Drug Analysis

Sumapen 500 mg/tab 1 tab OD:

 Indication: Respiratory tract infection, prevention & treatment of secondary bacterial
infection, streptococcal upper respiratory tract infections
 Mechanism of action: Phenoxymethylpenicillin (Penicillin V), the main component
is a natural penicillin produced by fermentation of mutant strains of Penicillium
chrysogenum. It is usually bactericidal in action by interfering with the bacterial cell
wall synthesis. Phenoxymethylpenicillin binds to penicillin-binding proteins on the
bacterial cell wall and blocks peptidoglycan synthesis. Peptidoglycan is a
heteropolymeric structure that gives the cell wall its mechanical stability.
 Side Effects:
o Common: Nausea, vomiting, stomach upset, diarrhea, black hairy tongue
 Nursing Responsibilities:
o Monitor renal and hematologic functions, usual signs of anaphylaxis during
1st dose.
o Know if patient is allergic to penicillin antibiotics
o Mild diarrhea is common, but watch out for serious forms of diarrhea

N- Acetylcysteine (Flumicil) 600 mg/tab in ½ glass of water:

 Indication: Mucolytic, therapy for abnormal thickened mucous secretions in patients
with pneumonia, bronchitis, and tuberculosis
 Mechanism of action: Acetylcysteine exerts mucolytic action through its free
sulfhydryl group which opens up the disulfide bonds in the mucoproteins thus
lowering mucous viscosity.
 Side Effects: Bronchospasm, angioedema, rash, pruritus, hypotension, HTN,
flushing, nausea, vomiting, fever, syncope, sweating, arthralgia, blurred vision, liver
function disturbances, acidosis, convulsion, cardiac or respiratory arrest; hemoptysis,
rhinorrhea, stomatitis (inhalation); itching, irritation, redness
 Nursing Responsibilities:
o Monitor for signs and symptoms of aspiration of excess secretions, and for
bronchospasm (unpredictable); withhold drug and notify physician
immediately if either occurs.
o Monitor cough type and frequency
o Warn patient that it may have a foul smell/ taste
o Instruct patient to do coughing exercises to clear his airway
o Prepare medication by diluting it in ½ glass of water

Warfarin 5mg/ tab 1 tab OD:

 Indication: Treatment and prophylaxis of venous thromboembolism, pulmonary
embolism, and atrial fibrilation
 Mechanism of action: Warfarin inhibits synthesis of vit aminK-dependent
coagulation factors II, VII, IX, and X as well as the anticoagulant protein C and its
cofactor protein S. These clotting factors are biologically activated by the addition of
carboxyl groups to key glutamic acid residues w/in the proteins' structure. Warfarin
competitively inhibits the C1 subunit of the multi-unit vitamin K epoxide reductase
 (VKORC1) enzyme complex, thus depleting functional vitamin K reserves and hence
reduces synthesis of active clotting factors.
 Side Effects: Jaundice, hepatic dysfunction, vasculitis, pancreatitis, nausea, vomiting,
diarrhea, taste perversion, abdominal pain, flatulence, bloating, rash, purpura,
erythematous swollen skin patches leading to ecchymosis, pruritus, alopecia, purple
discoloration of toes due to cholesterol embolization, tracheal or tracheobronchial
calcification, fever, chills. Unexplained drop in hematocrit, decreased Hb. Rarely,
hypersensitivity reactions.
 Nursing Responsibilities:
o Monitor prothrombin time and hematocrit
o Instruct patient to take medication as directed. Take missed doses as soon as
remembered that day; do not double doses.
o Caution patient to avoid IM injections and activities leading to injury. Instruct
patient to use a soft toothbrush, not to floss, and to shave with an electric razor
during warfarin therapy.
o Advise patient to report any symptoms of unusual bleeding or bruising
(bleeding gums; nosebleed; black, tarry stools; hematuria; excessive menstrual
flow) and pain, color, or temperature change to any area of your body to
health care professional immediately.
o Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products,
especially those containing aspirin or NSAIDs, or to start or stop any new
medications during warfarin therapy

Digoxin 0.25 mg/ tab OD:

 Indication: Heart failure, rapid digitalization, atrial fibrilation
 Mechanism of action: Digoxin is a cardiac glycoside which has positive inotropic
activity characterized by an increase in the force of myocardial contraction. It also
reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin
also exerts direct action on vascular smooth muscle and indirect effects mediated
primarily by the autonomic nervous system and an increase in vagal activity.
 Side Effects: Extra beats, anorexia, nausea and vomiting. Diarrhoea in elderly,
confusion, dizziness, drowsiness, restlessness, nervousness, agitation and amnesia,
visual disturbances, gynaecomastia, local irritation
 Nursing Responsibilities:
o Monitor pulse rate
o Review signs and symptoms of digitalis toxicity
o Advise patient that sharing of this medication can be dangerous.

Spironolactone 25 mg/ tab OD

 Indication: Hepatic cirrhosis with ascites, hypertension, severe congestive heart
failure, diuretic-induced hypokalemia
 Mechanism of Action: Spironolactone acts on the distal renal tubules as a
competitive antagonist of aldosterone. It increases the excretion of NaCl and water
while conserving K and hydrogen ions.
  Side Effects: Drowsiness, dizziness, headache, lethargy, leg cramps, GI disturbances
(e.g. diarrhoea, cramps), ataxia, mental confusion, rashes, pruritus, alopecia,
hyponatraemia, electrolyte disturbances, gynaecomastia, hirsutism, menstrual
irregularities, breast pain, deepening of the voice, impotence, leucopenia (including
agranulocytosis), thrombocytopenia, transient elevation in BUN concentration.
Rarely, breast enlargement.
 Nursing Responsibilities:
o Dose should be given in early timings because of increase urination.
o Obtain complete health history (Electrolyte balance & renal function)
o Obtain vital signs with the baseline values specially Blood pressure
o Find out patient’s medication history including alcohol and nicotine
consumption to avoid drug interaction
o Determine possible drug allergies of patient.
o Obtain blood and urine specimen for laboratory analysis
o Observe for any change in consciousness, dizziness, fatigue, postural
hypotension
o Monitor for fluid intake by measuring intake, output and daily weight.
o Monitor laboratory values specially potassium and sodium levels, BUN,
Serum Uric acid.

Trimetazidine 35mg/ tab OD:

 Indication: For angina pectoris (chest pain)
 Mechanism of Action: Trimetazidine inhibits β-oxidation of fatty acids through
inhibition of long-chain 3-ketoacyl-CoA thiolase, which enhances glucose
oxidation. It ensures proper functioning of ionic pumps and transmembrane Na-K
flow by preventing decrease in intracellular ATP levels.
 Side Effects: Dizziness, headache, abdominal pain, dyspepsia, diarrhea, nausea,
vomiting, pruritus, rash, urticaria, asthenia. Rarely, tachycardia, palpitations,
orthostatic hypotension, arterial hypotension, flushing.
 Nursing Responsibilities:
o Ensure patient has taken food before the medication
o Monitor blood pressure before drug administration
o Watch out for hypersensitivity reactions