Nursing Drug Analysis Generic Name & Possible Brand Names 1.

Sevoflurane Brand Name: Ultane Indications/Ratio nale for giving the medications Induction and maintena nce of general anesthesi a

Mechanism of Action induces a state in which the CNS is altered so that varying degrees of pan relief, depression of consciousness, skeletal muscle relaxation and reflex reduction are produced

Side Effects

Adverse Effects

Nursing Considerations

agitation dizziness drowsiness increased cough increased saliva lightheaded ness nausea shivering vomiting

Anaphylaxis Irregular heartbeat Seizure Yellowing of the skin or eyes

> Check the name of the patient and the time of administration. > Monitor vital signs. > Monitor all the body systems. > Continuous monitoring of pulse oximetry. > Postural BP should be taken. > Take note of that time that the drug has expired. >Stop drug immediately, administer oxygen >Start rapid fluid resuscitation >Make sure client is well ventilated >Seizure precation >Administer epinephrine

Hypotensio n

2. Atracurium Brand Name: Tracrium

Muscle relaxant in general

blocks neural transmission at the

heart rate increase, bronchospasm, decrease in blood

CV: Bradycardia, tachycardia. Respiratory:

Lab tests: Baseline serum electrolytes, acidbase balance, and renal function

anaesthes ia, Endotrach eal intubation , Aid controlled ventilation

neuromuscular junction by competitive binding at the cholinergic receptor sites on the motor end plate.

pressure and skin rash

Respiratory depression. Other: Increased salivation, anaphylaxis. Cutaneous reactions; bradycardia, transient hypotension in patients with CVS disorders; dyspnoea, bronchospasm; rash and urticaria Hematologic: neutropenia, leukopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria

as part of preanesthetic assessment. Note: Personnel and equipment required for endotracheal intubation, administration of oxygen under positive pressure, artificial respiration, and assisted or controlled ventilation must be immediately available. Evaluate degree of neuromuscular blockade and muscle paralysis to avoid risk of overdosage by qualified individual using peripheral nerve stimulator. Monitor BP, pulse, and patient's recovery from neuromuscular blocking (curare-like) effect as evidenced by ability to breathe naturally or to take deep breaths and cough, keep eyes open, lift head

hemolytic anemia, respirations and evaluate

keeping mouth closed, adequacy of hand-grip strength. Notify physician if recovery is delayed. Note: Recovery from neuromuscular blockade usually begins 3545 min after drug administration and is almost complete in about 1 h. Recovery time may be delayed in patients with cardiovascular disease, edematous states, and in older adults.

3. Fentanyl Brand name: Duragesic

Analgesic action of short duration during anesthesia and immediate postop period Analgesic supplement in general or

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

Anxiety; confusion; constipation; difficulty walking; dizziness; drowsiness; dry mouth; headache; indigestion; itching; nausea; vomiting.

Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia,

- Fentanyl interferes with respiratory function and pupil reaction, both of which are essential parts of neurological assessment. - Assess the therapeutic response and in breakthrough cancer pain consider adjustment of background

regional anesthesia

palpitations Rash, hives,

analgesia where this is appropriate.

Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia For use as an anesthetic agent with oxygen in selected high-risk patients Transdermal system: management of chronic pain in

pruritus, flushing, warmth, sensitivity to cold Diplopia, blurred vision Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm

- Excessive heat may increase absorption from patches so local heat should not be applied and patients with fever should be carefully monitored. Patient teaching - Medication should be kept out of reach of children and in its original packaging. - Avoid activities that require

Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

alertness if patient is affected by drowsiness. - Lozenges should be removed from foil just before administration and sucked over a 15-minute period, not chewed. - Patches should be applied

patients requiring opioid analgesia Treatment of breakthrough pain in cancer patients being treated with narcotics (Actiq)

to dry, intact skin, nonirradiated non-hairy skin on the torso or upper arm. Replacement patches should be sited on a different area. Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

4. Propofol Brand name: Diprivan

Induction or maintenance of anaesthesia in cardiology, neurology, paediatric surgery Torticollis, cardiovascular, MRI, malignant hyperthermia, obstetric analgesia Hypersensitivity ICU sedation in

The action of propofol involves a positive modulation of the inhibitory function of the neurotransmitter gamaaminobutyric acid(GABA) through GABA-A receptors.

difficulty breathing, wheezing, swelling of the throat

Metabolic Acidosis, Diabetes Mellitus, Rash, Renal Impairment, Renal Failure, Respiratory Failure, Diarrhoea, Respiratory Acidosis, Sepsis, Renal Tubular Necrosis, Clostridial Infection

Patient should be closely monitored following administration of propofol. Propofol is a very shortacting drug, and its effects generally wear off in just a few hours. However, propofol may affect your ability to drive or operate machinery for several hours after use. Do not attempt to drive yourself home if you have received propofol for minor outpatient surgery or diagnostic tests. Avoid alcohol, mood-

fast heartbeat, palpitations lightheadedne ss or fainting spells

numbness or tingling in the hands or feet

seizure (convulsion)

ventilated adults Status epilepti cus, nausea/vomiting , intubation, pruritus, sedation following cardiac surgery

skin rash, flushing (redness), or itching

altering drugs, or any other medicines for at least 24 hours after a dose of propofol, unless approved by your prescriber or health care professional. Aseptic technique is essential. Solution is capable of rapid growth of bacteria contaminants. Infections and subsequent dea6hs have been reported May cause drowsiness or dizziness. Advice patients to request assistance prior to ambulation and transfer to avoid driving or any kind of activities that requires alertness until response to medication is known

swelling or extreme pain at the injection site

uncontrollable muscle spasm dizziness pain or irritation at the injection site

5. Mannitol Brand Name: Osmitrol, Resectisol

Acute oliguric renal failure Toxic overdose Edema Increased intracranial

In the oliguric phase of acute renal failure, Mannitol increases osmotic pressure (pressure

dry mouth, increased thirst, blurred vision, or seizure (convulsions); swelling, pain, or

Dehydration Anuria Intracranial bleeding Headache Blurred vision

Assessment Monitor the following: 1. Vital signs 2. Intake and output 3. Central venous pressure Pulmonary artery pressure

pressure (ICP) Intraocular pressure (IOP)

needed to stop the absorption of something or osmosis) of the glumerular filtrate, thereby, promoting diuresis (treating the oliguric phase of renal failure) and excretes toxic materials (management for toxic overdose). It also elevates blood plasma osmolality thus, inhibiting the reabsorption of water and electrolytes (for relief of edema) and mobilizing fluids in the cerebral and

skin changes where the medicine was injected; chest pain, fast heart rate; feeling like you might pass out; feeling short of breath, even with mild exertion; swelling, rapid weight gain; or if you stop urinating. nausea, vomiting; runny nose; dizziness; chills; or mild skin rash.

Nausea and vomiting Volume expansion Chest pain Pulmonary edema Thirst Tachycardia Hypokalemia (increases the risk of digoxin toxicity) Chronic renal failure

Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst) Signs of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness, confusion, tingling sensation of extremity and excessive thirst) (for increase ICP) Neurologic status and intracranial pressure readings. (for increase IOP) Elevating eye pain or decreased visual acuity. Laboratory Tests Renal function (BUN and Creatinine) Serum Electrolyte (Sodium and Potassium) Precaution Pregnancy and lactation (safe use during these conditions is not established) Interventions

ocular spaces (lowers intracranial or intraocular pressure).

Observe the IV site regularly for infiltration. Administration rate for oliguria should be titrated to produce a urine output. (about 30-50 ml/hr in adult and 2-6 hours in children)

6.

Ketorolac Brand Name: Toradol

Short term management of pain (not to exceed 5 days total for all routes combined)

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and anti-inflammatory properties. - Therapeutic effect:Decreased pain

CNS: headache, dizziness, somnolence, insomnia, fatigue, dizziness, tinnitus, ophthalmologic effects

- CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP: 1) asthma 2) dyspnea - CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea

- Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. - Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid

4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL: 1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis

concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

7. Ranitidine Hydrochloride Brand Name: Zantac

Short-term treatment of active duodenal ulcer Short-term treatment of active, benign gastric ulcer Maintenance therapy for duodenal ulcer at reduced dosage. Short-term treatment for GERD. Pathologic hypersecretory conditions (Zollinger-Ellison syndrome) Treatment of erosive esophagitis Treatment of heartburn, acid

Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin

CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo CV: tachycardia, bradycardia Dermatologic: rash, alopecia GI: constipation, diarrhea, nausea and vomiting, abdominal pain, hepatitis GU: impotence or decreased libido Hematologic: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia

CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity

Assessment: 1. History: allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy. 2. Physical: skin lesions, orientation, affect, liver evaluation, abdominal examination, normal output, renal function tests, CBC Interventions: 1. Administer oral drug with meals and at bedtime. 2. Decrease doses in renal and liver failure. 3. Provide concurrent antacid therapy to relieve pain. 4. Administer IM dose undiluted, deep into large muscle group. 5. Arrange for regular followup including blood test, to evaluate effects.

indigestion, sour stomach

reactions, vasculitis

8. Cefazolin Brand Name: Ancef

Perioperative Prophylaxis

Bind to bacterial cell wall membrane, causing cell death. Active against many grampositive cocci including: Streptococcus pneumoniae, Group A betahemolytic streptococci; Penicillinasproducing staphylococci.

Diarrhea, nausea, vomiting, rashes, phlebitis at IV site

CNS: Seizures (high doses) GI: Pseudomembrano us colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis DERM: Rashes, urticaria HEMAT: Blood dyscrasias, hemolytic anemia LOCAL: Pain at IM site, phlebitis at IV site MISC: Allergic reactions including Anaphylaxis and

Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care

Serum sickness, superinfection

professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional.

9. Nalbuphine Brand Name: Nubain

Relief of moderate to severe pain Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery

Binds to opiate receptors in the CNS, alters the perception of and responses to painful stimuli while producing generalized CNS depression

Dizziness, headache, sedation, dry mouth, nausea, vomiting, clammy feeling, sweating

CNS: Sedation. Clamminess, sweating headache, nervousness, restlessness,depres sion, crying, confusion, faintness, hostility, unusual dreams, hallucinations,eup horia, dysphoria, unreality, dizziness, vertigo, floating feeling, feeling of heaviness,numbne ss, tingling, flushing, warmth, blurred vision. CV: Hypotension, Hypertension, bradycardia, tachycardia

* Reassess patients level of pain at least 15 and 30 minutes after parenteral administration. * Drug acts as an opioid antagonist and may use withdrawal syndrome. For patients who have received longterms opioids, give 25% of the usual dose initially. Watch for signs of withdrawal. * ALERT! Drug causes respiratory depression, which at 10 mg is equal to respiratory depression produced by 10 mg of morphine. * Monitor circulatory and respiratory status and bladder and bowel function. Withhold dose and notify prescriber if respirations are shallow or rate is below 12 breaths/minute. * Constipation is often severe

DERMATOLOGIC: Itching, burning, urticaria GI: Nausea, vomiting, cramps, dyspepsia, bitter taste, dry mouth GU: Urinary urgency RESPIRATORY: Respiratory depression, dyspnea, asthma

with maintenance therapy. Make sure stool softener or other laxative is ordered. * Psychological and physical dependence may occur with prolonged use. * ALERT! Dont confuse Nubain with Navane. * Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other hazardous activities that require mental alertness until drugs CNS effects are known. * Teach patient how to manage troublesome adverse effects such as constipation.

10. Paracetamol Brand name: Tylenol, Calpol

Mild to Pyrexia. Post-

Unknown. Thought to produce analgesia by blocking pain impulses by

Side-effects are rare and include skin rashes and blood disorders. - In overdose,

Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness,

Monitor liver function studies; may cause hepatic toxicity at doses >4g/day

moderate pain.

vaccination fever from two

months of age.

inhibiting synthesis of prostaglandin in the Central Nervous System (CNS) or of other substances that sensitize pain receptors to stimulation. The drug may relieve fever though central action in the hypothalamic heat-regulating center.

hepatocellular necrosis or less frequently renal tubular necrosis.

lethargy, confusion, lightheadedness, nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, convulsions

- Monitor renal function studies; albumin indicates nephritis - Monitor blood studies, especially CBC and pro-time if patient is on long-term therapy. - Check I&O ratio; decreasing output may indicate renal failure. and pain - Assess hepatotoxicity: dark urine, claycolored stools - Assess allergic reactions: rash, urticaria

headache, tremor, - Assess for fever