DRUG CLASSIFICATION SIDE EFFECTS NURSING CONSIDERATION GENERIC NAME: PARACETAMOL BRAND NAME: AEKNIL ADMINISTRATION: PARACETOMOL 1 AMP

IV Q 6HRS NONOPIOD ANALGESICS AND ANTIPYRETICS ACTION: THROUGH THE PRODUCE ANALGESIA BY BLOCKING PAIN IMPULSE BY INHIBITING SYNTHESIS OF PROSTAGLANDIN IN CNS THAT SYNTHESIZE PAIN RECEPTOR TO STIMULATION INDICATION: > ACUTE PAIN > FEVER HYPOGLYCEMIA RASH, URTICARIA > INSTRUCT PATIENT TO TAKE WITH MEALS > HAVE A PLENTY OF WATER WHEN TAKING THIS DRUG Contraindications Chronic active alcoholism, increased sensitivity to paracetamol, marked disturbances of liver function and / or kidney disease, anemia, pregnancy (I term).

atropine sulfate C l a s s

Anticholinergic Agent D e s c r i p t i o n

Atropine sulfate is a potent parasympatholytic. It inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias. You can think of the effects of atropine as being 'anti-SLUDGE'. O n Rapid D u r a t i o n s e t

2 - 6 hours I n d i c a t i o n s

Hemodynamically significant bradycardia

Asystole PEA Organophosphate poisoning (drug of choice) Pretreatment in pediatric patients receiving RSI. C o n t r a i n d i c a t i o n s

Tachycardia Hypersensitivity Unstable cardiovascular status in acute hemorrhage with myocardial ischemia A d v e r s e R e a c t i o n s

Tachycardia Possible paradoxical bradycardia when pushed slowly or when used at doses less than 0.5mg Palpitations, dysrhythmias, headache, dizziness, nausea/vomiting, flushed and dry skin, allergic reactions. Anticholinergic effects (dry mouth/nose, photophobia, blurred vision, urine retention)..think anti-SLUDGE. D r u g I n t e r a c t i o n s

Use with other anticholinergics may increase vagal blockade. Potential adverse effects when administered in conjunction with digitalis, cholinergics, neostigmine. The effects of atropine may be enhanced by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and benzodiazepines. S u p p l i e d

Various injection preparations. For emergency situations, atropine is usually supplied in prefilled syringes containing 1.0 mg in 10 ml of solution. D o s e / A d m i n i s t r a t i o n

Bradydysrhythmias Adu lt 0.5 1.0 mg IV, may be repeated at 5 min intervals until desired rate achieved. (max 0.03-0.04mg/kg) P ed iatr ic 0.02 mg/kg IV, IO, ET(diluted to 3-5ml). Min dose 0.1mg; max single dose fo 0.5 mg for a child and 1.0 mg for an adolescent; may be repeated in 5 minutes for a max total fo 1.0 mg for a child and 2.0 mg for an adolescent. Asystole

Adu lt 1.0 mg IV, ET, (1-2 mg diluted to a total of 10ml); may be repeated every 3-5 minutes (max 0.03 0.04mg/kg) P ed iatr ic unknown efficacy PEA Adu lt 1 mg IV (if bradycardic), repeat every 3-5 minutes, max 0.03 0.04mg/kg. P ed iatr ic unknown efficacy Anticholinesterase Poisoning Adu lt 2 mg IV push every 5-15 minutes to dry secretions. No max dose. P ed iatr ic 0.05 mg/kg/dose (usual dose 1-5 mg) IV, may be repeated in 15 minutes. Special Consideration Pregnancy Safety: Category C Follow ET administration with several positive pressure ventilations.

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Generic Name: Hyoscine ButylBromide Brand Name: Buscopan Classification: Belladona alkaloid, antimuscarinic Indication & Dosages: Spastic states Adults: 0.4 to 0.8 mg P.O. Delirium, preanesthetic sedation and obstetric amnesia with analgesics Adults: 0.3 to 0.65 mg I.V., I.M., or subcutaneously. Dilute solution with sterile water for injection before giving I.V. Children: 0.006mg/kg I.V., I.M., or subcutaneously. Maximum dose, 0.3 mg. Dilute solution with sterile water for solution before giving I.V. To prevent nausea and vomiting from motion sickness Adults: One Transderm-Scop, formulated to deliver 1mg scopolamine over 3 days, applied to the skin behing the ear at least 4 hours before antiemetic is needed. Or, 0.3 to 0.65 mg hydrobromide I.V., I.M. or subcutaneously. Or, 0.25 to 0.8 mg P.O. 1 hour before exposure to motion. Further doses of 0.25 to 0.8 mg may be given t.i.d., p.r.n. Children: 6 mcg/k or 200 mcg hydrobromide I.V., I.m., or subcutaneously Mode of Action: Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by postganglionic cholinergic neurons. May effect neural pathways originating in the inner ear to inhibit nausea and vomiting. Contraindication:

y y y y y y y

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Contraindicated in patients with angleclosure glaucoma, obstructive uropathy, obstructive disease of the GI tract, asthma, chronic pulmonary disease, myasthenia gravis, paralytic ileus, intestinal atony, unstable CV status in acute hemorrhage, tachycardia from cardiac insufficiency, or toxic megacolon. Contraindicated in patients with hypersensitive to belladonna or barbiturates. Use cautiously in patients with autonomicneuropathy, hyperthyroidism, coronary artery disease, arrhythmias, heart failure, hypertension, hiatal hernia with ferlux esophagitis, hepatc or renal disease, known as suspected GI infection, or ulcerative colitis. Use cautiously in children. Use cautiously in patients in hot or humid environments; drug can cause heat stroke. Side Effects: Frequent: Dry mouth (sometimes severe), decreased sweating, constipation. Occasional: Blurred vision; bloated feeling; urinary hesitancy; somnolence (with high dosage); headache; intolerance to light; loss of taste; nervousness; flushing; insomnia; impotence; mental confusion or excitement (particularly in the elderly and children); temporary light-headedness (parenteral form); local irritation(with parenteral form). Adverse Reaction: Overdose may produce temporary paralysis of ciliary muscle; papillary dilation; tachycardia; palpitations; hot, dry, or flushed skin; absence of bowel sounds; hyperthermia; increased respiratory rate; EKG abnormalities; nausea; vomiting; rash over face or upper trunk; CNSstimulations; and psychosis (marked by agitation, restlessness, rambling speech, visual hallucinations, paranoid behavior, and delusions, followed by depression). Nursing Responsibilities: Advise patient to apply patch the night before a planned trip. Transdermal method releases a controlled therapeutic amount of drug. Transderm-Scop is effective if applied 2 or 3 hours before experiencing motion but is more effective if applied 12 hours before. Instruct patient to remove one patch before applying another Instruct patient to wash and dry hands thoroughly before and after applying the transdermal patch (on dry skin behind the ear) and before touching the eye because pupil may dilate. Tell patient to discard patch after removing it and to wash application site thoroughly. Tell patient that if patch becomes displaced, he should remove it and apply another patch on a fresh skin site behind the ear. Alert patient to possible withdrawal signs or symptoms (nausea, vomiting, headache, dizziness) when transdermal system is used for longer than 72 hours. Advice patient that eyes may be ore sensitive to light while wearing patch. Advice patient to wear sunglasses for comfort Urge patient to report urinary hesitancy or urine retention.

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Brand Name: Calcium Gluconate Generic Drug: Calcium Gluconate

Indication & Dosage

Oral Hypocalcaemia and calcium deficiency states Adult: 10-50 mmol daily, adjusted according to patient's needs. Intravenous Severe acute hypocalcaemia or hypocalcaemic tetany Adult: 2.25 mmol by slow IV inj over 10 min, followed by 58-77 ml of 10% calcium gluconate solution in 0.5-1L of 5% dextrose solution as continuous IV infusion. Child: Neonate and 1 mth18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution. Intravenous

Severe hyperkalaemia Adult: 10 ml of 10% calcium gluconate solution over 2 min, repeated every 10 min if needed. Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution. Intravenous Antidote in severe hypermagnesaemia Adult: 10 ml of 10% calcium gluconate solution over 2 min, repeated every 10 min if needed. Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution. Contraindications Patients with calcium renal calculi or history of renal calculi. Conditions associated with hypercalcaemia and hypercalciuria. Special Precautions Impaired renal function; cardiac disease; hypercalcaemia-associated diseases, e.g. sarcoidosis; other malignancies. Pregnancy. Adverse Drug Reactions GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation. Potentially Fatal: Cardiac arrhythmias and coma. Drug Interactions Co-admin of high calcium doses with thiazide diuretics may result in milk-alkali syndrome and hypercalcaemia. May potentiate digoxin toxicity. Decreases effects of calcium-channel blockers. Enhanced absorption with calcitriol (a vitamin D metabolite). Pregnancy Category (US FDA) Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus. Mechanism of Action Calcium gluconate is used to prevent or treat negative calcium balance. It also helps facilitate nerve and muscle performance as well as normal cardiac function. Absorption: Soluble calcium is predominantly absorbed from the small intestine by active transport and passive diffusion. Small intestines by active transport and passive diffusion. There is increased absorption in calcium deficiency and during childhood, pregnancy and lactation. Distribution: Crosses the placenta and enters breast milk. Excretion: Excreted mainly in the kidneys (as excess calcium), faeces (as unabsorbed calcium) with traces found in sweat, skin, hair and nails. MIMS Class ATC Classification Electrolytes A12AA03 - Calcium gluconate ; Belongs to the class of calcium-containing preparations. Used as dietary supplements. D11AX03 - Calcium gluconate ; Belongs to the class of other dermatologicals.

Nursing Considerations 1. 2. 3. 4. 5. Observe site closely for extravasation. Infiltration of tissues may cause local tissue necrosis. Monitor for adverse reactions. Continuous cardiac monitoring during administration of slow IV infusion via a syringe pump. Observe for bradycardia and arrhythmia. Assess gastro-intestinal status carefully during oral administration.

Classification: ANXIOLYTICS, HYPNOTICS & SEDATIVES Action And Indication Name Of Drug Generic: midazolam Brand: Dormicum Dose Frequency And Route 15 mg 2 tablets HS Action May potentiate the effect of GABA, depress the CNS, and suppress the spread of seizure activity. Indication Disturbances of sleep rhythm, insomnia esp. difficulty in falling asleep either initially or after premature awakening. Adverse Effects CNS: Oversedation, drowsiness, amnesia, headache, involuntary movements, nystagmus, paradoxical behaviour or excitement. Cardiovascular: Variations in blood pressure and pulse rate. Respiratory: Apnea, decreased respiratory rate, hiccups. Gastrointestinal: Nausea, vomiting.

Contraindication Known hypersensitivity to benzodiazepines or to any component of Dormicum. y Severe respiratory and hepatic insufficiency, sleep apnea syndrome, myasthenia gravis. y

Those with acute angle closure glaucoma, shock, coma, or acute alcohol intoxication. y Children. Y NursingResponsibilities Tell patient to take drug with or without food. If patient is taking it as a sleeping pill, take drug before going to bed. y Advise patient to avoid alcohol and grapefruit juice while taking the drug. y Tell patient if he misses a dose take it at his next scheduled dose. y Warn patient to avoid hazardous activities that require alertnessor good coordinationuntil effects of drug are known. y Tell patient to store the drug in a cool, dry place away from the reach of children