DkUG S1UD

name of SLudenL C8uZ Au8lAn C uaLe of AsslgnmenL AugusL 19 2011

name of aLlenL AMn Ward LuP sL 4 8ed no ______________
ulagnosls or Cllnlcal lmpresslon Age 73 years old Sex Male

DkUG CkDLk
(Gener|c name
Dosage koute
Irequency
etc)
1kADL]
8kAND
NAML
nAkMACCLCGIC AC1ICN CI DkUG INDICA1ICNS AND
CCN1kAINDICA1ICNS
ADVLkSL LIILC1S
CI 1nL DkUG
DLSIkLD AC1ICN CN 1nL
CLILN1
NUkSING kLSCNSI8ILI1ILS]
kLCAU1ICNS

1Clopldogrel
73mg/Lab


















2LosarLan 30
mg/Lab Cu
before 8









lavlx



















Cozaar











Clopldogrel ls an lnhlblLor of plaLeleL
acLlvaLlon and aggregaLlon Lhrough Lhe
lrreverslble blndlng of lLs acLlve
meLabollLe Lo Lhe 2?
12
class of Au
recepLors on plaLeleLs

LosarLan blocks Lhe angloLensln
recepLor 8y blocklng Lhe acLlon of
angloLensln losarLan dllaLes blood
vessels and Lhereby reduces blood
pressure







I lor paLlenLs wlLh nonS1segmenL
elevaLlon ACS unsLable anglna
(uA)/nonS1elevaLlon myocardlal
lnfarcLlon (nS1LMl) lncludlng paLlenLs
who are Lo be managed medlcally and
Lhose who are Lo be managed wlLh
coronary revascularlzaLlon lavlx has
been shown Lo decrease Lhe raLe of a
comblned endpolnL of cardlovascular
deaLh myocardlal lnfarcLlon (Ml) or
sLroke as well as Lhe raLe of a comblned
endpolnL of cardlovascular deaLh Ml
sLroke or refracLory lschemla
CI lavlx ls conLralndlcaLed ln paLlenLs
wlLh acLlve paLhologlcal bleedlng such
as pepLlc ulcer or lnLracranlal
hemorrhage hypersenslLlvlLy (eg
anaphylaxls) Lo clopldogrel or any
componenL of Lhe producL

Iused Lo LreaL paLlenLs wlLh hlgh blood
pressure (hyperLenslon) and Lo help
proLecL Lhe kldneys from damage due
Lo dlabeLes lL ls also used Lo lower Lhe
rlsk of sLrokes ln paLlenLs wlLh hlgh
blood pressure and an enlarged hearL
Lowerlng hlgh blood pressure helps
prevenL sLrokes hearL aLLacks and
kldney problems
CIConLralndlcaLed wlLh hypersenslLlvlLy
Lo losarLan pregnancy (use durlng Lhe

O SLomach
upseL/paln
O dlarrhea
O consLlpaLlon
O headache
O dlzzlness
O rash
O flullke
sympLoms or
O back/[olnL
paln may
occur




O dlarrhea
O muscle
cramps
O dlzzlness
O lnsomnla
O nasal
congesLlon
O may also
cause a
perslsLenL
cough

Clopldogrel keeps Lhe
plaLeleLs ln your blood from
coagulaLlng (cloLLlng) Lo
prevenL unwanLed blood
cloLs LhaL can occur wlLh
cerLaln hearL or blood vessel
condlLlons
Clopldogrel ls used Lo
prevenL blood cloLs afLer a
recenL hearL aLLack or
sLroke and ln people wlLh
cerLaln dlsorders of Lhe
hearL or blood vessels







LosarLan belongs Lo a class of
drugs called angloLensln
recepLor blockers lL works
by relaxlng blood vessels so
LhaL blood can flow more
easlly






Orovlde small frequenL meals lf Cl upseL
occurs (noL as common as wlLh asplrln)
Orovlde comforL measures and arrange for
analgeslcs lf headache occurs
O1ake dally as prescrlbed May be Laken
wlLh meals
O?ou may experlence Lhese slde effecLs
ulzzlness llghLheadedness (Lhls may pass
as you ad[usL Lo Lhe drug) headache (lle
down ln a cool envlronmenL and resL C1C
preparaLlons may help) nausea gasLrlc
dlsLress (eaL frequenL small meals)
prolonged bleedlng (alerL docLors denLlsLs
of Lhls drug use)
O8eporL skln rash chesL paln falnLlng
severe headache abnormal bleedlng




AssessmenL
OPlsLory PypersenslLlvlLy Lo losarLan
pregnancy lacLaLlon hepaLlc or renal
dysfuncLlon hypovolemla
Ohyslcal Skln leslons Lurgor 1 reflexes
affecL 8 8 resplraLory ausculLaLlon llver
and kldney funcLlon LesLs
lnLervenLlons
OAdmlnlsLer wlLhouL regard Lo meals
OWA8nlnC AlerL surgeon and mark
paLlenLs charL wlLh noLlce LhaL losarLan ls





















3MeLformln
300mg/ Lab
8lu







































lormeL









































MeLformln decreases hepaLlc glucose
producLlon decreases lnLesLlnal
absorpLlon of glucose and lmproves
lnsulln senslLlvlLy by lncreaslng
perlpheral glucose upLake and
uLlllzaLlon unllke sulfonylureas
meLformln does noL produce
hypoglycemla ln elLher paLlenLs wlLh
Lype 2 dlabeLes or normal sub[ecLs and
does noL cause hyperlnsullnemla WlLh
meLformln Lherapy lnsulln secreLlon
remalns unchanged whlle fasLlng
lnsulln levels and daylong plasma
lnsulln response may acLually
decrease






second or Lhlrd LrlmesLer can cause
ln[ury or even deaLh Lo Lhe feLus)
lacLaLlon
use cauLlously wlLh hepaLlc or renal
dysfuncLlon hypovolemla
















I ManagemenL of Lype 2 dlabeLes
melllLus as monoLheraphy or
concomlLanLly wlLh an oral sulfonylurea
or lnsulln
CI conLralndlcaLed Lo paLlenLs wlLh
known hypersenslLlvlLy Lo meLformln
renal dlsease or renal dysfuncLlon (eg
as suggesLed by serum creaLlnlne levels
13 mg/dL males 14 mg/dL
females or abnormal creaLlnlne
clearance) whlch may also resulL from
condlLlons such as cardlovascular
collapse (shock) acuLe myocardlal
lnfarcLlon and sepLlcemla AcuLe or
chronlc meLabollc acldosls lncludlng
dlabeLlc keLoacldosls wlLh or wlLhouL
coma ulabeLlc keLoacldosls should be
LreaLed wlLh lnsulln
MeLformln should be Lemporarlly
dlsconLlnued ln paLlenLs undergolng
O lncrease
serum
poLasslum
O angloedema
O LosarLan may
reduce kldney
funcLlon ln
some paLlenLs
and should
noL be used
by paLlenLs
who have
bllaLeral renal
arLery
sLenosls (narr
owlng of boLh
arLerles golng
Lo Lhe
kldneys)


O CharacLerlzed
by lncrease ln
blood lacLaLe
levels (more
Lhan 3
mmol/L)
O decrease ln
blood pP
O elecLrolyLe
dlsLurbances
O unexplalned
hypervenLllaLl
on
O myalgla
O malalse
O May advance
Lo
cardlovascula
r collapse
(shock)
O acuLe CPl





















uecreases llver producLlon
of glucose decreases
absorpLlon of glucose
lmproves lnsulln senslLlvlLy
rovldes lmprovemenL ln
glycemlc conLrol
sLablllzes/decreases body
welghL lmproves llpld
proflle












belng Laken 1he blockage of Lhe renln
angloLensln sysLem followlng surgery can
produce problems PypoLenslon may be
reversed wlLh volume expanslon
OMonlLor paLlenL closely ln any slLuaLlon
LhaL may lead Lo a decrease ln 8
secondary Lo reducLlon ln fluld volume
excesslve persplraLlon dehydraLlon
vomlLlng dlarrheaexcesslve hypoLenslon
can occur
1eachlng polnLs
O1ake drug wlLhouL regard Lo meals
Ouo noL sLop Laklng Lhls drug wlLhouL
consulLlng healLh care provlder

Olnform Lhe paLlenL of poLenLlal rlsks/
advanLages of Lherapy and of alLernaLlve
modes of Lherapy
OAssess Pemoglobln hemaLocrlL red blood
cells and serum creaLlnlne prlor Lo
lnlLlaLlon of Lherapy
OMonlLor fasLlng blood glucose hemoglobln
a and renal funcLlon
OMonlLor renal funcLlon LesL for evldence of
early lacLlc acldosls
Olf paLlenL ls on oral sulfonylureas (class of
drug ln LreaLlng uM 2) assess for
hypoglycemla
O8e alerL Lo condlLlons LhaL alLer glucose
requlremenLs fever lncreased acLlvlLy or
sLress surglcal procedure
OulsconLlnue meLformln and conLacL Lhe
physlclan lmmedlaLely lf evldence of lacLlc
acldosls appears (unexplalned
hypervenLllaLlon muscle aches exLreme
Llredness unusual sleeplness)









4Celecoxlb
200mg 1 cap
8lu prn for
paln















3lvlC
2300mg/30
ml vlal




















Celebrex


















Camlmun
e





















Celecoxlb lnhlblLs cyclooxygenase2
an enzyme responslble for produclng
prosLagladln whlch causes paln and
lnflammaLlon lL produces anLl
lnflammaLory effecL














neuLrallzaLlon of auLoanLlbodles and
lnhlblLlon of complemenL acLlvaLlon
are Lwo ma[or mechanlsms whereby
lvlg alds recovery ln C8S
blocklng neuromuscular Lransmlsslon
requlres physlcal dlsrupLlon of Lhe
Lermlnal poLlon of Lhe nerve flber
where lL connecLs wlLh Lhe muscle and
depends on boLh anLlganglloslde
anLlbodles and complemenL




radlologlc sLudles lnvolvlng lnLravascular
admlnlsLraLlon of lodlnaLed conLrasL
maLerlals because use of such producLs
may resulL ln acuLe alLeraLlon of renal
funcLlon



ICelecoxlb ls used for Lhe rellef of slgns
and sympLoms of ArLhrlLls
(CsLeoarLhrlLls and 8heumaLhold
ArLhrlLls) ln adulLs lL ls also used for Lhe
LreaLmenL of acuLe paln and mensLrual
paln Celecoxlb ls also used Lo reduce
Lhe number of adenomaLous colorecLal
polyps ln famlllal adenomaLous
polyposls










I lClv ls used ln Lhe LreaLmenL of
Culllaln8arre syndrome (C8S) lClv ls
Lhe LreaLmenL of cholce for adulL
paLlenLs wlLh C8S provlded LhaL Lhey
are so severely affecLed LhaL Lhey aL
leasL requlre ald Lo walk LhaL Lhe
dlsorder ls dlagnosed durlng Lhe flrsL 2
weeks of Lhe lllness and LhaL Lhere are
no conLralndlcaLlons Lo lClv
CIlvlC ls conLralndlcaLed ln lndlvlduals
who have had anaphylacLlc or severe
sysLemlc reacLlon Lo lmmune globulln or
any lngredlenLs ln Lhe formulaLlons
MosL lvlC preparaLlons are
O acuLe Ml
O prerenal
azoLemla






O ularrhea
O uyspepsla
O Peadache
O upper
resplraLory
LracL
lnfecLlons
O Abdomlnal
paln
O llaLulence
O nausea
O 8ack paln
O erlpheral
edema
O ulzzlness
O 8ash



O vomlLlng
Peadache
O Mlgralne
O Chllls
O 8lgors
O Myalgla
O Plves
O 1achycardla
O nausea
O renal
dysfuncLlon
O asepLlc
menlnglLls









Celecoxlb ls a nonsLeroldal
anLl lnflammaLory drug
commonly used agalnsL
lnflammaLory dlseases llke
arLhrlLls and mlnor aches and
paln













lnLravenous lmmunoglobulln
(lvlC) ls a plasma producL
used ln Lhe LreaLmenL of
cerLaln condlLlons relaLed Lo
Lhe lmmune sysLem lvlC
LreaLmenL ls approved for
use ln people wlLh lmmune
deflclencles auLolmmune
dlseases some
lnflammaLlons and
lnfecLlons and lL ls also used
ln several offlabel ways
such as Lhe prevenLlon of
mlscarrlages
Orescrlbed dleL ls prlnclpal parL of
LreaLmenL do noL sklp or delay meals
ulabeLes MelllLus requlres llfelong conLrol
OAvold alcohol
Olnform physlclan lf headache nausea
vomlLlng dlarrhea skln rash unusual
brulslng or bleedlng and change ln color of
urlne or sLool occurs

OMay glve wlLhouL regard Lo food
Ouo noL crush or break capsules
OAssess onseL Lype locaLlon and duraLlon
of paln or lnflammaLlon
OlnspecL Lhe appearance of affecLed [olnLs
for lmmoblllLy deformlLy and skln
condlLlon
OLvaluaLe for LherapeuLlc response rellef of
paln decreased sLlffness swelllng
lncreased [olnL moblllLy decreased
Lenderness and lmproved grlp sLrengLh
A1lLn1 1LACPlnC
Olf gasLrolnesLlnal upseL occurs Lake wlLh
food
OAvold asplrln and alcohol because lL
lncreases Lhe rlsk of gasLrolnLesLlnal
bleedlng


OlvlC cannoL be mlxed wlLh oLher drugs or
lv lnfuslon flulds Lherefore lL musL be
glven Lhrough a separaLe lnfuslon llne
(McLvoy 1996 1rlssel 1996)
O1he boLLle or vlal musL be elLher roLaLed or
swlrled ln order Lo dlssolve Lhe parLlcles
Shaklng whlch resulLs ln foamlng should
be avolded because lL may lmpede Lhe
dlssoluLlon process (1rlssel 1996)
OSlnce many adverse effecLs of lvlC are
relaLed Lo Lhe raLe of lv lnfuslon Lhls
general guldellne should be followed for
lnlLlal lnfuslons
400 mg/kg dose 34 hour lnfuslon Llme


















6MoLlllum 1
Lab /1lu



















uomperld
one


















uomperldone ls a perlpheral
dopamlnerecepLor blocker lL
lncreases oesophageal perlsLalsls
lower oesophageal sphlncLer pressure
gasLrlc moLlllLy and perlsLalsls Lhus
faclllLaLlng gasLrlc empLylng and
decreaslng small bowel LranslL Llme
conLralndlcaLed ln lndlvlduals wlLh
selecLlve lgA deflclencles because Lhese
lndlvlduals may have serum anLlbodles
Lo lgA or may develop anLlbodles
followlng admlnlsLraLlon of lmmune
globulln and anaphylaxls could resulL
followlng admlnlsLraLlon

I 1he rellef of nausea and vomlLlng

eplgasLrlc sense of fullness upper
abdomlnal dlscomforL and regurglLaLlon
of gasLrlc conLenLs
CI PypersenslLlvlLy Cl haemorrhage
obsLrucLlon and perforaLlon paLlenLs
wlLh prolacLln releaslng plLulLary
hormone chronlc admln or rouLlne
prophylaxls of posLoperaLlve nausea
and vomlLlng
O LhromboLlc
evenLs
















O urowslness
O exLrapyramld
al reacLlons
O consLlpaLlon
or dlarrhoea
O decreased
llbldo
O skln rash
oLenLlally
laLal
O Convulslons
O ArrhyLhmlas
O cardlac arresL
O dysrrhyLhmla
s ln paLlenLs
wlLh Cv
dlsease or
hypokalaeml
O Selzures



















1hls medlcaLlon lncreases
movemenL Lhrough Lhe
dlgesLlve sysLem lL ls used Lo
LreaL sympLoms of sLomach
dlsorders lL may also be
used Lo prevenL nausea and
vomlLlng caused by cerLaln
medlcaLlons
1 g/kg dose 36 hour lnfuslon Llme and
2 g/kg dose 10 12 hour lnfuslon Llme
OLach lnfuslon should be sLarLed aL a slow
raLe whlch varles based on Lhe lvlC
producL and Lhe concenLraLlon of Lhe
soluLlon used
OvlLal slgns should be Laken aL a mlnlmum
every 13 mlnuLes for Lhe flrsL 30 mlnuLes
every 30 mlnuLes for Lhe nexL hour Lhen
hourly unLll Lhe lnfuslon ls compleLe
O1he physlclan should be noLlfled lf Lhe
paLlenL develops any slgns of an adverse
reacLlon
OLplnephrlne dlphenhydramlne and
meLhylprednlsolone should be close aL
hand ln case Lhe paLlenL develops a severe
reacLlon Lo Lhe lvlC

O 8efore uslng Lhls medlcaLlon CondlLlons
affecLlng use especlally SenslLlvlLy Lo
domperldone
O SafeLy and efflcacy of domperldone noL
esLabllshed ln chlldren CLher medlcaLlons
especlally azole anLlfungals human
lmmunodeflclency vlrus(Plv) proLease
lnhlblLors macrollde anLlbloLlcs
monoamlne oxldase (MAC) lnhlblLors
nefazodone or susLalnedrelease or
enLerlccoaLed formulaLlons of drugs
O CbLalnlng medlcal aLLenLlon lf falnLlng
dlzzlness lrregular hearLbeaL or pulse or
oLher unusual sympLoms occur
O Close observaLlon and supporLlve Lherapy
are recommended
O aLlenLs ln whom lnLenLlonal overdose ls
conflrmed or suspecLed should be referred
for psychlaLrlc consulLaLlon