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GENERIC NAME (BRAND NAME) Pantoprazole (Pantoloc IV) Drug Classification Belongs to the class of proton pump inhibitors.

Used in the treatment of peptic ulcer and gastrooesophageal reflux disease (GERD). Dosage & Frequency 40mg, once a day

ACTION

INDICATION

ADVERSE EFFECT Occasionally headache or diarrhea. Isolated cases of edema, blurred vision, fever, dizziness, thrombophlebitis, depression or myalgia subsiding after termination of therapy.

SIDE EFFECT

NURSING CONSIDERATION AND RESPONSIBILITY Assess underlying condition before therapy and thereafter to monitor drug effectiveness. Assess GI symptoms: epigastric/abdominal pain, bleeding and anorexia. Monitor for possible drug induced adverse reaction CNS: headache, insomnia, migraine, anxiety, dizziness, pain; CV: chest pain; EENT: pharyngitis, rhinitis, sinusitis; GI: diarrhea, flatulence, abdominal pain, constipation, dyspepsia, gastroenteritis, nausea, vomiting; GU: urinary frequency, UTI; Metabolic: hyperglycemia, hyperlipidemia; Musculoskeletal: back pain, neck pain, arthralgia, hypertonia; Respiratory: bronchitis, increased cough, dyspnea, URTI; Skin: rash; Other: flu-like syndrome, infection.

Inhibits both basal and stimulated gastric acid secretion by suppressing the final step in acids production, through the inhabitation of the proton pump by binding to and inhibiting hydrogenpotassium adenosine triphosphatase, the enzyme system located at the secretory surface of the gastric parietal cell.

Duodenal and gastric ulcer, moderate and severe reflux esophagitis. Eradication of H. pylori in patient with peptic ulcers, pathological hyper secretory conditions. Symptomatic improvement and healing of mild reflux esophagitis. Prevention of gastro-duodenal ulcers induced by NSAID in patients at risk with a need for continuous NSAID treatment.

Diarrhea; headache; nausea; stomach pain; vomiting. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); bone pain; chest pain; dark urine; fast or irregular heartbeat; fever, chills, or sore throat; red, swollen, blistered, or peeling skin; unusual bruising or bleeding; unusual tiredness; vision changes; yellowing of the skin or eyes.

GENERIC NAME (BRAND NAME) Cefuroxime (zinacef)

ACTION

INDICATION

Inhibits bacterial cell wall synthesis, rendering cell Drug Classification wall osmotically Anti-infective; unstable, leading to cell antibiotic; death by secondbinding to cell generation cephalosporin membrane. Dosage & Frequency 500 mg 1 tab BID

Treatment for infections caused by e.coli, proteus mirabilis, klebsiella sp., lower respiratory tract infections.

NURSING CONSIDERATION AND RESPONSIBILITY Thrombophlebitis, Pain, swelling, or redness at Determine history of gastrointestinal the injection site. Severe hypersensitivity tract allergic reactions (rash; hives; reactions to irritation, itching; difficulty breathing; cephalosporins, hypersensitivity tightness in the chest; penicillins, and history reactions, swelling of the mouth, face, of allergies, decreased lips, or tongue); black or particularly to drugs, hemoglobin count, bloody stools; decreased before therapy is decreased urination; fever, chills, or sore initiated. hematocrit, throat; hearing loss; seizures; Transient rise in severe diarrhea, nausea, or Inspect IM and IV SGOT and SGPT, vomiting; stomach pain or injection sites alkaline cramps; unusual bruising or frequently for signs of phosphatase, bleeding; vaginal irritation or phlebitis. LDH, and discharge; vein swelling at bilirubin the injection site; yellowing Report onset of loose levels, Elevations of the skin or eyes. stools or diarrhea. in Although serum creatinine pseudomembranous and/or blood urea colitis. nitrogen and a decreased Monitor I&O rates and creatinine pattern: Especially clearance important in severely ill patients receiving high doses. Report any significant changes.

ADVERSE EFFECT

SIDE EFFECT

Drug name
Generic: Cefoxitin Classification: Antibiotic Dose : 1 gm IV q8 Anst(-)

Action
Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death

Indication
Dermatologic infections caused by S. Aureus , S.Epidermis, streptococci, E.Coli. UTIs caused byE. Coli P.Mirabilis, Klebsiella.Intraabdominal infections caused by E. Coli,klebsiella

Contra indication
Contraindicat ed with allergy to cephalosporin s or penicillins. Use cautiously with renal failure, lactation, pregnancy

Adverse effect
CNS: headache, dizziness, lethargy, paraesthesias GI : Nausea, omitting, diarrhea ,anorexia, abdominal pain, flatulence GU : Nephrotoxicity HEMATOLOGIC LOCAL : Pain, abscess at injections site, inflammation at IV site

Nursing consideration
Avoid alcohol while taking this drug and for 3days after because severe reactions often occur. You may experience these side effects: stomach upset, diarrhea. Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.

Drug name
Bisacodyl (Dulcolax) Classification: Stimulantlaxativ es Dose :
1 suppository now

Action
It acts directly on the bowels, stimulating the bowel muscles to cause a bowel movement

Indication
Short term relief of constipation. Constipation, either chronic or of recent onset, whenever a stimulant laxative is required. Bowel clearance before surgery or radiological investigation. Replacement of the evacuant enema in all its indications

Contra indication
patients with ileus, intestinal obstruction, acute abdominal condition including appendicitis, acute inflammatory bowel diseases, and severe abdominal pain associated with nausea and vomiting

Adverse effect
IS Anaphylactic reactions, angioneurotico edema and other hypersensiti vity. GI vomiting, Abdominal discomfort, pain, abdominal cramps nausea and diarrhoea

Nursing consideration
Assess patient for abdominal distension, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency and amount of stool produced.

Drug name
Generic/dose: Lactulose 60 ml thru NGT General Classification: Gastro-Intestinal Drug Specific Classification: Ammonia Reduction Drug Laxativ

Action
Mode of Action: The drug passes unchanged into the colon where bacteria break it down to organic acids that increase the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in increase in stool water content, stool softening, laxative action. This also in migration of blood ammonia into the colon contents with subsequent trapping and expulsion in the feces

Indication
Constipation, salmonellosis. Treatment of hepatic encephalopathy.

Contra indication
Contraindicati on: Contraindicat ed with allergy to lactulose, lowgalactose diet Caution: Use cautiously with diabetes, pregnancy, and lactation

Adverse effect
GI : transient flatulence, distension, intestinal cramps, severe belching, diarrhea ,nausea Other: acid-base imbalances, electrolyte imbalance

Nursing consideration

* Assess patients condition before therapy and reassess regularly thereafter to monitor drugs effectiveness. Identify cause of constipation: Assess lifestyle in relation to fluids, bulk and exercise *For patient with hepatic encephalopathy, regularly assess mental condition (clearing of confusion, lethargy, restlessness, irritability) and ammonia level (30-70 mg/100 mL). *Monitor for possible adverse GI reaction: nausea, vomiting, abdominal cramps, belching, diarrhea, flatulence and distension. * Monitor fluid and electrolyte status: urine output, input-output ratio to identify fluid loss, hypokalemia and hypernatremia. *Monitor for increased glucose levels in diabetic patients. Assess patients and familys knowledge of drug therapy.

Drug name
Demerol Classification: Opoid analgesics Dose : 25 mg IV

Action
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).

Indication

Contra indication
Relief of moderate to severe pain (oral, parenteral) Preoperative medication, support of anesthesia, and obstetric analgesia (parenteral)

Adverse effect
dizziness, sedation, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, convulsions, visual disturbances, suppression of cough reflex

Nursing consideration
. Be sure to teach the patient the following about this medication Instruct patient how and when to ask for pain medication. Advise patient to call for assistance when ambulating. Advise patient to change positions slowly to minimize orthostatic hypotension. Advise ambulatory patients that nausea and vomiting may be decreased by lying down.

Relief of moderate to severe pain (oral, parenteral) Preoperative medication, support of anesthesia, and obstetric analgesia (parenteral)

Drug name
Hyoscine-Nbutylbromide Classification: Antispasmodic; Anticholinergic Dose : 1 amp IV

Action
(HNBB) acts by interfering with the transmission of nerve impulses by acetylcholine in the parasympathetic nervous system. Buscopan exerts a spasmolytic action on the smooth muscle of the gastrointestinal, biliary and urinary tracts. As a quaternary ammonium derivative, hyoscine-Nbutylbromide does not enter the central nervous system. Therefore, anticholinergic side effects at the central nervous system do not occur. Peripheral anticholinergic effects result from a ganglionblocking action within the visceral wall as well as from antimuscarinic activity.

Indication
Buscopan Tablets are indicated for the relief of spasm of the genito-urinary tract or gastro- intestinal tract and for the symptomatic relief of Irritable Bowel Syndrome )

Contra indication
Buscopan Tablets should not be administered to patients with myasthenia gravis, mega colon and narrow angle glaucoma. In addition, they should not be given to patients with a known hypersensitivit y to hyoscineNbutylbromide or any other component of the product.

Adverse effect
CNS: dizziness, anaphylactic reactions, anaphylactic shock, increased ICP, disorientation, restlessness, irritability, dizziness, drowsiness, headache, confusion, hallucination, CV: hypotension, tachycardia, palpitations, flushing GI: Dry mouth, constipation, nausea, epigastric distress

Nursing consideration
. Drug compatibility should be monitored closely in patients requiring adjunctive therapy Avoid driving & operating machinery after parenteral administration. Avoid strict heat Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy. Reorient patient, as needed, Tolerance may develop when therapy is prolonged Atropine-like toxicity may cause dose related adverse reactions. Individual tolerance varies greatly Overdose may cause curarelike effects, such as respiratory paralysis. Keep emergency equipment available.

DERM: Flushing, dyshidrosis GU: Urinary retention, urinary hesitancy Resp: dyspnea, bronchial plugging, depressed respiration EENT: mydriasis, dilated pupils, blurred vision, photopobia, increased intraocular pressure, difficulty of swallowing.

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