West Visayas State University

COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Name of Patient: M.F.L.A.G. Attending Physician: Dr. A. Impression /
Diagnosis: PCAP-C, PDA and Down Syndrome
Age:9 months old Ward/Bed Number: PSW-B, Bed #3

Dosage,
Name of Route, Mechanism of Indication Adverse Special Nursing Responsibilities
Drug Frequency Action Reactions Precautions
and Timing
Generic: Dosage: Inhibits the enzyme Temporary Hematologic: Use cautiously in Independent
cyclooxygenase, relief of pain Hemolytic patients with long term Monitor vital signs and assess pain
40 mg blocking prostaglandin and discomfort anemia, alcohol use because scale
Paracetamol production and from leukopenia, therapeuticdoses Use liquid form for children and
Route: interfering with pain headache, neutropenia, cause hepatotoxicity in patients who have difficulty swallowing.
impulse generation in fever, cold, flu, pancytopenia, these patients In children, dont exceed five doses in
IV the peripheral nervous minor thrombocytopeni 24 hours.
Brand: system.Acetaminophen muscular a Advise patient that drug is only for
Frequency: also acts directly on aches, Hepatic: liver short term use and to consult the
Biogesic Q4H for temperature-regulating overexertion, damage, physician if giving to children for longer
drops Temp >37.8 center in the menstrual jaundice than 5 days or adults for longer than 10
hypothalamus by cramps, Metabolic: days.
inhibiting synthesis of toothache, hypoglycemia Advise patient or caregiver that many
Timing: prostaglandin E2. minor arthritic over the counter products contain
pain. acetaminophen; be aware of this when
calculating total daily dose.
Warn patient that high doses or
unsupervised long term use can cause
liver damage.
Teach patient to recognize signs of
hepatotoxicity,such as bleeding,easy
bruising, and malaise, which commonly
occurs with chronic overdose.
Dependent
Administer medication as prescribed
by the physician
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Collaborative
Monitor liver function test
results,including AST,ALT, bilirubin, and
creatinine levels, as ordered.
Monitor renal function in patient on
long term therapy. Keep in mind that
blood or albumin in urine may indicate
nephritis; decreased urine output may
indicate renal failure; and dark brown
urine may indicate presence of the
metabolite phenacetin

Classifica Contraindi Side Effects

tion cations
Contraindicate GI: Abdominal
Functional: d to patients pain,
hypersensitivit hepatotoxicity,
Antipyretic, y to the drug. nausea,
nonopioid vomiting
analgesic SKIN:Jaundice,
rash, urticaria
Chemical: Other:
Angioedema,
Nonsalicylat hypoglycemic
e, coma
paraaminop
henol
derivative
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Dosage,
Name of Route, Mechanism Indication Adverse Special Nursing Responsibilities
Drug Frequency of Action Reactions Precautions
and Timing
Generic: Dosage: Inhibits sodium To treat breathing CNS: Fever, Use cautiously in Independent
Furosemide and water problems caused by headache, patients anuria,
4 mg/ pr tab, reabsorption in excess fluids in the paresthesia, hypokalemia or Monitor vital signs especially
1 pr tab the loop of lungs due to heart restlessness, vertigo, hyponatremia. blood pressure
Brand: Henle and problems weakness
Route: PO increases urine CV: Orthostatic Use furosemide Obtain patients weight before
Lasix formation.As ,shock, cautiously in and periodically during furosemide
the bodys thromboembolism, patients with therapy to monitor fluid loss.
plasma volume thrombophlebitis advanced hepatic
Frequency: decreases, EENT:Blurred cirrhosis, especially For once-a-day dosing, give drug
OD aldosterone vision,oral those who also in the morning so patients sleep
production irritation,ototoxicity, have a history of wont be interrupted by increased
increases, stomatitis, tinnitus, electrolyte need to urinate.
which transient hearing loss imbalance or
Timing: promotes (rapid I.V. injection), hepatic Notify prescriber if patient
sodium yellow vision encephalopathy; experiences hearing loss, vertigo,
reabsorption ENDO: Hyperglycemia drug may lead to or ringing, buzzing, or sense of
and the loss of GI: Abdominal cramps, lethal hepatic coma. fullness in her ears. Drug may
potassium and anorexia, constipation, need to be discontinued.
hydrogen ions. diarrhea, gastric May increase risk of
Furosemide irritation, cardiac arrythmias if Advise patient to change position
also increases hepatocellular mixed with cardiac slowly to minimize effects of
the excretion of insufficiency, glycosides orthostatic hypotension and to
calcium, indigestion, jaundice, take furosemide with food or milk
magnesium, pancreatitis, Has decreased GI to reduce GI distress.
bicarbonate, GU:Bladder spasms, absorption effects
ammonium, glycosuria with charcoal Emphasize the importance of
and phosphate. HEME:Agranulocytosi weight and diet control, especially
By reducing s (rare),anemia, Profound diuresis limiting sodium intake.
intracellular aplastic anemia with water and
and (rare),azotemia,hemol electrolyte depletion Instruct patient to keep follow-up
extracellular ytic anemia, can occur; medical appointments with prescriber to
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
fluid volume, leukopenia, supervision is monitor progress. Urge her to
the drug thrombocytopenia MS: required. notify prescriber about persistent,
reduces blood Muscle spasms severe nausea, vomiting, and
pressure and SKIN:Bullous Be aware that diarrhea because they may cause
decreases pemphigoid, erythema furosemide may dehydration.
cardiac output. multiforme, exfoliative worsen left
Over time, dermatitis, ventricular Dependent
cardiac output photosensitivity, hypertrophy and
returns to pruritus, purpura, rash, adversely affect If patient is at high risk for
normal. urticaria Other:Allergic glucose tolerance hypokalemia, give potassium
reaction (interstitial and lipid supplements along with
nephritis, necrotizing metabolism. furosemide, as prescribed.
vasculitis, systemic
vasculitis), Discontinue furosemide at
dehydration, Caution patient maximum dosage if oliguria
hyperuricemia, about drinking persists for more than 24 hours.
hypochloremia, alcoholic
hypokalemia, beverages, standing Administer medications as
hyponatremia, for prolonged prescribed by the physician
hypovolemia periods, and
exercising in hot Collaborative
weather because
these actions Monitor blood pressure and
increase the hepatic and renal function as well
hypotensive effect as BUN,blood glucose, and serum
of furosemide. creatinine, electrolyte, and uric
acid levels, as appropriate.

Unless contraindicated,urge
patient to eat more high-
potassium foods and to take a
potassium supplement, if
prescribed, to prevent
hypokalemia.

Classificatio Contraindications Side Effects

n
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Anuria unresponsive to Nausea, rash,
Functional: furosemide; diarrhea, abdominal
Diuretics, pain, hypotension,
Antihypertensiv Hypersensitivity to dizziness.
e furosemide,
sulfonamides, or their
components

Chemical:

Sulfonamide
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Dosage,
Name of Route, Mechanism of Indication Adverse Special Nursing
Drug Frequency Action Reactions Precautions Responsibilities
and
Timing
Generic: Dosage: 50 Increases the influx To increase CV: Accelerated Use with caution and Independent
mcg/ml 0.4 ml of calcium ions, myocardial junctional rhythm, reduce dosage in
digoxin from extracellular to contractility in asystole, atrial or nodal patients with renal Monitor vital signs especially
intracellular pediatrics with ectopic beats, atrial impairment. pulse rate
cytoplasm by cardiac disease tachycardia with or Auscultate heart sounds to note
Brand: Route: PO inhibition of sodium specifically without A-V block, A-V Use with caution in the presence of abnormal sounds
and potassium ion CHF block, AV dissociation, patients with sinus Before giving each dose, take
Lanoxin movement across bigeminy, facial edema, nodal disease (may patients apical pulse and notify
the myocardial PR prolongation, S-A worsen condition). prescriber if its below 60
Frequency: membranes; this block, sinus beats/minute (or other specified
BID increase in calcium bradycardia, ST Withdrawal of digoxin level).
ions results in a segment depression, in patients with heart Monitor patient closely for signs
potentiation of the trigeminy, ventricular failure may lead to of digitalis toxicity, such as altered
activity of the arrhythmias, ventricular recurrence of heart mental status, arrhythmias,heart
contractile heart tachycardia or failure symptoms block,nausea,vision disturbances,
Timing: 8 6 muscle fibers and ventricular fibrillation; (monitor carefully). and vomiting.
an increase in the first-, second- Stress importance of taking
force of myocardial (Wenckebach), or third- Atrial arrhythmias digoxin exactly as prescribed.
contraction (positive degree heart block associated with Warn about possible toxicity from
inotropic effect); CNS: Anxiety, apathy, hypermetabolic states taking too much and decreased
inhibits adenosine confusion, delirium, are difficult to treat effectiveness from taking too little.
triphosphatase depression, (use with caution). Instruct patient to take digoxin at
(ATPase); disorientation, same time each day to help
decreases dizziness (6%), Use with extreme increase compliance.
conduction through drowsiness, fatigue, caution in patients with Emphasize need to use special
the S-A and A-V fever, hallucinations, hypoxia, dropper supplied with elixir to
nodes headache (4%), hypothyroidism, acute ensure accurate dose
lethargy, mental myocarditis, electrolyte measurement.
disturbances (5%), disorders, acute MI. Urge patient to notify prescriber
vertigo Correct electrolyte if she experiences adverse
Dermatologic: disturbances, reactions, such as GI distress or
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Angioneurotic edema, especially hypokalemia pulse changes.
pruritus, rash or hypomagnesemia, Advise patient to consult
[erythematous, prior to use and prescriber before using other
maculopapular (most throughout therapy. drugs,including OTC products.
common), papular, Hypercalcemia may Avoid giving it with meals
scarlatiniform, increase the risk of Monitor I&O ratio,including
vesicular, or bullous], digoxin toxicity; urinary and bowel elimination
urticaria maintain
Endocrine & metabolic: normocalcemia. Dependent
Hyperkalemia with Monitor for Administer drug as prescribed by
acute toxicity proarrhythmic effects the physician
Neuromuscular & (especially with Frequently obtain ECG tracings
skeletal: Neuralgia, toxicity); monitor and as ordered
weakness adjust dose to prevent
GI: anorexia QTc prolongation. Collaborative
Ocular: Blurred vision, Monitor patients serum
diplopia, flashing lights, potassium level regularly
halos, photophobia, because hypokalemia
yellow or green vision predisposes to digitalis toxicity
Respiratory: Laryngeal and serious arrhythmias.
edema
Monitor ECG tracing
continuously.

Classificatio Contraindic Side Effects

n ations
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Hypersensitive
Functional: carotid sinus CNS: Confusion,
Antiarrhythmic, syndrome depression,
cardiotonic drowsiness,headache,s
Hypersensitivit yncope
y to digoxin,
Chemical: presence or GI: Abdominal
history of discomfort or pain,
Cardiac digitalis toxicity diarrhea, nausea,
Glycoside or idiosyncratic vomiting
reaction to
digoxin, Other:Electrolyte
ventricular imbalances
fibrillation,
ventricular
tachycardia
unless heart
failure occurs
unrelated to
digoxin therapy
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Dosage,
Name of Drug Route, Mechanis Indication Adverse Special Nursing Responsibilities
Frequenc m of Reactions Precautions
y and Action
Timing
Generic: Dosage: Antibacterial To treat CNS: Dizziness, Piperacillin and Independent
400 mg combination moderate to hallucinations, lethargy, tazobactam
piperacillin product severe seizures, stroke combination may Monitor vital signs because of cardiac
tazobactam consisting of nosocomial or CV: Cardiac arrest, cause diarrhea, arrhythmias, hypertension
Route: IV the community- hypotension, palpitations, and in some cases and fever as adversere actions.
semisynthetic acquired tachycardia, vasodilation, it can be severe. It
Brand: piperacillin pneumonia vasovagal reactions may occur 2 Monitor patient carefully during the first 30 min
and the beta- caused by EENT: Oral candidiasis, months or more after initiation of the infusion for signs of
Zosyn Frequency: lactamase piperacillin- pharyngitis GI: Diarrhea, after you stop hypersensitivity.
Q8H inhibitor resistant epigastric distress, receiving this Obtain history of hypersensitivity to penicillins,
tazobactam. intestinal necrosis, medicine. cephalosphorins, or other drugs prior to
Binds to pseudomembranous administration
specific colitis, Serious skin
penicillin- GU: Hematuria, reactions can occur Check for diarrhea during and after therapy
Timing: binding impotence, nephritis, with this medicine. because it may indicate pseudomembranous
proteins and neurogenic bladder, Check with your colitis caused by Clostridium difficile.
inhibits the priapism, proteinuria, renal doctor right away if
third and final failure, vaginal candidiasis your child have Monitor for hemorrhagic manifestations because
stage of HEME: Agranulocytosis, blistering, peeling, high dose may induce coagulation abnormalities.
bacterial cell eosinophilia, hemolytic or loosening of the
wall synthesis anemia, leukopenia, skin, red skin Advise patients folks to consult prescriber
by interfering neutropenia, lesions, severe before using OTC drugs during piperacillin
with an pancytopenia, prolonged acne or skin rash, therapy because of the risk of interactions.
autolysin bleeding time, sores or ulcers on
inhibitor. thrombocytopenia MS: the skin, or fever or Inform patient that increased bruising may occur
Uninhibited Arthralgia chills while you are if she takes anti-inflammatory drugs during
autolytic RESP: Dyspnea, receiving this piperacillin therapy.
enzymes pulmonary embolism, medicine.
destroy the pulmonary hypertension Advise patient to notify prescriber about signs
cell wall and SKIN: Exfoliative Safety and efficacy ofsuperinfection,such as white patches on tongue
result in cell dermatitis, mottling, rash, in children <12 y or in mouth.
lysis. toxic epidermal necrolysis, are not established.
urticaria Other: Instruct patient to complete full course of
Anaphylaxis;facial Use cautiously to therapy, even if symptoms subside.
edema;hypokalemia; patients with renal
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
hyponatremia; injection impairment.
site pain, phlebitis, and Dependent
skin ulcer; superinfection
Administer drugs as prescribed by the physician

Collaborative

Monitor serum potassium level to detect

hypokalemia from urinary potassium loss.

Monitor CBC regularly, as ordered, to detect

hematologic abnormalities, such as leukopenia
and neutropenia.

Classification Contraindic Side Effects

ations
Functional: Hypersensitivity CNS:Headache,
to piperacillin, insomnia, fever.
Antiinfective; beta- tazobactam,
lactam antibiotic penicillins, GI:Diarrhea, constipation,
cephalosporins, nausea, vomiting,
Chemical: or beta- dyspepsia.
Extended-spectrum lactamase
penicillin, beta inhibitors such as
lactamase inhibitor clavulanic acid
and sulbactam.
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY

Dosage,
Name of Route, Mechanism of Indication Adverse Special Nursing Responsibilities
Drug Frequency Action Reactions Precautions
and Timing
Generic: Dosage: Binds to negatively To treat serious CNS:Drowsiness, loss This medicine Independent
amikacin 60 mg charged sites on gram-negative of balance, may cause nerve
sulfate bacterias outer cell bacterial infections neuromuscular problems. Check Monitor vital signs to obtain baseline data
membrane,disrupting caused by blockade,tremor,vertigo right away if your
Route: IV cell integrity.Also binds Acinetobacter, EENT:Hearing loss, child have Expect to obtain results of culture and
to bacterial ribosomal Enterobacter, ototoxicity, tinnitus numbness, skin sensitivity testing before therapy begins.
Brand: subunits and inhibits Escherichia coli, GU: Azotemia, dysuria, tingling, muscle
protein synthesis. Klebsiella, nephrotoxicity, oliguria twitching, or Watch for signs of ototoxicity, such as
Cinmik Frequency: Q24H Both actions lead to Proteus,Providenci or polyuria, proteinuria seizures. tinnitus and vertigo, especially during
cell death a,Pseudomonas, MS:Acute muscle highdosage or prolonged amikacin therapy.
and Serratia; and paralysis; arthralgia; Patients treated
staphylococcal muscle fatigue, spasms, with parenteral Tell patient that daily laboratory tests are
infec and weakness aminoglycosides necessary during treatment.
Timing: 8 tions when penicillin RESP:Apnea should be under
is contraindicated. Other:Hyperkalemia close clinical Instruct patient to report ringing in ears,
observation hearing changes, headache, nausea,
because of the vomiting, and changes in urination.
potential
ototoxicity and Weight patient and review renal function
nephrotoxicity before therapy begins
associated with Evaluate patients hearing before and
their use. during therapy if he will be receiving drug for
longer than 2 weeks.

Watch for signs and symptoms of super

infection (especially URT),such as
continued fever, chills, andincreased pulse
rate.

Dependent

Administer drugs as prescribed by the

physician

Correct dehydration before therapy

 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
because of increase risk of toxicity.

Collaborative

Monitor serum creatinine or creatinine

clearance (generally preferred) more often,
in the presence of impaired renal
function, in neonates

Monitor peak and trough amikacin blood

levels

Classific Contraindicat Side Effects

ation ions
Functional: Hypersensitivity Skin rash,drug fever,
Antibiotic to aminoglycoside headache,paresthesia,
antibiotics, pregn tremor, nausea
ancy and breast- and vomiting, anemia,
Chemical: and hypotension
Aminoglycosi
feeding.
de
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY

Dosage,
Name of Route, Mechanism of Indication Adverse Reactions Special Nursing
Drug Frequency Action Precautions Responsibilities
and Timing
Generic: Dosage: 1 Albuterol attaches to beta 2 Used as a CNS: Anxiety, dizziness, Use cautiously in Independent
nebule receptors on bronchial cell bronchodilator to drowsiness, headache, patients with cardiac
albuterol membranes, which control and prevent hyperkinesia, insomnia, disorders, diabetes Assess lung sounds, pulse and
(salbutamol) stimulates the intracellular reversible airway irritability, vertigo, weakness mellitus, digitalis blood pressure before
enzyme adenylate cyclase obstruction caused b CV: Angina; arrhythmias, intoxication, administration and during peak
Route: to convert adenosine y Pneumonia including atrial fibrillation, hypertension, of medication.
Brand: Pulmonary triphosphate (ATP) to cyclic extrasystoles, hyperthyroidism, or
Inhalation adenosine monophosphate supraventricular history of Observe for paradoxical
Ventolin (cAMP). This reaction tachycardia,and seizures.Albuterol bronchospasm (wheezing). If
decreases intracellular tachycardia;chest pain; can worsen these condition occurs, with hold
calcium levels. It also hypertension; hypotension; conditions. medication and notify physician.
Frequency: increases intracellular levels palpitations EENT: Altered
Q6H of cAMP, as shown. taste,dry mouth and throat, Thyrotoxicosis. Instruct mother to take missed
Together, these effects relax ear pain, glossitis, Inhaled salbutamol dose as soon as
bronchial smooth-muscle hoarseness, oropharyngeal prep are not remembered, spacing remaining
cells and inhibit histamine edema, pharyngitis, rhinitis, appropriatefor doses at regular intervals.
Timing: 8 2 8 release. taste perversion managing
ENDO:Hyperglycemia premature labour. Inform the mother not to smoke
GI:Anorexia, diarrhea, near the child & to avoid
dysphagia, heartburn, Children less than 2 respiratory irritants
nausea, vomiting GU:UTI years of age
MS: Muscle cramps RESP: because safety of Advise the mother to rinse the
Bronchospasm, cough, its use has not been childs mouth w/ water after each
dyspnea, paradoxical established inhalation dose to minimize dry
bronchospasm,pulmonary mouth
edema SKIN: Diaphoresis, Excess inhaler
flushing, pallor, pruritus, use which may lead Advise patient to wait at least 1
rash, urticaria Other: to tolerance minute between inhalations.
Angioedema, hypokalemia, and paradoxical
infection, metabolic acidosis bronchospasm Instruct patient to wash
mouthpiece with water once a
week and let it air-dry.

Be aware that drug tolerance

can develop with prolonged use.
 West Visayas State University
COLLEGE OF NURSING
La Paz, Iloilo City

DRUG STUDY
Dependent

Administer drug as prescribed

by the physician

Collaborative

Monitor serum potassium level

because albuterol may cause
transient hypokalemia

Monitor pulmonary function tests

before initiating therapy
&periodically throughout course
to determine effectiveness
of medication
Classifica Contraindicati Side Effects
tion ons
Contraindicated with Nervousness
Functional: hypersensitivity to
albuterol; Restlessness
Bronchodilato tachyarrhythmias,tac
r hycardia cause by Tremor
digitalis intoxication.
Chest pain
Chemical: Hypersensitivity to ad
renergic amines Palpitations
Selective
beta2- Hypersensitivity to
adrenergic fluorocarbons
agonist,
sympathomim
etic