PHARMA CARDS
PATIENT’S NAME: R.L.R.; MALE; MARRIED; AGE: 39 years old
ROOM NUMBER: 344; RELIGION: ROMAN CATHOLIC; OCCUPATION: PNP OFFICER
DIAGNOSIS: Admitting Dx: R/o Pulmonary Vasculitis; Antiphospholipid Syndrome; r/o Pneumonia
Discharge Dx: CHF non-specified; Respiratory Tract Infection d/t External Agent; Deep Vein Thrombosis
1. Levopront 10 ml TID
Brand Name: Levipront
Generic Name: Levodropropizine
Classification: Antitussive, Pregnancy D category
Mechanism of Action: Is peripherally acting agent inhibiting the afferent pathways that mediate the generation of the cough reflex. Compared with the racemic drug, levodropropizine
maiantains the antitussive activity but considerably lower central nervous system depressant actions. Is activated in the bronchopulmonary system as the inhibitor of bronchospasm
induced by histamine, serotonin, and bradiquinina.
Indications: Levodropropizine is a cough suppressant that exerts peripheral action in nonproductive cough; Cough suppression or for the symptomatic relief of cough.
Dosage/Route: 10 mL TID, PO, Should be taken on an empty stomach: Take between meals.
Contraindications: Hypersensitivity to drug. Excessive mucus discharge and limited mucociliary function. Severe liver impairment.
Special Precautions: Severe renal insufficiency. May impair ability to drive or operate machinery. Child <2 yr. It may cause dizziness or drowsiness, do not drive a car or operate
machinery while taking this medication.
Side effects & Adverse effects: Nausea, vomiting, heartburn, diarrhea, fatigue, weakness, drowsiness, dizziness, headache, palpitations.
Nursing Responsibilities:
1. Instruct not to drive or operate machinery especially if you experience drowsiness, dizziness, hypotension or a headache as side-effects when using Levopront Syrup medicine
then it may not be safe to drive a vehicle or operate heavy machinery. One should not drive a vehicle if using the medicine makes you drowsy, dizzy or lowers your blood-
pressure extensively.
2. Advise patients not to drink alcohol with medicines as alcohol intensifies drowsiness side-effects and can disrupt efficacy of drugs/medication.
3. Take as directed by your doctor or follow the direction printed on the product insert.
4. Tell your doctor or your nurses if your condition persists or worsen.
5. Important counseling points are listed below.
• Children below 2 years
• Do not drive or operate machinery
• Pregnant or planning to become pregnant or are breastfeeding
• Take this drug for maximum 7 days
2. Sildenafil (Zilden) 50 mg/tab BID pc lunch and dinner
Brand Name: Zilden
Generic Name: Sildenafil
Classification: Erectile agent; antihypertensive; peripheral vasodilator; Pregnancy B category
Do not be confuse: Viagra/Allegra
Mechanism of Action: Enhances the effect of nitric oxide (NO) by inhibiting phosphodiesterase type 5 (PDE5), which is necessary for degrading cyclic GMP in the corpus cavernosum
Pharmacodynamics:
• Onset Unknown
• Peak: ½-1½ hr
• Duration Unknown
Indications: Treatment of erectile dysfunction, pulmonary hypertension; improvement in exercise ability
Dosage/Route: 50 mg/tab BID pc lunch and dinner, PO
• Erectile dysfunction
− Adult: 50 mg approx 1 hr before sexual intercourse, may adjust depending on response. Max: 100 mg daily.
• Pulmonary arterial hypertension
− Adult: 5 mg or 20 mg tid.
Child: 1-17 yr ≤20 kg: 10 mg tid; >20 kg: 20 mg tid.
Contraindications: Hypersensitivity to this product or nitrates
Special Precautions: Pregnancy B, anatomical penile deformities, sickle cell anemia, leukemia, multiple myeloma, retinitis pigmentosa, bleeding di sorders, active peptic ulceration,
CV/renal/ hepatic disease, multidrug antihypertensive regimens, geriatric patients
Side effects & Adverse effects: Headache, flushing, dyspepsia, visual disturbances (e.g. blurred vision, photophobia, chromatopsia, cyanopsia, eye irritation, eye pain and redness);
dizziness, insomnia, anxiety, vertigo, epistaxis, nasal congestion, pyrexia, GI disturbances (e.g. diarrhoea, vomiting), priapism; skin rashes, erythema, alopecia, limb/back pain, myalgia,
facial oedema, fluid retention, paraesthesia, UTI, dyspnoea, cough, rhinitis, sinusitis, bronchitis, cellulitis, sudden decrease or loss of hearing, anaemia, leucopenia, gynaecomastia,
urinary frequency or incontinence, haematuria, seizures, cerebrovascular haemorrhage, transient ischaemic attack, palpitations, syncope, HTN, hypotension. Rarely, hypersensitivity
reactions, NAION causing permanent loss of vision, retinal haemorrhage
Nursing Responsibilities
1. Teach patient that product does not protect against STDs, including HIV
2. Teach patient that product absorption is reduced with a high-fat meal
3. Teach patient that product should not be used with nitrates in any form
4. Teach patient that tab may be split
5. Teach patient to notify prescriber immediately and stop taking product if vision loss occurs
6. Do not use more often than 100 mg in 24 hr
7. Teach patient to notify prescriber immediately and to stop taking product if vision/hearing loss occurs or erection lasts > 4hr
3. Vigocid 2.25 mg IV infusion q 8H ANST
Brand Name: Vigocid
Generic Name: piperacillin + tazobactam
Classification: Piperacillin and Beta-lactamase inhibitor; Belongs to the class of penicillin combinations, including beta-lactamase inhibitors.
Mechanism of Action:
Indications: Treatment of severe gm -ve infection & other susceptible bacteria; neutropenic patients; cystic fibrosis; otitis media; skin infection; surgical infection prophylaxis; UTI;
bone & joint infections; gynecological infection including postpartum endometritis & pelvic inflammatory disease (PID); peritonitis; septicemia.
Dosage/Route: Adult
• Serious or complicated infections 200-300 mg/kg body wt IV daily in divided doses. Usual dose: 4 g 6-8 hrly.
• Life-threatening infections due to Klebsiella spp or Pseudomonas ≤16 g daily. Max: 24 g/day.
• Mild or uncomplicated infections 100-150 mg/kg/day. Usual dose: 2 g 6-8 hrly or 4 g 12 hrly IV.
• Prophylaxis of surgical infection 2 g pre-op or when the umbilical cord is clamped in CS followed by at least 2 doses of 2 g intervals of 4-6 hr w/in 24 hr of the procedure. IV
Child
• 1 mth-12 yr 100-300 mg/kg/day in 3-4 divided doses.
• Neonate >7 days or >2 kg 300 mg/kg/day in 3-4 divided doses, <7 days or <2 kg 150 mg/kg/day in 3 divided doses. May be administered by slow IV inj over 3-5 min; IV infusion
over 20-40 min.
• Renal insufficiency CrCl 20-80 mL/min 12 g/1.5 g/day in divided doses or 4 g/500 mg 8 hrly, <20 mL/min 8 g/1 g/day in divided doses or 4 g/500 mg 12 hrly.
Contraindications: History of allergic reactions to penicillins, cephalosporins, β-lactamase inhibitors.
Side effects & Adverse effects: (all systems involved) Nausea; indigestion, vomiting, diarrhea or constipation; rash, itchy or red skin, urticaria; sleeping difficulty, headache or dizziness;
superinfection.
Nursing Responsibilities:
4. Hydroxychloroquine (HCQS) 200 mg 1 tab OD pc dinner
Brand Name: Plaquenil
Generic Name: Hydroxychloroquine (HCQS)
Classification: Antimalarial, antirheumatic (DMARDs), Pregnancy C category
Mechanism of Action: Impairs complement-dependent antigen-antibody reactions
• Onset Rapid
• Peak 1-2 hr
• Duration Days-weeks
Therapeutic outcome: Resolution of infection
Indications: RA, discoid & SLE & dermatological conditions caused or aggravated by sunlight in adults. Juvenile idiopathic arthritis (in combination w/ other therapies), discoid & SLE
in paed patients. Malaria caused by Plasmodium vivax, P. malariae, P. ovale, P. falciparum (some strains); LE, rheumatoid arthritis
Dosage/Route: 200 mg 1 tab OD pc dinner
• Hydroxychloroquine is cumulative in action and will require several weeks to exert its beneficial effects, whereas minor side effects may occur relatively early.
• For rheumatic disease, treatment should be discontinued if there is no improvement by 6 months.
• In light-sensitive diseases, treatment should only be given during periods of maximum exposure to light.
• Adults (including the elderly): The minimum effective dose should be employed. This dose should not exceed 6.5 mg/kg/day (calculated from ideal body weight and not actual body weight)
and will be either 200 mg or 400 mg per day.
• In patients able to receive 400 mg daily: Initially 400 mg daily in divided doses. The dose can be reduced to 200 mg when no further improvement is evident. The maintenance dose should
be increased to 400 mg daily if the response lessens.
• Paediatric population: The minimum effective dose should be employed and should not exceed 6.5 mg/kg/day based on ideal body weight. The 200 mg tablet is therefore not suitable for
use in children with an ideal body weight of less than 31 kg.
Contraindications: Hypersensitivity to this product or chloroquine, retinal field changes
• Black Box Warning: Children (long term), ocular disease
Special Precaution: Pregnancy C, breastfeeding, blood dyscrasias, severe GI disease, neurologic disease, alcoholism, hepatic disease, G6PD deficiency, psoriasis, eczema
Side effects: Nausea, vomiting, loss of appetite, diarrhea, dizziness, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
Adverse effects:
• CNS: Headache, stimulation, fatigue, irritability, seizures, bad dreams, dizziness, confusion, psychosis, decreased reflexes
• CV: Hypotension, heart block, asystole with syncope
• EENT: Blurred vision, corneal changes, retinal changes, difficulty focusing, tinnitus, vertigo, deafness, photophobia, corneal edema
• GI: Nausea, vomiting, anorexia, diarrhea, cramps
• HEMA: Thrombocytopenia, agranulocytosis, leukopenia, aplastic anemia
• INTEG: Pruritus, pigmentation changes, skin eruptions, lichen planus–like eruptions, eczema, exfoliative dermatitis, alopecia, Stevens-Johnson syndrome, photosensitivity
Nursing Responsibilities:
1. Take hydroxychloroquine with a meal or a glass of milk unless your doctor tells you otherwise.
2. Remind patient to use this medicine for the full prescribed length of time, even if symptoms quickly improve.
3. Teach patient that urine may turn rust or brown
4. Teach patient to report hearing, vision problems; fever, fatigue, bruising, bleeding, which may indicate blood dyscrasias
5. Coralan 7.5 mg 1 tab BID
Brand Name: Coralan
Generic Name: Ivabradine
Classification: Anti-anginal drugs
Mechanism of Action:
Description: Ivabradine is a heart rate lowering agent that works through selective and specific inhibition of the cardiac pacemaker If current that controls the spontaneous diastolic depolarisation
in the sinus node and regulates heart rate.
Absorption: Almost completely absorbed from GI tract. Food delays absorption by approx. 1 hr and increases exposure by 20-30%.
Absolute bioavailability: Approx. 40%. Time to peak plasma concentration: Approx. 1 hr.
Distribution: Volume of distribution: Approx. 100 L. Plasma protein binding: Approx. 70%.
Metabolism: Extensively metabolized in the liver and gut via oxidation by CYP3A4 isoenzyme to form major active metabolite N-desmethyl-ivabradine (S-18982).
Excretion: Approx. 4% as unchanged drug via urine; metabolites are excreted to a similar extent via urine and feces. Plasma elimination half-life: 2 hr.
Indications: Symptomatic treatment of chronic stable angina pectoris in CAD in adults w/ normal sinus rhythm who are unable to tolerate or w/ contraindication to use of β-blockers; in combination
w/ β-blockers in patients inadequately controlled w/ an optimal β-blocker dose whose heart rate is >70 bpm. Treatment of chronic heart failure (NYHA class II-IV) w/ systolic dysfunction in
combination w/ standard therapy including β-blocker therapy or when β-blocker is contraindicated or not tolerated in patients in sinus rhythm & whose heart rate is ≥75 bpm.
Dosage/Route: Initially 5 mg bd for 3-4 wk, followed by up-titration to target dose 7.5 mg bd depending on the therapeutic response. Reduce dose to 2.5 mg bd if heart rate decreases to <50 bpm
or symptoms of bradycardia is present.
Contraindications: Resting heart rate <70 beats/min prior to treatment, cardiogenic shock, acute MI, severe hypotension (<90/50 mmHg), sick sinus syndrome, SA block, unstable or acute heart
failure, pacemaker dependent, unstable angina, 3rd degree AV block. Severe hepatic impairment. Pregnancy and lactation. Concurrent use w/ potent CYP3A4 inhibitors (e.g. azole antifungals,
macrolides, HIV protease inhibitors or nefazodone), moderate CYP3A4 inhibitors (e.g. verapamil or diltiazem).
Side effects & Adverse effects: (all systems involved) Luminous phenomena in the visual field (phosphenes), blurred vision, bradycardia, other cardiac arrhythmias, syncope, hypotension, asthenia,
fatigue, headache, dizziness, nausea, constipation, diarrhoea, dyspnoea, muscle cramps, skin reactions, angioedema, hyperuricaemia, eosinophilia, elevated blood-creatinine concentrations.
Nursing Responsibilities: Monitor heart rate prior to initiation of treatment, prior to increasing dose or after decreasing dose; BP, cardiac rhythm.
6. Levofloxacin (Levox) 750 mg 1 tab
Brand Name: Levox
Generic Name: Levofloxacin
Classification: Antibiotic; Fluoroquinolone
Mechanism of Action: Bactericidal: Interferes with DNA by inhibiting DNA gyrase replication in susceptible gramnegative and gram-positive bacteria, preventing cell reproduction.
Indications:
• Treatment of adults with community acquired pneumonia, bacterial sinusitis caused by susceptible bacteria including multidrug resistant strains
• Treatment of acute exacerbation of chronic bronchitis caused by susceptible bacteria
• Treatment of complicated and uncomplicated skin and skin structure infections caused by susceptible bacteria
• Treatment of complicated and uncomplicated UTIs and acute pyelonephritis caused by susceptible bacteria
• Treatment of complicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis and acute pyelonephritis caused by E. coli
• Treatment of chronic bacterial prostatitis caused by E. coli, Enterococcus faecalis, Staphylococcus
• Treatment of nosocomial pneumonia due to methicillin-sensitive Staphylococcus aureus, Pseudomonas strains, Serratia, E. coli, Klebsiella, Haemophilus influenzae, Streptococcus
pneumoniae
• Treatment of postexposure inhalational anthrax
Available forms: Tablets—250, 500, 750 mg; oral solution— 25 mg/mL; injection—5 mg/mL; injection concentrate—25 mg/mL
Dosage:
• Community-acquired pneumonia: 500 mg daily PO or IV for 7–14 days.
• Sinusitis: 500 mg daily PO or IV for 10– 14 days or 750 mg/day PO or IV for 5 days.
• Chronic bronchitis:500 mg daily PO or IV for 7 days.
• Skin infection:500–750 mg daily PO or IV for 7–14 days.
• UTIs:250 mg daily PO or IV for 3–10 days; complicated, 750 mg/day PO or IV for 5 days.
• Pyelonephritis: 250 mg daily PO or IV for 10 days or 750 mg PO or IV for 5 days.
• Nosocomial pneumonia:750 mg daily PO or IV for 7–14 days.
• Chronic prostatitis: 500 mg/day PO for 28 days or 500 mg/day by slow IV infusion over 60 min for 28 days.
• Postexposure anthrax: 500 mg/day PO or IV for 60 days.
• Plague:500 mg/day PO for 10–14 days
Contraindications:
• Contraindicated with allergy to fluoroquinolones, lactation, myasthenia gravis, tendinitis, tendon rupture.
• Use cautiously with renal impairment, seizures, pregnancy
Side effects & Adverse effects: (all systems involved)
• CNS: Headache, dizziness, insomnia, fatigue, somnolence, blurred vision
• CV: Prolonged QT interval
• GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain (occur less with this drug than with ofloxacin), constipation, flatulence, abnormal liver function
• GU: Abnormal renal function, acute renal failure, UTI, urine retention
• Hematologic: Elevated BUN, serum creatinine, and alkaline phosphatase; neutropenia, anemia
• Other: Fever, rash, photosensitivity, muscle and joint tenderness, increased serum glucose, tendinitis, tendon rupture, blood glucose alterations
Nursing Responsibilities:
• Assessment of history: Allergy to fluoroquinolones, renal impairment, seizures, lactation, pregnancy, myasthenia gravis, tendinitis
• Assessment of physical: Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; LFTs, renal function tests; blood glucose (patients with diabetes)
• Arrange for culture and sensitivity tests before beginning therapy.
• Continue therapy as indicated for condition being treated.
• Administer oral drug without regard to meals with a glass of water; separate oral drug from other cation administration, including antacids, by at least 2 hr.
• Ensure that patient is well hydrated during course of therapy.
• Discontinue drug at any sign of hypersensitivity (rash, photophobia) or at complaint of tendon pain, inflammation, or rupture.
• Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity test.
7. MV (Rejuvenex) capsule 1 capsule OD
Brand Name: Rejuvenex
Generic Name:
Classification: Multivitamins
Mechanism of Action: Vitamins B1, B6 and B12 (Vit B (Rejuvenex) TABLET) as coenzymes speed up the metabolic processes by which the breakdown products of carbohydrates, fats
and proteins are further biotransformed to produce energy and utilizable substances.
Vitamins B1, B6 and B12 (Vit B (Rejuvenex) TABLET) as metabolic activators enhance the production of energy needed to fuel the cellular activities of the body, specifically the
physiologic activities of the nervous system.
Vitamins B1, B6 and B12 (Vit B (Rejuvenex) TABLET) provide a substantial concentration of Thiamine Mononitrate. Thiamine as coenzyme of glucose metabolism, ensures
maximum production of energy from glucose and the conversion of glucose into other metabolites such as ribose, a major component of DNA and RNA. Glucose provides the basic
nutritional needs of the nervous system. The cells of the nervous system depend entirely on glucose as its fuel source. Independent of its coenzyme function, Thiamine acts as a
modulator in neuromuscular transmission of impulses.
Indications: Dietary supplement to help enhance mental functions; management of protein, vitamin and mineral deficiency associated with inadequate or deficient diet; in cases
where there are nutrient loss in strenuous physical activities; in conditions associated with protein loss or increased protein demands/nutritional requirements in stress,
convalescence, pregnancy and lactation, post-operative, wounds, burns and bone fracture.
Dosages: Syr Childn 4-12 yr 5 mL (1 tsp), 1-3 yr 2.5 mL-5 mL (½-1 tsp). Drops 6 mth-2 yr 0.6 mL, <6 mth 0.3 mL. All doses to be taken once daily.
Contraindications: Fe accumulation, disorders in Fe utilization.
Side effects & Adverse effects: (all systems involved): Hypervitaminosis A, hypercalcemia, allergic reactions
Nursing Responsibilities:
8. NaC (Fluimucil) 600 mg effervescent tablet 1 ta in 1 glass of water OD qHS
Brand Name: Fluimucil
Generic Name: Acetylcysteine
Classification: Mucolytic, antidote for acetaminophen overdose
Mechanism of Action: Increases respiratory tract fluids to help liquefy tenacious secretions. Restores glutathione in liver to treat acetaminophen toxicity.
Indications: Pneumonia, bronchitis, tuberculosis, cystic fibrosis, emphysema, atelectasis (adjunct), complications of thoracic and CV injury.
Contraindications: Contraindicated in patients hypertensive to drugs. Use cautiously in debilitated patients with severe respiratory insufficiency. In patients with asthma or a history of bronchospasm,
use IV formulation cautiously.
Side effects: Increased coughing, mouth sores, nausea, vomiting, fever, runny nose, chest tightness.
Adverse Reactions :
• EENT: Rhinorrhea, hemoptysis
• GI: Stomatitis, nausea, vomiting
• Respiratory: Bronchospasm
Nursing Responsibilities:
• Assess pt’s respiratory secretions before and frequently during therapy.
• Be alert for adverse reactions and drug interactions.
• Assess pt’s and family’s knowledge of drug therapy.
• Have suction equipment available in case pt can’t effectively clear his air passages.
• Alert prescriber if pt’s respiratory secretions thicken or become purulent or if bronchospasms occur.
9. Azathioprine 50 mg 1 tab pc dinner
Brand Name: Azasan, Imuran, Thioprine
Generic Name: Azathioprine
Classification: Immunosuppressant
Mechanism of Action: Suppresses immune system activity.
Indications: immunosuppression in renal kidney transplantation, severe: refractory rheumatoid arthritis
Contraindications: Contraindicated in patients hypertensive to drugs. Use cautiously in patients with hepatic or renal dysfunction
Side effects: Increased stomach irritation, nausea, vomiting, loss of appetite, blood in the urine or stool, fatigue, development of mouth sores and ulcers.
Adverse effects: (all systems involved): GI: Nausea, vomiting, esophagitis, anorexia, pancreatitis, steatorrhea, mouth ulceration
Hematologic: Leukopenia, bone marrow suppression, anemia, pancytopenia, thrombocytopenia
Hepatic: Hepatotoxicity, jaundice
Musculoskeletal: Arthralgia, muscle wasting
Skin: Rash, alopecia, pruritus
Others: Immunosuppression, infections, neoplasia
Nursing Responsibilities:
• Obtain history of pt’s immune status before therapy.
• Monitor effectiveness by observing pt for signs of organ rejection. Therapeutic response usually occurs within 8 weeks.
• Be alert for adverse reactions and drug interactions.
• Monitor hemoglobin levels, hematocrit, and WBC and platelet counts at least once monthly--- more often at the beginning of treatment.
• Assess pt’s and family’s knowledge of drug therapy.
• Give in divided doses or after meals to minimize adverse GI effects.
• Warn pt to report even mild infections (colds, fever, sore throat, malaise) because drug is a potent immunosuppressant.
• Warn pt that thinning of hair is possible.
10. MVT (Centrum Silver) 1 tab OD
Brand Name: Centrum Silver
Generic Name: Multi Vitamins
Classification: Vitamins and Minerals
Mechanism of Action: it strengthens the protective properties of the body and provides it with all necessary nutrients for normal biochemical processes.
Indications: Used to treat of prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy.
Contraindications: Pt’s with iron metabolism disorder, hemolytic anemia, ulcer from too much stomach acid, stomach irritation.
Side effects: Nausea, stomach upset, diarrhea, flushing, and unpleasant taste may occur.
Adverse effects: (all systems involved): Nausea, stomach upset, diarrhea, flushing, and unpleasant taste may occur.
Nursing Responsibilities:
• Assess if pt has an allergy or of it is any component.
• Assess if pt has liver problem and has B12 deficiency before taking it.
