University of the Philippines Manila

The Health Sciences Center

COLLEGE OF NURSING
A World Health Organization Collaborating Center
Sotejo Hall, Pedro Gil Street, Ermita, Manila

DRUG STUDY
NAME OF STUDENT: Ma. Stefanie P. Reyes DATE OF ASSIGNMENT: August 16-19, 2010
NAME OF PATIENT: Alfredo N. Frias CIVIL STATUS: Married WARD: 3 BED
NO.: 26
DIAGNOSIS OR CLINICAL IMPRESSION: Acute Respiratory Failure secondary to Status Asthmaticus—Hypoxic Ischemic Encephalopathy AGE: 57
SEX: Male

DRUG ORDER DESIRED

TRADE/ PHARMACOLOGI
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND C ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT

Acetylcysteine • Mucolytic INDICATIONS: • CNS: Dizziness, To help Assessment & Drug Effects
• 200mg in 100 cc • Acts by • Abnormal, viscid, or drowsiness liquefy • Monitor for s/sx of
PNSS disrupting inspissated mucous • GI: Nausea, vomiting, and aspiration of excess
• PO disulfide secretions in acute stomatitis, mobilize secretions, withhold drug
• 1 sachet BID (8—6) linkages of and chronic hepatotoxicity, the and notify physician
mucoproteins bronchopulmonary urticaria client’s immediately if it occurs.
in purulent diseases • Resp: secretions • Lab tests: Monitor ABGs,
and • Pulmonary Bronchospasm, . pulmonary functions and
nonpurulent complications of rhinorrhea, burning pulse oximetry as
secretions. cystic fibrosis and sensation in upper indicated.
• Lowers viscosity surgery, respiratory passages, • Have suction apparatus
and facilitates tracheostomy, and epistaxis immediately available.
the removal atelectasis Increased volume of
of secretions. • Diagnostic bronchial respiratory tract fluid may
studies be liberated—suction or
• Antidote for acute endotracheal aspiration
acetaminophen may be necessary to
poisoning establish and maintain an
open airway. Older adults
CONTRAINDICATIONS: and debilitated patients
• Hypersensitivity are particularly at risk.
• Patients at risk of gastric • Bronchospasm is most
hemorrhage likely to occur in patients
with asthma, and it may
Caution with pregnancy happen unpredictably. If it
(C), lactation, asthma, occurs, discontinue
older adults, debilitated immediately.
patients with severe • Nausea and vomiting may
respiratory insufficiency occur, particularly when
face mask is used, due to
unpleasant odor of drug
 and excess volume of
liquefied bronchial
secretions.

Patient & Family Education

• Report difficulty with
clearing the airway or any
other respiratory distress.
• Report nausea, as an
antiemetic may be
indicated.

DRUG ORDER DESIRED

TRADE/ PHARMACOLOG
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND IC ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT

Citicoline • A derivative of INDICATIONS: • CNS: Insomnia, To aid in Assessment & Drug Effects
• 1g/tab choline and • Cerebrovascular shock, excitement, the • Monitor vital signs.
• PO cytidine impairment in acute parasympathetic client’s • Monitor for s/sx of allergic
• 1 tab BID (8—6) involved in and recovery phase stimulation recovery reactions: GI disturbances
the • S/sx of cerebral • CVS: Hypotension phase of • Caution with large doses
biosynthesis insufficiency: dizziness, • Syst: stroke which could aggravate
of lecithin headache, poor Hypersensitivity increase in cerebral blood
• It is claimed to concentration, memory flow in episodes of
increase loss disorientation intracranial hemorrhage.
blood flow • Cranial trauma and • Drug must not be
and oxygen sequelae administered with
consumption • Parkinson’s disease medicaments containing
in the brain. meclophenoxate.
CONTRAINDICATIONS:
• Hypersensitivity Patient & Family Education
• Hypertonia of • Report adverse effects
parasympathetic that might aggravate the
nervous system client’s condition.

Caution with pregnancy

(C), lactation, persistent
intracranial hemorrhage

Topiramate Topama • Anticonvulsant, INDICATIONS: • CNS: Dizziness, To Assessment & Drug Effects
• 50mg/tab x CNS agent • Partial-onset seizures in diziness, somnolence, prevent • Monitor mental status and
• PO • Sulfamate- adults and children ataxia, psychomotor the onset report significant cognitive
• ½ tab BID (8—6) substituted above 2 yrs. old slowing, confusion, of impairment.
monosacchar • Migraine (prophylaxis) nystagmus, seizures • Lab tests: Periodically
ide with a paresthesia, memory on the monitor CBC with Hgb and
broad CONTRAINDICATIONS: difficulty, difficulty client Hct.
spectrum of • Hypersensitivity concentrating,
anticonvulsa • Epilepsy nervousness, Patient & Family Education
 nt activity. • Pregnancy (C) depression, anxiety, • Do not stop drug abruptly.
Its precise tremors Discontinue gradually to
mechanism Caution with renal and • GI: Anorexia minimize seizures.
of action is hepatic function • Misc: Speech • To minimize risk of kidney
unknown. impairments, lactation problems, weight loss, stones, drink at least 6–8
Exhibits fatigue full glasses of water each
sodium day if fluid intake is not
channel- restricted.
blocking • Be aware that
action, as psychomotor slowing and
well as speech/language
enhancing problems may develop
the ability of while on topiramate
GABA to therapy.
induce a flux • Report adverse effects.
of chloride
ions into the
neurons,
thus
potentiating
the activity
of this
inhibitory
neurotransmi
tter (GABA).

DRUG ORDER DESIRED

TRADE/ PHARMACOLOGI
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND C ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT

Potassium • Electrolytic and INDICATIONS: • CNS: Mental Assessment & Drug Effects
Chloride water balance • Potassium deficit confusion, • Monitor for and report
• 10% solution agents; secondary to diuretic irritability signs of GI ulceration
• PO replacement or corticosteroid • GI: Nausea, (esophageal or epigastric
• 30 cc BID (8—6) solution therapy vomiting, pain or hematemesis).
• Principal • Potassium depletion by diarrhea, • Lab test: Frequent serum
intracellular cation severe vomiting, abdominal electrolytes are
• Essential for diarrhea, intestinal distension warranted.
maintenance of drainage, fistulas, or • GU: Oliguria, • Be alert for potassium
intracellular malabsorption, anuria intoxication
isotonicity, prolonged diuresis, • Hema: (hyperkalemia). This may
transmission of diabetic acidosis Hyperkalemia result from any
nerve impulses, • Hypokalemic alkalosis • Resp: therapeutic dosage, and
contraction of Respiratory the patient may be
cardiac, skeletal, CONTRAINDICATIONS: distress. asymptomatic.
and smooth • Severe renal • CVS: • The risk of hyperkalemia
muscles, impairment Hypotension, with potassium
maintenance of • Severe hemolytic bradycardia, supplement increases (1)
normal kidney reactions cardiac in older adults because of
 function, and for • Untreated Addison's
enzyme activity. disease
Plays a prominent • Crush syndrome
role in both • Early postoperative
formation and oliguria (except
correction of during GI drainage)
imbalances in • Adynamic ileus
acid–base • Acute dehydration
metabolism. • Heat cramps
• Given special • Hyperkalemia
importance as • Patients receiving
therapeutic potassium-sparing
agents but are diuretics
also dangerous if Digitalis intoxication with
improperly AV conduction
prescribed and disturbance
administered.
Utilized for Caution with cardiac or
treatment of kidney disease, systemic
hypokalemia. acidosis, slow-release
potassium preparations in
presence of delayed GI
transit or Meckel's
diverticulum, extensive
tissue breakdown (such
as severe burns),
pregnancy (A), lactation
depression, decremental changes in
arrhythmias, kidney function associated
or arrest, with aging, (2) when
altered dietary intake of
sensitivity to potassium suddenly
digitalis increases, and (3) when
glycosides kidney function is
ECG changes in significantly compromised.
hyperkalemia:
Tenting (peaking) of T Patient & Family Education
wave (especially in • Teach about sources of
right precordial leads), potassium with special
lowering of R with reference to foods and
deepening of S waves OTC drugs.
and depression of RST; • Do not use any salt
prolonged P-R interval, substitute unless it is
widened QRS complex, specifically ordered by the
decreased amplitude physician. These contain a
and disappearance of P substantial amount of
waves, prolonged Q-T potassium and
interval, signs of right electrolytes other than
and left bundle block, sodium.
deterioration of QRS • Do not self-prescribe
contour and finally laxatives. Chronic laxative
ventricular use has been associated
fibrillation and with diarrhea–induced
death potassium loss.
• MS: Pain, • Notify physician of
paresthesias of persistent vomiting
extremities, because losses of
muscle potassium can occur.
weakness and • Report continuing signs of
heaviness of potassium deficit to
limbs, difficulty physician: weakness,
in swallowing, fatigue, polyuria,
flaccid polydipsia.
paralysis

DRUG ORDER DESIRED

TRADE/ PHARMACOL NURSING
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION
BRAND OGIC ACTION RESPONSIBILITIES/
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE
NAME OF DRUG PRECAUTIONS
Frequency, etc.) CLIENT
Heparin • Anticoagulant INDICATIONS: • Hema: Assessment & Drug
• 5000U/ml in 8L • Does not lyse • Venous thrombosis Spontaneous Effects
• SC already • Pulmonary embolism bleeding, transient • Lab tests: Baseline blood
• BID (8—6) existing • Thromboembolic complication thrombocytopenia, coagulation tests, Hct, Hgb,
thrombi but prevention hypofibrinogenemia, RBC, and platelet counts prior
may prevent • Disseminated intravascular “White clot to initiation of therapy and at
their extension coagulation (DIC) syndrome” regular intervals throughout
and • Atrial fibrillation with embolization • Integ: Injection therapy.
propagation. • Anticoagulant in blood site reactions (pain, • Patients vary widely in their
Inhibits transfusions and dialysis itching, ecchymoses, reaction to heparin: risk of
formation on procedures tissue irritation and hemorrhage appears greatest
new clots. sloughing), cyanosis in women, all patients > 60
• Exerts direct CONTRAINDICATIONS: and pains in arms or y.o., and patients with liver
effect on blood • Hypersensitivity legs (vasospasm), disease or renal insufficiency.
coagulation • Active bleeding reversible transient • Monitor vital signs: Report
(clotting) by • Bleeding tendencies: purpura, alopecia (usually fever, drop in BP, rapid pulse,
enhancing the hemophilia, thrombocytopenia around temporal and other s/sx of
inhibitory • Jaundice area), pruritus, skin hemorrhage.
actions of • Ascorbic acid deficiency rashes, itching and • Observe all needle sites
antithrombin III • Inaccessible ulcerative lesions burning sensations daily for hematoma and signs
(heparin • Visceral carcinoma of feet of inflammation (swelling,
cofactor) on • Open wounds • MS: Numbness and heat, redness, pain).
several factors • Extensive denudation of skin tingling of hands and • Antidote: Have on hand
essential to • Suppurative thrombophlebitis feet protamine sulfate (1%
normal blood • Advanced kidney, liver, or biliary • CVS: Elevated BP, solution), specific heparin
clotting, disease chest pains, antagonist.
thereby • Active tuberculosis • CNS: Headache Patient & Family
blocking the • Bacterial endocarditis • EENT: Nasal Education
conversion of • Continuous tube drainage of congestion, • Protect from injury and
prothrombin to stomach or small intestines lacrimation, notify physician of pink, red,
thrombin and • Threatened abortion conjunctivitis dark brown, or cloudy urine;
fibrinogen to • Intracranial hemorrhage • Resp: red or dark brown vomitus;
fibrin. • Severe hypertension Bronchospasm red or black stools; bleeding
• Recent surgery of eye, brain, or • Endo: gums or oral mucosa;
spinal cord Osteoporosis, ecchymoses, hematoma,
• Spinal tap hypoaldosteronism, epistaxis, bloody sputum.
• Shock suppressed renal • Teach correct technique for
function, SC administration if
Caution with alcoholism, history of hyperkalemia, discharged from hospital on
allergy (asthma), pregnancy (C) rebound heparin.
esp. last trimester, immediate hyperlipidemia • Do not take aspirin or any
postpartum period, during (following other OTC medication without
menstruation, patients with termination of physician's approval.
indwelling catheters, older adults, heparin therapy)
use of acid-citrate-dextrose (ACD)- • GI: Increased AST,
converted blood (may contain ALT
heparin), cerebral embolism • GU: Priapism (rare)
• Syst: Fever, chills,
urticaria,
anaphylaxis
 DRUG ORDER DESIRED
TRADE/ PHARMACOLOGI
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND C ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT

Ceftazidime • Antiinfective, INDICATIONS: • CNS: Dizziness, To treat Assessment & Drug Effects
• 1g/5ml antibiotic, • Serious infections convulsion, the client’s • Monitor for signs of infection:
• IV cephalosporin caused by susceptible myoclonus, Pseudomo fever, earache, characteristics of
• q12h (8—8) • Semisynthetic, organisms in the: headache, nas wounds, sputum, urine and stool,
third-  urinary tract encephalopathy, aeruginosa increased WBC.
generation tremors, paresthesia infection • Lab tests: Review culture and
broad-  lower respiratory tract • GI: Nausea, sensitivity studies, WBC counts.
spectrum  bones and joints vomiting, diarrhea, • If administered concomitantly
cephalosporin abdominal pain, with another antibiotic, monitor
antibiotic  skin and skin pseudomembranou renal function and report if
similar to structures s colitis, symptoms of dysfunction appear
cefotaxime  intraabdominal hemorrhagic colitis, (e.g., changes in I&O ratio and
but more  gynecologic gastroenteritis, oral pattern, dysuria).
active against thrush • Be alert to onset of rash, itching,
Pseudomonas  CNS • GU: Candidiasis, urticaria, chills, fever, joint pain
aeruginosa  EENT vaginitis and dyspnea. Angioedema may
and less • Hema: Phlebitis, also appear. Epinephrine and
active against  mixed infections transient changes resuscitation equipment should be
Staphylococci • Septicemia • Integ: Rash, available for possible anaphylactic
and • Bacteremia pruritus, urticaria, reaction.
Bacteroides • Peritonitis inflammation, • Monitor for superinfection:
fragilis. • Infections associated maculopapules perineal itching, fever, malaise,
• Preferentially with peritoneal and • Syst: Fever, redness, pain, swelling, drainage,
binds to one hemodialysis, angioedema, rash, severe diarrhea and changes
or more of the immunosuppression: anaphylaxis, in sputum.
penicillin- infected burns superinfections • If severe diarrhea occurs and is
binding • Prostatic surgery severe, suspect
proteins (PBP) (prophylaxis) pseudomembranous colitis
located on cell (caused by Clostridium difficile).
walls of CONTRAINDICATIONS: • If on long-term therapy, monitor
susceptible • Hypersensitivity to hematologic, electrolyte and
microbes. This cephalosporins and hepatic status. Hematologic:
inhibits third other beta-lactam Ecchymosis, bleeding gums,
and final antibiotics hematuria, stool guaiac, CBC, Hct.
stage of • Pregnancy (B) Electrolyte: Na, K, Cl. Hepatic: ALT,
bacterial cell AST, LDH, bilirubin, alk
wall Caution with lactation and phosphatase and Coomb’s test.
synthesis, allergy to penicillins, renal
leading to cell and hepatic impairments, Patient & Family Education
death of the aminoglycoside and • Report loose stools or diarrhea
bacterium. potent diuretics, GI promptly.
• Most strains of diseases (colitis), poor • Report any signs or symptoms of
gonococci, nutritional state, patients superinfection promptly.
meningococci, at risk and exogenous
and vitamin K administration
 Hemophilus
influenzae are
highly
susceptible,
Listeria
monocytoge-
nes organisms
are resistant.
Emergence of
resistance
during
treatment has
been
reported. May
be used
concomitantly
with other
antibiotics.

DRUG ORDER DESIRED

TRADE/ PHARMACOLOGI
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND C ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT

Salbutamol • Bronchodilator, INDICATIONS: • CNS: Headache, To relieve Assessment & Drug Effects
• 0.5% solution sympathomim • Bronchospasms in mild, tremors, dizziness, the client’s • Monitor therapeutic
• Neb etic moderate and severe hyperactivity, broncho- effectiveness which is indicated by
• q8h (8—4—12) • Synthetic asthma insomnia, spasms significant subjective
sympathomim • Chronic bronchitis restlessness, and improvement in pulmonary
etic amine • Emphysema and other convulsions, mobilize function within 60–90 min after
and reversible obstructive hallucinations his drug administration.
moderately pulmonary diseases • Resp: Paradoxical retained • Monitor for: s/sx of fine tremor in
selective • Co-existing heart bronchospasms, secretions fingers, CNS stimulation
beta2- disease or cough, bronchitis (hyperactivity, excitement,
adrenergic hypertension • CVS: Palpitations, nervousness, insomnia),
agonist with bradycardia, reflex, tachycardia, GI symptoms. Report
comparatively CONTRAINDICATIONS: tachycardia, promptly to physician.
long action. • Hypersensitivity to hypertension, • Lab tests: Periodic ABGs,
Acts more salbutamol and to hypotension, pulmonary functions, and pulse
prominently atropine and its peripheral oximetry.
on beta2 derivatives vasodilation, flushing • Provide frequent moth care.
receptors • Cardiac arrhythmia • Hema: Hypokalemia
(particularly associated with • GI: Nausea, Patient & Family Education
smooth tachycardia caused vomiting, mouth and • Review directions for correct use
muscles of by Digitalis throat irritation, of medication and nebulizer.
bronchi, intoxication heartburn, GI • Avoid contact of inhalation drug
uterus, and • Hypertrophic discomfort, dyspepsia with eyes.
vascular obstructive • EENT: Epistaxis, • Do not increase number or
supply to cardiomyopathy or blurred vision, dilated frequency of inhalations without
skeletal tachyarrhythmia pupils advice of physician.
 muscles) than • Thyrotoxicosis • Integ: Rash • Notify physician if salbutamol
on beta1 • Threatened abortion • MS: Fine skeletal fails to provide relief because this
(heart) during 1st and 2nd muscle tremor, leg can signify worsening of
receptors. trimester cramps pulmonary function and a
• Minimal or no reevaluation of condition/therapy
effect on Caution with may be indicated.
alpha- hyperthyroidism, CV • Do not use OTC drugs without
adrenergic disease, CAD, physician approval. Many
receptors. myocardialinsufficiency, medications (e.g., cold remedies)
• Inhibits hypokalemia, angina contain drugs that may intensify
histamine pectoris, unstable albuterol action.
release by vasomotor systems, • Provide mouth care.
mast cells. prostatic hypertrophy, hx • Consult physician about giving
• Salbutamol of seizures, elderly, last salbutamol dose several hours
produces psychoneurotic patients, before bedtime, if drug-induced
bronchodilatio degenerative heart insomnia is a problem.
n, regardless disease developed by
of long-standing BA and
administration emphysema patients,
route, by closed angle glaucoma,
relaxing pregnancy (C) and
smooth lactation
muscles of
bronchial
tree. This
decreases
airway
resistance,
facilitates
mucus
drainage, and
increases vital
capacity.
• Also causes CNS
and cardiac
stimulation,
increased
diuresis and
gastric acid
secretion, and
skeletal
muscle
tremors.

DRUG ORDER DESIRED

TRADE/ PHARMACOLOGI
(Generic name, INDICATIONS AND ADVERSE EFFECTS ACTION NURSING RESPONSIBILITIES/
BRAND C ACTION OF
Dosage, Route, CONTRAINDICATIONS OF THE DRUG ON THE PRECAUTIONS
NAME DRUG
Frequency, etc.) CLIENT
Salmeterol/Flutica Seretide • Bronchodilator, INDICATIONS: • CNS: Headache, To relieve Assessment & Drug Effects
sone sympathomim • Bronchospasms in mild, tremors the client’s • Assess for client’s condition
• 25mcg etic; Anti- moderate and severe • Resp: Paradoxical broncho- before therapy. Document
• MDI inflammatory, asthma bronchospasms spasms indications for therapy, onset and
• BID (8—6) corticosteroid • Asthma (treatment and • CVS: Palpitations characteristic s/sx.
• Salmeterol is a prophylaxis) • EENT: Cataract, • Withhold drug and notify
long-acting • Chronic bronchitis glaucoma, candidiasis physician immediately if
beta2- • Emphysema and dryness of mouth bronchospasms occur following its
adrenorecept • Allergic rhinitis and throat, use.
or agonist and (prophylaxis) hoarseness • Monitor cardiovascular status.
an analog of • Syst: Suppression Report tachycardia.
albuterol. CONTRAINDICATIONS: of adrenal function, • Treatment is not used for acute
Stimulation of • Hypersensitivity anaphylaxis asthma attacks.
beta2- • Acute asthmatic attacks • Administration: Shake aerosol
adrenorecept or status asthmaticus container well, ask patient to
ors relaxes (not used as primary exhale, then place the
bronchospas treatment) mouthpiece/spacer in trache
m and mask, inhale slowly remove,
increases Caution with acute exhale, and allow at least 1 min.
ciliary asthma attacks, between inhalations.
motility, thus thyrotoxicosis, active and • Notify physician for unresolved
facilitating quiescent PTB, CVS GI upset, rapid heartbeat or
expectoration. disorders esp. coronary palpitations, insomnia,
• It inhibits the insufficiency, cardiac hyperactivity, muscle cramping or
release of arrhythmias or skin rash.
mediators hypertension, pregnancy • Provide frequent moth care.
(i.e., (C) and lactation
histamine) Patient & Family Education
from mast • Notify physician immediately of
cells, worsening asthma or failure to
macrophages, respond to the usual dose.
and • Use exactly as directed. Do not
eosinophils. use more often than
• Prevents recommended (excessive use may
nocturnal result in tolerance, overdose) and
asthma do not discontinue without
symptoms. consulting the physician.
• Fluticasone is a • Provide mouth care.
glucocorticoid • Remind to use for acute asthma
with a high attacks.
anti-
inflammatory
potency. It
has a strong
affinity for
and agonist
activity at
human
glucocorticoid
receptors.