Drug Study- Paracetamol

UNIVERSITY OF CEBU – BANILAD COLLEGE OF NURSING DRUG STUDY Patient:Mr. R. B. O. Age: 29 yrs. old Impression: Multiple Physical Injuries secondary to Motor vehicular Accident Allergy to: None Generic & Brand Name

Dose, Strength & Formulation

Generic: Ordered: Paracetamol Give 1 tab by mouth Brand: 3x a day. Tylenol (Tylenol 650 mg tab) Classification: Timing: Analgesics 8 am ( Non1 pm opioid) 7 pm Antipyretics Duration: 4-6 hours Other forms: >Caplets: 165 mg, 500 mg,

Hospital No.: 070022437156 Room No.: A-701 Attending Physician(s): Dr. Christopher Ting Go

Indication/ Mechanisms Of Drug Action

Adverse/ Side Effects Drug Interactions

Nursing Responsibilities

Indications: Temporary relief of pain and discomfort from headache, fever, cold, flu, minor muscular aches, overexertion, menstrual cramps, toothache, minor arthritic pain.

Adverse Reaction Hematologic: hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia. Hepatic: liver damage, jaundice Metabolic: hypoglycemia Skin: rash, urticuria

ASSESSMENT 1. Assess patient’s pain or temperature before therapy and regularly thereafter. (Student’s Drug Handbook, 2009: 101)

Mechanism of Action: Paracetamol may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of

Interactions: Barbiturates, carbamapezine, hydantoins, isoniazid, rifampin, sulfinpyrazone:

Rationale

Client Teaching

1. To indicate baseline data and monitor drug’s effectiveness.

1. Tell patient not to use drug for fever that’s higher than 103.1 °F, lasts longer than 3 days, or recurs.

2, Asses patient’s drug history and calculate total daily dosage accordingly. (Student’s Drug Handbook, 2009: 101)

2. To prevent over dosage that could lead to toxicity and liver damage.

2Warn patient that high doses or unsupervised long-term use can cause liver damage.

3. Be alert for signs of reactions and drug

3. To establish proper precautionary

3. Tell patient to keep track of daily drug intake, including OTC and prescription

650 mg >Caplets ER: 650 mg >Capsules: 5oo mg >Elixir: 80 mg/2.5 mg, 80 mg/5 ml, 120 mg/5 ml >Gelcaps: 500 mg >Geltab: 500 mg

morphine is believed to involve decreased permeability of the cell membrane to sodium, which results in diminished transmission of pain impulses therefore analgesia.

May reduce therapeutic effect and enhance hepatotoxic effects of acetaminophen with high doses or long-term use of these drugs. Avoid use together. Lamotrigine: Serum lamotrigine concentrations may be reduced and may decrease therapeutic effects. Warfarin: May increase hypoprothrombinemic effect with long-term use of high doses. Monitor PT and INR closely. Zidovudine: May increase risk of bone marrow suppression because of impaired zidovudine metabolism. Monitor patient closely.

interactions. (Student’s Drug Handbook, 2009: 101)

measures and management for possible adverse effects of drug.

4. Assess patient’s and family’s knowledge of drug therapy. (Student’s Drug Handbook, 2009: 101)

4. To determine the level of understanding of the patient and her family about the drug therapy

NURSING DIAGNOSES • Acute pain related to patient’s underlying condition. • Risk for injury related to druginduced liver damage with toxic doses. • Deficient knowledge related to drug therapy.

medications. 4. Tell a breastfeeding woman that drug appears in breast milk in levels less than 1% of dose.

Generic & Brand Name

Dose, Indication/ Strength & Mechanisms Of Formulation Drug Action

Generic: Ordered: CoGive 1 tab Amoxiclave by mouth 3x a day. Brand: (Natravox Augmentin 625 mg tab) Classification: Penicillins

Timing: 8 am 1 pm 7 pm Duration: 6-8 hr Other forms: Chewable Tablets: 25 mg amoxicillin, 31.25 mg clavulanic acid; 200 mg amoxicillin, 62.5 mg clavulanic ER tablets:

Indications: Respiratory tract, GUT, abdominal, skin and soft tissues infection. Mechanism of Action: Prevents bacterial cell-wall synthesis during replication. Clavulanic acid increase amoxicillin’s effectiveness by inactivating beta lactamases, which destroy amoxicillin.

Adverse/ Side Effects Drug Interactions

Nursing Responsibilities

Adverse Reaction CNS: Agitation, anxiety behavioral changes, confusion, dizziness, insomnia. GI: Abdominal pain, black “hairy” tongue, diarrhea, enterocolitis, gastritis, glossitis, indigestion, nausea. GU: Vaginal candidiasis, vaginitis. Hematologic: Agranulocytosis, anemia, eosinophilia, leucopenia. Other: Hypersensitivity reactions, angioedema, pruritus, rash, urticaria.

ASSESSMENT 1. Assess patient’s infection, ask about past allergic reactions before therapy and regularly thereafter. (Student’s Drug Handbook, 2009: 147)

Rationale

Client Teaching

1. To indicate baseline data and monitor drug’s effectiveness.

1. Tell patient to take entire quantity of drug exactly as prescribed, even after he feels better.

2, Asses patient’s drug history and calculate total daily dosage accordingly. (Student’s Drug Handbook, 2009: 147)

2. To prevent over dosage that could lead to toxicity and liver damage.

3. Be alert for signs of reactions and drug interactions. (Student’s Drug Handbook, 2009: 147)

3. To establish proper precautionary measures and management for possible adverse effects of drug.

4. Monitor hydration status if

4. To prevent complications

2. Tell patient to call prescriber if rash develops (sign of allergic reaction). 3. Instruct patient to take drug with food to prevent GI distress.

1000 mg amoxicillin, 62.5 clavulanic acid Tablets (filmcoated): 250 mg amoxicillin, 125 mg clavulanic acid; 500 mg amoxicillin, 125 mg clavulanic acid

Interactions: Drug-drug Allopurinol: May cause rash. Monitor patient. Probenecid: May increase level of amoxicillin and other penicillins. Probenecid may be used for this purpose.

adverse GI reactions occur. (Student’s Drug Handbook, 2009: 147) 5. Assess patient’s and family’s knowledge of drug therapy. (Student’s Drug Handbook, 2009: 147) NURSING DIAGNOSES • Ineffective protection related to presence of susceptible bacteria. • Risk for deficient fluid volume related to druginduced adverse GI reactions. • Deficient knowledge related to drug therapy.

such as diarrhea. 5. To determine the level of understanding of the patient and her family about the drug therapy

Generic & Brand Name

Dose, Indication/ Strength & Mechanisms Of Formulation Drug Action

Adverse/ Side Effects Drug Interactions

Nursing Responsibilities

Generic: Betahistine DiHCl

Ordered: Give 1 tab by mouth now then 3x a day. (Serc 16 mg tab)

Adverse Reaction Skin: rashes GI: mild gastric complaints

ASSESSMENT

Brand: Serc Classification: Antivertigo

Timing: 8 am 1 pm 7 pm Duration: Unknown Other forms: No other than tablet

Indications: Meniere’s disease, vertigo, Menierelike syndrome characterized by attacks of vertigo, tinnitus and sendorineural deafness.

Mechanism of Action: Serc exerts a relaxant action on the precapillary sphincters of the microcirculation of the inner ear, and thereby increases the blood supply to the stria vascularis of the labyrinth. Investigations into the acute, subacute and chronic effects of

Interactions: Antihistamine: May affect how betahistine works or may be affected by betahistine.

Rationale

Client Teaching

1. Assess patient before therapy and regularly thereafter. (Student’s Drug Handbook, 2009: 10)

1. To indicate baseline data and monitor drug’s effectiveness.

2, Asses patient’s drug history and calculate total daily dosage accordingly. (Student’s Drug Handbook, 2009: 101)

2. To prevent over dosage that could lead to toxicity and liver damage.

2. Tell patient to report drug adverse reactions

3. Be alert for signs of reactions and drug interactions. (Student’s Drug Handbook, 2009: 101)

3. To establish proper precautionary measures and management for possible adverse effects of drug.

4. Teach patient how to store drug.

4. Assess patient’s and family’s knowledge of drug

4. To determine the level of understanding of

1. If patient misses a dose, tell her to take it as he remembers but not to double the dose.

3. Inform patient that drug may be taken with meals.

betahistine in animals have demonstrated the low toxicity and safety of the drug.

therapy. (Student’s Drug Handbook, 2009: 101)

the patient and her family about the drug therapy

Generic & Brand Name Generic: Mupirocin Brand: Bactroban 2% ointment Classification: Topical Antibiotic

Dose, Indication/ Strength & Mechanisms Of Formulation Drug Action Ordered: Apply ti abrasions twice a day. ( Bactroban 2% ointment 5 gram)

Indications: Impetigo due to Staphylococcus aureus, Streptococcus pyogenes, and beta-hemolytic streptococcus.

Timing: 8 am 7 pm

Mechanism of Action: Binds to bacterial isoleucyl transfer RNA synthetase, which results in inhibition of protein synthesis by the organism. Not absorbed into the systemic circulation. Serum present in exudative wounds decreases the antibacterial activity.

Duration: Other forms: Nasal ointment: 2%. Topical Cream: 2%

Adverse/ Side Effects Drug Interactions Adverse Reaction Skin: Burning, stinging or pain, itching, rash, erythema, dry skin, tenderness, swelling contact dermatitis, increased exudates GI: nausea Interactions: Caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of the drug.

Nursing Responsibilities ASSESSMENT 1. Assess patient before therapy and regularly thereafter. (Student’s Drug Handbook, 2008: 1058) 2, Note reasons for therapy, onset, duration, S & S characteristics. (Student’s Drug Handbook, 2008: 1058) 3. Be alert for signs of reactions and drug interactions. (Student’s Drug Handbook, 2008: 1058) 4. Assess patient’s and family’s knowledge of drug therapy. (Student’s Drug Handbook, 2008: 1058)

Rationale 1. To indicate baseline data and monitor drug’s effectiveness. 2. To determine the exact reason of therapy so that optimum treatment will be achieved. 3. To establish precautionary measures and management for possible adverse effects of drug. 4. To determine the level of understanding of the patient and her family about the drug therapy.

Client Teaching

1. Review technique for administering topical medications; use aseptic measures and handwashing before and after therapy to prevent contamination. 2. Report any symptoms of chemical irritation or hypersensitivity such as increased rash, itching, pain at site, or lack of healing. 3. Report if no improvement in skin infection after 3-5 days of therapy.