Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Rowachol® Cholagogues, Cholelitholytics & Hepatic Protectors

Cholelitholitic Agent - Rowachol increases biliary secretion, relieves spasm of the bile ducts and enhances metabolic liver function by reducing biliary stasis. By inhibiting HMG-CoA reductase, endogenous cholesterol production is reduced, maintaining the bile above saturation level, assisting the dissolution of gallstones and preventing the precipitation of further stones. The choleresis produced by Rowachol increases insulin production, assisting in the control of diabetes.

For hepatobiliary disorders including cholelithiasis.

None known. Increased prolactin levels. GI disorders. Transient intestinal cramps. Galactorrhea. Gynecomastia. Amenorrhea.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Motilium®

(Domperidone)

Antiemetics, GIT Regulators, Antiflatulents & Anti-Inflammatories

Domperidone is a peripheral dopamine-receptor blocker. It increases oesophageal peristalsis, lower oesophageal sphincter pressure, gastric motility and peristalsis, thus facilitating gastric emptying and decreasing small bowel transit time.

Dyspeptic symptom complex associated w/ delayed gastric emptying, GERD, esophagitis eg epigastric sense of fullness, early satiety, feeling of abdominal distension, upper abdominal pain; bloating, eructation, flatulence; heartburn w/ or w/o regurgitations of gastric contents in the mouth. Nausea & vomiting of functional, organic, infectious or dietetic origin or induced by radio- or drug therapy.

GI hemorrhage, mechanical obstruction or perforation; in patients w/ prolactin-releasing pituitary tumor (prolactinoma). Known intolerance to the drug.

Drowsiness, extrapyramidal reactions, galactorrhoea, gynaecomastia; constipation or diarrhoea, lassitude, decreased libido, skin rash, itch.Potentially Fatal: Convulsions, arrhythmias and cardiac arrest, dysrrhythmias in patients with CV disease or hypokalaemia, patients on cancer chemotherapy. Seizures; hypertensive crisis in patients with phaeochromocytoma.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Dulcolax®(Bisacodyl)

Laxatives, Purgatives

Bisacodyl acts mainly in the large intestine by increasng its motility to effect bowel evacuation.

Constipation. Prep for radiography; antepartum & postpartum care; prep for sigmoidoscopy or proctoscopy; colonoscopy; hemorrhoids & anal fissures. All conditions w/c require defacation to be facilitated

Ileus, intestinal obstruction, acute surgical abdominal conditions; severe dehydration. Appendicitis & acute inflammatory bowel diseases.

Abdominal discomfort (colic, cramps). Suppositories may cause irritation and proctitis.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Maalox®

Al(OH)3, Mg(OH)2

Antacids, Antireflux Agents & Antiulcerants

Pharmacodynamics: Maalox is a balanced mixture of 2 antacids: Aluminum hydroxide is a slow-acting antacid and magnesium hydroxide is fast acting. The 2 are frequently combined in antacid mixtures. Aluminum hydroxide on its own is astringent and may cause constipation. This effect is balanced by the effect of magnesium hydroxide, which, in common with other magnesium salts, may cause diarrhea.

Pharmacokinetics: The absorption of aluminium and magnesium from antacids is small. Aluminum hydroxide is slowly converted to aluminium chloride in the stomach. Some absorption of soluble aluminium salts occur in the gastrointestinal tract with urinary excretion. Any absorbed magnesium is likewise excreted in the urine.

Symptomatic relief of hyperacidity and as antiflatulent to alleviate symptoms of gas, including post-operation gas pain.

Use in severely debilitated patients or in those suffering from kidney failure.

Gastrointestinal side effects are uncommon.

Occasionally, high doses of antacids may cause diarrhea or constipation.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

captopril ACE Inhibitors Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased sodium and water retention. By these mechanisms, captopril produces a hypotensive effect and a beneficial effect in congestive heart failure.

Hypertension

Heart failure

Post myocardial infarction

Diabetic nephropathy

Known hypersensitivity to the drug. Bilateral renal artery stenosis, hereditary angioedema; renal impairment; pregnancy.

Hypotension, tachycardia, chest pain, palpitations, pruritus, hyperkalaemia. Proteinuria; angioedema, skin rashes; taste disturbance, nonproductive cough, headache.

Take drug 1 hr before or 2 hr after 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.

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.

These side effects may occur: GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (perform frequent mouth care); 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.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

cefuroxime Cephalosporins Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Uncomplicated urinary tract infections

Respiratory tract infections

Uncomplicated gonorrhea

Otitis media

Hypersensitivity to cephalosporins.

Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis.

• Before administration, ask patient if he is allergic to penicillins or cephalosporins.• Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may begin while awaiting result.• Instruct patient to take oral form with food.• If patient has difficulty swallowing tablets, show her how to dissolve or crush tablets but warn her that the bitter taste is hard to mask, even with food.• Instruct patient to notify prescriber about rash or evidence of superinfection.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

metronidazole Other Antibiotics, Topical Antibiotics, Antiamoebics, Preparations for Vaginal Conditions

Metronidazole is converted to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms.

Against a wide range of organisms including E. histolytica, T. vaginalis, Giardia, anaerobes e.g. Bacterioides sp, Fusobacterium sp, Clostridium sp, Peptococcus sp and Peptostreptococcus sp, and moderately active against Gardnerella sp and Campylobacter sp.

-Amoebiasis-Giardiasis-dental infections-Trichomoniasis-Acute necrotising ulcerative gingivitis-Anaerobic bacterial infections-Surgical prophylaxis-peptic ulcer disease-Prevention of post-op anaerobic bacterial infections

History of hypersensitivity to metronidazole or other nitroimidazole derivatives. Pregnancy (1st trimester) and lactation.

GI disturbances e.g. nausea, unpleasant metallic taste, vomiting, diarrhoea or constipation. Furred tongue, glossitis, and stomatitis due to overgrowth of Candida. Rarely, antibiotic-associated colitis. Weakness, dizziness, ataxia, headache, drowsiness, insomnia, changes in mood or mental state. Numbness or tingling in the extremities, epileptiform seizures (high doses or prolonged treatment). Transient leucopenia and thrombocytopenia. Hypersensitivity reactions. Urethral discomfort and darkening of urine. Raised liver enzyme values, cholestatic hepatitis, jaundice. Thrombophlebitis (IV).

Avoid use unless necessary. • Take full course of drug therapy; take the drug with food if GI upset occurs.• Your urine may appear dark; this is expected.• These side effects may occur: Dry mouth with strange metallic taste (use frequent mouth care, suck sugarless candy); nausea, vomiting, diarrhea (eat frequent small meals).• Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

paracetamol Analgesics (Non-Opioid) & Antipyretics

Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.

-Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper Gi disease, gouty arthritis

-Arthritis and rheumatic disorders involving musculoskeletal pain

-common cold, flu, other viral and bacterial infections with pain fever

Allergy to drug

Use cautiously with impaired hepatic function, lactation, pregnancy and chronic alcoholism

CNS: HeadacheCV: Chest Pain, Dyspnea, myocardial damage

GI: Hepatic toxicity and failure, jaundice

GU: Acute renal Failure, renal tubular necrosis

Hematologic: Methemoglobinemia-cyanosis; hemolytic anemia-hematuria

Hypersensitivity: Rash fever

AssessmentHistory: Allergy to Drug, impaired hepatic function, lactation, pregnancy and chronic alcoholism

Interventions:Do not exceed recommended dosage

Consult with physician if need with children less than 3 years; if needed for longer than 10 days

Reduce dosage with hepatic impairment

Carefully check OTC

Give with food if GI upset occurs

Discontinue if hypersensitivity reaction occurs

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Tramadol Analgesic (centrally acting)

Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to the opioids—dizziness, somnolence, nausea, constipation—but does not have the respiratory depressant effects.

Relief of moderate to moderately severe pain

• Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids, or psychotropic drugs.

• Use cautiously with pregnancy, lactation, seizures, concomitant use of CNS depressants or MAOIs, renal or hepatic impairment.

• CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures

• CV: Hypotension, tachycardia, bradycardia

• Dermatologic: Sweating, pruritus, rash, pallor, urticaria

• GI: Nausea, vomiting, dry mouth, constipation, flatulence

• Other: Potential for abuse, anaphylactoid reactions

• Control environment (temperature, lighting) if sweating or CNS effects occur.

• These side effects may occur: Dizziness, sedation, drowsiness, impaired visual acuity (avoid driving or performing tasks that require alertness); nausea, loss of appetite (lie quietly, eat frequent small meals).

• Report severe nausea, dizziness, severe constipation.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Generic:Hyoscine N-butylbromide

Anticholinergic; ANtispasmodic

>Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by postganglionic cholinergic neurons. May affect neural pathways originating in the inner ear to inhibit nausea and vomiting.

>Spastic states>Delirium, preanesthetic sedation, and obstetric amnesia with analgesics>To prevent nausea and vomiting from motion sickness

>Contraindicated in patients with obstructive disease of the GI tract, asthma, chronic pulmonary disease, myasthenia gravis, paralytic ileus, intestinal atony, unstable CV status in acute hemorrhage.>Use cautiously in patients with known or suspected GI infection or ulcerative colitis

>CNS: disorientation, restlessness, irritability, dizziness, drowsiness, headache, confusion>CV: palpitation, tachycardia>EENT: dilated pupils, blurred vision, difficulty swallowing>GI: constipation, dry mouth, nausea, vomiting, epigastric distress>Skin: rash, dryness

>Observe the 10 rights in drug administration.>Administer IVTT meds slowly.>Check v/s of the patient before giving>Check the patency of the IV tubing.>Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy.>Warn patient to avoid activities that require alertness until CNS effects of drug are known.>Urge patient to report urinary hesitancy or urine retention

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Cefoxitin sodium AntibioticCephalosporin [ 2nd generation]

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

-lower respiratory infections caused by S.pneumoniae, S.aureus, streptocooci, E.coli, klebsiella, H. influenza.

-UTI’S caused by E.coli P.mirabilis, klebsiella, Morganella morganii, Proteus rettgeri, Proteus vulgari

-Intra-abdominal infections caused by E.coli, Klebsiella, Bacteriodes, Clostridium

-Perioperative prophylaxis

-contraindicated with allergy to cephalosporins or penicillin.

-use cautiously with renal failure, lactation, pregnancy.

CNS- headache, dizziness, lethargy, paresthesia

GI- nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudo-membranous colitis

GU- nephrotoxicity

Hematologic- bone marrow depression—decreased WBC, decreased platelets, decreased Hct

Hypersensitivity- ranging from rashes to fever to anaphylaxis, serum sickness reaction

Local- pain, inflammation at IV site

AssessmentHistory: Hepatic and renal impairment, lactation and pregnancy

InterventionsCulture infection and arrange for sensitivity tests before and during therapy if expected response is not seen

Have vitamin K available in case hypoprothrombinemia occurs

Discontinue if hypersensitivity occurs

Advice patient to avoid alcohol while taking drug for 3 days after because severe reactions often occur

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Omeprazol AntisecretoryProton pump inhibitor

Gastric acid pump inhibitor. Suppresses gastric acid secretion by specific inhibition of the hydrogen-potssium ATPase enzyme system at the secretory surface of the gastric parietal cell; blocks the final step of the acid production.

-short-term treatment of active duodenal ulcer

-first line therapy in treatment of heartburn or symptoms of GERD

-short term treatment of active benign gastric ulcer

-GERD, severe erosuve esophagitis, poorly responsive symptomatic GERD -long term therapy: treatment of pathologic hypersecretory conditions

-Eradication of Helicobacter pylori with amoxicillin or metronidazole and clarithromycin

-Prilosec OTC: Treatment of frequent heartburn

-Zegerid oral suspension: reduction of risk of upper GI bleeding in critically ill patients

-Unlabeled use: posterior laryngitis; enhance efficacy of pancreatin for the treatment of steatorrea in cystic fibrosis

-contraindicated with hypersensitivity to omeprazole or its components

-use cautiously with pregnancy,lactation

CNS- headache, dizziness, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities

Dermatologic- rash, alopecia, inflammation, pruritis, dry skin

GI- diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth

Respiratory- URI’s symptoms, cough, epistaxis

Other: Cancer in preclinical studies, back pain, fever

AssessmentHistory: Hypersensitivity to omeprazole or any of its components: pregnancy, lactation

Physical: Skin lesions, urinary output, abdominal examination; respiratory auscultation

Interventions:-Administer before meals.-Caution patient to swallow capsules whole- not to open, chew, or crush them.-Administer antacids with, if needed.

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities

Dynastat Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Inhibition ofcyclooxygenase-2 (COX-2)-mediated prostaglandin synthesis. Cyclooxygenaseis responsible for generation of prostaglandins. Two isoforms, COX-1 andCOX-2, have been identified.COX-2 is the isoform of theenzyme that has been shown to be induced by pro-inflammatory stimuli and hasbeen postulated to be primarily responsible forthe synthesis of prostanoidmediators of pain, inflammation and fever. Attherapeutic doses,valdecoxib is a COX-2 selective inhibitor of bothperipheral and centralprostaglandins and does notinhibit COX-1, thereby sparing COX-1-dependent physiological processes intissues, particularly thestomach, intestine andplatelets. COX-2 is also thought to be involved inovulation, implantation andclosure of the ductus arteriosus and CNS functions (fever induction, pain perception and cognitivefunction).

Short termtreatment of acutepain & post-oppain. May be usedpre-op to preventor reduce post-oppain; can reduceopioidrequirementswhen usedconcomitantly

Hypersensitivityto parecoxib orto any otheringredient ofDynastat.

Post-op anemia, hypokalemia, agitation, insomnia, hypoesthesia, HTN, hypotension, pharyngitis, resp insufficiency, alveolar osteitis, dyspepsia, flatulence, pruritis, back pain, arthralgia, oliguria, peripheral edema, increased blood creatinine.

AssessmentHistory: Allergy to drug, pregnancy, lactation

InterventionsCheck if patient is taking DYNASTAT together with any medicines used to treat highblood pressure and some other heart problems such as ACE inhibitors,angiotensin receptor antagonistsand diuretics. When taken together these medicines can cause kidney problems

Name of Drug General Action Specific Action Indication Contraindication Adverse Effects Nursing Responsibilities