Rene John G. Francisco BN4-A; Group 2 February 15, 2013

Drug Study (Diazepam, Lanoxin, Hemostan, Naprex)

Name of the Drug

Dosage/ Route/ Timing

Mechanism of Action

Indication Contraindication Adverse Reaction Nursing Responsibility

Generic Name:

Diazepam

Brand Names:

Apo-Diazepam, Diastat, Diazemuls , E-Pam , Meval , Novodipam , Valium, Valrelease, Vivol 

Classifications:

Antianxiety agents, anticonvulsants, sedative/hyptonics, skeletal muscle relaxants (centrally acting)

2, 5, 10 mg/ tablet PO bid

5 mg/mL IVTT q3-4 hours PRN

Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.- Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways.- Has anticonvulsant properties due to enhanced presynaptic inhibition. Therapeutic effects:(1) Relief of Anxiety(2) Sedation(3) Amnesia(4) Skeletal muscle relaxant(5) Decreased seizure activity

.

Drug of choice for status epilepticus.

Management of anxiety disorders, for short-term relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs. Also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus.

- Hypersensitivity- Cross-sensitivity with other benzodiazepines may occurs- Comatose patients- Pre-existing CNS depression- Uncontrolled severe painUse cautiously in:1) Hepatic dysfunction2) Severe renal impairment3) History of suicide attempt or drug dependence

Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia. CV: Hypotension, tachycardia, edema, cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus. GI: Xerostomia, nausea, constipation, hepatic dysfunction. Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure. Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site.

Assessment & Drug Effects-Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy.- Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis.- Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies.- Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after administration.- IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption.- Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.- Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

Name of the Drug

Dosage/ Route/ Timing

Mechanism of Action

Indication Contraindication Adverse Reaction

Nursing Responsibility

Generic Name:

Digoxin

Brand Names:Lanoxicaps, Lanoxin

Classifications: Cardiovascular agent; cardiac glycoside; antiarrhythmic

Per Orem: 0.4-0.6 mg initially, followed by 0.1-0.3mg q6h or q8h

IV: 0.125-0.5mg/day

IVTT

Increases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance. Inhibits sodium/potassium-ATPase resulting in increased calcium influx and increased release of free calcium ions within the myocardial cells, which potentiates the contractility of cardiac muscle fibers which decreases the rate of conduction thereby decreasing heart rate

Treatment of congestive heart failure

Control of rapid ventricular contractions in clients with atrial fibrillation/flutter

Slow the heart rate in sinus tachycardia

Treatment of SVT

Treatment of cardiogenic shock

Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm

Contraindicated to patients with ventricular fibrillation, ventricular tachycardia, those with presence of digoxin toxicityHypersensitivity to the drug componentsPatients with conditions such as Beriberi, heart disease, hypersensitive carotid sinus syndrome

CNS: fatigue, generalized muscle weakness, agitation, hallucinations, CV: arrhythmias, heart block.

EENT: yellow-green halos around visual images, blurred vision, light flashes, photophobia, diplopia.

GI: anorexia, nausea

Assessment & Drug Effects Be familiar with patient’s baseline data (e.g., quality of

peripheral pulses, blood pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a foundation for making assessments.

Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Notify physician of abnormal values. Draw blood samples for determining plasma digoxin levels at least 6 h after daily dose and preferably just before next scheduled daily dose. Therapeutic range of serum digoxin is 0.8–2 ng/mL; toxic levels are >2 ng/mL.

Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If changes are noted, withhold digoxin, take rhythm strip if patient is on ECG monitor, notify physician promptly.

Withhold medication and notify physician if apical pulse falls below ordered parameters (e.g., >50 or 60/min in adults and >60 or 70/min in children).

Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.

Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate chest for rales.

Monitor serum digoxin levels closely during concurrent antibiotic–digoxin therapy, which can precipitate toxicity because of altered intestinal flora.

Observe patients closely when being transferred from

one preparation (tablet, elixir, or parenteral) to another; when tablet is replaced by elixir potential for toxicity increases since  30% of drug is absorbed.

Patient & Family Education Report to physician if pulse falls below 60 or rises

above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation.

Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances.

Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.

Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day.

Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician.

Continue with brand originally prescribed unless otherwise directed by physician.

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

Name of Drug Dosage, Route, Timing

Mechanism of Actions

Indications Contraindications Adverse Effect Nursing Responsibilities

Generic Name:

Tranexamic Acid

Brand name:

 Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin

Classification: 

Anti-fibrinolytic, antihemorrhagic

Oral Short-term management of haemorrhage

Adult: 1-1.5 g or 15-25 mg/kg 2-4times.Child: 25 mg/kg bid or tid. Renal impairment: Adjust dose based on serum creatinine c o n c e n tr a t i o n : 1 2 0 -2 50 micromol/l: 15 mg/kg bid daily;2 5 0 -5 0 0 m i c r o m o l /l : 1 5 m g / k g

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. Anti-fibrinolytic 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

Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas:

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.

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia

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

Precautions

Pregnancy. Tranexamic acid crosses the placenta.

Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration.

Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation.

Renal function

CNS: Confusion, Severe or persistent headache,Slurred speech, vision changes

Respiratory: Chest pain, Coughing up blood, Shortness of breath

Integ: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue

GU: Decreased urination

MS: Severe or persistent body malaise

Others: Calf pain, swelling or tenderness

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.

once daily; >500 micromol/l: 7.5m g / k g o n c e d a i l y

physiological hemostasis.

Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage

Effective in promoting hemostasis in traumatic injuries.

Preventing hemorrhage after orthopedic surgeries.

impairment    (medication may accumulate; dosage adjustment based on the degree of impairment is recommended)

Hematuria of upper urinary tract origin    (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease)

Name of Drugs Dosage/ Route/ Timing

Drug Mechanism of Action

Indications Contraindication Adverse Effect Nursing Responsibilities

Generic Name:Paracetamol

Brand Name:Naprex

Classification:Analgesic

200mg/ IVTT/ Q4º Produces analgesia by blocking

generation of pain impulses. This action

is probably caused by inhibition of prostaglandin

synthesis; it may also be caused by

inhibition of the synthesis or action of other substances that

sensitize pain receptors to

mechanical or chemical stimulation.

It relieves fever by central action in the hypothalamic heat-regulating center.

Mild pain or fever Paracetamol should not be used in

hypersensitivity to the preparation and in

severe liver diseases.

Skin: Rash, urticaria

Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia

Hepatic: jaundice, severe liver damage with toxic doses

Metabolic: hypoglycemia

Take the temperature before and 1 hour after giving the medication.

Provide tepid sponge if fever occurs.

Has no significant anti-inflammatory effect

Warn patient that high doses or unsupervised chronic use can cause hepatic damage. Excessive ingestion of alcoholic beverages may increase the risk of hepatoxicity

Should not be used for self-medication of marked fever (greater than 39.5°C), fever persisting longer than 3 days, or recurrent fever unless directed by doctor.

Inspect the insertion site for phlebitis (inflammation of a vein).

Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth.

If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion.