Tales from the hospital ward

Atropine / atropine sulfate     Preg risk A Classifications: anticholinergic Indications: symptomatic bradycardia, bradyarrhythmia. Action: an anticholinergic(antimuscarinic) that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes; this enhances conduction throught the AV node and speeds heart rate. Adverse reactions:  CNS: headache, resltesness, ataxia, disorientation, hallucinations, delirium, insomnia, dizziness, excitement, agitation, confusion ·              CV: palpitations and bradycardia(low dose); tachycardia(high dose) ·             Eye: photophobia, bluured vision , mydriasis, cycloplegia, increase introcular pressure ·               GI: dry mouth, thirst , constipation , nausea, vomiting · ...

Bethanachol chloride / Urocarb           Preg risk B2      Classification: Cholinergic (parasympathomimetic)   Indications: acute postoperative (functional) and postpartum nonobstructive(functional) urine retention. Action: Directly stimulates cholinergic receptors, mimicking the action of acetylcholine. Adverse reaction s:    CNS: headache, malaise, dizziness, drowsiness     eye: lacrimation, miosis     CV: bradycardia, profound hypotension with reflexive tachycardia      GI: abdominal cramps, diarrhoea, excessive salivation, nausea, belching, borborygmus      GU: urinary urgency     Hepatic: increased serum levels of amylase, lipase, bilirubin and AST      Respiratory: bronchoconstriction, increased bronchial secretions      Skin: flushing, sweating. Drug-drug: anticholinergics, atropine, procainamide, quinidine.- possible r...

Paracetamol (Panadol, Dymadon) Classification: analgesic . Treatment of mild to moderate pain, fever, or signs and symptoms  of common cold or flu. Musculoskeletal pain associated with arthritis. used in place of NSAIDs but is not of that class. Action: Acts directly of the hypothalamus to cause vasodilation and sweating, which reduces fever. Mechanism unknown. Adverse Effects:      CNS: headache     Hepatic: severe liver damage(with toxic doses), jaundice.      Metabolic: hypoglycaemia      Skin: rash urticaria. Dose : Adults  500 to 1000 mg PO t.i.d. Drug- drug: barbiturates , Warfarin, anticoagulants, carbamazapine, hydantoins, rifampicin.                     Caffeine, alcohol. Contraindications : hypersensitivity. liver disease. caution in pregnancy Care considerations :            Use cautiously if possible liver dise...

Ibuprofen / Advil, Brufen, Nurofen, Panafen Plus Classification: NSAID Action :  : anti-inflammatory, analgesic, antipyretic, related to inhibition of prostaglandin synthesis. NSAIDs block 2 enzymes, Cox 1 and Cox2. Cox1 is present in all tissues, involved in many body functions, including blood clotting, protecting the stomach lining and maintaining sodium and water balance in the kidney. Cox 2 is active at sites of trauma or injury when more prostaglandins are needed. THERefore it blocks inflammation and also blocks protection of the stomach lining as well as blocking the kidneys regulation of water. Adverse reaction:  : nausea, dyspepsia, gI pain, constipation, diarrhoea or flatulence. potential for gi bleeding with chronic use . headache, dizziness, somnolence and fatigue. Platelet and bone marrow depression with chronic use. Rash and mouth sores may develop , anaphylactic shock in cases of hypersensitivity.   Dose : mild to moderate pain     1.2 g...

Aspirin (acetylsalicylic acid) / Aspro, Cardiprin, Cartia, Disprin, Solprin Classification: antiplatelet agent, anti-pyretic, pain relief, reduction of risk in MI or TIA. Action: Produces analgesia, anti- inflammatory effect, and prevents formation of thromboxane A2             (platelet aggregator)  by blocking prostaglandin synthesis.             Blocks the effects of pyrogens at the hypothalamus.             May also inhibit other mediators of the inflammatory response. Peripheral vasodilation             by acting on hypothalamic heat-regulation centre. Vasodilation causes sweating(heat loss) and                       cooling(evaporation). Adverse/Side Effects          tinnitus, hearing loss         nausea, GI heartburn, occult bleeding , dyspepsi...

Naloxone hydrochloride / Narcan Classification: antagonist, antidote Action: Thought to displace previously administered narcotic analgesics from their receptors.              Competitive antagonism. Reverses Buprenorphine, Pethidine, Morphine Adverse/Side Effects               CNS: seizures, tremors               CV: tachycardia, hypertension (if dose high), hypotension, ventricular fibrillation.               GI: nausea, vomiting (if dose high).               Respiratory: pulmonary oedema               Skin: sweating               Other: withdrawal symptoms (in narcotic - dependents) Available forms: Injection Dose: 0.4 to 2 mg IV, SC or IM, repeated q 2 to 3 minutes, prn.             If no respo...

Oxycodone / OxyContin, Endone S8 Classification : Narcotic and opioid analgesic Action: Binds with opiate receptors in CNS, altering perception and emotional response to pain.             Mechanism unknown. Adverse/Side Effects :               CNS: sedation, somnolence, clouded sensorium, euphoria, dizziness, light-headedness.               CV: hypotension, bradycardia.               GI: nausea, vomiting, constipation, ileus.                GU: urinary retention.                 Respiratory depression.                 Skin: sweating, pruritis                 Other: physical dependence. Available Forms : Capsules, Oral suspension, Tablets, Tablets (SR), Injection, Solution for infu...

Ketoralac / Toradol Classification: NSAID : Acetic Acid Adverse/ Side effects:          CV: oedema, hypertension, palpitations, arrhythmias          CNS: drowsiness, sedation, dizziness, headache          GI: nausea, dyspepsia, GI pain, diarrhoea, peptic ulceration, vomiting,                constipation, flatulence, stomatitis           GU: acute renal failure            Haematologic: decreased platelet adhesion, purpura, thrombocytopenia           Respiratory: bronchospasm           Skin: pruritis, rash, sweating, pain at injection site Dose: 10 mg PO q4-6h; or 30-60 mg IM, switching to oral form asap;            30 mg IV as single dose           Opthalmic: 1 gtt to affected eye q.i.d;   ...

Fentanyl S8 fentanyl citrate  Actiq, Fentanyl injection, Sublimaze Classification : narcotic and opioid analgesics S8 Action : Unknown. Binds with opiate receptors in CNS, altering both perception of and  emotional response to pain. Adverse/Side Effects :      CNS: sedation, somnolence, clouded sensorium, euphoria, dizziness, headache, confusion,  asthenia, nervousness, hallucinations, anxiety, depression, siezures      CV: hypotension, hypertension, arrhythmias, chest pain.      GI: nausea, vomiting, constipation, ileus, abdominal pain, dry mouth, naorexia,           diarrhoea, dyspepsia       GU: urinary retention      Respiratory: respiratory depression, hypoventilation, dyspnoea, apnoea      Skin: reaction at application site (erythema, papules, oedema), pruritus      Other: physical dependence. Drug to drug: CNS depre...

Morphine hydrochloride / Fentanyl, Oxycodone, Ondine                         Classification : narcotic and opioid analgesic                  Indications: relief of severe acute or chronic pain, properative medication,                               component of combo therapy, intraspinal intractable pain.                     Action: binds with opiate receptors in CNS, altering both perception of and                            emotional response to pain through an unknown mechanism.                           Produces analgesia, euphoria and sedation.                    Ad...