VIII.

DRUG STUDY DRUGS Date Ordered: January 20, 2012 Generic Name: losartan Brand Name: Lifezar Classification: Therapeutic: Antihypertensives Pharmacologic: Angiotensin II Antagonists Dosage: 100 mg tab Route: Oral Frequency: Once a day INDICATIONS Treatment of hypertension, alone or in combination w/ other antihypertensives. Renal protection in type 2 diabetic patients with proteinuria. ACTIONS Block vasoconstrictor and aldosterone producing effects of angiotensin II at receptor sites, including vascular smooth muscle and adrenal glands. Therapeutic Effects: Lowering of blood pressure. Slowed progression of diabetic nephropathy. Decreased risk of stroke. SIDE EFFECTS/ADVERSE EFFECTS Dizziness, asthenia, fatigue, headache, insomnia, edema, chest pain (for nephropathy; hypotension, orthostatic hypotension, diabetic vascular disease), nasal congestion, sinusitis, pharyngitis, abdominal pain, nausea, diarrhea, dyspepsia, cramps, myalgia, back or leg pain Respiratory: cough, angioedema hyperkalemia, hypoglycemia NURSING CONSIDERATIONS Assess the patients blood pressure before starting therapy and regularly thereafter. Assess also for pulse rate and rhythm. Assess for hydration status: mucous membranes and skin turgor. Monitor electrolyte: potassium. Sodium and chloride and check for edema in feet and legs. Monitor for possible adverse drug reaction. PATIENT TEACHINGS Inform patient that drug may cause dizziness, fainting or light headedness. Caution patient to rise slowly to sitting or standing position to minimize orthostatic hypotension. Advice patient that excessive perspiration, vomiting and diarrhea may lead to dehydration and fall in blood pressure. Instruct patient to report drug induced adverse effects.

Date Ordered: January 20, 2012 Generic Name: hyoscine Butyl bromide Brand Name: Buscopan Classification: Therapeutic: Anti-spasmodic Dosage: 1amp Route: IV Frequency: Once a day Date Ordered: January 20, 2012 Generic Name: cefoxitin Brand Name: Foxitin Classification: Therapeutic: Anti-biotic Pharmacologic: 2nd generation cephalosporin Dosage: 1gm Route: IV

Acute GI , biliary and genitourinary spasm ,include biliary and renal colic, dysmenorrhea .

Inhibits acetylcholine at receptor sites in autonomic nervous system , which controls secretions, free acids in stomach: blocks muscarinic receptors, which decreses involuntary movements.

Xerostomia, tachycardia, urinary retention, visual accommodation disturbances, dizziness, agranulosytosis, pancytopenia, and brochospasm

Skin and soft tissue infections For prophylaxis surgical infection Inhibits bacterial cell wall synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death. Phlebitis and inflammation at the site of injection and GI reactions(i.e. nausea and vomiting). Allergic signs; skin reactions; digestive reaction; hematological disorders; liver function disorders; renal impairment, metabolic encephalopathy.

Assess for eye pain; discontinue use Monitor intake and output ratio; retention commonly causes decrease urinary output Assess for parkinsonism, extrapyramidal symptoms Assess for urinary hesitancy, retention; palpate bladder if retention occurs Assess for constipation Assess for tolerance over long term therapy Assess mental status Assess patients previous sensitivity reaction to penicillin or other cephalosporin. Cross sensitivity between penicillins and cephalosporins are common Assess patient for signs and symptoms of infection before and during treatment: fever, ear ache, characteristic of wounds, sputum, urine, stool and WBC greater than 10,000/mm3. Obtain C& S before beginning drug therapy to identify if

Tell patient to avoid hazardous activities requiring alertness: dizziness may occur Advise patient to avoid use of alcohol or other CNS depressant while taking medication

Instruct patient to take medication as prescribed for the length of time ordered even if he feels better. Teach patient to report sore throat, bruising, bleeding and joint pain, this may indicate blood dyscrasia(rare) Advise patient to report bloody, mucoid diarrhea which may indicate pseudomembran ous collitis.

Generic Name: Tramadol

For moderate to acute or chronic pain

Brand Name:

Classification: Opioid

Decreases pain by inhibiting the uptake of Norepinephrine & serotonin in the CNS. May produce opioid-like effects, but causes less respiratory depression than morphine.

Dizziness, somnolence, asthenia, fatigue, dry mouth, pruritis

Dosage: 50 mg

Frequency: Q8

Route: IV

Date ordered: January 20, 2012

For more effective analgesia, give tramadol before pain becomes intense. Reaassess the patients Tinnitus, level of pain at least 30 Nausea, minutes after constipation, diarrhea, administration. flatulenc Monitor the patients Hot flushes, cardiovascular and diaphoresis respiratory status. Withohold the dose and notify the prescriber if the respirations become shallow or the respiratory rate falls below 12 breaths/ minute. Monitor the patientss bowel function. If the patient is constipated, give him a laxative as ordered. Monitor the patient for seizures. Assess the patient for sighn of drug dependence. Tramadol may produce dependence similar to that of codeine or dextropropoxyphene and has a similar abuse potential.

Instruct patient to swallow tramadol with food to prevent stomach upset Instruct patient on how and when to ask for pain medication May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known Advise patient to change positions slowly to minimize orthostatic hypotension Caution patient to avoid concurrent use of alcohol or other CNS depressants with this medication Encourage turning, coughing & deep breathing q 2 hrs to prevent atelactasis & pneumonia

Generic Name: Omeprazole

To prevent chemotherapyinduced nausea and vomiting

Blocks serotonin receptors centrally in the chemoreceptor

Agitation, akathisia, anxiety, ataxia, dizziness, drowsiness, fever, headache, hypotension,

Should check the patients name, the correct route, dosage, frequency of the medicine to be

Advise patient to notify prescriber immediately about signs and symptoms of hypersensitivity reaction,