ranitidine, famotidine, essentiale,paracetamol, xyzal, aeknil

8/12/2019 Ranitidine, Famotidine, Essentiale,Paracetamol, Xyzal, Aeknil

1/12

VISIONA premier university in historic Cavite

recognized for excellence in the developmentof morally upright and globally competitive

individuals.Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino Delas Alas Campus

Indang, Cavite

MISSIONCavite State University shall provide excellent, equitable

and relevant educational opportunities in the arts,science and technology through quality instruction andrelevant research and development activities. It shall

produce professional, skilled and morally uprightindividuals for global competitiveness.

PUEDAN, JENIVIC E. BSN 3-1

Name of Patient (Initial): R.D Date of Admission: July 30, 2013

Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever

Sex: Male Date medication started: July 30 2013

Drug Mechanism of

Action

Indication Contraindication Side effects Nursing responsibilities

Generic: Ranitidine

Brand: Zantac

Classification:

Therapeutic:antiulcer

agents

Pharmacologic:

histamine H2

antagonists

Dosage: Tablet

75,150,300mg;capsules

150-00mg;syrup

15mg/ml;injection

1,25mg/ml

Short-term

treatment of active

duodenal ulcers and

benign gastric ulcers.

Maintenance

therapy for

duodenal and gastric

ulcers after healing

of active ulcers.

Management ofGERD.

Treatment of

heartburn, acid

indigestion, and sour

stomach (OTC use).

Cimetidine,

famotidine,

ranitidine:

Short-term

treatment of active

duodenal ulcers and

benign gastric ulcers.

Maintenance

therapy for

duodenal and gastric

ulcers after healing

of active ulcers.

Management ofGERD.

Treatment of

heartburn, acid

indigestion, and sour

stomach (OTC use).

Cimetidine,

famotidine,

ranitidine:

Hypersensitivity

Some products contain

alcohol and should be

avoided in patients with

known intolerance


aspartame and should be


phenylketonuria.

Use Cautiously in:Renal impairment (more

susceptible to adverse CNS

reactions; increased dosage

interval recommended for

cimetidineand nizatidineif

CCr 50 ml/min, and for

famotidineand ranitidineif

CCr


2/12

Route:

PO,IM,IV

Frequency: 0D

Form:

Color:

Management of

gastric

hypersecretory

states (Zollinger-

Ellison syndrome).

Cimetidine,

famotidine,

ranitidine IV:

Prevention and

treatment of stress-

induced upper GI

bleeding in critically

ill patients.

Ranitidine:

Treatment of and

maintenancetherapy for erosive

esophagitis.

Unlabelled Use:

Management of GI

symptoms

associated with the

use of NSAIDs.

Prevention of acid

inactivation of

supplementalpancreatic enzymes

in patients with

pancreatic

insufficiency.

Management of

urticaria.

Management of

gastric

hypersecretory

states (Zollinger-

Ellison syndrome).

Cimetidine,

famotidine,

ranitidine IV:

Prevention and


induced upper GI


ill patients.

Ranitidine:

Treatment of and

maintenancetherapy for erosive

esophagitis.

Unlabelled Use:

Management of GI

symptoms

associated with the

use of NSAIDs.

Prevention of acid

inactivation of


in patients with

pancreatic

insufficiency.

Management of

urticaria.

Hepatic impairment (for

ranitidine)

Acute porphyria (for

ranitidine)

Geri: Geriatric patients

(more susceptible to

adverse CNS reactions;

dosage reduction

recommended)

OB: Lactation: Pregnancy or

lactation.

AGRANULOCYTOSIS,

APLASTIC ANEMIA,

anemia,

neutropenia,

thrombocytopenia.

Local: pain at IM

site. Misc:

hypersensivity

reactions, vasculitis.

24 hr before the test.

-May cause false-negative

results in skin tests using

allergenic extracts.

Histamine H2

antagonists

should be discontinued 24

hr before the test.

-May cause in serum

transaminases and serum

creatinine.

-Serum prolactin

concentration may be

after IV bolus of

cimetidine. May also cause

parathyroid

concentrations.

Nizatidinemay cause

alkaline phosphatase

concentrations.

Ranitidineandfamotidine

may cause false-positive

results for urine protein;

test with sulfosalicylic

acid. .

-Advise patient to

report onset of black,tarry stools; fever,

sore throat; diarrhea;

dizziness; rash;

confusion; or

hallucinations to

health car

professional promptly


3/12

Drug Mechanism of

Action

Indication Contraindication Side effects Nursing responsibilities

Generic: Famotidine

Brand: Acid Control,

Apo-Famotidine, Gen-

Famotidine,

Maximum Strength

Pepcid, Mylanta AR,

Novo-Famotidine,

Nu-Famotidine,

Pepcid, Pepcid AC,

Pepcid AC Acid

Controller, Pepcid

RPD, Ulcidine

Classification:

HISTAMINE H2

ANTAGONISTS

Dosage: 300 mg 4

times daily, 5-10

mg/kg q 6 hr.

Route: PO,IM,IV

Frequency: OD

Form:

Color:

Short-term

treatment of active

duodenal ulcers

and benign gastric

ulcers.

Maintenance

therapy for

duodenal and

gastric ulcers after

healing of active

ulcers.

Management of

GERD.Treatment of

heartburn, acid

indigestion, and

sour stomach (OTC

use).

Cimetidine,

famotidine,

ranitidine:

Management of

gastrichypersecretory

states (Zollinger-

Ellison syndrome).

Cimetidine,

famotidine,

ranitidine IV:

Prevention and


Short-term

treatment of active

duodenal ulcers

and benign gastric

ulcers.

Maintenance

therapy for

duodenal and

gastric ulcers after

healing of active

ulcers.

Management of

GERD.

Treatment ofheartburn, acid

indigestion, and

sour stomach (OTC

use).

Cimetidine,

famotidine,

ranitidine:

Management of

gastric

hypersecretorystates (Zollinger-

Ellison syndrome).

Cimetidine,

famotidine,

ranitidine IV:

Prevention and


induced upper GI

Hypersensitivity


alcohol and should be


known intolerance


aspartame and should be


phenylketonuria.

Use Cautiously in:

Renal impairment (more

susceptible to adverse

CNS reactions; increaseddosage interval

recommended for

cimetidineand nizatidine

if CCr 50 ml/min, and for

famotidineand ranitidine

if CCr


4/12

induced upper GI


ill patients.

Ranitidine:

Treatment of and

maintenance

therapy for erosive

esophagitis.

Unlabelled Use:

Management of GI

symptoms

associated with the

use of NSAIDs.

Prevention of acid

inactivation of


in patients with

pancreatic

insufficiency.

Management of

urticaria.


ill patients.

Ranitidine:

Treatment of and

maintenance

therapy for erosive

esophagitis.

Unlabelled Use:

Management of GI

symptoms

associated with the

use of NSAIDs.

Prevention of acid

inactivation of

supplemental

pancreatic enzymesin patients with

pancreatic

insufficiency.

Management of

urticaria.

or other activities

requiring alertness until

response to the drug is

known.

-Advise patient to avoid

alcohol, products

containing aspirin or

NSAIDs, and foods that

may cause an increase in

GI irritation.

Inform patient that

increased fluid and fiber

intake and exercise may

minimize constipation.

-Advise patient to report

onset of black, tarrystools; fever; sore throat;

diarrhea; dizziness; rash;

confusion; or

hallucinations to health

care professional

promptly. .


5/12

Drug Mechanism of Action Indication Contraindication Side effects Nursing responsibilities

Generic: Essentiale

Forte

Brand:

Classification: A05BA -

Liver therapy ; Used in

liver therapy.

Dosage: 2 cap tid.

Route:

Frequency:

Form:

Color: Brown

Among the

pharmacodynamic

properties reported were

hepatoprotective effects

found in numerous

experimental models in

acute liver damage

(induced by ethanol,

alkyl alcohol, carbon

tetrachloride,

paracetamol and

galactosamine).

Furthermore, it was also

seen to inhibit steatosis

and fibrosis in chronicliver damage models

(induced by ethanol,

thioacetamide and

organic solvents). Its

suggested principal

actions have been

through accelerated

membrane regeneration

and stabilization,

inhibited lipidperoxidation and

inhibited collagen

synthesis.

Nutritional support

in the management

of damaged liver

due to chronicliver

disease,liver

cirrhosis,fatty liver

& intoxication by

hepatotoxic

substances.

Hypersensitivity to soya

bean prep.

Occasionally,

stomach complaints,

soft stool, diarrhea.
http://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/490?q=liver%20cirrhosishttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20diseasehttp://www.mims.com/Philippines/diagnoses/info/1396?q=liver%20disease


6/12

Drug Mechanism of

Action

Indication Contraindication Side effets Nursing

responsibilities

Generic: Paracetamol

, Acetaminophen

Brand: Biogesic,

Panadol, Tylenol

Classification:

Non-narcotic

analgesic, Antipyretic

Dosage: 500-1,000

mg

Route: Oral, IV

Frequency: 4-6 hrs

Form:

Color: Brown

- Decreases fever

by a hypothalamic

effect leading to

sweating andvasodilation

-Inhibits pyrogen

effect on the

hypothalamic-

heat-regulating

centers

-Inhibits CNS

prostaglandinsynthesis with

minimal effects on

peripheral

prostaglandin

synthesis

-Does not cause

ulceration of the

GI tract and causes

no anticoagulant

action.

Symptomatic treatment

of mild to

moderatepain &/orfever.

Nephrotoxicity.

Renal Insufficiency

Anemia

Occasionally, skin rashes

& hypersensitivity

reactions. Renal damage

(long-term use).Hematological reactions

including

thrombocytopenia,

leukopenia &

methemoglobinemia

resulting to cyanosis.

Minimal GI upset.

1. Methemoglobinemia

2. Hemolytic Anemia3. Neutropenia

4. Thrombocytopenia

5. Pancytopenia

6. Leukopenia

7. Urticaria

8. CNS stimulation

9. Hypoglycemic coma

10. Jaundice

11.Glissitis

12.Drowsiness

13.Liver Damage

1. Do not exceed

4gm/24hr. in

adults and

75mg/kg/day inchildren.

2. Do not take for

>5days for pain in

children, 10 days

for pain in adults,

or more than 3

days for fever in

adults.

3. Extended-Release

tablets are not tobe chewed.

4. Monitor CBC, liver

and renal

functions.

5. Assess for fecal

occult blood and

nephritis.

6. Avoid using OTC

drugs with

Acetaminophen.

7. Take with food ormilk to minimize GI

upset.

8. Report N&V.

cyanosis, shortness

of breath and

abdominal pain as

these are signs of

toxicity.
http://www.mims.com/Philippines/diagnoses/info/1692?q=painhttp://www.mims.com/Philippines/diagnoses/info/849?q=feverhttp://www.mims.com/Philippines/diagnoses/info/849?q=feverhttp://www.mims.com/Philippines/diagnoses/info/1692?q=pain


7/12

9. Report paleness,

weakness and

heart beat skips

10.Report abdominal

pain, jaundice, dark

urine, itchiness or

clay-colored stools.

11.Phenmacetin may

cause urine to

become dark

brown or wine-

colored.

12.Report pain that

persists for more

than 3-5 days

13.Avoid alcohol.14.This drug is not for

regular use with

any form of liver

disease.


8/12


Generic:

Levocetirizine

dihydrohloride

Brand: Xyzal

Classification:

Antihistamine

Dosage: tablet

5mg; oral

solution

2.5mg/5ml

Route: Oral

Frequency: BID

Form:

Color:

Potent Histamine (H1)

receptor antagonist;

inhibits histamine

relesase and

eosinophil chemotaxis

during

inflammation,reducing

swelling and

inflammatory

response.

-Relief from

symptoms of

seasonal and

perennial allergic

rhinitis in adults

and children 6

mos nd older.

-Treatment of

uncomplicated

skin effects in

chronic idiopathic

urtiuria in patients

2 yr and older.

-Hypersensitivity to

levocetirizine, any

of its components,

or cetirizine; end-

stage renal disease;

renl impairement in

children .

-Use cautiously

with pregnancy and

with use of CNS

depressants.

CNS: Somnolence,

asthenia

GI: Dry mouth

RESPI:

Nasopharyngitis,cough,p

haryngitis,epistaxis

Other: fatigue, fever

-Administer once each day, in the

evening.

-Alert patient to possible alterations

in mental alertness while taking this

rug.

-Encourage use of humidifiers and

adequate intake of fluids to help

prevent severe dryness of mucous

membranes.

-Provide skin care for urticuria.


9/12


Generic:

Paracetamol

Brand: Aeknil

Classification:

Analgesic (Opiod)

Dosage: 2-3 ml

Route: IV

Frequency: Q4

Form:

Color:

Paracetamol produces

analgesia by raising

the threshold of the

pain center in the

brain n by obstructing

impulses at the pain-

mediating

chemoreceptors. The

drug produces

antipyretics by an

action on the

hypothalamus; heat

dissipation is

increased as a result

of vasodilation anincreased peripheral

blood flow.

-pyrexia of

unknown

origin,fever and

pain associated

with common

childhood

disorders

,tonsillitis, upper

respiratory tract

infection post

immunization

reactions.

-Prevention of

febrile convulsion,headache, cold,

sinusitis,musle

pain,arthritis and

toothache.

-Liver damage

-skin rashes

-blood disorders and

swollen pancreas.

-Use liquid form of children and

patients who have difficulty

swallowing.

-In children, dont exceed five dose

in 24 hrs

-Advise patient that drug is only for

short term use and to consult the

physician if giving to children for

longer than 5 days.

- Advise patient that many over the

counter products contains

acetaminophen; be aware of thiswhen calculating total daily dose.

-Warn patient that high doses or

unsupervised long term can cause

liver damage.


10/12

FOCUS ASSESSMENT:

Name of Patient (Initial): R.D Date of Admission: July 30, 2013

Age: 16 years old Diagnosis: Dengue Hemorrhagic Fever

Sex: Male Date medication started: July 30 2013

Vital Signs

LABORATORY RESULTS

DATE: 08-01-13/ 7:20 PM

RESULT. Normal Value

Hematocrit 0.42 % 41-50 %

Hemoglobin 147 g/dl 13.5 - 16.5g/dl

Platelet count 86,000 x10 9/L

100,000 x10 9/L as of 08-

02-13

150,000-450,000

x10 9/L

APTT 40.0 sec 25-38 seconds

System Findings

General Good Hygiene, (-) fever, pallor

Musculoskeletal(-) Muscle and Joint pain

(-) Back pain

Skin Dry

Mouth Dry lips

Upper and Lower Extremities (+) rashes

Date: 08-01-13 08-02-13

Time: 8AM 12PM 8AM 12PM

T 36.4 36.7 36.5 36.0

PR 71 74 20 25

RR 24 24 73 74

BP 110/80 110/60 110/60 100/60


11/12

Assessment Nursing Diagnosis Scientific

Rationale

Planning Intervention Rationale Evaluation

Objective data:

Pallor

Weakness

Decreased

hematocrit

(0.42%)

Decreased

hemoglobin (

Decreased

platelet count

(100,00 x10

9/L) Decreased

capillary time

of 3-4 sec.

Rashes in

upper and

lower

extremities

Ineffective tissue

perfusion related

to decreased

hemoglobin

concentration in

blood,

hematocrit , and

platelet count

secondary to DHF

stage 2.

DHF

Viral infection

Decreased CBC

&platelet count

Decreased level

of hemoglobin

and hematocrit

Decreased

blood

oxygenation

Pallor and

muscle

weakness

Ineffective

tissue

perfusion

After 4hours of

nursing

intervention and

with the help of

Medical

Management the

patient will

demonstrate

behaviors to

improve circulation

and increased

perfusion as

appropriate.

Monitored Vital

signs of the

patient.

Assessed

patients

condition.

Performed

blanch test

Positioned

patient in semi

fowlers.

Encouraged quite

and restful

atmosphere. Instructed the

patient to avoid

tiring activities.

Encouraged light

ambulation.

Encourage use of

relaxation

techniques.

Administered

medication asordered by the

doctor.

Encourage

patient to take

iron supplements

and eat foods

rich in iron.

To obtain baseline

data.

To assess

contributing factors.

To determine

adequate perfusion

To promote

circulation.

To promote comfort

and decrease tissue

O2 demand. To decrease cardiac

workload.

To enhance venous

return.

To decrease tension

and anxiety.

To treat underlying

cause.

To help elevate

hemoglobin and

hematocrit levels.

After 8 hours of

nursing intervention

the patient shall

have demonstrated

behaviors to

improve circulation

and to increased

perfusion as

appropriate as

evidenced by the

result of platelet

count from 86,000

to 100,000.


12/12

Number 2: Risk for bleeding

Assessment Nursing Diagnosis Scientific

Rationale

Planning Intervention Rationale Evaluation

Objective data:

Rashes on the

upper and

lower

extremities

Restlessness

(-)bleeding

and

abdominal

pain

Platelet count

of 86,000 x109/L as of 08-

01-13

Vs as

followed.

T-36.7

PR-74

RR-24

BP-110/60

Risk for bleeding

related to altered

clotting factor

secondary to DHF

stage 2.

It is a mosquito

born viral disease

cause Aedis

Aegypti . This

infectious disease

is manifested by a

sudden onset

of fever, with severe

headache; muscle

and joint pains

severe pain gives it

the name breakbone fever or bone

crusher.

After 2 hours of

nursing

intervention and

with the help of

Medical

management the

patient will be able

to demonstrate

behaviors that

reduce the risk for

bleeding and will

be free of signs ofactive bleeding.

Monitored

Vital Signs of

the patient.

Assessed for

signs and

symptoms of

G.I bleeding.

Check for

secretions.

Instructed the

patient to

avoid eating

dark color

foods.

Assessed skin

color and

moisture, urine

output, level of

consciousness. Reviewed

laboratory data

such as CBC

and PC.

Serve as

baseline for

more effective

nursing action.

The G.I tract

(esophagus

and rectum) is the

most usual source

of bleeding of its

mucosal Fragility

It can affect

the color of his

stool.

Changes in

these signs

may be

indicative of

blood loss. To determine if

there is

abnormal of

patients blood

count.

Goal Met.

After 8 hours of

nursing

intervention the

patient was able to

demonstrate

behavior that

reduced the risk

for bleeding.

ranitidine, famotidine, essentiale,paracetamol, xyzal, aeknil

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