Case pres drugs.docx

8/14/2019 Case pres drugs.docx

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Drug Pharmacologic

actionIndication Contraindication Side effect Nursing responsibility

Classification:

Antipyretic Analgesic

(nonopioid)

Anti-inflammatory Antirheumatic Antiplatelet Salicylate NSAIDName:Aspirin

Dosage:

ADULTS

Minor aches andpains: 325650

mg q 4 hr.

Arthritis andrheumatic

conditions: 3.26g/day in divided

doses.

Acute rheumaticfever: 58 g/day;

Analgesic andantirheumatic

effects are

attributable to

aspirins ability to

inhibit the

synthesis of

prostaglandins,

important

mediators of

inflammation.Antipyretic effects

are not fully

understood, but

aspirin probably

acts in the

thermoregulatory

center of the

hypothalamus to

block effects of

endogenous

pyrogen by

inhibiting

synthesis of the

prostaglandin

Mild to moderatepain

Fever Inflammatory

conditions

rheumatic fever,

rheumatoid

arthritis,

osteoarthritis

Reduction of riskof recurrent TIAs

or stroke in males

with history of TIA

due to fibrin

platelet emboli

Reduction of riskof death or

nonfatal MI in

patients with

history of

infarction or

unstable angina

pectoris

Contraindicatedwith allergy to

salicylates or

NSAIDs (more

common with nasal

polyps, asthma,

chronic urticaria);

allergy to tartrazine

(cross-sensitivity to

aspirin is common);

hemophilia,bleeding ulcers,

hemorrhagic states,

blood coagulation

defects,

hypoprothrombine

mia, vitamin K

deficiency

(increased risk of

bleeding)

Use cautiously withimpaired renal

function;

chickenpox,

Nausea, GIupset, heartburn

(take drug with

food); easy

bruising, gum

bleeding (related

to aspirins

effects on blood

clotting).

Report ringing inthe ears;

dizziness,

confusion;

abdominal pain;

rapid or difficult

breathing;

nausea,

vomiting, bloody

stools.

BLACK BOXWARNING: Do not use

in children and

teenagers to treat

chickenpox or flu

symptoms without

review for Reyes

syndrome, a rare but

fatal disorder.

Give drug with food orafter meals if GI upsetoccurs.

Give drug with full glassof water to reduce risk

of tablet or capsule

lodging in the

esophagus.

Do not crush, andensure that patient does

not chew SRpreparations.

Do not use aspirin thathas a strong vinegar-

like odor.


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modify to maintain

serum salicylate

level of 1530

mg/dL.

TIAs in men:1,300mg/day in divided

doses (650 mg bid

or 325 mg qid).

MIprophylaxis: 75

325 mg/day.

intermediary.

Inhibition of

platelet

aggregation is

attributable to theinhibition of

platelet synthesis

of thromboxane

A2, a potent

vasoconstrictor

and inducer of

platelet

aggregation. This

effect occurs at

low doses and

lasts for the life of

the platelet (8

days). Higher

doses inhibit the

synthesis of

prostacyclin, a

potent vasodilator

and inhibitor of

platelet

aggregation.

MI prophylaxis Unlabeled use:

Prophylaxis

against cataract

formation with

long-term use

influenza (risk of

Reyes syndrome in

children and

teenagers);

children with feveraccompanied by

dehydration;

surgery scheduled

within 1 wk;

pregnancy

(maternal anemia,

antepartal and

postpartal

hemorrhage,

prolonged

gestation, and

prolonged labor

have been

reported; readily

crosses the

placenta; possibly

teratogenic;

maternal ingestion

of aspirin during

late pregnancy has

been associated

with the following

adverse fetal

WARNING: Instituteemergency procedures

if overdose occurs:

Gastric lavage,

induction of emesis,activated charcoal,

supportive therapy.

Take extra precautionsto keep this drug out of

the reach of children;

this drug can be very

dangerous for children.

Use the drug only assuggested; avoidoverdose. Avoid the use

of other over-the-

counter drugs while

taking this drug. Many

of these drugs contain

aspirin, and serious

overdose can occur.

Take the drug with foodor after meals if GI

upset occurs.

Do not cut, crush, orchew sustained-release

products.


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effects: low birth

weight, increased

intracranial

hemorrhage,

stillbirths, neonataldeath); lactation.

Over-the-counteraspirins are equivalent.

Price does not reflect

effectiveness.

Drug Pharmacologic action Indication Contraindication Side effect Nursingresponsibility

Classification:

Adenosinediphosphate

(ADP) receptorantagonist

AntiplateletGeneric name:Clopidogrel

Brand Name:Plavix

Dosages:

ADULTS

Recent MI, stroke, or

established peripheral

arterial disease:75 mg

PO daily.

Acute coronary

Inhibits plateletaggregation byblocking ADP receptorson platelets, preventingclumping of platelets.

Treatment ofpatients at risk for

ischemic events

history of MI,

ischemic stroke,

peripheral artery

disease

Treatment ofpatients with acute

coronary syndrome

Contraindicatedwith allergy

to clopidogrel,

active pathological

bleeding such as

peptic ulcer or

intracranial

hemorrhage,

lactation.

Use cautiously withbleeding disorders,

recent surgery,

hepatic impairment,

pregnancy.

Dizziness, light-headedness (this

may pass as you

adjust to the drug);

headache (lie down

in a cool

environment and

rest; OTC

preparations may

help); nausea,

gastric distress (eat

frequent small

meals); prolonged

bleeding (alert

doctors, dentists of

this drug use).

Report skin rash,chest pain, fainting,

Provide small,frequent meals if GI

upset occurs (not

as common as with

aspirin).

Provide comfortmeasures and

arrange for

analgesics if

headache occurs.


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syndrome:300 mg PO

loading dose, then 75

mg/day PO with

aspirin, given at a dose

from 75325 mg oncedaily

severe headache,

abnormal bleeding.

Drug Pharmacologic action

Indication Contraindication Side effect Nursing responsibility

Classification:-Anticoagulant-Low MolecularWeight Heparin

GENERIC NAME:enoxaparin

BRAND NAME:Lovenox

Dosage:- DVT

prophylaxis:30 mgsubcutaneously bidwith initial dose soonas possible aftersurgery, not more

than 24 hr aftersurgery. Continue throughout thepostoperative periodfor 710 days; then40 mg dailysubcutaneously for

Low-molecular-weightheparin thatinhibitsthrombusand clotformationby blockingfactor Xa,factor IIa,preventingtheformation ofclots.

Prevention ofDVT, which maylead to pulmonaryembolism followinghip replacement,knee replacementsurgery, abdominalsurgery

Prevention ofischemiccomplications ofunstable anginaand nonQ-waveMI

Treatment of DVT,pulmonary emboluswith warfarin

Prevention of DVT

in medical patientswho are at riskfor thromboemboliccomplications dueto severelyrestricted mobilityduring acute

Contraindicatedwithhypersensitivityto enoxaparin,heparin,porkproducts;severethrombocytopenia;uncontrolledbleeding.

Usecautiously

withpregnancy orlactation,history ofGI bleed,spinal

bleeding.Fever,nausea,diarrhea, and fluidretention are common.Less commonly,enoxaparin caninduceabnormal livertests in the blood,suggesting mild damageto the liver, and areduction in bloodplatelets and red bloodcells. Mild local irritation,pain,hematoma,ecchymosis, anderythema may occur atthe site of injection.Hypersensitivity reactionsalso may occur.

- Give drug as soon as possibleafter hip surgery, within 12 hr ofknee surgery, and within 2hr preoperatively for abdominalsurgery.- Give deep subcutaneousinjections; do notgive enoxaparin by IM injection.- Administer by deep subcutaneousinjection; patient should be lyingdown. Alternate between the leftandright anterolateral and posterolateral abdominal wall. Introduce thewhole length of the needle into askin fold held between the thumband forefinger; hold the skin foldthroughout the injection.

-Apply pressure to all injection

sites after needle is withdrawn;inspect injection sites for signsof hematoma; do not massageinjection sites.- Do not mix with other injectionsor infusions.
http://www.medicinenet.com/script/main/art.asp?articlekey=361http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=6274http://www.medicinenet.com/script/main/art.asp?articlekey=6274http://www.medicinenet.com/script/main/art.asp?articlekey=104680http://www.medicinenet.com/script/main/art.asp?articlekey=104680http://www.medicinenet.com/script/main/art.asp?articlekey=6274http://www.medicinenet.com/script/main/art.asp?articlekey=6274http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=361


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up to 3 wk may beused.-Patients undergoingabdominalsurgery:40 mg/daysubcutaneously

begun within 2hr preoperatively andcontinued for 710days.-Outpatient DVTtreatment:1 mg/kgsubcutaneously q 12hr.-Unstable angina andnonQ-wave MI:1mg/kgsubcutaneously q 12hr for 28 days.

-Inpatient DVTtreatment:1.5 mg/kgsubcutaneously oncedaily.-Prevention of DVT inhigh-risk medical

patients:40 mg/daysubcutaneously for611 days, has beenused up to 14 days.

illnesses tap,spinal/epiduralanesthesia

- Store at room temperature; fluidshould be clear, colorless to paleyellow.- Provide for safety measures(electric razor, soft toothbrush) toprevent injury to patient who is at

risk for bleeding.- Check patient for signs ofbleeding; monitor blood tests.- Alert all health care providers thatpatient is on enoxaparin.- Discontinue and initiateappropriate therapyif thromboembolic episode occursdespite enoxaparin therapy.

.

Drug Pharmacologic action Indication Contraindication Side effect Nursingresponsibility

Classification:Beta- adrenergic

Unknown. A selectivebeta blocker that

HypertensionAcute MI

-Hypersensitive todrug.

-CV: hypotension-GI: nausea and

-Always check patientsapical pulse


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blocking agents

GENERIC NAME:Metoprolol HCL

BRAND NAME:

Lopressor

selectively blocksbeta1 receptors;decreases cardiacoutput, peripheralresistance, and cardiacoxygen consumption;

and depresses renninsecretion

AnginaPectoris

-Patient with sinusbradycardia,-cardiogenic shockand heart failure

vomiting-Respi: dyspnea-Skin: rash

-Monitor BP-Store drug at roomtemperature.-Inform patient aboutthe side effects andadverse effects of the

medication.-Advise patient to takeit with meals.-Tell patient to report ifhe/she feels shortnessof breath.-Tell patientThat metoprolol is notadvisable tobreastfeeding mothers.-Advise not towithdrawn drugabruptly

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