DOCTORS ORDER

Simvastatin 20mg/tab OD HS

ACTION

INDICATION
- To reduce the risk of stroke, TIA, MI in patients with coronary heart disease and hypercholesterolemia -Treatment of patients with isolated hypertriglyceridemia

CONTRAINDICATION
- Contraindicated with allergy to simvastatin, fungal byproducts, pregnancy, lactation. -Use cautiously with impaired hepatic and renal function, cataracts.

ADVERSE EFFECTS
CNS: headache, dizziness, asthenia GI:.abdominal pain, constipation, nausea and vomiting RESPI: LOCAL: sinusitis, pharyngitis

NURSING RESPONSIBILITY
- Assess nutrition - Monitor bowel pattern daily - Advise patient that this drug cannot be taken during pregnancy; advise the use of barrier contraceptives. - Arrange for regular follow-up during long-term therapy. Consider reducing dose if cholesterol falls below target. - Take drug in the evening. Do not drink grapefruit juice while using this drug. - Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine or light-colored stools, fever, muscle pain, or soreness.

- Inhibits HMG coenzyme A, the enzyme that Drug Classification: catalyzes the first Antihyperlipidemic, step in the HMG CoA inhibitor cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

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SulbactamAmpicillin 1.5mg q8 Drug Classification: Anti-infectives Anti-Bacterial Aminopenicillin

ACTION
- Binds to bacteria cell wall, resulting in cell death, spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to betalactamase, enzymes produced by bacteria that may inactivate ampicillin.

INDICATION
-Treatment of infections caused by susceptible strains of Shigella, Salmonella, E. Coli, Haemophilus influenzae, S. typhosa, N. Gonorrhea, enterococci, gram-positive organisms Meningitis caused by Neisseria meningitides

CONTRAINDICATION
- Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.

ADVERSE EFFECTS
CNS: Lethargy, hallucinations, seizures CV: Heart failure GI: Glossitis, stomatitis, gastritis, sore mouth, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembra nous colitis, nonspecific hepatitis GU: Nephritis Hypersensitivit y: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis

NURSING RESPONSIBILITY
Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Instruct patient to notify physician if symptoms do not improve.

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Lactulose 20cc QD HS Drug Classification: Laxatives Purgatives

ACTION
- Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria

INDICATION
- Constipation, salmonellosis. Treatment of hepatic encephalopathy

CONTRAINDICATION
- Pt who require a low lactose diet. Galactosemia deficiency. Intestinal obstruction.

ADVERSE EFFECTS
-Lactose intolerance, diabetes -Abdominal discomfort associated with flatulence and intestinal cramps. -Nausea, vomiting, diarrhea on prolonged use

NURSING RESPONSIBILITY
>Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness >Monitor patient for any adverse GI reactions, nausea,vomiting,diarrhea, >Assess for adverse reactions > regularly assess mental condition for pt. with hepatic encelopathy: >monitor I & O >monitor for Inc. glucose level in diabetic patients

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KCL Tab TID Drug Classification: Electrolyte

ACTION
- Replaces and maintains potassium level.

INDICATION
- Hypokalemia

CONTRAINDICATION

ADVERSE EFFECTS
CNS: mental confusion DERMA: Rash GI:. nausea, vomiting, abdominal pain LOCAL: tissue sloughing, local necrosis, local phlebitis, and venospasm with injection OTHER: weakness or heaviness of limbs, flaccid paralysis, ECG changes, hypotension, arrhythmias, heart block, possible cardiac arrest, respiratory paralysis.

NURSING RESPONSIBILITY
- Monitor cardiac rhythm carefully during IV administration. - Arrange for serial serum potassium levels before and during therapy. - Monitor IV injection sites regularly for necrosis, tissue sloughing, phlebitis.

- Contraindicated with allergy to tartrazine, aspirin (tartrazine is -Prevention and correction found in some preparations of potassium deficiency; marketed as Kaon-Cl, Klor-Con); when associated with severe renal impairment with alkalosis, use potassium oliguria, anuria, azotemia; chloride; when associated untreated Addisons disease; with acidosis, use potassium hyperkalemia; adynamia acetate, bicarbonate, citrate, episodica hereditaria; acute or gluconate dehydration; heat cramps; GI disorders that delay passage in IV: Treatment of cardiac the GI tract. Use cautiously with arrhythmias due to cardiac cardiac disorders, especially if glycosides treated with digitalis, pregnancy, lactation.

- Report tingling of the hands or feet, unusual tiredness or weakness, feeling of heaviness in the legs, severe nausea, vomiting, abdominal pain, black or tarry stools, pain at IV injection site.

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Citicoline 1mg/tab BID

ACTION

INDICATION
- Citicoline is indicated in CVD in acute recovery phase in severe s/sx of cerebrovascular insufficiency and in-cranial traumatism and their sequellae. Citicoline in CVA, stimulates brain function.

CONTRAINDICATION
- Parasympathetic hypertonia. Any allergy or hypersensitivity to the drug Hypertonia of the parasympathetic nervous system Use cautiously for pregnancy and lactation Conscious use for patient with renal and hepatic damage

ADVERSE EFFECTS
CNS: headache GI:.nausea and vomiting, diarrhea, OTHER: hypotension, tachycardia, bradycardia. tching or hives, swelling in face or hands, chest tightness, tingling in mouth and throat

NURSING RESPONSIBILITY
- Monitor patients neurologic status - Note if there are signs of slurring of speech

- Citicoline increases blood flow and O2 Drug consumption in the Classification: brain. It is also CNS stimulant involved in the Neurotropics biosysntehsis Cerebral activators action. -Citicoline seems to increase a brain chemical called phosphatidylcholin e. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.It is usually known that phospholipid, especially lecithin, decreases following decline in brain activity with cerebral trauma.

- instruct the patient to avoid alcohol while taking Citicoline - watch out forn hypotensive effect -Somanize must not be administered along with medicaments containing.

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Clonidine 75mg/tab BID Drug Classification: cardiovascular agent; centralacting antihypertensive; analgesic

ACTION
- Centrally acting antiadrenergic derivative. Stimulates alpha2adrenergic receptors in CNS to inhibit sympathetic vasomotor centers. Central actions reduce plasma concentrations of norepinephrine. It decreases systolic and diastolic BP and heart rate. Orthostatic effects tend to be mild and occur infrequently. Also inhibits renin release from kidneys..

INDICATION
- Step 2 drug in stepped-care approach to treatment of hypertension, either alone or with diuretic or other antihypertensive agents. Epidural administration as adjunct therapy for severe pain.

CONTRAINDICATION
- hypersensitive to drug -patients receiving anticoagulant therapy, in those with bleeding diathesis, in those with an injection site infection. -use cautiously with severe coronary insufficiency, recent MI, cerebrovascular disease, chronic renal failure, or impaired renal function.

ADVERSE EFFECTS
CNS: drowsiness, dizziness, fatique, sedation, weakness, malaise GI:.constipation, dry mouth, nausea, vomiting, anorexia GU: urine retention, impotence

NURSING RESPONSIBILITY
- monitor blood pressure and pulse rate frequently - instruct patient to take drug exactly as prescribed - inform patient that dizziness after can be minimized by rising slowly from a sitting or lying position. -

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Amlodipine 10mg/tab BID

ACTION

INDICATION

CONTRAINDICATION
- contraindicated with allergy of amlodipine, , impaired hepatic or renal function, sick sinus syndrome, heart block, use cautiously with CHF, pregnancy.

ADVERSE EFFECTS
CNS: dizziness, light-headedness, headache, fatiguq, lethargy DERMA:.flushing, rash CV: peripheral edema, arrhythmias.

NURSING RESPONSIBILITY
- Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 69 h following oral doses. - Monitor heart rate; doserelated palpitations (more common in women) may occur. - Report significant swelling of face or extremities. - Take care to have support when standing & walking due to possible dose-related light-headedness/dizziness.

- block the - angina pectoris due to transport of coronary artery spasm calcium into the Drug smooth muscle Classification: cells lining the Calcium antagonist coronary arteries Calcium channel and other arteries blocker of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina).

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Cloxacillin 500mg/tab QID Drug Classification: Anti-infective antibiotic

ACTION
- interferes with cell wall replication of susceptible organisms, the cell wall, rendered osmotically unstable, swell, burst from osmotic pressure.

INDICATION
- treatment of infection caused by pneumococci, Group-A beta-hemolytic streptococci, and penicillin G sensitive staphylococci.

CONTRAINDICATION
- histpry of hypersensitivity to penicillins and cephallosporins. Sever pneumonia, emphysemia, bacteremia, pericarditis and purulent and septic arthritis.

ADVERSE EFFECTS
EENT: occiassionally, laryngeal edema GI:.nausea and vomiting, epigastric distress, diarrhea and flatulence. GU: interstitial nephristis and vasculitis. OTHER: hypersensitivity reactions

NURSING RESPONSIBILITY
- perform skin testing before administering the medications to prevent anaphylactic shock when administered - make sure the patient takes the drug at the same time of the day. And also to prevent them being drug resistant - provide rest and comfort - assess for any signs of hypersensitivity reaction.