Tolleno, Hannah M. CI: Sr.

Mary John Racines

NR-41 Area: Intensive Care Unit (ICU)

DRUG STUDY

Patient Name: Mr. Mulingtapang

Room: ISO 3

Age: 75 y/o

Diagnosis: Acute decompensated Heart Failure

Diet: DM diet, Limit Oral Fluid intake <1.5 ml per day

Name of Drug Mechanism of Action Indication Dosage Contraindication Adverse Action Nursing Responsibility
(Classification)

Generic name: Produce vasodilation Acute treatment of 60 mg Contraindicated in: CNS: dizziness, headache. History: Allergy to nitrates, severe anemia, GI
isosorbide (venous greater than anginal attacks (SL tab ½ tab Hypersensitivity; CV: hypotension, tachycardia, hypermobility, head trauma, cerebral hemorrhage,
mononitrate arterial). Decrease left only). Prophylactic OD Concurrent use of paradoxic bradycardia, hypertrophic cardiomyopathy, pregnancy, lactation
Brand name: ventricular end-di- management of sildenafil, vardenafil, syncope. Physical: Skin color, T, lesions; orientation, reflexes, affect;
P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R,
Ismo astolic pressure and left angina or GI: nausea, vomiting. Misc:
adventitious sounds; liver evaluation, normal output; CBC,
Classification: ventricular end- pectoris. Unlabeled tadalafil. flushing, tolerance. Hgb
Nitrates, Angina diastolic volume Use: Treatment of Use Cautiously in: Interventions
(preload). Net effect is chronic heart failure Volume depleted Give sublingual preparations under the tongue or in the
re- (unlabeled). patients; Right buccal pouch; discourage the patient from swallowing.
duced myocardial ventricular infarction; Create a nitrate-free period to minimize tolerance.
oxygen consumption. Hyper- WARNING: Give chewable tablets slowly, only 5 mg
Increase coronary trophic initially, because severe hypotension can occur; ensure that
blood flow by dilating cardiomyopathy; OB: patient does not chew or crush sustained-release
preparations.
coronary arteries and May compromise
Give oral preparations on an empty stomach, 1 hr before
improving collateral maternal/fetal
or 2 hr after meals; take with meals if severe, uncontrolled
flow to ischemic circulation; Lacta-
 regions. Therapeutic tion: No data headache occurs.
Effects: Relief and available; Pedi: WARNING: Keep life support equipment readily available
prevention of anginal Safety not if overdose occurs or cardiac condition worsens.
attacks. established; Geri: WARNING: Gradually reduce dose if anginal treatment is
being terminated; rapid discontinuation can lead to
Initial doseprequired
problems of withdrawal.
due toqpotential for
hypotension
Assessment
Generic name: Renin, synthesized by Enalapril is used in 5mg per Contraindicated with CNS: Headache, dizziness, History: Allergy to enalapril, impaired renal function, salt or
enalapril the kidneys, is released the treatment of tab allergy to enalapril. fatigue, insomnia, paresthesias volume depletion, lactation, pregnancy
into the circulation hypertension and 1 tab BID • CV: Syncope, chest pain, Physical: Skin color, lesions, turgor; T; orientation, reflexes,
Brand name:
where it acts on a heart failure. Use cautiously with palpitations, hypotension in affect, peripheral sensation; P, BP, peripheral perfusion;
Innovace mucous membranes, bowel sounds, liver evaluation;
plasma precursor to Treatment of impaired renal salt- or volume-depleted
Classification urinalysis, renal and liver function tests, CBC, and
produce angiotensin I, hypertension alone or function; salt or patients
Antihypertensive differential
which is converted by in combination with volume depletion • GI: Gastric irritation, Assess renal status: polyuria, oliguria, frequency dysuria
ACE inhibitor angiotensin-converting other (hypotension may nausea, vomiting, diarrhea, and edema
enzyme to angiotensin antihypertensives, occur); abdominal pain, dyspepsia, Monitor electrolytes: K, Na, CL, monitor also patient’s
II, a potent especially thiazide- elevated liver enzymes potassium intake
vasoconstrictor that type diuretics • GU: Proteinuria, renal Planning
also causes release of Treatment of acute insufficiency, renal failure, Store in air-tight container at 86°F or less
aldosterone from the and polyuria, oliguria, urinary Severe hypotension may occur after 1st dose of this
adrenals; both of these Chronic CHF frequency, impotence medication; decreased hypotension may be prevented by
actions increase BP. Unlabeled use: • Hematologic: Decreased reducing or discontinuing diuretic therapy 3 days before
Enalapril blocks the Diabetic hematocrit and hemoglobin beginning benazepril therapy
conversion of Nephropathy • Other: Cough, muscle Implementation
angiotensin I to cramps, hyperhidrosis Instruct patient on importance of complying with dosage
schedule, even if feeling better and to continue with
angiotensin II,
medical regimen to decrease B/P
decreasing BP,
Advise patient to change position slowly to minimize
decreasing aldosterone orthostatic hypotension.
secretion, slightly Teach patient to monitor for and report occurrence of
increasing serum K+ adverse reactions.
levels, and causing Na+ Inform patient that excessive perspiration, vomiting or
and fluid loss; increased diarrhea may lead to fall of BP
prostaglandin synthesis Evaluation
also may be involved in Normal blood pressure
the antihypertensive Absence of drug induced adverse reaction
action. In patients with
heart failure, peripheral
 resistance, afterload,
preload, and heart size
are decreased.
Generic name: It is similar to that of
Piperacillin / other penicillins.
Tazobactam Interfere with bacterial
Brand name: cell wall synthesis
Zosyn promotes loss of
Classification: membrane integrity
Antiinfective; and leads to death of
Beta-lactam the organism.
antibiotic; Anti-
pseudomonal
penicillin
Generic name A number of possible
Acetylcysteine mechanisms for the
Brand name: mucolytic activity of
Acetadote acetylcysteine have been
proposed.
Classification:
Acetylcysteine's sulfhydryl
groups may hydrolize
disulfide bonds within
mucin, breaking down the
oligomers, and making
the mucin less viscous.
Acetylcysteine has also
been shown to reduce
mucin secretion in rat
models. It is an
antioxidant in its own
right but is also
deacetylated to cysteine,
Treatment of 3.375 qm Hypersensitivity to CNS: headache, insomnia, - Obtain history of hypersensitivity to penicillins,
moderate to severe IV 96 penicillins, fever cephalosphorins, or other drugs prior to
appendicitis, cephalosphorins, or administration,
uncomplicated and other drugs. Safety in GI: diarrhea, nausea, -Obtain specimen for culture and sensitivity prior to
complicated skin and children < 12 years constipation, vomiting, first dose of the drug; start drug pending results.
skin structure old, pregnancy, pseudomembranous colitis Periodic CBC with differential, platelet count, Hgb &
infections, nosocomial lactation. Hgt, and serum electrolytes.
or community- SKIN: hypersensitivity -Monitor for hypersensitivity response; discontinue
acquired pneumonia reactions ,rash, pruritus drug and notify physician if allergic response noted.
caused piperacillin- -Monitor for hemorrhagic manifestations because
resistant, high dose may induce coagulation abnormalities.
piperacillin/tazobacta -Instruct family/significant others to report significant,
m susceptible, beta- unexplained diarrhea.
lactamase-producing -Monitor vital signs because of cardiac arrhythmias,
bacteria. hypertension and fever as adverse reactions.
- Instruct the mother not to breast feed the baby
while taking the drug without consulting physician.
Acetylcysteine is 600 mg Liquefaction of Incidence not known Difficulty Before
indicated for ½ tab secretions in high- with breathing or swallowing -Perform handwashing
mucolytic therapy and ODHS risk respiratory Fever check doctor's order.
in the management of patients who have hives or itching -Obtain patient's health history
acetaminophen difficulty moving nausea -Perform phvsical assessment and obtain patient's
overdose. secretions rash with or without a fever baseline data
including reddening of the skin, -Assess for any allergy to the Drug
postoperative especially around the ears -Ensure right patient, rightdrug, right dose, right
patients severe or ongoing vomiting route, and right time,
(e.g, patients with swelling of the eyes, face, or -Inform patient about the purpose of the drug, and its
tracheostomies to inside of the nose side effects.
facilitate airway unusual tiredness or weakness -Warn patient that drug may have a foul smell or taste
clearance and that may be distressing.
suctioning), clearing More common -Monitor blood pressure, pulse, respirations, and
of secretions for Mild nausea adventitious sounds.
diagnostic tests, used stomach upset
 which participates in the orally to protect the vomiting During
synthesis of the liver from -Avoid combining with other drugs in the nebulizer.
antioxidant glutathione acetaminophen -Make sure to use proper aseptic technique.
The antioxidant activity toxicity, treatment pf -Administer the drug following the protocols of the
may also alter
atelectase from thick right administration of medicine
intracellular redox
reactions, decreasing mucus secretions. -Provide thorough patient teaching, including drug
phosphorylation of EGFR name, prescribed dosage, ileasures to help avoid
and MAPK, which adverse effects, and for periodic monitoring.
decrease transcription of -Monitor patient's response to the drug
the gene MUC5AC which -Note for anv side or adverse effects.
produces mucin. -Provide comfort measures.
-Document procedure.

Generic name: Antiasthmatic & COPD Management 2 puffs Hypersensitivity to Significant: Hypersensitivity Assessment
salbutamol + Preparations Of reversible bro 94 hours salbutamol, reactions (e.g. urticaria, History: Hypersensitivity to atropine, soybeans, peanuts
ipratropium Pharmacology: nchospasm ass ipratropium or angioedema, rash, (aerosol preparation); acute bronchospasm, narrow-angle
Brand name: Ipratropium bromide: ociated with fenoterol, atropine anaphylaxis, bronchospasm, glaucoma, prostatic hypertrophy, bladder neck obstruction,
pregnancy, lactation
DuoNeb Ipratropium bromide is obstructive or its derivatives. oropharyngeal oedema),
Physical: Skin color, lesions, texture; T; orientation,
Classification: a quaternary airway diseases (eg, Hypertrophic paradoxical bronchospasm, reflexes, bilateral grip strength; affect; ophthalmic
bronchodilators or ammonium compound bronchial asthma). obstructive ocular complications (e.g. examination; P, BP; R, adventitious sounds; bowel sounds,
relievers with anticholinergic For patients cardiomyopathy, mydriasis, blurred vision, normal output; normal urinary output, prostate palpation
(parasympatholytic) With chronic tachyarrhythmia. narrow-angle glaucoma, eye
properties. Similar to obstructive pain), serious hypokalaemia, Interventions
atropine, it is a pulmonary gastrointestinal motility Protect solution for inhalation from light. Store unused
nonselective disease (COPD) on a disturbances, rapidly vials in foil pouch.
competitive antagonist regular inhaled worsening dyspnoea, ECG Use nebulizer mouthpiece instead of face mask to avoid
of muscarinic receptors bronchodilator changes, lactic acidosis, blurred vision or aggravation of narrow-angle glaucoma.
Can mix albuterol in nebulizer for up to 1 hr.
present in who continue urinary retention. Rarely,
Ensure adequate hydration, control environmental
airways and other to have evidence myocardial ischaemia.
temperature to prevent hyperpyrexia.
organs. Ipratropium of bronchospa Cardiac disorders: Palpitations, Have patient void before taking medication to avoid
bromide relaxes sm and who tachycardia. urinary retention.
smooth muscles of require a second Eye disorders: Teach patient proper use of inhaler.
bronchi and bronchodilator Accommodation disorders.
bronchioles by blocking Gastrointestinal disorders: Dry Teaching points
acetylcholine-induced mouth, nausea. Use this drug as an inhalation product. Review the proper
stimulation of guanyl Nervous system disorders: use of inhalator; for nasal spray, initiation of pump requires
cyclase, thus reducing Headache. 7 actuations; if not used for 24 hours, 2 actuations will be
formation of cyclic Respiratory, thoracic and needed before use. Protect from light; do not freeze.
 guanosine mediastinal disorders: You may experience these side effects: Dizziness,
monophosphate Coughing, dysphonia. headache, blurred vision (avoid driving or performing
(cGMP), a mediator of hazardous tasks); nausea, vomiting, GI upset (proper
bronchoconstriction nutrition is important; consult with your dietitian to
maintain nutrition); cough.
Report rash, eye pain, difficulty voiding, palpitations,
Salbutamol:
vision changes.
Salbutamol stimulates
adenyl cyclase, the
enzyme which
catalyzes the formation
of cyclic-3', 5'-
adenosine
monophosphate
(cAMP)
from adenosine
triphosphate (ATP).
The cAMP thus formed
mediates the cellular
response eg, bronchial
smooth muscle
relaxation. In vitro and
in vivo pharmacologic
studies have
demonstrated that
salbutamol has a
preferential effect on
β-adrenergic receptors
that areespecially
found in respiratory
tract compared with
isoproterenol.

Generic name: Linagliptin is a Linagliptin is 5 mg tab Linagliptin is Respiratory Observe patient for signs and symptoms of
Linagliptin competitive, reversible indicated for the OD contraindicated in bronchial hyperreactivity hypoglycemic reactions (abdominal pain, sweating,
Brand name: DPP-4 inhibitor. treatment of type II patients with a hunger, weakness, dizziness, headache, tremor,
Glyxambi, Inhibition of this diabetes in addition to history of Gastrointestinal tachycardia, anxiety).
Jentadueto, enzyme slows the diet and exercise5. It hypersensitivity to pancreatitis (life- Monitor for signs of pancreatitis (nausea, vomiting,
Tradjenta, breakdown of GLP-1 should not be used to linagliptin, such as threatening) anorexia, persistent severe abdominal pain,
Trajenta, Trijardy and glucose-dependant treat type I diabetes anaphylaxis, sometimes radiating to the back) during therapy. If
Classification: insulinotropic or in diabetic urticaria, Dermatologic pancreatitis occurs, discontinue linagliptin and
dipeptidyl polypeptide (GIP)3,5. ketoacidosis.5 An angioedema, localized exfoliation monitor serum and urine amylase, amylase/creatinine
peptidase-4 (DPP- GLP-1 and GIP extended-release exfoliative dermatitis urticaria clearance ratio, electrolytes, serum calcium, glucose,
4) inhibitors stimulate the release of combination product or other serious and lipase.
insulin from beta cells containing allergic skin condition Metabolic Lab Test Considerations: Monitor hemoglobin A1C
in the pancreas while empagliflozin, (serious rash), or hypoglycemia prior to and periodically during therapy.
inhibiting release of linagliptin, and bronchial hypertriglyceridemia May cause ↑ uric acid levels.
glucagon from metformin was hypersensitivity.
pancreatic beta cells5. approved by the FDA Miscellaneous
These effects together in January 2020 for hypersensitivity reactions
reduce the breakdown the improvement of including angioedema
of glycogen in the liver glycemic control in
and increase insulin adults with type 2
release in response to diabetes mellitus
glucose53. when used
adjunctively with diet
and exercise.6

Generic name: Atorvastatin -Reduction of risk of 20 mg Hypersensitivity, Adverse Effect:  Stress that atorvastatin is an adjunct to – not
Atorvastatin competitively inhibits stroke and heart tab active liver disease or Headache, flatulence, a substitute for low-cholesterol diet
Brand name: HMG-CoA reductase, attack in type 2 ODHS unexplained diarrhoea, nausea, vomiting,  Tell patient to take drug at the same time
lipitor the enzyme that diabetes patients persistent elevations anorexia, xerostomia, each day to maintain its effects
Classification: catalyses the without evidence of of serum angioedema, myalgia,  Instruct patient to take a missed dose as soon
Dyslipidaemic conversion of HMG- heart disease but with transaminase, rash/pruritus, alopecia, allergy, as possible. If it’s almost time for his next
Agent CoA to mevalonic acid. other CV risk factors, porphyria, infection, chest pain.  dose, he should skip the missed dose.
This results in the and revascularization pregnancy, lactation. 
induction of the LDL procedures in patients Potentially Advise patient to notify prescriber immediately if he
receptors, leading to without evidence of Fatal: Thrombocytopenia. develops unexplained muscle pain, tenderness, or
lowered LDL- coronary heart Rhabdomyolysis with acute weakness, especially if accompanied by fatigue or
cholesterol disease (CHD) but renal failure. fever
concentration. with multiple risk
Absorption: Rapid from factors other than
the GI tract (oral). diabetes (eg, smoking,
Distribution: Protein- HTN, low HDL-C,
binding: 98%. family history of early
Metabolism: Extensivel CHD)
y hepatic; converted to -Patients with CHD, to
 active inhibitors of reduce risks of MI,
HMG-CoA reductase. revascularization
Excretion: Faeces (as procedures,
metabolites); 14 hr hospitalization for
(elimination half-life). CHF, and angina

Generic name: Inhibits reabsorption of Oral, IV: Edema 40 mg IV Contraindicated with CNS: dizziness, vertigo, Before:
Furosemide sodium and chloride associated with heart Q12 allergy to paresthesias, xanthopsia, > check doctor’s order
Brand name: from the proximal and failure, cirrhosis, renal furosemide, weakness > assess allergy to furosemide, sulfonamides, tartrazine
Lasix distal tubules and disease sulphonamides; > do not mix parenteral solution with highly acidic solutions
with ph below 3.5
Classification: ascending limb of the IV: acute pulmonary allergy to tartrazine; CV: orthostatic hypertension,
> do not expose to light, which may discolour tablets or
loop diuretics loop of Henle, leading edema anuria, severe renal thrombophlebitis solution
to a sodium-rich oral: hypertension failure; hepatic coma; > educate the patient about the purpose and importance of
dieresis pregnancy; lactation Dermatologic: the drug
Furosemide is given to photosensitivity, pruritus,
Onset: 5 min patient to treat acute Precaution: urticaria, purpura During:
Peak: 30 min pulmonary congestion Use cautiously with > check the patency of the IV site and IV line
Duration: 2 hr and hypertension SLE, gout, diabetes GI: nausea, anorexia, vomiting, > Give early in the day so that increased urination will not
Metabolism: hepatic; mellitus oral and gastric irritation disturb sleep
30-60 min > administer the right dose at the right time
> measure and record weight to monitor fluid changes
Distribution: crosses Interactions: GU: nocturia, glycosuria,
placenta; enters breast > drug-drug: urinary bladder spasm
After:
milk increased risk of
> monitor blood glucose levels
Excretion: feces, urine cardia arrhythmias Hematologic: leukopenia, > arrange to monitor serum electrolytes, hydration, liver
with cardiac anemia, thrombocytopenia, and renal function
glycosides; increased > arrange for potassium-rich diet or supplemental
risk of ototoxicity Other: muscle cramps and potassium as needed
with aminoglycoside muscle spasms > report loss or gain of more than 1.5kg in 1 day, swelling in
antibiotics, cisplatin; your ankles or fingers, unusual bleeding or bruising
decreased absorption > document and record.
of furosemide with
phenytoin; decreased
GI absorption with
charcoal; may reduce
effect of insulin or
oral antidiabetics
because blood
glucose levels can
 become elevated

Generic name: Reduces glucose level To manage type 1 20 U SC Contraindicated Metabolic: hypoglycemia. Teach proper glucose monitoring, injection
insulin glargine by stimulating (insulin-dependent) ODHS during hypoglycemic Skin: lipodystrophy, pruritus, techniques, and diabetes management.
(rDNA peripheral glucose diabetes in patients episodes and in rash. • Tell patient to take dose once daily at the
origin) injection uptake, especially by who need basal patients same time each day.
Alert: Educate diabetic patients about
Brand name: skeletal muscle and fat, (longacting) hypersensitive to Other: allergic reactions, pain
signs and symptoms of low glucose level, such as fatigue,
Lantus and by inhibiting insulin to control drug or its at injection weakness, confusion,
Classification: hepatic glucose hyperglycemia components. site. headache, pallor, and profuse sweating.
long-acting production. • Urge patient to wear or carry medical
insulins To manage type 2 Use cautiously in identification at all times.
(non– patients with renal or • Advise patient to treat mild hypoglycemia
insulindependent) hepatic impairment. with oral glucose tablets. Encourage patient
diabetes in patients to always carry glucose tablets in case of a
who Overdose S&S: low-glucose episode.
• Educate patients on the importance of
need basal (long- Hypoglycemia,
maintaining prescribed diet, and explain
acting) insulin to severe hypoglycemia
that adjustments in drug dosage, meal
control (coma, neurologic patterns, and exercise may be needed to
hyperglycemia impairment, regulate glucose.
seizures). • Tell patient to consult prescriber before
using OTC medications.
• Inform patient to avoid alcohol, which
lowers glucose level.
• Advise patient to avoid vigorous exercise
immediately after insulin injection, especially
of the area where injection was given;
it causes increased absorption and increased
risk of low glucose.
• Advise woman planning pregnancy to first
consult prescriber.
• Advise patient that if OptiClik device
malfunctions, drug may be drawn from the
cartridge system into a U-100 syringe and
injected.

Generic name: Principal intracellular Prevention and 2 tabs 96 Allergy to aspirin, Rash, Nausea, vomiting, A-Assess vital signs
Potassium cation of most body correction of x 6 dose Severe renal Diarrhea, abdominal D -Hypokalemia/ Hyperkalemia
Brand name: tissues, participates in a potassium deficiency; impairment with discomfort, GI obstruction, GI P- Monitor IV injection sites regularly for necrosis,
Potassium number of physiologic when associated with oliguria, anuria, bleeding, GI ulceration or tissue sloughing, and phlebitis.
Chloride processes—maintaining alkalosis, use azotemia, perforation, Hyperkalemia, I- Take drug after meals or with food and a full glass
Classification: intracellular tonicity, potassium chloride; Hyperkalemia, Acute local phlebitis of water to decrease GI upset
Electrolyte transmission of nerve when associated with dehydration, GI E- Report tingling of the hands or feet, unusual
Pregnancy impulses, contraction acidosis, use disorders that delay tiredness or weakness, feeling of heaviness in the legs.
Category C of cardiac, skeletal, and potassium acetate, passage in the GI
smooth muscle, bicarbonate, citrate, tract.
maintenance of normal or gluconate Use cautiously with
renal function. cardiac disorders,
especially if treated
with digitalis,
pregnancy, lactation.