Drug Study

Generic Name:	Hyoscine N-butyl Bromide
Brand Name:	Buscopan
Classification:	Gastro-intestinal antispasmodic
Ordered Dose:	20mg 1amp IVTT now
Mode Of Action:	It's a competitive antagonist of the actions of acetylcholine and other muscarinic agonists. Hyoscine works by relaxing the muscle that is found in the walls of the stomach, intestines and bile duct (gastrointestinal tract) and the reproductive organs and urinary tract (genitourinary tract)
Indications:	This medication is used to relieve bladder or intestinal spasms.
Contraindications:	Hypersensitivity to hyoscine butylbromide, Patients with prostatic enlargement, paralytic ileus or pyloric stenosis, ulcerative colitis, closed angle glaucoma
Drug Interactions:	 Anticholinergic agents
	 Antihistamines
	 Monoamine oxidase inhibitors
	 Tricyclic antidepressants
	 Competitively blocks prokinetic agents
Side Effect:	Nausea, vomiting, loss of appetite, constipation, dry mouth, rash, itching, swelling of the hands or feet, trouble breathing, increased pulse, dizziness, diarrhea, vision problems, eye pain
Adverse Effects:	 CNS: light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, mood changes, lethargy, weakness, headache, tremor
	 CV: peripheral circulatory collapse, tachycardia,

	bradycardia, arrhythmia, palpitations, hypertension, hypotension
	 Dermatologic: pruritus, urticaria, bronchospasm, edema
	 GI: nausea, vomiting, dry mouth, anorexia, constipation,
	 GU: ureteral spasm, urinary retention, oliguria, decreased libido
	 MAJOR: respiratory depression, apnea, circulatory depression, respiratory arrest, shock, cardiac arrest
Nursing	 Inform patient that drug may cause blurred vision.  Assess for parkinsonism and Extra-pyramidal
Responsibilities:	Instruct patient to report if she experiences such
	symptom. symptoms.
	 Assess for urinary hesitancy
	 Assess for constipation.
	 Caution patient to avoid alcohol because it may increase CNS depression.
	 As appropriate, review all other significant adverse reactions and interactions
	 Give only prescribed dosage
	 Do not take left over medications for other disorders
	 Keep out the reach of children
Bibliography:	MIMS 113 th edition 2007 http://home.intekom.com/pharm/quatrom/q-hyosc.html
	http://www.medicinenet.com/hyoscine_butylbromide-
	oral/page2.htm
	http://www.netdoctor.co.uk/medicines/100000395.html

Generic Name:	Phytonadione

Brand Name:	Hema K
Classification:	Fat soluble vitamin; antifibrinolytic agent
Ordered Dose:	1amp now
Mode Of Action:	Vitamin K is required for the liver to make factors that are necessary for blood to properly clot (coagulate), including factor II (prothrombin), factor VII (proconvertin), factor IX (thromboplastin component), and factor X (Stuart factor).
Indications:	Preoperatively: to activate clotting factors to decrease chances of bleeding during surgical procedure
Contraindications:	Hypersensitivity to benzyl alcohol,
Drug Interactions:	Coumarin and indanedione derivatives
Side Effect:	No known side effects for this drug; bruising and bleeding are less likely to happen.
Adverse Effects:	No known adverse effects reported
Nursing	 Instruct patient to take only prescribed order
Responsibilities:	 If a dose is missed, take as soon as remembered unless almost time for the next dose
	 Cooking does not destroy substantial amounts of Vitamin K
	 Caution patient to avoid IM injection and activities leading to injury
	 Patient should not drastically alter diet while taking Vitamin K
	 Use a soft toothbrush until coagulation effect is corrected
	 Advise patient to report any signs of bleeding/bruising
	 Patient should be advised not to take OTC drugs without advice of health care provider
	 Advise patient to inform health care provider of medication regimen prior to treatment or surgery
	 Emphasize importance of frequent lab test to monitor coagulation factors
Source	MIMS 113 th edition 2007 http://www.nlm.nih.gov/medlineplus/druginfo/natural/patien t-vitamink.html
	http://www.drugs.com/enc/vitamin-k.html

Generic Name:	Celecoxib
Brand Name:	Arcoxia
Classification:	COX-2 Selective Inhibitor
Ordered Dose:	400mg/cap 1cap OD PRN
Mode Of Action:	Arcoxia reduces pain and inflammation by blocking COX-2, an enzyme in the body.Arcoxia does not block COX-1, the enzyme involved in protecting the stomach from ulcers.Other anti-inflammatory medicines (NSAIDS) block both COX-1 and COX-2.Arcoxia relieves pain and inflammation with less risk of stomach ulcers compared to NSAID
Indications:	relief of acute pain
Contraindications:	Hypersensitivity to arcoxia and it’s ingredients such as
	Celecooxib

Drug Interactions:	 warfarin, a medicine used to prevent blood clots
	 rifampicin, an antibiotic used to treat tuberculosis and other infections
	 water pills (diuretics)
	 ACE inhibitors and angiotensin receptor blockers, medicines used to lower high blood pressure or treat heart failure
	 lithium, a medicine used to treat a certain type of depression
	 birth control pills
	 hormone replacement therapy
	 methotrexate, a medicine used to suppress the immune system
Side Effect:	Nausea, vomiting, diarrhea, Headache, Rash, Blurred vision, Difficulty in sleeping, Muscle cramps, Fatigue
Adverse Effects:	 CNS: headache, malaise, dizziness, hallucinations, insomnia, vertigo, anxiety, drowsiness, confusion
	 CV: bradycardia, tachycardia, hypertension
	 Dermatologic: rash, urticaria
	 GI: constipation, diarrhea, nausea, anorexia, vomiting, abdominal pain, hepatic dysfunction, jaundice
	 GU: gynecomastia, impotence
	 Hematologic: leucopenia, granulocytopenia, thrombocytopenia, pancytopenia
	 Local: pain at IM site, local burning pain at injection site
Nursing	 Take Arcoxia only when prescribed by your doctor.
Responsibilities:	 For the relief of chronic musculoskeletal pain the recommended dose is 60 mg once a day.
	 If you have mild liver disease, you should not take more than 60 mg a day. If you have moderate liver disease, you should not take more than 60 mg every other day.
	 When taking the tablets, swallow them with a glass of water. Do not halve the tablet.
	 Take your Arcoxia at about the same time each day.
	 Taking Arcoxia at the same time each day will have the best effect. It will also help you remember when to take

	the dose.
	 It does not matter if you take Arcoxia before or after food.
	 Do not use Arcoxia for longer than your doctor says.
	 Do not take a double dose to make up for the dose that you missed.
	 If you get an infection while taking Arcoxia, tell your doctor. Arcoxia may hide fever and may make you think, mistakenly, that you are better or that your infection is less serious than it might be.
Bibliography:	MIMS 113th edition 2007
	http://www.drugs.com/arcoxia.html
	http://arcoxia-side-effects.com/

Generic Name:	Tramadol hydrochloride
Brand Name:	Ultram
Classification:	Central acting analgesic
Ordered Dose:	100mg 1tab PO
Mode Of Action:	Binds to mu-opioid receptors and inhibits the reuptake of norepinephrine and serotonin; causes many effects similar to opioids but doesn’t cause respiratory depression
Indications:	Relief of moderate to severe pain.
Contraindications:	Hypersensitivity to tramadol or opioids or intoxication with alcohol, opioids, or psychoactive drugs
Drug Interactions:	 Decreased effectiveness with carbamezapine
	 Increased risk of tramadol toxicity with MAOIs
Side Effect:	Dizziness, sedation, drowsiness, impaired visual acuity, nausea, loss of appetite
Adverse Effects:	 CNS: sedation, dizziness, headache, confusion, dreaming, anxiety, seizures

	 CV: hypotension, tachycardia, bradycardia,
	 Dermatologic: pruritus, urticaria, sweating, pallor
	 GI: nausea, vomiting, dry mouth, flatulence, constipation,
	 Other: potential for abuse, anaphylactoid reactions
Nursing	 Control environment ( temp, light, noise)
Responsibilities:	 Limit use in patients with past or present history of addiction or dependence to opioids
	 Caution patient not to chew or crush tablet
	 Keep opioid antagonist readily available in case of emergency
	 Instruct post-op patients that drug suppress cough reflex
	 Monitor bowel function and arrange laxatives for constipation
	 Institute safety precautions (side rails, assistive device)
	 Provide frequent, small meals if GI upset occurs
	 Provide back rubs, positioning, and other non pharmacological measures to alleviate pain
	 Take drug exactly as prescribed
	 Avoid alcohol, antihistamines, sedatives, tranquilizers while taking this drug
Bibliography:	2005 Lippincott’s Nursing Drug Guide
	http://www.webmd.com/drugs/drug-11276-
	Ultram+Oral.aspx
	http://www.drugs.com/ultram.html
	http://www.medicinenet.com/tramadol/article.htm