Generic Name: Brand name:

Furosemide Lasix

Classifications: Date ordered & dosage:

Diuretics, loop diuretic (6-16-13) stat 40 mg IV now (11:30am) (6-18-13) stat 20 mg IVTT now (6-21-13) stat 60 mg IVTT now (11:15pm) (6-23-13) 40 mg 1 tab OD (6pm)

Suggested dose:

20-80 mg/ day as a single dose initially, may repeat in 6-8 hours.

Indication:

Edema due to heart failure, hepatic impairment or renal disease. Hypertension.

Mode of Action:

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Decreases Blood pressure.

Contraindications:

Severe sodium and water depletion, hypersensitivity to sulphonamides and furosemide, hypokalaemia, hyponatraemia, precomatose states associated with liver cirrhosis, anuria or renal failure. Addison's disease.

Side effect:

CNS: blurred vision, dizziness, headache, vertigo EENT: hearing loss, tinnitus

Adverse Effects:

CV: hypotension GI: excessive urination Derm: photosensitivity, pruritis F&E: dehydration, hypochloremia, hypokalemia Endo: hyperglycemia, hyperuricemia Hemat: aplastic anemia, agranulocytosis, hemolytic anemia, leucopenia, thrombocytopenia

Drug interaction:

Analgesics reduce natriuretic action of furosemide. Antagoniseshypoglycaemic agents and drugs used for gout. Hyperglycaemia with antihypertensive agent diazoxide. Antagonises muscle relaxants. Increased risk of ototoxicity when used with aminoglycosides especially in renal impairment. May enhance nephrotoxicity of cephalosporins. Effects of antihypertensives enhanced. Action antagonised by corticosteroids. Phenytoin and indometacin may reduce effects of furosemide.

Nursing responsibilities:

- Assess fluid status. Monitor daily weight, intake and output ratios. - Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. - Geri: Diuretic use is associated with increased risk for falls in older adults. Keep patient safe at all times. - Monitor laboratory tests such as electrolytes, renal and hepatic function, serum glucose, etc. - PO: may be taken with food or milk to minimize gastric irritation. - Caution patient to change positions slowly to minimize orthostatic hypotension.

Generic Name: Brand name:

Acetamenophen Paracetamol

Classifications: Date ordered & dosage: Suggested dose: Indication: Mode of Action:

Antipyretics, Nonopioid Analgesics 6-18-13 1 tab 500 mg q4 PRN for fever 1 tab for mild to moderate pain and fever. Mild pain; fever Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the CNS. Has no significant anti-inflammatory properties or GI toxicity; Analgesia, antipyresis.

Contraindications:

Previous hypersensitivity; product containing alcohol, aspartame, saccharin, sugar or tartrazine should be avoided in patients who hypersensitivity or intolerance to these compounds. Use cautiously: Hepatic disease/ renal disease; chronic alcohol use/ abuse; malnutrition

Side effect:

CNS: confusion, headache GI: constipation nausea, vomiting

Adverse Effects:

GI: Hepatic failure, hepatotoxicity (overdose) GU: renal failure (high doses/chronic use); Heme: neutropenia, pancytopenia, leukopenia;

Drug interaction:

Drug-drug: chronic high-dose acetaminophen (>2g/day) may increase risk of bleeding with warfarin (PT should be monitored regularly and INR should not exceed 4); Hepatotoxicity is additive with other hepatotoxic substances including alcohol; concurrent use of sulfinpyrazone, isoniazid, rifampinrifabutin, phenytoin, barbiturates and carbamazepine may increase the risk of acetaminophen-induced liver damage; these agents will also decrease therapeutic effects of acetaminophen. Concurrent NSAIDs increase the risk of adverse renal effects; Propanolol decrease metabolism and may increase effects; may decrease effects of lamotrigine and zidovudine.

Nursing responsibilities:

- Assess overall health status and alcohol usage before administering acetaminophen. Patients who are

malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. - Asses fever; note presence of associated signs (diaphoresis, tachycardia and malaise). - If overdose occurs, acetylcysteine (Acetadote) is the antidote. When combined with opioids do not exceed the

maximum recommended daily dose of acetaminophen. - Advise patient to consult health care professional if discomfort or fever is not relieved by routine doses of this drug or if fever is greater than 39.5 C or lasts longer than 3 days.

Generic Name: Brand name:

Piperacillin + Tazobactam Tazovex

Classifications: Date ordered & dosage: Suggested dose: Indication:

Antibiotic, Penicillin 6-20-13 2.5 g IVTT q 6 ANST (-) (6-16-6-12) 3.75 4.5 grams q 6 Moderate to severe infections piperacillin-resistant, Blactamse producing strains causing infections in the respiratory, skin, urinary tract, bone, pneumonia.

Mode of Action:

This combination medication is an antibacterial agent, prescribed for various infections such as Nosocomial pneumonia. It blocks the bacteria's cell wall growth, which kills the bacteria. Tazobactam inhibits the action of bacterial beta-lactamases. It is added to the extended spectrum beta-lactam antibiotic piperacillin. It broadens the spectrum of piperacillin by making it effective against organisms that express beta-lactamase and would normally degrade piperacillin.

Contraindications: Side effect:

Hypersensitivity to penicillin, cephalosporin GI: Diarrhea, constipation, nausea and vomiting, dyspepsia, abdominal pain CNS: Headache, Insomnia, fever, dizziness, anxiety

Adverse Effects:

GI: PSEUDOMEMBRANOUS COLITIS , drug induced

hepatitis GU: interstitial nephritis Heme: leukopenia, neutropenia, thrombocytopenia Other: phlebitis at IV site, ANAPHYLAXIS Drug interaction: Probenecid decrease renal excretion and increases blood levels. May alter excretion of lithium. Potassium-losing diuretics, corticosteroids, or amphotericin B. Increases risk of hepatotoxicity with other hepatotoxic agents. Nursing responsibilities: - Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. - Assess patient for infection (vital signs; sputum, urine, and stool WBC) at beginning of and during therapy. - Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results. - Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care profession al immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. - Check lab results to evaluate renal and hepatic function, CBC, serum potassium, and bleeding times prior to and routinely during therapy. - Advise patient to report signs of superinfection (black furry overgrowth on tongue, loose or foul-smelling stools) and allergy.

Generic Name: Brand name:

Potassium Chloride KaliumDurule

Classifications: Date ordered & dosage: Suggested dose: Indication:

Electrolyte, supplement (6-21-13) 2 tabs now (8:30 pm) (6-23-13) 1 tab TID x 3 days 2 durules bid or more until serum K is restored to normal Prevention and correction of potassium deficiency; when associated with alkalosis, use potassium chloride.

Mode of Action:

Potassium chloride is amajorcation of theintracellular fluid. It plays an active role in the conduction of nerve impulses in the heart, brain and skeletal muscle; contraction of cardiac skeletal and smooth muscles; maintenance of normal renal f unction, acidbase balance, carbohydrate metabolism and gastric secretion.

Contraindications:

Contraindicated with allergy to tartrazine, aspirin,severe renal impairment with oliguria, anuria, azotemia; untreated Addisons disease; hyperkalemia; adynamiaepisodicahereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract. Use cautiously with cardiac disorders, especially if

treated with digitalis, pregnancy, lactation. Side effect: Adverse Effects: GI: Nausea, vomiting, diarrhea, abdominal discomfort GI obstruction, GI bleeding, GI ulceration or perforation Hematologic: Hyperkalemiaincreased serum K+ Local: Tissue sloughing, local necrosis, local phlebitis. Drug interaction: Using potassium phosphate IV and products containing calcium or magnesium potassium sparing diuretics or other potassium products. Nursing responsibilities: - Assess vital signs of the patient specifically the cardiac status : Monitor pulse, blood pressure, and ECG - Tell patient not break, crush or chew tablets/capsule or enteric products. - If GI upset occurs, tell the patient that the medicine can be taken after meals or with food with a full glass of water. - Monitor serum potassium before and periodically during therapy, Monitor renal function, serum bicarbonate, and pH - Encourage patient and watcher to report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea and vomiting and decreased urine output.) - discontinue potassium, administration if hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea; peaked T waves; depressed ST segments; prolonged QT segments; widened QRS complexes; loss of P waves; and cardiac arrhythmias) occur.

Generic Name: Brand name:

Mucosta Rebapimide

Classifications: Date ordered & dosage: Suggested dose: Indication: Mode of Action:

Antacid, cytoprotective agent 6-12-13 1 tab TID (6-12-6) 1 tab orally 3 times daily. Peptic ulcer, acute gastritis Increasing the prostaglandin E2 content and exerting a cytoprotective effect on the gastric mucosa. The medicine also increases the amount of gastric mucus and stimulates gastric mucosal blood flow to improve impaired hemodynamics, thus helps to suppress inflammation and repair the gastric mucosa.

Contraindications:

Hypersensitivity and its components, pregnant, breatfeeding.

Side effect:

CNS: headache GI: abdominal pain, diarrhea, constipation, dyspepsia, flatulence, nausea, vomiting

Adverse Effects:

Heme: leukopenia, thrompocytopenia Other: anaphylaxis, hepatic dysfunction, shock

Drug interaction:

Increased risk of diarrhea with magnesium-containing

antacids. Nursing responsibilities: - Assess patient routinely for epigastric or abdominal pain and for frank or occult blood, in the stool, emesis, or gastric aspirate - Check CBC, serum ALT, AST if available - Administer medication with meals to reduce severity of diarrhea - Inform patient that side effects may occur such as diarrhea, constipations. - instruct to report to health care professional if diarrhea persists, Also ad vise patient to report onset of black, tarry, stools or severe abdominal pain

Amlodipine Generic Name: Amlodipine Brand name: Norvasc Classification: Anti-Anginal Drugs Calcium-channel blocker

Mode of Action: It works by relaxing blood vessels which allows blood to circulate more freely around your body. This lowers blood pressure, improves the efficiency of the heart and helps prevent chest pain associated with angina. Suggested dose: 5 mg daily Ordered Dose: 5 mg 1 tab OD Indication: Hypertension; chronic stable angina; vasospastic angina.

Contraindication: Sick sinus syndrome; second- or 3rd- degree AV block; except w/ a functioning pacemaker. Drug interaction: Drug-drug Beta blockers may cause increased adverse cardiac effect as a result of myocardial depression. Fentanyl -Severe hypotension or increased fluid volume requirements have occurred w/ similar drugs. Side effect: dizziness, headache, nausea and vomiting.

Adverse effect: Skin rash, allergic reaction, dyspnea and anaphylaxis.

Nursing Responsibilities: Caution patient to change positions slowly to minimize orthostatic hypotension. Monitor blood pressure and pulse prior to administering the drug. Report immediately and swelling, redness, burning, or pain at infusion site. Discontinue the infusion if the patient develops tachycardia or hypotension. Assess for hypersensitivity after giving medications. Advise patient that compliance of this medication is important.

Insulin Generic Name: Insulin Brand Name: Humulin (isophane neutral protamine hagedorn 70%,regular 30%) Classification: anti-diabetic hormone Mode of Action: Promotes glucose transport,which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where its converted to glycogen. Directly affects fat and protein metabolism , stimulates protein synthesis , inhibits release of free fatty acids, and indirectly decreases phosphate and potassium. Suggested Dose: 0.2-0.5 unit/kg/day subcutaneously Ordered Dose: Indications: Type 1 (insulin dependent ) diabetes mellitus Type2 ( non-insulin-dependent)diabetes mellitus unresponsive to diet and oral hypoglycemic, diabetic ketoacidosis Contraindication: Hypersensitivity to drug or its components Hypoglycemia Insulin 70/30 18u SQ prebreakfast and predinner PRN- 6u CBG180 gm/dl

Side Effects: dry mucous membrane , hypoglycemia, headache ,fainting

Adverse Effects: extreme thirst , polyuria , kussmaul breathing ,dyspnea , rapid thready pulse ,brought about by the derangements of glucose and fat metabolism Drug Interactions: Alcohol, MAO inhibitors, beta-blockers, salicylates, and anabolic steroids= may lower blood glucose to a dangerous level (hypoglycemia) Tretracycline antibiotics, oral hypoglycemic drugs, Ace inhibitors= augment the blood glucose-lowering effect of insulin, but they are less likely to interact with insulin or have less of an effect

Dilitiazem, niacin, corticosteroids, thyroid hormones and, diuretics = decrease the effect of insulin

Nursing Responsibilities: Use the same type of and brand of syringe; use the same type and brand of insulin to avoid dosage errors. Do not change the order of mixing insulin. Rotate injection sites regularly to prevent breakdown at injection sites. Explain to patient that this medications controls hyperglycemia but does not cure diabetes. Monitor blood or urine glucose levels, and consult your health care provider if problems arise. Report fever, sore throat, vomiting, hypoglycaemic or hyperglycaemic reaction, rash

Generic Name: Brand Name: Date Ordered: Classification: Ordered Dose: Available Form:

Tranexamic acid Hemostan June 25, 2013 @ 3:30 pm Anti-fibrinolytic, antihemorrhagic 500 mg 1 capsule Adult: PO Short-term management of haemorrhage 1-1.5 g 2-3 times/day.Long-term management of hereditary angioedema 1-1.5 g 2-3 times/day. IVShort-term management of haemorrhage 0.5-1 g 3 times/day

Indication:

Medical: epistaxis, hemoptysis, hematuria, peptic ulcer

with hemorrhage and blood dyscrasias with hemorrhage

Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures.

Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia, heavy menstrual bleeding

Effective in promoting hemostasis in traumatic injuries.

Mode of Action:

Tranexamic acid is a synthetic derivative of the amino acid lysine. It is an antifibrinolytic agent that competitively inhibits breakdown of fibrin clots. It blocks binding of plasminogen and plasmin to fibrin, thereby preventing haemostatic plug dissolution or prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors.

Contraindications:

1. Severe renal failure, active intravascular clotting, thromboembolic disease, colour vision disorders, subarachnoid bleeding; 2. Pregnancy. Tranexamic acid crosses the placenta. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration.

Side and Adverse Effects:

CNS: headache, confusion, vision changes CV: hypotension, chest pain, dizziness Respi: shortness of breath GI: abdominal pain, nausea, vomiting Derm: rashes, itching, MS: body malaise, back pain Renal: decreased urine output

Interactions: Nursing Responsibilities:

Medicines containing estrogen 1. This medication can be administered with or without food. 2. Ensure clients safety by raising side rails, for the drug may headache and vision changes. 3. Monitor vital signs, especially the blood pressure and respirations of the client. 4. Assist client in activities and in ambulation to prevent injury. 5. Assess or instruct to report for severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue. 6. Encourage to perform simple range of motion. 7. Instruct to use soft-bristled toothbrush to prevent gum bleeding. 8. May have ice chips in the mouth for active gum bleeding. 9. Instruct to avoid hard and hot foods. 10. Monitor intake and output.

Potassium chloride Generic Name: Potassium Chloride Brand Name: Kalium durule Classification: mineral and electrolyte replacements Mode of Action:

Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell

Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis and carbohydrate metabolism

Suggested Dose: Ordered Dose: 2 tabs TID x 6 doses Indication: treatment of potassium depletion

Contraindications: Patients with oliguria, anuria, hyperkalemia and severe renal impairment.

Side/Adverse Effects: CNS: confusion, restlessness, weakness.

CV: arrhythmias, ECG changes.

GI: abdominal pain, diarrhea, flatulence, nausea, vomiting.

Neuro: paralysis, paresthesias.

Drug Interactions: Drug-Drug: Use with potassium sparring diuretics may lead to hyperkalemia.

Nursing Responsibilities: Monitor pulse, BP during therapy.

Assess for signs and symptoms of hypokalemia (weakness, fatigue, arrhythmia, polyuria, polydipsia) and hyperkalemia. Dissolve in at least one-half glass (4 ounces) of cold water or juice to reduce its possible stomach-irritating or laxative effect. Check with your doctor before starting any physical exercise program, exercise and certain medicines may increase the amount of potassium in the blood.

Check with your doctor at once if you notice blackish stools or other signs of stomach or intestinal bleeding. Monitor electrolyte results specifically potassium. Routine serum potassium test is indicated while administering this drug. Assess the patency of intravenous fluid. Potassium is vein irritant and is painful in peripheral vein when given.

Sultamicillin Generic Name: sultamicillin (sulbactam +ampicillin) Brand Name: Unasyn Classification: Anti-infectives (Penicillins) Mode of Action: Inhibits cell-wall synthesis during bacterial multiplication. Sultamicillin is hydrolyzed during absorption to provide sulbactam and ampicillin in the systemic circulation Suggested Dose: 375-750mg twice daily (IV/ PO) Ordered Dose: 750mg q8 IVTT Indication: intra-abdominal, gynecologic, and skin-structure infections caused by susceptible strains Contraindications: Contraindicated inpatients hypersensitive to drug or other penicillins Use cautiously in lactating and pregnant mothers Use cautiously inpatients with other drug allergies(especially to cephalosporins)because of possible cross-sensitivity and in those with mononucleosis because of high risk of maculopapular rash

Side Effects/Adverse Effects: CV: Thrombophlebitis, vein irritation GI: nausea, vomiting, diarrhea, glossitis, stomatitis, enterocolitis, pseudo membranous colitis Hematologic: Anemia, thrombocytopenia, thrombocytopenic purpura, eosinophilia, leukopenia, agranulocytosis SKIN: Pain at injection site Other: Hypersensitivity reactions, anaphylaxis, overgrowth of non susceptible organisms Drug Interaction: Concurrent use increases risk of bleeding with warfarin and methotrexate toxicity decreases efficacy of oestrgen-containing oral contraceptives Excretion of ampicillin is reduced when used with probencid

Nursing Responsibilities: Assess for hypersensitivity to drug or other penicillin products. Decreased dosage in patient with renal failure. Monitor liver function test results during therapy,especially in patients with impaired liver functions. Advise patient to report rash, fever or chills. A rash is the most common allergic reactions. Protect solution from light and refrigerate ampules Instruct patient to promptly report signs of enterocolitis,vomiting, diarrhea and nausea

Generic Name:

Albumin

Brand name:

Plasbumin

Classifications: Date ordered & dosage: Suggested dose: Indication:

Volume expander, colloids 6-12-13 Albumin drip 25% 50cc to run for 6 hours 5075 g diluted or undiluted Expansion of plasma volume and maintenance fluid volume deficit, including shock, hemorrhage, and burns. Temporary replacement of albumin.

Mode of Action:

Provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular tissuesback into the intravascular space.

Contraindications:

Hypersensitivity, severe anemia, CHF, hepatic and renal impairement.

Side effect:

CNS: headache GI: increased salivation, nausea, vomiting

Adverse Effects:

CV: Pulmonary edema, fluid overload hypotension, tachycardia

Drug interaction: Nursing responsibilities:

None significant. - Monitor vital signs, if fever, tachycardia, hypotension occurs.

- Assess vascular overload (jugular vein distension, dyspnea, hypertension) during administration. - Check serum albumin result, after administration. -Assess for increased bleeding after administration caused by increased blood pressure and circulating blood. - Explain purpose and side effects, & instruct watcher to notify care giver if hypersensitivity reaction occurs. - Evaluate intake, output, & sodium level.

Generic name Brand name Classification

Furosemide Lasix Therapeutic: diuretics Pharmacologic: loop diuretics

Date Ordered/ Ordered Dose

February 2, 2012 Albumin 20% 50 cc 1 vial to run in 4 hrs OD (10pm) THEN Furosemide 20 g IVTT after albumin Edema

Suggested dose

PO (Adults): 20-80 mg/day as a single dose initially, may repeat in 6-8 hr; may increase dose by 20-40 mg q

6-8 hr until desired response. Maintenance doses may be given once or twice daily (doses up to 2.5 g/day have been used in patients with congestive heart failure or renal disease) IM, IV (Adults): 20-40 mg, may repeat in 1-2 hr and increase by 20 mg every 1-2 hr until response is obtained, maintenance dose may be given q 6-12 hr. Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule; Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in Mode of action impaired renal function. Therapeutic Effects: Diuresis and subsequent mobilization of excess fluid (edema, fleural effusions). Decreased blood pressure. Edema due to hear failure, hepatic impairment or renal disease. Hypertension. Contraindicated in: Hypersensitivity; Cross-sensitivity with thiazides and sulfonamides may occur; hepatic coma or anuria; some liquid products may contain alcohol, avoid in patients with alcohol intolerance. Contraindications Use cautiously in: Severe liver disease (may precipitate hepatic coma; concurrent use with potassium-sparing & Precautions diuretics may be necessary); electrolyte depletion; Geri: geriatric patients may have increased of side effects, especially hypotension and electrolyte imbalance, at usual doses; diabetes mellitus; increase azotemia; pregnancy and lactation.

Indications

Drug-drug: Increase hypotension with anti hypertensives, nitrates, or acute ingestion of alcohol. Drug interaction Increase risk of hypokalemia with other diuretics, amphotericin B, stimulant laxatives, and corticosteroids. CNS: blurred vision, dizziness, headache, vertigo EENT: hearing loss, tinnitus CV: hypotension GI: excessive urination Derm: photosensitivity, pruritis, rash Endo: hyperglycemia, hyperuricemia Side effects / Adverse Effects F&E: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis and hypocalcemia Hemat: aplastic anemia, agranulocytosis, hemolytic anemia, leucopenia, thrombocytopenia MS: muscle cramps Neuro: paresthesia Misc: fever, increased BUN, nephrocalcinosis 1. Ensure that right drug with the right dosage is given to the right patient. 2. Assess fluid status. Monitor daily weight, intake and output ratios. Nursing Responsibilities 3. Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. 4. Geri: Diuretic use is associated with increased risk for falls in older adults. Keep patient safe at all times.

5. Asses patient for tinnitus or hearing loss. 6. Monitor laboratory tests such as electrolytes, renal and hepatic function, serum glucose, etc. 7. PO: may be taken with food or milk to minimize gastric irritation. 8. Caution patient to change positions slowly to minimize orthostatic hypotension.

Generic name Brand name Classification

Omeprazole Losec Therapeutic: antiulcer agents Pharmacologic: proton-pump inhibitors

Date Ordered/ Ordered Dose

2/4 - Omeprazole 40 mg IVTT OD once on NPO (6am)

PO (Adults): Suggested dose Gastric ulcer: 40 mg once daily for 4-6 wk Reduction of risk for GI bleeding in critically ill patients: 40 mg initially, then another 40 mg 6-8 hr later,

followed by 40 mg once daily up to 14 days. Binds on an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Mode of action Therapeutic Effect: Diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux. Healing of duodenal ulcers. GERD/ maintenance of healing in erosive esophagitis. Indications Duodenal ulcers (with or without anti infectives for H. pylori). Short-term treatment of active benign gastric ulcer. Contraindicated in: Hypersensitivity; Metabolic alkalosis Contraindications and hypocalcemia. & Precautions Use cautiously in: Liver disease (dosage reduction may be necessary). CNS: dizziness, drowsiness, fatigue, headache, weakness Side effects / Adverse Effects CV: chest pain GI: abdominal pain, and regurgitation, constipation, diarrhea, flatulence, nausea, vomiting Derm: itching, rash 1. Ensure that right drug with the right dosage is Nursing Responsibilities given to the right patient. 2. Assess patient routinely for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

3. Lab tests considerations: Monitor CBC 4. PO: Administer doses before meals, preferably in the morning 5. May cause occasional drowsiness or dizziness. Provide safety for the client. 6. Advise patient to report onset of black tarry stools, diarrhea, abdominal pain.

Generic Name Brand Name Classification Date Ordered Ordered Dose

Omeprazole Omepron Anti-ulcer drug; Proton pump inhibitor 8/7/12 40 mg 1 cap OD P.O (6AM)

Suggested Dose Mode of Action

20 mg twice daily Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

Indication

GERD/ maintenance of healing in erosive esophagitis. Duodenal ulcers (with or without anti-infectives for

Helicobacter pylori). Short-term treatment of active benign gastric ulcer. Pathologic hypersecretory conditions,

including Zollinger-Ellison syndrome. Reduction of risk of GI bleeding in critically ill patients.

Contraindication

Hypersensitivity; Metabolic alkalosis and hypocalcemia

Drug Interaction

Celexa, Valium, and iron supplements can alter the amounts of the medications in your blood, potentially increasing your risk of side effects or decreasing the effectiveness of the medications.

Side/Adverse effects

CNS: headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety Derm: rash, inflammation, uticaria, pruritus, alopecia, dry skin GI: diarrhea, abdominal pain, nausea, vomiting,

constipation dry mouth Respi: URI symptoms, cough, epistaxis

Nursing Responsibilities

Administer before meals. Assess patient routinely for epigastric or abdominal pain. Administer dose before meals, capsule should be swallowed whole and not crushed. Monitor for severe headache, fever, and chills

9.

Generic Name Available forms Date ordered Classification

Magnesium sulfate Injection, premixed infusion 7/15/12 Therapeutic: mineral and electrolyte

replacements/supplements Pharmacologic: minerals/electrolytes Indications Treatment/ prevention of hypomagnesemia. Treatment of hypertension. Anticonvulsant associated with severe

eclampsia, pre-eclampsia, or active nephritis Action Essential for the activity of many enzymes. Plays an important role in neurotransmission and muscular excitability. Therapeutic effects: Replacement in deficiency states.

Resolution of eclampsia Ordered dose MgSO4 500 mg + 9cc PNSS slow IV via soluset to run in 5/10 minutes 6 hrs. x 3 doses Suggested dose IM, IV (Adults): severe deficiency: 8-12 g/day in divided doses Mild deficiency: 1 g q 6 hr for 4 doses or 250 mg/kg over 4 hr Seizures/hypertension: IM, IV (Adults): 1 g q 6 hr for 4 doses as needed Contraindications/ Precautions Contraindicated in: Hypermagnesemia, hypocalcemia, anuria, heart block

Use cautiously in: Any degree of renal insufficiency, digitalized

patients. Adverse reactions/ Side effects CNS: drowsiness Resp: decreased respiratory rate CV: arrhythmias, bradycardia, hypotension GI: diarrhea MS: muscle weakness Derm: flushing, sweating Metab: hypothermia Nursing responsibilities Explain the purpose of this medication to patient and family Monitor vital signs of patient specially, pulse rate, BP, and respirations Monitor neurologic status before each dose Institute seizure precautions, patellar reflex (knee jerk) should be tested before each parenteral dose of magnesium sulfate. Monitor intake and output ratios. Urine output should be maintained at a level of at least 100 ml/4hr. Direct IV: Diluent: 50% solution must be diluted in 0.9% NaCl or D5W to a concentration of 20% prior to administration

10.

Generic Name Brand Name Available forms Date ordered Classification Pregnancy category Indications

Furosemide Lasix Tablets, injection 7/14/12 10:35 Therapeutic: diuretics Pharmacologic: loop diuretics Edema due to heart failure, hepatic impairment or renal disease. Hypertension.

Action

Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal eexcretion of water, sodium, chloride, magnesium, potassium, and calcium

Ordered dose Suggested dose

Furosemide 40 mg IVTT now Edema: PO (Adults): 20-80 mg/day as a single dose initially, may repeat in 6-8 hr; may increase dose by 20-40 mg q 6-8 hr until desired response. IM,IV (Adults): 20-40 mg, may repeat in 1-2 hr and increase by 20 mg every 1-2 hr until response Is obtained, maintenance dose may given q6-12 hr

Contraindications/ Precautions

Contraindicated in: Hypersensitivity, history symptoms or findings consistent with ischemic heart disease, coronary artery vasospasm. Cerebrovascular syndromes including: strokes of any type, transient ischemic attacks, uncontrolled

hypertension.

Use cautiously in: Elderly patients (may be more susceptible to adverse cardiovasculareffects). Adverse reactions/ Side effects CNS: dizziness, drowsiness, fatigue CV: coronary artery vasospasm, MI, ventricular fibrillation, ischemia GI: dry mouth, dyspepsia, nausea Derm: flushing MS: skeletal pain Neuro: paresthesia Nursing responsibilities Assess fluid status, intake and output ratios, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension or oliguria occurs Monitor blood pressure and pulse before and during administration. Geri: Diuretic use is associated with increased risk for falls in older adults. Implement fall prevention strategies Monitor electrolytes, renal and hepatic functions. Caution patient to change positions slowlyto minimize orthostatic hypotension.

2.

Generic Name

Ca polystyrene sulfonate

Brand Name Available forms Date ordered Classification

Kalimate Sachet (powder for oral suspension) 7/14/12 Electrolyte Serum potassium level lowering agent (treatment of hyperkalemia)

Indications

Prevention & treatment of hyperkalemia resulting from acute or chronic renal failure.

Action

Calcium ion of kalimate is exchanged for potassium ion in the intestinal tract, particularly around the colon, and the drug is excreted as unchanged polystyrene sulfonate resin into the feces without digestion and absorption. In consequence, potassium in the intestinal tracts excreted outside the body.

Ordered dose Suggested dose

Kalimate 3 sachets TID Adult: 15-30 g PO bid-tid, or 30 g by rectal route suspended in 100 mL water or 2% methylcellulose solution & left in the intestinal tract for 30 min-1 hr. Children: Acute Hyperkalemia: 1 g/kg body wt. daily in divided doses. Maintenance Therapy: 0.5 g/kg body wt daily in divided doses

Contraindications/ Precautions

Contraindicated in: Patients w/ intestinal obstruction & stenosis, constipation.

Use Cautiously in: Hyperparathyroidism & multiple myeloma. Monitor serum K &Ca levels regularly. Elderly, pregnancy, delivery & lactation Adverse reactions/ Side effects Constipation, anorexia & nausea

Nursing responsibilities

Intestinal perforation or intestinal obstruction may occur. If any abnormal findings such as severe constipation, prolonged abdominal pain, or vomiting, etc. are observed, administration of the drug should be discontinued and appropriate measures taken.

Patients should be instructed to pay attention to their feces Measurement of the serum potassium and serum calcium levels regularly to prevent the overdose Provide safety for the patient since one of its side effects is nausea

8.

Generic Name

calcium carbonate

Brand Name

Caltrate

Available forms Date ordered

Tablets, capsules 7/14/12

Classification Pregnancy category Indications

Therapeutic:

mineral

and

electrolyte

replacements/supplements Treatment and prevention of hypocalcemia PO: Adjunct in the prevention of post menopausal

osteoporosis Calcium carbonate: may be used as an antacids Action Essential for nervous, muscular, and skeletal systems. Maintain cell membrane and capillary permeability. Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle. Essential for bone formation and blood coagulation

Therapeutic effects: Replacement of calcium in deficiency states. Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption (calcium acetate) Ordered dose Suggested dose Caltrate 1 tab OD- 6am PO (Adults): Prevention of hypocalcemia, treatment of depletion, osteoporosis: 1-2 g/day Antacid: 0.5-1.5 g as needed (calcium carbonate only) Contraindications/ Precautions Contraindicated in: Hypercalcemia, renal calculi, Ventricular fibrillation

Use Cautiously in: Patients receiving digitalis glycosides, severe disease. Adverse reactions/ Side effects CNS: tingling CV: arrhythmias, bradycardia GI: constipation, nausea, vomiting GU: calculi, hypercalciuria Nursing Observe patient closely for symptoms of hypocalcemia respiratory insufficiency, renal disease, cardiac

responsibilities

(paresthesia, muscle twitching, colic, cardiac arrhythmias, Chvosteks or Trousseaus sign) Protect symptomatic patients by elevating and padding siderails and keeping bed in low position Monitor patients vital signs Assess patient for nausea, vomiting, anorexia, thirst, severe constipation, and bradycardia. Inform health care professional immediately Administer on an empty stomach before meals to optimize effectiveness. Administration with milk products may lead o milk-alkali syndrome (nausea, vomiting, confusion,headache) Advise patient that calcium carbonate may cause constipation. High fiber diet may be recommended and increasing oral fluid intake).