APINCH

The
The acronym
acronym APINCH
APINCH is
is often
often used
used to
to classify
classify high
high risk
risk medicines.
medicines.

Potassium chloride (KCL)

-isusedtopreventortotreatlowbloodlevelsofpotassium
(hypokalemia).Potassiumlevelscanbelowasaresultofadiseaseor
fromtakingcertainmedicines,orafteraprolongedillnesswithdiarrhea
orvomiting

Dosage and Administration

The dose and rate of administration are dependent upon the
specific condition of each patient.

WARNINGS
This injection is for preparation of intravenous admixtures only,
NOT FOR DIRECT INFUSION.
To avoid potassium intoxication,
DO NOT INFUSE THESE SOLUTIONS RAPIDLY. In patients with
renal insufficiency, administration of potassium chloride may cause
potassium intoxication and life-threatening hyperkalemia.

NURSING IMPLICATIONS

Assessment & Drug Effects

Check IV site for extravasation and infiltration
Monitor I&O ratio and pattern in patients receiving the parenteral
drug. If oliguria occurs, stop infusion promptly and notify physician.
Lab test: Frequent serum electrolytes are warranted.
Monitor for and report signs of GI ulceration (esophageal or
epigastric pain or hematemesis).
Monitor patients receiving parenteral potassium closely with cardiac
monitor. Irregular heartbeat is usually the earliest clinical indication
of hyperkalemia.

CALCIUM
CALCIUM GLUCONATE
GLUCONATE

Rapidly and effectively restores serum calcium levels in acute hypocalcemia of

various origins and effective cardiac stabilizer under conditions of
hyperkalemia or resuscitation.
It may be used to treat conditions caused by lowcalciumlevels such asbone
loss(osteoporosis), weak bones (osteomalacia/rickets), decreased activity of
the parathyroid gland (hypoparathyroidism), and a certain muscle disease
(latent tetany).
It may also be used in certain patients to make sure they are getting enough
calcium (e.g., women who arepregnant, nursing, or postmenopausal, people
taking certainmedications such as phenytoin,phenobarbital, orprednisone).

ADMINISTRAT
ION
Oral
Ensurethatchewabletabletsarechewedorcrushedbeforebeing
swallowedwithaliquid.
Givewithmealstoenhanceabsorption.
Intravenous
DIRECT:
Maybegivenundiluted.GivedirectIVatarateof0.5mLora
fractionthereofover1min.Donotexceed2mL/min
INTERMITTENT/CONTINUOUS:
Maybedilutedin1000mLofNS.Giveslowly,nottoexceed
200mg/min,throughasmall-boreneedleintoalargeveintoavoid
possibilityofextravasationandresultantnecrosis .

Avoid rapid infusion. High concentrations of calcium

suddenly reaching the heart can cause fatal cardiac
arrest.

NURSING IMPLICATIONS

Assessment & Drug Effects

Assess for cutaneous burning sensations and peripheral
vasodilation, with moderate fall in BP, during direct IV injection.
Monitor ECG during IV administration to detect evidence of
hypercalcemia: decreased QT interval associated with inverted
T wave.
Observe IV site closely. Extravasation may result in tissue
irritation and necrosis.
Monitor for hypocalcemia and hypercalcemia.
Lab tests: Determine levels of calcium and phosphorus (tend to
vary inversely) and magnesium frequently, during sustained
therapy. Deficiencies in other ions, particularly magnesium,
frequently coexist with calcium ion depletion

MAGNESIUM SULFATE
commonly known as EPSOM SALT, is a mineral. It
works by replacing magnesium in the body and
increasing water in the intestines.
used in pregnant women to control seizures due to
certain complications of pregnancy (eg, severe
toxemia)
can also be used to treat a dangerous arrhythmia,
lower high blood pressure,severe brain function
problems (encephalopathy), and sudden seizures
in children, severe inflammation of the kidneys
(acute nephritis).

Do NOT use magnesium sulfate if:

you are allergic to any ingredient in magnesium sulfate
you have a severe irregular heartbeat (eg, heart block) or if you
are pregnant and expect to deliver the baby within 2 hours
if it contains particles, is cloudy or discolored, or if the vial is
cracked or damaged.
NURSING IMPLICATIONS

Hypomagnesemia/Anticonvulsant:
Monitorpulse, blood pressure, respirations, andECG frequently
throughout administration ofparenteral magnesium sulfate.
Respirationsshould be at least 16/min before each dose.
Monitor neurologic status before andthroughouttherapy.
Institute seizure precautions. Patellar reflex (knee jerk) should
betestedbefore each parenteral dose of magnesiumsulfate. If
response is absent, no additionaldoses should be administered
untilpositive response is obtained.
Monitor intake and output ratios. Urine output should be
maintained at a level of at least100 ml/4 hr.

Morphine Sulfate
Severe pain (pain in sickle cell crisis, pain associated with
surgery preoperatively and postoperatively, pain
associated with trauma, cancer, renal colic, ureterolithiasis)
Pulmonary edema
Pain associated with myocardial infarction (MI)
Adjunct to general anesthesia
Intravenous Note:
PREPARE:
Direct:Dilute 210 mg in at least 5 mL of sterile water for injection.
Give a single dose over 45 min. Avoid rapid administration.

NURSING IMPLICATIONS
Assessment & Drug Effects

Obtain baseline respiratory rate, depth, and rhythm and size of pupils before administering
the drug. Respirations of 12/min or below and miosis are signs of toxicity. Withhold drug
and report to physician.
Observe patient closely to be certain pain relief is achieved. Record relief of pain and
duration of analgesia.
Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or drawn facial
expression that may indicate need for analgesia
Differentiate among restlessness as a sign of pain and the need for medication,
restlessness associated with hypoxia, and restlessness caused by morphine-induced CNS
stimulation (a paradoxic reaction that is particularly common in women and older adult
patients).
Monitor for respiratory depression; it can be severe for as long as 24 h after epidural or
intrathecal administration.
Monitor carefully those at risk for severe respiratory depression after epidural or intrathecal
injection: Older adult or debilitated patients or those with decreased respiratory reserve
(e.g., emphysema, severe obesity, kyphoscoliosis).
Continue monitoring for respiratory depression for at least 24 h after each epidural or
intrathecal dose.
Assess vital signs at regular intervals. Morphine-induced respiratory depression may occur
even with small doses, and it increases progressively with higher doses (generally max: 90
min after SC, 30 min after IM, and 7 min after IV).
Encourage changes in position, deep breathing, and coughing (unless contraindicated) at
regularly scheduled intervals. Narcotic analgesics also depress cough and sigh reflexes and
thus may induce atelectasis, especially in postoperative patients.
Be alert for nausea and orthostatic hypotension (with light-headedness and dizziness) in

TRAMADOL
TRAMADOL HYDROCHLORIDE
HYDROCHLORIDE
help relieve moderate to moderately severe pain.It works in
thebrainto change how your body feels and responds to pain.
SIDE EFFECTS:
Tramadol is generally well tolerated, and side effects are
usually transient. Commonly reported side effects include:
nausea,
Constipation,
dizziness,
Less
headache,
commonlyreported side effects include
drowsiness,
itching,
sweating,
vomiting.
drymouth,
diarrhea,
rash,

NURSING IMPLICATIONS
Assessment & Drug Effects
Assess for level of pain relief and administer PRN dose as needed but not to
exceed the recommended total daily dose.
Monitor vital signs and assess for orthostatic hypotension or signs of CNS
depression.
Discontinue drug and notify physician if S&S of hypersensitivity occur.
Assess bowel and bladder function; report urinary frequency or retention.
Use seizure precautions for patients who have a history of seizures or who
are concurrently using drugs that lower the seizure threshold.
Monitor ambulation and take appropriate safety precautions.
Control environment (temperature, lighting) if sweating or CNS effects occur.
WARNING:Limit use in patients with past or present history of addiction to
or dependence on opioids.

ALPRAZOLAM
Classification:Benzodiazepine,
Anxiolytic
Indications
Management of anxiety disorders, short-term
relief of symptoms of anxiety; anxiety
associated with depression.
Treatment of panic attacks with or without
agoraphobia unlabeled uses: Social phobia,
premenstrual
syndrome, depression

NURSING IMPLICATIONS
Arrange to taper dosage gradually after long-term therapy, especially

in epileptic patients.
Do not administer with grapefruit juice.
Taper drug slowly; decrease by no more than 0.5 mg every 3 days.
Take this drug exactly as prescribed; take extended-release form once
a day in the morning; place rapidly disintegrating tablet on top of
tongue, where it will disintegrate and can be swallowed with saliva.
Avoid alcohol, sleep-inducing, or over-the-counter drugs.
You may experience these side effects:
Drowsiness,
dizziness (these effects will be less pronounced after a few
days, avoid driving a car or engaging in other
dangerous activities if these occur);
GI upset (take drug with food);
fatigue;

depression;
Report
severe dizziness, weakness, drowsiness that
persists,
dreams;
rash or skin lesions, difficulty voiding,
palpitations,
crying;
swelling in the extremities.
nervousness.