Drug Study Amier

DRUG STUDY GENERIC NAME/ BRAND NAME

CLASSIFIC ATION

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 HYDROCORTIS  ONE SODIUM  SUCCINATE  [SOLUCORTEF]

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Short-acting Corticostero ids Antiinflammator  y

DOSAG E/ ROUTE/ FREQ. • 100 mg q 8 hrs

THERAPEUTIC ACTION

INDICATION

Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and  phagocytes and decreasing inflammatory mediators

Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer;arthriris; collagen disease; dermatologic disease; autoimmune and hematologic disorder; trichinosis; ulcerative colitis; multiple sclerosis; aspiration  pneumonia

ADVERESE REACTION/SIDE EFFECT

INTERACTIO NS

CNS: headache, DRUG-DRUG: nervousness, Loop and vertigo, insomnia, diuretics, restlessness, hormonal increase ICP, contraceptives, seizure insulin, CV: hypotension,  NSAID’s, hypertension, heart rifampin. failure, DRUG-Dx thrombophlebitis, TEST: fat embolism, Ca, k, T3, T4, arrhythmias cholesterol, EENT: glaucoma, glucose, digoxin cataract, increase assay ICP, epistaxis, nasal DRUGHERBS: congestion, hoarseness, Gensing, nasopharygeal/ echinacea esopharygeal fungat infection. GI: nausea and vomiting, abdominal distention, dry mouth, rectal  bleeding, peptic ulceration,  pancreatitis. METAB: sodium and fluid retention, hypokalemia,

CONTRAINDI CATION

Hypersentivity to drug Other  immunosuppre ssant corticosteroids Hypertension, osteoporosis, glaucoma, renal & GI disease, cirrhosis Pregnant  breastfeeding  patient Children age 6 and younger 

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NURSING IMPLICATION/ INTERVENTION

Give oral form with food or milk to avoid GI upset Give I.V. injection of  sodium succinate from over 30 sec. to few min. Know that drug may  be given as intermittent or  continuous I.V. dilute in NSS, D5W, and D5NSS. Monitor BP, weight, and electrolytes. As appropriate, review all other  significant and lifethreatening adverse reactions and interaction, especially those related to the drugs, tests, herbs, and behaviors.

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hypocalemia, hyperglycemia, amenorrhea, growth retardation, hypothalamicpituitary suppression. Musculoskeletal: osteoporosis, muscle pain, loss of  muscle mass, aseptic joinr  necrosis, RESP: cough, wheezing, rebound congestion, brochospasm. SKIN: rash,  pruritus, urticaria, acne, petechea. Other: anaphylaxis •

 LEVOFLOXACI   N  [LEVOFLOXA CIN]

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Fluoroquinon e Antiinfective

500 mg I.V. OD

Inhibits the enzyme DNA gyrase in susceptible gramnegative and gram positive aerobics and anerobic  bacteria, interfering with bacterial DNA synthesis.

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CNS: dizziness, DRUG-DRUG: Acute bacterial headache, insomnia, Antacids exacerbation of  containing chronic bronchitis seizure CV: chest pain, aluminum, or  Community palpitation, magnesium, acquired hypotension. cimetidine,  pneumonia EENT:  NSAID’s  Nosocomial DRUG-Dx  photophobia,  pneumonia TEST: sinusitis, caused by  pharyngitis. Glucose, nethicillinlymphocytes, susceptible strains GI: nausea, EEG of staphylococcus vomiting, diarrhea, DRUG-FOOD: constipation, aureus. abdominal pain, milk, yogurt. Acute bacterial DRUGdyspepsia, sinusitis HERBS: flatulence,

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Hypersensitito drug or  qunolones Bradycardia Acute myocardial ischemia Renal impairment, underlying CNS disease Elderly patient

To prepare I.V infusion, use compatible sol’n, such as 0.9% sodium chloride injection, D5% and 0.9% NSS, D5%W, D5%LR  sol’n. Infuse over 60-90 minutes, depending to the dosage. Don’t infuse with other  drugs.\avoid rapid or   bolus I.V administration,

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Uncomplicated skin to skin structure infection Complicated or  uncomplicated UTI, acute  pyelonephrits. Chronic bacterial  prostitis Conjunctivitis Corneal ulcer  Inhalation anthrax

pseudomembranou s coitis. GU: vaginitis HEMA: lymphocytopenia METAB: hyperglycemia, hypoglycemia MUSC: back pain, tendon rupture, tendinitis SKIN:  photosensitivity Other: altered taste,  pain on I.V site

fennel, st. john’s wort DRUGBEHAVIOR: sun exposure

 because this may cause severe hypotension. Flush I.V line before and after infusion. Check v/s, especially BP. Too-rapid infusion can cause hypotension. Closely monitor   patient with renal insufficiency. Assess severe diarrhea, w/c may indicate  pseudomembranousc olitis. Watch for  hypersensitivity reaction. D/C immediately if rash or other sign and symptoms occur.

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 PHYTONADIO  NE  [VITAMIN K]

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Vitamins Antihaemorrhagi c

1 amp I.V. OD

Promotes hepatic synthesis of   prothrombin,  proconvertin,  plasma thromblastin component, and stuart factor 

Hypothrobinemia Prevention and treatments of  hemorrhagic disease in new  born.

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Hyperbilirubine mia (n infant); with parenteral administration pain, sweeling, tenderness at injection site; itching rash after  repeated injection, transient flushing sensation,  peculiar taste, anaphylactoid reaction.

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GI: gastric upset, unusual taste. Derm: flushing, rash, urticaria. Hemat: hemolytic anemia. Misc: allergic reactions, hyperbilirubin emia (large doses in very

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Contraindicat ed in hypersensitiv ity to drug or  to its components. (lifethreatening reactions resembling hypersensitiv ity have occurred during and immediately

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Should be protected from light Should not be allowed to freeze Should be stored at 25°C or below Should not be used if  turbid

 premature infants), kernicterus.

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 PIPERACILLIN  SODIUM AND TAZOBACTAM  SODIUM  [PIPTAZ]

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Penicillin (extendedspectrum),  beatalactamase inhibitor  Antiinfective

2.25 gms. Piperacillin inhibits Q 8 hrs  bacterial cell- wall I.V OD synthesis, resulting in cell death. Tazobactam increases  piperacillin efficacy

Communityacquired  pneumonia Rupture appendix Peritonitis Pelvic inflammatory disease Skin and skin structure infections  Nosocomial infection

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CNS: headache insomnia, agitation, dizziness, anxiety, depression, twitching, coma,seizure. CV: hypertension, chest pain, tachycardia. EENT: rhinitis, glossitis GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pai, pseudomembra nuous colitis. GU: proteinuria,

DRUG-DRUG: Aminoglycoside ,aspirin, hormonal contraceptive, methotrexate, tetracyclines, vecuronium DRUG-Dx TEST: Urine glucose test, urine  protein, eosinophils, granulocytes, Hgb, platelets

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after I.V injection). Use cautiously in  pregnant or   breasetfeedin g patient, children, neonates. Avoid P.O use in disorder that may prevent adequate absorption. Hpersensivit y to  penicillin, cephalospori n, imipenems, or betalavtamase inhibitors  Neonates Heart failure Renal insufficiency Seizure Bleeding disorder  Uremia Hypokalemia Cystic fibrosis Patient with sodium restriction

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Ask patient about allergy to penicillins. Dilute each gram with 5cc of diluents, such as sterile or   bacteriostatic water  injection, NSS, D5W, D5NSS, don’t use LR. Shake vial until drug dissolve. Dilute again to a final vol. of 50 cc, infuse over 30 min. Assess neurologic status especially for  seizure. Monitor vital sign and i&O Instruct client to report rash, hives, severe diarrhea, black  tongue, sore throat,

hematuria, vaginal candidiasis, vaginitis, oliguria, interstitial glomerulonephr itis. HEMA: anemia, increased bleeding, bone marrow defression, leucopenia, thrombocytopen ia. METAB: hypokalemia, hypernatremia. RESP: dyspnea SKIN: rash,  pruritus Other: fever,  pain, edema, inflammation, or   phlebitis at I.V site, superinfection, hypersensitivity reaction, including serum sickness and anaphylais Hemolytic anemia Leucopenia  Neutropenia panyctopenia, Thrombosytopeni

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Pregnant or   breastfeeding  patient

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fever, or unusual  bleeding or bruising Tell patient to instruct to monitor I & O, annnd report significant changes. Kept patient monitored

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 PARACETAMO  L [BIOGESIC]

500 mg Anti1 tab q 4  pyretics Pain reliever  hrs/ 300 mg, 1 amp q 4

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May cause analgesia by inhibiting CNS  prostaglandin synthesis

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Temporary relief  of pain and discomfort for  headache, fever, cold, flu, minor 

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Barbiturates, carbamapezin e, hydantoins, isoniazid, rifampin,

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Contraindicate d with allergy to acetaminophe n

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Assess patients pain or temperature before

 beginning treatment •

Be alert for signs of 

hrs Decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation

muscular aches, overexertion

a liver damage,  jaundice, hypoglycemia, rash • • •

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 Ethambutol   HCl 300 mg,  INH 75 mg,

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Anti-TB agent

1 tab AC  breakfast, AC lunch

Unknown, may interfere with synthesis of one or  more bacterial

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initial & continuation  phase of 

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Leukopenia, Thrombocytope nia

sulfinpyrazon e: May reduce therapeutic effect and enhance hepatotoxic effects of  acetaminophe n with high doses or longterm use of  these drugs. Avoid use together. Lamotrigine: Serum lamotrigine concentration s may be reduced and may decrease therapeutic effects. Warfarin: May increase hypoprothrom  bin-emic effect with long-term use of high doses. Monitor PT and INR  closely.

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 Neurotoxic drugs Al-

Use cautiously with impaired hepatic function, chronic alcoholism,  pregnancy, lactation

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adverse reactions. •

Tell patient not to use drug fever that’s

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higher than 103.1 F Warn patient that high doses and unsupervised long term use can cause liver damage

tell patient keep tract of daily oral drug intake

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Alcoholism optic neuritis,

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Should be taken on an empty stomach (Take 1 hr before

rifampicin 150 mg 

metabolites, altering RNA synthesis during cell devision

 pulmonary & extrapulmonar  y TB.

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[MYRIN P] •

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Neutropenia anaphylactic/an aphylactoid reaction pemphigoid reaction Anorexia elevations of  serum uric acid concentration Dizziness Hypoesthesia Paresthesia decrease in visual acuity epigastric distress Constipation Nausea Vomiting abdominal pain metallic taste dry mouth liver  impairment Pruritus Rash toxic epidermal necrolysis joint pain acute gout Fever  Lymphadenopat hy

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containing antacids Phentolami ne coumarintype drugs OCs sulfonylure a oral antidiabetic agents  phenobarb systemic βadrenergic  blocking agents corticostero ids digitalis glycoside estramustin e clofazimine inandione derivative anticoagula nts,  benzodiaze  pines hepatotoxic medications or   parenteral miconazole

impaired hepatic function, severe renal insufficienc y, hyperuricem ia gouty arthritis  jaundice, retrobulbar  neuritis. Patients w/ mental illness/defic iency. Childn Giv >Givee

drug drug

with with

right dosage, route, and

time

for  

administration. Prior

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the

procedure: 

Read the Doctor’s order   before giving the medication to the patient, and always

in patients w/  preexisting outflow tract obstruction.

remember the

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10 R’s 

Inform the  patient about the action and the  purpose of the drug.

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Before giving the medication ask the patient first if she already take the medications or  not.

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 Note if all the medications are available, if one of the medication are not available make a  prescription and ask the patient’s SO to buy it for  the patient.

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Check if the

nebulizer is functioning 

Prepare the drug  by diluting it with distilled water 

During the procedure: 

Make sure that

the patient will take the medications on time. 

If the

medication is an IV route, make sure that you administer it on time. 

Always be at the

 bedside of the patient in order to help the patient in taking her  medications. 

Follow the

directions on your   prescription label 

Monitor the

 patient while inhaling the atomized drug if it

is in proper place 

Instruct patient

to take medication as directed for the full course of therapy. After the procedure: 

Instruct patient

to take medication at evenly spaced times and to finish the medication completely. 

Observe for side

effects or allergies. 

Inform the

 patient on the specific time the medication is to taken again. 

Inform patient

that increased fluid intake and exercise may minimize constipation 

 FLUTICASONE  [FLIXOTIDE]

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Prophylactic management for mild, moderate,

1 neb q 12 hrs

Glucocorticoid with a high topical antiinflammatory  potency. It has a

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It is used by inhalation for the  prophylaxis of the symptoms of 

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Candidiasis dryness of mouth and throat Hoarseness

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Ritovir  Ketoconazole MOI TCA

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Primary treatment of  severe acute asthmatic

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Document. Advice patient that drug is for long term maintenance.

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severe asthma Symptomati c COPD

strong affinity for  and agonist activity at human glucocorticoid receptors. •

asthma; also, is administered by nasal spray in the  prophylaxis and treatment of  allergic rhinitis. It is applied topically in the treatment of  various skin diorders.

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SALBUTAMOL [VENTOLIN]

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Therapeutic:  bronchodilat ors, antiasthmatic Pharmacolo gic: betaadrenergics agonist

1 neb q 4 hrs

Is a beta2adrenergic agent which acts on airway smooth muscle resulting in relaxation. Salbutamol relaxes all smooth muscle from the trachea to the terminal  bronchioles and  protects against all  bronchoconstrictor  challenges

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Treatment/  prevention of   bronchospasm

Paradoxical  bronchospasm. Cutaneous hypersensitivity reactions. Possible systemic effects include suppression of  adrenal function, growth retardation in children and adolescents, decrease in bone mineral density, cataract and glaucoma.

Tachycardia Dizziness Palpitations headache, espe especi ciaally lly in hypersensitive  patients Cough Headache  Nervousness Sinus inflammation Sore or dry throat Tremor  Trouble sleeping Unusual taste in mouth Vomiting

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Beta2adrenergic  blocker  diuretics

Beta-blocker  Diuretics Digoxin MAO/TCA

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attacks or  status asthmaticus when intensive measures are required. When applied topically: rosacea, acne vulgaris,  perioral dermatitis,  perianal and genital  pruritus. Cutaneous viral infections Hypersensiti ve reaction. Urticania. Anginoedem a. Rashes Anaphylaxis. Oropharynge al edema

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Tell the patient not to stop oral or  inhaled long acting  beta agonist.

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Instruct patient on the proper way of  drug inhalation and not to exceed dose under any circumstances.

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Instruct to rinse mouth after  inhalation.

Instruct the patient on the how to use the nebulizer. Instruct the patient on the frequency of  nebulization. Instruct the patient what to do during the asthma attack. Advice the client when to attend for  follow-up visits.

Paradoxical  bronchospasm Hypokalemia Immediate hypersensitivtity reaction

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 FLUCONAZOL  E  DIFLUCAN

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Antifungal

200 mg 1 cap q BID

Binds to sterols in the fungal cell membrane, changing membrane  permeability; fungicidal or  fungistatic depending on concentration and organism.

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Treatment of  oropharyngeal, esophageal, vaginal, and systemic candidiasis Treatment of  cryptococcal meningitis Prophylaxis of  candidiasis in  bone marrow transplants

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CNS: Headache  Drug-drug  • Increased GI: Nausea, serum levels vomiting, and therefore diarrhea, therapeutic abdominal pain and toxic Other: Rash effects of  cyclosporine,  phenytoin,  benzodiazepi nes, oral hypoglycemi cs, warfarin anticoagulant s, zidovudine • Decreased serum levels with rifampin, theophylline, tacrolimus

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Contraindicate  Interventions d with Culture infection hypersensitivit  prior to therapy; y to  begin treatment fluconazole,  before lab results are lactation. returned. Use cautiously Decrease dosage in with renal cases of renal failure. impairment. Infuse IV only; not intended for IM or  SC use. Do not add supplement medication to fluconazole. Administer through sterile equipment at a maximum rate of  200 mg/hr given as a continuous infusion. Monitor renal function tests weekly, discontinue or decrease dosage of  drug at any sign of  increased renal toxicity. •

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Teaching points Drug may be given

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TERGECEF  [TERGECEF]

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Cephalospor  200 mg 1 cap BID in Antiinfective

Third general cephalosporin that inhibits cell wall synthesis,  promoting osmotic instability usual  bactericidal.

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Bronchitis  bronchiectasis with infection, secondary infections of  chronic respiratory tract

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Shock  Hypersensitivity hematologic disorder  GI disorder  Vita. K  deficiency.

DRUG-DRUG: Aminoglycoside ,aspirin, hormonal contraceptive, methotrexate, tetracyclines,

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Hpersensivit y to  penicillin, cephalospori n, imipenems, or beta-

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orally or  intravenously as needed. The drug will need to be taken for the full course and may need to be taken long term. Use hygiene measures to prevent reinfection or spread of infection. Arrange for frequent follow-up while you are using this drug. Be sure to keep all appointments, including those for   blood tests. These side effects may occur: Nausea, vomiting, diarrhea (eat frequent small meals); headache (analgesics may be ordered). Report rash, changes in stool or urine color, difficulty  breathing, increased tears or salivation. Ask patient about allergy to penicillins. Dilute each gram with 5cc of diluents, such as sterile or   bacteriostatic water  injection, NSS, D5W,

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diseases pneumonia Pyelonephritis Cystitis gonococcal urethritis Cholecystitis Cholangitis scarlet fever  Otitis media Sinusitis.

vecuronium DRUG-Dx TEST: Urine glucose test, urine  protein, eosinophils, granulocytes, Hgb, platelets

D5NSS, don’t use LR. Shake vial until drug dissolve. Dilute again to a final vol. of 50 cc, infuse over 30 min. Assess neurologic status especially for  seizure. Monitor vital sign and i&O Instruct client to report rash, hives, severe diarrhea, black  tongue, sore throat, fever, or unusual  bleeding or bruising Tell patient to instruct to monitor I & O, annnd report significant changes.  Kept patient monitored  • Asses’ patient’s Patient with condition before abnormal amino acid starting the therapy. metabolism • Be alert to (since the infuse amino adverse acids are not reaction. • Monitor patient adequately metabolized temperature. If GI reaction occur  The patient monitor patient clinical hydration condition may  be worsened.)

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[AMINOLEBA N]

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A balance and tolerable food supplement to nutritionall y support  patients with liver  disease.

500 cc @ 20cc/hr q 24 hrs

Hepatic encephalopathy is a neuropsychiatric syndrome that develops secondary to liver disease or to  portal-systemic shunting of   blood, or both. In such a patient,  plasma

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For the treatment of Hepatic Encephalopathy in patient with chronic liver  disease.

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Hypersensitivity : rare skin eruptions Gastrointestinal : occasional nausea and vomiting Others: occasional chills, fever, headache

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lavtamase inhibitors  Neonates Heart failure Renal insufficiency Seizure Bleeding disorder  Uremia Hypokalemia Cystic fibrosis Patient with sodium restriction Pregnant or   breastfeeding  patient

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Use with

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concentrations of  aromatic amino acids (phenylalanine, tyrosine, tryptophan) is found to be higher than normal while the  plasma concentration of  BCAA (leucine, isoleucine, valine) is lower  than normal. It was suggested that a disturbance of plasma amino acid pattern may cause a disturbance in the  brain amino acid concentration. Brain neurotransmissio n is then impaired by an inhibition of  dopamine and noradrenaline synthesis, leading to an increase of  false neurotransmitters

care in  patients with severe acidosis and those with congestive heart failure.

including octopamine and  phenylethanolam ine. These toxic substances are suspected to induce hepatic encephalopathy. BCAA is given to normalize the amino acid imbalance in the  plasma in order  to compete with AAA for an uptake into the  brain. In addition, after  the infusion of  high BCAA solution, the ammonia concentration in the blood is also decreased mainly due to the detoxification of  ammonia to form glutamine. Another unique quality of BCAA is that they are

mostly metabolized in the skeletal muscle, not in the liver. They then  become good sources in  providing  peripheral energy. In catabolic state, BCAA play an important role in  preventing the muscle protein  breakdown and in promoting  protein synthesis to maintain  positive nitrogen  balance.