[MULTIPLE INJURIES] Case Sharing

Drug Studies
Drug Name
Generic
Tranexamic
Acid
Brand
Hemostan

Classification

Indications

Mechanism of
Action
Anti-fibrinolytic, Used for the
Tranexamic acid is a
antihemorrhagic prompt and
synthetic derivative
effective control of the amino acid
of hemorrhage
lysine. It exerts its
Treatment of
antifibrinolyticeffect
severe localized through the
bleeding
reversible blockade
secondary to
of lysine-binding
hyperfibrinolysis, sites on plasminogen
including
molecules. Antiepistaxis,
fibrinolytic drug
hyphema, or
inhibits endometrial
hypermenorrhea plasminogen
(menorrhagia)
activator and thus
and hemorrhage prevents fibrinolysis
following certain and the breakdown
surgical
of blood clots. The
procedures.
plasminogenplasmin enzyme
system is known to
cause coagulation
defects through lytic
activity on
fibrinogen, fibrin and
other clotting
factors. By inhibiting
the action of plasmin

Route/Frequency/
Dosage
Hemorrage,
hyperfibrinolysis
induced epistaxis :
PO: 1 to 1.5 grams
three or four times a
day for 10 days
IV: 15 mg per kg of
body weight or 1 gram
every six to eight hours
Angioedema,
hereditary
PO: 1 to 1.5 grams two
or three times a day.
Tranexamic Acid Oral
Solution
A 5% oral rinse is
prepared by diluting 5
mL of 10% tranexamic
acid injection with 5 mL
of sterile water

Adverse
Reactions
GI disorders,
nausea, vomiting,
anorexia,
headache may
appear, impaired
renal
insufficiency,
hypotension
when IV inj is too
rapid

Drug Interaction
Anti-inhibitor
coagulant
complex or
Factor IX
complex:
Concurrent use
may increase the
risk of
thrombotic
complications
Contraceptives,
estrogencontaining, oral
or Estrogens:
Concurrent use
with tranexamic
acid may
increase the
potential for
thrombus
formation

Nursing
Consideration
With meals
Unusual change
in bleeding
pattern should
be immediately
reported to the
physician.
For women who
are taking
Tranexamic acid
to control heavy
bleeding, the
medication
should only be
taken during the
menstrual
period.
Tranexamic Acid
should be used
with extreme
caution in
CHILDREN
younger than 18
years old; safety
and
effectiveness in
these children
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(finronolysin) the
anti-fibrinolytic
agents reduce
excessive breakdown
of fibrin and effect
physiological
hemostasis.

have not been

confirmed.
The medication
can be taken
with or without
meals.
Swallow
Tranexamic Acid
whole with
plenty of liquids.
Do not break,
crush, or chew
before
swallowing.
If you miss a
dose of
Tranexamic
Acid, take it
when you
remember, then
take your next
dose at least 6
hours later. Do
not take 2 doses
at once.
Inform the
client that
he/she should
inform the
physician
immediately if
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the following
severe side
effects occur.
Drug Name

Classification

Generic
Alpha Adrenergic
Norepinephrine agonist
Beta1-adrenergic
Brand
agonist
Levophed
Cardiac Stimulant
symphatomimetic
Vasopressor

Indications
Restoration of
BP on
controlling
certain acute
hypotensive
state.
Adjunct in the
treatment of
cardiac arrest
and profound
hypotension.

Mechanism of
Action
Vasopressor and
cardiac stimulant;
effects are
mediated by
alpha1 or beta1
adrenergic
receptors in target
organs; potent
vasoconstriction
(alpha effect)
acting in arterial
and venous beds;
potent positive
inotropic agent
(beta1 effect),
increasing the
force of myocardial
contraction and
increasing coronary
blood flow.

Route/Frequency/
Adverse
Dosage
Reactions
Acute Hypotension
Headache
Initial: 8-12 mcg/min IV Bradycardia
infusion; titrate to
Hypertension
effect
Maintenance: 2-4
mcg/min IV infusion
Cardiac Arrest
Initial: 8-12 mcg/min IV
infusion; titrate to
effect
Maintenance: 2-4
mcg/min IV infusion

Drug
Interaction
Increased
hypertensive
effects with
TCAs
(imipramine),
reserpine,
methyldopa,
Decreased
vasopressor
effects with
phenthiazines

Nursing
Consideration
- Central line
required for
administration;
in cases of
emergency or
profound
hypotension,
norepinephrine
may be given
peripherally
while
preparation for
central line is
underway using
the standard
concentration of
4 mg / 250 ml.
- Peripheral
administration
of the 4 mg /
250 ml
concentration
may be used for
short term
administration
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(e.g. pretransplant and

post-op
management of
labile blood
pressure in
which a central
line is a relative
contraindication
)
PA line
monitoring of
cardiac output,
cardiac index,
PCWP, CVP, and
SVR is
encouraged
during
maintenance
infusions.
Should be used
with caution in
patients with
ischemic heart
disease
Invasive blood
pressure
monitoring (e.g.
a-line) should be
considered
when centrally
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administered
vasoactive
agents are used
or when
frequent
changes in
infusion rate are
required.
Drug Name

Classification

Generic
Mefenamic
Acid

NSAID

Brand
Ponstan,
Ponstel

Indications
Antiinflammatory
analgesic and
antipyretic
activities
related to
inhibition of
prostaglandin
synthesis;
exact
mechanisms of
action are not
known.

Mechanism of
Action
Anti-inflammatory,
analgesic, and
antipyretic activities
related to inhibition
of prostaglandin
synthesis; exact
mechanism of
action not known.

Route/Frequency/
Dosage
Mild to Moderate Pain
Adult : 250-500mg tid
Child : >6mth : 25mg/kg
daily in divided doses for
up to 7 days

Adverse Reactions

Drug Interaction

Headache
Dizziness
Insomnia
Rash
Nausea
Dyspepsia
GI Pain
Diarrhea
Constipation
Dysuria
Renal Impairment
Bleeding
Leukopenia
Eosinophilia
Thrombocytopenia
Agranulocytosis
Pancytopenia
Aplastic Anemia
Dyspnea
Hemoptysis

Increased risk GI
bleeds with ASA,
anticoagulants,
other NSAIDs

Nursing
Consideration
Take with food;
take only in the
prescribed
dosage; do not
take drug longer
than 1week
Discontinue drug
promptly if
diarrhea, dark
stools,
hematemesis,
ecchymoses,
epistaxis, or rash
occur and do not
use again.
Contact
physician.
Notify physician
if persistent GI
discomfort, sore
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Anaphylactoid to
Anaphylactic
Shock

throat, fever, or
malaise occur.
Do not drive or
engage in
potentially
hazardous
activities until
response to drug
is known. It may
cause dizziness
and drowsiness.
Monitor blood
glucose for loss
of glycemic
control if
diabetic.
Do not breast
feed while taking
this drug without
consulting
physician.

Drug Name

Classification

Generic
Mannitol

Diagnostic
Agent
Osmotic
Diuretic
Urinary
Irritant

Brand
Osmitrol

Indications
Oliguria
Reduction of
IOP or ICP
Diuresis
Irrigating
solution
(transurethral

Mechanism of
Action
Mannitol elevates
blood plasma
osmolality, resulting
in enhanced flow of
water from tissues,
including the brain
and cerebrospinal

Route/Frequency/
Dosage
Adults
Prevention of acute renal
failure (oliguria): 50
to100 g of mannitol
given as 5%, 10%, or 15%
solution depending on
the patient's fluid

Adverse Reactions

Drug Interaction

Dizziness,
Headache,
Fatigue
Orthostatic
hypotension,
Palpitations,

Mannitol should
not be used with
tobramycin,
because
mannitol
increases
tobramycin

Anorexia,

Nursing
Consideration
Do not give
electrolyte free
mannitol with
blood. If blood
must be given,
add at least 20
mEq of sodium
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resection of
prostate gland

Drug Name

Classification

Generic
Nimodipine

Calcium
channel
blocker

Trade
Nimotop

Indications
This
medication is a
calcium
channel
blocker,
prescribed for
brain
hemorrhage
(bleeding in

fluid, into interstitial

fluid and plasma.
Induces diuresis
because mannitol is
not reabsorbed in
the renal tubule,
thereby increasing
the osmolality of the
glomerular filtrate,
facilitating excretion
of water, and
inhibiting the renal
tubular reabsorption
of sodium, chloride,
and other solutes.

requirements.
Treatment of oliguria:
100 g administered as a
15 or 20% solution.
Reduction of intracranial
pressure and brain mass:
0.25 g/kg given every 6
to 8 hours.
Reduction of intraocular
pressure: 1.5 to 2 g/kg
body weight, as 15% to
25% solution
administered over 30 to
60 minutes.

Mechanism of
Action
Nimodipine is
a calcium channel
blocker. The
contractile processes
of smooth muscle
cells are dependent
upon calcium ions,
which enter these
cells during

Route/Frequency/
Dosage
Oral: The recommended
dose is 60 mg (two 30
mg capsules) every 4
hours for 21 consecutive
days.

Nausea &
vomiting, Diarrhea,
Constipation,
Dry mouth
Diuresis,
Nocturia,
Polyuria,
Hyponatremia
Fluid and
Electrolytes
imbalances,
Dehydration
Muscle cramps
Dermatitis,
Photosensitivity
reactions
Rash

Adverse Reactions
Central Nervous
System- Dizziness,
lightheadedness,
headache and
depression.
Heart- Flushing,
fast/slow heart rate,
fainting and low

levels
significantly
through an
unknown
mechanism.

chloride to each
liter of mannitol
solution.
Do not expose
solutions to low
temperatures;
crystallization
may occur
Make sure the
infusion set
contains a filter if
giving
concentrated
mannitol.
Monitor serum
electrolytes
periodically with
prolonged
therapy.

Drug Interaction
Some medicines
can interact with
nimodipine and
should not be
used at the same
time. Your
doctor may need
to change your
treatment plan if

Nursing
Consideration
Instruct patient
to take
nimodipine on
an empty
stomach, one
hour before or
two hours after
meals.
Tell patient to
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the brain) and
also rarely
used for high
blood
pressure.

depolarization as
slow ionic
transmembrane
currents.
Nimodipine inhibits
calcium ion transfer
into these cells and
thus inhibits
contractions
of vascular smooth
muscle.

blood pressure.
GastrointestinalHeartburn, stomach
upset, constipation,
nausea and
vomiting.
Allergic reactionsRash, difficulty in
swallowing/breathing
and swelling of the
face, eyes, lips,
tongue, arms or legs.

you use any of

the following
drugs:
conivaptan;
imatinib;
nefazodone;
antibiotic-clarithromycin,
telithromycin;
antifungal
medication-itraconazole,
ketoconazole,
posaconazole,
voriconazole;
heart
medication-nicardipine,
quinidine;
hepatitis C
medications-boceprevir,
telaprevir; or
HIV/AIDS
medication-atazanavir,
cobicistat,
delavirdine,
fosamprenavir,
indinavir,

avoid drinking
alcohol while
you are taking
nimodipine.
Alcohol and
nimodipine may
cause low blood
pressure,
drowsiness, or
dizziness.
Remind patient
not to stop
taking
nimodipine
without first
talking to his/her
doctor, even if
he/she begins to
feel better. If
he/she will stop
taking the
medication,
his/her
condition could
become worse.
Monitor blood
pressure of
patient regularly
while taking the
medication.
Store it at
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nelfinavir,
ritonavir,
saquinavir.

Drug
Name
Generic
Tetanus
toxoid

Classification
Tetanus
toxoid
prophylaxis

Indications
provide
protection
(immunity)
against
tetanus (lockja
w) in adults
and children 7
years or older

Mechanism of
Action
Tetanus toxoid
promotes active
immunity by
inducing
production of
tetanus
antitoxin.

Route/Frequency/
Dosage
adsorbed toxoid
Injection: 5 to 10 Lf
units of inactivated
tetanus/0.5-ml
dose, in 0.5-ml
syringes and 5-ml
vials
toxoid
Injection: 4 to 5 Lf
units of inactivated
tetanus/0.5-ml
dose, in 0.5-ml
syringes and 7.5-ml
vials

Adverse Reactions
CNS: headache, seizures, malais
e, slight fever, aches and pains.
CV: tachycardia,
hypotension, flushing.
Skin: urticaria, pruritus,
erythema, induration, nodule
(at injection site).
Other: chills, anaphylaxis.

controlled room
temperature
(25C), and
protect from
light.

Drug Interaction

Nursing
Consideration
Chloramphenicol, - Monitor
corticosteroids,
patient for
immune
hypersensitivit
suppressants: Ma
y reactions,
y impair the
seizures, and
immune response
injection site
to tetanus
reactions.
toxoid. Avoid
- Check lab
concomitant
results for
elective
bleeding
immunization.
problems such
as low platelet.
- Inform patient
of possible
adverse
reactions.
Encourage
patient to
report
distressing
adverse
reactions.
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Drug Name

Classification

Indications

Mechanism of
Action

Route/Frequency/
Dosage

Adverse Reactions

Drug Interaction

Generic
Cephalexin

Cephalosporin
antibiotic

Used to treat
certain
infections
caused by
bacteria such as
pneumonia and
bone, ear, skin,
and urinary tract
infections

Interferes with the

bacteria's cell wall
formation, causing it
to rupture, and killing
the bacteria.

Cephalexin comes as a
capsule, tablet, and liquid
to take by mouth. It is
usually taken every 6 hours
(four times a day) or every
12 hours (twice a day) for 7
to 10 days.

GI- diarrhea,
stomach upset,
abdominal pain,
nausea/vomiting
CNS-dizziness,
headache,
Skin-itching/swelling
and rash.

Vaccines that
contain live
bacteria (such
as typhoid, BCG).

Trade
Keflex

Nursing
Consideration
Cephalexin may
cause an upset
stomach. Take
cephalexin with
food or milk
Before taking
cephalexin, tell
your doctor and
pharmacist if you
are allergic to
cephalexin or any
other
cephalosporin
antibiotic such as
cefadroxil
(Duricef) or
cephradine
(Velosef),
penicillin, or any
other drugs.
Advice the
patient to take
the missed dose
as soon as he/she
remembers it.

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