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Case Scenario Works
Case Scenario Works
Case Scenario Works
Furosemide 20 mg IV once a
• Contraindicated in patients hypersensitive to • Monitor fluid intake and output and
8 AM
or use with other ototoxic drugs. • Drug may not be well absorbed orally in
• Drug may exacerbate or activate SLE. patient with severe HF. Drug may need to
• Premature infants may be at increased risk for be given IV even if
persistent patent ductus arteriosus with patient is taking other oral drugs.
furosemide treatment during first weeks of life. • Monitor uric acid level, especially in
Dialyzable drug: No. patients with a history of gout.
WUP SN’25
CV: orthostatic hypotension, thrombophlebitis urine retention due to bladder emptying
10-23-2022
with IV administration. disorders, prostate
EENT: blurred or yellowed vision, transient enlargement, or urethral narrowing or
deafness, tinnitus. worsening of symptoms, especially during
GI: abdominal discomfort and pain, diarrhea, initial treatment.
anorexia, nausea, vomiting, constipation,
pancreatitis. PATIENT TEACHING
GU: azotemia, nocturia, polyuria, frequent • Advise patient to take drug in morning to
urination, oliguria. prevent need to urinate at night. If a second
Hematologic: agranulocytosis, aplastic dose is needed, tell
anemia, leukopenia, thrombocytopenia, patient to take it in early afternoon, 6 to 8
anemia. hours after morning dose.
Hepatic: hepatic dysfunction, jaundice, • Inform patient of possible need for
increased liver enzyme levels. potassium or magnesium supplements.
Metabolic: volume depletion and dehydration, • Instruct patient to stand slowly to prevent
asymptomatic hyperuricemia, impaired dizziness and to limit alcohol intake and
glucose tolerance, hypokalemia, strenuous exercise in
hypochloremic alkalosis, hyperglycemia, hot weather to avoid worsening dizziness
dilutional hyponatremia, hypocalcemia, upon standing quickly.
hypomagnesemia. Musculoskeletal: muscle • Advise patient to report all adverse
spasm. reactions and to immediately report ringing
Skin: dermatitis, purpura, photosensitivity in ears, severe
reactions, transient pain at IM injection site, abdominal pain, or sore throat and fever;
toxic epidermal necrolysis, SJS, erythema these symptoms may indicate toxicity.
multiforme. Alert: Discourage patient from storing
Other: gout. different types of drugs in the same
container, increasing risk of
drug errors. (The most popular strengths of
furosemide and digoxin are white tablets
that are about equal
in size.)
• Tell patient to consult prescriber or
pharmacist before taking OTC drugs.
• Teach patient to avoid direct sunlight and
to use protective clothing and sunblock
because of risk of
photosensitivity reactions.
Unasyn Ampicillin 1 gram IV ACTIONS: • Dosage is expressed as total drug. Each
Sulbactam every 12 • Inhibits cell-wall synthesis during bacterial 1.5-g vial contains 1 g ampicillin sodium
hrs. multiplication and 0.5 g sulbactam
ONSET: Immediate sodium.
PEAK: 15 min • In patients with impaired renal function,
DURATION: Unknown decrease frequency of administration.
ER 108
• Monitor LFT results during therapy,
CONTRAINDICATIONS: 10-23-2022 especially in patients with impaired liver
• Contraindicated in patients hypersensitive to function.
8AM-6PM
associated with ampicillin–sulbactam hypersensitivity, such as erythematous
injection. maculopapular rash, urticaria,
• Use cautiously in patients with other drug and anaphylaxis.
allergies (especially to cephalosporins) • Monitor for CDAD, which can be fatal.
because of possible cross-sensitivity and in Antibiotic may need to be stopped and other
those with renal impairment. treatment begun.
WUP SN’25
10-23-2022
GI: diarrhea. • Warn patient that IM injection may cause
Hematologic: agranulocytosis, leukopenia, pain at injection site.
thrombocytopenia,
thrombocytopenic purpura.
Skin: pain at injection site, thrombophlebitis,
rash, urticaria. Other: hypersensitivity
reactions.
every 6 hrs.
weakness, bradycardia, dizziness, constipation,
abdominal distention, flatus, diarrhea, nausea, patients who have received drug for several
vomiting, light-headedness. months, positive
reaction to direct Coombs test may indicate
12MN-6AM
SIDE EFFECTS: hemolytic anemia.
CNS: decreased mental acuity, sedation, • Report involuntary choreoathetoid
headache, weakness, dizziness, paresthesia, movements. Drug may be stopped.
parkinsonism,
involuntary choreoathetoid movements, PATIENT TEACHING
psychic disturbances, depression, nightmares. • If unpleasant adverse reactions occur,
CV: orthostatic hypotension, edema, advise patient not to suddenly stop taking
bradycardia, HF, myocarditis, aggravated drug but to notify
WUP SN’25
10-23-2022
tongue, abdominal distention, colitis. muscle aches.
GU: amenorrhea, breast enlargement, • Tell patient to check weight daily and to
impotence. notify prescriber for a weight gain of 900 g
Hematologic: thrombocytopenia, leukopenia, in 1 day or 2.3 kg in
bone marrow depression, hemolytic anemia. 1 week. Sodium and water retention may
Hepatic: hepatic necrosis, hepatitis, occur but can be relieved with diuretics.
jaundice. • Warn patient that, particularly at the start
Metabolic: hyperprolactinemia, weight gain. of therapy, drug may impair ability to
Musculoskeletal: arthralgia, myalgia. perform tasks that
Skin: rash. require mental alertness. A once-daily dose
Other: drug-induced fever. at bedtime minimizes daytime drowsiness.
• Inform patient that low BP and dizziness
upon rising can be minimized by rising
slowly and avoiding
sudden position changes and that dry mouth
can be relieved by chewing gum or sucking
on hard candy or
ice chips.
• Tell patient that urine may turn dark if left
sitting in toilet bowl or if toilet bowl has
been treated with
bleach.
Decadron Dexamethasone 3 mg IM ACTIONS: Alert: Epidural corticosteroid injections to
12 hrs. x 2 • Unclear. Decreases inflammation, mainly by treat neck and back pain and radiating pain
doses stabilizing leukocyte lysosomal membranes; in the arms and
suppresses legs may result in rare but serious adverse
immune response; stimulates bone marrow; events (vision loss, stroke, paralysis, death).
and influences protein, fat, and carbohydrate ER 108 The use of
metabolism. epidural corticosteroid injections isn't
ONSET: 1 hr. 10-23-2022 approved by the FDA.
PEAK: 1hr. • Most adverse reactions to corticosteroids
Dexamethasone 3 mg IM every
DURATION: 6 days are dose- or duration-dependent.
• For better results and less toxicity, give
12 hrs. x doses
• Contraindicated in patients hypersensitive to • Always adjust to lowest effective dose.
drug or its ingredients, in those with systemic • Monitor patient's weight, BP, and
fungal infections, and in those receiving electrolyte levels.
immunosuppressive doses together with live- • Monitor patient for cushingoid effects,
virus vaccines. IM administration is including moon face, buffalo hump, central
contraindicated in patients with ITP. obesity, thinning hair,
8AM-6PM
• Use cautiously in patients with recent MI. HTN, and increased susceptibility to
• Use cautiously in patients with GI ulcer, renal infection.
disease, HTN, osteoporosis, diabetes mellitus, • Watch for depression or psychotic
hypothyroidism, cirrhosis, diverticulitis, episodes, especially in high-dose therapy.
nonspecific ulcerative colitis, recent intestinal • Diabetic patient may need increased
anastomoses, thromboembolic disorders, insulin; monitor glucose levels.
seizures, myasthenia gravis, HF, TB, active • Drug may mask or worsen infections,
hepatitis, ocular HSV infection, emotional including latent amebiasis.
instability, or psychotic tendencies. • Elderly patients may be more susceptible
WUP SN’25
Dialyzable drug: No. therapy.
10-23-2022
• Look alike–sound alike: Don't confuse
SIDE EFFECTS: dexamethasone with desoximetasone.
CNS: euphoria, insomnia, psychotic behavior,
pseudotumor cerebri, vertigo, headache, PATIENT TEACHING
paresthesia, seizures, depression. • Instruct patient to take drug with food or
CV: HF, HTN, edema, arrhythmias, milk.
thrombophlebitis, thromboembolism. Alert: Counsel patient receiving epidural
EENT: cataracts, glaucoma. corticosteroid injections to seek immediate
GI: peptic ulceration, GI irritation, increased medical attention
appetite, pancreatitis, nausea,
vomiting.
GU: menstrual irregularities, increased urine for loss of vision or vision changes; tingling
glucose and calcium levels. in the arms or legs; sudden weakness or
Metabolic: hypokalemia, hyperglycemia, numbness of the
carbohydrate intolerance, face, arm, or leg on one or both sides of the
hypercholesterolemia, hypocalcemia, sodium body; dizziness; severe headache; or
retention, weight gain. seizures.
Musculoskeletal: growth suppression in • Tell patient not to stop drug abruptly or
children, muscle weakness, without prescriber's consent.
osteoporosis, tendon rupture, myopathy. • Teach patient signs and symptoms of early
Skin: hirsutism, delayed wound healing, acne, adrenal insufficiency: fatigue, muscle
various skin eruptions, atrophy at IM injection weakness, joint pain,
site, thin fragile skin. fever, anorexia, nausea, shortness of breath,
Other: cushingoid state, susceptibility to dizziness, and fainting.
infections, acute adrenal insufficiency after • Instruct patient to carry medical
increased stress or abrupt withdrawal after identification indicating the need for
long-term therapy, supplemental systemic
angioedema. glucocorticoids during stress, especially
After abrupt withdrawal: rebound when dosage is decreased. This card should
inflammation, fatigue, weakness, arthralgia, contain prescriber's
fever, dizziness, lethargy, fainting, orthostatic name, drug name, and drug dosage.
hypotension, dyspnea, anorexia, • Warn patient on long-term therapy about
hypoglycemia. After prolonged use, sudden cushingoid effects (moon face, buffalo
withdrawal may be fatal. hump) and the need to
notify prescriber about sudden weight gain
or swelling.
Warn patient about easy bruising.
• Advise patient receiving long-term
therapy to consider exercise or physical
therapy. Tell patient to ask
prescriber about vitamin D or calcium
supplement.
• Instruct patient receiving long-term
therapy to have periodic eye examinations.
• Advise patient to avoid exposure to
infections (such as measles and
chickenpox) and to notify prescriber
if such exposure occurs.
• Tell patient to avoid alcohol.
Alert: Counsel patient to discuss benefits
and risks along with other possible
treatments with health
care provider before undergoing epidural
corticosteroid injection.
Adalat Nifedipine 5 mg twice ACTIONS: • Monitor BP and HR regularly, especially
a day per in patients who take beta blockers or
Orem antihypertensives.
• Thought to inhibit calcium ion influx across • Watch for symptoms of HF.
cardiac and smooth muscle cells, decreasing • The most common adverse effect is
ER 108
contractility and peripheral edema, which occurs within 2 to
oxygen demand. Drug may also dilate coronary 10-23-2022 3 weeks of start of therapy.
arteries and arterioles • Don't give immediate-release capsules
8AM – 6PM
start of therapy or with dosage titration of compliance. Patient may take SL
dihydropyridine calcium channel blockers. nitroglycerin, as needed, for acute chest
Reflex tachycardia may occur, resulting in pain.
angina or MI in patients with obstructive • Tell patient that chest pain may worsen
coronary disease, especially in the absence of briefly as therapy starts or dosage increases.
concurrent beta blockade. • Instruct patient to swallow extended-
• BP must be lowered at a rate appropriate for release tablets without breaking, crushing,
patient's clinical condition to avoid or chewing them.
symptomatic hypotension with or without • Advise patient to avoid taking drug with
WUP SN’25
adverse events (death, cerebrovascular withdrawal may cause
10-23-2022
ischemia, syncope, stroke, acute MI, fetal rebound angina in patients with CAD.
distress) have been reported. Don't use • Advise patient that Adalat CC tablets
immediate release nifedipine for acute BP contain lactose and shouldn't be used by
reduction or to manage primary HTN. patients with galactose
• Avoid use in patients with HF; drug may intolerance, Lapp lactase deficiency, or
worsen symptoms. glucose-galactose malabsorption.
• Use with extreme caution in patients with • Reassure patient taking the extended-
severe aortic stenosis. Drug may reduce release tablet that the wax mold may be
coronary perfusion, resulting in ischemia. passed in the stools.
• Use cautiously in patients with hypertrophic Assure patient that drug has already been
cardiomyopathy and outflow tract obstruction completely absorbed.
because reduction in afterload may worsen • Tell patient to protect capsules from direct
symptoms. light and moisture and to store at room
• Use cautiously before major surgery. temperature
Cardiopulmonary bypass, intraoperative blood
loss, or
vasodilating anesthesia may result in severe
hypotension or increased fluid requirements.
Consider withdrawing nifedipine more than 36
hours before surgery if possible.
• Rare reversible elevations in BUN and serum
creatinine levels have been reported in patients
with preexisting chronic renal insufficiency.
• Use cautiously in patients with hepatic
impairment. Clearance of nifedipine is reduced
in cirrhotic patients, leading to increased
systemic exposure and possibly increasing
toxicities; monitor patient and consider dosage
adjustments.
Alert: Immediate-release drug is considered a
high-risk drug for elderly patients because of
the potential for hypotension and increased risk
of precipitating myocardial ischemia in this
population. Avoid use.
Alert: Use extended-release form cautiously
because of an increased risk of serious GI
obstruction in patients both with and without
risk factors. (Risk factors for GI obstruction
include altered GI anatomy, GI hypomotility
related to GERD, colon cancer, ileus, obesity,
hypothyroidism, diabetes, and concomitant
use of H2 blockers, NSAIDs, laxatives,
anticholinergic agents, and levothyroxine.)
• Safety and effectiveness in children haven't
been established.
Dialyzable drug: Unlikely.
Overdose S&S: Hypotension, dizziness,
palpitations, flushing, nervousness.
SIDE EFFECTS:
CNS: dizziness, light-headedness, giddiness,
headache, weakness, nervousness, mood
changes, shakiness, sleep disturbances, fever.
CV: flushing, heat sensation, peripheral
edema, palpitations, transient hypotension.
EENT: nasal congestion, sore throat, blurred
vision.
GI: nausea, heartburn,
diarrhea, constipation, cramps, flatulence.
Musculoskeletal: muscle cramps, tremor,
inflammation, joint stiffness.
Respiratory: dyspnea, cough, wheezing, chest
congestion, shortness of breath.
Skin: dermatitis, pruritus, urticaria, sweating.
Other: difficulties in balance, chills, sexual
difficulties.
MARY JULIANNE O. GALVAN
BSN 2 - 4
ENDORSEMENT
COLLABORATIVE:
• Request for further • For further monitoring
examinations/tests of results of the patient
as instructed. and as a representation
of patient’s
improvement about her
diagnosis