III- PLAN OF CARE AND NURSING INTERVENTIONS HOSPITAL MEDICATIONS A. DRUGS STUDY 1. PHENYTOIN III-Table 1.

A NAME OF DRUG

PREPARATION

Generic Name: Phenytoin Brand Name: Dilantin Classification: Therapeutic category: Anticonvulsants, Hydantoin, Anti-arrhythmic

Dosage: 100mg/capsule Route: Per Orem Frequency: TID ( Three times a day)

INDICATION & MECHANISM OF ACTION INDICATION:  To control tonic-clonic (gran mal)s and complex partial(temporal lobe)seizure  For patient requiring loading dose  Prevent and treat seizure during neurosurgery  Status epileticus

CONTRAINDICATION & ADVERSE EFFECTS CONTRAINDICATION: Hypersensitivity to drug and hydantoin and in those w/ sinus bradycardia, SA block, 2nd or 3rd degree AV block, Adam-stroke syndrome ADVERSE EFFECTS: CNS: ataxia, slurred speech, dizziness, insomnia, nervousness, twitching, headache, mental confusion, decreased coordination CV: periarteritisnodosa EENT:nystagmus, diplopia blurred vision GI: gingival hyperplasia, N/V, constipation

NURSING RESPONSIBILITIES  Use only clear solution for injection  Don’t give IM unless dosage adjustments are made;  Divide doses given w/ or after meals may decrease adverse GI reaction.  Stop drug if rashes appears and resume drug after rashes is clear.  Don’t stop this drug abruptly or suddenly, it may worsen seizure.  Monitor drug level in the blood  Monitor CBC and Ca+ level every 6 months and periodically monitor hepatic function.  Take appropriate safety precaution for seizure

MECHANISM OF ACTION: Unknown. A hydantoin derivatives that Hematologic:thrombocytopenia, probooly seizure leukopenia, agranulocytosis, neuronal membranes megaloblastic anemia

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and limits seizure activity by either increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of the nerve impulses.

Hepatic: toxic hepatitis Metabolic: hyperglycemia Musculoskeletal:steomalacia Skin:scarlantiniformrash,stevenjohnson syndrome, lupus erythematosus,toxic epidermal necrosis,

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2. CEFTRIAXONE III-Table 2.A NAME OF DRUG

PREPARATION

Generic Name: Ceftriaxone

Dosage: 2 mg Route: IV

Brand Name: Rocephin Classification: Antibiotic Cephalosporin

Frequency: Every 12 hours

INDICATION & MECHANISM OF ACTION INDICATION:  Uncomplicated gonococcalvulvovagi nitis  UTI  Septicemia  Meningitis  Perioperative prevention  Acute bacterial otitis media MECHANISM OF ACTION: Third generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability;usually bactericidal.

CONTRAINDICATION & ADVERSE EFFECTS CONTRAINDICATION:  Hypersensitivity to drug and other cephalosporin. ADVERSE EFFECTS: CNS: fever, headache, dizziness CV: phlebitis GI: pseudomembranous colitis, diarrhea HEMATOLOGIC: eosinophilia, thrombocytosis, leukopenia SKIN: tenderness at the injection site, rash, pruritus, induration OTHER: hypersensitivity reactions, serum sickness, anaphylaxis, chills

NURSING RESPONSIBILITIES  Before administration, ask the patient if he is allergic to penicillin or cephalosporin  Obtain for a culture and sensitivity test before giving first dose  Monitor patient for signs and symptoms of superinfection.  Monitor PT and INR in the patient with impaired vitamin k or low vitamin k store.

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3. ORPHENADRINE PARACETAMOL III-Table 3.A NAME OF DRUG

PREPARATION

Generic Name: Orphenadrine + paracetamol

Dosage: 100mg capsule Route: Per Orem

Brand Name: Norgesic Classification: Muscle Relaxants

INDICATION & MECHANISM OF ACTION INDICATION: Pain and muscular spasms in musculoskeletal disorders. MECHANISM OF ACTION: Paracetamol, a paraaminophenol derivative, is a peripherally acting analgesic with antipyretic and weak anti-inflammatory activity. Orphenadrine, an analog of diphenhydramine, is a skeletal muscle relaxant and is postulated to act on cerebral motor center or on the medulla through an atropine-like central action.

CONTRAINDICATION & ADVERSE EFFECTS

NURSING RESPONSIBILITIES

Frequency: TID (three times a day)

CONTRAINDICATION:  Provide safety measures as indicated. Supervised ambulation Bladder neck or prostate and transfer of patients. obstruction or hypertrophy, glaucoma,  Do not break, crush or chew extended release tablets myasthenia gravis,  Advice patient to take medication oesophageal spasm, as indicated. Take missed doses pyloric or duodenal within 1hr, if not return to regular obstruction, porphyria. dosing schedule. Do not double ADVERSE EFFECTS: CNS: Excitation, confusion, dizziness, drowsiness EENT: Blurred vision, dry eyes, CV: Orthostatic hypotension, tachycardia GI: Constipation, dry mouth GU: Urinary retention
doses  Medication can cause dizziness, drowsiness and blurred vision.  Advice patients to avoid driving and other activities requiring alertness until response to drug are known.  Instruct patient to make position changes slowly to minimize orthostatic hypotension  Encourage patient to comply with additional therapies prescribed for muscle spasm  Emphasize the importance of routine follow up exams to monitor progress.

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4. METRONIDAZOLE
III-Table 4.A

NAME OF DRUG

PREPARATION

INDICATION & MECHANISM OF ACTION
INDICATION:  Amebic liver abscess  Intestinal amebiasis  Trochonomiasis  Refractory trichonomiasis  Bacterial vaginosis  Clostridium difficile-associated diarrhea and colitis  Pelvic inflammatory disease(PID) MECHANISM OF ACTION: Direct acting trichonomocide and amebicide that works inside and outside the intestines. It’s thought to enter the cell of microorganism that contains nitroreductase, forming unstable compound that bind DNA and inhibit synthesis, causing cell death.

CONTRAINDICATION & ADVERSE EFFECTS CONTRAINDICATION: Blood dyscrasias, active organic disease of the CNS, trichomoniasis during the first trimester of pregnancy, lactation. Iscarcinogenic in rodents; avoid unnecessary use. Topical use if hypersentive to parabens or other ingredients of the formulation. Consumption of alcohol during use. For the vaginal gel, hypersensitivity to the drug, parabens, or other. ADVERSE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin:rashes, urticaria

NURSING RESPONSIBILITIES  Monitor liver function test result carefully in elderly patient  Give oral form w/ meals  Observe patient for edema specially if they are receiving corticosteroids  Record the number and characteristic of stools when this drug is used to treat amebiasis  Symptomatic and asymptomatic sexual partners of patient being treated for t. vaginalis infection must be treated simultaneously to avoid infection

Generic Name: Metronidazole

Dosage: 500 mg

Brand Name: Flagyl

Route: IVTT

Classification:Trichomonacide, amebicide

Frequency: TID (three times a day)

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5. . DIAZEPAM III-Table 5.A NAME OF DRUG

PREPARATION

Generic Name: Diazepam Brand Name: Valium Classification: Central nervous system agent, Benzodiazepine, anticonvulsant, antixiolytic

Dosage: 50 mg Route: Per Orem Frequency: PRN (as necessary)

INDICATION & MECHANISM OF ACTION INDICATION: Drug of choice of status epilepticus. Management of anxiety disorder, for short term relief of anxiety symptoms, to allay anxiety and tension prior to surgery. MECHANISM OF ACTION: Psychotherapeutic agent related to chlordiazepoxide; reportedly superior in anti anxiety and anticonvulsant activity, with somewhat shorter duration of action.

CONTRAINDICATION & ADVERSE EFFECTS CONTRAINDICATION: Contraindicated in patients hypersensitive to drug or soy protein; in patients experiencing shock, coma, or acute alcohol intoxication (parenteral form); in pregnant women, especially in first trimester; and in children younger than age 6 months (oral form). ADVERSE EFFECTS: Body as whole: Throat and chest pain. CNS: Drowsiness, ataxia, fatigue, amnesia, vertigo, slurred speech, headache, and tremor. CV: Hypotension, edema, tachycardia. GI: Nausea, constipation, hepatic dysfunction.

NURSING RESPONSIBILITIES  Monitor for adverse reaction.  Monitor for therapeutic effectiveness.  Monitor I&O ratio including urinary and bowel movement.  Observe patient closely and monitor vital signs when diazepam is given parentally.  Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression.  Supervise ambulation.

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