DRUG STUDY

Brandname: Celebrex
Generic name: Celecoxib
Indications: Acute or chronic use in the treatment on the signs and symptoms of
ostheoarthritis and RA. Management and treatment of post-surgical or
dental pain, and primary dysmenorrheal.
Classification: Anti-rheumatic, Anti-inflammatory Analgesics
Mechanism of Action: thought to inhibit prostaglandin synthesis, impeding
cyclooxygenase-2 to produce anti inflammatory, analgesic and anti pyretic effect.
Dosage: Oseoarthritis ADULT 200mg as a single dose or a 2 divided doses. RA
100-200mg bid. Post surgical or dental pain, acute flare pain or
Osteoarthritis 200mg od or bid.
Special precaution: Asthma, urticaria or acute rhinitis, Children <18yrs.old, pregnancy,
lactation, severe hepatic impairment.
Pregnancy Risk: C,D in 3rd trimester.
Adverse reacition: GI complaints, dizziness, bronchitis, coughing, pharyngitis, rhinitis,
sinusitis, upper respiratory tract infection, headache, accidental injury,
flu-like symptoms, peripheral edema.
Contraindications: hypersensitivity to drugs, severe hepatic impairment, 3rd trimester of
pregnancy.
Form: capsule 300 and 200 mg.
NSG. Considerations:
 Tell patient to report history of allergic reaction to sulfonamides, aspirin, NSAIDS.
 Instruct patient to report signs of GI bleeding.
 Advice patient to immediately report rash, unexplains weight gain, or swelling.
 Inform patient that it may take several days before he felt consistent pain relief.
Generic name: Clonidine
Brand name: Catapres
Classification: antihypertensive
Dose: 0.2, 0.1 mg
Route: patch, po
Time/Frequency: 1 path every sat, po bid
Peak: PO 2-4 hour, patch unknown
Onset: Po 30-60 mins., patch 30-60 days
Duration: Po 8-12 hour, patch 7 days
Side effects:
 CNS- drowsiness, depression, dizziness, nervousness, nightmares.
 CV- bradycardia, hypotension (increased with epidural), palpitations.
 GI- dry mouth, constipation, nausea, vomiting,
 METAB- weight gain
Nursing Assessment:
 (pre-administration assessment_
 Monitor intake and output ratios and daily weight.
 Assess for edema daily esp. at beginning of therapy
 Monitor blood pressure and pulse frequently,.
Generic name: albuterol
Brand name: salbutamol, ventolin, volmax
Classification: autonomic nervous system agent
Chemical classification: bronchodilator ( respiratory smooth muscle relaxant) beta
antagonist
Usual dosage: 2 inhalations repeated every 4-6 hours

Available forms: solution for inhalation: .083%, .05%, .63 mg/ml, 1:25mg/3ml
Syrup: 2mg/5ml
Tablets: 2mg, 4mg
Tablets: extended release 4mg, 8mg
Indications: to relieve bronchospasm associated with acute or chronic asthma,
bronchitis or other reversible obstructive airway diseases, also use to
prevent exercise –induced bronchospasm.
Contraindications:
 In patients hypersensitivity to drug or its ingredients
 Use cautiously in pts. With CV disorders (including coronary insufficiency and
hypertension) hyperthyroidism and diabetes mellitus.
 Use extended release tablets cautiously in pts with GI narrowing.

Side effects: bad taste, blurred vision, urinary retention, palpitation and ankle edema
can also occur.
NSG. Considerations:
 Drug may decrease sensitivity of spirometry used for diagnosis of asthma.
 When switching patients for regular to extended release tablets, remember that a regular
2mg tablet every 6hours is equivalent to an extended release 4mg tablet every 12 hours.
 Syrup contains no alcohol or sugar and maybe taken by children as young as age 2.
 In children, syrup may rarely cause erythema multiform or steven-johnsons syndrome.
 Patient may used tablets or aerosol together. Monitor this patient closely for signd and
symptoms of toxicity.
 Look alike sound alike: don’t confused albuterol with atenolol or albutein.
Generic name: paracetamol
Route: per orem
Drug class: analgesic and antipyretics
Indications: used to the relief of fever, headaches and other pains regarding surgical
wounds.
Contraindications: Contraindicated to allergy to acetaminophen or any component.
Use cautiously with impaired hepatic function, chronic alcoholism,
And pregnancy lactation.
Adverse reaction: chest pain, dyspnea, rash, fever, acute kidney failure, jaundice, hepatic
toxicity and failure.
NSG. Consideration:
 Instruct client to report any adverse reaction like allergies.
 Warn patients that high doses or unsupervised long term use can cause liver damage.
 Do not exceed the recommended dosage. Not use for marked fever ( temp.higher than
39.50C) fever persisting longer than 3 days.
Generic name: metropolol
Classification: beta-blockers
Contraindications:
 2nd or 3rd degree AV block
 Sick sinus syndrome
 Decompensated heart failure
 Clinically relevant sinus bradycardia
 Sever peripheral arterial circulatory disorders
 Cardiogenic shock
 Asthma
Indication:
 Hypertension
 Angina pectoris
 Arrhythmias
 Stable symptomatic heart failure

Adverse reaction: bradycardia, hypotension, arterial insufficiency, chest pain, CHF,

edema, palpitation, syncope, gangrene, dizziness, fatigue, headache,
insomnia,short term memory loss

NSG. Consideations;
 Give oral administration with meals to decrease gastric irritation
 Do not crush, break or chew extended release tablets
 Monitor for evidence of allergic reaction
 Instruct the patient to take all medication prescribed for the length of time ordered.
Generic name: furosemide
Brand name: lasix
Dosage: 20 mg/ tab 1 tab od 8am
Classification: diuretic
Indication: edema, hypertension
Contraindication:
 In patients hypersensitive to drug and those with anuria
 Use cautiously in pts with hepatic cirrhosis and those allergic to sulfonamides. Use during
pregnancy only if potential benefits to mother clearly outweigh risks to fetus

Side effects:
 CNS: headache, vertigo, dizziness, weakness, restlessness, fever
 CV: orthostatic, hypotension
 EENT: transient deafness, blurred or yellow vision, tinnitus
 GI: abdominal discomfort and pain, diarrhea, anorexia, nausea, vomiting, constipation,
pancreatitis
 HEPATIC: hepatic dysfunction, jaundice

NSG. Responsibility
 Test if the patient is allergic to the drug
 To prevent nocturia, give po and im preparations in the morning. Give the second dose in
early afternoon.
 Monitor weight, blood pressure and pulse rate routinely with no long term use and during
rapid dieresis. Use can lead to profound water and electrolyte depletion.
 Monitor fluid intake and output.
Medical management (small bowel obstruction)

Decompression of the bowel through a nasogastric tube is successful in most cases.

When the bowel is completely obstructed, the possibility of strangulation warrants surgical
intervention. Before surgery, IV therapy is necessary to replace the depleted water, sodium,
chloride and potassium.
The surgical treatment of intestinal obstruction depends largely on the cause of the
obstruction. In the most common causes of obstruction, such as hernia and adhesions, the
surgical procedure involves repairing the hernia or dividing the adhesion to which the intestine is
attached. In some instances, the portion of affected bowel maybe removed and an anastomosis
performed. The complexity of the surgical procedure for intestinal obstruction depends on the
duration of the obstruction and the condition of the intestine.

Medical management (large bowel obstruction)

Restoration of intravascular volume, correction of electrolyte abnormalities, and

nasogastric aspiration and decompression are instituted immediately. A colonoscopy maybe
performed to untwist and decompress the bowel. A cecostomy in which a surgical opening is
made into the cecum, maybe performed in patients who are poor surgical risks and urgently need
relief from the obstruction. The procedure provides an outlet for releasing gas and a small amount
of drainage. A rectal tube is used to decompress an area that is lower in the bowel. However, the
usual treatment is surgical resection to remove the obstructing lesion. A temporary or permanent
colostomy maybe necessary. An ileoanal anastomosis maybe performed if it is necessary to
removed the entire large bowel.

Surgical management

The surgical treatment for intestinal obstruction depends on the cause of the obstruction.
For the most common causes of obstruction, such as hernia and adhesions, the surgical
procedure involves repairing the hernia or dividing the adhesion to which the intestine is attached.
In some instances, the portion of affected bowel may be remove and an anastomosis performed.
The complexity of the surgical procedure depends on the duration of the intestinal obstruction and
the condition of the intestine.

Nursing management

Nursing management of the non surgical patient with a small bowel obstruction includes
maintaining the function of the nasogastric tube, assessing and measuring the nasogastric
output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and assessing
improvement, decreased abdominal distention, subjective improvement in abdominal pain and
tenderness, passage of flatus or stool. The nurse reports discrepancies in intake and output,
worsening of pain or abdominal distention and increase nasogastric output. If the patient’s
 condition does not improve, the nurse prepares him or her for surgery. Nursing care of the patient
after surgical repair of a small bowel obstruction is similar to that for other abdominal surgeries

Assessment Inference Diagnosis Planning Intervention Rationale Evaluation

Subjective: Constipatio Constipatio After 8 Independent: After 8 hours

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people of all patient will and amount g factors establish or
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and cramping, you feel that patterns of interventio bowel
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your sounds generally
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or that you in
have to constipatio
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completely of 2500- consistenc
empty your 3000ml/day y.
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n can also tolerance
cause your • Decreased
stools to be • Recommend gastric
unusually avoiding gas distress
hard, lumpy forming and
large or foods. abdominal
small. The distention.
severity of • Prevent
constipation skin
can vary excoriation
greatly. • Assist in and
Many peranal breakdown
people only condition
experience frequently,
constipation nothing • To enhace
for a short changes or easy
period of beginning defecation
time with no breakdown.
lasting
• Encourage
effects on to eat high
their health. fiber rich
For others, rood. • Fiber
constipation resist
can be Collaborative enzymatic
chronic digestion
(long-term) • Consult with and
condition dietitian to absorbs
which provide well liquids in
causes balanced its
significant diet high in passage
pain and fiber and along the
discomfort. bulk. intestinal
Chronic tract and
constipation thereby
can also produces
lead to bulk,
complicatio which acts
ns such as as a
faecal stimulant
impaction to
(where dry, defecation.
hard stools
collect in
your
rectum)or
faecal
incontinenc
e ( where
you
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stools
around solid
impacted
stools) the
treatment
for
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is usually
very
effective,
although in
some cases
it can take
several
months
before a
regular
bowel
pattern is re
established.