Chinese General Hospital College of Nursing and Liberal Arts DRUG STUDY DRUG INDICATION ACTION ADVERSE REACTION

CNS: Fever, pain CV: edema, peripheral edema HEMATOLOGIC: Thrombocytopenia, Hemorrhage, ecchymoses, bleeding complications, anemia SKIN: Irritation, pain, hematoma, and erythema at injection site CONTRAINDICATION S Contraindicated in patients hypersensitive to drug, heparin or pork products; in those with thrombocytopenia and anti-platelet antibodies in presence of drug. Use cautiously in elderly patients and in those with conditions that place them at increased risk for hemorrhage, such as bacterial endocarditis, congenital or acquired bleeding disorders, ulcer disease, angiodysplastic GI disease, hemorrhagic stroke or recent spinal, eye or brain surgery. NURSING CONSIDERATIONS

GENERIC NAME: Enoxaparin Sodium BRAND NAME: Clexane CLASSIFICATION: Anti-coagulant DOSE: 0.2 cc ROUTE: SQ FREQUENCY: OD

To prevent pulmonary embolism and DVT in patients with acute illness who are at risk because of decreased mobility

A low-molecular weight heparin derivative that accelerates formation of anti-thrombin III-thrombin complex and deactivates thrombin, preventing conversion of fibrinogen to fibrin. Has a higher antifactor-Xa-toantifactor-IIa activity ration than heparin.

Obtain patients history of coagulation parameters before starting therapy. NEVER EVER GIVE DRUG I.M. With patient lying down, give by deep subcutaneous injection, alternating doses between left and right anterolateral and posterolateral abdominal walls. Dont massage after subcutaneous injection. Watch for signs of bleeding at site. Rotate sites and keep record. Monitor platelet counts regularly. Patients with normal coagulation wont need close monitoring of PT or PTT. Regularly inspect patient for bleeding.

Chinese General Hospital College of Nursing and Liberal Arts DRUG STUDY DRUG INDICATION ACTION ADVERSE REACTION CV: peripheral edema, tachycardia GI: Abnormal stools, diarrhea, dyspepsia, flatulence, RESPIRATORY: Increased cough OTHER: Infection, bleeding CONTRAINDICATION S Contraindicated in patients hypersensitive to drug or its components and in those with heart failure if any severity. Contraindicated in patients with hemostatic disorders or active bleeding, such as bleeding peptic ulcer and intracranial bleeding. Use cautiously in patients with severe underlying heart disease; also use cautiously with other drugs having antiplatelet activity. NURSING CONSIDERATIONS

GENERIC NAME: Cilostazol BRAND NAME: Pleetal CLASSIFICATION: Antiplatelet DOSE: 50 mg/tab ROUTE: NGT FREQUENCY: bid

To reduce symptoms of intermittent claudication

A quinolone derivative thought to inhibit the enzyme phosphodiester ase III, thus inhibiting platelet aggregation and causing vasodilation.

Assess patients history of underlying condition and pain level before therapy and regularly thereafter. Monitor hematologic status: CBC, Hct, Hgb and Pro-time. Thrombocytopenia may occur in patients on long-term therapy Give drug at least 30 minutes before or 2 hours after breakfast and dinner. Cilostazol and similar drugs that inhibit the enzyme phosphodiesterase decrease the likehood of survival in patients with class III and IV heart failure. CV risk is unknown in patients who use drug on long-term basis and in those with severe underlying heart disease. Dosage can be reduced or stopped without such rebound effects as platelet hyper-aggregation. Drug may reduce triglyceride levels and increase HDL cholesterol level.

Chinese General Hospital College of Nursing and Liberal Arts DRUG STUDY DRUG INDICATION ACTION ADVERSE REACTION CONTRAINDICATION S NURSING CONSIDERATIONS

GENERIC NAME: Levofloxacin BRAND NAME: Floxel CLASSIFICATION: Anti-infectives DOSE: 500mg ROUTE: IVSD FREQUENCY: OD x 1o Q 11am

Communityacquired pneumonia from Klebsiella pneumoniae

Inhibits bacterial DNA gyrase and prevents DNA replication, transcription, repair and recombination in susceptible bacteria.

CV: Chest pain, palpitations, vasodilation GI: constipation , dyspepsia, Hematologic: anemia RESPIRATORY: ineffective cough

Contraindicated in patients hypersensitive to drug, its components, or other fluoroquinolones. Use cautiously in patients with history of seizure disorders or other CNS disease, such as cerebral arteriosclerosis. Use cautiously and with dosage adjustment in patients with renal impairment.

If patient experiences symptoms of excessive CNS stimulation (restlessness, tremor, confusion, and hallucinations), stop drug and notify prescriber. Begin seizure precautions. Patients with acute hypersensitivity reactions may need treatment with epinephrine, oxygen, IV fluids, antihistamines, corticosteroids, pressor amines and airway management. Most anti-bacterials can cause pseudomembranous colitis. If diarrhea, occurs, notify prescriber; drug may be stopped. Obtain specimen for culture and sensitivity tests before therapy and as needed to determine if bacterial resistance has occurred. If P. aeruginosa is a confirmed or suspected pathogen, use with a beta-lactam. Monitor glucose level and renal, hepatic and hematopoietic blood studies.

Chinese General Hospital College of Nursing and Liberal Arts DRUG STUDY DRUG INDICATION ACTION ADVERSE CONTRAINDICATION NURSING CONSIDERATIONS

REACTION GENERIC NAME: Ivabradine HCl BRAND NAME: Coralan CLASSIFICATION: Anti-anginal DOSE: 5mg/tab ROUTE: NGT FREQUENCY: bid Symptomatic treatment of chronic stable angina pectoris in coronary artery disease patients with normal sinus rhythm Ivabradine is a pure heart ratelowering agent, acting by selective and specific inhibition of the cardiac pacemaker current that controls the spontaneous diastolic depolarization in the sinus node and regulates heart rate. The cardiac effects are specific to the sinus nose with no effect on intra-atrial, atrioventricular conduction times, nor on myocardial contractility or ventricular repolarization. Cardiovascular: Bradycardia, GI: constipation

S Contraindicated in patients with cardiac dysrhythmias, unstable angina pectoris, acute coronary syndrome, class III to IV heart failure, 3rd degree AV block, cardiogenic shock, those with a pacemaker, a resting heart rate below 60 bpm or severe hypotension (<90/50mmHg) Not recommended for use in patients with liver dysfunction and is contraindicates in patients with severe liver dysfunction. Monitor vital signs. Take the drug as prescribed. Take the tablet on an empty stomach either 30 minutes before or 1-2 hours after meal.

Chinese General Hospital College of Nursing and Liberal Arts DRUG STUDY

DRUG

INDICATION

ACTION

ADVERSE REACTION CNS: headache, fever CV: vascular overload after rapid infusion, hypotension, tachycardia GI: increased salivation, nausea, vomiting MUSCKULOSKELE TAL: back pain RESPIRATORY: altered respiration, dyspnea, pulmonary edema Others: chills

CONTRAINDICATION S Contraindicated in patients hypersensitive to drug and in those with severe anemia, pulmonary edema, or cardiac failure Use with extreme caution in patients with hypertension, low cardiac reserve, hypervolemia, pulmonary edema, or hypoalbuminemia with peripheral edema

NURSING CONSIDERATIONS

Albumin 25% DOSE: 1 vial (50mg) ROUTE: IVSD FREQUENCY: Q 12o clamp ML x 2o

Shock

Albumin 25% provides intravascular oncotic pressure in a 5:1 ratio, shifting fluid from interstitial spaces to the circulation and slightly increasing plasma protein level.

Watch for hemorrhage or shock after surgery or injury. Rapid increase in blood pressure may cause bleeding from sites that arent apparent at lower pressures. Monitor vital signs carefully. Watch for signs of vascular overload (heart failure or pulmonary edema) Monitor fluid intake and output; protein, electrolyte and hemoglobin levels; hematocrit during therapy.