SISTER NIVEDITA GOVT.

NURSING COLLEGE
                           I.G.M.C. SHIMLA

SUBJECT – MEDICAL SURGICAL NURSING

DRUG BOOK

OF

HDU(HIGH DEPENDENCY UNIT)

SUBMITTED TO:                                   SUBMITTED BY:

  MADAM SUNITA VERMA                                   BANDANA DEVI

   LECTURER- Med.Sug.Nsg.       MSc(N) 1st yr

  SNGNC, IGMC SHIMLA  SNGNC, IGMC, SHIMLA

                                  SUBMITTED ON:

                                             12-FEB- 2020

 DRUG STUDY
ATROPINE SULPHATE
Introduction:- Atropine sulphate is the “Anticholinergic drug” which block the action of acetylcholine on
autonomic effectors and the CNS exerted through muscarinic receptors. These anticholinergic drugs are
also referred as Muscarinic receptor antagonists and parasympatholytic. Atropine is the natural alkaloid
and is highly selective for muscarinic receptors. The natural alkaloids are found in plants of the Solanaceae
family.

Generic Name:-Atropine Sulphate

Brand Name:- Isopto Atropine, Atrotas
Class:- Anticholinergics or Parasympatholytic
Subclass:- Antimuscarinic
Dosage/Route:-
 Adult:- Bradycardia: 0.5mg IV every 3-5 mins, maximum of 0.04 mg/kg
Cardiac arrest:- 1mg every 3-5 mins
Anesthesia adjunct 0.4-06 mg/SC/IM/IV every 4-6 hours [1 STdose to be given 30-60min
Organophosphate nerve agent poisoning:- 2mg IV/IM every 5-10 min prn]
 Children:- Bradycardia 0.02mg/kg/iv
Anesthesia adjunct:-0.02mg/kg SC/IM/IV
Organophosphate nerve agent poisoning:- 0.05mg/Kg/IM
Drug interactions:-
 It affect the growth hormone diagnostic test result and anticholinergic effects, so contraindicated with
potassium acid phosphate, potassium chloride, potassium citrate and potassium phosphate.
 Antacid interfere with anticholinergic absorption.
 MAOs inhibitor interfere with metabolism of anticholinergic.
Mechanism of action:- The action of atropine is as that of parasympathetic responses. Prominent effect
are seen in organs which normally receive strong parasympathetic tone. Atropine blocks all subtype of
muscarinic receptors. The anticholinesterase usually react with the enzyme essentially in the same way as
acetylcholine.
Pharmacokinetics:-
 Absorption:- Atropine rapidly absorbed from GI tract, and penetrate cornea when applied to eyes.
 Distribution:-Crosses placental barrier, crosses blood brain barrier.
 Metabolism:-50% metabolised in liver where the drug is hydrolysed to tropine and tropic acid.
 Elimination:- Remaining is excreted unchanged in urine. It has half-life of 3-4 hours
Indications:-
1.As antisecretory:-
2.As antispasmodic:-
a)Intestinal and renal colic.
b)Drug induced diarrhoea
c)To reduce urinary frequency and urgency.
3.Bronchial asthma, asthmatic bronchitis, COPD
4.To antagonise muscarinic effect of drugs and poison
5.Motion sickness
6.Antidote for cholinergic toxicity
7.To lessen the degree of A-V heart block
Contraindications:-
 Narrow iridocorneal angle
 Acute congestive glaucoma
 Prostatic hypertrophy
 Bladder obstruction
 Pregnancy breast feeding
 Dental diseases
 Ambient temperature increase, dehydration, fever, strenuous exercises.
Adverse effect:-
 CNS: Dizziness, confusion, loss of balance, hallucinations, excitations
 CVS: Palpitation, increased heart rate, ventricular fibrillation, supra ventricular or ventricular
tachycardia
 EENT: Dry mouth, large pupils, photophobia, blurred vision
 GI: Decreased gastric secretions, difficulty in swallowing and talking, dsecreased bowel sound
 Hematology: Dry flushed and hot skin
 Urinary: Difficulty in micturition, urinary retention
Nursing responsibilities:-
Before  Assess for the history of allergy to anticholinesterase.
 Before administering the atropine the nurse must know the indication for which it is
going to be administered.
 Nurse must have complete knowledge regarding the atropine, dose, rote, indication,
side effect, mechanism and action etc.
 Check for prescription written order must be there, while the atropine is administered
in emergency use repeat back policy to avoid medication order.
 Check complete baseline data, monitor vitals , Heart rate etc.
 Have patient to void before taking medicines if urinary retention is problem.
During  Check vital signs of patient and ECG finding, report any significant finding in heart rate
and blood pressure, increased ventricular ectopy or angina and report to physician.
 Check for the sign of hypersensitivity
After  Check for the desired outcome.
 Carefully monitoring the patient for palpitation, increased heart rate, tachycardia or
other associated complications.
 Ensure adequate hydration, provide environmental control to prevent hyperpyrexia.
 Keep patient mouth moisturized as patient will have dry mouth.
 Ask the patient for any blurred vision or other vision related problems.
 Close monitoring of urine output in elderly and surgical patient as atropine will
decrease the urine output.
  Assess patient for abdominal distention and auscultate for bowel sound. If
constipation is a problem adding fluids and bulk to diet may help alleviating the
constipation.
 Overdose or toxicity occur in case Physostigmine is administered.

GENTAMICIN

Introduction
Gentamicin, sold under brand name Garamycin among others, is an antibiotic used to treat several types of
bacterial infections.This may include bone infections, endocarditis, pelvic inflammatory disease, meningitis,
pneumonia, urinary tract infections, and sepsis among others. It is not effective for gonorrhea or chlamydia
infections. It can be given intravenously, by injection into a muscle, or topically.Topical formulations may
be used in burns or for infections of the outside of the eye. In the developed world, it is often only used for
two days until bacterial cultures determine what specific antibiotics the infection is sensitive to.The dose
required should be monitored by blood testing.
Gentamicin can cause inner ear problems and kidney problems. The inner ear problems can include
problems with balance and hearing loss. These problems may be permanent.If used during pregnancy, it
can cause harm to the developing baby. However, it appears to be safe for use during
breastfeeding.Gentamicin is a type of aminoglycoside. It works by disrupting the ability of the bacteria to
make proteins, which typically kills the bacteria.
Routes ofAdministration: IV, eye drop, IM, topical
Drug class :Aminoglycoside antibiotic
Bioavailability: limited bioavailability by mouth
Protein binding :0–10%
Elimination half-life: 2 h
Excretion: Kidney
Generic Name : gentamicin sulfate
Dosage
Available forms :Injection—10, 40 mg/mL; ophthalmic solution—3 mg/mL; ophthalmic ointment—3 mg/g;
topical ointment—0.1%; topical cream—0.1%; ointment—1 mg; cream—1 mg
Adults
3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four equal doses in severe
infections. For IV use, a loading dose of 1–2 mg/kg may be infused over 30–60 min, followed by a
maintenance dose, usually for 7–10 days.
PID: 2 mg/kg IV followed by 1.5 mg/kg tid plus clindamycin 600 mg IV qid. Continue for at least 4 days and
at least 48 hr after patient improves, then continue clindamycin 450 mg orally qid for 10–14 days total
therapy.
Surgical prophylaxis regimens: Several complex, multidrug prophylaxis regimens are available for
preoperative use; consult manufacturer’s instructions.
Pediatric patients:
2–2.5 mg/kg q 8 hr IM or IV.
Infants and neonates: 2.5 mg/kg q 8 hr.
Premature or full-term neonates: 2.5 mg/kg q 12 hr.
Geriatric patients or patients with renal failure
Reduce dosage or extend time dosage intervals, and carefully monitor serum drug levels and renal function
tests.
Medical uses
Gentamicin is active against a wide range of bacterial infections, mostly Gram-negative bacteria including
Pseudomonas, Proteus, Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Serratia, and the
Gram-positive Staphylococcus.[9] Gentamicin is used in the treatment of respiratory tract infections,
urinary tract infections, blood, bone and soft tissue infections of these susceptible bacteria. There is
insufficient evidence to support gentamicin as the first line treatment of Neisseria gonorrhoeae
infection.Gentamicin is not used for Neisseria meningitidis or Legionella pneumophila bacterial infections
(because of the risk of the person going into shock from lipid A endotoxin found in certain Gram-negative
organisms). Gentamicin is also useful against Yersinia pestis, its relatives, and Francisella tularensis (the
organism responsible for tularemia often seen in hunters and trappers).
Some Enterobacteriaceae, Pseudomonas spp., Enterococcus spp., Staphylococcus aureus and other
Staphylococcus spp. have varying degrees of resistance to gentamicin.
Adverse effects
Adverse effects of gentamicin can range from less severe reactions, such as nausea and vomiting, to more
severe reactions including:
 Low blood cell counts
 Allergic reactions
 Neuromuscular problems
 Nerve damage (neuropathy)
 Kidney damage (nephrotoxicity)
 Ear disorders (ototoxicity)
Mechanism of action
Gentamicin is a bactericidal antibiotic that works by binding the 30S subunit of the bacterial ribosome,
negatively impacting protein synthesis. The primary mechanism of action is generally accepted to work
through ablating the ability of the ribosome to discriminate on proper transfer RNA and messenger RNA
interactions. Typically, if an incorrect tRNA pairs with an mRNA codon at the aminoacyl site of the
ribosome, adenosines 1492 and 1493 are excluded from the interaction and retract, signaling the ribosome
to reject the aminoacylated tRNA::Elongation Factor Thermo-Unstable complex. However, when
gentamicin binds at helix 44 of the 16S rRNA, it forces the adenosines to maintain the position they take
when there is a correct, or cognate, match between aa-tRNA and mRNA. This leads to the acceptance of
incorrect aa-tRNAs, causing the ribosome to synthesize proteins with wrong amino acids placed
throughout (roughly every 1 in 500).The non-functional, mistranslated proteins misfold and aggregate,
eventually leading to death of the bacterium. A secondary mechanism has been proposed based on crystal
structures of gentamicin in a secondary binding site at helix 69 of the 23S rRNA, which interacts with helix
44 and proteins that recognize stop codons. At this secondary site, gentamicin is believed to preclude
interactions of the ribosome with ribosome recycling factors, causing the two subunits of the ribosome to
stay complexed even after translation completes. This creates a pool of inactive ribosomes that can no
longer re-intiate and translate new proteins.
Contraindications:
Gentamicin should not be used if a person has a history of hypersensitivity, such as anaphylaxis, or other
serious toxic reaction to gentamicin or any other aminoglycosides.Greater care is required in people with
myasthenia gravis and other neuromuscular disorders as there is a risk of worsening weakness.
Special populations
 Pregnancy and breastfeeding
Gentamicin is not recommended in pregnancy unless the benefits outweigh the risks for the mother.
Gentamicin can cross the placenta and several reports of irreversible bilateral congenital deafness in
children have been seen. Intramuscular injection of gentamicin in mothers can cause muscle weakness in
the newborn.
The safety and efficacy for gentamicin in nursing mothers has not been established. Detectable gentamicin
levels are found in human breast milk and in nursing babies.
 Elderly
In the elderly, renal function should be assessed before beginning therapy as well as during treatment due
to a decline in glomerular filtration rate. Gentamicin levels in the body can remain higher for a longer
period of time in this population. Gentamicin should be used cautiously in persons with renal, auditory,
vestibular, or neuromuscular dysfunction.
 Children
Gentamicin may not be appropriate to use in children, including babies. Studies have shown higher serum
levels and a longer half-life in this population. Kidney function should be checked periodically during
therapy. Long-term effects of treatment can include hearing loss and balance problems. Hypocalcemia,
hypokalemia, and muscle weakness have been reported when used by injection.
Interactions
Drug interactions may change how your medications work or increase your risk for serious side effects. This
document does not contain all possible drug interactions. Keep a list of all the products you use (including
prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do
not start, stop, or change the dosage of any medicines without your doctor's approval.
Other medications that may affect the kidneys or hearing may increase the risk of kidney damage or
hearing loss if taken with gentamicin. Some affected drugs include: amikacin, tobramycin, amphotericin B,
cidofovir, cisplatin, polymyxin B, cephalosporins such as cephaloridine, nonsteroidal anti-inflammatory
drugs (NSAIDs) such as ibuprofen, among others.
Adults
3 mg/kg/day in three equal doses q 8 hr IM or IV. Up to 5 mg/kg/day in three to four equal doses in severe
infections. For IV use, a loading dose of 1–2 mg/kg may be infused over 30–60 min, followed by a
maintenance dose, usually for 7–10 days.
PID: 2 mg/kg IV followed by 1.5 mg/kg tid plus clindamycin 600 mg IV qid. Continue for at least 4 days and
at least 48 hr after patient improves, then continue clindamycin 450 mg orally qid for 10–14 days total
therapy.
Surgical prophylaxis regimens: Several complex, multidrug prophylaxis regimens are available for
preoperative use; consult manufacturer’s instructions.
Pediatric patients
2–2.5 mg/kg q 8 hr IM or IV.
Infants and neonates: 2.5 mg/kg q 8 hr.
Premature or full-term neonates: 2.5 mg/kg q 12 hr.
Nursing Responsibility
Assessment  History: Allergy to any aminoglycosides; renal or hepatic disease; preexisting hearing
loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial
 infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant
botulism; lactation, pregnancy.
 Physical: Site of infection; skin color, lesions; orientation, reflexes, eighth cranial
nerve function; P, BP; R, adventitious sounds; bowel sounds, liver evaluation;
urinalysis, BUN, serum creatinine, serum electrolytes, LFTs, CBC.
Intervention  Give by IM route if at all possible; give by deep IM injection.
s  Culture infected area before therapy.
 Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use.
 Avoid long-term therapies because of increased risk of toxicities. Reduction in dose
may be clinically indicated.
 Patients with edema or ascites may have lower peak concentrations due to
expanded extracellular fluid volume.
 Cleanse area before application of dermatologic preparations.
 Ensure adequate hydration of patient before and during therapy.
 BLACK BOX WARNING: Monitor hearing with long-term therapy; ototoxicity can
occur.
 BLACK BOX WARNING: Monitor renal function tests, CBCs, serum drug levels during
long-term therapy. Consult with prescriber to adjust dosage.
Teaching  Apply ophthalmic preparations by tilting head back; place medications into
points conjunctival sac and close eye; apply light pressure on lacrimal sac for 1 minute.
Cleanse area before applying dermatologic preparations; area may be covered if
necessary.
 You may experience these side effects: Ringing in the ears, headache, dizziness
(reversible; use safety measures if severe); nausea, vomiting, loss of appetite (eat
frequent small meals, perform frequent mouth care); burning, blurring of vision with
ophthalmic preparations (avoid driving or performing dangerous activities if visual
effects occur); photosensitization with dermatologic preparations (wear sunscreen
and protective clothing).
 Report pain at injection site, severe headache, dizziness, loss of hearing, changes in
urine pattern, difficulty breathing, rash or skin lesions; itching or irritation
(ophthalmic preparations); worsening of the condition, rash, irritation (dermatologic
preparation).

HYDROCORTISON

Introduction
Hydrocortisone is the name for the hormone cortisol when supplied as a medication.Uses include
conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis,
rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical
insufficiency. It can be given by mouth, topically, or by injection. Stopping treatment after long-term use
should be done slowly.
Side effects may include mood changes, increased risk of infection, and swelling.With long-term use
common side effects include osteoporosis, upset stomach, physical weakness, easy bruising, and yeast
infections. While used, it is unclear if it is safe during pregnancy. Hydrocortisone is a glucocorticoid and
works as an anti-inflammatory and by immune suppression.
Pharmacokinetics
 Absorption:-Well absorbed after oral administration. Absorption from local site is slow but complete.
 Distribution:- Widely distributed, cross the placenta and probably enter the breast milk.
 Metabolism and excretion:- Metabolized in liver. Cortisone is converted by liver to hydrocortisone.
Half life of hydrocortisone is 1.5-2 hours.

Indication:-
 Adrenocortical insufficiency
 Allergy
 Inflammation
 Autoimmune disorders
 Asthma
 Organ transplant
 Physiologic replacement
 Hyperaldosteronism
 Decompensated heart failure

Contraindication:-
 Hypersensitivity
 Active untreated infection
 Lactation
 Known alcohol hypersensitivity
 Use cautiously in:-
 Chronic treatment as it will lead to adrenal suppression so use smallest possible dose for short time.
 Pregnancy
 Children
 Potential risk
 Stress

Adverse effect:-
 CNS:- Depression, euphoria, headache, increased ICP, personality change, psychosis, restlessness.
 EENT:- Cataract, increased intraocular pressure.
 CV:- Hypertension
 GI:- Peptic ulcer, anorexia, nausea, vomiting
 SKIN- Acne, wound healing, ecchymosis, fragility, hirsutism, petechia.
 ENDO:- Adrenal suppression, hyperglycemia
 Fluid and electrolyte:- Fluid retention, hypokalemic alkalosis,
 Hematology:- Thromboembolism, thrombophlebitis
 Metabolic change:- Weight gain, weight loss.
 Musculoskeletal:- Muscle wasting, osteoporosis, aseptic necrosis of joint, muscle pain.
NURSING RESPONSIBILITIES:-
Before  Assess for the history of allergy to hydro corticosteroid.
 Drug administered for many conditions, assess involved system before and
 periodically throughout the therapy.
 Before administering the hydrocortisone the nurse must know the indication for
which it is going to be administered.
 Nurse must have complete knowledge regarding the hydrocortisone , dose, rote,
indication, side effect, mechanism and action etc.
 Check for prescription written order must be there.
 Check complete baseline data, monitor vitals, blood sugar.
During  Check BP, pulse, ECG, respiratory rate, frequently during the IV administration.
Continuous ECG monitoring, hemodynamic parameters and urine output should
be monitored continuously during IV administration.
After  Assess patient for signs of adrenal insufficiency i.e hypotension, nausea,
vomiting, anorexia, lethargy, confusion.
 Monitor intake and output ratios and daily weight gain, rales/crackles or
dyspnoea, notify immediately.
 Children should be evaluated for periodic growth.
 Assess patient for cerebral edema manifested as change in level of consciousness
and headache.
 Monitor serum electrolyte and glucose, as it causes hyperglycemia especially in
diabetic patient.
 Assess for any signs of infection as it leads to immunosuppression.

LOMOH 40

Introduction
Lomoh 40 Injection is known as an anticoagulant and is used to prevent and treat harmful blood clots. It
stops the existing clots from getting any bigger and stops new ones forming. This helps prevent heart
attack, a type of clot called deep vein thrombosis (DVT) and pulmonary embolism.
Lomoh 40 Injection is injected under the skin by a doctor or nurse. It should not be injected into a muscle.
The dose and length of treatment are based on your medical condition, your response to the medicine and
what you are being treated for. It may also be based on your age and weight. It is important to keep using
this medicine even if you do not notice any symptoms because it is preventing future harm. If you stop
taking it, you could get a blood clot. While taking this medicine you should avoid doing things that increase
your risk of bleeding or injury.
Substitutes
List of substitutes for Lomoh 40 MG Injection
 Enclex 40 MG Injection
 Enoxarin 40 MG Injection
 Macparin 40 MG Injection
 Oxprin 40 MG Injection
Side effects
Major & minor side effects for Lomoh 40 MG Injection
 Bleeding gums
 Increased menstrual flow
 Collection of blood under the skin
 Fever
 Bleeding at the injection site
 Irritability
 Convulsions
 Back pain
 Dizziness
 Fast heartbeat
 Diarrhea
Uses of Lomoh 40 MG Injection
 Prophylaxis for Deep Vein Thrombosis
 Lomoh 40 MG Injection is used as a prophylaxis to prevent blood clots usually in the legs.
 Deep Vein Thrombosis
 Lomoh 40 MG Injection is used in the treatment of deep vein thrombosis which is caused due to the
blood clots usually in the legs.
 Prophylaxis for Angina and myocardial infarction
 Lomoh 40 MG Injection is used as a prophylaxis to prevent blood clots in the conditions like angina and
myocardial infarction.
 Deep Vein Thrombosis Prophylaxis after surgery
 Lomoh 40 MG Injection is used as a prophylaxis to prevent blood clots after surgeries like hip, knee
replacement surgery, and abdominal surgery.
Bibliography:
1. Deglin Hopfer Judith, “David’s Drug guide for nurses”, 8th edition published by Devis company.
2. www.wikipedia.com
3. Tripathi KD “essentials of Medical Pharmacology”7th edition published by JP Brothers Medical
Publisher (P) Ltd 17/1 Babar Road, Block B, Shaymali Dhaka Bnagladesh page No. 186, 198, 206,326,512.