Drug Study

DRUG STUDY

DRUG’S NAME: Bisacodyl (Bisacodyl) Dose / Frequency : I tab po @hs x 2 doses

Classification Mechanism of Action

Indication Contra-Indications

SideEffects/ Toxic Effect

Laxatives Stimulant laxative that increases peristalsis, probably by direct effect on smooth muscle of the intestine, by irritating the muscle or stimulating the colonic intramural plexus. Drug also promotes fluid accumulation in colon and small intestine.

preparation for surgery

Contraindicated in patients hypersensitive to drug or its components and in those with rectal bleeding, gastroenteritis, intestinal obstruction, abdominal pain, nausea, vomiting, orother symptoms of appendicitis or acute surgical abdomen.

Dizziness, abdominal cramps, vomiting, diarrhea, alkalosis,tetany

NURSING CONSIDERATIONS:1. Give drug at times that don’t interfere with scheduled activities or sleep. Soft, formed stools are usually produced 15 to 60

minutes after rectal use.2. Before giving for constipation, determine whether patient has adequate fluid intake, exercise and diet.3. Advise patient to swallow enteric-coated tablet whole to avoid GI irritation. Instruct him not to take within1 hour of milk or

antacid.4. Advise patient to report adverse effects to prescriber.5. Tables and suppositories are used together to clean the colon before and after surgery and before barium enema.

DRUG’S NAME:Metronidazole (Metronidazole) Dose / Frequency : 1 cap 500mg BID




Antibiotic, Amebicide, Antiprotozoal

Undergoes intracellular chemical reduction during anaerobic metabolism. After metronidazole is reduced, it damages DNA’s helical structure and breaks its strands, which inhibits bacterial nucleic acid synthesis and causes cell death

Trichomoniasis, Refractory trichomoniasis, Pelvic inflammatory disease, Bacterial Vaginosis

Breast-feeding, hypersensitivity to metronidazole or its components

CNS: headache, seizures, fever, vertigo, dizziness, confusion, irritability, depression, weakness, insomniaCV: edema, flushingEENT: rhinitis, sinusitisGI: nausea, vomiting, abdominal cramping or pain, constipation, diarrhea, dry mouthGU: darkened urine, vaginitis, polyuria, dysuria, cystitis, dryness of vagina and vulva, genital puritusMusculoskeletal: transient joint painRespiratory: upper respiratory tract infectionSkin: rash

NURSING CONSIDERATIONS: 1. If pt has adverse CNS reactions, such as seizures or peripheral neuropathy, tell prescriber and stop drug immediately.2. Monitor pt with severe liver disease because slowed metronidazole metabolism may cause drug to accumulate in the body

and increase the risk of adverse effects.3. If skin irritation occurs, apply topical gel less frequently or discontinue it, as ordered.4. Monitor CBC and culture and sensitivity test if therapy lasts longer than10 days or if second course of treatment is needed.5. Caution patient to avoid alcohol while being treated with vaginal preparation.

DRUG’S NAME: Conjugated estrogen (Premarin) Dose / Frequency : 0.625 mg 4 tabs TID




Estrogen Increases synthesis of DNA, RNA, and protein in responsive tissues, also reduces release of follicle-stimulating and luteinizing hormones from the pituitary gland

Vulvar or vaginal atrophy, Abnormal uterine bleeding (hormonal imbalance).

Contraindicated in pregnant patients and in patients with thrombophlebitis, thromboembolic disorders, estrogen-dependent neoplasia, breast or reproductive cancer (except for palliative treatment), or undiagnosed abnormal genital bleeding.

CNS: dizziness, headache, stroke and seizure CV: edema, pulmonary embolism, MIGI: dyspepsia, GI pain, nausea, constipation or diarrhea, flatulence, peptic ulceration and vomitingGU: renal failureHematologic: decreased platelet adhesion, prolonged bleeding timeSkin: diaphoresis, prurotus, rashGI: nausea, vomiting, abdominal cramping, bloating, increased appetiteEENT: worsening myopia or astigmatismGU: breakthrough bleeding, amenorrhea, altered cervical secretionHepatic: cholestatis jaundiceSkin: melasma, chloasma, hairloss, dermatitisMetabolic: weight changes, hypercalcemiaOther: breast tenderness changes in libido

NURSING CONSIDERATIONS: 1. Periodically monitor lipid levels, blood pressure, body weight, and hepatic function.2. Glucose tolerance may be impaired. Monitor glucose level closely in patients with diabetes.3. If pt has adverse CNS reactions tell prescriber and stop drug immediately.4. Tell diabetic patient to report elevated glucose level so that antidiabetic dosage can be adjusted.5. Encourage patient to stop smoking because of the risk of CV complications

DRUG’S NAME: Zinnat (Cefuroxime Sodium) Dose / Frequency : 500 mg I tab BID (D4)

Classification

Mechanism of Action



Cephalosporins

Second-generation cephalosporins that inhibitscell-wall synthesis, promoting osmotic instability; usually bactericidal.

Treatment of infections caused by sensitive bacteria

Sensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

CV: phlebitis, thrombophlebitisGI: diarrhea, nausea, anorexia, vomitingHematologic: hemolytic anemiaSkin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevationOther: hypersensitivity reaction, serum reaction

NURSING CONSIDERATIONS:1. Monitor patient for signs symptoms of superinfection.2. Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs,

before therapy is initiated.3. Report onset of loose stools or diarrhea. Although pseudomembranous colitis.4. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant

changes.5. Tell patient to take drug as prescribed, even after he or she feels better.

DRUG’S NAME: Adalat GITS (Nifedipine) Dose / Frequency : 30 mg 1 tab OD




Calcium channel blocker

Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole.

Hypertension Contraindicated in patients with bronchial asthma, sinus bradycardia and greater than first-degree heart block, cardiogenic shock, and overt heart failure.

CNS: dizziness, light headedness, headache, weakness, syncope, nervousnessCV: flushing peripheral, edema, heart failure, MI, hypotension, palpitationsEENT: nasal congestionGI: nausea, diarrhea, constipation, abdominal discomfortMusculoskeletal: muscle crampsRespiratory: dyspnea, pulmonary edema, coughSkin: rash, pruritus

NURSING CONSIDERATIONS:1. Monitor Blood pressure and heart rate regularly, especially in patients who take beta-blockers or antihypertensives.2. Watch for symptoms of heart failure.3. Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties.4. Encourage patient to stop smoking while taking the nifedipine.5. Observe 10 rights in giving the drugs.

DRUG’S NAME: BP norm (Fosinopril Sodium) Dose / Frequency : 10 mg ½ tab OD

Classification

Mechanism of Action



ACE inhibitor, Antihpertensives

May inhibit ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure.

Hypertension and Heart failure

Contraindicated in patients hypersensitive to drug or other ACE inhibors and in breast-feeding women.

CNS: dizziness, stroke, headache fatigue, paresthesia, sleep disturbanceCV: MI, chest pain, angina pectoris, rhythm disturbance, palpitations, hypotension, orthostatic hypotensionEENT: tinnitus, sinusitisGI: pancreatitis, nausea, vomiting, diarrhea, dry mouth, abdominal distention and pain, constipationGU: sexual dysfunction, renal insufficiency, hepatitisMetabolic: HypercalemiaMusculoskeletal: musculoskeletal painRespiratory: dry, persistent, tickling, non-productive cough, bronchospasmSkin: Urticaria, rash, photosensitivity reactions, pruritusOther: angioedema, decrease libido, gout

NURSING CONSIDERATIONS:1. Monitor Blood Pressure for drug effects.2. Monitor Potassium intake and potassium level. Diabetic patients, those with impaired renal function, and those receiving

drugs that can increase potassium level may develop hyperkalemia.3. Assess renal and hepatic function before and periodically throughout therapy.4. Tell patient to avoid salt substitutes; these products may contain potation, which can cause high potassium level in patients

taking drug.5. Instruct patient to call prescriber if he develops easy bruising or bleeding; swelling of tongue, lips, face, eyes, mucous

membranes, arms, or legs; difficulty swallowing or breathing; and hoarseness.

DRUG’S NAME: Lipitor (Atorvastatin calcium) Dose / Frequency : 80 mg ½ tab OD pc dinner




HMG-CoA reductase inhibitor, Antilipemics

Inhibits HMG-CoA reductase, and early(rate-limiting) step in cholesterol biosynthesis.

•In patients with clinically evident coronary heart disease, to reduce the risk of nonfatal MI, fatal and nonfatal strokes, angina, heart failure, and revascularization procedures.•To reduce the risk of MI, stroke, angina, or revascularization procedures in patient with multiple risk factors for CAD but who don’t yet have the disease.

Contraindicated in patients hypersensitive to drug and in those with active liver disease or unexplained persistent elevations of transaminase levels. Contraindicated in pregnant and breastfeeding women and in women of child-bearing age.

CNS: headache, asthenia, insomniaCV: peripheral edemaEENT: Pharyngitis, Rhinitis, SinusitisGI: Abdominal Pain, Constipation, Diarrhea, dyspepsia, flatulence, nauseaGU: UTI

NURSING CONSIDERATIONS:1. Patient should follow a standard cholesterol-lowering diet before and during therapy. 2. Before treatment, assess patient for underlying causes for hypercholesterolemia and obtain a baseline lipid profile. Obtain

periodic liver function test result and lipid levels before starting treatment and at 6 and 12 weeks after initiation, of after an increase in dosage and periodically thereafter.

3. Drug may be given as a single dose at any time of day, with or without food.4. Advise patient to inform prescriber of adverse reactions, such as muscle pain, malaise, and fever.5. Warn patient to avoid alcohol.

DRUG’S NAME: Iterax (Hydroxyzine diHCL) Dose / Frequency : 25 mg I tab P.O




Piperazine derivative

A piperazine antihistamine whose action may result from suppression of activity in certain essential regions of the subcortical area of the CNS.

Anxiety, Preoperative and Postoperative adjunctive therapy for sedation, pruritus, Psychiatric and emotional emergencies, including acute alcoholism, nausea and vomiting (excluding nausea and vomiting of pregnancy), Antepartum and post partum adjunctive therapy.

Contraindicated in patients hypersensitive to drug, Early pregnancy; hypersensitivity to hydroxyzine or cetirizine and breast feeding women.

CNS: drowsiness, involuntary motor activityGI: dry mouth, constipationSKIN: Pain at I.M. injection siteOTHER: Hypersensitivity reactions

NURSING CONSIDERATIONS:1. If patient takes other CNS drugs, watch for oversedation.2. Elderly patient maybe more sensitive to adverse anticholinergic effects; monitor these patients for dizziness, excessive

sedation, confusion, hypotension, and syncope.3. Warn patient to avoid hazardous activities that require alertness and good coordination until effects of drug are known.4. Tell patient to avoid alcohol while taking drug.5. Warn woman of childbearing age to avoid use during pregnancy and breastfeeding.

DRUG’S NAME: Dormicum (midazolam hydrochloride)




Benzodiazepine

May potentiate the effects of GABA, depress the CNS, and suppress the spread of seizure activity.

Sedation in Premed before surgical or diagnostic procedures, induction and maintenance of anesthesia.

Contraindicated in patients hypersensitive to drug and in those with acute angle-closure glaucoma, shock, coma, or acute alcohol intoxication.

Nausea, vomiting,headache, hiccoughs, laryngospasm, dyspnea hallucination, drowsiness, amnesic episode.

NURSING CONSIDERATIONS:1. Have oxygen and resuscitation equipment available in case of severe respiratory depression.2. Monitor blood pressure, heart rate and rhythm, respirations, airway integrity, and arterial oxygen saturation during

procedure.3. Use cautiously in patients with uncompensated acute illness and in elderly or debilitated patients.4. Because drug diminishes patient’s recall of events around the time of surgery, provide written information, family member

instructions, and follow-up contact.5. Warn patient to avoid hazardous activities that require alertness of good coordination until effects of drug are known.

DRUG’S NAME: Ketamine (Ketamine HCl)Dose / Frequency : 1 ml




Dissociative anesthetic, hallucinogen, psychotomimetic

Ketamine has been shown to block afferent impulses associated with the affective-emotional component of pain perception within the medical medullary reticular formation, to suppress spinal cord activity, and to interact with several central nervous system (CNS) transmitter systems. Ketamine blocks the NMDA glutamate receptor by a dual mechanism, blocking both the closed channel from the aqueous phase and the closed channel from the membrane phase.

Anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation.

Patients in whom significant BP elevation would be a serious hazard; hypersensitivity to the drug.

Blurred vision, confusion, drowsiness, increased or decreased blood pressure or heart rateMental status changes, nausea, vomiting

NURSING CONSIDERATIONS:1. Monitor circulatory and respiratory status2. Assess the blood pressure of the patient before the administration.3. Theophylline should not be coadministered with ketamine, it may interact and can cause unpredictable seizure.4. Because of rapid induction following the initial IV injection, the patient should be in a supported position during

administration.5. Rapid administration may result in respiratory depression and enhanced pressor response.

DRUG’S NAME: Cefuroxime Sodium (Zegen) Dose / Frequency : 1 ml




Second-generation cephalosporin

Ketamine has been shown to block afferent impulses associated with the affective-emotional component of pain perception within the medical medullary reticular formation, to suppress spinal cord activity, and to interact with several central nervous system (CNS) transmitter systems. Ketamine blocks the NMDA glutamate receptor by a dual mechanism, blocking both the closed channel from the aqueous phase and the closed channel from the membrane phase.

Anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation.

Patients in whom significant BP elevation would be a serious hazard; hypersensitivity to the drug.

Blurred vision, confusion, drowsiness, increased or decreased blood pressure or heart rateMental status changes, nausea, vomiting

NURSING CONSIDERATIONS:1. Monitor circulatory and respiratory status2. Assess the blood pressure of the patient before the administration.3. Theophylline should not be coadministered with ketamine, it may interact and can cause unpredictable seizure.4. Because of rapid induction following the initial IV injection, the patient should be in a supported position during

administration.5. Rapid administration may result in respiratory depression and enhanced pressor response.

Drug Study

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