B. Drug Study Date ordered: February 13, 2006 1.

Generic name: Ampicillin/Sulbactam Brand name: Unasyn Classification: Anti-infective, aminopenicillins/beta lactamase inhibitors Dosage, Frequency, Route: 1gm IVP every 8 hours Mechanism of action: This drug binds to bacterial cell wall, resulting in cell death. The addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin. Indication: This drug is indicated for patients after undergoing surgery to prevent infection of skin and soft-tissue structures. Contraindication: This drug is contraindicated to patients who are hypersensitive to penicillins or sulbactam. Desired effect: This drug was given to our client as prophylaxis against possible infection. Side effects and adverse reactions CNS: seizures GI: pseudomembranous colitis, diarrhea, nausea, vomiting Derm: rashes, urticaria Hemat: blood dyscrasias Local: pain at IV site Misc: allergic reactions such as anaphylaxis and serum sickness, superinfection. Nursing responsibilities 1. Check the doctors order to prevent error. 2. Observe the 10 RIGHTS in administering drug to avoid mistakes. 3. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. 4. Administer skin testing to assess if patient is sensitive to penicillin. 5. Observe patient for signs and symptoms of anaphylaxis. 6. Administer drug slowly to prevent irritation.

7. Monitor for side effects like nausea and vomiting, bleeding or bleeding gums, blood in the stool and urine. 8. Stop drug if allergic reaction occur and notify doctor on duty. 9. Advise to increase CHON and Vitamin C on diet. 10. Instruct client to clean wound aseptically to prevent infection. 2.Generic name: Ketorolac Brand name: Toradol Classification: NSAID, Non-opioid analgesics Dosage, route, frequency: 30 mg IV every 6 hours Mechanism of action: This drug inhibits prostaglandin synthesis, producing peripherally mediated analgesia, thus pain perception decreases. Indication: This drug is used for a short-term management of pain. Contraindication: This drug is contraindicated to patients who are hypersensitive to this drug and cross-sensitive with other NSAIDs and during pre or perioperative use. This is used cautiously in patients with a history of GI bleeding, renal impairment and cardiovascular disease. Desired effects: This drug was given to the patient to relieve pain. Adverse effects and side-effects CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache Resp: asthma, dyspnea CV: edema, pallor, vasodilation GI: GI bleeding, diarrhea, drymouth, dyspepsia, GI pain, nausea, abnormal taste GU: oliguria, renal toxicity, urinary frequency Derm: pruritus, purpura, sweating, urticaria Hemat: prolonged bleeding time Local: injection site pain Neuro: paresthesia Misc: allergic reactions including anaphylaxis Nursing Responsibilities

1. Check doctors order to avoid mistake. 2. Observe the 10 RIGHTs in administering drug to avoid mistakes. 3. Assess the clients history of allergy to the drug to avoid complications. 4. Encourage client to report severe pain for prompt intervention. 5. Administer the drug through the Y-tube in a free flow for at least 15 seconds because this can be irritating. 6. Tell patient to avoid activities requiring alertness because this drug can cause drowsiness. 7. Monitor for signs and symptoms of bleeding like melena or hematemesis. GI ulceration with perforation can occur anytime during treatment. This drug can decrease platelet aggravation, thus, may prolong bleeding. 8. Do not administer the drug longer than 5 days to prevent development of tolerance. 9. Instruct client to call the attention of any health care professional when difficulty of breathing is experienced to give prompt intervention. 3 Generic name: Nubain Brand name: Nalbuphine Classification: opioid analgesics Dosage, route, frequency: 10mg IVP every 6 hours Mechanism of action: This drug binds to opiate receptors in the CNS, which causes alteration in the perception and response to painful stimuli. Thus, pain decreases. Indication: This drug is used to treat moderate to severe pain. Contraindication: This drug is contraindicated to patients who are sensitive to nalbuphine. Desired effect: This drug is given to our patient to relieve pain after operation. Adverse effects and side effects CNS: dizziness, headache, sedation, confusion, floating feeling

EENT: blurred vision, diplopia, mioses Resp: respiratory depression CV: hypertension, orthostatic hypotension, palpitations GI: dry mouth, nausea, vomiting, constipation GU: urinary urgency Derm: clammy feeling, sweating Misc: physical dependence, psychological dependence, tolerance Nursing responsibilities 1. Check doctors order to avoid mistakes. 2. Consider the 10 RIGHTs in drug administration to avoid errors. 3. Instruct watcher to assist patient during doing activities to prevent accidents. 4. Encourage patient to take adequate bed rest to decrease oxygen demand and BMR, thereby conserving body energy 5. Provide proper oral care to decrease the incidence of dry mouth. 6. Assess vital signs to prevent complications. 7. Instruct patient on how and when to ask for pain medication to prevent drug dependence and tolerance. 8. Caution patient to change positions slowly to minimize orthostatic hypotension. 9. Encourage patient to turn, cough and breathe deeply every 2 hours to prevent lung collapse. Date ordered: February 17, 2006 4. Generic name: Mefenamic acid Brand name: N/A Classification: NSAIDs Dosage, route, frequency: 500 mg 1 tab TID Mechanism of action: This drug inhibits prostaglandin synthesis, thus, decreases pain. Indication: This is a short-term management of pain.

Contraindication: Desired effects: This drug was given to our patient to reduce pain. Adverse effects and side effects CNS: dizziness, headache GI: severe diarrhea, ulceration Special senses: eye irritation, ear pain Nursing responsibilities 1. Check the doctors order to avoid error. 2. Observe the 10 RIGHTs in drug administration to avoid mistakes. 3. Assess for the clients history of drug allergy to prevent complications. 4. Instruct patient to move slowly to prevent accidents. 5. Instruct patient to call the attention of any health care provider when melena or bleeding gums are experienced as, these will show that there is ulceration. 5. Generic name: Cefalexin Brand name: N/A Classification: 1st generation cephalosphorins Dosage, route, frequency: 500mg 1 cap TID Mechanism of action: This drug binds to bacterial cell wall membrane causing cell death. Indication: This drug is used to prevent skin and skin structure infection. Contraindication: This is contraindicated to patients who are hypersensitive to cephalosphorins Desired effects: This drug was given to our patient to prevent possible infection after the operation. Adverse effects and side effects CNS: seizures GI: pseudomembranous colitis, diarrhea, nausea, vomiting, cramps GU: interstitial nephritis Derm: rashes, urticaria

Hemat: blood dyscrasias, hemolytic anemia Misc: allergic reactions Nursing responsibilities 1. Check the doctors order to avoid error. 2. Observe the 10 RIGHTs in drug administration to avoid mistakes. 3. Inform patient to take the drug exactly as prescribed, even after he feels better. 4. Instruct patient to take drug with food or milk inorder to lessen discomfort. 5. Obtain a history before administering the drug to determine previous use of and reactions to penicillins and cephalosphorins to prevent complications. 6. Observe patient for signs and symptoms of anaphlaxis to give prompt intervention. 6. Generic name: Ranitidine Brand name: Zantac Dosage, Route, Frequency: 50 mg IVP every 8 Classification: H2 receptor antagonist Indication: This drug is indicated for our patient to prevent the occurrence of duodenal and gastric ulcer. Contraindication: To patients hypersensitive to Ranitidine Mechanism of Action: This drug inhibits gastric acid secretion by blocking the effect of histamine on histamine H2 receptors. Desired Effect: This drug is given to our patient for prophylaxis to ulcer Adverse Effects: GI: nausea, vomiting, diarrhea, abdominal pain CNS: malaise, dizziness, headache, insomnia, anxiety, fatigue CV: Bradycardia or tachycardia Hematologic: aplastic anemia Hepatic: hepatotoxicity, jaundice, hepatitis, increase in ALT Dermatologic: pruritus, rash, alopecia Nursing Responsibilities

1. Check for the doctors order and prepare drug aseptically. 2. Instruct patient to take without regard to meals because absorption is not affected by food. 3. Remind patient taking prescription drug once daily to take it at bedtime for best results. 4. Report any evidence of diarrhea and maintain adequate hydration. 5. Antacids decrease the absorption of ranitidine. 6. Instruct the watcher to assist patient in his activities of daily living because patient may feel dizzy and easily fatigue. 7. Intstruct patient to take medicines as prescribed. Dont overdose as this leads to damage of hepatic cells. 8. Tell patient to avoid eating fruits like oranges to prevent hypersecretions of gastric acids.. C. DRUG STUDY GENERIC NAME: Theophylline BRAND NAME: Respbid CLASSIFICATION: Bronchodilator ROUTE, DOSAGE & FREQUENCY: 200 mg 1 tab BID MECHANISM OF ACTION: It prevents breakdown of Adenosine Monophosphate (AMP) which promotes smooth muscle relaxation causing bronchodilation. DESIRED EFFECT: This was given to our patient to promote bronchodilation- greater airway passage hence relieving difficulty of breathing. INDICATION: Symptomatic relief or prevention of bronchial asthma and reversible bronchspasm associated with chronic bronchitis and emphysema. CONTRAINDICATIONS & CAUTIONS: Contraindicated with hypersensitivity to any xanthines, peptic ulcer, active gastritis, preganancy, underlying seizure disorders. Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe HPN, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor (may inhibit uterine contractions), lactation, status asthmaticus SIDE EFFECTS: diuresis, insomnia, nausea and vomiting, headache ADVERSE EFFECTS: GIT: epigastric pain, diarrhea and anorexia CNS: irritability, restlessness, dizziness, muscle twitching, headache, insomnia, lightheadedness, seizures, severe depression, stammering speech, abnormal behavior characterized by withdrawal, mutism and unresponsiveness alternating with hyperactive periods

CV: palpitations, sinus tachycardia, ventricular tachycardia, life-threatening ventricular arrhythmias, circulatory failure GUT: proteinuria, increase excretion of renal tubular cells and RBCs , urinary retention in man with prostate enlargement Respiratory: tachypnea, respiratory arrest Nursing Responsibilities Rationale 1. Check doctors order. To verify and avoid error in giving the drug. 2. Check vital signs before and after To evaluate cardiac response administration.(to be check) 3. Drug should be given on an empty To decrease gastric irritation stomach, 1 hour before or 2 hours after meals. 4. Check for adverse reactions. If present, To prevent further complications discontinue drug and notify the physician. 5. Teach the following: To expand lung tissue and move secretions * Breathing techniques *Coughing techniques 6. Avoid excessive intake of coffee, tea, These contain theophylline-related cocoa, cola beverages, and chocolate. substances that may increase side effects GENERIC NAME: Salbutamol Sulfate BRAND NAME: Ventolin CLASSIFICATION: Bronchodilator DOSAGE, ROUTE, FREQUENCY: 2.5 cc ever 6 hours to be added for nebulization MECHANISM OF ACTION: relaxes bronchial and uterine smooth muscle by acting on the beta 2-adrenergic receptors. Inhibit the release of mediators of immediate hypersensitivity reaction from mast cells. DESIRED EFFECT: To promote bronchodilation and help loss secretions. CONTRAINDICATION: contraindicated in patients hypersensitive to drug or its ingredients. SIDE EFFECTS: dizziness, insomia, headache, weakness, nausea and vomiting ADVERSE REACTIONS: CNS: tremor, nervousness, dizziness, malaise CV: tachycardia, palpitations EENT: nasal congestion, hoarseness GI: heartburn METABOLIC: hypokalemia MUSCULOSKELETAL: muscle cramps RESPIRATORY: wheezing, increased sputum Nursing responsibilities: Rationale: 1. Verify the doctors order. To avoid error in giving the drug. 2. Do chest physiotherapy as indicated after To help dislodge the secretions. each nebulization.

3. Encourage client to rinse mouth with H20 To minimize dry mouth. after nebulization. 4. Maintain adequate fluid intake. To liquefy the mucous secretions for easier expectoration. 5) Teach the ff: breathing techniques To expand lung tissue and move secretions coughing techniques 6) Teach patient pursed-lip breathing This creates a resistance to the air flowing out of the lungs, thereby prolonging exhalation GENERIC NAME: Ampicillin Sulbactam BRANDNAME: Unasyn CLASSIFICATION: anti-bacterial DESIRED DOSAGE, ROUTE & FREQUENCY: 750mg IV every 8 hours DESIRED EFFECT: This was given to our patient prevent infection. MECHANISM OF ACTION: inhibits cell-wall synthesis during bacterial multiplication. Sulbactam inactivates bacterial beta-lactamase, which inactivates ampicillin, causing bacterial resistance to it. INDICATION: to prevent the proliferation of susceptible microorganisms during infection. CONTRAINDICATIONS: Contraindicated in patients hypersensitive to the drug or other penicillin. Use cautiously in patients with other drug allergies because of possible crosssensitivity and in those with mononucleosis because of high risk in maculopapular rash. SIDE EFFECT: nausea and vomiting ADVERSE EFFECTS: CV: thrombophlebitis GI: diarrhea, glossitis, stomatitis, gastritis, black hairy tongue, enterocolitis, psuedomembranous colitis HEMATOLOGIC: anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, luekopenia, agranulocytis OTHER: hypersensitivity reactions, anaphylaxis, overgrowth of nonsusceptible organisms, pain at injection site, vein irritation Nursing responsibilities: 1. Check doctors order 2. Do skin testing and give only ANST. 3. Check the patency of the IV line. 4. Administer the drug slowly and always observe aseptic technique. 5. Tell the patient to report any allergic reaction and notify the physician. Observe Rationale: To avoid error in administering the drug To determine any allergic reaction To make sure that the IV line is in the vein To prevent irritation and facilitate absorption and also to avoid contamination of microorganism To prevent further complication and give necessary intervention if allergic reaction

for any manifestation of allergic reaction. 6. Provision of personal hygiene. 7. Encourage patient to cough out secretions and dispose it properly.

7. Encourage intake of vitamin C and mineral rich foods.

occurs. Good personal hygiene aids in the retardation of growth and multiplication of pathogenic microorganisms. To prevent the stasis of secretions in the respiratory tract which is good medium bacterial growth and proper disposal of secretions prevent the spread of microorganisms. To increase body resistance

GENERIC NAME: Hydrocortisone BRAND NAME: Sodium Succinate CLASSIFICATION: Corticosteroids DESIRED DOSAGE, ROUTE & FREQUENCY: 100mg IV every 12 hours MECHANISM OF ACTION: Decreases inflammation by entering target cells and binding to cytoplasmic receptors initiating many complex reactions thus resulting to blockage on the release of histamine, bradykinine and serotonin. DESIRED EFFECT: This drug is given to our patient to reduce inflammation. CONTRAINDICATIONS: Contraindicated with fungal infections, amoebiasis, hepatitis b, varicella and antibiotic-resistant infections, immunosuppression Use cautiously with kidney disease(risk to edema), liver disease, cirrhosis, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, resent GI surgery, active or latent peptic ulcer, inflammatory bowel disease(risk exacerbation or bowel perforation), hypertension, CHF, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, DM, TB, and lactation SIDE EFFECT: headache, insomia, nausea and vomiting, weakness ADVERSE EFFECT: CNS: vertigo, headache, paresthesia, insomnia, seizures, psychosis CV: hypotension, shock, hypertension, and CHF 2o to fluid retention, thromboembolism, thromplebitis, fat embolism, cardiac arrythmias 2o electrolyte disturbance DERMATOLOGIC: thin, fragile skin, petichiae, ecchymoses, purpura, striae, SC fat atrophy EENT: cataracts, glaucoma(long term therapy), increase IDP

ENDOCRINE: amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state(long-term therapy), HPA suppression systemic with therapy longer than 5 days GI: peptic or esophageal ulcer, pacreatitis, abdominal distention, N/V, increase appetite and weight gain(long-term therapy) HEMATOLOGIC: NA+ and fluid retention, hypokalemia, hypocalcemia,increase blood sugar, increase serum cholesterol, decrease serum T1 and T4 levels HYPERSENSITIVITY: anaphylactoid or hypersensitivity reactions MUSCOSKELETAL: muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures(long-term therapy) OTHER: immunosuppression, aggravation or masking of infections, impaired wound healing Rationale To avoid error in giving the drug To avoid error in giving the drug To determine any allergic reaction To make sure that it is in the vein To determine fluid and electrolyte imbalance Because this drug cause vasoconstriction effect thereby increasing BP To prevent hyperglycemia and glycosuria To determine if he gained weight and fluid retention To increase body resistance and to prevent the occurrence of hypokalemia To attain the desired outcome more effectively and to avoid reoccurrence of inflammation To elicit cooperation

Nursing Intervention 1. Check the doctors order 2. Observe the rights in administering the drug 3. Do skin testing and give ANST 4. Check the patency of the IV line 5. Monitor I & O accurately 6. Monitor BP 7. Encourage patient to increase intake of protein 8. Weigh the patient daily with the same clothing and weighing scale 9. Encourage patient to increase intake of Vitamin C and potassium rich foods such as banana, cantaloupe, potato, etc. 11. Tell the patient not to skip or suddenly stop medications 12. Provide emotional and psychological support

GENERIC NAME: Budesonide BRAND NAME: Pulmicort Turbuhaler CLASSIFICATION: Corticosteroid DESIRED DOSAGE, ROUTE & FREQUENCY: 2 puffs OD DESIRED EFFECT: This drug is given to our patient in order to reduce inflammation. MECHANISM OF ACTION:

Anti inflammatory effect: local administration into nasal passages maximizes beneficial on the tissues, while decreasing the likelihood of adverse effects from systemic absorption. Anti-inflammatory corticosteroid that exhibits potent glucocorticoid activity and weak minerolocorticoid activity. The exact mechanism of the cortiosteroids isnt known, but they have a wide range of inhibitory activity against such cell types such as mast cells and macrophages and mediators (such as leukotrienes) involved in allergic and non-allergic inflammation. INDICATION: Prophylactic therapy in maintenance treatment of asthma CONTRAINDICATIONS: Contraindicated with hypersensitivity with drug or for relief of acute asthma bronchospasm. Use cautiously with TB, systemic infections and lactation. Contraindicated with hypersensitivity with adrenergics, anines or formoterol, acute asthma attack, acute airway obstruction. Use cautiously in the elderly and with pregnancy and lactation. SIDE EFFECT: headache, insomnia, nausea ADVERSE EFFECT: CNS: headache asthenia, pain, insomnia, syncope, hypertonia EENT: sinusitis, pharyngitis, rhinitis, voice alteration GI: oral candidiasis, dyspepsia, gastroenteritis, nausea, dry mouth, taste perversion, abdominal pain METABOLIC: weight gain RESPIRATORY: respiratory tract infections, increased cough, bronchospasm SKIN: ecchymosis OTHER: flulike symptoms, fever, hypersensitivity reactions Nursing Responsibilities 1) Check doctors doctors order, 2) Observe the RIGHTS in administering a drug 3) Use cautiously, if at all, in patients with active or quiescent TB of the respiratory tract, ocular herpes simplex, or untreated systemic fungal, bacteria, viral, or parasitic infections 4) If bronchospasm occurs after using budesonide, stop therapy and treat with a bronchodilator 5) Watch for candida infections of the pharynx 6) Tell patient that budesonide inhaler isnt a bronchodilator and isnt intended to treat episodes of asthma 7) instruct patient to use inhaler at regular Rationale To avoid error in administering the drug To avoid error in administering the drug To avoid further complications

To prevent further complications For immediate treatment of the said complication For precautionary measures Because effectiveness depends on twice-

intervals as follows 8) pulmicort turbuhaler must be kept upright(mouthpiece on top) during loading 9) instruct patient to place mouthpiece between lips and to inhale forcefully and deeply 10) Tell the patient that he may not taste the drug or sense it entering his lungs, but it doesnt mean it isnt effective.

daily use on a regular basis To provide correct dosage To obtain the desired effect of the drug faster To make the patient aware on the possible outcome of the drug given

To decrease the risk of developing oral 11) instruct the patient to rinse his mouth candidiasis with water and then spit out the water after each dose 12) Replace mouthpiece cover after use and To prevent the contamination from always keep it clean and dry microorganisms, thereby preventing the occurrence of infection 13) Instruct the patient to carry or wear For identification purposes medical identification indicating need for supplementary corticosteroid during periods of stress or an asthma attack. GENERIC NAME: Formoterol Fumarate Inhalation BRAND NAME: foradil aerolizer CLASSIFICATION: beta2 adrenergic agonist DESIRED DOSSAGE, ROUTE & FREQUENCY: 2 puffs once a day DESIRED EFFECT: This drug is given to out patient in order to promote bronchodilation, thus relieving dyspnea MECHANISM OF ACTION: Beta agonists relax smooth muscle in the bronchioles by activating adenylate cyclase and increasing intracellular concentration of cyclic Adenosine Monophosphate. This increasing cAMP, beta agonist inhibits release of muscle mediators such as histamine and leukotrine (degranulation) which is inhibits smooth muscle contraction, thus bronchodilation occurs. INDICATION: Maintenance treatment and prevention of bronchospasm in patients with reversible obstructive airway disease or nocturnal asthma, who usually require treatment with short-acting inhaled beta2 adrenergic agonist Prevention of exercised induced bronchospasm CONTRAINDICATIONS: contraindicated in patients hypersensitive to drug or its component ADVERSE EFFECTS CNS: tremors, dizziness, nervousness, headache, fatigue, malaise CV: chest pain, angina, HPN, hypotension, tachycardia, arrhythmias, palpitations EENT: dry mouth, tonsillitis, dysphonia GI: nausea METABOLIC: hypokalemia, hyperglycemia, metabolic acidosis

MUSKULOSKELETAL: muscle cramps RESPIRATORY: chest infection SKIN: rash OTHER: viral infection Rationale To administer the correct drug t o be given To avoid error To know when to stop the medication to prevent further complications To prevent further complications

Nursing Responsibilities 1) Check doctors order 2) Observe the RIGHTS in administering the drug 3) Watch for immediate hypersensitivity reactions, such as anaphylaxis, urticaria, angioedema, rash and bronchospasm 4) Monitor patient for tachycardia, hypertension and other CV adverse effects. If these occurs, drug may need to be discontinue 5) Foradil capsules should only given via oral inhalation and used only with the Aerolizer Inhaler. They arent for oral ingestion. Patient shouldnt exhale into the device. Capsules should remain in the unopened blister until administration time and only removed immediately before use. 6) Tell patient not to increase the dosage or frequency of use without medical advice. 7) Tell patient to report nausea, vomiting, shakiness, headache, fast or irregular heart beat, or sleeplessness. 8) Instruct the patient not to use the Foradil Aerolizer with a spacer device or to exhale or blow into the Aerolizer inhaler.

Inhalation is preferred because of minimal systemic absorption

To prevent over dosage To know if the drug is to be discontinued Spacer is not applicable when an inhaler is held at the level of the mouth because in this position, large droplets tend to be delivered to the oropharynx and throat, rather than moving down into small airways.

GENERIC NAME: Isosorbide Dinitrate BRAND NAME: Isordil CLASSIFICATION: Anti-angina DESIRED DOSE, ROUTE AND FREQUENCY: 60mg tab OD MECHANISM OF ACTION: dilates the blood vessels by relaxing the muscles in their walls. Oxygen flow improves as the vessels relax, and chest pain subsides INDICATION: Isosorbide dinitrate reduces the blood pressure as well as the capillary pressure (vascular resistance), improving the heart's efficiency. It is used for the treatment and prevention of angina. DESIRED EFFECT: This was given to our patient to help relieve chest pain.

SIDE EFFECTS: headache, dizziness, light-headedness, low blood pressure and weakness, nausea and vomiting, constipation ADVERSE EFFECTS: Collapse, fainting, flushed skin, high blood pressure, pallor, perspiration, rash, restlessness, skin inflammation and flaking, vomiting, blurred vision and irregular heartbeat. CONTRAINDICATIONS: Use with caution if you have anemia, glaucoma, a previous head injury or heart attack, heart disease or thyroid disease. People taking diuretic medication or those who have low blood pressure should use the drug with caution. Do not use sildenafil while taking the drug because the combination could cause severe or life- threatening low blood pressure. Nursing interventions: 1. Verify doctors order. 2. Position client in a sitting or lying position when taking in the drug. 3. Encourage patient to consume a highfiber diet and drink plenty of fluids. 4. Provide oral care to the patient. Rationale: To prevent error. Since the drug may cause fainting or dizziness cause by hypotension. To prevent constipation.

To decrease likelihood of carries and periodontal disease caused by decreased salivation. 5. Instruct client to report recurrence of To see whether the pain was relieved by the pain and if pain is present, notify the doctor drug and for the doctor to know since this immediately. may indicate coronary occlusion. 6. Monitor the vital sign of the patient at Since the drug causes hypotension. regular intervals.

GENERIC NAME: Aspirin (ASA) BRAND NAME: CLASSIFICATION: Non-Steroidal Anti-inflammatory Drug (NSAID) DESIRED DOSE, ROUTE AND FREQUENCY: 80mg one tab a day MECHANISM OF ACTION: Its thought to relieve fever by central cation in the hypothalamic heat-regulating center. Exerts its anti-inflammatory by inhibiting prostaglandin synthesis; also may inhibit the synthesis or action of other mediators of the inflammatory response. DESIRED EFFECT: The drug is given to our patient to reduce inflammation. SIDE EFFECTS: ADVERSE EFFECTS: EENT: tinnitus, hearing loss GI: nausea, GI distress, occult bleeding, GI bleeding HEMATOLOGIC: leukopenia, thrombocytopenia, prolonged bleeding time HEPATIC: hepatitis SKIN: rash, bruising, urticartia

 Other: angioedema, hypersensitivity reactions, Reyes syndrome CONTRAINDICATIONS: Contraindicated in patients hypertensitive to drug and in those with NSAIDinduced sensitivity reactions and bleeding disorders, such as hemophilia. Nursing Responsibilities Rationale 1.Check Doctors order To prevent committing mistakes 2.Assess the patients allergy to drug To prevent hypersensitivity reactions 3.Encourage patient to take drugs with To reduce GI reactions food, milk or water 4. Encourage patient to take aspirin after To avoid GI distress meal

XIII.DRUG STUDY Date of administration: January 6 January 14, 2006 Generic Name: Captopril Brand Name: Capoten Classification: Antihypertensive-angiotensin converting enzyme inhibitor (ACE inhibitor) Dosage, Route, Frequency: 25mg/tab tab BID Mechanism of Action: Prevents the production of angiotensin II, a potent vasoconstrictor that stimulates the production of aldosterone by blocking its conversion to the active form. Result in systemic vasodilation.decreased preload and afterload in patients with CHF. Desired Effect: This drug was given to our patient to minimize pulmonary and venous congestion so as not to aggravate further edema, thus, preventing increase of blood pressure. Nursing Responsibilities 1. Monitor blood pressure and pulse rate, weight and fluid volume status (I and O) before and throughout the therapy and to assess patient routinely for resolution of fluid overload (weight gain, dyspnea, peripheral edema, and jugular neck vein) if on concurrent diuretic therapy. 2. Administer on empty stomach, 1 hour before or 2 To ensure proper absorption of Rationale To assess for the fluid balance.

hour after meals. 3. Inform the patient and significant others the mechanism of action of the drug and possible side effects such as tachycardia, angina, and cardiac arrhythmias; GI irritation, ulcers constipation, and liver injury; renal insufficiency, renal failure, and proteinuria; and rash, alopecia, dermatitis and photosensitivity. 4. Inform the patient and significant others to report if any of the side effects occur. 5. Monitor the patient carefully in any situation that might lead to a drop in fluid volume (e.g., excessive sweating, vomiting, diarrhea, dehydration). 6. Caution the patient to change positions slowly.

drug. To alleviate the anxiety of the patient and the significant others. This is also necessary for the client and significant others to appreciate the importance of taking the drug. To prevent further complications. To detect and treat excessive hypotension. To minimize orthostatic

hypotension, particularly after 7. Instruct SO to administer Captopril exactly as directed, even if feeling better. Missed doses should be taken as soon as possible but not if almost time for the next dose. Do not double doses. 8. Encourage the patient to decreased salt in the diet. 9. Provide comfort measures to help the patient tolerate drug effects such as small frequent feeding and safety precautions. initial dose. To ensure the effectivity of the drug and to prevent drug toxicity. To increase the effectiveness of the drug. To minimize effects. adverse side

Date of Administration: January 4 January 7, 2006 (IV), shifted to oral once IV consumed (January 7, 2006) until January 14, 2006 Generic Name: Digoxin Brand Name: Lanoxin Classification: Cardiac glycoside, inotropic agent, antiarrhythmi Dosage, Route, Frequency: 0.12 mg IV every 120 / 0.25-mg/tab tab every 12o Mechanism of Action: Prolongs refractory period of the AV node. Decreases conduction through the SA and AV node Desired Effect: This drug was given to our patient to increase the force of myocardial contraction.

Nursing Responsibilities 1. Inform to the patient and significant others the mechanism of action of the drug and possible side effects such as headache, weakness, drowsiness, and vision changes, GI upset and anorexia, and arrhythmias. 2. Monitor apical pulse for 1 full minute prior to administering. Withhold dose and notify physician if pulse rate is <70 bpm. 3. Monitor blood pressure before and throughout the therapy. 4. Monitor for cardiac arrhythmias, including sinus bradycardia. 5. Administer the drug with the correct dosage at an appropriate time. 6. Avoid administering with food or antacids. 7. Missed doses should be taken within 12o of scheduled dose or not taken at all. Do not double doses. Do not discontinue medication without consulting the physician. 8. Instruct patient to keep digoxin tablets in their original container and not mix in pillboxes with other medications, as they may look similar and maybe mistaken for other medications. 9. Teach patient and a responsible family member about the dosage regimen, how to take the pulse, reportable signs, and follow up care. 10. Instruct patient to report adverse reactions promptly such as nausea, vomiting diarrhea, appetite loss, and visual disturbances. 11. Monitor potassium levels carefully. Take corrective action before hypokalemia occurs. Encourage patient to eat potassium-rich foods. 12. Advice patient to have a small frequent feeding. 13. Advice patient to have adequate rest and sleep.

Rationale To alleviate anxiety and to gain cooperation. This is also necessary for the client and significant others to appreciate the importance of taking the drug. The drug has negative chronotropic effect. To observe for increased blood pressure and to prevent further complications. To detect early signs of digoxin toxicity. To avoid digoxin toxicity and to ensure the effectivity of the drug. To avoid delays in absorption. To ensure the effectivity of the drug and to prevent drug toxicity.

They may look similar and maybe mistaken for other medications.

To promote independence on the patient and significant others, These are early indicators of drug toxicity. To prevent hypokalemia which predispose the patient in development of toxicity. To minimize nausea and vomiting. To decrease metabolic demands.

Date of administration: January 4 January 14, 2006 Generic Name: Spironolactone Brand Name: Aldactone Classification: Potassium-sparing diuretics Dosage, Route, Frequency: 25 mg/tab 1 tab BID Mechanism of Action: Acts at distal renal tubule to antagonize the effects of aldosterone, causing excretion of sodium, bicarbonate, and calcium while conserving potassium and hydrogen ions. Desired Effect: This drug is given to our patient to promote excretion of excess fluids in the body, thus, relieving edema. It also lowers blood pressure. Nursing Responsibilities 1. Monitor I and O, weight, BP and PR before and throughout the therapy. 2. Administer drug early AM and early PM. 3. Administer the drug with food. 4. Emphasize the importance of continuing to take this medication even if feeling better. Instruct patient to take medication at the same time each day. If dose is missed, take as soon as remembered unless almost time for the next dose. 5. If dose is missed, take as soon as remembered unless almost time for the next dose. 6. Advice patient to change position slowly. 7. Caution patient to avoid activities requiring alertness until response to medication to known. 8. Avoid eating an excessive amount of foods that are high in potassium, such as citrus fruits, tomatoes, bananas, and apricots. Avoid salt substitutes containing potassium and potassium supplements, unless otherwise directed. Rationale To have a baseline data and to monitor for possible hypotension. So as not to interfere with sleep. To enhance absorption. To gain cooperation.

To ensure effectivity of the drug. To minimize hypotension and dizziness. Spironolactone may cause dizziness. To prevent hyperkalemia.

Date of administration: January 4 January 14, 2006 Generic Name: Prednisone Brand Name: Deltasone Classification: Glucocorticoid-intermidiate-acting Dosage, Route, Frequency: 5mg/tab 4 tabs TID Mechanism of Action: Suppresses response. inflammation Has minimal and the normal immune (sodiummineralocorticoid

retaining) activity. Desired Effect: This drug was given to our patient to decrease inflammation of the heart. Nursing Responsibilities 1. Administer drug regularly. Rationale To mimic normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary 2. Monitor intake and output ratios and daily weight throughout therapy. 3. Instruct patient to take medication exactly as desired, not to skip doses or double up on missed doses. 4. Encourage patients on long-term therapy to eat a diet high in protein, calcium, and potassium and low sodium and carbohydrates. 5. Protect the patient from unnecessary exposure to infection and invasive procedures. 6. Inform the patient and significant others the signs and symptoms of early adrenal insufficiency and notify health care provider if they experience tiredness, muscle weakness, joint pain, fever, poor appetite, nausea, difficulty breathing, dizziness, and fainting. 7. Instruct the patient and significant others the signs and symptoms of cushingoid symptoms To prevent the occurrence of cushingoid symptoms. axis. To identify changes and improvement of the patients condition. Stopping the medication suddenly may result in adrenal insufficiency that could lead to life threatening. To provide the nutritional needs of the body while preventing hypernatremia. The steroids suppress the immune system and the patient is at risk of infection. To prevent the occurrence of early adrenal insufficiency.

(moonface, buffalo hump) and notify a health care provider immediately of a sudden weight gain or swelling. 8. Advice patient to have small frequent feeding with balance diet. 9. Advice patient to have adequate rest and sleep. To minimize nausea and vomiting. To minimize side effects.

Date of administration: January 4 January 6, 2006 Generic Name: Ranitidine Brand Name: Zantac Classification: Histamine H2 antagonist or H2-blockers (anti-ulcer) Dosage, Route, Frequency: 30 mg IV every 8hr Mechanism of Action: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells. Desired Effect: This drug is given to our patient to prevent the hypersecretion of gastric acid (HCL), which will lead to ulcer development as a side effect of drugs particularly the Prednisone and Captopril. Nursing Responsibilities 1. Check for previous hypersensitivity to the drug. 2. Administer the drug accurately and periodically. 3. Monitor patient continually if giving intravenous dosage. Rationale To determine any sensitivity reaction to the drug. To ensure the effectivity of the drug. To allow early detection of potentially serious adverse effects on liver enzyme 4. Encourage patient to have small frequent feeding with balanced diet and avoid spicy foods. systems. To minimize nausea and vomiting. For us not to trigger HCL production, the patient 5. Advice patient not to do activities requiring alertness. 6. Provide thorough patient teaching, including drug name, prescribed dosage, measure for avoidance of adverse effects such as diarrhea or constipation, dizziness, headache, confusion, cardiac must avoid spicy foods. The drug can cause drowsiness or dizziness.

To enhance patient knowledge about drug therapy and to promote compliance.

arrhythmias, and hypotension, and warnings signs that may indicate possible problems. Instruct the patients about the need for periodic monitoring and evaluation. Date of administration: January 4 January 7, 2006 (IV), shifted to oral on January 7 until January 14, 2006 Generic Name: Furosemide Brand Name: Lasix Classification: Loop diuretic Dosage, Route, Frequency: 20 mg IV now then q 12hr Mechanism of Action: Inhibits the absorption of Na and chloride in the proximal and distal tubules as well as the ascending loop of Henle. Desired Effect: This drug was given to our patient to promote excretion of excess fluid in the body, hence, managing edema, congestion and consequently hypertension. Nursing Responsibilities 1. Monitor fluid status (I and O), weight, BP and PR before and throughout the therapy. 2. Administer the drug preferably in the morning and afternoon. 3. Advice patient to change position slowly. Rationale To monitor for any changes and or improvement of the clients condition. To prevent disruption of sleep cycle. To minimize orthostatic hypotension. This is most common following rapid high dose IV administration in patients with decrease renal function or those taking other ototoxic 5. Advise patient to report to health care professionals immediately if muscle weakness, cramps, nausea, dizziness, numbness or tingling sensation occurs. 6. Advice patient to increase intake of foods rich in To prevent hypokalemia since drugs. This could toxicity. indicate drug

4.Asses patient for tinnitus and hearing loss

potassium like bananas, apple etc. 7. Monitor electrolyte, renal and hepatic function, glucose and uric acid prior to and periodically throughout the course of therapy. 8. Advice patient on antihypertensive regimen to continue taking medications even if feeling better. 9. Advice patient to have small frequent feeding with balance diet. 10. Advice patient to have adequate rest and sleep.

this drug is a potassiumsparing diuretics. To prevent electrolyte imbalance.

Since this drug controls but does not cure hypertension. To minimize nausea and

vomiting. To decrease metabolic

demands.

Date of administration: January 4 January 5, 2006 Generic Name: Penicillin G benzanthine (benzanthine benzyl penicillin) Brand Name: Permapen Classification: Anti-infective Dosage, Route, Frequency: 750,000 units IV every 6 hours. Mechanism of Action: Binds to bacterial cell wall, resulting in cell death. Desired Effect: This drug was given to our patient to treat streptococcal infection or to prevent the further infection caused by streptococcus. Nursing Responsibilities 1. Obtain history of hypersensitivity to the drug. 2. Do skin testing prior to administration. Rationale To determine hypersensitivity to the drug. To prevent the occurrence of any sensitivity reaction 3. Administer the drug accurately and aseptically. through prior detection. To ensure the effectivity of the drug and to prevent further 4. Observe patient for signs and symptoms of anaphylaxis like rush, pruritis, laryngeal edema and infection. To prevent further anaphylactic reaction to the

wheezing. Discontinue the drug and notify physician immediately if this occur. 5. Advise patient to report signs of allergy and superinfection such as black, furry overgrowth on tongue; loose or foul-smelling stools. 6. Instruct patient or significant others to notify health care professional if fever and diarrhea develop especially if stool contains blood, pus or mucus. 7. Advice patient to have small frequent feeding 8. Advice patient to have and adequate rest and sleep, and have a balance diet.

drug.

To prevent the occurrence of further complications.

To prevent the occurrence of further complications.

To prevent nausea and vomiting To synergize the effect of the drug and to minimize possible adverse side effects like anemia and leucopenia.

Generic Name: Sucralfate Brand Name: Carafate Classification: Antiulcer; pepsin inhibitor Dosage; Route; Frequency: 1g QID for 2weeks Mechanism of Action: In combination with gastric acid, forms a protective covering on the ulcer surface. Desired Effect: This drug was given to our client in order to prevent further ulceration of the gastric mucosa. 1. 2. Nursing Responsibilities Administer drug on an empty stomach. Administer to 2 hours antacid to 30 minutes between prescribed Rationale Because presence of food in the stomach interferes with the absorption of the drug. Sucralfate binds with certain drugs (eg. Tetracycline, phenytoin) thus reducing the effects of the other drugs.

before or after sucralfate. Allow 1 elapse other sucralfate drugs. and

3. Advice client to take the drug exactly as ordered. Therapy usually requires 4 to 8 weeks for optimal ulcer healing. Instruct the client, even if she feels better, she should continue taking her medications. 4. Increase fluid, dietary bulk, and exercise. 5. Instruct the significant others to report if client experiences pain, coughing dizziness, constipation, or vomiting nausea, dry of blood, vomiting, rash,

To achieve optimal ulcer healing.

To

prevent

possible

occurrence

of

constipation. To provide immediate intervention to avoid complication.

mouth,

pruritus, back pain and sleepiness. 7. Advice the client to avoid foods and liquids such as caffeine-containing beverages, alcohol and spices.

These foods or liquids can cause gastric irritation that would aggravate the pain felt by the patient.

Generic Name: Diphenhydramine Brand Name: Benadryl Classification: Antihistamine Dosage; Route; Frequency: 50 mg IV now Mode of Action: Blocks histamine1 thereby decreasing allergic response; affects respiratory system, blood vessels and GI system. Desired Effects: This drug is given to treat allergic symptoms. Nursing Responsibilities 1. Administer with food. 2. Advice the client to avoid performing dangerous activities if drowsiness occurs or until stabilized on drug. 3. Avoid alcohol and other central nervous system depressants. 4. Monitor the blood pressure of the patient. To prevent further complications. One of the side effects of the drug is hypertension. Monitoring blood pressure will help the health care providers detect if patient is suffering already from Rationale To decrease gastric distress. To avoid accident or injury.

hypertension, thus immediate intervention will 5. Inform the client about the side effects such as dizziness, confusion, fatigue, nausea, vomiting, urinary retention, vision, reduced the dry constipation, mouth and secretions, effects blurred throat, epigastric such as be given thereby preventing complication. This will increase the clients knowledge about the drug so that she will not experience anxiety if ever these side or adverse effects will occur.

distress, hearing disturbances, and adverse agranulocytosis, hemolytic anemia, and thrombocytopenia.

Generic Name: Omeprazole Brand Name: Losec Classification: Proton Pump Inhibitor Dosage; Route; Frequency: 40 mg IV q 12 hours Mechanism of Action: Suppresses gastric secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells thereby it blocks the final step of acid production. Desired Effects: This drug was given to our patient to decrease gastric irritation caused by over secretion of hydrochloric acid. Nursing Responsibilities 1. Check for the patency of the IV line. 2. Administer the drug slowly. 3. Advice patient to avoid activities requiring alertness. 4. In cases of rashes, advice patient not to scratch the affected areas. 5. Instruct patient to avoid eating sour tasting foods. 6. Instruct patient large meal. to avoid eating Rationale To avoid wastage of the drug. To prevent phlebitis. Because it may cause dizziness and drowsiness. Because it may lead to bruises and also it will increase the tendency of infection. To prevent further irritation of gastric mucosa. To avoid aggravating the condition.

Generic Name: Esomeprazole Brand Name: No brand name indicated Classification: Proton Pump Inhibitor Dosage; Route; Frequency: 40 mg IV q 12 hours Mechanism of Action: Suppresses gastric secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells thereby it blocks the final step of acid production. Desired Effects: This drug was given to the patient to decrease gastric irritation caused by over secretion of hydrochloric acid. Nursing Responsibilities 1. Inform patient about side dry effects skin, such as Rationale To gain cooperation.

the

importance and the corresponding dizziness, and For better absorption thus maximum therapeutic effect of the drug will be achieved. To attain the exact treatment. To induce nausea and vomiting. To facilitate bowel movement. Because it may cause dizziness. Because it may lead to bruises and it will increase the tendency of infection. headache, rash, pruritus, alopecia, diarrhea, nausea vomiting, or constipation. 2. Encourage the patient to take drug 1 hour before or 2 hours after meal with a glass of water. 3. Encourage patient to take the drug religiously. 4. Instruct patient to take in or eat crackers or ice chips. 5. In cases of constipation, encourage patient to increase fluid intake. 6. Instruct patient to avoid activities requiring alertness. 7. In cases of rashes, instruct client not to scratch the affected area.

Generic Name: Aluminum/ Magnesium Hydroxide Brand Name: N/A Classification: Antacid Dosage; Route; Frequency: 2 tbsp q 6 hours 2x after meals

Mechanism of Action: It improves the resistance of the stomach lining to irritation and increase the tone of the lower esophageal sphincter. Desired Effects: This drug was given to our patient to decrease hyperacidity. 1. 2. Nursing Responsibilities Administer drug ANST (-). Inform the patient the adverse such as irritability, n/a, rebound hyperacidity, shake To facilitate passage. Rationale To prevent allergic reaction that may progress to anaphylactic shock. To lessen the patients worries if ever the patient experience adverse effects.

effects

weakness,

constipation, and flatulence 3. Instruct patient to

suspension well and to follow with a small amount of milk or water. 4. Watch for evidence hypophosphatemia of To prevent complication.

(anorexia,

malaise and muscle weakness) with prolonged use 5. Advice patient not to take Ca Carbonate switch indiscriminately without or to the To prevent further complications. antacids To prevent complications.

physicians advice. 6. Instruct patient to notify the physician about s/s of GI bleeding, such as black tarry stools, or coffee-ground vomitus.

Generic Name: Calcium Carbonate Brand Name: Maalox Classification: Antacid Dosage, Route, Frequency: 30 cc TID x 2 days Mechanism of Action: Reduces total load in the GIT, elevates gastric pH to reduce pepsin activity, strengthens the gastric mucosal barrier, and increase esophageal sphincter tone Desired Effect: This drug is given to our patient in order to prevent further irritation of the gastric mucosa, thus, relieving the pain experienced by the client. Nursing Responsibilities Rationale

1. Asses for any allergic reaction of the drug. 2. Inform the patient about the

This is necessary to prevent any untoward anaphylactic reaction. This is necessary precautionary so as to give the

possible adverse reactions of the drug. 3. Raise side rails as precaution. Reorient patient as needed.

measures

regarding

occurrence of the adverse effects. Because some patients

become

temporarily excited or disoriented while some develop amnesia or become drowsy.

Generic Name: Tramadol Hydrochloride Brand Name: Ultram Classification: Analgesics Dosage, Route, Frequency: 50 mg IV stat Mechanism of Action: A centrally acting synthetic analgesic compound not chemically related to opiates. Thought to bind to opoid receptors and inhibit reuptake of norepinephrine and serotonin. Desired Effect: This drug was given to our patient to relieve the pain brought about by the disease process. Nursing Responsibilities 1. Assess type, location and intensity of pain before and after 2-3 hours (peak) after administration. 2. Assess blood pressure before and periodically and RR Rationale This is necessary in order to determine improvements after drug administration. So as to determine the possibility of

during

respiratory depression and hypotension as an effect of the drug. In order to determine the presence of constipating effect of the drug. This is necessary to prevent the

administration. 3. Assess bowel function routinely. 4. Advice client to increase intake of fluids and bulk. 5. Monitor patient for seizures. 6. Caution patient to avoid activities requiring alertness until response to medication is known. 7. Advice patient to change positions slowly.

constipating effect of the drug. Drug may reduce seizure threshold. In order to prevent injury since dizziness and drowsiness may occur.

In

order

to

prevent

orthostatic

hypotension.

Generic Name: Scopalamine butylbromide (Hyoscine N-butylbromide) Brand Name: Buscopan Classification: Anticholinergic Dosage, Route, Frequency: 1 amp IM Mechanism of Action: Inhibits muscarinic actions of acetylcholine on autoimmune effectors innervated by prostaganglionic cholinergic neurons. Desired Effect: To prevent spastic states. Nursing Responsibilities 1. Assess for any allergic reaction of the drug. 2. Inform the patient about the Rationale In order to know the clients sensitivity to the drug. This is necessary so as to give the gain

possible adverse reactions of the drug.

precautionary

measures

regarding

occurrence of the adverse effects to 3. Raise siderails as precaution. Reorient patient as needed. 4. Keep emergency the patient equipment to avoid

cooperation. Because some patients become temporarily excited or disoriented while some develop amnesia or become drowsy. In order to be ready in case the patient becomes overdose. The drug may cause dizziness and

available. 5. Instruct

activities that require alertness. 6. Advise the patient to report urinary hesitancy or urine retention.

drowsiness. To prevent further complication.

Generic Name: Hydroxyzine Brand Name: Vistaril Classification: Antihistamine Dosage, Route, Frequency: 10 mg/tab 1 tab BID Mechanism of Action: Blocks the effects of histamine at the histamine 1 receptor sites decreasing the allergic response. They have also anti-cholinergic and antipriritc effects. Desired Effect: This drug was given to our patient to relieve allergic symptoms associated with release of histamine. Nursing Responsibilities 1. Instruct the patient to take this Rationale To reduce stomach upset.

medication with food or a glass of water or milk. 2. Advise patient not to drink alcoholic beverages while taking hydroxyzine. 3. Instruct the patient to take sugarless hard candy chips, mouthwash, or or gum, a ice saliva This may increase CNS depression. Because it increases your risk of tooth and gum problems.

substitute if dry mouth is developed. Advise her to report to the health care provider if dry mouth persists for To prevent photosensitivity reaction. longer than 2 weeks. 4. Tell the patient to Avoid prolonged exposure to sunlight. When outdoors, wear protective clothing, sunglasses, and sunblock.

Generic Name: Loratadine Brand Name: Claritin Classification: Antihistamine Dosage, Route, Frequency: 10 mg/tab 1 tab OD Mechanism of Action: Blocks the effects of histamine at the histamine 1 receptor sites. Loratadine is a nonsedating antihistamine; its chemical structure prevents entry into the CNS. Desired Effect: This drug was given to our patient to relieve allergic symptoms associated with release of histamine. Nursing Responsibilities 1. Instruct the patient to stop drug 4 days before patient undergoes diagnostic skin tests. 2. Warn patient not to engage self in activities that require alertness until CNS effects of drug is known. 3. Instruct patient to take sugarless gums, hard candy or ice chips. Generic Name: Magaldrate (aluminum magnesium complw To prevent the drying of mouth. Rationale Because drug can prevent, reduce, or mask positive skin test response. Because dizziness and headache are

Brand Name: Riopan Classification: Antacid Dosage, Route, Frequency: 20 mg/tab 1 tab Mechanism of Action: Antacid that increase total acid load in GI tact, elevates Desired Effect: This drug was given to our patient to relieve allergic symptoms associated with release of histamine. Nursing Responsibilities 1. Monitor magnesium level in patients with mild renal impairment. 2. Warn patient not to engage self in activities that require alertness until CNS effects of drug is known. 3. Instruct patient to take sugarless gums, hard candy or ice chips. To prevent the drying of mouth. Rationale Hypermagnesemia usually occurs only in severe real failure. Because dizziness and headache are