DRUG STUDY

Prescribed and Recommended Dosage, Frequency, and route of Administration

Generic Name Brand Name Classifications

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Methyldopa

Stimulates CNS alpha-adrenergic receptors, producing a decrease in sympathetic outflow to heart, kidneys, and blood vessels. Result is decreased blood pressure and peripheral resistance, a slight decrease in heart rate, and no change in cardiac output.

Management of moderate to severe hypertension

Contraindicated in: Hypersensitivity; Active liver disease. Use Cautiously in: Previous history of liver disease; OB: Has been used safely (may be used for treatment of hypertension in pregnancy); Lactation: Usually compatible with breastfeeding; Geri: qrisk of adverse reactions; consider age-related impairment of hepatic, renal and cardiovascular function as well as other chronic illnesses. Appears on Beers list. May cause bradycardia and exacerbate depression.

CNS: sedation,pmental acuity, depression. EENT: nasal stuffiness. CV: MYOCARDITIS, bradycardia, edema, orthostatic hypotension. GI:
DRUGINDUCED HEPATITIS,

diarrhea, dry mouth. GU: erectile dysfunction. Hemat: eosinophilia, hemolytic anemia. Misc: fever.

-Monitor blood pressure and pulse frequently -Monitor intake and output ratios and weight and assess for edema daily, -Monitor direct Coombs test before and after 6 and 12 mo of therapy. -Dose increases should be made with the evening dose to minimize drowsiness. -Tell patient not to suddenly stop taking drug, but to notify prescriber if unpleasant adverse reaction occurs -Tell patient that urine may turn dark if left sitting in toilet bowl. -Instruct patient to report signs and symptoms of infection.

DRUG STUDY
Prescribed and Recommende d Dosage, Frequency, and route of Administratio n

Generic Name Brand Name Classification s

Mechanism of Action

Indicatio n

Contraindicatio n

Adverse Reaction

Nursing Responsiblitie s

Acetaminophe n Paracetamol

Unknown. Thought to produce analgesia by blocking pain impulses by inhibing synthesis of prostaglandi n in the CNS or of other substances that sensitive pain receptors to stimulation. The drug may relieve

Indicated to mild pain or fever

Contraindicated in patients hypersensitive to drug Use cautiously in patients with long term alcohol use because therapeutic doses cause hepatoxicity in these patients.

Hematologic:hemolyti c anemia, neutropenia, leucopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria

-Advice patient that drug is only for short-term use -Tell breatsfeeding women that acetaminophen appears in breast milk in low levels. Drug may be used safely if therapy is short-term and doesnt exceed recommended doses -Warn patient that high doses

fever through central action in the hypothalami c heatregulating center.

or unsupervised long-term use can cause liver damage -

DRUG STUDY
Prescribed and Recommende d Dosage, Frequency, and route of Administratio n

Generic Name Brand Name Classification s

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblitie s

Carboprost tromethamine

A prostaglandi n that produces strong, prompt contractions of uterine smooth muscle, possibly mediated by calcium and cAMP

> to terminate pregnancy between weeks 13 and 20 gestation > postpartum hemorrhag e from uterine atony not managed by convention al methods.

- Contraindicated in patients hypersensitive to drug and in those with acute pelvic inflammatory disease or active cardiac, pulmonary, renal,or hepatic disease - Use cautiously in patients with history of asthma, hypotension, hypertension,anemi a, jaundice, or diabetes and those with seizure disorders, previous uterine surgery, or

CNS: fever, headache, anxiety, paresthesia, syncope, weakness CV: chest pain, arrhythmias, flushing EENT: blurred vision, eye pain GI: vomiting, diarrhea, nausea GU: endometritis, uterine or vaginal pain Musculoskeleta l: backache, leg cramps

-Instruct patient to report adverse reactions promptly -Explain use and administration of drug to patient and family -

CV, adrenal renal or hepatic disease

Respiratory: coughing, wheezing, Skin: rash, diaphoresis Other: breast tenderness, chills, hot flashes

DRUG STUDY
Prescribed and Recommended Dosage, Frequency, and route of Administration

Generic Name Brand Name Classifications

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Combivent

Inhaln: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation. Intranasal: Local application inhibits secretions from glands lining the nasal mucosa. Therapeutic Effects: Inhaln: Bronchodilation without systemic anticholinergic

Inhaln: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema. Intranasal: Rhinorrhea associated with allergic and nonallergic perennial rhinitis (0.03% solution) or the common cold (0.06% solution). Unlabeled Use: Inhaln: Adjunctive management

Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide; Avoid use during acute bronchospasm; Use Cautiously in: Patients with bladder neck obstruction, prostatic hyperplasia, glaucoma, or urinary retention

CNS: dizziness, headache, nervousness. EENT: blurred vision, sore throat; nasal only, epistaxis, nasal dryness/irritation. Resp: bronchospasm, cough. CV: hypotension, palpitations. GI: GI irritation, nausea. Derm: rash. Misc: allergic reactions.

- Assess for allergy to

atropine and belladonna alkaloids; - Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. - If paradoxical bronchospasm (wheezing) occurs, withhold medication and notify health care professional immediately. - Instruct patient in proper use of nebulizer and to take medication as directed - Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication. - Advise patient to contact health care professional

if symptoms do not improve within 12 wk or if condition worsens.

DRUG STUDY
Prescribed and Recommended Dosage, Frequency, and route of Administration

Generic Name Brand Name Classifications

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Tramadol Dolcet

Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. Therapeutic Effects: Decreased pain.

Moderate to moderately severe pain

Contraindicated in: Hypersensitivity; Crosssensitivity with opioids may occur; Patients who are acutely intoxicated with alcohol, sedatives/hypnotics, centrally acting analgesics, opioid analgesics, or psychotropic agents; Patients who are physically dependent on opioid analgesics Use Cautiously in: Geri: Not to exceed 300 mg/day in patients _75 yr; Renal impairment (qdosing interval recommended if CCr _30 mL/min); Hepatic impairment (qdosing interval recommended in patients with cirrhosis); Patients receiving MAO inhibitors or CNS depressants; Patients with a history of opioid dependence or who have recently received

CNS: SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, weakness. EENT: visual disturbances. CV: vasodilation. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting. GU: menopausal symptoms, urinary retention/frequency. Derm: pruritus, sweating. Neuro: hypertonia. Misc: physical dependence, psychological dependence,

- Assess type, location, and intensity of pain before and 23 hr (peak) after administration. - Assess blood pressure and respiratory rate before and periodically during administration. - Explain therapeutic value of medication before administration to enhance the analgesic effect. - Regularly administered doses may be more effective than prn administration. Analgesic is more effective if given before pain becomes severe. - May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.

large doses of opioids;

tolerance.

- Advise female patients to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. - Encourage patient to turn, cough, and breathe deeply every 2 hr to prevent atelectasis.