Folic Acid

Name Folic Acid (Vit B9)

Brand name Apo-Folic; Folate; Folvite; Novofolacid; Vitamin B9
Classification Vitamin b complex group
Water soluble Vitamin
Dosage Adult and child >14 years old: PO 400 mcg
AdGenericult (Pregnant/Lactating): PO 600 mcg/day
Children 9-13 years old: PO 300 mcg
Children 4-8 years old: PO 200 mcg
Child 1-3 years old: PO 150 mcg
Infants <6mo-1 yr: PO 80 mcg
Neonates and Infants <6mo: PO 65 mcg
Mechanism of Increases Red Blood Cells, White Blood Cells, and platelets formation in
Action megaloblastic anemias. Elevates the serum iron concentration which then
helps to form High or trapped in the reticuloendothelial cells for storage
and eventual conversion to a usable form of iron.
Indication Folic acid is effective in the treatment of megaloblastic anemias due to a
deficiency of folic acid as may be seen in tropical or non-tropical sprue, in
anemias of nutritional origin, pregnancy, infancy, or childhood.
Contraindication Hypersensitivity, anemias other than megaloblastic/macrocytic anemia, vit
B12 deficiency anemia, uncorrected pernicious anemia
Side effects Nausea, Gas or bloating, Poor appetite, Funny taste in your mouth,
Trouble sleeping, Feeling depressed or overly excited

Adverse effect Bronchospasm, Erythema, Malaise, Pruritus, Rash, Slight flushing

Nursing - Assess for fatigue, dyspnea, weakness, dyspnea that are signs of
responsibilities megaloblastic anemia
- Assess for hgb, hct, and reticulocyte count
- Assess for nutritional status: bran, yeast, dried beans, nuts, fruits,
fresh vegetables,asparagus
- Assess for products currently taken: estrogen, carbamazepine,
glucocorticoids, hydantoins; these products may increase folic acid
 use by body and contribute to a deficiency if taking other
neurotoxic products
- Evaluate therapeutic response: increased weight, oriented, well
being, absence of fatigue; increase in reticulocyte count within 5
days of beginning treatment, absence of neural tube defect
- Teach patient to take product exactly as prescribed
- Teach patient that urine will turn bright yellow
- Teach patient to notify the physician if any allergic reaction occurs

Drug interactions 5-Fluorouracil, Capecitabine (Xeloda), Fosphenytoin (Cerebyx),

Methotrexate (MTX, Rheumatrex), Phenobarbital (Luminal), Phenytoin
(Dilantin), Primidone (Mysoline), Pyrimethamine (Daraprim)

References:
Ferrous sulfate. (2009.). Retrieved from
http://drugsfornursingstudents.blogspot.com/2009/10/ferrous-sulfate.html

Folic Acid: Health Benefits, Uses, Side Effects, Dosage & Interactions. (2014). Retrieved
from https://www.rxlist.com/folic_acid/supplements.htm#Interactions

Folvite (folic acid) dosing, indications, interactions, adverse effects, and more. (2019, July
11). Retrieved from https://reference.medscape.com/drug/folvite-folic-acid-344419#10

Mosby, E. (2011). Mosby's nursing drug reference(24th ed.).

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Ferrous Sulfate

Generic Name Ferrous Sulfate

Brand name Feosol; Feratab; Slow FE
Classification
Dosage Usual Adult Dose for Iron Deficiency Anemia and Anemia Associated
with Chronic Renal Failure:
Initial: 300 to 325 mg of regular-release ferrous sulfate orally once a day.
Maintenance:
Regular-release ferrous sulfate: 325 mg orally 3 times a day.
Alternatively, 300 mg orally 4 times a day may be given.
Extended-release ferrous sulfate: 160 mg orally 1 to 2 times a day.
Usual Adult Dose for Vitamin/Mineral Supplementation during
Pregnancy/Lactation:
325 mg orally once a day.
The recommended daily allowance (RDA) of elemental iron is 30 mg
orally during pregnancy and 15 mg orally during lactation.
Usual Adult Dose for Vitamin/Mineral Supplementation:
325 mg orally once a day.
The recommended daily allowance (RDA) of elemental iron is 10 mg for
adult males, 15 mg for adult, premenopausal women, and 10 mg for
postmenopausal women.
Mechanism of Ferrous sulfate replaces iron stores found in hemoglobin in red blood
Action cells, myoglobin and other heme enzymes in the body. Additionally,
ferrous sulfate allows the transportation of oxygen via hemoglobin.
Approximately 60% of iron is stored in hemoglobin in red blood cells,
while 9% is stored in myoglobin and other heme enzymes. Additionally,
25% is held in reserve in reticulocytes of the liver, spleen and bones. Most
stored iron is bound to the protein ferritin. While being transferred in the
body, Fe2+ iron is converted to Fe3+ by ceruloplasmin so it can then be
bound to the protein transferrin.
Indication For prophylaxis and treatment of iron deficiency and iron-deficiency
anemias; to treat or prevent low blood levels of iron (such as those caused
by anemia or pregnancy).
Contraindication
Side effects Constipation, diarrhea, stomach cramps, or upset stomach may occur.
These effects are usually temporary and may disappear as your body
adjusts to this medication. If any of these effects persist or worsen, contact
your doctor or pharmacist promptly.

Iron may cause your stools to turn black, an effect that is not harmful.

Adverse effect allergic reaction: rash, itching/swelling (especially of the

face/tongue/throat), severe dizziness, trouble breathing, Dizziness, Nasal
Congestion, Dyspnea, Hypotension, CHF, Muscle cramps, Flushing.

Nursing 1. Advise patient to take medicine as prescribed.

responsibilities 2. Caution patient to make position changes slowly to minimize
orthostatic hypotension.
3. Instruct patient to avoid concurrent use of alcohol or OTC
medicine without consulting the physician.
4. Advise patient to consult physician if irregular heartbeat, dyspnea,
swelling of hands and feet and hypotension occurs.
5. Inform patient that angina attacks may occur 30 min. after
administration due reflex tachycardia.
6. Encourage patient to comply with additional intervention for
hypertension like proper diet, regular exercise, lifestyle changes
and stress management.

Drug interactions
acetohydroxamic acid (Lithostat); chloramphenicol; cimetidine
(Tagamet); etidronate (Didronel); dimercaprol (an injection used to treat
poisoning by arsenic, lead, or mercury); levodopa (Larodopa, Dopar,
Sinemet); methyldopa (Aldomet); or penicillamine (Cuprimine).

Erythromycin
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Generic Name Erythromycin

Brand name Ilotycin; Romycin; PremierPro RX Erythromycin
Classification Antibiotics
Dosage Adult:
0.5% ophthalmic ointment
Conjunctivitis
Apply ½ inch (1.25 cm) q4-12hr, depending on severity of infection
Trachoma
Apply q12hr for 2 months
Pediatric:
0.5% ophthalmic ointment
Conjunctivitis
Apply ½ inch (1.25 cm) q4-12hr, depending on severity of infection
Gonococcal Ophthalmia Neonatorum
Apply from unit dose (1 cm) to eyes after birth in newborns

Mechanism of It inhibits protein synthesis by binding to the 23S rRNA molecule (in the
Action 50S subunit) of the bacterial ribosome blocking the exit of the growing
peptide chain. of sensitive microorganisms. (Humans do not have 50 S
ribosomal subunits, but have ribosomes composed of 40 S and 60 S
subunits). Certain resistant microorganisms with mutational changes in
components of this subunit of the ribosome fail to bind the drug. The
association between erythromycin and the ribosome is reversible and takes
place only when the 50 S subunit is free from tRNA molecules bearing
nascent peptide chains. Gram-positive bacteria accumulate about 100
times more erythromycin than do gram-negative microorganisms. The non
ionized form of the drug is considerably more permeable to cells, and this
probably explains the increased antimicrobial activity that is observed in
alkaline pH.
 Indication It is used to treat certain infections caused by bacteria, such as infections
of the respiratory tract, including bronchitis, pneumonia, Legionnaires'
disease (a type of lung infection), and pertussis (whooping cough; a
serious infection that can cause severe coughing); diphtheria (a serious
infection in the throat); sexually transmitted diseases (STD), including
syphilis; and ear, intestine, gynecological, urinary tract, and skin
infections. It also is used to prevent recurrent rheumatic fever and to treat
infections of the eye. They also may be used to prevent certain eye
infections of newborn babies, such as neonatal conjunctivitis and
ophthalmia neonatorum. They may be used with other medicines for some
eye infections.
Contraindication Contraindicated for patients with Macrolide antibiotics allergy
Side effects 1. Minor eye irritation
2. Stinging
3. Temporary blurred vision

Adverse effect 1. Hypersensitivity reactions

2. Minor ocular reactions
3. Redness

Nursing 1. Screen the pregnant mother for gonorrhea and chlamydia at their
responsibilities first prenatal visit.
2. If the mother tests positive for gonorrhea at the time of birth, then
the newborn should be treated with injectable antibiotics without
waiting for test results and should be further evaluated if unwell in
any way. This recommendation includes babies born by Cesarean.
3. If the mother tests positive for chlamydia at the time of birth, then
the newborn should be closely watched for symptoms of pink eye
and treated only if the infection occurs.
4. Monitor vital signs especially heart rate for arrhythmias
5. Observe for signs of adverse effects eg. allergic reactions.
6. Observe for signs of super infection including fungal infection.

https://www.mayoclinic.org/drugs-supplements/erythromycin-ophthalmic-route/description/drg-
20068673
https://www.rxlist.com/ilotycin-side-effects-drug-center.htm
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Oxytocin

Generic Name Oxytocin

Brand name Pitocin; Syntocinon
Classification Oxytocic drug
Dosage Dilute 10 units to 1000 ml isotonic saline or D5W for IV infusion
Mechanism of works by increasing the concentration of calcium inside muscle cells that
Action control contraction of the uterus. Increased calcium increases contraction
of the uterus
Indication
hormone that is used to induce labor or strengthen uterine contractions, or
to control bleeding after childbirth. Oxytocin is also used to stimulate
uterine contractions in a woman with an incomplete or threatened
miscarriage.

Contraindication 1. Hypersensitivity to drug

2. Unfavorable fetal position that are undeliverable without
conversion prior to delivery
3. Fetal distress where delivery is imminent
Side effects 1. Nausea
2. Vomiting
3. Increase in contraction

Adverse effect 1. Abnormal heart rate

2. Jaundice
 3. Seizure
4. Hives
5. Difficulty in breathing (dyspnea)
6. Swelling of face, lips, and throat

Nursing
1. Assess patient for any history of allergy with oxytocin before
responsibilities
administering
2. Follow the 10 rights in administering the drug
3. Teach patient to report any deadly effects of oxytocin like high
blood pressure, bleeding in the brain, rupture of the uterus, too
much water in the body
4.

https://www.drugs.com/cdi/oxytocin.html
https://www.medicinenet.com/oxytocin-injectable/article.htm

Mefenamic Acid

Generic Name Mefenamic Acid

Brand name Ponstel
Classification nonsteroidal anti-inflammatory drugs
Dosage Adult
Pain initial dose: 500 mg orally once
Following initial dose: 250 mg orally every 6 hours as needed
Duration of therapy: Usually not to exceed 1 week

Dysmenorrhea Initial dose: 500 mg orally once

Following initial dose: 250 mg orally every 6 hours as needed
Duration of therapy: 2 to 3 days

Usual Pediatric Dose for Pain (Dysmenorrhea)

14 years or older:
-Initial dose: 500 mg orally once
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-Following initial dose: 250 mg orally every 6 hours as needed

-Duration of therapy: Usually not to exceed 1 week

Usual Pediatric Dose for Dysmenorrhea

14 years or older:
-Initial dose: 500 mg orally once
-Following initial dose: 250 mg orally every 6 hours as needed
-Duration of therapy: 2 to 3 days
Mechanism of works by blocking the action of a substance in the body called cyclo-
Action oxygenase (COX). Cyclo-oxygenase is involved in the production of
various chemicals in the body, some of which are known as
prostaglandins. Prostaglandins are produced by the body in response to
injury and certain diseases and conditions, and cause pain, swelling and
inflammation. Mefenamic acid blocks the production of these
prostaglandins and so reduces inflammation and pain. Mefenamic acid
may also work by preventing the action of prostaglandins after they have
already been formed

Indication
Used to relieve pain and inflammation in a wide range of musculoskeletal
conditions, including those below. It can also be used to relieve some
other types of pain, and to reduce blood loss in women with very heavy
periods.

Contraindication
1. People in whom aspirin or other NSAIDs, eg ibuprofen, cause
allergic reactions such as asthma attacks, itchy rash (urticaria),
nasal inflammation (rhinitis) or swelling of the lips, tongue and
throat (angioedema).
2. People with an active peptic ulcer or bleeding in the gut.
3. People who have had recurrent peptic ulcers or bleeding in the gut
(two or more episodes).
4. People who have experienced bleeding or perforation in the gut as
a result of previous treatment with an NSAID.
5. Inflammatory bowel disease such as ulcerative colitis or Crohn's
disease.
6. People with severe heart failure.
7. People with severe liver or kidney failure.
8. Third trimester of pregnancy.
9. Relieving pain following coronary artery bypass graft (CABG)
surgery.
 10. Rare hereditary problems of galactose intolerance, the Lapp lactase
deficiency or glucose-galactose malabsorption (Ponstan capsules
and Ponstan forte tablets contain lactose).

Side effects
1. stomach pain
2. nausea
3. vomiting
4. heartburn
5. constipation
6. diarrhea
7. rash
8. dizziness
9. tinnitus (ringing in your ears)

Adverse effect
1. Heart attack or stroke
2. Heart failure
3. Ulcers/bleeding
4. Jaundice (Liver problem)
5. Skin reactions

Nursing
1. Warn patient that this medicine may raise the chance of heart and
responsibilities
blood vessel side effects like heart attack, stroke, and may raise the
chance of very bad and sometimes deadly stomach or bowel side
effects like ulcers or bleeding
2. Teach patient to report any of the following:
- If you have any of these health problems: GI (gastrointestinal)
swelling, kidney disease, or ulcer disease.
- If you have GI (gastrointestinal) bleeding.
- If you are having trouble getting pregnant or you are having your
fertility checked.
- If you are pregnant or may be pregnant. Do not take mefenamic
acid if you are in the third trimester of pregnancy. You may also
need to avoid mefenamic acid at other times during pregnancy.
Talk with your doctor to see when you need to avoid taking
mefenamic acid during pregnancy.
- If you are breast-feeding or plan to breast-feed.
- If you are taking any other NSAID.
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- If you are taking a salicylate drug like aspirin.

- If you are taking pemetrexed

3. Monitor vitals signs after taking the drug

https://www.healthline.com/health/mefenamic-acid-oral-capsule#side-effects
https://www.drugs.com/cdi/mefenamic-acid.html
https://www.netdoctor.co.uk/medicines/aches-pains/a7366/ponstan-mefenamic-acid/

Magnesium Sulfate

Generic Name Magnesium Sulfate

Brand name Epsom salt; Sulfamag
Classification Laxative; Antidysrhythmic; V electrolyte; anticonvulsant
Dosage Injectable solution:
40 mg/ml
80 mg/ml
Infusion solution:
1g/100ml
2g/100 ml
Adult:
Mild: 1g intramuscularly (I'M) q6 for 4 doses
Severe: 5g intravenously (IV) over 3 hours
Maintenance: 30-60 mg/kg/day IV
Pediatric:
(IM/IV) 25-50 mg/kg q4-6 for 3-4 doses as needed
Oral: 100-200 mg/kg q6
Toxemia of pregnancy:
4-5 g (diluted in 250 ml NS/D5W) intravenously in combination with
either
(a) Up to 10g (10 ml of undiluted 50% solution) divided and
administered I'M into each buttock
(b) After initial IV dose, 1-3g/hour IV
Torsades de pointes (Abnormal heart rhythm)
With pules (ACLS) 1-2 g slow IV diluted in 50-100 ml D5W over 5-60
minutes then 0.5-1g/hour IV
Cardiac arrest (ACLS): 1-2g slow IV diluted in 10 ML D5W over 5-20
minutes
Mechanism of The mechanism of action of magnesium sulfate is thought to trigger
Action cerebral vasodilation, thus reducing ischemia generated by cerebral
vasospasm during an eclamptic event. The substance also acts
competitively in blocking the entry of calcium into synaptic endings,
thereby altering neuromuscular transmission.
Indication Used to control low blood levels of magnesium. Magnesium sulfate
injection is also used for pediatric acute nephritis and to prevent seizures
in severe pre-eclampsia, eclampsia, or toxemia of pregnancy. It is also
indicated to prevent seizures associated with pre-eclampsia.
Contraindication 1. Magnesium sulfate has a serious drug interaction with the
following drugs: demeclocycline, doxycycline, eltrombopag,
lymecycline, minocycline, oxytetracycline, tetracycline
2. If allergic to MgSO4 drugs
3. Myocardial damage, diabetic coma, heart block
4. Hypermagnesemia
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5. Hyperkalemia
6. Administration during 2 hours preceding delivery for mothers with
toxemia of pregnancy
Side effects Upset stomach, diarrhea, nausea, vomiting

Adverse effect Respiratory paralysis, sweating, anxiety, cold feeling, flushing,

weak/shallow breathing, extreme drowsiness, numbness or tingly feeling
around your mouth/ hypotension, visual changes.

Nursing
responsibilities 1. Assess patient if he/she is allergic to MgSO4

2. In patients with renal impairment, ensure that renal excretory

capacity is not exceeded.

3. Use with caution in digitalized patients.

4. Use with extreme caution in patients with myasthenia gravis or

other neuromuscular disease.

5. Low blood magnesium (hypomagnesemia) is usually associated

with low blood potassium (hypokalemia) (potassium levels must
be normalized).

6. Monitor renal function, blood pressure, respiratory rate, and deep

tendon reflex when magnesium sulfate is administered
parenterally.

7. Do not give Magnesium Sulfate to patients having nausea and

vomiting

8. Monitor patients knee jerk reflex

9. If diarrhea and cramping occur in patient taking this drug,

discontinue use

10. Teach and inform the patient with the possible side effects of this
drug
References: Magnesium sulfate - brand name list from Drugs.com. (2012). Retrieved from
https://www.drugs.com/ingredient/magnesium-sulfate.html

Magnesium Sulfate: Side Effects, Dosages, Treatment, Interactions, Warnings. (2018, July).

Retrieved from https://www.rxlist.com/consumer_magnesium_sulfate_mgso4/drugs-

condition.htm

MgSO4 (magnesium sulfate) dosing, indications, interactions, adverse effects, and more.

(2019, July 11). Retrieved from https://reference.medscape.com/drug/mgso4-magnesium-

sulfate-344444#4

CHAPTER 14
DRUG STUDIES

Generic Name

Brand name
Classification
Dosage
Mechanism of
Action
Indication
Contraindication
Side effects

Adverse effect
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Nursing
responsibilities