Drug Study 612c25

DRUG Generic Name: Gliclazide Brand Name: Diamicron Drug Classification: Oral Anti-Diabetic agent

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Dosage: Diamicron MR is for use in adults only. Dose may vary from 30120mg, taken once daily Should be taken with food, preferably at breakfast time Tablets are modified release, therefore should not be broken or chewed Always titrate dose according to individual patient requirements, in steps of 30mg Daily dose should not exceed 120mg Diamicron MR can replace other Gliclazide 80mg tablets, one for one

INDICATIONS Diamicron MR is used in the treatment of type II (non-insulin dependent) diabetes that cannot be controlled with diet and exercise.

ACTIONS Gliclazide is a blood glucose-lowering agent. Non-insulin dependent diabetes (NIDDM) is due to a decreased sensitivity of the body cells to insulin, but the pancreas still has the ability to produce insulin. Gliclazide stimulates the islet cells of the pancreas to secrete insulin, and also increases their sensitivity to their normal stimulus, glucose. These effects restore the (first-phase) insulin secretion that has become diminished in NIDDM patients. Gliclazide also has effects outside the pancreas, where it improves insulinstimulated usage of glucose. This combined with its continuing ability to

CONTRAINDICATIONS This medication must not be used in the following cases: -if you are allergic to gliclazide -if you have diabetes requiring treatment with insulin, -in case of diabetes complicated by ketosis and acidosis, diabetic precoma -if you suffer from severe liver or kidney disease. -in case of porphyria: accumulation of pigments (porphyria) in the body -if you are presently taking a treatment with miconazole (see  interactions with other medications) -if you are breastfeeding

SIDE EFFECTS Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect. Disturbances of the gut such as diarrhoea, constipation, indigestion, nausea, vomiting or abdominal pain.  Temporary visual disturbances at

NURSING CARE Patients who are NPO may need to have their dose held to avoid hypoglycemia

stimulate insulin secretion, allow Gliclazide to have long-term blood glucose-lowering ability.Diamicron MR is a modified release tablet, meaning the blood concentrations of Gliclazide increase slowly. This produces steadier insulin release and more moderated diabetic control.

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Generic name: Insulin Injection [Regular] (in´su-lin) Brand name: Humulin R, Novolin R, Regular Insulin, Pork Regular Iletin II, Regular Purified Pork Insulin, Velosulin, Velosulin BR, Velosulin Human

-diabetic comadiabetic acidosisclients sufferingfrom labile diabetes.

Short-acting, clear, colorless solution of exogenous unmodified insulin extracted from beta cells in pork pancreas or synthesized by recombinant DNA technology (human). Enhances transmembrane age of glucose

hypersensitivity t o insulin

start of treatment. Low blood glucose level (hypoglycaemia. Skin reactions such as rash and itch. Disturbances in the normal levels of blood cells in the blood. Yellowing of the skin and eyes (jaundice). Disturbance in liver function. Inflammation of the liver (hepatitis). Hypoglycemia, hypokalemia, injection site reaction pruritus, rash

Assessment & Drug Effects  Note: Frequency of blood glucose monitoring is determined by the type of insulin regimen and health status of the patient.  Lab tests: Periodic postprandial blood glucose, and HbA1C. Test urine for

Classifications: hormone and synthetic substitute; antidiabetic agent; insulin Pregnancy Category: B Route & dosage Diabetes Mellitus adult:SC 5–10 U 15– 30 min a.c. and h.s. (dose adjustments based on blood glucose determinations) child:SC 2–4 U 15–30 min a.c. and h.s. (dose adjustments based on blood glucose determinations) Ketoacidosis adult:IV 2.4–7.2 U loading dose, followed by 2.4–7.2 U/h continuous infusion child:IV 0.1 U/kg loading dose, followed by 0.1 U/h continuous infusion

across cell membranes of most body cells and by unknown mechanism may itself enter the cell to activate selected intermediary metabolic processes. Promotes conversion of glucose to glycogen.

ketones in new, unstable, and type 1 diabetes; if patient has lost weight, exercises vigorously, or has an illness; whenever blood glucose is substantially elevated.  Notify physician promptly for presence of acetone with sugar in the urine; may indicate onset of ketoacidosis. Acetone without sugar in the urine usually signifies insufficient carbohydrate intake.  Monitor for hypoglycemia at time of peak action of insulin. Onset of hypoglycemia (blood sugar: 50–40 mg/dL) may be rapid and sudden.  Check BP, I&O ratio, and blood glucose and ketones every hour during treatment for

ketoacidosis with IV insulin.  Give patients with severe hypoglycemia glucagon, epinephrine, or IV glucose 10%–50%. As soon as patient is fully conscious, give oral carbohydrate (e.g., dilute corn syrup or orange juice with sugar, Gatorade, or Pedialyte) to prevent secondary hypoglycemia. Patient & Family Education  Learn correct injection technique.  Inject insulin into the abdomen rather than a near muscle that will be heavily taxed, if engaged in active sports.  Notify physician of local reactions at injection site; may develop 1–3 wk after therapy starts and last several hours to days, usually disappear with

continued use.  Do not change prescription lenses during early period of dosage regulation; vision stabilizes, usually 3–6 wk.  Note: Hypoglycemia can result from excess insulin, insufficient food intake, vomiting, diarrhea, unaccustomed exercise, infection, illness, nervous or emotional tension, or overindulgence in alcohol.  Respond promptly to beginning symptoms of hypoglycemia. Severe hypoglycemia is an emergency situation. Take 4 oz (120 mL) of any fruit juice or regular carbonated beverage (1.5–3 oz [45–90 mL] for child) followed by a meal of longer-acting carbohydrate or protein food. Failure to show signs of

recovery within 30 min indicates need for emergency treatment.  Carry some form of fast-acting carbohydrate (e.g., lump sugar, LifeSavers or other candy) at all times to treat hypoglycemia.  Check blood glucose regularly during menstrual period; loss of diabetes control (hyperglycemia or hypoglycemia) is common; adjust insulin dosage accordingly, as prescribed by physician.  Notify physician of S&S of diabetic ketoacidosis.  Continue taking insulin during an illness, go to bed, and drink noncaloric liquids liberally (every hour if possible). Consult physician for insulin regulation if unable

to eat prescribed diet.  Avoid OTC medications unless approved by physician.  Do not breast feed while taking this drug without consulting physician. Generic Name: Paracetamol Brand Name: Aeknil Classification:  Analgesics (Nonopioid)  Anti-pyretics DOSAGE Adults and Children ≥10 years: 2-3 mL. Children up to 10 years: 1-2 mL. Infants: ½-1 mL. Depending on severity of case, dose may be repeated 4-hourly till temperature returns to normal. In severe cases, dose may be istered IV very slowly.

Temporary relief of pain and discomfort. Pyrexia of unknown origin and for symptomatic relief of fever and pain as sociated with common childhood disorders, tonsillitis, upper respiratory tract infections, post-immunization reactions, after tonsillectomy and other conditions where patient is unable to take oral medications but where paracetamol can be istered with advantage. For prevention of febrile convulsion.

As an antipyretic, acetaminophen reduces fever by acting directly on the hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat As an analgesic, the site and mechanism of action unclear.

Not for patients with hypersensitivity to acetaminophen, it should be used with caution with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

Headache and high grade fever

Do not exceed the recommended dosage. • Consult physician if needed for children < 3 yr; if needed for longer than 10 days; if continued fever, severe or recurrent pain occurs (possible serious illness). • Avoid using multiple preparations containing acetaminophen. Carefully check all OTC products. • Give drug with food if GI upset is noted. • Discontinue drug if hypersensitivity reactions occur. • Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should be available as a specific antidote; basic life measures may be necessary.

Ciprofloxacin Dosage: 500mg Frequency: BID Route: Per Orem Classification: Antibacterial fluoroquinolone

Headache, cold, sinusitis, musc le pain, arthritis and t oothache. Ciprofloxacin is used to treat infections of the skin, lungs, airways, bones, and ts caused by susceptible bacteria . Ciprofloxacin is also frequently used to treat urinary infections caused by bacteria such as E. coli. Ciprofloxacin is effective in treating infectious diarrheas caused by E. coli, Campylobacter jej uni , and Shigellabacteria.

Bactericidal; interferes with DNA replication in susceptible bacteria preventing cell reproduction

Allergy to ciprofloxacin, norfloxacin or other fluoroquinolones

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nausea

Twice a day dosage;

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vomiting

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stomach pain

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heartburn

Make sure to drink plenty of water or other fluids everyday while taking Ciprofloxacin;

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diarrhea

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feeling an urgent need to urinate

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headache

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vaginal itching and/or discharge

Instruct patient not to take ciprofloxacin with dairy products such as milk or yogurt, or with calciumfortified juice. He may eat or drink dairy products or calcium-fortified juice with a regular meal, but do not use them alone when taking ciprofloxacin. They could make the medication less effective. Instruct client to report any adverse reaction to the physician or nurse. Tell patient that antacids and mineral supplements may decrease the absorption of Ciprofloxacin which makes it less effective. Do not take the medication

in larger amounts, or take it for longer than recommended by the doctor Generic Name: Tramadol Hydrochloride Brand Name: (Ultram, Ultracet) Classifications: Analgesic

To treat moderate to moderately severe pain

Unknown. A centrally acting synthetic analgesic compound not chemically related to opioids. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine and serotonin.

hypersensitive to drug or other opioids, Use cautiously in patients at risk for seizures

dizziness, vertigo, headache, vasodilation, chest pain, nausea, vomiting, constipation,

* Reassess level of pain at least 30 minutes after istration. * Monitor patient closely for evidence of serotonin syndrome, such as agitation, hallucinations, coma, tachycardia, labile blood pressure, hyperthermia, hyperreflexia, incoordination, nausea, vomiting, or diarrhea. Notify prescriber at once because serotonin syndrome may be lifethreatening. Be prepared to discontinue drug and provide ive care. * Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate is below 12 breaths/minute. * Monitor bowel and bladder function. Anticipate need for laxative. * For better analgesic

effect, give drugs before onset of intense pain. * Monitor patients at risk for seizures. Drug may reduce seizure threshold. * In the case of an overdose, naloxone may also increase risk of seizures. * Monitor patient for drug dependence. Drug can produce dependence similar to that of codeine or dextropropoxyphene and thus has potential for abuse. * Withdrawal symptoms may occur if drug is stopped abruptly. Reduce dosage gradually. * Take drug as prescribed and not to increase dose or dosage interval unless ordered by prescriber. * For ambulatory patients: Be careful in rising and walking. Avoid driving and other potentially hazardous activities that require mental alertness until drug’s CNS effects are known. * Check with prescriber before taking any OTC drugs as drug interactions

Generic Name: Clindamycin hydrochloride Brand Name: DalacinC, Cleocin Classification: Antibio tic, lincosamide Dosage: Per Orem: 150300mg q6h. For severe infections: 300-450mg q6h. Life-threatening infections: 4.8 grams/IV Topical: Apply a thin film on the affected area.

1. Treatment of serious respiratory tract infections caused by anaerobes 2. Treatment of serious skin and soft tissue infections, septicemia and abdominal infections 3. Serious infections caused by Streptococci/ Staphylocicci/ Pneumococci 4. Adjunct to surgery for chronic

1. Suppresses protein synthesis by microorganisms by binding to ribosomes 2. Prevents peptide formation 3. Does not diffuse adequately to the CSF

1. Hypersensitivity 2. Use in treating minor bacterial infections 3. Use in clients with a history of regional enteritis, ulcerative colitis, meningitis, antibioticassociated colitis 4. Use for treating viral infections 5. Lactation

1. Diarrhea 2. Pseudomemb ranous colitis 3. Tinnitis 4. Nausea and vomiting 5. Skin rashes 6. Dry skin 7. Burning 8. Itching 9. Skin erythema 10. Peeling 11. Oily skin 12. Cardiopulm onary arrest 13. Anaphylaxis 14. Agranulocyt osis 15. Aplastic

may occur. * Avoid giving tramadol to patients with acute abdominal conditions because it may mask evidence and disrupt assessment of the abdomen. * Monitor patient closely for evidence of suicidal thinking or behavior, especially when therapy starts or dosage changes. 1. Use parenteral form for anaerobic infections 2. Reduce dosage in severe renal impairment 3. Give parenteral dosage for hospitalized clients only 4. ister IV over 2060 minutes 5. Assess for diarrhea and possible colitis 6. Assess extent of infections and if improvement occurs 7. Monitor liver and renal function 8. With IV, keep in bed for 30 min. following infusion to prevent hypotension

bone/t infections 5. Treatment of acne vulgaris 6. Treatment of bacterial vaginosis

Metformin (Glucophage, Glucophage XR) Classification: Metformin ; biguanides, Antidiabetic Agents

Diabetes Mellitus type 2

anemia

Biguanide oral hypoglycemic agent. Unlike sulfonylureas, biguanides do not stimulate the release of insulin from the beta cells of the pancreas. Mechanism of action is thought to be due to both increasing the binding of insulin to its receptor and potentiating insulin action. Improves tissue sensitivity to insulin, increases glucose transport into

Hypoglycemia

 headache or muscle pain;  weakness; or  mild nausea, vomiting, diarrhea, gas, stomach pain.

9. Take orally with a full glass of water to prevent stomach distress 10. If diarrhea occurs, do not use antiperistaltic agents 11. If using vaginal cream, it weakens latex-containing condoms due to the mineral oil content 12. Do not use peeling agents on affected acne areas      

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Give with food. Swallow them whole. Do not break or crush them. Take exactly as prescribed. Monitor Blood Glucose levels, to evaluate effectiveness. Withhold drug if patient develops hypoxemia or sepsis this will increase the risk for lactic acidosis. Teach the patient to avoid alcohol = will increase the risk of hypoglycemia.

Hypertension Clonidine (Catapres) Classification: cardiovascular agent; central-acting antihypertensive; analgesic

skeletal muscles and fat, and suppresses gluconeogenesis and hepatic production of glucose, thus lowering blood glucose levels. Stimulates CNS alpha2-adrenergic receptors, inhibits sympathetic cardio accelerator and vasoconstrictor centers, and decreases sympathetic outflow from the CNS.

Stress the importance of diet, exercise, controlling weight, and monitoring blood glucose is the regimen of treatment. Contraindicated with hypersensitivity to clonidine or any adhesive layer components of the transdermal system.

Anxiety; confusion; constipation; dizziness; drowsiness; dry mouth; general weakness; nausea; ringing in the ears; sweating; tiredness; vomiting.

Name confusion between clonidine and Klonopin  Do not discontinue abruptly; discontinue therapy by reducing the dosage gradually over 2–4 days to avoid rebound hypertension, tachycardia, flushing, nausea, vomiting, cardiac arrhythmias (hypertensive encephalopathy and death have occurred after abrupt cessation of clonidine).  Do not discontinue prior to surgery; monitor BP carefully during surgery; have other BP-controlling drugs on standby.  Store epidural injection at room temperature; discard any unused portions.  Reevaluate therapy if clonidine tolerance

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Albuterol/ Salbutamol (Ventolin Nebules) Classification: Bronchodilator (therapeutic); adrenergics (pharmacologic)

1. To control and It relieves nasal prevent congestion and reversible reversible airway bronchospasm by obstruction relaxing the smooth caused by muscles of the asthma or bronchioles. The chronic relief from nasal obstructive congestion and pulmonary bronchospasm is disorder (COPD) made possible by 2. Quick relief for the following bronchospasm mechanism that 3. For the takes place when prevention of Salbutamol is exerciseistered. induced 1. First, it binds to bronchospasm the beta24. Long-term adrenergic

1. Hypersensitivity to adrenergic amines 2. Hypersensitivity to fluorocarbons

occurs; giving concomitant diuretic increases the antihypertensive efficacy ofclonidine. Monitor BP carefully when discontinuing clonidine ; hypertension usually returns within 48 hr. Assess compliance with drug regimen in a ive manner with pill counts, or other methods.

 Fast, irregular, pounding, or racing heartbeat or pulse

 Use one container of solution or mix the exact amount of solution using the dropper provided for each dose.

 shakiness in the legs, arms, hands, or feet

 Place the inhalation solution in the medicine reservoir or nebulizer cup on the machine.

 trembling or shaking of the hands or feet

 Connect the nebulizer to the face mask or mouthpiece.  Use the face mask or mouthpiece to breathe in the

control agent for patients with chronic or persistent bronchospasm

receptors in the airway of the smooth muscle which then leads to the activation of the adenyl cyclase and increased levels of cyclic- 3’5’adenosine monophosphate (cAMP). 2. When cAMP increases, kinases are activated. 3. Kinases inhibit the phosphorylation of myosin and decrease intracellular calcium. 4. Decreased in intracellular calcium will result to the relaxation of the smooth muscle airways.

medicine.  Use the nebulizer for about 5 to 15 minutes, or until the medicine in the nebulizer cup is gone.  Clean all the parts of the nebulizer after each use.