September 4, 2009 GENERIC NAME citicholine BRAN D NAME Zynaps e DOSAGE 500mg IV q8 Discontinu ed on September 9, 2009 INDICATIO N Cerebrovascu

lar Diseases, accelerates the recovery of consciousness and overcoming motor deficit. MECHANISM OF ACTION Citicoline activates the biosynthesis of structural phospholipids in the neuronal membrane, increases cerebral metabolism and increases the level of various neurotransmitt ers, including acetylcholine and dopamine. Citicoline has shown neuroprotectiv e effects in situations of hypoxia and ischemia. . metabolism of lactulose by CONTRAINDICATI ON hypertonia of the parasympathetic ADVERSE EFFECT NURSING RESPONSIBILITI ES citicoline may • Watch out for exert a hypotensive stimulating effects action of the • Somazine parasympathetic, must not be as well as a administered fleeting and along with discrete medicaments hypotensor effect containing

lactulose

Lilac

80cc HS

Constipation

Low galactose diet & Abdominal intestinal obstruction discomfort

Do not administer if

bacteria results in reduced colonic pH which stimulates peristalsis and decreases stool transit time. In turn, decreased water reabsorption from the feces further facilitates the passage of soft well-formed stools. And increased osmotic pressure of fecal material secondary to an increase in colonic organic acids results in accumulation of fluid from surrounding tissues, helping to soften stool mass.

associated w/ flatulence or cramps. Prolonged use or large doses may result in diarrhea w/ excessive loss of water & electrolytes

patient has already pass out stool especially if stool is liquid

Mannitol

100cc IV

Raised intracranial pressure

It raises the osmotic pressure of the plasma allowing water to be drawn out of body tissues.

Pulmonary congestion or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration.

Fluid and electrolyte imbalance; acidosis (with high doses). Nausea, vomiting, thirst; headache, dizziness, convulsions, chills, fever; tachycardia, chest pain; blurred vision; urticaria and hypotension or hypertension; acute renal failure; skin necrosis; thrombophloebiti s.

Nimodipine Nimoto 30 mg / tab Prophylaxis p 2 tabs q 6 and treatment of ischemic neurological deficits due to

Calcium channel blocking agent that is relatively

None

Severe BP lowering, GI disturbances, deterioration of renal function,

Take care to avoid extravasation. Observe injection site for signs of inflammation or edema check for signs of fluid and electrolyte imbalance measure I&O accurately and record to achieve proper fluid balance monitor vital signs closely. Report significant changes in BP and signs of CHF Take apical pulse prior to administering drug and hold it if pulse is

cerebral vasospasms after subarachnoid hemorrhage

selective for cerebral arteries compared with arteries elsewhere in the body. This may be attributed to the drug’s high lipid solubility and specific binding to cerebral tissue.

disturbances of heart rhythm, phlebitis, increase of liver enzymes.

below 60. notify the physician. Establish baseline data before treatment is started.BP, pulse and laboratory evaluations of liver and kidney function. Monitor frequently for adverse drug effects, including hypotension, peripheral edema, tachycardia, or skin rash. Monitor frequently for dizziness or lightheadednes s in older adult, risk of

hypotension is increased. Phenobarbi tal 60 mg/tab 1 tab HS Used as a sedative in anxiety or tension states. It depresses the sensory cortex, reduces motor activity, changes cerebellar function, and produces drowsiness, sedation and hypnosis. Its anticonvulsant property is exhibited at high doses. Severe renal and hepatic disorders. Severe respiratory depression, dyspnoea or airway obstruction; porphyria. Pregnancy. Bradycardia, hypotension, syncope; drowsiness, lethargy, CNS excitation or depression, impaired judgment, confusion, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness; rash, thrombocytopeni a, megaloblastic anaemia; respiratory depression, apnoea (especially with rapid IV admin), • Observe patients receiving large doses closely for at least 30 mins to endure that sedation is not excessive. Keep patient under constant observation when drug is administered every hour or more often if indicated Monitor serum drug levels. Serum concentrations >50 mcg/ml may cause coma. Therapeutic serum concentrations of 15-40

• •

mcg/ml produce anticonvulsant activity in most patients. Expect barbiturates to produce restlessness when given to patients in pain because these drugs do not have analgesic action Be prepared for paradoxical responses Monitor for drug interactions. Barbiturates increase the metabolism of many drugs, leading to decreased pharmacologic al effects of those drugs.

Ranitidine

Zantac

50 mg IV q 8 shifted to September 7, 2009

Prophylaxis of stress ulceration and recurrent hemorrhage from peptic ulcer

Potent antiulcer drug that competitively and reversibly inhibits histamine action at H2receptor sites on parietal cells, thus blocking gastric acid secretion.

Safe use during pregnancy or lactation is not established

Headache, malaise, dizziness, mental confusion, agitation, depression, hallucinations in older adult. Constipation, nausea, abdominal pain

Avoid administering with betablockers, calcium channel blockers, warfarin, oral contraceptives Potential toxicity results from decreased clearance (elimination) and therefore prolonged action; greatest in the older adult patients or those with hepatic or renal dysfunction. Be alert for early signs of hepatotoxicity; jaundice (dark urine, pruritus, yellow slera

Tramadol

Tramal

50 mg / cap 1 cap q 8 RTC shifted to September 10, 2009

Moderate to severe acute or chronic pain and in painful diagnostic or therapeutic measures

Centrally acting opiate receptor agonist that inhibits the uptake of norepinephrine and serotonin, suggesting both opiod and nonopioid mechanisms of pain relief. May produce opioid-like effects, but causes less respiratory depression than morphine

Hypersensitivity to tamadol or other opioid analgesics; patients on MAOI, patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs; patients on obstetric preoperative medication, lactation.

Drowsiness, dizziness, vertigo, fatigue, headache, restlessness, euphoria, confusion, anxiety, palpitations, vasodilation, nausea, constipation, urinary retention/frequen cy.

and skin) Long term therapy may lead to vitamin B12 deficiency. Assess for level of pain relief and administer dose as needed but not to exceed the recommended total daily dose. Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression. Discontinue drug and notify the physician if s/sx of hypersensitivit y occur.

Assess bowel and bladder function, report urinary frequency or retention.\ Take appropriate safety precautions.

September 6, 2009 GENERI C NAME Potassium chloride BRAN D NAME Kalium durule DOSAG E 1 tab TID * 6 doses INDICATIO N hypokalemia MECHANIS M OF ACTION Provides a direct replacement of potassium in the body CONTRAINDICATIO N Renal insufficiency, hyperkalemia, untreated Addison’s disease, constriction of the esophagus and or obstructive changes in the alimentary tract. ADVERSE EFFECT Diarrhea, nausea, stomach pain, discomfort or gas vomiting. NURSING RESPONSIBILITIE S • Watch out for levels of potassium electrolyte level to prevent hyperkalemia. • Observe 10 rights of giving medication. • Watch out for possible adverse reaction of the patient. • Potential toxicity

Ranitidine

Zantac

150 mg /

Prophylaxis

Potent anti-

Safe use during

Headache,

tab q 12

of stress ulceration and recurrent hemorrhage from peptic ulcer

ulcer drug that competitively and reversibly inhibits histamine action at H2receptor sites on parietal cells, thus blocking gastric acid secretion.

pregnancy or lactation is malaise, not established dizziness, mental confusion, agitation, depression, hallucination s in older adult. Constipation, nausea, abdominal pain

results from decreased clearance (elimination) and therefore prolonged action; greatest in the older adult patients or those with hepatic or renal dysfunction. Be alert for early signs of hepatotoxicity; jaundice (dark urine, pruritus, yellow slera and skin) Long term therapy may lead to vitamin B12 deficiency.

September 8, 2009 GENERI C NAME Mannitol BRAN D NAME DOSAGE 50 cc q 8 INDICATIO N Raised MECHANIS CONTRAINDICATIO ADVERSE M OF N EFFECT ACTION It raises the Pulmonary congestion Fluid and NURSING RESPONSIBILITI ES • Take care to

discontinue d on September 10, 2009

intracranial pressure

osmotic pressure of the plasma allowing water to be drawn out of body tissues.

or oedema; intracranial bleeding; CHF; metabolic oedema with abnormal capillary fragility; anuria due to severe renal disease; severe dehydration.

electrolyte imbalance; acidosis (with high doses). Nausea, vomiting, thirst; headache, dizziness, convulsions, chills, fever; tachycardia, chest pain; blurred vision; urticaria and hypotension or hypertension; acute renal failure; skin necrosis; thrombophloebiti s.

avoid extravasation. Observe injection site for signs of inflammation or edema check for signs of fluid and electrolyte imbalance measure I&O accurately and record to achieve proper fluid balance monitor vital signs closely. Report significant changes in BP and signs of CHF

September 10, 2009 GENERIC NAME Tramadol BRAN D NAME Dolcet DOSAG E 1 tab TID INDICATIO N Moderate to MECHANIS M OF ACTION Analgesic CONTRAINDICATIO N Acute intoxication with ADVERSE EFFECT CNS and GI NURSING RESPONSIBILITIE S • Assess for level

HCl 37.5 mg, paracetamo l 325 mg

severe pain

alcohol, hypnotics, narcotics, centrallyacting analgesics, opioids or psychotropic drugs. Hypersensitivity.

disturbances . Nausea, dizziness. Fatigue, constipation, dry mouth. •

• • Potassium chloride Kalium durule 1 tab TID hypokalemia Provides a direct replacement of potassium in the body Renal insufficiency, hyperkalemia, untreated Addison’s disease, constriction of the esophagus and or obstructive changes in the alimentary tract. Diarrhea, nausea, stomach pain, discomfort or gas vomiting. •

• •

of pain relief and administer dose as needed but not to exceed the recommended total daily dose Discontinue drug and notify the physician if s/sx of hypersensitivity occur Take appropriate safety precautions. To be taken with food to avoid GI upset. Watch out for levels of potassium electrolyte level to prevent hyperkalemia. Observe 10 rights of giving medication. Watch out for possible adverse reaction of the

patient. September 11, 2009 GENERI C NAME metoprol ol BRAN D NAME DOSAG E 50 mg/tab BID INDICATIO N Hypertensio n MECHANIS M OF ACTION Metoprolol selectively inhibits βadrenergic receptors but has little or no effect on β2-receptors except in high doses. CONTRAINDICATI ON NURSING RESPONSIBILITI ES 2nd or 3rd degree AV Bradycardia, • Take apical block; decompensated hypotension, arterial pulse and BP heart failure; insufficiency, chest before clinically relevant pain, CHF, , administering sinus bradycardia. palpitation, syncope, drug. Report to Severe peripheral dizziness, fatigue, physician arterial circulatory depression, significant disorders. Cardiogenic confusion, headache, changes in rate, shock. Asthma. insomnia, short-term rhythm, or Phaeochromocytoma memory loss, rash, quality of pulse (without α-blockade), sexual or variations in systolic BP <100 dysfunction/impotenc BP prior to mmHg. Metabolic e,; diarrhea, administration. acidosis. Pregnancy constipation, • Monitor BP, (2nd and 3rd flatulence, GI pain, HR, and ECG trimesters). heartburn, nausea, carefully during Heart failure, heart administration block, bronchospasm. • Expect maximal effect on BP after 1 week of therapy • Observe hypertensive ADVERSE EFFECT

patients with CHF closely for impending heart failure. Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins. Monitor I&O, daily weight, auscultate daily for pulmonary rales.

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