drug study

GENERIC NAME

BRAND NAME

CLASSIFICATION MOA INDICATION CONTRAINDICATI

ON ADVERSE REACTION DOSAG E NSG. RESPONSIBILITI ES Levetiracetam KEPPRA SYRUP

ANTICONVULSANT The precise mechanism(s) by which levetiracetam exerts its antiepileptic effect is unknown. Howe ver, the drug binds to a synaptic vesicle glycoprotein,SV 2A,( Synaptic vesicle glycoprotein 2A is a ubiquitous synaptic vesicle protein t hat in humans is encoded by the SV2A gene. The protein is targeted by the anti-epileptic drug (AED) levetirac etam. ) and inhibits presynaptic Monotherapy in the treatment of partial onset seizures with or without secondary generalization in patients ≥16 years with newly diagnosed epileps y. As adjunctive therapy in the treatment of partial onset seizures with or without secondary generalization in adults and children ≥4 years with epilepsy; myoclonic seizures in adults and adolescents ≥12 years with juvenile myoclonic epilepsy; primary generalized tonic-clonic seizures in adults and adolescents ≥4 Hypersensitivity to levetiracetam or other pyrrolidone derivatives or any of the excipients of Keppra. -Gastrointestina l Disorders: Abdominal pain, diarrhea, dyspepsia, nausea, vomiting. -Nervous System Disorders: Amnesia, ataxia, convulsion, dizziness, headache, hyperkinesia, tremor, balance disorder, disturbance in attention, memory impairment. - Psychiatric Disorders: Aggression, agitation, depression, emotional lability/mood swings, hostility, insomnia, irritability, nervousness, 10 cc -Establish safety precautions (siderails, proper lighting) -Take drug as prescribed -Monitor elderly patients carefully for adverse effect

-Report difficulty breathing, tremors, loss of coordination, sore muscle or muscle spasm

channels. This is believed to impede nerve conduction across synapses. idiopathic generalized epile psy. Keppra infusion concentrate is an alternative for patients when oral administration is temporarily not feasible. disorders, abnormal thinking. -Metabolism and Nutrition Disorders: Anorexia, increased weight. The risk of anorexia is higher when topiramate is co-administered with levetiracetam. -Musculoskelet al and Connective Tissue Disorders: Myalgia. - Skin and Subcutaneous Tissue Disorders: Eczema, pruritus, rash.

GENERIC NAME

BRAND NAME

CLASSIFICATION MOA INDICATION CONTRAINDICATION ADVERSE

REACTION

DOSAGE NSG.

RESPONSIBILITIES

Cilostazol Pletaal Anticoagulants The mechanism of the effects of cilostazol on the symptoms of intermittent claudication is not fully understood. Pletaal and several of its metabolites are cyclic AMP (cAMP) phosphodiesterase III inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing cAMP degradation with a resultant increase in cAMP in

platelets and blood vessels, leading to inhibition of platelet aggregation and vasodilation. Management of peripheral vascular disease. Powd for oral liqd: Relief of various ischemic symptoms eg ulcer, pain & cold sensation due to chronic arterial occlusive diseases. Prevention of recurrence of cerebral infarction excluding cardiogenic cerebral embolism. Cerebral infarction; CHF. Hemophilia, increased capillary fragility, hemoptysis; intracranial,

digestive & urinary tract & vitreous body hemorrhage. Women of childbearing potential. Pregnancy. Rash; palpitation, tachycardia, hot flushes; headache/dull headache, dizziness, insomnia, numbness; abdominal pain, nausea, vomiting, anorexia, diarrhea, heartburn & abdominal distention; SC hemorrhage; increased ALT, AST, alkaline phosphatase & lactate dehydrogenase; sweating,

edema & chest pain. 50 mg ( 1 sachet ) -Provide safety measures to prevent injury from bleeding.

-Check for signs of bleeding -Report nosebleed, bleeding of the gums, unusual bruising , black or tarry stools, cloudy or dark urine , abdominal or lower back pain, severe

NAME NAME REACTION RESPONSIBILITIES Atorvastatin

Lipitor

HMG-CoA

reductase

inhibitor

Its MOA

is

specific

inhibition

of

HMG-CoA

reductas

e.

To reduce the risk of MI,

stroke, angina, and revascularization procedures in patients with no evidence of CAD with multiple risk factors. Heterozygous familial hypercholesterolemi a. -AAdjunct to diet to reduce elevated LDL, total cholesterol, apo B, and triglyceride levels to increase HDL level in patients with primary hypercholesterolemi a and mixed dyslipidemia. CContraindicated in patients hypertensive to the drug and in those with active liver disease or conditions linked with unexplained persistent increases in transaminase levels. Adolescent girl must be at least 1 year post-menarche CNS Headache (17%); asthenia (4%); dizziness, insomnia (at least 2%). Dermatologic Rash (4%); bullous rashes including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (postmarketin g). EENT Sinusitis (6%); pharyngitis (3%); rhinitis (at least 2%). GI Diarrhea (5%); abdominal pain (4%); 80 mg - Monitor patient’s lipid and liver function levels at baseline and periodically thereafter. -Monitor patient for signs of rhabdomyolyis, especially if taking more than one class of lipid lowering drugs. - Asses patient’s and family’s knowledge of drug therapy.

constipation, dyspepsia, flatulence (3%); nausea (at least 2%). Genitourinary Albuminuria, hematuria, UTI (at least 2%). Metabolic Peripheral edema (at least 2%). Musculoskelet al Myalgia (6%); arthralgia (5%); back pain (4%); arthritis (at least 2%); rhabdomyolysi s (postmarketin g). Respiratory Bronchitis (at least 2%).

NAME REACTION RESPONSIBILITIES

Arixtra Fondaparinx Anticoagulats a synthetic and selective inhibitor of activated factor X (Xa). The antithrombotic activity of fondaparinux is the result of antithrombin III (ATIII)-mediated selective inhibition of factor Xa. By binding selectively to ATIII, fondaparinux potentiates (about 300 times) the innate neutralization of factor Xa by ATIII. Neutralization of factor Xa interrupts the blood coagulation Prevention of venous thromboembolic

events (VTE) in patients undergoing major

orthopedic surgery of the lower limbs eg hipfracture including extended prophylaxis, knee & hip replacement surgery; abdominal surgery at risk of thromboembolic

complications, restricted mobility during acute illness who are at risk of thromboembolic

complications. Treatment of

acuteDVT & pulmonary embolism (PE), unstable angina or non-ST

segment elevation MI (UA/NSTEMI) acute coronary syndrome for the prevention of death, MI &

refractory ischemia; ST segment elevation MI (STEMI) acute coronary syndrome for the

prevention of death & myocardial re-infarction Known hypersensitivity to fondaparinux sodium or any of the excipients of Arixtra. Active clinically significant bleeding. Acute bacterial endocarditis. Anemia, bleeding, purpura; edema. 2.5 gm. -Provide safety measures to prevent injury from bleeding.

-Check for signs of bleeding -Report nosebleed, bleeding of the gums, unusual bruising , black or tarry stools, cloudy or dark urine , abdominal or lower back pain, severe

cascade and inhibits both thrombin formation and thrombus development. -Fondaparinux does not inactivate thrombin (activated factor II) and has no known effect on platelet function.

in patients who are managed w/

thrombolytics or who initially are to receive no other form of

NAME REACTION RESPONSIBILITIES Cerebrolysin

Neurotrophics

Nootropics &

Neurotonics

-Cerebrolysin reduced infarct volume, inhibited edema formation, stabilized microcirculation, doubled the survival rate, and normalized lesion-related neurological failure and learning deficits. Positive results were also obtained using models of Alzheimer's disease. -Cerebrolysin appears to significantly increase the number of glucose transport molecules in the blood-brain barrier, thereby balancing out the critical energy deficit associated with this disease. Organic, metabolic and neurodegenerative disorders of the brain especially senile dementia of Alzheimer's type; postapoplectic complications; craniocerebral trauma; postoperative trauma, cerebral contusion or concussion. Hypersensitivity to one of the components of Cerebrolysin. Epilepsy. Severe renal impairment. Although there are no data indicating that Cerebrolysin causes renal stress, Cerebrolysin should not be administered in the presence of existing severe renal failure. In rare cases, the desired activating effects have also been associated with agitation (aggression, confusion, insomnia). In 1 study, rare cases of hyperventilation, hypertension, hypotension, tiredness, tremor, depression, apathy, dizziness and symptoms of influenza (eg, cold, cough, respiratory tract infections) were reported. Single cases of grand mal attacks and convulsions have been reported after administration of Cerebrolysin. In rare cases, gastrointestinal disturbances eg, loss of appetite, dyspepsia, 10 mg

diarrhea, constipation, vomiting and nausea, have been observed. If injected too quickly, feelings of heat or sweating, dizziness, and in isolated instances, palpitations or arrhythmias may result. Injection site reactions eg, erythema, pruritus and burning have been reported. In very rare cases, hypersensitivity or allergic reactions eg, skin and local inflammatory reactions, headache, neck and limb pain, fever, low back pain, dyspnea, chills and shock-like state have been observed.

NAME REACTION RESPONSIBILITIES

Pantoloc

Pantoprozole

Antacids,

Antireflux

Agents &

Antiulcerants

it inhibits specifically and dose-proportionally H+,K+ -ATPase, the enzyme which is responsible for gastric acid secretion in the parietal cells of the stomach. - thus inhibiting the proton pump and causing suppression of stimulated and basal gastric acid secretion after single and multiple intravenous and oral pantoprazole dosing -Symptomatic treatment of mild reflux esophagitis -Duodenal & gastric ulcers, reflux esophagitis -Duodenal & gastric ulcer -Eradication of H. pylori Pantoloc Hepatic impairment. Pregnancy. Pantoloc IV Concomitant use w/ atazanavir. Pantoloc Headache, diarrhea. Rarely, nausea, upper abdominal pain, flatulence, rash, pruritus or dizziness. 40 mg

IVTT -Tell the client to swallow the tablets whole—do not chew, cut, or crush them. -Tell the client to Report severe headache, worsening of symptoms, fever, chills, blurred vision, periorbital pain. - Maintain all of the usual activities and restrictions that apply to your condition. If this becomes difficult, consult with your nurse or physician.

GENERIC NAME

BRAND NAME

CLASSIFICATION MOA INDICATION CONTRAINDICATION ADVERSE

REACTION DOSAGE NSG. RESPONSIBILITIES Per 250 mL Na lactate (50%) 28.25g, KCL 0.075g, CaCl2 (100%) 0.05g Totilac

Intravenous

& Other

Sterile

Solutions

Totilac is a neutral solution (pH = 7) containing cations (sodium, potassium, calcium) and anions (chloride and lactate) that causes a moderate pH increase after lactate is metabolized in the body.

Small vol fluid therapy for rapid restoration of intravascular vol (eg hemorrhagic & dengue shock, burnt patient); prevention of hypovolemia & maintaining stable hemodynamic status (peri-op condition); as an alternative in the treatment of metabolic acidosis & electrolyte disorder (hyponatremia); treatment for

tissue/peripheral edema; reduction of intracranial pressure in traumatic brain injury; source of alternative energy substrate during cell restoration post-ischemia. Severe hypernatremia (plasma Na >155 mmol/L), metabolic alkalosis (pH >7.5) & renal failure w/ anuria. Febrile response, infection at site of inj, venous thrombosis or phlebitis extending from site of inj, extravasation, hypervolemia, hypernatremia, hypochloremia & metabolic alkalosis. 120 cc

NAME NAME REACTION RESPONSIBILITIES

Citicoline

Somazine CNS Drugs & Agents for ADHD Citicoline is a complex organic molecule that functions as an intermediate in the biosynthesis of cell membrane phospholipids. It is also known as CDP-choline or cytidine diphosphate choline (cytidine 5'-diphosphocholine). CDP-choline belongs to the group of biomolecules in living systems known as nucleotides that play important roles in cellular metabolism.

Acute and recovery phase of cerebral infarction

(eg, ischemia due to stroke). Cognitive dysfunction due to degenerative (ie, Alzheimer's disease) and cerebrovascular disease. Cerebral insufficiency

(eg, dizziness, memory loss, poor

concentration, disorientation) due to head trauma or brain injury. Patients with hypertonia of the parasympathetic nervous system. Gastrointestinal disorders (ie, stomach pain, diarrhea). Vascular side effects (ie, hypotension, tachycardia, bradycardia). Tablet: Usual Dose: 500 mg once or twice daily. Drops: Usual Dose: 100-200 mg (1-2 mL) twice or thrice daily. Ampoule: 125 mg/mL: Usual Dose: 1-2 injections daily. 250 mg/mL: Usual Dose: 1 injection daily. Adjust dose according to disease severity. Can be administered through IM or IV (3-5 min) route and IV drip (infusion rate of 40-60 drops/min). Direct IV administration should be made very slowly to prevent episodes of hypotension. Cholinerv is compatible with hypertonic glucose solution and all IV isotonic solutions. -Somazine must not administered together with medicines containing meclophenexate.

GENERIC NAME

BRAND NAME

CLASSIFICATION MOA INDICATION CONTRAINDICATION ADVERSE REACTION

DOSAGE NSG.

Co-amoxicla

v

Broad-spectrum

penicillin

antibiotic that combines amoxicilli n and clavulanic acid. It destroys bacteria by disrupting their ability to form cell walls. - Clavulani c acid blocks the chemical defence, known as beta-lactamas e, that some bacteria have against penicillins . l Co-amoxicla v is active against suspected amoxicillin-resistant infections including respiratory tract, skin and soft tissue, genitourinary, and ear, nose and throat infections. - Effective against strains of Escherichia coli, Proteus mirabilis, Haemophilus influenzae, Streptococcu s faecalis, Streptococcu s pneumoniae and some beta- lactamase-producing organisms. hypersensitivity. - History of co- amoxiclav-associated or penicillin-associated jaundice or hepatic dysfunction. Infestations: Common: Mucocutaneous candidiasis. Blood and Lymphatic System Disorders: Rare: Reversible leukopenia (including neutropenia) and thrombocytopen ia. Very Rare: Reversible agranulocytosis and hemolytic anemia. Prolongation of bleeding time and prothrombin time. Immune System Disorders: Very Rare: Angioneurotic edema, anaphylaxis, serum sickness-like syndrome, hypersensitivity vasculitis. Nervous System Disorders: 250/125 mg tablets should not be substituted for 1 co-amoxiclav 500/125 mg tablets since they are not equivalent.

Children: Dosage

should be expressed in terms of age of the child and either in mg/kg/day or mL of suspension per dose or equivalent for other presentations. Children weighing ≥40 kg should be dosed according to the adult recommendations The lower dose is recommended for infections eg, skin and soft tissue and recurrent tonsillitis. The higher dose is recommended for infections eg, otitis media, sinusitis, lower respiratory tract infections and UTI.

No clinical data are available on doses of these formulations >40/10 mg/kg/day 3 times daily (4:1) or 45/6.4 mg/kg/day considerations - Assess bowel pattern before and during treatment as pseudomembranou s colitis may occur. - Report haematuria or oliguria as high doses can be nephrotoxic. - Assess respiratory status. - Observe for anaphylaxis. - Ensure that the patient has adequate fluid intake during any diarrhoea attack. Patient teaching - If the patient develops a rash, wheezing, itching, fever or swelling in the joints, this could indicate an allergy and should be reported. - Patients must ensure they take

bacterial infections that have become resistant to amoxicilli n. Uncommon: Dizziness, headache. Very Rare: Reversible hyperactivity and convulsions. Convulsions may occur in patients with impaired renal function or in those receiving high doses. Gastrointestinal Disorders: Adults: Very Common: Diarrhea. Common: Nausea, vomiting. Children: Common: Diarrhea, nausea, vomiting. twice daily (7:1) in children <2 years. There are no clinical data for the 7:1 formulation for patients <2 months. Dosing recommendations in this population therefore cannot be made. Premature: No dosage recommendation can be made for this category.

Elderly: No

adjustment needed; dose as for adults. If there is evidence of renal impairment, dose should be adjusted as for renally impaired adults. Renal Impairment: Dosage adjustments are based on the maximum recommended level of amoxicillin.

the full course of the medicine.

- The medicine must be taken in equal doses around the clock to

maintain level in the blood. - If oral contraceptives are used, use alternative contraception. - Report diarrhoea, cramping and blood in stools as

pseudomembranou s colitis may occur.