DRUG STUDY DRUG NUMBER 1 January 29, 2013 Barbilixir (CAN), Barbita (CAN), Bellatal, Solfoton, phenobarbital sodium,

Parenteral: Luminal Sodium Phenobarbital Sodium Barbiturate (long acting), Sedative, Hypnotic, Anticonvulsant, Antiepileptic agent Phenobarbital acts on GABAA receptors, increasing synaptic inhibition. This has the effect of elevating seizure threshold and reducing the spread of seizure activity from a seizure focus. Phenobarbital may also inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNS arousal. Insomnia Adults PO / IM / IV 100 to 320 mg. Sedation Adults PO 30 to 120 mg/day in 2 to 3 divided doses. Epilepsy Adults PO 60 to 250 mg/day. Convulsions Adults IV 100 to 320 mg. Repeat if needed (max, 600 mg per 24 h). Status Epilepticus Adults IV 10 to 20 mg/kg. Repeat if needed. Children IV 15 to 20 mg/kg over 10 to 15 min. Preoperative Sedation Children PO / IM / IV 1 to 3 mg/kg. Anticonvulsant Children IM / IV 4 to 6 mg/kg/day. For 10days, then adjust to blood level. Alternatively, use IM / IV 10 to 15mg/kg/day to reach therapeutic level more quickly. Max IV rate 60mg/min. Max adult IM dose is 500mg or 5 mL volume

Date ordered: Brand name: Generic name: Classification:

Mechanism of action:

Dosage and frequency:

regardless of concentration. Indication: Short-term treatment of insomnia; long-term treatment of generalized tonicclonic and cortical focal seizures; emergency control of acute convulsions; preanesthetic sedation. Unlabeled Uses Treatment of febrile seizures in children; treatment and prevention of hyperbilirubinemia in newborns; management of chronic cholestasis. Contraindication: Hypersensitivity to barbiturates; history of addiction to sedative/hypnotic drugs; history of porphyria; severe liver impairment; respiratory disease with dyspnea; nephritic patients. Cardiovascular Bradycardia; hypotension; syncope. CNS Drowsiness; agitation; confusion; anxiety; headache; hyperkinesia; ataxia; CNS depression; paradoxical excitement; nightmares; psychiatric disturbances; hallucinations; insomnia; dizziness. GI Nausea; vomiting; constipation. Hematologic Blood dyscrasias (eg, agranulocytosis, thrombocytopenia). Hepatic Liver damage.

Adverse reactions:

Respiratory Hypoventilation; apnea; laryngospasm; bronchospasm. Miscellaneous Hypersensitivity reactions (eg, angioedema, rashes, exfoliative dermatitis); fever; injection-site reactions (eg, local pain, thrombophlebitis).

Nursing Responsibilities:

Interventions 1.) Observe for the 12 Rights of Medication Administration such as right drug, dose, route, time, and patient. 2.) Advise patient to increase intake of vitamin D-fortified foods (eg, milk products) while taking this medication. 3.) Instruct patient to report the following symptoms to health care provider: nausea, vomiting, drowsiness, dizziness, fever, sore throat, mouth sores or easy bleeding or bruising. 4.) Explain the following importances of maintaining adequate intake of folic acid: fresh vegetables, fruits, whole grains, liver. 5.) Instruct patient not to stop taking medication abruptly without consulting health care provider.

Rationale 1.) To ensure correct drug administration is done. 2.) Because phenobarbital inhibits calcium channels, an increase of intake of vitamin D is essential. 3.) To be able to indicate the presence of adverse actions of the drug or risks for other complications. 4.) 5.) Continuous intake of this medicine helps in the progress of recovery of the patient.

Rationale for drug administration:

This drug is given to the patient because it depresses sensory cortex, decreases motor activity, alters cerebellar function and produces drowsiness, sedation, and hypnosis.

DRUG STUDY DRUG NUMBER 2 January 29, 30, 31, 2013; February 3, 2013 Depakene Valproic Acid Antiepileptic, Anticonvulsant Mechanism of action not understood: antiepileptic activity may be related to the metabolism of the inhibitory neurotransmitter, GABA; divalproex sodium is a compound containing equal proportions of valproic acid and sodium valproate.

Date ordered: Brand name: Generic name: Classification: Mechanism of action:

Dosage and frequency: Indication: For pediatric patients, administer 10-15 mg/kg/day PO. Sole and adjunctive therapy in simple (petit mal) and complex absence seizures Unlabeled uses: Adjunct in symptom management of schizophrenia, treatment of aggressive outbursts in children with attention-deficit hyperactivity disorder, organic brain syndrome Adjunctive therapy with multiple seizure types, including absence seizures Contraindicated with hypersensitivity to valproic acid and hepatic disease or significant hepatic impairement. Use cautiously with chilfren <18 months; children <2 year olds especially with multiple antiepileptics, congenital metabolic disorders. unexplained weakness with vomiting and confusion or fainting; easy bruising or bleeding, blood in your urine; fever, chills, body aches, swollen glands, flu symptoms; urinating less than usual; hallucinations (seeing things that aren't there); extreme drowsiness, lack of coordination; double vision or back-and-forth movements of the eyes; or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. pancreatitis Interventions 1.) Observe for the 12 Rights of Medication Administration such as right drug, dose, route, time, and patient. 2.) Reduce dosage, discontinue, Rationale 1.) To ensure correct drug administration is done. 2.) To prevent an overdose intake of the drug which may result to possible risk

Contraindication:

Adverse reactions:

Nursing Responsibilities:

or substitute other antiepileptics gradually; abrupt discontinuation of all antiepileptics may precipitate absence seizures. 3.) Observe signs of pancreatitis 4.) Give drug with food if GI upset occurs; substitution of the enteric-coated formulation also may be of benefit; have patient swallow SR tablet whole; do not cut, crush, or chew.

complications. 3.) The drug may alter the serum level in the body thus may result to pancreatitis. 4.) The drug should not be mechanically altered because it is designed at a predetermined rate in order to function properly.

Rationale for drug administration:

Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is also used to treat mania (episodes of frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). It is also used to prevent migraine headaches, but not to relieve headaches that have already begun. Valproic acid is in a class of medications called anticonvulsants. It works by increasing the amount of a certain natural substance in the brain.

DRUG STUDY DRUG NUMBER 3 January 29, 2013, February 3, 4, 2013 Ceftin , Zinacef cefuroxime, cefuroxime axetil, cefuroxime sodium Antibiotic, Cephalosporin (second generation) Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death. PO Uncomplicated UTI 125 mg twice daily. Respiratory tract infections 250-500 mg twice daily. Uncomplicated gonorrhea W/ oral probenecid: 1 g as a single dose. IVMeningitis 3 g 8 hrly. IM Gonorrhea W/ oral probenecid: 1.5 g as a single dose. IV/IMSurgical prophylaxis 1.5 g IV per-op, then 750 mg IM 8 hrly for up to 24-48 hr.Susceptible infections 750 mg 8 hrly, up to 1.5 g 6-8 hrly for severe infections.

Date ordered: Brand name: Generic name: Classification: Mechanism of action:

Dosage and frequency:

Indication:

Oral (cefuroxime axetil)

Pharyngitis, tonsillitis caused by Streptococcus pyogenes Otitis media caused by Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae, Moraxella catarrhalis Lower respiratory infections caused by S. pneumoniae, Haemophilus parainfluenzae, H. influenzae UTIs caused by Escherichia coli, Klebsiella pneumoniae Uncomplicated gonorrhea (urethral and endocervical) Dermatologic infections, including impetigo caused by Streptococcus aureus, S. pyogenes Treatment of early Lyme disease

Parenteral (cefuroxime sodium)

Lower respiratory infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae, S. pyogenes Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter UTIs caused by E. coli, Klebsiella Uncomplicated and disseminated gonorrhea caused by N. gonorrhoeae Septicemia caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae Meningitis caused by S. pneumoniae, H. influenzae, S. aureus, N. meningitidis Bone and joint infections caused by S. aureus Perioperative prophylaxis Treatment of acute bacterial maxillary sinusitis in patients 3 mo12 yr

Contraindication: Adverse reactions:

Hypersensitivity to cephalosporins. Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis. Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis. Pheblitis in the cardiovascular system.

Nursing Responsibilities:

Interventions 1.) Observe for the 12 Rights of Medication Administration such as right drug, dose, route, time, and patient. 2.) Monitor for manifestations of hypersensitivity. 3.) Inspect IM and IV injections sites

Rationale 1.) To ensure correct drug administration is done. 2.) Hypersensitivity is a contraindication of this drug. 3.) To monitor if there is presence of pheblitis, this is an adverse effect of the drug.

frequently. Rationale for drug administration: Cefuroxime is used to treat a wide variety of bacterial infections. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections (e.g., common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

DRUG STUDY DRUG NUMBER 4 January 30, 2013 Biogesic, Panadol, Tylenol Paracetamol, Acetaminophen Non-narcotic analgesic, Antipyretic 1. Decreases fever by a hypothalamic effect leading to sweating and vasodilation 2. Inhibits pyrogen effect on the hypothalamic-heat-regulating centers 3. Inhibits CNS prostaglandin synthesis with minimal effects on peripheral prostaglandin synthesis 4. Does not cause ulceration of the GI tract and causes no anticoagulant action. Dosage and frequency: Per Orem: 325-650mg q4h up to a maximum of 1 gram q6h. Suppositories: 650mg q4h not to exceed 4 grams a day for up to 10 days.

Date ordered: Brand name: Generic name: Classification: Mechanism of action:

Indication:

Temporary relief of pain and discomfort from fever, headache, cold, flu, minor muscle aches, overextension, menstrual cramps, toothache, minor arthritic pain. 1. Renal Insufficiency 2. Anemia

Contraindication:

Adverse reactions:

1. Minimal GI upset. 2. Methemoglobinemia 3. Hemolytic Anemia 4. Neutropenia

5. Thrombocytopenia 6. Pancytopenia 7. Leukopenia 8. Urticaria 9. CNS stimulation 10. Hypoglycemic coma 11. Jaundice 12. Glissitis 13. Drowsiness 14. Liver Damage Nursing Responsibilities: Interventions 1.) Observe for the 12 Rights of Medication Administration such as right drug, dose, route, time, and patient. 2.) Assess patients fever or pain: type of pain, location, intensity, duration, temperature, diaphoresis. 3.) Teach patients guardian to recognize signs of chronic overdose: bleeding, bruising, malaise, fever, sore throat. 4.) Assess allergic reactions: rash, urticarial; if these occur, drug may have to be discontinued. Rationale 1.) To ensure correct drug administration is done and safety. 2.) The nature of the fever helps indicate the condition of the patient and if the drug is working. 3.) So that the client may be aware of the possible signs of the adverse actions of the drug and it is their responsibility to know. 4.) The presence of this allergic reactions indicates an over dosage of the drug and the drug must be discontinued.

Rationale for drug administration:

The drug is given because it helps our patient by relieving pain and fever. It also helps the patient in maintaining normal temperature by lowering it down.