WEEK2 Course Task (ALFEREZ, DINIELA)

Look for the drug-drug interaction of the following drugs given and give nursing
considerations as you give the drugs together:

1. Celecoxib with ACE inhibitors
Drug-drug interactions: No changes in body weight, serum creatinine, or potassium

occurred in either group. Thus, these data demonstrate that high doses of celecoxib have
no significant effect on the antihypertensive effect of the ACE inhibitor lisinopril.
Considerations: Abdominal pain, diarrhea, nausea, edema, dizziness, headache,

insomnia, upper respiratory tract infections; rash. Potentially Fatal: Serious skin reactions
such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal
necrolysis.
2. amitriptyline hydrochloride with barbiturates
Drug-drug interactions: Amitriptyline can induce significant sedation, particularly

during the initiation of treatment. Amitriptyline may enhance the response to alcohol, the
effects of barbiturates, and increase sedation or central nervous system (CNS) effects
during coadministration with other CNS depressants.
Considerations: Amitriptyline can induce significant sedation, particularly during the

initiation of treatment. Amitriptyline may enhance the response to alcohol, the effects of
barbiturates, and increase sedation or central nervous system (CNS) effects during
coadministration with other CNS depressants. Restrict drug access for depressed and
potentially suicidal patients. Give IM only when oral therapy is impossible. Do not
administer IV. Administer major portion of dose at bedtime if drowsiness, severe
anticholinergic effects occur (note that the elderly may not tolerate single-daily-dose
therapy).
3. acetylcysteine with activated charcoal
Drug-drug: (Moderate) Administration of activated charcoal and oral acetylcysteine at

the same time may cause a reduction in acetylcysteine (NAC) absorption. There are
conflicting data as to whether the reduced bioavailability of NAC is clinically significant
during the treatment of drug overdoses.
Considerations: Patients treated with oral acetylcysteine should be monitored for

vomiting, and the dose should be repeated if the patient vomits within 60 minutes after
any dose. Patients receiving intravenous acetylcysteine for liver failure should be
hospitalized in a critical care unit.
4. budesonide inhalation with ketoconazole
Drug-drug: Clarithromycin, erythromycin, itraconazole, ketoconazole and other strong

CYP3A4 inhibitors such as atazanavir, clarithromycin, indinavir, itraconazole,
nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin: Possibly increased blood
budesonide level.
Considerations: Check or assess the patient for allergies in food or drug, check for
Untreated local nasal infections, nasal trauma, septal ulcers, recent nasal surgery,
lactation. Monitor BP, P, auscultation; R, adventitious sounds; examination of nares
5. clobazam with hormonal contraceptives
Drug-drug: Possible diminished effectiveness of oral contraceptive.
Considerations: Monitor patient closely for skin reactions, especially during the first 8
weeks of therapy or when reintroducing clobazam therapy. If the patient develops a rash,
notify prescriber immediately and expect drug to be discontinued, as serious
dermatological adverse reactions have occurred with clobazam therapy. Expect to
withdraw clobazam therapy gradually when the drug is discontinued by decreasing total
daily dose by 5 to 10 mg/day on a weekly basis until discontinued, as ordered, to avoid
withdrawal symptoms such as anxiety, dysphoria, and insomnia.
6. esmolol hydrochloride with antidiabetic agents
Drug-drug: Epinephrine, or norepinephrine: Increased risk of reducing cardiac

contractility in presence of high systemic resistance.
Considerations: Use esmolol cautiously if patient has supraventricular arrhythmias with

decreased cardiac output, hypotension, or other hemodynamic compromise or is taking
drugs that decrease contractility, impulse generation, myocardial filling, or peripheral
resistance. Monitor blood pressure and heart rate often during therapy. Hypotension can
occur at any dose but usually is dose related. It typically reverses within 30 minutes after
dose is decreased or infusion stopped. Inspect site often for thrombophlebitis (pain,
redness, swelling at site). Infusion of 20 mg/ml is more likely to cause serious vein
irritation than 10 mg/ml. Extravasation of 20 mg/ml may cause a serious local reaction
and skin necrosis. Don’t give more than 10 mg/ml into a small vein or using a butterfly
catheter.
7. indomethacin with aminoglycosides
Drug-drug: Diuretics (loop, potassium-sparing, and thiazide): Decreased

antihypertensive and diuretic effects; increased risk of hyperkalemia with potassium-
sparing diuretics.
Considerations: Be aware that serious GI tract, bleeding, perforation, and ulceration may
occur without warning symptoms. Elderly patients are at greater risk. To minimize risk,
give oral indomethacin with an antacid, food, or a full glass of water (not suspension), to
reduce GI distress. Know that if GI distress occurs, withhold drug and notify prescriber
immediately. Use indomethacin cautiously in patients with hypertension, and monitor
blood pressure closely throughout therapy. Drug may cause hypertension or worsen it.
Shake suspension well before giving it. Make sure suppository stays in rectum at least 1
hour to improve absorption.
8. isoniazid with acetaminophen
Drug-drug: Acetaminophen: Increased risk of hepatotoxicity.
Considerations: Watch for adverse reactions, such as peripheral neuritis; if they occur,
expect to decrease dosage. Give isoniazid with other antituberculotic drugs, as prescribed,
to prevent development of resistant organisms. Be aware that patients with advanced HIV
infection may experience more severe adverse reactions in greater numbers
9. mesalamine with warfarin
Drug-drug: Azathioprine, 6-mercaptopurine: Possibly increased risk for blood disorders
Considerations: Assess patient for evidence of acute intolerance similar to flare-up of

inflammatory bowel
10. rifampicin with probenecid
Drug-drug: Concomitant use with probenecid and cotrimoxazole increases the

concentration of rifampin which may increase the risk of RIFADIN toxicities. Monitor
for adverse reactions associated with RIFADIN during coadministration.
Considerations: Advise patient about possible discoloration of tears, saliva, urine, and
other body fluids. Instruct patient to notify physician if discoloration becomes
troublesome. Advise patient about the likelihood of GI reactions (nausea, vomiting,
diarrhea, flatulence, abdominal pain, heartburn).
Give the adverse reactions of the following drugs on the systems indicated:
1) cimetidine – GI
Effects: Headache, dizziness, drowsiness, or diarrhea may occur. If any of these effects last
or get worse, tell your doctor or pharmacist promptly. If your doctor has directed you to use
this medication, remember that your doctor has judged that the benefit to you is greater than
the risk of side effects.
2) esterified estrogen – CNS
Effects: Headache; migraine; dizziness; mental depression; chorea; nervousness; mood
disturbances; irritability; exacerbation of epilepsy, dementia.
3) gentamicin sulfate – respiratory
Effects: A very serious allergic reaction to this drug is rare. However, get medical help right
away if you notice any of the following symptoms of a serious allergic reaction: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
4) iloperidone – EENT
Effects: Drowsiness, dizziness, lightheadedness, dry mouth, tiredness, stuffy nose, and
weight gain may occur. If any of these effects last or get worse, tell your doctor or
pharmacist promptly. This medication may cause a serious drop in blood pressure, especially
when starting or increasing the dose.
5) meropenem – CNS
Effects: seizures, confusion, headaches, numbness or tingling sensation
6) simvastatin – respiratory
Effects: The most commonly reported adverse reactions (incidence ≥5%) in simvastatin
controlled clinical trials were: upper respiratory infections (9.0%), headache (7.4%),
abdominal pain (7.3%), constipation (6.6%), and nausea (5.4%).
7) trospium chloride – EENT
Effects: Dry mouth, constipation, stomach upset, headache, dry eyes, dizziness, blurred
vision, or drowsiness may occur.
8) desmopressin acetate – GI
Effects: Low levels of sodium in the body--headache, confusion, hallucinations, muscle
cramps, severe weakness, vomiting, loss of coordination, feeling restless or unsteady;
flushing (sudden warmth, redness, or tingly feeling);
9) ethambutol hydrochloride – musculoskeletal
Effects: Itching or rash; joint pain; headache, dizziness; or. nausea, vomiting, stomach pain,
indigestion, loss of appetite.
10) promethazine hydrochloride – metabolic
Effects: Dizziness, lassitude, disturbed coordination, and muscular weakness have all been
reported.

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Look for the drug-drug interaction of the following drugs given and give nursing

considerations as you give the drugs together:

Drug-drug interactions: No changes in body weight, serum creatinine, or potassium

Considerations: Abdominal pain, diarrhea, nausea, edema, dizziness, headache,

2. amitriptyline hydrochloride with barbiturates

Drug-drug interactions: Amitriptyline can induce significant sedation, particularly

Considerations: Amitriptyline can induce significant sedation, particularly during the

Drug-drug: (Moderate) Administration of activated charcoal and oral acetylcysteine at

Considerations: Patients treated with oral acetylcysteine should be monitored for

4. budesonide inhalation with ketoconazole

Drug-drug: Clarithromycin, erythromycin, itraconazole, ketoconazole and other strong

5. clobazam with hormonal contraceptives

Drug-drug: Possible diminished effectiveness of oral contraceptive.

6. esmolol hydrochloride with antidiabetic agents

Drug-drug: Epinephrine, or norepinephrine: Increased risk of reducing cardiac

Considerations: Use esmolol cautiously if patient has supraventricular arrhythmias with

7. indomethacin with aminoglycosides

Drug-drug: Diuretics (loop, potassium-sparing, and thiazide): Decreased

8. isoniazid with acetaminophen

Drug-drug: Acetaminophen: Increased risk of hepatotoxicity.

9. mesalamine with warfarin

Drug-drug: Azathioprine, 6-mercaptopurine: Possibly increased risk for blood disorders

Considerations: Assess patient for evidence of acute intolerance similar to flare-up of

10. rifampicin with probenecid

Drug-drug: Concomitant use with probenecid and cotrimoxazole increases the

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