Drug Name

Actions
Thought to inhibit prostaglandin synthesis, impeding cyclooxygenase2(COX-2), to produce anti-inflammatory, analgesic, and antipyretic effects

Indication
To relieve signs and symptoms of osteoarthritis To relieve signs and symptoms of rheumatoid arthritis To relieve signs and symptoms if ankylosing and spondylitis Adjunctive treatment for familial adenomatous poplyposis to reduce the number of adenomatous colorectal polyps

Side Effects
CNS: headache, dizziness, insomnia CV: hypertension, peripheral edema EENT: pharyngitis, rhinitis, sinusitis GI: abdominal pain, diarrhea, dyspepsia, flatulence, nausea Metabolic: hyperchloremia Muscuskeletal: back pain Respiratory: Upper respiratory tract infection Skin: erythema multiforme,exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, rash Other: accidental injury

Contraindications
Contraindicated in patients hypersensitive to drug, sulfonamides, aspirin, or other NSAIDs Contraindicated in those with severe hepatic impairment in the treatment of perioperative pain after coronary artery bypass graft surgery Avoid using in the third trimester of pregnancy Use cautiously in patients with history of ulcers or GI bleeding, advanced renal disease, dehydration, anemia, symptomatic liver disease, hypertension, edema, heart failure or asthma and in poor CYP2C9 metabolizers Use cautiously in elderly or debilitated patients.

Nursing Considerations
Alert: Patients allergic to or with a history of anaphylactic reactions to sulfonamides, aspirin, or other NSAIDs may be allergic to this drug. Patient with history of ulcers or GI bleeding is at higher risk for GI bleeding while taking NSAIDs such as celecoxib. Other risk for Gi bleeding include treatment with corticosteroids or anticoagulants, longer duration of NSAID treatment, smoking, alcoholism, older age, and poor overall health. Alert:NSAIDs may increase the risk of serious thrombotic eventd, MI, or stroke. The risk may be greater with longer use or in patients with CV disease or risk factors of CV disease. Although drug may be used with low aspirin dosages, the combination may increase risk of GI bleeding.

Celecoxib

Watch for signs and symptoms of overt and occult bleeding. Drug can cause fluid retention; monitor patient with hypertension, edema or heart failure. Assess patient for CV risk factors before therapy. Drug may be hepatotoxic; watch for signs and symptoms of liver toxicity,. Before starting drug therapy,rehydrate dehydrated patient. Drug can be given without regard to meals, but food may decrease GI upset. Look alike-sound alike: Dont confuse Celebrex with Cerebyx or Celexa.

Methyldopa

May inhibit the central vasomotor centers decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature.

Hypertension (or high blood pressure) Gestational hypertension (or pregnancy-induced hypertension) and pre-eclampsia

Heart: Aggravation of chest pain, heart failure, sinus hypersensitivity, low blood pressure, swelling or weight gain and slow heart rate. Gastrointestinal- Inflammation of intestine/pancreas/ mouth, vomiting, diarrhea, sore or "black" tongue, nausea, constipation, distension, flatulence and dryness of mouth.

Contraindicated in patients hypersensitive to drug and in those with active hepatic disease (such as acute hepatitis) or active cirrhosis. Contraindicated in those whose previous methyldopa therapy caused liver problems and in those taking MAO inhibitors.

Monitor patients blood pressure regularly. Elderly patients are more likely to experience hypotension and sedation. Occasionally, tolerance may occur, usually between the second and third months of therapy.

Blood: Bone marrowdepression. Liver: Liver inflammation, jaundice and abnormal liver function. Hypersensitivity: Inflammation of heart muscle, blood vessels, lupus-like syndrome, drugrelated fever andeosinophilia. CNS: Parkinsons disease, Bell's palsy, decreased mental acuity, involuntary movements, mild psychoses or depression, headache, sleepiness, weakness,dizziness, lightheadedness and tingling. Metabolic: Rise in Blood Urea Nitrogen. Musculoskeletal: Joint pain/swelling and muscle pain. Respiratory: Nose stuffiness. Skin: Skin damage and rash. Genitourinary: Absence of menstrual periods, breast enlargement in male, spontaneous secretion of milk, impotence and decreased libido.

Use cautiously in patients with history pf impaored hepatetic function of sulfite sensitivity and in breast-feeding women.

Dicycloverine (Dicyclomine)

Inhibits action of acetylcholine on post-ganglionic, parasympathetic muscarinic receptors, decreasing GI motility. Also, possesses local

Irritable bowel syndrome,other functional DI disorders

CNS: headache, dizziness, fever, insomnia, light-headedness, drowsiness, nervousness, confusion and excitement in elderly patients CV: palpitations, tachycardia EENT: blurred vision, increased intraocular pressure,mydriasis,

Contraindicated in patients hypersensitive to anticholineggenics and in those with obstructive uropathy, obstructive disease of the GI tract, reflux esophagitis, severe ulcerative colitis, toxic megacolon, myasthenia

Adding a diuretic or adjusting dosage may be needed. If patients response changes significantly, notify prescriber. Monitor CBC with differential counts before therapy and and periodically thereafter. Patients who need blood transfusions should have direct and indirect Coombs test. Monitor patients Coombs test result. In patients who have received drug for several months, positive reaction to Direct Coombs Test indicates hemolytic enema. Report involuntary choreoathetoid movements. Drug may be stopped. Look alike-sound alike: Dont confuse Aldomet with Anzemet. Give drug 30-60 mins. Before meals and at bedtime. Bedtime dose can be larger; give at least 2 hours after last meal of day. Alert: Dont give

anesthetic properties that may be partly responsible for spasmolysis.

photophobia GI: urinary hesitancy and retention, impotence Skin: Urticaria, decreased sweating or inability to sweat, local irritation. Other: allergic reactions, heat prostration

gravis, unstable CV status in acute hemorrhage, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, or glaucoma. Contraindicated in breastfeeding patients in children younger than age 6 months. Use cautiously in patients with autonomic neuropathy, hyperthyroidism, coronary artery disease, arrhythmias, heart failure, hypertension, hiatal hernia, hepatic or renal disease, prostatic hyperplasia, known or suspected GI infection, and ulcerative colitis.

subcutaneously or I.V. Adjust dosage base on patients needs and response. Dicycloverine is a synthetic tertiary derivative that may be atropinelike adverse reactions. Alert: Overdose may cause curarelike effects such as respiratory paralysis. Monitor patients vital signs and urine output carefully. Look like-sound like: Dont confuse Dicyclomine with dyclonine or doxycycling; dont confuse Bentyl with Adventil or Benadryl. Raise side rails as a precaution because some patients becomr temporarily excited to disoriented and some develop amnesia or become drowsy. Reorient patient, as needed. Tolerance may develop when therapy is prolonged. Alert: Overdose may cause resp. paralysis.

Hyoscine (Scopolamine)

Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by postganglionic cholinergic neurons. May affect neural pathways originating in the inner ear to inhibit nausea nad vomiting

Spastic States Delirium, preanesthetic sedation, and obstetric amnesia with analgesics To prevent nausea and vomiting from motion sickness

CNS: disorientation, restlessness, irritability, dizziness, dizziness, drowsiness, headache, confusion, hallucinations, delirium, impaired memory CV: paradoxical bradycardia, palpitations, tachycardia, flushing EENT: dilated pupils, blurred vision, photophobia, increased intraocular pressure,difficulty swalling

Contraindicated in patients with angle closure glaucoma, obstructive uropathy, obstructive disease of the GI tract, asthma, chronic pulmonary disease, myasthenia, gravis, paralytic ileus, intestinal atony, unstable CV status. Contraindicated in patients hypersensitive in belladonna or barbiturates

FeSO4

Elevates the serum iron concentration which then helps to form High or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron.

Prevention and treatment of iron deficiency anemias. Dietary supplement for iron.

Dizziness, nausea and vomiting, nasal congestion, dyspnea, hypotension, CHF, MI, muscle cramps, flushing

Hypersensitivity, Severe hypotension.

Advise patient to take medicine as prescribed. Caution patient to make position changes slowly to minimize orhtostatic hypotension. Instruct patient to avoid concurrent use of alcohol or OTC medicine without consulting the physician. Advise patient to consult physician if irregular heartbeat, dyspnea, swelling of hands and feet and hypotension occurs. Inform patient that angina attacks may occur 30 min. after administration due reflex tachycardia. Encourage patient to comply with additional intervention for hypertension like proper diet, regular exercise, lifestyle changes and stress management.

DRUG STUDY
April Ciebbie D. Casanova 2-NRS-1 Group 1