Generic Name :

Brand Name: Avandia

Classification: Antidiabetic, Thiazolidinedione

Pregnancy Category C

Dosage & Route

Available forms : Tablets—2, 4, 8 mg

ADULTS

• 4 mg as a single oral dose or divided into two doses; if adequate response is not seen in 8–12 wk, may be increased to 8 mg daily PO.
• Combination therapy with metformin: 4 mg daily PO added to the established dose of metformin; may be increased after 12 wk to 8 mg daily PO.
• Combination with insulin: Continue insulin dose and start with 4 mg/day; monitor patient and decrease insulin dose by 10–25% based on patient response.

PEDIATRIC PATIENTS

• Safety and efficacy not established.

PATIENTS WITH HEPATIC IMPAIRMENT

• Use caution and monitor patient closely. Do not administer if AST > 2.5 times the upper level of normal.

Therapeutic actions

• Rosiglitazone is a thiazolidinedione antidiabetic agent which improves insulin sensitivity by lowering blood glucose level without increasing pancreatic insulin secretion. It is dependent on the presence of insulin. Rosiglitazone is a potent agonist for the peroxisome proliferator-activated receptor-gamma, which in turn regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport and utilization.

Indications

• Monotherapy as an adjunct to diet and exercise to improve glucose control in patients with type 2 diabetes
• As part of combination with insulin, metformin or a sulfonylurea when diet, exercise, and either agent alone does not result in adequate glycemic control in type 2 diabetes
• Unlabeled use: Increased ovulation frequency in women with polycystic ovary syndrome

Adverse effects

• Upper respiratory tract infections, headache, back pain, hyperglycemia, fatigue, sinusitis, diarrhea, hypoglycemia, edema, anemia, weight gain.

Contraindications

• Hypersensitivity, symptomatic heart failure. Not to be used in patients with established NYHA (New York Heart Association) class III or IV heart failure. Pregnancy, lactation.

Nursing considerations

Assessment

• History: Allergy to any thiazolidinedione; type 1 diabetes, ketoacidosis, serious hepatic impairment, advanced heart disease, pregnancy, lactation
• Physical: T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation; LFTs, blood glucose, CBC

Interventions

• Monitor serum glucose levels frequently to determine effectiveness of drug and dosage being used.
• Monitor baseline LFTs before beginning therapy and periodically during therapy.
• Administer without regard to meals.
• Arrange for consult with dietitian to establish weight loss program and dietary control as appropriate.
• Arrange for thorough diabetic teaching program to include disease, dietary control, exercise, signs and symptoms of hypo- and hyperglycemia, avoidance of infection, hygiene.

Teaching points

• Do not discontinue this medication without consulting your health care provider; continue with diet and exercise program for diabetes control.
• Take this drug with meals if desired. If dose is missed, it may be taken at the next meal. If dose is missed for an entire day, do not double dose the next day.
• Monitor urine or blood for glucose and ketones as prescribed; watch very closely while adjusting to drug.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-colored stools, hypo- or hyperglycemic reactions.

Rosiglitazone Maleate (Avandia) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Apo-Sucralfate (CAN), Carafate, Novo-Sucralfate (CAN), Sulcrate (CAN)

Classification: Antiulcer drug

Pregnancy Category B

Dosage & Route

Available forms : Tablets—1 g; suspension—1 g/10 mL

ADULTS

• Active duodenal ulcer: 1 g PO qid on an empty stomach (1 hr before meals and at bedtime). Continue treatment for 4–8 wk.
• Maintenance: 1 g PO bid.

PEDIATRIC PATIENTS

• Safety and efficacy not established.

Therapeutic actions

• Sucralfate protects GI lining against peptic acid, pepsin and bile salts by binding with positively-charged proteins in exudates forming a viscous paste-like adhesive substance thus forming a protective coating.

Indications

• Short-term treatment of duodenal ulcers, up to 8 wk
• Maintenance therapy for duodenal ulcer at reduced dosage after healing
• Orphan drug use: Treatment of oral and esophageal ulcers due to radiation, chemotherapy, and sclerotherapy
• Unlabeled uses: Accelerates healing of gastric ulcers, long-term treatment of gastric ulcers, treatment of reflux and peptic esophagitis, treatment of NSAID or aspirin-induced GI symptoms and GI damage, prevention of stress ulcers in critically ill patients

Adverse effects

• Constipation, diarrhea, nausea, dizziness, dry mouth. GI disturbances, rash, pruritus, headache, vertigo, back pain, drowsiness.

Contraindications

• Contraindicated with allergy to sucralfate, chronic renal failure or dialysis (buildup of aluminum may occur with aluminum-containing products).
• Use cautiously with pregnancy, lactation.

Nursing considerations

Assessment

• History: Allergy to sucralfate; chronic renal failure or dialysis; pregnancy, lactation
• Physical: Skin color, lesions; reflexes, orientation; mucous membranes, normal output

Interventions

• Give drug on an empty stomach, 1 hr before or 2 hr after meals and at bedtime.
• Monitor pain; use antacids to relieve pain.
• Administer antacids between doses of sucralfate, not within 30 min before or after sucralfate doses.
• Measure and record regular weight to monitor mobilization of edema fluid.
• Avoid giving food rich in potassium.
• Arrange for regular evaluation of serum electrolytes, BUN.

Teaching points

• Take the drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime.
• If you are also taking antacids for pain relief, do not take antacids 30 minutes before or after taking sucralfate.
• You may experience these side effects: Dizziness, vertigo (avoid driving or operating dangerous machinery); indigestion, nausea (eat frequent small meals); dry mouth (use frequent mouth care, suck on sugarless lozenges); constipation (request aid).
• Report severe gastric pain.

Sucralfate (Carafate) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Apo-Propranolol (CAN), Inderal, Inderal LA, InnoPran XL, Nu-Propranolol (CAN), Propranolol Intensolol

Classification: Beta-adrenergic blocker (nonselective), Antianginal, Antiarrhythmic, Antihypertensive

Pregnancy Category C

Dosage & Route

Available forms : ER capsules—60, 80, 120, 160 mg; tablets—10, 20, 40, 60, 80, 90 mg; SR capsules—60, 80, 120, 160 mg; injection—1 mg/mL; oral solution—4, 8 mg/mL; concentrated oral solution—80 mg/mL

ADULTS

Oral

• Hypertension: 40 mg regular propranolol bid or 80 mg SR daily initially; usual maintenance dose, 120–240 mg/day given bid or tid or 120–160 mg SR daily (maximum dose, 640 mg/day).
• Angina: 80–320 mg/day divided bid, tid, or qid or 80 mg SR daily initially; gradually increase dosage at 3- to 7-day intervals; usual maintenance dose, 160 mg/day (maximum dose, 320 mg/day).
• IHSS: 20–40 mg tid or qid or 80–160 mg SR daily.
• Arrhythmias: 10–30 mg tid or qid.
• MI: 180–240 mg/day given tid or qid (maximum dose, 240 mg/day).
• Pheochromocytoma: Preoperatively, 60 mg/day for 3 days in divided doses; inoperable tumor, 30 mg/day in divided doses.
• Migraine: 80 mg/day daily (SR) or in divided doses; usual maintenance dose, 160–240 mg/day.
• Essential tremor: 40 mg bid; usual maintenance dose, 120 mg/day (maximum dose, 320 mg/day)

Parenteral

• Life-threatening arrhythmias: 1–3 mg IV with careful monitoring, not to exceed 1 mg/min; may give second dose in 2 min, but then do not repeat for 4 hr.

PEDIATRIC PATIENTS

• Safety and efficacy not established.

Therapeutic actions

• Propranolol competitively blocks β1- and β2-receptors resulting to decreased heart rate myocardial contractility, BP and myocardial oxygen demand. It only possesses membrane-stabilising properties.

Indications

• Hypertension alone or with other drugs, especially diuretics
• Angina pectoris caused by coronary atherosclerosis
• Idiopathic hypertrophic subaortic stenosis to manage associated stress-induced angina, palpitations, and syncope
• Cardiac arrhythmias, especially supraventricular tachycardia, and ventricular tachycardias induced by digitalis or catecholamines
• Prevention of reinfarction in clinically stable patients 5–21 days after MI
• Pheochromocytoma, an adjunctive therapy after treatment with an alpha-adrenergic blocker to manage tachycardia before or during surgery or if the pheochromocytoma is inoperable
• Prophylaxis for migraine headache
• Treatment of essential tremor, familial or hereditary
• Unlabeled uses: Recurrent GI bleeding in cirrhotic patients, schizophrenia, tardive dyskinesia, acute panic symptoms, anxiety, CHF

Adverse effects

• Cold extremities, insomnia, fatigue, dizziness, vivid dreams, lassitude, nausea, constipation or diarrhoea, vomiting, anorexia, stomach discomfort, impotence. Weakness, paraesthesia, wheezing, pharyngitis, bronchospasm. CNS disturbances at higher doses and mood alterations. Thrombocytopenic purpura, agranulocytosis, nonthrombocytopenic purpura, thrombocytopenia. Depression, confusion, cognitive dysfunction, emotional lability, fatigue, hallucinations.
• Potentially Fatal: Heart failure, heart block and bronchospasm.

Contraindications

• Sinus bradycardia, cardiogenic shock, pulmonary oedema, severe hyperactive airway disease, compensated cardiac failure, Raynaud’s disease, hypoglycaemia, severe haemorrhage, metabolic acidosis, severe peripheral arterial disease, 2nd or 3rd degree heart block. Pregnancy (2nd and 3rd trimesters).

Nursing considerations

Assessment

• History: Allergy to beta-blocking agents, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, CHF, bronchial asthma, bronchospasm, COPD, hypoglycemia and diabetes, thyrotoxicosis, hepatic impairment, pregnancy, lactation
• Physical: Weight, skin color, lesions, edema, T; reflexes, affect, vision, hearing, orientation; BP, P, ECG, peripheral perfusion; R, auscultation; bowel sounds, normal output, liver evaluation; bladder palpation; LFTs, thyroid function tests; blood and urine glucose

Interventions

• Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial).
• Provide continuous cardiac and regular BP monitoring with IV form. Change to oral form as soon as possible.
• Give oral drug with food to facilitate absorption.

Teaching points

• Take this drug with meals. Do not discontinue the medication abruptly; abrupt discontinuation can cause a worsening of your disorder.
• If you have diabetes, the normal signs of hypoglycemia (tachycardia) may be blocked by this drug; monitor your blood or urine glucose carefully; eat regular meals, and take your diabetic medication regularly.
• You may experience these side effects: Dizziness, drowsiness, light-headedness, blurred vision (avoid driving or performing hazardous tasks); nausea, loss of appetite (eat frequent small meals); nightmares, depression (request change of your medication); sexual impotence.
• Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.

Propranolol HCl (Inderal) Drug Study Original source at: Nurseslabs

Generic Name

Brand Name: Aldactone, Novospiroton (CAN)

Classification: Potassium-sparing diuretic, Aldosterone antagonist

Pregnancy Category D

Dosage & Route

Available forms : Tablets—25, 50, 100 mg

ADULTS

• Edema: Initially, 100 mg/day (range 25–200 mg/day) when given as the sole agent; continue > 5 days, then adjust dose or add another diuretic or both.
• Diagnosis of hyperaldosteronism: 400 mg/day PO for 3–4 wk (long test). Correction of hypokalemia and hypertension are presumptive evidence of primary hyperaldosteronism. 400 mg/day PO for 4 days (short test). If serum K+ increases but decreases when drug is stopped, presumptive diagnosis can be made.
• Maintenance therapy for hyperaldosteronism: 100–400 mg/day PO.
• Essential hypertension: 50–100 mg/day PO. May be combined with other diuretics.
• Hypokalemia: 25–100 mg/day PO.

PEDIATRIC PATIENTS

• Edema: 1–3.3 mg/kg/day PO adjusted to patient’s response, administered as single or divided dose.

Therapeutic actions

• Spironolactone acts on the distal renal tubules as a competitive antagonist of aldosterone. It increases the excretion of sodium chloride and water while conserving potassium and hydrogen ions.

Indications

• Diagnosis and maintenance of primary hyperaldosteronism
• Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate
• Treatment of hypokalemia or prevention of hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias
• Essential hypertension, usually in combination with other drugs
• Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties, palliation of symptoms of PMS, treatment of familial male precocious puberty, short-term treatment of acne vulgaris

Adverse effects

• Fluid or electrolyte imbalance, gynecomastia, GI upset, drowsiness, headache, hyponatremia; tachycardia, hypotension, oliguria, hyperkalemia; confusion, weakness, paresthesia, hirsutism, mental disturbances, menstrual irregularities, loss of libido and impotence.

Contraindications

• Anuria, hyperkalemia, acute or progressive renal insufficiency. Addison’s disease.

Nursing considerations

Assessment

• History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation
• Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns, menstrual cycle; CBC, serum electrolytes, renal function tests, urinalysis

Interventions

• Mark calendars of edema outpatients as reminders of alternate day or 3- to 5-day/wk therapy.
• Give daily doses early so that increased urination does not interfere with sleep.
• Make suspension as follows: Tablets may be pulverized and given in cherry syrup for young children. This suspension is stable for 1 mo if refrigerated.
• Measure and record regular weight to monitor mobilization of edema fluid.
• Avoid giving food rich in potassium.
• Arrange for regular evaluation of serum electrolytes and BUN.

Teaching points

• Record alternate-day therapy on a calendar, or prepare dated envelopes. Take the drug early because of increased urination.
• Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar.
• Avoid foods that are rich in potassium (fruits, Sanka); avoid licorice.
• You may experience these side effects: Increased volume and frequency of urination; dizziness, confusion, feeling faint on arising, drowsiness (avoid rapid position changes, hazardous activities: such as driving, using alcohol); increased thirst (suck on sugarless lozenges; use frequent mouth care); changes in menstrual cycle, deepening of the voice, impotence, enlargement of the breasts can occur (reversible).
• Report weight change of more than 3 pounds in 1 day, swelling in your ankles or fingers, dizziness, trembling, numbness, fatigue, enlargement of breasts, deepening of voice, impotence, muscle weakness, or cramps.

Spironolactone (Aldactone) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Accolate

Classification: Antasthmatic, Leukotriene receptor antagonist

Pregnancy Category B

Dosage & Route

Available forms : Tablet—10, 20 mg

ADULTS AND CHILDREN > 12 YR

• 20 mg PO bid on an empty stomach.

PEDIATRIC PATIENTS 5–11 YR

• 10 mg PO bid on an empty stomach.

Therapeutic actions

• Zafirlukast selectively antagonizes the leukotriene D4 receptor. It inhibits bronchoconstriction caused by various inhaled antigens or irritants. It is not used in acute asthma attacks.

Indications

• Prophylaxis and long-term treatment of bronchial asthma in adults and children > 5 yr
• Unlabeled use: Chronic urticaria

Adverse effects

• GI disturbances, headache, myalgia, generalized pain, fever, dizziness, raised LFT, respiratory tract infections, hypersensitivity reactions, Churg-Strauss syndrome.
• Potentially Fatal: Severe hepatotoxicity.

Contraindications

• Hypersensitivity, hepatic impairment, cirrhosis, acute asthmatic attacks. Lactation.

Nursing considerations

Assessment

• History: Hypersensitivity to zafirlukast; impaired renal or hepatic function; pregnancy, lactation; acute asthma or bronchospasm
• Physical: T; orientation, reflexes; R, adventitious sounds; GI evaluation; LFTs, renal function tests

Interventions

• Administer on an empty stomach 1 hr before or 2 hr after meals.
• Ensure that drug is taken continually for optimal effect.

Teaching points

• Take this drug on an empty stomach, 1 hour before or 2 hours after meals.
• Take this drug regularly as prescribed; do not stop taking it during symptom-free periods; do not stop taking it without consulting your health care provider.
• Do not take this drug for acute asthma attack or acute bronchospasm; this drug is not a bronchodilator; routine emergency procedures should be followed during acute attacks.
• Avoid use of over-the-counter medications while using this drug; many of them contain products that can interfere with drug or cause serious side effects. If you think that you need one of these products, consult your health care provider.
• You may experience these side effects: Dizziness (use caution when driving or performing activities that require alertness); nausea, vomiting (eat frequent small meals); headache (analgesics may be helpful).
• Report fever, acute asthma attacks, severe headache.

Zafirlukast (Accolate) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Apo-Warfarin (CAN), Coumadin, Gen-Warfarin (CAN)

Classification: Oral anticoagulant, Coumarin derivative

Pregnancy Category X

Dosage & Route

• Available forms :Tablets—1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg; powder for injection—5.4 mg reconstitutes to 2 mg/mL
• Dosages :Adjust dosage according to the one-stage PT to achieve and maintain 1.5–2.5 times the control value or prothrombin activity 20%–30% of normal; PT ratio of 1.3–1.5 or INR of 2–3. IV use is reserved for situations in which oral warfarin is not feasible. Dosages are the same for oral and IV forms.

ADULTS

• Initially, 2–5 mg/day PO. Adjust dose according to PT response. For maintenance, 2–10 mg/day PO based on PT ratio or INR.

GERIATRIC PATIENTS

• Lower doses are usually needed; begin with smaller doses than those recommended for adults and closely monitor PT ratio or INR.

Therapeutic actions

• Warfarin inhibits synthesis of vit K-dependent coagulation factors VII, IX, X and II and anticoagulant protein C and its cofactor protein S. No effects on established thrombus but further extension of the clot can be prevented. Secondary embolic phenomena are avoided.

Indications

• Venous thrombosis and its extension, treatment, and prophylaxis
• Treatment of thromboembolic complications of atrial fibrillation with embolization, and cardiac valve replacement
• Pulmonary embolism, treatment, and prophylaxis
• Prophylaxis of systemic embolization after acute MI
• Unlabeled uses: Prevention of recurrent TIAs, prevention of recurrent MI, adjunct to therapy in small-cell carcinoma of the lung

Adverse effects

• Hypersensitivity, rash, alopecia, diarrhea, drop in hematocrit, purple toes syndrome, skin necrosis, jaundice, nausea, vomiting, hepatic dysfunction, pancreatitis, increased LFT.

Contraindications

• Hypersensitivity; hemorrhagic tendencies or blood dyscrasia; recent surgery; peptic ulcer; severe hypertension; bacterial endocarditis; cerebrovascular disorders; psychosis; senility; aneurysms; pericarditis; pericardial effusion; eclampsia; pre-eclampsia; threatened abortion; alcoholism; severe renal and hepatic impairment; pregnancy.

Nursing considerations

Assessment

• History: Allergy to warfarin; SBE; hemorrhagic disorders; TB; hepatic diseases; GI ulcers; renal disease; indwelling catheters, spinal puncture; aneurysm; diabetes; visceral carcinoma; uncontrolled hypertension; severe trauma; threatened abortion, menometrorrhagia; pregnancy; lactation; CHF, diarrhea, fever; thyrotoxicosis; senile, psychotic or depressed patients
• Physical: Skin lesions, color, T; orientation, reflexes, affect; P, BP, peripheral perfusion, baseline ECG; R, adventitious sounds; liver evaluation, bowel sounds, normal output; CBC, urinalysis, guaiac stools, PT, LFTs, renal function tests

Interventions

• Do not use drug if patient is pregnant (heparin is anticoagulant of choice); advise patient to use contraceptives.
• Monitor PT ratio or INR regularly to adjust dosage.
• Administer IV form to patients stabilized on Coumadin who are not able to take oral drug. Dosages are the same. Return to oral form as soon as feasible.
• Do not change brand names once stabilized; bioavailability may be a problem.

• Do not give patient any IM injections.

• Use caution when discontinuing other drugs; warfarin dosage may need to be adjusted; carefully monitor PT values.
• Keep vitamin K readily available in case of overdose.
• Arrange for frequent follow-up, including blood tests to evaluate drug effects.

Teaching points

• Many factors may change your body’s response to this drug—fever, change of diet, change of environment, other medications. Your dosage may have to be changed repeatedly. Write down changes that are prescribed.
• Do not start or stop taking any medication without consulting your health care provider. Other drugs can affect your anticoagulant; starting or stopping another drug can cause excessive bleeding or interfere with the desired drug effects.
• Carry or wear a medical ID tag to alert emergency medical personnel that you are taking this drug.
• Avoid situations in which you could be easily injured (contact sports, shaving with a straight razor).
• Have periodic blood tests to check on the drug action. These tests are important.
• Use contraception; do not become pregnant while taking this drug.
• You may experience these side effects: Stomach bloating, cramps (transient); loss of hair, rash; orange-red discoloration to the urine (if upsetting, add vinegar to your urine and the color should disappear).
• Report unusual bleeding (from brushing your teeth, excessive bleeding from injuries, excessive bruising), black or bloody stools, cloudy or dark urine, sore throat, fever, chills, severe headaches, dizziness, suspected pregnancy.

Warfarin Sodium (Coumadin) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Apo-Verapamil (CAN), Calan, Calan SR, Covera-HS, Gen-Verapamil (CAN), Gen-Verapamil SR (CAN), Isoptin SR, Novo-Verapamil SR (CAN), Nu-Verap (CAN), Verelan, Verelan PM

Classification: Calcium channel-blocker, Antianginal, Antiarrhythmic, Antihypertensive

Pregnancy Category C

Dosage & Route

ADULTS

Oral

Immediate release

• Angina: 80 mg q 6–8 hr; may increase by 80 mg at weekly intervals until control is achieved. Maintenance 240–480 mg daily.
• Arrhythmias: 240–480 mg/day.
• In digitalized adults: 240–320 mg/day.
• Hypertension: 40 mg to 80 mg PO tid.

ER

• Capsules: 120–240 mg/day PO in the morning. Titrate dose to a maximum 480 mg/day.
• Tablets: 120–180 mg/day PO in the morning. Titrate to a maximum 240 mg q 12 hr.

SR

• 120–180 mg/day PO. Titrate up to a maximum 480 mg PO in the morning.

Parenteral

• IV use only. Initial dose, 2.5–10 mg over 2 min; may repeat dose of 10 mg 30 min after first dose if initial response is inadequate.

PEDIATRIC PATIENTS

IV

• < 1 yr: Initial dose, 0.1–0.2 mg/kg over 2 min.
• 1–15 yr: Initial dose, 0.1–0.3 mg/kg over 2 min. Do not exceed 5 mg. Repeat above dose 30 min after initial dose if response is not adequate. Repeat dose should not exceed 10 mg.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT

• Reduce dosage, and monitor patient response carefully. Give IV doses over 3 min to reduce risk of serious side effects. Administer IV doses very slowly, over 2 min.

Therapeutic actions

• Verapamil inhibits entry of calcium ions into arterial smooth muscle cells as well as the myocytes and conducting tissue. These actions lead to reversal and preventions of coronary artery spasm, reduction in afterload through peripheral vasodilatation and reduction in ventricular rate in patients with chronic atrial flutter or fibrillation and reduction in the occurrence of paroxysmal supraventricular tachycardia. Verapamil reduces BP, relieves angina and slows AV conduction.

Indications

• Angina pectoris due to coronary artery spasm (Prinzmetal’s variant angina)
• Effort-associated angina
• Chronic stable angina
• Unstable, crescendo, preinfarction angina
• Essential hypertension
• Parenteral: Treatment of supraventricular tachyarrhythmias
• Parenteral: Temporary control of rapid ventricular rate in atrial flutter or atrial fibrillation

Adverse effects

• Bradycardia, CHF, MI, AV block, worsening heart failure, transient asystole, hypotension, pulmonary and peripheral edema, nausea. Constipation, fatigue, hypotension, dizziness, headache, palpitation, flushing, nausea, rashes, alopecia, hyperprolactinaemia, increased LFT and arthralgia.

Contraindications

• Cardiogenic shock, severe bradycardia, severe left ventricular dysfunction, uncompensated heart failure, hypotension (systolic pressure

Nursing considerations

Assessment

• History: Allergy to verapamil; sick sinus syndrome; heart block; IHSS; cardiogenic shock, severe CHF; hypotension; impaired hepatic or renal function; pregnancy, lactation
• Physical: Skin color, edema; orientation, reflexes; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, normal output; LFTs, renal function tests, urinalysis

Interventions

• Ensure that patient swallows SR tablets whole; patient should not cut, crush, or chew them.
• Monitor BP very carefully with concurrent doses of antihypertensives.
• Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.
• Administer SR form in the morning with food to decrease GI upset.
• Protect IV solution from light.
• Monitor patients with renal or hepatic impairment carefully for possible drug accumulation and adverse reactions.

Teaching points

• Take sustained-release form in the morning with food; swallow it whole, do not cut, crush, or chew it. Do not drink grapefruit juice while using this drug.
• You may experience these side effects: Nausea, vomiting (eat frequent small meals); headache (adjust lighting, noise, and temperature; request medication); dizziness, sleepiness (avoid driving or operating dangerous equipment); emotional depression (reversible); constipation (request aid).
• Report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, nausea, constipation.

Verapamil HCl (Verelan) Drug Study Original source at: Nurseslabs

Generic Name :

Brand Name: Ultram

Classification: Analgesic, centrally acting

Pregnancy Category C

Dosage & Route

Available forms : Tablets—50 mg

ADULTS

• Patients who require rapid analgesic effect: 50–100 mg PO q 4–6 hr; do not exceed 400 mg/day.
• Patients with moderate to moderately severe chronic pain: Initiate at 25 mg/day in the morning and titrate in 25-mg increments q 3 days to reach 100 mg/day. Then, increase in 50 mg-increments q 3 days to reach 200 mg/day. After titration, 50–100 mg q 4–6 hr; do not exceed 400 mg/day.
• Patients with cirrhosis: 50 mg q 12 hr.
• Patients with creatinine clearance < 30 ml/min: 50–100 mg PO q 12 hr. Maximum 200 mg/day. PEDIATRIC PATIENTS Safety and efficacy not established.
• GERIATRIC PATIENTS OR PATIENTS WITH HEPATIC OR RENAL IMPAIRMENT > 75 yr: Do not exceed 300 mg/day.

Therapeutic actions

• Tramadol inhibits reuptake of norepinephrine, serotonin and enhances serotonin release. It alters perception and response to pain by binding to mu-opiate receptors in the CNS.

Indications

• Relief of moderate to moderately severe pain

Adverse effects

via Wikipedia

• Sweating, dizziness, nausea, vomiting, dry mouth, fatigue, asthenia, somnolence, confusion, constipation, flushing, headache, vertigo, tachycardia, palpitations, miosis, insomnia, orthostatic hypotension, seizures, CNS stimulation e.g. hallucinations.

Contraindications

• Suicidal patients, acute alcoholism; head injuries; raised intracranial pressure; severe renal impairment; lactation.

Nursing considerations

Assessment

• History: Hypersensitivity to tramadol; pregnancy; acute intoxication with alcohol, opioids, psychotropic drugs or other centrally acting analgesics; lactation; seizures; concomitant use of CNS depressants or MAOIs; renal or hepatic impairment; past or present history of opioid addiction
• Physical: Skin color, texture, lesions; orientation, reflexes, bilateral grip strength, affect; P, auscultation, BP; bowel sounds, normal output; LFTs, renal function tests

Interventions

• Control environment (temperature, lighting) if sweating or CNS effects occur.

Teaching points

• You may experience these side effects: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).
• Report severe nausea, dizziness, severe constipation.

Tramadol HCl (Ultram) Drug Study Original source at: Nurseslabs

Generic Name:

Brand Name:

• Parenteral, intrathecal: Alcomicin (CAN), Garamycin, Pediatric Gentamicin Sulfate
• Topical dermatologic cream, ointment: Garamycin
• Ophthalmic: Garamycin, Gentacidin, Gentak, Genoptic, Genoptic S.O.P.
• Gentamicin impregnated PMMA beads: Septopal
• Gentamicin Liposome injection: Maitec

Classification:

• Aminoglycoside

Pregnancy Category D 

Dosage & Route 

Available forms :Injection—10, 40 mg/mL; ophthalmic solution—3 mg/mL; ophthalmic ointment—3 mg/g; topical ointment—0.1%; topical cream—0.1%; ointment—1 mg; cream—1 mg

Parenteral
ADULTS

• 3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four equal doses in severe infections. For IV use, a loading dose of 1–2 mg/kg may be infused over 30–60 min, followed by a maintenance dose, usually for 7–10 days.
• PID: 2 mg/kg IV followed by 1.5 mg/kg tid plus clindamycin 600 mg IV qid. Continue for at least 4 days and at least 48 hr after patient improves, then continue clindamycin 450 mg orally qid for 10–14 days total therapy.
• Surgical prophylaxis regimens: Several complex, multidrug prophylaxis regimens are available for preoperative use; consult manufacturer’s instructions.

PEDIATRIC PATIENTS

• 2–2.5 mg/kg q 8 hr IM or IV.
• Infants and neonates: 2.5 mg/kg q 8 hr.
• Premature or full-term neonates: 2.5 mg/kg q 12 hr.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE

• Reduce dosage or extend time dosage intervals, and carefully monitor serum drug levels and renal function tests.

Ophthalmic solution 
ADULTS AND PEDIATRIC PATIENTS

• 1–2 drops into affected eye or eyes q 4 hr; use up to 2 drops hourly in severe infections.

Ophthalmic ointment 
ADULTS AND PEDIATRIC PATIENTS

• Apply small amount to affected eye bid–tid.

Dermatologic preparations 
ADULTS AND PEDIATRIC PATIENTS

• Apply tid to qid. Cover with sterile bandage if needed.

Therapeutic actions 

• Gentamicin is an aminoglycoside that binds to 30s and 50s ribosomal subunits of susceptible bacteria disrupting protein synthesis, thus rendering the bacterial cell membrane defective.

Indications 

Parenteral 

• Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus species
• Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin)
• Unlabeled use: With clindamycin as alternative regimen in PID

Intrathecal 

• Gram-negative infections
• Serious CNS infections, such as meningitis, ventriculitis, infections caused by susceptible Pseudomonas species

Ophthalmic preparations 

• Treatment of superficial ocular infections due to strains of microorganisms susceptible to gentamicin

Topical dermatologic preparation 

• Infection prophylaxis in minor skin abrasions and treatment of superficial infections of the skin due to susceptible organisms amenable to local treatment

Gentamicin-impregnated PMAA beads on surgical wire 

• Orphan drug use: Treatment of chronic osteomyelitis of posttraumatic, postoperative, or hematogenous origin

Gentamicin liposome injection 

• Orphan drug use: Treatment of disseminated Myobacterium avium-intracellulare infection

Adverse effects 

• Dizziness or vertigo; acute renal failure, interstitial nephritis, acute tubular necrosis; electrolyte imbalances; transient elevation of serum bilirubin and aminotransferases; purpura; nausea, vomiting; convulsions, mental depression, hallucinations. Atrophy or rat necrosis at inj sites.
• Potentially Fatal: Nephrotoxicity, ototoxicity and neuromuscular blockade (may unmask or aggravate myasthaenia gravis).

Contraindications 

• History of hypersensitivity to aminoglycoside; pregnancy; hepatic impairment, perforated ear drum.

Nursing considerations 

Assessment 

• History: Allergy to any aminoglycosides; renal or hepatic disease; preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; lactation, pregnancy
• Physical: Site of infection; skin color, lesions; orientation, reflexes, eighth cranial nerve function; P, BP; R, adventitious sounds; bowel sounds, liver evaluation; urinalysis, BUN, serum creatinine, serum electrolytes, LFTs, CBC

Interventions 

• Give by IM route if at all possible; give by deep IM injection.
• Culture infected area before therapy.
• Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use.
• Avoid long-term therapies because of increased risk of toxicities. Reduction in dose may be clinically indicated.
• Patients with edema or ascites may have lower peak concentrations due to expanded extracellular fluid volume.
• Cleanse area before application of dermatologic preparations.
• Ensure adequate hydration of patient before and during therapy.

Teaching points 

• Apply ophthalmic preparations by tilting head back; place medications into conjunctival sac and close eye; apply light pressure on lacrimal sac for 1 minute. Cleanse area before applying dermatologic preparations; area may be covered if necessary.
• You may experience these side effects: Ringing in the ears, headache, dizziness (reversible; use safety measures if severe); nausea, vomiting, loss of appetite (eat frequent small meals, perform frequent mouth care); burning, blurring of vision with ophthalmic preparations (avoid driving or performing dangerous activities if visual effects occur); photosensitization with dermatologic preparations (wear sunscreen and protective clothing).
• Report pain at injection site, severe headache, dizziness, loss of hearing, changes in urine pattern, difficulty breathing, rash or skin lesions; itching or irritation (ophthalmic preparations); worsening of the condition, rash, irritation (dermatologic preparation).

Gentamycin Sulfate (Garamycin) Drug Study Original source at: Nurseslabs

aspirin

Buffered aspirin products:
Alka-Seltzer, Ascriptin, Asprimox, Bufferin, Buffex, Magnaprin

Pregnancy Category D

Drug classes of aspirin

• Antipyretic
• Analgesic (nonopioid)
• Anti-inflammatory
• Antirheumatic
• Antiplatelet
• Salicylate
• NSAID

Therapeutic actions of aspirin

• Analgesic and antirheumatic effects are attributable to aspirin’s ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation.

Indications of aspirin

• Mild to moderate pain
• Fever
• Inflammatory conditions—rheumatic fever, rheumatoid arthritis, osteoarthritis
• Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli
• Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris
• MI prophylaxis
• Unlabeled use: Prophylaxis against cataract formation with long-term use

Dosage & Route of aspirin

• Available in oral and suppository forms. Also available as chewable tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin is not recommended for antipyresis, short-term analgesia, or children < 12 yr.)

ADULTS

• Minor aches and pains: 325–650 mg q 4 hr.
• Arthritis and rheumatic conditions: 3.2–6 g/day in divided doses.
• Acute rheumatic fever: 5–8 g/day; modify to maintain serum salicylate level of 15–30 mg/dL.
• TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg qid).
• MI prophylaxis: 75–325 mg/day.

PEDIATRIC PATIENTS

• Analgesic and antipyretic: 65 mg/kg per 24 hr in four to six divided doses, not to exceed 3.6 g/day. Dosage recommendations by age:

• Juvenile rheumatoid arthritis: 60–110 mg/kg per 24 hr in divided doses at 6- to 8-hr intervals. Maintain a serum level of 150–300 mcg/mL.
• Acute rheumatic fever: Initially, 100 mg/kg/day, then decrease to 75 mg/kg/day for 4–6 wk. Therapeutic serum salicylate level is 150–300 mg/dL.
• Kawasaki disease: 80–180 mg/kg/day; very high doses may be needed during acute febrile period; after fever resolves, dosage may be adjusted to 10 mg/kg/day.

Adverse effects of aspirin

• Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea, hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures, tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory failure (dose related, 20–25 g in adults, 4 g in children)
• Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with nasal polyps, asthma, rhinitis)
• GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia, hepatotoxicity
• Hematologic: Occult blood loss, hemostatic defects
• Hypersensitivity: Anaphylactoid reactions to anaphylactic shock
• Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, lassitude (dose related)

Contraindications of aspirin

• Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding)
• Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye’s syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy (maternal anemia, antepartal and postpartal hemorrhage, prolonged gestation, and prolonged labor have been reported; readily crosses the placenta; possibly teratogenic; maternal ingestion of aspirin during late pregnancy has been associated with the following adverse fetal effects: low birth weight, increased intracranial hemorrhage, stillbirths, neonatal death); lactation.

Nursing considerations of aspirin

Assessment of aspirin

• History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function; chickenpox, influenza; children with fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation
• Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, LFTs, renal function tests

Interventions of aspirin

• BLACK BOX WARNING: Do not use in children and teenagers to treat chickenpox or flu symptoms without review for Reye’s syndrome, a rare but fatal disorder.
• Give drug with food or after meals if GI upset occurs.
• Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.
• Do not crush, and ensure that patient does not chew SR preparations.
• Do not use aspirin that has a strong vinegar-like odor.
• WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, activated charcoal, supportive therapy.

Teaching points of aspirin

• Take extra precautions to keep this drug out of the reach of children; this drug can be very dangerous for children.
• Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur.
• Take the drug with food or after meals if GI upset occurs.
• Do not cut, crush, or chew sustained-release products.
• Over-the-counter aspirins are equivalent. Price does not reflect effectiveness.
• You may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirin’s effects on blood clotting).
• Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools.

Aspirin (Bayer) Drug Study Original source at: Nurseslabs