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Generic Name: Allopurinol

Brand Name: Lopurin, Zyloprim, Alloprim, Alloprin, Novopurinol

Classification: Antigout agent

Indication: Control primary hyperuricemia that accompanies severe gout and to prevent possibility of flare up of acute gouty attack; to prevent recurrent Ca oxalate stones; prophylactically to reduce severity of hyperuricemia associated w/ antineoplastic & radiation therapies, both of which greatly increase plasma uric acid lvls by promoting nucleic acid degradation; Reduce hyperuricemia secondary to LeschNyhan syndrome, polycythemia vera, G6PD deficiency, sarcoidosis, & therapy w/ thiazides/ethambutol Mechanism of Action: Reduces endogenous uric acid by selectively inhibiting action of xanthine oxidase, the enzyme responsible for converting hypo-xanthine to xanthine and xanthine to uric acid (end product of purine catabolism). Thus, urate pool is decreased by the lowering of both serum and urinary uric levels, and hyperuricemia is prevented. A/E: Agranulocytosis, aplastic anemia, bone marrow depression Nursing Interventions:
>Monitor for therapeutic effectiveness which is indicated by normal serum & urinary uric acid lvls usually by 1-3 wks (aim of therapy is to lower serum uric acid lvl gradually about 6 mg/dL), gradual decrease in the size of tophi, absence of new tophaceous deposits(after approx 6 mo.) with consequent relief of joint pain and increased joint mobility; > Monitor for S&S of an acute gouty attack which is most likely to occur during 6 wk of therapy; > Monitor serum uric acid lvls q 1-2 wk to check adequacy of dosage. Perform baseline CBC, liver and kidney fxn tests before therapy is initiated and then monthly, particularly during first few months. Check urinary pH at regular intervals; > Monitor pts with renal d/o more often; they tend to have a higher incidence of renal stones and drug toxicity px; > Report onset of rash/fever immediately to physician; withdraw drug. Life threatening toxicity syndrome can occur 2-4 wk after initiation of therapy (more common w/ impaired renal fxn) and is generally accompanied by malaise, fever, and aching, a diffuse erythematous, desquamating rash, hepatic dysfxn eosinophilia, & worsening renal fxn; Pt. and Family Education: > Drink enough fld to produce urine output of at least 2L. Report diminishing urinary output, cloudy urine, unusual color/ odor to urine, pain/discomfort urinating; > Report onset of itch/rash. Stop drug if skin rash appears, even after 5/ more wk; > Minimize exposure of eyes to ultraviolet/sunlight w/c may stimulate development of cataracts; > Do not drive/ engage in potentially hazardous activities until response to drug is unknown; > Remain under medical supervision while taking allpurinol(generally continued indefinitely); > Do not breast feed while taking this drug without consulting physician

Generic Name: Ambroxol Hydrochloride Brand Name: Mucosolvan, Bioxol SR Classification: Mucolytic Indication: Adjuvant therapy in patients with abnormal, viscid or inspissated mucous secretions in acute and chronic bronchopulmonary diseases, & in pulmonary complications of cystic fibrosis & surgery, tracheostomy & atelectasis. Also used in dx bronchial studies & as an antidote for acute acetaminophen poisoning

Mechanism of Action: Ambroxol is an active N-desmethyl metabolite of the mucolytic, bromhexine. Ambroxol is shown to exert several activities, as follows: Its mucolytic activity by which it facilitates breakdown of acid mucopolysaccharide fibres in the mucous making it thinner and less viscous and, therefore, easy for expectoration; it stimulates the ciliary activity thereby improving mucokinesis (transport of mucous); it stimulates production of pulmonary surfactant, a substance found to play a major role in the lung host defense mechanism, thereby further protecting against lung inflammation and infection; also exhibits anti-inflammatory and antioxidant activity. When administered orally, onset of action occurs after about 30 minutes. S/E: Mild upper gastro-intestinal side effects (primarily pyrosis, dyspepsia, and occasionally nausea, vomiting) Mild upper gastro-intestinal side effects (primarily pyrosis, dyspepsia, and occasionally nausea, vomiting). Allergic reactions have occurred rarely, primarily skin rashes. There have been extremely rare case reports of severe acute anaphylactic-type reactions Nursing Intervention: >Monitor s&s of aspiration of excess secretions & for bronchospasm (unpredictable; withhold drug & notify physician immediately if either occur > Monitor ABGs, pulmonary functions and pulse oximetry as indicated >Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be liberated; suction or endotrachial aspiration may be necessary to establish and maintain an open airway > Ambroxol hydrochloride has not been shown to have any teratogenic or toxic effects on the fetus. It is advisable to avoid use during the first trimester of pregnancy. >Give after meals to reduce nausea Pt. and Family Education: >Remind client and SOs to report difficulty with clearing the airway or any other respiratory distress.

Generic Name: Aspirin (Acetylsalicyclic acid) Brand Name: Aspilets, Novasen, ZORpin, Cosprin, Triaphen-10 Classification: CNS agent, analgesic (nonopioid), salicylate, antipyretic, anti-inflammatory, antiplatelet, antirheumatic, NSAID Indication: Relieve pain of low to moderate intensity. Also various inflammatory conditions such as acute rheumatoid arthritis, osteoarthritis, bursitis and calcific tendonitis & to reduce fever in selected febrile conditions. Used to reduce recurrence of TIA due to fibrin platelet emboli and risk of stroke in men; to prevent recurrence of MI; as prophylaxis against MI in men w/ unstable angina; as prophylactic against thromboembolism; to prevent cataract and progression of diabetic retinopathy; & to control Sx r/t gluten sensitivity Mechanism of Action: Antiinflamm: Inhibits prostaglandin synthesis; involved in antigen removal; Analgesic & antirheumatic: Inhibits prostaglandin synthesis. Antipyretic: acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of prostaglandin intermediary. Antiplatelet: Inhibits platelet aggregation attributable to the inhibition of platelet synthesis of thromboxane A 2, a potent vasoconstrictor & inducer of platelet aggregation, this effect occurs at low doses & last for thr life of the platelet, higher doses inhibit synthesis of prostacyclin, a potent vasodilator & platelet aggregation inhibitor; high serum salicylate concentrations can impair hepatic synthesis of blood coagulation factors VII, IX, X possibly by inhibiting axn of vit. K.
Nursing Intervention: > Monitor loss of tolerance to aspirin; Sx (15min-3h) after ingestion: profuse rhinorrhea, erythema, n/v, intestinal cramps, diarrhea > Monitor salicylate toxicity. Adults-sensation of fullness in the ears, tinnitus, & /muffled hearing - chronic salicylate over dosage > Monitor diabetic child carefully for indicated need of insulin adjustment. Children- high dose of aspirin prone to hypoglycemia; >Potential toxicity is high in older adults and pts w/ asthma, nasal polyps, perennial vasomotor rhinitis, hay fever/chronic urticaria >Do not give to children/teenagers w/ Sx of varicella/influenza like illness bec of association of aspirin usage w/ Reyes syndrome >Use enteric coated/extended release tablets, buffered aspirin or administered w/ antacid to reduce GI disturbances Pt. and Family Education: >Take 1-2 d before menses when prescribed for dysmenorrhea >Discontinue aspirin therapy 1 wk before surgery to reduce risk for bleeding >Observe and report signs of bleeding (e.g petechiae, ecchymoses, bleeding gums, bloody stool, urine

Generic Name: Amlodipine besylate Brand Name: Norvasc Classification: Anatianginal, antihypertensive, Ca channel blocker Indication: Angina pectoris due to coronary artery spasm (Prinzmetals variant angina); chronic stable angina, alone or in combination with other drugs, to reduce risk of hospitalization and reduce need for coronary revascularization procedures in patients with angioraphically documented CAD w/o heart failure or ejection < 40 %, essential hypertension, alone/ in combi w/ other antihypertensives Mechanism of Action: Inhibits the movement of Ca ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane Ca flow, w/c results in the depression of impulse formation in specialized cardiac pacemaker cells, slowing the velocity of conduction of the cardiac impulse , depression of myocardial contractility ; and dilation of coronary arteries & arterioles and peripheral arterioles; these effects lead to decreased cardiac work; decreased cardiac O 2 consumption, and in pts. w/ vasospastic (Prinzmetals) angina, increased delivery of O2 to cardiac cells Blocks Ca ion reflux across cell membranes of Cardiac and vascular smooth muscle w/o changing serum Ca concentrations, predominantly acts on peripheral circulation decreasing peripheral vascular resistance and inc. CO Nursing Intervention: >Monitor BP carefully if pt. is also on nitrates for therapeutic effectiveness. BP reduction is greatest after peak levels, achieved 69 hrs following oral doses >Monitor for s&s of dose-related peripheral/facial edema that may not be accompanied by wt gain; rarely severe edema may cause discontinuation of drug >Monitor BP w/ postural changes; Report postural hypotension; Monitor more frequently when additional antihypertensives or diuretics are added >Monitor HR; dose related palpitations (more common in women) may occur Pt and Family Education: >Report significant swelling of face or extremities >Take care to have support when standing and walking due to possible dose-related light headedness/dizziness >Report shortness of breath, palpitations, irregular heartbeat nausea or constipation to physician >do not breastfeed while taking this drug w/o consulting physician >Take with meals if upset stomach occurs, >May experience n/v (eat frequent small meals), headache (adjust lighting, noise, med)

Generic Name: Etoricoxib Brand Name: Arcoxia Classification: Antirheumatic, NSAID Indication: Relief of acute pain; prescribed for osteoarthritis, rheumatoid arthritis and gouty arthritis. It blocks a substance in the body named as cyclo-oxygenase 2 (COX-2). Mechanism of Action: Arcoxia (etoricoxib) is a member of a class of arthritis/analgesia medications called coxibs. It is a highly selective inhibitor of cyclooxygenase-2 (COX-2). It exhibits anti-inflammatory, analgesic and antipyretic activities in animal models. Arcoxia is a potent, orally active, highly selective COX-2 inhibitor within and above the clinical dose range. Two isoforms of cyclooxygenase have been identified: Cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). COX-1 is responsible for prostaglandin-mediated normal physiologic functions eg, gastric cytoprotection and platelet aggregation. Inhibition of COX-1 by nonselective NSAIDs has been associated with gastric damage and platelet inhibition. COX-2 has been shown to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation and fever. Selective inhibition of COX-2 by etoricoxib decreases these clinical signs and symptoms with decreased GI toxicity and without effects on platelet function.Across clinical pharmacology studies, Arcoxia produced dose-dependent inhibition of COX-2 without inhibition of COX-1 at doses up to 150 mg daily.The influence on gastroprotective COX-1 activity was also assessed in a clinical study where prostaglandin synthesis was measured in gastric biopsy samples from subjects administered either Arcoxia 120 mg daily, naproxen 500 mg twice daily or placebo. Arcoxia did not inhibit gastric prostaglandin synthesis as compared to placebo. In contrast, naproxen inhibited gastric prostaglandin synthesis by approximately 80% compared with placebo. These data further support the COX-2 selectivity of Arcoxia.Platelet Function: Multiple doses of Arcoxia up to 150 mg administered daily up to 9 days had no effect on bleeding time relative to placebo. Similarly, bleeding time was not altered in a single-dose study with Arcoxia 250 or 500 mg. There was no inhibition of ex vivo arachidonic acid- or collagen-induced platelet aggregation at steady-state with doses of Arcoxia up to 150 mg. These findings are consistent with the COX-2 selectivity of etoricoxib. Nursing Intervention: >Use in caution with elderly people, history of disorders affecting the stomach or intestines, such as ulceration or bleeding, decreased kidney function and decreased liver function; >Monitor BP as it can cause hypertension >Provide assistance as it may cause weakness or loss of strength (asthenia) Pt. and Family Education: >Teach patient to take medicine or medication as ordered by the physician >Tell pt. to report disturbances of the gut such as diarrhea, constipation, n/v, indigestioln, flatulence or abdominal pain >Tell patient to maintain normal diet

Generic Name: Atropine sulfate (AtSO4) BN: AtropairIsopto, Atropisol Classification: ANS Agent; Anticholinergic ( parasympatholytic); antimuscarinic

Indication: Adjunct symptomatic ttt of GI d/o (PUD, pylorospasm, GI hypermotility, IBS) and spastic d/o of biliary tract; relaxes upper GI tract and colon during hypotonic radiography. Ophthalmic use: to produce mydriasis & cycloplegia before refraction and for ttt of anterior uveitis and iritis. Preop use: to suppress salivation, perspiration, and resp tract secretions, to reduce incidence of laryngospasm, reflex bradycardia, arrhythmia, &hypotension during GA. Cardiac uses: for sinus bradycardia/asystole during CPR/ that is induced by drugs/ toxic substances (eg.: pilocarpine, beta adrenergic blockers, organophosphate pesticides & Amanita mushroom poisoning); for mgmt of selected pts. w/ symptomatic sinus bradycardia and associated hypotension & ventricular irritability; for dx of sinus node dysfxn. Other uses: Oral inhalation for short term ttt & prevention of bronchospasms associated w/ asthma, bronchitis, & COPD & as drying agent in URI; Adjunctive therapy for hypermotility of GI tract. Mechanism of Action: Acts by selectively blocking all muscarinic responses to acetylcholine(Ach), whether excitatory/ inhibitory. Selective depression of CNS relieves rigidity and tremor of Parkinsons syndrome. Antisecretory axn (vagolytic effect) suppre sses sweating, lacrimation, salivation, and secretions from nose, mouth, pharynx and bronchi. Blocks vagal impulses to heart w/ resulting decrease in AV conduction time, increase in HR and CO, and shortened PR interval. AtSO4 is a potent bronchodilator when bronchoconstriction has been induced by parasympathomimetics. Produces mydriasis(dilation of pupils) & cyclopegia (paralysis of accommodation) by blocking responses of iris sphincter muscle & ciliary muscle of lens to cholinergic stimulation. Nursing Intervention:>Monitor v/s. HR (sensitive indicator of pts response to atropine). Alert! in changes in quality, rate, rhythm, RR, BP and temp > Initial paradoxical bradycardia ff. IV atropine usually lasts only 1-2 min; most likely occurs when IV admin. slowly (>1 min)/ when small doses (<0.5mg). Postural hypotension occurs when pt ambulates too soon after giving > Frequent & continued eye preparation use/overdosage systemic effect death from systemic absorption ff ocular admin to children/infants >Monitor CNS status. Older adults & debilitated pts sometimes manifest drowsiness/ CNS stimulation (excitement, agitation, confusion) w/ usual doses of drug/ other belladonna alkaloids. Dosage adjustment, side rails, and supervision of ambulation >Monitor I&O, esp. in older adults & pts who have had surgery (urinary retention). Palpate lower abdomen for distention. Have pt void before giving > Monitor infants, small children, & older adults for atropine fever (hyperpyrexia due to suppression of perspiration & heat loss), w/c increases the risk of heat stroke > Intraocular tension & depth of anterior chamber should be determined a & during therapy w/ ophthalmic prep to avoid glaucoma attacks > Inhalation manifest mild CNS stimulation w/ doses in excess of 5 mg & mental depression and other mental disturbances w/ larger doses Pt. and Family Education: > Dry mouth small frequent mouth rinses w/ tepid water, gum chewing/ suck sugarless sourballs > Avoid driving& other activities requiring visual acuity & mental alertness

Generic Name: Methylergonovine maleate Brand Name: Methergine Classification: Oxytocic, ANS agent, Adrenergic antagonist (sympatholytic), ergot alkaloid Indication: To prevent and treat postpartum hemorrhage caused by uterine atony/sub involution

Mechanism of Action: Increases motor activity of the uterus by direct stimulation of the smooth muscle, shortening the third stage of labor and reduces blood loss. Minimal vasoconstrictive activity
S/E: increased blood pressure (severe headache, blurred vision); seizure (convulsions); feeling light-headed, fainting; pounding heartbeat; chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; or hallucinations.

Generic Name: Domperidone Brand Name: Motilium, Adzole DM Classification: Antiemetic; dopaminergic blocking agent Indication: Dyspeptic symptom complex that is often associated with delayed gastric emptying, gastro-oesophageal reflux and oesophagitis: epigastric sense of fullness, early satiety, feeling of abdominal distension, upper abdominal pain; bloating, eructation, flatulence; nausea and vomiting; heartburn with or without regurgitation of gastric contents in the mouth; Nausea and vomiting of functional, organic, infectious or dietetic origin or induced by radiotherapy or drug therapy. A specific indication is nausea and vomiting induced by dopamine agonists, as used in Parkinsons disease (such as L -dopa and bromocriptine).

Nursing Intervention: >Contraindicated in pregnant patients, in patients sensitive to ergot preparations and in patients with hypertension/toxemia >Use cautiously in patients with sepsis, obliterative vascular dse, or hepatic or renal dse Use cautiously during last stage of labor >Monitor v/s particularly BP and uterine response during & after parenteral administration until partum period is stabilized (1-2 h) >Notify physician if BP suddenly increases/ if there are frequent periods of uterine relaxation Pt. and Family Education: > Report severe cramping for increased bleeding > Report any of the ff: Cold/numb fingers or toes, nausea or vomiting. Chest/ muscle pain >Do not breastfeed while taking this drug

Mechanism of Action: Domperidone is a dopamine antagonist (blocking both D1 & D2 receptors) which is structurally related to the benzimidazole. Domperidone is a potent gastrokinetic agent. Domperidone facilitates gastrointestinal smooth muscle activity by inhibiting dopamine at the D1 receptors and inhibiting the release of neural acetylcholine by blocking D2 receptors. Domperidone binds with high affinity to the dopamine receptor. It does not cross the blood -brain barrier or the placental barrier but exerts its effects at peripheral sites: the chemoreceptor trigger zone (in the brainstem) and the gastrointestinal tract. Domperidone inhibits dopamine induced gastric relaxation and the inhibitory effects of secretin, whose actions may be mediated by dopamine release. Finally, it stimulates phasic activity in the gastro-duodenal area and improves gastro-duodenal coordination. Antiemetic: The antiemetic properties of domperidone are related to its dopamine receptor blocking activity at both the chemoreceptor trigger zone and at the gastric level. It has strong affinities for the D2 and D3 dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which among others - regulates nausea and vomiting
S/E: dry mouth, headache, insomnia, dizziness, thirst, transient mild abdominal cramps, diarrhea, nostalgia Nursing Intervention: >Take this medication by mouth as prescribed usually 30 minutes before meals and at bedtime, take tablets with a drink of water Pt. and Family Education: >Obtain medical attention if fainting, dizziness, irregular heartbeat or pulse, or other unusual symptoms occur >Do not increase your dose or take this more often than directed >Inform of potential side effects and to seek further advice should these occur >Side effects include transient intestinal cramps; extrapyramidal side effects, urticaria and allergic reactions

Generic Name: Azithromycin Brand Name: Zithromax Classification: Macrolide antibiotic, antiinfective Indication: Pneumonia, lower respiratory tract infxn, pharyngitis/tonsillitis, gonorrhea, nongonococcal urethritis, skin and skin structure infections due to susceptible organisms, otitis media, Mycobacterium avium intracellulare complex (MAC) infections in patients with advanced AIDS Mechanism of Action: Reversibly binds to 50s ribosomal subunit of susceptible organisms and consequently inhibits protein synthesis S/E: Headache, dizziness, nausea, vomiting, diarrhea, abdominal pain; hepatotoxicity, mild elevation in liver fxn tests Nursing Intervention: >Culture site of infection before therapy. >Administer on an empty stomach--1 hr before or 23 hr after meals. Food affects the absorption of this drug >Monitor PT and INR closely w/ concurrent warfarin use Pt. and Family Education: >Counsel patients being treated for STDs about appropriate precautions and additional therapy >Monitor and report loose stools/ diarrhea, since pseudomembranous colitis must be ruled out
Generic Name: Betahistine dihydrochloride Brand Name: Serc, Hiserk, Betaserc Classification: antivertigo, antiemetics

Generic Name: Mefenamic acid Brand Name: Ponstel Classification: NSAID, CNS agent, Analgesic, Antipyretic Indication: Relief of moderate pain when therapy will not exceed 1 week, treatment of primary dysmenorrhea Mechanism of Action: Anti-inflammatory, antipyretic activities related to inhibition of prostaglandin synthesis and affects platelet fxn. Analgesic, antipyretic and ainti-inflamm axns similar to those of ibuprofen S/E: Drowsiness, dizziness, bleeding, agranulocytosis, nephrotoxicity, rash, ear pain, blurred vision, palpitation, dyspnea Nursing Intervention: >Take the drug with food >WOF dizziness and drowsiness >Discontinue drug and consult your health care provider if rash, diarrhea, or digestive problems occur >Use cautiously with asthma, renal/hepatic impairment, PUD, GI bleeding, HPN, heart failure, pregnancy, lactation >With long term therapy (not recommended) obtain periodic CBC, Hct and Hgb, and kidney fxn >Monitor blood glucose for loss of glycemic control if diabetic Pt. and Family Education: >Do not drive/ engage in potentially hazardous activities until response to drug is known

Indication: Menieres disease, Meniere-like syndrome (with symptoms of vertigo, tinnitus and sensorineural deafness) and vertigo of peripheral origin

Mechanism of Action: Have a very strong affinity as an antagonist for histamine H3 receptors & a weak affinity as an agonist for histamine H1 receptors. Seems to dilate the blood vessels within the middle ear which can relieve pressure from excess fluid and act on the smooth muscle. Has two modes of action: Primarily, it has a direct stimulating (agonistic) effect on H1 receptors located on blood vessels in the inner ear. This gives rise to local vasodilation and increased permeability, w/c helps to reverse the underlying problem of endolymphatic hydrops. Has a powerful antagonistic effects at H3 receptors, and increases the levels of neurotransmitters released from the nerve endings. This is thought to have two consequences: Increased amounts of histamine released from histaminergic nerve endings can stimulate H1 receptors, thus augmenting the direct agonistic effects of betahistine on these receptors. This explains the potent vasodilatory effects in the inner ear, which are well documented Increases the levels of neurotransmitters such as serotonin in the brainstem, which inhibits the activity of vestibular nuclei.
Nursing Intervention: >Avoid contact of oral solution/injection with skin >Raise bed rails, institute safety measures, supervise ambulation > Patients suffering from pheochromocytoma, bronchial asthma need to be carefully monitored during the therapy. Caution should be taken in the treatment of patients with a history of peptic ulcer. Pregnancy risk category Adverse Effects: Occasionally patients have experienced gastric upset, nausea and headache. Pt. and Family Education: >Take w/ food, Support patients ambulation, protect med from moisture; Do not giveto children. Swallow tablet whole with 1 full glass of water, never take a double dose if you missed one medication. If you missed one, take medication immediately.

Generic Name: Pilocarpine hydrochloride/nitrate Brand Name: Miocarpine, Salagen, Isopto Classification: Eye preparation, miotic(antiglaucoma agent); ANS agent; direct-acting cholinergic (parasympathomimetic) Indication: Open-angle and angle-closure glaucomas; to reduce IOP and to protect the lens during surgery and laser iridotomy; to counteract effects of mydriatics and cycloplegics ff surgery/ ophthalmoscopic exam; to treat xerostomia Mechanism of Action: Tertiary amine that acts directly on cholinergic receptor sites, thus mimicking acetylcholine. Induces miosis, spasm of accommodation, and fall in intraocular pressure (IOP) that may be preceded by a transitory rise; Decrease in IOP results from stimulation of ciliary and papillary sphincter muscles, which pull iris away from filtration angle, thus facilitating outflow of aqueous humor C/I: 2ndary glaucoma, acute iritis, acute inflamm dse of anterior segment of eye; pregnancy (category C), lactation Nursing Intervention:>Be aware that hourly tonometric tests may be done during early ttt bec drug may cause an initial transitory increase in IOP >Ocular Therapeutic System Review info/directions about inserting the ocular system included in the drug package w/ health care provider. Demonstrate to establish ability to adjust, insert, and remove the system; unit is placed in the eye cul-de-sac, where it remains for a wk. slow release of drug provides nonfluctuating concentration of pilocarpine in the ciliary body and iris; induced myopia, miosis, and spasm of accommodation are less than that produced by eyedrops. However, since transient blurring and dimness of vision may occur ff Ocusert insertion, have pt do so at bedtime; myopia will be at a stable level at am; several hours after insertion, induced myopia decreases to a low base lvl that persists for the life of the therapeutic system; notify physician if ff sx does not subside: conjunctival irritation w/ mild erythema and increase in mucus secretion; generally accompany early use of ocusert; wash system w/ cool tap water before replacing it into cul-de-sac if it contacts an unclean surface; retention of system: superior conjunctival cul-de-sac may be preferred for insertion and during sleep; change placement: may be transferred from lower conjunctival sac to superior by closing eyelids, rolling the eye towards the nose and w/ gentle digital pressure through the closed eyelid, directly moving the system. Avoid moving it over the colored part of the eye; remove system and replace w/ new one if an unexpected increase in drug axn occurs(sudden miosis, ciliary spasm, decreased visual acuity) Pt. and Family Education: >Monitor changes in visual acuity >Monitor for adverse effects. Brow pain and myopia tend to be more prominent in younger pts and generally disappear w/ continued use of drug >Pt- understand that therapy for glaucoma is prolonged & that adherence to established regimen is crucial to prevent blindness, do not drive/ engage in potentially hazardous activities until vision clears. Drug causes blurred vision and difficulty in focusing, discontinue medn if sx of irritation/sensitization persist and report to physician

Generic Name: Cinnarizine Brand Name: Stugeron Forte Classification: Peripheral Vasodilators & Cerebral Activators / Antivertigo Drugs Indication: Prescribed for the control of nausea and vomiting due to motion sickness. It is also used for vertigo, vestibular disorders and brain disorder, Peripheral vascular disease, Cerebrovascular disorders; Blocks the histamine action, which reduces allergy symptoms Mechanism of Action: Cinnarizine has calcium-channel blocking activity selective for arterial smooth muscle. It also has some antihistamine activity. Cinnarizine acts as a labyrinthine sedative. It also improves microcirculation by reducing ischaemia - induced blood viscosity. Absorption: Absorbed from the GIT (oral); peak plasma concentrations after 2-4 hrs. Excretion: Via feces (as unchanged drug), via urine (as metabolites); 3-6 hrs (elimination half-life). Side effects: Headache, dry mouth, weight gain, perspiration or allergic reactions Nursing Intervention: > As with other antihistamines, cinnarizine may cause epigastric distress; taking it after meals may diminish gastric irritation Pt. and Family Education: >Cinnarizine may cause somnolence, especially at the start of treatment. Therefore, caution should be taken when alcohol or CNS depressants are used concomitantly.
Generic Name: Epinephrine Bitartrate/Hydrochloride; Epinephrine, Racemic/ Epinephryl Borate Brand Name: Epipen, Primatene, Bronkaid Mist Suspension, Adrenalin, Epinal Classification: ANS agent, Alpha and Beta-adrenergic agonist, Bronchodilator Indication: Temporary relief of bronchospasm, acute asthmatic attack, mucousal congestion, hypersensitivity & anaphylactic rxns, syncope due to heart block/carotid sinus hypersensitivity, & restore cardiac rhythm in arrest. Ophthalmic prep-mgmt of simple(open-angle) glaucoma, generally as an adjunct to topical miotics & oral carbonic anhydrase inhibitors; ophthalmic decongestant. Relaxes myometrium and inhibits uterine contractions; prolongs axn and delays systemic absorption of local and intraspinal anes. Used topically to control bleeding

Generic Name: Loratadine 5 mg, betamethasone 250 mcg. Brand Name: Claricort Classification: Antihistamine Indication: Relief of symptoms of atopic dermatitis, angioedema, urticaria, seasonal &perennial allergic rhinitis, food & drug allergic reaction, allergic contact dermatitis, severe seborrheic dermatitis, neurodermatitis, allergic asthma, ocular allergic manifestations (eg conjunctivitis, iridociclitis & allergic reactionsto insect stings) Mechanism of Action: By using loratadine-betamethasone in combination, tablets combine the anti-inflammatory and antiallergic effect of the corticosteroid (betamethasone) with the nonsedating antihistamine (loratadine). >Loratadine is a potent long-acting tricyclic antihistamine with selective peripheral H 1-receptor antagonistic activity. >Glucocorticosteroids eg, betamethasone, cause profound and varied metabolic effects and modify the body's immune response to diverse stimuli. Side Effects: Fatigue, headache, somnolence, nervousness, dry mouth, GI disorders (e.g. nausea, gastritis) & allergic symptoms e.g.: rash Nursing Intervention: > Use combination with caution. >Monitor patient clinically Pt. and Family Education: >Take medication with food
Generic Name: Hydroxychloroquine Classification: Antiinfective, Antimalarial Brand Name: Plaquenil Sulfate

Mechanism of Action: Naturally occurring catecholamine, acts directly on both alpha and beta receptors; the most potent activator of alpha receptors. Strengthens myocardial contraction; increases systolic but may dec. diastolic BP; increases CR and CO Constricts bronchial arterioles and inhibits histamine release, thus reducing congestion & edema & in increasing tidal vol and vital capacity. Relaxes uterine smooth musculature & inhibits uterine contractions. Imitates all actions of sympathetic NS except those on arteries of the face & sweat glands Nursing Intervention: > Monitor BP, PR, RR, & UO & observe closely ff IV admin. Epi may widen pulse pressure. If disturbances in cardiac rhythm occur, withhold and notify Dr. > Keep Dr. informed of any changes in I&O ratio > Use cardiac monitor w/ pts receiving IV. Have crash cart immediately avail > Check BP repeatedly when admin. IV 1st 5 min, then q3-5 min until stable > Advise pt. report bronchial irritation, nervousness, sleeplessness-reduce dosage > monitor bld glucose & HbA1c Pt. and Family Education: > Be aware intranasal application may sting slightly, Admin ophthalmic drug at HS or ff. prescribed miotic to minimize mydriasis, w/ blurred vision & light sensitivity(glaucoma pts) > Ophthalmic admintransitory sting, headache & browache occur frequently at 1st but usually subside w/ continued use, notify Dr. if sx persists > Learn to admin subQ, keep medn equipment avail for home emergency, confer w/ Dr. > inhalationreduces bronchial secretions & thus makes mucous plugs more difficult to dislodge > continued use I presence of tolerance can be dangerous > take medn only as prescribed & immed notify Dr. of onset systemic effect > Discard discolored/precipitated solns > do not BF while taking the drug

Indication: Suppressive prophylaxis and ttt of acute malarial attacks due to all forms of susceptible malaria. Used adjunctively with primaquine for eradication of P. vivax and P. malariae. More commonly prescribed than chloroquine for ttt of RA and SLE (usually in conjuction with salicylate/ corticosteroid therapy. Treats fatigue and moderate skin and joint problems, prevents flares Mechanism of Action: Derivative closely related to chloroquine. Antimalarial activity is believed to be based on ability to form complexes to with DNA of parasite, thereby inhibiting replication and transcription to RNA and DNA synthesis of the parasite C/I:known hypersensitivity to, or retinal/ visual field changes associated with quinoline compounds, psoriasis, porphyria, long term therapy in children; pregnancy(category c) Nursing Intervention: >Monitor for therapeutic effectiveness; may not appear for several weeks, and maximal benefit may occur for 6 mos. >Baseline and periodic ophthalmoscopic exam and blood cell counts on long-term therapy pts. >Discontinue drug if weakness, visual sx, hearing loss, unusual bleeding, bruising, or skin eruptions occur Pt. and Family Education: >Follow drug regimen exactly as prescribed by the physician, do not BF, consult physician

Generic Name: Methotrexate/ M. Na

Brand Name: Amethopterin, Folex

Classification: Antineoplastic, antimetabolite, immunosuppressant

Indication: Principally in combination regimens to maintain induced remissions in neoplastic dses. Effective in ttt of gestational choriocarcinoma and hyatidiform mole and as immunosuppressant in kidney transplantation, for acute and subacute leukemias and leukemic meningitis, esp. in children. Used in lymphosarcoma, in certain inoperable tumors of head, neck, and pelvis, and in mycosis fungoides. Ttt of severe psoriasis non responsive to other form of therapy, RA Mechanism of Action: Antimetabolite and folic acid antagonist. Blocks folic acid participation in nucleic acid synthesis, thereby interfering with mitotic process. C/I: Pregnancy (category D), men and women in childbearing age; lactation, hepatic and renal insufficiency, comitant a admin of hepatotoxic drugs and hematopoietic depressants; ROH; ultraviolet exposure to psoriatic lesions; pre-existing bld dyscrasias
Nursing Intervention: >Obtain baseline liver and kidney fxn, CBC with differential, platelet count and chest x-rays. Repeat weekly during therapy >Prolonged ttt with small frequent doses may lead to hepatotoxicity, w/c is best diagnosed by liver biopsy >Monitor for and report ulcerative stomatitis with glossitis and gingivitis, often the first signs of toxicity. Inspect mouth daily; report patchy necrotic areas, bleeding and discomfort, or overgrowth (black, furry toungue) >keep pt well hydrated (2000mL/24hr) >monitor I&O ratio and pattern. Sever nephrotoxicity (hematuria, dysuria, azotemia, oliguria) fosters drug accumulation and kidney damage >prevent exposure to infxns/colds during leucopenia periods. Be alert to onset of agranulocytosis (cough, extreme fatigue, sore throat, chills, and fever) and report sx promptly. Therapy will be interrupted and appropriate antibiotic drugs prescribed. >be alert for and report sx of thrombocytopenia (e.g. ecchymoses, petechiae, epistaxis, melena, hematuria, vaginal bleeding, slow and protracted oozing following trauma) >report bloody diarrhea to physician; necessitates interruption of therapy to prevent perforation/hemorrhagic enteritis >monitor bld glucose and HbAlc periodically in diabetes Pt. and Family Education: >Pt- ROH increases severity of methotrexate hepatotoxicity, practice fastidious mouth care to prevent infxn, provide comfort and maintain adequate nutritional status, report joint pains to physician; drug may precipitate G. arthritis, do not self medicate w/ vitamins. Some OTC may contain folic acid that may alter methotrexate response, use contraceptive measures during and for at least 8 wk following therapy, avoid exposure to sunlight & ultraviolet light. Wear eyeglasses and sunscreen, do no BF while using the drug

Generic Name: Nifedipine Brand Name: Adalat, Procardia Classification: Cardiovascular agent, Ca channel blocker, antiarrhythmic (class IV), non-nitrate vasodilator Indication: Vasospastic variant or Prinzmetals angina and chronic stable angina w/o vasospasm. Mild to mod HPN alone/ in combi w/ a diuretic

Mechanism of Action: Selectively blocks Ca ion influx across cell membranes of cardiac muscle and vascular smooth muscle w/o changing serum Ca concentrations. Class IV antiarrythmic. Reduces myocardial exygen utilization & supply,relaxes, & prevents coronary artery spasm; has little/no effect on SA & AV nodal conduction e/ therapeutic dosing. Decreases peripheral vascular resistance & increases CO. vasodilation of both coronary and peripheral vessels is > that produced by verapimil/diltiazem & frequently results in reflex tachycardia. Decreased peripheral vascular resistance also leads to a rise in peripheral bld flow. Minimal effect on myocardial contractility
C/I: Known hypersensitivity. Safety during pregnancy (category C) or in children is not established Nursing Intervention: >Monitor BP carefully during titration period. Pt may become severely hypotensive, esp if also taking other drugs known to lower BP. Withhold drug and notify physician if systolic BP <90 >Monitor bld sugar in DM pts. Nifedipine has diabetogenic properties >Monitor for gingival hyperplasia & report promptly. This is a rare but serious A/E (similar to phenytoin induced hyperplasia) Pt. and Family Education: >Keep a record of nitroglycerin use & promptly report any changes in previous pattern. Occasionally, people develop increased frequency, duration, and severity of angina when they start ttt w/ this drug or when dosage is increased, withdrawal sx may occur w. abrupt discontinuation of the drug (chest pain, increase in angina episodes, MI, dysrhytmias), smoking decreases efficacy of nifedipine and has direct and A/E on the heart in the pt, do not BF, consult physician

Generic Name: Capsaicin Brand Name: Axsain, Capsin Classification: Skin and mucous membrane agent; topical analgesic Indication: Temporary relief of pain from arthritis, neuralgias, diabetic neuropathy, and herpes zoster Mechanism of Action: alkaloid derived from plants & is the active ingredient in hot peppers. Substance P is tought to act as a principal neurotransmitter of pain sensations from the peripheral neurons to the CNS; renders skin and joints insensitive to pain by preventing reaccumulation of substance P in peripheral sensory neurons. C/I: hypersensitivity Nursing Intervention: >Monitor for significant pain relief, which may require 4-6 wks of application, 3-4x/day >Monitor and report for signs of skin breakdown as these generally indicate need for discontinuation Pt. and Family Education: >Pt- report local discomfort at site of application, if discomfort is distressing/persist beyond the first 3-4 d of use, wash hands thoroughly before touching lenses, notify physician if sx do not improve/condition worsens w/in 14 28 days, apply frequently 3-4x daily to maximize therapeutic effectiveness

Generic Name: Tetracycline hydrochloride Brand Name: Achrocyclin, Tetram Classification: Antiinfective, antibiotic, tetracycline Indication: Chlamydial, mycoplasmal, ricketsial, spirochetal, gram + infxns; leptospirosis Mechanism of Action: Exerts anti-acne action by suppressing growth of Propionibacterium acnes w/in sebaceous

follicles, thereby reducing free fatty acid content in sebum. Free fatty acids are thought to be produced by breakdown of triglycerides by lipases liberated from P. acne and are believed to be largely responsible for inflammatory skin lesions and comedones of acne
C/I: Hypersensitivity, severe renal/hepatic impairment, common bile duct obstruction Nursing Intervention: >Obtain baseline & periodic C&S tests to confirm susceptibility of infecting organism to tetracycline. Initial and periodic kidney, liver, and hematopoietic fxn tests, det. Serum tetracycline lvls in pts at risk for hepatotoxicity >Be alert to evidence of superinfxns. Regularly inspect toungue & mucous membrane of mouth for candidiasis. Suspect superinfxn if pt complains of irritation/soreness of mouth, tongue, throat, vagina, or anus, or persistent itching of any area, diarrhea, or foul smelling excreta/discharge > Withhold drug & notify physician if superinfxn develops. Superinfxn occur most frequently in pts receiving prolonged therapy, the debilitated, or those who have DM, leukemia, SLE, or lymphoma >Obtain follow-up culture fr. all gonococcal infxn sites 3-7 d after completion of tetracycline therapy to verify eradication of infxn >Monitor I&O in pts-parenteral. Report oliguria/any changes in appearance of urine or in I&O Pt. and Family Education: >Meticulous care of mouth, skin, and perineal area, report onset of diarrhea. It is important to det whether diarrhea is due to irritating drug effect or superinfxns/ pseudomembranous colitis(caused by overgrowth of toxin producing bacteria: C. difficile). Te latter 2 conditions can be life threatening and require immediate withdrawal of tetracycline and prompt initiation of symptomatic and supportive therapy, avoid direct exposure to sunlight during and for several days after therapy is terminated to reduce possibility of photosensitivity rxn(appering like an exaggerated sunburn, it begins a few minutes to hours ff sun exposure, often with tingling, burning sensation), report onset of severe headache/ visual disturbances immediately. These are possible sx of increased ICP and necessitate prompt withdrawal of tetracycline to prevent irreversible visual loss, tetracycline for brucellosis/spirochetal infxns may cause a Jarisch-Herxheimer rxn. It is usually mild and appears abruptly 6-24 h after initiation of therapy. It is manifested by malaise, fever, chills, headache, adenopathy, leukocytosis, exacerbation of skin lesions, arthralgia, transient hypotension. Ttt is symptomatic, recovery generally occurs w/in 24 h, do not allow topical med to contact eyes, nose/mouth. It may stain clothing, clean affected area w/ soap and water; rinse and dry well before application of drug, skin treated w/ topical drug will exhibit bright yellow to green fluorescence under UV light and black light

Generic Name: Rebamipide Brand Name: Mucosta Classification: Antacid, Antireflux Agents & Antiulcerants Indication: Treatment of gastric mucosal lesions (erosion, bleeding, redness & edema) in acute gastritis & exacerbation of chronic gastritis; gastric ulcer, prevention of NSAID-induced gastropathy Mechanism of Action: Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow,prostaglandin biosynthesis and decrease free oxygen radicals. Stimulates prostaglandin generation in gastric mucosa and improves not only the speed but also the quality of ulcer healing. It protects the gastric mucosa against acute injury caused by various noxious and ulcerogenic factors. It increases gastric mucus glycoprotein components, stimulates migration and proliferation of wounded epithelial cell monolayers, increases expression of epidermal growth factor and its receptor in normal and ulcerated gastric mucosa, and scavenges active oxygen radicals. Also attenuates the activity of neutrophils and the production of inflammatory cytokines stimulated by NSAIDs and/or H. pylori. Therefore, rebamipide can contribute to the management of patients who are taking NSAIDs or are infected with H. pylori. The inhibition of immunoinflammatory responses by rebamipide in H. pylori-infected patients may prevent development of gastritis, peptic ulcer disease, its recurrence, and possibly gastric cancer. Moreover, rebamipide may enhance eradication of H. pylori-infection using standard eradication therapy. Further studies are needed to clarify these possible advantages of rebamipide. Adverse Reaction: Rash, pruritus, constipation, diarrhoea, nausea Nursing Intervention: >Monitor for any adverse reaction >Can be taken with meals or without meals, Assess if hypersensitive to drug >Assess for GI symptoms, Assess for skin rashes and other allergic reactions > administer the drug before meals. Pt. and Family Education: > Teach to take medications religiously to promote faster healing

Generic Name: Co-amoxiclav (amoxicillin & clavulanic acid)

Brand Name: Augmentin, Clavulin

Classification: Penicillin

Indication: To reduce the development of drug-resistant bacteria and maintain the effectiveness of AUGMENTIN (amoxicillin/clavulanate potassium) and other antibacterial drugs; to treat infections that are proven or strongly suspected to be caused by susceptible bacteria Mechanism of Action: Amoxicillin is a semisynthetic antibiotic with a broad spectrum of antibacterial activity against many gram-positive and gram-negative microorganisms. Amoxicillin is, however, susceptible to degradation by lactamases and therefore, the spectrum of activity of amoxicillin alone does not include organisms which produce these enzymes. Clavulanic acid is a -lactam, structurally related to the penicillins, which possesses the ability to inactivate a wide range of -lactamase enzymes commonly found in microorganisms resistant to penicillins and cephalosporins. In particular, it has good activity against the clinically important plasmid-mediated -lactamases frequently responsible for transferred drug resistance. It is generally less effective against chromosomally-mediated type 1 -lactamases. The presence of clavulanic acid in co-amoxiclav formulations protects amoxicillin from degradation by -lactamase enzymes, and effectively extends the antibacterial spectrum of amoxicillin to include many bacteria normally resistant to amoxicillin and other penicillins and cephalosporins. Thus, amoxicillin-clavulanate possesses the distinctive properties of a broad-spectrum antibiotic and a -lactamase inhibitor. A/E: Abdominal discomfort, allergic reactions, vomiting, diarrhea, rash, nausea, hyperactivity, drowsiness. Nursing Intervention: >Evaluate for infection, use barrier contraception >Monitor for S&S of a rash (usually occurring within a few days after start of drug) suggestive of a hypersensitivity reaction. If it occurs, look for other signs of hypersensitivity (fever, wheezing, generalized itching, dyspnea), and report to physician immediately >Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens prior to therapy; > Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results. >Monitor for S&S of an urticarial rash (usually occurring within a few days after start of drug) suggestive of a hypersensitivity reaction. If it occurs, look for other signs of hypersensitivity (fever, wheezing, generalized itching, dyspnea), and report to physician immediately. Pt. and Family Education: >Note: Generalized, erythematous, maculopapular rash (ampicillin rash) is not due to hypersensitivity. It is usually mild, but can be severe. Report onset of rash to physician, since hypersensitivity should be ruled out.

Generic Name: Telmisartan Brand Name: Micardis Classification: Cardiovascular agent, Antihypertensive, Angiotensin II receptor antagonist Indication: Treatment of hypertension Mechanism of Action: Selectively blocks the binding of angiotensin II to AT 1

receptors in many tissues (vascular smooth muscles, adrenal glands). Blocks the vasoconstricting and aldosterone-secreting effects of AT2 thus resulting in antihypertensive effect. Indicated by reduction in BP
A/E: Back pain, flu like syndrome, myalgia, headache, fatigue, dizziness, hypotension, chest pain, peripheral edema, diarrhea, dyspepsia, abdl pain, nausea, sinusitis, pharyngitis

Generic Name: Moringa oleifera (Malunggay) Brand Name: Natalac Classification: Gruppo Medical/Metropolitan Pharma Indication: Food supplement for breastfeeding mothers Mechanism of Action: Enhances milk let down, lactation and increases milk volume Nursing Intervention:

Nursing Intervention: >Monitor BP carefully after initial dose; & periodically thereafter. Monitor more frequently w/ preexisting biliary obstructive d/o or hepatic insufficiency >Monitor dialysis pts closely for orthostatic hypotension >Lab tests: Periodic Hgb, creatinine clearance, liver enzymes >Monitor concominant diggoxin lvls throughout therapy Pt. and Family Education: >Report pregnancy to physician immediately >Allow 2 4 wks for maximum therapeutic response

Pt. and Family Education: