a.

Medical-Surgical Ward ( 3 Medications )

DRUG STUDY

Patient: Q.W.E Age: 49 years old Hospital no.: 1234567

Impression: Severe Coronary Artery Disease Attending Physician: Dr. Santos Room no.: 111
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CNS: Abnormal dreams, •Atorvastatin is used • Stress that atorvastatin
atorvastatin calcium 10 – 20 mg/day To reduce debilitating amnesia, asthenia in patients with is an adjunct to—
cardiovascular events such as emotional lability, facial homozygous familial not a substitute for—
stroke and MI in patients with paralysis, fever, headache, hypercholesterolemia low-cholesterol diet.
Brand: Timing:
multiple risk factors but without hyperkinesia, lack of as an adjunct to other • Tell patient to take
Lipitor OD (Once a Day) coordination, malaise, lipid-lowering drug at the same time
known coronary artery disease.
paresthesia, peripheral treatments each day to maintain its
Classification: Duration: Mechanism of Action: neuropathy, somnolence, or alone only if other effects.
HMG-CoA reductase 4 weeks Reduces plasma cholesterol and syncope, weakness treatments • Instruct patient to take
inhibitors (statins) lipoprotein levels by inhibiting CV: Arrhythmias, aren’t available. a missed dose as
Other forms: HMG-CoA reductase and elevated serum CK level, • Atorvastatin may be soon as possible. If it’s
cholesterol synthesis in the liver orthostatic hypotension, used with colestipol almost time for his
N/A
and by increasing the number of palpitations, phlebitis, or cholestyramine for next dose, he should
LDL receptors on liver cells to vasodilation additive skip the missed dose.
enhance LDL uptake and EENT: Amblyopia, antihyperlipidemic Tell him not to double
breakdown. altered refraction, dry effects. the dose.
eyes, dry mouth, • Expect atorvastatin • Instruct patient to
epistaxis, eye to be used in patients consult prescriber
hemorrhage, without obvious before taking OTC
gingival hemorrhage, coronary artery disease niacin because of
glaucoma, glossitis, (CAD) but with increased risk of
hearing loss, lip swelling, multiple risk factors rhabdomyolysis.
loss of taste, pharyngitis, (such • Advise patient to
sinusitis, stomatitis, taste as age 55 or over, notify prescriber
perversion, tinnitus smoker, history of immediately
ENDO: Hyperglycemia hypertension or low if he develops
or hypoglycemia HDL level, or family unexplained muscle
GI: Abdominal or biliary history of early CAD). pain, tenderness, or
pain, anorexia, Drug is used to weakness, especially if
colitis, constipation, reduce risk of MI, accompanied by fatigue
diarrhea, duodenal or angina, and adverse or fever.
stomach ulcers, effects of • Be aware that
dysphagia, eructation, revascularization atorvastatin is
esophagitis, flatulence, procedures. expensive.
gastroenteritis, hepatic Reinforce the benefits of
• Also expect drug to
failure, hepatitis, therapy, and urge
be used in patients
increased appetite, with type 2 diabetes patient to comply if
indigestion, melena, possible.
who have no obvious
pancreatitis, rectal
CAD but multiple risk
hemorrhage, tenesmus,
factors, such as
vomiting retinopathy,
GU: Abnormal
albuminuria, smoking,
ejaculation; cystitis;
or
decreased libido; dysuria;
hypertension. Drug is
epididymitis; hematuria;
used in these
impotence; nephritis;
patients to reduce risk
nocturia; renal calculi;
of MI and stroke.
urinary frequency,
• Expect liver function
incontinence, or urgency;
tests to be performed
urine retention; vaginal
before atorvastatin
hemorrhage
therapy starts, after
HEME: Anemia, 6 and 12 weeks, with
thrombocytopenia each dosage increase,
MS: Arthralgia, back and every 6 months
pain, bursitis, gout, leg thereafter.
cramps, myalgia, • Expect to measure
myasthenia gravis, lipid levels 2 to 4
myositis, neck rigidity, weeks
tendon contracture, after therapy starts, to
tenosynovitis, torticollis adjust dosage as
RESP: Dyspnea, directed, and to repeat
pneumonia periodically until
SKIN: Acne, alopecia, lipid levels are within
contact dermatitis,
desired range.
diaphoresis, dry skin,
ecchymosis, eczema,
jaundice, petechiae,
photosensitivity, pruritus,
rash, seborrhea,
ulceration, urticaria
Other: Allergic reaction,
facial or generalized
edema, flulike symptoms,
infection,
lymphadenopathy, weight
gain
Patient: R.T.Y Age: 60 years old Hospital no.: 1234567
Impression: Marfan syndrome Attending Physician: Dr. Santillan Room no.: 222
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CNS: Dizziness, fatigue, • In some patients, • Instruct patient to
losartan potassium 50 – 100 mg/day To reduce stroke risk in headache, insomnia, losartan is more avoid potassium
patients with hypertension and malaise effective containing
left ventricular hypertrophy. CV: Hypotension when given in two salt substitutes because
Brand: Timing:
EENT: Nasal congestion divided doses daily; it that
Cozaar OD (Once a Day) GI: Diarrhea, indigestion, may be used with may increase risk of
Mechanism of Action:
Blocks binding of angiotensin II nausea, vomiting other hyperkalemia.
Classification: Duration: to receptor sites in many tissues, HEME: antihypertensives. • Advise patient to avoid
Antihypertensive As needed (PRN) including vascular smooth Thrombocytopenia • Know that patients of exercising in hot
muscle and adrenal glands. MS: Back pain, leg pain, African descent with weather and drinking
Other forms: Angiotensin II is a potent muscle spasms hypertension and left excessive amounts
vasoconstrictor that also RESP: Cough, upper ventricular of alcohol; instruct her
N/A
stimulates the adrenal cortex to respiratory tract infection hypertrophy to notify prescriber
secrete aldosterone. The SKIN: Erythroderma may not benefit from if she has prolonged
inhibiting effects of angiotensin Other: Angioedema, losartan to diarrhea, nausea, or
II reduce blood pressure. hyperkalemia, reduce stroke risk. vomiting.
hyponatremia WARNING Be aware
that patients who have
severe heart failure or
renal artery stenosis
may experience acute
renal failure from
losartan therapy
because losartan
inhibits
the angiotensin-
aldosterone system, on
which renal function
depends.
•Monitor blood
pressure and renal
function
studies to evaluate
drug effectiveness.
• Periodically monitor
patient’s serum
potassium level, as
appropriate, to detect
hyperkalemia.
•Monitor patient for
muscle pain; rarely,
rhabdomyolysis
develops in patients
taking
other angiotensin II
receptor blockers.
Patient: U.I.O Age: 85 years old Hospital no.: 1234567
Impression: Atrial fibrillation Attending Physician: Dr. Matiga Room no.: 333
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CNS: Anxiety, asthenia, • Give I.M. form of • Advise patient to take
quinidine gluconate E.R. Tablet To prevent or treat cardiac ataxia, confusion, quinidine undiluted. quinidine at the
324 – 660 mg arrhythmias, including delirium, difficulty • For intermittent I.V. same times every day
established atrial fibrillation, speaking, dizziness, infusion, dilute drug and at evenly spaced
Brand: every 8 to 12 hr.
atrial flutter, paroxysmal atrial drowsiness, in 40 ml of D5W and intervals.
Quinaglute Dura-tabs, Tablet extrapyramidal reactions, administer using an • Instruct patient to
fibrillation, paroxysmal atrial
Quinate (CAN), 325 mg every 2 to fever, infusion pump at a rate swallow E.R. tablets
tachycardia, paroxysmal
Quin-Release 3 hr for 5 to 8 headache, hypertonia, of 0.25 mg/kg/ whole, with a full glass
atrioventricular junctional
doses rhythm, paroxysmal ventricular syncope, vertigo min or less. Rapid of water, preferably
Classification: tachycardia not associated with CV: Complete heart administration may while sitting upright.
Class IA Timing: complete heart block, and block, orthostatic cause hypotension. • Advise patient to take
antiarrhythmic Three times a day premature atrial and ventricular hypotension, palpitations, Monitor ECG tracings drug with food if GI
(t.i.d.) or Four contractions. peripheral and blood pressure upset occurs.
times a day (q.i.d.) edema, prolonged QT throughout • Urge patient to inform
Mechanism of Action: interval, torsades de administration. prescriber immediately
Depresses excitability, pointes, vasculitis, •Monitor therapeutic of blurred or double
Duration: ventricular arrhythmias, blood level of vision, change
conduction velocity,
As needed (PRN) and contractility of the widening QRS complex quinidine, in color perception,
myocardium and EENT: Blurred vision, as ordered. confusion, diarrhea,
Other forms: increases the effective change in color •Monitor heart rate fever, headache, loss of
I.V. infusion refractory period, thus perception, and rhythm closely hearing, or tinnitus.
suppressing arrhythmic activity diplopia, dry mouth, because quinidine may
in the atria, ventricles, and His- hearing loss cause serious
Purkinje system. (high-frequency), adverse reactions and
pharyngitis, photophobia, can be cardiotoxic,
rhinitis, tinnitus especially at dosages
GI: Abdominal pain, exceeding 2.4 g daily.
anorexia, constipation, Implement continuous
diarrhea, indigestion, cardiac monitoring,
nausea, vomiting as ordered.
HEME: Agranulocytosis, • Assess for early signs
hemolytic anemia, and symptoms of
leukopenia, neutropenia, cinchonism, including
thrombocytopenia, blurred vision,
thrombocytopenic change in color
purpura perception, confusion,
MS: Arthralgia, myalgia diplopia, headache,
RESP: Dyspnea and tinnitus, which
SKIN: Diaphoresis, may indicate quinidine
eczema, exfoliative toxicity.
dermatitis,
flushing,
hyperpigmentation,
photosensitivity,
pruritus, psoriasis,
purpura,
rash, urticaria
Other: Angioedema,
flulike symptoms,
weight gain
a. Intensive Care Unit (2 Medications)

Patient: A.S. D Age: 70 years old Hospital no.: 1234567

Impression: Congestive heart failure Attending Physician: Dr. Yu Room no.: 111
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CNS: Fever WARNING Be aware • Instruct patient to
Inamrinone I.V. infusion CV: Chest pain,
To treat heart failure in patients that inamrinone may notify you or another
(amrinone) Initial: 0.75 mg/kg who haven’t responded hypotension, pericarditis, increase risk of nurse if he becomes
by bolus over 2 to sufficiently to digoxin, supraventricular ventricular dizzy, which may
3 min and repeated diuretics, or vasodilators tachycardia, ventricular arrhythmias in indicate hypotension.
Brand: arrhythmias patients with atrial
after 30 min, if
Inocor needed. Mechanism of Action: GI: Abdominal pain, flutter or fibrillation.
Maintenance: 5 to Inhibits phosphodiesterase anorexia, elevated liver To minimize risk,
Classification: 10 mcg/ kg/min by enzymes that normally degrade function test results, expect to pretreat such
Cardiac inotrope infusion. myocardial cAMP. This hepatotoxicity, nausea, patients with digoxin.
Maximum: 10 action increases intracellular vomiting • Give drug undiluted
mg/kg daily. levels of cAMP, which HEME: Elevated or diluted in normal
regulates intracellular and erythrocyte sedimentation or half-normal (0.45)
Timing: extracellular calcium balance. rate, thrombocytopenia saline solution to a
Once a day (OD) Increased intracellular cAMP (especially with concentration of 1 to 3
level enhances influx of high-dose or prolonged mg/ml, as prescribed.
calcium into cell, thereby treatment) Use diluted solution
Duration: MS: Myositis within 24 hours.
increasing force of
As needed (PRN) myocardial contractions. RESP: Hypoxemia, WARNING Monitor
Inamrinone also acts directly on pleuritis vital signs regularly. If
Other forms: peripheral vascular SKIN: Jaundice blood pressure falls
smoothmuscle cells, causing Other: Infusion site significantly, slow or
relaxation and dilation, which burning stop infusion and
reduces preload and afterload. notify prescriber.
•Monitor weight,
cardiac index, central
venous pressure,
pulmonary artery
wedge pressure, and
fluid intake and output
as
appropriate to assess
drug’s effectiveness.
WARNING Assess
often for signs of
thrombocytopenia,
such as bruising or
bleeding
and altered platelet
count. If signs appear,
expect to decrease
inamrinone dose or
discontinue
drug.
Patient: F. G. H Age: 72 years old Hospital no.: 1234567
Impression: Ventricular fibrillation Attending Physician: Dr. Lee Room no.: 222
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CV: Increased ventricular • Expect each 38-mg • Inform patient of the
digoxin immune Fab I.V. injection To treat acute toxicity from an rate (in atrial fibrillation), vial of purified digoxin purpose of digoxin
(ovine) Individualized unknown amount of digoxin or worsening of heart failure immune Fab to bind immune Fab and how it
dosage digitoxin during long-term or low cardiac output about 0.5 mg of will be given.
for digoxin therapy Other: Allergic reaction digoxin or digitoxin. • Advise patient to
Brand:
toxicity: dose (mg) (difficulty breathing, • To reconstitute for notify you immediately
Digibind urticaria), febrile reaction, I.V. use, dissolve 38 if she experiences
5 serum Mechanism of Action:
digoxin level Binds with digoxin or digitoxin hypokalemia mg adverse reactions,
Classification: (ng/ml) multiplied molecules. in 4 ml of sterile water especially
Digitalis glycoside by body The resulting complex is for injection to difficulty breathing and
antidote weight (kg), then excreted through yield 9.5 mg/ml.Mix urticaria.
divided by 100, the kidneys. As the free serum gently. Further dilute
and then digoxin level with normal saline
multiplied by 38. declines, tissue-bound digoxin solution to proper
Individualized enters the volume
dosage for serum and also is bound and for I.V. infusion. For
digitoxin toxicity: excreted. very small doses,
dose (mg) 5 serum reconstituted 38-mg
digitoxin vial may be diluted
level (ng/ml) with 34 ml of normal
multiplied by body saline solution to
weight (kg) and yield 1 mg/ml.
then divided by WARNING Before
1,000, giving digoxin
multiplied by 38, immune
and rounded up to Fab to high-risk
next patient, test for allergic
whole vial. reaction as prescribed
by diluting 0.1 ml of
Timing: reconstituted drug in
Once a day (OD) 9.9 ml sodium chloride
for injection and then
injecting 0.1 ml
Duration: (9.5 mcg/0.1 ml)
As needed (PRN) intradermally. After 20
minutes, observe for
an urticarial wheal
Other forms:
surrounded by
erythema.
Alternatively,
perform a scratch test
by placing one drop
of 9.5 mcg/0.1 ml
dilution on patient’s
skin and making a
1/40 scratch through
the drop with a sterile
needle. Inspect site
in 20 minutes. Test is
considered positive if
it produces a wheal
surrounded by
erythema.
If test causes a
systemic reaction,
apply tourniquet above
test site, notify
prescriber, and prepare
to respond to
anaphylaxis.
Be aware that if a skin
or systemic
reaction occurs,
additional drug
shouldn’t be given
unless essential; if
more
of the drug must be
given, expect
prescriber
to pretreat patient with
corticosteroids
and diphenhydramine.
Prescriber
should be on standby
to treat anaphylaxis.
• For an infant,
reconstitute digoxin
immune Fab as
ordered and administer
with a tuberculin
syringe.
•When administering
to a child, watch for
fluid volume overload.
•When giving a large
dose, expect a faster
onset but watch
closely for febrile
reaction.
• Give I.V. infusion
through a 0.22-micron
membrane filter over
30 minutes. Keep in
mind that drug may be
given by rapid I.V.
injection if cardiac
arrest is imminent.
•Monitor serum
potassium level often,
especially during first
few hours of therapy.
Potassium level may
drop rapidly.
c. Out-patient Department ( 1 Medication)

Patient: Z. X.C Age: 48 years old Hospital no.: 1234567

Impression: Hypertension Attending Physician: Dr. Aguilar Room no.: 111
Allergic to: N/A

Generic/Brand Dose, Strength Indication/Mechanism of Adverse Effects & Nursing Client Teaching
Name & & Formulation Action Contraindications Responsibilities
Classification
Generic: Ordered: Indication: CNS: Amnesia, anxiety, • Use bepridil • Advise patient to avoid
bepridil 200 – 400 mg/day CNS: Amnesia, anxiety, asthenia, asthenia, depression, cautiously in patients driving and other
hydrochloride depression, dizziness, drowsiness, with activities that require
dizziness, drowsiness, fever, fever, hallucinations, heart failure because it alertness and
Timing: hallucinations,
Once a day (OD) headache, insomnia, nervousness,
headache, insomnia, can induce new coordination
Brand:
paranoia, paresthesia, psychosis, nervousness, arrhythmias and may until bepridil’s CNS
Vascor paranoia, paresthesia, worsen heart failure. effects are
syncope,
Duration: tremor, vertigo psychosis, syncope, • Because bepridil is known.
Classification: 10 days CV: Edema, hypertension, tremor, vertigo metabolized by the
palpitations,
Antianginal CV: Edema, liver and its
premature ventricular contractions,
Other forms: prolonged hypertension, palpitations, metabolites are
QT interval, sinus bradycardia or premature ventricular excreted in
tachycardia, torsades de pointes, contractions, prolonged urine, monitor results
vasodilation, QT interval, sinus of liver function
ventricular fibrillation, ventricular
bradycardia or studies as well as BUN
tachycardia
EENT: Altered taste, blurred vision, tachycardia, torsades de and serum electrolyte
dry pointes, vasodilation, and creatinine levels as
mouth, pharyngitis, rhinitis, tinnitus ventricular fibrillation, appropriate.
GI: Abdominal cramps or ventricular • Assess patient’s heart
discomfort, anorexia, tachycardia rate and rhythm to
appetite increase, constipation, diar-
EENT: Altered taste, obtain baseline. Then
Mechanism of Action:
blurred vision, dry monitor frequently
Inhibits calcium movement into
mouth, pharyngitis, during therapy. Also,
coronary
rhinitis, tinnitus monitor serial 12-
and vascular smooth-muscle
GI: Abdominal cramps or lead ECG tracings. Be
cells by blocking
discomfort, anorexia, aware that bepridil
slow calcium channels in their
appetite increase, can induce new
membranes.
constipation, diar rhea, arrhythmias, including
flatulence, gastritis, ventricular tachycardia
nausea and fibrillation
This decreases intracellular GU: Decreased libido, (which are more
calcium level, which inhibits impotence difficult to convert),
smooth-muscle cell HEME: Agranulocytosis, torsades
contractions and causes: leukopenia, neutropenia de pointes, and
• relaxation of coronary and MS: Arthritis, myalgia prolonged QT
vascular RESP: Cough, dyspnea, intervals.
smooth muscles, decreased respiratory tract
WARNING Be alert
peripheral vascular infection for QT intervals that
resistance, and reduced systolic SKIN: Dermatitis,
exceed 0.52 second. If
and diaphoresis, rash
this occurs, expect
diastolic blood pressure, which Other: Flulike symptoms
to reduce bepridil dose
decrease or discontinue
myocardial oxygen demand
drug.
• depression of impulse
•Monitor WBC count
formation (automaticity)
to detect
and conduction velocity.
agranulocytosis,
Bepridil also inhibits fast
which may warrant
inward sodium
stopping bepridil
channels, reducing speed and
therapy.
degree of
WARNING Be aware
action potential and increasing
that bepridil shouldn’t
its duration
be discontinued
in cardiac muscle.
abruptly. Instead,
gradually
taper dosage as
prescribed to prevent
increased frequency
and duration of chest
pain as increased
calcium moves into
cells,
causing coronary
artery spasm.
•Monitor blood
pressure often if
patient
takes a nitrate or beta
blocker. Assess for
hypotension.
•Monitor serum
electrolyte levels.
Especially note
decreased potassium
level,
which may worsen
existing arrhythmias or
induce new ones.