Drug Study DRUG MELOXICAM (mel-ox-i-cam) Mobic 500mg; 1 tab PO BID (8AM;6PM) CLASSIFICATION CENTRAL NERVOUS SYSTEM (CNS)

AGENT; ANALGESIC; NONSTEROIDAL ANTIINFLAMMATORY DRUG (NSAID); COX-2 MECHANISM OF ACTION Unlike ibuprofen, inhibits prostaglandin synthesis by inhibiting cyclooxygenase2 (COX-2), but does not have a major effect on cyclooxygenase-1 (COX-1). ADVERSE EFFECT/ SIDE EFFECTS Body as a Whole: Edema, fall, flu-like syndrome, pain. GI: Abdominal pain, diarrhea, dyspepsia, flatulence, nausea, constipation, ulceration, GI bleed. Hematologic: Anemia. Musculoskeletal: Arthralgia. CNS: Dizziness, headache, insomnia. Respiratory: Pharyngitis, upper respiratory tract infection, cough. Skin: Rash, pruritus. Urogenital: Micturition frequency, urinary tract infection. NURSING RESPONSIBILITIES Monitor for and immediately report S&S of GI ulceration or bleeding, including black, tarry stool, abdominal or stomach pain; hepatotoxicity, including fatigue, lethargy, pruritus, jaundice, flu-like symptoms; skin rash; weight gain and edema. Withhold drug and notify physician if hepatotoxicity or GI bleeding is suspected. Monitor carefully patients with a history of CHF, HTN, or edema for fluid retention. Monitor diabetics using sulfonylureas for hypoglycemia. Calci-8 1 tab PO OD (8AM) Calcium supplements Replaces and maintain calcium -GI irritation -Hemorrhage -Constipation -Vomiting -Thirst -Renal Calculi -Hypercalcemia

>use cautiously in patients sarcoidosis and renal or cardiac diase and digitalized patients >monitor blood calcium

-Polyuria level frequently >take drug between meal and bedtime >report loss of appetite, N&V, abdominal pain, constipation, dry mouth, thirst and increase in voiding RANITIDINE HYDROCHLORIDE (ra-nyete-deen) Zantac, Zantac EFFERdose, Zantac GELdose, Zantac-75 50mg IVTT On call to Operating Room GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST) Potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2receptor sites on parietal cells, thus blocking gastric acid secretion. Indirectly reduces pepsin secretion but appears to have minimal effect on fasting and postprandial serum gastrin concentrations or secretion of gastric intrinsic factor or mucus. CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo, mental confusion, agitation, depression, hallucinations in older adults. CV: Bradycardia (with rapid IV push). GI: Constipation, nausea, abdominal pain, diarrhea. Skin: Rash. Hematologic: Reversible decrease in WBC count, thrombocytopenia. Body as a Whole: Hypersensitivity reactions, anaphylaxis (rare). *Potential toxicity results from decreased clearance (elimination) and therefore prolonged action; greatest in the older adult patients or those with hepatic or renal dysfunction. *Lab tests: Periodic liver functions. Monitor creatinine clearance if renal dysfunction is present or suspected. When clearance is <50 mL/min, manufacturer recommends reduction of the dose to 150 mg once q24h with cautious and gradual reduction of the interval to q12h or less, if necessary. *Be alert for early signs of hepatotoxicity (though low and thought to be a

hypersensitivity reaction): jaundice (dark urine, pruritus, yellow sclera and skin), elevated transaminases (especially ALT) and LDH. *Long-term therapy may lead to vitamin B12 deficiency.