Module 6 Elaborate - Sanchez
Module 6 Elaborate - Sanchez
1. Create a Drug Study on Cardiovascular Drugs that are commonly used in clinical settings. Utilize the drug study template.
DRUG STUDY
Patient : Palacio, Ma. Reshel
_________________________________ Age : _______________________
55 Hospital No. : __________
20556468
Impression : Patient has hypertension
_________________________________ Attending : Dr. Aike Ubay
_______________________ Room No. 001
: __________
Allergic to : No known allergies
_________________________________ Physician
DRUG STUDY
Patient : Labiste, Gem Angiely
_________________________________ Age : 27
_______________________ Hospital No. 20556468
: __________
Impression : Patient has hypertension
_________________________________ Attending : Dr. Aike Ubay
_______________________ Room No. 002
: __________
Allergic to : No known allergies
_________________________________ Physician
GENERIC/BRAND DOSE, STRENGTH,
INDICATION/ MECHANISM ADVERSE EFFECT AND
AND AND NURSING RESPONSIBILITIES CLIENT TEACHING
OF ACTION CONTRAINDICATIONS
CLASSIFICATION FORMULATION
DRUG STUDY
Patient : Sanchez, Kristine Chloe
_________________________________ Age : 31
_______________________ Hospital No. 20556468
: __________
Impression : Patient has hypertension
_________________________________ Attending : Dr. Aike Ubay
_______________________ Room No. 003
: __________
Allergic to : No known allergies
_________________________________ Physician
GENERIC/BRAND DOSE, STRENGTH,
INDICATION/ MECHANISM ADVERSE EFFECT AND
AND AND NURSING RESPONSIBILITIES CLIENT TEACHING
OF ACTION CONTRAINDICATIONS
CLASSIFICATION FORMULATION
Generic: Ordered: Indication: Adverse Effect: - Note reasons for therapy, other agents Instruct patient to:
Prazosin Mild to moderate Dizziness, drowsiness, trialed, outcome.
hydrochloride hypertension alone or in headache, lack of - Assess cardiopulmonary status and - Take first dose at
combination with other energy, weakness, renal function. bedtime.
Brand:
palpitations, nausea - Monitor patient's blood pressure and
antihypertensive drugs. - Do not drive or operate
Minipress Timing: pulse rate.
- Elderly patients may be more sensitive machinery for 24 hrs. after
Contraindications:
Classification: to the drug's hypotensive effects. the first dose.
Antihypertensive Clients with - Monitor patient compliance. - food may delay
Duration: Mechanism of action: hypersensitivity to - If first does is more than 1 mg, first- absorption and minimize
Alpha-1- Produces selective prazosin or related dose syncope may occur. side effects of the drugs.
adrenergic blockade of postsynaptic quinazolines. - Full therapeutic effect of drug is
Other forms: - avoid rapid changes in
blocking drug alpha-1-adrenergic reached within 4-6 weeks.
Capsules body positions that may
receptors. Dilates arterioles - Educate the patient about weight loss,
and veins, thereby exercise programs as needed. precipitate weakness
decreasing total; peripheral - Provide resources for complementary dizziness, and syncope.
resistance and decreasing and alternative therapies to promote - Do not stop medication
DBP more than SBP. positive coping mechanisms and stress unless directed.
reduction
DRUG STUDY
Patient : Dacillo, Marlo
_________________________________ Age 37
: _______________________ Hospital No. 20556468
: __________
Impression : Patient has hypertension
_________________________________ Attending : Dr. Aike Ubay
_______________________ Room No. 005
: __________
Allergic to : No known allergies
_________________________________ Physician
GENERIC/BRAND DOSE, STRENGTH,
INDICATION/ MECHANISM ADVERSE EFFECT AND
AND AND NURSING RESPONSIBILITIES CLIENT TEACHING
OF ACTION CONTRAINDICATIONS
CLASSIFICATION FORMULATION
Generic: Ordered: Indication: Adverse Effect: - Note reasons for therapy, other agents -
Instruct patient to:
To treat chronic stable Flushing, increased
Nicardipine prescribed, outcome.
angina alone or in angina, hypotension, - Establish baseline data before - Take at the same time
hydrochloride
Brand: combination with beta- palpations, treatment is started including BP, pulse, each day.
adrenergic blocking agent. tachycardia, and lab values of liver and kidney - Report any
Cardene Timing: function.
And hypertension alone or vasodilation, anxiety, persistent/bothersome
and dizziness. - Assess for CHF, if beta blockers
Classification: combination with other side effects.
Contraindications: prescribed, monitor closely
Calcium antihypertensive drugs. - Maintain proper intake
- Monitor ECG, renal and LFTs, note any
Mechanism of action: Used in advance aortic
Channel blocker Duration: dysfunction. of fluids to avoid
Moderately increases Co stenosis due to the - Closely monitor blood pressure and constipation.
and HR and significantly effect on reducing heart rate since it may produce
Other forms: - Avoid alcohol and limit
decreases peripheral afterload, and lactation. symptomatic hypotension and
Capsules caffeine.
vascular resistance. tachycardia.
(extended release) - Avoid prolong sun
- Observe for large peak and trough
Capsules differences in BP. Initially, measure BP at exposure.
(immediate peak effect (1–2 h after dosing) and at - Report any change in
release) trough effect (8 h after dosing). psychologic state.
2. Briefly organize and bring together main ideas. Explain in your own words. (50 – 150 words for each question)
I. TM, a 57-year-old man, has thrombophlebitis in the right lower leg. IV heparin, 5000 units by bolus, was given. Following the IV bolus, heparin
5000 units given subcutaneously every 6 hours was prescribed. Other therapeutic means to decrease pain and alleviate swelling and redness
were also prescribed, and an aPTT test was ordered.
A. Was TM’s heparin order within the safe daily dosage range?
Answer:
TM’s heparin order is within the safe daily dosage range. The standard bolus dosage of IV heparin is 5,000 units, and the patient
received the same. While the standard dosage of IV heparin is given by an infusion of 20,000-40,000 units in 24 hours. Which means
that every 6 hours, the patient can take a minimum of 5,000-10,000 units. In in this situation, TM is given a dosage of 5,000 units every
6 hours which is under the normal dosage range. Therefore, it is clear that the daily dosage of TM was in the safe daily dosage range.
B. What are the various methods for administering heparin?
Answer:
Heparin is administered subcutaneously, wherein it is injected into the layer of the skin just below the epidermis and the dermis, in
areas such as the upper arm, thighs, two inches around the navel, hip bone, and the buttocks. Moreover, it can also be given
intravenously, wherein the medication is infused into the body of the patient through the veins, it could be in the form of intermittent
or continuous infusion.
C. Why was an aPTT test ordered? How would you determine whether TM is within the desired range? Explain your answer.
Answer:
An aPTT is a test used for detecting deficiencies for clotting factors and it was ordered to monitor the patient's response
to heparin therapy. Heparin is a blood thinner and if consumed in large quantities that are not required for the body, it can decrease the
count of the platelet and lead to prolonged aPTT result. However, if the patient is taking the desired dose of heparin, his aPTT result
would be in the desire range which is 1.25 to 2.5 times in the control level.
After 5 days of heparin therapy, TM was prescribed oral warfarin 5 mg daily. An INR test was ordered.
D. What is the pharmacologic action of warfarin? Is the warfarin dose within the safe daily dosage range? Explain your answer.
Answer:
Warfarin is an anticoagulant, it disrupts the coagulation cascade to reduce frequency and extent of thrombus formation. By interfering
with the synthesis of vitamin K-dependent clotting factor resulting in depletion of clotting factor II, VII, IX, and X. The normal dosage
of warfarin for an adult is 5-10 milligrams per day and can be maintained from 2-10 milligrams per day. TM is given 5 milligrams per
Day which means that the daily dosage of warfarin given to the patient is within the safe daily dosage.
E. What is the half-life and protein binding for warfarin? If a patient takes a drug that is highly protein bound, would there be a
drug interaction? Explain your answer.
Answer:
The half-life of warfarin is generally 20 to 60 hours; however, it is highly variable among individuals. Meanwhile its protein binding
is 99%. Thus, there would be a drug interaction if the patient takes another medication that is highly protein bound. When a patient
takes in another medication that is highly protein bound this could result in the displacement of warfarin from the protein binding site,
which increases warfarin free plasma concentration, and increase the risk of warfarin toxicity.
F. Why was an INR ordered for TM? What is the desired range?
Answer:
International Normalized Ratio (INR) testing was ordered because it is as an integral part of warfarin treatment. INR is done to ensure
the desire dose of the warfarin, it has a critical role in maintaining the warfarin response within a therapeutic range, to provide the
benefits of anticoagulation, while avoiding the risks of hemorrhage. The therapeutic INR ranges between 2.0 to 3.0. INR levels.
G. What serious adverse reactions could result with prolonged use or large doses of warfarin?
Answer:
Prolonged or taking large doses of warfarin could result in the following adverse reactions: red spots on the skin that look like a rash,
severe headache or dizziness, heavy bleeding after an injury, heavy bleeding during monthly period in women, severe stomach pain or
vomiting blood, pink, red, or dark brown urine, and black or bloody bowel movements
H. What patient teaching interventions should the nurse include? List three interventions.
Answer:
In the nurse’s patient teaching intervention, she should teach the patient that the intake of aspirin along with warfarin causes heavy
bleeding, thus the patient should seek physician advise first before doing so. Moreover, the nurse should advise the patient to take
laboratory test such as PT (prothrombin time) or INR (international normalized ratio) to ensure that the medication is in the therapeutic
dose. And lastly, the patient must avoid activities that may cause injury or cuts and bruises since he/she is taking a blood thinner that
may slow down blood clotting which could result to excessive bleeding.
I. Months later, TM has hematemesis. What nursing action should be taken?
Answer:
The nursing action to be taken in the given case is to provide drugs or food rich in vitamin k. This will decrease the outflow of blood
from the body and increase the clotting of blood.
3. JH had a myocardial infarction (MI) 3 years ago. He was prescribed gemfibrozil 600 mg twice daily before meals, but his cholesterol remained between
220 and 240 mg/dL, and his LDL was 140 mg/dL. His anticholesterol drug was changed to simvastatin 20 mg/day in the evening.
A. How does simvastatin differ from gemfibrozil?
Answer:
Gemfibrozil and simvastatin are used to treat high cholesterol and triglyceride levels but have different mechanisms. They belong in
different drug classes, gemfibrozil is a lipid-regulating agent while simvastatin is an HMG-CoA reductase inhibitor. Moreover, gemfibrozil
has high side effects and does not lower the risk of heart attacks whereas simvastatin has the most minimal side effects and can decrease
the risk of heart attacks which makes it the preferred choice of drug.
B. Why do you think JH’s cholesterol drug, gemfibrozil, was changed to simvastatin?
Answer:
JH had a history of myocardial infraction and is at high risk of getting it again due to very high cholesterol level. Gemfibrozil can prevent
the formation of abnormal lipid level by increasing the HDL and simultaneously lowering the LDL. However, the expected changes did
not occur and the patient had an LDL of 140mg which is considered to be borderline in a patient who already has heart problems. Thus, the
drug was changed to simvastatin which has a greater benefit than gemfibrozil in decreasing heart attacks and strokes.
C. While JH is taking simvastatin, which group of serum levels should be monitored?
Answer:
While taking simvastatin, JH should monitor his lipid levels which includes his total cholesterol, HDL, LDL, and triglycerides to assess the
changes, LFT (liver function test) since the drugs has effects on the liver, CBC since there will be a rise in patients taking the medication,
and CPK to rule out muscle wasting.
D. How long after taking simvastatin should JH’s cholesterol and lipoproteins be checked?
Answer:
After starting a statin such as simvastatin, it takes about six weeks for cholesterol levels to stabilize, so most doctors would re-check the
cholesterol and lipoproteins after about eight weeks. There is a need for a blood test when taking medications such as simvastatin to check
whether the blood cholesterol level has come down and lipoproteins are on normal range.
References:
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