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Makati Medical Center College of Nursing DRUG STUDY Patients Name: V., A.M. L.

. Age: 53Y Attending Physician/s: Dr. B. C. Allergies: No known Prepared by: Abantao, Justine Hana T. / BSN IV-A Group1 DRUG NAME GENERIC: Esomeprazole BRAND: Nexium Tab 40 mg DOSE AND FREQUENCY: 1 tablet once a day ROUTE: PO Rx CLASSIFICATION: Proton Pump Inhibitor PREGNANCY RISK CATEGORY: Category B MECHANISM OF ACTION Inhibit the H+-K+-ATPase pump (proton pump) in gastric parietal cells effectively blocking the final step in acid production, thereby reducing gastric acidity. Medical Diagnosis: Community Acquired Pneumonia Allergic Responses: None ADVERSE DRUG EFFECT
Headache, abdominal pain, diarrhea, flatulence, nausea/vomiting, constipation, dermatitis, pruritus, urticaria, dizziness, dry mouth, blurred vision, hypersensitivity reactions.

RATIONALE FOR THIS PATIENT Treatment of GERD as an alternative to oral therapy

NURSING IMPLICATIONS
Assess patient condition before and during drug therapy; Assess GI system: anorexia and abdominal pain; Assess hepatic function because drug is extensibly metabolized in the liver: AST, ALT; Monitor for adverse reactions; Long term therapy with omeprazole has cause atrophic gastritis; Make sure capsule is swallowed whole, do not break, crush or chew.

DRUG NAME GENERIC: Azithromycin 500mg/cap BRAND: Zenith DOSE AND FREQUENCY: 1cap ROUTE: PO Rx CLASSIFICATION: Antibacterial. PREGNANCY RISK CATEGORY: B

MECHANISM OF ACTION Azithromycin monohydrate is active against certain bacteria. Azithromycin passes into the bloodstream from the GIT and is carried to the diseased tissue, where it starts acting against the bacteria. Because azithromycin remains at the site of infection longer than other antibiotics, the healing action continues for several days after taking Zenith.

RATIONALE FOR THIS PATIENT Antibiotic given to fight for the bacteria to treat productive cough and colds.

ADVERSE DRUG EFFECT


Loss of appetite, impaired digestion, loose stools, upper abdominal pain, constipation, flatulence, hepatitis, jaundice, irregular heart beat.

NURSING IMPLICATIONS
Adverse reactions could occur if ergot alkaloids (eg, ergotamin) are used concomitantly with Zenith. Warfarin, cyclosporin, digoxin, theophylline and terfenadine must only be taken as instructed by the physician. An interval of 2-3 hrs should be observed between antacids and Zenith. May be taken with or without food (Swallow whole, do not chew/crush.).

DRUG NAME GENERIC: Hydrocortisone 100mg/2ml vial BRAND: Solu-cortef DOSE AND FREQUENCY: 100mg/2ml ROUTE: inhalation Rx CLASSIFICATION: Anti-inflammatory (steroidal) short-acting corticosteroids PREGNANCY RISK CATEGORY: C

MECHANISM OF ACTION Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators

RATIONALE FOR THIS PATIENT It also helps in treatment of bronchospasms because it dilates the bronchial tree to facilitate gas exchange and airway clearance.

ADVERSE DRUG EFFECT


Adverse reactions CNS: headache, nervousness, depression, euphoria, personality changes, psychoses, vertigo, paresthesia, insomnia, restlessness, conus medullaris syndrome, meningitis, increased intracranial pressure, seizures CV: hypotension, hypertension, thrombophlebitis, heart failure, shock, fat embolism, thromboembolism, arrhythmias EENT: cataracts, glaucoma, increased intraocular pressure, epistaxis, nasal congestion, perforated nasal septum, dysphonia, hoarseness, nasopharyngeal or oropharyngeal fungal infections GI: nausea, vomiting, esophageal candidiasis or ulcer, abdominal distention, dry mouth, rectal bleeding, peptic ulceration, pancreatitis Hematologic: purpura

NURSING IMPLICATIONS
Patient monitoring watch closely for signs and symptoms of depression or psychotic episodes. Monitor patients response during weaning from drug.Watch for adrenal crisis, which may occur if drug is discontinued too quickly. Patient teaching Instruct patient to take daily P.O. dose with food by 8 A.M. . Urge patient to immediately report unusual weight gain, face or leg swelling, epigastric burning, vomiting of blood, black tarry stools, irregular menstrual cycles, fever, prolonged sore throat, cold or other infection, or worsening of symptoms Advise patient to discontinue topical drug and notify prescriber if local irritation occurs. Instruct patient to eat small, frequent meals and to take antacids as needed to minimize GI upset. Caution patient not to stop taking drug abruptly. Instruct patient to wear medical identification stating that hes taking this drug.

DRUG NAME GENERIC: acetylcysteine 1 tab BRAND: Friumucil DOSE AND FREQUENCY: ROUTE: PO

MECHANISM OF ACTION Decreases viscosity of secretions, promoting secretion removal through coughing, postural drainage, and mechanical means. In acetaminophen overdose, maintains and restores

RATIONALE FOR THIS PATIENT It helps to easily expectorate lung secretions to prevent clogging.

ADVERSE DRUG EFFECT


CNS: dizziness, drowsiness, headache CV: hypotension, hypertension, tachycardia EENT: severe rhinorrhea GI: nausea, vomiting, stomatitis, constipation, anorexia Hepatic: hepatotoxicity

NURSING IMPLICATIONS
Patient monitoring Monitor respirations, cough, and character of secretions. Patient teaching Instruct patient to report worsening cough and other respiratory symptoms. Advise patient to mix oral form with

Rx CLASSIFICATION: Mucolytic, acetaminophen antidote PREGNANCY RISK CATEGORY: B

hepatic glutathione, needed to inactivate toxic metabolites

Respiratory: hemoptysis, tracheal and bronchial irritation, increased secretions, wheezing, chest tightness, bronchospasm Skin: urticaria, rash, clamminess, angioedema Other: tooth damage, chills, fever, hypersensitivity including anaphylaxis

juice or cola to mask bad taste and odor. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

DRUG NAME GENERIC: ipratropium+salbutamol BRAND: Combivent Unit Dose Vial (UDV) DOSE AND FREQUENCY: 1 neb ROUTE: inhalation Rx CLASSIFICATION: Bronchodilator, antiasthmatic PREGNANCY RISK CATEGORY: C

MECHANISM OF ACTION Ipraprotium bromide: Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa. Salbutamol: Stimulates beta-2 receptors of bronchioles to produce bronchodilation MECHANISM OF ACTION Inhibits cell-wall synthesis in bacteria, causing cell death

RATIONALE FOR THIS PATIENT Treatment for bronchospasm to facilitate airway clearance and effective gas exchange.

ADVERSE DRUG EFFECT


Fine tremor of skeletal muscle Palpitations Headache Dizziness Nervousness dryness of mouth throat irritation urinary retention

NURSING IMPLICATIONS
Assess cardio-respiratory function: heart rate and rhythm, respiration rate and breathing pattern, and breath sounds. Note adventitious sounds. Ensure adequate hydration; provide ventilation to prevent hyperpyrexia. Do not double doses or increase the frequency of doses. Drug should be given exactly as prescribed. Perform chest physiotherapy after nebulization. Report rash, eye pain, palpitations, tremors, weakness, irregular heartbeat. Provide proper nutrition. Give small frequent feedings for GI upset, nausea and vomiting.

DRUG NAME GENERIC: Entrapenem 1gram/ vial BRAND: Invanz DOSE AND FREQUENCY: 1 gram dissolve with 10cc PNSS IV Drip ROUTE: PO Rx CLASSIFICATION: Anti-infective PREGNANCY RISK CATEGORY: B

RATIONALE FOR THIS PATIENT Treatment to fight for infections.

ADVERSE DRUG EFFECT


CNS: headache, dizziness, asthenia, fatigue, insomnia, altered mental status, anxiety, seizures CV: hypotension, hypertension, chest pain, phlebitis, thrombophlebitis, arrhythmias, heart failure EENT: pharyngitis GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, gastroesophageal reflux disease, pseudomembranous colitis

NURSING IMPLICATIONS
Patient teaching Tell patient to notify nurse right away if drug causes pain or swelling at injection site. Inform patient that drug can be toxic to many organ systems. Tell him to promptly report significant adverse reactions. Tell female patient to inform prescriber of pregnancy or breastfeeding before taking drug. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially

GU: vaginitis Hepatic: hepatotoxicity Respiratory: crackles, cough, dyspnea, wheezing, respiratory distress

those related to the drugs mentioned above.

DRUG NAME GENERIC: budesonide 250mcg/ml BRAND: Budecort DOSE AND FREQUENCY: 2ml respule ROUTE: inhalation Rx CLASSIFICATION: Antiasthmatic, steroidal anti-inflammatory PREGNANCY RISK CATEGORY: B (inhalation), C (oral)

MECHANISM OF ACTION Decreases inflammation by inhibiting migration of inflammatory mediators to injury site, where it reverses dilation and increases vessel permeability. Also decreases plasma exudation and mucus secretions within airway.

RATIONALE FOR THIS PATIENT Treatment for bronchospasm to facilitate airway clearance and effective gas exchange.

ADVERSE DRUG EFFECT


CNS: headache, nervousness, depression, euphoria, psychoses, increased intracranial pressure CV: hypertension, Churg-Strauss syndrome, thrombophlebitis, thromboembolism EENT: cataracts, nasal congestion, nasal burning or dryness, epistaxis, perforated nasal septum, hoarseness, nasopharyngeal and oropharyngeal fungal infections GI: nausea, vomiting, peptic ulcers, anorexia, esophageal candidiasis, dry mouth Metabolic: hyperglycemia, decreased growth (in children), cushingoid appearance (moon face, buffalo hump), adrenal suppression or insufficiency

NURSING IMPLICATIONS
Teach patient proper use of inhaler. Tell patient to swallow capsules whole without crushing or chewing them. 2Instruct patient to contact prescriber immediately if he develops itching, rash, fever, swelling of face and neck, or difficulty breathing. Encourage patient to document medication use and his response in diary. Advise patient to report signs and symptoms of fungal infections of mouth. Tell female patient to inform prescriber if she is pregnant or plans to become pregnant. Caution patient to avoid exposure to chickenpox and measles, if possible. Emphasize importance of rinsing mouth after each inhaler treatment and washing and drying inhaler thoroughly after each use. Instruct patient to avoid high-fat meals, grapefruit, and grapefruit juice. As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and foods mentioned above.

SOURCES: Nursing Spectrum Drug Handbook, 2010