drug study

Drug Study

Date Ordered November 7, 2010

Generic Name

Brand Name Kalium Durule

Drug Image

Classification Therapeutic: mineral and electrolyte

replacements/supplements

Ordered Dose i tab TID

Suggested Dose PO (Adults): 20–40 mEq/day in 1–2

divided doses; single dose should not

exceed 20 mEq.

Adult & elderly Prophylaxis 2 durules

daily. Hypokalemia Adjust dosage

according to serum K level. Suggested

dose: 2 durules bid or more until serum K

is restored to normal, then prophylactic

dosage.

Mode of Action Maintain acid-base balance, isotonicity,

and electrophysiologic balance of the cell.

Activator in many enzymatic reactions;

essential to transmission of nerve

impulses; contraction of cardiac, skeletal,

and smooth muscle; gastric secretion;

renal function; tissue synthesis; and

carbohydrate metabolism. Therapeutic Ef fects: Replacement. Prevention of

deficiency.

Indication PO, IV: Treatment/prevention of potassium

depletion.

IV: Arrhythmias due to digoxin toxicity.

Hypokalemia. Prophylaxis during

treatment with diuretics

Contraindication Contraindicated in: Hyperkalemia;

Severe renal impairment; Untreated

Addison’s disease; Severe tissue trauma;

Hyperkalemic familial periodic paralysis;

Some products may contain tartrazine

(FDC yellow dye #5) or alcohol; avoid

using in patients with known

hypersensitivity or intolerance; Potassium

acetate injection contains aluminum, which

may become toxic with prolonged use to

high risk groups (renal impairment,

premature neonates).

Drug Interactions Drug-Drug: Use with potassium-sparing

diuretics or ACE inhibitors or angiotensin II

receptor antagonists may lead to

hyperkalemia. Anticholinergics may ↑ GI

mucosal lesions in patients taking wax-

matrix potassium chloride preparations.

Side-Effects/ Adverse Reactions CNS: confusion, restlessness, weakness.

CV: ARRHYTHMIAS, ECG changes.

GI: abdominal pain, diarrhea, flatulence,

nausea, vomiting; tablets, capsules only—

GI ulceration, stenotic lesions.

Local: irritation at IV site.

Neuro: paralysis, paresthesia.

Nursing Responsibilities a. Assess for signs and symptoms of

hypokalemia (weakness, fatigue, U

wave on ECG, arrhythmias,

polyuria, polydipsia) and

hyperkalemia

b. Monitor pulse, blood pressure, and

ECG periodically during IV therapy.

c. Monitor serum potassium before

and periodically during therapy.

d. Monitor renal function, serum

bicarbonate, and pH.

e. PO: Administer with or after meals

to decrease GI irritation.

f. Report dark, tarry, or bloody stools;

weakness; unusual fatigue; or

tingling of extremities. Notify health

care professional if nausea,

vomiting, diarrhea, or stomach

discomfort persists. Dosage may

require adjustment.

g. Explain to patient purpose of the

medication and the need to take as

directed.

h. Instruct patient to avoid salt

substitutes or low-salt milk or food

unless approved by health care

professional.


Generic Name esomeprazole

Brand Name

Drug Image

Classification Therapeutic: antiulcer agents

Pharmacologic: proton-pump inhibitors

Ordered Dose 40mg i tab OD

Suggested Dose PO (Adults): 20 or 40 mg once daily for

up to 6 mo.

Mode of Action Binds to an enzyme on gastric parietal

cells in the presence of acidic gastric pH,

preventing the final transport of hydrogen

ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid

in the gastric lumen with lessened

gastroesophageal reflux. Healing of

duodenal ulcers. Decreased incidence of

gastric ulcer during continuous NSAID

therapy.

Indication GERD including: erosive esophagitis.

Hypersecretory conditions, including

Zollinger-Ellison syndrome. With

amoxicillin and clarithromycin to eradicate

Helicobacter pylori in duodenal ulcer

disease or history of duodenal ulcer

disease.

Decrease risk of gastric ulcer during

continuous NSAID therapy.

Contraindication Contraindicated in: Hypersensitivity; OB:

Lactation (not recommended).

Use Cautiously in: Severe hepatic

impairment (daily dose should not exceed

20 mg); Geri: Increased risk of hip

fractures in patients using high-doses for

>1 year; OB: Pregnancy (use

only if clearly needed); Pedi: Children <18

yr (safety not established).

Drug Interactions Drug-Drug: May ↓ absorption and effects

of drugs where gastric pH is a determinant

of bioavailability, including digoxin,

ketoconazole, and iron salts.May ↑ risk of

bleeding with warfarin (monitor INR and

PT).

Side-Effects/ Adverse Reactions CNS: headache.

GI: abdominal pain, constipation, diarrhea,

dry mouth, flatulence, nausea.

Nursing Responsibilities a.


Generic Name ketoanalogues & essential amino acids

Brand Name Ketosteril

Drug Image

Classification Other Drugs Acting on the Genito-Urinary

System (MIMS)

Ordered Dose i tab TID

Suggested Dose Adult 70 kg 4-8 tab tid given if GFR is <25

mL/min.

Mode of Action

Indication Prevention & therapy of damages due to

faulty/deficient protein metabolism in

chronic renal insufficiency.

Contraindication Hypercalcemia, disturbed amino acid

metabolism.

Drug Interactions The simultaneous administration of

medications containing calcium (eg,

acetolyte) may lead to pathological

increases of the serum calcium level or

intensification. As the uremia symptoms

improve with Ketosteril, a possible

administration of aluminium hydroxide

should be reduced. Pay attention to a

reduction of serum phosphate. In order not

to interfere with absorption, do not take

drugs together with Ketosteril that form

sparingly soluble compounds with calcium

(eg, tetracyclines).

Side-Effects/ Adverse Reactions Hypercalcemia. Monitor regularly the

serum calcium level. Ensure the sufficient

supply with calories.

Nursing Responsibilities a.


Generic Name Ferrous sulfate, Folic acid, Vitamin B-

complex (PPD)

Brand Name Terraferon

Drug Image

Classification Dietary/ Dietary Drugs/ Hematinics (PPD)

Vitamins & Minerals (Pre & Post

Natal) / Antianemics (MIMS)

Ordered Dose i cap OD

Suggested Dose Usual dose: 1-2 cap daily.

Severe anemia 1 cap tid. Prophylaxis 15-

30mg/day. Therapeutic 200 mg/day.

Mode of Action

Indication Prevention & treatment of Fe-

deficiency anemia due to hemorrhage,

infections, intestinal parasitism, prolonged

illness, rapid growth, menstruation.

Prevention & treatment of anemia due to

folic acid & vit B12 deficiencies. Fe

depletion secondary to post-op blood loss.

Pregnancy & lactation.

Contraindication

Drug Interactions

Side-Effects/ Adverse Reactions Heartburn, nausea, vomiting, constipation

& diarrhea.

Nursing Responsibilities a. Take on an empty stomach (Best

taken between meals. May be taken

w/ meals to reduce GI discomfort.).

b.


Generic Name calcium carbonate

Brand Name Caltrate Plus

Drug Image



Ordered Dose i tab OD

Suggested Dose PO (Adults): 1–2 g/day.

Mode of Action Essential for nervous, muscular, and

skeletal systems. Maintain cell membrane

and capillary permeability. Act as an

activator in the transmission of nerve

impulses and contraction of cardiac,

skeletal, and smooth muscle. Essential for

bone formation and blood coagulation.

Therapeutic Effects: Replacement of

calcium in deficiency states. Control of

hyperphosphatemia in end-stage renal

disease without promoting aluminum

absorption (calcium acetate).

Indication PO, IV: Treatment and prevention of

hypocalcemia. PO: Adjunct in the

prevention of postmenopausal

osteoporosis. IV: Emergency treatment of

hyperkalemia and hypermagnesemia and

adjunct in cardiac arrest or calcium

channel blocking agent toxicity (calcium

chloride, calcium gluconate). Calcium carbonate: May be used as an antacid.

Calcium acetate: Control of

hyperphosphatemia in end-stage renal

disease.

Contraindication Contraindicated in: Hypercalcemia;

Renal calculi; Ventricular fibrillation. Use Cautiously in: Patients receiving digitalis

glycosides; Severe respiratory

insufficiency; Renal disease; Cardiac

disease.

Drug Interactions Drug-Drug: Hypercalcemia increases the

risk of digoxin toxicity. Chronic use with

antacids in renal insufficiency may lead to

milk-alkali syndrome. Ingestion by mouth

decreases the absorption of orally

administered tetracyclines,

fluoroquinolones, phenytoin, and iron salts.

Excessive amounts may decrease the

effects of calcium channel blockers.

Decreases absorption of etidronate and

risedronate (do not take within 2 hr of

calcium supplements). May decrease the

effectiveness of atenolol. Concurrent use

with diuretics (thiazide) may result in

hypercalcemia. May decrease the ability of

sodium polystyrene sulfonate to decrease

serumpotassium.

Drug-Food: Cereals, spinach, or rhubarb

may decrease the absorption of calcium

supplements. Calcium acetate should not

be given concurrently with other calcium

supplements.

Side-Effects/ Adverse Reactions CNS: syncope (IV only), tingling.

CV: CARDIAC ARREST (IV only),

arrhythmias, bradycardia.

GI: constipation, nausea, vomiting.

GU: calculi, hypercalciuria.

Local: phlebitis (IV ONLY).

Nursing Responsibilities a. Observe patient closely for

symptoms of hypocalcemia

(paresthesia, muscle twitching,

laryngospasm, colic, cardiac

arrhythmias, Chvostek’s or

Trousseau’s sign).

b. Monitor blood pressure, pulse, and

ECD frequently. May cause

vasodilation with resulting

hypotension, bradycardia,

arrhythmias, and cardiac arrest.

c. When used as an antacid, assess

for heartburn, indigestion, and

abdominal pain. Inspect abdomen;

auscultate bowel sounds.

d. Monitor serum calcium or ionized

calcium chloride, sodium,

potassium, magnesium, albumin,

and parathyroid hormone (PTH)

concentrations before and

periodically during therapy for

treatment of hypocalcemia.

e. Monitor cardiac rate and rhythm

closely.

f. Do not administer concurrently with

foods containing large amounts of

oxalic acid (spinach, rhubarb),

phytic acid (brans, cereals), or

phosphorus (milk or dairy products).

g. Do not take within 1-2 hours of

other medications if possible.

h. Advise patient to avoid excessive

use of tobacco or beverages

containing alcohol or caffeine.


Generic Name losartan

Brand Name

Drug Image

Classification Therapeutic: antihypertensives

Pharmacologic: angiotensin II receptor

antagonists


50mg i tab OD (November 7, 2010: 9AM)

Suggested Dose PO (Adults): Hypertension—50 mg once

daily initially (range 25–100 mg/day as a

single daily dose or 2 divided doses)

Prevention of stroke in patients with

hypertension and left ventricular

hypertrophy—50 mg once daily initially; or

losartan increased to 100 mg once daily

Type 2 diabetic nephropathy — 50mg

once daily; may increase to 100mg once

daily; depending on blood pressure

response

Mode of Action Blocks vasoconstrictor and aldosterone-

producing effects of angiotensin II at

receptor sites, including vascular smooth

muscle and the adrenal glands.

Therapeutic Effects: Lowering of blood

pressure. Slowed progression of diabetic

nephropathy (irbesartan and losartan

only). Reduced cardiovascular death and

hospitalizations due to CHF in patients

with CHF (candesartan and valsartan

only). Decreased risk of cardiovascular

death in patients with left ventricular

systolic dysfunction who are post-MI

(valsartan only). Decreased risk of stroke

in patients with hypertension and left

ventricular hypertrophy (effect may be less

in black patients) (losartan only).

Indication Alone or with other agents in the

management of hypertension.

Treatment of diabetic nephropathy in

patients with type 2 diabetes and

hypertension (irbesartan and losartan

only).Management of CHF in patients who

cannot tolerate ACE inhibitors

(candesartan and valsartan only) or in

combination with an ACE inhibitor and

beta-blocker (candesartan only).

Prevention of stroke in patients with

hypertension and left ventricular

hypertrophy (losartan only). Reduction of

risk of death from cardiovascular causes in

patients with left ventricular systolic

dysfunction after MI (valsartan only)

Contraindication Contraindicated in: Hypersensitivity; OB:

Can cause injury or death of fetus;

Lactation: Discontinue drug or provide

formula. Use Cautiously in: CHF (may

result in azotemia, oliguria, acute renal

failure, and/or death); Impaired renal

function due to primary renal disease or

CHF (may worsen renal function);

Drug Interactions Drug-Drug: Antihypertensive effect may

be blunted by NSAIDs. ↑ antihypertensive

effects with other antihypertensives and

diuretics. Telmisartan may ↑ serum digoxin

levels. Concurrent use of potassium-

sparing diuretics, potassium-containing

salt substitutes, angiotensin-converting

enzyme inhibitors, or potassium

supplements may ↑ risk of hyperkalemia.

Candesartan may ↑ serum lithium levels.

Irbesartan and losartan may ↑ effects of

amiodarone, fluoxetine, glimepiride,

glipizide, phenytoin, rosiglitazone, and

warfarin. Rifampin may ↓ effects of

losartan.

Side-Effects/ Adverse Reactions CNS: dizziness, anxiety, depression,

fatigue, headache, insomnia, weakness.

CV: hypotension, chest pain, edema,

tachycardia.

Derm: rashes.

EENT: nasal congestion, pharyngitis,

rhinitis, sinusitis.

GI: abdominal pain, diarrhea, drug-

induced hepatitis, dyspepsia, nausea,

vomiting.

GU: impaired renal function.

F and E: hyperkalemia.

MS: arthralgia, back pain, myalgia.

Misc: ANGIOEDEMA.

Nursing Responsibilities a. Assess blood pressure (lying,

sitting, and standing) and pulse

periodically during therapy. Notify

health care professional of

significant changes.

b. Monitor frequency of prescription

refills to determine adherence.

c. Assess patient for signs of

angioedema (dyspnea, facial

swelling). May rarely cause

angoedema.

d. Monitor daily weight and assess

patient routinely for resolution of

fluid overload (peripheral edema,

rales/crackles, dyspnea, weight

gain, jugular venous distention).

e. Monitor renal function and

electrolyte levels periodically.

Serum potassium, BUN, and serum

creatinine may be ↑.

f. May be administered without regard

to meals.

g. Caution patient to avoid sudden

changes in position to decrease

orthostatic hypotension.

h. Assist patient in ambulation since it

may cause dizziness.

i. Allow patient to sit on bed and

dangle feet before standing to

prevent orthostatic hypotension.


Generic Name simvastatin

Brand Name

Drug Image

Classification Therapeutic: lipid-lowering agents

Pharmacologic: HMG-CoA reductase

inhibitors


Suggested Dose PO (Adults): 5–80mg once daily in the

evening

Mode of Action Inhibit an enzyme, 3-hydroxy-3-

methylglutaryl-coenzyme A (HMG-CoA)

reductase, which is responsible for

catalyzing an early step in the synthesis of

cholesterol. Therapeutic Effects: Lowers

total and LDL cholesterol and triglycerides.

Slightly increase HDL. Slows of the

progression of coronary atherosclerosis

with resultant decrease in CHD-related

events (all agents except rosuvastatin

have indication for ↓ events).

Indication Adjunctive management of primary

hypercholesterolemia andmixed

dyslipidemias. Simvastatin: Secondary

prevention of cardiovascular events (↓ risk

of MI, coronary revascularization, stroke,

and cardiovascular mortality) in patients

with clinically evident CHD or those at

high-risk for CHD (history of diabetes,

peripheral arterial disease, or stroke).

Contraindication Contraindicated in: Hypersensitivity;

Active liver disease or unexplained persistent ↑ in AST or ALT; OB, Lactation: Pregnancy or lactation (potential for fetal anomalies); Concurrent use of gemfibrozil or azole antifungals; Concurrent use of nelfinavir or ritonavir (with lovastatin or simvastatin).

Drug Interactions Drug-Drug: Atorvastatin, lovastatin and

simvastatin may interact with CYP3A4

inhibitors. Bioavailability and effectiveness

may be ↓ by cholestyramine and

colestipol. Risk of myopathy with

atorvastatin, lovastatin, and simvastatin is

↑ with amiodarone, cyclosporine,

gemfibrozil, clofibrate, diltiazem,

veraverapamil, erythromycin,

clarithromycin, telithromycin, nefazodone,

large doses of niacin, azole antifungals,

nelfinavir, saquinavir, and ritonavir.

Atorvastatin, fluvastatin, and simvastatin

may slightly ↑ serum digoxin levels.

Atorvastatin, fluvastatin, lovastatin,

rosuvastatin, and simvastatin may ↑ risk of

bleeding with warfarin.

Drug-Natural Products: St. John’s wort

may ↓ levels and effectiveness (lovastatin

and simvastatin). Drug-Food: Large quantities of grapefruit

juice ↑ blood levels and ↑ risk of

rhabdomyolysis. Food enhances blood

levels of lovastatin.

Side-Effects/ Adverse Reactions CNS: dizziness, headache, insomnia,

weakness.

CV: chest pain, peripheral edema.

EENT: rhinitis;

Resp: bronchitis

GI: abdominal cramps, constipation,

diarrhea, flatus, heartburn, altered taste,

drug-induced hepatitis, dyspepsia,

elevated liver enzymes, nausea,

pancreatitis.

GU: erectile dysfunction.

Derm: rashes, pruritus.

MS: RHABDOMYOLYSIS, arthralgia,

arthritis, myalgia, myositis.

Misc: hypersensitivity reactions.

Nursing Responsibilities a. Obtain a dietary history, especially

with regard to fat consumption.

b. Monitor liver function tests,

including AST. If AST levels ↑ to 3

times normal, HMG-CoA reductase

inhibitor therapy should be reduced

or discontinued. May also cause ↑

alkaline phosphatase and bilirubin

levels.

c. If patient develops muscle

tenderness during therapy, monitor

CK levels. If CK levels are >10

times the upper limit of normal or

myopathy occurs, therapy should

be discontinued.

d. Administer fluvastatin, pravastatin,

and simvastatin once daily in the

evening.

e. May be administered without regard

to food.

f. Avoid large amounts of grapefruit

juice during therapy; may ↑ risk of

toxicity.

g. Advise patient that this medication

should be used in conjunction with

diet restrictions (fat, cholesterol,

carbohydrates, alcohol), exercise,

and cessation of smoking.

h. Watch out for hypersensitivity

reations.


Generic Name amlodipine

Brand Name Norvasc

Drug Image

Classification Therapeutic: antihypertensives

Pharmacologic: calcium channel blockers


Suggested Dose PO (Adults): 5–10 mg once daily

Mode of Action Inhibits the transport of calcium into

myocardial and vascular smooth muscle

cells, resulting in inhibition of excitation-

contraction coupling and subsequent

contraction. Therapeutic Effects: Systemic vasodilation resulting in

decreased blood pressure. Coronary

vasodilation resulting in decreased

frequency and severity of attacks of

angina.

Indication Alone or with other agents in the

management of hypertension, angina

pectoris, and vasospastic (Prinzmetal’s)

angina.

Contraindication Contraindicated in: Hypersensitivity;

Blood pressure <90mmHg.

Drug Interactions Drug-Drug: Additive hypotension may

occur when used concurrently with

fentanyl, other antihypertensives, nitrates,

acute ingestion of alcohol, or quinidine.

Antihypertensive effects may be ↓ by

concurrent use of nonsteroidal anti-

inflammatory agents. May ↑ risk of

neurotoxicity with lithium.

Drug-Food: Grapefruit juice ↑ serum

levels and effect

Side-Effects/ Adverse Reactions CNS: headache, dizziness, fatigue.

CV: peripheral edema, angina,

bradycardia, hypotension, palpitations.

GI: gingival hyperplasia, nausea.

Derm: flushing.

Nursing Responsibilities a. Monitor blood pressure and pulse

before therapy, during dose

titration, and periodically during

therapy. Monitor ECG periodically

during prolonged therapy.

b. Monitor intake and output ratios and

daily weight. Assess for signs of

CHF (peripheral edema,

rales/crackles, dyspnea, weight

gain, jugular venous distention).

c. May be administered without regard

to meals.

d. Advise patient to avoid large

amounts (6–8 glasses of grapefruit

juice/day) during therapy.

e. Caution patient to change positions

slowly to minimize orthostatic

hypotension.

f. Caution patient to avoid sudden

changes in position to decrease

orthostatic hypotension.

g. Assist patient in ambulation since it

may cause dizziness.

h. Allow patient to sit on bed and

dangle feet before standing to

prevent orthostatic hypotension.


Generic Name citicoline

Brand Name

Drug Image

Classification Nootropics & Neurotonics

Ordered Dose 1gm q12 IVTT

Suggested Dose IV: Adult: Up to 1 g IM/IV daily.

Mode of Action Citicoline increases blood flow and

O2 consumption in the brain. It is also

involved in the biosynthesis of lecithin.

Indication Treatment for head injury, cerebrovascular

disorders, and Parkinsonism

Contraindication

Drug Interactions

Side-Effects/ Adverse Reactions

Nursing Responsibilities a. May be taken with or without food.

(Take w/ or between meals.)

b.


Generic Name sodium chloride

Brand Name

Drug Image



Ordered Dose 2 tabs TID

Suggested Dose PO (Adults): 1–2 g 3 times daily.

Mode of Action Sodium is a major cation in extracellular

fluid and helps maintain water distribution,

fluid and electrolyte

balance, acid-base equilibrium, and

osmotic pressure. Chloride is the major

anion in extracellular fluid and is involved

in maintaining acid-base balance.

Solutions of NaCl resemble extracellular

fluid. Reduces corneal edema by an

osmotic effect. Therapeutic Effects: IV, PO: Replacement in deficiency states and

maintenance of homeostasis.

Indication PO: Prevention of or management of

volume depletion due to salt restriction or

heat prostration when excessive sweating

occurs during exposures to high

temperatures.

Contraindication Contraindicated in: IV solution: Hypertonic (3%, 5%) solutions should not

be used in patients with elevated, slightly

decreased, or normal serum sodium, Fluid

retention or hypernatremia.

Drug Interactions Drug-Drug: Excessive amounts of NaCl

may partially antagonize the effects of

antihypertensives. Use with

corticosteroids may result in excess

sodium retention.

Side-Effects/ Adverse Reactions Seen primarily during PO and IV use

CV: CHF, PULMONARY EDEMA, edema.

F and E: hypernatremia, hypervolemia,

hypokalemia.

Nursing Responsibilities a. Assess fluid balance (intake and

output, daily weight, edema, lung

sounds) throughout therapy.

b. Assess patient for symptoms of

hyponatremia (headache,

tachycardia, lassitude, dry mucous

membranes, nausea, vomiting,

muscle cramps) or hypernatremia

(edema, weight gain, hypertension,

tachycardia, fever, flushed skin,

mental irritability) throughout

therapy.

c. Monitor serum sodium, potassium,

bicarbonate, and chloride

concentrations and acid-base

balance periodically for patients

receiving prolonged therapy with

sodium chloride.

d. Monitor vital signs periodically

e. Watch out for signs and symptoms

of pulmonary edema (difficulty of

breathing, excessive sweating, skin

pallor)


Generic Name aspirin

Brand Name

Drug Image

Classification Therapeutic: antipyretics, nonopioid

analgesics

Pharmacologic: salicylates

Ordered Dose 80mg i tab OD (pc)

Suggested Dose PO (Adults): 50–325 mg once daily.

Mode of Action Produce analgesia and reduce

inflammation and fever by inhibiting the

production of prostaglandins. Aspirin Only

Decreases platelet aggregation.

Therapeutic Effects: Analgesia.

Reduction of inflammation. Reduction of

fever. Aspirin. Decreased incidence of

transient ischemic attacks and MI.

Indication Inflammatory disorders including:

Rheumatoid arthritis, Osteoarthritis. Mild to

moderate pain. Fever. Aspirin: Prophylaxis of transient ischemic attacks

and MI.

Contraindication Contraindicated in: Hypersensitivity to

aspirin, tartrazine (FDC yellow dye #5), or

other salicylates; Cross-sensitivity with

other NSAIDs may exist (less with

nonaspirin salicylates); Bleeding disorders

or thrombocytopenia (more important with

aspirin); Children or adolescents with viral

infections (may increase the risk of Reye’s

syndrome).

Drug Interactions Drug-Drug: Aspirin may ↑ the risk of

bleeding with warfarin, heparin, heparin-

like agents, thrombolytic agents,

ticlopidine, clopidogrel, abciximab,

tirofiban, or eptifibatide, although these

agents are frequently used safely in

combination and in sequence. Ibuprofen

may negate the cardioprotective anti-

platelet effects of low-dose aspirin. Aspirin

may ↑ risk of bleeding with cefoperazone,

cefotetan, and valproic acid. May ↑ activity

of penicillins, phenytoin, methotrexate,

valproic acid, oral hypoglycemic agents,

and sulfonamides. May ↓ beneficial effects

of probenecid or sulfinpyrazone.

Corticosteroids may ↓ serum salicylate

levels. Urinary acidification ↑ reabsorption

and may ↑ serum salicylate levels.

Alkalinization of the urine or the ingestion

of large amounts of antacids ↑ excretion

and ↓ serum salicylate levels. May blunt

the therapeutic response to diuretics, and

antihypertensives. ↑ risk of GI irritation with

NSAIDs.

Drug-Natural Products:_anticoagulant

effect and bleeding risk when using aspirin

with arnica, chamomile, clove, feverfew,

garlic, ginger, ginkgo, Panax ginseng, and

others.

Drug-Food: Foods capable of acidifying

the urine may ↑ serum salicylate levels.

Side-Effects/ Adverse Reactions EENT: tinnitus.

GI: GI BLEEDING, dyspepsia, epigastric

distress, nausea, abdominal pain,

anorexia, hepatotoxicity, vomiting.

Hemat: aspirin—anemia, hemolysis,

increased bleeding time

Misc: allergic reactions including

ANAPHYLAXIS and LARYNGEAL

EDEMA.

Nursing Responsibilities a. Assess pain and limitation of

movement; note type, location, and

intensity before and at the peak

after administration.

b. Assess fever and note associated

signs (diaphoresis, tachycardia,

malaise, chills).

c. Prolongs bleeding time for 4–7 days

and, in large doses, may cause

prolonged prothrombin time.

d. Monitor patient for the onset of

tinnitus, headache, hyperventilation,

agitation, mental confusion,

lethargy, diarrhea, and sweating. If

these symptoms appear, withhold

medication and notify physician or

other health care professional

immediately.

e. Administer after meals or with food

or an antacid to minimize gastric

irritation. Food slows but does not

alter the total amount absorbed.

f. Do not crush or chew enteric-

coated tablets. Do not take antacids

within 1–2 hr of enteric-coated

tablets. Chewable tablets may be

chewed, dissolved in liquid, or

swallowed whole.


Generic Name Epoetin alpha (α)

Brand Name Eprex®

Drug Image

Classification Therapeutic: antianemics

Pharmacologic: hormones

Ordered Dose 4000 ‘u’ once a week

Suggested Dose SQ, IV (Adults): 50-100 units/kg 3 times

weekly initially, then adjust dose based on

hematocrit

Mode of Action Stimulates erythropoeisis (production of

red blood cells). Therapeutic effects:

Maintains and may elevate RBCs,

decreasing the need for transfusions.

Indication Anemia associated with chronic renal

failure. Anemia secondary to zidovudine

(AZT) therapy in HIV-infected patients.

Anemia from chemotherapy in patients

with nonmyeloid malignancies. Reduction

of need for transfusions after surgery.

Contraindication Contraindicated in: Hypersensitivity to

albumin or mammalian cell-derived

products; uncontrolled hypertension;

patients with erythropoietin

levels>200mU/ml. Use cautiously in history

of seizures; history of porphyria;

pregnancy or lactation.

Drug Interactions Drug-Drug: May increase the requirement

for heparin anticoagulation during

hemodialysis.

Side-Effects/ Adverse Reactions CNS: seizures, headache

CV: hypertension, thrombotic events such

as myocardial infarction or stroke (↑ in

hemodialysis patients or

hemoglobin≥12g/dL)

Derm: transient rashes

Endo: restored fertility, resumption of

menses

Misc: ↑ mortality and ↑ tumor growth ( with

hemoglobin≥12g/dL)

Nursing Responsibilities a. Monitor blood pressure before and

during therapy.

b. Monitor for symptoms of anemia

(fatigue, dyspnea, pallor)

c. Monitor lab tests: may cause ↑ in

WBCs and platelets. May ↓

bleeding times

d. Monitor renal function studies and

electrolytes closely

e. Give supplemental iron as ordered

f. Institute seizure precautions

g. Do not shake vial; inactivation of

medication may occur

h. Explain rationale for concurrent iron

therapy (increased RBC production

requires iron)

i. Discuss ways of preventing self-

injury in patients at risk for seizures.

Driving and activities requiring

continuous alertness should be

avoided

j. Stress importance of compliance

with dietary restrictions,

medications. Foods high in iron and

low in potassium include liver, pork,

veal, beef, mustard and turnip

greens, peas, eggs, broccoli, kale,

blackberries, strawberries, apple

juice, watermelon, oatmeal, and

enriched bread

drug study

Documents

suggested dose

drug interactions drugdrug

risk of gastric ulcer

monitor serum potassium

gi hyperkalemia

duodenal ulcer disease

gastric lumen reflux

monitor renal function