UNDERSTANDING PATIENT'S DRUG THERAPY

PATIENT PROFILE
DOB: 11/06/91
Age: 23
Sex:
Female
Citizenship: Filipino
Civil Status: Female
Pertinent History and PE:
Four days prior to admission, patient had
onset of pain and tenderness on both lower
extremities with limitation of movement.
Unable to ambulate due to pain, positive cough
with blood tinged sputum, positive pain on
back area, stabbing when in deep inspiration,
no fever. Patient took prednisone 20 mg thrice
a day with relief after 5 hours.
On the day of admission, there is persistence
and did not took prednisone 20 mg thus sought
admission for further management.
Admitting Impression:
Systemic Lupus Erythematosus (SLE)
Doctor's complete drug order:
Cefuroxime (zegen 750 mg vial 1's)
Give 1 vial IV infusion every 8 hours
After negative skin test

Laboratory/Diagnostic Procedure Related

to Drug Therapy:
Urinalysis

Generic Name: Cefuroxime

Brand name: Zegen
Therapeutic Category: Cephalosporins

Category:
O HAMS
REGULAR DRUG
O LASA

Uses:
Inj: Treatment of bone & joint infections, bronchitis (& other lower resp tract infections),
gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infections, surgical
infections & UTI.
Pharmacokinetics:
Following IV doses of 750 mg and 1.5 g, serum concentrations were approximately 50and 100 mcg/mL,
respectively, at 15 min, while the therapeutic serum concentrations of approximately 2 mcg/mL or more
were maintained for 5.3 and 8 hrs or more, respectively.
Contraindications:
Known hypersensitivity to cefuroxime or other cephalosporins or any component of Zegen.
Special Concerns/Warnings/Precautions:
Hypersensitivity to penicillins. Possible superinfection in prolonged use. Nephrotoxicity &
ototoxicity. Patients w/ poor nutritional state, renal or hepatic impairment, receiving
protracted antimicrobial course & previously stabilized on anticoagulant
therapy. Discontinue use if seizures develop.
Side effects (most common):
Thrombophlebitis. Pruritus, urticaria, +ve Coombs' test, diarrhea, nausea,
pseudomembranous colitis. Decrease in Hb & hematocrit, transient increase in liver
enzymes, elevation in serum creatinine & BUN.
Food and drug interactions:
Aminoglycosides, diuretics eg furosemide & ethacrynic acid. Probenecid. Tab: Oral antacids,
OCs.
Overdose Management:
If acute overdosage occurs, cefuroxime may be removed by hemodialysis or peritoneal
dialysis.

NURSING CONSIDERATIONS
O LASA
Administration/Storage:
> Should be taken immediately after food.
> Store at temperatures not excedding 30

Assessment:
> Assess patient for infection at the beginning and during the therapy.
> before initiating therapy, obtain a history to determine previous use
of and reaction to penicillin Person with negative history of penicillin
sensitivity may still have an allergic response.
> obtain specimen for culture and sensitivity before initiating the
therapy.
> observe patient for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema. wheezing)
> assess patient for renal dysfunction and adjust accordingly.

Patient and Family Teaching:

> teach the patient to take the medicine immediately with food.
> report loose stools or diarrhea promptly
> report any signs of hyper sensitivity
> do not breastfeed while taking this drug

Outcome/Evaluation:

UNDERSTANDING PATIENT'S DRUG THERAPY

UNDERSTANDING PATIENT'S DRUG THERAPY

PATIENT PROFILE
DOB: 11/06/91
Age: 23
Sex:
Female
Citizenship: Filipino
Civil Status: Female
Pertinent History and PE:
Four days prior to admission, patient had
onset of pain and tenderness on both lower
extremities with limitation of movement.
Unable to ambulate due to pain, positive cough
with blood tinged sputum, positive pain on
back area, stabbing when in deep inspiration,
no fever. Patient took prednisone 20 mg thrice
a day with relief after 5 hours.
On the day of admission, there is persistence
and did not took prednisone 20 mg thus sought
admission for further management.
Admitting Impression:
Systemic Lupus Erythematosus (SLE)
Doctor's complete drug order:
Pregabalin (Lyrica 50 mg capsule 56's)
Give 1 cap oral twice a day

Generic Name: Pregabalin

Category:
Brand name: Lyrica
O HAMS
O
Therapeutic Category: drugs for
REGULAR DRUG
neuropathic pain / Anticonvulsant
O LASA
Uses:
Treatment of neuropathic pain in adults, including neuropathic pain associated w/ spinal cord
injury. Adjunctive therapy in adults w/ partial seizures w/ or w/o secondary generalization;
generalized anxiety disorder (GAD) in adults. Management of fibromyalgia .
Pharmacokinetics:
Absorption: Pregabalin is rapidly absorbed when administered in the fasted state, with peak
plasma concentrations occurring within 1 hr following both single and multiple dose
administration. Pregabalin oral bioavailability is estimated to be 90% and is independent of
dose
Contraindications:
Hypersensitivity to pregabalin.
Special Concerns/Warnings/Precautions:
Discontinue use if symptoms of angioedema or upper airway swelling occur.
Side effects (most common):
Nasopharyngitis, increased appetite, euphoric mood, confusion, irritability, depression,
disorientation, insomnia, decreased libido, dizziness, somnolence, ataxia, coordination
abnormality, tremor, dysarthria, amnesia, memory impairment, disturbance in attention,
paresthesia, hypoesthesia, sedation, balance disorder, lethargy, blurred vision, diplopia,

Laboratory/Diagnostic Procedure Related

to Drug Therapy:

vertigo, vomiting, constipation, flatulence, abdominal distention, dry mouth, muscle cramp,
arthralgia, back pain, pain in limb, cervical spasm, peripheral edema, edema, gait
abnormality, fall, feeling drunk, feeling abnormal, fatigue & increased wt; headache, nausea
& diarrhea.
Food and drug interactions:
Potentiate effects of ethanol & lorazepam. Resp failure & coma may occur w/ other CNS
depressants. Additive impairment of cognitive & gross motor function w/ oxycodone.
Overdose Management:
Treatment of pregabalin overdose should include general supportive measures and may
include hemodialysis if necessary

UNDERSTANDING PATIENT'S DRUG THERAPY

NURSING CONSIDERATIONS
O LASA
Administration/Storage:
> Store at temperatures not exceeding 30C.
> May be taken with or without food.
> when discontinuing lyrica, taper gradually over a minimum of 1
week.

Patient and Family Teaching:

> Do not drive or engage in potentially hazardous activities until
response to drug is known.
> Report any of the following to a health care provider: changes in
vision (i.e., blurred vision); dizziness and incoordination; unexplained
muscle pain, weakness, or tenderness; weight gain and swelling of the
extremities.
> Avoid alcohol consumption while taking this drug.
> Inform your physician if you plan to become pregnant or father a
child.
> Do not breast feed while taking this drug without consulting
physician.
> warn against stopping pregabalin abruptly
> alert patient that drug may cause edema and weight gain

Assessment:
> Monitor for weight gain, peripheral edema, and S&S of heart
failure, especially with concurrent thiazolidinedione (e.g.,
rosiglitazone) therapy.
> Monitor diabetics for increased incidences of hypoglycemia.
> Withhold drug and notify physician if rhabdomyolysis is suspected
> Supervise ambulation especially when other CNS drugs are used
concurrently.
Outcome/Evaluation:

UNDERSTANDING PATIENT'S DRUG THERAPY

PATIENT PROFILE
DOB: 11/06/91
Age: 23
Sex:
Female
Citizenship: Filipino
Civil Status: Female
Pertinent History and PE:
Four days prior to admission, patient had
onset of pain and tenderness on both lower
extremities with limitation of movement.
Unable to ambulate due to pain, positive cough
with blood tinged sputum, positive pain on
back area, stabbing when in deep inspiration,
no fever. Patient took prednisone 20 mg thrice
a day with relief after 5 hours.
On the day of admission, there is persistence
and did not took prednisone 20 mg thus sought
admission for further management.
Admitting Impression:
Systemic Lupus Erythematosus (SLE)

Doctor's complete drug order:

Levetiracetam (Keppra 500 mg tablet 60's)
Give 1 tab oral twice a day

Generic Name: Levetiracetam

Brand name: Keppra
Therapeutic Category: Anticonvulsants

Category:
O HAMS
REGULAR DRUG
O LASA

Uses:
Monotherapy in the treatment of partial onset seizures w/ or w/o secondary generalization in
adults & adolescents 16 yr w/ newly diagnosed epilepsy.
Pharmacokinetics:
Levetiracetam is a highly soluble and permeable compound. The pharmacokinetic profile is
linear with low intra- and intersubject variability. There is no modification of the clearance
after repeated administration.
Absorption: Levetiracetam is rapidly absorbed after oral administration. Oral absolute
bioavailability is close to 100%.
Rapidly and almost completely absorbed. Peak plasma concentrations (C max) are achieved at
1.3 hrs after dosing. Steady-state is achieved after 2 days of a twice-daily administration
schedule.
Contraindications:
Hypersensitivity to levetiracetam or other pyrrolidone derivatives or to any of the excipients
of Keppra.
Special Concerns/Warnings/Precautions:
Avoid abrupt w/drawal. Monitor for signs of depression &/or suicidal ideation & behaviors.
Renal & severe hepatic impairment.
Side effects (most common):
Nasopharyngitis, somnolence, headache, anorexia, depression, hostility/aggression, anxiety,
insomnia, nervousness/irritability, convulsion, balance disorder, dizziness, lethargy, tremor,
vertigo, cough, abdominal pain, diarrhea, dyspepsia, vomiting, nausea, rash,
asthenia/fatigue.
Food and drug interactions:
Higher clearance w/ enzyme-inducing antiepileptic drugs (in childn). Slightly reduced

absorption w/ food.
Laboratory/Diagnostic Procedure Related
to Drug Therapy:

Overdose Management:
After an acute overdose, the stomach may be emptied by induction of emesis. There is no
specific antidote for levetiracetam. Treatment of an overdose will be symptomatic and may
include hemodialysis. The dialyzer extraction efficiency is 60% for levetiracetam and 74% for
the primary metabolite.

UNDERSTANDING PATIENT'S DRUG THERAPY

NURSING CONSIDERATIONS
O LASA
Administration/Storage:
> Oral

Solution: Store at temperatures not exceeding 25C. Once

opened, Keppra Oral Solution is considered stable for up to 2 months
when stored at the prescribed temperature.
If not used immediately, in-use storage time and conditions prior to
use are responsibility of the user and would normally not be >24 hrs
at 2-8C unless dilution has taken place in controlled and validated
aseptic conditions.
> Oral solution may be taken directly or diluted in a glass of water.
> reduced dose are indicated when creatinine clearance is
<80ml/min.
> Taper dos if discontinue

Assessment:
> Monitor and notify physician of difficulty with gait or coordination.
> monitor for changes in phenytoin blood levels with coadministration
drugs.

Patient and Family Teaching:

> do not drive or engage in potentially hazardous activities until
response to drug is known
> do not abruptly discontinue drug. must use gradual dose
reduction/taper.
> notify physician of intention to become pregnant
> do not breastfeed while taking this drug without consulting
physician

Outcome/Evaluation:

UNDERSTANDING PATIENT'S DRUG THERAPY

PATIENT PROFILE
DOB: 11/06/91
Age: 23
Sex:
Female
Citizenship: Filipino
Civil Status: Female
Pertinent History and PE:
Four days prior to admission, patient had
onset of pain and tenderness on both lower
extremities with limitation of movement.
Unable to ambulate due to pain, positive cough
with blood tinged sputum, positive pain on
back area, stabbing when in deep inspiration,
no fever. Patient took prednisone 20 mg thrice
a day with relief after 5 hours.
On the day of admission, there is persistence
and did not took prednisone 20 mg thus sought
admission for further management.

Generic Name: Nexium

Category:
Brand name: Esomeprazole
O HAMS
O
Therapeutic Category: Antacids,
REGULAR DRUG
Antireflux agent and Antiuclerants
O LASA
Uses:
Patients Requiring Continued NSAID Therapy: Healing of gastric ulcers associated with NSAID
therapy including COX-2-selective NSAIDs; prevention of gastric and duodenal ulcers
associated with NSAID therapy, in patients at risk.
Short-term maintenance of hemostasis and prevention of rebleeding in patients following
therapeutic endoscopy for acute bleeding gastric or duodenal ulcers.
Pharmacokinetics:
Absorption and Distribution: Esomeprazole is acid labile and is administered orally as
enteric-coated granules. In vivo conversion to the R-isomer is negligible. Absorption of
esomeprazole is rapid with peak plasma levels occurring approximately 1-2 hrs after dose.

Admitting Impression:
Systemic Lupus Erythematosus (SLE)

Special Concerns/Warnings/Precautions:
In the presence of any alarm symptom (eg, significant unintentional weight loss, recurrent
vomiting, dysphagia, hematemesis or melena) and when gastric ulcer is suspected or
present, malignancy should be excluded, as treatment with esomeprazole may alleviate
symptoms and delay diagnosis.
Side effects (most common):
Headache; abdominal pain, diarrhea, flatulence, nausea, vomiting, constipation.

Doctor's complete drug order:

Esomeprazole (Nexium) 400mg tab 14's
Give 1 tab oral once a day

Contraindications:
Hypersensitivity to esomeprazole & substituted benzimidazoles. Lactation.

Food and drug interactions:

May decrease (eg ketoconazole, itraconazole & erlotinib) or increase (eg digoxin) absorption
of drugs. Decreased clearance of diazepam.

Laboratory/Diagnostic Procedure Related

to Drug Therapy:

Overdose Management:
As in any case of overdosage, treatment should be symptomatic and general supportive
measures should be utilized.

UNDERSTANDING PATIENT'S DRUG THERAPY

NURSING CONSIDERATIONS
O LASA

Patient and Family Teaching:

Administration/Storage:
> May be taken with or without food. MUPS tab: For patients w/
swallowing difficulties, the tab may also be dispersed in a glass of
non-carbonated water. No other liqd should be used. Stir gently &
leave for a few min to thicken. Stir again & drink the liqd w/ the
pellets immediately or w/in 30 min. Rinse the glass w/ a glass of
water & drink. Do not chew/crush the tab or the pellets.
> Store at a temperature not exceeding 30C.

> Report any changes in urinary elemination such as pain or

discomfort associated with urination to physician.
> Repost sever diarrhea. Drug may need to be discontinued.
> Do not breastfeed while taking this drug without consulting
physician.

Assessment:
> monitor for signs and symptoms of adverse CNS effects (vertigo,
Agitation, depression) especially in severely ill patients
> monitor phenytoin levels with concurrent use
> monitor PT with concurrent warfarin use
Outcome/Evaluation:

UNDERSTANDING PATIENT'S DRUG THERAPY

PATIENT PROFILE
DOB: 11/06/91
Age: 23
Sex:
Female
Citizenship: Filipino
Civil Status: Female
Pertinent History and PE:
Four days prior to admission, patient had
onset of pain and tenderness on both lower
extremities with limitation of movement.
Unable to ambulate due to pain, positive cough
with blood tinged sputum, positive pain on
back area, stabbing when in deep inspiration,
no fever. Patient took prednisone 20 mg thrice
a day with relief after 5 hours.
On the day of admission, there is persistence
and did not took prednisone 20 mg thus sought
admission for further management.
Admitting Impression:
Systemic Lupus Erythematosus (SLE)

Doctor's complete drug order:

Etoricoxib (Arcoxia Ac 120 mg tab 30's)
Give 1 tab oral once a day

Generic Name: Etoricoxib

Brand name: Arcoxia Ac
Therapeutic Category: NSAIDS

Category:
O HAMS
REGULAR DRUG
O LASA

Uses:
Acute & chronic treatment of signs & symptoms of OA & RA. Treatment of ankylosing
spondylitis, acute gouty arthritis & primary dysmenorrhea. Relief of acute pain.
Pharmacokinetics:
Absorption: Orally administered etoricoxib is well-absorbed. The mean oral bioavailability is
approximately 100%. Following 120-mg once-daily dosing to steady-state, the peak plasma
concentration (geometric mean Cmax=3.6 mcg/mL) was observed at approximately 1 hr (Tmax)
after administration to fasted adults.
Contraindications:
Active peptic ulceration or GI bleeding. Previous history of bronchospasm, acute rhinitis,
nasal polyps, angioneurotic edema, urticaria or allergic-type reactions after taking aspirin or
NSAIDs including COX-2 inhibitors. Severe hepatic dysfunction (serum albumin <25 g/L or
Child-Pugh score 10).
Special Concerns/Warnings/Precautions:
Use at the shortest possible duration & the lowest effective daily dose to avoid CV risk. Not a
substitute for aspirin for CV prophylaxis. Patients at risk of CV events (HTN, hyperlipidemia,
DM, smoking), w/ peripheral arterial disease, or w/ preexisting edema, impaired renal
function, HTN or uncompensated heart failure or cirrhosis; considerable dehydration. History
of GI perforation, ulcers & bleeding. Elderly >65 yr.
Side effects (most common):
Asthenia/fatigue, dizziness, lower extremity edema, HTN, dyspepsia, heartburn, nausea,
increased ALT & AST. Thrombocytopenia, hypersensitivity reactions including
anaphylactic/anaphylactoid reactions including shock; hyperkalemia, anxiety, insomnia,
confusion, hallucinations, depression, restlessness; dysgeusia, somnolence, blurred vision,
CHF, palpitations, angina, arrhythmia, hypertensive crisis, bronchospasm, abdominal pain,
oral ulcers, peptic ulcer including perforation or bleeding (elderly), vomiting, diarrhe

Laboratory/Diagnostic Procedure Related

to Drug Therapy:

Food and drug interactions:

Warfarin, rifampin, methotrexate, ACE inhibitors & AIIAs, lithium, aspirin, OCs, hormone
replacement therapy. Diuretics, NSAIDs.
Overdose Management:
In the event of overdose, it is reasonable to employ the usual supportive measures eg,
remove unabsorbed material from the GIT, employ clinical monitoring and institute
supportive therapy, if required. Etoricoxib is not dialyzable by hemodialysis; it is not known
whether etoricoxib is dialyzable by peritoneal dialysis.

UNDERSTANDING PATIENT'S DRUG THERAPY

NURSING CONSIDERATIONS
O LASA
Administration/Storage:
> May be taken with or without food.
> Store below 30C. Protect from light.

Assessment:
> Provide the patient proper management upon taking medications.
> Assess for adverse reaction of the drug

Patient and Family Teaching:

> Teach patient to take medicine or medications as physicians
ordered
> Tell the patient for the possible effects of drug prior to its adverse
reactions and consider such reactions mentioned as normal
> Tell the patient to seek for help if no such effects of drugs are noted
or that if symptoms prior to his conditions are still noted
> Tell patient to maintain his normal diet and possible consequences
of the drugs effect concerning on his appetite
> If you notice any of the following, tell your doctor immediately ;
vomiting blood or material that looks like coffee grounds , bleeding
from the back passage, black sticky bowel motions (stools), or bloody
diarrhoea , any symptoms that could indicate a severe allergic
reaction such as inability to breathe, chest pains or ankle swelling or a
serious skin reaction These symptoms may occur without warning.
Stop your treatment with ARCOXIA. You may need urgent medical
attention.

Outcome/Evaluation: