Drug Study Atenolol, Cefuroxime, Simvastatin

University of the Philippines The Health Sciences Center COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street, Manila Drug Study DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Atenolol 50 mg/tab 1 tab OD (p.o.)

PHARMACOLOGI C ACTION OF DRUG

Blocks betaadrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of renin from the kidney, and lowering BP.

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS OF THE DRUG

Indications • Treatment of angina pectoris due to coronary atherosclerosis • Hypertension, as a step 1 agent, alone or with other drugs, especially diuretics • Treatment of MI

Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm, respiratory distress CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV: Bradycardia, CHF, cardiac arrhythmias, sinoatrial or AV nodal block, tachycardia, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia,

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Unlabeled uses: Prevention of migraine headaches; alcohol withdrawal syndrome, treatment of ventricular and supraventricular arrhythmias.

Contraindications •

Contraindicated with sinus bradycardia, second- or thirddegree heart block, cardiogenic

DESIRED ACTION ON THE CLIENT

NURSING RESPONSIBILITIES /PRECAUTIONS

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Monitor BP and pulse; not rate, rhythm, quality Check for baselines in renal and liver function tests before therapy begins. Assess edema in feet, legs daily Monitor I&O, daily weight Check for JVD

Precautions: • Major surgery, lactation, DM, renal disease, thyroid disease, CHF, COPD, asthma, wellcompensated heart failure, dialysis, myasthenia gravis

shock, CHF, pregnancy.

Cefuroxime 500mg/tab 1 tab BID (p.o.) for 7 days

Inhibits bacterial wall synthesis, rendering cell wall osmotically unstable, leading to cell death by binding to cell wall membrane

Indications: • Urinary tract infections, Otitis media, • Severe infections Contraindications: • Sensitivity to cephalosporins

ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination Musculoskeletal: Joint pain, arthralgia, muscle cramps Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis (less likely than with propranolol) Other: Decreased exercise tolerance, development of antinuclear antibodies, hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline phosphatase, and LDH CNS: Dizziness, headache, fatigue, paresthesia, fever, chills, confusion GI: Diarrhea, nausea, vomiting, anorexia, glossitis, bleeding, increased AST, ALT, bilirubin, LDH, alkaline phosphatase, abdominal pain, loose stools, flatulence, heartburn, stomach cramps, colitis, jaundice

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Assess patient for signs and symptoms of infection Assess for anaohylaxis: rash, urticaria, chills, fever, dyspnea Identify urine output Assess bowel pattern daily

Simvastatin 40mg/tab 1 tab OD at hs (p.o.)

Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs, and either an increase or no change in serum HDLs.

Indications • Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterole mia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measures • To reduce the risk of coronary disease, mortality, and CV events, including stroke, TIA, MI and reduction in need for bypass surgery and angionplasty in patients with coronary heart disease and hypercholesterole mia • Treatment of patients with isolated hypertriglyceridem ia • Treatment of type III hyperlipoproteine

GU: vaginitis, pruritus, candidiasis, increased BUN, nephrotoxicity, renal failure, pyuria, dysuria, reversible interstitial nephritis CNS: Headache, asthenia, sleep disturbances GI: Flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure Respiratory: Sinusitis, pharyngitis Other: Rhabdomyolysis, acute renal failure, arthralgia, myalgia

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Monitor for bleeding

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Assess nutrition: fat, protein, carbohydrates Monitor bowel pattern daily Monitor triglycerides, cholesterol baseline throughout treatment

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Precautions: • Past liver disease, alcoholism, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, elderly, renal disease

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mia Treatment of adolescents 10-17 yr with heterozygous familial hypercholesterole mia

Contraindications

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Norxifloxacin 400mg/tab 1 tab BID (p.o.)

Interferes with conversion of intermediate DNA fragments into high-molecular weight DNA in bacteria

Contraindicated with allergy to simvastatin, fungal byproducts, pregnancy, lactation.

Indications: • UTI, uncomplicated gonorrhea Contraindications: • Hypersensitivity to quinolones

CNS: headache, dizziness, fatigue, somnolence, depression, insomnia EENT: visual disturbances GI: nausea, constipation, decreased ALT, AST, flatulence, heartburn, vomiting, diarrhea, dry mouth INTEG: rash

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Assess patient for previous sensitivity reaction Assess patient for signs and symptoms of infection, allergic reactions Monitor blood studies Assess bowel pattern daily