Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: IV DOSE AND FREQUENCY: 20mg+D5W100 MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Nicardipine BRAND: Cardepine Rx CLASSIFICATION: Calcium channel blocker

Inhibits calcium ion influx across cardiac and smooth muscle cells, thus decreasing myocardial contractility and oxygen demand and coronary arteries and arterioles.

THERAPEUTIC RATIONALE FOR THIS DOSE: Initially PATIENT: treat hypertension, 20mg 3 times daily; adjust at intervals of at least 3 days; max 120mg daily. Severe hepatic impairment: initially 20mg twice daily. Renal insufficiency: 20mg 3 times daily and titrate carefully.

Increased angina, hypotension, flushing, headache, pedal edema, asthenia, dizziness, tachycardia, somnolence, GI upset, insomnia.

Patients with hepatic impairment should receive lower dose. Monitor blood pressure. Allow at least 3 days between dosage adjustments to achieve steady plasma levels. Advise patient to report immediately if experiencing chest pain.

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: IV infusion DOSE AND FREQUENCY: 40mg every 8 hours, IV push THERAPEUTIC DOSE: PO: ADULTS, ELDERLY: Initially, 20-80 mg/dose; may increase by 20-40 mg/dose at 6-8 hour intervals. May titrate up to 600 mg/day in severe edematous state, CHILDREN: 1-6 mg/kg/day in divided doses q6MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Furosemide BRAND: Lasix Rx CLASSIFICATION: Loop Diuretic

Enhances excretion of sodium, chloride, potassium by direct action at ascending limb of loop of Henle and produces a diuretic effect. RATIONALE FOR THIS PATIENT: Treatment of edema and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents.

dry mouth, thirst, nausea, vomiting; feeling weak, drowsy, restless, or light-headed; fast or uneven heartbeat; muscle pain or weakness; urinating less than usual or not at all; easy bruising or bleeding, unusual; weakness; a red, blistering, peeling skin rash; hearing loss; or nausea; stomach pain, low fever, loss of appetite, dark urine, claycolored stools, jaundice (yellowing of the

Give with food to avoid gastroinestinal upset, preferably with breakfast (to prevent nocturia). If given IM, temporary pain at injection site may be noted. Check vital signs especially blood pressure for hypotension prior to administration. Assess baseline electrolyte, particularly check for low potassium. Assess edema, skin turgor, and mucous membranes for hydration status. Assess muscle strength

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DRUG STUDY

12 hours. IM/IV: ADULTS, ELDERLY: 20-40 mg/dose; may repeat in 1-2 hours and increase by 20 mg/dose. CHILDREN: 1-2 mg/kg/dose q6-12 hours. NEONATES: 1-2 mg/kg/dose q12-24 hours. IV infusion: ADULTS, ELDERLY: Bolus of 0.1 mg/kg, then 0.1 mg/kg/hour; may double q2hours. Maximum: 0.4 mg/kg/hour. CHILDREN: 0.05 mg/kg/hour, titrate to desired effect.

skin or eyes).

and mental status. Obtain baseline weight. Initiate Input and Output monitoring. Note extent of diuresis.

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: PO DOSE AND FREQUENCY: 1tablet 3x a day THERAPEUTIC DOSE: Hypocalcemia PO: ADULTS, ELDERLY: 1-2 g/day in 3-4 divided doses. CHILDREN: 4565 mg/kg/day in 34 divided doses. Antacid PO: ADULTS, ELDERLY: 1-2 tabs (5-10 ml) every 2 hours as MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Calcium carbonate BRAND: Calsan Rx CLASSIFICATION: Electrolyte replenisher, antacid

Calcium is essential for function, integrity of nervous, muscular, and skeletal systems. It plays an important role in normal cardiac and renal functions, respiration, blood coagulation, cell membrane, and capillary permeability. It assists in regulating the release and storage of neurotransmitters and hormones. Calcium neutralizes or reduces gastric acid production. RATIONALE FOR THIS PATIENT: used as antacid because the other drugs of the patient are gastric irritants

Hypercalcemia (Early Signs: Constipation, headache, dry mouth, increased thirst, irritability, decreased appetite, metallic taste, fatigue, weakness, depression.

Assess blood pressure, ECG readings, renal function, magnesium, phosphate, and potassium concentrations. Take tablets with full glass of water 30 minutes to 1 hour after meals. Give syrup diluted in juice or water. Chew chewable tablets well before swallowing. Monitor blood pressure, ECG, renal function, magnesium, phosphate,

Hypercalcemia (Late signs: Confusion, drowsiness, increased blood

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DRUG STUDY

needed. Osteoporosis PO: ADULTS, ELDERLY: 1,200 mg/day.

pressure, light sensitivity, urination, irregular heartbeat, nausea, vomiting)

potassium, serum, and urine calcium concentrations. Monitor for signs of hypercalcemia.

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 ROUTE, DOSAGE, THERAPEUTIC DOSE GENERIC: Clonidine ROUTE: PO BRAND: Catapres Rx CLASSIFICATION: Alpha-adrenergic antagonist DOSE AND FREQUENCY: 1tablet 3x a day THERAPEUTIC DOSE: Hypertension PO: ADULTS: Initially, 0.1 mg two times a day. Increase by 0.1-0.2 mg every 2 to 4 days. MAINTENANCE: 0.2-1.2 mg per day in two to four DRUG NAME MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

It reduces peripheral resistance; decreases blood pressure and heart rate. Epidurally administered clonidine prevents pain signal transmission to the brain and produces analgesia at pre- and postalpha-adrenergic receptors in the spinal cord. RATIONALE FOR THIS PATIENT: treat hypertension

Profound hypotension; Irritability; Bradycardia; Respiratory depression; Hypothermia; Miosis; Arrhythmias; Apnea; Abrupt withdrawal may result in: rebound hypertension, nervousness, agitation, anxiety, insomnia, hand tingling, tremor, flushing, and

Obtain blood pressure immediately before each dose is administered in addition to regular monitoring (be alert on blood pressure fluctuations).

Give without regard to food.

Tablets may be crushed.

Monitor pattern of daily bowel activity and stool consistency.

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DRUG STUDY

divided doses up to a maximum of 2.4 mg/day. CHILDREN: 5-25 mcg/kg/day in divided doses every 6 hours; increase at 5- to 7day intervals. Maximum: 0.9 mg/day. TRANSDERMAL : ADULTS, ELDERLY: System delivering 0.1 mg/24 hours up to 0.6 mg/24 hours every 7 days. Usual Elderly Dosage PO: Initially, 0.1 mg at bedtime. may increase

sweating. If clonidine is to be withdrawn, discontinue concurrent beta-blocker therapy several days before discontinuing clonidine. This prevents clonidine withdrawal hypertensive crisis.

Slowly reduce clonidine dosage over 2-4 days.

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gradually. ADHD PO: CHILDREN: Initially 0.05 mg per day. May increase by 0.05 mg per day every 3-7 days. Maximum: 0.3-0.4 mg per day. Severe Pain Epidural: ADULTS, ELDERLY: 30-40 mcg per hour. CHILDREN: Initially 0.5 mcg/kg/hour not to exceed adult dose.

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: PO MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Losartan BRAND: Cozaar Rx CLASSIFICATION: Angiotensin II receptor blocker

Angiotensin, formed in the blood by the action of angiotensin converting enzyme (ACE), is a DOSE AND powerful chemical that attaches to FREQUENCY: angiotensin receptors found in 1tablet 2x a day many tissues but primarily on smooth muscle cells of blood THERAPEUTIC vessels. Angiotensin's attachment to the receptors causes the blood DOSE: The usual vessels to narrow (vasoconstrict) which leads to an increase in blood starting dose of pressure (hypertension). Losartan losartan for adults (more specifically, the chemical is 50 mg daily. The formed when the liver converts the inactive losartan into an active maximum dose is chemical) blocks the angiotensin 100 mg daily. The receptor. By blocking the action of angiotensin, losartan dilates blood total daily dose vessels and thereby reduces blood may be divided and pressure. administered twice

Administer without diarrhea, muscle regard to meals. cramps, dizziness, insomnia, and nasal Ensure that patient is not pregnant before congestion, beginning therapy, persistent cough, suggest using barrier increase serum birth control while using losartan; fetal potassium, and injury and deaths angioedema, have been reported. reduce kidney Find an alternative function in some method of feeding patients and should the baby if given to a not be used by nursing mother. patients who have Depression of the renin-angiotensin bilateral renal system in infants is artery stenosis potentially very (narrowing of both dangerous. arteries going to

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DRUG STUDY

daily. Losartan may be given with or without food. The starting dose of losartan for pediatric patients 6 years of age or older is 0.7 mg/kg up to 50 mg once daily. Doses more than 1.4 mg/kg or 100 mg daily have not been evaluated in pediatric patients.

RATIONALE FOR THIS PATIENT: treat hypertension

the kidneys).

Alert surgeon and mark patient's chart with notice that losartan is being taken. The blockage of the renin-angiotensin system following surgery can produce problems. Hypotension may be reversed with volume expansion. Monitor patient closely in any situation that may lead to a decrease in blood pressure secondary to reduction in fluid volumeexcessive perspiration, dehydration, vomiting, diarrhea excessive hypotension can occur.

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: PO MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Iron+Multivitamins+F olic Acid

DOSE AND FREQUENCY: BRAND: Iberet-Folic1tablet once daily 500 Rx CLASSIFICATION: Vitamins and Minerals, Antianemic THERAPEUTIC DOSE: Pregnant and nonpregnant adult one tablet daily

Iberet-Folic 500 is a hematinic containing iron in a sustainedrelease system, vitamin C for enhancement of iron absorption, and the vitamin B complex including folic acid.

Allergic reactions, GI effects, hyperbilirubinemia, acneform vulgaris deterioration or

Let the patient take this medication by mouth, usually once daily or as directed. Tell the patient not to crush or chew this medication. Doing so can release all of the drug at once, Tell the patient that this medication is best taken on an empty stomach 1 hour before or 2 hours after meals. Take with a full glass of water (8 ounces or 240 milliliters).

acneform exanthema Iron: Iron is required for hemoglobin (Hb) production so that eruption, bright iron deficiency will cause yellow urine production of smaller red cells, discoloration, which contain lower level of Hb flushing, dizziness and can cause microcytic or faintness, hypochromic anemia. peripheral sensory Vitamin C: Vitamin C supports the neuropathies, stone formation, body's metabolism and helps absorption of iron from the crystalluria & duodenal level. Folic Acid: Folic oxalosis, black

Makati Medical Center-College of Nursing

DRUG STUDY

acid is influencing hematopoietic system like vitamin B12 deficiency does.

discoloration of stool.

RATIONALE FOR THIS PATIENT: Treatment & prevention of Fe-deficiency in chronic kidney disease

Makati Medical Center-College of Nursing

DRUG STUDY

Patients Name: A.S.J Age: 81 Medical Diagnosis: Hypertensive Urgency, Chronic Kidney Disease s/t Hypertensive Nephrosclerosis, Hypervolemia, Anemia Attending Physician/s: Dr. A Allergies: Seafoods, Chicken, Egg Allergic Responses: skinrashes Prepared by: Jacklyn C. Nevado BSN IVB Group3 DRUG NAME ROUTE, DOSAGE, THERAPEUTIC DOSE ROUTE: SQ DOSE AND FREQUENCY: 1 pre-filled syringe every MWF THERAPEUTIC DOSE: .6 mcg/kg body weight administered as a single IV or SC injection MECHANISM OF ACTION ADVERSE DRUG EFFECTS NURSING RESPONSIBILITIES

GENERIC: Epoetin beta BRAND: Recormon Rx CLASSIFICATION: Erythropoiesisstimulating agent

A primary growth factor for erythroid development, erythropoietin is produced in the kidney and released into the bloodstream in response to hypoxia. In responding to hypoxia, erythropoietin interacts with erythroid progenitor cells to increase red cell production. Production of endogenous erythropoietin is impaired in patients with chronic renal failure (CRF) and erythropoietin deficiency is the primary cause of their anemia. RATIONALE FOR THIS PATIENT: Treatment of renal anemia

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling; feeling short of breath, even with mild exertion; swelling, rapid weight gain; sudden numbness or weakness, especially on one side of the body; sudden headache, confusion,

Confirm chronic, renal nature of anemia; not intended as a treatment of severe anemia or substitute for emergency transfusion. Gently mix; do not shake, shaking may denature the glycoprotein. Use only one dose per vial; do not reenter the vial. Discard unused portions. Do not give with any other drug solution. Administer dose three times per week. If administered independent of dialysis, administer into venous

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DRUG STUDY

problems with vision, speech, or balance; chest pain, sudden cough, wheezing, rapid breathing, fast heart rate; or pain or swelling in one or both legs.

access line. If patient is not on dialysis, administer IV or subcutaneously. Monitor access lines for signs of clotting. Arrange for Hct reading before administration of each dose to determine dosage. If patient fails to respond within 8 wk of therapy, evaluate patient for other etiologies of the problem. Evaluate iron stores prior to and periodically during therapy. Supplemental iron may need to be ordered. Institute seizure precautions.