DRUG STUDY

GENERIC NAME: Nootropil

Brand Name: Piracetam
Drug Classification: Anti-infective
DOSAGE, ROUTE, FREQUENCY: 1.2 gm/ 60 ml IV to run in 1-hour q 8 hours
INDICATION: Cerebral insufficiency and chronic manifestation of CVA, post traumatic
syndromes, severe mental cloudiness and vascular coma of a traumatic of
toxicorigin, chronic alcoholism and addiction, pre-
delirium, chronic vertigo of peripheral or central origin, pediatric therapy e.g.
Dyslexia in children, involutional syndromes related to aging, cortical myoclonus.
MECHANISM OF ACTION: Piracetam acts selectively upon telencephalon by improving its
associative function. It increases the energy output of the brain cell and activate sits
neurophysiological potentialities, especially in deficit conditions.
Nootropilis virtually nontoxic and has no stimulating, sedative or neurovegetative activities.
SIDE EFFECTS and ADVERSE REACTIONS:
Hyperkinesia, weightr gain, asthenia, nervousness, agitation,
irritability, anxiety and sleep disturbances, fatigue or drowsiness, GIdisturbances.
CONTRAINDICATION/S: Cerebral hemorrhage, end stage renal disease.

NURSING RESPONSIBILITIES:
 Monitor heart rate, ECG and BP periodically throughout the therapy.
 Drug has strong taste. Mixing oral form with orange juice mask the taste.
 Assess patient to clear airway
 Provide support ventilation, if it is needed.
 Assess and support cardiac function.
 Reassure patient that communication abilities will return as the medication wears off.
 Monitor weight, temperature, respiratory status with chest x-ray throughout therapy.
 Monitor carefully, especially during first 6 weeks of therapy, for severe rash (with or
without fever, blistering, oral lesions, conjunctivitis, swelling, joint aches, or general
malaise)
 Withhold drug and notify physician if severe rash appears.
 Do not drive or engage in potentially hazardous activities until response to drug is
known. There is a high potential for drowsiness and fatigue.
GENERIC NAME: Norepinephrine
Brand Name: Levophed
Drug Classification: Vasopressor

DOSAGE, ROUTE, FREQUENCY:

INDICATION: produces vasoconstriction and myocardial stimulation, which may be required

after adequate fluid replacement in the treatment of severe hypotension and shock.

MECHANISM OF ACTION: Direct-acting sympathomimetic amine identical to body catecholamine

norepinephrine. Acts directly and predominantly on alpha-adrenergic receptors; little action on beta
receptors except in heart (beta1 receptors). Vasoconstriction and cardiac stimulation; also powerful
constrictor action on resistance and capacitance blood vessels.

SIDE EFFECTS and ADVERSE REACTIONS: Anxiety, dizziness, headache, insomnia, restlessness,
tremor, weakness, dyspnea, arrhythmias, bradycardia, chest pain hypertension, decreased
urine output, renal failure, hyperglycemia, metabolic acidosis, phlebitis at "V site, fever
CONTRAINDICATION/S: Vascular, mesenteric or peripheral thrombosis, hypoxia, hypercabia,
hypotension secondary to hypovolemia (without appropriate volume replacement),
hypersensitivity to bisulfites.

NURSING RESPONSIBILITIES:

 Monitor constantly while patient is receiving norepinephrine. Take baseline BP and pulse
before start of therapy, then q2min from initiation of drug until stabilization occurs at
desired level, then every 5 min during drug administration.
 Adjust flow rate to maintain BP at low normal (usually 80–100 mm Hg systolic) in
normotensive patients. In previously hypertensive patients, systolic is generally
maintained no higher than 40 mm Hg below preexisting systolic level.
 Observe carefully and record mental status (index of cerebral circulation), skin
temperature of extremities, and color (especially of earlobes, lips, nail beds) in addition to
vital signs.
 Monitor I&O. Urinary retention and kidney shutdown are possibilities, especially in
hypovolemic patients. Urinary output is a sensitive indicator of the degree of renal
perfusion. Report decrease in urinary output or change in I&O ratio.
 Be alert to patient's complaints of headache, vomiting, palpitation, arrhythmias, chest
pain, photophobia, and blurred vision as possible symptoms of over dosage. Reflex
bradycardia may occur as a result of rise in BP.
 Continue to monitor vital signs and observe patient closely after cessation of therapy for
clinical sign of circulatory inadequacy.
 Use or add barrier contraceptive if using hormonal contraceptive.
GENERIC NAME: Tramadol
Brand Name: Siverol
Drug Classification: Analgesics

DOSAGE, ROUTE, FREQUENCY:

INDICATION: Management of moderate to moderately severe pain.

MECHANISM OF ACTION: Centrally acting opiate receptor agonist that inhibits the uptake of
norepinephrine and serotonin, suggesting both opioid and non-opioid mechanisms of pain relief. May
produce opioid-like effects, but causes less respiratory depression than morphine.

SIDE EFFECTS and ADVERSE REACTIONS: Sedation, dizziness/vertigo, headache,

confusion, dreaming, anxiety, seizures, Hypotension, tachycardia, bradycardia, sweating, pruritus, rash, pallor,
urticaria, Nausea, vomiting, dry mouth, constipation, flatulence, potential for abuse, anaphylactic reactions

CONTRAINDICATION/S: Hypersensitivity to tramadol or other opioid analgesics; patients on MAO

inhibitors; patients acutely intoxicated with alcohol, hypnotics, centrally acting analgesics, opioids, or
psychotropic drugs; substance abuse; patients on obstetric preoperative medication; abrupt
discontinuation; alcohol intoxication; pregnancy (category C); lactation; children <16 years old.

NURSING RESPONSIBILITIES:

 Assess for level of pain relief and administer prn dose as needed but not to exceed the
recommended total daily dose.
 Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.
 Discontinue drug and notify physician if S&S of hypersensitivity occur.
 Assess bowel and bladder function; report urinary frequency or retention.
 Use seizure precautions for patients who have a history of seizures or who are
concurrently using drugs that lower the seizure threshold.
 Monitor ambulation and take appropriate safety precautions.
 Understand potential adverse effects and report problems with bowel and bladder
function, CNS impairment, and any other bothersome adverse effects to physician.
GENERIC NAME: Salbutamol
Brand Name: Duavent
Drug Classification: Bronchodilator, Adrenergic

DOSAGE, ROUTE, FREQUENCY: 1 neb q 6 hours

INDICATION:

 To control and prevent reversible airway obstruction caused by asthma or chronic

obstructive pulmonary disorder (COPD)
 Quick relief for bronchospasm
 For the prevention of exercise-induced bronchospasm
 Long-term control agent for patients with chronic or persistentbronchospasm
MECHANISM OF ACTION:

It relieves nasal congestion and reversible bronchospasm by relaxing the smooth muscles of the
bronchioles. It binds to the beta2-adrenergic receptors in the airway of the smooth muscle
which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 3’5’-
adenosine monophosphate (cAMP). When cAMP increases, kinases are activated,
kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased in
intracellular calcium will result to the relaxation of the smooth muscle airways
SIDE EFFECTS and ADVERSE REACTIONS: nervousness, restlessness, tremor, headache, insomnia,
chest pain, palpitations, angina, arrhythmias, hypertension, nausea and vomiting, hyperglycemia,
hypokalemia
CONTRAINDICATION/S: Hypersensitivity to adrenergic amines and fluorocarbons

NURSING RESPONSIBILITIES:

 Assess lung sounds, PR and BP before drug administration and during peak of
medication.
 Observe fore paradoxical spasm and withhold medication and notify physician if
condition occurs.
 Administer PO medications with meals to minimize gastric irritation.
 Extended-release tablet should be swallowed-whole. It should not be crushed or
chewed.
 If administering medication through inhalation, allow at least 1 minute between
inhalation of aerosol medication.
 Advise the patient to rinse mouth with water after each inhalation to minimize dry
mouth.
 Inform the patient that Albuterol may cause an unusual or bad taste.
GENERIC NAME: Furosemide
Brand Name: Lasix
Drug Classification: Diuretics

DOSAGE, ROUTE, FREQUENCY:

INDICATION: Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including
nephrotic syndrome. May be used for management of hypertension, alone or in combination with other
antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with
mannitol for treatment of severe cerebral edema, particularly in meningitis.

MECHANISM OF ACTION: Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with
pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not
clearly defined; decreases renal vascular resistance and may increase renal blood flow.

SIDE EFFECTS and ADVERSE REACTIONS: low blood pressure, dehydration and electrolyte depletion,
jaundice, tinnitus, sensitivity to light, rash, pancreatitis, nausea, abdominal pain, dizziness, diarrhea,
increased blood sugar and uric levels.

CONTRAINDICATION/S: History of hypersensitivity to furosemide or sulfonamides; increasing oliguria,

anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.

NURSING RESPONSIBILITIES:

 Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs.
Sudden death from cardiac arrest has been reported.
 Monitor for S&S of hypokalemia (see Appendix F).
 Monitor BP during periods of diuresis and through period of dosage adjustment.
 Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood
sugar, and uric acid values during first few months of therapy and periodically thereafter.
 Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive
diuresis can result in dehydration and hypovolemia, circulatory collapse, and
hypotension. Weigh patient daily under standard conditions.
 Monitor urine and blood glucose & HbA1C closely in diabetics and patients with
decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
 Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce
or prevent potassium depletion.
 Make position changes slowly because high doses of antihypertensive drugs taken
concurrently may produce episodes of dizziness or imbalance.
 Avoid replacing fluid losses with large amounts of water.
GENERIC NAME: Piperacillin/ Tazobactam
Brand Name: Zosyn
Drug Classification: Anti-infective, beta-lactam antibiotic

DOSAGE, ROUTE, FREQUENCY: 4.5 grams IV q 8 hours

INDICATION: Treatment of moderate to severe appendicitis, uncomplicated and complicated skin and
skin structure infections, endometritis, pelvic inflammatory disease, or nosocomial or community-
acquired pneumonia caused by piperacillin-resistant, piperacillin/tazobactam-susceptible, beta-
lactamase-producing bacteria.

MECHANISM OF ACTION: Antibacterial combination product consisting of the semisynthetic piperacillin

and the beta-lactamase inhibitor tazobactam. Tazobactam component does not decrease the activity of
the piperacillin component against susceptible organisms.

SIDE EFFECTS and ADVERSE REACTIONS: headache, insomnia, fever, diarrhea, constipation, nausea,
vomiting, dyspepsia, rash, pruritus, hypersensitivity reactions, pseudomembranous colitis

CONTRAINDICATION/S: Hypersensitivity to piperacillin, tazobactam, penicillins, cephalosporins, or beta-

lactamase inhibitors such as clavulanic acid and sulbactam; safety in children < 12 years old,
pregnancy, lactation

NURSING RESPONSIBILITIES:

 Obtain history of hypersensitivity to penicillin’s, cephalosporin’s, or other drugs prior to

administration.
 Lab tests: C&S prior to first dose of the drug; start drug pending results. Monitor
hematologic status with prolonged therapy
 Monitor patient carefully during the first 30 min after initiation of the infusion for signs
of hypersensitivity
 Report rash, itching, or other signs of hypersensitivity immediately.
 Report loose stools or diarrhea as these may indicate pseudomembranous colitis.
GENERIC NAME: Citicoline
Brand Name: Zynapse
Drug Classification: CNS stimulant

DOSAGE, ROUTE, FREQUENCY: 1-gram Iv q 8h

INDICATION:

 Cerebrovascular disease, accelerates the recovery of consciousness and overcoming

motor deficit.
 Head Trauma of varying severity: In a clinical trial, Citicoline accelerated the recovery
from post-traumatic coma and the recuperation of walking ability, achieved a better
final functional result and reduced hospital stay.
 Cognitive disorders of diverse etiology (e.g. Alzheimer’s disease). Citicoline improves
scores on cognitive evaluation scales and slowed the progression of Alzheimer’s
disease.
 Parkinson’s disease
MECHANISM OF ACTION: Citicoline consumption promotes brain metabolism by restoring phospholipid
content in the brain and regulation of neuronal membrane excitability. It also influences the mitochondria or
energy factories of the brain cells and found to improve memory function. After several clinical trials,
Citicoline has been shown to raise the amount of acetylcholine in the brain.
SIDE EFFECTS and ADVERSE REACTIONS: Fleeting and discrete hypotension effect, increased
parasympathetic effects, hypotension, itching or hives, swelling in face or hands, chest
tightness, tingling in mouth and throat, headache, nausea, diarrhea, blurred Vision
CONTRAINDICATION/S: Hypersensitivity to the drug and its components and patients with
hypertonic of the parasympathetic.

NURSING RESPONSIBILITIES:

 Watch out for hypotensive effects.

 Somazine must not be administered along with meidcaments containing
meclophenoxate.
 Store medicine away from heat and direct light.
 Instruct patient to take the medication as prescribed.
 Teach the patient that citicoline may be taken with or without food.
 Monitor for adverse effects; instruct patient to report immediately if he/she develops
chest tightness, tingling in mouth and throat, headache, diarrhea and blurring of vision.
GENERIC NAME: Sodium Bicarnonate
Brand Name: Sodium Bicarnonate
Drug Classification: Fluid and electrolyte agent, antcaid

DOSAGE, ROUTE, FREQUENCY:

INDICATION: Systemic alkalinizer to correct metabolic acidosis to minimize uric acid crystallization
associated with uricosuric agents, to increase the solubility of sulfonamides, and to enhance renal
excretion of barbiturate and salicylate over dosage. Commonly used as home remedy for relief of
occasional heartburn, indigestion, or sour stomach. Used topically as paste, bath, or soak to relieve
itching and minor skin irritations such as sunburn, insect bites, prickly heat, poison ivy, sumac, or oak.
Sterile solutions are used to buffer acidic parenteral solutions to prevent acidosis.

MECHANISM OF ACTION: Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to form
sodium chloride, carbon dioxide, and water. After absorption of sodium bicarbonate, plasma alkali
reserve is increased and excess sodium and bicarbonate ions are excreted in urine, thus rendering urine
less acid. Not suitable for treatment of peptic ulcer because it is short-acting, high in sodium, and may
cause gastric distention, systemic alkalosis, and possibly acid-rebound.

SIDE EFFECTS and ADVERSE REACTIONS:

CONTRAINDICATION/S: Hypoventilation, hypocalcemia, increase serum osmolality, further in all

situations where sodium intake must be restricted like cardiac insufficiency, edema
hypertension, eclampsia, severe kidney insufficiency.

NURSING RESPONSIBILITIES:

 Obtain patient history including drug history and any hypersensitivity.

 Assess respiratory and pulse rate, rhythm, depth, lung sounds and notify the physician.
 Assess for carbon dioxide in G.I tract, may lead to perforation if ulcer is severe.
 Test and monitor urine pH, urinary output, during beginning treatment.
 If patient has edematous tendency, notify physician.
 If patient is vomiting withhold medication and immediately inform the physician.
 If the patient exhibits shortness of breath and hyperpnea, immediately inform the
physician.
 Inform physician if relief is not obtained or if the patient demonstrate any symptoms
suggest bleeding, such as black tarry stools or coffee ground emesis.
 Caution patient to immediately report to physician if symptoms such as nausea,
vomiting and anorexia occurs