Drug Study

AcetaminophenAcetaminophen

Drug #1

Patient: Mr. Abs

Drug Ordered: September 14, 2010

Attending Physician: Vivian Polarez

Generic name: Acetaminophen

Brand name: Paracetamol

Classification: Analgesic

Indications:Indications:

Relief of mild to moderate pain; treatment of fever. Analgesic-antipyretic in patients with aspirin allergy,

hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis

Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant anti-rheumatic and anti-inflammatory effects)

Common cold, flu, other viral and bacterial infections with pain and fever

Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

Contraindication:Contraindication:

Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function,

chronic alcoholism, and pregnancy, lactation.

Dosage: 500mg PRN

Mechanism of Action:Mechanism of Action:

Decrease fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leaders to sweating and vasodilation. Relieves pain by inhibiting prostaglandin synthesis at the CNS but does not have anti-inflammatory action because of its minimal effects of peripheral prostaglandin synthesis.

Adverse reaction:Adverse reaction:

• CNS: Headache •CV: Chest pain, dyspnea, myocardial damage when

doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr

•GI: Hepatic toxicity and failure, jaundice •GU: Acute kidney failure, renal tubular necrosis •Hematologic: Methemoglobinemia—cyanosis;

hemolytic anemia—hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia

•Hypersensitivity: Rash, fever.

Nursing responsibility:Nursing responsibility:

Do not exceed the recommended dosage. Avoid using multiple preparations containing

acetaminophen. Carefully check all OTC products. Give drug with food if GI upset occurs. Discontinue drug if hypersensitivity reactions occur Treatment of overdose: Monitor serum levels regularly, - acetylcysteine should be available as a specific

antidote; basic life support measures may be necessary.

Health Teaching:Health Teaching:

Do not take for longer than 10 days. Take the drug only for complaints indicated; it is not an

anti-inflammatory agent. Avoid the use of other over-the-counter preparations.

They may contain acetaminophen, and serious over dosage can occur. If you need an over-the-counter preparation, consult your health care provider.

Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns.

Rationale:Rationale:

the drug was given to decrease the patient’s body temperature of 38 degrees to the normal range.

Cefuroxime axetilCefuroxime axetil

Drug #2

Patient: Mr. Abs

Drug Ordered: September 14, 2010

Attending Physician: Vivian Polarez

Generic name: Cefuroxime axetil

Brand name: Ceftin

Classification: Second generation’s cephalosporins

Indications:Indications:

Both cefuroxime sodium and cefuroxime axetil is used in treating infections of Upper and Lower respiratory tract, skin and soft tissue, UTI, bone & joint infections and gonococcal infections.

Cefuroxime sodium on addition is indicated in treating serious infection pending bacteriological identification, Meningitis, Prophylaxis against infection in surgical procedures, Urinary infections, Patients with renal failure undergoing CAPD (continuous ambulatory peritoneal dialysis).

Cefuroxime axetil is also indicated in treating and preventing Lyme disease.

Contraindication:Contraindication:

Ceftin products are contraindicated in patients with known allergy to the cephalosporin group of antibiotics.

Dosage: 500mg BID

Mechanism of Action:Mechanism of Action:

Cefuroxime, a beta-lactam antibiotic, inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) that are located inside the bacterial cell wall.

Adverse reaction:Adverse reaction:

Anaphylaxis, pseudomembranous colitis, nausea and vomiting, transient elevation of liver enzymes.

altered laboratory tests: toxic nephropathy, aplastic anemia, hemorrhage, increased BUN, increased creatinine, false-positive test for urinary glucose, increased alkaline phosphatase, neutropenia, elevated bilirubin, and agranulocytosis.

Nursing responsibility:Nursing responsibility:

Instruct the patient to take drug exactly as prescribes, even after he feels better. Because bacteria may still be present even if he or she feels ok already.

Oral drugs should be taken with food to enhance absorption.

Tablet are not bio-equivalent and not substitutable on a mg-per-mg basis.

Prior to reconstitution, protect the drug front he light. The power and reconstituted drug may darken without affecting potency.

Health TeachingHealth Teaching

Cefuroxime axetil for PO use is available in tablet and suspension forms. Swallow tablets whole and not crush, crushed tablet has a strong, bitter, persistent taste. The tablets may be taken without regard for food. Protect tablets from excessive moisture.

Instruct patient to not take drug if patient cefuroxime have ever had an allergic reaction to another cephalosporin to to penicillin unless the doctor is aware of the allergy and monitors their therapy.

MetronidazoleMetronidazole

Drug #3

Patient: Mr. Abs

Drug Ordered: September 14, 2010

Attending Physician: Vivian Polarez

Generic name: Metronidazole

Brand name: Flagyl

Classification: Antiprotozoal, antibacterial agent, Anti-infectives,

Indications:Indications:

Metronidazole is given for treatment of protozoal infections like amoebiasis, giardiasis and trichomonas vaginitis. It is also used in the treatment of anaerobic infection, ulcerative gingivitis, trench mouth, guinea worm infestation.

Contraindication:Contraindication:

Flagyl is contraindicated in patients with a prior history of hypersensitivity to metronidazole or other nitroimidazole derivatives.

In patients with trichomoniasis, Flagyl is contraindicated during the first trimester of pregnancy.

Metronidazole is contraindicated in blood dyscrasias, hypersensitivity, certain serious neurological diseases, alcohol and severe hepatic failure.

Dosage: 500mg

Mechanism of Action:Mechanism of Action:

Metronidazole is amebicidal, bactericidal, and trichomonicidal. Unionized metronidazole is readily taken up by anaerobic organisms and cells. Its selectivity for anaerobic bacteria is a result of the ability of these organisms to reduce metronidazole to its active form intracellularly. The electron transport proteins necessary for this reaction are found only in anaerobic bacteria. Reduced metronidazole then disrupts DNA's helical structure, thereby inhibiting bacterial nucleic acid synthesis. This eventually results in bacterial cell death. Metronidazole is equally effective against dividing and nondividing cells.

Adverse reaction:Adverse reaction:

seizures (convulsions); fever, chills, body aches, sore throat, flu symptoms; 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; or Diarrhea that is watery or bloody.

Less serious side effects may include: nausea, stomach pain, diarrhea; headache, dizziness, loss of balance; vaginal itching or discharge; dry mouth or unpleasant metallic taste; cough, sneezing, runny or stuffy nose; or Swollen or sore tongue.

Nursing responsibility:Nursing responsibility:

Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated.

Assess for allergic reactions: rash, urticaria, pruritus.. May cause dizziness or light-headedness. Caution

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

Inform patient that medication may cause an unpleasant metallic taste.

Inform patient that medication may cause urine to turn dark.

Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

Health TeachingHealth Teaching

Instruct patient to take with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing.

Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose.

May cause lightheadedness. Caution patient or other activities requiring alertness until response to medication is unknown.

Patient & Family EducationPatient & Family Education

* Adhere closely to the established regimen without schedule interruption or changing the dose.

* Do not drink alcohol during therapy; may induce a disulfiram-type reaction . Avoid alcohol or alcohol-containing medications for at least 48 h after treatment is completed.

* Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears to have no clinical significance.

* Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis; vaginitis, curd-like, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be indicated.

Rationale:Rationale:

This is given to patient for infection.

Essentiale ForteEssentiale Forte

Drug #4 Patient: Mr. Abs Drug Ordered: September 14, 2010 Attending Physician: Vivian Polarez Generic name: @@@@ Brand name: Essentiale Forte Classification: Cholagogues, Cholelitholytics

& Hepatic Protectors 

Indications:Indications:

Acute, subacute & chronic hepatitis; toxic metabolic liver diseases, intoxications (eg from drugs); infection, fatty degeneration of the liver due to alcohol, hypernutrition, DM, kwashiorkor, pregnancy; cholestasis; pre- & post-op care, esp in liver/gallbladder surgery.

Dosage:Dosage:

Intensive Therapy: 1-2 forte caps 3 times a day for the first 2 months.

Maintenance Therapy: 1-2 plain caps 3 times a day. To be swallowed whole, with a little liquid if desired.

Mechanism of Action:Mechanism of Action:

Essentiale/Forte regulates membrane permeability and improves the exchange of substances between the intra- and extracellular space. It activates metabolic function and supports the energy balance of the liver. It restores enzyme functions and promotes detoxification of the liver. Neutral fats and cholesterol are transformed into transportable forms and led to their physiological oxidation. Liver cell regeneration is stimulated and the bile is stabilized.

Nursing Responsibilities:Nursing Responsibilities:

Advice patient to take drug with food. Instruct patient to decrease alcohol intake. Increase fluid intake.

Rationale:Rationale:

This drug is given to the patient to restore the normal liver functioning.