DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism

Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Paracetamol, Acetaminophen B: Biogesic, Panadol, Tylenol C: Non-narcotic analgesic, Antipyretic

300 mg IVTT then q 4 hrs PRN for T= 38 degrees celsius

Inhibits the synthesis of prostaglandin that serves as mediators of pain and fever, primarily in the CNS. Analgesia

Mild pain and fever.

Hypersensitivity, renal insufficiency, anemia.

GI: hepatic failure, hepatotoxicity (overdose) GU: renal failure Hemat: neutropenia, pancytopenia, leucopenia Derm: rash, urticaria

Assess overall health status and alcohol before administering. Assess amount, frequency, and type of drugs taken in patients selfmedicating, especially with OTC drugs. Pain: Assess type, location, intensity prior to and 30-60 min following administration. Fever: Assess fever, note presence of associated signs (diaphoresis, tachycardia, and malaise). Report nausea and vomiting, cyanosis, SOB, and abdominal pain as these are signs of toxicity.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G:Piperacillin / Tazobactam B: Zosyn C: Anti-infective

4.5 gm IVTT q 8 hrs ANST (-)

Piperacillin : Binds to bacterial cell wall membrane, causing cell death. Spectrum is extended compared with other penicillins Tazobactam : Inhibits beta-lactamase, an enzyme that can destroy penicillins

Treatment of moderate to severe appendicitis, uncomplicated and complicated skin and skin structure infections.

Hypersensitivity to penicillins, cephalosphorins, or other drugs. Safety in children< 12 years old, pregnancy, lactation.

CNS: headache, insomnia, fever GI: diarrhea, nausea, constipation, vomiting SKIN: Hypersensitivity reactions ,rash, pruritus

Obtain history of hypersensitivity to penicillins, cephalosporins, or other drugs prior to administration. Lab tests : C&S prior to first dose of the drug; start drug pending results. Periodic CBC with differential, platelet count, Hgb and Hct, and serum electrolytes.

Monitor for hypersensitivity response; discontinue drug and notify physician if allergic response noted.

Lab tests: Periodic

CBC with differential, platelet count, Hgb and Hct, and serum

electrolytes. Monitor for hemorrhagic manifestations because high doses may induce coagulation abnormalities.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G:Omeprazole B: Omepron C: Anti-ulcer agent Proton pump inhibitor

40 mg IV OD

Suppresses gastric secretion by inhibiting hydrogen/potassium ATP as enzyme system in the gastric parietal cell: characterize as a gastric acid pump inhibitor, since it block the final step of acid production

Short term treatment of active duodenal ulcer, gastroesophageal reflux disease (GERD), including erosive esophagitis and symptomatic GERD. Long term treatment of pathologic hypersecretory condition: to maintain healing of erosive esophagitis. Short term treatment of active benign gastric ulcer

hypersensitivity pregnancy lactation and children Combination therapy with clarithromicin should not be used in patients with hepatic impairment

CNS : Headache, dizziness, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic : Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI : Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory : URI symptoms, cough, epistaxis Other : Cancer in preclinical studies, back pain, fever

Assess other medications patient maybe taking for effectiveness and interaction. Monitor therapeutic effectiveness and adverse reaction at the beginning of therapy and periodically throughout the therapy. Assess GI system: bowel sounds 8 hrly, abdomen for pain and swelling, appetite loss. Monitor hepatic enzymes. Assess knowledge/teach appropriate use of this medication, interventions to reduce side effects ,and other symptoms to report.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Metronidazole B: Protostat C:Anti-infective, antibiotic, amoebiside

500mg IV q 8 hrs ANST (-) Hinders growth of selected organism including most anaerobic and protozoans.

>amebic hepatic abscess >intestinal amebiasis >trichomoniasis >retractory trichomoniasis >bacterial infection caused by anaerobic microorganisms >to prevent post operative infection incontaminated colorectal surgery >pelvic inflammatory disease

Breast-feeding, hypersensitivity to metronidazole or its components, trichomoniasis during first trimester of pregnancy.

CNS: Ataxia, dizziness, encephalopathy, fever ,headache, lightheadedness, peripheral neuropathy, seizures (highdoses) EENT: Dry mouth, lacrimation (topical form),metallic taste, pharyngitis GI: Abdominal cramps or pain, anorexia, diarrhea, nausea, pancreatitis, vomiting GU: Darkened urine, vaginal candidiasis (oral, parenteral, and topical forms); burning or irritation of sexual partners, dysuria, urinary frequency,

If pt has adverse CNS reactions, such as seizures or peripheral neuropathy, tell prescriber and stop drug immediately. Monitor pt with severe liver disease because slowed metronidazole metabolism may cause drug to accumulate in the body and increase the risk of adverse effects. If skin irritation occurs, apply topical gel less frequently or discontinue it, as ordered. Monitor CBC and culture and sensitivity test if therapy lasts longer than10 days or if second course of treatment Is needed Give IV drug by

slow infusion over 1 hr; dont give by direct IN injection.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Bisacodyl B: Dulcolax C: Gastrointestinal agent / Laxative

2 suppository

Expands intestinal fluid volume by increasing epithelial permeability. Induces peristaltic contractions by direct stimulation of sensory nerve endings in the colonic wall.

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.

Ileus, intestinal obstruction, acute surgical abdominal conditions; severedehydration. Appendicitis & acute inflammatory bowel diseases.

Rarely, abdominal discomfort & diarrhoea.

Evaluate periodically patients 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 absor ption of vitamin K. Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake includes at least 68 glasses/d.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Methylprednisolone B: Medrol C: Corticosteroid (Antiinflammatory) Glucocorticoid Hormone

8 mg 1 tab

Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions that are responsible for its antiinflammatory and immunosuppressive effects.

Hypercalcemia associated with cancer Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (eg, SLE), dermatologic diseases and autoimmune disorders.

Contraindicated with infections, especially tuberculosis, fungal infections:lactation; allergy to tartrazine Use cautiously with kidney or liver disease, hypothyroidism, ulcerative colitisr, inflammatory bowel disease, CHF, hypertension, osteoporosis, seizure disorders, diabetes mellitus, pregnancy.

CNS: Vertigo, headache, paresthesias, insomnia, seizures, CV:Hypot ension, shock, hypertension and CHF secondary to fluid retention, thrombophlebitis, Electrolyte imbalance: Na+ and fluid retention, hypokalemia,hypocalcemia Endocrine: Amenorrhea, irregular menses, growth retardation, decreased carbohydrate tolerance, diabetes mellitus, GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain Musculoskeletal: Muscle weakness, steroid, loss of muscle mass, osteoporosis Other: Immunosuppression;

History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, diverticulitis, active or latent peptic ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure disorders, diabetes mellitus; pregnancy; lactation Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion prominence of superficial veins, R and adventitious sounds, serum electrolytes, blood glucose. Give daily dose before 9 AM to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Tramadol B: Ultram C: Analgesic

50 mg IV q 8 hrs PRN for Binds to mu-opioid pain receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. Decreased pain.

Moderate to moderately severe pain.

Hypersensitivity; pregnancy and lactation; renal impairment; history of epilepsy because they are at risk of seizure.

CNS: Seizure, dizziness, headache EENT: Visual disturbances CV: Vasodilation GI: Constipation, nausea, abdominal pain GU: urinary frequency Germ: Pruritus, swelling Misc: physical dependence, tolerance.

Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms.

Prolonged use may lead to physical and psychological dependence and tolerance, Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: NaHCO3 (Sodium Bicarbonate) B: Sodium Bicarbonate C: Antacid

1 tab BID

Acts as an alkalinizing agent by releasing bicarbonate ions. Neutralization of gastric acid.

Treatment of metabolic acidosis, promotion of gastric, systemic and urine alkalinization in the case of intoxication with weak organic acids.

Metabolic or respiratory alkalosis; hypocalcemia; CHF; renal insufficiency.

CNS: tetany CV: edema GI: gastric distention, flatulence Metabolic: hypokalemia, hyponatremia

Obtain patient history including drug history and hypersensitivity.

Assess respiratory and pulse rate, rhythm, depth, lung sounds and notify the physician. Assess for carbon dioxide in GI tract, may lead to perforation if ulcer is severe. Test and monitor urine pH, urinary output, during beginning treatment. If patient has edematous tendency, notify physician. If patient is vomiting with hold medication and immediately inform the physician. If the patient exhibits shortness of breath and hyper apnea, immediately inform the physician. Inform physician if relief is not obtained or if the patient demonstrate any symptom suggest bleeding,

such as black tarry stools or coffee ground emesis. Caution patient to immediately report to physician if symptoms such as nausea, vomiting and anorexia occurs. Advise the patient to notify the physician if indigestion occurs.

DRUG STUDY BRAND NAME GENERIC NAME CLASSIFICATION Prescribed and Recommended dosage, frequency, route of administration Mechanism Of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

G: Colchicine B: Colcrys C: Antigout agent

0.5 mg 1 tab

Interferes with the functions of WBCs initiating and perpetuating the inflammatory response to monosodium urate crystals. Decrease pain and inflammation in acute attacks of gout.

Acute attacks of gouty arthritis. Treatment of hepatic cirrhosis and familial.

Serious GI, renal, hepatic, or cardiac disorders; blood dyscrasias; hypersensitivity to the drug.

GI: Diarrhea, nausea and vomiting, abdominal pain. GU: Anuria, hematuria Hemat: Aggranulocytosis, anemia

Assess patient for toxicity (weakness, abdominal discomfort, nausea, vomiting, difficulty swallowing) withhold drug and report symptoms immediately. Assess involved joints for pain, mobility, and edema throughout therapy. Monitor intake and output ratios. Fluids should be encouraged to promote urinary output of at least 2000 mL/day. Check CBC periodically in patients undergoing longterm therapy. Administer with great caution to debilitated patients and to those with early manifestations of GI or cardiac disorders.

SUMMARY OF MEDICATION

DATE

MEDICATIONS- dosage, frequency, route

Remarks

November 22, 2012

Paracetamol 300 mg IVTT then q 4 hrs PRN for T= 38 degrees Celsius Piperacillin, Tazobactam 4.5 gm IVTT q 8 hrs ANST (-) Omeprazole 40 mg IV OD Metronidazole 500 mg IV q 8 hrs ANST (-)

Given, tolerated and recorded Given, tolerated and recorded Given, tolerated and recorded Given, tolerated and recorded

November 23, 2012 November 25, 2012

Dulcolax 2 suppositories

Given, tolerated and recorded

Colchicine 0.5 mg 1 tab Medrol 8 mg 1 tab Tramadol 50 mg IV q 8 hrs PRN for pain

Given, taken, tolerated and recorded Given, taken, tolerated and recorded Given, tolerated and recorded

November 26, 2012

NaHCO3 (Sodium Bicarbonate) 1 tab BID

Given, taken, tolerated and recorded