15 pharmacological study

8/2/2019 15 Pharmacological Study

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C. PHARMACOLOGICAL STUDY


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PHARMACOLOGICAL STUDYTable 25

Name of Drug Mechanisms

of Action

Route/

Dosage

Indications Contraindications Side

Effects

Adverse

Effects

Nursing

Management

Generic Name:Diazepam

Brand Name:Valium

Classification:

AnxiolyticAntiepilepticBenzodiazepineSkeletal musclerelaxant(centrallyacting)

Exact mechanismof action notunderstood; actsmainly at thelimbic system andreticular formation;may act in spinalcord and at

supraspinal sitesto produce skeletalmuscle relaxation;potentiates theeffects of GABA,an inhibitoryneurotransmitter,anxioloytic effectsoccur at doseswell below those

necessary tocause sedation,ataxia; has littleeffect on corticalfunction.

Actual:

Ideal:Anxiety:2 10 mg IMor IV; repeatin 3-4 hours

if necessary

Alcoholwithdrawal:10mg IM orIv initially,then 5-10mg in 3-4hours ifnecessary

Managementof anxietydisorders orfor short-termrelief ofsymptoms ofanxiety.

Acute alcoholwithdrawal;may beuseful insymptomaticrelief of acuteagitation,tremor,deliriumtremens,

hallucinosis.

Contraindicatedwithhypersensitivity tobenzodiazepines;psychoses, acute-narrow angleglaucoma, shock,coma, acute

alcoholicintoxication;pregnancy (cleft lipor palate, inguinalhernia, cardiacdefects,microcephaly,pyloric stenosiswhen used in firsttrimester; neonatal

withdrawalsyndromwreported innewborns);lacatation.

Noted for:

DrowsinessDizzinessConfusionHeadacheAnxietyFatigue

DepressionInsomniaPhotophobiaCoughConstipationDry mouth

Noted for:

TremorParadoxicalexcitementOrthostatichypotensionHypotension

Monitor BP,PR,RR priorto periodicallythroughouttherapy andfrequentlyduring IVtherapy.

Assess IV sitefrequentlyduringadministration, diazepammay causephlebitis andvenousthrombosis.

Observedepressedpatientsclosely forsuicidaltendencies.

Observe andrecord


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intensity,duration andlocation ofseizureactivity.Cautionpatient to

avoid takingalcohol orother CNSdepressantsconcurrentlywith thismedication.


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PHARMACOLOGICAL STUDY

Table 26Name of Drug Mechanisms

of ActionRoute/Dosage

Indications Contraindications SideEffects

AdverseEffects

NursingManagement

Generic Name:Chlorpromazine

Brand Name:

Thorazine

Classification:AntiemeticAntipsychoticAnxiolyticDopamenergicblocker

Mechanism notfullyunderstood;antipsychotic

drugs blockpostsynapticdopaminereceptors in thebrain; depressthose parts ofthe braininvolved withwakefulnessand emesis;

anticholinergic,antihistamine(H1), and alphaadrenergicblocking.

Actual:100 mg 1 tabPO every 8hours

Ideal:75 200 mg/day PO

Managementofmanifestationsof psychotic

disorders;control ofmanic phaseof manicdepressiveillness.

Contraindicatedwith allergy tochlorpromazine,comatose or

severelydepressed states,bone marrowdepression,circulatorycollapse,subcortical braindamage,Parkinsonsdisease, liver

damage, cerebralor coronaryarteriosclerosis,severehypotension orhypertension.

Noted for:

DrowsinessInsomnia

HeadacheWeaknessTachycardiaBradycardiaBlurredvisionDry mouthSalivationNausea

Noted for:

SeizureExacerbation

of psychoticsymptomsExtraparamidalsyndromesHypotensionOrthostatichypotensionCardiac arrestHeart failure

Keep patientrecumbentfor 30minutes after

injection toavoidorthostatichypotension.

The patientsguardianshould beadvisedabout the

possibility oftardivedyskinesias.

Instruct theguardian toreport to thenurse stationif the clientexperiencing


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sore throat,fever,unusualbleeding,rash,weakness,tremors, and

impairedvision.


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Name of Drug Mechanisms

of Action

Route/

Dosage

Indications Contraindications Side Effects Adverse

Effects

Nursing

Management

Generic Name:Ciprofloxacin

Brand Name:Ciloxan

Classification:Antibacterial

Fluoroquinolone

Bactericidal;interfereswith DNAreplication insusceptiblebacteriapreventingcell

reproduction.

Actual:500mg 1 tabBID

Ideal:500 700mg PO every12 hours

For thetreatment ofinfectionscaused bysusceptiblegram-negativebacteria,including E.

coli, P.mirabilis, K.pneumoniae,Enterobactercloacae, P.vulgaris, P.rettgeri, M.morganii, P.aeruginosa,Citrobacter

freundii, S.aureus, S.epidermidis,group Dstreptococci.

Contraindicatedwith allergy tociprofloxacin,norfloxacin or otherfluoroquinolones.

Noted for:

HeadacheNauseaDiarrheaHallucinationsHypersensitivity reaction

Confusion

Noted for:

CNS:Dizziness,insomnia,fatigue,depression,blurred vision.

GI: Vomiting,dry mouth,abdominalpain.

Hematologic:ElevatedBUN, AST,ALT, serum

creatinine andalkalinephosphatase;decreasedWBC,neutrophilcount,Hematocrit.

Ensure thatthe client iswelldehydrated.

Give antacidsto the clientatleast 2 hour

after dosing.

Instruct thesignificantother to giveplenty offluids to theclient whiletaking thisdrug.

Instruct thesignificantother toreport if theclient isexperiencingrash, visualchanges,weakness,


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Others:Fever, rash

Watched for:

CV:Arrhythmias,hypotension,angina.

and tremors.


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Indications Contraindications Side Effects AdverseEffects

NursingManagement

GenericName:Omeprazole

Brand Name:LosecPrilosec

Classification:

AntisecretorydrugProton pumpinhibitor

Gastric acid-pumpinhibitor.Suppressesgastric acidsecretion byspecificinhibition ofthe hydrogen

potassiumATPaseenzymesystem at thesecretorysurface of thegastricparietal cells;blocks thefinal stage of

acidproduction.

Actual:20 mgone capOD

Ideal:60 mg POdaily

Shot-termtreatment forerosiveesophagitis andsymptomaticgastroesophagealreflux disease(GERD) poorlyresponsive to

other treatment.

Long-termtreatment ofpathologichypersecretoryconditions andactive duodenalcancer. It is amaintenance

healing of erosiveesophagitis.

Treatment of H.pylori associatedwith duodenalulcer and activebenign gastriculcers. It is alsoused in the

Contraindicatedwithhypersensitivity toomeprazole or itscomponents.

Noted for:

HeadacheDizzinessInsomniaApathyAnxietyDreamAbnormalities

DiarrheaAbdominalpainNauseaVomitingConstipationDry mouthCoughBack painFever

Noted for:

ParesthesiasTongueatrophyEpistaxis

Give the drugbefore meals.

Instruct theclient not tocrush or chewtablets,swallow whole.

Evaluate clientfor therapeuticresponse likerelief ofGastrointestinalsymptoms.

Instruct thesignificantother or

guardian to thenurse stationreport if theclientexperiencingsevereheadache,worsening ofsymptoms,fever, chills and


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prevention andtreatment ofNSAID-inducedulcers.

severediarrhea.


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Name of Drug Mechanismsof Action

Route/Dosage

Indications Contraindications Side Effects Adverse Effects NursingManagement

Generic

Name:Esomeprazole

Brand Name:Nexum

Classification:AntisecretorydrugProton pump

inhibitor

Gastric acid-

pump inhibitor.Suppressesgastric acidsecretion byspecificinhibition of thehydrogenpotassiumATPaseenzyme

system at thesecretorysurface of thegastric parietalcells; blocksthe final step ofacidproduction; isbroken downless in the first

pass throughthe liver thanthe parentcompoundomeprazole,allowing forincreasedserum levels.

Actual:

40 mg onetab OD x 7days

Ideal:20 40 mgPO daily for4-8 weeks

Treatment

of GERDheartburnand othersymptoms.

Short termtreatment oferosiveesophagitis.

As part ofcombinationfortreatment ofduodenalulcerassociatedwithHelicobacterpylori.

Contraindicated

withhypersensitivity toomeprazole,esomeorazole, orother proton pumpinhibitor.

Noted for:

HeadacheDizzinessInsomniaAnxietyRashesDiarrheaNauseaAbdominalpain

VomitingConstipationDry mouthSinusitisCoughApathyVertigo

Noted for:

Tongue atrophyFlatulenceAlopeciaEpistaxisParesthesia

Assess for

hypersensitivityto any protonpump inhibitoror hepaticimpairment.

Instruct thesignificantother of theclient to take

drug at least 1hour beforemeals.

Instruct theclient or thesignificantother of theclient to reportif the client is

experiencingsevereheadache,worsening ofsymptoms,fever, chills,darkening ofthe skin, andchanges incolor of urine


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and stool.

Instruct theclient or thesignificantother of theclient to limit

activities tothose that donot requirealertness andprecision asthe drug maycause vertigoand dizziness.


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Name of Drug Mechanisms ofAction

Route/Dosage


AdverseEffects

NursingManagement

GenericName:HydrocortisoneSodiumSuccinate

Brand Name:

Solu Cortef

Classification:AdrenocorticalsteroidCortecosteroid(short-acting)GlucocorticoidHormone

Enters targetcells and bindsto cytoplasmicreceptors;initiates manycomplexreactions that

are responsiblefor its anti-inflammatory,immuno-suppressive(glucocorticoid),and saltretaining(mineral-corticoid)

actions. Someactions may beundesirable,depending ondrug use.

Actual:250mg IVTTnow

Ideal:100 500 mginitially and

every 2, 4, or6 hoursbased oncondition andresponse

Replacementtherapy inadrenalcorticalinsufficiency.

Hyperthermia

associatedwith cancer.

Hematologicdisordersthrombocytopenic purpura,erythro-blastopenia.

Trichinosiswithneurologic ormyocardialinvolvement.

Contraindicatedwith allergy to anycomponent of thedrug, fungalinfections,amebiasis, hepatitisB, vaccine, or

varicella, andantibiotic resistantinfections, immuno-suppression.

Noted for:

VertigoHeadacheInsomniaMuscleweakness

Noted for:

SeizurePsychosisHypotensionShockSodium and

fluid retentionHypocalcemiaHypokalemiaIncreasedblood sugarIncreasedserumcholesterolAnaphylactoidor hyper-

sensitivityreactionsAtrophy atinjection site

Instruct theclient or thesignificantother of theclient to takewith meals orsnacks when

GI upsetoccurs to theclient.


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of ActionRoute/Dosage Indications Contraindications Side

EffectsAdverseEffects

NursingManagement

GenericName:PotassiumChloride

Brand Name:

PotassiumChloride

Classification:Electrolyte

Principalintracellularcation of mostbody tissues,participates ina number of

physiologicprocessesmaintainingintracellulartonicity;transmissionof nerveimpulses;contraction ofcardiac,

skeletal, andsmoothmuscle;maintenanceof normalrenal function;also plays arole incarbohydrate

Actual:40 mEq IVTT

Ideal:40 80 mEq/L

Preventionandcorrection ofpotassiumdeficiency;when

associatedwith alkalosisusepotassiumchloride;whenassociatedwith acidosis,usepotassium

acetate,bicarbonate,citrate, orgluconate.

Treatment ofcardiacarrhythmiasdue to

Contraindicated withallergy to taatrazine,aspirin (tartrazine isfound in somepreaprationsmarketedas Kaon Cl, Klor -

Con); therapy withpotassium-sparingdiuretics oraldosteroneinhibiting agents;severe renalimpairment witholiguris, anuria,azotemia; untreatedAddisons disease,

hyperkalemia.

Noted for:

NauseaVomitingDiarrheaAbdominal

discomfort

Noted for:

GIobstructionGI bleedingGI ulceration

Hyperkalemia

Monitorplasmapotassiumlevels.

Monitor acid-

base balanceand ECG.


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metabolismand variousenzymaticreactions.

cardiacglycosides.


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of ActionRoute/Dosage Indications Contraindications Side Effects Adverse

EffectsNursingManagement

Generic

Name:Cefuroxime

Brand Name:CosefSufrexin

Classification:AntibioticCephalospirin

(secondgeneartion)

Bactericidal:

Inhibitssynthesis ofbacterial cellwall, causingcell death.

Actual:

750 mg IVTTq6 hours

Ideal:750 mg 1gIVTT q8 hours

Lower

respiratoryinfectionscaused by S.pneumoniae,S. aureus,E.coli,Klebsiellapneuemoniae,H. influenzae,and S.

pyogens.

Contraindicated

with allergy tocephalosporins orpenicillins.

Noted for:

HeadacheDizzinessLethargyNauseaVomitingAbdominalpainInflammationat IV site

Noted for:

HepatotoxicityNephrotoxicityBone marrowdepressionAnaphylaxisreaction

Discontinue if

hypersensitivityreactionoccurs.

Instruct theclient to avoidalcohol whiletaking the drugand for 3 daysafter because

severereactions oftenoccur.

Instruct theclient that hemayexperiencestomach upsetor diarrhea.


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Route/Dosage Indications Contraindications SideEffects

AdverseEffects

NursingManagement

GenericName:Acetaminophen

Brand Name:Paracetamol

Classification:Analgesic

Decreasesfever byinhibiting theeffects ofpyogens onthehypothalamicheatregulating

centers andby ahypothalamicaction leadingto sweatingandvasodilation.

Relievesfever by

inhibitingprostaglandinsynthesis atthe CNS butdoes nothave anti -inflammatoryactionbecause of itsminimal effect

Actual:500mg 1 tabq4PRN

Ideal:500mg 1 tabq4

Relief ofmild tomoderatepain,treatment offever.

Hypersensitivity;intolerance totartrazine, alcohol,table sugar.

Noted for:

DrowsinessNauseaVomitingAbdominalpain

Noted for:

HepatoxicityHepatic seizureRenal failureHypersensitivityDeliriumConvulsionsComa

Give the drugafter meal.

Advise thepatient to avoidalcohol; acutepoisoning withliver damagemay result.

Teach patient torecognize signsof chronicoverdose;bleeding,bruising,malaise, fever,sore throat.

Inform patientthat urine maybecome darkbrown as aresult ofphenacetin(metabolite ofacetaminophen).

Tell the patient


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of peripheralprostaglandinsynthesis.

to notifyprescriber forpain or fever.


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Route/Dosage Indications Contraindications SideEffects

AdverseEffects

NursingManagement

GenericName:PotassiumChloride

Brand Name:Kalium durule

Classification:Electrolyte

Supplementalpotassium inthe form ofhigh potassiumfood orpotassiumchloride maybe able torestore normalpotassium

levels.

Actual:one tab T.I.D

Ideal:one tab B.I.D

To preventhypokalemia;prophylaxisduringtreatmentwith diuretics.

HyperkalemiaSevere renalimpairmentSevere haemolyticreactions

Noted for:

NauseaVomitingIrritability

Noted for:

HyperkalemiaMuscleweaknessDifficulty inswallowing

Administerwhile patient issitting up orstanding toprevent druginducedpsychosis.

Followinstruction

regardingdilution.


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AdverseEffects

NursingManagement

GenericName:PNSS

Classification:

Isotonic volumeexpander

Electrolytereplacement

NormalSaline is asterile,nonpyrogenicsolution forfluid andelectrolytereplinishment.

It contains noantimicrobialagents.

The pH is 5.0(4.5 to 7.0).

It contains 9g/L SodiumChloride with

an osmolarityof 308mOsmol/L.

It contains154 mEq/LSodium andChloride.

.

Actual:PNSS 1L@ 100cc/h

Ideal:20cc/kg oflean bodyweight forhypovolemi

chypotension. Repeatonce PRN.

It is indicatedas a source ofwater andelectrolytes.

In general,intravenouslines shouldnot be started

unless thepatientcurrently, ormay soonneed eitherfluidreplenishmentor medicationadministration.

If used toreplenishfluids, a largebore IV (18Gor more)should bestarted, hungwith a 1000mL bag of

SevereHypertensionPulmonary edema

No sideeffectsnoted.

Reactionswhich mayoccurbecause ofthe solutionor thetechnique ofadministration include

febrileresponse,infection atthe site ofinjection,venousthrombosis orphlebitisextendingfrom the site

of injection,extravasation, andhypervolemia.

If an adversereaction doesoccur,discontinue

Observe ten rights ingiving medications.

Performhandwashing beforegiving medications.


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saline.

If saline isbeing startedfor medicationadministrationmaintain at

TKVO, orconsider usinga saline lockinstead ofintravenousline.

the infusion,evaluate thepatient,instituteappropriatetherapeuticcountermeas

ures andsaveremainder ofthe fluid forexaminationif deemednecessary.


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Route/Dosage

Indications Contraindications Side Effects Adverse Effects NursingManagement

GenericName:PLR

Classification:

Hypertonicvolume

expander

Electrolytereplacement

IV hypertonicsaline (HS)induces ashift of fluidfrom theintracellular totheextracellualrspace across

the osmoticgradient itgenerates.

It thereforereduces brainwater,increasesblood volumeand increasesplasmasodium. Notethatintracellularvolumeis inverselyproportionalto plasmasodiumconcentration

Actual:PLR 1L@20gtts/min

Ideal:

Osmotherapeutic agentfortreatment ofcerebraloedemaand raisedintracranialpressure

(eg headinjury,DKA).

Treatmentofsymptomatichyponatraemicseizures.

Smallvolumeresuscitation for shock(e.g.associatedwithtraumatic

Pre-existingplasmatichyperosmolarity -dehydration withextracellularpredominance.

Anuria due tosevere renal

disease, severepulmonarycongestion or frankpulmonary edema;active intracranialbleeding exceptduring craniotomy;progressive renaldamage ordysfunction afterinstituting mannitoltherapy, includingincreasing oliguriaand azotemia;progressive heartfailure or pulmonarycongestion afterinstituting mannitoltherapy.

HypertensionTachycardiaThirstOliguriaThrombophlebitisShiversFeverUrticaria

NauseaVomiting

Failure torecognize severeimpairment ofrenal functionwith the highlikelihood ofnondiurecticresponse can leadto aggravateddehydration of

tissues andincreased vascularfluid load.

Induced diuresis inthe presence ofpreexistinghemoconcentration and preexistingdeficiency of water

and electrolytescan lead to seriousimbalances.

Expansion of theextracellular spacecan aggravatecardiacdecompensationor induce it in the

Observe tenrights in givingmedications.

Performhandwashingbefore givingmedications.


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head injury)or as asrenoprotective agent(e.g.preventionof

radiocontrast andcytotoxicnephropathy,rhabdomyolysisinducedrenalfailure)

presence of latentheart failure.Pulmonarycongestion oredema can beseriouslyaggravated withthe expansion ofthe extracellularand thereforeintravascular fluidload.

Hemodilution anddilution of theextracellular fluidspaceby osmotic shift of

water can induceor aggravatepreexistinghyponatremia.If unrecognized,such fluid and/orelectrolyte shiftcanproduce thereported adversereactions ofpulmonarycongestion,acidosis,electrolyte loss,dryness of mouth,thirst, edema,head ache, blurredvision, convulsionsand congestive


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cardiac failure..


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SUMMARY OF MEDICATION ADMINISTRATION RECORD

Table 37

DateOrdered

Time Name of Drug &Preparation

Generic Name (Brand

Name)

Classification Dosage Route Frequency

02/13/2012 6:05pm Diazepam (Valium ) AnxiolyticAntiepileptic

BenzodiazepineSkeletal muscle

relaxant (centrallyacting)

5mg IVTT q6

8:45pm Chlorpromazine(Thorazine)

AntiemeticAntipsychotic

Anxiolytic

Dopamenergicblocker

100mg 1tab

PO now

02/14/2012 4:00am12:00noon

Chlorpromazine(Thorazine)


AnxiolyticDopamenergic

blocker

100mg 1tab

PO q8

10:30am Omeprazole (Losec) Antisecretory drugProton pump inhibitor

20mg 1 cap PO O.D

02/15/2011 10:00am Omeprazole (Losec) Antisecretory drug

Proton pump inhibitor

20mg 1 cap PO O.D

10:00am Chlorpromazine(Thorazine)



blocker

100mg 1tab

PO O.D

10:00am3:00pm8:00pm

Potassium Chloride(Kalium Dunule)

Electrolyte 1 tab PO T.I.D


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blocker

100mg 1tab

PO O.D


20mg 1 cap PO O.D

12noon Acetaminophen(Paracetamol)

Analgesic 500mg 1tab

PRN Q4

02/16/2012 10:00am Cefuroxime (Cosef) AntibioticCephalospirin

(second geneartion)

750mg IVTT q6

8:00am6:00pm

Ciprofloxacin (Ciloxan) AntibacterialFluoroquinolone

500mg 1tab

PO B.I.D

11:30am Hydrocortisone (SoluCortef)

Adrenocorticalsteroid

Cortecosteroid

(short-acting)Glucocorticoid

Hormone

250mg IVTT now

8:00am1:00pm6:00pm






blocker

100mg 1 PO O.D

(Thorazine) tab10:00am Omeprazole (Losec) Antisecretory drug

Proton pump inhibitor20mg 1 cap PO O.D

5:00pm Acetaminophen(Paracetamol)

Analgesic 500mg 1tab

PRN q4

02/17/2012 10:00am3:00pm8:00pm




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8:00am6:00pm

Ciprofloxacin (Ciloxan) AntibioticCephalospirin

(second geneartion)

500mg 1tab

PO B.I.D

10:00am Cefuroxime (Sufrexin) AntibioticCephalospirin

(second geneartion)

750mg IVTT q6

10:00am

6:00pm

Chlorpromazine

(Thorazine)

Antiemetic

AntipsychoticAnxiolytic

Dopamenergicblocker

100mg 1

tab

PO O.D

11:15am Hydrocortisone (SoluCortef)

Adrenocorticalsteroid

Cortecosteroid(short-acting)Glucocorticoid

Hormone

250mg IVTT now

02/18/2012 10:00am3:00pm8:00pm



8:00am6:00pm

Ciprofloxacin (Ciloxan) AntibacterialFluoroquinolone

500mg 1tab

PO B.I.D




blocker

100mg 1tab

PO B.I.D

10:00am6:00pm




blocker

100mg 1tab

PO q8


20mg 1 cap PO O.D

6:00pm12midnight


Electrolyte 1 tab PO q6


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8:00am1:00pm



02/19/2012 8:00am Ciprofloxacin (Ciloxan) AntibacterialFluoroquinolone

500mg 1tab

PO B.I.D

10:00am Omeprazole (Losec) Antisecretory drug

Proton pump inhibitor

20mg 1 cap PO O.D

6:00am2:00pm6:00pm




blocker

100mg 1tab

PO q8

6:00am12noon6:00pm

12midnight



02/20/2012 6:00am12noon



2:00am10:00pm




blocker

100mg 1tab

PO q8


20mg 1 cap PO O.D

15 pharmacological study

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