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IX.

DRUG STUDY Drug


Meloxicam Brand name: - Apomeloxic am (CAN), Mobic, Novomeloxic am(CAN ), ratioMeloxic am (CAN) Classification: - NSAID (oxicam derivativ e)

Action
Anti Inflammatory; analgesic & anti pyretic activities related to inhibition of the enzyme cyclooxygenase (COX), which is required for the synthesis of prostaglandins & thromboxanes. Somewhat more selective for COX-2 sites than for COX-1 sites which are found throughout the tissues & are related to protection if GI mucosa.

Indication
Relief from the S/Sx of osteoarthritis & rheumatoid arthritis. Relief from the S/Sx of particular or poly articular coarse juvenile rheumatoid arthritis in patients 2yr or older Unlabeled uses: Treatment of ankylosing spondylitis, acute shoulder pain.

Contraindication
Contraindicated with allergy to aspirin or meloxicam; for perioperative pain after coronary artery bypass surgery. Use cautiously with allergies, renal , hepatic, CV,GI conditions; bleeding disorders, pregnancy, lactation

Adverse effect
CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmologic effects. Dermatologic: Rash, pruritus, sweating, dry mucus membranes, stomatitis GI: nausea, GI pain, diarrhea, vomiting, constipation, flatulence GU: dsyuria, renal impairment Hematologic: bleeding, platelet inhibition, neutropenia, leukopenia Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis

Interaction
Drug-drug: Increased serum lithium level & risk of toxicity if taken concurrently, monitor patient carefully. Possible increased rick of renal failure if combined with ACE inhibitors, diuretics Increased risk of GI bleeding if combined with aspirin, anticoagulants, and oral corticosteroids.

Nursing Responsibilities
Administer drug with food or milk if GI upset occurs. Establish safety measures if CNS distubances occurs Monitor patient prolonged therapy for signs of bleeding or hepatic toxicity. Provide further comfort measures to reduce pain & reduce inflammation.

IX. DRUG STUDY

Other: peripheral edema, anaphylactoid reaction to anaphylactic shock

IX. DRUG STUDY Drug


Ketorolac tromethamine Brand name: - Acular LS, Acular PF Classification: - Antipyreti c - Non opioid analgesic - NSAID

Action
Anti inflammatory & analgesic activity, inhibits prostaglandins & leukotriene synthesis.

Indication
Short term management of pain. Ophthalmic: relief ocular itching due to seasonal conjunctivitis & relief of post operative inflammation after cataract surgery

Contraindication
Contraindicated with significant renal impairment, during labor & delivery, lactating, patient wearing soft contact lenses, aspirin allergy, concurrent use of NSAIDs; active peptic ulcer disease, recent GI Bleed perforation, suspect or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete homeostasis, increased risk of bleeding: use with probenecid, pentoxyphylline. Use cautiously with impaired hearing, allergies; hepatic, CV, & GI conditions.

Adverse effect
CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmologic effects. Dermatologic: Rash, pruritus, sweating, dry mucus membranes. GI: nausea, Dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence GU: Dysuria, renal impairment Hematologic: bleeding, platelet inhibition, neutropenia, leukopenia, menorrhagia, thrombocytopenia Respiratory: Dyspnea,

Interaction
Drug-drug: Increased risk of nephrotoxicity with pother nephrotoxins Increased risk of bleeding with anticoagulants, aspirin.

Nursing Responsibilities
Be aware that patient may be at increased risk of CV events, GI bleeding, renal toxicity, Monitor accordingly. Do not use during labor, delivery or while nursing, serious adverse effects to the fetus or baby are possible Protect drug vial from light Administer every 6 hours to maintain serum levels & control pain.

IX. DRUG STUDY


hemoptysis, pharyngitis, bronchospasm, rhinitis Other: peripheral edema, anaphylactoid reaction to anaphylactic shock; local burning stinging

IX. DRUG STUDY Drug


Mefenamic Acid Brand name: - Ponstel Classification: NSAID

Action
Anti-inflammatory, analgesic, & antipyretic activities related to inhibition of prostaglandin synthesis; exact mechanisms of action are not known.

Indication
Relief of moderate pain when therapy will not exceed 1 week Treatment of primary dysmenorrhea

Contraindication
Contraindicated with hypersensitivity to mefenamic acid, aspirin allergy, and as treatment of perioperative pain with coronary artery bypass grafting. Use cautiously with asthma, renal or hepatic impairment, peptic or ulcer disease, GI bleeding, or hypertension, heart failure, pregnancy, lactation.

Adverse effect
CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness, tinnitus, ophthalmologic effects. Dermatologic: Rash, pruritus, sweating, dry mucus membranes, stomatitis GI: nausea, Dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence GU: Dysuria, renal impairment

Interaction
Drug-drug: Increased risk of GI bleeds with ASA, anticoagulants Drug-lab test: False-positive reaction for urinary bile using the Diazo tablet test

Nursing Responsibilities
Give with milk or food to decrease GI upset. Arrange for periodic ophthalmologic examinations during long-term therapy. If overdose occurs, institute emergency procedures- supportive therapy and induced emesis, activated charcoal, and/or an osmotic cathartic.

Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia,

IX. DRUG STUDY


eosinophilia, pancytopenia, aplastic anemia, bone marrow depression Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Other: peripheral edema, anaphylactoid reaction to anaphylactic shock.

IX. DRUG STUDY Drug


Ferrous sulfate

Action

Indication
Prevention & treatment of iron deficiency anemia Dietary suplement for iron Unlabeled use: Supplemental use during epoetin therepy to ensure to proper hematologic response to epoetin

Contraindication
Contraindicated with allery to any ingredient; sulfite allergy; hemochromatosis, hemosiderosis, hemolytic anemia. Use cautiously with normal iron balance; peptic ulcer, regional enteritis, ulcerative colitis.

Adverse effect
CNS: CNS toxicity, acidosis, coma and death with overdose.

Interaction

Nursing Responsibilities
Confirm that patient does have iron defiency anemia before treatment. Give drug with meals if GI discomfort is severe; slowly increase to build up tolerance. Administer liquid preparation in water or juice to mask the taste & prevent staining of teeth; have the patient drink solution with a straw. Warm the patient that stool may be dark or green. Arrange periodic monitoring of Hct & Hgb levels.

Elevates the serum iron concentration, Brand name: which then helps to form Hgb or - ApoFerrous trapped in the reticuloendothelial sulfate( cells for storage CAN), Feosol,F and eventual conversion to a er-gensol, Fer- usable form of iron. in, Sol Class: - Iron preparat ion

Drug- drug: Decreased anti infective response to ciprofloxacin, GI: Gi upset, norfloxacin, anorexia, nausea, ofloxacin; vomiting, separate doses constipation, by at least 2 hr. diarrhea, dark stools, temporary Decreased absorption with staining of the antacid, teeth cimitidine. Decreased effects of levedopa if taken with iron. Increased serum iron levels with chloramphenicol Decreased absorption levothyroxine; separate doses by at least 2 hr. Drug-food: Decreased absorption with

IX. DRUG STUDY


antacid, egg or milk, coffee & tea; avoid concurrent administration of any of these.

IX. DRUG STUDY Drug


Cefalexin/ Cephalexin Brand name: - ApoCephale x(CAN), Keflex Classes: - Antibioti c - Cephalo sphorin(f irst generati on

Action
Bactericidal: inhibits synthesis of bacterial cell wall using cell death.

Indication
Respiratory tract infection caused by streptococcus pneumoniae, a group A beta hemolytic streptococci. Skin & skin structure infection caused by staphylococcus, streptococcus. Otitis media caused by S.pneumoniae, Haemophilus influenza, streptococcus, staphylococcus, Moxarella catarrbalis. Bone infectious caused by staphylococcus, Proteus mirabilis GUinfections caused by Escherichia coli, P. mirabilis,Klebsiella

Contraindication
Contraindicated with allergy to cephalosporin or penicillin Use cautiously with renal failure, lactation or pregnancy.

Adverse effect
CNS: headache, dizziness, lethargy, paresthesias GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseodomembran ous colitis, hepatotoxicity GU: nephrotoxicity Hematologic: Bone marrow depression Hypersensitivity : Ranging from rash to fever, to anaphylaxis; serum sickness reaction Other: Superinfections

Interaction
Drug- drug: Increased nephrotoxicity with aminoglycosides Increased bleeding effects with oral anti coagulants Disulfuram-like reaction may occur if alcohol is taken within 72 hr after cephalexin administration Drug-lab test: Possibility of false results on tests of urine glucose using Benedicts solution, Fehlings solution, Clinitest tablets.

Nursing Responsibilities
Arrange for culture & sensitivity test of infection before & during therapy if infection does not resolve. Give the drug with meals; arrange for small, frequent meals if GI complication occurs. Refrigerate suspension, discard after 14 days.

IX. DRUG STUDY Drug


Cefazolin Brand Name: - Ancef Classification: Anti-infectives

Action
Bind to bacterial cell wall membrane, causing cell death.

Indication
Treatment of: Skin & skin structure infections; pneumonia; urinary tract infections; bone & joint infections

Contraindication
Contraindicated with Hypersensitivity to cephalosphorins. Serious hypersensitivity to penicillin. Use Cautiously in: Renal impairment History of GI disease, especially colitis Geriatric patients (consider agerelated decrease in body mass, renal/hepatic/ cardiac function, concurrent medications and chronic disease states) Pregnancy or Lactation

Adverse effect
CNS: Seizures (high doses) GI: Pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: Interstitial nephritis Dermatologic Rashes, urticaria Hematologic: Blood dyscrasias, hemolytic anemia Other: Pain at IM site, phlebitis at IV site

Interaction
Drug-drug: Increased nephrotoxicity with aminoglycosides Increased bleeding effects oral anticoagulants Disulfiram-like reaction may occur if alcohol is taken with in 72hr of cefazolin administration. Drug-lab test: False result of urine glucose using benedicts solution, Fehlings solution, Clinitest tablets; urinary 17ketosteroids.

Nursing Responsibilities
Assess patient for infection (vital signs; appearance of surgical site, urine; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosphorins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. Monitor site for thrombophlebitis (pain, redness, swelling). Change sites every 48-72 hr to prevent phlebitis. Instruct patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching

IX. DRUG STUDY


or discharge, loose or foul-smelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise not to treat diarrhea without consulting healthcare professional.

IX. DRUG STUDY Drug


Tramadol hydrochloride Brand name: - Ultram Classification: - Analgesic/ centrally acting

Action
Binds to muopioids receptors & inhibits the reuptake of norepiniphrine & serotonin; causes many effects similar to opioidsdizziness, somnolence, nausea, constipation-but does not have the respiratory depressant effects.

Indication
Relief of moderate to moderately severe pain

Contraindication
Contraindicated with allergy to tramadol or opioids or acute intoxication with alcohol, opioids or psychoactive drugs. Use cautiously in pregnancy, lactation, seizures, concomitant use of CNS depressants or MAOIs, renal dysfunction, or hepatic impairment.

Adverse effect
CNS: sedation, dizziness, vertigo, headache, confusion, dreaming, anxiety CV: hypotension, tachycardia, bradycardia Dermatologic: sweating, pruritus, rash, pallor, uticaria GI: nausea, vomiting, dry mouth, constipation, flatulence Other: potential for abuse, anaphylactic reaction.

Interaction
Drug-drug: Decrease effectiveness with carbamezepine Increased risk of tramadol toxicity with MAOIs.

Nursing Responsibilities
Control environment (temperature, lighting) if sweating or CNS effects occurs.

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