In Partial Fulfillment of the Subject NCM 103 RLE (Drugs Study )

Submitted By: May Ann C. Regala BSN III Submitted To: Prof. Luisito P. Yolangco RN, DVM, MAN

Date Submitted: February 14, 2013

Generic Name Clopidogrel

Brand Name Plavix

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations

DOSAGE 1 tab Route PO Frequency OD

Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

Treatment of patients at risk for ischemic events history of MI,ischemic stroke, peripheral artery disease Treatment of patients with acute coronary syndrome

Allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation

Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

CNS: Headache, dizziness,weakness, syncope, flushing CV: Hypertension, edema Dermatologic:Rash, pruritus GI: Nausea, GI distress, constipation, diarrhea, GI bleed Other: Increased bleeding risk

> Assess for symptoms of stroke, MI during treatment > Monitor liver function studies: AST,ALT, bilirubin,creatinine if patient is on longterm therapy > Monitor blood studies: CBC,Hgb, Hct, protime,cholesterol if the patient is on longterm therapy; thrombocytopenia and neutropenia may occur. > Precautions: bleeding disorders, recent surgery

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Generic Name Lactulose

Brand Name Duphalac

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Assess condition before therapy and reassess regularly there after to monitor drugs effectiveness >Monitor pt for any adverse GI reactions, nausea, vomiting, diarrhea >Assess for adverse reactions >For pt. with hepatic encelopathy: regularly assess mental condition >Monitor I & O >Monitor for Inc. glucose level in diabetic pts.

Anti- Allergics Anti- Histamine

DOSAGE Infants: 5lm Children: 1-6 y/o, 5-10 ml 7-14 y/o, 15-30 ml Dose: given in 3 days

Constipation, salmonellosis. treatment of hepatic encephalopathy

Pt . who require a low lactose diet, Galactosemia deficiency, Intestinal obstruction

Inhibits bacterial DNA Gyrase thus preventing replication insusceptible bacteria

PRECAUTION: Lactose intolerance, diabetes Adverse Rxn: Abdominal discomfort associated with flatulence and intestinal cramps, nausea, vomiting, diarrhea on prolonged

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Generic Name Diazepam

Brand Name Valium

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Inform pt. that drug mybe taken with food >Advice pt. not to abruptly discontinue drug after long term use > Advice pt. to not avoid driving and activities that require alertness bec, drug can cause drowsiness >Inform pt. that smoking may decrease effect.

DOSAGE Adult: 250-500 mg every 8 hrs. Children: 20-40 mg/kg/day divided dosage given every 8 hrs.

Anti- anxiety, anticonvulsant/ hypnotics/ sedatives/ anxiolytics

Symptomatic relief of anxiety, agitation, tension

Hypersensitivity, dependence, widrawal symptoms

Facilitates/ potentiates the inhibitory activity of GABA at the limbic system and reticular formation to reduce anxiety promote calmness and sleep

PRECAUTION: Hypersensitivity cardio resperatory insufficiency, pregnancy, lactation ADVERSE RXN: Dizziness, fatigue, blurred vision, dependence, widrawal reactions

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Generic Name ASA/ Aspirin

Brand Name Aspilet

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Give milk, food antacid or large glass of water to reduce GI adverse reactions. > Warn patients taking prescription drugs to check with doctor before taking OTC combination containing aspirin. > Watch out for petechiae, bleeding gums, signs of GI bleeding. > Maintain adequate fluid intake. > Obtain hemoglobin and prothrombin test periodically.

Non narcotic /analgesics and antipyretic/ anti platelet

DOSAGE 80mg/tab itab ODPC PO

Mild pain/fever arthritis reduce risk of heart attack in patient with previous MI or unstable angina

GI ulcer GI bleeding patients with bleeding disorders Aspirin hypersensitivity Vit.K deficiency

Produces analgesia by an ill defined effecton the hypothalamus and by blocking generation of pain impulses (peripheralaction) Also impedes clotting by blocking prostagland in synthesis which prevents formation of platelet-aggregating substances.

> Prolonged bleeding time > Tinnitus > Hearing loss > Nausea,vomiting > GI distress > Occult bleeding > Abnormal liver function > Rash >Bruising Hypersensitivity manifested by asthma and anaphylaxis

Generic

Brand

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing

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Name Ranitidine

Name Xantac Anti-ulcer Duodenal andgastric ulcers >Maintenance therapy for gastric and duodenal ulcer GERD > Erosive esophagitis > Heartburn >Contraindicated in patients hypersensitive to drug and those with porphyria > Use cautiously in patients with hepatic dysfunction. > Adjust dose in patients with impaired renal Completely inhibits action of histamine on the H2 atreceptor sites of parietal cells, decreasing gastric acid secretions Vertigo, malaise, headache, blurred vision, jaundice, burning and itching at injection site

DOSAGE 50 mg by slow IV then 0.1250.25 mg/kg/hr as continous IV infusion

Considerations > Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate. > Ranitidine may be added to total parenteral nutrition solution. > Instruct patient on proper use of OTC preparation as indicated. > Remind patient to take once daily prescription drug at bed time for best results. > Instruct patient to take without regard to meals because absorption isnt affected by food.

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Generic Name Metoprolol

Brand Name Prolol

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Assess patients condition before therapy and regularly there after to monitor drug effectiveness. > Do not crush or chew tablets. > Monitor urine output. > Tell patient to avoid taking OTC products contain in galphaadrenergic stimulants (such as nasal decongestant, cold preparations), alcohol, smoking and to limit sodium intake.

Antihypertensive drugs (betablockers

Indicated to hypertension

Contraindicated to kidney and liver failure

DOSAGE 50mg Route PO Frequency OD

Exerts mainly beta1adrenergic blocking activity but also blocks beta2receptors at high doses. It reversibly and competitively combines with beta-1 adrenergic receptors to block sympathetic nerve impulses, resulting to decreased myocardial contractility, heart rate, cardiac output and myocardial oxygen consumption. These effects lead to decreased blood pressure.

> Fatigue > Dizziness > Headache > Bradycardia > GIdisturbances > Skin rashes > Sleepdisturbances > Sweating >Abdominalpain > Vomiting

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Generic Name Captopril

Brand Name Capoten

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations History: Allergy to captopril, history of angioedema, impaired renal function, CHF, salt or volume depletion, pregnancy, lactation. Physical: skin color, lesions, turgor; T; P; BP; peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis,renal and liver function tests, CBC and differential > Administer 1 hr before or 2 hr after meals. > Alert surgeon and mark patients chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory rennin release during surgery will be blocked;

DOSAGE 25 mg q6

Angiotensin converting enzyme ( ACE) inhibitors Antihypertensive

> Treatment of hypertension alone or in combination with thiazide- type diuretics. > Treatment of CHF in patients unresponsive to conventional therapy ; used with diuretics and digitalis. > Treatment of diabetic nephropathy. > Treatment of left ventricular dysfunction after MI. Unlabeled uses: management of hypertensive crises; treatment of rheumatoid arthritis; diagnosis of anatomic renal artery stenosis, hypertension

Contraindicated with allergy to captopril, history of angioderma. Use cautiously with impaired renal function; CHF: salt or volume depletion, lactation, pregnancy.

Blocks ACE from converting angiotensin I to angiotensin II, A powerful vasoconstrictor, leading to decreased blood pressure, decreased aldosterone secreation, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.

CV: tachycardia, angina pectoris, MI, Raynauds syndrome, CHF, hypertension in salt or volume depleted patients Dermatologic: rash, pruritus, pemphigoidlike reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity, alopecia GI: gastric irritation, aphthous ulcers,peptic ulcers. Dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation GU; Proteinuri a, renal insufficiency, renal failure, polyuria, oliguria, urinary frequency Hematologic: neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia,

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related to scleroderma renal crisis; diagnosis of primary aldosteronism, idiopathic edema; Bartters syndrome; Raynauds syndrome

pancytopenia Other: cough, malaise, dry mouth, lymphadenopathy

hypotension mybe reversed with volume expansion. > Monitor patient closely for fall in BP secondary to education in fluid volume ( excessive perspiration and dehydration, vomiting diarrhea);excessive hypotension may occur. > Reduce dosage in patients with impaired renal function.

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Generic Name Simvastatin

Brand Name Zocor

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Assess nutrition: fat, protein, carbohydrates > Monitor bowel pattern daily. >Monitor triglycerides, cholesterol base line throughout treatment Precautions: Past liver disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, elderly, renal disease.

Lipid regulating drug

DOSAGE 1 tab 40 mg OD, HS

To reduce low density lipoprotein (LDL) cholesterol, apolipoprotein beta, and triglycerides. To increase high density lipoprotein (HDL) cholesterol in the treatment of hyperlipidaemias.

Contraindicated with allergy to simvastatin, fungal by products, pregnancy, lactation

Inhibits HMGCOA reductase enzyme, which reduces cholesterol synthesis; this enzyme is needed for cholesterol production.

Back pain, constipation, diarrhea, flushing (dizziness, itching, redness, tingling, warmth), headache, nausea, runny or stuffy nose, stomach upset.

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Generic Name Domperidone

Brand Name Andlogan

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Assess for GI complaints, before & after administration. > Assess for change in bowel habits. > Inform the pt. to take the medication before meals. If taken after meals absorption is some what delayed. > Instruct the pt to inform physician if transient intestinal cramps occur.

Anti flatulents

DOSAGE 10 mg 1 tab TID

> Symptomatic management of upper gastro intestinal motility disorders associated with chronic and subacute gastritis and diabetic gastro paresis. > May also be used to prevent gastro intestinal symptoms associated with the use of dopamine agonist anti Parkinsonian agents.

>Contraindicated in patients with known sensitivity or intolerance to the drug. > Domperidone should not be used whenever gastro intestinal stimulation might be dangerous, i.e., gastrointestinal hemorrhage, mechanical obstruction or perforation. > Also contra indicated in patients with a prolactinreleasing pituitary tumor (prolactinoma)

Selectively blocks peripheral dopamine receptors in the GI wall and in the chemo receptor trigger zone thus enhancing normal synchronized GI peristalsis & motility in the proximal region of GIT counter act anticholinergic induced relaxation of lower esophageal sphincter.

intestinal cramps, drowsiness, lashes & other allergic reaction

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Generic Name Perindopril

Brand Name Coversyl

Classification

Indication

Contraindication

Mechanism of Action

Adverse Reaction

Nursing Considerations > Patients with history of angioedema unrelated to ACE inhibitor use may be at increased risk fo rangioedema during therapy. > If angioedema occurs, stop drug. and observe patient until swelling disappears. Antihistamines may relieve swelling of the face and lips. Swelling of the tongue, glottis or throat may cause life threatening airway obstruction. Give prompt treatment, such as epinephrine. > Monitor cbc with differential for agranulocytosis and neutropenia before therapy,especially in renally impaired patients with lupus or scleroderma-severe hypotension canoccur

Antihypertensive (ACE Inhibitor)

DOSAGE Initial dose: 4 mg orally once a day Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

> Essential hypertension,CHF > Prevention of stroke recurrence in combination with Indapamide in patients with a history of cerebrovascular disease-reduction risk of CV events inpatients w/ stable coronary artery disease

Hypersensitivity, angioedema, renal impairment, heart failure, ischemic heart disease, cvd, renal, or artery stenosis Collagen vascular disease (SLE or scleroderma)

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure.

CNS: dizziness, asthenia, sleep disorder, paresthesia, depression, somnolence, nervousness, headache. CV: palpitations, edema, chest pain, abnormal ECG. EENT:rhinitis, sinusitis, ear infection, pharyngitis, tinnitus. GI: dyspepsia, diarrhea, abdominal

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when drug is given with diuretics. If possible, stop diuretic 2 to 3days before starting this drug. > If possible uselower doses of either drug.in patient who is volume or sodium depleted from prolonged diuretic therapy, dietary sodium restriction,dialysis, diarrhea, or vomiting, correct fluid andsodium deficits before starting drug. >Monitor renal function before and periodically throughout therapy >Monitor potassium level closely

REFERENCE www. mims. com www. scribd.com

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