Drug

Study
Acetaminophen

Drug #1
Patient: Mr. Abs
Drug Ordered: September 14, 2010
Attending Physician: Vivian Polarez
Generic name: Acetaminophen
Brand name: Paracetamol
Classification: Analgesic
Indications:
 Relief of mild to moderate pain; treatment of fever.
 Analgesic-antipyretic in patients with aspirin allergy,
hemostatic disturbances, bleeding diatheses, upper
GI disease, gouty arthritis
 Arthritis and rheumatic disorders involving
musculoskeletal pain (but lacks clinically significant
anti-rheumatic and anti-inflammatory effects)
 Common cold, flu, other viral and bacterial
infections with pain and fever
 Unlabeled use: Prophylactic for children receiving
DPT vaccination to reduce incidence of fever and
pain
Contraindication:

 Contraindicated with allergy to acetaminophen.

 Use cautiously with impaired hepatic function,
chronic alcoholism, and pregnancy, lactation.

Dosage: 500mg PRN

Mechanism of Action:
 Decrease fever by inhibiting the effects of pyrogens
on the hypothalamic heat regulating centers and by
a hypothalamic action leaders to sweating and
vasodilation. Relieves pain by inhibiting
prostaglandin synthesis at the CNS but does not
have anti-inflammatory action because of its
minimal effects of peripheral prostaglandin
synthesis.
Adverse reaction:
 • CNS: Headache
 •CV: Chest pain, dyspnea, myocardial damage when
doses of 5–8 g/day are ingested daily for several
weeks or when doses of 4 g/day are ingested for 1 yr
 •GI: Hepatic toxicity and failure, jaundice
 •GU: Acute kidney failure, renal tubular necrosis
 •Hematologic: Methemoglobinemia—cyanosis;
hemolytic anemia—hematuria, anuria; neutropenia,
leukopenia, pancytopenia, thrombocytopenia,
hypoglycemia
 •Hypersensitivity: Rash, fever.
Nursing responsibility:
 Do not exceed the recommended dosage.
 Avoid using multiple preparations containing
acetaminophen. Carefully check all OTC products.
 Give drug with food if GI upset occurs.
 Discontinue drug if hypersensitivity reactions occur
 Treatment of overdose: Monitor serum levels regularly,
 - acetylcysteine should be available as a specific
antidote; basic life support measures may be necessary.
Health Teaching:
 Do not take for longer than 10 days.
 Take the drug only for complaints indicated; it is not an
anti-inflammatory agent.
 Avoid the use of other over-the-counter preparations.
They may contain acetaminophen, and serious over
dosage can occur. If you need an over-the-counter
preparation, consult your health care provider.
 Report rash, unusual bleeding or bruising, yellowing of
skin or eyes, changes in voiding patterns.
Rationale:
 the drug was given to decrease the patient’s body
temperature of 38 degrees to the normal range.
Cefuroxime axetil

Drug #2
Patient: Mr. Abs
Drug Ordered: September 14, 2010
Attending Physician: Vivian Polarez
Generic name: Cefuroxime axetil
Brand name: Ceftin
Classification: Second generation’s cephalosporins
Indications:
 Both cefuroxime sodium and cefuroxime axetil is used
in treating infections of Upper and Lower respiratory
tract, skin and soft tissue, UTI, bone & joint infections
and gonococcal infections.
 Cefuroxime sodium on addition is indicated in treating
serious infection pending bacteriological identification,
Meningitis, Prophylaxis against infection in surgical
procedures, Urinary infections, Patients with renal
failure undergoing CAPD (continuous ambulatory
peritoneal dialysis).
 Cefuroxime axetil is also indicated in treating and
preventing Lyme disease.
Contraindication:
 Ceftin products are contraindicated in patients
with known allergy to the cephalosporin group of
antibiotics.

 Dosage: 500mg BID

Mechanism of Action:
 Cefuroxime, a beta-lactam antibiotic, inhibits the third
and final stage of bacterial cell wall synthesis by
preferentially binding to specific penicillin-binding
proteins (PBPs) that are located inside the bacterial
cell wall.
Adverse reaction:
 Anaphylaxis, pseudomembranous colitis, nausea and
vomiting, transient elevation of liver enzymes.
 altered laboratory tests: toxic nephropathy, aplastic
anemia, hemorrhage, increased BUN, increased
creatinine, false-positive test for urinary glucose,
increased alkaline phosphatase, neutropenia,
elevated bilirubin, and agranulocytosis.
Nursing responsibility:
 Instruct the patient to take drug exactly as prescribes,
even after he feels better. Because bacteria may still
be present even if he or she feels ok already.
 Oral drugs should be taken with food to enhance
absorption.
 Tablet are not bio-equivalent and not substitutable on
a mg-per-mg basis.
 Prior to reconstitution, protect the drug front he light.
The power and reconstituted drug may darken without
affecting potency.
Health Teaching
 Cefuroxime axetil for PO use is available in tablet
and suspension forms. Swallow tablets whole and
not crush, crushed tablet has a strong, bitter,
persistent taste. The tablets may be taken without
regard for food. Protect tablets from excessive
moisture.
 Instruct patient to not take drug if patient
cefuroxime have ever had an allergic reaction to
another cephalosporin to to penicillin unless the
doctor is aware of the allergy and monitors their
therapy.
Metronidazole

Drug #3
Patient: Mr. Abs
Drug Ordered: September 14, 2010
Attending Physician: Vivian Polarez
Generic name: Metronidazole
Brand name: Flagyl
Classification: Antiprotozoal, antibacterial agent, Anti-
infectives,
Indications:

 Metronidazole is given for treatment of protozoal

infections like amoebiasis, giardiasis and trichomonas
vaginitis. It is also used in the treatment of anaerobic
infection, ulcerative gingivitis, trench mouth, guinea
worm infestation.
Contraindication:
 Flagyl is contraindicated in patients with a prior
history of hypersensitivity to metronidazole or other
nitroimidazole derivatives.
 In patients with trichomoniasis, Flagyl is
contraindicated during the first trimester of
pregnancy.
 Metronidazole is contraindicated in blood
dyscrasias, hypersensitivity, certain serious
neurological diseases, alcohol and severe hepatic
failure.

Dosage: 500mg
Mechanism of Action:
 Metronidazole is amebicidal, bactericidal, and
trichomonicidal. Unionized metronidazole is readily
taken up by anaerobic organisms and cells. Its
selectivity for anaerobic bacteria is a result of the
ability of these organisms to reduce metronidazole
to its active form intracellularly. The electron
transport proteins necessary for this reaction are
found only in anaerobic bacteria. Reduced
metronidazole then disrupts DNA's helical structure,
thereby inhibiting bacterial nucleic acid synthesis.
This eventually results in bacterial cell death.
Metronidazole is equally effective against dividing
and nondividing cells.
Adverse reaction:
 seizures (convulsions);
 fever, chills, body aches, sore throat, flu symptoms;
 numbness or tingling in your hands or feet;
 white patches or sores inside your mouth or on your
lips;
 pain or burning when you urinate; or
 Diarrhea that is watery or bloody.
Less serious side effects may include:
 nausea, stomach pain, diarrhea;
 headache, dizziness, loss of balance;
 vaginal itching or discharge;
 dry mouth or unpleasant metallic taste;
 cough, sneezing, runny or stuffy nose; or
 Swollen or sore tongue.
Nursing responsibility:
 Obtain C&S before beginning drug therapy to identify if
correct treatment has been initiated.
 Assess for allergic reactions: rash, urticaria, pruritus..
 May cause dizziness or light-headedness. Caution
patient or other activities requiring alertness until
response to medication is known.
 Inform patient that medication may cause an unpleasant
metallic taste.
 Inform patient that medication may cause urine to turn
dark.
 Advise patient to consult health care professional if no
improvement in a few days or if signs and symptoms of
superinfection (black furry overgrowth on tongue; loose
or foul-smelling stools develop).
Health Teaching
 Instruct patient to take with food or milk to minimize
GI irritation. Tablets may be crushed for patients
with difficulty swallowing.
 Instruct patient to take medication exactly as
directed evenly spaced times between dose, even if
feeling better. Do not skip doses or double up on
missed doses. If a dose is missed, take as soon as
remembered if not almost time for next dose.
 May cause lightheadedness. Caution patient or
other activities requiring alertness until response to
medication is unknown.
Patient & Family Education
 * Adhere closely to the established regimen without
schedule interruption or changing the dose.
 * Do not drink alcohol during therapy; may induce a
disulfiram-type reaction . Avoid alcohol or alcohol-
containing medications for at least 48 h after
treatment is completed.
 * Urine may appear dark or reddish brown (especially
with higher than recommended doses). This appears
to have no clinical significance.
 * Report symptoms of candidal overgrowth: Furry
tongue, color changes of tongue, glossitis, stomatitis;
vaginitis, curd-like, milky vaginal discharge; proctitis.
Treatment with a candidacidal agent may be
indicated.
Rationale:
 This is given to patient for infection.
Essentiale Forte
 Drug #4
 Patient: Mr. Abs
 Drug Ordered: September 14, 2010
 Attending Physician: Vivian Polarez
 Generic name: @@@@
 Brand name: Essentiale Forte
 Classification: Cholagogues, Cholelitholytics
& Hepatic Protectors 
Indications:
 Acute, subacute & chronic hepatitis; toxic metabolic
liver diseases, intoxications (eg from drugs); infection,
fatty degeneration of the liver due to alcohol,
hypernutrition, DM, kwashiorkor, pregnancy; 
cholestasis; pre- & post-op care, esp in
liver/gallbladder surgery.
Dosage:
 Intensive Therapy: 1-2 forte caps 3 times a day for the
first 2 months.
 Maintenance Therapy: 1-2 plain caps 3 times a day.
To be swallowed whole, with a little liquid if desired.
Mechanism of Action:
 Essentiale/Forte regulates membrane permeability
and improves the exchange of substances between
the intra- and extracellular space. It activates
metabolic function and supports the energy balance
of the liver. It restores enzyme functions and
promotes detoxification of the liver. Neutral fats and
cholesterol are transformed into transportable forms
and led to their physiological oxidation. Liver cell
regeneration is stimulated and the bile is stabilized.
Nursing Responsibilities:
 Advice patient to take drug with food.
 Instruct patient to decrease alcohol intake.
 Increase fluid intake.
Rationale:
 This drug is given to the patient to restore the normal
liver functioning.