Submitted by: GALICINAO, Gretta Shalou G.

Section 3 Year 5 RLE 1 UST Pedia Ward | MTW 7-12

DRUG ANALYSIS
GENERIC NAME CLASSIFICATI ON Corticosteroid, Glucocorticoid Hormone ACTION INDICATION CONTRAINDICATIO NS Oedema, hypertension, arrhythmia; CNS, endocrine, metabolic and GI effects; hirsutism, acne, skin atrophy, bruising, hyperpigmentation; transient leukocytosis; arthralgia, muscle weakness, osteoporosis, fractures, cataracts, glaucoma; infections, hypersensitivity reactions, avascular necrosis, secondary malignancy, intractable hiccups. ADVERSE EFFECTS Serious infections except septic shock or tuberculous meningitis; viral, fungal and tubercular skin lesions; admin of live virus vaccines. Preparations containing benzyl alcohol preservative are contraindicated in infants. NURSING RESPONSIBILITI ES Assessment History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; pregnancy; lactation Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose Interventions Use caution with

1)methylprednisolo ne

Methylprednisolo ne is a synthetic corticosteroid that decreases inflammation by suppressing the migration of polymorphonucle ar leukocytes and reversal of increased capillary permeability. > antiinflammatory ang immunosuppressi ve effects

> Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune disorders > Hematologic disorders: Thrombocytopeni a purpura, erythroblastopeni a > Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas >Trichinosis with neurologic or myocardial

involvement >Prevention of nausea and vomiting associated with chemotherapy > Unlabeled use: Septic shock, respiratory distress syndrome, acute spinal cord injury

the 24-mg tablets marketed as Medrol; these contain tartrazine, which may cause allergic reactions, especially in people who are allergic to aspirin. Give daily dose before 9 to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress. WARNING: Taper doses when discontinuing highdose or long-term therapy to allow adrenal recovery. WARNING: Do not give live virus vaccines with immunosuppressive doses of corticosteroids. Teaching points Do not to stop taking the oral drug without consulting your health care provider. Avoid exposure to infections. Report unusual weight gain,

2) Vincristine sulfate

Antineoplastic Mitotic inhibitor

Arrests mitosis at metaphase, thereby, inhibiting cell division.

> Acute leukemia > Hodgkins lymphoma, rhabdomyosarco ma, neuroblastoma, Wilms tumor as part of combination therapy

> allergy to vincristine, leucopenia, acute infection, pregnancy, lactation, demyelinating form, use cautiously with neuromuscular disease, diabetes insipidus, hepatic impairment

CNS: Peripheral neuropathy, neuritic pain, paresthesias, especially of hands and feet; foot and hand drop, sensory loss, athetosis, ataxia, loss of deep tendon reflexes, muscle atrophy, dysphagia, weakness in larynx and extrinsic eye muscles, ptosis, diplopia, mental depression. Special Senses: Optic atrophy with blindness; transient cortical blindness, ptosis, diplopia, photophobia. GI: Stomatitis, pharyngitis,

swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of disorder. Assessment & Drug Effects Monitor I&O ratio and pattern, BP, and temperature daily. Weigh patient under standard conditions weekly or more often if ordered. In the presence of edema or ascites, patient's ideal weight is used to determine dosage. Report a steady gain or sudden weight change to physician. Lab tests: Monitor serum electrolytes and CBC with differential. Complete bone marrow remission in leukemia varies widely and may not occur for as long as 100 d after therapy is started. Be aware that neuromuscular

anorexia, nausea, vomiting, diarrhea, abdominal cramps, severe constipation (upper-colon impaction), paralytic ileus (especially in children), rectal bleeding; hepatotoxicity. Urogenital: Urinary retention, polyuria, dysuria, SIADH (high urinary sodium excretion, hyponatremia, dehydration, hypotension); uric acid nephropathy. Skin: Urticaria, rash, alopecia, cellulitis and phlebitis following extravasation (at injection site). Body as a Whole: Convulsions with hypertension, malaise, fever,

adverse effects, most apt to appear in the patient with preexisting neuromuscular disease, usually disappear after 6 wk of treatment. Children are especially susceptible to neuromuscular adverse effects. Assess for hand muscular weakness, and check deep tendon reflexes (depression of Achilles reflex is the earliest sign of neuropathy). Also observe for and report promptly: Mental depression, ptosis, double vision, hoarseness, paresthesias, neuritic pain, and motor difficulties. Provide special protection against infection or injury during leukopenic days. Leukopenia occurs in a significant number of patients; leukocyte count in children usually reaches nadir on

headache, pain in parotid gland area, weight loss. Metabolic: Hyperuricemia, hyperkalemia. CV: Hypertension, hypotension. Respiratory: Bronchospasm.

fourth day and begins to rise on fifth day after drug administration. Avoid use of rectal thermometer or intrusive tubing to prevent injury to rectal mucosa. Check patient's ability to ambulate and supply support if necessary. Walking may be impaired. Take care to distinguish between the depression associated with realization of neoplastic disease and that which is drug-induced. Patient & Family Education Notify physician promptly of stomach, bone, or joint pain, and swelling of lower legs and ankles. Start a prophylactic regimen against constipation and paralytic ileus (adequate fluids, high-fiber diet, laxatives) at

3) Folinic Acid

folic acid derivative

active reduced form of folic acid; required for neucloprotein synthesis and maintenance of normal hematopoiesis

In combination with fluoruracil to treat cancers such as; colon and rectal, head and neck, esophageal, and other cancers of the gastrointestinal tract. As an antidote to effects of certain chemotherapy drugs such as

> allergy to leucovorin on previous exposure, pernicious anemia or other megaloblastic anemias in which vitamin B12 is deficient

Hypersensitivit y: allergic reaction Local: Pain, discomfort at injection site

beginning of treatment and report changes in bowel habit to health care providers as soon as manifested (paralytic ileus is most likely to occur in young children). Reversible hair loss is reportedly the most common adverse reaction and may persist for the duration of therapy. Regrowth may start before end of treatment. This is a distressing adverse effect because the scalp hair will drop out in large clumps. Do not breast feed while taking this drug. Interventions: > Begin leucovorin rescue within 24 hours of methotrexate administration. arrange for fluid loading and urine alkalinization during this procedure to decrease methotrexate toxicity. > give drug orally

methotrexate. Treatment of megaloblastic anemia when folic acid deficiency is present. > Leucovorin rescue after highdose methotrexate therapy for various cancers > to decrease toxicity of methotrexate caused by decreased elimination or for inadvertent overdose of folic acid antagonists such as trimethoprim

unless intolerance to oral route develops due to nausea and vomiting from chemotherapy or clinical condition. Switch to oral drug when feasible. Doses more than 25 mg should be divided or given IV > Monitor patient for hypersensitivity reactions, especially if drug has been used previously. Keep supportive equipment and emergency drugs readily available in case of serious allergic response. > Report rash, difficulty breathing, pain, or discomfort at injection site. > Mark calendars with treatment days > Protect solution fro inhalation from light. Store unused vials in foil pouch. > use nebulizer mouthpiece instead of face mask to avoid blurred vision or aggravation of

4) ipratropium bromide + salbutamol sulfate (nebulizer)

(for ipratropium bromide) Anticholinergic Antimuscarinic Bronchodilator Parasympatholytic

Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine.

> obstructive pulmonary disease > bronchodilator for maintenance treatment of bronchospasm associated with COPD, chronic

> hypersensitivity to atropine or its derivatives, soybean or peanut allergies > use cautiously with narrow-angle glaucoma, prostatic hypertrophy, bladder neck obstruction, pregnancy,

Bronchitis, respiratory tract infections. Chest pain, arrhythmia, oedema, hypertension, hypokalaemia, palpitation,

Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa

bronchitis, emphysema > nasal spray: symptomatic relief of rhinorrhea associated with perennial rhinitis, common cold, seasonal allergic rhinitis

lactation

tachycardia. Headache, dizziness, fatigue, insomnia, tremor, nervousness. GI symptoms e.g. nausea, vomiting, diarrhoea, dyspepsia and constipation. Respiratory: dyspnea, bronchitis, bronchospasms, URI, cough, exacerbation of symptoms, hoarseness, pharyngitis

narrow-angle glaucoma > can mix with albuterol in nebulizer for up to 1 hr > ensure adequate hydration; control environment (temp) to prevent hyperexia > have patient void before taking medication to avoid urinary retention > teach patient proper use of inhaler.

5) D5IMB Balanced Multiple Maintenace Solution with 5% dextrose

Hypertonic solution

Contain a high concentration of solute relative to another solution (e.g. the cell's cytoplasm). When a cell is placed in a hypertonic solution, the water diffuses out of the cell, causing the cell to shrivel

Slow administration essential to prevent overload (100 mL/hr) Water intoxication Severe sodium depletion

-phlebitis, peripheral edema, cellular dehydration

> Do not administer unless solution is clear and container is undamaged. > Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. >Solution containing acetate should be used with caution as excess

administration may result in metabolic alkalosis. >Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus. > Discard unused portion. > In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage. 6) Ampicillin 7) Salbutamol 8) Nasal Spray Sodium Chloride