Name Indication Action Adverse Reaction Nursing Responsibilities

Mupirocin >This medication is >It works by stopping >Contraindicated in patients >Mupirocin ointment is for external use only. Do not get
Ointment an antibiotic, production of essential with hypersensitivity to the in eyes or mouth
prescribed for proteins needed for bacterial drug >Use Mupirocin Ointment with caution on skin with open
impetigo. surveillance. wounds
>It is not effective >Be sure to use the drug for the full course of treatment
against fungal or viral >Long term or repeated use of Mupirocin ointment may
infections cause second infection
>Apply a small amount of ointment 3x a day
>Wash and completely dry the affected area. Gently rub
the medicine in until it is evenly distributed. The affected
area may be covered with gauze or bandage
>Wash hands immediately after using the ointment
TRAMADOL Analgesic Binds to -opiatereceptors in Hypersensitivity to tramadol, >Instruct client to report any adverse reaction to
Management of pain the CNS causing inhibition opioids, or any component of the physician or nurse. Tell patient that tolerance or drug
in the operation site. of ascending pain pathways, the formulation; opioid- dependence may result from extended use (withdrawal
altering the perception of and dependent patients; acute symptoms have been reported); abrupt discontinuation
response to pain; also inhibits intoxication with alcohol, should be avoided.
the reuptake hypnotics, centrally-acting >
of norepinephrine and analgesics, opioids, You should not take Ultram if you have ever been
serotonin, which also modifies or psychotropic drugs addicted to drugs or alcohol. Should be used only with
the ascending pain pathway. extreme caution in patients receiving MAO inhibitors

Paracetamol  Mild Pain  Inhibits the synthesis BEFORE DRUG ADMINISTRATION:

 Fever of prostaglandins GI: HEPATIC FAILURE,  Assess overall health status and alcohol usage
that may serve as HEPATOXICITY before administering.
mediators of pain GU: renal failure  Assess amount, frequency and type of drugs
and fever, primarily DERM: rash, urticaria taken in patients self-medicating.
in the CNS  Pain: Assess type, location and intensity prior or
 Has no significant to and 30-60 min following administration
anti –inflammatory  Fever: Assess fever; note presence of associate
properties or GI signs.
toxicity DURING DRUG ADMINISTRATION
Therapeutic Effects  General: When combined with opiods do not
 Analgesia exceed the maximum recommended daily dose
Antipyresis of drug.
 PO: Administer with a full glass of water.
 May be taken with food or an empty stomach
AFTER DRUG ADMINISTRATION
  Advise pt. to take medication exactly as directed
and not to take more than the recommended
amount.
 Advise pt. to avoid alcohol if taking more than an
occasional 1-2 doses and to avoid taking
concurrently with salicylates or NSAIDs for more
than a few days.
 Inform patients with diabetes that
acetaminophen may alter results of blood
glucose monitoring.
 Caution pt. to check labels on all OTC products.

 To prevent  Albuterol attaches to Adverse Reactions CNS: Administer pressurized inhalations of albuterol during
Sabutamol exercise- beta 2 receptors on Anxiety, dizziness, drowsiness, second half of inspiration, when airways are open wider
Sulfate induced bronchial cell headache, hyperkinesia, and aerosol distribution is more effective. WARNING Use
asthma membranes, which insomnia, irritability, cautiously in patients with cardiac disorders, diabetes
 To treat stimulates the nervousness, tremor, vertigo, mellitus, digitalis intoxication, hypertension,
bronchospas intracellular enzyme weakness CV: Angina; hyperthyroidism, or history of seizures.Albuterol can
m in adenylate cyclase to arrhythmias, including atrial worsen these conditions.
patients convert adenosine fibrillation, extrasystoles, •Monitor serum potassium level because albuterol may
with triphosphate (ATP) to supraventricular cause transient hypokalemia. •Be aware that drug
reversible cyclic adenosine tachycardia,and tolerance can develop with prolonged use. PATIENT
obstructive monophosphate tachycardia;chest pain; TEACHING •Teach patient to use inhaler.Tell him to shake
airway (cAMP). This reaction hypertension; hypotension; canister before use and to check that a new canister is
disease or decreases palpitations EENT: Altered working by spraying it the appropriate number of times
acute intracellular calcium taste,dry mouth and throat, (once to four times based on manufacturer instructions)
bronchospas levels. It also ear pain, glossitis, hoarseness, into the air while looking for a fine mist. •Instruct patient
tic attack increases oropharyngeal edema, to wash mouthpiece with water once a week and let it air-
intracellular levels of pharyngitis, rhinitis, taste dry. •Advise patient to wait at least 1 minute between
cAMP, as shown. perversion inhalations. •Tell patient to check with his prescriber
Together, these ENDO:Hyperglycemia before using other inhaled drugs. •Warn patient not to
effects relax GI:Anorexia, diarrhea, exceed prescribed dose or frequency. If doses become
bronchial smooth- dysphagia, heartburn, nausea, less effective,tell patient to contact his prescriber. •Tell
muscle cells and vomiting GU:UTI MS: Muscle patient to immediately report signs and symptoms of
inhibit histamine cramps RESP: Bronchospasm, allergic reaction, such as difficulty swallowing,itching,and
release. cough, dyspnea, paradoxical rash.
bronchospasm,pulmonary
edema SKIN: Diaphoresis,
flushing, pallor, pruritus, rash,
urticaria Other: Angioedema,
 hypokalemia, infection,
metabolic acidosis
ipratropium  To treat  After acetylcholine is CNS: Dizziness, insomnia
bromide bronchitis released from CV: Atrial fibrillation (oral
and COPD cholinergic fibers, inhalation), bradycardia (nasal
ipratropium prevents spray), edema, hypertension,
it from attaching to palpitations, supraventricular
muscarinic receptors tachycardia (oral
on membranes of inhalation),tachycardia
smooth-muscle cells, EENT: Acute eye pain,dry
as shown at right. By mouth or pharyngeal area,
blocking laryngospasm, taste perversion
acetycholine’s effects (all drug forms);blurred
in bronchi and vision,eye irritation and pain,
bronchioles, glaucoma or worsening of
ipratropium relaxes existing glaucoma (if nasal
smooth muscles and spray comes in contact with
causes eyes); epistaxis, mydriasis,
bronchodilation. nasal dryness and irritation,
pharyngitis, rhinitis, sinusitis,
tinnitus (with nasal spray)
GI:Bowel obstruction,
constipation, diarrhea, ileus,
nausea, vomiting GU:
Prostatitis, urine retention
MS: Arthritis
RESP:Bronchitis,
bronchospasm, cough,
dyspnea, increased sputum
production, wheezing
SKIN:Dermatitis, pruritus, rash,
urticarial
Other: Anaphylaxis,
angioedema, flulike symptoms
KETOROLAC >To treat moderate Blocks cyclooxygenase, an >Advanced renal impairment
to severe pain. enzyme needed to synthesize or risk of renal impairment due
prostaglandins. to volume depletion; before or
Prostaglandins mediate during surgery if homeostasis is
inflammatory response and critical; breastfeeding;
cause local vasodilation, cerebrovascular bleeding,
•Use ipratropium cautiously in patients with angle-
closure glaucoma, benign prostatic hyperplasia,or bladder
neck obstruction and in patients with hepatic or renal
dysfunction.
•As prescribed, mix ipratropium inhalation solution with
preservative-free albuterol, and preservative-free
ipratropium inhalation solution with cromolyn inhalation
solution. Use within 1 hour.
•When using a nebulizer, apply a mouthpiece to prevent
drug from leaking out around mask and causing blurred
vision or eye pain. PATIENT TEACHING •Caution patient
not to use ipratropium to treat acute bronchospasm.
•Inform patient that although some people feel relief
within 24 hours of drug use, maximum effect may take up
to 2 weeks.
•Teach patient to use inhaler or nasal spray.
Tell him to shake inhaler well at each use.
•Advise patient to keep spray out of his eyes because it
may irritate them or blur his vision. If spray comes in
contact with eyes, instruct patient to flush them with cool
tap water for several minutes and to contact prescriber.
•Instruct patient to rinse mouth after each nebulizer or
inhaler treatment to help minimize throat dryness and
irritation.
•If patient is using 0.06% nasal spray for a common cold,
advise against use for longer than 4 days.
•Teach patient to track canister contents by counting and
recording number of doses.
•Advise patient to report decreased response to
ipratropium as well as difficulty voiding, eye pain, nasal
dryness, nose bleeds, palpitations, and vision changes.
>>Read ketorolac label carefully. Don’t use IM form for IV
route. Know that ketorolac isn’t for intrathecal or epidural
use.
>Inject IM ketorolac slowly, deep into a large muscle
mass. Monitor site for bleeding, bruising, or hematoma.
>Give IV injection over at least 15 seconds.
 swelling and pain. They also concurrent use of aspirin or
promote pain transmission other salicylates, other NSAIDs
from periphery to spinal cord. or probenecid; history of GI
By blocking cyclooxygenase bleeding;hypersensitivity to
and inhibiting prostaglandins, ketorolac.
this NSAID reduces
inflammation and relieves
pain.
diphenhydram  To treat Binds to central and CNS:Confusion, dizziness, Expect to give parenteral form ofdiphenhydramine only
ine hypersensiti peripheral H1 drowsiness CV: Arrhythmias, when oral ingestion isn’t possible. •Keep elixir container
hydrochloride. vity receptors,competing with palpitations, tachycardia EENT: tightly closed. Protect elixir and parenteral forms from
reactions,su histamine for these sites and Blurred vision, diplopia light. •Expect to discontinue drug at least 72 hours before
ch as preventing it from reaching its GI:Epigastric distress, nausea skin tests for allergies because drug may inhibit
perennial site of action. By blocking HEME: cutaneous histamine response, thus producing false-
and histamine, diphenhydramine Agranulocytosis,hemolytic negative results. PATIENT TEACHING •Instruct patient to
seasonal produces antihistamine anemia, thrombocytopenia take diphenhydramine at least 30 minutes before
allergic effects, inhibiting respiratory, RESP: Thickened bronchial exposure to situations that may cause motion sickness.
rhinitis, vascular, and GI smooth- secretions SKIN: •Advise her to take drug with food to minimize GI
vasomotor muscle contraction; Photosensitivity distress. •Urge patient to avoid alcohol while taking
rhinitis, decreasing capillary diphenhydramine. •Instruct her to use sunscreen to
allergic permeability, which reduces prevent photosensitivity reactions. •Advise patient to
conjunctiviti wheals, flares, and itching; avoid taking other OTC drugs that contain
s, and decreasing salivary and diphenhydramine to prevent additive effects.
uncomplicat lacrimal gland secretions.
ed allergic Diphenhydramine produces
skin antidyskinetic effects,possibly
eruptions, by inhibiting acetylcholine in
and the CNS. It also produces
transfusion antitussive effects by directly
reactions suppressing the cough center
in the medulla oblongata in
the brain. Diphenhydramine’s
antiemetic and antivertigo
effects may be related to its
ability to bind to CNS
muscarinic receptors and
depress vestibular stimulation
and labyrinthine function. Its
sedative effects are related to
its CNS depressant action..
Acetazolamid > To treat chronic >Inhibits the enzyme carbonic >Hypersensitivity to the drug, >Use drug cautiously in patients with calcium-based renal
e simple glaucoma anhydrase, which normally chronic non-congestive closed- calculi, diabetes mellitus, gout, or respiratory impairment
appears in the eyes’ ciliary angle glaucoma; cirrhosis; >Know that the drug may increase risk of hepatic
processes, brain’s choroid hyperchloremic acidosis, encephalopathy in patients with hepatic cirrhosis
plexus, and kidneys’ proximal hypokalemia; hyponatremia; >To avoid painful IM injections (caused by alkaline
tubule cells. In the eyes, severe pulmonary obstruction; solution), give acetazolamide by mouth or IV injection if
enzyme inhibition decreases severe renal, hepatic or possible
aqueous, humor secretion, adrenocortical impairment. >Monitor blood tests during drug therapy to detect
which lowers intraocular electrolyte imbalances
pressure. >Inform patient that acetazolamide tablets may crushed
and suspended in chocolate or another sweet syrup. Or,
one tablet may be dissolved in 10 ml hot water and added
to 10 ml honey or syrup.
>Advised patient to avoid hazardous activities if dizziness
or drowsiness occurs
Co-amoxiclav >Known or suspected >It destroys bacteria by >History of penicillin >Assess bowel patterns before and during treatment as
amoxicillin-resistant disrupting their ability to from hypersensitivity, pseudomembranous colitis may occur
infections including cell walls. superinfections involving >Report hematuria or Oliguria as high doses can be
respiratory tract, skin pseudomonas or candida, nephrotoxic
and soft tissue, pregnancy and lactation >Assess respiratory status
genitourinary, and >Observe for anaphylaxis
ear and nose and >Ensure that the patient has adequate fluid intake during
throat infections. any diarrhea attack
OMEPRAZOLE Antiulcer Omeprazole interferes with >Hypersensitivity to >Give omeprazole before meals preferably in the morning
>To treat GERD gastric acid secretion by omeprazole, other proton for once a day dosing.
without esophageal inhibiting the hydrogen- pump inhibitors, or their >To give drug via NGT, mix granules in acidic juice
lesions, to prevent potassium-adenosine components. because enteric coating dissolves in alkaline pH.
erosive esophagitis triphosphatase enzyme >Be aware of the long term use of omeprazole may
>To treat GERD with system or proton pump, in increase the risk for gastric carcinoma.
erosive esophagitis. gastric parietal cells.
> To provide short
term treatment of
active benign gastric
ulcer.
Hydrocortison  To treat  Binds to intracellular CNS: Ataxia, behavioral •Systemic hydrocortisone shouldn’t be given to
e severe glucocorticoid changes, depression, dizziness, immunocompromised patients, such as those with fungal
inflammatio receptors and euphoria, fatigue, headache, and other infections, including amebiasis, hepatitis B,
n or acute suppresses increased intracranial pressure tuberculosis, vaccinia, and varicella.
adrenal inflammatory and with papilledema, insomnia,
insufficiency immune responses malaise, mood changes,
by: •inhibiting paresthesia, seizures, steroid
neutrophil and psychosis, syncope, vertigo
monocyte CV:Arrhythmias (from
accumulation at hypokalemia), fat embolism,
inflammation site heart failure, hypertension,
and suppressing their hypotension,
phagocytic and thromboembolism,
bactericidal activity thrombophlebitis
•stabilizing lysosomal EENT: Exophthalmos,
membranes glaucoma, increased
•suppressing antigen intraocular pressure,
response of nystagmus, posterior
macrophages and subcapsular cataracts
helper T cells ENDO: Adrenal insufficiency
•inhibiting synthesis during stress, cushingoid
of cellular mediators symptoms (buffalo hump,
of inflammatory central obesity, moon face,
response, such as supraclavicular fat pad
cytokines, enlargement), diabetes
interleukins, and mellitus, growth suppression in
prostaglandins. children, hyperglycemia,
negative nitrogen balance from
protein catabolism
GI: Abdominal
distention;hiccups; increased
appetite; nausea; pancreatitis;
peptic ulcer; rectal
abnormalities, such as
bleeding, blistering, burning,
itching, or pain (rectal form);
ulcerative esophagitis;
vomiting
GU: Amenorrhea, glycosuria,
menstrual irregularities,
perineal burning or tingling
HEME: Easy
bruising,leukocytosis
MS: Arthralgia;aseptic necrosis
offemoral and humeral heads;
compression fractures; muscle
•Give daily dose of hydrocortisone in morning to mimic
normal peak in adrenocortical secretion of
corticosteroids.
•When possible, give oral dose with food or milk to avoid
GI distress.
•Don’t give acetate injectable suspension by I.V. route.
•Give hydrocortisone sodium succinate as a direct I.V.
injection over 30 seconds to several minutes, or as an
intermittent or a continuous infusion.For infusion,dilute
to 1 mg/ml or less with D5W, normal saline solution, or
dextrose 5% in normal saline solution.
•Inject I.M. form deep into gluteal muscle, and rotate
injection sites to prevent muscle atrophy. Subcutaneous
injection may cause atrophy and sterile abscess.
•Shake foam container vigorously for 5 to 10 seconds
before each use. Gently withdraw applicator plunger past
the fill-line on the applicator barrel while container is
upright on a level surface.Administer rectal foam only
with provided applicator. After each use, wash applicator,
container cap, and underlying tip with warm water.
•High-dose therapy shouldn’t be given for longer than 48
hours. Be alert for depression and psychotic episodes.
•Monitor weight, blood pressure, and electrolyte levels
regularly during therapy.
•Expect hydrocortisone to worsen infections or mask
signs and symptoms.
•Monitor blood glucose level in diabetic patients, and
increase insulin or oral antidiabetic drug dosage, as
prescribed.
•Know that elderly patients are at high risk for
osteoporosis during long-term therapy.
•Anticipate the possibility of acute adrenal insufficiency
with stress, such as emotional upset,fever,surgery,or
trauma.Increase hydrocortisone dosage, as prescribed.
WARNING Avoid withdrawing drug suddenly after long-
term therapy because adrenal crisis can result.Expect to
reduce dosage gradually and monitor response.
PATIENT TEACHING
•Advise patient to take daily dose of hydro
cortisone at 9 a.m.
 atrophy, twitching, or
weakness;
myalgia;osteoporosis;spontane
ous fractures; steroid
myopathy; tendon rupture
SKIN: Acne; altered skin
pigmentation; diaphoresis;
erythema; hirsutism;
necrotizing vasculitis;
petechiae; purpura; rash;
scarring; sterile abscess; striae;
subcutaneous fat
atrophy;thin,fragile
skin;urticaria Other:
Anaphylaxis, hypocalcemia,
hypokalemia, hypokalemic
alkalosis, impaired wound
healing, masking of signs of
infection, metabolic alkalosis,
suppressed skin test reaction,
weight gain
TRANEXAMIC Anti-fibrinolytic, Displaces plasminogen from > Active thromboembolic
ACID antihemorrhagic surface of fibrin by binding to disease; history or intrinsic risk
>To treat cyclic heavy high affinity lysine site of of thrombosis or
menstrual bleeding. plasminogen. This diminishes thromboembolism, including
dissolution of hemostatic retinal vein or artery occlusion;
fibrin, which decreases hypersensitivity to tranexamic
bleeding acid or its components.
piperacillin To treat moderate to  Binds to specific CNS: Dizziness, fever,
sodium severe bacterial penicillin-binding hallucinations, headache,
infections, including proteins and inhibits lethargy, seizures, stroke
bone and joint the third and final CV: Cardiac arrest,
infections, stage of bacterial cell hypotension, palpitations,
gynecologic wall synthesis by tachycardia, vasodilation,
infections, interfering with an vasovagal reactions EENT: Oral
intraabdominal autolysin inhibitor. candidiasis, pharyngitis GI:
infections, lower Uninhibited autolytic Diarrhea, epigastric distress,
respiratory tract enzymes destroy the intestinal necrosis, nausea,
•Instruct patient to take tablets or oral suspension with
milk or food.
•Teach patient how to use foam or enema form, if
prescribed. •Caution patient not to stop drug abruptly
without first consulting prescriber.
•Instruct patient to report early evidence of adrenal
insufficiency: anorexia, difficulty breathing, dizziness,
fainting, fatigue, joint pain, muscle weakness, and nausea.
•Inform patient that he may bruise easily.
•Advise patient on long-term therapy to have periodic
eye examinations.
•If patient receives long-term therapy, urge her to carry
or wear medical identification.
•Caution patient to avoid people with infections because
drug can suppress immune system, increasing risk of
infection. If patient comes into contact with chickenpox
or measles,instruct him to call prescriber because he may
need prophylactic care.
> Tranexamic acid therapy isn’t recommended for women
who use hormonal contraceptives or who take factor IX
complex concentrates or anti-inhibitor coagulant
concentrated because of the increased risk of
thromboembolism.
>Use tranexamic acid cautiously in patients with acute
promyelocytic leukemia taking oral tretenoin for
remission induction because of possible exacerbation of
the pro coagulant effect of tretenoin.
Expect to obtain blood,sputum,or other samples for
culture and sensitivity testing before giving piperacillin
and to start therapy before results are available.
•Be aware that sunlight may darken piperacillin powder
for dilution but won’t alter drug potency.
•For initial dilution for I.V. infusion, reconstitute each
gram of drug with at least 5 ml sterile water for injection,
sodium chloride for injection, D5W,dextrose 5% in normal
saline solution, or bacteriostatic water that contains
parabens or benzyl alcohol. Shake solution vigorously
 infections, cell wall and result in pseudomembranous colitis, after adding diluent, and inspect for particles and
septicemia, and skin cell lysis. vomiting discoloration before giving.
and soft-tissue GU: Hematuria, impotence, •For further dilution, use sodium chloride for
infections, caused by nephritis, neurogenic bladder, injection,D5W, dextrose 5% in normal saline solution,
susceptible strains of priapism, proteinuria, renal lactated Ringer’s solution, or dextran 6% in normal saline
Acinetobacter failure, vaginal candidiasis solution. Solutions diluted with lactated Ringer’s solution
species, anaerobic HEME: Agranulocytosis, should be given within 2 hours. •For intermittent
cocci, Bacteroides eosinophilia, hemolytic infusion, infuse appropriate dose over 20 to 30 minutes.
species, Enterobacter anemia, leukopenia, •Give aminoglycosides 1 hour before or after piperacillin;
species, Escherichia neutropenia, pancytopenia, use a separate site, I.V. bag, and tubing.
coli, Haemophilus prolonged bleeding time, •For I.M. injection, reconstitute each gram of piperacillin
influenzae, Klebsiella thrombocytopenia with at least 2 ml of an appropriate diluent listed above.
species, Proteus MS: Arthralgia •Don’t give more than 2 g I.M. in one site. Use deltoid
species, RESP: Dyspnea, pulmonary area cautiously and only if well developed to avoid
Pseudomonas embolism, pulmonary injuring radial nerve.
aeruginosa, and hypertension •Watch for bleeding or excessive bruising because drug
Serratia species SKIN: Exfoliative dermatitis, can decrease platelet aggregation, especially in patients
mottling, rash, toxic epidermal with renal failure. If bleeding occurs, notify prescriber and
necrolysis, urticaria Other: expect to stop piperacillin.
Anaphylaxis;facial •Monitor CBC regularly, as ordered, to detect
edema;hypokalemia; hematologic abnormalities, such as leukopenia and
hyponatremia; injection site neutropenia. •Monitor serum potassium level to detect
pain, phlebitis, and skin ulcer; hypokalemia from urinary potassium loss.
superinfection •Check for diarrhea during and after therapy because it
may indicate pseudomembranous colitis caused by
Clostridium difficile. If diarrhea occurs, notify prescriber
and expect to withhold piperacillin and treat with fluids,
electrolytes, protein, and an antibiotic effective against C.
difficile.
•Watch for hypersensitivity reactions, especially if
patient has cystic fibrosis. Notify prescriber,and expect to
stop drug.
ceftriaxone To treat infections of Interferes with bacterial cell CNS:Chills, fever, headache, WARNING Calcium-containing products must not be given
sodium the lower respiratory wall synthesis by inhibiting hypertonia, reversible I.V. within 48 hours of ceftriaxone, including solutions
tract, skin, soft cross-linking of peptidoglycan hyperactivity, seizures given through a different I.V.line and at a different site,
tissue, urinary tract, strands. Peptidoglycan makes CV:Edema EENT:Glossitis, because a ceftriaxone-calcium salt may precipitate in the
bones, and joints; the cell membrane rigid and hearing loss, stomatitis lungs and kidneys and could be fatal.
sinusitis; protective.Without it, GI:Abdominal cramps, •Use ceftriaxone cautiously in patients who are
intraabdominal bacterial cells rupture and die. cholestasis, diarrhea, elevated hypersensitive to penicillins because cross-sensitivity has
infections; and liver function test results, occurred in about 10% of such patients.
septicemia caused by gallbladder dysfunction, •If possible, obtain culture and sensitivity results, as
anaerobes (including hepatic failure, hepatomegaly, ordered, before giving drug.
Bacteroides bivius, nausea, oral candidiasis, •Protect powder from light.
Bacteroides fragilis, pancreatitis, pseudolithiasis, •For I.V. use, reconstitute with an appropriate diluent,
Bacteroides pseudomembranous colitis, such as sterile water for injection or sodium chloride for
melaninogenicus, vomiting injection, as
and GU: Elevated BUN follows: for 250-mg vial, add 2.4 ml; for 500-mg vial, add
Peptostreptococcus level,nephrotoxicity, oliguria, 4.8 ml; for 1-g vial, add 9.6 ml; and for 2-g vial, add 19.2
species), renal failure, vaginal ml to yield 100 mg/ml. For piggyback bottles, reconstitute
gramnegative candidiasis with 10 ml of diluent indicated above for 1-g bottle and
organisms (including HEME: Aplastic anemia, 20 ml for 2-g bottle.After reconstitution, further dilute to
Citrobacter species, eosinophilia, hemolytic 50 to 100 ml with diluent indicated above and infuse over
Enterobacter anemia,hemorrhage,hypoproth 30 minutes. WARNING Never give ceftriaxone by I.V.
aerogenes, rombinemia, neutropenia, infusion and calcium-containing IV solutions at the same
Escherichia thrombocytopenia,unusual time, including such continuous calcium-containing
coli,Haemophilus bleeding infusions as parenteral nutrition via Y-site. For patients
influenzae, Klebsiella MS: Arthralgia RESP:Allergic other than neonates, ceftriaxone and calcium-containing
species, Neisseria pneumonitis,dyspnea solutions may be given sequentially if infusion lines are
species, Proteus SKIN:Allergic dermatitis, thoroughly flushed with a compatible fluid between
mirabilis, Proteus ecchymosis, erythema, infusions.
vulgaris, Providencia erythema multiforme, •For I.M. administration, reconstitute with an appropriate
species, Salmonella exanthema, pruritus, rash, diluent, such as sterile water for injection or sodium
species, Serratia Stevens-Johnson syndrome, chloride for injection, as follows: for 250-mg vial, add 0.9
marcescens, Shigella, toxic epidermal necrolysis, ml; for 500-mg vial, add 1.8 ml; for 1-g vial, add 3.6 ml;
and some strains of urticarial and for 2-g vial, add 7.2 ml to make a 250-mg/ml
Pseudomonas Other:Anaphylaxis; drug fever; concentration.Shake well.Inject deep into large muscle
aeruginosa), and injection site pain,redness, and mass, such as the gluteus maximus.
gram-positive swelling; serum sickness; •Monitor BUN and serum creatinine levels to detect early
organisms (including superinfection signs of nephrotoxicity. Also monitor fluid intake and
Staphylococcus output; decreasing urine output may indicate
aureus, nephrotoxicity.
Streptococcus •Monitor patient for allergic reactions a few days after
pneumoniae, and therapy starts.
Streptococcus •Assess CBC, hematocrit,and serum AST, ALT, bilirubin,
pyogenes) LD, and alkaline phosphatase levels during long-term
therapy. If abnormalities occur, notify prescriber. Drug
may need to be discontinued.
•Assess bowel pattern daily; severe diarrhea may
indicate pseudomembranous colitis caused by Clostridium
difficile. If diarrhea occurs, notify prescriber and expect to
 withhold cefotaxime and treat with fluids,
electrolytes,protein,and an antibiotic effective against C.
difficile.
•Monitor patient for evidence of gallbladder disease
(abdominal pain, nausea, vomiting) because drug may
cause ceftriaxonecalcium salt to deposit in the
gallbladder, which may mimic gallstones. Expect drug to
be discontinued if gallbladder disorders arise.
Levofloxacin >To treat mild to >Interferes with bacterial cell >Contraindicated in patients >Use drug cautiously in patients with renal insufficiency.
moderate skin and replication by inhibiting the hypersensitive to drug, other >Monitor renal function as appropriate drug treatment
soft tissue infections bacterial enzyme DNA gyrase, fluoroquinolones, or their >Use drug cautiously in patients with CNS disorders, such
caused by S. Aureus which is essential for components; myasthenia as epilepsy, that may lower the seizure threshold. Also
or S. Pyogenes replication and repair of gravis use cautiously in patients taking corticosteroids especially
bacterial DNA. elderly patients, because of increased risk of tendon
rupture.
>Expect to obtain culture and sensitivity tests before
levofloxacin treatment begins
>Know that levofloxacin therapy should begin as soon as
possible after suspected or confirmed exposure to Y.
pestis
>Avoid giving drug within 2 hours of antacids
>Monitor blood glucose level, especially in diabetic
patient who takes an oral antidiabetic or uses an insulin,
because levofloxacin may alter blood glucose level.
Digoxin  To treat  Increases the force CNS: Confusion, depression, •Give parenteral digoxin undiluted,or dilute with a
heart and velocity of drowsiness, extreme fourfold or greater volume of sterile water for injection,
failure, atrial myocardial weakness,headache,syncope normal saline solution,or D5W for I.V.administration.
flutter, atrial contraction, resulting CV:Arrhythmias, heart block Once diluted, give immediately. Discard if solution is
fibrillation, in positive inotropic EENT: Blurred vision, colored markedly discolored or contains precipitate.
and effects. Digoxin halos around objects •Before giving each dose, take patient’s apical pulse and
paroxysmal produces GI: Abdominal discomfort or notify prescriber if it’s below 60 beats/minute (or other
atrial antiarrhythmic pain, anorexia, diarrhea, specified level).
tachycardia effects by decreasing nausea, vomiting •Monitor patient closely for signs of digitalis toxicity, such
with rapid the conduction rate Other:Electrolyte imbalances as altered mental status, arrhythmias,heart
digitalization and increasing the block,nausea,vision disturbances, and vomiting. If they
effective refractory appear, notify prescriber,check serum digoxin level as
period of the AV ordered,and expect to withhold drug until level is
node. known.Monitor ECG tracing continuously.
•If patient has acute or unstable chronic atrial
fibrillation,assess for drug effectiveness.Ventricular rate

Furosemide  To manage Inhibits sodium and water
mild to reabsorption in the loop of
moderate Henle and increases urine
hypertensio formation.As the body’s
n, as adjunct plasma volume decreases,
to treat aldosterone production
acute increases, which promotes
pulmonary sodium reabsorption and the
edema and loss of potassium and
hypertensiv hydrogen ions. Furosemide
e crisis also increases the excretion of
calcium, magnesium,
bicarbonate, ammonium, and
phosphate. By reducing
intracellular and extracellular
fluid volume, the drug
reduces blood pressure and
decreases cardiac output.
Over time, cardiac output
returns to normal.
CNS:Dizziness, fever, headache,
paresthesia, restlessness,
vertigo, weakness
CV: Orthostatic
hypotension,shock,
thromboembolism,
thrombophlebitis
EENT:Blurred vision,oral
irritation,ototoxicity,
stomatitis, tinnitus, transient
hearing loss (rapid I.V.
injection), yellow vision
ENDO: Hyperglycemia
GI: Abdominal cramps,
anorexia, constipation,
diarrhea, gastric irritation,
hepatocellular insufficiency,
indigestion, jaundice, nausea,
pancreatitis, vomiting
GU:Bladder spasms, glycosuria
HEME:Agranulocytosis
(rare),anemia, aplastic anemia
(rare),azotemia,hemolytic
anemia, leukopenia,
thrombocytopenia
may not normalize even when serum drug level falls
within therapeutic range;raising the dosage probably
won’t produce a therapeutic effect and may lead to
toxicity.
•Frequently obtain ECG tracings as ordered in elderly
patients because of their smaller body mass and reduced
renal clearance. Elderly patients,especially those with
coronary insufficiency, are more suscepti
ble to arrhythmias—particularly ventricular fibrillation—if
digitalis toxicity occurs.
•Monitor paptient’s serum potassium level regularly
because hypokalemia predisposes to digitalis toxicity and
serious arrhythmias.Also monitor potassium level often
when giving potassium salts because hyperkalemia in
patients receiving digoxin can be fatal.
WARNING Use furosemide cautiously in patients with
advanced hepatic cirrhosis, especially those who also
have a history of electrolyte imbalance or hepatic
encephalopathy; drug may lead to lethal hepatic coma.
•Obtain patient’s weight before and periodically during
furosemide therapy to monitor fluid loss. •For once-a-day
dosing, give drug in the morning so patient’s sleep won’t
be interrupted by increased need to urinate. •Prepare
drug for infusion with normal saline solution, lactated
Ringer’s solution, or D5W.
•Administer drug slowly I.V.over 1 to 2 minutes to
prevent ototoxicity.
•Expect patient to have periodic hearing tests during
prolonged or high-dose I.V. therapy.
•Monitor blood pressure and hepatic and renal function
as well as BUN,blood glucose, and serum creatinine,
electrolyte, and uric acid levels, as appropriate.
•Be aware that elderly patients are more susceptible to
hypotensive and electrolytealtering effects and thus are
at greater risk for shock and thromboembolism.
•If patient is at high risk for hypokalemia, give potassium
supplements along with furosemide, as prescribed.
•Expect to discontinue furosemide at maximum dosage if
oliguria persists for more than 24 hours
 MS: Muscle spasms . •Be aware that furosemide may worsen left ventricular
SKIN:Bullous pemphigoid, hypertrophy and adversely affect glucose tolerance and
erythema multiforme, lipid metabolism.
exfoliative dermatitis, •Notify prescriber if patient experiences hearing loss,
photosensitivity, pruritus, vertigo, or ringing, buzzing, or sense of fullness in her
purpura, rash, urticaria ears. Drug may need to be discontinued.
Other:Allergic reaction
(interstitial nephritis,
necrotizing vasculitis, systemic
vasculitis), dehydration,
hyperuricemia, hypochloremia,
hypokalemia, hyponatremia,
hypovolemia
Pantoprazole >Duodenal and gastric > Inhibits both basal and >Hypersensitivity to the drug >>Assess underlying condition before therapy and
ulcer, moderate and stimulated gastric acid thereafter to monitor drug effectiveness.
severe reflux esophagitis. secretion by suppressing the >Assess GI symptoms: epigastric/abdominal pain,
>Eradication of final step in acids production, bleeding and anorexia.
H. pylori inpatient through the inhabitation >Monitor for possible drug induced adverse reaction.
with peptic of the proton pump
ulcers, pathological by binding to and inhibiting
hyper-secretory hydrogen- potassium
conditions. >Symptomatic adenosine triphosphatase in
improvement and the enzyme system located at
healing of mild reflux the secretory surface of the
esophagitis. gastric parietal cell.
>Prevention of gastro-
duodenal ulcers induced
by NSAID in patients
at risk with a need
for continuous NSAID
treatment.
sodium  To treat less Increases plasma bicarbonate CNS: Mental or mood changes •Monitor sodium intake of patient taking sodium
bicarbonate urgent level, buffers excess hydrogen CV: Irregular heartbeat, bicarbonate because effervescent powder contains 700.6
forms of ions, and raises blood pH, peripheral edema (with large mg of sodium/ 3.9 g; oral powder contains 952 mg of
metabolic thereby reversing metabolic doses), weak pulse sodium/tsp; and tablets contain 325 mg/ 3.9-mEq tablet,
acidosis acidosis. Sodium bicarbonate EENT: Dry mouth 520 mg/6.2-mEq tablet, and 650 mg/7.7-mEq tablet.
also increases the excretion of GI: Abdominal cramps,thirst •For I.V. infusion, dilute drug with normal saline solution,
free bicarbonate ions in urine, MS: Muscle spasms, myalgia D5W, or other standard electrolyte solution before
raising urine pH; increased administration.
alkalinity of urine may help to
 dissolve uric acid calculi. In
addition,it relieves symptoms
ofhyperacidity by neutralizing
or buffering existing stomach
acid, thereby increasing the
pH of stomach contents.
Isosorbide >Treatment and >Relaxes vascular smooth
Dinitrate prevention of angina muscle with a resultant
pectoris decrease in venous return and
decrease in arterial BP, which
reduces left ventricular
workload and decreases
myocardial oxygen
consumption
SKIN: Extravasation with
necrosis, tissue sloughing, or
ulceration
>Contraindicated with allergy
to nitrates, severe anemia,
head trauma, cerebral
hemorrhage, hypertrohic
cardiomyopathy, narrow-angle
glaucoma, postdural
hypotension
•Avoid rapid I.V. infusion, which can cause severe
alkalosis. Be aware that during cardiac arrest, risk of
death from acidosis may outweigh risks of rapid infusion.
•Monitor urine pH, as ordered, to determine drug’s
effectiveness as urine alkalizer.
•If patient on long-term sodium bicarbonate therapy is
consuming calcium or milk, watch for milk-alkali
syndrome, characterized by anorexia, confusion,
headache, hypercalcemia, metabolic acidosis, nausea,
renal insufficiency,and vomiting.
•Be aware that parenteral forms are hypertonic and that
increased sodium intake can produce edema and weight
gain.
•Assess I.V. site often for evidence of extravasation. If it
occurs, notify prescriber at once and remove I.V. catheter.
Elevate the limb,apply warm compresses, and expect
prescriber to administer a local injection of hyaluronidase
or lidocaine.
>Assess for pain: duration, time started, activity being
performed, character, intensity
>Assess orthostatic hypotension, blood pressure at
baseline and during treatment