Saint Marys University SCHOOL OF HEALTH SCIENCES Bayombong, Nueva Vizcaya A Drug Study presented to a Faculty of the School

of Health Sciences
A partial fulfillment in NCM 103 RLE ( VRH Pay Ward )

Presented to:

Mrs. Joy Lyzette R. Carreon, RN

Clinical Instructor

Presented by:

Hannah Philene D. Calub

BSN3A, Group 10

September
S.Y 2011-2012
Drug Action Side Effects Nursing Considerations

Generic Name: Dopamine Hydrochloride Brand Name: Intropin Classification: Adrenergics (Sympathomimetics)

Stimulates dopaminergic and alpha and beta receptors of the sympathetic nervous system. Action is dose-related; large doses cause mainly alpha stimulation.

dyspnea nausea vomiting tachycardia headache ectopic beats palpitation vasoconstriction

Indication To treat shock and correct hemodynamic imbalances, improve perfusion to vital organs, increase cardiac output, or correct hypertension

Adverse Reactions CNS: headache CV: ectopic beats, tachycardia, angina, palpitations, hypotension GI: nausea, vomiting Metabolic: azotemia, hyperglycemia Respiratory: dyspnea, asthmatic episodes Skin: necrosis and tissue sloughing with extravasation, piloerection Other: anaphylactic reactions

Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed by physician. Precise measurements are essential for accurate titration of dosage. Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure); signs of peripheral ischemia Dopamine is potent drug. Dilute before use if not prediluted. If a marked decrease in pulse pressure and disproportionate increase in diastolic BP are observed, the rate of infusion should be decreased and the patient monitored for further evidence of predominant vasoconstrictive activity, unless such an effect is desired. If an increased number of

ectopic beats are observed, the dose should be reduced if possible. Drug Generic Name: Dobutamine Hydrochloride Brand Name: Dobutrex Classification: Adrenergics (Sympathomimetics) Action Stimulates hearts beta1 receptors to increase myocardial contractility and stroke volume. At therapeutic dosages, drug increases cardian output by decreasing peripheral vascular resistance, reducing ventricular filling pressure, and facilitating AV node conduction. Side Effects skin rash upset stomach fever irregular heartbeat vomiting tingling sensations increases in blood pressure and heart rate chest pain shortness of breath swelling of the lower legs and ankles increasing fatigue lightheadedness, dizziness, or faintness leg cramps headaches Adverse Reactions CNS: headache CV: phlebitis, nonspecific chest pain, hypotension, angina, palpitations, increased heart rate, hypertension GI: nausea, vomiting Respiratory: shortness of breath, asthma attacks Other: anaphylactic reactions Nursing Considerations As needed, correct hypovolemia before starting therapy by giving volume expanders, as prescribed. Monitor ECG and blood pressure continuously during administration. Monitor fluid intake and output. Assess electrolyte levels. Stay especially alert for hypokalemia. Instruct patient to report anginal pain, headache, leg cramps, and shortness of breath. Explain need for close observation and monitoring. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.

Indication Increased cardiac output in shortterm treatment of cardiac decompensation caused by depressed contractility, such as during refractory heart failure; adjunctive therapy in cardiac surgery

Drug Generic Name: Enoxaparin Sodium Brand Name: Lovenox Classification: Anticoagulant

Action Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparins inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.

Side Effects Bleeding Thrombocytopenia, i.e. can be associated with heparin-induced thrombocytopenia (0.5-5.0% of patients treated for at least five days Pain, bruising or irritation; hard, inflamed nodules or an itchy red rash at the injection site Symptoms similar to those of hayfever Abdominal/chest pain Headache Hyperkalemia Transaminitis

Nursing Considerations Periodic CBCs, including platelet count, and stool occult blood tests are recommended. Monitor frequently for signs/symptoms of neurological impairment. Monitor thrombocytopenia of any degree. Observe all low-weight women (less than 45 kg), low-weight men (less than 57 kg), pregnant women, and patients with renal impairment carefully for signs and symptoms of bleeding. Advise patients that the use of aspirin and other NSAIDs may enhance the risk of hemorrhage. Instruct patient to report any signs of bleeding or bruising; signs of thrombocytopenia (eg, a rash of dark spots under

Indication The treatment of unstable angina (UA) and non-Qwave myocardial infarction (NQMI), administered Adverse Reactions CNS: fever, pain CV: edema, peripheral edema GI: nausea, diarrhea Metabolic: azotemia,

concurrently with aspirin. Prophylaxis of DVT Total hip & knee replacement Abdominal surgery. Treatment of DVT with or without PE. Treatment of DVT inpatient, with ACS, including STEMI.

hyperglycemia Respiratory: dyspnea, lung edema, pneumonia Hematologic: anemia, hemorrhage ,major bleeding, thrombocytopenia, thrombocytopenia with thrombosis, thrombocytosis Skin: Cutaneous vasculitis, purpura, skin necrosis occurring at the injection site or distant from the injection Other: anaphylactic reactions Side Effects Hypercalcemia may develop

the skin); or black, bloody, or tarry stools immediately. If patient has home therapy, teach patient or family member proper subcutaneous injection technique. Caution patient to take safety precautions to prevent cuts and bruising (eg, use electric razor, soft toothbrush, handrails).

Drug Generic Name: Essential Amino Acids Brand Name: Ketosteril Classifications: Ketoanalogs; Essential amino acids

Action Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesium and phosphate.

Nursing Considerations Evaluate for any contraindications Take drug as prescribed Warn the patient about possible side effects and how to recognize them Give with food if GI upset occurs Frequently assess for hypercalcemia

Indication Protein energy malnutrition

Adverse Reactions Hypercalcemia may develop

Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure

Drug Generic Name: Clopidogrel bisulfate Brand Name: Plavix Classification: Cardiovascular System Drug

Action Inhibits the binding of adenosine diphosphate (ADP) to its receptor, impending ADP-mediated activation and subsequent platelet aggregation. Clopidogrel irreversibly modifies the platelet ADP receptor.

Side Effects excessive tiredness headache dizziness nausea stomach pain diarrhea nosebleed

Nursing Considerations Assess History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer Assess Physical Status: Skin color, temperature, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds Provide small, frequent meals if GI upset occurs (not as common as with aspirin). Provide comfort measures

Indication Adverse Reactions

Prevention of vascular ischemic events in patients with symptomatic atherosclerosis Acute coronary syndrome without ST-segment elevation (NSTEMI), ST elevation MI (STEMI) It is used, along with aspirin, for the prevention of thrombosis after placement of intracoronary stent or as an alternative antiplatelet drug for patients who are intolerant to aspirin.

CNS: headache depression, dizziness, fatigue, pain CV: edema, hypertension GI: hemorrhage, abdominal pain, dyspepsia, gastritis, constipation, diarrhea, ulcer GU: UTI Musculoskeletal: arthralgia Respiratory: dyspnea, URTI, bronchitis, coughing Hematologic: purpura Skin: rash, pruritus Other: flulike syndrome

and arrange for analgesics if headache occurs. Take daily as prescribed. May be taken with meals. Report skin rash, chest pain, fainting, severe headache, abnormal bleeding.

Drug

Action

Side Effects

Nursing Considerations

Generic Name: Tranexamic acid - oral Brand Name: Cyklokapron Classification: Anti-fibrinolytic, Antihemorrhagic

Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogenplasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Indication Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas:

nausea vomiting diarrhea dizziness

Adverse Reactions Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent

Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX

Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.

deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

headache Severe or persistent body malaise Shortness of breath Slurred speech

Drug Generic Name: Omeprazole / Omeprazole magnesium Brand Name: Prilosec, Losec, Zegerid Classification: GIT drug, Antiulcer drug

Action Inhibits activity of acid (proton) pump and binds to hydrogenpotassium adenosine triphosphate at secretory surface of gastric parietal cells to block formation of gastric acid.

Side Effects fever cold symptoms such as stuffy nose sneezing, sore throat stomach pain, gas nausea, vomiting, diarrhea headache.

Nursing Considerations Assess History: Hypersensitivity to omeprazole or any of its components; pregnancy, lactation Assess Physical Status : Skin lesions; T; reflexes, affect; urinary output, abdominal examination; respiratory auscultation Administer before meals. Caution patient to swallow capsules whole not to open, chew, or crush them. WARNING: Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not intended for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did occur in preclinical studies. Administer antacids with omeprazole, if needed.

Indication Treatment of duodenal ulcers Prevention of relapse of duodenal ulcers Treatment of gastric ulcers Prevention of relapse of gastric ulcers In combination with appropriate antibiotics, Helicobacter pylori (H. pylori) eradication in peptic ulcer disease Treatment of NSAID-associated gastric and duodenal ulcers Prevention of NSAID-associated

Adverse Reactions CNS: headache, dizziness, asthenia CV: edema, hypertension GI: abdominal pain, constipation, diarrhea, flatulence, nausea, vomiting Musculoskeletal: back pain Respiratory: URTI, cough Skin: rash

gastric and duodenal ulcers in patients at risk Treatment of reflux oesophagitis Long-term management of patients with healed reflux oesophagitis Treatment of symptomatic gastro-oesophageal reflux disease Treatment of Zollinger-Ellison syndrome Drug Generic name: Pinene alpha + beta, Camphene, Cineol, Fenchone, Borneol, Anethol and Olive Oil Brand name: Rowtinex Classification: Antiurolithic Action ROWATINEX promotes a diuresis and relaxes urinary tract spasm, thus assisting the passage of stones. The therapeutic effect of the balanced combination of terpenes reduces urinary tract inflammation, stimulating renal blood flow through the kidneys and increasing the output of less concentrated urine. Side Effects No untoward side effects have been reported.

Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush them. Have regular medical follow-up visits. Report severe headache, worsening of symptoms, fever, chills. Nursing Considerations Monitor Intake and Output Take on empty stomach Liquid intake should be increased during therapy. Store at temperatures not exceeding 30 degrees Celcius.

Indication For the treatment of urinary tract spasm and inflammation associated with urolithiasis. Assists in the dissolution and expulsion of stones in the renal

Adverse Reactions No untoward adverse reactions have been reported.

system.

Drug Generic Name: Azithromycin Brand Name: Zithromax Classification: Macrolide antiinfectives

Action Binds to the 50S subunit of bacterial ribosomes, blocking protein synthesis; bacteriostatic or bactericidal, depending on concentration.

Side Effects upset stomach diarrhea vomiting stomach pain mild skin rash

Nursing Considerations Monitor for and report loose stools or diarrhea, since pseudomembranous colitis (see Appendix F) must be ruled out. Monitor PT and INR closely with concurrent warfarin use. Direct sunlight (UV) exposure should be minimized during therapy with drug. Take aluminum or magnesium antacids 2 h before or after drug. Report onset of loose stools or diarrhea. Do not breast feed while taking this drug without consulting physician.

Indication For the treatment of mild to moderate acute bacterial exacerbations of chronic bronchitis in patients with COPD caused by susceptible strains of Haemophilus influenza, Moraxella catarrhalis, or Streptococcus pneumoniae For the treatment of Adverse Reactions CNS: headache, dizziness, fatigue, vertigo, somnolence CV: palpitations, chest pain GI: abdominal pain, constipation, diarrhea, flatulence, nausea, vomiting, melena, psuedomonas colitis GU: candidiasis, vaginitis, nephritis Hepatic: cholestatic jaundice

moderate upper respiratory tract infections due to susceptible strains of H. influenzae or S. pneumoniae For the treatment of acute otitis media For the treatment of community-acquired pneumonia (CAP) due to susceptible strains of Chlamydia pneumoniae, H. influenzae, Mycoplasma pneumoniae, or S. pneumoniae For the treatment of pelvic inflammatory disease (PID) For the treatment of urethritis and cervicitis Drug Generic Name: Rowachol Capsule Brand Name: Rowachol Classification: Cholagogues, Cholelitholytics & Hepatic Protectors; BILE AND LIVER THERAPY Action Rowachol increases biliary secretion, relieves spasm of the bile ducts, enhances metabolic liver function by reducing biliary stasis. By inhibiting HMGCoA reductase, endogenous cholesterol production is reduced, maintaining the bile above saturation level, assisting the dissolution of gallstones and preventing precipitation of further stones. The choleresis produced by Rowachol increases insulin production, assisting in the control of diabetic states.

Skin: rash, photosensitivity Other: angioedema

Side Effects No side effects have been reported with this medicine

Nursing Considerations Take this medication half to one hour before food. No safety information is available in pregnancy. Avoid use in pregnancy particularly during the first trimester. Seek medical advice from your doctor. It is recommended that women should not breastfeed whilst taking

this medicine. Indication Biliary disorders, toxic & chronic inflammatory conditions of the liver, pre-op & post-op treatment of the hepatobiliary system, especially after operations for gallstone & to prevent the recurrence of stone formation. Adjunct in the treatment of diabetic condition. Dyspepsia. Adverse Reactions No adverse reactions have been reported with this medicine Care should be exercised in the dosage of patients receiving anticoagulants or drugs dependent on the liver for metabolism and excretion. Reducing fat intake in the diet is advisable