XIV.

Drug Study DRUGS MECHANISM OF ACTION

30 mins. For analgesia and approximately 1 week for antiinflammatory effect.

INDICATION

CONTRAINDICATIO N
Pregnancy especially during the last trimester. Use in clients with the aspirin triad(bronchial asthma, rhinitis, aspirin intolerance)

SIDE EFFECTS

NURSING RESPONSIBILITIE S
Review history for any conditions that may preclude drug therapy(e.g. PUD, Lupus, asa intolerance, heavy alcohol intake.) Obtain/monitor CBC, liver and renal function studies, x-rays and eye exam prior to initiating long-term therapy. Take with meals or milk to decrease GI upset. Report any nausea and vomiting , diarrhea and constipation. Take the dosage prescribed for the best results. May cause dizziness and drowsiness.Do not perform activities that require mental alertness until drug effects realized. Individualize dosage based on tolerance and effectiveness. Give with meals starting at a low dose

*Generic Name: Ibuprofen Brand Name: Mortin, Advil 400mg P.O. tid Classification: Non-Steroidal AntiInflammatory Drugs(NSAIDs)

Analgesic for mild to moderate pain. Fever and minor aches and pain due to colds, flu, sorethroat, headaches and toothaches. Pain of migraine headaches.

Dermatitis, rashes.Hypersensitivity reaction consisting of abdominal pain, fever, headache,nausea and vomiting.

Generic Name: Metformin hydrochloride Brand Name: Glucophage

Decreases hepatic glucose production, decreases intestinal absorption of glucose and increases

Alone as adjunct to diet to lower blood glucose in clients having NIDDM whose

Renal disease or dysfunction (serum creatinine levels > 1.5mg/dL in males and >14 md/dL in females.In

Lactic acidosis (fatal), Diarrhea, nausea and vomiting, abdominal bloating, flatulence, anorexia, unpleasant and

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500mg tid Classification: Antidiabetic peripheral uptake and utilization of glucose.Does not cause hypoglycemia in either diabetic or non-diabetic clientsand it does not cause hyperinsulinemia.Ins ulin secretion remains unchanged, while fasting insulin levels and day long plasma insulin response may decrease.In contrast to sulfonylureas, the body weight of clients treated with metformin remains stable or may decrease somewhat.Food decreases or slightly delays the absorption of metformin. Bactericidal: Inhibits cell wall synthesis of sensitive organisms, causing cell death. Indications: Infections due to penicillinaseproducing blood glucose cannot be managed satisfactorily via diet alone. Extended release form used to treat Type 2 diabetes as initial therapy and in combination with a sulfonylurea and insulin in clients aged 17 y/o and older. Polycystic ovary syndrome to improve rate of ovulation, cervical scores and pregnancy rates. clients undergoing radiologic studies using iodinated contrast medium because use of such products may cause alteration of renal function, leading to acute renal failure and lactic acidosis. -Acute and chronic metabolic acidosis, including diabetic ketoacidosis with or without coma. -Lactation. metallic taste, abnormal stools, taste disorder.Lightheadedness , Headache.asthenia, rashes,chills, flu, syndrome, flushing and increased sweating. with gradual escalation.This will reduce GI side effects and allow determination of the minimal dose necessary for any adequate control of blood glucose. Monitor BP, CBC, BS , electrolytes, urinalysis, liver and renal function test.

Generic Name: Oxacillin Sodium 500 mg IV q 6 Classification: Antibiotic

Infections due to penicillinaseproducing staphylococci; may be used to initiate treatment when a staphylococci is

Contraindicated with allergies to penicillin, cephalosporin, or other allergens. Use cautiously with renal disorders, pregnancy and lactation.

gastritis, nausea, vomiting, diarrhea, abdominal pain, rashes, anemia

Make sure that client has no allergies to penicillin, cephalosporin or other allergens. Finish entire course of therapy as prescribed.

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staphylococci; may be used to initiate treatment when a staphylococci is expected. Generic Name: Secnidazole 500 mg Brand Nmae: Flagentyl Classification: Antiamoebics Generic Name: Ketorolac 3 mg IV q8 Classification: Antipyretic NSAIDs Anti-inflammatory and analgesic activity, inhibits prostaglandins and leukotriene synthesis. expected.

Amoebiasis

Hypersensitivity to imidazole derivatives

GI disturbances, nausea, epigastric pain, metallic taste, glossitis and stomatitis.

Generic Name: Omeprazole Classification: Antisecretory drug Proton pump inhibitor

Gastric acid pump inhibitor:Suppresses gastric acid secretion by specific inhibition of the hydrogenpotassium ATPase enzyme system at the

Short-term management of pain(up to 5 days) ophthalmic:Relie f of ocular itching due to seasonal conjunctivitis and relief of postoperative inflammation after cataract surgery. Short-term treatment of active duodenal ulcer. First-line therapy treatment of heartburn or

Contraindicated with significant renal impairment, during labor and delivery, lactation;patients wearing soft contact lenses(ophthalmic); aspirin allergy; concurrent use of NSAIDs; active peptic ulcer disease, recent GI bleed or perforation . Contraindicated with hypersensitivity to omeprazole and its components. Use cautiously with pregnancy and lactation.

Headache, dizziness, somnolence, insomnia, fatigue, tinnitus, ophthalmologic effects.Rash, pruritus, sweating, dry mucous membranes.Nausea, dyspepsia, GI Pain, diarrhea, vomiting, constipation, flatulence,gastric or duodenal ulcers. Headache,dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, rash, inflammation, urticaria, pruritis,alopecia, dry skin.Diarrhea, abdominal

Do not use ophthalmic drops with contact lenses. Report sore throat , fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision, black tarry stool, bruising.

Take the drug before meals. Report severe headache, worsening of symptoms, fever, chills. Have regular medical

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secretory surface of the gastric parietal cells;blocks the final step of acid production. symptoms of GERD. pain, nausea, vomiting, constipation, dry mouth, tongue atrophy. follow-up visits.

DRUGS

MECHANISM OF ACTION
Acts to suppress gastric acid secretion by specifically inhibiting the hydrogen-potassium ATPase enzyme system at the secretory surface of gastric parietal cells;blocks the final step of acid production. The antiinflammatory effect is likely due to inhibition of the enzyme cyclooxygenase (cox). These are 2 cox isoenzymes-cox1 and cox 2. Depending on NSAID, either cox1 and cox2 both enzymes may be inhibited. Inhibition of cyclooxygenase results in decreased prostaglandin synthesis. Effective in reducing joint swelling pain and

INDICATION

CONTRAINDICATIO N
Lactation

SIDE EFFECTS

NURSING RESPONSIBILITIE S
Take with meals Antacids maybe used with proton pump inhibitors Record abdominal assessments, Xray(UGI,US,Barium,En ema) Endoscopic findings and H.Pyloric results.

*Generic Name: Omeprazole Brand Name: Prilosec, Losec 40mg IV O.D. Classification: Proton Pump Inhibitor

Short term treatment of active duodenal ulcer & active benign gastric ulcer.

Hypoglycemia, Gout, Weight Gain

Generic Name: Ketorolac Tromethamine Brand Name: Toradol 30mg IV q8 Classification: Non Steroidal Anti Inflammatory Drugs

Use with morphine and meperdine shows an opioidsharing effect,combinati on can be used for breakthrough pain. Mild to moderate pain.

Adjunct dosage age for 65 y/o and older for clients less than 50 kg. and for those with moderately elevated serum creatinine. Do not exceed IV/IM doses of 60mg/day in these clients.

Nausea, Flatulence, GI Pain, Peptic Ulcers

If given on PRN basis base the size of a repeat dose on the duration of pain relief from previous dose if pain returns within 3-5 hr. the next dose can be increased by up to 50 % (as long as the total daily dose is not exceeded. If the pain does not return for 812 hour the next dose can be decrease by as much as 50% or the dosing interval may be increased to every 8-12 hours. Do not mix IV/IM

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morning stiffness, as well as in increasing mobility in individuals with inflammatory disease. Ketorolac in small volume (syringe) morphine sulfate, meperidine HCL, Promethazine HCL will precipitate from solution IV Bolus may be given over or no less than 15 sec. give IM slowly and deeply into the muscle. Protect injection from light. Document indications for therapy, onset, location, pain intensity/level and characteristics of symptoms. Document indications for therapy, onset, frequency, and characteristics of stools. May cause a dry mouth; try ice chips, sugarless chewing gum and candy to alleviate. Record the number, frequency, and consistency of stools per day and amount of medication consumed. report if diarrhea last

Brand Name: Loperamide Generic Name: Imodium 1 tablet Classification: Anti-diarrhea

Slows intestinal motility by acting on the nerve endings and or intramural ganglia embedded in the intestinal wall. The prolonged retention of the feces in the intestine results in reducing the volume of the stools, increasing viscosity and decreasing fluid and electrolyte loss.

Symptomatic relief of acute non-specific diarrhea and of chronic diarrhea associated with inflammatory bowel disease

Presence of bloody diarrhea.

Abdominal pain, distention or discomfort, dry mouth, nausea and vomiting, epigastric distress.

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up to 5 days without relief. Report if fever, nausea, abdominal pain distention occurs, may require dosage adjustment.

Brand Name: Metformin HCL Generic Name: Glucophage 500mg PO TID Classification: Anti-diabetic agents

Restimulate B-cells insulin.

Non insulin dependent diabetes mellitus (TYPE II) that does not respond to diet management and exercise alone. Impaired glucose intolerance

Diabetic coma, Ketoacidosis,Renal impairment, chronic liver disease, cardiac failure

Hypoglycemia is most common; heartburn; epigastric fullness, diarrhea.

To decrease the incidence of gastric upset take P.O. drugs with food. For clients receiving 20-40 units of insulin daily, initiate oral hypoglycemic therapy and reduce insulin dose by 25-50%. Discontinue insulin gradually using the absence of glucose in the urine as guide with glyburide insulin maybe discontinued abruptly. Monitor v/s, ecg, cholesterol panel, electrolytes, CBC and urine for microalbuminuria. Strive for control. Record blood sugar at diff. times during day

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and night for provider review.

DRUGS

MECHANISM OF ACTION
Following a combination with insulin receptors on cell plasma membranes , insulin facilitates the transport of glucose into cardiac and skeletal muscles and adipose tissue. It also increases synthesis of glycogen in the liver. Insulin stimulates protein synthesis and lipogenesis and inhibits lypolysis and release of free fatty acids from cells. Insulin also causes intracellular shifts in Mg and K+ Since insulin is a protein. It is destroyed in the GI tract. Thus it must be administered SC, so

INDICATION

CONTRAINDICATIO N
IV or IM use due to possible inadvertment overdosage

SIDE EFFECTS

NURSING RESPONSIBILITIE S
Rotation of injection sites may lead to differences in blood levels of insulin . the abdomen is considered the best site due to constant insulin peak times with better gradual absorption. Apply gentle pressure after injection but do not massage since this may alter rate of absorption. Weigh to determine amount of agent needed Monitor electrolytes, lipid profile, thyroid studies, BS phosphate, Mg, CBC, HBA 1c & urinalysis. Assess injection sites, monitor VS plot growth & weight every 3-4 months.

*Generic Name: Rapid Acting Insulin (RAI) Brand Name: Humulin R Regular u 500 ( concentrated) 25 "u" SC Classification: Insulin Products

Insulin resistance requiring more than 200 units insulin/day.

Lipodystrophy, insulin resistance, local and generalized allergic.

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that it is readily absorbed in bloodstream and distributed throughout the extracellular fluid. Metabolized mainly by the liver. Reduces air or flatuce inside the body.

Generic Name: Domperidone Brand Name: Domphenyl Classification: Non Steroidal Anti-Flatulence Brand Name: Isophane Insulin Suspension (Nph) Generic Name: Humulin N Classification: Insulin Product

Symptomatic relief of acute nausea and vomiting

Intolerance GI bleeding, perforation , prolactinoma

Anorexia, constipation , vomiting

Following a combination with insulin receptors on cell plasma membranes , insulin facilitates the transport of glucose into cardiac and skeletal muscles and adipose tissue. It also increases synthesis of glycogen in the liver. Insulin stimulates protein synthesis and lipogenesis and inhibits lypolysis and release of free fatty

Treatment of diabetes mellitus for control of hyperglycemia. Not recommended for emergency use. Not suitable for IV administration. For SC only.

Hypoglycemia, IV administration, hyperglycemic coma

Lipodystrophy, insulin resistance local and generalized allergic Rxn.

Rotation of injection sites may lead to differences in blood levels of insulin . the abdomen is considered the best site due to constant insulin peak times with better gradual absorption. Apply gentle pressure after injection but do not massage since this may alter rate of absorption. Weigh to determine amount of agent needed Monitor electrolytes,

XIV. Drug Study

acids from cells. Insulin also causes intracellular shifts in Mg and K+ Since insulin is a protein. It is destroyed in the GI tract. Thus it must be administered SC, so that it is readily absorbed in bloodstream and distributed throughout the extracellular fluid. Metabolized mainly by the liver. Bactericidal; interferes with DNA replication in susceptible bacteria preventing cell reproduction. lipid profile, thyroid studies, BS phosphate, Mg, CBC, HBA 1c & urinalysis. Assess injection sites, monitor VS plot growth & weight every 3-4 months.

Brand Name: Ciprofloxacin HCL Generic Name: Ciloxan Classification: Antibiotic, Fluoroquinolone

For the treatment of infections caused by susceptible gram negative bacteria including E.coli, Pseudomonas Aeruginosa, Staphylococcus Aureus

With allergy to ciprofloxacin, norfloxacin,or other fluoroquinolones, pregnancy lactation. Use cautiously with renal impairment , seizures, tendonitis.

Nausea, Vomiting Dry mouth, diarrhea, abdominal pain, constipation, blurring of vision, dizziness (use caution if driving)

Ensure that patient is well hydrated. Monitor clinical response. Give anatacids 2 hours before or after dose

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