Chapter V A.

Pharmacologic Intervention

 Assess patient for *megaloblast ic anemia+ ea1ness. alcoholi sm. nausea and flatulence.  These drugs may cause increased folic acid used by the body and contribute to the defiency.  Monior folate levels *34"5 mcg6m7+. intestin al obstruct ion.  to prevent complication . mg . $s al# Adult and children age .) anorexia. and &'% bitter older% -.eryth ema+. !ationale Brand Name# folvite Classification# Vitamins Supplement  To maintai n health. taste.etc+.  'dentify drugs currently ta1en% alcohol. )ther% allergic reactions *rash. fatgue.  Assess nutrional status2 determine if high folic acid foods are missing ftom the diet. pruritus. hepatic disease .  to prevent imbalance nutrition to the patiet and to give proper intervention.  Megalo blastic or macroc ytic anemia caused by folic acid or other nutrition al deficien cy. daily. shortness of breath and activity intolerance.  serve as baseline data for proceeding the use of the drug6test.. Contraindicated in patients ith vitamin !"# deficiency or undiagnosed anemia. glucocorticoi ds. 8gb.Generic / Brand/ Classification Generic Name# Folic Acid Mechanism of Action Stimulates normal erythropoiesi s and nucleoprotei n synthesis. Act al# (espiratory% .  To serve as baseline data. Indication Contraindication Adverse Effect C$S% general malaise. excessi ve hemoly sis.) " tab !ronchospas )/ m. Dosage N rsing !esponsi"ilities  Assess patient0s folic acid deficiency before starting therapy.8ct and .

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5-. 5-branous mg.. "tab )/ ? photosensitiv 5days ity. days # abdominal through 5.  Acute bacteria l exacerb ations of chronic obstruct ive pulmon ary disease s caused by streptoc occus pneum oniae. somnolence.mg S1in% rash.  Serve as baseline data and to give proper treatment of the patient. as a palpitations. $s al# Adults and children age "3 and older% initially. /o not give ith fruit =uices. vertigo.  To prevent . A9alide Macrolide Mechanism of Action Indication Contraindication Adverse Effect Dosage N rsing !esponsi"ilities !ationale !inds to 5-S subunit of bacterial ribosomes.  !e alert about allergic reactions  Monitor hydration status if &' reaction occurs  &ive drug ith food. vaginitis. pneum Contraindicated in patients hypersensitive to erythromycin or other macrolides. fatigue.  Commu nity ac. <se cautiously in patients ith impaired hepatic function. pain. daily on diarrhea. including many gram4 positive and gram4 negative aerobic and anaerobic bacteria.  .  Tell patient to ta1e entire .. pn day ".).uire d pneum onia caused by chlamy dial pneum oniae. inluen9 ae. bloc1ing protein synthesis2 bacteriostati c or bactericidal. cumulative flatulence. follo ed by &'% nausea. depending on concentratio n. dose is ". S. or for cholestatic C).erform culture sensitivity determina tions before and after therapy. #5. nephritis.5 melena.uantity of drug exactly as ordered. Act al# 5-. )ther% angioedema./ =aundice. total dyspepsia. 8.  Assess previous  To prevent complicati on  To monitor hydration and prevent dehydrati on  To prevent &' upset  To receive all course action of the drug or the effectiven ess of the drug .mg vomiting. exacerbati pseodomem ons.Generic / Brand/ Classification Generic Name# A9ithromycin Brand Name# :ithromax Classification# Antiinfective. single dose chest pain. g.mg CV% . C$S% di99iness. mycopl asma pneum oniae. &<% candidiasis. headache. 8inders or 1ills susceptible bacteria.) colitis. daily for > days.

minutes2 peripheral then A.  To prevent further complica tion  To monitor fluid changes . di99iness.atients ith allergic to furosemide.  To prevent &' upset. headache.sodiu thromboph m. . 'VTT post4 volume !T depletion  Assess and fluid volume dehydratio satus% $s al#  So increase urination ill not disturb sleep. uric * ith '.underlying mg '. Indication Contraindication Adverse Effect C$S% fever.  8yperte nsion.Generic / Brand/ Classification Generic Name# Furosemide Mechanism of Action 'nhibits sodium and chloride reabsorption at proximal and and distal tubules and ascnding loop of henle. use+. "amp acid and !<$. condition before in=ected starting therapy. . Contraindicated in patients hypersensitive to drug or any of its components and in the those ith anuria.  Monitot CV% if needed.V. lebitis .mg edema. <se cautiously in patients ith hepatic cirrhosis. paresthesi a. breath '. restlessne ss.  @dema..V.V. " B hours. Dosage N rsing !esponsi"ilities !ationale Brand Name# 7asix Classification# 7oop diuretic  Acute pulmon ary edema. inta1e and orthostatic output.mg magnesium. hypotensio electrolytes% n. slo ly over  Monitor " to # eight. calcium.  8yperc alcemia . Act al# potassium. ea1ness. in " to sounds. vertigo.  8eart failure and chronic renal impairm ent.  Assess patient0s Adults% .

n.V. &<% a9otemia. anorexia. abdominal discomfort. fre.uent urination. therefore food rich in potassium should be added . &'% pancreatiti s. @@$T% transient deafness * ith too rapid '.  Chec1 !. in=ection+. to prevent &' upset. blurred or yello ish vision. 8ematolog urine%color.  &ive the drug early in the day to prevent nocturia and to continue ta1ing medication even if feeling better. ith  To 1no if there is excess6d eficit in fluid balance.  &ive food or mil1. .uality and specific gravity.  'f &' systoms of nausea and anorexia occur. this drug controls symptoms but does not cure the condition. diarrhea. before giving the drug.  'nform patient that this drug causes a loss of potassium.n octuria. oliguria. polyuria. vomiting. constipatio n. nausea.

aplastic anemia. 8epatic% hepatic dysfunctio n. thrombocu topenia. Metabolic% asymptom atic hyperurice mia. hyperglyce mia and glucose intolerance .  'nstruct patient to lie do n if di99iness occurs.  'nstruct the pt. fluid and electrolyte to the diet. to report any of the said adverse effect.ic% agranulocy tosis. hypoclore mic al1alosis. hypo1alem ia. . anemia. leucopenia .

photosensi tivity. )ther% gout. Musculos1 eletal% muscle spasm. hypocalce mia. including dilutional hyponbatr emia. S1in% dermatitis. . purpura. hypomagn esemia.M. in=ection site.imbalance s. transient pain at '.

/ecreases blood ammonia build4up that causes hepatic encephalopa thy. $s al# Adults% "to #. ith hepatic encelopathy% regularly assess • to monitor drug0s effectiveness • to prevent further complication for baseline data • • To monitor hydration To determine blood glucose level 't may interfere ith sleep. belching. Cfor pt. diarrhea.g *"5 to >. nausea. increase to 3. distention. flatulence.roduces osmotic effect in colon..m76day. diarrhea. hypo1alemia and hypernatremia. flatulence and distention. (esulting distention promotes peristalsis.m7+ .  To prevent and treat hepatic enceph alopath y. bul1 and exercise.belching. Indication Contraindication Adverse Effect Dosage N rsing !esponsi"ilities !ationale  Constip Contraindicated in patients on lo 4 ation. hich lo ers p8 of colon contents. (elieves constipation. vomiting.Generic / Brand/ Classification Generic Name# 7actulose Brand Name# /uphalac Classification# 7axative Mechanism of Action . if needed. decreases blood ammonia concentratio n. daily. Act al# >-cc at 8S CAssess condition before therapy and reassess regularly there after to monitor drugs effectiveness. vomiting. Cmonitor fluid and electrolyte status% urine output. abdominal cramps. • • . probably as a result of bacterial degration.  To induce bo el evacuat ion in geriatric patients ith colonic retentio n of barium and severe constip ation after a barium &'% abdominal cramps. includin g hepatic precom a and coma in patients ith severe hepatic disease . galactose diet.). input4 output ratio to identify fluid loss. 'dentify cause of constipation% assess lifestyle in relation to fluids. CMonitor pt for possible adverse &' reactions% nausea.

Generic / Brand/ Classification Mechanism of Action Indication Contraindication Adverse Effect Dosage N rsing !esponsi"ilities !ationale .

/epresses rennin secretion and preventsbva sodilation of cerebral arteries. di99iness $s al# 'nitial dose% . restores normal sinus rhythm. and force myocardial contraction.cardiogeni c shoc1. vomiting. <se cautiously in patients ta1ing antihypertensive and in those ith renal impairement.  8yperte nsion  . sinus bradycardia.Generic Name# . heart failure. non4 allergic bronchospastic diseases. olff4 par1inson4 hite syndrome. drug history and hypersens itivity  Assess !. lo ers blood pressure. intermittent claudication.mg tab T'/ CV% bradycardia. and helps limit M'  Angina pectoris  Suprav entricul ar. antianginal. constipation. 8ematologic% agranulocyto  )btain patient history. or overt cardiac failure *unless failure is secondary to tachyarrhthmia that can be treated ith propanolol+. and pulse before therapy. antiarrhythmic (educes cardiac oxygen demand by bloc1ing catecholami ne4induced increases in heart rate. &'% nausea.mg6day Act al# ". hallucination s. diabetes mellitus or thyrotoxicosis. severe. hepatic disease. heart bloc1 greater than first4 degree.ropranolol Brand Name# 'nderal Classification# !eta4!loc1ers 6 antihypertensiv e. ventricu lar and atrial arrhyth mias2 tachyar rhythmi as caused by excessi ve catecho lamine action during anesthe sia.uen t. (elieves anginal and migraine pain.. C$S% fatigue. mental depression. Monitor periodicall y during treatment  Assess hydration status2 s1in turgor2 and mucous membran es  Monitor for drug induced adverse reaction  Monitor  Serve as baseline data  To 1no if there is increase or decreasei n blood pressure  To monitor hydration  To prevent further drug complicati . or Contraindicated in patients ith bronchial asthma. fever. diarrhea. blood pressure. hypotension. uncontr olled. vivid dreams. lethargy.mg orally t ice a day or Amg Maximum dose% 3.revent ion of fre.

 To prevent &' upset  To receive fully the therapeuti c action of the drug  'nstruct pt to ta1e drug as prescribed . S1in% rash.damage.  &ive ith food on  To 1no if there is excess6d eficit in fluid balance.  @ssenti al tremor. 'D). disablin g migrain e or vascula r headac he. sis. eight daily Musculos1el etal% arthralgia. (espiratory% increased air ay resistance.  8ypertr ophic subaorti c stenosi s  Ad=unct theraph y in pheoch romocyt oma.

s eating. 8ypersensitivity to mammalin cell4 derived products or human albumin.u61g > times ee1ly until appropriate maintenan ce dose is reached.-. To prevent serious complicati on to the patient. Indication Contraindication Adverse Effect 8ypertensio n2 tachycardia2 clotting vascular access2 headcahe2 sei9ures. Allergy.u SF >? a ee1  To prevent further complicati on. pain in long bones  Tell the patient that after in=ection *usually after # hours+. Dosage N rsing !esponsi"ilities  Assess patients C!C and blood pressure before starting therapy  'nstruct patient to report if &' reaction occurs.Generic / Brand/ Classification Generic Name# @poetin E Mechanism of Action Mimics effects of erythropoieti n hich functions as a gro th factor and as a differentiatin g factor. $ausea2 vomiting2 diarrhea.  Serve as baseline data Act al# . .  To provide informatio n and a arenes s. enhancing (!C production2 drug is developed by recombinant /$A technology. $s al# Adult 5-4 "-. including anaphylaxis. used in the management of chemotherapyinduced anaemia in patients with non-myeloid malignant disease. some pt0s complain of pain or discomfort in their limbs and pelvis and !ationale Brand Name# (enogen Classification# 8ematopoietic Agents Management of anaemia associated with chronic renal failure in dialysis and predialysis patients. Also. Shortness of breath. s1in rashes and urticaria2 fever2 paresthesia2 arthralgia.. 'f this occur monitor patient hydration  Assess C$S symptoms % coldness. uncontrolled hypertension. they may reduce or obviate the need for blood transfusions in these patients.

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calcium ionof Galimate is exchanged for potassium ion in the intestinal tract. abdominal pain. feeling of heaviness in the legs. Administer oral drug after meals or ith food and a full glass of ater. stenosis or constipation. and Galimate is excreted asunchanged polystyrene sulfonate resin into the feces ithoutdigestio n and absorption. vomiting.g .uence. potassium in theintestinal tract is excreted outside the body hyper1alemia from acute or chronic renal failure patients ith intestinal obstruction. (eport tingling of the hands or feet.) bid4tid Act al# " sachet T'/ Arrange for serial serum potassium levels before and during therapy. 8ypopotassemi a.particularl y around the colon. 'n conse. unusual tiredness or ea1ness. . perforation Constipation. $s al# "54>. anorexia D nausea. Caution patient that expended ax matrix capsules in the stools. severe nausea.Generic / Brand/ Classification Mechanism of Action Indication Contraindication Adverse Effect Dosage N rsing !esponsi"ilities Generic Name# calcium polystyrene sulfonate Brand Name# Galimate Classification# electrol%tes After administration of Galimate via oral or rectal route.