XI.

DRUG STUDY Drug Date Ordered: 2/2/11 Generic Name: Scopolamine butylbromide (hyoscine butylbromide) Brand Name: Buscopan Classification: Belladonna alkaloid, antimuscarinic Dosage: 1 amp q4 Indicatio n Action Side Effects & Adverse Reactions Nursing Considerations -Raise side rails as a precaution because some patients become temporarily excited or disoriented and some develop amnesia or become drowsy. Reorient patient, as needed. -Tolerance may develop when therapy is prolonged. -Atropine-like toxicity may cause dose-related adverse reactions. Individual tolerance varies greatly. -Alert: overdose may cause curare-like effects such as respiratory paralysis. Keep emergency equipment available. -Warn patient to avoid activities that require alertness until CNS effects of drug are known Patient Teachings

CNS: disorientation, restlessness, irritability, dizziness, drowsiness, >Inhibits headache, confusion, muscarinic hallucinations, delirium, actions of impaired memory acetylcholine on CV: paradoxical autonomic bradycardia, palpitations, effectors tachycardia, flushing > innervated by EENT: constipation, dry Delerium, postganglionic mouth, epigastric preanesth cholinergic distress, nausea, vomiting etic neurons. RESPI: bronchial sedation, plussing, depressed and >May affect respirations obstetric neural pathways SKIN: rash, dryness, amnesia originating in the contact dermatitis with with inner ear to transdermal patch analgesic inhibit nausea OTHER: heat s and vomiting intolerance

Date Ordered: 2/8/11 Generic Name: celecoxib Brand Name: Celebrex Classification: Cyclooxygenase2 (COX-2) inhibitor Dosage: 1 tab TID

>Acute pain and primary dysmenor rhea

>Thought to inhibit prostaglandin synthesis, impeding COX2, to produce antiinflammatory, analgesic, and antipyretic effects.

CNS: headache, dizziness, insomnia. CV: hypertension, peripheral edema EENT: pharyngitis, rhinitis, sinusitis GI: abdominal pain, diarrhea, dyspepsia, flatulence, nausea METABOLIC: hyperchloremia MUSCULOSKEL: back pain RESPI: upper respi tract infection SKIN: erythema multiforme, exfoliative dermatitis, StevensJohnson syndrome, toxic epidermal necrolysis, rash

-Alert: Pts allergic to or with a history of anaphylactic reactions to sulfonamides, aspirin, or other NSAIDs may be allergic to this drug -NSAIDS cause an increased risk of serious GI adverse events, including bleeding, ulceration, and perforation of the stomach or intestines which can be fatal. -Although drug may be used with low aspirin dosages, the combination may increase risk of GI bleeding. -Drug can cause fluid retention -Assess pt for CV risk factors before therapy -Drug may be hepatotoxic; watch for signs and symptoms of liver toxicity -before drug therapy, rehydrate dehydtrated pt. -Monitor pts renal functions

-Tell pt to report history of allergic reactions to sulfonamides, aspirin, or other NSAIDs before therapy. -Instruct pt to promptly report signs of GI bleeding such as blood in vomit, urine, or stool; or black, tarry stools -Alert: advise pt to immediately report rash, unexplained weight gain, or swelling -Tel woman to notify prescriber if she becomes pregnant during drug therapy -Instruct pt to take drugs with food if stomach upset occurs -Tell pt that drug may harm the liver. Advise pt to stop therapy and notify prescriber immediately if he experiences signe

and symptoms of liver toxicity, including nausea, fatigue, lethargy, itching, yellowing or skin or eyes, right upper quadrant tenderness, and flulike symptoms. -Inform pt that it may take several days before he feels consistent pain relief. CNS: dizziness, -Reassess pts level o pain at -Caution headache, sedation, least 15-30 min after parenteral ambulatory pt about vertigo, confusion, admin getting out of bed or crying, delusions, walking. Warn depression, euphoria, -Drug acts as an opioid outpatient to avoid hallucinations, hostility, antagonist and may cause driving and other nervousness, restlessness, withdrawal syndrome. hazardous activities speech disorders, unusual that require mental dreams -Alert: Drug causes respiratory alertness until drugs CV: bradycardia, depression, which at 10mg is CNS effects are hypertension, equal to respiratory depression known. hypotension, tachycardia produced by 10mg of EENT: blurred vision, morphine. -Teach pt how to dry mouth manage troublesome GI: biliary tract spasms, -Monitor circulatory and adverse effects such constipation, cramps, respiratory status and bladder as constipation. dyspepsia, nausea, and bowel function. If vomiting respirations are shallow or rate GU: urinary urgenc is below 12 breaths/min, RESPI: respiratory withhold dose and notify depression, asthma, prescriber. dyspnea, pulmonary edema -Constipation is commonly SKIN: burning, severe with maintenance

Date Ordered: 2/8/11 Generic Name: nalbuphine hydrochloride Brand Name: nalbuphine hydrochloride Classification: Opioid agonistantagonist, opioid partial agonist Dosage: 10mg q6

>Modera te to severe pain >Adjunct to balanced anesthesi a

>Unknown. Binds with opioid receptors in the CNS, alerting perception of and emotional response to pain

therapy. Make sure stool softener or other stimulant laxative is ordered. clamminess, diaphoresis, pruritis, urticaria -Psychological and physical dependence may occur with prolonged use.