Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations Cefuroxime IV 50mg q6 ANTIINFECTIVE; ANTIBIOTIC; SECOND- GENERATION CEPHALOSPORIN Body as a Whole: Thrombophleb itis (IV site); pain, burning, cellulitis (IM site); superinfecti ons, positive Coombs' test. GI: Diarrhea, nausea, antibiotic- associated colitis. Skin: Rash, pruritus, urticaria. Urogenital: Increased It is effective for the treatment of penicillinas e-producing Neisseria gonorrhoea (PPNG). Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/ tonsillitis, sinusitis, lower respiratory tract infections, Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation. Determine history of hypersensitivi ty 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
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Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations
Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea, nausea, antibiotic-associated 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.
Name of DrugClassification Adverse effect Indication Contraindication Nursing Consideration
Ambroxol0.5m 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 Monitor for S&S of
aspiration of excess secretions, and for bronchospasm (unpredictable); withhold drug and notify physician immediately if either occur.
Lab tests: Monitor ABGs, pulmonary functions and pulse oximetry as indicated.
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 Report difficulty with
clearing the airway or any other respiratory distress.
DRUGNAME: Classification Mechanism of Action
INDICATION/CONTRAINDICATION
ROUTES/ DOSAGE
ADVERSE EFFECTS OF THE DRUG
Side Effects NURSING RESPONSIBILITIES /PRECAUTIONS
Ipraprotium bromide:Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Causes bronchodilation and inhibits secretion from serous and seromucous glands lining the nasal mucosa.Salbutamol:Stimulates beta-2 receptors of bronchioles to produce bronchodilation
INDICATIONS
COMBIVENT Inhalation Aerosol is indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continue to have evidence of bronchospasm and who require a second bronchodilator.
ContraindicationHypersensitivity to the drug, tachyarrythmias, hypertrophic obstructive cardiomyopathies, hypersensitivity to atropine
Fine tremor of skeletal muscles, palpitations, nervousness, urinary retention, dyspnea, exacerbation of symptoms, allergic-type reactions
Headache, dizziness, dryness of mouth, throat irritation, nausea, vomiting, GI upset
*Assess cardio-respiratory function: heart rate and rhythm, respiration rate and breathing pattern, and breath sounds.Note adventitious sounds.*Ensure adequate hydration; provide ventilation to prevent hyperpyrexia.*Do not double doses or increase the frequency of doses. Drug should be given exactly as prescribed.Perform chest physiotherapy after nebulization.*Report rash, eye pain, palpitations, tremors, weakness, irregular heartbeat.Provide proper nutrition. Give small frequent feedings for GI upset/nausea/vomiting.
DRUGNAME: Classification Mechanism of Action
INDICATION/CONTRAINDICATI
ROUTES/ DOSAGE
ADVERSE EFFECTS OF THE DRUG
Side Effects NURSING RESPONSIBILITIES /
ON PRECAUTIONS
GENERIC
NAME:
budesonide
BRAND NAME:
Pulmicort
Turbuhaler,
Pulmicort
Respules
glucocorticoid steroid
Budesonide is a man-made glucocorticoid steroid related to the naturally-occurring hormone, cortisol or hydrocortisone which is produced in the adrenal glands. It is used for treating asthma by inhalation
The budesonide inhaler is used for the control of asthma in persons requiring continuous, prolonged treatment. Such patients may include those with frequent asthmatic episodes requiring bronchodilators, for example, albuterol (Ventolin) or those with asthmatic episodes at night.
inhaler The most commonly noted side effects associated with inhaled budesonide are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler, for example, albuterol (Ventolin), prior to the budesonide. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler
The most commonly noted side effects associated with inhaled budesonide are mild cough or wheezing; these effects may be minimized by using a bronchodilator inhaler, for example, albuterol (Ventolin), prior to the budesonide. Oral candidiasis or thrush (a fungal infection of the throat) may occur in 1 in 25 persons who use budesonide without a spacer device on the inhaler
Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations
Brand name: AnsimarGeneric name: Doxofylline
Antiasthmatic & COPD Preparations
No CNS and CVS side effects.Doxofylline has a prolonged bronchodilator effects and unlike theophylline it has least adenosine interactions.It is highly safe in smokers.There is no sleep disturbances and no effects on gastric secretions with doxofylline.
Adrenergic bronchodilators and phosphodiesterase inhibitors both work by increasing intracellular level of cyclic-3’,5’- adenosine monophosphate (cAMP); adrenergics by increasing production and phosphodiesterase inhibitors by decreasing breakdown. Increased levels of cAMP produce bronchodilation. Corticosteroids act by decreasing airway inflammation. Anticholinergics (ipratropium) produce brondhodilation by decreasing intracellular levels of cyclic guanosine monophosphate (cGMP). Leukotriene receptor antagonists and mast cell stabilizers decrease the release of substances that can contribute to bronchospasm.
Assess lung sounds, pulse and blood pressure before administration and during peak of medication. Not amount, color, and character of sputum produced.
Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness of medication.
Observe for paradoxical bronchospasm (wheezing). If conditions occur, withhold medication and notify physician of other health care professional immediately.
Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations
Assess patient for signs of vitamin deficiency before and periodically throughout therapy. Assess nutritional status through 24 h diet recall. Determine frequency of consumption of vit rich foods
Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations
Name of Drug Classification Adverse effect Indication Contraindication Nursing Considerations
Generic Name:
Ethambutol, Isoniazid, Rifampicin
Anti-infectives/ Antituberculosis/Antilepros
Rifampicin: "flu-like" syndrome (such as, fever, chills, sometimes with headache, dizziness, and bone pain); hematopoietic reactions (such as, leukopenia, thrombocytopenia, and acute hemolytic anemia); cutaneous; Gastrointestinal and hepatic reactions; dyspnea, wheezing; shock; and acute renal failure. Elevations in serum concentrations of alanine transaminase, aspartate transaminase, bilirubin, and alkaline phosphatase, asymptomatic jaundice, and hepatitis.
For the continuation phase treatment of all forms of pulmonary and extrapulmonary tuberculosis.
Hypersensitivity. Jaundice or severe liver disease. Pre-existing optic neuritis
. Neutropenia has been reported in a patient on ethambutol,isoniazid, and rifampicin. Each drug induced neutropenia individually on rechallenge.
Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis.
History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation.
Assessment & Drug Effects
Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia. Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result
irreversible renal failure, urinary frequency. Hematologic: Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare). Special Senses: Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision. Skin: Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). Body as a Whole: Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site.
in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions. Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONSDrug name:-digoxinBrand name:-lanoxinDoctor’s order:-0.25mg 1tab OD
-atrial fibrillationACTION
-(+) inotrophic effect more available calcium promotes increase forces to increase cardiac output
-monitor v/s-should be administered with food or after eating-watch out for the adverse reaction of drug
DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS
Arcoxia etoricoxib
Adult: PO Osteoarthritis 60 mg once
daily. Rheumatoid arthritis 90 mg once
daily. Acute gout 120 mg once daily.
Max duration: 8 days. Inflammatory bowel disease,
severe congestive heart
failure, active peptic
ulceration, cerebrovascular
disease, CrCL <30 ml/min;
lactation. Children and
adolescent < 16 yr
GI disorders; ischemic
cardiac events;
hypersensitivity reactions,
headache, dizziness,
nervousness, depression,
drowsiness, insomnia,
vertigo, tinnitus,
photosensitivity; blood
disorders, fluid retention,
hypertension; dry mouth,
taste disturbance, mouth
ulcers; appetite and wt
changes; chest pain, fatigue,
paraesthesia, influenza-like
syndrome, myalgia. Renal
toxicity
Allergic disorders,
coagulation defects;
history of cardiac failure,
left ventricular dysfunction,
hypertension, or in patients
with oedema due to other
reasons; elderly, renal,
cardiac or hepatic
impairment
Generic /Brand name Classification Dosage, Timing, Route
Indication Mechanism of Action
Adverse reaction Nursing responsibilities
TRAMADOL(9/20/10)
Analgesics 50mg IVTT q 8hrs Moderate to moderately severe pain
Healthprofessionals havenot yet fullyendorsed of its useon a large scale forthese disorders,although it may beused when othertreatments havefailed (under thesupervision of apsychiatrist).
• Binds to mu-opioid
receptors.
• Inhibits reuptake of
serotonin and
norepinephrine in
the CNS
nausea, vomiting, sweating and constipation. Drowsiness is reported, although it is less of an issue than for non-synthetic opioids. Patients prescribed tramadol for general pain relief with or without other agents have reported withdrawal symptoms including uncontrollable nervous tremors, muscle contracture, and 'thrashing' in bed (similar to restless leg syndrome.
GENERIC NAME INDICATION AND DOSAGE ACTIONCONTRAINDICATIO
NSIDE EFFECTS
NURSING CONSIDERATION
Ranitidine HCL
•Active Duodenal UlcerAdults: PO 150mg b.i.d. or 300 mg at bedtime. Maintenance dose is 150 mg at bedtime. IM/IV/Intermittent IV 50 mg every 6 to 8 h.Children 1 mon -16 y/o: PO 2 to 4 mg/kg twice daily (max, 300 mg/day).•Maintenance therapy for Duodenal and Gastric UlcersAdults: 150mg P.O at bedtimeChildren 1 mon -16 y/o: PO 2 to 4 mg/kg daily up to 150mg daily•Pathologic Hypersecretory ConditionsAdults: PO 150 mg twice daily. Individualize.•GERD and Erosive EsophagitisAdults: PO 150mg b.i.d.Children 1 mon -16 y/o: PO 5 to
•Completely inhibits action of histamine on the H2 at receptor sites of parietal cells, decreasing gastric acid secretions
•Contraindicated in patients hypersensitive to drug and those with porphyria•Use cautiously in patients with hepatic dysfunction. Adjust dose in patients with impaired renal function
•CNS: headache, malaise, vertigo
•EENT: Blurred vision,
•Hepatic: jaundice
•Other: anaphylaxis, angioedema, burning ad itching at injection site
•Instruct patient on proper use of OTC preparation as indicated.•Assess patient for abdominal pain. Note presence of blood in emesis, stool, or gastric aspirate•Ranitidine may be added to total parenteral nutrition solution•Remind patient to take once daily prescription drug at bedtime for best results•Instruct patient to take without regard
10 mg/kg daily usually given in 2 divided doses.•Erosive Esophagitis: Maintenance dosage is 150mg P.O. q.i.d.•HeartburnAdults and Children 1 mon -12 y/o and older: 75mg of Zantac 75 P.O. as symptoms occur, up to 150mg daily, not to exceed 2 weeks of continuous treatment.
to meals because absorption isn’t affected by food• Remind patient not to confuse ranitidine with rimantadine: don’t confuse Zantac with Xanax or Zyrtec
GENERIC NAME
INDICATION AND DOSAGE ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION
Nalbuphine HCL
•Management of moderate to severe pain•preoperative and postoperative analgesia•supplement to balanced anesthesia•obstetrical analgesia during labor and deliveryDOSAGEAdults Subcutaneous / IM / IV 10 mg per 70 kg q 3 to 6 h as needed. Individualize dosage. In nontolerant patients, do not exceed 20 mg/dose or 160 mg/day
•Binds with opiate receptors in the CNS, altering perception of and emotional response to pain.
•Contraindicated in patients hypersensitive to drug •Use cautiously in patients with history of drug abuse and in those with emotional instability, head injury, increased ICP, impaired ventilation, MI accompanied by N/V, upcoming biliary surgery, and hepatic or renal disease
•Reassess patient’s level of pain at least 15 and 30 minutes after parenteral administration•Nalbuphine acts as an opioid antagonist and may cause withdrawal syndrome. For patients who have received log-term opioids, give 25% of the usual dose initially. Watch for sings of withdrawal.•Alert: Drug causes respiratory depression, which at 10mg is equal to respiratory depression produced by 10 mg of morphine •Monitor circulatory and respiratory status, bladder and bowel function. If respirations are shallow or rate is below 12 breaths/minute, withhold dose and notify prescriber
•Constipation is often severe with maintenance therapy. Make sure stool softener or other laxative is ordered.•Psychological and physical dependence may occur with prolonged use.• Remind patient not to confuse Nubain with Navane.
Name of Drug Classification & Indication
Contraindication & Adverse Reaction
Drug to Drug Interaction Nursing Responsibilities
Methergine(Methylergonovine Maleate)
Dosage:0.6 mg/3 ml
Preparation:Intramascular
Classification:PC: Ergot Alkaloid and DerivativeTC: oxytoxic, lactation stimulant
Indication: Management and prevention of postpartum and postabortal hemorrhage by producing firm uterine contractions and decreasing uterine bleeding.
Indication: Headache Dizziness Sweating Nasal Congestion Leg cramps
Antifungals like: Azole
(litraconazole, ketoconazole, vericonazole) – Increase risk of vasospasm leading to cerebral ischemia or ischemia of extremities; do not use together. Clarithomycin –
Increase risk of vasospasm leading to cerebral ischemia or ischemia of extremities; do not use together. Erythomycins –
Increase risk of vasospasm leading
1. Before administering the methergine, give only if the solution is clear and colorless; discard if ampule is discolored.
2. Note reason for therapy. List drug prescribe to ensure none interact.
3. Assess fundal tone and nonphasic contractures, massage to check for relaxation or
to cerebral ischemia and ischemia of extremities; do not use together. Protease
inhibitors – increase risk of vasospasm leading to cerebral ischemia or ischemia of extremities; do not use together.
severe cramping.
4. Monitor Vital Signs, CBC, and calcium; Correct if low to improve drug effectiveness and assess for decrease milk production.
5. Report frequency, amount, color, any associated S&S. Ensure placenta completely passed or removed.
6. Take only directed and do not exceed dosage
7. Report any severe cramping, headaches, or increase bleeding.
8. Evaluate for improved
uterine tone and control of postpartum hemorrhage.
Drug Data Classification Indication Contraindications Adverse Reaction Nursing Responsibilities
Generic Name Oxytocin
Trade Name Pitocin
ContentSynthetic oxytocin
Pharmacologic Class Hormone
Therapeutic ClassOxytocic
Pregnancy category X
- Antepatum: to initiate or improve uterine contractions to achieve early vaginal delivery; stimulation or reinforcement of labor in selected cases of uterine inertia; management of inevitable or incomplete abortion; second trimester abortion- Postpartum: To produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.- lactation deficiency- Unlabeled use; To evaluate fetal distress (oxytocin challenge test), treatment off breast engorgement
- significant cephalopelvic disproportion, unfavorable fetal positions or presentations, obstetric emergencies that favor surgical intervention, prolonged use in severe toxemia, uterine inertia, hypertonic uterine patterns, induction or ougmentation of labor when vaginal delivery is contraindicated, previous cesarean section, pregnancy (nasal)
Use cautiously with renal impairment.
CV: Cardiac arryhtsmias, PVCs, HPN, subarachnoid hemorrhageFetal effects: Fetal bradycaria, neonatal jaundice, low Apgar scoresGI: nausea, vomitingGU: postpartum hemorrhage, uterine rupture, pelvic hematoma, uterine hypertonicity, spasm, tetanic contraction, rupture of the uterus with excessive dosage, or hypersensitivityHypersensitivity: Anaphylactic reactionsOther: Maternal and fetal deaths when used to induce labor or in 1st or 2nd stages of labor; afibrinogemia; severe water intoxication with seizures and coma, maternal death
Before- Assess for significant cephalopelvic disproportion, unfavorable fetal positions or presentations, severe toxemia, uterine inertia, hypertonic uterine patterns, previous cesarean section- Assess fetal heart rate, uterine tone- Ensure fetal position and size and absence of complications.
During- Infuse via constant infusion pump to ensure accurate control of rate; rate determined by uterine response; begin with 1-2mL/min and increase at 16- to 60-min intervals- Do not combine in solution with fibrinolysin or heparin- Monitor maternal BP- Monitor neonate for jaundice- Discontinue drug and notify physician at any sign of hypertensive emergency
After- Educate client on the side effects of the medication and what to expect.- Document that drug has been given.
DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS
Drug name:-telmisartan, hydrochlorothiazideBrand name:-micardis plusDoctor’s order:-40mg 1tab OD
-essential hypertensionACTION
-blocks the vasoconstrictive and aldosterone-secreting effects of angotensin II by binding angiotensin II to the AT I receptor in many tissue.
-hypersensitivity to the drug-2nd and 3rd trimester of pregnancy-lactation
-diarrhea-anorexia-loss of appetite-gastric irritation-constipation
-special precaution in patients with impaired hepatic and renal impairment-special precaution with volume and/or Na-depleted patients-may impair ability to drive or operate machineries
DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONS
Drug name:-diltiazemBrand name:-cordazemDoctor’s order:-90mg 1tab BID
-angina pectorisACTION -inhibits calcium ion influx across cell membrane during cardiac depolarization, produces relaxation of coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries.
-sick-sinus syndrome-2nd and 3rd AV block-severe hypotension-pregnancy
-monitor v/s especially the BP-should be administered with food or after eating
DRUG INDICATION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATIONSTranexamic acid
short term management of hemorrhage
severe renal failure, active intravascular clotting, thromboembolic disease, colour vision disorders, subarachnoid bleeding
> diarrhea, N/V> disturbances in color vision> giddiness> hypotension (after rapid IV injection)
> Incompatible with benzylpenicillin> may be taken with or without food> monitor eye examination regularly during long term use> discontinue if changes in color vision occurs> avoid IV injection rate of more than 1 ml/minute due to risk of hypotension> monitor bleeding
