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Drug Data Generic Name Metoclopramide Trade Name Reglan, Maxolon Dosages 10-15 mg PO up to 4 times/day 30 minutes before each

meal and at bedtime for 2-8 weeks Contents Metoclopramide Availability and color Tablets: 5, 10 mg Oral solution: 1 mg/mL Injection: 5 mg/mL Routes of administration Oral Intramuscular Intravenous

Classification Pharmacologic Class Dopaminergic blocker Therapeutic Class Antiemetic GI stimulant Pregnancy Risk Factor B

Mechanism of Action Stimulates motility of upper GI tract without stimulating gastric, billiary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. Pharmacokinetics D: Crosses placenta; enters breast milk M: Hepatic E: Urine Drug Half Life 5-6 hours

Indication - Relief of symptoms of acute and reccurent diabetic gastroparesis - Short-term therapy for adults with symptomatic GERD who fail to respond to conventional therapy - Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy - Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable - Facilitation of smallbowel intubation when tube does not pass the pylorus with conventional maneuvers - Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic examination of the stomach or small intestine - Unlabeled uses: Improvement of lactation; treatment of nausea and vomiting of a variety of etiologies: hyperemesis gravidarum, gastric ulcer, anorexia nervosa
Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783

Contraindications Concentrations - Allergy to metoclopramide - GI hemorrhage - Mechanical obstruction or perforation - Pheochromocytoma - Epilepsy Precaution - Previously detected breast cancer - Lactation - Pregnancy - Fluid overload - Renal impairment Drug interaction Drug to drug - Decreased absorption of digoxin from the stomach - Increased toxic and immunosuppressive effects of cyclosporine - Increased neuromuscular blocking effect of succinylcholine

Adverse Reaction CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parinsonismlike reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea

Nursing Responsibilities Before - Observe 15 rights in drug administration. - Assess for allergy to metoclopramide. - Assess for other contraindications. - Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). - Have phentolamine readily available in case of hypertensive crisis. During - Monitor BP carefully dring IV administration. - Monitor for extrapyramidal reactions, and consult physician if they occur. - Monitor diabetic patients. - Give direct IV doses slowly over 1-2 minutes. - For IV infusion, give over at least 15 minutes. After - Dispose of used materials properly. - Educate patient about side effects. - Instruct to report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea. - Instruct patient to take drug exactly as prescribed. - Instruct not to use alcohol, sleep remedies or sedatives; serious sedation could occur. - Do proper documentation.

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 783784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 783

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783-784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783-784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 784-785

NAME OF DRUGS Generic name: Ceftriaxone sodium Brand name: Rocephine Dosage: Every 8 hours IV

CLASSIFICATION And ACTION Pharmacologic class: Third-generation cephalosporin Pregnancy risk category B antiinfectives


CONTRAINDICATE D Contraindic ated in patints hypersensiti ve to drug or other cephalospor ins.

ADVERSE REACTIONS CNS: fever, headache, dizziness CV: phlebitis, GI: diarrhea, pseudomembranous colitis GU: genital pruritus, candidiasis Hema: thrombocytosis, eosinophilia, leukopenia Skin: pain, induration, tenderness at injection site, rash, pruritus Other: hypersensitivity reactions, serum sickness, anaphylaxis, chills

NURSING RESPONSIBILITIES Before giving drug, ask patient if he is allergic to penicillins or cephalospor in. Obtain specimen for culture and sensitivity tests before giving first dose.

MONITORING PARAMETERS Monitor PT and INR in patients with impaired vit. K synthesis or low vit. K stores. Vit. K may be needed.

Uncomplicated gonococcal vulvovaginitis UTI; lower respiratory tract, gynecologic, bone or joint, intra-abdominal, skin, or skin structure infection; septicemia Meningitis Perioperative prevention Acute bacterial otitis media Neurologic complications, carditis, and arthritis from penicillin Grefractory Lyme disease

Action: thirdgeneration cephalosporin that inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal.

Drug Data Generic Name: Paracetamol Trade Name: Abenol, acephen, aceta elixir, acetaminophen, anacin, tempra, tylenol Pts Dose: 50 mg IVTT T.I.D. Minimum Dose: 10-15 mg/kg/ dose q4 hrs, prn P.O. Maximum Dose: 650 mgP.O. q4-6hrs or 1 g TID or QID or prn Content: Acetamenophen 500 mg diphenylhydramine citrate 38mg Availability: Caplets,capsule, oral syrup,oral suspension Route of Administration: P.O., IVTT

Classification Non-opioid analgesics and antipyretics

Mechanism of Action A>rapid and complete D>25% protein-bound. Level isnt connected strongly with analgesic effect but is with toxicity M>90-95% metabolized in liver E>in urine Onset: Unknown Peak: 1-3 hrs Duration: 1-3 hrs Half-life: 1-4 hrs Chemical Effect: may produce analgesic effect by blocking pain impulses, by inhibiting prostaglandin or pain receptor sebsitizer. May relieve fever by acting in hypothalamic heat-regulating center. Therapeutic Effect: Relieves pain and reduces fever

Indication General Indication: >mild pain or fever >osteoarthritis Patients Indication: >patient is febrile and also has arthritis

Contraindication Concentration: Contraindicated in patients hypertensive to drug

Adverse Reaction

Nursing Responsibilities Before: >orient self to patient >note significant lab results >note pts drug allergy >Explain therapeutic effects of the drug Calculate dose effectively and accurately During: >use liquid form to children >administer as directed >warn pt to avoid alcoholic intake After: >hypersensitivity reaction caution >management of side effects >evaluate drug effectiveness of the drug

Hematologic Hemolytic anemia, neutropenia, leucopenia, Precaution: pancytopenia, Use cautiously in thrombocytope patients with history of nia chronic alcohol abuse because Hepatic hepatotoxicity may Liver damage occur after the (with toxic therapeutic dose doses), jaundice Drug-drug: Barbiturates, Metabolic carbamazepine,hydan Hypoglycemia toins,isoniazid, rifampin with high Skin dose use of these Rash, urticaria drugs, may reduce therapeutic effects and enhanced hapatotoxic effects. Avoid use together. Drug-food: Caffeine may enhance analgesic effects.

Drug Generic Name Cloxacillin Trade Name

Mechanism of Action


Contraindicati ons

Adverse Reaction

Nursing Responsibilities

Classification Anti-infective, Antibiotic Dosage

150 mg every 6 hours

Routes of administration IVTT ANST (-)

Interferes with cell wall replication of susceptible organisms, the cell wall, rendered osmotically unstable, swell, bursts from osmotic pressure; resists the penicillinase action that inactivates penicillins.

Treatment of infections caused by pneumococci, Group A betahemolytic streptococci, and penicillin G sensitive staphylococci.

History of hypersensitivit y to penicillins and cephallosporin s. Sever pneumonia, emphysema, bacteremia, pericarditis, Prophylaxis: meningitis and Staphylococcal purulent and infection during septic arthritis major during the cardiovascular and acute the orthopedic stage. Subsurgery. conjunctival infections.

EENT: occasionally, laryngeal edema, Skin: urticaria, skin rashes, exfoliative dermatitis, rash

1.) Perform skin testing before giving the medication. RATIONALE: To prevent anaphylactic shock when administered. 2.) Administer drug slowly to the IV line RATIONALE: The drug is very irritating to the tissue and blood vessels. Injecting slowly the drug prevents phlebitis

GI: GI disturbances, nausea, vomiting, 3.) Explain to the patient that antibiotic therapy lasts epigastric distress, for 7 days will take the drug without any miss. diarrhea and flatulence, antibiotic- RATIONALE: Taking the drug for 7 days helps to kill the bacteria and growth. associated pseudomembranous 4.) Make sure that the patient takes the drug at the same time of the day. And also to prevent them colitis
being drug resistant.

GU: interstitial RATIONALE: To prevent growth of bacteria and to nephritis and vasculitis continue the efficacy of the drug.
5.) Provide rest and comfort. Hematologic: eosinophilia, RATIONALE: the drug may cause dizziness which is a agranulocytosis, normal side effect of the drug. anemia, 6.) Assess for any signs of hypersensitivity reaction thrombocytopenia, such as purpura, rash, urticaria, exfoliative transient rise in dermatitis, itching transminases and RATIONALE: to discontinue the therapy and alkaline phophatase immediately call the physician for an antidotE

Other: hypersensitivity reactions, serum sickness-like reactions, fever

Domperidon e (Motillium) 1 tab TID

Antidopaminergic Antiemetic
acts as a gastrointestinal emptying (delayed) adjunct and peristaltic stimulant gastroprokinetic properties of domperidone are related to its peripheral dopamine receptor blocking properties facilitates gastric emptying and decreases small bowel transit time by increasing esophageal and gastric peristalsis and by lowering esophageal sphincter pressure antiemetic properties are related to its dopamine receptor blocking activity at both the chemoreceptor trigger zone and at the gastric level. It has strong affinities for the D2 and D3

Symptomatic management of upper gastrointestinal motility disorders associated with chronic and subacute gastritis and diabetic gastroparesis. May also be used to prevent gastrointestinal symptoms associated with the use of dopamine agonist antiparkinsonian agents.

Contraindicated in patients with known sensitivity or intolerance to the drug. Domperidone should not be used whenever gastrointestinal stimulation might be dangerous, i.e., gastrointestinal hemorrhage, mechanical obstruction or perforation. Also contraindicated in patients with a prolactinreleasing pituitary tumor (prolactinoma).

Serum prolactin level may increase resulting in galactorrhoea in females (increasing of milk production, probably by increasing prolactin production by the pituitary gland) & less frequently gynaecomastia in males. CNS: dry mouth (1.9%), headache/migraine (1.2%), insomnia, nervousness, dizziness, thirst, lethargy, irritability (all<1%). Gastrointestinal (2.4%): abdominal cramps, diarrhea, regurgitation, changes in appetite, nausea, heartburn, constipation (all<1%). Endocrinological (1.3%): hot flushes, mastalgia, galactorrhea, gynecomastia, menstrual irregularities. Mucocutaneous (1.1%): rash, pruritus, urticaria, stomatitis, conjunctivitis. Urinary (0.8%): urinary frequency, dysuria. Cardiovascular (0.5%):

Teaching points: Proper dosing: Missed dose: Take as soon as possible; not taking if almost time for next scheduled dose; not doubling doses. Obtaining medical attention if fainting, dizziness, irregular heartbeat or pulse, or other unusual symptoms occur.

dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which - among others - regulates nausea and vomiting

edema, palpitations. Musculoskeletal (0.1%): leg cramps, asthenia. Miscellaneous (0.1%): drug intolerance. Laboratory parameters: elevated serum prolactin, elevation of AST, ALT and cholesterol (all<1%). Extrapyramidal phenomena are rare in adults; they reverse spontaneously as soon as treatment is stopped. When the blood-brain barrier is immature (as in infants) or impaired, the possible occurrence of neurological side effects cannot be excluded.









NURSING IMPLICATIONS RESPONSIBILITIES 1. Administer medication via IVTT. 2. Position client in high fowlers upon administration of medication to prevent aspiration. 3. Check the placement of NGT. 4. Assess and ask client or SO about previous allergic reactions to penicillins. 5. Monitor for any adverse reactions. 6. Ensure right amount of dose is given.

July 22, 2012

Piperacillin sodium and tazobactam sodium

Penicillin Antibiotic

4.45gm IVTT q 8

Piperacillin inhibits cell wall synthesis during microorganism multiplication; tazobactam increases piperacillin effectiveness by inactivating beta-lactamase which destroys penicillins.

Moderate to severe nosocomial pneumonia caused by piperacillinresistant.

Patients hypersensitive to the drug or other penicillin. Use cautiously in patients with other drug allergies, especially to cephalosporin and in those with bleeding tendencies, uremia or hypokalemia.

CNS: pain, headache, insomnia, agitation, fever, dizziness, anxiety. CV: hypertension, tachycardia, chest pain, edema GI: diarrhea, nausea, constipation, vomiting, dyspepsia, stool changes, abdominal pain. Hematologic: thrombocytopenia Respiratory: dyspnea