Atorvastatin

Why the patient is on it

AdjuncttodietforthereductionofLDLcholesterolandtriglyceridesbecauseshehas
hypercholesterolemia

.Actions
Atorvastatinisaninhibitorofreductase3hydroxy3methylglutarylcoenzymeA(HMGCoA),whichis
essentialtohepaticproductionofcholesterol.

Lifethreatening
Hypersensitivitytoatorvastatin,myopathy,activeliverdisease,unexplainedpersistenttransaminase
elevations,pregnancy(categoryX),lactation.

Dosage
POStartwith1040mgq.d.,mayincreaseupto80mg/d

Nursinginterentions

MonitorfortherapeuticeffectivenesswhichisindicatedbyreductioninthelevelofLDLC.

Labtests:Monitorlipidlevelswithin24wkafterinitiationoftherapyoruponchangeindosage;
monitorliverfunctionsat6and12wkafterinitiationorelevationofdose,andperiodically
thereafter.

Assessformusclepain,tenderness,orweakness;and,ifpresent,monitorCPKlevel(discontinue
drugwithmarkedelevationsofCPKorifmyopathyissuspected).

Monitorcarefullyfordigoxintoxicitywithconcurrentdigoxinuse.

Therapeutic Effects
AtorvastatinreducesLDLandtotaltriglyceride(TG)productionaswellasincreasestheplasmalevelof
highdensitylipids(HDL).

BENZTROPINE
Why the patient is on it
Action
Synthetic centrally acting anticholinergic (antimuscarinic) agent. Acts
by diminishing excess cholinergic effect associated with dopamine
deficiency.
Therapeutic Effects
Suppressestremorandrigidity;doesnotalleviatetardivedyskinesia.

Life threning
Narrow angle glaucoma; myasthenia gravis; obstructive diseases of GU
and GI tracts; tendency to tachycardia; tardive dyskinesia, children <3
y. Safety during pregnancy (category C) or lactation is not established.

Nursing interventions

Assesstherapeuticeffectiveness.Clinicalimprovementmaynotbeevidentfor23dafteroral
drugisstarted.

MonitorI&Oratioandpattern.Advisepatienttoreportdifficultyinurinationorinfrequent
voiding.Dosagereductionmaybeindicated.

CloselymonitorforappearanceofS&Sofonsetofparalyticileusincludingintermittent
constipation,abdominalpain,diminutionofbowelsoundsonauscultation,anddistention.

Monitorforandreportmuscleweaknessorinabilitytomovecertainmusclegroups.Dosage
reductionmaybeneeded.

Superviseambulationandusebedsiderailsasnecessary.

ReportimmediatelyS&SofCNSdepressionorstimulation.Theseusuallyrequireinterruptionof
drugtherapy.

Dosage
PO 0.51 mg/d, may gradually increase as needed up to 6 mg/d

CEFTRAXONE

WHY THE PATIENT IS ON IT Patient has a urinary tract infection.

Actions
Semisyntheticthirdgenerationcephalosporinantibiotic.Preferentiallybindstooneormoreofthe
penicillinbindingproteins(PBP)locatedoncellwallsofsusceptibleorganisms.Thisinhibitsthirdand
finalstageofbacterialcellwallsynthesis,thuskillingthebacterium.

Therapeutic Effects
Effectivelytreatsboneandjointinfections,gonorrheaandintraabdominalinfections,meningitisandlower
respiratorytractinfections,otitismedia,pelvicinflammatorydisease,Proteusinfections,septicemia,skin
andsofttissueinfections,urinarytractinfections,andisusedforsurgicalprophylaxis,reducingor
eliminatinginfection.

Contraindications
Hypersensitivitytocephalosporinsandrelatedantibiotics;pregnancy(categoryB).

DOSAGE
Adult: IV/IM 12 g q1224h (max: 4 g/d)

NURSING INTERVETNIONS

Determinehistoryofhypersensitivityreactionstocephalosporinsandpenicillinsandhistoryofother
allergies,particularlytodrugs,beforetherapyisinitiated.
Labtests:Performcultureandsensitivitytestsbeforeinitiationoftherapyandperiodicallyduring
therapy.Dosagemaybestartedpendingtestresults.Periodiccoagulationstudies(PTandINR)shouldbe
done.
Inspectinjectionsitesforindurationandinflammation.Rotatesites.NoteIVinjectionsitesforsignsof
phlebitis(redness,swelling,pain).
Monitorformanifestationsofhypersensitivity(seeAppendixF).Reporttheirappearancepromptlyand
discontinuedrug.
Watchforandreportsigns:petechiae,ecchymoticareas,epistaxis,oranyunexplainedbleeding.
CeftriaxoneappearstoaltervitaminKproducinggutbacteria;therefore,hypoprothrombinemicbleeding
mayoccur.

CALCIFEDIOL (D3)
WHY THE PT ON IT
Actions
VitaminDanalogandmajortransportformofcholecalciferol(D3)VitaminDanalogisfatsoluble.
Becauseitisactivatedinthebodyandhasregulatoryeffects,itisconsideredahormone

Therapeutic Effects
Helpstomaintainserumcalciuminpatients

Contraindications
HypersensitivitytovitaminD,vitaminDtoxicity,hypercalcemia.

ROUTE
PO Initially 300350 mcg/wk administered on a daily or alternate day
schedule

NURSING INTERVENTIONS
Labtests:Determinebaselineandperiodicvaluesforserumcalcium,phosphorus,magnesium,and
alkalinephosphatase.Monitorserumcalciumwheneverdosageadjustmentsaremade.Measureurinary
calciumandphosphoruslevelsq24h.
Effectivenessoftherapydependsonanadequatedailyintakeofcalcium.Sincedietarycalciumand
phosphatearedifficulttocontrol,thephysicianmayprescribeacalciumsupplementasneeded.

Monitorformanifestationsofhypercalcemia

LACTULOSE
WHYTHEPATIENTISONITthepatienthadahighammonialevel,sothiswasgiventoreducethe
ammonialevels

Actions
Reducesbloodammonia;appearstoinvolvemetabolismoflactosetoorganicacidsbyresidentintestinal
bacteria.

Therapeutic Effects
Acidifiescoloncontents,whichretardsdiffusionofnonionicammonia(NH3)fromcolontobloodwhile
promotingitsmigrationfrombloodtocolon.Intheacidiccolon,NH3isconvertedtononabsorbable
ammoniumions(NH4)andisthenexpelledinfecesbylaxativeaction

Contraindications
Lowgalactosediet;pregnancy(categoryC).Safeuseinlactationorchildrenisnotestablished.

ROUTE
PO 3045 mL t.i.d. or q.i.d. adjusted to produce 23 soft stools/d

NURSING INTERVENTIONS

Inchildreniftheinitialdosecausesdiarrhea,dosageisreducedimmediately.Discontinueif
diarrheapersists.

Promotefluidintake( 15002000mL/d)duringdrugtherapyforconstipation;olderadultsoften
selflimitliquids.Lactuloseinducedosmoticchangesinthebowelsupportintestinalwaterloss
andpotentialhypernatremia.

SERTRALINE
WHYISTHISPATIENTONIT
Actions

Potentinhibitorofserotonin(5HT)reuptakeinthebrain

Therapeutic Effects
Treatsdepression,obsessivecompulsivedisorder,anxiety,andpanicdisorder.

Contraindications
PatientstakingMAOinhibitorsorwithin14dofdiscontinuingMAOinhibitor;antabuse;suicidalideation,
hyponatremia;maniaorhypomania,pregnancy(categoryC);thirdtrimesterofpregnancy.

ROUTE
PO Begin with 50 mg/d, gradually increase every few weeks according
to response (range: 50200 mg)

NURSING INTERVENTIONS

Supervisepatientsatriskforsuicidecloselyduringinitialtherapy.

Monitorforworseningofdepressionoremergenceofsuicidalideation.

Monitorolderadultsforfluidandsodiumimbalances.

Monitorpatientswithahistoryofaseizuredisorderclosely