GENERIC NAME: Doses of Potassium Citrate Tablets greater than 100 mEq/day

Potassium Citrate have not been studied and should be avoided.

BRAND NAME: Serum electrolytes (sodium, potassium, chloride and carbon

Acalka dioxide), serum creatinine, and complete blood count should be
monitored every four months. Treatment should be
CLASSIFICATION: discontinued if there is hyperkalemia, a significant rise in
Antiurolithic serum creatinine, or a significant fall in blood hematocrit or
hemoglobin.
DOSAGE:
Treatment with Potassium Citrate Tablets should be added to a INDICATION:
regimen that limits salt intake (avoidance of foods with high -Treatment of patients with renal lithiasis and hypocitraturia,
salt content and of added salt at the table) and encourages high chronic formers of calcium oxalate, phospate calculia.
fluid intake (urine volume should be at least two liters per day). - Uric acid lithiasis alone or accompanied by calcium lithiasis
The objective of treatment with Potassium Citrate Tablets is to
provide potassium citrate in sufficient dosage to restore normal CONTRAINDICATIONS:
urinary citrate (greater than 320 mg/day and as close to the - Renal insufficiency¨ Persistent alkaline urinary infections
normal mean of 640 mg/day as possible), and to increase - Obstruction of the urinary tract
urinary pH to a level of 6.0 to 7.0. - Hyperpotassemia¨Adrenal insufficiency
- Respiratory or metabolic alkalosis
In patients with severe hypocitraturia (urinary citrate of less - Active peptic ulcer
than 150 mg/day), therapy should be initiated at a dosage of 60 - Intestinal obstruction
mEq/day (20 mEq three times/day or 15 mEq four times/day - Patients submitted to anticholinergic therapy
with meals or within 30 minutes after meals or bedtime snack). - Patients with slow gastric emptying.
In patients with mild-moderate hypocitraturia (>150 mg/day),
Potassium Citrate Tablets should be initiated at a dosage of 30 SIDE EFFECTS/ ADVERSE EFFECTS:
mEq/day (10 mEq three times/day with meals). Twenty-four - Slight gastrointestinal disorders may appear which can be
hour urinary citrate and/or urinary pH measurements should be palliated by means of the joint administration of food.
used to determine the adequacy of the initial dosage and to
evaluate the effectiveness of any dosage change. In addition, NURSING IMPLICATIONS/RESPONSIBILITIES:
urinary citrate and/or pH should be measured every four - The tablets must not be masticated or diluted. The active
months. component of Acalka is contained with a porous wax matrix.
As this was matrix is insoluble, it can be eliminated in visible
form in the feces. The active component, however, has been - The recommended treatment in case of hyperpotassemia is:
released in the gastrointestinal tract. IV administratioin f 10% dextrose solution, containing 10-12
- Must not be administered to patients receiving potassium- units of insulin/1000ml. Correction of the possible acidosis
sparing diuretics (traimterene, spirolactone, or amyloride). with IV sodium bicarboate and hemodialysis or peritoneal
- It is advisable to carry out an evaluation of electrolytes (Na- dialysis.
K-Cl) and CO2, creatinine and hemogram every 4 hrs.
- It is recommended that the patients in treatment with Acalka
follow a diet w/o salt and increase the intake of fluids.
 Drug Name Dosage & Route Action Indication Adverse Effects Contraindication Nursing Responsibility

Assessment & Drug

Hypertension Effects
CLONIDINE Adult: PO 0.1 mg b.i.d. or t.i.d., Centrally acting
Step 2 drug in stepped- CV: Hypotension Pregnancy (category C),
care approach to
HYDROCHLORI may increase by 0.1–0.2 mg/d antiadrenergic
treatment of (epidural), postural lactation. Use of
derivative. Stimulates clonidine patch in  Monitor BR closely.
DE until desired response is achieved hypertension, either hypotension (mild), Determine positional
alpha2-adrenergic polyarteritis nodosa,
(kloe'ni-deen) (max: 2.4 mg/d) Transdermal 0.1 receptors in CNS to
alone or with diuretic or peripheral edema, ECG scleroderma, SLE changes (supine, sitting,
other antihypertensive standing).
mg patch once q7d, may inhibit sympathetic
agents. Epidural
changes, tachycardia,
vasomotor centers.  With epidural
Catapres, increase by 0.1 mg q1–2 wk administration as adjunct bradycardia, flushing, administration, frequently
Central actions reduce
Catapres-TTS, Geriatric: PO Start with 0.1 mg plasma concentrations
therapy for severe pain. rapid increase in BP monitor BP and HR.
Dixaril , Duraclon once daily of norepinephrine. It with abrupt Hypotension is a
common side effect that
Child: PO 5–10 mcg/kg/d divided
decreases systolic and withdrawal. GI: Dry may require intervention.
diastolic BP and heart
Classifications: q8–12h, may increase to 5–25 rate. Orthostatic effects mouth, constipation,  Monitor BP closely
cardiovascular mcg/kg/d divided q6h (max: 0.9 tend to be mild and abdominal pain, whenever a drug is
occur infrequently. Also pseudo-obstruction of added to or withdrawn
agent; central- mg/d) inhibits renin release from therapeutic
acting from kidneys.
large bowel, altered regimen.
antihypertensive; Severe Pain taste, nausea,  Monitor I&O during
analgesic Adult: Epidural start infusion at vomiting, hepatitis, period of dosage
adjustment. Report
30 mcg/h and titrate to response. hyperbilirubinemia, change in I&O ratio or
Use rates >40 mcg/h with weight gain (sodium change in voiding
caution retention). CNS: pattern.
 Determine weight daily.
Child: Epidural start infusion at Drowsiness, sedation, Patients not receiving a
0.5 mcg/kg/h and titrate to dizziness, headache, concomitant diuretic
response fatigue, weakness, agent may gain weight,
sluggishness, dyspnea, particularly during first 3
or 4 d of therapy,
ADDH vivid dreams, because of marked
Child: PO 5 mcg/kg/d in 4 nightmares, insomnia, sodium and water
behavior changes, retention.
divided doses (average dose,  Supervise closely
0.15–0.2 mg/d) Transdermal agitation, hallucination, patients with history of
0.2–0.3 mg/d q5–7d nervousness, mental depression, as
restlessness, anxiety, they may be subject to
further depressive
mental depression. episodes.
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.

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda,  Surgical: General surgical cases but most especially
Transamin operative procedures on the prostate, uterus, thyroid,
lungs, heart, ovaries, adrenals, kidneys, brain, tonsils,
Classification: Anti-fibrinolytic, antihemorrhagic lymph nodes and soft tissues.
 Obstetrical and gynecological: abortion, post-partum
Indications: hemorrhage and menometrorrahgia
 Medical: epistaxis, hemoptysis, hematuria, peptic ulcer
Tranexamic acid is used for the prompt and effective control of with hemorrhage and blood dyscrasias with hemorrhage
hemorrhage in various surgical and clinical areas:  Effective in promoting hemostasis in traumatic injuries.
 Preventing hemorrhage after orthopedic surgeries.
 Treating heavy menstrual bleeding
 Hemorrhage following dental and/or oral surgery in Contraindications
patients with hemophilia
 Management of hemophilic patients (those having 1. Allergic reaction to the drug or hypersensitivity
Factor VIII or Factor IX deficiency) who have oral 2. Presence of blood clots (eg, in the leg, lung, eye, brain),
mucosal bleeding, or are undergoing tooth extraction or have a history of blood clots, or are at risk for blood
other oral surgical procedures. clots
 3. Current administration of factor IX complex
concentrates or anti-inhibitor coagulant concentrates

Precautions

1. Pregnancy. Tranexamic acid crosses the placenta.

2. Lactation. Tranexamic acid is distributed into breast
milk; concentrations reach approximately 1% of the
maternal plasma concentration.
3. Contraceptives, estrogen-containing, oral or Estrogens.
Concurrent use with tranexamic acid may increase the
potential for thrombus formation.
4. Renal function impairment    (medication may
accumulate; dosage adjustment based on the degree of
impairment is recommended)
5. Hematuria of upper urinary tract origin    (risk of
intrarenal obstruction secondary to clot retention in the
renal pelvis and ureters if hematuria is massive; also, if
hematuria is associated with a disease of the renal
parenchyma, intravascular precipitation of fibrin may
occur and exacerbate the disease)

Nursing Responsibilities

1. Unusual change in bleeding pattern should be

immediately reported to the physician.
2. For women who are taking Tranexamic acid to control
heavy bleeding, the medication should only be taken
during the menstrual period.
 Drug Name Dosage & Route Action Indication Adverse Effects Contraindication Nursing Responsibility

Assessment & Drug

Effects
DIAZEPAM Status Psychotherapeutic agent Drug of choice for Body as a Injectable form: Shock,
(dye-az'e-pam) Epilepticus related to status epilepticus. Whole: Throat coma, acute alcohol
 Monitor for adverse
Adult: IV/IM chlordiazepoxide; Management of anxiety and chest pain. intoxication, depressed
reactions. Most are dose
reportedly superior in disorders, for short- vital signs, obstetrical
Apo-Diazepam, 5–10 mg, antianxiety and term relief of anxiety
CNS: Drowsiness, patients, infants <30 d of
related. Physician will rely on
Diastat, repeat if fatigue, ataxia, accurate observation and
anticonvulsant activity, symptoms, to allay age. Tablet form:
reports of patient response to
Diazemuls , E- needed at 10– with somewhat shorter anxiety and tension confusion, Infants <6 mo of age,
the drug to determine lowest
Pam , Meval , 15 min duration of action. Like prior to surgery, paradoxic rage, acute narrow-angle
effective maintenance dose.
chlordiazepoxide, it cardioversion and glaucoma, untreated
Novodipam , intervals up to appears to act at both endoscopic procedures,
dizziness, vertigo, open-angle glaucoma;
 Monitor for therapeutic
Valium, 30 mg, then amnesia, vivid effectiveness. Maximum effect
limbic and subcortical as an amnesic, and during or within 14 d of
may require 1–2 wk; patient
Valrelease, Vivol  repeat if levels of CNS. treatment for restless dreams, headache, MAO inhibitor therapy.
tolerance to therapeutic effects
needed q2–4h legs. Also used to slurred speech, Safe use during
may develop after 4 wk of
Classifications: alleviate acute pregnancy (category D)
Child: IV/IM withdrawal symptoms
tremor; EEG and lactation is not
treatment.
CENTRAL NERVOUS <5 y, 0.2–0.5 of alcoholism, voiding changes, tardive established.
 Observe necessary
SYSTEM AGENT; preventive precautions for
mg slowly q2– problems in older dyskinesia. CV: suicidal tendencies that may be
BENZODIAZEPINE 5min up to 5 adults, and Hypotension, present in anxiety states
ANTICONVULSANT; adjunctively for relief
mg; >5 y, 1 mg of skeletal muscle
tachycardia, accompanied by depression.
ANXIOLYTIC slowly q2–5min spasm associated with edema,  Observe patient closely and
monitor vital signs when
up to 10 mg, cerebral palsy, cardiovascular diazepam is given parenterally;
repeat if paraplegia, athetosis, collapse. Special hypotension, muscular
stiff-man syndrome,
needed q2–4 h tetanus. Senses: Blurred weakness, tachycardia, and
vision, diplopia, respiratory depression may
occur.
Anxiety, nystagmus. GI:  Lab tests: Periodic CBC and
Muscle Xerostomia, liver function tests during
Spasm, nausea, prolonged therapy.
Convulsions, constipation,  Monitor I&O ratio, including
urinary and bowel elimination.
Alcohol hepatic
Withdrawal dysfunction.
Adult: PO 2–10 Urogenital:
mg b.i.d. to Incontinence,
q.i.d. or 15–30 urinary retention,
mg/d sustained gynecomastia
release IV/IM (prolonged use),
2–10 mg, menstrual
repeat if irregularities,
needed in 3–4 ovulation failure.
h Respiratory:
Geriatric: PO Hiccups, coughing,
1–2 mg 1–2 laryngospasm.
times/d (max: Other: Pain,
10 mg/d) venous thrombosis,
Child: PO >6 phlebitis at
mo, 1–2.5 mg injection site.
b.i.d. or t.i.d.
3. Tranexamic Acid should be used with extreme caution  Severe allergic reactions such as rash, hives, itching,
in CHILDREN younger than 18 years old; safety and dyspnea, tightness in the chest, swelling of the mouth,
effectiveness in these children have not been confirmed. face, lips or tongue
4. The medication can be taken with or without meals.  Calf pain, swelling or tenderness
5. Swallow Tranexamic Acid whole with plenty of liquids.  Chest pain
Do not break, crush, or chew before swallowing.  Confusion
6. If you miss a dose of Tranexamic Acid, take it when  Coughing up blood
you remember, then take your next dose at least 6 hours  Decreased urination
later. Do not take 2 doses at once.
 Severe or persistent headache
7. Inform the client that he/she should inform the
 Severe or persistent body malaise
physician immediately if the following severe side
effects occur:  Shortness of breath
 Slurred speech
 Slurred speech

 Vision changes
Generic name: vitamins B1 + B6 + B12 Dosage and administration:
Brand name: Neurobion tablet Unless otherwise prescribed by the physician, one to two
tablets 3 times daily to treat moderate case or to provide
Formulation: interval and follow-up therapy for a course of injections.
Each coated tablet contains:
Thiamine mononitrate (Vitamin B1) = 100mg, Pyridoxine Storage condition:
hydrochloride (Vitamin B6) = 200mg, Cyanocobalamin Store at a temperature not exceeding 25 degrees Celsius.
(Vitamin B12) = 200mcg
Availability:
Indications: Box of 100 coated tablets in blister strips of 10’s
Neuritis and neuralgia, especially cervical syndrome, shoulder-
arm syndrome, lumbalgia, sciatica, facial paresis. Alcoholic Manufactured by: PT, Merck Tbl.
polyneuropathy, Diabetic neuropathy, including impotence due Jl. T.B. Simatupang No. 8 Pasar Rebo, Jakarta 13760,
to autonomic neuropathy. Metabolic and neuropathic changes Indonesia
due to pregnancy and oral contraceptives. Drug-induced Under license of Merck KGaA, Darmstadt, Germany
neuropathies. Supplemental therapy following major surgery or
debilitating illness.
Indications Central Nervous System – Restlessness, anxiety, nervousness
and dizziness.
Phenylephrine HCl is indicated for the temporary relief of
coughs and upper respiratory symptoms, including nasal Cardiovascular – Hypertension (see WARNINGS).
congestion, associated with allergy or the common cold.
Other – Primordial pain, respiratory distress, tremor and
Dosage weakness.

The average effective dose is given in the following table: Phenylephrine is contraindicated in patients with hypertension or
with peripheral vascular insufficiency (ischemia may result with risk
Adults (12 years 5 mL every 4 not to exceed of gangrene or thrombosis of compromised vascular beds).
of age and (1 teaspoonful) to 30.0 mL Phenylephrine should not be used in patients known to be
over) 6 hours in 24 hours. hypersensitive to the drug or in those receiving a monoamine
          oxidase inhibitor (MAOI).
Children (6 years to 2.5 mL to 5 mL every 4 not to exceed
under 12 (½ to 1 to 30.0 mL
years) teaspoonful) 6 hours in 24 hours.
 Monitor cardiac output, central venous
pressure, pulmonary artery wedge pressure,
standard vital signs and urinary output.
 Monitor vital signs and observe the nasal
Phenylephrine: mucosa for changes such as excoriation or
bleeding.