C.

DRUG STUDY
DRUG STUDY
Age: 57 yrs.old
Sex: Male
Date of
Admission:
November 21,
2013
Indication
Contraindication

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM Nephropathy
Doctor: Dr. Augustine Aguhob

Drug Data
Generic
Name:
Isosorbide
Mononitrate

Classificat
ion
Pharmacol
ogic Class:
Nitrates

Trade Name:
IMDUr,
Monoket

Therapeut
ic Class:
antianginal
s

Patients
Dose:
20mg tab OD
@ 8AM

Pregnancy
Risk
Category:
C

Maximum
Dose:
60 mg OD
Minimum
Dose:
5mg BID
Availability:
Tablets (ISMO,
Monoket): 10
mg, 20 mg.
Extendedrelease tablets
(Imdur): 30
mg, 60 mg,
120 mg.
Route:
PO

Mechanism of
Action
Produce
vasodilation
(venous greater
than arterial).
Decrease left
ventricular end
diastolic pressure
and left ventricular
enddiastolic
volume (preload).
Net effect is
reduced myocardial
oxygen
consumption.
Increase coronary
blood flow by
dilating coronary
arteries and
improving collateral
flow to ischemic
regions.
Absorption:has
100% bioavailability
(does not un- dergo
first-pass
metabolism).
Distribution:Unkno
wn.
Metabolism &
Excretion:
primarily
meteabolized by the
liver to inactive
metabolites;
primarily excreted
in urine as

General:
Acute treatment of
anginal attacks (SL
only). Prophylactic
management of
angina pectoris.
Treatment of
chronic CHF
(unlabeled).
Patients
Indication:
Prophylaxis for
heart attack.

Contraindicated to:
Hypersensitivity;
Concur- rent use of
sildenafil, vardenafil
or tadalafil.
Precaution:
Volume
depleted
patients;
Right
ventricular infarction;
Hypertrophic
cardiomyopathy;
Geri:
Older patients may
be more sensitive to
hypotension
(start
with lower doses);
OB: Pregnancy (may
compromise
maternal/fetal
circulation)
or
lactation; Pedi: Children
(safety
not
established).
Interactions
Drug-drug
Concurrent use of
sildenafil, ta- dalafil,
or vardenafil may
result in significant
and potentially fatal
hypotension (do not
use
these
drugs
within
24
hr
of
isosorbidedinitrate or
mononitrate).
Additive hypotension
with
antihypertensives,
acute ingestion of

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic

Adverse
Effect/Reaction
CNS: dizziness,
headache.
CV: hypotension,
tachycardia,
paradoxicbradyca
rdia, syncope.
GI: nausea,
vomiting.
Misc: flushing,
tolerance.

Nursing Responsibilities
Before:
Verify patients identity
Assess for allergy
Assess level of consciousness
Make sure that the dose is right for
the patient
Refer if patient refuses to take the
medication.
Assess location, duration, intensity,
and pre- cipitating factors of
anginal pain.
Monitor blood pressure and pulse
routinely during period of dosage
adjustment.
During:
Administer initial dose at bedtime to
minimize adverse reactions.
Avoid eating, drinking, or smoking
until tablet is dissolved. Replace
tablet if inadvertently swallowed.
PO: Extended-release tablets should
be swallowed whole. Do not crush,
break, or chew.
Caution patient to make position
changes slowly to minimize
orthostatic hypotension.
After:
Document after administration.
Instruct patient to take medication
as directed, even if feeling better.
Take missed doses as soon as
remembered. Caution not to stop
abruptly.
Caution against double dosing.
Avoid hazardous activities until
drugs CNS effects are known

metabolites.

alcohol,
beta
blockers,
calcium
channel blockers, and
phenothiazines.

Drug Half- Life:

5hr

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data

Classification

Mechanism
of Action

Indication

Generic
Name:
Acetaminophen

Pharmacologi
c Class:
Paraaminophenol
derivative

Inhibits
the
synthesis
of
prostaglandins
that
may
serve
as
mediators
of
pain and fever
primarily
in
the CNS.

General
Indication:

Trade Name:
tempra, tylenol
Patients
Dosage:
300mg IVTT q4
PRN
Maximum
Dose:
Dont
exceed
2.6 g daily
Minimum
Dose:
325-650 mg PO
q4 to 6 hrs
Availability:
Caplets:
160
mg, 500 mg
Capsules: 325
mg, 500mg
Injection: vials

Therapeutic:
Antipyretics,
non-opioid
analgesics

Pregnancy
Risk
Category:
B

Absorption
75% absorbed
after
oral
administration
Distribution
Crosses the
placenta,enter
s
the
breastmilk in
low
concentrations
Metabolism
Mostly
metabolized
by the liver
Excretion
Metabolites
excreted
by

Mild pain
and Fever

Patients
indication:
Relief for
fever

DRUG STUDY
Age: 57 yrs.old
Sex: Male

Height: 52ft.
Weight: 50kg.

65

Date of Admission: November

21, 2013
Contraindicatio
Adverse
n
Effect/Reac
tion

Body Build: Asthenic

Hypersensitivity;
products
containing alcohol,
aspartate,
saccharin, sugar,or
tartrazine
should
be
avoided
in
patients who have
hypersensitivity pr
intolerance
to
these compounds

Before:
Assess type , location and intensity of pain prior to and 3060 minutes following administration.
Assess overall status and alcohol usage before
administering to avoid risk of developing hepatotoxicity.
Assess amount, frequency, and type of drug the patient was
self- medicating, especially OTCs.
Evaluate hepatic, hematologic, and renal function
periodically .
For fever, assess fever, note presence of associated signs
( diaphoresis, tachycardia, and malaise.
During:
Check IV patency
Use aseptic technique in administering the drug to avoid
introduction of microorganisms.
May be administered without regard to meals since GI
integrity is maintained.
Keep a dose of acetylcysteine readily available at time
when overdose occurs.
After:
Inform pt of what to expect on adverse effects that may
occur to modify activities and be guided.
Advise pt. to take the medication exactly as directed and
not to take more than the recommended dose.
Advise pt. to avoid alcohol if taking more than an occasional
1-2 doses and to avoid taking concurrently with salicylates
or NSAIDs for more than a few days.
Advise pt. to avoid taking more than one acetaminophen
containing product at a time to prevent toxicity

Precaution
.Use
cautiouslyin
hepatic
disease,
renal
disease,
chronic
alcohol
abuse, malnutrition
Interactions:
Drug-Drug
Barbiturates,
carbamazepine,
rifampin,
sulfinpyrazone:
high doe or long
term use of these
drugs may their
therapeutic ffects
and
enhance
hepatotoxic effects

Hematologic:
Hemolytitopc
anemia,
leukopenia,
neutropenia,
pancytopenia
Hepatic:
Jaundice

GI:
liver
failure,
hepatotoxicit

Derm: rash,

urticaria

Nursing Responsibilities

the kidneys
Route
of
Administratio
n
IV

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data

Classification

Mechanism of
Action

of acetaminophen.
Avoid
using
together.

DRUG STUDY
Age: 57 yrs.old
Sex: Male
Date of Admission: November
21, 2013
Indication
Contraindicatio
n

Teach pt to recognize signs of chronic overdose: bleeding,

bruising, malaise, fever, sore throat.

Height: 52ft.
Weight: 50kg.

66

Body Build: Asthenic

Adverse
Effect/Reaction

Nursing Responsibilities

Generic
Name:
Clonidine
Trade Name:
Catapres

Therapeutic:
Antihypertensive
Pharmacologic:
Centrally Acting
Sympatholytic

Patients
Dose:
75mcg BID
Minimum
Dose:
0.15mg PO
Maximum
Dose
1.2mg PO
Contents:
not known
Availability:
Injectable
Tablets
Transdermal
Route/s for
Administratio
n:
PO
Transdermal

Pregnancy
Category Risk:
C

Pharmacodynamics
:
May inhibit central
vasomotor centers
decreasing
sympathetic outflow
to heart, kidneys and
peripheral
vasculature thus
lowering blood
pressure and
decreases neurogenic
pain.
Pharmacokinetics
Absorption:
Good
Distribution:
Nearly 50% is
transform to inactive
metabolites
Metabolism &
Excretion:
65% in urine, 20% in
feces
Time Reaction
Profile
Onset: 15-30mins
Peak: 1.5-2.5 hours
Duration: 6-8 hours

General
Indication:
Essential,
renal,malignant
hypertension

Contraindicate
d in:
Hypersensitivity
and to those
patients
receiving
anticoagulation
therapy

Sever pain
Prophylaxis for
Vascular
headache

Precaution:
Severe coronary
insufficiency,
recent MI, CVD,
Hepatic
Impairment

Adjunctive
therapy for
nicotine
Diabetic Diarrhea
Dysmenorrhea

Patients Actual
Indication:
Treatment for

hypertension

Interaction:
Drug-Drug:
Beta blockers
may cause
severe rebound
hypertension
CNS depressants
enhances CNS
depression
MAO Inhibitors
Decrease
Antihypersensit
ive effects

CNS: anxiety,

confusion, dizziness,
drowsiness, fatigue,
headache,
nervousness,

sedation,
somnolence

CV: bradycardia,
hypotension,
orthostatic
hypertension

Before:
Assess blood pressure
Verify Dr.s order
Prepare drug aseptically
Assess for any allergic reaction
to drug

Prepare right dosage

GI: constipation, dry

mouth, nausea,
During:
vomiting
Verify identity
GU: urine retention, Explain rationale on giving drug
impotence, UTI
Metabolic: transient
glucose intolerance
SKIN: pruritus,
dermatitis

Drug may be given rapidly in

emergency situations
Administer drug aseptically
Advise not to stop drug abruptly
After:
Document drug administration.
Advise client to report to
healthcare facility for
complications.

Half-Life:
6-20 hours

Caution pt. that drug can cause

drowsiness
Monitor blood pressure of client
carefully.
Urge pt to rise slowly & avoid
sudden position changes

DRUG STUDY

67

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data
Generic
Name:
Furosemide
Trade Name:
Lasix,
Novosemide
Patients
Dose:
40mg IVTT
every 12 hours
Minimum
Dose:
20mg IVTT
STAT
Maximum
Dose:
40mg IVTT
STAT
Contents:
not known
Availability:
Tablets; 20mg,
40mg, 80mg
Oral solution:
8mg/ml,
10mg/ml
Solution for
injection:
10mg/ml
Route/s for
Administratio
n:
PO, IM, IV

Classificatio
n

Mechanism of Action

Therapeutic:
diuretics

Pharmacodynamics:
Inhibits the reabsorption of sodium
and chloride from the loop of Henle
and distal renal tubule. Increases
renal excretion of water, sodium,
chloride, magnesium, potassium, and
calcium. Effectiveness persists in
impaired renal function.

Pharmacolo
gic:
loop diuretics

Pregnancy
Category
Risk:
C

Therapeutic Effects:
Diuresis and subsequent mobilization
of excess fluid. Decreases blood
pressure.
Pharmacokinetics
Absorption:
60-67% absorbed after oral
administration; also absorbed from
IM sites.
Distribution:
Crosses the placenta, enters breast
milk.
Metabolism & Excretion:
Minimally metabolized by the liver,
some nonhepatic metabolism, some
renal excretion as unchanged drug.

Age: 57 yrs.old
Sex: Male
Date of Admission:
November 21, 2013
Indication
Contraindication
General
Indication:
Edema due to
heart failure,
hepatic
impairment
or renal
disease.
Hypertension.
Patients
Actual
Indication:
Edema and
hypertension
prevention
due to renal
failure.

Precaution:
Severe live disease;
Electrolyte
depression; Geriatric
patients Diabetes
mellitus; Increasing
azotemia; Pregnancy
and lactation;
Children.

Time Reaction Profile

Rout
e
PO
IM
IV

Ons
et
3060mi
n
1030
min
5min

Peak
1-2 hr.

Durati
on
6-8 hr.

unkno
wn

4-8 hr.

30 min

2 hr.

Half-Life:

Contraindicated in:
Hypersensitivity;
Cross sensitivity with
thiazides and
sulfonamides may
occur; Hepatic come
and anuria; Some
liquid products may
contain alcohol, avoid
in patients with
alcohol intolerance.

Interaction:
Drug-Drug:
Increased
hypotension with
antihypertension,
nitrates or acute
ingestion of alcohol
Increses risk of
hypokalemia with
other diuretics,
amphotericin B,
stimulant laxatives
and digoxin and
increase risk or
arrhythmias.
May cause lithium
toxicity.

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic
Adverse
Effect/Reac
tion
CNS: blurred
vision,
dizziness,
headache,
vertigo

EENT:
hearing loss,
tinnitus

CV:
hypotension
GI: anorexia,
constipation,
diarrhea, dry
mouth,
dyspepsia
GU:
excessive
urination
Derm:

photosensiti
vity,

pruritus,
rash
Endo:
hyperglycem
ia,
hyperuricem
ia

F&E:
dehydration,
hypochlore
mia,
hypokalemia
,
hypomagnes
emia,
hyponatremi
a,

hypovolemia
, metabolic
alkalosis

Nursing Responsibilities
Before:
Assess client for history of
hypersensitivity of drug
components.
Do not give drug if patient
has low blood pressure.
Check for input and output
of client.
Assess client for alcohol
intolerance.
Assess client for electrolyte
status.
During:
Administer around the clock.
Explain to patient the use
and side effects of the
drug.
Observe proper route of
administration.
Promote bed rest for client.
Check patient for signs for
anaphylactic reactions.
After:
Document drug
administration.
Advise client to report to
healthcare facility for
complications.

68

30-60 min.

Hemat:
aplastic
anemia

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data
Generic
Name:
Clopidogrel
Trade Name:
Plavix

Classificatio
n
Therapeutic:
Platelet
Aggregation
Inhibitor
Pharmacolo

Mechanism of
Action
Pharmacodyna
mics:
Binds to
adenosine
diphosphate
receptors on the

DRUG STUDY
Age: 57 yrs.old
Sex: Male

Date of Admission:
November 21, 2013
Indication
Contraindicatio
n
General
Contraindicate
Indication:
d in:
To reduce
Active
atherosclerotic
pathological
events such as
bleeding,
stroke and MI
including peptic

Monitor renal function of

client by input and output.

Monitor blood pressure of

client carefully.

Monitor for recurrent

symptoms of anemia and
advise to client to rest.

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic
Adverse Effect/Reaction

Nursing Responsibilities

CNS: Confusion, depression, Before:

dizziness,
fatigue, hallucinations, headache Obtain blood cell count, as
CV:
Chest
pain,
edema,
ordered
before
hypercholesterolemia,
administration.
hypertension,
hypotension, Avoid clopidogrel in patients who

Patients
Dose:
75mg pc
lunch

gic:
Thienopyridin
e derivative

Minimum
Dose:
75mg

Pregnancy
Category
Risk:

Maximum
Dose
300mg
(loading dose)

surface of
activated
platelets. This
action blocks ADP,
which deactivates
nearby
glycoprotein
IIB/IIIA receptors
and prevents
fibrinogen from
attaching to
receptors. Without
fibrinogen,
platelets cant
aggregate and
form thrombi.

Availability:
Tablets

Pharmacokineti
cs

Route/s for
Administrati
on:
PO

Route: PO
Onset: 2hr
Peak: 3-7 days
Duration: 5 days

To reduce rate of
death, reinfarction
or stroke

ulcer
and
intracranial
hemorrhage;
hypersensitivity
to drug and its
components

Patients Actual
Indication:
To prevent clot
formation

Interaction:
Drug-Drug:
Aspirin
Increased risk of
bleeding
NSAIDS:
increased risk of
GI bleeding,
interference with
NSAID
metabolisim
Warfarin:
Prolonged
bleeding time,
interference with
warfarin
metabolism

vasculitis
EENT:
Altered
taste;
conjunctival, ocular, or retinal
bleeding;
epistaxis;
rhinitis;
taste disorders
GI: Abdominal pain; acute liver
failure;
colitis;
diarrhea;
duodenal,

gastric, or peptic ulcer; elevated

liver
function
test
results;
gastritis; indigestion; nausea;
noninfectious
hepatitis;
pancreatitis
GU: Elevated serum creatinine
level, glomerulopathy, UTI
HEME: Agranulocytosis, aplastic
anemia,
neutropenia,
pancytopenia,
prolonged
bleeding time, thrombocytopenic
purpura,
thrombotic
thrombocytopenic
purpura,
unusual bleeding or bruising
MS:
Arthralgia,
back
pain,
myalgia
RESP:
Bronchitis,
bronchospasm, cough,
dyspnea,
interstitial
pneumonitis, upper
respiratory tract infection
SKIN: Erythema multiforme,
lichen planus,
pruritus, purpura, rash, StevensJohnson
syndrome,
toxic
epidermal
necrolysis
Other:
Anaphylaxis,
angioedema, flulike
symptoms, serum sickness

have a genetic variation or

receiving CYP2c19 inhibitors.
Verify doctors order
Assess for any allergies of drug
Assess over-all condition
During:
Verify Pts identity
Explain rationale on giving drug
Clean site of administration
Administer drug aseptically
Note that clopidogrel prolongs
bleeding time
After:
Inform of the possible side effects
of drug
Monitor for signs of bleeding
Caution that bleeding may
continue longer than usual.
Instruct to report unusual
bleeding or bruising.
Monitor condition
Evaluate knowledge of drug

69
DRUG STUDY

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data
Generic
Name:
Metropolol
Trade
Name:
Inderal

Classification
Therapeutic:
Antianginals,
antiarrhythmic
s,
antihypertensiv
e, vascular
headache
suppressants

Patients
Dose:
50mg OD
Minimum
Dose:
80 mg / daily

Pharmacologi
c:
Beta blockers

Maximum
Dose:
240 mg /
daily
Availability
:
Oral Solution
Tablets
Sustainedrelease
capsules
Extendedrelease
capsules
Injection
Route/s for
Administra
tion:
PO
IV

Pregnancy
Category:
C

Mechanism of
Action
Blocks stimulation of
beta and adrenergic
receptor sites thus
decreasing heart rate
and blood pressure.
Pharmacokinetics
Absorption:
Well absorbed but
undergoes extensive
first-pass hepatic
metabolism.
Distribution:
Moderate CNS
penetration, crosses
placenta; enters
breast milk.
Metabolism &
Excretion:
Almost completely
metabolized by the
liver.
Time Reaction
Profile
Onset:
PO: 30 mins
IV: immediate
Peak:
PO: 60 90 mins
IV: 1 min
Duration:
PO: 6-12 hr
IV: 4-6 hr
Half-Life: 3.4 6 hr

Age: 57 yrs.old
Sex: Male
Date of Admission: November
21, 2013
Indication
Contraindication
General
Indication:
Management of
hypertension,
angina, arrhythmias,
hypertrophic
cardiomyopathy,
thyrotoxicosis,
essentials tremors,
pheochromocytoma.
Prevention and
management of MI,
and the prevention
of vascular
headaches

Patients Actual
Indication:
Management of
hypertension

Contraindication:
Uncompensated
CHF; Pulmonary
Edema; Cardiogenic
shock; Bradycardia
or heart block

Precaution:
Renal or hepatic
impairment,
pulmonary disease,
diabetes
mellitus,
thyrotoxicosis,
lactating
women,pregnant
women,
geriatric
clients.
Drug Interaction:
General anesthesia,
IV phenytoin and
verapamil
may
cause
additive
myocardial
depression.
Additive bradycardia
may
occur
with
digoxin.
Additive
hypotension
may
occure with other
hypertensives,
alcohol or nitrates.

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic
Adverse
Effect/Reaction
CNS: fatigue,
weakness,
anxiety,
dizziness,
drowsiness,
insomnia,
memory loss,
mental
depression,
mental status
changes,
nervousness,
nightmares
EENT: blurred
vision, dry eyes,
nasal stuffiness
Resp:
bronchospasm,
wheezing
CV: arrhythmias,
bradycardia,
CHF, pulmonary
edema,
orthostatic
hypotension,
peripheral
vasoconstriction
GI: constipation,
diarrhea, nausea
GU: erectile
dysfunction,
decreased libido
Derm: itching,
rashes
Endo:
hyperglycemia,
hypoglycemia
MS: arthralgia,
backpain, muscle
cramps

Nursing Responsibilities
Before:
Check lab test for blood levels of
BUN, serum lipoprotein,
potassium, triglyceride and
uric acid levels.
Check Blood Glucose level
Assess patients over-all
condition.
Take baseline vital sign
Take apical pulse, if < 50 bpm or
if arrhythmia occurs, withhold
medication and notify
physician.
During:
Instruct patient to take
medication as directed, at the
same time each day.
Explain rationale on giving
medication
Verify patients identity
Caution patient that this
medication may increase
sensitivity to cold.
Evaluate patients knowledge of
drug.
After:
Advised patient to change
position slowly to minimize
orthostatic hypotension
Advise patient to notify health
care professional if slow pulse,
dizziness, unusual bleeding
occurs.
Reinforce the need to continue
additional therapies for
hypertension.
Caution patient to avoid activities
that require alertness
Inform patient that abrupt
withdrawal can cause life-

threatening conditions.

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data

Classificati
on

Generic Name:
Omeprazole

Therapeuti
c:
antiulcer
agents

Trade Name:
Losec, Zegerid
Patients Dose:
A: 4g IVTT q 24
B: 40mg PO OD

Pharmacolo
gic:
proton-pump
inhibitors

Minimum
Dose:
20mg PO OD
Maximum
Dose:
120mg 3x daily

Pregnancy
Category
Risk:
C

Contents:
not known
Availability:
Delayed-release
capsules: 10mg,
20mg, 40mg
Immediatepowder for oral
suspension:
20mg packet,

Mechanism of Action
Pharmacodynamics:
Binds to enzyme on gastric
parietal cells in the presence
of acidic gastric pH,
preventing the final transport
oh hydrogen ions into the
gastric lumen.
Therapeutic Effects:
Diminished accumulation of
acid in the gastric lumen with
lessened gastroesophageal
reflux. Healing of duodenal
ulcers.
Absorption:
Rapidly absorbed following
oral administration;
immediate-release formulation
contains bicarbonate to
prevent acid degradation.
Distribution:
Good distribution into gastric
parietal cells.
Metabolism & Excretion:
Extensively metabolized by
the liver.
Time Reaction Profile

DRUG STUDY
Age: 57 yrs.old
Sex: Male
Date of Admission:
November 21, 2013
Indication
Contraindicatio
n

General
Indication:
GERD/
maintenance of
healing in erosive
esophagitis.
Duodenal ulcers.
Short-term
treatment of
active benign
gastric ulcer.
Pathologic
hypersecretory
conditions,
including
Zollinger-Ellison
syndrome.
Reduction of risk
of GI bleeding in
critically ill
patients.
Patients Actual
Indication:
Prevention of gastric
ulcers in NPO status

Contraindicated
in:
Hypersensitivity;
Metabolic
alkalosis and
hypocalcemia.
Precaution:
Liver disease;
Geriatric patients,
Bartters
syndrome,
hypokalemia and
respiratory
alkalosis;
Pregnancy,
lactation o
children.
Interaction:
Drug-Drug:
Decreases metabolism
of antifungal agents,
atazanavir,
diazepam, digoxin,
flurazepam,
triazolam,
cyclosporine,disulfer
am, phenytoin and

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic
Adverse
Effect/Rea
ction
CNS:

dizziness,
fatigue,
headache,
weakness
CV: chest
pain
GI:
abdominal
pain, acid
regurgitatio

n,
constipatio
n, diarrhea,
flatulence,
nausea and
vomiting
Derm:
itching,
rash

Misc:
allergic

reactions

Nursing Responsibilities
Before:
Assess client for history of
hypersensitivity of drug components.
Assess client for abdominal pain.
Check clients vital signs prior to
administration.
Assess client metabolic alkalosis.
Assess client for electrolyte status.
During:
Administer around the clock.
Explain to patient the use and side effects
of the drug.
Observe proper route of administration.
Administer doses before meals early in the
morning
Check patient for signs for anaphylactic
reactions.
After:

70

40mg packet
Route/s for
Administration
:
PO

Rou
te
PODR

Ons
et
w/in
1hr.

POIR

rapi
d

Pe
ak
w/i
n
2hr.
30
min
.

Duratiand underlying
condition.
on
72-96
hr.

Classification

Generic
Name:
Ketoanalogues+
essential amino
acids

Therapeutic:
Supplements

Trade Name:
Ketolog

-Amino Acid
Solution

Patients
Dose:
60g PO

Pregnancy
Category Risk:

Minimum
Dose:
Adults
(70kg/body
weight): 4
tablets 3 times
daily during
meals
Maximum
Dose:
Adults
(70kg/body

Pharmacologic
:

My increase risk of
bleeding with
warfarin.

24 hr.

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data

warfarin.

Mechanism of Action
Pharmacodynamics:
Pharmacokinetics: The
plasma kinetics of amino
acids and their integration in
metabolic pathways are well
established. It should
nevertheless be noted that,
in uremic patients, the
plasma disturbances do not
seem to depend on digested
amino acid intake, and that
the post-absorptive kinetics
seems to be distributed very
early in the development of
the disease.
In normal individuals, there is
an increase in the plasma
level of ketoanalogues, 10
min after oral ingestion.
These levels reach values
that are approximately 5
times higher than the initial
level. Peak levels are reached
within 20-60 min and normal
levels are reached again

DRUG STUDY
Age: 57 yrs.old
Sex: Male

Patients Actual
Indication:
Prevention of further
liver damage

Document drug administration.

Advise client to report to healthcare

facility for complications.

Advise client to limit ambulation and

moving on bed.

Monitor vital signs of client carefully.

Inform client on next administration of

drug.

Height: 52ft.
Weight: 50kg.

Date of Admission: November 21,

2013
Indication
Contraindicatio
n
General Indication:
Prevention and
therapy of damages
due to faulty or
deficient protein
metabolism in
chronic renal
insufficiency in
connection with
limited protein food of
40 g/day (for
adults).

Contraindicated
in:
Hypercalcemia,
disturbed amino
acid metabolism.
In case of
hereditary
phenylketonuria,
it has to be taken
into account that
Ketolog contains
phenylalanine.
Precaution:
Ketolog should be
taken during
meals to allow
proper absorption
and metabolism
into the
corresponding
amino acids. The
serum calcium
levels should be
monitored
regularly..

Body Build: Asthenic

Adverse
Effect/React
ion

Nursing Responsibilities

71
Administration:
Hypercalcemi For oral use. Tablets may be taken
a may
during meals; should be
develop.
swallowed whole.
Duration of Use: Ketolog tablets
are given as long as the GFR is
between 5 and about 15
mL/min.
Simultaneously for adults, food
should contain 40 g/day of
protein ie, generally in patients
with glomerular filtration rate
(GFR) between 5 and about 15
mL/min.
Inform health care
professional if toxicity
occurs.
Take supplements regularly
as prescribed.
Store at temperatures not
exceeding 30C. Keep in a cool
and dry place.

weight):
8tablets 3 times
daily during
meals

after 90 min. Gastrointestinal

absorption is thus very rapid.
In the plasma a simultaneous
increase in levels of the
ketoanalogue and the
corresponding amino acid
show that transamination of
the ketoanalogues are very
rapid. Due to natural
pathways of disposal of ketonic acids in the
organism, it is probable that
exogenous intakes are very
rapidly integrated into
metabolic cycles.

Contents:
Ketoanalogues
and essential
amino acids
Availability:
Tablets
Route/s for
Administratio
n:
PO

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data
Classification
Mechanism of
Action
Generic Name:
Sodium
Bicarbonate
Trade Name:
Bell-ans

Therapeutic:
Anti ulcer
Pharmacologic:
Alkalanizing agent

Patients Dose:
1 tab TID PO
Minimum Dose:
12 meQ
Maximum Dose
48 meQ

Availability:
Oral powder
Tablets
Solution for

Pharmacodynami
cs:
Acts as an
alkalinizing agent
by releasing
bicarbonate ions
which is capable of
neutralizing gastric
acid.

Pregnancy
Category Risk:
C

Pharmacokinetics
Absorption:
Rapidly absorbed
Distribution:
Widely distributed
into extracellular
fluid
Metabolism &
Excretion:
Metabolized in the

Shelf-Life: 24 months.
Interaction:
Drug-Drug:
Simultaneous
administration of
medicaments
containing
calcium (eg,
acetolyte) may
lead to
pathological
increases of the
serum calcium
level or
intensification.

DRUG STUDY
Age: 57 yrs.old
Sex: Male

Height: 52ft.
Weight: 50kg.

Date of Admission: November 21, 2013

Indication
Contraindicatio
n
General Indication:
Management of
metabolic acidosis

Contraindicated
in:
Metabolic and
respiratory
alkalosis.
Hypocalcemia,
and excessive
chloride loss

Alkalinize urine and

promote excretion
Antacid

Precaution:
Use cautiously in
CHF, renal
insufficiency,
corticosteroids
therapy

Patients Actual
Indication:
Alkalinize urine and
promote excretion

Interaction:
Drug-Drug:
May decrease
absoption of
ketoconazole

Body Build: Asthenic

Adverse
Nursing
Effect/Reactio
Responsibilities
72
n
Before:
CV: edem
Assess fluid balance all
throughout the therapy
GI: Flatulence,
Gastric
Assess for signs of
distention
acidosis
F&E: metabolic

alkalosis,
hypernatremia,
hypocalcemia,
hypokalemia,
sodium and
water retention

Neuro: Tetany

Observe proper dosage

of medication
Monitor serum
electrolyte
Assess urine PH
During:
Verify Pts identity
Medication may cause
premature dissolution of

injection
Route/s for
Administration:
PO

liver. Excreted in
the kidneys in the
form of urine

enteric-coated tablets

May negate the

protectiveness
effects of
enteric-coated
products

Explain rationale on
giving drug
Administer with full glass
of water
Keep emergency
treatment in case of
toxicity occurs

After:
Instruct to take meds as
directed

Inform of the possible

side effects of drug

Review symptoms of
electrolyte imbalance

Monitor serum
electrolyte level

Evaluate knowledge of
drug

73
DRUG STUDY

DRUG STUDY
Patients Name: Mr. NC
Diagnosis: Chronic Renal Failure secondary to DM Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data
Generic
Name:
Metocloprami
de
Trade Name:
Reglan
Patients
Dose:
10g IVTT q8

Classificati
on
Therapeuti
c:
Antiemetic
Upper GI
stimulant
Pharmacol
ogic:
Benzamide

Minimum
Dose:
10mg

Pregnancy
Category
Risk:

Maximum
Dose
2mg/kg

Availability:
Oral solution
Tablets
Injectables
Route/s for
Administrati
on:
PO
IM
IV

Mechanism of Action
Pharmacodynamics:
Antagonizes the inhibitory
effect of dopamine on GI
smooth
muscles.
This
causes gastric contraction,
which promotes gastric
emptying and peristalsis,
thus
reducing
gastroesophageal
reflux.
Metoclopramide
also
blocks
dopaminergic
receptors
in
the
chemoreceptor
trigger
zone, preventing
nausea and vomiting.
Pharmacokinetics
Absorption:
Rapidly absorbed
Distribution:
Unknown
Metabolism & Excretion:
Metabolized in the liver.
Excreted in the kidneys in
the form of urine
Rout
e
PO
IV
IM

Onse
t
3060
mins
1-3
mins
1015mi
ns

Peak

Duration

N/A

1-2 hr

N/A

1-2 hr

N/A

1-2 hr

Indication
General
Indication:
Diabetic
Gastroparesis
Gastroesophag
eal Reflux
Disease
Prevention of
Therapyinduced
Vomiting
Prevention of
postoperative
nausea and
vomiting

Patients
Actual
Indication:
Prevention of
therapyinduced
vomiting

Age: 57 yrs.old
Height: 52ft.
Sex: Male
Weight: 50kg.
Date of Admission:
Body Build: Asthenic
November 21, 2013
Contraindication
Adverse
Nursing Responsibilities
Effect/Reaction
Contraindicated in:
CNS: Agitation,
Before:
Concurrent
use
of anxiety,
Assess patient for signs of
butyrophenones,phenot
depression,
intestinal
hiazines,
dizziness,
obstruction, such as abnormal
or other drugs that may drowsiness,
bowel
cause
extrapyramidal
sounds, diarrhea, nausea, and
extrapyramidal
reactions
vomiting,
reactions;
GI (motor
Use metoclopramide cautiously
Hemorrhage,mechanica restlessness,
in patients with hypertension
l
obstruction,
or parkinsonism,
because it may increase
perforation;
tardive
catecholamine levels.
hypersensitivity
to dyskinesia),
Urge patient to avoid alcohol
metoclopramide or its fatigue,
and CNS
components;
headache,
depressants while taking drug
insomnia,
Verify doctors order
Precaution:
irritability,
Dont administer
lassitude,
Assess for any allergies of drug
metoclopramide
neuroleptic
through
malignant
During:
same I.V. line as
syndrome, panic
Verify Pts identity
calcium
reaction,
gluconate,cephalothin
restlessness
Explain rationale on giving drug
sodium,
CV: AV block,
chloramphenicol
fluid retention,
sodium,cisplatin,erythro heart failure,
For I.V. use, you need not dilute
mycin
hypertension,
doses of
lactobionate,furosemid
hypotension,
10 mg or less. Give drug over 1 to 2
e, methotrexate,
supraventricular
minutes.
penicillin G
tachycardia
Clean site of administration
potassium, or sodium
EENT: Dry mouth
bicarbonate.
ENDO:
Administer drug aseptically
Galactorrhea,
Interaction:
gynecomastia
After:
Drug-Drug:
GI: Constipation,
Inform of the possible side effects of
Anticholinergics, opioid
diarrhea, nausea
drug
analgesics: Possibly
GU: Menstrual
decreased
irregularities
Monitor patient, especially one
metoclopramide effects
HEME:
with heart failure or cirrhosis,
Agranulocytosis
for possible fluid retention or
SKIN: Rash
volume
overload
due
to
transient increase in plasma
aldosterone level.

74

Store drug in a light-resistant

container;
discard if discolored or contains
particulate.
Advise against activities that
require alertness
for about 2 hours after each dose
Evaluate knowledge of drug

Patients Name: Mr. NC

Diagnosis: Chronic Renal Failure secondary to DM
Nephropathy
Doctor: Dr. Augustine Aguhob
Drug Data

Generic
Name:
Calcium
Carbonate
Trade Name:
Apo-Cal
Patients
Dose:
1 tab TID
Minimum
Dose:
2 tablets
Maximum
Dose
3-4 tablets

Classification

Mechanism of
Action

Therapeutic:
Antacid
Antihypermagnese
mic,
Antihyperphosphat
emic
Antihypocalcemic
Calcium
replacement
Cardiotonic

Pharmacodyna
mics:
Increases levels
of intracellular
and extracellular
calcium, which is
needed to
maintain
homeostasis,
especially in the
nervous and
musculoskeletal
systems.
Neutralize or
buffer stomach
acid to relieve
discomfort
caused by
hyperacidity.

Pharmacologic:
Elemental cation

Pregnancy
Category Risk:
C

Availability:
Tablets
Capsules
Oral
suspension
Syrup
IV injection

Pharmacokinet
ics
Route: PO
Onset: unknown
Peak: unknown
Duration:
unknown

DRUG STUDY
Age: 57 yrs.old
Sex: Male
Date of Admission:
November 21, 2013
Indication
Contraindication

General
Indication:
To treat
hyperphospha
temia
Prevention of
hypocalcemia
Provide
antacid
effects
Replace
calcium in
hypocalcemia
Patients
Actual
Indication:
To bind
dietary
phosphorus,
reduce
phosphorus
retention, and

Contraindicated
in:
Hypercalcemia,
hypersensitivity to
calcium salts or
their components,
hypophosphatemia
, renal calculi
Interaction:
Drug-Drug:
Aluminumcontaining
antacids: enhance
aluminum
absorption with
use of calcium
citrate
Atenolol:
decreased blood
atenolol level and
beta blockade
Calcitonin: possibly
antagonized

Height: 52ft.
Weight: 50kg.
Body Build: Asthenic
Adverse
Effect/Reaction

Nursing Responsibilities

CNS: Paresthesia
CV: Hypotension,
irregular heartbeat
GI: Nausea or

vomiting
SKIN: Diaphoresis,
flushing, or
sensation of

warmth
Other:

Hypercalcemia;
injection site
burning,
pain,
rash,
or
redness

Before:
Obtain
serum
values
Verify doctors order

electrolyte

Assess for any allergies of drug

Assess over-all condition
Assess for signs of hypocalcemia
During:
Verify Pts identity
Explain rationale on giving drug

Instruct to take calcium carbonate

tablets 1 2 hours after meals.
Give with full glass of water
Administer drug aseptically

After:
Inform of the possible side effects of
drug

Route/s for
Administrati
on:
PO
IM
IV

prevent
negative
calcium
balance.

effects of calcitonin
in hypercalcemia
treatment
Calcium /
magnesiumcontaining
preparations:
increased serum
calcium or
magnesium level

Regularly
monitor
serum
calcium level
Instruct
to
avoid
taking
calcium within 2 hours of
another oral drug because of
risk of interactions
Monitor condition
Evaluate knowledge of drug

75