You are on page 1of 14

CHINESE GENERAL HOSPITAL COLLEGE OF NURSING DRUG STUDY Patients Name: Josephine Samson Age: 46 years old Drugs

Drug Classification & Mechanism of action Indication Contraindication Side effect / Adverse reaction Nursing Considerations

Brand Name: Zegen Generic Name: Cefuroxime Dose: 750mg Route: IVT Frequency: Q8 x 3 dose

Antibiotic Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death.

Oral

(Cefuroxime axetil) Pharyngitis Otitis Media Lower respiratory infections UTIs Uncomlpicated gonorrhea Dermatologic infections including impetigo Treatment of early Lyme disease Parenteral (Cefuroxime Sodium) Lower respiratory infections Dermatologic infections UTIs Uncomplicated and disseminated gonorrhea Septicemia Meningitis Bone and joint infections Perioperative prophylaxis

Contraindica ted with allergy to cephaloporin s or penicillin Use cautiously with renal failure, lactation and pregnancy

CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembrano us colitis, liver toxicity GU: Bone marrow depression (decreased WBC, decreased platelets, decreased Hct) Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction Local: Pain, abscess at injection site, phlebitis, inflammation at IV site Other: Superinfections, disulfiram like reaction with

Assess patient from infection at the beginning and during the therapy. Question for history of allergies, particularly cephalosporins and penicillin. Give oral drug with food to decrease GI upset and enhance absorption. Monitor bowel activity and stool consistency carefully. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngealedema, wheezing). Have vitamin K available in case hyperprothrombinemia occurs. Discontinue if hypersensitivity reaction occurs.

alcohol NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Drugs

Drug Classification & Mechanism of action

Indication

Contraindication

Side effect / Adverse reaction

Nursing Considerations

Brand Name: Eliphorin Generic Name: Cephalexin Dose: 500 mg cap Route: Oral Frequency: TID for two days

Antibiotic Bactericidal: inhibu=its the syntheisis of the bacterial cell wall, causing death.

Respiratory tract infections Skin and skin structure infections Otitis Media Bone infections GU infections

Contraindica ted with allergy to cephalospori ns or penicillins. Use cautiously with renal failure, lactation and pregnancy.

CNS: headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous GU: Nephroxicity Hematologic: Bone marrow depression Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness reaction Other: Superinfections

Assess patient from infection at the beginning and during the therapy. Question for history of allergies, particularly cephalosporins and penicillin. Monitor bowel activity and stool consistency carefully. Give drug with meals; arrange for small, frequent meals if GI complications occur. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngealedema, wheezing).

NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Drugs

Drug Classificati

Indication

Contraindication

Side effect / Adverse reaction

Nursing Considerations

Brand Name: Flanax Forte Generic Name: Naproxen Na Dose: 550mg tab Route: Oral Frequency: TID for two days

on & Mechanism of action Analgesic: anti inflammator y, and anti pyretic activities largely related to inhibition of prostaglandi n synthesis; exact mechanisms of action are not known.

Mild to moderate pain Treatment of primary dysmenorrhea , rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tenditis, bursitis, acute gout OTC Use: Temporary relief of minor aches and pains associated with the common colds, headache, toothache, muscular aches, back aches, minor pain of arthritis, pain of menstrual cramps, reduction of fever

Contraindic ated with allergy to naproxen, salicylates, other NSAIDS; pregnancy; lactation Use cautiously with asthma, chronic urticaria, CV dysfunction; hypertensio n; GI bleeding; peptic ulcer; impaired hepatic or renal function

CNS: headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmic effects Dermatologic: rash, pruritus, sweating, dry mucous membranes, stomatitis GI: nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence GU: dysuria, renal impairment, including renal failure, interstitial nephritis hematuria Hematologic: bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopinia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia Respiratory: dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Other: peripheral edema, anaphylactoid reactions to

Assess patient from pain at the beginning and during the therapy. Question for history of allergies, particularly naproxen, salicylates and other NSAIDS. Give with food or after meals if GI upset occurs. Arrange for periodic ophthalmologic examination during long term therapy. Monitor blood pressure closely. Drug may cause hypertension. Watch for fluid retention because of naproxen sodium content. Rehydrate a dehydrated patient befor giving the drug. If renal patient has renal disease, monitor renal function closely during therapy. Observe patient for signs of rash or other hypersensitivity reaction. Assess drug effectiveness.

anaphylactic shock NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Drugs

Drug Classification & Mechanism of action

Indication

Contra-indication

Side effect / Adverse reaction

Nursing Considerations

Brand Name: Glumet Generic Name: Metformin hydrochloride Dose: 500mg tab Route: Oral Frequency: TID on full diabetic diet

Antidiabetic exact mechanism is not understood; possibly increases peripheral utilization of glocuse, decreases hepatic glocuse production and alters intestinal absorption of glocuse.

Adjunct to diet to lower blood glucose with type ii (non insulin dependent) diabetes mellitus in patients 10 yr; extended release in patients 17 yr As part of combination therapy with a sulfonylurea or insulin whether drug alone cannot control glucose levels in patients with type II Diabetes Mellitus

Drugs

Drug Classification &

Endocrine: Assess patient blood glucose Contraindicated hypoglycemia, count beginning and during with allergy with lactic acidosis the therapy. metformin; CHF; Question for history of diabetes GI: anorexia, allergies, particularly complicated with nausea, vomiting, metformin. fever, severe epigastric Monitor urine or serum infections, severe discomfort, glucose levels frequently trauma, major heartburn, to determine effectiveness surgery, ketosis, diarrhea, of drug and dosage. acidosis, coma flatulence Arrange for transfer insulin (use insulin); type therapy during periods of I (insulin Hypersensitivity: high stress (infections, dependent) allergic skin surgery, and trauma). diabetes, serious reactions, eczema, Use IV glucose if severe hepatic pruritus, hypoglycemia occurs as a impairment, erythema, result of over lose. serious renal urticaria Do not discontinue this impairment, medication without uremia, thyroid or NO SIDE EFFECTS consulting health care endocrine EXPERIENCED BY THE provider. impairment, PATIENT Instruct patient to swallow glucosuria, extended release tablets hyperglycemia whole; do not cut, crush or associated with chew. renal disease; Do not give this drug labor and delivery during pregnancy. (if metformin is used during pregnancy, discontinue drug at least one month before delivery); lactation (safety not established. Use cautiously with the elderly Indication Contra-indication Side effect / Nursing Adverse reaction Considerations

Brand Name: Vidastat Generic Name: Simvastatin Dose: 40mg tab Route: Oral Frequency: Once a day

Mechanism of action Antihyperlipidemic HMG CoA reductase inhibitor Inhibits HMG CoA reductase, the enzyme that catalyses the first steo in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

Adjunct to diet in the treatment of elevated total cholesterol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and restriction of saturated fat and cholesterol and other nonpharmalogic measures To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, Mi, and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholoestrolemia Treatment of patients with isolated hypertriglyceridemia Treatment of type III hyperpoproteinemia Treatment of adolescents 10 17

Contraindicat ed with allergy to simvastatin, fungal byproducts; pregnancy, lactation Use cautiously with impaired hepatic and renal function, cataracts

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

NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Secure patients lipid studies. Question for history of allergies, simvastatin and fungal byproducts. Ensure that patient has tried cholesterol lowering diet regimen for 3 6 mos. before beginning therapy. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 am. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives. Arrange regular follow up during long term therapy.

yr with heterozygous familial hypercholeserolemia

Consider reducing dose if cholesterol falls below the target.

Drugs

Drug Classificati

Indication

Contra-indication

Side effect / Adverse reaction

Nursing Considerations

on & Mechanism of action Brand Opoiod Name: agonist Oxynorm analgesic acts as Generic agonist at Name: specific Oxycodone opioid hydrochlorid receptors in e the CNS toproduce Dose: analgesia, 2mg euphoria, sedation, the Route: receptore IVT mediating these effects Frequenc are thought y: to be the Q6 x 4 same as dose those mediating the effects of endogenous opioids (enkephalins , endorphins).

Relief to moderate to moderatel y severe pain CR tablets: managem ent of moderate to severe pain when a continuou s, around the clock analgesic is needed for an extended period of time

Contraindicated with hypersensitivity to opioids, diarrhea caused by poisoning (before toxins are eliminated); pregnancy (readily crosses placenta; neonatal withdrawal); labor or delivery (opioids given to the mother can cause respiratory depression in neonate; premature infants are at special risk, may prolong labor); bronchial asthma,COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial pressure, lactation Use cautiously with acute abdominal conditions, CV diseae, supraventricular tachycardias, myxedemia, seizure disorders, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Addisons disease, prostatic hyperthrophy,

CNS: light headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances CV: facial flushing, peripheral circulatory collapse, tachycardia, brabychardia, arrythemia, palpitations, chest wall rigidity,hypertension, hypotension, orthostatic hypotension, syncope, respiratory depression, shock, cardiac arrest Dermatologic: pruritus, urticaria, edema, hemorrhagic urticaria (rare) GI: Nausea, vomiting, sweating (more common in ambulatory patients and those without severe pain), dry mouth, anorexia, constipation, biliary tract spasm; increased colonic motility in patients with chronic ulcerative colitis GU: urethral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic

Question for history of hypersensitivity to opioids, diarrhea, pregnancy, labor or delivery, respiratory depression, bronchial asthma, COPD, anoxia, kyphoscoliosis, acute alcoholism and lactation. Administer to nursing women 4 6 hours before the next feeding to minimize amount of milk. Do not crush or allow patient to chew CR preparations. Administer immediate release preparations to cover breakthrough pain. Reassure patient that addiction is unlikely; most

urethral structure, recent GI or GU surgery, toxic psychosis, renal or hepatic dysfunction

effect, reduced libido or potency Respiratory: suppression of cough reflex, respiratory depression, apnea, respiratory arrest, laryngospasm, bronchospasm Other: physical tolerance and dependence, physiological dependence

patients who receive opiates for medical reasons do not develop dependence syndrome.

NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Drugs

Drug Classification & Mechanism of action

Indication

Contra-indication

Side effect / Adverse reaction

Nursing Considerations

Brand Name: Diamicron MR Generic Name: Gliclazide MR Dose: 30mg Route: Oral Frequency: BID

Oral hypoglycemic

Gliclazide selectively binds to sulfonylurea receptors on the surface of the pancreatic betacells. It was shown to provide cardiovascular protection as it does not bind to sulfonylurea receptors in the heart. This binding effectively closes the K+ ion channels. This decreases the efflux of potassium from the cell, which leads to the depolarization of the cell. This causes voltage dependent Ca++ ion channels to open increasing the Ca++ influx. The calcium can then bind to and activate calmodulin, which in turn leads to exocystosis of insulin vesicles leading to insulin release.

Used for the control of blood glucose in people with type 2 diabetes. It is used when diet, exercise, and weight reduction have not been found to control blood glucose well enough on their own. Gliclazide MR increases the amount of insulin released by the pancreas and helps the body use insulin more efficiently

Unstable and/or insulin dependent diabetes mellitus ketoacidosis coma; Known hypersensitivit y or allergy to gliclazide; During stress conditions such as serious infection trauma or surgery

Hypoglycemia: - Shakiness and paresthesia; - Nervousness; - Lack of energy; - Headache and sweating have been observed apart from Weakness; - Drowsines; - Dizziness; GI: Diarrhea, Epigastric fullness, Gastric irritation, Nausea, Vomiting Allergic reactions such as: - Erythema; - Morbiliform or maculopapular rash; - Pruritus; - Urticaria NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

Diamicron MR is for use in adults only. Should be taken with food, preferably at breakfast time Do not crush or allow patient to chew Always titrate dose according to individual patient requirements, in steps of 30mg Daily dose should not exceed 120mg Diamicron MR can replace other Gliclazide 80mg tablets, one for one

Drugs

Brand Name: Zantac Generic Name: Ranitidine Dose: 1 amp Route: IVT Frequency: Q12 x 2 dose

Drug Classificatio n& Mechanism of action Histamine2 antagonist competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin.

Indication

Contra-indication

Side effect / Adverse reaction

Nursing Considerations

Short term treatment of active duodenal ulcer Maintenance therapy for duodenal ulcer at reduced dosage Short 0- term treatment of active, benign gastric ulcer Short term treatment of GERD Pathologic hypersecreto ry conditions (e.g. Zollinger Ellison syndrome) Treatment of erosive esophangitis Treatment of heatburn, acid

Contraindicate d with allergy with ranitidine, lactation Use cautiously with impaired renal or hepatic function, pregnancy

CNS: headache, malaise, dizziness, somnolence, insomnia, vertigo CV: tachycardia, bradychardia, PVCs (rapid IV administration DERMATOLOGIC: rash, alopecia GI: constipation, diarrhea, nausea, vomiting, abdominal pain, hepatitis, increased ALT levels GU: gynecomastia, impotence or decreased libido HEMATOLOGIC: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia LOCAL: pain at IM site, local burning, or itching at IV site Other: arthralgias

Question for history of allergies, particularly to ranitidine, impaired renal or hepatic function, lactation pregnancy Administer local drug with meals and hs. Decrease dose in renal and liver failure Provide concurrent antacid therapy to relieve pain Arrange to regular follow up, including blood tests, to evaluate effects

NO SIDE EFFECTS EXPERIENCED BY THE PATIENT

ingestion, sour stomach

Submitted By: Bernardez, Kristin T.