Generic Name

: Albuterol
Brand Name: Salbutamol, Proventil, Ventolin, Accuneb, airet, Novo-Salbutamol, Proventil HFA, Gen-salbutamol, Ventodisk,
Ventolin HFA, Volmax, VoSpira ER
Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)
Indications
1. To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
2. Quick relief for bronchospasm
3. For the prevention of exercise-induced bronchospasm
4. Long-term control agent for patients with chronic or persistent bronchospasm
Mechanism of Action
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.
1. First, it binds to the beta2-adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the
adenyl cyclase and increased levels of cyclic- 3’5’-adenosine monophosphate (cAMP).
2. When cAMP increases, kinases are activated.
3. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium.
4. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.
Contraindications
1. Hypersensitivity to adrenergic amines
2. Hypersensitivity to fluorocarbons
Precaution
1. Cardiac disease including coronary insufficiency, a history of stroke, coronary artery diseaseand cardiac arrhythmias
2. Hypertension
3. Hyperthyroidism
4. Diabetes
5. Glaucoma
6. Geriatric patients – older individuals are at higher risk for adverse reactions and may require lower dosage
7. Pregnancy especially near term
8. Lactation
9. Children less than 2 years of age because safety of its use has not been established
10. Excess inhaler use which may lead to tolerance and paradoxical bronchospasm
Side Effects and Adverse Reactions
1. Nervousness
2. Restlessness
3. Tremor
4. Headache
5. Insomnia
6. Chest pain
7. Palpitations
8. Angina
9. Arrhythmias
10. Hypertension
11. Nausea and vomiting
12. Hyperglycemia
13. Hypokalemia
Nursing Interventions
1. Assess lung sounds, PR and BP before drug administration and during peak of medication.
2. Observe fore paradoxical spasm and withhold medication and notify physician if condition occurs.
3. Administer PO medications with meals to minimize gastric irritation.
4. Extended-release tablet should be swallowed-whole. It should not be crushed or chewed.
5. If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication.
6. Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth.
7. Inform the patient that Albuterol may cause an unusual or bad taste.

Generic Name:Cetriaxone
Brand Name:Rocephin
Classifications:antiinfective; antibiotic; third-generationcephalosporin
Pregnancy Category:B
Availability
250 mg, 500 mg, 1 g, 2 g injection
Actions
Semisynthetic thirdgeneration 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.

Therapeutic effects
Spectrum of activity similar to that of cefotaxime including most Enterobacteriaceae, most gram-positive aerobic cocci, Neisseria
meningitidis, and most strains of penicillinase-producing and nonpenicillinase-producing Neisseria gonorrhoeae. Has some
activity against Treponema pallidum but none against most strains of Clostridia. Effectively treats bone and joint infections,
gonorrhea and intra-abdominal infections, meningitis and lower respiratory tract infections, otitis media, pelvic inflammatory
disease, Proteus infections, septicemia, skin and soft tissue infections, urinary tract infections, and is used for surgical
prophylaxis, reducing or eliminating infection.
Uses
Infections 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.
Contraindicatons
Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B).

Assessment & Drug Effects

 Determine history of hypersensitivity reactions to cephalosporins and penicillins 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 may be started
pending test results. Periodic coagulation studies (PT and INR) should be done.
 Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness, swelling,
pain).
 Monitor for manifestations of hypersensitivity . Report their appearance promptly and discontinue drug.
 Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter vitamin
K-producing gut bacteria; therefore, hypoprothrombinemic bleeding may occur.
 Check for fever if diarrhea occurs: Report both promptly. The incidence of antibiotic-produced pseudomembranous colitis is higher
than with most cephalosporins. Most vulnerable patients: chronically ill or debilitated older adult patients undergoing abdominal
surgery.
  Omeprazole(o-me´pra-zole)
Brand Name:Losec,Prilosec
Classifications:gastrointestinal agent; proton pump inhibitor
Pregnancy Category:C
Availability: 10 mg, 20 mg, 40 mg capsules
 Actions
An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+,
K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.
 Therapeutic effects
Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing.
 Uses
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk
treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome,multiple
endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers
associated with Helicobacter pylori.
 Contraindications
Long-term use for gastroesophageal reflux disease, duodenal ulcers; lactation.
Adverse effects
CNS:Headache, dizziness, fatigue.
GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests.
Urogenital:Hematuria, proteinuria.
Skin:Rash.

 Report any changes in urinary elimination such as pain or discomfort associated with urination, orblood in urine.
 Report severe diarrhea; drug may need to be discontinued.
 Do not breast feed while taking this drug.
 Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use.

International- Hepasil, Heptosil, Liprotec, Sarim, Silimarin, Silirin.

Why it is prescribed (Indications) :
This medication is a herb, prescribed for liver disease.
When it is not to be taken (Contraindications):
Hypersensitivity.

Warnings and Precautions :

* Caution needed in patients with history of hepatic encephalopathy (confusion, altered level of consciousness and coma as a
result of liver failure), and in pregnant and breastfeeding women.

Side Effects :
Abdominal bloating, diarrhea, flatulence, loss of appetite, nausea and stomach upset.

Digoxin
Brand Name
 Digitek,
 Lanoxicaps,
 Lanoxin
Classification
 Cardiac glycoside,
 Cardiotonic
 Pregnancy Category C

Therapeutic actions
Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of
myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin
also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic
nervous system and an increase in vagal activity.
Indications
 CHF
 Atrial fibrillation

Adverse Effects
 Extra beats, anorexia, nausea and vomiting.
 Diarrhea in elderly, confusion, dizziness, drowsiness, restlessness, nervousness, agitation and amnesia, visual
disturbances, gynecomastia, local irritation (IM/SC inj), rapid IV admin may lead to vasoconstriction and
transient hypertension.
 Potentially Fatal: Cardiac arrhythmias in combination with heart block.

Contraindications
 Digitalis toxicity, ventricular tachycardia/fibrillation, obstructive cardiomyopathy.
 Arrhythmias due to accessory pathways (e.g. Wolff-Parkinson-White syndrome).

Nursing considerations
Assessment
 History: Allergy to digitalis preparations, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus
syndrome, IHSS, acute MI, renal insufficiency, decreased K+, decreased Mg2+ increased Ca2+, pregnancy,
lactation
 Physical: Weight; orientation, affect, reflexes, vision; P, BP, baseline ECG, cardiac auscultation, peripheral
pulses, peripheral perfusion, edema; R, adventitious sounds; abdominal percussion, bowel sounds, liver
evaluation; urinary output; electrolyte levels, LFTs, renal function tests

 Piperacillin/Taxobactam
Brand Name:Zosyn
Classifications: antiinfective; beta-lactam antibiotic; antipseudomonal penicillin
Pregnancy Category: B
Actions
  Antibacterial combination product consisting of the semisynthetic piperacillin and the beta-lactamase
inhibitor tazobactam. Tazobactam component does not decrease the activity of the piperacillin component against
susceptible organisms.

 Therapeutic Effects
Tazobactam is an inhibitor of a wide variety of bacterial beta–lactamases. It has little antibacterial activity itself;
however, in combination with piperacillin, it extends the spectrum of bacteria that are susceptible topiperacillin. Two-
drug combination has antibiotic activity against an extremely broad spectrum of gram-positive, gram-negative
and anaerobic bacteria.
 Uses
Treatment of moderate to severe appendicitis, uncomplicated and complicated skin and skin structure infections,
endometritis, pelvic inflammatory disease, or nosocomial or community-acquired pneumonia caused by piperacillin-
resistant, piperacillin/tazobactam-susceptible, beta-lactamase-producing bacteria.
 Contraindications
Hypersensitivity to piperacillin, tazobactam, penicillins, cephalosporins, or beta-lactamase inhibitors such as clavulanic
acid and sulbactam.

Adverse effects
CNS:Headache, insomnia, fever.
GI:Diarrhea, constipation, nausea, vomiting, dyspepsia, pseudomembranous colitis.
Skin:Rash, pruritus, hypersensitivity reactions.
Nsg. responsibility
 Report rash, itching, or other signs of hypersensitivity immediately.
 Report loose stools or diarrhea as these may indicate pseudomembranous colitis.
 Do not breast feed while taking this drug without consulting physician.

Generic name:
metronidazole
Brand name:
Flagyl
Preparations:
PO 7.5 mg/kg q6hr (not to exceed 4g/day)
CLASSIFICATION: Anti-infectives,
Anti-protozoals
ACTION:
• Disrupts DNA and protein synthesis in susceptible organisms
• Bactericidal, or amebicidal action
INDICATION / USES:
•Amebicide in the management of amebic dysentery
COMMON ADVERSE EFFECTS:
•CNS: seizures, dizziness, headache
• GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste,
vomiting
• Hematologic: leukopenia
• Skin: rashes, urticaria
CONTRA-INDICATIONS:
• hypersensitivity
NURSING CONSIDERATIONS:
• Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty
swallowing.
• Instruct patient to take medication exactly as directed evenly spaced times between dose, even if
feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as
remembered if not almost time for next dose.
•May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until
response to medication is known.
• Inform patient that medication may cause an unpleasant metallic taste.
• Inform patient that medication may cause urine to turn dark.
• Advise patient to consult health care professional if no improvement in a few days or if signs and
symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

citicoline sodium
Brand Name
Zynapse, Somazina, Cholinerv
Drug Class
CNS Stimulant, Peripheral Vasodilators, Cerebral Activators, Nootropics
Therapeutic Action
Citicoline increases blood flow and O2 consumption in the brain. It is also involved in the biosynthesis action.
Indications
Citicoline is indicated in CVD in acute recovery phase in severe s/sx of cerebrovascular insufficiency and in-cranial
traumatism and their sequellae. Citicoline in CVA, stimulates brain function.
Contraindications
 Any allergy or hypersensitivity to the drug
 Hypertonia of the parasympathetic nervous system
 Use cautiously for pregnancy and lactation
 Conscious use for patient with renal and hepatic damage

Adverse Effects
 Fleeting and discrete hypotension effect, increased parasympathetic effects, low blood pressure
 Itching or hives, swelling in face or hands, chest tightness, tingling in mouth and throat

Dosage of Citicoline
 100mg/mL x 15mL, adult oral drops of citicoline

Nursing Responsibilities
 Take Citicoline as prescribed
 Take Citicoline on time
 Monitor patients neurologic status
 Note if there are signs of slurring of speech
 Note for adverse reactions
 Titer medication when discontinuing
 Teach patient on how to take the drug
 Arrange for regular follow-ups

atorvastatin calcium
Brand Name: Lipitor
Classification: Antihyperlipidemic, HMG-CoA reductase inhibitor

Indications

 Adjunct to diet in treatment of elevated total cholesterol, serum triglycerides, and LDL
cholesterol in patients with primary hypercholesterolemia (types IIa and IIb) and mixed
dyslipidemia, primary dysbetalipoproteinemia, and homozygous familial hypercholesterolemia
whose response to dietary restriction of saturated fat and cholesterol and other
nonpharmacologic measures has not been adequate
 To increase HDL-C in patients with primary hypercholesterolemia and mixed dyslipidemia
 Adjunct to diet to treat elevated serum triglyceride levels
 Adjunct to diet in treatment of boys and postmenarchal girls ages 10–17 with heterozygous
familial cholesterolemia if diet alone is not adequate to control lipid levels and LDL-C levels are
> 190 mg/dL or if LDL-C level is > 160 mg/dL and there is a family history of premature CV
disease or the child has two or more risk factors for the development of coronary disease
 Prevention of CV disease in adults without clinically evident coronary disease but with multiple
risk factors for CAD such as age > 55 yr, smoking, hypertension, low HDL-C, family history of
early CAD; to reduce the risk of MI and risk for revascularization procedures and angina

Adverse effects

 CNS: Headache, asthenia

 GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver
failure
 Respiratory: Sinusitis, pharyngitis
 Other: Rhabdomyolysis with acute renal failure, arthralgia, myalgia

Contraindications

 Contraindicated with allergy to atorvastatin, fungal byproducts, active liver disease or

unexplained and persistent elevations of transaminase levels, pregnancy, lactation.
 Use cautiously with impaired endocrine function.

Nursing considerations
CLINICAL ALERT!

 Name confusion has been reported between written orders for Lipitor (atorvastatin) and Zyrtec
(certirizine). Use extreme caution.

Assessment

 History: Allergy to atorvastatin, fungal byproducts; active hepatic disease; acute serious
illness; pregnancy, lactation
 Physical: Orientation, affect, muscle strength; liver evaluation, abdominal examination; lipid
studies, LFTs, renal function tests
  You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint
aches and pains (may lessen over time).
  Report muscle pain, weakness, tenderness; malaise; fever; changes in color of urine or stool; swelling.

Generic name:
Betahistine dihydrochloride
Brand name:
SERC
Indication:
Meniere’s disease, Meniere-like syndrome (with symptoms of vertigo, tinnitus and sensorineural deafness) and
vertigo of peripheral origin.
Drug Classification:
Anti emetics and Anti vertigo
Mechanism of Action:
Betahistine was found to have a histamine-like action in animals. Since parenteral histamine has been used in
the treatment of Meniere’s disease, studies were conducted to test the action of betahistine in this condition.
Unlike some other anti-vertigo drugs, testing with nystagmus induced by caloric and rotational stimulation has
demonstrated that betahistine does not decrease the vestibular response, as recorded by electronystagmography.
In addition, the absorption, metabolism and action of betahistine when administered by the oral route are not
known. However, clinical studies indicate that SERC may be useful in reducing the vertigo of Meniere’s
disease.
Dosage:
 Adults: 24-48 mg divided over the day
 8 mg tablets- 1-2 tablets, 3 times/day
 16 mg tablets: 1 tablet, 3 times/day
 Form: Tablet 8 mg x 100’s, 16 mg x 100’s

Special Precaution:
Patients suffering from pheochromocytoma, bronchial asthma need to be carefully monitored during the
therapy. Caution should be taken in the treatment of patients with a history of peptic ulcer. Pregnancy risk
category Adverse Effects: Occasionaly patients have experienced gastric upset, nausea and headache.
Contraindication:
Hypersensitivity to any component of the product.
Nursing Responsibilities for SERC (Betahistine)
 Avoid contact of oral solution or injection with skin
 Raise bed rails, institute safety measures, supervise ambulation