Drug Study NAME OF DRUG Classification/ Dosage/ Frequency MECHANISM OF ACTION INDICATIONS/ CONTRAINDICATIONS Indi: • Relief symptoms of acute

and recurrent diabetic gastro paresis. • Short term therapy (4-12 weeks) for adults with symptomatic gastroesophageal reflux who fail to respond to conventional therapy Contra: • Contraindicated with allergy to metaclopramide, GI hemorrhage, mechanical obstruction or perforation. SIDE EFFECTS NURSING RESPONSIBILITIES

.Metoclopramide

• Antiemetic • Dopaminergic Blocker • GI stimulant

• 1 amp • IV

• Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions, appears to sensitize tissues to action of acetylcholine. • Relaxes pyloric sphincter which when combined with effects on motility, accelerates gastric emptying and intestinal transit.

• Restlessness • Drowsiness • Fatigue • Insomia • Transient hypertension • Nausea • Diarrhea

• Asses if the patient has history of allergies to metoclopramide. • Monitor BP carefully during IV administration. • Monitor extrapyramidal reactions, and consult physician if they occur. • Monitor patients with diabetes, arrange for alteration in insulin dose or timing if diabetic control is comprised by alterations in timing of food absorbtion.

Azithromycin

• Marcolide antibiotic

• Bacteriostatic or bactericidal in susceptible bacteria.

Indi: • Treatment of lower respiratory infections (Haemophilus influenzae, Moraxella catarrbalis, streptococcus pneumoniea, CAP,

CNS: • • • • GI • • • • • • Diarrhea Abdominal pain Nausea Vomiting Melena Pseudome mbranous colitis Dizziness Headache Vertigo Fatigue

• 500 mg tab • OD

Monitor for and report loose stools or diarrhea, since pseudo membranous colitis (see Appendix F) must be ruled out. Monitor PT and INR closely with concurrent warfarin use.

Contra: • Contraindicated with hypersensetivity to azithromycin, erythromycin, or any macrolide antibiotic. • Use continously with gonorrhea or syphilis, hepatic or renal impairment.

Patient & Family Education • Direct sunlight (UV) exposure should be minimized during therapy with drug. • Take aluminum or magnesium antacids 2 h before or after drug. • Report onset of loose stools or diarrhea. • Do not breast feed while taking this drug without consulting physician.

Clopidogrel

Antiplatelet

• Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

Indi: • Treatment of patients at risk for ischemic eventsrecent MI, recent ischemic CVA, peripheral artery disease.

CNS • Headache • Dizziness • Weakness • Flushing

Assessment History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer Physical: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds Interventions • Provide small, frequent meals if GI upset occurs (not as common as with aspirin). Provide comfort measures and arrange for analgesics if headache occurs.

75 mg

OD

• Treatment of the patient with Acute Coronary CV Syndrome Contra: • Contraindicated with allergy to clapidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage. • •

Hypertensi on Edema

GI •Nausea •GI distress •Constipation •Diarrhea •GI bleeding •

• Enoxaparin • Antithrombotic

Low molecular

Indi: • Prevention of DVT,

Hematologic • Hemorrhage • Thrombocytope nia • Hyperkalemia Others • Fever Prevention of ischemic • Pain • Local irritation • Epidural or spinal hematoma.

Assessment · History: Recent surgery or injury; sensitivity to heparin, pork products, enoxaparin; lactation; history of GI bleed; pregnancy Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, kidney function tests

weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing the formation of clots.

which may lead to to pulmonary embolism following hip replacement, knee replacement surgery, abdominal surgery. •

4cc

·

Q8

complications of unstable angina and non Q wave MI. • Treatment od acute ST

segment elevation MI, managed medically or with subsequent percutaneous coronary intervention. Contra: • Hypersensitivy to

Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.

Monitor platelet count closely. Withhold drug and notify physician if platelet count less than 100,000/mm3.

enoxaparin, heparin, pork products, severe thrombocytopenia, uncontrolled bleeding.

Monitor closely patients with renal insufficiency and older adults who are at higher risk for thrombocytopenia.

Monitor for and report immediately any sign or symptom of unexplained bleeding

• Anticholinergic, Ipratropium • Anticholinergic • Bronchodilator chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the • 1 neb action of acetylcholine. and inhibits the • Q4 secretion from serous and seromucous glands lining the nsal mucosa.

Indi: • Bronchodilator for

CNS • Dizziness • Nervousness • Headache • Fatigue • Insomnia • Blurred vision GI • Nausea • GI distress Respiratory Dyspnea Bronchitis Bronchospasm Cough Hoarseness Others • Back pain • Chest pain • Dry mouth • palpitation • Ensure adequate hydration; control environment (temperature) to prevent hyperpyrexia • Have patient void before taking medication to avoid urinary retention.

maintenance treatment of bronchospasm associated with COPD, chronic bronchitis, and emphysema.

Causes bronchodilation Contra: • Hypersensitivity to atropine or its derivatives, soybean, or peanut. • Use continuously with narrow angle of glaucoma, prostatic hypertrophy, and bladder neck obstruction.

• The drug unchanged Lactulose • Laxative into the colon where bacteria break it down to organic acids that increase the osmotic • 30cc pressure in the colon and slightly acidify the colonic contents, • OD/ HS resulting in an increase stool water content, stool softening, laxative action.

Contra: • Treatment of

GI • Transient flatulence • Distension • Intestinal cramps • Diarrhea • Nausea Others • Acid base imbalance • Electrolyte imbalance
• • • •

Give laxative syrup orally with fruit juice, water or milk to increase palatability. Administer retention enema using a rectal balloon catheter. Do not use cleansing enemas containing soap suds or other alkaline agents that counteract the effects of lactulose. Do not administer other laxatives while using lactulose. Monitor serum ammonia levels. Monitor with long-term therapy for potential electrolyte and acid---base imbalances.

constipation • Prevention and

treatment of portal systemic encephalopathy. Contra: • Allergy to lactulose, low

galactose diet • Use continuously with

diabetes.

Indi: Furosemide • Anti diuretics • Inhibits reabsorption of sodium chloride from the proximal ang • 20mg distal tubules and ascending limb of the loop of Henle, leading • OD to a sodium-rich dieresis. Contra: Contraindicated with allergy to furosemide, sulfonamides, allergy to tartrazine, anuria, and severe renal failure • Constipation • Diarrhea • Oral, IV: Edema associated with heart failure, cirrhosis, renal disease. • IV: acute Pulmonary Edema • Oral: Hypertension • Dizziness • Weakness • Headache • Drowsiness • Nausea • Blurred vision • Fatigue • Gatric irritation • Administer with food or milk to prevent GI upset. • Reduce dosage if given with other anti-hypertensive’s readjust dosage gradually as BP respond. • Give early in the day so that increased urination will not disturb sleep. • Avoid IV use if oral use is at all possible.

Indi: Omeprazole • Proton Pump Inhibitor • Gastric acid pump inhibitor, suppresses gastric acid secretion by • 40mg cap specific inhibition of the hydrogen potassium ATPase enzymes system • OD at the secretory surface of the gastric parietal cells, blocks the final step acid production. Contra: • Allergy to omeprazole or its components. • Short term treatment of active benign gastric ulcer • Short term treatment of active duodenal ulcer. • Treatment of symptoms of GERD and heartburn.

CNS • Headache • Dizziness • Vertigo • Insomnia • Anxiety • Paresthesia GI • Diarrhea • Abdominal pain • Nausea • Vomiting • constipation • Administer antacids with omeprazole, if needed. • Administer before meals.

Caution patient to swallow capsules whole—not to open, chew, or crush them. If using oral suspension, empty packet into a small cup containing 2 tbsp of water. Stir and have patient drink immediately; fill cup with water and have patient drink this water. Do not use any other diluent. • WARNING: Arrange for

further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies.

CNS Rosuvastatin • Antihyperlipidemic drug • • 40mg tab OD/HS • A fungal metabolite that inhibits the enzymes (HMG-CoA) that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decreased in serum cholesterol, serum LDLs (associated with increased risk of coronary artery disease) and either an increase or no change in serum HDLs (associated with decreased risk of coronary artery disease) Contra: Indi: • As an adjunct to diet in Headache Dizziness Insomnia • paresthesia • anxiety CV • hypertension • Adjunct to diet to slow atherosclerosis progression in patients with elevated cholesterol. • angina • palpitation • peripheral edema GI • nausea • diarrhea • constipation • vomiting • flatulence • Promote fluid intake

(>=1500–2000 mL/d) during drug therapy for constipation; older adults often self-limit liquids. Lactulose-induced osmotic changes in the bowel support intestinal water loss and potential hypernatremia. • Establish baseline serum

the treatment of elevated total cholesterol and LDL cholesterol land triglyceride levels in patient with primary hypercholesterolemia.

lipid level and liver function test results before beginning the therapy • Consults with dietitian

about low cholesterol diet. • Administer drug at

bedtime(highest rates of cholesterol synthesis occur between midnight and 5 am)

Provide comfort

measures to deal with headache, muscle cramps, or nausea.

Hydrocortisone

•Corticosteroid

50mg

IV

Q8

• Enters target cells and binds to cystoplasmic receptors; initiates many complex reactions that are responsible for its inflammatory, immunosuppressive (glucocorticoid), and salt retaining (mineralocorticoid) actions. Some actions maybe undesirable, depending on drug use.

Indi: • Replacement therapy in adrenal cortical insufficiency. Contra: • • • • • • Allergy to any component of drug Fungal infection Hepa B Vaccinia Antibiotic resistants infection Immunosupression.

CNS • Vertigo • Headache • Paresthesis • Insomnia CV • Hypotension • Shock • Hypertension • Heart failure secondary to fluid retention • Thromboemboli sm GI • Peptic ulcer • Pancreatitis • Abdominal distension • Nausea/vomiti ng EENT • Cataract • Glaucoma • Increased IOP

Assessment • History of infection, kidney

disease, liver disease, hypothyroidism, ulcerative colitis with impending perforation; recent GI surgery, hypertension, heart failure. • Give daily before 9am to mimic

normal pick diurnal corticosteroid levels and minimize HPA suppression. • Provide antacids between

meals to help avoid peptic ulcer.

Indi: Acetylcysteine • • Antidote Mucolytic • Splits links in the

Mucolytic adjuvant

• Nausea • Stomatitis • Bronchospasm • Rash • Vomiting

Inform the patient that

mucoproteins contained in the respiratory mucus secretions, decreasing the viscosity of the

theraphy for abnormal, viscid, or inspissated mucus secretions in acute and chronic bronchopulmonary disease (emphysema, asthmatic bronchitis, TB, pneumonia) Contra: • Hypersensitivity to

nebularization may produce an initial disagreeable odor, but the odor will soon disappear. • Monitor nebulizer for buildup of

600mg tab

mucus. Antidote to

drug from evaporation; dilute with sterile water for injection to prevent concentrate from impeding nebulization and drug delivery.

HS

acetaminophen hepatotoxicity: protects liver cells by maintaining cell function and detoxifying acetaminophen metabolites.

acetylcysteine; use caution and discontinue immediately if bronchospasm occurs.

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