NCMA216: COURSE TASK 2

Pharmacology: Course Task 2

Using your drug handbook, answer the following questions:

A. Look for the drug-drug interaction of the following drugs given and give nursing
considerations as you give the drugs together:
1. Celecoxib with ACE inhibitors
Drug-drug interaction. May decrease antihypertensive effects. Monitor BP.
Nursing considerations. (1) Patients allergic to or with a history of anaphylactic
reactions to sulfonamides, aspirin, or other NSAIDS may be allergic to this drug. (2) Watch for
immediately evaluate signs and symptoms of heart attack or stroke.

2. Amitriptyline hydrochloride with barbiturates

Drug-drug interaction. May increase amitriptyline metabolism. Consider therapy
modification.
Nursing considerations. (1) If linezolid or methylene blue must be given, amitriptyline
must be stopped and patient should be monitored for serotonin toxicity for 2 weeks, or until 24
hours after the last dose of methylene blue or linezolid, whichever comes first. Treatment with
amitriptyline may be resumed 24 hours after last dose of methylene blue or linezolid.

3. Acetylcysteine with activated charcoal

Drug-drug interaction. May limit acetylcysteine’s effectiveness. Avoid using activated
charcoal before or with oral acetylcysteine.
Nursing considerations. (1) Monitor patient for bronchospasm, especially if patient has
asthma. (2) Drug is used for acetaminophen overdose within 24 hours of ingestion. Start drug
immediately; don’t wait for results of acetaminophen level. Give within 10 hours of
acetaminophen ingestion to minimize hepatic injury.

4. Budesonide inhalation with ketoconazole

Drug-drug interaction. May inhibit metabolism and increase level of budesonide.
Monitor patient for adverse reactions and adjust dosage as needed.
Nursing considerations. (1) When transferring from systemic corticosteroid to inhalation
drug, use caution and gradually decrease corticosteroid dose to prevent adrenal insufficiency. (2)
Corticosteroids may increase risk of developing serious or fatal infections in patients exposed to
viral illnesses, such as chickenpox or measles.

5. Clobazam with hormonal contraceptives

Drug-drug interaction. May diminish contraceptive effectiveness. Patient should use
nonhormonal contraception as needed.
Nursing considerations. (1) Monitor patients for skin reactions (rash, blistering or
peeling skin, mouth sores, hives). Rare but serious skin reactions, including SJS and toxic
epidermal necrolysis, have occurred with drug use, especially during first 8 weeks of treatment
or when reintroducing therapy. Discontinue drug at first sign of reaction unless reaction is
obviously not drug-related. Don't resume drug if rash is suggestive of SJS or toxic epidermal
necrolysis. (2) Drug may increase risk of suicidal thoughts or behavior. Monitor patients treated
with AEDs for indications of emergence or worsening of depression, suicidal thoughts or
behavior, or unusual changes in mood or behavior.

6. Esmolol hydrochloride with antidiabetic agents

Drug-drug interaction. May increase blood glucose-lowering effect of antidiabetic agent.
Closely monitor blood glucose concentration.
Nursing considerations. (1) Monitor ECG and BP continuously during infusion. Nearly
half of patients will develop hypotension. Diaphoresis and dizziness may accompany
hypotension. Monitor patient closely, especially if patient had low BP before treatment. (2)
Hypotension can usually be reversed within 30 minutes by decreasing the dose or, if needed, by
stopping the infusion. Notify prescriber if this becomes necessary.

7. Indomethacin with aminoglycosides

Drug-drug interaction. May enhance toxicity of these drugs. Avoid using together.
 Nursing considerations. (1) Watch for and immediately evaluate signs and symptoms of
heart attack (chest pain, shortness of breath or trouble breathing) or stroke (weakness in one part
or side of the body, slurred speech). (2) Monitor patient for rash and respiratory distress, which
may indicate a hypersensitivity reaction.

8. Isoniazid with acetaminophen

Drug-drug interaction. May inhibit acetaminophen metabolism. Monitor patient closely
for hepatotoxicity.
Nursing considerations. (1) Drug's pharmacokinetics vary among patients because drug
is metabolized in the liver by genetically controlled acetylation. Fast acetylators metabolize drug
up to 5 times faster than slow acetylators. About 50% of Blacks and Whites are fast acetylators;
more than 80% of Chinese, Japanese, and Inuits are fast acetylators. A report suggests the risk of
fatal hepatitis increases in Black and Hispanic women and in the postpartum period. The risk of
hepatitis increases with daily alcohol use and with age. (2) Peripheral neuropathy is more
common in patients who are slow acetylators, malnourished, alcoholic, or diabetic. Give
pyridoxine to prevent peripheral neuropathy.

9. Mesalamine with warfarin

Drug-drug interaction. May decrease anticoagulation effect. Monitor effectiveness of
therapy closely.
Nursing considerations. (1) May decrease anticoagulation effect. Monitor effectiveness
of therapy closely. (2) Drug may be associated with an acute intolerance syndrome in which
signs and symptoms (abdominal pain, cramping, bloody diarrhea, headache, fever, rash) may be
similar to an ulcerative colitis exacerbation. If acute intolerance syndrome is suspected,
discontinue drug. (3) Apriso contains phenylalanine.

10. Rifampicin with probenecid

Drug-drug interaction. May increase rifampin levels. Use together cautiously.
Nursing considerations. (1) Monitor hepatic function, hematopoietic studies, and uric
acid level. Drug's systemic effects may asymptomatically raise LFT values and uric acid level. In
patients with existing impaired hepatic function, monitor LFT values, especially AST and ALT,
before therapy, then every 2 to 4 weeks during therapy. (2) Watch for and report to prescriber
signs and symptoms of hepatic impairment.

B. Give the adverse reactions of the following drugs on the systems indicated:
1) Cimetidine – GI
Adverse reactions. Oral Candida Infections, Gingival Hyperplasia
2) Esterified estrogen – CNS
Adverse reactions. Headache, Photosensitivity
3) Gentamicin sulfate – respiratory
Adverse reactions. Difficulty breathing
4) Iloperidone – EENT
Adverse reactions. Blurred Vision, Conjunctivitis, Dry mouth, Nasal Congestion,
Nasopharyngitis
5) Meropenem – CNS
Adverse reactions. Headache
6) Simvastatin – respiratory
Adverse reactions. URI, Bronchitis
7) Trospium chloride – EENT
Adverse reactions. Dry eyes and nose, Nasopharyngitis
8) Desmopressin acetate – GI
Adverse reactions. Nausea, Abdominal cramps
9) Ethambutol hydrochloride – musculoskeletal
Adverse reactions. Joint pain
10) Promethazine hydrochloride - metabolic
Adverse reactions. Hyperglycemia