Drug General Action

Mechanism of action

Contraindications Indications Side effect Nursing responsibilities

Generic name: Streptokinase

Brand Name: Streptase

Route of Administration: IV

Dosage:250,000 IU/ 30 min

Thrombolytic enzyme

Acts with plasminogen to produce a new activator complex which enhances the conversion of of plasminogen to plasmin. Plasmin then beaks down fibrinogen, fibrin clots, and other plasma protein promoting the dissolution of he insoluble fibrin trapped in intravascular emboli and thrombi. Also, inhibitors of streptokinase such as alpha-2-macroglobulin are rapidly inactivated by streptokinase,

Any condition presenting a risk of hemorrhage, such as recent surgery or biopsies, delivery within 10 days, ulcerative disease. Arterial emboli originating from left of the heart. Also hepatic or renal insufficiency, tuberculosis, recent cerebral embolism, thrombosis, hemorrhage, SBE, rheumatic valvular disease, thrombocytopenia. Streptokinase resistance in excess of q million IU. Use to restore patency to IV catheters.

Arterial thrombosis and embolism, acute evolving tansmural MI. pulmonary embolism, clearing of occluded arteriovenous and IV cannulae,

Minor bleeding at invaded or disturbed sites, major bleeding, fever, shivering in acute MI.CV: superficial bleeding, minor bleeding at invaded or disturbed sites. Severe and internal bleeding involving GI, GU, retroperitoneal or intracerebral sites.Allergic: Nausea, headache, breathing difficulties, fever, shivering, bronchospasm, angioneurotic edema, urticaria, itching, flushing, musculoskeletal pain, vasculitis, interstitial nephritis, respiratory depression, back pain

1.NaCl injectioin or D5W is the preffered diluent for IV use.

2. For AV cannulae, dilute 250,000 units with 2 ml of NaCl injection or D5W. 3. reconstitute gently, a directed without shaking the vial.4. use within 24 hour of reconstitution5. use an electronic infusion device to administer streptokinase and do not add any other medications to the line. Note any redness and or pain at the site6. Do not add any medication to streptokinase. 7. Identify other drugs taking such as aspirin or NSAIDs that could increase bleeding times.

Drug General Mechanism of Contraindications Indications Side effect Nursing

Generic name: Digoxin

Brand Name: Digitek, digoxin injection, Lanoxicaps, Lanoxin

Route of Administration: Oral

Dosage:

Action action responsibilities

Cardiac Glycoside

Inceases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance. This effect is due to inhibition of sodium/potassium ATPase in the sarcolemmal membrane, which alters excitation contraction coupling. Inhibiting sodium potassium ATPase results in increased calcium influx and increased release of free calcium ionsd which then potentiates the contractility of cardiac muscles

Ventricular fibrillation or tachycardia(unless congestive failure supervenes after protracted episode not due to digitalis), in presence of digoxin toxicity, hypersensitivity to cardiac glycosides, beriberi heart disease, certain cases of hypersensitive carotid sinus syndrome.

CHF, including that due to venous congestion, edema, dyspnea, orthopnea, and cardiac arrhythmia. May be drug of choice for CHF because of rapid onset, relatively short duration and ability to be administered PO or IV; control of rapid ventricular contraction rate in clients with atrial fibrillation or flutter; Slow HR in sinus tachycardia due to CHF;

Tachycardia, headache, dizziness, mental disturbances, diarrhea, anorexia, blurred or yellow vision, hypokalemiaCV: changes in the heart rate, rhythm and irritability of the heart and the mechanism of the heartbeat. Extra-systoles, bigeminal pulse, coupled rhythm, ectopic beat, and other forms of arrhythmias have been noted.GI: Anorexia, excessive salivation, epigastric distress, abdominal pain, diarrhea, bowel necrosis.Miscellaneous: chest pain, coldness of extremities

1.note any drugs prescribed that would adversely interact with digoxin and monitor2. Assess for hyper or hypothyroidism3. monitor vital signs4. monitor weighs and input and output6. if taking non-K-sparing diuretics as well as digoxin, will need potassium supplements. Provide the most palatable preparation available. 7. if gastric distress experienced, use antacid.

8. when given to newborns, use cardiac monitor to identify early evidence of toxicity9. monitor digoxin levels periodically

Drug General Action

Mechanism of action

Contraindications

Indications Side effect Nursing responsibilities

Generic Name: Epinephrine

Brand Name: epinephrine Amp, adrenin amp,

Antiglaucoma preparations

Epinephrine, an active principle of the adrenal medulla, is a direct-acting sympathomimetic. It stimulates α- and β-adrenergic receptors resulting in relaxation of smooth muscle of the bronchial tree, cardiac stimulation and dilation of skeletal muscle vasculature. It is frequently added to local anaesthetics to retard diffusion and limit absorption, to prolong the duration of effect and to lessen the danger of toxicity.

Preexisting hypertension; occlusive vascular disease; angle-closure glaucoma (eye drops); hypersensitivity; cardiac arrhythmias or tachycardia. When used in addition to local anaesthetics: Procedures involving digits, ears, nose, penis or scrotum.

Advanced cardiac life support, anaphylactic shock, ocular hypertension, open-angle glaucoma, asthmatic attacks

epigastric pain; CV disorders; difficulty in micturition with urinary retention; dyspnoea; hyperglycaemia; sweating; hypersalivation; weakness, tremors; coldness of extremities; hypokalaemia. Gangrene, tissue necrosis and sloughing (extravasation) when used in addition to local anaesthetics. Eye drops: Severe smarting, blurred vision, photophobia; naso-lachrymal ducts obstruction. Oedema, hyperaemia and inflammation of the eyes with repeated administration.

1. note indications for therapy, onset, characteristics of signs and symptoms. 2. monitor v/s 3. document disease onset, subtype, other agents trialed and outcome.4. take extra precaution on the patients with following conditions: CV diseases; hyperthyroidism; DM; Parkinson's disease; elderly; pregnancy, lactation.

Drug General Action

Mechanism of action Contraindications Indications Side effects Nursing responsibilites

Generic Name: Konakion

Brand Name: Konakion MM

Route of administration: Parenteral, oral

Dosage:Therapy: 10 mg (up to 20 mg)

Oral: 2 mg

HaemostaticsAs a component of a liver carboxylase system, it is involved in the carboxylation of the coagulation factors II (prothrombin), VII, IX and X, and of the coagulation inhibitors protein C and protein S in the post-ribosomal phase. Anticoagulants of the dicoumarol type inhibit reduction of vitamin K1 (quinone form) to vitamin K1 hydroquinone and also prevent the vitamin K1 epoxide which arises after the carboxylation reaction from being reduced to the quinone form. Phytomenadione is thus an antagonist of Marcouman and similar anticoagulants. It does not, however, inhibit the action of heparin;.

Hypersensitivity to any of the constituents of Konakion MM/MM Pediatric.Pronounced allergic diathesis.

Hemorrhage or threatened hemorrhage as a result of severe hypoprothrombinemia (ie, deficiency of coagulation factors II, VII, IX, X) due, for instance, to overdosage of anticoagulants of the dicoumarol type or their combination with phenylbutazone or to other forms of hypovitaminosis K; Prophylaxis and treatment of hemorrhagic disease of the newborn.

severe, shock-like reactions.In rare cases, anaphylactoid reactions have been reported after parenteral use of konakion MM Pediatric. Local irritation may occur at the injection site, but is unlikely due to the small injection volume.

1. The 10 mg/mL mixed-micelle ampoule must not be given to infants <1 year old2. Parenteral administration may be associated with an increased risk of kernicterus in premature infants weighing <2.5 kg.3. At the time of use, the ampoule solution must be clear. Improper storage can cause turbidity or phase separation. In this case, the ampoule must not be used.

Drug General Action

Mechanism of action

Contraindications Indications Side Effects Nursing Responsibilities

Generic Name: Ketorolac tromethamine

Brand Name: Acular

Route of AdministrationIM, IV, PO, ophthalmic

Dosage:60 mg for less than 65 years old, IM

30 mg for IV

60 mg PO

1gtt 4x a day for ophthalmic route

Nonsteroidal anti-inflammatory

Posseses anti-inflammatoy, analgesic, and antipyretic effects

Hypersenstivty to the drug or allergic symtpms to aspirin or other NSAIDs. Active peptic ulcer disease, recent GI bleeding or perforatin, history of peptic ulcer disease, advanced renal impairment and in those at risk for renal failure due to volume depletion, suspected or confirmed cerebrovaxcula bleeding, hemorrhagic diathesis, or incomplete hemostasis and in those with high risk of bleeding.

Severe, acute pain in adults, itching causzed by seasonal allergic conjunctivitis, , post operative inflammation following cataract surgery, reduce ocular pain, burining and stinging after corneal refractive surgery, reduction of ocular pain and photophobia following incisional refractive surgery,

Headache, dizziness, rdrowsiness, diarrhea, nausea, dyspepsia, indigestion, epigastric pain, edema, transient burning stinging upon administration, ocular irritation,

1. use as a part of a regular analgesic schedule rather than on an as-needed basis

2. if given p.r.n, basis, base size of repeat dose. If pain returns within 3-5 hr, the enxt dose can be increased by up to 50 percent

3. shortening the dosing intervals recommended will lead to an increased frequency and duation of side effects.

Drug General Action

Mechanism of Action

Contraindications Indications Side Effects Nursing responsibilities

Generic Name: Tramadol hydrochloride

Brand name: Ultram, Ultram ER

Route of administration:Oral

Dosage: 50-100mg q 4-6 hr prn

AnalgesicThe analgesic effect is only partially antagonized by the antagonist naloxone. Causes significantly lesss respiratory depression than morphine. In contrast to morphine, tramadol does not cause release of histamine. Produces dependence of the mu-opioid type how ever there is little evidence of abuse. Tolerance occurs but is relatively mild; the withdrawal syndrome is not as severe as with other opiates

Hypersensitivity to tramadol, in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opiates or psychotropic drugs. Use in cleitns with past r resent addictin or opiate dependence or in those with a prior history of allergy to codeine or opiates. Use for obstetric preoperative medicatin of postdelivery analgesia In nursing mothers.

Moderate to moderately severe pain.

Dizziness, headache, CNS stimulation, ataxia, sedation, vertigo, itching, constipation, nausea, seizures, paresthesia, cognitive dysfunction, hallucinations, tremor, amnesia, concentration difficulty, abnormal gait, migraine, nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea, anorexia

1.do not confuse Ultram with Ultrase

2. List easons for theapy, location, onset, trigges, characteristics of S and S. use a pin-rating scale to rate pain.

3. Assess for history of drug addiction, allergy to opiates or codeine, seizures; drug may increase the risk of convulsions

4. Monitor VS, Iand O, renal and LFTs, reduce dose with dysfunction and if over 75 years old.

Drug General action

Mechanism of Action

Contraindication Indication Side Effect Nursing responsibilities

Generic Name:Diphenhydramine HCl

Brand Name:Benadryl

Route of administration:Oral, IV or IM

Dosage: Cap Adult & childn ≥12 yr 25-50 mg tid-qid. Syr Adult & childn ≥12 yr 12.5-25 mg qid. Childn 6 yr-<12 yr 12.5 mg qid, 2-<6 yr 6.25 mg qid.

antihistamineHigh sedative, anticholinergic, and antiemetic effects

Premature & newborn infants; asthma attack; lactation.

Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness.

CV & CNS effects. Blood disorders. GI disturbances. Antimuscarinic effects. Allergic reactions. Drowsiness, constipation, diarrhea, dizziness, dry mouth, nose, throat, headache, anorexia, anxiety, GI upset, asthenia

1. note reasons fo therapy, signs and symptoms of charactgeristics, other agents trialed, triggers, outcome

2. do not confuse diphenhydramine with desipramine with dimenhydrinate

3. take 30 minutes before travel

4. use sugarless gum, candy to diminish dry mouth effects.

5. avoid alcohol and any other CNS depressants unless prescrived

6. Stop therapy 72-96 hour before skin testing

Drug General Mechanism of Contraindication Indication Side effect Nursing

action Action responsibilities

Generic Name:Isosorbide dinitrate

Brand Name:Isordil

Route of administration:Sublingual, oral

Dosage:Oral 5-30 mg

qid. Sublingual 5-10 mg 2-3

hrly. Acute CHF Oral 10-40 mg qid. Sublingual 5-10 mg 2 hrly. Chronic CHF Initially 5-10 mg/day 2 hrly sublingually.

Maintenance: 20-40 mg qid orally.

Anti-angina, coronary

vasodlator

Relaxes vascular smooth muscle by

stimulatng production of

intracellular cyclic guanosine

monophosphate. Dilation of post capillary vessels decreases venous return to the heart due to pooling of blood; thus LV end-diastolic

pressure is educed. Elaxation of

arteriololes results in a decreased

systemic vascular resistance and

arterial pressure.

Use to abort anginal attacks

Angina pectoris, acute and chronic

CHF

Headache, vascular headache,

lightheadedness, hypotension.

1.note reasons fo therapy; include onset, location, characteristics of chest pain; pain levels

2. assess VS and ECGT; note stress thallium, catheterization, or IVUS findins as well as CAD history/interventions.

3. store at room temperature protected from light. Keep bottles tighly closed. Dipense in alight resistant tight contaainer

Drug General Action

Mechanism of action

Contraindications

Indications Side Effects Nursing Responsibilities

Generic Name: Nifedipine

Brand Name: Calcibloc

Route of administration:Oral

Dosage:Capsules: 10-20 mg 3x a dayTablets: 30-60 mg per day

Calcium channel blocker

. It blocks the calcium or "slow" channels and inhibits entry of calcium ions into vascular smooth muscles particularly of resistance vessels and coronary arteries. dilates coronary and peripheral arteries, as well as veins. Coronary arterial vasodilation increases coronary blood flow in the ischemic post-stenotic areas, while dilation of the peripheral arteries lowers arterial blood pressure and reduces left ventricular afterload. Some renal artery dilatation may stimulate mild diuresis.

Cardiovascular shock, severe aortic stenosis or in patients known to be hypersensitive to nifedipine. Care is needed in patients with very low blood pressure (severe hypotension with systolic pressure <90 mmHg) or decompensated heart failure.

All forms of hypertension, primary or secondary. Nifedipine is most effective for mild to moderate degrees of hypertension but the capsule may be bitten and swallowed for more rapid effects as in hypertensive crises. Hypertension in pregnancy (at any term of pregnancy). Coronary insufficiency with or without angina. Vasospastic angina (Prinzmetal's angina). To increase heart rate in patients with sinus bradycardia and sick-sinus syndrome.

Side effects are mild, transient and relatively infrequent. These include flushing, nausea, dizziness, headache, tiredness, sedation, leg edema and other manifestations of peripheral vasodilation.

1. dot not confuse nifedipine with nicardipine2. do not exceed a single dose3. before increasing dose, carefully monitor BP4. use only the sustained release tablets to treat hypertension5. concomitant therapy with beta renergic blocking agents may be used6. clients withdrawn from beta blockers may manifest symptoms of increased angina which cannot be prevented by nifedipine; in fact nifedipine may increase the severity of angina situation

PAMANTASAN NG CABUYAOKatapatan Vill, Banay-banay, Cabuyao, Laguna

AGNES D. CABINTOYIVN2- GROUP5