DRUG STUDY GENERIC NAME & TRADE NAME CLASSIFICAT ION INDICATIO NS Analgesicantipyretic in patients with aspirin allergy,

hemostatic disturbance s, bleeding diatheses, upper GI disesase, gouty arthritis Arthritis and rheumatic disorders involve musculoskel etal pain common cold, flu, other viral and bacterial infections with pain and fever MECHANI SM OF ACTION Antipyretic : Reduces fever by acting directly on the hypothala mic heatregulating center to cause vasodilatio n and sweating, which helps dissipate heat. ROUTE/FREQUENCY/D OSAGE Adults: PO or PR By suppository, 325-650 mg q 4-6 hrs or PO, 1000 mg tid or qid. Do not exceed 4g/day Pediatric: PO or PR Doses may be repeated 4-5 times/day; do not exceed five doses in 24 hr; give PO or by suppository. ADVERSE REACTIONS/SI DE EFFECTS CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5-8 g/day are ingested daily for several weeks or when dosage of 4gday are ingested for 1 year. DRUG-TODRUG, FOODTO-DRUG INTERACTION Increased toxicity with longterm, excessive ethanol ingestion NURSING CONSIDERATIONS/PA TIENT TEACHING Do not exceed the recommended dosage.

Generic Antipyretic Name: Analgesic Acetaminop hen Trade Name: Oral: Aceta, Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol, Tapanol, Tempra, Tylenol Suppositori es: Abenol (CAN), Acephen

Consult physician if needed for < 3 yr; if needed for longer than 10 days; if continued Increased fever, severe or hypoprothrombin recurrent pain occurs emic effect of (possible serious oral illness). anticoagulants Avoid using multiple Increased risk of preparations containing hepatotoxicity acetaminophen. GI: Hepatic and possible Carefully check all OTC toxicity and renal decreased products. They may failure, jaundice therapeutic contain acetaminophen, effects with and serious overdose GU: Acute renal barbiturates, can occur. If OTC drugs failure, renal carbamazepine, is needed, consult tubular necrosis hydantoins, health care provider. rifampin, HEMATOLOGIC: sulfinpyrazone Give drug with food if Methemoglobine GI upset occurs. mia-cyanosis; Possible hemolytic delayed or Discontinue drug if anemiadecreased hypersensitivity hematuria, effectiveness reaction occurs. anuria; with neutropenia, anticholinergics Report rash, unusual leucopenia, bleeding or bruising.

pancytopenia, thrombocytopeni a, hypoglycemia HYPERSENSITI VITY: Rash, fever

Possible reduced absorption of acetaminophen with activated charcoal Possible decreased effectiveness with zidovudine

DRUG STUDY Generic/Trade Name Omeprazole(omepron ) Classificatio n *Antiulcer drugs Indication *Symptomatic gastroesophageal reflux disease (or GERD) without esophageal lesions. *Erosive esophagitis and accompanying symptoms caused by GERDs. *Maintenance of healing erosive esophagitis. *Pathologic hypersecretory conditions. Duodenal ulcers. Action *Inhibits activity of acid (proton) pump and binds to hydrogenpotassium adenosin triphosphatase at sedretory surface of gastric parietal cells to block formation of gastric acid. Side/Adverse Effects *CNS: asthenia, dizziness, headache. *GI: abdominal pain, constipation, diarrhea, flatulence, nausea, and vomiting. *MUSCULOSKELETAL: Backpain, *RESPIRATORY: Cough, upper respiratory tract infection, *SKIN: rash Drug Interaction *Ampicillin esters, iron derivatives, ketokonazole: may cause poor bioavailability of these drugs because they need a low gastric PH for optimal absorption. Avoid using together. *Diazepam,fosphenytoin, phenytoin, warfarin: may decrease hepatic clearance, possibly leading to increased levels of these drugs. Monitor levels of drugs. Route, Dosage, Frequency *20mg capsule once a day Nursing Consideration *Dosage adjustment may be necessary in Asians and patients with hepatic impairment. *Drug increases its own bioavailability with repeated doses. Drug is unstable in gastric acid; less drug is lost by hydrolysis because drug increases gastric pH. *Gastrin level rises in most patients during the 1st 2 weeks of therapy. Reference: Nursing 2008 Drug Handbook 28th Edition.

DRUG STUDY Generic/Trade Name Phytomenadione / konakion Classification Indication Action *Vitamin K1 is a coagulationpromoting factor. As a component of a liver carboxylase system, it is involved in the carboxylation of the coagulation factors II (prothrombin), VII, IX and X, and of the coagulation inhibitors protein C and protein S in the postribosomal phase.Anticoagulant s of the dicoumarol type inhibit reduction of vitamin K1 (quinone form) to vitamin K1 hydroquinone and also prevent the vitamin K1 epoxide which arises after the carboxylation reaction from being reduced to the quinone form. Side/Adverse Effects *cause severe, shock-like reactions. the veins may become irritated or phlebitis tenderness. anaphylactoid reactions . Drug Interaction * Dicoumarol and its derivatives antagonize the effect of vitamin K on postribosomal carboxylation of certain coagulation factors and inhibitors. Route, Dosage, Frequency *10mg slow IVTT every 1 dose Nursing Consideration *Administer slowly. *regular monitoring of prothrombin values until coagulation returns to normal. *Monitor BP, pulse rate and heart rate *Monitor urine output

*Haemostatics *Hemorrhage or threatened hemorrhage as a result of severe hypoprothrombinemia (ie, deficiency of coagulation factors II, VII, IX, X) due, for instance, to overdosage of anticoagulants of the dicoumarol type or their combination with phenylbutazone or to other forms of hypovitaminosis K (eg, obstructive jaundice, liver and intestinal disorders, prolonged administration of antibiotics, sulfonamides or salicylates). Prophylaxis and treatment of hemorrhagic disease of the newborn.

DRUG STUDY Generic/Trade Name dopamine Classification *Alpha and Beta *Adrenergic *Agonist Indication *Correction of hemodynamic imbalances Action *Dopamine stimulates dopaminergic receptors at lower doses producing renal and mesenteric vasodilation while at higher doses stimulate both dopaminergic and adrenergic receptors producing cardiac stimulation and renal vasodilation. It increases heart rate and force of contraction. At low infusion rates vasodilatation occurs in the renal, mesenteric, coronary and cerebral beds. At higher rates vasoconstriction in skeletal muscles and a Side/Adverse Drug Interaction Effects *CNS: headache, *Cyclopropane and dizziness halogenated hydrocarbon *CV: tachycardia, anaesthetics may sensitise hypotension, myocardium to vasoconstriction, dopamine and hypertension, precipitate dsypnea, ventricular bradycardia. Irregular heart arrhythmias. MAO inhibitors prolong beat and increase *GI: nausea and dopamine effects. Ergots potentiate vomiting, vasoconstriction action of dopamine. Alpha-blockers unmask dopamine's beta action. Route, Dosage, Frequency *Dopamine 20cclhr side drip Nursing Consideration *Monitor BP, pulse rate and heart rate *Monitor urine output *Assess for blanching *Monitor pulmonary artery catheter

rise in BP.

DRUG STUDY Generic/Trade Name Classification Indication Action Side/Adverse Effects *Gastrointestinal disturbances including diarrhea, nausea and vomiting have occurred in some patients receiving cefuroxime axetil. There have been rare reports of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Drug Interaction *Probenecid reduces the renal clearance of cefuroxime. Route, Dosage, Frequency *750 mg IVTT every 8 hours Nursing Consideration *Cefuroxime should not be given to patients who are hypersensitive to cefuroxime or to cephalosporines. About 10% of penicillin-sensitive patients may also be allergic to cephalosporins although the true incidence is uncertain. Great care should be taken if it is to be given to such patients. Caution is also necessary in patients with a history of allergy. It should be given with caution to patients with renal impairment; a dosage reduction may be necessary. Renal

Cefuroxime/Zetagal *Cephalosporins *Cefuroxime is a 2nd generation cephalosporin antibiotic used in the treatment of susceptible infections. These have included bone and joint infections, bronchitis (and other lower respiratory tract infections), gonorrhea, meningitis, otitis media, peritonitis, pharyngitis, sinusitis, skin infections (including soft tissue infections) and urinary tract infections. It is also used as prophylaxis for surgical infection.

*Cefuroxime is widely distributed in the body including pleural fluid, sputum, bone, synovial fluid and aqueous humor, but only achieves therapeutic concentrations in the CSF when the meninges are inflamed. It crosses the placenta and has been detected in breast milk. It is excreted unchanged, by glomerular filtration and renal tubular secretion and high concentrations are achieved in the urine. Following injection, most of a dose of cefuroxime is excreted within 24 hrs, the majority within 6 hrs.. Plasma concentrations are reduced by

dialysis.

and hematological status should be monitored especially in prolonged drug use and highdose therapy

DRUG STUDY Generic/Trade Name Classification Indication Action Side/Adverse Effects Drug Interaction Route, Dosage, Frequency Nursing Consideration

Voluven [IV infusion]

*B05AA07 Hydroxyethylstarch ; Belongs to the class of blood substitutes and plasma protein fractions. Used as blood substitutes.

*Therapy and prophylaxis of hypovolemia; acute normovolemic hemodilution technique (ANH).

*Voluven contains hydroxyethyl starch in a colloidal solution which expands plasma volume when administered intravenously. Hydroxyethyl starch is a derivative of thin boiling waxy corn starch, which mainly consists of a glucose polymer (amylopectin) predominately composed of -1-4connected glucose units with several -1-6-branches. Substitution of hydroxyethyl groups on the glucose units of the polymer reduces the normal

*Medicinal products containing hydroxyethyl starch may lead to anaphylactoid reactions (hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm, non-cardiac pulmonary edema) in very rare cases.. *Pruritus (itching) after prolonged administration of high dosages is a known undesirable effect of hydroxyethyl starches.

*No interactions with other drugs or nutritional products are known to date. Please refer to Adverse Effects section concerning the concentration of serum amylase which can rise during administration of hydroxyethyl starch and can interfere with the diagnosis of pancreatitis

*500cc @25 gtts/min

*Fluid overload caused by overdose should be avoided in general. Particularly for patients with cardiac insufficiency or severe kidney dysfunctions, the increased risk of hyperhydration must be taken into consideration; dosage must be adapted. In cases of severe dehydration, a crystalloid solution should first be given.It is important to supply sufficient fluid and to regularly monitor

degradation of amylopectin by amylase in the body.

kidney function and fluid balance

DRUG STUDY GENERIC NAME & TRADE NAME Furosemide CLASSIFIC ATION Loop diuretic INDICATION S Acute pulmonary edema MECHANI SM OF ACTION ROUTE/FREQUENCY/ DOSAGE 10.0 mg slow IVTT ADVERSE REACTIONS/SID E EFFECTS CNS: vertigo, headache, dizziness, paresthesia, weakness, restlessness, fever. CV: orthostatic hypotension, thrombophlebitits with I.V. administration. DRUG-TO-DRUG, FOOD-TO-DRUG INTERACTION Amino glycoside antibiotics, cisplatin: may increase ototoxicity. Use together cautiously. o Amphotericin B, corticosteroids, corticotrophin, metolazone: may NURSING CONSIDERATIONS/P ATIENT TEACHING Advise patient to take drug with food to prevent GI upset, and to take drug in the morning to prevent the frequent need to urinate at night. If patient needs second dose, tell him or her to take it early in the afternoon, 6-8 hrs after morning dose. Inform patient of possible need for potassium or magnesium supplements. Instruct patient to stand slowly to prevent orthostatic dizziness, and to limit alcohol intake and stenous exercise in

A potent drug that inhibits sodium Edema and Hypertension chloride reabsorptio n at the proximal distal tubules and the ascending loop of Henle.

increase risk of EENT: transient hypokalemia. deafness, blurred Monitor potassium or yellowed level closely. vision, tinnitus. o Ant diabetics: GI: abdominal may decrease discomfort and hypoglycemic pain, diarrhea, effects. Monitor anorexia, nausea, glucose vomiting, level. constipation, o pancreatitis. Antihypertensive: GU: nocturia, may increase risk

polyuria frequent urination, oliguria. Hematologic: agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia , azotemia, anemia. Hepatic: hepatic dysfunction, jaundice. Metabolic: volume depletion and dehydration, asymptomatic hyperurecemia, impaired glucose tolerance, hypokalemia, hypochloremic alkalosis, hyperglycemia, dilutional hyponatremia, hypocalcemia, hypomagnesemia .

of hypotension. Use together cautiously. Decrease antihypertensive dose if needed. o Cardiac glycosides, neuromuscular blockers: may increase toxicity of these drugs from furosemide induced hypokalemia. Monitor potassium level. o Chlorothiazide, chlorthalidone, hydrochlorothiazid e, indapamide, metolazone: may cause excessive diuretic response, causing serious electrolyte abnormalities or dehydration. Adjust doses

hot weather to avoid worsening dizziness upon standing quickly. Advise patient to immediately report ringing in the ears, severe abdominal pain, or sore throat and fever, these symptoms may indicate toxicity. ALERT: Discourage patient from storing different types of drugs in the same container, increasing risk of drug errors. The most popular strengths of this drug and digoxin are white tablets about equal in size. Tell patient to check with prescriber or pharmacist before taking OTC drugs. Teach patient to avoid direct sunlight

Musculoskeleta l: muscle spasm. Skin: dermatitis, purport, photosensitivity reactions, transient pain at I.M. injection site.

carefully and monitor patient for signs and symptoms of excessive diuretic response. o Ethacrynic acid: may increase risk of ototoxicity. Avoid using together. o Lithium: may decrease lithium excretion resulting in lithium toxicity. Monitor lithium level. o NSAIDS: may inhibit diuretic response. Use together cautiously. o Phenytoin: may inhibit diuretic effect of furosemide. Use together cautiously.

and to use protective clothing and a sun block because of risk of photosensitivity.

o Propanolol: may increase propanolol level. Monitor patient closely. o Salicylates: may cause salicylate toxicity. Use together cautiously. o Sucralfate: may reduce diuretic and hypertensive effect. Discourage

DRUG STUDY GENERIC NAME & TRADE NAME Famotidine : Famotidine: Pepcid, Pepcid AC (nonprescrip tion) CLASSIFIC ATION H2 receptor antagonist INDICATION S MECHANI SM OF ACTION ROUTE/FREQUENCY/ DOSAGE ADVERSE REACTIONS/SID E EFFECTS Drug-induced hepatitis Bone marrow depression (Lowered white blood cells or hemoglobin),rare Confusion (particularly in compromised elderly with some of these drugs) DRUG-TO-DRUG, FOOD-TO-DRUG INTERACTION None significant. NURSING CONSIDERATIONS/P ATIENT TEACHING Instruct patient in proper use of OTC product if appropriate. Warn patient with PKU that Peptic AC chewable tablets contain phenylalanine. Tell patient to take prescription drug with a snack, if desired. Remind patient that prescription drugs most effective is taken at bedtime. Tell patient taking 20 mg twice daily to take one dose at bedtime. Advise patient to limit use of prescription drug no longer than 8 weeks, unless

Effective treatment of GERD and Peptic Ulcers in children (FAMOTIDIN E ONLY) Effective treatment of Peptic Ulcer Disease: relief of symptoms, acceleration of healing, prevention of recurrence Control of Hypersecreto ry Stomach Disorders Treatment of Reflux Esophagitis

Competitiv ely inhibits the action of antihistami ne on the H2 at the receptor sites of parietal cells, decreasing gastric acid secretions.

Short-term treatment for benign gastric ulcer o Children ages 1-16: 0.5 mg/kg/day P.O. at bedtime or divided b.i.d., up to 40 mg daily. astroesophageal G reflux disease ( GERD)

o Children ages 1-16: 1mg/kg/day P.O. divided Low blood twice platelet counts (all the above are daily up to 40 mg b.i.d. case report to rare effects) Abnormal heart rhythm changes (slow heart beat or atrioventricular block) Bronchospasm, rare

Treatment of Heartburn

Impotence

ordered by the prescriber, and OTC drug no longer than 2 weeks. With prescribers knowledge. Let patient take antacids together especially at the beginning of therapy when pain is severe. Urge patient to avoid cigarette smoking because it may increase gastric acid secretion and worsen disease. Advise patient to report abdominal pain or blood in stools or vomit.

DRUG STUDY GENERIC NAME & TRADE NAME Tranexamic Acid Brand name: Cyklokapron CLASSIFIC ATION INDICATION S MECHANI SM OF ACTION Tranexami c acid competitiv ely inhibits activation of plasminog en, thereby reducing conversion of plasminog en to plasmin (fibrinolysi n), an enzyme that degrades fibrin clots, fibrinogen, and other plasma proteins, including the ROUTE/FREQUENCY/ DOSAGE mild to moderate pain, fever o Children ages 6-8 yrs old: 320 mg P.O. q 4-6 hrs, p.r.n ADVERSE REACTIONS/SID E EFFECTS Blurred vision or other changes in vision hypotension (dizziness or lightheadedness; unusual tiredness or weakness) may be associated with too-rapid intravenous administration thrombosis or thromboembolism (pains in chest, groin, or legs [especially calves]; severe, sudden headache; sudden and unexplained shortness of DRUG-TO-DRUG, FOOD-TO-DRUG INTERACTION Anti-inhibitor coagulant complex or Factor IX complex (although tranexamic acid is often used in conjunction with clotting factor replacement for the perisurgical management of hemophilic patients, concurrent use may increase the risk of thrombotic complications.) Contraceptives, estrogencontaining, oral or Estrogens (concurrent use with NURSING CONSIDERATIONS/P ATIENT TEACHING Antifibrinolytic agents are ineffective in bleeding caused by loss of vascular integrity; a definite clinical diagnosis or confirmation of hyperfibrinolysis (hyperplasminemia) via laboratory studies is required before tranexamic acid is used to treat hemorrhage. Carcinogenicity/Tum origenicity Pregnancy Tranexamic acid crosses the placenta. Breast-feedingtranexamic acid is distributed into breast milk; concentrations

Antifibrinolyt Used for ic, antihemorrh short term control of agic bleeding on hemophiliacs and used in other bleeding control that is required

procoagula nt factors V and VIII. Tranexami c acid also directly inhibits plasmin activity, but higher doses are required than are needed to reduce plasmin formation. In vitro, the antifibrinol ytic potency of tranexamic acid is approximat ely 5 to 10 times that of aminocapr oic acid. In patients

breath, slurred speech, vision changes, and/or weakness or numbness in arm or leg; sudden loss of coordination) depending on site of thrombus formation or embolization Diarrhea Nausea vomiting Incidence unknown

tranexamic acid may increase the potential for thrombus formation) Thrombolytic agents (the actions of tranexamic acid and of thrombolytic agents [e.g., alteplase (tissuetype plasminogen activator, recombinant; tPA), anistreplase (anisoylated plasminogenstreptokinase activator complex;

reach approximately 1% of the maternal plasma concentration Ophthalmological examinations, including tests for visual acuity, color vision, eyeground, and visual fields

Unusual menstrual discomfort APSAC), caused by clotting streptokinase, or of menstrual fluid urokinase] are mutually antagonistic; although

controlled studies to demonstrate its efficacy have not

with hereditary angioedem a, inhibition of the formation and activity of plasmin by tranexamic acid may prevent attacks of angioedem a by decreasing plasmininduced activation of the first compleme nt protein.

been done in humans, tranexamic acid may be useful in treating severe hemorrhage caused by a thrombolytic agent.