University of the Philippines Manila The Health Sciences Center

COLLEGE OF NURSING
WHO Collaborating Center for Leadership in Nursing Development CHED Center for Excellence Sotejo Hall, Pedro Gil St., Ermita, Manila

NAME OF STUDENT: Geneva Munich L. Latorre DATE OF ASSIGNMENT: January 10, 2014 NAME OF PATIENT: Jennifer Miradol CIVIL STATUS: Single MEDICAL DIAGNOSIS: PU 40 weeks, 3 days AOG by late UTZ, cephalic in labor G4P3 WARD: _15_ BED: 10 AGE: ___25___

DRUG STUDY

SEX: __F__

DRUG ORDER Ferrous Sulfate 500 mg/tablet OD

USUAL DOSAGE/ AVAILABILITY Ferrous sulfate comes as regular, coated, extendedrelease (long acting) tablets, regular and extended release capsules, and oral liquid (syrup, drops, and elixir) to take by mouth. Deficiency120 240 mg/day (2 3mg/kg/day) in 2 4 divided doses. Prophylaxis60 100 mg/day PO (Infants and Children): Severe deficiency 46 mg/kg/day in 3 divided doses. Mild

PHARMACOLOGIC ACTION OF DRUG Iron is an essential mineral found in hemoglobin, myoglobin and many enzymes. It enters the bloodstream and it is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow), where it is separated out and becomes part of iron stores. PHARMACOKINETI CS Absorption: 510% of dietary iron is absorbed. In

INDICATIONS AND CONTRAINDICATIONS Indication: Prevention and treatment of iron-deficiency anemia

INTERACTIONS

Drug-Drug: Tetracycline and antacids inhibit the oral absorption of iron by forming insoluble compounds Oral iron supplements decrease the absorption of Tetracyclines, fluoroquinolones, and penicillamine (simultaneous administration should be avoided) Decreases absorption of and

Contraindications: Patients receiving repeated blood transfusions; anemia not due to iron deficiency. Some products contain alcohol, tartrazine, or sulfites and should be avoided in patients with known intolerance or hypersensitivity, Concurrent oral iron therapy Use Cautiously in: PO: Peptic ulcer Ulcerative colitis or regional enteritis (condition may be aggravated) Indiscriminate chronic use (may lead to iron overload) IM, IV:Autoimmune
DRUG STUDY

ADVERSE EFFECTS OF THE DRUG GI: PO - Nausea, constipation, dark stools, diarrhea, epigastric pain, GI bleeding

NURSING RESPONSIBILITIES/ PRECAUTIONS Assessment: >Assess nutritional status and dietary history to determine the possible cause of anemia and the need for patient teaching >Assess bowel function for constipation or diarrhea. >Assess patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing) Notify physician immediately if these occur Implementation: >Oral Preparations are most effectively absorbed if administered 1 hour before or 2 hours after meal. If gastric

Latorre, Geneva Munich L. 2010-60366

Patient: Jennifer Miradol Ward 15, Bed 10

to moderate deficiency3 mg/kg/day in 12 divided doses. Prophylaxis12 mg/kg/day in 12 divided dose (maximum: 15 mg/day). PO (Neonates, Premature): 24 mg/kg/day in 12 divided doses,maximum: 15mg/day.

deficiency states, disorders and arthritis (more this increases up to susceptible to allergic 30%. reactions following IM, IV Therapeutically use). administered PO Geriatric patients (lower iron may be 60% initial dose may be absorbed; recommended) absorption is an Lactation or children (safety active and passive of some parenteral products transport process. not established) Well absorbed following IM administration. Distribution: Remains in the body for many months. Crosses the placenta; enters breast milk. Protein Binding: 90%. Metabolism and Excretion: Mostly recycled; small daily losses occurring via desquamation, sweat, urine, and bile.

may decrease effects of levodopa and methyldopa May decrease the efficacy of levothyroxine (concurrent administration should be avoided) Concurrent administration of cimetidine may decrease absorption Doses of ascorbic acid 200 mg may enhance absorption by 30% Chloramphenicol and vitamin E may impair the hematologic response to iron therapy

irritation occurs, administer with meals. Take tablets and capsules with a full glass of water or juice > Avoid using antacids, coffee, tea, dairy products, eggs or wholegrain breads with or within 1 hour after administration of ferrous salts. Iron adsorption is decreased by 33% if given with meals. Evaluation: >Increase in hemoglobin, which may reach normal parameters after 1-2 mos. of therapy. >Improvement in irondeficiency anemia or anemia of chronic renal failure

Drug-Food:
Iron absorption is

decreased by 3350% by concurrent administration

Latorre, Geneva Munich L. 2010-60366

DRUG STUDY

Patient: Jennifer Miradol Ward 15, Bed 10

of food.
Celecoxib 200 mg/cap. 1 cap. BID for pain PRN

PO (Adults): Osteoarthritis 200 mg/day as a single dose or 100 mg twice daily. Rheumatoid arthritis100 200mg twice daily. Anky losing spondylitis200 mg once daily or 100 mg twice daily; dose may be increased after 6 wk to 400mg daily. Familial adenomatous polyosis 400 mg twice daily. Acute pain, including dysmenorrhea 400mg initially, then a 200mg dose if needed on the first day; then 200 mg twice daily as needed. PO (Children 2 yrs and older, 10 kg25 kg): 50-mg capsule twice daily PO (Children 2 yrs and older, >25 kg):

NSAID: NSAID that exhibits antiinflammatory, analgesic, and antipyretic activities. Unlike ibuprofen, inhibits prostaglandin synthesis by inhibiting cyclooxygenase-2 (COX-2), but does not inhibit cyclooxygenase-1 (COX-1).

Indications: Relief of S&S of osteoarthritis and rheumatoid arthritis. Treatment of acute pain primary dysmenorrhea. Reduction of polyp formation in Familial Adenomatous Polyposis (FAP) Contra indications: Severe hepatic impairment; hypersensitivity to celecoxib asthmatic patients with aspirin triad advanced renal disease concurrent use of diuretics and ACE inhibitors anemia CAUTION IF: Patients who are P450 2C9 poor metabolizers; patients who weigh <50 kg; moderate hepatic impairment; renal insufficiency aspirin use; prior history of GI bleeding or peptic ulcer disease; asthmatics; elevated liver function tests;
DRUG STUDY

Drug-Drug: Significant interactions may occur when celecoxib is coadministered with other drugs that inhibit the CYP450 2C9 enzyme system. May decrease effectiveness of ACE inhibitors, thiazide diuretics, and furosemide. Fluconazole increase celecoxib blood levels (dosage reduction recommended). May increase risk of bleeding with warfarin. May increase serum lithium levels. Does not inhibit the cardioprotective effect of low-dose aspirin.

Body as a Whole: Back pain, peripheral edema. GI: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea. CNS: Dizziness, headache, insomnia. Respiratory: Pharyngitis, rhinitis, sinusitis, URI. Skin: Rash

DRUGS: May diminish effectiveness of ACE INHIBITORS; fluconazole increases celecoxib concentrations; may increase lithium concentrations; may increase INR in older patients on warfarin. ADMINISTRATION: Give 2 h before/after magnesium or aluminum-containing antacids. Monitor closely lithium levels when the two drugs are given concurrently. Monitor closely PT/INR when used concurrently with warfarin. Monitor for fluid retention and edema especially in those with a history of hypertension or CHF. LAB TESTS: Lab tests: Periodically monitor Hct and Hgb, liver functions, BUN and creatinine, and serum electrolytes.

Latorre, Geneva Munich L. 2010-60366

Patient: Jennifer Miradol Ward 15, Bed 10

100-mg capsule twice daily. Availability Capsules: 50mg, 100mg, 200mg, 400mg.

heart failure; kidney disease; hypertension; fluid retention.

References: Deglin and Vallerand. (2008). Davis Drug Guide for Nurses. Philadelphia, USA: FA Davis

Latorre, Geneva Munich L. 2010-60366

DRUG STUDY

Patient: Jennifer Miradol Ward 15, Bed 10