DRUG STUDY

DRUGS NAME: Bisacodyl (Bisacodyl)

Dose / Frequency : I tab po @hs x 2 doses
Classification Mechanism of Action
Stimulant laxative that increases peristalsis, probably by direct effect on smooth muscle of the intestine, by irritating the muscle or stimulating the colonic intramural plexus. Drug also promotes fluid accumulation in colon and small intestine.

Indication

ContraIndications
Contraindicated in patients hypersensitive to drug or its components and in those with rectal bleeding, gastroenteritis, intestinal obstruction, abdominal pain, nausea, vomiting, orother symptoms of appendicitis or acute surgical abdomen.

Side Effects/ Toxic Effect

Dizziness, abdominal cramps, vomiting, diarrhea, alkalosis,tetany

Laxatives

preparation for surgery

NURSING CONSIDERATIONS: 1. Give drug at times that dont interfere with scheduled activities or sleep. Soft, formed stools are usually produced 15 to 60 minutes after rectal use. 2. Before giving for constipation, determine whether patient has adequate fluid intake, exercise and diet. 3. Advise patient to swallow enteric-coated tablet whole to avoid GI irritation. Instruct him not to take within1 hour of milk or antacid. 4. Advise patient to report adverse effects to prescriber. 5. Tables and suppositories are used together to clean the colon before and after surgery and before barium enema.

DRUGS NAME:Metronidazole (Metronidazole)

Dose / Frequency : 1 cap 500mg BID
Classification Mechanism of Action
Undergoes intracellular chemical reduction during anaerobic metabolism. After metronidazole is reduced, it damages DNAs helical structure and breaks its strands, which inhibits bacterial nucleic acid synthesis and causes cell death

Indication
Trichomoniasis, Refractory trichomoniasis, Pelvic inflammatory disease, Bacterial Vaginosis

ContraIndications
Breast-feeding, hypersensitivity to metronidazole or its components

Side Effects/ Toxic Effect

CNS: headache, seizures, fever, vertigo, dizziness, confusion, irritability, depression, weakness, insomnia CV: edema, flushing EENT: rhinitis, sinusitis GI: nausea, vomiting, abdominal cramping or pain, constipation, diarrhea, dry mouth GU: darkened urine, vaginitis, polyuria, dysuria, cystitis, dryness of vagina and vulva, genital puritus Musculoskeletal: transient joint pain Respiratory: upper respiratory tract infection Skin: rash

Antibiotic, Amebicide, Antiprotozoal

NURSING CONSIDERATIONS: 1. If pt has adverse CNS reactions, such as seizures or peripheral neuropathy, tell prescriber and stop drug immediately. 2. Monitor pt with severe liver disease because slowed metronidazole metabolism may cause drug to accumulate in the body and increase the risk of adverse effects. 3. If skin irritation occurs, apply topical gel less frequently or discontinue it, as ordered. 4. Monitor CBC and culture and sensitivity test if therapy lasts longer than10 days or if second course of treatment is needed. 5. Caution patient to avoid alcohol while being treated with vaginal preparation.

DRUGS NAME: Conjugated estrogen (Premarin)

Dose / Frequency : 0.625 mg 4 tabs TID
Classification Mechanism of Action
Increases synthesis of DNA, RNA, and protein in responsive tissues, also reduces release of follicle-stimulating and luteinizing hormones from the pituitary gland

Indication
Vulvar or vaginal atrophy, Abnormal uterine bleeding (hormonal imbalance).

ContraIndications
Contraindicated in pregnant patients and in patients with thrombophlebitis, thromboembolic disorders, estrogendependent neoplasia, breast or reproductive cancer (except for palliative treatment), or undiagnosed abnormal genital bleeding.

Side Effects/ Toxic Effect

CNS: dizziness, headache, stroke and seizure CV: edema, pulmonary embolism, MI GI: dyspepsia, GI pain, nausea, constipation or diarrhea, flatulence, peptic ulceration and vomiting GU: renal failure Hematologic: decreased platelet adhesion, prolonged bleeding time Skin: diaphoresis, prurotus, rash GI: nausea, vomiting, abdominal cramping, bloating, increased appetite EENT: worsening myopia or astigmatism GU: breakthrough bleeding, amenorrhea, altered cervical secretion Hepatic: cholestatis jaundice Skin: melasma, chloasma, hairloss, dermatitis Metabolic: weight changes, hypercalcemia Other: breast tenderness changes in libido

Estrogen

NURSING CONSIDERATIONS: 1. Periodically monitor lipid levels, blood pressure, body weight, and hepatic function. 2. Glucose tolerance may be impaired. Monitor glucose level closely in patients with diabetes. 3. If pt has adverse CNS reactions tell prescriber and stop drug immediately. 4. Tell diabetic patient to report elevated glucose level so that antidiabetic dosage can be adjusted. 5. Encourage patient to stop smoking because of the risk of CV complications

DRUGS NAME: Zinnat (Cefuroxime Sodium)

Dose / Frequency : 500 mg I tab BID (D4)
Classificatio n Mechanism of Action
Secondgeneration cephalosporins that inhibitscellwall synthesis, promoting osmotic instability; usually bactericidal.

Indication
Treatment of infections caused by sensitive bacteria

ContraIndications
Sensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Side Effects/ Toxic Effect

CV: phlebitis, thrombophlebitis GI: diarrhea, nausea, anorexia, vomiting Hematologic: hemolytic anemia Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation Other: hypersensitivity reaction, serum reaction

Cephalos porins

NURSING CONSIDERATIONS: 1. Monitor patient for signs symptoms of superinfection. 2. Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. 3. Report onset of loose stools or diarrhea. Although pseudomembranous colitis. 4. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. 5. Tell patient to take drug as prescribed, even after he or she feels better.

DRUGS NAME: Adalat GITS (Nifedipine)

Dose / Frequency : 30 mg 1 tab OD
Classification
Calcium channel blocker

Mechanism of Action
Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole.

Indication
Hypertension

ContraIndications
Contraindicated in patients with bronchial asthma, sinus bradycardia and greater than first-degree heart block, cardiogenic shock, and overt heart failure.

Side Effects/ Toxic Effect

CNS: dizziness, light headedness, headache, weakness, syncope, nervousness CV: flushing peripheral, edema, heart failure, MI, hypotension, palpitations EENT: nasal congestion GI: nausea, diarrhea, constipation, abdominal discomfort Musculoskeletal: muscle cramps Respiratory: dyspnea, pulmonary edema, cough Skin: rash, pruritus

NURSING CONSIDERATIONS: 1. Monitor Blood pressure and heart rate regularly, especially in patients who take beta-blockers or antihypertensives. 2. Watch for symptoms of heart failure. 3. Monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties. 4. Encourage patient to stop smoking while taking the nifedipine. 5. Observe 10 rights in giving the drugs.

DRUGS NAME: BP norm (Fosinopril Sodium)

Dose / Frequency : 10 mg tab OD
Classificatio n
ACE inhibitor, Antihperten sives

Mechanism of Action
May inhibit ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure.

Indication
Hypertensio n and Heart failure

ContraIndications
Contraindicated in patients hypersensitive to drug or other ACE inhibors and in breastfeeding women.

Side Effects/ Toxic Effect

CNS: dizziness, stroke, headache fatigue, paresthesia, sleep disturbance CV: MI, chest pain, angina pectoris, rhythm disturbance, palpitations, hypotension, orthostatic hypotension EENT: tinnitus, sinusitis GI: pancreatitis, nausea, vomiting, diarrhea, dry mouth, abdominal distention and pain, constipation GU: sexual dysfunction, renal insufficiency, hepatitis Metabolic: Hypercalemia Musculoskeletal: musculoskeletal pain Respiratory: dry, persistent, tickling, non-productive cough, bronchospasm Skin: Urticaria, rash, photosensitivity reactions, pruritus Other: angioedema, decrease libido, gout

NURSING CONSIDERATIONS: 1. Monitor Blood Pressure for drug effects. 2. Monitor Potassium intake and potassium level. Diabetic patients, those with impaired renal function, and those receiving drugs that can increase potassium level may develop hyperkalemia. 3. Assess renal and hepatic function before and periodically throughout therapy. 4. Tell patient to avoid salt substitutes; these products may contain potation, which can cause high potassium level in patients taking drug. 5. Instruct patient to call prescriber if he develops easy bruising or bleeding; swelling of tongue, lips, face, eyes, mucous membranes, arms, or legs; difficulty swallowing or breathing; and hoarseness.

DRUGS NAME: Lipitor (Atorvastatin calcium)

Dose / Frequency : 80 mg tab OD pc dinner
Classification
HMG-CoA reductase inhibitor, Antilipemics

Mechanism of Action
Inhibits HMGCoA reductase, and early(ratelimiting) step in cholesterol biosynthesis.

Indication
In patients with clinically evident coronary heart disease, to reduce the risk of nonfatal MI, fatal and nonfatal strokes, angina, heart failure, and revascularization procedures. To reduce the risk of MI, stroke, angina, or revascularization procedures in patient with multiple risk factors for CAD but who dont yet have the disease.

ContraIndications
Contraindicated in patients hypersensitive to drug and in those with active liver disease or unexplained persistent elevations of transaminase levels. Contraindicated in pregnant and breastfeeding women and in women of childbearing age.

Side Effects/ Toxic Effect

CNS: headache, asthenia, insomnia CV: peripheral edema EENT: Pharyngitis, Rhinitis, Sinusitis GI: Abdominal Pain, Constipation, Diarrhea, dyspepsia, flatulence, nausea GU: UTI

NURSING CONSIDERATIONS: 1. Patient should follow a standard cholesterol-lowering diet before and during therapy. 2. Before treatment, assess patient for underlying causes for hypercholesterolemia and obtain a baseline lipid profile. Obtain periodic liver function test result and lipid levels before starting treatment and at 6 and 12 weeks after initiation, of after an increase in dosage and periodically thereafter. 3. Drug may be given as a single dose at any time of day, with or without food. 4. Advise patient to inform prescriber of adverse reactions, such as muscle pain, malaise, and fever. 5. Warn patient to avoid alcohol.

DRUGS NAME: Iterax (Hydroxyzine diHCL)

Dose / Frequency : 25 mg I tab P.O
Classification
Piperazine derivative

Mechanism of Action
A piperazine antihistamine whose action may result from suppression of activity in certain essential regions of the subcortical area of the CNS.

Indication
Anxiety, Preoperative and Postoperative adjunctive therapy for sedation, pruritus, Psychiatric and emotional emergencies, including acute alcoholism, nausea and vomiting (excluding nausea and vomiting of pregnancy), Antepartum and post partum adjunctive therapy.

ContraIndications
Contraindicated in patients hypersensitive to drug, Early pregnancy; hypersensitivity to hydroxyzine or cetirizine and breast feeding women.

Side Effects/ Toxic Effect

CNS: drowsiness, involuntary motor activity GI: dry mouth, constipation SKIN: Pain at I.M. injection site OTHER: Hypersensitivity reactions

NURSING CONSIDERATIONS: 1. If patient takes other CNS drugs, watch for oversedation. 2. Elderly patient maybe more sensitive to adverse anticholinergic effects; monitor these patients for dizziness, excessive sedation, confusion, hypotension, and syncope. 3. Warn patient to avoid hazardous activities that require alertness and good coordination until effects of drug are known. 4. Tell patient to avoid alcohol while taking drug. 5. Warn woman of childbearing age to avoid use during pregnancy and breastfeeding.

DRUGS NAME: Dormicum (midazolam hydrochloride)

Classification

Mechanism of Action
May potentiate the effects of GABA, depress the CNS, and suppress the spread of seizure activity.

Indication
Sedation in Premed before surgical or diagnostic procedures, induction and maintenance of anesthesia.

ContraIndications
Contraindicated in patients hypersensitive to drug and in those with acute angle-closure glaucoma, shock, coma, or acute alcohol intoxication.

Side Effects/ Toxic Effect

Nausea, vomiting,headache, hiccoughs, laryngospasm, dyspnea hallucination, drowsiness, amnesic episode.

Benzodiaze pine

NURSING CONSIDERATIONS: 1. Have oxygen and resuscitation equipment available in case of severe respiratory depression. 2. Monitor blood pressure, heart rate and rhythm, respirations, airway integrity, and arterial oxygen saturation during procedure. 3. Use cautiously in patients with uncompensated acute illness and in elderly or debilitated patients. 4. Because drug diminishes patients recall of events around the time of surgery, provide written information, family member instructions, and follow-up contact. 5. Warn patient to avoid hazardous activities that require alertness of good coordination until effects of drug are known.

DRUGS NAME: Ketamine (Ketamine HCl) Dose / Frequency : 1 ml

Classification
Dissociative anesthetic, hallucinogen, psychotomim etic

Mechanism of Action
Ketamine has been shown to block afferent impulses associated with the affectiveemotional component of pain perception within the medical medullary reticular formation, to suppress spinal cord activity, and to interact with several central nervous system (CNS) transmitter systems. Ketamine blocks the NMDA glutamate receptor by a dual mechanism, blocking both the closed channel from the aqueous phase and the closed channel from the membrane phase.

Indication
Anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation.

ContraIndications
Patients in whom significant BP elevation would be a serious hazard; hypersensitivity to the drug.

Side Effects/ Toxic Effect

Blurred vision, confusion, drowsiness, increased or decreased blood pressure or heart rate Mental status changes, nausea, vomiting

NURSING CONSIDERATIONS: 1. Monitor circulatory and respiratory status 2. Assess the blood pressure of the patient before the administration. 3. Theophylline should not be coadministered with ketamine, it may interact and can cause unpredictable seizure. 4. Because of rapid induction following the initial IV injection, the patient should be in a supported position during administration. 5. Rapid administration may result in respiratory depression and enhanced pressor response.

DRUGS NAME: Cefuroxime Sodium (Zegen) Dose / Frequency : 1 ml

Classification
Secondgeneration cephalosporin

Mechanism of Action
Ketamine has been shown to block afferent impulses associated with the affectiveemotional component of pain perception within the medical medullary reticular formation, to suppress spinal cord activity, and to interact with several central nervous system (CNS) transmitter systems. Ketamine blocks the NMDA glutamate receptor by a dual mechanism, blocking both the closed channel from the aqueous phase and the closed channel from the membrane phase.

Indication
Anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation.

ContraIndications
Patients in whom significant BP elevation would be a serious hazard; hypersensitivity to the drug.

Side Effects/ Toxic Effect

Blurred vision, confusion, drowsiness, increased or decreased blood pressure or heart rate Mental status changes, nausea, vomiting

NURSING CONSIDERATIONS: 1. Monitor circulatory and respiratory status 2. Assess the blood pressure of the patient before the administration. 3. Theophylline should not be coadministered with ketamine, it may interact and can cause unpredictable seizure. 4. Because of rapid induction following the initial IV injection, the patient should be in a supported position during administration. 5. Rapid administration may result in respiratory depression and enhanced pressor response.