DRUG STUDY Drug Name Generic Name: Warfarin Sodium Brand Name: Coumadin Indication Mechanism of Action A Coumadin

derivative that interferes with hepatic synthesis of Vitamin Kdependent clotting factors, resulting in depletion of coagulation factors II, VII, IX and X. Therapeutic Effect: Classification: Pharmacotherapeutic: Coumarin derivative Clinical: anticoagulant Prevents further extension of formed existing clot; prevents new clot formation or secondary thromboembolic complications. Side Effect Occasional: GI distress, such as nausea, anorexia, abdominal cramps, diarrhea. Rare: Hypersensitivity reaction, including dermatitis and urticaria, especially in those sensitive to aspirin. Contraindication Neurosurgical procedures, open wounds, pregnancy, severe hypertension, severe hepatic or renal damage, spinal puncture, uncontrolled bleeding, ulcers. Nursing Consideration

Anticoagulant

Monitor INR reports

diligently.

Assess Hct, platelet

count, urine and stool culture for occult blood, AST, ALT, regardless of route of administration. Be alert to complaints of abdominal or back pain, severe headache. Decrease in BP, increase in pulse rate may also be sign of hemorrhage. Question for increase in amount of discharge during menses. Assess area of thromboembolus for color, temperature.

DRUG STUDY Drug Name Generic Name: Prednisone Brand Name: Prednicot Indication Substitution therapy in deficiency states: acute or chronic adrenal insufficiency, congenital adrenal hyperplasia and adrenal insufficiency secondary to pituitary insufficiency. Nonendocrine disorders: Arthritis. >Rheumatic carditis >Allergic, collagen, intestinal tract, liver, ocular, renal, skin diseases. >Bronchial asthma >Cerebral Edema >Malignancies Mechanism of Action An adrenocortical steroid that inhibits accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis, and release of mediators of inflammation. Therapeutic effect: Prevents or suppresses cell-mediated immune reactions. Decreases or prevents tissue response to inflammatory process. Side Effect Frequent: Insomnia, heartburn, nervousness, abdominal distention, increased sweating, acne, mood swings, increased appetite, facial flushing, delayed wound healing, increased susceptibility to infection, diarrhea or constipation. Occasional: Headache, edema, change in skin color, frequent urination. Rare: Tachycardia, allergic reaction, psychological changes, hallucinations, depression. Contraindication Acute superficial herpes simplex keratitis, systemic fungal infections, varicella. Nursing Consideration

Monitor BP, weight,

serum electrolytes, glucose, and height. Be alert to infection (sore throat, fever, vague symptoms). Assess oral cavity daily for signs of candida infection (white patches, painful tongue or mucous membranes)

Classification: Pharmacotherapeutic: Adrenal corticosteroid Clinical: Glucocorticoid

DRUG STUDY Drug Name Generic Name: Methylprednisolone Brand Name: Medrol Indication Mechanism of Action An adrenocortical steroid that suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability. Therapeutic effect: Decreases inflammation Side Effect Frequent: Insomnia, heartburn, anxiety, abdominal distention, diaphoresis, acne, mood swings, increased appetite, facial flushing, GI distress, delayed wound healing, increased susceptibility to infection, diarrhea or constipation. Occasional: Headache, edema, tachycardia, change in skin color, frequent urination, depression. Rare: Psychosis, increased blood coagulability, hallucinations. Contraindication Administration of live virus vaccines, systemic fungal infection. Nursing Consideration

Anti- inflammatory Immunosuppressive Status asthmaticus Spinal cord injury

Monitor I&O, daily

weights.

Assess for edema Evaluate bowel activity Check vital signs at

least 2 times a day Be alert for infection: sore throat, fever, vague symptoms. Monitor serum electrolytes Monitor for hypocalcemia & hypokalemia Assess emotional status, ability to sleep. Check lab results for blood coagulability, clinical evidence of thrombo-embolism.

Classification: Pharmacotherapeutic: Adrenal corticosteroid Clinical: glucocorticoid

DRUG STUDY Drug Name Generic Name: Cyclophosphamide Indication Mechanism of Action An alkylating agent that inhibits DNA & RNA protein synthesis by cross-linking with DNA & RNA strands, preventing cell growth, cell cycle phase. Therapeutic effect: Potent immunosuppressant Side Effect Expected: Marked leucopenia 8-15 days after initial therapy Frequent: Nausea, vomiting, alopecia (33%) Occasional: Diarrhea, darkening of skin & fingernails, stomatitis, headache, diaphoresis. Rare: Pain or redness at injection site. Contraindication Severe bone marrow suppression Nursing Consideration

Ovarian
adenocarcinoma

Monitor CBC, serum

uric acid, concentration, blood chemistries. Monitor WBC closely during initial therapy. Monitor for hematologic toxicity, symptoms of anemia. Recovery from markedly leucopenia due to bone marrow depression can be expected in 17-28 days.

Breast carcinoma
Brand Name:

Hodgkins disease
Cytoxan

Non-Hodgkins
lymphoma Classification:

Multiple myeloma
Pharmacotherapeutic: Alkylating agent Clinical: antineoplastic

Leukemia Mycosis fungoides Disseminated

neuroblastoma

DRUG STUDY Drug Name Generic Name: Metoclopramide Brand Name: Plasil Classification: Pharmacotherapeutic: Dopamine receptor antagonist Clinical: GI emptying adjunct, peristaltic stimulant, antiemetic. Indication Mechanism of Action A dopamine receptors antagonist that stimulates motility of the upper GI tract and decreases reflux into the esophagus. Also raises the threshold of activity in the chemoreceptor trigger zone. Therapeutic effect: accelerates intestinal transit and gastric emptying; relieves nausea and vomiting. Side Effect Frequent: somnolence, restlessness, fatigue lethargy. Occasional: dizziness, anxiety, headache, insomnia, breast tenderness, altered menstruation, constipation, rash, dry mouth, galactorrhea, gynecomastia. Rare: hypotension or hypertension, tachycardia. Contraindication Concurrent used of medications likely to produce extrapyramidal reactions, GI hemorrhage, GI obstruction or perforation, history of seizure disorders, pheochromocytoma. Nursing Consideration

Prevention of
chemotherapyinduced nausea and vomiting

Monitor for anxiety,

restlessness, extrapyramidal symptoms (EPS) during IV administration. Monitor pattern of daily bowel activity and stool consistency. Asses skin for rash. Evaluate for therapeutic response from gastroparesis. Monitor renal function, BP, heart rate.

Post operative nausea,

vomiting

Diabetic Gastro paresis Symptomatic Gastro

esophageal reflux

To facilitate small
bowel intubations

Dosage in renal
impairment

DRUG STUDY Drug Name Generic Name: Azathioprine Brand Name: Imuran Indication Mechanism of Action An immunologic agent that antagonize purine metabolism and inhibits DNA, protein, and RNA synthesis. Therapeutic effect: suppresses cell-mediated hypersynsesitivities; alters antibody production and immune response in transplant recipients; reduces the severity of arthritis symptoms. Side Effect Frequent: nausea, vomiting, anorexia. Occasional: rash Rare: severe nausea and vomiting with diarrhea, abdominal pain, hypersensitivity reaction. Contraindication Pregnant patients with rheumatoid arthritis Nursing Consideration

Adjunct in prevention
of renal allograft rejection

CBC, platelet count,

liver function studies should be performed weekly during first month of therapy, twice monthly during second and third months of treatment, then monthly thereafter. If rapid fall in WBC occurs, dosage should be reduced or discontinued. Asses particularly for delayed bone narrow suppression. Evaluate for therapeutic response:

Rheumatoid arthritis Dosage in renal

Classification: Immunologic agent, Immunosuppressant

impairment

DRUG STUDY Drug Name Generic Name: Hydroxychloquine Sulfate Indication Mechanism of Action An antimalarial and antirheumatic that concentrates in parasites acid vesicles, increasing the ph of the vesicles and interfering with parasite protein synthesis. Antirheumatic action may involve suppressing formation of antigens responsible for hypersensitivity reactions. Therapeutic effect: Inhibits parasite growth. Side Effect Frequent: mild, transient headache; anorexia; nausea; vomiting. Occasional: Visual disturbances, nervousness, fatigue, pruritus (palms, sole and scalp), irritability, personality changes, diarrhea. Rare: Stomatitis, dermatitis, impaired hearing. Contraindication Long term therapy for children, porphyria, psoriasis, retinal or visual field changes. Nursing Consideration

Treatment of acute
attack of malaria

Monitor & report any

visual disturbances promptly. Evaluate for GI distress. Give dose with food. Monitor liver function tests. Assess skin or buccal mucosa, inquire about pruritus. Report impaired vision/hearing immediately.

Suppression of malaria
Brand Name: Plaquenil Classification: Antimalarial, Antirheumatic.

Rheumatoid arthritis Lupus erythematosus

DRUG STUDY Drug Name Generic Name: Alendronate Sodium Brand Name: Fosamax Indication Mechanism of Action Side Effect Contraindication GI disease, including dysphagia, frequent heart burn, gastrointestinal reflux disease, hiatal hernia, & all ulcers, inability to stand or sit- up right for at least 30; renal impairment; sensitivity to alendronate. Nursing Consideration

Osteoporosis in men Glucocorticoidinduced osteoporosis

Post-menopausal
osteoporosis

Classification: Pharmacotherapeutic: Biphosphate Clinical: Bone reception inhibitor, calcium regulator.

Pagets disease

A Biphosphonate that Frequent: inhibits normal & abnormal Back pain, abdominal pain. bone resorption, without retarding mineralization. Occasional: Nausea, abdominal Therapeutic Effect: distention, constipation, Leads to significantly diarrhea, flatulence. increase bone mineral density; reverses the Rare: progression of Rash, severe bone, joint, osteoporosis. muscle pain.

Monitor electrolytes
(especially calcium and alkaline phosphatase serum levels)

DRUG STUDY Drug Name Generic Name: Furosemide Brand Name: Lasix Classification: Loop diuretic Therapeutic Effect: Produces diuresis and lowers BP. Indication Mechanism of Action A loop diuretic that enhances excretion of sodium, chloride and potassium by direct action at the ascending limb of the loop of Henle. Side Effect Expected: Increased urinary frequency and urine volume. Frequent: Nausea, dyspepsia, abdominal cramps, diarrhea, or constipation, electrolyte disturbances. Occasional: Dizziness, lightheadedness, headache, blurred vision, paresthesia, photosensitivity, rash, fatigue, bladder spasm, restlessness, and diaphoresis. Rare: Flank pain Contraindication Anuria, hepatic coma, severe electrolyte depletion. Nursing Consideration

Edema Hypertension

Monitor BP, V/S,

serum electrolytes, I&O, and weight. Note extent of diuresis. Watch for changes from initial assessment (hypokalemia may result in changes in muscle strength, tremor, muscle cramps, change in mental status, cardiac arrhythmias.) Hyponatremia may result in confusion, thirst, cold and clammy skin.

DRUG STUDY Drug Name Generic Name: Amlodipine Brand Name: Norvasc Classification: Pharmacotherapeutic: Calcium Channel Blocker Clinical: Antihypertensive, Anti-anginal Indication Mechanism of Action A calcium channel blocker that inhibits calcium movement across cardiac and vascular smoothmuscle cell membranes. Therapeutic Effect: Relieves angina by dilating coronary arteries, peripheral arteries and arterioles. Decreases total peripheral vascular resistance and BP by vasodilation. Side Effect Frequent: Peripheral edema, headache, and flushing. Occasional: Dizziness, palpitations, nausea, unusual fatigue or weakness. Rare: Chest pain, bradycardia, orthostatic hypotension. Contraindication Severe hypotension Nursing Consideration

Hypertension Chronic stable or

Vasospatic Angina

Assess BP (if systolic

Bp is less than 90 mmHg, withhold medication, contact physician.) Assess for peripheral edema behind medial malleolus (sacral area in bedridden). Assess skin for flushing. Question for headache and asthenia.