Known Medicines and their Contraindications

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Sheila, a student nurse, is about to prepare the due medications of her patient when her clinical instructor stops her and questions her about the drugs’ actions, side effects, and contraindications. Ugh, another drug study, she mutters to herself. She does not fully understand why you need to do drug study before administering medications. Aren’t medications supposed to make your patient feel better? Why waste time trying to review all of those written in books? Instead of doing so, you can just proceed with the administration and get on with other tasks. Such a waste of time, she thinks to herself as she continues on thinking of how to best answer the questions posed.

 

There are just some things that though, they are intended for the good, may sometimes turn out to be bad. One example are medications. Sure, meds were created in the aim to cure certain diseases and to help the patient recover fast. However, if not used correctly, they might just worsen the patient’s condition. Take for example, by not considering the contraindications of the drug, you are putting your patient’s health at risk. Some medications, though they do miracles on other patients, may be harmful to others. They may bring about unwanted consequences that may even be fatal to some. Thus, the reason why contraindications are indicated in the label of each drug, serving as a warning.

A contraindication is defined as a condition which makes a specific treatment or procedure possibly inadvisable. It may either be absolute (a situation which makes a particular treatment or procedure absolutely inadvisable) or relative (a condition which makes a particular treatment or procedure possibly inadvisable).

Below are some of the most prescribed drugs and their contraindications:

Hydrocodone (combined with acetaminophen) which reaches about 131.2 million prescriptions and is used to relieve moderate to severe pain

Contraindications:

  • Hypersensitivity to acetaminophen, hydrocodone, or similar compounds.

Simvastatina cholesterol-lowering statin drug which has over 94.1 million prescriptions

Contraindications:

  • Concomitant administration of strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone, and cobicistat-containing products)
  • Concomitant administration of gemfibrozil, cyclosporine, or danazol
  • Hypersensitivity to any component of this medication
  • Active liver disease, which may include unexplained persistent elevations in hepatic transaminase levels
  • Women who are pregnant or may become pregnant. Serum cholesterol and triglycerides increase during normal pregnancy, and cholesterol or cholesterol derivatives are essential for fetal development. Because HMG-CoA reductase inhibitors (statins) decrease cholesterol synthesis and possibly the synthesis of other biologically active substances derived from cholesterol, Simvastatin tablets may cause fetal harm when administered to a pregnant woman. Atherosclerosis is a chronic process and the discontinuation of lipid-lowering drugs during pregnancy should have little impact on the outcome of long-term therapy of primary hypercholesterolemia. There are no adequate and well-controlled studies of use with Simvastatin during pregnancy; however, in rare reports congenital anomalies were observed following intrauterine exposure to statins. In rat and rabbit animal reproduction studies, Simvastatin revealed no evidence of teratogenicity. Simvastatin tablets should be administered to women of childbearing age only when such patients are highly unlikely to conceive. If the patient becomes pregnant while taking this drug, Simvastatin tablets should be discontinued immediately and the patient should be apprised of the potential hazard to the fetus
  • Nursing mothers. It is not known whether Simvastatin is excreted into human milk; however, a small amount of another drug in this class does pass into breast milk. Because statins have the potential for serious adverse reactions in nursing infants, women who require treatment with Simvastatin tablets should not breastfeed their infants

Lisinoprilblood pressure drug which reaches over 87.4 million prescriptions

Contraindications:

  • Patients with a history of angioedema or hypersensitivity related to previous treatment with an angiotensin converting enzyme inhibitor
  • Patients with hereditary or idiopathic angioedema
  • Do not co-administer aliskiren with Lisinopril in patients with diabetes

levothyroxine sodium – a synthetic thyroid hormone which reaches over 70.5 million prescriptions

Contraindications:

  • Patients with untreated subclinical (suppressed serum TSH level with normal T3 and T4 levels) or overt thyrotoxicosis of any etiology and in patients with acute myocardial infarction.
  • Patients with uncorrected adrenal insufficiency since thyroid hormones may precipitate an acute adrenal crisis by increasing the metabolic clearance of glucocorticoids.
  • Patients with hypersensitivity to any of the inactive ingredients in Levothyroxine sodium tablets.

Amlodipine besylate – an angina/blood pressure drug which has over 57.2 million prescriptions

Contraindications:

  • Patients with known sensitivity to Amlodipine

Omeprazole – an antacid drug which reaches over 53.4 million prescriptions excluding over the counter sales

Contraindications:

  • Omeprazole Delayed-Release Capsules is contraindicated in patients with known hypersensitivity to substituted benzimidazoles or to any component of the formulation. Hypersensitivity reactions may include anaphylaxis, anaphylactic shock, angioedema, bronchospasm, interstitial nephritis, and urticarial

Azithromycinan antibiotic which has over 52.6 million prescriptions

Contraindications:

  • Patients with known hypersensitivity to azithromycin, erythromycin, any macrolide or ketolide drug
  • Patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of azithromycin.

Amoxicillinan antibiotic which has 52.3 million prescriptions

Contraindications:

  • Patients who have experienced a serious hypersensitivity reaction (e.g., anaphylaxis or Stevens-Johnson syndrome) to Amoxicillin or to other ?-lactam antibiotics (e.g., penicillins and cephalosporins).

Glucophagea diabetes drug which has 48.3 million prescriptions

Contraindications:

  • Patients with enal disease or renal dysfunction (e.g., as suggested by serum creatinine levels ?1.5 mg/dL [males], ?1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia
  • Patients with known hypersensitivity to metformin hydrochloride.
  • Patients with acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.

Hydrochlorothiazide – a water pill used to lower blood pressure which has 47.8 million prescriptions.

Contraindications:

  • Patients with anuria.
  • Patients with hypersensitivity to this product or to other sulfonamide-derived drugs

 

Sources:

Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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