Drug Study 1 DRUG NAME AND CLASSIFICATION DOSE, FREQUEN CY, ROUTE, DURATION OF ADMINIST RATION Generic Name: diphenhydramine Dose: Brand Name: Banophen Route: Po 50mg Frequency: ODHS PRN Therapeutic Class: Antihistamines Pharmacologic Class: Ethanolamines MECHANISM OF ACTION Completes with histamine for H1-receptor sites. Prevents, but doesn’t reverse, histaminemediated responses, particularly those of the bronchial tubes, GI tract, uterus, and blood vessels INDICATION Nighttime Sleep aid CONTRAINDICATIO N Contraindicate d/ Avoid use in patients taking MAO inhibitors Use cautiously in patients with angle-closure glaucoma, stenosing peptic ulcer symptomatic prostatic hyperplasia, bladder neck obstruction, pyloroduodena l obstruction or asthma Use within caution in patient with prostatic ADVERSE EFFECT CNS: drowsiness, sedation, sleepiness, dizziness, incoordination, seizures, confusion, insomnia, headache, vertigo, fatigue, restlessness, tremor, nervousness. CV: palpitation, hypotension, tachycardia EENT: diplopia, blurred vision, tinnitus, nasal congestion GI: dry mouth, nausea, epigastric distress, vomiting, NURSING RESPONSIBILITY Dizziness, excessive sedation, syncope, toxicity, paradoxical stimulation, and hypotension are more likely to occur in elderly patients Don’t confuse diphenhydramine with dimenhydrinate. Don’t confuse Benadryl with Bentyl or Benazepril hyperplasia, asthma, COPD, increased IOP, hyperthyroidis m, CV disease, and HTN diarrhea, constipation, anorexia GU: dysuria, urine retention, urinary frequency Hematologic: thrombocytopenia, agranulocytosis, hemolytic anemia Respiratory: thickening of bronchial secretions Skin: urticaria, photosensitivity, rash Other: Anaphylactic shock Drug Study 2 DRUG NAME AND CLASSIFICATIO N DOSE, FREQUENCY, ROUTE, DURATION OF ADMINISTRATI ON Generic Name: rosuvastatin Calcium Brand Name: Crestor Dose: 20mg Classification: Therapeutic Class: Antilipemic Duration: 2 months Pharmacologic Class: HMG-CoA reductase inhibitors Frequency: PO Route: ODHS MECHANISM OF ACTION Inhibits HMGCoA reductase, increases LDL receptors on liver cells, and inhibits hepatic synthesis of very-low density lipoprotein INDICATION Adjunct to diet to reduce LDL cholesterol, total cholesterol, apolipoprotei n B, nonHDL cholesterol, and triglyceride (TG) levels and to increase HDL cholesterol level in patients with primary hypercholest erolemia (heterozygou s familial and non-familial) and mixed CONTRAINDICATION Contraindicated in patients hypersensitive to rosuvastatin or its components, patients with active liver disease and those with unexplained persistently increase transaminase levels. Rare post marketing reports of cognitive impairment (memory loss, forgetfulness, amnesia, memory impairment, confusion) have been associate with statin use. These reported symptoms are ADVERSE EFFECT CNS: asthenia, dizziness, headache NURSING RESPONSIBILITY GI: abdominal pain, constipation, diarrhea, dyspepsia, nausea vomiting GU: cystitis Hematologic: anemia, ecchymosis Metabolic: diabetes mellitus Musculoskeletal: arthralgia, myalgia, neck pain Before therapy starts, assess patient for underlying causes of hypercholeste rolemia, including poorly controlled diabetes, hypothyroidis m, nephrotic syndrome, dyslipoprotein emias, obstructive liver disease, drug interaction, and alcoholism Before therapy starts advise patient to control dyslipidemia (Fredrickson types IIa and IIb); adjunct to diet to treat primary dysbetalipopr oteinemia Adjunct to diet to slow atheroscleros is progression in patients with elevated cholesterol Adjunct to lipidlowering therapies, to reduce LDL cholesterol, apolipoprotei n B, and total cholesterol levels in homozygous familial hypercholest erolemia generally not serious and are reversible upon statin discontinuation, with variable times to symptoms onset (1 day to years) and symptom resolution (median of 3 weeks) hypercholeste rolemia with diet, exercise, and weigh reduction Interrupt statin therapy if patient shows signs of symptoms of serious liver injury, hyperbilirubin emia or jaundice, Don’t restart drug if another cause don’t be found Monitor lipid panel at baseline and a fasting lipid profile within 4-12 weeks after initiating or dosage adjustment and every 3 to 12 months thereafter. Drug Study 3 DRUG NAME AND CLASSIFICATIO N Generic Name: Amoxicillin DOSE, FREQUENCY, ROUTE, DURATION OF ADMINISTRATI ON Dose: 500 mg Route: PO Brand Name: Amoxil MECHANISM OF ACTION Inhibits cell-wall synthesis during bacterial multiplication INDICATION Frequency: Q8H Classification: Therapeutic Class: antibiotics Pharmacologic class: aminopenicillins Duration: 7 days Pharyngitis, tonsilitis, or both secondary to streptococcus pyogenes infection Mild to moderate infection of the ear, nose, and throat, skin and skin structure or GU tract CONTRAINDICATION Contraindicated in patients hypersensitive to drug or other penicillin Use cautiously in patients with other drug allergies (especially to cephalosporins) because of possible crosssensitivity ADVERSE EFFECT CNS: seizures, anxiety, confusion, agitation, dizziness, reversible hyperactivity, anxiety, insomnia, behavioral changes NURSING RESPONSIBILITY GI: diarrhea, nausea, and vomiting GU: interstitial nephritis, nephropathy Hematologic: agranulocytosis, leukopenia, thrombocytopenic peupura, anemia, eosinophilia, hemolytic anemia Other: anaphylaxis, hypersensitivity reactions, If large dose are given or if therapy is prolonged, bacterial or fungal superinfection may occur especially in elderly, debilitated, or immunosuppr essed patients Amoxicillin usually causes fever cases of diarrhea than ampicillin Don’t confuse amoxicillin with amoxapine overgrowth of no susceptible organisms Drug Study 4 DRUG NAME AND CLASSIFICATIO N Generic Name: Mefenamic acid DOSE, FREQUENCY, ROUTE, DURATION OF ADMINISTRATI ON Dose: 500mg Route: PO Brand Name: Mefenax Frequency: TID Classification: Therapeutic Class: Antiinflammatory, Anti-pyretic Pharmacologic class: NSAID Duration: 3 days MECHANISM OF ACTION Inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily the CNS INDICATION General medicationheadache, dental pain, postoperative and postpartum pain, joint disorders Patient’s indication relieves pain when bleeding occurs CONTRAINDICATION Contraindicated in patients hypersensitive to the drug or any of fits component Impaired renal or liver function ADVERSE EFFECT CNS: headache, dizziness, insomnia, fatigue, tiredness, ophthalmic effects NURSING RESPONSIBILITY - Derm: pruritis, sweating, stomatitis GI: nausea, dyspepsia, GI pain, diarrhea. Vomiting, constipation, flatulence Hematologic: bleeding, platelet inhibition, neutropenia, eosinophilia GU: dysuria, renal impairment - Give drug with food, milk, or antacids Do not increase or double dose; follow exactly as prescribed and indicated Discontinue drug promptly if diarrhea