SOLIS, NIÑA ANTONET

BSN 2-YA-26

Using your drug handbook, answer the following questions:

A. Look for the drug-drug interaction of the following drugs given and give nursing
considerations
as you give the drugs together:

1. Celecoxib with ACE inhibitors

Drug to drug interactions:

 Celecoxib may diminish the antihypertensive effect of ACE inhibitors.

Nursing Considerations:
 Before and during therapy, evaluate the range of motion, swelling, and pain in the
affected joints.
 Examine the patient for sulfonamide, aspirin, or NSAID allergies. Celecoxib should not
be given to patients who have these allergies.
 Throughout therapy, check the patient for skin rashes on a regular basis. Stop taking it
as soon as you notice a rash; it could be fatal. Stevens-Johnson syndrome is possible.
Treat symptomatically; recurrence may occur if treatment is discontinued.
 During treatment, keep an eye out for signs and symptoms of DRESS (fever, rash,
lymphadenopathy, facial swelling). If symptoms appear, discontinue therapy.
 Monitor blood pressure while taking CELEBREX and an ACE inhibitor at the same time
to ensure that the desired blood pressure is achieved.
 Monitor for signs of worsening renal function when using CELEBREX and ACE inhibitors
together in patients who are elderly, volume-depleted, or have impaired renal function.
 Patients should be adequately hydrated when these drugs are administered
concurrently.
 Assess renal function at the start of the concomitant treatment and on a regular basis
after that.

2. Amitriptyline hydrochloride with Barbiturates

Drug to drug Interactions:

 Increased response (especially CNS depression) to barbiturates.
 Induce metabolism and decrease therapeutic efficacy of amitriptyline. Monitor drug
effects closely.

Nursing Considerations:
 Restrict drug access for depressed and potentially suicidal patients.
 Give IM only when oral therapy is impossible.
 Do not administer IV.
 Administer major portion of dose at bedtime if drowsiness, severe anticholinergic effects
occur (note that the elderly may not tolerate single daily dose therapy).
 Reduce dosage if minor side effects develop; discontinue if serious side effects occur.
 Arrange for CBC if a patient develops fever, sore throat, or other sign of infection.

3. Acetylcysteine with Activated charcoal

Drug to drug Interactions:

 Administration of activated charcoal and oral acetylcysteine at the same time may cause
a reduction in acetylcysteine (NAC) absorption.

Nursing Considerations:
 Monitor signs of angioedema, including rashes, raised patches of red or white skin
(welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify the
physician of these signs immediately.
 Monitor other signs of allergic reactions and anaphylaxis, especially after IV
administration. Signs include pulmonary symptoms (tightness in the throat and chest,
 wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria). Notify physician
or nursing staff immediately if these reactions occur.
 Monitor signs of bronchospasm and respiratory irritation, including wheezing, cough,
dyspnea, increased secretions, and tightness in the chest and throat. Report excessive
or prolonged respiratory problems to the physician.
 When used as a mucolytic, assess the quantity and consistency of sputum to help
document whether this drug is successful in reducing the viscosity of respiratory
secretions.

4. Budesonide inhalation with Ketoconazole

Drug to drug Interactions:

● Budesonide inhalation will decrease the level or effect of ketoconazole by altering drug
metabolism.

Nursing Considerations:
● Monitor patients for signs of hypercorticism—acne, bruising, moon face, swollen ankles,
hirsutism, skin striae, buffalo hump—which could indicate a need to decrease dosage.
● Instruct patients to rinse and gargle after each use of a steroid inhaler (budesonide
inhalation) to prevent thrush (candidiasis).
● Monitor for an allergic response: patients allergic to other azole antifungals may be allergic
to ketoconazole.

5. Clobazam with Hormonal contraceptives

Drug to drug Interactions:

● Hormonal contraceptives may not be reliable when coadministered with clobazam.
● Clobazam is a weak CYP3A4 inducer.
● As some hormonal contraceptives are metabolized by CYP3A4, their effectiveness may be
diminished when given with Clobazam.

Nursing Considerations:
● Prescribers should monitor patients for somnolence and sedation, particularly with
concomitant use of other central nervous system depressants.
● Prescribers should caution patients against engaging in hazardous activities requiring
mental alertness, such as operating dangerous machinery or motor vehicles, until the effect of
clobazam is known.

6. Esmolol hydrochloride with Antidiabetic agents

Drug to drug Interactions:

● Concomitant use of beta-blockers and antidiabetic agents can increase the effect of the
antidiabetic agents.
● Concomitant use of Esmolol hydrochloride 10 mg/ml and insulin or oral antidiabetic drugs
may intensify the blood sugar lowering effect (especially non-selective beta-blockers).

Nursing Considerations:
● Monitor BP, pulse, ECG, during esmolol infusion. Hypotension may have its onset during
the initial titration phase; thereafter the risk increases with increasing doses. Usually the
hypotension experienced during esmolol infusion is resolved within 30 min after infusion is
reduced or discontinued.
● Change injection site if local reaction occurs. IV site reactions (burning, erythema) or
diaphoresis may develop during infusion. Both reactions are temporary. Blood chemistry
abnormalities have not been reported.
● Overdose symptoms: Discontinue administration if the following symptoms occur:
bradycardia, severe dizziness or drowsiness, dyspnea, bluish-colored fingernails or palms of
hands, seizures.

7. Indomethacin with Aminoglycosides

Drug to drug Interactions
● When indomethacin is used in combination with aminoglycosides (for example, gentamicin)
the blood levels of the methotrexate or aminoglycoside may increase, presumably because
their elimination from the body is reduced.

Nursing Considerations
● Be aware that patients may be at increased risk for CV events, GI bleeding; monitor
accordingly.
● Do not give SR tablets for gouty arthritis.
● Give drugs with food or after meals if GI upset occurs.
\● Arrange for periodic ophthalmologic examination during long-term therapy.
● Discontinue drugs if eye changes or symptoms of hepatic or renal impairment occur.
● For overdose, use emergency procedures—gastric lavage, induction of emesis, support.
● Test renal function between doses. If severe renal impairment is noted, do not give the next
dose.

8. Isoniazid with Acetaminophen

Drug to drug Interactions

● Using acetaminophen together with isoniazid may alter the effects of acetaminophen and
cause serious side effects that may affect your liver.
● The combination of isoniazid and acetaminophen has caused severe hepatotoxicity in at
least one patient; studies in rats have demonstrated that pre-treatment with isoniazid
potentiates acetaminophen hepatotoxicity.

Nursing Considerations
● Be alert for signs of drug-induced hepatitis, including anorexia, abdominal pain, severe
nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial
edema, lethargy, and unusual bleeding or bruising.

9. Mesalamine with Warfarin

Drug to drug Interactions

● This combination has the potential to alter the effects of warfarin through an unknown
mechanism.

Nursing Considerations
● Advise patient about the likelihood of GI problems such as nausea, diarrhea, vomiting,
belching, flatulence, and anal irritation. Instruct patients to report severe or prolonged GI
reactions, or signs of pancreatitis such as upper abdominal pain (especially after eating),
indigestion, weight loss, and oily stools.
● Watch for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds,
unusual bruising, coughing up blood, black/tarry stools, hematuria, or a fall in hematocrit or
blood pressure.

10. Rifampicin with Probenecid

Drug to drug Interactions

● Concomitant use with probenecid increases the concentration of rifampicin (rifampin) which
may increase the risk of rifampin toxicities.

Nursing Considerations
● Monitor for adverse reactions during coadministration.
● Advise patients about possible discoloration of tears, saliva, urine, and other body fluids.
Instruct the patient to notify the physician if discoloration becomes troublesome. Advise
patients about the likelihood of GI reactions (nausea, vomiting, diarrhea, flatulence,
abdominal pain, heartburn).
● Give the adverse reactions of the following drugs on the systems indicated:
1. Cimetidine

Gastrointestinal
● Common (1% to 10%): Constipation, diarrhea, flatulence, nausea, vomiting.
● Rare (0.01% to 0.1%): Acute pancreatitis/pancreatitis.

2. Esterified estrogen

Central Nervous System

● Frequency not reported: Migraine, dizziness, headache, exacerbation of epilepsy,
dementia, chorea.

3. Gentamicin sulfate

Respiratory
● Frequency not reported: Laryngeal edema, postoperative respiratory distress, pulmonary
fibrosis, respiratory depression.

4. Iloperidone

EENT
● Common (1% to 10%): Blurred vision, conjunctivitis, nasopharyngitis, nasal congestion.

5. Meropenem

Central Nervous System

● Common (1% to 10%): Headache.
● Uncommon (0.1% to 1%): Dizziness, seizure, paresthesia, somnolence, syncope, asthenia.
● Frequency not reported: Hearing loss, other adverse central nervous system (CNS)
experiences.

6. Simvastatin

Respiratory
● Common (1% to 10%): Respiratory tract infection, bronchitis, sinusitis
● Postmarketing reports: Interstitial lung disease

7. Trospium chloride

EENT
● More common: Blurred vision, dry mouth, sleepiness or unusual drowsiness.
● Less common: Dry eyes, sore throat.
● Incidence not known: Dry throat, changes in vision, red, irritated eyes.

8. Desmopressin acetate

Gastrointestinal
● Mild abdominal cramps and nausea in 2% of patients.
● Dyspepsia and vomiting have rarely been associated with DDAVP nasal spray.

9. Ethambutol hydrochloride

Musculoskeletal
● Very rare (less than 0.01%): Joint pain.

10. Promethazine hydrochloride

Metabolic
● Frequency not reported: Anorexia, loss of appetite, appetite stimulation.