7/23/10

CEFUROXIME
Cefuroxime - cephalosporins-2nd generation

Classification:
Therapeutic: anti-infectives
Pharmacologic: 2nd generation cephalosporin’s
Pregnancy category B

Doctor’s Order: 1.5 gm IV 1hr prior to OR (-) ANST

Indications:
Treatment of the following infections caused by susceptible organisms: respiratory tract
infections, skin and skin structure infections, bone and joint infections, urinary tract
infections. Otitis media, meningitis gynecologic infections, and lyme disease.

Action:
Bind the bacterial cell wall membrane, causing cell death.
Therapeutic effects: bactericidal action against susceptible bacteria.
Spectrum: similar to 1st generation cephalosporin but have increase activity
against several others gram- negative pathogens.
Cefuroxime: active against borelia burgdorferi.

Contraindication:
Contraindicated in hypersensitivity to cephalosporins; serious hypersensitivity to
penicillin’s. Use cautiously in: renal impairment (decrease dose/ increase dosing interval
recommended for: cefuroxime if CCr < 20ml/min)

Side-effects:
- diarrhea - bleeding
- nausea - pain at IM site
- vomiting - super infection
- rashes

Nursing implication:
- Assess for infection (vital signs, appearance of wound, sputum, urine, and stool;
WBC) at the beginning and during the therapy.
- Before initiating the therapy, obtain a history to determine the previous use of and
reaction to penicillin’s or cephalosporins. Persons with a negative history of
penicillin sensitivity may still have an allergic response.
- Obtain specimen for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
- Observe s/s of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). If those
occur stop the medication and notify physician or other health care provider
immediately.
Patient teaching:
- Instruct patient to take medication around the clock at evenly spaced times and to
finish the medication completely, and if feeling better. Take missed dose as soon
as possible unless almost time for the next dose, do not double doses. Advise
patient that sharing of this medication may be dangerous.
- Advise pt. to report s/s of super infection and allergy.

7/24/2010
RANITIDINE

Classification:
Therapeutic: anti-ulcer agents
Pharmacologic: Histamine H2 antagonists
Pregnancy Category: B

Doctor’s order: 50mg IV at 6 am

Indication:
Short term treatment of active duodenal ulcers and benign gastric ulcers.
Maintenance therapy for duodenal and gastric ulcers after healing of active ulcers.
Treatment of heart burn, acid indigestion, and sour stomach.

ACTION:
Inhibits the action of histamine at h2 receptors site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid secretion.
THERAPEUTIC EFFECTS: healing and prevention of ulcers.
Decrease symptoms of gastroesophageal reflux.
Decrease secretions of gastric acid

CONTRAINDICATIONS:
Contraindicated in: some products contains alcohol and should be avoided in patients
with known intolerance -
-some products aspartame and should be avoided in patient with PKU.

SIDE EFFECTS:
- Confusion -neutropenia
- Dizziness -pain at IM site
- Drowsiness -hypersensivity reactions,vasculitis
- Hallucination
- Diarrhea
- Nausea
- Gynecomastia
- Anemia
NURSING IMPLICATION:
 - assess for abdominal and epigastric pain
- LAB TEST CONSIDERATION: monitor CBC w/ differential periodically
during therapy.
- May cause false negative results in skin test using allergenic extracts.

PATIENT/FAMILY TEACHING
- instruct patient to take medication as directed for the full course of therapy, even if
feeling better.
- advise patients taking OTC preparations not to take the maximum dose
continuously for more than two weeks with out consulting health care professional.
- may cause drowsiness or dizziness.
- inform patient that increased fluid and fiber intake and exercise may minimize
constipation.

HYDROXYZINE

CLASIFICATION
Therapeutic: anti anxiety agents, anti histamine, sedatives, hypnotics
Pregnancy category: C

Doctors order: 50 mg deep IM

INDICATION:
- treatment of anxiety
- preoperative sedation
- anti emetic
- antipruritic
- May combine with opiod analgesics.

ACTION:
- acts as CNS depressants at subcortical level of CNS. Have anticholinergic,
antihistaminic and antiemetic properties. Blocks histamine 1 receptors.
- Therapeutic effects: sedation, relief anxiety, decreased nausea and vomiting.

CONTRAINDICATIONS:
-contraindicated in: hypersensitivity;
-use cautiously in: severe hepatic dysfunction.
-geriatric patients are more susceptible to adverse reactions due to anticholinergic
effects.

SIDE EFFECTS:
- drowsiness
- dizziness
- agitation
- headache
 - weakness
- dry mouth
- bitter taste
- constipation
- nausea

NURSING IPMPLICATION:
- assess patient for profound sedation and provide safety precautions as
indicated( side rails up, bed in low position, call bell with in reach)
- Anxiety (assess mental status) orientation, mood and behavior.
- Assess degree of nausea and frequency and amount of emesis.
- May cause false negative results in skin test using allergenic extracts.

PATIENT/FAMILY TEACHING
- instruct patient to take medication as directed for the full course of therapy
- may cause dizziness or drowsiness. Caution patient to avoid driving and
other activities requiring alertness. Advise patient to avoid concurrent use of
alcohol or other CNS depressants with this medication.
- Teach other methods to decrease anxiety, such as, increase exercise, support
groups, and relaxation techniques.

July 25, 2010

Ketorolac tromethamine

CLASSIFICATION
NSAID

DOCTOR’S ORDER
Ketorolac 30mg IV q 8°

INDICATION
Short term management of moderately severe, acute pain.

ACTION
May inhibit prostaglandin synthesis, to produce anti-inflammatory, analgesic, and
antipyretic effect

CONTRAINDICATION
- Contraindicated in clients hypersensitive to drug and in those with active
PUD, or any bleeding problem or at risk of bleeding.
- Contraindicated as prophylactic analgesic before major surgery or
intraoperatively when hemostasis is critical; and in patients currently
receiving aspirin.
-
SIDE EFFECTS
- CNS: headache, dizziness, drowsiness
- GI: GI pain, nausea, constipation, flatulence

NURSING IMPLICATION
- Provide safety of the patient
- Give ice chips
- Encourage high fiber diet
- Encourage ambulation
- Increase fluid intake
- Correct hypovolemia before giving
- Serious GI toxicity, including peptic ulcer and bleeding
Perform skin testing prior to drug administration

PATIENT TEACHING
- Instruct patient on how and when to ask for pain medication
- Instruct patient to take medication exactly as directed
- Do not double doses.
- Do not take more than prescribed or for longer than five days
- May cause dizziness or drowsiness. Caution patient to avoid driving and
other activities requiring alertness. Advise patient to avoid concurrent use of
alcohol or other CNS depressants with this medication.

Tramadol hydrochloride

CLASSIFICATION
Opioid analgesic

DOCTOR’S ORDER
50mg IV every 8 hours x 3 doses

INDICATION
Moderate to moderately severe pain

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

CONTRAINDICATION
Contraindicated in clients hypersensitive to drug or other opioid.
Use cautiously in patients at risk for seizures or respiratory depression; in patient
with increased ICP or head injury.
SIDE EFFECTS
- CNS: dizziness, headache
- GI: constipation, nausea, vomiting, abdominal pain, flatulence
Skin: diaphoresis

NURSING IMPLICATION
- Provide safety of the patient
- Encourage high fiber diet
- Frequent light feeding
- Give ice chips
- Increase fluid intake
- Encourage ambulation
- Reassess patients level of pain at least 30 minutes after administration
- Monitor CV and respiratory status
- For better effect, give drug before onset of intense pain
Withdrawal symptoms may occur if drug is topped abruptly. Taper dosage.

PATIENT TEACHING
- May cause dizziness or drowsiness. Caution patient to avoid driving and
other activities requiring alertness. Advise patient to avoid concurrent use of
alcohol or other CNS depressants with this medication.
- Advise patient to change position slowly to minimize orthostatic hypotension.
- Encourage patient to turn and breath deeply and cough every 2 hours to
prevent atelectasis.

FAMOTIDINE

CLASSIFICATION
Antiulcer agient

DOCTOR’S ORDER
20mg every 12 hours x 2 doses

INDICATION
- Decrease gastric acid secretion
- Prevention of acid inactivation of supplemental pancreatic enzyme

ACTION
Inhibits the action of histamine at the H2-receptor site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid secretion.

CONTRAINDICATION
- Hypersensitivity
- Some products contain alcohol and should be avoided in patients with no
tolerance.
 - Use cautiously in patient with renal impairment

SIDE EFFECTS
GI: constipation, diarrhea, drug induced hepatitis
NURSING IMPLICATION
- - assess for abdominal and epigastric pain
- LAB TEST CONSIDERATION: monitor CBC w/ differential periodically
during therapy.
- May cause false negative results in skin test using allergenic extracts.

PATIENT TEACHING
- instruct patient to take medication as directed for the full course of therapy, even
if feeling better.
- advise patients taking OTC preparations not to take the maximum dose
continuously for more than two weeks with out consulting health care professional.
- may cause drowsiness or dizziness.
- inform patient that increased fluid and fiber intake and exercise may minimize
constipation.