Centrally acting antiadrenergi

Centrally acting antiadrenergic derivative. Stimulates alpha2-adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys.

* Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain.
Pregnancy (category C), lactation. Use of clonidine patch in polyarteritis nodosa, scleroderma, SLE
CV: Hypotension (epidural), postural hypotension (mild), peripheral edema, ECG changes, tachycardia, bradycardia, flushing, rapid increase in BP with abrupt withdrawal.
GI: Dry mouth, constipation, abdominal pain, pseudo-obstruction of large bowel, altered taste, nausea, vomiting, hepatitis, hyperbilirubinemia, weight gain (sodium retention). CNS: Drowsiness, sedation, dizziness, headache, fatigue, weakness, sluggishness, dyspnea, vivid dreams, nightmares, insomnia, behavior changes, agitation, hallucination, nervousness, restlessness, anxiety, mental depression.
Skin: Rash, pruritus, thinning of hair, exacerbation of psoriasis; with transdermal patch: hyperpigmentation, recurrent herpes simplex, skin irritation, contact dermatitis, mild erythema.
Special Senses: Dry eyes. Urogenital: Impotence, loss of libido.
* Monitor BR closely. Determine positional changes (supine, sitting, standing).
* With epidural administration, frequently monitor BP and HR. Hypotension is a common side effect that may require intervention.
* Monitor BP closely whenever a drug is added to or withdrawn from therapeutic regimen.
* Monitor I&O during period of dosage adjustment. Report change in I&O ratio or change in voiding pattern.
* Determine weight daily. Patients not receiving a concomitant diuretic agent may gain weight, particularly during first 3 or 4 d of therapy, because of marked sodium and water retention.
* Supervise closely patients with history of mental depression, as they may be subject to further depressive episodes.
Name of Drug Mechanism of Action Indication Contraindication Adverse Effect Nursing Consideration
GENERIC:
metronidazole
BRAND:
cetaz

CLASSIFICATION
Anti-infectives,
Anti-protozoals

DOSAGE:
500mg iv q8
• Disrupts DNA and protein synthesis in susceptible organisms
• Bactericidal, or amebicidal action
* Asymptomatic and symptomatic trichomoniasis in females and males; acute intestinal amebiasis and amebic liver abscess;
* IV metronidazole is used for the treatment of serious infections caused by susceptible anaerobic bacteria in intra abdominal infections, skin infections, gynecologic infections, septicemia, and for both pre- and postoperative prophylaxis
Blood dyscrasias; active CNS disease; first trimester of pregnancy (category B), lactation.

Body as a Whole: hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, overgrowth of Candida.
CNS: Vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, drowsiness, insomnia
GI: Nausea, vomiting, anorexia, epigastric distress, abdominal cramps, diarrhea, constipation, dry mouth, metallic or bitter taste, proctitis.
Urogenital: Polyuria, dysuria, pyuria, incontinence
CV: ECG changes (flattening of T wave).

* Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing.
* Discontinue therapy immediately if symptoms of CNS toxicity develop. Monitor especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).
* Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a second course is necessary.
* Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of CHF.
* Monitor patients on lithium for elevated lithium levels.
* Report appearance of candidiasis(milk-vaginal discharge,stomatitis, furry tongue) or its becoming more prominent with therapy to physician promptly.
* Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated.
* Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance.

Name of Drug Mechanism of Action Indication Contra
-indication Adverse Effect Nursing Consideration
GENERIC:
gentamycin

BRAND:
garamycin
CLASSIFICATION
Antiinfective,
Aminoglycoside antibiotic

DOSAGE:
80mg iv q8
Bactericidal: inhibits protein synthesis in susceptible strains of gram-negative bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death
> Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus species, E. coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus species
* Serious infections when causative organisms are not known (often in conjunction with a penicillin or cephalosporin). > allergy to any aminoglycosides
> Use cautiously with renal or hepatic disease; sulfite sensitivity; pre-existing hearing loss; active infection with herpes, vaccinia, varicella, fungal infections; myasthenia gravis; parkinsonism; infant botulism; burn patients; lactation, pregnancy

CNS: tinnitus, dizziness, vertigo, deafness (partially reversible to irreversible), vestibular paralysis, confusion, disorientation, depression, lethargy, nystagmus, visual disturbances, headache, numbness, tingling, tremor, paresthesia, muscle twitching, seizures, muscular weakness, neuromuscular blockade
CV: Palpitations, hypertension, hypotension
GI: hepatic toxicity, nausea, vomiting, anorexia, weight loss, stomatitis, increased salivation
GU: nephrotoxicity
Hematologic: Leukemoid reaction, agranulocytosis, granulocytosis, leucopenia, leukocytosis, thrombocytopenia, eosinophilia, pancytopenia, anemia, hemolytic anemia, increased or decreased reticulocyte count, electrolyte disturbances
Hypersensitivity: Purpura, rash, urticaria, exfoliative dermatitis, itching
Local: pain, irritation, arachnoiditis at IM injection sites
Other: fever, apnea, splenomegaly, joint pain, superinfections
* Client experiencing side effects, such as: ringing in the ears, headache, dizziness (reversible; use safety measures if severe)
* In cases of nausea, vomiting, loss of appetite (instructed the client toeat frequent small meals, and perform frequent mouth care)
* . Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 days, patients with fever or extensive burns, edema, obesity.
* Repeat C&S if improvement does not occur in 3-5 days; reevaluate therapy.
Name of Drug Mechanism of Action Indication Contraindication Adverse Effect Nursing Consideration
GENERIC:
Tramadol hydrochloride

BRAND:
CLASSIFICATION
Analgesic (centrally acting)
DOSAGE:
50mg iv q8
Binds to mu-opioid receptors.
• Inhibits reuptake of serotonin and norepinephrine in the CNS.

* Relief of moderate to moderately severe pain
* Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids, or psychotropic drugs.
* Use cautiously with pregnancy, lactation, seizures, concomitant use of CNS depressants or MAOIs, renal or hepatic impairment.
* CNS: Sedation, dizziness or vertigo, headache, confusion, dreaming, sweating, anxiety, seizures
* CV: Hypotension, tachycardia, bradycardia
* Dermatologic: Sweating, pruritus, rash, pallor, urticaria
* GI: Nausea, vomiting, dry mouth, constipation, flatulence
* Other: Potential for abuse, anaphylactoid reactions
Interactions
Drug-drug
* Decreased effectiveness with carbamazepine
Increased risk of tramadol toxicity with MAOIs
Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration.
• Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses.
• Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects.
• Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms.
• Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain do not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain.

• Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold.
• Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange.
• Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.