Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo.

Drug Study

Generic Name (Brand Name) Felodipine

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

Order: 5mg OD Dosages: Adults Initially, 5mg PO daily; dosage may be gradually increased over at least 14 days. Usual dose is 2.5mg10mg PO daily. Doses greater than 10mg PO daily are associated with an increased risk of peripheral edema. Pediatric Patients Safety and efficacy not established. Geriatic patients or patients with hepatic impairment

Drug Classes: Antihypertensive Calcium channel blocker Therapeutic actions: Inhibits the movement of calcium ion across the membranes of cardiac and vascular smooth muscle cells; greater selectivity for vascular smooth muscle as compared to cardiac muscle; leads to arterial and coronary artery vasodilation and decreased peripheral vascular resistance.

Essential hypertension, alone or in combination with other antihypertensive

Contraindicated with allergy to felodipine or other calcium channel blockers, sick sinus syndrome, heart block(second or third degree), lactation. Use cautiously with pregnancy, impaired hepatic function.

CNS: Dizziness, light-headedness, headache, asthenia, fatigue, lethargy CV: Peripheral Edema, arrhythmias Dermatologic: Flushing, rash GI: Nausea, abdominal discomfort, reflux, constipation.

Assessment History: Allergy to felodipine, impaired hepatic function, sick sinus syndrome, heart block, lactation, pregnancy Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation, R, adventitious sounds, Liver evaluation, GI normal output; LFTs, urinalysis Interventions: Have patient swallow tablet whole; do not chew or crush. Monitor patient carefully(BP, Cardiac rhythm and output) while drug is being adjusted to therapeutic dose. Monitor cardiac Rhythm regularly during

Monitor carefully; begin with 2.5mg daily, and do not exceed 10mg daily PO.

stabilization of dosage and periodically during long term therapy Administer drug without regard o meals

Teaching Points Take this drug with meals if upset stomach occurs; swallow tablet whole, do not cut, crush or chew, Do not drink grapefruit juice while using this drug You may experience this side effects: Nausea, vomiting(eat frequent small meals); headache(adjust lighting, noise, and temperature; medication may be ordered if severe). Report irregular heart beat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Magnesiu m sulfate

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

Dosages: Adults Parenteral Nutrition : 824mEq/day IV. Mild magnesium deficiency: 1 g IM or IV every 6 hour for 4 doses (32.5 mEq/ day) Eclampsia, severe eclampsia: Total initial dose of 10 14 g. May infuse 4-5 g in 250 ml. 5% dextrose injection or 0.09% sodium chloride while giving IM doses up to 10g. ( 5g or 10 ml of undiluted 50% solution in each buttock). Or, may give initial Iv dose of 4 g by diluting

Drug Classes: Antiepileptic Electrolyte Laxative Therapeutic actions: Cofactor of many enzyme systems involved in neurochemical transmission and muscular excitability; prevents or controls seizures by blocking neuromuscular transmission; attracts and retains water in the intestinal lumen and distends the bowel to promote mass movement and relieve constipation.

Acute nephritis(children), to control hypertension IV; hypomagnesemia, replacement therapy IV or IM: Pre-eclampsia or eclampsia PO: short term treatment of constipation PO: evacuation of the colon for rectal and bowel examinations To correct or prevent hypomagnesemia in patients on parenteral nutrition Unlabeled uses : inhibition of premature labor(parenteral), adjunct treatment of exacerbations of acute asthma; treatment torsades de pointes: atypical ventricular arrhythmias.

Contraindicated with allergy to magnesium products; heart block, myocardial damage; abdominal pain, nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen, fetal impaction,intestine and biliary tract obstruction, hepatitis. Do not give during two hour preceeding delivery because of risk of magnesium toxicity in the neonate. Use cautiously with renal insufficiency.

CNS: Weakness, Dizziness, Fainting, Sweating(PO) CV: Palpitation GI: Excessive bowel activity, perianal irritation(PO) Metabolic: Magnesium Intoxication(Flush ing, Sweating, Hypotension, Depressed reflexes, Flaccid Paralysis, Hypothermia, Circulatory collapse, Cardiac and CNS depression Parenteral) ; Hypocalcemia with tetany(Secondary to treatment of eclampsia Parenteral)

Assessment History: Allergy to magnesium products; renal insufficiency; heart block, myocardial damage; symptoms of appendicitis; acute surgical abdomen, fecal impaction, intestinal and biliary tract obstruction, hepatitis. Physical: Skin color, texture; muscle tone; orientation, affect, reflexes, peripheral sensation; P, Auscultation, BP, Rhythm strip; abdominal examination, bowel sounds; Renal function test, serum magnesium and calcium(Oral Used) Interventions: Reserved IV used in eclampsia for immediate life threatening

50%solution to 10% or 20% ; may inject diluted fluid ( 4ml of 10- % or 20 mL of 20% solution) IV over 3-4 min. then inject 4-5 g (8 to 10 mL of 50% solution) im into alternate buttocks every 4 hr as needed depending on the patellar reflex and and respiratory function. Or, after initial IV dose, may give 1-2 g/hr by constant IV infusion. Continue until paroxyxms stop. To control seizures, optimal magnesium level is 6mg/100 ml. Do not exceed 30-40 g in 24 hr.

situation Teaching Points Use only as a temporary measure to relieve constipation You may experience diarrhea with oral used Report sweating, flushing, muscle tremors or twitching, inability to move extremnities

Far Eastern University Institute of Nursing

Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study Generic Name (Brand Name) Isordil Catapres

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

Order: 5mg OD Dosage/Frequency: Empty stomach w/ full glass of water 20-40mg/day or twice/day after meals Route: PO

Cardiovascular drug

Prevents & long-term treatment of angina-pectoris or post myocardial infarction (MI) angina. Treatment of severe congestive heart failure (CHF) in combination with cardiac glycosides, diuretics, angiotensin converting enzyme(ACE) inhibitors, arterial vaso dilators;pulmonary hypertension

Acute myocardial infarction(MI); with low filling pressures, except in intensive care unit (ICU) with continuous haemodynamic monitoring; left heart failure with low filling pressures; very low BP; circulatory collapse; hypertrop hic obstructive cardiomyopathy; constrictive pericarditis; pericardial tamponade; aorticstenosis; mitral stenosis; marked anemia; head trauma; cerebral hemorrhage; close angle glaucoma; hyperthyroidism; concomitant therapy w/ sildenafil

Transient hypoxemia; headache; fall in blood pressure; reflex rise in pulse rate, dizziness &weakness, nausea and vomiting, transient skin disorders & allergic skin reactions may sometimes occur. Rare: Paradoxical nitrate effect and/or marked collapse with cardiac arrhythmias. Nitrate headache erythema. Increase in heart rate at start of treatment. Cerebral ischemia. Headache and dizziness.

Assess for pain: duration, time started, activity being performed, character, intensity. Monitor BP; pulse at baseline & during treatment. Cardiac output, decreased(uses) Knowledge deficit(teaching) Give 1hr before or 2hrsafter meals with 8oz of water. Sustained release tablets should not be chewed, or crushed; tablet should be chewed thoroughly.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Ferrous Sulfate ApoFerrous Sulfate (CAN), Feosol, Fer-gensol, Fer-InSol

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

Order: OD Dosages: Daily Requirements Men: 8-11 mg/day Women: 8-18 mg/day PO Pregnant and Lactating women: 10-27 mg/day PO. Replacement in deficiency states 90-300 mg/day(6 mg/kg/day) PO for approximately 6-10 mo may be required.

Drug Classes: Iron preparation Therapeutic actions: Elevates the serum iron concentration, which then helps to form hemoglobin or trapped in the reticuloendotheli al cells for storage and eventual conversion to a usable form of iron.

Prevention and treatment for iron deficiency. Dietary supplement for iron. Unlabeled use:supplemental use during epoetin therapy to ensure proper hematologic response to epoetin.

Contraindicated with allergy to any ingredient; sulfite allergy; hemochromatosis, hemosiderosis, hemolytic anemias. Use cautiously with normal iron balance; peptic ulcer, regional enteritis, ulcerative colitis.

CNS: CNS toxicity, acidosis, coma and death with overdose. GI: GI upset anorexia, nausea, vomiting, constipation, diarrhea, dark stools, temporary staining of the teeth.

Assessment History: Allergy to any ingredient sulfite; hemochromatosis, hemosiderosis, hemolytic anemias; normal iron balnce; peptic ulcer, rehional enteritis, ulcerative colitis. Physical: Skin lesions, color, gums, teeth; Bowelo sounds; CBC, Hgb, Hct, serum ferritin nad iron levels. Interventions: Confirm that pt. does have iron deficiency anemia before treatment. Give drug with meals (avoiding milk, eggs, coffee, tea) if GI discomfort is severe; may slowly increase to build up tolerance. Administer liquid preparations in

water or juice to mask the taste and prevent staining of teeth; have the patient drink the solution with straw. Warn pt. that stool may be dark or green. Arrange for periodic monitoring of Hct and Hgb levels. Teaching Points Do not take this preparation with antacids and tetracyclines. Have periodic blood tests during therapy to determine the appropriate dosage. Report GI upset, lethargy, rapid respirations, constipation.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) HyoscineNbutylbromi

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

1 amp every 8

hours

Classification: Anti spasmodic

de
Brand Name: Buscopan

Inhibits acetylcholineat receptor sites inautonomic nervoussystem, which controlssecretions, free acidsin stomach.

Glaucoma megacolon,hypers

Dry mouth, dizziness,fatigue,

>Give by direct IVafter diluting

ensitivity,paralytic ileus,tachycardia

rash anorexia,headache

withsterilize water >Monitor I&O ratio,retention commonly causes decreasedurinary output

>Assess for constipation >Assess for toleranceover long

term therapy

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Cefalexin Also known as Cephalexin

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

250 mg q6, OD

Drug Class: Anti Bacterial Drugs Cephalosporins Cephalexin, like the penicillins, is a beta-lactam antibiotic. By binding to specific penicillin-binding proteins(PBPs) located inside the bacterial cell wall, it inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall

For the treatment of respiratory tract infections caused by Streptococcus pneumoniae And Streptococcus pyogenes

Hypersensitivity to cephalosporins.

Pain at injection site; hypersensitivity; GI disturbances; eosinophilia, neutropenia, leucopenia, thrombocytopenia. Potentially Fatal: Anaphylactic reactions; nephrotoxicity.

1. The drug should be taken with or without food. (May be taken with meals to reduce GI discomfort) 2.Before administ ration, ask patient if he is allergic to penicillins or cephalosporins. 3. Tell patient to take entire amount of drug exactly as prescribed, even after he feels better. 4. Advise patient to notif y prescriber if rash develops or signs and symptoms of super infection appear. 5. Inform the client not to chew, or cut extended tablets.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Mefenamic acid

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility > assess patients pain before therapy >monitor for possible drug induced adverse reactions >advice patient not to take drug for more than 7 days >advice patient to report immediately persistence or failure torelieve pain

Adult: start with 75-150 mcg BID

Drug Class: Analgesics Aspirin-like drug that has analgesic, antipyretic, & antiinflammatory activities

Relief of pain including muscular, rheumatic, traumatic, dental, postop and postpartum pain, headache, migraine, fever, dysmenorrheal.

Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs

If rash occurs, administration should be stopped, asthmatics, Hx of liver and kidney disease Ddverse reaction: GI discomfort, diarrhea or constipation, gas pain, nausea, vomiting, drowsiness.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Clonidine hydrochlor ide

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

Individualize dosage. Initial dose is 0.1 mg bid; for maintenanc e dosage, increase in increments of 0.1 or 0.2 mg to reach desired response. Common range is0.20.6 mg/day, in divided doses; maximum dose is2.4 mg/day. Minimize sedation by slowly increasing daily dosage; giving majority of daily dose at bedtime.

Drug Class: Anti hypertensive Sympatholytic (centrally acting), Central analgesic Therapeutic Actions: Clonidine stimulates alpha2receptors in brainstem which results in reduced sympathetic out flow from the CNS and a decrease in peripheral resistance leading o reduced BP and pulse rate. It does not alter normal hemodynamic response to exercise at recommended dosages.

Hypertension, use dalone or as part of combination therapy Treatment of severe pain in cancer patients in combination with opiates; epidural more effective with neuropathic pain (Duraclon) Unlabeled uses: Tourette's syndrome; migraine, decreases severity and frequency; menopausal flushing, decreases severity and frequency of episodes; chronic methadone detoxification; rapid opiate detoxification(in doses up to 17mcg/kg/day); alcohol and benzo diazepine withdrawal treatment; management of hypertensive "urgencies"; (oral clonidine "loading" is used; initial dose of 0.2 mg then 0.1 mg every hour until a dose of 0.7 mg is reached or until BP is controlled)

Hypersensitivity. Disorders of cardiac pacemaker activity and conduction. Pregnancy and lactation.

Dry mouth, drowsiness, dizziness, headache, constipation, impotence, vivid dreams, urinary retention; dry, itching, burning sensation in the eye; fluid or electrolyte imbalance, GI upset, paralytic ileus, orthostatic hypotension, weakness, sedation, pruritus, myalgia, urticaria, nausea, insomnia, arrhythmias, agitation. Reduced GI motility at times may cause paralytic ileus..

Assessment History: Hypersensitivity to clonidine or adhesive layer components of the transdermal system; severe coronary insufficiency, recent MI, cerebrovascular dise ase; chronic renal failure; lactation, pregnancy Physical: Body weight; T; skin color, lesions, T; mucous membranes color, lesions; breast examination; orientation, affect, reflexes; ophthalmologic examination; P, BP, orthostatic BP, perfusion, edema, auscultation; bowel sounds, normal output ,liver evaluation, palpation of salivary glands; normal urinary

output, voiding pattern; LFTs, ECG. Nursing Interventions WARNING: Do not discontinue abruptly; discontinue therapy by reducing the dosage gradually over 24 days to avoid rebound hypertension, tachycardia, flushing, nausea, vomiting, cardiac arrhythmias (hypertensive encephalopathy and death have occurred after abrupt cessation of clonidine). Do not discontinue transdermal therapy prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs readily available. Continue oral clonidine therapy within 4 hr of surgery then resume as soon as possible thereafter. Store epidural injection at room temperature; discard any unused portions. Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic

increases the antihypertensive efficacy of clonidine. Monitor BP carefully when discontinuing clonidine; hypertension usually returns within 8 hr.

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Metoprolol

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

100 mg / day

Drug Class: Beta1-selective adrenergic blocker Antihypertensive Therapeutic actions: Competitively blocks betaadrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

- Hypertension, alone or with other drugs, especially diuretics - Immediate-release tablets and injection: Prevention of reinfarction in MI patients who are hemodynamically stable or within 3\u201310 days of the acute MI - Treatment of angina pectoris - Toprol XL only: Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin.

Contraindicated with sinus bradycardia (HR < 45 beats/min), second- or thirddegree heart block (PR interval > 0.24 sec), cardiogenic shock, CHF, systolic BP < 100 mm Hg; lactation. - Use cautiously with diabetes or thyrotoxicosis; asthma or COPD; pregnancy

Allergic: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV:CHF, cardiac arrhythmias, peripher al vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting,anorexia, ischemic colitis, renal

Do not discontinue drug abruptly after long-term therapy (hypersensitivity tocatecholamines may have developed, causing exacerbation of angina, MI, andventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew them. Consult physician about withdrawing drug if patient is to undergo surgery (controversial). Give oral drug with food to facilitate absorption. Provide continual cardiac monitoring for patients receiving IV metoprolol

and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination Musculoskeletal: Joint pain, arthralgia, muscle cramp Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis Other: Decreased exercise tolerance, development of antinuclear antibodies (ANA), hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline Phosphatase. .

Far Eastern University Institute of Nursing Name & age of Patient: Zipagan, Chatelyn 24 yo. Drug Study

Generic Name (Brand Name) Generic Name Hydralazine Trade Name: Apresoline , NovoHylazin

Dosage Frequency

Classification

Indication

Contraindication

Adverse Effects

Nursing Responsibility

10 mg by IV infusion

Pharmacologic Class Vasodilator Therapeutic Class Antihypertensive

General Indications - Hypertension - Eclampsia .

Concentrations - HypersensitivityCAD- mitral valvular rheumatic heart disease Precaution - with CAVs - increased intracranial pressure - severe hypertension with uremia - advanced renal damage - slow acetylators - lactation - pregnancy - pulmonary hypertension

CNS: Headache, periphera lneuritis, dizziness, tremors, psychotic reactions, characterized by depression, disorientation, anxiety CV: Palpitations, tachycardia, angina pectoris, hypotension, paradoxical pressor response, orthostatic hypotension GI: Anorexia, nausea, vomiting, diarrhea, constipation, paralyticileus GU: Difficult micturition, impotence Hematologic: Blood dyscrasias Hypersensitivity: Rash, urticaria, pruritus, fever, chills, arthralgia, eosinophilia; rarely, hepatits, obstructive jaundice Other: Nasal congestion,

Before - Check blood pressure. - Arrange for CBC, LE cell preparations, and ANA titers before therapy - Assess for contraindicated conditions. - Observe the 15 rights of drug administration. - Assess bowel sounds. - Assess voiding pattern. During - Give oral drug with food.- Use parenteral drug immediately after opening ampule. - Discard discolored solutions .- Arrange for CBC, LE cell preparations, and ANA titers during prolonged therapy. - Instruct to take drug exactly as prescribed.

flushing, edema, muscle cramps, lymphadenopathy, splenomegaly, dyspnea, lupus-like syndrome, possible carcinogenesis, lacrimation, conjunctivitis .

After - Withdraw drug gradually. - Discontinue if blood dyscrasias occur. - Arrange for pyridoxine therapy if patient develops symptoms of peripheral neuritis. - Monitor for orthostatic hypotension. - Report persistent or severe constipation, unexplained fever or malaise, muscle or joint aching, chest pain, rash, numbness, tingling. - Do proper documentation