DRUG STUDY 1

(Case Study No. 3)

MEDICATION CLASSIFICATION/ INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING
ACTION RESPONSIBILITIES
Classification Hypokalemia. Prophylaxis Renal insufficiency, Common side effects of Common adverse effects Before
Generic Name: A12BA01 - potassium during treatment with hyperkalemia, untreated Kalium Durules are of Kalium Durules are  Check and verify
Kalium Durules chloride ; Belongs to the saluretic diuretics, Addison's disease, follows: follows: doctor’s order
class of potassium- especially in combination stricture of the esophagus  Hyperkalemia regarding the
Brand Name: containing preparations. with digitalis. and/or obstructive  Abdominal pain Uncommon (<1/100): medication.
Used as dietary changes in the alimentary  Diarrhea Metabolism:  Observe 10 rights:
Usual Route: supplements. tract. Hypersensitivity to Hyperkalemia. Right patient, drug,
 nausea.
Oral, IV route the active substance or to dose, time, and route.
Action any of the excipients. Gastrointestinal:  Make a medication
Dosage/Frequency: Pharmacology: Abdominal pain, diarrhea, card with the
Adult: 20-40 mEq orally Pharmacodynamics: nausea. complete doctor’s
two to three times daily· Potassium plays a major Rare (<1/1000): order, name of the
role in a number of Gastrointestinal: patient, bed number
Pediatric: 0.5-2 mEq/kg physiological processes Ulceration, perforation and
orally every 12 hours and room/ward
like the maintenance of stricture/stenosis of the  Obtain and record
intracellular tonicity, the esophagus or small vital signs.
Drug Order: transmission of nerve intestine.
Kalium Durules 750mg impulses,  Secure a copy of the
the renal Skin: Rash. client’s health history
one tablet per orem BID function and the for contraindications
contraction of cardiac, and drug interactions
skeletal and smooth (notify the physician if
muscle. any).
Potassium depletion may
 Ask the client’s full
occur when the loss
name to verify his
through renal excretion
identity..
and/or the loss from the
 Educate and explain
gastrointestinal tract
the medication to the
exceeds the potassium
client, how it works,
intake.
why it is given to him,
Pharmacokinetics: The and the possible side
bioavailability of effects
potassium from Potassium
During:
Chloride (Kalium Durules)
is similar to that of a  Administer Kalium
standard potassium Durules in the right
chloride solution. The time and route with
Tmax for excretion occurs desire dosage and as
after 1-1.5 hours after per doctor order
intake of Potassium  Give while patient is
Chloride (Kalium Durules).
Therapeutic effects
Given special importance
as therapeutic agents but
are also dangerous if
improperly prescribed and
administered. Utilized for
treatment of hypokalemia
sitting up or standing
(never in recumbent
position) to prevent
drug–induced
esophagitis. Some
patients find it difficult
to swallow the large
sized KCl tablet.
 Do not crush or allow
to chew any
potassium salt
tablets. Observe to
make sure patient
does not suck tablet
(oral ulcerations have
been reported if tablet
is allowed to dissolve
in mouth).
 Swallow whole tablet
with a large glass of
water or fruit juice (if
allowed) to wash drug
down and to start
esophageal
peristalsis.

After:
 Monitor signs of
allergic reactions and
anaphylaxis, including
pulmonary symptoms
(tightness in the
throat and chest,
wheezing, cough
dyspnea) or skin
reactions (rash,
prurits, urticaria).
Notify physician or
nursing staff
immediately if these
reactions occur.
 Monitor B/P
(standing, sitting,
supine).
 Monitoring its
effectiveness and
 educating the patient.
 Wash your hands
properly
 Document the time,
location, dose,
medication given to
the patient.
 DRUG STUDY 2
(Case Study No. 3)
MEDICATION CLASSIFICATION/ INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING
ACTION RESPONSIBILITIES
Classification Metronidazole is one of Hypersensitivity to Common side effects of Common adverse effects Before
Generic Name: Metronidazole belongs to the mainstay drugs for the metronidazole and other metronidazole are follows: of metronidazole are  Check and verify
Metronidazole the class of medicines treatment of anaerobic nitroimidazoles.  vomiting. follows: doctor’s order
known as antibiotics. It bacterial infections, Concomitant use with  nausea. regarding the
Brand Name: works by killing bacteria or protozoal infections, and disulfiram within the last  diarrhea. Significant: Severe medication.
Flagyl, Flagyl ER, and preventing their growth. microaerophilic bacterial 14 days. Coadministration  constipation. neurological disturbances,  Observe 10 rights:
Flagyl IV RTU. However, this medicine infections. It is cytotoxic to with alcohol or propylene encephalopathy, Right patient, drug,
 upset stomach.
will not work for colds, flu, facultative anaerobic glycol containing products  stomach cramps. convulsive seizures, dose, time, and route.
Usual Route: or other virus infection microorganisms. during or 3 days after aseptic meningitis,
 loss of appetite.  Make a medication
Oral, IV route therapy discontinuation. peripheral and optic
 headache. card with the
Action Pregnancy during the 1st neuropathy, paraesthesia; complete doctor’s
Dosage/Frequency: Description: trimester in the treatment superinfection (e.g. fungal order, name of the
Adult: single dose of 2 Metronidazole interacts of trichomoniasis. or bacterial patient, bed number
grams, as 1 gram 2 times with the microbial DNA to superinfection, C. difficile- and room/ward
a day for 1 day, or as 250 break its strand and associated diarrhoea).
milligrams (mg) 3 times a helical structure leading to  Obtain and record
day for 7 days vital signs.
inhibition of protein Blood and lymphatic  Secure a copy of the
synthesis, degradation, system client’s health history
The capsule dose is 375 and cell death. disorders: Leucopenia,
mg 2 times a day for 7 for contraindications
neutropenia. and drug interactions
days. Pharmacokinetics:
(notify the physician if
Absorption: Rapidly and Cardiac disorders: Chest
Drug Order: any).
almost completely pain, tachycardia.
Metronidazole 500mg absorbed  Ask the client’s full
from the Ear and labyrinth
through intravenous fluid gastrointestinal tract. Food name to verify his
disorders: Tinnitus. identity.
every 6 hours delays absorption.
 Educate and explain
Eye disorders: Light
Time to peak plasma the medication to the
sensitivity, nystagmus.
concentration: 1-2 hours client, how it works,
(oral); 20 minutes (IV); 5- why it is given to him,
Gastrointestinal
12 hours (rectal); 8 hours and the possible side
disorders: Nausea, dry
(intravaginal gel). effects
mouth, vomiting,
constipation, abdominal During:
Bioavailability: 60-80% pain, diarrhoea, sharp
(rectal); 20-25% (vag  Administer
unpleasant metallic taste.
pessaries); 56% Metronidazole in the
(intravaginal gel). right time and route
Investigations: Flattening
Distribution: Widely with desire dosage
of T wave on ECG.
distributed into most body and as per doctor
tissues and fluids. order
Crosses blood-brain Metabolism and  Administer oral doses
barrier. Readily crosses nutrition with food.
the placenta and enters disorders: Anorexia.  Apply topically
breast milk in (MetroGel) after
concentrations equal to Musculoskeletal and cleansing the area.
the concurrent serum connective tissue Advise patient that
concentrations disorders: Myalgia. cosmetics may be
used over the area
Plasma protein binding: Nervous system after application.
<20%. disorders: Insomnia,  Reduce dosage in
headache, ataxia, vertigo, hepatic disease.
Metabolism: Mainly incoordination, dizziness.
metabolised in the liver via
hydroxylation, side- Psychiatric After:
oxidation, and disorders: Confusion,  Monitor signs of
glucuronidation to active hallucination. allergic reactions and
hydroxyl metabolite and Reproductive system and anaphylaxis, including
several metabolites. breast disorders: Genital pulmonary symptoms
pruritus. (tightness in the
Excretion: Via urine (60- throat and chest,
80% as unchanged drug Respiratory, thoracic wheezing, cough
and metabolites; approx and mediastinal dyspnea) or skin
20% of total as unchanged disorders: Pharyngitis, reactions (rash,
drug); faeces (6-15%) sinusitis. prurits, urticaria).
Notify physician or
Elimination half-life: Skin and subcutaneous nursing staff
Approx 8 hours. tissue immediately if these
disorders: Erythematous reactions occur.
rash, urticaria, dry skin.  Monitor B/P
(standing, sitting,
Vascular supine).
disorders: Syncope.  Monitoring its
effectiveness and
educating the patient.
 Wash your hands
properly
 Document the time,
location, dose,
medication given to
the patient.
 DRUG STUDY 3
(Case Study No. 3)
MEDICATION CLASSIFICATION/ ACTION INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING
RESPONSIBILITIES
Classification Metoclopramide has Patient with Common side effects of Common adverse effects of Before
Generic Name: Metoclopramide is in a class been approved by the gastrointestinal Metoclopramide metoclopramide are  Check and verify
Metoclopramide of medications called FDA specifically to treat perforation, haemorrhage drowsiness. follows: doctor’s order
prokinetic agents. It works by nausea and vomiting in or mechanical obstruction,  excessive regarding the
Brand Name: speeding the movement of patients with suspected or known tiredness. significant: Dystonic medication.
Reglan, and Metozolv food through the stomach gastroesophageal reflux pheochromocytoma or  weakness. reactions, akathisia,  Observe 10 rights:
ODT. and intestines disease or diabetic other catecholamine-  headache. parkinsonian symptoms, Right patient, drug,
gastroparesis by releasing paragangliomas,  dizziness. tardive dyskinesia, dose, time, and
Usual Route: Action increasing gastric history of neuroleptic or methaemoglobinaemia, route.
Oral, IV, and IM route  diarrhea.
Description: Metoclopramid motility. It is also used to drug-induced tardive circulatory collapse, severe  Make a medication
 nausea.
e is a substituted benzamide control nausea and dyskinesia, seizure bradycardia, cardiac arrest, card with the
Dosage/Frequency:  vomiting.
with prokinetic and antiemetic vomiting in disorder (e.g. epilepsy), QT prolongation, sinus complete doctor’s
0.1 to 0.15 mg/kg body properties. It stimulates the chemotherapy patients Parkinson’s disease, arrest, torsades de pointes. order, name of the
weight, repeated up to motility of the upper known history of depression, suicidal patient, bed number
three times daily by gastrointestinal tract and methaemoglobinaemia ideation; gynaecomastia, and room/ward
intravenous route. The accelerates gastric peristalsis with metoclopramide or galactorrhoea,
maximum dose in 24  Obtain and record
without stimulating gastric, nicotinamide adenine amenorrhoea and vital signs.
hours is 0.5 mg/kg body biliary or pancreatic dinucleotide-cytochrome impotence secondary to
weight.  Secure a copy of the
secretions, leading to b5 reductase (NADH- hyperprolactinaemia, client’s health history
increased gastric emptying Cyb5R) deficiency. for contraindications
Drug Order: and intestinal transit time. It Concomitant use with Blood and lymphatic
Metoclopramide one and drug interactions
blocks dopamine receptors drugs which may cause system disorders: Rarely, (notify the physician
tablet every 8 hours PRN and serotonin receptors (at extrapyramidal reactions agranulocytosis, if any).
higher doses) in (e.g. antipsychotics, leucopenia, neutropenia,  Ask the client’s full
chemoreceptor trigger zone levodopa). Children <1 sulfhaemoglobinaemia. name to verify his
of the CNS. year. identity.
Onset: 30-60 minutes (oral); Cardiac
 Educate and explain
1-3 minutes (IV); 10-15 disorders: Supraventricula
the medication to the
minutes (IM). r tachycardia, acute CHF,
client, how it works,
Duration: 1-2 hours. AV block.
why it is given to him,
Pharmacokinetics:
and the possible side
Absorption: Rapidly and Eye disorders: Visual
effects
almost completely from the disturbance.
gastrointestinal tract after oral
During:
administration. Absolute Gastrointestinal  Administer
bioavailability: 80±15.5%. disorders: Diarrhoea, Metoclopramide in
Time to peak plasma nausea, vomiting, bowel
concentration: Approx 1-2 disturbance. the right time and
hours (oral). route with desire
Distribution: Extensively General disorders and dosage and as per
distributed to body tissues. admin site doctor order
Crosses the blood-brain conditions: Asthenia,  Assess for
barrier and placenta and fatigue. extrapyramidal
enters breast milk at low symptoms and
level. Volume of distribution: Hepatobiliary tardive dyskinesia
Approx 3.5 L/kg. Plasma disorders: Rarely, (more likely in older
protein binding: Approx 30%. hepatoxicity. patients).
Metabolism: Metabolised in  Assess for
the liver by CYP2D6 via Immune system gastrointestinal
oxidation and glucuronide disorders: Hypersensitivity complaints, such as
and sulfate conjugation to , rarely, angioedema. nausea, vomiting and
major metabolite, constipation.
monodeethylmetoclopramide. Nervous system  In oral administration,
Undergoes hepatic first-pass disorders: Somnolence, for better absorption
metabolism. restlessness, headache, allow 30 minutes to
Excretion: Via urine (approx dizziness, seizure, rarely, one hour before
85%, with approx 50% as tremor. eating.
free or conjugated
metoclopramide); faeces Psychiatric After:
(approx 5%). Elimination half- disorders: Insomnia.  Monitor signs of
life: 2.5-6 hours. Rarely, anxiety, agitation, allergic reactions and
confusion, hallucinations. anaphylaxis,
including pulmonary
Renal and urinary symptoms (tightness
disorders: Urinary in the throat and
incontinence or urgency. chest, wheezing,
Reproductive system and cough dyspnea) or
breast disorders: Priapism. skin reactions (rash,
prurits, urticaria).
Respiratory, thoracic and Notify physician or
mediastinal nursing staff
disorders: Bronchospasm, immediately if these
rarely, laryngospasm, reactions occur.
laryngeal oedema.  Monitor B/P
Skin and subcutaneous (standing, sitting,
tissue disorders: Rarely, supine).
rash, urticaria.  Monitoring its
effectiveness and
educating the patient.
Vascular  Wash your hands
disorders: Hypotension properly
(IV), hypertension, flushing.  Document the time,
location, dose,
Potentially Fatal: Rarely, medication given to
neuroleptic malignant the patient.
syndrome characterised by
muscle rigidity,
hyperthermia, altered
consciousness, autonomic
instability.
 DRUG STUDY 4
(Case Study No. 3)
MEDICATION CLASSIFICATION/ ACTION INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING
RESPONSIBILITIES
Classification Hyoscine butylbromide is Patient with Common side effects of Common adverse effects of Before
Generic Name: Hyoscine butylbromide - indicated in acute spasm, gastrointestinal Hyoscine-N-Butyl Hyoscine-N-Butyl bromide  Check and verify
Hyoscine-N-Butyl buscopan is an as in renal or biliary colic, perforation, haemorrhage bromide Or buscopan are follows: doctor’s order
bromide antispasmodic medicine in radiology for or mechanical obstruction, Or buscopan are follows: regarding the
which is taken to relieve differential diagnosis of suspected or known Significant: Tachyarrhyth medication.
Brand Name: cramps in the stomach, obstruction and to reduce pheochromocytoma or  drowsiness. mias, hypotension,  Observe 10 rights:
Buscopan intestines or bladder. In spasm and pain in other catecholamine-  dry mouth. increased intra-ocular Right patient, drug,
particular, it helps to ease pyelography, and in other releasing paragangliomas,  constipation. pressure, drowsiness, dose, time, and
Usual Route: bloating and the spasm-type diagnostic procedures history of neuroleptic or  blurred vision. confusional states, visual route.
Oral, IV route pain that can be associated where spasm may be a drug-induced tardive hallucinations, blurred
 fast heart rate.  Make a medication
with irritable bowel syndrome problem (e.g. dyskinesia, seizure vision, eye pain, card with the
Dosage/Frequency: and diverticular disease. gastroduodenal disorder (e.g. epilepsy), idiosyncratic reactions (e.g. complete doctor’s
Adult: As hyoscine endoscopy). Parkinson’s disease, agitation, delusion, acute order, name of the
butylbromide: 20 mg 4 Action known history of toxic psychosis), epileptic patient, bed number
times daily. Description: Hyoscine is a methaemoglobinaemia seizures. and room/ward
Child: As hyoscine tertiary amine antimuscarinic with metoclopramide or
butylbromide: 6-11 years  Obtain and record
agent. It blocks the action of nicotinamide adenine Nervous system vital signs.
10 mg tid; acetylcholine in the smooth dinucleotide-cytochrome disorders: Dizziness,
≥12 years Same as adult  Secure a copy of the
muscles of the b5 reductase (NADH- headache, equilibrium client’s health history
dose gastrointestinal, biliary and Cyb5R) deficiency. disturbance, excitement, for contraindications
urinary tracts, in secretory Concomitant use with ataxia, hallucinations, and drug interactions
Drug Order: glands and in the CNS, thus drugs which may cause behavioural abnormalities,
Hyoscine-N-Butyl (notify the physician
exhibiting spasmolytic actions extrapyramidal reactions acute toxic psychosis, if any).
bromide 10 mg P.O., TID on smooth muscles and (e.g. antipsychotics, agitation, confusion,  Ask the client’s full
inhibit secretions. It also levodopa). Children <1 paranoia, rambling speech, name to verify his
blocks transmission of year. fatigue, migraine, irritability, identity.
cholinergic impulses from the amnesia, restlessness,
 Educate and explain
vestibular nuclei to the CNS, sedation.
the medication to the
thus preventing motion-
client, how it works,
induced nausea and Cardiac
why it is given to him,
vomiting. disorders: Bradycardia.
and the possible side
Onset: Inhibition of saliva:
effects
Within 30-60 minutes (IM, Gastrointestinal
oral); Amnesia: Within 10 disorders: Nausea, During:
minutes (IV); Antiemesis: vomiting, hypersalivation,
 Administer Hyoscine-
Within 15-30 minutes (IM), diarrhoea, dry mouth,
N-Butyl bromide
approx 4 hours (transdermal). abdominal cramps,
Duration: Antiemesis: Up to constipation, oesophageal Or buscopan in the
72 hours. (transdermal), ulceration. right time and route
approx 4 hours (IM); General disorders and with desire dosage
Inhibition of saliva: Up to 4-6 administration site and as per doctor
hours (IM, oral); Amnesia: ≥2 conditions: Hyperpyrexia. order
hours (IV); Mydriasis: Up to 8  Drug compatibility
hours (IM). Eye disorders: Mydriasis, should be monitored
Pharmacokinetics: cycloplegia, eye pruritus. closely in patients
Absorption: Tertiary salts: requiring adjunctive
Readily absorbed from the Musculoskeletal: Muscle therapy
gastrointestinal tract. weakness.  Avoid driving &
Quaternary salts: Poorly operating machinery
absorbed. Bioavailability: 8% Renal and urinary after parenteral
(oral). Time to peak plasma disorders: Urinary administration.
concentration: Within 24 retention, dysuria.  Avoid strict heat
hours (transdermal); As Raise side rails as a
hydrobromide: Approx 20 Skin and subcutaneous precaution because
minutes (IM), 15 minutes tissue some patients
(SC); As butylbromide: disorders: Flushing, become temporarily
Approx 2 hours (oral). sweating, dry skin, rash, excited or disoriented
Distribution: Tertiary salts: erythema, pruritus, skin and some develop
Crosses blood-brain barrier burns, contact dermatitis amnesia or become
and the placenta, enters (transdermal). drowsy.
breast milk. Volume of Reorient patient, as
distribution: As butylbromide: Potentially needed, Tolerance
128 L. Plasma protein Fatal: Anaphylaxis, shock. may develop when
binding: As butybromide: therapy is prolonged
Approx 4%, to albumin. Atropine-like toxicity
Metabolism: Metabolised in may cause dose
the liver mainly via related adverse
conjugation. reactions. Individual
Excretion: As hydrobromide: tolerance varies
Mainly via urine (<10% as greatly
unchanged drug and some
metabolites). As After:
butylbromide: IV: Via urine  Monitor signs of
(42-61% as unchanged drug) allergic reactions and
and faeces (28-37%). anaphylaxis,
Elimination half-life: Hyoscine including pulmonary
base 9.5 hours; As symptoms (tightness
butylbromide: Approx 5-11 in the throat and
hours; As hydrobromide: chest, wheezing,
Approx 1-4 hours. cough dyspnea) or
skin reactions (rash,
prurits, urticaria).
Notify physician or
 nursing staff
immediately if these
reactions occur.
 Monitor B/P
(standing, sitting,
supine).
 Monitoring its
effectiveness and
educating the patient.
 Wash your hands
properly
 Document the time,
location, dose,
medication given to
the patient.