DRUG NAME Salbutamol neb, 1 neb q 4 CLASSIFICATI ON: Bronchodilator (therapeutic); adrenergics (pharmacologi c)

ACTION It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the bronchioles. The relief from nasal congestion and bronchospasm is made possible by the following mechanism that takes place when Salbutamol is administered. First, it binds to the beta2adrenergic receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 35adenosine monophosphate (cAMP)

INDICATION To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD) Quick relief for bronchospasm For the prevention of exerciseinduced bronchospasm Long-term control agent for patients with chronic or persistent bronchospasm

CONTRAINDICA TION Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons

SIDE EFFECT Nervousness Restlessness Tremor Headache Insomnia Chest pain Palpitations Angina Arrhythmias Hypertension Nausea and vomiting Hyperglycemia Hypokalemia

EVALUATION Assess lung sounds, PR and BP before drug administration and during peak of medication. Observe for paradoxical spasm and withhold medication and notify physician if condition occurs. Administer PO medications with meals to minimize gastric irritation. Extended-release tablet should be swallowed-whole. It should not be crushed or chewed. If administering medication through inhalation, allow at least 1 minute between inhalation of aerosol medication. Advise the patient to rinse mouth with water after each inhalation to minimize dry mouth. Inform the patient that Albuterol may cause an unusual or bad taste.

When cAMP increases, kinases are activated. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways. Budesonide controls the rate of protein synthesis, depresses the migration of polymorphonuclea r leukocytes, fibroblasts, reverses capillary permeability and lysosomal stabilisation at the cellular level to prevent or control inflammation

Budesonide neb, 1 neb q 12 CLASSIFICATI ON:Corticoster oid

Management of symptoms of seasonal or perennial allergic rhinitis in adults and children; nonallergic perennial rhinitis in adults

Hypersensitivity. Acute infections uncontrolled by antimicrobial chemotherapy

Loss of skin collagen and SC atrophy; local hypopigmentatio n of deeply pigmented skin; dryness, irritation, epistaxis, rarely ulceration or perforation of the nasal septum; smell and taste disturbances; hoarseness and

Assessment History: Untreated local nasal infections, nasal trauma, septal ulcers, recent nasal surgery, lactation Physical: BP, PR, auscultation; RR, adventitious sounds; examination of nares Interventions Nasal inhalation Prime pump eight times before first use. If not used for 2 consecutive days, reprime with 1 spray or until

candidiasis of the mouth or throat Unknown. May inhibit prostaglandin synthesis, to produce antiinflammatory, analgesic, and antipyretic effects. It works by blocking the action of a substance in the body called cyclooxygenase. Cyclooxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandin s. Prostaglandin s are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and CNS Contraindicated in patients Headache, hypersensitive to dizziness, drug and in those nervousness, with angioedema, aseptic syndrome of meningitis. nasal polyps, or CV bronchospastic Peripheral reaction to edema, fluid aspirin or other retention, NSAIDs. edema. EENT Contraindicated Tinnitus in pregnant GI women. Epigastric distress, Use cautiously in nausea, patients with GI occult blood disorders, history loss, peptic of peptic ulcer ulceration, disease, cardiac diarrhea, decompensation, constipation, hypertension, abdominal asthma, or pain, intrinsic bloating, GI coagulation fullness, defects. dyspepsia, flatulence, heartburn, decreased appetite.

fine mist appears. If not used for more than 14 days, rinse applicator and reprime with 2 sprays or until fine mist appears
Tell patient to take with meals or milk to reduce adverse GI reactions. Note: Drug is available at OTC. Instruct patient not to exceed 1.2 g daily, not to give to chidren younger than age 12, and not to take for extended periods ( longer than 3 days for fever or longer than 10 days for pain) without consulting presciber. Tell patient that full therapeutic effect for arthritis may be delayed for 2 to 4 weeks. Although pain relief occurs at low dosage levels, inflammation doesnt improve at dosages less than 400 mg q.i.d. Teach patient to watch for and report to prescriber immediately signs and symptoms of GI bleeding, including blood in vomit, urine, or stool or coffee ground vomit, and black, tarry stool. Warn patient to avoid hazardous activities that require mental alertness until effects on CNS are known. Advise patient to wear sunscreen to avoid hypersensitivity to sunlight.

Ibruprofen 200 mg/5ml, 9 ml q 6 for T >= 37.5 C CLASSIFICATI ON: Antipyretic and antiinflammatory analgesics

inflammation. Ibuprofen is therefore used to relieve pain and inflammation. All the medicines in this group (NSAIDs) reduce inflammation caused by the body's own immune system, and are effective pain killers. Ibuprofen can be used to relieve pain such as muscular aches and pains, period pains, headache, backache, rheumatic pain, dental pain and neuralgia. It can also reduce feverishness

GU Acute renal failure, azotemia, cystitis, hematuria. HEMATOLOGIC Plonged bleeding time, anemia, neutropenia, pancytopenia , thrombocyto penia, aplastic anemia, leucopenia, agranulocyst ocis. METABOLIC Hypoglycemi a, hyperkalemia . RESPIRATORY: Bronchospas m SKIN Pruritus, rash, urticaria, stevens Johnson syndrome

Loratadine CLASSIFICATI ON: Antihistamine (nonsedating type)

It works by selectively binding to peripheral histamine H1 -receptors on effector cells.

and the symptoms of colds and flu. Symptomatic Pregnancy, relief of lactation, perennial and children <2 yr. seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis, and mild, uncomplicate d urticaria and angioedema Treatment of rhinitis and chronic urticaria in children > 2 yr

Fatigue, giddiness, dizziness, dry mouth, headache, nausea, somnolence.

Assessment History: Allergy to any antihistamines; narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthma, bladder neck obstruction, pyloroduodenal obstruction; lactation, pregnancy Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examinations; R, adventitious sounds; prostate palpation; serum transaminase levels Interventions Administer without regard to meals. Teaching points If using rapid or orally dissolving tablets, place on tongue, tablet will dissolve within seconds, swallow with or without water. Avoid the use of alcohol; serious sedation could occur. You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or

performing tasks that require alertness); headache; thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier). Report difficulty breathing, hallucinations, tremors, loss of coordination, irregular heartbeat. NaCl nasal spray CLASSIFICATI ON: Decongestants A mist of saline solution is delivered to help moisturize dry or irritated nostrils. They can also relieve nasal congestion and remove airborne irritants such as pollen, dust etc. thereby providing sinus allergy relief. The solution can be either isotonic or hypertonic. Isotonic solutions have the same salt concentration as the human body whereas hypertonic solutions have a higher salt content. Moisturizes dry, crusted, and stuffy nostrils due to allergy, colds, overuse of antihistaminic decongestant s None reported Temporary burning, stinging, dryness in the nose, runny nose, and sneezing may occur. Ask client to clean nostril first before giving medication Ask parent to place infant or child to supine position Spray to each nostril as indicated Inform to remain in position for a while for the medication to absorb in the nasal passage Inform patient to keep medication bottle away from sunlight Discard bottle after symptoms are not present anymore Dont share medication to another

Ceftriaxone 750 mg q 12 (-) ANST CLASSIFICATI ON: 2nd Generation Cephalosphori ns

Hypertonic solutions may be more useful at drawing moisture from the mucus membrane and relieving nasal congestion. Inhibits cellw a l l synthesis, promoting osmotic instability;usuall y bactericidal

Used for treatment of serious infections of the lower respiratory tracts.

Hypersensitivity to cefuroxime, any component, or other cephalospo rin

Diarrhea, nausea, vomiting, rash, pain, temperature elevation

Assess for previous history of reactions to other cephalosporin or penicillin Modify dosage in patients with severe renal impairment. Prolonged use may result in super infection. A low incidence of crosshypersensitivity to penicillins exist.