X.

Drug Study

Name of the Patient: Florante Bajet

Attending Physician: Dr. Ruel Sunio

NAME DRUG ACTION SIDE EFFECT CONTRAINDICATION NURSING RESPONSIBILITIES

Generic: Mechanisms ofCNS: Dizziness, vertigo Contraindicated in the patient 1. Consider the patients 10 rights
Tramadol Action: headache, malaise, sleep hypersensitivity to drug or other R: to ensure proper administration of
Unknown. Adisorder opioid breastfeeding woman, drug and most of all to avoid mistakes.
Brand: centrally actingCV: vasolidation and in those with acute 2. Practice proper hand washing
Ultram synthetic analgesicEENT: visual intoxification from alcohol, R: Hand washing deters the spread of
compound notdisturbance hypnotics centrally acting microorganism thus preventing
Classification: chemically relatedGI: nausea, constipation, analgesic, opioids or nosocomial infections.
Opioids to opiates.vomiting dyspepsia, dry psychotropic drug. Serious 3. Reassess patient level of pain at least 30
Analgesic Thought to bind to mouth, diarrhea, hypersensitivity reaction can minutes after administering.
opioids receptor abdominal pain, occur, usually after the first R: to assess patients conditions and
and inhibitanorexia, flatulence. dose. Patient with history of effectiveness of drug
MODE OF reuptake ofGU: urine retention, anaphylaxis to codeine and 4. Assess the breathing pattern of the
ADMINISTRAT norepinephrine urinary frequency, other opioids may be at an patient
ION and serotonin. proteinuria. increase risk. R: Assessing the respiratory rate of the
Musculoskeletal: patient is important to prevent
Route: Bibliography: hypertonic SPECIAL PRECAUTION respiratory depression and have
IVTT ANST (-) Nursing Drug SkinL pruritus, immediate actions.
Handbook 2005, diaphoresis rash. Use cautiously in patient at risk 5. Monitor bowel and bladder function,
Dosage: Page 405, 406 for seizures or respiratory anticipate the need for laxatives
50mg ADVERSE EFFECT depression, in patient with R: Monitoring these function will aide
Indication; increased intracronial pressure the patient if he/she as feeling of
Time: Moderate to CNS: CNS stimulation, or head injury, acute abdominal constipation.
q8 moderately severe asthenia, anxiety, coordination or renal or hepatic 6. For better analgesic effects, give drug
pain confusion coordination impairment; or in patient with before onset of intense pain
disturbance euphoria, physical dependence an opioids.
nervousness, seizure
Respiratory: Respiratory
depression. DRUG INTERACTION
Drug-Drug
Carbomazepine: May increased
tramadol metaboism, patients
receiving long term 8. Educate the patient about the purpose
carbamazephine therapy at up to
800mg daily may need up to
twice the recommended dose of
tremadol.
R: Giving the drug this way will
minimize effect of intense pain thus
promoting comfort to the client.
7. Monitor patient for drug dependence
R: Drug can produce dependence similar
to that of codiene and
dextropropoxyphene and thus potential
for abuse.
and administration of drug
R: doing this will relieve patients
anxiety, making them aware and
facilitate cooperation
9. Instruct patient to rest after
R: resting promotes relaxation and
comfort to the patient
10. Assess the patient sleep pattern before
giving the drug.
R: Sleep disturbance its one of the side
effect of tramadol by doing this proper
intervention and action should be
done.
Name Drug Action
Mechanism of Action
Generic Name: Inhibit reabsorption of
sodium and water in the
furosemide
ascending limb of the
loop of Henle by
interfering with the
Brand Name: chloride binding site of
the 1Na+, 1K+, 2Cl-
Lasix
cotransport system. Loop
diuretics increase the rate
Classification: of delivery of tubular
fluid and electrolytes to
Diuretics the distal sites of
hydrogen and potassium
ion secretion, while
Dosage:
plasma volume
5mg(0.5ml) contraction increases
aldosterone production.
The increased delivery
and high aldosterone
Frequency:
levels promote sodium
Every 12 hours. Hold reabsorption at the distal
for BP less than 85 tubules, thus increasing
Side Effects/ Indication/ Nursing Responsibilities
Adverse Effects Contraindication
 low blood INDICATIONS:  Assess patient’s nderlying condition
pressure, before starting theraphy.
Edema due to cardiac,
 dehydration and hepatic & renal disease,  Monitor for renal cardiac,neurologic,
electrolyte burns; mild to moderate GI manifestations of hypokalemia.
depletion (for HTN, hypertensive
crisis, acute heart failure,  Monitor for CNS, GI, cardiovascular,
example, sodium,
reduced urinary output integumentarym neurologic
potassium).
due to gestoses, chronic manifestations of jypocalcemia,
 jaundice, renal failure, nephrotic  Monitor for CNS, hyperactive reflexes,
 ringing in the ears syndrome. depressed cardiac output,nausea,
(tinnitus), vomiting, tachycardia
 sensitivity to light  Assess fluid volume status(urine,color,
CONTRADICTIONS:
(photophobia), quality and specific gravity)
Anuria; hepatic coma &
 rash,  Assess patient tinnitus, or pain
precoma; severe
 pancreatitis, hypokalemia &/or
hyponatremia;
 nausea, hypovolemia w/ or w/o
 diarrhea, hypotension.
Hypersensitivity to
 abdominal pain, sulfonamides.
and dizziness.
 systolic the loss of potassium and Increased blood
hydrogen ions. sugar and uric acid
levels
Route:
IV Push

Drug Drug Action Side effect Contra-indication Nursing Responsibilities

Name
 Contraindication:
Sodium Increases plasma bicarbonate, Treatment of metabolic Hypoventilation,  Obtain patient history including
neutralizes gastric acid which acidosis, promotion of hypocalcemia, increase serum drug history and any
Bicarbonate forms water, sodium chloride, gastric, systemic and osmolarity, further in all
carbon dioxide, and raises urine alkalinization in situations where sodium intake hypersensitivity.
Classification blood pH. the case of intoxication must be restricted like cardiac  Assess respiratory and pulse rate,
with weak organic insufficiency, edema
Fluids, acids. hypertension, eclampsia, severe rhythm, depth, lung sounds and
Electrolyte, kidney insufficiency. notify the physician.
Blood Products, Indication:
And Treatment of metabolic  Assess for carbon dioxide in GI
Hematological acidosis, promotion of gastric, tract, may lead to perforation if
Drugs systemic and urine
alkalinization in the case of ulcer is severe.
Route:Ora intoxication with weak organic  Test and monitor urine pH, urinary
acids.
output, during beginning treatment.
 If patient has edematous tendency,
notify physician.
 If patient is vomiting withhold
medication and immediately inform
the physician.
 If the patient exhibits shortness of
breath and hyperpnea, immediately
 inform the physician.
 Inform physician if relief is not
obtained or if the patient
demonstrate any symptoms suggest
bleeding, such as black tarry stools
or coffee ground emesis.
 Caution patient to immediately
report to physician if symptoms
such as nausea, vomiting and
anorexia occurs.
 Advise the patient to notify the
physician if indigestion is
accompanied by chest pain,
dyspnea, diarrhea.
Generic Name Indication/ Mechanisms Adverse/ Side Effects Indications Nursing Responsibilities
Of Drug Action Drug Interactions

Generic: Mechanism of Action: Adverse Reaction Indications: ASSESSMENT

Paracetamol Paracetamol may cause Hematologic: Temporary relief of pain 1. Assess patient’s pain or temperature before
analgesia by inhibiting hemolytic anemia, and discomfort from therapy and regularly thereafter.
Give 1 tab by CNS prostaglandin leukopenia, neutropenia, headache, fever, cold, flu, (Student’s Drug Handbook, 2009: 101)
mouth 3x a day. synthesis. The pancytopenia, minor muscular aches,
mechanism of morphine thrombocytopenia. overexertion, menstrual 2, Asses patient’s drug history and calculate
Classification: is believed to involve Hepatic: cramps, toothache, minor total daily dosage accordingly.
Analgesics decreased permeability liver damage, jaundice arthritic pain. (Student’s Drug Handbook, 2009: 101)
( Non-opioid) of the cell membrane to Metabolic:
Antipyretics sodium, which results in hypoglycemia 3. Be alert for signs of reactions
diminished transmission Skin: rash, urticuria and drug interactions. (Student’s Drug
of pain impulses Handbook, 2009: 101)
therefore analgesia. Interactions:
Barbiturates, 4. Assess patient’s and family’s knowledge of
carbamapezine, drug therapy.
hydantoins, isoniazid, (Student’s Drug Handbook, 2009: 101)
rifampin,
sulfinpyrazone: May NURSING DIAGNOSES
reduce therapeutic effect • Acute pain related to patient’s underlying
and enhance hepatotoxic condition.
effects of • Risk for injury related to drug-induced liver
acetaminophen with damage with toxic doses.
high doses or long-term • Deficient knowledge related to drug therapy.
use of these drugs.
Avoid use together.
Lamotrigine: Serum
lamotrigine
concentrations may be
reduced and may
decrease therapeutic
effects.
Warfarin: May increase
hypoprothrombin-emic
effect with long-term
use of high doses.
Monitor PT and INR
closely.
Zidovudine: May
increase risk of bone
marrow suppression
because of impaired
zidovudine metabolism.
Monitor patient closely.
NAME OF DRUG MECHANISM OF SIDE/ADVERSE CONTRAINDICATIONS NURSING
ACTION EFFECT RESPONSIBILITIES
Generic name: Inhibits bacterial DNA CNS: Seizures, Contraindicated in -Assess for infection prior
Ciprofloxacin synthesis by inhibiting dizziness, drowsiness, hypersensitivity, cross-sensitivity to and during therapy.
DNA gyrase. headache, insomnia, acute among agents may occur.
psychoses, agitation, -Obtain specimens for
Classification: Therapeutic Effects: confusion, hallucinations, Use cautiously in underlying culture and sensitivity
Anti-infectives Death of susceptible increased intracranial CNS pathology, renal before initiating therapy.
bacteria. pressure, tremors. impairment, cirrhosis. First dose may be given
Antibiotic Class: GI: pseudomembranous Indications: before receiving results. To
Fluoroquinolones Spectrum: Broad activity colitis, abdominal pain, Ciprofloxacin is used to treat prevent development of
includes many diarrhea, nausea, altered infections of the skin, lungs, resistant bacteria, therapy
gram-positive pathogens. taste airways, bones, and joints caused should only be used to treat
GU: interstitial cystitis, by susceptible bacteria. infections that are proven
vaginitis or strongly suspected to be
Derm: rash It is also frequently used to treat caused by susceptible
Endo: hyperglycemia, urinary infections caused by bacteria.
hypoglycaemia bacteria such as E. coli.
Local: phlebitis at IV site -Observe for signs and
MS: tendinitis, tendon It is effective in treating symptoms of anaphylaxis
rupture infectious diarrheas caused by E. (rash, pruritus, laryngeal
Misc: hypersensitivity coli, Campylobacter jejuni, and edema, wheezing).
reactions including Shigella bacteria Discontinue drug and
anaphylaxis, notify physician
Stevens-Johnson immediately if these
syndrome, problems occur. Keep
lymphadenopathy epinephrine and
resuscitation equipment
close by in case of an
anaphylactic reaction.

-Encourage patient to
maintain a fluid intake of at
least 1500-2000 ml/day to
prevent crystalluria.

-Advise patients that

antacids or medications
containing iron or zinc will
decrease absorption and
should not be taken.

-Caution patient that this

may cause dizziness and
drowsiness
 MECHANISM OF SIDE/ADVERSE
DRUG NAME CONTRAINDICATION NURSING RESPONSIBILITIES
ACTION EFFECTS

GENERIC NAME: It is similar to CNS: headache, Hypersensitivity to - Obtain history of hypersensitivity to

Piperacillin / that of other insomnia, fever penicillins, cephalosphorins, penicillins, cephalosphorins, or other
Tazobactam penicillins. Interfere or other drugs. Safety in drugs prior to administration,
with bacterial cell GI: diarrhea, nausea, children < 12 years old,
wall synthesis constipation, vomiting, pregnancy, lactation. - Obtain specimen for culture and
promotes loss of pseudomembranous Indications: sensitivity prior to first dose of the drug;
CLASSIFICATION: membrane integrity colitis Treatment of moderate to start drug pending results. Periodic CBC
Antiinfective; and leads to death of severe appendicitis, with differential, platelet count, Hgb &
Beta-lactam the organism. SKIN: hypersensitivity uncomplicated and Hgt, and serum electrolytes.
antibiotic; reactions ,rash, pruritus complicated skin and skin - Monitor for hypersensitivity
Anti-pseudomonal structure infections, response; discontinue drug and notify
penicillin nosocomial or physician if allergic response noted.
community-acquired - Monitor for hemorrhagic
pneumonia caused manifestations because high dose may
piperacillin-resistant, induce coagulation abnormalities.
piperacillin/tazobactam
- Instruct family/significant others to
 NAME OF DRUG MECHANISM OF
ACTION
TRANEXAMIC ACID Tranexamic acid is a
Anti-fibrinolytic, synthetic derivative of the
antihemorrhagic amino acid lysine. It exerts
its antifibrinolytic effect
through the reversible
blockade of lysine-binding
sites on plasminogen
molecules. Anti-fibrinolytic
drug inhibits endometrial
plasminogen activator and
thus prevents fibrinolysis
and the breakdown of blood
clots. The
plasminogen-plasmin
enzyme system is known to
cause coagulation defects
ADVERSE/SIDE susceptible, CONTRAINDICATION report significant, unexplained
NURSING diarrhea.
EFFECT beta-lactamase-producing - RESPONSIBILITIES
Monitor vital signs because of
 Renal function
bacteria. cardiac arrhythmias, hypertension and
impairment (medica  Allergic reaction adverse reactions.
fevertoasthe Unusual change in
tion may accumulate; -
drug or hypersensitivity
Instruct the bleeding
mother notpattern should
to breast feed
 Presence of blood clots be immediately reported
dosage adjustment the baby while taking the drug without
based on the degree (eg, in the leg, lung, physician.
consulting to the physician.
of impairment is eye, brain), have a  For women who are
recommended) history of blood clots, taking Tranexamic acid
 Hematuria of upper or are at risk for blood to control heavy
urinary tract clots bleeding, the medication
origin (risk of  Current administration should only be taken
intrarenal obstruction of factor IX complex during the menstrual
concentrates or period.
secondary to clot
retention in the renal anti-inhibitor coagulant  Tranexamic Acid should
pelvis and ureters if concentrates be used with extreme
hematuria is massive; Indication: caution in CHILDREN
 Treating heavy menstrual
through lytic activity on
fibrinogen, fibrin and other
clotting factors. By
inhibiting the action of
plasmin (finronolysin) the
anti-fibrinolytic agents
reduce excessive
breakdown of fibrin and
effect physiological
hemostasis
also, if hematuria is bleeding younger than 18 years
associated with a  Hemorrhage following old; safety and
disease of the renal dental and/or oral surgery effectiveness in these
parenchyma, in patients children have not been
intravascular with hemophilia confirmed.
precipitation of fibrin  Management of  The medication can be
may occur and hemophilic patients taken with or without
exacerbate the (those having Factor VIII meals.
disease) or Factor IX deficiency)  Swallow Tranexamic
who have oral mucosal Acid whole with plenty
bleeding, or are of liquids. Do not break,
undergoing tooth crush, or chew before
extraction or other oral swallowing.
surgical procedures.  If you miss a dose of
 Surgical: General surgical Tranexamic Acid, take it
cases but most especially when you remember,
operative procedures on then take your next dose
the prostate, uterus, at least 6 hours later. Do
thyroid, lungs, heart, not take 2 doses at once.
ovaries, adrenals,  Inform the client that
kidneys, brain, tonsils, he/she should inform the
lymph nodes and soft physician immediately if
tissues. the following severe side
 Medical: epistaxis, effects occur:
hemoptysis,
hematuria, peptic
 ulcer with hemorrhage
and blood dyscrasias with
hemorrhage
 Effective in promoting
hemostasis in traumatic
injuries.