DRUG STUDY

GENERIC NAME/ BRAND NAME

CLASSIFICATION

DOSAGE/

ROUTE/ FREQ.

THERAPEUTIC ACTION

INDICATION ADVERESE REACTION/SIDE

EFFECT

INTERACTIONS

CONTRAINDICATION

NURSING IMPLICATION/

INTERVENTION

HYDROCORTISONE SODIUM SUCCINATE[SOLU-CORTEF]

Short-acting Corticosteroids

Anti-inflammatory

100 mg q 8 hrs

Suppresses inflammatory and immune responses, mainly by inhibiting migration of leukocytes and phagocytes and decreasing inflammatory mediators

Replacement therapy in adrenocortical insufficiency; hypercalcemia due to cancer;arthriris; collagen disease; dermatologic disease; autoimmune and hematologic disorder; trichinosis; ulcerative colitis; multiple sclerosis; aspiration pneumonia

CNS: headache, nervousness, vertigo, insomnia, restlessness, increase ICP, seizureCV: hypotension, hypertension, heart failure, thrombophlebitis, fat embolism, arrhythmiasEENT: glaucoma, cataract, increase ICP, epistaxis, nasal congestion, hoarseness, nasopharygeal/ esopharygeal fungat infection.GI: nausea and vomiting, abdominal distention, dry mouth, rectal bleeding, peptic ulceration, pancreatitis.METAB: sodium and fluid retention, hypokalemia,

DRUG-DRUG:Loop and diuretics, hormonal contraceptives, insulin, NSAID’s, rifampin.DRUG-Dx TEST:Ca, k, T3, T4, cholesterol, glucose, digoxin assayDRUG-HERBS:Gensing, echinacea

Hypersentivity to drug

Other immunosuppressant corticosteroids

Hypertension,osteoporosis, glaucoma, renal & GI disease, cirrhosis

Pregnant breastfeeding patient

Children age 6 and younger

Give oral form with food or milk to avoid GI upset

Give I.V. injection of sodium succinate from over 30 sec. to few min.

Know that drug may be given as intermittent or continuous I.V. dilute in NSS, D5W, and D5NSS.

Monitor BP, weight, and electrolytes.

As appropriate, review all other significant and life-threatening adverse reactions and interaction, especially those related to the drugs, tests, herbs, and behaviors.

hypocalemia, hyperglycemia, amenorrhea, growth retardation, hypothalamic-pituitary suppression.Musculoskeletal: osteoporosis, muscle pain, loss of muscle mass, aseptic joinr necrosis, RESP: cough, wheezing, rebound congestion, brochospasm.SKIN: rash, pruritus, urticaria, acne, petechea.Other: anaphylaxis

LEVOFLOXACIN[LEVOFLOXACIN]

Fluoroquinone

Anti-infective

500 mg I.V. OD

Inhibits the enzyme DNA gyrase in susceptible gram-negative and gram-positive aerobics and anerobic bacteria, interfering with bacterial DNA synthesis.

Acute bacterial exacerbation of chronic bronchitis

Community-acquired pneumonia

Nosocomial pneumonia caused by nethicillin-susceptible strains of staphylococcus aureus.

Acute bacterial sinusitis

Uncomplicated

CNS: dizziness, headache, insomnia, seizureCV: chest pain, palpitation, hypotension.EENT: photophobia, sinusitis, pharyngitis.GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, flatulence,

DRUG-DRUG: Antacids containing aluminum, or magnesium, cimetidine, NSAID’sDRUG-Dx TEST:Glucose, lymphocytes, EEGDRUG-FOOD: milk, yogurt.DRUG-HERBS:

Hypersensitito drug or qunolones

Bradycardia Acute

myocardial ischemia

Renal impairment, underlying CNS disease

Elderly patient

To prepare I.V infusion, use compatible sol’n, such as 0.9% sodium chloride injection, D5% and 0.9% NSS, D5%W, D5%LR sol’n.

Infuse over 60-90 minutes, depending to the dosage. Don’t infuse with other drugs.\avoid rapid or bolus I.V administration, because this may

skin to skin structure infection

Complicated or uncomplicated UTI, acute pyelonephrits.

Chronic bacterial prostitis

Conjunctivitis Corneal ulcer Inhalation anthrax

pseudomembranous coitis.GU: vaginitisHEMA: lymphocytopeniaMETAB: hyperglycemia, hypoglycemiaMUSC: back pain, tendon rupture, tendinitisSKIN: photosensitivityOther: altered taste, pain on I.V site

fennel, st. john’s wortDRUG-BEHAVIOR: sun exposure

cause severe hypotension.

Flush I.V line before and after infusion.

Check v/s, especially BP. Too-rapid infusion can cause hypotension.

Closely monitor patient with renal insufficiency.

Assess severe diarrhea, w/c may indicate pseudomembranouscolitis.

Watch for hypersensitivity reaction. D/C immediately if rash or other sign and symptoms occur.

PHYTONADIONE[VITAMIN K]

Vitamins Anti-

haemorrhagic

1 amp I.V. OD

Promotes hepatic synthesis of prothrombin, proconvertin, plasma thromblastin component, and stuart factor

Hypothrobinemia Prevention and

treatments of hemorrhagic disease in new born.

Hyperbilirubinemia (n infant); with parenteral administration- pain, sweeling, tenderness at injection site; itching rash after repeated injection, transient flushing sensation, peculiar taste, anaphylactoid reaction.

GI: gastric upset, unusual taste.

Derm: flushing, rash, urticaria. Hemat: hemolytic anemia. Misc: allergic reactions, hyperbilirubinemia

(large doses in very premature infants),

Contraindicated in hypersensitivity to drug or to its components. (life-threatening reactions resembling hypersensitivity have occurred during and immediately after I.V injection).

Should be protected from light

Should not be allowed to freeze

Should be stored at 25°C or below

Should not be used if turbid

kernicterus. Use cautiously in pregnant or breasetfeeding patient, children, neonates.

Avoid P.O use in disorder that may prevent adequate absorption.

PIPERACILLIN SODIUM AND TAZOBACTAM SODIUM[PIPTAZ]

Penicillin(extended-spectrum), beata-lactamase inhibitorAnti-infective

2.25 gms. Q 8 hrs I.V OD

Piperacillin inhibits bacterial cell- wall synthesis, resulting in cell death. Tazobactam increases piperacillin efficacy

Community-acquired pneumonia

Rupture appendix Peritonitis Pelvic

inflammatory disease

Skin and skin structure infections

Nosocomial infection

CNS: headache insomnia, agitation, dizziness, anxiety, depression, twitching, coma,seizure.

CV: hypertension, chest pain, tachycardia.

EENT: rhinitis, glossitis

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pai, pseudomembranuous colitis.

GU: proteinuria, hematuria, vaginal candidiasis,

DRUG-DRUG:Aminoglycoside,aspirin, hormonal contraceptive, methotrexate, tetracyclines, vecuroniumDRUG-Dx TEST:Urine glucose test, urine protein, eosinophils, granulocytes, Hgb, platelets

Hpersensivity to penicillin, cephalosporin, imipenems, or beta-lavtamase inhibitors

Neonates Heart failure Renal

insufficiency Seizure Bleeding

disorder Uremia Hypokalemia Cystic

fibrosis Patient with

sodium restriction

Pregnant or breastfeeding patient

Ask patient about allergy to penicillins.

Dilute each gram with 5cc of diluents, such as sterile or bacteriostatic water injection, NSS, D5W, D5NSS, don’t use LR.

Shake vial until drug dissolve. Dilute again to a final vol. of 50 cc, infuse over 30 min.

Assess neurologic status especially for seizure.

Monitor vital sign and i&O

Instruct client to report rash, hives, severe diarrhea, black tongue, sore throat, fever, or unusual bleeding or bruising

Tell patient to

vaginitis, oliguria, interstitial glomerulonephritis.

HEMA: anemia, increased bleeding, bone marrow defression, leucopenia, thrombocytopenia.

METAB: hypokalemia, hypernatremia.

RESP: dyspnea SKIN: rash,

pruritus Other: fever,

pain, edema, inflammation, or phlebitis at I.V site, superinfection, hypersensitivity reaction, including serum sickness and anaphylais

instruct to monitor I & O, annnd report significant changes.

Kept patient monitored

PARACETAMOL[BIOGESIC]

Anti-pyretics

Pain reliever

500 mg 1 tab q 4 hrs/ 300 mg, 1 amp q 4 hrs

May cause analgesia by inhibiting CNS prostaglandin synthesis

Decreases fever by inhibiting the effects of pyrogens

Temporary relief of pain and discomfort for headache, fever, cold, flu, minor muscular aches, overexertion

Hemolytic anemia Leucopenia Neutropenia panyctopenia, Thrombosytopeni

a liver damage, jaundice, hypoglycemia,

Barbiturates, carbamapezine, hydantoins, isoniazid, rifampin, sulfinpyrazone: May reduce therapeutic effect and

Contraindicated with allergy to acetaminophen

Use cautiously with impaired hepatic

Assess patients pain

or temperature before

beginning treatment

Be alert for signs of

adverse reactions.

on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation

rash enhance hepatotoxic effects of acetaminophen with high doses or long-term use of these drugs. Avoid use together.

Lamotrigine: Serum lamotrigine concentrations may be reduced and may decrease therapeutic effects.

Warfarin: May increase hypoprothrombin-emic effect with long-term use of high doses. Monitor PT and INR closely.

function, chronic alcoholism, pregnancy, lactation

Tell patient not to use

drug fever that’s

higher than 103.1 F

Warn patient that high doses and unsupervised long term use can cause liver damage

tell patient keep tract of daily oral drug intake

Ethambutol HCl 300 mg, INH 75 mg, rifampicin 150 mg

[MYRIN P]

Anti-TB agent

1 tab AC breakfast, AC lunch

Unknown, may interfere with synthesis of one or more bacterial metabolites, altering RNA synthesis during cell devision

initial & continuation phase of pulmonary & extrapulmonary TB.

Leukopenia, Thrombocytope

nia Neutropenia anaphylactic/

anaphylactoid reaction

Neurotoxic drugs

Al-containing antacids

Phentolamine

Alcoholism optic neuritis, impaired

hepatic function,

severe renal

Should be taken on an empty stomach (Take 1 hr before or 2 hr after meals.)

Administer in a single daily dose;

pemphigoid reaction

Anorexia elevations of

serum uric acid concentration

Dizziness Hypoesthesia Paresthesia decrease in

visual acuity epigastric

distress Constipation Nausea Vomiting abdominal pain metallic taste dry mouth liver

impairment Pruritus Rash toxic epidermal

necrolysis joint pain acute gout Fever Lymphadenopat

hy lupus-like Rheumatoid Stevens-

Johnson &

coumarin-type drugs

OCs sulfonylure

a oral antidiabetic agents

phenobarb systemic β-

adrenergic blocking agents

corticosteroids

digitalis glycoside

estramustine

clofazimine inandione

derivative anticoagulants,

benzodiazepines

hepatotoxic medications  or

parenteral miconazole

Cheese eg Swiss or Cheshire

fish eg tuna

insufficiency,

hyperuricemia

gouty arthritis

jaundice, retrobulbar neuritis.

Patients w/ mental illness/deficiency.

Childn <13 yr.

Pregnancy & lactation.

must be used in combination with other anti-TB drug

Take drug regularly; avoid missing dose. Do not D/C this drug without first consulting your AP.

Avoid aluminum-containing antacids within 1 hour of taking drugs

Arrage to have a periodic medical check-ups, which will include an eye examination

Instruct the client about the effect of anti- tb drugs

prostatic obstruction syndrome

Arthritic symptoms.

Fungal overgrowth

renal & hepatic effect

; malaise menstrual

disturbances tinnitus.

or sardines.

Buclizine HCl 25 mg, vit B1 10 mg, vit B12 25 mcg, vit B6 5 mg, vit C 500 mg

[APPEBON]

Appetite Enhancers 

1 tab OD The mechanism by which buclizine exerts its antiemetic and antimotion sickness effects is not precisely known but may be related to its central anticholinergic actions. It diminishes vestibular stimulation and depresses labyrinthine function. An action on the medullary chemoreceptive trigger zone may also be involved in the antiemetic effect.

Thiamin is used in all key metabolic processes in the nervous system, heart, blood cells and muscles. It helps convert carbohydrates into energy and is useful in the treatment of nervous disorders. It may also be useful in treating certain types of heart disease.

tamin B6 is a water

Poor appetite Underwt  anorexia

nervosa. For nutritional support in post-op cases,

metabolic disorders & convalescence.

Drowsiness & dulling of mental alertness

dry mouth, headache, nausea, jitteriness, tiredness.

Reduce the effectiveness of l dopa. CNS depressants, alcohol.

Angle closure glaucoma,

prostatic hypertrophy

primary hemochromatosis.

instruct client not to take alcohol

take sips of water for dry mouth

monitor patient status

safety precaution

soluble vitamin that is probably involved in more bodily processes than any other vitamin. It functions as a coenzyme, helping to speed up chemical reactions in cells. It is required by over 60 enzymes. There is evidence that it also plays a role in preventing and treating many diseases including heart disease.

Some women suffering from premenstrual syndrome (PMS) find that supplementing with Vitamin B6 brings relief from their symptoms. It is thought that this is down to its role in clearing out excess oestrogen from the body.

Vitamin B6 is required for Vitamin B12 to be absorbed.

bsorption of Vitamin B12 by the body is a very complicated process. Low levels of stomach acid or low levels of intrinsic factor can lead to deficiencies, which is why people over the age of 50 may have difficulty absorbing it from food. However the body generally has good reserves of Vitamin 12.

Vitamin B12 is essential for cell replication, especially red blood cells. It maintains the protective myelin sheath around nerves, helps convert food to energy, and plays a vital role in the creation of DNA and RNA, the

genetic material in cells.

ivabradin HCl[CORALAN]

Ant-anginal 7.5 mg 1 tab BID

Ivabradine is a pure heart rate-lowering agent, acting by selective and specific inhibition of the cardiac pacemaker Ifcurrent that controls the spontaneous diastolic depolarisation in the sinus node and regulates heart rate. The cardiac effects are specific to the sinus node with no effect on intra-atrial, atrioventricular or intraventricular conduction times, nor on myocardial contractility or ventricular repolarisation

Symptomatic treatment of chronic stable angina pectoris in coronary artery diseasepatients w/ normal sinus rhythm.

Cardiovascular: bradycardia, palpitations, supraventricular extrasystoles

GI: nausea, constipation

Concomitant use not recommendedQT prolonging medicinal products- Cardiovascular QT prolonging medicinal products (e.g. quinidine, disopyramide, bepridil, sotalol, ibutilide, amiodarone).- Non cardiovascular QT prolonging medicinal products (e.g. pimozide, ziprasidone, sertindole, mefloquine, halofantrine, pentamidine, cisapride, erythromycin IV).The concomitant use of cardiovascular and non cardiovascular QT prolonging medicinal products with ivabradine should be avoided since QT prolongation may be exacerbated by heart rate reduction. If the combination appears necessary, close cardiac monitoring is needed.Pharmacokinetic interactionsCytochrome P450 3A4 (CYP3A4)Ivabradine is metabolised by CYP3A4 only and it is a very weak inhibitor of this cytochrome. Ivabradine was shown

Hypersensitivity, blood pressure is <90mmHg; sick sinus syndrome

Monitor BP and pulse before therapy, during dosage titration, and periodically throughout therapy.

Assess for signs of CHF ( peripheral edema, crackles, dyspnea, weight gain, jugular venous distention)

Angina: Assess location, duration, intensity and precipitating factors of patient's anginal pain.

Hypertension: Check frequency of refills to monitor adherence.

Monitor serum potassium periodically. Hypokalemia increases the risk of arrhythmias and should be corrected.

not to influence the metabolism and plasma concentrations of other CYP3A4 substrates (mild, moderate and strong inhibitors). CYP3A4 inhibitors and inducers are liable to interact with ivabradine and influence its metabolism and pharmacokinetics to a clinically significant extent. Drug-drug interaction studies have established that CYP3A4 inhibitors increase ivabradine plasma concentrations, while inducers decrease them. Increased plasma concentrations of ivabradine may be associated with the risk of excessive bradycardia.

DIGOXIN[LANOXIN]

Cardiac glycoside

Inotropic Anti-

arrythmic

0.25 mg 1 tab OD

Increases forces and velocity of myocardial contraction and prolongs refractory period of atrioventricular (AV) node by increasing calcium entry into myocardial cell. Slows conduction through sinoatrial and AV nodes and produces anti-arrhythmic effect

Heart failure Tachyarrhythmias Atrial fibrillation Flutter Paroxysmal atrial

tachycardia

CNS fatigue, headache, astheniaCV: bradycardia, ECG changes, arrhythniasEENT: blurred or yellow visionGI: nausea and vomiting, diarrheaGU: gynecomastiaHEMA: thrombocytopeniaOther: decreased appetite

DRUG-DRUG: Amiodarone, cyclosporine, diclofenacCorticosteroids, loop diuretica and thiazide, antacids, beta-adrenergic blockersThyroid hormonesDRUG- Dx TEST:Creatinine kinase,

Uncontrolled ventricular arrhhythmias

AV block Idiophatic

hypertrphic subaooortic stenosis

Constrictive pericarditis

Supraventricular tachyarrhythmias

Intrauterine tachyarrhyth

Assess apical pulse regularly for a full minutes. If rate is less than 60 beats/ min. withhold dose and notify physician

Monitoer for drug toxicity (nausea and vomiting, visual disturbances, arrhythmias, and altered mental status).

Monitor ECG and blood digoxin, potassium,

DRUG-HERBS:Coffee seed, cola seed, ephedra, st. john’s wort

mias Renal

impairements Hyperthyroid Elderlt

patientDdobesity

magnesium, calcium, creatinine

Stay alert for hypocalcemia. Know that digoxin toxicity, and may decreased digoxin efficacy

Tell patient to take drug at same time everyday

Teach patient how to recognize and report signs and symptoms of digoxin toxicity

Monitor BP and HR..REBAMIPIDE[MUCOSTA]

Antacids, Antireflux

Agents Antiulcerant

s

100 mg , 1 tab OD

Rebamipide is a mucosal protective agent and is postulated to decrease gastric blood flow, prostaglandin biosynthesis and decrease free oxygen radicals

Acute gastritis & acute exacerbation of chronic gastritis. Gastric ulcer

CNS: confusion, dizziness, drowsiness, hallucination, peripheral-neuropathy, brain stem dysfunction.CV: hypotension, arrhythmias, cardiac arrestGI: nausea, diarrhea, constipationHEMA: anemia, neutropenia, thrombocytopenia, agranulocytopenia, aplastic anemiaHEPATIC: hepatitisOther: altered tasye, pain at I.M injection site, hypersensitivity

Alkalinization of gastric content decreases the bioavailability of Fe,

ketoconazole & tetracyclines. The absorption of tetracyclines is further reduced by its chelation with Al & Mg ions

Contraindicate in hypersensitivity to any anti-ulcer drugs and in alcohol intolerance

Renal impairment

Elderly patient

Breastfeeding

Monitor for resolution of GI symptom

Assess CBC in liver function tests

Assess constipation Monitor electrolytes

levels as appropriate

DIBENCOZIDE

[HERACLENE]

Appetite enhancer

1 cap OD Dibencozide increases the protein "efficiency coefficient" ie, the percentage of "bound nitrogen" for protein build-up in the body compared to "ingested nitrogen" with food intake. The initial sign of effectiveness is manifested by a marked increase in appetite.Thus, dibencozide facilitates optimum utilization of dietary protein intake, contributes to the formation and repair of body tissues and stimulates appetite.

Premature babies

Low birth wt. retarded growth poor appetite in

infant children &

adult, adjuvant to treatment of TB & other chronic ailments

Convalescence from acute infection or surgery

Faulty nutrition in older people.

Dibencozide seems to be safe for most people. There are no reported side effects.Special Precautions & Warnings:Pregnancy and breast-feeding: Not enough is known about the use of dibencozide during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Gastrointestinal (GI) conditions: Some GI conditions, such as ileal disease or surgical removal of part of the intestine, can reduce that amount of Vitamin B12, including dibencozide, that is absorbed from the intestine.

Chloramphenicol interacts with DIBENCOZIDE

Dibencozide is a form of vitamin B12. Vitamin B12 is important for producing new blood cells. Chloramphenicol might decrease new blood cells. Taking chloramphenicol for a long time might decrease the effects of dibencozide on new blood cells. But most people only take chloramphenicol for a short time so this interaction isn't a big problem

Dibencozide is a form of vitamin B12, since it is a nutritional supplement and not a medication, the side effect profiles and contraindications have not been studied. 

However, it is important not to use it more often than directed, as too much Vitamin B12 can cause health problems

Take with food Report any lactose

intolerance

LANAOPRAZOLE[PREVACID]

Antiulcer agents,

Proton-

30 mg , 1 tab + 5 ml water

Binds to an enzyme in the presence of acidic gastric pH,

Erosive esophagitis, duodenal ulcers,

CNS: headache, dizziness

GI: abdominal

Drug with pH-dependent absorption

Hypersensitivity

Amoxicillin

Assess patient routinely for epigastric or

pump inhibitors

preventing the final transport of hydrogen ions into the gastric lumen.Therapeutic effect: Diminished accumulation of acid in the gastric lumen,with lessened acid reflux

active benign gastric ulcer, short-term

treatment of symptomatic GERD, healing and risk reduction of NSAIDassociated

gastric ulcer, Pathologic hypersecretory conditiond, including

Zollinger-Ellison syndrome.

pain, diarrhea, nausea

Derm: rash.

kinetics Warfarin Tacrolimus theophylline

clarithomycin abdominal pain and for frank

or occult blood in stool, emesis, or gastric aspirate.

Administer before meals. Capsules may be opened and sprinkled on 1

tbsp of applesauce, pudding, cottage cheese, or yogurt and swallowed

immediately for patients with difficulty swallowing. Do not crush or

chew capsule contents

Advise patient to avoid alcohol, products containing aspirin, or NSAIDs, and foods that

may cause an increase in GI irritation

Protein, carbohydrate, vitamins Protein, carbohydrate, vitamins[FRESBIN MILK]

Fat/carbohydrates/proteins/minerals/vitamins, combinations ;

Used as

3 scoop in ½ glass of water q TID

Aflavoured liquid consisting of protein(milk),carbohydrate(maltodextrinandsucrose),vegetableoils(rapeseedandsunfloweroils), minerals, vitamins and trace elements

Provides complete & balanced nutrition; sole source of nutrition (meal replacement) or food (diet) supplement.

No side effect mention

Iron supplementation

Lactise intolerance

Allergy on any ingredients of the product

Hypsersensitivity to milk

Instruct client to mix 3 scoop of fresubin milkto ½ glass of sterile water

Use measuring cup Maintain clean

preparation

general nutrients.

FENOTEROL[BERODUAL]

Antiasthmatic & COPD Preparations

1 neb q 8 hrs

Ipratropium bromide-salbutamol fixed-dose combination (FDC) maximizes the response to treatment in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD) by increasing bronchodilation through 2 distinctly different mechanisms ie, anticholinergic (parasympatholytic) and β2-agonist

Prevention & treatment of symptoms in chronic obstructive airway disorders w/ reversible bronchospasm eg bronchial asthma & esp chronic bronchitis w/ or w/o emphysema.

Fine tremor of skeletal muscles,

nervousness, restlessness, palpitations; less frequently tachycardia, dizziness or headache. Dry mouth, throat irritation

or allergic

reactions, cough, paradoxical bronchoconstric

tion (rare). Urinary

retention may occur in particular,

in patients w/ preexisting outflow tract obstruction.

Other β-adrenergics,

anticholinergics,

xanthine derivatives;

β-blockers; diuretics; 

digoxin , MAOIs,

tricyclic antidepressants;

halogenated hydrocarbo

n anesth

Hypertrophic obstructive

cardiomyopathy,

tachyarrhythmias.

Hypersensitivity to atropine-like substances or soya lecithin or related food products 

Nursing

Responsibilities:

>Before

administering,

check for doctor’s

order.

>Give drug with

right dosage, route,

and time for

administration.

Prior to the

procedure:

Read the

Doctor’s order

before giving

the medication

to the patient,

and always

remember the

10 R’s

Inform the

patient about the

action and the

purpose of the

drug.

Before giving

the medication

ask the patient

first if she

already take the

medications or

not.

Note if all the

medications are

available, if one

of the

medication are

not available

make a

prescription and

ask the patient’s

SO to buy it for

the patient.

Check if the

nebulizer is

functioning

Prepare the drug

by diluting it

with distilled

water

During the procedure:

Make sure that

the patient will take the

medications on time.

If the

medication is an IV

route, make sure that

you administer it on

time.

Always be at

the bedside of the

patient in order to help

the patient in taking her

medications.

Follow the

directions on your

prescription label

Monitor the

patient while inhaling

the atomized drug if it

is in proper place

Instruct patient

to take medication as

directed for the full

course of therapy.

After the procedure:

Instruct patient

to take medication at

evenly spaced times

and to finish the

medication completely.

Observe for side

effects or allergies.

Inform the

patient on the specific

time the medication is

to taken again.

Inform patient

that increased fluid

intake and exercise may

minimize constipation

Document.

FLUTICASONE[FLIXOTIDE]

Prophylactic management for mild, moderate, severe asthma

Symptomatic COPD

1 neb q 12 hrs

Glucocorticoid with a high topical anti-inflammatory potency. It has a strong affinity for and agonist activity at human glucocorticoid receptors.

It is used by inhalation for the prophylaxis of the symptoms of asthma; also, is administered by nasal spray in the prophylaxis and treatment of allergic rhinitis.

It is applied topically in the treatment of various skin

Candidiasis dryness of mouth

and throat Hoarseness Paradoxical

bronchospasm. Cutaneous

hypersensitivity reactions.

Possible systemic effects include suppression of adrenal function, growth

Ritovir Ketoconazole MOI TCA Beta2-

adrenergic blocker

diuretics

Primary treatment of severe acute asthmatic attacks or status asthmaticus when intensive measures are required. When applied topically:

Advice patient that drug is for long term maintenance.

Tell the patient not to stop oral or inhaled long acting beta agonist.

Instruct patient on the proper way of drug inhalation and not to exceed dose under any

diorders. retardation in children and adolescents, decrease in bone mineral density,

cataract and glaucoma.

rosacea, acne vulgaris, perioral dermatitis, perianal and genital pruritus. Cutaneous viral infections

circumstances.

Instruct to rinse mouth after inhalation.

SALBUTAMOL[VENTOLIN]

Therapeutic: bronchodilators, anti-asthmatic

Pharmacologic: beta-adrenergics agonist

1 neb q 4 hrs

Is a beta2-adrenergic agent which acts on airway smooth muscle resulting in relaxation. Salbutamol relaxes all smooth muscle from the trachea to the terminal bronchioles and protects against all bronchoconstrictor challenges

Treatment/ prevention of bronchospasm

Tachycardia Dizziness Palpitations headache,

especially in hypersensitive patients

Cough Headache Nervousness Sinus

inflammation Sore or dry throat Tremor Trouble sleeping Unusual taste in

mouth Vomiting Paradoxical

bronchospasm Hypokalemia Immediate

hypersensitivtity reaction

Beta-blocker Diuretics Digoxin MAO/TCA

Hypersensitive reaction.

Urticania. Anginoedem

a. Rashes Anaphylaxis. Oropharynge

al edema

Instruct the patient on the how to use the nebulizer.

Instruct the patient on the frequency of nebulization.

Instruct the patient what to do during the asthma attack.

Advice the client when to attend for follow-up visits.

FLUCONAZOLE

Antifungal 200 mg 1 cap q

Binds to sterols in the fungal cell

Treatment of oropharyngeal,

CNS: Headache GI: Nausea,

Drug-drug Increased

Contraindicated with

Interventions Culture infection

DIFLUCAN BID membrane, changing membrane permeability; fungicidal or fungistatic depending on concentration and organism.

esophageal, vaginal, and systemic candidiasis

Treatment of cryptococcal meningitis

Prophylaxis of candidiasis in bone marrow transplants

vomiting, diarrhea, abdominal pain

Other: Rash

serum levels and therefore therapeutic and toxic effects of cyclosporine, phenytoin, benzodiazepines, oral hypoglycemics, warfarin anticoagulants, zidovudine

Decreased serum levels with rifampin, theophylline, tacrolimus

hypersensitivity to fluconazole, lactation.

Use cautiously with renal impairment.

prior to therapy; begin treatment before lab results are returned.

Decrease dosage in cases of renal failure.

Infuse IV only; not intended for IM or SC use.

Do not add supplement medication to fluconazole.

Administer through sterile equipment at a maximum rate of 200 mg/hr given as a continuous infusion.

Monitor renal function tests weekly, discontinue or decrease dosage of drug at any sign of increased renal toxicity.

Teaching points Drug may be given

orally or intravenously as needed. The drug will need to be taken for the full course and may need to be taken long term.

Use hygiene measures to prevent reinfection or spread of infection.

Arrange for frequent follow-up while you are using this drug. Be sure to keep all appointments, including those for blood tests.

These side effects may occur: Nausea, vomiting, diarrhea (eat frequent small meals); headache (analgesics may be ordered).

Report rash, changes in stool or urine color, difficulty breathing, increased tears or salivation.

TERGECEF[TERGECEF]

Cephalosporin

Anti-infective

200 mg 1 cap BID

Third general cephalosporin that inhibits cell wall synthesis, promoting osmotic instability usual bactericidal.

Bronchitis bronchiectasis

with infection, secondary infections of chronic respiratory tract diseases

pneumonia Pyelonephritis Cystitis gonococcal

urethritis Cholecystitis Cholangitis scarlet fever Otitis media Sinusitis.

Shock Hypersensitivity hematologic

disorder GI disorder Vita. K

deficiency.

DRUG-DRUG:Aminoglycoside,aspirin, hormonal contraceptive, methotrexate, tetracyclines, vecuroniumDRUG-Dx TEST:Urine glucose test, urine protein, eosinophils, granulocytes, Hgb, platelets

Hpersensivity to penicillin, cephalosporin, imipenems, or beta-lavtamase inhibitors

Neonates Heart failure Renal

insufficiency Seizure Bleeding

disorder Uremia Hypokalemia Cystic

Ask patient about allergy to penicillins.

Dilute each gram with 5cc of diluents, such as sterile or bacteriostatic water injection, NSS, D5W, D5NSS, don’t use LR.

Shake vial until drug dissolve. Dilute again to a final vol. of 50 cc, infuse over 30 min.

Assess neurologic status especially for seizure.

Monitor vital sign and i&O

fibrosis Patient with

sodium restriction

Pregnant or breastfeeding patient

Instruct client to report rash, hives, severe diarrhea, black tongue, sore throat, fever, or unusual bleeding or bruising

Tell patient to instruct to monitor I & O, annnd report significant changes.

Kept patient monitored[AMINOLEBAN]

A balance and tolerable food supplement to nutritionally support patients with liver disease.

500 cc @ 20cc/hr q 24 hrs

 Hepatic encephalopathy is a neuropsychiatric syndrome that develops secondary to liver disease or to portal-systemic shunting of blood, or both. In such a patient, plasma concentrations of aromatic amino acids (phenylalanine, tyrosine, tryptophan) is found to be higher than normal while the plasma concentration of

For the treatment of Hepatic Encephalopathy in patient with chronic liver disease.

Hypersensitivity: rare skin eruptions

Gastrointestinal: occasional nausea and vomiting

Others: occasional chills, fever, headache

Patient with abnormal amino acid metabolism (since the infuse amino acids are not adequately metabolized

The patient clinical condition may be worsened.)

Use with care in patients with severe acidosis and those with congestive heart failure.

• Asses’ patient’s condition before starting the therapy.

• Be alert to adverse reaction.

• Monitor patient temperature.

If GI reaction occur monitor patient hydration

BCAA (leucine, isoleucine, valine) is lower than normal. It was suggested that a disturbance of plasma amino acid pattern may cause a disturbance in the brain amino acid concentration. Brain neurotransmission is then impaired by an inhibition of dopamine and noradrenaline synthesis, leading to an increase of false neurotransmitters including octopamine and phenylethanolamine. These toxic substances are suspected to induce hepatic encephalopathy. BCAA is given to normalize the amino acid

imbalance in the plasma in order to compete with AAA for an uptake into the brain.

In addition, after the infusion of high BCAA solution, the ammonia concentration in the blood is also decreased mainly due to the detoxification of ammonia to form glutamine.

Another unique quality of BCAA is that they are mostly metabolized in the skeletal muscle, not in the liver. They then become good sources in providing peripheral energy. In catabolic state,

BCAA play an important role in preventing the muscle protein breakdown and in promoting protein synthesis to maintain positive nitrogen balance.