CASE STUDY: CHAPTER 49

Assessment and Management of Patients With Hepatic Disord

GENERIC NAME INDICATIONS ACTION ADVERSE INTERACTION(S) CONTRAINDICATION PATIENT NURSE

REACTION(S) (S) TEACHINGS(S) INDICATION(S)

10/005/2021
JAKE YVAN DIZON
Bsn-iv
 NADOLOL >Angina Reduces cardiac CNS: Fatigue, Antihypertensives: Use cautiously in Explain importance of Monitor BP
pectoris oxygen demand dizziness, May increase patients with HF, taking drug as frequently. If patient
>Hypertension by blocking drowsiness, antihypertensive chronic bronchitis, prescribed, with or develops severe
catecholamine- insomnia, effect. Monitor BP emphysema, renal, or without regard to hypotension, give
induced depression, closely hepatic impairment, food, even when vasopressors, as
increases in HR, sedation, fever. Cholinergic agonists: myasthenia gravis, patient feels well prescribed.
BRAND NAME BP, and force of May increase peripheral vascular
myocardial CV: Bradycardia, potential for cardiac disease, psoriasis, or Teach patient how to Drug masks sign and
CORGARD infarction. HF, hypotension, conduction psychiatric disease check pulse rate and symptom of shock,
peripheral abnormalities and and in patients to check it before hypoglycemia, and
Depresses renin vascular disease, bronchoconstriction. undergoing major each dose. If pulse hyperthyroidism.
DOSAGE: secretion rhythm and Administer with surgery involving rate is below 60b/min,
40mg conduction caution; monitor general anesthesia. tell patient to notify
disturbances, patient for Drug shouldn’t be prescriber.
ROUTE: edema, conduction routinely withdrawn
PO palpitations, disturbances before major surgery. Warn patients not to
Raynaud General anesthetics: stop drug suddenly
FREQUENCY: phenomenon May increase Generally, patients
QD hypotensive effects. with bronchospastic
Consider stopping disease shouldn’t
nadolol before receive beta blockers
surgery because they may
Drug-herb: Dong block bronchodilation
quai, ephedra, garlic
ginseng, licorice, Exacerbation of
yohimbe: May ischemic heart
worsen hypertension disease may occur
or affect fluid and following abrupt
electrolytes. Avoid withdrawal of drug.
use Exacerbation of
Drug-food: green angina and, in some
tea: May decrease cases, MI have
nadolol serum occurred after abrupt
concentration. discontinuation of
 Patient should therapy.
minimize green tea
consumption while
using nadolol

GENERIC NAME INDICATION(s) ACTION(s) ADVERSE INTERACTION(s) CONTRAINDICATION PATIENT NURSING

REACTION(s) (S) TEACHING(s) INDICATION(S)
ISOSORBIDE Treatment Thought to reduce CNS: headache, Drug-drug: Venous pooling, Caution patient to Monitor BP, HR,
DINITRATE (immediate-release cardiac oxygen dizziness, weakness Antihypertensives: decreased cardiac take drug as and intensity and
isosorbide demand by CV: orthostatic may increase output, hypotension, prescribed and to duration of drug
mononitrate only) decreasing preload hypotension, hypotensive methemoglobinemia keep it accessible response
and prevention of and afterload. Drug tachycardia, effects. Monitor , headache, at all times
angina pectoris may also increase palpitations, ankle patient closely confusion, vertigo, Drug may cause
blood flow through edema, flushing, during initial fever, palpitations, Advise patient that headaches,
BRAND NAME the collateral fainting therapy nausea, vomiting, stopping drug especially at
ISORDIL coronary vessels EENT: sublingual syncope, air hunger, abruptly may cause beginning of
TITRADOSE burning PDE5 inhibitors: dyspnea, slow increased angina therapy. Treat
GI: nausea and may cause life- breathing, symptoms and risk with aspirin or
vomiting threatening diaphoresis, flushed for MI acetaminophen
SKIN: cutaneous hypotension. Use skin, heart block,
vasodilation, rash of nitrates in any bradycardia, Advise patient on
DOSAGE form with these paralysis, coma isosorbide dinitrate
5-20mg drugs is to take oral tablet
contraindicated on an empty
ROUTE stomach either
PO Drug-lifestyle: diuretic 30 minutes
Alcohol use: may before or 1 to 2
FREQUENCY increase hours after meals
B.I.D to T.I.D hypotension. suspected and to
Discourage use swallow oral
together tablets whole.
Tell patient to
change to an
upright position
slowly, to climb
stairs carefully, and
to lie down at first
sign of dizziness.

Caution patient to
avoid alcohol
because it may
worsen low BP
effects.

Advise patient that

use of sildenafil,
vomiting tadalafil,
vardenafil, or
avanafil with any
diarrhea), nitrate
may cause severe
low BP.

Counsel patient to
talk to prescriber
before using these
heart block, drugs
together.

Tell patient to
store drug in a cool
dark place, in a
tightly closed
container.
GENERIC NAME INDICATION(S) ACTION(S) ADVERSE INTERACTION(s) CONTRAINDICATION PATIENT NURSING
REACTION(s) (s) TEACHING(S) INDICATION(s)
FUROSEMIDE Edema Inhibits sodium CNS: vertigo, Drug-drug. Contraindicated in Advise patient to Monitor weight,
chloride headache, dizziness, patients take drug in BP, and pulse
reabsorption at paresthesia, Aminoglycoside hypersensitive to morning to prevent rate routinely
BRAND NAME the proximal and weakness, antibiotics, cisplatin: drug and in those need to urinate at with long-term
May increase
LASIX distal tubules restlessness, fever. with anuria. night. If a second use.
ototoxicity. Use
and the together cautiously. • Use cautiously in dose is needed tell
ascending loop of CV: orthostatic patients with hepatic patient to take it in Drug is potent
DOSAGE Henle hypotension, Amphotericin B, cirrhosis and in early afternoon, 6 diuretic and can
thrombophlebitis corticosteroids, those allergic to to 8 hours after cause severe
20-80mg with I.V. corticotropin, sulfonamides. Use morning dose. diuresis with
administration. metolazone: May during pregnancy water and
FREQUENCY increase risk of only if potential Inform patient of electrolyte
EENT: blurred or hypokalemia. Monitor benefits to mother possible need for depletion.
potassium level closely
6-8hours yellowed vision, clearly outweigh potassium or Monitor patient
together cautiously.
transient deafness, risks to fetus. magnesium closely and
ROUTE tinnitus. Antidiabetics: May supplements. adjust dose
decrease hypoglycemic Alert: Drug may carefully.
P.O GI: abdominal effects. Monitor cause tinnitus and Instruct patient to
discomfort and pain, glucose level. reversible or stand slowly to If oliguria or
diarrhea, anorexia, irreversible hearing prevent dizziness azotemia
nausea, vomiting, Antihypertensives: May loss. Ototoxicity is and to limit alcohol develops or
constipation, increase risk of associated with intake and increases, drug
pancreatitis. hypotension. Use rapid injection, strenuous exercise may need to be
together cautiously.
severe renal in hot weather to stopped.
Decrease
GU: azotemia, impairment, use of avoid worsening
antihypertensive dose
nocturia, polyuria, if needed. higher-than dizziness upon Monitor fluid
frequent urination, recommended standing quickly. intake and
oliguria. doses, output and
hypoproteinemia, or Advise patient to electrolyte, BUN,
Hematologic: Cardiac glycosides, use with other report all adverse and carbon
agranulocytosis, Neuromuscular ototoxic drugs. Drug reactions and to dioxide levels
blockers: May increase
aplastic anemia, may exacerbate or immediately report frequently
toxicity of these drugs
leukopenia, from furosemide- activate systemic ringing in ears,
thrombocytopenia, induced hypokalemia. lupus severe abdominal Watch for signs
anemia. Hepatic: Monitor potassium erythematosus. pain, or sore throat of hypokalemia,
hepatic dysfunction, level. and fever; these such as muscle
jaundice. Premature infants symptoms may weakness and
Chlorothiazide, may be at increased indicate toxicity. cramps.
Metabolic: volume chlorthalidone, risk for persistent
depletion and hydrochlorothiazide, patent ductus Discourage patient Consult
indapamide,
dehydration, arteriosus with from storing prescriber and
metolazone: May cause
asymptomatic furosemide different types of dietitian about a
excessive diuretic
hyperuricemia, response, causing treatment during drugs in the same high-potassium
impaired glucose serious electrolyte first weeks of life. container, diet or potassium
tolerance, abnormalities or increasing risk of supplements.
hypokalemia, hypo- dehydration. Adjust drug errors. (The
chloremic alkalosis, doses carefully, and most popular Monitor glucose
hyperglycemia, monitor patient closely strengths of level in diabetic
dilutional for signs and symptoms furosemide and patients
hyponatremia, of excessive diuretic digoxin are white
response.
hypocalcemia, tablets that are Drug may not be
hypomagnesemia. about equal in well absorbed
Ethacrynic acid: May
increase risk of size.) orally in patient
Musculoskeletal: ototoxicity. Avoid using with severe HF.
muscle spasm. together. Tell patient to Drug may need
consult prescriber to be given I.V.
Skin: dermatitis, Lithium: May decrease or pharmacist even if patient is
purpura, lithium excretion, before taking OTC taking other oral
photosensitivity resulting in lithium drugs. drugs
reactions, transient toxicity. Monitor
lithium level.
pain at I.M. injection Teach patient to Monitor uric acid
site, toxic epidermal NSAIDs: May inhibit avoid direct level, especially
necrolysis, Stevens diuretic response. Use sunlight and to use in patients with a
Johnson syndrome, together cautiously. protective clothing history of gout.
erythema Phenytoin: May and sunblock
decrease diuretic
multiforme. because of risk of Monitor elderly
effects of furosemide.
Use together photosensitivity patients, who are
Other: gout. cautiously. reactions. especially
susceptible to
Propranolol: May Teach patient to excessive
increase propranolol avoid direct diuresis.
level. Monitor patient sunlight and to use Because
closely. protective clothing circulatory
and sunblock collapse and
Salicylates: May cause
because of risk of thromboembolic
salicylate toxicity. Use
photosensitivity complications are
together cautiously.
reactions. possible
Sucralfate: May reduce
diuretic and Monitor patients
antihypertensive effect. with severe
Separate doses by 2 symptoms of
hours. urine retention
due to bladder
Drug-herb. emptying
Aloe: May increase
disorders,
drug effect. Discourage
prostate
use together.
Bayberry, blue cohosh, enlargement, or
cayenne, ephedra, urethral
ginger, ginseng narrowing or
(American), kola, worsening of
licorice: May worsen symptoms,
hypertension. especially during
Discourage use initial treatment.
together
Drug may
Licorice: May cause
 unexpected rapid increase fetal
potassium loss. birth weight.
Discourage use Monitor fetal
together. growth during
pregnancy.
Drug-food.
Any food: May
decrease furosemide Nephrocalcinosis
serum level. Don't give and
with food. Drug- nephrolithiasis
lifestyle. have occurred in
premature
Sun exposure: May infants and in
increase risk of children younger
photosensitivity
than age 4 on
reactions. Advise
long-term
patient to avoid
excessive sunlight furosemide
exposure. therapy. Monitor
renal function
and renal
ultrasounds.

Look alike-sound
alike: Don't
confuse
furosemide with
torsemide. Don't
confuse Lasix
with Lonox,
Lidex, or Luvox

GENERIC INDICATION(s) ACTION(s) ADVERSE INTERACTION(S) CONTRAINDICATION PATIENT NURSING INDICATION(s)

NAME REACTION(s) (s) TEACHING(S)
LACTULOSE To prevent and Lactulose is Dehydration, Lactulose has no Galactosemia (patients Do not take Monitor
treat hepatic a colonic acidifi diarrhea, known severe require low- Enulose, for electrolyte imbalance
encephalopathy, er that works excessive bowel ac interactions with galactose diet) Kristalose, when the drug is used
including by decreasing tivity, high other drugs. Constulose or for longer than 6 months
BRAND hepatic
the amount blood sodium level Generlac, if or in patients
NAME precoma and
of ammonia in  s, low blood Lactulose has no you are predisposed to
ENULOSE coma in patients
the blood. It is sodium levels, known serious allergic to electrolyte abnormalities
with severe
hepatic disease a man-made nausea, vomiting, interactions with lactulose or
DOSAGE sugar solution. abdominal crampi other drugs. any
ng, ingredients
20 to 30g or abdominal distenti Moderate contained in
30 to 45 mL on, burping interactions of this drug.
(belching), gas lactulose include:
ROUTE (flatulence) aluminum
hydroxide, calcium
P.O carbonate, Avoid using
deflazacort, other
FREQUENCY
dichlorphenamide, laxatives
T.I.D / Q.I.D
sodium concomitantl
until 2-3 bicarbonate, y
soft stools sodium
are citrate/citric acid.
produced
daily Lactulose has no
known mild
interactions with
other drugs.