Question

Hello , I would like to know about these two durgs medication classification, name of common medication in this classification, major action, common side effects, why client is taking this drug? Is these drugs is working for this client( must include the rational with proof( lab work, charting documentation, what action the nurse take when monitoring the patient? nursing assessment of drug's effectiveness, teaching about medications, important information relating to these drugs on discharge. Drug names are Farxiga, cetirzine Thank you.

Answer 1

1) Classification :-
Farxiga comes as a tablet you take by mouth once daily. It contains the active drug dapagliflozin. And it belongs to a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors.
2) Name Of Common Medication in this Classification :-
Dapagliflozin (Farxiga) is an oral medication used to improve glycemia (blood glucose) control in patients with type 2 diabetes. Dapagliflozin is a sodium-glucose cotransporter (SGLT2) inhibitor. It is similar to canagliflozin (Invokana) and empagliflozin (Jardiance).
3)Major Action :-
Farxiga is a prescription medicine used in adults with type 2 diabetes to: improve blood sugar (glucose) control along with diet and exercise. reduce the risk of hospitalization for heart failure.
4) Common Side Effects :-Dehydration (loss of body water and salt). Dehydration leading to symptoms of low blood pressure and changes in kidney function have happened in people who are taking FARXIGA.Ketoacidosis in people with diabetes mellitus (increased ketones in your blood or urine).Serious urinary tract infections.
5) Why Client is taking this drug?
Farxiga helps excess sugar leave the body through urine. This results in lower blood sugar levels. This is different from other diabetes medications. Most medications used to treat Type 2 diabetes involve the hormone insulin.
6) The diagnostic process proceeds as first a patient experiences a health problem. The patient is likely the first person to consider his or her symptoms and may choose at this point to engage with the health care system. Once a patient seeks health care, there is an iterative process of information gathering, information integration and interpretation, and determining a working diagnosis.Performing a clinical history and interview, conducting a physical exam, performing diagnostic testing, and referring or consulting with other clinicians are all ways of accumulating information that may be relevant to understanding a patients health problem. The information gathering approaches can be employed at different times, and diagnostic information can be obtained in different orders. The continuous process of information gathering, integration, and interpretation involves hypothesis generation and updating prior probabilities as more information is learned.Communication among health care professionals, the patient, and the patient’s family members is critical in this cycle of information gathering, integration, and interpretation.The working diagnosis may be either a list of potential diagnoses a differential diagnosis or a single potential diagnosis. Typically, clinicians will consider more than one diagnostic hypothesis or possibility as an explanation of the patients symptoms and will refine this list as further information is obtained in the diagnostic process. The working diagnosis should be shared with the patient, including an explanation of the degree of uncertainty associated with a working diagnosis. Each time there is a revision to the working diagnosis, this information should be communicated to the patient. As the diagnostic process proceeds, a fairly broad list of potential diagnoses may be narrowed into fewer potential options, a process referred to as diagnostic modification and refinement. As the list becomes narrowed to one or two possibilities, diagnostic refinement of the working diagnosis becomes diagnostic verification, in which the lead diagnosis is checked for its adequacy in explaining the signs and symptoms, its coherency with the patients context physiology, risk factors, and whether a single diagnosis is appropriate. When considering invasive or risky diagnostic testing or treatment options, the diagnostic verification step is particularly important so that a patient is not exposed to these risks without a reasonable chance that the testing or treatment options will be informative and will likely improve patient outcomes.Throughout the diagnostic process, there is an ongoing assessment of whether sufficient information has been collected. If the diagnostic team members are not satisfied that the necessary information has been collected to explain the patients health problem or that the information available is not consistent with a diagnosis, then the process of information gathering, information integration and interpretation, and developing a working diagnosis continues. When the diagnostic team members judge that they have arrived at an accurate and timely explanation of the patients health problem, they communicate that explanation to the patient as the diagnosis.
Assess renal function prior to initiation of Farxiga therapy and then as clinically indicated. In patients with volume depletion, correct this condition prior to initiation of Farxiga.
7) Serious side effects and their symptoms can include: Dehydration and low blood pressure. Symptoms can include: dizziness,feeling faint,lightheadedness,weakness, especially when you stand up,low blood sugar level (hypoglycemia). Symptoms can include: drowsiness,headache,confusion,weakness,hunger,irritability,sweating,feeling jittery,fast heartbeat,severe allergic reaction,kidney damage,serious urinary tract infections (UTIs),ketoacidosis,fournier’s gangrene.
8) Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of antihyperglycaemic agents with an insulin independent mode of action. Dapagliflozin is a member of the SGLT2 inhibitors class that has received marketing authorization in Europe and the US for use in patients with type 2 diabetes. This review summarizes current evidence from clinical trials assessing the clinical efficacy and safety of dapagliflozin, and presents data regarding its cost effectiveness. Treatment with dapagliflozin results in similar reduction in haemoglobin A1c with other oral antihyperglycaemic drugs, which is preserved over 4 years of treatment. However, compared with most antidiabetic agents, dapagliflozin provides additional clinical benefits including body weight loss and blood pressure reduction. Moreover, treatment with dapagliflozin does not increase risk for hypoglycaemia, but is associated with increased incidence of mild to moderate urinary and genital tract infections. A pivotal outcomes trial of dapagliflozin is expected to clarify its effect on cardiovascular endpoints, whilst a causative relationship between dapagliflozin and select malignancies is unlikely. Finally, based on recent economic evaluations dapagliflozin seems to be a cost effective option for type 2 diabetes in some settings.
9) Farxiga (dapagliflozin) is an oral diabetes medicine that helps control blood sugar levels. Dapagliflozin works by helping the kidneys get rid of glucose from your bloodstream. Farxiga is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.
10) Farxiga is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.Farxiga is used to lower the risk of needing to be in the hospital for heart failure in adults with type 2 diabetes who also have heart disease.Farxiga is also used to lower the risk of needing to be in the hospital for heart failure in adults who have heart failure when the heart is weak and cannot pump enough blood to the rest of the body.Farxiga is not for treating type 1 diabetes.You should not use Farxiga if you have diabetic ketoacidosis, severe kidney disease, or if you are on dialysis.Taking Farxiga can make you dehydrated, which could cause you to feel weak or dizzy especially when you stand up. Farxiga can cause serious infections in the pe-nis or vag-ina. Get medical help right away if you have burning, itching, odor, discharge, pain, tenderness, redness or swelling of the genital or rectal area, fever, or if you don't feel well.

CETIRIZINE-
1) Cetirizine is in a class of medications called antihistamines. It works by blocking the action of histamine, a substance in the body that causes allergic symptoms. Cetirizine is also available in combination with pseudoephedrine.
2) Cetirizine, a metabolite of hydroxyzine, is an antihistamine drug. Its main effects are achieved through selective inhibition of peripheral H1 receptors. Theantihistamine activity of cetirizine has been shown in a variety of animal and human models.
3)Common side effects:
feeling sleepy and tired.
headaches.
dry mouth.
feeling sick (nausea)feeling dizzy.
stomach pain.
diarrhoea.
sore throat.
4) Cetirizine is used to temporarily relieve the symptoms of hay fever (allergy to pollen, dust, or other substances in the air) and allergy to other substances (such as dust mites, animal dander, cockroaches, and molds). These symptoms include sneezing; runny nose; itchy, red, watery eyes; and itchy nose.
5) Molecular Formula- C21H25ClN2O3
6)Cetirizine is a metabolite of hydroxyzine and a selective peripheral histamine H1-receptor antagonist. It is used for symptomatic treatment of seasonal and perennial allergic rhinitis and for chronic urticaria. (NCI)

NCI Thesaurus (NCIt)
Cetirizine Hydrochloride is a synthetic phenylmethyl-piperazinyl derivative, antihistaminic Cetirizine is a metabolite of hydroxyzine and a selective peripheral histamine H1-receptor antagonist. It is used for symptomatic treatment of seasonal and perennial allergic rhinitis and for chronic urticaria. (NCI04)

NCI Thesaurus (NCIt)
Cetirizine is a member of the class of piperazines that is piperazine in which the hydrogens attached to nitrogen are replaced by a (4-chlorophenyl)(phenyl)methyl and a 2-(carboxymethoxy)ethyl group respectively. It has a role as an anti-allergic agent, a H1-receptor antagonist, an environmental contaminant and a xenobiotic. It is a monocarboxylic acid, a member of piperazines, a member of monochlorobenzenes and an ether.

7) Nursing Assessment
History taking and examination of a patient using Cetirizine may include the following:

Assess for possible contraindications or cautions: any history of allergy to antihistamines; pregnancy and lactation; and prolonged QT interval, which are contraindications to the use of the drug; and renal or hepatic impairment, which requires cautious use of the drug.
Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with the drug therapy.
Assess the skin color, texture, and lesions to monitor for anticholinergic effects or allergy.
Evaluate orientation, affect, and reflexes to monitor for changes due to CNS effects.
Assess respirations and adventitious sounds to monitor drug effects.
Evaluate renal and liver function tests to monitor for factors that could affect the metabolism or excretion of the drug.

Nursing interventions for patients using Cetirizine include the following:

Proper administration. Administer drug on an empty stomach, 1 hour before or 2 hours after meals, to increase the absorption.
Drug effectiveness. Note that the patient may have a poor response to one of these agents but a very effective response to another; the prescriber may need to try several different agents to find the one that is most effective.
Relief from dry mouth. Because of the drying nature of antihistamines, patients often experience dry mouth, which may lead to nausea and anorexia; suggest sugarless candies or lozenges to relieve some of the discomforts.
Safety measures. Provide safety measures as appropriate if CNS effects occur to prevent patient injury.
Increase fluid intake. Increase humidity and push fluids to decrease the problem of thickened secretions and dry nasal mucosa.
Ensure voiding. Have patient void before each dose to decrease urinary retention if this is a problem.
Skin care. Provide skin care as needed if skin dryness and lesions become a problem to prevent skin breakdown.
Avoid alcohol. Caution the patient to avoid alcohol while taking these drugs because serious sedation can occur.
Avoid OTC drugs. Caution the patient to avoid excessive dose and to check OTC drugs for the presence of antihistamines, which are found in many OTC preparations and could cause toxicity.
Health teaching. Provide thorough patient teaching, including the drug name and prescribed dosage measure to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about the drug therapy and promote compliance.
Encourage patient support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.

Evaluation
Evaluation of a patient using Cetirizine include:

Monitor patient response to the drug (relief of the symptoms of allergic rhinitis).
Monitor for adverse effects (skin dryness, GI upset, sedation and drowsiness, urinary retention, thickened secretions, glaucoma).
Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug.
Monitor the effectiveness of comfort and safety measures and compliance with the regimen.