Question

Complete drugs cards

Generic /brand name

Category class

expected Pharmacological Action

Complications

Contraindications/Precautions

Interactions

Medication Administration

Evaluation of Medication Effectiveness

Therapeutic Use

Nursing Interventions

Client Education

1. Sinemet

2. Amantadine

3. Rocephin

Answer 1

1. Sinemet :-combination of two medications levodopa and carbidopa

Generic /brand name :-carbidopa levodopa /atamet

Category class:-levodopa central nervous system agent/carbidopa Decarboxylase inhibitors

Expected Pharmacological Action:-levodopa is converted to dopamine in the brain.Carbidopa works by preventing levodopa being broken down before it reaches the brain

Complications:-dizziness ,nausea,vomiting,loss of appetite,diarrhea,dry mouth,constipation,confusion,nervousness,nightmares,difficulty sleeping,headache,weakness,increased sweating,impaired movement,chest pain,hypotention,cardiac irregularities

Contraindications/Precautions:-allergic to carbidopa or levodopa,taking or have recently stopped taking a monoamine oxidase inhibitor,pregnancy and lactation .Use cautiously in patients with history of severe cardiovascular and pulmonary disease,renal hepatic or endocrine disease ,do not drive or operate heavy machinery .

Interactions:-

• Dopamine D2 receptor antagonist and isoniazid may reduce therapeutic effects of levodopa
• Use of sinemet with dopamine depleting agents or other drugs known to deplete monoamine stores is not recommended
• Antidepressant antihistamines haloperidol iron pills and vitamins containing iron metoclopromide phenytoin resperidone

Medication Administration:-recommended starting dose of carbidopa levodopa is 25mg-100mg tablet orally thrice daily

Evaluation of Medication Effectiveness:-carbidopa allows patients treated for parkinsons disease to use much lower doses of levodopaSome patient who responded poorly to levodopa have improved on sinemet this is most likely due to decreased peripheral decarboxylation of levodopa caused by administration of carbidopa rather than by a primary effect of carbidopa on the nervous system.carbidopa may also reduce nausea and vomiting and permit more rapid titration of levodopa

Therapeutic Use:-parkinsons disease ,symptomatic parkinsonism,post encephalitic parkinsonism

Nursing Interventions:-

● Assess parkinsonian symptoms (akinesia, rigidity, tremors, pill rolling, shuffling gait, mask-like face, twisting motions, and drooling) during therapy. “On-off phenomenon” may cause symptoms to appear or improve suddenly.

● Assess BP and pulse frequently during period of dose adjustment.

● Monitor hepatic and renal function and CBC periodically in patients on long-term therapy. May causeqAST, ALT, bilirubin, alkaline phosphatase, LDH, and serum protein-bound iodine concentrations. May causepBUN, creatinine, and uric acid.

● May cause hemoglobin,phematocrit, agranulocytosis, hemolytic and nonhemolytic anemia, thrombocytopenia, leukopenia..

● Toxicity and Overdose: Assess for signs of toxicity (involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of tongue, behavioral changes). Consult health care professional if symptoms occur.

Client Education:-

1:-take these medication by mouth with or without food as directed by your doctor usually 3 to 4 times a day

2:-taking these medication with food may help to decrease nausea

3:-best to avoid high protien diet (decreases the amount of levodopa that your body takes in)during treatment

4:-seperate your dose of these medication by as many hours as possible from any iron suppliments or products containing iron such as multivitamine with minarals

5:-to reduce the risk of side effects start these medication at a low dose and gradualy increase your dose

6:-follow your doctors instuction carefully

7:-use these medication regularly to get the most benifit from it take it at the same time each day

8:-do not stop taking medication with out consulting your doctor

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2. Amantadine

Generic /brand name:-Amantadine/Symmetrel

Category class-antiparkinson agent,anti virals

Expected Pharmacological Action-Potentiates the action of dopamine in the CNS. Prevents penetration of influenza A virus into host cell. Therapeutic Effects: Relief of Parkinson’s symptoms. Prevention and decreased symptoms of influenza A viral infection.

Complications:-CNS: ataxia, dizziness, insomnia, anxiety, confusion, depression, drowsiness, psychosis, seizures, urges (gambling, sexual).GI: nausea, vomiting, anorexia, constipation. EENT: blurred vision, dry mouth. Resp: dyspnea. CV: hypotension, HF, edema. GU: urinary retention. Derm: mottling, livedo reticularis, melanoma, rashes.Hemat: leukopenia, neutropenia.

Contraindications/Precautions:-Contraindicated in: Hypersensitivity. Use Cautiously in:Seizure disorders; Liver disease; Psychiatric problems; HF; Renal impairment

Interactions:-Drug-Drug: Concurrent use of antihistamines, phenothiazines, quinidine, disopyramide, and tricyclic antidepressants may increase anticholinergic effects (dry mouth, blurred vision, constipation).increase risk of adverse CNS reactions withalcohol. increase risk of CNS stimulation with other CNS stimulants.

Medication Administration:-Parkinson’s Disease PO (Adults): 100 mg 1– 2 times daily (up to 400 mg/day). Influenza A Viral Infection PO (Adults and Children 12 yr): Treatment—200 mg/day as a single dose or 100 mg bid (not 100 m g/day in geriatric patients); Prophylaxis—100 mg/day in 1– 2 divided doses. PO (Children 10–12 yr): 100 mg q 12 hr or 5 mg/kg/day in 1– 2 divided doses; not to exceed 200 mg/day. PO (Children 1–9 yr): 5 mg/kg/day in 1– 2 divided doses; not to exceed 150 mg/ day.

Evaluation of Medication Effectiveness:-

● Decrease in akinesia and rigidity. Full therapeutic effects may require 2 wk of therapy.

● Absence or reduction of influenza A symptoms

Therapeutic Use:-

Symptomatic initial and adjunct treatment of Parkinson’s disease. Prophylaxis and treatment of influenza A viral infections.

Nursing Interventions:-

● Monitor BP periodically. Assess for drug-induced orthostatic hypotension.

● Monitor vital signs and mental status periodically during first few days of dose adjustment in patients receiving 200 m g daily; side effects are more likely.

● Assess for HF (peripheral edema, weight gain, dyspnea, rales/crackles, jugular venous distention), especially in patients on chronic therapy or with a history of HF.

● Assess patient for the appearance of a diffuse red mottling of the skin (livedo reticularis), especially in the lower extremities or on exposure to cold. Disappears withcontinued therapy but may not completely resolve until 2– 12 wk after therapy has been discontinued.

● Geri: Monitor intake and output closely in geriatric patients. May cause urinary retention. Report significant discrepancy or bladder distention.

● Parkinson’s Disease: Assess akinesia, rigidity, tremors, and gait disturbances before and throughout therapy.

● Influenza Prophylaxis or Treatment: Monitor respiratory status (rate, breath sounds, sputum) and temperature periodically. Supportive treatment is indicated if symptoms occur.

● Toxicity and Overdose:Symptoms of toxicity include CNS stimulation (confusion, mood changes, tremors, seizures, arrhythmias and hypotension

Client Education

● Advise patient to take medication around the clock as directed and not to skip doses or double up on missed doses. If a dose is missed, do not take within 4 hr of the next dose.

● May cause dizziness or blurred vision. Advise patient to avoid driving or other activities that require alertness until response to the drug is known.

● Advise patient to make position changes slowly to minimize orthostatic hypotension.

● Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may decrease dry mouth. Consult health care professional if dry mouth persists for 2 wk.

● Advise patient to confer with health care professional before taking OTC medications, especially cold remedies, or drinking alcoholic beverages.

● Instruct patient to notify health care professional if confusion, mood changes, difficulty with urination, edema and shortness of breath, new or increased gambling, sexual, or other intense urges, or worsening of Parkinson’s disease symptoms occurs.

● Antiviral: Instruct patient and family to notify health care professional if influenza symptoms occur when amantadine is used as prophylaxis or if symptoms do not improve in a few days when product is used for treatment.

● Parkinson’s Disease: Advise patient that up to 2 wk of therapy may be needed for full benefit of medication. Notify health care professional if medication gradually loses its effectiveness. Amantadine should be tapered gradually; abrupt withdrawal may precipitate a parkinsonian crisis.

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3. Rocephin

Generic /brand name:-ceftriaxone/rocephin

Category class:-anti infectives/third generation cephalosporin

Expected Pharmacological Action:-Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum:Similar to that of second-generation cephalosporins, but activity against staphylococci is less, while activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents

Complications:-CNS: SEIZURES (high doses).

GI: Pseudomembranous colitis, diarrhea, cholelithiasis, gallbladder sludging.

Dermatology: rashes, urticaria.

Hematology: bleeding, eosinophilia, hemolytic anemia, leukopenia, thrombocytosis

Local: pain at IM site, phlebitisatIV site.Misc:allergic reactions including ANAPHYLAXIS, superinfection

Contraindications/Precautions:-

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins

Use Cautiously in: Combined severe hepatic and renal impairment

pregnancy and lactation

Interactions:-should not be administerd with any calcium containing solutions

Medication Administration:-

• im /iv adult:-infections 1-2 gm every 12 to 24 hrs
• gonorrhea 250 mg im single dose
• meningitis 2gm every 12 hr
• perioperative prophylaxis 1gm 0.5 to 2 hr before surgery single dose

Evaluation of Medication Effectiveness:-

• Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
• Decreased incidence of infection when used for prophylaxis

Therapeutic Use:-

Treatment of: Skin and skin structure infections, Bone and joint infections, Complicated and uncomplicated urinary tract infections, Uncomplicated gynecological infections including gonorrhea, Lower respiratory tract infections, Intra-abdominal infections, Septicemia, Meningitis, Otitis media. Perioperative prophylaxis.

Nursing Interventions:-

● Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.

● Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.

● Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.

● Pediatrics: Assess newborns for jaundice and hyperbilirubinemia; can increase bilirubinemia and should not be administered to jaundiced neonates, especially premature neonates.

● Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.

● Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy

Client Education:-

● Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.

● Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.