Generic name: Captopril

Brand name: Apo-Capto, capoten, Novo-captopril, Nu-capto

Classification: ACE inhibitor, Antihypertensive

Mode of Action:

Blocks ACE from converting angiotensin I to angiotensin II, a powerful

vasoconstrictor, leading to decreased BP, decreased aldosterone secretion, a

small increase in serum potassium levels, and sodium and fluid loss;

increased prostaglandin synthesis also may be involved in the

antihypertensive action.

Indication:

Treatment of hypertension alone or in combination with thiazide-type

diuretics

Treatment of CHF in patients unresponsive to conventional therapy;

used with diuretics and digitalis

Treatment of diabetic nephropathy

Treatment of left ventricular dysfunction after MI

Unlabeled uses: Management of hypertensive crises; treatment of

rheumatoid arthritis; diagnosis of anatomic renal artery stenosis,

hypertension related to scleroderma renal crisis; diagnosis of primary

aldosteronism, idiopathic edema; Bartter's syndrome; Raynaud's

syndrome

Contraindication:

Contraindicated with allergy to captopril, history of angiodema, second

or third trimester of pregnancy.

Use cautiously with impaired renal function; CHF; salt or volume

depletion,

lactation.

Adverse effects

CV: Tachycardia, angina pectoris, MI, Raynaud's syndrome, CHF,

hypotension in salt- or volume-depleted patients

Dermatologic: Rash, pruritus, scalded mouth sensation, pemphigoid-

like reaction, exfoliative dermatitis, alopecia, photosensitivity

GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia,

cholestatic jaundice, hepatocellular injury, anorexia, constipation

GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria,

urinary frequency

Hematologic: Neutropenia, agranulocytosis, thrombocytopenia,

hemolytic anemia, pancytopenia

Other: Cough, malaise, dry mouth, lymphadenopathy

Dosages

ADULTS

Hypertension: 25 mg PO bid or tid; if satisfactory response is not noted

within 1–2 wk, increase dosage to 50 mg bid–tid; usual range is 25–

150 mg bid–tid PO with a mild thiazide diuretic. Do not exceed

450 mg/day.

CHF: 6.25–12.5 mg PO tid in patients who may be salt or volume

depleted. Usual initial dose, 25 mg PO tid; maintenance dose, 50–

100 mg PO tid. Do not exceed 450 mg/day. Use in conjunction with

diuretic and digitalis therapy.

Left ventricular dysfunction after MI: 50 mg PO tid, starting as early as

3 days post-MI. Initial dose of 6.25 mg, then 12.5 mg tid, increasing

slowly to 50 mg tid.

Diabetic nephropathy: 25 mg PO tid.

Nursing Responsibilty

Take drug 1 hour before meals; do not take with food. Do not stop

without consulting your health care provider.

Be careful of drop in blood pressure (occurs most often with diarrhea,

sweating, vomiting, dehydration); if light-headedness or dizziness

occurs, consult your health care provider.

Severe fetal damage can occur if captopril is taken during pregnancy.

Use of contraceptives is advised; if pregnancy should occur, stop drug

and notify your health care provider.

Avoid over-the-counter medications, especially cough, cold, allergy

medications that may contain ingredients that will interact with ACE

inhibitors. Consult your health care provider.

You may experience these side effects: GI upset, loss of appetite,

change in taste perception (limited effects, will pass); mouth sores

(frequent mouth care may help); rash; fast heart rate; dizziness, light-

headedness (usually passes after the first few days; change position

slowly, and limit your activities to those that do not require alertness

and precision).

Report mouth sores; sore throat, fever, chills; swelling of the hands,

feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips,

tongue, difficulty breathing.

Generic name: Furosemide

Brand name: Lasix Apo-furosemide

Classification: Loop diuretic

Mode of Action:

Inhibits the reabsorption of sodium and chloride from the ascending

limb of the loop of Henle, leading to a sodium-rich diuresis.

Indication:

Oral, IV: Edema associated with CHF, cirrhosis, renal disease

IV: Acute pulmonary edema

Oral: Hypertension

Contraindication:

Contraindicated with allergy to furosemide, sulfonamides; allergy to

tartrazine (in oral solution); anuria, severe renal failure; hepatic coma;

pregnancy; lactation.

Use cautiously with SLE, gout, diabetes mellitus.

Adverse Effect/ Side effect:

Dizziness, lightheadedness, or fainting when sitting up or standing; fast

heartbeat; flushing of face and neck; headache; irritation at site of patch;

nausea; vomiting.

CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness,

headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible

hearing loss

CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias,

thrombophlebitis

Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura,

exfoliative dermatitis, erythema multiforme

GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation,

diarrhea, acute pancreatitis, jaundice

GU: Polyuria, nocturia, glycosuria, urinary bladder spasm

Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and

electrolyte imbalances, hyperglycemia, hyperuricemia

Other: Muscle cramps and muscle spasms

Dosages

ADULTS

Edema: Initially, 20–80 mg/day PO as a single dose. If needed, a

second dose may be given in 6–8 hr. If response is unsatisfactory, dose

may be increased in 20- to 40-mg increments at 6- to 8-hr intervals. Up

to 600 mg/day may be given. Intermittent dosage schedule (2–4

consecutive days/wk) is preferred for maintenance, or 20–40 mg IM or

IV (slow IV injection over 1–2 min). May increase dose in increments of

20 mg in 2 hr. High-dose therapy should be given as infusion at rate

not exceeding 4 mg/min.

Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to

80 mg IV given over 1–2 min if response is unsatisfactory after 1 hr.

Hypertension: 40 mg bid PO. If needed, additional antihypertensive

agents may be added.

Nursing Resposibilty:

Administer with food or milk to prevent GI upset.

Reduce dosage if given with other antihypertensives; readjust dosage

gradually as BP responds.

Give early in the day so that increased urination will not disturb sleep.

Avoid IV use if oral use is at all possible.

WARNING: Do not mix parenteral solution with highly acidic solutions

with pH below 3.5.

Do not expose to light, may discolor tablets or solution; do not use

discolored drug or solutions.

Discard diluted solution after 24 hr.

Refrigerate oral solution.

Measure and record weight to monitor fluid changes.

Arrange to monitor serum electrolytes, hydration, liver and renal

function.

Arrange for potassium-rich diet or supplemental potassium as needed.

Weigh yourself on a regular basis, at the same time and in the same

clothing, and record the weight on your calendar.

Blood glucose levels may become temporarily elevated in patients with

diabetes after starting this drug.

You may experience these side effects: Increased volume and

frequency of urination; dizziness, feeling faint on arising, drowsiness

(avoid rapid position changes; hazardous activities, like driving; and

consumption of alcohol); sensitivity to sunlight (use sunglasses, wear

protective clothing, or use a sunscreen); increased thirst (suck on

sugarless lozenges; use frequent mouth care); loss of body potassium

(a potassium-rich diet or potassium supplement will be needed).

Report loss or gain of more than 3 pounds in 1 day, swelling in your

ankles or fingers, unusual bleeding or bruising, dizziness, trembling,

numbness, fatigue, muscle weakness or cramps.

Generic name: Phenytoin

Brand name: Dilantin

Classification: Anti convulsant

Mode of Action:

Limit seizure propagation by altering ion transport. Antiarryhythmic

poperties as a result of improvement I AV conduction. May also decrease

synaptic transmission.

Indication:

Treatment/prevention of tonic clonic (grand mal) seizures and complex

partial seizure.

As an antiarrhythmic, particularly for arrhythmias associated with

cardiac glycoside toxicity. Management of painful syndromes,

including trigeminal neuralagia.

Contraindication:

Hypersensitivity

Alcohol intolerance

Sinus bradycadia

Heart block

Stroke syndrome

Side Effect:

drowsiness , difficulty focusing (vision), unsteady gate, tiredness,

abnormal involuntary movements, nausea, vomiting, constipation,

abdominal pain, loss of appetite, Dizziness

Dosage

IV adults: 50-100 mg q 10-15 min until arrythmias is abolished. 15 mg/kg

have been given, or toxic occurs.

PO adults: 200-600 mg/day in divided doses.

Nursing Resposibilty:

Seizure: assess location, duration, frequency and characteristics of

seizure activity.

Arrythmias: Monitor ECG contiously during treatment of arrythmias

Assess patient for phenytoin hypersensitivity syndrome( fever, skin

rash, lymphopathy). Rash usually occurs within the first 2 weeks of

therapy.

Assess oral hygiene. Vigorous oral cleaning beginning within 10 days of

initiation of phenytoin therapy may help control gingival hyperplasia.

May cause increase serum alkaline phosphates,GTT and glucose level.

Generic name: Nitroglycerin Transdrmal patch

Brand name: Nitro-bid, Minitran, Nitrogard, Nitro par,

NitroQuick

Classification: Anti anginal

Mode of Action:

Nitroglycerin Patch is a nitrate vasodilator. It works by relaxing blood

vessels in the body, which allows them to widen (dilate). This allows more

blood to flow through the blood vessels easier, which reduces the workload

on the heart.

Indication:

Prophylactic management of anginal pectoris

For acute angina attack

Acute myocardial infarction

Contraindication:

Hypersensitive to drug or adhesive

Close-anginal glausonma

Orthostatic hypotension

Allergy on Transdermal patch

Side Effect:

Dizziness

lightheadedness, or fainting when sitting up or standing

fast heartbeat

flushing of face and neck

headache; irritation at site of patch

nausea

vomiting

Nursing Resposibilty:

Remove patch from foil pouch immediately prior to application.

Remove protective liner from patch and apply to any area of the

body except the extremities below the knee or elbow; the chest is

preferred site. Press the patch on the skin and smooth down.

Apply only to area that is clean, dry, and hairless. If hair is likely to

interfere with patch adherence, clip, do not shave, the area before

application.

Do not apply patch to skin areas with cuts or irritation or

immediately after showering or bathing.

If the patch becomes dislodged, discard it and put a new one on at

a different skin site.

Do not discharge cardioverter/defribrillator through paddle

electrode that overlies a transdermal patch. May cause current

arching that can damage the paddles and burn the patient.

Nitroglycerin Patch may give you daily headaches. This should

become less noticeable with time.

Nitroglycerin Patch takes about 1 to 2 hours to start working and

should not be used for a sudden chest pain attack.

Use Nitroglycerin Patch with caution in the ELDERLY because they

may be more sensitive to its effects.

Nitroglycerin Patch is not recommended for use in CHILDREN;

safety and effectiveness have not been confirmed.

PREGNANCY and BREAST-FEEDING: If you become pregnant,

discuss with your doctor the benefits and risks of using Nitroglycerin

Patch during pregnancy. It is unknown if Nitroglycerin Patch is

excreted in breast milk. Do not breast-feed while taking Nitroglycerin

Patch.

Generic name: Ranitidine

Brand name: Zantac

Classification: Anti ulcer drug

Mode of Action:

Inhibits the action of histamine at the H2 receptor site located

primarily in gastric parietal cells, resulting in inhibition of gastric acid

secretion.

Indication:

Prevention and treatment of self stress induce upper GI bleeding in

critically ill patient.

Short term treatment of active duodenal ulcers and benign ulcer.

Prophylaxis of duodenal ulcer.

Management of GERD.

Prevention and treatment of heartburn, acid ingeston and sour

stomach

Contraindication:

Porphyria, Hypersensitivity, Renal impairement, Some products of

alcohol must be avoided, Some products contains as partame and

should be avoided I patients with phenylketonuria

Side effect:

headache (may be severe); drowsiness, dizziness; sleep problems

(insomnia); decreased sex drive, impotence, or difficulty having an

orgasm; or swollen or tender breasts (in men); nausea, vomiting,

stomach pain; or Diarrhea or constipation. drowsiness, dizziness;

decreased sex drive, impotence, or difficulty having an orgasm; or

swollen or tender breasts (in men); nausea, vomiting, stomach pain; or

Diarrhea or constipation

Dosage:

IM,IV adultd: 50 g q 6-8 hrs ( no to exceed 400 mg/day). Continuous IV

infusion 6.25 mg/hr. gastric hypersecretory condition-1mg/kg/hr; may be

increase by 0.5 mg/kg/hr ( not to exceed 2.5 mg/kg/hr).

Nursing Resposibilty:

Assess for epigastric pain or abdominal pain and frank or occult blood

in the stool, emesis or gastric aspirate.

Antagonize effects of pentagstrin and histamine during gastric acid

secretion testing

May cause uncrease in serum transaminase and serum creatinine

Ranitidine may cause false positive results for urine protein, test with

sulfosalicylic acid.

Instruct the patient to take the medication as directed for the full

course of therapy, even if feeling better.

Inform the patient that smoking interferes with the action of histamine

antagonist.

Advise the patient to avoid alcohol products containing to avoid aspirin

or NSAIDS, and foods that may cause increase in GI irritation.

Inform the patient that increase fluid and fiber intake and exercise may

minimize constipation.

Generic name: Ketolac

Brand name: Remopain, Acular

Classification: Nonsteroidal Anti-inflammatory Drug (NSAID

Mode of Action:

It acts on cyclooxigenase route, inhibits prostaglandins synthesis and

may be considered a strong analgesic, both peripherally and centrally,

besides having anti-inflammatory and antipyretic effects. Ketorolac reduce

the mild to severe pain at emergency cases, musculosceletal pain, post

minor or major operative, renal cholic & pain in cancer at adults or children.

Ketorolac has analgesic efficacy equivalent to morphine or pethidin. Initial

analgesic effects of ketorolac may be slower, but the duration longer than

opioid.

Indication:

::: Ketorolac is indicated for the short-term (≤ 5 days) management of

moderate and severe acute pain that requires analgesia at the opioid

level.

Contraindication:

Ketorolac tromethamine or in patients in whom aspirin or other NSAIDS

induce serious allergic manifestations

patients with recent gastrointestinal bleeding or perforation and in

patients with a history of peptic ulcer disease or gastrointestinal

bleeding

Patients with severe renal impairment or patients at high risk of renal

failure.In labor and delivery, it may adversely affect fetal circulation

and inhibit uterine contraindications, thus increasing the risk of uterine

hemorrhage

Nursing mother because of the potential adverse effects of

prostaglandin inhibiting drugs on neonates

Adverse Effect:

Central nervous system: Headache (17%)

Gastrointestinal: Gastrointestinal pain (13%), dyspepsia (12%), nausea (12%)

>1% to 10%:

Cardiovascular: Edema (4%), hypertension

Central nervous system: Dizziness (7%), drowsiness (6%)

Dermatologic: Pruritus, purpura, rash

Gastrointestinal: Diarrhea (7%), constipation, flatulence, GI bleeding, GI

fullness, GI perforation, GI ulcer, heartburn, stomatitis, vomiting

Hematologic: Anemia, bleeding time increased

Hepatic: Liver enzymes increased

Local: Injection site pain (2%)

Renal: Renal function abnormal

Dosage

I.V.: Initial dose: 0.5 mg/kg, followed by 0.25-1 mg/kg every 6 hours for up to

48 hours (maximum daily dose: 90 mg) Oral: 0.25 mg/kg every 6 hours

Nursing Resposibilty:

Monitor response (pain, range of motion, grip strength, mobility, ADL

function),

Should be used cautiously in patients receiving anticoagulant therapy

and patients with hemophilia.

Haematological effects : Ketorolac inhibits thrombocyte aggregation

and prolong bleeding time. Because of that ketorolac should not be

used before surgery and use with caution if there is hemostasis

disturbances.

Should be used with caution in patients with cardiac decompensation,

acute renal failure, hypertension or other conditions associated with

fluid retention.

Ketorolac tromethamine should be used with caution in patients with

impaired hepatic function or patients with history of hepatic desease.

Hepatic effects : Ketorolac therapy increases hepatic enzymes and in

hepatic disease patients, severe hepatic risk reaction may occur.

Administration of ketorolac should be discontinued if abnormality of

hepatic function test occurs after ketorolac administration.

Ketorolac tromethamine is not recommended for children under 16

years (Safety and efficacy have not been established).

Generic name: Co amoxiclav

Brand name: amoxcil

Classification: Antibiotics

Mode of Action:

Co-amoxiclav is an antibiotic that is a combination of a penicillin

(amoxicillin)and a substance called clavulanic acid. It kills bacteria, by

interfering with their ability to form cell walls. The bacteria therefore break

up and die.

Indication:

Abdominal infections

Animal bites

Infections of the organs associated with breathing, including nasal

passages, sinuses, windpipe and lungs (respiratory tract)

Infections of the sex organs and organs associated with urination

(genito-urinary infections)

Inflammation of connective tissue, commonly the skin (cellulitis)

Contraindication:

History of allergies, Severe hepatic impairment, Geriatric patient,

Aortic stenosis, Pregnancy, lactation, Liver disease

Side Effect:

Diarrhea, Vomiting, Jaundice, Fever, Pseudomembranous colitis,

Angina, Bradycardia, Flushing, Nausea, Gingival hyperplasia

Dosage;

Standard adult dosages for respiratory tract, urinary, abdominal and

dental infections as well as cellulitis and animal bites is co-amoxiclav

250/125 (one tablet Augmentin 250) taken every 8 hours, which may

be doubled in severe infections (as a single tablet of co-amoxiclav

500/125 Augmentin 500, but not as two co-amoxiclav 250/125 tablets

which would double the maximum recommended dose of clavulanic

acid

Nursing Resposibilty:

Assess for infection

Obtain specimens for culture and sensitivity prior to therapy. First dose

may be given before receiving the result

Monitor bow function

Instruct the patient to take the medication around the cock and to

finish the drug completely as directed.

Review use and preparation of tablets for oral suspension

Instruct female patients taking oral contraceptives to use an alternate

or additional non-hormonal method contraception during therapy with

amoxicillin and until next menstrual period.

Advise the patient to report signs of superinfection ( furry overgrowth

on the tongue, vagina itching or discharge, foul-smelling stools.and

allergy.

Generic Name: Paracetamol

Brand Name: Biogesic

Classification: AntipyreticAnalgesic (nonopioid)

Mode of Action:

Reduces fever by acting directll on the hypothalamic heat regulating

center to cause vasodilation and sweating, which helps dissipate heat.

Indication: for mild pain and fever

Indication:  

Analgesic-anipyretic in patients with aspirin allergy, hemostatic

disturbances, bleeding diatheses, upper GI disease, gouty arthritis. Arthritis

and rheumatic disorders involving musculoskeletal pain (but l acks clinically

significant antirheumatic and anti-inflammatory effects)Common cold, flu,

other viral and bacterial infections with pain and fever Unlabeled use:

Prophylactic for children receiving DPT vaccination to reduce incidence of

fever and pain .

Contraindication:

Contraindicated with allergy to acetaminophen.Use cautiously with

impaired hepatic function, chronic alcoholism, pregnancy, lactation

Ordered Dose: 500mg prn for fever

Drug Interaction:

Increased toxicity with long-term, excessive ethanol ingestion.

Increased hypoprothrombinemic effect of oral anticoagulants. Increased risk

of hepatotoxicity and possible decreased therapeutic effects with

barbiturates, carbamazepine, hydantoins, rifampin, sulfinpyrazone. Possible

delayed or decreased effectiveness with anticholinergics. Possible reduced

absorption of acetaminophen with activated charcoal

Possible decreased effectiveness of zidovudine 

Side Effects:

Headache, Chest pain, dyspnea,

Adverse Effects: Rash, fever Methemoglobinemia—cyanosis; hemolytic

anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia,

thrombocytopenia, hypoglycemia Acute kidney failure, renal tubular necrosis

*Hepatic toxicity and failure, jaundice, myocardial damage when doses of 5–

8 g/day are ingested daily for several weeks or when doses of 4 g/day are

ingested for 1 yr

Nursing Responsibilities:

Do not exceed the recommended dosage.

Consult physician if needed for children < 3 yr; if needed for longer

than 10 days; if continued fever, severe or recurrent pain occurs

(possible serious illness).

Avoid using multiple preparations containing acetaminophen. Carefully

check all OTC products.

Give drug with food if GI upset occurs.

Discontinue drug if hypersensitivity reactions occur.

Treatment of overdose: Monitor serum levels regularly, N-

acetylcysteine should be available as a specific antidote; basic life

support measures may be necessary.

Do not exceed recommended dose; do not take for longer than 10

days.

Take the drug only for complaints indicated; it is not an anti-

inflammatory agent.

Avoid the use of other over-the-counter preparations. They may

contain acetaminophen, and serious overdosage can occur. If you need

an over-the-counter preparation, consult your health care provider.

Report rash, unusual bleeding or bruising, yellowing of skin or eyes,

changes in voiding patterns.

 

Generic Name: Potassium chloride

Brand Name: Kalium Durule

Classification: Electrolyte

Mode of Action:

Principal intracellular cation of most body tissues, participates in a

number of physiologic processes—maintaining intracellular tonicity,

transmission of nerve impulses, contraction of cardiac, skeletal, and smooth

muscle, maintenance of normal renal function; also plays a role in

carbohydrate metabolism and various enzymatic reactions. 

Indication:

Prevention and correction of potassium deficiency; when associated with

alkalosis, use potassium chloride; when associated with acidosis, use

potassium acetate, bicarbonate, citrate, or gluconate. IV: Treatment of

cardiac arrhythmias due to cardiac glycosides

Contraindication:

      Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in

some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment

with oliguria, anuria, azotemia; untreated Addison's disease; hyperkalemia;

adynamia episodica hereditaria; acute dehydration; heat cramps; GI

disorders that delay passage in the GI tract. Use cautiously with cardiac

disorders, especially if treated with digitalis, pregnancy, lactation. 

Drug Interaction:

      Drug-drug

Increased risk of hyperkalemia with potassium-sparing diuretics,

salt substitutes using potassium 

Side Effects & Adverse Effects:

      Dermatologic: Rash

GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction,

GI bleeding, GI ulceration or perforation

Hematologic: Hyperkalemia—increased serum K+, ECG changes

(peaking of T waves, loss of P waves, depression of ST segment,

prolongation of QTc interval)

Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm

with injection 

Nursing Responsibilities:

Arrange for serial serum potassium levels before and during therapy.

Administer liquid form to any patient with delayed GI emptying.

Administer oral drug after meals or with food and a full glass of water

to decrease GI upset.

Caution patient not to chew or crush tablets; have patient swallow

tablet whole.

Mix or dissolve oral liquids, soluble powders, and effervescent tablets

completely in 3–8 oz of cold water, juice, or other suitable beverage,

and have patient drink it slowly.

Arrange for further dilution or dose reduction if GI effects are severe.

Agitate prepared IV solution to prevent "layering" of potassium; do not

add potassium to an IV bottle in the hanging position.

Monitor IV injection sites regularly for necrosis, tissue sloughing,

phlebitis.

Monitor cardiac rhythm carefully during IV administration.

Caution patient that expended wax matrix capsules will be found in the

stool.

Caution patient not to use salt substitutes.

Take drug after meals or with food and a full glass of water to decrease

GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or

dissolve oral liquids, soluble powders, and effervescent tablets

completely in 3–8 ounces of cold water, juice, or other suitable

beverage, and drink it slowly. Take the drug as prescribed; do not take

more than prescribed.

Do not use salt substitutes.

You may find wax matrix capsules in the stool. The wax matrix is not

absorbed in the GI tract.

Have periodic blood tests and medical evaluation.

You may experience these side effects: Nausea, vomiting, diarrhea

(taking the drugs with meals, diluting them further may help).

Report tingling of the hands or feet, unusual tiredness or weakness,

feeling of heaviness in the legs, severe nausea, vomiting, abdominal

pain, black or tarry stools, pain at IV injection site.

Generic name: Citicoline

Brand name: Zynapse

Drug Class:

Neuroprotective

CNS Drugs & Agents for ADHD

Indication:

Treatment of cerebrovascular accident in acute and recovery phase,

symptoms and signs of cerebral insufficiency eg, dizziness, memory loss,

poor concentration, disorientation, recent cranial trauma and their sequelae.

Therapeutic Action:

Pharmacology: Somazine contains as its single active component,

cytidine-5-diphosphate choline. CDP-choline is a biologic product. It is found

in the body and takes part in the biosynthesis of phospholipids which

integrate into the structures of the nervous system especially in the

membranes of the neurons. The formation of phospholipids is needed for the

re-structuring of cell membranes by the damaged neurons.

Citicoline is an interneuronal communication enhancer. It increases the

neurotransmission levels because it favors the synthesis and production

speed of dopamine in the striatum, acting then as a dopaminergic agonist

thru the inhibition of tyrosine-hydroxylase. Citicoline acts as a presynaptic

cholinergic agent which favors the synthesis of acetylcholine. It also

decreases the release of serotonin. Citicoline improves neuronal metabolism

in those cases where there is a neuronal deterioration due to degenerative,

toxic or ischemic cause. The cause of poor neuronal metabolism is brought

about by a decrease in neuronal activity which makes the astrocytes swell.

Swelling is due to electrolyte imbalance. Active neurons release potassium

ions. These are taken up by astrocytes (K+ buffers) and distributed to regions

with less K+. When neuronal activity decreases, less K+ is released,

astrocytes take up Na+ instead of K+. The hydrated Na+ is larger than the

hydrated K+ and so the astrocyte swells. Improvement of neurometabolism is

demonstrated by citicoline's ability of restoring the activity of mitochondrial

ATPase and of membranal Na+/K+ ATPase. Citicoline also increases glucose

incorporation aside from metabolism while at the same time decreasing

lactate accumulation in the brain. Citicoline makes the neurons more active,

causing the astrocytes to loosen their grip on the capillaries, thus improving

microcirculation. By virtue of this action, citicoline has an indirect effect on

microcirculation. It has the ability to slightly increase cerebral blood flow and

exerts an anti-aggregation effect on platelets.

Dosage:

Ordered dose: 1 grm. IV q 12 hrs. / 5 ml TID

Contraindication:

Patients with parasympathetic hypertonia.

Caution:

Somazine must not be administered along with medicaments containing

meclophenoxate.

Interaction:

Somazine potentiates the effects of L-dopa. Incompatibilities: Somazine must

not be administered with products containing meclofenoxate (clophenoxate)

Side Effects:

Gastrointestinal disorders. Allergic reaction: Itching or hives, swelling in your

face or hands, swelling or tingling in your mouth or throat, chest tightness,

trouble breathing, or rash, Low blood pressure (faintness, dizziness), Slow or

fast heart beat, Headache, Nausea, vomiting, or diarrhea (loose BMs)

Generic name: Mannitol

Brand name: Osmitrol, Resctisol

Classification: Osmotic diuretic

Mode of Action:

Increase the osmotic pressure of the glomerular filtrate, therapy

inhibiting reabsorbtion of water and electrolytes. Cause excretion of water,

sodium, potassium, chloride, calcium, phosphorus, Magnessium, Urea and

uric acid.

Indication:

Promotion of diuresis in the prevention or treatment of the oliguric phase of

acute renal failure before irreversible renal failure becomes

established.

Reduction of intracranial pressure and brain mass.

Reduction of high intraocular pressure when the pressure cannot be

lowered by other means.

Promotion of urinary excretion of toxic materials.

Eddema

Contraindication:

Well established anuria due to severe renal disease.

Severe pulmonary congestion or frank pulmonary edema.

Active intracranial bleeding except during craniotomy.

Severe dehydration.

Progressive renal damage or dysfunction after institution of mannitol

therapy, including increasing oliguria and azotemia.

Progressive heart failure or pulmonary congestion after institution of

mannitol therapy. Do not administer to patients with a known

hypersensitivity to mannitol

Adverse Effect/side effect:

Pulmonary congestion, fluid and electrolyte imbalance, acidosis,

electrolyte loss, dryness of mouth thirst, marked dieresis, urinary

retention, edema, headache, blurred vision, convulsions, nausea,

vomiting, rhinitis, arm pain, skin necrosis, thrombophlebitis

chills, dizziness, urticaria, dehydration, hypotension, tachycardia,

fever, angina-like chest pains.

Nursing Responsibility:

The cardiovascular status of the patient should be carefully evaluated

before rapidly administering mannitol since sudden expansion of the

extracellular fluid may lead to fulminating congestive heart failure.

Shift of sodium-free intracellular fluid into the extracellular compartment

following mannitol infusion may lower serum sodium concentration and

aggravate pre-existing hyponatremia.

By sustaining diuresis, mannitol administration may obscure and intensify

inadequate hydration or hypovolemia.

Electrolyte-free mannitol solutions should not be given conjointly with

blood. If it is essential that blood be given simultaneously, at least 20 mEq

of sodium chloride should be added to each liter of mannitol solution to

avoid pseudoagglutination.

When exposed to low temperatures, solutions of mannitol may crystalize.

If crystals are observed, the container should be warmed to redissolve,

then cooled to body temperature before administering. See NOTE under

how supplied. When infusing 20% or 25% mannitol concentrations, the

administration set should include a filter. Do not infuse mannitol solution

if crystals are present.

Do not administer unless solution is clear and container is undamaged.

Discard unused portion. Do not administer Mannitol 25% if the Fliptop vial

seal is not intact.

Generic name: Magnesium Sulfate

Brand name: Epsom salt

Classification: electrolytes, antiepileptic, laxative

Mode of Action:

Cofactor of many enzyme system involve in

neurochemical transmission and muscular excitability. Prevent or control

seizure by blocking neuromuscular transmission. Attracts and retain water in

intestinal lumen and distends the bowel to promote mass movement and

relieve constipation.

Dosage:

Intramuscular: Adults and older children: For severe hypomagnesemia, 1 to 5 g (2 to 10 mLof 50% solution) daily in divided doses; administration is repeated daily until serum levels have returned to normal. If deficiency is not severe, 1 g (2 mL of 50% solution) can be given once or twice daily. Serum magnesium levels should serve as a guide to continued dosage.

Intravenous: 1 to 4 g magnesium sulfate may be given intravenously in 10% to 20% solution, but only with great caution; the rate should not exceed 1.5 mL of 10% solution or equivalent per minute until relaxation is obtained.

Intravenous Infusion: 4 g in 250 mL of 5% Dextrose Injection at a rate not exceeding 3 mL per minute.

Usual Dose Range: 1 to 40 g daily.

Electrolyte Replenisher: Intramuscular 1 to 2 g in 50% solution four times a day until serum magnesium is within normal limits.

Usual Pediatric Dose: Intramuscular 20 to 40 mg per kg of body weight in a 20% solution repeated as necessary.

For Eclampsia: Initially 1 to 2 g in 25% or 50% solution is given intramuscularly. Subsequently, 1 g is given every 30 minutes until relief is obtained. The blood pressure should be monitored after each injection.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Indication:

Convulsions (treatment) - Intravenous magnesium sulfate is indicated for immediate control of life-threatening convulsions in the treatment of severe toxemias (pre-eclampsia and eclampsia) of pregnancy and in the treatment of acute nephritis in children.

Hypomagnesemia (prophylaxis and treatment) - Magnesium sulfate is indicated for replacement therapy in magnesium deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those of hypocalcemia.

Magnesium sulfate is also used to prevent or treat magnesium deficiency in patients receiving total parenteral nutrition.

Tetany, uterine (treatment) - Magnesium sulfate is indicated in uterine tetany as a myometrial relaxant.

Contraindication:

Magnesium sulfate should not be administered parenterally in patients

with heart block or myocardial damage.

Adverse Effect/side effect:

Flushing, sweating, sharply lowered blood pressure, hypothermia, stupor and

ultimately, respiratory depression.

When barbiturates, narcotics, or other hypnotics (or systemic anesthetics) are to be given in conjunction with magnesium, their dosage should be adjusted with caution because of the additive central depressive effects of magnesium.

Pregnancy - Teratogenic effects: Pregnancy category C. Animal reproduction studies have not been conducted with Magnesium Sulfate Injection, USP 50%. It is also not known whether Magnesium Sulfate Injection, USP 50% can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Magnesium Sulfate Injection, USP 50% should be given to a pregnant woman only if clearly needed.

Nursing Responsibility:

Use only as a temporary measure to relieve constipation. Do not take if

abdominal pain, nausea, or vomiting.

You nay experience diarrhea with oral use. If this occurs, discontinue

drug and consultant your health provider.

Report sweating, flushing, muscle tremors or twitching, inability to

extremities.

Reserve Iv use in eclampsia for immediate life threatening situation

Do not give oral magnesium sulfate with abdominal pain, nausea or

vomiting.

Monitor bowel function; if diarrhea and cramping occurs, discontinue

oral drugs.

Maintain urine out put at the level of 100 ml q 4 hr. during parenteral

administration.