Drugs Name RANITIDINE (Zantac)

Classification Histamine Blocker

Indication Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Action Potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2-receptor sites on parietal cells, thus blocking gastric acid secretion. Indirectly reduces pepsin secretion but appears to have minimal effect on fasting and postprandial serum gastrin concentrations or secretion of gastric intrinsic factor or mucus.

Contraindications/ Precautions Contraindicated with allergy to ranitidine, lactation. Use cautiously with impaired renal or hepatic function and pregnancy.

Adverse Reaction

Patient/ Family Teaching CNS: Take drug Confusion, with meals and dizziness, at bedtime. drowsiness, Therapy may hallucinations, continue for 4headache 6 weeks or CV: longer. Arrhythmias If you are GI: also using an Altered taste, antacid, take it black tongue, exactly as constipation, dark prescribed, stools, diarrhea, being careful of nausea the times of GU: administration. Decreased sperm Have regular count, impotence medical follow HEMATOLOGY: up care to Agranulocytosis, evaluate your neutropenia, response. thrombocytopenia Report sore MISC: throat, fever, Hypersensitivity unusual reactions, bruising or vasculitis bleeding, tarry stools, severe headache, muscle or joint pain.

Drugs Name Phospho-soda (sodium biphosphate and sodium phosphate)

Classification Laxatives, Purgatives

Indication Relief of occasional constipation. For bowel cleansing prior to medical procedures e.g. surgery, x-ray or endoscopic exam.

Action Saline laxative; osmotically mediated water retention which stimulates peristalsis.

Contraindications/ Adverse Reaction Precautions Impaired renal Transient function, hyperphosphatemia. preexisting electrolyte imbalances, and debilitated patients. Rectal bleeding or no bowel movement after use.

Patient/ Family Teaching Should be taken on an empty stomach (Take on an empty stomach 1 hr before or 2 hr after meals. Dilute recommended dose w/ glass of water, drink & follow w/ 1 full glass of water.).

Drugs Name

Classification

Indication

Action

Contraindications/ Precautions Severe renal impairment; pregnancy, lactation; hypersensitivity to penicillins. Hypersensitivity to cephalosporins.

Adverse Reaction

Darcef (cefuroxime)

Second Uncomplicated generation urinary tract cephalosporins infections Respiratory tract infections Uncomplicated gonorrhoea Otitis media Meningitis Renal impairment

Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. Absorption: Absorbed from the GI tract with peak plasma concentrations after 23 hr (oral); may be enhanced by the presence of food. Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic concentrations). Crosses the placenta and enters breast milk. Protein-binding: Up to 50%. Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).

Patient/ Family Teaching Large doses Advise patient can cause to cerebral immediately irritation and report rash or convulsions; bleeding nausea, tendency. vomiting, Instruct diarrhea, GI patient to take disturbances; drug with food erythema every 12 multiform, hours as Stevensprescribed. Johnson Teach syndrome, patient how to epidermal recognize necrolysis. signs and Potentially symptoms of Fatal: Anaphyl super axis, infection. nephrotoxicity Instruct him to , report these pseudomembr right away. anous colitis. Advise patient to report CNS changes. As appropriate, review all other significant and lifethreatening

Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile (small amounts); 70 min (elimination halflife); prolonged in neonates and renal impairment.

adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

Drugs Name Hemostan

Classification

Indication

Action

Contraindications/ Precautions Forms a reversible complex that displaces plasminogen from fibrin resultin g in inhibition of fibrinolysis Forms a reversible complex that displaces plasminogen from fibrin resultin g in inhibition of fibrinolysis, Not advisable to use for prolonged periods in patients predisposed to thrombosis. Not recommended for prophylaxis during pregnancy and before delivery. Opthalmic exam before and during therapy required if patient is treated beyond several days; caution in patients with cardiovascular, renal and cerebrovascular disease.

Adverse Reaction

Antihemophilic agent

Antihemorrhagic and antifibrinolytic for effective hemostasis in various surgical and clinical cases.

Gastrointestina l disorders: Nausea, Vomiting Central Nervous System: Anorexia, Headache, impaired renal insufficiency, hypotension occurs when iv injection is too rapid

Patient/ Family Teaching Dosage modificati on required in patients with renal impairme nt. Watch out for any signs of bleeding.

Drugs Name Furosemide

Classification Electrolytic and water balance agent; loop diuretic.

Indication For the treatmen t of edema associat ed with congesti ve heart failure, cirrhosis of the liver, and renal disease, including the nephrotic syndrom e. Also for the treatmen t of hyperten sion alone or in combinat ion with other antihyper tensive agents.

Action Furosemide inhibits reabsorptio n of Na and chloride mainly in the medullary portion of the ascending Loop of Henle. Excretion of potassium and ammonia is also increased while uric acid excretion is reduced. It increases plasmarenin levels and secondary hyperaldost eronism may result. Furosemide reduces BP

Contraindications/ Adverse Precautions Reaction Severe sodium and water depletion, hypersens itivity to sulphona mides and furosemid e, hypokalae mia, hyponatra emia, precomato se states associate d with liver cirrhosis, anuria or renal failure. Addison's disease. Monitor fluid and electrolyte balance and renal function. It also lowers serum levels of Rashe s, photos ensitivi ty, nause a, diarrh oea, blurre d vision, dizzin ess, heada che, hypote nsion. Hypok alaemi a and magne sium depleti on can cause cardia c arrhyt hmias. Fluid and electro lyte

Patient/ Family Teaching Instruct patient to take furosemide as directed. Take missed doses as soon as possible; do not double doses Caution patient to change positions slowly to minimize orthostatic hypotension. Instruct patient to consult health care professional regarding a diet high in potassium Advise patient to contact health care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs. Emphasize the importance of routine follow-up examinations Advise patients on antihypertensive

in hypertensiv es as well as in normotensiv es. It also reduces pulmonary oedema before diuresis has set in.

calcium and magnesiu m, thus serum levels should be monitored. Pregnanc y and lactation.

imbala nce.

regimen to continue taking medication even if feeling better. Furosemide controls but does not cure hypertension.

Drugs Name Metronidazo le

Classificati on Antimicrobi al

Indication

Action

Contraindications/ Precautions History of hypersensit ivity to metronidaz ole or other nitroimidaz ole derivatives. Patients with Central Nervous System diseases; discontinue iv therapy if abnormal neurologic symptoms occur. History of seizure disorder. Evidence or a history of blood dyscrasias; perform total and differential leukocyte counts

Adverse Reaction

Treatment of serious abdominal infections due to susceptible anaerobic bacteria. Treatment of protozoal infections. e.g. Amebiasis, giardiasis, trichomonia sis

selectively absorbed by anaerobic bacteria and sensitive prot ozoa. Once taken up by anaerobes, it is nonenzymaticall y reduced by reacting with reduced ferre doxin, which is generated by pyruvate oxidoreductase.

GIdisturbances e.g. Nausea, unpleasant metallic taste, vomiting, diarrhoea or constipation. Furred tongue, glossitis, and stomatitis due to overgrowth of candida. Rarely, antibioticassociated colitis. Weakness, dizziness, ataxia, headache, drowsiness, insomnia, changes in mood or mental state. Numbness or tingling in the extremities, epileptiform seizures (high doses or prolonged

Patient/ Family Teaching Advise patient to take drug with food if it causes GI upset. Howev er, instruct him to take extend edrelease tablets 1 hour before or 2 hours after meals. Advise patient to report fever, sore

before and after treatment. Severe hepatic impairment; monitor plasma levels. Prolonged use may result in fungal or bacterial superinfecti on.

treatment). Transient leucopenia and thrombocytopen ia. Hypersensitivity reactions. Urethral discomfort and darkening of urine. Raised liver enzyme values, cholestatic hepatitis, and jaundice. Thrombophlebiti s.

throat, bleedin g, or bruisin g. Infor m patie nt that drug may caus e metal lic taste and may discol or urine to brow nishred.

Drugs Name Salbutamol

Classification Bronchodilator (therapeutic); adrenergics (pharmacologic)

Indication For symptomatic relief and prevention of bronchospasm due to bronchial asthma, chronic bronchitis, and other chronic bronchopulmon ary disorders such as COPD.

Action It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.

Contraindications/ Precautions Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons Cardiac disease including coronary insufficiency, a history of stroke, coronary artery diseaseand cardiac arrhythmias Hypertension Hyperthyroidism Diabetes Glaucoma Geriatric patients older individuals are at higher risk for adverse reactions and may require lower dosage Pregnancy especially near term Lactation Children less than 2 years of age because safety of its use has not been established Excess inhaler use which may lead to tolerance and paradoxical bronchospasm

Adverse Reaction Nervousness Restlessness Tremor Headache Insomnia Chest pain Palpitations Angina Arrhythmias Hypertension Nausea and vomiting Hyperglycemia Hypokalemia

Patient/ Family Teaching Tell patient to swallow extendedrelease tablets whole and not to mix them with food. Teach patient signs and symptoms of hypersensitivity reaction and paradoxical bronchospasm. Tell him to stop taking drug immediately and contact prescriber if these occur. Instruct patient to notify prescriber immediately if prescribed dosage fails to provide usual relief, because this may indicate seriously worsening asthma. Advise patient

to limit intake of caffeine containing foods and beverages and to avoid herbs unless prescriber approves. Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness. Advise patient to establish effective bedtime routine and to take drug well before bedtime to minimize insomnia. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to

the drugs, foods, and herbs mentioned above.

Drugs Name Ketorola c (Toradol )

Classificatio n Nonsteroida l antiinflammator y agents, nonopioid analagesics

Indication

Action Inhibits prostaglandin synthesis, producing peripherally mediated analgesia. Also have antipyretic and antiinflammatory properties. Therapeutic effect: Decreased pain.

Contraindications/ Precautions Hypersensitivity Cross-sensitivity with other Non-Steroidal Anti-Inflammatory Drugs may existPre- or perioperative use Known alcohol intolerance Use cautiously in: 1. History of GastroIntestinal bleeding 2. Renal impairment (dosage reduction may be required) 3. Cardiovascular disease

Adverse Reaction

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

CENTRAL NERVOUS SYSTEM: drowsiness, abnormal thinking, dizziness, euphoria, headache RESPIRATORY: asthma, dyspnea CARDIOVASCULAR: edema, pallor, vasodilation GASTROINTESTINAL: GI Bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea GENITOURINARY: oliguria, renal toxicity, urinary frequency DERMATOLOGY: pruritis, purpura, sweating, urticaria HEMATOLOGY: prolonged bleeding time LOCAL: injection site pain NEURO: paresthesia MISCELLANEOUS: allergic reaction, anaphylaxis

Patient/ Family Teaching Instruct patient on how and when to ask for pain medicatio. Take missed doses as soon as remember ed if not almost time for next dose. Do not double doses. Do not take more than prescribed or for longer than 5 days. May cause drowsiness or dizziness. Advise patient to avoid driving or

other activities requiring alertness until response to the medication is known.

Drugs Name Tramadol

Classification Analgesics

Indication Moderate to moderately severe pain

Action Physiologic Mechanism Decreased pain. Pharmacologic Mechanism Binds to muopioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS

Contraindications/ Precautions abrupt discontinuation, ethanol intoxication, opiate agonist hypersensitivity, breastfeeding, children, driving or operating machinery, elderly, GI disease, head trauma, hepatic disease, increased intracranial pressure, labor, pregnancy, renal impairment, respiratory depression, seizure disorder, substance abuse

Adverse Reaction Dizziness or vertigo, Nausea and Vomiting, Constipation, Headache, Somnolence, Pruritus, CNS Stimulation, Asthenia, Diaphoresis, Dyspepsia, Dry mouth, Diarrhea, Malaise, Vasodilatation, Anorexia, Flatulence, Rash, Visual disturbance, Urinary retention or frequency, Menopausal symptoms

Patient/ Family Teaching May cause dependence. Avoid alcohol and over-thecounter medications. May cause drowsiness, dizziness, and blurred vision. Avoid tasks requiring alertness and motor skills until response to drug is established. Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.

Drugs Name Cefuroxime

Classification cephalosporin

Indication For the treatment of many different types of bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections.

Action Secondgeneration cephalosporin that inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal.

Contraindications/ Adverse Reaction Precautions * Contraindicated in patients hypersensitive to drug. * Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other betalactam antibiotics. * Use with caution in breast-feeding women and in patients with history of colitis or renal sufficiency.

Patient/ Family Teaching

CV Report loose phlebitis, stools or thrombophlebitis diarrhea GI promptly. pseudomembranous Report any colitis, nausea, signs or anorexia, vomiting, symptoms of diarrhea hypersensitivity Hematologic Do not breast transient feed while neutropenia, taking this eosinophilia, drug. hemolytic anemia, thrombocytopenia Skin maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection site Other Hypersensitivity reactions, serum sickness, anaphylaxis.

Drugs Name Nalbuphine

Classification Narcotic agonistantagonist analgesic

Indication For the relief of moderate to severe pain. Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and delivery

Action Nalbuphine acts as an agonist at specific opioid receptors in the CNS to produce analgesia, sedation but also acts to cause hallucinations and is an antagonist at receptors.

Contraindications/ Precautions Contraindications: hypersensitivity to nalbuphine, sulfites; lactation. Use cautiously with emotionally unstable clients or those with a history of narcotic abuse; pregnancy prior to labor, labor or delivery, bronchial asthma, COPD, respiratory depression, anoxia, increased intracranial pressure, acute MI when nausea and vomiting are present, biliary tract surgery

Adverse Reaction CNS: Sedation. Clamminess, sweating headache, nervousness, restlessness, depression, crying, confusion, faintness, hostility, unusual dreams, hallucinations, euphoria, dysphoria, unreality, dizziness, vertigo, floating feeling, feeling of heaviness, numbness, tingling, flushing, warmth, blurred vision. CV: Hypotension, Hypertension, bradycardia, tachycardia DERMATOLOGIC: Itching, burning, urticaria GI:

Patient/ Family Teaching Instruct patient on how and when to ask for pain medication. May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating and to avoid driving or other activities requiring alertness until response to the medication is known. Caution patient to change positions slowly to minimize orthostatic hypotension. Advise patient that frequent

Nausea, vomiting, cramps, dyspepsia, bitter taste, dry mouth GU: Urinary urgency RESPIRATORY: Respiratory depression, dyspnea, asthma

mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth. Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis . Advise patient to avoid concurrent use of alcohol or other CNS depressants with this medication.