Dexamethasone 6mg IV q 6

Omeprazole 40mg/cap OD

Gabapentin 100mg/cap BID

Arcoxia 90mg 1tab OD

1. Dexamethasone

Brand Name:Cortastat, Dalalone, Decadrol, Decaject, Deronil, Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol, Primethasone, SolurexClassification:Long- acting corticosteroidIndications1. Management of cerebral edema2. Diagnostic agent in adrenal disorders3. Relieves inflammation4. Allergic disorders5. Asthma6. ArthritisMechanism of ActionDexamethasone suppresses inflammation and the normal immune response. It prevents the release of substances in the body that causes inflammation.Contraindications1. Hypersensitivity2. Active untreated infection3. Lactation4. Systemic fungal infectionUse Cautiously in:1. Children (chronic use may result in decreased growth)2. Stress (surgery or infections)3. Potential infections as dexamethasone may mask the signs of infection such as fever and inflammation.4. Pregnancy (safety is not established with the sue of the drug during pregnancy)Side Effects1. Acne2. Decreasedwound healing3. Depression4. Vomiting5. Easy bruising6. Headache7. Increased hair growth8. Insomnia9. Restlessness10. Stomach irritation11. Irregular or absent menstruation12. DizzinessAdverse reactionsIf thesesigns and symptomswill be noted instruct the patient to call or notify the physician immediately.1. Skin rash2. Swollen face, legs or ankles (fluid retention)3. Vision problems ( Dexamethasone may cause cataracts and increased intraocular pressure)4. Cold or infection that last for a long time5. Muscle weakness6. Black or tarry stool (suggestive of peptic ulceration caused by Dexamethasone use)Route and DosageCerebral EdemaPO (Adults): 2 mg q 8-12 hoursIM, IV (adults): 10 mg initially IV, 4 mg q 6 hr, may be decreased to 2 mg q 8-12 hr, then change PO.Adrenocortical Insufficiency/Anti-inflammatoryPO (Adults): 0.5-9 mg daily insingleor divided dosesPO (children): 23.3 mcg/kg in 3 divided doses.IV (Adults): 0.5-24 gm/dayIM (Adults): 8-16 mg q 1-3 wkNursing Interventions1. Monitor intake and output of patient.2. Observe the patient for peripheral edema, steady weight gain, rales or crackles or dyspnea. Notify the physician immediately if these clinical manifestations are noted.3. Periodic growth evaluation for children should be done time to time.4. For patients with cerebral edema, assess then for level of consciousness changes and headache during the therapy.5. Guaiac-test stools should be carried out. Guaiac-positive stools should be reported to the physician immediately.6. Administer with meals to minimize GI irritation.7. For patients with difficulty swallowing, tablets can be crushed and administered with fluids or food. However, capsules should be swallowed whole.8. Educate the patient to take missed doses as soon as remembered, unless almost time for the next dose skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.9. Instruct patient to avoid people with known infection and contagious illnesses ascorticosteroidscauses immunosuppression and may mask symptoms of infection.

2. Omeprazole

Generic Name:Omeprazole(o-mepra-zole)Brand Name:Losec,PrilosecClassifications:gastrointestinal agent;proton pump inhibitorPregnancy Category:CAvailability:10 mg, 20 mg, 40 mg capsulesActions An antisecretory compound that is a gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.Therapeutic effects Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing.Uses Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine adenomas, and systemic mastocytosis. In combination with clarithromycin to treat duodenal ulcers associated with Helicobacter pylori.ContraindicationsLong-term use for gastroesophageal reflux disease, duodenal ulcers; lactation.Route & dosageGastroesophageal Reflux, Erosive Esophagitis, Duodenal Ulceradult:PO 20 mg once/d for 48 wkGastric Ulceradult:PO 20 mg b.i.d. for 48 wk

Hypersecretory Diseaseadult:PO 60 mg once/d up to 120 mg t.i.d.Duodenal Ulcer Associated with H. pyloriadult:PO 40 mg once/d for 14 d, then 20 mg/d for 14 d, in combination with clarithromycin 500 mg t.i.d. for 14 dAdministration

Oral Give before food, preferably breakfast; capsules must be swallowed whole (do not open, chew, or crush).Note:Antacids may be administered with omeprazole.Adverse effectsCNS:Headache, dizziness, fatigue.GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests.Urogenital:Hematuria, proteinuria.Skin:Rash.Nursing implications

Assessment & Drug Effects Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use.Patient & Family Education Report any changes in urinary elimination such as pain or discomfort associated with urination, or blood in urine. Report severe diarrhea; drug may need to be discontinued. Do not breast feed while taking this drug

3. GabapentinPregnancy Category CDrug classAntiepilepticTherapeutic actions Mechanism of action not understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block post tetanicpotentiation.Indications Adjunctive therapy in the treatment of partial seizures with and without secondary generalization in adults and children 312 yr with epilepsy Orphan drug use: Treatment of amyotrophic lateral sclerosis Management of postherpetic neuralgia or pain in the area affected by herpes zoster after the disease has been treated Unlabeled uses: Tremors of MS,neuropathicpain, bipolar disorder, migraine prophylaxisContraindications and cautions Contraindicated with hypersensitivity togabapentin. Use cautiously with pregnancy, lactation.Available formsCapsules100, 300, 400mg; tablets100, 300, 400, 600, 800mg; oral solution250mg/5mLExcretion: Urine, unchangedAdverse effects CNS: Dizziness, insomnia, nervousness, fatigue,somnolence, ataxia, diplopia, tremor Dermatologic: Pruritus, abrasion GI: Dyspepsia, vomiting, nausea, constipation, dry mouth Respiratory: Rhinitis,pharyngitis Other: Weight gain, facial edema, cancer, impotenceInteractionsDrug-drug Decreased serum levels with antacidsDrug-lab test False positives may occur withAmes N-Multistix SG dipstick test for protein in the urineNursing considerationsAssessment History: Hypersensitivity togabapentin; lactation, pregnancy Physical: Weight; T; skin color, lesions; orientation, affect, reflexes; P; R, adventitious sounds; bowel sounds, normal outputInterventions Give drug with food to prevent GI upset. Arrange for consultation with support groups for people with epilepsy. WARNING: If overdose occurs, hemodialysis may be an option.Teaching points Take this drug exactly as prescribed; do not discontinue abruptly or change dosage, except on the advice of your health care provider. Wear a medical alert ID at all times so that any emergency medical personnel will know that you have epilepsy and are taking antiepileptic medication. You may experience these side effects: Dizziness, blurred vision (avoid driving or performing other tasks requiring alertness or visual acuity); GI upset (take drug with food or milk, eat frequent small meals); headache, nervousness, insomnia; fatigue (periodic rest periods may help). Report severe headache, sleepwalking, rash, severe vomiting, chills, fever, difficulty breathing.4. Arcoxia

Indications:This medication is a non-steroidal anti-inflammatory drug (NSAID), prescribed for osteoarthritis, rheumatoid arthritis and gouty arthritis.It blocks a substance in the body named as cyclo-oxygenase-2 (COX-2).

Contraindications:Contraindicated in patients with peptic ulcer, severe heart disease, stroke, and hypersensitivity.Pregnancy Category :ABCDX

Category X :Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Dosage & When it is to be taken :PO- Adult- The recommended dosage is 60 to 120mg once daily.

How it should be taken :It comes as a tablet to take by mouth, with or without food.

Warnings and Precautions :Caution should be exercised in patients with history of heart, liver, kidney disease, high blood pressure, blood clotting disorder, any allergy, children, elderly, during pregnancy and breast feeding.Drink adequate fluid to avoid dehydration.Stop the medication immediately if gastrointestinal lesions occur.Monitor blood pressure regularly while taking this medication.

Side Effects :

Central Nervous System- Headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo and ringing in the ear.

Heart- Chest pain, high blood pressure and fluid retention.

Metabolic- Taste disturbances, mouth ulcer, loss of appetite and weight loss.

Miscellaneous- Kidney damage, fever, GI disorders, muscle pain and influenza-like syndrome.

Storage Conditions :Store it in refrigerator.