Case Study Module 5

UNIVERSITY OF CEBU - BANILAD
Gov. M. Cuenco Ave, Cebu City, 6000 Philippines

College of Nursing
Telephone No: (032) 231- 8631
NCM 106 – Pharmacology
Course Outputs /Assessment of Learning for CILO # 1

Written Outputs (Mental Models, Group Activity and Reflection Journal)
Name of Student : VILLALUNA, KHYLAMARIE P. Yr.& Sec. : BSN-2A

Module/Topic : MODULE 5 - ELABORATE Date : 11/3/21
1. Create a Drug Study on Neuro Drugs that are commonly used in clinical settings. Utilize the drug study template.
a. Neuro Ward ( 5 Medications )

i. Local Anesthesia – Lidocaine
Patient: Bogart Dominador Allergic to: N/A Attending Physician: Dr. Carlo Magalzo Room no: 397
Impression: Appendicitis Age: 18 Hospital no: 50502344
Generic /
Client Teaching
Brand Name Dose, Strenght And Indication/Mechanis Adverse Effects &
Nursing Responsibilities
& Formulation m Of Action Contraindications
Classification
Generic: Ordered: Indication: Adverse effects: Assessment: Instruct patient to:
lidocaine Apply 2 to 2.5 g for 20 Xylocaine (lidocaine Cardiovascular: History:  Swish and spit out if
to 60 minutes before HCl) 2% Jelly is Bradycardia, hypotension, using for relief of
procedure and cover indicated for cardiovascular collapse,  Allergy to lidocaine mouth discomfort or
with an occlusive prevention and control cardiac arrest, circulatory or amide-type local pharyngeal discomfort
dressing (Max of pain in procedures collapse, hypertension, anesthetics, CHF,  Avoid applying to
application time: 2 involving the male and arrhythmia, maternal cardiogenic shock, broken or abraded
Brand:
female urethra, for hypotension, shock, second- or third-
Pharmacology Module 1 st Semester S.Y. 2021- 2022 UCBC Page 1

College of Nursing
Telephone No: (032) 231- 8631
Anestacon, hours). topical treatment of tachycardia, ventricular degree heart block, skin
Dilocaine, L- painful urethritis, and fibrillation, heart block, Wolff-Parkinson-  Avoid contact of
Caine, as an anesthetic myocardial depression, White syndrome, medication with eyes
Lidoderm lubricant for peripheral vasodilation Stokes-Adams  Report any unusual
Timing:
Patch, Lidoject, endotracheal intubation syndrome, hepatic or heart palpitations.
LidoPen Auto- (oral and nasal). Nervous system: renal disease,
20-60 minutes before  See their health care
Injector, procedure inflammation or provider regularly if
Lightheadedness,
Nervocaine, sepsis in region of using medication on a
headache, dizziness,
Xylocaine, injection, lactation, regular basis
Mechanism of Action: drowsiness,
Xylocaine pregnancy  Instruct patient to
Duration: cold/numbness, tremor,
Viscous, Lidocaine stabilizes the  Physical: T; skin report irritation or
convulsions,
Zilactin-L neuronal membrane by color, rashes, lesions; increase in discomfort
2 hrs unconsciousness,
inhibiting the ionic orientation, speech, in areas medication
positional headache,
fluxes required for the reflexes, sensation used
peripheral nerve
initiation and and movement (local  Instruct patient that
Classification: symptoms, spinal cord
Other Forms: conduction of impulses, anesthetic); P, BP, he/she will have no
deficit, paresthesia,
Pharmacologic thereby effecting local auscultation, feeling in anesthetized
Injection: 5 mg/ml, 10 speech slurred,
classification: anesthetic action. continuous ECG area, so must take
mg/ml, 15 mg/ml, 20 arachnoiditis, peripheral
amide monitoring during use extra caution to avoid
mg/ml, 40 mg/ml, 100 nerve injury, coma,
derivative as antiarrhythmic; injury, including heat-
mg/ml, 200 mg/ml paralysis of the lower
edema; R, related injury.
extremities, cauda equina
Therapeutic adventitious sounds;  Not to eat within 1
Jelly: 2% syndrome, Horner's
classification: bowel sounds, liver hour of administration
syndrome, hemiparesis,
ventricular Ointment: 5% evaluation; urine  Not to chew gum
circumoral paresthesia,
antiarrhythmic, output; serum while any portion of
nystagmus
local anesthetic Parenteral injection: electrolytes, LFTs, mouth or throat is
0.5%, 1%, 1.5%, 2%, Gastrointestinal: renal function tests anesthetized to
Pregnancy risk 4% (lidocaine with Vomiting, nausea, bowel prevent biting injuries
category B epinephrine Interventions:
control loss, swallowing
combinations also

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available) difficult, numbness of  Check BP and cardiac

tongue monitor prior to
Premixed solutions: 2 administration of
mg/ml, 4 mg/ml, 8 Psychiatric: lidocaine.
mg/ml in D5W  For stable patients,
Nervousness,
doses should be given
Spray: 10% apprehension, euphoria,
slow IV push at 25
confusion, agitation,
Topical solution: 2%, mg/minute.
disorientation, psychosis,
4% restlessness, excitement  Monitor blood
pressure and cardiac
Cream: 0.5% Hematologic: monitor during
therapy with
Gel: 0.5%, 2.5% Methemoglobinemia lidocaine.
Liquid: 2.5%  Assess neurological
Dermatologic:
and respiratory status
Ointment: 2.5% Urticaria, cutaneous frequently for signs of
lesion, dermatitis, rash, toxicity.
Spray: 0.5%  When treating a
angioedema, face edema
patient for ventricular
Transdermal patch:
Genitourinary: Bladder dysrhythmias with
5%
control loss, sexual lidocaine, an IV
function loss, perineal infusion (drip) must
sensation loss, urinary be started soon after
retention the bolus or serum
level will drop below
Immunologic: Allergic therapeutic range and
reaction, ventricular
anaphylaxis/anaphylactoi dysrhythmias will
d reaction return.

College of Nursing
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Metabolic:  If patient appears

Hypoglycemia upset or agitated,
consider lidocaine
Musculoskeletal: toxicity. If toxicity is
blurred/doubled vision, evident, simply
diplopia, transient discontinue IV
amaurosis, bilateral infusion–serum levels
amaurosis drop in 10-20
minutes.
Respiratory: Respiratory
depression, respiratory
arrest, dyspnea,
bronchospasm,
hypoventilation, apnea,
respiratory inadequacy,
respiratory failure,
yawning
Contraindications:
Lidocaine is
contraindicated in patients
with a known history of
hypersensitivity to local
anesthetics of the amide
type or to other
components of Xylocaine
2% Jelly.
ii. Anticonvulsant/Anti-epileptic – Phenytoin

College of Nursing
Telephone No: (032) 231- 8631
Patient: Camille De Guzman Allergic to: N/A Attending Physician: Dr. Miguel Yu Room no: 567
Impression: Epilepsy Age: 23 Hospital no: 50502344
Client Teaching
Generic / Brand Name Dose, Strenght Indication/Mechanism Adverse Effects & Nursing
& Classification And Formulation Of Action Contraindications Responsibilities
Generic: Ordered: Indication: Adverse effects: Assessment: Instruct patient to:
phenytoin 100–200 mg Phenytoin is  thoughts of harming History:  Take this drug

IM q 4 hr indicated to treat or killing yourself – exactly as
during surgery grand mal seizures, a small number of  Hypersensitivity prescribed,
and the complex partial people taking to hydantoins; with food to
postoperative seizures, and to phenytoin have had sinus reduce GI
Brand: period prevent and treat suicidal thoughts, bradycardia, AV upset, or
seizures during or which can happen heart block, without food—
Dilantin, Phenytek, Stokes-Adams
following after a few weeks but maintain
Epanutin, Epanutin syndrome, acute
Timing: neurosurgery.14 of treatment consistency in
Infatabs intermittent
Injectable phenytoin  unexpected bruising the manner in
q4h and Fosphenytoin, porphyria, which you take
Classification: or bleeding, a high
which is the hypotension, it. Be
temperature or sore
Anticonvulsants, phosphate ester severe especially
throat – these could
Hydantoins, prodrug formulation myocardial careful not to
Duration: be warning signs of
Antidysrhythmics, of phenytoin2, are insufficiency, miss a dose if
a blood disorder
group 1b, pregnancy Surgery to indicated to treat diabetes mellitus, you are on
 a high temperature
category D postoperative tonic-clonic status hyperglycemia, once-a-day
with swollen glands
period pregnancy,

College of Nursing
Telephone No: (032) 231- 8631
epilepticus, and for and a skin rash, lactation therapy.

the prevention and sometimes with  Physical: T; skin  Do not
Other forms: treatment of seizures yellowing of your color, lesions; discontinue
Chewable occurring during skin or the whites lymph node this drug
tablets—50 mg; neurosurgery. of your eyes, palpation; abruptly or
oral suspension particularly in the orientation, change dosage,
—125 mg/5 first 2 months of affect, reflexes, except on the
mL; capsules— treatment – these vision advice of your
100 mg; ER may be signs of a examination; P, health care
capsules—30, hypersensitivity BP; R, provider.
100, 200, 300 reaction, which is adventitious  Maintain good
Mechanism of
mg; injection— Action: more likely to sounds; bowel oral hygiene
50 mg/mL happen if you're sounds, normal (regular
Phenytoin is often black African- output, liver brushing and
described as a non- Caribbean or have a evaluation; flossing) to
specific sodium weakened immune periodontal prevent gum
channel blocker and system examination; disease;
targets almost all  a skin rash – this LFTs, urinalysis, arrange
voltage-gated sodium might be a sign of CBC and frequent dental
channel subtypes.7 Stevens-Johnson differential, checkups to
More specifically, syndrome blood proteins, prevent serious
phenytoin prevents blood and urine gum disease.
seizures by inhibiting glucose, EEG  Arrange for
the positive feedback Contraindications: and ECG frequent
loop that results in checkups to

College of Nursing
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neuronal propagation DILANTIN is monitor your

of high frequency contraindicated in response to this
action potentials. patients with: Interventions: drug.
 Use only clear  Monitor your
parenteral blood or urine
 A history of solutions; a faint sugar
hypersensitivity to yellow color may regularly, and
phenytoin, its develop, but this report any
inactive has no effect on abnormality to
ingredients, or potency. If the your health
other solution is care provider if
 Reactions have refrigerated or you have
included frozen, a diabetes.
angioedema. precipitate might  This drug is not
 A history of prior form, but this recommended
acute will dissolve if for use during
hepatotoxicity the solution is pregnancy. It is
attributable to allowed to stand advisable to
phenytoin. at room use some form
 Coadministration temperature. Do of
with delavirdine not use solutions contraception
that have other than
because of the
potential for loss of haziness or a hormonal
precipitate. contraceptives.
virologic response
 Wear a medical

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Telephone No: (032) 231- 8631
and possible  WARNING: alert tag so that

resistance to Administer IV any emergency
delavirdine or to slowly to prevent medical
the class of non- severe personnel will
nucleoside reverse hypotension; the know that you
transcriptase margin of safety have epilepsy
inhibitors. between full and are taking
therapeutic and antiepileptic
toxic doses is medication.
small.  You may
Continually experience
monitor patient’s these side
cardiac rhythm effects:
and check BP Drowsiness,
frequently and dizziness,
regularly during confusion,
IV infusion. blurred vision
Suggest use of (avoid driving
fosphenytoin or performing
sodium if IV other tasks
route is needed. requiring
 Monitor injection alertness or
sites carefully; visual acuity;
drug solutions alcohol may
are very alkaline intensify these

College of Nursing
Telephone No: (032) 231- 8631
and irritating. effects); GI

 WARNING: upset (take
Monitor for drug with food,
therapeutic eat frequent
serum levels of small meals).
10–20 mcg/mL.  Report rash,
 Give oral drug severe nausea
with or without or vomiting,
food in a drowsiness,
consistent slurred speech,
manner. Give impaired
with food if coordination
patient complains (ataxia),
of GI upset. swollen glands,
 Recommend that bleeding,
the oral swollen or
phenytoin tender gums,
prescription be yellowish
filled with the discoloration
same brand each of the skin or
time; differences eyes, joint
in bioavailability pain,
have been unexplained
documented. fever, sore
throat, unusual

College of Nursing
Telephone No: (032) 231- 8631
 Suggest that adult bleeding or

patients who are bruising,
controlled with persistent
300-mg extended headache,
phenytoin malaise, any
capsules try indication of
once-a-day an infection or
dosage to bleeding
increase tendency,
compliance and abnormal
convenience. erection,
 WARNING: pregnancy.
Reduce dosage,
discontinue
phenytoin, or
substitute other
antiepileptic
medication
gradually; abrupt
discontinuation
may precipitate
status epilepticus.
 Phenytoin is
ineffective in
controlling

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Telephone No: (032) 231- 8631
absence (petit
mal) seizures.
Patients with
combined
seizures will
need other
medication for
their absence
seizures.
 WARNING:
Discontinue drug
if rash,
depression of
blood count,
enlarged lymph
nodes,
hypersensitivity
reaction, signs of
liver damage, or
Peyronie’s
disease
(induration of the
corpora
cavernosa of the
penis) occurs.

College of Nursing
Telephone No: (032) 231- 8631
Institute another
antiepileptic drug
promptly.
 Monitor hepatic
function
periodically
during long-term
therapy; monitor
blood counts and
urinalysis
monthly.
 Monitor blood or
urine sugar of
patients with
diabetes mellitus
regularly.
Adjustment of
dosage of
hypoglycemic
drug may be
needed because
antiepileptic may
inhibit insulin
release and
induce

College of Nursing
Telephone No: (032) 231- 8631
hyperglycemia.
 WARNING:
Have lymph
node
enlargement
occurring during
therapy evaluated
carefully.
Lymphadenopath
y that simulates
Hodgkin’s
lymphoma has
occurred. Lymph
node hyperplasia
may progress to
lymphoma.
 Monitor blood
proteins to detect
early malfunction
of the immune
system (eg,
multiple
myeloma).
 Arrange
instruction in

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Telephone No: (032) 231- 8631
proper oral
hygiene
technique for
long-term
patients to
prevent
development of
gum hyperplasia.
iii. Anticonvulsant /Anti-epileptic – Carbamazepine

Patient: Camila Kabillo Allergic to: N/A Attending Physician: Dr. Ramon Sy Room no: 567
Generic / Brand Client Teaching

Dose, Strenght Indication/Mechanism Of Adverse Effects &
Name & Nursing Responsibilities
And Formulation Action Contraindications
Classification
Generic: Ordered: Indication: Adverse effects: Assessment Instruct patient to:
carbamazepine Initial dose, 200 Epilepsy Hemopoietic System: History:  Take drug with
mg PO bid on food as
the first day; Tegretol is indicated for use Aplastic anemia,  Hypersensitivity prescribed.
increase as an anticonvulsant drug. agranulocytosis, to carbamazepine
Brand: Swallow ER
gradually by up
Evidence supporting pancytopenia, bone or TCAs; history
efficacy of Tegretol as an tablets whole,
Apo- to 200 mg/day marrow depression, of bone marrow
anticonvulsant was derived do not cut,
Carbamazepine in divided thrombocytopenia, depression;
from active drug-controlled crush, or chew

College of Nursing
Telephone No: (032) 231- 8631
(CAN), Carbatrol, doses q 6–8 hr, leukopenia, concomitant use them.

Epitol, Novo- until best studies that enrolled patients leukocytosis, of MAOIs;  Do not
with the following seizure
Carbamaz (CAN), response is eosinophilia, acute history of discontinue
types:
Tegretol, Tegretol- achieved. intermittent porphyria, adverse this drug
XR 1. Partial seizures variegate porphyria, hematologic abruptly or
with complex porphyria cutanea reaction to any change dosage,
Timing: symptomatology tarda. drug; glaucoma except on the
(psychomotor, tem or increased IOP; advice of your
Classification: poral lobe).
q6-8hr history of physician.
Patients with these
antiepileptic Skin: cardiac, hepatic,  Avoid alcohol,
seizures appear to
show greater or renal damage; sleep-inducing,
Duration: improvement than Toxic epidermal psychiatric or OTC drugs;
those with other necrolysis (TEN) and history; lactation; these could
until best types. Stevens-Johnson pregnancy cause
response is 2. Generalized tonic- syndrome (SJS), Acute  Physical: Weight;
clonic seizures dangerous
achieved. Generalized T; skin color, effects.
(grand mal).
3. Mixed seizure Exanthematous lesions; palpation  Arrange for
patterns which Pustulosis (AGEP), of lymph glands; frequent
Other forms: include the above, pruritic and orientation, checkups,
or other partial or erythematous rashes, affect, reflexes; including
Tablets—200 generalized
urticaria, ophthalmologic blood tests, to
mg; chewable seizures. Absence
seizures (petit mal)
photosensitivity examination monitor your
tablets—100 reactions, alterations
do not appear to be (including response to
mg; ER tablets controlled by in skin pigmentation, tonometry, this drug. Keep
—100, 200, Tegretol exfoliative dermatitis, funduscopy, slit all

College of Nursing
Telephone No: (032) 231- 8631
400 mg; ER erythema multiforme lamp appointments

capsules—200, Trigeminal Neuralgia and nodosum, purpura, examination); P, for checkups.
300 mg; aggravation of BP, perfusion;  Use
Tegretol is indicated in the
suspension— treatment of the pain
disseminated lupus auscultation; contraceptives
100 mg/5 mL, associated with true erythematosus, peripheral at all times; if
200 mg/10 mL trigeminal neuralgia. alopecia, diaphoresis, vascular you wish to
onychomadesis and examination; R, become
Beneficial results have also hirsutism. In certain adventitious pregnant, you
been reported in
cases, discontinuation sounds; bowel should consult
glossopharyngeal neuralgia.
of therapy may be sounds, normal your physician.
This drug is not a necessary. output; oral  Wear a medical
simple analgesic and should mucous alert tag at all
not be used for the relief of membranes; times so that
trivial aches or pains.
Cardiovascular normal urinary any emergency
System: output, voiding medical
Mechanism of Action:
pattern; CBC personnel will
Tegretol has Congestive heart including know that you
demonstrated failure, edema, platelet, have epilepsy
anticonvulsant aggravation of reticulocyte and are taking
properties in rats and hypertension, counts and serum antiepileptic
mice with electrically hypotension, syncope iron; hepatic medication.
and chemically induced and collapse, function tests,  You may
seizures. It appears to aggravation of urinalysis, BUN, experience
act by reducing coronary artery thyroid function these side
polysynaptic responses disease, arrhythmias effects:

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Telephone No: (032) 231- 8631
and blocking the post- and AV block, tests, EEG Drowsiness,

tetanic potentiation. thrombophlebitis, dizziness,
Tegretol greatly thromboembolism blurred vision
reduces or abolishes (e.g., pulmonary Intervention: (avoid driving
pain induced by embolism), and or performing
stimulation of the adenopathy or  Use only for other tasks
infraorbital nerve in lymphadenopathy. classifications requiring
cats and rats. It listed. Do not use alertness or
depresses thalamic as a general visual acuity);
potential and bulbar Some of these analgesic. Use GI upset (take
and polysynaptic cardiovascular only for epileptic the drug with
reflexes, including the complications have seizures that are food or milk;
linguomandibular resulted in fatalities. refractory to eat frequent
reflex in cats. Tegretol Myocardial infarction other safer small meals).
is chemically unrelated has been associated agents.  Report
to other anticonvulsants with other tricyclic  Give drug with bruising,
or other drugs used to compounds. food to prevent unusual
control the pain of GI upset. bleeding,
trigeminal neuralgia.  Do not mix abdominal
The mechanism of suspension with pain,
Liver:
action remains other medications yellowing of
unknown. Abnormalities in liver or elements— the skin or
function tests, precipitation may eyes, pale
cholestatic and occur. feces,
hepatocellular  WARNING: darkened

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jaundice, hepatitis, Reduce dosage, urine,

very rare cases of discontinue, or impotence,
hepatic failure. substitute other CNS
antiepileptic disturbances,
medication edema, fever,
Pancreatic: gradually. Abrupt chills, sore
discontinuation throat, mouth
Pancreatitis. of all ulcers, rash,
antiepileptic pregnancy.
medication may
Respiratory System: precipitate status
epilepticus.
Pulmonary  Suspension will
hypersensitivity produce higher
characterized by fever, peak levels than
dyspnea, pneumonitis, tablets—start
or pneumonia. with a lower dose
given more
frequently.
Genitourinary  Ensure that
System: patient swallows
ER tablets whole
Urinary frequency,
—do not cut,
acute urinary
crush, or chew.
retention, oliguria with
 Arrange for

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Telephone No: (032) 231- 8631
elevated blood frequent liver

pressure, azotemia, function tests;
renal failure, and discontinue drug
impotence. immediately if
Albuminuria, hepatic
glycosuria, elevated dysfunction
BUN, and microscopic occurs.
deposits in the urine  Arrange for
have also been frequent eye
reported. There have examinations,
been rare reports of urinalysis, and
impaired male fertility BUN
and/or abnormal determinations.
spermatogenesis.  Arrange for
frequent
monitoring of
Nervous System: serum levels of
carbamazepine
Dizziness, drowsiness, and other
disturbances of antiepileptics
coordination, given
confusion, headache, concomitantly,
fatigue, blurred vision, especially during
visual hallucinations, the first few
transient diplopia, weeks of therapy.

College of Nursing
Telephone No: (032) 231- 8631
oculomotor Adjust dosage on

disturbances, basis of data and
nystagmus, speech clinical response.
disturbances, abnormal  Counsel women
involuntary who wish to
movements, peripheral become pregnant;
neuritis and advise the use of
paresthesias, barrier
depression with contraceptives.
agitation,  Evaluate for
talkativeness, tinnitus, therapeutic serum
hyperacusis, levels (usually 4–
neuroleptic malignant 12 mcg/mL).
syndrome.
Digestive System:
Nausea, vomiting,
gastric distress and
abdominal pain,
diarrhea, constipation,
anorexia, and dryness
of the mouth and
pharynx, including

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Telephone No: (032) 231- 8631
glossitis and
stomatitis.
Eyes:
Scattered punctate
cortical lens opacities,
increased intraocular
pressure as well as
conjunctivitis, have
been reported.
Although a direct
causal relationship has
not been established,
many phenothiazines
and related drugs have
been shown to cause
eye changes.
Musculoskeletal
System:
Aching joints and

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Telephone No: (032) 231- 8631
muscles, and leg

cramps.
Metabolism:
Fever and chills.

Hyponatremia,
Decreased levels of
plasma calcium have
been reported.
Osteoporosis has been
reported.
Contraindications:
Tegretol should not be

used in patients with a
history of previous
bone marrow
depression,
hypersensitivity to the
drug, or known
sensitivity to any of

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Telephone No: (032) 231- 8631
the tricyclic
compounds, such as
amitriptyline,
desipramine,
imipramine,
protriptyline,
nortriptyline, etc.
Likewise, on
theoretical grounds its
use with monoamine
oxidase (MAO)
inhibitors is not
recommended. Before
administration of
Tegretol, MAO
inhibitors should be
discontinued for a
minimum of 14 days,
or longer if the clinical
situation permits.

College of Nursing
Telephone No: (032) 231- 8631
iv. Anticonvulsant/Anti-epileptic –Phenobarbital
Patient: Jayzam Manala Allergic to: N/A Attending Physician: Dr. Carla Diaz Room no: 567
Generic / Brand Dose, Strenght Client Teaching
Indication/Mechanism Of Adverse Effects &
Name & And Nursing Responsibilities
Action Contraindications
Classification Formulation
phenobarbital 4–6 Oral Nervous system: History:  This drug will

mg/kg/day Agitation, confusion, make you
for 7–10 days hyperkinesia, ataxia,  Hypersensitivity drowsy and less
to a blood a. Sedatives. CNS depression, to barbiturates, anxious; do not
Brand:
level of 10– nightmares, manifest or latent try to get up
Oral 15 mcg/mL nervousness, porphyria; after you have
preparations: or 10–15 b. Hypnotics, for the short- psychiatric marked liver received this
Bellatal, Solfoton mg/kg/day
term treatment of
disturbance, impairment; drug (request
insomnia, since they nephritis; severe
IV or IM. appear to lose their hallucinations, assistance to sit
Parenteral: respiratory
effectiveness for sleep insomnia, anxiety, up or move
Luminal Sodium distress; previous
induction and sleep dizziness, thinking around).
maintenance after 2 abnormality. addiction to
Classification: Timing:  Take this drug
weeks. sedative-hypnotic
exactly as
Barbiturate (long everyday Respiratory system: drugs; pregnancy;
prescribed; this
acting), Sedative, Hypoventilation, acute or chronic
drug is habit
Hypnotic, pain; seizure

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Antiepileptic c. Preanesthetics. apnea. disorders; forming; its

lactation, fever; effectiveness in
Duration: Cardiovascular hyperthyroidism; facilitating
d. Long-term system: Bradycardia, diabetes mellitus; sleep disappears
7-10 days hypotension, syncope.
anticonvulsants for the
severe anemia; after a short
treatment of generalized
tonic-clonic and cortical Digestive system: cardiac disease; time.
local seizures. And, in the Nausea, vomiting, shock; uremia;  Do not take this
Other forms:
emergency control of constipation. impaired liver or drug longer
certain acute convulsive renal function; than 2 weeks
Tablets—15,
episodes, e.g., those Other reported
16, 16.2, 30, debilitation (for insomnia),
associated with status
60, 90, 100 reactions: Headache,  Physical: Weight; and do not
epilepticus, cholera,
mg; capsules eclampsia, meningitis, injection site reactions, T; skin color, increase the
—16 mg; tetanus, and toxic hypersensitivity lesions; dosage without
elixir—15 reactions to strychnine or reactions (angioedema orientation, consulting your
local anesthetics. skin rashes, exfoliative
mg/5 mL, 20 affect, reflexes; health care
mg/5 mL; dermatitis), fever, liver P, BP, orthostatic provider.
injection— damage, megaloblastic BP; R,  Do not reduce
Mechanism of Action: anemia following adventitious
30, 60, 65, the dosage or
130 mg/mL chronic phenobarbital sounds; bowel discontinue this
Phenobarbital acts on
use. sounds, normal drug (when
GABAA receptors,
increasing synaptic output, liver used for
inhibition. This has the evaluation; LFTs, epilepsy);
effect of elevating seizure Contraindications: renal function abrupt
threshold and reducing tests, blood and discontinuation
urine glucose, could result in a

College of Nursing
Telephone No: (032) 231- 8631
the spread of seizure Phenobarbital is BUN serious increase

activity from a seizure contraindicated in in seizures.
focus. Phenobarbital may patients with known  Wear a medical
also inhibit calcium phenobarbital Interventions
alert tag so that
channels, resulting in a sensitivity or a history  Monitor patient emergency
decrease in excitatory of manifest or latent responses, blood medical
transmitter release porphyria. levels (as personnel will
appropriate) if know you have
any interacting epilepsy and are
drugs listed taking this
above are given medication.
with  Avoid
phenobarbital; pregnancy
suggest while taking
alternative means this drug; use a
of contraception means of
to women using contraception
hormonal other than
contraceptives. hormonal
 WARNING: Do contraceptives.
not give intra-  You may
arterially; may experience
produce these side
arteriospasm, effects:
Drowsiness,

College of Nursing
Telephone No: (032) 231- 8631
thrombosis, dizziness,
gangrene. hangover,
 Administer IV impaired
doses slowly. thinking (may
 Administer IM lessen after a
doses deep in a few days; avoid
large muscle driving or
mass (gluteus engaging in
maximus, vastus dangerous
lateralis) or other activities); GI
areas where there upset (take drug
is little risk of with food);
encountering a dreams,
nerve trunk or nightmares,
major artery. difficulty
 WARNING: concentrating,
Monitor injection fatigue,
sites carefully for nervousness
irritation, (reversible).
extravasation (IV  Report severe
use). Solutions dizziness,
are alkaline and weakness,
very irritating to drowsiness that
the tissues. persists, rash or
skin lesions,

College of Nursing
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 Monitor P, BP, fever, sore

respiration throat, mouth
carefully during sores, easy
IV bruising or
administration. bleeding,
 Arrange for nosebleed,
periodic lab tests petechiae,
of hematopoietic, pregnancy.
renal, and hepatic
systems during
long-term
therapy.
 WARNING:
Taper dosage
gradually after
repeated use,
especially in
patients with
epilepsy. When
changing from
one antiepileptic
drug to another,
taper dosage of
the drug being
discontinued

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while increasing
the dosage of the
replacement drug.
v. Anticonvulsant/Anti-epileptic –Lorazepam
Patient: Andrea Ortega Allergic to: N/A Attending Physician: Dr. Solomon Solon Room no: 567
Generic / Brand Dose, Strenght Client Teaching

Indication/Mechanism Of Adverse Effects &
Name & And Nursing Responsibilities
Action Contraindications
Classification Formulation
lorazepam 0.05-0.1 Ativan (lorazepam) is  Drowsiness, History:  Take drug

mg/kg IV indicated for the headache, exactly as
over 2-5 management of anxiety dizziness,  Hypersensitivity prescribed; do
minutes; not disorders or for the confusion; to not stop taking
Brand:
to exceed 4 short-term relief of the blurred vision; benzodiazepines, drug (in long-
Ativan, mg/dose; symptoms of anxiety or nausea; propylene glycol, term therapy)
may repeat anxiety associated with weakness; polyethylene without
Lorazepam glycol or benzyl
q10-15min depressive symptoms. unsteadiness. consulting
Intensol alcohol;
PRN Anxiety or tension  Potentially Fatal: health care
associated with the stress psychoses; acute provider.
Respiratory
of everyday life usually narrow-angle
 You may

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Telephone No: (032) 231- 8631
Classification: Timing: does not require depression. glaucoma; shock; experience

treatment with an coma; acute these side
Benzodiazepine Repeat q10- anxiolytic. alcoholic effects:
anticonvulsants, 15min intoxication with Drowsiness,
Benzodiazepines, Contraindications:
depression of dizziness (may
Miscellaneous Ativan (lorazepam) is vital signs; be transient;
Mechanism of Action:
antiemetics Duration: contraindicated in pregnancy; avoid driving
Lorazepam binds to patients with: lactation; or engaging in
over 2-5 benzodiazepine impaired liver or dangerous
minutes; receptors on the renal function, activities); GI
PRN postsynaptic GABA-A
 hypersensitivity debilitation upset (take
ligand-gated chloride  Physical: Skin drug with
to
channel neuron at color, lesions; T; food);
benzodiazepines
Other forms: several sites within the orientation, nocturnal
or to any
central nervous system reflexes, affect, sleep
oral components of
(CNS). It enhances the ophthalmologic disturbances
concentrate the formulation
inhibitory effects of examination; P, for several
(2 mg/mL);  acute narrow-
GABA, which increases BP; R, nights after
oral tablet angle glaucoma.
the conductance of adventitious discontinuing
(0.5 mg; 1 chloride ions into the sounds; liver the drug if
mg; 2 mg) cell. evaluation, used as a
abdominal sedative and
examination, hypnotic;
bowel sounds, depression,
normal output; dreams,

College of Nursing
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CBC, LFTs, emotional

renal function upset, crying.
tests  Report severe
dizziness,
weakness,
Interventions
drowsiness
 Sublingual that persists,
administration rash or skin
has more rapid lesions,
absorption than palpitations,
PO, and edema of the
bioavailability extremities;
compares to IM visual
use. changes;
 Do not administer difficulty
intra-arterially; voiding.
arteriospasm or
gangrene may
result.
 Give IM
injections of
undiluted drug
deep into muscle
mass, monitor

College of Nursing
Telephone No: (032) 231- 8631
injection sites.
 Do not use
solutions that are
discolored or
contain a
precipitate.
Protect drug from
light, and
refrigerate oral
solution.
 Intensol is a
concentrated
solution; it is
recommended it
be mixed with
water, juice,
soda, applesauce,
or pudding.
 WARNING:
Keep equipment
to maintain a
patent airway
readily available
when drug is

College of Nursing
Telephone No: (032) 231- 8631
given IV.
 Refrigerate
injection and oral
solution (36° to
46° F).
 Reduce dose of
opioid analgesics
by at least half in
patients who
have received
parenteral
lorazepam.
 Keep patients
who have
received
parenteral doses
under close
observation,
preferably in bed,
up to 3 hr. Do not
permit
ambulatory
patients to drive
following an

College of Nursing
Telephone No: (032) 231- 8631
injection.
 WARNING:
Taper dosage
gradually after
long-term
therapy,
especially in
patients with
epilepsy.
b. Operating Room/Post Anesthesia Care Unit ( 2 Medications )

i. General Anesthetics: Inhalation - Nitrous oxide
Patient: Daisy Go Allergic to: N/A Attending Physician: Dr. Carmelita Dy Room no: 527
Impression: Labor Age: 22 Hospital no: 50502344
Dose, Strenght And Indication/Mechanism Of Adverse Effects & Nursing
Name &
Formulation Action Contraindications Responsibilities
Classification
Severe pain General anesthesia, in  Assess  Self-

College of Nursing
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nitrous oxide control during combination with other effectiveness of administer

obstetric or other anesthetics: pain relief the gas
procedures not  Respiratory  Monitor  Hold the
requiring loss of Depression: maternal vital mask over
Brand:
consciousness:  Nitrous oxide is a When used signs during mouth and
weak inhalational alone, nitrous
Alnox, analgesia use nose or
anesthetic. Because
Entonox has limited including the insert
105% alveolar
concentration is
respiratory patient’s level mouthpiece
Adults:
needed to induce effects, but consciousness into mouth
general anesthesia when used in
Classification:  Monitor fetal  At the onset
when nitrous oxide is combination
heart rate by of
dissociative  20%-50% used as a sole with other
anesthetic agent, it is auscultation or contraction
anaesthetic, INH nitrous sedatives,
ineffective as a single electronic fetal breathe in
general oxide agent for general hypnotics, or
monitoring and out
anaesthesia delivered anesthesia. As a opioids, it can
 Observe for deeply and
with oxygen result, nitrous oxide is potentiate the
most commonly used adverse effects fairly
respiratory
in combination with rapidly into
depressant
other more potent the mask or
Timing: inhalational effects of these Interventions mouthpiece
anesthetics for agents.
As needed  Ensure patient is  Continue to
general anesthesia.  Diffusion
closely breathe
hypoxia:
observed and deeply but
Following
check her q15 less
Duration:  One of the most discontinuation
common uses of min during frequently
of nitrous oxide,
nitrous oxide in throughout

College of Nursing
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at the end of anesthesia is during the nitrous oxide the

contraction mask induction of concentration use remainder
general anesthesia in
pediatric patients. It is
gradient  The patient self of the
combined with between the administers only contraction
Other forms: oxygen and gases in the lung during her  Stop
incrementally and alveolar contractions as inhalation at
-- increasing doses of a circulation prolonged the end of
more potent
rapidly reverses. breathing could the
inhalational
anesthetic (eg, This can lead to result in contraction
sevoflurane) and rapid dilution of unconsciousness
delivered via mask the oxygen in  Nitrous oxide
inhalation. the alveoli, and does not
subsequent prolong labor
hypoxia and and can be used
Mechanism of Action: 100% oxygen right up until
administration the birth of the
Findings to date indicate
should follow baby
that nitrous oxide
nitrous oxide  Use of a pulse
induces opioid peptide
cessation. oximeter may
release in the brain stem
 Postoperative be required if
leading to the activation
of descending Nausea and there is
Vomiting: increased
noradrenergic neurones,
which results in Nitrous has an maternal
increased risk of sedation or
modulation of the
postoperative

College of Nursing
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nociceptive process in nausea and drowsiness.

the spinal cord. Several vomiting  Discontinue
receptor–effector (PONV) nitrous oxide
mechanisms including compared with administration if
dopamine receptors, α2 other agents, but adverse affects
adrenoceptors, this is are observed.
benzodiazepine receptors controllable
and -methyl- -aspartate with
(NMDA) receptors have prophylactic
been implicated although anti-emetics.
the relationship of one
with the other is not
known. Contraindications:
 nitrous is
contraindicated
in patients in
whom
expansion of
these air-filled
cavities could
compromise
patient safety.
This includes
patients with

College of Nursing
Telephone No: (032) 231- 8631
pneumothorax,
pulmonary
blebs, air
embolism,
bowel
obstruction, and
those
undergoing
surgery of the
middle ear.
 Nitrous oxide is
absolutely
contraindicated
in patients who
have had eye
surgery that
uses an
intraocular gas
 Head trauma,
increased

College of Nursing
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intracranial
pressure,
intracranial
mass
ii. General Anesthetics: Intravenous – Propofyl
Patient: Liam Xian Lim Allergic to: N/A Attending Physician: Dr. Kimberly Chan Room no: 367
Impression: Stomach ulcer Age: 26 Hospital no: 50502344
Dose, Strenght And Indication/Mechanism Of Adverse Effects & Nursing
Name &
Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: Adverse effects: Assessment What is this drug used
for?
40 mg Used for induction and/or  Transient local

College of Nursing
Telephone No: (032) 231- 8631
propofol intravenously maintenance of anaesthesia pain at the • It is used to put you to

(IV) every 10 and for management of injection site is Monitor sleep for surgery.
refractory status the most hemodynamic status
seconds until
epilepticus. common adverse and assess for dose- • It is used to calm you
Brand: onset (2-2.5
reaction. This related hypotension. before a procedure.
mg/kg IV when may be
Diprivan not pre-
Mechanism of Action: decreased by  Take seizure • It is used to cause
medicated with administering IV precautions. sleep during a
oral The action of propofol lidocaine before Tonic-clonic procedure.
Classification: benzodiazepines involves a positive propofol bolus. seizures have
or intramuscular modulation of the  Hypotension occurred • It may be given to you
general  Myoclonus following for other reasons. Talk
opioids) inhibitory function of
anesthetic,  Occasionally has general with the doctor.
the neurotransmitter anesthesia with
sedative- been seen to
gama-aminobutyric cause EKG propafol. All drugs may cause
hypnotic acid (GABA) through side effects. However,
Timing: changes (QT  Be alert to the
GABA-A receptors. interval potential for drug many people have no
Every 10 Rapid - time to onset prolongation). induced side effects or only have
seconds This is rarely excitation (e.g., minor side effects. Call
of unconsciousness is
clinically twitching, your doctor or get
15-30 seconds, due to medical help if any of
Duration: significant. tremor,
rapid distribution from these side effects or any
 Discolored urine hyperclonus) and
Until onset plasma to the CNS. take appropriate other side effects bother
(a green tint);
safety measures. you or do not go away:
this adverse
 Provide comfort
event is • Feeling sleepy
Other forms: measures; pain at
exceedingly rare
the injection site
• Cough after waking up
is quite common

College of Nursing
Telephone No: (032) 231- 8631
Injectable Contraindications: especially when

solution small veins are WARNING/CAUTION:
10mg/ml Contraindicated for used. Even though it may be
patients with: rare, some people may
have very bad and
Administration
 low amount of sometimes deadly side
magnesium in effects when taking a
the blood  Use strict drug. Tell your doctor
 low amount of aseptic or get medical help right
potassium in the technique to away if you have any of
blood prepare the following signs or
 torsades de propofol for symptoms that may be
pointes, a type of injection; related to a very bad
abnormal heart drug side effect:
rhythm emulsion
supports • Pancreatitis like very
 prolonged QT
rapid growth bad stomach pain, very
interval on EKG
of bad back pain, or very
 abnormal EKG
microorganis bad upset stomach or
with QT changes
ms. throwing up
from birth
 Inspect
 hardening of the
ampuls and • High or low blood
arteries in the
vials for pressure like very bad
brain
particulate headache, dizziness,
 low blood matter and
pressure passing out, or change
discoloration. in eyesight
 seizures Discard if
 weakened patient either is • Trouble breathing,
 decreased blood noted.

College of Nursing
Telephone No: (032) 231- 8631
volume  Shake well slow breathing, or

before use. shallow breathing
Inspect for
separation of • Fast or slow heartbeat
the emulsion.
Do not use if • Trouble controlling
there is body movements,
evidence of twitching, change in
separation of balance, trouble
phases of the swallowing or speaking
emulsion.
• Severe injection site
redness, burning, pain,
swelling, blistering, skin
sores, or leaking of fluid
• Propofol infusion
syndrome like
confusion; very sleepy;
very tired or weak; dark
urine or not able to pass
urine; fast breathing;
fast heartbeat or
abnormal heartbeat;
severe stomach pain,
upset stomach, or
throwing up; muscle
pain or weakness; or

College of Nursing
Telephone No: (032) 231- 8631
shortness of breath, a
big weight gain, or
swelling of the arms or
legs
• Signs of an allergic
reaction, like rash;
hives; itching; red,
swollen, blistered, or
peeling skin with or
without fever;
wheezing; tightness in
the chest or throat;
trouble breathing,
swallowing, or talking;
unusual hoarseness; or
swelling of the mouth,
face, lips, tongue, or
throat.
Propofol FDA fact

sheets – Health care
provider; Patient
Note: This is not a

comprehensive list of all
side effects. Talk to
your doctor if you have

College of Nursing
Telephone No: (032) 231- 8631
questions.
Consumer Information
Use and Disclaimer:
This information should
not be used to decide
whether or not to take
this medicine or any
other medicine. Only
the healthcare provider
has the knowledge and
training to decide which
medicines are right for a
specific patient. This
information does not
endorse any medicine as
safe, effective, or
approved for treating
any patient or health
condition. This is only a
limited summary of
general information
about the medicine's
uses from the patient
education leaflet and is
not intended to be
comprehensive. This
limited summary does

College of Nursing
Telephone No: (032) 231- 8631
NOT include all

information available
about the possible uses,
directions, warnings,
precautions,
interactions, adverse
effects, or risks that may
apply to this medicine.
This information is not
intended to provide
medical advice,
diagnosis or treatment
and does not replace
information you receive
from the healthcare
provider. For a more
detailed summary of
information about the
risks and benefits of
using this medicine,
please speak with your
healthcare provider and
review the entire patient
education leaflet
2. Briefly organize and bring together main ideas. Explain in your own words. (50 – 150 words for each question)

College of Nursing
Telephone No: (032) 231- 8631
I. AMELIA, a 26-year-old woman, takes phenytoin 100 mg three times daily to control tonic-clonic seizures. She and her
husband are contemplating starting a family.
A. What action should the nurse take in regard to the patient’s family planning? AMELIA complains of frequent
upset stomach and bleeding gums when brushing her teeth.
The nurse should tell the patient that, “If you're taking anti-epileptic drugs (AEDs) and you're planning
to get pregnant, you should continue to use contraception and take your medicine until you discuss
your plans with a GP or epilepsy specialist. This is because your doctor may want to make changes to
the dose or type of medicine you are taking, which is best done before you become pregnant. You
should also be offered pre-conception counselling, which will help you understand any risks and plan
for a healthy pregnancy and baby.”
B. To decrease GI distress Amelia, what can be suggested?

To decrease GI distress, there are several home remedies that Amelia can do. One is to drink water
specifically, women should have around 2.7 liters, or 91 ounces, of water a day. Another is avoiding
lying down. People with an upset stomach should avoid lying down or going to bed for at least a few
hours until it passes. Someone who needs to lie down should prop up their head, neck, and upper
chest with pillows, ideally at a 30-degree angle. Next is the use of ginger as it is a common natural
remedy for an upset stomach and indigestion. Ginger contains chemicals called gingerols and shogaols
that can help speed up stomach contractions. Doctors may also recommend the BRAT diet to people
with upset stomach, which stands for Bananas, Rice, Applesauce, and Toast. These foods are all
starchy, so they can help bind foods together to make stools firmer. This may decrease the number of
stools a person passes and help ease their diarrhea. Avoiding difficult-to-digest foods can also help.
Anyone with an upset stomach should avoid fried or fatty, rich or creamy, salty or heavily preserved
food.
C. To alleviate bleeding gums, what patient teaching for AMELIA may be included?

College of Nursing
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If a medicine is causing your dental health problems, it advisable to talk to her doctor about adjusting
the dose or method of taking it. In some cases, it may be possible to switch to another type of
medicine that does not risk your dental health. If the doctor advises that changing your medication is
not possible, talk to your dentist about professional and at-home treatments that can help to protect
your teeth. Fluoride strengthens teeth and reduces the risk of decay. The dentist may apply topical
fluoride to the surface of your teeth. Fluoride tablets or mouthwashes may be recommended for use at
home.
D. The nurse checks AMELIA’s serum phenytoin level. What are the indications of an abnormal serum level?
What appropriate actions should be taken?
The typical value for serum albumin in blood is 3.4 to 5.4 grams per deciliter. Levels that are too high or
too low can be indicative of an underlying health problem. Low albumin levels can indicate a number
of health conditions, including:
 liver disease
 inflammation
 shock
 malnutrition
 nephritic syndrome or nephrotic syndrome
Higher than normal levels of albumin may indicate dehydration or severe diarrhea.
If your albumin levels are not in the normal range, it doesn't necessarily mean you have a medical condition
needing treatment. Certain drugs, including steroids, insulin, and hormones, can raise albumin levels. Other
drugs, including birth control pills, can lower your albumin levels.
Foods with a lot of protein, including nuts, eggs, and dairy products, are all good choices to raise your albumin
levels. If you drink alcohol, your doctor may recommend that you drink less or stop drinking. Drinking alcohol
can lower your blood protein levels and make your symptoms worse. It can be treated by addressing the
underlying condition or by getting your albumin levels back to normal. This is possible through lifestyle

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changes or medication. For example, if your diet is causing the condition, eating more protein-rich foods may
help get your albumin levels back to normal. If serum level is high, lose weight if you are overweight, avoid
foods high in sodium or salt, eat the right amounts and types of protein.
II. NOAH, a 79-year-old man, was diagnosed with Parkinson’s disease 10 years ago. During his early treatment, he took
selegiline. The drug dosage was increased to alleviate symptoms.
A. How does selegiline alleviate symptoms of Parkinson’s disease ?
Selegiline is used to help control the symptoms of Parkinson’s disease by increasing the amount of
dopamine in the brain. Dopamine is a naturally occurring substance that is needed to control
movement and its levels are reduced in people with Parkinson’s. It is intended as an add-on therapy for
Parkinson’s disease patients who are taking levodopa and carbidopa. Selegiline is a selective
monoamine oxidase B (MAO-B) inhibitor. MAO-B is an enzyme that breaks down dopamine in the
brain. By inhibiting the action of the MAO-B enzyme, selegiline leads to an increase in the amount of
dopamine. As a result, the dose of levodopa/carbidopa needed to control Parkinson’s disease
symptoms can be reduced, helping to stop the effect of those therapies wearing off between doses.
B. What dietary changes should be made during the time NOAH takes selegiline? Because NOAH developed
numerous side effects and adverse reactions to selegiline, the health care provider changed the drug to
carbidopa-levodopa. NOAH asks the nurse why the drug was changed.
Noah may have to limit the amount of cheese, smoked meat, and soy sauce in his diet while taking
selegiline since it can raise your blood pressure.
The nurse should reply to Noah’s query by saying, “Starting in late middle age, the risk of adverse
effects related to the use of drugs increases and people your age are more than twice as susceptible to
the adverse effects of drugs as younger people. These are also likely to be more severe, affecting

College of Nursing
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quality of life and resulting in visits to the doctor and in hospitalization. Which is why we have to
change your medication.”
C. What are the similarities and differences between selegiline and carbidopa-levodopa?
Carbidopa-levodopa Similarities Selegiline
 Sinemet (carbidopa / levodopa) is  Treats Parkinson’s disease  There are two different versions of
widely available as a regular pill, a  Dosage form: pill, dissolving tablet Eldepryl (selegiline), a quick
quick dissolving pill or a liquid  Makes you fall asleep during the dissolving tablet and a regular
taken through a feeding tube.
day tablet.
 Sinemet (carbidopa / levodopa) is
 Eldepryl (selegiline) is one of the
available in generic.
 Can make you very sleepy. recommended medicines you can
 Can stain your saliva, sweat and take along with
urine a dark color. carbidopa/levodopa if your
 Will lose its effect over time as Parkinson's disease is getting
your disease progresses. worse.
 May need to be taken several  You may have to limit the amount
times during day to control
of cheese, smoked meat, and soy
symptoms of Parkinson's disease
 May cause unusual cravings in sauce you eat while taking Eldepryl
some people. (selegiline) since it can raise your
 The Sinemet (carbidopa / blood pressure.
levodopa) FDA package insert  Can keep you up at night if you
doesn’t have numbers about how take it later in the day

College of Nursing
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common side effects are.  Doesn't work by itself to treat

 Falling asleep during the day Parkinson's disease.
 High fever and confusion  Side effects: Skin irritation at the
Stopping Sinemet (carbidopa /
patch, Headache, Insomnia,
levodopa) suddenly
Diarrhea, Dry mouth, Weight loss
 Changes in behavior
 Lack of impulse control of at least 5%, Indigestion, Rash,
 Changes in blood pressure and falls Sore throat, Sinus infection,
Weight gain of at least 5%
D. What are the advantages of carbidopa-levodopa? NOAH’s family says they know a person with Parkinson’s
disease who takes the antiviral drug amantadine. The family asks whether amantadine is the same as
carbidopa-levodopa and, if so, whether NOAH can take amantadine instead of carbidopa-levodopa.
Carbidopa-levodopa provides the greatest antiparkinsonian benefit with the fewest adverse effects in
the short term. It is introduced at a low dose and escalated slowly. Carbidopa inhibits the
decarboxylation of levodopa to dopamine in the systemic circulation, allowing for greater levodopa
delivery into the central nervous system.
Carbidopa-levodopa is not the same with amantadine. Though they are both used in the treatment of
Parkinson’s disease, amantadine is also used in treating flu, extrapyramidal symptoms from
antipsychotic drugs, brain injury, and restless legs syndrome while carbidopa-levodopa only focuses on
the treatment of Parkinson’s disease and Parkinsonism. Amantadine also have more severe or

College of Nursing
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dangerous risks and risk factors such as death from overdosage, risk of suicide, risk of seizures, heart
failure, and lack of impulse control. So it is therefore much better to take carbidopa-levodopa rather
than amantadine as it has a lot of adverse effects that may only bring more harm to the patient, also
considering the age of Mr. Noah.
E. What is the effect of amantadine on symptoms of Parkinson’s disease?

In the treatment of Parkinson disease, studies have shown amantadine acts on dopamine neurons.
Amantadine is a weak, non-competitive antagonist of the NMDA receptor, which increases dopamine
release and prevents dopamine reuptake. In the early stages of disease, it can help improve slow
movements and rigidity. It may be used in combination with other medications (Sinemet®) in later
stages of Parkinson's disease. It can help to reduce dyskinesias, involuntary movements that may result
from taking some Parkinson's medications.
F. What would be an appropriate response to the family’s question concerning the use of amantadine for NOAH?
“We understand that amantadine may cost lesser and we can give you the option whether to use
amantadine or carbidopa-levodopa. However, the doctor is also considering the minimization of harm
and maximization of effectiveness and according to Noah’s reaction to previous medication selegiline,
he has also experienced a lot of side effects which may bring more harm to his overall condition. And
amantadine may be cheaper than carbidopa-levodopa but it may also pose a bigger threat to the
patient’s health because of its risks and risk factors like death from overdosage, higher risk of suicide,
higher risk of seizures, heart failure, and lack of impulse control which is why the doctor opted to
change the medication to carbidopa-levodopa.”

College of Nursing
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III. ISABELLA, a 35-year-old woman, is receiving risperidone, 3 mg twice daily, to control a psychotic disorder. She has
taken the drug for 6 months but has recently become agitated and is complaining of insomnia.
A. What is the relation between ISABELLA’s drug dose and her complaints? Explain your answer.
Drug dose of risperidone initially should start with 1mg or 2mg in a day. Later it can be increased to 4-
8mg per day. There is no problem with the dose. The drug such as atypical antipsychotics like
olanzapine, risperidone has a little evidence that they actually help you stay ‘asleep’ and the dose
should be taken earlier in the day.
B. How does risperidone compare with other antipsychotics such as chlorpromazine and haloperidol regarding
actions and adverse effects?
Risperidone & haloperidol are both antipsychotic drugs prescribed to treat Schizophrenia but
haloperidol control motor movement. Chlorpromazine stabilizes the mood whereas risperidone helps
to control thoughts. With risperidone, there is a risk of weight gain, insomnia, risk of diabetes. And
with haloperidol are tardive dykinesia, irregular heart beats. Compared to chlorpromazine, risperidone
has high ADR’s
IV. ST, a 37-year-old woman, is receiving fluoxetine 20 mg in the evening for depression. ST complains of insomnia and GI
upset.
A. What could you suggest to ST to help her avoid insomnia? Explain your answer.
Insomnia is a side effect of antidepressant medication Some of the ways to help the patient are:
 Antidepressant medication like Fluoxetine can be taken in the morning after breakfast so that it dies not
interrupt sleep in the night time

College of Nursing
Telephone No: (032) 231- 8631
 Encourage patient to have dinner before 4 hours to bed time and avoid drinks or snacks at late night
 Inform patient to avoid drinks which are stimulant like coffee
 Provide relaxation therapy, warm bath, dim light, noise free area to help in inducing sleep
 In clinical trials, 10% to 33% of people taking Prozac experienced trouble sleeping. If Prozac causes
insomnia, patients will initially be advised to take the daily dose early in the morning. If insomnia persists,
a healthcare professional will typically prescribe mirtazapine, trazodone, or a sedative along with Prozac.
Both mirtazapine and trazodone are antidepressants like Prozac, but they also have powerful sedative
effects.
B. How might ST avoid GI upset when taking fluoxetine? What food should be avoided?
Gastrointestinal side effects may get better as the body adjusts to Prozac. If diarrhea persists, a healthcare
provider may prescribe mirtazapine along with Prozac. Diarrhea could, however, be a potentially serious
problem in any person with an electrolyte imbalance.
The following foods has to be avoided because taking this can aggravate the levels in the blood
 Alcohol
 Caffeinated products
 Avoid tyramine rich foods

College of Nursing
Telephone No: (032) 231- 8631
References:
https://www.nhs.uk/medicines/phenytoin/
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/phenytoin/
https://www.rxlist.com/tegretol-drug.htm#overdosage
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/carbamazepine-tegretol/
https://www.rnpedia.com/nursing-notes/pharmacology-drug-study-notes/phenobarbital/
https://reference.medscape.com/drug/ativan-loreev-xr-lorazepam-342906
https://emedicine.medscape.com/article/1413427-overview#a3
http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Standards/Competencies/5ACoreCompDSTAdminofNO.pdf
https://glowm.com/resources/glowm/cd/pages/resources/Pharmacy/nitrous_oxide.htm
https://www.medicalnewstoday.com/articles/322047#Twenty-one-home-remedies
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Teeth-and-medication
https://www.healthline.com/health/albumin-serum#results

College of Nursing
Telephone No: (032) 231- 8631
https://parkinsonsnewstoday.com/eldepryl-selegiline/
https://www.msdmanuals.com/home/older-people%E2%80%99s-health-issues/aging-and-drugs/aging-and-drugs
https://www.iodine.com/compare/carbidopa-levodopa-vs-eldepryl
https://www.iodine.com/compare/symmetrel-vs-carbidopa-levodopa
https://journals.sagepub.com/doi/pdf/10.1177/1755738013491400
https://www.singlecare.com/blog/prozac-side-effects/
https://www.webmd.com/drugs/2/drug-3519/propofol-intravenous/details/list-contraindications
https://www.singlecare.com/blog/prozac-side-effects/
https://online.epocrates.com/u/1081978/propofol/Patient+Education
https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139023480
https://reference.medscape.com/drug/diprivan-propofol-343100#0
https://www.rxlist.com/consumer_propofol_diprivan/drugs-condition.htm#what_are_dosages_of_propofol
Prepared by:
VILLALUNA, KHYLAMARIE P.
Students Signature over
Printed Name

College of Nursing
Telephone No: (032) 231- 8631
Submitted to:
Lemuel C. Candelasa, EdD(c) ,MAN,RN

ProfeAmeliaor – Pharmacology

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UNIVERSITY OF CEBU - BANILAD

Gov. M. Cuenco Ave, Cebu City, 6000 Philippines

NCM 106 – Pharmacology

Course Outputs /Assessment of Learning for CILO # 1

Name of Student : VILLALUNA, KHYLAMARIE P. Yr.& Sec. : BSN-2A

a. Neuro Ward ( 5 Medications )

Generic: Ordered: Indication: Adverse effects: Assessment: Instruct patient to:

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available) difficult, numbness of  Check BP and cardiac

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Metabolic:  If patient appears

ii. Anticonvulsant/Anti-epileptic – Phenytoin

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Generic: Ordered: Indication: Adverse effects: Assessment: Instruct patient to:

phenytoin 100–200 mg Phenytoin is  thoughts of harming History:  Take this drug

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epilepticus, and for and a skin rash, lactation therapy.

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neuronal propagation DILANTIN is monitor your

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and possible  WARNING: alert tag so that

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and irritating. effects); GI

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 Suggest that adult bleeding or

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iii. Anticonvulsant /Anti-epileptic – Carbamazepine

Generic / Brand Client Teaching

Generic: Ordered: Indication: Adverse effects: Assessment Instruct patient to:

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(CAN), Carbatrol, doses q 6–8 hr, leukopenia, concomitant use them.

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400 mg; ER erythema multiforme lamp appointments

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and blocking the post- and AV block, tests, EEG Drowsiness,

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jaundice, hepatitis, Reduce dosage, urine,

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elevated blood frequent liver

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oculomotor Adjust dosage on

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Aching joints and

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muscles, and leg

Fever and chills.

Tegretol should not be

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iv. Anticonvulsant/Anti-epileptic –Phenobarbital

Generic: Ordered: Indication: Adverse effects: Assessment Instruct patient to:

phenobarbital 4–6 Oral Nervous system: History:  This drug will

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Antiepileptic c. Preanesthetics. apnea. disorders; forming; its

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the spread of seizure Phenobarbital is BUN serious increase

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 Monitor P, BP, fever, sore