Post on 26-Oct-2014
Drug Study
NAME OF DRUG
Classification/Dosage/
FrequencyMECHANISM OF
ACTIONINDICATIONS/
CONTRAINDICATIONSSIDE
EFFECTSNURSING RESPONSIBILITIES
.Metoclopramide
Antiemetic
Dopaminergic Blocker
GI stimulant
1 amp
IV
Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions, appears to sensitize tissues to action of acetylcholine.
Relaxes pyloric sphincter which when combined with effects on motility, accelerates gastric emptying and intestinal transit.
Indi:
Relief symptoms of acute and recurrent diabetic gastro paresis.
Short term therapy (4-12 weeks) for adults with symptomatic gastro-esophageal reflux who fail to respond to conventional therapy
Contra:
Contraindicated with allergy to metaclopramide,
GI hemorrhage, mechanical obstruction or perforation.
Restlessness
Drowsiness
Fatigue
Insomia
Transient hypertension
Nausea
Diarrhea
Asses if the patient has history of allergies to metoclopramide.
Monitor BP carefully during IV administration.
Monitor extrapyramidal reactions, and consult physician if they occur.
Monitor patients with diabetes, arrange for alteration in insulin dose or timing if diabetic control is comprised by alterations in timing of food absorbtion.
Azithromycin Marcolide antibiotic
500 mg tab
OD
Bacteriostatic or bactericidal in susceptible bacteria.
Indi:
Treatment of lower respiratory infections (Haemophilus influenzae, Moraxella catarrbalis, streptococcus pneumoniea, CAP,
Contra:
Contraindicated with hypersensetivity to azithromycin, erythromycin, or any macrolide antibiotic.
Use continously with gonorrhea or syphilis, hepatic or renal impairment.
CNS:
Dizziness
Headache
Vertigo
Fatigue
GI
Diarrhea
Abdominal pain
Nausea
Vomiting
Melena
Pseudomembranous colitis
Monitor for and report loose stools or diarrhea, since pseudo membranous colitis (see Appendix F) must be ruled out.
Monitor PT and INR closely with concurrent warfarin use.
Patient & Family Education Direct sunlight (UV)
exposure should be minimized during therapy with drug.
Take aluminum or magnesium antacids 2 h before or after drug.
Report onset of loose stools or diarrhea.
Do not breast feed while taking this drug without consulting physician.
Clopidogrel Antiplatelet
75 mg
OD
Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.
Indi:
Treatment of patients at risk for ischemic events- recent MI, recent ischemic CVA, peripheral artery disease.
Treatment of the patient with Acute Coronary Syndrome
Contra:
Contraindicated with allergy to clapidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage.
CNS
Headache
Dizziness
Weakness
Flushing
CV
Hypertension
Edema
GI
Nausea
GI distress
Constipation
Diarrhea
GI bleeding
Assessment
History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer
Physical: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds
Interventions
Provide small, frequent meals if GI upset occurs (not as common as with aspirin).
Provide comfort measures and arrange for analgesics if headache occurs.
Enoxaparin Antithrombotic
4cc
Q8
Low molecular
weight heparin that
inhibits thrombus
and clot formation
by blocking factor
Xa, factor IIa,
preventing the
formation of clots.
Indi:
Prevention of DVT,
which may lead to to
pulmonary embolism
following hip
replacement, knee
replacement surgery,
abdominal surgery.
Prevention of
ischemic complications
of unstable angina and
non Q wave MI.
Treatment od acute
ST segment elevation MI,
managed medically or
with subsequent
percutaneous coronary
intervention.
Contra:
Hypersensitivy to
enoxaparin, heparin,
pork products, severe
thrombocytopenia,
uncontrolled bleeding.
Hematologic
Hemorrhage
Thrombocytopenia
Hyperkalemia
Others
Fever
Pain
Local irritation
Epidural or spinal hematoma.
Assessment
· History: Recent surgery or injury; sensitivity to heparin, pork products, enoxaparin; lactation; history of GI bleed; pregnancy
· Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, kidney function tests
Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.
Monitor platelet count closely. Withhold drug and notify physician if platelet count less than 100,000/mm3.
Monitor closely patients with renal insufficiency and older adults who are at higher risk for thrombocytopenia.
Monitor for and report immediately any sign or symptom of unexplained bleeding
Ipratropium Anticholinergic
Bronchodilator
1 neb
Q4
Anticholinergic,
chemically related
to atropine, which
blocks vagally
mediated reflexes
by antagonizing the
action of
acetylcholine.
Causes
bronchodilation and
inhibits the
secretion from
serous and
seromucous glands
lining the nsal
mucosa.
Indi:
Bronchodilator for
maintenance treatment
of bronchospasm
associated with COPD,
chronic bronchitis, and
emphysema.
Contra:
Hypersensitivity to
atropine or its derivatives,
soybean, or peanut.
Use continuously
with narrow angle of
glaucoma, prostatic
hypertrophy, and bladder
neck obstruction.
CNS
Dizziness Nervousnes
s Headache Fatigue Insomnia Blurred
visionGI
Nausea GI distress
Respiratory Dyspnea Bronchitis Bronchospa
sm Cough HoarsenessOthers Back pain Chest pain Dry mouth palpitation
Ensure adequate
hydration; control
environment (temperature)
to prevent hyperpyrexia
Have patient void before
taking medication to avoid
urinary retention.
Lactulose Laxative
30cc
OD/ HS
The drug
unchanged into the
colon where
bacteria break it
down to organic
acids that increase
the osmotic
pressure in the
colon and slightly
acidify the colonic
contents, resulting
in an increase stool
water content, stool
softening, laxative
action.
Contra:
Treatment of
constipation
Prevention and
treatment of portal
systemic encephalopathy.
Contra:
Allergy to lactulose,
low galactose diet
Use continuously
with diabetes.
GI
Transient
flatulence
Distension
Intestinal
cramps
Diarrhea
Nausea
Others
Acid base
imbalance
Electrolyte
imbalance
Give laxative syrup orally
with fruit juice, water or
milk to increase
palatability.
Administer retention
enema using a rectal
balloon catheter. Do not
use cleansing enemas
containing soap suds or
other alkaline agents that
counteract the effects of
lactulose.
Do not administer other
laxatives while using
lactulose.
Monitor serum ammonia
levels.
Monitor with long-term
therapy for potential
electrolyte and acid---base
imbalances.
Furosemide Anti diuretics
20mg
OD
Inhibits
reabsorption of
sodium chloride
from the proximal
ang distal tubules
and ascending limb
of the loop of
Henle, leading to a
sodium-rich
dieresis.
Indi:
Oral, IV: Edema
associated with heart
failure, cirrhosis, renal
disease.
IV: acute Pulmonary
Edema
Oral: Hypertension
Contra:
Contraindicated with
allergy to furosemide,
sulfonamides, allergy to
tartrazine, anuria, and
severe renal failure
Dizziness
Weakness
Headache
Drowsiness
Nausea
Blurred vision
Fatigue
Gatric
irritation
Constipation
Diarrhea
Administer with food or milk
to prevent GI upset.
Reduce dosage if given with
other anti-hypertensive’s
readjust dosage gradually as
BP respond.
Give early in the day so that
increased urination will not
disturb sleep.
Avoid IV use if oral use is
at all possible.
Omeprazole Proton Pump
Inhibitor
40mg cap
OD
Gastric acid
pump inhibitor,
suppresses gastric
acid secretion by
specific inhibition of
the hydrogen
potassium ATPase
enzymes system at
the secretory surface
of the gastric parietal
cells, blocks the final
step acid production.
Indi:
Short term
treatment of active
benign gastric ulcer
Short term
treatment of active
duodenal ulcer.
Treatment of
symptoms of GERD and
heartburn.
Contra:
Allergy to
omeprazole or its
components.
CNS
Headache
Dizziness
Vertigo
Insomnia
Anxiety
Paresthesia
GI
Diarrhea
Abdominal
pain
Nausea
Vomiting
constipation
Administer before
meals. Caution patient to
swallow capsules whole—not to
open, chew, or crush them. If
using oral suspension, empty
packet into a small cup
containing 2 tbsp of water. Stir
and have patient drink
immediately; fill cup with water
and have patient drink this
water. Do not use any other
diluent.
WARNING: Arrange
for further evaluation of patient
after 8 wk of therapy
for gastroreflux disorders; not
intended for maintenance
therapy. Symptomatic
improvement does not rule out
gastric cancer, which did occur
in preclinical studies.
Administer antacids
with omeprazole, if needed.
Rosuvastatin Antihyperlipide
mic drug
40mg tab
OD/HS
A fungal
metabolite that
inhibits the
enzymes (HMG-
CoA) that
catalyzes the first
step in the
cholesterol
synthesis pathway,
resulting in a
decreased in
serum cholesterol,
serum LDLs
(associated with
increased risk of
coronary artery
disease) and either
an increase or no
change in serum
HDLs (associated
with decreased
risk of coronary
artery disease)
Indi:
As an adjunct to diet
in the treatment of
elevated total cholesterol
and LDL cholesterol land
triglyceride levels in
patient with primary
hypercholesterolemia.
Adjunct to diet to
slow atherosclerosis
progression in patients
with elevated cholesterol.
Contra:
CNS
Headache
Dizziness
Insomnia
paresthesia
anxiety
CV
hypertension
angina
palpitation
peripheral edema
GI
nausea
diarrhea
constipation
vomiting
flatulence
Promote fluid intake
(>=1500–2000 mL/d) during
drug therapy for constipation;
older adults often self-limit
liquids. Lactulose-induced
osmotic changes in the bowel
support intestinal water loss
and potential hypernatremia.
Establish baseline
serum lipid level and liver
function test results before
beginning the therapy
Consults with
dietitian about low cholesterol
diet.
Administer drug at
bedtime(highest rates of
cholesterol synthesis occur
between midnight and 5 am)
Provide comfort
measures to deal with
headache, muscle cramps, or
nausea.
Hydrocortisone Corticosteroid
50mg
IV
Q8
Enters target cells and binds to cystoplasmic receptors; initiates many complex reactions that are responsible for its inflammatory, immunosuppressive (glucocorticoid), and salt retaining (mineralocorticoid) actions. Some actions maybe undesirable, depending on drug use.
Indi:
Replacement therapy in adrenal cortical insufficiency.
Contra:
Allergy to any component of drug
Fungal infection
Hepa B
Vaccinia
Antibiotic resistants infection
Immunosupression.
CNS Vertigo Headache Paresthesis InsomniaCV Hypotension Shock Hypertension Heart failure
secondary to fluid retention
Thromboembolism
GI Peptic ulcer Pancreatitis Abdominal
distension Nausea/
vomitingEENT
Cataract
Glaucoma
Increased IOP
Assessment
History of infection, kidney
disease, liver disease,
hypothyroidism, ulcerative colitis
with impending perforation;
recent GI surgery, hypertension,
heart failure.
Give daily before 9am to
mimic normal pick diurnal
corticosteroid levels and
minimize HPA suppression.
Provide antacids between
meals to help avoid peptic ulcer.
Acetylcysteine Antidote
Mucolytic
600mg tab
HS
Splits links in
the mucoproteins
contained in the
respiratory mucus
secretions,
decreasing the
viscosity of the
mucus.
Antidote to
acetaminophen
hepatotoxicity:
protects liver cells
by maintaining cell
function and
detoxifying
acetaminophen
metabolites.
Indi:
Mucolytic adjuvant
theraphy for abnormal,
viscid, or inspissated
mucus secretions in acute
and chronic
bronchopulmonary
disease (emphysema,
asthmatic bronchitis, TB,
pneumonia)
Contra:
Hypersensitivity to
acetylcysteine; use
caution and discontinue
immediately if
bronchospasm occurs.
Nausea
Stomatitis
Bronchospas
m
Rash
Vomiting
Inform the patient that
nebularization may produce an
initial disagreeable odor, but
the odor will soon disappear.
Monitor nebulizer for
buildup of drug from
evaporation; dilute with sterile
water for injection to prevent
concentrate from impeding
nebulization and drug delivery.