DRUG STUDY Prescribed and Recommended Dosage, Frequency, and route of Administration 39 mg IV Drip q 24 hours

Generic Name Brand Name Classifications

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Ceftriaxone Forgram Cephalosporins- 3rd generation

Bind to the bacterial cell wall membrane, causing cell death. Therapeutic effects: bactericidal action against susceptible bacteria.

Respiratory tract infection

Contraindicated in: CNS: seizures (high > hypersensitivity to doses) cephalosporins. GI: pseudolithiasis > Carnitine deficiency or inborn DERM: rashes, errors of metabolism urticaria Use cautiously in: HEMAT: blood > Renal impairment dyscrasias , > Severe hepatic/ biliary hemolytic anemia impairment

> Assess for infection (V/S, sputum, urine, and stool; WBC) at beginning of and throughout therapy. > Observe pt for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician of other health professional immediately if symptoms occur > Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.

DRUG STUDY

Generic Name Brand Name Classifications

Prescribed and Recommended Dosage, Frequency, and route of Administration

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Paracetamol Para-aminophenol derivative, Nonopoid Analgesics, Antipyretics

1 tab q 4 hours, PRN for fever

Thought to produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation. The drug may relieve fever through central action in the hypothalamic heat-regulating center.

>Mild pain >Fever

> Contraindicated Hema: hemolytic anemia, hypertensive to drug leukemia, neutropenia, pancytopenia >Used cautiously to in pts. With long term Hepatic: jaundice alcohol use because therapeutic doses Metab: hypoglycemia Skin: rash, uticaria

>Many OTC and prescription products contain acetaminophen, be aware of these when calculating total daily dose. >Tell pt. not to use for mark fever (temperature higher than 39 C) fever persisting longer than 3 days or recurrent fever unless directed by prescriber. >warn pt. that high dose are unsupervised long term use can cause liver damage. Excessive alcohol use may increase liver damage. Caution: Long term alchoholics to limit drug to 2 grams/day or less.

Name of Drug

Classification

Adverse effect

Indication

Contraindication

Nursing Considerations

Cefuroxime IV 50mg q6

ANTIINFECTIVE; ANTIBIOTIC; SECONDGENERATION CEPHALOSPORIN

Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea, nausea, antibioticassociated colitis. Skin: Rash, pruritus, urticaria. Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance.

It is effective for the treatment of penicillinase-producing Neisseria gonorrhoea (PPNG). Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/tonsillitis, sinusitis, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection.

Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Inspect IM and IV injection sites frequently for signs of phlebitis. Report onset of loose stools or diarrhea. Although pseudomembranous colitis. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Classification Name of Drug

Adverse effect

Indication

Contraindication

Nursing Consideration

Ambroxol 0.5m tid

Mucolytic

Occasional gastrointestinal side effects may occur but these are almost invariably mild.

Adjuvant therapy in patients with abnormal, viscid, or inspissated mucous secretions in acute and chronic bronchopulmonary diseases, and in pulmonary complications of cystic fibrosis and surgery, tracheostomy, and atelectasis. Also used in diagnostic bronchial studies and as an antidote for acute acetaminophen poisoning.

There are no absolute contraindication but in patients with gastric ulceration relative caution should be observed.

Assessment & Drug Effects y Monitor for S&S of aspiration of excess secretions, and for bronchospasm (unpredictable); withhold drug and notify physician immediately if either occur. y Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated. y Have suction apparatus immediately available. Increased volume of respiratory tract fluid may be liberated; suction or endotracheal aspiration may be necessary to establish and maintain an open airway. Patient & Family Education y Report difficulty with clearing the airway or any other respiratory distress.

Classification: ANTI-INFECTIVES-Quinolones GENERIC NAME INDICATION Infections of the resp. tract, middle ear,paranasal sinuses, eyes, kidneys, urinary tract ACTION Inhibits bacterial DNA gyrase thus preventing replication in susceptible bacteria CONTRAINDICATION Drugs that inhibit peristalsis. Infants and children, growing adolescents. Pregnancy and lactation PRECAUTION/ ADVERSE REACTION PRECAUTION Severe and persistent diarrhea during and after treatment ADVERSE RXN Common:Nausea, diarrhea, vomiting, rash Uncommon: Anorexia, headache,dizziness, fever, GI and abdominal pain, flatulence, confusion, vertigo NURSING CONSIDERATION >Assess pt for previous sensitivity reaction >Assess pt for any s/s of infection before & during treatment >Assess for adverse reactions >assess pt. & family s knowledge of drug therapy

Ciprofloxacin

BRAND NAME Ciprobay

DOSAGE 250-500mg BID

Classification: GASTROINTESTINAL DRUGS-Laxatives GENERIC NAME Mefenamic acid BRAND NAME Dolfenal DOSAGE Adult: start with 75150mcg BID Severe HPN 300mg BID INDICATION Relief of pain including muscular, rheumatic, traumatic, dental, postop and postpartum pain, headache, migraine, fever, dysmenorrhea ACTION Aspirin-like drug that has analgesic,antipyreti c, & antiinflammatory activities CONTRAINDICATION Pregnancy & lactation, hypersensitivity, active ulceration or chronic inflammation of either upper or lower GIT, blood disorders, poor platelet function, kidney or liver impairment, children < 14 yrs PRECAUTION/ ADVERSE REACTION PRECAUTION: If rash occurs, administration should be stopped, asthmatics, Hx of liver and kidney disease ADVERSE RXN GI discomfort, diarrhea or constipation, gas pain, nausea, vomiting, drowsiness NURSING CONSIDERATION > assess pt. s pain before therapy >monitor for possible drug induced adverse reactions >advice pt. not to take drug for more than 7 days >advice pt. to report immediately persistence or failure to relieve pain

Classification: ANTI-INFECTIVES GENERIC NAME metoclopramide BRAND NAME Plasil DOSAGE Adult 10mg 3x/day pedia: 15-20yrs 510mg 3x/day 5-14yrs: 2.5-5mg 3x/day 3-4yrs: 3mg 2-3x/day 1-2yrs: 1mg 2-3x/day Under 1 yr: 1mg 2x/day INDICATION Gastrointestinal motility, nausea, vomiting of central and peripheral origin assoc. with surgery ACTION Dopamine antagonist that acts by increasing receptor sensitivity and response of upper GIT tissues to acetylcholine CONTRAINDICATION GI hemorrhage, epileptics, hypersensitivity, lactation, pts. With breast cancer PRECAUTION/ ADVERSE REACTION PRECAUTION: Activities requiring mental alertness, elderly, lactation ADVERSE RXN Restlessness, drowsiness, fatigue, insomnia, headache, dizziness, nausea NURSING CONSIDERATION >give 30 mins before meals and at bed time > assess mental status during treatment >tell pt. To avoid driving & other hazardous activities for at least 2 hrs >advice pt. to avoid alcohol and other CNS depressant that enhance sedating properties of this drug

Classification: CARDIOVASCULAR DRUGS- BETA-BLOCKERS GENERIC NAME metropolol BRAND NAME Neobloc DOSAGE Adult : 50mg BID or 100 mg OD INDICATION Hypertension, chronic angina pectoris ACTION Exerts mainly beta1 adrenergic blocking activity but also blocks beta-2 receptors at high doses CONTRAINDICATION AV blocks, cardiogenic shock, sinus bradycardia PRECAUTION/ ADVERSE REACTION PRECAUTION: Slowing of heart rate, occasionally severe bradycardia may lead to vertigo ADVERSE RXN Occasionally fatigue, dizziness, headache, GI disturbance, skin rashes nausea NURSING CONSIDERATION >tablet may be crashed or swallowed whole > instruct pt to take with meals >inform the pt that drug only controls but does not cure the disorder >tell the pt. not to discontinue drug abruptly can worsen angina

Classification: CNS DRUGS- HYPNOTICS/ SEDATIVES

GENERIC NAME Nifedipine BRAND NAME Adalat DOSAGE Adults: Initial: 10-30mg PO TID Maximum: 120-180mg Hypertension: 30-60mg PO

INDICATION Vasospastic angina, classic chronic stable angina pectoris Hypertension

ACTION Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arteriole

CONTRAINDICATION Contraindicated in patients hypersensitive to drug Use cautiously in patients with heart failure or hypotension and in elderly patients. Use extended-release tablets cautiously in patients with severe GI narrowing

ADVERSE REACTION Dizziness, lightheadedness, headache, weakness, peripheral edema, flushing, nausea, Syncope, nervousness, hypotension, palpitations, nasal congestion, diarrhea, constipation, abdominal discomfort, muscle cramps, dyspnea, pulmonary edema, cough, rash, puritus

NURSING CONSIDERATION y Don t give immediate-release form within 1 week of acute MI or in acute coronary syndrome y Alert: despite the previously widespread SL use nifedipine capsule, avoid this route of administration. Excessive hypotension, MI, and death may result y Monitor blood pressure regularly, especially in patients who take beta blockers or antihypertensive y Watch for symptoms of heart failure

DRUG NAME GENERIC NAME: cefalexin BRAND NAME: Bioflex CLASSIFICATION: Cephalosporins (antiinfectives) PREPARATION: capsule DOSAGE: 500mg ROUTE: Oral FREQUENCY: q6

ACTION Inhibits bacterial cell wall synthesis, thus promoting osmotic instability which eventually leads to bacterial cell death.

INDICATION Skin and skin structure infections caused by staphylococcus streptococcus. GU infections caused by E.coli klebsiella.

CONTRAINDICATION Contraindicated with allergy to cephalosporins of penicillins. Use cautiously with renal failure, lactation, pregnancy.

ADVERSE REACTION Skin rashes, flushing, headache

NURSING CONSIDERATIONS Assess patient s previous sensitivity to penicillin or other cephalosporins. Assess patient for signs and symptoms of infection before and during treatment. Assess for anaphylaxis: rash, urticaria, pruritus, chills, fever. Assess renal function before and during therapy.

DRUG NAME GENERIC NAME: chlorpheniramine BRAND NAME: Antamin CLASSIFICATION: Anti-histamine PREPARATION: Ampoule DOSAGE: 1 amp ROUTE: IV FREQUENCY: STAT

ACTION Competes with histamine for H1-receptor site on effector cells; decreases allergic response by blocking histamine.

INDICATION Treatment of allergic disorders of allergic rhinitis, bronchial asthma, urticaria, vasomotor (non allergic) rhinitis, contact dermatoses, food and drug allergy and insect bites.

CONTRAINDICATION Lower respiratory tract symptoms. Herpes simplex of the eye. Newborn or premature infants. Patients receiving monoamine oxidase inhibitors (MAOI) therapy. Hyperthyroidism, hypertension, coronary disease.

ADVERSE REACTION Dry mouth, constipation, difficulty with micturition, blurred vision. Delirium agitation, insomnia. Jaundice, postural hypotension. Cardiac arrhythmias including atrial arrhythmia.

NURSING CONSIDERATIONS Assess for allergy symptoms: rhinitis, pruritus, urticaria, watering eyes, before and periodically during treatment Assess respiratory status and increase in bronchial secretions, wheezing or chest tightness Monitor I & O: be alert for urinary retention, frequency, dysuria, esp. elderly; drug should be discontinued if these occur.

MEDICATION (include dosage, route & frequency) CLOPIDOGREL 75 mg OD

DRUG CLASSIFICATION Adenosine diphosphate (ADP)induced platelet aggregation inhibitor

INDICATION

MECHANISM OF ACTION Inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor, impending ADPmediated activation and subsequent platelet aggregation, and irreversibly modifies the platelet ADP receptor.

SIDE EFFECTS/ ADVERSE REACTIONS CNS: depression, dizziness, fatigue, headache, pain CV: edema, hypertension EENT: epistaxis, rhinitis GI: hemorrhage, abdominal pain, constipation, diarrhea, dyspepsia, gastritis, ulcers GU: UTI Hematologic: purpura Musculoskeletal: arthralgia Respiratory: bronchitis, coughing, dyspnea, upper respiratory tract infection Skin: rash, pruritus Other: flulike syndrome

NURSING RESPONSIBILITIES  Platelet aggregation won t return to normal for at least 5 days after drug has been stopped.  Alert: Drug may cause fatal thrombotic thrombocytopenic purpura (thrombocytopenia, hemolytic anemia, neurologic findings, renal dysfunction, and fever) that requires urgent treatment, including plasmapharesis.

CONTRAINDICATIONS AND CAUTIONS  Contraindicated in patients hypersensitive to drug or its components and in those with pathologic bleeding (such as peptic ulcer or intracranial hemorrhage).  Use cautiously in patients at risk for bleeding from trauma, surgery, or other pathologic conditions and in those with renal or hepatic impairment.

 To reduce thrombotic events in patients with atherosclerosis documented by recent stroke, MI, or peripheral arterial disease  To reduce thrombotic events in patients with acute coronary syndrome (unstable angina and non-Q-wave MI), including those receiving drugs and those having percutaneous coronary intervention (with or without stent) or coronary artery bypass graft (CABG) y ST-segment elevation acute MI

Generic Name Brand Name Classifications

Prescribed and Recommended Dosage, Frequency, and route of Administration

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsiblities

Ampicillin sodium Ampicin, Ampicyn, Penbritin Penicillins

250 mg IV q 6H ANST(-)

Inhibits cell wall synthesis during bacterial multiplication

Respiratory tract infection

y Patients hypersensitive to drugs and other penicillins y Used cautiously in patients with other drug allergies

CV: thrombophlebitis, vain irritation GI: nausea, vomiting, diarrhea, black hairy tongue, HEMA: thrombocytopenia, thrombocytopenic purpura, leukopenia, agranulocytosis Other: anaphylaxis

y Before giving drug, ask patient about allergic reactions to penicillin y In patients with impaired renal function, increase dosage. y Monitor liver function test results before therapy y Tell patient to report rash, fever or chills. y Advise patient to report discomfort at I.V. insertion site.

MEDICATION (include dosage route & Frequency) Tramadol hydrochloride 50 mg IVTT q 6 hrs RTC x 8 doses

DRUG CLASSIFICATION Opioid analgesics

INDICATION Moderate to moderately severe pain

MECHANISM OF ACTION Unknown: a centrally acting synthetic analgesic compounds not chemically related to opioids. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine and serotonin

SIDE EFFECTS ADVERSE REACTIONS CNS: dizziness, vertigo, headache, somnolence, CNS stimulation, malaise CV: vasodilation GI: nausea, constipation, vomiting, dyspepsia, dry mouth, diarrhea RESPIRATORY: respiratory depression

CONTRAINDICATIONS AND CAUTIONS Contraindicated in patients hypersensitive to drug or other opioids, in breastfeeding women, and in those with acute intoxication from alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs

NURSING RESPONSIBILITIES y Reassess patient s level of pain at least 30 minutes after administration y Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate is below 12 bpm y Monitor patients at risk for seizures y Monitor patient for drug dependence. y Drug can produce dependence similar to that of codeine or dextroppropoxyphene and thus has potential for abuse

DRUG NAME

CLASS

INDICATIONS

DOSAGE

Ascorbic Acid (Vitamin C)

Vitamins

RDA 500mg/tab Frank and subclinical 1tab OD scurvy Extensive burns, delayed fracture or wound healing, postoperative wound healing, severe febrile or chronic disease states To prevent vitamin C deficiency in patients with poor nutritional habits or Increased requirements. To acidify urine Macular degeneration

MECHANISM OF ACTION Stimulates collagen formation and tissue formation; involved in oxidationreduction reactions throughout the body.

ADVERSE REACTIONS Transient mild soreness may occur at the site intramuscular or subcutaneous injection. Too rapid IV administration of the solution may cause temporary faintness or dizziness.

CONTRAINDICATIONS AND CAUTIONS Contraindicated in patients who are hypersensitive to the drug. In pregnant women, give only if clearly needed.

NURSING RESPONSIBILITIES Protect drug from heat and sunlight. Inform patient that there may be changes in the color of his urine. Give PO solution directly into mouth or with food. Utilization of vitamin may be better with IM route. Dissolve tablet in glass of water immediately before giving.

MEDICATION (include dosage route & Frequency) Celecoxib 200 mg 1 cap PO BID PRN for pain

DRUG CLASSIFICATION Nonsteroidal antiinflammatory drugs

INDICATION Acute pain

MECHANISM OF ACTION Thought to inhibit prostaglandin synthesis impeding cyclooxygenase2 (COX-2), to produce antiinflammatory, analgesic, antipyretic

SIDE EFFECTS ADVERSE REACTIONS CNS: headache, dizziness, insomnia CV: peripheral edema EENT: pharyngitis, rhinitis, sinusitis GI: nausea, vomiting, diarrhea, abdominal pain, flatulence METAB: hyperchloremia MUSCULO: back pain RESPI: URTI SKIN: erythema, rash, dermatitis Other: accidental injury

CONTRAINDICATIONS AND CAUTIONS Patients hypersensitive to drugs, sulfonamides, aspirin, or other NSAIDs With severe hepatic impairment Avoid use in the third trimester of pregnancy Use cautiously in patients with history of ulcers or GI bleeding, renal disease, DHN, anemia, asthma, heart failure, HPN In elderly or debilitated patients

NURSING RESPONSIBILITIES y Watch for signs and symptoms of overt and occult bleeding y Monitor patient with HPN, edema or heart failure y Drug may be hepatotoxic; watch for signs and symptoms of liver toxicity y Drug may be given without regard to meals, but food may decrease GI upset y Instruct patient to promptly report sign of GI bleeding such as blood in the vomit, urine or stool; or black tarry stools

MEDICATION (include dosage route & Frequency) Metronidazole 500 mg IVTT q 6hrs ANST(-)

DRUG CLASSIFICATION Amebicides and antiprotozoal

INDICATION Bacterial infections caused by anaerobic microorganism To prevent postoperative infection

MECHANISM OF ACTION Direct acting trichomonaside and amebecide that works inside and outside the intestines. It is thought to enter the cells of microorganisms that contain nitroreductase, forming unstable compounds that bind to DNA and inhibit synthesis causing cell death

SIDE EFFECTS ADVERSE REACTIONS CNS: fever, vertigo, headache, confusion, dizziness CV: flattened T wave, edema, flushing EENT: rhinitis, sinusitis, pharyngitis GI: abdominal cramping or pain, nausea, vomiting, diarrhea, constipation, dry mouth, metallic taste GU: darkened urine, polyuria, dysuria HEMA: transient leukopenia MUSCULO: fleeting joint pains RESPI: URTI SKIN: rash OTHER: decrease libido

CONTRAINDICATIONS AND CAUTIONS Patients hypersensitive to drug or other nitroimidazole derivatives Used cautiously in patients with history of blood dyscrasia, CNS disorder or retinal or visual field changes Used cautiously in patients who take hepatotoxic drugs or have hepatic disease or alcoholism

NURSING RESPONSIBILITIES y Monitor liver function test results y Give oral forms with meals y Observe patient for edema especially if he is receiving corticosteroids y Record number and character of stools y Instruct patient in proper hygiene y Tell patient to avoid alcohol and alcholo containing drugs during and for atleast 3 days after treatment y Tell patient that he might experience metallic taste and have dark or red brown urine

MEDICATION (include dosage route & Frequency) Ranitidine hydrochloride 50 mg IVTT q 8hrs

DRUG CLASSIFICATION Antiulcer drugs; H2-receptor antagonist

INDICATION Active duodenal and gastric ulcer

MECHANISM OF ACTION Competitively inhibits action of histamine on the H2 at receptor sites at parietal cells, decreasing gastric acid secretion

SIDE EFFECTS ADVERSE REACTIONS CNS: vertigo, malaise, headache EENT: blurred vision HEPA: jaundice OTHER: burning and itching at the injection site; anaphylaxis, angioedema

CONTRAINDICATIONS AND CAUTIONS patients hypersensitive to drug and those with acute porphyria use cautiously on patients with hepatic dysfunction. Adjust dosage in patients with impaired renal function

NURSING RESPONSIBILITIES y Assess patient for abdominal pain y Note presence of blood in emesis, stool or gastric aspirate y Remind patient to take once daily prescription drug at bedtime for best results y Instruct patient to take drug without regard to meals because absorption isn t affected with food y Urge patient to avoid cigarette smoking because this may increase gastric acid secretion and worsen disease y Correct hypovolemia before giving drug y Don t give drug epidurally, intrathecally because of alcohol-content y Carefully observe patient with coagulopathies and those taking anticoagulants y Teach patient signs and symptoms of GI bleeding including blood in vomit, urine or stool; coffee-ground vomit; and black tarry stools. Tell him to notify prescriber if any of these occurs

MEDICATION (include dosage route & Frequency) Cefazolin 1 gm IVTT q 8hrs ANST (-)

DRUG CLASSIFICATION First generation cephalosporins

INDICATION Perioperative prevention in contaminated surgery Infections of biliary, GU tract, soft tissue, bone and joints

MECHANISM OF ACTION First generation cephalosporins that inhibits cell way synthesis, promoting osmotic instability; usually bactericidal

SIDE EFFECTS ADVERSE REACTIONS CNS: headache, , confusion, seizures CV: phlebitis, thrombophlebitis GI: nausea, diarrhea, vomiting, abdominal cramps GU: genital pruritus, candidiasis HEMA: leukopenia, neutropenia, thrombocytopenia SKIN: maculopapular and erythematous rashes, urticaria, pruritus OTHER: anaphylaxis, drug fever

CONTRAINDICATIONS AND CAUTIONS Patients hypersensitive to drug and other cephalosporins Used cautiously in patients hypersensitive to penicilin

NURSING RESPONSIBILITIES y Before giving drug, ask patient if he is allergic to penicillin y Obtain specimen for culture and sensitivity test y Instruct patient to report adverse reactions promptly y Advise patient to notify prescriber if rashes develop or if signs and symptoms of super infection appear such as recurring fever, malaise and chills

MEDICATION (include dosage route & Frequency) Penicillin G 5 ml IVTT q 6hrs ANST(-)

DRUG CLASSIFICATION Penicillin

INDICATION Treatment of a wide variety of infections including: treatment of enterococcal infections, pneumococcal pneumonia

MECHANISM OF ACTION Bind to bacterial cell wall, resulting in cell death; bactericidal action against susceptible bacteria

SIDE EFFECTS ADVERSE REACTIONS CNS: seizures GI: diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis GU: interstitial nephritis HEMA: eosinophilia, hemolytic anemia, leukopenia SKIN: rashes, urticaria OTHER: anaphylaxis, serum sickness and superinfection

CONTRAINDICATIONS AND CAUTIONS Previous hypersensitivity to penicillins Hypersensivity to procaine or benzathine, tartrazine Use cautiously in geriatric patients, severe renal insufficiency

NURSING RESPONSIBILITIES y Assess for infection at beginning of and during therapy y Obtain a history to determine previous use of and reactions to penicillins or cephalosporins. y Obtain specimens for culture and sensitivity before initiating therapy y Observe patient for signs and symptoms of anaphylaxis. Discontinue drug and notify physician. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction