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DRUG STUDY

Name of Patient: Mr. AB


Diagnosis: Anemia secondary to CRF

DRUG NAME DRUG ACTION INDICATION CONTRAINDICATION ADVERSE DRUG NURSING


S EFFECTS INTERACTIONS CONSIDERATIONS

Generic Name: Reduces cardiac ♦ Acute anginal Contraindicated in CNS: headache, Antihypertensives: ♦ Monitor blood
isosorbide oxygen demand attacks; to prevent patients throbbing, possibly increased pressure and
decreasing left situations that may hypersensitive to dizziness, hypotensive intensity and
ventricular end cause anginal nitrites, head trauma, weakness effects. Monitor duration of
Brand Name: diastolic pressure attacks cerebral hemorrhage closely during initial response to drug.
Isordil (preload) and to a or severe anemia. CV: orthostatic therapy.
lesser hypotension. ♦ Advise patient to
extent,systemic Use cautiously in tachycardia, avoid alcoholic
Pharmalogical vascular resistance hypotension. palpitation, ankle beverages; they
Class: (afterload). Also edema, fainting may produce
nitrate increases blood increased
flow through the GI: nausea and hypotension.
collateral coronary vomiting
Therapeutic Class: vessels. ♦ Warn patient not
antianginal Skin: cutaneous to confuse
vasodilation, sublingual with oral
Dosage/Route/Freq flushing form.
uency:
♦ 5mg one tablet ♦ Store in cool
sublingual now place, in tightly
closed container,
away from light.
DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME DRUG ACTION INDICATION/ CONTRAINDICATION ADVERSE DRUG NURSING


DOSAGE/ROUTE S EFFECTS INTERACTIONS CONSIDERATIONS

Generic Name: Inhibits cell wall ♦ Lower Contraindicated in CV: phlebitis, Aminoglycosides: ♦ Before giving dug.
cefuroxime synthesis respiratory tract patients thrombophlebitis May cause ask patient if she is
promoting osmotic infections caused hypersensitive to drug synergistic activity allegic to penicillin
instability usually by S. or other GI: diarrhea, against some or cephalosporin.
Brand Name: bactericidal cephalosporin. anorexia, vomiting organisms.May Obtain specimen for
pneumoniae, S.
Xorimix increase culture and
aureus, E. coli, Use cautiously in Hematologic: nephrotoxicity. sensitivity tests
Klebsiella, H. patients hemolytic anemia, Monitor patient’s before giving first
Pharmalogical influenzae, S. hypersensitive to thrombocytopenia, renal function dose. Absorption of
Class: pyogenes penicillin because of transient closely. oral drug is
2nd generation possibility of cross- neutropenia, induced.
cephalosporin ♦ Dermatologic sensitivity with other eosinophilia
infections caused beta lactam ♦ Avoid alcohol
by S. aureus, S. antibiotics while on this drug
Therapeutic Class: pyogenes, E. coli, and for 3 days
Cephalosporin Klebsiella, after because
Enterobacter severe reactions
Dosage/Route/Freq
uency: often occur.
♦ 750 mg IVTT q8 ♦ UTIs caused by
hours ANST E. coli, Klebsiella ♦ Report severe
diarrhea, difficulty
breathing,
unusual tiredness
or fatigue, pain at
injection site.
DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME DRUG ACTION INDICATION CONTRAINDICATION ADVERSE DRUG NURSING


S EFFECTS INTERACTIONS CONSIDERATIONS

Generic Name: A benzodiazepine ♦ Management of Contraindicated to CNS: drowsiness, Cimetidine, ♦ When using oral
diazepam that probably anxiety patients dysarthria, slurred disulfiram, solution, dilute dose
potentiates the disorders or for hypersensitive to drug speech, tremor, dfluoxetine, just before giving.
effects of GABA, short-term relief and soy proteins, in transient amnesia fluvoxamine,
Brand Name: depresses the CNS, patients experiencing CV: CV collapse, hormonal ♦ Monitor periodic
of symptoms of
Valium and suppresses the shock and coma or bradycardia, contraceptives, hematopoietic,
spread of seizure
anxiety acute alcohol hypotension isoniazid: may hepatic and renal
activity. intoxication; in EENT: diplopia, decrease clearance function studies in
Pharmalogical pregnant women blurred vision, of diazepam and patients receiving
Class: especially in first nystagmus increase risk of repeated or
benzodiazepine trimester; and in GI: nausea, adverse effects. prolonged therapy.
children younger than constipation, Monitor patient of
age 6 months. diarrhea with rectal excessive sedation ♦ Monitor patients
Therapeutic Class: form and impaired for dizziness,
Anxiolytic/ GU: incontinence, psychomotor ataxia, mental
Antianxiety agent urine retention function. status changes.
Hematologic:
Dosage/Route/Freq neutropenia CNS depressants: ♦ Do not
uency: Hepatic: jaundice May increase CNS administer intra-
♦ 5mg IVTT now Respiratory: depression arterially; may
respiratory produce
depression, apnea
arteriospasm,
Skin: rash
Other: pain,
gangrene.
phlebitis at
injection ♦ Change from IV
site,altered libido therapy to oral
therapy as soon
as possible.

♦ Do not use small


veins (dorsum of
hand or wrist) for
IV injection.

♦ Reduce dose of
narcotic
analgesics with IV
diazepam; dose
should be reduced
by at least one-
third or
eliminated.

♦ Carefully
monitor P, BP,
respiration during
IV administration.

♦ Maintain
patients receiving
parenteral
benzodiazepines
in bed for 3 hr; do
not permit
ambulatory
patients to
operate a vehicle
following an
injection.

♦ Monitor EEG in
patients treated
for status
epilepticus;
seizures may
recur after initial
control,
presumably
because of short
duration of drug
effect.

♦ Monitor liver and


kidney function,
CBC during long-
term therapy.

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME DRUG ACTION INDICATION CONTRAINDICATION ADVERSE DRUG NURSING


S EFFECTS INTERACTIONS CONSIDERATIONS
Generic Name: Provides elemental ♦ Iron deficiency Contraindicated in GI: N/V, Antacids, levdopa, Tell patient to
ferrous sulfate iron, an essential hemosiderosis and constipation, black penicilllamine, continue regular
component in the ♦ 1 tab OD hemochromatosis. stools quinolones, dosing schedule if
formation of also contraindicated in tetracycline, she misses a dose.
Brand Name: hemoglobin patients with Other: elixir may Vitamin E,: Patient shouldn’t
Iberet hemolytic anemia stain teeth decreased iron double the dose.
unless IDA is present. absorption.
separate doses if To avoid staining
Pharmalogical Use cautiously in possible teeth, give elixir
Class: peptic ulcer, iron preparations
Hematinic ulcerative colitis and Chloramphenicol: with straw.
regional enteritis Watch for delayed
response to iron Check for
Therapeutic therapy constipation; record
Class: color and amount of
Hematinic stool. Teach dietary
measures for
preventing
constipation.

Do not crush, chew,


sustain or release
preparations.

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS
Generic Name: Competitively ♦ Active duodenal Contraindicated to CNS: headache, Antacids: May ♦ Monitor patient
Ranitidine inhibits the action or gastric ulcer patients malaise, dizziness, interfere with continually if
of histamine (H2) at hypersensitive to confusion absorption of giving intravenous
receptor sites of the ♦ Relief of drug or any ranitidine.
(IV) doses to allow
Brand Name: parietal cells, symptoms of component of the CV: bradycardia
Zantac decreasing gastric enteric formulation Diazepam:
early detection of
heartburn, acid potentially serious
acid secretion. Hepatic: elevated decreases
indigestion, and adverse effects,
Use cautiously in liver enzymes, absorption when
Pharmalogical
sour stomach hepatic dysfunction. jaundice administered including cardiac
Class: concomitantly with arrhythmias.
H2 receptor GI: nausea, ranitidine.
antagonist constipation ♦ Arrange for
Procainamide: May decreased dosage
Skin: rash, local decrease renal in cases of hepatic
Therapeutic Class: burning and itching clearance. or renal
Antiulcer of injection site
dysfunction to
Warfarin: May
Dosage/Route/Freq interfere with prevent serious
uency: Warfarin clearance. toxicity.
♦ 50 mg IVTT ANST
q12 hours ♦ Assess patient
carefully for any
potential drug-
drug interactions
if giving in
combination with
other drugs
because of the
drug effects on
liver enzyme
systems.

♦ Provide comfort
and safety
measures,
including
analgesics, ready
access to
bathroom
facilities,
assistance with
ambulation, and
periodic
orientation if GI or
CNS effects occur,
to ensure patient
safety and
improve patient
tolerance of the
drug and drug
effects.

♦ Provide thorough
patient teaching,
including drug
name, prescribed
dosage, measures
for avoidance of
adverse effects
and warning signs
that may indicate
possible problems.
Instruct patients
about the need for
periodic
monitoring and
evaluation to
enhance patient
knowledge about
drug therapy and
to promote
compliance.

♦ Offer support
and
encouragement to
help patients cope
with the disease
and the drug
regimen

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS
Generic Name: Inhibits the ♦ Management of ♦ Contraindicated CNS: Headache, ♦ Increased risk of ♦ Administer drug
Allopurinol enzyme the signs and with allergy to drowsiness, hypersensitivity after meals.
responsible for symptoms of allopurinol, blood peripheral reaction with ACE
the conversion of primary and dyscrasias. neuropathy, inhibitors ♦ Encourage
Brand Name:
purines to uric secondary gout neuritis, patient to drink
Purinase
acid, thus ♦ Use cautiously paresthesias ♦ Increased 2.5 to 3 L/day to
reducing the ♦ Management of with liver disease, Dermatologic: toxicity with decrease the risk
Pharmalogical production of uric patients with renal failure, Rashes— thiazide diuretics of renal stone
Class: acid with a malignancies that lactation, maculopapula development.
Antigout decrease in serum result in pregnancy. r, scaly or ♦ Increased risk of
and sometimes in elevations of exfoliative— rash with ♦ Check urine
urinary uric acid serum and urinary sometimes ampicillin alkalinity—urates
Therapeutic Class: levels, relieving uric acid fatal crystallize in acid
Antigout the signs and GI: Nausea, ♦ Increased risk of urine; sodium
symptoms of gout ♦ Management of vomiting, bone marrow bicarbonate or
Dosage/Route/Freq
patients with diarrhea, suppression with potassium citrate
uency:
recurrent calcium abdominal cyclophosphamide may be ordered to
♦ 300mg one tablet
oxalate calculi pain, gastritis, , other cytotoxic alkalinize urine.
daily.
whose daily uric hepatomegaly, agents
acid excretion hyperbilirubine ♦ Arrange for
exceeds mia, cholestatic ♦ Increased half- regular medical
800 mg/day jaundice life of follow-up and
(males) or GU: Exacerbation oral blood tests.
750 mg/day of gout and anticoagulants
(females) renal calculi,
renal failure ♦ Increased serum
Hematologic: levels of
Anemia, Ztheophylline
leukopenia,
agranulocytosis,
thrombocytopenia
, aplastic anemia,
bone marrow
DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS
 May  Monitor
Generic Name: Increases plasma Treatment of metabolic Hypoventilation, Hypernatremia and decrease closely for
Sodium Bicarbonate bicarbonate, neutralizes acidosis, promotion of hypocalcemia, increase serum osmolarity, renal signs of
gastric acid which forms gastric, systemic and serum osmolarity, further paravenous clearance toxicity
water, sodium chloride, urine alkalinization in the in all situations where administrations may lead
carbon dioxide, and of these
case of intoxication with sodium intake must be to tissue necrosis.
Brand Name: raises blood pH. drug and  Monitor for
weak organic restricted like cardiac
Sodium Bicarbonate acids.failure, insufficiency, edema Hypocalemia, increased effect of the
hypertension, eclampsia, hyperosmolarity with the risk of drug
severe kidney over dose, gastric toxicity
Pharmalogical insufficiency. destention, belching,
Class: flatulence.  May
Contraindicated in increase
patien with the risk
metabolic and urine
Therapeutic Class: respiratory alkalinizati
Antigout alkalosis. on,
increase
Dosage/Route/Freq Contraindicated in renal
uency: patient with losing clearance
♦ 300mg one tablet chloride. of this
daily. drug and
Use with caution in decreases
patients with renal the effect
insufficiency , heart
failure or other
edematous or
sodium –retaining
conditions.

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS

Generic Name: B1 – Combines with B1 - Recommended Hypersensitivity to B1-restlessness, B1- neuromuscular Don’t mix
Multivitamin B- adenosine daily allowance – B1, B6, B12. weakness, nausea blockers increase parenteral
complex triposphate to form vitamin b1 pulmonary edema, effects preparation with
B1 Thiamine a enzymes needed supplement urticaria , Of this drug. same syringe with
B6 Pyridoxine for carbohydrate Vitamin B1 diaphoresis. other drugs
B12 metabolism. deficiency
Cyanocobalamin Beriberi Don’t give large oral
B6 – Acts as a co B6 – Photo allergic B6 – levodopa may doses of vitamin
Brand Name: enzyme that B6 – dietary vitamin reaction, numbness, decrease B12 routinely ; drug
Javanex stimulates various B6 deficiency headache. effectiveness of is lost through
metabolic functions, Responsive anemia levodopa. excretion
including amino or dependency Pyridoxine has a
Pharmalogical acids metabolism. syndrome little to no effect of Monitor pt. for
Class: the combination hypokalemia for
Vitamins and B12 – a co enzyme B12- deficiency drug levodopa and first 48hours, give
menirals that stimulates from inadequate carbidopa. potassium
metabolic function diet supplement as
and is needed for Alcohol use may needed.
Dosage/Route/Freq cell replication, cause dillirium and
uency: hematopoietic, and B12 – pulmonary lactic acidosis. Teach pt. dietary
 ♦ 300mg one nucleoprotein and edema, urticaria. habits
tablet daily. myelin synthesis.
B12- Instruct pt. not to
aminogycosides take folic acid as a
, aminosalisilic, replacement for
anti combulsant, vitamin B12; folic
colchasine, acid may ease
extended- blood related
release symptoms of
potassium pernicious anemia
products, salts: but neurologic
may cause mal complication is
absorption of progress.
b12 from G.I.
DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS
Generic Name: Not completely Acute angina Contraindicated Headache, Anti- hypersensitive Monitor blood
Isosorbide known. Thought to attacks to with pt. with dizziness, may increase pressure and
reduce cardiac prevent situation hypersensitivity or weakness, hypotensive intensity and
Brand Name: oxygen demand by that may cause idiosyncrasy to orthostatic effects duration of drug
decreasing preload angina attacks’ nitrate in dose with hypotension, response
Indur and actual load. severe hypotension, tachycardia,
Drug may also may angle closure palpitations, ankle Drug may cause
Pharmalogical increase blood flow glaucoma, increase edema, fainting headaches,
Class: through the intra cranial flusing. especially at the
Anti angina collateral coronary pressure. beginning of the
pectoris vessels therapy dosage may
reduce temporarily
but tolerance
Dosage/Route/Freq usually develops.
uency:
60mg/S.L/ half Patients must avoid
tablet once a day alcohol it can
worsen low blood
pressure effects.

Safety measures
are considered

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

Drug Name Mechanism of Indication Contraindication Adverse Effects Drug interaction Nursing Responsibilities
Action
Generic name: Co-amoxiclav is • Abdominal Hypersensitivity to GI: Nausea, vomiting, Allopurinol; May Before giving, ask patient
an antibiotic infections drug. diarrhea, gastritis, abd increase risk of rash. about allergic reaction to
Co-amoxiclav
that is a • Animal bites pain. penicillin. A negative history
Brand name: combination of • Infections of the CNS: dizziness, of allergy is no guaranty
a penicillin organs associated fatigue against allergic reaction.
amoxcil
(amoxicillin)and with breathing, GU: Interstitial
Classification: a substance including nasal nephritis Tell patient to take entire
called passages, sinuses, Hematolic: Anema, quantity of drug exactly as
Antibiotics thrombocytopenia,agr prescribed even after he feels
clavulanic acid. windpipe and lungs
Dosage/Route/Freq It kills bacteria, (respiratory tract) anulocytosis better.
uency by interfering • Infections of the Others: Anaphylaxis
with their ability sex organs and Drug can be taken with or
625 mg TID to form cell without food.
organs associated
walls. The with urination
bacteria (genito-urinary
therefore break infections)
up and die. • Inflammation of
connective tissue,
commonly the skin
(cellulitis)

DRUG STUDY
Name of Patient: Mr. AB
Diagnosis: Anemia secondary to CRF

DRUG NAME MECHANISM OF INDICATION CONTRAINDICATI ADVERSE DRUG NURSING


ACTION ONS EFFECTS INTERACTIONS CONSIDERATIONS
Generic Name: Inhibits the • Oral, IV: Edema • Contraindicated with • CNS: Dizziness, • Increased risk of • Administer with
reabsorption of sodium associated with allergy to vertigo, weakness, cardiac arrhythmias food or milk to
Furosemide and chloride from the CHF, cirrhosis, furosemide, headache, with digitalis prevent GI upset.
ascending limb of the renal disease sulfonamides; allergy drowsiness, fatigue, glycosides (due to • Reduce dosage if
Brand Name: loop of Henle, leading • IV: Acute to tartrazine (in oral blurred vision, electrolyte given with other
to a sodium-rich pulmonary edema solution); anuria, tinnitus, irreversible imbalance) antihypertensives;
Lasix
diuresis. • Oral: Hypertension severe renal failure; hearing loss • Increased risk of readjust dosage
Pharmalogical hepatic coma; • CV: Orthostatic ototoxicity with gradually as BP
Class: pregnancy; lactation. hypotension, volume aminoglycoside responds.
• Use cautiously with depletion, cardiac antibiotics, cisplatin • Give early in the
Loop diuretic SLE, gout, diabetes arrhythmias, • Decreased day so that
mellitus. thrombophlebitis absorption of increased urination
• Dermatologic: furosemide with will not disturb
Dosage/Route/Freq Photosensitivity, phenytoin sleep.
uency: rash, pruritus, • Decreased • Avoid IV use if oral
urticaria, natriuretic and use is at all possible.
20 mg IVTT stat
40 mg IVTT stat • GI: Nausea, antihypertensive • Do not mix
40 mg tablet q 8 anorexia, vomiting, effects with parenteral solution
hours oral and gastric indomethacin, with highly acidic
irritation, ibuprofen, other solutions with pH
constipation, , NSAIDs below 3.5.
jaundice • Decreased GI • Do not expose to
• GU: Polyuria, absorption with light, may discolor
nocturia, glycosuria, charcoal tablets or solution;
urinary bladder • May reduce effect of do not use
spasm insulin or oral discolored drug or
• Hematologic: antidiabetic agents solutions.
Leukopenia, anemia, because blood • Discard diluted
thrombocytopenia, glucose levels can solution after 24 hr.
fluid and electrolyte become elevated • Refrigerate oral
imbalances solution.
• Other: Muscle • Measure and record
cramps and muscle weight to monitor
spasms fluid changes.
• Arrange to monitor
serum electrolytes,
hydration, liver
function.
• Arrange for
potassium-rich diet
or supplemental
potassium as
needed.