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

INDICATIONS

CONTRAINDICATE D Contraindicat ed in patints hypersensitiv e to drug or other cephalospori ns.

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 cephalospori n. 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, intraabdominal, 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 cell-wall synthesis, promoting osmotic instability; usually bactericidal.

Drug Data Generic Name: Paracetamol Trade Name: Abenol, acephen, aceta elixir, acetaminophen, anacin, tempra, tylenol

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

Indication

Contraindicati ons

Adverse Reaction

Nursing Responsibilities

Avastoph
Classification Anti-infective, Antibiotic

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

DRUG
Domperidon e (Motillium)

ACTION
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

INDICATION/S
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.

CONTRAINDICATIONS
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).

ADVERSE EFECTS
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%):

NURSING RESPONSIBILITIES
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.

GENERIC NAME (BRAND NAME)

CLASSIFICATI ON

DOSAGE

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIO NS

SIDE EFFECTS/ ADVERSE EFFECTS

NURSING IMPLICATIONS RESPONSIBILITIES 1. Administer medication via IVTT.

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

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.

Drug Name
Generic name: Meropenem Brand name: Merrem

Classification

Indications & Dosage

Indications: For serious infections caused by gram-positive or gram-negative organisms

Contraindications

Adverse Effect

Nursing Responsibilities

Belongs to the class of carbapenem s. Used in the systemic treatment of infections.

Contraindications: Hypersensitivit y to meropenem or imipenem

Diarrhoea, nausea, vomiting, abdominal pain; headache; constipation; rash, pruritus, uticaria; apnoea; phlebitis, thrombophlebitis, swelling and pain at inj site; disturbances in LFTs (may cause increases in serum transaminases, alkaline phosphatase, lactic dehydrogenase). Rarely: erythema multiforme; eosinophilia, thrombocytopenia, leucopenia, neutropenia; seizures and CNS effects reported in patients with underlying CNS disorders or renal impairment.

Assess patient for previous sensitivity reaction to carbapenems Assess patient for signs and symptoms of infection, including characteristics of wounds, sputum, urine, stool Complete C/S tests before beginning drug therapy Assess for allergic reactions, anaphylaxis Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding

Precautions: Pregnancy, lactation, renal disease, elderly

Potentially Fatal: Anaphylaxis; pseudomembranous colitis; Stevens-Johnsons sydrome.

Drug Tramadol HCl 37.5 mg, paracetamol 325 mg Brand name: Dolcet

Classificatiion Analgesic Indication: Moderate to severe pain. Contraindications: Acute intoxication w/ alcohol, hypnotics, narcotics, centrally-acting analgesics, opioids or psychotropic drugs. Hypersensitivity.

Mechanism Of Action Tramadol binds to opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain.

Side Effects Dizziness or vertigo Nausea and Vomiting Constipation Headache Somnolence Pruritus CNS Stimulation Asthenia Diaphoresis Dyspepsia Dry mouth Diarrhea Malaise Vasodilation Anorexia Flatulence Rash Visual disturbance Urinary retention or frequency Menopausal symptoms

Adverse Effects Respiratory depression Seizures Prolonged duration of action and cumulative effect may occur in patients with impaired hepatic or renal function.

Nursing Considerations Assess onset, type, location, and duration of pain. Effect of medication is reduced if full pain recurs before next dose. Review past medical history, especially epilepsy or seizures. Assess renal or hepatic function laboratory values. Give without regards to meals Monitor pulse and blood pressure. Assist with ambulation if dizziness or vertigo occurs. Dry crackers or cola may relieve nausea. Palpate bladder for urinary retention. Monitor pattern of daily bowel activity and stool consistency. Sips of tepid water may relieve dry mouth. Assess for clinical improvement and record onset of relief from pain.

Name of drug Generic Name: Kalium durule Brand Name: Potassium Chloride

General Action Classification s: electrolytic and water balance agent; replacement solution

Specific Action Principal intracellular cation; essential for maintenance of intracellular isotonicity, transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, maintenance of normal kidney function, and for enzyme activity. Plays a prominent role in both formation and correction of imbalances in acidbase metabolism.

Adverse Effects GI:Nausea, vomiting, diarrhea, abdominal distension.

Indication

Contraindicati on . Severe renal impairment; severe hemolytic reactions; untreated Addisons disease; crush syndrome; early postoperative oliguria (except during GI drainage); adynamic ileus; acute dehydration; heat cramps, hyperkalemia, patients receiving potassiumsparing diuretics, digitalis intoxication with AV conduction disturbance.

Nursing Responsibilities Monitor I&O ratio and pattern in patients receiving the parenteral drug. If oliguria occurs, stop infusion promptly and notify physician. Lab test: Frequent serum electrolytes are warranted.

To prevent and treat potassium deficit BodyWhole:Pain, mental secondary to confusion, irritability, diuretic or listlessness, paresthesias of corticosteroid extremities, muscle therapy. Also weaknessand heaviness of indicated limbs, difficulty in swallowing, flaccid paralysis. when potassium is Urogenital:Oliguria, anuria. depleted by Hematologic:Hyperkalemia severe . vomiting, diarrhea; Respiratory:Respiratory intestinal distress. drainage, fistulas, or CV:Hypotension, malabsorption; bradycardia; cardiac prolonged depression, arrhythmias, or diuresis, arrest; altered sensitivity to diabetic digitalis glycosides. ECG changes in hyperkalemia: acidosis. Tenting (peaking) of T wave Effective in the (especially in right precordial treatment of leads), lowering of R with hypokalemic deepening of S waves and alkalosis depression of RST; (chloride, not prolonged P-R interval, the widened QRS complex, gluconate). decreased amplitude and

Monitor for and report signs of GI ulceration (esophageal or epigastric pain or hematemesis).

Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular heartbeat is usually the earliest clinical indication of hyperkalemia.

Be alert for potassium intoxication (hyperkalemia, see S&S, Appendix F); may result from any therapeutic dosage, and the patient may be asymptomatic. The risk of hyperkalemia with potassium supplement increases (1) in older adults because of decremental changes in kidney function associated with aging, (2) when dietary intake of potassium suddenly increases, and (3)

disappearance of P waves, prolonged Q-T interval, signs of right and left bundle block, deterioration of QRS contour and finally ventricular fibrillation and death.

when kidney function is significantly compromised.

DRUG NAME Generic name: Lactulose

MECHANISM OF ACTION Reduces blood ammonia by acidifying colon contents, thus retarding diffusion of Brand non-ionic ammonia from name: colon to blood while Constulose, promoting its migration Kristalose, from blood to colon. In Chronulac, the acidic colon, NH is Cephulac, converted to Constilac, nonabsorbable Cholac, ammonium ions and is Duphalac, then expelled in feces. Evalose, Heptalac, Enulose, Generlac

INDICATION Prevention and treatment of portal-systemic encephalopath y (PSE), including stages of hepatic precoma and coma, and by prescription for relief of chronic constipation.

ADVERSE REACTION (1%) GI: Flatulence, borborygmi, belching, abdominal cramps, pain, and distention (initial dose); diarrhea (excessive dose); nausea, vomiting, colon accumulation of hydrogen gas; hypernatremia.

CONTRAINDICATION Low galactose diet.

NURSING CONSIDERATION >In children if the initial dose causes diarrhea, dosage is reduced immediately. Discontinue if diarrhea persists. >Promote fluid intake during drug therapy for constipation; older adults often self-limit liquids. Lactulose-induced osmotic changes in the bowel support intestinal water loss and potential hypernatremia. Discuss strategy with physician.