DRUG STUDY

1. Generic Name: Carboprost tromethamine

Brand Name: Hemabate
Classification: Prostaglandin; Abortifacient
Therapeutic Actions:
• Stimulates the myometrium of the pregnant uterus to contract; similar to the
contractions of the uterus during labor, thus evacuating the contents of the
uterus.
Indications:
- Termination of pregnancy 13-20 wk from the first day of the LMP
- Evacuation of the uterus in instance of missed abortion or intrauterine fetal
death in the 2nd trimester
- Postpartum hemorrhage due to uterine atony unresponsive to conventional
methods
Contraindications:
- Contraindicated with allergy to prostaglandin preparations, acute PID; active
cardiac,hepatic, pulmonary, renal disease
Adverse Effects:
CNS: headache, paersthesias, flushing, anxiety, weakness, syncope, dizziness
CV: hypotension, arrhythmias, chest pain
GI: vomiting, diarrhes, nausea
Nursing Considerations:
- Assess allergy to the drug
- Monitor uterine tone and vaginal discharge during procedure and several
days after to assess drug effects and recovery
- Ensure adequate hydration

Generic Name: Midazolam hydrochloride

Brand Name: Versed
Classification: Benzodiazepine (short-acting); CNS depressant
Therapeutic actions:
- Exact mechanisms of action not understood; acts mainly at the limbic
system and reticular formation; potentiates the effects of GABA, an
inhibitory neurotransmitter; anxiolytic and amnesia effects occur at
doses below those needed to cause sedation, ataxia; has little effect on
cortical function.
Indications
- IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic,
therapeutic, or endoscopic procedures or surgery
- Induction of general anesthesia
- Continuous sedation of intubated and mechanically ventilated patients
as a component of anesthesia or during treatment in the critical care
setting
- Unlabeled uses: Treatment of epileptic seizure or refractory status
epilepticus

Contraindications and cautions

- Contraindicated with hypersensitivity to benzodiazepines; psychoses,
acute narrow-angle glaucoma, shock, coma, acute alcoholic
intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac
defects, microcephaly, pyloric stenosis have been reported when used
in first trimester; neonatal withdrawal syndrome reported in infants);
neonates.
- Use cautiously in elderly or debilitated patients; with impaired liver or
kidney function, lactation.
Adverse effects
CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy,
apathy, fatigue, light-headedness, disorientation, restlessness, confusion,
crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity,
tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration,
vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild
paradoxical excitatory reactions (during first 2 wk of treatment), visual and
auditory disturbances, diplopia, nystagmus, depressed hearing, nasal
congestion
CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension,
palpitations, edema
Dermatologic: Urticaria, pruritus, skin rash, dermatitis
GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting,
difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH,
alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice
GU: Incontinence, urinary retention, changes in libido, menstrual
irregularities
Hematologic: Decreased Hct, blood dyscrasias
Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever,
diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain,
burning, and redness after IM injection
Dependence: Drug dependence with withdrawal syndrome when drug is
discontinued (more common with abrupt discontinuation of higher dosage
used for longer than 4 mo)

Nursing considerations

- History: Hypersensitivity to benzodiazepines; psychoses, acute

narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with
depression of vital signs; elderly or debilitated patients; impaired liver
or kidney function; pregnancy, lactation
- Physical: Weight; skin color, lesions; orientation, affect, reflexes,
sensory nerve function, ophthalmologic examination; P, BP; respiratory
rate, adventitious sounds; bowel sounds, normal output, liver
evaluation; normal output; LFTs, renal function tests, CBC
- Do not administer intra-arterially, which may produce arteriospasm or
gangrene.
- Do not use small veins (dorsum of hand or wrist) for IV injection.
- Administer IM injections deep into muscle.
- Arrange to reduce dose of midazolam if patient is also being given
opioid analgesics; reduce dosage by at least 50% and monitor patient
closely.
- Monitor level of consciousness before, during, and for at least 2–6 hr
after administration of midazolam.
- Carefully monitor P, BP, and respirations carefully during
administration.
- Keep resuscitative facilities readily available; have flumazenil available
as antidote if overdose should occur.
- Keep patients in bed for 3 hr; do not permit ambulatory patients to
operate a vehicle following an injection.
- Establish safety precautions if CNS changes occur (use side rails,
accompany ambulating patient).
- Client may experience these side effects: Drowsiness, dizziness (these
may become less pronounced after a few days; avoid driving a car or
engaging in other dangerous activities if these occur); GI upset;
 dreams, difficulty concentrating, fatigue, nervousness, crying (it may
help to know that these are effects of the drug; consult your health
care provider if these become bothersome).
- Report severe dizziness, weakness, drowsiness that persists, rash or
skin lesions, visual or hearing disturbances, difficulty voiding.

Generic Name: Hyoscine-N-butylbromide

Brand Name: Buscopan
Classification: Antispasmodic; Anticholinergic
Therapeutic Actions:
- acts by interfering with the transmission of nerve impulses by
acetylcholine in the parasympathetic nervous system.
Indications:
- Buscopan Tablets are indicated for the relief of spasm of the genito-
urinary tract or gastro- intestinal tract and for the symptomatic relief of
Irritable Bowel Syndrome
Contraindications:
- Buscopan Tablets should not be administered to patients with
myasthenia gravis, megacolon and narrow angle glaucoma. In
addition, they should not be given to patients with a known
hypersensitivity to hyoscine-N-butylbromide or any other component of
the product.
Adverse Effects:
CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP,
disorientation,
restlessness, irritability, dizziness, drowsiness, headache, confusion,
hallucination, delirium, impaired
memory
CV: hypotension, tachycardia, palpitations, flushing
GI: Dry mouth, constipation, nausea, epigastric distress
DERM: flushing, dyshidrosis
GU: Urinary retention, urinary hesitancy
Resp: dyspnea, bronchial plugging, depressed respiration
EENT: mydriasis, dilated pupils, blurred vision, photopobia, increased
intraocular pressure,
difficulty of swallowing.
Nursing Considerations:
- Drug compatibility should be monitored closely in patients requiring
adjunctive therapy
- Avoid driving & operating machinery after parenteral administration.
- Avoid strict heat
- Raise side rails as a precaution because some patients become
temporarily excited or disoriented and some develop amnesia or
become drowsy.
- Reorient patient, as needed, Tolerance may develop when therapy is
prolonged
- Atropine-like toxicity may cause dose related adverse reactions.
Individual tolerance varies greatly
- Overdose may cause curare-like effects, such as respiratory paralysis.
Keep emergency equipment available.