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DRUGS INDICATIONS / REACTIONS NURSING CONSIDERATIONS

/ RESPONSIBILITIES
1.) MEBENDAZOLE is a (synthetic) broad- Indications and Usage: • Your doctor has prescribed this
spectrum anthelmintic available as chewable Mebendazole tablets are indicated for the medicine to treat an infection caused
tablets, each containing 100 mg of treatment of Enterobius vermicularis by an intestinal worm. Follow your
Mebendazole. Inactive ingredients are: (pinworm), Trichuris trichiura (whipworm), doctor’s instructions carefully. In
anhydrous lactose NF, corn starch, magnesium Ascaris lumbricoides (common roundworm), addition to your doctor’s treatment,
stearate, microcrystalline cellulose, sodium Ancylostoma duodenale (common you can help prevent reinfection and
lauryl sulfate, sodium saccharin, sodium hookworm), Necator americanus (American infection of other people by
starch glycolate, stearic acid, and FD&C hookworm) in single or mixed infections. understanding a few simple facts about
Yellow #6. worms.
Contraindications: • PINWORM: Pinworms look like tiny
Mebendazole is contraindicated in persons white threads and live in the bowel.
who have shown hypersensitivity to the drug. Usually at night, they travel to the
rectal opening and lay eggs on the
Adverse Reactions: outside skin. This sometimes causes
Gastrointestinal: itching which may be very annoying.
Transient symptoms of abdominal pain and That is why restless sleep is a frequent
diarrhea in cases of massive infection and sign of pinworms, especially in
expulsion of worms. children. Scratching will cause
Hypersensitivity: pinworm eggs to stick to the fingers.
Rash, urticaria and angioedema have been Reinfection will result if the fingers are
observed on rare occasions. placed in the mouth.
To help prevent reinfection follow these
Central Nervous System: rules:
Very rare cases of convulsions have been
• Wash hands and fingernails with soap
reported.
often during the day, especially before
Liver:
eating and after using the toilet.
There have been liver function test elevations
• Wear tight underpants both day and
[AST (SGOT), ALT (SGPT), and GGT] and
night. Change them daily.
rare reports of hepatitis when Mebendazole
• For several days after treatment, clean
was taken for prolonged periods and at
dosages substantially above those the bedroom floor by vacuuming or

recommended. damp mopping. Avoid dry sweeping

Hematologic: that may stir up dust.

Neutropenia and agranulocytosis. (See • After treatment, wash bed linens and

WARNINGS). night clothes (don’t shake them).

Overdosage: • Keep the toilet seats clean

In the event of accidental overdosage,


The medication used to treat these worms
gastrointestinal complaints lasting up to a few
causes them to be expelled from the body.
hours may occur. Vomiting and purging should
Hookworms and whipworms may be seen and
be induced.
resemble small white threads. Roundworms
are much larger and easily seen.
To help prevent reinfection follow these
rules:

• Wash hands and fingernails with soap


often during the day, especially before
eating and after using the toilet.
• Wash all fruits and vegetables
thoroughly or cook them well.
• Wear shoes.
• Use the bathroom.

Follow your doctor’s advice, take the


medication he gives you and follow the rules
mentioned here. If you have other questions
about worms, be sure to ask your doctor.

WARNING: Do not take this medication if


you are pregnant or think you may be
pregnant. Consult your physician.

2.) LOMOTIL is the trade name of a popular Indications and Usage: Adverse Reactions:
oral anti-diarrheal drug in the United States,
Lomotil is effective as adjunctive therapy in
manufactured by Pfizer. Its UK BAN generic At therapeutic doses, the following have been
the management of diarrhea.
name is Co-phenotrope. Its active ingredients reported; they are listed in decreasing order of
are diphenoxylate and atropine. Diphenoxylate severity, but not of frequency:
Contraindications:
is anti-diarrheal and atropine is Nervous system: numbness of extremities,
anticholinergic. Diphenoxylate is chemically euphoria, depression, malaise/lethargy,
Lomotil is contraindicated in patients with
related to the narcotic drug meperidine. A confusion, sedation/drowsiness, dizziness,
subtherapeutic amount of atropine sulfate is 1. Known hypersensitivity to diphenoxylate restlessness, headache.
present to discourage deliberate overdosage. Allergic: anaphylaxis, angioneurotic edema,
or atropine.
Atropine has no anti-diarrheal properties, but urticaria, swelling of the gums, pruritus.
2. Obstructive jaundice.
will cause tachycardia when overused. The Gastrointestinal system: toxic megacolon,
3. Diarrhea associated with
medication diphenoxylate works by slowing paralytic ileus, pancreatitis, vomiting, nausea,
pseudomembranous enterocolitis or
down the movement of the intestines. The anorexia, abdominal discomfort.
enterotoxin-producing bacteria.
inactive ingredients of Lomotil (as a liquid - it The following atropine sulfate effects are
comes in pill form as well) are cherry flavor, listed in decreasing order of severity, but not
Warnings:
citric acid, ethyl alcohol 15%, FD&C Yellow of frequency: hyperthermia, tachycardia,
Lomotil IS NOT AN INNOCUOUS DRUG
No. 6, glycerin, sodium phosphate, sorbitol, urinary retention, flushing, dryness of the skin
AND DOSAGE RECOMMENDATIONS
and water. Other trade names for the same and mucous membranes. These effects may
SHOULD BE STRICTLY ADHERED TO,
therapeutic combination are Lofene, Logen, occur, especially in children.
ESPECIALLY IN CHILDREN. Lomotil IS
Lomanate and Lonox, among others. In other
NOT RECOMMENDED FOR CHILDREN
countries, Lomotil may have other names. In THIS MEDICATION SHOULD BE KEPT IN
UNDER 2 YEARS OF AGE. OVERDOSAGE
the United States, Lomotil (Diphenoxylate A CHILD-RESISTANT CONTAINER AND
MAY RESULT IN SEVERE RESPIRATORY
HCl and atropine sulfate) is classified as a OUT OF THE REACH OF CHILDREN
DEPRESSION AND COMA, POSSIBLY
Schedule V controlled substance by federal SINCE AN OVERDOSAGE MAY RESULT
LEADING TO PERMANENT BRAIN
law, and is available only for a medical IN SEVERE RESPIRATORY DEPRESSION
DAMAGE OR DEATH (SEE
purpose. AND COMA, POSSIBLY LEADING TO
OVERDOSAGE). THEREFORE, KEEP THIS
PERMANENT BRAIN DAMAGE OR
MEDICATION OUT OF THE REACH OF
DEATH.
CHILDREN.
THE USE OF Lomotil SHOULD BE
Drug Abuse and Dependence:
ACCOMPANIED BY APPROPRIATE
FLUID AND ELECTROLYTE THERAPY,
WHEN INDICATED. IF SEVERE
DEHYDRATION OR ELECTROLYTE Controlled Substance:
IMBALANCE IS PRESENT, Lomotil
SHOULD BE WITHHELD UNTIL Lomotil is classified as a Schedule V
APPROPRIATE CORRECTIVE THERAPY controlled substance by federal regulation.
HAS BEEN INITIATED. DRUG-INDUCED Diphenoxylate hydrochloride is chemically
INHIBITION OF PERISTALSIS MAY related to the narcotic analgesic meperidine.
RESULT IN FLUID RETENTION IN THE
INTESTINE, WHICH MAY FURTHER Drug abuse and dependence:
AGGRAVATE DEHYDRATION AND
ELECTROLYTE IMBALANCE. In doses used for the treatment of diarrhea,
Lomotil SHOULD BE USED WITH whether acute or chronic, diphenoxylate has
SPECIAL CAUTION IN YOUNG not produced addiction.
CHILDREN BECAUSE THIS AGE GROUP Diphenoxylate hydrochloride is devoid of
MAY BE PREDISPOSED TO DELAYED morphine-like subjective effects at therapeutic
DIPHENOXYLATE TOXICITY AND doses. At high doses it exhibits codeine-like
BECAUSE OF THE GREATER subjective effects. The dose which produces
VARIABILITY OF RESPONSE IN THIS antidiarrheal action is widely separated from
AGE GROUP. the dose which causes central nervous system
effects. The insolubility of diphenoxylate
Antiperistaltic agents may prolong and/or hydrochloride in commonly available aqueous
worsen diarrhea associated with organisms media precludes intravenous self-
that penetrate the intestinal mucosa (toxigenic administration. A dose of 100 to 300 mg/day,
E. coli, Salmonella, Shigella), and which is equivalent to 40 to 120 tablets,
pseudomembranous enterocolitis associated administered to humans for 40 to 70 days,
with broad-spectrum antibiotics. produced opiate withdrawal symptoms. Since
Antiperistaltic agents should not be used in addiction to diphenoxylate hydrochloride is
these conditions. possible at high doses, the recommended
In some patients with acute ulcerative colitis, dosage should not be exceeded.
agents that inhibit intestinal motility or
prolong intestinal transit time have been
reported to induce toxic megacolon.
Consequently, patients with acute ulcerative
colitis should be carefully observed and
Lomotil therapy should be discontinued
promptly if abdominal distention occurs or if
other untoward symptoms develop.

Since the chemical structure of diphenoxylate


hydrochloride is similar to that of meperidine
hydrochloride, the concurrent use of Lomotil
with monoamine oxidase (MAO) inhibitors
may, in theory, precipitate hypertensive crisis.
Lomotil should be used with extreme caution
in patients with advanced hepatorenal disease
and in all patients with abnormal liver
function since hepatic coma may be
precipitated.
Diphenoxylate hydrochloride may potentiate
the action of barbiturates, tranquilizers, and
alcohol. Therefore, the patient should be
closely observed when any of these are used
concomitantly.

Drug Interactions:

Known drug interactions include barbiturates,


tranquilizers, and alcohol. Lomotil may
interact with MAO inhibitors (see Warnings).
In studies with male rats, diphenoxylate
hydrochloride was found to inhibit the hepatic
microsomal enzyme system at a dose of 2
mg/kg/day. Therefore, diphenoxylate has the
potential to prolong the biological half-lives of
drugs for which the rate of elimination is
dependent on the microsomal drug
metabolizing enzyme system.