Drug Name: lactulose Brand Name: Cephulac, Cholac Pharmacologic Class: dissacharride Therapeutic Class: Laxative

Indication - Constipation - To prevent and treat hepatic encephalopathy, including hepatic precoma and coma in patients with severe hepatic disease - To induce bowel evacuation in geriatric patient with colonic retention of barium and severe constipation after a barium meal examination. - To restore bowel movements after hemorrhoidectomy

Contraindication - Contraindicated in patients with lowgalactose diet. - Use cautiously in patients with Diabetes Mellitus because drugs contains lactose and galactose

Adverse Effect - Abdominal cramps and distension, belching, diarrhea, flatulence, n/v

Action - Chemical Effect: Produces osmotic effect in colon. Resulting distension promotes peristalsis. Decrease blood ammonia buildup that causes hepatic encephalopathy ; probably result of bacterial degradation, which lowers pH of colon contents. - Therapeutic Effect: Relieves constipation, decreases blood ammonia concentration.

Nursing Responsibilities - Assess condition before therapy and reassess regularly thereafter to monitor drugs effectiveness - Monitor pt for any adverse GI reactions, nausea, vomiting, diarrhea, - Assess for adverse reactions - for pt. with hepatic encepalopathy: regularly assess mental condition - monitor I & O - monitor for Inc. glucose level in diabetic pts

Drug Name: Kalium Durule Brand Name: Potassium Chloride Pharmacologic Class: Electrolytic and water balance agent Therapeutic Class: Mineral

Indication - To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy. -Indicated when potassium is depleted by severe vomiting, diarrhea, intestinal drainage, fistulas or malabsorption, prolonged diuresis, diabetic acidosis. - Effective in the treatment of hypokalemic alkalosis.

Contraindication - severe renal impairment, untreated addisons disease - early postoperative oliguria - acute dehydration, heat cramps, hyperkalemia, patients receiving potassium sparing diuretics - digitalis intoxication with AV conduction disturbance.

Adverse Effect - GI: n/v, diarrhea, vomiting, diarrhea, abdominal distension - Whole Body: pain mental confusion, irritability, listleness, paresthesias of extremities, muscle weakness - Urogenital: oliguria, anuria - Hematologic: Hyperkalemia - CV: hypotension, bradycardia, cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides.

Action - Chemical Effect: Aids in transmitting nerve impulses, contracting cardiac and skeletal muscles, and maintaining intracellular tonicity, cellular metabolism, acid-base balance and normal renal function. - Therapeutic Effect: Replaces and maintains potassium level.

Nursing Responsibilities - monitor I&O ratio pattern in patients receiving the parenteral drug. If oliguria occurs stop the infusion promptly and notify the physician. - Lab test: Frequent serum electrolytes are warranted. Monitor for and report signs of GI ulceration Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia. Be alert for potassium intoxication; it may result from any therapeutic dosage, and tha patient may be asymptomatic.

-ECG: changes in hyperkalemia: peak of T wave, lowering of R with deepening of S waves and depression of RST; prolonged P-R interval; widened QRS complex, decreased amplitude and disappearance of P waves, prolonged Q-T interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death.

Drug Name: Furosemide Brand Name: Lasix Pharmacologic Class: loop diuretic Therapeutic Class: Diuretic; antihypertensive

Indication Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.

Contraindication History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.

Adverse Effect - CV: Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse. - Metabolic: Hypovolemia, dehydration, hyponatremia hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemi a, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia. - GI: Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis,

Action Rapid-acting potent sulfonamide "loop" diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow

Nursing Responsibilities
Observe patients

receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia. Monitor I&O ratio and pattern. Report

jaundice. - Urogenital: Allergic interstitial nephritis, irreversible renal failure, urinary frequency. - Hematologic: Anemia, leukopenia, thrombocytopeni c purpura; aplastic anemia, agranulocytosis (rare). - Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision. - Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). - Body as a

decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis , pain at IM injection site.

Drug Name: Omeprazole Brand Name: Prilosec Pharmacologic Class: substituted benzimidazole Therapeutic Class: Proton pump inhibitor

Indication - Erosive esophagitis; symptomatic, poorly responsive gastroesophageal reflux disease (GERD) - GERD without erosive esophagitis - Patholigic hypersecretory conditions - duodenal & Gastric ulcers -

Contraindication - patients with hypersensitivity to drug or any of its components. -use cautiously with pregnancy, lactation

Adverse Effect - CNS: dizziness, headache - GI: abdominal pain, constipation, diarrhea, flatulence, n/v -Musculoskeletal: Back pain - Respiratory: cough - Skin: rash

Action - Chemical Effect: inhibits acid (proton) pump and binds to hydrogenpotassium adenosine triphosphate on secretory surface of gastric parietal cells to block formation of gastric acid. - Therapeutic Effect: relieves symptoms caused by excessive gastric acid.

Nursing Responsibilities - assess history of hypersensitivity to omeprazole or any of it component - assess patient condition before starting therapy and regularly thereafter to monitor drugs effectiveness. - be alert for adverse reaction and drug interactions - if adverse GI reactions occur, monitor patients hydration

Drug

Indication - Peptic ulcer, Gastritis

Contraindication

Adverse Effect

Action

Nursing Responsibilities

Name: Rebamipide Brand Name: mucosta Pharmacologi c Class: Therapeutic Class: Antacid

-use cautiously with pregnancy, lactation

Rash, pruritus, constipation, di arrhoea, nausea

Rebamipide is a mucosal protective agent and is postulated to increase gastric blood flow,prostaglandin biosynthesis and decrease free oxygen radicals.

- monitor any signs of adverse reaction.