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NAME INDICATION MECHANISM

OF ACTION
CONTRAINDICATION SIDE EFFECTS NURSING
MANAGEMENT
Drug name:
Ketorolac
(Toradol)

Chemical
class: Acetic
acid
derivative
Therapeutic
class:
Analgesic,
antiinflamma
tory
Pregnancy
category: C

Dosage: 20
mg PRN but
no more than
40 mg per
day.
To treat
moderate to
severe pain
Blocks
cyclooxygenase,
an enzyme
needed
to synthesize
prostaglandins.
Prostaglandins
mediate
inflammatory
response and
cause
local
vasodilation,
swelling, and
pain. They
also promote
pain
transmission
from
periphery to
spinal cord. By
blocking
cyclooxygenase
and inhibiting
prostaglandins,
this NSAID
reduces
inflammation and
relieves pain
Advanced renal
impairment or risk of
renal
impairment due to
volume depletion;
before or during surgery
if hemostasis is
critical; breast-feeding;
cerebrovascular
bleeding; concurrent
use of aspirin or other
salicylates, other
NSAIDs, or probenecid
CNS: Aseptic meningitis,
cerebral hemorrhage,
coma, dizziness, drowsiness,
headache,
psychosis, seizures, stroke
CV: Edema, fluid retention,
hypertension
EENT: Laryngeal edema,
stomatitis
ENDO: Hyperglycemia
GI: Abdominal pain; acute
pancreatitis;
bloating; constipation; diarrhea;
diverticulitis;
flatulence; GI bleeding,
perforation, or
ulceration; hepatitis; hepatic
failure; jaundice;
indigestion; nausea; perforation
of
stomach or intestines; vomiting;
worsening
of inflammatory bowel disease
GU: Interstitial nephritis, renal
failure,
urine retention
HEME: Agranulocytosis, anemia,
aplastic or
hemolytic anemia, eosinophilia,
leukopenia,
lymphadenopathy, pancytopenia,
thrombocytopenia
RESP: Bronchospasm,
pneumonia, respiratory
depression
SKIN: Diaphoresis, erythema
multiforme,
Read ketorolac label
carefully. Dont use
I.M. form for I.V. route.
Know that ketorolac
isnt for intrathecal or
epidural use.
Inject I.M. ketorolac
slowly, deep into a
large muscle
mass.Monitor site for
bleeding,
bruising, or
hematoma.
Give I.V. injection
over at least 15
seconds.
Notify prescriber if
pain relief is
inadequate
or if breakthrough pain
occurs
between doses
because supplemental
doses
of an opioid analgesic
may be required.
WARNING Monitor
liver function test
results. If elevated
levels persist or
worsen,
notify prescriber and
expect to stop drug,
as ordered, to prevent
hepatic impairment.













exfoliative dermatitis,
photosensitivity, pruritus,
rash, Stevens-Johnson
syndrome,
toxic epidermal necrolysis,
urticaria
Other: Anaphylaxis,
angioedema, hyperkalemia,
hyponatremia, injection site pain,
sepsis, unusual weight
gain
NAME INDICATION MECHANISM
OF ACTION
CONTRAINDICATION SIDE EFFECTS NURSING MANAGEMENT
Drug name:
Ranitidine
(Zantac)

Chemical
class:
Aminoalkyl-
substituted
furan
derivative
Therapeutic
class:
Antiulcer
agent,
gastric
acid
secretion
inhibitor
Pregnancy
category: B

Dosage: 150
mg B.I.D PO
To provide
short-term
treatment of
active
duodenal and
benign
gastric
ulcers
Inhibits basal
and nocturnal
secretion of
gastric acid
and pepsin by
competitively
inhibiting the
action of
histamine at H2
receptors on
gastric parietal
cells. This
action reduces
total volume of
gastric juices
and, thus,
irritation of GI
mucosa.
Acute porphyria,
hypersensitivity to
ranitidine
or its components
CNS: Dizziness,
drowsiness, fever,
headache,
insomnia
CV: Vasculitis
GI: Abdominal
distress,
constipation,
diarrhea,
nausea, vomiting
GU: Acute
interstitial
nephritis,
impotence
MS: Arthralgia,
myalgia
RESP:
Bronchospasm
SKIN: Alopecia,
erythema
multiforme, rash
Other:
Anaphylaxi
s,
angioedem
a
Be aware that ranitidine must be
diluted
for I.V. use if not using premixed
solution.
For I.V. injection, dilute to total of 20 ml
with normal saline solution, D5W,
D10W,
lactated Ringers solution, or 5%
sodium
bicarbonate. For I.V. infusion, dilute to
total volume of 100 ml of same
solutions.
Give I.V. injection at no more than 4
ml/
min, intermittent I.V. infusion at 5 to
7 ml/min, and continuous I.V. infusion
at
6.25 mg/hr (except with hypersecretory
conditions, when initial infusion rate is
1 mg/kg/hr, gradually increased after
4 hours, as needed, in increments of
0.5 mg/kg/hr).
Dont add additives to premixed
solution.
Stop primary I.V. solution infusion
during
piggyback administration.
PATIENT TEACHING
Tell patient to dissolve 150-mg
effervescent
tablets or granules in 6 to 8 oz water
or 25-mg effervescent tablets in at least
5 ml water.
Advise patient (or parent) to wait until
effervescent tablet is completely
dissolved
before taking (or giving to child or












infant).
Caution patient not to chew
effervescent
tablets, swallow them whole, or let
them
dissolve on the tongue.
NAME INDICATION MECHANISM
OF ACTION
CONTRAINDICATION SIDE EFFECTS NURSING MANAGEMENT
Drug name:
Nalbuphine
(Nubain)

Chemical
class:
Phenanthren
e derivative
Therapeutic
class:
Analgesic,
anesthesia
adjunct
Pregnancy
category: B

Dosage: 10
mg
every 3 to 6
hr, p.r.n.
Dosage
adjusted for
patients
weighing
more or less.
To treat
moderate to
severe pain
Binds with and
stimulates mu
and kappa
opiate receptors
in the spinal cord
and
higher levels in
the CNS. In this
way, nalbuphine
alters the
perception of
and emotional
response to pain.
Hypersensitivity to
nalbuphine or its
components
CNS: Confusion,
depression, dizziness,
euphoria, fatigue,
hallucinations, headache,
nervousness,
restlessness, seizures,
syncope,
tiredness, weakness
CV: Hypertension,
hypotension, tachycardia
EENT: Blurred vision,
diplopia, dry mouth
GI: Abdominal cramps,
anorexia, constipation,
nausea, vomiting
GU: Decreased urine
output, ureteral
spasm
RESP: Dyspnea,
pulmonary edema,
respiratory
depression, wheezing
SKIN: Diaphoresis,
flushing, pruritus, rash,
sensation of warmth,
urticaria
Other: Injection site
burning, pain, redness,
swelling, and
warmth
Use nalbuphine cautiously
in patients taking
other drugs that can cause
respiratory
depression.
Keep resuscitation
equipment and
naloxone readily available to
reverse nalbuphines
effects, if needed.
For direct I.V. injection
through an I.V.
line with a compatible
infusing solution,
give drug slowlyno more
than 10 mg
over 3 to 5 minutes. Inject
into free-flowing
normal saline solution, D5W,
or lactated
Ringers solution.
During prolonged use,
expect to give a
stool softener to minimize
constipation.
If patient is opioid-
dependent, expect
drug to cause withdrawal
symptoms, such
as abdominal cramps,
anorexia, anxiety,
backache, bone or joint pain,
confusion,
depression, diaphoresis,
dysphoria, erythema,
fear, fever, irritability, labile
blood













pressure and pulse,
lacrimation, muscle
spasms, myalgia, mydriasis,
nasal congestion,
nausea, opioid craving,
piloerection,
restlessness, rhinorrhea,
sensation of crawling skin,
sleep disturbances, tremor,
uneasiness, vomiting, and
yawning.
NAME INDICATION MECHANISM
OF ACTION
CONTRAINDICATION SIDE EFFECTS NURSING MANAGEMENT
Drug name:
Co-
Amoxiclav
(augmentin)

Chemical
class:
Phenanthren
e derivative
Therapeutic
class:
Analgesic,
anesthesia
adjunct
Pregnancy
category: B

Dosage: 10
mg
every 3 to 6
hr, p.r.n.
Dosage
adjusted for
patients
weighing
more or less.
- Known or
suspected
amoxicillin-
resistant
infections
including
respiratory
tract, skin
and soft
tissue,
genitourinary,
and ear, nose
and throat
infections.
- An antibiotic
that combines
amoxicillin and
clavulanic acid. It
destroys bacteria
by disrupting
their ability to
form cell walls.
- Clavulanic acid
blocks the
chemical
defence, known
as beta-
lactamase, that
some bacteria
have against
penicillins. l Co-
amoxiclav is
active against
bacterial
infections that
have become
resistant to
amoxicillin.

- Penicillin
hypersensitivity
- History of co-
amoxiclav-associated
or penicillin-associated
jaundice or hepatic
dysfunction.

- History of allergy.
- Renal impairment.
- Erythematous rashes
common in glandular
fever.
- Cytomegalovirus
infection.
- Acute or chronic
lymphocytic leukaemia.
- Hepatic impairment.
- Pregnancy.
- Cholestatic jaundice.
Common side-effects
- Hepatitis.
- Cholestatic jaundice.
- Erythema multiforme
(including Stevens-
Johnson syndrome).
- Toxic epidermal
necrolysis.
- Exfoliative dermatitis.
- Vasculitis.
- Dizziness.
- Headache.
- Convulsions (especially
in high doses or in renal
impairment).
- Assess bowel pattern
before and during treatment
as pseudomembranous
colitis may occur.
- Report haematuria or
oliguria as high doses can be
nephrotoxic.
- Assess respiratory status.
- Observe for anaphylaxis.
patient has adequate fluid
intake during any diarrhoea
attack.
Patient teaching
- If the patient develops a
rash, wheezing, itching, fever
or swelling in the joints, this
could indicate an allergy and
should be reported.
- Patients must ensure they
take the full course of the
medicine.
- The medicine must be
taken in equal doses around
the clock to maintain level in
the blood.
- If oral contraceptives are
used, use alternative
contraception.
- Report diarrhoea, cramping
and blood in stools as
pseudomembranous colitis
may occur.

















- Superficial teeth staining
when using the
suspension.
- Phlebitis at injection site.


NAME INDICATION MECHANISM
OF ACTION
CONTRAINDICATION SIDE EFFECTS NURSING MANAGEMENT
Drug name:
Castor Oil


Incomplete or
Infrequent
Bowel
Movements
the active
component of
castor oil,
ricinoleic acid, is
a selective
agonist of
EP3and EP4
receptors, and
that the
pharmacological
effects of castor
oil are mediated
by activation of
EP3 receptors
on smooth-
muscle cells
- Castor Oil
hypersensitivity

Stomach/abdominal
pain or
cramping, nausea, diarrhe
a, or weakness may
occur.
persistent
nausea/vomiting/diarrhea,
muscle
cramps/weakness, irregul
ar heartbeat,dizziness,
decreased urination,
mental/mood changes
(such as confusion).
serious allergic reaction,
including: rash,itching/swe
lling (especially of the
face/tongue/throat),
severe dizziness, trouble
breathing.
Children: Castor oil might be
safe when taken by mouth in
appropriate doses short-
term. But taking castor oil for
more than one week or
taking more than the typical
children's dose of 1-15 mL
per day, depending on age,
can cause a chemical
imbalance in the body. Of
course, all the warnings
against chewing or
swallowing whole seeds
apply to children as well as
adults.

Pregnancy: Using castor oil
in pregnant women at term
(ready to deliver) seems to
be safe. Midwives routinely
use castor oil for starting
labor in pregnant women
who are ready to deliver.
However, castor oil should
not be used for this purpose
without the supervision of a
healthcare provider.
Pregnant women who are
not at term should not use
castor oil because it might
start labor early and cause
a miscarriage. Do not chew
or swallow whole seeds.
Serious health effects,
including death, can occur.

Dont take castor oil if you

are breast-feeding. Not
enough research has been
done to know whether a
mothers use of castor oil is
safe for nursing infants.

Intestinal problems: Dont
use castor oil if you have a
blocked intestine,
unexplained stomach pain,
or problems with your bile
ducts or gall bladder.