DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Simvastatin 40mg/tab 1 tab OD at hs (p.o.

) PHARMACOLOGIC ACTION OF DRUG INDICATIONS AND CONTRAINDICATIONS ADVERSE EFFECTS OF THE DRUG

NURSING RESPONSIBILITIES /PRECAUTIONS Assess nutrition: fat, protein, carbohydrates Monitor bowel pattern daily Monitor triglycerides, cholesterol baseline throughout treatment

Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

Indications Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, MI and reduction in need for bypass surgery and angionplasty in patients with coronary heart disease and hypercholesterolemia Treatment of patients with isolated hypertriglyceridemia Treatment of type III hyperlipoproteinemia Treatment of adolescents 10-17 yr with heterozygous familial hypercholesterolemia

CNS: Headache, asthenia, sleep disturbances GI: Flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure Respiratory: Sinusitis, pharyngitis Other: Rhabdomyolysis, acute renal failure, arthralgia, myalgia

Precautions: Past liver disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, elderly, renal disease

Classification Diuretics Generic Name: Furosemide Brand Name: Lasix

Mechanism of Action A potent loop diuretic that inhibit sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

Indication and Contraindication Indication: Acute pulmonary edema, edema, hypertension Contraindication: Contraindicated to patients hypersensitivity to drug and in those with anuria Use cautiously in patients with hepatic cirrhosis and in those allergic to sulfonamidfes. Use furosemide during pregnancy only if potential benefits to mother clearly out weight risks to fetus.

Side Effects CNS: vertigo, headache, dizziness, paresthesia, weakness, restlessness,fever. CV: orthostatic, hypotension; thrombophlebitis with I.V administration EENT: transient deafness, blurred or yellowed vision GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation Hepatic: Hepatic Dysfunction Metabolic: volume depletion and dehydration, asymptomatic hyperuricemia, impaired glucose intolerance, hypokalemia, hypochloremic alkalosis, fluids and electrolyte imbalance Musculoskeletal: muscle spasm Skin: dermatitis, purpura, photosensitivity, transient pain at I.V injection site

Nursing Responsibilities Observe 10 Rs in giving medication. Monitor weight, blood pressure, and pulse rate routinely with long term use and during rapid dieresis. Furosemide can lead to profound and electrolyte depletion. Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide level frequently. Watch for signs of hypokalemia such as muscle weakness and cramps Advise patient to immediately report ringing ears, severe abdominal pain, or soar throat and fever which may indicate furosemide toxicity.

GENERIC/ TRADE NAME Fluticasone, Salmeterol SERETIDE Dosage: 500 mcg Diskus 1 PUFF BID

Mechanism Of Action

INDICATION

SIDE EFFECTS

NURSING RESPONSIBILITIES

Seretide contains salmeterol and fluticasone propionate which have different modes of action. Salmeterol protects against symptoms, fluticasone propionate improves lung function and prevents exacerbations of the condition. Seretide can offer a more convenient regimen for patients on concurrent agonist and inhaled corticosteroid therapy. The respective mechanisms of action of both drugs are discussed as follows: Salmeterol: Salmeterol is a selective longacting (12 hrs) 2adrenoceptor agonist with a long side chain which

Regular treatment of reversible obstructive airways disease (ROAD), including asthma where use of combination therapy (bronchodilator and inhaled corticosteroid) is appropriate. Maintenance treatment of chronic obstructive pulmonary disorder including chronic bronchitis and emphysema. Contraindication: Contraindicated in patients hypersensitive to drug or any of its components. Also contraindicated as primary therapy for status asthmaticus or other potentially life threatening acute asthmatic episodes.

Salmeterol: Tremor, subjective palpitations and headache, cardiac arrhythmias, arthralgia, hypersensitivity reactions, muscle cramps (rarely). Fluticasone: Hoarseness, candidiasis of mouth and throat, paradoxical bronchospasm.

Instruct patient to keep the Diskus in a dry place, to avoid washing the mouthpiece or other parts of the device, and to avoid taking the Diskus apart.

Tell patient to stop taking an oral or inhaled long-acting beta2 agonist simultaneously when beginning the Diskus.

Instruct patient to rinse mouth after 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.

Drug isnt indicated for exercise-induced bronchospasm.

DRUGS

ACTION

INDICATION

ADVERSE REACTION

NURSING

PATIENT

CONSIDERATION Date Ordered: August 19, 2010 Generic Name: Cefixime Brand Name: Tergecef Dosage: 200 mg 1 tab BID Classification: Anti-infective (Third Generation Cephalosporin Antibiotic) Cefixime, an antibiotic, is a third-generation cephalosporin like ceftriaxone and cefotaxime. Cefixime is highly stable in the presence of betalactamase enzymes. As a result, many organisms resistant to penicillins and some cephalosporins due to the presence of betalactamases, may be susceptible to cefixime. The antibacterial effect of cefixime results from inhibition of mucopeptide synthesis in the bacterial cell wall. Like all beta-lactam antibiotics, cefixime binds to specific penicillinbinding proteins (PBPs) located inside the bacterial cell wall, causing the inhibition of the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that cefixime interferes with an autolysin inhibitor. Bronchitis, Bronchiectasis with infection, secondary infections of chronic respiratory tract diseases, pneumonia, otitis media, sinusitis. Pyelonephritis, cystitis, gonococcal urethritis, cholecystitis, cholangitis. Scarlet fever. Shock, granulocytopenia or eosinophilia, anaphylactoid symptoms, Stevens-Jonhson syndrome, hematologic disorder, acute renal failure, psuedomembranous colitis, interstitial pneumonia or Pulmonary Interstitial Emphysema (PIE) syndrome, GI disturbances, Vitamin B deficiency. Assess patients previous sensitivity reaction to penicillin or other cephalosporins. Cross-sensitivity is common. Assess for allergic reaction and anaphylaxis: rash, urticaria, pruritus, chills, fever or joint pain. Assess renal function before and during therapy: urine output, BUN and creatinine. Monitor for nephrotoxicity. Assess for possible superinfection: fever, malaise, redness, pain, swelling, rash.

TEACHINGS Advise patient to take drug exactly as prescribed and to continue to take full amount prescribed even when he feels better. Instruct patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.