DRUG STUDY

DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
CONSIDERATION
Cefuroxime Cephalosporin  Upper and Cefuroxime is  diarrhea  Anaphylaxis   Patients with  Determine history of
(Ceftin) Antibiotic Lower bactericidal antibiotic.  difficulty  pseudomembr known allergy to hypersensitivity
respiratory Cefuroxime exerts breathing or anous colitis penicillins or reactions to
tract antibacterial activity swallowing   nausea and cephalosphorins cephalosporins,
by inhibition of penicillins, and history
 Skin and soft  Hives vomiting
bacterial cell wall of allergies, particularly
tissue synthesis in  itching  transient to drugs, before therapy
 UTI susceptible species.  severe skin rash elevation of is initiated.
 Bone & joint Cefuroxime has good  stomach pain liver enzymes  Inspect IM and IV
infections stability to several  upset stomach  injection sites
 Gonococcal bacterial beta-  vomitin frequently for signs of
infections. lactamase enzymes  wheezing phlebitis.
and, consequently, is  Report onset of loose
active against many stools or diarrhea.
penicillin-resistant or Although
ampicillin and pseudomembranous
amoxicillin-resistant colitis.
strains of susceptible  Monitor I&O rates and
species. pattern: Especially
important in severely ill
patients receiving high
doses. Report any
significant changes.

MCGL 7/26/10
 DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
CONSIDERATION

Ranitidine Histamine H2 Treatment and Inhibits the action of  Headache (may  Chest pain,  Hypersensitivity,  Assess patient for
antagonists prevention of histamine at the H2 be severe); fever, feeling Cross-sensitivity epigastric or abdominal
heartburn, acid receptor site located  Drowsiness, short of breath, may occur; some pain and frank or occult
indigestion, and primarily in gastric dizziness; coughing up oral liquids contain blood in the stool,
sour stomach parietal cells,  Sleep problems green or yellow alcohol and should emesis, or gastric
resulting in inhibition (insomnia); mucus; be avoided in aspirate.
of gastric acid  Decreased sex patients with known
secretion. drive, impotence,  Easy bruising or intolerance.  Nurse should know that
or difficulty bleeding,  Use Cautiously in: it may cause false-
having an unusual positive results for urine
orgasm; or weakness;  Renal impair- ment protein; test with
 Swollen or tender sulfosalicylic acid.
breasts (in men);  Fast or slow  Geriatric patients
 Nausea, heart rate; (more  Inform patient that it
vomiting, susceptible to may cause drowsiness
stomach pain; or  Problems with adverse CNS or dizziness.
 Diarrhea or your vision; reactions)
constipation.  Inform patient that
 Fever, sore  Pregnancy or increased fluid and fiber
throat, and Lactation intake may minimize
headache with a constipation.
severe
blistering,
 Advise patient to report
peeling, and red
onset of black, tarry
skin rash; or
stools; fever, sore
throat; diarrhea;
 Nausea, dizziness; rash;
stomach pain, confusion; or
low fever, loss of hallucinations to health
appetite, dark care professional
urine, clay- promptly.
colored stools,
jaundices
(yellowing of the  Inform patient that
skin or eyes). medication may
temporarily cause
stools and tongue to
appear gray black.

MCGL 7/26/10
 DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
CONSIDERATION

Metronidazole  cerebral Antibiotic effective  vomiting  CNS: seizures, hypersensitivity • Administer with food or
abscesses against anaerobic  diarrhea dizziness, milk to minimize GI
 intra-abdominal bacteria and certain  upset stomach headache irritation. Tablets may be
abscesses parasites. It  loss of appetite • GI: abdominal crushed for patients with
 gynecological selectively blocks  dry mouth; pain, anorexia, difficulty swallowing.
infections of the some of the functions sharp, nausea, • Instruct patient to take
pelvic organ within the bacterial unpleasant diarrhea, dry medication exactly as
 soft tissue cells and the metallic taste mouth, furry directed evenly spaced
infections parasites resulting in  dark or tongue, glossitis, times between dose, even if
 osteomyelitis their death. reddish- unpleasant feeling better. Do not skip
 colorectal and brown urine taste, vomiting doses or double up on
• Hematologic: missed doses. If a dose is
gynecological  furry tongue;
interventions leukopenia missed, take as soon as
mouth or
• Skin: rashes, remembered if not almost
tongue
urticaria time for next dose.
irritation
•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).

MCGL 7/26/10
 DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
CONSIDERATIO
N

Ketorolac Nonsteroidal anti- Short term It inhibit the  Headache Whole: hypersensitivity Hypersensitivity  Patients who
inflammatory management of prostaglandin  Abdominal reactions such as Cross-sensitivity with have asthma,
agents, nonopioid pain (not to exceed synthesis by pain (or anaphylaxis, anaphylactoid other NSAIDs may aspirin-induced
analagesics 5 days total for all competitive blocking stomach pain) reaction, laryngeal edema, exist¨Pre- or perioperative allergy, and nasal
routes combined) of  Nausea tongue edema (see Boxed use Known alcohol polyps are at
the enzyme cyclooxy WARNING, WARNINGS), intolerance increased risk for
 Heartburn or angioedema, myalgia.
genase (COX). Like indigestion Use cautiously in: developing
Cardiovascular: hypotensio
most NSAIDs,  Diarrhea 1) History of GI bleeding hypersensitivity
n and flushing.
ketorolac is a non-  Dizziness Dermatologic: Lyell’s 2) Renal impair-ment reactions. Assess
selective COX syndrome, Stevens-Johnson (dosage reduction may for rhinitis,
 Drowsiness
inhibitor. syndrome, exfoliative be required) asthma, and
 Swelling.
dermatitis, maculo-papular 3) Cardiovascular urticaria.
 High blood rash, urticaria. disease Assess pain (note
pressure (hy Gastrointestinal: peptic type, location,
pertension) ulceration, G.I. hemorrhage, and intensity)
 Itching G.I. perforation (see Boxed
prior to and 1-2 hr
 Unexplained WARNING, WARNINGS),
following
rash melena, acute pancreatitis,
hematemesis, esophagitis. administration.
 Constipation  Ketorolac therapy
Hemic and
 Vomiting Lymphatic: postoperative should always be
 Sweating wound hemorrhage rarely given initially by
requiring blood transfusion the IM or IV
(see Boxed WARNING, route. Oral
WARNINGS and therapy should be
PRECAUTIONS),
thrombocytopenia,
used only as a
leukopenia. continuation of
Hepatic: hepatitis, liver parenteral
failure, cholestatic jaundice. therapy.
Nervous - Caution patient
System: convulsions, to avoid
psychosis, aseptic concurrent use of
meningitis. alcohol, aspirin,
Respiratory: asthma, NSAIDs,
bronchospasm.
Urogenital: acute renal
acetaminophen,
failure (see Boxed or other OTC
WARNING, WARNINGS), medications
without consulting
MCGL 7/26/10
 flank pain with or without health care
hematuria and/or azotemia, professional.
nephritis, hyponatremia, - Advise patient
hyperkalemia, hemolytic to consult if rash,
uremic syndrome itching, visual
 disturbances,
tinnitus, weight
gain, edema,
black stools,
persistent
headche, or
influenza-like
syndromes
(chills,fever,muscl
es 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.

MCGL 7/26/10
DRUG NAME CLASSIFICATIO INDICATION ACTION SIDE ADVERSE CONTRAINDICATION NURSING CONSIDERATION
N EFFECTS EFFECT
Tramadol Analgesics Moderate to  modulation of Nausea, Seizure Hypersensitivity. Acute Assess type, location, and intensity of pain before
(centrally acting) moderately serotonin and dizziness, intoxication with and 2-3 hr (peak) after administration.
severe pain norepinephrine in somnolence alcohol, hypnotics, • Assess BP & RR before and periodically during
addition to its mild sweating narcotics, centrally- administration. Respiratory depression has not
agonism of the μ-  constipation. acting analgesics occurred with recommended doses.
opioid receptor. • Assess bowel function routinely. Prevention of
The contribution of constipation should be instituted with increased
non-opioid activity intake of fluids and bulk and with laxatives to
is demonstrated minimize constipating effects.
by the fact that the • Assess previous analgesic history. Tramadol is
analgesic effect of not recommended for patients dependent on
tramadol is not opioids or who have previously received opioids for
fully antagonised more than 1 wk; may cause opioid withdrawal
by the μ-opioid symptoms.
receptor • Prolonged use may lead to physical and
antagonist naloxo psychological dependence and tolerance, although
ne. these may be milder than with opioids. This should
not prevent patient from receiving adequate
analgesia. Most patients who receive tramadol for
pain d not develop psychological dependence. If
tolerance develops, changing to an opioid agonist
may be required to relieve pain.
• Tramadol is considered to provide more analgesia
than codeine 60 mg but less than combined aspirin
650mg/codeine 60 mg for acute postoperative pain.
• Monitor patient for seizures. May occur within
recommended dose range. Risk increased with
higher doses and inpatients taking antidepressants
(SSRIs, tricyclics, or Mao inhibitors), opioid
analgesics, or other durgs that decrese the seizure
threshold.
• Overdose may cause respiratory depression and
seizures. Naloxone (Narcan) may reverse some,
but not all, of the symptoms of overdose.
Treatment should be symptomatic and supportive.
Maintain adequate respiratory exchange.
• Encourage patient to cough and breathe deeply
every 2 hr to prevent atelactasis and pneumonia.

DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
MCGL 7/26/10
 CONSIDERATION

Hyoscine Butyl- Butylscopolamine Paroxysmal pain It relax the muscle  Dry mouth.  rash, G6PD deficiency,
Brumide and analgesics; in that is found in the  Blurred vision.  itching, known
antispasmodic diseases of the walls of the stomach,  Reduced ability  swelling of the hypersensitivity to
stomach or intestines and bile to sweat. hands or feet, paracetamol.
intestine, spastic duct (gastrointestinal  Increase in heart  trouble
pain in the biliary tract) and the rate breathing,
& urinary tracts reproductive organs (tachycardia).  increased pulse,
& female genital and urinary tract  Constipation.  dizziness,
organs (genitourinary tract).  Difficulty in  diarrhea,
 passing urine  vision problems,
(urinary  eye pain. 
retention).
 Allergic skin
reactions.

DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING
CONSIDERATION

Oxacillin Penicillin beta-  Treatment of By binding to  Mild diarrhea,  Fever  Allergic to  Advise the patient to
(Bactocill) lactam antibiotic infections caused specific penicillin-  nausea, or  Rash penicillins, take the medicine with
by penicillinase binding proteins vomiting;  Diarrhoea cephalosporins, a full glass of water.
(PBPs) located  Swelling or  Nausea or other
producing Advise the client to take
inside the bacterial redness at the  Vomiting allergens.
staphylococci cell wall, Oxacillin the Oxacillin on an
injection site.  Agranulocytosi  Use cautiously
which have inhibits the third  Eosinophilia empty stomach, at least
with renal
demonstrated and last stage of  Leukopenia 1 hour before or 2
disorders,
susceptibility to bacterial cell wall  Neutropenia, hours after eating a
pregnancy,
synthesis. Cell lysis  Thrombocytopenia meal.
the drug.  lactation (may
is then mediated by  AST
 Increased,
cause diarrhea or
bacterial cell wall
hepatotoxicity; candidiasis in
autolytic enzymes
 Acute interstitial infants).
such as autolysins;
it is possible that  Nephritis,
Oxacillin interferes  Haematuria;
 Serum
with an autolysin
sickness-like
inhibitor. reactions.
DRUG NAME CLASSIFICATION INDICATION ACTION SIDE EFFECTS ADVERSE EFFECT CONTRAINDICATION NURSING

MCGL 7/26/10
 CONSIDERATION
Diclofenac Nonsteroidal anti-  musculoskeletal Taken to  Gastrointestin    Abnormal renal  Hypersensitivity  Evaluate therapeutic
inflammatory drugs complaints, reduce inflammatio al problems function, against diclofenac response by assessing
 dental pain,  n and as including  anemia,  History of pain, joint stiffness, joint
 TMJ,  an analgesic reduci ulceration.  dizziness, allergic reactions swelling and mobility.
ng pain in  edema, (bronchospasm,  Assess any worsening
 spondylarthritis, 
conditions  Hypersensitivit  elevated liver shock, rhinitis, of asthma in
 ankylosing urticaria) following
y reactions. enzymes, appropriate patients.
spondylitis,  the use of Aspirin or
 Headache.  headaches,  Regular full dosage has
 gout attacks,
 Dizziness. another NSAID both lasting analgesic
 increased bleeding
 pain  Depression.  Third-trimester and anti-inflammatory
time,
management   Drowsiness. pregnancy effects, making it useful
 pruritus,
 Active stomach for continuous pain
 Sleeping  rashes and/or duodenal associated with
problems.  tinnitus. ulceration or inflammation.
 Hearing
gastrointestinal  Nurses should refer to
disturbance.
bleeding manufacturer's
 Photosensitivit  Inflammative
y. summary of product
intestinal disorders characteristics and to
 Haematuria. such as Crohn's appropriate local
 Fluid disease or ulcerative guidelines.
retention. colitis
 Raised blood  Severe
pressure. insufficiency of the
 Papillary heart (NYHA III/IV)
necrosis.  Recently, a
 Hepatic warning has been
damage. issued by FDA not
 Alveolitis. to use to treat
 Pulmonary patients recovering
eosinophilia. from heart surgery
 Pancreatitis.  Severe liver
insufficiency (Child-
Pugh Class C)
 Severe renal
insufficiency
(creatinine
clearance <30
ml/min)
 Caution in
patients with
preexisting hepatic
MCGL 7/26/10
 porphyria, as
diclofenac may
trigger attacks
 Caution in
patients with severe,
active bleeding such
as cerebral
hemorrhage
 NSAIDs in
general should be
avoided
during dengue fever.

MCGL 7/26/10
MCGL 7/26/10