DRUG STUDY Drug Name Paracetam ol Classificati on Analgesics (NonOpioid) & Antipyretic s Dosa ge 500 mg Mode of Action Paracetamol

exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heatregulating centre. Its weak antiinflammatory activity is related to inhibition of prostaglandin synthesis in the CNS. Indication Mild to moderate pain and f ever Contraindic ation Contraindica ted in patients hypersensiti ve to drug Drug Interaction Reduced absorption of cholestyramine wit hin 1 hr of admin. Accelerated absorption with metoclopramide. Decreased effect with barbiturates, carbama zepine, hydantoins, rifampicin and sulfinpyrazone. Paracetamol may increase effect of warfarin. Potentially Fatal: Paracetamol increases the risk of liver damage in chronic alcoholics. Increased risk of toxicity with other hepatotoxic drugs or drugs which induce microsomal enzymes Side Effects Nausea, allergic reactions, skin rashes, acute renal tubular necrosis. Potentially Fatal: Very rare, blood dyscrasias (e.g. thrombocyto penia, leucopenia, neutropenia, agranulocyto sis); liver damage Nursing Responsibilities Do not exceed the recommend d 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. Teaching Point: Do not take for longer than 10 days. Take the drug only for complaints indicated it is not an antiinflammatory agent Avoid the use of other over-thecounter preparations. They may contain acetaminophen, and serious over dosage may occur. Report rash, unsual bleeding or bruising, yellowing of skin or eyes, changes in voiding pattern.

Drug Name Clindamyci n

Classificati on Antibiotics

Dosag e 300 mg

Mode of Action Clindamycin inhibits protein synthesis by reversibly binding to the 50S subunit of the ribosomal thus blocking the transpeptidati on or translocation reactions of susceptible organisms resulting to stunted cell growth.

Indication Severe ana erobic infections Prophylaxis of endocar ditis Toxic shock syndrome Acne

Contraindicati on Contraindicate d in patients hypersensitive to drug or lincomycinuse cautiously in patients with renal or hepatic disease, asthma, history of GI disease, or significant allergies

Drug Interaction Increased neuromuscu lar blockade with neuromuscu lar agents Decreased GI absorption with kaolin, aluminum salts

Side Effects CNS: headache CV: Thrombophlebitis EENT: pharyngitis GI: abdominal pain, Anorexia, bloody or tarry stools ,constipation, diarrhea , dysphagia , esophagitis, flatulence, nausea, psuedome mbranuscolitis, unpleasant or bitter taste, vomiting. GU: UTI HEMATOLOGIC: Eosinophilia, thrombocytopenia, Transientleukopenia SKIN: maculopapular rash, urticaria OTHER: anaphylaxis, erythema

Nursing Responsibilities Assess patients infection before and regularly throughout therapy-before giving first dose, obtain specimen for culture and sensitivity test, and begin therapy pending results. Monitor renal, hepatic, and hematopoetic functions during prolonged therapy.-be alert for adverse reactions and drug interactions Question patient for history of allergies, particularly to clindamycin, lincomycin, and aspirin. Avoid concurrent use of neuromuscular blocking agents. Monitor bowel activity, stool consistency; report diarrhea promptly due to potential for serious colitis. Assess skin for rash with topical application. Assess for superinfection: severe diaarhea, genital/anal pruritus, increase fever, and change of oral mucosa.

Drug Name Hydrocrotis one

Classificatio n Adrenocorti cal steroid Corticostero id Glucocortico id

Dosa ge 100 mg

Mode of Action Enters target cells and binds to cytoplasm ic receptors; initiates many complex reactions that are responsibl e for its antiinflammat ory, immunos uppressiv e and salt retaining actions.

Indication Replacemen t therapy in adrenocor tical insufficiency As supplement in adrenal insufficiency during minor surgery under general anaesthesia Acute adrenocortic al insufficiency Soft tissue inflammatio n Joint inflammatio ns

Contraindi cation Viral/funga l infections, tubercular or syphilitic lesions, bacterial infections unless used in conjunctio n with appropriat e chemother apy.

Drug Interaction Thiazides may enhance hyperglycaemia and hypokalaemia caused by corticosteroids. Increased incidence of peptic ulcer or GI bleeding with concurrent NSAIDs admin. Response to anticoagulants altered. Dose of antidiabetics and antihypertensives needs to be increased. Decreases serum conc of salicylates and antimuscarinic agents. Ethanol may enhance gastric mucosal irritation. Reduced efficacy with concurrent use ofcarbamazepine, phenytoin, primidone, barbiturates and rifampicin. Mutual inhibition of metabolism between ciclospori n and

Side Effects Sodium and fluid retention. Potassium and calcium depletion. Muscle wasting, weakness, osteoporosis. GI disturbances and bleeding. Increased appetite and delayed wound healing. Bruising, striae, hirsutism, acne, flushing. Raised intracranial pressure, headache, depression, psychosis, menstrual irregularities. Hyperglycaemia, glycosuria, DM, obesity, moonface, buffalo hump. Suppression of pituitaryadrenocortical system. Increased susceptibility for infection. Potentially

Nursing Responsibilities Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose. Lab tests: Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC with differential. Be alert to signs of hypocalcemia onitor for persistent backache or chest pain; compression and spontaneous fractures of long bones and vertebrae present hazards. Monitor for and report changes in mood and behavior, emotional instability, or psychomotor activity, especially with long-term therapy. Be alert to possibility of masked infection and delayed healing Patient & Family Education Expect a slight weight gain with improved appetite. After dosage is stabilized, notify physician of a sudden slow but steady weight increase [2 kg (5 lb)/wk]. Avoid alcohol and caffeine; may contribute to steroid-ulcer development in long-term

corticosteroids increase plasma conc of both drugs. Enhanced effect in women taking oestrogens or oral contraceptives.

Fatal: Abrupt withdrawal leading to acute adrenal insufficiency. Rapid IV Inj may cause CV collapse.

therapy. Do not ignore dyspepsia with hyperacidity. Report symptoms to physician and do NOT self-medicate to find relief. Do NOT use aspirin or other OTC drugs unless prescribed specifically by the physician. Note: A high protein, calcium, and vitamin D diet is advisable to reduce risk of corticosteroidinduced osteoporosis. Notify physician of slow healing, any vague feeling of being sick, or return to pretreatment symptoms. Do not abruptly discontinue drug; doses are gradually reduced to prevent withdrawal symptoms. Report exacerbation of disease during drug withdrawal.

Drug Name Ciprofloxa cin

Classification Antibacterial Fluoroquinol one

Dosa ge 400 mg

Mode of Action Bactericida l; interferes with DNA replication in susceptible bacteria preventing cell reproducti on.

Indication For the treatment of infections caused by susceptible gramnegative bacteria Treatment of uncomplica ted UTIs Treatment of nosocomial pneumonia Lower respiratory infections

Contraindicat ion Contrainticat ed with allergy to ciprofloxacin, norfloxacin or other fluoroquinolo nes, pregnancy, lactation.

Drug Interaction Decreased absorption with concurrent sucralfate, magnesium-aluminum antacids, calcium, iron, zi nc and multivitamins. Increased methotrexate a ndcaffeine levels when taken concurrently with ciprofloxacin. Probenecid reduces renal clearance of ciprofloxacin. Potentiates oral anticoagulants and glibenclamide. Concurrent use with corticosteroids may increase tendon rupture. Concurrent use with ciclosporin may cause transient increases in serum creatinine. CNS excitation may occur with concurrent admin of quinolones and NSAIDs. Serum concentrations of theophyllineare markedly elevated when co-administered with ciprofloxacin; monitor serum levels of theophylline. Potentially Fatal: Concurrent use with tizanidine can cause marked elevation in

Side Effects GI disturbances; headache, tremor, confusion, convulsions; rashes; joint pain; phototoxicity. Transient increases in serum creatinine. Haematological, hepatic and renal disturbances. Vasculitis, pseudomembran ous colitis and tachycardia. Phototoxicity. Potentially Fatal: Anaphylact oid reaction; cardiopulmonary arrest.

Nursing Responsibilities Report tendon inflammation or pain. Cipro needs to be discontinued. Lab tests: Culture and sensitivity tests should be done prior to initial dose. Treatment may be implemented pending results. Monitor urine pH; it should be less than 6.8, especially in the older adult and patients receiving high dosages of ciprofloxacin, to reduce the risk of crystalluria. Monitor I&O ratio and patterns: Patients should be well hydrated; assess for S&S of crystalluria. Patient & Family Education Immediately report tendon inflammation or pain. Cipro should be discontinued. Fluid intake of 23 L/d is advised, if not contraindicated. Report sudden, unexplained joint pain. Restrict caffeine due to the following effects (e.g., nervousness,

serum levels of tizanidine; avoid concurrent usage. Click to view more ciprofloxacin Drug Interactions

insomnia, anxiety, tachycardia). Use caution with hazardous activities until reaction to drug is known. Drug may cause light-headedness

Drug Name Ketorolac

Classification Antipyretic Nonopioid analgesic NSAID

Dosage 30 mg

Mode of Action Antiinflammatory and analgesic activity; inhibits prostaglandin and leukotriene synthesis.

Indicati on Short term manage ment of pain.

Contraindication Hypersensitivity to aspirin or other NSAIDs, asthma. Hypovolaemia or dehydration. Do not give postoperatively to patients with high risk of haemorrhage. History of peptic ulcer or coagulation disorders. Nasal polyps, angioedema, bronchospasm. Labour. Moderate to severe renal impairment. GI bleeding, cerebrovascular bleeding. As prophylactic analgesic before surgery. Pregnancy, lactation.

Drug Interaction Increased risk of nephrotoxici ty with other toxins. Increased risk of bleeding with anticoagula nts

Side Effects GI ulcer, bleeding and perforation, drowsiness, rash, bronchospasm, hypotension, psychosis, dry mouth, fever, bradycardia, chest pain, dizziness, headache, sweating, oedema, pallor, liver function changes. Transient stinging and local irritation (ophthalmic). Potentially Fatal: Anaphylaxi s. Severe skin reactions. MI, stroke, GI bleeding.

Nursing Responsibilities Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. 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. Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

Drug Name Benzydamine Hydrochloride

Classification Nonsteroidal AntiInflammatory Drugs (NSAIDs) Mouth/Throat Preparations

Dosage 2 spray

Mode of Action Benzydamine belongs to a family of medicines known as nonsteroidal antiinflammatory drugs (NSAIDs). They work to reduce pain and inflammation in the body by reducing the production of hormone-like substances that promote the inflammatory response.

Indication Relief of painful conditions of the oral cavity including tonsillitis, sor e throat, radiation mucositis, aphthous ulcers, post-orosurgical & periodontal procedures; for pharyngitis, swelling & inflammatory conditions. DifflamC:Antiseptic.

Contraindica tion Severe hepatic or renal impairment. Sensitization reaction w/ soln. Appropriate antibacterial therapy should be considered in bacterial infection complication s. Excessive lozenge consumption may have laxative effect. Pregnancy.

Drug Interaction There are no known drug interactions with benzydamin e

Side Effects Oral, numbness; dryness or thirst, tingling, warm feeling in mouth, altered sense of taste.

Nursing Responsibilities Do not exceed 12lozenges a day. Do not take Difflam Sugar-Free Lozenges continuously for more than seven days