Drug Study

NAME OF DRUG

Classification/Dosage/

FrequencyMECHANISM OF

ACTIONINDICATIONS/

CONTRAINDICATIONSSIDE

EFFECTSNURSING RESPONSIBILITIES

.Metoclopramide

Antiemetic

Dopaminergic Blocker

GI stimulant

1 amp

IV

Stimulates motility of upper GI tract without stimulating gastric, biliary, or pancreatic secretions, appears to sensitize tissues to action of acetylcholine.

Relaxes pyloric sphincter which when combined with effects on motility, accelerates gastric emptying and intestinal transit.

Indi:

Relief symptoms of acute and recurrent diabetic gastro paresis.

Short term therapy (4-12 weeks) for adults with symptomatic gastro-esophageal reflux who fail to respond to conventional therapy

Contra:

Contraindicated with allergy to metaclopramide,

GI hemorrhage, mechanical obstruction or perforation.

Restlessness

Drowsiness

Fatigue

Insomia

Transient hypertension

Nausea

Diarrhea

Asses if the patient has history of allergies to metoclopramide.

Monitor BP carefully during IV administration.

Monitor extrapyramidal reactions, and consult physician if they occur.

Monitor patients with diabetes, arrange for alteration in insulin dose or timing if diabetic control is comprised by alterations in timing of food absorbtion.

Azithromycin Marcolide antibiotic

500 mg tab

OD

Bacteriostatic or bactericidal in susceptible bacteria.

Indi:

Treatment of lower respiratory infections (Haemophilus influenzae, Moraxella catarrbalis, streptococcus pneumoniea, CAP,

Contra:

Contraindicated with hypersensetivity to azithromycin, erythromycin, or any macrolide antibiotic.

Use continously with gonorrhea or syphilis, hepatic or renal impairment.

CNS:

Dizziness

Headache

Vertigo

Fatigue

GI

Diarrhea

Abdominal pain

Nausea

Vomiting

Melena

Pseudomembranous colitis

Monitor for and report loose stools or diarrhea, since pseudo membranous colitis (see Appendix F) must be ruled out.

Monitor PT and INR closely with concurrent warfarin use.

Patient & Family Education Direct sunlight (UV)

exposure should be minimized during therapy with drug.

Take aluminum or magnesium antacids 2 h before or after drug.

Report onset of loose stools or diarrhea.

Do not breast feed while taking this drug without consulting physician.

Clopidogrel Antiplatelet

75 mg

OD

Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

Indi:

Treatment of patients at risk for ischemic events- recent MI, recent ischemic CVA, peripheral artery disease.

Treatment of the patient with Acute Coronary Syndrome

Contra:

Contraindicated with allergy to clapidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage.

CNS

Headache

Dizziness

Weakness

Flushing

CV

Hypertension

Edema

GI

Nausea

GI distress

Constipation

Diarrhea

GI bleeding

Assessment

 History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer

   Physical: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds

Interventions

Provide small, frequent meals if GI upset occurs (not as common as with aspirin).

Provide comfort measures and arrange for analgesics if headache occurs.

Enoxaparin Antithrombotic

4cc

Q8

Low molecular

weight heparin that

inhibits thrombus

and clot formation

by blocking factor

Xa, factor IIa,

preventing the

formation of clots.

Indi:

Prevention of DVT,

which may lead to to

pulmonary embolism

following hip

replacement, knee

replacement surgery,

abdominal surgery.

Prevention of

ischemic complications

of unstable angina and

non Q wave MI.

Treatment od acute

ST segment elevation MI,

managed medically or

with subsequent

percutaneous coronary

intervention.

Contra:

Hypersensitivy to

enoxaparin, heparin,

pork products, severe

thrombocytopenia,

uncontrolled bleeding.

Hematologic

Hemorrhage

Thrombocytopenia

Hyperkalemia

Others

Fever

Pain

Local irritation

Epidural or spinal hematoma.

Assessment

·        History: Recent surgery or injury; sensitivity to heparin, pork products, enoxaparin; lactation; history of GI bleed; pregnancy

·        Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, kidney function tests

Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.

Monitor platelet count closely. Withhold drug and notify physician if platelet count less than 100,000/mm3.

Monitor closely patients with renal insufficiency and older adults who are at higher risk for thrombocytopenia.

Monitor for and report immediately any sign or symptom of unexplained bleeding

Ipratropium Anticholinergic

Bronchodilator

1 neb

Q4

Anticholinergic,

chemically related

to atropine, which

blocks vagally

mediated reflexes

by antagonizing the

action of

acetylcholine.

Causes

bronchodilation and

inhibits the

secretion from

serous and

seromucous glands

lining the nsal

mucosa.

Indi:

Bronchodilator for

maintenance treatment

of bronchospasm

associated with COPD,

chronic bronchitis, and

emphysema.

Contra:

Hypersensitivity to

atropine or its derivatives,

soybean, or peanut.

Use continuously

with narrow angle of

glaucoma, prostatic

hypertrophy, and bladder

neck obstruction.

CNS

Dizziness Nervousnes

s Headache Fatigue Insomnia Blurred

visionGI

Nausea GI distress

Respiratory Dyspnea Bronchitis Bronchospa

sm Cough HoarsenessOthers Back pain Chest pain Dry mouth palpitation

Ensure adequate

hydration; control

environment (temperature)

to prevent hyperpyrexia

Have patient void before

taking medication to avoid

urinary retention.

Lactulose Laxative

30cc

OD/ HS

The drug

unchanged into the

colon where

bacteria break it

down to organic

acids that increase

the osmotic

pressure in the

colon and slightly

acidify the colonic

contents, resulting

in an increase stool

water content, stool

softening, laxative

action.

Contra:

Treatment of

constipation

Prevention and

treatment of portal

systemic encephalopathy.

Contra:

Allergy to lactulose,

low galactose diet

Use continuously

with diabetes.

GI

Transient

flatulence

Distension

Intestinal

cramps

Diarrhea

Nausea

Others

Acid base

imbalance

Electrolyte

imbalance

Give laxative syrup orally

with fruit juice, water or

milk to increase

palatability.

Administer retention

enema using a rectal

balloon catheter. Do not

use cleansing enemas

containing soap suds or

other alkaline agents that

counteract the effects of

lactulose.

Do not administer other

laxatives while using

lactulose.

Monitor serum ammonia

levels.

Monitor with long-term

therapy for potential

electrolyte and acid---base

imbalances.

Furosemide Anti diuretics

20mg

OD

Inhibits

reabsorption of

sodium chloride

from the proximal

ang distal tubules

and ascending limb

of the loop of

Henle, leading to a

sodium-rich

dieresis.

Indi:

Oral, IV: Edema

associated with heart

failure, cirrhosis, renal

disease.

IV: acute Pulmonary

Edema

Oral: Hypertension

Contra:

Contraindicated with

allergy to furosemide,

sulfonamides, allergy to

tartrazine, anuria, and

severe renal failure

Dizziness

Weakness

Headache

Drowsiness

Nausea

Blurred vision

Fatigue

Gatric

irritation

Constipation

Diarrhea

Administer with food or milk

to prevent GI upset.

Reduce dosage if given with

other anti-hypertensive’s

readjust dosage gradually as

BP respond.

Give early in the day so that

increased urination will not

disturb sleep.

Avoid IV use if oral use is

at all possible.

Omeprazole Proton Pump

Inhibitor

40mg cap

OD

Gastric acid

pump inhibitor,

suppresses gastric

acid secretion by

specific inhibition of

the hydrogen

potassium ATPase

enzymes system at

the secretory surface

of the gastric parietal

cells, blocks the final

step acid production.

Indi:

Short term

treatment of active

benign gastric ulcer

Short term

treatment of active

duodenal ulcer.

Treatment of

symptoms of GERD and

heartburn.

Contra:

Allergy to

omeprazole or its

components.

CNS

Headache

Dizziness

Vertigo

Insomnia

Anxiety

Paresthesia

GI

Diarrhea

Abdominal

pain

Nausea

Vomiting

constipation

Administer before

meals. Caution patient to

swallow capsules whole—not to

open, chew, or crush them. If

using oral suspension, empty

packet into a small cup

containing 2 tbsp of water. Stir

and have patient drink

immediately; fill cup with water

and have patient drink this

water. Do not use any other

diluent.

WARNING: Arrange

for further evaluation of patient

after 8 wk of therapy

for gastroreflux disorders; not

intended for maintenance

therapy. Symptomatic

improvement does not rule out

gastric cancer, which did occur

in preclinical studies.

Administer antacids

with omeprazole, if needed.

Rosuvastatin Antihyperlipide

mic drug

40mg tab

OD/HS

A fungal

metabolite that

inhibits the

enzymes (HMG-

CoA) that

catalyzes the first

step in the

cholesterol

synthesis pathway,

resulting in a

decreased in

serum cholesterol,

serum LDLs

(associated with

increased risk of

coronary artery

disease) and either

an increase or no

change in serum

HDLs (associated

with decreased

risk of coronary

artery disease)

Indi:

As an adjunct to diet

in the treatment of

elevated total cholesterol

and LDL cholesterol land

triglyceride levels in

patient with primary

hypercholesterolemia.

Adjunct to diet to

slow atherosclerosis

progression in patients

with elevated cholesterol.

Contra:

CNS

Headache

Dizziness

Insomnia

paresthesia

anxiety

CV

hypertension

angina

palpitation

peripheral edema

GI

nausea

diarrhea

constipation

vomiting

flatulence

Promote fluid intake

(>=1500–2000 mL/d) during

drug therapy for constipation;

older adults often self-limit

liquids. Lactulose-induced

osmotic changes in the bowel

support intestinal water loss

and potential hypernatremia.

Establish baseline

serum lipid level and liver

function test results before

beginning the therapy

Consults with

dietitian about low cholesterol

diet.

Administer drug at

bedtime(highest rates of

cholesterol synthesis occur

between midnight and 5 am)

Provide comfort

measures to deal with

headache, muscle cramps, or

nausea.

Hydrocortisone Corticosteroid

50mg

IV

Q8

Enters target cells and binds to cystoplasmic receptors; initiates many complex reactions that are responsible for its inflammatory, immunosuppressive (glucocorticoid), and salt retaining (mineralocorticoid) actions. Some actions maybe undesirable, depending on drug use.

Indi:

Replacement therapy in adrenal cortical insufficiency.

Contra:

Allergy to any component of drug

Fungal infection

Hepa B

Vaccinia

Antibiotic resistants infection

Immunosupression.

CNS Vertigo Headache Paresthesis InsomniaCV Hypotension Shock Hypertension Heart failure

secondary to fluid retention

Thromboembolism

GI Peptic ulcer Pancreatitis Abdominal

distension Nausea/

vomitingEENT

Cataract

Glaucoma

Increased IOP

Assessment

History of infection, kidney

disease, liver disease,

hypothyroidism, ulcerative colitis

with impending perforation;

recent GI surgery, hypertension,

heart failure.

Give daily before 9am to

mimic normal pick diurnal

corticosteroid levels and

minimize HPA suppression.

Provide antacids between

meals to help avoid peptic ulcer.

Acetylcysteine Antidote

Mucolytic

600mg tab

HS

Splits links in

the mucoproteins

contained in the

respiratory mucus

secretions,

decreasing the

viscosity of the

mucus.

Antidote to

acetaminophen

hepatotoxicity:

protects liver cells

by maintaining cell

function and

detoxifying

acetaminophen

metabolites.

Indi:

Mucolytic adjuvant

theraphy for abnormal,

viscid, or inspissated

mucus secretions in acute

and chronic

bronchopulmonary

disease (emphysema,

asthmatic bronchitis, TB,

pneumonia)

Contra:

Hypersensitivity to

acetylcysteine; use

caution and discontinue

immediately if

bronchospasm occurs.

Nausea

Stomatitis

Bronchospas

m

Rash

Vomiting

Inform the patient that

nebularization may produce an

initial disagreeable odor, but

the odor will soon disappear.

Monitor nebulizer for

buildup of drug from

evaporation; dilute with sterile

water for injection to prevent

concentrate from impeding

nebulization and drug delivery.