DRUG STUDY DRUG Generic Name: Tramadol Brand Name: Ultram, Ultram ER INDICATIONS Carbamazepine (Tegretol, Tegretol XR , Equetro,

Carbatrol) reduces the effect of tramadol by increasing its inactivation in the body. Quinidine (Quinaglute, Quinidex) reduces the inactivation of tramadol, thereby increasing the concentration of tramadol by 50%-60%. Combining tramadol with monoamine oxidase inhibitors (for example, Parnate) or CONTRAINDICATIONS Tramadol may increase central nervous system and respiratory depression when combined with alcohol, anesthetics, narcotics, tranquilizers or sedative hypnotics. ACTIONS Tramadol is used in the management of moderate to moderately severe pain. Extended release tablets are used for moderate to moderately severe chronic pain in adults who require continuous treatment for an extended period. SIDE EFFECTS Tramadol is generally well tolerated, and side effects are usually transient. Commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Some patients who received tramadol have reported NURSING RESPONSIBILITIES Assess type, location, and intensity of pain before and 23 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to

selective serotonin inhibitors ((SSRIs, for example, fluoxetine Prozac]) may result in severe side effects such as seizures or a condition called serotonin syndrome.

seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations.

physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause

respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

DRUG

INDICATIONS

CONTRAINDICA TIONS

ACTIONS

SIDE EFFECTS

NURSING RESPONSIBILITIES 1. Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended

Generic Name: Fluconazole Classification: antifungal, antibiotic

Fluconazole is a drug indicated for the treatment and prophylaxis of fungal infections where other antifungalshav e failed or are not tolerated (e.g., due to adverse effects),

Like other imidazol eand triazoleclass antifung als, fluconazol e inhibits the medicine fungal cytochr ome Are taking P450 enzyme terfenadine, 14if 400 mg demethylase. Mammalian per day Have known hypersensiti vity to other azole

Common (1% of patients): rash, headache, dizziness, nausea, vomiting, abdominal pain,

including:[4] Candidiasis ca used by susceptible strains of Candida

Tinea corporis, tinea cruris or tinea pedis Onychomycosi s Cryptococcal

meningitis Fluconazole can be used first-line for the following indications:[4] Coccidioidomy cosis

demethylase activity is much less sensitive to fluconazole than fungal demethylase. This inhibition prevents the t conversion administrati of lanosterol to on ergosterol, an of fluconaz essential component of ole and the quinidine, fungal cytopla especially smic when flucon membrane, and azole is subsequent ac administere cumulation of 14-methyl d in high sterols. Flucon dosages azole is Are primarily fungi static; pregnant. multidose of fluconaz ole is administere d Concomitan

diarrhea, and/or elevated liver enzymes Infrequent (0.11% of patients): a norexia, fatigue, constipatio n Rare (<0.1% of patients): o liguria, hyp okalaemia, paraesthe sia, seizures, a lopecia, St evensJohnson syndrome, thrombocyt

by your doctor. Follow the directions on your prescription label. 2. Your dose will depend on the infection you are treating. Vaginal infections are often treated with only one pill. For other infections, your first dose may be a double dose. Carefully follow your doctors instructions. Tell your doctor if your symptoms do not improve. 3. Take this medicine with a full glass of

Cryptococcosis Histoplasmosis Prophylaxis of candidiasis i n immunocomp

romised people

openia, other bloo d dyscrasi as, serious he patotoxicit y including hepatic failure, ana phylactic/a naphylacto id reactions

water. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dosemeasuring device, ask your pharmacist for one. 4. Take this medication for the entire length of time

Very rare: prolonged QT interval, tor sades de pointes

prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Diflucan will not treat a viral infection such as the common cold or flu.

DRUG

INDICATIONS

CONTRAINDICA TIONS

ACTIONS Essential element of the body; helps maintain the functional integrity of the nervous and

SIDE EFFECTS

NURSING RESPONSIBILITIES 1. do not give if calcium levels is more than normal 2. may take in with food

Generic Name: Calcium Carbonate Classification: Antacid, electrolyte

Dietary supplement wh en calcium intake is inadequate. Treatment of

Contraindic ated in patients with ventricular fibrillation,

CV: Slowed heart rate, tingling, heat waves

calcium deficiency in tetany of the newborn, acute and chronic hypoparathyroi dism, pseudohypopa rathyroidism, postmenopaus al and senile osteoporosis, rickets,

hypercalce mia, hypophaste mia, or renal calculi. Use all calcium products caustiously in patients taking digitalis and in patients with sarcidosis and renal or cardiac disease

muscular systems; helps maintain cardi ac function, blood coagulation; is an enzyme co-factor and affects the secretory activity of endocine and exocrine glands; neutralizes or reduces gastri c acidity (oral use).

(rapid IV administrat ion); peripheral vasodilatio n, local burning, drop in BP (calcium chloride injection) Local: Local irritation, severe necrosis, sloughing and abscess formation )IM, subcutane ous use of calcium chloride)

3. increase fluid intake if constipation occurs 4. eat small frequent feedings if nausea occurs 5. take with a large glass of water

osteomalacia. Prevention of hypocalcemia during exchange transfusions. Adjunctive therapy for insect bites or stings, such as black widow spider bites;

sensitivity reactions, particularly when characterized by urticaria; depression due to overdose of magnesium sulfate; acute symptoms of lead colic. Improves weak or ineffective myocardial contractions when epinephrine falls in cardiac resuscitation , particularly after open heart surgery. Symptomatic relief of upset

Metabolic: Hypercalc emia (anorexia, nausea, vomiting constipatio n, abdominal pain, dry mouth, thirst, polyuria), rebound hyperacidit y and milkalkali syndrome (hypercalc emia, alkalosis, renal damage withcalciu m

stomach associated with hyperacidity; hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, hiatal hernia. Prophylaxis of GI bleeding, stress ulcers, and aspiration pneumonia; possibly useful.

carbonate used as an antacid.

DRUG

INDICATIONS Prevention & therapy of damages due to faulty or deficient protein metabolism in

CONTRAINDICA TIONS Allergy and hypersensitivity to any content of this drug

ACTIONS Normalizes metabolic process, promotes recycling

SIDE EFFECTS hyperkalemia

NURSING RESPONSIBILITIES 1. Evaluate for any contraindications 2. Take drug as prescribed

Generic Name: Ketosteril Classification:

Essential Amino Acid

chronic renal insufficiency together w/ a protein restricted (40 g/day) diet. Protein energy malnutrition Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure

Hypercalcaemia Disturbed amino acid metabolism Caution use for patietn with phenylketonuria

product exchange. REduces ionconcentrati on of potassium, magnesium and phosphate.

3. Warn the patient about possible side effects and how to recognize them 4. Give with food if GI upset occurs 5. Frequently assess for hypercalcemia

DRUG

INDICATIONS After topical application on the

CONTRAINDICA TIONS Contraindicated i

ACTIONS After topica lapplication on

SIDE EFFECTS Burning

NURSING RESPONSIBILITIES

Generic Name: Zinc Oxide Topical Classification: Antibacterial

skin, Zinc Oxide has an adstringent and antiseptic action.

n patients hypersensitive to drug/ointment. Not applied ondischarging wound surface. The ointment should never be used whilepregnant or nursing a baby, and should never be used on the breast area.

the skin, Zinc Oxide has an adstringent and antiseptic action.

Stinging Itching Tingling Dark discoloration of skin

Asses allergic reactions: rash. Make sure to completely cover the area that needs to be treated. Dont let the patient rub theointment on the affected area.

DRUG

INDICATIONS Trophoblastic neoplasms (choriocarcinoma , Hydatidiform Mole) Leukemia Breast, head and neck carcinoma Severe psoriasis and rheumatoid

CONTRAINDICA TIONS

ACTIONS Methotrexate works against folic acid metabolism which leads to the inhibition of DNA synthesis and cell production. The drugs

SIDE EFFECTS 1. 2. 3. 4. 5. 6. Dizziness Drowsiness Headaches Malaise Anorexia Nausea and vomiting 7. Hepatoxicity 8. Alopecia 9. Ulcerative stomatitis

NURSING RESPONSIBILITIES 1. Solutions for injection must be prepared in a biologic cabinet. Gloves, gown and mask are worn while preparing and handling the medication. 2. Administer

Generic Name: Methotrexate Classification: Antineoplastic, antirheumatic, immunosuppre ssant, antimetabolite

Known allergic hypersensitivi ty to the drug Pregnancy Methotrexate ha s caused fetal death and/or congenital anomalies,

arthritis unresponsive to conventional therapy Ectopic pregnancy Lymphosarcoma Mycosis fungoides

therefore, it is not recommended in women of childbearing potential unless there is imperative medical evidence that the benefits can be expected to outweigh the considered risks. Pregnant psoriatic patients should not receive this drug. Concomitant use of other drugs that has a hepatotoxic potential (including alcohol) should be avoided.

principal mechanism is through competitive inhibition of the enzyme folic acid reductase. For the cells to proliferate and replicate, folic acid must be reduced to tetrahydrofolic acid by this enzyme (folic acid reductase) in the process of DNA synthesis and cellular replication. With the dministration of Methotrexat e, the reduction of folic acid to

10. Leukopenia Allopurinol per 11. Chills and doctors order to fever decrease uric acid 12. Photosensivi levels. ty 3. Instruct patient to 13. Thrombocyto avoid caffeine as it penia may decrease the 14. Hyperurece efficacy of the mia drug. 4. To prevent hematologic toxicity (platelet levels are decreased) salicylates, NSAIDs, phenytoin, tetracycline and chlorampenicol should be avoided.

tetrahydrofolic acid is inhibited thus, interfering with the tissue cell reproduction. Because of this function, death of rapidly replicating cells (e.g. cancer cells, choriocarcino ma, leukemia, carcinoma in different body parts and ectopic pregnancy) specifically the malignant ones is made possible. It also has an immunosuppr essive activity.