241603963-Drug-Study-FINAL.docx

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DRUG MECHANISM OF ACTION

INDICATION CONTRAINDICATIONS ADVERSE EFFECTS AND SIDE EFFECTS

NURSING RESPONSIBILITIES



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Generic Name Potassium Chloride

Brand Name Kalium Durule

ClassificationElectrolyte

Sub Classification

Dosage1 tab

Routeoral

FrequencyEvery 8 hours

FormTablet

Color White

Principal intracellular cation of most body tissues participates in a number of physiologic processes – maintaining intracellular tonicity; transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscle; maintenance of normal renal function; also plays a role in carbohydrate metabolism and various enzymatic reactions.

Prevention and correction of potassium deficiency; when associated with alkalosis, use potassium chloride; when associated acidosis, use potassium acetate bicarbonate, citrate, or gluconate.

Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in some preparations marketed as Kaon-Cl, Klor-Con); therapy with potassium-sparing diuretics or aldosterone-inhibiting agents; severerenal impairment with oliguria, anuria, azotemia; untreated Addison’s disease; hyperkalemia; adynamiaepisodicahereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract.

Use cautiously with cardiac disorders, especially if treated with cardiac glycosides, pregnancy and lactation.

Adverse Effects:

Dermatologic: Rash

GI: Nausea, vomiting, diarrhea, abdominal discomfort, GI obstruction, GI bleeding, GI ulceration or perforation.

Hematologic: Hyperkalemia-increased serum potassium, ECG changes (peaking of T waves, loss of P waves, depression of ST segment, prolongation of OTC interval).

Local: Tissue sloughing, local necrosis, local phlebitis, and venospasm with injection.

Side Effects:

Confusion, anxiety, feeling like you might pass out

Uneven heartbeat Extreme thirst,

increased urination

Consider the 10 Golden Rights of administering medication

Arrange for serial serum potassium levels before and during therapy

Administer oral drugs after meals or with food and a full glass of water to decrease GI upset.

Caution patient not to chew or crush tablet; have patient swallow tablet whole.

Caution patient that expanded wax matrix capsules will be found in stool.

Caution patient not to use salt substitutes.

Ask the patient to have periodic blood tests and medical evaluation.

Tell the patient to report tingling of hands or feet, unusual tiredness or weakness, feeling of heaviness in the

http://bsnurse.com/aspirin/

Leg discomfort Muscle weakness

or limp feeling Numbness or

tingly feeling in your hands or feet, or around your mouth

Severe stomach pain, ongoing diarrhea or vomiting

Black, bloody, or tarry stools; or

Coughing up blood or vomit that looks like coffee grounds

legs, severe nausea, vomiting, abdominal pain, black or tarry stool.



NURSING RESPONSIBILITIE

S

Generic NameMetronidazole

Brand NameFlagyl

Classification Amebicide, Antibacterial, Antibiotic, Antiprotozoal

Sub Classification

Dosage500mg/tablet

RouteOral

Frequency Thrice a day (TID)

Form Tablet

Color White

Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoal- trichomonacidal, amebicidal: Biochemical mechanism of action is not known.

Acute infection with susceptible anaerobic bacteria

Acute intestinal amebiasis

Amebic liver abscess

Trichomoniasis (acute and partners of patients undergoing colorectal surgery

Unlabeled uses: Prophylaxis for patients undergoing gynecologic, abdominal surgery, hepatic encephalopathy, Crohn’s disease; antibiotic- associated pseudo membranous colitis, treatment of Gardnerella vaginalis, giardiasis (use recommended by the CDC); infected decubitus ulcers; perioral dermatitis

Contraindicated with hypersensitivity to metronidazole; pregnancy ( do not use for trichomoniasis in first trimester)

Use continuously with CNS diseases, hepatic diseases, candidiasis (moniliasis), blood dyscrasias, lactation.

Adverse Effect:

CNS: Headache, dizziness, ataxia, vertigo, incoordiantion, insomnia, seizures, peripheral neurophaty, fatigue

GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps

GU: Dysuria, incontinence, darkening of the urine

Local: Thrombophlebitis (IV); redness, burning, dryness, and skin irritation (topical)

Others: Severe, disulfiram- like interaction with alcohol,


Tell the patient to take full course drug therapy; take the drug with food if GI upset occur.

Tell the patient not to take alcohol (beverages or preparations containing alcohol, cough syrups) for 24-72 hr of drug use; severe reactions may occur.

Caution the patient that their urine may be darker in color than usual; this is expected

Tell the patient that they may experience

candidiasis (superinfection)

Side Effects:

Numbness or tingling in your hands or feet;

White patches or sores inside your mouth or on your lips;

Pain or burning when you urinate;

Diarrhea that is watery or bloody;

Vision problems, pain behind your eyes;

Trouble concentrating, slurred speech, mood or behavior changes, tremors, muscle twitching, seizure (convulsions);

Fever, chills,

this side effects like: Dry mouth with strange metallic taste (frequent mouth care, sucking sugarless candies may help); nausea, vomiting, diarrhea (eat frequent small meals)

Tell the patient to report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills.

muscle pain, confusion, headache, sore throat, neck stiffness, increased sensitivity to light, drowsiness, nausea and vomiting; or

Severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.




Generic NameMetoclopramide

Brand Name Reglan

Classification Antiemetic, Dopaminergic blocker, GI stimulant

Sub Classification

Dosage 1 ampule

Route Parenteral

Frequency TID/ q6

Form Liquid ampule

Color Clear

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; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties,

Relief symptoms of acute and recurrent diabetic gastroparesis.

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

Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable

Contraindicated with allergy to metaclopramide, GI hemorrhage, mechanical obstruction or perforation; pheochromocytoma (may cause hypertensive crisis); epilepsy.

Use continuously with previously detected breast cancer (one third of such tumors are prolactin dependent); lactation, pregnancy; fluid overload; renal impairment.

Adverse Effects:

CNS: Restlessness, drowsiness, fatigue, lasitudes, insomnia, extrapyramidalreaction, parkinsonism- like reactions, akathisia, dystonia, myoclonus, dizziness, anxiety

CV: Transient hypertension

GI: Nausea, diarrhea

Side Effects:

tremors, or restless muscle movements in your eyes, tongue, jaw, neck, arms, or legs

mask-like appearance of the face

very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out

depressed mood, thoughts of suicide or hurting yourself

hallucinations,


Asses if the patient has historyof allergies tometoclopramide.

·Monitor BP carefully during IVadministration.

Monitor extrapyramidal reactions and consultphysician if they occur.

Monitor patients with diabetes, arrange for alteration in insulin dose or timing ifdiabetic control is comprisedby alterations in timing of food absorption.

Keep diphenhydramine injection readily available in case extrapyramidal

induces release of prolactin.

anxiety, agitation, jittery feeling, trouble staying still

swelling, fluid retention

jaundice (yellowing of your skin or eyes)

seizure (convulsions)

Less serious side effects may include:

feeling restless, drowsy, tired, or dizzy

headache, sleep problems (insomnia)

nausea, vomiting, diarrhea

breast tenderness or swelling

changes in your menstrual periods

urinating more than usual

reaction occur (50mg IM)

Have phentolamine readily available in case of hypertensive crisis (most likely to occur with undiagnosed pheochromocytoma)

Do not use alcohol, sleep remedies, or sedatives; serious sedation could occur.

Tell the patient that they may experience these side effects: drowsiness, dizziness (do not drive or perform other task that requires alertness); restlessness, anxiety, depression, headache, insomnia (reversible); nausea,

diarrhea. Tell the patient

to report involuntary movement of the face, eyes, or limbs, severe depression, and severe diarrhea.




Generic Name Furosemide

Brand Name Lasix

ClassificationLoop Diuretics

Sub Classification

Dosage10mg

Route Parenteral

Frequency STAT

Form Liquid ampule

Color Clear

Inhibits reabsorption of sodium chloride from the proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich diuresis.

Oral, IV: Edema associatedwith heart failure, cirrhosis,renal disease.

IV: acute Pulmonary Edema

Oral: hypertension

Contraindicated with allergy to furosemide, sulfonamides, allergy to tartrazine (in oral solution); anuria, severe renal failure; hepatic coma; pregnancy; lactation.

Use cautiously with SLE, gout, diabetes mellitus.

Adverse Effects:

CNS: dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss

CV: orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis

Dermatologic: photosensitivity, rash, pruritus, urticaria, purpura, exfoliative, dermatitis, erythema multiforme

GI: nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pacreatitis, jaundice

GU: polyuria, nocturia, glycosuria, urinary bladder spasm.

Hematologic: leukopenia, anemia, thrombocytopenia, fluid and electrolytes imbalance, hyperglycemia, hyperuricemia

Others: Muscle cramps and muscle spasm


Profound dieresis with water and electrolyte depletion can occur, careful medical supervision is required.

Administer with food or milk to prevent GI upset.

Reduce dosage if given with other anti hypertensive; readjust dosage gradually as BP responds.

Give early in the day so that increase urination will not disturb sleep.

Do not mix parenteral solution with highly acidic salutions with pH below 3.5

Do not expose

Side Effects:

Common side effects of furosemide:

low blood pressure dehydration electrolyte depletion

(for example, sodium, potassium)

Less common side effects include :

jaundice, ringing in the ears

(tinnitus) sensitivity to light

(photophobia) rash pancreatitis nausea diarrhea abdominal pain dizziness Increased blood sugar increase uric acid level

to light, which may discolor tablets or solution; do not use discolored drug or solution.

Discard diluted solutions after 24 hr.

Measure and record weight to monitor fluid change

Arrange to monitor serum electrolytes, hydration, liver and renal function.

Arrange with potassium rich diet or supplemental potassium as needed.

Tell the patient that they may experience this side effects: increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness

http://www.medicinenet.com/script/main/art.asp?articlekey=97800











(avoid rapid position changes; hazardous activities, like driving and consumption of alcohol); sensitivity to sun light( use sun glasses, wear protective clothing, or use sunscreen; increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium(a potassium rich diet or potassium supplement will be needed).

Tell the patient to report loss or gain of more than 1.5kg in 1 day, swelling in the ankle or fingers, unusual bleeding or

bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.




Generic Name Omeprazole

Brand Name Zefxon

Classification: Antisecretory drugProton pump inhibitor

Sub Classification

Dosage40mg

RouteParenteral

Frequencytwice a day (BID)

Form Powder in vial, diluted with sterile water

Color Cloudy

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 finalstep acid production.

Short term treatment of active duodenal ulcer.

Treatment of heartburn or symptoms of GERD

Short term treatment of active benign gastric ulcer

GERD, severe erosive esophagitis, poorly responsive symptomatic GERD

Long term therapy: treatment of pathologic hypersecretory conditions (Zollinger Ellison’s syndrome, multiple adenomas, systemic mastocytosis)

Eradication of H. pylori with amoxicillin or metronidazole and clarithromycin

Contraindicated with hypersensitivity to Omeprazole or it’s components

Use cautiously with pregnancy, lactation

Adverse Effects:

CNS: headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities

Dermatologic: rash, inflammation, urticaria, pruritus, alopecia, dry skin.

GI: diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy

Respiratory: URI symptoms, cough, epistaxis

Others: cancer in preclinical studies, back pain, fever

Side Effects:

Dizziness (avoid driving or performing hazardous tasks)

headache (request medications)

nausea vomiting diarrhea (maintain


Assess other medications patient may be taking for effectiveness and interactions (especially those dependent on cytochrome P450 metabolism or those dependent on acid environment for absorption).

Monitor therapeutic effectiveness and adverse reactions at beginning of therapy and periodically throughout therapy.

Assess GI system: bowel sounds every 8hours, abdomen for pain and swelling, appetite loss.

Monitor hepatic enzymes: AST,

proper nutrition) symptoms of URI cough (do not self-

medicate; consult with your health care provider if uncomfortable).

ALT, increased alkaline phosphatase during treatment.

Tell the patient to report if experiencing this side effects: dizziness, headache, nausea, vomiting, diarrhea.


INDICATION CONTRAINDICATIONS ADVERSE EFFECT AND SIDE EFFECT


Generic NameAmbroxol HCL

Brand Name Ambrolex

Classification Mucolytic

Sub Classification

Dosage75mg

Route Oral

Frequency Once a day

Form Capsule

Color Half white and half green

It makes phlegm in the airways thinner and less sticky. It does this by increasing the body's natural production of surfactant. This contributes to a secretomotoric effect: it helps the cilia - tiny hairs that line the respiratory tract - to transport the phlegm out of the lungs.

Adjuvant therapy in patients with abnormal, viscid, or in spissated mucous secretions in acute and chronic broncho pulmonary diseases, and in pulmonary complications of cystic fibrosis and surgery, tracheostomy, and atelectasis.

There is no absolute contraindication but in patient with gastric ulceration relative caution should be observed.

Adverse Effect:

Occasional gastrointestinal side effects may occur but these are almost invariably mild

Rashes Fatigue Dry mouth Rhinorrhea Constipation Dysuria Contact

dermatitis


Monitor S/Sx of aspiration of excess secretions and for bronchospasm.

Have suction apparatus immediately available.

Tell the client to report difficulty with clearing the airway or any other respiratory distress.

Tell the client to report if experiencing this side effects: GI upset, rashes, fatigue, dry mout.


INDICATION CONTRAINDICATIONS

ADVERSE EFFECT AND SIDE EFFECTS


Generic Name Cefuroxime Sodium

Brand Name Zinacef

Classification Antibiotic, Cephalosporin

Sub Classification Second generation

Dosage 750mg

Route Parenteral

Frequency q8

Form powder in vial, diluted with sterile water

Color Light yellow

Bactericidal: inhibits synthesis of bacterial cell wall, causing cell death.

Lower respiratory infections caused by S. pneumonia, S. aureus, E. coli, Klebsiella pneumonia, H. influenza, S. pyogenes

Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, K. pneumonia, Enterobacter

UTIs caused by E. coli, K. pneumonia

Uncomplicated and disseminated gonorrhea caused by N. gonorrhoeae

Septicimia caused by S. pneumonia, S. aureus, E. coli, K pneumonia, H. influenza

Meningitis caused by S. pneumoniae, H. influenza, S. aureus, N. meningitides

Contraindicated with allergy to cephalosporins or penicillins

Use continuously with renal failure, lactation, pregnancy

Side Effects

Diarrhea, stomach upset

Difficulty of breathing

Anusual tiredness or fatigue

Pain at injection site

Adverse Effect:

CNS: headache, dizziness, lethargy, paresthesias

GI: nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomenbranouse colitis, hepatotoxicity

GU: Nephrotoxicity

Hematologic: Bone marrow depression

Hypersensitivity: ranging from rash to fever to anaphylaxis; serum sickness reaction

Local: pain, abcess at injection


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.

Do skin test before administering the drug

Inspect IV injection sites frequently for signs of phlebitis.

Monitor for manifestations of hypersensitivity. Discontinue drug

Bone and joint infections due to S. aureus

Perioperative prophylaxis

Treatment of acute bacterial maxillary sinusitis in patients 3-mo 12yr

site, phlebitis, inflammation of IV site

Others: superinfection, disulfram- like reaction with alcohol

and report their appearance promptly.

Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Tell the client to report loose stools or diarrhea promptly.

Tell the client to avoid alcohol while taking this drug and for 3days after because severe reaction often occurs.



ADVERSE EFFECTS AND SIDE EFFECTS


Generic Name Paracetamol

Brand Name Biogesic

Classification Non- narcotic analgesic, Antipyretic

Sub Classification

Dosage 300mg

Route P.O

Frequency PRN

Form Ttablet

Color Orange

Decreases fever by a hypothalamic effect leading to sweating and vasodilation

Inhibits pyrogen effect on the hypothalamic-heat-regulating centers

Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis

Does not cause ulceration of the GI tract and causes no anticoagulant action

Control of pain due to headache, earache, dysmenorrhea, arthralgia, myalgia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy

Reduce fever in viral and bacterial infections

As a substitute for aspirin in upper GI disease, bleeding disorders clients in anticoagulant therapy and gouty arthritis

Anemia, cardiac & pulmonary disease. Hepatic or severe renal disease.

Liver toxicity (hepatocyte necrosis) may occur with doses not far beyond labeled dosing.

Side Effects:

Minimal GI upset, methemoglobinemia, hemolytic anemia, neutropenia, thrombocytopenia, pancytopenia, leucopenia,urticaria, CNS stimulation, hypoglycemic coma, jaundice, glissitis, drowsiness, liver damage

Adverse Effect

Allergic skin reactions & GI disturbances.


Monitor CBC, liver and renal functions.

Assess for fecal occult blood and nephritis.

Tell the patient to avoid using OTC drugs with Acetaminophen

Tell the patient to take the drug with food or milk to minimize GI upset.

Tell the client to report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity.

Tell the client to report paleness, weakness and heart beat skips

Tell the client to report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools.

Tell the client that Phenmacetin may cause urine to

become dark brown or wine-colored.

Tell the client to report pain that persists for more than 3-5 days

Tell the client that this drug is not for regular use with any form of liver disease because it might cause further damage.



ADVERSE EFFECT AND SIDE EFFECT


Generic Name Aminoleban

Brand Name

Classification V06DD - Amino acids, incl. combinations with polypeptides ; Used as general nutrients.

Sub Classification

Dosage 500mg

Route Parenteral

Frequency q8

Form Liquid

Color Clear

Given to normalize the amino acid, carbohydrates, fats, vitamins and minerals in the plasma

Hepatic encephalopathy due to acute or chronic liver diseases & of -ve nitrogen balance when adequate nutrition PO or gastro duodenal tube is impossible or undesirable.

Patient with abnormal amino acid metabolism (since the infuse amino acids are not adequately metabolized, the patient clinical condition may be worsened.)

Severe renal disorders

Adverse Effect:

Cardiovascular: Chest discomfort, & palpitation.

Hypersensitivity: rare skin eruptions

Gastrointestinal: occasional nausea and vomiting

Others: occasional chills, fever, headache

Side Effects:

Hypoglycemia may occur and

hyperammonemia has been reported.

Hypersensitivity reactions such as skin rash may occur rarely.

Nausea, vomiting, chest discomfort and palpitations may occur infrequently.

Large doses and rapid administration may lead to acidosis.


Asses’ patient’s condition before starting the therapy.

Be alert to adverse reaction.

Monitor patient temperature.

If GI reaction occur monitor patient hydration.

Tell the patient to report if felt this side effects: nausea, vomiting, chest discomfort, palpitation occur.

Chills, fever and headache may infrequently occur.



ADVERSE EFFECT AND SIDE EFFECTS


Generic Name Sinutab extra-strength

Brand Name Sinutab Forte

Classification phenylpropanolamine, combinations ; Belongs to the

Sinutab Extra-Strength is a fixed-dose combination capsule containing the following 3 active ingredients: Phenylpropanolamine HCl (PPA) or Phenylephrine: A systemic decongestant to

Temporary relief of sinus headache; promote nasal and sinus drainage; help relieve runny nose, facial pain, malaise and fever often associated with colds,

Patients who are hypersensitive or allergic to any of the components of Sinutab Extra-Strength. Unless otherwise advised by a

Adverse Effect:

chest pain, rapid pulse, fast or uneven heart rate;

confusion, hallucinations, severe nervousness;

tremor, seizure (convulsions);


Tell the patient not take more of this medication than is recommended. An overdose of acetaminophen can damage your liver or cause death.

class of systemic sympathomimetic preparations used as nasal decongestant

Sub Classification

Dosage 1 cap

Route oral

Frequency TID

Form Capsule

Color Red and yellow

relieve clogged nose and sinuses.

Chlorphenamine Maleate or Phenyltoloxamine Citrate: An antihistamine/antiallergy.

Paracetamol: A pain killer, as well as an antipyretic (for fever).

influenza, acute and chronic sinusitis, allergic rhinitis (hay fever) and vasomotor rhinitis.

physician, during pregnancy and lactation, patients with severe kidney disease or who are taking other medications containing PPA.

easy bruising or bleeding, unusual weakness;

little or no urinating;

nausea, pain in your upper stomach, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of your skin or eyes); or

Dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, chest pain, shortness of breath, uneven heartbeats, seizure).

Side Effect:

dizziness, drowsiness;

mild headache, blurred vision;

dry mouth, nose, or throat;

constipation;

Instruct the patient that this medication could not use if she/he are allergic to acetaminophen, chlorpheniramine, or pseudoephedrine.

Inform patient that she need to avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen, and can increase certain side effects of chlorpheniramine.

Explain to the patient that there’s a side effects that she may experience upon taking the medication such as blurred vision or impair your thinking or reactions.

If other unwanted effects not previously listed occur, consult a physician.

feeling nervous; sleep problems

(insomnia);





Generic Name Ketorolac Tromethamine

Brand Name Toradol

Classification nonsteroidal anti-inflammatory agents, nonopioid analgesics

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia.

Also has antipyretic and anti-inflammatory properties. Therapeutic Effects:

Short-term management of pain (not to exceed 5 days total for all routes combined).

Contraindicated in:

Hypersensitivity

Cross-sensitivity with other NSAIDs may exist

Pre- or perioperative use

Known alcohol

Adverse Effects:

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache.

Respiratory: asthma, dyspnea.


AssessmentPatients who have

asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.

Sub Classification pyrroziline carboxylic acid

Dosage 30 mg

Route Parenteral

Frequency q8

Form Liquid ampule

Color Clear

Decreased pain. intolerance (injection only)

Perioperative pain from coronary artery bypass graft (CABG) surgery .

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, especially with prolonged use)

History of GI bleeding

Renal impairment (dosage reduction may be required)

CV: edema, pallor, vasodilation.

GI: GI bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea.

GU: oliguria, renal toxicity, urinary frequency.

Dermatologic: exfoliative dermatitis, Stevens Johnson Syndrome, toxic necrolysis pruritus, purpura, sweating, urticaria.

Hematology: prolonged bleeding time.

Local: injection site pain.

Neurology: paresthesia.

Misc: allergic reactions

Pain: Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration.

Lab Test Considerations: Evaluate liver function tests, especially AST and ALT, periodically in patients receiving prolonged therapy. May cause ↑ levels.

tell the patient that it may cause prolonged bleeding time that may persist for 24-48 hr following discontinuation of therapy.

Inform the patient that it may cause ↑ BUN, serum creatinine, or potassium concentrations. . Implementation

Do not confuse Toradol (ketorolac) with Torecan (thiethylperazine) or tramadol (Ultram).

Administration in higher-than-recommended doses does not provide increased effectiveness but may cause increased side effects. Duration of ketorolac therapy, by all routes combined, should not exceed 5 days Use lowest effective dose for shortest period of time.

including, anaphylaxis

Side Effects:

chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance;

black, bloody, or tarry stools;

coughing up blood or vomit that looks like coffee grounds;

swelling or rapid weight gain;

urinating less than usual or not at all;

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

fever, sore throat, and headache with a severe blistering,

Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses. .

PO: Ketorolac therapy should always be given initially by the IM or IV route. Use oral therapy only as a continuation of parenteral therapy.

injection, 0.9% NaCl.

Patient/Family Teaching

Instruct patient on how and when to ask for pain medication.

Instruct patient to take medication exactly as directed. Take missed doses as soon as remembered if not almost time for next dose. Do not double doses. Do not take more than prescribed or for longer than 5 days.

May cause drowsiness or dizziness. Advise patient to avoid

peeling, and red skin rash;

the first sign of any mouth sores or skin rash, no matter how mild;

pale skin, easy bruising, severe tingling, numbness, pain, muscle weakness; or

fever, headache, neck stiffness, chills, increased sensitivity to light, purple spots on the skin, and/or seizure (convulsions).

Less serious side effects may include:

upset stomach, mild nausea or vomiting, diarrhea, constipation;

mild heartburn, stomach pain, bloating, gas;

dizziness, headache, drowsiness;

sweating; or ringing in your

driving or other activities requiring alertness until response to the medication is known.

Caution patient to avoid the concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional.

Advise patient to inform health care professional of medication regimen prior to treatment or surgery.

Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, pain)

ears. occurs. .

Evaluation/Desired Outcomes

Decrease in severity of pain. Patients who do not respond to one NSAID may respond to another.





Generic Name Perindopril

Brand Name Coversyl plus

Classification Antihypertensive

Sub Classification ACE Inhibitor

Dosage 1 cap

Route oral

Frequency BID

Form Tablet

Color White

Antihypertensive.Pharmacology: Perindopril is an ACE-inhibitor that works by widening the blood vessels, which makes it easier for the heart to pump blood through them.Indapamide is a diuretic that causes an increase in the amount of urine produced.Each of the active ingredients of Coversyl Plus reduces blood pressure and work together to control blood pressure.

Treatment of essential hypertension

Allergy to perindopril or other ACE-inhibitors, or to indapamide or any other sulfonamides.

History or presence of wheezing, swelling of the face or tongue, intense itching or severe skin rashes with previous ACE-inhibitor treatment, or other circumstances (eg, angioedema).Severe liver diseases or if suffering from hepatic encephalopathy; severe kidney disease, or on dialysis; low or high blood potassium; untreated decompensated heart failure (severe water retention, difficulty in breathing);

Adverse Effect:

CNS: dizziness, asthenia, sleep disorder, paresthesia, depression, somnolence,nervousness, headache.

CV: palpitations, edema, chest pain, abnormal ECG.

EENT:rhinitis, sinusitis, ear infection, pharyngitis, tinnitus.

GI: dyspepsia, diarrhea, abdominalpain, nausea, vomiting, flatulence.

GU: proteinuria, urinarytract infection, malesexual dysfunction, menstrual disorder.

Musculoskeletal: back pain, hyperonia, neck pain,


Assess patient’s condition.

Don’t let the patient to take this if she has an allergy to penidopril. And if she has a history of wheezing, swelling of the face or tongue, intense itching or severe skin rashes.

Explain to patient what was the medication for, and what are the side effects that she may encounter.

Instruct the patient to consult her doctor if she experiencing unwanted effect.

children.

Use in pregnancy & lactation: Coversyl Plus should not be used during the first 3 months of pregnancy and must not be taken from the 4th month of pregnancy. When pregnancy is planned or confirmed, the switch to an alternative treatment should be initiated as soon as possible.Do not take Coversyl Plus if breastfeeding.

joint pain, myalgia, arthritis, arm or leg pain

Respiratory: cough, upper respiratory infection

Skin: Rash Other: viral

infection, injury, seasonal allergy

Side Effect:

Cough, often described as dry and irritating, shortness of breath, discomfort on exertion.

Headache, dizziness, vertigo, pins and needles.

Changes in the rhythm or rate of the heart beat, fast or irregular heart beat

Stroke, myocardial infarction, angina pectoris (a feeling of tightness,

pressure or heaviness in the chest).

Feeling tired or lethargic.

Tinnitus (persistent noise in the ears), vision disturbances.

Hypotension, flushing, impaired peripheral circulation, nose bleeds.

Nausea, vomiting, taste disturbances, indigestion, diarrhoea, constipation or stomach pain.

Muscle cramps. Rash, pruritus

(itching). Eosinophilic

pneumonia. Hepatitis. Renal failure. Bleeding or

bruising more easily than normal caused by a low blood platelet count , frequent infections such as fever, severe

chills, sore throat or mouth ulcers caused by a lack of white blood cells, pancytopenia (a rare type of anaemia).

Decreased blood sugar levels.

Fainting.

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