a.

DRUG STUDY
NAME OF THE
DRUG
Ranitidine
hydrochloride
Brand name:
Apo-Ranitidine;
Zantac
Dose: 1 amp
Route: IV

NURSING INTERVENTION
INDICATION

CONTRAINDICATION

ACTIONS

SIDE EFFECTS

Duodenal &
gastric
ulcer(shortterm
treatment);
pathologic
hypersecret
ory
conditions,
such as
ZollingerEllison
Syndrome
Adults:
50mg I.V.

Contraindicated in
patients
hypersensitive to the
drug.

Competitively
inhibits the
action of
histamine-2 at
receptor sites
of the parietal
cells,
decreasing
gastric acid
secretion.

CNS: vertigo,
malaise.
EENT: BLURRED
VISION.
Hematologic:
reversible
leucopenia,
pancytopenia.
Hepatic: elevated
liver enzymes,
jaundice.
Other: burning &
itching at injection
site, anaphylaxis,
angioneurotic
edema

*I.V. use: When administering by

I.V. push, dilute to a total volume of
20ml, & inject over a period of 5
minutes. No dilution is necessary
when administering I.M.
*When administering premixed I.V.
infusion, given by slow I.V. drip
(over 15 to 20 minutes). Dont ad
other drugs to the solution. If used
with a primary I.V. fluid system,
discontinue the primary solution
during the infusion.

NAME OF THE DRUG

ketorolac
tromethamine
Brand name:
Toradol
Dose:
Route:

INDICATION
Short-term
management of pain
(up to 5 days)

CONTRAINDICATION
Contraindicated in the
patients with
hypersensitivity to this
drug & in patients with
active peptic ulcer
disease, recent GI
bleeding or
perforation.

ACTIONS
Unknown. Thought to
inhibit prostaglandin
synthesis.

SIDE EFFECTS
CNS: drowsiness,
sedation, dizziness,
headache.
CV: edema,
hypertension,
palpitations,
arrhythmias.
Hematologic:
decreased platelet
adhesion , purpura,
thrombocytopenia.

NSG. INTERVENTION
- Assess pain (note
type, location, and
intensity) prior to and
1-2 hr following
administration.
- Ketorolac therapy
should always be given
initially by the IM or IV
route. Oral therapy
should be used only as
a continuation of
parenteral therapy.
- Advise patient to
consult if rash, itching,
visual disturbances,
tinnitus, weight gain,
edema, black stools,
persistent headche, or
influenza-like
syndromes
(chills,fever,muscles
aches, pain) occur.
- Effectiveness of
therapy can be
demonstrated by
decrease in severity of
pain. Patients who do
not respond to one
NSAIDs may respond
to another.

NAME OF THE DRUG

tramadol
hydrochloride
Brand Name:
Tramadol
Dose: 500 mg
Route: IV

INDICATION
* To treat moderate to
moderately severe
pain

CONTRAINDICATION
* Contraindicated in
patients hypersensitive
to drug or other
opioids, in
breastfeeding women.
Serious
hypersensitivity
reactions can occur,
usually after the first
dose. Patients with
history of anaphylactic
reaction to codeine
and other opioids may
be at increased risk.

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

SIDE EFFECTS
* May increase liver
enzyme level.
* May decrease
creatinine and
hemoglobin levels.

NSG. INTERVENTION
* Reassess level of pain
at lesser 30 minutes
after administration.
* Monitor patient
closely for evidence of
serotonin syndrome,
such as agitation,
hallucinations, coma,
tachycardia, labile
blood pressure,
hyperthermia,
hyperreflexia,
incoordination,
nausea, vomiting, or
diarrhea. Notify
prescriber at once
because serotonin
syndrome may be lifethreatening. Be
prepared to
discontinue drug and
provide supportive
care.
* Monitor CV and
respiratory status.
Withhold dose and
notify prescriber if
respirations decrease
or rate is below 12
breaths/minute.
* Monitor bowel and
bladder function.
Anticipate need for
laxative.

* For better analgesic

effect, give drugs
before onset of intense
pain.
* Monitor patients at
risk for seizures. Drug
may reduce seizure
threshold.
* In the case of an
overdose, naloxone
may also increase risk
of seizures.
* Monitor patient for
drug dependence.
Drug can produce
dependence similar to
that of codeine or
dextropropoxyphene
and thus has potential
for abuse.
* Withdrawal
symptoms may occur if
drug is stopped
abruptly. Reduce
dosage gradually.
* Take drug as
prescribed and not to
increase dose or
dosage interval unless
ordered by prescriber.
* For ambulatory
patients: Be careful in
rising and walking.
Avoid driving and other
potentially hazardous

activities that require

mental alertness until
drugs CNS effects are
known.
* Check with
prescriber before
taking any OTC drugs
as drug interactions
may occur.
* Avoid giving
tramadol to patients
with acute abdominal
conditions because it
may mask evidence
and disrupt
assessment of the
abdomen.
* Monitor patient
closely for evidence of
suicidal thinking or
behaviour, especially
when therapy starts or
dosage changes.

NAME OF THE DRUG

Brand Name:
Mefenamic Acid
Dose:
500mg
Route:
Oral

INDICATION
This medication is a
non-steroidal antiinflammatory drug
(NSAID), prescribed for
dysmenorrhea and
other pain. It
decreases
inflammation and
uterine contractions.

CONTRAINDICATION
Hypersensitivity to
mefenamic acid;
patients who have
experienced asthma,
urticaria, or allergictype reactions after
taking aspirin or other
NSAIDs; treatment of
perioperative pain in
the setting of coronary
artery bypass graft
(CABG) surgery; active
ulceration or chronic
inflammation of either
the upper or lower GI
tract; preexisting renal
disease.

ACTIONS
Anthranilic acid
derivative. Like
ibuprofen inhibits
prostaglandin
synthesis and
affects platelet functio
n. No evidence that it
is superior to aspirin.

SIDE EFFECTS
CNS:Drowsiness,
insomnia, dizziness,
nervousness,
confusion, headache.
GI:Severe diarrhea,
ulceration, and
bleeding; nausea,
vomiting, abdominal
cramps, flatus,
constipation, hepatic
toxicity.
Hematologic:Prolonge
d prothrombin time,
severe autoimmune
hemolytic anemia
(long-term use),
leukopenia,
eosinophilia,
agranulocytosis,
thrombocytopenic
purpura, megaloblastic
anemia, pancytopenia,
bone marrow
hypoplasia.
Urogenital:Nephrotoxi
city, dysuria,
albuminuria,
hematuria, elevation of
BUN.
Skin:Urticaria, rash,
facial edema.
SpecSenses:Eye

NSG. INTERVENTION
Give with meals,
food, or milk to
minimize GI
adverse effects.
Do not use drug
for a period
exceeding 1 wk
(manufacturers
warning).

irritation, loss of color

vision (reversible),
blurred vision, ear
pain.
BodyWhole:Perspiratio
n.
CV:Palpitation.
Respiratory:Dyspnea;
acute exacerbation of
asthma;
bronchoconstriction (in
patients sensitive to
aspirin)

NAME OF THE DRUG

Brand Name:
Cefradine
Dose:
500mg
Route:
IV

INDICATION

CONTRAINDICATION

ACTIONS

SIDE EFFECTS

NSG. INTERVENTION

It is prescribed in the
treatment of certain
infections caused by
susceptible bacterial
strains causing
genitourinary,
gastrointestinal, skin
and soft tissue,
septicemia. It is
effective against many
gram-positive bacilli
and cocci (other than
enterococcus) and
some gram-negative
bacilli.

Contraindications
Known hypersensitivity
to this drug or to any
cephalosporin
medication prohibits
its use. It is prescribed
with caution for
patients who are
allergic to penicillin.

Interferes with
bacterial cell-wall
synthesis, causing cell
to rupture and die.
Active against many
gram-positive bacteria;
shows limited activity
against gram-negative
bacteria.

Cephalosporins are a
class of antibiotic drugs
available through a
doctor's prescription.
Like other drugs,
manufacturers
produce
cephalosporins under
a variety of brand
names, including
Cefradine, which is
commonly sold in the
United Kingdom.
Available in capsules,
syrup and as an
injection, Cefradine is a
common treatment for
a wide variety of
infections caused by
bacteria. Despite its
effectiveness,
Cefradine is not for
everyone, as it
presents several risks
for side effects and
complications in some
patients.

Instruct patient to
complete full course of
therapy.
Advise patient to take
with food or milk if GI
distress occurs.
Remind patient to
check body
temperature daily. If
fever persists for more
than a few days or if
high fever (higher than
102F) or shaking chills
are noted, notify
health care provider
immediately.
Advise patient to
maintain normal fluid
intake while using this
medication.

NAME OF THE DRUG

Brand Name:
Ferrous Sulfate
Dose:
Route:
Oral

INDICATION
Prevention and
treatment of iron
deficiency anemias.
Dietary supplement
for iron

CONTRAINDICATION

ACTIONS

SIDE EFFECTS

NSG. INTERVENTION

Hypersensitivity
Severe hypotension.

Provides elemental
iron component in the
formation of
hemoglobin

Common: nausea,
constipation, black
stools
Uncommon: epigastric
pain, vomiting,
diarrhea, anorexia;
liquid forms may
temporarily stain teeth

Use cautiously on longterm basis

Keep in mind that GI
upset may be related
to dose. Between-meal
doses are preferable,
but can be given with
some foods, although
absorption may be
decreased. Entericcoated products
reduce GI upset but
also reduce amount of
iron absorbed
Be aware that oral iron
may turn stools black.
Although this
unabsorbed iron is
harmless, it could mask
melenas.
Monitor hemoglobin
and hematocrit levels
and reticulocyte count
during therapy, as
ordered

NAME OF THE
DRUG
Hydoxyzine
Dose:
1 vial
Route:
IM

INDICATION
Symptomatic relief of anxiety and
tension associated with
psychoneurosis; adjunct in organic
disease states in which anxiety is
manifested; alcoholism and
asthma; before dental procedures
Management of pruritus due to
allergic conditions, such as chronic
urticaria, atopic and contact
dermatosis, and in histaminemediated pruritus
Sedation when used as
premedication and following
general anesthesia
Control of nausea and vomiting and
as adjunct to analgesia
preoperatively and postoperatively
(parenteral) to allow decreased
opioid dosage
IM

CONTRAINDICATION
Porphyria, neonates,
pregnancy, lactation.

ACTIONS
Hydroxyzine blocks
histamine H1receptors on
effector cells of the
GI tract, blood
vessels and
respiratory tract; a
sedating
anihistamine with
antimuscarinic and
significant sedative
properties. It also
possesses skeletal
muscle relaxing,
bronchodilator,
antiemetic and
analgesic
properties.

SIDE EFFECTS

NURSING
INTERVENTION
CNS depression,
WARNING: Determine
paradoxical CNS
and treat underlying
stimulation, dry
cause of vomiting. Drug
mouth, thickened
may mask signs and
respiratory
symptoms of serious
secretions,
conditions, such as
constipation, blurring brain tumor, intestinal
of vision,
obstruction, or
tachycardia, GI
appendicitis.
disturbances,
Do not administer
headache,
parenteral solution
hypotension,
subcutaneously, IV, or
tinnitus.
intra-arterially; tissue
necrosis has occurred
with subcutaneous and
intra-arterial injection,
and hemolysis with IV
injection.
Give IM injections deep
into a large muscle: In
adults, use upper outer
quadrant of buttocks or
midlateral thigh; in
children use midlateral
thigh muscles; use
deltoid area only if well
developed

NAME OF THE DRUG

Nalbuphine
Dose:
10 mg
Route:
IV

INDICATION
Relief of moderate to severe
pain
Preoperative analgesia, as a
supplement to surgical
anesthesia, and for obstetric
analgesia during labor and
delivery

CONTRAINDICATION

ACTIONS

SIDE EFFECTS

Contraindications:
hypersensitivity to
nalbuphine, sulfites; lactation.
Use cautiously with
emotionally unstable clients
or those with a history
of narcotic abuse; pregnancy
prior to labor, labor or
delivery, bronchialasthma,
COPD, respiratory depression,
anoxia, increased
intracranialpressure, acute MI
when nausea and vomiting
are present, biliary
tractsurgery.

Nalbuphine acts as an agonist

at specific opioid receptors in
the CNS to produceanalgesia,
sedation but also acts to
cause hallucinations and is an
antagonist at receptors

CNS: headache, sedation,

dizziness, vertigo,
nervousness, depression,
restlessness, crying, euphoria,
hostility, confusion, unusual
dreams, hallucinations,
speech disorders, delusions
CV: hypertension,
hypotension, tachycardia,
bradycardia
EENT: blurred vision, dry
mouth
GI: cramps, dyspepsia, bitter
taste, nausea, vomiting,
constipation, biliary tract
spasms
GU: urinary urgency
Respiratory: respiratory
depression, dyspnea, asthma,
pulmonary edema
Skin: pruritus, burning,
urticaria, clamminess,
diaphoresis

NURSING
INTERVENTION
Reassess patients level of
pain at least 15 and 30
minutes after parenteral
administration.
* Drug acts as an opioid
antagonist and may use
withdrawal syndrome. For
patients who have received
longterms opioids, give 25%
of the usual dose initially.
Watch for signs of
withdrawal.
* ALERT! Drug causes
respiratory depression, which
at 10 mg is equal to
respiratory depression
produced by 10 mg of
morphine.
* Monitor circulatory and
respiratory status and bladder
and bowel function. Withhold
dose and notify prescriber if
respirations are shallow or
rate is below 12
breaths/minute.
* Constipation is often severe
with maintenance therapy.
Make sure stool softener or
other laxative is ordered.
* Psychological and physical
dependence may occur with
prolonged use.
* ALERT! Dont con

Name of
Drug
Ceftriaxone
sodium
Brand name:
Rocephin
Dose:
Route:

Indication

Contraindication

Action

Side Effects

Nsg. Intervention

Most infections caused

by susceptible
organismsAdults: 1 to 2 g I.M. or
I.V. daily or b.i.d.
depending on type &
severity of infection.
Uncomplicated
gonococcal
vulvovaginitis-

Contraindicated in
patients with
hypersensitivity to the
drug or other
cephalosporin.

A third-generation
cephalosporin that inhibits
cell-wall synthesis,
promoting osmotic
instability; usually
bactericidal.

CNS: headache, dizziness.

GI: pseudomembranous
colitis, nausea, vomiting,
diarrhea.
GU: genital pruritus,
moniliasis, elevated BUN
levels.
Hematologic: eosinophilia,
thrombocytosis,
leucopenia.
Skin: pain, induration,
tenderness at injection
site; phlebitis; rash;
pruritus.

*Use cautiously in
patients with a history
of sensitivity to
penicillin & in breastfeeding women.
*Obtain specimen for
culture & sensitivity
tests before first dose.
Therapy may begin
pending results.
*With large doses or
prolonged therapy,
monitor for super
infection, especially in
high-risk patients.