CITICOLINE

Generic Name: Citicoline Brand Name: Nicholin, Somazine, 5-Cytidine diphosphate choline, CDPC, CDP Choline, CDPCholine, Citicholine, Citicolina, Cytidine 5-Diphosphocholine, Cytidine 5-diphosphocholine, Cytidine (5) diphosphocholine Classification: Neurotonics, Nootropics Mechanism of Action Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.It is usually known that phospholipid, especially lecithin, decreases following decline in brain activity with cerebral trauma. Citicoline, which is a co-enzyme, accelerates the biosynthesis of lecithin in the body. This medication enhances the action of the brain stem ciliary body especially the ascending ciliary body activating system, which is closely related to consciousness, but does not exert effort on the extrapyramidal system. Citicoline increases cerebral blood flow and oxygen consumption of the brain and improves cerebral circulation and metabolism. Scientific research demonstrates that Citicoline consumption promotes brain metabolism by enhancing the synthesis of acetyl-choline, restoring phospholipid content in the brain and affecting neuron membrane excitability and osmosis (by its effect on the ATP-dependent sodium and potassium pump). When taken orally, its two main components, Cytidine and Choline are absorbed into the bloodstream. Citicoline is also believed to protect nerve cells when in low oxygen conditions. Citicoline may be used for nutritional support in cerebral vascular disease, head trauma, stroke, and cognitive disorders. It also is used by those who have age related mental decline, such as Alzheimers and Parkinsons. Indication

Parkinsons disease Head injury Cerebral vascular disease Alzheimers disease Cerebral surgery or acute cerebral disturbance Disturbance of consciousness following brain surgery

Dose, Route, Frequency :1gm IVTT q12hr Side Effects Citicoline seems to be safe when taken short-term (up to 90 days). The safety of long-term use is not known. Most people who take citicoline dont experience problematic side effects. However, these are the common side effects reported by some patients:

Body temperature elevation Restlessness Headaches Nausea and vomiting Diarrhea Low or high blood pressure Tachycardia

Sleeping troubles or insomnia Blurred vision Chest pains Citicoline may be taken with or without food. Take it with or between meals. The supplement should not be taken in the late afternoon or at night because it can cause difficulty sleeping. Women who are pregnant or trying to become pregnant should consult with their doctor before taking the supplements. Not enough is known about the use of Citicoline during pregnancy and breast-feeding. Stay on the safe side and avoid use. Special attention should be paid for administration in the neonate, premature and children. Contact the physician immediately if allergic reaction such as hives, rash, or itching, swelling in your face or hands, mouth or throat, chest tightness or trouble breathing are experienced. 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.

Nursing Management

OMEPRAZOLE
GENERIC NAME: OMEPRAZOLE BRAND NAME: Prilosec, Zegerid DRUG CLASS : Proton pump inhibitors (PPI) that block the production of acid by the stomach. MECHANISM OF ACTION : Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Zegerid contains omeprazole and an antacid (sodium bicarbonate). The FDA approved omeprazole in September 1989. DOSE, ROUTE, FREQUENCY :40mg IVTT (start of admission) DRUG INTERACTIONS: Omeprazole potentially can increase the concentrations in blood of diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin) by decreasing the elimination of these drugs by the liver. The absorption of certain drugs may be affected by stomach acidity. Therefore, omeprazole as well as other PPIs reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may reduce the effectiveness of ketoconazole or increase digoxin toxicity. SIDE EFFECTS: Omeprazole like other PPIs is well-tolerated. The most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps, and water retention occur infrequently. Each packet of Zegerid powder for oral suspension contains 460 mg of sodium and each capsule contains 304 mg of sodium. This should be taken into consideration in patients who need a

sodium restricted diet. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated. USES: Omeprazole is used to treat certain stomach and esophagus problems (such as acid reflux, ulcers). It works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn, difficulty swallowing, and persistent cough. This medication helps heal acid damage to the stomach and esophagus, helps prevent ulcers, and may help prevent cancer of the esophagus. Omeprazole belongs to a class of drugs known as proton pump inhibitors (PPIs).If you are self-treating with this medication, over-the-counter omeprazole products are used to treat frequent heartburn (occurring 2 or more days a week). Since it may take 1 to 4 days to have full effect, these products do not relieve heartburn right away.For over-the-counter products, carefully read the package instructions to make sure the product is right for you. Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar brand names may contain different ingredients meant for different purposes. Taking the wrong product could harm you.

SENNA CONCENTRATE
Generic name: standardized senna concentrate Brand name: Senokot 187 mg Tablet/ granules Category: laxative Dose, Route, Frequency : 2tab od qh.s. Mechanism of action: Senokot preparations contain glycosides (the natural principles of senna) which, upon ingestion, exert no action in the stomach or small intestine. In the colon, according to current theory, enzymatic action converts the inactive glycosides into active aglycones which act specifically in the large bowel through the auerbachs plexus to stimulate peristalsis. Virtually Free from side effects: The action of Senoko tablets and granules is virtually limited to the colon. In proper dosage, there is usually no intestinal turmoil, cramping, or gripping that occur with orindary laxatives and harsh purgatives.

ENALAPRIL
GENERIC NAME: Enalapril BRAND NAME: Vasotec Dose, Route, Frequency: 5mg 1 tab od DRUG CLASS AND MECHANISM: Enalapril is a drug that is used for treating high blood pressure. It is in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE is an enzyme in the body that causes the formation of angiotensin II. Angiotensin II causes the arteries in the body to narrow, thereby elevating blood pressure. ACE inhibitors, such as enalapril, lower blood pressure by preventing the formation of angiotensin II thereby relaxing

the arteries. ACE inhibitors also improve the effectiveness of the heart in patients with heart failure by reducing the blood pressure that the heart must maintain. Enalapril was approved by the FDA in December, 1985. Dose, Route, Frequency : 5mg 1 tab od PRESCRIBED FOR: Enalapril is used alone or in combination with other drugs to treat high blood pressure or congestive heart failure. After a heart attack, enalapril has been found to be effective in improving function of the damaged heart and in reducing symptoms and hospitalizations related to heart failure. SIDE EFFECTS: Enalapril is generally well tolerated, and side effects usually are mild and transient. A dry, persistent cough has been reported with the use of ACE inhibitors. Coughing resolves after discontinuing the medication. Other side effects include abdominal pain, diarrhea, dizziness, fatigue, headache, loss of appetite, nausea and vomiting, chest pain, dizziness or fainting, numbness or tingling in the hands or feet, rash, and a sore or swollen throat. In rare instances, liver dysfunction and skin yellowing (jaundice) have been reported with ACE inhibitors. In susceptible individuals ACE inhibitors may reduce kidney function. USES: This drug belongs to a group of medications called ACE inhibitors. It is used to treat high blood pressure (hypertension) in adults and children. It works by relaxing blood vessels, causing them to widen. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.This medication is also used with other drugs (e.g., "water pills"/diuretics, digoxin) to treat congestive heart failure.OTHER This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.This medication may also be used to help protect the kidneys from damage due to diabetes.

NCP

NCP: Impaired Physical Mobility r/t neuromuscular impairment as evidenced by difficulty with purposeful movement

Subjective: di jud xa makalakaw, iyang liog maglisod og lingilingi, og sauna magtakilid na xa matog karon maghayang na kay maglisod as verbalized by da SO Objectives: Weak motor movements on both upper and lower extremities. Limited range of motion Difficulty turning Difficulty in turning his head from side to sides He was not able to shrug his shoulders

Diagnosis
Impaired Physical Mobility related to neuromuscular impairment as evidenced by difficulty with purposeful movement.

Objectives
At the end of our 3 days span of care, our patient will be able to increase strength function of affected compensatory body part and demonstrate participation of activites

Interventions
1.) Instruct/assist patient with exercise program and use of mobility aids. Increase in self-care as tolerated. R: lengthy convalescence often follows brain injury, and physical

reconditioning is an essential part of the program 2.) Position patient to avoid skin/ tissue pressure damage. Turn at regular intervals, and make small position changes between turn. R: regular turning more normally distributes body weight and promotes circulation to all areas. 3.) Maintain functional body alignment e.g hips, feet, hands. Monitor for proper placement of devices and or signs of pressure from devices. R: handsplints are variable and designed to prevent hand deformities and promote optimal function. Use of pillows, bedrolls, sandbags can help prevent abnormal hip rotation 4.) Change positions at least every 2 hour (supine, sidelying) and possibly more often if placed on affected side R: reduces risk of tissue ischemia/ injury. Affected side has poorer circulation and reduced sensation and is more predisposed to skin breakdown. 5.) Position in prone position once or twice a day if patient can tolerate. R: helps maintain functional hip extension; however, may increase anxiety especially about ability to breathe. 6.) Observe affected side for color, edema, or other signs of compromised circulation R: Edematus tissue is more easily traumatized and heals more slowly. 7.) Inspect skin regularly, particularly over bony prominences. Gently massage any rebbened areas and provide aids such as sheepskin pads as necessary R: pressure prints over bony prominences are most at risk for decrease perfusion/ ischemia. Circulatory stimulation and

padding help prevent skin breakdown. 8.) Perform passive range of motion R: To allow stasis. muscular and joint movements thus decreasing

Evaluation
After 3 days span of our duty, our patient was able to increase strength function of affected body part. Demonstrate participation in activities, obey verbal command like raise leg and rotate his arm