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DRUG
NAME
BRAND
NAME
CLASSIFICATION MECHANISM OF
ACTION
INDICATION ADVERSE EFFECT NURSING
CONSIDERATION
Tramadol hydrochloride 50 mg IVTT q8H PRN Ultram Pharmacologic class: Opioid agonist Therapeutic class: Analgesic Tramadol is a centrally acting analgesic that has opioid agonist properties. It binds to μ-opiate receptors in the CNS resulting in inhibition of ascending pain pathways, thus altering the perception of and response to pain. Its inhibition of neuronal uptake of norepinephrine and enhancement of serotonin release may also contribute to its analgesic effect. Inhibits reuptake of serotonin and nor- epinephrine in CNS.
N02AX02 -
tramadol; Belongs to the class of other opioids. Used to relieve moderate to severe pain. CNS : dizziness, vertigo, headache, drowsiness, anxiety, stimulation, con- fusion, incoordination, euphoria, nervousness, sleep disorder, asthenia, hypertonia, seizures, suicide CV : vasodilation EENT: visual disturbances GI : nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, dry mouth, anorexia GU: urinary retention and frequency, proteinuria, menopausal symptoms Respiratory : respiratory depression (With large doses, concomitant anesthetic use, or alcohol ingestion), bronchospasm Skin: pruritus, sweating, hives, Patient monitoring ● Assess patient’s response to drug 30 minutes after administration. ● Monitor respiratory status. Withhold drug and contact prescriber if respirations become shallow or slower than 12 breaths/minu te.
- Monitor for physical and psychological drug dependence. Report signs to prescriber. -Monitor patient for signs and symptoms of potentially life- threatening serotonin syndrome, which may range from shivering and diarrhea to muscle rigidity, fever, mental status changes, and seizures. Patient teaching ● Tell patient drug works best when taken before pain becomes severe.
angioedema, toxic epidermal necrolysis, Stevens-Johnson syndrome Other : physical or psychological drug dependence, drug tolerance, serotonin syndrome, serious and rarely fatal anaphylactoid reactions ● Inform patient (and significant other as appropriate) that drug may cause respiratory depression if used with alcohol. Recommend abstinence. -Instruct patient to immediately report seizure, suicidal behavior, or suicidal ideation. -Instruct patient to watch for and immediately report signs and symptoms of serotonin syndrome (shivering and diarrhea, muscle rigidity, fever, and seizures). -Tell patient to immediately report sign and symptoms of allergic reaction (Such as itching, hives, difficulty breathing, or swelling of face, tongue, or throat). ● Tell patient drug interacts with many
Omeprazole 40 mg given as an intravenous infusion to be completed one hour before surgery. Prilosec, prilosec OTC Pharmacologic class: Proton pump inhibitor Therapeutic class: Antiulcer Omeprazole interferes with gastric acid secretion by inhibiting the hydrogen potassium adenosine triphosphatase (H+ K+ -ATPase) enzyme system, or proton pump, in gastric parietal cells. Normally, the proton pump uses energy from hydrolysis of adenosine triphosphate to drive hydrogen (H+) and chloride (Cl−) out of parietal cells and into the stomach lumen in exchange for potassium (K+), which leaves the stomach lumen and enters parietal cells. After this exchange, H+ and Cl− combine in the stomach to form hydrochloric acid (HCl), as shown below For Treatment of duodenal and gastric ulcer. CNS: Agitation, asthenia, dizziness, drowsiness, fatigue, fever, headache, malaise, psychic disturbance, somnolence CV: Chest pain, hypertension, peripheral edema EENT: Anterior ischemic optic neuropathy, optic atrophy or neuritis, otitis media, stomatitis ENDO: Hypoglycemia GI: Abdominal pain, acid regurgitation, constipation, diarrhea, Clostridium difficile-associated diarrhea, dyspepsia, elevated liver enzymes, flatulence, fundic gland polyps (long- term use), hepatic dysfunction or failure, indigestion, nausea, pancreatitis, vomiting GU: Interstitial nephritis HEME: Agranulocytosis, anemia, hemolytic anemia, leukopenia, leukocytosis, neutropenia, pancytopenia, Give omeprazole before meals, preferably in the morning for once-daily dosing. If needed, also give an antacid, as prescribed. Give drug via NG tube, when needed by mixing granules in acidic juice, because enteric coating dissolves in alkaline pH, or using the delayed-release oral suspension form by mixing with water. Know that because drug can interfere with absorption of vitamin B12, monitor patient for macrocytic anemia. Be aware that long-term use of omeprazole may increase the risk of gastric carcinoma and symptomatic response to omeprazole therapy does not rule out the presence of gastric tumors. Know that omeprazole
left. Omeprazole irreversibly blocks the exchange of intracellular H+ and extracellular K+, as shown below right. By preventing H+ from entering the stomach lumen, omeprazole keeps additional HCl from forming thrombocytopenia MS: Back pain, bone fracture, joint painRESP: Bronchospasms, cough, upper respiratory infection SKIN: Cutaneous lupus erythematosis, erythema multiforme, photosensitivity, pruritus, rash, Stevens– Johnson syndrome, toxic epidermal necrolysis, urticaria Other: Anaphylaxis, angioedema, hypomagnesemia, hyponatremia, systemic lupus erythematosus, vitamin B12 deficiency (long-term use) therapy may produce false elevations of serum chromogranin levels, used to help diagnosis presence of neuroendocrine tumors. If test results are high, withhold omeprazole therapy temporarily and repeat test, as ordered Keep in mind that if omeprazole is given with antibiotics, watch for diarrhea from C. difficile. If diarrhea occurs, notify prescriber and expect to withhold drug and treat with electrolytes, fluids, protein, and an antibiotic effective against C. difficile. Monitor patient’s urine output because omeprazole may cause acute interstitial nephritis. Notify prescriber if urine output decreases or there is blood in patient’s urine. Know that proton pump inhibitors such as
vomiting abdominal pain stomach upset gas headache itching or rash hives cough stuffy nose stiff or tight muscles muscle pain joint pain or swelling restlessness irritability hyperactivity vaginal itching or discharge unusual or unpleasant taste in the mouth white patches or sores in the mouth, and diaper rash (in infants taking liquid cefuroxime). urticaria). Notify physician or nursing staff immediately if these reactions occur. Monitor signs of blood dyscrasias, including eosinophilia (fatigue, weakness, myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), leukopenia (fever, sore throat, mucosal lesions, signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums, other bleeding problems). Report these signs to the physician. Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.
Paracetamol IV: 300mg IVTT q 4 h Acetaminophe n
PHARMACOTHERAPEUTIC:
analgesics and antipyretics Paracetamol has a central analgesic effect that is mediated through activation of descending serotonergic pathways. Debate exists about its primary site of action, which may be inhibition of prostaglandin (PG) synthesis or through an active metabolite influencing cannabinoid receptors. Paracetamol is a mild analgesic and antipyretic, and is recommended for the treatment of most painful and febrile conditions, for example, headache including migraine, toothache, neuralgia, colds and influenza, sore throat, backache, rheumatic pain and dysmenorrhoea. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. Do not exceed 4gm/24hr. In adults Monitor CBC, liver, and renal functions. Assess for fecal occult blood and nephritis. Avoid using OTC drugs with Acetaminophen. Take with food or milk to minimize GI upset. Report N&V. cyanosis, shortness of breath, and abdominal pain as these are signs of toxicity. Report paleness, weakness, and heartbeat skips Report abdominal pain, jaundice, dark urine, itchiness, or clay- colored stools. Phenmacetin may cause urine to become dark brown or wine-colored. Report pain that persists for more than 3-5 days Avoid alcohol. This drug is not for regular use with any form of liver disease.
