Drug Studies

B. Drug Study Date ordered: February 13, 2006 1. Generic name: Ampicillin/Sulbactam Brand name: Unasyn Classification: Anti-infective, aminopenicillins/beta lactamase inhibitors Dosage, Frequency, Route: 1gm IVP every 8 hours Mechanism of action: This drug binds to bacterial cell wall, resulting in cell death. The addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin. Indication: This drug is indicated for patients after undergoing surgery to prevent infection of skin and soft-tissue structures. Contraindication: This drug is contraindicated to patients who are hypersensitive to penicillins or sulbactam. Desired effect: This drug was given to our client as prophylaxis against possible infection. Side effects and adverse reactions CNS: seizures GI: pseudomembranous colitis, diarrhea, nausea, vomiting Derm: rashes, urticaria Hemat: blood dyscrasias Local: pain at IV site Misc: allergic reactions such as anaphylaxis and serum sickness, superinfection. Nursing responsibilities 1. Check the doctor’s order to prevent error. 2. Observe the 10 RIGHTS in administering drug to avoid mistakes. 3. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. 4. Administer skin testing to assess if patient is sensitive to penicillin. 5. Observe patient for signs and symptoms of anaphylaxis. 6. Administer drug slowly to prevent irritation.

7. Monitor for side effects like nausea and vomiting, bleeding or bleeding gums, blood in the stool and urine. 8. Stop drug if allergic reaction occur and notify doctor on duty. 9. Advise to increase CHON and Vitamin C on diet. 10. Instruct client to clean wound aseptically to prevent infection. 2.Generic name: Ketorolac Brand name: Toradol Classification: NSAID, Non-opioid analgesics Dosage, route, frequency: 30 mg IV every 6 hours Mechanism of action: This drug inhibits prostaglandin synthesis, producing peripherally mediated analgesia, thus pain perception decreases. Indication: This drug is used for a short-term management of pain. Contraindication: This drug is contraindicated to patients who are hypersensitive to this drug and cross-sensitive with other NSAIDs and during pre or perioperative use. This is used cautiously in patients with a history of GI bleeding, renal impairment and cardiovascular disease. Desired effects: This drug was given to the patient to relieve pain. Adverse effects and side-effects CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache Resp: asthma, dyspnea CV: edema, pallor, vasodilation GI: GI bleeding, diarrhea, drymouth, dyspepsia, GI pain, nausea, abnormal taste GU: oliguria, renal toxicity, urinary frequency Derm: pruritus, purpura, sweating, urticaria Hemat: prolonged bleeding time Local: injection site pain Neuro: paresthesia Misc: allergic reactions including anaphylaxis Nursing Responsibilities

1. Check doctor’s order to avoid mistake. 2. Observe the 10 RIGHTs in administering drug to avoid mistakes. 3. Assess the client’s history of allergy to the drug to avoid complications. 4. Encourage client to report severe pain for prompt intervention. 5. Administer the drug through the Y-tube in a free flow for at least 15 seconds because this can be irritating. 6. Tell patient to avoid activities requiring alertness because this drug can cause drowsiness. 7. Monitor for signs and symptoms of bleeding like melena or hematemesis. GI ulceration with perforation can occur anytime during treatment.

This drug can decrease platelet aggravation, thus, may

prolong bleeding. 8. Do not administer the drug longer than 5 days to prevent development of tolerance. 9. Instruct client to call the attention of any health care professional when difficulty of breathing is experienced to give prompt intervention. 3 Generic name: Nubain Brand name: Nalbuphine Classification: opioid analgesics Dosage, route, frequency: 10mg IVP every 6 hours Mechanism of action: This drug binds to opiate receptors in the CNS, which causes alteration in the perception and response to painful stimuli. Thus, pain decreases. Indication: This drug is used to treat moderate to severe pain. Contraindication: This drug is contraindicated to patients who are sensitive to nalbuphine. Desired effect: This drug is given to our patient to relieve pain after operation. Adverse effects and side effects CNS: dizziness, headache, sedation, confusion, floating feeling

EENT: blurred vision, diplopia, mioses Resp: respiratory depression CV: hypertension, orthostatic hypotension, palpitations GI: dry mouth, nausea, vomiting, constipation GU: urinary urgency Derm: clammy feeling, sweating Misc: physical dependence, psychological dependence, tolerance Nursing responsibilities 1. Check doctor’s order to avoid mistakes. 2. Consider the 10 RIGHTs in drug administration to avoid errors. 3. Instruct watcher to assist patient during doing activities to prevent accidents. 4. Encourage patient to take adequate bed rest to decrease oxygen demand and BMR, thereby conserving body energy 5. Provide proper oral care to decrease the incidence of dry mouth. 6. Assess vital signs to prevent complications. 7. Instruct patient on how and when to ask for pain medication to prevent drug dependence and tolerance. 8. Caution patient to change positions slowly to minimize orthostatic hypotension. 9. Encourage patient to turn, cough and breathe deeply every 2 hours to prevent lung collapse. Date ordered: February 17, 2006 4. Generic name: Mefenamic acid Brand name: N/A Classification: NSAIDs Dosage, route, frequency: 500 mg 1 tab TID Mechanism of action: This drug inhibits prostaglandin synthesis, thus, decreases pain. Indication: This is a short-term management of pain.

Contraindication: Desired effects: This drug was given to our patient to reduce pain. Adverse effects and side effects CNS: dizziness, headache GI: severe diarrhea, ulceration Special senses: eye irritation, ear pain Nursing responsibilities 1. Check the doctor’s order to avoid error. 2. Observe the 10 RIGHTs in drug administration to avoid mistakes. 3. Assess for the client’s history of drug allergy to prevent complications. 4. Instruct patient to move slowly to prevent accidents. 5. Instruct patient to call the attention of any health care provider when melena or bleeding gums are experienced as, these will show that there is ulceration. 5. Generic name: Cefalexin Brand name: N/A Classification: 1st generation cephalosphorins Dosage, route, frequency: 500mg 1 cap TID Mechanism of action: This drug binds to bacterial cell wall membrane causing cell death. Indication: This drug is used to prevent skin and skin structure infection. Contraindication: This is contraindicated to patients who are hypersensitive to cephalosphorins Desired effects: This drug was given to our patient to prevent possible infection after the operation. Adverse effects and side effects CNS: seizures GI: pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: interstitial nephritis Derm: rashes, urticaria

Hemat: blood dyscrasias, hemolytic anemia Misc: allergic reactions Nursing responsibilities 1. Check the doctor’s order to avoid error. 2. Observe the 10 RIGHTs in drug administration to avoid mistakes. 3. Inform patient to take the drug exactly as prescribed, even after he feels better. 4. Instruct patient to take drug with food or milk inorder to lessen discomfort. 5. Obtain a history before administering the drug to determine previous use of and reactions to penicillins and cephalosphorins to prevent complications. 6. Observe patient for signs and symptoms of anaphlaxis to give prompt intervention. 6. Generic name: Ranitidine Brand name: Zantac Dosage, Route, Frequency: 50 mg IVP every 8° Classification: H2 receptor antagonist Indication: This drug is indicated for our patient to prevent the occurrence of duodenal and gastric ulcer. Contraindication: To patients hypersensitive to Ranitidine Mechanism of Action: This drug inhibits gastric acid secretion by blocking the effect of histamine on histamine H2 receptors. Desired Effect: This drug is given to our patient for prophylaxis to ulcer Adverse Effects: GI: nausea, vomiting, diarrhea, abdominal pain CNS: malaise, dizziness, headache, insomnia, anxiety, fatigue CV: Bradycardia or tachycardia Hematologic: aplastic anemia Hepatic: hepatotoxicity, jaundice, hepatitis, increase in ALT Dermatologic: pruritus, rash, alopecia Nursing Responsibilities

1. Check for the doctor’s order and prepare drug aseptically. 2. Instruct patient to take without regard to meals because absorption is not affected by food. 3. Remind patient taking prescription drug once daily to take it at bedtime for best results. 4. Report any evidence of diarrhea and maintain adequate hydration. 5. Antacids decrease the absorption of ranitidine. 6. Instruct the watcher to assist patient in his activities of daily living because patient may feel dizzy and easily fatigue. 7. Intstruct patient to take medicines as prescribed. Don’t overdose as this leads to damage of hepatic cells. 8. Tell patient to avoid eating fruits like oranges to prevent hypersecretions of gastric acids.. C. DRUG STUDY GENERIC NAME: Theophylline BRAND NAME: Respbid CLASSIFICATION: Bronchodilator ROUTE, DOSAGE & FREQUENCY: 200 mg 1 tab BID MECHANISM OF ACTION: It prevents breakdown of Adenosine Monophosphate (AMP) which promotes smooth muscle relaxation causing bronchodilation. DESIRED EFFECT: This was given to our patient to promote bronchodilation- greater airway passage hence relieving difficulty of breathing. INDICATION: Symptomatic relief or prevention of bronchial asthma and reversible bronchspasm associated with chronic bronchitis and emphysema. CONTRAINDICATIONS & CAUTIONS: • Contraindicated with hypersensitivity to any xanthines, peptic ulcer, active gastritis, preganancy, underlying seizure disorders. • Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe HPN, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor (may inhibit uterine contractions), lactation, status asthmaticus SIDE EFFECTS: diuresis, insomnia, nausea and vomiting, headache ADVERSE EFFECTS: • GIT: epigastric pain, diarrhea and anorexia • CNS: irritability, restlessness, dizziness, muscle twitching, headache, insomnia, lightheadedness, seizures, severe depression, stammering speech, abnormal behavior characterized by withdrawal, mutism and unresponsiveness alternating with hyperactive periods

•

CV: palpitations, sinus tachycardia, ventricular tachycardia, life-threatening ventricular arrhythmias, circulatory failure • GUT: proteinuria, increase excretion of renal tubular cells and RBC’s , urinary retention in man with prostate enlargement • Respiratory: tachypnea, respiratory arrest Nursing Responsibilities Rationale 1. Check doctors order. To verify and avoid error in giving the drug. 2. Check vital signs before and after To evaluate cardiac response administration.(to be check) 3. Drug should be given on an empty To decrease gastric irritation stomach, 1 hour before or 2 hours after meals. 4. Check for adverse reactions. If present, To prevent further complications discontinue drug and notify the physician. 5. Teach the following: To expand lung tissue and move secretions * Breathing techniques *Coughing techniques 6. Avoid excessive intake of coffee, tea, These contain theophylline-related cocoa, cola beverages, and chocolate. substances that may increase side effects GENERIC NAME: Salbutamol Sulfate BRAND NAME: Ventolin CLASSIFICATION: Bronchodilator DOSAGE, ROUTE, FREQUENCY: 2.5 cc ever 6 hours to be added for nebulization MECHANISM OF ACTION: relaxes bronchial and uterine smooth muscle by acting on the beta 2-adrenergic receptors. Inhibit the release of mediators of immediate hypersensitivity reaction from mast cells. DESIRED EFFECT: To promote bronchodilation and help loss secretions. CONTRAINDICATION: contraindicated in patients hypersensitive to drug or its ingredients. SIDE EFFECTS: dizziness, insomia, headache, weakness, nausea and vomiting ADVERSE REACTIONS: • CNS: tremor, nervousness, dizziness, malaise • CV: tachycardia, palpitations • EENT: nasal congestion, hoarseness • GI: heartburn • METABOLIC: hypokalemia • MUSCULOSKELETAL: muscle cramps • RESPIRATORY: wheezing, increased sputum Nursing responsibilities: Rationale: 1. Verify the doctor’s order. To avoid error in giving the drug. 2. Do chest physiotherapy as indicated after To help dislodge the secretions. each nebulization.

3. Encourage client to rinse mouth with H20 To minimize dry mouth. after nebulization. 4. Maintain adequate fluid intake. To liquefy the mucous secretions for easier expectoration. 5) Teach the ff: breathing techniques To expand lung tissue and move secretions coughing techniques 6) Teach patient pursed-lip breathing This creates a resistance to the air flowing out of the lungs, thereby prolonging exhalation GENERIC NAME: Ampicillin Sulbactam BRANDNAME: Unasyn CLASSIFICATION: anti-bacterial DESIRED DOSAGE, ROUTE & FREQUENCY: 750mg IV every 8 hours DESIRED EFFECT: This was given to our patient prevent infection. MECHANISM OF ACTION: inhibits cell-wall synthesis during bacterial multiplication. Sulbactam inactivates bacterial beta-lactamase, which inactivates ampicillin, causing bacterial resistance to it. INDICATION: to prevent the proliferation of susceptible microorganisms during infection. CONTRAINDICATIONS: • Contraindicated in patients hypersensitive to the drug or other penicillin. • Use cautiously in patients with other drug allergies because of possible crosssensitivity and in those with mononucleosis because of high risk in maculopapular rash. SIDE EFFECT: nausea and vomiting ADVERSE EFFECTS: • CV: thrombophlebitis • GI: diarrhea, glossitis, stomatitis, gastritis, black hairy tongue, enterocolitis, psuedomembranous colitis • HEMATOLOGIC: anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, luekopenia, agranulocytis • OTHER: hypersensitivity reactions, anaphylaxis, overgrowth of nonsusceptible organisms, pain at injection site, vein irritation Nursing responsibilities: 1. Check doctor’s order 2. Do skin testing and give only ANST. 3. Check the patency of the IV line. 4. Administer the drug slowly and always observe aseptic technique. 5. Tell the patient to report any allergic reaction and notify the physician. Observe

Rationale: To avoid error in administering the drug To determine any allergic reaction To make sure that the IV line is in the vein To prevent irritation and facilitate absorption and also to avoid contamination of microorganism To prevent further complication and give necessary intervention if allergic reaction

for any manifestation of allergic reaction. 6. Provision of personal hygiene. 7. Encourage patient to cough out secretions and dispose it properly.

7. Encourage intake of vitamin C and mineral rich foods.

occurs. Good personal hygiene aids in the retardation of growth and multiplication of pathogenic microorganisms. To prevent the stasis of secretions in the respiratory tract which is good medium bacterial growth and proper disposal of secretions prevent the spread of microorganisms. To increase body resistance

GENERIC NAME: Hydrocortisone BRAND NAME: Sodium Succinate CLASSIFICATION: Corticosteroids DESIRED DOSAGE, ROUTE & FREQUENCY: 100mg IV every 12 hours MECHANISM OF ACTION: Decreases inflammation by entering target cells and binding to cytoplasmic receptors initiating many complex reactions thus resulting to blockage on the release of histamine, bradykinine and serotonin. DESIRED EFFECT: This drug is given to our patient to reduce inflammation. CONTRAINDICATIONS: • Contraindicated with fungal infections, amoebiasis, hepatitis b, varicella and antibiotic-resistant infections, immunosuppression • Use cautiously with kidney disease(risk to edema), liver disease, cirrhosis, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, resent GI surgery, active or latent peptic ulcer, inflammatory bowel disease(risk exacerbation or bowel perforation), hypertension, CHF, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, DM, TB, and lactation SIDE EFFECT: headache, insomia, nausea and vomiting, weakness ADVERSE EFFECT: • CNS: vertigo, headache, paresthesia, insomnia, seizures, psychosis • CV: hypotension, shock, hypertension, and CHF 2o to fluid retention, thromboembolism, thromplebitis, fat embolism, cardiac arrythmias 2o electrolyte disturbance • DERMATOLOGIC: thin, fragile skin, petichiae, ecchymoses, purpura, striae, SC fat atrophy • EENT: cataracts, glaucoma(long term therapy), increase IDP

• • • • • •

ENDOCRINE: amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state(long-term therapy), HPA suppression systemic with therapy longer than 5 days GI: peptic or esophageal ulcer, pacreatitis, abdominal distention, N/V, increase appetite and weight gain(long-term therapy) HEMATOLOGIC: NA+ and fluid retention, hypokalemia, hypocalcemia,increase blood sugar, increase serum cholesterol, decrease serum T1 and T4 levels HYPERSENSITIVITY: anaphylactoid or hypersensitivity reactions MUSCOSKELETAL: muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures(long-term therapy) OTHER: immunosuppression, aggravation or masking of infections, impaired wound healing

Nursing Intervention 1. Check the doctors order 2. Observe the rights in administering the drug 3. Do skin testing and give ANST 4. Check the patency of the IV line 5. Monitor I & O accurately 6. Monitor BP 7. Encourage patient to increase intake of protein 8. Weigh the patient daily with the same clothing and weighing scale 9. Encourage patient to increase intake of Vitamin C and potassium rich foods such as banana, cantaloupe, potato, etc. 11. Tell the patient not to skip or suddenly stop medications 12. Provide emotional and psychological support

Rationale To avoid error in giving the drug To avoid error in giving the drug To determine any allergic reaction To make sure that it is in the vein To determine fluid and electrolyte imbalance Because this drug cause vasoconstriction effect thereby increasing BP To prevent hyperglycemia and glycosuria To determine if he gained weight and fluid retention To increase body resistance and to prevent the occurrence of hypokalemia To attain the desired outcome more effectively and to avoid reoccurrence of inflammation To elicit cooperation

GENERIC NAME: Budesonide BRAND NAME: Pulmicort Turbuhaler CLASSIFICATION: Corticosteroid DESIRED DOSAGE, ROUTE & FREQUENCY: 2 puffs OD DESIRED EFFECT: This drug is given to our patient in order to reduce inflammation. MECHANISM OF ACTION:

•

Anti – inflammatory effect: local administration into nasal passages maximizes beneficial on the tissues, while decreasing the likelihood of adverse effects from systemic absorption. • Anti-inflammatory corticosteroid that exhibits potent glucocorticoid activity and weak minerolocorticoid activity. The exact mechanism of the cortiosteroids isn’t known, but they have a wide range of inhibitory activity against such cell types such as mast cells and macrophages and mediators (such as leukotrienes) involved in allergic and non-allergic inflammation. INDICATION: Prophylactic therapy in maintenance treatment of asthma CONTRAINDICATIONS: • Contraindicated with hypersensitivity with drug or for relief of acute asthma bronchospasm. Use cautiously with TB, systemic infections and lactation. • Contraindicated with hypersensitivity with adrenergics, anines or formoterol, acute asthma attack, acute airway obstruction. • Use cautiously in the elderly and with pregnancy and lactation. SIDE EFFECT: headache, insomnia, nausea ADVERSE EFFECT: • CNS: headache asthenia, pain, insomnia, syncope, hypertonia • EENT: sinusitis, pharyngitis, rhinitis, voice alteration • GI: oral candidiasis, dyspepsia, gastroenteritis, nausea, dry mouth, taste perversion, abdominal pain • METABOLIC: weight gain • RESPIRATORY: respiratory tract infections, increased cough, bronchospasm • SKIN: ecchymosis • OTHER: flulike symptoms, fever, hypersensitivity reactions Nursing Responsibilities 1) Check doctor’s doctor’s order, 2) Observe the RIGHT’S in administering a drug 3) Use cautiously, if at all, in patients with active or quiescent TB of the respiratory tract, ocular herpes simplex, or untreated systemic fungal, bacteria, viral, or parasitic infections 4) If bronchospasm occurs after using budesonide, stop therapy and treat with a bronchodilator 5) Watch for candida infections of the pharynx 6) Tell patient that budesonide inhaler isn’t a bronchodilator and isn’t intended to treat episodes of asthma 7) instruct patient to use inhaler at regular

Rationale To avoid error in administering the drug To avoid error in administering the drug To avoid further complications

To prevent further complications For immediate treatment of the said complication For precautionary measures Because effectiveness depends on twice-

intervals as follows 8) pulmicort turbuhaler must be kept upright(mouthpiece on top) during loading 9) instruct patient to place mouthpiece between lips and to inhale forcefully and deeply 10) Tell the patient that he may not taste the drug or sense it entering his lungs, but it doesn’t mean it isn’t effective.

daily use on a regular basis To provide correct dosage To obtain the desired effect of the drug faster To make the patient aware on the possible outcome of the drug given

To decrease the risk of developing oral 11) instruct the patient to rinse his mouth candidiasis with water and then spit out the water after each dose 12) Replace mouthpiece cover after use and To prevent the contamination from always keep it clean and dry microorganisms, thereby preventing the occurrence of infection 13) Instruct the patient to carry or wear For identification purposes medical identification indicating need for supplementary corticosteroid during periods of stress or an asthma attack. GENERIC NAME: Formoterol Fumarate Inhalation BRAND NAME: foradil aerolizer CLASSIFICATION: beta2 adrenergic agonist DESIRED DOSSAGE, ROUTE & FREQUENCY: 2 puffs once a day DESIRED EFFECT: This drug is given to out patient in order to promote bronchodilation, thus relieving dyspnea MECHANISM OF ACTION: Beta agonists relax smooth muscle in the bronchioles by activating adenylate cyclase and increasing intracellular concentration of cyclic Adenosine Monophosphate. This increasing cAMP, beta agonist inhibits release of muscle mediators such as histamine and leukotrine (degranulation) which is inhibits smooth muscle contraction, thus bronchodilation occurs. INDICATION: • Maintenance treatment and prevention of bronchospasm in patients with reversible obstructive airway disease or nocturnal asthma, who usually require treatment with short-acting inhaled beta2 adrenergic agonist • Prevention of exercised –induced bronchospasm CONTRAINDICATIONS: contraindicated in patients hypersensitive to drug or its component ADVERSE EFFECTS • CNS: tremors, dizziness, nervousness, headache, fatigue, malaise • CV: chest pain, angina, HPN, hypotension, tachycardia, arrhythmias, palpitations • EENT: dry mouth, tonsillitis, dysphonia • GI: nausea • METABOLIC: hypokalemia, hyperglycemia, metabolic acidosis

• • • •

MUSKULOSKELETAL: muscle cramps RESPIRATORY: chest infection SKIN: rash OTHER: viral infection

Nursing Responsibilities 1) Check doctor’s order 2) Observe the RIGHT’S in administering the drug 3) Watch for immediate hypersensitivity reactions, such as anaphylaxis, urticaria, angioedema, rash and bronchospasm 4) Monitor patient for tachycardia, hypertension and other CV adverse effects. If these occurs, drug may need to be discontinue 5) Foradil capsules should only given via oral inhalation and used only with the Aerolizer Inhaler. They aren’t for oral ingestion. Patient shouldn’t exhale into the device. Capsules should remain in the unopened blister until administration time and only removed immediately before use. 6) Tell patient not to increase the dosage or frequency of use without medical advice. 7) Tell patient to report nausea, vomiting, shakiness, headache, fast or irregular heart beat, or sleeplessness. 8) Instruct the patient not to use the Foradil Aerolizer with a spacer device or to exhale or blow into the Aerolizer inhaler.

Rationale To administer the correct drug t o be given To avoid error To know when to stop the medication to prevent further complications To prevent further complications

Inhalation is preferred because of minimal systemic absorption

To prevent over dosage To know if the drug is to be discontinued Spacer is not applicable when an inhaler is held at the level of the mouth because in this position, large droplets tend to be delivered to the oropharynx and throat, rather than moving down into small airways.

GENERIC NAME: Isosorbide Dinitrate BRAND NAME: Isordil CLASSIFICATION: Anti-angina DESIRED DOSE, ROUTE AND FREQUENCY: 60mg ½ tab OD MECHANISM OF ACTION: dilates the blood vessels by relaxing the muscles in their walls. Oxygen flow improves as the vessels relax, and chest pain subsides INDICATION: Isosorbide dinitrate reduces the blood pressure as well as the capillary pressure (vascular resistance), improving the heart's efficiency. It is used for the treatment and prevention of angina. DESIRED EFFECT: This was given to our patient to help relieve chest pain.

SIDE EFFECTS: headache, dizziness, light-headedness, low blood pressure and weakness, nausea and vomiting, constipation ADVERSE EFFECTS: Collapse, fainting, flushed skin, high blood pressure, pallor, perspiration, rash, restlessness, skin inflammation and flaking, vomiting, blurred vision and irregular heartbeat. CONTRAINDICATIONS: • Use with caution if you have anemia, glaucoma, a previous head injury or heart attack, heart disease or thyroid disease. • People taking diuretic medication or those who have low blood pressure should use the drug with caution. • Do not use sildenafil while taking the drug because the combination could cause severe or life- threatening low blood pressure. Nursing interventions: 1. Verify doctor’s order. 2. Position client in a sitting or lying position when taking in the drug. 3. Encourage patient to consume a highfiber diet and drink plenty of fluids. 4. Provide oral care to the patient.

Rationale: To prevent error. Since the drug may cause fainting or dizziness cause by hypotension. To prevent constipation.

To decrease likelihood of carries and periodontal disease caused by decreased salivation. 5. Instruct client to report recurrence of To see whether the pain was relieved by the pain and if pain is present, notify the doctor drug and for the doctor to know since this immediately. may indicate coronary occlusion. 6. Monitor the vital sign of the patient at Since the drug causes hypotension. regular intervals.

GENERIC NAME: Aspirin (ASA) BRAND NAME: CLASSIFICATION: Non-Steroidal Anti-inflammatory Drug (NSAID) DESIRED DOSE, ROUTE AND FREQUENCY: 80mg one tab a day MECHANISM OF ACTION: Its thought to relieve fever by central cation in the hypothalamic heat-regulating center. Exerts its anti-inflammatory by inhibiting prostaglandin synthesis; also may inhibit the synthesis or action of other mediators of the inflammatory response. DESIRED EFFECT: The drug is given to our patient to reduce inflammation. SIDE EFFECTS: ADVERSE EFFECTS: • EENT: tinnitus, hearing loss • GI: nausea, GI distress, occult bleeding, GI bleeding • HEMATOLOGIC: leukopenia, thrombocytopenia, prolonged bleeding time • HEPATIC: hepatitis • SKIN: rash, bruising, urticartia

• Other: angioedema, hypersensitivity reactions, Reye’s syndrome CONTRAINDICATIONS: Contraindicated in patients hypertensitive to drug and in those with NSAIDinduced sensitivity reactions and bleeding disorders, such as hemophilia. Nursing Responsibilities Rationale 1.Check Doctors order To prevent committing mistakes 2.Assess the patient’s allergy to drug To prevent hypersensitivity reactions 3.Encourage patient to take drugs with To reduce GI reactions food, milk or water 4. Encourage patient to take aspirin after To avoid GI distress meal

XIII.DRUG STUDY Date of administration: January 6 – January 14, 2006 Generic Name: Captopril Brand Name: Capoten Classification: Antihypertensive-angiotensin converting enzyme inhibitor (ACE inhibitor) Dosage, Route, Frequency: 25mg/tab ¼ tab BID Mechanism of Action:

Prevents the production of angiotensin II, a potent vasoconstrictor

that

stimulates

the

production

of

aldosterone by blocking its conversion to the active form. Result in systemic vasodilation.decreased preload and afterload in patients with CHF. Desired Effect: This drug was given to our patient to minimize pulmonary and venous congestion so as not to aggravate further edema, thus, preventing increase of blood pressure. Nursing Responsibilities 1. Monitor blood pressure and pulse rate, weight

Rationale To assess for the fluid balance.

and fluid volume status (I and O) before and throughout the therapy and to assess patient routinely for resolution of fluid overload (weight gain, dyspnea, peripheral edema, and jugular neck vein) if on concurrent diuretic therapy. 2. Administer on empty stomach, 1 hour before or 2

To ensure proper absorption of

hour after meals. 3. Inform the patient and significant others the

drug. To alleviate the anxiety of the

mechanism of action of the drug and possible side

patient

effects such as tachycardia, angina, and cardiac

others. This is also necessary

arrhythmias; GI irritation, ulcers constipation, and

for the client and significant

liver injury; renal insufficiency, renal failure, and

others

proteinuria; and rash, alopecia, dermatitis and

importance of taking the drug.

photosensitivity. 4. Inform the patient and significant others to report if any of the side effects occur. 5. Monitor the patient carefully in any situation that

and

to

the

significant

appreciate

the

To prevent further complications. To detect and treat excessive

might lead to a drop in fluid volume (e.g., excessive

hypotension.

sweating, vomiting, diarrhea, dehydration). 6. Caution the patient to change positions slowly.

To

minimize

orthostatic

hypotension, particularly after 7. Instruct SO to administer Captopril exactly as

initial dose. To ensure the effectivity of the

directed, even if feeling better. Missed doses should

drug

be taken as soon as possible but not if almost time

toxicity.

for the next dose. Do not double doses. 8. Encourage the patient to decreased salt in the

To increase the effectiveness

diet. 9. Provide comfort measures to help the patient

of the drug. To minimize

tolerate drug effects such as small frequent feeding

effects.

and

to

prevent

adverse

drug

side

and safety precautions.

Date of Administration: January 4 – January 7, 2006 (IV), shifted to oral once IV consumed (January 7, 2006) until January 14, 2006 Generic Name: Digoxin Brand Name: Lanoxin Classification: Cardiac glycoside, inotropic agent, antiarrhythmi Dosage, Route, Frequency: 0.12 mg IV every 120 / 0.25-mg/tab ½ tab every 12o Mechanism of Action:

Prolongs refractory period of the AV node. Decreases conduction through the SA and AV node

Desired Effect: This drug was given to our patient to increase the force of myocardial contraction.

Nursing Responsibilities 1. Inform to the patient and significant others the mechanism of action of the drug and possible side effects such as headache, weakness, drowsiness, and vision changes, GI upset and anorexia, and arrhythmias. 2. Monitor apical pulse for 1 full minute prior to administering. Withhold dose and notify physician if pulse rate is