Drug Generic Name: lactulose Brand Name: Duphalac Drug Classification: Ammonia reduction drug Laxative

Dose 30 ml ODHS hold for bowel movement 2x/day

Mechanism of Action The drug passes unchanged into the colon where bacteria break it down to organic acids that increase the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in an icrease in stoll water content, stool softening, laxative action. This alsi results in migration of blood ammonia into the colon contents with sbsequent trapping and expulsion in the feces.

Indications and Contraindications Indication: - Treatment of constipation Contraindication: - Allergy to lactulose, loq-galactose diet

Side Effects and Adverse Effects Side Effects: -Abdominal fullness - Flatulence - Belching Adverse Effects: - Distention - Intestinal cramps - Diarrhea - Nausea

Nursing Responsibilities - Do not freeze laxative form. Extremely dark or cloudy syrup may be unsafe; do not use. - Give laxative syrup orally with fruit juice, water, or milk to increase palatability. - Administer retention enema using a rectal balloon catheter. - DO not administer other laxatives while using lactulose. - Monitor serum ammonia levels. - Monitor with long-term therapy for potential electrolyte and acid-base imbalances. - Carefully monitor blood glucose levels in diabetec patients. - Make sure patient has access to bathroom; bowel movements will be increased to two or three per day.

Drug Generic name: Aspirin Brand name: Aspilet Drug classification: Antiplatelet

Dose 80mg/tab PO OD

Mechanism of action Prevent blood coagulation due to hypertension (narrow blood vessels may cause blood to aggregate.

Indication and contraindication Indication: CVA Contraindication: Hypersensitivity to salicylates

Side effects and adverse effect GI: dyspepsia, heartburn, anorexia, nausea, epigastric discomfort, potentiation of peptic ulcer Allergic: bronchospasm, skinrashes, urticarial. Hematologic: prolongation of bleeding time, thrombocytopenia, leukopenia.

Nursing responsibilities - Monitor renal function. - Determine history of peptic ulcer disease or bleeding tendencies. - Give drug with food and full glass of water.

Drug, Dosage and Route Generic Name Ranitidine Hydrochloride Brand Name Zantac Classification Histamine-2 antagonist Dosage & Route 75 mg bid PO

Mechanism of Action Competitively inhibits the action o histamine at the H2 receptors of the parietal cells of the stomach, inhibiting basal gastric acid secretion and gastric acid secretion that is stimulated by the food, insulin, histamine, cholinergic agonists, gastrin and pentagatrin.

Indications Short term treatment of active duodenal ulcer Maintenance therapy for duodenal ulcer at reduced dosage Short-term treatment and maintenance therapy of active, benign gastric ulcer Short-term treatment of GERD Treatment of erosive esophagitis Treatment of heartburn, acid indigestion, sour stomach

Contraindications Contraindicate d with allergy to ranitidine, lactation Use cautiously with impaired renal or hepatic function pregnancy.

Side Effects CNS: Headache, malaise, dizziness CV: Tachycardia, Bradycardia, PVCs Dermatologic: Rash GI: Contipation, diarrhea, nausea, vomiting, abdominal pain Local: Pain at IM site, local burning or itching at IV site.

Nursing Considerations Assessment: History: Allergy to ranitidine, impaired renal function, lactation, pregnancy Interventions: Administer oral drug with meal and at bed time. Decrease doses in renal and liver failure Provide concurrent antacid therapy to relieve pain. Administer IM dose undiluted, deep into large muscle group. You may experience constipation or diarrhea, nausea, vomiting, enlargement of breasts, impotence, libido, headache

Drug, Dosage and Route Generic Name Rosuvastatin calcium Brand Name Crestor Classification Antilipemic HMG-CoA reductase inhibitor Dosage 10 mg/day Route PO

Mechanism of Action Selectively and competitively inhibits HMGCoA reductase, which catalyzes its conversion to the cholesterol precursor mevalonate and thus limits cholesterol synthesis. This action increases high-density lipoprotein level and decreases low-density lipoprotein level.

Indications Hypertriglyceridemia

Contraindications -Breast feeding or pregnancy -Hypersensitivity to drug and its component

Side Effects CNS: headache, dizziness, anxiety, depression, insomnia, hypertonia CV: palpitations, tachycardia, hypertension, angina pectoris EENT: rhinitis, sinusitis, pharyngitis GI: nausea and vomiting, diarrhea, constipation, abdominal pain GU: UTI, acute renal failure Metabolic: hypoglycemia Musculoskeletal: Rhabdomyolysis Skin: rash, pruritus

Nursing Considerations Check liver function tests before therapy starts. Give with or without food. Monitor CK, creatinine, and urine protein levels closely. Watch for signs of rhabdomyolysis with acute renal failure. Tell patient he may take with or without food. If hes using antacids, instruct him to take these 2 hours after rosuvastatin. Encourage to limit caffeine intake and avoid ephedra. Advise against heavy intake of alcohol.

Drug, Dosage and Route Generic Name Enoxaparin Brand Name Lovenox Classification Anticoagulant Antithrombotic Dosage 1mg/kg q12h until stabilized with aspirin 100-325mg daily x >2days Route SQ

Mechanism of Action Binds to antithrombin III inactivating factors Xa/IIa resulting in higher ratio of antifactor Xa to IIa

Indications Prevention of ischemic complications in unstable angina/non-Q-wave MI

Contraindications Hypersensitivity to this drug, benzyl alcohol, heparin or pork; active major bleeding hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, heparininduced thrombocytopenia

Side Effects Fever, confusion, nausea, hemorrhage, hypochromic anemia, thrombocytopeni a, bleeding -

Nursing Considerations Assess blood studies Administer only after screening patient for bleeding disorders Administer SQ only; do not give IM Do not mix with other drugs or infusion fluids Administer at the same time each day to maintain steady blood levels Teach patient to use softbristle toothbrush to avoid bleeding gums Instruct patient to report any signs of bleeding; gums, under skin, urine stools