Drug Studies

B. Drug Study

Date ordered: February 13, 2006

1. Generic name: Ampicillin/Sulbactam

Brand name: Unasyn

Classification: Anti-infective, aminopenicillins/beta lactamase inhibitors

Dosage, Frequency, Route: 1gm IVP every 8 hours

Mechanism of action: This drug binds to bacterial cell wall, resulting in cell

death. The addition of sulbactam increases resistance to beta-lactamases,

enzymes produced by bacteria that may inactivate ampicillin.

Indication: This drug is indicated for patients after undergoing surgery to prevent

infection of skin and soft-tissue structures.

Contraindication: This drug is contraindicated to patients who are hypersensitive

to penicillins or sulbactam.

Desired effect: This drug was given to our client as prophylaxis against possible

infection.

Side effects and adverse reactions

CNS: seizures

GI: pseudomembranous colitis, diarrhea, nausea, vomiting

Derm: rashes, urticaria

Hemat: blood dyscrasias

Local: pain at IV site

Misc: allergic reactions such as anaphylaxis and serum sickness,

superinfection.

Nursing responsibilities

1. Check the doctor’s order to prevent error.

2. Observe the 10 RIGHTS in administering drug to avoid mistakes.

3. Obtain a history before initiating therapy to determine previous use of and

reactions to penicillins or cephalosporins.

4. Administer skin testing to assess if patient is sensitive to penicillin.

5. Observe patient for signs and symptoms of anaphylaxis.

6. Administer drug slowly to prevent irritation.

7. Monitor for side effects like nausea and vomiting, bleeding or bleeding gums,

blood in the stool and urine.

8. Stop drug if allergic reaction occur and notify doctor on duty.

9. Advise to increase CHON and Vitamin C on diet.

10. Instruct client to clean wound aseptically to prevent infection.

2.Generic name: Ketorolac

Brand name: Toradol

Classification: NSAID, Non-opioid analgesics

Dosage, route, frequency: 30 mg IV every 6 hours

Mechanism of action: This drug inhibits prostaglandin synthesis, producing

peripherally mediated analgesia, thus pain perception decreases.

Indication: This drug is used for a short-term management of pain.

Contraindication: This drug is contraindicated to patients who are hypersensitive

to this drug and cross-sensitive with other NSAIDs and during pre or

perioperative use. This is used cautiously in patients with a history of GI

bleeding, renal impairment and cardiovascular disease.

Desired effects: This drug was given to the patient to relieve pain.

Adverse effects and side-effects

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache

Resp: asthma, dyspnea

CV: edema, pallor, vasodilation

GI: GI bleeding, diarrhea, drymouth, dyspepsia, GI pain, nausea, abnormal

taste

GU: oliguria, renal toxicity, urinary frequency

Derm: pruritus, purpura, sweating, urticaria

Hemat: prolonged bleeding time

Local: injection site pain

Neuro: paresthesia

Misc: allergic reactions including anaphylaxis

Nursing Responsibilities

1. Check doctor’s order to avoid mistake.

2. Observe the 10 RIGHTs in administering drug to avoid mistakes.

3. Assess the client’s history of allergy to the drug to avoid

complications.

4. Encourage client to report severe pain for prompt intervention.

5. Administer the drug through the Y-tube in a free flow for at least 15

seconds because this can be irritating.

6. Tell patient to avoid activities requiring alertness because this drug can

cause drowsiness.

7. Monitor for signs and symptoms of bleeding like melena or

hematemesis. GI ulceration with perforation can occur anytime during

treatment. This drug can decrease platelet aggravation, thus, may

prolong bleeding.

8. Do not administer the drug longer than 5 days to prevent development

of tolerance.

9. Instruct client to call the attention of any health care professional when

difficulty of breathing is experienced to give prompt intervention.

3 Generic name: Nubain

Brand name: Nalbuphine

Classification: opioid analgesics

Dosage, route, frequency: 10mg IVP every 6 hours

Mechanism of action: This drug binds to opiate receptors in the CNS, which

causes alteration in the perception and response to painful stimuli. Thus,

pain decreases.

Indication: This drug is used to treat moderate to severe pain.

Contraindication: This drug is contraindicated to patients who are sensitive to

nalbuphine.

Desired effect: This drug is given to our patient to relieve pain after operation.

Adverse effects and side effects

CNS: dizziness, headache, sedation, confusion, floating feeling

EENT: blurred vision, diplopia, mioses

Resp: respiratory depression

CV: hypertension, orthostatic hypotension, palpitations

GI: dry mouth, nausea, vomiting, constipation

GU: urinary urgency

Derm: clammy feeling, sweating

Misc: physical dependence, psychological dependence, tolerance


1. Check doctor’s order to avoid mistakes.

2. Consider the 10 RIGHTs in drug administration to avoid errors.

3. Instruct watcher to assist patient during doing activities to prevent

accidents.

4. Encourage patient to take adequate bed rest to decrease oxygen demand and

BMR, thereby conserving body energy

5. Provide proper oral care to decrease the incidence of dry mouth.

6. Assess vital signs to prevent complications.

7. Instruct patient on how and when to ask for pain medication to prevent drug

dependence and tolerance.

8. Caution patient to change positions slowly to minimize orthostatic

hypotension.

9. Encourage patient to turn, cough and breathe deeply every 2 hours to

prevent lung collapse.

Date ordered: February 17, 2006

4. Generic name: Mefenamic acid

Brand name: N/A

Classification: NSAIDs

Dosage, route, frequency: 500 mg 1 tab TID

Mechanism of action: This drug inhibits prostaglandin synthesis, thus, decreases

pain.

Indication: This is a short-term management of pain.

Contraindication:

Desired effects: This drug was given to our patient to reduce pain.


CNS: dizziness, headache

GI: severe diarrhea, ulceration

Special senses: eye irritation, ear pain


1. Check the doctor’s order to avoid error.

2. Observe the 10 RIGHTs in drug administration to avoid mistakes.

3. Assess for the client’s history of drug allergy to prevent complications.

4. Instruct patient to move slowly to prevent accidents.

5. Instruct patient to call the attention of any health care provider when

melena or bleeding gums are experienced as, these will show that there

is ulceration.

5. Generic name: Cefalexin

Brand name: N/A

Classification: 1st generation cephalosphorins

Dosage, route, frequency: 500mg 1 cap TID

Mechanism of action: This drug binds to bacterial cell wall membrane causing

cell death.

Indication: This drug is used to prevent skin and skin structure infection.

Contraindication: This is contraindicated to patients who are hypersensitive to

cephalosphorins

Desired effects: This drug was given to our patient to prevent possible infection

after the operation.


CNS: seizures

GI: pseudomembranous colitis, diarrhea, nausea, vomiting, cramps

GU: interstitial nephritis

Derm: rashes, urticaria

Hemat: blood dyscrasias, hemolytic anemia

Misc: allergic reactions


1. Check the doctor’s order to avoid error.

2. Observe the 10 RIGHTs in drug administration to avoid mistakes.

3. Inform patient to take the drug exactly as prescribed, even after he feels

better.

4. Instruct patient to take drug with food or milk inorder to lessen discomfort.

5. Obtain a history before administering the drug to determine previous use of

and reactions to penicillins and cephalosphorins to prevent complications.

6. Observe patient for signs and symptoms of anaphlaxis to give prompt

intervention.

6. Generic name: Ranitidine

Brand name: Zantac

Dosage, Route, Frequency: 50 mg IVP every 8

Classification: H2 receptor antagonist

Indication: This drug is indicated for our patient to prevent the occurrence of

duodenal and gastric ulcer.

Contraindication: To patients hypersensitive to Ranitidine

Mechanism of Action: This drug inhibits gastric acid secretion by blocking the

effect of histamine on histamine H2 receptors.

Desired Effect: This drug is given to our patient for prophylaxis to ulcer

Adverse Effects:

GI: nausea, vomiting, diarrhea, abdominal pain

CNS: malaise, dizziness, headache, insomnia, anxiety, fatigue

CV: Bradycardia or tachycardia

Hematologic: aplastic anemia

Hepatic: hepatotoxicity, jaundice, hepatitis, increase in ALT

Dermatologic: pruritus, rash, alopecia

Nursing Responsibilities

1. Check for the doctor’s order and prepare drug aseptically.

2. Instruct patient to take without regard to meals because absorption is not

affected by food.

3. Remind patient taking prescription drug once daily to take it at bedtime for

best results.

4. Report any evidence of diarrhea and maintain adequate hydration.

5. Antacids decrease the absorption of ranitidine.

6. Instruct the watcher to assist patient in his activities of daily living because

patient may feel dizzy and easily fatigue.

7. Intstruct patient to take medicines as prescribed. Don’t overdose as this leads

to damage of hepatic cells.

8. Tell patient to avoid eating fruits like oranges to prevent hypersecretions of

gastric acids..

C. DRUG STUDY

GENERIC NAME: TheophyllineBRAND NAME: Respbid CLASSIFICATION: Bronchodilator ROUTE, DOSAGE & FREQUENCY: 200 mg 1 tab BIDMECHANISM OF ACTION: It prevents breakdown of Adenosine Monophosphate (AMP) which promotes smooth muscle relaxation causing bronchodilation.DESIRED EFFECT: This was given to our patient to promote bronchodilation- greater airway passage hence relieving difficulty of breathing. INDICATION: Symptomatic relief or prevention of bronchial asthma and reversible bronchspasm associated with chronic bronchitis and emphysema.CONTRAINDICATIONS & CAUTIONS:

Contraindicated with hypersensitivity to any xanthines, peptic ulcer, active gastritis, preganancy, underlying seizure disorders.

Use cautiously with cardiac arrhythmias, acute myocardial injury, CHF, cor pulmonale, severe HPN, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor (may inhibit uterine contractions), lactation, status asthmaticus

SIDE EFFECTS: diuresis, insomnia, nausea and vomiting, headacheADVERSE EFFECTS:

GIT: epigastric pain, diarrhea and anorexia CNS: irritability, restlessness, dizziness, muscle twitching, headache,

insomnia, lightheadedness, seizures, severe depression, stammering speech, abnormal behavior characterized by withdrawal, mutism and unresponsiveness alternating with hyperactive periods

CV: palpitations, sinus tachycardia, ventricular tachycardia, life-threatening ventricular arrhythmias, circulatory failure

GUT: proteinuria, increase excretion of renal tubular cells and RBC’s , urinary retention in man with prostate enlargement

Respiratory: tachypnea, respiratory arrestNursing Responsibilities Rationale

1. Check doctors order. To verify and avoid error in giving the drug.

2. Check vital signs before and after administration.(to be check)

To evaluate cardiac response

3. Drug should be given on an empty stomach, 1 hour before or 2 hours after meals.

To decrease gastric irritation

4. Check for adverse reactions. If present, discontinue drug and notify the physician.

To prevent further complications

5. Teach the following:* Breathing techniques*Coughing techniques

To expand lung tissue and move secretions

6. Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate.

These contain theophylline-related substances that may increase side effects

GENERIC NAME: Salbutamol SulfateBRAND NAME: VentolinCLASSIFICATION: BronchodilatorDOSAGE, ROUTE, FREQUENCY: 2.5 cc ever 6 hours to be added for nebulizationMECHANISM OF ACTION: relaxes bronchial and uterine smooth muscle by acting on the beta 2-adrenergic receptors. Inhibit the release of mediators of immediate hypersensitivity reaction from mast cells. DESIRED EFFECT: To promote bronchodilation and help loss secretions.CONTRAINDICATION: contraindicated in patients hypersensitive to drug or its ingredients.SIDE EFFECTS: dizziness, insomia, headache, weakness, nausea and vomitingADVERSE REACTIONS:

CNS: tremor, nervousness, dizziness, malaise CV: tachycardia, palpitations EENT: nasal congestion, hoarseness GI: heartburn METABOLIC: hypokalemia MUSCULOSKELETAL: muscle cramps RESPIRATORY: wheezing, increased sputum

Nursing responsibilities: Rationale:1. Verify the doctor’s order. To avoid error in giving the drug.2. Do chest physiotherapy as indicated after each nebulization.

To help dislodge the secretions.

3. Encourage client to rinse mouth with H20 To minimize dry mouth.

after nebulization.4. Maintain adequate fluid intake. To liquefy the mucous secretions for easier

expectoration.5) Teach the ff: breathing techniques coughing techniques

To expand lung tissue and move secretions

6) Teach patient pursed-lip breathing This creates a resistance to the air flowing out of the lungs, thereby prolonging exhalation

GENERIC NAME: Ampicillin SulbactamBRANDNAME: UnasynCLASSIFICATION: anti-bacterialDESIRED DOSAGE, ROUTE & FREQUENCY: 750mg IV every 8 hoursDESIRED EFFECT: This was given to our patient prevent infection.MECHANISM OF ACTION: inhibits cell-wall synthesis during bacterial multiplication. Sulbactam inactivates bacterial beta-lactamase, which inactivates ampicillin, causing bacterial resistance to it. INDICATION: to prevent the proliferation of susceptible microorganisms during infection.CONTRAINDICATIONS:

Contraindicated in patients hypersensitive to the drug or other penicillin. Use cautiously in patients with other drug allergies because of possible cross-

sensitivity and in those with mononucleosis because of high risk in maculopapular rash.

SIDE EFFECT: nausea and vomitingADVERSE EFFECTS:

CV: thrombophlebitis GI: diarrhea, glossitis, stomatitis, gastritis, black hairy tongue, enterocolitis,

psuedomembranous colitis HEMATOLOGIC: anemia, thrombocytopenia, thrombocytopenic purpura,

eosinophilia, luekopenia, agranulocytis OTHER: hypersensitivity reactions, anaphylaxis, overgrowth of nonsusceptible

organisms, pain at injection site, vein irritation

Nursing responsibilities: Rationale:1. Check doctor’s order To avoid error in administering the drug2. Do skin testing and give only ANST. To determine any allergic reaction 3. Check the patency of the IV line. To make sure that the IV line is in the vein4. Administer the drug slowly and always observe aseptic technique.

To prevent irritation and facilitate absorption and also to avoid contamination of microorganism

5. Tell the patient to report any allergic reaction and notify the physician. Observe for any manifestation of allergic reaction.

To prevent further complication and give necessary intervention if allergic reaction occurs.

6. Provision of personal hygiene. Good personal hygiene aids in the retardation of growth and multiplication of pathogenic microorganisms.

7. Encourage patient to cough out secretions and dispose it properly.

To prevent the stasis of secretions in the respiratory tract which is good medium bacterial growth and proper disposal of secretions prevent the spread of microorganisms.

7. Encourage intake of vitamin C and mineral rich foods.

To increase body resistance

GENERIC NAME: HydrocortisoneBRAND NAME: Sodium SuccinateCLASSIFICATION: CorticosteroidsDESIRED DOSAGE, ROUTE & FREQUENCY: 100mg IV every 12 hoursMECHANISM OF ACTION: Decreases inflammation by entering target cells and binding to cytoplasmic receptors initiating many complex reactions thus resulting to blockage on the release of histamine, bradykinine and serotonin.DESIRED EFFECT: This drug is given to our patient to reduce inflammation.CONTRAINDICATIONS:

Contraindicated with fungal infections, amoebiasis, hepatitis b, varicella and antibiotic-resistant infections, immunosuppression

Use cautiously with kidney disease(risk to edema), liver disease, cirrhosis, hypothyroidism, ulcerative colitis with impending perforation, diverticulitis, resent GI surgery, active or latent peptic ulcer, inflammatory bowel disease(risk exacerbation or bowel perforation), hypertension, CHF, thrombophlebitis, osteoporosis, convulsive disorders, metastatic carcinoma, DM, TB, and lactation

SIDE EFFECT: headache, insomia, nausea and vomiting, weaknessADVERSE EFFECT:

CNS: vertigo, headache, paresthesia, insomnia, seizures, psychosis CV: hypotension, shock, hypertension, and CHF 2o to fluid retention,

thromboembolism, thromplebitis, fat embolism, cardiac arrythmias 2o electrolyte disturbance

DERMATOLOGIC: thin, fragile skin, petichiae, ecchymoses, purpura, striae, SC fat atrophy

EENT: cataracts, glaucoma(long term therapy), increase IDP

ENDOCRINE: amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state(long-term therapy), HPA suppression systemic with therapy longer than 5 days

GI: peptic or esophageal ulcer, pacreatitis, abdominal distention, N/V, increase appetite and weight gain(long-term therapy)

HEMATOLOGIC: NA+ and fluid retention, hypokalemia, hypocalcemia,increase blood sugar, increase serum cholesterol, decrease serum T1 and T4 levels

HYPERSENSITIVITY: anaphylactoid or hypersensitivity reactions MUSCOSKELETAL: muscle weakness, steroid myopathy and loss of muscle

mass, osteoporosis, spontaneous fractures(long-term therapy) OTHER: immunosuppression, aggravation or masking of infections, impaired

wound healing

Nursing Intervention Rationale1. Check the doctors order To avoid error in giving the drug2. Observe the rights in administering the drug

To avoid error in giving the drug

3. Do skin testing and give ANST To determine any allergic reaction4. Check the patency of the IV line To make sure that it is in the vein5. Monitor I & O accurately To determine fluid and electrolyte

imbalance6. Monitor BP Because this drug cause vasoconstriction

effect thereby increasing BP7. Encourage patient to increase intake of protein

To prevent hyperglycemia and glycosuria

8. Weigh the patient daily with the same clothing and weighing scale

To determine if he gained weight and fluid retention

9. Encourage patient to increase intake of Vitamin C and potassium rich foods such as banana, cantaloupe, potato, etc.

To increase body resistance and to prevent the occurrence of hypokalemia

11. Tell the patient not to skip or suddenly stop medications

To attain the desired outcome more effectively and to avoid reoccurrence of inflammation

12. Provide emotional and psychological support

To elicit cooperation

GENERIC NAME: Budesonide BRAND NAME: Pulmicort TurbuhalerCLASSIFICATION: Corticosteroid DESIRED DOSAGE, ROUTE & FREQUENCY: 2 puffs ODDESIRED EFFECT: This drug is given to our patient in order to reduce inflammation.MECHANISM OF ACTION:

Anti – inflammatory effect: local administration into nasal passages maximizes beneficial on the tissues, while decreasing the likelihood of adverse effects from systemic absorption.

Anti-inflammatory corticosteroid that exhibits potent glucocorticoid activity and weak minerolocorticoid activity. The exact mechanism of the cortiosteroids isn’t known, but they have a wide range of inhibitory activity against such cell types such as mast cells and macrophages and mediators (such as leukotrienes) involved in allergic and non-allergic inflammation.

INDICATION: Prophylactic therapy in maintenance treatment of asthmaCONTRAINDICATIONS:

Contraindicated with hypersensitivity with drug or for relief of acute asthma bronchospasm. Use cautiously with TB, systemic infections and lactation.

Contraindicated with hypersensitivity with adrenergics, anines or formoterol, acute asthma attack, acute airway obstruction.

Use cautiously in the elderly and with pregnancy and lactation.SIDE EFFECT: headache, insomnia, nauseaADVERSE EFFECT:

CNS: headache asthenia, pain, insomnia, syncope, hypertonia EENT: sinusitis, pharyngitis, rhinitis, voice alteration GI: oral candidiasis, dyspepsia, gastroenteritis, nausea, dry mouth, taste

perversion, abdominal pain METABOLIC: weight gain RESPIRATORY: respiratory tract infections, increased cough, bronchospasm SKIN: ecchymosis OTHER: flulike symptoms, fever, hypersensitivity reactions

Nursing Responsibilities Rationale1) Check doctor’s doctor’s order, To avoid error in administering the drug2) Observe the RIGHT’S in administering a drug

To avoid error in administering the drug

3) Use cautiously, if at all, in patients with active or quiescent TB of the respiratory tract, ocular herpes simplex, or untreated systemic fungal, bacteria, viral, or parasitic infections

To avoid further complications

4) If bronchospasm occurs after using budesonide, stop therapy and treat with a bronchodilator


5) Watch for candida infections of the pharynx

For immediate treatment of the said complication

6) Tell patient that budesonide inhaler isn’t a bronchodilator and isn’t intended to treat episodes of asthma

For precautionary measures

7) instruct patient to use inhaler at regular intervals as follows

Because effectiveness depends on twice-daily use on a regular basis

8) pulmicort turbuhaler must be kept up-right(mouthpiece on top) during loading

To provide correct dosage

9) instruct patient to place mouthpiece between lips and to inhale forcefully and deeply

To obtain the desired effect of the drug faster

10) Tell the patient that he may not taste the drug or sense it entering his lungs, but it doesn’t mean it isn’t effective.

To make the patient aware on the possible outcome of the drug given

11) instruct the patient to rinse his mouth with water and then spit out the water after each dose

To decrease the risk of developing oral candidiasis

12) Replace mouthpiece cover after use and always keep it clean and dry

To prevent the contamination from microorganisms, thereby preventing the occurrence of infection

13) Instruct the patient to carry or wear medical identification indicating need for supplementary corticosteroid during periods of stress or an asthma attack.

For identification purposes

GENERIC NAME: Formoterol Fumarate Inhalation BRAND NAME: foradil aerolizerCLASSIFICATION: beta2 adrenergic agonistDESIRED DOSSAGE, ROUTE & FREQUENCY: 2 puffs once a dayDESIRED EFFECT: This drug is given to out patient in order to promote bronchodilation, thus relieving dyspnea MECHANISM OF ACTION: Beta agonists relax smooth muscle in the bronchioles by activating adenylate cyclase and increasing intracellular concentration of cyclic Adenosine Monophosphate. This increasing cAMP, beta agonist inhibits release of muscle mediators such as histamine and leukotrine (degranulation) which is inhibits smooth muscle contraction, thus bronchodilation occurs. INDICATION:

Maintenance treatment and prevention of bronchospasm in patients with reversible obstructive airway disease or nocturnal asthma, who usually require treatment with short-acting inhaled beta2 adrenergic agonist

Prevention of exercised –induced bronchospasmCONTRAINDICATIONS: contraindicated in patients hypersensitive to drug or its componentADVERSE EFFECTS

CNS: tremors, dizziness, nervousness, headache, fatigue, malaise CV: chest pain, angina, HPN, hypotension, tachycardia, arrhythmias, palpitations EENT: dry mouth, tonsillitis, dysphonia GI: nausea METABOLIC: hypokalemia, hyperglycemia, metabolic acidosis MUSKULOSKELETAL: muscle cramps

RESPIRATORY: chest infection SKIN: rash OTHER: viral infection

Nursing Responsibilities Rationale1) Check doctor’s order To administer the correct drug t o be given2) Observe the RIGHT’S in administering the drug

To avoid error

3) Watch for immediate hypersensitivity reactions, such as anaphylaxis, urticaria, angioedema, rash and bronchospasm

To know when to stop the medication to prevent further complications

4) Monitor patient for tachycardia, hypertension and other CV adverse effects. If these occurs, drug may need to be discontinue


5) Foradil capsules should only given via oral inhalation and used only with the Aerolizer Inhaler. They aren’t for oral ingestion. Patient shouldn’t exhale into the device. Capsules should remain in the unopened blister until administration time and only removed immediately before use.

Inhalation is preferred because of minimal systemic absorption

6) Tell patient not to increase the dosage or frequency of use without medical advice.

To prevent over dosage

7) Tell patient to report nausea, vomiting, shakiness, headache, fast or irregular heart beat, or sleeplessness.

To know if the drug is to be discontinued

8) Instruct the patient not to use the Foradil Aerolizer with a spacer device or to exhale or blow into the Aerolizer inhaler.

Spacer is not applicable when an inhaler is held at the level of the mouth because in this position, large droplets tend to be delivered to the oropharynx and throat, rather than moving down into small airways.

GENERIC NAME: Isosorbide DinitrateBRAND NAME: IsordilCLASSIFICATION: Anti-anginaDESIRED DOSE, ROUTE AND FREQUENCY: 60mg ½ tab OD MECHANISM OF ACTION: dilates the blood vessels by relaxing the muscles in their walls. Oxygen flow improves as the vessels relax, and chest pain subsidesINDICATION: Isosorbide dinitrate reduces the blood pressure as well as the capillary pressure (vascular resistance), improving the heart's efficiency. It is used for the treatment and prevention of angina.DESIRED EFFECT: This was given to our patient to help relieve chest pain.

SIDE EFFECTS: headache, dizziness, light-headedness, low blood pressure and weakness, nausea and vomiting, constipationADVERSE EFFECTS: Collapse, fainting, flushed skin, high blood pressure, pallor, perspiration, rash, restlessness, skin inflammation and flaking, vomiting, blurred vision and irregular heartbeat.CONTRAINDICATIONS:

Use with caution if you have anemia, glaucoma, a previous head injury or heart attack, heart disease or thyroid disease.

People taking diuretic medication or those who have low blood pressure should use the drug with caution.

Do not use sildenafil while taking the drug because the combination could cause severe or life- threatening low blood pressure.

Nursing interventions: Rationale:1. Verify doctor’s order. To prevent error.2. Position client in a sitting or lying position when taking in the drug.

Since the drug may cause fainting or dizziness cause by hypotension.

3. Encourage patient to consume a high-fiber diet and drink plenty of fluids.

To prevent constipation.

4. Provide oral care to the patient. To decrease likelihood of carries and periodontal disease caused by decreased salivation.

5. Instruct client to report recurrence of pain and if pain is present, notify the doctor immediately.

To see whether the pain was relieved by the drug and for the doctor to know since this may indicate coronary occlusion.

6. Monitor the vital sign of the patient at regular intervals.

Since the drug causes hypotension.

GENERIC NAME: Aspirin (ASA)BRAND NAME:CLASSIFICATION: Non-Steroidal Anti-inflammatory Drug (NSAID)DESIRED DOSE, ROUTE AND FREQUENCY: 80mg one tab a dayMECHANISM OF ACTION: Its thought to relieve fever by central cation in the hypothalamic heat-regulating center. Exerts its anti-inflammatory by inhibiting prostaglandin synthesis; also may inhibit the synthesis or action of other mediators of the inflammatory response.DESIRED EFFECT: The drug is given to our patient to reduce inflammation.SIDE EFFECTS: ADVERSE EFFECTS:

EENT: tinnitus, hearing loss GI: nausea, GI distress, occult bleeding, GI bleeding HEMATOLOGIC: leukopenia, thrombocytopenia, prolonged bleeding time HEPATIC: hepatitis SKIN: rash, bruising, urticartia Other: angioedema, hypersensitivity reactions, Reye’s syndrome

CONTRAINDICATIONS:Contraindicated in patients hypertensitive to drug and in those with NSAID-

induced sensitivity reactions and bleeding disorders, such as hemophilia.

Nursing Responsibilities Rationale1.Check Doctors order To prevent committing mistakes2.Assess the patient’s allergy to drug To prevent hypersensitivity reactions3.Encourage patient to take drugs with food, milk or water

To reduce GI reactions

4. Encourage patient to take aspirin after meal

To avoid GI distress

XIII.DRUG STUDY

Date of administration: January 6 – January 14, 2006

Generic Name: Captopril

Brand Name: Capoten

Classification: Antihypertensive-angiotensin converting enzyme inhibitor (ACE

inhibitor)

Dosage, Route, Frequency: 25mg/tab ¼ tab BID

Mechanism of Action: Prevents the production of angiotensin II, a potent

vasoconstrictor that stimulates the production of

aldosterone by blocking its conversion to the active form.

Result in systemic vasodilation.decreased preload and

afterload in patients with CHF.

Desired Effect: This drug was given to our patient to minimize pulmonary and

venous congestion so as not to aggravate further edema,

thus, preventing increase of blood pressure.

Nursing Responsibilities Rationale1. Monitor blood pressure and pulse rate, weight

and fluid volume status (I and O) before and

throughout the therapy and to assess patient

routinely for resolution of fluid overload (weight

gain, dyspnea, peripheral edema, and jugular neck

vein) if on concurrent diuretic therapy.

To assess for the fluid balance.

2. Administer on empty stomach, 1 hour before or 2

hour after meals.

To ensure proper absorption of drug.

3. Inform the patient and significant others the

mechanism of action of the drug and possible side

effects such as tachycardia, angina, and cardiac

arrhythmias; GI irritation, ulcers constipation, and

liver injury; renal insufficiency, renal failure, and

proteinuria; and rash, alopecia, dermatitis and

photosensitivity.

To alleviate the anxiety of the

patient and the significant

others. This is also necessary

for the client and significant

others to appreciate the

importance of taking the drug.

4. Inform the patient and significant others to report

if any of the side effects occur.

To prevent further complications.

5. Monitor the patient carefully in any situation that

might lead to a drop in fluid volume (e.g., excessive

sweating, vomiting, diarrhea, dehydration).

To detect and treat excessive

hypotension.

6. Caution the patient to change positions slowly. To minimize orthostatic

hypotension, particularly after

initial dose.

7. Instruct SO to administer Captopril exactly as

directed, even if feeling better. Missed doses should

be taken as soon as possible but not if almost time

for the next dose. Do not double doses.

To ensure the effectivity of the

drug and to prevent drug

toxicity.

8. Encourage the patient to decreased salt in the

diet.

To increase the effectiveness

of the drug.

9. Provide comfort measures to help the patient

tolerate drug effects such as small frequent feeding

and safety precautions.

To minimize adverse side

effects.

Date of Administration: January 4 – January 7, 2006 (IV), shifted to oral once IV

consumed (January 7, 2006) until January 14, 2006

Generic Name: Digoxin

Brand Name: Lanoxin

Classification: Cardiac glycoside, inotropic agent, antiarrhythmi

Dosage, Route, Frequency: 0.12 mg IV every 120 / 0.25-mg/tab ½ tab every 12o

Mechanism of Action: Prolongs refractory period of the AV node. Decreases

conduction through the SA and AV node

Desired Effect: This drug was given to our patient to increase the force of

myocardial contraction.

Nursing Responsibilities Rationale1. Inform to the patient and significant others the

mechanism of action of the drug and possible side

effects such as headache, weakness, drowsiness,

and vision changes, GI upset and anorexia, and

arrhythmias.

To alleviate anxiety and to gain cooperation. This is also necessary for the client and significant others to appreciate the importance of taking the drug.

2. Monitor apical pulse for 1 full minute prior to

administering. Withhold dose and notify physician if

pulse rate is <70 bpm.

The drug has negative

chronotropic effect.

3. Monitor blood pressure before and throughout

the therapy.

To observe for increased blood pressure and to prevent further complications.

4. Monitor for cardiac arrhythmias, including sinus

bradycardia.

To detect early signs of

digoxin toxicity.

5. Administer the drug with the correct dosage at an

appropriate time.

To avoid digoxin toxicity and to ensure the effectivity of the drug.

6. Avoid administering with food or antacids. To avoid delays in absorption.

7. Missed doses should be taken within 12o of

scheduled dose or not taken at all. Do not double

doses. Do not discontinue medication without

consulting the physician.

To ensure the effectivity of the drug and to prevent drug toxicity.

8. Instruct patient to keep digoxin tablets in their

original container and not mix in pillboxes with

other medications, as they may look similar and

maybe mistaken for other medications.

They may look similar and maybe mistaken for other medications.

9. Teach patient and a responsible family member

about the dosage regimen, how to take the pulse,

reportable signs, and follow up care.

To promote independence on the patient and significant others,

10. Instruct patient to report adverse reactions

promptly such as nausea, vomiting diarrhea,

appetite loss, and visual disturbances.

These are early indicators of

drug toxicity.

11. Monitor potassium levels carefully. Take

corrective action before hypokalemia occurs.

Encourage patient to eat potassium-rich foods.

To prevent hypokalemia which predispose the patient in development of toxicity.

12. Advice patient to have a small frequent feeding. To minimize nausea and vomiting.

13. Advice patient to have adequate rest and sleep. To decrease metabolic

demands.


Generic Name: Spironolactone

Brand Name: Aldactone

Classification: Potassium-sparing diuretics

Dosage, Route, Frequency: 25 mg/tab 1 tab BID

Mechanism of Action: Acts at distal renal tubule to antagonize the effects of

aldosterone, causing excretion of sodium, bicarbonate,

and calcium while conserving potassium and hydrogen

ions.

Desired Effect: This drug is given to our patient to promote excretion of excess

fluids in the body, thus, relieving edema. It also lowers blood

pressure.

Nursing Responsibilities Rationale1. Monitor I and O, weight, BP and PR before and

throughout the therapy.

To have a baseline data and to monitor for possible hypotension.

2. Administer drug early AM and early PM. So as not to interfere with

sleep.

3. Administer the drug with food. To enhance absorption.

4. Emphasize the importance of continuing to take this medication even if feeling better. Instruct patient to take medication at the same time each day. If dose is missed, take as soon as remembered unless almost time for the next dose.

To gain cooperation.

5. If dose is missed, take as soon as remembered

unless almost time for the next dose.

To ensure effectivity of the drug.

6. Advice patient to change position slowly. To minimize hypotension and

dizziness.

7. Caution patient to avoid activities requiring alertness until response to medication to known.

Spironolactone may cause

dizziness.

8. Avoid eating an excessive amount of foods that

are high in potassium, such as citrus fruits,

tomatoes, bananas, and apricots. Avoid salt

substitutes containing potassium and potassium

To prevent hyperkalemia.

supplements, unless otherwise directed.


Generic Name: Prednisone

Brand Name: Deltasone

Classification: Glucocorticoid-intermidiate-acting

Dosage, Route, Frequency: 5mg/tab 4 tabs TID

Mechanism of Action: Suppresses inflammation and the normal immune

response. Has minimal mineralocorticoid (sodium-

retaining) activity.

Desired Effect: This drug was given to our patient to decrease inflammation of the

heart.

Nursing Responsibilities Rationale1. Administer drug regularly. To mimic normal peak diurnal

concentration levels and

thereby minimize suppression

of the hypothalamic-pituitary

axis.

2. Monitor intake and output ratios and daily weight

throughout therapy.

To identify changes and

improvement of the patients

condition.

3. Instruct patient to take medication exactly as

desired, not to skip doses or double up on missed

doses.

Stopping the medication

suddenly may result in adrenal

insufficiency that could lead to

life threatening.

4. Encourage patients on long-term therapy to eat a

diet high in protein, calcium, and potassium and low

sodium and carbohydrates.

To provide the nutritional

needs of the body while

preventing hypernatremia.

5. Protect the patient from unnecessary exposure to

infection and invasive procedures.

The steroids suppress the

immune system and the

patient is at risk of infection.

6. Inform the patient and significant others the signs

and symptoms of early adrenal insufficiency and

notify health care provider if they experience

tiredness, muscle weakness, joint pain, fever, poor

To prevent the occurrence of

early adrenal insufficiency.

appetite, nausea, difficulty breathing, dizziness, and

fainting.

7. Instruct the patient and significant others the

signs and symptoms of cushingoid symptoms

(moonface, buffalo hump) and notify a health care

provider immediately of a sudden weight gain or

swelling.


cushingoid symptoms.

8. Advice patient to have small frequent feeding

with balance diet.

To minimize nausea and

vomiting.

9. Advice patient to have adequate rest and sleep. To minimize side effects.


Generic Name: Ranitidine

Brand Name: Zantac

Classification: Histamine H2 antagonist or H2-blockers (anti-ulcer)

Dosage, Route, Frequency: 30 mg IV every 8hr

Mechanism of Action: Inhibits the action of histamine at the H2-receptor site

located primarily in gastric parietal cells.

Desired Effect: This drug is given to our patient to prevent the hypersecretion of

gastric acid (HCL), which will lead to ulcer development as a side

effect of drugs particularly the Prednisone and Captopril.

Nursing Responsibilities Rationale1. Check for previous hypersensitivity to the drug. To determine any sensitivity

reaction to the drug.

2. Administer the drug accurately and periodically. To ensure the effectivity of the

drug.

3. Monitor patient continually if giving intravenous

dosage.

To allow early detection of

potentially serious adverse

effects on liver enzyme

systems.

4. Encourage patient to have small frequent feeding

with balanced diet and avoid spicy foods.


vomiting. For us not to trigger

HCL production, the patient

must avoid spicy foods.

5. Advice patient not to do activities requiring The drug can cause

alertness. drowsiness or dizziness.

6. Provide thorough patient teaching, including drug

name, prescribed dosage, measure for avoidance of

adverse effects such as diarrhea or constipation,

dizziness, headache, confusion, cardiac

arrhythmias, and hypotension, and warnings signs

that may indicate possible problems. Instruct the

patients about the need for periodic monitoring and

evaluation.

To enhance patient knowledge

about drug therapy and to

promote compliance.

Date of administration: January 4 – January 7, 2006 (IV), shifted to oral on January

7 until January 14, 2006

Generic Name: Furosemide

Brand Name: Lasix

Classification: Loop diuretic

Dosage, Route, Frequency: 20 mg IV now then q 12hr

Mechanism of Action: Inhibits the absorption of Na and chloride in the proximal

and distal tubules as well as the ascending loop of

Henle.

Desired Effect: This drug was given to our patient to promote excretion of excess fluid

in the body, hence, managing edema, congestion and consequently

hypertension.

Nursing Responsibilities Rationale1. Monitor fluid status (I and O), weight, BP and PR

before and throughout the therapy.

To monitor for any changes

and or improvement of the

client’s condition.

2. Administer the drug preferably in the morning

and afternoon.

To prevent disruption of sleep

cycle.

3. Advice patient to change position slowly. To minimize orthostatic

hypotension.

4.Asses patient for tinnitus and hearing loss This is most common following

rapid high dose IV

administration in patients with

decrease renal function or

those taking other ototoxic

drugs.

5. Advise patient to report to health care

professionals immediately if muscle weakness,

cramps, nausea, dizziness, numbness or tingling

sensation occurs.

This could indicate drug

toxicity.

6. Advice patient to increase intake of foods rich in

potassium like bananas, apple etc.

To prevent hypokalemia since

this drug is a potassium-

sparing diuretics.

7. Monitor electrolyte, renal and hepatic function,

glucose and uric acid prior to and periodically

throughout the course of therapy.

To prevent electrolyte

imbalance.

8. Advice patient on antihypertensive regimen to

continue taking medications even if feeling better.

Since this drug controls but

does not cure hypertension.

9. Advice patient to have small frequent feeding

with balance diet.


vomiting.

10. Advice patient to have adequate rest and sleep. To decrease metabolic

demands.


Generic Name: Penicillin G benzanthine (benzanthine benzyl penicillin)

Brand Name: Permapen

Classification: Anti-infective

Dosage, Route, Frequency: 750,000 units IV every 6 hours.

Mechanism of Action: Binds to bacterial cell wall, resulting in cell death.

Desired Effect: This drug was given to our patient to treat streptococcal infection or

to prevent the further infection caused by streptococcus.

Nursing Responsibilities Rationale1. Obtain history of hypersensitivity to the drug. To determine hypersensitivity

to the drug.

2. Do skin testing prior to administration. To prevent the occurrence of

any sensitivity reaction

through prior detection.

3. Administer the drug accurately and aseptically. To ensure the effectivity of the

drug and to prevent further

infection.

4. Observe patient for signs and symptoms of

anaphylaxis like rush, pruritis, laryngeal edema and

wheezing. Discontinue the drug and notify physician

immediately if this occur.

To prevent further

anaphylactic reaction to the

drug.

5. Advise patient to report signs of allergy and

superinfection such as black, furry overgrowth on

tongue; loose or foul-smelling stools.


further complications.

6. Instruct patient or significant others to notify

health care professional if fever and diarrhea

develop especially if stool contains blood, pus or

mucus.


further complications.

7. Advice patient to have small frequent feeding To prevent nausea and

vomiting

8. Advice patient to have and adequate rest and

sleep, and have a balance diet.

To synergize the effect of the

drug and to minimize possible

adverse side effects like

anemia and leucopenia.

Generic Name: Sucralfate

Brand Name: Carafate

Classification: Antiulcer; pepsin inhibitor

Dosage; Route; Frequency: 1g QID for 2weeks

Mechanism of Action: In combination with gastric acid, forms a protective covering

on the ulcer surface.

Desired Effect: This drug was given to our client in order to prevent further ulceration

of the gastric mucosa.

Nursing Responsibilities Rationale1. Administer drug on an empty

stomach.

Because presence of food in the stomach

interferes with the absorption of the drug.

2. Administer antacid 30 minutes

before or after sucralfate. Allow 1

to 2 hours to elapse between

sucralfate and other prescribed

drugs.

Sucralfate binds with certain drugs (eg.

Tetracycline, phenytoin) thus reducing the

effects of the other drugs.

3. Advice client to take the drug

exactly as ordered. Therapy usually

requires 4 to 8 weeks for optimal

ulcer healing. Instruct the client,

even if she feels better, she should

continue taking her medications.

To achieve optimal ulcer healing.

4. Increase fluid, dietary bulk, and

exercise.

To prevent possible occurrence of

constipation.

5. Instruct the significant others to

report if client experiences pain,

coughing or vomiting of blood,

dizziness, nausea, vomiting,

constipation, dry mouth, rash,

pruritus, back pain and sleepiness.

To provide immediate intervention to avoid

complication.

7. Advice the client to avoid foods and

liquids such as caffeine-containing

beverages, alcohol and spices.

These foods or liquids can cause gastric

irritation that would aggravate the pain felt

by the patient.

Generic Name: Diphenhydramine

Brand Name: Benadryl

Classification: Antihistamine

Dosage; Route; Frequency: 50 mg IV now

Mode of Action: Blocks histamine1 thereby decreasing allergic response; affects

respiratory system, blood vessels and GI system.

Desired Effects: This drug is given to treat allergic symptoms.

Nursing Responsibilities Rationale1. Administer with food. To decrease gastric distress.

2. Advice the client to avoid performing

dangerous activities if drowsiness

occurs or until stabilized on drug.

To avoid accident or injury.

3. Avoid alcohol and other central

nervous system depressants.


4. Monitor the blood pressure of the

patient.

One of the side effects of the drug is

hypertension. Monitoring blood pressure

will help the health care providers detect if

patient is suffering already from

hypertension, thus immediate intervention

will be given thereby preventing

complication.

5. Inform the client about the side

effects such as dizziness, confusion,

fatigue, nausea, vomiting, urinary

retention, constipation, blurred

vision, dry mouth and throat,

reduced secretions, epigastric

distress, hearing disturbances, and

the adverse effects such as

agranulocytosis, hemolytic anemia,

and thrombocytopenia.

This will increase the client’s knowledge

about the drug so that she will not

experience anxiety if ever these side or

adverse effects will occur.

Generic Name: Omeprazole

Brand Name: Losec

Classification: Proton Pump Inhibitor

Dosage; Route; Frequency: 40 mg IV q 12 hours

Mechanism of Action: Suppresses gastric secretion by specific inhibition of the

hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric

parietal cells thereby it blocks the final step of acid production.

Desired Effects: This drug was given to our patient to decrease gastric irritation caused

by over secretion of hydrochloric acid.

Nursing Responsibilities Rationale1. Check for the patency of the IV line. To avoid wastage of the drug.

2. Administer the drug slowly. To prevent phlebitis.

3. Advice patient to avoid activities

requiring alertness.

Because it may cause dizziness and

drowsiness.

4. In cases of rashes, advice patient

not to scratch the affected areas.

Because it may lead to bruises and also it

will increase the tendency of infection.

5. Instruct patient to avoid eating sour

tasting foods.

To prevent further irritation of gastric

mucosa.

6. Instruct patient to avoid eating

large meal.

To avoid aggravating the condition.

Generic Name: Esomeprazole

Brand Name: No brand name indicated

Classification: Proton Pump Inhibitor

Dosage; Route; Frequency: 40 mg IV q 12 hours

Mechanism of Action: Suppresses gastric secretion by specific inhibition of the

hydrogen-potassium ATPase enzyme system at the secretory surface of the

gastric parietal cells thereby it blocks the final step of acid production.

Desired Effects: This drug was given to the patient to decrease gastric irritation

caused by over secretion of hydrochloric acid.

Nursing Responsibilities Rationale1. Inform patient about the

importance and the corresponding

side effects such as dizziness,

headache, rash, pruritus, alopecia,

dry skin, diarrhea, nausea and

vomiting, or constipation.

To gain cooperation.

2. Encourage the patient to take drug

1 hour before or 2 hours after meal

with a glass of water.

For better absorption thus maximum

therapeutic effect of the drug will be

achieved.

3. Encourage patient to take the drug

religiously.

To attain the exact treatment.

4. Instruct patient to take in or eat

crackers or ice chips.

To induce nausea and vomiting.

5. In cases of constipation, encourage

patient to increase fluid intake.

To facilitate bowel movement.

6. Instruct patient to avoid activities

requiring alertness.

Because it may cause dizziness.

7. In cases of rashes, instruct client

not to scratch the affected area.

Because it may lead to bruises and it will

increase the tendency of infection.

Generic Name: Aluminum/ Magnesium Hydroxide

Brand Name: N/A

Classification: Antacid

Dosage; Route; Frequency: 2 tbsp q 6 hours 2x after meals

Mechanism of Action: It improves the resistance of the stomach lining to

irritation and increase the tone of the lower esophageal sphincter.

Desired Effects: This drug was given to our patient to decrease hyperacidity.

Nursing Responsibilities Rationale1. Administer drug ANST (-). To prevent allergic reaction that may

progress to anaphylactic shock.

2. Inform the patient the adverse

effects such as irritability, n/a,

weakness, rebound hyperacidity,

constipation, and flatulence

To lessen the patient’s worries if ever the

patient experience adverse effects.

3. Instruct patient to shake

suspension well and to follow with a

small amount of milk or water.

To facilitate passage.

4. Watch for evidence of

hypophosphatemia (anorexia,

malaise and muscle weakness) with

prolonged use

To prevent complication.

5. Advice patient not to take Ca

Carbonate indiscriminately or to

switch antacids without the

physician’s advice.

To prevent complications.

6. Instruct patient to notify the

physician about s/s of GI bleeding,

such as black tarry stools, or coffee-

ground vomitus.


Generic Name: Calcium Carbonate

Brand Name: Maalox


Dosage, Route, Frequency: 30 cc TID x 2 days

Mechanism of Action: Reduces total load in the GIT, elevates gastric pH to reduce

pepsin activity, strengthens the gastric mucosal barrier, and increase esophageal

sphincter tone

Desired Effect: This drug is given to our patient in order to prevent further irritation of

the gastric mucosa, thus, relieving the pain experienced by the client.

Nursing Responsibilities Rationale

1. Asses for any allergic reaction of the

drug.

This is necessary to prevent any untoward

anaphylactic reaction.

2. Inform the patient about the possible

adverse reactions of the drug.

This is necessary so as to give

precautionary measures regarding the

occurrence of the adverse effects.

3. Raise side rails as precaution. Re-

orient patient as needed.

Because some patients become

temporarily excited or disoriented while

some develop amnesia or become drowsy.

Generic Name: Tramadol Hydrochloride

Brand Name: Ultram

Classification: Analgesics

Dosage, Route, Frequency: 50 mg IV stat

Mechanism of Action: A centrally acting synthetic analgesic compound not

chemically related to opiates. Thought to bind to opoid receptors and inhibit re-

uptake of norepinephrine and serotonin.

Desired Effect: This drug was given to our patient to relieve the pain brought about by

the disease process.


1. Assess type, location and intensity of

pain before and after 2-3 hours (peak)

after administration.

This is necessary in order to determine

improvements after drug administration.

2. Assess blood pressure and RR before

and periodically during administration.

So as to determine the possibility of

respiratory depression and hypotension as

an effect of the drug.

3. Assess bowel function routinely. In order to determine the presence of

constipating effect of the drug.

4. Advice client to increase intake of

fluids and bulk.

This is necessary to prevent the

constipating effect of the drug.

5. Monitor patient for seizures. Drug may reduce seizure threshold.

6. Caution patient to avoid activities

requiring alertness until response to

medication is known.

In order to prevent injury since dizziness

and drowsiness may occur.

7. Advice patient to change positions

slowly.

In order to prevent orthostatic hypotension.

Generic Name: Scopalamine butylbromide (Hyoscine N-butylbromide)

Brand Name: Buscopan

Classification: Anticholinergic

Dosage, Route, Frequency: 1 amp IM

Mechanism of Action: Inhibits muscarinic actions of acetylcholine on autoimmune

effectors innervated by prostaganglionic cholinergic neurons.

Desired Effect: To prevent spastic states.


1. Assess for any allergic reaction of

the drug.

In order to know the client’s sensitivity to

the drug.

2. Inform the patient about the possible

adverse reactions of the drug.

This is necessary so as to give

precautionary measures regarding the

occurrence of the adverse effects to gain

cooperation.

3. Raise siderails as precaution. Re-

orient patient as needed.

Because some patients become

temporarily excited or disoriented while

some develop amnesia or become drowsy.

4. Keep emergency equipment

available.

In order to be ready in case the patient

becomes overdose.

5. Instruct the patient to avoid

activities that require alertness.

The drug may cause dizziness and

drowsiness.

6. Advise the patient to report urinary To prevent further complication.

hesitancy or urine retention.

Generic Name: Hydroxyzine

Brand Name: Vistaril


Dosage, Route, Frequency: 10 mg/tab 1 tab BID

Mechanism of Action: Blocks the effects of histamine at the histamine 1 receptor

sites decreasing the allergic response. They have also anti-cholinergic and antipriritc

effects.

Desired Effect: This drug was given to our patient to relieve allergic symptoms

associated with release of histamine.


1. Instruct the patient to take this

medication with food or a glass of

water or milk.

To reduce stomach upset.

2. Advise patient not to drink alcoholic

beverages while taking hydroxyzine.

This may increase CNS depression.

3. Instruct the patient to take sugarless

hard candy or gum, ice chips,

mouthwash, or a saliva substitute if dry

mouth is developed. Advise her to

report to the health care provider if dry

mouth persists for longer than 2 weeks.

Because it increases your risk of tooth and

gum problems.

4. Tell the patient to Avoid prolonged

exposure to sunlight. When outdoors,

wear protective clothing, sunglasses,

and sunblock.

To prevent photosensitivity reaction.

Generic Name: Loratadine

Brand Name: Claritin


Dosage, Route, Frequency: 10 mg/tab 1 tab OD

Mechanism of Action: Blocks the effects of histamine at the histamine 1 receptor

sites. Loratadine is a nonsedating antihistamine; its chemical structure prevents

entry into the CNS.




1. Instruct the patient to stop drug 4

days before patient undergoes

diagnostic skin tests.

Because drug can prevent, reduce, or mask

positive skin test response.

2. Warn patient not to engage self in

activities that require alertness until

CNS effects of drug is known.

Because dizziness and headache are

3. Instruct patient to take sugarless

gums, hard candy or ice chips.

To prevent the drying of mouth.

Generic Name: Magaldrate (aluminum magnesium complw

Brand Name: Riopan


Dosage, Route, Frequency: 20 mg/tab 1 tab

Mechanism of Action: Antacid that increase total acid load in GI tact, elevates




1. Monitor magnesium level in patients

with mild renal impairment.

Hypermagnesemia usually occurs only in

severe real failure.

2. Warn patient not to engage self in

activities that require alertness until

CNS effects of drug is known.

Because dizziness and headache are

3. Instruct patient to take sugarless

gums, hard candy or ice chips.

To prevent the drying of mouth.

Drug Studies

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