DRUG NAME

Diclofenac Sodium

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

HEALTH TEACHINGS

The exact mechanism of action is not entirely known, but it is thought that the primary mechanism responsible for its antiinflammatory, antipyretic, and analgesic action is inhibition of prostaglandin synthesis by inhibition of cyclooxygenase (COX). It also appears to exhibit bacteriostatic activity by inhibiting bacterial DNA synthesis. Inhibition of COX also decreases prostaglandins in the epithelium of the stomach, making it more sensitive to corrosion by gastric acid. This is also the main side-effect of diclofenac. Diclofenac has a low to moderate preference to block the COX2-isoenzyme (approximately 10-fold) and is said to have, therefore, a somewhat lower incidence of gastrointestinal complaints than noted with indomethacin and

Diclofenac is used to treat pain, inflammatory disorders, and dysmenorrhea. Inflammatory disorder may include musculoskeletal complaints, especially arthritis, rheumatoid arthritis, polymyositis, dermatomyositis, osteoarthritis, dental pain, TMJ, spondylarthritis, ankylosing spondylitis, gout attacks, and pain management in cases of kidney stones and gallstones. An additional indication is the treatment of acute migraines. Diclofenac is used commonly to treat mild to moderate postoperative or posttraumatic pain, in particular when inflammation is also present, and is effective against menstrual pain and endometriosis.

y y

Hypersensitivit y against diclofenac History of allergic reactions (bronchospasm, shock, rhinitis, urticaria) following the use of aspirin or another NSAID Third-trimester pregnancy Active stomach and/or duodenal ulceration or gastrointestinal bleeding Inflammatory intestinal disorders such as Crohn's disease or ulcerative colitis Severe insufficiency of the heart (NYHA III/IV) Recently, a warning has been issued by the FDA not to

Diclofenac is among the better tolerated NSAIDs. Though 20% of patients on longterm treatment experience sideeffects, only 2% have to discontinue the drug, mostly due to gastrointestinal complaints. CNS: dizziness, headache. CV: hypertension. EENT: tinnitus. GI: GI BLEEDING, HEPATOTOXICITY, abdominal pain, constipation, diarrhea, dyspepsia, flatulence, heartburn,
liver enzymes, nausea, vomiting. GU: acute renal failure, hematuria. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL

Caution patient to avoid concurrent use of alcohol, aspirin, acetaminophen, other NSAIDs, or other OTC medications without consulting health care professional Instruct patient to notify health care professional of medication regimen before treatment or surgery May cause serious side effects: CV (MI or stroke), GI (ulcers, bleeding), skin (exfoliative dermatitis, Stevens-Johnson Syndrome, toxic epidermal necrolysis) and hypersensitivity (anaphylaxis). May occur without warning symptoms. Advise patient to stop medication and notify health care professional immediately if symptoms of CV side effects (chest pain, shortness of breath, weakness, slurring of speech), GI side effects (epigastric pain, dyspepsia, melana, hematemesis), skin side effects (skin rash, blisters, fever, itching) or hypersensitivity reactions (difficulty breathing or

aspirin. Inhibits prostaglandin synthesis Therapeutic Effect(s): Suppression of pain and inflammation y Relief of acute migraine attacks Topical (Solaraze): Clearance of actinic keratosis lesions y y

use for the treatment of patients recovering from heart surgery Severe liver insufficiency (Child-Pugh Class C) Severe renal insufficiency (creatinine clearance <30 ml/min) Caution in patients with preexisting hepatic porphyria, as diclofenac may trigger attacks Caution in patients with severe, active bleeding such as cerebral hemorrhage NSAIDs in general should be avoided during dengue fever, as it induces (often severe) capillary leakage and subsequent heart failure.

NECROLYSIS, pruritis, rashes, eczema, photosensitivity. F and E: edema. Hemat: anemia, prolonged bleeding time. Local: Topical only contact dermatitis, dry skin, exfoliation. Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS

swelling of face or throat) occur. Inform patient that risk for heart attack or stroke that can lead to death increases with longer use of NSAID medications and in people who have heart disease and that risk of ulcer increases with concurrent use of corticosteroids and anticoagulants, longer use, smoking, drinking alcohol, older age, and having poor health Advise patient to notify health care professional promptly if unexplained weight gain, swelling of arms and legs or hands and feet, nausea, fatigue, lethargy, rash, pruritis, yellowing of skin or eyes, itching, stomach pain, vomiting blood, bloody or tarry stools, or flu-like symptoms occur Instruct female patients to inform health care professional if they plan or suspect pregnancy. Caution female patient to avoid use of diclofenac in last trimester of pregnancy and to notify health care professional if breastfeeding PO: Instruct patient to take diclofenac with a full glass of water and to remain in an

upright position for 15 30 min after administration. Take missed doses as soon as possible within 1 2 hr if taking once or twice a day or unless almost time for next dose if taking more than twice a day. Do not double doses May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions Topical: Advise patient to minimize use of concurrent NSAIDs during topical therapy. Instruct patient to read Medication Guide before starting therapy and with each Rx refill in case changes have been made Instruct patient to avoid covering lesion with occlusive dressing and to avoid applying sunscreen or cosmetics to the affected area Advise patient that it may take up to 1 mo for complete healing

of the lesion to occur Transdermal: Instruct patient on correct application procedure for patch. Apply patch to most painful area. Change patch every 12 hr. Remove patch if irritation occurs. Fold used patches so adhesive sticks to itself and discard where children and pets cannot get them. Encourage patient to read the NSAID Medication Guide that accompanies the prescription Instruct patients if patch begins to peel off to tape the edges. Do not wear patch during bathing or showering. Bathing should take place between scheduled patch removal and application Advise patient referred for MRI test to discuss patch with referring health care professional and MRI facility to determine if removal of patch is necessary prior to test and for directions for replacing patch

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

HEALTH TEACHINGS

Metronodazole

Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action

Amebicide in the management of amebic dysentery

hypersensitivity

CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria

Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or lightheadedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

HEALTH TEACHINGS

Cefuroxime

Decrease or control infection Secondgeneration cephalospori n that inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal.

Less susceptible to betalactamase and have greater activity against Haemophilus Influenzae,gonorrhea and Lyme disease * Pharyngitis, tonsillitis, infections of the urinary and lower respiratory tracts, and skin and skin-structure infections caused by Streptococcus pneumoniae and S. pyogenes, Haemophillus influenzae, Staphylococcus aureus, Escherichia coli, Moraxella catarrhalis (including beta-lactamaseproducing strains), Neisseria gonorrheae, and Klebsiella and Enterobacter species. * Serious lower respiratory tract infections, UTIs, skin and skin-structure

If the drug was tolerated it can cause diarrhea,nausea, vomiting,headache, or migraines, dizziness and abdominal pain * Contraindicated in patients hypersensitive to drug. * Use cautiously in patients hypersensitive to penicillin because of possibility of crosssensitivity with other beta-lactam antibiotics. * Use with caution in breast-feeding women and in patients with history of colitis or renal sufficiency.

CV: phlebitis, thrombophlebitis GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia Skin: maculopapular and erythematous rashes, urticaria, pain, induration, sterile abscesses, temperature elevation, tissue sloughing at intramuscular injection site Other: hypersensitivity reactions, serum sickness, anaphylaxis.

Should the check the patients name,the correc troute, dosage,and frequency of the medicine that should be given. * Before administering, make sure patient is not allergic to penicillins or cephalosporins. * Absorption of cefuroxime axetil is enhanced by food. * Cefuroxime axetil tablets may be crushed if swallowing is a difficulty. Cefuroxime axetil tablets may be dissolved in small amounts of apple, orange or grape juice, even chocolate milk. However, drugs bitter taste is difficult to mask even with food. * High-fat meals increased drug bioavailability. * ALERT! Cefuroxime axetil film-coated tablet and oral suspension are not bioequivalent. * If large doses are given, therapy is prolonged, or patient is at high risk, monitor patient for signs and symptoms of superinfection.

infections, bone and joint infections, septicemia, meningitis, and gonorrhea * Uncomplicated UTIs * Otitis Media * Pharyngitis and Tonsillitis * Perioperative Prevention * Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi * Secondary bacterial infection of acute bronchitis * Uncomplicated gonorrhea * Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenza (only strains that don t produce beta-lactamase)

* Unlike other second generation cephalosporins, cefuroxime can cross the blood-brain-barrier. * ALERT! Do not confuse with other cephalosporins that sound alike. * Take medication as prescribed, even after feeling better. * Take oral form with food. * If suspension is being used, shake the container well before measuring dose. * Notify prescriber about rashes or superinfections. * Notify prescriber about loose stools or diarrhea.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

HEALTH TEACHINGS

Mefenamic Acid

Decreases inflammation , pain, and fever, probably through inhibition of cyclooxygena se activity and prostaglandi n synthesis.

Relief of moderate pain lasting less than 1 wk; treatment of primary dysmenorrhea.

Unlabeled Uses
Treatment of sunburn, migraine (acute attack), PMS.

Patients in whom aspirin, iodides, or any NSAID has caused allergic-type reactions; preexisting renal disease; active ulceration or chronic inflammation of GI tract.

Cardiovascular Edema; weight gain; CHF; altered BP; palpitations; chest pain; bradycardia; tachycardia. CNS Headache; vertigo; drowsiness; dizziness; insomnia. Dermatologic Rash; urticaria; purpura. EENT Blurred vision; tinnitus; salivation; glossitis. GI Diarrhea; dry mouth; vomiting; abdominal pain; dyspepsia; GI bleeding; nausea; constipation; flatulence. Genitourinary

Inform patient not to use drug for longer than 1 wk. If given for dysmenorrhea, instruct patient to begin taking drug with onset of bleeding and associated symptoms. Warn patient about potential for bleeding, and advise patient to notify other health care professionals that drug is being taken. Advise patient to discontinue medication if rash develops and to contact health care provider. Instruct patient to report the following symptoms to health care provider: rash, visual problems, dark stools, decreased urinary output, persistent headache or stomach pain and unusual bruising or bleeding.

Hematuria; proteinuria; dysuria; renal failure. Hematologic Decreased hematocrit; bleeding; neutropenia; leukopenia; pancytopenia; eosinophilia; thrombocytopenia. Hepatic Mild elevations in LFT results. Respiratory Bronchospasm; laryngeal edema; rhinitis; dyspnea; pharyngitis; hemoptysis; shortness of breath. Miscellaneous Autoimmune hemolytic anemia may occur if used long term.

Advise patient to avoid intake of alcoholic beverages. Instruct patient that drug may cause drowsiness and to use caution while driving or performing other activities requiring mental alertness. Caution patient to avoid prolonged exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction. Instruct patient not to take OTC medications, including aspirin and ibuprofen or other prescription drugs, without consulting health care provider.