DRUG NAME Ipratropium BromideSalbutamol Sulfate (Combivent) Classification: >bronchodilator

DOSAGE AND ROUTE >inhalation

MECHANISM OF ACTION Combivent Inhalation Solution is a combination of the anticholinergic bronchodilator, ipratropium bromide, and the beta2adrenergic bronchodilator, salbutamol sulfate. Ipratropium bromide is a quaternary ammonium derivative of atropine and is an anticholinergic drug which has bronchodilator properties. Salbutamol produces bronchodilation through stimulation of beta2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of muscle fibres. This action is manifested by an increase in pulmonary function as demonstrated by spirometric measurements.

INDICATION For the management of bronchospasm in patients suffering from chronic obstructive pulmonary disease (COPD) who requires regular treatment with both ipratropium and salbutamol.

CONTRAINDICATION Patients with cardiac tachyarrhythmias, hypertrophic obstructive cardiomyopathy and patients with a history of hypersensitivity to any of its components or to atropine or its derivatives.

ADVERSE REACTIONS Fatigue, abdominal pain, hypertension, dyspepsia, tachycardia, sinusitis, dysuria, and urinary retention blurred vision, taste perversion, dry mouth, paradoxical bronchospasm, bronchitis, angina, arrhythmia, lightheadedness, drowsiness, insomnia, dizziness, vertigo, CNS stimulation, weakness, itching, rash, flushing, alopecia, hypotension, increased blood pressure, gastrointestinal distress, vomiting, diarrhea, edema, constipation and urinary difficulty

NURSING RESPONSIBILITIES Assessment and Drug Effects: 1.monitor respiratory status; auscultate lungs before and after inhalation 2. report treatment failure (exacerbation of respiratory symptoms) to physician Patient and Family Education: 1. do not allow the solution/ mist to enter the eyes 2. Consult a doctor immediately in the event of acute, rapidly worsening dyspnea. In addition, the patient should be warned to seek medical advice should a reduced response become apparent. 3. The concomitant use of Combivent with other sympathomimetic agents is not recommended since such combined use may lead to deleterious cardiovascular effects. 4. Eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival and corneal congestion may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately. 5. Allow 30-60 sec between puffs for optimum results. 6. Wait 5 min between this and other inhaled medications. 7. rinse mouth after medication puffs to reduce bitter taste

DRUG NAME Ranitidine

DOSAGE Ranitidine 50mg TIV Adult: 150mg twice a day or 300mg at once a day

MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori.

INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach.

CONTRAINDICATION Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance. Use Cautiously in: Renal impairment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation

ADVERSE REACTIONS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

NURSING RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.

DRUG NAME Flutocasone

DOSAGE Fluticasone inhalation 1-2x daily

MECHANISM OF ACTION Glucocorticoid with a high topical antiinflammatory potency. It has a strong affinity for and agonist activity at human glucocorticoid receptors.

INDICATION It is used by inhalation for the prophylaxis of the symptoms of asthma; also by nasal spray for allergic rhinitis.

CONTRAINDICATION Known hypersensitivity to fluticasone propionate or any ingredient in the formulation.

ADVERSE REACTIONS Candidiasis or dryness of mouth and throat. Hoarseness. Suppression of adrenal function, growth retardation in children.

NURSING RESPONSIBILITIES ASSESSMENT Assess pts condition before therapy. Assess active infection and assess if immunocompromised Assess pulmonary and cardiac status. Monitor possible adverse reaction PLANNING Store at controlled room temperature away from direct sunlight IMPLEMENTATION Advise that the drug is for long term maintenance Instruct proper way of drug inhalation Instruct to rinse mouth after each inhalation to prevent oral candidiasis. Instructs to immediately report decreasing effect of inhaled beta agonist Instruct to report drug induced adverse reaction

DRUG NAME Ampicillin

DOSAGE 1-2 g a day in divided doses every 6 hours

MECHANISM OF ACTION Interferes with cell wall synthesis of susceptible organisms, preventing bacterial multiplication, it also renders cell wall osmotically unstable and burst due to osmotic pressure. Deactivated by betalactamase, an enzyme produced by resistant.

INDICATION Treatment of respiratory tract and soft tissue infection. Bacterial meningitis. Septicemia and gonoccocal infection caused by susceptible microorganisms; prophylaxis in rape victims and for bacterial endocarditis.

CONTRAINDICATION Hypersensitivity to penicillin, cephalosporin or imipenem.

ADVERSE REACTIONS Thromboplebitis at injection site, dizziness, fatigue, insomia, reversible hyperactivity

NURSING RESPONSIBILITIES ASSESSMENT Obtain patients history Assess signs and symptoms of infection Obtain baseline data of WBC Obtain C&S before drug therapy Assess sensitivity reactions Assess allergic reactions Monitor renal function Monitor blood studies Assess for overgrowth of infection PLANNING Give in even doses round the clock IM route reconstitute with 125mg/0.9 1.2mL; 500mg/1.2 1.8mL; 1g/2.4 7.4mL; 2g/6.8mL Give by direct IV over 3-5 mins in lower dosage IMPLEMENTATION Instruct to take medications as prescribed Advise to monitor adverse reaction Instruct pt if diarrhea with blood or pus occur notify physician

DRUG NAME Budesonide

DOSAGE Children: 12mg maintenance 0.5-1mg Adult: 0.51mg maintenance 0.25-5mg Tubuhaler: 400-1600mcg divided in 2-4 divided doses

MECHANISM OF ACTION Exerts a local anti inflammatory effect by depression of migaration of polymorphonuclear leukocytes and fibroblasts; reversal of increased capillary permeability and lysosomal stabilization. It does not suppress hypothalamus and pituitary function.

INDICATION Used for management of bronchial asthma and symptomatic management of seasonal or perennial allergic rhinitis.

CONTRAINDICATION Hypersensitivity to budesonide.

ADVERSE REACTIONS Nasal irritation/bleeding; burning; stinging; sneezing; pharingitis. GI: dry mouth, indigestion, rash, face and tongue edema, pruritus, bronchospasm.

NURSING RESPONSIBILITIES ASSESSMENT Obtain patients history Assess respiratory status Check for oral candidiasis Be alert for bronchospasm Carefully assess presence of viral infection Regularly assess intraocular pressure PLANNING Do not crush, break or chew the capsule Store at 15-39 degrees Celsius (59-86F) IMPLEMENTATION Instruct how to use nasal inhaler himself Teach pt to notify physician of pharyngitis, nasal bleeding Instruct pt not to exceed recommemded dosage; adrenal suppression may occur Instruct pt to prevent exposure to infections, especially viral.

Pamantasan ng Lungsod ng Pasay College of Nursing and School of Midwifery

EMPHYSEMA

Submitted by: Madeliene Kae R. Estanislao BSN IV-2 Submitted to: Mrs. Bautista