drug study

Drug Study

ANALGESICS

• Generic name: Paracetamol• Brand name: Biogesic, Panadol, Tylenol• Pregnancy Category: B• Classification: Non-narcotic analgesic,

Analgesics, Muscle Relaxants

• Mode of action: Decreases fever by a hypothalamic effect

leading to sweating and vasodilation Inhibits pyrogen effect on the hypothalamic-

heat-regulating centers Inhibits CNS prostaglandin synthesis with

minimal effects on peripheral prostaglandin synthesis

Does not cause ulceration of the GI tract and causes no anticoagulant action.

• Suggested Dose: 1-2 tablets thrice daily• Ordered Dose: 500 mg tab q4

• Indications: Pain• Contraindication: Renal Insufficiency,

Anemia, Hypersensitivity• Side effects: drowsiness, nausea,

vomiting, abdominal pain, hepatotoxicity, hepatic seizure, Jaundice, Glissitis, Drowsiness ,Liver Damage

• Adverse reaction: Allergic skin reactions & GI disturbances.

• Drug Interaction: Anticonvulsants, aspirin, Phenothiazine, alcohol

• Nursing Interventions:

1. Monitor Vital Sign

2. Do TSB, if fever occurs

3. Do not exceed 4gm/24hr. in adults and 75mg/kg/day in children.

4. Do not take for >5days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults.

5. Monitor CBC, liver and renal functions.

6. Assess for fecal occult blood and nephritis.

7. Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity.

8. Report paleness, weakness and heart beat skips

9. Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools.

10. Phenmacetin may cause urine to become dark brown or wine-colored.

ANTACIDS

• Generic name: Calcium Carbonate • Brand name: Dicarbosil, Rolaids, • Titralac, Tums• Classification: Antacids• Mode of action: Rapid-acting antacid with high

neutralizing capacity and relatively prolonged duration of action. Decreases gastric acidity, thereby inhibiting proteolytic action of pepsin on gastric mucosa. Also increases lower esophageal sphincter tone. Although classified as a nonsystemic antacid, a slight to moderate alkalosis usually develops with prolonged therapy. Acid rebound, which may follow even low doses, is thought to be caused by release of gastrin triggered by action of calcium in small intestines.

• Suggested Dose: 1 to 1.2 g given daily in 2 or 4 divided doses with meals.

• Ordered Dose: 500 mg tab T.I.D• Indications: Fast relief of acid

indigestion, heartburn, sour & upset stomach associated w/ these symptoms. Calcium supplement & as an adjunct in the treatment of osteoporosis.

• Contraindication: hypercalcemia, hypercalciuria, or on a low-phosphate diet.

• Contraindication: hypercalcemia, hypercalciuria, or on a low-phosphate diet.

• Side effects: Constipation, headache, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

• Adverse reaction: GI: Constipation or laxative effect, acid rebound, nausea,

eructation, flatulence, vomiting, fecal concretions. Metabolic: Hypercalcemia with alkalosis, metastatic calcinosis,

hypercalciuria, hypomagnesemia, hypophosphatemia (when phosphate intake is low).

CNS: Mood and mental changes. Urogenital: Polyuria, renal calculi.• Drug Interaction:

Drug: May enhance inotropic and toxic effects of digoxin; magnesium may compete for GI absorption; decreases absorption of TETRACYCLINES, QUINOLONES (ciprofloxacin).



2. Note number and consistency of stools. If constipation is a problem, physician may prescribe alternate or combination therapy with a magnesium antacid or advice patient to take a laxative or stool softener as necessary.

3. Lab tests: Determine serum and urine calcium weekly in patients receiving prolonged therapy and in patients with renal dysfunction.

4. Record amelioration of symptoms of hypocalcemia (see Signs & Symptoms, Appendix F).

5. Observe for S&S of hypercalcemia in patients receiving frequent or high doses, or who have impaired renal function (see Appendix F).

6. o not continue this medication beyond 1–2 wk, since it may cause acid rebound, which generally occurs after repeated use for 1 or 2 wk and leads to chronic use. It is potentially dangerous to self-medicate. Do not take antacids longer than 2 wk without medical supervision.

7. Avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine with calcium carbonate to form insoluble, nonabsorbable compounds.

8. Do not use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium bicarbonate, as it may cause milk-alkali syndrome: hypercalcemia, distaste for food, headache, confusion, nausea, vomiting, abdominal pain, metabolic alkalosis, hypercalciuria, polyuria, soft tissue calcification (calcinosis), hyperphosphatemia and renal insufficiency. Predisposing factors include renal dysfunction, dehydration, electrolyte imbalance, and hypertension.

9. Instruct patient to Increase fluid intake

10. Report severe headache, worsening of symptoms, fever, chills.

ANTIBACTERIAL

• Generic name: cefuroxime• Brand name: Kefox• Pregnancy Category: B • Classification: Cephalosporins, antibacterial• Mode of action: Cefuroxime binds to one or

more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

• Suggested Dose: 30-100g/kg/day in 3 or 4 divided doses

• Ordered Dose: 750 mg IVTT q8• Indications: Respiratory Tract, ENT, urinary tract,

skin & soft tissue, O&G, bone & joint infections, surgical prophylaxis.

• Contraindication: hypersensitivity to cephalosporin. Acute porphyria.

• Side effects: Glossitis, nausea, vomiting, diarrhea, gastric pyrosis, abdominal pain. Very seldom urticarial or cutaneous rash, pruritus & arthralgia.

• Adverse reaction: CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal

pain, flatulence, pseudomembranous colitis, liver toxicity Hematologic: Bone marrow depression: decreased

WBC, decreased platelets, decreased Hct GU: Nephrotoxicity Hypersensitivity: Ranging from rash to

fever to anaphylaxis, serum sickness reaction Local: Pain, abscess at injection site; phlebitis,

inflammation at IV site Other: Superinfections, disulfiram-like reaction with

alcohol

• Drug Interaction: Drug-drug

Increased nephrotoxicity with aminoglycosides Increased bleeding effects with oral anticoagulants Disulfiram-like reaction may occur if alcohol is taken

within 72 h after cefuroxime administration. Drug-lab test

Possibility of false results on tests of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; urinary 17-ketosteroids; direct Coombs' test.


1. Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated.

2. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance.

3. Inspect IV injection sites frequently for signs of phlebitis.

4. Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy.

5. Monitor for manifestations of hypersensitivity .Discontinue drug and report their appearance promptly.

6. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

7. Report loose stools or diarrhea promptly.

8. Report any signs or symptoms of hypersensitivity.

9. Have regular medical follow-up visits.

10. Instruct patient or watcher to report unusualities.

ANTIHISTAMINE

• Generic name: Benadryl• Brand name: diphenhydramine• Classification: Antihistamine Anti-motion sickness agent Sedative-hypnotic Antiparkinsonian• Cough suppressant• Mode of action: It stimulates changes within the cells that

lead to the release of chemicals that cause sneezing, itching, and increased mucus production. Antihistamines compete with histamine for cell receptors and bind to the receptors without stimulating the cells. In addition, they prevent histamine from binding and stimulating the cells.

• Suggested Dose: Capsules: 20- 50 mg every 4-6 hours • Ordered Dose: 30mg 1 cap, OD• Indications: Relief of symptoms associated with perennial and seasonal

allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive therapy in anaphylactic reactions

Active and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism (including drug-induced parkinsonism and

extrapyramidal reactions), in the elderly intolerant of more potent agents, for milder forms of the disorder in other age groups, and in combination with centrally acting anticholinergic antiparkinsonian drugs

Syrup formulation: Suppression of cough due to colds or allergy

• Contraindication: Lower respiratory tract symptoms including asthma. Hypersensitivity

• Side effects: Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dry mouth, nose & throat. Hypotension, palpitations, sedation, sleepiness, disturbed coordination. Hallucination, convulsions or death (overdosage)

• Adverse reaction: CNS: headache, fatigue, anxiety, tremors, vertigo, confusion,

depression, seizures, hallucinations CV: tachycardia, palpitations, orthostaic hypotension, heart failure EENT: blurred vision GI: dry mouth, nausea, vomiting, constipation, flatulence GU: urinary hesitancy or frequency, urine retention Hematologic: leukopenia Skin: photosensitivity, dermatitis• Drug Interaction: Alcohol & other central nervous system

depressants.



2. Raise railing, dizziness or drowsiness may occur.

3. Caution the client that the medication may cause drowsiness, creating difficulties or hazards or other activities that require alertness.

4. Tell the client to take the medication with food to decrease GI upset.

5. Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension.

6. When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored.

7. Adverse effects of these drugs occur more commonly in elderly clients.

8. Explain to the client that use of these drugs in warm weather may increase the likelihood of heatstroke.



• Generic name: Kestine• Brand name: Ebastine• Pregnancy Category: C• Classification: Antihistamines• Mode of action: In vitro studies with human liver

microsomes show that ebastine is metabolised to carebastine predominantly via the CYP3A4 pathway. Concurrent administration of ebastine with ketoconazole or erythromycin (both CYP3A4 inhibitors) to healthy volunteers was associated with significantly increased plasma concentration and elimination half-life of ebastine and carebastine. With ketoconazole the Cmax and AUC were 15 times and 40 times respectively increased, with erythromycin the values were doubled.

• Suggested Dose: 10-20 mg once daily• Ordered Dose: 10 mg tab T.I.D• Indications: Ebastine is indicated for the

symptomatic treatment of:Seasonal and perennial allergic rhinitisIdiopathic chronic urticaria• Contraindication: hypersensitivity

• Side effects: headache, dry mouth and drowsiness, pharyngitis, abdominal pain, dyspepsia, asthenia, epistaxis, rhinitis, sinusitis, nausea and insomnia.

• Adverse reaction: CNS (central nervous system) may headache,

drowsiness, rarely - asthenia (weakness), and insomnia.

Digestive system: dry mouth, rarely - abdominal pain, dyspepsia (violation of gastric digestion), nausea (vomiting).

Other reactions and symptoms: rarely - rhinitis, sinusitis.• Drug Interaction: Claromycin,

Erythromycin ,Itraconazole, Ketoconazole


1. Monitor Vital Signs.

2. Instruct patient to Increase fluid intake.

3. Raise railing , if patient is drowsy and dizziness occurs.

4. Monitor weight at least weekly.

5. Discontinued slowly after systemic use of <=1 wk. Abrupt withdrawal, especially following high doses or prolonged use, can cause dizziness, nausea, vomiting, fever, muscle and joint pain, weakness.

6. Instruct patient to report the sign and symptoms such as headache, dry mouth and drowsiness, pharyngitis, abdominal pain.

7. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report immediately if significant changes.




COUGH AND COLD

• Generic name: Ambroxol• Brand name: Mucosolvan and Mucoangin• Pregnancy Category: C• Classification: cough & cold preparations• Mode of action: Ambroxol is the active metabolite of

bromhexine. Ambroxol causes an increase in secretion in the respiratory tract. It promotes production and stimulates ciliary activity. These effects assist the flow of mucus and its removal (mucociliary clearance).An improvement in mucociliary clearance was demonstrated in clinical pharmacological studies. The increase in secretion and mucociliary clearance facilitate expectoration and reduce the cough.

• Suggested Dose: Ambroxol (as hydrochloride) (Ambrolex®) 30mg Tablet ½ tablet 3 times daily

• Ordered Dose: 30 mg tab B.I.D • Indications:

For the treatment of: Acute respiratory tract diseases with impaired formation of

secretions, particularly in acute exacerbations of chronic bronchitis, asthmatic bronchitis, bronchial asthma and bronchiectasis.

The following additional indications are also present in some local markets:

Treatment of respiratory disorders associated with viscid mucus such as: pneumonia, otitis media, sinusitis, nasopharyngitis.

Secretolytic therapy for relieving cough in acute and chronic disorders of the respiratory tract associated with pathologically thickened mucus and impaired mucus transport.

• Contraindication: Ambroxol is contraindicated in: hypersensitivity to ambroxol or any of the excipients.

• Side effects: Mild gastrointestinal effects, runny nose and allergic reactions.

• Adverse reaction: Respiratory, thoracic and mediastinal disorders Rare: rhinorrhoea Gastrointestinal disorders Common: diarrhoea Uncommon: nausea, vomiting, other mild gastrointestinal symptoms Rare: hypersalivation, heartburn, constipation Skin and subcutaneous tissue disorders

Very rare: severe skin damage such as Stevens-Johnson syndrome and Lyell’s syndrome (see Section Warnings and Precautions).

Not known: skin rashes, urticaria, angioedema Renal and urinary disorders Rare: dysuria

• Drug Interaction: Antitussives: Concomitant administration of antitussives may impair the

expectoration of liquefied bronchial mucus due to inhibition of the cough reflex and cause congestion of secretions.

Antibiotics: After using ambroxol the concentrations of the antibiotics

amoxicillin, cefuroxime and erythromycin in bronchial secretions and sputum are increased.

• Rare: hypersalivation, heartburn, constipation• Skin and subcutaneous tissue disorders• Very rare: severe skin damage such as Stevens-

Johnson syndrome and Lyell’s syndrome (see Section Warnings and Precautions).

• Not known: skin rashes, urticaria, angioedema• Renal and urinary disorders• Rare: dysuria


1. Monitor Vital Signs

2. Raise Railings, if dizziness may occur.

3. Monitor for S&S of aspiration of excess secretions, and for bronchospasm (unpredictable); withhold drug and notify physician immediately if either occur.

4.Lab tests: Monitor ABGs, pulmonary functions and pulseoximetry as indicated.

5. Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be liberated; suction or endotracheal aspiration may be necessary to establish and maintain an open airway.

6. Instruct watcher report difficulty with clearing the airway or any other respiratory distress.

7. Instruct patient to do breathing exercise.

8. If sign and symptoms occurs such as runny nose and allergic reactions report immediately.


10. Inspect IM and I V injection sites frequently for signs of phlebitis.

HYPERTONIC SOLUTION

• Generic Name: Lactated Ringer’s

• Solution with 5%Dextros (D5LR)

• Brand Name: Euro-med 5% Dextrose • in lactated Ringer;s solution, Vis IV• Pregnancy Category: C• Classification: Nonpyrogenic, parenteral fluid, electrolyte

and nutrient replenisher• Mode of action: Hypertonic solutions are those that have

an effective osmolarity greater than the body fluids. These solutions draw fluid out of the intracellular and interstitial compartments into the vascular compartment, expanding vascular volume. It raises intravascular osmotic pressure and provides fluid, electrolytes and calories for energy

• Suggested Dose: 1L @ 30gtts/min• Ordered Dose: 1L @ 120cc/ hr• Indications: Replacement therapy particularly in extracellular fluid deficit

accompanied by acidosis Treatment of shock Persons needing extra calories who cannot tolerate fluid overload• Contraindication: Hypersensitivity to any of the components. Contains potassium, do not use with renal failure

patients/Hyperkalemia Liver Dysfunction• Side effects: Increased serum osmolality, Hypernatremia,

Hypokalemia, Altered thermoregulation, pulmonaryedema, cardiovascular overload

• Adverse reaction: Reactions which may occur because of the solution or the

technique of administration includes: Febrile response; infection at the site of injection; venous

thrombosis or phlebitis extending from the site of injection, extravasation: hypervolemia.

Integ: Allergic reaction or anaphylactoid symptoms such as localized or generalized urticarial and pruritus;periorbital, facial ,and/or laryngeal edema;

Respi: Coughing, sneezing and/or difficulty with breathing

• Drug Interaction: Should not be used with phenytoin (Dilantin) or amrinone (Inocor) Increase risk of sodium and fluid retention; corticosteroids Renal clearance of acidic drugs such as solicyeates and

barbiturates Increase risk of hyperkalemia; increase renal clearance of lithium;

decrease renal clearance of alkaline drug


1. Do not administer unless solution is clear and container is undamaged.

2. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin.

3. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis.

4. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus.

5. Check vital signs frequently; Report adverse reactions.

6. Monitor fluid intake and output.

7. In very low birth weight infants or children, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage.

8. Properly label the IV Fluid

9. Observe aseptic technique when changing IV fluid.

10. Don’t give concentrated solutions IM or subcutaneously.

• Generic name: D5NSS • (Normal Saline Solution/• 0.9% NaCl)• Brand Name: Euro-med 5% • Dextrose in Normal Saline solution• Classification: Hypertonic• Mode of action: Hypertonic solutions contain a

high concentration of solute relative to another solution when a cell is placed in a hypertonic solution, the water diffuses out of the cell,causing the cell to shrivel.

• Suggested Dose: D5NSS 500-1000cc/hr• Ordered Dose: D5NSS 500cc/hr • Indications: Forreplacement ormaintenance of

fluidandelectrolytes• Contraindication: Hypersensitivity to any

of thecomponents.• Side effects:hypotension due

tohypovolemia.Vomiting, Shock, Hyperkalaemia• Adverse reaction: febrile response, infection at the

site of injection, venous thrombosisor phlebitisextending from thesite of injection,-extravasation,-and hypervolemia.

• Drug Interaction: No known drug interactions.

• Nursing Responsibilities:

1. Monitor patient frequently for Signs of infiltration/sluggish flow.

2. Monitor patient frequently for signs of phlebitis/infection.

3. Give the Correct solution, medication and volume.

4. Check and regulate the drop rate.

5. Check Vital Sign frequently

6. monitor fluid intake and output

7. Observe aseptic technique when changing IV fluid.

8. Properly label the IV Fluid

9. Don’t give concentrated solutions IM or subcutaneously


HYPOPROTHROMBINEMIA

• Generic name: Vitamin K• Brand name: Phytomenadione• Pregnancy Category: C• Classification: Hypoprothrombinemia

Therapy• Mode of action: Anticoagulant-induced

prothrombin deficiency; prophylaxis & therapy of hemorrhagic disease of the newborn & it may also given to the mother before delivery; hypoprothrombinemia due to oral antibacterial therapy; hypoprothrombinemia.

• Suggested Dose: 1 to 2 mg IV, IM or subcutaneously may be administered.

• Ordered Dose: 10 mg in 1 hour• Indications: • Phytonadione is used in the prevention and treatment of

hypoprothrombinemia caused by vitamin K deficiency, oral anticoagulants, or other factors which impair the absorption or synthesis of vitamin K. Phytonadione is also used in the prevention and treatment of hemorrhagic disease of the newborn. Phytonadione may have a role in restoring normal clotting time in patients with hypoprothrombinemia induced by salicylates, sulfonamides, quinidine, quinine or broad-spectrum antibiotics, when interference with vitamin K activity is clearly the cause.

• Contraindication: Hypersensitivity• Side effects: Anaphylaxis, difficulty in breathing, cyanosis, pain,

swelling, vein inflammation at the injection site, increased sweating, dizziness, low blood pressure, allergic reactions after SC and IM injection.

• Adverse reaction: Transient flushing sensations, peculiar sensations of taste

dizziness, rapid and weak pulse, profuse sweating, brief hypotension, dyspnea, cyanosis, Bronchospasm, shock, cardiac and/or respiratory arrest ,Pain, swelling, and tenderness at the injection site may occur. allergic sensitivity (i.e., rash, urticaria),

including an anaphylactoid reaction.

• Drug Interaction: Anticoagulants (coumarin)

Nursing Interventions:

1. Monitor Vital Signs

2. Instruct Patient to increase oral intake3. Assess for bleeding or bruising: hematuria, black tarry stools, hematemesis4. Teach patient not to take other supplements unless directed by prescriber5. Teach patient necessary foods in Vit K to be included in diet.6. Advise patient to avoid IM inj., hard toothbrush, flossing until treatment is terminated.

7. Instruct patient to raise railings, dizziness may occur.




HYPOTONIC SOLUTION

• Generic name: D5W • (Dextrose 5% Water) IV Fluid• Brand name: EUROSOL-M IN D5 WATER• Classification:• Isotonic then hypotonic• Nonpyrogenic• Parenteral fluid• Electrolyte• Nutrient replenisher• Mode of action: Dextrose provides a source of calories.

Dextrose is readily metabolized, may decrease losses of body protein and nitrogen, promotes glycogen deposition and decreases or prevents ketosis if sufficient doses are provided

• Suggested Dose: 1 Liter• Ordered Dose: 20cc x 1 hr• Indications: Maintenance therapy in dehydration. Fluid&

electrolyte maintenance. Used in the treatment of diarrhea.• Contraindication: solutions containing dextrose may be

contraindicated in patients with knownallergy to corn or corn products.

• Side effects: severe burning, pain, or swelling around the IV needle; warmth, redness, oozing, or bleeding where the IV was placed; fever, ongoing cough;

• Adverse reaction: Hyperkalemia,hypernatremia or hyperchloremia & conditions arising from them eg.edema, certain cardiac diseases. Rarely, hypermagnesemia or hyperphosphatemia.

• Drug Interaction: Amrinone lactate

• Nursing Responsibilities:

1. Monitor Vital sign

2. Monitor I and O every shift.

3. Suspend container from eyelet support.

4. Remove plastic protector from outlet port at bottom of container.

5. Attach administration set. Refer to complete directions accompanying set

6. Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte concentrations, and acid base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation.

7. Lactated Ringer’s and 5% Dextrose Injection, USP should be used with caution. Excess administration may result in metabolic alkalosis.

8. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin.

9. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis.

10. If an adverse reaction does occur, discontinue the infusion, evaluate the patient, and institute appropriate therapeutic countermeasures.

MOTILIUM

• Generic name: Doperidone• Brand name: Motilium• Classification: Prokinetic Drugs &Antiflatulents• Mode of action: Domperidone is a dopamine antagonist

with antiemetic properties. Domperidone does not readily cross the blood-brain barrier. It seldom causes extrapyramidal side effects, but does cause a rise in prolactin levels. Its antiemetic effect may be due to a combination of peripheral (gastrokinetic) effects and antagonism of central dopamine receptors in the chemoreceptor trigger zone which lies in the area postrema and is regarded as being outside the blood-brain barrier.

• Suggested Dose: 0.25-0.5 mg/kg three to four times per day with a maximum daily dose of 2.4 mg/kg

• Ordered Dose: 10 mg tab , 1 tab, PRN• Indications: Dyspeptic symptom complex assoc w/ delayed gastric

emptying, gastroesophageal reflux & esophagitis. Nausea & vomiting of functional, organic infections, or dietetic origin or induced by radiotherapy or drug therapy especially dopamine agonists as used in Parkinson disease.

• Contraindication: Hypersensitivity, prolactinoma, GI hemorrhage, mechanical obstruction or perforation, moderate or severe hepatic impairment.

• Side effects: Gitation, nervousness, anaphylactic shock, extrapyramidal disorder, convulsion, sudden cardiac death, serious ventricular arrhythmias, angioedema, urticaria , urinary retention, gynecomastia, amenorrhea, liver function test abnormal, blood prolactin incrd.

• Adverse reaction: CNS: dry mouth ,headache/migraine,insomnia, nervousness,

dizziness, thirst, lethargy,irritability Gastrointestinal ,abdominal cramps, diarrhea,regurgitation,

changes inappetite, nausea, heartburn,constipation . Endocrinological :hot flushes, mastalgia,galactorrhea,

gynecomastia,menstrual irregularities. Mucocutaneous :rash, pruritus, urticaria,stomatitis,

conjunctivitis. Urinary :urinaryfrequency, dysuria Cardiovascular: edema, palpitations. Musculoskeletal: leg cramps, asthenia. Miscellaneous: drug intolerance.

• Drug Interaction: Antacids &antisecretory drugs CYP3A4 inhibitors, oral ketoconazole or oral erythromycin.


1. Monitor Vital Signs.

2. Instruct patient to increase oral fluid

3. Position the patient in semi fowler’s if vomiting occurs to prevent aspiration

4. Instruct patient to eat Ice chips or crackers to relieve sensation of nausea.

5. Report severe headache, dizziness, thirst, lethargy, irritability.




9. Instruct Proper dosing: Missed dose: Take as soon as possible; not taking if almost time for next scheduled dose; not doubling doses.

10. Obtaining medical attention if fainting, dizziness, irregular heartbeat or pulse, or other unusual symptoms occur.

PROTON PUMP INHIBITORS

• Generic name: omeprazole • Brand Names: Prilosec, Prilosec OTC, Zegerid • Pregnancy Category: C• Classification: Proton Pump Inhibitors (PPIs),

gastrointestinal agent• Mode of action: An antisecretory compound that is a

gastric acid pump inhibitor. Suppresses gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid (proton H+) pump] in the parietal cells.Suppresses gastric acid secretion relieving gastrointestinal distress and promoting ulcer healing.

• Suggested Dose: 40 mg IVTT for 20-30 min period in 100 l of NaCI 0.9 %

• Ordered Dose: 40 mg IVTT O.D• Indications: Drug-drug• WARNING: Increased serum levels and potential

increase in toxicity of benzodiazepines, phenytoin, warfarin; if these combinations are used, monitor patient very closely

• Decreased absorption with sucralfate; give these drugs at least 30 min apart.

• Contraindication: Hypersensitivity

• Side effects: Headache, diarrhea, constipation, abdominal pain, nausea, vomiting, dizziness, rash.

• Adverse reaction: CNS: Headache, dizziness, fatigue. GI: Diarrhea, abdominal pain, nausea, mild transient

increases in liver function tests. Urogenital: Hematuria, proteinuria. Skin: Rash.• Drug Interaction:Warfarin, phenytoin, cyclosporine,

disulfiram, benzodiazepines, ketoconazole, ampicillin esters, iron salts.

Nursing Interventions:

1. Monitor Initial vital signs.

2. Report any changes in urinary elimination such as pain or discomfort associated with

urination, or blood in urine.

3. Report severe diarrhea; drug may need to be discontinued.

4. Take the drug before meals. Swallow the capsules whole; do not chew, open, or crush

them. If using the oral suspension, empty packet into a small cup containing 2 tbsp of water.

Stir and drink immediately; fill cup with water and drink this water. Do not use any other liquid

or food to dissolve the packet. This drug will need to be taken for up to 8 wk (short-term

therapy) or for a prolonged period (> 5 yr in some cases).


6. You may experience these side effects: Dizziness; headache (request medications);

nausea, vomiting, diarrhea (maintain proper nutrition); symptoms of URI, cough (do not self-

medicate; consult with your health care provider if uncomfortable).


8. Instruct patient to increase oral fluid.

9. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high

doses. Report immediately if significant changes.


drug study

Documents