University of Perpetual Help System Dalta

College of Nursing

Drug Study

Mechanism of
Drug Indications Side Effects Nursing Responsibilities
Action
1. KALIUM DURULE Prevention and Principal  Dermatologic: Rash a. Assessment
correction of intracellular cation  GI: Nausea,  History: Allergy to tartrazine,
a. Generic name: potassium deficiency; of most body vomiting, diarrhea, aspirin; severe renal impairment;
Potassium Acetate when associated with tissues, abdominal untreated Addison’s disease;
acidosis, use potassium participates in a discomfort, GI hyperkalemia; adynamia
b. Brand name: acetate, bicarbonate, number of obstruction, GI episodica hereditaria;acute
Kalium Durule 20 citrate, or gluconate. physiologic bleeding, GI dehydration; heat cramps; GI
processes – ulceration of disorders that cause delay in
c. Classification: maintaining perforation passage in the GI tract, cardiac
Electrolyte intracellular  Hematologic: disorders, lactation
tonicity, Hyperkalemia –  Physical: Skin color, lesions,
d. Dosage: transmission of increased serum K+, turgor, injection sites, pulse,
Individualize dosage nerve impulses, ECG changes baseline ECG; bowel sounds,
based on patient response contraction of (peaking of T waves, abdominal exam; urinary output;
using serial ECG and cardiac, skeletal loss of P waves, serum electrolytes, serum
electrolyte determinations in and smooth depression of ST bicarbonate
severe cases: muscle, segment,
 Adults- for prevention maintenance of prolongation of QTc b. Interventions
of Hypokalemia 16-24 normal renal interval)  Arrange for serial serum
mEq/day PO; for function; also plays  Local: Tissue potassium levels before and
treatment of potassium a role in sloughing, local during therapy.
depletion 40-100 carbohydrate necrosis, local  Administer liquid form to any
mEq/day PO metabolism and phlebitis, and patient with delayed GI
 Pediatric Patient- for various enzymatic venospasm with emptying.
replacement 3 reactions. injection  Administer oral drug after meals
 mEq/kg/day or 40 mg/
m 2/day PO
 Geriatric Patient or
with renal impairment-
carefully monitor
serum potassium
concentration and
reduce dosage
appropriately.
“With regards to the use of
drug, animal studies have not
demonstrated a risk to the
fetus but there are no
adequate studies in pregnant
women. Or, animal studies
have shown an adverse effect,
but adequate studies in
pregnant women have not
demonstrated a risk to the
fetus during the 1st trimester
of pregnancy, and there is no
evidence of risk in later
trimesters.”
or with food and a full glass of
water to decrease GI upset.
 Caution patient not to chew or
crush tablets, have patient
swallow tablet whole.
 Mix or dissolve oral liquids,
soluble powders, and
effervescent tablets completely
in 3-8 oz of cold water, juice, or
other suitable beverage, and
have patient drink it slowly.
 Arrange for further dilution or
reduction if GI effects are severe.
 Caution patient that expended
wax matrix capsules will be found
in the stool.
 Caution patient not to use salt
substitutes.
c. Teaching points
 Take drugs after meals or with
food and a full glass of water to
decrease GI upset. Do not chew
or crush tablets, swallow tablets
whole. Mix or dissolve oral
liquids, soluble powders, and
effervescent tablets completely
in 3-8 oz of cold water, juice, and
other suitable beverage, and
drink slowly. Take the drug as
prescribed.
 Have periodic blood tests and
medical evaluation.
  You may experience these side
effects: Nausea, vomiting,
diarrhea (taking the drugs with
meals, diluting them further may
help).
2. DEPAKENE (VALPROIC  Sole and adjunctive Mechanism of  CNS: Sedation, a. Assessment
therapy in simple action not tremor (may be  History: Hypersensitivity to
ACID)
(petit mal) and understood: dose-related), valproic acid; hepatic
complete absence Antiepileptic emotional upset, dysfunction; pregnancy, lactation
A. Generic name:
seizures activity may be depression,  Physical: Weight; skin color,
Sodium Valproate
 Adjunctive therapy related to the psychosis, lesions; orientation, affect,
with multiple metabolism of the aggression, reflexes; bowel sounds, normal
b. Brand name:
seizure types, inhibitory hyperactivity, output; CBC and differential,
Depakene
including absence neurotransmitter behavioral bleeding time tests, hepatic
seizures gamma- deterioration, function tests, serum ammonia
c. Classification:
 Unlabeled uses: aminobutyric acid weakness level, exocrine pancreatic
Antiepileptic
Sole and adjunctive (GABA); divalproex  Dermatologic: function tests, EEG
therapy in atypical sodium is Transient increases
d. Dosage:
absence, myoclonic compound in hair loss, rash, b. Interventions
 Adults - Dosage is
and grand mal containing equal petechiae  Give drug with food if GI upset
expressed as valproic
seizures; possibly proportions of  GI: Nausea, occurs; substitution of the
acid equivalents. Initial
effective therapy in valproic acid and vomiting, enteric-coated formulation also
dose is 10-15
atonic, elementary sodium valproate. indigestion, maybe of benefit; have patient
mg/kg/day PO,
partial, and diarrhea, abdominal swallow SR tablet whole; do not
increasing at 1-wk
infantile spasm cramps, cut, crush, or chew.
intervals by 5-
seizures; constipation,  Reduce dosage, discontinue, or
10mg/kg/day until
prophylaxis for anorexia with weight substitute other antiepileptics
seizures are controlled
recurrent febrile in loss, increased gradually; abrupt discontinuation
or side effects preclude
children, adjunct in appetite with weight of all antiepileptics may
further increases.
symptom gain, life-threatening precipitate absence seizures.
Maximum
management of pancreatitis, hepatic  Arrange for frequent liver
recommended dosage
schizophrenia, failure function tests; discontinue drug
is 60mg/kg/day PO. If
relief of tardive  GU: Irregular immediately with significant
 total dose > 250 dykinesia in menses, secondary hepatic dysfunction, suspected or
mg/day, give in divided patients receiving amenorrhea apparent; hepatic dysfunction
doses. long-term  Hematologic: Slight has progressed in spite of drug
 Pediatric patients-Use psychotics, elevations in AST, discontinuation.
extreme caution. Fatal treatment of ALT, LDH; increases  Arrange for patient to have
hepatotoxicity has aggressive in serum bilirubin, platelet counts, bleeding time
occurred. Children < 2 outbursts in abnormal changes in determination before therapy,
yr are susceptible. children with other liver function periodically during therapy, and
Monitor all children ADHD, organic tests, altered prior to surgery. Monitor patient
carefully. ≥ 10yr: 10-15 brain syndrome bleeding time; carefully for clotting defects
mg/kg/day PO thrombocytopenia; (bruising, blood-tinged
bruising; hematoma toothbrush). Discontinue if there
“With regards to drug use, formation; frank is evidence of hemorrhage,
there is evidence of human hemorrhage; relative bruising, or disorder of
fetal risk, but the potential lymphocytosis; hemostasis.
benefits from the use of the hypofibrinogenemia;  Monitor ammonia levels, and
drug in pregnant women may leucopenia, discontinue if there is clinically
be acceptable despite its eosinophilia, significant elevation inlevel.
potential risks.” anemia, bone  Monitor serum levels of valproic
marrow suppression acid and other antiepileptics
given concomitantly, especially
during the first few weeks of
therapy. Adjust dosage on the
basis of these data and clinical
response.
 Arrange for counseling for
women of child-bearing age who
wish to become pregnant.
 Discontinue drug at any sign of
pancreatitis.
 Evaluate for Therapeutic serum
levels – usually 50-100 mcg/ml.
c. Teaching points
 Take this drug exactly as
prescribed. Do not chew tablets
or capsules before swallowing
them. Swallow them whole to
prevent local irritation of mouth
and throat. Sprinkle tablets may
be opened and sprinkled on
applesauce or pudding.
 Do not discontinue this drug
abruptly or change dosage except
on the advice of your physician.
 Avoid alcohol and sleep-inducing
and over-the-counter drugs.
These could cause dangerous
effects.
 Have frequent checkups,
including blood tests to monitor
your drug response. Keep all
appointments for checkups.
 Use contraceptive techniques at
all times. If you wish to become
pregnant, you should consult
your physician.
 Wear a medical ID tag to alert
emergency medical personnel
that you have epilepsy and are
taking epileptic medication.
 If you have diabetes, this drug
may interfere with urine tests for
ketones.
 You may experience these side
effects: Drowsiness (avoid driving

3. SOLU-CORTEF  Allergic states –
a. Generic name:
Hydrocortisone sodium
succinate  Short-term
b. Brand name:
Solu-Cortef
c. Classification:
d. Dosage:
 Adults – Individualize
dosages based on severity
and response. Give daily
dose before 9 AM to
minimize adrenal
suppression. If long-term
therapy is needed,
alternate-day therapy
or performing other tasks
requiring alertness; take at
bedtime); GI upset (take with
food or milk, eat frequent small
meals; if problem persists,
substitute enteric-coated drug);
transient increase in hair loss.
 Report bruising, pink stain on the
toothbrush, yellowing of the skin
or eyes, pale feces, rash,
pregnancy, abdominal pain with
nausea, vomiting, and anorexia.
Enters target cells Systemic a. Assessment
severe or and binds to  CNS: Vertigo,  History: Infections, kidney
incapacitating cytoplasmic headache, disease, liver disease,
allergic conditions receptors; initiates paresthesias, hypothyroidism; ulcerative
many complex insomnia, seizures, colitis with impending
inflammatory and reactions that are psychosis perforation; divrticulitis; recent
allergic disorders, responsible for its  CV: Hypotension, GI surgery; active or latent
such as rheumatoid anti-inflammatory, shock, hypertension peptic ulcer; inflammatory
arthritis, collagen immunosuppressiv and CHF secondary bowel disease; hypertension,
diseases (SLE) , e (glucocorticoid), to fluid retention, CHF; thromboembolitic
dermatologic and salt-retaining thromboembolism, tendencies, thrombophlebitis,
diseases (mineralocorticoid) thrombophlebitis, osteoporosis, seizure disorders,
(pemphigus), status actions. Some fat embolism, metastatic carcinoma, diabetes
asthmaticus, and actions may be cardiac arrhythmias mellitus; lactation. Retention
autoimmune undesirable, secondary to enemas, intrarectal foam;
disorders depending on drug electrolyte Systemic fungal infections;
use. disturbances recent intestinal surgery,
 Dermatologic: thin, extensive fistulas. Topical
fragile skin; dermatologic administration:
petechiae, Fungal, tubercular, herpes
ecchymoses,; simplex skin infections; vaccinia,
 should be considered.
After long-term, withdraw
drug slowly to avoid
adrenal insufficiency. For
maintenance therapy,
reduce initial dose in small
increments at intervals
until lowest clinically
satisfactory dose is
reached.
 100-50 mg
initially and q2
– 10 hr, based
on condition
and response
 Pediatric patients –
Individualize dosage
based on severity and
response rather than
on formulae that
correct adult doses for
age and weight.
Carefully observe
growth and
development in infants
and children on
prolonged therapy.
 Reduce dose, based on
condition and response,
but give no less than 25
mg/day.
“With regards to the use of
purpura; striae; SC varicella; ear application when is
fat atrophy perforated
 EENT: Cataracts,  Physical: Systemic
glaucoma (long-term administration: Weight,
therapy), increased temperature; reflexes, affect,
IOP bilateral grip strength,
 Endocrine: ophthalmologic exam; BP, pulse,
Amenorrhea, auscultation, peripheral
irregular menses, perfusion, discoloration, pain or
growth retardation, prominence of superficial
decreased vessels; respiratory, adventitious
carbohydrate sounds, chest x-ray; upper GI x-
tolerance and ray (history or symptoms of
diabetes mellitus, peptic ulcer), liver palpation;
cushingoid state CBC, serum electrolytes, 2-hr
(long-term therapy), postprandial blood glucose,
HPA suppression urinalysis, thyroid function tests,
systemic with serum cholesterol. Topical,
therapy longer than dermatologic preparations:
5 days Affected area, integrity of skin
 GI: Peptic or
esophageal ulcer, b. Interventions
pancreatitis, Systemic Administration
abdominal  Give daily before 9 AM to mimic
distention, nausea, normal peak diurnal
vomiting, increased corticosteroid levels and
appetite and weight minimize HPA suppression.
gain (long-term  Space multiple doses evenly
therapy) throughout the day.
 Hematologic: Na +
 Use minimal doses for minimal
and fluid retention, duration to minimize adverse
hypokalemia, effects.
hypocalcemia,  Taper doses when discontinuing
drug, animal studies have
shown an adverse effect on
the fetus but there are no
adequate studies in humans;
the benefits from the use of
the drug in pregnant women
may be acceptable despite its
potential risks. Or there are no
animal reproduction studies
and no adequate studies in
humans.”
IV Facts
Preparation: Give directly or
dilute in normal saline or D5W.
Administer within 24 hr of
diluting
Infusion: Inject slowly, directly
or dilute, and infuse
hydrocortisone sodium
succinate at rate of each 500
mg over 30-60 sec.
increased blood high-dose or long-term therapy.
sugar, increased  Arrange for increased dosage
serum cholesterol, when patient is subject to
decreased serum T1 unusual stress.
and T4 levels  Use alternate-day maintenance
 Hypersensitivity: therapy with short-acting
Anaphylactoid or corticosteroids whenever
hypersensitivity possible.
reactions  Do not give live virus vaccines
 Musculoskeletal: with immunosuppressive doses
Muscle weakness, of hydrocortisone
steroid myopathy  Provide antacids between meals
and loss of muscle to help avoid peptic ulcer.
mass, osteoporosis,
spontaneous Topical dermatologic administration
fractures (long-term  Use caution with occlusive
therapy) dressings; tight or plastic diapers
 Other: over affected area can increase
immunosuppression, systemic absorption.
aggravation, or  Avoid prolonged use, especially
masking infections, near eyes, in genital and rectal
impaired wound areas, on face, and in skin
healing; creases.
osteonecrosis, c. Teaching points
tendon rupture, Systemic administration
infection  Take this drug exactly as
described. Do not stop taking
this drug without notifying your
health care provider; slowly
taper dosage to avoid problems.
 Take with meals or snacks if GI
upset occurs.
 Take single daily or alternate-
 day doses before 9 AM; mark
calendar or use other measures
as reminder of treatment days.
 Do not overuse joint after intra-
articular injections, even if pain
is gone.
 Frequent follow-up visits to your
health care provider are needed
to monitor drug response and
adjust dosage.
 Report the abovementioned side
effects should those be
experienced.
 Dosage reductions may create
adrenal insufficiency. Report any
fatigue, muscle and joint points,
anorexia, nausea, vomiting,
diarrhea, weight loss, weakness,
dizziness, or low blood sugar (if
you monitor blood sugar)
 Do not overuse the injected joint
even if the pain is gone. Adhere
to rules of proper rest and
exercise.
4. INSULIN ASPART  Treatment of type
1 (insulin-
dependent)
a. Generic name:
diabetes
Insulin
 Treatment of type
2 (non – insulin-
b. Brand name:
dependent)
Novolog
diabetes that
cannot be
 c. Classification: controlled by diet
Antidiabetic or oral drugs
 Regular insulin
d. Dosage: injection:
 Adult and Pediatric Treatment of
patients: General severe ketoacidosis
guidelines, 0.5 – 1 or diabetic coma
unit/kg/day. The  Treatment of
number and size of hyperkalemia with
daily doses, times of infusion of glucose
administration, and to produce a shift
type of insulin of potassium into
preparation are cells
determined after close 
medical scrutiny of the
patient’s blood and
urine glucose, diet,
exercise, and
intercurrent infections
and other stresses.
Usually given SC.
Regular insulin may be
given IV or IM in
diabetic coma or
ketoacidosis. Insulin
injection concentrated
may be given SC or IM
but do not administer
IV.
 Adults with type 2 diabetes
requiring basal insulin
control: 10 units/day SC,
given at the same time
each day.