2A - Pasay - Module 5 - Elaborate

UNIVERSITY OF CEBU - BANILAD
Gov. M. Cuenco Ave, Cebu City, 6000 Philippines

College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : M. J. N.____________________________ Age : 61__________________ Hospital : 204________________

No
Impression : Ventricular arrythmia_________________ Attending Physician : Dr. Kim_________ ____ Room No : 015________________
Allergic to : N/A____________ _______ ___________
Generic / Brand Dose, Strenght Indication/Mechanism Adverse Effects & Nursing Responsibilities Client Teaching
Name & And Formulation Of Action Contraindications
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment” • Due to loss of feeling/sensation,
Lidocaine 1mg/kg by IV Infiltration or mucosal or CNS: confusion, tremor, • Assess for protective measures may be needed
topical anesthetic stupor, restlessness, light- hypersensitivity to until anesthetic wears off (no
Brand: Timing: headedness, seizures, lidocaine, amide ambulation, including special
Xylocaine once before surgery lethargy, somnolence, anesthetics positions for some regional
Mechanism of Action: anxiety, hallucinations, • Obtain baseline B/P, anesthesia).
Classification: Duration: Produces local anesthesia nervousness, paresthesia, pulse, respiratory rate, • Advise patient to report slowed or
Local Anesthesia 12 hours by inhibiting transport of muscle twitching EKG, serum electrolytes abnormal heart rhythms, ringing in
ions across neuronal CV: hypotension, the ears, vision changes, difficulty
Other Forms: membranes, thereby bradycardia, new or Intervention/Evaluation: breathing, and confusion.
Infusion preventing initiation and worsened arrhythmias, • Assess pulse for • Tell patient receiving lidocaine
Injection for IM conduction of normal cardiac arrest rhythm, rate, quality. that drug may cause soreness at
Direct IV nerve impulses EENT: blurred or double • Assess B/P for evidence injection site.
IV admixtures vision, tinnitus of hypotension.
GI: vomiting • Monitor EKG, vital
Respiratory: respiratory signs closely during and
depression and arrest following drug
Skin: soreness at injection administration for cardiac
site performance.
Pharmacology Drug Study 1st Semester S.Y. 2021- 2022 UCBC Page 1
College of Nursing
Telephone No: (032) 231- 8631
Other: anaphylaxis, • Inform physician

sensation of cold immediately if EKG
shows arrhythmias,
Contraindications: prolongation of PR
• Contraindicated in patients interval or QRS complex
hypersensitive to lidocaine • Monitor for therapeutic
or amide-type local serum level (1.5–6
anesthetics mcg/mL)
• Contraindicated in patients • If signs of overdose
with Adams-Stokes occur, stop the infusion
syndrome immediately and monitor
• Contraindicated in patients the patient closely
with Wolff-Parkinson-White
syndrome.
• Contraindicated in patients
with severe degree of SA,
AV, or intraventricular heart
block (except in patients
with functioning pacemaker)
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : A. C. E.____________________________ Age : 21 __________________ Hospital : 067________________

No
Impression : Tonic-clonic seizure__________________ Attending Physician : Dr. Kim________ _____ Room No : 008________________
Allergic to : N/A__________________________ ____
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Tell patient to report all adverse
Phenytoin 100 mg PO Treatment of tonic-clonic CNS: ataxia, decreased • Review history of reactions and to notify prescriber if
seizures, prevention of coordination, mental seizure disorder rash develops
Brand: Timing: status epilepticus, and confusion, slurred speech, (intensity, frequency, • Report any unusual changes in
Dilantin daily in three treatment of seizures after dizziness, headache, duration, LOC) behavior that may indicate
divided doses which neurosurgery insomnia, nervousness, • Initiate seizure worsening of suicidal thoughts or
Classification: are given at 2-hour twitching, peripheral precautions. LFT, CBC behavior or depression
Anticonvulsant/Anti- intervals with neuropathy, vertigo should be performed • Advise patient to avoid tasks that
epileptic careful monitoring Mechanism of Action: CV: bradycardia, before beginning therapy require alertness, motor skills until
Stabilizes neuronal periarteritis nodosa, and periodically during response to drug is established
Duration: membranes and limit hypotension, CV shock therapy • Advise patient not to change
10 days seizure activity either by EENT: diplopia, nystagmus, • Repeat CBC 2 weeks brands or dosage forms once
increasing efflux or blurred vision, thickening of following initiation of stabilized on therapy
Other Forms: decreasing influx of facial features therapy and 2 weeks • Tell patient not to use capsules
Oral suspension sodium ions across cell GI: gingival hyperplasia, following administration that are discolored
Tablets membranes in the motor nausea, vomiting, of maintenance dose • Advise patient to avoid alcohol
Injection cortex during generation constipation • Warn patient and parents not to
Capsules of nerve impulses Hematologic: leukopenia, stop drug abruptly after long-term
agranulocytosis, use
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pancytopenia, Intervention/evaluation: • Stress importance of good oral

thrombocytopenia, • Observe frequently for hygiene and regular dental exams.
macrocythemia, recurrence of seizure Surgical removal of excess
megaloblastic anemia activity gum tissue may be needed
Hepatic: toxic hepatitis • Monitor ECG for periodically if dental hygiene is
Metabolic: hyperglycemia cardiac arrhythmia poor.
Skin: SJS, toxic epidermal • Assess for clinical • Advise patient that drug may
necrolysis, bullous or improvement (decrease in cause an increase in blood glucose
purpuric dermatitis, intensity/frequency of levels.
hypertrichosis, inflammation seizures)
at injection site, necrosis, • Monitor for
pain, photosensitivity signs/symptoms of
reactions, scarlatiniform or depression, suicidal
morbilliform rash tendencies, unusual
Other: lymphadenopathy, behavior
SLE • Monitor CBC with
differential, renal
Contraindications: function, LFT, B/P (with
• Contraindicated in patients IV use)
hypersensitive to hydantoin, • Assist with ambulation
in those taking delavirdine, if drowsiness, lethargy
and in those with a history of occurs
prior acute hepatotoxicity • Monitor for
attributable to phenytoin therapeutic serum level
• Contraindicated in patients (10–20 mcg/mL)
with sinus bradycardia, SA
block, second- or third-
degree AV block, or Adams-
Stokes syndrome
• Use cautiously in patients
with hepatic dysfunction,
College of Nursing
Telephone No: (032) 231- 8631
hypotension, myocardial
insufficiency, diabetes, or
respiratory depression; in
elderly or debilitated
patients; and in those
receiving other hydantoin
derivatives
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : C. Y. P. ___________________________ Age : 24_______ ___________ Hospital : 105________________

No
Impression : Complex partial seizure_______________ Attending Physician : Dr. Kim______ _______ Room No : 031________________
Allergic to : N/A_________________________ _____
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Tell patient that genetic testing
Carbamazepine 200 mg PO Treatment of partial CNS: ataxia, dizziness, • CBC, serum iron may be needed before start of
seizures with complex drowsiness, somnolence, determination, urinalysis, therapy
Brand: Timing: symptomatology, vertigo, seizures, confusion, BUN should be • Instruct patient to take drug with
Carbatrol initially twice a day generalized tonic-clonic fatigue, fever, headache, performed before food to minimize GI distress
with meals and seizures, mixed seizure depression including suicidal therapy begins and • Tell patient taking suspension
Classification: increased weekly by patterns, pain relief of ideation, speech disorder periodically during form to shake container well before
Anticonvulsant/Anti- 200 mg daily in trigeminal, CV: arrhythmias, AV block, therapy measuring dose
epileptic divided doses at 12- glossopharyngeal hypotension • Review history of • Tell patient not to crush or chew
hour intervals neuralgia EENT: blurred vision, seizure disorder tablets or capsules and not to take
conjunctivitis, diplopia, (intensity, frequency, broken or chipped tablets
Duration: Mechanism of Action: nystagmus, dry pharynx duration, level of • Advise patient to keep tablets in
2 weeks Stabilizes neuronal GI: nausea, vomiting, consciousness [LOC]). the original container and to keep
membranes and limit abdominal pain, anorexia, • Initiate seizure the container tightly closed and
Other Forms: seizure activity by either diarrhea, dry mouth, precautions away from moisture.
Capsules increasing efflux or dyspepsia, glossitis, • Inform patient that when drug is
Oral suspension decreasing influx of stomatitis Intervention/Evaluation: used for trigeminal neuralgia, an
Tablets sodium ions across cell GU: albuminuria, • Observe frequently for attempt to decrease dosage or
membranes in the motor glycosuria, erectile
College of Nursing
Telephone No: (032) 231- 8631
cortex during generation dysfunction, urinary recurrence of seizure withdraw drug is usually made
of nerve impulses. frequency, urine retention activity every 3 months.
Hematologic: aplastic • Monitor therapeutic • Advise patient to report adverse
anemia, agranulocytosis, levels reactions and to immediately report
thrombocytopenia, • Assess for clinical fever, sore throat, mouth ulcers, or
eosinophilia, leukocytosis improvement (decrease in easy bruising or bleeding.
Hepatic: hepatitis intensity, frequency of
Metabolic: hyponatremia seizures)
Musculoskeletal: leg cramps • Assess for clinical
Respiratory: pulmonary evidence of early toxicity
hypersensitivity (fever, sore throat, mouth
Skin: erythema multiforme, ulcerations, unusual
SJS, excessive diaphoresis, bruising/bleeding, joint
rash, urticaria, pruritus pain)
Other: SIADH, chills
Contraindications:
hypersensitive to this drug or
TCAs and in those with a
history of bone marrow
suppression
who have taken an MAO
inhibitor within 14 days
• Contraindicated in
concomitant use with
delavirdine or other NNRTIs
or nefazodone
with mixed seizure disorders
College of Nursing
Telephone No: (032) 231- 8631
because they may experience

an increased risk of seizures
with renal and hepatic
dysfunction
• Avoid use in patients with
porphyria
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : R. B. P.____________________ _______ Age : 68__________________ Hospital : 083________________

No
Impression : Status epilepticus____________________ Attending Physician : Dr. Kim_______ ______ Room No : 022________________
Allergic to : N/A_______________________ _______
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Advise patient to avoid alcohol,
Phenobarbital 20 mg/kg by IV Management of CNS: headache, drowsiness, • Assess B/P, pulse, limit caffeine.
generalized tonic-clonic somnolence, insomnia, respirations immediately • Tell patient not to discontinue
Brand: Timing: (grand mal) seizures, lethargy, ataxia, vertigo, before administration. drug abruptly.
Luminal Sodium repeat once in 10 partial seizures, control of anxiety, hallucinations, • Review history of • Report severe dizziness, weakness,
min with a dose of acute seizure episodes CV: bradycardia, seizure disorder (length, fever, drowsiness, rash sore throat,
Classification: 5–10 mg/kg (status epilepticus) hypotension, syncope presence of auras, LOC). easy bruising or bleeding, mouth
Anticonvulsant/Anti- GI: nausea, vomiting, • Observe for recurrence sore
epileptic Duration: constipation, diarrhea, of seizure activity. • Avoid tasks that require alertness,
4-16 h Mechanism of Action: epigastric pain motor skills until response to drug is
Depresses sensory cortex, Hematologic: megaloblastic Intervention/evaluation: established.
Other Forms: decreases motor activity, anemia, agranulocytosis, • Initiate seizure
Elixir alters cerebellar function thrombocytopenia precautions
Oral solution Metabolic: hypocalcemia, • Monitor CNS status,
Injection osteomalacia, rickets seizure activity,
Tablets Skin: rash, serum sickness, hepatic/renal function,
Stevens-Johnson syndrome respiratory rate, heart
rate, B/P.
College of Nursing
Telephone No: (032) 231- 8631
Contraindications: • Monitor for therapeutic

• Contraindicated in patients serum level. Neurological
hypersensitive to assessments may be
phenobarbital and other inaccurate until drug has
barbiturates properly cleared the body
with porphyria, dyspnea, or
airway obstruction
• Use cautiously in nephritic
patients with severe hepatic
impairment
with history of
sedative/hypnotic addiction
• Contraindicated for intra-
arterial or subcutaneous
administration
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : J. J. P.____________________ _________ Age : 56__________________ Hospital : 054________________

No
Impression : Insomnia due to anxiety_________ ______ Attending Physician : Dr. Kim____ _________ Room No : 035________________
Allergic to : N/A_______________________________
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Caution patient or caregiver of
Lorazepam 2 mg PO Management of anxiety CNS: drowsiness, sedation, • Assess motor responses patient taking an opioid with a
disorders, short-term amnesia, insomnia, agitation, (agitation, trembling, benzodiazepine, CNS depressant, or
Brand: Timing:: relief of symptoms of dizziness, weakness, tension), autonomic alcohol to seek immediate medical
Ativan at bedtime anxiety,anxiety associated unsteadiness, disorientation, responses (cold or attention for dizziness, light-
with depressive depression, headache, clammy hands, headedness, extreme sleepiness,
Classification: Duration: symptoms. Insomnia due somnolence diaphoresis). slowed or difficult breathing, or
Anticonvulsant/Anti- 2 weeks to anxiety or transient CV: hypotension • Offer emotional support unresponsiveness.
epileptic stress EENT: visual disturbances, to anxious pt. Pt must • Warn patient to avoid hazardous
Other Forms: nasal congestion remain recumbent activities that require alertness or
Injection Mechanism of Action: GI: abdominal discomfort, following parenteral good coordination until effects of
Oral solution Potentiates the effects of nausea, change in appetite administration to reduce drug are known.
Tablets GABA, depresses the Respiratory: respiratory hypotensive effect. • Tell patient to avoid use of alcohol
CNS, and suppresses the failure, respiratory Intervention/Evaluation: while taking drug.
spread of seizure depression • Monitor B/P, respiratory • Notify patient that smoking may
activity rate, heart rate. For those decrease drug's effectiveness.
Contraindications: on long-term therapy, • Warn patient not to stop drug
• Contraindicated in patients hepatic/renal function abruptly because withdrawal
hypersensitive to drug, other symptoms may occur.
College of Nursing
Telephone No: (032) 231- 8631
benzodiazepines, or the tests, CBC should be

vehicle used in parenteral performed periodically.
dosage form, and in patients • Assess for paradoxical
with acute angle-closure reaction, particularly
glaucoma. during early therapy.
• Contraindicated in patients • Evaluate for therapeutic
with sleep apnea and in response: calm facial
patients with severe expression, decreased
respiratory insufficiency, restlessness, insomnia,
except those who are decrease in seizure-
mechanically ventilated. related symptoms.
• Contraindicated for intra-
arterial administration.
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : T. N. R. ____________________________ Age : 32__________________ Hospital : 072________________

No
Impression : Acute pain related to labor _____ _______ Attending Physician : Dr. Kim__ ___________ Room No : 011________________
Allergic to : N/A________________________ _______
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Nitrous oxide/oxygen is self-
Nitrous oxide INH 70% nitrous Moderate to severe pain CNS: dizziness, drowsiness, • Conduct a history and administered through a demand-
oxide with 30% management situations headache, confusion, physical examination to valve with face mask or
Brand: oxygen when immediate, short- seizures, amnesia, giddiness, rule out the mouthpiece.
Entonox term analgesia and tingling contraindications for use • If the pain is spasmodic or
Timing: anxiolysis with minimal EENT: acute sinus pain, of nitrous oxide/oxygen. episodic, as in labor, encourage the
Classification: for induction, sedation is required such middle ear pain This includes a cardio- client to stop using the gas during
General Anesthetics: followed by 30%- as during a difficult GI: nausea, vomiting, bowel respiratory, the pain-free periods.
Inhalation 70% for dressing change, the obstruction gastrointestinal and ear- • Review the adverse effects of
maintenance of application of splints to Respiratory: apnea nose-throat (ENT) exam nitrous oxide /oxygen.
anesthesia fracture sites or Cardiac: decreased cardiac •Ensure adequate • Do not use while smoking.
during labour output and hypotension ventilation of the room to
Duration: Other: vitamin B12 avoid bystander effects
5 minutes after the Mechanism of Action: deficiency • Obtain a baseline set of
mask has been Central nervous system vital signs, including
removed (CNS) depressant action Contraindications: oxygen saturation
by partially inhibiting • Contraindicated in patients
Other Forms: action potentials of the hypersensitive to nitrous
oxide
College of Nursing
Telephone No: (032) 231- 8631
Gas CNS that leads to • Contraindicated in patients Intervention/Evaluation:

sedation with air-enclosing cavities • Ensure client is able to
(cysts or air embolism), follow directions
acute GI obstruction, • Monitor closely during
pneumothorax administration; note
• Contraindicated in patients patient responsiveness,
with head trauma, increased color, respiratory status
intracranial pressure, • Have the client apply
intracranial mass the mask or hold
• Contraindicated in patients mouthpiece to own face
with suspected inhalation • Encourage slow, deep
injury with oxygen breaths to allow the
saturation of less than 100% demand-valve to function
• If the mask falls away
as the client becomes
sedated, do not replace
the mask
• Allow the client to use
nitrous oxide/oxygen
until the pain is relieved
or side-effects appear
• Discontinue if cyanosis
develops
College of Nursing
Telephone No: (032) 231- 8631
DRUG STUDY
Patient : A. L. S.____________________________ Age : 53__________________ Hospital : 524________________

No
Impression : Sedation for colonoscopy______________ Attending Physician : Dr. Kim______ _______ Room No : 065________________
Allergic to : N/A_______________________________
Classification
Generic: Ordered: Indication: Adverse Effects: Baseline assessment: • Advise patient that performance of
Propofyl 2 mg/kg by IV Induction/maintenance of CNS: dystonic or choreiform • Resuscitative activities requiring mental alertness
infusion anesthesia. Continuous movement equipment, suction, O2 may be impaired for some time after
Brand: sedation in intubated and CV: bradycardia, must be available drug use.
Diprivan Timing: respiratory controlled hypotension, HTN, • Obtain vital signs before • Tell patient that abnormal dreams
every 10 seconds adult patients in ICU. decreased cardiac output administration. or anesthesia awareness may occur.
Classification: until onset of Metabolic: hyperlipidemia • Discuss with patient the benefits,
General Anesthetics: anesthesia Respiratory: apnea, Intervention/evaluation: risks, and appropriate timing of
Intravenous Mechanism of Action: respiratory acidosis • Observe patient for surgery or procedures requiring
Duration: Causes CNS depression Skin: rash, pruritus signs of wakefulness, anesthetic and sedation drugs.
10 minutes through agonist action of Other: burning or stinging at agitation.
GABA receptors injection site • Monitor respiratory rate,
Other Forms: B/P, heart rate, O2
Injection Contraindications: saturation, ABGs, depth
• Contraindicated in patients of sedation, serum lipid,
hypersensitive to drug or its triglycerides (if used
components (soybean oil, longer than 24 hours).
glycerol, egg, lecithin, May change urine color
disodium edetate, sodium to green. If continuous
College of Nursing
Telephone No: (032) 231- 8631
hydroxide); in patients with high dose infusions do

allergies to eggs, egg not properly induce
products, soybeans, or soy sedation, consider
products; and in those additional sedatives (e.g.,
unable to undergo general opioids, hypnotics,
anesthesia or sedation. benzodiazepines) to
• Use cautiously in patients achieve desired response.
who are hemodynamically
unstable or who have
seizures, disorders of lipid
metabolism, or increased
ICP.
College of Nursing
Telephone No: (032) 231- 8631
NCM 106 – Pharmacology
Course Outputs /Assessment of Learning for CILO # 1

Written Outputs (Mental Models, Group Activity and Reflection Journal)
Name of Student : Trisha Faye Y. Pasay________ Yr.& Sec. : BSN 2 - A_______

Module/Topic : Module 5 - Elaborate________ Date : 11/3/2021____ ___
1. Create a Drug Study on Neuro Drugs that are commonly used in clinical settings.
Utilize the drug study template.
a. Neuro Ward (5 Medications)

. Local Anesthesia – Lidocaine
i. Anticonvulsant/Anti-epileptic – Phenytoin
ii. Anticonvulsant /Anti-epileptic – Carbamazepine
iii. Anticonvulsant/Anti-epileptic –Phenobarbital
iv. Anticonvulsant/Anti-epileptic –Lorazepam
b. Operating Room/Post Anesthesia Care Unit (2 Medications)
. General Anesthetics: Inhalation - Nitrous oxide
i. General Anesthetics: Intravenous - Propofyl
2. Briefly organize and bring together main ideas. Explain in your own words. (50 –
150 words for each question)
I. AMELIA, a 26-year-old woman, takes phenytoin 100 mg three times daily to control tonic-
clonic seizures. She and her husband are contemplating starting a family.
A. Family Planning for Amelia
Objectives Learning Teaching- Time Resources Method of

Contents Learning Allotment Required Evaluation
Methods and
Activities
After an hour Definition: The “Gather” 30 minutes ●Visual aids After one hour of
of nurse- client Family Counseling ●Pictures health teaching,
interaction the planning Process: ●Pamphlets the client will be
client will be allows people ●Posters able to
able to: to attain their G – Greet demonstrate
desired clients in an positive toward
1. Discuss the number of open, family planning
client’s needs children and respectful and acknowledge
and situation determine the manner. that personal
and the factors spacing of needs and rights
that he/she pregnancies. have been met
It is achieved and fears or
Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 1

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considers through use A – Ask misapprehensions

important in of clients about have been allayed
choosing an FP contraceptive themselves. and addressed.
method. methods and
the treatment T – Tell
of infertility. clients about
choices.
2. Discuss Right to 30 minutes
relevant information- H – Help
information to learn about clients make
about each the benefits informed
method, and and choices.
assist the availability of
client family E – Explain
in determining planning fully how to
the most use the
suitable Right to chosen
method. access- to method.
Include in the obtain
discussion the services R – Return
client’s regardless of visits should
medical sex, creed, be welcomed.
eligibility and color, marital
ensure that status, social
her choice is status, or
an informed location
one.
Right to
3. Discuss how choice- to
to correctly decide freely
use the chosen on whether to
method and practice
how to handle family
any side effect. planning and
which
4. Provide the method to
method. use
Right to
continuity- to
receive FP
services and
supplies as
long as
needed

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Telephone No: (032) 231- 8631
B. Phenytoin is an antiepileptic drug which can be used in the treatment of epilepsy.

Gastrointestinal (GI) discomforts are among the most common side effects of
antiepileptic drug (AED) that includes heartburn, nausea, constipation, vomiting,
diarrhea, etc. To avoid GI distress, Amelia must take phenytoin with or after
meals. It is suggested to eat frequent, small meals. Client must avoid lying down
for about 30 minutes after eating. Tell the physician if symptoms continue. The
physician may consider changing client’s dosage of the medicine or trying a new
medicine.
C. To alleviate bleeding gums, the patient teaching for Amelia may include:
• Emphasize the importance of oral hygiene to the patient.
• Instruct the patient to avoid vigorous brushing of teeth.
• Encourage the patient to use soft bristle brush.
• Instruct the patient to inform her dentist about phenytoin therapy.
D. High serum levels of phenytoin indicate phenytoin toxicity. It progresses from

mild nystagmus to coma. The therapeutic range is 10-20 mcg/mL. Total phenytoin
levels (mcg/mL) and typical corresponding signs and symptoms are as follows:
• Lower than 10 – Rare
• Between 10 and 20 - Occasional mild nystagmus
• Between 20 and 30 – Nystagmus
• Between 30 and 40 - Ataxia, slurred speech, nausea, and vomiting
• Between 40 and 50 - Lethargy and confusion
• Higher than 50 - Coma and seizures
In the abnormal serum level, immediately perform a dextrose fingerstick test in

any patient with altered mental status. Consider measurement of other drugs the
patient is taking, in view of the possibility of drug interactions with phenytoin.
For acute toxicity, do the following:
• Measure ethanol level for multiple ingestions or altered mental status
• Measure electrolyte levels for questionable clinical presentation, elderly
persons, or patients with multiple medical problems
For patients with hypersensitivity reactions, do the following:

• Obtain a complete blood count (CBC) to rule out anemia, eosinophilia,
atypical lymphocytosis, and pancytopenia
• Perform liver function tests (LFTs) to rule out hepatotoxicity
II. NOAH, a 79-year-old man, was diagnosed with Parkinson’s disease 10 years ago. During
his early treatment, he took selegiline. The drug dosage was increased to alleviate
symptoms.

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A. Selegiline is a selective monoamine oxidase B (MAO-B) inhibitor. MAO-B is an

enzyme that breaks down dopamine in the brain. By inhibiting the action of the
MAO-B enzyme, selegiline leads to an increase in the amount of dopamine. As a
result, the dose of levodopa/carbidopa needed to control Parkinson’s disease
symptoms can be reduced, helping to stop the effect of those therapies wearing
off between doses.
B.
➢ Noah must ingest foods high in fiber and to increase fluids to prevent constipation
and needs to avoid the following while taking selegiline:
• alcohol
• foods that are high in tyramine, including:
- air dried meats, aged or fermented meats, sausage, or salami
(including cacciatore and mortadella), pickled herring
- any spoiled or improperly stored beef, poultry, fish, or liver
- beer from a tap, beer that has not been pasteurized
- aged cheeses (such as blue, Swiss, cheddar, Parmesan, or Romano
cheese)
- over-the-counter supplements or cough and cold medicines that
contain tyramine
- sauerkraut, soybeans, soy sauce, tofu, fava beans; or
- yeast extracts (such as Marmite).
Eating tyramine while taking selegiline can raise the blood pressure to
dangerous levels which could cause life-threatening side effects.
➢ Selegiline is a selective, irreversible inhibitor of monoamine oxidase type B (MAO-

B) used in the early treatment of Parkinson's disease. Unlike the nonselective
MAO inhibitors, selegiline does not significantly potentiate tyramine-induced
hypertension (the 'cheese effect') at the dosages (5 to 10 mg daily) used for the
treatment of Parkinson's disease. If patient develops numerous side effects and
adverse reactions to selegiline, the health care provider may change the drug to
carbidopa-levodopa. Carbidopa/levodopa is the most common drug used to treat
Parkinson’s disease and is usually started as soon as the patient becomes
functionally impaired. The addition of carbidopa allows lower doses of levodopa
to be used. This reduces the risk of side effects from levodopa such as nausea and
vomiting.

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Telephone No: (032) 231- 8631
C.
Selegiline Carbidopa-levodopa
• Blocks breakdown of Both • Selective and
dopamine via MAO-B minimize reversible COMT
inhibition progression inhibitor that Inhibits
• Used only for early of Parkinson’s
decarboxylation of
disease
treatment peripheral levodopa
symptoms
• Used with other • First choice treatment
medicines for for Parkinson's
Parkinson's disease disease
to boost its effect
D.
➢ Carbidopa-levodopa is considered the most effective drug to treat
Parkinson’s disease. The advantages of carbidopa-levodopa are more
dopamine reaches the basal ganglia and that smaller doses of levodopa are
required. In addition to helping prevent nausea, carbidopa prevents levodopa
from being converted into dopamine prematurely in the bloodstream,
allowing more of it to get to the brain.
➢ Amantadine is a type of medicine used to treat some symptoms of
Parkinson’s disease (PD). It is used to treat tremors and dyskinesias.
Dyskinesias are uncontrollable, abnormal movements. They are a common
side effect of levodopa, a long-term PD treatment. Amantadine can be used
as a monotherapy for Parkinson’s motor symptoms or as combination
therapy with levodopa for levodopa-induced dyskinesia. In relation to the
client’s family query, the nurse should respond to the client and explain that
nurses are not the one held accountable to prescribe medications. The nurse
should advice the patient to consult to his physician about whether NOAH
can take amantadine instead of carbidopa-levodopa.

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E. Amantadine is a medication useful in treating some symptoms of Parkinson's

disease. Its pharmacological actions are unique in combining dopaminergic and
glutamatergic properties, which account for its dual effect on parkinsonian signs
and symptoms. Amantadine can be used by itself to treat people in the early
stages of Parkinson's disease. In the early stages of disease, it can help improve
slow movements and rigidity. It can help to reduce dyskinesias, involuntary
movements that may result from taking some Parkinson's medications.
F. The nurse should respond to the client and explain that nurses are not the one
held accountable to prescribe medications. In fact, it is not included in the scope
of nursing practice. The nurse should advice the client to consult to his physician
about their concern. I will explain to the client and his family that a prescription
is needed because the drug in the prescription is specifically tailored for his
condition. This means that it is prescribed according to her level of condition.
Dispensing medications of certain condition without prescription may cause
serious health risks and problems.
III. ISABELLA, a 35-year-old woman, is receiving risperidone, 3 mg twice daily, to control a

psychotic disorder. She has taken the drug for 6 months but has recently become agitated
and is complaining of insomnia.
A. Risperidone is second generation antipsychotic that reduces dopaminergic
neurotransmission by blocking D2 receptors. Drug dose of risperidone initially
should start with 1 mg or 2 mg in a day. Later it can be increased to 4-8 mg per
day. There is not a problem with dose. The drug such as atypical antipsychotics
like risperidone has a little evidence that they actually help patient stay asleep,
and the dose should be taken earlier in the day.

College of Nursing
Telephone No: (032) 231- 8631
B.
Risperidone
• Risperidone is second-generation
antipsychotics: serotonin-dopamine
antagonists
• MOA- Decrease dopaminergic and
serotonergic pathway activity in the brain
• AE- Increase the risk of diabetes, weight
gain, high cholesterol, and high triglycerides
increase side effects such

as drowsiness, blurred helps control thoughts
vision, dry mouth, heat and mood
Chlorpromazine intolerance All are Haloperidol
antipsychotic
drugs prescribed
to treat
• MOA- Blocks postsynaptic schizophrenia • MOA- Blocks postsynaptic
dopamine (D2) receptors in the Chlorpromazine and
dopamine (D2) receptors in the
mesolimbic system of the brain Haloperidol are both
mesolimbic system of the brain
• AE- Extrapyramidal reactions first-generation
• AE- Extrapyramidal reactions
(e.g., Parkinson-like symptoms, antipsychotics:
(e.g., restlessness, tremor,
dystonia, akathisia, tardive dopamine
stiffness, tardive dyskinesia,
dyskinesia receptor
antagonists irregular heartbeat
IV. ALEXANDER, a 37-year-old woman, is receiving fluoxetine 20 mg in the evening for

depression. ST complains of insomnia and GI upset.
A. Insomnia is a side effect of antidepressant medication. Some of the ways to help the
patient are:
• Antidepressant medication like Fluoxetine can be taken in the morning after
breakfast so that it dies not interrupt sleep in the nighttime.
• Encourage patient to have dinner before 4 hours to bedtime and avoid
drinks or snacks at late night.
• Inform patient to avoid drinks which are stimulant like coffee.
• Provide relaxation therapy, warm bath, dim light, noise-free area to help in
inducing sleep.

College of Nursing
Telephone No: (032) 231- 8631
B. Fluoxetine is a member of the selective serotonin reuptake inhibitor (SSRI) family of

drugs. This class of drug works by stimulating the effects of serotonin, a
neurotransmitter associated with mood, cognition, and appetite. When serotonin
levels increase under the influence of SSRIs, they stimulate serotonin receptors in the
GI tract as well as the brain. The combined stimulatory effect—on both the GI tract
and CNS—can trigger such side effects as GI upset. To avoid GI upset, ST needs to take
fluoxetine antidepressant with food, unless otherwise directed. Eat smaller, more-
frequent meals and drink plenty of fluids. The following foods ST must avoid because
taking them can aggravate the levels in the blood are alcohol, caffeinated products,
and tyramine rich foods.
References:
• Department of Health. The Philippine Clinical Standards Manual on Family Planning (2014
Edition). Manila, Philippines: DOH. 2014. 437 pages.
• Miller, C., MD. (2021, May 3). Phenytoin Toxicity Workup: Laboratory Studies, Imaging Studies,
Electrocardiography. Medscape. https://emedicine.medscape.com/article/816447-workup.
• DeMaagd, G., & Philip, A. (2015). Parkinson's Disease and Its Management: Part 3:
Nondopaminergic and Nonpharmacological Treatment Options. P & T: a peer-reviewed journal
for formulary management, 40(10), 668–679.
• Compare carbidopa / levodopa vs. Eldepryl Head-to-head comparisons of medication uses, side
effects, ratings, and more. (2021). Iodine. https://s3.amazonaws.com/eu.iodine.com/index.html
• Nursing, O. R. F. (2020). 8.11 Antiparkinson Medications – Nursing Pharmacology. Pressbooks.
https://wtcs.pressbooks.pub/pharmacology/chapter/8-11-antiparkinson-medications/
Hunter, R., Kennedy, E., Song, F., Gadon, L., & Irving, C. B. (2003). Risperidone versus
typical antipsychotic medication for schizophrenia. Cochrane database of systematic reviews, (2).
• Comerford, K. C., & Durkin, M. T. (2021). Nursing 2021 drug handbook. 41st edition.
Philadelphia: Wolters Kluwer.
• Karch, A. M. (2017). Focus on nursing pharmacology. Philadelphia: Lippincott Williams &
Wilkins.

College of Nursing
Telephone No: (032) 231- 8631
Prepared by:
Trisha Faye Y. Pasay

Students Signature over
Printed Name
Submitted to:
Lemuel C. Candelasa, EdD(c) ,MAN,RN

ProfeAmeliaor – Pharmacology

2A - Pasay - Module 5 - Elaborate

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UNIVERSITY OF CEBU - BANILAD

Gov. M. Cuenco Ave, Cebu City, 6000 Philippines

Patient : M. J. N.____________________________ Age : 61__________________ Hospital : 204________________

Allergic to : N/A____________ _______ ___________

Other: anaphylaxis, • Inform physician

Patient : A. C. E.____________________________ Age : 21 __________________ Hospital : 067________________

Allergic to : N/A__________________________ ____

pancytopenia, Intervention/evaluation: • Stress importance of good oral

Patient : C. Y. P. ___________________________ Age : 24_______ ___________ Hospital : 105________________

Allergic to : N/A_________________________ _____

because they may experience

Patient : R. B. P.____________________ _______ Age : 68__________________ Hospital : 083________________

Allergic to : N/A_______________________ _______

Contraindications: • Monitor for therapeutic

Patient : J. J. P.____________________ _________ Age : 56__________________ Hospital : 054________________

benzodiazepines, or the tests, CBC should be

Patient : T. N. R. ____________________________ Age : 32__________________ Hospital : 072________________

Allergic to : N/A________________________ _______

Gas CNS that leads to • Contraindicated in patients Intervention/Evaluation:

Patient : A. L. S.____________________________ Age : 53__________________ Hospital : 524________________

hydroxide); in patients with high dose infusions do

NCM 106 – Pharmacology

Course Outputs /Assessment of Learning for CILO # 1

Name of Student : Trisha Faye Y. Pasay________ Yr.& Sec. : BSN 2 - A_______

a. Neuro Ward (5 Medications)

Objectives Learning Teaching- Time Resources Method of

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 1

considers through use A – Ask misapprehensions

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 2

B. Phenytoin is an antiepileptic drug which can be used in the treatment of epilepsy.

D. High serum levels of phenytoin indicate phenytoin toxicity. It progresses from

In the abnormal serum level, immediately perform a dextrose fingerstick test in

For patients with hypersensitivity reactions, do the following:

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 3

A. Selegiline is a selective monoamine oxidase B (MAO-B) inhibitor. MAO-B is an

➢ Selegiline is a selective, irreversible inhibitor of monoamine oxidase type B (MAO-

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 4

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 5

E. Amantadine is a medication useful in treating some symptoms of Parkinson's

III. ISABELLA, a 35-year-old woman, is receiving risperidone, 3 mg twice daily, to control a

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 6

increase side effects such

IV. ALEXANDER, a 37-year-old woman, is receiving fluoxetine 20 mg in the evening for

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 7

B. Fluoxetine is a member of the selective serotonin reuptake inhibitor (SSRI) family of

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 8

Trisha Faye Y. Pasay

Lemuel C. Candelasa, EdD(c) ,MAN,RN

Pharmacology Module 1st Semester S.Y. 2021- 2022 UCBC Page 9

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Patient : M. J. N.__________ Age : 61 Hospital : 204

Allergic to : N/A________ _ _________

Patient : A. C. E.__________ Age : 21 Hospital : 067

Allergic to : N/A______________________

Patient : C. Y. P. _______________________ Age : 24_ _ Hospital : 105________

Allergic to : N/A_____________________ _

Patient : R. B. P.________________ _ Age : 68 Hospital : 083

Allergic to : N/A_________________ _

Patient : J. J. P.________________ _ Age : 56 Hospital : 054__

Patient : T. N. R. __________ Age : 32 Hospital : 072

Allergic to : N/A__________________ _

Patient : A. L. S.__________ Age : 53 Hospital : 524

Name of Student : Trisha Faye Y. Pasay__ Yr.& Sec. : BSN 2 - A_