PROMETHAZINE HYDROCHLORIDE

Pentazine, Phenazine, Phencen, Phenergan, Phenoject-50, Prometh, Prorex, Prothazine, V-Gan
Classifications: GASTROINTESTINAL AGENT; ANTIEMETIC; ANTIVERTIGO AGENT; PHENOTHIAZINE

Indication
Symptomatic relief of various allergic conditions, to ameliorate and prevent reactions to blood and plasma,
and in prophylaxis and treatment of motion sickness, nausea, and vomiting. Preoperative, postoperative, and
obstetric sedation and as adjunct to analgesics for control of pain.

Actions
Long-acting derivative of phenothiazine with marked antihistamine activity and prominent sedative, amnesic,
antiemetic, and anti-motion-sickness actions. Unlike other phenothiazine derivatives, relatively free of
extrapyramidal adverse effects; however, in high doses it carries same potential for toxicity.

Contraindications
Hypersensitivity to phenothiazines; narrow-angle glaucoma; stenosing peptic ulcer, pyloroduodenal
obstruction; prostatic hypertrophy; bladder neck obstruction; epilepsy; bone marrow depression; comatose or
severely depressed states; pregnancy (category C), lactation, newborn or premature infants, acutely ill or
dehydrated children; children <2 y; Reye's syndrome, encephalopathy, hepatic diseases.

Route & Dosage

Nausea Child: PO/PR/IM/IV 0.25–0.5 mg/kg q4–6h
Adult: PO/PR/IM/IV 12.5–25 mg q4–6h prn prn
Allergies Sedation
Adult: PO/PR/IM/IV 12.5 mg q.i.d. or 25 mg Adult: PO/PR/IM/IV 25–50 mg preoperatively
h.s. or h.s.
Child: PO/PR/IM/IV 6.25–12.5 mg q.i.d. or 25 Child: PO/PR/IM/IV 12.5–25 mg
mg h.s. preoperatively or h.s.

Adverse Effects ( 1%)

Body as a Whole: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal reactions,
nightmares (in children), CNS stimulation, abnormal movements. Respiratory: Irregular
respirations, respiratory depression. CNS: Sedation drowsiness, confusion, dizziness, disturbed coordination,
restlessness, tremors. CV: Transient mild hypotension or hypertension. GI: Anorexia, nausea, vomiting,
constipation. Hematologic: Leukopenia, agranulocytosis. Special Senses: Blurred vision, dry mouth, nose,
or throat. Skin: Photosensitivity. Urogenital: Urinary retention.

NURSING IMPLICATIONS
Assessment & Drug Effects
 Supervise ambulation. Promethazine sometimes produces marked sedation and dizziness.
 Be aware that antiemetic action may mask symptoms of unrecognized disease and signs of drug
overdosage as well as dizziness, vertigo, or tinnitus associated with toxic doses of aspirin or other ototoxic
drugs.
 Patients in pain may develop involuntary (athetoid) movements of upper extremities following parenteral
administration. These symptoms usually disappear after pain is controlled.
 Monitor respiratory function in patients with respiratory problems, particularly children. Drug may suppress
cough reflex and cause thickening of bronchial secretions.
Patient & Family Education
 For motion sickness: Take initial dose 30–60 min before anticipated travel and repeat at 8–12 h intervals if
necessary. For duration of journey, repeat dose on arising and again at evening meal.
 Do not drive or engage in other potentially hazardous activities requiring mental alertness and normal
reaction time until response to drug is known.
 Avoid sunlamps or prolonged exposure to sunlight. Use sunscreen lotion during initial drug therapy.
 Do not take OTC medications without physician's approval.
 Avoid alcohol and other CNS depressants.
 Relieve dry mouth by frequent rinses with water or by increasing noncaloric fluid intake (if allowed),
chewing sugarless gum, or sucking hard candy. If these measures fail, add a saliva substitute (e.g., Moi-
Stir, Orex, Xero-Lube).
 Do not breast feed while taking this drug.
 NALBUPHINE HYDROCHLORIDE
Nubain
Classifications: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST-ANTAGONIST

Indications
Symptomatic relief of moderate to severe pain. Also preoperative sedation analgesia and as a supplement to
surgical anesthesia.

Actions
Synthetic narcotic analgesic with agonist and weak antagonist properties. Analgesic potency is about 3 or 4
times greater than that of pentazocine and approximately equal to that produced by equivalent doses of
morphine. On a weight basis, produces respiratory depression about equal to that of morphine; however, in
contrast to morphine, doses >30 mg produce no further respiratory depression. Antagonistic potency is
approximately one fourth that of naloxone and about 10 times greater than that of pentazocine.

Contraindications
History of hypersensitivity to drug. Safety during pregnancy (category C) or lactation is not established.
Prolonged use during pregnancy could result in neonatal withdrawal.

Route & Dosage

Moderate to Severe Pain
Adult: IV/IM/SC 10–20 mg q3–6h prn (max 160 mg/d)
Child: IV/IM/SC 0.1–0.15 mg/kg q3–6h prn
Adverse Effects ( 1%)
CV: Hypertension, hypotension, bradycardia, tachycardia, flushing. GI: Abdominal cramps, bitter
taste, nausea, vomiting, dry mouth. CNS: Sedation, dizziness, nervousness, depression, restlessness,
crying, euphoria, dysphoria, distortion of body image, unusual dreams, confusion, hallucinations; numbness
and tingling sensations, headache, vertigo. Respiratory: Dyspnea, asthma, respiratory
depression.Skin: Pruritus, urticaria, burning sensation, sweaty, clammy skin. Special Senses: Miosis,
blurred vision, speech difficulty. Urogenital: Urinary urgency.

NURSING IMPLICATIONS
Assessment & Drug Effects
 Assess respiratory rate before drug administration. Withhold drug and notify physician if
respiratory rate falls below 12.
 Watch for allergic response in persons with sulfite sensitivity.
 Administer with caution to patients with hepatic or renal impairment.
 Monitor ambulatory patients; nalbuphine may produce drowsiness.
 Watch for respiratory depression of newborn if drug is used during labor and delivery.
 Avoid abrupt termination of nalbuphine following prolonged use, which may result in
symptoms similar to narcotic withdrawal: nausea, vomiting, abdominal cramps, lacrimation, nasal
congestion, piloerection, fever, restlessness, anxiety.
 Patient & Family Education
 Do not drive or engage in potentially hazardous activities until response to drug is known.
 Avoid alcohol and other CNS depressants.
 Do not breast feed while taking this drug without consulting physician.
MELOXICAM
(mel-ox'-i-cam)
Mobic
Classifications: CENTRAL NERVOUS SYSTEM AGENT (CNS); ANALGESIC; NONSTEROIDAL ANTI-INFLAMMATORY
(NSAID)

Actions
Is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits anti-inflammatory, analgesic, and antipyretic
activities. The mechanism of action, like other NSAIDs, may be related to prostaglandin synthetase
(cyclooxygenase) inhibition.

Indications
Relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis.

Contraindications
Hypersensitivity to meloxicam; rhinitis, urticaria/angioedema, asthma; allergic reactions to aspirin or other
antiinflammatory agents; NSAID hypersensitivity, severe renal or hepatic disease; salicylate hypersensitivity,
pregnancy [(category C) first and second trimester, (category D) third trimester)], lactation; bleeding.
Route & Dosage
Osteoarthritis Rheumatoid Arthritis
Adult: PO 7.5–15 mg once daily Adult: PO 15 mg once daily

Adverse Effects ( 1%)

Body as a Whole: Edema, fall, flu-like syndrome, pain. GI: Abdominal pain, diarrhea, dyspepsia,
flatulence, nausea, constipation, ulceration, GI
bleed. Hematologic: Anemia. Musculoskeletal:Arthralgia. CNS: Dizziness, headache,
insomnia. Respiratory: Pharyngitis, upper respiratory tract infection, cough. Skin: Rash,
pruritus. Urogenital: Micturition frequency, urinary tract infection.

NURSING IMPLICATIONS
Assessment & Drug Effects
 Monitor for and immediately report S&S of GI ulceration or bleeding, including black, tarry stool,
abdominal or stomach pain; hepatotoxicity, including fatigue, lethargy, pruritus, jaundice, flu-like
symptoms; skin rash; weight gain and edema.
 Withhold drug and notify physician if hepatotoxicity or GI bleeding is suspected.
 Monitor carefully patients with a history of CHF, HTN, or edema for fluid retention.
 Monitor diabetics using sulfonylureas for hypoglycemia.
 Lab tests: Hgb & Hct, CBC with differential, liver function tests, serum electrolytes, BUN, and creatinine
within 3 mo of initiating therapy and every 6–12 mo thereafter; with high-risk patients (e.g., >60 yr,
 history of peptic ulcer disease, prolonged or high-dose NSAID therapy, concurrent use of
corticosteroids or anticoagulants) monitor within first 3–4 wk and every 3–6 mo thereafter.
 Coadministered drugs: With warfarin, closely monitor INR when meloxicam is initiated or dose
changed; monitor for lithium toxicity, especially during addition, withdrawal, or change in dose of
meloxicam.
Patient & Family Education
 Report any of the following to the physician immediately: nausea, black tarry stool, abdominal or
stomach pain, unexplained fatigue or lethargy, itching, jaundice, flu-like symptoms, skin rash, weight
gain, or edema.
 Minimize alcohol intake and use of tobacco. Discontinue drug if hepatotoxicity or GI bleeding is
suspected. Note that GI bleeding may occur without forewarning and is more likely in older adults, in
those with a history of ulcers or GI bleeding, and with alcohol consumption and cigarette smoking.
 Do not take aspirin or other NSAIDs while on this medication.
 Do not breast feed while taking this drug.
 CEFUROXIME SODIUM
Kefurox, Zinacef
Classifications: ANTIINFECTIVE; ANTIBIOTIC; SECOND-GENERATION CEPHALOSPORIN
Indications
Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin, and skin
structures; also used for treatment of meningitis, gonorrhea, and otitis media and for perioperative
prophylaxis (e.g., open-heart surgery), early Lyme disease.

Actions
Semisynthetic second-generation cephalosporin antibiotic with structure similar to that of the penicillins.
Resistance against beta-lactamase-producing strains exceeds that of first generation cephalosporins.
Antimicrobial spectrum of activity resembles that of cefonicid. Preferentially binds to one or more of the
penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final
stage of bacterial cell wall synthesis, thus killing the bacterium. Partial cross-allergenicity between other
beta-lactam antibiotics and cephalosporins has been reported.

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

Route & Dosage

Moderate to Severe Infections
Adult: PO 250–500 mg q12h. IV/IM 750 mg–1.5 g q6–8h
 Child  (3 mo–12 y): PO 10–15 mg/kg (125–250 mg) q12h. IV/IM 75–100 mg/kg/d divided q8h
(max 6 g/d)
Neonate: IM/IV 20–100 mg/kg/d divided q12h

Bacterial Meningitis
Adult: IV/IM 3 g q8h
Child: IV/IM 200–240 mg/kg/d divided q6–8h; reduced to 100 mg/kg/d upon improvement

Surgical Prophylaxis
Adult: IV/IM 1.5 g 30–60 min before surgery, then 750 mg q8h for 24 h
Child: IV/IM Same as for adult

Adverse Effects ( 1%)

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.

NURSING IMPLICATIONS
Assessment & Drug Effects
 Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies,
particularly to drugs, before therapy is initiated.
  Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy
if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine
clearance.
 Inspect IM and IV injection sites frequently for signs of phlebitis.
 Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms,
Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause
of diarrhea during and after antibiotic therapy.
 Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their
appearance promptly.
 Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report
any significant changes.

Patient & Family Education

 Report loose stools or diarrhea promptly.
 Report any signs or symptoms of hypersensitivity (see Appendix F).
 Do not breast feed while taking this drug.
 FERROUS SULFATE 
Feosol, Fer-In-Sol, Fer-Iron, Fero-Gradumet, Ferospace, Ferralyn, Ferra-TD, Fesofor, Hematinic, Mol-
w-Fe
Classifications: BLOODS FORMERS, COAGULATORS, AND ANTICOAGULANTS; IRON PREPARATION
Indications
To correct simple iron deficiency and to treat iron deficiency (microcytic, hypochromic) anemias. Also may
be used prophylactically during periods of increased iron needs, as in infancy, childhood, and pregnancy.

Actions
Ferrous sulfate: Standard iron preparation against which other oral iron preparations are usually
measured. Corrects erythropoietic abnormalities induced by iron deficiency but does not stimulate
erythropoiesis. May reverse gastric, esophageal, and other tissue changes caused by lack of iron. 

Contraindications
Peptic ulcer, regional enteritis, ulcerative colitis; hemolytic anemias (in absence of iron deficiency),
hemochromatosis, hemosiderosis, patients receiving repeated transfusions, pyridoxine-responsive anemia;
cirrhosis of liver.

Route & Dosage

Iron Deficiency
Adult: PO Sulfate (30% elemental iron) 750–1500 mg/d in 1–3 divided doses; Fumarate (33%
 elemental iron) 200 mg t.i.d. or q.i.d.; Gluconate (12% elemental iron) 325–600 mg q.i.d.,
may be gradually increased to 650 mg q.i.d. as needed and tolerated
Child: PO Sulfate (30% elemental iron) <6 y, 75–225 mg/d in divided doses; 6–12 y, 600
mg/d in divided doses; Fumarate (33% elemental iron) 3 mg/kg t.i.d.; Gluconate (12%
elemental iron) <6 y, 100–300 mg/d in divided doses; 6–12 y, 100–300 mg t.i.d.

Iron Supplement
Adult: PO Sulfate Pregnancy, 300–600 mg/d in divided doses; Fumarate 200 mg
once/d; Gluconate 325–600 mg once/d
Child: PO Fumarate 3 mg/kg once/d; Gluconate <6 y, 100–300 mg/d in divided doses; 6–12
y, 100–300 mg once/d
Infant: PO Fumarate Low birth weight, 2 mg/kg/d up to 15 mg/d;  3 y, 1 mg/kg/d (max: 15
mg/d)

Adverse Effects ( 1%)

GI: Nausea, heartburn, anorexia, constipation, diarrhea, epigastric pain, abdominal distress, black
stools. Special Senses: Yellow-brown discoloration of eyes and teeth (liquid forms.) Large Chronic
Doses in Infants Rickets (due to interference with phosphorus absorption). Massive
Overdosage Lethargy, drowsiness, nausea, vomiting, abdominal pain, diarrhea, local corrosion of stomach
and small intestines, pallor or cyanosis, metabolic acidosis, shock, cardiovascular collapse, convulsions, liver
necrosis, coma, renal failure, death.
NURSING IMPLICATIONS
Assessment & Drug Effects
 Lab tests: Monitor Hgb and reticulocyte values during therapy. Investigate the absence of satisfactory
response after 3 wk of drug treatment.
 Continue iron therapy for 2–3 mo after the hemoglobin level has returned to normal (roughly twice the
period required to normalize hemoglobin concentration).
 Monitor bowel movements as constipation is a common adverse effect.

Patient & Family Education

 Note: Ascorbic acid increases absorption of iron. Consuming citrus fruit or tomato juice with iron
preparation (except the elixir) may increase its absorption.
 Be aware that milk, eggs, or caffeine beverages when taken with the iron preparation may inhibit
absorption.
 Be aware that iron preparations cause dark green or black stools.
 Report constipation or diarrhea to physician; symptoms may be relieved by adjustments in dosage or
diet or by change to another iron preparation.
 Do not breast feed while taking this drug without consulting physician.
 RANITIDINE HYDROCHLORIDE
Zantac, Zantac EFFERdose, Zantac GELdose, Zantac-75
Classifications: GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST)
Indications
Short-term treatment of active duodenal ulcer; maintenance therapy for duodenal ulcer patient after
healing of acute ulcer; treatment of gastroesophageal reflux disease; short-term treatment of active,
benign gastric ulcer; treatment of pathologic GI hypersecretory conditions (e.g., Zollinger-Ellison syndrome,
systemic mastocytosis, and postoperative hypersecretion); heartburn.

Actions
Potent anti-ulcer drug that competitively and reversibly inhibits histamine action at H2-receptor sites on
parietal cells, thus blocking gastric acid secretion. Indirectly reduces pepsin secretion but appears to have
minimal effect on fasting and postprandial serum gastrin concentrations or secretion of gastric intrinsic
factor or mucus.

Contraindications
Hypersensitivity to ranitidine; acute porphyria; OTC administration in children <12 y.

Route & Dosage

Duodenal Ulcer, Gastric Ulcer, Gastroesophageal Reflux

Adult: PO 150 mg b.i.d. or 300 mg h.s. IV 50 mg q6–8h; 150–300 mg/24 h by continuous
 infusion
Child: PO 4–5 mg/kg/d divided q8–12h (max: 6 mg/kg/d or 300 mg/d) IM/IV 2–4 mg/kg/d
divided q6–8h; 0.1–0.125 mg/kg/h by continuous infusion
Infant: PO <2 wk, 2 mg/kg/d divided q12h IV 1.5 mg/kg/d divided q12h or 0.04 mg/kg/h by
continuous infusion

Duodenal Ulcer, Maintenance Therapy

Adult: PO 150 mg h.s.

Pathologic Hypersecretory Conditions

Adult: PO 150 mg b.i.d. up to 6.3 g/d IV 50 mg q6–8h

Heartburn
Adult: PO 75–150 mg b.i.d.

Adverse Effects ( 1%)

CNS: Headache, malaise, dizziness, somnolence, insomnia, vertigo, mental confusion, agitation, depression,
hallucinations in older adults. CV: Bradycardia (with rapid IV push). GI: Constipation, nausea, abdominal
pain, diarrhea. Skin: Rash. Hematologic: Reversible decrease in WBC count, thrombocytopenia. Body as a
Whole: Hypersensitivity reactions, anaphylaxis (rare).

NURSING IMPLICATIONS
Assessment & Drug Effects
 Potential toxicity results from decreased clearance (elimination) and therefore prolonged action; greatest
in the older adult patients or those with hepatic or renal dysfunction.
 Lab tests: Periodic liver functions. Monitor creatinine clearance if renal dysfunction is present or
suspected. When clearance is <50 mL/min, manufacturer recommends reduction of the dose to 150 mg
once q24h with cautious and gradual reduction of the interval to q12h or less, if necessary.
 Be alert for early signs of hepatotoxicity (though low and thought to be a hypersensitivity reaction):
jaundice (dark urine, pruritus, yellow sclera and skin), elevated transaminases (especially ALT) and LDH.
 Long-term therapy may lead to vitamin B12 deficiency.

Patient & Family Education

 Note: Long duration of action provides ulcer pain relief that is maintained through the night as well as
the day.
 Be aware that even if symptomatic relief is provided by ranitidine, this should not be interpreted as
absence of gastric malignancy. Follow-up examinations will be scheduled after therapy is discontinued.
 Adhere to scheduled periodic laboratory checkups during ranitidine treatment.
 Do not supplement therapy with OTC remedies for gastric distress or pain without physician's advice
(e.g., Mylanta II reduces ranitidine absorption).
 Do not smoke; research shows smoking decreases ranitidine efficacy and adversely affects ulcer healing.
 Do not breast feed while taking this drug without consulting physician.
 METRONIDAZOLE 
Flagyl, Flagyl ER, Flagyl IV RTU, Flagyl 375, Metizol, Metric 21, Metro I.V., MetroGel, MetroGel
Vaginal, MetroLotion, Noritate, Protostat
Classifications: ANTIINFECTIVE; ANTITRICHOMONAL; AMEBICIDE; ANTIBIOTIC
Indications
Asymptomatic and symptomatic trichomoniasis in females and males; acute intestinal amebiasis and amebic
liver abscess; preoperative prophylaxis in colorectal surgery, elective hysterectomy or vaginal repair, and
emergency appendectomy. IV metronidazole is used for the treatment of serious infections caused by
susceptible anaerobic bacteria in intraabdominal infections, skin infections, gynecologic infections, septicemia,
and for both pre- and postoperative prophylaxis, bacterial vaginosis. Topical: Rosacea.

Actions
Synthetic compound with direct trichomonacidal and amebicidal activity as well as antibacterial activity
against anaerobic bacteria and some gram-negative bacteria.

Route & Dosage

Trichomoniasis, Giardiasis, Gardnerella
Adult: PO 2 g once or 250 mg t.i.d.; 375 mg b.i.d. or 500 mg b.i.d. for 7 d Vaginal Apply once or
twice daily times 5 d
Child: PO 15 mg/kg/d in 3 divided doses for 7–10 d
Infant: PO 10–30 mg/kg/d for 5–8 d
Amebiasis
Adult: PO 500–750 mg t.i.d.
Child: PO 35–50 mg/kg/d in 3 divided doses
Anaerobic Infections
Adult: PO 7.5 mg/kg q6h (max: 4 g/d) IV Loading Dose 15 mg/kg IV Maintenance Dose 7.5
mg/kg q6h (max: 4 g/d)
Child: PO/IV 30 mg/kg/d divided q6h (max: 4 g/d)
Neonate: PO/IV 7.5–15 mg/kg/d divided q12–48h
Pseudomembranous Colitis
Adult: PO 250–500 mg t.i.d. IV 250–500 mg t.i.d. or q.i.d.
Child: PO 30 mg/kg/d divided q6h times 7 d
Bacterial Vaginosis
Adult: PO (Flagyl ER) 750 mg q.d. times 7 d

Adverse Effects ( 1%)

Body as a Whole: hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains,
overgrowth of Candida. CNS: Vertigo, headache, ataxia, confusion, irritability, depression, restlessness,
weakness, fatigue, drowsiness, insomnia, paresthesias, sensory neuropathy (rare). GI: Nausea, vomiting,
anorexia, epigastric distress, abdominal cramps, diarrhea, constipation, dry mouth, metallic or bitter taste,
proctitis. Urogenital: Polyuria, dysuria, pyuria, incontinence, cystitis, decreased libido, dyspareunia,
 dryness of vagina and vulva, sense of pelvic pressure. Special Senses: Nasal congestion. CV:ECG
changes (flattening of T wave).
NURSING IMPLICATIONS
Assessment & Drug Effects
 Discontinue therapy immediately if symptoms of CNS toxicity (see Appendix F) develop. Monitor
especially for seizures and peripheral neuropathy (e.g., numbness and paresthesia of extremities).
 Lab tests: Obtain total and differential WBC counts before, during, and after therapy, especially if a
second course is necessary.
 Monitor for S&S of sodium retention, especially in patients on corticosteroid therapy or with a history of
CHF.
 Monitor patients on lithium for elevated lithium levels.
 Report appearance of candidiasis or its becoming more prominent with therapy to physician promptly.
 Repeat feces examinations, usually up to 3 mo, to ensure that amebae have been eliminated.

Patient & Family Education

 Adhere closely to the established regimen without schedule interruption or changing the dose.
 Refrain from intercourse during therapy for trichomoniasis unless male partner wears a condom to
prevent reinfection.
 Have sexual partners receive concurrent treatment. Asymptomatic trichomoniasis in the male is a
frequent source of reinfection of the female.
 Do not drink alcohol during therapy; may induce a disulfiram-type reaction (see Appendix F). Avoid
alcohol or alcohol-containing medications for at least 48 h after treatment is completed.
 Urine may appear dark or reddish brown (especially with higher than recommended doses). This appears
to have no clinical significance.
 Report symptoms of candidal overgrowth: Furry tongue, color changes of tongue, glossitis, stomatitis;
vaginitis, curd-like, milky vaginal discharge; proctitis. Treatment with a candidacidal agent may be
indicated.
 Do not breast feed while taking this drug.
 BISACODYL 
(bis-a-koe'dill)
Bisacolax,  Dacodyl, Deficol, Dulcolax,  Theralax
Classifications: GASTROINTESTINAL AGENT; STIMULANT LAXATIVE

Indications
Temporary relief of acute constipation and for evacuation of colon before surgery, proctoscopic,
sigmoidoscopic, and radiologic examinations. Also used to cleanse colon before delivery and to relieve
constipation in patients with spinal cord damage.

Actions
Expands intestinal fluid volume by increasing epithelial permeability.

Contraindications
Acute surgical abdomen, nausea, vomiting, abdominal cramps, intestinal obstruction, fecal impaction; use
of rectal suppository in presence of anal or rectal fissures, ulcerated hemorrhoids, proctitis.

Route & Dosage

 Laxative
Adult: PO 5–15 mg prn (max: 30 mg for special procedures) PR 10 mg prn
Child: PO  6 y, 5–10 mg prn PR  2 y, 10 mg; <2 y, 5 mgAdministration

Adverse Effects ( 1%)

 Systemic effects not reported. Mild cramping, nausea, diarrhea, fluid and electrolyte disturbances
(especially potassium and calcium).

NURSING IMPLICATIONS
Assessment & Drug Effects
 Evaluate periodically patient's need for continued use of drug; bisacodyl usually produces 1 or 2 soft
formed stools daily.
 Monitor patients receiving concomitant anticoagulants. Indiscriminate use of laxatives results in
decreased absorption of vitamin K.

Patient & Family Education

 Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake includes at
least 6–8 glasses/d.
 Do not breast feed while taking this drug without consulting physician.
 MUPIROCIN
Bactroban, Bactroban Nasal
Classifications: ANTIINFECTIVE; PSEUDOMONIC ACID ANTIBIOTIC
Pregnancy Category: B

Inidications
Impetigo due to Staphylococcus aureus, beta-hemolytic Streptococci, and Streptococcus pyogenes; nasal
carriage of S. aureus.

Actions
Topical antibacterial produced by fermentation of Pseudomonas fluorescens.

Contraindications
Hypersensitivity to any of its components and for ophthalmic use.

Route & Dosage

Impetigo
Adult/Child: Topical Apply to affected area t.i.d., if no response in 3–5 d, reevaluate (usually
continue for 1–2 wk)

Elimination of Staphylococcal Nasal Carriage

Child: Intranasal Apply intranasally b.i.d. to q.i.d. for 5–14 dAdministration
Adverse Effects ( 1%)
Skin: Burning, stinging, pain, pruritus, rash, erythema, dry skin, tenderness,
swelling. Special Senses: Intranasal, local stinging, soreness, dry skin, pruritus.

NURSING IMPLICATIONS
Assessment & Drug Effects
 Watch for signs and symptoms of superinfection (see Appendix F). Prolonged or repeated therapy
may result in superinfection by nonsusceptible organisms.
 Reevaluate drug use if patient does not show clinical response within 3–5 d.
 Discontinue the drug and notify physician if signs of contact dermatitis develop or if exudate
production increases.

Patient & Family Education

 Discontinue drug and contact physician if a sensitivity reaction or chemical irritation occurs (e.g.,
increased redness, itching, burning).
 Do not breast feed while taking this drug without consulting physician.
 TRANEXAMIC ACID
Cyclotrax, Dostan, Fibrinon, Hemoclot, Hemostan, Hemostop, Hemotrex, Micranex, Pantrex, Trenaxin
Classifications: HAEMOSTATICS
Pregnancy Category: B

Inidications/Dosage
PO Short-term management of haemorrhage 1-1.5 g 2-4 times/day. Long-term management of
hereditary angioedema 1-1.5 g 2-3 times/day. IV Short-term management of haemorrhage 0.5-1 g 3
times/day

Actions
Tranexamic acid is an antifibrinolytic agent that competitively inhibits breakdown of fibrin clots. It blocks
binding of plasminogen and plasmin to fibrin, thereby preventing haemostatic plug dissolution.

Contraindications
Severe renal failure, active intravascular clotting, thromboembolic disease, colour vision disorders,
subarachnoid bleeding.

Adverse Effects
Diarrhoea, nausea, vomiting, disturbances in colour vision, giddiness, hypotension (after rapid IV inj),
thromboembolic events.
NURSING IMPLICATIONS
 Prepare and administer medication. 
 Monitor for occurrence of adverse effects.
 TETANUS IMMUNE GLUBULIN
BayTet
Classifications: IMMUNE SERUM
Pregnancy Category: C
Inidications/Dosage
Tetanus exposure: adults and children age 7 and older: 250 units IM
Tetanus: adults and children: single doses of 3,000 to 6,000 units IM

Actions
Provides passive immunity to tetanus.

Contraindications
Contraindicated in patients with thrombocytopenia or coagulation disorders.

Adverse Effects
GU: slinght fever, nephritic syndrome; Other: erythema, pain, stiffness at injection site; hypersensitivity
reactions

NURSING IMPLICATIONS
 Be alert for adverse reactions and drug interactions.
 Assess patient’s and family’s knowledge of drug therapy.
  Have epinephrine available to treat hypersensitivity reactions.
 Don’t confuse drug for tetanus toxiod.

Patient & Family Education

 Warn patient of pain and tenderness at injection site.
 TETANUS TOXOID VACCINE
Tetanus Toxoid, Tetanus Toxoid adsorbed
Classifications: VACCINE
Pregnancy Category: C
Inidications/Dosage
Primary Prevention to prevent tetanus: ages ≥ 7 y.o.: 0.5 ml IM. 4-8 weeks apart for two doses; then
give third dose 6-12 months
Booster dose to prevent tetanus: ages ≥ 7 y.o.: 0.5 ml at 10 yr intervals
Postexposure prevention of tetanus

Actions
Promotes immunity to tetanus by inducing antitoxin production.

Contraindications
Hypersensitivity. Febrile illness, other acute infections. Postpone vaccination in patient w/ low immune
response.

Adverse Effects
Local reactions eg redness, swelling & pain w/ local lymphadenopathy. Occasionally granuloma. Local &
systemic hypersensitivity reactions. GI disorders eg vomiting, diarrhoea & loss of appetite. Rarely peripheral
& CNS disorders, including Guillain-Barre syndrome. Thrombocytopenia.
NURSING IMPLICATIONS
  Obtain history of allergies and reaction to immunization
 Determine date of last tetanus immunization
 Keep epinephrine available to treat anaphylaxis
 Don’t confuse drug with tetanus immune globulin

Patient & Family Education

 Advise patient to avoid hot and cold compresses at injection site; this may increase severity of local
reaction
 Instruct patient to report persistent or severe adverse reactions
 Tell patient that nodule at injection site may b present for a few weeks