furosemide lasix diuretic

DRUG STUDIESDRUG STUDIES

DRUG ORDERMECHANISM OF

ACTIONINDICATION CONTRAINDICATION

ADVERSE EFFECT

NURSING CONSIDERATION

GENERIC NAME:Furosemide

BRAND NAME:Lasix

CLASSIFICATION:Loop Diuretic

ROUTE: IV; Oral

DOSAGE & FREQUENCY:20-40 mg OD; 20 mg tab OD

Date Started:08/02/11Initially 40 mg/IV OD; ↓ dosage to 20 mg at 8:59PM

08/03/11↑ dosage back to 40 mg

Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the loop of Henle, leading to a sodium-rich dieresis.

Pulmonary edema, Edema associated with heart disease, Hypertension

Severe sodium and water depletion

Fluid and electrolyte imbalance, Orthostatic hypotension, Volume depletion

Check the BP; if less than 90/60 mmHg, hold the medication.

Reduce dosage if given with other antihypertensive drugs; readjust dosage gradually as BP responds.

Give early in the day so that increased urination will not disturb sleep.

Encourage the patient to eat foods rich in potassium such as bananas and citrus fruits.

08/05/11Shifted to 20 mg tab OD at 12:00PM



ADVERSE EFFECT


GENERIC NAME:Levofloxacin

BRAND NAME:Levox

CLASSIFICATION:Fluoroquinolone

ROUTE: IV

DOSAGE & FREQUENCY:500 mg OD

Date Started:08/02/11

Bactericidal: Interferes with DNA by inhibiting DNA gyrase replication in susceptible gram- negative and gram-positive bacteria; preventing cell reproduction.

Acute bacterial exacerbation of chronic bronchitis

Hypersensitivity to fluoroquinolones

Nausea, Vomiting, Diarrhea, Constipation

Arrange for culture and sensitivity tests before beginning therapy.

Continue therapy as indicated for condition being treated.

Ensure that patient is well hydrated during course of therapy.



ADVERSE EFFECT


GENERIC NAME:Ipratropium + Salbutamol

BRAND NAME:Duavent®

CLASSIFICATION:Antiasthmatic

ROUTE: Inhalation

DOSAGE & FREQUENCY:2.5 mL pulmoneb Q4o


08/04/11↓ frequency to Q6o

Ipratropium bromide: Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa.

Salbutamol sulfate:In low doses, acts relatively selectively at beta-adrenergic receptors to cause bronchodilation and vasodilation; at higher doses, β2 selectivity Is lost, and drug acts at β2 receptors.

Relieve or prevention of bronchospasm in patients with reversible obstructive airway disease such as Bronchial Asthma

Hypersensitivity to any component of Duavent or to atropine

Bronchospasm, Cough, Headache

Use minimal doses for minimal periods; drug tolerance can occur with prolonged use.

Prepare solution for inhalation by diluting 0.5 mL 0.5% solution with 2.5 mL normal saline; deliver over 5-15 minutes by nebulization.

http://mims.com/Philippines/drug/info/Duavent/?q=duavent&type=brief



ADVERSE EFFECT


GENERIC NAME:Hydrocortisone

BRAND NAME:

CLASSIFICATION:Glucocorticoid

ROUTE: IV

DOSAGE & FREQUENCY:50 mg Q8o


08/02/11↓ dosage to 50 mg

Enters target cells and binds to cytoplasm receptors; initiates many complex reactions that are responsible for its immunosuppressive actions.

Acute adrenocortical insufficiency

Viral/fungal infections, Immunosupression

Fluid and electrolyte disturbances, Hyperglycemia

Ensure that adequate amount of calcium is taken if prolonged administration of steroids.

Taper doses when discontinuing high-dose or long term therapy.



ADVERSE EFFECT


GENERIC NAME:Cimetidine

BRAND NAME:Tagamet

CLASSIFICATION:H2-receptor antagonist

ROUTE: IV

DOSAGE & FREQUENCY:200 mg Q8o


Inhibit the action of histamine at H2-

receptors of the stomach, inhibiting gastric acid secretion and reducing pepsin output.

Non-ulcer dyspepsia Hypersensitivity to cimetidine

Hypotension (IV use), Diziness

Give drug with meals and at bedtime.

Arrange for regular follow-up check up, including blood tests to evaluate effects.



ADVERSE EFFECT


GENERIC NAME:Acetylcysteine

BRAND NAME:Fluimucil

CLASSIFICATION:Mucolytic

ROUTE: Oral

DOSAGE & FREQUENCY:600 mg tab OD


Splits links in the muco-proteins contained in respiratory mucus secretions, decreasing viscosity of the mucus

Inspissated mucus secretions in acute and chronic bronchopulmonary disease (Asthmatic Bronchitis)

Hypersensitivity to acetylcysteine

Respiratory bronchospasm

Dilute the 20% acetylcysteine solution with either normal saline or sterile water for injection; use the 10% solution undiluted. Refrigirate unused, undiluted solution and use within96 hr.

Administer the following drugs separately, because they are incompatible with acetylcysteine solutions: Tetracyclines, erythromycin lactobionate, amphotericin B, iodized oil chymotrypsin, trypsin, hydrogen peroxide.



ADVERSE EFFECT


GENERIC NAME:Clopidrogel bisulfate

BRAND NAME:Clopida

CLASSIFICATION:Antiplatelet

ROUTE: Oral



Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets

Acute coronary syndrome

Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.

Headache, Dizziness, Rash

Provide small frequent meals if GI upset occurs.

Provide comfort measures and arrange for analgesics if headache occurs.



ADVERSE EFFECT


GENERIC NAME:Enoxaparin

BRAND NAME:Clexane

Low-modular-weight heparin that inhibits thrombus and clot formation by blocking factor Xa, factor IIa, preventing formation

Unstable angina Uncontrolled hemorrhage including major bleeding disorders

Hemorrhage, Bruising

Give deep subcutaneous injections; do not give enoxaparin by IM injection.

Administer by deep

CLASSIFICATION:Antithrombotic

ROUTE: SQ

DOSAGE & FREQUENCY:0.4 cc Q12o


Date Discontinued:08/03/11

of clots. subcutaneous injection; patient should be lying down. Alternate between the left and right anterolateral and posterolateral abdominal wall. Introduce the whole length of needle into a skin fold held between thumb and forefinger; hold skin fold throughout the injection.

Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for hematoma; do not massage the injection sites.

Do not mix with other injections or infusions.

Store at room temperature. Fluid should be clear, colorless to pale yellow.

Provide safety measures (electric razor, toothbrush) to

prevent injury to patient who is at risk for bleeding.

Check patient for signs of bleeding; monitor for blood tests.



ADVERSE EFFECT


GENERIC NAME:Nitroglycerin

BRAND NAME:Transderm-Nitro

CLASSIFICATION:Antianginal

ROUTE: Transdermal



Relaxes vascular smooth muscle with resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.

Angina pectoris Severe anemia, early MI, head trauma, cerebral hemorrhage

Hypotension Administer transdermal systems to skin site free of hair and not subject to much movement. Do no apply to distal extremities. Change sites to decrease the chance of local irritation and sensitization.

Remove transdermal system before attempting defibrillation or cardioversion.

Remove old system before applying new

one.



ADVERSE EFFECT


GENERIC NAME:Trimetazidine HCl

BRAND NAME:Vastarel MR®

CLASSIFICATION:Antianginal

ROUTE: Oral

DOSAGE & FREQUENCY:35 mg tab BID


Specific and selective inhibitor of an enzyme of the fatty acid β-oxidation: 3-ketoacyl CoA thiolase (3-KAT). This inhibition of β-oxidation allows a recoupling of glycolysis and an increase in glucose oxidation

Angina pectoris Hypersensitivity to Trimetazidine HCl Or any of the constituents of Vastarel MR.

Nausea, Vomiting Use cautiously in patients with heart failure or hypertension and in elderly patients.

http://mims.com/Philippines/drug/info/Vastarel%20MR/Vastarel%20MR%20tab?q=vastarel&type=brief



ADVERSE EFFECT


GENERIC NAME:Digoxin

BRAND NAME:Lanoxin

CLASSIFICATION:Cardic glycoside

ROUTE: Oral

DOSAGE & FREQUENCY:0.25 mg tab OD


Increases intracellular calcium and allows calcium to enter the myocardial cell during depolarization via sodium-potassium pump mechanism; this force of contraction (positive inotropic effeect), increases renal perfusion (seen as diuretic effect in patients with heart failure), decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity.

Heart failure, Atrial fibrillation

Ventricular tachycardia, Ventricular fibrillation, Acute MI, Renal insufficiency

Arrhythmias, Headache, Weakness

Avoid giving with meals; taking this drug with food will delay absorption and alter drug pharmacokinetics.

Have emergency equipment ready; have K+ salts lidocaine, phenytoin, atropine and cardiac monitor available in case toxicity develops.



ADVERSE EFFECT


GENERIC NAME:Acetylsalicylic acid

BRAND NAME:Aceprin®

CLASSIFICATION:Antiplatelet

ROUTE: Oral



Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation.

Inflammatory conditions —Osteoarthritis

Hypersensitivity to salicylates, Hemorrhagic states, Vitamin K defficiency

Prolonged bleeding time, Bronchospasm, Epigastric discomfort

Give drug with food or after meals to prevent GI upset.

Give drug with full glass of water to reduce risk of tablet or capsule lodging in the esophagus.

Do not crush, and ensure the patient does not chew SR preparations.

Do not use aspirin that has strong vinegar like odor.



ADVERSE EFFECT


GENERIC NAME:Levetiracetam

BRAND NAME:Keppra

CLASSIFICATION:Antiepileptic

ROUTE: IV; Oral

DOSAGE & FREQUENCY:500 mg Q12o; 500 1½ tab BID


08/03/11Shifted to 500 1½ tab BID

Mechanism of action not well understood; antiepileptic activity may be related to its ability to inhibit polysynaptic responses and block posttetanic potentiation.

Adjunct therapy in the treatment of partial-onset seizures when used with other epilepsy medication

Hypersensitivity to levetiracetam

Diziness, Headache

Give drug with food to prevent GI upset; use oral solutions if the patient has difficulty of swallowing.

If CNS, vision or coordination changes occur, establish safety precautions (use side rails).



ADVERSE EFFECT


GENERIC NAME:Diazepam

BRAND NAME:Valium

CLASSIFICATION:Antiepileptic

ROUTE: IV

DOSAGE & FREQUENCY:5 mg PRN for frank seizure


Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; may act in spinal cord and at supraspinal sites to produce skeletal muscle relaxation; potentiates effects of GABA, an inhibitory neurotransmitter

Adjunct in status epilepticus and severe recurrent convulsive seizures

Psychoses, Acute-narrow-angle glaucoma, Shock, Acute alcoholic intoxication

Transent, mild drowsiness initially, Sedation, Bradycardia, Tachycardia,Drug dependence with withdrawal syndrome

Do not use small veins (dorsum of hand or wrist) for IV injection.

Reduce opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.

Carefully monitor P, BP, RR during IV administration.



ADVERSE EFFECT


GENERIC NAME:Metoclopramide

BRAND NAME:Plasil

CLASSIFICATION:Antiemetic

ROUTE: IV

DOSAGE & FREQUENCY:1 amp Q12o


Stimulates motility of upper GI tract without stimulating gastric, biliary or pancreatic secretions; appears sensitive tissues to action of acetylcholine, relaxes pyloric sphincter which when combined with effects of motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure.

Nausea and vomiting GI hemorrhage, Mechanical obstruction and perforation

Restlessness, Drowsiness, Diarrhea

Monitor BP carefully during IV administration.

Monitor for extrapyramidal reactions and consult physician if the occur.



ADVERSE EFFECT


GENERIC NAME:Meloxicam

BRAND NAME:Mobic

CLASSIFICATION:NSAID

ROUTE: IV

DOSAGE & FREQUENCY:15 mg tab PRN for pain


Inhibits the enzyme cyclooxygenase (COX), which is required for the synthesis of prostaglandins and thromboxanes. Somewhat more selective for COX-2 sites (found in the brain and at sites of inflammation) than COX-1 sites, which are found throughout the tissues and are related to protection of GI mucosa.

Relief of painful osteoarthritis

Hypersensitivity to aspirin or meloxicam, Bleeding disorders

Headache, Dizziness, Insomnia, Nausea, Dyspepsia

Administer drug with food if GI upset occurs.

Establish safety measures if CNS disturbances occur.

Monitor patient on prolonged therapy for signs of bleeding.

furosemide lasix diuretic

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