Sheena Reprt.eng

…al so cal led medici ne is any substance taken by mout h, inj ect ed into a muscl e, the ski n, a bl ood ves sel , or a cav ity of the body, or appli ed topi call y to tr eat or pr ev ent a dis eas e or a

P.O.- by mouth q- every b.i.d.- twice daily GI- gastrointestinal I.V- intravenous EENT- eyes, ears, nose, throat

HIV- human immunodeficiency virus WBC- white blood cell Wk- week UTI- urinary tract infection DNA- deoxyribonucleic acid

CV- cardiovascular CNS- central nervous system G6PD- glucose-6-phosphate dehydrogenase CBC- complete blood count

PT- prothrombin time INR- International Normalized Ratio p.r.n.- as needed ALT- alanine transaminase AST- aspartate transaminase GGT- gamma-glutamyltransferase

GENERIC NAME: nitazoxanide BRAND NAME: Alinia

Ava il ab le For ms Oral Su sp en si on: 10 0 mg /5 ml Table ts: 5 00 mg Ind ic atio ns a nd Dos ag es >Dia rrhe a c au se d b y Cryp tosp orid iu m p ar vum o r gi rdia l ambl ia Chi ld ren ag es 4 to 11 : 1 0m l (2 00 mg ) P. O. wi th fo od q 1 2 ho ur s fo r 3 da ys . Chi ld ren ag es 1 to 3: 5m l (10 0

New Indications: Diarrhea caused by G. lamblia Adults and children age 12 and older: 500 mg P.O. (tablet or suspension) with food q 12 hours for 3 days.

Actions May interfere with enzymedependent electron transfer reaction, essential for aerobic energy metabolism. Route

Onset

Peak

Duration

P.O.

Rapid

1-4 hr

unknow n

Adverse Reactions CNS: headache GI: abdominal pain, diarrhea, nausea, vomiting Interactions Drug-drug. Drugs that are highly protein-bound: May compete for binding sites. Use together cautiously.

Effects on Lab Test Results May increase creatinine and glutamate pyruvate transaminase levels. Contradictions and Cautions * Contraindicated in patients hypersensitive to nitazoxanide * Use cautiously in patients with renal or hepatic dysfunction.

…Safety and efficacy haven’t been established in HIV-positive patients, immunodeficient patients, children younger than age 1, or those age 12 and older being treated for diarrhea caused by C. parvum

Nursing Considerations * Give drug with food. * Alert: A single nitazoxanide tablet contains more of the drug than is recommended for pediatric does and shouldn’t be used in pediatric patients age 11 or younger.

* Monitor glucose level in patients with diabetes who are taking the suspension. * Store tablets, suspension, and powder at 77°F (25°C). Patient Teaching * Tell caregiver or patient to give drug with food.

* Instruct patient to keep container tightly closed and to shake it well before each use. * Advice patient that reconstituted suspension or tablets may be stored at room temperature.

* Advice patient to discard suspension after 3 days. * Inform diabetic patient or his caregiver that the suspension contains 1.48g of sucrose per 5 ml.

GENERIC NAME: hydroxychloroquine sulfate BRAND NAME: Plaquenil Sulfate

Available Forms Tablets: 200 mg (equivalent to 155 mg base) Indications and dosages > Suppressive prevention of malaria attacks caused by Plasmodium vivax, P. malariae, P. ovale, and susceptible strains of P. falciparum

ADULTS: 310 mg base P.O. weekly on the same day each week, beginning 1 to 2 weeks before entering malariaendemic area and continuing for 4 weeks after leaving area. If not started before exposure, double first dose to 620 mg base in two divided doses 6 hours apart.

Children: 5 mg/kg base P.O. weekly on the same day each week, beginning 1 to 2 weeks before entering malariaendemic area and continuing for 4 weeks after leaving area. Don’t exceed adult dose. If not started before exposure, double first dose to 10 mg/kg base in two divided doses, 6 hours apart.

> Acute Malarial Attacks Adults: Initially, 620 mg base P.O., followed by 310 mg base 6 to 8 hours after first dose: then 310 mg base daily for 2 days. Children: Initially, 10 mg/kg base P.O.; then 5 mg/kg base at 6, 24, and 48 hours after the first dose.

> Lupus erythematosus Adults: 310 mg base P.O. daily or b.i.d., continued for several weeks or months, depending on response. For prolonged maintenance dose, 155 to 310 mg base daily. > Rheumatoid arthritis Adults: Initially, 310 to 465 mg base P.O. daily. When good response occurs, usually in 4 to 12 weeks, cut dosage in half.

Action Unknown, May bind to and alter the properties of DNA in susceptible organisms. Route P.O.

On se t Un know n

Pe ak 2-4½h r

Duration Unknow n

Adverse Reactions CNS: irritability, nightmares, ataxia, seizures, psychosis, vertigo, dizziness, hypoactive deep tendon reflexes, lassitude, headache. CV: T-wave inversion or depression, widening of QRS complex.

EENT: blurred vision, difficulty in focusing, reversible corneal changes, nystagmus, typically irreversible, sometimes progressive or delayed retinal changes such as narrowing of anterioles, mascular lesions, pallor or optic disk, optic atrophy.

GI: anorexia, abdominal cramps, diarrhea, nausea, vomiting. Metabolic: weight loss. Musculoskeletal: skeletal muscle weakness. Skin: pruritus, lichen planus eruptions, skin and mucosal pigmentary changes, pleomorphic skin eruptions, worsened psoriasis, alopecia, bleaching of hair.

Interactions Drug-drug. Aluminum salts (kaolin). Magnesium: May decrease GI absorption. Separate dose times. Cimetidine: May decrease hepatic metabolism of hydroxychloroquine. Monitor patients for toxicity.

Effects on Lab Tests * May decrease hemoglobin level * May decrease granulocyte, WBC, and platelet counts.

Contradictions and Cautions * Use with caution in patients with hepatic disease or alcoholism because drug concentrates in liver. * Contradicted as long-term therapy for children

*Use with caution in those G6PD deficiency or psoriasis because drug may worsen these conditions. *Use with caution in patients with severe GI, neurologic, or blood disorders.

Nursing Considerations * Alert: Drug dosage may be discussed in “mg” or “mg base”, be aware of the difference * Ensure that all baseline and periodic ophthalmic examinations are performed . Check periodically for ocular muscle weakness after long-term use.

* Assist patient with obtaining audiometric examinations before, during and after therapy , especially if therapy is long term. * CBC and liver function studies periodically during longterm therapy; if severe blood disorder not attributable to disease develops, drug may need to be stopped.

* Alert: Monitor patient for possible overdose, which can quickly lead to toxic signs or symptoms: headache, drowsiness, visual disturbances, CV collapse, and seizures—then cardiopulmonary arrest. Children are extremely susceptible to toxicity; avoid long-term treatment.

Patient Teaching * Advice patient taking drug for prevention to take drug immediately before or after a meal on the same day each week, to improve compliance. * Instruct patient to report adverse reactions promptly.

GENERIC NAME: cofaclor BRAND NAME: Ceclor. Ceclor CD, Raniclor

Available Forms Capsules: 250 mg, 500 mg Oral Suspension: 125 mg/5ml, 187 mg/5ml, 250 mg/5ml, 375 mg/5ml Tablets (chewable): 125mg, 187 mg, 250 mg, 375 mg Tablets (extended-release): 375 mg, 500 mg

Indications and Dosages > Respiratory tract infections, UTI’s, skin and softtissue infections, and ottis media caused by Haemophilus influenzae, Streptoccus pneumoniae, S. pyogenes, Escherichia coli, Proteus mirabilis, Klebsiella species and staphylococci.

Adults: 250 to 500 mg P.O. q 8 hours. For pharyngitis or otitis media, daily dose may be given in two equally divided doses y 12 hours. For extended-release forms in bronchitis, 500 mg P.O. q 12 hours for 7 days; for extendedrelease forms in pharyngitis or skin and skin-structure infections, 375 mg P.O. q 12 hours for ten days and 7 to 10 days respectively.

Children: 20 mg/kg daily P.O. in divided doses q 8 hour. For pharyngitis or otitis media, daily dose may be given in two equally divided doses q 12 hours. In more serious infections, 40 mg/kg daily is recommended, not to exceed 1 g daily.

Action Second-generation cephalosporin that inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal Route

Onset

P.O.

Unknown

30-60 min Unknown

P.O. (extended)

Unknown

1½-2½ hr Unknown

Peak

Duration

Adverse Reactions CNS: fever, dizziness, headache, somnolence, malaise GI: nausea, vomiting, diarrhea, anorexia, dyspepsia, abdominal cramps, pseudomembranous colitis, oral candidiasis.

GU: vaginal candidiasis, vaginitis Hematologic: transient leukopenia, anemia, eosinophilia, thrombocytopenia, lymphcytosis

Skin: maculopapular rash, dermatitis, pruritus

Other: hypersensitivity reactions, serum sickness, anaphylaxis. Interactions Drug-drug. Aminoglycosides. May increase risk of nephrotoxicity. Avoid using together.

Antacids: May decrease absorption of extendedrelease cefaclor if taken within 1 hour. Separate doses by 1 hour. Anticoagulants: May increase anticoagulant effects. Monitor PT and INR.

Chloramphenicol: May cause antagonistic effect: Avoid using together. Probenecid: May inhibit excretion and increase cefaclor level. Monitor patient for increased adverse reactions.

Effects on Lab Test Results * May increase alkaline phosphatase, ALT, AST, bilirubin, GGT, and LDH levels. May decrease hemoglobin level. * May increase eosinophil count. May decrease platelet and WBC count

* May falsely increase serum or urine creatinine level in tests using Jaffe reaction. May cause false-positive results of Coomb’s test and urine glucose tests that use cupric sulfate, such as Benedict’s reagent and Clinitest.

Contradictions and Cautions * Contradicted in patients hypersensitive to drug or other cephalosporins. * Use cautiously in patients hypersensitive to penicillin because of the possibility of cross-sensitivity with other betalactam antibiotics

* Use cautiously in breastfeeding women and in patients with a history of colitis or renal insufficiency. Nursing Considerations * Before administration, ask patient if he is allergic to penicillins or cephalosporins.

* Obtain specimen for culture and sensitivity test before giving first dose. Therapy may begin while awaiting results. * If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of supperinfection

* Store reconstituted suspension in refrigerator. Suspension is stable for 14 days if refrigerated. Shake well before use. Patients Teaching * Tell patient to take entire amount of drug exactly as prescribed

* Tell patient that drug may be taken with meals. If suspension is used, instruct him to shake to shake container well before before measuring dose and to keep the drug refrigerated. * Advice patient to notify prescriber if rash develops or signs and symptoms of superinfection appear.

* Advice the patient not to rush, cut, or chew extended-release tablets.

GENERIC NAME: Milrinone lactate BRAND NAME: Primacor

Available Forms Injection: 1 mg/ml Injection (premixed): 200 mcg/ml in D5W Indications and Dosages > Short-term treatment of heart failure

Adults: Give first loading dose of 50 mcg/kg I.V. slowly over 10 minutes; then give continuous I.V. infusion of 0.375 to 0.75 mcg/kg/minute. Titrate infusion dose based on clinical and hemodynamic responses. Don’t exceed 1.13 mg/kg/day

Administration Prepare I.V. infusion solution using half-normal saline solution, normal saline solution, or D5W. Prepare the 100-mcg/ml solution by adding 180 ml of diluent per 20-mg (20-ml) vial, the…

…150-mcg/ml solution by adding 113 ml of diluent per 20-mg (20ml) vial, and the 200-mcg?ml solution by adding 80 ml of diluent per 20-mg (20-ml) vial Incompabilities Bumetanide, Furosemide, imipenem and cilastatin sodium, procainamide, torsemide

Action Produces inotropic action by increasing cellular levels of CAMP and vasodilation by relaxing vascular smooth muscle. Route

On set

Peak

Duration

I.V .

5-1 5 min

1-2 hr

3-6 h r

Adverse reactions CNS: headache CV: Ventricular Arrhythmias, ventricular ectopic activity, nonsustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation.

Interactions None significant Effects on Lab Test None reported Contradictions and cautions *Contradicated in patients hypersensitive to drug

* Contradicated for use in patients with severe aortic or pulmonic valvular disease in place of surgery and during acute phase of MI (myocardial infarction) * Use cautiously in patients with atrial flutter or fibrillation because drug slightly shortens AV (atrioventricular) node conduction time and may increase ventricular response rate.

Nursing Considerations *Give digoxin before therapy. Drug is typically given with digoxin and diuretics. * Improved cardiac output may increase urine output. Reduce diuretic dosage when heart failure improves. Potassium loss may cause digitalis toxicity

* Monitor fluid and electrolyte status, blood pressure, heart rate, and renal function during therapy. Excessive decrease in blood pressure requires stopping or slowing rate of infusion. * Correct hypoxemia

Patient Teaching * Instruct patient to promptly report adverse reactions to prescriber promptly, especially angina * Tell patient that drug may cause headache, which can be treated with analgesics * Tell patient to report discomfort at I.V. insertion site.

f

GENERIC NAME: rabeprazole sodium BRAND NAME: Aciphex

Available Forms Tablets (delayedrelease): 20 mg Indications and dosages > Healing of erosive or ulcerative gastroesophageal reflux disease (GERD)

Adults: 20 mg P.O. daily for 4 to 8 weeks. Additional 8-week course may be considered, if needed. > Maintenance of healing of erosive or ulcerative GERD Adults: 20 mg P.O. daily

>Healing of duodenal ulcers Adults: 20 mg P.O. daily after morning meal for up to 4 weeks. > Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome Adults: 60 mg P.O. daily; may be increased as needed , to 100 mg P.O. daily 60 mg P.O. b.i.d.

> Symphtomatic GERD, including daytime and nighttime heartburn Adults: 20 mg P.O. daily for 4 weeks. Additional 4-week course may be considered, if needed.

>Helicobacter pylori eradication, to reduce the risk of duodenal ulcer recurrence Adults: 20 mg P.O. b.i.d., combined with amoxicillin 1,000 mg P.O. b.i.d. and clarithromycin 500 mg P.O. b.i.d., for 7 days.

Action Blocks proton pump activity and gastric acid secretion by inhibiting gastric hydrogen-potassium adenosine triphosphatase at secretory surface of gastric parietal cells

Ro ute

Onset

Peak

Du ratio n

P.O.

Ra pi d

1-4 h r

unk nown

Adverse reactions CNS: headache Interactions Drug-drug. Clarithromcy: may increase rabeprazole level. Monitor patient closely.

Cyclosporine: May inhibit cyclosporine metabolism. Use together cautiously. Digoxin, ketoconazole, other gastric pH dependent drugs:May decrease or increase drug absorption at increased pH values. Monitor patient closely. Warfarin: May inhibit warfarin metabolism. Monitor PT and INR.

Effects on Lab Test Results None reported Contraindication and Cautions * Contraindicated in patients hypersensitive to drug, other benzimidazoles (lansoprazole, omeprazole), or components of these formulations.

*Use cautiously in patients with severe hepatic impairment. Nursing Considerations * Consider additional courses of therapy if duodenal ulcer or GERD isn’t healed after first course of therapy.

* Symptomatic response to therapy doesn’t preclude presence of gastric malignancy. Patient Teaching * Explain importance of taking drug exactly as prescribed.

* Advise patient to swallow delayed-release tablets whole and not to crush, chew or split. * Inform patient that drug may be taken without regard to meals.

ANALGESIC Alor 5/500 Azdone Damason-P Lortab ASA Panasal 5/500 CSS III

GENERIC COMPONENTS 500 mg aspirin and 5 mg hydrocodone bitartate DOSAGES Moderate to moderately severe pain Adults: 1 or 2 tablets q hours. Maximum dosage, 8 tablets in 24 hours.

ANTIDIABETICS Metaglip GENERIC COMPONENT Tablets 2.5 mg glipizide and 250 mg metformin 2.5 mg glipizide and 500 mg metformin 5 mg glipizide and 500 mg metformin

DOSAGES Adults: 1 tablet per day with a meal; adjust dose based on patient response. Maximum dose, 20 mg glipizide with 2,000 mg metformin daily

Facilitator: Sheena Mae P. Rom Observer: Charrymor C. Samocino

Recorder: Ezramarie Reponte Members: Caballes Buttac Corvera Platero Cariaga caseres