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Drug Study of Celecoxib

Generic Name: celecoxib


Brand Name: Celecoxib
Functional Class: CNS Agent, Analgesic, NSAID, Cyclooxgenase-2 inhibitor, Antipyretic
Pregnancy Category: C (first and second trimesters), D (third trimester)
Mechanism of Action: NSAID that exhibits anti-inflammatory, analgesic and antipyretic
activities. Unlike ibuprofen, inhibits prostaglandin synthesis by inhibiting cyclooxygenase-2
(COX-2), but does not inhibit cyclooxygenase-1 (COX-1).
Indication: Relief of signs and symptoms of osteoarthritis and rheumatoid arthritis and
musculoskeletal pain.
Contraindication: Contraindicated to patients with severe hepatic impairment, hypersensitivity to
celecoxib, asthmatic patients with aspirin triad; advanced renal disease; concurrent use of
diuretics and ACE inhibitors; and anemia
Actual Indication: Relief of pain due to crutch field tong insertion
Usual Dose: 100-200mg 1 cap bid or 200mg qid PO
Actual Dose: 400mg 1 cap OD PRN (for pain)
Side Effects: Body as a whole: peripheral edema
CNS: dizziness
GI: GI irritation diarrhea
Adverse Effects: Body as a whole: back pain
CNS: headache, insomnia
GI: dyspepsia, abdominal pain, flatulence, nausea
Respiratory: pharyngitis, rhinitis, sinusitis, URTI
Skin: rash
Drug-drug Interaction: May diminish effectiveness of ACE inhibitors; fluconazole: increases
celecoxib concentrations; may increase lithium concentration

Nursing Considerations:
- Celecoxib may be more effective if given 2h before/after magnesium or aluminum-
combining antacids.
- Periodically monitor lithium levels when the two drugs are given concurrently.
- Monitor for fluid retention and edema especially in those with a history of hypertension
or CHF.
Rationale: This drug was given to patient N.O because shes experiencing pain due to the crutch
field tong insertion.
Drug Study of Pregabalin
Generic Name: pregabalin
Brand Name: Pregabalin
Functional Class: analgesic, antiepileptic, calcium channel modulator
Pregnancy Category: C (unsafe for first and second trimester)
Mechanism of Action: Binds to alpha2-delta sites on the nerves in the CNS, which reduces the
calcium influx into the cell and decreases the release of neurotransmitters into the synaptic cleft,
resulting in less stimulation of the nerve; in lab studies, it also increases the transport and density
of GABA, which is known to suppress nerve activity.
Indications:
- Management of acute associated with peripheral neuropathy.
- Management of post hepatic neuralgia
- Adjunct therapy of adult patients with partial onset seizures
- Management of fibromyalgia
- Treatment of generalized anxiety disorders
Actual Indication: Acute pain post-op and decrease anxiety r/t crutch field insertion.
Contraindications: Contraindicated to patients with known hypersensitivity to pregabalin or any
component of the drug and lactation.
Usual Dose: 100mg PO tid
Actual Dose: 75mg 1 tab OD tid

Side Effects:
CNS: dizziness, vertigo
GI: constipation
Other: weight gain
Adverse Effects:
CNS: somnolence, neuropathy, ataxia, confusion, euphoria, incoordination, vision abnormalities,
tremors, thinking abnormalities, suicidal ideation
GI: dry mouth
Other: peripheral edema, hypoglycemia, back pain, chest pain, infection, creatine kinase
duration, loss of fertility (male), angioedema
Drug-drug interactions: Increased risk of sedation and dizziness if combined with ploglitazone,
rosiglitazone
Nursing Considerations:
- Do not administer this drug after a fatty or large meal, absorption can be affected.
- Instruct the patient to do not stop taking drug suddenly; dosage should be adjusted to
avoid adverse effects.
- Risk for suicide ideation: Monitor patient accordingly.
Rationale: This drug was prescribed to patient N.O because shes experiencing pain after surgery
and shes anxious due to what is attached in her head.

Drug Study of Paracetamol
Generic Name: acetaminophen
Brand Name: Paracetamol
Functional Class: Analgesic, Antipyretic
Pregnancy Category: B (animal studies have not demonstrated a fetal risk)
Mechanism of Action: Unlike aspirin, acetaminophen has little effect on platelet effect on
platelet junction, does not affect bleeding time, generally produces no gastric bleeding. Produces
analgesic by unknown mechanism, perhaps by action on peripheral nervous system. Produces
fever by direct action on hypothalamus
Indication: Fever reduction. Temporary relief of mild to moderate pain. Generally as substitute
for aspirin when the latter is not tolerated or is contraindicated.
Actual Indication: To reduce fever.
Contraindication: Contraindicated to patients with hypersensitivity to acetaminophen or
phenacetin, in children below 3 years old unless directed by a physician and repeated
administration to patient with anemia or hepatic disease.
Usual Dose: 325-650mg q4-q6
Actual Dose: 500mg 1 tab PRN F=37.8
Side Effects: epigastric pain, diarrhea
Adverse Effects: anorexia, rash, vomiting, dizziness, lethargy, diaphoresis, chills, onset of
hepatotoxicity elevation of serum transaminases and bilirubin.
Drug-to-drug Interaction: Cholestyramine may decrease acetaminophen absorption. With chronic
coadministration, barbiturates, carbamazepine, phenytoin, and rifampin may increase potential
for chronic hepatotoxicity,
Nursing Considerations:
- May be crushed and taken with fluid of patients choice. Chewable tablets should be
thoroughly chewed and before they are swallowed.
- Abuse potential is high; psychological dependence can occur.
- Overdosing and chronic use can cause liver damage and other toxic effects.
Rationale: Patient N.O was given paracetamol because she had fever. Paracetamol aids in fever
reduction.

Drug Study of Ascorbic Acid (Vitamin C)
Generic Name: ascorbic acid
Brand Name: Ascorbic acid (Vitamin-C)
Functional Class: Vitamin
Pregnancy Category: C
Mechanism of Action: Water-soluble vitamin essential for synthesis and maintenance of collagen
and intercellular ground substance of body tissues, bones, skin and cartilages. Increases
protection mechanism of the immune system.
Indication: Prophylaxis and treatment of scurvy and as dietary supplement.
Actual Indication: Prophylaxis and treatment of scurvy foot.
Contraindication: Contraindication to patient in use of sodium ascorbate, in patients on sodium
restriction. Use of calcium ascorbate in patients receiving digitalis.
Usual dose: PO 150-500mg in 1-2doses
Actual dose: 500mg 1tab OD
Side Effects: epigastric pain
Adverse Effects: nausea and vomiting, heartburn, diarrhea, insomnia, urthritis, dysuria,
crystalluria
Drug-to-drug Interaction: Large doses may attenuate hypoprothombinemic effects of oral
anticoagulants; salicytes may inhibit ascorbic acid uptake by leukocytes and tissues.
Nursing Considerations:
- Doses of Vitamin-C are not recommended during pregnancy. It has been suggested that
the fetus may adapt to high levels of the vitamin by development of the capacity to
inactivate it.
- Vitamin C increases the absorption of iron when taken at the same time.
- Vitamin C is rapidly oxidized when exposed to air (slight darkening of tablets may occur
with loss of potency.
Rationale: This vitamin is given to the patient to improve immune system and cure her scurvy @
R foot.
Drug Study of Ranitidine Hydrochloride
Generic Name: ranitidine hydrochloride
Brand Name: Ranitidine Hydrochloride
Functional Class: Antacid
Pregnancy Category: B
Mechanism of Action: Blocks daytime and nocturnal basal gastric acid secretion stimulated by
histamine and reduces gastric acid release in response to food, pertogastrin and insulin.
Actual Indication: Used for prevention of epigastric pain caused by celecoxib.
Contraindications: N/A
Actual Dose: 150mg 1tab PRN
Side Effects: headache
Adverse Effects: headache, abdominal pain, agitation, depression, hallucinations, anaphylaxis
Drug-to-drug Interactions: Incompatible with: amphoterecin B, clindamycin, chlorpromazine,
diazepam, hydroxyzine, methotrineprin, midezolam,nalbuphine
Nursing Considerations:
- Long term ranitidine therapy may lead to vit. B12 deficiency
- Long duration of action provides ulcer pain relief that is maintained through the might as
well as the day.
- Most patients have healed ulcers by 4 week, however, if healing cannot be confirmed
endoscopically, treatment may be continued for up to 8 week.
Rationale: This medicine is given to this patient to prevent epigastric pain. Cause of celecoxib.