Manglapus, Giana L.

BSN IV-A4

Drug study
BUMETANIDE
Bumex
Classifications: FLUID AND WATER BALANCE AGENT; LOOP DIURETIC

Actions
Sulfonamide derivative structurally related to furosemide and with similar pharmacologic effects.
Diuretic activity is 40 times greater, however, and duration of action is shorter than that of furosemide.
Causes both potassium and magnesium wastage.

Therapeutic Effects
Inhibits sodium and chloride reabsorption by direct action on proximal ascending limb of the loop of
Henle. Also appears to inhibit phosphate and bicarbonate reabsorption. Produces only mild hypotensive
effects at usual diuretic doses.

Uses
Edema associated with CHF; hepatic or renal disease, including nephrotic syndrome. Has been used in
management of postoperative and premenstrual edema, edema accompanying disseminated
carcinoma, and mild hypertension. May be used concomitantly with a potassium-sparing diuretic.

Contraindications
Hypersensitivity to bumetanide or to other sulfonamides; anuria, markedly elevated BUN; hepatic coma;
severe electrolyte deficiency; lactation. Safety during pregnancy (category C) is not established.

Adverse Effects
Body as a Whole: Sweating, hyperventilation, glycosuria. CNS: Dizziness, headache, weakness, fatigue.
CV: Hypotension, ECG changes, chest pain, hypovolemia. GI: Nausea, vomiting, abdominal or stomach
pain, GI distress, diarrhea, dry mouth. Metabolic: Hypokalemia, hyponatremia, hyperuricemia,
hyperglycemia; hypomagnesemia; decreased calcium, chloride. Musculoskeletal: Muscle cramps, muscle
pain, stiffness or tenderness; arthritic pain. Special Senses: Ear discomfort, ringing or buzzing in ears,
impaired hearing.

Nursing Implications
Assessment & Drug Effects
1. Monitor I&O and report onset of oliguria or other changes in I&O ratio and pattern promptly.
2. Monitor weight, BP, and pulse rate. Assess for hypovolemia by taking BP and pulse rate while
patient is lying, sitting, and standing. Older adults are particularly at risk for hypovolemia with
resulting thrombi and emboli.
3. Lab tests: Serum electrolytes, blood studies, liver and kidney function tests, uric acid (particularly
patients with history of gout), and blood glucose. Determine values initially and at regular intervals;
measurements are especially important in patients receiving prolonged treatment, high doses, or
who are on sodium restriction.
Manglapus, Giana L. BSN IV-A4

4. Monitor for S&S of hypomagnesemia and hypokalemia (see Appendix F) especially in those receiving
digitalis or who have CHF, hepatic cirrhosis, ascites, diarrhea, or potassium-depleting nephropathy.
5. Monitor patients with hepatic disease carefully for fluid and electrolyte imbalances which can
precipitate encephalopathy (inappropriate behavior, altered mood, impaired judgment, confusion,
drowsiness, coma).
6. Question patient about hearing difficulty or ear discomfort. Patients at risk of ototoxic effects
include those receiving the drug IV, especially at high doses, those with severely impaired renal
function, and those receiving other potentially ototoxic or nephrotoxic drugs (see Appendix F).
7. Monitor diabetics for loss of glycemic control.

Patient & Family Education

1. Report symptoms of electrolyte imbalance to physician promptly (e.g., weakness, dizziness, fatigue,
faintness, confusion, muscle cramps, headache, paresthesias).
2. Eat potassium-rich foods such as fruit juices, potatoes, cereals, skim milk, and bananas while taking
bumetanide.
3. Report S&S of ototoxicity promptly to physician (see Appendix F).
4. Monitor blood glucose for loss of glycemic control if diabetic.
5. Do not breast feed while taking this drug.

DOMPERIDONE
Therapeutic Classification: gastric stimulant

Action
Domperidone acts as a gastrointestinal emptying (delayed) adjunct and peristaltic stimulant. The
gastroprokinetic properties of domperidone are related to its peripheral dopamine receptor blocking
properties. Domperidone facilitates gastric emptying and decreases small bowel transit time by
increasing esophageal and gastric peristalsis and by lowering esophageal sphincter pressure. Antiemetic:
The antiemetic properties of domperidone are related to its dopamine receptor blocking activity at both
the chemoreceptor trigger zone and at the gastric level. It has strong affinities for the D2 and D3
dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood
brain barrier, which - among others - regulates nausea and vomiting

Indication
symptomatic management of gastrointestinal (GI) motility disorders and to treat gastroesophageal
reflux disease

Side Effects
insomnia, irritability, lethargy, dry mouth, gynecomastia, extrapyramidal symptoms (such as agitation,
tremor and increased or decreased muscle movement) are rare
QTc prolongation at higher doses, especially in patients with other risk factors such as other medications
known to prolong QTc (for example chloral hydrate, ciprofloxacin, clarithromycin, dopamine,
epinephrine, erythromycin, norepinephrine, salbutamol), hypokalemia or hyperkalemia, congenital long
QT syndrome
Manglapus, Giana L. BSN IV-A4

Contraindications
conditions in which stimulation of the GI tract may be dangerous (eg. gastrointestinal hemorrhage, NEC,
mechanical obstruction or perforation, Hirschsprung's disease)

Nursing Implications
monitor gastric residuals
monitor for side effects as above

GENERIC NAME: CALCIUM SUPPLEMENT/VITAMIN D - ORAL

BRAND NAME(S): Citracal + D, Os-Cal, Oyster Shell + D

Action
Vitamin D analog and major transport form of cholecalciferol (D3) Vitamin D analog is fat soluble.
Because it is activated in the body and has regulatory effects, it is considered a hormone. Primary action
leads to regulation of serum calcium, which is affected also by the activity of other vitamin D analogs
(e.g., ergocalciferol), parathyroid hormone, and calcitonin. Pharmacologic effects of calcifediol are
related to its intrinsic vitamin D activity as well as to the properties of active metabolites (e.g., calcitriol),
which result from renal metabolism.

USES: This combination medication is used to prevent or treat low blood calcium levels in people who
do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium
levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the
parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be
used in certain patients to make sure they are getting enough calcium (e.g., women who are pregnant,
nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or
prednisone).Calcium plays a very important role in the body. It is necessary for normal functioning of
nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take
calcium from bones, thereby weakening bones. Vitamin D helps your body absorb calcium and
phosphorus. Having the right amounts of vitamin D, calcium, and phosphorus is important for building
and keeping strong bones.

Contraindication
Hypersensitivity to vitamin D, vitamin D toxicity, hypercalcemia. Safe use of doses in excess of RDA
during pregnancy (category C), lactation, and children not established.

SIDE EFFECTS: Constipation or stomach upset may occur

serious side effects occur: nausea/vomiting, loss of appetite, unusual weight loss, mental/mood
changes, change in the amount of urine, bone/muscle pain, headache, increased thirst, increased
urination, weakness, tiredness, fast/pounding heartbeat.
serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe
dizziness, trouble breathing.

Nursing Implication
Manglapus, Giana L. BSN IV-A4

Take this medicine (calcium and vitamin D capsules and tablets) with food.

Assessment & Drug Effects

Lab tests: Determine baseline and periodic values for serum calcium, phosphorus, magnesium, and
alkaline phosphatase. Monitor serum calcium whenever dosage adjustments are made. Measure urinary
calcium and phosphorus levels q24h.
Effectiveness of therapy depends on an adequate daily intake of calcium. Since dietary calcium and
phosphate are difficult to control, the physician may prescribe a calcium supplement as needed.
Monitor for manifestations of hypercalcemia (see Appendix F). If hypercalcemia occurs, discontinue
calcifediol until serum calcium returns to normal (9–10.6 mg/dL).
Report a fall in serum alkaline phosphatase as this usually signals the onset of hypercalcemia.

amlodipine
Classification
Therapeutic: antihypertensives
Pharmacologic: calcium channel blockers

Indications
Alone or with other agents in the management of hypertension, angina pectoris, and vasospastic
(Prinzmetal's) angina.

Contraindications
Hypersensitivity to amlodipine; pregnancy (category C).

Action
Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition
of excitation-contraction coupling and subsequent contraction. Therapeutic Effects: Systemic
vasodilation resulting in decreased blood pressure. Coronary vasodilation resulting in decreased
frequency and severity of attacks of angina.

Adverse Reactions/Side Effects

CNS: headache, dizziness, fatigue. CV: peripheral edema, angina, bradycardia, hypotension, palpitations.
GI: gingival hyperplasia, nausea. Derm: flushing.

Nursing Implications
Assessment & Drug Effects
Monitor BP for therapeutic effectiveness. BP reduction is greatest after peak levels of amlodipine are
achieved 6–9 h following oral doses.
Monitor for S&S of dose-related peripheral or facial edema that may not be accompanied by weight
gain; rarely, severe edema may cause discontinuation of drug.
Monitor BP with postural changes. Report postural hypotension. Monitor more frequently when
additional antihypertensives or diuretics are added.
Monitor heart rate; dose-related palpitations (more common in women) may occur.
Manglapus, Giana L. BSN IV-A4

Patient & Family Education

Report significant swelling of face or extremities.
Take care to have support when standing & walking due to possible dose-related light-
headedness/dizziness.
Report shortness of breath, palpitations, irregular heartbeat, nausea, or constipation to physician.
Do not breast feed while taking this drug without consulting physician.

Carnisure
Supplement

Action
Levocarnitine (Carnitor) is a naturally occurring substance that the cells of mammals need to produce
energy. It is used to treat carnitine deficiency. Carnitine is a small protein that binds to and helps
transport fatty acids into the mitochondria, the site of energy production within cells. In the
mitochondria, carnitine binds to and removes toxins from the cells.

Indication
This medication is a diet supplement used to prevent and treat low blood levels of carnitine. Carnitine is
a substance made in the body from meat and dairy products. It helps the body use certain chemicals
(long-chain fatty acids) for energy and to keep you in good health. Low blood levels of carnitine may
occur in people whose bodies cannot properly use carnitine from their diets, people on dialysis due to
serious kidney disease, and people being treated with certain drugs (e.g., valproic acid, zidovudine).
Carnitine levels that are too low can cause liver, heart, and muscle problems.

Contraindications
This medicine is not recommended for use in patients with a known allergy to levocarnitine or any other
components present along with it.

Side effects
Hypersensitivity
Increased blood pressure
Increased heartbeat
Fever
Seizure

Nursing Intervention
Monitor carnitine level
Ensure that the course of treatment is completed.
Manglapus, Giana L. BSN IV-A4

Here are 13 nursing care plans for patients with Alzheimer’s Disease and Dementia:

Disturbed Thought Process

Chronic Confusion
Impaired Verbal Communication
Self-Care Deficit: Bathing/Hygiene
Self-Care Deficit: Dressing and Grooming
Self-Care Deficit: Toileting
Impaired Physical Mobility
Disturbed Sleep Pattern
Disturbed Sensory Perception
Social Isolation
Compromised Family Coping
Wandering
Risk for Injury

(NCP) for fluid and electrolyte imbalances, more specifically:

Risk For Electrolyte Imbalance (Hyperkalemia)

Risk For Electrolyte Imbalance (Hyponatremia)
Risk For Electrolyte Imbalance (Hypocalcemia)

Here are six (6) hypertension nursing care plans:

Risk for Decreased Cardiac Output
Activity Intolerance
Acute Pain
Ineffective Coping
Imbalanced Nutrition: More Than Body Requirements
Deficient Knowledge