DRUG STUDY

NAME OF DRUG
Generic Name: Ceftriaxone Sodium Anti- Infectives Third Generation Cephalosporins Pregnancy Risk category B Brand Name : Rocephin

ROUTE AND DOSAGE

1g IVTT Q8

MECHANISM OF ACTION
Thirdgeneration cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal

INDICATION

CONTRAINDICATION
Contraindicated to patients hypersensitive to drug or other cephalosporins Use catiously in patients hyperseneitive to penicillin because of possibility of cross- sensitivity with other beta lactam antibiotics

ADVERSE EFFECTS
CNS : dizziness, headache, fever CV: Phlebitis GI: diarrhea HEMA : Luekopenia SKIN : Rash, pain Others: anaphylaxis

INTERACTIONS

NURSING RESPONSIBILITI ES
Before: Observe 10 rights Obtain specimen for c/s before giving first dose Monitor for signs of superinfection During : For IM use, inject deep into a large muscle, such as the gluteus maximus or the lateral aspect of the thigh After: Instruct patient to report discomfort at I.V. insertion site Tell patient to notify prescriber about loose stools or diarrhea

Uncomplicated gonococcal vulvo vaginitis UTI; lower resp. tract infection, bone or joint, intra abdominal, skin, or skin structure infection, septicemia Meningitis Perioperative prevention

Drug to drug Aminoglycosides : may cause synergistic effect against some strains of p. aeruginosa. Monitor patient Probenecid : High doses (1g or 2g daily) may enhance hepatic clearance of ceftriaxone and shorten its halflife. Avoid using together.

DRUG STUDY
NAME OF DRUG
Generic Name: Gentamycin Sulfate Anti- Infectives Aminoglycosid e Pregnancy Risk category D Brand Name : Cidomycin, Geramycin

ROUTE AND DOSAGE

80mg IVTT Q8

MECHANIS M OF ACTION
Inhibits protein synthesis by binding directly to the 30s ribosomal subunit; bactericidal.

INDICATION

CONTRAINDICATION
Contraindicated to patients hypersensitive to drug or other aminoglycoside s. Use cautiously in neonates, infants, elderly patients, and patients with impaired renal function or neuromuscular disorders.

ADVERSE EFFECTS
CNS : dizziness, headache, fever, seizures, encephalopath y CV: hypotension EENT : ototoxicity GI: Vomiting, nausea GU: nephrotoxicity HEMA: Leukopenia, agranulocytosis , Thrombocytopenia MUSCULO : Muscle twitching RESP : Apnea SKIN : Rash, pruritus Others: Anaphylaxis

INTERACTION S
Drug to drug Atracurium. Pancurorium, recuronium, vecuronium: May increase effects of nondepolarizing muscle relaxants, including, prolonged resp. depression. Dimenhydranat e: May mask ototoxicity symptoms. Monitor patients hearing. Indomethacion : may increase peak and tough levels of gentamycin. Monitor gentamycin level.

NURSING RESPONSIBILITI ES
Before: Observe 10 rights Obtain c/s test before giving. During : Maintain peak levels at 4 to 12 mcg/ml and trough levels at 1 to 2 mcg/ml. After: Monitor renal function, UO, urinalysis, BUN, and crea levels. Instruct patient to promptly report adverse reactions, such as dizziness, vertigo, unsteady gait, hearing loss, numbness, and muscle twitching. Encourage to increase oral fluid.

Serious infection cause by sensitive strains of pseudomonas aeruginosa, Escherichia coli, Proteus, Klebsiella, or Staphylococcus To prevent endocarditis before GI or GU procedure or surgery

DRUG STUDY
NAME OF DRUG
Generic Name: Clindamycin Phosphate Anti Infectives Lincomycin derivative Pregnancy Risk category B Brand Name: Cleocin phosphate

ROUTE AND DOSAGE

D5W (50ml) + 600mg IVTT Q8 (-) ANST

MECHANISM OF ACTION
Inhibits bacterial protein synthesis by binding to the 50s subunit of the ribosome.

INDICATION

CONTRAINDICATION
Contraindicated in patients hypersensitive to drug or lincomycin Use cautiously in neonates and patients with renal or hepatic disease, asthma, history of GI disease, or significant allergies.

ADVERSE EFFECTS
CV: thrombophlebit is GI: Pseudomembranous colitis, diarrhea, vomiting HEMA: Thrombocytopenia, transient leukopenia Hepatic: Jaundice Skin: Maculopapular rash, urticaria Others: anaphylaxis

INTERACTION S
Drug to drug Erythromycin: May block access of clindamycin to its site of action. Avoid using together. Kaolin: May decrease absorption of oral clindamycin. Neuromascular Blocker: May increase neuromuscular blockade Drug to food: Diet foods with sodium cyclamate: May decrease drug level.

NURSING RESPONSIBILI TIES

Before: Observe 10 rights Obtain specimen for c/s. During : IM administration: Inject deep into muscle. Rotate sites. Dont exceed 600 mg per injection. After: Monitor renal, hepatic, and hematopoeitic functions during prolonged therapy. Observe patient for sx and sy of superinfection. Watch for signs of adverse reactions.

Infection caused by sensitive staphylococci, streptococci, pneumococci. Bacteroides, fusabacterium, clostridium perfringes and other sensitive aerobic and anaerobic organisms. Pelvic inflammatory disease

DRUG STUDY

NAME OF DRUG
Generic Name: Ketorolac Tromethamine Non- Steroidal AntiInflammatory Drug Pregnancy Risk category C; D in 3rd trimester Brand Name : Toradol

ROUTE AND DOSAGE

30mg IVTT Q6

MECHANISM OF ACTION
May inhibit prostaglandin synthesis, to produce antiinflammatory, analgesic, and antipyretic effects.

INDICATION

CONTRAINDICATION
Contraindicated to patients hypersensitive to drug and in those with active peptic ulcer disease, recent GI bleeding or perforation. Contraindicated as prophylactic analgesic before major surgery or intra operative when homeostasis is critical; and in patients currently receiving aspirin. Use cautiously to elderly patients with hepatic impairment.

ADVERSE EFFECTS
CNS : dizziness, headache, drowsiness CV: Arrhythmias GI: diarrhea, dyspepsia, GI pain, nausea, vomiting HEMA : Prolonged bleeding time SKIN : Pruritus, rash Others: Pain in injection site

INTERACTIONS

NURSING RESPONSIBILITI ES
Before: Observe 10 rights Correct hypovolemia before giving. Dont give drug epidurally or intrathecally bec. Of alcohol content During: Giving IM, pt may feel pain at injection site, put pressure on site for 15 to 30sec. After: Teach patient sx and sy of GI bleeding, including blood in vomit, and black tarry stool.Notify prescriber immediately. Tell patient not to take drug for more than 5 days in a row.

Short term management of moderately severe, acute pain for single dose treatment

Drug to drug ACE inhibitor: may cause renal impairment. Lithium: may increase lithium level Methotrexate: May decrease methotrexate clearance and increase toxicity Probenecid: May increase level and toxicity of ketorolac Salicylates: May increase the risk of serious ketorolac adverse effects. Drug to herb: White willow: Herb and drug contain similar components. Discourage use together.

DRUG STUDY

NAME OF DRUG
Generic Name: Tramadol Hydrochloride Opioid analgesics Synthetic, centrally active analgesic Pregnancy risk category C Brand Name : Ultram

ROUTE AND DOSAGE

50mg IVTT Q6

MECHANISM OF ACTION
Unknown. A centrally acting synthetic analgesic compound not chemically related to opioids. Thought to bind to opioid receptors and inhibit reuptake of norepinephrin e and serotonin.

INDICATION

CONTRAINDICATION
Contraindicated to patients hypersensitive to drug or other opioids, in breast feeding women, and in those with acute intoxication from alcohol, hypnotics, centrally acting analgesics, psychotropic drugs. Use cautiously in patients at risk for seizures or respiratory depression ; in patients with increased ICP or head injury, acute abdominal conditions, or renal or hepatic impairment.

ADVERSE EFFECTS
CNS : dizziness, headache, seizures, confusion, euphoria CV: Vasodilation EENT: Visual Disturbances GI: Constipation, nausea, vomiting,, anorexia, diarrhea GU: Menopausal symptoms; proteinuria, urinary frequency Musculo: Hypertonia Resp.: Respiratory depression Skin: Pruritus, Rash

INTERACTIONS

NURSING RESPONSIBILITI ES
Before: Observe 10 rights Reassess pts level of pain at least 30 min after administration During: Give drug before onset of intense pain. Instruct patient to take drug as prescribed and not to increase dosage unless prescribed. After: Monitor bowel and bladder function. Monitor pts risks for seizures. Monitor for drug dependence. Monitor for drug dependence. Warn patient not to stop drug abruptly.

Moderate to moderately severe pain.

Drug to drug Carbamazepine: May increase tramadol metabolism CNS Depressants: May cause additiveeffects. Cyclobenzaprine, MAO inhibitors: May increase risk of seizures. Quinidine: May increase level of tramadol. SSRIs: May increase risk of serotonin syndrome. Use cautiously and monitor patient for adverse effects.

DRUG STUDY

NAME OF DRUG
Generic Name: Ketorolac Tromethamine Non- Steroidal AntiInflammatory Drug Pregnancy Risk category C; D in 3rd trimester Brand Name : Toradol

ROUTE AND DOSAGE

30mg IVTT Q6

MECHANISM OF ACTION
May inhibit prostaglandin synthesis, to produce antiinflammatory, analgesic, and antipyretic effects.

INDICATION

CONTRAINDICATION
Contraindicated to patients hypersensitive to drug and in those with active peptic ulcer disease, recent GI bleeding or perforation. Contraindicated as prophylactic analgesic before major surgery or intra operative when homeostasis is critical; and in patients currently receiving aspirin. Use cautiously to elderly patients with hepatic impairment.

ADVERSE EFFECTS
CNS : dizziness, headache, drowsiness CV: Arrhythmias GI: diarrhea, dyspepsia, GI pain, nausea, vomiting HEMA : Prolonged bleeding time SKIN : Pruritus, rash Others: Pain in injection site

INTERACTIONS

NURSING RESPONSIBILITI ES
Before: Observe 10 rights Correct hypovolemia before giving. Dont give drug epidurally or intrathecally bec. Of alcohol content During: Giving IM, pt may feel pain at injection site, put pressure on site for 15 to 30sec. After: Teach patient sx and sy of GI bleeding, including blood in vomit, and black tarry stool.Notify prescriber immediately. Tell patient not to take drug for more than 5 days in a row.

Short term management of moderately severe, acute pain for single dose treatment

Drug to drug ACE inhibitor: may cause renal impairment. Lithium: may increase lithium level Methotrexate: May decrease methotrexate clearance and increase toxicity Probenecid: May increase level and toxicity of ketorolac Salicylates: May increase the risk of serious ketorolac adverse effects. Drug to herb: White willow: Herb and drug contain similar components. Discourage use together.