Drug Study Paracetamol, Ibuprofen, Cotrimoxazole, Allopurinol

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.) 1. Paracetamo l (250mg/5ml ) 3ml q4h for fever 2. Paracetamo l 145mg IV q4h for T > 38oC

PHARMACOLOGI C ACTION OF DRUG Antipyretic: Reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat. Analgesic: Site and mechanism of action unclear

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS OF THE DRUG

Indications - Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis - Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and antiinflammatory effects) - Common cold, flu, other viral and bacterial infections with pain and fever - Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain

CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia —cyanosis; hemolytic anemia— hematuria, anuria; neutropenia, leucopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitivity: Rash, fever

Contraindications - Contraindicated with allergy to acetaminophen. - Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

DESIRED ACTION ON THE CLIENT

Fever reduction

NURSING RESPONSIBILITIES /PRECAUTIONS -

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Monitor liver function studies; may cause hepatic toxicity at doses >4g/day Monitor renal function studies; albumin indicates nephritis Monitor blood studies, especially CBC and pro-time if patient is on long-term therapy. Check I&O ratio; decreasing output may indicate renal failure. Assess for fever and pain Assess hepatotoxicity: dark urine, claycolored stools Assess allergic reactions: rash,

urticaria

Ibuprofen (200mg/5ml) 4ml q6h for T>/= 39oC

Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic

Indications -Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis -Relief of mild to moderate pain -Treatment of primary dysmenorrhea -Fever reduction -Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine Contraindications -Contraindicated with allergy to ibuprofen, salicylates, or other NSAIDs (more common in patients with rhinitis, asthma, chronic urticaria, nasal polyps).

CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmologic effects CV: Hypertension, palpitations, arrhythmia Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, GI bleeding GU: Dysuria, renal impairment, menorrhagia Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Other: Peripheral edema, anaphylactoid reactions to

Fever reduction

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Assess pain Assess musculoskeletal status: ROM before dose and 1 hr after. Monitor liver function studies Monitor renal function studies Monitor blood studies: CBC, Hgb, Hct, protime if patient is on long-term therapy Check I&O ratio Assess hepatotoxicity Assess for allergic reactions, visual changes and ototoxicity Identify prior drug history Identify fever: length of time in evidence and related symptoms

Precautions: - Pregnancy B, lactation, children, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, elderly, CHF

anaphylactic shock

Cotrimoxazole (200mg/5ml) 5ml BID

Blocks synthesis of tetrahydrofolic acid;combination blocks two consecutive steps

Indications - Uncomplicated UTIs caused by susceptible strains of E. coli, Proteus mirabilis, Klebsiella

Dermatologic: Rash, pruritus, exfoliative dermatitis GI: Epigastric distress, nausea,

Prevent infection

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Assess allergic reactions Monitor I&O ratio Monitor kidney function

in bacterial synthesis of essential nucleic acids, protein

pneumoniae, Enterobacter species, and coagulase-negative Staphylococcus species, including Staphylococcus saprophyticus - Treatment of acute otitis media due to susceptible strains of S. pneumoniae and H. influenza in children Contraindications - Allergy to trimethoprim, pregnancy (teratogenic in preclinical studies), megaloblastic anemia due to folate deficiency.

Allopurinol 100mg/tab 1 tab BID

Inhibits the enzyme responsible for the conversion of purines to uric acid, thus reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the signs and symptoms of gout

Indications: - Management of the signs and symptoms of primary and secondary gout - Management of patients with malignancies that result in elevations of serum and urinary uric acid - Management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day (males) or 750 mg/day (females) - Orphan drug use: Treatment of Chagas' disease; cutaneous and visceral leishmaniasis - Unlabeled uses: Amelioration of granulocyte suppression with fluorouracil; as a

vomiting, glossitis Hematologic: Thrombocytopenia, leukopenia, neutropenia, megaloblastic anemia, methemoglobinemia, elevated serum transaminase and bilirubin, increased BUN and serum creatinine levels Other: Fever

CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias Dermatologic: Rashes— maculopapular, scaly or exfoliative —sometimes fatal GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice GU: Exacerbation of gout and renal calculi, renal failure Hematologic: Anemia, leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia,

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Reduce uric acid synthesis

Assess type of infection; obtain C&S before starting therapy Assess blood dyscrasias

Precautions: - Pregnancy C, renal disease, eldery, G6PD deficiency, impaired hepatic/renal disease, possible folate deficiency, severe allergy, bronchial asthma - Assess for pain - Monitor uric acid levels q2 wk - Monitor CBC, AST, BUN, creatinine before starting treatment - Monitor nutritional status: discourage organ meat, sardines, salmon, legumes (high purine), gravies,alcohol Precautions: - Pregnancy C, lactation, renal disease, hepatic disease, children

mouthwash to prevent fluorouracil-induced stomatitis Contraindications - allergy to allopurinol, blood dyscrasias, hypersensitivity.

bone marrow depression