Drug Study

DRUG

INDICATION

MECHANISM OF ACTION

SIDE EFFECT 1.

NURSING INTERVENTION Assess patients condition before therapy and regularly thereafter to monitor drug effectiveness. Periodically monitor adrenal function for suppression of hypothalamic-pituitaryadrenal axis. Monitor patients weight (report weekly gain >5lbs), blood pressure, potassium, blood glucose, urine glucose and plasma cortisol levels. Monitor vital signs regularly. Assess for edema, hypertension and other cardiac symptoms and report chest pain. Also monitor input-output ratio. Carefully assess for infection because drug can mask infection symptom even after withdrawal of medications: increased temperature and WBC. Assess mental status note for aggression and behavioural/mood changes. Give medicine with food or milk to decrease GI symptoms.

Brand Name: Medrol Generic Name: methylprednisolone Classification: Glucocorticoid Dosage:

Suppression of inflammatory and allergic disorders

16 mg/tab; 1tab
Route: PO Frequency: BID; p.c. (post cebum)/ aft er meals

As a glucocorticoid, it GI upset has marked Headache antiinflamatory action due to its ability to Dizziness inhibit prostaglandin Insomnia synthesis. As an Weight gain immunosuppressant, it inhibits phagocytosis and migration of macrophages and leukocytes to the site of CONTRAINDICATION ADVERSE REACTION inflammation as well as Systemic fungal stabilizes lysosomes to infections Euphoria prevent release of Septic shock Pseudomotor enzymes and reverses Hypersensitivity cerebri increased capillary Administration of Heart failure permeability. live/ live attenuated Pancreatitis vaccine Carbohydrate Tuberculous or intolerance syphilitic processes Hypokalemia in the area to be Hyperglycemia treated Hirsutism Viral diseases (e.g. Skin eruptions varicella, herpes zoster)

2.

3.

4.

5.

6.

7.

DRUG

INDICATION Secondary infections of chronic respiratory tract diseases

MECHANISM OF ACTION Inhibits bacterila cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death.

SIDE EFFECT Nausea and vomiting Abdominal pain Dyspepsia Flatulence 1.

NURSING INTERVENTION Assess patients previous sensitivity reaction to penicillin or other cephalosporins. Crosssensitivity between penicillins and cephalosporins is common. Obtain Culture and Sensitivity before beginning drug therapy to identify if correct treatment has been initiated. Assess renal function before and during therapy: urine output, BUN and creatinine. Monitor for nephrotoxicity. Teach patient to take medication as directed; complete entire prescription. May cause GI upset; report persistent adverse effects esp. Diarrhea. May alter results of urine glucose and ketone testing.

Brand Name: Tergecef Generic Name: cefixime Classification: Cephalosporin, third generation Dosage: 200mg/cap; 1 cap Route:

2.

CONTRAINDICATION Hypersensitivity History of shock due to any ingredient of this product.

ADVERSE REACTION Shock Granulocytopenia Acute renal failure Interstitial pneumonia Lyells syndrome Diarrhea

3.

PO
Frequency: BID

4.

5.

DRUG

INDICATION Treatment of angina pectoris caused coronary artery spasm.

MECHANISM OF ACTION Inhibits calcium ion influx across cell membrane during cardiac depolarization, produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries.

SIDE EFFECT 1. Edema Dizziness Headache Infection Rhinitis Dyspnea

Brand Name: Dilatam Generic Name: diltazem Classification: Calcium channel blocker Dosage: 30mg/tab; tab Route: PO

2.

3.

4. ADVERSE REACTION Hypotension Bradycardia Atrioventricular block Asystole Sinus arrest

CONTRAINDICATION Patients with the sick sinus syndrome, pre-existing second- or thirddegreeatrioventricular block, or marked bradycardia.

5.

Frequency:
TID

6.

NURSING INTERVENTION Instruct patient to limit caffeine consumption. Caution patient to change positions slowly to minimize orthostatic hypotension. Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions Inform patient to take extended-release capsules on an empty stomach at same time each day. Do not open, chew, or crush; swallow whole. Teach patient that drug does not cure high Bp or angina just controls it so continue taking as prescribed even when BP is not elevated or angina symptoms are not present. Teach patient to continue diet (low fat/ low Na), regular exercise, and decreased caffeine; stop tobacco and alcohol. Reduce fluid and salt intake to control swelling.

DRUG

INDICATION

MECHANISM OF ACTION

SIDE EFFECT 1. Diarrhea Constipation Dyspepsia Headache Abdominal pain

NURSING INTERVENTION Note reasons for therapy, type, location, characteristics of signs and symptoms. 2. List any sensitivity to penicillins, cephalosporins, beta-lactamase inhibitors, or other allergens. 3. List drugs prescribed to ensure none interact unfavourably.

Brand Name: Tazocin Generic Name:

piperacillin/tazobactam
Classification: Antibiotic, penicillin Dosage: 4.5gm Route:

IV
Frequency: q8

Community-acquired A combination of pneumonia of moderate piperacillin sodiumand severity caused by tazobactam sodium, a betapiperacillin resistant, betalactamase inhibitor. lactamase-producing strains Tazobactam inhibits betaof haemophilus influenzae. lactamases, thus ensuring activity of piperacillin against beta-lactamaseproducing microorganisms. Thus, tazobactam broadens the antibiotic spectrum of piperacillin to those bacteria normally resistant to it. CONTRAINDICATION

ADVERSE REACTION

4.

Monitor C&S, urinalysis, hematologic, coagulation

Hypersensitivity to penicillins, cephalosporins, or beta-lactamase inhibitors.

Agitation Anxiety Pruritus Thrombocytopenia Edema Moniliasis Hemolytic anemia

profile, electrolytes, renal and liver function test. Reduce dosage with renal

impairment.

DRUG
Brand Name: Fluimucil Generic Name: acetylcysteine Classification: Mucolytic Dosage:

MECHANISM OF ACTION Decreases viscosity of Treatment of respiratory respiratory tract secretions affections characterized by and promote their removal thick and viscous hyper by breaking disulfide secretions: acute and bonds. chronic bronchitis and its exacerbation.

INDICATION

600mg/tab;
1tab on 75ml water Route: PO Frequency: OD Hypersensitivity Phenylketonuria (contains aspartame) CONTRAINDICATION

NURSING INTERVENTION 1. Asses patients Bronchial/tracheal history of underlying irritation condition, cough: Rash type, frequency, Stomatitis character Nausea & Vomiting 2. Assess patients respiration and pulmonary secretions, exercise caution on patients with respiratory insufficiency and history of ADVERSE REACTION bronchospasm. 3. Instruct patient to Generalized urticaria follow directions accompanied by mildfever exactly. Explain Hypotension importance of using Wheezing drug as directed. Dyspnea 4. Tell patient to avoid hazardous activities until patients is stabilized on this medication, avoid alcohol and other CNS depressants, these will enhance sedating properties of this drugs.

SIDE EFFECT

DRUG Brand Name:

INDICATION Short term treatment of gastroesophageal reflux disease (GERD)

MECHANISM OF ACTION Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in the gastric parietal cell: characterized as a gastric acid pump inhibitor, since it blocks the final step of acid.

SIDE EFFECT 1. Headache Abdominal pain Dairrhea URTI Dizziness Rash

Losec
Generic Name: omeprazole Classification: Proton pump inhibitor Dosage: 40mg/tab; 1tab Route: PO Frequency: OD

2.

3.

CONTRAINDICATION Hypersensitivity Combination therapy with clarythromycin should not be used in patients with hepayic impairment.

ADVERSE REACTION Pancreatitis Liver necrosis Hepatic failure Toxic epidermal necrolysis Agranulocytosis

4.

5.

6.

NURSING INTERVENTION List reason for therapy, triggers, frequency, characteristics of signs and symptoms. Record abdominal assessments, radiologic/endoscopic findings, and H. Pylori results. Monitor urinalysis, CBC, and liver function test; adjust dosage with hepatic dysfunction. Take capsule at least 1 hr before eating and swallow whole; do not open, chew, or crush. Antacids can be administered with omeprazole. Teach patient to report any changes in urinary elimination, pain, discomfort or persistent diarrhea. Avoid alcohol and OTC agents as well as foods known to cause GI upset/irritation.

DRUG Brand Name: Micardis Generic Name: telmisartan Classification: Antihypertensive, angiotensin II receptor blocker Dosage: 40/12.5 mg/tab; 1 tab Route: PO Frequency: OD

INDICATION For hypertension

MECHANISM OF ACTION The angiotensin II receptor antagonists competitively block the angiotensin AT1 recepor located in vascular smooth muscles and the adrenal glands, thus blocking the vasoconstrictor and aldosterone-secreting effects of angiotensin II. Thus, BP is reduced.

SIDE EFFECT Diarrhea Pain Sinusitis Myalgia Abdominal pain Cough Flu-like symptoms

CONTRAINDICATION
Use with caution in impaired hepatic function or in biliary obstructive disorders.

ADVERSE REACTION
Anaphylaxis Angioedema Cardiac arrest Hepatic necrosis

NURSING INTERVENTION 1. May be taken with or without food. 2. Teach patient to store drug from 15-30 degrees Celsius. Do not remove tablet from blisters until just before use. 3. Take as directed at the same time daily with or without food. 4. Teach patient to use drug with caution, may experience dizziness related to low BP. Change positions slowly. 5. Teach patient to have regular exercise, lowsalt diet, and lifestyle changes (e.g., no smoking, low alcohol, low-fat diet, low stress, adequate rest) contribute to enhanced Bp control. Monitor BP regularly.

DRUG

INDICATION Respiratory disease

Brand Name: Solu-cortef Generic Name: hydrocortisone Classification: Glucocorticoid

MECHANISM OF ACTION Glucocorticoid with anti inflammatory effect because of its ability to inhibit prostaglandin synthesis, inhibit migration of macrophages, leucocytes and fibroblasts at sites of inflammation, phagocytosis and lysosomal enzyme release. It also cause the reversal of increased capillary permeability.

SIDE EFFECT Flushing Sweating Headache Nausea Diarrhea

Dosage:
100 mg Route: IV Frequency: Q8

CONTRAINDICATION Nonasthmatic bronchial disease Administration of live virus vaccines in patients receiving immunosuppressive corticoid doses Acute glomerulonephritis

ADVERSE REACTION Thrombophlibitis Circulatory collapse Pancreatitis Thrombocytopenia Hemorrhage Fractures

NURSING INTERVENTION 1. Assess patients condition before starting therapy and reassess regularly. 2. Monitor patients weight, blood pressure, glucose and electrolyte levels. 3. Monitor weight, input-output ratio, urine output and increasing edema (daily). Report hypertension, edema, cardiac symptoms or weekly weight gain of >5lbs. 4. Assess carefully for signs of infection especially fever and WBC count (even after withdrawal of medication) because the drug masks infection symptoms. 5. Caution patient on use of OTC products that contain salicylates and alcohol.

DRUG

INDICATION For acute pulmonary edema

MECHANISM OF ACTION Inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of Henle; this results in the excretion of sodium, chloride, and, to a lasser degree, potassium and carbonate ions. Diuretic action is independent of changes in clients acidbase balance.

SIDE EFFECT Jaundice Tinnitus Hypotension Pancreatitis Abdominal pain Electrolyte depletion

Brand Name:

Lasix
Generic Name: furosemide Classification: Diuretic, loop Dosage: 40 mg Route: IV Frequency: CONTRAINDICATION Never use with ethacrynic acid. Anuria Hypersensitivity to drug Severe renal disease associated with azotemia and oliguria Hepatic coma associated with electrolyte depletion.

ADVERSE REACTION Agranulocytosis Aplastic anemia Thrombophlebitis Cardiac arrest

NURSING INTERVENTION 1. Should be given in the morning on an empty stomach to enhance absorption and avoid interruption of sleep from frequent urination. 2. Drug may cause BP drop. Change position slowly. Avoid alcohol and do not exercise heavily in hot weather. 3. Use sunscreens and protective clothing when sun expose to minimize the effects of drug induced photosensitivity. 4. Record Bp and weights; report any gains of >2 lb per day or >5 lb per week. 5. Supplement diet with vegetables and fruits that are high in potassium (bananas, oranges) if oral supplements are not prescribed.

DRUG

INDICATION Congestive heart failure, including that due to venous congestion, edema, dyspnea, orthopnea, and cardiac arrhythmia. CONTRAINDICATION Ventricular fibrillation or tachycardia ( unless congestive heart failure supervenes after protracted episode not due to digitalis), in presence of digoxin toxicity, hypersensitivity to cardiac glycosides, beriberi heart disease, certain cases of hypersensitive carotid sinus syndrome

Brand Name: Lanoxin Generic Name: digoxin Classification: Cardiac glycoside

Dosage:
0.25/tab; 1tab Route: PO Frequency: OD

SIDE EFFECT Tachycardia 1. Inhibits sodium-potassium Headache activated adenosine Dizziness 2. triphosphatase, thereby Anorexia allowing influx of calcium Blurred or yellow into the intrecellular space vision (cytoplasm), more available calcium 3. ADVERSE REACTION promotes increased force by myocardial contraction Convulsion (positive inotropic effect) Acute hemorrhage resulting to increased Angioneurotic edema cardiac output. It also acts on the CNS to enhance Seizures Multiform PVCs 4. vagal tone, causing the decrease of conduction AV block speed between the SA and 5. AV nodes. This vagal stimulation decreases the cardiac rate (negative chronotropic effect) to 6. prevent arrhythmia. 7.

MECHANISM OF ACTION

8.

NURSING INTERVENTION Obtain patients history of underlying condition before therapy. Assess and document apical pulse( rate, rhythm, character) for 1 full minute before giving drug. If pulse <60 or is significantly different, reassess after 1 hr, if <60, inform physician. Monitor cardiac status; apical pulse, character, rate, rhythm, ECG to determine resolution of atrial dysrhythmias. If tachydysrythmias develops, hold drug and delay cardioversion while drug levels are determined. Monitor electrolytes: potassium, sodium, chloride, magnesium, calcium. Monitor renal function: input-output ratio, urine out put, skin turgor, lung sounds, weight (daily) edema, BUN and creatinine. Do not give at same time as antacids or other drugs that decrease absorption. Advice patient to maintain a sodium restricted diet and to take potassium supplements to prevent toxicity. Teach patient to take medication at the same time each day, take missed dose within 12 hrs and do not double doses. Notify physician if doses are missed for 2 days or more.

DRUG Brand Name: Zykast

INDICATION Relief of symptoms associated with seasonal and perennial allergic rhinitis

MECHANISM OF ACTION Montelukast inhibits bronchoconstriction due to antigen challenge. Montelukast is a selective leukotriene receptor antagonist of the cysteinyl leukotriene Cys LT1receptor. The cysteinyl leukotrienes (LTC4, LTD4,LTE4) are products of arachidonic acid metabolism that are released from various cells, including mast cells andeosinophils. They bind to cysteinyl leukotriene receptors(CysLT) found in the human airway.

SIDE EFFECT 1. Fever Abdominal pains Fatigue Headache Cough

Generic Name: Montelukast sodium + levotirizine dihydrochloride Classification: Repiratory/ Astham & COPD Drugs/ Leukotriene Antagonists, Allergy/ Antihistamines, 3rd generation
Dosage: 10mg/5mg/tab; 1tab Route: PO Frequency: ODHS

2.

CONTRAINDICATION Hypersensitivity to one of its component. Severe renal or hepatic impairment.

ADVERSE REACTION 3. Hepatitis Myalgia Urticaria Convulsion Angioneurotic edema 4. Influenza

NURSING INTERVENTION Teach patient to take this drug regularly as prescribed; do not stop taking this drug during symptom-free periods; do not stop taking this drug without consulting your health care provider. Continue taking any other antiasthma drugs that have been prescribed for you. Notify your health care provider if your asthma becomes worse. Do not take this drug for an acute asthma attack or acute bronchospasm; this drug is not a bronchodilator, and routine emergency procedures should be followed during acute attacks. Avoid the use of aspirin or NSAIDs if you have a known sensitivity to these drugs. Montelukast will not prevent reactions. You may experience these side effects: Dizziness (use caution when driving or performing activities that require alertness); nausea, vomiting (eat frequent small meals, take drug with food); headache (analgesics may be available). Report fever, acute asthma attacks, flulike symptoms, lethargy.

DRUG Brand Name: Maxivent

INDICATION Bronchial asthma & pulmonary disease w/ spastic bronchial component.

MECHANISM OF ACTION

SIDE EFFECT 1. Nausea vomiting epigastric pain

NURSING INTERVENTION Assess lung sounds, pulse and blood pressure before administration

Generic Name: doxofylline

Classification: Antiasthmatic Dosage: 400mg/tab; tab Route: PO Frequency: BID

Adrenergic bronchodilators and phosphodiesterase inhibitors bothwork by increasing intracellular level of cyclic-3,5- adenosine monophosphate(cAMP); adrenergics by increasing production and phosphodiesterase inhibitors by decreasing breakdown. Increased levels of cAMP produce bronchodilation.Corticosteroi CONTRAINDICAT ds act by decreasing airwa ION y inflammation. Anticholin ergics(ipratropium) produce Acute MI brondhodilation by decreasin hypotension g intracellular levels of cyclic guanosine monophosphate (cGMP). Leukotriene receptor antagonists andmast cell stabilizers decrease the release of substances that can contribute to bronchospasm

and during peak of

medication. Not amount, color, and character of sputum produced. 2. Monitor pulmonary function tests before initiating therapy and ADVERSE REACTION periodically during therapy to determine effectiveness of cephalalgia irritability insomnia tachycardia extrasystole tachypnea hyperglycemia albuminuria medication. 3. Observe for paradoxical bronchospasm (wheezing ). If conditions occur,with hold medication and notify physician of other health care professional immediately