Dexamethasone 4mg/1ml

Brand Name: Cortastat, Dalalone, Decadrol, Decaject, Deronil,

Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol,
Primethasone, Solurex

Classification: Long- acting corticosteroid

Indication:
1. Management of cerebral edema
2. Relieves inflammation
3. Allergic disorders
4. Asthma
5. Arthritis

Mechanism of Action: Dexamethasone suppresses inflammation and the normal

immune response. It prevents the release of substances in the body that causes
inflammation. Exact action is unknown.

Adverse Effect: Acne, Decreased wound healing, Depression, Vomiting, Easy

bruising, Headache, Increased hair growth, Insomnia, Restlessness, Stomach irritation,
Irregular or absent menstruation, Dizziness

Nursing consideration:

a.) Monitor intake and output of patient.

b.) Observe the patient for peripheral edema, steady weight gain, rales or crackles or
dyspnea. Notify the physician immediately if these clinical manifestations are noted.

c.) Periodic growth evaluation for children should be done time to time.

d.) For patients with cerebral edema, assess then for level of consciousness changes
and headache during the therapy.

e.) Guaiac-test stools should be carried out. Guaiac-positive stools should be reported
to the physician immediately.
f.) Administer with meals to minimize GI irritation.

g.) For patients with difficulty swallowing, tablets can be crushed and administered
with fluids or food. However, capsules should be swallowed whole.

h.) Educate the patient to take missed doses as soon as remembered, unless almost
time for the next dose skip the missed dose and continue your regular dosing
schedule. Do not take a double dose to make up for a missed one.

i.) Instruct patient to avoid people with known infection and contagious illnesses as
corticosteroids causes immunosuppression and may mask symptoms of infection.
Epinephrine 1:10,000/ 10ml

Brand Name: Adrenaclick, Adrenalin, Adrenalin Chloride,

Auvi-Q, Epipen, Twinject

Classification: alpha- and beta-adrenergic agonists

Indication:
1. Anaphylaxis.
2. Bronchospasm.
3. Urticaria.
4. Angioedema.
5. Serum sickness.

Mechanism of action: It activates an adrenergic receptive mechanism on effector cells

and imitates all actions of the sympathetic nervous system except those on the arteries
of the face and sweat glands. Epinephrine acts on both alpha and beta receptors and is
the most potent alpha receptor activator. Epinephrine relaxes the smooth muscle of the
bronchi and iris and is a physiologic antagonist of histamine. The drug also produces
an increase in blood sugar and glycogenolysis in the liver.

Adverse Effect: head ache, flushing, orthostatic hypotension

Nursing consideration:

1.) Monitor BP, pulse, respirations, and urinary output and observe patient closely
following IV administration. Epinephrine may widen pulse pressure. If disturbances in
cardiac rhythm occur, withhold epinephrine and notify physician immediately.

2.) Keep physician informed of any changes in intake-output ratio.

3.) Use cardiac monitor with patients receiving epinephrine IV. Have full crash cart
immediately available.

4.) Check BP repeatedly when epinephrine is administered IV during first 5 min, then
q35min until stabilized.

5.) Advise patient to report to physician if symptoms are not relieved in 20 min or if
they become worse following inhalation.

6.) Advise patient to report bronchial irritation, nervousness, or sleeplessness. Dosage

should be reduced.

7.) Monitor blood glucose & HbA1c for loss of glycemic control if diabetic.
Digoxin 0.5mg/2ml

Brand Name: Digitek, Lanoxicaps, Lanoxin

Classification: Cardiac glycoside, Cardiotonic

Indication:
1. CHF
2. Atrial fibrillation

Mechanism of action: Acts as 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.
Adverse Effect: anorexia, nausea and vomiting, Diarrhea, confusion, dizziness,
drowsiness, restlessness, nervousness, agitation and amnesia, visual disturbances,
gynecomastia, local irritation (IM/SC inj), Cardiac arrhythmias in combination with
heart block.

Nursing consideration:

a.) 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.

b.) 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.

c.) 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.

d.) 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).

e.) 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.

f.) Monitor I&O ratio during digitalization, particularly in patients with impaired renal
function. Also monitor for edema daily and auscultate chest for rales.
Diphenhydramine 50mg/1ml

Brand Name: Benadryl

Classification: Antiparkinsonian drug

Indication:

1. Relief of allergic symptoms caused by histamine release including:

o Anaphylaxis,
o Seasonal and perennial allergic rhinitis,
o Allergic dermatoses.

2. Parkinson's disease and dystonic reactions from medications.

Mechanism of action: Diphenhydramine competes with free histamine for binding at

HA-receptor sites. This antagonizes the effects of histamine on HA-receptors, leading
to a reduction of the negative symptoms brought on by histamine HA-receptor
binding.

Adverse Effect: drowsiness, dizziness, headache, blurred vision, tinnitus, hypotension,

palpitations, anorexia, dry mouth, constipation, nausea, dysuria, frequency, urinary
retention, photosensitivity, chest tightness, thickened bronchial secretions, wheezing,
pain at IM site

Nursing consideration:

a.) Monitor cardiovascular status especially with pre-existing cardiovascular disease.

b.) Monitor for adverse effects especially in children and the older adult.
c.)Supervise ambulation and use side-rails as necessary. Drowsiness is most
prominent during the first few days of therapy and often disappears with continued
therapy. Older adults are especially likely to manifest dizziness, sedation, and
hypotension.
d.) Instruct to not use alcohol and other CNS depressants because of the possible
additive CNS depressant effects with concurrent use.
e.) Advise to increase fluid intake, if not contraindicated; drug has an atropine-like
drying effect (thickens bronchial secretions) that may make expectoration difficult.
f.) Advise to not breast feed while taking this drug.