DRUG STUDY NEURO nsflknlefmknsfnlnlsfhl.docx

drug study

1. NAME OF DRUG MECHANISM OF
ACTION
INDICATION/
CONTRAINDICATION
SIDE EFFECTS ADVERSE EFFECTS NURSING IMPLICATION
GENERIC NAME:
Diazepam
BRAND NAME:
Valium
CLASSIFICATION:
Analgesic (centrally
acting)
Opioid analgesic
FREQUENCY/
DOSAGE/
ROUTES:
5 mg IV then PRN for
frank seizure episodes max
of 20 mg
ACTION:
1.Suppresses the
spread of seizure
activity through the
motor cortex of the
brain (cerebral
cortex)
2.Effective intreating
the tremors and
anxiety
3.Diminishes recall of
patients for
cardioversion

INDICATION:
Short-term
management of anxiety
Insomnia associated
with anxiety
Sleepwalking
Night terrors
Premedication before
anaesthesia
Adjunct in the
management of
seizures
Muscle spasms
Acute symptoms of
alcohol withdrawal
Premedication before
anaesthesia
CONTRAINDICATION:
Hypersensitivity
Preexisting CNS
depression or coma
Respiratory depression
Acute pulmonary
insufficiency or sleep
apnea
Severe hepatic
impairment
Acute narrow angle
glaucoma
Frequent: Pain with IM
injection, drowsiness,
fatigue, ataxia.
Occasional: Slurred
speech, orthostatic
hypotension, headache,
hypoactivity,
constipation, nausea,
blurred vision.
Rare: Paradoxical CNS
reactions
(hyperactivity/
nervousness in
children, excitement/
restlessness in elderly/
debilitated) generally
noted during first 2
weeks of therapy,
particularly in presence
of uncontrolled pain.
CNS
dizziness
drowsiness
lethargy
hangover
headache
depression
EENT:
blurred vision
RESP:
respiratory
depression
CV:
hypotension
GI:
constipation
diarrhea
nausea
vomiting
DERM:
rashes
LOCAL:
pain (IM)
phlebitis (IV)
venous
thrombosis
MISC:
physical &
psychological
BASELINE ASSESSMENT
- Assess B/P, pulse, respirations
immediately before administration.
- Anxiety: Assess autonomic
response (cold, clammy hands,
diaphoresis), motor response
(agitation, trembling, tension).
- Musculoskeletal spasm: Record
onset, type, location, duration of
pain. Check for immobility,
stiffness, swelling.
- Seizures: Review history of
seizure disorder (length, intensity,
frequency, duration, LOC).
- Observe frequently for recurrence
of seizure activity.
- Initiate seizure precautions.
INTERVENTION/EVALUATION
- Monitor heart rate, respiratory
rate, B/P, mental status.
- Assess children, elderly for
paradoxical reaction, particularly
during early therapy.
- Evaluate for therapeutic response
(decrease in intensity/frequency of
seizures; calm facial expression,
decreased restlessness; decreased
intensity of skeletal muscle pain).
- Therapeutic serum level: 0.5–2

2. Children < 6 months
Pregnancy and
lactation.
Precaution
Impaired renal and
hepatic function
Chronic pulmonary
insufficiency
Organic cerebral
changes; elderly
History of alcohol or
drug addiction.
dependence,
tolerance
mcg/ml; toxic serum level: greater
than 3 mcg/ml.
PATIENT/FAMILY TEACHING
- Avoid alcohol.
- Limit caffeine.
- May cause drowsiness, avoid tasks
that require
alertness, motor skills until response
to drug is
established.
- May be habit forming.
- Avoid abrupt discontinuation after
prolonged use.
Drug INDICATION CONTRA-
INDICATION
ADVERSE REACTION NURSING CONSIDERATION
Generic name: >Anaerobic Hypersensitivity. Significant: Superinfection. Blood and Assessment:

3. Clindamycin
Brand names:
Cleocin Phosphate,
Cleocin T,
Clindagel,
Pharmacologic class:
Lincosamide
Dosage/Frequency/Route:
300 mg 1 cap q8
Action:
Clindamycin, a
lincosamide antibiotic,
inhibits bacterial protein
synthesis by reversibly
binding to the 50S
ribosomal subunit, thereby
preventing the peptide
bond formation, ribosome
assembly and translation
process.
infections; Disease
due to Gram-
positive bacteria.
> Anaerobic
infections; Disease
due to Gram-
positive bacteria.
> Topical/
Cutaneous Acne
vulgaris
> Bacterial
vaginosis
Topical and vaginal:
History of
inflammatory bowel
disease, regional
enteritis, ulcerative
colitis or antibiotic-
associated colitis.
Neonates
(parenteral).
lymphatic system disorders: Leucopenia,
agranulocytosis, eosinophilia,
neutropenia, thrombocytopenia.
Gastrointestinal disorders: Diarrhea,
abdominal pain, nausea, vomiting,
oesophagitis, oesephageal ulcer. General
disorders and admin site conditions:
Application site reactions (e.g.,
inflammation, irritation, burning
sensation, pain, dryness, oiliness), inj site
reactions (e.g. pain, irritation, abscess,
induration). Hepatobiliary disorders:
Jaundice. Immune system disorders:
Urticaria. Infections and infestations:
Cervicitis, vaginal candidiasis, vaginitis.
Investigations: Abnormal LFT. Nervous
system disorders: Dysgeusia, headache,
dizziness. Renal and urinary disorders:
Azotaemia, oliguria, proteinuria.
Reproductive system and breast
disorders: Vulvovaginal irritation, vaginal
moniliasis. Skin and subcutaneous tissue
disorders: Maculopapular rash, pruritus,
erythema, seborrhoea, contact dermatitis.
Vascular disorders: Hypotension (IV),
thrombophlebitis (IV).
History: Allergy to clindamycin, history of asthma or
other allergies, allergy to tartrazine (in 75- and 150-mg
capsules); hepatic or renal dysfunction; lactation; history
of regional enteritis or ulcerative colitis; history of
antibiotic associated colitis
> Physical: Site of infection or acne; skin color, lesions;
BP; R, adventitious sounds; bowel sounds, output, liver
evaluation; CBC, LFTs, renal function tests
Interventions:
Systemic administration
> Culture infection before therapy.
> Administer oral drug with a full glass of water or with
food to prevent esophageal irritation.
> Do not give IM injections of more than 600 mg; inject
deep into large muscle to avoid serious problems.
> Do not use for minor bacterial or viral infections.
> BLACK BOX WARNING: Be aware that serious to
fatal colitis can occur; reserve use, and monitor patient
closely.
> Monitor LFTs and renal function tests, and blood
counts with prolonged therapy.
Topical dermatologic administration:
> Keep solution away from eyes, mouth and abraded skin
or mucous membranes; alcohol base will cause stinging.
Shake well before use.
> Keep cool tap water available to bathe eye, mucous
membranes.
DRUG MECHANISM
OF ACTION
INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING RESPONSIBILITIES

4. Generic Name:
Tramadol
Trade Name:
Ultram
Classification:
Analgesic (centrally
acting)
Opioid analgesic
Dosage/Frequency/
Route:
50 mg
Binds to mu-
opioid
receptors.
Inhibits
reuptake of
serotonin and
norepinephrine
in the CNS.
Therapeutic
Effects:
Decreased pain
Relief of moderate
to moderately
severe pain
Contraindicated with allergy
to tramadol or opioids or
acute intoxication with
alcohol, opioids, or
psychotropic drugs.
Patients with a history of
epilepsy or risk factors for
seizures
Renal impairment (increased
dosing interval recommended
if CCr<30 ml/min)
Hepatic impairment
(increased interval
recommended in patients
with cirrhosis)
Patients receiving MAO
inhibitors or CNS depressants
Increased intracranial
pressure or head trauma
Acute abdomen (may
preclude accurate clinical
assessment)
Patients with a history of
opioid dependence or who
have recently received large
doses of opioid.
CNS: SEIZURES, dizziness,
headache, somnolence, anxiety,
confusion, coordination
disturbance, malaise,
nervousness, sleep disorder,
weakness
EENT: visual disturbances
CV: vasodilation
GI: constipation, nausea,
abdominal pain, anorexia,
diarrhea, dry mouth, dyspepsia,
flatulence, vomiting
GU: menopausal symptoms,
urinary retention/frequency
Derm: pruritus, sweating
Neuro: hypertonia
Assess type, location, and
intensity of pain before and
2-3 hour (peak) after
administration.
Assess bowel function
routinely.
Assess previous analgesic
history. Tramadol is not
recommended for patients
dependent on opioids or who
have previously received
opioids for more than 1 week;
may cause opioid withdrawal
symptoms.
Monitor patient for seizures.
May occur within
recommended dose range.
NAME OF
THE DRUG
MECHANISM
OF ACTION
INDICATION/
CONTRAINDICATI
ON:
SIDE EFFECTS ADVERSE EFFECTS NURSING IMPLICATION

5. GENERIC
NAME:
Losartan
potassium
BRAND
NAME:
Cozaar
CLASSIFICAT
ION:
Pharmacologic
class:
Angiotensin II
receptor
antagonist
Therapeutic
class:
Antihypertensiv
e
FREQUENCY/
DOSAGE/
ROUTES:
50 mg/tab 1 tab
OD
ACTION:
Blocks
vasoconstricting
and
aldosterone-
secreting effects
of
angiotensin II at
various
receptor sites,
including vascular
smooth
muscle and
adrenal glands.
Also
increases urinary
flow and enhances
excretion
of chloride,
magnesium,
calcium, and
phosphate.
INDICATION:
Hypertension,
Nephepatically in type
2
diabetic patients, to
reduce risk of CVA in
patients with
hypertension and left
ventricular hypertrophy.
CONTRAINDICATIO
NS:
Hypersensitivity to drug
or its
components
● Pregnancy (second
and
third
trimesters)
Precautions
Use cautiously in:
● heart failure, renal or
hepatic impairment,
obstructive biliary
disorders
● high-dose diuretic
therapy
● black patients
● pregnant patients
Side effects associated
with the
use of losartan
include:
Feeling dizzy
Headaches
Feeling sick (nausea)
Being sick (vomiting)
Diarrhoea
Pain in your joints or
muscles.
CNS: dizziness, insomnia,
headache, asthenia, fatigue
CV: hypotension
EENT: sinus disorders
GI: nausea, vomiting, diarrhea,
dyspepsia, abdominal pain
Metabolic: hyperkalemia
Musculoskeletal: joint pain, back
pain, muscle cramps
Respiratory: symptoms of upper
respiratory infection, dry cough
Other: hypersensitivity reactions
including angioedema
Interactions
Drug-drug. Diuretics, other
antihypertensives: increased risk
of hypotension
Fluconazole: inhibited losartan
metabolism, increased
antihypertensive effects
Indomethacin: decreased
losartan effects
Lithium: decreased lithium
metabolism
Nonsteroidal anti-inflammatory
drugs: decreased renal function
Potassium-sparing diuretics,
potassium supplements:
hyperkalemia
Pt monitoring
Watch for angioedema and other hypersensitivity
reactions.
● Monitor blood pressure to evaluate drug
efficacy.
● Assess liver and kidney function tests and
electrolyte levels.
● Stay alert for oliguria, progressive azotemia,
and renal failure in patients with severe heart
failure whose renal function depends on the
renin angiotensin-aldosterone system.
● Know that in black patients, losartan and other
ACE inhibitors may be ineffective when used
alone. Drug isn’t indicated for stroke prevention
in black hypertensive patients with LVH.
● Be aware that drug may cause fetal injury or
death when used during second or third trimester
of pregnancy
Patient teaching
● Instruct patient to avoid potassium
supplements and salt substitutes containing
potassium, unless directed byprescriber.2Caution
female patient not to take drug during second or
third trimester of pregnancy. Advise her to
contact prescriber immediately if she suspects
pregnancy.
● Tell female patient to discuss breastfeeding
with prescriber before taking.2Instruct patient to

6. (first
trimester) or
breastfeeding patients
● children younger than
age 6 (safety
not established)
Rifamycins: enhanced losartan
metabolism, decreased
antihypertensive effects
Drug-diagnostic tests. Albumin:
increased level
Drug-food. Salt substitutes
containing
potassium: hyperkalemia
immediately report hypersensitivity reactions,
especially lip or eyelid swelling, throat tightness,
and difficulty breathing.
● As appropriate, review all other significant and
life-threatening adverse reactions and
interactions, especially those related to the drugs,
tests, and foods mentioned above.
DRUG NAME MECHANISM OF ACTION INDICATIONS CONTRAINDICATIONS SIDE EFFECTS NURSING RESPONSIBILITIES
Generic Name: Increases glucose transportModerate to severe Contraindicated in hypoglycemia Cardiovascular: atrial fibrillation, 1. Assess patient’s glucose

7. Insulin ( Regular )
Brand Name:
Humulin R
Novolin R
Penfill
Classification:
Antidiabetic
FREQUENCY/ DOSAGE/
ROUTES:
5 units RI if CBG > 180
across muscle and fat cell
membranes to reduce
glucose level. Promotes
conversion of glucose into
its storage form, glycogen.
diabetic ketoacidosis or
hyperglycemia, mild
diabetic ketoacidosis,
newly diagnosed diabetes
mellitus to control
hyperglycemia
and in patients hypersensitive to
insulin or its ingredients.
Drug-drug: AIDS antiretrovirals,
corticosteroids, dextrothyroxine,
epinephrine, thiazide diuretics
may increase insulin response.
Beta blockers may conceal signs
of hypoglycemia. Hormonal
contraceptives may decrease
glucose tolerance, monitor
glucose level and adjust insulin
dosage carefully. Metabolic:
hyperglycemia, hypoglycemia.
Respiratory: dyspnea, increased
cough, reduced pulmonary
function, respiratory tract
infection.
Skin: itching, rash, redness,
stinging, swelling, urticaria,
warmth at injection site.
heart failure, myocardial
infarction, nodal arrhythmia,
supraventricular tachycardia,
ventricular extrasystoles,
ventricular tachycardia
Digestive: anorexia, melena
Hematologic and Lymphatic:
anemia
Metabolic and Nutritional:
increased creatinine,
hyperuricemia
Nervous: insomnia
Respiratory: epistaxis
Skin and Appendages: urticaria
Special Senses: conjunctivitis,
retinal hemorrhage, tinnitus
Urogenital: urinary frequency
Frequent (34%–10%):Headache,
diarrhea, palpitations, dizziness,
pharyngitis.
level before starting therapy
and regularly thereafter. If
patient is under stress,
unstable, pregnant, recently
diagnosed, or taking drugs
that can interact with insulin,
monitor level more
frequently.
2. Monitor patient’s
glycosylated hemoglobin level
regularly.
3. Monitor urine ketone level
when glucose level is
elevated.
4. Be alert for adverse
reaction and drug
interactions.
5. Monitor injection sites for
local reactions.
6. Assess patient and family’s
knowledge of drug therapy.

8. NCP
ASSESSMENT NURSING
DIAGNOSIS
NURSING GOAL INTERVENTION RATIONALE EVALUATION
Received patient lying on
bed with ongoing PNSS
1Lx12 @ 500cc and with
intact NGT
Awake, Afebrile BP-36.7,
Non conversant
(-) DOB (-) Desaturation
Capillary refill of 2-3
secs, GCS 10/15
Needs assistance in doing
ADLS
Slurred speech, facial
drooping @ left side
Body weakness @ right
side
Impaired Physical
Mobility
Within 8 hours of nursing
intervention the patient will be
able to:
Understand the activities
that can help him with the
least amount of assistance,
considering his disease and
condition.

Perform motion exercises.
Understand the foods that
needed to be avoided in
order not to increase the
BP
Know relaxation
techniques.
1.Administered prescribed
medication.
2.Encouraged and guided the
patient for active and passive
range of motion exercises daily.
3.Encouraged to do deep
breathing exercises and
relaxation techniques.
4.Assisted with activities of
hygiene and bathing.
5.Supported affected body parts
using pillows to maintain
position of function and reduce
risk of pressure ulcers.
6.Monitored physiologic
response to increased activity
level including respirations,
heart rate, rhythm and blood
pressure.
-for controlling chronic conditions,
treating temporary conditions, and
overall long-term health and well-
being.
-Even a passive range of motion
increases circulation. Range of
motion exercises will help the
patient increase muscle strength and
prevent contractures.
-Breathing exercises and stretching
helps to conserve energy and
recharge.
-helps the patient to feel clean and
gain a sense of normalcy.
-to reduce or relieve the pressure on
the area at risk, maintain muscle
mass and general tissue integrity and
ensure adequate blood supply to the
at-risk area.
-helps nurses identify when a patient
has an elevated heart rate or blood
pressure, which could indicate
dehydration or shock; rapid
breathing, which could indicate
respiratory distress; or low blood
pressure, which could indicate
shock.
Patient still needs
assistance in doing
ADLS and body
weakness @ right
side.
Endorsed for
further care and
management.