VIII.

Drug(s) Analysis: Side Effect(s) & Adverse Effect(s) CNS: Sedation, drowsiness, dizziness, fatigue and lethargy GI: nausea and vomiting Nursing Considerations/Health Teaching(s) -Provide patients safety. -Administer medication with food to reduce gastric irritation. - Provide good oral hygiene including gum massage and frequent brushing. -Monitor for sore throat, fever, purpura, jaundice. Laboratory studies (RBC, WBC and differential count) should be scheduled. -Monitor for signs of hepatotoxicity such as hepatomegaly, splenomegaly, jaundice and abnormal liver function test (AST, ALT, GGT, elevated billirubin, prothrombin time). Health Teaching: -Explain to the caregiver the importance of taking the medicine on time. -Inform the caregiver to report rash immediately

Drug(s) Brand Name: Dilantin Generic Name: Phenytoin Classification: Anticonvulsants Dose: 100 mg Frequency: Every other day Date ordered: 1/21/2013

Indication Used to control partial seizures and generalized tonic-clonic seizures.

Action The medication limits the seizure activity by promoting sodium efflux from neurons in motor complex & reducing activity in the brainstem center responsible for tonic phase of tonic-clonic seizures.

Gingival Hyperplasia

Hematologic: Blood dyscrasias

Hepatotoxicity

Drug(s) Brand Name: Lasix Generic Name: Furosemide Classification: Sulfonamide type Loop diuretics Dosage: tab Frequency: Q12

Indication One of the potent and effective diuretics in treating edema caused by heart failure, renal disease, cirrhosis of the liver and hypertension.

Action Acts primarily on the ascending limb of the loop of henle but also on the proximal and distal tubule to prevent sodium and chloride reabsoption. It also increases renal blood flow and glomerular filtration rate.

Side Effect(s) & Adverse Effect(s) GI: Oral irritation, dry mouth

Nursing Considerations/Health Teaching(s) -Instruct caregiver to provide oral hygiene measures. Use hydrogen peroxide and water as a mouth wash and do not use commercial toothpaste. Administer medication with food or milk.

Gastric irritation and abdominal pain.

Electrolyte imbalance Date ordered: 01/30/13 Date discontinued: 02/01/2013

Electrolytes most commonly altered are potassium. Gather data about changes in patients appearance like muscle cramps and tremor. Monitor for the development of hyperglycemia and assess regularly fro glycosuria and report if it occurs with any frequency. Monitor CBC.

Metabolic: Hyperglycemia

Hematologic: Anemia

Health Teachings -Instruct caregiver that drug may cause serious interactions with many common drugs. -Inform the caregiver that the patient will undergo regular blood testing during therapy.

Drug(s) Brand Name: Medrol Generic Name: Methylpredisolone Classification: Antiasthmatic, Antiinflammatory (steroid), immunosuppressant Dose: 16mg 1tab Frequency: OD Date ordered: 01/31/2013

Indication Diseases or disorders of GI tract, respiratory system, allergies, edema, rheumatic disorder, and localized inflammation lesions.

Action Reduces inflammation and prevents edema by stabilizing membranes and reducing permeability of leukocytic cells. Suppresses immune system by interfering with antigen-antibody interactions of macrophages and T-cells.

Side Effect(s) & Adverse Effect(s) Electrolyte imbalance and fluid accumulation.

-Susceptibility to infection.

Nursing Considerations/Health Teaching(s) Gather data about changes in patients appearance like muscle cramps and tremor. Always check the electrolyte report for early indication and keep accurate record of intake and output and vital signs. Monitor patient for signs of infection such as fever, nausea and vomiting. Monitor for the development of hyperglycemia and assess regularly fro glycosuria and report if it occurs with any frequency. Periodic testing of stools for occult blood may be ordered. Antacids may also be recommended by the physicians to minimize gastric symptoms. Health Teaching; Advise caregiver that drug increases risk of infection. Avoid exposure to people with infection.

Metabolic: Hypergycemia

Peptic Ulcer formation

Drug(s) Brand Name: Cardarone Generic Name: Amiodarone Hydrochloride Classification: Antiarrythmic Dose: 100 mg 1tab Frequency: OD Date ordered: 01/26/2013

Indication Used in the management of life-threatening Supra ventricular tachyarrythmias, atrial fibrillation, and flutter, and brady-tachycardia symptoms.

Action Prolongs the action potential of atrial and ventricular tissue by increasing the refractory period without altering the resting membrane potential, thus delaying the repolarization.

Side Effect(s) & Adverse Effect(s) CNS:Fatigue and tremors, involuntary movements, numbness and tingling and ataxia. CV: heart failure, worsening arrhythmia, cardiac arrest

Nursing Considerations/Health Teaching(s) -Monitor patient closely. Report development of alteration and always provide safety. Monitor ECG continuously during loading dose and when dosage is change. Check patients pulse, heart rhythm regularly. Monitor for symptoms of hepatotoxicity such as vomiting, jaundice, hepatomegaly, slenomegaly and abnormal liver function test. Health Teaching: -Instruct caregiver that drug may cause serious adverse reactions. -Inform the caregiver that the patient will undergo regular blood testing during therapy.

Hepatic: Hepatotoxicity

Drug(s) Brand Name: Pantoloc Generic Name: Pantoprazole Sodium Classification: Proton Pump Inhibitor Dose: 40 mg Frequency: OD Date Ordered: 1/22/2013

Indication Used to treat severe esophagitis, GERD, gastric and duodenal ulcers and hypersecretory disorders, such as Zollinger-Ellison Disease

Action Proton pump inhibitors, inhibit gastric secretion by inhibiting gastric acid pump of the stomachs parietal cells.

Side Effect(s) & Adverse Effect(s) -Headache, muscle pain and fatigue. Diarrhea, vomiting and abdominal pain. Metabolic: Hyperglycemia

Nursing Considerations/Health Teaching(s) -Provide patients safety.

Maintain the patients state of hydration. Monitor for the development of hyperglycemia and assess regularly fro glycosuria and report if it occurs with any frequency. Report further observation. Report symptoms for further evaluation of the health care provider. Health Teaching: -Instruct caregiver to report signs of bleeding such as tarry stool.

Skin: Rash

Drug(s) Brand Name: Recormon Generic Name: Epoetin alfa Classification: Recombinant human erytropoetin Dose: 5000 units SQ Frequency: 2x a week (Monday & Friday) Date Ordered: 1/30/2013

Indication - Treatment of symptomatic anemia associated with chronic renal failure. - Treatment of symptomatic renal anemia in patients not yet undergoing dialysis. - Treatment of symptomatic anemia in adult patients with non-myeloid malignancies receiving chemotherapy.

Action Binds to erythropoietin, stimulating mitotic activity of erythroid progenitor cells in the bone marrow and causing release of reticulocytes from bone marrow into bloodstream, where they become mature RBCs.

Side Effect(s) & Adverse Effect(s) CNS: Headache, paresthesias, fatigue and dizziness.

Nursing Considerations/Health Teaching(s) Monitor patient closely. Report development of alteration and always provide safety. Maintain the patients state of hydration Electrolytes most commonly altered are potassium. Gather data about changes in patients appearance like muscle cramps and tremor. Report symptoms for further evaluation of the health care provider. Pruritus may be relieved by adding baking soda to the bath water. Health Teaching: -Instruct caregiver that blood specimens will be drawn weekly for blood counts and that dose adjustments maybe based on results.

GI: nausea, vomiting and diarrhea Metabolic: Hyperkalemia

Skin: Rash and pruritus

Drug(s) Brand Name: Xarelto Generic Name: Rivaroxaban Classification: Anticoagulants Dose: 15mg Frequency: q8 Date ordered: 01/29/2013 Date completed: 01/31/2013

Indication Treatment or prophylaxis of venous thrombosis, pulmonary embolis, atrial fibrillation with embolization or thromboembolic events(deep vein thrombosis).

Action Interfere with one or more parts of the pathways that lead to stable fibrin clot formation. May inhibit coagulation factors, binds to antithrombin, cause release of tissue factor pathway inhibitors.

Side Effect(s) & Adverse Effect(s) CNS: headache, dizziness, spinal hematoma and cerebral bleeding.

Nursing Considerations/Health Teaching(s) Assess and record vital signs at regular intervals. Report signs of internal bleeding e.g. decrease blood pressure, increase pulse, cold clammy skin. Check urine and stool for blood. Urine may appear red, smoke-colored. Stool may appear dark and tarry. Vomitus may contain bright red color or coffee ground appearance. Monitor platelet count on a daily basis. Maintain the patients state of hydration. Monitor for patients sign of dehydration. Carefully assess patient for thrombophlebitis. Inspect the IV area frequently. Report for redness, warmth, tenderness in the affected part.

GI: Hematemesis, melena and intra-abdominal bleeding.

Brand Name: Meropenem Generic Name: Meromax Classification: Antibiotics Dose: 500mg IV Frequency: q12 Date Ordered: 1/30/2013

It is used in the treatment of lower respiratory tract and intra abdominal infections, infection of the urinary tract, bones, joint and skin, endocarditis and septicemia caused by gram negative and gram positive bacteria.

Carbapenems are extremely potent broad spectrum antibiotics resistant to betalactamase enzymes secreted by bacteria. This act by inhibiting bacterial cell wall synthesis.

Hematologic: anemia, thrombocytopenia Severe Diarrhea

Phlebitis

Drug(s) Brand Name: Bactroban Generic Name: Mupirocin calcium cream, 2%

Indication Bactroban is an antibiotic that is used topically for the treatment of impetigo, a bacterial ailment of the skin caused by streptococcus pyogenes, staphylococcus aureus, beta-hemolytic..

Action Mupirocin is an antibacterial agent produced by fermentation using the organism Pseudomonasfluore scens. It is active against a wide range of gram-positive bacteria including methicillinresistant Staphylococcus aure us . It is also active against certain gram-negative bacteria. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase. Due to this unique mode of action, mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents. Increases respiratory tract fluids to help liquefy tenacious secretions.

Side Effect(s) & Adverse Effect(s) Pain, itching, stinging and burning sensation

Nursing Considerations/Health Teaching(s) Monitor symptoms for further evaluation.

Frequency: Sacral ulcer every diaper change, tracheostomy care and stoma care.

Health Teaching: Instruct caregiver that pruritus may be relieved by adding baking soda to the bath water of the patient.

Brand Name: Fluimucil Generic Name: Acetylcysteine Classification: Mucolytic Agent Dose: 1 sachet in glass of water Frequency: TID Date Ordered: 2/1/2013

Treatment of respiratory infections characterized by thick and viscous hypersecretions: pneumonia, bronchitis and its exacerbations; pulmonary emphysema, mucoviscidosis and bronchiectasis.

-Hemoptysis, rhinnorhea

Nausea, stomatitis, vomiting Bronchospasm

-Assess patients respiratory secretions before and often during therapy -Monitor effectiveness of therapy and advent of adverse/allergic effects. Health Teaching: Instruct caregiver to notify prescriber if patients condition doesnt improve within 10 days. Drug should not be used for prolonged period without direct medical supervision.

Drug(s) Brand Name: Ketosteril Generic Name: Essential Amino Acid Classification: Essential Amino Acid Dose: Frequency: Date Ordered:

Indication For protein energy malnutrition. Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal insufficiency.

Action Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesium and phosphate.

Side Effect(s) & Adverse Effect(s) Hypercalcemia

Nursing Considerations/Health Teaching(s) -Monitor serum calcium level regularly. It is recommended to decrease vitamin D intake. If the hypercalcemia persists, the dosage of Ketosteril should be reduced as well as any other source of calcium. Health Teaching: Instruct caregiver that it should be taken during meals to allow proper absorption and metabolism into the corresponding amino acids. Ensure the sufficient supply with calories. -Assess patients blood pressure before starting therapy and regularly thereafter to monitor drugs effectiveness. -Observe the patient closely for at least 2 hours after the initial dose and for at least 1 additional hour until blood pressure has stabilized. Health Teaching: Instruct caregiver to avoid sodium substitutes because they may contain potassium, which can cause hyperkalemia.

Brand Name: Lifezar Generic Name: Losartan Potassium Classification: Antihypertensive Dose: 50 mg tab Frequency: hold for systolic BP 100 Date Ordered:

Indicated for the treatment of hypertension and may be used alone or in combination with other antihypertensive agents. Indicated as well to reduce risk of stroke in patients with hypertension and left ventricular hypertrophy.

Inhibits vasoconstricting and aldosterone-secreting effects of angiotensin II by selectively blocking binding of angiotensin II to receptor sites in many tissues, including vascular smooth muscle and adrenal glands. >Lowers blood pressure

-Orthostatic hypotension characterized by: dizziness, weakness, and faintness.

-Headache, dyspnea, cramps, diarrhea

Drug(s) Brand Name: Dilatrend Generic Name: Carvedilol Classification: Antihypertensive Dose: 6.25mg Frequency: Date Ordered: 1/26/2013

Indication Indicated for patients with hypertension, heart failure, and myocardial infarction.

Action Carvedilol is both an alphaand beta adrenergic blocking agents act by plugging the alpha or beta receptors, which prevents other agents, usually the naturally accuring catecholamins, from stimulating the specific receptor

Side Effect(s) & Adverse Effect(s) - Bradycardia, peripheral vasoconstriction (characterized by purple, mottled skin) - Bronchospasm, Wheezing

Nursing Considerations/Health Teaching(s) -Monitor pulse rate; withhold medication if patient experienced bradycardia -Monitor respiratory rate and use of accesory muscles when breathing; withhold additional dosage if patient manifest any signs of difficulty of breathing. Refer accordingly to the attending physician. -Monitor for symptoms of hypoglycemia, characterized by: headache, weakness, decreased coordination, general apprehension, diaphoresis, hunger, or blurred or double vision. These symptoms may be masked by beta-adrenergic blocking agents. Notify health care provider if suspect that any of the symptoms described appear intermittently. -Monitor patient for an increase in edema, dyspnea, crackles, bradycardia, and orthopnea. Notify the health care provider if these symptoms develop.

- Hypoglycemia

- Heart failure

Drug(s) Brand Name: Aeknil Generic Name: Paracetamol Drug Class : Analgesics (NonOpioid) & Antipyretics

Indication Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders, tonsillitis, upper resp tract infections post-immunization reactions, after tonsillectomy & other conditions. Prevention of febrile convulsion. Headache, cold, sinusitis, muscle pain, arthritis & toothache.

Action

Side Effect(s) & Adverse Effect(s)

Antipyretic, analgesic. Gastric Irritation Pharmacology: Paracetamol produces analgesia by raising the threshold of the pain center in the brain and by obstructing impulses at the pain-mediating chemoreceptors. The drug produces antipyresis by an action on the hypothalamus; heat dissipation is increased as a result of vasodilation and increased peripheral blood flow. Pharmacokinetics: Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Following oral administration, peak plasma levels are attained in 10 min to 1 hr and the half-life is 75 min to 3 hrs. Distribution of paracetamol to most body tissues and fluids is both rapid and uniform. Paracetamol is excreted in the urine primarily as the glucuronide and smaller amounts as the sulfate, mercapturate and unchanged drug. Approximately 85% of a dose of paracetamol is excreted in the urine within 24 hrs after administration.

Nursing Considerations/Health Teaching(s) Administer medication with food, milk, antacids or large amount of water. Health Teaching: Advice caregiver that, when used as directed, paracetamol is extremely well tolerated by the patient

Drug(s) Brand name: Restine Generic Name: Simeticone Classification: Antiflatulent Dosage: 1 tab TID Date Ordered: 1/30/2013

Indication

Action

Side Effect(s) & Adverse Effect(s) Difficulty of breathing and allergic reactions such as swelling of the face, lips, tongue and throat. Nausea, vomiting and headache.

Used to relieve painful It allows gas bubbles in the pressure caused by excess gas stomach and intestines to in the stomach and intestines. come together more easily, which allows for easier passage of gas.

Brand Name: Solu-Cortef Generic Name: Hydrocortisone Classification; Short-acting corticosteroid Dose: 100 mg IV Frequency: q8 Date ordered: 01/30/2013

Replacement therapy in adrenocortical insufficiency,arthritis, collagen diseases, autoimmune and hematologic disorders, ulcerative colitis, nephritic syndrome and aspiration pneumonia.

Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators.

Electrolyte imbalance, fluid accumulation

Nursing Considerations/Health Teaching(s) -Crash tablet thoroughly before administering via PEG for faster and more complete results. -Instruct patients caregiver to notify the prescriber if signs of sensitivity have been noticed. Always check the electrolyte reports for early indications of electrolyte imbalance. Keep accurate records of intake and output. Monitor vital signs. Monitor patients for signs of infection such as fever, nausea and vomiting. Assess regularly for glycosuria, blood glucose and report any frequent occurrences. Antacids may be required by the physicians to minimize gastric symptoms. Periodic testing of stools for occult blood may be ordered.

Susceptibility to infection.

Hyperglycemia

Peptic Ulcer formation