Mannitol Drug Study

Brand Name:
Osmitrol, Resectisol
Classification: Osmotic Diuretic
Action Summary
Half-life
Onset
Peak
Duration
100 minutes
30-60 minutes
1 hour
6-8 hours
Indications
1. Acute oliguric renal failure
2. Toxic overdose
3. Edema
4. Increased intracranial pressure (ICP)
5. Intraocular pressure (IOP)
Action
1. In the oliguric phase of acute renal failure, Mannitol increases osmotic pressure (pressure
needed to stop the absorption of something or osmosis) of the glumerular filtrate,
thereby,promoting diuresis (treating the oliguric phase of renal failure) and excretes toxic
materials (management for toxic overdose).
2. It also elevates blood plasma osmolality thus, inhibiting the reabsorption of water and
electrolytes (for relief of edema) and mobilizing fluids in the cerebral and ocular
spaces(lowers intracranial or intraocular pressure).
Contraindications
1. Susceptibility
2. Dehydration
Adverse reactions
1. Dehydration
2. Anuria
3. Intracranial bleeding
4. Headache
5. Blurred vision
6. Nausea and vomiting
7. Volume expansion
8. Chest pain
9. Pulmonary edema
10. Thirst
11. Tachycardia
12. Hypokalemia (increases the risk of digoxin toxicity)
13. Chronic renal failure
Dosage
Adult
Oliguria: 50-100 g as a 5-25% solution.
Intracranial/Intraocular pressure: 0.25-2 g/kg as 15-25% solution administered for 30-60
minutes.
Children
Oliguria: 0.25-2 g/kg as a 15-20% solution for 2-6 hours
Intracranial/Intraocular pressure: 1-2 g/kg as a 15-20% solution administered for 30-60 minutes.
Nursing considerations

Assessment Monitor the following:

1. 1. Vital signs
2. 2. Intake and output
3. 3. Central venous pressure
4. Pulmonary artery pressure
5. Signs and symptoms of dehydration (e.g. poor skin turgor, dry skin, fever, thirst)
6. Signs of electrolyte imbalance/deficit (e.g. muscular weakness, paresthesia, numbness,
confusion, tingling sensation of extremity and excessive thirst)
7. (for increase ICP) Neurologic status and intracranial pressure readings.
8. (for increase IOP) Elevating eye pain or decreased visual acuity.
Laboratory Tests
1. Renal function (BUN and Creatinine)
2. Serum Electrolyte (Sodium and Potassium)
Precaution
Pregnancy and lactation (safe use during these conditions is not established)
Interventions
1. Observe the IV site regularly for infiltration.
2. Administration rate for oliguria should be titrated to produce a urine output. (about 30-50
ml/hr in adult and 2-6 hours in children)

Dexamethasone
Brand Name:
Cortastat, Dalalone, Decadrol, Decaject, Deronil, Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol,
Primethasone, Solurex
Classification: Long- acting corticosteroid
Indications
1. Management of cerebral edema
2. Diagnostic agent in adrenal disorders
3. Relieves inflammation
4. Allergic disorders
5. Asthma
6. Arthritis
Mechanism of Action
Dexamethasone suppresses inflammation and the normal immune response. It prevents the
release of substances in the body that causes inflammation.
Contraindications
1. Hypersensitivity
2. Active untreated infection
3. Lactation
4. Systemic fungal infection
Use Cautiously in:
1. Children (chronic use may result in decreased growth)
2. Stress (surgery or infections)

3. Potential infections as dexamethasone may mask the signs of infection such as fever and
inflammation.
4. Pregnancy (safety is not established with the sue of the drug during pregnancy)
Side Effects
1. Acne
2. Decreased wound healing
3. Depression
4. Vomiting
5. Easy bruising
6. Headache
7. Increased hair growth
8. Insomnia
9. Restlessness
10. Stomach irritation
11. Irregular or absent menstruation
12. Dizziness
Adverse reactions
If these signs and symptoms will be noted instruct the patient to call or notify the physician
immediately.
1. Skin rash
2. Swollen face, legs or ankles (fluid retention)
3. Vision problems ( Dexamethasone may cause cataracts and increased intraocular pressure)
4. Cold or infection that last for a long time
5. Muscle weakness
6. Black or tarry stool (suggestive of peptic ulceration caused by Dexamethasone use)
Route and Dosage
Cerebral Edema
PO (Adults): 2 mg q 8-12 hours
IM, IV (adults): 10 mg initially IV, 4 mg q 6 hr, may be decreased to 2 mg q 8-12 hr, then change
PO.
Adrenocortical Insufficiency/Anti-inflammatory
PO (Adults): 0.5-9 mg daily in single or divided doses
PO (children): 23.3 mcg/kg in 3 divided doses.
IV (Adults): 0.5-24 gm/day
IM (Adults): 8-16 mg q 1-3 wk
Nursing Interventions
1. Monitor intake and output of patient.
2. Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea.
Notify the physician immediately if these clinical manifestations are noted.
3. Periodic growth evaluation for children should be done time to time.
4. For patients with cerebral edema, assess then for level of consciousness changes and
headache during the therapy.
5. Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the
physician immediately.
6. Administer with meals to minimize GI irritation.
7. For patients with difficulty swallowing, tablets can be crushed and administered with fluids or
food. However, capsules should be swallowed whole.

8. Educate the patient to take missed doses as soon as remembered, unless almost time for
the next dose skip the missed dose and continue your regular dosing schedule. Do not take
a double dose to make up for a missed one.
9. Instruct patient to avoid people with known infection and contagious illnesses
ascorticosteroids causes immunosuppression and may mask symptoms of infection.

GENERIC NAME: atorvastatin

BRAND NAME: Lipitor
DRUG CLASS AND MECHANISM: Atorvastatin is an oral drug that lowers the level
of cholesterol in the blood. It belongs to a class of drugs referred to as statins, which
includes lovastatin (Mevacor), simvastatin, (Zocor),fluvastatin (Lescol),
and pravastatin (Pravachol) and rosuvastatin (Crestor). All statins, including atorvastatin,
prevent the production of cholesterol in the liver by blocking HMG-CoA reductase, an enzyme
that makes cholesterol. Statins reduce total cholesterol as well as LDL cholesterol in blood. LDL
cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the
development of coronary artery disease. Reducing LDL cholesterol levels retards progression
and may even reverse coronary artery disease. Atorvastatin also raises the concentrations of
HDL ("good") cholesterol that protects against coronary artery disease and reduces the
concentration of triglycerides in the blood. (High blood concentrations of triglycerides also have
been associated with coronary artery disease.) The FDA approved atorvastatin in December
1996.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets of 10, 20, 40, and 80 mg
STORAGE: Tablets should be stored at room temperature, 20-25 C (68-77 F).
PRESCRIBED FOR: Atorvastatin is used for the treatment of elevated total cholesterol, LDL,
and triglycerides and to elevate HDL cholesterol. The effectiveness of atorvastatin in lowering
cholesterol is dose-related, meaning that higher doses reduce cholesterol more. Atorvastatin
preventsangina, stroke, heart attack, hospitalization for congestive heart failure, and
revascularization procedures in individuals with coronary artery disease. Atorvastatin reduces
the risk of myocardial infarction (heart attack), stroke, angina and revascularization procedures
in adults with multiple risk factors for coronary artery disease. Atorvastatin also prevents heart
attacks and strokes in patients with type 2 diabetes with multiple risk factors for coronary artery
disease.
DOSING: Atorvastatin is prescribed once daily. The usual starting dose is 10-20 mg per day,
and the maximum dose is 80 mg per day. Individuals who need more than a 45% reduction in
LDL cholesterol may be started at 40 mg daily. Atorvastatin may be taken with or without food
and at any time of day.

DRUG INTERACTIONS: Decreased elimination of atorvastatin could increase levels of

atorvastatin in the body and increase the risk of muscle toxicity from atorvastatin. Therefore,
atorvastatin should not be combined with drugs that decrease its elimination. Examples of such
drugs includeerythromycin (EMycin), ketoconazole (Nizoral), itraconazole (Sporanox),clarithromycin (Biaxin), telithromycin
(Ketek), cyclosporine (Sandimmune),nefazodone (Serzone), and HIV protease inhibitors such
as indinavir(Crixivan) and ritonavir (Norvir).
Large quantities of grape fruit juice (>1.2 liters daily) also will increase blood levels of
atorvastatin and should not be taken.
Amiodarone (Cordarone), verapamil (Calan Verelan, Isoptin), cyclosporine
(Sandimmune), niacin (Niacor, Niaspan, Slo-Niacin), gemfibrozil (Lopid) and fenofibrate (Tricor)
also may increase the risk of muscle toxicity when combined with atorvastatin.
Atorvastatin increases the effect of warfarin (Coumadin) and the concentration in blood
of digoxin (Lanoxin). Patients taking atorvastatin and warfarin or digoxin should be monitored
carefully. Cholestyramine(Questran) decreases the absorption of atorvastatin. Atorvastatin
should be given at least two hours before and at least four hours after cholestyramine.
PREGNANCY: Atorvastatin should not be taken during pregnancy because the developing
fetus requires cholesterol for development, and atorvastatin reduces the production of
cholesterol. Atorvastatin should only be administered to women of childbearing age if they are
not likely to become pregnant.
NURSING MOTHERS: It is not known if atorvastatin is secreted in breast milk. Because of the
potential risk of adverse events, breastfeeding mothers should not use atorvastatin.
SIDE EFFECTS: Atorvastatin is generally well-tolerated. Minor side effects
include constipation, diarrhea, fatigue, gas, heartburn, and headache. Atorvastatin may cause
liver and muscle damage. Serious liver damage caused by statins is rare. Liver tests should be
performed at the beginning of treatment then as needed thereafter. Inflammation of the muscles
caused by statins can lead to serious breakdown of muscle cells calledrhabdomyolysis.
Rhabdomyolysis causes the release of muscle protein (myoglobin) into the blood, and
myoglobin can cause kidney failure and even death. When used alone, statins cause
rhabdomyolysis in less than one percent of patients. To prevent the development of serious
rhabdomyolysis, patients taking atorvastatin should contact their health care professional
immediately if they develop unexplained muscle pain,weakness, or muscle tenderness.
Statins have been associated with increases in HbA1c and fasting serum glucose levels as
seen in diabetes. There are also post-marketing reports ofmemory loss, forgetfulness,
amnesia, confusion, and memory impairment. Symptoms may start one day to years after
starting treatment and resolve within a median of three weeks after stopping the statin.
USES: Atorvastatin is used along with a proper diet to help lower "bad"cholesterol and fats
(such as LDL, triglycerides) and raise "good" cholesterol (HDL) in the blood. It belongs to a

group of drugs known as "statins." It works by reducing the amount of cholesterol made by
the liver. Lowering "bad" cholesterol and triglycerides and raising "good" cholesterol decreases
the risk of heart disease and helps prevent strokes and heart attacks.In addition to eating a
proper diet (such as a low-cholesterol/low-fat diet), other lifestyle changes that may help this
medication work better include exercising, losing weight if overweight, and stopping smoking.
Consult your doctor for more details.
atorvastatin - oral, Lipitor (cont.)
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor,
usually once daily.Dosage is based on your medical condition, response to treatment, age, and
other medications you may be taking. Be sure to tell your doctor and pharmacist about all the
products you use (including prescription drugs, nonprescription drugs, and herbal
products).Avoid eating grapefruit or drinking grapefruit juice while using this medication unless
your doctor instructs you otherwise. Grapefruit can increase the amount of this medication in
your bloodstream. Consult your doctor or pharmacist for more details.If you also take certain
other drugs to lower your cholesterol (bile acid-binding resins such
as cholestyramine orcolestipol), take atorvastatin at least 1 hour before or at least 4 hours after
taking these medications. These products can react with atorvastatin, preventing its full
absorption.Take this medication regularly in order to get the most benefit from it. Remember to
take it at the same time each day. It is important to continue taking this medication even if you
feel well. Most people with high cholesterol or triglycerides do not feel sick.It is very important to
continue to follow your doctor's advice about diet and exercise. It may take up to 4 weeks before
you get the full benefit of this drug.
SIDE EFFECTS: Remember that your doctor has prescribed this medication because he or she
has judged that the benefit to you is greater than the risk of side effects. Many people using this
medication do not have serious side effects.A very small number of people taking atorvastatin
may have mild memory problems or confusion. If these rare effects occur, talk to your
doctor.This drug may infrequently cause muscle problems (which can rarely lead to a very
serious condition called rhabdomyolysis). Tell your doctor immediately if you develop any of
these symptoms: muscle pain/tenderness/weakness (especially with fever or unusual
tiredness), change in the amount of urine.This medication may rarely cause liver problems. If
you notice any of the following rare but serious side effects, tell your doctor immediately:
yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent nausea/vomiting.A
very serious allergic reaction to this drug is rare. However, seek immediate medical attention if
you notice any symptoms of a serious allergic reaction, including: rash,itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete
list of possible side effects. If you notice other effects not listed above, contact your doctor or
pharmacist.In the US -Call your doctor for medical advice about side effects. You may report
side effects to FDA at
PRECAUTIONS: Before taking atorvastatin, tell your doctor or pharmacist if you are allergic to
it; or if you have any other allergies. This product may contain inactive ingredients, which can
cause allergic reactions or other problems. Talk to your pharmacist for more details.Before

using this medication, tell your doctor or pharmacist your medical history, especially of:liver
disease, kidney disease, alcohol use.Before having surgery, tell your doctor or dentist about all
the products you use (including prescription drugs, nonprescription drugs, and herbal
products).Limit alcoholic beverages. Daily use of alcohol may increase your risk for liver
problems, especially when combined with atorvastatin. Ask your doctor or pharmacist for more
information.Older adults may be more sensitive to the side effects of this drug, especially
muscle problems.This medication must not be used during pregnancy. Atorvastatin may harm
an unborn baby. Therefore, it is important to prevent pregnancy while taking this medication.
Consult your doctor for more details and to discuss using at least 2 reliable forms of birth
control (such as condoms, birth control pills) while taking this medication. If you become
pregnant or think you may be pregnant, tell your doctor immediately.It is unknown if this
medication passes into breast milk. Because of the possible risk to the infant, breast-feeding
while using this drug is not recommended. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your
medications work or increase your risk for serious side effects. This document does not contain
all possible drug interactions. Keep a list of all the products you use (including
prescription/nonprescription drugs and herbal products) and share it with your doctor and
pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's
approval.Some products that may interact with this drug include: cyclosporine,
telaprevir, tipranavir plus ritonavir.Other medications can affect the removal of atorvastatin from
your body, which may affect how atorvastatin works. Examples include colchicine, saquinavir,
telithromycin, among others.
OVERDOSE: If overdose is suspected, contact a poison control center or emergency room
immediately. US residents can call the US National Poison Hotline at
1-800-222-1222.
Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as
blood cholesterol/triglyceride levels) should be performed periodically to monitor your progress
or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the
next dose, skip the missed dose and resume your usual dosing schedule. Do not double the
dose to catch up.
STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from
light and moisture. Do not store in the bathroom. Keep all medicines away from children and
pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do
so. Properly discard this product when it is expired or no longer needed. Consult your
pharmacist or local waste disposal company for more details about how to safely discard your
product.
GENERIC NAME:Omeprazole
BRAND NAME:Losec
(CAN)DRUG CLASSIFICATION:Antisecretory drugProton pump inhibitor

DOSAGE: 40gFREQUENCY: OD
ROUTE: IVTTGastric acid-pump inhibitor: Suppresses gastric acid secretion by
specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory
surface of the gastric parietal cells; blocks the final step of acid production.
Indicated for:
y
Short-term treatment of active duodenal ulcer; First-line therapy intreatment of
heartburn or symptoms of gastroesophageal reflux disease (GERD);
y
Short-term treatment of active benign gastric ulcer;
y
GERD, severe erosiveesophagitis, poorlyresponsive symptomaticGERD;
y
Long-term therapy:Treatment of pathologichypersecretory conditions(ZollingerEllisonsyndrome, multipleadenomas, systemicmastocytosis);
y
Eradication of H. pyloriwith amoxicillin ormetronidazole
andclarithromycin;Contraindicated withhypersensitivity toomeprazole or
itscomponents;Use cautiously withpregnancy,lactation.
CNS
: Headache, dizziness,asthenia, vertigo, insomnia,apathy, anxiety,paresthesias,
dreamabnormalities
Dermatologic
: Rash,inflammation, urticaria,pruritus, alopecia, dry skin
GI
: Diarrhea, abdominalpain, nausea, vomiting,constipation, dry mouth,tongue atrophy
Respiratory
: URI symptoms,cough, epistaxis
Other
: Cancer inpreclinical studies,back pain, feverC: Antisecretory drug;Proton pump
inhibitorH: IVTTE: decrease gastric acidsecretionC: Take the drug
beforemeals.Report severe headache,worsening of symptoms, fever, chills.K: Swallow
thecapsules whole; do notchew, open, or crushthem.