DRUG STUDY

Generic name: Ceftiaxone

Brand name: Rocephine
Classification: Third- generation cephalosporin
Mode of Action: Interferes with bacterial cell wall synthesis by inhibiting cross-linking
of peptidoglycan strands. Peptidoglycan makes the cell membrane rigid and
protective. Without it, bacterial cells rupture and die. Active against gram-negative
and gram-positive bacteria, with expanded activity against gram-negative bacteria.
Exhibits minimal immunosuppressant activity.
Dose: -Infections of respiratory system, bones, joints, and skin; septicemia
Adults: 1 to 2g/day IM or IV or in equally divided doses
-Uncomplicated gonorrhea
Adults: 250 mg IM as single dose
-Surgical prophylaxis
Adults: 1g IV as single dose whining 1 hour before start of surgical procedure
-Meningitis
Adults: Initially 1g to 2g iv q 12 hours for 10 to 14 days
Children: 100mg/kg/day IM or IV. Then 100mg/kg/day IM or IV once daily or in
Equally divided doses q 12 hours
-Otitis media
 Children: 50 mg/kg IM as a single dose; maximum of 1g/dose
-Skin and skin-structure infections
Children: 50 to 70mg/kg/day IV or IM or twice daily. Maximum dosage is 2g
daily.
-Other serious infections
Children: 50 to 75mg/kg/day IV or IM
Drug indication/s: Infections of the respiratory system, bones, joints, skin,
septicemia, meningitis, acute bacterial otitis media, chancroid, uncomplicated
gonorrhea, gonococcal conjunctivitis, disseminated gonococcal infection and pelvic
inflammatory disease, gonococcal meningitis, endocarditis, and surgical prophylaxis.
Contraindications: Calcium- containing IV solutions, hyperbilirubinemic neonates,
hypersensitivity to ceftriaxone and other cephalosporins and neonates who are 28
days old or less if they are expected to need calcium.
Side effects: rash, diarrhea, nausea, vomiting, upset stomach, blood clots, dizziness,
headache, pain or swelling in the tongue, lump in injection site, sweating, vaginal
yeast injection, vaginal itching or discharge, anemia, change in taste and flushing
Adverse effects: Chills, fever hypertonia, hyperactivity, seizures, edema, glossitis,
hearing loss, stomatitis, abdominal cramps, cholestasis, elevated liver function test
results, gallbladder dysfunction, hepatic failure, hepatomegaly, oral candidiasis,
pancreatitis, pseudolithiasis, pseudomembranous colitis, elevated BUN level,
nephrotoxicity, oliguria, renal failure, aplastic anemia, eosinophilia, hemolytic anemia,
hemorrhage, hypoprothrombinemia, neutropenia, thrombocytopenia, unusual
bleeding, arthralgia, allergic dermatitis, ecchymosis, erythema, erythema multiforme,
pruritus, steven-Johnson syndrome, toxic epidermal necrolysis, urticaria and
superinfections.
Drug interaction/s: Aminoglycosides, loop diuretics, increased risk of nephrotoxicity.
Nursing responsibilities:
1. Monitor for extreme confusion, tonic-clonic seizures, and mild hemiparesis
when giving high doses.
2. Monitor coagulation studies.
3. Assess CBC and kidney and liver function test results
4. Monitor for signs and symptoms of superinfection and other serious adverse
reactions.
 5. Assess patient’s bowel pattern daily, severe diarrhea may indicate
pseudomembranous colitis.
6. Caution patient not to use herbs unless prescriber approves.
7. Monitor BUN and serum creatinine levels to detect early signs of
nephrotoxicity.
8. Monitor fluid intake and output; decreased urine output may indicate
nephrotoxicity.
9. Monitor patient for allergic reactions a few days after therapy starts.
10. Assess patient for pharyngitis, ecchymosis, bleeding and arthralgia; may
indicate a blood dyscrasia.
References:

Aw-Abdi, I. (2019). 2020 Nurse's Drug Handbook (18th ed.). Jones & Bartlett

Learning.

Schull, P. (2013). McGraw-Hill nurses drug handbook (7th ed.). Mcgraw-hill.

Generic name: Dexamethasone
Brand name: Decadron
Classification: Anti- inflammatory and immunosuppressant
Mode of Action: Unclear. Reduces inflammation by suppressing polymorphonuclear
leukocyte migration, reversing increased capillary permeability, and stabilizing
leukocyte lysosomal membranes. Also suppresses immune response (by reducing
lymphatic activity), stimulates bone marrow, and promotes protein, fat, and
carbohydrate metabolism.
Dose: -Macular edema following branch retinal vein occlusion or central retinal vein
Occlusion; noninfectious uveitis affecting posterior segment of eye.
Adults: 0.7mg by intravitreal implant
-Allergic and inflammatory conditions
Adults: 0.75 to 9mg/day. PO as single dose or in divided doses.
-Cerebral edema
Adults: Initially, 10mg IV follower by 4mg IM. Then reduce dosage gradually
over
5 to 7 days.
-Suppression test for Cushing’s syndrome
Adults: 1mg PO or 0.5mg PO

Drug indication/s: Acute altitude sickness, bacterial meningitis, bronchopulmonary

dysplasia in preterm infants, hirsutism, suppression test for detection, diagnosis,
management of depression, cerebral edema, allergies, inflammations, macular
edema, and noninfectious uveitis.
Contraindications: Hypersensitivity to drug, benzyl alcohol, bisulfites, EDTA,
creatinine, polysorbate 80, methylparaben, systemic fungal infections, active or
suspected ocular or periocular infections and advanced glaucoma (intravitreal
implant.
Side effects: Stomach upset, headache, dizziness, menstrual changes, trouble
sleeping, increased appetite and weight gain.
Adverse effects: Malaise, vertigo, psychiatric disturbances, increased intracranial
pressure, seizures, hypotension, thrombophlebitis, myocardial infarction,
thromboembolism, cataracts, elevated intraocular pressure, conjunctival hemorrhage,
abdominal distention, dry mouth, anorexia, peptic ulcer, bowel perforation,
pancreatitis, ulcerative esophagitis, decreased carbohydrate tolerance,
hyperglycemia, cushingoid appearance, decreased growth (children), latent diabetes
mellitus, sodium and fluid retention, negative nitrogen balance, adrenal suppression,
hypokalemic alkalosis, muscle wasting, muscle pain, osteoporosis, aseptic joint
necrosis, tendon rupture, long bone fractures, diaphoresis, angioedema, erythema,
rash pruritis, urticaria, contact dermatitis, acne, decreased wound healing, bruising,
skin fragility, petechiae, facial edema, weight gain or loss, increased susceptibility to
infection and hypersensitivity reactions.
Drug interaction/s: Barbiturates, phenytoin rifampin, digoxin, ephedrine, estrogen,
fluroquinolones, itraconazole, ketoconazole, live-virus vaccines, loop and thiazide
diuretics, and nonsteroidal anti-inflammatory drugs.
Nursing responsibilities:
1. Instruct patient to immediately report sudden weight gain, swelling of face or
limbs, excessive nervousness or sleep disturbances, excessive body hair
growth, vision changes, difficulty breathing, muscle weakness, persistent
abdominal pain or change in stool color.
2. Instruct patient to take oral drug with meals or after meals to prevent GI
distress.
3. Advise patient to report vision changes and if eye becomes red, sensitive to
light, or painful after intravitreal implant.
4. Inform patient that this drug can make them more susceptible to infection.
5. Advice patient to avoid crowds and exposure to illness to avoid infections.
6. Monitor blood glucose level closely in diabetic patients receiving drug orally.
7. Monitor hemoglobin and potassium levels.
8. Assess for occult blood loss.
9. Monitor neonate for signs of hypoadrenocorticism if mother received
dexamethasone during pregnancy. Be aware that some preparations contain
benzyl alcohol, which may cause fatal toxic syndrome in neonates and
immature infants.
10. Monitor fluid intake and output, daily weight and watch for crackles, dyspnea,
peripheral edema, and steady weight gain.
References:

Aw-Abdi, I. (2019). 2020 Nurse's Drug Handbook (18th ed.). Jones & Bartlett

Learning.

Schull, P. (2013). McGraw-Hill nurses drug handbook (7th ed.). Mcgraw-hill.