GENERIC, DOSE, BRAND NAME & STRENGTH, & CLASSIFICATION FORMULATION Generic: Fondaparinux Sodium Brand name: O.

D Arixtra Duration: Classification: Anticoagulant 12 hrs. Other Forms: Injection (single dose prefilled syringe) Ordered: 2.5 MG tablet Timing:

INDICATION AND MECHANISM OF ACTION Indication: To prevent deep vein thrombosis and pulmonary embolism in pts. undergoing abdominal surgery or surgery for hip fracture. Hip replacement and knee replacement. Mechanism of Action: Binds to AT-III and potentiates the natural neutralization of factor Xa by ATIII. Neutralization of factor Xn interrupts the coagulation cascade, hereby inhibiting formation of thrombin and and thrombus development Source: Lippincott Williams, 2009, p. 591

ADVERSE REACTIONS AND DRUG INTERACTIONS ADVERSE REACTIONS:. CNS: Headache, confusion, dizziness, fever, insomnia, pain, spinal and epidural hematomas. CV: Edema, hypotension, palpitation. GI: Constipation, nausea & vomiting. GU: Urine retention, UTI. Metabolic: Hypokalemia. Musculoskeletal: Arthralgia, back pain and limb, myalgia. Hematologic: Hemorrhage, thrombocytopenia. Skin: Bolus eruption, increase wound drainage, mild local irritation(bleeding pruritus rash)

NURSING RESPONSIBILITIES Monitor the patients vital signs.

RATIONALE

CLIENT TEACHING 70 Teach patient for signs and symptoms of bleeding. If any occur patient should immediately contact the prescriber. Advise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately. Instruct patient to avoid OTC products that contain aspirin other salicylate and other prescribes coagulants.

To have a baseline data. Source: Lippincott Williams, 2009, p. 591 To avoid complications and further damage. Source: Lippincott Williams, 2009, p. 591

Assess for signs of bleeding and hemorrhage: -bleeding gums -nosebleed -black, tarry stools

Assess pts condition before therapy and regularly thereafter.

To monitor drug effectiveness. Source: Lippincott Williams, 2009, p. 591 To prevent from injury. Source: Lippincott Williams, 2009, p. 591 To avoid complications. Source: Lippincott Williams, 2009, p. 591

INTERACTION: Drug-Drug: Drugs that increase risk of bleeding(anticoagulant, platelets, inhibitor, Be alert for adverse or NSAIDS, hypersensitivity reactions salicylates)may such as : increase risk of hemorrhage if drugs - Edema must be use together. - Hypokalemia Monitor pt. closely. - Chills

Promote safe and quite environment and always assess the pt. in doing activities.

Teach patient the correct way to give long medication to himself subcutaneously. Instruct patient not to take aspirin or NSAIDs without

71

GENERIC, BRAND NAME & CLASSIFICATION

DOSE, STRENGTH, & FORMULATION

INDICATION AND MECHANISM OF ACTION

ADVERSE REACTIONS AND DRUG INTERACTIONS

NURSING RESPONSIBILITIES

RATIONALE

CLIENT TEACHING

72 Indication: Hypertension, Heart Failure, Diabetic Nephropathy, Left Ventricular Dysfunction after MI. Mechanism of Action: Though to inhibit ACE preventing conversion of angiotensin 1 to angiotensin 2. Reduce formation of angiotensin 2 decrease peripheral arterial resistance thus decreasing aldosterone secretion. Source: Lippincott Williams, 2009, p. 252 ADVERSE REACTIONS:. CNS: Dizziness, fever, fainting. CV: Angina pectoris, hypotension, GI: Anorexia, dysgeusia. GU: Renal impairment. Metabolic: Hyperkalemia.. Hematologic: Thrombocytopenia, agrunulocytosis, leucopenia, pancytopenia. Hepatic: Cholistatic jaundice. Respiratory: Cough. Skin: Maculopapular rash. INTERACTION: Drug-Drug: Antacids: May decrease captopril effect. Digoxin: Monitor pt. for digitalis toxicity. Diuretics: Other anti hypertensives: May increase risk for Monitor WBC and differential count before therapy every 2wks. For first 3 mos. And periodically thereafter.. To monitor drug effectiveness and to know if there is any adverse reaction. Source: Lippincott Williams, 2009, p. 252 To prevent from injury. Source: Lippincott Williams, 2009, p. 252 To avoid complications. Source: Lippincott Williams, 2009, p. 252 . To avoid complications. Source: Lippincott Williams, 2009, p. 252 - To stop drug in pt. who develops and stable renal function. Source: Lippincott Williams, 2009, p.252 Instruct pt. to take drug one hour before meals because food decreases drug absorption. Tell pt. to use caution in hot weather and during exercise. Inadequate fluid intake, vomiting, diarrhea, and exercise. Perspiration can lead to light headedness and syncope. Advise pt. to report signs of infection such as fever and sore throat. Tell pt. to notify prescriber if cough interferes with sleep or requires activities so that drug can be change.

Generic: Captopril Brand name: Primase Classification:

Ordered: 25 mg tab Timing: BID (8am-7pm) Duration: 6-12hrs.

Antihypertensive, ACE inhibitor

Promote safe and quite environment to prevent from injury.

Other Forms: Tablets 50 mg.

Monitor blood pressure and pulse frequently during initial dose adjustment and periodically during therapy . Be alert for adverse reaction and drug interaction.

Monitor renal function periodically.

73 excessive hypotension. Stop diuretic or lower captopril dosage. Drug- Food: Any food may reduce absorption of drug. Drug-Herb: Black Catechu: May have additional hypotensive effects of catechu.

Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema,rales\crackles,dys pnea, weight gain,jugular venous distention) .

To stop drug in patient who develops chronic heart failure. Source: Lippincott Williams, 2009, p. 252

74 ADVERSE REACTIONS AND DRUG INTERACTIONS ADVERSE REACTIONS: CNS: Agitation, anxiety, ataxia, confusion, depression, difficulty speaking, dizziness, drowsiness. CV: Chest pain, hypotension, palpitation. GI: Diarrhea, nausea & vomiting, abdominal cramps, distention, belching, flatulence. EENT: Allergic rhinitis, blurred vision, nasal congestion, sore throat. GU: Difficulty urinating. Metabolic: Increase weight. Musculoskeletal: Arthalgia, back pain

GENERIC,BRAND NAME & CLASSIFICATION Generic: Alprazolam Brand Name: Xanor Classification:

DOSE, STRENGTH & FORMULATION Ordered: 250mg tablet Timing: O.D. Duration: 12-15 hours

INDICATION & MECHANISM OF ACTION Indication: Anxiety, panic disorders, social phobias. Mechanism of Action: May potentiate effects of GABA and inhibitory neurotransmitter depress CNS at limbic and subcortical levels of brain. Source: Lippincott Williams, 2009, p.130

NURSING RESPONSIBILITIES Assess patients condition before therapy and regularly thereafter. Source: Lippincott Williams,2009. p.131 Promote safe and quite environment to prevent injury. Source: Lippincott Williams,2009. p.130 Monitor patients weight, intake and output. Source: FDA Prescribing Information

RATIONALE

CLIENT TEACHING Warn patient to avoid hazardous activities that require alertness and psychomotor coordination until CNS effect of drug are known. Tell patient to avoid alcohol and smoking while taking drug. Advise the patient to take drug as prescribed and not to stop without prescribers approval. Explain the risk of dependence if taken longer

To monitor drug effectiveness. Source: Lippincott Williams,2009.p. 131

Anxiolytic Other Forms: Oral Solution; Tablets; Injection; Tablets (extended release)

To prevent patient from injury. Source: Lippincott Williams,2009, p.130

To avoid constipation and note for weight changes since alprazolam has an effect in the appetite.

75 and limb, myalgia. Respiratory: Dyspnea, hyperventilation, URTI. Skin: Dermatitis, increase sweating, pruritus. Other: Decrease or increase libido, hot flushes, sexual dysfunction. INTERACTIONS: Drug-drug: Anti-convulsant: May increase depressant effect. Digoxin: May increase digoxin level. Monitor it closely. Drug-herb: Calendula hops, lemon balm, skull cap, valerian: May increase sedative effects. Source: FDA Prescribing Information than as directed. Instruct patient to swallow extended release tablets whole and not to chew or crashed. Tell patient taking half of a scored orally disintegrating tablet to destroy the unused portion. Tell pregnant and breast feeding woman not to take drug because it can cause fetal abnormalities and that alprazolam can be excreted in breast milk.

Always assess patient in doing activities. Source: Lippincott Williams,2009. p.131 Note for the proper dosage and timing of the drug. Source: FDA Prescribing Information Be alert for withdrawal symptoms such as insomnia, nausea & vomiting, headaches, lightheadedness , sweating, anxiety, and fatigue

To avoid complications. Source: Lippincott Williams, 2009, p.130 To take note if drug dependency occurs. Source: FDA Prescribing Information To avoid complications. Source: Lippincott Williams, 2009, p.130

76 seizures. Source: Lippincott Williams,2009. p.131

77 GENERIC, DOSE, INDICATIONS AND BRAND STRENGTH, & MECHANISM OF NAME & FORMULATION ACTON CLASSIFIC ATION Generic: Metropolol Tartrate Brand name: O.D @ 8 pm Betaloc Duration: Classificatio n: Antihyperten sive, Adjunct therapy for MI 6-24 hrs. Other forms: Tablets; injection; tablets (extended release) Mechanism of Action: Reduces blood pressure, decreases myocardial contractility, heart rate, and cardiac output, reduces myocardial oxygen consumption and helps to prevent myocardial tissue damage. Source: Lippincott Wiliiams: 2009, p.875 Ordered: 50mg tablet Timing: Indication: Hypertension Early intervention in acute MI Angina Pectoris Stable, symptomatic heart failure resulting from ischemia, hypertension or cardiomyopathy ADVERSE REACTION AND DRUG INTERACTIONS NURSING RESPONSIBILITIE S RATIONALE CLIENT TEACHING

ADVERSE REACTION: CNS: dizziness, fatigue, fever, lethargy. CV: AV block, bradycardia, heart failure, hypotension, peripheral vascular disease. GI: Diarrhea, nausea & vomiting. Musculoskeletal: Arthralgia. Skin: rash INTERACTIONS Drug-Drug: Amobarbital, Aprobarbital; may reduce the effects of metropolol. Increase beta blocker dose. Drug-Food: Any food: may increase absorption. Give together .

Take vital sign first especially blood pressure before and after giving the medications.

To be able to know if the patient blood pressure was just normal or it increases. Source: Lippincott William; 2009 p.875

Tell pt. that abruptly stopping therapy can worsen angina and precipitate MI. He should stop taking the drugs gradually 1-2 weeks. Instruct pt. to take oral forms with meals to enhance absorption. Advice pt. to report adverse reaction to prescriber. Warn pt. to avoid

Monitor pt. after taking the drug.

To determine or indicate the proper effects of the drugs. Source; Lippincott William; 2009 p.875

In giving medication, explain to the pt. what are the purpose of the drugs and its effect.

To let the pt. know the drug itself. Source; Lippincott William; 2009 p.875

78 performing hazardous activities until drugs CNS effect are known.

Be alert for adverse reaction and drug interaction such as: dizziness, fatigue, nausea and vomiting, heart failure. Monitor pt. food intake.

To avid complications. Source; Lippincott William; 2009 p.875

To be able to know if patient was taking food that can increase in b.p

GENERIC AND BRAND CLASSIFICA

DOSE, STRENGTH AND

INDICATION /MECHANISM OF DRUG

ADVERSE/SIDE EFFECTS DRUG

NURSING RESPONSIBILITIES

RATIONALE

CLIENT TEACHING

79 TION GENERIC: Morphine Sulfate DURATION: BRAND: 4-5 hr Morphine TIMING: CLASSIFICATI ON: PRN Central Nervous System drugs OTHER FORMS: Tablets Tablets<extendedrelease> Soluble tablets Oral solution Syrup Injection Suppositories FORMULATION ORDERED 16 mg/amp. ACTION INDICATION: Severe pain ACTION: Binds with opiate receptors in the CNS, altering both perception of and emotional response to pain through an unknown mechanism. (Lippincott, 10th edition, pp.866) INTERACTION ADVERSE REACTION CNS: sedation, somnolence, clouded sensorium, euphoria, seizures, dizziness, nightmares, lightheadedness, hallucinations, nervousness, depression, syncope. CV: hypotension, bradycardia, shock, cardiac arrest, tachycardia, hypertension G.I.: nausea, vomiting, constipation, ileus, dry mouth, biliary tract spasms,anorexia. G.U.: urine retention HEMATOLOGIC: Thrombocytopenia RESPIRATORY: respiratory depression ,apnea, respiratory arrest SKIN: pruritus, and skin flushing , diaphoresis, edema. OTHER: physical 1. Assess patients pain score. 1. To have baseline data and to know if drug should be given. (Lippincott, 10th edition, pp.866) 2. Drug may cause hypotension and respiratory depression. (Lippincott, 10th edition, pp.866) 3. To know if theres urinary retention. (Edmunds, 6th edition, pp. 292) 4. Helps patient to relax and to prevent dyspnea. (Edmunds, 6th edition, pp. 292) When drug is postoperatively, encourage patient to turn, cough, and deep-breathe and to use incentive spirometer to prevent atelectasis. Caution ambulatory patient about getting out of bed or walking. Warn outpatient to avoid driving and other potentially hazardous activities that require mental alertness until drugs adverse CNS effects are known. Advise patient to avoid alcohol during therapy. The patient should take the medication

2. Monitor vital signs specifically blood pressure, respiration.

3. Monitor intake and output.

4. Teach patient for deep breathing exercise.

80 dependence, decreased libido, increased plasma amylase levels. DRUG INTERACTIONS: Drug-drug. CNS depressants, general anaesthetics, hynotics, MAO inhibitors, other narcotic analgesics, sedatives, tranquilizers, tricyclic antidepressants: Possible respiratory depression, hypotension, profound sedation or coma. Use together with extreme caution. Reduce morphine dose and monitor patient response. Drug-lifestyle.alcohol use; additive effects.advise caution. 5.Instruct patient not to stand up for at least 3-5 minutes 5. Drug may cause dizziness and lightheadedness . (Edmunds, 6th edition, pp. 292) exactly as prescribed, and should make an effort to wait for longer periods of time between doses if the medication is taken for a long time. The patient should urinate often and prevent constipation by increasing fluid intake and adding extra fiber to the diet.

Generic and Brand,

Dose, Strength and formulation

Indication/ Mechanism of

Adverse/Side Effects Drug Interaction

Nursing Responsibilities

Rationale

Client Teaching

81 Classification Generic: Levofloxacin Timing: Brand: Levox OD 8 am Duration: Ordered: 500 mg tablet Drug Action Indication: Acute bacterial sinusitis caused by susceptibl e strains of streptococ cus pneumoni a, Moraxella catarrhalis , or haemophil us influenza. Acute bacterial exacerbati on of chronic bronchitis caused by Staphyloc occus aureus, S. pneumoni a, M. catarrhalis Adverse reaction: CNS: headache, insomnia, encephalopathy, headache, dizziness, pain, paresthesia, seizures. CV: abnormal ECG, chest pain, palpitations, vasodilation GI: abdominal pain, constipation, diarrhea, dyspepsia, flatulence, nausea, pseudomembranous colitis, vomiting GU: vaginitis Hematologic: eosinophilia, hemolytic anemia, lymphocytopenia Metabolic: hypoglycemia Musculoskeletal: back pain, tendon rupture Respiratory: allergic pneomonitis Skin: erythema multiforme, photosensitivity 1. Advise patient to take drug with plenty of fluids and to avoid antacids. 2. Obtain specimen for culture and sensitivity tests before starting therapy. 3. Monitor glucose level and renal, hepatic, and hemtopoietic blood studies. 1. Antacids may interfere with G.I absorption of drug -Kluwer, 2009, page 754 -Tell patient to take drug as prescribed, even if symptoms resolved - Advise patient to tell prescriber or health care professional if symptoms do not improve in 2 to 3 days. -warn patient to avoid hazardous tasks until the drugs CNS effect are known. - Advise patient to avoid excessive sunlight. - Instruct patient to notify prescriber about loose stool or diarrhea.

2. To check bacterial resistance. -Kluwer, 2009, page 754

Classification: Broadspectrum antibiotic

Other forms: Tablets Single-use vials Infusion<premixe d>

3. Evaluation of organ system functions (renal, hepatic, ophthalmologic, and hematopoietic) is recommended periodically during therapy; the possibility of crystalluria should be assessed; WBC and signs of infection -drugsarea.com/DetsDrugs/Print/Levofloxacinpd.html 4. To avoid hepatotoxicity. --Kluwer, 2009, page 754 5. Drug can cause dizziness and to prevent injury.

4. Give oral drugs with plenty of fluids. 5. Assure patient is sitting or lying

82 , or H. influenza or parainflue nzae. Mechanism of Action: Chemical effect: Inhibits bacterial DNA gyrase and prevents DNA replication, transcription, repair, and recombination in susceptible bacteria. Therapeutic effect: Kills susceptible bacteria. Kluwer, 2009, page 753 reactions, pruritus, rash Other: anaphylaxis, hypersensitivity reactions, multisystem organ failure down after taking the medicine http://netexpresspharmacy.com/le vaquin. html#

GENERIC AND BRAND CLASSIFICAT

DOSE, STRENGTH AND

INDICATION /MECHANISM OF DRUG ACTION

ADVERSE/SIDE EFFECTS DRUG

NURSING RESPONSIBILITIE S

RATIONALE

CLIENT TEACHING

83 ION GENERIC: Isosorbide Dinitrate BRAND: isordil CLASSIFICATI ON: Antianginals FORMULATIO N ORDERED 5 mg tablet DURATION: 1.5 hr INTERACTION INDICATION: Acute angina attacs, prophylaxis in situations likely to cause angina attacks. ADVERSE REACTION CNS: headache, dizziness, weakness CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing. EENT: S.L. burning G.I.: nausea, vomiting SKIN: cutaneous vasodilation, rash. DRUG INTERACTION Drug-drug. antihypertensives: may increase hypotensive effects. Monitor patient closely during initial therapy SILDENAFIL: may increase hypotensive effects. Avoid concomitant use. 1. Monitor vital signs 1. Drug may cause specifically blood hypotension and pressure and pulse rate palpitations. (Kozier2008; pg864) 2. Instruct patient not to stand up for at least 3-5 minutes upon intake of drug. 3. Advise patient not to stop drug abruptly. 2. Drug may cause dizziness and weakness. (Kozier2008;pg864) 3. May cause coronary vasospasm with increased angina symptoms and potential risk of MI. (Doenges2007;pg645) 4. To promote fast recovery and to alleviate pain. (Doenges2007;pg645) 5.To reduce risk of infection (Kozier2008;pg864) Caution patient to take drug regularly, as prescribed, and to keep it accessible at all times. Tell patient to take S.L. tablet at first sign of attack. The tablet should be wet with saliva and placed under the tongue until absorbed; the patient should sit down and rest. Dose may be repeated every 10 to 15 minutes for a maximum of three doses. If drug doesnt provide relief, tell patient to

ACTION: TIMING: Not completely known. Though to PRN reduce cardiac oxygen demand by OTHER FORMS: decreasing preload and Tablets afterload. Drug also Tablets<S.L> may increase blood Tablets<chewable flow through the > collateral coronary Tablets vessels. <sustained(Spratto and Woods release> 2009; pg.758) Capsules<sustain ed-release>

4. Note indications for therapy; also include onset ,location ,and characteristics of pain. 5. Note stress thallium ,catheterization ,or IVUS findings.

84 seek medical help promptly. Advise patient who complains of tingling sensation with S.L. drug to try holding tablet in buccal pouch.

85 GENERIC, BRAND NAME & CLASSIFICATION Generic: Isosorbide Mononitrate Brand Name: Imdur Classification: Antianginal vasodilator DOSE, STRENGTH, & FORMULATION Ordered: 60 mg tablet Timing: OD 8am Duration: 1-12 hours Other forms: Capsules (extended release): 40mg Tablets: 50mg, 10mg, 20mg, 30mg, 40mg INDICATION AND MECHANISM OF ACTION Indication: Acute angina, prophylaxis in situations likely to cause angina. Adjunctive treatment of heart failure. Diffuse esophageal reflux. Mechanism of Action: Chemical effect may reduce cardiac oxygen demand for decrease left ventricular end diastolic pressure (preload) and, to a lesser extent systemic vascular resistance (afterload), may increase blood flow through collateral coronary vessels. ADVERSE REACTION AND DRUG INTERACTIONS ADVERSE REACTIONS: CNS: dizziness, headache, weakness CV: ankle edema, fainting, flushing, orthostatic hypotension GI: Nausea and vomiting Skin: Cutaneos vasodilation INTERACTION: Drug-drug. Antihypertensive: may increase hypotensive effects. Monitor patient closely during initial therapy. Drug-Lifestyle. Alcohol use may increase hypotension. Discourage use together. NURSING RESPONSIBILTIES RATIONALE CLIENT TEACHING

1. Monitor blood pressure, intensity and duration of drugs response.

1. To monitor drugs effectiveness and prevent adverse drug reaction such as headache, dizziness, edema, etc. Lippincott Williams, 2009, p. 675 2. To prevent the patient from injury. Lippincott Williams, 2009, p. 675

-Advised patient to take drug regularly as prescribed, and to keep it accessible at all times. -Instruct patient taking P.O. form to take tablet on an empty stomach. Either 30 mins before or 1-2 hrs after meals and to swallow the tablet whole. -Caution patient to avoid alcohol because it may worsen low blood pressure effects.

2. Be alert for any signs of adverse drug reaction such as dizziness, ankle edema, nausea and vomiting. 3. Obtain liver function test results at start of therapy then periodically.

3. This will ensure that the liver is in good condition to metabolize the drug and reduces the risk for hepatotoxicity. Lippincott Williams, 2009, p. 675

4. Instruct the patient 4. This will indicate and SO to report signs drug toxicity and of hypotension such prevents the client

86 as dizziness, blurry vision, weakness, nausea and confusion. from injury. Refer to the physician immediately. Lippincott Williams, 2009, p. 675 5. To prevent orthostatic hypotension. Lippincott Williams, 2009, p. 675 6. To prevent injury from falling because the client may feel dizzy or weak and is at risk for injury. Lippincott Williams, 2009, p. 675

5. If the client is lying in bed, instruct him/her to sit before standing up. 6. Provide a safe environment such as raising side rails or assisting client in doing any activities.

87 GENERIC, DOSE, INDICATION & BRAND NAME & STRENGTH MECHANISM CLASSIFICATIO & OF ACTION N FORMULAT ION Generic: Ordered: Indication: PANTOPRAZOLE 40 MG tablet Short term therapy for erosive Brand Name: Timing: esophagitis r/t PANTOLOC O.D (before gastroesophageal breakfast) reflux disease. Classification: Patient with Gastric Acid Duration: GERD who are Supresant 24 hrs. unable to continue pantoprazole Other Forms: sodium delayedGranules for release tablets. suspention 40 Long term MG unit dose maintenance of packet; healing erosive esophagitis and Injection: 40 reduction in Mg vial; relapse rates of daytime and night Tablets(delay time heart burn ed-release): symptoms in 20 MG, 40 patients with MG GERD. Mechanism of Action: Supress gastric acid secretion. ADVERSE REACTIONS & DRUG INTERACTIONS Adverse Reactions: CNS:anxiety, dizziness, headache, insomnia, migrane, pain. CV: chest pain, peripheral edema. EENT: pharyngitis, rhinitis, sinusitis. GI: abdominal pain, constipation, diarrhea, dyspepsia, flatulence. MUSCULOSKELE TAL: Arthralgia, back pain, hypertonia. RESPIRATORY: bronchitis, dyspnea, increased cough, URTI SKIN: rash NURSING RESPONSIBILITIES RATIONALE CLIENT TEACHING

Obtain complete health history including allergies, drug history and possible drug interactions Assess patient for complaints of epigastric or abdominal pain and for bleeding.

To monitor drug effectiveness. Source: Lippincott Williams, 2009, p. 856

Instruct patient to take exactly as prescribe and at appropriately the same time eveyday. Tell patient that drug can be taken witj or without foods.

To determine or indicate the proper effect of the drugs. Source: Lippincott Williams, 2009, p. 856

Before administering

INTERACTION: DRUG-DRUG: ampicilin esters, iron Demonstrate salts ketoconazole; understanding of risks

pantoprazole ensure that the patient has no allergy to it, and there are no contraindications with other medications.

To avoid complications Source: Lippincott Williams, 2009, p. 856

Instruct the patient to report abdomional pain or signs of bleeding, such as tarry stools.

To promote cooperation of both

Advise patient not to drink alcohol, eat food or take other drugs that coukd cause gastric irritation.

88 Source: Lippincott Williams, 2009, p.856 may decrease absorption of this drug. Monitor patient closely and try to separate doses. DRUG-HERB: St. Johns wort; may increase risk of sunburn. Discourage use together. DRUG-FOOD: may delay absorption of pantoprazole forup to 2hrs. but the extent of absorption isnt affected. Give with or without meals. and benefits of drug therapy. patient and the S.O Source: Lippincott Williams, 2009, p. 856 To avoid patient from any injuries. Source: Lippincott Williams,

Insruct the patient if he

Institute safety procedures to protect the patient who experiences dizziness.

missed a dose, use it as soon as he remembers. If it is near the time of the next dose, skip the missed dose and resume the usual dosing schedule. Do not double the dose to catch up.

89 GENERIC AND BRAND CLASSIFICA TION GENERIC: Aspirin <acetylsalicylic acid> BRAND: Aspilet CLASSIFICAT ION: Nonnarcotic analgesics and antipyretics DOSE, STRENGTH AND FORMULATI ON ORDERED INDICATION /MECHANISM OF DRUG ACTION INDICATION: Rheumatoid arthritis, osteoarthritis, or other polyarthritic or inflammatory conditions ADVERSE/SIDE EFFECTS DRUG INTERACTION NURSING RESPONSIBILITIE S 1.Assess laboratory results specifically Complete Blood Count RATIONALE CLIENT TEACHING

ADVERSE REACTION 80 mg tablet EENT: tinnitus, hearing loss DURATION: G.I. nausea, G.I. 1-4 HR distress, occult bleeding, dyspepsia, TIMING: ACTION: G.I. bleeding. Sep.19,2010HEMATOLOGIC: 6pm stat Produces analgesia by Leucopenia, blocking prostaglandin thrombocytopenia, synthesis <peripheral prolonged bleeding action>. Aspirin and time OTHER other salicylates may HEAPATIC: FORMS: prevent the lowering of Abnormal liver Tablets the pain threshold that function test results, Tablets occurs when the hepatitis. <chewable> prostaglandins sensitize SKIN: rash, bruising, Tablets<enteric- pain receptors to urticaria coated> mechanical and OTHER: Tablets<control chemical stimulation. angioedema, led-release> Exerts its antihypersensitivity Tablets<timeinflammatory effect by reactions, Reyes release> inhibiting prostaglandin syndrome Chewing gum synthesis or action of other mediators of the inflammatory response. Drugs relieves fever by DRUG

1. To be cautious , drug may lead to leucopenia, thrombocytopenia. (footnote: MedicalSurgical Nursing, 12th edition, pg.771) 2. To reduce adverse G.I. reactions. (footnote: MedicalSurgical Nursing, 12th edition, pg.771) 3. To give immediate cure if side effects occur. (footnote: MedicalSurgical Nursing, 12th edition, pg.771)

2. Advise patient to take drug with food, milk, antacid, or large glass of water. 3. Instruct patient to report any unusualities such as rashes, bruising, and loss of hearing.

Tell patient who is allergic to tartrazine dye to avoid aspirin. Advise patient on a sodiumrestricted diet that one tablet of buffered aspirin contains 553 mg of sodium. Instruct patient to discard aspirin tablets that have a strong vinegar-like odor. Encourage patient to retain suppository for as long as possible, preferably at least 10 hours to maximize absorption.

4. Monitor the intake and output of the patient.

4. This drug can cause urinary retention. To monitor side effects.

90 acting on the hypothalamic heat regulating center to cause peripheral vasodilation, thus increasing peripheral blood supply and promoting sweating, which leads to heat loss and to cooling by evaporation. In low doses, aspirin also appears to impede clotting b inhibiting prostaglandin synthesis, which prevents formation of the platelet-aggregating substance thromboxane A2. (Footnote : Nursing 2009 Student Drug Handbook, 10th edition, pg. 176) INTERACIONS: Drug-drug.ACE inhibitors: may decrease antihypertensive effects. Monitor blood pressure closely. Ammonium chloride,other urine acidifiers: increased blood levels of aspirin products. Watch for aspirin toxicity. Antacids in high doses, other urine alkalizers: decreased levels of aspirin products. Watch for decreased aspirin effects. Avoid long term aspirin use if patient is taking hypertensives. Drug-food. Caffeine: may increase the absorption of aspirin. Watch for increased effects.

5. During long term therapy, monitor salicylate level. Therapeutic level in arthritis is 10 to 30 mg/dl.

5.With long term therapy, mild toxicity may occur at levels of 20 mg/dl. Tinnitus may occur at levels of 30 mg/dl and above but doesnt reliably indicate toxicity, esp. in very young patients and those older than 60. (Footnote: Nursing 2009 Student Drug Handbook, 10th edition, pg. 176)

Advice patient receiving high-dose prolonged treatment to watch for petechiae, bleeding gums, and signs of GI bleeding and to maintain adequate fluid intake. Encourage use of a soft toothbrush. Advise patient to avoid alcohol use and restrict intake of caffeine during drug therapy.

91

GENERIC AND BRAND CLASSIFICAT ION GENERIC: Paracetamol Acetaminophen BRAND: Biogesic CLASSIFICATI ON: Non-opiod analgesic and antipyretic

DOSE, STRENGTH AND FORMULATI ON ORDERED 500 mg tablet DURATION: Q 4hr TIMING:

INDICATION /MECHANISM OF DRUG ACTION INDICATION: For mild pain or fever ACTION: Blocks pain impulses probably by inhibiting prostaglandins or pain receptor sensitizers.May relieve fever by acting in hypothalamic heat regulating center. (Nursing Students Drug Handbook 2009 10th ed. P.100)

ADVERSE/SIDE EFFECTS DRUG INTERACTION ADVERSE REACTION DRUG INTERACTION: HEMATOLOGIC: Hemolytic anemia HEPATIC: Liver damage METABOLIC; hypoglycemia SKIN: rash, urticaria Drugdrug.Barbituratees,rifampici n:may reduce therapeutic effect and enhance hepatoxicity effects.

NURSING RESPONSIBILITIES

RATIONALE

CLIENT TEACHING

1. Assess vital signs specifically temperature 2.Assess effectiveness of drug after 2hours upon intake 3.Be alert for liver damage 4.Check if the patient has allergic reactions specifically rashes and urticaria. 5.Use cautiously in patients with a history of chronic alcohol abuse.

1.To know when to administer drugs 2. If fever did not decrease do tepid sponge bath 3.Acetaminophen cause hepatoxicity 4.To determine if the patient is allergic to the drug. 5. Hepatoxicity may occur after therapeutic doses. (Nursing Student Drug Handbook 10th ed.P.101)

OTHER FORMS: Caplets Capsules Liquids Solution Suppositories

Tell patient not to take drug for fever thats higher than 39c that last longer for 3 days Tell patientthat drug is for short term use Warn patient that high doses or unsupervis ed long term use can cause liver damage Warn patient not to exceed total

92 recommend ed dose of acetaminop hen per day Tell a breast feeding woman that drug appears in breast milk in levels less than 1% of dose

93 GENERIC, DOSE, BRAND NAME & STRENGTH & CLASSIFICATION FORMULATION INDICATION AND MECHANISM OF ACTION Indication: Constipation. To prevent and treat hepatic encephalopathy including hepatic precoma and coma in patients with severe hepatic disease. Mechanism of Action: Produces osmotic effect in colon.Resulting distention promotes peristalsis.Decreases ammonia build up that causes hepatic encephalopathy, probably as result of bacterial degradation, which lowers pH of colon contents. Source: Lippincott Williams, 2009, p. 723 ADVERSE NURSING REACTIONS & RESPONSIBILITIES DRUG INTERACTIONS ADVERSE -Assess for any allergic REACTIONS: reaction to drug GI: Diarrhea, nausea and vomiting, abdominal cramps, distention, belching, flatulence. -Assess if patient is diabetic or is having a INTERACTION: low-galactose diet Drug-drug: Antacids, antibiotics, oral neomycin: May decrease -Monitor patients effectiveness of electrolyte levels lactulose. Avoid during long term use using together. RATIONALE CLIENT TEACHING -Inform patient of adverse reaction and tell him to notify prescriber if reactions become bothersome or if more than 2 or 3 soft stools daily are passed. -Advise patient to dilute drug with juice or water, or to take with food to improve taste. -Tell patient to store drug at room temperature. -Tell patient to stop medication if he is experiencing adverse reactions and to call doctor immediately. -Tell patient not to take drug if it becomes very dark or if it gets thicker or

Generic: Lactulose Brand Name: Lilac Classification:

Ordered: 250 MCG tablet Timing: P.O. O.D @ 8 am Duration: Unknown

-to avoid allergic reactions Source: Lipincott Williams, 2009, p. 723 -lactulose contain galactose and other forms of sugar Source: Lipincott Williams, 2009, p. 723 -to prevent fluid and electrolyte imbalance Source: Lipincott Williams, 2009, p. 723

Laxative Other Forms: Tablets, injection,tablets (extended release)

-Give drug with food or -to improve the taste dilute with water or of lactulose or fruit juice minimize sweet taste Source: Lipincott Williams, 2009, p. 723 - Assess if patient is -may decrease taking prescription and effectiveness of nonprescription lactulose

94 medications, especially antacids, antibiotics including neomycin (Mycifradin), and other laxatives. Source: Lipincott Williams, 2009, p. 723 thinner in texture.

95

GENERIC AND BRAND CLASSIFICAT ION GENERIC: Clopidogrel bisulfate

DOSE, STRENGTH AND FORMULATI ON ORDERED 75 mg tablet DURATION:

INDICATION /MECHANISM OF DRUG ACTION INDICATION: To reduce atherosclerotic events in patients with atherosclerosis documented by recent CVA, MI, or peripheral arterial disease. ACTION: Inhibits platelet aggregation by inhibiting the binding of adenosine diphosphate to its platelet receptor, inhibiting ADPmediated activation and subsequent platelet aggregation. Because clopidogrek acts by irreversibly modifying the platelet ADp receptor, platelets exposed to

ADVERSE/SIDE EFFECTS DRUG INTERACTION ADVERSE REACTION CNS: headache, dizziness, fatigue, depression. CV:edema, hypertension. EENT: rhinitis, epistaxis G.I.: hemorrhage, abdominal pain, dyspepsia, gastrirtis, constipation, diarrhea, ulcers. G.U.:UTI HEMATOLOGIC: purpura MUSCULOSKELETAL : Arthalgia RESPIRATORY: bronchitis, coughing, dyspnea,URTI. SKIN: rush, pruritus OTHER: flu syndrome, pain DRUG INTERACTION:

NURSING RESPONSIBILITIES

RATIONALE

CLIENT TEACHING

1.Monitor vital signs specifically blood pressure.

1.Drug may cause hypertension. Source: Lippincott Williams, 2009, p.339

BRAND: 5 days Plavix TIMING: CLASSIFICATI ON: Anti-platelet and Anti-coagulant O.D. OTHER FORMS: Tablets: 75mg

2..Instruct patient not to 2.Drug may cause stand up for at least 3-5 dizziness. minutes. Source: Lippincott Williams, 2009, p.339 3.Encourage patient to increase oral fluid intake. 4. Assess patient for increased bleeding or bruising tendencies before and during drug therapy. 3.Drug may cause constipation or diarrhea. Source: Lippincott Williams, 2009, p.339 4. To have an appropriate intervention. Source: Lippincott Williams, 2009, p.339

Advise patient it may take longer than usual to stop bleeding. Tell him to refrain from activities in which trauma and bleeding may occur, and encourage him to wear a seat belt when in car. Instruct patient to notify prescriber if unusaual bleeding or bruising occurs. Tell patient to inform all health care providers, including dentists, that he is taking drug

96 the drug are affected for their life span. Drug-drug. Aspirin, NSAIDs: may increase risk of G.I. bleeding. Source: Lippincott Use cautiously Heparin, Williams, 2009, p. 339 warfarin. Safety hasnt been established. Use together cautiously. Drug-herb.red clover. Possible increased risk of bleeding. Use cautioin. before undergoing procedures or starting new drug therapy. Inform patient that drug may be taken without regards to meal.

97 GENERIC, BRAND NAME & CLASSIFI CATION Generic: Metoprolol DOSE, STRENG TH, & FORMUL ATION Ordered: INDICATION AND MECHANISM OF ACTION ADVERSE NURSING RATIONALE REACTIONS RESPONSIBI AND DRUG LITIES INTERACTIO NS ADVERSE Assess To have a baseline data REACTIONS: pts condition Source: Lippincott Williams, 2009, p. CNS: dizziness, before therapy 963 headache, and regularly paresthesia thereafter CV: chest pain, such as: flushing , Monitor palpitations, ng vital signs peripheral and ECG edema every 5 to 15 EENT: gingival minutes hyperplasia,rhin before, orrhea during, and GI: abdominal after pain, administration constipation of drug. if MUSCULOSK pulse rate is< ELETAL: 50 refer to the Back pain, physician. muscle cramps Monitor RESPIRATOR intake and Y: cough, upper output and respiratory daily weights infection SKIN: rash INTERACTIO N: CLIENT TEACHIN G Instruct patient to swallow tablets whole and not to crush or chew them. Tell patient to take drug even when he feels better, to watch his diet, and to check with prescriber or pharmacist before taking other drugs, including OTC and herbal remedies.

5+50 mg. tab Brand name: Hold for BP less Logimax than Or equal to 110/60 Classificatio mmhg. n: Timing: Antihyperte nsive O.D Duration: 24 hrs. Other Forms: Tablets (extendedrelease) 2.5 mg,5 mg,10 mg

Indication: Treatment of hypertension, ventricular arrhythmias, atrial ectopy; migraine prophylaxis, essential tremor, prevention of reinfarction and sudden death after myocardial infarction; prevention and treatment of atrial fibrillation and atrial flutter; multifocal atrial tachycardia; symptomatic treatment of hypertrophic obstructive cardiomyopathy Mechanism of Action: Logimax combines two medicines that have different ways of working (modes of action) and which doctors know lead to a greater lowering of blood pressure in some people than with either medicine used alone. Felodipine (see Plendil) belongs to the group of medicines called calcium-channel blockers which stop calcium entering into cells

98 Drug-Drug: anticonvulsants; through holes (channels) in the may decrease cell wall.Calcium is necessary felodipine level. for muscle cells to Avoid use contract.Felodipine interferes together. with calcium movement in the Drug-Herb: St. muscle cells of the small Johns wort; arteries and thereby causes the muscles to relax and the arteries may increase to expand, which in turn lowers felodipine metabolism. the blood pressure.Metoprolol Discourage use (see Seloken ZOK) works by together. blocking the action of a Drug-Food: chemical called noradrenaline, which is released from nerves in Grapefruit, Lime; may the heart to control its rate. Metoprolol also blocks another increase level and adverse chemical called adrenaline, effects of drug. which is a hormone (chemical signal carried in the blood) that Discourage use together. has similar effects to noradrenaline. Metoprolol stops these chemicals from attaching (binding) to special sites, called beta-receptors, in the heart so they cant produce their effects.Metroprolol reduces the heart rate.It also reduces the force of heart muscle contraction and thereby lowers blood pressure. Source: Be alert for adverse reactions such as: 1. Paresth esia 2. Dizzine ss 3. Vomitin g 4. Bradyc hardia To avoid complications 5. Hypote Source: Lippincott Williams, 2009, p. nsion 963 6. Abdomi nal pain 7. Constip ation 8. Muscle cramps Withdraw drug if patient presents symptoms of mental depression. Possible symptoms of depression: disinterest in

Advice patient to practice good oral hygiene and to see dentist regularly

99 http://patienthealthinternational.com/co ntent/product/logimax-forte people, surroundings, food, personal hygiene; withdrawal, apathy, sadness, difficulty in concentrating, insomnia

To further prevent the complications which may lead to Catatonia Source: http://nursingcrib.com/drugguides/metoprolol-tartrate/

Observe hypertensive patients with CHF closely for impending heart failure: Dyspnea on exertion, orthopnea, night cough, edema, distended neck veins. Do not discontinue drug abruptly after long-term It may indicate cardiac Arrhythmias or peripheral vascular insufficiency. Source: http://nursingcrib.com/drugguides/metoprolol-tartrate/

100 therapy

hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias source: http://web.squ.edu.om/medLib/MED_CD/E_CDs/Nursing%20Drug %20Guide/mg/metoprolol.htm

101 GENERIC, BRAND NAME & CLASSIFICA TION Generic: Ezetimibe Brand name: Ezetrol Classification: unknown Antilipemic Other Forms: Tablets: 10 mg DOSE, STRENGTH, & FORMULATI ON Ordered: 10 MG tablet Timing: O.D Duration: INDICATION AND MECHANISM OF ACTION Indication: Primary hypercholesterolem ia, alone or with HMG-CoA reductase inhibitor, adjunct to atorvastatin in patient with homozygous familial hypercholesterolem ia to reduce sitosterol and campesterol levels. Mechanism of Action: Lowers cholesterol levels. Source: Lippincott Williams, 2009, p. 783 ADVERSE REACTIONS AND DRUG INTERACTIONS ADVERSE REACTIONS: CNS: dizziness, headache, fatigue CV: chest pain EENT: pharyngitis, sinusitis GI: abdominal pain, diarrhea MUSCULOSKELETAL: Arthralgia, back pain RESPIRATORY: cough, URTI INTERACTION: Drug-Drug: Aluminum/Magnesium antacids, bile acid sequestrant(cholestyramine); may decrease ezetimide level. Monitor patient closely for adverse effects. NURSING RESPONSIBILITIES RATIONALE CLIENT TEACHING

To monitor drug effevtiveness. Source: Lippincott Williams, 2009, p. 783 Monitor total To determine or cholesterol, LDL, HDL indicate the proper and triglyceride levels effect of the drugs. before and during Source: Lippincott therapy. Williams, 2009, p. 783 Obtain history of patient underlying condition before starting therapy. Assess patient and familys knowledge of drug therapy. To promote cooperation of both patient and the S.O Source: Lippincott Williams, 2009, p. 783

Emphasize importance of following a cholesterollowering diet. Tell patient he may take drug without regard to meals. Advise patient to notify prescriber of unexplained muscle pain, weakness, or tenderness.

102

GENERIC AND DOSE,STRENGTH BRAND AND CLASSIFICATION FORMULATION GENERIC : Senna Concentrate BRAND: Senokot CLASSIFICATION: Laxative OTHER FORMS: Tablets Granules Liquid Suppositories Syrup DURATION: variable TIMING: HS ORDERED: 187 mg give 2 tablets

INDICATION/ MECHANISM OF ACTION INDICATION: Acute constipation, preparation for bowel examination.

ADVERSE/ SIDE EFFECTS, DRUG INTERACTION ADVERSE REACTION

NURSING RESPONSIBLITIES 1. 1.Monitor intake and output. 2. 2.Anticipate when constipation is likely to occur.

RATIONALE

CLIENT TEACHING

G.I.: nausea, vomiting, diarrhea, loss of normal bowel function with excessive use, abdominal cramps especially in severe ACTION: constipation after catharsis, Unknown, yellow or yellow-green cast Stimulant laxative to feces, darkened that increases pigmentation of rectal peristalsis, mucosa with long term use, probably by direct protein losing enteropathy. effect in smooth G.U.: red-pink discoloration muscle of the in alkaline urine, yellowintestine. It's brown discoloration in acidic thought to either urine. irritate the METABOLIC: electrolyte musculature or imbalance such as stimulate the hypokalemia. colonic OTHER: laxative intramural plexus. dependence with long term or Drug also excessive use. promotes fluid accumulation in DRUG INTERACTIONS colon and small intestine. none significant

3. 3.Teach patient exercises that would promote peristalsis. 4. 4.Advise patient to increase intake of fiber.

1. 1.Stop drug if output is 3 stools per shift. 2. 3. 2.To have precautio nary measures of patient having constipati on and add a preventiv e bowel regimen. 4. 5. 3.To avoid dependen ce on drug . 4. t4.o

Teach patient about dietary sources of bulk, including bran and other cereals, fresh fruit and vegetables . Tell patient to report persistent or severe reactions. Explain that stimulant laxatives may cause harmless urine

103

(Lippincott,2009, Laxatives, pp. 74)

5. 6. 5.Drug is preferably administered during daytime. (Lippincott,2009, Laxatives, pp. 74)

promote peristalsis . 5. 5.So that bowel evacuatio n doesn't interfere with sleep.

(Lippincott,2009, Laxatives, pp. 74)

discolorati on. Encourage patient to remain active and drink plenty of fluids if he takes a bulkforming laxative.

(Lippincott,2009, Laxatives, pp. ((Lippincott,2009, 74) Laxatives, pp. 74)

104

GENERIC AND BRAND NAME

DOSE, STRENGTH AND FORMULATION ORDERED: 50mg tablet DURATION:

INDICATION/ MECHANISM OF ACTION INDICATION: Hypertension ACTION:

ADVERSE/SIDE EFFECTS AND DRUG INTERACTION ADVERSE REACTION: CNS: fatigue, dizziness, depression CV:bradycardia, hypotension, heart failure, AV block G.I: nausea, diarrhea HEPATIC: elevated serum transaminase, alkaline phosphate, and LDL levels METABOLIC: elevated uric acid level RESPIRATORY: dyspnea SKIN: rash DRUG INTERACTION: DRUG-DRUG. Barbiturates, rifampin: increased metabolism of metropolol. Watch for

NURSING RESPONSIBILITIE S 1. Monitor vital signs specifically blood pressure and respiration.

RATIONALE

CLIENT TEACHING

GENERIC: Metoprolol tartrate BRAND:

Unknown. A selective Neobloc beta blocker that TIMING: decreases myocardial CLASSIFICATIO contractility, heart rate, N: OD (8AM) cardiac output, and Antihypertensive, blood pressure and adjunct therapy of reduces myocardial acute MI OTHER FORMS: oxygen use. Also Tablets, tablets depresses rennin (extended-release), secretion. injection - Nursing 2009 Student Drug Handbook. 2009. pp. 838.

6-12 hours

1. To establish baseline data. To monitor any signs of symptomatic hypotension and possible decrease in heart rate. -Smeltzer, et al. 2010. pp. 831. 2.Any type of betablocker is contraindicated in patients with severe of uncontrolled asthma. -Smeltzer, et al. 2010. pp. 831. 3. The drug has its adverse side effects such as hypotension and dizziness due to its mechanism of action in

2. Carefully assess the patients history of asthma. Administer drug cautiously.

3. Educate the patient about the potential worsening of symptoms during the

Instruct patient to take drug exactly as prescribed and to take it with meals. Caution patient to avoid driving and other tasks requiring mental alertness until response to therapy has been established. Advise patient to inform dentist or prescriber about use of

105 decreased effects. early phase of treatment and stressing that improvement may take several weeks. our body thereby putting the patient into such discomforts. -Smeltzer, et al. 2010. pp. 831. this drug before procedures or surgery. Tell patient to alert prescriber if shortness of breath occurs. Instruct patient not to stop drug suddenly but to notify prescriber about unpleasant adverse reactions. Inform him that drug must be withdrawn gradually over 1-2 weeks. Tell patient that drug may deplete bodys stores of coenzyme Q10 and that he should discuss the need for supplements

4. Due to side frequent side effects of 4. Administer drug dizziness, hypotension starting at low dose and bradycardia. with close monitoring -Smeltzer, et al. 2010. after each dose pp. 831. increase. 5. Drug may cause dizziness. -Smeltzer, et al. 2010. 5. Instruct patient not pp. 831. to stand up for at least 3-5 minutes upon intake of drug.

106 with prescriber.

TYPE OF SOLUTION

CLASSIFICATION

CONTENT

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

HOW SUPPLIED

DOSE

NURSING RESPONSIBILITY

107 Hypo- osmolality possible infusion because solutions have a lower concentration of electrolytes than plasma does,transcend all membranes from vascular space to tissue to cell. -hypertonic dehydration -sodium and chloride depletion -water replacement 10cc/hr -Hypertensive Single dose container 500ml 1.Assess fluid balance throughout therapy. 2.Assess patients for symptoms of hypernatremia(headache,tachycardia, nausea,vomiting) throughout therapy. 3.Check the level of IVF throughout the therapy. 4.Check and regulate the flow rate of IVF. 5.Change the IVF solution if needed.

D5 0.3% NaCL

Hypotonic

3%NaCL, Na 513 meq/L, Cl-513meq/L, (1026 mOsm/L)