Fmw- Drug Study

8/6/2019 Fmw- Drug Study

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Lukban, Elaine CherizdeeA4A

DRUGNAME

MECHANISMOF ACTION

INDICATION ADVERSEREACTION

CONTRAINDICATION NURSINGCONSIDERATION

Atorvastatin(Lipitor)

Antilipemics

Inhibits HMG-CoAreductase, anearly (and ratelimiting) step incholesterol

biosynthesis.

- In patients withclinically evidentcoronary heartdisease, to reducethe risk of nonfatalMI, fatal & nonfatal

strokes, angina heartfailure, &revascularizationprocedures

- Adjunct to diet toreduce LDL, totalcholesterol,

apolipoprotein B, &triglyceride levels &to increase HDLlevels in patients withprimaryhypercholesterolemia& mixed dyslipidemia

- Alone or as adjunctto lipid loweringtreatments, such asLDL apheresis, toreduce total & LDLcholesterol inpatients with

homozygous familial

CNS: headache,asthenia, insomnia

CV: peripheraledema

EENT: pharyngitis,rhinitis, sinusitis

GI: abdominal pain,constipation,anorexia, diarrhea,nausea, dyspepsia,flatulence

GU: UTI

Musculoskeletal:rhabdomyolysis,arthrisis, arthralgia,myalgia

Respiratory:bronchitis

Skin: rash

Other: allergic

reactions, flulike

syndrome, infection

- Contraindicated inpatients hypersensitive todrug & in those with activeliver disease orunexplained persistentelevations of transminase

levels.

- Contraindicated inpregnant & breast-feedingwomen & in women ofchildbearing age

- Use cautiously in

patients with history ofliver disease or heavyalcohol use

- Withhold or stop drug inpatients at risk for renalfailure caused byrhabdomyolysis resultingfrom trauma; in serious,acute conditions thatsuggest myopathy; & inmajor surgery, severeacute infection,hypotension, uncontrolledseizures, or severe

metabolic, endocrine, or

- Patient should follow astandard cholesterol lowering diet before &during therapy

- Before treatment,

assess patient forunderlying causes forhypercholesterolemia &obtain a baseline lipidprofile. Obtain periodicliver function testresults & lipid levelsbefore starting treatment

& at 6 & 12 weeks afterinitiation, or after anincrease in dosage &periodically thereafter

- Watch for signs ofmyositis


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hypercholesterolemia electrolyte disorders.

- Limit use in children tothose older than age 9with homozygous familialhypercholesterolemia

DRUG NAME MECHANISMOF ACTION

INDICATION ADVERSEREACTION

CONTRAINDICATION NURSINGCONSIDERATION

Citicoline

(Somazine)

Neurotonics,Nootropics

Citicoline is aninterneuronalcommunicationenhancer. Itincreases the

neurotransmissionlevels because itfavors thesynthesis andproduction speedof dopamine in thestriatum, actingthen as adopaminergicagonist thru theinhibition oftyrosine -hydroxylase.

- CVD in acute &recovery phase,symptoms &signs of cerebralinsufficiency

(dizziness,memory loss,poor concentration,disorientation,recent cranialtrauma & theirsequelae.)

- Fleeting anddiscrete

hypotension effect,

increasedparasympatheticaffects, low blood

pressure

- Itching or hives,swelling in face or

hands, chest

tightness, tingling in

mouth and throat

- Body temperatureelevation

- Restlessness

- Headaches,

- Any allergy orhypersensitivity to the

drug

- Hypertonia of theparasympathetic

nervous system

- Use cautiouslyfor pregnancy and

lactation

- Conscious usefor patient with renal and

hepatic damage

- Parasympathetichypertonia

- Citicoline may be takenwith or without food. Takeit with or between meals.

- The supplement

should not be taken in thelate afternoon or at nightbecause it can causedifficulty sleeping.

- Women who arepregnant or trying tobecome pregnantshould consult with theirdoctor before taking thesupplements. Not enoughis known about the use ofCiticoline duringpregnancy and breast-feeding. Stay on the safe

side and avoid use.


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Name and

Classification

Indication Mechanism of

Action

Adverse Effect Contraindicatio

n

Nursing Management

Nicardipine(Cardene)

Antihypertensives, Antiarrythmias,Antianginals,VascularHeadache,Suppresants

Alone or withother agents inthemanagement ofhypertension,angina pectoris,and vasospastic(Prinzmetals)angina.

Inhibits thetransport ofcalcium intomyocardial andvascular smoothmuscle cells,resulting ininhibiton ofexcitation-contractioncoupling andsubsequentcontraction

CNS: dizziness,nervousness,psychiatricdisturbances,headache, weakness,shakiness, anxiety,drowsiness, abnormaldreams

EENT: Blurred vision,disturbed equilibriumand tinnitus

Resp: Shortness ofbreath, dyspnea,

congestion, cough,epistaxis.

CV: Peripheraledema, palpitation,hypotension, syncope,arrythmias, chest pain

GI: nausea,constipation, diarrhea,abnormal l iver functionstudies, dyspepsia,vomiting, dry mouth,anorexia.

Contraindicatedin:Hypersensitivity,Sick sinussyndrome,Second and third

AV block, Bloodpressure


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Name and

Classification

Indication Mechanism of Action Adverse Effect Contraindication Nursing Management

Omeprazole(Prilosec)

Gastrointestinal(antiulcer), Gastriculcer pump

inhibitor

Management ofgastroesophageal reflux diseasethat has notresponded toconventionaltherapy with his

tamine H2-receptorblocking agents

Short termmanagement ofactive duodenalulcers

Treatment ofgastrichypersecretoryconditionassociated withZollinger Ellison

syndrome,systemicmastocytosis ormultipleendocrineadenomas

Binds to an enzymeon gastric parietalcells in the presenceof acidic gastric pH,preventing the finaltransport of hydrogenions into the gastric

lumen

CNS: weakness,dizziness,headache,somnolence,fatigue

CV: chest pain

GI: abdominal pain,acid regurgitation,constipation,diarrhea, flatulence,nausea, vomiting

Derm: rash, itching

ContraindicatedHypersensitivity

Administer doses beforemeals, preferably in themorning. Capsulesshould be swallowedwhole; do not crush,open, or chew

May be administeredconcurrently withantacids

Instruct patient to takemedication as directedfor the full course oftherapy, even if feelingbetter.

May cause occasionaldrowsiness or dizziness.

Advise pt. To avoidalcohol

Advise pt. To reportonset of black tarry stool,diarrhea, abdominal pain,or persistent headache tothe physician promptly


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DRUG NAME INDICATION MECHANISM OFACTION

ADVERSEEFFECT

CONTRAINDICATION

NURSINGMANGEMENT

Kalium durule(PotassiumChloride)

electrolytereplenishe

Antihypokalemic

Hypokalemia.Prophylaxisduringtreatment w/diuretics.

Potassium is thepredominant action withincells. Intracellular sodiumcontent is relatively low. Inextracellular fluid, sodiumpredominates and actively

transports or pumpssodium out and potassiuminto cells to maintain theseconcentration gradients.The intracellular toextracellular potassiumgradients are necessaryfor the conduction of nerveimpulses in suchspecialized tissues as theheart, brain, and skeletalmuscle, and for themaintenance of normalrenal function and acid-base balance. High

intracellular potassiumconcentrations arenecessary for numerouscellular metabolicprocesses..

Diarrhea

nausea

stomach

pain,

discomfort, or

gas, mild

vomiting

Renal insufficiency,hyperkalemia,untreated Addison'sdisease, constrictionof the esophagus&/or obstructivechanges in the

alimentary tract.

appropriate,discontinuingblood products,foods andmedication thatcontainpotassium, as well

as ACE inhibitors,beta blockingagents,nonsteroidal anti-inflammatorydrugs (NSAIDs),heparin,cyclosporine, andpotassium-sparingdiuretics.


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DRUG NAME INDICATION MECHANISMOF ACTION

ADVERSE EFFECT CONTRAINDICATION NURSINGMANGEMENT

ketorolactromethamine

(Antipyretic,nonopioid

analgesic,NSAID)

Short termmanagementof pain (up to5days)

Ophthalmic

relief of ocularitching due toseasonalconductivitiesand relief ofpostoperativeinflammationafter cataractsurgery

Antiinflammationand analgesicactivity inhibitsprostaglandinand leukotrine

synthesis.

CNS:Headache,dizziness,sommolence,insomia

Dermatologic:rash, pruritus,

sweating

GI: nauseadyspepsia, GI pain,Diarrhea, vomiting,Constipation,flatulence,

Resp:Dyspnea,hemoptysis.,pharyngitis,bronchospasm,rhinitis

Other:Peripheral edema,Anaphylactoidreaction.

Contraindicated withsignificant renalimpairment,duringlabor anddelivery,lactation,patient wearing soft

contact lenses,aspirinallergy,cocurrent useofNSAID; activepeptic ulcer disease orGI bleedinghypersensitivity toketoralac. Incompletehemostasis, high riskof bleeding,

Renalinpairment,impairedhearing allegies,hepticCV, aGIcondition,lactation,Pregnancy

Physical:Skin color and lesion

orientation, reflex,opthalmologis andaudiometricevaluation, peripheralsensation, edema,BP,adventioussounds,liverevaluation, clottingtimes.


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INDICATION MECHANISHOF ACTION

ADVERSEREACTION

CONTRAINDICATION

NURSINGMANAGEMENT

GENERICNAME:Mannitol

BRAND NAME:Osmitol

CLASSIFICATION:OsmoticDiuretic

Acute oliguric renalfailure, toxic renaloverdose, edema,ICP, IOP

Increasesosmolarity ofglomenularfiltrate which

raises osmoticpressure of fluidin renal tubules;

decreases inreabsorption ofwater,

electrolytes,increases inurinary output,sodium, chlorideexcretion.

Dehydration,anuria, intracranialbleeding,headache, blurred

vision, nausea &vomiting, volumeexpansion, chest

pain, pulmonaryedema, thrist,tachycardia,

hypokalemia,chronic renalfailure

Susceptibilitydehydration, anuriadue to severe renaldisease, Severe

pulmonarycongestion or frankpulmonary edema,

Active intracranialbleeding exceptduring craniotomy.

-Monitor V/S, I &

O.- Monitor CVP.- Assess forpulmonary arterypressure.- Assess for s/sx of

dehydration.- Assess forelectrolyteimbalance/ deficit.- Check weight,renal function, fluidbalance, and serumand urine sodiumand potassiumlevels daily.- For ICP- assessfor neurologicstatus andintracranialpressure.

-For IOP

-assess

for elevating eyepain and decreasevisual acuity.


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INDICATION MECHANISH OF

ACTION

ADVERSE

REACTION

CONTRAINDICATION NURSINGMANAGEMENT

BRAND NAME:Azithromycin

GENERICNAME:Zithromax

CLASSIFICATION:Anti-infectives

URTI, LRTI, skin &soft tissue

infections, otitismedia, STD &uncomplicatedgenital infectionsCommunity

acquiredpneumonia causedby susceptible

organisms inc.Leogionellapneumophilia,

pelvic inflammatorydisease caused by

susceptibleorganism

Binds to the Psite of 50s

bacterialribosomalsubunits therebyinhibiting proteinsynthesis;

bactericidal orbacteriostaticdepending on

concentrationwith muchgreater spectrum

of activity thanerythromycin.

Arthralgia, edema,

urticaria,

angioedema,

Arrhythmias,

hypotension, Anor

exia, constipation,dyspepsia,

flatulence,

pancreatitis, oral

candidiasis, pyloric

stenosis,

Interstitial

nephritis and acute

renal failure,

vaginitis.

Thrombocytopenia

Hypersensitivity toazithromycin or any

of the macrolidesImpaired hepaticfunction,

- Assess patient forinfection (vitalsigns; appearanceof wound, sputum,urine, and stool;WBC) at beginningof and throughout

therapy.- First dose may begiven beforereceiving results.- Observe for signsand symptoms ofanaphylaxis (rash,pruritus, laryngeal

edema, wheezing).- Discontinue

azithromycin atfirst sign of rash;may be life-threatening.Stevens-Johnson

syndrome or toxicepidermalnecrolysis maydevelop. Treatsymptomatically;may recur oncetreatment isstopped.


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DrugName/Classificati

on

Indication Mechanism ofaction

Adverse Effect Contraindication

NursingConsideration

s

Losartan(Cozaar)

CV system drugsAntihypertensives

Hypertension

Nephropathy in

type 2 diabetec

patients

To reduce riskof stroke inpatients with

hypertensionand leftventricular

hypertrophy

Inhibits

vasoconstrictiveand aldosterone

secreting action

of angiotensin IIby blocking

angiotensin IIreceptor on thesurface of

vascular smoothmuscle andother tissue cells

CNS: Dizziness,

asthenia, fatigue,headache,

insomnia

CV: chest pain,edema

EENT: nasalcongestion,sinusitis,

pharyngitisG.I: Abdominalpain, nausea,

diarrheaMusculoskeletal:muscle cramps,

myalgia, back orleg painRespiratory:

Cough, upper

respiratoryinfectionOther:

Angioedema

Contraindicated in

patientshypertensive to

drug. Breastfeeding

isnt recommendedduring losartan

therapyUse cautiously inpatients with

impaired renal orhepatic function

Drug can beused alone orwith otherhypertensives

Monitorpatients bloodpressureclosely toevaluateeffectiveness oftherapy.Monitorpatients whoare also takingdiuretics forsymptomatichypotensionRegularly assespatients renal

function


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organisms; do notuse to treat

meningitis; doesnot cross thebloodbrainbarrier.

Topicaldermatologicsolution:

Treatment ofacne vulgaris

Vaginalpreparation:Treatment ofbacterial vaginosis

injection, induration and sterile

abscess after IMinjection, thrombophlebitis after IV useTopicaldermatologicsolution:CNS: Fatigue,headache

Dermatologic: Contact dermatitis,dryness, gram-negative folliculitis

GI: Pseudomembranous colitis, dia

rrhea, bloodydiarrhea;abdominal pain,sore throat

GU: UrinaryfrequencyVaginalpreparation

GU: Cervicitis, vaginitis, vulvar irritation

Use caution with

history of regionalenteritis orulcerative colitis;history ofantibiotic-associated colitis.

dermatologicadministration:

Keep solutionaway from eyes,mouth and abradedskin or mucousmembranes;alcohol base willcause stinging.Shake well before

use.

Keep cool tap wateravailable to batheeye, mucousmembranes,abraded skininadvertently

contacted by drugsolution.

Vaginalpreparation:Give intravaginally,preferably at hs.


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DRUG NAMECLASSIFICATION

INDICATION MECHANISM OFACTION

ADVERSE EFFECT CONTRAINDICATION

NURSING MANAGEMENT

Generic name:digoxin

Brand name:Digitek,Lanoxicaps,Lanoxin, Novo-Digoxin (CAN)

Drug classCardiacglycosideCardiotonic

CHF

Atrial fibrillation

Increasesintracellular calciumand allows morecalcium to enter themyocardial cellduringdepolarization via asodiumpotassiumpump mechanism;

this increases forceof contraction(positive inotropic effect), increasesrenal perfusion(seen as diureticeffect in patientswith CHF),decreases heart

rate(negative chronotropic effect), anddecreases AV nodeconduction velocity.

CNS: Headache,weakness, drowsiness,visual disturbances,mental status change

CV: Arrhythmias

GI: GIupset, anorexia

Contraindicatedwith allergy todigitalispreparations,ventriculartachycardia,ventricularfibrillation, heartblock, sick sinus

syndrome, IHSS,acute MI, renalinsufficiency andelectrolyteabnormalities(decreased K

+,

decreasedMg

2+, increased Ca

2+).

Use cautiously withpregnancy andlactation.

WARNING: Monitor apical pulse for 1min before administering; hold doseif pulse < 60 in adult or < 90 in infant;retake pulse in 1 hr. If adult pulseremains < 60 or infant < 90, hold drugand notifyprescriber. Note anychange from baseline rhythm or rate.

Take care to

differentiateLanoxicaps from Lanoxin; dosage is very different

Check dosage and preparationcarefully.

Avoid IM injections, which may bevery painful.

Follow diluting instructions carefully,and use diluted solution promptly.

Avoid giving with meals; this willdelay absorption.

Have emergency equipment ready;have K

+salts, lidocaine, phenytoin,

atropine, cardiac monitor readilyavailable in case toxicity develops.

WARNING: Monitor for therapeuticdrug levels: 0.52 ng/mL.


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Drug Name/Classification

Indication Mechanism ofAction

Adverse Effect Contraindication Nursing Management

CEFUROXIME(ceftin)

AntibioticCephalosporin

(secondgeneration)

Infections causedby susceptibleorganisms in thelower respiratorytract, urinarytract, skin andskin structures;also used for

treatment ofmeningitis,gonorrhea andotitis media andfor perioperativeprophylaxis (e.g.open-heartsurgery), earlyLyme disease.

Bactericidal:inhibitssynthesis ofbacterial cellwall, causingcell death.

Thrombophlebitis(IV site); pain,burning, cellulitis(IM site);superinfections,positive Coombstest.GI: diarrhea,

nausea,antibiotic-associatedcolitis.Skin: Rash,pruritus, urticaria

Hypersensitivityto cephalosporinsand relatedantibiotics;pregnancy(category B),lactation

Determine history ofhypersensitivityreactionstocephalosporins,penicillins,and historyof allergies,particularly to drugs, beforetherapy is initiated. Inspect IM and IV injectionsites frequently for signs of

phlebitis. Report onset of loose stools ordiarrhea. AlthoughPseudomembranous colitis. Monitor I&O rates and pattern:Especially important in severelyill patients receiving high doses.Report any significant changes.


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Drug Name/

Classification

Indication Mechanism of

Action

Adverse Effect Contraindicatio

n

Nursing Management

CEFTRIAXONESODIUM

(Rocephin)

Antibiotic

Cephalosporin (third

generation)

-lower respiratory

infections caused by S.

Pneumoniae, S. Aureus.

-acute bacterial otitis

media.

-UTI

-gonorrhea

-intra-abdominal

infections

-sin and skin structure

infections

-septicemia

-bone and joint

infection

-meningitis

-

Bactericidal:

inhibits synthesis of

bacterial cell wall,

causing cell death.

CNS: headache, dizziness,

lethargy, paresthesias

GI: nausea, vomiting,

diarrhea, anorexia,

abdominal pain, flatulence,

pseudomembranous colitis,

hepatotoxicity,

GU: nephrotoxicity

Hematologic: bone marrow

depression- decreased

WBC count, decreased

platelet, decreased

hematocrit.

Hypersensitivity: ranging

from rash to fever to

anaphylaxis

Local: Pain, abscess at

injection site.

-Contraindicated

with allergy to

cephalosporins or

penicillins

-Use cautiously

with renal failure,

lactation and

pregnancy.

Assess:

-History: Hepatic and renal

impairment, lactation,

pregnancy

-Physical: skin status, renal

function test.

Intervention:

-culture infection and arrange

for sensitivity test duringtherapy.

-check manufacturers details.

Stability of reconstituted and

diluted solution depends on

diluents, concentration, and

types of container.

-protect drug from light.

-do not mix with ceftriaxonewith other antimicrobial drugs

-have Vit. K available in case of

hypoprothrobemia occurs.

-discontinue if

hypersensitivity reaction

occurs.Health teaching

-avoid alcohol while taking

this drug and for 3 days after

because severe reactions may

occur.


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DRUG NAME/

CLASSIFICATION INDICATION MEACHANISMOF ACTION ADVERSE EFFECTS CONTRAINDICATION NURSING MANAGEMENTSODIUMBICARBONATE

Class:

-Laxative-Hyperosmotic

-Barium EnemaColonoscopy preparation ofbowel for procedure-Fecal Impaction-Operativeprocedure on large

intestine,Colorectal-preparation ofbowel for procedure

Polyethyleneglycol acts anosmotic agent toproduce alaxative effect.

Along with theelectrolyte

solution,practically no netabsorption orexcretion of ionsor water occurs.

CommonGastrointestinal:

Anal irritation, Bloatingsymptom, Epigastricfullness, Nausea,stomach cramps,Vomiting

Serious

-Dermatologic:Urticaria-Immunologic:

Anaphylaxis(rare)

-bowelperforation-gastricretention-gastrointestinalobstruction

-ileus-toxic colitis-toxicmegacolon

-Advise patient to reporturticaria, rhinorrhea, ordermatitis.-Patient should not eat solidfood for at least 2 hour(preferably 3 to 4h) beforetaking this preparation.

- Encourage patient to drinkeach portion rapidly, as thismethod is preferred overdrinking small amountscontinuously. The solutionmay be more palatable ifchilled first.


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DRUG NAME/

CLASSIFICATION INDICATION MEACHANISMOF ACTION ADVERSEEFFECTS CONTRAINDICATION NURSINGMANAGEMENTAMLODIPINE

(Norvasc)

Class:

-Calcium Channel

Blocker

-Cardiovascular

Agent

-Dihydropyridine

Disorder of

cardiovascular system;

-Hypertension

-Stable Angina

-Variant Angina

Amlodipine is a

dihydropyridine

calcium antagonist

(calcium ion

antagonist or slow-

channel blocker) that

inhibits the

transmembrane influx

of calcium ions intovascular smooth

muscle and cardiac

muscle. Experimental

data suggest that

amlodipine binds to

both dihydropyridine

and

nondihydropyridine

binding sites. Thecontractile processes

of cardiac muscle and

vascular smooth

muscle are dependent

upon the movement

of extracellular

calcium ions into

these cells through

specific ion channels.

- Very often: peripheral

edema ,fatigue

- Often: dizziness;

palpitations; muscle-,

stomach- or headache;

dyspepsia; nausea

- Sometimes: blooddisorders, development

of breasts in men

(gynecomastia),

impotence, depression,insomnia, tachycardia,

gingival enlargement

- Rarely: erratic

behavior, hepatitis,jaundice

- Very rarely:

hyperglycemia, tremor,

Stevens-Johnson

syndrome

Known sensitivity to

amlodipine

-Instruct patient to

report

signs/symptoms of

exacerbation of angina

or myocardial

infarction with

initiation and increase

in dose. Patients with

severe cardiovascular

disease have anincreased risk.

-Advise patient there

are multiple significant

drug-drug interactions

for this drug. Consult

healthcare

professional prior tonew drug use

(including otc and

herbal drugs).

-Instruct patient to

take a missed dose as

soon as possible, but if

it has been more than

12 hours since thedose was missed, skip

the dose.

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