CP Intestinal Obstruction Drug Study

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


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


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


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


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


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.


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


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.


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


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


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


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


Assess for history of CNS or hepatic disease, candidiasis, blood dyscrasias

Reduce dosage with hepatic disease




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


Expect dark colored urine

Report severe GI upset, dizziness, unusual fatigue or weakness, fever, chills

Rationale: To treat the existing acute infection.

Drug # 8


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


Assess for history of hepatic and renal impairment, CV and GI conditions,

impaired hearing


Administer drug with food

Institute emergency procedures if overdose occurs


Monitor with use of anticoagulants ( increased risk of bleeding)

Health Teachings:

Take drug with food

Take only the prescribed dosage


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


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


Assess for hypersensitivity to omeprazole or its components


Administer with antacids if needed administer before meals


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


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


Assess for hypersensitivity to nalbuphine, sulfites, emotional instability or history

of opioid abuse, bronchial asthma, COPD, respiratory depression, anoxia,

increased ICP, and MI


Taper dosage when discontinuing after prolonged use to avoid withdrawal

symptoms

Reassure patient about addiction liability



Health Teachings:


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.

CP Intestinal Obstruction Drug Study

Documents

existing acute

hypersensitivity

gastric ulcers

nursing responsibilities

acute infection

dry mouth

respiratory

severe reactions