MOIRA MAE B.

BALITE BSN 2A

Drug Study: COTRIMOXAZOLE

Complete the drug study of the ordered drug below. You may use a drug handbook such as Lippincott’s Nursing Drug Guide as your reference.

Dr. Postrano ordered the drug: Cotrimoxazole 500mg tab PO TID x 7 days
Patient HRN: 1234567 Age/Gender: 30/F Rm: 102
Admitting Diagnosis: Urinary Tract Infection Birthday: 10/24/1990

Indications or
Drug Mechanism of Action Contraindications Side Effects Adverse Reactions Nursing Responsibilities
Purpose

Co-trimoxazole is a synthetic  Treatment of  Nausea  Assess for any known allergies to

Generic Name: antibacterial combination urinary tract  Allergy to  Dizziness sulfonamides, sulfonylureas, thiazides,
product. Sulfamethoxazole infection sulfonamides,  Vomiting trimethoprim to avoid hypersensitivity
inhibits bacterial synthesis of sulfonylureas,  Loss of reactions.
dihydrofolic acid by competing  Acute otitis thiazides Appetite  Diarrhea
Sulfamethoxazole and
with para-aminobenzoic acid media in  Assess for impaired liver or kidney
(PABA). Trimethoprim blocks children  Pregnancy (may function, which could alter
Trimethoprim  Nausea  Hepatocellular
the production of bump fetal bilirubin metabolism and excretion of the drug.
Necrosis
tetrahydrofolic acid from  Exacerbations of from plasma
(Co-trimoxazole) dihydrofolic acid by binding to chronic protein-binding  Assess for glaucoma, benign prostatic
and reversibly inhibiting the  Hematuria
bronchitis in sites and cause hypertrophy, cardiac dysfunction,
required enzyme, adults kernicterus) gastrointestinal (GI) obstruction,
dihydrofolate reductase. Thus,  Bone Marrow
surgery, or recent myocardial
Brand Name: co-trimoxazole blocks two Suppression
 Traveler’s  Lactation (risk of infarction.
consecutive steps in the
diarrhea in kernicterus,
biosynthesis of nucleic acids  Stevens–Johnson
adults diarrhea, rash)  Assess for pregnancy or lactation to
and proteins essential to many Syndrome
avoid potential adverse effects on the
Bactrim, Septra bacteria.
 Pneumocystis  Hypersensitivity to fetus or baby.
 Rash
carinii trimethoprim
 Assess whether the patient has a
 Urticaria
 Megaloblastic history of seizure disorders or a
Classification: history of psychiatric problems or
anemia due to
folate deficiency  Photophobia suicidal thoughts, or myelography
within the past 24 hours or in the next
  Fever 48 hours, or is taking a monoamine
oxidase inhibitor.
Sulfonamides  Chills
 Assess vital signs including
temperature and weight; skin color
and lesions; blood pressure, including
Dose, Route & Timing: orthostatic blood pressure; pulse and
perfusion; respiratory rate and
adventitious sounds; and bowel
sounds on abdominal examination.
500mg tablet orally
three times a day for 7  Limit drug access if patient is suicidal.
days
 Reduce dose if minor adverse effects
occur and discontinue the drug slowly
if major or potentially life- threatening
adverse effects occur.

 Provide comfort measures to help the

patient tolerate drug effects including
voiding before dosing, instituting a
bowel program as needed, taking food
with the drug if GI upset is severe, and
environmental control.

 Provide thorough patient teaching,

including drug name, prescribed
dosage, measures for avoidance of
adverse effects, and warning signs
that may indicate possible problems.

 Offer support and encouragement to

help the patient cope with the
diagnosis and the drug regimen.
  Monitor patient response to the drug
(alleviation of signs and symptoms of
depression).

 Monitor for adverse effects.

 Evaluate the effectiveness of the

teaching plan.

Reference/s: https://www.pediatriconcall.com/drugs/cotrimoxazole/446#:~:text=Co%2Dtrimoxazole%20is%20contraindicated%20in,anemia%20due%20to
%20folate%20deficiency.

Drug Study: RIMANTADINE

Complete the drug study of the ordered drug below. You may use a drug handbook such as Lippincott’s Nursing Drug Guide as your reference.

Dr. Postrano ordered the drug: Rimantidine 100mg PO BID x 5 days

Patient HRN: 1234567 Age/Gender: 30/F Rm: 102
Admitting Diagnosis: Influenza A Birthday: 10/24/1990

Indications or
Drug Mechanism of Action Contraindications Side Effects Adverse Reactions Nursing Responsibilities
Purpose

 Allergy to  Light-  Assess for any known allergies to

Generic Name:  Inhibits viral replication of  Prophylaxis amantadine,  Drowsiness headedness amantadine, rimantadine.
three subtypes of influenza A and and rimantadine
(H1N1, H2N2, H3N2) early in treatment of  Blurred  Dizziness  Assess for history of seizures, liver or renal
the viral replicative cycle. Has illness caused  Patients with vision disease.
Remantadine no activity against influenza by influenza history of dizziness  Insomnia
 B virus. A virus in seizures  Light-  Nausea  Assess for pregnancy and lactation.
adults headedness
Brand Name:  The mechanism of action of  Liver or renal  Dyspnea  Assess and record vital signs including
rimantadine is not fully  Prophylaxis disease  Irritability or Blood Pressure, orthostatic BP,
understood. Rimantadine against mood  Orthostatic auscultation, perfusion, edema; R,
appears to exert its inhibitory influenza A  Pregnancy changes Hypotension adventitious sounds; urinary output; BUN,
Flumadine effect early in the viral virus in creatinine clearance. Assess orientation,
replicative cycle, possibly children.  Lactation  Depression vision, speech, reflexes.
inhibiting the uncoating of
the virus. The protein coded  Administer full course of drug to achieve
by the M2 gene of influenza the beneficial antiviral effects. Initiate
Classification:
A may play an important role therapy for treatment within 48 hour of
in rimantadine susceptibility. onset of symptoms and continue for 7
days.

Antiviral Agent
 Provide thorough patient teaching,
including drug name, prescribed dosage,
measures for avoidance of adverse effects,
and warning signs that may indicate
Dose, Route & Timing: possible problems as well as safety
precautions.

 Monitor for adverse effects.

100mg tablet orally
twice a day for 5 days

Reference/s: https://www.drugbank.ca/drugs/DB00478
Drug Study: DOXORUBICIN

Complete the drug study of the ordered drug below. You may use a drug handbook such as Lippincott’s Nursing Drug Guide as your reference.

Dr. Postrano ordered the drug: Doxorubicin 60–75 mg/m2 as a single IV dose; repeat every 21 d
Patient HRN: 1234567 Age/Gender: 30/F Rm: 102
Admitting Diagnosis: Leukemia Birthday: 10/24/1990

Drug Mechanism of Action Indications or Contraindications Side Effects  Adverse Reactions Nursing Responsibilities 
Purpose

 Treatment of a  Allergy to  Rash  CV: Cardiac toxicity, Assessment:

Generic Name: Doxorubicin has antimitotic and number of doxorubicin heart failure,
cytotoxic activity through a leukemias and hydrochloride  Skin lesions phlebosclerosis  History: Allergy to doxorubicin
number of proposed cancers hydrochloride, malignant melanoma,
mechanisms of action:  Malignant  Loss of hair  Dermatologic: kidney carcinoma, large bowel
Doxorubicin Doxorubicin forms complexes  Used to induce melanoma Complete but carcinoma, brain tumors, CNS
with DNA by intercalation regression reversible alopecia, metastases, myelosuppression, cardiac
 Changes in
between base pairs, and it  Kidney carcinoma, hyperpigmentation of disease, impaired hepatic function,
nails
inhibits topoisomerase II activity  Available in a nailbeds and dermal previous courses of doxorubicin or
by stabilizing the DNA- creases, facial daunorubicin therapy, prior mediastinal
Brand Name: liposomal form  Large bowel  Loss of
topoisomerase II complex, for treatment of flushing irradiation, concurrent
carcinoma appetite
preventing the religation portion AIDS-associated cyclophosphamide therapy, lactation,
of the ligation-religation reaction Kaposi sarcoma  GI: Nausea, vomiting, pregnancy
 Brain tumors  Nausea,
that topoisomerase II catalyzes. mucositis,anorexia,
Adriamycin diarrhea  Physical: T; skin color, lesions; weight;
 CNS metastases  Mouth sores hair;
 GU: Red urine
 Myelosuppression  nailbeds; local injection site;
Classification:  Hematologic: auscultation,
 Cardiac disease
Myelosuppression,
hyperuricemia due to  peripheral perfusion, pulses, ECG; R,
 Pregnancy cell lysis adventitious sounds; liver evaluation,
Anthracycline mucous
 Lactation  Hypersensitivity:
Antibiotic Fever, chills, urticaria,  membranes; CBC, LFTs, uric acid levels
 Impaired hepatic anaphylaxis
function
  Previous courses  Local: Severe local Interventions
of doxorubicin or cellulitis, vesication
Dose, Route & Timing: daunorubicin and tissue necrosis if ● Do not give IM or subcutaneously because
therapy extravasation occurs
severe local reaction and tissue necrosis
 Prior mediastinal  Other: Carcinogenesis occur.
 A single dose irradiation,
of 60-75 q Black box warning Monitor injection site
mg/m2  Concurrent for extravasation and for reports of
cyclophosphamide
 Intravenous therapy 418 ■ doxorubicin hydrochloride
route of
administratio LWBK849-D_p337-430.qxd 3/3/11 2:47 AM
n Page 418

 Repeat every burning or stinging. If these events occur,

21 days discontinue administration and restart in
another

vein. Local subcutaneous extravasation:

Local

infiltration with corticosteroid may be

ordered;

flood area with normal saline; apply cold

compress to area. If ulceration begins,
arrange consultation with plastic surgeon.

q Black box warning Monitor patient’s

response frequently at beginning of therapy:

Serum uric acid level, cardiac output (listen

for S3); CBC changes may require a decrease

in the dose; consult with physician; risk of

 heart

failure, myelosuppression, liver damage.

Record doses received to monitor total
dosage;

toxic effects are often dose-related, as total

dose

approaches 550 mg/m2.

● Ensure adequate hydration during the

course

of therapy to prevent hyperuricemia.

Teaching points

● Prepare a calendar of days to return for

drug

therapy.

● Avoid pregnancy while using this drug;

using barrier contraceptives is advised.

● Arrange for regular medical follow-up,

including blood tests.

● You may experience these side effects:

Rash,

skin lesions, loss of hair, changes in nails

(you may want to obtain a wig before hair

loss occurs; skin care may help); loss of

appetite, nausea, mouth sores (frequent
 mouth

care, eat frequent small meals; try to

maintain good nutrition; a dietitian may be
able

to help; an antiemetic may be ordered); red

urine (transient).

● Report difficulty breathing, sudden weight

gain, swelling, burning or pain at injection

site, unusual bleeding or bruising.

Reference/s: https://www.drugbank.ca/drugs/DB00997