1. Which medications may have contributed to Ms. Espinoza’s altered mental status?

Make a drug study of all the medications taken by Ms. Espinoza.

Drugs Mechanism of Action Rationale Common Side Effects Nursing Considerations

Generic name Reduces fever and relieves mild Treatment for patients with high fever, EENT: tinnitus, hearing ● Monitor vital signs
Aspirin to moderate pain from conditions toothaches, and reduces swelling for loss. frequently, especially
such as muscle aches, patients with arthritis. temperature.
Brand name toothaches, common colds , and GI: nausea, GI distress, ● Monitor CBC, platelets,
Ecotrin, Zorprin headaches. It may also be used occult bleeding, PT, BUN, serum
to reduce pain and swelling in CONTRAINDICATIONS: dyspepsia, GI bleeding.
creatinine, and liver
Classification conditions such as arthritis. . Contraindicated in patients
Non-steroidal hypersensitive to drugs and in those GU: acute renal function studies
anti-inflammatory with G6PD deficiency or bleeding insufficiency. periodically during
drug (NSAID), disorders such as hemophilia, von salicylate therapy to
Antiplatelet Agents, Willebrand’s disease, or telangiectasia. Hematologic: detect abnormalities.
Cardiovascular; Also contraindicated in patients with leukopenia, ● Assess patients for
Antiplatelet Agents, NSAID-induced sensitivity reactions thrombocytopenia, signs and symptoms of
Hematologic and in children with chickenpox or flu prolonged bleeding hemorrhage, such as
like symptoms. time. petechiae, bruising,
Dosage coffee ground vomitus,
Adults: 325-650 mg Hepatic: liver and black tarry stools.
Children under 12 dysfunction, hepatitis. ● Stop aspirin therapy 1
years:10-15 mg/kg
week before elective
Children 12 years and Skin: rash, bruising,
older: 325-650 mg urticaria. surgery, if possible.
● Advise patients to sit up
Frequency Other: hypersensitivity for 15 to 30 minutes
Q 4-6 hrs reactions (anaphylaxis, after taking salicylates to
asthma), Reye’s prevent lodging of
Route syndrome, angioedema salicylates in the
Orally/rectally esophagus.
Generic name Metoprolol is a beta-1-adrenergic Treatment for patients with chest pain CNS: fatigue, dizziness, ● Decrease dose of Toprol
Metoprolol succinate receptor inhibitor specific to (angina), heart failure , and high depression, insomnia, XL if a patient with heart
cardiac cells with negligible effect blood pressure. Lowering high blood headaches, nightmares, failure experiences
Brand name on beta-2 receptors. This pressure helps prevent strokes, heart drowsiness. symptomatic bradycardia.
Tropol inhibition decreases cardiac attacks, and kidney problems. ● Administer drugs with
output by producing negative CV: bradycardia, meals to enhance
Classification chronotropic and inotropic effects CONTRAINDICATIONS: hypotension, heart absorption.
Cardioselective beta1 without presenting activity failure, cold limbs, ● Reduce dosage in patients
Antagonist; exact towards membrane stabilization Contraindicated in patients Raynaud’s disease, with impaired hepatic
mechanism of nor intrinsic sympathomimetics hypersensitive to drug or other beta arrhythmias. function.
Antihypertensive blockers. Also contraindicated in ● Avoid late-evening doses
patients with sinus bradycardia, heart GI: nausea, diarrhea, to minimize insomnia.
Dosage block greater than first-degree, constipation, flatulence. ● Monitor heart rate, blood
Adults: 50 to 100 mg cardiogenic shock, or overt cardiac Respiratory: dyspnea, pressure, and ECG during
failure when used to treat hypertension bronchospasm. I.V. administration.
Frequency or angina. When used to treat MI, drug ● Check blood pressure
Q 6 hours for 48 also is contraindicated in patients with Skin: rash. during dosage adjustment
hours heart rate less than 45 beats/minute, and every 3 to 6 months
second- or third-degree heart block, PR Other: decreased during maintenance
Route interval of 0.24 second or longer with libido. therapy.
PO first-degree heart block, systolic blood ● Assess patients for signs
pressure less than 100 mm Hg, or of mental depression.
moderate to severe cardiac failure.
Use cautiously in patients with
diabetes mellitus, impaired hepatic or
respiratory function, diabetes, or heart
failure.