VIII.

PHARMACOLOGIC INTERVENTION (DRUG STUDY)

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

OMEPRAZOLE

Pharmacologic Class:  Block gastric acid  Contraindicated in  Abdominal pain  Monitor for diarrhea
secretion by patients with known  Nausea and abdominal pain
Proton Pump Inhibitor inhibiting acid pump hypersensitivity.  Vomiting  Administer one hour
in gastric parietal  Used cautiously in  Diarrhea before meals.
cells. pregnant and  Instruct the patient to
Dosage:  PPI; binds to H+/K+ breastfeeding patient. swallow the capsules
exchanging ATPase whole and not to chew
40 mg
in gastric parietal or crush them.
cells, resulting in  Instruct the patient to
suppression of basal avoid gastric irritants
Frequency: and stimulated acid such as smoking,
secretion. alcohol, product
O.D ( 1 x a day)
containing aspirin,
caffeine, NSAID’s and
foods that cause GI
Route: irritation.
IVTT

33
 Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

DEXAMETHASONE

Pharmacologic Class:  Dexamethasone  Hypersensitivity  Skin rash  Monitor intake and

suppresses  Active untreated  Swollen face, legs output of patient.
Corticosteroids inflammation and the infection or ankles (fluid  Observe the patient
normal immune  Lactation retention) for peripheral edema,
response. It prevents  Systemic fungal  Vision problems steady weight gain,
Dosage: the release of infection (Dexamethasone rales or crackles or
substances in the may cause dyspnea. Notify the
5 mg
body that causes cataracts and physician immediately
inflammation. increased if these clinical
intraocular manifestations are
Frequency: pressure) noted.
 Cold or infection  For patients with
Q8h
that last for a long cerebral edema,
time assess then for level
 Muscle weakness of consciousness
Route:  Black or tarry changes and
IVTT stool. headache during the
therapy.

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

LEVETIRACETAM

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 Pharmacologic Class:  Block gastric acid  Contraindicated in  Abdominal pain  Monitor for diarrhea
secretion by patients with known  Nausea and abdominal pain
Proton Pump Inhibitor inhibiting acid pump hypersensitivity.  Vomiting  Administer one hour
in gastric parietal  Used cautiously in  Diarrhea before meals.
cells. pregnant and  Instruct the patient to
Dosage:  PPI; binds to H+/K+ breastfeeding patient. swallow the capsules
exchanging ATPase whole and not to chew
500 mg
in gastric parietal or crush them.
cells, resulting in  Instruct the patient to
suppression of basal avoid gastric irritants
Frequency: and stimulated acid such as smoking,
secretion. alcohol, product
BID (2x a day)
containing aspirin,
caffeine, NSAID’s and
foods that cause GI
Route: irritation.
oral

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

DIAZEPAM

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 Table VIII.6
Table VIII.8

Pharmacologic Class:  Depress the CNS,  Contraindicated in  dizziness  Monitor BP, PR, RR
probably by patients with known  drowsiness prior to periodically
Anticonvulsants potentiating GABA, hypersensitivity.  lethargy throughout therapy
an inhibitory  hangover and frequently during
neurotransmitter. -  headache IV therapy. -
Dosage: Produces skeletal  depression  Assess IV site
muscle relaxation by frequently during
5 mg
inhibiting spinal administration,
polysynaptic afferent diazepam may cause
pathways. - Has phlebitis and venous
Frequency: anticonvul-sant thrombosis.
properties due to  Prolonged high-dose
PRN for active seizure
enhanced therapy may lead to
presynaptic psychological or
inhibition. physical dependence.
Route:  Restrict amount of
IVTT drug available to
patient. Observe
depressed patients
closely for suicidal
tendencies.

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

PARACETAMOL

36
Pharmacologic Class:  Thought to produce  Contraindicated in  Hematologic:  If there is fever,
analgesia by blocking patients with known  Hemolytic  assess patient’s
Analgesic; Antipyretic generation of pain hypersensitivity. anemia,  fever or pain: type of
impulses, probably neutropenia, pain, location,
by inhibiting leukopenia, intensity, duration,
Dosage: prostaglandin pancytopenia temperature, and
synthesis in the CNS  Hepatic: diaphoresis.
600 mg
or the synthesis or  liver damage,  Tell patient not to use
action of other jaundice for marked fever
substances that  Metabolic: Fever persisting
Frequency: sensitize pain  hypoglycemia longer than 3 days, or
receptors to  Skin: recurrent fever unless
Q6h
mechanical or  rash, directed by prescriber.
chemical stimulation.  urticaria  Avoid giving patient
aspirin or aspirin-like
Route: analgesics because it
IVTT inhibits platelet
aggregation

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

NALBUPHINE

Pharmacologic Class:  Binds to opiate  Contraindicated in  Sedation  Reassess patient’s

receptors in the CNS patients with known  Vertigo level of pain at least
Opioid Analgesics alters the perception hypersensitivity.  Headache 15 and 30 minutes
of and responses to  Agitation

37
 painful stimuli while  Use cautiously  Confusion after parenteral
producing inpatients with history  Depression administration
Dosage: generalized CNS of drug abuse  Dysphoria  Nalbuphine acts as an
5 mg depression  euphoria opioid antagonist and
 faintness may cause withdrawal
 floating syndrome.
 feeling
 hallucinations
Frequency:
 seizures
Q 4 h PRN for pain
score ≥ 4/10

Route:

IVTT

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

METROCLOPRAMIDE

Pharmacologic Class:  Dopamine antagonist  Metoclopramide should  Depression (with  Inject IV slowly over
that acts by not be used whenever suicidal ideation), 1-2 mins to prevent
increasing sensitivity stimulation of  seizures,

38
Gastrointestinal to acetylcholine; gastrointestinal motility  agranulocytosis, transient feelings of
stimulant results increase might be dangerous,  hypotension anxiety
motility of the upper e.g., in the presence of  Note reasons for
GI tract and gastrointestinal therapy
Dosage: relaxation of pyloric hemorrhage,  Assess abdomen
sphincter and mechanical bowel sounds,
10 mg duodenal bulb obstruction, or distention,
perforation

Frequency:

Q 6 h PRN for nausea

and vomiting

Route:

IVTT

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

MANNITOL

Pharmacologic Class:  It also elevates blood  Susceptibility  Dehydration  Vital signs

plasma osmolality  Anuria

39
Osmotic diuretics thus, inhibiting the  Dehydration  Intracranial  Signs and symptoms
reabsorption of water bleeding of dehydration (e.g.
and electrolytes (for  Headache poor skin turgor, dry
Dosage: relief of edema) and  Blurred vision skin, fever, thirst)
mobilizing fluids in  Nausea and  Signs of electrolyte
20% 75 cc the cerebral and vomiting imbalance/deficit (e.g.
ocular spaces  Volume muscular weakness,
(lowers intracranial or expansion paresthesia,
intraocular pressure).  Chest pain numbness, confusion,
Frequency:  Pulmonary tingling sensation of
edema extremity and
Q6h  Thirst excessive thirst)
 Tachycardia  (for increase ICP)
Neurologic status and
intracranial pressure
Route: readings.
IVTT

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

ONDANSETRON

Pharmacologic Class:  Block the effects of  Contraindicated in  Headache  Be sure to teach the
serotonin at 5-HT3 patients with known  Constipation client the following
Antiemetic receptor sites located hypersensitivity.  Diarrhea about this medication
in vagal nerve  Notify physician
terminals and the immediately if

40
Dosage: chemoreceptor involuntary movement
trigger zoned in the of eye, face or limbs
4 mg CNS occur

Frequency:

Not indicated

Route:

IVTT

Generic Name: Mechanism of Action Contraindication Adverse Effect Nursing Responsibility

TRAMADOL

Pharmacologic Class:  Binds to mu-opioid  Pregnancy; allergy to  Dizziness  Assess bowel function
receptors. Inhibits tramadol; acute in  Sedation routinely.
Antiemetic reuptake of serotonin toxification with alcohol  Confusion  Minimize
and norepinephrine  Hypotension constipation.
in the CNS  tachycardia

41
Dosage:  Assess previous
analgesic history.
50 mg Tramadol is not
recommended for
opiod dependent
patients(with drawal
Frequency: symptoms)Monitor
patients for seizures
Q8h

Route:

IVTT

42