Date ordered Feb.

7, 2012

Name of the drug Ranitidine Dosage: 50mg Route: TIV Frequency: q8 Drug Class: Histamine2 antagonist

Drug action Pharmacodynamics Competitively inhibits the action of histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion that is stimulated by food, insulin, histamine, cholinergic agonists, gastrin and pentagastrin. Pharmacokinetics Metabolism: Hepatic. Onset: immediate Peak: 5-10min Duration: 37 h. Distribution: Crosses placenta; enters breast milk Excretion: Urine

Indication -Short-term active treatment of duodenal / gastric ulcer -maintenance therapy for duodenal ulcer at reduced dosage -treatment of heartburn, acid indigestion, sour stomach

Nursing Responsibilities -Advise to have regular follow-up care to evaluate response to drug. -Instruct that patient may experience these side effects: constipation or diarrhea, enlargement of breasts, headache (adjust lights and avoid noise) -Instruct to report sore throat, fever, unusual bruising or bleeding, tarry stools, confusion, dizziness, severe headache, muscle or joint pain.

Date ordered Feb. 7, 2012

Name of the drug Nalbuphine Hcl Frequency: q4 Dosage: 5mg Route: TIV Drug Class Opioid agonist-antagonist analgesic

Drug action Pharmacodynamics Acts as an agonist at specific opioid receptors in the CNS to produce analgesia and sedation but also acts to cause hallucinations and is an antagonist at mu receptors. Pharmacokinetics Metabolism: Hepatic Onset: 2-3 min. Peak: 15-20 min Distribution: crosses placenta; enters breast milk Elimination: urine Half-Life: 5 hr

Indication Relief of moderate to severe pain

Nursing Responsibilities -Keep opioid antagonists and assisted or controlled respiration available in case of respiratory depression -instruct that patient may experience these side effects: dizziness, sedation, drowsiness, impaired visual acuity, nausea, loss of appetite (eat small frequent meals) -instruct to report severe nausea, vomiting, palpitations, shortness of breath, or difficulty breathing

Date ordered Feb. 7, 2012

Name of the drug Celecoxib Frequency: OD Dosage: 400mg Route: PO Drug Class

Drug action Pharmacodynamics Analgesic and antiinflammatory activities related to inhibition of COX-2 enzyme, which is activated in inflammation to cause the signs and symptomsassociated with inflammation; does not affect the COX-1 enzyme, which protect the lining of the GI tract and has blood clotting and renal functions. Pharmacokinetics Onset: slow Peak:3 hr Metabolism: Hepatic Distribution: Crosses placenta; may enter breast milk Excretion: bile, urine

Indication Reduction of the number of colorectal polyps in familial adenomatous polyposis

Nursing Responsibilities -advise to take drug with food or meals if GI upset occurs -instruct to take only the prescribed drug and avoid over dosage. -provide further comfort measures to reduce pain and reduce inflammation e.g., positioning, environmental control, warmth, rest. -instruct to report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers, changes in vision.