University of the Philippines Manila

The Health Sciences Center

COLLEGE OF NURSING
Sotejo Hall, Pedro Gil St. Ermita, Manila

DRUG STUDY

NAME OF STUDENT: Constance Isabelle M. Mercado DATE OF

ASSIGNMENT: September 14, 2010
NAME OF CLIENT: Anna Marie A. Nacion WARD: 9 BED NO.:8
AGE: 18 years old SEX: Female
DIAGNOSIS: Upper Gastrointestinal Bleeding probably 2° to Bleeding Esophageal Varices; Liver Failure 2° Liver Cirrhosis 2° Hemosiderosis with
Portal Hypertension; Chronic Myelogenous Leukemia

PHARMACOLOGIC INDICATIONS AND ADVERSE EFFECTS OF DESIRED NURSING

DRUG ACTION OF DRUG CONTRAINDICATIONS THE DRUG ACTION ON RESPONSIBILITIES
ORDER THE CLIENT /PRECAUTIONS

Vitamin K Serves as the Indications- Client with GI- Can upset the Increase the -Asses the bleeding and notify
10 mg IV q precursor for hypprothrombobinemia, stomach, chance of liver MD if signs of bleeding and
8h coagulation factors tendency to bleed, absorption of hypervolemia develop
Phytomena synthesized by the prevent Hemorrhagic SENSORY- can cause Vitamin K. The (decreased urine output,
dione liver. disease of newborn, abnormal taste liver is the restlessness and anxiety,
Vitamin K deficiency organ that weakness)
DERMAL- rashes, flushing, produces the - Monitor patient’s vital signs
Contraindications- urticaria clotting/ -Check if patient is on nay
hypersensitivity to coagulation anticoagulants such as warfarin
benzyl alcohol factors which may cancel out Vit K’s
effects.
-Check patient’s PTPTT test
Cefuroxime Kills bacteria by Indications -Skin rashes,fever -Is patient hypersensitive to
750 mg IV binding to their cell (Oral)-Bone & joint BLOOD- eosinophilia, cephalosporins and/or
q8h wall infections, meningitis, Hypothrombopenia/platele penicillins
bronchitis, peritonitis, t -Monitor patient renal &
Cefuroxime pharyngitis, sinusitis, Dysfunction. hematologic profile
750mg/tab otitis media, gonorrhea, Nephrotoxicity, acute -Assess for infection, WBC
1tab BID Lyme disease renal tubular necrosis increase tachycardia,
-Prophylaxis for Hemolytic anemia, respiratory syndromes, etc.
abdominal operation Neutropenia -Check for signs of anaphylaxis
-Septicemia, UTI’s GI- Diarrhea, such as rashes , pruritus,,
(Parenteral) Pseudomembrenous wheezes and laryngeal edema,
Lower respiratory colitis etc.
infections -Increased doses can IV Preparation: Reconstitute
Dermatologic infections cause seizures parenteral drug with sterile
UTIs water for injection, D5W,
 Uncomplicated and O.9%NaCl or any of the ff: ).9%
disseminated gonrrhea NaCl, 5% or 10% dextrose
Septicemia caused by injection, 5%dextrose and
Streptococcus 0.45% or 0.9%NaCl in injection.
pneumoniae Do not mix with IV solutions
Meningitis containing aminoglycosides.
Bone and joint Infusion: Inject slowly over 3-
infections 5mins directly into vein for IV
Perioperative administration or infuse over
prophylaxis 30min.
Contra-indications
Reactivity to
cephalosporins or
penicillins
Use causiously with
renal failure, lactation,
pregnancy
Calcium • Essential Indication: • CV: slowed heart rate, • •Ask client to report loss of
gluconate element of the Treatment of calcium peripheral appetite, nausea, vomiting,
2gm IV OD body, helps deficiency in acute and vasodilation, local abdominal pain,
maintain chronic burning, drop in BP constipation, dry mouth,
integrity of hypoparathyroidism, •Local: local irritation, thirst, increased voiding.
nervous and pseudohypoparathyroidi severe necrosis, •Take drug in between meals
muscular sm. sloughing and abscess and aat bedtime.
systems, helps Prevention of formation. •Do not take with other oral
maintain cardiac hypocalcemia during drugs. Absorption of those
•Metabolic: Hypercalcemia
function, blood exchange transfusions medications can be blocked,
(anorexia, nausea,
coagulation, is vomiting, constipation, take them at least 1 – 2
an enzyme Contraindication: hours after taking calcium
dry mouth, thirst,
cofactor and Allergy to calcium, renal carbonate
polyuria)
affects secretory calculi, hypercalcemia •IV infusion preferred. Every
activity of and clients with 1gm contains 90mg
endocrine and increased risk for (4.5mEq Calcium)
exocrine glands digitalis toxicity •IV preparation: Warm solutions
Use cautiously with to body temperature, use a
renal impairment small needle inserted into a
large vein to decrease
irritation.
•Infuse slowly, 0.5-2ml/min Stop
infusion if patient complains
of discomfort; resume when
symptoms disappear.
•Incompatibilities: Avoid mixing
calcium salts with
carbonates, phosphates,
 sulfates, tartrates,
amphotericin, cefazolin,
clindamycin, dobutamine,
prednisolone
•Monitor serum phosphorus
levels during long-term
therapy
•Monitor cardiac response
closely during parenteral
treatment with calcium
Lactulose Metabolites in the Indications In the Gastrointestinal -Passage of -Check for bowel sounds before
drug cause a Constipation associated tract , it may cause: stool administering medication
cathartic effect by with PED problems, Flatulence (defacation). -Assess stool- color, quality,
pulling water into bedridden/geriatric Diarrhea Because client amount, frequency.
the bowel. patients, painful Belching is bedridden, -Check patient’s blood sugar
Sugar Molecules rectal/anal conditions, Cramps constipation is level
when broken down laxative dependence, Distention a very possible -Assess mental status
by bacteria in the barium x-ray, drug- problem -Assess for signs of
bowels, cause it to induced constipation, It may also cause hypernatremia (lethargy,
become more pregnancy and hyperglycemia and in -It is also used weakness, edema, etc)
acidic, decreasing postnatal period. terms of fluid and to treat hepatic -Assess for signs of
ammonia electrolyte balance, encephalopathy hypokalemia (flattened or
absorption (this is Contra-indications hypernatremia and . inverted T waves, U wave, and
excreted to counter Galactosaemia, low hyperkalemia prolongation of the QT interval,
acidity, as it is an galactose diet, bowel which may lead to arrhythmias.
essential base). obstruction Also, there may be fatigue,
Ammonia draws muscle weakness, paresthesia,
water and can help mental stress, dyspnea)
hepathic Ask client to report diarrhea,
encephalopathy by severe belching, abdominal
trapping ammonia fullness
in the colon.

Metronidaz • Bactericidal: Indications: •CNS: Headache, •Avoid use unless needed. May
ole, 500 Inhibits DNA • Acute infection with dizziness, ataxia, be carcinogenic.
mg/cap synthesis in susceptible vertigo, •Administer oral doses with
1cap BID specific anaerobic bacteria incoordination, food.
(obligate) • Acute intestinal insomnia, seizures, •Apply topically after cleansing
anaerobes, amebiasis peripheral neuropathy, the area.
causing cell • Amebic liver abscess fatigue •Reduce dosage in hepatic
death; • Trichomoniasis •GI: Unpleasant metallic disease.
antiprotozoal- (acute and partners •Instruct client to not drink
taste, anorexia,
trichomonocidal, of patients with alcohol (beverages or
nausea, vomiting,
amebicidal acute infection) preparations containing
diarrhea, GI upset,
• Bacterial vaginosis cramps alcohol, cough syrups) for
• Preoperative, •GU: Dysuria, 24-72 hr of drug use; severe
intraoperative, incontinenece, reactions may occur.
postoperative darkening of the urine •Inform client that her urine
prophylaxis for may be a darker color than
•Local: Thromboplebitis
patients undergoing usual; this is expected.
(IV); redness, burning,
colorectal surgery dryness, and skin •Warn patient of the side
• Topical application: irritation (topical) effects: Dry mouth with
Treatment of strange metallic taste
inflammatory
•Other: Severe, (frequent mouth care,
disulfiram-like sucking sugarless candies
papules, pustules
interaction (flushing, may help); nausea,
and erythema of
tachycardia, nausea vomiting, diarrhea (eat
rosacea
and vomiting) with frequent small meals).
• Unlabeled uses: alcohol, candidiasis
Prophylaxis for •Instruct client to report severe
(superinfection)
patients undergoing GI upset, dizziness, unusual
gynecologic, fatigue or weakness, fever,
abdominal surgery; chills.
hepatic
encephalopathy;
Crohn's disease;
antibiotic-associated
pseudomembranous
colitis; treatment of
Gardnerella
vaginalis; giardiasis
(use recommended
by the CDC);
infected decubitis
ulcers, perioral
dermatitis

Contraindications:
• Contraindicated with
hypersensitivity to
metronidazole;
pregnancy (not
given for
trichomoniasis in
first trimester)
• Use cautiously with
CNS diseases,
hepatic disease,
candidiasis
(moniliasis), blood
 dyscrsias, lactation.

Famotidine Histamine 2 Indications: Adverse Effects: As the client's Tell client she may experience
40mg/tab receptor antagonist Short term therapy and CNS: Headache, malaise, activity is these side effects: constipation
1tab ODs Competitvely blocks maintenance of dizziness, somnolence, restricted, she or diarrhea, loss of libidoor
the action of duodenal ulcer insomnia may be at risk impotence, headache
histamine at the H2 Short term treatment of Dermatologic: Rash for developing Ask client to report sore throat,
receptors of the benign gastric ulcer GI: diarrhea, constipation, cosntipation. unusual bruising or bleeding,
parietal cells of the Treatment of pathologic anorexia, abdominal pain severe headache, muscle otr
stomach, inhibits hyperseceretory Other: muscle cramp, joint pain.
basal gastric acid conditions increase in total bilirubin,
secretion and Short term treatment of sexual impotence
chemically induced GERD, esophagitis d/t
gastric acid GERD
secretion OTC: relief of symptoms
of heartburn,
indigestion, sour
stomach

Contra-indications:
Allergy to famotidine,
renal failure, l;actation
Use cautiously with
pregnancy
Morphine Unknown. Binds Indications: •CNS: sedation, somnolence, • Relief of • Oral solutions at various
sulfate, with opiate Severe pain euphoria, seizures, dizziness, pain concentrations and an
30mg/tab receptors in the nightmares, physical intensified oral solution are
½ tab q4h CNS, altering both Contraindications: dependence, available. Carefully note the
perception of and Patients hypersensitive lightheadedness, strength administered.
Morphine emotional response to drug hallucinations, nervousness,
• Monitor circulatory,
sulfate, to pain. depression, syncope
respiratory, bladder and
30mg/tab •CV: hypotension, bowel functions carefully.
½ tab PRN bradycardia, shock, cardiac
• Withhold dose if respirations
for arrest, tachycardia,
hypertension are below 12
breakthrou breaths/minute.
gh pain •GI: nausea, vomiting,
constipation, ileus, dry
mouth, biliary tract spasms,
anorexia
•GU: urine retention
•Hematologic:
 thrombocytopenia
•Respiratory: respiratory
depression, apnea, arrest
•Skin: pruritis, diaphoresis,
edema

CaCO3 • Essential Indication: • CV: slowed heart rate, • •Ask client to report loss of
500mg TID element of the Treatment of calcium peripheral appetite, nausea, vomiting,
body, helps deficiency in acute and vasodilation, local abdominal pain,
maintain chronic burning, drop in BP constipation, dry mouth,
integrity of hypoparathyroidism, •Local: local irritation, thirst, increased voiding.
nervous and pseudohypoparathyroidi severe necrosis, •Take drug in between meals
muscular sm. sloughing and abscess and aat bedtime.
systems, helps Prevention of formation. •Do not take with other oral
maintain cardiac hypocalcemia during drugs. Absorption of those
•Metabolic: Hypercalcemia
function, blood exchange transfusions medications can be blocked,
(anorexia, nausea,
coagulation, is vomiting, constipation, take them at least 1 – 2
an enzyme Contraindication: hours after taking calcium
dry mouth, thirst,
cofactor and Allergy to calcium, renal carbonate
polyuria)
affects secretory calculi, hypercalcemia
activity of and clients with
endocrine and increased risk for
exocrine glands digitalis toxicity
Use cautiously with
renal impairment

SOURCES:

Karch, M. (2010). 2010 Lippincott’s Nursing Drug Guide. Philadelphia: Lippincott Williams & Wilkins