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Actual Pharmacologic Management (Drug Study)
Drug # 1
Date Ordered: Dec. 09, 2010
Generic Name: esomeprazole magnesium
Brand Name: Nexium
Classification: Antiulcer drugs
Dosage: 40 mg 1 tab OD P.O
Mechanism of Action: Proton pump inhibitor that reduces gastric acid secretion and
decreases gastric acidity.
Indications:
Indicated to Gastroesophageal reflux disease (GERD)
Healing erosive esophagitis
Reduce the risk of gastric ulcers in patients receiving continuous NSAID therapy.
Contraindications:
Contraindicated to patients hypersensitive to drug or components of esoprazole
or omeprazole.
Patients receiving continuous NSAID therapy who are at increased risk for
gastric ulcers include those age 60 and older or those with a history of gastric
ulcers.
Adverse Reactions:
CNS: headache
GI: dry mouth, diarrhea, abdominal pain, nausea, flatulence, vomiting,
constipation
Nursing Responsibilities:
Give drug at least 1 hour before meals.
Antacids can be used while taking drug, unless otherwise directed by prescriber.
Monitor patient for rash or signs and symptoms of hypersensitivity or worsening.
Monitor GI symptoms for improvement or worsening.
Instruct patient to take drug exactly as prescribed.
Health Teachings:
Tell patient to take drug at least 1 hour before a meal.
Advise patient that antacids can be used while taking drug unless otherwise
directed by prescriber.
Warn patient not to chew or crush drug pellets because this makes the drug
ineffective.
Tell patient to inform prescriber of worsening signs and symptoms or pain.
Rationale: To reduce gastric acid secretion.
Drug # 2
Date Ordered: Dec. 09, 2010
Generic Name: potassium chloride
Brand Name: Kalium Durule
Classification: Electrolytes and minerals
Dosage: 1 tab tid x 6 doses
Mechanism of Action: Supplemental potassium in the form of high potassium food or
potassium chloride may be able to restore normal potassium levels.
Indications:
For hypokalemia
As prophylaxis during treatment with diuretics
Indicated when potassium is depleted by severe vomiting, and prolonged dieresis
Contraindications:
Severe renal impairment
Severe hemolytic reactions
Acute dehydration
Heat cramps
Hyperkalemia
Cautious use in: cardiac or renal disease; systematic acidosis
Adverse Reactions:
Renal insufficiency
Hyperkalemia
Nausea and Vomiting
Irritability and Muscle Weakness
Difficulty in swallowing
Nursing Responsibilities:
Some patients find it difficult to swallow the large sized KCl tablet. Administer
while patient is sitting up or standing (never in recumbent position) to prevent
drug- induced esophagus.
Don’t crush sustained-release potassium products.
Monitor ECG and electrolyte levels during therapy.
Monitor for adverse effect that may reflect by perkalemia.
Health Teachings:
Tell patient to take with or after meals with full glass of water or fruit juice to
lessen GI distress.
Teach patient signs and symptoms of hyperkalemia, and tell patient to notify
prescriber if they occur.
Warn patient not to use salt substitutes concurrently, except with prescriber’s
permission.
Rationale: To provide a direct replacement of potassium in the body.
Drug # 3
Date Ordered: Dec. 09, 2010
Generic Name: domperidone
Brand Name: Motilium
Classification: Antidiarrheal and Antiemetic
Dosage: 10 mg 1 tab tid
Mechanism of Action: Gastrointestinal emptying (delayed) adjunct; peristaltic
stimulant: The gastroprokinetic properties of domperidone are related to its peripheral
dopamine receptor blocking properties. Motilium facilitates gastric emptying and
decreases small bowel transit time by increasing esophageal and gastric peristalsis and
by lowering esophageal sphincter pressure. Antiemetic: The antiemetic properties of
domperidone are related to its dopamine receptor blocking activity at both the
chemoreceptor trigger zone and at the gastric level.
Indication: For management of dyspepsia, heartburn, epigastric pain, nausea, and
vomiting
Contraindications:
Known hypersensitivity to domperidone or any of the excipients
Prolactin-releasing pituitary tumour (prolactinoma).
Motilium should not be used when stimulation of the gastric motility could be
harmful:
Gastro-intestinal haemorrhage, mechanical obstruction or perforation.
Adverse Reactions:
Immune System Disorder: Very rare; Allergic reaction
Endocrine disorder: Rare; increased prolactin levels
Nervous system disorders: Very rare; extrapyramidal side effects
Gastrointestinal disorders: Rare; gastro-intestinal disorders, including very rare
transient intestinal cramps
Skin and subcutaneous tissue disorders:Very rare; urticaria
Reproductive system and breast disorders: Rare; galactorrhoea, gynaecomastia,
amenorrhoea
Nursing Responsibilities:
If clinical symptoms don’t improve within 48 hours, stop therapy and consider
other alternatives.
Drug produces antidiarrheal action similar to that of diphenoxylate but without as
many adverse CNS effects.
Know the patient’s sensitivity to domperidone before giving it.
Health Teachings:
Advise patient not to exceed recommended dosage.
Tell patient with acute diarrhea to stop drug and seek medical attention if no
improvement occurs within 48 hours. In chronic diarrhea, tell patient to notify
prescriber and to stop drug if no improvement occurs after taking 16 mg daily for
at least 10 days.
Advise patient with acute colitis to stop drug immediately and notify prescriber
about abdominal distention.
Warn patient to avoid activities that require mental alertness until CNS effects of
drug are known.
Rationale: To increase the movements or contractions of the stomach and bowel. It is
also used to treat nausea and vomiting.
Drug # 4
Date Ordered: Dec. 10, 2010
Generic Name: senna
Brand Name: Senokot Forte
Classification: Laxatives
Dosage: 2 tabs bid x3 doses
Mechanism of action: Unknown. Stimulant laxative that increases peristalsis, probably
by direct effect on smooth muscle of the intestine. It’s thought to either irritate the
musculature or stimulate the colonic intramural plexus. Drug also promotes fluid
accumulation in colon and small intestine.
Indication: Acute constipation, preparation for bowel examination.
Contraindications: Contraindicated in patients with ulcerative bowel lesions, fecal
impaction, intestinal obstruction, intestinal perforation, or signs and symptoms of acute
surgical abdomen, such as nausea, vomiting, and abdominal pain.
Adverse reactions:
GI: nausea, vomiting, diarrhea, loss of normal bowel function with excessive use,
abdominal cramps, especially in severe constipation, malabsorption of nutrients,
yellow or yellow-green cast to feces, darkened pigmentation of rectal mucosa
with long-term use, protein losing enteropathy.
GU: red-pink discoloration in alkaline urine, yellow-brown discoloration in acidic
urine.
Metabolic: electrolyte imbalance such as hypokalemia.
Other: laxative dependence with long-term or excessive use.
Nursing Responsibilities:
Before giving drug for constipation, determine whether patient has adequate fluid
intake, exercise and diet.
Limit diet to clear liquids after X-prep liquid is taken.
Avoid exposing product to excessive heat or light.
Drug is for short-term use.
Health Teachings:
Teach patient about dietary sources of bulk, including bran and other cereals,
fresh fruit, and vegetables.
Tell patient to report persistent or severe reactions.
Rationale: To stimulate peristalsis and increase intestinal motility.
Drug # 5
Date Ordered: Dec. 12, 2010
Generic Name: lactulose
Brand Name: Duphalac
Classification: Laxatives
Dosage: 30 cc now
Mechanism of Action: Produces an osmotic effect in colon; resulting distention
promotes peristalsis. Also decreases ammonia, probably as a result of bacterial
degradation, which lowers the pH of colon contents.
Indication: Constipation
Contraindications: Contraindicated in patients on a low galactose diet and in those
with diabetes mellitus.
Adverse Reactions:
GI: abdominal cramps, belching, diarrhea, gaseous distention, flatulence,
nausea, vomiting.
Nursing Responsibilities:
To minimize sweet taste, dilute with water or fruit juice or give with food.
Prepare enema by adding 200 g (300 ml) to 700 ml of water or normal saline
solution. The diluted solution is given as retention enema for 30 to 60 minutes.
Use a rectal balloon.
If enema isn’t retained for at least 30 minutes, be prepared to repeat dose.
Monitor sodium level for hypernatremia, especially when giving to patients with
hepatic encephalopathy.
Monitor mental status and potassium level when giving to patients with hepatic
encephalopathy.
Be prepared to replace fluid loss.
Health Teachings:
Show home care patient how to mix and use drug.
Inform patient about adverse reactions and tell him to notify prescriber if
reactions become bothersome or if diarrhea occurs.
Instruct patient not to take other laxatives during lactulose therapy.
Rationale: To increase water content in colon and enhances peristalsis and for the
breakdown of products in colon that lead to acidification of colonic contents, softening of
feces, and decreased ammonia absorption from colon to systemic circulation.
Drug # 6
Date Ordered: Dec. 13, 2010
Generic Name: cefuroxime
Brand Name: Zegen
Classification: Antibiotic
Cephalosporin ( 2nd generation)
Dosage: 750 mg q8 IVTT
Mechanism of Action: Cefuroxime is a bactericidal antibiotic, which exerts antibacterial
activity by inhibition of bacterial cell wall synthesis in susceptible species. Cefuroxime
has good stability to several bacterial beta-lactamase enzymes and, consequently, is
active against many penicillin-resistant and amoxicillin-resistant strains of susceptible
species.
Indications:
Lower respiratory tract infections caused by S. pneumoniae, S. aureus, E. coli,
Klebsiella, H. influenzae, S. pyogenes
Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella,
Enterobacter
UTIs caused by E. coli, Klebsiella
Uncomplicated and disseminated gonorrhea caused by N. gonorrhoea
Septicemia caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H.
influenzae
Meningitis caused by S. pneumoniae, H. influenzae, S. aureus, N. meningitidis
Bone and joint infections caused by S. aureus
Perioperative prophylaxis
Contraindications:
Allergy to cephalosporins or penicillins
Renal failure
Adverse Reactions:
CNS: Headache, dizziness, lethargy, paresthesias
GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence,
pseudomembranous colitis, liver toxicity
Hematologic: Bone marrow depression: decreased WBC, decreased platelets,
decreased Hct
GU: Nephrotoxicity
Hypersensitivity: Ranging from rash to fever to anaphylaxis, serum sickness
reaction
Local: Pain, abscess at injection site; phlebitis, inflammation at IV site
Other: Superinfections, disulfiram-like reaction with alcohol
Nursing Responsibilities:
Assess for history of hepatic and renal impairment
Observe the 12 rights when administering the drug
Have vitamin K available in case hypoprothrombinemia occurs
Discontinue if hypersensitivity occurs
Observe for adverse reactions
Do not mix with aminoglycosides
Inject slowly over 3-5min
Health Teachings:
Avoid alcohol while taking this drug and 3 days after because severe reactions
often occurs
May experience side effects
Report diarrhea, difficulty in breathing, unusual tiredness or fatigue, pain at
injection site
Rationale: To treat the existing acute infection.
Drug # 7
Date Ordered: Dec. 13, 2010
Generic Name: metronidazole
Brand Name: Rosex
Classification: Amebicide; Antibacterial;
Antibiotic; Antiprotozoal
Dosage: 500mg q8 IVF @ am
Mechanism of Action: Metronidazole exerts rapid bactericidal effects against
anaerobic bacteria. It inhibits DNA synthesis, causing cell death.
Indications:
Acute infection with susceptible anaerobic bacteria
Acute intestinal amebiasis
Amebic liver abscess
Trichomonias ( acute and partners of patients with acute infection)
Bacterial vaginosis
Preoperative, intraoperative, postoperative prophylaxis for patients undergoing
colorectal surgery
Prophylaxis for patients undergoing abdominal surgery
Contraindications:
Hypersensitivity to metronidazole
Used cautiously with CNS, hepatic diseases, candidiasis, blood dyscrasias
Adverse Reactions:
CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures,
peripheral neuropathy, fatigue
GI : unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset,
cramps
GU:dysuria, incontinence, darkening of the urine
Local: thrombophlebitis
Other: Superinfections , disulfiram-like reaction with alcohol
Nursing Responsibilities:
Assess for history of CNS or hepatic disease, candidiasis, blood dyscrasias
Reduce dosage with hepatic disease
Observe the 12 rights when administering the drug
Discontinue if hypersensitivity occurs
Observe for adverse reactions
Do not refrigerate neutralized solution
Do not administer solution that has not been neutralized
Infuse over 1hr
Discontinue other solutions while running metronidazole
Protect medication from sunlight
Health Teachings:
Take full course of drug therapy
Avoid alcohol while taking this drug and 3 days after because severe reactions
often occurs
May experience side effects
Expect dark colored urine
Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills
Rationale: To treat the existing acute infection.
Drug # 8
Date Ordered: Dec. 13, 2010
Generic Name: diclofenac sodium
Brand Name: Voltaren
Classification: Analgesic (non-opioid); Anti-
inflammatory (NSAID); Antipyretic
Dosage: 20cc/hr IV
Mechanism of Action: Inhibits prostaglandin synthetase to cause antipyretic and anti-
inflammatory effects; the exact mechanism of action is not known.
Indications:
Acute or long-term treatment of mild to moderate pain
Rheumatoid arthritis
Osteoarthritis
Ankylating spondylitis
Contraindications:
Contraindicated in the presence of significant renal impairment, and allergies to
NSAIDs
Use caution in the presence of impaired hearing, allergies, hepatic,
cardiovascular, and GI conditions and in elderly patients
Adverse Reactions:
CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness,
tinnitus, ophthamologic effects
GI: Nausea, dyspepsia, GI pain, vomiting, constipation, flatulence, diarrhea, GI
bleed
Hematologic: Bleeding, platelet inhibition with higher doses
GU: Dysuria, renal impairment
Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
Other: Peripheral edema, anaphylactoid reactions to fatal anaphylactic shock
Nursing Responsibilities:
Assess for history of hepatic and renal impairment, CV and GI conditions,
impaired hearing
Observe the 12 rights when administering the drug
Administer drug with food
Institute emergency procedures if overdose occurs
Observe for adverse reactions
Monitor with use of anticoagulants ( increased risk of bleeding)
Health Teachings:
Take drug with food
Take only the prescribed dosage
May experience side effects
Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers,
changes in vision, black, tarry stools
Rationale: This drug is given to alleviate the pain perceived and experienced.
Drug # 9
Date Ordered: Dec. 13, 2010
Generic Name: omeprazole
Brand Name: Omepron
Classification: Antisecretory drug; Proton pump inhibitor
Dosage: 40mg IVTT OD
Mechanism of Action: Gastric acid pump inhibitor: Suppresses gastric acid secretion
by specific inhibition of the hydrogen-potassium ATPase enzyme system at the
secretory surface of the gastric parietal cells; blocks the spinal step of acid production
Indications:
Short-term treatment of active duodenal ulcer
Treatment of heartburn or symptoms of GERD
Short-term treatment of active benign gastric ulcer
GERD
Eradication of H. Pylori
Reduction of risk of upper GI bleeding in critically ill patients
Contraindications:
Hypersensitivity to omeprazole or its components
Adverse Reactions:
CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety,
paresthesia, dream abnormalities
GI: Nausea, vomiting, constipation, diarrhea, abdominal pain, dry mouth, tongue
atrophy
Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin
Respiratory : cough, epistaxis
Other: back pain, fever
Nursing Responsibilities:
Assess for hypersensitivity to omeprazole or its components
Observe the 12 rights when administering the drug
Administer with antacids if needed administer before meals
Observe for adverse reactions
Health Teachings:
Take drug before meals and take only the prescribed dosage
May experience side effects and report severe headache, worsening of
symptoms, fever, chills
Rationale: This is given to suppress the gastric secretion and thus, reduce the pain
perceived.
Drug # 10
Date Ordered: Dec. 13, 2010
Generic name: nalbuphine
Brand name: Nubain
Classification: Opioid agonist-antagonist analgesic
Dosage: 5mg q6 x 12 doses IVTT
Mechanism of Action: Nalbuphine acts as an agonist at specific opioid receptors in the
CNS to produce analgesia and sedation. It inhibits the ascending pain pathways,
altering the perception of and response to pain by binding to opiate receptors in the
CNS but also acts to cause hallucinations and is an antagonist at mu receptors.
Indications:
Relief to moderate to severe pain
Preoperative analgesia, as a supplement to surgical anesthesia
Prevention and treatment of intrathecal morphine-induced pruritus after CS
Contraindications:
Hypersensitivity to nalbuphine, sulfites
Use cautiously with emotionally unstable patients or those with history of opioid
abuse, bronchial asthma, COPD, respiratory depression, anoxia, increased
ICP,acute MI
Adverse Reactions:
CNS: sedation, clamminess, sweating, headache, nervousness, restlessness,
depression, crying, confusion, faintness, unusual dreams, hallucinations,
dizziness, vertigo, floating feeling, feeling of heaviness, numbness, tingling,
flushing, warmth, blurred vision
GI: Nausea, vomiting, cramps, dyspepsia, bitter taste dry mouth
GU: urinary urgency
Respiratory : respiratory depression, dyspnea, asthma
Nursing Responsibilities:
Assess for hypersensitivity to nalbuphine, sulfites, emotional instability or history
of opioid abuse, bronchial asthma, COPD, respiratory depression, anoxia,
increased ICP, and MI
Observe the 12 rights when administering the drug
Taper dosage when discontinuing after prolonged use to avoid withdrawal
symptoms
Reassure patient about addiction liability
Discontinue if hypersensitivity occurs
Observe for adverse reactions
Health Teachings:
May experience side effects
Avoid performing tasks that require alertness
For loss of appetite, lying quietly and eating small frequent meals may help
Report severe nausea, vomiting, palpitations, shortness of breath, or difficulty in
breathing
Rationale: It is given to alleviate the pain experienced by the patient.