final drug study (eclampsia patient)

8/3/2019 Final Drug Study (Eclampsia Patient)

1/28

GenericName

(BrandName)

Dosage,Timing

andRoute

ClassificationGeneral Class

and Family

Indications Mechanism ofAction

Side Effects NursingConsiderations

Lactulose(Duphalac)

15cc,(HS)OD, PO

Ammoniareductiondrug

Laxative

Treatment ofconstipationPreventionand treatmentof postal-systemicencephalopath

y

Drug passesunchanged intocolon wherebacteria break itdown to organicacid that increasethe osmotic

pressure in colonand slightlyacidify coloniccontents resultingin increase stoolwater content,stool softening.This also result inmigration of bloodammonia into

colon contentswith subsequenttrapping andexpulsion infeces.

GI: flatulence,distention,intestinalcramps,belching,diarrhea,nausea

Other: acid-baseimbalance,electrolyteimbalance

Extremely darkor cloudy syrupmay be unsafe.Dont use.

Give with fruitjuice, water or

milk

Administerretention enemausing rectalballoon catheter,dont usecleansing enema

Dont administer

with otherlaxative

Monitor serumammonia levelCarefully monitorblood glucoselevels in diabeticpatients


2/28

Generic Name(Brand Name)

Dosage,Timing

andRoute

ClassificationGeneral Class

and Family

Indications Mechanismof Action

Side Effects Nursing Considerations

KetorolacTromethamine(Acular LS,Acular PF)

10 mg(1tab),q8, PO

Antipyr

etic

Nonopi

oid

analges

ic

NSAID

Short-termmanagement of pain(up to 5days)

Opthalmic:relief ofocularitching dueto seasonalconjuctivitisand relief ofpostopearativeinflammation aftercataractsurgery

Anti-inflammatoryandanalgesicactivity,inhibitsprostaglandi

ns andleukotrienesynthesis

CNS: drowsiness,abnormalthinking,dizziness,euphoria,headacheRESP: asthma,

dyspneaCV:Edema, pallor,vasodilationGI:GI Bleeding,abnormal taste,diarrhea, drymouth,dyspepsia, GI

pain, nauseaGU:Oliguria,renal toxicity,urinary frequencyDERMA:pruritis,purpura,sweating,urticaria

Patients who haveasthma, aspirin-inducedallergy, and nasal polypsare at increased risk fordevelopinghypersensitivityreactions. Assess for

rhinitis, asthma, andurticaria.

Assess pain (note type,location, and intensity)prior to and 1-2 hrfollowing administration

Ketorolac therapyshould always be given

initially by the IM or IVroute. Oral therapyshould be used only asa continuation ofparenteral therapy.

Caution patient to avoidconcurrent use ofalcohol, aspirin,


3/28

HEMA:prolongedbleeding timeLOCAL: injection

site pain NEURO:paresthesiaMISC:allergic reaction,anaphylaxis

NSAIDs,acetaminophen, or otherOTC medicationswithout consulting health

care professional.

Advise patient to consultif rash, itching, visualdisturbances, tinnitus,weight gain, edema,black stools, persistentheadche, or influenza-like syndromes(chills,fever,muscles

aches, pain) occur.

Effectiveness of therapycan be demonstrated bydecrease in severity ofpain. Patients who donot respond to oneNSAIDs may respond toanother.


4/28

GenericName(BrandName)

Dosage,TimingandRoute

ClassificationGeneralClass andFamily



N-Acetylcysteine

(Broncoflem)

20mgsachet+ 50

mLwater,BIDOD,PO

Respir

atory

and

intratracheal

inhala

nt

Mucoly

tic

An

Antidot

e.

adjuncttreatment forabnormally

viscid mucoussecretionspresent in acuteand chronicbronchopulmonary disease andpulmonarycomplication ofcystic fibrosis,tracheostomy

care

treatment ofacetaminophenoverdose.prevention ofrenal damagefrom dyes givenduring certain

Acetylcysteine splitslinkage ofmucoproteins. It

reduces theviscosity ofpulmonarysecretions,facilitates removalby coughing,postural drainage,mechanical means.Acetylcysteineprotects against

acetaminophenoverdose-inducedliver toxicity.

Stickiness onface

Transientunpleasant odor

Increasedbronchialsecretions

Irritated throat

Nausea

Vomiting

Rhinorrhea

Skin rash

Assesspretreatment

respirations forrate, depth, andrhythm.

If bronchospasmoccurs, stop thetreatment andnotify thephysician.

Monitor rate,depth, rhythm,and type ofrespiration

Check sputum forcolor, consistencyand amount.


5/28

diagnostic testslike CT scan.

Facial edema

Bronchospasm

Wheezing



ClassificationGeneral Classand Family



Amlodipi

ne(Alzor)

10mg

(1tab),OD, PO

Calciu

mchannel

blocker

anti-

hyperte

nsive

anti-

anginal.

used to

managehypertension, chronicstableangina, andvasospasticangina. Itmay beused aloneor with

other anti-hypertensives or anti-anginals.

Amlodipine

inhibits calciummovementacross cellmembranes ofcardiac andvascularsmoothmuscle. Itdilatescoronary

arteries,peripheralarteries andarterioles.Amlodipinedecreases totalperipheralvascularresistance by

Peripheraledema

Headache

Flushing

Dizziness

Palpitations

Nausea

Unusualtiredness orweakness

Chest pain

Assess baseline renaland liver function.

Assess blood pressure.

Assess apical pulse.

Assess for peripheraledema behind medialmalleolus.

Assess skin forflushing.

Question for headacheand weakness.

May be given without


6/28

vasodilation. Bradycardia

OrthostaticHypotension

regards to food.

Grapefruit juice mayincrease drug

concentration



ClassificationGeneralClassandFamily



Furosemide(Lasix)

50mg(1tab),OD, PO

Loopdiuretic

Treatment ofedemaassociated withcongestiveheart failure,chronic renalfailure, hepaticcirrhosis, andacute

pulmonaryedema

It is also usedfor treatment ofhypertension,alone or incombinationwith other

Enhancesexcretion ofsodium,chloride,potassium bydirect action atascendinglimb of loop ofHenle and

produces adiuretic effect.

Increase inurinaryfrequency orvolume

Nausea

Gastric upset

with cramping

Diarrhea orconstipation

Electrolytedisturbances

Dizziness or light

Give with food toavoidgastroinestinalupset, preferablywith breakfast (toprevent nocturia).

Check vital signs

especially bloodpressure forhypotension priorto administration.

Assess baselineelectrolyte,particularly check


7/28

hypertensive

Can also beused for

treatment ofhypercalcemia.

headedness

Headache

Blurred Vision

Paresthesia

Photosensitivity

Rash

Weakness

Bladder spasm

for low potassium.

Assess edema,skin turgor, and

mucousmembranes forhydration status.

Assess musclestrength andmental status.

Obtain baselineweight..

Note extent ofdiuresis


8/28






Metropol

ol(Lopressor)

100mg

(1tab),BID, PO

autonomic

nervoussystem

agent

beta-

adrenergic

antagonist

(sympathol

ytic);

antihyperte

nsive

Metoprolol

isprescribedfor patientswith highbloodpressure(hypertensionIt is alsoused totreat chestpain(anginapectoris)related tocoronaryarterydisease.slowing and

Metoprolol

blocks theaction of thesympatheticnervoussystem, aportion of theinvoluntarynervoussystem, byblocking betareceptors onsympatheticnerves. Sincethesympatheticnervoussystem isresponsible forincreasing the

Constipation;

diarrhea;dizziness; drymouth or eyes;gas; headache;heartburn;lightheadedness; milddrowsiness;muscle aches;nausea;stomach pain;trouble sleeping;unusualtiredness orweakness;vomiting.

Take apical pulse andBP beforeadministering drug.Report to physiciansignificant changes inrate, rhythm, or qualityof pulse or variationsin BP prior toadministration.

Monitor BP, HR, andECG carefully duringIV administration.

Take several BPreadings close to theend of a 12 h dosinginterval to evaluateadequacy of dosage
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regulatingcertaintypes ofabnormally

rapid heartrates

Other usesinclude thepreventionof migraineheadacheandtreatment

of certaintypes oftremors(familial orhereditaryessentialtremors).

rate withwhich theheart beats,by blocking

the action ofthese nervesmetoprololreduces theheart rate andis useful intreatingabnormallyrapid heartrhythms.

for patients withhypertension,particularly in patientson twice daily doses.

Some patients requiredoses 3 times a day tomaintain satisfactorycontrol.

Monitor I&O, dailyweight; auscultatedaily for pulmonaryrales.

Withdraw drug ifpatient presentssymptoms of mentaldepression because itcan progress tocatatonia.
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10/28

GenericName(Brand

Name)

Dosage,Timing andRoute

ClassificationGeneralClass and

Family



Captopril(Capoten)

125 mg(1tab), q6hold ifSBB


11/28

renal failure,polyuria, oliguria,urinary frequencyHematologic:

Neutropenia,agranulocytosis,thrombocytopenia,hemolytic anemia,pancytopeniaOther: Cough,malaise, drymouth,lymphadenopathy

mark patient's chartwith notice thatcaptopril is beingtaken; the

angiotensin IIformation subsequentto compensatoryrenin release duringsurgery will beblocked; hypotensionmay be reversed withvolume expansion.

Monitor patientclosely for fall in BPsecondary toreduction in fluidvolume


12/28

GenericName(Brand

Name)

Dosage,Timingand

Route




Amikacin

sulfate

(Amikin)

500mg,q12,IVTT

Aminoglycoside Short-termtreatment ofseriousinfectionscaused bysusceptiblestrains ofPseudomonasspecies,Escherichia coli,indole-positiveand indole-negativeProteusspecies,Klebsiella,Enterobacter,and Serratiaspecies,Acinetobacterspecies.

Bactericidal:Inhibits proteinsynthesis insusceptiblestrains of gram-negativebacteria cellmembraneappears to bedisrupted,causing celldeath.

Ototoxicity,nausea,vomiting,diarrhea,superinfections

Correct dehydrationbefore therapybecause of increase riskof toxicity.

Watch for signs andsymptomsofsuper infection(especially URT),such as continuedfever, chills, andincreased pulse rate.

Weigh patient andreview renalfunctionstudies beforetherapybegins.

Evaluate patientshearing beforeand during therapy if hewill be receiving drug forlonger than 2weeks. Notify prescriberif patienthas tinnitus, vertigo, orhearing loss


13/28

Obtain specimen forculture andsensitivity test beforegiving first

dose. Therapy maybegin whileawaiting the results.


14/28

GenericName(Brand

Name)



Indications Mechanismof Action


Potassium

Chloride

(KaliumDurule)

1 tab, PO Electrolytesand Minerals For hypokalemia

As prophylaxisduring treatmentwith diuretics

To prevent and

treat potassium,

deficitsecondary

to diuretics or

corticosteroid

therapy.

Also indicated

when

potassium,

is depleted by

severe vomiting,

prolonged

diuresis and

diabetic

acidosis.

Supplementalpotassium inthe form ofhighpotassiumfoodor potassiumchloridemay be ableto restorenormalpotassiumlevels.

Renal insufficiency,hyperkalemia,nausea, vomiting,muscle weakness,difficulty inswallowing

Some patients

find it difficult

to swallow the

large sized KCl

tablet.

Administer

while patient is

sitting up or

standing (neverin recumbent

position) to

prevent drug-

induced

esophagus.

Watch out forlevels of

potassiumelectrolyte levelto preventhyperkalemia.


15/28






Cefazolin

(Ancef)

500mg(1tab) q8,PO

Anit-

infectives

Pharmacol

ogic: first

generation

Cephalosp

horins

Skin & skinstructureinfections;pneumonia;urinary tractinfections;bone & jointinfections

Bind to

bacterial cell

wall

membrane,

causing cell

death.

Active against

many gram-positive cocciincluding:Streptococcuspneumoniae,Group A beta-hemolyticstreptococci;Penicillinas-producing

staphylococci.

diarrhea,nausea,vomiting,cramps,Rashes,allergicreactionsincludingAnaphylaxisand Serumsickness,superinfection

Assess patient forinfection (vital signs;appearance of surgicalsite, urine; WBC) atbeginning and duringtherapy.

Before initiatingtherapy, obtain a historyto determine previoususe of and reactions topenicillins orcephalosphorins.Persons with a negativehistory of penicillinsensitivity may still havean allergic response.

Obtain specimens forculture and sensitivitybefore initiating therapy.

Observe patient forsigns and symptoms ofanaphylaxis (rash,pruritis, laryngealedema, wheezing).Discontinue drug andnotify physician or other


16/28

health care professionalimmediately if theseproblems occur. Keepepinephrine, anantihistamine, andresuscitation equipmentclose by in case ofanaphylactic reaction.

Instruct patient to reportsigns of superinfection(furry overgrowth on thetongue, vaginal itchingor discharge, loose orfoul-smelling stools) andallergy.

Instruct patient to notifyhealth care professionalif fever and diarrheadevelop, especially ifdiarrhea contains blood,mucus, or pus. Advisenot to treat diarrheawithout consultinghealthcare professional.


17/28



ClassificationGeneralClass andFamily



Paracetamol

(Biogesic)

300mg,STATorder,IVT

Anti-pyretic Symptomatic

relief of pain

and fever.

Acetaminophenrelieves pain byelevating the painthreshold, that is,by requiring agreater amount ofpain to developbefore a personfeels it. It reducesfever through itsaction on the heat-regulating centerof the brain.Specifically, it tellsthe center to lowerthe body'stemperature whenthe temperature iselevated.

hemolyticanemia,

neutropenia,leucopenia,

pancytopenia,jaundice,

hypoglycemia,rash, urticaria.

Use liquid form forchildren andpatients who havedifficultyswallowing.

Advise patient that drugis only for short termuse.

Advise patient thatmany over the counterproducts containacetaminophen; beaware of this whencalculating total dailydose.

Warn patient that highdoses orunsupervised long termuse cancause liver damage.

Use cautiously inpatients with longterm alcohol use


18/28

because therapeuticdoses causehepatotoxicity in thesepatients.


19/28



ClassificationGeneral Class and Family



Diazepam

(Valium)

5mg(1tab),STATorder,IVTT

Benzodiazepine

Anxiolytic

Antiepileptic

Skeletal muscle

relaxant (centrallyacting)

Managementof anxietydisorders orfor short-termrelief ofsymptoms ofanxiety.

Exactmechanisms ofaction notunderstood; actsmainly at thelimbic systemand reticularformation; mayact in spinal cordand atsupraspinal sitesto produceskeletal musclerelaxation;potentiates theeffects of GABA,an inhibitoryneurotransmitter;anxiolytic effectsoccur at doseswell below thosenecessary tocause sedation,ataxia; has littleeffect on corticalfunction.

Throat, chestpain,

drowsiness,fatigue,

confusion,dizziness,headache,

slurred speech,hypotension,tachycardia,

edema, blurredvision, nausea,constipation,

urinaryretention,hiccups,

coughing.

Superviseambulation.Adversereactions suchas drowsinessand ataxia aremore likely tooccur in olderadults anddebilitated orthose receivinglarger doses.Dosageadjustment maybe necessary.

Monitor I and Oratio, includingurinary andbowelelimination.

Observe patientclosely andmonitor vitalsigns when


20/28


21/28

Name(BrandName)

TimingandRoute

General Classand Family

Action Considerations

Magnesium

Sulfate

(Epsomsalt,sulfamag)

2g, PRNmed,IVTT

Electrolyteimmediate control of life-threatening convulsionsin the treatment of severetoxemias (pre-eclampsia and eclampsia)of pregnancy .

believed toreduceacetylcholinereleased bynerve impulses,resulting inanticonvulsanteffects andcentral nervoussystemdepression andblockingperipheralneuromusculartransmission.Becausemagnesiumantagonizescalcium andblocks calciumchannels inbronchial andvascular smoothmuscle, it alsohasantihypertensiveactions.

Flushing,nausea,vomiting,palpitations,headache,generalmuscleweakness,lethargy,constipation.

serummagnesiumlevels, bloodpressure andrespiratory rateshould bemonitored;patellar reflexescan beassessed todetect onset ofmagnesiumintoxication.

antidote forrespiratorydepression iscalcium chlorideor calciumgluconate.
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22/28






Ranitidinehydrochloride(Zantac)

50mg,q8, IVTT

H2- receptorantagonistantiulcerative

For occasionalheartburn, acidindigestion,and sourstomach

Chemical:Competitivelyinhibits actionof H2 receptorsites ofparietal cells,decreasinggastric acidsecretion

Therapeutic:Relieves GIdiscomfort

CNS: vertigo,malaiseEENT: blurredvisionHematologic:reversibleleukopenia,pancytopenia,thrombocytopeniaHepatic: jaundiceOther:anaphylaxis,angioedema

assess patientscondition beforestarting therapy andregularly thereafter tomonitor drugseffectiveness

be alert for adversereactions and druginteractions

Dont use aluminium-based needles orequipment whenmixing or giving drugparenterally becausedrug is incompatiblewith aluminum.


23/28

Generic Name(Brand Name)


ClassificationGeneral Class andFamily



Spironolactone(Aldactone)

25mg,BID,PO

Aldosterone

Antagonist

Potassium-

sparing

diuretic

Foradjunctivetherapy inedemaandhypertension

Chemical:Completelyblocks theeffects ofaldosterone in therenaltubule,causingloss ofsodiumand waterandretention ofpotassium.

Therapeutic:Lowers

bloodpressure

CNS:Dizziness,headache,drowsiness,fatigueDermatologic: Rash,UrticariaGI:Cramping,Diarrhea, drymouth, thirst,vomitingGU:impotence,amenorrhea,irregularmensesHematologic

:Hyperkalemia,HyponatremiaOther:hirsutism

take the drugearlybecause ofincreasedurination.

weigh patienton regularbasis at thesame timeand in thesameclothing andrecord theweight.

avoid foodsthat are richin potassium

(e.g banana,potatoes,watermelon,tomatoes,nuts, avocado,grapefruitandoranges).


24/28






Omeprazole(Losec)

20mg,OD, PO

Antisecretory

Drug

Proton Pump

Inhibitor

Short termtreatmentof activeduodenalulcer.

Chemical:Gastricacid-pumpinhibitor:Suppressesgastric acidsecretion byspecificinhibition ofthehydrogen-potassiumATPaseenzymesystem atthe

secretorysurface ofthe gastricparietalcells; blocksthe finalstep of acidproduction.

CNS: Headache,dizziness,vertigo, anxiety,insomniaDermatologic:Rash,inflammation,urticaria, pruritus,alopecia, dryskinGI: Diarrhea,abdominal pain,nausea,vomiting,constipation, drymouth, tongue

atrophyRespiratory:cough, epistaxisOther: back pain,fever

take drugbefore meals.

swallow thecapsulewhole; do notchew, open,or crush themand followwith a glassof water.

have regularmedicalfollow-upvisits.

report severeheadache,worsening ofsymptoms,fever, chills.


25/28

GenericName(Brand Name)





Cefuroxime(Zinacef)

750mg,q8, IVTT

Antibiotic

Cephalospo

rin (second

generation)

To Lowerrespiratoryinfections.

Chemical:Bactericidal:Inhibits synthesisof bacterial cellwall, causing celldeath.

CNS:Headache,dizziness,lethargyGI: Nausea,vomiting,diarrhea,anorexia,abdominal pain,flatulenceHematologic:decreasedplateletsHypersensitivity:rash, feverLocal: PainOther:superinfections

take full courseof therapy evenif feeling better.

discontinue ifhypersensitivityreaction occurs.


26/28






Tramadolhydrochloride(Ultram)

50mg,q8, IVTT

Analgesic

Opioid

analgesic

Relief ofmoderate tomoderatelysevere pain

Chemical:Binds to mu-opioidreceptors andinhibits thereuptake ofnorepinephrineand serotonin;causes manyeffects similar tothe opioids--dizziness,somnolence,nausea,constipation-- butdoes not have therespiratorydepressanteffeffects.

CNS: Sedation,Dizziness,headache,confusion,dreaming,sweating,anxiety,seizuresCV:Hypotension,tachycardia,bradycardiaDermatologic:sweating,pruritus, rash,pallor, urticariaGI: Nausea,vomiting, dry

mouth,constipation,flatulenceOther:anaphylactoidreactions

controlenvironment ifsweating orCNS effectsoccur.

limit in use inpatients withpast or presenthistory ofaddiction to ordependence onopioids.


27/28






TranexamicAcid(Cyklokapron)

50mg,q8, PO

Antifibrinolytic For excessivebleeding

Chemical:Exerts itsantifibrinolyticeffect through thereversibleblockade oflysine-bindingsites onplasminogenmolecules. Itinhibitsendometrialplasminogenactivator and thuspreventsfibrinolysis andthe breakdown ofblood clots.

CNS: Headache,dizziness,lethargyGI: Nausea,vomiting,diarrhea,anorexia,abdominal pain,flatulenceHematologic:Arterialthrombosis,thromboembolismHypersensitivity:rash, feverLocal: PainOther:superinfections

The dose ofCYKLOKAPRON Injectionshould bereduced inpatients withrenalinsufficiencybecause of therisk ofaccumulation.

Patients with aprevious historyofthromboembolicdisease may beat increased riskfor venous or

arterialthrombosis.


28/28






HydralazineHydrochloride(Apresoline)

5mg, q6,IVTT

Antihypertensi

ve

Vasodilator

(peripheral)

For severeessentialhypertension.

Chemical:Acts directly onvascular smoothmuscle to causevasodilation,primarilyarteriolar,decreasingperipheralresistance;maintains orincreases renaland cerebralblood flow.

CNS: Headache,peripheral neuritis,dizziness,tremors,anxiety,disorientationCV: Hypotension,tachycardia,palpitations, anginapectorisGI: Nausea,vomiting, dry mouth,anorexia, diarrhea,constipationGU: impotenceHematologic: BlooddyscrasiasHypersensitivity:Rash, urticaria, fever,chills, hepatitis

Other: nasalcongestion, flushingedema,splenomegaly,dyspnea

use parenteraldrugimmediatelyafter openingampule. Use asquickly aspossibleafterdrawing to aneedle into asyringe.

Hydralazinechanges colorafter contactwith metal, anaddiscoloredsolutions shouldbe discarded.

final drug study (eclampsia patient)

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