drugstudy casestudy

8/13/2019 DRUGSTUDY casestudy

1/17

GENERIC

NAME/TRA

DE NAME

CLASSIFICAT

ION

INDICATI

ON

MECHANIS

M OF

ACTION

ROUTE/FREQUENCY

/DOSAGE

ADVERSE

RXNS/SIDE

EFFECTS

DRUG-

DRUG,FOO

D-DRUG

INTERACTIO

N

NURSING

CONSIDERA

TIONS

Dopamine

Inotropin

Sympathomi

metic

Alpha-

adrenergic

agonist

Beta1

selective

adrenergic

agonist

Dopaminerg

ic drug

Correctio

n of

hemodyn

amic

imbalanc

es

present

in the

shock

syndrom

e due to

trauma

Drug acts

directly and

by the

release of

norepineph

rine from

sympatheti

c nerve

terminals;

dopaminer

gic

receptors

mediate

dilation of

vessels in

the renal

andsplanchinic

2-5 mcg/kg/min IV CV: ectopic

beats,

tachycardia,

angina pain,

palpitations,

hypotension,

vasoconstrictio

n, dyspnea,

bradycardia,

hypertension,

widened QRS

GI: nausea,

vomiting

Other:

headache,piloerection,

Drug-drug:

increased

effects with

MAOIs,

TCAs

(imipramin

e),

increased

risk of

hypertensio

n with

furazolidon

e,

methyldopa

, seizures,

hypotensio

n,bradycardia

Used only in

acute

emergency;

teaching

will depend

on patients

awareness

and will

relate

mainly to

patients

status and

monitors,

rather than

to drug.

Monitorurine flow,


2/17

beds, which

maintains

renal

perfusion

and fxn;alpha

receptors,

which are

activated

by higher

doses of

dopamine,

mediate

vasoconstri

ction,

which can

override

the

vasodilatin

g effects;

beta1

receptorsmediate a

azotemia,

gangrene with

prolonged use

when

infused

with

phenytoin,

decreasedcardiostimu

lating

effects with

guanethidin

e

cardiac

output, and

BP closely

during

infusion.

Keep

phentolami

ne readily

available in

case

extravasatio

n occurs.


3/17

positive

inotropic

effect on

the heart.

DigoxinLanoxin

Cardiacglycoside

Cardiotonic

Increasecontractil

ity for

burn

clients

Increasesintracellula

r calcium

and allows

more

calcium to

enter the

myocardial

cell during

depolarizati

on via a

sodium-

potassium

pump

mechanism

; this

increases

force ofcontraction

0.7-1.25 mg PO0.125-0.25 mg IV

CNS: headache,weakness,

drowsiness,

visual

disturbances,

mental status

change

CV: arrhythmias

GI: GI upset,

anorexia

Increasedtherapeutic

and toxic

effects of

digoxin

with

thioamines,

verapamil,

amiodarone

, quinidine,

quinine,

erythromyci

n,

cyclosporin

e, increased

incidence of

cardiac

arrhythmiaswith

Monitorapical pulse

for 1 min

before

administeri

ng; hold

dose if

pulse < 60 in

adult or >

90 in infant;

retake pulse

in 1 hr.


4/17

(positive

inotropic

effect),

increases

renalperfusion

(seen as

diuretic

effect in

patients

with CHF),

decreases

heart rate

(negative

chronotrop

ic effect),

and

decreases

AV node

conduction

velocity.

potassium-

losing (loop

and

thiazide)

diuretics,increased

absorption

or

increased

bioavailabili

ty of oral

digoxin,

leading to

increased

effects with

tetracycline

s,

erythromyci

n

Morphinesulfate

Opioidagonist

Relief ofmoderate

Principalopium

10-30 mg q 4 hr PO. CNS: light-headedness,

Drug-drug:increased

Tell pt to liedown


5/17

analgesic to severe

acute and

chronic

pain

alkaloid;

acts as

agonist at

specific

opioidreceptors

in the CNS

to produce

analgesia,

euphoria,

sedation;

the

receptors

mediating

these

effects are

thought to

be the

same as

those

mediating

the effectsof

dizziness,

sedation,

euphoria,

dysphoria,

delirium,insomnia,

agitation,

anxiety, fear

hallucinations,

disorientation,

drowsiness,

lethargy,

impaired

mental and

physical

performance,

coma, mood

changes,

weakness,

headache,

tremor,

seizures, miosis,visual

likelihood

of

respiratory

depression,

hypotension, profound

sedation or

coma in

patients

receiving

barbiturate

general

anesthetics,

risk of

toxicity if

combined

with

alcohol (ER

forms

especially

likely)

during IV

administrati

on


6/17

endogenou

s opioids

(enkephalin

s,

endorphins).

disturbances,

suppression of

cough reflex

CV: facialflushing,

peripheral

circulatory

collapse,

tachycardia,

bradycardia,

arrhythmia,

palpitations,

chest wall

rigidity,

hypertension,

hypotension,

orthostatic

hypotension,

syncope

Dermatologic:pruritus,


7/17

urticaria,

laryngospasm,

bronchospasm,

edema

GI: nausea,

vomiting, dry

mouth,

anorexia,

constipation,

biliary tract

spasm;

increased

colonic motility

in patients with

chronic

ulcerative

colitis

GU: ureteral

spasm, spasm

of vesicalsphincters,


8/17

urinary

retention or

hesitancy,

oliguria,

antidiureticeffect, reduced

libido or

potency

Local: tissue

irritation and

induration (SQ

injection)

Hydromorp

hone

dilaudid

Opioid

agonist

analgesic

(phenanthre

ne)

Relief of

moderate

to severe

pain,

acute and

chronic

pain

Acts

agonist at

specific

opioid

receptors

in the CNS

to produce

analgesia,

euphoria,sedation;

Oral tablet, 2-4mg q

4-6 hr

CNS: light-

headedness,

dizziness,

sedation,

euphoria,

dysphoria,

delirium,

insomnia,

agitation,anxiety, fear

Drug-drug:

potentiatio

n of effects

of

hydromorp

hone with

barbiturate

anesthetics;

decreasedose of

Take drug

exactly as

prescribed

Ensure

opioid

antagonist

and

facilities forassisted or


9/17

the

receptors

mediating

these

effects arethought to

be the

same as

those

mediating

the effects

of

endogenou

s opioids(enkephalin

s,

endorphins

).

hallucinations,

disorientation,

drowsiness,

lethargy,

impairedmental and

physical

performance,

coma, mood

changes,

weakness,

headache,

tremor,

seizures, miosis,visual

disturbances,

suppression of

cough reflex

CV: facial

flushing,

peripheralcirculatory

hydromorp

hone when

coadminist

ering

controlled

respiration

are readily

available

duringparenteral

administrati

on.


10/17

collapse,

tachycardia,

bradycardia,

arrhythmia,

palpitations,chest wall

rigidity,

hypertension,

hypotension,

orthostatic

hypotension,

syncope

Dermatologic:pruritus,

urticaria,

laryngospasm,

bronchospasm,

edema

GI: nausea,

vomiting, drymouth,


11/17

anorexia,

constipation,

biliary tract

spasm;

increasedcolonic motility

in patients with

chronic

ulcerative

colitis

GU: ureteral

spasm, spasm

of vesicalsphincters,

urinary

retention or

hesitancy,

oliguria,

antidiuretic

effect, reduced

libido orpotency


12/17

Hypersensitivity

: anaphylactoid

rxns (IV

administration)

Local: phlebitis

following IV

injection pain at

ijection site;

tissue irritation

and induration

(SQ injection)

Pentobarbital sodium

Nembutal,

novopento

barb

BarbiturateSedative or

hypnotic

antiepileptic

Sedative,parenter

al

GeneralCNS

depressant;

barbiturate

s inhibit

impulse

conduction

in the

ascendingRAS,

20 mg tid-qid PO CNS:somnolence,

agitation,

confusion,

hyperkinesias,

ataxia, vertigo,

CNS depression,

nightmares,

lethargy,residual

Drug-drug:increased

CNS

depression

with

alcohol,

increased

nephrotoxic

ity withmethoxyflu

Do not tryto get up

after you

have

received

this drug,

this drug

will make

you drowsyand less


13/17

depress the

cerebral

cortex,

alter

cerebellar

function,

depress

motor

output, and

can

produce

excitation,

sedation,

hypnosis,anesthesia,

and deep

coma; at

anesthetic

doses,

hasantiseiz

ure activity.

sedation

(hangover),

paradoxical

excitement,

nervousness,

psychiatric

disturbance,

hallucinations,

insomnia,

anxiety,

dizziness,

thinking

abnormality

CV:

bradycardia,

hypotension,

syncope

GI: nausea,

vomiting,

constipation,diarrhea,

rane,

decreased

effects of

these

drugs: oral

anticoagula

nts,

corticostero

ids,

hormonal

contracepti

ves and

estrogens,

beta-adrenergic

blockers

anxious.


14/17

epigastric pain

Hypersensitivity

: rashes,

angioneurotoxi

c edema, serum

sickness,

morbiliform

rash, urticaria;

rarely,

exfoliative

dermatitis,

Local: pain,tissue necrosis

at injection site,

gangrene;

arterial spasm

with

inadvertent

intra-arterial

injection;thrombophlebit


15/17

is; permanent

neurologic

deficit if

injected near a

nerve

Respi:

hypoventilation

,apnea,

respiratory

depression,

laryngospasm,

bronchospasm,

circulatorycollapse

Gentamicin

Garamycin,

Alcomicin

Aminoglycos

ide

Preventio

n for

infection

for burn

clients

Bactericidal

: inhibits

protein

synthesis in

susceptible

strains of

gram-negative

3 mg/kg/day in

three equal doses q

8 hr IM or IV.

CNS:

ototoxicity-

tinnitus,

dizziness,

ertigo, deafness

(partially

reversible toirreversible),

Drug-drug:

increased

ototoxic,

nephrotoxic

, neurotoxic

effects with

otheraminoglyco


16/17

bacteria;

appears to

disrupt

functional

integrity of

bacterial

cell

membrane,

causing cell

death.

vestibular

paralysis,

confusion,

disorientation,

depression,

lethargy,

nystagmus,

visual

disturbances,

headache,

numbness,

tingling,

tremor,

paresthesias,muscle

twitching,

seizures,

muscular

weakness,

neuromuscular

blockade

CV:

sides,

cephalothin

, potent

diuretics,

cephalospo

rins,

vancomycin

,

methoxyflu

rane,

enflurane,

increased

neuromusc

ularblocking

drugs,

succinylchol

ine, citrate-

anticoagula

ted blood

potentioal

inactivationof both


17/17

palpitations,

hypotension,

hypertension

GI: hepatic

tocxicity,

nausea,

vomiting,

anorexia,

weight loss,

stomatitis,

increased

salivation

GU:

nephrotoxicity

drugs if

mixed with

beta-

lactam-type

antibiotics,

increased

bactericidal

effect with

penicillins,

cephalospo

rins

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