OMEPRAZOLE (Losec,Prilosec)

Drug class

Gastrointestinal agent; proton pump inhibitor

Pregnancy Category C

Therapeutic effects

Suppresses gastric acid secretion relieving

gastrointestinal distress and promoting ulcer
healing.

Patient & Family Education

Indications

Duodenal and gastric ulcer. Gastroesophageal reflux

disease including severe erosive esophagitis (4 to 8
wk treatment). Long-term treatment of pathologic
hypersecretory conditions such as Zollinger-Ellison
syndrome, multiple endocrine adenomas, and
systemic
mastocytosis.
In
combination
with
clarithromycin to treat duodenal ulcers associated
with Helicobacter pylori.

Contraindications

Long-term use for gastroesophageal reflux disease,

duodenal ulcers.

Side effects

CNS:Headache, dizziness, fatigue.

GI:Diarrhea, abdominal pain, nausea, mild transient
increases in liver function tests.
Urogenital:Hematuria, proteinuria.
Skin:Rash

Nursing implications

Assessment & Drug Effects

Lab tests: Monitor urinalysis for hematuria and

proteinuria. Periodic liver function tests with
prolonged use.

Report any changes in urinary elimination such as

pain or discomfort associated with urination, or
blood in urine.
Report severe diarrhea; drug may need to be
discontinued.

Ampicillin Sulbactam (Unasyn)

Drug class

antibacterial
Pregnancy Category: B

Therapeutic effects

Bactericidal action against sensitive organisms;

inhibits synthesis of bacterial cell wall, causing
cell death.

Indications

Treatment of skin and skin structure, intraabdominal, and gynecologic infections caused by
susceptible microorganisms.

Contraindications

Hypersensitivity to penicillins.

Side effects

Dermatologic: Rash (less than 2%); erythema

multiforme, exfoliative dermatitis, urticaria.

GI: Diarrhea (3%); black, hairy tongue; Clostridium

difficile associated diarrhea; enterocolitis; gastritis;
pseudomembranous colitis; stomatitis.
Genitourinary: Increased BUN and creatinine;
presence of RBCs and hyaline casts in urine.
Hematologic: Agranulocytosis; decreased Hct, Hgb,
lymphocytes, neutrophils, RBC, platelets, and WBC;
increased basophils, eosinophils, lymphocytes,
monocytes, and platelets; positive direct Coombs
tests.
Hypersensitivity:
Hypersensitivity
(anaphylactic)
reactions (sometimes fatal).
Local: Pain at IM injection site (16%); pain at IV
injection site, thrombophlebitis at injection site (3%).
Metabolic: Elevated serum alkaline phosphatase,
ALT, AST, and LDH; reduced serum albumin and total
proteins.

Nursing implications

Assessment

History: Allergies to penicillins, cephalosporins, or

other allergens; renal disorders; lactation
Physical: Culture infected area; skin color, lesion; R,
adventitious sounds; bowel sounds; CBC, LFTs, renal
function tests, serum electrolytes, Hct, urinalysis

Teaching points

Take this drug around-the-clock.

Take the full course of therapy; do not stop taking
the drug if you feel better.
This antibiotic is specific to your problem and should
not be used to self-treat other infections.
You may experience these side effects: Nausea,
vomiting, GI upset (eat frequent small meals),
diarrhea.

Report pain or discomfort at sites, unusual bleeding

or bruising, mouth sores, rash, hives, fever, itching,
severe diarrhea, difficulty breathing.

D5050
Drug class

Caloric Agent

Therapeutic effects

Rapidly increases blood glucose levels

Transient osmotic diuretic

Indications

Documented hypoglycemia
Seizures of unknown etiology
Cerebral/meningeal edema related to eclampsia

Contraindications

No significant contraindications in the emergency

setting

Side effects

Pain, phlebitis at injection site

Hyperglycemia and glycosuria
Fluid overload

Special Considerations

Rapid rates of administration predisposes the patient

to pain and may cause phlebitis if aperipheral vein is
used; to minimize this effect administer slowly
Excessive IV administration may cause fluid
overload, water intoxication, +/or CHF
D50W and Thiamine 100 mg IV (mini bag or IVP)
should be given together when alcoholism or
malnutrition are suspected

Teaching points

Do not stop taking this drug without notifying

your health care provider.
Take pulse rate before administering.
Do not start taking any prescription or over-thecounter products without talking to your health
care provider. Some combinations may increase
the risk of digoxin toxicity and may put you at
risk of adverse reactions.
Report unusually slow pulse, irregular pulse, rapid
weight gain, loss of appetite, nausea, diarrhea,
vomiting, blurred or yellow vision, unusual
tiredness and weakness, swelling of the ankles,
legs or fingers, difficulty breathing.

Epinephrine

(Adrenaline)

Drug class

Alpha-adrenergic agonist
Cardiac stimulant
Antasthmatic drug

Mechanism of Action

Epinephrine acts by binding to a variety of adrenergic

receptors.
Adrenergic receptor binding triggers glucagon secretion in
the pancreas, increased adrenocorticotropic hormone
(ACTH) secretion by the pituitary gland, and increased
lipolysis by adipose tissue. Together these effects lead to
increased blood glucose and fatty acids, providing substrates
for energy production within cells throughout the body.

Indications

Treatment and prohylaxis of cardiac arrest and attacks of

transitory AV heart block with syncopal seizures; syncope due to
carotid sinus syndrome, acute hypersensitivity reactions
Injection: relief from respiratory distress of bronchial asthma,
chronic bronchitis, emphysema, other COPDs
Temporary relief from acute attacks of bronchial asthma,
COPD

Contraindications

Contraindicated with allergy or hypersensitivity to epinephrine or

components of preparation; narrow-angle glaucoma; shock other
than anaphylactic shock; hypovolemia; general anesthesia with
halogenated hydrocarbons; organic brain damage; cerebral
arteriosclerosis; cardiac dilation and coronary insufficiency;
tachyarrhythmia; ischemic heart disease; hypertension; renal
dysfunction; COPD patients who have developed degenerative
heart disease; diabetes mellitus; hyperthyroidism; lactation.

Side effects

CNS: fear, anxiety, tenseness, restlessness, headache, dizziness,

drowsiness, tremor, insomnia, hallucinations, seizures
CNS depression, weakness, blurred vision, tearing, photophbia
CV: Arrhythmias, hypertension resulting in intracranial
hemorrhage
CV collapse with hypotension, palpitations, tachycardia,
precordial pain
GI: Nausea, vomiting, anorexia
GU: Constriction of blood vessels and decreased urine formation,
dysuria, urinary retention in males with prostatism
OTHER: pallor, respiratory difficulty, orofactial dystonia,
sweating.

Nursing implications

Rotate SC injection sites to prevent necrosis; monitor sites

frequently
Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug.

Protect drug solutions from light, extreme heat and freezing.

Shake the suspension for injection well before withdrawing
the dose.

Lidocaine (Xylocaine)
Drug class

Lidocaine suppresses the automaticity and spontaneous

depolarization of the ventricles during diastole by altering the
flux of sodium ions across the cell membrane with little or no
effect on the heart. Locally, it produces local anesthesia effect
by inhibiting the transport of ions across the neural
membranes. Thus, initiation and conduction of normal nerve
impulses is prevented.
Indications

Intravenous ventricular arrhythmias

Intramuscular self-injected or when IV is
unavailable during transport to local facilities
Local infiltration or mucosal or topical
anesthetic
Patch used when pain is present due to postherpetic neuralgia

Contraindications

Hypersensitivity
Advanced AV block

Side effects

Drowsiness
Dizziness
Nervousness
(mucosal use) decreased or absent gag reflex

Bradycardia
Hypotension
Burning sensation

Nursing implications

Anesthetic topical or local, Antiarrythmics

Mechanism of Action
When administered intramuscularly or intravenously,

When Lidocaine is administered as an antiarrhythmic the

nurse should monitor the ECG continuously. Blood pressure
and respiratory status should be monitored frequently during
the drug administration.
When administered as an anesthetic, the numbness of the
affected part should be assessed.
Serum Lidocaine levels should be monitored frequently
during prolonged use. Therapeutic serum lidocaine levels
range from 1.5 to 5 mcg/ml.
If signs of overdose occur (listed above), stop the infusion
immediately and monitor the patient closely.
For throat sprays, make sure that the patients gag reflex is
intact before allowing the patient to eat or drink.
When IM injections are used, the medication should be
administered in the deltoid muscle only while frequently
aspirating to prevent IV injection.
For direct IV injection only 1% and 2% solutions are used.
Undiluted IV loading dose of Lidocaine is administered at 1
mg/kg at a rate of 25 to 50 mg over 1 minute. The dose may
be repeated after 5 minutes.

Magnesium sulfate
Drug class

Anticonvulsant

Therapeutic effects

Replacement in deficiency states. Resolution

of eclampsia.

Indications

Treatment/prevention
of
hypomagnesemia. Treatment
of
hypertension.
Anticonvulsant associated with severe eclampsia,
pre-eclampsia, or acute nephritis. Unlabeled uses:
Preterm labor. Treatment of Torsade de pointes.
Adjunctive
treatment
for
bronchodilation
in
moderate to severe acute asthma.

Contraindications

Hypermagnesemia; Hypocalcemia; Anuria; Heart

block; Active labor or within 2 hr of delivery (unless
used for preterm labor).

Drug class

Therapeutic effects
Competitively blocks the effects of acetylcholine

at muscarinic cholinergic receptors that mediate

the effects of parasympathetic postganglionic
impulses, depressing salivary and bronchial
secretions, dilating the bronchi, inhibiting vagal
influences on the heart, relaxing the GI and GU
tracts, inhibiting gastric acid secretion (high
doses), relaxing the pupil of the eye (mydriatic
effect), and preventing accommodation for near
vision (cycloplegic effect); also blocks the effects
of acetylcholine in the CNS.

Side effects

Anticholinergic
Antimuscarinic
Parasympatholytic
Antiparkinsonian
Antidote
Diagnostic agent (ophthalmic preparations)
Belladonna alkaloid

CNS: drowsiness.
Resp: decreased respiratory rate.
CV: arrhythmias, bradycardia, hypotension.
GI: diarrhea.
MS:muscle weakness.
Derm: flushing, sweating.
Metab: hypothermia.

Nursing implications

Hypomagnesemia/Anticonvulsant: Monitor pulse, blood

pressure, respirations, and ECG frequently throughout
administration of parenteral magnesium sulfate.
Respirations should be at least 16/min before each dose.
Monitor neurologic status before and throughout therapy.
Institute seizure precautions. Patellar reflex (knee jerk)
should be tested before each parenteral dose of
magnesium sulfate. If response is absent, no additional doses
should be administered until positive response is obtained.
Monitor intake and output ratios. Urine out put should be
maintained at a level of at least 100 ml/4 hr.
Explain purpose of medication to patient and family.

Atropine sulfate (AtroPen)

Indications

Antisialagogue for preanesthetic medication to

prevent or reduce respiratory tract secretions
Treatment of parkinsonism; relieves tremor and
rigidity
Restoration of cardiac rate and arterial pressure
during anesthesia when vagal stimulation produced
by intra-abdominal traction causes a decrease in
pulse rate, lessening the degree of AV block when
increased vagal tone is a factor (eg, some cases due
to digitalis)
Relief of bradycardia and syncope due to
hyperactive carotid sinus reflex

Relief of pylorospasm, hypertonicity of the small

intestine, and hypermotility of the colon
Relaxation of the spasm of biliary and ureteral
colic and bronchospasm
Relaxation of the tone of the detrusor muscle of
the urinary bladder in the treatment of urinary
tract disorders

Contraindications

Contraindicated
with
anticholinergic drugs.

hypersensitivity

Side effects

CNS: Blurred vision, mydriasis, cycloplegia,

photophobia, increased IOP, headache, flushing,
nervousness, weakness, dizziness, insomnia,
mental confusion or excitement (after even
small doses in the elderly), nasal congestion
CV: Palpitations, bradycardia (low doses),
tachycardia (higher doses)
GI: Dry mouth, altered taste perception, nausea,
vomiting, dysphagia, heartburn, constipation,
bloated feeling, paralytic ileus, gastroesophageal
reflux
GU: Urinary hesitancy and retention; impotence
Other: Decreased sweating and predisposition
to heat prostration, suppression of lactation

to

Teaching points
When used preoperatively or in other acute situations,
incorporate teaching about the drug with teaching about the
procedure; the ophthalmic solution is mainly used acutely
and will not be self-administered by the patient; the
following apply to oral medication for outpatients:
Take as prescribed, 30 minutes before meals; avoid excessive
dosage.
Avoid hot environments; you will be heat intolerant, and
dangerous reactions may occur.
You may experience these side effects: Dizziness, confusion
(use caution driving or performing hazardous tasks);
constipation (ensure adequate fluid intake, proper diet); dry
mouth (sugarless lozenges, frequent mouth care may help;
may be transient); blurred vision, sensitivity to light
(reversible; avoid tasks that require acute vision; wear
sunglasses in bright light); impotence (reversible); difficulty
in urination (empty the bladder prior to taking drug).
Report rash; flushing; eye pain; difficulty breathing; tremors,
loss of coordination; irregular heartbeat, palpitations;
headache; abdominal distention; hallucinations; severe or
persistent dry mouth; difficulty swallowing; difficulty in
urination; constipation; sensitivity to light.

DOPAMINE HYDROCHLORIDE (Dopastat)

Drug class

AUTONOMIC NERVOUS SYSTEM AGENT; ALPHAAND BETA-ADRENERGIC AGONIST

(SYMPATHOMIMETIC)

Nursing implications

Interventions
Ensure adequate hydration; provide environmental control
(temperature) to prevent hyperpyrexia.
Have patient void before taking medication if urinary
retention is a problem.

Therapeutic effects
Positive inotropic effect on myocardium

increases cardiac output with increase in systolic

and pulse pressure and little or no effect on
diastolic pressure. Improves circulation to renal
vascular bed by decreasing renal vascular

resistance with resulting increase in glomerular

filtration rate and urinary output.

Report the following indicators promptly to physician

for use in decreasing or temporarily suspending dose:
Reduced urine flow rate in absence of hypotension;
ascending tachycardia; dysrhythmias; disproportionate
rise in diastolic pressure (marked decrease in pulse
pressure); signs of peripheral ischemia (pallor, cyanosis,
mottling, coldness, complaints of tenderness, pain,
numbness, or burning sensation).

Monitor therapeutic effectiveness. In addition to

improvement in vital signs and urine flow, other indices
of adequate dosage and perfusion of vital organs include
loss of pallor, increase in toe temperature, adequacy of
nail bed capillary filling, and reversal of confusion or
comatose state.

Indications

Correction of hemodynamic imbalances present in

shock syndrome after MI, trauma, endotoxic
septicemia, open heart surgery, and renal failure or
chronic cardiac decompensation (eg, CHF).

Contraindications

Pheochromocytoma; tachyarrhythmias or ventricular

fibrillation. Safe use during pregnancy (category C),
lactation, or children is not established.

Side effects

CV: Hypotension, ectopic beats, tachycardia, anginal

pain, palpitation, vasoconstriction (indicated by
disproportionate rise in diastolic pressure), cold
extremities; less frequent: aberrant conduction,
bradycardia, widening of QRS complex, elevated
blood pressure.
GI: Nausea, vomiting.
CNS: Headache. Skin: Necrosis, tissue sloughing with
extravasation, gangrene, piloerection.
Other: Azotemia, dyspnea, dilated pupils (high
doses).

Clonidine Hydrochloride (catapres)

Drug class

Therapeutic effects
Clonidine stimulates alpha-2receptors in

brainstem which results in reduced sympathetic

outflow from the CNS and decrease in peripheral
resistance leading to reduced BP and pulse rate.
It does not alter normal hemodynamic response
to exercise at recommended dosages

Nursing implications

Assessment & Drug Effects

cardiovascular agent;
central-acting anti-hypertensive
analgesic

Indications

Monitor blood pressure, pulse, peripheral pulses, and

urinary output at intervals prescribed by physician.
Precise measurements are essential for accurate titration
of dosage.

Step 2 drug in stepped-care approach to treatment

of hypertension, either alone or with diuretic or other
antihypertensive agents. Epidural administration as
adjunct therapy for severe pain.


Contraindications

Pregnancy (category C),lactation. Use of clonidine

patch in polyarteritis nodosa, scleroderma, SLE

Side effects

CV: Hypotension (epidural),postural hypotension

(mild),peripheral edema, ECG changes, tachycardia,
bradycardia, flushing, rapid increase in BP with
abrupt withdrawal.
GI: Dry mouth, constipation, abdominal pain,
pseudo-obstruction of large bowel, altered taste,
nausea, vomiting, hepatitis, hyperbilirubinemia,
weight gain(sodium retention).
CNS: Drowsiness, sedation, dizziness, headache,
fatigue, weakness, sluggishness, dyspnea, vivid
dreams, nightmares, insomnia, behavior changes,
agitation, hallucination, nervousness, restlessness,
anxiety, mental depression.
Skin: Rash, pruritus, thinning of hair, exacerbation
of psoriasis; with transdermal patch:
hyperpigmentation, recurrent herpes simplex, skin
irritation, contact dermatitis, mild erythema.
Special Senses: Dry eyes.
Urogenital: Impotence, loss of libido

Nursing implications

Hydralazine Hydrochloride (Apresoline)

Drug class

Monitor BR closely. Determine positional changes

(supine, sitting, standing).
With epidural administration, frequently monitor BP
and HR. Hypotension is a common side effect that
may require intervention.
Monitor BP closely whenever drug is added to or
withdrawn from therapeutic regimen.

Antihypertensive, Vasodilator

Therapeutic effects
Acts directly on vascular smoothmuscle to cause

vasodilation,primarily arteriolar,
decreasingperipheral resistance; maintains
or increases renal and cerebral flow.
Indications

Moderate to severe hypertension (with a diuretic).

Lowering high blood pressure helps prevent strokes,
heart attacks, and kidney problems.

CHF unresponsive to conventional therapy with

Digoxin and diuretics

Assessment & Drug Effects

Monitor I&O during period of dosage adjustment.

Report change in I&O ratio or change in voiding
pattern.
Determine weight daily. Patients not receiving
concomitant diuretic agent may gain weight,
particularly during first 3 or 4 d of therapy, because
of marked sodium and water retention.
Supervise closely patients with history of mental
depression, as they may be subject to further
depressive episodes

Contraindications

Hypersensitivity, Severe tachycardia, Dissecting

aortic aneurysm, Heart failure with high cardiac
output, Cor pulmonale,Myocardial insufficiency due
to mechanical obstruction, Coronary artery disease,
Idiopathic SLE, Patients with recent MI

Side effects

CNS: Headache, peripheral neuritis, dizziness,

tremors, psychotic reactions, characterized by
depression, disorientation, anxiety
CV: Palpitations, tachycardia, angina pectoris,
hypotension, paradoxical pressor response,
orthostatic hypotension
GI: Anorexia, nausea, vomiting, diarrhea,
constipation, paralytic ileus
GU: Difficult micturition, impotence
Hematologic: Blood dyscrasias
Hypersensitivity: Rash, urticaria, pruritus, fever,
chills, arthralgia, eosinophilia; rarely, hepatitis,
obstructive jaundice
Other: Nasal congestion, flushing, edema, muscle
cramps, lymphadenopathy, splenomegaly, dyspnea,
lupus-like syndrome, possible carcinogenesis,
lacrimation, conjunctivitis

Nursing implications

Monitor the clients blood pressure and pulse

frequently during initial dosage adjustment and
periodically throughout therapy. Report significant
changes to the physician.
Monitor frequency of prescription refills to determine
adherence.
Prior to and periodically during prolonged therapy
the following lab values should be monitored: CBC,
electrolytes, LE Cell Prep and ANA titer.
The nurse must be aware that Hydralazine may
cause a positive direct Coombs test result.
IM or IV route should be used only when the drug
cannot be given orally.

Hydralazine may be administered concurrently with

diuretics or beta blockers to permit lower doses and
minimize side effects.
Instruct the patient not to let anyone else take his or
her medication.
Inform the patient to take hydralazine with meals or
a snack.
Instruct the patient to take this medication exactly
as prescribed by the doctor. He or she should not
take it in larger amounts or for longer than
recommended. Directions on the prescription label
should be followed.
It is important to remind the patient to keep using
Hydralazine as directed, even if he or she feels well.
High blood blood pressure often has no symptoms,
so you may not know when your blood pressure is
high.
STORAGE: Store hydralazine at room temperature
away from moisture and heat.
In cases where the patient missed a dose he or she
should take the missed dose as soon as he or she
remembers. If it is almost time for the next dose,
wait until then to take the medicine and skip the
missed dose. Do not take extra medicine to make up
the missed dose.
Instruct the patient to call the physician immediately
if he or she experiences the following symptoms:
Fainting, Joint or muscle pain, unexplained fever,
Rapid heartbeat, Chest pain, swollen ankles or feet,
Numbing or tingling in hands or feet.