Generic Name/ Brand Name/ Drug Category or Classification Generic Name: Mefenamic Acid Brand Name: Apo-Mefenamic (CAN),

Ponstan Drug class: NSAID

Mechanism of Action

*Indication

Contraindication

Side effects/ Adverse effects

Drug to drug Interaction

*Nursing Consideration/ Responsibility

Mefenamic acid inhibits the enzymes cyclooxygenase (COX)-1 and COX-2 and reduces the formation of prostaglandins and leukotrienes. It also acts as an antagonist at prostaglandin receptor sites. It has analgesic and antipyretic properties with minor anti-inflammatory activity. Absorption: Absorbed from the GIT (oral); peak plasma concentrations after 2-4 hrs. Distribution: Enters breast milk (small amounts). >90% bound to plasma albumin. Apparent volume of distribution 1.06 l/kg. Metabolism: Hepatic via enzyme CYP2C9. Excretion: Urine (52%) as unchanged drug and metabolites; fasces (20%). Elimination half life 2-4 hrs.

Headache, muscular and traumatic pain; post-op and postpartum pain; relief of primary dysmenorrhea.

Peptic or intestinal ulceration, inflammatory bowel disease, renal or hepatic impairment.

GI Increased risk of GI Assessment disturbances Bleeds with ASA, History: Allergies, renal;, hepatic, CV, GI & bleeding, anticoagulants conditions; pregnancy, lactation diarrhea, Physical: Skin color and lesion; orientation, peptic reflexes, liver evaluation; clotting times, ulceration; LFTs, renal function tests, serum dizziness, electrolytes, stool guaiac. skin rashes, blood Interventions dyscrasias, Be aware that patient may be at increased nephropathy. risk for CV events, GI bleeding; monitor accordingly. Give with milk or food to decrease GI upset Teaching Points Take drug with food; take only the prescribed dosage; do not take the drug longer than 1 week Discontinue drug and consult your health care provider if rash, diarrhea, or digestive problems occur Dizziness or drowsiness can occur Report some sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision; black, tarry stools; severe diarrhea, right upper abdominal pain, flulike symptoms.

Generic Name/ Brand Name/ Drug Category or Classificat Generic Name: Cefuroxime sodium Brand Name: Zinacef Drug Classification: Antibiotic

Mechanism of Action

*Indication

Contraindication

Side effects/ Adverse effects Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, StevensJohnson syndrome, epidermal necrolysis.

Drug to drug Interaction

*Nursing Consideration/ Responsibility

of Cefuroxime binds to one or Prophylaxis more of the penicillin- surgical infections binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. Absorption: Absorbed from the GI tract with peak plasma concentrations after 2-3 hr (oral); may be enhanced by the presence of food. Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic concentrations). Crosses the placenta and enters breast milk. Proteinbinding: Up to 50%. Metabolism: Rapidly hydrolysed (intestinal mucosa and blood). Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile (small

Hypersensitivity to cephalosporins. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other betalactam antibiotics.

Use cautiously in breast-feeding women and in patients with history of colitis or Potentially renal Fatal: Anaphy insufficiency. laxis, nephrotoxicity , pseudomemb ranous colitis.

Assement Increased nephrotoxicity with History: Hepatic and renal impairment, lactation, pregnancy aminoglycoside Physical: Skin status, LFTs, renal function tests, Increased bleeding culture of affected area, sensitivity tests effects with oral Interventions anticoagulants Culture infection, and arrange for sensitivity Risk disulfiram-like tests before and during therapy if expected reaction with response is not seen. alcohol Give oral drug with food to decrease GI upset and enhance absorption. Give oral tablets to children who can swallow tablets; crushing the drug results in a bitter unpleasant taste. Use solution for children who cannot swallow tablets. Have vitamin K available in case hypoprothrombinemia occurs. Discontinue if hypersensitivity reaction occurs. Teaching points: Oral drug Take full course of therapy even if you are feeling better. This drug is specific for this infection and should not be used to self-treat other problems. Swallow tablets whole; do not crush them. Take drug with food. Store solution in the refrigerator . Shake well before each use. You may experience these side effects: Stomach upset or diarrhea. Report severe diarrhea with blood, pus, or

amounts); 70 min (elimination half-life); prolonged in neonates and renal impairment.

mucus; rash difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising; unusual itching or irritation.

Generic Name/ Brand Name/ Drug Category or Classification

Mechanism of Action

*Indication

Contraindication

Side effects/ Adverse effects

Drug to drug Interaction

Nursing Consideration/ Responsibility

Generic Name: Nifedipine Brand Name: Calcibloc Drug Classification: Calcium channel blocker

Nifedipine blocks the slow Hypertension calcium channels thus preventing the flow of calcium ions into the cell. It produces peripheral and coronary vasodilatation, reduces afterload, peripheral resistance and BP, increases coronary blood flow and causes reflex tachycardia. It has little or no effect on cardiac conduction and rarely has negative inotropic activity. Absorption: Rapidly and completely absorbed from the GI tract (oral); peak plasma concentrations after 30 min (as liquid-filled capsules). Distribution: Enters breast milk. Proteinbinding: 92-98%. Metabolism: hepatic metabolism. Extensive first-pass

Contraindicated Infrequently, Increased effects with allergy to flushing, with cimetidline nifedipine. nausea, dizziness, Use cautiously headache, with lactation, tiredness, pregnancy, HF, sedation; leg aortic stenosis. edema.

Assement History: Allergy to nifedipine, pregnancy lactation Physical: Skin lesion, color, edema, orientation, reflexes, P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, normal GI output; LFTs Interventions Warning Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being adjusted to therapeutic dose; the dosage may be increased more rapidly in hospitalized patients under close supervision. Do not exceed 30mg/dose increases. Ensure that patients do not chew or divide ER tablets. Taper dosage of beta blockers before nifedipine therapy. Protect drug from light and moisture. Teaching points: Do not chew, cut, crush extended-release tablets. Swallow whole. You may experience these side effects: Nausea, vomiting (eat frequent small meals); dizziness, light-headedness, vertigo (avoid driving and operating dangerous machinery; take special precautions to avoid falling); muscle cramps, joint stiffness, sweating, sexual difficulties (reversible). Report irregular heartbeat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

Excretion: Via urine (7080% as inactive metabolites); 2 hr(elimination half-life).

Generic Name/ Brand Name/ Drug Category or Classification Generic Name: Cefalexin Brand Name: Cefalin Capsule Drug Classification: Antibiotic

Mechanism of Action

*Indication

Contraindication

Side effects/ Adverse effects

Drug to drug Interaction

Nursing Consideration/ Responsibility

Cefalexin binds to one or Prophylaxis more of the penicillinbinding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. Absorption: Almost completely absorbed from the GI tract with peak plasma concentrations after 1 hr (oral); may be delayed if taken with food. Distribution: Widely distributed but does not penetrate the CSF; bile (therapeutic concentrations). Crosses the placenta and enters the breast milk (small amounts). Protein-binding: Up to 15% Metabolism: metabolised. Not

Hypersensitivity to cephalosporins.

Hypersensitivi ty; GI disturbances; eosinophilia, neutropenia, leucopenia, thrombocytop enia. Potentially Fatal: Anaphy lactic reactions; nephrotoxicity .

Increased Assessment nephrotoxicity with History: renal impairment, impaired hearing, aminoglycoside allergies, hepatic and CV conditions, lactation, pregnancy Increased bleeding Physical: Skin color and lesions; orientation, effects with oral reflexes, ophthalmologic and audiometric anticoagulants evaluation, peripheral sensation; P, edema; R, adventitious sounds; liver evaluation; CBC, LFTs, Disulfiram-like renal function tests; serum electrolytes reaction may occur if alcohol is taken Interventions within 72 hr after Warning Be aware that patient may be at cephalexin increased risk for CV events, GI bleeding; administration monitor accordingly. Administer drug with food or after meals if GI upset occurs. Establish safety measures if CNS or visual disturbances occur. If overdose occurs, institute emergency procedures---gastric lavage, induction of emesis, supportive therapy. Provide further comfort measures to reduce pain (eg, positioning, environmental control) and to reduce inflammation (eg, warmth, positioning, rest). Teaching points: Take drug with food or meals if GI upset occurs. Take only the prescribed dosage; do not increase dosage. You may experience these side effects: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while taking this drug).

Excretion: Via the urine within 6 hr by glomerular filtration and renal tubular

secretion (>80% as unchanged); via the bile. May be removed by haemodialysis and peritoneal dialysis; 1 hr (elimination half-life).

Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers; changes in vision.

Generic Name/ Brand Name/ Drug Category or Classification

Mechanism of Action

*Indication

Contraindication

Side effects/ Adverse effects

Drug to drug Interaction

Nursing Consideration/ Responsibility

Generic Name: hydralazine hydrochloride Brand Name: Apresoline Drug Classification: Antihypertensive Vasodilator (peripheral)

Hydralazine is a directacting vasodilator which acts predominantly on the arterioles. It reduces BP and peripheral resistance but produces fluid retention. Hydralazine tends to improve renal and cerebral blood flow and its effect on diastolic pressure is more marked than on systolic pressure. Onset: Oral: 45 min. IV: 10-20 min. Duration: Oral and IV: 3-8 hr. Absorption: Rapidly absorbed from the GI tract after oral admin. Distribution: About 90% bound to plasma proteins. Metabolism: Undergoes considerable first-pass metabolism by acetylation in the GI mucosa and liver. Excretion: excreted in metabolites. Mainly urine as

Essential hypertension alone or in combination with other drugs

Severe tachycardia, dissecting aortic aneurysm, heart failure with high cardiac output, cor pulmonale, myocardial insufficiency due to mechanical obstruction, coronary artery disease, idiopathic SLE. Patients with recent MI.

Tachycardia; palpitations; angina pectoris; haemolytic anaemia; paralytic ileus; severe headache; GI disturbances; flushing, dizziness; nasal congestion; peripheral neuropathy with numbness and tingling of extremities; lupus erythematosu s-like syndrome; postural hypotension; fluid retention; hepatotoxicity ; blood dyscrasias; difficulty in urinating; glomerulonep hritis; constipation;

Increased pharmacologic effects of betaadrenergic blockers and hydralazine when given concomitantly; dosage of beta blocker may need adjustment

Assessment History: Hypersensitivity to hydralazine, tartrazine; heart disease; CVA; increased intracranial pressure; severe hypertension; advanced renal damage; slow acetylators; lactation, pregnancy Physical: Weight; T; skin color, lesions; lymph node palpation; orientation, affect, reflexes; examination of conjunctiva; P, BP, orthosthatic BP, supine BP, perfusion, edema, auscultation; R, adventitious sounds, status of nasal mucous membranes; bowel sounds, normal output; voiding pattern, CBC differential, lupus-like cell preparations, ANA determinations, renal function tests, urinalysis Interventions Give oral drug with food to increase bioavail-ability (drug shold be given in a consistent relationship to ingestion of food for consistent response to therapy). Monitor patient for orthostatic hypotension, which most marked in the morning and in hot weather, and with alcohol or exercise. Teaching points: Take this drug exactly as prescribed. Take with food. Do not discontinue or reduce dosage without consulting your health care provider. Report persistent or severe constipation; unexplained fever or malaise, muscle or joint aching; chest pain; rash; numbness, tingling.

depression; anxiety; hypersensitivit y reactions; conjunctivitis; lachrymation, tremor; muscle cramps.

Elleene S. Miranda II-A