Ma. Rita Concepcion B.

Tungul
BSN – 2
Activity 3: Drug Study

DRUG CLASSIFICATION MECHANISM OF INDICATION ADVERSE CONTRAINDICATION/ DOSAGE & NURSING CONSIDERATION /
NAME ACTION REACTION INTERACTION ROUTE DIAGNOSIS
Generic Pharmacologic Action: Treatment of CNS: Dizziness,  Hypersensitivity Rheumatoid Baseline Assessment:
Name: class: Reversibly inhibits acute or drowsiness, to drug or other Arthritis (RA),  Assess the onset, severity,
naproxen Nonsteroidal COX-1 and COX-2 chronic mild- fatigue, NSAIDs. Osteoarthritis, location, and duration of
anti- enzymes, reducing to-moderate tremors,  Asthma, Ankylosing pain and inflammation.
Brand inflammatory the synthesis of pain, primary confusion, urticaria, or Spondylitis  Inspect the affected
Name: drug (NSAID) prostaglandin dysmenorrhea, insomnia, allergic-type PO: joints' appearance for
Aleve, precursors. rheumatoid anxiety, reactions after (Adults, Elderly) immobility, abnormalities,
Anaprox, Therapeutic Therapeutic arthritis (RA), depression taking aspirin Immediate and skin condition.
Anaprox class: Effect: Reduces juvenile CV: Tachycardia, or other Release: 500–  Ask about gastrointestinal
DS, EC- Nonopioid inflammatory rheumatoid peripheral NSAIDs. 1,000 mg/day in bleeding, gastric or duodenal
Naprosyn, analgesic, response, fever, arthritis (JRA), edema,  Perioperative 2 divided doses. ulcers, and hypertension.
Maxidol, antipyretic, anti- intensity of pain. osteoarthritis, palpitations, discomfort in May increase to
Naprelan, inflammatory ankylosing dysrhythmias, coronary artery 1,500 mg/day for Intervention/Evaluation:
Naprosyn spondylitis, MI, stroke bypass graft limited time (less  If dizziness occurs, assist
Pharmacokinetics: acute gouty EENT: Tinnitus, surgery. than 6 months). the patient with walking.
Pregnancy Absorption: arthritis, hearing loss, Extended-  Periodically monitor renal
Category: Completely absorb bursitis, blurred vision Use cautiously in: Release: Initially, function test during chronic
Category B from the GI tract. tendonitis, and GI: Nausea,  Severe 750–1,000 mg use.
for first fever. anorexia, cardiovascular, once daily. May  Monitor daily bowel
and Distribution: vomiting, renal, or increase activity pattern and stool
second Naproxen has a diarrhea, hepatic disease temporarily to consistency.
trimesters, volume of jaundice,  Advanced renal 1,500 mg once  Monitor CBC and renal
and distribution of hepatitis, disease (not daily. and hepatic function during
Category 0.16 L/kg. constipation, recommended) long-term therapy every 4 to
D for third Protein binding: flatulence,  History of ulcer Acute Gouty 6 months.
trimester 99% cramps, peptic disease or GI Arthritis  Observe and immediately
Metabolism: ulcer, bleeding bleeding use PO: examine the signs and
Primarily GU: with extreme Adults, Elderly: symptoms of a heart attack
metabolized in the Nephrotoxicity: caution 500 mg twice (chest pain, shortness of
liver. dysuria,  Chronic alcohol daily (start within breath, or difficulty
Half-life: hematuria, use or abuse 24–48h of flare- breathing) or a stroke
13 hours oliguria,  Elderly patients up). Discontinue (weakness in one part or side
azotemia  Pregnant 2–3 days after of the body, slurred speech).
Excretion: HEMA: Blood patients clinical signs  Evaluate for therapeutic
Primarily excreted dyscrasias  Breastfeeding resolve. response: relief of pain,
in urine and INTEG: Purpura, patients Usual duration: stiffness, swelling; increased
breastmilk and not rash, pruritus,  Children and 5–7 days joint mobility, reduced joint
removed by sweating, skin naproxen use in tenderness, improved grip
hemodialysis. eruptions, children Mild to strength.
photosensitivity, younger than Moderate Pain,
exfoliative age 2 as its Dysmenorrhea, Patient/Family Teaching:
Route: dermatitis, toxic safety not Bursitis,  Advise the patient to
PO (analgesic) epidermal established. Tendonitis avoid tasks that demand
Onset: necrolysis PO: attentiveness or motor skills
1 hour Others: Interactions: (Adults, Elderly) until the drug's effects are
Peak: Anaphylaxis, Immediate determined.
2 to 4 hours Stevens-Johnson Drug-drug. Release: Initially,  Advise the patient to take
Duration: syndrome, Acetaminophen 500 mg, then 500 the medication with food
7 hours or less thirst, edema (chronic mg q12h or 250 and milk to prevent
Route: use), cyclosporine: mg q6–8h as gastrointestinal distress and
PO (anti- increased risk of needed. to drink a full glass of water
inflammatory) adverse renal effects Maximum: 1,250 or another liquid with each
Onset: Anticoagulants, mg on day 1, dose.
2 weeks thrombolytics: then 1,000 mg  During treatment, advise
Peak: increased anticoagulant once daily. the patient to avoid aspirin
2 to 4 weeks effect Extended- and alcohol as they increase
Duration: Antihypertensives, Release: Initially, the risk of gastrointestinal
12 hours cefamandole, 1,000 mg once bleeding.
cefoperazone, daily. May  Advise the patient to
cefotetan, diuretics, temporarily report a change in urine
eptifibatide: increase to 1,500 pattern, weight gain, edema
decreased response mg once daily, (facial, lower extremities);
Antineoplastics, then reduce to increase in joint pain, fever,
methotrexate: 1,000 mg once blood in the urine (indicates
increased daily. nephrotoxicity); black stools,
risk of nephrotoxicity influenza-like symptoms,
Aspirin: decreased Juvenile indicators of myocardial
naproxen efficacy Idiopathic infarction, and stroke.
Aspirin, Arthritis (JIA)  Advise the patient that
corticosteroids, other PO: Oral the entire therapeutic
NSAIDs: Suspension benefit of arthritis
additive adverse GI Recommended) medications may be delayed
effects Children older by two to four weeks.
Clopidogrel, plicamycin, than 2 yrs:
ticlopidine, 10–15 mg/kg/day Nursing Diagnosis:
valproic acid: increased in 2 divided  Risk for Dizziness,
risk of bleeding doses. Insomnia, and
Insulin, oral Maximum: 1,000 Anxiety related to
hypoglycemics: mg/day. possible side effects
increased of naproxen.
risk of hypoglycemia  Risk for Anaphylactic
Lithium: increased OTC Uses (Pain, Reaction related to
lithium blood level Fever) an allergy to
and risk of PO: naproxen and its
nephrotoxicity Adults 65 yrs and other components.
Other photosensitizing younger, children  Risk for Anorexia,
agents: increased 12 yrs and older: Nausea, and
risk of photosensitivity 400 mg once, Vomiting related to
Probenecid: increased then 200 mg q8– the effects of
naproxen blood 12h. naproxen in the GI.
level, increased risk of Maximum: 400
toxicity mg in any 8-
 to12-hr period or
Drug-diagnostic tests. 600 mg/day.
Alanine Elderly: Use with
aminotransferase, caution (consider
alkaline phosphatase, a lower dose).
aspartate
aminotransferase,
blood urea
nitrogen, creatinine,
lactate
dehydrogenase,
potassium: increased
levels
Bleeding time:
prolonged for up to
4 days after therapy
ends
Creatinine clearance,
glucose, hematocrit,
hemoglobin,
leukocytes, platelets:
decreased values
Urine 5-hydroxy-
indoleacetic acid, urine
steroids: test
interference

Drug-herbs.
Anise, arnica,
chamomile,
clove, dong quai,
fenugreek, feverfew,
garlic, ginger, ginkgo,
 ginseng, licorice:
increased anticoagulant
effect,
increased risk of
bleeding

DRUG NAME CLASSIFICATION MECHANISM INDICATION ADVERSE CONTRAINDICATION/ DOSAGE & ROUTE NURSING CONSIDERATION /
OF ACTION REACTION INTERACTION DIAGNOSIS
Generic Pharmacologic Action: Treatment of CNS: suicidal  Hypersensitivit Depression Baseline Assessment:
Name: class: Blocks uptake major behavior, fever, y to drug. PO:  Periodically, LFT, renal
escitalopram Selective of depressive insomnia,  Concurrent Adults: 10 mg once function tests, and blood
serotonin neurotransmi disorder and dizziness, use of daily in the counts should be conducted
Brand Name: reuptake tter serotonin generalized somnolence, pimozide. morning or for patients on long-term
Cipralex, inhibitor at neuronal anxiety paresthesia,  MAO inhibitor evening. May therapy.
Lexapro presynaptic disorder light- uses within increase to 20 mg  Observe the patient and
Therapeutic membranes, (GAD). headedness, past 14 days. after a minimum of record behavior.
Pregnancy class: increasing its migraine, 1 wk.  Assess psychological
Category: Antidepressant availability at tremor, vertigo, Use cautiously in: Elderly: 10 mg/day. condition, cognitive content,
Category C postsynaptic abnormal  Renal or Children 12–17 sleep pattern, appearance,
receptor sites. dreams, hepatic y/o: 10 mg once and environmental interest.
irritability, impairment, daily. May increase
Therapeutic impaired other to 20 mg/day after Intervention/Evaluation:
Effect: concentration, conditions at least 3 wks.  During early treatment,
Antidepressan fatigue, that cause Maximum: 20 mg regularly monitor patients at
t effect lethargy. altered once daily. risk for suicide (as depression
CV: palpitations, metabolism or Recommended: 10 lessens, energy level
HTN, flushing, hemodynamic mg once daily. improves, suicide potential
Pharmacokine chest pain. responses, increases).
tics: EENT: rhinitis, history of Generalized  Evaluate appearance,
Absorption: sinusitis, blurred mania or Anxiety Disorder behavior, speech pattern,
Well absorbed vision, tinnitus, seizures, PO: interest level, and disposition.
after PO earache. suicidal Adults: Initially, 10  Monitor suicidal ideation,
administration GI: nausea, tendency mg once daily in particularly at the onset of
Distribution: diarrhea,  Concomitant morning or treatment or when doses are
Escitalopram constipation, use of evening. May raised or lowered, social
appears to indigestion, nonsteroidal increase to 20 mg interaction, mania, and panic
distribute abdominal pain, anti- after minimum of 1 attacks.
extensively vomiting, inflammatory wk.
into tissues increased or drugs Elderly: 10 mg/day. Patient/Family Teaching:
Protein decreased (NSAIDS),  Advise the patient not to
binding: 56% appetite, dry aspirin, Dosage in Renal discontinue or raise the
mouth, warfarin, or Impairment dosage of the medication.
Metabolism: flatulence, other drugs Mild to moderate  Advise the patient to avoid
Primarily heartburn, that affect impairment: No alcohol while taking the drug.
metabolized in cramps, coagulation dose adjustment.  Advise the patient to avoid
the liver. gastroesophage  Elderly Severe tasks that demand
Half-life: al reflux. patients impairment: Use attentiveness or motor skills
27-32 hours GU: ejaculation  Pregnant or caution in pts with until the drug's effects are
Half-life disorder, breastfeeding CrCl less than 20 determined.
increased by erectile patients mL/min.  Advise the patient to report
50% in dysfunction,  Children increased depression, suicidal
geriatric anorgasmia, younger than thoughts, and strange
patients menstrual age 12 with Dosage in Hepatic behavioral changes.
cramps, major Impairment: 10  Advise the patient that
Excretion: UTI, urinary depression mg/day symptoms should
Primarily frequency. and younger progressively improve for
excreted in Metabolic: than age 18 several weeks instead of
feces, with a weight gain or with immediately.
lesser amount loss, generalized  Advise the female patient
eliminated in hyponatremia. anxiety to inform the healthcare
urine. Musculoskeleta disorder professional if she is pregnant
l: arthralgia, (safety and or breastfeeding prior to
myalgia, muscle efficacy not beginning treatment.
Route: cramps, pain in established).
PO arms or legs. Nursing Diagnosis:
Onset: Respiratory:  Risk for Migraine,
Slow bronchitis, Vertigo, and Lethargy
Peak: cough. Interactions: related to the possible
5 hours Skin: rash, side effects of
Duration: increased Drug-drug. escitalopram.
Unknown sweating. Aspirin, NSAIDs,  Risk for Confusion and
Others: warfarin: increased Tachycardia related to
decreased risk of bleeding overdosing on
libido, yawning, Carbamazepine, escitalopram.
flulike lithium: decreased  Risk for Hypertension
symptoms. effects of escitalopram related to the adverse
Citalopram: increased effect of escitalopram
risk of serious toxic on the cardiovascular
effects system.
MAO inhibitors:
increased
escitalopram blood
level and risk of
toxicity
Pimozide: prolonged
QT interval
Triptans: weakness,
hyperreflexia,
incoordination

Drug-diagnostic tests.
Sodium: decreased
level Drug-herbs.
Ginkgo, St. John’s
wort: increased risk of
adverse effects

Drug-behaviors.
 Alcohol use: increased
motor impairment

References
Schull, P. D. (2013). McGraw-Hill Nurses Drug Handbook, Seventh Edition. McGraw Hill LLC.
Skidmore-Roth, L. (2020). Mosby's 2021 Nursing Drug Reference. Elsevier - Health Sciences Division.
Kizior, R. J., & Hodgson, K. J. (2020). Saunders Nursing Drug Handbook 2021. Elsevier Health Sciences.