GENERAL ADVERSE NSG
DRUG NAME SPECIFIC ACTION INDICATION CONTRAINDICATION
ACTION EFFECTS RESPONSIBILITIES
ACETAZOLAMIDE Diuretic Promotes renal Secondary Hypersensitivity to CNS: seizure, Cross-sensitivity
250mg/tab 1 tab excretion of sodium, glaucoma; sulphonamides drowsiness, between
now then TID potassium, preoperative including Steven- paresthesia, antibacterial
bicarbonate, and treatment of acute Johnson syndrome, confusion, sulphonamides and
water. As angle-closure toxic epidermidal depression, sulphonamide-
anticonvulsant, drug glaucoma necrolysis, weakness, ataxia. derivative diuretics
normalizes neuronal Chronic angle fulminant hepatic EENT: transient such as
discharge. In glaucoma necrosis, myopia, hearing acetazolamide has
mountain sickness, To prevent or treat agranulocytosis, dysfunction, tinnitus. been reported.
drug stimulates acute mountain aplastic anemia, GI: nausea, vomiting, Monitor fluid intake
ventilation and sickness and other blood anorexia, metallic and output, glucose,
increases cerebral Adjunct for epilepsy dyscrasias. taste, diarrhea, black and electrolytes
blood flow. In and myoclonic, Sensitization may tarry stools, especially
glaucoma, drug refractory, recur when constipation. potassium,
reduces intraocular generalized tonic- sulphonamide is GU: polyuria, bicarbonate and
pressure. clonic, absence or readministered, hematuria, chloride.
mixed seizure. irrespective of the crystalluria, Monitor elderly
route of glycosuria, patients closely
administration. phosphaturia, renal because they are
Contraindicated in calculus. especially
patients Hemat: aplastic susceptible to
hypersensitive to anemia, leukopenia, excessive diuresis.
drug and those with thrombocytopenia, Weight patient daily.
hyponatremia or haemolytic anemia. Rapid or excessive
hypokalemia, renal Metab: hypokalemia, fluid loss may cause
or hepatic disease asymptomatic weight loss and
or dysfunction, hyperuricemia, hypotension.
renal calculi, hyperchloremic Diuretic effect
adrenal gland acidosis. decreases when
failure, Skin: pain at injection acidosis occurs but
hyperchloremic site, steven-johnson can be re-
acidosis, or severe syndrome, rash, established by using
pulmonary utricaria. intermittent
obstruction. administration of
Contraindicated in schedules.
those receiving
long term treatment Monitor patient for
for chronic signs of haemolytic
noncongestive anemia.
angle closure Drug may increase
glaucoma. glucose level and
Use cautiously in cause glycosuria.
patients receiving Tell patient to take
other diuretics and oral form with food to
in those with minimize GI upset.
respiratory acidosis Tell patient not to
or COPD. crush, chew or open
capsules.
Caution patient not
to perform
hazardous activities
if adverse CNS
reaction occur.
Instruct patient to
avoid prolonged
exposure to sunlight
because drug may
cause phototoxicity.
Instruct patient to
notify prescriber or
any unusual
bleeding, bruising,
tingling or tremors.
TIMOLOL eye drop Anti- Thought to reduce To reduce IOP in Contraindicated in CNS: syncope, Monitor diabetic
1 drop now then glaucoma formation, and ocular hypertension patients stroke, confusion, patients carefully.
BID, OU possibly increase or open-angle hypersensitive to depression, Systemic beta-
outflow of aqueous glaucoma. drug and in those dizziness, fatigue, blocking effects can
humour. with bronchial hallucinations, mask some signs
asthma, sinus lethargy, headache. and symptoms of
bradycardia, second- CV: hypotension, hypoglycaemia.
or third-degree AV arrhythmia, Some patients may
block, cardiac failure, bradycardia, cardiac need a few weeks of
cardiogenic shock, or arrest, heart block, treatment to stabilize
history of bronchial heart failure, pressure-lowering
asthma or severe worsening of angina, response. Determine
COPD. palpitations, slight IOP after 4 weeks of
Use cautiously in reduction of resting treatment.
patietns with heart rate, Drug can be used
nonallergic hypertension. safely in patients
bronchospasm, EENT: burning and with glaucoma who
chronic bronchitis, stinging, blepharitis, wear conventional
emphysema, DM, conjunctivitis, PMMA hard contact
hyperthyroidism, or decreased corneal lenses.
cerebrovascular sensitivity with long Teach patient how to
insufficiency. term use diplopia, instill eye drops.
keratitis, minor eye Advise him to wash
irritation, ptosis, hands before and
visual disturbances, after instillations and
discharge, tearing, to apply light finger
ocular pain, itching. pressure on lacrimal
sac for 1 minute
after drops are
instilled. Warn
patient not to touch
the tip of dropper to
the eye or
surrounding tissue.
Instruct patient using
gel to invert
container and shake
once before each
use. Also tell him to
use other ophthalmic
drugs atleast 10
minutes before
applying gel.
Tell patient to instill
drug without contact
lenses in place.
Lenses may be
reinserted about 15
minutes after drug
use.
Drugs may be
absorbed
systemically and
produce signs and
symptoms of beta
blockade. Advise to
monitor pulse rate
and report slow rate
to prescriber.
Tell patient to report
difficulty breathing or
chest pain to
prescriber.
BRIMONIDINE eye Antiglaucoma Reduces aqueous To reduce IOP in Contraindicated in CNS: asthenia, Monitor IOP
drop, 1 drop TID OU humor production open-angle patients dizziness, headache. because drug effect
and increases glaucoma or ocular hypersensitive to CV: hypotension, may reverse after
uveoscleral outflow. hypertension. drug or its hypertension. first month therapy.
components and in EENT: allergic Tell patient to wait at
those taking MAO conjunctivitis, ocular least 15 minutes
inhibitors. hyperemia, pruritus, after instilling drug
Use cautiously in abnormal vision, before wearing soft
patients with CV allergic reaction, contact lenses.
disease, cerebral, or blepharitis, burning Caution patient to
coronary conjunctival edema, avoid hazardous
insufficiency, hepatic haemorrhage, or activities because
or renal impairment, inflammation, risk of decreased
depression, dryness, eyelid mental alertness,
Raynauds edema, or fatigue, or
phenomenon, erythemea, follicular drowsiness.
orthostatic conjunctivitis, foreign Advise patient to
hypotension or body sensation, avoid alcohol.
thromboangitis increased tearing, If patient is using
obliterans. pain, pharyngitis, more than one
photophobia, rhinitis, ophthalmic drug, tell
sinus infection or him to apply them at
inflammation, least 5 minutes
stinging, superficial apart.
punctate
keratopathy, visual
disturbances, visual
field defect, vitreous
floaters, worsened
visual acuity.
GI: dyspepsia, oral
dryness.
RESPI: bronchitis,
cough, dyspnea
Skin: rash
Others:
PILOCARPINE eye Cholinergic Directly stimulates Treatment Hypersensitivity to Ophthalmic: Ophthalmic: Wash
drop 1 drop q 2hrs drug cholinergic receptors for glaucoma pilocarpine or any Frequency not hands before using.
OU in the eye causing Sjgren's syndrome component of the defined: Do not let tip of
miosis (by Dry mouth formulation; acute Cardiovascular: applicator touch eye;
contraction of the iris inflammatory Hypertension, do not contaminate
sphincter), loss of disease of the tachycardia tip of applicator (may
accommodation (by anterior chamber of Gastrointestinal: cause eye infection,
constriction of ciliary the eye; in addition, Diarrhea, nausea, eye damage, or
muscle), and tablets are also salivation, vomiting vision loss). Sit or lie
lowering of contraindicated in Ocular: Burning, down. Open eye, look
intraocular pressure patients with ciliary spasm, at ceiling, and instill
(with decreased uncontrolled asthma, conjunctival vascular prescribed amount of
resistance to angle-closure congestion, corneal solution. Do not blink
aqueous humor glaucoma, severe granularity (gel 10%), for 30 seconds, close
outflow) hepatic impairment lacrimation, lens eye and roll eye in all
opacity, myopia, directions, and apply
retinal detachment, gentle pressure to
supraorbital or inner corner of eye
temporal headache, for 1-2 minutes.
visual acuity Temporary stinging or
decreased blurred vision may
Respiratory: occur. You may
Bronchial spasm, experience altered
pulmonary edema dark adaptation; use
Miscellaneous: caution when driving
Diaphoresis at night or in poorly lit
Oral (frequency
varies by indication environments. Report
and dose): persistent pain,
>10%: redness, burning,
Cardiovascular: double vision, or
Flushing (8% to 13%) severe headache.
Central nervous Pregnancy/breast-
system: Chills (3% to feeding precautions:
15%), dizziness (5% Inform prescriber if
to 12%), headache you are pregnant.
(11%) Breast-feeding is not
Gastrointestinal: recommended.
Nausea (6% to 15%) Usually causes
Genitourinary: difficulty in dark
Urinary frequency adaptation; advise
(9% to 12%) patients to use
Neuromuscular & caution while night
skeletal: Weakness driving or performing
(2% to 12%) hazardous tasks in
Respiratory: Rhinitis poor illumination;
(5% to 14%) finger pressure
Miscellaneous: should be applied to
Diaphoresis (29% to lacrimal sac for 1-2
68%) minutes after
1% to 10%: instillation to
Cardiovascular: decrease risk of
Edema (<1% to 5%), absorption and
facial edema, systemic reactions.
hypertension (3%), Assure the patient or
palpitation, a caregiver can
tachycardia adequately
Central nervous administer ophthalmic
system: Pain (4%), medication dosage
fever, somnolence form.
Dermatologic:
Pruritus, rash
Gastrointestinal:
Diarrhea (4% to 7%),
dyspepsia (7%),
vomiting (3% to 4%),
constipation,
flatulence, glossitis,
salivation increased,
stomatitis, taste
perversion
Genitourinary:
Vaginitis, urinary
incontinence
Neuromuscular &
skeletal: Myalgias,
tremor
Ocular: Lacrimation
(6%), amblyopia
(4%), abnormal
vision, blurred vision,
conjunctivitis
Otic: Tinnitus
Respiratory: Cough
increased,
dysphagia, epistaxis,
sinusitis
Miscellaneous:
Allergic reaction,
voice alteration
MANNITOL 500cc, Osmotic Increases osmotic Test dose for marked Contraindicated in CNS: seizure, Monitor vital signs
let 200cc diuresis pressure of oliguria or suspected patients dizziness, headache, including central
glomerular filtrate, inadequate renal hypersensitive to fever. venous pressure and
thus inhibiting tubular function. drug. CV: edema, fluid intake and output
reabsorption of water Oliguria Contrainidicated in thrombophlebitis, hourly. Report
and electrolytes. To prevent oliguria or patietns with anuria, hypotension, increasing oliguria.
Drug elevates acute renal failure. sever pulmonary hypertension, heart Check weight, renal
plasma osmolality To reduce IOP or ICP congestion, frank failure, tachycardia, function, fluid balance,
and increases water or cerebral edema. pulmonary edema, angina-like chest and serum and urine
flow into extracellular Diuresis in drug active intracranial pain, vascular sodium and potassium
fluid. intoxication. bleeding, severe overload. levels daily.
Irrigating solution dehydration, EENT: blurred vision, In comatose on
during transurethral metabolic edema, rhinitis. incontinent patient,
surgical procedures. previous progressive GI: urine retention. use urinary catheter
Metab: dehydration.
renal disease or Skin: local pain, because therapy is
dysfunction after urticarial. based on strict
starting drug, Others: chills, thirst. evaluation of fluid
including increasing intake and output. If
azotemia and patient has urinary
oliguria or previous catheter use an hourly
progressive heart urometer collection
failure or pulmonary bag to evaluate output
congestion after accurately and easily.
drug. Drug is commonly
used in chemotherapy
regimens to enhance
diuresis of renally toxic
drugs.
Dont give electrolyte
free solutions with
blood. If blood is given
simultaneously, add at
least 20 mEq of
sodium chloride to
each liter of drug
solution to avoid
pseudoagglutination.
Tell patient that he
may feel thirsty or
have a dry mouth and
emphasize importance
of drinking only the
amount of fluid
ordered.
Instruct patient to
promptly report
adverse reactions and
discomfort at IV site.
