Digoxin

action
Digoxin exerts hemodynamic, electrophysiologic, and neurohormonal
effects on the cardiovascular system.
It inhibits the sodium pump that leads to increases the intracellular
sodium and increases the calcium level in heart muscles leading to
increase the contractile force of the heart muscle this improves the left
ventricular ejection fraction.
It stimulates the parasympathetic nervous system via vagus nerve to
decreasing the heart rate.
Indications
treatment of mild to moderate heart failure in adult patients
to increase myocardial contraction in children diagnosed with heart
failure
To maintain control ventricular rate in adult patients diagnosed with
chronic atrial fibrillation

Side effects of Digoxin:-

Common Side effects of Digoxin include:

• Dizziness
• Mental disturbances
• Diarrhea
• Headache
• Nausea
• Vomiting
• Red, bumpy rash

Less common side effects of digoxin include:

• Loss of appetite
• Irregular heartbeat
• Arrhythmia in children (consider a toxicity)
 Other side effects of digoxin include:

• Visual disturbance (blurred or yellow vision)

• Heart block (1°/2°/3°)
• Cardiac arrest rhythm (asystole)
• Fast heart rate

calcium channel blockers

action
it prevents the calcium form entering the cells of the heart and arteries
to allow blood vessels to relax and open.
calcium channel blockers also have an additional benefit of slowing the
heart rate which can lower the Blood pressure and relive chest
pain(angina) and control irregular heartbeat.
Examples of calcium channel blockers
Diltiazem
Verapamil
Side Effects of Calcium Channel Blockers
Dizziness or lightheadedness
Low blood pressure
Heart rhythm problems
Dry mouth
Edema (swelling of ankles, feet, or lower legs)
Headache
Nausea
Fatigue
Skin rash
Constipation or diarrhea
Gastroesophageal reflux disease (GERD)
Indications :
High blood pressure
prevent, treat or improve symptoms in a variety of conditions, such as:
Coronary artery disease
Chest pain (angina)
Irregular heartbeats (arrhythmia)
Some circulatory conditions, such as Raynaud's disease

Beta blockers also known as beta-adrenergic blocking agents

Action
it blocks the effect of the epinephrine hormone (adrenaline), causing
the heart to beat more slowly with less force which lowers blood
pressure ex. Atenolol, propranolol.
Indications
hypertension
Angina pectoris
Post myocardial infarction
Atrial fibrillation
Heart failure

Side effects
Common side effects of beta blockers can include:
Cold hands or feet
Fatigue
Weight gain
Less common side effects include:
Depression
Shortness of breath
Trouble sleeping
Cefotax

Mechanism of action

As a class, β-lactams inhibit bacterial cell wall synthesis by

binding to one or more of the penicillin-binding proteins (PBPs).
This inhibits the final transpeptidation step of peptidoglycan
synthesis in bacterial cell walls, thus inhibiting cell wall
biosynthesis.

Indications

Therapeutic Indications

CEFOTAX is indicated in the treatment of serious infections,

either before the infecting organism has been identified or
when caused by bacteria of established sensitivity, including:

Osteomyelitis.

Septicaemia.

Bacterial endocarditis.

Meningitis.

Peritonitis.

Other serious bacterial infections suitable for parenteral

antibiotic therapy.
CEFOTAX may be used for pre-operative prophylaxis in patients
undergoing surgical procedures, that may be classified as
contaminated or potentially so.

Contraindications

Hypersensitivity to cefotaxime, to other cephalosporins or to

any of the excipients.

Previous immediate and/or severe hypersensitivity reaction to

a penicillin or to any other beta-lactam medicinal product.

Common side effects of cefotaxime include:

injection site reactions (pain, irritation, a hard lump, or

inflammation), rash, itching, hives, fever, ausea, vomiting,
stomach pain, headache, diarrhea, vagina itching or discharge,
and colitis.

Less common side effects of cefotaxime include:

arrhythmias, low white blood cell levels, low blood platelet

levels, and yeast infection.

Nursing intervention

Observe site closely for extravasation during administration.

Observe for signs of adverse effects, especially those suggesting
a superinfection. Observe for signs of renal, hepatic or
haematological dysfunction during prolonged therapy.
Peralgan

Action

The precise mechanism of the analgesic and antipyretic

properties of paracetamol has yet to be established; it may
involve central and peripheral actions. PERFALGAN provides
onset of pain relief within 5 to 10 minutes after the start of
administration.

Indications

Therapeutic indications

Perfalgan is indicated for the short-term treatment of

moderate pain, especially following surgery and for the short-
term treatment of fever, when administration by intravenous
route is clinically justified by an urgent need to treat pain or
hyperthermia and/or when other routes of administration are
not possible.

Contraindications

PERFALGAN is contraindicated:

in patients with hypersensitivity to paracetamol or to

propacetamol hydrochloride (prodrug of paracetamol) or to
one of the excipients.
in cases of severe hepatocellular insufficiency.

Side effects

Possible side effects of Perfalgan infusion

Pain and burning sensation at injection site.

General feeling of being unwell (malaise).

Decreased blood pressure.

Raised liver enzymes.

Flushing.

Increased heart rate.

Skin rash.

Decreased numbers of white blood cells or platelets in the

blood.

Nursing Intervention

Take care when prescribing and administering PERFALGAN to

avoid dosing errors due to confusion between milligram (mg)
and milliliter (mL), which could result in accidental overdose
and death. Take care to ensure the proper dose is
communicated and dispensed. When writing prescriptions,
include both the total dose in mg and the total dose in volume.
The paracetamol solution is administered as a 15-minute
intravenous infusion.
Protamine sulphate

Action Mechanism .

It is a highly cationic peptide that binds to either heparin or low

molecular weight heparin (LMWH) to form a stable ion pair,
which does not have anticoagulant activity. The ionic complex
is then removed and broken down by the reticuloendothelial
system.

Indications

Protamine sulfate is a medication that is used to reverse the

effects of heparin. It is specifically used in heparin overdose,
in low molecular weight heparin overdose, and to reverse the
effects of heparin during delivery and heart surgery. It is given
by injection into a vein.The onset of effects is typically within
five minutes.

Contraindications

Protamine administration has a risk of serious hypersensitivity

reactions or anaphylaxis manifesting as severe hypotension,
cardiovascular collapse, pulmonary edema, pulmonary
vasoconstriction, and pulmonary hypertension.
Side effects

Common side effects of Protamine Sulfate include:

sudden fall in blood pressure,

slow heart rate (bradycardia,)

pulmonary hypertension,

shortness of breath, or.

temporary flushing and a feeling of warmth.

Nursing intervention

Monitor BP and pulse q15–30min, or more often if indicated.

Continue for at least 2–3 h after each dose, or longer as
dictated by patient's condition. Be prepared to treat patient for
shock as well as hemorrhage. Lab tests: Monitor effect
of protamine in neutralizing heparin by aPTT or ACT values.
Zantac

Mechanism of Action

Ranitidine is a competitive inhibitor of histamine H2-receptors.

The reversible inhibition of H2-receptors in gastric parietal cells
results in a reduction in both gastric acid volume and
concentration.

Indications

Ranitidine is used to treat ulcers of

the stomach and intestines and prevent them from coming
back after they have healed. This medication is also used to
treat certain stomach and throat (esophagus) problems (such
as erosive esophagitis, gastroesophageal reflux disease-
GERD, Zollinger-Ellison syndrome). It works by decreasing the
amount of acid your stomach makes. It relieves symptoms such
as cough that doesn't go away, stomach pain, heartburn, and
difficulty swallowing. Ranitidine belongs to a class of drugs
known as H2 blockers. This medication is also available without
a prescription. It is used to prevent and treat heartburn and
other symptoms caused by too much acid in the stomach
(acid indigestion). If you are taking this medication for self-
treatment, it is important to read the manufacturer's package
instructions carefully so you know when to consult your doctor
or pharmacist.
This drug has been withdrawn from the US market due to
problems with safety. A possible cancer-causing impurity has
been found in some ranitidine products.

Contraindications

General Information.

H2-blocker hypersensitivity.

Gastric cancer.

Infection.

Hepatic disease.

Renal disease, renal failure, renal impairment.

Pregnancy.

Side Effects

Headache, constipation or diarrhea may occur. If any of these

effects persist or worsen, tell your doctor
or pharmacist promptly.

Nursing intervention

Administer oral drug with meals and at bedtime.

Decrease doses in renal and liver failure.

Provide concurrent antacid therapy to relieve pain.

Administer IM dose undiluted, deep into large muscle group.

Arrange for regular follow-up, including blood tests, to evaluate

effects.
 MEDI
CATI
ONS
① (UNICTAM )
→ Acti
on:
-

Sulbactam :
isabet a-
lact
amaseant agoni
stthati
nhibi
ts
t
heenz ymebet a-
lactamasesecr etedbysomebact eri
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whichenablesampi cil
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makesi thaveawi deranti
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um.

Ampi ci
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factt
hatitcontainsabet a-
lact
am r
ingi
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Mostofthem (
suchasampicil
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kbyi
nhi
bit
ingcel
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wal
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mat i
oninthebact
eri
a

I
ndi
cat
ions:
-→

1-
Treat
ingani
nfect
ioni
ntheabdomen

2-
Inf
ect
ionoft
her
epr
oduct
ivesy
stem

3-
Thr
oati
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4-
Middl
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nfect
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5-
Sinusi
nfect
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6-
Lowerr
espi
rat
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racti
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ions

7-
Ski
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obact
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a

8-
Uri
nar
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stem i
nfect
ions

9-
Mol
arandt
oot
habscess

→ Cont
rai
ndi
cat
ions

I
ncase:
 1-Thepr
esenceofhy
per
sensi
ti
vi
tyt
openi
cil
l
in.

2-Thepr
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mpai
redl
i
verf
unct
ion.

3-Ther
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nki
dneyf
unct
ion.

4-Thepr
esenceofsensi
ti
vi
tyt
ooneoft
hecomponent
s
thedr
ug.of

5-Iti
sfor
biddentotakethismedi
cinef
orpat
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recei
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6-Iti
scontrai
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catedwit
hsomeot heranti
biot
ics,
such
astet
racycl
i
ne,becausei
tint
erf
ereswiththeacti
ve
si
deeffect
s:-→ i
ngredi
ent.

1-Diarr
hea, of
teni
nchil
dren,
duetot
heeliminat
ionof
benefi
cialbact
eri
a,andt
hesymptom di
sappearsaft
ert
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endoftreatment

2-Arashandt
heappear
anceofcol
oredspot
sont
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ski
n

3-Chestpai
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ight
nessi
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hroat

4-I
nfl
ammat
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onandi
ndi
gest
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5-I
nfect
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te

6-Ashor
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oodcel
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7-Ret
ent
ioni
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a.

nur
singr
ole→

Gi
vemedi
cinesont
ime

Not
etheemer
genceofsi
deef
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sandi
nfor
mthedoct
or
② Repar
il
→ Act
ion:
-

I
tsmechani sm ofacti
onisbasedondiluti
ngtheblood,
preventi
ngleakageoffl
uidsfrom t
heveinsandcapil
lar
ies,
asittarget
sthewallsofbloodvessel
s,inaddit
ionto
reducingfl
uidlosst
otheur i
netohelppreventwater
backflow

→I
ndi
cat
ions:
-

-1 ‫ﺮ‬
‫ﻴ‬‫ﺍﺳ‬
‫ﻮ‬‫ﺒ‬‫ﻟ‬
‫ﺍ‬
Hemor
rhoi
ds

2-Muscl
ecr
amps‫ﺎﺕ‬
‫ﻨﺠ‬‫ﺗﺸ‬

3-Fl
uidr
etent
ionandpost
oper
ati
veedema

4-Tr
eatingswel
l
ingcausedbychr
oni
cvenous
i
nsuf
fi
ciency

5-Var
icosev
eins‫ﻴﻦ‬
‫ﻗ‬‫ﺎ‬‫ﻟﺴ‬
‫ﺍ‬‫ﻟﻲ‬
‫ﺍ‬
‫ﻭ‬‫ﺩ‬

6-Backpai
ninpat
ient
swi
thsy
mpt
omsofner
ver
oot
s

→ Cont
rai
ndi
cat
ions:
-

1-Hy
per
sensi
ti
vi
tyt
oanycomponentoft
hedr
ug.

2-
Pregnancyandbr
east
-f
eedi
ng.

3-
Pat
ient
swi
thl
i
verandki
dney
s.

4-
Peopl
ewi
thr
api
dbl
eedi
ngandbr
uisi
ng

→ si
deef
fect
s:-

st
omachupset
,nausea,
Headache
i
tchi
ng ‫ﻪ‬
‫ﻜ‬‫ﻟﺤ‬
‫ﺍ‬
→:- Fol
l
owupont
hepat
ientandt
akecar
eofanysi
deef
fect
s
Nur
singr
ole

③ Cl
exane
→ Act
ion:
-
Clexaneisoneofagr
oupofmedici
nescall
edl
owmolecul
arweighthepar
ins
(LMWH) .Thesemedi
cineswor
kbyreduci
ngbl
oodcl
ott
ingact
ivi
ty.

Cl
exanecont
ainst
heact
ivei
ngr
edi
ent
senox
apar
insodi
um.

→I
ndi
cat
ions:
-

Pr
event
ionofbl
oodcl
otsaf
tersur
ger
y.-
1

I
nahear
tat
tack.-
2

Treati
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ingbl
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sandusingcl
exanei
nject
ionundert
heskini
nthe-3
hospital
,thereisnoobj
ecti
ont
ousingitathomeaslongastheclot
sdonotreach
thelung.

→ Cont
rai
ndi
cat
ions:
-

1-
All
ergyt
oenox apari
nandhepar
in.2-I
tiscont
rai
ndicat
edfort
hosesuf
fer
ingf
rom
l
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eletsresul
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rom recei
vi
nghepari
ntherapy
.

3-Suf
fer
ingf
rom bl
eedi
ng.

5-
Usei
tfort
heel
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lyov
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heageofsi
xty
-fi
vey
ear
s

6-
Chi
l
drenundert
heageofei
ght
eeny
ear
s

→ si
deef
fect
s:-

- Feel
i
ngofpai
natt
hei
nject
ionsi
te

(-
Youmayhav
east
rokeaf
terqui
tt
ingcl
exanei
nject
ionBl
eedi
ng
-

-
Anemi
a

-
Hight
emper
atur
e

-
Swol
l
enf
eet

→ Nur
singr
ole:
-
Doingasensit
ivi
tytestfort
hepat
ientandf
oll
owi
ngupt
hepat
iental
lthet
imef
ort
he
ri
skofanysideeffects