DRUG STUDY

Classification: ANTI-INFECTIVES-Quinolones

GENERIC NAME Ciprofloxaci n BRAND NAME Ciprobay DOSAGE 250-500mg BID

INDICATION Infections of the resp. tract, middle ear,paranas al sinuses, eyes, kidneys, urinary tract

ACTION Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria

CONTRAINDICATIO N Drugs that inhibit peristalsis. Infants and children, growing adolescents. Pregnancy and lactation

PRECAUTION/ ADVERSE REACTION PRECAUTION Severe and persistent diarrhea during and after treatment ADVERSE RXN Common:Nausea, diarrhea, vomiting, rash Uncommon: Anorexia, headache,dizzines s, fever, GI and abdominal pain, flatulence, confusion, vertigo

NURSING CONSIDERATIO N >Assess pt for previous sensitivity reaction >Assess pt for any s/s of infection before & during treatment >Assess for adverse reactions >assess pt. & familys knowledge of drug therapy

Classification: GASTROINTESTINAL DRUGS-Laxatives

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATIO N

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

LACTULOSE Gastrointesti nal agent, hyperosmotic laxative BRAND NAME duphalac DOSAGE Infants: 5 ml Children: 1-6 y/o- 510ml 7-14y/o15ml 15-45y/o- 1530ml.

Constipatio n, salmonello sis. Treatment of hepatic encephalop athy

Inhibits bacterial DNA gyrase thus preventin g replicatio n in susceptibl e bacteria

Pt who require a low lactose diet. Galactosemia deficiency. Intestinal obstruction.

PRECAUTION: Lactose intolerance, diabetes Adverse Rxn: Abdominal discomfort associated with flatulence and intestinal cramps. Nausea, vomiting, diarrhea on prolonged use.

Dose given in 3 days Classification: ANTI-ALLERGICS_Anti-histamine

>Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness >Monitor pt for any adverse GI reactions, nausea,vomiting,diarr hea, >Assess for adverse reactions >for pt. with hepatic encelopathy: regularly assess mental condition >monitor I & O >monitor for Inc. glucose level in diabetic pts

GENERIC NAME levocetirizin e BRAND NAME Xyzal

INDICATION Treatment of symptoms associated with allergic conditions (including ocular symptoms)

ACTION Longacting nonsedating antihistami ne that selectively inhibits peripheral HI receptors

CONTRAINDICATIO N Pts with severe renal impairment, pts with rare problems of galactose intolerance

PRECAUTION/ ADVERSE REACTION PRECAUTION Adjustment of dose is recommended in elderly pts w/ compromised renal function. Lactation. ADVERSE RXN Dry mouth, headache, fatigue, rhinitis, abdominal pain, migraine

DOSAGE Adult and adolescents more than 12 yrs- 1 tab/day Pedia: 6-12 yrs- 1 tab/ day Classification: ANTI-INFECTIVES-Penicillins

NURSING CONSIDERATIO N >obtain pt hx inc. drug hx and any unkown allergies >monitor pulse, BP, respiration > observe dizziness and excessive sedation

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Amoxicillin BRAND NAME Amoxil DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/da y divided dosage given every 8 hrs

Infections of the resp. tract, skin & skin structures,parana sal sinuses, genitourinary tract, otitis media, sinusitis, meningitis,septic emia

Prevents bacterial cell wall synthesis during replication .

Hypersensitivity to penicillins, cephalosporins. Not used to treat pneumonia, bacteremia pericarditis during acute stage.

PRECAUTION: Hypersensitivit y: rxn range from mild to life threatening ADVERSE RXN: Dizziness, fatigue, insomnia, skin rashes, itchy eyes, sore or dry mouth, abnormal taste sensation, diarrhea, rectal bleeding

>obtain pts hx of allergy >Assess pt for any s/s of infection >Assess for pts sensitivity to penicillin ot other cepalosporins >assess for allergic rxn during therapy >Assess for bowel pattern, if diarrheashld be discontinue

Classification: CARDIOVASCULAR DRUGS-Calcium Antagonist

GENERIC NAME felodipine BRAND NAME Plendil DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/da y divided dosage given every 8 hrs

INDICATION Treatment of hypertensio n

ACTION Inhibits calcium ion influx across cell membrane, resulting in inhibition of excitation/ contraction.

CONTRAINDICATION Sick sinus syndrome, second or third-degree Av block except with functioning pacemaker, hypotension with systolic BP<90mmHg

PRECAUTION/ ADVERSE REACTION ADVERSE RXN: Peripheral edema, hypotension, syncope, MI, angina, tachycardia, headache, dizziness, lightheadedness, nausea, vomiting, sinusitis, wheezing cough, sneezing

NURSING CONSIDERATION >assess fluid volume status, adequacy of pulses, pitting edema, dehydration, hypotension, dry mouth >monitor cardiac status: BP, pulse, respiration >Assess for angina pain: duration,intensity, aggravating factors

Classification: CARDIOVASCULAR DRUGS-Angiotensin II Antagonist

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

TELMISART AN BRAND NAME Pritor DOSAGE Adult: 2080mg daily, usual starting dose 40mg daily

Treatment of hypertension

Blocks the vasoconstricti ve ans aldosteroneone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the ATI receptor in many tissues

Hypersensitivity, pregnancy, lactation. Severe hepatic or renal impairment

PRECAUTION: Can cause death to the fetus if used on the 2nd trimester, safety in children not yet established ADVERSE RXN Diarrhea and angioedema. Sinusitis, pharyngitis, upper resp. tract infection, back pain

>assess pts condition before therapy >Assess for heart failure >Assess for obstructive jaundice >monitor for possible drug induced adverse rxn >close monitoring of BP and pulse

Classification: ANTI-DIARRHEALS

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Loperamide HCl BRAND NAME IMODIUM DOSAGE Adult: initially 2 cap; subsequent dose a cap after every stool

Symptomatic control of acute and chronic diarrhea

Acts on the nerve endings &/or intramural ganglia of the intestinal wall to decrease intestinal motility, resulting to prolonged retention of feces in the intestines

Those in whom constipation must be avoided, children less than 1 yr, hypersensitivity, abdominal distention

PRECAUTION: Hepatic dysfunction, chronic diarrhea, dehydration ADVERSE RXN Hypersensitivit y reactions, flatulence, abdominal pain, distention or discomfort, nausea and vomiting

>assess pts bowel pattern >check response after 48 hrs >Assess hydration >assess for abdominal distention >inform pt. that dry mouth may be relieved by frequent sips of water, hard candy or sugarless gum

Classification: CENTRAL NERVOUS SYSTEM DRUGS-Anti-anxiety

( Anticonvulsant/Hypnotics/Sedatives/Anxiolytics)
GENERIC NAME INDICATION ACTION CONTRAINDICATION PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

DIAZEPAM BRAND NAME Valium DOSAGE Adult: 250500mg every 8 hours Children: 2040mg/kg/da y divided dosage given every 8 hrs

Symptomatic relief of anxiety, agitation, tension

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Hypersensitivity. Dependence, withdrawal symptoms

PRECAUTION: Hypersensitivit y: cardiorespirato ry insufficiency, pregnancy, lactation ADVERSE RXN Dizziness, fatigue, blurred vision, dependence, withdrawal reactions

> inform pt. that drug may be taken with food >advice pt. not to abruptly discontinue drug after long term use >advice pt. to avoid driving and activities that require alertness bec, drug can cause drowsiness >inform pt. that smoking may decrease effect

Classification: DIETARY/NUTRITIONAL DRUGS-Vitamins and Minerals

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Calcium carbonate BRAND NAME Calci-Aid DOSAGE Adult: 1-2 capsules daily Pedia: 1-2 tablets daily

Antacid, calcium supplement, osteoporosis

Decreases total acid load of GI tract. Increase esophageal sphincter tone

Hypercalcemia, bone tremors, severe renal failure,hypersensit ivity

PRECAUTION: History of stone formation, pregnancy ADVERSE RXN Constipation, flatulence, diarrhea, renal dysfunction, acid rebound

> administer as antacid 1 hr fter meal and at bed time >administer as supplement 1 hrs after meal and at bed time >advice pt to increase fluids to 2L unless contraindicated

Classification: ANTI-ASTHMA

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATI ON

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

Salbutamol BRAND NAME Ventolin vilmax DOSAGE Adult: 8mg tablet BID Pedia: 3-12 yrs 4mg tab BID

Reversible airway obstruction including bronchial asthma, chronic bronchitis

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety, promote calmness and sleep

Hypersensitivity

PRECAUTION: Hyperthyroidism ,DM, cardiovascular disease ADVERSE RXN Fine tremor of skeletal muscle, feeling of tension, a compensory small increase in heart rate, headache, muscle cramps

> drug may be decrese sensitivity of spirometry used for diagnosis of asthma >syrup may be taken as young as age 2 >monitor for evidence of allergic rxn

Classification: CARDIAC DRUGS-Centrally-acting Drugs

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATI ON

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

orlistat BRAND NAME Xenical DOSAGE Adult: 1 cap with each main meal

Long-term treatmentof obese and overweight patients with risk factors and comorbiditi, associated with obesity including hypercholesterolemia, NIDD, impaired glusoce tolerance, hypertension and reduction of visceral fat

Inhibits the absorption of dietary fat

Chronic malabsorption syndrome

PRECAUTION: Children <18 yrs, pregnancy, lactation, shld be given with caution to diabetic pt. ADVERSE RXN Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation. Fecal incontinence

> assess effectiveness of other medications pt may be taking (esp. anticoagulant) >pt. may experience dizziness or lightheadedness >advice pt to report persistens back pain, muscle, or joint pain, signs of resp. tract infection

Classification: ANALGESICS

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATIO N

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATIO N

Mefenamic acid BRAND NAME Dolfenal DOSAGE Adult: start with 75150mcg BID Severe HPN 300mg BID

Relief of pain including muscular, rheumatic, traumatic, dental, postop and postpartum pain, headache, migraine, fever, dysmenorrhe a

Aspirin-like drug that has analgesic,antipyr etic, & antiinflammatory activities

Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs

PRECAUTION: If rash occurs, administration should be stopped, asthmatics, Hx of liver and kidney disease ADVERSE RXN GI discomfort, diarrhea or constipation, gas pain, nausea, vomiting, drowsiness

> assess pt.s pain before therapy >monitor for possible drug induced adverse reactions >advice pt. not to take drug for more than 7 days >advice pt. to report immediately persistence or failure to relieve pain

Classification: ANTI-INFECTIVES

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATI ON

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

chloroquine BRAND NAME chlorofoz DOSAGE Adult: initially four 250mg tablet followed by 2 tab after 6-8 hrs, then2 tab daily for 2 days

Antacid, calcium suppleme nt, osteoporo sis

Inhibits the perioxidativ e activity of heme, and disrupt its nonenzymat ic polymerizati on to hemozin

Presence of retinal or visual field changes

PRECAUTION: Hepatic disease, alcoholism, monitor complete blood count ADVERSE RXN Headache, nausea, vomiting, diarrhea, skin eruptions

>advice pt that compliance with dosage schedule & duration of tx are necessary >caution pt to avoid alcohol while taking drug >assess hepatic status (dec. appetite,jaundice, dark urine >instruct pt to use sunglasses in bright sunlight

Classification: GASTROINTESTINAL DRUGS-LAXATIVES

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

bisacodyl BRAND NAME Dulcolax DOSAGE Adult: 2 tab at bedtime or 30 mins before breakfast, max 4 tabs Pedia: greater than 4 yrs- 1 tab Suppository: Pedia 5mg Adult- 10mg

Constipatio n, relief of evacuation in hemorrhoid s, prep for barium enema, pre and post-op

Increases peristalsis & motor activity of the small intestines by acting directly on the smooth muscles.

Nausea, vomiting or other symptoms of appendicitis, acute surgical abdomen, abdominal pain, ulcerative lesions of colon

PRECAUTION: Caution is advised during 1st 3 mos of pregnancy as well as administration to children < 4 yrs ADVERSE RXN Occasional abdominal discomfort, soreness in anal region

> monitor frequency & character of stool >monitor occurrence of adverse rxn >swallow the tablet whole, do not crush or chew

Classification: RESPIRATORY DRUGS- MUCOKINETICS/EXPECTORANTS

GENERIC NAME INDICATION ACTION CONTRAINDICATI ON PRECAUTION/ ADVERSE NURSING CONSIDERATION

REACTION

Carbocisteine BRAND NAME Loviscol DOSAGE Capsule: Adult: 250mg 2 caps, 500mg 1 cap TID Suspension: Adult 15ml; Pedia: 612yrs: 5ml, 2-5 yrs: 1.252.5 ml Syr: 6-12yrs: 10ml 2-5 yrs: 2.5ml Drops: 12-24mos: 1.25ml, 911mos: 1ml, 6-8mos: 0.75ml, 3-5mos: .50ml, <3mos: 0.25ml All doses 3-4x/ day

Acute/chro nic disorders of the upper & lower respiratory tract associated with the secretion & formation of excessive and viscid mucus

Reduces the viscosity of bronchial secretions & facilitate expectoration

active peptic ulcer. Hypersensitivit y to carbocisteine

PRECAUTION: Hx of peptic ulcer, hypothyroidis m ADVERSE RXN Nausea, headache, vomiting, anorexia, gastric discomfort, diarrhea, GI bleeding

>assess cough: type, frequency, character > advice medical consultation for persistent cough of more than 7 days >advice pt. to avoid smoking >suggest sugarless lozenges to decrease throat irritation and cough

Classification: CARDIOVASCULAR DRUGS- ANTI-ARRYTHMICS

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATI ON

PRECAUTIO N/ ADVERSE REACTION

NURSING CONSIDERATION

Amiodarone Hcl BRAND NAME Cordarone DOSAGE

Tab: initially 3 tab/day maintenance: 1-2 tab/day

Cardiac arrhythmias, ventricular rhythm disorders

Blocks sodium channels at rapid pacing frequencies, prolonging myocardial cell action potential and refractory period

Sinus bradycardia,. SA and AV blocks, pregnancy, hypersensitivity

PRECAUTI ON: Goiter, CHF, respiratory disease ADVERSE RXN Bradycardi a, heart block, sinus arrest, flushing, fatigue, insomnia, headache

>assess cardiovascular status before therapy > loading dose with food to decrease nausea >instruct pt. that skin discoloration is reversible >advice pt. to wear sunglasses for photophobia, protective clothing to prevent burning

Classification: GASTROINTESTINAL DRUGS- ANTI-FLATULENTS

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

PRECAUTION/ ADVERSE REACTION

NURSING CONSIDERATION

metoclopramide BRAND NAME Plasil DOSAGE Adult 10mg 3x/day pedia: 15-20yrs 5-10mg 3x/day 5-14yrs: 2.5-5mg 3x/day 3-4yrs: 3mg 23x/day 1-2yrs: 1mg 23x/day Under 1 yr: 1mg 2x/day

Gastrointestinal motility, nausea, vomiting of central and peripheral origin assoc. with surgery

Dopamine antagonist that acts by increasing receptor sensitivity and response of upper GIT tissues to acetylcholine

GI hemorrhage, epileptics, hypersensitivity, lactation, pts. With breast cancer

PRECAUTIO N: Activities requiring mental alertness, elderly, lactation ADVERSE RXN Restlessnes s, drowsiness, fatigue, insomnia, headache, dizziness, nausea

>give 30 mins before meals and at bed time > assess mental status during treatment >tell pt. To avoid driving & other hazardous activities for at least 2 hrs >advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug

Classification: CARDIOVASCULAR DRUGS- BETA-BLOCKERS

GENERIC NAME INDICATION ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

metropolol BRAND NAME Neobloc DOSAGE

Adult : 50mg BID or 100 mg OD

Hypertensi on, chronic angina pectoris

Exerts mainly beta-1 adrenergic blocking activity but also blocks beta-2 receptors at high doses

AV blocks, cardiogenic shock, sinus bradycardia

PRECAUTION: Slowing of heart rate, occasionally severe bradycardia may lead to vertigo ADVERSE RXN Occasionally fatigue, dizziness, headache, GI disturbance, skin rashes nausea

>tablet may be crashed or swallowed whole > instruct pt to take with meals >inform the pt that drug only controls but does not cure the disorder >tell the pt. not to discontinue drug abruptly can worsen angina

Classification: CNS DRUGS- HYPNOTICS/ SEDATIVES

GENERIC NAME INDICATIO N ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

phenobarbit al BRAND NAME luminal DOSAGE

100-320mg. max 600mg daily

Shortterm treatment of insomnia, long- term treatment of generalize d toniclonic seizures

Depressant and anticonvulsant effects may be related to its ability to increase the inhibitory activity of GABA on nerve impulses

Hypersensitivity to barbiturates, pregnancy, severe renal, hepatic, resp. impairment

PRECAUTION: Impaired renal, hepatic cardiac or resp. functions ADVERSE RXN Dizziness, headache, hangover, confusion in elderly, GI disturbances, allergic reactions, sedation and depression may occur

>instruct pt. to avoid alcohol and other CNS depressant to prevent inc. depression > withdrawal insomnia may occur after short-term use, insomnia improves in 1-3 nights >on empty stomach, 30-60 mins before bedtime for expected sleeplessness >advice pt to change positions slowly to prevent orthostatic hypotension

Classification: CARDIOVASCULAR DRUGS- ANTI-INFECTIVE ( ANTI-FUNGALS)

GENERIC NAME INDICATIO N ACTION CONTRAINDICATIO N PRECAUTION/ ADVERSE REACTION NURSING CONSIDERATION

Nystatin BRAND NAME Mycostatin DOSAGE 4-6ml susp 4x/day or 12 tabs 3x/day Infants: 2ml pedia susp 4x/day

Antifungal antibiotic used for prophylaxi s and treatment of candidiasi s of the skin and mucous membran es

Interferes with fungal DNA replication: binds sterols in fungal cell membrane, w/c increases permeability, resulting in leaking of cell nutrients

hypersensitivity

PRECAUTION: Discontinue if sensitization occurs ADVERSE RXN Diarrhea, GI distress, nausea, vomiting

>oral suspension, shake well before using > report persistent nausea and vomiting, diarrhea or if condition worsens >inform physician if pt is pregnant

Classification: Anticholinergic
GENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

Atropine SO4 BRAND NAME Dose/Route: 0.5-1.0 mg IVP Q3-5min max of 0.04mg/kg (ETT 2-2.5 x dosage) OPP: 2-5mg Q1015 min (Peds 0.05mg/kg) Pediatric: 0.02mg/kg (minimum 0.1mg - Antidote to overdosage with cholinergic substances (nerve gases, poisonous mushroom) - Pre-op medication to reduce salivary and resp. tract secretions.

Helps to reduce saliva and fluid in the respiratory tract. May also be used to treat a slow heartbeat or insecticide or mushroom poisoning

Contraindicated in patients with glaucoma, pyloric stenosis or prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication.

Can cause blurred vision, dilated pupils, dry mouth, palpitations urinary retention, tachycardia drowsiness, and confusion

monitor level of consciousness do not sit up or stand up quickly advise patient to stay out of bright light chew sugarless gums and suck hard candies to avoid mouth dryness use lubricating drops is wearing contact lenses avoid extreme heat

Classification: Andrenergics GENERIC NAME INDICATION ACTION CONTRAINDICATI ON SIDE EFFECTS NURSING CONSIDERATION

Dobutamin e HCL

BRAND NAME
Dobutrex

Infusion rate: 2.5-10 mcg/kg/min

Increased cardiac output in short-term treat ment of cardiac decompensati on caused by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery

Stimulates hearts beta1 receptors to increase myocardial contractility and stoke volume. At dosages, drug increases cardiac output by decreasing peripheral vascular resistance, Zeducing ventricular filling pressure and facilitating AV node therapeutic conduction

Contra indicated in patients hypersensitive to drug and in those with idiopathic hypertrophic subaortic stenosis Use cautiously in patients with history of hypertension because drug may increase pressor response Use cautiously in patients with history of sulfite sensitivity .

Increased heart rate, hypertension, Angina, phlebitis, nonspecific chest pain, palpitations, hypotension, nausea, vomiting, shortness of breath, hypersensitivit y reactions

Before starting dobutamine therapy: (1) give a plasma volume expander to correct hypovolemia (2) give cardiac glycoside Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output Monitor Electrolyte levels. Drug may lower potassium level Do not confuse with Dopamine Tell patient to report adverse reactions promptly, especially labored breathing and drug-induced headache Instruct patient to report discomfort at IV insertion site

Classification: Antihistamine/ anti allergic

GENERIC NAME
Diphenhydra mine HCl BRAND NAME Benadryl
DOSAGE Capule/syrup Adult: 50 mg tid-qid. Children >20 lb: 12.5-25 mg tidqid

INDICATION
Hay fever, urticaria, vasomotor rhinitis, angioneurotic edema, drug sensitization, serum & penicillin reaction, contact dermatitis, atopic eczema, other allergic dermatoses, pruritus, food sensitivity, parkinsonism, motion sickness

ACTION
Antihistami ne that reduces allergic reactions, motion sickness and vertigo (dizziness and loss of balance), and Parkinson's disease

CONTRAINDICATI ON
Premature & newborn infants; asthma attack; lactation

SIDE EFFECTS
CV & CNS effects Blood disorders GI disturbances Antimusc arinic effects Allergic reactions

NURSING CONSIDERATION
Special precaution for Narrow-angle glaucoma stenosing peptic ulcer pyloroduodenal obstruction symptoms of prostatic hypertrophy or bladder-neck obstruction History of bronchial asthma increased intraocular pressure hyperthyroidism CV disease or hypertension. Pregnancy. Avoid operating vehicles or machinery

Classification: Antagonist and antidotes

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

SIDE EFFECTS/ ADVERSE REACTION

NURSING CONSIDERATION

Naloxone hydrocholori de BRAND NAME Narcan

DOSAGE Adult : 0.4 -2 mg IV q2 to 3 mins. p.r.n.

Displaces Known previously suspected administer narcotic ed induced narcotic respiratory analgesics depression from their including that receptors. cause by Has no pentazocine pharmacol and ogic propaxyphene activity of its own

Patient known to be hypersensitive to naloxone hydrochloride

Tachycardia Hypertension Nausea Vomiting Tremors

Safest drug to use when cause respiratory depression is uncertain. Monitor respiratory depth and rate. Be prepared to provide O2, ventilation and resuscitative measures. Also been shown to improve circulation in refractory shock

Classification: Antispasmodic

GENERIC NAME

INDICATION indicated for the control of abdominal pain (colic) associated with spasmodic colic, flatulent colic

ACTION Relieve cramps or spasms of the stomach,in testines, and bladder

CONTRAINDICATION Myasthenia gravis, megacolon. Parenteral Untreated narrowangle glaucoma, prostate hypertrophy w/ urinary retention, mechanical stenosis of GIT, tachycardia

SIDE EFFECTS/ ADVERSE REACTION

xerostomi a tachycardi a

NURSING CONSIDERATION Drug compatibility should be monitored closely in patients requiring adjunctive therapy Avoid driving & operating machinery after parenteral administration Avoid strict heat

Hyoscine-Nbutylbromide
BRAND NAME

Buscopan

DOSAGE Adult & childn >6 yr 1-2 tab 3-5 times daily. Amp Acute attacks of colicky pain Adolescent >12 yr 12 amp IV, IM or SC several times daily. Max: 100 mg aily. Infant & young childn Severe cases: 0.3-0.6 mg/kg body wt by slow IV, IM or SC several times daily. Max: 1.5 mg/kg body wt/day.

urinary retention allergic & skin reactions rarely dyspnea (in patients w/ history of bronchial asthma or allergy) parenteral visual accommodation disturbance infrequently inj site pain (after IM inj), rarely anaphylactoid reactions & anaphylactic shock

Classification: CNS stimulant CONTRAINDICATI ON

Parasympathetic hypertonia

GENERIC NAME

INDICATION

ACTION - Citicoline is an interneuronal communication enhancer. It increases the neurotransmission levels because it favors the synthesis and production speed of dopamine in the striatum, acting then as a dopaminergic agonist thru the inhibition of tyrosinehydroxylase.

SIDE EFFECTS/ ADVERSE REACTION

Gastrointestinal disorders

NURSING CONSIDERATION
Somazine must not be administered along with medicaments containing meclophenoxate

Citicoline
BRAND NAME Somazine amp DOSAGE 125 mg/mL 12 inj/day. 250 mg/mL 1 inj/day

CVD in acute & recovery phase, symptoms & signs of cerebral insufficiency (dizziness, memory loss, poor concentration, disorientation, recent cranial trauma & their sequelae.)

Classification: Loop Diuretic GENERIC NAME Furosemide

BRAND NAME Lasix DOSAGE
Adult: Initially 1/2-1-2 tab/day Maintenance: 1/2-1 tab/day 20-40 mg IV/IM Children: 2 mg/kg body/wt

INDICATION
acute pulmonary edema edema hypertension

ACTION
inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

CONTRAINDICATI ON
Anuria hepatic coma & precoma severe hypokalemia &/or hyponatremia hypovolemia w/ or w/o hypotension Hypersensitivity to furosemide or sulfonamides

SIDE EFFECTS
vertigo, dizziness, headache, paresthesia, orthostatic hypotension, thrombophlebitis, abdominal pain, hypokalemia, anemia muscle spasm

NURSING CONSIDERATION
To prevent nocturia, give preparation in the morning and early in the afternoon Watch for signs of hpokalemia do not confuse with Torsemide or Lasix with Lonox advise patient to take drug with food to prevent GI upset inform patient of possible need for potassium or magnesium supplements

Classification: Anri- ulcer GENERIC NAME Ranitidine HCL

BRAND NAME Xantac DOSAGE 50 mg by slow IV then 0.1250.25 mg/kg/hr as continuous IV infusion

INDICATION
Duodenal and gastric ulcers Maintenance therapy for gastric and duodenal ulcer GERD Erosive esophagitis Heartburn

ACTION
Completely inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretions

CONTRAINDICATI ON
Contraindicated in patients hypersensitive to drug and those with porphyria Use cautiously in patients with hepatic dysfunction. Adjust dose in patients with impaired renal function

SIDE EFFECTS
Vertigo, malaise, headache, blurred vision, jaundice, burning and itching at injection site

NURSING CONSIDERATION
Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate Ranitidine may be added to total parenteral nutrition solution Instruct patient on proper use of OTC preparation as indicated. Remind patient to take once daily prescription drug at bedtime for best results Instruct patient to take without regard to meals because absorption isnt

affected by food

Classification: Nutrional Agents (Calorics) GENERIC NAME INDICATION ACTION CONTRAINDICATI ON SIDE EFFECTS NURSING CONSIDERATION

Dextrose
BRAND NAME DOSAGE Dosage depends on fluid and caloric requirements

Fluid replacement and caloric supplementati on in patient who cant maintain adequate oral intake or who is restricted from doing so.

Minimize glyconeogenesi s and promotes anabolism in patients who cant receive sufficient oral caloric intake.

Hyperglycemia, diabetic coma, intracranial or intra spinal hemorrhage or delirium tremens.

Mental confusion, unconsciousne ss in hyperosmolar nonketotic syndrome. Pulmonary edema Glycosuria, osmotic diuresis Metabolic: hyperglycemia , hypervolemia Rapid termination after long term infusion may cause hypoglycemia rebound hyperinsuline mia. Sloughing and tissue necrosis

Use cautiously in cardiac or pulmonary disease, hypertension, renal insufficiency urinary obstruction and hypovolemia. Never infuse concentrated solutions rapidly, may cause hyperglycemia and fluid shift. Monitor glucose level carefully. Prolonged therapy can cause depletion of pancreatic insulin production and secretion.

Classification: Electrolytes and replacement solutions

GENERIC NAME

INDICATION

ACTION

CONTRAINDICATION

SIDE EFFECTS

NURSING CONSIDERATION

Calcium gluconate
BRAND NAME

Hypocalcemia, hypocalcemic tetany, magnesium toxicity, hypoparathyroidism

Replaces and maintains calcium

Hypercalcemia, ventricular fibrillation, renal canaliculi

Kalcinate
DOSAGE Tablets 500 mg, 650 mg, 975 mg, 1 g (contains 90 mg elemental calcium/g)

GI irritation hemorrhage constipation vomiting thirst renal canaliculi hypercalcemia polyuria

Use cautiously in patients with sarcoidosis and renal or cardiac disease and in digitalized patients. monitor blood calcium level frequently.

Classification: Non narcotic /analgesics and antipyretic/ antiplatelet

GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

Mild pain/fever

Aspirin (acetylsalicylic acid)

Arthritis Reduce risk of heart attack in patient with previous MI or unstable angina

BRAND NAME
Aspilet

Produces analgesia by an ill defined effect on the hypothalamus and by blocking generation of pain impulses (peripheral action)

GI ulcer GI bleeding Patients with bleeding disorders Aspirin hypersensitivity Vit.K deficiency

DOSAGE
Fever/mild pain: 325-650 mg P.O q4 hours; p.r..n unstable angina: 325 P.O once/daily
Also impedes clotting by blocking prostaglandin synthesis which prevents formation of plateletaggregating substances.

Prolonged bleeding time Tinnitus Hearing loss Nausea,vomiting GI distress Occult bleeding Abnormal liver function Rash Bruising Hypersensitivity manifested by asthma and anaphylaxis

Give milk, food antacid or large glass of water to reduce GI adverse reactions. Warn patients taking prescription drugs to check with doctor before taking OTC combination containing aspirin. Watch out for petechiae, bleeding gums, signs of GI bleeding. Maintain adequate fluid intake. Obtain hemoglobin and prothrombin test periodically.

Classification: Antihypertensives
GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

Clonidine hydrochloride BRAND NAME Catapres DOSAGE

01-02 mg P.O B.

Essential renal and malignant hypertension

Inhibits central vasomotor centers, thereby decreasing sympatheric outflow.

Patient hypersensitive to clonidine

drowsiness dizziness fatigue sedation nervousness headache orthostatic hypotension bradycardia urine retetion impotence transient glucose intolerance (after large dose) constipation pruritis dermatitis

Monitor blood pressure and pulse rate. May be given rapidly lower blood pressure in some hypertensive emergencies. Rising slowly and avoid sudden position change to prevent orthostatic hypotension. Remove patch before defribrillation to prevent arcing

Classification: Antianginals
GENERIC NAME INDICATION ACTION CONTRAINDICATION ADVERSE REACTION NURSING CONSIDERATION

Nifedipine BRAND NAME Adalat DOSAGE

Adults: Initial: 10-30mg PO TID Maximum: 120180mg Hypertension: 30-60mg PO

Vasospastic angina, classic chronic stable angina pectoris Hypertension

Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole

Contraindicated in patients hypersensitive to drug Use cautiously in patients with heart failure or hypotension and in elderly patients. Use extended-release tablets cautiously in patients with severe GI narrowing

Dizziness, lightheadedness, headache, weakness, peripheral edema, flushing, nausea, Syncope, nervousness, hypotension, palpitations, nasal congestion, diarrhea, constipation, abdominal discomfort, muscle cramps, dyspnea, pulmonary edema, cough, rash, puritus

Dont give immediate-release form within 1 week of acute MI or in acute coronary syndrome

Alert: despite the previously widespread SL use nifedipine capsule, avoid this route of administration. Excessive hypotension, MI, and death may result Monitor blood pressure regularly, especially in patients who take beta blockers or antihypertensive Watch for symptoms of heart failure

Classification: Antianginals
GENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

Nicardipine BRAND NAME

Cardipine

Chronic stable angina

DOSAGE
Initially 20 mg P.O Tid hypertension 20 to 40 mg P.O t.i.d increase dosage depends on the patients response

Inhibits calcium ion influx across cardiac and smooth muscle cells, thus decreasing myocardial contractility and oxygen demand and coronary arteries and arterioles.

Patient who are hypersensitive to nicardipine

Dizziness Headache Paresthesis Drowsiness Peripheral edema Palpitations Tachycardia Nausea Dry mouth Abdominal discomfort Rash Flushing

Patients with hepatic impairment should receive lower dose Monitor blood pressure. Allow atleast 3 days between dosage adjustment to achieve steady plasma levels. Advise patient to report immediately if experiencing chest pain

Classification: Corticosteroids
GENERIC NAME INDICATION ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION

Dexamethasone BRAND NAME Dexon DOSAGE

The initial dosage varies from 0.75 to 9 mg a day depending on the disease being treated

Inflammation of corticosteroidresponsive dermatoses

Diffuses across cell membrane and complexes with specific cytoplasmic receptors

Patient had an allergic reaction previously. Have an active peptic ulcer Have an active herpes simplex fungal or mycobacterial infection ot the eye, ear infection

Increased appetite Weight gain Water retention Increased WBC Hypokalemia Skin rash Dizziness Insomia Headache

Stop drug and notify doctor if patient develops signs of systemic absorption. Before applying, gently wash skin to prevent damage to skin rub medication gently. Treatment should be continued for a few days after clearing of lesions to prevent recurrence

antiinflammatory effects in disorders of many organ systems

Active tuberculosis Have psychoneurosis or psychosis

Drug Study DRUG Name INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG DESIRED ACTION ON THE CLIENT NURSING RESPONSIBILITIES PRECAUTIONS

Aspirin 80mg/tab Indications: 1 tab p lunch PO For pain on OD integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout. Arthritis, SLE, acute rheumatic fever

GI: dyspepsia, heartburn, anorexia, nausea, epigastric discomfort, potentiation of peptic ulcer Allergic: Bronchospasm, asthma-like symptoms, anaphylaxis, skin rashes, urticaria Hematologic: Contraindications: Hypersensitivity prolongation of bleeding time, to salicylates, severe anemia, thrombocytopenia, history of blood leucopenia, Other: Thirst, coagulation defects, vitamin K fever, dimness of vision deficiency, 1 week before and after surgery, pregnancy in the

Prevent blood coagulation due to hypertension (narrow blood vessels may cause blood to aggregate)

Assess for pain: type, location and pattern Note for asthma Monitor renal, LFTs and CBC Determine history of peptic ulcers or bleeding tendencies.

Precautions: Do not use in children with chicken pox or flu symptoms Lactation Mild diabetes, erosive gastritis,

last trimester

bleeding tendencies, liver or kidney disease.

Clopidogrel 75mg/tab 1 tab OD

Indications CNS: Headache, Prevent dizziness, platelet Treatment of weakness, syncope, aggregation patients at risk flushing for ischemic eventshistory ofCV: Hypertension, edema MI, ischemic stroke, peripheral Dermatologic: Rash, pruritus artery disease GI: Nausea, GI Treatment of distress, patients with constipation, acute coronary diarrhea, GI bleed syndrome Other: Increased bleeding risk Contraindications Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.

Assess for symptoms of stroke, MI during treatment Monitor liver function studies: AST, ALT, bilirubin, creatinine if patient is on long-term therapy Monitor blood studies: CBC,Hgb, Hct, protime, cholesterol if the patient is on long-term therapy; thrombocytope nia and neutropenia

may occur. Precautions: bleeding disorders, recent surgery, hepatic impairment, pregnancy

Hydrochlorothiazid Indications e 12.5 mg 1 tab Adjunctive

CNS: Dizziness, vertigo,

Decrease blood pressure

Assess improvement

OD PO

therapy in edema paresthesias, associated with weakness, CHF, cirrhosis, headache, corticosteroid, drowsiness, and estrogen fatigue therapy; renal CV: Orthostatic dysfunction hypotension, venous Hypertension as thrombosis, sole therapy or in volume combination with depletion, other cardiac antihypertensives arrhythmias, Unlabeled uses: chest pain Calcium Dermatologic: nephrolithiasis Photosensitivity, alone or with rash, purpura, amiloride or exfoliative allopurinol to dermatitis, prevent hives, alopecia recurrences in GI: Nausea, hypercalciuric or anorexia, normal calciuric vomiting, dry patients; diabetes mouth, insipidus,

in CVP q8h Check for rashes and temperature elevation daily Assess for confusion Monitor manifestations of hypokalemia: acidic urine, reduced urine, osmolality, nocturia, hypotension, tachycardia, weak pulse, weakness, altered LOC Monitor for manifestations of hypomagnese

especially nephrogenic diabetes insipidus; osteoporosis Contraindications Contraindicated with allergy to thiazides, sulfonamides; fluid or electrolyte imbalance; renal disease (can lead to azotemia); liver disease (risk of hepatic coma); anuria.

diarrhea, constipation, jaundice, hepatitis, pancreatitis GU: Polyuria, nocturia, impotence, loss of libido Hematologic: Leukopenia, thrombocytopen ia, agranulocytosis, aplastic anemia, neutropenia Other: Muscle cramps and muscle spasms, fever, gouty attacks, flushing, weight loss, rhinorrhea, electrolyte

mia: agitation, muscle twitching, paresthesias, hyperactive reflexes, dysphagia, tetany, nausea, vomiting, diarrhea Monitor for manifestations of hyponatremia: increased BP, cold, clammy skin, hypovolemia, abdominal cramps, lethargy Assess fluid volume status Monitor

imbalances, hyperglycemia

Isosorbide mononitrate 60mg/tab 1 tab OD at HS PO

Indications Dinitrate: Treatment and prevention of

CNS: Headache, apprehension, restlessness, weakness,

Relief of angina pectoris

electrolytes Precautions: gout (risk of attack); SLE; glucose tolerance abnormalities, diabetes mellitus; hyperparathyro idism; manicdepressive disorder (aggravated by hypercalcemia) ; pregnancy; lactation, elevated triglyceride levels. Assess for pain: duration, time started, activity being

Isosorbide dinitrate 5 mg PRN for chest pain

vertigo, dizziness, faintness CV: Tachycardia, retrosternal discomfort, Contraindications palpitations, Contraindicated hypotension, with allergy to syncope, nitrates, severe collapse, anemia, head orthostatic trauma, cerebral hypotension, hemorrhage, angina, rebound hypertrophic hypertension, cardiomyopathy, atrial fibrillation, narrow-angle postdural glaucoma, hypertension postdural Dermatologic: hypotension Rash, exfoliative dermatitis, cutaneous vasodilation with flushing GI: Nausea,

angina pectoris Mononitrate: Prevention of angina pectoris

performed, character, intensity Assess orthostatic hypotension, blood pressure at baseline and during treatment

Precautions: pregnancy, lactation, acute MI, CHF, postural hypotension, severe renal, hepatic disease

vomiting, incontinence of urine and feces, abdominal pain, diarrhea GU: Dysuria, impotence, urinary frequency Other: Muscle twitching, pallor, perspiration, cold sweat, arthralgia, bronchitis

XII.

Drug Study

Generic Name Ranitidine Brand name: Zantac Classificatio n: Gastointest inal agent; Antisecretor y (H2receptor antagonist) Source: Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams &

Indicatio n Used to prevent ulcer while patient is on NPO.

Contraindic ation Hypersensitiv ity to ranitidine or any component of the formulation.

Adverse Reactions Constipation Diarrhea Fatigue Headache Insomnia Muscle pain Nausea Vomiting Agitation Anemia Confusion Depression Easy bruising or bleeding

Nursing Responsibilities C - Gastointestinal agent; Antisecretory (H2-receptor antagonist) H - Reduced amount of acid in the stomach that may result to prevented ulcer incidence. E - Every 8 hours while patient is on NPO. C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that antacids may decrease the absorption of ranitidine. K - Ranitidine can interfere with the

Nursing Implication Inform patient that the medication may cause drowsiness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness). Instruct patient to avoid taking any new medication during therapy without consulting prescriber.

Wilkins

metabolism of alcohol. Patients taking ranitidine who drink alcohol may have elevated blood alcohol levels. Mechanism of Action Indicatio n Contraindic ation Adverse Reactions

Instruct patient to avoid alcohol and follow diet as prescriber recommends. Nursing Implicati on

Nursing Responsibil ities

Generic Name: Tramadol Brand name: Ultram Classificat ion: Analgesic Source: Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams & Wilkins

Binds to -opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephri ne and serotonin, which also modifies the ascending pain pathway.

Manageme nt of pain in the operation site.

Hypersensitiv ity to tramadol, opioids, or any component of the formulation; opioiddependent patients; acute intoxication with alcohol, hypnotics, centrallyacting analgesics, opioids, or psychotropic drugs

Dizziness Nausea Drowsiness Dry mouth Constipation Headache Sweating Vomiting Itching Rash Visual disturbances Vertigo

C - Analgesic H - Relief of pain in the operation site. E - Every 6 hours x 6 doses. May be taken with or without food. C - Instruct client to report any adverse reaction to the physician or nurse. Tell patient that tolerance or drug dependenc

Tell patient that driving or operating machinery should be avoided until the effect of drug wears off. Instruct patient to repot cravings to physician immediate ly. Inform client that medicatio

Mechanism of Action

Indicatio n

Contraindic ation

Adverse Reactions

Nursing Responsibil ities

Nursing Implicat ion

Generic Name: Ketorolac Brand name: Toradol Classificat ion: Nonsteroid al AntiInflammato ry Drugs (NSAIDs) Source: Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams & Wilkins

Inhibits prostaglandi n synthesis by decreasing the activity of the enzyme, cyclooxygen ase, which results in decreased formation of prostaglandi n precursors, chemicals that cells of the immune system make that cause the redness, fever, and pain of inflammation

Used for treating inflammati on and pain in the operation site.

Hypersensitiv ity to ketorolac, aspirin, other NSAIDs, or any component of the formulation; patients who have developed nasal polyps, angioedema, or bronchospasti c reactions to other NSAIDs; active or history of peptic ulcer disease; recent or history of GI bleeding or

Rash Ringing in the ears Headaches Dizziness Drowsiness Abdominal pain Nausea Diarrhea Constipation Heartburn Fluid retention

CNonsteroidal AntiInflammator y Drugs (NSAIDs) H - Pain as well as inflammati on and its signs and symptoms redness, swelling, fever, and pain are reduced. E - Every 6 hours x 6 doses. C - Instruct client to report any adverse reaction to

Instruct client to avoid alcohol and maintain adequate hydration (2-3 L/day of fluids) unless instructe d to restrict fluid intake. Monitor for signs of pain relief, such as an increase

Mechanism of Action Generic Name: Ampicillin Brand name: Omnipen, Polycillin, Principen Classificat ion: Antibiotic (penicillins) Source: Nursing 2007 Drug Handbook 27th Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidat ion step of peptidoglyca n synthesis in bacterial cell walls, thus

Indicatio n Used for treating bacterial infection.

Contraindic ation Hypersensitiv ity to ampicillin, any component of the formulation, or other penicillins

Adverse Nursing Reaction Responsibiliti s es Nausea C - Antibiotic Vomiting H - Pain as well Loss of as appetite inflammation Diarrhea and its signs Abdomina and l pain symptoms Rash redness, Itching swelling, Headache fever, and Confusion pain are Dizziness reduced. E - Every 6 hours C - Instruct client to report any adverse reaction to the physician

Nursing Implication Tell patient that medication may cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (buttermilk, boiled milk, or yogurt

Edition, Lippincot Williams & Wilkins

inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Mechanis m of Action Indicati on Contraindic ation

or nurse. Tell patient that Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. K - Do not take the medication in larger amounts, or take it for longer than recommended by your doctor.

may help). Instruct client to maintain adequate hydration (23 L/day of fluids) unless instructed to restrict fluid intake.

Adverse Reactio ns

Nursing Responsibil ities

Nursing Implicati on

Generic Name: Paracetam ol Classificat ion: Analgesic and Antipyretic Source: Nursing 2007 Drug Handbook 27th Edition, Lippincot Williams & Wilkins

Dosage: 500mg Frequen cy: PRN Route: IVTT

Reduces fever by acting on the hypothala mus to cause vasodilatati on & sweating.

Used for the relief of fever, headach es, and other and pains regardin g surgical wound.

Contraindicat ed with allergy to acetaminoph en or any component. Use cautiously with impaired hepatic function, chronis alcoholism, and pregnancy lactation.

Chest pain Dyspn ea Rash Fever Acute kidney failure Jaundi ce Acute kidney failure Hepati c toxicit y and failure

CAnalgesic and Antipyretic H - Relief of fever, headaches, and other minor aches and pains. E - as necessary or when temperatur e is more than 37.80C C- Instruct client to report any adverse reaction like allergies to

Warn patient that acute overdoses (above 1000 mg per single dose and above 4000 mg per day for adults, above 2000 mg per day if drinking alcohol) of paraceta mol can cause potentiall y fatal liver damage and, in

rXIII. Health Teaching Plan Medication Exercise

Treatme nt

Hygiene

Outpatient

Diet

Ranitidine CGastointestin al agent; Antisecretory (H2-receptor antagonist) H - Reduced amount of acid in the stomach that may result to prevented ulcer incidence. E - Every 8 hours while patient is on NPO. C - Instruct client to report any adverse reaction to the physician

The extended period of bed rest after a hysterectomy can weaken the muscles in the lower back and stomach. Following exercises should be held for five to 10 seconds and repeated 10 times on a daily basis. The chin tuck can be performed while sitting in a chair or on the side of

Pain relievers prescribe d by the doctor Indwelli ng catheter

Make sure you have enough sanitary pads for vaginal bleeding and discharge. You may have some discharge and bloody drainage for several days after your hysterectomy. Keep sanitary environment one that would not allow microorganisms to multiply and cause infection. Provide catheter care: Keep the catheter coiled

Instruct patient to have follow up check up consultation and regular check ups. Instruct patient to follow good compliance to medication Instruct patient to limit her movement at the beginning or if her doctor authorizes it take some short walks to keep her blood circulating and prevent blood clots from forming in her legs.

Try eating smaller meals than normal and have healthy snacks in between .Eat healthy, because the patients body needs nutrients to heal (even if she doesnt feel like it). Eat coldwater fish as well as turkey, chicken, organic bread, soups, salads, vegetables and broths. Take the best daily multiple premium vitamins

Generic/ Trade Name Losartan / Cozaar

Dosage / Freque ncy Initial dose: 50mg PO daily Dosage range from 25100mg daily PO given once or twice a day

Classifica tion Antihypertensi ve

Indication

Contraindica tions Contraindicate d with allergy to lovastalin, active liver disease, unexplained persistent serum transaminase, pregnancy

Side Effects

Nursing Indications Give in the evening Arran ge for regular check ups Arran ge for periodic ophthal mologic examina tions Admin ister only when diet

Hypertension, used alone as part of combination therapy

CNS: headache, blurred vision, dizziness, insomnia, fatigue, muscle cramps, cataracts GI: flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn

restricte d in cholester ol

Etoricoxi b / Arcoxia

90 mg/ tab

Cox-2 selective inhibitor

Acute and chronic treatment of osteoarthritis and RA. Treatment of acute gouty arthritis and primary dysmenorrheal. Relief of acute and chronic pain

Asthenia/ fatigue. Dizziness, lower extremity edema, HPN, dyspepsia, heartburn, nausea

Special precautions: Advanced renal disease, preexisting edema, hypertension or heart failure, liver dysfunction, previous, acute asthmatic attacks, urticaria or rhinitis

Cefuroxi me / CEFTIN

500mg/ 1tab BID

antiviral

Urinary tract infections , otitis media Severe infections

Sensitivity to cephalospori ns

CNS: dizziness, headache, fatigue, paresthesua, fever, chills, confusion GI: diarrhea, nausea, vomiting, anorexia, glossitis, bleeding

precipitated by salicylates or non selective COX inhibitors Asses s patien t for signs and sympt oms of infecti on Asses s for anaph ylaxis: rash, uticari a,

chills, fever, dyspn ea Identif y urine outpu t Asses s bowel patter n daily

Metronidazole Drug Generic: Metronidazole Action Direct-acting trichomonacide and amebicide Indication -For Intestinal amoebiasis, Bacterial Adverse Reaction CNS: headache, seizure, ataxia, dizziness, Nursing Patient Consideration Teaching -Do not give by -Instruct pt. IV bolus. to take extended-

Brand: Flagyl Dose: 500mg Route: Per Orem Frequency: TID for 10 days

that works inside and outside the intestine. Its thought to enter the cells microorganisms that contain nitroreductase, forming unstable compounds that bind to DNA and inhibit synthesis, causing cell death.

infections caused by anaerobic microorganisms, Clostridium difficcileassociated with diarrhea and colitis. -To reduce postoperative anaerobic infection following surgery.

syncope, in coordination, confusion, irritability, depression, weakness, insomnia C.V: flattened Twave, edema, flushing, thrombophlebitis, after I.V infusion EENT: rhinitis, sinusitis, pharyngitis G.I: nausea, abdominal cramping or pain, stomatitis, epigastric distress

-Monitor liver function test results carefully in elderly pt.

release tablets at least 1hr before or 2hrs. After meals but -Observe pt. for to take all edema, other oral especially if form with hes receiving food to corticosteroid; minimize Flagyl IV RTU G.I upset. may cause sodium -Report retention lack of response , -record number any of stools and symptoms character when of CNS drug is used to toxicity

treat amoebiasis.

such as numbness, seizures and unusual bleeding -Do not perform tasks that require mental alertness -Drug may turn urine brown; do not be alarmed

Nexium Drug Action Indication Adverse Reaction Nursing Consideration Patient Teaching

Generic: Esomeprazole Magnesium Brand: Nexium Dose: 40mg Route: Per Orem Frequency: OD

Suppresses the final step in gastric acid production by inhibiting the H+/K+ ATPase in the gastric parietal cells. This decreases gastric acid secretion.

-Reduce occurrence of gastric ulcers associated with continuous NSAID therapy

GI: diarrhea, nausea, flatulence, abdominal pain, constipation, melena, vomiting CNS: headache, anorexia, confusion, dizziness, migraine, sleep disorder, insomnia CV: hypertension, tachycardia GU: dysmenorrhea, mental disorder, vaginitis,

-store between 15-30C with container tightly closed -reconstitute with 5ml of 0.9% NaCl injection; withdraw 5ml of the reconstituted solution and give over no less than 3 minutes -for use by IV injection over 10-30 minutes, reconstitute the contents of 1 vial with 5ml of 0.9% NaCl, lactated ringers injection, or

-may take antacids -avoid alcohol and OTC drugs products unless approved -drug is for short term use only -long term use may cause side effects

Celebrex Drug Action Indication Adverse Reaction Nursing Consideration Patient Teaching

Generic: Celecoxib Brand: Celebrex Dose: 200mg Route: Per Orem Frequency: BID

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia. Also have antiinflammatory properties.

> to decrease level of pain experienced by the patient

Anaphylactic reactions, renal toxicity, Hallucination, ageusia, anosmia, aseptic menlugitis, vasculitis, GI hemorrhage, Hepatitis, liver failure, interstitial nephritis, photosensitivity reaction, exfoliative dermatitis, erythema multiforme, Stevens-

> assess patient in history of asthma, rhinitis, uticaria and use of aspirin > assess patients pain > obtain lab results of urinalysis

>instruct client on how and when to take the pain medication >Instruct patient to take medication exactly as directed. If dose is missed, it should Be taken as soon as remembered if not almost time for the next dose. Do not double dose >may cause drowsiness or dizziness. >Advice patient to avoid driving to other activities requiring alertness until response to the medication is

Amlodipine Drug Generic: Amlodipine Brand: Norvasc Dose: 5mg Route: Per Orem Frequency: OD Action Inhibits influx of calcium through the cell membrane, resulting in a depression of automaticity and conduction velocity in cardiac muscle. Decreases SA and AV conduction Indication >Hypertension >angina >myocardial >ischemia >Reduce the risk of coronary revascularization >fetal coronary heart disease >non-fatal MI >stroke Adverse Reaction Headache, edema, fatigue, somnolence, nausea, abdominal pain, flushing, palpitations, dizziness. Asthenia, vasodilation & epistaxis Nursing Consideration >foods does not affect bioavailability of Amlodipine >can be given safely with beta blockers, nitrates and nitrogycerin or thiazides >review list of drugs prescribed to prevent interactions Patient Teaching >take as directed, once daily >may take without meals; but foods help decrease stomach upset >report signs and symptoms of chest pain, shortness of breath, dizziness, swelling of

and prolongs AV node effective and functional refractory periods. Slight decreases in HR.

extremities >use caution, may experience light headedness or dizziness >may ask for generic; cost savings

Monowel Drug Generic: Brand: Action Indication -Peritonitis & other intra-abdominal & intrapelvic infections, septicemia, Adverse Reaction G.I: nausea, vomiting Phlebitis and Nursing Consideration -check if patient has hypersensitivity to Patient Teaching -instruct patient to report any side effects

Dose: Route: Intravenous Frequency: Every 8 hours

endocarditis, gynecological, respiratory tract, bone & joint, skin & soft tissue infections, UTI including uncomplicated gonorrhea.

inflammation at injection site

cephalosporins -chech with doctor if patient has renal insufficiency, pregnant and lactating -Observe pt. for phlebities and inflammation on site -record number of stools and character when drug is used to treat

experienced -instruct patient to report swelling or pain over the injection site

-To reduce postoperative infection following surgery.

amoebiasis.
Brand name: Moriamin Forte Generic name: Calcium pantothenic Indication: malnutrition, protein and vitamin deficiencies, anemia, convalescence, restoration and maintenance of body resistance, pregnancy and lactation, adjuvant in the therapy of peptic ulcer and TB. Drug classification: multivitamins and minerals Mechanism of action: Dosage: adult 1-2 cap/day; children 1 cap/day Special precaution: may color urine yellow Pregnancy risk category Adverse reactions: hypervitaminosis (large doses)

Contraindications: contraindicated for patients with malabsorption syndrome Form: cap 100s Nursing responsibilities: Assess patient for signs of vitamin deficiency before and periodically throughout therapy. Assess nutritional status through 24 h diet recall. Determine frequency of consumption of vit rich foods

DRUG

INDICATION

CONTRAINDICA TION

SIDE EFFECTS

NURSING CONSIDERATI ONS

Drug name: -telmisartan, hydrochlorothia zide Brand name: -micardis plus Doctors order: -40mg 1tab OD

-essential hypertension ACTION

-hypersensitivity to the drug -2 and 3 trimester of pregnancy

nd rd

-diarrhea -anorexia -loss of appetite -gastric irritation -constipation

-blocks the vasoconstrict ive and -lactation aldosteronesecreting effects of angotensin II by binding angiotensin II to the AT I receptor in many tissue.

-special precaution in patients with impaired hepatic and renal impairment -special precaution with volume and/or Nadepleted patients -may impair ability to drive or operate

machineries

DRUG

INDICATION

CONTRAINDICATI ON

SIDE EFFECTS

NURSING CONSIDERATIO NS

Drug name: -diltiazem Brand name: -cordazem Doctors order: -90mg 1tab BID

-angina pectoris ACTION -inhibits calcium ion influx across cell membrane during cardiac depolarizatio n, produces relaxation of coronary arteries, slows SA/AV

-sick-sinus syndrome -2nd and 3rd AV block -severe hypotension -pregnancy

-nausea swelling/edem a -arrhythmia -headache -rash -fatigue

-monitor v/s especially the BP -should be administered with food or after eating

node conduction times, dilates peripheral arteries.

DRUG

INDICATION

CONTRAINDICA TION

SIDE EFFECTS

NURSING CONSIDERATI ONS

Drug name: -nicorandil Brand name: -aprior Doctors order: -10mg/tab; 1tab BID

-angina pectoris ACTION - Nicorandil dilates arterioles and large coronary arteries by opening the potassium channels, and stimulates guanylate cyclase causing

-cardiogenic shock -hypotension -left ventricular failure with low filling pressure -lactation

-headache -flushing dizziness -n&v -weakness -hypotension

-may be taken with or without food -monitor v/s especially the BP -may impair ability to drive or operate machineries

venous vasodilatation . It therefore reduces preload and afterload, and improves coronary blood flow.

DRUG

INDICATION

CONTRAINDICA TION

SIDE EFFECTS

NURSING CONSIDERATI ONS

Drug name:

-reduction of elevated total -atorvastatin cholesterol & Brand name: LDL cholesterol -lipitor ACTION Doctors -selectively order: HMG-CoA -80mg 1tab reductase HS which converts HMG-CoA to mevalonate, a precursor of sterols.

-active liver disease -pregnancy -lactation

-Gi disturbance -headache -myalgia -insomnia -pruritus -muscle cramps

-avoid intake of alcohol -monitor creatinine phosphokinase and transaminase elevation -history of liver disease -monitor v/s especially the BP -should be administered

-lowers cholesterol and lipoprotein levels

with food or after eating

UG

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURS CONSIDE

e:

-hypertension ACTION

-low BP -CHF

-headache -edema -dizziness -flushing -palpitation -fatigue -nausea -abdominal pain

-monitor v/ especially t

me:

order:

OD

-inhibits influx of -hypersensitivity calcium ion across -hepatic impairment cell membranes to produce relaxation of coronary vascular smooth muscle, decrease peripheral vascular resistance of smooth muscle (BP)

-should be administere food or afte

UG

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURS CONSIDE

e:

-atrial fibrillation ACTION

-hypersensitivity -intermittent complete heart block

-anorexia -GI disturbance -atrial tachycardia -gynecomastia -CNS effect

-monitor v/

me:

order:

ab OD

-(+) inotrophic effect more available -2nd heart block calcium promotes increase forces to increase cardiac output

-should be administere food or afte

-watch out adverse rea drug

UG

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURS CONSIDE

e:

ACTION -inhibits both basal & stimulated gastric acid secretion by suppressing the final step in acids production, through inhibition of proton pump by binding to & inhibiting hydrogen potassium adenosine triphosphate, the enzyme system located at the

ole Na

-hypersensitivity to pantoprazole Na and its components

-abdominal pain -diarrhea -constipation -flatulence -nausea -headache -dizziness -blurred vision -rash -pruritus

me:

-should be an empty s (take 1 hou meal)

order:

secretory surface of gastric parietal cell.

UG

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURS CONSIDE

e:

ast

me:

-prophylaxis & -hypersensitivity to treatment of asthma, montelukast and its including prevention component of day & night time symptoms ACTION - Montelukast is a selective leukotriene receptor antagonist that blocks the effects of cysteinyl leukotrienes in the airways.

-abdominal pain -thirst -headache -vomiting

order:

b OD

UG

INDICATION -maintenance treatment for patients with COPD ACTION -By binding to the muscarinic receptors in the bronchial smooth musculature, tiotropium bromide inhibits the cholinergic (bronchoconstrictive) effects of acetylcholine,

CONTRAINDICATION -hypersensitivity to tiotropium Br and its component

SIDE EFFECTS -dry mouth -constipation -cough & local irritation -tachycardia -urinary retention

NURS CONSIDE

e:

m Br

-do not take than there recommend

me:

order:

released from parasympathetic nerve endings. It has a similar affinity to the subtypes of muscarinic receptors M1-M5. In the airways, tiotropium bromide competitively and reversibly antagonises the M3receptors, resulting in relaxation