Rene John G.

Francisco BN4-A; Group 2

Drug Study (Diazepam, Lanoxin, Hemostan, Naprex) Name of the Drug Generic Name: Diazepam Brand Names: Apo-Diazepam, Diastat, Diazemuls , EPam , Meval , Novodipam , Valium, Valrelease, Vivol Classifications: Antianxiety agents, anticonvulsants, sedative/hyptonic s, skeletal muscle relaxants (centrally acting) 5 mg/mL IVTT q3-4 hours PRN Dosage/ Route/ Timing 2, 5, 10 mg/ tablet PO bid Mechanism of Action Depress the CNS, probably by potentiating GABA, an inhibitory neurotransmitter. - Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. - Has anticonvulsant properties due to enhanced presynaptic inhibition. Therapeutic effects: (1) Relief of Anxiety (2) Sedation (3) Amnesia (4) Skeletal muscle relaxant (5) Decreased seizure activity . Indication Drug of choice for status epilepticus. Contraindication

February 15, 2013

Adverse Reaction Body as a Whole: Throat and chest pain. CNS: Drowsiness, fatigue, ataxia, confusion, paradoxic rage, dizziness, vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia. CV: Hypotension, tachycardia, edema, cardiovascular collapse. Special Senses: Blurred vision, diplopia, nystagmus. GI: Xerostomia, nausea, constipation, hepatic dysfunction. Urogenital: Incontinence, urinary retention, gynecomastia (prolonged use), menstrual irregularities, ovulation failure. Respiratory: Hiccups, coughing, laryngospasm. Other: Pain, venous thrombosis, phlebitis at injection site.

Nursing Responsibility Assessment & Drug Effects -Monitor BP, PR,RR prior to periodically throughout therapy and frequently during IV therapy. - Assess IV site frequently during administration, diazepam may cause phlebitis and venous thrombosis. - Prolonged high-dose therapy may lead to psychological or physical dependence. Restrict amount of drug available to patient. Observe depressed patients closely for suicidal tendencies. - Observe and record intensity, duration and location of seizure activity. The initial dose of diazepam offers seizure control for 15-20 min after administration. - IM injections are painful and erratically absorbed. If IM route is used, inject deeply into deltoid muscle for maximum absorption. - Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. - Effectiveness of therapy can be demonstrated by decrease anxiety level; control of seizures; decreased tremulousness.

- Hypersensitivity - Cross-sensitivity with other Management of anxiety benzodiazepines disorders, for shortmay occurs term relief of anxiety - Comatose symptoms, to allay patients anxiety and tension - Pre-existing prior to surgery, CNS depression cardioversion and - Uncontrolled endoscopic procedures, severe painUse as an amnesic, and cautiously in: treatment for restless 1) Hepatic legs. Also used to dysfunction alleviate acute 2) Severe renal withdrawal symptoms impairment of alcoholism, voiding 3) History of problems in older suicide attempt or adults, and adjunctively drug dependence for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiff-man syndrome, tetanus.

Name of the Drug Generic Name: Digoxin Brand Names: Lanoxicaps, Lanoxin

Dosage/ Route/ Timing Per Orem: 0.4-0.6 mg initially, followed by 0.1-0.3mg q6h or q8h IV: 0.1250.5mg/day IVTT

Mechanism of Action Increases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance. Inhibits sodium/potassiumATPase resulting in increased calcium influx and increased release of free calcium ions within the myocardial cells, which potentiates the contractility of cardiac muscle fibers which decreases the rate of conduction thereby decreasing heart rate

Indication

Contraindication

Adverse Reaction

Nursing Responsibility

Treatment of congestive heart failure Control of rapid ventricular contractions in clients with atrial fibrillation/flutter Slow the heart rate in sinus tachycardia Treatment of SVT Treatment of cardiogenic shock Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm

Classifications: Cardiovascular agent; cardiac glycoside; antia rrhythmic

Contraindicated to patients with ventricular fibrillation, ventricular tachycardia, those with presence of digoxin toxicity Hypersensitivity to the drug components Patients with conditions such as Beriberi, heart disease, hypersensitive carotid sinus syndrome

CNS: fatigue, Assessment & Drug Effects generalized Be familiar with patients baseline data (e.g., quality of muscle weakness, peripheral pulses, blood pressure, clinical symptoms, agitation, serum electrolytes, creatinine clearance) as a foundation hallucinations, for making assessments. CV: arrhythmias, Lab tests: Baseline and periodic serum digoxin, heart block. potassium, magnesium, and calcium. Notify physician of abnormal values. Draw blood samples for EENT: yellowdetermining plasma digoxin levels at least 6 h after green halos daily dose and preferably just before next scheduled around visual daily dose. Therapeutic range of serum digoxin is 0.82 images, blurred ng/mL; toxic levels are >2 ng/mL. vision, light Take apical pulse for 1 full min noting rate, rhythm, flashes, and quality before administering. If changes are noted, photophobia, withhold digoxin, take rhythm strip if patient is on ECG diplopia. monitor, notify physician promptly. Withhold medication and notify physician if apical GI: anorexia, pulse falls below ordered parameters (e.g., >50 or nausea 60/min in adults and >60 or 70/min in children). Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children. Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate chest for rales. Monitor serum digoxin levels closely during concurrent antibioticdigoxin therapy, which can precipitate toxicity because of altered intestinal flora. Observe patients closely when being transferred from

one preparation (tablet, elixir, or parenteral) to another; when tablet is replaced by elixir potential for toxicity increases since 30% of drug is absorbed. Patient & Family Education Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation. Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances. Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d. Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day. Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician. Continue with brand originally prescribed unless otherwise directed by physician. Do not breast feed while taking this drug without consulting physician.

Name of Drug

Dosage, Route, Timing

Mechanism of Actions

Indications

Contraindications

Adverse Effect

Nursing Responsibilities

Generic Name: Tranexamic Acid Oral Shortterm management of haemorrhage

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin

Adult: 1-1.5 g or 15-25 mg/kg 24times.Child: 25 mg/kg bid or tid. Renal impairment: Classification: Adjust dose based on Antiserum fibrinolytic, creatinine antihemorrhagic concen tration : 1202 5 0 micro mol/l: 15 mg/kg bid daily;2 5 0 500 micromol/ l: 15 mg/kg

Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysinebinding sites on plasminogen molecules. Antifibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown

Tranexamic acid is used for the Allergic reaction to the drug prompt and effective control of or hypersensitivity hemorrhage in various surgical Presence of blood clots (eg, in and clinical areas: the leg, lung, eye, brain), have Treating heavy menstrual a history of blood clots, or are bleeding at risk for blood clots Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues. Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates Precautions Pregnancy. Tranexamic acid crosses the placenta. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration. Contraceptives, estrogencontaining, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation. Renal function

CNS: Confusion, Severe or persistent headache,Slurred speech, vision changes Respiratory: Chest pain, Coughing up blood, Shortness of breath Integ: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue GU: Decreased urination MS: Severe or persistent body malaise Others: Calf pain, swelling or tenderness

Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.

once daily; >500 micromol/l: 7.5m g / k g once daily

of fibrin and effect physiological hemostasis.

Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

impairment (medication may accumulate; dosage adjustment based on the degree of impairment is recommended) Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease)

Name of Drugs

Dosage/ Route/ Timing 200mg/ IVTT/ Q4

Drug Mechanism of Action Produces analgesia by blocking generation of pain impulses. This action is probably caused by inhibition of prostaglandin synthesis; it may also be caused by inhibition of the synthesis or action of other substances that sensitize pain receptors to mechanical or chemical stimulation. It relieves fever by central action in the hypothalamic heatregulating center.

Indications

Contraindication

Adverse Effect

Nursing Responsibilities Take the temperature before and 1 hour after giving the medication. Provide tepid sponge if fever occurs. Has no significant antiinflammatory effect Warn patient that high doses or unsupervised chronic use can cause hepatic damage. Excessive ingestion of alcoholic beverages may increase the risk of hepatoxicity Should not be used for selfmedication of marked fever (greater than 39.5C), fever persisting longer than 3 days, or recurrent fever unless directed by doctor. Inspect the insertion site for phlebitis (inflammation of a vein). Assess IV site for swelling, erythema, tenderness, leakage of fluid, or warmth. If phlebitis is detected, discontinue the infusion and apply warm compress to the venipuncture site. Do not use this injured vein for further infusion.

Generic Name: Paracetamol Brand Name: Naprex Classification: Analgesic

Mild pain or fever

Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases.

Skin: Rash, urticaria Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia Hepatic: jaundice, severe liver damage with toxic doses Metabolic: hypoglycemia