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Lukban, Elaine CherizdeeA4A
DRUGNAME
MECHANISMOF ACTION
INDICATION ADVERSEREACTION
CONTRAINDICATION NURSINGCONSIDERATION
Atorvastatin(Lipitor)
Antilipemics
Inhibits HMG-CoAreductase, anearly (and ratelimiting) step incholesterol
biosynthesis.
- In patients withclinically evidentcoronary heartdisease, to reducethe risk of nonfatalMI, fatal & nonfatal
strokes, angina heartfailure, &revascularizationprocedures
- Adjunct to diet toreduce LDL, totalcholesterol,
apolipoprotein B, &triglyceride levels &to increase HDLlevels in patients withprimaryhypercholesterolemia& mixed dyslipidemia
- Alone or as adjunctto lipid loweringtreatments, such asLDL apheresis, toreduce total & LDLcholesterol inpatients with
homozygous familial
CNS: headache,asthenia, insomnia
CV: peripheraledema
EENT: pharyngitis,rhinitis, sinusitis
GI: abdominal pain,constipation,anorexia, diarrhea,nausea, dyspepsia,flatulence
GU: UTI
Musculoskeletal:rhabdomyolysis,arthrisis, arthralgia,myalgia
Respiratory:bronchitis
Skin: rash
Other: allergic
reactions, flulike
syndrome, infection
- Contraindicated inpatients hypersensitive todrug & in those with activeliver disease orunexplained persistentelevations of transminase
levels.
- Contraindicated inpregnant & breast-feedingwomen & in women ofchildbearing age
- Use cautiously in
patients with history ofliver disease or heavyalcohol use
- Withhold or stop drug inpatients at risk for renalfailure caused byrhabdomyolysis resultingfrom trauma; in serious,acute conditions thatsuggest myopathy; & inmajor surgery, severeacute infection,hypotension, uncontrolledseizures, or severe
metabolic, endocrine, or
- Patient should follow astandard cholesterol lowering diet before &during therapy
- Before treatment,
assess patient forunderlying causes forhypercholesterolemia &obtain a baseline lipidprofile. Obtain periodicliver function testresults & lipid levelsbefore starting treatment
& at 6 & 12 weeks afterinitiation, or after anincrease in dosage &periodically thereafter
- Watch for signs ofmyositis
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Lukban, Elaine CherizdeeA4A
hypercholesterolemia electrolyte disorders.
- Limit use in children tothose older than age 9with homozygous familialhypercholesterolemia
DRUG NAME MECHANISMOF ACTION
INDICATION ADVERSEREACTION
CONTRAINDICATION NURSINGCONSIDERATION
Citicoline
(Somazine)
Neurotonics,Nootropics
Citicoline is aninterneuronalcommunicationenhancer. Itincreases the
neurotransmissionlevels because itfavors thesynthesis andproduction speedof dopamine in thestriatum, actingthen as adopaminergicagonist thru theinhibition oftyrosine -hydroxylase.
- CVD in acute &recovery phase,symptoms &signs of cerebralinsufficiency
(dizziness,memory loss,poor concentration,disorientation,recent cranialtrauma & theirsequelae.)
- Fleeting anddiscrete
hypotension effect,
increasedparasympatheticaffects, low blood
pressure
- Itching or hives,swelling in face or
hands, chest
tightness, tingling in
mouth and throat
- Body temperatureelevation
- Restlessness
- Headaches,
- Any allergy orhypersensitivity to the
drug
- Hypertonia of theparasympathetic
nervous system
- Use cautiouslyfor pregnancy and
lactation
- Conscious usefor patient with renal and
hepatic damage
- Parasympathetichypertonia
- Citicoline may be takenwith or without food. Takeit with or between meals.
- The supplement
should not be taken in thelate afternoon or at nightbecause it can causedifficulty sleeping.
- Women who arepregnant or trying tobecome pregnantshould consult with theirdoctor before taking thesupplements. Not enoughis known about the use ofCiticoline duringpregnancy and breast-feeding. Stay on the safe
side and avoid use.
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Name and
Classification
Indication Mechanism of
Action
Adverse Effect Contraindicatio
n
Nursing Management
Nicardipine(Cardene)
Antihypertensives, Antiarrythmias,Antianginals,VascularHeadache,Suppresants
Alone or withother agents inthemanagement ofhypertension,angina pectoris,and vasospastic(Prinzmetals)angina.
Inhibits thetransport ofcalcium intomyocardial andvascular smoothmuscle cells,resulting ininhibiton ofexcitation-contractioncoupling andsubsequentcontraction
CNS: dizziness,nervousness,psychiatricdisturbances,headache, weakness,shakiness, anxiety,drowsiness, abnormaldreams
EENT: Blurred vision,disturbed equilibriumand tinnitus
Resp: Shortness ofbreath, dyspnea,
congestion, cough,epistaxis.
CV: Peripheraledema, palpitation,hypotension, syncope,arrythmias, chest pain
GI: nausea,constipation, diarrhea,abnormal l iver functionstudies, dyspepsia,vomiting, dry mouth,anorexia.
Contraindicatedin:Hypersensitivity,Sick sinussyndrome,Second and third
AV block, Bloodpressure
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Lukban, Elaine CherizdeeA4A
Name and
Classification
Indication Mechanism of Action Adverse Effect Contraindication Nursing Management
Omeprazole(Prilosec)
Gastrointestinal(antiulcer), Gastriculcer pump
inhibitor
Management ofgastroesophageal reflux diseasethat has notresponded toconventionaltherapy with his
tamine H2-receptorblocking agents
Short termmanagement ofactive duodenalulcers
Treatment ofgastrichypersecretoryconditionassociated withZollinger Ellison
syndrome,systemicmastocytosis ormultipleendocrineadenomas
Binds to an enzymeon gastric parietalcells in the presenceof acidic gastric pH,preventing the finaltransport of hydrogenions into the gastric
lumen
CNS: weakness,dizziness,headache,somnolence,fatigue
CV: chest pain
GI: abdominal pain,acid regurgitation,constipation,diarrhea, flatulence,nausea, vomiting
Derm: rash, itching
ContraindicatedHypersensitivity
Administer doses beforemeals, preferably in themorning. Capsulesshould be swallowedwhole; do not crush,open, or chew
May be administeredconcurrently withantacids
Instruct patient to takemedication as directedfor the full course oftherapy, even if feelingbetter.
May cause occasionaldrowsiness or dizziness.
Advise pt. To avoidalcohol
Advise pt. To reportonset of black tarry stool,diarrhea, abdominal pain,or persistent headache tothe physician promptly
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Lukban, Elaine CherizdeeA4A
DRUG NAME INDICATION MECHANISM OFACTION
ADVERSEEFFECT
CONTRAINDICATION
NURSINGMANGEMENT
Kalium durule(PotassiumChloride)
electrolytereplenishe
Antihypokalemic
Hypokalemia.Prophylaxisduringtreatment w/diuretics.
Potassium is thepredominant action withincells. Intracellular sodiumcontent is relatively low. Inextracellular fluid, sodiumpredominates and actively
transports or pumpssodium out and potassiuminto cells to maintain theseconcentration gradients.The intracellular toextracellular potassiumgradients are necessaryfor the conduction of nerveimpulses in suchspecialized tissues as theheart, brain, and skeletalmuscle, and for themaintenance of normalrenal function and acid-base balance. High
intracellular potassiumconcentrations arenecessary for numerouscellular metabolicprocesses..
Diarrhea
nausea
stomach
pain,
discomfort, or
gas, mild
vomiting
Renal insufficiency,hyperkalemia,untreated Addison'sdisease, constrictionof the esophagus&/or obstructivechanges in the
alimentary tract.
appropriate,discontinuingblood products,foods andmedication thatcontainpotassium, as well
as ACE inhibitors,beta blockingagents,nonsteroidal anti-inflammatorydrugs (NSAIDs),heparin,cyclosporine, andpotassium-sparingdiuretics.
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Lukban, Elaine CherizdeeA4A
DRUG NAME INDICATION MECHANISMOF ACTION
ADVERSE EFFECT CONTRAINDICATION NURSINGMANGEMENT
ketorolactromethamine
(Antipyretic,nonopioid
analgesic,NSAID)
Short termmanagementof pain (up to5days)
Ophthalmic
relief of ocularitching due toseasonalconductivitiesand relief ofpostoperativeinflammationafter cataractsurgery
Antiinflammationand analgesicactivity inhibitsprostaglandinand leukotrine
synthesis.
CNS:Headache,dizziness,sommolence,insomia
Dermatologic:rash, pruritus,
sweating
GI: nauseadyspepsia, GI pain,Diarrhea, vomiting,Constipation,flatulence,
Resp:Dyspnea,hemoptysis.,pharyngitis,bronchospasm,rhinitis
Other:Peripheral edema,Anaphylactoidreaction.
Contraindicated withsignificant renalimpairment,duringlabor anddelivery,lactation,patient wearing soft
contact lenses,aspirinallergy,cocurrent useofNSAID; activepeptic ulcer disease orGI bleedinghypersensitivity toketoralac. Incompletehemostasis, high riskof bleeding,
Renalinpairment,impairedhearing allegies,hepticCV, aGIcondition,lactation,Pregnancy
Physical:Skin color and lesion
orientation, reflex,opthalmologis andaudiometricevaluation, peripheralsensation, edema,BP,adventioussounds,liverevaluation, clottingtimes.
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INDICATION MECHANISHOF ACTION
ADVERSEREACTION
CONTRAINDICATION
NURSINGMANAGEMENT
GENERICNAME:Mannitol
BRAND NAME:Osmitol
CLASSIFICATION:OsmoticDiuretic
Acute oliguric renalfailure, toxic renaloverdose, edema,ICP, IOP
Increasesosmolarity ofglomenularfiltrate which
raises osmoticpressure of fluidin renal tubules;
decreases inreabsorption ofwater,
electrolytes,increases inurinary output,sodium, chlorideexcretion.
Dehydration,anuria, intracranialbleeding,headache, blurred
vision, nausea &vomiting, volumeexpansion, chest
pain, pulmonaryedema, thrist,tachycardia,
hypokalemia,chronic renalfailure
Susceptibilitydehydration, anuriadue to severe renaldisease, Severe
pulmonarycongestion or frankpulmonary edema,
Active intracranialbleeding exceptduring craniotomy.
-Monitor V/S, I &
O.- Monitor CVP.- Assess forpulmonary arterypressure.- Assess for s/sx of
dehydration.- Assess forelectrolyteimbalance/ deficit.- Check weight,renal function, fluidbalance, and serumand urine sodiumand potassiumlevels daily.- For ICP- assessfor neurologicstatus andintracranialpressure.
-For IOP
-assess
for elevating eyepain and decreasevisual acuity.
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Lukban, Elaine CherizdeeA4A
INDICATION MECHANISH OF
ACTION
ADVERSE
REACTION
CONTRAINDICATION NURSINGMANAGEMENT
BRAND NAME:Azithromycin
GENERICNAME:Zithromax
CLASSIFICATION:Anti-infectives
URTI, LRTI, skin &soft tissue
infections, otitismedia, STD &uncomplicatedgenital infectionsCommunity
acquiredpneumonia causedby susceptible
organisms inc.Leogionellapneumophilia,
pelvic inflammatorydisease caused by
susceptibleorganism
Binds to the Psite of 50s
bacterialribosomalsubunits therebyinhibiting proteinsynthesis;
bactericidal orbacteriostaticdepending on
concentrationwith muchgreater spectrum
of activity thanerythromycin.
Arthralgia, edema,
urticaria,
angioedema,
Arrhythmias,
hypotension, Anor
exia, constipation,dyspepsia,
flatulence,
pancreatitis, oral
candidiasis, pyloric
stenosis,
Interstitial
nephritis and acute
renal failure,
vaginitis.
Thrombocytopenia
Hypersensitivity toazithromycin or any
of the macrolidesImpaired hepaticfunction,
- Assess patient forinfection (vitalsigns; appearanceof wound, sputum,urine, and stool;WBC) at beginningof and throughout
therapy.- First dose may begiven beforereceiving results.- Observe for signsand symptoms ofanaphylaxis (rash,pruritus, laryngeal
edema, wheezing).- Discontinue
azithromycin atfirst sign of rash;may be life-threatening.Stevens-Johnson
syndrome or toxicepidermalnecrolysis maydevelop. Treatsymptomatically;may recur oncetreatment isstopped.
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DrugName/Classificati
on
Indication Mechanism ofaction
Adverse Effect Contraindication
NursingConsideration
s
Losartan(Cozaar)
CV system drugsAntihypertensives
Hypertension
Nephropathy in
type 2 diabetec
patients
To reduce riskof stroke inpatients with
hypertensionand leftventricular
hypertrophy
Inhibits
vasoconstrictiveand aldosterone
secreting action
of angiotensin IIby blocking
angiotensin IIreceptor on thesurface of
vascular smoothmuscle andother tissue cells
CNS: Dizziness,
asthenia, fatigue,headache,
insomnia
CV: chest pain,edema
EENT: nasalcongestion,sinusitis,
pharyngitisG.I: Abdominalpain, nausea,
diarrheaMusculoskeletal:muscle cramps,
myalgia, back orleg painRespiratory:
Cough, upper
respiratoryinfectionOther:
Angioedema
Contraindicated in
patientshypertensive to
drug. Breastfeeding
isnt recommendedduring losartan
therapyUse cautiously inpatients with
impaired renal orhepatic function
Drug can beused alone orwith otherhypertensives
Monitorpatients bloodpressureclosely toevaluateeffectiveness oftherapy.Monitorpatients whoare also takingdiuretics forsymptomatichypotensionRegularly assespatients renal
function
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organisms; do notuse to treat
meningitis; doesnot cross thebloodbrainbarrier.
Topicaldermatologicsolution:
Treatment ofacne vulgaris
Vaginalpreparation:Treatment ofbacterial vaginosis
injection, induration and sterile
abscess after IMinjection, thrombophlebitis after IV useTopicaldermatologicsolution:CNS: Fatigue,headache
Dermatologic: Contact dermatitis,dryness, gram-negative folliculitis
GI: Pseudomembranous colitis, dia
rrhea, bloodydiarrhea;abdominal pain,sore throat
GU: UrinaryfrequencyVaginalpreparation
GU: Cervicitis, vaginitis, vulvar irritation
Use caution with
history of regionalenteritis orulcerative colitis;history ofantibiotic-associated colitis.
dermatologicadministration:
Keep solutionaway from eyes,mouth and abradedskin or mucousmembranes;alcohol base willcause stinging.Shake well before
use.
Keep cool tap wateravailable to batheeye, mucousmembranes,abraded skininadvertently
contacted by drugsolution.
Vaginalpreparation:Give intravaginally,preferably at hs.
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DRUG NAMECLASSIFICATION
INDICATION MECHANISM OFACTION
ADVERSE EFFECT CONTRAINDICATION
NURSING MANAGEMENT
Generic name:digoxin
Brand name:Digitek,Lanoxicaps,Lanoxin, Novo-Digoxin (CAN)
Drug classCardiacglycosideCardiotonic
CHF
Atrial fibrillation
Increasesintracellular calciumand allows morecalcium to enter themyocardial cellduringdepolarization via asodiumpotassiumpump mechanism;
this increases forceof contraction(positive inotropic effect), increasesrenal perfusion(seen as diureticeffect in patientswith CHF),decreases heart
rate(negative chronotropic effect), anddecreases AV nodeconduction velocity.
CNS: Headache,weakness, drowsiness,visual disturbances,mental status change
CV: Arrhythmias
GI: GIupset, anorexia
Contraindicatedwith allergy todigitalispreparations,ventriculartachycardia,ventricularfibrillation, heartblock, sick sinus
syndrome, IHSS,acute MI, renalinsufficiency andelectrolyteabnormalities(decreased K
+,
decreasedMg
2+, increased Ca
2+).
Use cautiously withpregnancy andlactation.
WARNING: Monitor apical pulse for 1min before administering; hold doseif pulse < 60 in adult or < 90 in infant;retake pulse in 1 hr. If adult pulseremains < 60 or infant < 90, hold drugand notifyprescriber. Note anychange from baseline rhythm or rate.
Take care to
differentiateLanoxicaps from Lanoxin; dosage is very different
Check dosage and preparationcarefully.
Avoid IM injections, which may bevery painful.
Follow diluting instructions carefully,and use diluted solution promptly.
Avoid giving with meals; this willdelay absorption.
Have emergency equipment ready;have K
+salts, lidocaine, phenytoin,
atropine, cardiac monitor readilyavailable in case toxicity develops.
WARNING: Monitor for therapeuticdrug levels: 0.52 ng/mL.
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Drug Name/Classification
Indication Mechanism ofAction
Adverse Effect Contraindication Nursing Management
CEFUROXIME(ceftin)
AntibioticCephalosporin
(secondgeneration)
Infections causedby susceptibleorganisms in thelower respiratorytract, urinarytract, skin andskin structures;also used for
treatment ofmeningitis,gonorrhea andotitis media andfor perioperativeprophylaxis (e.g.open-heartsurgery), earlyLyme disease.
Bactericidal:inhibitssynthesis ofbacterial cellwall, causingcell death.
Thrombophlebitis(IV site); pain,burning, cellulitis(IM site);superinfections,positive Coombstest.GI: diarrhea,
nausea,antibiotic-associatedcolitis.Skin: Rash,pruritus, urticaria
Hypersensitivityto cephalosporinsand relatedantibiotics;pregnancy(category B),lactation
Determine history ofhypersensitivityreactionstocephalosporins,penicillins,and historyof allergies,particularly to drugs, beforetherapy is initiated. Inspect IM and IV injectionsites frequently for signs of
phlebitis. Report onset of loose stools ordiarrhea. AlthoughPseudomembranous colitis. Monitor I&O rates and pattern:Especially important in severelyill patients receiving high doses.Report any significant changes.
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Lukban, Elaine CherizdeeA4A
Drug Name/
Classification
Indication Mechanism of
Action
Adverse Effect Contraindicatio
n
Nursing Management
CEFTRIAXONESODIUM
(Rocephin)
Antibiotic
Cephalosporin (third
generation)
-lower respiratory
infections caused by S.
Pneumoniae, S. Aureus.
-acute bacterial otitis
media.
-UTI
-gonorrhea
-intra-abdominal
infections
-sin and skin structure
infections
-septicemia
-bone and joint
infection
-meningitis
-
Bactericidal:
inhibits synthesis of
bacterial cell wall,
causing cell death.
CNS: headache, dizziness,
lethargy, paresthesias
GI: nausea, vomiting,
diarrhea, anorexia,
abdominal pain, flatulence,
pseudomembranous colitis,
hepatotoxicity,
GU: nephrotoxicity
Hematologic: bone marrow
depression- decreased
WBC count, decreased
platelet, decreased
hematocrit.
Hypersensitivity: ranging
from rash to fever to
anaphylaxis
Local: Pain, abscess at
injection site.
-Contraindicated
with allergy to
cephalosporins or
penicillins
-Use cautiously
with renal failure,
lactation and
pregnancy.
Assess:
-History: Hepatic and renal
impairment, lactation,
pregnancy
-Physical: skin status, renal
function test.
Intervention:
-culture infection and arrange
for sensitivity test duringtherapy.
-check manufacturers details.
Stability of reconstituted and
diluted solution depends on
diluents, concentration, and
types of container.
-protect drug from light.
-do not mix with ceftriaxonewith other antimicrobial drugs
-have Vit. K available in case of
hypoprothrobemia occurs.
-discontinue if
hypersensitivity reaction
occurs.Health teaching
-avoid alcohol while taking
this drug and for 3 days after
because severe reactions may
occur.
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Lukban, Elaine CherizdeeA4A
DRUG NAME/
CLASSIFICATION INDICATION MEACHANISMOF ACTION ADVERSE EFFECTS CONTRAINDICATION NURSING MANAGEMENTSODIUMBICARBONATE
Class:
-Laxative-Hyperosmotic
-Barium EnemaColonoscopy preparation ofbowel for procedure-Fecal Impaction-Operativeprocedure on large
intestine,Colorectal-preparation ofbowel for procedure
Polyethyleneglycol acts anosmotic agent toproduce alaxative effect.
Along with theelectrolyte
solution,practically no netabsorption orexcretion of ionsor water occurs.
CommonGastrointestinal:
Anal irritation, Bloatingsymptom, Epigastricfullness, Nausea,stomach cramps,Vomiting
Serious
-Dermatologic:Urticaria-Immunologic:
Anaphylaxis(rare)
-bowelperforation-gastricretention-gastrointestinalobstruction
-ileus-toxic colitis-toxicmegacolon
-Advise patient to reporturticaria, rhinorrhea, ordermatitis.-Patient should not eat solidfood for at least 2 hour(preferably 3 to 4h) beforetaking this preparation.
- Encourage patient to drinkeach portion rapidly, as thismethod is preferred overdrinking small amountscontinuously. The solutionmay be more palatable ifchilled first.
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Lukban, Elaine CherizdeeA4A
DRUG NAME/
CLASSIFICATION INDICATION MEACHANISMOF ACTION ADVERSEEFFECTS CONTRAINDICATION NURSINGMANAGEMENTAMLODIPINE
(Norvasc)
Class:
-Calcium Channel
Blocker
-Cardiovascular
Agent
-Dihydropyridine
Disorder of
cardiovascular system;
-Hypertension
-Stable Angina
-Variant Angina
Amlodipine is a
dihydropyridine
calcium antagonist
(calcium ion
antagonist or slow-
channel blocker) that
inhibits the
transmembrane influx
of calcium ions intovascular smooth
muscle and cardiac
muscle. Experimental
data suggest that
amlodipine binds to
both dihydropyridine
and
nondihydropyridine
binding sites. Thecontractile processes
of cardiac muscle and
vascular smooth
muscle are dependent
upon the movement
of extracellular
calcium ions into
these cells through
specific ion channels.
- Very often: peripheral
edema ,fatigue
- Often: dizziness;
palpitations; muscle-,
stomach- or headache;
dyspepsia; nausea
- Sometimes: blooddisorders, development
of breasts in men
(gynecomastia),
impotence, depression,insomnia, tachycardia,
gingival enlargement
- Rarely: erratic
behavior, hepatitis,jaundice
- Very rarely:
hyperglycemia, tremor,
Stevens-Johnson
syndrome
Known sensitivity to
amlodipine
-Instruct patient to
report
signs/symptoms of
exacerbation of angina
or myocardial
infarction with
initiation and increase
in dose. Patients with
severe cardiovascular
disease have anincreased risk.
-Advise patient there
are multiple significant
drug-drug interactions
for this drug. Consult
healthcare
professional prior tonew drug use
(including otc and
herbal drugs).
-Instruct patient to
take a missed dose as
soon as possible, but if
it has been more than
12 hours since thedose was missed, skip
the dose.