PARACETAMOL I: Ma’am Valencia Generic Name
Dosage 500 mg
Paracetamol
Classification: • Analgecsic (Opioid)
Form: IV
Mechanism of Action
Indications
Adverse Reaction
Pharmacology: Paracetamol produ ces analgesia by raising the threshold of the pain center in the brain and by obstructing impulses at the pain-mediating chemoreceptors. The drug produces antipyresis by an action on the hypothalamus; heat dissipation is increased as a result of vasodilation and increased peripheral blood flow.
• Pyrexia of unknown origin. Fever & pain associated w/ common childhood disorders, tonsillitis, upper resp tract infections postimmunization reactions, after tonsillectomy & other conditions. Prevention of febrile convulsion.Headach e, cold, sinusitis, muscl e pain, arthritis & toot hache.
• A paracetamol overdose is particularly dangerous because the liver damage may not be obvious for four to six days after the drug has been taken. Even if someone who has taken a paracetamol overdose seems fine and doesn't have any symptoms, it's essential that they are taken to hospital urgently. An overdose of paracetamol can be fatal.
Pharmacokinetics: Paracetamol is rapidly and almost completely absorbed from the gastrointestinal tract. Following oral administration, peak plasma levels are attained in 10 min to 1 hr and the half-life is 75 min to 3 hrs. Distribution of paracetamol to most body tissues and fluids is both rapid and uniform. Paracetamol is excreted in the urine primarily as the glucuronide and smaller amounts as the sulfate, mercapturate and unchanged drug. Approximately 85% of a dose of paracetamol is excreted in the urine within 24 hrs after administration.
• When taken at the recommended dose, side-effects of paracetamol are rare. Skin rashes, blood disorders and a swollen pancreas have occasionally happened in people taking the drug on a regular basis for a long time.
Nursing Considerations • Use liquid form for children and patients who have difficulty swallowing. • In children, don’t exceed five doses in 24 hours. • Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days. • Advise patient or caregiver that many over the counter products contain acetaminophen; be aware of this when calculating total dailydose. • Warn patient that high doses or unsupervised long term use can cause liver damage.
METOCLOPRAMIDE
Generic Name
Dosage 10mg
Metoclopramide
Classification: • GIT Regulators, Antiflatulents, Antiinfammatories
Form: IV TAB
Mechanism of Action
Indications
Pharmacology: Metoclopramide, a dopamine antagonist, stimulates motility of the upper gastrointestinal tract without stimulating gastric, biliary or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. The effect of metoclopramide on motility is not dependent on intact vagal innervation but it can be abolished by anticholinergic drugs. Metoclopramide increases the tone and amplitude of gastric (especially antral) contractions, relaxes the pyloric sphincter and the duodenum and jejunum, resulting in accelerated gastric emptying and intestinal transit. It increases the resting tone of the lower esophageal sphincter. Pharmacokinetics: Peak plasma levels are reached 30-60 min following an oral dose. Excretion is primarily in the urine. The plasma half-life is about 3 hrs. Metoclopramide undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal.
• Disturbances of GI motility including GERD & diabetic gastroparesis. Naus ea &vomiting of central & peripheral origin associated w/ surgery, metabolic diseases, infectious diseases, migraine h eadache or drugs including cancer chemotherapy. Facilitate small bowel intubation & radiological procedures of GIT.
Adverse Reaction • Restlessness, drowsiness, fatigue & lassitude. Extrapyramidal symptoms, insomnia, headache, dizziness, nausea, galactorrhea, gynecomastia, rash including urticaria, bowel disturbances. Increased prolactin levels; gastroparesis.
Nursing Considerations • Give 30 mins before meals and at bed time • Assess mental status during treatment • Tell patient to avoid driving & other hazardous activities for at least 2 hrs • Advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug
BDIAZEPAM
Generic Name Diazepam
Classification: Benzodiazepine Therapeutic Class Antiepileptic, Anxiolytic, Skeletal muscle relaxant
Dosage
Mechanism of Action
Indications
Adverse Reaction
Nursing Considerations
Adult: 250-500mg every 8 hours Children: 2040mg/kg/day divided dosage given every 8 hrs
Pharmacology:It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilization.
Short-term management of anxiety Insomnia associated with anxiety Sleepwalking Night terrors Premedication before anaesthesia Adjunct in the management of seizures Muscle spasms Acute symptoms of alcohol withdrawal
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, disorientation, restlessness, confusion, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, mild paradoxical excitatory reactions, extrapyramidal symptoms, visual and auditory disturbances CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, edema Dependence: Drug dependence with withdrawal syndrome Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, elevation in blood enzymes, hepatic impairment GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis, thrombosis, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia, pain, burning, redness after IM injection
Inform pt. that drug may be taken with food
Pharmacokinetics: A: Readily and completely absorbed from the GI tract, peak plasma concentrations after 30-90 min (oral). Rapidly absorbed, peak plasma concentrations after 10-30 min (rectal). D: Readily crosses the blood-brain barrier; redistributed into fat depots and tissues. Proteinbinding: 98-99%. M: Extensively hepatic; converted to desmethyldiazepam, oxazepam and temazepam. E: Urine (as free or conjugated metabolites) Drug Half Life 20-80 hr
Advice pt. not to abruptly discontinue drug after long term use Advice pt. to avoid driving and activities that require alertness because drug can cause drowsiness Inform pt. that smoking may decrease effect
METOPROLOL Generic Name
Dosage
Metoprolol
50mg
Classification: Beta1-selective adrenergic blocker Antihypertensive
Form: TAB
Mechanism of Action
Indications
Pharmacology: Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.
Hypertension, alone or with other drugs, especially diuretics Immediaterelease tablets and injection: Prevention of reinfarction in MI patients who are hemodynamically stable or within 3– 10 days of the acute MI Treatment of angina pectoris
Adverse Reaction Allergic: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV: CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision
Nursing Considerations Do not stop taking this drug unless instructed to do so by a health care provider. Swallow the ER tablets whole; do not cut, crush, or chew them.
PHENOBARBITAL Generic Name Phenobarbital
Classification: Barbiturate (long acting) Sedative Hypnotic Antiepileptic
Dosage 60mg Form: TAB
Mechanism of Action Pharmacology: General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at subhypnotic doses, has antiseizure activity, making it suitable for long-term use as an antiepileptic.
Indications Treatment of generalized tonicclonic and cortical focal seizures Emergency control of acute seizures (tetanus, eclampsia, epilepticus)
Adverse Reaction Bradycardia, hypotension, syncope; drowsiness, lethargy, CNS excitation or depression, impaired judgment, confusion, nervousness, headache, insomnia, nightmares, hallucinations, anxiety, dizziness; rash, thrombocytopenia, megaloblastic anaemia; respiratory depression, apnoea (especially with rapid IV admin)
Nursing Considerations Administer IV doses slowly. Administer IM doses deep in a large muscle mass (gluteus maximus, vastus lateralis) or other areas where there is little risk of encountering a nerve trunk or major artery. • Monitor injection sites carefully for irritation, extravasation (IV use). Solutions are alkaline and very irritating to the tissues. • Monitor P, BP, respiration carefully during IV administration.
METRONIDAZOLE Generic Name Metronidazole
Classification: Antibiotic Amebicide Antiprotozoal
Dosage IV: 500mg/100ml solution PO: 250mg, 500mg tablets, 750mg extended release tablet
Mechanism of Action
Indications
Pharmacology: 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.
To treat systemic anaerobic infections caused by Bacteroides fragilis, Clostidium difficile, Clostridium perfingens, Eubacterium, Fusobacterium, Peptococcus, Peptostreptococc us, and Veillonella sp. To treat amebiasis (Entamoeba histolytica)
Adverse Reaction
Nursing Considerations
CNS: Ataxia, dizziness, encephalopathy, fever, headache, light-headedness, peripheral neuropathy, seizures (high doses) EENT: Dry mouth, lacrimation (topical form), metallic taste, pharyngitis GI: Abdominal cramps or pain, anorexia, diarrhea, nausea, pancreatitis, vomiting GU: Darkened urine, vaginal candidiasis (oral, parenteral, and topical forms); burning or irritation of sexual partener’s penis, candidal cervicitis or vaginitis, dysuria, urinary frequency, vulvitis (vaginal form) HEME: Leukopenia MS: Back pain SKIN: burning sensation, stinging sensation, dry skin (topical form); erythema, pruritus, rash, urticaria (oral and parenteral forms) OTHER: injection site edema, pain, or, tenderness.
If pt has adverse CNS reactions, such as seizures or peripheral neuropathy, tell prescriber and stop drug immediately. 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. If skin irritation occurs, apply topical gel less frequently or discontinue it, as ordered. Monitor CBC and culture and sensitivity test if therapy lasts longer than 10 days or if second course of treatment is needed Give IV drug by slow infusion over 1 hr; don’t give by direct IN injection
CEFUROXIME Generic Name Cefuroxime Classification: Anti-infectives
Dosage Tablets: 125mg, 250mg, 500mg Powder for injection: 750mg, 1.5g, 7.5g Premixed containers: 750 mg/50ml, 1.5g/50ml
Mechanism of Action Pharmacology: Bind to bacterial cell wall membrane, causing cell death Therapeutic Effects: Bactericidal action
Indications Treatment of It is effective for the treatment of penicillinaseproducingNeisseria gonorrhoea(PPNG). Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/tonsilliti s, sinusitis, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection.
Adverse Reaction GI: Diarrhea,nausea, antibiotic-associated colitis. Skin: Ra sh ,pruritus, urticaria. Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance. Hemat: Hemolytic anemia MISC: Anaphylaxis
Nursing Considerations Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance. Inspect IM and IV injection sites frequently for signs of phlebitis. Monitor for manifestations of hypersensitivity .. Monitor I&O rates . Report onset of loose stools or diarrhea.
CEFTAZIDIME Generic Name Ceftazidime Classification: Antibiotic, Cephalosphorin (3rd Generation)
Dosage 500 mg Powder for Injection
Mechanism of Action Pharmacology:Interfere with a final step formation of the bacterial cell wall (inhibition of mucopeptide biosynthesis), resulting in unstable cell membranes that undergo lysis. Also, cell division and growth are inhibited. More activity against gram-negative organisms and resistant organisms and les activity against gram-positive organisms than first-generation drugs.
Indications
Adverse Reaction
UTI’s uncomplicated
CNS: Headache, dizziness, lethargies, paresthesias, malaise, fatigue, vertigo
UTI’s complicated
GI: nausea, vomiting, diarrhea, glossitis, abdominal cramps or pain
Uncomplicated pneumonia, mild skin and skin structure infections
GU: Nephrotoxicity
Bone and joint infections
Hepatic:hepatomegaly, hepatitis
Hematologic:leukopenia, leukocytosis, lymphocytosis, neutropenia (transient), eosinophilia
Other: Superinfections including oral candidiasis and enterococcal infections, hypotension, sweating, flushing dyspnea, interstitial pnuemonitis, disulfiram-like reactions with alcohol
Nursing Considerations Assess for liver and renal dysfunction. Obtain CBC, renal function studies; reduce dose with dysfunction. Culture infection, and arrange sensitivity tests before and during therapy if expected response is not seen. Do not mix with aminoglycoside solutions, administer these drugs separately. Monitor prothrombin time in patients w/ renal or hepatic impairment, in a poor nutritional state or are on prolonged therapy. Store at temperatures not exceeding 30°C. Have Vit. K available in case hypoprothrombinemia occurs. Discontinue if hypersensitivity occurs.
DIPHENHYDRAMINE Generic Name Diphenhydramine Hydrochloride
Classification: Antihistamine, Antimotion sickness drug, Sedative-hypnotic, Antiparkinsonian, Cough suppressant
Dosage 25 mg Form: Capsule
Mechanism of Action
Indications
Pharmacology: Diphenhydramine blocks histamine H1-receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action.
Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive therapy in anaphylactic reactions Active and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism
Adverse Reaction CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias
Nursing Considerations History: Allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction, third trimester of pregnancy, lactation Administer with food if GI upset occurs. Administer syrup form if patient is unable to take tablets. Monitor patient response, and arrange for adjustment of dosage to lowest possible effective dose. Avoid alcohol; serious sedation could occur. Report difficulty breathing, hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual disturbances, irregular heartbeat.
TRANEXAMIC ACID Generic Name
Dosage
Tranexamic Acid
Classification: Anti-fibrinolytic, antihemorrhagic
100 mg/ml Injection
Mechanism of Action
Indications
Adverse Reaction
Nursing Considerations
Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis.
Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.
Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates
Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.
CITICOLINE
Generic Name
Dosage
Citicoline
Classification: Neurotonics, Nootropics
500 mg Form: Capsule
Mechanism of Action Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.It is usually known that phospholipid, especially lecithin, decreases following decline in brain activity with cerebral trauma. Citicoline, which is a co-enzyme, accelerates the biosynthesis of lecithin in the body. Citicoline is also believed to protect nerve cells when in low oxygen conditions. Citicoline may be used for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. It also is used by those who have age related mental decline, such as Alzheimer’s and Parkinsons.
Indications
Adverse Reaction
Parkinson’s
Body temperature elevation
disease
Restlessness
Head injury
Headaches
Cerebral vascular
Nausea and vomiting
disease
Diarrhea
Alzheimer’s
Low or high blood pressure
disease
Tachycardia
Cerebral surgery
Sleeping troubles or insomnia
or acute cerebral
Blurred vision
disturbance
Chest pains
Nursing Considerations Citicoline may be taken
Disturbance of consciousness following brain
surgery
with or without food. Take it with or between meals. The supplement should not be taken in the late afternoon or at night because it can cause difficulty sleeping. Women who are pregnant or trying to become pregnant should consult with their doctor before taking the supplements. Not enough is known about the use of Citicoline during pregnancy and breastfeeding. Stay on the safe side and avoid use. Special attention should be paid for administration in the neonate, premature and children. Contact the physician immediately if allergic reaction such as hives, rash, or itching, swelling in your face or hands, mouth or throat, chest tightness or trouble breathing are experienced.
KETOROLOAC Generic Name Ketorolac
Classification: Nonsteroidal Aanti-inflammatory agents, Nonopioid analagesics
Dosage 30mg/amp
Mechanism of Action
IM
Inhibits prostaglandin synthesis, producing peripherally mediated analgesia Also has antipyretic and antiinflammatory properties. Therapeutic effect:Decreased pain
Indications Short term management of pain (not to exceed 5 days total for all routes combined)
Adverse Reaction
CNS: drowsiness, dizziness, euphoria,headache RESP: dyspnea CV: edema, pallor, vasodilation GI: GI Bleeding, abnormal taste, Diarrhea, dry mouth, dyspepsia, GI pain, nausea GU: oliguria, renal toxicity, urinary frequency
Nursing Considerations Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes occur.
POTASSIUM CHLORIDE Generic Name
Dosage
Mechanism of Action
Indications
Adverse Reaction
Nursing Considerations Use cautiously in patients
Potassium Chloride
Classification: Electrolytes and Replacement solutions
6.7 mEq, 8 mEq, 10 mEq, 20 mEq sustained release tablets; 500 mg, 595 mg tablets; 20 mEq, 25 mEq, 50 mEq effervescent tablets; 20 mEq/15 mL, 40 mEq/15 mL, 45 mEq/15 mL liquid; 15 mEq, 20 mEq, 25 mEq powder; 2 mEq/mL injection; 10 mEq, 20 mEq, 30 mEq, 40 mEq, 60 mEq, 90 mEq vials; 20 mEq/15 mL liquid
Replaces and maintains potassium level.
Hypokalemia
Nausea, vomiting, abdominal pain, Post infusion phlebitis, paresthesia of
the extremities, Mental confusion, weakness or
heaviness of limbs, flaccid paralysis ECG changes, hypotension, arrhythmias, heart block, possible cardiac arrest Respiratory paralysis.
with cardiac disease and in those with renal impairment Alert: IV use: Give by infusion only; never give IV push or IM. give slowly as dilute solution; potentially fatal hyperkalemia may result from too-rapid infusion Give oral potassium supplements with extreme caution because different forms deliver varying amounts of potassium. Never switch products without a doctor’s order. Give oral potassium supplements with extreme caution because different forms deliver varying amounts of potassium. Never switch products without doctor’s order. Make sure powders are completely dissolved before administering Know that drug is often used orally with potassiumwasting diuretics to maintain potassium levels.
CELECOXIB
Generic Name
Dosage
Mechanism of Action
Celecoxib
Classification: NSAID, Analgesic (nonopioid), Specific COX-2 enzyme blocker
Indications Hypokalemia
50 mg Form: Capsule
Therapeutic: Celecoxib has COX-2 specific inhibitory activity. It inhibits the conversion of arachidonic acid to prostaglandins while having no effect on the formation of prostaglandins that mediate the normal homeostasis in the GI tract, kidneys and platelets catalyzed by COX-1. Absorption: Absorbed from the GI
Adverse Reaction
Nursing Considerations
Acute and long-term treatment of signs and symptoms of rheumatoid arthritis and osteoarthritis Reduction of the number of colorectal polyps in familial adenomatous polyposis (FAP) Management of acute pain Treatment of primary dysmenorrhea Relief of signs and symptoms of anklylosing spondylitis Relief of signs and symptoms of juvenile rheumatoid arthritis
BLACK BOX WARNING: Be
tract (oral); peak plasma concentrations after 3 hr.
Distribution: Protein-binding: 97%. Metabolism: Hepatic; converted to inactive metabolites. Excretion: Feces and urine (as metabolites and unchanged drug); 11 hr (elimination half-life).
aware that patient may be at increased risk for CV events, GI bleeding; monitor accordingly. Administer drug with food or after meals if GI upset occurs. WARNING: If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy. Provide further comfort measures to reduce pain (eg, positioning, environmental control) and to reduce inflammation (eg, warmth, positioning, and rest).Take drug with food or meals if GI upset occurs. You may experience these side effects: Dizziness, drowsiness (avoid driving or the use of dangerous machinery while taking this drug).
AMLODIPINE Generic Name
Dosage
Mechanism of Action
Amlodipine
Classification: Cardiovascular agent Calcium channel blocker Antihypertensive agent
2.5 mg Form: Tablet
Inhibits calcium ions from entering the slow channels or select voltage sensitive areas of vascular smooth muscle and myocardium during depolarization.
Indications Amlodipine is indicated for the treatment of hypertension, chronic stable angina and confirmed or suspected vasospastic angina. Amlodipine is indicated alone or in combination with other prescription to treat high blood pressure and chest pain (angina). Amlodipine is in a class of prescription called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard.
Adverse Reaction
CNS: Dizziness Lightheadedness Fatigue Lethargy
CV: Peripheral edema Arhythmias
Dermatologic: Flushing, rash
GI: Nausea Abdominal discomfort
Nursing Considerations Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are achieved 6–9 h following oral doses. Monitor for S&S of doserelated peripheral or facial edema that may not be accompanied by weight gain; rarely, severe edema may cause discontinuation of drug. Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when additional antihypertensives or diuretics are added. Monitor heart rate; doserelated palpitations (more common in women) may occur. Report significant swelling of face or extremities. Take care to have support when standing & walking due to possible doserelated lightheadedness/dizziness. Report shortness of breath, palpitations, irregular heartbeat.
CEFRADINE Generic Name
Dosage
Mechanism of Action
Cefradine
Classification: Cephalosporins
500 mg IV
Inhibits mucopeptide synthesis in bacterial cell wall.
Indications Reducing the numbers of postoperative infections in patients undergoing surgical procedures associated with a high risk of infection.
Adverse Reaction
Glossitis (inflammation or infection of the tongue) Heartburn Dizziness Tightness in the chest Headache Nausea Vomiting Diarrhoea Abdominal pain Vaginitis Candidal overgrowth (yeast-like infection) Urticaria (hives - an itchy skin eruption) Pruritus (Severe itching) Skin rashes Fever Arthralgia (sharp pain in a joint or joints) Edema (swelling from excessive accumulation of watery fluid)
Nursing Considerations
Hypersensitivity to drugs Monitor for positive response to antibiotic therapy Monitor for signs of infections
OMEPRAZOLE Generic Name
Dosage
Omeprazole
Classification: Gastrointestinal agent Proton pump inhibitor
10 mg, 20 mg, 40 mg Capsules
Mechanism of Action
Indications
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.
Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe erosive esophagitis (4 to 8 wk treatment). Longterm 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.
Adverse Reaction
CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild transient increases in liver function tests. Urogenital:Hematuria, proteinuria. Skin:Rash
Nursing Considerations Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with prolonged use. 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.
CLONIDINE Generic Name
Dosage
Clonidine 75 mcg
Classification: Centrally- actingdrugs
Tablet
Mechanism of Action
Indications
StimulatesCentral alphaadrenergicreceptors toinhibitsympatheticcardioaccelera torand vasoconstrictor centers.
Management of all grades of hypertension.
Adverse Reaction
Local skin irritation, allergic contact dermatitis, hypopigmentation and hyperpigmentation of the skin Constipation Depression, anxiety, fatigue, Nausea, anorexia, parotid pain, sleep disturbances Impotence, urinary retention, itching sensation of the eye.
Nursing Considerations Assess bloodpressure andapical pulse beforeinitial dose. If systolic bloodpressure is <90mmhg or pulse is<60 bpm, withhold drug andnotify physician. Check for edemain feet, legs daily, Monitor input-output ratio: checkfor decreasingoutput. Note allergicreactions: fever,rash, pruritus,urticaria, andioedema.
ATORVASTATIN Generic Name
Dosage
Atorvastatin 10, 20, 40, and 80 mg
Classification: Antihyperlipidemic, HMG-CoA reductase inhibitor
Tablet
Mechanism of Action
Indications
Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs (associated with increased risk of CAD), and increases serum HDLs (associated with decreased risk of CAD); increases hepatic LDL recapture sites, enhances reuptake and catabolism of LDL; lowers triglyceride levels.
Adjunct to diet in treatment of elevated total cholesterol, serum triglycerides, and LDL cholesterol in patients with primary hypercholesterole mia (types IIa and IIb) and mixed dyslipidemia, primary dysbetalipoprotein emia, and homozygous familial hypercholesterole mia whose response to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures has not been adequate
Adverse Reaction
CNS: Headache, asthenia
GI: Flatulence, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure
Respiratory: Sinusitis, pharyngitis
Other: Rhabdomyolysis with acute renal failure, arthralgia, myalgia
Nursing Considerations Name confusion has been reported between written orders for Lipitor (atorvastatin) and Zyrtec (certirizine). Use extreme caution. History: Allergy to atorvastatin, fungal byproducts; active hepatic disease; acute serious illness; pregnancy, lactation Physical: Orientation, affect, muscle strength; liver evaluation, abdominal examination; lipid studies, LFTs, renal function tests WARNING: Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder, seizures) that may suggest myopathy or serve as risk factor for development of renal failure.
ENELAPRIL Generic Name
Dosage
Enelapril 2.5, 5, 10, 20 mg;
Classification: Antihypertensive, ACE inhibitor
Tablet 1.25 mg/mL IV
Mechanism of Action
Indications
Enalapril is de-esterified into the active enalaprilat resulting in potent inhibition of ACE thus leading to reduced levels of angiotensin II and aldosterone. Clinically, BP is reduced, salt and water retention is corrected. Ventricular hypertrophy is reversed. Renal blood flow is increased but in patients with renal impairment there may be oliguria or acute renal failure.
Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics Treatment of acute and chronic CHF Treatment of asymptomatic left ventricular dysfunction (LVD) Unlabeled use: Diabetic nephropathy.
Adverse Reaction
Initial hypotension may be severe and prolonged. Dizziness, headache, fatigue, persistent dry cough, abnormal taste, lassitude, rash, neutropenia, renal impairment or failure. Potentially Fatal: Angioedema.
Nursing Considerations WARNING: Alert surgeon,
and mark patient's chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. Be aware that use of this drug in second and third trimesters can cause serious injury or death to the fetus; advise contraceptive use. Monitor patients on diuretic therapy for excessive hypotension after the first few doses of enalapril. Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive hypotension may occur.
FDAR 6:00 AM
F> Post-endorsement Assessment
D> awake on bed; conscious and coherent; on diet as tolerated; with D5LR 1000 ml x 8 hrs. on left hand infusing well; with foley catheter to urine bag draining yellow urine; with the following vital signs: T- 36.9, PR- 80, RR20, BP- 120/80.
10:00 AM
F> Hyperthermia
D> increase in body temperature above normal range T- 38.4; skin is flushed and warm to touch. A> tepid sponge bath done; informed resident on duty, Dr. Obnamia with verbal order of Paracetamol 500 mg; gave Paracetamol 500 mg as per Dr. Obnamia’s order; instructed patient to wear loose clothing; instructed to drink plenty of fluids; provided opportunity for patient to rest; due meds given. R> patient was able to rest; patient’ temperature decreased to 37.5 degrees. D> with diagnosis of non-healing wound 4th digit on left foot; with consent for procedure; with OR proposal; with materials; with MRA A> assessed patient; vital signs taken and recorded; verified doctor’s order; prepared patient with OR attire; advised to remove underwear, dentures, nail polish and jewelries; kept rested and comfortable; needs properly attended. R> still for emergency wound debridement. D> 40 y/o male; status post emergency wound debridement; incision and drainage day1 A> assessed patient; vital signs taken and recorded; due medications given; left foot dressing dry and intact; encouraged deep breathing exercise; instructed patient on nothing per orem; kept safe and comfortable. D> on full diet A> advised mother to feed her child nutritious foods such as fruits and vegetables and give it as much as she likes; advised also to give fresh fruit
11:00 AM
F> For Emergency Wound Debridement
1:00 PM
F> Post-operative Care
11:00 AM
F> Health Teaching Regarding Diet
9:00 AM
F> Referral to Rehabilitation Medicine
8:30 AM
F> Hematochezia
10:00 AM
F> Pain
10:00 AM
F> Sleep Deprivation
1:30 PM
F> To Discharge
Sheryl G. Realino, RN Nursing Service
juices aside from water. R> mother understood the importance of health teaching. D> s/p excision of meningioma with orders by Dr. Atazan; vital signs taken and recorded as follows: T- 36.9; PR- 80, RR- 20, BP- 120/80. A> assessed; informed patient about her rehabilitation; informed rehabilitation medicine c/o ma’am Lhisa for follow and to wait for the doctor’s rounds. R> checked and examined by rehabilitation medicine Dr. Calma. D> fresh blood noted with the stool A> vital signs taken; informed Dr. Ancheta; kept rested; advised patient and relative to inform nurse on duty once incident re-occur. D> complaining of continuous, sharp pain on abdominal incision area; states pain is 8/10. A> assessed patient; verified doctor’s order; medicated with Tramadol 50 mg IV as per Dr. Fausto’s order. R> reported pain is reduced from 8/10 to 3/10. D> less movement with verbalization of “Di ako makatulog. Madali akong nagigising” A> assessed patient’s needs; morning care done; monitored vital signs and charted; advised relative to always stay at bedside; provided comfort measures and provided opportunity to rest; due meds given. D> with discharge orders made by Dr. atazan A> verified and carried out doctor’s order; informed patill for dient and relative; advised to secure necessary requirements for discharge; coordinated with social service ma’am Sharon regarding borrowed blood; coordinated with pharmacy for clearance; informed intern on duty for discharge summary; kept well monitored; all needs are attended. R> still for discharge.
Sheryl G. Realino, RN Nursing Service
