DRUG STUDY

Date ordered: Drug Name Dosage Classification Mechanism of Action: Dexamethasone 5 milligram IVTT every 6 hours Glucocorticoid / Corticosteroid Enters target cells and bind to specific receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressive effects; Suppress inflammatory process and for immunosuppression. Indications Acute allergic disorder Asthma attack Cerebral Edema and unresponsive shock. Contraindications Hypersensitivity, psychosis, fungal infection Caution: Diabetes Mellitus Side Effects Nausea Diarrhea Abdominal Distention Increased appetite Sweating Headache Depression Flush

Mood changes Adverse Effects Petechiae Ecchymosis Hypertension Tachycardia Osteoporosis Muscle wasting Drug Interaction 1. NSAIDS = increase risk of GI bleeding and ulceration 2. Potassium-wasting Diuretics = increase potassium loss (hypokalemia <3.5mEq/L)

Nursing Responsibilities

1. Ten rights in giving the medication Avoid medication error. 2. The IV line should be intact before giving the medication Iv medication can cause tissue damage if injected into the tissue through an infiltrated IV site. 3. Monitor Vital Signs and Body weight Glucocorticoids can increase blood pressure and sodium and water retention 4. Monitor weight. Due to water retention 5. Monitor Laboratory values esp. Serum electrolytes and blood sugar. Serum potassium level could decrease to less than 3.5mEq/L and blood sugar level would probably increase. 6. If drug therapy is discontinued, the dose should be tapered. to allow adrenal cortex to produce its own cortisol and other corticosteroids 7. Avoid abrupt discontinue of the drug. to prevent severe adrenocortical insufficiency 8. Be aware of using glucocorticoids and NSAID. glucocorticoids potentiates the action of NSAID thus increasing

risk of GI bleeding and ulceration. 9. Report changes in muscle strength. Increase dose of glucocorticoid promotes loss of muscle tone. 10. Monitor older adults for signs of osteoporosis GLucocorticoids promotes calcium loss from the bone

Date: Generic Name: Brand Name: Classification: Required dose:

March 3, 2011 Mannitol Osmitrol Osmotic (Potassium-wasting) Diuretic For ICp/IOP : 15-25% solution infuse over 30-60 minutes For edema, ascites, oliguria : 10-20% solution over 90 minutes to 6 hours

Given dose: Indication: Mode of action:

20% 100 millilitre to 6 hours Used to prevent kidney failure,toxic over dose, decrease Intracranial pressure (cerebral edema) and intraocular pressure Increasing the Osmolality (concentration of plasma and fluid renal tubules). Sodium, chloride, potassium and water are excreted. Thus, inhibiting the reabsorption of water and electrolyes leading to the relief of edema and mobilizing fluids in the cerebral and ocular spaces (lowers intracranial or intraocular pressure). Dehydration Severe fluid and electrolytes imbalances Hypovolemia

Contraindication:

Side-effects: Adverse effects: Dehydration Anuria Intracranial bleeding Headache

Blurred vision Nausea and vomiting Volume expansion Chest pain Pulmonary edema Thirst Tachycardia Hypokalemia (increases the risk of digoxin toxicity) Chronic renal failure

Drug Interaction:

1.

Anti-coagulant = increase bleeding

Nursing Responsiblities:

1. Ten rights in giving the medication. Avoid medication error 2. The IV line should be intact before giving the medication Iv mediaction can cause tissue damage if injected into the tissue through an infiltrated IV site. 3. Monitor vital signs Increase water secretion, thus decrease in blood pressure 4. Monitor intake and output Increase in fluid secretion affecting the hydration status 5. Check ECG Potassium loss leading to hypokalemia results to cardiac dysrrhytmias. 6. Check urine output. It must increase in 5-20 minutes. If not, notify he physician. Severe renal disorder may be present. 7. Check for signs of electrolyte imbalances: muscular weakness,

paresthesia, numbness, confusion, tingling sensation of extremity and excessive thirst. Adverse effects of the drug 9. Instruct client to rise slowly from bed. risk of dizziness from fluid loss 10. Laboratory work-up (BUN and creatinine) to monitor renal function

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication: Mode of action: Contraindication:

March 2, 2011 Morphine Sulfate Astramorph Opiod Analgesic / Narcotic 4-10 milligram every 4 hours PRN: diluted; inject over 5 minutes 2 milligram IVTT every 6 hours To relieve severe pain / pre-op medication Depression of the CNS: depression of pain impulse by binding with the opiate receptor in the CNS. Increase Intracranial pressure (more than 15mmHg) Shock Asthma

Side-effects:

Anorexia Nausea and Vomiting Drowsiness Sedation Rash Blurred vision

Adverse effects:

Hypotension

Urticaria Respiratory Depression Increase intracranial pressure Miosis Urinary retention Constipation caused by reduced bowel motility Cough suppression Drug Interaction: Nursing Responsiblities:

1. Ten rights in giving the medication Avoid medication error 2. The IV line should be intact before giving the medication IV medication can cause tissue damage if injected into the tissue through an infiltrated IV site 3. Monitor Vital signs at frequent intervals to detect respiratory changes; <10 cpm can indicate respiratory distress 4. Monitor clients urine output Urine out should be atleast 600ml per day 5. Check bowel sounds for decrease peristalsis May exhibit constipation due to slowed bowel motility caused by drug therapy 6. Check pupil changes and reaction pinpoint pupils can indicate morphine sulphate toxicity 7. Have naloxone (narcan) available. as an antidote for morphine toxicity 8. Suggest nonpharmacologic measures to relieve pain as patient recuperates from surgery.

Date: Generic Name: Brand Name: Classification: Required dose: Captopril Capoten Anti-hypertensive: angiotensin converting enzyme (ACE) inhibitor Initial: 12.5 25 mg BID TID Maintenance: 25 100 mg BID TID Max: 450 mg / day Given dose: Indication: 25 mg Sublingual every 4 hours PRN for BP > 140/90 To reduce Blood pressure To control CHF Mode of action: Suppression of ACE: inhibits Angiotensin 1 conversion to angiotensin 2 (potent vasoconstrictor) leading to decreased blood pressure, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action. Blocks the relase of aldosteron (for water rentention). If aldosterone is blocked, sodium is excreted with water and potassium is retained. Contraindication: Side-effects: Heart Block Dizziness Cough Nocturia Rash

Hyperkalemia Taste disturbance Adverse effects: Oliguria Urticaria Severe hypotension Drug Interaction: Increase hypotensive effects with: nitrates, diuretics, beta-blockes, vasodilators and other hypertensive drugs

Nursing Responsibilities:

1. Ten rights in giving the medication Avoid medication error 2. Check vital signs before giving the medication prevention of severe hypotension 3. Check Mucous membrane (under the tongue) Change in contour and discoloration could affect the drug effectively 4. Give the drug before meals; do not give with foods. affects drug absorption. 5. Inform patient that there will be stingy sensation under the tongue]

6. Re-check BP 30 minutes after giving. To check the blood pressure has decreased and the effectiveness of the drug. 7. Monitor BUN and Creatinine to monitor renal function 8. Report the presence of Mucosal ulceration Sign of captopril complication

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication: Mode of action:

March 20, 2011 Metoclopramide Plasil Anti-emetic 10 mg AC (ante cibum) or HS (hours of sleep) 10 mg To treat and prevent vomiting / post operative emesis Suppresses emesis by blocking the dopamine and the serotonin in the Chemoreceptor trigger zone.

Inhibits medullary chemoreceptor trigger zone as anti emetic; anticholinergic blocking agent. Contraindication: Glaucoma Severe liver damage GI haemorrhage and perforation Side-effects: Adverse effects: Dry mouth Extra-pyramidal Syndrome : tardive diskensia, Akathisia Tachycardia Drug Interaction: Increase effects of alcohol Decrease effect of levodopa Toxicity with epinephrine Increase liver and cardiac enzymes, sugar and cholesterol Nursing Responsibilities: 1. Ten rights in giving the medication

 Avoid medication error 2. Provide mouth care if vomiting occurs encourage patient to maintain oral hygiene 3. Suggest patient non-pharmacologic methods of alleviating nausea and vomiting: crackers and dry toast to decrease chances of drug toxicity and over-dose 4. Report if drowsiness is present. then dose should be decreased.

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication:

March 20, 2011 Ranitidine Zantac H2 blocker 150 mg every 12 hours or 30 mg Hours of sleep 10 mg To prevent and treat peptic ulcer, gastric and duodenal ulcer, gastroesophageal reflux, stress ulcer (from major surgery); Prophylaxis Preventing aspiration pneumonitis that can result from aspiration of gastric acid secretion.

Mode of action:

Inhibition of gastric acid secretion by inhibiting histamine at histamine 2 receptors in parietal cells.

Prevents acid reflux in the esophagus.

Blocks the histamine 2 receptors of parietal cells in the stomach thus reducing gastric acid secretion and concentration.

Healing ulcer by eliminating the cause.

Duration of action: LONGER helps to decrease frequency of dosing Contraindication: Hypersensitivity Severe renal and lover disease Side-effects: Headache Confusion Nausea and Vomiting Diarrhea Malaise Adverse effects: Hepatotoxicity Cardiac Dysrrythmias Blood dyscrasia Drug Interaction: Decrease absorption with ANTACIDS Decrease absorption of Ketoconazole Toxicity with Metroprolol Nursing Responsibilities: 1. Ten rights in giving the medication Avoid medication error 2. Administer drug just before meals or at bedtime to decrease food-induced acid secretion 3. Be alert that reduce dose of drug is need for older adult since older adult has decrease gastric acid and metabolic acidosis should be prevented 4. Advise patient to avoid caffeinated drinks, alcohol and spices. thses can cause gastric irritation 5. Instruct to report pain, coughing and vomiting of blood. 6. Advise patient to eat food rich in vitamin B 12. to avoid deficiency due to drug therapy.

Date: Generic Name: Brand Name: Classification:

March 6, 2011 Cefuroxime Ceftin Second generation Cephalosporin Broad spectrum against other gram-negative bacteria H. influenza, N. Gonorrhoea, M. meningitidis

Required dose: Given dose: Indication:

750 mg 1.5 gram every 8 hours 750 mg IVTT evry 8 hours For the treatment of septicaemia For surgical prophylaxis

Mode of action: Contraindication:

Inhibition of cell wall synthesis causing cell death; bactericidal effect Hypersensitivity Renal disease Lactation

Side-effects:

Pruritus Headache Diarrhea Weakness

Adverse effects:

Superinfection

Urticaria Drug Interaction: Increase toxicity with lop diuretics Decrease effects with erythromycin Nursing Responsibilities: 1. Ten rights in giving the medication. Avoid medication error 2. The IV line should be intact before giving the medication Iv mediaction can cause tissue damage if injected into the tissue through an infiltrated IV site. 3. Asses for allergy to cephalosporin if allergic to one type/class of cephalosporin the patient should not receive any other type of cephalosporin 4. Asses vital signs and intake and output. increase temperature = infection decrease output = renal disease 5. Check laboratory results : BUN and Crea Monitor the renal function 6. Dilute in an appropriate amount of IV fluid (50-100 ml) or 6 ml 8 ml sterile water 7. Administer IV over 30-40 minutes slow push decrease pain sensation at IV site 8. Instruct patient to report headache, dizziness, itchiness, rash

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication:

March 10, 2011 Gentamycin Garamycin Antibacterial: aminoglycosides 3-5 mg / kg / day in 3 individual doses 80 mg IVTT every 12 hours To treat serious infections occurs by gram-negative organism (pseudomonas aeroginosa) and staphylococcus aureus

Given with cephalosporin Mode of action: Inhibition of bacterial protein synthesis; bactericidal effect

Onset action: Rapid / Immediate Peak: 30 minutes (FASTER) Contraindication: Hypersensitivity Pregancy / Breast feeding Side-effects: Anorexia Nausea and vomiting Rash Numbness

Photosensitivity Muscle cramps Adverse effects: Oliguria Urticaria Palpitation Superinfection

Drug Interaction:

Increase risk of Ototoxicity with loop diuretics Increase risk of nephrotoxicity with furosemide

Nursing Responsibilities:

1. Ten rights in giving the medication. Avoid medication error 2. The IV line should be intact before giving the medication Iv medication can cause tissue damage if injected into the tissue through an infiltrated IV site. 3. Monitor Vital signs and urine output. Compare these results with future vital signs and urine output. Adverse reaction to most aminoglycosides is nephrotoxicity. 4. If combination of antibiotics is given IV, the IV line should flushed after each antibiotic has been administer.

Date: Generic Name: Brand Name: Classification: Required dose: Given dose:

March 2,3 and 10, 2011 Citicholine Zynapse Psychostimulant / nootropic 500 mg per 2 ml 1000 mg per 4 ml once a day or twice a day 2 mg IVTT every 8 hours (march 10, 2011) 1 gram IVTT every 8 hours (march 3, 2011) 1 gram IVTT every 12 hours (march 2, 2011)

Indication:

Cerebral trauma and disturbance of consciousness following brain surgery Signs of cerebral insufficiency e.g. dizziness, memory loss, poor concentration, disorientation, recent cranial trauma.

Mode of action:

Increases the neurotransmission levels because it favors the synthesis and production speed of dopamine. Citicoline acts as a presynaptic cholinergic agent which favors the synthesis of acetylcholine. By virtue of this action, citicoline has an indirect effect on microcirculation. It has the ability to slightly increase cerebral blood flow.

Citicoline reveres poor neuronal metabolism (caused by astrocyte swelling) by loosen the grip of astrocytes on the capillaries and thus improving the microcirculation.

Contraindication:

Hypersensitivity Heart block

Side-effects:

Drowsiness Unsteady gait Tiredness Abnormal involuntary movements Nausea and vomiting

Adverse effects:

Itching or hives swelling in your face or hands Chest tightness Trouble breathing Low blood pressure

Drug Interaction: Nursing Responsibilities: 1. Ten rights in giving the medication. Avoid medication error 2. The IV line should be intact before giving the medication Iv mediaction can cause tissue damage if injected into the tissue through an infiltrated IV site. 3. Check neurological vital signs To determine the extent of neurological deficit of the patient and refer the physician 4. Hold and refer physician if the patient develops Hives, swelling of hands and face, and troubled breathing. Signs of adverse effects of the drug

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication: Mode of action: Contraindication:

March 3, 2011 Phenytoin Dilantin Anti-convulsant 100 mg three times a day or four times a day 100 mg 1 tablet three times a day To prevent grand mal and complex partial seizure Reduces motor cortex activity by altering transport of ions Heart block Hypersensitivity Psychiatric disorder

Side-effects:

Headache Diplopia Confusion Dizziness Slurred speech Rash Anorexia Hypotension Discoloration of urine

Adverse effects:

Blood dyscrasia

Respiratory Depression Hepatitis Gingival hyperplasia Drug Interaction: Nursing Responsibilities: Decrease effects of corticosteroids 1. Ten rights in giving the medication. Avoid medication error 2. Be aware of therapeutic serum concentration: 1020 mcg/mL toxic level: 3050 mcg/mL Margin between toxic and therapeutic doses is relatively small. 3. Check Vitals Signs, continuously To detect respiratory depression 4. Assess oral hygiene. to control gingival hyperplasia 5. Inform patient that there will be discoloration of urine during the course of therapy 6. Tell the patient to report symptoms of sore throat, bruising, and nose bleeding. Indication of blood dyscrasia 7. Give the drug same time every day with food. 8. Assess seizure location, duration, frequency and characteristics of seizure activity 9. Asses patient for phenytoin hypersensitivity syndrome (fever, skin, rash and lymphopathy) rash usually occurs within the first 2 weeks of therapy

Date: Generic Name: Brand Name: Classification: Required dose: Given dose: Indication:

March 2, 2011 Lactulose Dulphalac Osmotic laxative 15-30 ml 30 ml For the treatment of constipation. Used in bowel preparation for diagnostic and surgical procedure.

Mode of action: Contraindication: Side-effects: Adverse effects: Drug Interaction: Nursing Responsibilities:

Pull water into the colon and increase water in the feces to increase bulk which stimulates peristalsis and defecation. Intenstinal obstruction Flatulence Diarrhea

1. Ten rights in giving the medication. Avoid medication error 2. Instruct patient to increase water intake, if not contraindicated To decrease hard and dry stools 3. Assess patient for diarrhea sign of adverse reaction and at risk for dehydration

4. Monitor Intake and Output to asses patients hydration status

Date: Generic Name: Brand Name: Classification: Required dose: Nimodepine Nimotop Calcium-channel blocker For impaired brain function: 2 tablets 6 times a day following infusion therapy Initially, 1 mg per hour for first 2 hours, if well tolerated, increase to 2 mg per hour for 5 14 days, then about 7 days, 2 tabs 6 times daily. Given dose: Indication: Treatment of impaired brain function in old age with pronounced symptoms e.g. impaired memory, impaired drive and consciousness and mood liability. Prophylaxis and treatment o ischemic neurological deficits due to cerebral vasospasms after subarahnoid hemorrhage Post aneurysm hemorrhage Mode of action: Decreases calcium levels by blocking free calcium ions in the myocardium thus decreases cardiac contractility (relaxes smooth muscle) and workload of the heart thus decreasing the need of oxygen. Cerebral arteries are sensitive to Calcium channel blockers in which the drug promotes vasodilatation (relaxation)by decreasing the need of oxygen. Nimodipine is thought to work by relaxing narrowed blood vessels in the brain near the area of bleeding so blood can flow more easily. This effect stops bleeding and reduces brain damage.

Contraindication: Side-effects: Stomach and bowel complaints

irritability light-headedness fatigue Adverse effects: Severe lowering of BP GI disturbance Disturbances in heart rhythm Nephrotoxic Drug Interaction: Potentiates effects of anti-hypertensive drugs Decrease effects with rifampicin. Nursing Responsibilities: 1. Ten rights in giving the medication. Avoid medication error 2. Check Vitals signs before and after giving the drug, esp. BP do not give if patients BP below or normal range to prevent hypotension 3. Instruct patient to report dizziness or faintness occurs. these are signs of hypotension 4. Place patient in supine position with legs elevated after giving. to relieve patient if hypotension occurs 5. Monitor BUN and creatinine to check renal function since the drug is nephrotoxic.