to report any discomfort on the IV insertion site.

Generic Name: Cefuroxime

Brand Name:

Classification: 2nd generation Cephalosporin

Secondgeneration cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.

Preoperative prophylaxis in clients undergoing surgical procedures classified as clean contaminated or potentially contaminated.

* Contraindicated in patients hypersensitive to drug. * Use cautiously in patients hypersensitive to penicillin because of possibility of crosssensitivity with other beta-lactam antibiotics.

GI: Diarrhea, nausea, antibioticassociated colitis. Skin: Rash, pruritus, urticaria. Urogenital: Increased serum cretonne and BUN, decreased creatinine clearance

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DOSAGE / ROUTE / FREQUENCY 30mg (3doses) IV q 6hrs

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

SIDE EFFECTS > Rash > Ringing in the ears > Headaches > Dizziness > Drowsiness > Abdominal pain > Nausea > Diarrhea > Constipation > Heartburn > Fluid retention > Somnolence

NURSING CONSIDERATIONS

Generic Name: Ketorolac

Brand Name: Toradol

Classification: Nonsteroidal antiinflammatory drug

Reduces the production of prostaglandins, chemicals that cells of the immune system make that cause the redness, fever, and pain of inflammation and that also are believed to be important in the production of non inflammatory pain.

For short term management (up to 5 days) of moderately severe acute pain that otherwise would require narcotics. It most often is used after surgery.

Hypersensitivity to ketorolac, renal Impairment, aspirin allergy

1. Assess patient for contraindication. 2. Assess for baseline data. 3. Infuse slowly as a bolus over no less than 15 seconds. 4. Tell patient that he may experience side effects brought upon by the drug. 5. Provide comfort measures if headache occurs.

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DOSAGE / ROUTE / FREQUENCY Bupivacaine 0.25% 10cc + 0.25MSO4 OD

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

SIDE EFFECTS

NURSING CONSIDERATIONS

Generic Name: Bupivacaine

Brand Name: Bupican

Classification: Anesthesia

> Block the generation and the conduction of nerve impulses, presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. > The analgesic effects of Bupivacaine are thought to be due to its binding to the prostaglandin E2 receptors, subtype EP1 (PGE2EP1), which inhibits the production of

> Local or regional anesthesia > Analgesia for surgery

> Hypersensitivity to bupivacaine or other local anesthesia e.g. lignocaine, blood clotting disorder, low blood pressure,

> Nervousness > Tingling around the mouth > Tinnitus > Tremor > Dizziness > Blurred vision > Ringing of the ears > Feeling of disorientation > Nausea > Vomiting > Drowsiness > Numbness of tongue > Lightheadedness

1. Assess for contraindication. 2. Assess for baseline data. 3. Monitor vital signs carefully, drug depresses the pulmonary and cardiac system. 4. Monitor for side effects. 5. Tell patient that he may experience side effects brought about by the drug and if such is/are intolerable he must report them so as prompt interventions be done. 6. Oral care if vomiting occurs. 7. Monitor for occurrence of adverse effects, report to the anesthesiologist any signs and symptoms of adverse

prostaglandins, thereby reducing fever, inflammation, and

effects. 8. Continue to monitor patient following discontinuation of anesthesia.

DRUG

DOSAGE / ROUTE / FREQUENCY 5mg IM

MECHANISM OF ACTION

INDICATIONS Management of moderate to severe pain preoperative and postoperative analgesia supplement to balanced anesthesia

CONTRAINDICATIONS Contraindicated in patients hypersensitive to drug Use cautiously in patients with history of drug abuse and in those with emotional instability, head injury, increased ICP, impaired ventilation, MI accompanied by N/V, upcoming biliary surgery, and hepatic or renal disease

SIDE EFFECTS

NURSING CONSIDERATIONS Reassess patients level of pain at least 15 and 30 minutes after parenteral administration Nalbuphine acts as an opioid antagonist and may cause withdrawal syndrome. For patients who have received log-term opioids, give 25% of the usual dose initially. Watch for sings of withdrawal. Alert: Drug causes respiratory depression, which at 10mg is equal to respiratory depression produced by 10 mg of morphine Monitor circulatory and respiratory status, bladder and bowel function. If respirations are shallow or rate is below 12 breaths/minute,

Generic Name: Nalbuphine HCL

Brand Name: Nubain

Binds with opiate receptors in the CNS, altering perception of and emotional response to pain.

Classification: Narcotic agonistantagonist analgesic

CNS: Sedation, dizziness, vertigo, headache, agitation, confusion, crying, depression, dysphoria, euphoria, faintness, floating feeling, hallucinations, heaviness feeling, hostility, nervousness, numbness, restlessness, seizures, tingling, unreality, unusual dreams CV: Bradycardia, hypertension, hypotension, tachycardia

EENT: Blurred vision, dry mouth GI: Nausea, vomiting, biliary tract spasms, constipation cramps, dyspepsia GU: Urinary urgency Respiratory: Respiratory depression, asthma, dyspnea, pulmonary edema Skin: Burning, clamminess, diaphoresis, pruritus, uticaria

withhold dose and notify prescriber Constipation is often severe with maintenance therapy. Make sure stool softener or other laxative is ordered. Psychological and physical dependence may occur with prolonged use.

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DOSAGE / ROUTE / FREQUENCY

MECHANIS M OF ACTION

INDICATIONS

CONTRAINDICATION S

SIDE EFFECTS

NURSING CONSIDERATION S

Generic Name: Promethazine hydrochloride

25mg IM

Brand Name: Phenergan

Classification: Phenothiazine, Dopaminergic bloking agent, Antihistamine, Antiemetic, Antimotion sickness agent, Sedative/hypnoti c.

Selectively blocks H1 receptors, diminishing the effects of histamine on cells of the upper respiratory tract and eyes and decreasing the sneezing, mucus production, itching and tearing that accompany allergic reactions in sensitized people exposed to antigens; blocks cholinergic receptors in the vomiting center that are believed to mediate

Treatment and prevention of motion sickness; prevention and control of nausea and vomiting associated with anesthesia and surgery. Preoperative , postoperativ e or obstetric sedation. Adjunct to analgesics to control postoperativ e pain.

hypersensitivity to antihistamines or phenothiazines, coma or severe CNS depression, bone marrow depression, vomiting of unknown cause, concomitant therapy with MAOIs, lactation.

CNS: Dizziness, Drowsiness, poor coordination, confusion, restlessness, excitation, convulsions, tremors, headache, blurred vision, diplopia, vertigo, tinnitur CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles DERMATOLOGI C: Urticaria, rash, photosensitivity, chills. GI: Epigastric distress, nausea, vomiting, diarrhea, constipation GU: Urinary frequency, dysuria, urinary retention,

Observe 10 rights in drug administration. Assess for hypersensitivity and other contraindication.

nausea and vomiting caused by gastric irritation, by input from the chemorecepto r trigger zone; depress the RAS, including the parts of the brain involves in wakefulness.

decreased libido, impotence HEMATOLOGIC: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leucopenia, agranulocytosis, pancytopenia. RESPIRATORY: Thickening of brochial secretions, chest tightness, dry mouth, suppression of cough reflex, potential for aspiration.