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CHAPTER VII DRUG STUDY Name of Patient: J.M.T.

Age: 68 years old Chief complaint: Difficulty of breathing DRUG NAME Generic Name: Hydrocortisone Brand Name: Cortef Dosage: 250mg IV now then 100mg q8 Route: Intravenous Date ordered January 22, 2014 Classification: Corticosteroid MECHANISM OF ACTION Enters target cells and binds to cytoplasmic receptors; initiates many complex reactions that are responsible for its antiinflammatory, immunosuppres sive (glucocorticoid), and saltretaining (mineralocortico id) actions. INDICATION Short-term inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders CONTRAINDICATION Contraindicated in patients with systemic fungal infection, who are taking mifepristone and hypersensitivity to drug. SIDE EFFECTS Headache Dizziness Nausea and vomiting Restlessness NURSING RESPONSIBILITIES 1. Identify if patient has allergy to the drug. 2. Watch out for any adverse reaction such as convulsions, insomnia or sever nausea and vomiting. Report immediately to the care provider.

DRUG NAME

MECHANISM OF ACTION Inhibits the reabsorption of sodium and chloride in the proximal and distal tubules as well as the ascending loop of Henle; this results in the excreation of sodium, chloride and to a lesser degree, potassium and bicarbonate ions.

INDICATION

CONTRAINDIC ATION

SIDE EFFECTS Hypotens ion Water/el ectrolyte depletion Abdomin al pain Dizziness Anemia

NURSING RESPONSIBILITIES Note reasons for therapy, clinical presentation, other agents trialed, and outcome. When more than 40 mg/day is required, give in divided doses

Generic Name: Furosemide Brand Name: Lasix Dosage: 40 mg OD Route: Oral Date ordered: January 22, 2014 Classification Loop Diuretic

Edema associated with CHF, nephritic syndrome, hepatic cirrhosis, and ascites.

Furosemide is contraindicated in patients with anuria or who are hypersensitive to the drug. The manufacturer states that the drug should be IV for acute discontinued in pulmonary patients with edema. progressive renal disease if increasing PO to treat azotemia and hypertension in oliguria occur conjuction with during therapy. spironolactone, triamterene, and other diuretics except ethacrynic acid.

Monitor BP, weight, breath sounds I&O, electrolyte; observe for S&S of hypokalemia and for edema

With rapid diuresis, observe for dehydration and circulatory collapse; monitor BP and pulse

NAME OF DRUG Generic name: Clonidine Brand name: Catapres Dose: 75 mcg now Route: Sublingual Date Ordered January 22, 2014 Classification Antihypentens ive

MECHANISM OF ACTION Clonidine stimulates alpha-2 receptors in brain stem which results in reduced sympathetic outflow from the CNS and a decrease in peripheral resistance leading to reduced BP and pulse rate. It does not alter normal hemodynamic response to exercise at recommended dosages

INDICATION Hypertension, used alone or as part of combination therapy.

CONTRAINDIC ATION Hypersensitivity . Disorders of cardiac pacemaker activity and conduction

ADVERSE EFFECT Dry mouth, drowsiness, dizziness, headache, orthostatic hypotension, weakness, nausea,

NURSING CONSIDERATION Do not discontinue abruptly; discontinue therapy by reducing the dosage gradually over 24 days to avoid rebound hypertension, tachycardia, flushing, nausea, vomiting, cardiac arrhythmias (hypertensive encephalopathy and death have occurred after abrupt cessation of clonidine). Do not discontinue transdermal therapy prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs readily available.

Reevaluate therapy if clonidine tolerance occurs; giving concomitant diuretic increases the antihypertensive efficacy of clonidine. Monitor BP carefully when discontinuing clonidine; hypertension usually returns within 48 hr. WARNING: Remove transdermal patch before defibrillation to prevent arcing.

DRUG ORDER Generic Name: Ipratropium /Albuterol (Salbutamol) Brand Name: Duavent Classification Bronchodilator Frequency: 3 doses q 15 min. then q6 Route: Inhalants Date ordered January 22, 2014

MECHANISM OF ACTION Relaxing the smooth muscles of the bronchioles

INDICATION Management of reversible broncho spasm associated with obstructive airway diseases in patients who require more than a single bronchodilator

CONTRAINDIC ATION -Patients who is allergic to the Drugs

ADVERSE EFFECT Palpitations; Headache, dizziness, nervousness; Dryness of the mouth.

NURSING RESPONSIBILITIES -Use Cautiously to patients with known sensitivity to atropine, soybeans, and peanuts.

-Patients with Hypertropic obstructive cardiomyopathy

-Assess Vital Signs Before drug administration

-Patients having tachyarrythmia

-Observe for paradoxical broncho spasm (Wheezing). If Condition occurs, withhold Medication and notify physician or other healthcare professional immediately.

-Instruct patient to

contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.

-Advise the patient to rinse mouth with water after using the nebulizer to minimize dry mouth

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