I.

DRUG STUDY

Brand Name: Zovirax

Generic Name: Acyclovir

Doctor’s Order: Give Acyclovir 200 mg

Date Ordered: 11/24/17

Drug Class: Antivirals

Mechanism of Action: Acyclovir (9-2-hydroxymethyl guanine) is a nucleoside analog that

selectively inhibits the replication of herpes simplex virus types 1 and 2 (HSV-1, HSV-2) and
varicella-zoster virus (VZV). After intracellular uptake, it is converted to acyclovir
monophosphate by virally-encoded thymidine kinase. This step does not occur to any significant
degree in uninfected cells and thereby lends specificity to the drug's activity. The monophosphate
derivative is subsequently converted to acyclovir triphosphate by cellular enzyme

Contraindication: Hypersensitivity

Nursing Implications:

 Monitor I&O renal function test if ordered, electrolyte levels

 Check food tolerance, vomiting.
 Assess Intravenous site for phlebitis(heat, pain, red streaking over vein)
 Evaluate cutaneous lesions.
 Be alert to neurologic effects: headache, lethargy, confusion, agitation, hallucinations,
seizures
 Assure adequate ventilation.
 Provide analgesics and comfort measures; esp. exhausting to elderly.
 Encourage fluids

Generic Name: Aspirin

Doctor’s Order: Give Asa/Aspirin 80mg

Date Ordered: 11/24/17

Drug Class: Non-steroidal Anti-inflammatory drug (NSAID) – Acetylsalic acid (ASA)

Mechanism of Action: Reduction of Inflammation (also antipyretic effect);

analgesic(prostaglandin inhibitor); anti-platelet (blocks formation of thromboxane A2 reducing
platelet aggregation and vasoconstriction of coronary arteries)

Contraindication: Hypersentsitivity to salicylates or NSAIDs

Side effects: - A high incidence of gastro-intestinal irritation with slight asymptomatic blood
loss; Bronchospasm; Increased bleeding time; Possible skin reactions in hypersensitive patients.

Nursing Implications:

 Assess patient for signs of bleeding (petechiae. Ecchymosis, bloody or black stools,
bleeding gums).
 Drink adequate fluids while taking aspirin
 Advise patient to avoid alcohol when prescribed high doses of aspirin
 Discontinue aspirin use of ringing or buzzing in ears or unrelieved GI discomfort

Generic Name: Candesartan

Doctor’s Order; Give Candesartan ,16 mg #30 tabs ,½ tabs OD

Date Ordered: 1/22/18

Drug Class: Cardiovascular agent; angiotensin II receptor antagonist

Mechanism of Action: blocks the vasoconstrictor and aldosterone-secreting effects of

angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many
tissues, such as vascular smooth muscle and the adrenal gland.

Contraindications: Known sensitivity to candesartan or any other angiotensin II (AT1) receptor

antagonist (e.g., losartan, valsartan); primary hyperaldosteronism;
Adverse Effects: Body as a Whole: Fatigue, peripheral edema, back pain, arthralgia. CV: Chest
pain. GI: Nausea, abdominal pain, diarrhea, vomiting. CNS: Headache,
dizziness. Respiratory: Cough, sinusitis, upper respiratory infection, pharyngitis,
Rhinitis. Urogenital: Albuminuria.

Nursing Implications:

 Monitor BP as therapeutic effectiveness is indicated by decreases in systolic and diastolic

BP within 2 wk with maximal effect at 4–6 wk.
 Monitor for transient hypotension in volume/salt-depleted patients; if hypotension occurs,
place in supine position and notify physician.
 Monitor BP periodically; trough readings, just prior to the next scheduled dose, should be
made when possible.
 Lab tests: Periodically monitor BUN and creatinine, serum potassium, liver enzymes, and
CBC with differential.

Generic Name: Trimetazidine

Doctor’s Order: Give Trimetazidine 35mg, #60 tabs, 1 tab 2x/day

Drug Class: Anti-antiginal drug

Mechanism of Action: Improves myocardial glucose utilization through stopping of fatty acid
metabolism by limitation of intracellular acidosis, correction of disturbances of transmembrane
ion exchanges and prevention of excessive production of free radicals.

Indication: w/ heart failure

Contraindications: Parkinson's disease, parkinsonian symptoms, tremors, restless leg syndrome

and other movement related disorders. Severe renal impairment (CrCl <30 mL/min). Lactation.

Side effects: Dizziness, headache, rashes, abdominal pain, nausea, vomiting and diarrhea

Nursing Implications:

 Assess for hypersensitivity to trimetazidine, with heart failure

  Administer drug after patient has eaten with full glass of water
 Encourage patient to continue efforts at smoking cessation
 Provide safety measures if lethargy occurs

Brand Name: Nebivolol

Doctor’s Order: 2.5 mg, OD

Drug Class: Beta blockers

Mechanism of Action: Binds to and blocks the beta-1 adrenergic receptors in the heart, thereby
decreasing cardiac contractility and rate. This leads to a reduction in cardiac output and lowers
blood pressure.

Contraindications:

 diabetes
 low blood sugar
 complete heart block
 second degree atrioventricular heart block
 sick sinus syndrome
 slow heartbeat
 sudden and serious symptoms of heart failure called acute decompensated heart failure
 peripheral vascular disease
 bronchospasm
 liver problems
 severe liver disease
 blood circulation failure due to serious heart condition
 pregnancy
 chronic kidney disease stage 4 (severe)
 chronic kidney disease stage 5 (failure)
 kidney disease with likely reduction in kidney function
Side effects:

 headache.
 tiredness.
 weakness.
 dizziness.
 diarrhea.
 nausea.
 stomach pain.
 difficulty falling asleep or staying asleep.

Generic Name: Pregabalin

Doctor’s order: Give Pregabalin 75mg, ODHS

Date ordered: 1/13/18

Drug Class: Analgesic, anticonvulsant

Mechanism of Action: Binds to calcium channels in CNS tissues which regulate

neurotransmitter release. Does not bind to opioid receptors

Contraindications: contraindicated with known pregabalin hypersensitivity or with product

specific ingredient hypersensitivity.

Side effects: dizziness, sleepiness, trouble concentrating, blurry vision, dry mouth, weight gain,
swelling of your hands or feet

Nursing Implications

 Monitor for weight gain, peripheral edema, and S&S of heart failure, especially with
concurrent thiazolidinedione (e.g., rosiglitazone) therapy.
 Lab tests: Baseline and periodic kidney function tests; periodic platelet counts; CPK if
rhabdomyolysis is suspected.
  Monitor diabetics for increased incidences of hypoglycemia.
 Withhold drug and notify physician if rhabdomyolysis is suspected
 Supervise ambulation especially when other CNS drugs are used concurrently.

Generic Name: Dexamethasone

Doctor’s Order: Give Dexamethasone 4mg

Date ordered: 1/13/18

Drug Class: Anti-inflammatory glucocorticoid

Mechanism of Action: Suppresses inflammation and the normal immune response. Has
numerous intense metabolic effects.

Contraindications: active untreated infectious (except for certain forms of meningitis)

Side effects: headache, dizziness, spinning sensation, nausea and vomitting

Nursing Implications:

 Monitor intake and output ratios and daily weights

 Observe patient for appearance of pheripheral edema, steady weight gain, crackles or
dyspnea.

Generic Name: Acetylcysteine

Doctor’s order: Give Acetylecystine 600 mg

Date ordered: 1/4/19

Drug Class: Mucokinetics/Expectorant

Mechanism of Action: Decreases viscosity of respiratory tract secretions and promote their
removal by breaking disulphide bonds. In acetaminophen overdose. It protects the liver from
injury by restoring glutathione levels by acting as alternate substrate for acetaminophen
metabolism.
Contraindications: Hypersensitivity

Side effects: Mild fever, hypotension, nausea and vomiting. Dyspnea, wheezing, generalized
urticarial, stomatitis

Nursing Implications

 During IV infusion, carefully monitor for fluid overload and signs of hyponatremia (i.e.,
changes in mental status).
 Monitor for S&S of aspiration of excess secretions, and for bronchospasm
(unpredictable); withhold drug and notify physician immediately if either occurs.
 Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated.
 Have suction apparatus immediately available. Increased volume of respiratory tract fluid
may be liberated; suction or endotracheal aspiration may be necessary to establish and
maintain an open airway. Older adults and debilitated patients are particularly at risk.
 Nausea and vomiting may occur, particularly when face mask is used, due to unpleasant
odor of drug and excess volume of liquefied bronchial secretion

Generic Name: Penicillin V

Doctor’s Order: Give Penicillin VK 500 mg

Drug Class: Anti-ineffective, antibiotic

Mechanism of Action: Interferes with bacteria cell wall synthesis during active multiplication,
causing cell wall death and resultant bactericidal activity against susceptible bacteria.

Contraindications: Allergies to penicillins, cephalosporins, or other allergens, renal disorders

Side effects: CNS: Lethargy, hallucinations, seizures. GI: gastritis, sore mouth, furry tongue,
vomiting, diarrhea, abdominal pain

Nursing Implications

 Monitor for allergic reactions. Have emergency equipment available

 Empty stomach with full glass of water
  Monitor CBC, BUN, creatinine

Generic Name: Febuxostat

Brand Name: Atenurix

Doctor’s Order: Give Febuxostat, 40 mg, OD at 8am

Drug Class: Xanthine Oxidase Inhibitors

Mechanism of Action: The primary mechanism of action of febuxostat evaluated in trials was

the inhibition of xanthine oxidase, evidenced by the increase in serum and urine xanthine
concentrations, decrease in serum and urine uric acid levels, and lack of significant reduction in
total purine synthesis.

Contraindications: Febuxostat is contraindicated in patients being treated with azathioprine or

mercaptopurine. Patient with severe rash, cardiac disease, mortality, myocardial infarction,
stroke, Hepatic disease, Dialysis, renal failure, and renal impairment

Side effects:

Common reactions to febuxostat include:

 nausea, rash, joint pain, gout flares, and liver problems.

Other important, but less common side effects include:

stroke, heart attack, anemia, hepatitis, hypersensitivity, and weight loss.

Nursing Implications

 Assess for joint pain and swelling, especially during early therapy. Changing serum uric a
cid levels from mobilization of urate from tissue deposits may cause gout flares. Use prop
hylactic NSAID or colchicine therapy for up to 6 mo. If a gout flare occurs, continue febu
xostat therapy and treat flare concurrently.
 Monitor for signs and symptoms of MI and stroke.
 Lab Test Considerations: Monitor serum uric acid levels prior to, 2 wk after intitiating, an
d periodically thereafter. If serum uric acid levels are ≥6 mg/dL after 2 wk of daily 40 mg 
therapy, increase dose to 80 mg daily.