Medication Drug Class

Indication

Contraindication

Action Adverse effects Nursing Consideration

Lactulose

(Cephulac, Chronulac, Movelax, Lilac)

Gastrointestinal agent; hyperosmotic laxative

Prevention and treatment of portal-systemic encephalopathy (PSE), including stages of hepatic precoma and coma, and by prescription for relief of chronic constpation

Diabetes mellitus; contaminant use with electrocautery procedures (proctoscopy, colonoscopy); older adult and debilitated patients; pediatric use

Lactulose reduces blood ammonia; appears to involve metabolism of lactose to organic acids by resident intestinal bacteria. Lactulose acidifies colon contents which retards diffusion of nonionic ammonia (NH3) from colon to blood while promoting its migration from blood to colon. In the acidic colon, NH3 is converted to nonabsorbable ammonium ions (NH4) and is then expelled in feces by laxative action. Decreased blood ammonia in a patient with hepatic

GI: flatulence, borborygmi, blenching, abdominal cramps, pain and sitention (initial dose); diarrhea (excessive dose); nausea & vomiting, colon accumulation of hydrogen gas; hypernatremia

In children, if the initial dose causes diarrhea, dosage is reduced immediately. Discontinue if diarrhea persists.

Promote fluid intake (> = 1500-2000 ml/d) during drug therapy for constipation; older adults often self-limit liquids. Lactulose-induced osmotic changes in the bowel support intestinal water loss and potential hypernatremia. Discuss strategy

encephalopathy is marked by improved EEG patterns and mental state (clearing of confusion, apathy, and irritation). Osmotic effect of organic acids causes laxative action, which moves water from plasma to intestines, softens stools, and stimulates peristalsis by pressure from water content of stool.

with physician. Laxative action is

not instituted until drug reaches the colon; therefore, about 24-48 hours is needed.

Instruct the patient not to self-medicate with another laxative due to slow onset of drug action.

Notify physician of diarrhea (more than 2 or 3 soft stools) persists more than 24-48 hours. Diarrhea is a sign of overdosage. Dose adjustment may be indicated.

Instruct mothers not to breast feed while taking

this drug without consulting the physician.

Ketorolac

(Toradol)

Nonsteroidal anti-inflammatory agent, nonopioid aanalgesics

Short term management of pain (not to exceed 5 days total for all routes combined)

Contraindicated with significant renal impairment, during labor and delivery, lactation, aspirin allergy, recent GI bleed or perforation. Use cautiously with impaired hearing, allergies and hepatic conditions

It inhibits prostaglandin synthesis, producing peripherally mediated analgesia; also has antipyretic and anti-inflammatory properties.

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache

Respiratory: asthma, dyspnea

Cardiovascular: edema, pallor, vasodilation

GI: GI bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea

GU: oliguria, renal toxicity, urinary frequency

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.

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 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

Morphine Sulfate

(Astramorph PF, Avinza, Duramorph, Epimorph , Kadian, MSIR, MS Contin, Oramorph SR, Roxanol, RMS, Statex)

Narcotic agonist analgesic

Relief of

moderate

to severe

acute

and

chronic

pain;

preopera

tive

medicati

on to

sedate

and allay

apprehen

sion,

facilitate

Contraindicated with hypersensitivity to narcotics; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature blood–brain barrier more readily); after biliary tract

Principal opium alkaloid acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Light-headedness,

dizziness, sedation,

euphoria, dysphoria,

delirium, insomnia, agitation,

anxiety, fear, hallucinations,

disorientation, drowsiness,

lethargy, impaired mental

and physical performance,

coma, mood changes,

weakness, headache,

tremor, convulsions, miosis,

visual disturbances,

suppression of cough reflex

Facial flushing, peripheral

circulatory collapse,

tachycardia, bradycardia,

Caution patient

not to chew or

crush controlled-

release

preparations.

Dilute and

administer slowly

IV to minimize

likelihood of

adverse effects.

Direct patient to

lie down during

IV administration.

Provide narcotic

antagonist,

facilities for

induction

of

anesthes

ia, and

reduce

anestheti

c

dosage;

analgesic

adjunct

during

anesthes

ia;

compone

nt of

most

preparati

ons that

are

referred

to as

Brompto

n's

cocktail

or

mixture,

surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor).

arrhythmia, palpitations,

chest wall rigidity,

hypertension, hypotension,

orthostatic hypotension,

syncope

Pruritus, urticaria,

laryngospasm,

bronchospasm, edema

Nausea, vomiting, dry

mouth, anorexia,

constipation, biliary tract

spasm; increased colonic

motility in patients with

chronic ulcerative colitis

assisted or

controlled

respiration on

standby during

IV administration.

Use caution

when injecting

SC or IM into

chilled areas or

in patients with

hypotension or in

shock; impaired

perfusion may

delay absorption;

with repeated

doses, an

excessive

amount may be

absorbed when

circulation is

restored.

Reassure patient

about addiction

liability; most

patients who

receive opiates

an oral

alcoholic

solution

that is

used for

chronic

severe

pain,

especiall

y in

terminal

cancer

patients;

intraspin

al use

with

microinfu

sion

devices

for the

relief of

intractabl

e pain;

unlabele

d use:

dyspnea

for medical

reasons do not

develop

dependence

syndromes.

associate

d with

acute left

ventricul

ar failure

and

pulmonar

y edema

Etericoxib

(Arcoxia)

Antirheumatic

This medication is a non-steroidal anti-inflammatory drug (NSAID), prescribed for osteoarthritis, rheumatoid arthritis and gouty arthritis.

Contraindicated in patients with peptic ulcer, severe heart disease, stroke, and hypersensitivity.

ARCOXIA belongs to a group of medicines called Coxibs. It works in a similar way to traditional anti-inflammatory medicines, known as Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), by blocking the production of substances that cause pain and inflammation. In clinical trials, ARCOXIA has been shown to have a lower risk of serious side effects on the

Central Nervous System - Headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo and ringing in the ear. Heart - Chest pain, high blood pressure and fluid retention. Metabolic - Taste disturbances, mouth ulcer, loss of appetite and weight loss. Miscellaneous - Kidney damage, fever, GI disorders, muscle pain and influenza-like syndrome.

Caution should be exercised in patients with history of heart, liver, kidney disease, high blood pressure, blood clotting disorder, any allergy, children, elderly, during pregnancy and breast feeding. 

Drink adequate fluid to avoid dehydration. 

Stop the medication immediately if

stomach (for example, bleeding stomach ulcers) than NSAIDs. However taking aspirin with ARCOXIA may reverse this benefit.

gastrointestinal lesions occur. 

Monitor blood pressure regularly while taking this medication.