Paracetamol or acetaminophen is an over-the-counter analgesic used as a pain reliever and antipyretic.

Common brand names are Aeknil, Biogesic, Calpol, Neo-kiddielets, Tempra. Paracetamol is classified as an Analgesic and Antipyretic. Indications for Paracetamol Fever, Relief of mild to moderate pain like headaches, muscular aches and pain, toothache, colds, earache, fever due to tonsillectomy, inoculations, and vaccinations. Routes and Dosage of Paracetamol Analgesia, Antipyresis PO: ADULTS, ELDERLY: 325-650 mg q4-6h or 1g 3-4 time/day. Maximum: 4 g/day. CHILDREN: 10-15 mg/kg/dose q4-6h as needed. Maximum: 5 doses/ 24 hours. NEONATES: 10-15 mg/kg/dose q6-8h as needed. Rectal: ADULTS: 650 mg q4-6h. Maximum: 6 doses/ 24 hours. CHILDREN: 10-20 mg/kg/dose q4-6h as needed. NEONATES: 10-15 mg/kg/dose q6-8h as needed Dosage for Clients with Renal Impairment: If creatinine clearance is 10-50mL/min the frequency should be q6h. If the creatinine clearance is <10mL/min the frequency should be q8h. Action of Paracetamol Inhibits prostaglandin synthesis in the CNS and blocks the pain impulse through a peripheral action. It acts on the hypothalamic heat-regulating center, producing peripheral vasodilation. It results in antipyresis and produces analgesic effect. Side Effects and Adverse Reactions of Paracetamol Side Effects of Paracetamol Side effects are well tolerated. Cramping, heartburn, abdominal distention can be experienced. On a rarity, hypersensitivity reactions. Adverse Reactions or Toxic Effects of Paracetamol Early signs of toxicity: Anorexia, nausea, diaphoresis (excessive sweating), generalized weakness within the first 12-24 hours. Late signs of toxicity: Vomiting, right upper quadrant tenderness, elevated liver function tests within 48-72 hours after ingestion. Antidote: Acetylcysteine.

Nursing Considerations for Clients Taking Paracetamol

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If to be given as analgesia, assess onset, type, location, duration of pain. Can be given without regards to meals. Tablets can be crushed. Assess temperature directly before and 1 hour after giving medication. If respirations are <12/min (<20/min in children), withhold the medication and contact the physician. Evaluate for therapeutic response: relief of pain, stiffness, swelling; increasing in joint mobility; reduced joint tenderness; improve grip strength. Therapeutic blood serum level: 10-30 mcg/mL; toxic serum level: >200 mcg/mL.

Patient Teaching for Clients Taking Paracetamol

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Consult physician for use in children less than 2 years old; oral use more than 5 days for children, more than 10 days for adults, or fever more than 3 days. Do not crush or chew sustained-release or enteric-coated form. Report ringing in ears and persistent GI pain. Severe, recurrent pain or high continuous fever may indicate serious illness.

Brand Name: Zegen Generic Name:Cefu roxime Indications: Treatment of bone and joint infections, bronchitis (and other lower respiratory tract infections), gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infections, surgical infections and UTI. Drug Classification:Antibiotics Mechanism of Action: Bind to bacterial cell wall membrane which causes cell death. Dosage: Cap Adult and children > 10 y/o 250-500mg q8h, Inj Adult 750mg-1.5g every 68 hrs for 5-10 days. Children > 3 months 50-100 mg/kg body wt/day in equally divided doses every 6-8 hrs. Special Precaution: Hypersensitivity to penicillins. Possible superinfection in prolonged use. Nephrotoxicity and ototxicity. Pregnancy Risk: B Adverse Reaction: Thrombophlebitis, Pruritus, urticaria, +ve Coombss test, diarrhea, nausea, pseudomembrenous colitis,. Decrease in Hb and hematocrit transient increase in liver enzymes, elevation in serum creatinine and BUN. Possible seizure and angiodema. Contraindications: Known allergy to cephalosporins. Form: Capsule and inj. Nursing Responsibilities: y Assess patient fro infection at the beginning and during the therapy. y Before initiating thepary, obtain a history to determine previous use of and reaction to penicillin or cephalosporins. Person with a negative history of penicillin sensitivity may still have an allergic response. y Obtain specimens for culture and sensitivity before initiating the therapy. y Observe patient for sings and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing) y Assess patient for renal dysfunction and adjust accordingly.

GENERIC NAME: amlodipine besylate BRAND NAME: Norvasc Drug class and mechanism: Amlodipine belongs to a class of medications called calcium channel blockers. These medications block the transport of calcium into the smooth muscle cells lining the coronary arteries and other arteries of the body. Since calcium is important in muscle contraction, blocking calcium transport relaxes artery muscles and dilates coronary arteries and other arteries of the body. By relaxing coronary arteries, amlodipine is useful in preventing chest pain (angina) resulting from coronary artery spasm. Relaxing the muscles lining the arteries of the rest of the body lowers the blood pressure, which reduces the burden on the heart as it pumps blood to the body. Reducing heart burden lessens the heart muscle's demand for oxygen, and further helps to prevent angina in patients with coronary artery disease. Indication: Chest pain or heart pain (angina) occurs because of insufficient oxygen delivered to the heart muscles. Insufficient oxygen may be a result of coronary artery blockage or spasm, or because of physical exertion which increases heart oxygen demand in a patient with coronary artery narrowing. Amlodipine is used for the treatment and prevention of angina resulting from coronary spasm as well as from exertion. Amlodipine is also used in the treatment of high blood pressure. Dosing: Amlodipine can be taken with or without food. Amlodipine is metabolized mainly by the liver and dosages may need to be lowered in patients with liver dysfunction. Mechanism of actions: In patients with severe coronary artery disease, amlodipine can increase the frequency and severity of angina or actually cause a heart attack on rare occasions. This phenomenon usually occurs when first starting amlodipine, or at the time of dosage increase. Excessive lowering of blood pressure during initiation of amlodipine treatment can occur, especially in patients already taking another blood pressure lowering medication. In rare instances, congestive heart failure has been associated with amlodipine, usually in patients already on a beta blocker.

GENERIC NAME: losartan BRAND NAME: Cozaar DRUG CLASS AND MECHANISM: Losartan is an oral medication that belongs to a class of drugs called angiotensin receptor blockers (ARBs). Other ARBs include irbesartan (Avapro), valsartan (Diovan), and candesartan (Atacand). Angiotensin, formed in the blood by the action of angiotensin converting enzyme (ACE), is a powerful chemical that attaches to angiotensin receptors found in many tissues but primarily on smooth muscle cells of blood vessels. Angiotensin's attachment to the receptors causes the blood vessels to narrow (vasoconstrict) which leads to an increase in blood pressure (hypertension). Losartan (more specifically, the chemical formed when the liver converts the inactive losartan into an active chemical) blocks the angiotensin receptor. By blocking the action of angiotensin, losartan dilates blood vessels and thereby reduces blood pressure. Losartan was approved by the FDA in April 1995. PRESCRIBED FOR: Losartan is used for treating hypertension, left ventricular hypertrophy (increase in muscle) and diabetic nephropathy (kidney disease). It may be used alone or in combination with other drugs. DOSING: The usual starting dose of losartan for adults is 50 mg daily. The maximum dose is 100 mg daily. The total daily dose may be divided and administered twice daily. Losartan may be given with or without food. The starting dose of losartan for pediatric patients 6 years of age or older is 0.7 mg/kg up to 50 mg once daily. Doses more than 1.4 mg/kg or 100 mg daily have not been evaluated in pediatric patients. DRUG INTERACTIONS: Inhibitors of cytochrome P450 enzymes such as fluconazole (Diflucan) reduced the formation of the active drug metabolite in laboratory studies. Therefore, caution should be used when adding losartan in a patient taking Nizoral, as reduced activity of losartan may occur. Losartan may increase levels of blood potassium which can lead to serious heart problems (arrhythmias). Therefore, concomitant use of other substances that increase blood-such as potassium-sparing diuretics (for example, spironolactone (Aldactone), triamterene, and amiloride), potassium supplements, or salt substitutes containing potassium--may lead to dangerous increases in serum potassium. The antihypertensive effect of losartan may be reduced by nonsteroidal antiinflammatory drugs (for example, indomethacin, ibuprofen, aspirin , and naproxen). SIDE EFFECTS: In clinical studies the overall incidence of side effects was similar to placebo. Side effects reported included diarrhea, muscle cramps, dizziness, insomnia, and nasal congestion. Losartan also may cause a persistent cough, increase serum potassium, and angioedema. Losartan may reduce kidney function in some patients and should not be used by

patients who have bilateral renal artery stenosis (narrowing of both arteries going to the kidneys). Rare cases of rhabdomyolysis (muscle breakdown) have been reported.