Generic Name: phytonadione Brand Name: Vitamin K Classification: Antidote, Vitamins Date Ordered: july, 30 Ordered Dose: 1 amp

IVTT now @ 9pm Suggested Dose: 120 micrograms per day Mechanism of Action: Promotes liver synthesis of clotting factors (II, VII, IX, X); however, the exact mechanism as to this stimulation is unknown. Menadiol is a water soluble form of vitamin K; phytonadione has a more rapid and prolonged effect than menadione; menadiol sodium diphosphate (K4) is half as potent as menadione (K3). Indication: coagulation disorders Contraindication: hypersensitivity, hereditary hypoprothrombinemia, overanticoagulants due to heparin, caution to neonates and elderly patients. Drug Interactions: Mineral oil. May decrease serum concentration of Phytonadione. Orlistat. May decrease serum concentration of Vitamin K

Side Effects: CV: cyanosis, flushing, hypotension CNS: dizziness META: hyperbilirubinemia GI: abnormal taste RESPI: dyspnea MISC: anaphylactic reactions, diaphoresis, hypersensitivity

Nursing Responsibilities: Assessment: 1. Monitor for frank and occult bleeding. 2. Monitor pulse and blood frequently.

3. Monitor prothrombin time prior to and throughout the therapy. 4. Inform physician for bleeding tendency to prevent further trauma. Patient/Family Teaching: 1. Instruct patient to take medication as directed. 2. Advise patient to report any unusual bleeding or bruises. 3. Advise patient to inform health care professional of treatment regimen prior to treatment or surgery.

Generic Name: acetylcysteine Brand Name: fluimucil Drug class: Mucolytic, antidote Date Ordered: august 24,2012 Ordered Dosage: 600mg 1tab PO BID Mode of Action: Mucolytic activity: splits link in the mucoproteins contained in respiratory mucus secretions, decreasing the viscosity of the mucus. Antidote to acetaminophen hepatoxicity: Protects liver cells by maintaining cell function and detoxifying acetaminophen metabolites. Indications: 1. Mucolytic adjuvant therapy for abnormal, viscid, or inpissated mucus secretions in acute and chronic broncopulmonary disease, in pulmonary complications of cystic fibrosis, and in tracheostomy care; pulmonary complications associated with surgery; anesthesia, posttraumatic chest conditions; diagnostic bronchial studies. 2. To prevent or lessen hepatic injury that may occur after ingestion of a potentially hepatotoxic dose of acetaminophen; treatment must start as soon as possible; most effective if administered within 8 hr of ingestion, but can be given within 24 hr or longer after ingestion. Contraindications: Contraindicated with hypersensitivity to acetylcysteine; use caution and discontinue immediately if bronchospasm occurs. Side Effects: Increased productive cough, nausea, GI upset Adverse effects: GI: nausea, stomatitis Hypersensitivity: urticaria Respiratory: bronchospasm, especially in patients with asthma Other: rhinorrhea

Nursing Responsibilities: 1. dilute the 20% acetylcysteine solution with either normal saline or sterile water for injection; use the 10% solution undiluted. Refrigerate unused, undiluted solution, and use within 96 hour drug solution in the opened bottle, may change color, but this does not alter safety or efficacy.

2. use water to remove residual drug solution on the patients face after administration by face mask. 3. inform patient that nebulization may produce an initial disagreeable odor, but the odor will soon disappear 4. monitor nebulizer for buildup of drug from evaporation; dilute with sterile water for injection to prevent concentrate from impending nebulization and drug delivery.

Generic Name: senna, sennosides Brand Name: Black Draught, Dr. Caldwell Dosalax, Fletchers Castoria, Senokot, Senolax Classification: Laxative-stimulant Date Ordered: july 30,2012 Ordered Dose: 2 tabs OD @ HS Suggested Dose: 1-8 tabs/day or to 4 tsp of granules (1tsp-4mL) added to water or juice Mechanism of Action: stimulates peristalsis by action on Auerbachs plexus; softens feces by increasing water, electrolytes in large intestine Indication: acute constipations, bowel preparation for surgery or examination Contraindication: hypersensitivity, GI bleeding, obstruction, CHF, lactation, abdominal pain, nausea/vomiting, appendicitis, acute surgical abdomen Drug Interactions: Do not use with disulfiram (Ant-abuse)

Side Effects: GI: nausea, vomiting, cramps, diarrhea, flatulence GU: pink, red, brown, or black urine META: enteropathy

Adverse Effects: GI: anorexia META: hypocalcemia, alkalosis, hypokalemia, tetany

Nursing Responsibilities: Assess: 1. Stool: color, consistency, amount 2. Blood, urine electrolytes if drug is used often 3. I&O ratio to identify fluid loss 4. Cause of constipation; fluids, bulk, exercise missing, constipating drugs 5. Cramping, rectal bleeding, nausea, vomiting; drug should be discontinued Administer: 1. In morning or evening (oral dose) with full glass of water 2. Dissolve granules in water or juice before administration 3. On empty stomach for more rapid results 4. Shake oral sol before giving

Evaluate: 1. Therapeutic response: decrease in constipation Teach Patient/Family: 1. That urine, feces may turn yellow-brown to red 2. Not to use laxatives for long-term therapy; bowel tone will be lost 3. That normal bowel movements do not always occur daily 4. Not to use in presence of abdominal pain, nausea, vomiting 5. To notify prescriber if constipation unrelieved or of symptoms of electrolyte imbalance: muscle cramps, pain, weakness, dizziness, excessive thirst

Generic name: albumin Brand name: Albuminar; Albutein; Plasbumin. Classification: Volume expanders Date ordered: august 21, 2012 Ordered Dose: Albumin 20% 50 cc IVTT q12 for 4hrs Suggested dose: Dosage is highly individualized and depends on condition being treated. For shock 5%; IV (adults) 500 ml, may be repeated within 30 min; IV (children) 50 ml; IV (infants and neonates) 10-20 ml/kg as a 5% solution. Ordered dose: Albumin 20% to run at 4 hours OD, 6PM Indications: Expansion of plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns. Temporary replacement of albumin in diseases associated with low levels of plasma proteins, such as nephritic syndrome or end-stage renal disease, resulting in relief or reduction of associated edema. Contraindications: Allergic reaction to albumin, severe anemia, CHF, normal or increased intravascular volume. Mode of action: Provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular tissues back into the intravascular space. Require concurrent administration of appropriate crystalloid. Side/adverse effects: headache, pulmonary edema, fluid overload, hypertension, hypotension, tachycardia, increased salivation, nausea, vomiting, rash, urticaria, back pain, chills, fever, flushing. Drug/food interaction: non-significant Nursing responsibilities: Monitor vital signs frequently throughout the therapy. Monitor intake and output throughout the therapy. Assess for signs of vascular overload (elevated CVP, rales/crackles, dyspnea, hypertension, jugular vein distension) during and after the therapy. Monitor serum sodium levels may cause increased concentration during therapy. Monitor hemoglobin and hematocrit levels these values may decrease because of hemodilution (watch out for bleeding/hemorrhage) Follow physicians order of administration promptly. Make sure to use large gauge of needles when going to administer (at least gauge 20)

Watch out for side/adverse effects of the drugs. Withhold infusion if fever, tachycardia, or hypotension occurs notify physician immediately

Generic Name: Furosemide Brand Name: Lasix Drug Class: Loop diuretic Date Ordered: august 23,2012 Ordered Dosage: 40 mg IVTT post albumin drip Mode of action: Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich dieresis. Indications: 1. Edema associated with CHF, cirrhosis, renal disease 2. Acute pulmonary edema 3. Hypertension Contraindications: Contraindicated with allergy to furosemide, sulfonamides, allergy to tartrazine; anuria, severe renal failure, hepatic coma; pregnancy, lactation Side Effects: Increased volume and frequency of urination, dizziness, feeling faint on arising, drowsiness, sensitivity to sunlight, increased thirst Adverse Effects: CNS: dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss CV: orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis Dermatologic: photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme GI: nausea, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice GU: polyuria, nocturia, glycosuria, urinary bladder spasm Hematologic: leucopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances, hyperglycemia, hyperuricemia Other: Muscle cramps and spasms Drug-Drug Interactions: >increased risk of cardiac arrhythmias with digitalis glycosides > increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin

> decreased absorption of furosemide with phenytoin > Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs > decreased GI absorption with charcoal > May reduce effect of insulin or oral antidiabetes because blood glucose levels can become elevated Nursing Responsibilities: 1. Administer with food or milk to prevent GI upset 2. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP respond 3. Give early in the day so that increased urination will not disturb sleep 4. Measure and record weight to monitor fluid changes 5. Refrigerate oral solution

Generic Name: Cefuroxime Brand Name: Ceftin Classification: Cephalosporins Ordered Dose: 500mg 1 tab q12 PO Suggested Dose: Uncomplicated urinary tract infections. Adult: 125 mg bid. Respiratory tract infections. Adult: 250-500 mg bid.

Child: >3 mth: 125 mg bid or 10 mg/kg bid. Max dose: 250 mg daily. Uncomplicated gonorrhoea. Adult: 1 g as a single dose. 1 g oral probenecid may be given concurrently. Otitis media. Child: >2 yr: 250 mg bid or 15 mg/kg bid up to 500 mg daily. Intravenous Meningitis. Adult: 3 g every 8 hr.

Child: 200-240 mg/kg/day in 3-4 divided doses. Renal impairment: 750-mg bid.

Mode of Action: Act by inhibiting bacterial cell wall synthesis, causing rapid cell destruction. Their sites of action are enzymes known as penicillin-binding proteins. Therapeutic Effects: Hinders or kills susceptible bacteria, including many gram-positive organism and enteric gram-negative bacilli. Indications: Uncomplicated urinary tract infections Respiratory tract infections Uncomplicated gonorrhoea Otitis media Meningitis Renal impairment

Contraindications: Hypersensitive to cephalosporins. Drug Interactions: Drug-Drug. Diuretics. May increase risk of adverse renal reactions. Probenecid. May inhibit excretion and increase level of cefuroxime. Drug-Food. Any food: May increase absorption and bioavailability of suspension.

Side Effects: Nausea, vomiting, diarrhoea, GI disturbance Adverse Effects: Cerebral irritation and convulsions, Stevens-Johnson syndrome, epidermal necrolysis, anaphylaxis, nephrotoxicity, pseudomembranous colitis. Nursing Interventions: 1. Asses patients condition before therapy and regularly thereafter. 2. Obtain culture and sensitivity specimen before giving first dose; check test results periodically to assess drugs effectiveness. 3. Monitor BUN and creatinine levels and urine output for significant changes for patients with decreased renal function. 4. Monitor PT and platelet count, and assess patient for signs of hypoprothrombinemia commonly in elderly, debilitated, malnourished, or immunocompromised. 5. Should be taken with food. 6. Use cautiously among patients with severe renal impairment, pregnancy, lactation, hypersensitivity to penicillins. 7. Observe patient for adverse reactions. 8. Notify physician for any serious or persistent adverse reactions. 9. Instruct patient to take it exactly as prescribed because excessive use can lead to dependence. 10. Assess patients and familys knowledge of the drug therapy.

Generic Name: ipratropium bromide + albuterol Brand Name: Combivent Classification: Antiasthmatics, COPD preparations Ordered Dose: q 4 hours Suggested Dose: Two inhalations q.i.d. Mode of Action: Selectively activates beta2-adrenergic receptors, which results in

bronchodilation, and blocks release of allergic mediators from mast cells in respiratory tract. Therapeutic Effects: Improves breathing ability. Reduces inflammation in the lungs.

Indications: Bronchospasm with COPD in patients who require more than a single bronchodilator. Contraindications: Hypertrophic obstructive cardiomyopathy or tachyarrhythmia. History of hypersensitivity to soya lecithin or related food products

Drug Interactions: Drug-Drug. Altizide, althiazide, aminophylline, amphotericin: May add toxicity. Avoid using together. Side Effects: Palpitations, headache, dizziness, nervousness, dry mouth, throat irritation. Adverse Effects: Fine tremor of skeletal muscle, palpitations, urinary retention. Nursing Interventions: 1. Asses patients respiratory condition before therapy and regularly thereafter.

2. Use cautiously among patients who have insufficiently controlled diabetes mellitus, recent MI, severe organic heart or vascular disorders, hyperthyroidism,

phaeochromocytoma, risk of narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction; cystic fibrosis. 3. Observe patient for adverse reactions. 4. Notify physician for any serious or persistent adverse reactions. 5. Evaluate drug effectiveness at regular intervals. 6. Assess patients and familys knowledge of the drug therapy.

Generic Name: fenoterol + ipratropium Brand Name: Berodual Classification: Antiasthmatic, COPD Preparations Ordered Dose: 1neb q8 Suggested Dose: Adult & childn >6 yr : 2 puff for prompt relief. Mode of Action: Selectively activates beta2-adrenergic receptors, which results in

bronchodilation, and blocks release of allergic mediators from mast cells in respiratory tract. Therapeutic Effects: Improves breathing ability. Reduces inflammation in the lungs.

Indications: Prevention & treatment of symptoms in chronic obstructive airway disorders w/ reversible bronchospasm especially with or without chronic bronchitis or emphysema. Contraindications: Hypertrophic obstructive cardiomyopathy, Tachyarrhythmias. Hypersensitivity to atropine-like substances or soya lecithin or related food products.

Drug Interactions: Drug-Drug. Altizide, althiazide, aminophylline, amphotericin: May add toxicity. Avoid using together. Side Effects: Restlessness, palpitations, dizziness, headache, dry mouth, throat irritation or allergic reaction, cough.

Adverse Effects: Fine tremor of skeletal muscles, nervousness, paradoxical bronchoconstriction (rare), urinary retention may occur in patients w/ pre-existing outflow tract obstruction. Nursing Interventions: 1. Asses patients respiratory condition before therapy and regularly thereafter. 2. Use cautiously among patients who are diabetic patients w/ unstable metabolism, recent MI, severe organic heart or vascular disorders, narrow-angle glaucoma, hyperthyroidism, pheochromocytoma, prostatic hypertrophy or bladder-neck

obstruction, cystic fibrosis, pregnancy and lactation. 3. Observe patient for adverse reactions. 4. Notify physician for any serious or persistent adverse reactions. 5. Evaluate drug effectiveness at regular intervals. 6. Assess patients and familys knowledge of the drug therapy.

Brand name: Pantoloc, Protonix, Protonix I.V Generic name: Pantoprazole Classification: anti-ulcer: proton-pump inhibitor Ordered dose: 40 mg 1tab OD BID ac Suggested dose: PO/IV: 30mg daily for 8weeks, then 15 mg daily. 40mg once daily; gastric hypersecretory conditions 40mg twice daily up to 120mg twice daily. Mode of action: binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions to gastric lumen. Drug interaction: may decrease theophylline levels: sucral ate decreases pantoprazole bioavailability: may interfere with absorption of ampicillin, ketoconazole, digoxin. Food decreases peak levels. Indication: to treat peptic and duodenal ulcers, GERD, erosive esophagitis and H. pylori. Suppresses gastric acid secretion. Contraindication: hypersensitivity, pregnancy, lactation. Side effects: headache, dizziness, fatigue, diarrhea, constipation, rash. Adverse reaction: elevated AST, ALT. thirst, increase appetite, anorexia, nausea,

Nursing responsibilities: 1. Check the chart for the order. 2. Follow strictly the 10 rules in administering medications. 3. Determine clients renal function. Report urine output of <600ml ml/d or <25ml/h 4. Assess for fluid and electrolyte imbalances. 5. Measure gastic pH (>5 is desired). 6. Administer drug on an empty stomach. 7. Administer antacid 30minutes before or after sucralfate. Allow 1 to 2 hours to elapse between sucralfate and other prescribed drugs. 8. Instruct client in the use of relaxation techniques. 9. Monitor for severe, persistent constipation. 10. Teach client to avoid liquids and foods that can cause gastric irritation: alcohol, certain fats and spices.

Brand Name: Vastarel MR Generic Nam: Trimetazidine Drug Classification: Anti-Anginal Drugs Ordered dose:35 mg 1tab BID Suggested dose: Tablets : 10 mg, 20mg Tablets(extended-release) :30mg, 60mg,120mg

Indication: Long treatment of coronary insufficiency, angina pectoris. Adjunctive treatment to heart failure. Diffuse esophageal spasm with gastroesophageal reflux.

Mechanism of

Act ion

: acts

by dir ect ly counteract ing all ischem ic cell.

the m aj or of

m et abolic disor ders

occurr ing wit hin the

T he act ions

t r imetazidine include lim it at ion of intr acellular acidosis, correction of disturbances of transmembrane ion exchanges, and prevention

of e x c e s s i v e p r o d u c t i o n o f f r e e r a d i c a l s . d e c r e a s e m y o c a r d i a l o x y g e n requirement bydecreasing the heart rate, ventricular volume, blood p r e s s u r e a n d c o n t r a c t i l i t y . I n som e cases, m yocar dial oxyg en deliver y is increased thru r eversing cor onar y arterial spasm. May reduce cardiac oxygen demand by decreasing left ventricular end diastolic pressure (preload) and to a lesser extent systemic vascular resistance(afterload). May increase bloodflow through collateral coronary vessels. Relieves angina.

Side effects: CNS: dizziness, headache, weakness. CV: ankle edema, fainting, flushing, orthostatic, hypontension, palpitations, tachycardia. GI: nausea, vomiting Skin: cutaneous vasodilation Others: hypersensitivity, reactions, sublingual burning.

Drug Interaction: Antihypertensives: May increase hypotensive effects. Monitor patient closely during initial therapy. Sildefanil, tadalafil, vardenafil: may increase hypotensive effect. Avoid use together.

Contraindications : MAOIs (monoamine oxidase inhibitors)

Nursing responsibilities: 1. Assess patients condition before and regularly during therapy. 2. Monitor blood pressure, heart rate and rhythm and intensity and duration of drug response. 3. Be alert for adverse and drug interactions. 4. To know the drug effectiveness and reaction in the body. 5. To obtain baseline data of the patient. 6. To establish management for possible drug effects. 7. Promote proper guidance and information. 8. Administer crushed tablet on empty stomach either 30 minutes before or 1 to 2 hours after mealsof feeding

Generic name: Digoxin Brand Name Digitek, Lanoxicaps, Lanoxin Classification Cardiac glycoside, Cardiotonic Pregnancy Category C Ordered dose: 0.25 mg IVTT q12 x 2 days Suggested dose: Loading dose, 0.751.25 mg PO or 0.1250.25 mg IV. Maintenance dose, 0.1250.25 mg/day PO. Lanoxicaps capsules Loading dose, 0.40.6 mg PO. Maintenance dose, 0.1 0.3 mg/day PO. Mode of action: Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity. This medication works by blocking a specific enzyme in the body (known as sodium-potassium ATPase). This enzyme controls the amount of sodium and potassium that enters the cells. Blocking this enzyme increases the amount of calcium and potassium inside heart cells. This helps the heart contract more forcefully with each heartbeat, making it more efficient at pumping blood throughout the body. It also slows down the rate at which the heart beat Indications : CHF, Atrial fibrillation Contraindications: Side effects: Get emergency medical help if you have any of these signs of an allergic reaction to Lanoxin: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

fast, slow, or uneven heart rate; bloody or black, tarry stools;

blurred vision, yellowed vision; or confusion, hallucinations, unusual thoughts or behavior.

Less serious Lanoxin side effects may include:

nausea, vomiting, diarrhea, loss of appetite; feeling weak or dizzy; headache, anxiety, depression; enlarged breasts in men; or mild skin rash.

Drug interactions: Many drugs can interact with Lanoxin. Below is just a partial list. Tell your doctor if you are using:

an antacid, or Kaopectate; alprazolam (Xanax); cancer medications; clonidine (Catapres); supplements or medications that contain calcium; a diuretic (water pill), such as spironolactone (Aldactone, Aldactazide); amphotericin B (Fungizone, AmBisome, Abelcet); cholestyramine (Questran, Prevalite); epinephrine (EpiPen); indomethacin (Indocin);

isoproterenol (Isuprel); itraconazole (Sporanox); levothyroxine (Synthroid, Levothroid, and others); metoclopramide (Reglan); neomycin (Mycifradin, Neo-Fradin, Neo-Tab); rifampin (Rifadin, Rifater, Rifamate); sulfasalazine (Azulfidine); or an antibiotic such as erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin), clarithromycin (Biaxin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap);

heart or blood pressure medicine such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), carvedilol (Coreg), diltiazem (Cardizem, Cartia, Dilacor, Diltia, Diltzac, Taztia, Tiazac), metoprolol (Dutoprol, Lopressor, Toprol), nebivolol (Bystolic), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan, Tarka), and others;

decongestant cold or allergy medicine, or nasal sprays such as Afrin, Duramist, NeoSynephrine, Tysine Nasal, and others;

a heart rhythm medication such as amiodarone (Cordarone, Pacerone), propafenone (Rythmol), or quinidine (Quin-G); or

steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex), dexamethasone (Decadron, Hexadrol) and others.

Nursing responsibilities: WARNING: Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90 in infant; retake pulse in 1 hr. If adult pulse remains < 60 or infant < 90, hold drug and notify prescriber. Note any change from baseline rhythm or rate. Take care to differentiate Lanoxicaps from Lanoxin; dosage is very different Check dosage and preparation carefully. Avoid IM injections, which may be very painful. Follow diluting instructions carefully, and use

diluted solution promptly. Avoid giving with meals; this will delay absorption. Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor readily available in case toxicity develops. WARNING: Monitor for therapeutic drug levels: 0.52 ng/mL. Nursing responsibilities:

Be familiar with patients baseline data (e.g., quality of peripheral pulses, blood pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a foundation for making assessments.

Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Notify physician of abnormal values. Draw blood samples for determining plasma digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dose. Therapeutic range of serum digoxin is 0.82 ng/mL; toxic levels are >2 ng/mL.

Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If changes are noted, withhold digoxin, take rhythm strip if patient is on ECG monitor, notify physician promptly.

Withhold medication and notify physician if apical pulse falls below ordered parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children). Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.

Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate chest for rales. Monitor serum digoxin levels closely during concurrent antibioticdigoxin therapy, which can precipitate toxicity because of altered intestinal flora. Observe patients closely when being transferred from one preparation (tablet, elixir, or parenteral) to another; when tablet is replaced by elixir potential for toxicity increases since 30% of drug is absorbed.

Patient & Family Education

Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation. Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances. Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d. Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day.

Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician. Continue with brand originally prescribed unless otherwise directed by physician. Do not breast feed while taking this drug without consulting physician.

Generic Name: Potassium Chloride Brand Name: Kalium [durule] Classification: Electrolytes Ordred dose: 1tab TID x3 Mode of action: Supplemental potassium in the form of high potassium food or potassium chloride may be able to restore normal potassium levels. Provides a direct replacement of potassium in the body.

Indication: Hypokalemia. Prophylaxis during treatment w/ diuretics. Contraindication: Renal insufficiency, hyperkalemia, untreated Addison'sdisease, constriction of the esophagus &/or obstructive changes in thealimentary tract. Side/ Adverse Effect: Diarrhea, nausea, stomach pain, discomfort or gas vomiting Drug interactions: Hyperkalemia with potassium phosphate IV and products containing calcium or magnesium; potassium-sparing diuretics, or other potassium products, ACEinhibitor Nursing Responsibilities: Watch out for levels of potassium electrolyte level to prevent hyperkalemia. Observe 10 rights of giving medication. Assess: 1.ECG for peaking T waves, lowered R, depressed RST, prolonged P-Rinterval, widening QRS complex, hyperkalemia; drug should be reducedor discontinued 2.Potassium level during treatment (3.5 5 mg/dl is normal level) 3.I&O ratio: watch for decreased urinary output; notify prescriber immediately

4.Cardiac status: rate, rhythm, CVP, PWP, PAWP, if being monitored directly

Administer: 1.If PO: with meal or pc; DO NOT GIVE IM, OR SQ 2.IV route: through large-bore needle to decrease vein inflammation; checkfor extravasation 3.IV route: after diluting in large volume of IV solution and give as aninfusion, slowly by IV infusion to prevent toxicity, never give as an IVbolus or IMPerform/Provide: 1.Storage at room temperatureEvaluate: 1.Therapeutic response: absence of fatigue, muscle weakness, decreasedthirst and urinary output, cardiac changes

. To avoid OTC products: antacids, salt substitutes, analgesics, vitaminpreparations, unless specifically directed by prescriber 2.To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea,vomiting, fainting, decreased output) or continued hypokalemia symptoms(fatigue, weakness, polyuria, polydipsia, cardiac changes) 3.To dissolve powder or tablet completely in at least 120 mL water or juice

Generic Name: propranolol hydrochloride Brand Name: inderal

Ordered dose: 10 mg 1tab q8 Mode of action: The mechanism of the antihypertensive effect of propranolol has not been established. Factors that may contribute to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain. Although total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol. Effects of propranolol on plasma volume appear to be minor and somewhat variable.

In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction. Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and systolic ejection period. The net physiologic effect of beta-adrenergic blockade is usually advantageous and is manifested during exercise by delayed onset of pain and increased work capacity.

Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action. In dosages greater than required for beta-blockade, propranolol also exerts a quinidine-like or anestheticlike membrane action, which affects the cardiac action potential. The significance of the membrane action in the treatment of arrhythmias is uncertain.

The mechanism of the antimigraine effect of propranolol has not been established. Betaadrenergic receptors have been demonstrated in the pial vessels of the brain.

The specific mechanism of propranolol's antitremor effects has not been established, but beta-2 (noncardiac) receptors may be involved. A central effect is also possible. Clinical studies have demonstrated that propranolol hydrochloride is of benefit in exaggerated physiological and essential (familial) tremor. The mechanism of the antihypertensive effect of propranolol has not been established. Factors that may contribute to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain. Although total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol. Effects of propranolol on plasma volume appear to be minor and somewhat variable. Indications: Inderide is indicated in the management of hypertension.

This fixed combination is not indicated for initial therapy of hypertension. Hypertension requires therapy titrated to the individual patient. If the fixed combination represents the dosage so determined, its use may be more convenient in patient management. Contraindication: Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than first degree block; 3) bronchial asthma; and 4) in patients with known hypersensitivity to propranolol hydrochloride. Side effects: Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

fast, slow, or uneven heartbeats feeling light-headed, fainting feeling short of breath, even with mild exertion swelling of your ankles or feet nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes) cold feeling in your hands and feet depression, confusion, hallucinations; or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling

Less serious side effects may include:

nausea, vomiting, diarrhea, constipation, stomach cramps decreased sex drive, impotence, or difficulty having an orgasm sleep problems (insomnia); or tired feeling

Drug interactions: CYP1A2, 2C18, 2C19, and 2D6 enzyme substrate

Alpha-blockers (prazosin, terazosin): Concurrent use of beta-blockers may increase risk of orthostasis.

Cimetidine increases the plasma concentration of propranolol and its pharmacodynamic effects may be increased.

Clonidine: Hypertensive crisis after or during withdrawal of either agent.

Drugs which slow AV conduction (digoxin): Effects may be additive with beta-blockers.

Epinephrine (including local anesthetics with epinephrine): Propranolol may cause hypertension.

Flecainide: Pharmacological activity of both agents may be increased when used concurrently.

Fluoxetine may inhibit the metabolism of propranolol, resulting in cardiac toxicity.

Glucagon: Propranolol may blunt hyperglycemic action.

Haloperidol: Hypotensive effects may be potentiated.

Hydralazine: The bioavailability propranolol (rapid release) and hydralazine may be enhanced with concurrent dosing.

Insulin: Propranolol inhibits recovery and may cause hypertension and bradycardia following insulin-induced hypoglycemia. Also masks the tachycardia that usually accompanies insulininduced hypoglycemia.

NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam) may reduce the antihypertensive effects of beta-blockers.

Salicylates may reduce the antihypertensive effects of beta-blockers.

Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents.

Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken concurrently with beta-blockers; avoid concurrent I.V. use of both. Nursing responsibilities: 1. Patient's therapeutic response may be evaluated by looking at blood pressure, apical and radial pulses, fluid I & O, daily weight, respirations, and circulation in extremities before and during therapy 2. Take exactly as directed; do not increase, decrease, or discontinue without consulting prescriber. Take at the same time each day. Tablets may be crushed and taken with liquids. 3. Do not alter dietary intake of protein or carbohydrates without consulting prescriber. 4. Watch out for nausea, vomiting, or stomach discomfort (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); 5. If diabetic, monitor serum glucose closely. 6. Report unusual swelling of extremities, difficulty breathing, unresolved cough, or unusual weight gain, cold extremities, persistent diarrhea, confusion, hallucinations, headache, nervousness, lack of improvement, or worsening of condition.

Generic: Spironolactone Brand: Aldizide, Aldactone Classification: potassium-sparring diuretic Ordered dose: 25mg OD Mode of Action Competes with aldosterone at receptor sites at distal tubules, resulting in excretion of Sodium Chloride, water, retention of Potassium and phosphate. Indications: Edema of congestive heart failure, hypertension, diuretic induced hypokalemia, primary hyperaldosteronism, edema of nephrotic syndrome, liver cirrhosis with ascites Why is it indicated to the client? Client has ascites as a result of congestive heart failure. Also, the ultrasound of the whole abdomen revealed that client has cirrhosis. Contraindications: Pregnancy, hypersensitivity, anuria, severe renal disease, hyperkalemia Drug/food interaction: Decreased effect of anticoagulant, Increase action of antihypertensives, digitalis Increase hyperkalemia; Potassium-sparing diuretics, potassium products, ACE inhibitors Decrease effect of spironolactone; ASA Increase effect; cucumber, licorice, pumpkin

Adverse Effects: headache, drowsiness, lethargy, confusion, ataxia

GastrointestinaI: diarrhea, gastric bleeding, ulceration, cramping, gastritis, vomiting, diarrhea Genito-Urinary: impotence, menstrual disturbance electrolytes: hyperkalemia, hyponatremia, mild acidosis, dehydration integumentary: urticaria, hirsutism, maculopapular eruptions, erythematus rash OTHER: drug fever, gynecomastia, breast soreness, anaphylaxis, angioedema

Nursing Responsibilities: 1. Monitor electrolyte, Sodium, Calcium, Potassium, BUN, serum creatinine, ABGs and CBC 2. Weigh patient daily, monitor intake and output to determine fluid loss 3. Assess for signs of metabolic acidosis such as drowsiness and restlessness 4. Watch out for rashes and increase in temperature (drug fever) 5. instruct clients to avoid food with high potassium content such as bananas, oranges, dried apricots 6. instruct patient to notify presciber should he feel cramps, diarrhea, lethargy, headache, skin rashes, deepening voice, and breast enlargement

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Generic name: Tranexamic acid Classification: Anti-fibrinolytic, antihemorrhagic Ordered dose: 500 g IVTT q8 Mechanism of Action: Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Indications: CYKLOKAPRON (tranexamic acid) Injection is indicated in patients with hemophilia for shortterm use (two to eight days) to reduce or prevent hemorrhage and reduce the need for replacement therapy during and following tooth extraction Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage

Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

Contraindications 1. Allergic reaction to the drug or hypersensitivity 2. Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots 3. Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates CYKLOKAPRON (tranexamic acid) Injection is contraindicated: 1. In patients with acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity (see WARNINGS). 2. In patients with subarachnoid hemorrhage. Anecdotal experience indicates thatcerebral edema and cerebral infarction may be caused by CYKLOKAPRON (tranexamic acid) in such patients. 3. In patients with active intravascular clotting.

Side effects:

Applies to: compounding powder; intravenous solution; oral tablet

Gastrointestinal

Gastrointestinal side effects have frequently included nausea, vomiting, and diarrhea. Abdominal pain has also been reported.

Nervous system

Nervous system side effects have included giddiness, dizziness, headache, tension headache, and migraine.

Hematologic

Hematologic side effects have included thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism, cerebral thrombosis, acute renal cortical necrosis, and central retinal artery and vein obstruction) and anemia.

Hypersensitivity

Hypersensitivity side effects have included allergic skin reactions, anaphylactic shock and anaphylactoid reactions.

A case of severe allergic reaction to tranexamic acid was reported involving a subject on her fourth cycle of treatment who experienced dyspnea, tightening of her throat, and facial flushing that required emergency medical treatment.

Ocular

Ocular side effects have rarely included disturbances of color vision and retinal artery occlusion.

Musculoskeletal

Musculoskeletal side effects have included back pain, musculoskeletal pain, muscle cramps and spasms, myalgia, and arthralgia including joint stiffness and swelling.

Respiratory

Respiratory side effects have included nasal and sinus symptoms including nasal, respiratory tract and sinus congestion, sinusitis, acute sinusitis, sinus headache, and allergic sinusitis and sinus pain.

Cardiovascular

Cardiovascular side effects have included hypotension when intravenous administration exceeded 1 mL per minute.

Genitourinary

Genitourinary side effects have included ureteral obstruction due to clot formation in patients with upper urinary tract bleeding.

Drug interactions: Tranexamic acid causes additive toxicity with retinoic acid

Tranexamic acid causes additive toxicity with tretinoin

Tranexamic acid causes additive toxicity with tretinoin tocoferil

Increased risk of thrombus formation with estrogens, Factor IX complexconcentrates or antiinhibitor coagulant concentrates. Increased risk of fatalthrombotic complications withtretinoinin acute promyelocytic leukaemia

Nursing Responsibilities 1. Unusual change in bleeding pattern should be immediately reported to the physician. 2. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. 3. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. 4. The medication can be taken with or without meals. 5. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. 6. 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. 7. Inform the client that he/she should inform the physician immediately if the following severe side effects occur:

Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech Slurred speech Vision changes

GENERIC NAME: amiodarone

BRAND NAME: Cordarone Classification: anti-arrhythmic Ordered dose: 150mg IV in 10 mis now Suggested dose: The recommended dosing schedule is an initial loading dose of 800-1600 mg daily for 1 to 3 weeks, followed by 600-800 mg daily for 1 month, then 400 mg daily for maintenance. Response should be closely monitored and dosing is individualized for each patient. Amiodarone may be administered once daily or given twice daily with meals to minimize stomach upset which is seen more frequently with higher doses. Mode of action: Amiodarone is an oral and injectable drug that is used to correct abnormal rhythms of the heart. (It is an antiarrhythmic medication.) Although amiodarone has many side effects, some of which are severe and potentially fatal, it has been successful in treating many arrhythmias when other antiarrhythmic drugs have failed. Amiodarone is considered a "broad spectrum" antiarrhythmic medication, that is, it has multiple and complex effects on the electrical activity of the heart which is responsible for the heart's rhythm. Among its most important electrical effects are:

a delay in the rate at which the heart's electrical system "recharges" after the heart contracts (repolarization); a prolongation in the electrical phase during which the heart's muscle cells are electrically stimulated (action potential); a slowing of the speed of electrical conduction (how fast each individual impulse is conducted through the heart's electrical system);

a reduction in the rapidity of firing of the normal generator of electrical impulses in the heart (the heart's pacemaker); a slowing of conduction through various specialized electrical pathways (called accessory pathways) which can be responsible for arrhythmias.

In addition to being an antiarrhythmic medication, amiodarone also causes blood vessels to dilate (enlarge). This effect can result in a drop in blood pressure. Because of this effect, it also may be of benefit in patients with congestive heart failure.

Indication: Cordarone is indicated only for the treatment of the following documented, life-threatening recurrent ventricular arrhythmias when these have not responded to documented adequate doses of other available antiarrhythmics or when alternative agents could not be tolerated. 1. Recurrent ventricular fibrillation. 2. Recurrent hemodynamically unstable ventricular tachycardia. As is the case for other antiarrhythmic agents, there is no evidence from controlled trials that the use of Cordarone Tablets favorably affects survival. Cordarone should be used only by physicians familiar with and with access to (directly or through referral) the use of all available modalities for treating recurrent life-threatening ventricular arrhythmias, and who have access to appropriate monitoring facilities, including inhospital and ambulatory continuous electrocardiographic monitoring and electrophysiologic techniques. Because of the life-threatening nature of the arrhythmias treated, potential interactions with prior therapy, and potential exacerbation of the arrhythmia, initiation of therapy with Cordarone should be carried out in the hospital.

Contraindication: Cordarone is contraindicated in patients with cardiogenic shock; severe sinus-node dysfunction, causing marked sinus bradycardia; second- or third-degree atrioventricular block; and when

episodes of bradycardia have caused syncope (except when used in conjunction with a pacemaker). Cordarone is contraindicated in patients with a known hypersensitivity to the drug or to any of its components, including iodine.

DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: fingolimod.Many drugs besides amiodarone may affect the heart rhythm (QT prolongation), including dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), quinolone antibiotics (such as levofloxacin), among others. (See also Precautions section.)Other medications can affect the removal of amiodarone from your body, which may affect how amiodarone works. Examples include azole antifungals (such as itraconazole), cimetidine, protease inhibitors (such as indinavir), rifamycins (such as rifampin), St. John's wort, among others.Amiodarone can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include beta blockers (such as propranolol), calcium channel blockers (such as diltiazem, verapamil), clopidogrel, cyclosporine, digoxin, phenytoin, certain "statin" drugs (atorvastatin, lovastatin, simvastatin), trazodone, warfarin, among others. Sid effects: Side effects that you should report to your doctor or health care professional as soon as possible:

allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue breathing problems chest pain dark urine fast, irregular heartbeat

feeling faint or light-headed intolerance to heat or cold nausea or vomiting pain and swelling of the scrotum pain, tingling, numbness in feet, hands spitting up blood stomach pain sweating unusual or uncontrolled movements of body unusually weak or tired weight gain or loss yellowing of the eyes or skin

nursing rsponsibilities: Injection 1. For IV infusion only; initial infusion rate should not exceed 30 mg/min. 2. Administer by volumetric infusion pump using polyvinyl chloride tubing and an in-line filter. 3. Prepare infusions that will exceed 2 h in glass or polyolefin bottles containing 5% dextrose in water. Do not use evacuated glass containers because incompatibility of amiodarone with a buffer in container may cause precipitation. 4. Injection solution (50 mg/mL): To prepare first rapid loading infusion, add 3 mL (150 mg) of IV amiodarone to 100 mL of 5% dextrose in water (concentration = 1.5 mg/mL). 5. Injection solution (50 mg/mL): To prepare 6 h slow loading infusion and 18 h initial maintenance infusion, add 18 mL (900 mg) of IV amiodarone to 500 mL of 5% dextrose in water (concentration = 1.8 mg/mL) 6. Injection solution (50 mg/mL): For maintenance infusions after first 24 h, use infusion solutions containing 1 to 6 mg/mL. 7. Administer concentrations greater than 2 mg/mL via central venous catheter.

8. Premix injection: Administer 1.5 mg/mL strength for first rapid loading infusion, followed by 1.8 mg/mL strength. 9. Solution should be clear and may have a pale yellow coloration. Do not administer if solution is discolored or cloudy, or contains particulate matter. 10. Amiodarone should not be combined with any product in the same IV line or premixed container. 11. The premix container is for single-use only, discard any unused portion. No further dilution is required. Do not combine with any product in the same IV line or premixed container. 12. IV loading infusions at much higher concentrations and rates of infusion much faster than recommended have resulted in hepatocellular necrosis and acute renal failure leading to death. 13. Amiodarone has been found to leach out plasticizers, including diethylhexyl phthalate from IV tubing (including polyvinyl chloride tubing). 14. Tablets 15. Administer consistently either with food or on an empty stomach. Administer with food if GI upset occurs. Administer doses greater than 1,000 mg in divided doses with food. 16. Administer maintenance doses as a single daily dose or, in patients with severe GI intolerance, divide into 2 daily doses. 17. The loading phase should be performed in a hospital setting. 18. Upon starting therapy, attempt to gradually discontinue prior antiarrhythmic drugs. MONITOR Monitor effectiveness in long-term prevention of ventricular tachycardia and ventricular fibrillation using ambulatory monitoring, programmed electrical stimulation, or a combination of these, as appropriate. Monitor for hypotension, especially during the first few hours of IV infusion. Close perioperative monitoring is recommended in patients undergoing general anesthesia. Closely monitor FiO 2 and the determinants of oxygen delivery to the tissues (eg, SaO 2 , PaO 2 ). Close clinical monitoring is recommended during the loading phase.

Generic Name:rebamipide Brand Name:Mucosta Classification:antiulcerant, cytoprotective Ordered dose: 100g 1tab TID Suggested Dose:1 tab tid, to be taken in the morning, evening & before bedtime Mode of Action:It works by enhancing mucosal defense, scavenging free radicals,and temporarily activating genes encodingcyclooxygenase-2 Indication:acute gastritis, acute exacerbation of chronic gastritis, PUD Contraindication:lactation Drug Interaction: 1.Rebamipide has shown no remarkable interaction with other drugs Side Effects: GI: nausea, vomiting, constipation, diarrhea INTEG: rash Adverse Effects: INTEG: pruritus Nursing Responsibilities: Assess: 1.Gastric pH (>5 should be maintained) 2.Blood in stools, Hematemesis 3.Side Effects: n/v, pruritus, constipation, diarrhea; drug may have to bediscontinued Administer

On an empty stomach, 1 hour before meals and at bedtime Do not crush or chew tablets; it can be broken or dissolved in water; donot take antacids 30 minutes before or after taking the drug3.With full glass of water to maintain adequate hydration

Evaluate: 1. Therapeutic response: absence of pain Teach patient/family: 1.To take on an empty stomach 2.To avoid antacids within hours of taking the drug

Generic name: piperacillin Tazobactam Brand name: Zosyn Classification: antibiotic Ordered dose: 4.5 g IVTT (-) ANST Mode of action: PIPERACILLIN; TAZOBACTAM (pi PER a sil in; ta zoe BAK tam) is a penicillin antibiotic. It is used to treat certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections. Piperacillin is a penicillin-type antibiotic that works by stopping the growth of bacteria. Tazobactam is an enzyme inhibitor (beta-lactamase inhibitor) that helps the piperacillin work better. Indication: used to treat many different infections caused by bacteria, such as urinary tract infections, bone and joint infections, severe vaginal infections, stomach infections, skin infections, and pneumonia. It is a combination of two antibiotics. Contraindication: allergic to either of the drugs; or to penicillin, cephalosporin, or beta-lactam antibiotics; or to other beta-lactamase inhibitors such as sulbactam; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding problems, cystic fibrosis, kidney disease, seizures. This medication contains sodium. Consult your doctor or pharmacist if you are on a saltrestricted diet or if you have a condition that could be worsened by an increase in salt intake (e.g., congestive heart failure, high blood pressure). Before having surgery, tell your doctor or dentist that you are using this medication. Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be at greater risk for side effects while using this drug, especially salt retention.

Side effects: swelling, redness, pain, or soreness at the injection site. Dizziness, trouble sleeping, nausea, vomiting, diarrhea, or headache may also occur. Drug interactions: Potentiated by probenecid. May potentiate non-depolarizing muscle relaxants (eg, vecuronium). Monitor methotrexate, heparin, anticoagulants. False (+) Clinitest or Coomb's test. Some products that may interact with this drug include: "blood thinners" (e.g., enoxaparin, heparin, warfarin), live bacterial vaccines, cancer chemotherapy, lithium, methotrexate, probenecid, tetracyclines, "water pills" (diuretics such as furosemide,

hydrochlorothiazide) Nursing responsibilities: 1. Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration. 2. Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor hematologic status with prolonged therapy (Hct and Hgb, CBC with differential and platelet count). 3. Monitor patient carefully during the first 30 min after initiation of the infusion for signs of hypersensitivity (see Appendix F). 4. Check for rash, itching, or other signs of hypersensitivity immediately. 5. Report loose stools or diarrhea as these may indicate pseudomembranous colitis. 6. Check the injection site for redness,pain, signs of infection.

Generic name: Carbimazole Brand name: Neomercazole Classification: Anti-thyroid agent Ordered dose: 20 mg 1tab q12 Suggested dose: The initial dose is in the range of 20-60 mg and should be titrated against thyorid function until the patient is euthyorid in order to reduce the risk of over-treatment and resultant hypothyoridism. Subsequent therapy may then be administered in one of two ways: Maintenance regimen: Final dosage is usually in the range of 5-15 mg per day, which may be taken as a single daily dose. Therpay should be continued for at least six, and up to 18 months. Serial thyroid function monitoring is recommended, together with appropriate dosage modification in order to maintain an euthyorid state. Blocking-replacement regimen: Dosage is maintained at the intial level, i.e. 20-60 mg per day, and supplemental l-thyorxine, 50-150 mcg per day, is administered concomitantly, in order to prevent hypothyoridism. Therapy should be continued for at least six months and up to eighteen months. Where a single dosage of less than 20 mg is recommended, it is intended that NeoMercazole 5 should be taken. Elderly No special dosage regimen is required, but care should be taken to observe the contraindications and warnings as it has been reported that the risk of a fatal outcome to neutrophil dycrasia may be greater in the elderly (aged 65 or over). Children The usual intial daily dose is 15 mg per day. Mode of action:

Neo-Mercazole works by decreasing the amount of thyroid hormones produced by the thyroid gland. Iodine is a chemical used by the thyroid gland in the formation of thyroid hormones. Iodine must be converted in the body to a useable form before it may be combined with other components to form thyroid hormones. Neo-Mercazole acts to prevent the conversion of iodine to its usable form. It also acts to block the combination of converted iodine with other components to form thyroid hormones. This therefore results in decreased production of thyroid hormones. As a result, Neo-Mercazole is useful in the treatment of conditions where excessive amounts of thyroid hormones are being produced (hyperthyroidism). Indication: Neo-Mercazole is a medicine used to decrease the amount of thyroid hormones produced by the thyroid gland. It is used to treat conditions resulting in an overactive thyroid gland (hyperthyroidism ) Indicated to conditions where reduction of thyroid function is required, such as: Hyperthyroidism Preparation for thyoridectomy in hyperthyoridism Therapy prior to and post radio-iodine treatment

Contraindication: contrainidicated in patients with a previous history of adverse reactions to carbimazole or to any of the excipients in the composition. Serious, pre-existing hematological conditions, severe hepatic insufficiency. Side effects: Adverse reactions usually occur in the first eight weeks of treatment. The most frequently occuring reactions are nausea, headacha, arthralgia, mild gastric distress, skin rashes and pruritus. These reactions are usually self-limiting and may not require withdrawal of the drug. Blood and Lymphatic System Disorders Bone marrow depression including neutropenia, eosinophilia, leukopenia, agranulocytosis has been reported. Fatalities with carbimaole-induced

agranulocytosis have been reported. Rare cases of pancytopenia/aplastic

anemia and isolated thrombocytopenia have also been reported. Additionally, very rare cases of hemolytic anemia have been reported. Patients should always be warned about the onset of sore throats, bruising or bleeding, mouth ulcers, fever, malaise and should be instructed to stop the drug and to seek medical advice immediately. In such patients, blood cell counts should be performed immediately, particularly where there is any clinical evidence of infection. Nervous System Disorders Headache. Gastrointestinal System Disorders Nausea, mild gastric distress. Loss of the sense of taste has been observed. General Disorders and Administration Site Conditions Fever, malaise.

Hepatobiliary System Disorders Hepatic disorders, including abnormal liver function tests, hepatitis, cholestatic hepatitis, cholestatic jaundice and most commonly jaundice, have been reproted; in these cases carbimazole should be withdrawn. Injury, Poisoning and Procedural Complicatons Bruising.

Skin and Subcutaneous Tissue Disorders Skin rashes, pruritus, urticaria. Hair loss has been occasionally reported.

Musculoskeletal System Disorders Isolated cases of myopathy have been reported. Patients experiencing mylagia after the intake of NeoMercazole should have their creatine phosphokinase levels monitored. Hypersensitivity and Allergic Raections Angioedema and multi-system hypersensitivity reactions such as cutaneous vasculitis, liver, lung and renal effects occur.

Vascular Disorders Bleeding.

Drug interactions: ittle is known about interactions. Particular care is required in case of concurrent administration of medication capable of inducing agranulocytosis. Since carbimazole is a vitamin K antagonist, the effect of anticoagulants could be intensified. The serum levels of theophylline can increase and toxicity may develop if hyperthyroidic patients are treated with anti-thyroid medications without reducing the theophylline dosage. Nursing responsibilities:

Generic name: Dabigatran etexilate

Brand name: Pradaxa Classification: blood thinners Ordered dose: 110 mg 1tab OD Suggested dose: Swallow whole. CrCl>30mL/min: 150mg twice daily. Severe renal impairment (CrCl 1530mL/min): 75mg twice daily; CrCl<15mL/min or on dialysis: not recommended. Moderate renal impairment (CrCl 3050mL/min) with concomitant dronedarone or systemic ketoconazole: consider reducing dose to 75mg twice daily. Severe renal impairment (CrCl 15 30mL/min) with concomitant P-gp inhibitors: avoid. Converting from warfarin, other anticoagulants: see literature. Take missed dose as soon as possible on same day; skip dose if it cannot be taken at least 6 hours before the next scheduled dose; do not double doses For patients with creatinine clearance (CrCl) >30 mL/min, the recommended dose of Pradaxa is 150 mg taken orally, twice daily, with or without food. For patients with severe renal impairment (CrCl 15-30 mL/min), the recommended dose of Pradaxa is 75 mg twice daily Mode of action: Pradaxa (dabigatran etexilate mesylate) is a competitive, direct thrombin inhibitor. Because thrombin (serine protease) enables the conversion of fibrinogen into fibrin during the coagulation cascade, its inhibition prevents the development of a thrombus. Both free and clotbound thrombin, and thrombin-induced platelet aggregation are inhibited by the active moieties Pradaxa (dabigatran etexilate mesylate) is a competitive, direct thrombin inhibitor. Because thrombin (serine protease) enables the conversion of fibrinogen into fibrin during the coagulation cascade, its inhibition prevents the development of a thrombus. Both free and clotbound thrombin, and thrombin-induced platelet aggregation are inhibited by the active moieties.Pradaxa is specifically indicated to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation.

Indication: indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Contraindication: Pradaxa is contraindicated in patients with: Active pathological bleeding History of a serious hypersensitivity reaction to Pradaxa (e.g., anaphylactic reaction or anaphylactic shock) Side effects: o bleeding

gastrointestinal events (dyspepsia, nausea, upper abdominal pain, gastrointestinal hemorrhage, and diarrhea)

Drug interactions: o The concomitant use of PRADAXA with P-gp inducers (e.g., rifampin) reduces exposure to dabigatran and should generally be avoided [see CLINICAL PHARMACOLOGY].

P-gp inhibition and impaired renal function are the major independent factors that result in increased exposure to dabigatran [see CLINICAL PHARMACOLOGY]. Concomitant use of P-gp inhibitors in patients with renal impairment is expected to produce increased exposure of dabigatran compared to that seen with either factor alone.

In patients with moderate renal impairment (CrCl 30-50 mL/min), consider reducing the dose of PRADAXA to 75 mg twice daily when administered concomitantly with the P-gp inhibitor dronedarone or systemic ketoconazole. The use of P-gp inhibitors (verapamil, amiodarone, quinidine, and clarithromycin)

does not require a dose adjustment of PRADAXA. These results should not be extrapolated to other P-gp inhibitors o The concomitant use of PRADAXA and P-gp inhibitors in patients with severe renal impairment (CrCl 15-30 mL/min) should be avoided Nursing responsibilities: 1. Monitor symptoms of bleeding: unexpected bleeding or bleeding that lasts a long time, such as: unusual bleeding from the gums nose bleeds that happen often menstrual bleeding or vaginal bleeding that is heavier than normal bleeding that is severe or you cannot control pink or brown urine red or black stools (looks like tar) bruises that happen without a known cause or get larger cough up blood or blood clots vomit blood or your vomit looks like coffee grounds unexpected pain, swelling, or joint pain headaches, feeling dizzy or weak

Generic name: Acetazolamide Brand name: Diamox, Dazamide, Diamox Sequels, Storzolamide, Acetazolam, ApoAcetazolamide Ordered dose: 250mg 1tab TID Classification: Pharmacologic Classification: Carbonic Anhydrase Inhibitor Therapeutic Classification: antiglaucoma, diuretics, ocular hypotensive agents, anticonvulsants Suggested dose: PO (adults) Glaucoma: 250-1000 mg/day in 1-4 divided doses (up to 250 mg every 4 hours) Epilepsy: 4-30 mg/kg/day in 1-4 divided doses Altitude sickness: 250 mg 2-4 times a day started 24-48 hours before ascent, continued for 48 hours or longer to control symptoms. PO (Children) Glaucoma: 8-30 mg/kg/day in 3 divided doses IM, IV (Adults): 250-500 mg, may repeat in 2-4 hours IM, IV (children): 5-10 mg/kg every 6 hours

Mode of action: Acetazolamide is a potent carbonic anhydrase inhibitor, effective in the control of fluid secretion, in the treatment of certain convulsive disorders and in the promotion of diuresis in instances of abnormal fluid retention. Acetazolamide is not a mercurial diuretic. Rather, it is a nonbacteriostatic sulfonamide possessing a chemical structure and pharmacological activity distinctly different from the bacteriostatic sulfonamides. The anticonvulsant activity of Acetazolamide may depend on a direct inhibition of carbonic anhydrase in the CNS, which decreases carbon dioxide tension in the pulmonary alveoli, thus increasing arterial oxygen

tension. The diuretic effect depends on the inhibition of carbonic anhydrase, causing a reduction in the availability of hydrogen ions for active transport in the renal tubule lumen. This leads to alkaline urine and an increase in the excretion of bicarbonate, sodium, potassium, and water. Indication:

Glaucoma (lowers intraocular pressure in the treatment of glaucoma) Epilepsy Congestive heart failure Drug-induced edema Altitude sickness (mountain sickness)

Contraindication:

Hypersensitivity to carbonic anhydrase inhibitor Hypersensitivity to sulfonamides Depressed levels of serum potassium and sodium Marked kidney and liver disease Suprarenal grand failure Hyperchloremic disease First trimester of pregnancy Concurrent use of ophthalmic carbonic anhydrase inhibitors (brinzolamide, dorzolamide) Adrenal gland failure (Addisons disease) Sickle cell anemia Chronic non-congestive glaucoma

Side effects:

Depression Tiredness Body malaise Drowsiness and confusion Transient nearsightedness Anorexia Metallic taste

Nausea and vomiting Crystalluria Renal calculi Rashes Hyperglycemia Hyperchloremic acidosis Hypokalemia Aplastic anemia Hemolytic anemia Leucopenia Weight loss Paresthesias Tingling feeling of the extremities Polyuria Polydipsia Blushing Headache Irritability Photosensitivity (rare)

Drug interactions: Acetazolamide can decrease excretion of dextroamphetamine, anticholinergics, mecamylamine, ephedrine, mexiletine, or quinidine because carbonic anhydrase inhibitors increase the alkalinity of the urine, thereby increasing the amount of nonionized drug available for renal tubular reabsorption. The effects of these drugs can be prolonged or enhanced. Increased urine alkalinity also can inhibit the conversion of methenamine to formaldehyde, which is the active bacteriostatic form. Concurrent use of methenamine and acetazolamide is not recommended. Acetazolamide produces alkaline urine and can increase the rate of excretion of weakly acidic drugs including barbiturates and salicylates. Large or regular dosing with aspirin and other salicylates should be avoided as acetazolamide can potentiate salicylate toxicity by causing metabolic acidosis and enhancing the penetration of the salicylate into

tissues. In addition, salicylates decrease the elimination of acetazolamide, which could result in CNS toxicity. Acetazolamide can induce osteomalacia in patients being concomitantly treated with carbamazepine, primidone, or phenytoin. Potential mechanisms for this interaction include an acetazolamide-induced increase in the urinary excretion of calcium and effects resulting from metabolic acidosis.

Nursing responsibilities: 1. . Monitor individuals taking acetazolamide with primidone and

carbamazepine. Acetazolamide may increase the blood levels of carbamazepine and quinidine and may decrease the blood levels of primidone. 2. Instruct the patient to avoid taking aspirin with Acetazolamide. Increase in side effects such as drowsiness, confusion, lethargy, hyperventilation and ringing in the ears when acetazolamide is taken with aspirin. 3. Monitor electrolyte levels 4. Do not share your medicine with others and do not take anyone else's medicine.

5. Keep all medicine out of the reach of children and pets. 6. Keep a list of all your medicines (prescription, natural products, supplements, vitamins, over-the-counter) with you. Give this list to healthcare provider (doctor, nurse, nurse practitioner, pharmacist, physician assistant). 7. Call your doctor for medical advice about side effects

Generic name: Ivabradine HCL Brand name: Coralan Classification: Anti - anginal Ordered dose: 5 mg 1tab q12 Suggested dose: The usual recommended dose is 5 mg twice daily. The dose may be increased after 2 to 4 weeks to 7.5 mg twice daily, if necessary. If the heart rate decreases below 50 bpm at rest or if the patient experiences symptoms related to bradycardia, the dose should be reduced to 2.5 mg twice daily. Treatment should be stopped if the heart rate remains below 50 bpm or if symptoms of bradycardia persist. Adults over the age of 75 years should start treatment with a lower dose i.e. 2.5 mg twice daily Mode of action: Ivabradine is a heart rate lowering agent. It acts by selective and specific inhibition of the cardiac pacemaker, current, an important ionic current that usually controls spontaneous diastolic depolarisation in the sinus node and thereby regulates heart rate. The cardiac effects of ivabradine are specific to the sinus node and ivabradine has no effect on intra-atrial, atrioventricular or intraventricular conduction times, myocardial contractility or ventricular repolarisation. An elevated heart rate increases myocardial oxygen demand and limits tissue perfusion, the latter by reducing the duration of diastole, during which most myocardial perfusion occurs. Therefore, a pure reduction in heart rate can reduce myocardial ischaemia and prevent angina pectoris. Indication: Ivabradine is indicated for the symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm who are intolerant to beta-blockers or in whom these agents are contraindicated.

Contraindication: Ivabradine is contraindicated in patients with cardiac dysrhythmias, unstable angina pectoris, acute coronary syndrome, class lll to lV heart failure, 3rd degree AV block, cardiogenic shock, those with a pacemaker, a resting heart rate below 60 bpm or severe hypotension (< 90/50 mm Hg). Ivabradine is not recommended for use in patients with liver dysfunction and is contraindicated in patients with severe liver dysfunction. Side effects: Luminous phenomena (phosphenes) i.e. enhanced brightness in the visual field, have been reported in 14.5% of patients. These effects usually resolve spontaneously during treatment. Other common side effects include bradycardia, AV 1st degree heart block, ventricular extrasystoles, headache and dizziness. Drug interactions: The concurrent use of ivabradine with St Johns Wort, strong cytochrome P450 inhibitors (such as the azole antifungals, macrolides, HIV protease inhibitors and nefazodone) is contraindicated. The concomitant use of medicines that prolong the QT intervals should be avoided since QT prolongation may be exacerbated by heart rate reduction. The concomitant use of ivabradine with heart rate reducing calcium channel blockers such as verapamil or diltiazem is not recommended. Nursing responsibilities: 1. Ivabradine should be taken twice daily in the morning and in the evening. 2. The tablets should be swallowed with a little water and taken with some food. 3. Changes in vision may occur, but usually resolve with continued treatment.

4. Do not give this medicine to anyone else, even if their symptoms seem similar to your 5. Keep CORALAN in a cool dry place where the temperature stays below 30C, but not in the fridge or freezer. 6. Do not store it, or any other medicine, in a bathroom or near a sink. Do not leave it in the car or on window sills. 7. Keep your tablets in their blister pack until it is time to take them. 8. If you take the tablets out of the box or the blister pack they may not keep well.