Drug Study Final (1)

7/28/2019 Drug Study Final (1)

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DRUG STUDY

Drug Order Pharmacologic

Act ion of Drug

Indicat ion/Contraindicat ion Adv erse Effects Desired

Act ions

Nursing

Responsibi l i t ies

HydrocortisoneSodium

Succinate

(Solu-Cortef)

250 mg IV @ LD

and 100 mg IV q 6

Short-actingcorticosteroid

Anti-inflammatory

Inhibitsaccumulation of

inflammatorycells at

inflammatorysites,

phagocytosis,

lysosomalenzyme release,synthesis and/or

release ofmediators ofinflammation.

Indication:Treatment for people with:

Short-terminflammatory

disorders

Allergic disorders

Autoimmunedisorders

Contraindication:

Hypersensitivity todrugs, alcohol,

bisulfites, ortartrazine.

Concurrent use ofother

immunosuppressantcorticosteroids.

Concurrentadministration of live-

virus vaccines.

CNS: Headache,restlessness, seizureCV: Hypertension,arrhythmiasGI: Nausea andvomitingMetabolic:

Hypokalemia,hyperglycemia,hypocalcemia,sodium and fluidretentionMusculoskeletal:Muscle pain orweaknessRespiratory: CoughSkin: Rash, pruritis

To decreaseinflammation.

Assess for anyhypersensitivity or

any allergicreaction in the

patient.

Assess weight, BP(take note of

hypertension),serum glucose(take note of

hyperglycemia)and cholesterol.

Monitorelectrolytes and

note forhypokalemia ,nausea andvomiting and

irritability.

Instruct patient toeat small, frequentmeals if prescribed

to minimize GI


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Use cautiously inpatients with cardiac

disease,hypertension,

glaucoma, seizuredisorders and

hyperthyroidism.

Monitor patientsvital signs

especially bloodpressure and

electrolyte levels.Take note of

hypertension andhypokalemia.

Instruct patient toswallow extended-release tablets and

not to mix themwith food.

Advise patient toestablish effectivebedtime routineand to take drug

well beforebedtime to

minimize insomnia.


Act ion of Drug


Act ions

Nursing


Ipratropiumbromide-

Salbutamol

Inhibitscholinergicreceptors in

Indications:

Treatment for people with:

CNS: HeadacheCV: Palpitations,arrhythmias,

To preventobstructed

airway


any allergic


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(Duavent)

72 mcg

q 6

Anticholinergic

Allergy, cold andcough remedy,bronchodilator

bronchial smoothmuscle,

decreasing levelof cyclic

guanosinemonophosphate

and dilatingbronchioles.When used

locally, inhibitssecretions fromglands lining the

nasal mucosa.

Management ofreversible

bronchospasmassociated with

obstructive airwaydiseases (e.g.,

bronchial asthma).

For patients withchronic obstructivepulmonary disease

(COPD).

Contraindication:

Hypersensitivity tocomponents,

atrophine or soyalecithin and related

food products.

Hypertrophicobstructive

cardiomyopathy ortachyarrhythmia.

hypotensionRespiratory: Chest

pain, cough,bronchospasmGI: Nausea andvomiting, GI irritation,throat irritation anddrynessMusculoskeletal:Back pain

passages. reaction in thepatient.

Assess vital signsespecially blood

pressure and takenote of

hypotension.

Position patient onhigh back rest

position.

Provide backtapping afternebulization.

Instruct patient toprevent intake offood right afternebulization.

Instruct patient torinse mouth after

each dose tominimize throat

irritation anddryness.
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Act ion of Drug


Act ions

Nursing


TicarcillinClavulanic Acid

(Timentin)

3.2 g IV q8 (-)ANST

Penicillin

(extendedspectrum)

Anti-infective

Ticarcillinimpairs the

bonds that holdthe bacterial cellwall together andClavulanic Acidprevents thesebacteria from

inactivating the

ticarcillin, andleaves thebacteria

susceptible toattack.

Indication:

Treatment for people with:

Systemic and urinarytract Infections

caused by susceptiblestrains of thedesignated

microorganisms.

Contraindication:

Hypersensitivity todrug or otherpenicillins.

Use cautiously incystic fibrosis, renal or

hepatic diseases.

CNS: Headache,dizziness,hyperreflexia, fatigue,lethargy, seizuresGI: Nausea andvomiting, diarrhea,flatulenceMetabolic:Hypernatremia,

hypokalemiaHematologic:Bleeding, prolongedbleeding time,thrombocytopeniaSkin: Rash

To preventbacterialgrowth.


any allergic reactionin the patient.

Assess patients vitalsigns.

Monitor neurologicstatus and take note

of seizures.

Monitor serumelectrolyte levels forhypernatremia due

to drugs highsodium content andfor hypokalemia dueto increased urinary

potassium loss.

Monitor patientsplatelet count, PT

and APTT becausemedicine may cause

increase bleedingtime and in rare


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cases, may inducethrombocytopenia.

Assess for signs ofbleeding such aseasy bruising with

induration andfrequent or

prolonged nosebleeding.

Instruct patient to

decrease sodiumintake to reduce the

risk of electrolyteimbalance.

Instruct patient toreport severe or

prolonged diarrhea.Remind patient that

watery or bloody

stools can occur 2 ormore months afterantibiotic therapy

and can be serious,requiring prompt

treatment.

Levetiracetam May protectagainst

Indication: CNS: Anxiety,depression, fatigue,

To preventseizure.

Assess for any
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(Keppra)

500 mg BID

Pyrrolidinederivative

Anticonvulsant

secondarygeneralized

seizure activityby preventing

coordination ofepileptiformburst firing.

Levetiracetamdoesnt seem toinvolve inhibitory

and excitatoryneurotransmissio

n.

For people with:

Partial onset seizure

Epilepsy

Contraindication:

Hypersensitivity tolevetiracetam or other

pyrrolidonederivatives or any of

the excipients ofKeppra.

headache, insomnia,somnolence,

seizures, irritabilityGI: Constipation,diarrhea, hepaticfailure, nausea andvomitingRespiratory:Asthma, coughOther: Infection, pain

hypersensitivity orany allergic reaction

in the patient.

Assess vital signsespecially

temperature andtake note of signsand symptoms ofinfection (such as

fever).

Instruct patient totake medicine withor without food and

to swallow themedicine whole.

Instruct patient totake safety

measures (such as

raise side rails whenlying in bed) andavoid dangerous

activities to preventinjury.

Instruct patient toavoid mental

activities that require


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mental alertness toprevent mental

stress and disorders(such as headache).

Instruct patient totake small, frequent

meals to minimize GIupset (such as

nausea andvomiting).

Encourage patient toavoid alcohol during

therapy becausealcohol can increase

incidence ofdrowsiness and

dizziness.

Carbamazepine

(Tegretol)

200 mg/tabTID

Iminostilbenederivative

Anticonvulsant

Decreasessynaptic

transmission inthe CNS by

affecting sodiumchannels in

neurons.

Indication:

For people with: Partial Seizures

Generalized Tonic-Clonic Seizures

(Grand Mal)

CNS: Drowsiness,fatigue, headache

and ataxiaCV: Hypertension,hypotensionGI: Nausea andvomiting, diarrhea,abdominal pain,anorexia and drymouthGU: Albuminuria,

To preventseizures.


any allergic reactionin the patient

Assess patients vitalsigns especially BP

and intake andoutput, and take

note of hypertension,


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Contraindication:

Hypersensitivity Bone marrow

depression

Porphyria

glycosuria, fluidretention

hypotension or Fluidretention.

Provide mouth careto help reduce dry

mouth.

Instruct patient totake medicine with

food to preventgastric irritation.

Instruct patient toavoid hazardous

activities to preventmental stress (such

as headache,drowsiness and

fatigue).

Salmeterolxinafoate

(Seretide)

250 mcg1 PUFF BID

Beta2-adrenergicreceptor agonist

(long acting)

Bronchodilator

Protects againstsymptoms,

improves lungfunction and

preventsexacerbations of

the condition.

Indication:

For people with:

Asthma

Chronic bronchitis

Emphysema

Prevention ofexercise-inducedbronchospasm

Contraindication:

CNS: Headache,nervousness,dizziness, tremorCV: Palpitations,

hypertension,tachycardia,arrhythmiasGI: Nausea andvomiting, abdominalpain, dry mouthMetabolic:Hyperglycemia,hypokalemia

To help treatobstructedairwaypassages.


any allergic reactionto the patient.

Assess vital signsespecially heart rate

(take note oftachycardia andarrhythmias) and

blood pressure (takenote of


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Hypersensitivity toany ingredient of

Seretide.

Use cautiously incardiovascular

disease, diabetesmellitus,

hyperthyroidism.

Musculoskeletal:Muscle cramps and

sorenessRespiratory:ParadoxicalbronchospasmSkin: Angioedema,rash

hypertension).

Assess patientspulmonary status

and take note of anysigns of rash,

urticaria,angioedema, and

paradoxicalbronchospasm.

Instruct patient how

to use the inhaler byinstructing him to

slide the lever onlyonce when preparing

dose to avoidwasting doses.

Advise him to exhaleimmediately before

using the inhaler andthen to place

mouthpiece to hislips and inhale

through his mouth,not his nose. Thenhe should remove

mouthpiece from hismouth, hold his

breath for at least 10seconds and exhale


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slowly.

Provide patient withoral care to prevent

dry mouth.

Potassiumchloride

(Kalium Durule)

20 mEq/1 tab TID

Mineral,electrolyte

Electrolytereplacement,

nutritionalsupplement

Essential formaintenance of

intracellularisotonicity,

transmission ofnerve impulses,

contraction ofcardiac, skeletal,

and smoothmuscles,

maintenance ofnormal kidney

function, and forenzyme activity.

Indication:

For people with:

Potassium deficitsecondary to diuretic

or corticosteroid

therapy.

Contraindication:

Severe renalimpairment

Severe hemolyticreactions

Untreated Addisonsdisease

Crush syndrome

Early postoperativeoliguria (except during

GI drainage)

Adynamic ileus

Acute dehydration

Heat cramps

Hyperkalemia

CNS: Confusion,unusual fatigue,restlessness,paresthesiaCV: Hypotension,arrhythmias

GI: Nausea andvomiting, diarrhea,abdominaldiscomfort, flatulenceMetabolic:HyperkalemiaMusculoskeletal:Weakness andheaviness of legsRespiratory:

Respiratory paralysis

To increasepatients

potassiumlevel.


any allergic reactionin the patient.

Assess vital signs of

patient especiallyintake and outputpattern and blood

pressure.

Assess patient forany signs and

symptoms of GIulceration (such as

burning pain at

ulceration site,nausea and

vomiting, vomiting ofblood).

Monitor patient withcardiac monitor, take

note for irregular


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Patients receivingpotassium-sparing

diuretics

heartbeat andarrhythmias.

Instruct patient totake oral medicinewith or just after

meal (with glass ofwater or fruit juice) toprevent GI irritation

and to swallowextended-releasecapsules whole

without crushing orchewing them.

Instruct patient totake small, frequent

meals and drinkplenty of fluids toprevent GI upset.

Instruct patient to

minimize intake offoods containing

potassium to avoidpotassium deficit.


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Prednisone

(Deltasone)

20 mg 1 tabTID

Corticosteroid(immediate

acting)

Anti-inflammatory,immuno

suppressant

Decreases

inflammation bysuppression of

migration ofpolymorphonucle

ar leukocytesand reversal of

increasedcapillary

permeability;suppresses the

immune systemby reducing

activity and volof the lymphatic

system;suppresses

adrenal functionat high doses.

Indication:

For people with:

Severe allergicreactions

Breathing problems

Immune systemdisorders.

Contraindication:

Hypersensitivity

Serious infections(except tuberculous

meningitis)

Varicella

Systemic fungalinfections

CNS: Headache,

nervousness,depression, seizures,restlessness,paresthesia,insomniaCV: Hypotension,hypertension, heartfailure, arrhythmiasGI: Nausea andvomiting, abdominal

distention, dry mouthMetabolic: Sodiumand fluid retention,hypokalemia,hypocalcemia,hyperglycemia,diabetes mellitus,decreasedcarbohydratetolerance

Musculoskeletal:Muscle weakness oratrophy, myalgia,myopathyRespiratory: Cough,wheezing,bronchospasm

To lessen

inflammation

Assess for any

hypersensitivity orany allergic reaction

to the patient.

Assess for patientsvital signs especially

blood pressure,intake and outputpattern and sleep

pattern.

Assess patientsfasting blood

glucose and serumglucose levels for

hypoglycemia.

Monitor patient forchanges in mood

and behavior,

emotional stability orpsychomotor activity,especially with long-

term therapy.

Instruct patient totake medicine withfood or milk and to


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take once-daily dosein the morning to

reduce GI upset(nausea and

vomiting).

Instruct patient toestablish effective

bedtime routine andto take drug wellbefore bedtime to

minimize insomnia.

Instruct patient toavoid alcohol duringtherapy because ofincreased risk of GIulcers and bleeding.

Instruct patient toavoid hazardous

activities to prevent

mental stress.

Instruct patient toavoid people with

contagious diseasebecause drug has

immunosuppressanteffect. Advise to

report exposure to


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contagious diseaseif any.


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Intravenous Fluids

Treatment/Infusion

Classification Indication Contraindication Nursing Responsibilities/Precautions

D5NM 1L x 12hours

30 gtts + 40 mEqKCl

Hypertonic,nonpyrogenic,

parenteral fluid,electrolyte and

nutrientreplenisher

Parenteral maintenanceof routine daily fluid andelectrolyte requirements

with minimalcarbohydrate calories

from dextrose.

Hypersensitivity toany of the

components.

Check vital signs frequently.

Do not administer unlesssolution is clear and

container is undamaged.

Caution must be exercised

in the administration ofparenteral fluids, especiallywith containing sodium ions

receiving corticosteroids.

Discard unused portion.

Report adverse reactions.

Monitor fluid intake andoutput

Reference: Nurses Drug Handbook by McGraw-Hill 6th edition,Nurses Drug Handbook by Jones and Bartlett Learning 10th edition

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Drug Study Final (1)