Makati Medical Center College of Nursing DRUG STUDY Patient’s Name: M. D.
C. Age: 42 y/o Medical Diagnosis: Leptospirosis Attending Physician/s: M. TAllergies: noneAllergic Responses: none Prepared by: Shiela Guiquing DRUG NAME |MECHANISM OF ACTION |RATIONALE FOR THIS PATIENT |ADVERSE DRUG EFFECT |NURSING IMPLICATIONS | | | | | | | | | | |nausea, headaches, anxiety, insomnia, | | |BRAND NAME: | |To improve mood, sleep, appetite, |drowsiness, and loss of appetite, |Combining SSRIs with aspirin, | |Prozac | |energy level and may help restore |Increased blood pressure , Seizures , |nonsteroidal anti-inflammatory | | | |interest in daily living. It |sexual dysfunction. drugs or other drugs that affect | |GENERIC NAME: | |decreases fear, anxiety, unwanted | |bleeding may increase the | |(fluoxetine) | |thoughts, and the number of panic | |likelihood of upper | | | |attacks. | |gastrointestinal bleeding.
| |DRUG CLASSIFICATION: | | | | | |selective serotonin reuptake inhibitors | | | |Do not take Prozac together with | |(SSRI) antidepressant. | | |pimozide (Orap), thioridazine | | | | | |(Mellaril), or an MAO inhibitor | |DOSE AND | | | |such as furazolidone (Furoxone), | |FREQUENCY: | | | |isocarboxazid (Marplan), | | | | | |phenelzine (Nardil), rasagiline | |ROUTE: oral | | | |(Azilect), selegiline (Eldepryl, | | | | | |Emsam, Zelapar), or | | | | | |tranylcypromine (Parnate). A | | | | |Neuritis, polyneuritis, lumbago, |dangerous drug interaction could | | | | |cervical & shoulder-arm syndrome, |occur, leading to serious side | | | | |rheumatic pains, herpes zoster, |effects. | | | |alcoholism, cardiac disorders, diabetic| | | | | |neuropathy, hyperemesis gravidarum, | | | | | |encephalopathies, iatrogenic |May be taken with or without food| | | | |complications arising from INH, |(May be taken w/ meals to reduce | | | | |reserpine or phenothiazines.
|GI discomfort. ). | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |Used as dietary supplements. |Rare cases of gastrointestinal | | | | | |disturbances have been reported. | |BRAND NAME: | | | | | |Polynerv 1000 Tablet | | | | | | | | | | | |GENERIC NAME: | | | | | |Vit B1+ vit B6 +vit B12 | | | | | | | | | | | |DRUG CLASSIFICATION: | | | | | |Vitamin B-Complex/ | | | | | |with C | | | | | | | | | | | |DOSE AND | | | | | |FREQUENCY: | | | |Caution is advised for patients | | | | | |who may have folate-dependent | |Prophylaxis 1-2 tab daily.
Therapeutic 2-4 | | | |tumors. | |tab daily. | | | | | | | | |May be taken with or without food| |ROUTE: oral | | | | | | | | | | | | | | | | | | | | | | | | | | |Anorexia, nausea, vomiting, diarrhea, | | | | |Used in the treatment of anemia |glossitis, dysphagia, enterocolitis, | | |BRAND NAME: | | |inflammatory lesions in the anogenital | | |Folart Cap | | |region. Maculopapular & erythematous | | | | | |rashes. Rise in BUN.
Urticaria, | | |GENERIC NAME: |Pharmacology: Folic acid (pteroylmonoglutamic acid)| |angioneurotic edema, anaphylaxis, | | |Folic acid |in its reduced form of tetrahydrofolate, serves as | |anaphylactoid purpura, serum sickness, | | | |an important mediator of many reactions involving | |pericarditis & exacerbation of SLE. | | |DRUG CLASSIFICATION: |1-carbon transfers. Important reactions involve the| |Hemolytic anemia, thrombocytopenia, | | |Antianemics |conversion of homocysteine to methionine and of | |neutropenia, eosinophilia. | | | |deoxyuridylate to thymidylate, an important step in| |intracranial HTN in adults. | | |DOSE AND |DNA synthesis. It is also implicated in the | | | | |FREQUENCY: |conversion of some amino acids, and in the | | | | |Adults and Children >1 year: 5 mg daily for 4|synthesis and utilization of formate.
The | |Gastrointestinal: Diarrhea, nausea, | | |months |deficiency of folic acid can lead to megaloblastic | |vomiting, flatulence, abdominal | | | |anemia, which develops when dietary intake of folic| |discomfort or distention, rectal | | |ROUTE: oral |acid is inadequate eg, in pregnancy, excessive | |bleeding and glossitis, gastritis, | | | |menstrual flow, and as a result of the concurrent | |stomatitis, black or "hairy" tongue, | | | |administration of folate antagonist and other drugs| |enterocolitis, pseudomembranous | | | |which interfere with normal folate metabolism. | |colitis. | | |Pharmacokinetics: Folic acid is absorbed mainly | | | | | |from the proximal part of the small intestine, and | |Nervous: Headache, dizziness, | | | |from there, it is distributed throughout the body | |confusion, changes in smell or taste | | | |tissues. The principal storage site is the liver.
| |perception, rare reports of | | | |It is also actively concentrated in the | |convulsions. | | | |cerebrospinal fluid.Folate is circulated | | | | | |enterohepatically and about 4-5 mcg is excreted in | |Renal: Urine retention, dysuria, | | | |the urine daily. Intake of larger doses of folic | |increased BUN and creatinine, presence | | | |acid leads to a proportionate amount of the vitamin| |of red blood cells and hyaline casts in| | | |excreted. Folate s also distributed in the breast | |urine. | | | |milk.
| | | | | | | |Hepatic: Bilirubinemia, abnormal | | | | | |hepatic function and jaundice. | | | | |Laboratory Changes: Increased aspartate| | | | | |aminotransferase (AST), alanine |Should be taken with food (Take | | | | |aminotransferase (ALT), alkaline |w/ a full glass of water & remain| | | | |phosphatase and lactate dehydrogenase |upright for at least ? hr. Avoid | | | | |(LDH); decreased hemoglobin, |taking w/ dairy products. ). | | | |hematocrit, red blood cell, white blood| | | | | |cell, neutrophils, lymphocytes, |It may cause skin to be more | | | | |platelets; increased lymphocytes, |sensitive to sunlight than it is | | | | |monocytes, basophils, eosinophils and |normally.Exposure to sunlight, | | | | |platelets; decreased serum albumin and |even for brief periods of time, | | | | |total proteins; agranulocytosis; |may cause a skin rash, itching, | | | | |positive direct Coombs' tests.
|redness or other discoloration of| |BRAND NAME: | |Used in the systemic treatment of | |the skin, or a severe sunburn. | |Doxin Capsule | |infections. Dermatologic and Sensitivity Reactions:| | | | | |Rash, itching, other skin reactions, |Do not take milk, milk formulas, | |GENERIC NAME: | | |Stevens-Johnson syndrome, epidermal |or other dairy products within 1 | |Doxycycline hyclate | | |necrolysis, urticaria, pruritus, dry |to 2 hours of the time you take | | | | |skin, erythema, erythema multiforme, |tetracyclines | |DRUG CLASSIFICATION: | | |exfoliative dermatitis. | |Tetracyclines | | | | | | | | |Local Reactions: Pain at injection | | |DOSE AND | | |site, phlebitis, thrombophlebitis and | | |FREQUENCY: | | |inflammation at the injection site. | | |Usual dose Adult 200 mg (100 mg 12 hrly); | | |Other Effects: Fatigue, malaise, chest |Ampimax IM or IV injection should| |then 100 mg/day once daily.
| |pain or tightness, edema, facial |be reconstituted with sterile | | | | |swelling, chills, throat tightness, |water for injection or any | |ROUTE: oral | | |substernal pain, epistaxis and mucosal |compatible solution and allowed | | | | |bleeding, acute hyperpyrexia (oral |to stand after dissolution to | | |Pharmacology: Ampicillin is a ? -lactam antibiotic | |temperatures of up to 40°C), rapid |allow any foaming to dissipate in| | |with a mode of action similar to benzylpenicillin. |defervescence after completion of the |order to permit visual inspection| | |Its amino group side chain structure enables it to | |infusion, candidiasis. |after complete solubilization. | | |penetrate the outer membrane of some gram-negative | | |Strict aseptic technique should | | |bacteria and accounts for its broader spectrum of | | |be observed | | |activity.
| | | | |Ampicillin's bactericidal action is due to its | | |Concurrent use with probenecid | | |ability to interfere with the synthesis of the | | |may delay renal tubular secretion| |BRAND NAME: |bacterial cell wall. Peptidoglycan is a | | |of ampicillin and sulbactam. | |Ampimax |heteropolymeric structure that provides the cell |Used in the systemic treatment of | | | | |wall with mechanical stability. The final stage in |infections.
|If used with aminoglycosides - | |GENERIC NAME: |the synthesis of peptidoglycan involves the |Respiratory tract infections | |the two solutions should not be | |ampicillin & sulbactam |completion of the crosslinking and the terminal |including pneumonia, urinary tract | |mixed and must be administered at| | |glycine residue of the pentaglycine bridge is |infections including pyelonephritis, | |different sites. | |DRUG CLASSIFICATION: |linked to the fourth residue of the pentapeptide |intra-abdominal infections including | | | |Penicillins |(D-alanine). The transpeptidase enzyme that |peritonitis, endometritis and pelvic | |Concurrent use with fusidic acid | | |performs this step is inhibited by penicillins. As |cellulitis, bacterial septicemia. |may decrease the efficacy of | |DOSE AND |a result, the bacterial cell wall is weakened and | | |penicillins; penicillins should | |FREQUENCY: |the cell swells and then ruptures.
| | |be given at least 2 hr before | |Adults: Most Infections: Recommended Dose: |Sulbactam is a penicillanic acid sulfone with | | |fusidic acid admin. | |Usual Total Daily Dose Range: 1. 5 g |? lactamase inhibitory properties. It is an | | | | |(ampicillin 1 g plus sulbactam 0.
5 g) to12 g |irreversible inhibitor of many plasmid-mediated and| | | | |(ampicillin 8 g plus sulbactam 4 g) per day |some chromosomal ? -lactamases and has a similar | | | | |to be given in divided doses every 6 or 8 |spectrum of ? lactamase inhibition as clavulanic | | | | |hrs. |acid. Sulbactam can therefore enhance the activity | | | | |The dose and duration of treatment is based |of penicillins and cephalosporins against many | | | | |on the type and severity of infection: |strains of bacteria. | | | | |Mild: 1.
g (ampicillin 1 g plus sulbactam |Microbiology: The combination of ampicillin and | | | | |0. 5 g) to 3 g (ampicillin 2 g plus 1 g |sulbactam is active in clinical infections against | | | | |sulbactam). |the following susceptible microorganisms: | | | | |Moderate: Up to 6 g (ampicillin 4 g plus 2 g |Gram-Positive Bacteria: Staphylococcus aureus. | | | | |sulbactam). Gram-Negative Bacteria: Escherichia coli, | | | | |Severe: Up to 12 g (ampicillin 8 g plus 4 g |Klebsiella spp (all known strains are | | | | |sulbactam).
|? -lactamase-producing), Proteus mirabilis. | | | | | |Anaerobes: Bacteroides sp, including Bacteroides | | | | |ROUTE: IV or deep IM |fragilis. | | | |Reconstitute with sterile water for inj or |Ampicillin and sulbactam has demonstrated in vitro | | | | |0. 5-2% lidocaine hydrochloride injection |activity against most strains of the following | | | | |(IM). Sodium chloride 0. 9% is the diluent of |microorganisms; however, clinical significance is | | | | |choice for IV piggyback use.
unknown: Gram-Positive Bacteria: Staphylococcus | | | | | |aureus, Staphylococcus epidermidis, Staphylococcus | | | | | |saprophyticus, Staphylococcus warneri, | | | | | |Streptococcus faecalis* (Enterococcus), | | | | |Streptococcus pneumoniae*, Streptococcus pyogenes*,| | | | | |Streptococcus viridans*, Streptococcus agalactiae, | | | | | |Listeria monocytogenes, Enterococcus faecalis, | | | | | |Enterococcus faecium, Haemophilus ducreyi. | | | | | |Gram-Negative Bacteria: Haemophilus influenzae, | | | | | |Moraxella catarrhalis, Escherichia coli, Klebsiella| | | | | |spp (all known strains are ? lactamase producing), | | | | | |Proteus mirabilis, Proteus vulgaris, Providencia | | | | | |rettgeri, Providencia stuartii, Acinetobacter, | | | | | |Burkholderia pseudomallei, Campylobacter fetus, | | | | | |Salmonella, Shigella, Citrobacter, Morganella | | | | | |morganii, Neisseria gonorrhoeae, Neisseria | | | | | |meningitidis, Yersinia enterocolitica.Anaerobes: | | | | | |Clostridium spp*, Peptococcus spp*, | | | | | |Peptostreptococcus spp, Bacteroides spp including | | | | | |Bacteroides fragilis, Actinomyces, Bifidobacterium,| | | | | |Eubacterium, Lactobacillus, Propionibacterium, | | | | | |Prevotella, Fusobacterium. | | | | | |*These are not ? -lactamase producing strains and | | | | | |therefore, are susceptible even to ampicillin | | | | | |alone.
Sulbactam generally has weak antibacterial | | | | | |activity against microorganisms except | | | | | |Neisseriaceae and Acinetobacter | | | | | |baumanii. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |BRAND NAME: | | | | | |Ampimax | | | | | | | | | | |GENERIC NAME: | | | | | |ampicillin & sulbactam | | | | | | | | | | | |DRUG CLASSIFICATION: | | | | | |Penicillins | | | | | | | | | | | |DOSE AND | | | | | |FREQUENCY: | | | | | |Adults: Most Infections: | | | | | | | | | | | |ROUTE: IV or deep IM | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |BRAND NAME: | | | | | |Ampimax | | | | | | | | | | | |GENERIC NAME: | | | | | |ampicillin & sulbactam | | | | | | | | | | | |DRUG CLASSIFICATION: | | | | |Penicillins | | | | | | | | | | | |DOSE AND | | | | | |FREQUENCY: | | | | | |Adults: Most Infections: | | | | | | | | | | | |ROUTE: IV or deep IM | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |BRAND NAME: | | | | | |Ampimax | | | | | | | | | | |GENERIC NAME: | | | | | |ampicillin & sulbactam | | | | | | | | | | | |DRUG CLASSIFICATION: | | | | | |Penicillins | | | | | | | | | | | |DOSE AND | | | | | |FREQUENCY: | | | | | |Adults: Most Infections: | | | | | | | | | | | |ROUTE: IV or deep IM | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
