Chapter V A.

Pharmacologic Intervention

Generic / Brand/ Classification Generic Name# Folic Acid

Mechanism of Action Stimulates normal erythropoiesi s and nucleoprotei n synthesis.

Indication

Contraindication

Adverse Effect C$S% general malaise.

Dosage

N rsing !esponsi"ilities Assess patient0s folic acid deficiency before starting therapy. Assess patient for *megaloblast ic anemia+ ea1ness, fatgue, shortness of breath and activity intolerance. Assess nutrional status2 determine if high folic acid foods are missing ftom the diet. 'dentify drugs currently ta1en% alcohol, glucocorticoi ds,etc+.

!ationale

Brand Name# folvite Classification# Vitamins Supplement

To maintai n health. Megalo blastic or macroc ytic anemia caused by folic acid or other nutrition al deficien cy, hepatic disease , alcoholi sm, intestin al obstruct ion, excessi ve hemoly sis.

Contraindicated in patients ith vitamin !"# deficiency or undiagnosed anemia.

$s al# Adult and children age , and &'% bitter older% -., taste, mg .) anorexia, daily. nausea and flatulence. Act al# (espiratory% .) " tab !ronchospas )/ m. )ther% allergic reactions *rash, pruritus,eryth ema+.

serve as baseline data for proceeding the use of the drug6test. to prevent complication .

to prevent imbalance nutrition to the patiet and to give proper intervention. These drugs may cause increased folic acid used by the body and contribute to the defiency. To serve as baseline data.

Monior folate levels *34"5 mcg6m7+, 8gb,8ct and

Generic / Brand/ Classification Generic Name# A9ithromycin Brand Name# :ithromax Classification# Antiinfective, A9alide Macrolide

Mechanism of Action

Indication

Contraindication

Adverse Effect

Dosage

N rsing !esponsi"ilities

!ationale

!inds to 5-S subunit of bacterial ribosomes, bloc1ing protein synthesis2 bacteriostati c or bactericidal, depending on concentratio n. 8inders or 1ills susceptible bacteria, including many gram4 positive and gram4 negative aerobic and anaerobic bacteria.

Acute bacteria l exacerb ations of chronic obstruct ive pulmon ary disease s caused by streptoc occus pneum oniae. Commu nity ac;uire d pneum onia caused by chlamy dial pneum oniae, 8. inluen9 ae, mycopl asma pneum oniae, S. pneum

Contraindicated in patients hypersensitive to erythromycin or other macrolides. <se cautiously in patients ith impaired hepatic function.

C$S% di99iness, vertigo, headache, fatigue, somnolence.

$s al# Adults and children age "3 and older% initially, 5-- mg CV% ..). as a palpitations, single dose chest pain. pn day ", follo ed by &'% nausea, #5- mg vomiting, daily on diarrhea, days # abdominal through 5. pain, total dyspepsia, cumulative flatulence, dose is ".5 melena, g. or for cholestatic C)./ =aundice, exacerbati pseodomem ons, 5-branous mg..) colitis. daily for > days. &<% candidiasis, vaginitis, nephritis. Act al# 5-- mg S1in% rash, "tab )/ ? photosensitiv 5days ity. )ther% angioedema.

!e alert about allergic reactions Monitor hydration status if &' reaction occurs &ive drug ith food. /o not give ith fruit =uices. Tell patient to ta1e entire ;uantity of drug exactly as ordered. .erform culture sensitivity determina tions before and after therapy. Assess previous

To prevent complicati on To monitor hydration and prevent dehydrati on To prevent &' upset

To receive all course action of the drug or the effectiven ess of the drug . Serve as baseline data and to give proper treatment of the patient. To prevent

Generic / Brand/ Classification Generic Name# Furosemide

Mechanism of Action 'nhibits sodium and chloride reabsorption at proximal and and distal tubules and ascnding loop of henle.

Indication

Contraindication

Adverse Effect C$S% fever, vertigo, headache, di99iness, paresthesi a, restlessne ss, ea1ness.

Dosage

N rsing !esponsi"ilities

!ationale

Brand Name# 7asix

Classification# 7oop diuretic

Acute pulmon ary edema. @dema. 8eart failure and chronic renal impairm ent. 8yperte nsion. 8yperc alcemia .

Contraindicated in patients hypersensitive to drug or any of its components and in the those ith anuria. <se cautiously in patients ith hepatic cirrhosis. .atients ith allergic to furosemide.

Assess patient0s Adults% ,underlying mg '.V. condition before in=ected starting therapy. slo ly over Monitor " to # eight, minutes2 peripheral then A- mg edema, breath '.V. in " to sounds. " B hours, Monitot CV% if needed. inta1e and orthostatic output, hypotensio electrolytes% n, Act al# potassium,sodiu thromboph m, calcium, lebitis ,- mg magnesium, uric * ith '.V. "amp acid and !<$. use+, 'VTT post4 volume !T depletion Assess and fluid volume dehydratio satus%

$s al#

So increase urination ill not disturb sleep. To prevent &' upset. To prevent further complica tion To monitor fluid changes .

n. @@$T% transient deafness * ith too rapid '.V. in=ection+, blurred or yello ish vision. &'% pancreatiti s, anorexia, abdominal discomfort, diarrhea, nausea, vomiting, constipatio n. &<% a9otemia,n octuria, polyuria, fre;uent urination, oliguria. 8ematolog

urine%color, ;uality and specific gravity. Chec1 !. before giving the drug. &ive the drug early in the day to prevent nocturia and to continue ta1ing medication even if feeling better, this drug controls symptoms but does not cure the condition. &ive food or mil1. ith

To 1no if there is excess6d eficit in fluid balance. 'f &' systoms of nausea and anorexia occur, to prevent &' upset.

'nform patient that this drug causes a loss of potassium, therefore food rich in potassium should be added

ic% agranulocy tosis, leucopenia , thrombocu topenia, anemia, aplastic anemia. 8epatic% hepatic dysfunctio n. Metabolic% asymptom atic hyperurice mia, hyperglyce mia and glucose intolerance , hypoclore mic al1alosis, hypo1alem ia, fluid and electrolyte

to the diet.

'nstruct the pt. to report any of the said adverse effect. 'nstruct patient to lie do n if di99iness occurs.

imbalance s, including dilutional hyponbatr emia, hypocalce mia, hypomagn esemia. Musculos1 eletal% muscle spasm. S1in% dermatitis, purpura, photosensi tivity. )ther% gout, transient pain at '.M. in=ection site.

Generic / Brand/ Classification Generic Name# 7actulose Brand Name# /uphalac Classification# 7axative

Mechanism of Action .roduces osmotic effect in colon. (esulting distention promotes peristalsis. /ecreases blood ammonia build4up that causes hepatic encephalopa thy, probably as a result of bacterial degration, hich lo ers p8 of colon contents. (elieves constipation, decreases blood ammonia concentratio n.

Indication

Contraindication

Adverse Effect

Dosage

N rsing !esponsi"ilities

!ationale

Constip Contraindicated in patients on lo 4 ation. galactose diet. To prevent and treat hepatic enceph alopath y, includin g hepatic precom a and coma in patients ith severe hepatic disease . To induce bo el evacuat ion in geriatric patients ith colonic retentio n of barium and severe constip ation after a barium

&'% abdominal cramps, belching, diarrhea, distention, flatulence, nausea, vomiting.

$s al# Adults% "to #- g *"5 to >- m7+ ..). daily, increase to 3- m76day, if needed. Act al# >-cc at 8S

CAssess condition before therapy and reassess regularly there after to monitor drugs effectiveness. 'dentify cause of constipation% assess lifestyle in relation to fluids, bul1 and exercise. CMonitor pt for possible adverse &' reactions% nausea, vomiting, abdominal cramps,belching, diarrhea, flatulence and distention. Cmonitor fluid and electrolyte status% urine output, input4 output ratio to identify fluid loss, hypo1alemia and hypernatremia. Cfor pt. ith hepatic encelopathy% regularly assess

to monitor drug0s effectiveness

to prevent further complication for baseline data

To monitor hydration To determine blood glucose level 't may interfere ith sleep.

Generic / Brand/ Classification

Mechanism of Action

Indication

Contraindication

Adverse Effect

Dosage

N rsing !esponsi"ilities

!ationale

Generic Name# .ropranolol Brand Name# 'nderal Classification# !eta4!loc1ers 6 antihypertensiv e, antianginal, antiarrhythmic

(educes cardiac oxygen demand by bloc1ing catecholami ne4induced increases in heart rate, blood pressure, and force myocardial contraction. /epresses rennin secretion and preventsbva sodilation of cerebral arteries. (elieves anginal and migraine pain, lo ers blood pressure, restores normal sinus rhythm, and helps limit M'

Angina pectoris Suprav entricul ar, ventricu lar and atrial arrhyth mias2 tachyar rhythmi as caused by excessi ve catecho lamine action during anesthe sia. 8yperte nsion .revent ion of fre;uen t, severe, uncontr olled, or

Contraindicated in patients ith bronchial asthma, sinus bradycardia, heart bloc1 greater than first4 degree,cardiogeni c shoc1, or overt cardiac failure *unless failure is secondary to tachyarrhthmia that can be treated ith propanolol+. <se cautiously in patients ta1ing antihypertensive and in those ith renal impairement, non4 allergic bronchospastic diseases, olff4 par1inson4 hite syndrome, hepatic disease, diabetes mellitus or thyrotoxicosis.

C$S% fatigue, lethargy, vivid dreams, fever, hallucination s, mental depression, di99iness

$s al# 'nitial dose% ,- mg orally t ice a day or Amg Maximum dose% 3,mg6day Act al# "- mg tab T'/

CV% bradycardia, hypotension, heart failure, intermittent claudication.

&'% nausea, vomiting, diarrhea, constipation,

8ematologic% agranulocyto

)btain patient history, drug history and hypersens itivity Assess !. and pulse before therapy. Monitor periodicall y during treatment Assess hydration status2 s1in turgor2 and mucous membran es Monitor for drug induced adverse reaction Monitor

Serve as baseline data

To 1no if there is increase or decreasei n blood pressure To monitor hydration

To prevent further drug complicati

damage.

disablin g migrain e or vascula r headac he. @ssenti al tremor. 8ypertr ophic subaorti c stenosi s Ad=unct theraph y in pheoch romocyt oma.

sis.

'D), eight daily

Musculos1el etal% arthralgia. (espiratory% increased air ay resistance. S1in% rash.

&ive ith food

on To 1no if there is excess6d eficit in fluid balance. To prevent &' upset To receive fully the therapeuti c action of the drug

'nstruct pt to ta1e drug as prescribed

Generic / Brand/ Classification Generic Name# @poetin E

Mechanism of Action Mimics effects of erythropoieti n hich functions as a gro th factor and as a differentiatin g factor, enhancing (!C production2 drug is developed by recombinant /$A technology.

Indication

Contraindication

Adverse Effect 8ypertensio n2 tachycardia2 clotting vascular access2 headcahe2 sei9ures. $ausea2 vomiting2 diarrhea. Shortness of breath. Allergy, including anaphylaxis, s1in rashes and urticaria2 fever2 paresthesia2 arthralgia..

Dosage

N rsing !esponsi"ilities Assess patients C!C and blood pressure before starting therapy 'nstruct patient to report if &' reaction occurs. 'f this occur monitor patient hydration Assess C$S symptoms % coldness, s eating, pain in long bones Tell the patient that after in=ection *usually after # hours+, some pt0s complain of pain or discomfort in their limbs and pelvis and

!ationale

Brand Name# (enogen Classification# 8ematopoietic Agents

Management of anaemia associated with chronic renal failure in dialysis and predialysis patients; they may reduce or obviate the need for blood transfusions in these patients. Also, used in the management of chemotherapyinduced anaemia in patients with non-myeloid malignant disease.

8ypersensitivity to mammalin cell4 derived products or human albumin, uncontrolled hypertension.

$s al# Adult 5-4 "-- u61g > times ee1ly until appropriate maintenan ce dose is reached.

Serve as baseline data

Act al# ,-- u SF >? a ee1

To prevent further complicati on.

To prevent serious complicati on to the patient.

To provide informatio n and a arenes s.

Generic / Brand/ Classification

Mechanism of Action

Indication

Contraindication

Adverse Effect

Dosage

N rsing !esponsi"ilities

Generic Name# calcium polystyrene sulfonate Brand Name# Galimate Classification# electrol%tes

After administration of Galimate via oral or rectal route, calcium ionof Galimate is exchanged for potassium ion in the intestinal tract,particularl y around the colon, and Galimate is excreted asunchanged polystyrene sulfonate resin into the feces ithoutdigestio n and absorption. 'n conse;uence, potassium in theintestinal tract is excreted outside the body

hyper1alemia from acute or chronic renal failure

patients ith intestinal obstruction, stenosis or constipation.

perforation Constipation, anorexia D nausea. 8ypopotassemi a.

$s al# "54>- g .) bid4tid Act al# " sachet T'/

Arrange for serial serum potassium levels before and during therapy. Administer oral drug after meals or ith food and a full glass of ater. Caution patient that expended ax matrix capsules in the stools. (eport tingling of the hands or feet, unusual tiredness or ea1ness, feeling of heaviness in the legs, severe nausea, vomiting, abdominal pain.