DRUG STUDY GENERIC NAME/ BRAND NAME CLASSIFIC ATION DOSAGE / ROUTE/ FREQ. THERAPEUTIC ACTION INDICATION ADVERESE REACTION/SIDE EFFECT INTERACTION S CONTRAINDIC ATION NURSING IMPLICATION/ INTERVENTION HYDROCORTIS ONE SODIUM SUCCINATE [SOLU- CORTEF] Short- acting Corticos teroids Anti- inflamma tory 100 mg q 8 hrs Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer;arthrir is; collagen disease; dermatologic disease; autoimmune and hematologic disorder; trichinosis; ulcerative colitis; multiple sclerosis; aspiration pneumonia CNS: headache, nervousness, vertigo, insomnia, restlessness, increase ICP, seizure CV: hypotension, hypertension, heart failure, thrombophlebi tis, fat embolism, arrhythmias EENT: glaucoma, cataract, increase ICP, epistaxis, nasal congestion, hoarseness, DRUG-DRUG: Loop and diuretics, hormonal contracepti ves, insulin, NSAID’s, rifampin. DRUG-Dx TEST: Ca, k, T3, T4, cholesterol , glucose, digoxin assay DRUG-HERBS: Gensing, echinacea Hypersenti vity to drug Other immunosupp ressant corticoste roids Hypertensi on,osteopo rosis, glaucoma, renal & GI disease, cirrhosis Pregnant breastfeed ing patient Children age 6 and younger Give oral form with food or milk to avoid GI upset Give I.V. injection of sodium succinate from over 30 sec. to few min. Know that drug may be given as intermittent or continuous I.V. dilute in NSS, D5W, and D5NSS. Monitor BP, weight, and electrolytes. As appropriate, review all other
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DRUG STUDY
GENERIC NAME/ BRAND NAME
CLASSIFICATION
DOSAGE/
ROUTE/ FREQ.
THERAPEUTIC ACTION
INDICATION ADVERESE REACTION/SIDE
EFFECT
INTERACTIONS
CONTRAINDICATION
NURSING IMPLICATION/
INTERVENTION
HYDROCORTISONE SODIUM SUCCINATE[SOLU-CORTEF]
Short-acting Corticosteroids
Anti-inflammatory
100 mg q 8 hrs
Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators
Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer;arthriris; collagen disease; dermatologic disease; autoimmune and hematologic disorder; trichinosis; ulcerative colitis; multiple sclerosis; aspiration pneumonia
Hypertension,osteoporosis, glaucoma, renal & GI disease, cirrhosis
Pregnant breastfeeding patient
Children age 6 and younger
Give oral form with food or milk to avoid GI upset
Give I.V. injection of sodium succinate from over 30 sec. to few min.
Know that drug may be given as intermittent or continuous I.V. dilute in NSS, D5W, and D5NSS.
Monitor BP, weight, and electrolytes.
As appropriate, review all other significant and life-threatening adverse reactions and interaction, especially those related to the drugs, tests, herbs, and behaviors.
Inhibits the enzyme DNA gyrase in susceptible gram-negative and gram-positive aerobics and anerobic bacteria, interfering with bacterial DNA synthesis.
Acute bacterial exacerbation of chronic bronchitis
Community-acquired pneumonia
Nosocomial pneumonia caused by nethicillin-susceptible strains of staphylococcus aureus.
Contraindicated in hypersensitivity to drug or to its components. (life-threatening reactions resembling hypersensitivity have occurred during and immediately after I.V injection).
Should be protected from light
Should not be allowed to freeze
Should be stored at 25°C or below
Should not be used if turbid
kernicterus. Use cautiously in pregnant or breasetfeeding patient, children, neonates.
Avoid P.O use in disorder that may prevent adequate absorption.
must be used in combination with other anti-TB drug
Take drug regularly; avoid missing dose. Do not D/C this drug without first consulting your AP.
Avoid aluminum-containing antacids within 1 hour of taking drugs
Arrage to have a periodic medical check-ups, which will include an eye examination
Instruct the client about the effect of anti- tb drugs
prostatic obstruction syndrome
Arthritic symptoms.
Fungal overgrowth
renal & hepatic effect
; malaise menstrual
disturbances tinnitus.
or sardines.
Buclizine HCl 25 mg, vit B1 10 mg, vit B12 25 mcg, vit B6 5 mg, vit C 500 mg
[APPEBON]
Appetite Enhancers
1 tab OD The mechanism by which buclizine exerts its antiemetic and antimotion sickness effects is not precisely known but may be related to its central anticholinergic actions. It diminishes vestibular stimulation and depresses labyrinthine function. An action on the medullary chemoreceptive trigger zone may also be involved in the antiemetic effect.
Thiamin is used in all key metabolic processes in the nervous system, heart, blood cells and muscles. It helps convert carbohydrates into energy and is useful in the treatment of nervous disorders. It may also be useful in treating certain types of heart disease.
tamin B6 is a water
Poor appetite Underwt anorexia
nervosa. For nutritional support in post-op cases,
soluble vitamin that is probably involved in more bodily processes than any other vitamin. It functions as a coenzyme, helping to speed up chemical reactions in cells. It is required by over 60 enzymes. There is evidence that it also plays a role in preventing and treating many diseases including heart disease.
Some women suffering from premenstrual syndrome (PMS) find that supplementing with Vitamin B6 brings relief from their symptoms. It is thought that this is down to its role in clearing out excess oestrogen from the body.
Vitamin B6 is required for Vitamin B12 to be absorbed.
bsorption of Vitamin B12 by the body is a very complicated process. Low levels of stomach acid or low levels of intrinsic factor can lead to deficiencies, which is why people over the age of 50 may have difficulty absorbing it from food. However the body generally has good reserves of Vitamin 12.
Vitamin B12 is essential for cell replication, especially red blood cells. It maintains the protective myelin sheath around nerves, helps convert food to energy, and plays a vital role in the creation of DNA and RNA, the
genetic material in cells.
ivabradin HCl[CORALAN]
Ant-anginal 7.5 mg 1 tab BID
Ivabradine is a pure heart rate-lowering agent, acting by selective and specific inhibition of the cardiac pacemaker Ifcurrent that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate. The cardiac effects are specific to the sinus node with no effect on intra-atrial, atrioventricular or intraventricular conduction times, nor on myocardial contractility or ventricular repolarisation
Symptomatic treatment of chronic stable angina pectoris in coronary artery diseasepatients w/ normal sinus rhythm.
Concomitant use not recommendedQT prolonging medicinal products- Cardiovascular QT prolonging medicinal products (e.g. quinidine, disopyramide, bepridil, sotalol, ibutilide, amiodarone).- Non cardiovascular QT prolonging medicinal products (e.g. pimozide, ziprasidone, sertindole, mefloquine, halofantrine, pentamidine, cisapride, erythromycin IV).The concomitant use of cardiovascular and non cardiovascular QT prolonging medicinal products with ivabradine should be avoided since QT prolongation may be exacerbated by heart rate reduction. If the combination appears necessary, close cardiac monitoring is needed.Pharmacokinetic interactionsCytochrome P450 3A4 (CYP3A4)Ivabradine is metabolised by CYP3A4 only and it is a very weak inhibitor of this cytochrome. Ivabradine was shown
Hypersensitivity, blood pressure is <90mmHg; sick sinus syndrome
Monitor BP and pulse before therapy, during dosage titration, and periodically throughout therapy.
Assess for signs of CHF ( peripheral edema, crackles, dyspnea, weight gain, jugular venous distention)
Angina: Assess location, duration, intensity and precipitating factors of patient's anginal pain.
Hypertension: Check frequency of refills to monitor adherence.
Monitor serum potassium periodically. Hypokalemia increases the risk of arrhythmias and should be corrected.
not to influence the metabolism and plasma concentrations of other CYP3A4 substrates (mild, moderate and strong inhibitors). CYP3A4 inhibitors and inducers are liable to interact with ivabradine and influence its metabolism and pharmacokinetics to a clinically significant extent. Drug-drug interaction studies have established that CYP3A4 inhibitors increase ivabradine plasma concentrations, while inducers decrease them. Increased plasma concentrations of ivabradine may be associated with the risk of excessive bradycardia.
DIGOXIN[LANOXIN]
Cardiac glycoside
Inotropic Anti-
arrythmic
0.25 mg 1 tab OD
Increases forces and velocity of myocardial contraction and prolongs refractory period of atrioventricular (AV) node by increasing calcium entry into myocardial cell. Slows conduction through sinoatrial and AV nodes and produces anti-arrhythmic effect
Assess apical pulse regularly for a full minutes. If rate is less than 60 beats/ min. withhold dose and notify physician
Monitoer for drug toxicity (nausea and vomiting, visual disturbances, arrhythmias, and altered mental status).
Monitor ECG and blood digoxin, potassium,
DRUG-HERBS:Coffee seed, cola seed, ephedra, st. john’s wort
mias Renal
impairements Hyperthyroid Elderlt
patientDdobesity
magnesium, calcium, creatinine
Stay alert for hypocalcemia. Know that digoxin toxicity, and may decreased digoxin efficacy
Tell patient to take drug at same time everyday
Teach patient how to recognize and report signs and symptoms of digoxin toxicity
Monitor BP and HR..REBAMIPIDE[MUCOSTA]
Antacids, Antireflux
Agents Antiulcerant
s
100 mg , 1 tab OD
Rebamipide is a mucosal protective agent and is postulated to decrease gastric blood flow, prostaglandin biosynthesis and decrease free oxygen radicals
Acute gastritis & acute exacerbation of chronic gastritis. Gastric ulcer
1 cap OD Dibencozide increases the protein "efficiency coefficient" ie, the percentage of "bound nitrogen" for protein build-up in the body compared to "ingested nitrogen" with food intake. The initial sign of effectiveness is manifested by a marked increase in appetite.Thus, dibencozide facilitates optimum utilization of dietary protein intake, contributes to the formation and repair of body tissues and stimulates appetite.
Premature babies
Low birth wt. retarded growth poor appetite in
infant children &
adult, adjuvant to treatment of TB & other chronic ailments
Convalescence from acute infection or surgery
Faulty nutrition in older people.
Dibencozide seems to be safe for most people. There are no reported side effects.Special Precautions & Warnings:Pregnancy and breast-feeding: Not enough is known about the use of dibencozide during pregnancy and breast-feeding. Stay on the safe side and avoid use.
Gastrointestinal (GI) conditions: Some GI conditions, such as ileal disease or surgical removal of part of the intestine, can reduce that amount of Vitamin B12, including dibencozide, that is absorbed from the intestine.
Chloramphenicol interacts with DIBENCOZIDE
Dibencozide is a form of vitamin B12. Vitamin B12 is important for producing new blood cells. Chloramphenicol might decrease new blood cells. Taking chloramphenicol for a long time might decrease the effects of dibencozide on new blood cells. But most people only take chloramphenicol for a short time so this interaction isn't a big problem
Dibencozide is a form of vitamin B12, since it is a nutritional supplement and not a medication, the side effect profiles and contraindications have not been studied.
However, it is important not to use it more often than directed, as too much Vitamin B12 can cause health problems
Take with food Report any lactose
intolerance
LANAOPRAZOLE[PREVACID]
Antiulcer agents,
Proton-
30 mg , 1 tab + 5 ml water
Binds to an enzyme in the presence of acidic gastric pH,
preventing the final transport of hydrogen ions into the gastric lumen.Therapeutic effect: Diminished accumulation of acid in the gastric lumen,with lessened acid reflux
active benign gastric ulcer, short-term
treatment of symptomatic GERD, healing and risk reduction of NSAIDassociated
gastric ulcer, Pathologic hypersecretory conditiond, including
Zollinger-Ellison syndrome.
pain, diarrhea, nausea
Derm: rash.
kinetics Warfarin Tacrolimus theophylline
clarithomycin abdominal pain and for frank
or occult blood in stool, emesis, or gastric aspirate.
Administer before meals. Capsules may be opened and sprinkled on 1
tbsp of applesauce, pudding, cottage cheese, or yogurt and swallowed
immediately for patients with difficulty swallowing. Do not crush or
chew capsule contents
Advise patient to avoid alcohol, products containing aspirin, or NSAIDs, and foods that
Aflavoured liquid consisting of protein(milk),carbohydrate(maltodextrinandsucrose),vegetableoils(rapeseedandsunfloweroils), minerals, vitamins and trace elements
Provides complete & balanced nutrition; sole source of nutrition (meal replacement) or food (diet) supplement.
No side effect mention
Iron supplementation
Lactise intolerance
Allergy on any ingredients of the product
Hypsersensitivity to milk
Instruct client to mix 3 scoop of fresubin milkto ½ glass of sterile water
Use measuring cup Maintain clean
preparation
general nutrients.
FENOTEROL[BERODUAL]
Antiasthmatic & COPD Preparations
1 neb q 8 hrs
Ipratropium bromide-salbutamol fixed-dose combination (FDC) maximizes the response to treatment in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) by increasing bronchodilation through 2 distinctly different mechanisms ie, anticholinergic (parasympatholytic) and β2-agonist
Prevention & treatment of symptoms in chronic obstructive airway disorders w/ reversible bronchospasm eg bronchial asthma & esp chronic bronchitis w/ or w/o emphysema.
Fine tremor of skeletal muscles,
nervousness, restlessness, palpitations; less frequently tachycardia, dizziness or headache. Dry mouth, throat irritation
or allergic
reactions, cough, paradoxical bronchoconstric
tion (rare). Urinary
retention may occur in particular,
in patients w/ preexisting outflow tract obstruction.
Other β-adrenergics,
anticholinergics,
xanthine derivatives;
β-blockers; diuretics;
digoxin , MAOIs,
tricyclic antidepressants;
halogenated hydrocarbo
n anesth
Hypertrophic obstructive
cardiomyopathy,
tachyarrhythmias.
Hypersensitivity to atropine-like substances or soya lecithin or related food products
Prophylactic management for mild, moderate, severe asthma
Symptomatic COPD
1 neb q 12 hrs
Glucocorticoid with a high topical anti-inflammatory potency. It has a strong affinity for and agonist activity at human glucocorticoid receptors.
It is used by inhalation for the prophylaxis of the symptoms of asthma; also, is administered by nasal spray in the prophylaxis and treatment of allergic rhinitis.
It is applied topically in the treatment of various skin
Candidiasis dryness of mouth
and throat Hoarseness Paradoxical
bronchospasm. Cutaneous
hypersensitivity reactions.
Possible systemic effects include suppression of adrenal function, growth
Ritovir Ketoconazole MOI TCA Beta2-
adrenergic blocker
diuretics
Primary treatment of severe acute asthmatic attacks or status asthmaticus when intensive measures are required. When applied topically:
Advice patient that drug is for long term maintenance.
Tell the patient not to stop oral or inhaled long acting beta agonist.
Instruct patient on the proper way of drug inhalation and not to exceed dose under any
diorders. retardation in children and adolescents, decrease in bone mineral density,
Is a beta2-adrenergic agent which acts on airway smooth muscle resulting in relaxation. Salbutamol relaxes all smooth muscle from the trachea to the terminal bronchioles and protects against all bronchoconstrictor challenges
Treatment/ prevention of bronchospasm
Tachycardia Dizziness Palpitations headache,
especially in hypersensitive patients
Cough Headache Nervousness Sinus
inflammation Sore or dry throat Tremor Trouble sleeping Unusual taste in
mouth Vomiting Paradoxical
bronchospasm Hypokalemia Immediate
hypersensitivtity reaction
Beta-blocker Diuretics Digoxin MAO/TCA
Hypersensitive reaction.
Urticania. Anginoedem
a. Rashes Anaphylaxis. Oropharynge
al edema
Instruct the patient on the how to use the nebulizer.
Instruct the patient on the frequency of nebulization.
Instruct the patient what to do during the asthma attack.
Advice the client when to attend for follow-up visits.
FLUCONAZOLE
Antifungal 200 mg 1 cap q
Binds to sterols in the fungal cell
Treatment of oropharyngeal,
CNS: Headache GI: Nausea,
Drug-drug Increased
Contraindicated with
Interventions Culture infection
DIFLUCAN BID membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism.
esophageal, vaginal, and systemic candidiasis
Treatment of cryptococcal meningitis
Prophylaxis of candidiasis in bone marrow transplants
vomiting, diarrhea, abdominal pain
Other: Rash
serum levels and therefore therapeutic and toxic effects of cyclosporine, phenytoin, benzodiazepines, oral hypoglycemics, warfarin anticoagulants, zidovudine
Decreased serum levels with rifampin, theophylline, tacrolimus
hypersensitivity to fluconazole, lactation.
Use cautiously with renal impairment.
prior to therapy; begin treatment before lab results are returned.
Decrease dosage in cases of renal failure.
Infuse IV only; not intended for IM or SC use.
Do not add supplement medication to fluconazole.
Administer through sterile equipment at a maximum rate of 200 mg/hr given as a continuous infusion.
Monitor renal function tests weekly, discontinue or decrease dosage of drug at any sign of increased renal toxicity.
Teaching points Drug may be given
orally or intravenously as needed. The drug will need to be taken for the full course and may need to be taken long term.
Use hygiene measures to prevent reinfection or spread of infection.
Arrange for frequent follow-up while you are using this drug. Be sure to keep all appointments, including those for blood tests.
These side effects may occur: Nausea, vomiting, diarrhea (eat frequent small meals); headache (analgesics may be ordered).
Report rash, changes in stool or urine color, difficulty breathing, increased tears or salivation.
TERGECEF[TERGECEF]
Cephalosporin
Anti-infective
200 mg 1 cap BID
Third general cephalosporin that inhibits cell wall synthesis, promoting osmotic instability usual bactericidal.
Bronchitis bronchiectasis
with infection, secondary infections of chronic respiratory tract diseases
pneumonia Pyelonephritis Cystitis gonococcal
urethritis Cholecystitis Cholangitis scarlet fever Otitis media Sinusitis.
Hpersensivity to penicillin, cephalosporin, imipenems, or beta-lavtamase inhibitors
Neonates Heart failure Renal
insufficiency Seizure Bleeding
disorder Uremia Hypokalemia Cystic
Ask patient about allergy to penicillins.
Dilute each gram with 5cc of diluents, such as sterile or bacteriostatic water injection, NSS, D5W, D5NSS, don’t use LR.
Shake vial until drug dissolve. Dilute again to a final vol. of 50 cc, infuse over 30 min.
Assess neurologic status especially for seizure.
Monitor vital sign and i&O
fibrosis Patient with
sodium restriction
Pregnant or breastfeeding patient
Instruct client to report rash, hives, severe diarrhea, black tongue, sore throat, fever, or unusual bleeding or bruising
Tell patient to instruct to monitor I & O, annnd report significant changes.
Kept patient monitored[AMINOLEBAN]
A balance and tolerable food supplement to nutritionally support patients with liver disease.
500 cc @ 20cc/hr q 24 hrs
Hepatic encephalopathy is a neuropsychiatric syndrome that develops secondary to liver disease or to portal-systemic shunting of blood, or both. In such a patient, plasma concentrations of aromatic amino acids (phenylalanine, tyrosine, tryptophan) is found to be higher than normal while the plasma concentration of
For the treatment of Hepatic Encephalopathy in patient with chronic liver disease.
Hypersensitivity: rare skin eruptions
Gastrointestinal: occasional nausea and vomiting
Others: occasional chills, fever, headache
Patient with abnormal amino acid metabolism (since the infuse amino acids are not adequately metabolized
The patient clinical condition may be worsened.)
Use with care in patients with severe acidosis and those with congestive heart failure.
• Asses’ patient’s condition before starting the therapy.
• Be alert to adverse reaction.
• Monitor patient temperature.
If GI reaction occur monitor patient hydration
BCAA (leucine, isoleucine, valine) is lower than normal. It was suggested that a disturbance of plasma amino acid pattern may cause a disturbance in the brain amino acid concentration. Brain neurotransmission is then impaired by an inhibition of dopamine and noradrenaline synthesis, leading to an increase of false neurotransmitters including octopamine and phenylethanolamine. These toxic substances are suspected to induce hepatic encephalopathy. BCAA is given to normalize the amino acid
imbalance in the plasma in order to compete with AAA for an uptake into the brain.
In addition, after the infusion of high BCAA solution, the ammonia concentration in the blood is also decreased mainly due to the detoxification of ammonia to form glutamine.
Another unique quality of BCAA is that they are mostly metabolized in the skeletal muscle, not in the liver. They then become good sources in providing peripheral energy. In catabolic state,
BCAA play an important role in preventing the muscle protein breakdown and in promoting protein synthesis to maintain positive nitrogen balance.