VIII.

DRUG STUDY

DRUG Generic Name: Captopril Brand Name: Capoten Classification: Antihypertensive Dosage, Frequency, Route: Generic Name: Tramadol Brand Name: Dolcet Classification: Dosage, Frequency, Route Dolcet 1 tab PO Q6H/PRN pleuritic chest pain,,, Generic Name: Lactulose Brand Name: Duphalac Classification: Laxative Dosage, Frequency, Route 30ml HS PO hold with BM 2x/day Generic Name: Losartan K Brand Name: Cozaar Classification:

INDICATION for hypertension

ACTION Blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. Decreases pain by inhibiting the uptake of Norepinephrine & serotonin in the CNS. May produce opioid-like effects, but causes less respiratory depression than morphine.

ADVERSE REACTION GI upset, loss of appetite, change in taste perception, mouth sores ,rash; fast heart rate; dizziness, lightheadedness; mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing. -Nausea, dizziness, somnolence. -Asthenia, fatigue, hot flushes, constipation, diarrhea, flatulence, dry mouth, pruritis, diaphoresis, tinnitus.

NSG CONSIDERATION Assess patient history regarding allergy to captopril Assess patients renal function. Assess vital signs. Monitor patients health status. Monitor patients output. Monitor vital signs. Be alert for adverse reaction.

For moderate to acute or chronic pain

assess for level of pain relief -assess BP & RR -assess bladder & bowel function -monitor for respiratory depression & seizures

PATIENT TEACHING Take drug 1 hr before or 2 hr after meals; do not take with food. Do not stop without consulting your health care provider. Be careful of drop in blood pressure and consult your health care provider. Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that will interact with ACE inhibitors. Report any adverse reaction take w/ meals to avoid GI upset. -encourage coughing & deep breathing q 2 hrs to prevent atelactasis & pneumonia

For constipation

Drug passes unchanged into colon where bacteria breaks it down into organic acids that increase the osmotic pressure & slightly acidify colonic contents w/c increase stool softening action

abdominal discomfort associated w/ flatulence/cramps -prolonged use/large doses may result in diarrhea w/ excessive loss of water & electrolytes

do not administer if pt. has already pass out stool -give laxative syrup w/ water, juice or milk to increase palatability -do not give other laxatives -replace fluid loss -monitor serum ammonia levels & blood glucose levels

-Advise patient to take drug with juice to improve taste -Tell patient to report unusual sign of diarrhea.

For Hypertension

Abdominal pain, edema/swelling, asthenia/fatigue, headache. Palpitation, diarrhea, nausea, back pain, dizziness. Dry cough, sinusitis, bronchitis, pharyngitis, upper resp

-When treating hypertension, use the lowest dose(25mg) initially in patients with impaired hepatic function and those who are intravascularly volume depleted(receiving diuretics) -Closely monitor patient during the

Advise patient to take drug with food to minimize GI upset. Warn patient not to change position suddenly and to rise slowly to avoid orthostatic hypotension. Instruct patient not to drink alcohol during drug therapy.

Generic Name Amiodarone Brand Name Cordarone Classification Antianginal / antiarrhythmic drug Dosage, Frequency, Route 200mg NGT OD,

Ventricular and supraventrcular arrhythmias.

increases the duration of ventricular and atrial muscle action by inhibiting Na,Kactivated myocardial adenosine triphosphatase resulting to a decrease in heart rate and in vascular resistance.

Blue-grey discoloration of skin, photosensitivity, peripheral neuropathy, paraesthesia, myopathy, ataxia, tremor, nausea, vomiting, metallic taste, hypothyroidism, hyperthyroidism, alopecia, sleep disturbances, corneal microdeposits, hot flushes, sweating. Heart block, bradycardia, sinus arrest, hepatotoxicity, heart failure.

Generic Name: Hydrocortisone Brand Name Solu- Cortef Classification corticosteroid hormones Dosage, Frequency, Route: 100mg IV Q8H 12nn 8PM 4am, Generic Name: Sodium Bicarbonate Brand Name Sodium Bicarbonate For metabolic acidosis or symptomatic relief of upset stomach from hyperacidity associated w/

Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes, suppresses immune response, stimulates bone marrow and influences protein, fat, and carbohydrate metabolism

Burning, itching, irritation, dryness, allergic contact dermatitis, secondary infection, skin atrophy, striae, fatigue, muscle weakness, lethargy, joint pain, fever, anorexia, nausea, dyspnea, dizziness, and fainting

Monitor cardiac rhythm continuously. Monitor for an extended period when dosage adjustments are made. Monitor for safe and effective serum levels (0.52.5 mcg/mL). Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when amiodarone is started. Give drug Arrange for ophthalmologic exams; reevaluate at any sign of optic neuropathy. Arrange for periodic chest x-ray to evaluate pulmonary status (every 36 mo). Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels. Provide antacids between meals to help avoid peptic ulcer Use minimal doses for minimal duration to minimize adverse effects. Arrange for increased dosage when patient is subject to unusual stress. Use alternate-day maintenance therapy with short-acting corticosteroids whenever possible. assess for edema, w/c may indicate inability to utilize NaHCO3 -observe for dry skin & mucous membranes, polydipsia, polyuria, & air hunger may indicate a reversal of metabolic

Take with meals to decrease GI problems. Inform patient that this drug may cause vision problems including permanent blindness. Be sure to have regular eye exams during your treatment Instruct patient to avoid drinking grapefruit as this can alter the effect of the drug leading to potentially dangerous effects Instruct patient to avoid exposure to sunlight. This can make your skin sensitive to sunlight which may lead to sunburn and blue-gray discoloration of the skin

Tell patients signs of early adrenal insufficiency Tell patient not to abruptly stop taking the drug without prescribers consent because the drug may cause rebound.

increases plasma Bicarbonate, neutralizes gastric acid, raises blood pH, urine pH & gastric pH, inhibits pepsin activity -treatment of metabolic acidosis

Gastric distention, belching, flatulence, metabolic alkalosis, hypernatrmia, increased serum lactate levels

Advise patient not to take drug with milk. Doing so may cause hypercalcemia, alkalosis, and possibly renal calculi. If patient takes an oral dose for, tell patient to take drug 1 hour before

Classification Dosage, Frequency, Route: NaHCO3 1 tab NGT TID Generic Name: Generic Name: Acetylcysteine Brand Name Fluimucil Classification Respiratory Expectorants / Cough & Cold Preparations Dosage, Frequency, Route: 600mg 1 tab NGT BID Generic Name: Omeprazole Brand Name Risek Classification Antaids/ anti ulcerants Dosage, Frequency, Route: 40mg 1 cap NGT 30 mins pre am feeding OD Generic Name: Fluticasone, Salmeterol Brand Name

peptic ulcer, gastritis,

acidosis. -monitor electrolytes & ABGs. -WOF: s/sx of milk-alkali syndrome (polyuria)

or 2 hours after taking enteric coated drugs because sodium bicarbonate may cause enteric coated drugs to be dissolved in the stomach.

For acute respiratory tract infections w/ abundant mucus secretions

Exerts mucolytic action through its free sulfhydryl group which opens up the disulfide bonds in the mucoproteins thus lowering mucous viscosity.

nausea, vomiting. Rarely, urticaria and bronchospasm. Nasopharyngeal and gastrointestinal irritation like rhinitis, stomatitis.

-monitor effectiveness of therapy & adverse effects -instruct pt. in appropriate use -report if adverse effects occurs

Drug shouldnt be used for prolonged period without direct medical supervision. Inform patient that drug may have a foul taste or smell.

Treatment of duodenal /gastric ulcer

Inhibition of gastric acid secretion

Headache, diarrhea, constipation, abdominal pain, nausea/vomiting & flatulence. Increased liver enzymes, rash, urticaria &/or pruritus, dizziness, paresthesia, somnolence, insomnia, vertigo & malaise

_Drug increases its bioavailability with repeated administration -Should not be crushed( Use of orange juice during administration may decrease risk of clogging -Monitor liver function test.

Takenwith food. Take immediately before a meal Warn patient not to crush or chew tablets or capsules. Advise patient that OTC drug isnt intended for immediate relief of heartburn or to treat occasional heartburn (one episode of heartburn a week or less). Inform patient that OTC drug may require 1 to 4 days for full effect, although some patients may get complete relief of symptoms within 24 hours. Tell patient to take the drug at about 12-hour intervals even if he is feeling better. Instruct patient to rinse mouth after

Maintenance treatment for COPD including chronic bronchitis

Selectively activates beta 2 adrenergic receptors, which results in bronchodilation and blcks the release of allergic

Tremor, subjective palpitations and headache, cardiac arrhythmias, arthralgia, hypersensitivity reactions,

Assess patients respiratory condition before starting therapy. Assess peak flow readings before

Seretide Classification Dosage, Frequency, Route: 250 mcg puff BID Generic Name: Brand Name Centrum Silver Classification vitamin and/or minerals Dosage, Frequency, Route: 1 tab NGT OD Generic Name: insulin lispro Brand Name humalog Classification antidiabetic, pancreatic hormone Dosage, Frequency, Route: 30 units SQ 8am, *pm hold CBG </= 100 or if on NPO

and emphysema.

mediators from the mast cells in the respiratory tract.

oropharyngeal irritation, hoarseness,oral candidiasis, paradoxical bronchospasm.

starting therapy and periodically thereafter. Be alert for adverse reactions and drug reactions

each inhalation to prevent oral candidiasis. Inform patient that improvement may be seen within 30 minutes after a Seretide dose; however full benefit may not occur for 1 week or more.

Treatment & prevention of vit & mineral deficiencies

Acts as a supplement of vitamins and minerals

Tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling.

May be taken with or without food (May be taken w/ meals for better absorption or if GI discomfort occurs.)

Comply with diet recommendations of provider. The best source of vitamins is a well-balanced diet with foods from the basic food groups. Take with food for best absorption.

Use in the treatment of DM who require insulin for the maintenance of normal glucose homeostasis & initial stabilization of DM.

Insulin lispro, a rapid-acting analog of human insulin, lowers blood glucose levels. It regulates carbohydrate, protein and fat metabolism by inhibiting hepatic glucose production and lipolysis, and enhancing peripheral glucose disposal.

Lipodystrophy. Local & generalized allergic reaction. flushing, rash, urticaria, warmth, swelling, redness, hypoglycemia, rebound hyperglycemia

When used as a mealtime insulin, give within 15 min before a meal or 15 min of finishing a meal, as compared with human regular insulin, which is best given 3060 min before a meal Do not give mixtures IV If Humalog is mixed with a longer-acting insulin, draw Humalog into the syringe first to prevent clouding of the Humalog by the longer-acting insulin May be given by an external insulin pump Store in refrigerator at 2-8C. Do not freeze. If refrigeration not possible, can store unrefrigerated for up to 28 days, provided it is kept as cool as possible and

Take with food (Administer w/in 15 mins before or immediately after meals.). Teach patient/family that blurred vision may occur Keep insulin, equipment available at all times

Generic Name: Insulin glulisine Brand Name Apidra Classification Insulin preparations Dosage, Frequency, Route: 8 units SQ CBG>200mg/dl 12mn, 4pm,12mn,4am,,,T

Treatment of DM, where insulin is required.

Insulin glulisine is a rapid acting human insulin analog produced by recombinant DNA technology using a non-pathogenic laboratory strain of Escherichia coli (K12). Insulin glulisine and insulin human are equipotent on a unit-for-unit basis. Insulin glulisine has a more rapid onset and shorter duration of action compared with insulin human after subcutaneous admin.a

Hypoglycemia, inj site reactions, lipodystrophy, local & systemic hypersensitivity reactions.

away from direct heat and light. Should be taken with food (Administer within 15 mins before a meal or within 20 mins after starting a meal.).

Drug onset of action is quicker than regular human insulin. Take within 15 min before a meal or within 20 min after starting a meal. Administer subcutaneously into the abdomen, thigh or arm. Rotate injection sites and monitor finger sticks regularly. May also be administered via pump into the abdomen as directed. Continue diet, exercise and weight control along with insulin to control blood sugar and prevent organ damage. Ensure BP and LDL cholesterol well controlled and keep all F/U appointments for labs and medical evaluation. Warn patient that headache may follow after administration of transdermal patch and will subside with continues treatment. Warn patient that this causes dizziness and he must go upright slowly. -Tell patient to report persistent headached, blurred vision and dry mouth.

Generic Name: Nitroglycerin Brand Name Transdermal patch-nitro Classification Anti anginal Dosage, Frequency, Route: 5mg OACW x 24H only

Prevention of attacks of angina pectoris. Supplementary treatment for CHF. Prevention of phlebitis & extravasation.

Generic Name: Ipratropium bromide Brand Name Pulmodual Neb Classification Anti asthmatic / COPD preparations

Treatment of reversible airways obstruction as in asthma & COPD .

Nitroglycerin relaxes, vascular smooth muscle of both the venour and arterial beds, resulting in a net decrease in myocardial oxygen consumption. It also dilates coronary vessels, leading to redistribution of blood flow to ischemic tissue. Systemic and coronary vascular effects of drug, which may vary slightly with the various nitroglycerin forms, probably account for its value in treating angina. Ipratropium appears to inhibits vagally mediated reflexes by antagonizing the action of acetylcholine. Anticholinergics prevent the increase in intracellular concentration of cyclic guanosine

Postural hypotension, flushing, tachycardia, dizziness

Remove transdermal patch before defibrillation. Aluminunm backing of the patch may exploded when exposed to electrical current.

Dry mouth, nausea, constipation, headache, fine tremor (particularly the hands), nervous tension, muscle cramps & palpitations, tachycardia, atrial fibrillation, arrhythmias, peripheral

Because delayed onset of bronchodilation, drug is not recommended for treating acute respiratory distress

Advise patient to allow 1 minute inhalation -Instruct patient to call if she experiences dry mouth that persist longer than 2 weeks. -Instruct patient to report if he is not experiencing benefits after 30 minutes or if condition worsens.

Dosage, Frequency, Route: 7 gtts + 3cc NSS Q4/PRN 12nn,4pm,8pm,12mn,4 am,8am Generic Name: Alprazolam Brand Name Xanor Classification anxiolytics Dosage, Frequency, Route: 250 mcg 1 tab NGT HS For short-term relief of the symptoms of anxiety & panic disorders w/ or w/o agoraphobia; or depression.

monophosphate(cyclic GMP) that result from the bronchial smooth muscle.

vasodilation, disturbances of sleep & behavior.

Alprazolam, depresses CNS at the limbic and subcortical levels of the brain. It produces an anti anxiety effect by enhancing the effect of the neutransmitter gammaaminobutyric acid on its receptor in the ascending reticular activating system, which increases inhibition and blocks both cortical and limbic arousal.

GI effects; drowsiness, lightheadedness, depression, headache, confusion, insomnia, syncope; tachycardia, palpitations, hypotension; blurred vision; muscle rigidity & tremor; dermatitis/allergy; nasal congestion, wt gain or loss, sedation, fatigue, sexual dysfunction, memory impairment & confusion, ataxia, slurred speech.

May be taken with or without food (Side effects such as sleepiness/ drowsiness may be reduced if taken immediately after meals.).

Make sure patient understand potential for physical and psychological dependence with long term use. -Instruct patient not to alter drug regimen. -Warn patient that sudden changes in position can cause dizziness.