Alcid, Bernalene Joy L.

Flores, Errol Grace

Ike, Miracle

Pascua, John Mark January 29, 2021

BSN 2B Mr. Eugene Flor

Ulpindo

DRUG NAME MECHANISM OF INDICATION ADVERSE EFFECTS NURSING

ACTION /CONTRAINDICATION RESPONSIBILITIES
Generic: Blocks cyclooxygenase, Indication: CNS: Aseptic meningitis, Before:
Ketorolac an enzyme needed Indicated for the short term cerebral
to synthesize management of moderately hemorrhage, coma, dizziness, Dx
Brand: prostaglandins. severe acute pain that drowsiness, a. Read ketorolac label
Toradol Prostaglandins requires analgesia at the headache, psychosis, seizures, carefully.
mediate inflammatory opioid level, usually in a stroke. b. Monitor urine output
Class response and cause postoperative setting. in older adults and
Therapeutic: local vasodilation, CV: Edema, fluid retention, patients with a history
Analgesic swelling, and pain. They Contraindication: hypertension. of cardiac
also promote pain Advanced renal  impairment decompensation, renal
Pharmacologic: transmission from or risk of EENT: Laryngeal edema, impairment, heart
Nonsteroidal anti – periphery to spinal cord. renal impairment due to stomatitis. failure, or liver
Inflammatory drugs By blocking volume depletion; dysfunction as well as
(NSAIDs). cyclooxygenase and breastfeeding; ENDO: Hyperglycemia. those taking diuretics.
inhibiting cerebrovascular c. Check for allergies.
Dosage: prostaglandins, this bleeding; concurrent use of GI: Abdominal pain; acute  
30 mg IV q6 x 4 doses. NSAID reduces aspirin or pancreatitis; Tx
inflammation other salicylates, other bloating; constipation; a. Use ketorolac with
Route: and relieves pain. NSAIDs, or diarrhea; extreme caution in
IV   probenecid; incomplete diverticulitis; flatulence; GI patients with history of
Source: hemostasis; labor and bleeding, worsening of ulcer disease or
Jones and Bartlett delivery; treatment GI bleeding because
Learning: Nurse's Drug of perioperative pain during inflammatory bowel NSAIDs like
Handbook Fourteenth coronary disease. ketorolac increase risk
Edition artery bypass graft surgery. of GI bleeding and
GU: Interstitial nephritis, renal ulceration. Use
Drug to drug interaction: failure, ketorolac in these
urine retention. patients
ACE inhibitors, angiotensin for shortest length of
II receptor SKIN: Diaphoresis, erythema time possible.
antagonists: Increased risk of multiform, b. Periodically assess
renal exfoliative dermatitis, dose.
impairment; decreased photosensitivity,
effectiveness of pruritus, rash. Edx
these drugs. a. Encourage patient to
Other: Anaphylaxis, have dental
Acetaminophen, gold angioedema, procedures performed
compounds: Increased hyperkalemia, hyponatremia, before starting
risk of adverse renal effects. injection-site drug therapy because of
pain, sepsis, unusual weight increased risk of
Corticosteroids, potassium gain. bleeding.
supplements: b. Caution patient to
Increased risk of gastric avoid hazardous
 
ulcers or activities
hemorrhage. until drug’s CNS effects
are known.
Lithium: Possibly increased
blood lithium During:
level and increased risk of
lithium toxicity. Dx
a. Assess patient’s skin
routinely for rash or
Plicamycin, valproic acid:
other evidence of
Possibly
hypersensitivity
hypoprothrombinemia and
reactions because
increased risk
ketorolac is an NSAID
of bleeding.
and may cause serious
 skin reactions
Probenecid: Decreased without warning, even
elimination of in patients with no
ketorolac, increased risk of history of NSAID
adverse effects. hypersensitivity.
b. Monitor liver
Drug to food interaction: function test results
While taking this medication, because
take it with food, milk or an rarely, elevations may
antacid. progress to severe
hepatic reactions,
including fatal hepatitis,
liver necrosis, and
hepatic failure.
c. Monitor for adverse
effects.

Tx
a. Give IV injection
over at least 15 seconds.
b. Administer a major
portion of dose.
c. Assist patient in
taking medication.

Edx
a. Urge patient to
seek immediate medical
attention if signs
or symptoms occur,
such as a rash,
blisters, fever, or other
signs of
hypersensitivity, such as
itching.
b. Urge patient to limit
use of acetaminophen
to only a few days
during ketorolac
therapy and to notify
prescriber of use.
c. Instruct patient to
verbalize concerns.

After:

Dx
a. Notify prescriber if
pain relief is inadequate
or if breakthrough pain
occurs between doses
because supplemental
doses of an opioid
analgesic may be
required.
b. Monitor for
effectiveness.
c. Monitor CBC for
decreased hemoglobin
and hematocrit because
drug may worsen
anemia.

Tx
a. Take safety
precautions.
b. Provide comfort
measures.
c. Advise her to take
drug with a full glass of
water and to stay
upright for at least 15
minutes afterward.

Edx
a. Monitor patient
especially if elderly.
b. Urge patient to avoid
alcohol while taking
ketorolac.
c. Alert patient to the
possibility of serious
skin reactions.
 DRUG NAME MECHANISM OF INDICATION ADVERSE EFFECTS NURSING
ACTION /CONTRAINDICATION RESPONSIBILITIES
Generic: May slow movement of Indication: CNS: Anxiety, ataxia, Before:
Nifedipine calcium into myocardial Indicated for the treatment of
confusion, dizziness,
and vascular smooth high blood pressure and todrowsiness, headache, BEFORE:
Brand: muscle cells by control angina. It
nervousness, (possibly
Adalat, Adipine, deforming calcium lowers blood pressure by
extreme), nightmares, Dx:
Coracten, Fortipine, channels in cell relaxing the blood vessels so
paresthesia, psychiatric  Monitor patient
Nifedipress, Tensipine membranes, inhibiting the heart does not have todisturbance, syncope, tremor, carefully (BP,
and Valni. ion-controlled gating pump as hard. weakness.  cardiac rhythm,
mechanisms, and and output)
Class disrupting calciumContraindication: CV: Arrhythmias, chest pain,  Assess for
Therapeutic: release fromHypersensitivity to a calcium heart failure, hypotension, allergy
Antianginal, anti – sarcoplasmic reticulum. channel blocker, second or palpitations, peripheral edema.  Assess for Skin
hypertensive Decreasing intracellular third degree AV block lesions, color,
calcium level inhibits without artificial pacemaker, EENT: Altered taste, blurred edema;
Pharmacologic: smooth muscle cell sick sinus syndrome. vision, dry mouth, epistaxis, orientation, BP,
Calcium channel contraction and dilates gingival hyperplasia, nasal peripheral
blocker arteries, whichDrug to drug interaction: congestion, pharyngitis, perfusion.
decreases myocardial Anesthetics: possibly sinusitis, tinnitus. Tx:
Dosage: oxygen demand, hypotension.  Perform a
30 mg OD peripheral resistance, ENDO: Gynecomastia, thorough
blood pressure, and Benazepril: Possibly hyperglycemia. physical
Route: afterload.  increased heart rate and assessment to
Oral hypotensive effect. GI: Anorexia; constipation; establish
Source: diarrhea; dyspepsia; elevated baseline data
Jones and Bartlett Beta blockers: Increased risk liver function test results; before drug
Learning: Nurse's Drug of profound hypotension, gastrointestinal bleeding, therapy begins.
Handbook Fourteenth heart failure, and worsening irritation, or obstruction.  Protect drug
Edition of angina. from light and
GU: Dysuria, nocturia, moisture
Calcium supplements: polyuria, sexual dysfunction,
Possibly interference with urinary frequency. EDx:
action of nifedipine.  Educate client
HEME: Anemia, leukopenia, on drug therapy
Digoxin: Transiently positive Coombs’ test, to promote
increased blood digoxin level, thrombocytopenia. compliance.
increased risk of digitalis  Ensure the
toxicity SKIN: Acute generalized patient takes the
exanthematous pustulosis, medication as
Disopyramide, flecainide: diaphoresis, erythema prescribed
Increased risk of bradycardia, multiforme, exfoliative
conduction defects, and heart dermatitis, flushing. During:
failure.
Dx
Doxazocin: Decreased a. Because of drug’s
doxazocin effectiveness; negative inotropic effect
increased nifedipine on some patients,
effectiveness. frequently monitor heart
rate and rhythm, as well
Tacrolimus: Decreased as blood pressure,
tacrolimus metabolism. especially in patients
who take a beta blocker
Drug to food interaction: or have heart failure,
Grapefruit, grapefruit juice: significant left
Possibly increased ventricular dysfunction,
bioavailability of nifedipine or tight aortic stenosis.
high-fat meals: Possibly b. Monitor fluid
delayed nifedipine intake/output and daily
absorption. weight; fluid retention
may lead to heart
failure. Also assess for
signs of heart failure,
such as crackles,
dyspnea, jugular vein
distention, peripheral
edema, and weight gain.
c. Monitor for adverse
effects.

Tx
a. Instruct patient to
swallow E.R. tablets
whole, not to crush,
chew, or break them.
Inform her that their
empty shells may
appear in stool.
b. Urge patient not to
take drug within 1 hour
of a high fat meal or
grapefruit. Urge her not
to alter the amount of
grapefruit in her diet
without consulting
prescriber.
c. Assist patient in
taking medication.

Edx
a. Teach patient to
measure pulse rate and
blood pressure, and
advise her to call
prescriber if they drop
below accepted levels.
b. Instruct patient to
notify prescriber
immediately about chest
pain, difficulty
breathing, ringing in
ears, and swollen gums.
c. Instruct patient to
verbalize concerns.

After:

Dx
a. Teach patient to
minimize constipation
by increasing her intake
of fluids, if allowed,
and dietary fiber.
b. Monitor for
effectiveness.
c. Advise her to notify
prescriber if she misses
two or more doses.

Tx
a. Take safety
precautions.
b. Provide comfort
measures.
c. Advise patient to
avoid hazardous
activities until drug’s
CNS effects are known.

Edx
a. Emphasize the need
to comply with
prescribed lifestyle
changes, such as
alcohol moderation, low
fat or low sodium diet,
regular exercise,
smoking cessation,
stress reduction, and
weight reduction.
b. Caution patient that
hot tubs, saunas, and
prolonged hot showers
may cause dizziness and
fainting.
c. Advise patient to
avoid prolonged sun
exposure and to wear
sunscreen outdoors.