Drug Study

Domperidone Motilium (1 tab, 100 mg) Classification: Anti-emetic and anti-vertigo Desired Dosage and Directions for use: Acute conditions (mainly nausea, vomiting, hiccup) Adults: Two tablets ( 0 mg) ! to " times #er da$, 1% to !0 minutes before meals and, if necessar$, before retiring& Chronic conditions (mainly dyspepsia) Adults: 'ne tablet (10 mg) ta(en ! times #er da$, 1% to !0 minutes before meals and, if necessar$, before retiring& T)e dosage ma$ be doubled& Mode of Action: Dom#eridone is a do#amine-rece#tor bloc(ing agent& *ts action on t)e do#amine-rece#tors in t)e c)emo-emetic trigger +one #roduces an anti-emetic effect& *nteractions: Concomitant administration of anti-c)olinergic drugs ma$ in)ibit t)e antid$s#e#tic effects of M'T*,*-M& Anti-muscarinic agents and o#ioid analgesics ma$ antagoni+e t)e effect of M'T*,*-M M'T*,*-M su##resses t)e #eri#)eral effects (digestive disorders, nausea and vomiting) of do#aminergic agonists& .ince M'T*,*-M )as gastro-(inetic effects, it could influence t)e absor#tion of concomitant orall$ administered medicines, #articularl$ t)ose wit) sustained release or enteric coated formulations& As M'T*,*-M interferes wit) serum #rolactin levels, it ma$ interfere wit) ot)er )$#o#rolactinaemic agents and wit) some diagnostic tests& Antacids and anti-secretor$ agents lower t)e oral bioavailabilit$ of dom#eridone& T)e$ s)ould be ta(en after meals and not before meals, i&e& t)e$ s)ould not be ta(en simultaneousl$ wit) M'T*,*-M& /educed bicarbonate .ide 0ffects: gastric acidit$ im#airs t)e absor#tion of dom#eridone& 'ral bioavailabilit$ is decreased b$ #rior administration of cimetidine or sodium

55

Allergic reactions, suc) as ras) or urticaria, )ave been re#orted& Abdominal cram#s )ave been re#orted& D$stonic reactions (e1tra#$ramidal #)enomena) ma$ occur& /eversible raised serum #rolactin levels )ave been observed w)ic) ma$ lead to galactorr)oea and g$naecomastia& 2$#ertensive crises in #atients wit) #)aeoc)romoc$toma ma$ occur wit) administration of dom#eridone& 3)ere t)e blood brain barrier is not full$ develo#ed (mainl$ in $oung babies) or is im#aired, t)e #ossible occurrence of neurological side-effects cannot be totall$ e1cluded

4ursing /es#onsibilities: 1& Assess for e1tra-#$ramidal effects suc) as 5er(ing and tongue #rotrusion& & C)ec( for )$#otension& Imdur Durule (60 mg 7 tab 'D 8 2.) Classification: Anti-anginal Desired Dosage: 60 mg once dail$ in t)e morning, ma$ be increased to 1 0 mg dail$ in t)e morning& *f )eadac)e occurs, t)e dose ma$ initiall$ be reduced to !0 mg dail$ for t)e 1st -" da$s& Mode of Action: T)e #rinci#al #)armacological action of isosorbide-%-mononitrate, an active metabolite of isosorbide dinitrate, is rela1ation of t)e vascular smoot) muscle, #roducing vasodilatation of bot) arteries and veins, wit) t)e latter effect #redominating& T)e effect of t)e treatment is de#endent of t)e dose& ,ow #lasma concentrations lead to venous dilatation, resulting in #eri#)eral #ooling of blood, decreased venous return and reduction in left ventricular end-diastolic #ressure (#reload)& 2ig) #lasma concentrations also dilate t)e arteries reducing s$stemic vascular resistance and arterial #ressure leading to a reduction in cardiac afterload& *sosorbide-%-mononitrate ma$ also )ave a direct dilating effect on t)e coronar$ arteries& 9$ reducing t)e end-diastolic #ressure and volume, t)e #re#aration lowers t)e intramural #ressure, t)ereb$ leading to an im#rovement in t)e sub-endocardial blood flow& T)e net effect w)en administering isosorbide-%-mononitrate is t)erefore a reduced

56

wor(load of t)e )eart and an im#roved o1$gen su##l$:demand balance in t)e m$ocardium& *nteractions: Concomitant administration of *mdur and #)os#)odiesterase t$#e % in)ibitors can #otentiate t)e vasodilator$ effect of *mdur wit) t)e #otential results of serious side effects as s$nco#e or m$ocardial infarction& .ide 0ffects: Most of t)e adverse reactions are #)armacod$namicall$ mediated and dose de#endent& 2eadac)e ma$ occur w)en treatment is initiated, but usuall$ disa##ears during continued treatment& 2$#otension wit) s$m#toms eg, di++iness and nausea wit) s$nco#e in isolated cases, )as occasionall$ been re#orted& T)ese s$m#toms generall$ disa##ear during continued treatment& Cardiovascular .$stem: Common: 2$#otension, tac)$cardia Central 4ervous .$stem: Common: 2eadac)e, di++iness& /are: ;ainting& <astrointestinal: Common: 4ausea& -ncommon: =omiting, diarr)ea& Musculos(eletal: =er$ /are: M$algia& .(in: /are: /as), #ruritus&

4ursing /es#onsibilities: 1& C)ec( for )$#otension& & >ut #atient on bed rest because of fainting& >rovide su#ervision w)en ambulating& !& >erform non#)armacologic measures for nausea and vomiting suc) as letting client to drin( wea( tea, <atorade, carbonated beverages, #edial$te and eat gelatin, crac(ers and dr$ toast& Calcium Carbonate (1 tab tid) Classification: 0lectrol$te re#lacement or su##lements& Antacid Desired Dosage: %00 mg ( 00 mg Ca), 600 mg ( "0 mg Ca), 6%0 mg ( 60 mg Ca), 66? mg ( 66&@ mg Ca), 1 g ("00 mg Ca), 1& % mg (%00 mg Ca), 1&% mg (600 mg Ca) Mode of Action: 0ssential for nervous, muscular, and s(eletal s$stems& Maintain cell membrane and ca#illar$ #ermeabilit$& Act as an activator in t)e transmission of nerve

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im#ulses and contraction of cardiac, s(eletal and smoot) muscles& *t is essential for bone formation and blood coagulation& *t is also used a re#lacement of calcium in deficienc$ states& *t controls of )$#er#)os#)atemia in end-stage renal disease wit)out #romoting aluminum absor#tion& *nteractions: 2$#ercalcemia increases t)e ris( of digo1in to1icit$& C)ronic use wit) antacids in renal insufficienc$ ma$ lead to mil(-al(ali s$ndrome& *ngestion b$ mout) ma$ decrease t)e absor#tion of orall$ administered tetrac$clines, fluoroAuinolones, #)en$toin, and iron salts& 01cessive amounts ma$ decrease t)e effects of calcium c)annel bloc(ers, atenolol& Concurrent use wit) diuretics ma$ result in )$#ercalcemia& .ide 0ffects: C4.: s$nco#e, tingling C=: cardiac arrest, arr$t)mias, brad$cardia <*: consti#ation, nausea, vomting <-: calculi, )$#ercalciuruia ,ocal: #)lebitis (*= onl$)

4ursing /es#onsibilities: 1& Monitor =. es#eciall$ 9> and >/& & 'btain 0C< result& !& Asses for )eartburn, indigestion, abdominal #ain& "& Monitor serum calcium before treatment& %& Assess for nausea and vomiting, anore1ia, t)irst, severe consti#ation& Metoprolol 9eloc, 9etaloc Durules, ,o#resor, Meto#rol (100 mg 1 tab A 1 )rs) Classification: Anti-anginal and Anti-)$#ertensive: Beta-blockers Desired Dosage: (>') %-100 mg:da$ as a single dose initiall$ divided or divided dosesB ma$be increased A ? da$s as needed u# to "%0 mg:da$& Mode of Action: 9loc(s stimulation of beta1 (m$ocardial)-adrenergic rece#tors& *t does not usuall$ affect beta (#ulmonar$, vascular, uterine)-adrenergic rece#tor sites& *t also decreases blood #ressure and )eart rate& *t decreases freAuenc$ of attac(s of angina

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#ectoris, and decreases rate of cardiovascular mortalit$ and )os#itali+ation in #atients wit) )eart failure& *nteraction:

Additive effect wit) catec)olamine-de#leting drugs e&g& reser#ine and MA'*s& Ma$ antagonise C1-adrenergic stimulating effects of s$m#at)omimetics& Additive negative effects on .A or A= nodal conduction wit) cardiac gl$cosides, nondi)$dro#$ridine calcium-c)annel bloc(ers& *ncreased oral bioavailabilit$ wit) aluminium:magnesium-containing antacids& >arado1ical res#onse to e#ine#)rine wit) ma$ occur& *ncreased #lasma in)ibitors

concentrations

CD> D6

(e&g& bu#ro#ion, cimetidine,di#)en)$dramine, fluo1etine, )$dro1$c)oloAuine, #aro1etine, #ro#afenone, Auinidine,ritonavir, terbinafine, t)iorida+ine)& *ncreased ris( of )$#otension and )eart failure wit) m$ocardial de#ressant general anaest)etics (e&g& diet)$l et)er)& /is( of #ulmonar$ )$#ertension wit) vasodilators e&g& )$drala+ine in uraemic #atients&

/educed #lasma levels wit) rifam#icin& Ma$ increase negative inotro#ic and negative dromotro#ic effect of antiarr)$t)mic drugs e&g& Auinidine and amiodarone& >ro#afenone ma$ increase serum levels of meto#rolol& Concurrent use wit) indomet)acin ma$ reduce t)e anti)$#ertensive efficac$ of Cbloc(er& Ma$ reduce clearance of lidocaine& Ma$ increase effects of )$#ogl$cemics& 0fficac$ ma$ be reduced b$ iso#renaline& Concurrent use wit) digo1in ma$ lead to additive brad$cardia&

4ursing /es#onsibilities: 1& Monitor blood #ressure, and #ulse freAuentl$& & Monitor inta(e and out#ut ratios and dail$ weig)t& !& Assess routinel$ for signs and s$m#toms of C2; (d$s#nea, rales, crac(les, weig)t gain, #eri#)eral edema, 5ugular venous distention)

59

"& Ta(e a#ical #ulse before administering& *f E%0b#m or if arr)$t)mia occurs, wit))old medication and notif$ )ealt) care #rofessional& %& Administer meto#rolol wit) meals or directl$ after eating& 6& Caution #atient minimi+e activities t)at reAuire alertness because meto#rolol can cause di++iness& ?& Caution #atient t)at t)is medication can increase sensitivit$ to cold& @& *nstruct to avoid caffeinated drin(s li(e teas and colas& F& Monitor blood glucose levels es#eciall$ if wea(ness, malaise, irritabilit$, or fatigue occurs& 10& /einforce t)e need to continue additional t)era#ies for )$#ertension suc) as sodium restriction, stress reduction, regular e1ercise) 11& 0m#)asi+e com#liance to t)e medication& Prednisone .tera#red (%000 u 1:wee( .C) Classification: ast)matics Desired Dosage: (>') %-60 mg:da$ as single dose or in divided doses& Mode of Action: *t su##resses inflammation and t)e normal immune res#onse& >rednisone is biologicall$ inert and converted to t)e #redominantl$ #rednisolone in t)e liver& *t decreases inflammation b$ su##ression of migration of #ol$mor#)onuclear leu(oc$tes and reversal of increased ca#illar$ #ermeabilit$B su##resses t)e immune s$stem b$ reducing activit$ and vol of t)e l$m#)atic s$stemB su##resses adrenal function at )ig) doses& *nteraction: *ncrease ris( of )$#o(alemia wit) t)ia+ide and loo# diuretics, or am#)otericin 9& Ma$ increase reAuirement for insulin or oral )$#ogl$cemic agents& >)e$toin, >)enobarbital, and rifam#in increase metabolismB ma$ decrease effectiveness& At c)ronic cases, ma$ decrease antibod$ res#onse to and increase ris( of adverse reactions from live-virus vaccines& Antacids decrease absor#tion of it& *ncrease ris( of <* ulceration wit) 4.A*Ds& .$stemic corticosteroids, anti-

60

.ide 0ffects: *nsomnia, nervousness, increased a##etite, indigestion, di++iness:lig)t)eadedness, )eadac)e, )irsutism, )$#o#igmentation, diabetes mellitus, glucose intolerance, )$#ergl$caemia, art)ralgia, cataracts, glaucoma, e#ista1is, dia#)oresis, Cus)ingGs s$ndrome, edema, fractures, )allucinations, )$#ertension, muscle-wasting, osteo#orosis, #ancreatitis, #ituitar$-adrenal a1is su##ression, sei+ures 4ursing /es#onsibilities& 1& Assess for adverse effects & *m#lement safet$ measures to #revent falls and fractures& !& Monitor clients wit) diabetes for )$#ergl$cemia& "& Assess for fluid and electrol$te imbalance& %& Assess stools for melena& 6& Administer wit) food to minimi+e gastric irritation& ?& *nstruct to avoid #eo#le wit) active infection because resistance is low& @& *nstruct to avoid activities t)at could cause bone fracture& F& 4ot to ta(e 4.A*Ds unless directed& 10& *ncrease inta(e of #rotein, calcium, and #otassium& Albumin 25% Albuminar, Albutein, 9uminate, 4ormal 2uman .erum Albumin, >lasbumin (%0cc H ;urosemide 0 mg 1 " to 'D) Classification: =olume e1#anders, blood #roducts, colloids Desired Dosage: (*=) 1 &%-%0 g:da$ in !-" divided doses& (Availabilit$ Injection: %0 mg:m,) Mode of Action: *t #rovides colloidal oncotic #ressure, w)ic) serves to mobili+e fluid from e1travascular tissues bac( into intravascular s#ace& *t increases intravascular fluid volume& *nteractions: Do not mi1 wit) #rotein )$drol$sates, amino acid solution and alco)ol& .ide 0ffects: C4.: 2eadac)e C=: >ulmonar$ edema, fluid overload, )$#ertension, )$#otension, tac)$cardia <*: =omiting, increased salivation, nausea Derm: /as), urticaria

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M.: 9ac( #ain C)ills, fever, flus)ing

4ursing /es#onsibilities: 1& Monitor vital signs, and inta(e and out#ut& & Assess for signs of vascular overload suc) as elevated C=D, rales:crac(les, d$s#nea, )$#ertension, 5ugular venous distention) during and after administration& !& Monitor serum sodium levels because it ma$ cause increase concentrations& "& .olution s)ould be clear amber, and do not administer solutions t)at are discolored or contain #articulate matter& Sodium Bicarbonate 9a(ing .oda, 9ell-Ans, Citrocarbonate, 4eut, .oda Mint (6%0 mg 1 tab tid) Classification: Anti-ulcer agent and al(alini+ing agent Desired Dosage: Alkalini ation o! urine: (>') "@ m0A or " g initiall$& T)en 1g A" )r or 1 ts# of #owder A" )r as needed& "etabolic acidosis: I"&@ g:da$ as needed& Mode of Action: Acts as an al(alini+ing agent b$ releasing bicarbonate ions& *t is used to al(alini+e urine and #romote e1cretion of certain drugs in overdosage situations& *nteractions: *ncrease to1icit$ of am#)etamins, e#)edrine, #seudoe#)edrine, flecainide, Auinidine and Auinine& *t decreases effects of lit)ium, c)lor#ro#amide and salic$lates due to increased clearance& *t ma$ affect t)e absor#tion of certain drugs due to raised intragastric #2& .ide 0ffects: Metabolic al(alosisB mood c)anges, tiredness, s)ortness of breat), muscle wea(ness, irregular )eartbeatB muscle )$#ertonicit$, twitc)ing, tetan$B )$#ernatraemia, )$#erosmolalit$, )$#ocalcaemia, )$#o(alaemiaB stomac) cram#s, flatulence& 4ursing /es#onsibilities: 1& Assess for signs of acidosis (disorientation, )eadac)e, wea(ness, d$s#nea, )$#erventilation), al(alosis (confusion, irritabilit$, #arest)esia, tetan$, altered breat)ing #attern), )$#ernatremia (edema, weig)t gain, )$#ertension, tac)$cardia, fever, flus)ed s(in, mental irritabilit$), or )$#o(alemia (wea(ness, fatigue, arr)$t)mias, #ol$uria, #ol$d$#sia) & Assess fluid balance (inta(e and out#ut, dail$ weig)t, edema, lung sounds) !& Ta(e med wit) full glass of water&

62

"& Monitor serum electrol$te concentrations, serum osmolarit$, acid-base balance, and renal function #rior to and #eriodicall$ t)roug) out t)e t)era#$& Clonazepam /ivotril (1:" tab dail$) Classification: Anticonvulsant Desired Dosage: 0&% mg !1 dail$ Mode of Action: *t #roduces sedative effects in t)e C4., #robabl$ b$ stimulating in)ibitor$ <A9A rece#tors& *t #revents sei+ures and decreases manifestations of #anic disorder& *nteractions: C4. de#ression wit) alco)ol, antide#ressants, disulfiram, anti)istamines, fluo1etine, ot)er ben+odia+e#ines, and o#ioid analgesics& Cimetidine, )ormonal contrace#tives, isonia+id, (etocona+ole, meto#rolol, #ro#o1$#)ene, #ro#anolol, or val#roic acid ma$ decrease metabolism of clona+e#am& .edative effects wit) t)eo#)$lline& .ide 0ffects: ;atigue, somnolence, muscular )$#otonia, coordination disturbances, aggressiveness, irritabilit$ or agitation& 4ursing /es#onsibilities: 1& Assess for drowsiness, unsteadiness, and clumsiness& T)ese s$m#toms are dose related and most sever during initial t)era#$& & Administer wit) food to minimi+e gastric irritation& !& 2ave C9C and liver function test results evaluated #eriodicall$ because it ma$ cause increase in serum bilirubin, A.T and A,T& Epoetin B /ecormon (%000 u .C) Classification: 2emato#oeitic Agent Desired Dosage: %0-100 u:(g !1 wee(l$ initiall$, t)en ad5ust dose base on 2ct&

Anemia w/ CRF: Correction phase #C inj *nitiall$, ! 1 0 iu:(g:w(, ma$ be

increased ever$ " w( b$ ! 1 0 iu:(g:w( if t)e increase of #ac(ed cell vol (>C=) is

63

inadeAuate (E 0&%J #er w()& 3(l$ dose can be divided into dail$ doses or administered as a single dose& Ma1: ? 0 iu:(g:w(& I$ inj *nitiall$, ! 1 "0 iu:(g:w(& Dose ma$ be increased after " w( to ! 1 @0 iu:(g:w(& *f furt)er increments are needed, increase at 0 iu:(g ! times w(l$ at mt)l$ intervals& Ma1: ? 0 iu:(g:w(&

Maintenance phase *n .C in5, to maintain a >C= of !0-!%J, initiall$ reduce to 7

of t)e #reviousl$ administered amount& .ubseAuentl$, ad5ust dose at 1switc)ed to once ever$ w( administration& w( intervals individuall$ for t)e #atient& >atient stable on a once-w(l$ dosing regimen ma$ be

Prevention of anaemia of prematurity #C inj ! 1 %0 iu:(g:w( for 6 w(& Increasing the amount of autologous blood #C or I$ inj Twice w(l$ over " w(&
Ma1 *= Dose: 1,600 iu:(g:w(& Ma1 .C Dose: 1, 00 iu:(g:w(&

Symptomatic anaemia in cancer #C inj 1 in5:w( or !-? divided doses:w(&

/ecommended Dose: *nitiall$, !0,000 iu:w( (a##ro1 "%0 iu:(g bod$ wt:w( based on ave wt)& Treatment is indicated if )aemoglobin value is K11 g:d, (6&@! mmol:,), s)ould not e1ceed 1! g:d, (@&0? mmol:,)& After " w( t)era#$, if )aemoglobin value increased b$ at least 1 g:d, (0&6 mmol:,), continue t)era#$B if not, double t)e w(l$ dose& After @ w(, if value )as not increased b$ at least 1 g:d,, discontinue t)era#$& After t)e end of c)emot)era#$, continue t)era#$ u# to " w(& Ma1: K60,000 iu:w(& 3)en t)era#eutic ob5ective )as been ac)ieved, reduce dose b$ %-%0J to maintain )aemoglobin at t)at level, ma$ reduce furt)er to ensure )aemoglobin level does not e1ceed 1! g:d,& *f I g:d, (1&! mmol:,) )aemoglobin rise in " w(, reduce dose b$ %-%0J& Mode of Action: 0#oetin beta is identical in its amino acid and carbo)$drate com#osition to er$t)ro#oietin t)at )as been isolated from t)e urine of anemic #atients& 0r$t)ro#oietin is a gl$co#rotein t)at stimulates t)e formation of er$t)roc$tes from #recursors of t)e stem cell com#artment& *t acts as a mitosis-stimulating factor and differentiation )ormone& After administration of e#oetin beta, t)e number of er$t)roc$tes, t)e 2b values and reticuloc$te counts increase as well as t)e %F;e-incor#oration rate& An increased !2t)$midine incor#oration in t)e er$t)roid-nucleated s#leen cells )as been found in vitro (mouse s#leen cell culture) after incubation wit) e#oetin beta& *nteraction: T)e clinical results obtained so far do not indicate an$ interaction of /ecormon wit) ot)er substances& *ncom#atibilities: To avoid incom#atibilit$ or loss of activit$, do not mi1 wit) ot)er drugs or infusion solutions& .ide 0ffects:

64

C4.: .ei+ures, )eadac)e C=: 2$#ertension, t)rombotic events suc) as M* or stro(e Derm: Transient ras)es

4ursing /es#onsibilities: 1& Monitor blood #ressure before and after t)era#$& Additional anti)$#ertensive drug ma$be reAuired during initiation of t)era#$& & Monitor 2ct and ot)er )emato#oietic #arameters (C9C wit) differential and #latelet count) !& Monitor renal function studies and electrol$tes closel$& *ncrease in 9-4, creatinine, uric acid, #)os#)orus, and #otassium ma$ occur& "& Do not s)a(e vial because inactivation of medication ma$ occur& %& Discard vial immediatel$ after wit)drawing dose from single-use 1-ml vial& /efrigerate multi-dose -ml vialB stable for 1 da$s after initial entr$& 6& .tress im#ortance of com#liance wit) dietar$ restrictions, medications, and dial$sis& ;oods )ig) in iron and low in #otassium include liver, #or(, veal, beef, mustard and turni# greens, etcL abapentin 4eurontin (!00 mg 1 tab 8 nig)t) Classification: Analgesic ad5uncts, anticonvulsants, mood stabili+ers Desired Dosage: CCr !0-60 m,:minM!00 mg 1 dail$B 1%!0 m,:minM!00 mg 11 dail$& Mode of Action: Mec)anism of action is not (nown& *t ma$ affect trans#ort of amino acids across and stabili+e neuronal membranes& *t can decrease incidence of sei+ures& <aba#entin is structurall$ related to t)e neurotransmitter <A9A but is neit)er a <A9A agonist nor antagonist& <aba#entin-binding sites )ave been identified t)roug)out t)e brain tissues e&g& neocorte1 and )i##ocam#us& 2owever, t)e e1act mec)anism of action is still un(nown& *nteractions: Antacids ma$ decrease absor#tion of gaba#entin& *ncrease ris( of C4. de#ression wit) ot)er C4. de#ressants li(e alco)ol, anti)istamines, o#ioids, and sedatives&

Mor#)ine ma$ increase level of gaba#entin and increase ris( of to1icit$&

65

.ide 0ffects: .omnolence, di++iness, ata1ia, wea(ness, #araest)esia, fatigue, )eadac)eB n$stagmus, di#lo#iaB nausea, vomiting, wt gain, d$s#e#siaB r)initisB tremorB leuco#eniaB altered ,;TsB .tevens-No)nson s$ndrome 4ursing /es#onsibilities: 1& Caution #atient to avoid activities t)at reAuire alertness to #revent in5ur$ d:t di++iness& & >rovide su#ervision w)en #atient is ambulating& !& Monitor for side effects and instruct #atient to refer if adverse effects are felt& Sennosides .eno(ot Classification: ,a1ative Desired Dosage: 1 -%0 mg 1- 1 dail$ Mode of Action: Active com#onents of senna (sennosides) alter water and electrol$te trans#ort in t)e large intestine, resulting in accumulation of water and increased #eristalsis& *nteractions: Ma$ decrease absor#tion of ot)er orall$ administered drugs because of decreased transit time& .ide 0ffects: <*: cram#ing, diarr)ea, nausea <-: #in(-red or brown-blac( discoloration of urine ; O 0: electrol$te abnormalities Misc: la1ative de#endence

4ursing /es#onsibilities: 1& Asses #atient for abdominal distention, #resence of bowel sounds, and usual #attern of bowel function& & Assess for color, consistenc$, and amount of stool #roduced& !& Ta(e wit) full glass of water& *deall$, administer at bedtime for evacuation 6-1 )ours later& Administer on an em#t$ stomac) for a ra#id result& "& Advise #atient t)at la1atives s)ould be used onl$ for s)ort-term t)era#$& ,ong-term t)era#$ ma$ cause electrol$te imbalance and de#endence, %& 0ncourage #atient to use ot)er forms of bowel regulation suc) as increasing bul( in t)e diet, increasing fluid inta(e, and increasing mobilit$&

66

6& *nform t)at medication ma$ cause c)ange in )is urinePs color to #in(, red, violet, $ellow or brown& Berodual (neb) *#ratro#nium 9r, ;enoterol 29r Classification: Antic)olinergic *ndication: Acute #revention and treatment of s$m#toms of c)ronic obstructive airwa$ disorders wit) Contraindication: tac)$arr)$t)mia& >recaution: Diabetic #atient wit) unstable metabolism, recent m$ocardial infarction, severe organic )eart or vascular disorderB transient dose de#endent doer in serum QHB )$#ert)$roidismB narrow-angle glaucomaB urinar$ outflow obstruction d:t #rostatic )$#ertro#)$& .ide effects: Tremor, restlessness, #al#itation, tac)$cardia, di++iness, )ead ac)e, #otentiall$ serious )$#o(alemia, dr$ness of mout), t)roat irritation, allrergic reactions, coug)& *nteractions: 9 adrenergics, s$stematicall$ absorbed antic)olinergics, 1ant)ine derivatives and corticosteroids ma$ increase in effect and ma$ occur on concurrent administration of 9 bloc(er& Availabilit$ O >ri+e: -D= solution for in)alation "ml (%@&@%) *n)alation solution 0 ml (F! &00) Metered aerosol 10ml (1, %!&00) 2$#ertro#)ic reversible obstructive bronc)os#asm cardioma$o#at)$, (e&g&bronc)ial ast)ma sc)ronic bronc)itis wit) or wit)out em#)$sema)

!orgesic "orte >er norgesic tab- '#)enadrine citrate !% mg H >aracetamol "%0mg& >er norgesic forte tab- '#)enadrine citrate %0 mg H >aracetamol 6%Fmg&

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*ndication: ;or t)e relief of #ainful s(eletal muscle s#asm associated wit) c)ronic low bac( #ain, s#asms and strains, #rola#sed intervertebral disc, muscle in5ur$, non-articular r)eumatism (fibrisitis, m$ositis, O m$algia) w)i#las) in5uries, tension )ead ac)e, d$smenorr)ea, and ot)er acute or c)ronic #ainful muscular condition& Dosage: 4orgesic tab 1- tab T*D& Contraindications: <laucomaB #rostatic )$#ertro#)$ or bladder nec( obstruction& >recaution: Cardiac arr)$t)mias, tac)$cardia, cardiac decom#ensation, coronar$ insuffienc$, #regnanc$& .ide effects: 4ausea, dr$ mout), blurred vision, rarel$ ras), drowsiness, di++iness, and restlessness& >ri+e: 4orgesic ;orte tab ( 1&00)B 4orgesic tab (1"&00) Cilostazol >letal Classification: Anti#latelet Action: *n)ibits t)e en+$me c$clic adenosine mono#)os#)ate (cAM>) #)os#)odiesterase ***, w)ic) results in increased cAM> in #latelets and blood vessels, #roducing in)ibition of #latelet aggregation and vasodilation& *ndication: /eduction of s$m#toms of intermittent claudication allowing increased wal(ing distance& Contraindications: 2$#ersensitivit$, )eart failure, active bleeding, )emostatic disorders& -se cautiousl$ wit) renal d$sfunction& Availabilit$: %0,100 mg tablets Dosage: 100 mg #o 9*D 8 least !0 minute before or Adverse effects: C4. R di++iness, )ead ac)e C= R )eart failure, tac)$cardia, #al#itations <* R diarr)ea, nausea, flatulence, d$s#e#sia /es#irator$ R coug), #)ar$ngitis, r)initis 't)ers R #eri#)eral edema, infection, bac( #ain 4ursing /es#onsibilities: 1& Assess #atient for intermittent claudication & Administer on an n em#t$ stomac), 1 )our before of )ours #ost meal& !& Do not administer wit) gra#efruit 5uice& Ma$ increase cilosta+ol levels& )ours #ost brea(fast and dinner&

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"& Caution #atient to avoid driving or ot)er activities reAuiring alertness& %& Advise #atient to avoid smo(ingB nicotine constricts blood vessels& 6& >revent in5ur$ w)ic) ma$ cause bleeding& - use soft bristled toot)brus)& - avoid s)ar# ob5ects& - instruct #atient not to strain too muc) w)ile defecating to avoid #erforating t)e rectal muscle& #umulin $%&'% *nsulin (mi1tures) Classification: Antidiabetics, )ormones Action: ,owers blood glucose b$: stimulating glucose u#ta(e in s(eletal muscle and fat, in)ibiting )e#atic glucose #roduction& Contraindications: 2$#ogl$cemiaB allerg$ or )$#ersensitiv$& >recautions: *n #atient wit) real:)e#atic im#airment (ma$ decrease insulin reAuirements) Adverse effects: 0ndo R 2$#ogl$cemia ,ocal R 0r$t)ema, li#od$stro#)$, #ruritus, swelling Misc R Allergic reactions including ana#)$la1is Drug-Drug interactions: 9-bloc(ers, clonidine and reser#ine R ma$ mas( some of t)e signs ands$m#toms of )$#ogl$cemia& Corticosteroids, t)$roid su##lements, estrogens, isonia+id,niacin, #)enot)ia+ines and rifam#in R increase insulin reAuirements& Alco)ol, AC0 in)ibitors, MA' in)ibitors, oral )$#ogl$cemic agents and salic$lates R decrease insulin reAuirements Availabilit$: (100 units:ml total) in 10 ml vials and ! ml dis#osable deliver$ devices& 4ursing *nterventions: 1& Assess for s$m#toms of )$#ogl$cemia suc) as: an1iet$, restlessness, tingling in )ands, feet, li#s or tongue, c)ills, cold sweat, confusion, #ale s(in, difficult$ in concentration, drowsiness, e1cessive )unger, )ead ac)e, irritabilit$, nig)tmares or trouble slee#ing, nausea, tac)$cardia, tremor, wea(ness, unstead$ gait& & Assess for s$m#toms of )$#ergl$cemia: confusion, drowsiness, flus)ed and dr$ s(in, ra#id dee# breat)ing, #ol$uria, loss of a##etite, nausea O vomiting, unusual t)irst&

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!& Monitor bod$ weig)t #eriodicall$& C)anges in weig)t ma$ necessitate c)anges in insulin dose& "& Monitor blood glucose ever$ 6 )ours during t)era#$& %& 4ote for to1icit$ and overdose: 2D>'<,DC0M*A - let #atient ingest oral glucose - if severe )$#ogl$cemia: administer *= glucose, glucagon or e#ine#)rine& 6& viscous& ?& @& F& 10& /otate site of infection& *nstruct #atient on #ro#er tec)niAues for administration& 01#lain to t)e #atient t)at t)is medication controls )$#ergl$cemia but does 0m#)asi+e t)e im#ortance of com#liance wit) nutritional guidelines and .tore insulin in refrigerator& Do not use if cloud$, discolored or unusuall$

not cure diabetes& regular e1ercise as directed&

(operamide Diar-aid ca#lets, *modium, *modium A-D, Qao#ectate ** ca#lets, Maalo1 antidiarr)eal ca#lets, 4eo-Diaral, >e#to Diarr)ea control Classification: Antidiarr)eals *ndications: Ad5unctive t)era#$ of acute diarr)ea& C)ronic diarr)ea associated wit) inflammator$ bowel disease decrease t)e volume of ileostom$ drainage& Action: *n)ibits #eristalsis and #rolongs transit time b$ a direct effect on nerves in t)e intestinal muscle wall& /educes fecal volume, increases fecal viscosit$ and bul( w)ile diminis)ing loss of fluid and electrol$tes& T)era#eutic effects: /elief of diarr)ea& Contraindications: 2$#ersensitivit$B #atients in w)om consti#ation must be avoidedB abdominal #ain of un(nown cause, es#eciall$ if associated wit) feverB alco)ol intolerance(liAuid onl$)& >recautions: 2e#atic d$sfunction .ide effects: C4. R drowsiness , di++iness

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<* R consti#ation, abdominal #ain:distention:discomfort, dr$ mout), nausea and vomiting& Misc R allergic reactions Drug-Drug interactions: *ncrease C4. de#ression wit) ot)er C4. de#ressants including alco)ol, anti)istamines, o#ioid analgesics, and sedatives& *ncrease antic)olinergic #ro#erties wit) t)e ot)er drugs )aving antic)olinergic #ro#erties including antide#ressants and anti)istamines& 4ursing Management: 1& Assess freAuenc$ and consistenc$ of stools and bowel sounds #rior to and during t)era#$& & Assess s(in turgor for de)$dration& !& Administer wit) clear fluids to )el# #revent de)$dration w)ic) ma$ accom#an$ diarr)ea& "& *nstruct #atient to ta(e medication as directed& *n acute diarr)ea, medication ma$ be ordered after eac) unformed stool& %& Advise #atient t)at freAuent mout) rinses and good oral )$giene ma$ relieve dr$ mout)& 6& *nstruct #atient to notif$ )ealt) care #rofessional if diarr)ea #ersist or if fever, abdominal #ain, or distention occurs& "urosemide 4ovosimideB >M.-;urosimide Classification: ,oo# diuretics *ndications: 0dema d:t )eart failure, )e#atic im#airment or renal disease& 2$#ertension& Action: *n)ibits t)e reabsor#tion of sodium and c)loride from t)e loo# of 2enle and distal renal tubule& *ncreases renal e1cretion of water, sodium, c)loride, magnesium, #otassium, and calcium& 0ffectiveness #ersists in im#aired renal function& Decreased blood #ressure& Dosage: 1 tablet, 00 mg Contraindication: 2$#ersensitivit$B Cross-sensitivit$ wit) t)ia+ides and sulfonamides ma$ occurB 2e#atic coma or anuriaB .ome liAuid #roducts ma$ contain alco)ol, avoid in #atients wit) alco)ol intolerance&

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>recautions: .evere liver diseaseB electrol$te de#ression .ide effects: C4. R blurred vision, di++iness, )ead ac)e, vertigo 004T R )earing loss, tinnitus C= R )$#otension <* R anore1ia, consti#ation, diarr)ea, dr$ mout), nausea, vomiting <- R e1cessive urination Derm R #)otosensitivit$, ras) ; and 0 R de)$dration 4ursing /es#onsibilities: 1& Assess fluid status& 4otif$ #)$sician or ot)er )ealt) care #rofessional if t)irst, dr$ mout), )$#otension, or oliguria occurs& & Monitor blood #ressure and #ulse before and during administration& !& Monitor blood glucose closel$B ma$ cause increased blood glucose level& "& Caution #atient to c)ange #ositions slowl$ to minimi+e ort)ostatic )$#otension& %& Advise #atient to contact )ealt) care #rofessional immediatel$ if muscle wea(ness, cram#s, nausea, di++iness and numbness occurs& 6& Caution older #atients or t)eir caregivers about increased ris( for falls& (actulose Du#)alac Classification: ,a1atives *ndications: Treatment of c)ronic consti#ation in adults and geriatric #atients& Ad5unct in t)e management or #ortal- s$stemic ()e#atic) ence#)alo#at)$& Action: *ncreases water and softens t)e stool& ,owers t)e #2 of t)e colon, w)ic) in)ibits t)e diffusion of ammonia from t)e colon into t)e blood, t)ereb$ reducing blood ammonia levels& Contraindication: >atients on low-galactose diets& >recautions: Diabetes mellitusB e1cessive use ma$ lead to de#endence& .ide effects: <* R belc)ing, cram#s, distention, diarr)ea 0ndo R )$#ergl$cemia

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Drug-Drug interactions: s)ould not be used wit) ot)er la1atives in t)e treatment of )e#atic ence#)alo#at)$ (leads to inabilit$ to determine o#timal dose of lactulose)& Antiinfectives ma$ diminis) effectiveness in treatment of )e#atic ence#)alo#at)$& Dosage: !0 cc >' 4ursing *nterventions: 1& Assess #atient for abdominal distention, #resence of bowel sounds, and normal #attern of bowel function& & Assess color, consistenc$, and amount of stool #roduced& !& Ma$ cause increased blood glucose levels in diabetic #atients& "& 0ncourage #atient to increased oral fluid inta(e& %& Caution #atients t)at t)is medication ma$ cause belc)ing, flatulence, or abdominal cram#ing& 2ealt) care #rofessional s)ould be notified if t)is becomes bot)ersome or if diarr)ea occurs&

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