Medication

Drug Class Gastroint estinal agent; hyperos motic laxative

Indicatio n Preventio n and treatment of portalsystemic encephal opathy (PSE), including stages of hepatic precoma and coma, and by prescripti on for relief of chronic constpati on

Contraindicati on Diabetes mellitus; contaminant use with electrocautery procedures (proctoscopy, colonoscopy); older adult and debilitated patients; pediatric use

Action

Adverse effects

Nursing Consideration In children, if the initial dose causes diarrhea, dosage is reduced immediately. Discontinue if diarrhea persists. Promote fluid intake (> = 15002000 ml/d) during drug therapy for constipation; older adults often self-limit liquids. Lactuloseinduced osmotic changes in the bowel support intestinal water loss and potential

Lactulose (Cephulac, Chronulac, Movelax, Lilac)

Lactulose reduces blood ammonia; appears to involve metabolism of lactose to organic acids by resident intestinal bacteria. Lactulose acidifies colon contents which retards diffusion of nonionic ammonia (NH3) from colon to blood while promoting its migration from blood to colon. In the acidic colon, NH3 is converted to nonabsorbable ammonium ions (NH4) and is then expelled in feces by laxative action. Decreased blood

GI: flatulence, borborygmi, blenching, abdominal cramps, pain and sitention (initial dose); diarrhea (excessive dose); nausea & vomiting, colon accumulation of hydrogen gas; hypernatremia

ammonia in a patient with hepatic encephalopathy is marked by improved EEG patterns and mental state (clearing of confusion, apathy, and irritation). Osmotic effect of organic acids causes laxative action, which moves water from plasma to intestines, softens stools, and stimulates peristalsis by pressure from water content of stool.

hypernatremia. Discuss strategy with physician. Laxative action is not instituted until drug reaches the colon; therefore, about 24-48 hours is needed. Instruct the patient not to self-medicate with another laxative due to slow onset of drug action. Notify physician of diarrhea (more than 2 or 3 soft stools) persists more than 24-48 hours. Diarrhea is a sign of overdosage. Dose adjustment may be indicated. Instruct mothers

not to breast feed while taking this drug without consulting the physician. Ketorolac (Toradol) Nonsteroi dal antiinflammat ory agent, nonopioid aanalgesi cs Short term manage ment of pain (not to exceed 5 days total for all routes combine d) Contraindicated with significant renal impairment, during labor and delivery, lactation, aspirin allergy, recent GI bleed or perforation. Use cautiously with impaired hearing, allergies and hepatic conditions It inhibits prostaglandin synthesis, producing peripherally mediated analgesia; also has antipyretic and antiinflammatory properties. CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache Respiratory: asthma, dyspnea Cardiovascular: edema, pallor, vasodilation GI: GI bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea GU: oliguria, renal toxicity, urinary frequency Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Ketorolac therapy should always be given initially by the IM

or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes

(chills,fever,musc les aches, pain) occur. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another Caution patient not to chew or crush controlledrelease preparations. Dilute and administer slowly IV to minimize likelihood of adverse effects. Direct patient to lie down during IV administration. Provide narcotic

Morphine Sulfate (Astramorp h PF, Avinza, Dura morph, Epimorph , Kadian, MSIR, MS Contin, Oramorph SR, Roxanol , RMS, Statex)

Narcotic agonist analgesic

Relief of moderate to severe acute and chronic pain; preoperat ive medicatio n to sedate and allay apprehen

Contraindicated with hypersensitivity to narcotics; diarrhea caused by poisoning until toxins are eliminated; during labor or delivery of a premature infant (may cross immature bloodbrain barrier more

Principal opium alkaloid acts as agonist at specific opioid receptors in the CNS to produce analgesia, euphoria, sedation; the receptors mediating these effects are thought to be the same as those mediating the effects of endogenous opioids (enkephalins, endorphins).

Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions, miosis, visual disturbances, suppression of cough reflex Facial flushing, peripheral

sion, facilitate induction of anesthesi a, and reduce anestheti c dosage; analgesic adjunct during anesthesi a; compone nt of most preparati ons that are referred to as Brompto n's cocktail

readily); after biliary tract surgery or following surgical anastomosis; pregnancy; labor (respiratory depression in neonate; may prolong labor).

circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope Pruritus, urticaria, laryngospasm, bronchospasm, edema Nausea, vomiting, dry mouth, anorexia, constipation, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis

antagonist, facilities for assisted or controlled respiration on standby during IV administration. Use caution when injecting SC or IM into chilled areas or in patients with hypotension or in shock; impaired perfusion may delay absorption; with repeated doses, an excessive amount may be absorbed when circulation is restored. Reassure patient about addiction liability; most

or mixture, an oral alcoholic solution that is used for chronic severe pain, especiall y in terminal cancer patients; intraspin al use with microinfu sion devices for the relief of intractabl e pain; unlabele

patients who receive opiates for medical reasons do not develop dependence syndromes.

d use: dyspnea associate d with acute left ventricula r failure and pulmonar y edema Etericoxib (Arcoxia) Antirheu matic This medicatio n is a nonsteroidal antiinflamma tory drug (NSAID), prescribe d for osteoarth ritis, rheumato id arthritis Contraindicated in patients with peptic ulcer, severe heart disease, stroke, and hypersensitivity. ARCOXIA belongs to a group of medicines called Coxibs. It works in a similar way to traditional antiinflammatory medicines, known as Non-Steroidal AntiInflammatory Drugs (NSAIDs), by blocking the production of substances that cause pain and inflammation. In clinical trials, ARCOXIA has been Central Nervous System Headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo and ringing in the ear. Heart - Chest pain, high blood pressure and fluid retention. Metabolic - Taste disturbances, mouth ulcer, loss of appetite and weight loss. Miscellaneous - Kidney damage, fever, GI disorders, muscle pain and influenza Caution should be exercised in patients with history of heart, liver, kidney disease, high blood pressure, blood clotting disorder, any allergy, children, elderly, during pregnancy and breast feeding. Drink adequate fluid to avoid dehydration.

and gouty arthritis.

shown to have a lower like syndrome. risk of serious side effects on the stomach (for example, bleeding stomach ulcers) than NSAIDs. However taking aspirin with ARCOXIA may reverse this benefit.

Stop the medication immediately if gastrointestinal lesions occur. Monitor blood pressure regularly while taking this medication.