IX. PHARMACOLOGICAL MANAGEMENT

Generic NameBrand NameClassificationIndicationActionAdverse ReactionTime & DosageNursing Considerations

ParacetamolCalpolAnalgesicsRelief of mild-to-moderate pain; treatment of fever. Decreases fever by inhibiting the effects of pyrogens on the hypothalamus heat regulating centers & by a hypothalamic action leading to sweating & vasodilatation.

Relieves pain by inhibiting prostaglandin synthesis at the CNS but does not have anti-inflammatory action because of its minimal effect on peripheral prostaglandin synthesis.Stimulation, drowsiness, nausea, vomiting, abdominal pain, hepatotoxicity, hepatic seizure(overdose, Renal failure(high, prolonged doses), leucopenia, neutropenia, hemolytic anemia (long term use) thrombocytopenia, pancytopenia, rash, urticaria, hypersensitivity, cyanosis, anemia, jaundice, CNS, stimulation, delirium followed by vascular collaps, convulsions, coma, death.BID & 1 tab Assess patients fever or pain: typeof pain, location, intensity, duration, temperature, and diaphoresis.

Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.

Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat.

Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.

Generic NameBrand NameClassificationIndicationActionAdverse ReactionTime & DosageNursing Interventions

Albuterol sulfatesalbutamolBronchodilator (therapeutic)To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)Quick relief for bronchospasmFor the prevention of exercise-induced bronchospasmLong-term control agent for patients with chronic or persistent bronchospasm

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered.increases, kinases are activated.Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways

CNS:Restlessness, apprehension, anxiety, fear, CNS stimulation,hyperkinesia, insomnia, tremor, drowsiness, irritability, weakness, vertigo, headacheCV:Cardiac arrhythmias, tachycardia, palpitations, PVCs (rare), anginal painDermatologic:Sweating, pallor, flushingGI:Nausea,vomiting, heartburn, unusual or bad taste in mouthGU:Increased incidence of leiomyomas of uterus when given in higher than human doses in preclinical studiesRespiratory:Respiratory difficulties, pulmonary edema, coughing,bronchospasm, paradoxical airway resistance with repeated, excessive use of inhalation preparationsTID & 4-8mgAssess lung sounds, PR and BP before drug administration and during peak of medication.Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.Administer PO medications with meals to minimize gastric irritation.Extended-release tablet should be swallowed-whole. It should not be crushed or chewed.If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.Inform the patient that Albuterol may cause an unusual or bad taste

Generic NameBrand NameCassificationIndicationActionAdverse ReactionTime & DosageNursing Interventions

AmbroxolAmbrolexMucolyticsTreatment of acute & chronic respiratory tract disorders associated with abnormal bronchial mucus secretion, ex. Bronchitis, bronchial asthma, pneumonia % other pulmonary disease. Adjuvant in the treatment of sinusitis, rhinitis & other inflammatory diseases of the nasal cavity & throat.It makes phlegm in the airways thinner and less sticky. It does this by increasing the body's natural production of surfactant. This contributes to a secretomotoric effect: it helps the cilia - tiny hairs that line the respiratory tract - to transport the phlegm out of the lungs. Here is a step-by-step description of how Ambroxol works:Mild, GI irritation & discomfort, ex. Diarrhea, abdominal fullness & nausea.60-120 mg ODTake immediately after meals.Determine history ofhypersensitivityreactions tocephalosporins,penicillins, and historyof allergies,particularly to drugs,before therapy isinitiated.Inspect IM and IVinjection sitesfrequently for signs ofphlebitis.Report onset of loosestools or diarrhea.Althoughpseudomembranouscolitis.Monitor I&O rates andpattern: Especiallyimportant in severelyill patients receivinghigh doses. Reportany significantchanges.

Generic NameBrand NameClassificationIndicationActionAdverse ReactionTime & DosageNursing Interventions

CarvedilolCoregAutonomic Nervous System Agent Alpha- and beta- adrenergic antagonist; antihypertensive Management of essential hypertension, congestive heart failure, in conjunction with other heart failure medications.Adrenergic receptors blocking agent that combines selective alpha activity and nonselective beta-adrenergic blocking actions. Both activities contribute to blood pressure reduction. Peripheral vasodilatation and, therefore, decreased peripheral resistance results from alpha-blocking activity of coreg. It is 3-5 times more potent than labetalol in lowering blood pressure. Body as a whole: Increased sweating, fatigue, chest pain, pain, arthralgia. CV: Bradycardia, hypotension, syncope, hypertension, AV block, angina. GI: Diarrhea, nausea, abdominal pain, vomiting. Respiratory: sinusitis, bronchitis. Hematologic: Thrombocytopenia.Metabolic: Hyperglycemia, weight increased, gout. CNS: Dizziness, headache, paresthesias. 3.125 mg. & BID1. monitor for therapeutic effectiveness which is indicate by lessening of S&S of CHF and improved blood pressure control.2. Lab tests: Monitor liver function tests periodically; at first sign of hepatic toxicity, stop drug and notify physician.3. Monitor for worsening of symptoms in patients with PVD.4. Monitor digoxin levels with concurrent use; plasma digoxin concentration may increase.5. You may experience dizziness or faintness, as a risk of orthostatic hypotension.6. Do not engage hazardous activities while experiencing dizziness.

Generic NameBrand NameClassificationIndicationActionAdverse ReactionTime & DosageNursing Interventions

CeftriaxoneRoxephineAntiinfective; AntibioticInfections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and joints; also intra- abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis and surgical prophylaxis.Semisynthetic third generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin- binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Body as a whole: Pruritus, fever, chills, pain, induration at IM injection site; phlebitis(IV site). GI: diarrhea, abdominal cramps, pseudomembraneous colitis, biliary sludge. Urogenital: genital pruritus; moniliasis.1-2 grams ODDetermine history of hypersensitivity reactions to cephalosporin and penicillin and history of other, allergies, particularly to drugs, before therapy is initiated.Lab tests: perform culture and sensitivity tests before initiation of therapy and periodically during therapy. Dosage maybe started pending tests results. Periodic coagulation studies (PT & INR) should be done.Inspect injection sites for induration and inflammation rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling pain).Check for fever if diarrhea occurs. Report both promptly.

Generic NameBrand NameClassificationIndicationActionAdverse ReactionTime & DosageNursing Interventions

DobutamineDobutrexAutonomic Nervous System Agent : Beta-Adrenergic AgonistIsotropic support in short-term treatment of adults with cardiac decompensation due to depressed myocardial contractility(cardiogenic shock) resulting from either organic heart disease or from cardiac surgery. Produces isotropic effect by acting on beta receptors and primarily on myocardial alpha- adrenergic receptors. Increases cardiac output and deceases pulmonary wedge pressure and total systemic vascular resistance with comparatively little or no effect on blood pressure. Also increases conduction through AV node. Has lower potential for precipitating arrhythmias than dopamine.All: Generally close related. CNS: Headache, tremors, paresthesias, mild leg cramps, nervousness, fatigue(with overdosage) CV: increased heart rate and bp, premature ventricular beats, palpitation. Other: Nonspecific chest pain, shortness of breath. 2.5-15 mcg/kg/min IVCorrect hypovolemia by administraton of appropriate volume expanders prior to initiation of therapy.Monitor therapeutic effectiveness at any given dosage level 10-20 mins. To produce peak effects.Monitor ECG and BP continuously during administrationObserve patients with pre existing hypertension closely for exaggerated presser response.

Generic NameBrand NameClassificationIndication ActionAdverse reactionTime & DosageNursing Interventions

KetorolacToradolCNS Agent; NSAID, Analgesic; AntipyreticShort-term management of pain; ocular itching due to seasonal allergic conjunctivitis.

It inhibits synthesis of prostaglandins and is a peripherally acting analgesics. Ketorolac does not have any known effects on opial receptors. CNS: drowsiness, dizziness, headache. GI: Nausea, dyspepsia, GI pain, hemorrhage. Other: Edema, sweating, pain at injection site.300mg BID IVTTCorrect hypovolemia prior to administration of ketorolac.Monitor urine output in older adults and patient with a history of cardiac decompensation, renal impairment, heart failure, or liver dysfunctions as well as those taking diuretics. Discontinuation of drug will return urine output to pretreatment level. Monitor for fluid retention and edema in a patients with a history of CHF.