Nursing Drug Analysis Generic Name & Possible Brand Names 1.

Sevoflurane Brand Name: Ultane Indications/Rationale for giving the medications Induction and maintenance of general anesthesia Mechanism of Action induces a state in which the CNS is altered so that varying degrees of pan relief, depression of consciousness, skeletal muscle relaxation and reflex reduction are produced Side Effects agitation dizziness drowsiness increased cough increased saliva lightheadedness nausea shivering vomiting Adverse Effects Anaphylaxis Irregular heartbeat Seizure Yellowing of the skin or eyes Hypotension Nursing Considerations > Check the name of the patient and the time of administration. > Monitor vital signs. > Monitor all the body systems. > Continuous monitoring of pulse oximetry. > Postural BP should be taken. > Take note of that time that the drug has expired. >Stop durg immediately, administer oxygen >Start rapid fluid resuscitation >Make sure client is well ventilated >Seizure precation >Administer epinephrine

2. Atracurium Brand Name: Tracrium

Muscle relaxant in general anaesthesia, Endotracheal intubation, Aid controlled ventilation

blocks neural transmission at the neuromuscular junction by competitive binding at the cholinergic receptor sites on the motor end plate.

heart rate increase, bronchospasm, decrease in blood pressure and skin rash

CV: Bradycardia, tachycardia. Respiratory: Respiratory depression. Other: Increased salivation, anaphylaxis. Cutaneous reactions; bradycardia, transient hypotension in patients with CVS disorders; dyspnoea, bronchospasm; rash and urticaria

Lab tests: Baseline serum electrolytes, acidbase balance, and renal function as part of preanesthetic assessment. Note: Personnel and equipment required for endotracheal intubation, administration of oxygen under positive pressure, artificial respiration, and assisted or controlled

Hematologic: hemolytic ventilation must be anemia, leukopenia, pancytopenia Hepatic: jaundice Metabolic: hypoglycemia Skin: rash, urticaria neutropenia, immediately available. Evaluate degree of neuromuscular blockade and muscle paralysis to avoid risk of overdosage by qualified individual using peripheral nerve stimulator. Monitor BP, pulse, and respirations and

evaluate patient's recovery from neuromuscular blocking (curare-like) effect as evidenced by ability to breathe naturally or to take deep breaths and cough, keep eyes open, lift head keeping mouth closed, adequacy of hand-grip strength. Notify physician if recovery is delayed. Note: Recovery from neuromuscular blockade usually begins 3545 min after drug administration and is almost complete in about 1 h. Recovery time may be delayed in patients with cardiovascular disease, edematous states, and in older adults.

3. Fentanyl Brand name: Duragesic

Analgesic action of short duration during anesthesia and immediate postop period Analgesic supplement in general or regional anesthesia Administration with a neuroleptic as an anesthetic premedication, for induction of anesthesia, and as an adjunct in maintenance of general and regional anesthesia For use as an anesthetic agent with oxygen in selected highrisk patients Transdermal system:

Binds to opiate receptors in the CNS, altering the response to and perception of pain.

Anxiety; confusion; constipation; difficulty walking; dizziness; drowsiness; dry mouth; headache; indigestion; itching; nausea; vomiting.

Palpitation, increase or decrease in BP, circulatory depression, cardiac arrest, shock, tachycardia, bradycardia, arrhythmia, palpitations

- Fentanyl interferes with respiratory function and pupil reaction, both of which are essential parts of neurological assessment. - Assess the therapeutic

Rash, hives, pruritus, flushing, warmth, sensitivity to cold Diplopia, blurred vision Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm Ureteral spasm, spasm of retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

response and in breakthrough cancer pain consider adjustment of background analgesia where this is appropriate. - Excessive heat may increase absorption from patches so local heat should not be applied should be carefully monitored. Patient teaching

vesical sphincters, urinary and patients with fever

management of chronic pain in patients requiring opioid analgesia Treatment of breakthrough pain in cancer patients being treated with narcotics (Actiq)

- Medication should be kept out of reach of children and in its original packaging. - Avoid activities that require alertness if patient is affected by drowsiness. - Lozenges should be removed from foil just before administration and sucked over a 15minute period, not chewed. - Patches should be applied to dry, intact skin, non-irradiated nonhairy skin on the torso or upper arm. Replacement patches should be sited on a different area.

4. Propofol

Induction or

The action of propofol

difficulty breathing,

Metabolic Acidosis,

Nurses should refer to

Brand name: Diprivan

maintenance of anaesthesia in cardiology, neurology, paediatric surgery Torticollis, cardiovascular, MRI, malignant hyperthermia, obstetric analgesia Hypersensitivity ICU sedation in ventilated adults Status epilepti cus, nausea/vomiting, intubation, pruritus, sedation following cardiac surgery

involves a positive modulation of the inhibitory function of the neurotransmitter gamaaminobutyric acid(GABA) through GABA-A receptors.

wheezing, swelling of the throat fast heartbeat, palpitations lightheadedness or fainting spells numbness or tingling in the hands or feet seizure (convulsion) skin rash, flushing (redness), or itching swelling or extreme pain at the injection site uncontrollable muscle spasm dizziness pain or irritation at the injection site

Diabetes Mellitus, Rash, Renal Impairment, Renal Failure, Respiratory Failure, Diarrhoea, Respiratory Acidosis, Sepsis, Renal Tubular Necrosis, Clostridial Infection

manufacturer's summary of product characteristics and to appropriate local guidelines Patient should be closely monitored following administration of propofol. Propofol is a very short-acting drug, and its effects generally wear off in just a few hours. However, propofol may affect your ability to drive or operate machinery for several hours after use. Do not attempt to drive yourself home if you have received propofol for minor outpatient surgery or diagnostic tests. Avoid alcohol, mood-altering drugs, or any other medicines for

at least 24 hours after a dose of propofol, unless approved by your prescriber or health care professional. Aseptic technique is essential. Solution is capable of rapid growth of bacteria contaminants. Infections and subsequent dea6hs have been reported May cause drowsiness or dizziness. Advice patients to request assistance prior to ambulation and transfer to avoid driving or any kind of activities that requires alertness until response to medication is known 5. Mannitol Brand Name: Osmitrol, Resectisol Acute oliguric renal failure Toxic overdose In the oliguric phase of acute renal failure, Mannitol increases dry mouth, increased thirst, blurred vision, or seizure (convulsions); Dehydration Anuria Intracranial bleeding Assessment Monitor the following: 1. Vital signs

Edema Increased intracranial pressure (ICP) Intraocular pressure (IOP)

osmotic pressure (pressure needed to stop the absorption of something or osmosis) of the glumerular filtrate, thereby, promoting diuresis (treating the oliguric phase of renal failure) and excretes toxic materials (management for toxic overdose). It also elevates blood plasma osmolality thus, inhibiting the reabsorption of water and electrolytes (for relief of edema) and mobilizing fluids in the cerebral and ocular spaces (lowers intracranial or intraocular pressure).

swelling, pain, or skin changes where the medicine was injected; chest pain, fast heart rate; feeling like you might pass out; feeling short of breath, even with mild exertion; swelling, rapid weight gain; or if you stop urinating. nausea, vomiting; runny nose; dizziness; chills; or mild skin rash.

Headache Blurred vision Nausea and vomiting Volume expansion Chest pain Pulmonary edema Thirst Tachycardia Hypokalemia (increases the risk of digoxin toxicity) Chronic renal failure

2. Intake and output 3. Central venous pressure Pulmonary artery pressure Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst) Signs of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness, confusion, tingling sensation of extremity and excessive thirst) (for increase ICP) Neurologic status and intracranial pressure readings. (for increase IOP) Elevating eye pain or decreased visual acuity. Laboratory Tests Renal function (BUN and Creatinine)

Serum Electrolyte (Sodium and Potassium) Precaution Pregnancy and lactation (safe use during these conditions is not established) Interventions Observe the IV site regularly for infiltration. Administration rate for oliguria should be titrated to produce a urine output. (about 3050 ml/hr in adult and 2-6 hours in children) 6. Ketorolac Brand Name: Toradol Short term management of pain (not to exceed 5 days total for all routes combined) Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and anti-inflammatory properties. - Therapeutic effect:Decreased pain CNS: headache, dizziness, somnolence, insomnia, fatigue, dizziness, tinnitus, ophthalmologic effects - CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP: 1) asthma 2) dyspnea - Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.

- CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea 4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL: 1) injection site pain

- Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles

- NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis

aches, pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

7. Ranitidine Hydrochloride Brand Name: Zantac

Short-term treatment of active duodenal ulcer Short-term treatment of active, benign gastric ulcer Maintenance therapy for duodenal ulcer at reduced dosage. Short-term treatment for GERD. Pathologic hypersecretory

Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the

CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo

CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia,

Assessment: 1. History: allergy to ranitidine, impaired renal or hepatic function, lactation, pregnancy. 2. Physical: skin lesions, orientation, affect, liver evaluation, abdominal examination, normal output, renal function tests, CBC Interventions: 1. Administer oral drug with meals and at bedtime.

stomach, inhibiting basal CV: tachycardia, gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin GI: constipation, diarrhea, nausea and vomiting, abdominal pain, hepatitis GU: impotence or decreased libido Dermatologic: rash, alopecia bradycardia

conditions (ZollingerEllison syndrome) Treatment of erosive esophagitis Treatment of heartburn, acid indigestion, sour stomach Hematologic: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia

thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

2. Decrease doses in renal and liver failure. 3. Provide concurrent antacid therapy to relieve pain. 4. Administer IM dose undiluted, deep into large muscle group. 5. Arrange for regular follow-up including blood test, to evaluate effects. Assess patient for

8. Cefazolin Brand Name: Ancef

Perioperative Prophylaxis

Bind to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci including: Streptococcus pneumoniae, Group A beta-hemolytic streptococci; Penicillinas-producing staphylococci.

Diarrhea, nausea, vomiting, rashes, phlebitis at IV site

CNS: Seizures (high doses) GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis DERM: Rashes, urticaria HEMAT: Blood dyscrasias,

infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history

hemolytic anemia LOCAL: Pain at IM site, phlebitis at IV site MISC: Allergic reactions including Anaphylaxis and Serum sickness, superinfection

of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Observe patient for signs and symptoms of anaphylaxis (rash, pruritis, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of anaphylactic reaction. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis.

 Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional. 9. Nalbuphine Brand Name: Nubain Relief of moderate to severe pain Preoperative analgesia, as a supplement to surgical anesthesia, and for obstetric analgesia during labor and Binds to opiate receptors in the CNS, alters the perception of and responses to painful stimuli while producing generalized CNS depression Dizziness, headache, sedation, dry mouth, nausea, vomiting, clammy feeling, sweating CNS: Sedation. Clamminess, sweating headache, nervousness, restlessness,depression, crying, confusion, faintness, hostility, * Reassess patients level of pain at least 15 and 30 minutes after parenteral administration. * Drug acts as an opioid antagonist and may use

delivery

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

withdrawal syndrome. For patients who have received longterms opioids, give 25% of the usual dose initially. Watch for signs of withdrawal. * ALERT! Drug causes respiratory depression, which at 10 mg is equal to respiratory depression produced by 10 mg of morphine. * Monitor circulatory and respiratory status and bladder and bowel function. Withhold dose and notify prescriber if respirations are shallow or rate is below 12 breaths/minute. * Constipation is often severe with maintenance therapy. Make sure stool softener or other laxative is

ordered. * Psychological and physical dependence may occur with prolonged use. * ALERT! Dont confuse Nubain with Navane. * Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other hazardous activities that require mental alertness until drugs CNS effects are known. * Teach patient how to manage troublesome adverse effects such as constipation. 10. Paracetamol Brand name: Tylenol, Calpol pain. age. Pyrexia. Post-vaccination Mild to moderate Unknown. Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the Central Nervous System - In overdose, hepatocellular necrosis or Side-effects are rare and include skin rashes and blood disorders. Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, lightheadedness, Monitor liver function studies; may cause hepatic toxicity at doses >4g/day

fever from two months of

(CNS) or of other substances that sensitize pain receptors to stimulation. The drug may relieve fever though central action in the hypothalamic heatregulating center.

less frequently renal tubular necrosis.

nervousness, unusual dreams, agitation, euphoria, hallucinations, delirium, insomnia, anxiety, fear, disorientation, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions

- Monitor renal function studies; albumin indicates nephritis - Monitor blood studies, especially CBC and pro-time if patient is on long-term therapy. - Check I&O ratio; decreasing output may indicate renal failure. - Assess for fever and pain - Assess hepatotoxicity: dark urine, claycolored stools - Assess allergic reactions: rash, urticarial