DRUG STUDIES

DRUG ORDER GENERIC NAME: Furosemide BRAND NAME: Lasix CLASSIFICATION: Loop Diuretic ROUTE: IV; Oral DOSAGE & FREQUENCY: 20-40 mg OD; 20 mg tab OD Date Started: 08/02/11 Initially 40 mg/IV OD; dosage to 20 mg at 8:59PM 08/03/11 dosage back to 40 mg MECHANISM OF ACTION Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich dieresis. INDICATION Pulmonary edema, Edema associated with heart disease, Hypertension CONTRAINDICATION Severe sodium and water depletion ADVERSE EFFECT Fluid and electrolyte imbalance, Orthostatic hypotension, Volume depletion NURSING CONSIDERATION  Check the BP; if less than 90/60 mmHg, hold the medication.  Reduce dosage if given with other antihypertensive drugs; readjust dosage gradually as BP responds.  Give early in the day so that increased urination will not disturb sleep.  Encourage the patient to eat foods rich in potassium such as bananas and citrus fruits.

08/05/11 Shifted to 20 mg tab OD at 12:00PM

DRUG ORDER GENERIC NAME: Levofloxacin BRAND NAME: Levox CLASSIFICATION: Fluoroquinolone ROUTE: IV DOSAGE & FREQUENCY: 500 mg OD Date Started: 08/02/11

MECHANISM OF ACTION Bactericidal: Interferes with DNA by inhibiting DNA gyrase replication in susceptible gramnegative and grampositive bacteria; preventing cell reproduction.

INDICATION Acute bacterial exacerbation of chronic bronchitis

CONTRAINDICATION Hypersensitivity to fluoroquinolones

ADVERSE EFFECT Nausea, Vomiting, Diarrhea, Constipation

NURSING CONSIDERATION  Arrange for culture and sensitivity tests before beginning therapy.  Continue therapy as indicated for condition being treated.  Ensure that patient is well hydrated during course of therapy.

DRUG ORDER GENERIC NAME: Ipratropium + Salbutamol BRAND NAME: Duavent CLASSIFICATION: Antiasthmatic ROUTE: Inhalation DOSAGE & FREQUENCY: 2.5 mL pulmoneb Q4o Date Started: 08/02/11 08/04/11 frequency to Q6o

MECHANISM OF ACTION Ipratropium 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 sulfate: In low doses, acts relatively selectively at beta-adrenergic receptors to cause bronchodilation and vasodilation; at higher doses, 2 selectivity Is lost, and drug acts at 2 receptors.

INDICATION

CONTRAINDICATION

ADVERSE EFFECT Bronchospasm, Cough, Headache

NURSING CONSIDERATION  Use minimal doses for minimal periods; drug tolerance can occur with prolonged use.  Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 515 minutes by nebulization.

Relieve or prevention Hypersensitivity to any of bronchospasm in component of Duavent patients with reversible or to atropine obstructive airway disease such as Bronchial Asthma

DRUG ORDER GENERIC NAME: Hydrocortisone BRAND NAME: CLASSIFICATION: Glucocorticoid ROUTE: IV DOSAGE & FREQUENCY: 50 mg Q8o Date Started: 08/01/11 08/02/11 dosage to 50 mg

MECHANISM OF ACTION Enters target cells and binds to cytoplasm receptors; initiates many complex reactions that are responsible for its immunosuppressive actions.

INDICATION Acute adrenocortical insufficiency

CONTRAINDICATION Viral/fungal infections, Immunosupression

ADVERSE EFFECT Fluid and electrolyte disturbances, Hyperglycemia

NURSING CONSIDERATION  Ensure that adequate amount of calcium is taken if prolonged administration of steroids.  Taper doses when discontinuing highdose or long term therapy.

DRUG ORDER GENERIC NAME: Cimetidine BRAND NAME: Tagamet CLASSIFICATION: H2-receptor antagonist ROUTE: IV DOSAGE & FREQUENCY: 200 mg Q8o Date Started: 08/01/11

MECHANISM OF ACTION Inhibit the action of histamine at H2receptors of the stomach, inhibiting gastric acid secretion and reducing pepsin output.

INDICATION Non-ulcer dyspepsia

CONTRAINDICATION Hypersensitivity to cimetidine

ADVERSE EFFECT Hypotension (IV use), Diziness

NURSING CONSIDERATION  Give drug with meals and at bedtime.  Arrange for regular follow-up check up, including blood tests to evaluate effects.

DRUG ORDER GENERIC NAME: Acetylcysteine BRAND NAME: Fluimucil CLASSIFICATION: Mucolytic ROUTE: Oral DOSAGE & FREQUENCY: 600 mg tab OD Date Started: 08/01/11

MECHANISM OF ACTION Splits links in the muco-proteins contained in respiratory mucus secretions, decreasing viscosity of the mucus

INDICATION Inspissated mucus secretions in acute and chronic bronchopulmonary disease (Asthmatic Bronchitis)

CONTRAINDICATION Hypersensitivity to acetylcysteine

ADVERSE EFFECT Respiratory bronchospasm

NURSING CONSIDERATION  Dilute the 20% acetylcysteine solution with either normal saline or sterile water for injection; use the 10% solution undiluted. Refrigirate unused, undiluted solution and use within96 hr.  Administer the following drugs separately, because they are incompatible with acetylcysteine solutions: Tetracyclines, erythromycin lactobionate, amphotericin B, iodized oil chymotrypsin, trypsin, hydrogen peroxide.

DRUG ORDER GENERIC NAME: Clopidrogel bisulfate BRAND NAME: Clopida CLASSIFICATION: Antiplatelet ROUTE: Oral DOSAGE & FREQUENCY: 75 mg tab OD Date Started: 08/01/11

MECHANISM OF ACTION Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

INDICATION Acute coronary syndrome

CONTRAINDICATION Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.

ADVERSE EFFECT Headache, Dizziness, Rash

NURSING CONSIDERATION  Provide small frequent meals if GI upset occurs.  Provide comfort measures and arrange for analgesics if headache occurs.

DRUG ORDER GENERIC NAME: Enoxaparin BRAND NAME: Clexane

MECHANISM OF ACTION Low-modular-weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing formation

INDICATION Unstable angina

CONTRAINDICATION Uncontrolled hemorrhage including major bleeding disorders

ADVERSE EFFECT Hemorrhage, Bruising

NURSING CONSIDERATION  Give deep subcutaneous injections; do not give enoxaparin by IM injection.  Administer by deep

CLASSIFICATION: Antithrombotic ROUTE: SQ DOSAGE & FREQUENCY: 0.4 cc Q12o Date Started: 08/01/11 Date Discontinued: 08/03/11

of clots.

 

subcutaneous injection; patient should be lying down. Alternate between the left and right anterolateral and posterolateral abdominal wall. Introduce the whole length of needle into a skin fold held between thumb and forefinger; hold skin fold throughout the injection. Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for hematoma; do not massage the injection sites. Do not mix with other injections or infusions. Store at room temperature. Fluid should be clear, colorless to pale yellow. Provide safety measures (electric razor, toothbrush) to

prevent injury to patient who is at risk for bleeding.  Check patient for signs of bleeding; monitor for blood tests.

DRUG ORDER GENERIC NAME: Nitroglycerin BRAND NAME: Transderm-Nitro CLASSIFICATION: Antianginal ROUTE: Transdermal DOSAGE & FREQUENCY: 5 mg tab OD Date Started: 08/01/11

MECHANISM OF ACTION Relaxes vascular smooth muscle with resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

INDICATION Angina pectoris

CONTRAINDICATION Severe anemia, early MI, head trauma, cerebral hemorrhage

ADVERSE EFFECT Hypotension

NURSING CONSIDERATION  Administer transdermal systems to skin site free of hair and not subject to much movement. Do no apply to distal extremities. Change sites to decrease the chance of local irritation and sensitization.  Remove transdermal system before attempting defibrillation or cardioversion.  Remove old system before applying new

one.

DRUG ORDER GENERIC NAME: Trimetazidine HCl BRAND NAME: Vastarel MR CLASSIFICATION: Antianginal ROUTE: Oral DOSAGE & FREQUENCY: 35 mg tab BID Date Started: 08/01/11

MECHANISM OF ACTION Specific and selective inhibitor of an enzyme of the fatty acid oxidation: 3-ketoacyl CoA thiolase (3-KAT). This inhibition of oxidation allows a recoupling of glycolysis and an increase in glucose oxidation

INDICATION Angina pectoris

CONTRAINDICATION Hypersensitivity to Trimetazidine HCl Or any of the constituents of Vastarel MR.

ADVERSE EFFECT Nausea, Vomiting

NURSING CONSIDERATION  Use cautiously in patients with heart failure or hypertension and in elderly patients.

DRUG ORDER GENERIC NAME: Digoxin BRAND NAME: Lanoxin CLASSIFICATION: Cardic glycoside ROUTE: Oral DOSAGE & FREQUENCY: 0.25 mg tab OD Date Started: 08/03/11

MECHANISM OF ACTION Increases intracellular calcium and allows calcium to enter the myocardial cell during depolarization via sodium-potassium pump mechanism; this force of contraction (positive inotropic effeect), increases renal perfusion (seen as diuretic effect in patients with heart failure), decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity.

INDICATION Heart failure, Atrial fibrillation

CONTRAINDICATION Ventricular tachycardia, Ventricular fibrillation, Acute MI, Renal insufficiency

ADVERSE EFFECT Arrhythmias, Headache, Weakness

NURSING CONSIDERATION  Avoid giving with meals; taking this drug with food will delay absorption and alter drug pharmacokinetics.  Have emergency equipment ready; have K+ salts lidocaine, phenytoin, atropine and cardiac monitor available in case toxicity develops.

DRUG ORDER GENERIC NAME: Acetylsalicylic acid BRAND NAME: Aceprin CLASSIFICATION: Antiplatelet ROUTE: Oral DOSAGE & FREQUENCY: 80 mg tab OD Date Started: 08/03/11

MECHANISM OF ACTION Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation.

INDICATION Inflammatory conditions Osteoarthritis

CONTRAINDICATION Hypersensitivity to salicylates, Hemorrhagic states, Vitamin K defficiency

ADVERSE EFFECT Prolonged bleeding time, Bronchospasm, Epigastric discomfort

NURSING CONSIDERATION  Give drug with food or after meals to prevent GI upset.  Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.  Do not crush, and ensure the patient does not chew SR preparations.  Do not use aspirin that has strong vinegar like odor.

DRUG ORDER GENERIC NAME: Levetiracetam BRAND NAME: Keppra CLASSIFICATION: Antiepileptic ROUTE: IV; Oral DOSAGE & FREQUENCY: 500 mg Q12o; 500 1
tab BID

MECHANISM OF ACTION Mechanism of action not well understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block posttetanic potentiation.

INDICATION Adjunct therapy in the treatment of partialonset seizures when used with other epilepsy medication

CONTRAINDICATION Hypersensitivity to levetiracetam

ADVERSE EFFECT Diziness, Headache

NURSING CONSIDERATION  Give drug with food to prevent GI upset; use oral solutions if the patient has difficulty of swallowing.  If CNS, vision or coordination changes occur, establish safety precautions (use side rails).

Date Started: 08/02/11 08/03/11 Shifted to 500 1 tab

BID

DRUG ORDER GENERIC NAME: Diazepam BRAND NAME: Valium CLASSIFICATION: Antiepileptic ROUTE: IV DOSAGE & FREQUENCY: 5 mg PRN for frank seizure Date Started: 08/02/11

MECHANISM OF ACTION Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation; potentiates effects of GABA, an inhibitory neurotransmitter

INDICATION Adjunct in status epilepticus and severe recurrent convulsive seizures

CONTRAINDICATION Psychoses, Acutenarrow-angle glaucoma, Shock, Acute alcoholic intoxication

ADVERSE EFFECT Transent, mild drowsiness initially, Sedation, Bradycardia, Tachycardia,Drug dependence with withdrawal syndrome

NURSING CONSIDERATION  Do not use small veins (dorsum of hand or wrist) for IV injection.  Reduce opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.  Carefully monitor P, BP, RR during IV administration.

DRUG ORDER GENERIC NAME: Metoclopramide BRAND NAME: Plasil CLASSIFICATION: Antiemetic ROUTE: IV DOSAGE & FREQUENCY: 1 amp Q12o Date Started: 08/02/11

MECHANISM OF ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT

NURSING CONSIDERATION  Monitor BP carefully during IV administration.  Monitor for extrapyramidal reactions and consult physician if the occur.

Stimulates motility of Nausea and vomiting upper GI tract without stimulating gastric, biliary or pancreatic secretions; appears sensitive tissues to action of acetylcholine, relaxes pyloric sphincter which when combined with effects of motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure.

GI hemorrhage, Restlessness, Mechanical obstruction Drowsiness, and perforation Diarrhea

DRUG ORDER GENERIC NAME: Meloxicam BRAND NAME: Mobic CLASSIFICATION: NSAID ROUTE: IV DOSAGE & FREQUENCY: 15 mg tab PRN for pain Date Started: 08/04/11

MECHANISM OF ACTION Inhibits the enzyme cyclooxygenase (COX), which is required for the synthesis of prostaglandins and thromboxanes. Somewhat more selective for COX-2 sites (found in the brain and at sites of inflammation) than COX-1 sites, which are found throughout the tissues and are related to protection of GI mucosa.

INDICATION Relief of painful osteoarthritis

CONTRAINDICATION Hypersensitivity to aspirin or meloxicam, Bleeding disorders

ADVERSE EFFECT Headache, Dizziness, Insomnia, Nausea, Dyspepsia

NURSING CONSIDERATION  Administer drug with food if GI upset occurs.  Establish safety measures if CNS disturbances occur.  Monitor patient on prolonged therapy for signs of bleeding.