DRUG STUDY

Generic Name Sulodexide

Brand Name Vessel due F
Classification Anticoagulant, antithrombotics & fibrinolytics
Date Ordered June 25, 2018
Order Give Sulodexide 1 amp IV q 8 hours
Indication  Vascular pathologies w/ thrombotic risk, peripheral vascular insufficiency,
diabetic retinopathy, retinal vasal thrombosis
 Inhibits coagulation by attacking several sites of the coagulation system. Its
effect is dependent on the presence of antithrombin III, an alpha 2-globulin
whose activity is augmented by heparin. The heparin-
antithrombincomplex inactivates factors IXa, Xa, XIa and XIIa, and prevents t
hrombi formation. Furthermore, the complex reverses
the effect of already formed thrombin. In high concentrations, heparin also
inhibits thrombocyte aggregation.
Adverse Effects GI disorders: nausea, vomiting, epigastralgia, pain, burn, hematoma at the site
of injection.
Nursing  Assess patients for signs of bleeding and hemorrhage (bleeding
Implications gums;nosebleed; unusual bruising; black, tarry stools; hematuria; fall in
hematocrit or blood pressure; guaiac- positive stools). Notify physician if
these occur.
 Monitor patient for hypersensitivity reactions (chills, fever, urticaria). Report
signs to physician
 Subcutaneous: observe injection sites for hematomas, ecchymosis, or
inflammation.
 Instructed the relative to assist the patient when going to comfort room
 Instructed to avoid extraneous activities
Why is it given? Sulodexide has been used clinically for the prophylaxis and treatment of vascular
diseases with increased risk of thrombosis, including intermittent claudication,
peripheral arterial occlusive disease and post-myocardial infarction. Also investigated
in the treatment of diabetic kidney disease and diabetic neuropathy. New anti-
inflammatory properties have also extended its use in venous disease.

Generic Name Cilostazol

Brand Name Pletaal
Classification Antiplatelet
Date Ordered June 25, 2018
Order Give Cilostazol 100mg 1 tab, BID
Indication Reduction of symptoms of intermittent claudication allowing increased walking
distance.
Mechanism of Inhibits the enzyme cyclic adenosine monophosphate (cAMP) phosphodiesterase III,
Action which results in increased cAMP in platelets and blood vessels, producing inhibition
 of platelet aggregation and vasodilation.
Adverse Effects CNS – dizziness, head ache
CV – heart failure, tachycardia, palpitations
GI – diarrhea, nausea, flatulence, dyspepsia
Respiratory – cough, pharyngitis, rhinitis
Nursing  Assess patient for intermittent claudication
Implications  Administer on an empty stomach, 1 hour before of 2 hours post meal.
 Do not administer with grapefruit juice. May increase cilostazol levels.
 Caution patient to avoid driving or other activities requiring alertness.
 Advise patient to avoid smoking; nicotine constricts blood vessels.
 Prevent injury which may cause bleeding.
- Use soft bristled toothbrush.
- Avoid sharp objects.
- instruct patient not to strain too much while defecating to avoid perforating the
rectal muscle.
Why is it given? To reduce significantly the incidence of vascular death, nonfatal myocardial
infarction, and nonfatal stroke

Generic Name Metoprolol

Brand Name Beloc, Betaloc Durules, Lopresor, Metoprol (100 mg 1 tab q 12 hrs)
Classification Anti-anginal and Anti-hypertensive: Beta-blockers
Date Ordered June 26, 2018
Order Give Metoprolol 50mg/tab BID
Indication Management of mild to severe hypertension (monotherapy or in combination with a
thiazide or vasodilator or both);
Mechanism of Blocks stimulation of beta1 (myocardial)-adrenergic receptors. It does not usually
Action affect beta2 (pulmonary, vascular, uterine)-adrenergic receptor sites. It also
decreases blood pressure and heart rate. It decreases frequency of attacks of angina
pectoris, and decreases rate of cardiovascular mortality and hospitalization in
patients with heart failure.

Adverse Effects None

Contraindications: Hypersensitivity, heart failure, active bleeding, hemostatic disorders. Use cautiously
with renal dysfunction.
Nursing  Monitored blood pressure and pulse frequently.
Implications  Monitored intake and output ratios
 Assessed routinely for dyspnea, rales, crackles, weight gain, peripheral
edema, jugular venous distention
 Administered with meals or directly after eating.
 Assisted in going to comfort room
 Instructed to avoid caffeinated drinks like teas and colas.
 Monitored blood glucose levels especially if weakness, malaise, irritability,
or fatigue occurs.
Why is it given? To reduce blood pressure. It works by blocking the effects of the hormone
epinephrine, also known as adrenaline. When taking beta blockers, your heart beats
more slowly and with less force, thereby reducing blood pressure. Beta blockers also
help blood vessels open up to improve blood flow.

Generic Name Albumin 20%

Brand Name Albuminar
Classification Volume expanders, blood products, colloids
Date Ordered June 30, 2018
Order Give 30% Albumin + Furosemide 20mg q 8 hours for 6 doses
Indication Management of mild to severe hypertension (monotherapy or in combination with a
thiazide or vasodilator or both);
Mechanism of It provides colloidal oncotic pressure, which serves to mobilize fluid from
Action extravascular tissues back into intravascular space. It increases intravascular fluid
volume.
Side Effect CNS: Headache
CV: Pulmonary edema, fluid overload, hypertension, hypotension, tachycardia
GI: Vomiting, increased salivation, nausea
Derm: Rash, urticaria
MS: Back pain, chills, fever, flushing
Contraindications: Do not mix with protein hydrolysates, amino acid solution and alcohol.
Nursing  Monitored for intake and output.
Implications  Assessed for signs of vascular overload such as elevated CVD,
rales/crackles, dyspnea, hypertension, jugular venous distention) during and
after administration.
 Assessed the blood pressure first before giving the medications
Why is it given? It helps to increase the volume of the blood in the blood vessels. It helps to draw
fluid from the body into the blood vessels. This is especially useful in treating shock
(when blood can't carry enough oxygen to tissues in the body) due to various causes,
including serious injury, bleeding, surgery, or severe burns. Albumin can also
replace low blood protein. Albumin solutions are also used to treat acute liver failure
because of its ability to bind excess bilirubin (a substance produced by the liver) and
increase the volume of blood.

Generic Name Furosemide

Brand Name Lasix
Classification Loop diuretics
Date Ordered July 5, 2018
Order Give Furosemide 40mg/tab, OD
Indication Hepatic impairment or renal disease. Hypertension.
Mechanism of Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal
Action renal tubule. Increases renal excretion of water, sodium, chloride, magnesium,
 potassium, and calcium. Effectiveness persists in impaired renal function. Decreased
blood pressure.
Side Effect CNS: blurred vision, dizziness, head ache, vertigo
EENT: hearing loss, tinnitus
CV: hypotension
GI: anorexia, constipation, diarrhea, dry mouth, nausea, vomiting
GU: excessive urination
Derm: photosensitivity, rash
F and E: dehydration
Contraindications: Hypersensitivity; Cross-sensitivity with thiazides and sulfonamides may occur;
Hepatic coma or anuria; Some liquid products may contain alcohol, avoid in patients
with alcohol intolerance.
Nursing  Assessed fluid status. Notify physician or other health care professional if
Implications thirst, dry mouth, hypotension, or oliguria occurs.
 Monitored blood pressure and pulse before and during administration.
 Monitored blood glucose closely; may cause increased blood glucose level.
 Caution patient to change positions slowly to minimize orthostatic
hypotension.
 Advise patient to contact health care professional immediately if muscle
weakness, cramps, nausea, dizziness and numbness occurs.
 Caution older patients or their caregivers about increased risk for falls.
Why is it given? The treatment of edema in patients with nephrotic syndrome is generally managed
by dietary sodium restriction and loop diuretics. It is well established that both
diuretics and albumin will induce diuresis and natriuresis in patients with edema and
hypoalbuminemia. It is also known that the diuretic response is suboptimal in some
patients with hypoalbuminemia despite the use of high doses alone or in
combination with other diuretics.

Generic Name Meropenem

Brand Name Meromax
Classification Antiinfective; carbapenemantibiotic
Date Ordered June 25, 2018
Order Give Meropenem 1 gm then q 8 hours
Indication Prescribed for bacterial infections like skin and skin structure infections, bacterial
meningitis, serious nosocomial infections like septicaemia. The medication inhibits
cell wall synthesis in bacteria, and thereby leading to cell death.
Mechanism of Hypersensitivity to meropenem, other carbapenem antibiotics including imipenem,
Action penicillins, cephalosporins, or other beta-lactams; lactation.
Side Effect GI: Diarrhea, nausea, vomiting, constipation. Other: Inflammation at injection site,
phlebitis, thrombophlebitis. CNS: Headache. Skin: Rash, pruritus, diaper rash. Body
as a Whole: Apnea, oral moniliasis, sepsis, shock. Hematologic: Anemia.
Contraindications: Contraindicated with hypersensitivity to carbapenem antibiotic
Nursing  Monitored periodically liver and kidney function.
Implications  Determine history of hypersensitivity reactions to other betalactams,
cephalosporins, penicillins, or other drugs.
 Discontinue drug and immediately report S&Sof hypersensitivity
 Report S&S of superinfection or pseudomembranouscolitis
 Monitor for seizures especially in older adults and those with renal
insufficiency.
Why is it given? Over the years, meropenem has become the mainstay of empiric therapy for serious
systemic infections in critically ill patients. Although it has no extensive clinical
experience, using meropenem safely in treating hundreds of patients with reported
allergic reactions to penicillin without any adverse events.

Generic Name Metronidazole

Brand Name Flagyl
Classification Antiprotozoal
Date Ordered June 25, 2018
Order Give Metronidazole 500mg IV q 6 hours
Indication Treatment of bacterial infection
(a drug of choice for Tetanus)
Mechanism of Bactericidal: inhibits DNA synthesis in specific anaerobes, causing cell death.
Action
Side Effect  Headache
 Dizziness
 Ataxia
 Vertigo
 Insomnia
 Fatigue
 Incontinence
 GI upset
Contraindications: Contraindicated with hypersensitivity to metronidazole; use cautiously with CNS
disease, hepatic disease, candidiasis, blood dyscrasias.
Nursing  Metronidazole may be carcinogenic.
Implications  Reduce dosage in hepatic disease.
 Discontinue therapy immediately if symptoms of CNS toxicity develop.
Monitor especially for seizures and peripheral neuropathy
 Monitor for S&S of sodium retention, especially in patients on corticosteroid
therapy or with a history of CHF.
Why is it given? While penicillin and metronidazole are both recommended in treating tetanus, some argue
that metronidazole may be a better option. This is based on the fact that penicillin produces
a non-competitive voltage-dependent inhibition of GABA-A receptors obtunding post-
synaptic inhibitory potentials. In this regard, penicillin in large doses is known to cause
seizures and many have proposed a theoretical possibility of potentiating the action of
tetanospasmin. If such an effect exists, it becomes a serious issue as there is no solid
evidence for a benefit of antibiotic therapy itself in tetanus.
Generic Name Tramadol
Brand Name Tramal
Classification Analgesic u-opiod receptor antagonist
Date Ordered June 26, 2018
Order Give Tramadol 50mg IV q 6 hours x 4 doses
Indication Treatment of acute to chronic pain.
Mechanism of Treats moderate to moderately severe pain and most types of neuralgia,
Action including trigeminal neuralgia
Side Effect  Nausea
 Vomiting
 Sweating
 Constipation
 Drowsiness
 Respiratory depression
Contraindications: Acute intoxication with alcohol hypnotics, analgesics or psychotropic, narcotic
withdrawal treatment.
Nursing  Assess for level of pain relief and administer prn dose as needed but not to
Implications exceed the recommended total daily dose.
 Monitor vital signs and assess for orthostatic hypotension or signs of CNS
depression.
 Discontinue drug and notify physician if S&S of hypersensitivity occur.
 Assess bowel and bladder function; report urinary frequency or retention.
 Use seizure precautions for patients who have a history of seizures or who
are concurrently using drugs that lower the seizure threshold.
 Monitor ambulation and take appropriate safety precautions.
Why is it given? It is a widely used centrally acting synthetic opioid analgesic indicated for moderate
to moderately severe pain. Tramadol's analgesic activity results from at least two
complementary mechanisms of action including binding of μ-opioid receptors and
weak inhibition of the reuptake of norepinephrine and serotonin.

Generic Name Tetanus Immune Globulin

Brand Name Tetanus immune globulin
Classification Immune globulin
Date Ordered June 25, 2018
Order Give Tetanus Human IG 1 amp IM
Indication Is indicated for prophylaxis against tetanus following injury in patients whose
immunization is incomplete or uncertain. It is also indicated, although evidence of
effectiveness is limited, in the regimen of treatment of active cases of tetanus.
Mechanism of Supplies passive immunity to those individuals who have low or no immunity to the
Action toxin produced by the tetanus organism, Clostridium tetani. The antibodies act to
neutralize the free form of the powerful exotoxin produced by this bacterium
Side Effect  Tenderness
  Muscle stiffness at injection site
 Urticaria
 Angioedema
 Fever
 Chills
 Chest tightness
 Precipitous fall in BP
Contraindications: Contraindicated to patients with a history of prior systemic allergic reactions
following the administration of human immunoglobulin preparations, and severe
thrombocytopenia or any coagulation disorder that would contraindicate
intramuscular injections.
Nursing  Do not administer to patients with history of allergy to gamma globulin or
Implications anti immunoglobulin A antibodies.
 Administer 2 weeks before or 3 months after immune globulin
administration because antibodies in the globulin preparation may interfere
with the immune response to the vaccination.
 Do not mix globulin with any other medications.
 Shake well before giving
Why is it given? Tetanus immune globulin (TIg) provides immediate, short-term protection against
the bacteria that cause tetanus (lockjaw). TIg contains large amounts of antibodies
taken from donated human blood. Antibodies are proteins that a person’s immune
system makes to fight germs, such as bacteria and viruses.

Generic Name Carizoprodel/ Paracetamol

Brand Name Lagaflex
Classification Muscle relaxant
Date Ordered June 26, 2018
Order Give Carizoprodol/Paracetamol (Lagaflex) 1 tab QID
Indication Painful muscle spasm associated w/ musculoskeletal conditions.
Mechanism of Carisoprodol is a CNS depressant that has skeletal muscle relaxant and sedative
Action properties. It produces relaxation by blocking interneuronal activity and depressing
polysynaptic neuron transmission in the spinal cord and descending reticular
formation of the brain.
Side Effect Drowsiness, dizziness, headache; postural hypotension, facial flushing; vertigo,
ataxia, tremor, agitation, irritability, depressive reactions, syncope, insomnia,
seizures; nausea, vomiting, epigastric discomfort; leucopenia, pancytopenia. Rarely,
anaphylactic shock, syncope, tachycardia, confusion, transient quadriplegia,
bronchospasm.
Contraindications: History of acute intermittent porphyria.
Nursing  This drug may cause sedation, addiction, and impairment of physical and
Implications mental abilities if affected do not drive or operate machinery.
 Instruct to stay in bed for a while to avoid accident because of the side effect
 May be taken with or without food
Why is it given? To that blocks pain sensations between the nerves and the brain. It is used together
with rest and physical therapy to treat skeletal muscle conditions such as pain or
injury.

Generic Name Midazolam

Brand Name Dormicum
Classification Anxiolytics / Hypnotics & Sedatives / Anticonvulsants
Date Ordered June 26, 2018
Order Give Midazolam incorporate to present IVF (4mg)
Indication Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due to local
pathology or secondary to trauma; spasticity caused by upper motoneuron disorders
Mechanism of Midazolam is a short-acting benzodiazepine. It exerts sedative and hypnotic, muscle
Action relaxant, anxiolytic and anticonvulsant actions. While the probable anxiolytic action
might be as a result of the drug's ability to increase glycine inhibitory
neurotransmitter level, the hypnotic/anaesthetic action may be due to the occupation
of the benzodiazepine and GABA receptors leading to membrane hyperpolarisation
and neuronal inhibition, and further interfering with the re-uptake of GABA at the
synapses.
Side Effect  Drowsiness
 Dizziness
 GI upset
 bradychardia
 Fatal: Respiratory depression, respiratory arrest; hypotension.
Contraindications: History of acute intermittent porphyria.
Nursing  Assess level of sedation and level of consciousness throughout and for 2-6 hr
Implications following administration.
 Monitor BP, pulse and respiration continuously during IV administration.
Oxygen and resuscitative equipment should be immediately available.
 If overdose occurs, monitor pulse, respiration , and BP continuously.
Maintain patent airway and assist ventilation as needed. If hypotension
occurs, treatment includes IV fluids, repositioning and vasopressors.
 The effects of midazolam can be reversed with flumazenil (Romazicon).
Why is it given? Benzodiazepines are the standard therapy for controlling muscle spasms in tetanus
and have gained popularity over other agents due to their combined muscle relaxant,
anticonvulsant, sedative and anxiolytic effects, which can be quite useful in
managing a patient with tetanus.

Generic Name Anti-tetanus serum

Brand Name Tetanus Toxoid
Classification EPI vaccine; Anti-tetanus
Date Ordered June 26, 2018
Order Give If tetanus toxoid not yet given, give one dose now
Indication  Tetanus Toxoid is not to be used for treatment of tetanus infection.
  As with any vaccine, vaccination with tetanus toxoid may not protect 100%
of susceptible individuals
 Tetanus toxoid adsorbed induces active immunity to tetanus antigen by
stimulating the immune system to produce specific antitoxin.
 educate patient that pain and tenderness in the injection site may occur
Side Effect  Body System as a whole: Redness, warmth, edema, induration with or
without tenderness as well as urticaria, and rash. Malaise, transient fever,
pain, hypotension, nausea, and arthralgia
 Adverse reactions: Local reactions (e.g., redness, swelling & pain with local
 lymphadenopathy), tachycardia, hypotension, flushing, muscle pain,
thrombocytopenia
Nursing  Educate patient that pain and tenderness in the injection site may occur.
Implications  Shake well the vial before withdrawing each dose
 Special care should be taken to ensure that the injection does not enter the
blood vessel
 For Geriatric Use: Tetanus Toxoid should only be used in geriatric patients
known to have received a primary series of tetanus-containing vaccine, since
many such as persons have no prior immunity
Why is it given? To provide protection (immunity) against tetanus (lockjaw) in adults. Vaccination is
the best way to protect against this life-threatening disease. Vaccines work by
causing the body to produce its own protection (antibodies).

Generic Name Losartan K 50mg, Hydrochlorothiazide 12.5 mg

Brand Name Combizar
Classification Angiotensin II Antagonist, Diuretics
Date Ordered June 25, 2018
Order Give Losartan + Hctz 1000/25mg – maintenance meds
Indication Hypetension, Nephepatically in type 2daibetic patients, to reduce risk of CVA in
patients with hypertension and left ventricular hypertrophy
Action Inhibits vasoconstrictive and aldosterone-secreting action of angiotensin II by
blocking angiotensin II receptor on the surface of vascular smooth muscle and other
tissue cells
Side Effect CNS: dizziness, asthenia, fatigue, headache, insomia.
CV: edema, chest pain.
EENT: nasal congestion, sinusitis, pharyngitis, sinus disorder.
GI: Abdominal pain, nausea, diarrhea, dyspepsia.
Musculoskeletal: muscle cramps, myalgia, back or leg pain.
Respiratory: cough, upper respiratory infection.
Nursing  Monitor patients BP.
Implications  Monitor patients who are also taking diuretics for symptomatic hypotension.
 Assess patients renal function
 Tell patient to avoid salt substitute
 Monitor for hypotension and fainting
Why is it given? To lower blood pressure if your blood pressure is too high (hypertension). To help
your heart if it is not beating as well as it should (heart failure). To help protect your
kidneys if you have kidney disease associated with type 2 diabetes mellitus.
It works by blocking the effect of a substance in your body called angiotensin II.
Angiotensin II causes your blood vessels to narrow and also leads to the production
of another substance called aldosterone, which increases the amount of fluid in your
blood. By preventing the action of angiotensin II, losartan reduces how much work
your heart has to do and lowers your blood pressure. It also has a protective effect
on your kidneys.

Generic Name Sitagliptin/metformin

Brand Name Janumet
Classification Hormones synthetic substitutes antidiabetic agent; biguanides
Date Ordered July 6, 2018
Order Give Home meds
Indication For the treatment of type 2 diabetes mellitus in combination with diet and exercise.
Note: Sitagliptin is used as monotherapy or in combination with other drugs used to
treat type 2 diabetes mellitus
Mechanism of Sitagliptin prolongs the action of GLP-1 and GIP by enhancing active incretin
Action levels. Sitagliptin increases insulin production and lowers glucagon secretion from
alpha cells. Which decreases hepatic glucose overproduction
Side Effect Upper respiratory tract infection, nasopharyngitis, headache; pancreatitis,
hypersensitivity reactions (eg, anaphylaxis, angioedema, Stevens-Johnson
syndrome), severe and disabling arthralgia.
Nursing  Do not use this medication if you are allergic to sitagliptin, or if you are in a
Implications state of diabetic ketoacidosis
 Take this medication exactly as it was prescribed for you.
 You may take this medicine with or without food.
 Do not crush, chew, or break a sitagliptin tablet. Swallow it whole.
 Your blood sugar will need to be checked often
 Know the signs of low blood sugar (hypoglycemia) and how to recognize
them: headache, hunger, weakness, sweating, tremor, irritability, or trouble
concentrating.
Why is it given? Metformin ameliorates insulin resistance, reduces hyperinsulinemia, and counteracts
weight gain. It exerts an insulin-sparing and antihyperglycemic effect and may
improve cardiovascular risk factors. Metformin is effective in conjunction with
insulin in NIDDM. Because of its action on insulin resistance, it might be a more
suitable adjunct to insulin than sulfonylurea in obese patients with NIDDM who are
receiving high insulin doses, but it has been less well studied.