Glucocorticoid

/ Corticosteroid

Given dose: 5 milligram IVTT every 6 hours

MOA: Suppress inflammatory process and for immunosuppression.

 Indication:

Cerebral Edema Side-effects: Mood changes Headache

NURSING RESPONSIBILITIES
Monitor

Vital Signs and Body weight If drug therapy is discontinued, the dose should be tapered.

 Osmotic

Diuretic For ICp/IOP : 15-25% solution infuse over 30-60 minutes For edema, ascites, oliguria : 10-20% solution over 90 minutes to 6 hours Given Dose: 20% 100 millilitre to 6 hours

Indication: Used to prevent kidney failure,toxic over dose, decrease Intracranial pressure (cerebral edema) and intraocular pressure

MOA: Increasing the Osmolality (concentration of plasma and fluid renal tubules). Sodium, chloride, potassium and water are excreted.

Side-effects: >Tachycardia >Hypokalemia (increases the risk of digoxin toxicity)

NURSING RESPONSIBILITIES
Monitor

vital signs

Monitor
Check Check

intake and output

ECG

urine output. It must increase in 5-20 minutes. If not, notify he physician.

 Opiod

Analgesic / Narcotic Given dose: 2 milligram IVTT every 6 hours MOA: Depression of the CNS: depression of pain impulse by binding with the opiate receptor in the CNS.

 Indication:

To relieve severe pain / pre-op

medication
Side-effects:

Drowsiness Sedation Rash

NURSING RESPONSIBILITIES
Monitor Monitor Have

Vital signs at frequent intervals clients urine output

naloxone (narcan) available.

 Anti-hypertensive:

angiotensin converting enzyme (ACE) inhibitor

dose: 25 mg Sublingual every 4 hours PRN for BP > 140/90

Given

Indication: To reduce Blood pressure MOA: Suppression of ACE: inhibits Angiotensin 1 conversion to angiotensin 2 (potent vasoconstrictor) leading to decreased blood pressure. Blocks the relase of aldosteron (for water rentention). If aldosterone is blocked, sodium is excreted with water and potassium is retained.

 Side-effects:

Hyperkalemia Taste disturbance

NURSING RESPONSIBILITIES
Check

vital signs before giving the medication Mucous membrane (under the tongue)

Check

Re-check

BP 30 minutes after giving.

 Anti-emetic

Given dose: 10 mg AC (ante cibum) or HS (hours of sleep) Indication: To treat and prevent vomiting / post operative emesis

 MOA:

Suppresses emesis by blocking the dopamine and the serotonin in the Chemoreceptor trigger zone.
Side-effects: Dry mouth

NURSING RESPONSIBILITIES
Provide Suggest

mouth care if vomiting occurs

patient non-pharmacologic methods of alleviating nausea and vomiting: crackers and dry toast

H2 blocker
Given Dose: 10 mg

Indication: To prevent and treat peptic ulcer, gastric and duodenal ulcer, gastroesophageal reflux, stress ulcer (from major surgery)

 MOA:

Inhibition of gastric acid secretion by inhibiting histamine at histamine 2 receptors in parietal cells thus reducing gastric acid secretion and concentration.

Side-effects:

Nausea and Vomiting Diarrhea

NURSING RESPONSIBILITIES
Administer

drug just before meals or at

bedtime
Be

alert that reduce dose of drug is need for older adult patient to avoid caffeinated drinks, alcohol and spices.

Advise

 Second

generation Cephalosporin -Broad spectrum against other gram-negative bacteria H. influenza, N. Gonorrhoea, M. Meningitidis.

Given dose: 750 mg IVTT every 8 hours

Indication: For surgical prophylaxis;

MOA: Inhibition of cell wall synthesis causing cell death; bactericidal effect Side-effects: Pruritus Headache Diarrhea Weakness

NURSING RESPONSIBILITIES

Asses for allergy to cephalosporin Asses vital signs and intake and output.

Check laboratory results : BUN and Crea

Dilute in an appropriate amount of IV fluid (50-100 ml) or 6 ml 8 ml sterile water Administer IV over 30-40 minutes Instruct patient to report headache, dizziness, itchiness, rash

Antibacterial: aminoglycosides
Given dose: 80 mg IVTT every 12 hours Indication: To treat serious infections occurs by gram-negative organism (pseudomonas aeroginosa) and staphylococcus aureus Given with cephalosporin

 MOA:

Inhibition of bacterial protein synthesis; bactericidal effect Side-effects: Rash Numbness Photosensitivity Muscle cramps

NURSING RESPONSIBILITIES Monitor Vital signs and urine output. Compare these results with future vital signs and urine output.
If

combination of antibiotics is given IV, the IV line should flushed after each antibiotic has been administer.

Psychostimulant / nootropic

Given dose: 2 mg IVTT every 8 hours (march 10, 2011) 1 gram IVTT every 8 hours (march 3, 2011) 1 gram IVTT every 12 hours (march 2, 2011)

 Indication:

Cerebral trauma and disturbance of consciousness following brain surgery Signs of cerebral insufficiency e.g. dizziness, memory loss, poor concentration, disorientation, recent cranial trauma.

 MOA:

Increases the neurotransmission levels because it favors the synthesis and production speed of dopamine Side-effects: Unsteady gait Abnormal involuntary movements

NURSING RESPONSIBILITIES
Check Hold

neurological vital signs

and refer physician if the patient develops Hives, swelling of hands and face, and troubled breathing.

 Anti-convulsant

Given dose: 100 mg 1 tablet three times a day Indication: To prevent grand mal and complex partial seizure

 MOA:

Reduces motor cortex activity by altering transport of ions Side-effects:

Discoloration of urine Confusion Dizziness

NURSING RESPONSIBILITIES

Be aware of therapeutic serum concentration: 1020 mcg/mL toxic level: 3050 mcg/mL Check Vitals Signs, continuously

Assess oral hygiene.

Inform patient that there will be discoloration of urine during the course of therapy

 Give

the drug same time every day with food. Assess seizure location, duration, frequency and characteristics of seizure activity Asses patient for phenytoin hypersensitivity syndrome (fever, skin, rash and lymphopathy) rash usually occurs within the first 2 weeks of therapy

 Osmotic
Given

laxative

Dose: 30 ml

Indication:

For the treatment of constipation. Used in bowel preparation for diagnostic and surgical procedure.

 MOA:

Pull water into the colon and increase water in the feces to increase bulk which stimulates peristalsis and defecation.

Side-effects: Flatulence

NURSING RESPONSIBILITIES
Ten

rights in giving the medication.

Instruct

patient to increase water intake, if not contraindicated

Assess

patient for diarrhea

Intake and Output

Monitor

 Calcium-Channel

blocker
Dose: Indication: Prophylaxis and treatment o ischemic neurological deficits due to cerebral vasospasms after subarahnoid hemorrhage

 MOA:

Decreases calcium levels by blocking free calcium ions in the myocardium thus decreases cardiac contractility. Side effects: light-headedness

 NURSINGRESPONSIBILITIES: Check

Vitals signs before and after giving the drug, esp. BP Instruct patient to report dizziness or faintness occurs. Place patient in supine position with legs elevated after giving.