DRUG STUDY
Brand Name: Lasix Generic Name: furosemide Classification: loop diuretic Suggested Dose: 20-40 mg Mode of Action: inhibits the absorption of sodium and chloride in the proximal
and distal tubules as well as the ascending loop of Henle; this results in the excr excret etio ion n of sodi sodium um,, chlo chlori ride de,, and, and, to a less lesser er degr degree ee of pota potass ssiu ium m and and bicarbonate ions Indication: edema
never use with with ethacry ethacrynic nic acid; acid; anuria, anuria, hyperse hypersensit nsitivit ivity y to Contraindication: never drug, severe renal disease, hepatic coma Drug Interaction: charcoal – ↓ absorption of furosemide from GIT;
Clofibrate – enhanced diuretic effects; hydantoins - ↓diuretic effect of furosemide Propanolol - ↑ plasma propanolol levels Side Side
Effe Effect cts: s:
jaundice,
tinnitus,
hearing
impairment, impairment,
hypotension, hypotension,
water/electrolyte depletion, pancreatitis, abdominal pain, dizziness, anemia Nursing Responsibilities:
1. Take Take on morning morning on an empty stomach stomach to enhanc enhance e absorptio absorption n and avoid avoid interruption of sleep from frequent urination 2. Drug Drug may cause cause BP to drop. drop. Change Change positi position ons s from from lying lying to stan standin ding g slowly. 3. Avoid Avoid alcohol alcohol and and do not exerci exercise se in hot weath weather. er. 4.
Use sunscre sunscreens ens and protecti protective ve clothing clothing when when sun exposed exposed to minimize minimize the effects of drug – induced photosensitivity
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Brand Name: interferon alfacon-1 Generic Name: Infergen Classification: immunomodulator, antiviral Suggested Dose: 9mcg SC 3 times per week for 24 weeks Mode of Action: has antiviral, antiproliferative and immunomodulatory effects,
regulation of cell surface major histocompatibility antigen expression and regulation of cytokine expression Indication: Hepatits B infection Contraindication: hypersensitivity to alpha interferon or to products derived from
E.coli. Use in autoimmune hepatitis or in decompensated hepatic disease Drug Interaction: Drugs metabolized by cytochrome P450/ Possible changes in
therapeutic and/or toxic levels of drug Myelosuppressive drugs – use caution when given with such drug Side Effects: headache, fatigue, fever, myalgia, body pain, abdominal pain,
nausea, back pain, insomnia, nervousness, pharyngitis, URTI, dizziness, diarrhea, anorexia, dyspepsia, injection site erythema, depression, cough Nursing Responsibilities:
1. Review dose and method of administration (SC); usually administered 3 times per week with 48 hr between doses. 2. May experience flu-like symptoms, including headache, fatigue, fever, muscle/joint pain and increased sweating. 3. Stop drug, report any signs and symptoms of depression, suicide thoughts/attempt. 4. Do not change brands of interferon without provider approval. 5. Keep all F/U to assess response, labs, and for adverse SE.
Brand Name: lamivudine 76
Generic Name: Epivir-HBV Classification: antiviral Suggested Dose: 150 mg twice a day or 300 mg once per day Mode of Action: converted to active 5’-triphosphate (L-TP) metabolite which
inhibits HIV reverse transcription via viral DNA chain termination. L-TP also inhibts the RNA- and DNA-dependent DNA polymerase activities of reverse transcriptase. Indication: Hepatitis B infection Contraindication: Lactation. Use of Epivir-HBV tablets or oral solution to treat
HIV infections (due to the lower amount of lamivudine compared with Epivir) Drug Interaction: interferon alpha – may cause hepatic decompensation
Ribavirin – possible decreased phosphorylation of lamivudine Zalcitabine – inhibition of the intracellular phosphorylation of one another Zidovudine – increase about 39% of zidovudine Side Effects: headache, ear/nose/ throat infections, malaise, fatigue, N&V,
abdominal discomfort/pain Nursing Responsibilities:
1. Take as prescribed with another antiretroviral drug twice a day. Drug works by inhibiting replication of HIV and/or Hepatitis B virus. 2. May take without regard to food. Drug is not a cure; may continue to experience illnesses and opportunistic infections associated with HBV. 3. Use
barrier
protection
with
sexual
partner
to
prevent hepatitis
transmission. 4. May experience faint or dizziness, GI upset and insomnia may resolve after 3-4 weeks of therapy. Do not stop without provider approval. 5. Use caution with activities that require mental alertness. Report memory loss, confusion or s/s of infection
Brand Name: Hepsera 77
Generic Name: Adefovir dipivoxil Classification: antiviral Suggested Dose: 10 mg once daily Mode of Action: a prodrug that is phosphorylated to the active metabolite,
adefovir diphosphate by cellular kinases. Inhibits HBV DNA polymerase by competing with the natural substrate deoxyadenosine triphosphate. This causes DNA chain termination after being incorporated into viral DNA. Indication: chronic hepatitis B Contraindication: hypersensitivity to any of the product components. Drug Interaction: drugs that reduce renal function or compete for active tubular
secretion – increase serum levels of adefovir or coadministered drugs Ibuprofen – increase AUC, and urinary recovery of adefovir Side Effects: asthenia, headache, abdominal pain, nausea, flatulence, diarrhea,
dyspepsia Nursing Responsibilities:
1.) Take as directed once daily. 2.) Review enclosed patient literature before starting therapy and with each refill. Do not stop suddenly. 3.) May experience weakness, headache and GI upset. Report appetite loss, light colored BM’s, yellowing of skin/eyes, dark colored urine, cold feeling in arms and legs, difficulty in breathing. 4.) Does not cure disease but controls it; must continue to practice safe
behavior. Do not share; needles or injection equipment, personal items that have blood on them.
Brand Name: Entecavir 78
Generic Name: baraclude Classification: Antiviral Suggested Dose: 1 mg once daily Mode of Action: nucleoside analog with selective activity against hepatitis B
virus (HBV). Nucleoside analogs inhibit DNA synthesis in HBV infected cells Indication: treatment of chronic hepatitis B infection Contraindication: hepatomegaly, renal impairment, liver transplant recipients Drug Interaction: Side Effects: Headache, fatigue, diarrhea, dyspepsia Nursing Responsibilities:
1.) Take as directed once daily. 2.) Review enclosed patient literature before starting therapy and with each refill. Do not stop suddenly. 3.) May experience weakness, headache and GI upset. Report appetite loss, light colored BM’s, yellowing of skin/eyes, dark colored urine, cold feeling in arms and legs, difficulty in breathing. 4.) Does not cure disease but controls it; must continue to practice safe behavior. Do not share; needles or injection equipment, personal items that have blood on them.
Brand Name: Prednisone 79
Generic Name: prednisolone Classification: corticosteroid Suggested Dose: 1-2mg per day Mode of Action: decreases inflammation by suppression of migration of
polymorphonuclear leukocytes and reversal of increased capillary permeability; suppresses the immune system by reducing activity and vol of the lymphatic system; suppresses adrenal function at high doses; Inhibits phagocytosis of antibody-covered red blood cells. Indication: hemolytic anemia Contraindication: hypersensitivity to drug Drug Interaction: Substrate of CYP3A4; induces CYP2C19, 3A4. Increased risk
of GI ulceration with NSAIDs. Decreased effect with barbiturates, phenytoin, rifampin. Decreased effect of salicylates, vaccines and toxoids. Ethanol may increase gastric mucosal irritation. Side Effects: Insomnia, nervousness, increased appetite, indigestion, dizziness,
headache, diaphoresis, hypertension, muscle-wasting, pancreatitis, seizures Nursing Responsibilities:
1. When first placed on corticosteroids, check BP twice until maintenance dose established. 2. Evaluate for increase sodium and fluid retention. Monitor weight and observe for edema. If noted, adjust to low sodium, high potassium diet. 3. Assess for SOB, distended neck veins, edema, and easy fatigue. 4. Assess muscle for weakness and wasting; report changes in appearance. 5. Monitor serum glucose, electrolytes, and platelet counts with long term therapy.
Brand Name: Iberet Folic-500 80
Classification: vitamins and minerals Suggested Dose: 1 tab daily Indication: Prophylaxis and treatment of iron & folic acid deficiency and
nutritional anaemia, especially indicated throughout pregnancy and lactation. Prevention of concomitant folic acid deficiency. Contraindication: Thalassemia, sideroblastic anemia, hemochromatosis &
hemosiderosis Side Effects: Allergic reactions, GI effects, hyperbilirubinemia, bright yellow
urine discoloration, flushing, dizziness, peripheral sensory neuropathies, stone formation, crystalluria & oxalosis, black discoloration of stool. Nursing Responsibilities:
1. Assess allergies from taking drug 2. Increase oral fluid intake 3. Watch out for any side effects of drug 4. Instruct patient to report immediately any side effects of the drug
Brand Name: Cecon, Fern C Generic Name: ascorbic acid 81
Classification: vitamin c Suggested Dose: 100-200mg daily Mode of Action: Ascorbic acid is a functional and principal in vivo form of
vitamin C, an essential water-soluble vitamin which is fundamental in the synthesis of collagen and intercellular materials. Indication: anemia Contraindication:
Diabetics;
patients
prone
to
recurrent
renal
calculi,
Haemochromatosis; hyperoxaluria Side Effects: Diarrhea, GI disturbances. May cause acidification of the urine;
precipitation of urate, cystine or oxalate stones, or drugs in the urinary tract. Nursing Responsibilities:
1. Assess allergies from taking drug 2. Increase oral fluid intake 3. Watch out for any side effects of drug 4. Instruct patient to report immediately any side effects of the drug
Brand Name: Penicillin VK, Veetids Generic Name: penicillin Classification: antibiotic 82
Suggested Dose: 250mg twice a day Mode of Action: binds to pencillin - binding proteins in the cytoplasmic
membranes of bacteria, thus inhibiting cell wall synthesis. Cell division and growth are inhibited and often lysis and elongation of susceptible bateria occur. Indication: prphylaxis Contraindication: severe pneumonia, empyema, pericarditis Drug Interaction: Oral contraceptives – decrease effectiveness of oral
contraceptives Neomycin – decrease absorption of penicillin Side Effects: hypersensitivity reactions, n & v, diarrhea, abdominal cramps, sore
mouth/tongue Nursing Responsibilities:
1. Take without regard to meals. Blood level may be slightly higher when administered on an empty stomach. Take after meals to enhance absorption. 2. Report lack of response, adverse SE, bloody stools, severe diarrhea or stomach cramps; may need to reevaluate and alter therapy. 3. If reaction occurs, seek care immediately.
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