Chapter 3

Implementation
A. Drug Study

Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Meropenem Carbapenem Meropenem is a Hypersensitivity to CNS: seizures, headache. 1) Monitor periodically liver and
CV: phlebitis,
Antibiotic synthetic carbapenem meropenem, other kidney function, especially seizures
thrombophlebitis,
β-lactam antibiotic that carbapenems. History peripheral vascular in older adults and those with renal
exerts its bactericidal of anaphylactic reaction disorder. insufficiency.
Brand Name Indication
EENT: oral candiasis,
activity by inhibiting to β-lactams (e.g. 2) Determine history of
glossitis.
Merrem Complicated skin bacterial cell wall penicillins, GI: clostridium difficile- hypersensitivity reactions to other

& skin structure synthesis in gm+ve and cephalosporins). associated diarrhea, beta-lactams, cephalosporins,
constipation, diarrhea,
infections gm-ve bacteria through penicillins, or other drugs.
glossitis, nausea, vomiting
binding to several GU: RBCs in urine 3) Discontinue drug and immediately
penicillin-binding Hematologic: anemia report S&S of hypersensitivity.
proteins (PBPs). Resp.: apnea, pneumonia 4) Report S&S of superinfection or
Skin: injection-site
Frequency, Dose and inflammation, pruritis, rash pseudomembranous colitis.
Route Other: anaphylaxis, .
1g/vial, IV, q8 sepsis, hypersensitivity
reactions, inflammation,
pain.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Esomeprazole Proton Pump Suppresses gastric acid Contraindicated with CNS: Headache, vertigo, 1) Assess for hypersensitivity to any
Inhibitor secretion by specific hypersensitivity to Dizziness, insomnia, proton pump inhibitor or hepatic
inhibition of the omeprazole, apathy, anxiety, impairment.
Brand Name Indication hydrogen potassium esomeprazole, or other paresthesias, dream 2) Obtain baseline liver function
ATPase enzyme proton pump inhibitors. abnormalities Respiratory: tests and monitor periodically during

S-Omipin - Short-term system at the secretory Use cautiously with URI symptoms Sinusitis the course of therapy.

treatment for surface of the gastric hepatic dysfunction, Cough, epistaxis 3) Instruct patient to take drug at

erosive parietal cells; blocks the pregnancy, and Dermatologic: Rash, least 1 hr before meals.

esophagitis final step of the acid lactation. inflammation Urticaria, 4) Monitor for severe headache,

- Treatment of production. pruritus Alopecia, dry skin worsening of symptoms, fever, chills,

GERD Frequency, Dose and GI: Diarrhea, nausea, darkening of the skin, changes in
Route abdominal pain, vomiting, color of urine or stool.
40 mg/vial, IV, OD constipation, dry mouth, 5) For GI symptoms such as nausea
tongue atrophy, flatulence and vomiting, instruct patient to have
small, frequent meals.
6) Instruct patient to limit activities to
those that do not require alertness
and precision as the drug may cause
vertigo and dizziness.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Sodium Electrolyte Sodium chloride is the Conditions whereby CNS: reduced salivation 1) Monitor electrolytes, ECG, liver
major extracellular
Chloride admin of sodium and lachrymation, fever, and renal function studies.
cation. It is important in
electrolyte and fluid chloride would be headache, dizziness, 2) Note LOC
balance, osmotic detrimental. Not to be restlessness, irritability and 3) Assess heart and lung sounds.
Brand Name Indication
pressure control and
used to induce emesis. weakness 4) Observe S&Sx of hypernatremia,
water distribution as it
Rhea Sodium Fluid end restores sodium ions. It Sustained release Hematologic: flushed skin, elevated temperature,

Chloride electrolyte is used as a source of tablets: GI disorders tachycardia, hypertension rough dry tongue, and edema.
electrolytes and water
replacement in associated with Other: hypernatremia, 5) Monitor V/S and I&O.
for hydration, treatment
hyponatremia of metabolic acidosis, strictures or diverticula. thirst 6) Assess urine specific gravity and
priming solution in serum sodium levels.
haemodialysis and
Prophylaxis of
treatment of
muscle hyperosmolar diabetes.
cramps during Frequency, Dose and
routine Route
haemodialysis
1g/tab, TID, NGT
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Essentiale Forte Hepatic Works by improving the Hypersensitivity to any In very rare cases it can 1) Do not use essentiale in
protectors synthesization of liver components of the cause: Abdominal pain, hypersentive or pt’s allergic to any of
phospholipids, drug. nausea, diarrhea and the ingredients of the drug.
Brand Name Indication promotes cell Newborns and allergic reaction (skin 2) Check the medication sheet and
membrane prematurely born rash). the doctor’s order before medicating.

sanofi-aventis Nutritional regeneration, children. 3) Secure a copy of the client’s

support in the reactivates different history to drug interactions and

management of enzyme systems and allergies.

damaged liver receptors, increases 4) Provide enough knowledge to the

(chronic disease, detoxification ability of patient of what drug he/she would be

liver cirrhosis, the liver and through taking and what are the expected

fatty liver and that mechanism therapeutic and side effects.

intoxication of normalizes liver 5) Monitor V/S after administration of

hepatotoxic function. medication and observe for adverse

substances). Frequency, Dose and reactions

Route

300 mg/tab, NGT, BID

 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Albumin 25% Plasma Volume It is osmotically Hypersensitivity to Mild reactions such as 1) Monitor BP, pulse and respiration,
Expander equivalent to an equal albumin preparations or flush, urticaria, fever, and and IV albumin flow rate. Adjust flow
volume of normal to any of the excipients. nausea occur rarely. These rate as needed.
Brand Name Indication human plasma and will reactions normally 2) Lad tests: Monitor dosage of
increase circulating disappear rapidly when the albumin using plasma albumin

Albunorm Restoration & plasma volume by an infusion rate is slowed (normal: 3.5-5 g/dL); total serum

maintenance of amount approximately down or the infusion is protein (normal: 6-8.4 g/dL); Hgb;

circulating blood equal to the volume stopped. Very rarely, Hct; and serum electrolytes.

vol where vol infused. It provides severe reactions such as 3) Observe closely for S&Sx of

deficiency has colloidal oncotic shock may occur. In case circulatory overload and pulmonary

been pressure, which serves of severe reactions, the edema. If S&Sx appear, slow

demonstrated & to mobilize fluid from infusion should be stopped infusion rate just sufficiently to keep

use of a colloid is extravascular tissues and an appropriate vein open, and report immediately to

appropriate. back into the treatment should be physician.

intravascular space initiated. 4) Observe for bleeding points that
Frequency, Dose and did not bleed at lower BP with
Route injuries or surgery and as BP rises.
5) Monitor I&O ratio and pattern.
250mgl/vial, IV, QD Note and report changes of urinary
output.
6) Report chills, nausea, headache,
or back pain to physician
immediately.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Phenytoin Anti-epileptic Phenytoin stabilizes Patients w/ severe CNS: headache, tremor, 1) Continuously monitor vital signs
neuronal membranes damage to the blood dizziness, insomnia, and symptoms during and after
and decreases seizure cells and bone marrow, transient nervousness. administration of drugs for an hour
Brand Name Indication activity by increasing grade II and III AV block GI disturbances: nausea, afterward.
efflux or decreasing or Stokes-Adams vomiting, constipation, gum 2) Observe patient closely for

Dilantin Epilepsy, influx of Na ions across syndrome, sick sinus tenderness and neurologic adverse effects

Seizures cell membranes in the syndrome, sinus hyperplasia, acne, 3) Reduce dosage, discontinue

associated w/ motor cortex during bradycardia, sino-atrial hirsutism, coarsening of phenytoin, or substitute other

neurosurgery generation of nerve block; w/in the first 3 the facial features. antiepileptic medication gradually;
impulses. mth after MI and in abrupt discontinuation may
Frequency, Dose and case of cardiac output Phenytoin toxicity precipitate status epilepticus.
Route failure (LVEF <35%). manifestation: Cerebellar 4) Monitor hepatic function
Concomitant use w/ syndrome, vestibular and periodically during long-term
100 mg/cap, TID, NGT delavirdine. ocular effects, nystagmus, therapy; monitor blood counts and
diplopia, slurred speech, urinalysis monthly.
ataxia, mental confusion, 5) Maintain good oral hygiene to
dyskinesia, seizure prevent gum disease
frequency exacerbation, 6) Use caution and monitor for early
hyperglycaemia. signs of toxicity; phenytoin is
metabolized in the liver.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Citicoline Neurotropic A derivative of choline History of Shock, hypersensitivity, 1) Monitor blood pressure, pulse and
and cytidine involved in hypersensitivity to hypotension, insomnia, heart rate.
the biosynthesis of citicoline sodium or to excitement. 2) Assess allergic reaction like GI
Brand Name Indication lecithin. It is claimed to any of the ingredients disturbances.
increase blood flow and of Citicoline. 3) Only give prescribed dose.

Zynapse Cerebrovascular O2 consumption in the 4) Advise relative to consult the

disorders, Head brain. In addition, physician if any problems occur to

injury, Frequency, Dose and Citicoline should not be the patient during medication.

Parkinsonism Route used if you have the 5) WOF hypotensive effects.

following conditions: 6) The supplement should not be
1 gram/tab, BID, NGT  Patients with taken in the late afternoon or at night
Hypertonic of the because it can cause difficulty
parasympathetic sleeping.
7) Citicoline therapy should be
started within 24 hours of a stroke.
The physician will prescribe the
correct dosage and the length of
time it should be taken for a medical
condition.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Clopidogrel Antiplatelet Inhibits platelet - Hypersensitivity to CNS: Confusion, fatal 1) Assess pt for symptoms of stroke,
Agents aggregation by platelet aggregation intracranial bleeding, peripheral vascular disease, or MI
irreversibly inhibiting inhibitors. hallucination periodically
the binding of ATP of - Pathologic bleeding CV: hypotension 2) Monitor pt. for signs of thrombotic
Brand Name Indication platelet receptors. (peptic ulcer, EENT: Epistaxis, rhinitis, thrombocytic purpura
Therapeutically, it intracranial taste disorder 3) If dose is missed, administer as
Plavix Prophylaxis of decreases the hemorrhage) Resp: bronchospasm, soon as possible unless almost time
thromboembolic occurrence of - Lactation interstitial pneumonitis, for next dose, do not do double
disorders atherosclerotic events resp. tract bleeding doses.
in patients at risk. Use Cautiously in: CV: Hypertension. 4) Note for the ff after administration
Acute coronary Frequency, Dose and - Patients at risk for GI: GI Bleeding, Abdominal of medication: fever, chills, unusual
syndrome Route bleeding (trauma, Pain, Diarrhea, Dyspepsia, bleeding or if bruising occurs.
surgery, or other Gastritis.
75 mg/tab, OD, NGT pathologic conditions) Skin: Pruritus, rash,
- History of GI bruising eczema.
bleeding/ulcer disease. Hemat:
- Severe hepatic Thrombotic
impairment Thrombocytopenic
Purpura.
Other: flu-like syndrome,
angioedema anaphylaxis
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Lactulose Laxative Lactulose promotes Galactosaemia, GI GI: Abdominal discomfort 1) Assess for history of allergy to
peristalsis by producing obstruction, digestive (e.g. flatulence, cramps), lactulose, low-galactose diet,
an osmotic effect in the perforation or risk of nausea and vomiting. diabetes, pregnancy, and lactation.
Brand Name Indication colon w/ resultant digestive perforation. 2) Do not freeze laxative form.
distention. In hepatic Patient on low Extremely dark or cloudy syrup may

Lilac Constipation encephalopathy, it galactose diet. be unsafe; do not use.

reduces absorption of Galactosaemia, GI 3) Give laxative syrup orally with
ammonium ions and obstruction, digestive water to increase palatability.
toxic nitrogenous perforation or risk of 4) Monitor for adverse drug effects.
compounds, resulting in digestive perforation. Report diarrhea, severe belching,
reduced blood Patient on low abdominal fullness.
ammonia galactose diet. 5) Do not administer other laxatives
concentrations. while using lactulose.
Frequency, Dose and 6) Monitor serum ammonia levels.
Route 7) Not that bowel movements will be
increased 2-3 days.
30cc syrup OD HS,
NGT
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities
CNS: vertigo, headache, 1) Monitor fluid I&O and electrolyte,
Furosemide Loop Diuretic Inhibits sodium and Contraindicated in dizziness, paresthesia, BUN, and CO2 levels frequently.
chloride reabsorption at patients hypersensitive weakness, restlessness, 2) Watch for signs of hypokalemia,
the proximal and distal to drug and those with fever. such as muscle weakness and
Brand Name Indication tubules and the anuria CV: orthostatic cramps.
ascending loop of hypotension, 3) Monitor glucose level in diabetic

Lasix Acute pulmonary Henle. Caution: Use thrombophlebitis w/ I.V. patients.

edema Frequency, Dose and cautiously in patients w/ administration. 4) Drug may not be well absorbed
Route hepatic cirrhosis and in GI: abdominal discomfort orally in patients w/ severe heart

Edema those allergic to and pain, diarrhea, failure.

20 mg/vial, with sulfonamides. anorexia, nausea, 5) Make position changes slowly

Hypertension albumin, IV vomiting, constipation, because high doses of

pancreatitis.
GU: azotemia, nocturia,
polyuria, frequent urination,
oliguria.
Hematologic: agra-
nulocytosis, aplastic
anemia, leukopenia,
thrombocytopenia anemia.
Musculoskeletal: muscle
spasm.
Skin: S-J syndrome
antihypertensive drugs taken
concurrently may produce episodes
of dizziness or imbalance.
7) Avoid replacing fluid losses with
large amounts of water.
8) Observe older adults closely
during period of brisk diuresis.
Sudden alteration in fluid and
electrolyte balance may precipitate
significant adverse reactions. Report
symptoms to physician.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Levetiracetam Anticonvulsants The exact mechanism Contraindicated in CNS: asthenia, headache, 1) Assess pt’s mental status.
of anticonvulsant effect patients hypersensitive somnolence, amnesia, 2) Assess duration, location and
is unknown. May act by to drug. anxiety, ataxia, depression, characteristics of seizure activity.
Brand Name Indication inhibiting simultaneous dizziness, emotional 3) Confirm medication from doctor’s
neuronal firing that Caution: Use lability, hostility, orders.

Keppra Adjunct in leads to seizure activity. cautiously in patients nervousness, paresthesia, 4) Monitor for changes in phenytoin

seizures Frequency, Dose and with history of pain, vertigo. blood levels with co-administered

(Monotherapy for Route psychiatric symptoms, EENT: diplopia, drugs.

partial seizures especially psychotic pharyngitis, rhinitis, 5) Monitor patients closely for such

with or without 500 mg/tab, BID, NG symptoms and sunisitis. adverse reactions dizziness, which

secondary behavior. GI: anorexia. may lead to falls.

generalization) Hematologic: leukopenia, 6) Seizures can occur if drug is

neutropenia. stopped abruptly. Tapering is
Respiratory: cough recommended.
Other: Infection. 7) Lab tests: Periodic CBC with
differential, Hct & Hgb, LFTs.
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities
Contraindicated to CNS: anxiety, fatigue,
Paracetamol Analgesic Exhibits analgesic patients with headache, insomnia, 1) Assess patient’s fever or pain:
action by peripheral hypersensitivity, pyrexia. type of pain, location, intensity,
blockage of pain intolerance to tartrazine CV: hypertension, duration, temperature, and
Brand Name Indication impulse generation. It (yellow dye #5), hypotension, peripheral diaphoresis.
produces antipyresis by alcohol, table sugar, edema, periorbital edema, 2) Assess allergic reactions: rash,

Biogesic Mild to moderate inhibiting the saccharin tachycardia (I.V.). urticaria; if these occur, drug may

pain and fever hypothalamic heat- GI: nausea, diarrhea, have to be discontinued.
regulating centre. Its Contraindicated with vomiting, abdominal pain, 3) Teach patient to recognize signs
weak anti-inflammatory allergy to diarrhea, constipation of chronic overdose: bleeding,
activity is related to acetaminophen (I.V.). bruising, malaise, fever, sore throat.
inhibition of Hematologic: hemolytic 4) Notify physician for pain/ fever
prostaglandin synthesis anemia, leukopenia, lasting for more than 3 days
in the CNS. neutropenia, pancytopenia,
Frequency, Dose and anemia (I.V.).
Route Hepatic: jaundice
Metabolic: hypoglycemia,
500 mg/tab, 1 tab, q4, hypokalemia,
NGT PRN fever hypervolemia,
hypermagnesemia,
hypophosphatemia (I.V.)
Muscu: muscle spasms,
extremity pain (I.V.)
 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Anorectal Emollient/Skin Promotes would Contraindicated w/ Skin: rash; hives; itching; 1) Cleanse the affected area with
Ointment protectives granulation and re- allergy to calmoseptine red, swollen, blistered, or mild soap and warm water and rinse
epithiliazation. peeling skin with or without thoroughly.Gently dry by patting or
Brand Name Indication CNS: fever; Respiratory: blotting with to before applying
wheezing; tightness in the ointment

Calmoseptine Protects, soothes chest or throat; trouble 2) Monitor for adverse reactions.

Ointment & helps promote Frequency, Dose and breathing, swallowing, or 3) Discontinue if site worsens or

healing in those Route talking; unusual does not improve or if bleeding

w/ impaired skin hoarseness; or swelling of occurs

integrity related BID, apply on sacral the mouth, face, lips,

to: Bed Sores area tongue, or throat.

 Drug Name Classification Mechanism of Action Contraindication Adverse Effects Nursing Responsibilities

Bisacodyl Laxative Bisacodyl stimulates Acute abdominal GI: Abdominal discomfort 1) Check for the doctor’s order
peristalsis by directly conditions (e.g. (e.g. colic, cramps), 2) Confirm patient’s identity
irritating the smooth appendicitis, intestinal diarrhoea, electrolyte 3) Assess patient for abdominal
Brand Name Indication muscle of the large inflammatory bowel disturbance, nausea, distension, presence of bowel sounds
intestine. It alters water disease), intestinal vertigo, vomiting, and usual pattern of bowel function.

Dulcolax Constipation and electrolyte obstruction, ileus, haematochezia; irritation 4) Assess color, consistency and
secretion, producing net severe dehydration, and proctitis (rectal). amount of stool produced.
interstitial fluid severe abdominal pain Rarely, hypersensitivity
accumulation and associated w/ nausea reactions (e.g.
laxation. and vomiting. Presence angioedema,
Frequency, Dose and of anal fissures or anaphylactoid reactions).
Route ulcerative colitis w/
mucosal damage
10 mg/anal suppository, (rectal).
P.R., O.D.