Drug Study Generic Name Metoclopramide

Classification Pharmacologic Class Dopaminergic blocker Therapeutic Class

Trade Name Antiemetic GI stimulant Reglan, Maxolon Dosages 10-15 mg PO up to 4 times/day 30 minutes before each meal and at bedtime for 2-8 weeks Contents Metoclopramide Availability and color Tablets: 5, 10 mg Oral solution: 1 mg/mL Injection: 5 mg/mL Routes administration Intramuscular Intravenous of Oral Pregnancy Factor B Risk

Mechanism OF action Stimulates motility of upper GI tract without stimulating gastric, billiary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. Pharmacokinetics D: Crosses placenta; enters breast milk M: Hepatic E: Urine Drug Half Life 5-6 hours

Indications - Relief of symptoms of acute and reccurent diabetic gastroparesis Short-term therapy for adults with symptomatic GERD who fail to respond to conventional therapy - Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable Facilitation of smallbowel intubation when tube does not pass the pylorus with conventional maneuvers - Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic examination of the stomach or small intestine Unlabeled uses: Improvement of lactation; treatment of nausea and vomiting of a variety of etiologies:

Contraindications Concentrations Allergy to metoclopramide - GI hemorrhage Mechanical obstruction or perforation - Pheochromocytoma Epilepsy Precaution

Adverse Reaction CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parinsonismlike reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: hypertension Transient

Nursing Responsibility Before - Observe 15 rights in drug administration. Assess for allergy to metoclopramide. Assess for other contraindications. Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). Have phentolamine readily available in case of hypertensive crisis. During - Monitor BP carefully dring IV administration. Monitor for extrapyramidal reactions, and consult physician if they occur. - Monitor diabetic patients. - Give direct IV doses slowly over 1-2 minutes. - For IV infusion, give over at least 15 minutes. After - Dispose of used materials properly. -

GI: Nausea, diarrhea - Previously detected breast cancer Lactation - Pregnancy - Fluid overload - Renal impairment Drug interaction Drug to drug - Decreased absorption of digoxin from the stomach Increased toxic and immunosuppressive effects of cyclosporine Increased neuromuscular blocking effect of succinylcholine

hyperemesis gravidarum, gastric ulcer, anorexia nervosa

Educate patient about side effects. - Instruct to report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea. Instruct patient to take drug exactly as prescribed. Instruct not to use alcohol, sleep remedies or sedatives; serious sedation could occur. Do proper documentation.

Drug Study Generic Name Allopurinol Trade name Purinol Zyloprim Dosage ADULTS Gout and hyperuricemia: 100\u2013800 mg/day PO in divided doses, depending on the severity of the disease (200\u2013300 mg/day is usual dose).

Classification Antigout Drug Pregnancy Category C

Mechanism OF action Inhibits the enzyme responsible for the conversion of purines to uric acid, thus reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the signs and symptoms of gout

Indications Management of the signs and symptoms of primary and secondary gout Management of patients with malignancies that result in elevations of serum and urinary uric acid Management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day (males) or 750 mg/day (females)

Contraindications Contraindicated with allergy to allopurinol, blood dyscrasias. Use cautiously with liver disease, renal failure, lactation, pregnancy.

Adverse Reaction CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias Dermatologic: Rashes\u2014maculopapular, scaly or exfoliative\u2014sometimes fatal GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice GU: Exacerbation of gout and renal calculi, renal failure Hematologic: Anemia, leukopenia, agranulocytosis,

Nursing Responsibility Assessment History: Allergy to allopurinol, blood dyscrasias, liver disease, renal failure, lactation Physical: Skin lesions, color; orientation, reflexes; liver evaluation, normal urinary output; normal output; CBC, renal and liver function tests, urinalysis Interventions

Maintenance: Establish dose that maintains serum uric acid levels within normal limits. Prevention of acute gouty attacks: 100 mg/day PO; increase the dose by 100 mg at weekly intervals until uric acid levels are within normal limits. Prevention of uric acid nephropathy in certain malignancies: 600\u2013800 mg/day PO for 2\u20133 days; maintenance dose should then be established as above. \ Recurrent calcium oxalate stones: 200\u2013300 mg/day PO; adjust dose up or down based on 24-hr urinary urate determinations.

Orphan drug use: Treatment of Chagas' disease; cutaneous and visceral leishmaniasis \ Unlabeled uses: Amelioration of granulocyte suppression with fluorouracil; as a mouthwash to prevent fluorouracil-induced stomatitis

thrombocytopenia, aplastic anemia, bone marrow depression

Administer drug after meals. Encourage patient to drink 2.5 to 3 L/day to decrease the risk of renal stone development. Check urine alkalinity\u2014urates crystallize in acid urine; sodium bicarbonate or potassium citrate may be ordered to alkalinize urine. Arrange for regular medical follow-up and blood tests. Take the drug after meals. Avoid over-the-counter medications. Many of these preparations contain vitamin C or other agents that might increase the likelihood of kidney stone formation. If you need an over-thecounter preparation, check with your health care provider. These side effects may occur: Exacerbation of

Pediatrics Secondary hyperuricemia associated with various malignancies:6\u201310 yr: 300 mg/day PO.< 6 yr: 150 mg/day; adjust dosage after 48 hr of treatment based on serum uric acid levels.

gouty attack or renal stones (drink plenty of fluids while on this drug, 2.53 L/day); nausea, vomiting, loss of appetite (take after meals or eat small, frequent meals); drowsiness (use caution while driving or performing hazardous tasks). Report rash; unusual bleeding or bruising; fever, chills; gout attack; numbness or tingling; flank pain. Classification Antihypertensive Beta blockers Mechanism OF action Metoprolol selectively inhibits adrenergic receptors but has little or no effect on 2-receptors except in high doses Indications Hypertension Lopressor (metoprolol tartrate) tablets are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive agents. Angina Pectoris Lopressor (metoprolol tartrate) is indicated in the long-term treatment Contraindications 2nd or 3rd degreeA V block; decompensated heart failure; clinically relevant sinus bradycardia. Severe peripheral arterial circulatory disorders. Cardiogenic shock.Asthma. Phaeochromocytoma (without -blockade), systolic BP<100 mmHg. Metabolic acidosis. Pregnancy (2nd and 3rd trimesters) Adverse Reaction Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, , palpitation, syncope, dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, rash, sexual dysfunction/impotenc e,; diarrhea, constipation, flatulence, GI pain, heartburn, nausea, Heart failure, heart Nursing Responsibility Take apical pulse and BP before administering drug. Report to physician significant changes in rate, rhythm, or quality of pulse or variations in BP prior to administration. Monitor BP , HR, and ECG

Drug Study metoprolol

of angina pectoris. Myocardial Infarction Lopressor (metoprolol tartrate) ampuls and tablets are indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular morta Drug Study Generic Name : dexamethasone,dex amethasone acetate , dexamethasone sodium phosphate Brand Name: Oral, topical dermatologic aerosol and gel, ophthalmic suspension: Aero seb-Dex, Decadron, Hexadrol, Maxidex Ophthalmic, ratioDexanamethaso Classification Mechanism OF action Dexamethasone is a synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability. It suppresses normal immune response Indications Hypercalcemia associated with cancer Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders Contraindications Hypersensitivity; active untreated infections; ophthalmic use in viral, fungal disease of the eye

block, bronchospasm

carefully during administration Expect maximal effect on BP after 1 week of therapy Observe hypertensive

Adverse Reaction Growth retardation, osteoporosis, peptic ulcer, glaucoma and subcapsular cataracts, vertebral compression fractures. Cushing-like features, pancreatic dysfunction and pancreatitis, GI upsets, increased appetite, increased fragility of the skin. Increased susceptibility to infection. Topical application: Dermal atrophy, local irritation, folliculitis, delayed wound healing, systemic

Nursing Responsibility Interventions For systemic administration, do not give drug to nursing mothers; drug is secreted in breast milk. WARNING: Give daily doses before 9 AM to mimic normal peak corticosteroid blood levels Increase dosage when patient is subject to stress. Taper doses when

ne (CAN) IM, intraarticular, or softtissue injection: Cortast at LA, Dalalone L.A., Decaject LA, DexasoneL.A., Dexone LA, Solurex LA IV, IM, intraarticular, intralesional injection; respiratory inhalant; intranasal steroid; ophthalmic solution and ointment; topical dermatologic cream: Cortastat, Dalalone, Decadron Phosphate, Decaject, Dexasone, Hexadrol Phosphate, Solurex

Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia Trichinosis with neurologic or myocardial involvement Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas Cerebral edema associated with brain tumor, craniotomy, or head injury Testing adrenocortical hyperfunction Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of depression Intra-articular or soft-tissue

absorption and toxicity with occlusive dressing on application to large areas of the body and broken skin. Topical application to eye: Corneal ulcers, glaucoma and reduced visual ability. Inhalation: Hoarseness, candidiasis of mouth and throat. Intraarticular inj: Aseptic necrosis of bone and joint damage. Potentially Fatal: HPA supression; CV collapse on rapid IV admin

discontinuing high-dose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids. For respiratory inhalant, intranasal preparation, do not use respiratory inhalant during an acute asthmatic attack or to manage status asthmaticus. Do not use intranasal product with untreated local nasal infections, epistaxis, nasal trauma, septal ulcers, or recent nasal surgery. WARNING: Taper systemic steroids carefully during transfer to inhalational steroids; adrenal insufficiency deaths have occurred. For topical dermatologic preparations, use caution

administration: Arthritis, psoriatic plaques Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments Dermatologic preparations: Relief of inflammatory and pruritic manifestations of dermatoses that are steroidresponsive Ophthalmic preparations: Inflammation of the lid, conjunctiva, cornea, and globe

when occlusive dressings, tight diapers cover affected area; these can increase systemic absorption. Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.

Drug Study Generic Name: Diphenhydramine hydrochloride Brand Name: Benadryl

Classification Antihistamine H2 receptor blocker

Mechanism OF action Has high sedative, anticholinergic and antiemetic effects Blocks the action of acetylcholine Blocks H-1 receptors on effector cells of the GI tract, blood vessels, and respiratory tract

Indications Treatment of hypersensitivity reactions Treatment of motion sickness

Contraindications Use with other products containing diphenhydramine Hypersensitivity antihistamines to

Adverse Reaction fast or uneven heart rate; mood changes; tremor, seizure (convulsions); easy bruising or bleeding, unusual weakness; shortness of breath; or little or no urinating.

Nursing Responsibility Give full prophylactic dose 30min. prior to travel if used as a prophylaxis for motion sickness Take similar doses with meals and at bedtime Do not use more than 2 weeks to treat insomnia For IV, may give undiluted Do not exceed IV rate of 25mg/minute Drug causes drowsiness. Avoid activities requiring mental alertness Use sun protection as it may cause photosensitivity Use sugarless candy/gum to diminish dry mouth effects Avoid alcohol and other CNS depressants

Treatment of Parkinsonism Nighttime sleep aid Antitussive

Drug Study Domperidone (Motillium) 1 tab TID

Classification Antidopaminergic Antiemetic

Mechanism OF action nhibits bacterial cell wall synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death

Indications Symptomatic management of upper gastrointestinal motility disorders associated with chronic and subacute gastritis and diabetic gastroparesis. May also be used to prevent gastrointestinal symptoms associated with the use of dopamine agonist antiparkinsonian agents.

Contraindications Contraindicated in patients with known sensitivity or intolerance to the drug. Domperidone should not be used whenever gastrointestinal stimulation might be dangerous, i.e., gastrointestinal hemorrhage, mechanical obstruction or perforation. Also contraindicated in patients with a prolactinreleasing pituitary tumor (prolactinoma)

Adverse Reaction Serum prolactin level may increase resulting in galactorrhoea in females (increasing of milk production, probably by increasing prolactin production by the pituitary gland) & less frequently gynaecomastia in males. CNS: dry mouth (1.9%), headache/migraine (1.2%), insomnia, nervousness, dizziness, thirst, lethargy, irritability (all<1%). Gastrointestinal (2.4%): abdominal cramps, diarrhea, regurgitation, changes in appetite, nausea, heartburn, constipation (all<1%). Endocrinological (1.3%): hot flushes, mastalgia, galactorrhea, gynecomastia, menstrual irregularities.

Nursing Responsibility Teaching points: Proper dosing: Missed dose: Take as soon as possible; not taking if almost time for next scheduled dose; not doubling doses. Obtaining medical attention if fainting, dizziness, irregular heartbeat or pulse, or other unusual symptoms occur

Mucocutaneous (1.1%): rash, pruritus, urticaria, stomatitis, conjunctivitis. Urinary (0.8%): urinary frequency, dysuria. Cardiovascular (0.5%)