Drug Study
Medication # 1 Name: FeSO4 Syrup Dosage: 7.5ml OD Action: Provides/ Replacement elemental iron, an essential component in formation of hemoglobin in red blood cell development. Indication: Prevent and treatment of iron deficiency anemia. Contraindication: Hypersensitivity to any ingredients hemosiderosis, hemolytic anemia. Adverse Effect: GI irritation, anorexia, nausea, vomiting, diarrhea, constipation, dark stool. Teeth staining with liquid formulation. Drug Interaction: Antacid, chloramphenicol, levodopa, penicilliamine, quinolones, tetracyclines. Nursing Consideration: Assessment: Obtain baseline assessment of iron deficiency before starting therapy. Evaluate hemoglobin, hematocrit, and reticulocyte count during therapy. Monitor for adverse reaction Assess bowel elimination, increase water, bulk and activity if constipation occurs. Identify cause of iron loss or anemia. Assess patients family knowledge of drug therapy. Nursing Diagnoses: Nutritional imbalance: Less than body requirements r/t to underlying condition. Fatigue r/t iron deficiency. Constipation r/t adverse effect. Knowledge deficit of the drug therapy. Planning: Give between meals for best absorption; may give with juice ; do not give with antacids or milk , delay at least 1hr; if GI symptoms occur give after meals even if absorption is decreased; egg, milk products, chocolate, caffeine interfere with absorption ferrous gluconate is less GI irritating than ferrous sulfate. Do not crush, chew tablets Give liquid preparation through plastic straw to avoid discoloration of tooth enamel; dilute thoroughly. Give at least 1 hr before bedtime because corrosion may occur in stomach Give for <6 mons. for anemia Store in airtight, light- resistant container. Implementation: Instruct patient not to substitute one iron salt for another because they have different elemental iron content. Swallowing the whole table, do not crush or chew, do not double if missed, but take it as soon as remembered and avoid taking the drug with certain foods that may impair oral iron absorption like yogurt, cheese eggs, milk, cereals tea and coffee. Remind patient that poisoning may occur if increase beyond recommended level, as few as three tablets can cause poisoning in children. Caution patient to avoid reclining position for 15-30 mins. after taking drugs avoid esophageal corrosion. Inform patient that iron may turn stool black; this could mask the presence of melena. Evaluation: Decreased feeling of fatigue and weakness. Constipation is relieved or prevented by appropriate measure by the patient. Improvement in results of Hct, Hgb and reticulocytes on follow up examination. Patient and family state understanding of drug therapy.
Medication # 2
Name: Cefalexin Dosage: 500g IV q8O Action: Inhibits bacterial cell way synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death. Drug Interaction: Probenecid. Nephrotoxic agents such as aminoglycosides, colistin, polymixin beta, or vancomycin. Nursing Consideration: Assessment: Assess patients previous sensitivity reaction to penicillin or other cephalosporins. Cross- sensitivity between penicillin or cephalosporins is common. Assess patient for signs and symptoms of infection before and during treatment: fever, sputum, urine, stool, and WBC> 10,000/ mm3 Obtain C&S before begging drug therapy to identify if correct treatment has been initiated. Assess for anaphylaxis: rash, urticaria, pruritus, chills, fever or joint pain. Angioedema may occur a few days after the beginning of therapy. Epinephrine and resuscitation equipment should be available for anaphylactic reaction. Assess renal function before and during therapy: urine output, BUN and creatinine. Monitor for nephrotoxicity. Monitor hematologic, electrolyte and hepatic status if patient is on long term therapy. Assess for possible superinfection and severe diarrhea may indicated pseudomembranous colitis. Nursing Diagnosis: Risk for infection Diarrhea Risk for deficient fluid volume Risk for injury related to adverse drug reaction Knowledge deficit Noncompliance Implementation: Advise not to crush or chew capsules Shake suspension, refrigerate, discard after 2 wks. Evaluation: Absence of sign & symptoms of infection Observed and experienced improvement tom of infection Negative C&S
Medication # 3
Name: Clindamycin Dosage: 300 mg 1 cup q8o Action: Inhibits bacterial protein synthesis by binding to the 50s subunit of the ribosomes. Indication: Treatment of respiratory tract, skin or soft tissue, chronic bone or joint infections; septicemia; intra-abdominal, female genitourinal infections; bacterial vaginosis; endocarditis. Can be used for acne vulgaris. Clindamycin is used for treatment of malaria, otitis media, Pneumocystis carinii pneumonia, and toxoplasmosis. Action: Bacteriostatic. Clindamycin binds to bacterial ribosomal receptor sites. Topically, it decreases fatty acid concentration on skin. It inhibits protein synthesis of bacterial cell wall and prevents outbreak of acne vulgaris. Adverse Reaction: Abdominal pain Nausea and Vomiting Diarrhea Vaginitis and itching Dry scaly skin Phlebitis, thrombophlebitis with IV administration Pain, induration, at the IM injection site Allergic reaction, urticaria, pruritus Headache and dizziness Contact dermatitis Hypersensitivity reaction Nursing Considerations: Store capsules at room temperature After reconstitution, oral solution is stable for 2 weeks at room temperature. Do not refrigerate oral solution to avoid thickening. Give with 8 oz water. Question patient for history of allergies, particularly to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor bowel activity, stool consistency; report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea, genital/anal pruritus, increase fever, and change of oral mucosa.
