Cardiac-> Antihypertensive -> ACE Inhibitor (ACEI)

Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Lotensin 1. Benazepril PO Chemical Effect: 1. Hypertension GI: ALT, AST increase, Monitor BP/ Pulse -> Fall risk
Inhibit ACE, preventing 2. Heart Failure Constipation, Gastric mcrease
2. Capoen 2. Captopril Angiotensin I transform into 3. Left ventricular irritation, Peptic ulcer
Angiotensin II. Decreasing dysfunction Monitor WBC level
3. Renitec 3. Enalapril
peripheral arteries resistance after MI CV: Tachycardia, MI,
4. Fosinopril 4. Monopril and aldosterone secretion Hypotension DM -> Adjust insulin level
(Risk of K level increase)
5. Zestril 5. Lisinopril Therapeutic Effect: Haematology: Close monitor patient with
Reduce water and sodium Neutropenia, volume deficit (Risk of K
6. Univasc 6. Moexipril
retention -> Lower BP + Thrombocytopenia, level increase)
7. Quinapril 7. Accupril Help improve renal function Decrease RBC, WBC,
Sodium level If patient develop fever, sire
8. Altace 8. Ramipril Increase K level throat, leukopenia,
hypotension or tachycardia ->
9. Macvik 9. Trandolapril
GU: Proteinuria, Polyuria, Withhold + inform doctor
10. Acertil 10. Perindorpril Oliguria, Increase in
Bilirubin + Creatinine Do not admin with Antacid

Dermatologic: Rash, Avoid food that is rich in K

(-pril)
Pruritus, Photosensitivity
Dont stop medication abruptly
Other: Persistence Cough
Assess RFT before admission-> Withhold if Creatinine increase or GFR <S0mL/min or K >5.0mmol/L or SBP <lO0mmHg (Asymptomatic)
Contraindication / Caution for all ACEI -> Pregnancy
Cardiac-> Antihypertensive -> ACE Inhibitor (ACEI) + Diuretic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Zestoretic 1. Lisnopril + PO Refer to ACEI + Refer to ACEI Refer to ACEI + Diuretic Refer to ACEI + Diuretic
2. Co-Renitec Hydrochlorothiazide Diuretic
2. Enalapril +
Hydrochlorothiazide
Assess RFT before admission-> Withhold if Creatinine increase or GFR <SOmL/min or K >5.Smmol/L or SBP <lOOmmHg (Asymptomatic)
Contraindication / Caution for all ACEI -> Pregnancy

2
Cardiac -> Antihypertensive -> Angiotensin Receptor Blockers (ARB)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Atacand Candesartan PO Block the vasoconstrictor 1. Hypertension 1. Renal Failure Administer without regard to
Selectively blocks the 2. Angioedema
meals
binding of Angiotensin II to
Avapro Irbesartan PO the Angiotensin I receptor in 1. Hypertension 1. Edema Same asACEI
tissues 2. Neuropathy in 2. Tachycardia
Type2 DM
patient

Olmetec Olmesartan PO Blocks the binding of 1. Hypertension 1. Arthralgia

Angiotensin II to the 2. Angioedema
Angiotensin I receptor in 3. Sinusitis
tissues and reduce secretion
of aldosterone

Cozaar Losartan PO Reduce the end organ I. Hypertension I. Renal Failure

response to Angiotensin II 2. Neuropathy in 2. Blurred Vision
Type 2 DM 3. Upper Respiratory
patient infection
4. Insomnia

Diovan Valsartan PO Block the action of I. Hypertension 1. Weight gain

Angiotensin 2. Congestive 2. Fatigue
Heart Failure 3. Anemia

Micardis Telmisartan PO Blocks RAs 1. Hypertension I. Tachy/Brady - cardia

2. Hypotension
3. Edema

Teveten Eprosartan PO Blocks the binding of 1. Hypertension 1. Upper respiratory

Angiotensin II to the infection
Angiotensin I receptor in 2. Dyspepsia
tissue -> Vasodilation
Inhibit Norepinephrine
production -> BP drop
Contraindication/ Caution for all ACEI -> Renal Insufficiency (Creatinine clearance <lOmL/min)

3
Cardiac -> Antihypertensive -> Angiotensin Receptor Blockers (ARB) + Diuretic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. BlopressPlus 1. Candesartan + PO Refer to ARB + Refer to ARB Refer to ARB + Diuretic Refer to ARB + Diuretic
Hydrochlorothiazide Diuretic
2. Co-Diovan
2. Valsartan +
3. Hyzaar
Hydrochlorothiazide
4. Coaprovel
3. Lorsartan +
5. Micardis Plus
Hydrochlorothiazide
6. Olmetec Plus 4. lrbesartan +
7. Teveten Plus Hydrochlorothiazide
5. Telmisartan +
Hydrochlorothiazide
6. Olmesartan +
Hydrochlorothiazide
7. Eprosartan +
Hydrochlorothiazide
Contraindication / Caution for all ACEI -> Renal Insufficiency (Creatinine clearance <lOmL/min)

4
Cardiac -> Antihypertensive -> Peripheral Alpha-1 Receptor Blocker
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Cardura / 1. Doxazosin PO Block Postsynaptic Alpha- 1. Hypertension CNS: Dizziness, Check Prostate-Specific antigen
Adrenergic Receptor-> 2. Treatment of Headache, Drowsiness, before admin
CarduraXL 2. Prazosin
Decrease sympathetic tone BPH Weakness
2. Minipress 3. Tarnsulosin on vasculature -> BP drop (Tamsulosin / Admin drug after meal
3. Tarnsulosin 4. Terazosin Terazosin) CV: Orthostatic
BPH: Block Alpha- I 3. Unlabelled Hypotension, Sodium and
4. Hytrin Likelihood of first dose
adrenergic receptors on Use: Water retention,
syncope due to excessive
smooth muscle in the Management of Tachycardia
postural hypotension
prostate, prostatic capsule, refractory CHF
prostatic urethra and bladder and Raynaud GI: Abdominal Pain,
Monitor + Education for
neck + Relaxing bladder Vasospasm Constipation, Vomiting
orthostatic hypotension

GU: Urinary Frequency,

Impotence Monitor oedema and weight in
patient with CHF
EENT: Blurred Vision
Tablet should be swallow
Respiratory: Coughing, whole, no crush / chew / cut
URI, LRI

5. Trandate 5. Labetalol PO SAME AS ABOVE 1. Hypertension SAME AS ABOVE SAME AS ABOVE

Non-selective Alpha 2. BPH

Antagonist

5
Cardiac -> Antihypertensive -> Beta-Adrenoceptor Bloker (BAB)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Betaloc 1. Metoprolol -PO Chemical Effect: 1. Hypertension GI: Gastric Pain, flatulence, Do not stop medication
- IV Competitively block beta- 2. Angina Pectoris constipation, diarrhea, abruptly
2. Inderal 2. Propranolol
adrenergic receptors in heart 3. Palpitation, Cardiac nausea, vomiting
3. Tenormin 3. Atenolol arrthymias, Admin with food
4. Normodyne 4. Labetalol Decrease influence of the Superventricular CV: Bradycardia,
sympathetic nervous system tachycardia Tachycardia, CHF,
5. Concor 5. Bisoprolol Monitor Hstix for
on excitability of heart, 4. Ventricular Hypotension
hypoglycemia
6. Dilatrend 6. Carvedilol cardiac workload, oxygen tachycardia induced
consumption, release of by digitals or Resp: Bronchospasm
Monitor changes in CNS
rennin, vasoconstrictor tone catecholamines
5. Prophylaxis for Neuro: Fatigue, dizziness
Withhold dug if :
With local anaesthetic effect migraine headache
to provide anti-arrhythmic (Propranolol) GU: Dysuria, Nocturia - Pulse <60/min or -

action 6. Management of - BP<100/60mmHg

(-olol)
stage fright EENT: Blurred vision
Therapeutic Effect: 7. Unlabelled use:
- Lower Heart Rate Schizophrenia, GI
- Lower Cardiac output bleed
- Lower Contractility
- Decrease Dysrhythmias

Betoptic Betaxolol -PO SAME AS ABOVE 1. Hypertension 1. Orthostatic Hypotension SAME AS ABOVE
- Ocular 2. Glaucoma 2. Tinnitus
Contraindication / Caution for all ACEI -> COPD / PVD / Heart block greater than 1st degree
Selectivity of the drug is not absolute but DOSE DEPENDENT

6
Cardiac-> Antihypertensive -> Calcium Channel Blocker (CCB)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Norvasc 1. Amlodipine PO Chemical Effect: 1. Hypertension CNS: Dizziness. Tablet should be

Inhibit the movement of calcium 2. Angina Pectoris Headache, Nervousness swallow whole, no
2. Adalat CC/ 2. Nifedipine
ions move across the membrane of 3. Vasospastic crush / chew / cut
AdalatXL 3. Felodipine cardiac and arterial muscle cells Angina GI: Nauseas, Diarrhea,
Do not stop medication
3. Plendil 4. Diltiazem 4. Migraines Constipation
abruptly
Depress the impulse formation in
4. Herbesser 5. Verapamil
specialised cardiac pacemaker cell CV: Peripheral
5. Isorptin Taper dosage of beta-
Slowing of conduction of impulse oedema, Hypotension,
blockers before
Depress the contract of myocardial AV Block, Bradycardia
beginning CCB
muscle
Dilation of artery Derma: Rash, Flushing Protect drug from light /
(-ipine)
moisture
Therapeutic Effect: Other: Nasal
Decreased cardiac workload Congestion, Cough, Monitor for CNS
Decreased energy consumption SOB, Weight Gain change
Increase 02 delivery to myocardial
cells

7
Cardiac -> Antihypertensive -> Centrally Acting Antihypertensive
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Aldomet 1. Methyldopa PO Chemical Effect: 1. Hypertension CNS: Sedation Effect, Monitor Hepatic Function
Drug metabolism to alpha- Hallucination, Headache, especially in the first 6-12
2. Clonidine
methy I norepinephrine Weakness, Dizziness weeks
3. Guanabenz which lower arterial blood
4. Guanfacine pressure by stimulating CNS CV: AV block, Angina Do not miss dose
alpha II adrenergic receptors, Pectoris, Hypotension,
which in tum decrease Bradyarrhythmias
Monitor CV / CNS/ Heamat
sympathetic outflow from
CNS GI: Vomiting, Distention,
Allert on sedation use with
Constipation
patient administering central
Therapeutic Effect:
acting antihypertensive drug
Sympathoplegics that act in Haemat: Positive
the central nervous system Coombs Test
produce a moderate
hypotensive effect free of Liver: Abnormal LFT,
postural hypertension. Jaundice

Other: Dry mouth

Cardiac-> Antihypertensive -> Alpha/Beta Adrenergic Blocker

Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Coreg 1. Carvedilol PO I Heart Failure/ MI Bradyarrhythmia, Avoid activities

Hypertension Hypotension, Diarrhea, Monitor Hstix
Impaired LVF Dizziness, Fatigue Take drug with food

8
Cardiac -> Antihypertensive -> Vasodilator Antihypertensive
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Apresoline 1. Hydralazine PO Chemical Effect: 1. Hypertension CNS: Headache, Do not stop medication
IV Direct Acting smooth muscle 2. CHF Dizziness, Depression, abruptly
relaxant used to treat 3. Primary Anxiety Disorientation
hypertension by acting as a pulmonary Admin medication with food

vasodilator primarily in hypertension GI: Anorexia, Vomiting,

Check CBC I LE / ANA titer
arteries and arterioles. Diarrhea, Constipation

Observe for peripheral neuritis

Therapeutic Effect: CV: Tachycardia,
Decrease Peripheral Hypotension
resistance -> Lowering BP
GU: Impotence

Other: LE (Lupus-like),
Muscle cramps

9
Cardiac -> Positive Inotropic or Inotropic Sympathomimetics
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Lanoxin Digoxin PO Inhibit Na/K ATPase, Heart Failure CNS: Fatigue, Dizziness, Close monitor on BP/P
. . .
IV causmg mcrease m AF Headache Close monitor on ECG
intracellular Na and K. CV: Bradycardia, SA
Result in HR decrease Block, AV Block
and BP increase EENT: Blurred vision,
NORMALDOSE yellow or green vision
Act on vagal nerve, 1st 250mg over 30mins GI: Diarrhea
produce direct effect on 2nd 250mg Q6H
pacemaker cell.
MAX DOSE
lg in 24hr

Dopamine IV Act through sympathetic Hypotension CNS: Headache

nervous system to Low cardiac output GI: Nausea Vomiting
increase heart muscle Acute Liver injury Other: Chills
contraction force and Low vital organ
cause vasoconstriction perfusion

10
Cardiac -> Positive Inotropic or Inotropic Sympathomimetics
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Atropine Atropine PO Atropine poison the vagus nerve Vagally-mediated CNS: Dizziness, Close monitor on BP/P
IV therefore remove the effect of bradycardia Headache, Mood change, Close monitor on ECG
parasympathetic. Which cause the Blurred vision, Dry eyes,
increase of heart rate. Pain, Numbness, Tingling
in hands or feet

GI: Constipation, Loss of

MAX DOSAGE: appetite, N+V
3mg
CV: Tachycardia

Adrenaline Adrenaline IV Blind to Alpha-1 and Beta-1 Arrest CNS: Headache

receptor. Causing increased CHF GI: Nausea Vomiting
peripheral circulation pressure. Cardiogenic shock CV: Hypotension, HR
Thus increasing coronary and increase
cerebral perfusion pressure -> Other: Chills
Increase 02 exchange in cell level.

Increase Aortic, Cerebral and

Carotid circulation pressure

11
Cardiac-> Positive Inotropic or Inotropic Sympathomimetics -> Beta-Adrenergic Agonist
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Isopreterenol Isoprenaline PO Directly stimulates beta-1 receptors - Heart Block - N+V Close monitor on BP/P
IV of the heart to increase myocardial - Bradycardia - Headache Close monitor on ECG
contractility and stroke volume, - Sever Asthma - Palpitation
resulting in increased cardiac output - Hypovolemic - Sweating
Shock - Hypo/Hypertension

Dobutrex Dobutamine IV Heart Failure CNS: Headache

Cardiogenic Shock GI: Nausea Vomiting
CV: Hypotension, HR
mcrease
Other: Chills

12
Cardiac -> Anti-Arrhythmias
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Adenosine ATP IV Provide energy to human Arrhythmia CNS: Fatigue, Dizziness,

triphosphate body cell Headache
disodium CV: Hypotension
NORMAL DOSE Dermat: Flushing
1st: 10mg Bolus GI: Nausea
2nd: 20mg Other: Coughing

Cordarone Amiodarone PO Prolongs the myocardial Arrhythmia CNS: Dizziness, Educate patient to not take
IV cell-action potential (phase Tiredness, Headache grape or grape juice while
3) duration and refractory GI: Nausea, Constipation having medication
period and acts as a Other: Shaking
noncompetitive a- and b-
adrenergic inhibitor

Atropine Atropine PO Atropine poison the vagus Arrhythmia CNS: Dizziness,

IV nerve therefore remove the Headache, Mood change,
effect of parasympathetic. Blurred vision, Dry eyes,
Which may normalise the Pain, Numbness, Tingling
heart rate. in hands or feet

GI: Constipation, Loss of

appetite, N+V

CV: Tachycardia

13
Cardiac -> Anti-Arrhythmias
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Rythmol Propafenone PO Slowing the influx of Na into Arrhythmia - N+V

cardiac cell, thus slowing the - Dizziness
heart beat - Lupus like syndrome
- Bronchospasm

14
Cardiac -> Antianginal - Nitrates
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Elantan 1. Isosorbide PO Chemical Effect: 1. Angina Pectoris CNS: Headache, Give oral medication with
Mononitrate Activates the enzyme (Treatment and Dizziness, Faintness, empty stomach
2. Isosorbide (cGMP) which then Prevention) Fatigue
2. Elantan Mononitrate activates a series of Withhold if bradycardia /
LONG SR protein kinase- GI: Vomiting, hypotension
3. IMDUR 3. Isosorbide dependent Abdominal Pain
Mononitrate phosphorylations in Contraindication
Sublingual -> Repeat every
CR smooth muscle fiber - Early MI CV: Tachycardia,
5mins until relief (Do not take
4. Isodrill 4. Isosorbide - Severe anemia Hypotension, Postural
>3 tablets/15mins)
5. Isodrill Dinitrate Therapeutic Effect: - Cerebral Hypotension
5. Isosorbide Relax vascular haemorrhage/
Tembids Transdermal Patch change
Dinitrate SR smooth muscle with a hypotension/ Dermat: Rash, Cold
every 24hrs or according to
resultant decrease in hypovolemia Sweat
6. Isoket 6. Isosorbide IV
venous return and - Increase manufacture prescription
Dinitrate decrease in arterial intracranial Local: Local burning
7. Nitro POHL Nitroglycerin / IV BP, which reduce left pressure sensation at the point of Do not chew or swallow the
ventricular workload - Low ventricular dissolution (Sublingual) drug, place it under the tongue
8. Angised Glyceryl Sublingual
and decrease filling pressure
9. Nitrolingual Trinitrate Translingual
myocardial oxygen Other: Muscle Do not apply transdermal patch
Spray consumption Twitching, Ethanol on hairy skin
10. Nitrodur Transdermal Intoxication

11. Nitrodisc Do not stop medication

abruptly
Mononitrate - Chronic Stable Angina / Dinitrate - CHF / Trinitrate - Acute Angina
Discard 8 weeks after opening of the package
15
Cardiac-> Anti-Lipidaemia
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication
1. Lipitor 1. Atorvastatin PO - Decrease cholesterol - Hypercholesterolaemia - Constipation - Monitor LFT
2. Lescol 2. Fluvastatin synthesis and increase - Flatulence - Admin drug at night to
3. Mevacor 3. Lovastatin LDL receptors on - Abd pain minimise drug effect
4. Pravachol 4. Pravastatin hepatocytes - Insomnia - Not to take grape food
5. Crestor 5. Rosivastatin - Increase LDL uptake - Headache with statin medication
6. Zocor 6. Simvastatin by the hepatocytes and - Dizziness
decreasing LDL - Blurred Vision
concentration in blood - Fatigue
1. Lopid Gemfibrozil PO - Increase in the - Hypercholesterolaemia - GI upset - I
2. Fenofibrate synthesis of lipoprotein - Mixed - Fatigue
lipase Hypercholesterolaemia - Dyspepsia
- Hypertriglyceridaemia
- Mixed
Hypertriglyceridaemia
Niaspan Nicotinic Acid PO - Decrease lipolysis in - Hypercholesterolaemia - Flushing Caution with patient with :
adipocytes -> Reducing - Diarrhea - Bleeding tendency
plasma free fatty acids - N+V - Undergoing surgery
lv and decrease VLDL - Abd pain - On Anti-coagulant
production by the liver - Dizziness - On nitrates / CCB / ARB
- Increase HDL-C and - Headache
Withhold if AST and ALT
reducing TG, LDL-C - Elevation of AST/ ALT
hit 3 times the upper limit
and Lp(a) - Reduction of platelet count
of normal

16
Cardiac-> Anti-Lipidaemia
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication
Ezetrol Ezetimbie PO - Decrease cholesterol - Hypercholesterolaemia - N+V - Monitor LFT
absorbed in the - Use in conjunction - Dizziness
digestive tract with Statin to maximise - Headache
effect - Abd Pain
- ALT Increase

17
Diuretic -> Loop Diuretic
Trade Name Generic Route Action Indication Side Effect Nursing Implication
Name

1. Bumentanide Burinex PO Inhibiting reabsorption of Oedema CNS: Headache/ Dizziness Monitor I/O and BP before admin
water and electrolytes in the CV: ECG changes
Monitor for imbalance electrolytes
ascending Loop of Henle and EENT: impaired hearing
proximal renal tube Other: Muscle Cramps Monitor RFT and serum electrolyte

1. Furosemide CP-Furo I PO Inhibit reabsorption of Na and Oedema CNS: Headache/ Ototoxicity Monitor for Hypo-K
IV chloride mainly in the medulla Dermat:Fluid and electrolyte Monitor oedema level
2. Furosemide Lasix /
portion of the ascending Loop imbalance / Rash /
Forte Urex Low salt diet
of Henle and increase Photosensitivity
excretion of potassium and GI: Diarrhea/ Nausea
ammonia while decrease uric EENT: Blurred vision
acid excretion CV: Hypotension

Diuretic -> Osmotic Diuretic

Trade Name Route Action Indication Side Effect Nursing Implication

Mannitol IVI Pull fluid out of the tissue with 1. Renal Failure CNS: Dizziness, - Do not use with patient with severe
hypertonic effect 2. Cerebral Oedema (Reduce IC Headache, blurred renal failure / active intracranial
Elevate osmolarity of hypertension) vision, convulsion bleeding
glomerular filtrate-> Hindering 3. Reduce intraocular pressure - Use infusion set with filter
CV: Hypotension,
reabsorption of Na/ H2O 4. Promote urinary excretion Edema - Check any crystal before admin
As irritant Create osmotic gradient in eye 5. As irritant in transurethral
Urea - Monitor serum electrolye/ BP/ I&O
Haemat: Fluid and
between plasma and ocular procedures
electrolytes imbalance Do not give blood with electrolyte
Decrease swelling in post-post-
free mannitol -> Add 20mEq of Na to
transurethral prostatic resection Dermat: Rash
each /L of mannitol if give blood

18
Diuretic -> Potassium-Sparing Diuretics (Aldosterone Antagonist)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Midamor Amiloride PO Act on distal renal 1. Primary CNS: Headache, Monitor 1/0 and BP before
Weakness, Dizziness admin
tubules. It increase the Hyperaldosteronism
(Week)
excretion of Na and 2. Oedema Monitor for imbalance
GI: Thirst, Nausea electrolytes
reduce secretion of K 3. CHF
It diminishes 4. Nephrotic Syndrome Haemat: Hypo-Na, Monitor RFT and serum
kaliuretic effect of 5. HypoK electrolyte
Hyper-K
other diuretic 6. Essential HT Monitor for Hyper-K
Block the effects of Dermat: Rash, Pruritus
2. Aldactone Spironolactone Monitor oedema level
aldosterone in the
EENT: Visual Change Low salt diet
renal tubule, causing
loss of Na and H20 Other: Postural
and retention ofK Hypotension
3. Moduretic Amiloride +
Hydrochlorothiazide
Contraindication / Caution -> Pregnancy

19
Diuretic -> Thiazides
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Amithiazide 1. Hydrochlorothiazide PO Chemical Effect: 1. Oedema CNS: Dizziness, Monitor I/O and BP
before admin
Inhibits reabsorption of Na 2. CHF Weakness, Vertigo
2. Apo-Amilzide
and Chloride by inhibition of a 3. Cirrhosis of Monitor for imbalance
3. Apo-Lisinopril/ specific Na+Cl- co transporter Liver GI: Nausea, Diarrhe, electrolytes

HCTZ 4. Renal Constipation, Monitor serum

Therapeutic Effect: disfunction Jaundice, Hepatitis calciuric level
4. Apo-Triazide
Na and H2O reabsorption 5. HT Monitor signs of
5. Microzide decrease CV: Postural Hypo, venous thrombus

6. Dichlotride Ca reabsorption increase Chest pain

K and H excretion increase
- Indapamide (/ - Nartrilx 1. Oedema
GU: Polyuria, loss of
2. CHF
SR) libido
- Diulo - Metolazone SAME AS ABOVE
Other: Muscle
cramps/ spasm, fever,
gouty attack, flushing

20
Urinary -> Diuretic -> Carbonic Anhydrase Inhibitor
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Diamox Acetazolamide PO A nonbacteriostatic 1. Chronic open-angle GI: Nausea, Constipation Stop medication when
Onset in 1hr sulfonamide that block the glaucoma reduce the sign of edema
Last 8-12 hrs action of carbonic 2. Secondary glaucoma Haemat: Bone Marrow
anhydrase, which is need 3. CHF suppression Monitor CBC and platelet
IV for active transport of ions 4. Drug induced edema count
Onset in 2min across the proximal tube 5. Epilepsy CNS: Anorexia
Last 4-5hrs 6. Mountain Sickness
Take medication with food
Decrease hydrogen ion
IM secretion by the tubules and
increase Na, K bicarbonate
and H2O excretion

Reduce pH of body fluid

Decrease formation of
aqueous humour
Contraindication / Caution -> Renal or Hepatic Disease

21
Urinary - Anti-Gouty Agent
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Colcrys Colchicine PO - Inhibition of inflammatory - Gouty Prophylaxis - N+V - Monitor patient I/O
caused by tubular disruption - Gouty flares - Dizziness (Withhold if diarrhoea)
- Familial Mediterranean - Headache - Prepare for Gouty
- For pain relief in gouty attack Fever (FMF) (Peadi) - Diarrhoea treatment
rather then curative - Pericarditis

Zyloric Allopurinol PO - Inhibit xanthine oxidase, - High Blood Uric Acid - N+V - I
which terminate the - Gouty - Itchiness
production of uric acid - Renal Stone - Rash
- Chemotherapy add-on

22
Endocrine System-> Anti-Diabetic Drug (DM drug)
Drug Group Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Meglitinides Novonorm Repaglinide PO - Prandial beta-cell DM - - Time to eat, time to treat

stimulators - Take with meal
(HK Common)
- Augment glucose- - Caution when take with
induced insulin Gemfibrozil or
secretion in Type II DM Clarithromycin, it may
patient
cause hypogly
Meglitinides - - Prandial glucose DM Hypoglycaemia - Limited clinical efficacy
regulation (Longterm - Fatigue since very short action
control) - Excessive Hunger - Before meal
- Sweating
- Dizziness

Sulfonylureas - Gliclazide - Diamicron (/MR) PO - Stimulate insulin DM - Hypoglycaemia - Check Hstix prior to admin
- Glibenclamide - Daniel/Euglucon release (at pancreatic - Hyponatremia - Before or with meal
(HK Common)
- Glipizide - Minidiab beta cell) - Weight gain

- Glimepriride -Amaryl - Increase tissue - Headache

- Tolbutamide - Rastinon sensitivity to circulating - Diarrhea, N+V

insulin - Heartburn
- Chlorpropamide - Diabinese

Biguanides - Metformin - Glucophage PO - Decrease glucose DM SAME AS ABOVE - SAME AS ABOVE

- Phenformin production by liver - Lactic acidosis - Avoid alcohol beverage
(HK Common)
- Increase peripheral - Wight Loss - With meal or after meal
utilisation of glucose - Withhold when
- Reduce insulin resistance undergone contrast
examination

23
Endocrine System -> Anti-Diabetic Drug (DM drug) (Cont'd)
Drug Group Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Alpha- - Glucobay - Acarbose PO - Delay absorption of DM - Flatulence - Before meal

Glyset - Miglitol glucose from small - Diarrhea - Contrindication: hx of
glucosidase
intestine Abdominal pain intestinal obstruction/ IBD/
inhibitor
Colonic ulceration
(HK Common)

TZDs - Rosiglitazone - Avandia PO - Increase insulin DM - Weight Gain - Contraindication: Active

- Pioglitazone - Actos sensitivity and glucose - Fluid Retention liver disease/ CHF/
uptake - Oedema Myocardial Ischaemia
- Decrease hepatic - Anaemia

(-azone) glucose output

- Improve lipid profile

DDP-4 - Januvia - Sitagliptin PO - Enhance glucose DM - Resp tract - Galvus -> Withhold if CrCl
- Galvus - Vildagliptin dependent insulin infection < 50mi/min
Inhibitor
Onglyza Saxagliptin secretion and inhibit - Sore Throat Precaution -> Patient with
(HK Common)
Trajenta Linagliptin glucagon release - Diarrhea ESRD

GLP-1 - Byetta PO - Increase insulin DM - Nausea

Analog secretion and reduce - Vomiting
Exanatide rate of gastric emptying
(HK Common)

SGLT2 - Dapagliflozin PO DM - UTI

- Canagliflozin - Vaginal Yeast
Inhibitor
(-gliflozin) infection

24
Endocrine System-> Anti-Diabetic Drug (DM drug) (Cont'd)
Drug Group Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Glitazones Actos Piogiltazone PO - Enhance insulin DM - Oedema - May lead to unexpected

sensitivity in muscle - Anemia pregnancy if proper
(HK Common)
and liver - Headache contraception is not used
- Raise HDL and - URTI - Caution with women with
decrease TG - Sinusitis low bone density
Janumet Sitagliptin + PO - Increase insulin release DM - Running nose - Caution with patient with
Metformin - Decrease hepatic - Headache CHF
Galvus Met Vildagliptin + PO glucose release - URTI - With hold if eGFR
Metformin - GI disturbance <30mlL/min
- Withhold when
Combine
undergone contrast
Types examination
Glucovance Metformin + PO - Increase insulin release DM - N+V - Swallow as whole
Glibenclamide and sensitivity - Abdpain - Withhold when
- Decrease hepatic - Itching undergone contrast
glucose release - Urticaria examination
Contraindication / Caution for all Anti-Diabetic Drug -> Hypoglycaemia

25
Endocrine System-> Insulin (DM drug)
Type of insulin Onset Peak time Duration Appearance Storage Storage Nursing
(Opened) (Unopened) Intervention(s)

Novorapid (Aspart) 10-20 mins 1-3 hrs 3-5 hrs

Rapid Humalog (Lispro) 0-15 mins 1 hr 2-5 hrs Clear

Apidra (Glulisine) 10-20 mins 1 hr 1.5-4 hrs

Actrapid 30 mins 1.5-3.5 hrs 8 hrs

Short Clear
HumulinR 30 mins 2-4 hrs 6-8 hrs

Protaphane 90 mins 4-12 hrs 24 hrs - Discard every 6

Inter-
Cloudly weeks for vials - Pre-Mix
mediate HumulinN 60 mins 4-10 hrs 24 hrs - Store in
- Discarding rd insulin must
refrigerator
Lantus (Glargine) 3-5 hrs No Peak 24 hrs every 4 weeks be mixed well
until expire
for pre-filled before use
Long Clear
Levermir (Detemir) 1-2 hrs No Peak 24 hrs
pens

Mixtard 30 30 mins 2-8 hrs 24 hrs

NovoMix 30 10-20 mins 1-4 hrs 24 hrs

Humulin 70/30 30 mins 2-12 hrs 24 hrs

Pre-Mix Cloudy

Humalog Mix 25 0-15 mins 1 hr 24 hrs

Humalog Mix 50 0-15 mins I hr 24 hrs

26
Endocrine System-> GLP-1 receptor agonist (DM drug)
Type Generic Name Apperance Dosing Storage (Opened) Storage (Unopened) Precaution

Byetta Exanatide Injection Pre-filled Pen - Start with 5mcg in first - Discard every Store in refrigerator - Do not freeze
month to reduce the 30days - Admin 60mins before
incidence and severity - Keep in refrigerator meal
of GI side effect -> - 6 hours apart two
Afterward I 0mcg injections
- Twice a day
Victoza Liraglutide Pre-filled Pen - Start with 0.6mg -> - Discard every 30 Store in refrigerator - Do not freeze
1.2mg -> 1.8mg days
- Once a day - Keep in room
temperature

27
Endocrine System-> Thyroid Hormone-> Levoisomer of Thyroxine (T4)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Eltroxin Levothyroxine PO - Control protein synthesis - Hypothyroidism CNS: Anxiety, Insomnia, - Monitor Height and Weight,
IV - Increase metabolic rate, - Myxedema coma Tremors, Thyroid Storm T3, T4, Pro-time check for
(Thyroxine)
IM cardiac output, renal - Thyroid bleeding brushing, increase
2. Levo-T blood flow, 02 hormone CV: Tachycardia, in nervousness or excitability
3. Levothroid consumption, body temp, replacement Palpitation, Angina, - Dilute medication
blood volume growth at - Congenital Dysrhythmias,
4. Levothyroxine - Do not take with food
cellular level hypothyroidism Hypertension, Cardiac
- Avoid food that is rich in
Sodium - Some types of arrest
iodine
5. Levoxyl thyroid cancer
GI: Nausea, Diarrhea,
6. PMS-
Increased/Decreased
Levothyroxine appetite , Cramps
7. Synthroid T4
MISC: Weight loss,
Menstrual irregular,
Sweating, Heat
intolerance, Fever,
Alopecia
Contraindication / Caution for Levothyroxine-> Adrenal insufficiency / Recent MI / Thyrotoxicosis / Hypersensitive to beef

28
Endocrine System-> 5-Alpha Reductase Inhibitor
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Proscar Finasteride PO Inhibit transformation of - Enlarged Prostate - Sexual Dysfunction - Education on side effect
testosterone to DHT, thus - Prostate Cancer - Decreased libido - Psychological support
- Propecia
decrease amount ofDHT, a - Scalp hair loss - Ejaculatory Disorder
powerful sex hormone steroid - Transgender hormone - Fatigue Contraindication = Pregnancy
and hormone. therapy - Dry skin

Nolvadex Tamoxifen PO Decrease DNA synthesis, - Breast CA - Irregular periods - Educate the importance of
causing cell to remain in early - Albright Syndrome - Weight loss adherence to medication
cell cycle, thus slowing / - Hot flashes
inhibit the growth of pre- - PE (Risk)
cancerous cell - Uterine CA (Risk)

29
Gastrointestinal Tract -> Laxative
Drug Group Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Stimulant Dulcolax Bisacodyl PO Chemical Effect: - Constipation - Abdominal Cramps - Dont admin within 1hr of milk
Stimulate gut - Prep for procedure - Diarrhea or antacids
Laxatives
peristalsis and promote - Rectal Burning Increase fluid intake to prevent
accumulation of fluid - Hypokalemia dehydration
- Muscle Weakness - Take drug as whole
Therapeutic Effect: - Tetany
Evacuation of the
SANNA/ Senokot PO - Constipation - Abdominal - Increase high fiber content
colon
Sennosides - Irritable or spastic discomfort intake
bowel syndrome - Abdominal Cramp
- Neurologic
Constipation

Laxatives Fleet Phosphate/ PR Chemical Effect: - Constipation CNS: Headache, - Administer on empty bowel
Enema Biphosphate Osmotic Effect cause - Prep for procedure Dizziness - Caution patient that this product
water to de drawer in has a high sodium content
to intestinal lumen and CV: Arrhythmias - Not to take oral form of drug
stimulate motility of within 2hrs of Fleet Enema
intestine GI: Abdominal pain,
Bloating, Vomiting
Therapeutic Effect:
Evacuation of the Hemat: HypoCa, HypoK
colon
Other: Sodium Retention
Contraindication/ Caution for all Laxative-> Unknown Abdominal Pain/ Ulcerated haemorrhoids/ Alcohol Intolerance / N+V

30
Gastrointestinal Tract-> Laxative (Cont'd)
Drug Group Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Osmotic Kleen Prep Polyethylene PO Chemical Effect: - Prep for procedure - Abdominal Fullness - Shake vigorously until powered
I Glycol ELE Drawing water into - Unlabelled Use: - Diarrhea is dissolved
Laxative
Golytely intestine lumen Acute iron - Bloating - Contrindication: IO/ Gastric
overdose in - Cramps retention I Toxic colitis /
Therapeutic Effect: children - Nausea+ Vomiting Megacolon
Evacuation of the
colon

Lactulose Duphalac PO Chemical Effect: - Constipation - Flatulence - Risk ofHyperNa

Retains fluid in bowel - Adjunct therapy - Cramp
to soften feces for hepatic - Discomfort
encephalopathy
Therapeutic Effect:
Soften feces for easy
evacuation

Bulk Metamucil - PO Chemical Effect: - Constipation - Abdominal bloating - Drug may reduce appetite if
I Stimulate peristalsis - Haemorrhoids taken before diet
Forming
Naturlax - Contraindication : IO / fecale
Laxative Therapeutic Effect:
suger-free impaction
Increase bulk forming
Contraindication/ Caution for all Laxative-> Unknown Abdominal Pain/ Ulcerated haemorrhoids/ Alcohol Intolerance / N+V

31
Gastrointestinal Tract -> Anti-spasmodic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

- Holopon Hyoscine PO Chemical Effect: - Anti-motion CNS: Pupil dilation, - Take medication 30mins
Inhibits muscarinic actions sickness blurred vision, drowsiness before meal
Methobromide
of acetylcholine on - Antimetic and - Encourage fluid intake
- Buscopan Hyoscine PO
autonomic effectors CV: Tachycardia,
control nausea - Monitor CV condition
IM
Butylbromide innervated by postganglionic - Adjunctive Palpitation - Avoid alcohol to avoid
IV cholinergic neurone therapy with H2
serious sedation effect
- Ariel TDDS Scopolamine PO anti-histammines GI: Dry mouth,
- Avoid operating heavy
IM Interference with cholinergic in peptic ulcer Constipation, Paralytic
- Epilon machinery
IV impulses to vomiting centre - Biliary Colic ileus, N+V, Epigastric
- Scopolamine - USE WITH CAUTION IF:
by sedative and amnesia- - Bowel colic distress
- Patient with Glaucoma,
inducing properties - Relief urinary
Stenosing Peptic ulcer,
frequency and GU: Urinary, Hesitancy
Therapeutic Effect: urgency and retention, Impotence Pyloroduodenal

Relax smooth muscle of - Pre-op prep to obstruction, Ulcerative

organs of abdominal and decrease Other: Anaphylaxis, Colitis, Prostatic

pelvic cavities bronchial, nasal, Nasal congestion, Hypertrophy, Bladder

pharyngeal and Decreased sweating, neck obstruction,
Relieve pain and discomfort salivary Increase CNS depression Bronchial asthma,
associated with muscle secretion when use with alcohol Tachycardia, Cardiac
spasm in GI or genitourinary - Relieve failure
tracts symptoms of
spastic state

32
Gastrointestinal Tract -> Antiflatulent
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Mylicon Simethicone PO Chemical Effect: - Relief symptoms of - N+V - Take medication after meal
Change surface tension bloating and fullness - Diarrhea - Advice patient to change
Gasteel Dimethylpolysiloxane
of gas bubbles in from excess gas - Constipation position often and ambulate
stomach and small - Air swallowing, - Belching to aid flatus passage
intestine -> Enable Functional - Passing of flatus - Check for extreme
bubbles to coalesce and dyspepsia, Spastic / - Headache
abdominal pain
allowing gas to be more Irritable colon,
easily freed by belching Diverticulosis
or flatus - For better USG /
Gastroscopy
Therapeutic Effect: imaging and
Disperse and prevent visualisation
formation of mucus-
surrounded gas pocket in Unlabelled use:
the GI tract - Treatment of colic in
infants
- Prep for procedure

33
Gastrointestinal Tract -> Proton-pump inhibitor
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Losee Omeprazole PO Suppress gastric acid - Duodenal Ulcer GI: Diarrhea, Nausea, - Do not chew / crush
secretion by specific - Gastric Ulcer Vomiting, Abd pain, - Can be gave with water or
inhibition of the H+/K+- - Reflux Flatulence, Constipation slightly acid fluid
PO ATPase Enzyme oesophagits I
Nexium Esomeprazole
IV - H.Pylori CNS: Headache
- Prevention of
Pantoloc Pantoprazole PO GI: Diarrhea, Nausea, - Should be take with empty
DU/ GU related
IV Vomiting, Upper Abd stomach
to longterm
pain, Flatulence,
NSAID intake
PO Constipation I
- Pariet Rabeprazole Gastric Pain
Sandoz - GERO
CNS: Headache,
Dizziness, Blurred vision

Takepron Lansoparzole OD PO GI: Abd pain, I

Constipation, Diarrhea,
Takepron OD
Nausea

34
Gastrointestinal Tract -> H2 Antagonist
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Tagamet Cimetidine PO Inhibit action of the - Known allergy CNS: Dizziness, Headache, - Check Renal and Hepatic
IM histamine in H2-Receptor reaction to drug Confusion function for elderly, critically
IV sites in parietal cells of ill patient
stomach and suppress GI: Diahhrea - Monitor BP if IV route
gastric acid secretion - Monitor S/S for peptic ulcer
CV: Cardiac arrest if rapid
IV dose

Pepcidine Famotidine PO CNS: Dizziness, Headache, - Admin at bedtime

IV Confusion

GI: Diahhrea, Constipation

Zantac Ranitidine PO CNS: Dizziness, Headache, - Monitor serum creatinine if

IM Confusion renal dysfunction is
IV presented
GI: Diahhrea - Monitor ALT+ LDH
- Monitor S/S for peptic ulcer

35
Gastrointestinal Tract -> Antacid
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Alu-Tab Aluminium PO Neutralize or reduce the I - Constipation - Chew the tablet throughly
gastric acidity and resulting - Hypophosphateemia - Monitor serum phosphate
Alu-Mag Tab Hydroxide
in an increase in pH of the level if prolonged use
stomach
1. Triact Aluminum/ PO I - Abdominal cramp - Monitor serum magnesium
Diarrhea concentration
2. Gastrocaine Magnesium
- Hypermagnesemia
3. Magnesium Hydroxide - Hypotension
Trisilicate Simethicone - Bradycardia

4. Mylanta

5. Mucaine
Contraindication / Caution for Aluminium Hydroxide -> Contraindication in prolonged use of high dose in presence of low serum phosphate
Contraindication / Caution for Aluminium / Magnesium Hydroxide Simethicone -> Abd pain / Diarrhea / Colostomy / Ileostomy

Gastrointestinal Tract -> Stomach Protecting Agent

Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Cytotec Misoprostol PO - I - Stomach ulcer prevention - I - I

when taking NSAID

36
Gastrointestinal Tract -> Antimetic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Maxolon Metoclopramide PO - Increase bowel and - Dyspepsia - Extrapyramidal - Take medication 30mins
IM stomach movement - Flatulence reaction before meal
IV - Act on brain centre - Haitus hernia - Travide dyskinesia - Use with caution in patient:
that control vomiting - Peptic Ulcer - Raised serum prolactin - Stomach bleeding
- Reflux oesophagits levels - IO
- Cholelithiasis - Mild sedation
- Breast cancer
- Gastritis
- Seizure
- Duodenitis
- Parkinson's disease
- High BP
- Severe Kidney or Renal
disease

Stemetil Prochlorperazone PO - Relieve or prevent - Psychotic Disorder - Trainsient numbness of - Take Omeprazole with drug
nausea and stop - Anxiety gum and tongue - Use cautiously in patient with
Maleate
vomiting - N+V - Extrapyramidal tartrazine and sulfite
- Act on nerves and disorder sensitivities
brain centre that - CV hypertension
control vomiting - Hypoparathyroidism

Zofran Ondansetron PO - Act on nerves and - Emetogenic chemotherapy - Headache - Use cautiously in patient with
brain centre that - Post-op N+V - Sensation of warmth of liver problems
control vomiting - Hepatic impairment flushing - Take 30mns prior to
- Hiccups chemotherapy

37
Gastrointestinal Tract-> Antimetic (Cont'd)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Navoban Tropisetron HCL PO - 5HT3 blocker to - Prevention ofN+V - Headache - Do not use in pregnancy
inhibit nausea and caused by cancer - Constipation women or children
vomiting caused by therapy - Dizziness - Use with caution on patient
anti-cancer drugs - Post-op N+V - Fatigue with raised BP that has not
- Diarrhea been controlled

Gravol Dimenhydrinate PO - Hl receptor antagonist - Motion Sickness - Headache

IV - Vertigo and vestibular - Fatigue
IM disorder - Rash
- Constipation

Motilium Domperidone PO - Target D2 and D3 - Dyspepsia - Abd pain - Take drug 15-30mins before
receptor to control - Heartburn - Headache meal
N+V - Epigastric pain - Nausea
- N+V
- Increase gastric
- Gastric Air
emptying speed by
lowering sphincter
pressure and increase
peristalsis

Merislon Betahistine PO - Inhibit Hl and H3 - Reduction of episodes - Abd discomfort - Take drug 15-30mins before
receptor of vertigo association meal
Mesylate
with Meniere's
disease

38
Gastrointestinal Tract -> Antidiarrhea -> Opiate Agonists
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Lomotil Atropine+ PO - Inhibit excess GI motility in - Adjunct therapy CNS: Dizziness, - DONT admin drug to
order to decrease in in treatment of Headache, Mood change, children under 2 OR Patient
Diphenoxylate
diarrhoea diarrhea Blurred vision, Dry eyes, with Down's Syndrome.
- Atropine is used to Pain, Numbness, Tingling - Advice patient to drink more
discourage abuse in hands or feet water if with no
contraindication
GI: Constipation, Loss of
- Avoid concurrent use with
appetite, N+V
MOAI therapy (Monoamine
Oxidise Inhibitors Therapy)
CV: Tachycardia

High Dosage Use:

- Euphoria
- Dependence
- Withdrawal Symptoms

Motilium Domperidone PO Same As Above (@P.25) Same As Above Same As Above (@P.25) Same As Above (@P.25)
(@P.25)
Contraindication / Caution for Lomotil -> Hypersensitive / Dehydrated / Electrolyte Imbalance / Severe Liver Disease / Known Alcohol
Intolerance / Angle-Closure Glaucoma / Diarehea caused by pesudomembranous colitis / Patient contraindicated in atiocholinergic medication

39
Gastrointestinal Tract - Bile and Pancreas
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Ursodiol Ursodexoxycholic PO Secondary bile which - Gallbladder stone - RUQ Abd Pain - Monitor pain score
may be able to dissolve - Cholangitis - N+V - Monitor S/S of infection
Acid
gallbladder stone - Cholestasis - Fever

Pancreatin PO Contain digestive - Exocrine pancreatic insufficiency - Fibrosing I

enzyme include amylase, - Pancreatectomy Colonpathy
lipase and protease - Chronic Pancreatitis

40
Analgesics -> General
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Easprin Aspirin / Salicylates PO - Produce analgesia and - Inflammatory GI: N+V, Dyspepsia, - Observe S/S of GI bleed
Rect reduce inflammation Disorder Heartburn, Abd discomfort, or chronic blood loss
and fever - RA Hepatotoxicity - Avoid Aspirin if patient
- Decrease platelet - Prophylaxis of other bleed problem (E.g.
aggregation and MI CNS: Tinnitus, Dizziness, Cerebral Haemorrhage)
incidence of MI - Prophylaxis of Coma
- Use with caution with
MI orDVT
patient who are on other
Hemat: Occult Blood loss,
anticoagulant
Hemostatic Defects
- Assess for Rhinitis/
Asthma / Urticaria
CV: Cardiovascular Collapse

Resp: Bronchospasm,
Rhinitis, Hyperpnea,
Tachypnea, Resp. Failure

Panadol Paracetamol PO - I - Mild pain - Liver Failure - I

IV - Fever
Rect

41
Analgesics -> Opioid and Morphinomimetrics
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Tramal / Tramadol PO Binds to mu-opioid - Moderate to CNS: Seizure/ Dizziness/ - Assess bowel function
IM receptors, inhibits reuptake Moderately Headache/ Sommolence - Monitor patient for seizure
Ultram
IV of serotonin and severe pam
norepinephrine in CNS GI: Constipation

GI: N+V

Physeptone Methadone PO Decrease in severity of pain. - Severe Pain CV: Heart Failure, - Observe for respiratory
IV Suppression of withdrawal - Suppress Thrombocytopenia, depression
symptoms during withdrawal Hypotension - Observe for dependence
detoxification and symptoms in response
maintenance from heroin and opioid GI: Constipation - Fall prevention
other opioids detoxification
CNS: Sedation, Confusion

Astramorph Morphine / PO Binds to opiate receptor in - Severe Pain CV: Heart Failure, - Monitor Vital Sign
IM CNS -> Altering response - Pulmonary Thrombocytopenia, - Assess lv of sedation
Morphine Syrup
IV and perception of painful Edema Hypotension - Observe for respiratory
(MST) SC stimuli while producing - Pain associated depression
Rect generalised CNS depression with MI GI: Constipation - Fall prevention
Epidural
Pethidine HCL
CNS: Sedation, Confusion

42
Analgesics-> Opioid and Morphinomimetrics (Cont'd)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Paveral Codeine PO - Binds to opiate receptor in - Moderate to - Confusion - Monitor Vital Sign
IV the CNS Severe Pain - Seation - Assess lv of sedation
IM - Decrease cough reflex and - Amtitussive - Hypotension Fall prevention
SC GI motility - N+V

Sublimaze Fentanyl IM - Binds to opiate receptor in Supplement to GA - Apnea - Monitor Vital Sign
IV CNS -> Altering response - Laryngospasm
Epidural and perception of painful
stimuli
- Supplement in anaesthesia

1. OxyContin Oxycondone PO Binds to opiate receptor in - Moderate to - Pruritus - MUST swallow as whole
CNS -> Altering response Severe Pain - Sweating - Assess lv of sedation
2. Oxaydo
and perception of painful - Abd pain Fall prevention
3. Roxicodone stimuli - Constipation
4. Roxybond - N+V
- Dizziness

Doloxene Dextropropo PO Chemical Effect: - Mild to - Dizziness - Monitor Vital Sign

xyphene Blind to opiate receptors in Moderate pain - Weakness - Assess lv of sedation
HCL brain - N+V
- Constipation
Doloxene C065 Dextropropo
Therapeutic Effect:
/C032 xyphene +
Alters the perception and
Aspirin+
response to painful stimuli
Caffeine
Contraindication / Caution for all Opioid Analgesics -> Respiratory Depression

43
Analgesics -> NSAID
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

1. Volteren / Volteren SR PO Anti-inflammatory + - Relief of S/S of CNS: Headache, Dizziness - Caution with impaired hepatic
IV Analgesic+ Antipyretic RA and OA & Renal function
(Diclofenac Sodium)
IM through inhibition of - Mild to moderate CV: Congestive heart - GI adverse drug reaction can be
2. Burfen (Ibuprofen) prostaglandin synthesis pam failure, Hypertension reduced with PPI
3. Ponstan (Mefenamic Acid) - Primary - Monitor for vision change, liver
dysmenorrhea GI: N+V, Gastric
4. Naprosyn. (Naproxen) dysfunction, renal impairment
- Fever ulceration, Gastric Bleed,
- Monitor for S/S of GI bleed
5. Celebrex (Celecoxib) - Flu related pain Diarrhea, Constipation
- NEVER be used on individual
6. Toradol (Ketorolac)
with Inflammatory Bowel
Other: Salt and Fluid
7. Aspirin Disease (CD/UC)
retention, Dyspepsia
8. Indocid (Indomethancin) - EXTRA CAUTION with
patient on ACEI and Diuretic
9. Nidal (Nimesulide)
Drug- Drug interaction (May cause "Triple whammy"
10. Angenol
- Increase toxic effects of effect)
11. Solihy (Clinoril) lithium
12. Toradol (Ketorolac) - Decrease diuretic effect
of loop diuretics
13. Naprosyn (Naproxen)
- Decrease effect of beta-
blocker

44
Anti-inflammatory Drug
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Lysozyme Neuzym PO - I - Chronic sinusitis - Rash - Should be take with food

- Difficult in expelling sputum - Skin redness
associated with rest disease - Anorexia
- Mild to moderate inflammation - GI intolerance
- Stomatitis

Serrin Serrapeptase PO - I - Inflammation - Interference with - Omit before surgery

- Pain clotting
- Swelling - Bleeding Disorder

Corticosteroid Refer to P.58

45
Haematology -> Anti Thrombus
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Heparin / Heparin Saline IV - Inhibit thrombus - Blood clotting disorder - Haemorrhage - Check for clotting profile and
SC and clot formation - Prophylaxis of blood clotting - Osteoporosis CBC (Antifactor Xa Level
Infusion by blocking the disorder - Hair Loss should be 0.3 - 0.7 U/mL)
conversion of - Blood transfusion (PRN) - Thrombocytopenia Monitor for GI bleed
prothrombin to - Cardiopulmonary bypass - Hyper-K - NO IMI
thrombin and - Haemodialysis
- Withhold prior surgery or
fibrinogen to fibrin - Venous / Pulmonary Embolism
traumatic investigation
- AF with embolisation
- Treatment of overdose:
- DIC
- Infuse of Protamine Sulfate
- Unlabelled use: Acute MI
- 1mg I lO0unit of UFH
- Max=S0mg
Route Specific-> SC
- Venous thromboembolism (T + P) - Infuse over 10mins

- Mural Thrombosis (P)

Route Specific-> IV
*T = Treatment P = Prophylaxis

46
Haematology-> Low-Molecular Weight Heparins (LMWH)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Clexane Enoxaparin SC Inhibit coagulation - DVT - Bleeding - Check clotting profile and CBC
factors Xa and Ila - Pulmonary Embolism - Thrombocytopenia prior use
Sodium
(PE) - Brusing - Observe for GI Bleed
Fraxiparine Nadroparin - Haemodialysis - Abdominal Pain - Withhold prior surgery or traumatic
Dalteparin - Unstable Angina - Chest Pain investigation
- Headache
Innohep Tinzaparin

Aterina Sulodexide PO Activate - Venous leg ulcer - Bleeding

IV Antithrombin III - Intermitten claudication - Thrombocytopenia
IM and heparin - Peripheral arterial - Brusing
SC cofactor II occlusive disease - Abdominal Pain
- Post MI - Headache
Contraindication / Caution for LMWH -> Coagulation Disorder / Severe Renal Dysfunction / Pregnant

47
Haematology-> Warfarin
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Marevan Warfarin PO Inhibit Vit. K dependent - Venous Thrombosis - Haemorrhage - Check for clotting factor prior use
synthesis of biological - Pulmonary Embolism - Osteoporosis (INR = 2.0 - 3.0)
- Jantoven
active forms of Calcium- - AF with embolisation - Warfarin Necrosis Observe for GI Bleed
- Coumadin dependent clotting factors - Preventing of recurrent - Purple toe syndrome Maintain Vit. K standby
II, VII, IX and X. And stroke - Educate patient to take Warfarin
also Vit. C, S and Z
Diet (Low Vit. K Diet)
Contraindication / Caution for LMWH -> Pneumonic Dysfunction / Renal Dysfunction

Haematology-> NAOC (New Oral Anticoagulant)

Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Pradoxa Dabigatran Act on clotting factor Ila to - DVT - Bleeding - Check clotting profile and
inhibit clotting. - Pulmonary - Thrombocytopenia CBC prior use

Rivaroxaban Act on clotting factor Xa to Embolism (PE) - Brusing - Observe for GI Bleed
Xarelto
inhibit clotting. - Haemodialysis - Abdominal Pain - Withhold prior surgery or
Eliquis Apixaban
- Unstable Angina - Chest Pain traumatic investigation
Lixiana Endoxaban - Headache

48
Haematology-> Antiplatelet
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Aspirin Salicylate PO - Inhibit synthesis of - Fever GI: N+V, Dyspepsia, Heartburn, - Check clotting profile
prostaglandins - Pain Epigastric Discomfort, Hepatotxicity - Observe GI bleed
- Lower inflammatory - Inflammatory condition - Withhold prior
Hemat: Blood loss, Hemostatic
effects (E.g. RA I OA) surgery or traumatic
defects
- Antipyretic Effect - Reduce risk of TIA investigation
Cartia Diltiazem
- Inhibit - Reduce risk of MI CNS: Dizziness, Tinnitus,
Cardiprin Aspirin+ vasoconstriction and - Longterm use for
Glycine platelet aggregation prophylaxis against CV: Cardiovascular Collapse
Effient Prasugel cataract formation

Brilinta Ticagrelor

Plavix Clopidogrel PO - Inhibit platelet - Risk of ischemic MI CNS: Headache, Dizziness SAME AS ABOVE
aggregation by - Ischemic Stroke GI: GI disturbance, GI Bleed
blocking ADP - Peripheral Artery Disease Dermat: Rash
receptors on platelet Other: Bleeding risk increase

Dipyridamole Persantine IV - Decrease coronary - Angina pectoris CNS: Headache, Dizziness SAME AS ABOVE
vascular resistance - Adjunction to warfarin to
Pletal Cilostazol GI: GI disturbance, GI Bleed
and increase prevent thromboembolism - Admin at least one
CV: Fatal and nonfatal MI,
coronary blood flow in patient with prosthetic hour before food with
without increasing heart valve Ventricular fibrillation (IVI) a full glass of fluid
myocardial oxygen - Prevention of MI
Resp: Bronchospasm - Do not admin
consumption - Adjunction to Aspirin to
grapejuice with
- Inhibit platelet prevent coronary bypass Dermat: Rash
Pletal
aggregation graft occlusion

49
Haematology -> Haemostatic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Cykloapron Transamin / PO Antiallergic + Anti-inflammatory - Abnormal bleeding - Shock - Care when co-admin with:
Antiplasmin + Haemostatic: with local - Itching - Haemostatic organ preparation
Lysteda Transamin Acid IV
- Inhibit binding of plasmin or hyperfibrinolysis - Skin Rash Haemocoagulase
plasminogen to fibrin by involved - Anorexia Reduce dose in elderly -> Reduce
binding to to LBS or fibrin - Bleeding tendencies - N+V physiological function
- Inhibit fibrinolysis induced by with systemic - Diarrhea
- Check clotting profile (PRN)
plasmin hyperfibrinolysis - Heartburn
- Exhibit hemostatica effect by involved - Drowsiness
inhibiting fibrinolysis in - Pharyngalgia - Headache
common types of haemorrhage - Pharyngolaryngitis
- Swelling
- Pruritus
- Toxicoderma
- Urticaria
- Pain in oral cavity
- Anemia
Contraindication / Caution for Transamin -> Thrombosis / Risk of Thrombosis / Consumption of Coagulopathy / Hypersensitivity

50
Respiratory System -> Bronchodilators -> Anticholinergics
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Atreza Atropine IV - Block acetylcholine at - During CPR CNS: Coma, - Assess Heart Rate
GUTT cholinergic receptors, that - Bronchodilator Headache - Ensure patient coding after
mediate the effects of - Bradydysrhythmia operation
parasympathetic - Restore PR and GI: Dry mouth, GI - +/- ECG
postganglionic impulse arterial pressure disorder, Paralytic
- Decrease bronchial - GI discomfort Ulcer
Secretion - Relax uterine
- Dilating Bronchi hypertonicity Resp: Bronchospasm
- Inhibiting vagal - Prep for lower GI
influence on the heart secretion CV: Palpitation,
- Relax GI and GI tract - Eye examination for Tachycardia
- Inhibit gastric acid dilate pupil
secretion - Iris / uveal tract GU: Urinary
- Block the effects of inflammation Retention
acetylcholine in CNS

Atrovent Ipratropium Inhaler - Bronchodilation by - Asthma - Patient with atropine sensitivity

inhibiting interaction of - COPD may also be sensitive to Atrovent
Handihaler acetylcholine on bronchial - This product is not for immediate
Spiriva Tiotropium
smooth muscle relief of breathing problem
- Time to effective= ~20mins

51
Respiratory System -> Bronchodilators -> Beta2 Agonist
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Formoterol - Symbicort Inhaler Long acting effect: - Asthma CNS: Headache, Tremor - Not for acute stage o
- Binds to beta-2 receptors in - COPD - NO MORE THAN 4 PUFFS
- Salmeterol - Seretide /
lung -> Bronchodilation CV:: Tachycardia, IN ONE TIME
Servent - Inhibit release of Palpiation, Hypertension - Use 30-60mins prior
inflammatory mediators in exercise
lung -> Block swelling and Resp: Bronchospasm
inflammation

Bricanyl / Terbutaline PO Short acting effect: - Bronchospasm CNS: Restless, - Use minimal dose to avoid
IV - Selectively at Beta-2 - Prevention of Apprehension, Anxiety tolerance for prolonged use
Bricanyl Durule
Inhaler adrenergic receptors to exercise induced - DONT crush or chew slow
- Salbutamol PO cause bronchodilation and bronchospasm GI: N+V, Heartburn release tablet
Ventolin /
IV vasodilation - Avoid use on
Volmax (Albuterol)
Puff - Unlabelled use: CV: Tachycardia,
tachycarrhythmias, digitalis
- Salbutamol - HyperK in Palpitation
intoxication, coronary
CR dialysis
insufficiency patient
Resp: Pulmonary oedema,
nronchospasm

Dermat: Sweating, Pallor,

Flushing

52
Respiratory System -> Bronchodilators -> Phosphodiesterase inhibitors
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Nulein - Theophyline PO - Inhibit Prevent or treat CNS: Irritability, Restlessness, - Assess theophylline blood
IV phosphodiesterase - Bronchial Muscle twitching, Convulsion, Iv (Lv = 5-15 mcg/ml)
- Nulein SR - Theophyline
Syrup - Inhibit release of asthma Depression, Sleep Disturbance (Toxicity may occur above
- Aminophyline SR - Bronchospasm
slow-reacting 20mcg/ml)
CV: Palpitations, Tachycardia,
substance of - Chronic - Avoid High/ Low protein
Ventricular arrhythmias
anaphylaxis and bronchitis
and low-low-carbohydrate
histamine - Emphysema GI: Loss of appetite, Epigastric diet
- Increase concentration pain, Gastroesophageal reflux - Take drug as whole + empty
of cyclic adenosine
stomach
monophosphate Resp: Respiratory arrest,
Tachypnea - Avoid cola, coffee, tea
- Relax bronchial smith
during medication since it
muscle
GU: RBC in urine, Diursis, may increase S/E
- Bronchodilation and
Urinary retention
increasing vital
capacity Other: Fever, Flushing,
Hypergly

Toxicity: N+V, Diarrhea,

Headache, Insomnia,
Irritability, Cardiac
arrhythmias, Tachycardia,
Seizures

53
Respiratory System -> Bronchodilators -> Leukotriene Receptor Antagonist
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Singulair Montelukast Inhaler Decrease inflammatory - Asthma - N+V

and relaxation of smooth - Urticaria - Headache
muscle - Allergic Rhinitis - Cough
- Exercise induced bronchospasm

54
Respiratory System -> Cough and Cold Remedies
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication
Bisolvon Bromhexine PO Enhance mucus transport by Broncho-pulmonary disease - Diarrhea - Patient with
reducing mucus viscosity and with abnormal mucus - GI disturbance hypersensitive to
activating the chelated epithelium secretion + impaired mucus Bromhexine
transport
Fluimucil Acetylcysteine PO Restore hepatic stores of Acute or chronic CNS: Dizziness - 20% solution maybe
Inhale glutathione/inactive toxic metabolite respiratory infection with GI: N+V, Stomatitis diluted with NS/WFI
of acetaminophen via chemical abundant mucus secretion Resp: Rhiorrhea,
interaction -> Prevent hepatic Bronchospasm
damage Hepat: Urticaria
Mixture Ammonia PO Effective for productive cough -> Irritated mucous - Vomit I
Expectorant Helps relax and soothe tight chest, membranes of the throat - GI disturbance
ipecacuanha
Stimulant reduce mucus formation and aid and chest
Neozep expectoration

Phensedyl Prmethazine PO Compete with HI-histamine-> - Motion sickness CNS: Sedation, - IM require aspiration
PR Suppressing allergic rhinitis and - N+V Confussion, Dizziness - IM require deeper
Codeine IM
urticaria Allergic reaction CV: Hypo/Hypertension muscle mass
IV
Ephedrine Decrease stimuli to the brain-stem - Adjunct to analgesic for EENT: Bluured vision
reticular system control of pain GI: N+V, dry mouth
GU: Urine retention
Hemat: Leukopenia,
Agranulocytosis,
Thrombocytopenia
Contraindication / Caution for Fluimucil-> Risk of gastric haemorrhage
Contraindication/ Caution for Phensedyl -> Narrow-angle glaucoma/ Stenosing Peptic Ulcer/ Prostatic Hypertrophy

55
Respiratory System-> Cough and Cold Remedies (Cont'd)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Syneophyllin Diprophylline PO Inhibition of phosphodiesterase with - Cough - Gastric Reflux I

IM a resulting increase in cyclic AMP - Emphysema - Headache
producing relaxation of bronchial - Chronic bronchitis - Increase urination
smooth muscle as well as - Bronchial Asthma - N+V
antagonism of adenosine receptors - Insomnia
Acetylcysteine PO Mucolytic - Mucolytic - N+V I
IV - Reduce disulphide bonds in - Panadol overdoes - Fever
Inhale
mucus matrix and lower mucus - Severe alcoholic Hepatitis - Running nose
viscosity - Prevent CIN - Chest Tightness

Panadol overdose
- Replenishing body stores of
antioxidant glutathione.
Glutathione will protect cell and
allow toxic to excreted safely

56
Respiratory System -> Throat Remedies
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Dequadin - I PO Ammonium antiseptic active against - Sore Throat - Hypertensive reaction I

(fl* ) gram-positive and gram-negative - Tonsillitis - Stomach discomfort if
bacteria, yeasts and fungi - Glossitis overdose
- Thrush

57
Corticosteroid
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Bacloforte Beclomethasone Puff Prevent inflammation dose Chronic Asthma Angioedema Assess adrenal insufficiency
not suppress hypothalamus Adreanl insufficiency
and pituitary Bronchospasm

- Pulmicort Budesonide Puff Prophylaxis Bronchospasm - Assess Respiratory Status

- If bronchospasm occur ->
- Symmbicort
Admin bronchodilator

Flixotide / Fluticasone Puff Decrease Inflammation Prevention of chronic - Eosinophilic Condition Assess adrenal insufficiency
asthma - Bronchospasm
Seretide
- Angioedema

Cortone Cortisone PO Decrease Inflammation - Immunosuppression - Circulatory collapse - Assess Potassium + Blood
- Severe Inflammation - Thrombophlebitis Glucose + Urine glucose
Acetate - CHF
while on longterm therapy
- GI haemorrhage
Celestone Betamethasone PO - Inflammation
- Thrombocytopenia
IM - Severe allergies
- Pancreatitis
IV - Seizure
- Circulatory collapse
Decadron Dexamethasone PO Decrease Inflammation - Inflammation
IV - Severe allergies

58
Corticosteroid
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Cortef Hydrocortisone PO Decrease Inflammation Severe Inflammation - Circulatory collapse - Assess adrenal
- Thrombophlebitis insufficiency
- CHF
Depoject Methylprednisolone PO Severe Inflammation - Assess potassium, blood
- GI haemorrhage
IM glucose, urine glucose
- Thrombocytopenia
IV while on longterm therapy
- Pancreatitis
- Seizure
- Circulatory collapse
Meticorten - Prednisone PO - Severe Inflammation
- Immunosuppression
- Prednisolone

Regime (Stepping) of Corticosteroid

Cortisone -> Hydrocortisone -> Prednisone -> Prednisolone -> Methylprednisolone -> Dexamethasone -> Betamethsone

59
Neuro-muscular -> Antiparkinsonism Preparation
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Symmetrel Amantadine PO Antiparkinsonian activity maybe - Parkinsonian - Orthostatic - Monitor Renal function, Mental
due to its blocking the reuptake of - Prophylaxis hypotension status and BP
dopamine into presynaptic neurons treatment of Flu. A - Peripheral edema - Do not stop medication abruptly
and causing direct stimulation of - Drug induced - Insomnia
postsynaptic receptors extrapyramidal - Dizziness
symptoms - IO

Sinemet Levodopa + PO - Levodopa is the metabolic - Parkinsonian - Orthostatic - Monitor BP, Dyskinesias,
precursor of dopamine, dose Hypotension Mental Status
Carbidopa
cross the BBB and presumably is - Reddish - Education on Orthostatic
converted to dopamine in brain discolouration of Hypotension
Carbidopa- Increase the levodopa unne - Do not stop taking the drug
concentration in the blood - Involuntary
movement

Madopar Levodopa + PO - Medopar is used to increase - Parkinsonian - Loss of appetite - Monitor BP and mental status
dopamine concentration. - Skin rash - Do not stop taking the drug
Benserazide
- Carbidopa- Increase the levodopa - Itching
concentration in the blood - Drowsiness
- Depression

Artane Benzhexol + PO Blocking the acetylcholine at - Parkinsonian - Constipation - Admin TDS with food
cerebral synapses - Drug induced - Dry mouth - Do not stop medication abruptly
Trihexypheni
extrapyramidal - Tachycardia - Avoid alcohol or CNS
dyl HCL symptoms depressants

60
Neuro-muscular -> Antiparkinsonism
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

NEUPRO Rotigotine Dermal Act as dopamine agonist - Parkisonian - N+V - Change every 24hrs
that restore balance of - Restless leg Syndrome - Drowsiness - Caution when admin with CNS
certain natural substance - Headache depression medication
- Dopamine blocker may minimise
effect of medication

61
Neuro-muscular -> Anticonvulsants
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Dilantin Phenytoin PO - Inhibit spread of seizure - Generalised CNS: Slurring speech, - PO route -> Admin with food
IV activity in motor cortex tonic-clonic Headache, Anxiety,
Phenytex - IV route -> Admin slowly
Dizziness, Aggression,
Diphenylan by altering ion transport seizure Weakness (<50mg/min)
Diphenylphydantonin - Increase AV conduction to - Status epileptics Avoid alcohol or CNS
CV: Hypotension, V-Fib
decrease dysrhythmias - Bell's palsy depressants
GI: N+V, Constipation,
- Trigeminal Weight loss, Hepatitis, - Do not stop medication abruptly
neuralagia Jaundice
- Urine may tum pink/red/brown
GU: Nephritis, Urine
discolouration
HEMA: Agranulocytosis,
Leukopenia, Aplastic
Anemia
SYST: Hypocalcemia

Epilim Sodium Valproate PO - Controlling brain - Epilepsy CNS: Headache, Unusual - Do not take drug with "fizzy"
chemicals with send - Control of movement, Dizziness,
drinks (E.g. Soda, Soft Drink )
Depression, Tired
signals to nerves so that Mania - Swallow tablet as whole
seizure do not happen - Acute Manic GI: Weight change, N+V, (Epilim ECT Tablet)
- Stabilising electrical episode in BAD Cramps, Change in
appetite
activity in brain (Bipolar
- Increase production and Affective GU: Irregular menstrual
period
prevent breakdown of Disorder)
GABA
Contraindication/ Caution for Dilantin-> Bradycardia / SA and AV blocks/ Hepatic Failure/ Stoke-Adams Syndrome
Contraindication/ Caution for Epilim-> Hepatic Dysfunction/ Urea cycle disorder/ Porphyria

62
Neuro-muscular -> Anticonvulsants (Cont'd)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Luminal Barbita PO - Depress activity in brain cells - Epilepsy CNS: Paradoxic, Excitement, - Avoid alcohol and
Solfoton IV primarily in reticular - Status Epilepticus Drowsiness, Bangover CNS depressants
Phenobarbitone activating system in brainstem - Febrile seizure in Headache, Flushing, Coma
- Inhibition of impulse in CNS children
- Decrease motor activity - Sedation INTEG: Rash, urticaria!,

- Depress neurones in posterior - Insomnia Angioedema, Local Pain,

hypothalamus and limbic Swelling, Thromboplebitis

structure
Tegretol Carbamazepine PO - Decrease polysynaptic - Tonic-Clonic Seizure CNS: Drowsiness, Dizziness, Monitor for chills, Rash,
Confusion
Atretol response - Complex Partial Seizure Light-coloured stool,
Carbatrol - Block post-tetanic - Mixed Seizure CV: Hypertension, CHF Dark urine, Abdominal
Epitol potentiation Trigeminal Neuralgia pain , blurred vision
EENT: Blurred vision

GI: N+V, abdominal pain,

hepatitis, increase enzyme

GU: Renal Failure, retention

HEMA: Thrombocytopenia,
Leukocytosis

INTEG: Rash
Methycobal Vit Bl2 PO - I - Vit Bl2 deficiency - Diarrhea - I
- N+V
- Peripheral Neuropathies
- Anorexia
- Pain
Contraindication/ Caution for Luminal-> Porphyria / Hepatic Disease/ Respiratory Disease/ Nephritis/ DM / Pregnancy
Contraindication / Caution for Tegretol-> Bone marrow depression / Pregnancy / Concomitant use of MAOIs (Antidepressant)

63
Neuro-muscular -> Anticonvulsants (Cont'd)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Neurontin Gabapentin PO - Inhibition of VDDCs, thus - Partial Seizure CNS: Sleepiness, Dizziness, - Mental Status
IV achieving anticonvulsant, - Neuropathic pain Aggression Behaviour - Suicidal Precaution
analgesic and anxiolytic effect - Hot Flashes
- Restless leg syndrome PSY: Suicide thought,

- Anxiety Disorder Addiction, Withdrawal

- Drug Dependence Syndrome

META: Cancer

64
Neuro-muscular -> Anti-epileptic
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Keppra Levetiracetam IV - Unknown - Epilepsy - N+V - Monitor drug reaction

PO - Partial onset Seizures - Fatigue - Monitor mental status
- Myoclonic Epilepsy Associated - Dizziness - Place patient in quiet and
with Ragged-Red Fibers - Headache relax environment
- Aggetitation
- Hypersomnia
Lyrica Pregablin PO - Inhibition of - Epilepsy - N+V - Monitor drug reaction
IV VDDCs, thus - Neuropathic pain - Dizziness - Monitor mental status
achieving - Restless leg syndrome - Sleepiness
- Regular blood sugar level
- Headache
anticonvulsant, - Anxiety Disorder check
- Confusion
analgesic and - Partial onset Seizures (Add-on)
- Dry mouth
anxiolytic effect - Weight gain

5
Psychiatric - Tricyclic Antidepressant (TCA)
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Saroten Amitriptyline IV Inhibit reuptake of serotonin - Mental Disorder - Blurred Vision - Monitor mental status
PO and noradrenaline - Depressive Disorder - Dry mouth - Monitor 1/0
- Elavil
- Anxiety Disorder - LowBP Education on pharmacology of
- ADHD - Sleepiness medication (Staging)
- Bipolar Disorder - Constipation
- Seizure
- Suicidal Thought

Remeron Mitrazapine PO Inhibit reuptake of serotonin - Depressive Disorder - N+V - Do not crush / chew
and noradrenaline - Dizziness Allow medication to dissolve on
SolTab
- Headaches tongue
Increase secretion of - Weight Gain Administer before bed time
serotonin and noradrenaline - Constipation

Contraindication = Bipolar Disorder

66
Supplement -> Vitamins
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Enervon C VitB + C PO - I - Increased requirement of fit for - Yellowish urine - I

growth / pregnancy / lactation /
development

Aminoleban / PO - I - Chronic hepatic insufficiency - I - Provide both medication

- Hepatic Encephalopathy powder and flavour powder
EN
to patient

Macalol Calcitriol PO - I - Vit D deficiency - Muscle pain - I

- Chondrosis - Hypercalcemia

Biotin Vit B7 + Vit H PO - I - Severe hair loss - I - I

Acetomena- VitK PO - I - Vit K deficiency - I - I

IV
phthone
IM
SC

67
Supplement -> Electrolytes
Generic Name Route Action Indication Side Effect Nursing Implication

Calcium Gluconate IV - I - Hyperkalemia - Bradycardia - Monitor for kidney stone

PO - Low blood Calcium - Hypotension - MonitorVS
- Magnesium Toxicity - Constipation - Blood check after administration
- N+V

Magnesium Sulfate IV - I - Sever Asthma - Heart disturbance - Monitor heart rhythm

PO - Eclampsia - Poor reflexes - Monitor mental status
- Arrhythmia - Confusion
- Torsades de pointes - Weakness
- Flushing

Sodium Chloride PO - I - Hyponatremia - I - I

Potassium PO - I - Hypokalemia - I - Monitor heart rhythm

IV - Monitor mental status

68
Antibiotics - Penicillins
Name Route Action Indication Side Effect Nursing Implication

- Amoxycillin PO Interfere with the cell wall Mainly used to against 5 - N+V Monitor WBC and S/S of infection
IV production, causing types of bacteria - Diarrhoea Prep of medication
- Ampicillin
IM imbalance between - Rash Augmentin
- Augmentin production and - Streptococcus - Neurotoxicity
- Normal Dose: 1.2g
degradation. (Degradation - Staphylococcus - Fever
- Bacampicillin - 20ml WFI Bolus
> Production). Causing - Clostridium - Dermatitis
- Benzathine Penicillin cell to die rapidly. - Neisseria - Seizure
Tazo
- Listeria
- Benzylpenicillin Sodium - Normal Dose: 4.5g
Gram-Positive cell will
- 100ml NS infusion
- Cloxacillin loose the cell wall
completely
- Flucloxacillin Piperacillin Sodium

- Penicillin V Gram-Negative cell will - Normal Dose: 4g

not loose cell wall - 20ml NS Bolus / 100ml NS infusion
- Tazo
completely
- Piperacillin Sodium Unsayn
- Normal Dose: 750mg
- Procaine Penicillin
- 20ml WFI Bolus I 100ml NS infusion
- Timentin

- Unasyn

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

69
Antibiotics - Cephalosporins
Name Route Action Indication Side Effect Nursing Implication

- Cefazolin (Cefazolin) IV Interfere with the cell wall 1st Generation - N+V Monitor WBC and S/S of infection
IM production, causing Actively against Gram- - Diarrhoea
- Cefepime (Maxipime) Prep of medication
PO imbalance between Positive bacteria - Rash
Cefazolin
- Cefopeazone Sodium production and - Neurotoxicity
- Normal Dose: 1mg
degradation. (Degradation 2nd Generation - Fever
(Sulperazone) - 10ml WFI Bolus
> Production). Causing Actively against Gram- - Dermatitis
- Cefotazime Sodium cell to die rapidly. Negative bacteria Disulflram-Like
But will decreased reaction after Maxipime
(Claforan)
Gram-Positive cell will efficacy on against ingestion of - Normal Dose: lg
- Ceftriaxone (Rocephin) loose the cell wall Gram-Positive bacteria alcohol - lOmk WFI/NS Bolus
- Cefuroxime (Zinacef) completely
3rd Gemeration Sulperazone
- Ceftazidime (Fortum) Gram-Negative cell will Actively against Gram- - Normal Dose: qg
- Cefaclor not loose cell wall Negative bacteria - 3.4ml WFI/NS Bolus
completely But will decreased
- Cefadroxil
efficacy on against
Rocephin
- Cefetamet Pivoxil HCL Gram-Positive bacteria
- Normal Dose: lg - 2g
- Cefmetazole Sodium - lg in 10ml NS/WFI Bolus (Slow)
4th Gerneation
- Cefoxitin Sodium Broad Spectrum activity
Zinacef
- Ceftibuten
- Normal Dose: 750mg
- Cefahalexin - 10ml NS Bolus
- Cephamandole
Fortum
- Cephradine
- Normal Dose: lg
- Sulperazon - 10ml NS/WFI Bolus
ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS
70
Antibiotics - Carbapenems
Trade Name Route Action Indication Side Effect Nursing Implication

- Meropenem IM Interfere with the cell wall High Risk or - N+V Prep of medication
IV production, causing imbalance complicated infection. - Diarrhoea
- Imipenem (Tienam)
PO between production and Mostly reserved for - Rash Meropenem
degradation. (Degradation > multi-drug resistance - Neurotoxicity - Normal Does: 500mg - lg
Production). Causing cell to die bacteria infection case. - Fever - 20ml WFI Bolus
rapidly. - Seizure
- Sepsis
- UTI with E.Coli

- Ertapenem - MDR Pneumonia

Antibiotics -Vancomycin
Trade Name Route Action Indication Side Effect Nursing Implication

- Teicoplanin IV Same action as vancomycin but with - MRSA - Red-man Syndrome - Culture had to be obtained before
PO different chemical structure, which - Patient with gram-p - Nephrotoxicity prescribing Vancomycin
allow medication to maintain a longer infection but allergy - Ototoxicity - Regular blood check x Vanco lv.
duration of action to beta-lectam

- Vancomycin Interfere with the cell wall production Prep of Medication

- Normal Dose: 500mg
- 100ml NS infusion over 60mins

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

71
Antibiotics -Trimethoprim-Sulfamethoxazole (TMX-SMP)
Name Route Action Indication Side Effect Nursing Implication

Cotrimoxazole IV Bactericidal - UTI - N+V - Culture had to be obtained before (?)

PO - URTI - Diarrhoea - Monitor WBC and S/S of infection
(Septrin)
- MRSA - Rash
- Traveler's Diarrhoea - Leukopenia
- Thrombocytopenia
- Hepatotoxicity

Antibiotics - Aminoglycosides
Name Route Action Indication Side Effect Nursing Implication

Amikacin IV Interfere bacteria through Against MOST Gram- - N+V - Culture had to be obtained before (?)
IM protein synthesis inhibition, Negative Aerobes and - Diarrhoea - Monitor WBC and S/S of infection
- Gentamicin
PO with addition causing cell to Anaerobic Bacilli - Rash
- Kanamycin Sulphate misread mRNA and - Fever Prep of medication
Neomycin Sulphate premature termination of cell Not against Gram-Positive - Nephrotoxicity Gentamicin
growth, which eventually bacteria and anaerobic - Ototoxicity
- Netilmcin Sulphate - Normal Dose: 80mg / 2m
causing the death of bacteria. Grim-Negative bacteria - Neuromuscular
- Ready to use - Bolus
- Spectinomycin Blockage
- Streptomycin
Streptomycin
- Tobramycin - Normal Dose: 1mg
- 3ml WFI IM

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

72
Antibiotics -Macrolides
Name Route Action Indication Side Effect Nursing Implication

- Azithromycin IV Protein synthesis inhibitor - Gram-Positive bacteria - N+V - Culture had to be obtained before (?)
- Clarithromycin PO - Limited Gram-Neg - Myopathy - Monitor WBC and S/S of infection
(Klacid) Mess with RNA - Soft tissue infection - Cholestasis
- Erythromycin
- URTI - Prolonged QT Prep of medication
- Roxithromycin
Bacteriostatic Klacid
- Normal Dose: 500mg
;1:t:1m11!a}] :) - 250ml NS infusion

Antibiotics - Fluoroquinolones
Trade Name Route Action Indication Side Effect Nursing Implication

- Ciprofloxacin IV Prevent bacterial DNA from Effective on both Gram- - N+V - Monitor WBC and S/S of infection
PO unwinding and duplicating. Positive and Gram-Negative - Diarrhoea
(Ciprocina)
bacteria - Headache Prep of medication
- Levofloxacin - Tendonitis Ciprocina
Moxifloxacin - Insomnia - Normal Dose: 200mg - 400mg
- Seizure
- Nalidxic Acid - Ready to use - Infusion (Slow)

- Norfloxacin

- Ofloxacin

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

73
Antibiotics - Clindamycin
Trade Name Route Action Indication Side Effect Nursing Implication

Chloraphenical Eye Protein synthesis inhibitor - Bone infection - N+V - Culture had to be obtained before (?)
IV - Joint infection - Diarrhoea - Monitor WBC and S/S of infection
- Clindamycin
PO Low concentration cause - Pelvic inflammatory - Rash
- Lincomycin HCL bacteriostatic disease - Abd Pain
- Strep Throat
High concentration cause - Middle Ear infection
bactericidal - Endocarditis

Antibiotics - Tetracyclines
Name Route Action Indication Side Effect Nursing Implication

- Doxycycline IV Bacteriostatic Broad Spectrum Activity - Photosensitivity - Monitor WBC and S/S of infection
PO - Hepatotoxicity - Monitor urine output
- Minocycline
Both aerobic and - Oesophageal Ulceration - Monitor lab result
- Oxytetracycline anaerobic - GI intolerance Education
- Tertacycline - Nephrogenic DI

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

74
Antibiotics -Monobactam
Name Route Action Indication Side Effect Nursing Implication

Aztreonam IV Interfere with the cell wall Grem- Negative bacteria - N+V - Culture had to be obtained before (?)
IM production, causing - Rash - Monitor WBC and S/S of infection
- Endometritis
Inhale imbalance between - Diarrhoea
- Intra Abd infection
production and degradation. - Eosinophilia
- Pneumonia
(Degradation> Production).
- UTI
Causing cell to die rapidly.
- Sepsis

Antibiotics - Nitroimidazoles
Name Route Action Indication Side Effect Nursing Implication

- Metronidazole PO Inhibits nucleic acid synthesis - Pelvic inflammatory - N+V - Culture had to be obtained before (?)
IV by disrupting the DNA of disease - Rash Monitor WBC and S/S of infection
(Flagyl)
microbial cells - Aspiration Pneumonia - Diarrhoea
- H. Pylori - Abd pain
- Headache
- Dizziness

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

75
Antibiotics - Oxazolindnone
Name Route Action Indication Side Effect Nursing Implication

- Linezolid IV Bactericidal against - Pneumonia - N+V - Culture had to be obtained before (?)
Gram-Positive infection - Skin and soft tissue - Headache - Monitor WBC and S/S of infection
infection - Lactic Acidosis Cover medication with black plastic
- Osteomyelitis - Myelosuppression bag during infusion
- Endocarditis - Low Blood Sugar
- Deep infection - Serotonin Syndrome

ALWAYS ENSURE BLOOD CULTURE HAD BEEN OBTAINED BEFORE ADMINISTERING ANTIBIOTICS

76
Antiviral
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Viread Tenofovir PO Inhibit the replication of - HepB - N+V

virus through blocking - HIV/AIDS - Rash
reverse transcriptase - Diarrhoea
- Headache

Baraclude Entecavir PO Inhibit the replication ofHeP - HepB - N+V - Monitor LRFT
B virus through blocking - Headache
reverse transcriptase - High Blood sugar
- Impaired renal function

Ganciclovir PO Mess with DNA - Cytomegalovirus - N+V

- Organ Transpant - Abd Pain
- Fever
- Anaemia

Valcyte Valganciclovir PO Mess with DNA - Cytomegalovirus - Abd pain

- Organ Transpant - N+V
- Increase renal function

Tamiflu Oseltamivir PO Inhibit influenza - Influenza A - N+V

neuraminidase enzyme - Influenza B - Diarrhoea
- Insomnia

Zocirax Acyclovir PO Inhibit viral DNA synthesis - Cold sores - N+V

Cream - Shingles - Diarrhoea
- Chickenpox - Headache

Remdesivir IV - Unknown -Temp for - Unknown - Unknown

NCOVID-19

77
Chemotherapy
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Lysodren Mitotane PO - Produce direct and - Adrenocortical CA - N+V - I

selective cytotoxic - Cushing Syndrome - Anorexia
effect on adrenal cortex - Diarrhoea
- Inhibitor of the adrenal - Decreased memory
cortex - Rash
- Leukopenia

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 Autoimmune -> Antihistamine
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Dimetane Brompheniramine PO Chlorpheniramine binds - Allergic Reaction - Dry mouth - Admin before bedtime
- Rhinitis - Drowsiness - Do not operate heavy
Piriton Chlorphenamine PO to the histamine Hl
- Urticaria - Dizziness machinery after medication
IV receptor-> Block the
- Allergy - N+V
Polaramine Dexchlorpheniramine PO action of endogenous - Cold - Restlessness
I Diphenhydramine PO histamine -> Temporary - Asthma - Blurred Vision

Clarityine Loratadine PO relief of the negative - Confusion

Fexofenadine PO symptoms brought on by

Telfast
histamine
Clarinex Desloratadine PO

Aerius

Zyrtec Cetirizine PO

Xyzal Levocetirizine PO
First Generation Anti-Histamine Drug = Brompheniramine / Chlorphenamine / Dexchlorpheniramine / Diphenhydramine
Second Generation Anti-Histamine Drug= Loratadine / Fexofenadine / Desloratadine I Cetirizine I Levocetirizine

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[在此鍵入]
Autoimmune -> Immunosuppressive - TNF- Alpha
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Enbrel Etanercept IV Interfering with tumor - RA - N+V - Slow infusion

SC narcosis factor (TNF) by - Idiopathic Arthritis - Diarrhoea - Monitor allergy
- Benepali
acting as TNF-alpha - Psoriatic Arthritis - Stomach pain reaction CLOSELY
inhibitor, thus terminating - Ankylosing Spondylitis - Headache
the inflammatory process - Rash
- Heartburn

Remicade Infliximab IV Neutralise the biological - Crohn's Disease - N+V - Monitor for allergy /
activity ofTNF-Alpha by - UC - Diarrhoea reaction CLOSELY at
binding a high affinity to - IBD - Stomach pain the beginning of
soluble. - RA - Headache infusion
- Psoriatic Arthritis - Rash - Slow infusion
Completely neutralising all - Ankylosing Spondylitis - Heartburn
according to guideline
form ofTNF-Alpha. - Behcet Disease - Acute infusion
Uveitis reaction
SC Greater potency than - Juvenile idiopathic arthritis - Same as Infliximab - Monitor for allergy /
Humira Adalimumab
Etanercept. - URTI reaction CLOSELY

Cimzia Certolizumab SC - Crohn's RA - URTI

- RA - Sinus / Abd pain
Pegol
- Psoriatic Arthritis - Diarrhoea

Simponi Golimumab IV - UC - URTI

SC - RA - Injection site
Psoriatic Arthritis reaction
- Ankylosing Spondylitis

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Autoimmune -> Immunosuppressive
Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Azulfidine Sulfasalazine PO Inhibit prostaglandins, resulting - RA - N+V - Monitor LFT

in local anti-inflammatory effect - UC - Diarrhoea
- IBD - Anorexia
- Crohn's Disease - Rash
- Liver function decrease

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Trade Name Generic Name Route Action Indication Side Effect Nursing Implication

Cytotec Misoprostol PO Blind to myometrial cells to - Labour induction - Abdpain - I

PR induce strong myometrial - Abortion - Diarrhoea
contractions leading to - Failed Miscarriage - Headache
expulsion of tissue - Postpartum Bleeding - Chest pain

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