DRUG STUDY FOR CHAPTER III

Pharmacology

SUBMITTED BY: PAULINE RABOY BASI

Section: NBD
Name of Drug Classification Mechanism of Indication Contraindication Adverse Nursing
Action Effects consideration
 Aminoglycosid Aminoglycosides For treatment of serious infections Myasthenia gravis. Causes
Generic name: e like gentamicin caused by susceptible strains of the Ototoxicity, tinnitus-hearing
Gentamicin  Anti infectives "irreversibly" bind following microorganisms: P. nephrotoxicity, loss/do not
to specific 30S- aeruginosa, Proteus species (indole- neuromuscular administer with
subunit proteins positive and indole-negative), E. bloackade. penicillin
and 16S rRNA. coli, Klebsiella-Enterobactor-
Specifically Serratia species, Citrobacter specie
Use
Brand name: gentamicin binds s and Staphylococcus species
caution in renal
Cidomycin Inj to four
nucleotides of impairment
16S rRNA and a
Dose: single amino acid Assess
10 mg/ml of protein S12. for infection
This interferes
with decoding Obtain
Route: site in the vicinity cultures prior to
Intravenous of nucleotide therapy
1400 in 16S
rRNA of 30S Monitor
Frequency: subunit. This liver function
OD region interacts tests
with the wobble
base in the
Monitor
anticodon of
blood levels of
tRNA. This leads
to interference drug
with the initiation
complex,
misreading of
mRNA so
incorrect amino
acids are
inserted into the
polypeptide
leading to
nonfunctional or
toxic peptides
and the breakup
of polysomes into
nonfunctional
monosomes.
Name of Classification Mechanism of Action Indication Contraindicatio Adverse Effects Nursing consideration
Drug n
 Anti Invanz (ertapenem sodium Effective against both Hypersensitivity Assessment & Drug
Generic Infectiv ) is a structurally unique 1- gram-positive and gram- to ertapenem, Drug rash w/ Effects
name: es (beta) methyl-carbapenem negative bacteria. Highly other eosinophilia and
Ertapene related to a class of resistant to most bacterial carbapenems; systemic symptoms  Lab tests: Perform
m antibiotics known as beta- beta-lactamases. Effective history of (DRESS), pruritus, C&S tests prior to
lactams, which includes against anaphylactic diarrhoea, nausea, therapy. Monitor
penicillins and most Enterobacteriaceae, reaction to β- vomiting, infused vein periodically liver
cephalosporins. Invanz wor Pseudomonas lactams (e.g. complication, phlebitis and kidney
ks by blocking the aeruginosa, penicillins, or thrombophlebitis, function.
Brand formation of bacterial cell and Acinetobacter spp. It cephalosporins). headache, muscular  Determine history
name: walls, thereby causing cell is poorly effective Known weakness, gait of hypersensitivity
Invanz death. against Enterococci bacter hypersensitivity disturbance, abnormal reactions to other
ia, particularly to local anaesth coordination, vaginitis; beta-lactams,
vancomycin-resistant of the amide elevations in ALT, cephalosporins,
Dose: strains (VRSA). type due to use AST, alkaline penicillins, or
1g of lidocaine as phosphatase and other drugs.
diluent in IM platelet count. Dry  Discontinue drug
use. mouth, taste and immediately
Route: disturbances, report S&S of
Intravenou dyspepsia, abdominal hypersensitivity
s pain, anorexia, Report S&S of
constipation, melaena, superinfection or
bradycardia, pseudomembrano
Frequency hypotension, chest us colitis (see
: pain, oedema, Appendix F).
OD pharyngeal discomfort,  Monitor for
dyspnoea, dizziness, seizures
sleep disturbances, especially in older
confusion, asthenia, adults and those
seizures, raised with renal
glucose, petechiae. insufficiency.
Potentially  Lab tests: Monitor
Fatal: Hypersensitivity AST, ALT,
reactions (e.g. alkaline
anaphylaxis), Clostridi phosphatase,
um difficile-associated CBC, platelet
colitis.. count, and routine
blood chemistry
during prolonged
therapy.

Patient & Family

Education

 Learn S&S of
hypersensitivity,
superinfection,
and
pseudomembrano
us colitis; report
any of these to
physician
promptly.
 Do not breast
feed during and
for at least 5 d
following
termination of
therapy.
Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIINFECTIVE; ANTI Semisynthetic, second- Respiratory tract Hypersensitivity to  Determine
Generic name: BIOTIC; SECOND- generation oral infection including cephalosporins. Serum sickness-like previous
Cefaclor GENERATION cephalosporin antibiotic pneumonia, reaction, hypersensitivity
CEPHALOSPORIN similar to cefonicid. pharyngitis/tonsilliti eosinophilia, joint to
Possibly more active s & sinusitis. Skin & pain or swelling, cephalosporins,
Brand name: than other oral skin structure fever, penicillins, and
Ceclor cephalosporins against infections; UTI superinfections. other drug
gram-negative bacilli, including  GI: Diarrhea, nause allergies before
Dose: especially beta- pyelonephritis & a, vomiting, therapy is
125 mg/5 mL lactamase-producing H cystitis. Otitis anorexia, pseudome initiated.
aemophilus media, gonococcal mbranous  Lab tests:
Route: influenzae, including urethritis. colitis (rare).  Perform culture
Intravenous ampicillin-resistant Skin: Urticaria, and sensitivity
strains. Also active pruritus, morbilliform tests prior to
against Escherichia eruptions... and periodically
Frequency: coli, Proteus mirabilis, during therapy.
OD Klebsiella sp and  Diarrhea, the
certain gram-positive most frequent
strains, adverse effect,
e.g., Streptococcus may be due to a
pneumoniae, S. pharmacologic
pyogenes, and Staphyl effect or to
ococcus aureus. associated
Preferentially binds to change in
one or more of the intestinal flora. If
penicillin-binding it persists,
proteins (PBPs) located interruption of
on cell walls of therapy may be
susceptible organisms. necessary.
This inhibits third and  Monitor for
final stage of bacterial manifestations
cell wall synthesis, thus of drug
killing the bacterium hypersensitivity
Discontinue
 drug and
promptly report
them if they
appear.
 Monitor for
manifestations
of
superinfection.
Promptly report
their
appearance.
Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
QUINOLONES Ciprofloxacin, a Treatment and Known GI: Nausea,  mmediately
Generic name: fluoroquinolone anti- postexposure hypersensitivity to vomiting, diarrhea, report tendon
Ciprofloxacin infective agent, acts by prophylaxis of ciprofloxacin or cramps, gas, inflammation or
inhibiting DNA gyrase inhalation other quinolones, pseudomembranous pain. Drug
and topoisomerase IV, anthrax, Bone and syphilis, viral colitis. Metabolic: T should be
Brand name: both essential in joint infections, infection; tendon ransient increases discontinued.
Ciprovita bacterial DNA Lower respiratory inflammation or in liver  Fluid intake of
replication, tract infections; tendon pain; transaminases, 2–3 L/d is
Dose: transcription, repair and Upper respiratory pregnant women alkaline advised, if not
250 mg recombination tract infections; (category C), phosphatase, lactic contraindicated.
Skin and soft lactation.. dehydrogenase, and  Report sudden,
Route: tissue infections, eosinophilia unexplained
Per Orem Malignant otitis count. Musculoskel joint pain.
externa, etal: Tendon  Restrict caffeine
Uncomplicated rupture, cartilage due to the
Frequency: pyelonephritis,  erosion. CNS: Head following effects
Every 12 hours Complicated ache, vertigo, (e.g.,
pyelonephritis, malaise, peripheral nervousness,
Complicated neuropathy, insomnia,
cystitis, seizures (especially anxiety,
Uncomplicated with rapid IV tachycardia).
cystitis, Typhoid infusion). Skin: Ras  Report possible
fever, h, phlebitis, pain, toxicity. If taking
Gonococcal burning, pruritus, theophylline
urethritis; and erythema at derivatives,
Gonococcal infusion there is
cervicitis., site. Special potential for
Epididymo- Senses: Local adverse effects.
orchitis; Pelvic burning and  Report nausea,
inflammatory. discomfort, diarrhea,
crystalline vomiting, and
precipitate on abdominal pain
superficial portion of or discomfort.
cornea, lid margin  Use caution
crusting, scales, with hazardous
foreign body activities until
sensation, itching, reaction to drug
and conjunctival is known. Drug
hyperemia. may cause light-
headedness.
Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIINFECTIVE; ANTI Broad-spectrum, acid- Infections of ear, Hypersensitivity to Body as a  Determine
Generic name: BIOTIC; AMINOPENICI stable, semisynthetic nose, throat, GU penicillins; Whole: As with previous
amoxicillin LLIN aminopenicillin and tract, skin, and soft infectious other penicillins. hypersensitivity
analogue of ampicillin. tissue caused by mononucleosis. Hypersensitivity reactions to
Acts by inhibiting susceptible (rash, anaphylaxis), penicillins,
Brand name: mucoprotein synthesis bacteria. Also used superinfections. GI:  cephalosporins,
Amoxil in cell wall of rapidly in uncomplicated Diarrhea, nausea, and other
multiplying bacteria. It is gonorrhea. vomiting, pseudo- allergens prior
Dose: bactericidal and is Available in membranous to therapy.
250 mg/ 5 mL inactivated by combination with colitis (rare). Hemat  Lab tests:
penicillinase. potassium ologic: Hemolytic Baseline C&S
Route: clavulanate, which anemia, tests prior to
intravenous extends eosinophilia, agranu initiation of
antibacterial locytosis (rare). Ski therapy, start
spectrum of n: Pruritus, urticaria, drug pending
Frequency: amoxicillin to or other skin results; periodic
OD include beta- eruptions. Special assessments of
lactamase- Senses: Conjunctiv renal, hepatic,
producing strains. al ecchymosis. and
hematologic
functions should
be made during
prolonged
therapy.
 Monitor for S&S
of an urticarial
rash (usually
occurring within
a few days after
start of drug)
suggestive of a
hypersensitivity
reaction. If it
occurs, look for
 other signs of
hypersensitivity
(fever,
wheezing,
generalized
itching,
dyspnea), and
report to
physician
immediately.
 Report onset of
generalized,
erythematous,
maculopapular
rash (ampicillin
rash) to
physician.
Ampicillin rash
is not due to
hypersensitivity;
however,
hypersensitivity
should be ruled
out.
 Closely monitor
diarrhea to rule
out
pseudomembra
nous colitis.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
 consideration
ANTIINFECTIVE; URIN Fixed combination of Pneumocystis Hypersensitivity to Skin: Mild to  Be aware that
Generic name: ARY TRACT sulfamethoxazole carinii pneumonitis,  TMP, SMZ, moderate rashes IV Septra
Cotrimoxazole AGENT; SULFONAMI (SMZ), an intermediate Shigellosis enteritis sulfonamides, or (including fixed drug contains sodium
DE acting antiinfective , and severe bisulfites; group A eruptions), toxic metabisulfite,
Brand name: sulfonamide, and complicated UTIs beta-hemolytic epidermal which produces
Ciplin trimethoprim (TMP), a due to most strains streptococcal necrolysis. GI: Naus allergic-type
synthetic antiinfective. of pharyngitis; ea, reactions in
Dose: Both components of the the Enterobacteriac megaloblastic vomiting, diarrhea, a susceptible
80 mg combination are eae. Also children anemia due to norexia, hepatitis, p patients: Hives,
trimethoprim/4 synthetic folate with acute otitis folate deficiency; seudomembranous itching,
00 mg antagonist media due to creatinine enterocolitis, wheezing,
sulfamethoxaz antiinfectives. susceptible strains clearance <15 stomatitis, glossitis, anaphylaxis.
ole Mechanism of action is of Haemophilus mL/min; abdominal Susceptibility
principally enzyme influenzae, and pregnancy pain. Urogenital: Ki (low in general
Route: inhibition, which acute episodes of (category C), dney failure, population) is
P.O prevents bacterial chronic bronchitis lactation. Not oliguria, anuria, seen most
synthesis of essential in adults.. recommended for crystalluria. Hemato frequently in
nucleic acids and infants <2 mo.. logic: Agranulocyto asthmatics or
Frequency: proteins. sis (rare), aplastic atopic
OD anemia (rare), nonasthmatic
megaloblastic persons.
anemia,  Lab tests:
hypoprothrombinemi Baseline and
a, thrombocytopenia followup
(rare). Body as a urinalysis; CBC
Whole: Weakness, with differential,
arthralgia, myalgia, platelet count,
photosensitivity, alle BUN and
rgic myocarditis.. creatinine
clearance with
prolonged
therapy.
 Monitor
coagulation
tests and
 prothrombin
times in patient
also receiving
warfarin.
Change in
warfarin dosage
may be
indicated.
 Monitor I&O
volume and
pattern. Report
significant
changes to
forestall renal
calculi
formation. Also
report failure of
treatment (i.e.,
continued UTI
symptoms).
 Older adult
patients are at
risk for severe
adverse
reactions,
especially if liver
or kidney
function is
compromised or
if certain other
drugs are given.
Most frequently
observed:
Thrombocytope
nia (with
concurrent
 thiazide
diuretics);
severe
decrease in
platelets (with or
without
purpura); bone
marrow
suppression;
severe skin
reactions.
 Be alert for
overdose
symptoms (no
extensive
experience has
been reported):
Nausea,
vomiting,
anorexia,
headache,
dizziness,
mental
depression,
confusion, and
bone marrow
depression.
Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
TETRACYCLINES Tetracycline exhibits its Tetracycline- Hypersensitivity to Significant: Photose  Obtain baseline
Generic name: bacteriostatic action by sensitive infection tetracyclines. nsitivity, intracranial and periodic
Metrocycline reversibly binding to the s, including Children <8 years. hypertension, C&S tests to
30S subunits of the respiratory, Severe renal increased BUN. confirm
Brand name: ribosome, thereby genitourinary, skin impairment. Enamel hypoplasia susceptibility of
Tetracycline preventing the binding and soft tissue, and Pregnancy and or permanent tooth infecting
of aminoacyl transfer those caused by lactation.  discolouration in organism to
Dose: RNA and inhibiting rickettsiae and Concurrent use of children, tissue tetracycline.
250 mg protein synthesis, thus Mycoplasma methoxyflurane, hyperpigmentation Also, preform
arresting cell growth.. pneumoniae; also retinoids or in children <8 years. initial and
Route: cholera, psittacosis, vitamin A. Blood and lymphatic periodic kidney,
P.O plague, shigellosis system liver, and
disorders: Rarely, hematopoietic
agranulocytosis, function tests,
Frequency: aplastic or particularly
TID haemolytic during high-
anaemia, dose, long-term
eosinophilia, therapy.
neutropenia, Determine
thrombocytopenia. serum
Gastrointestinal tetracycline
disorders: Oesopha levels in
gitis, oesephageal patients at-risk
ulceration, for
epigastric distress, hepatotoxicity
glossitis, (sometimes
gastrointestinal associated with
irritations, pancreatitis and
dysphagia, nausea, occurs most
vomiting, diarrhoea, frequently in
abdominal patients
discomfort, receiving other
pancreatitis. hepatotoxic
Hepatobiliary drugs or with
disorders: Rarely, history of renal
transient increases or hepatic
in LFT, hepatitis, impairment).
hepatic failure,  Report GI
jaundice. symptoms (e.g.,
Metabolism and nausea,
nutrition vomiting,
disorders: Anorexia. diarrhea) to
Skin and physician.
subcutaneous These are
tissue generally dose-
disorders: Erythema dependent,
tous or occurring mostly
maculopapular rash, with oral forms
pruritus, bullous in patients
dermatoses, skin receiving 2 g/d
discolouration. or more and
Potentially during
Fatal: Hypersensitiv prolonged
ity reactions (e.g. therapy.
anaphylaxis, Frequently,
angioedema, symptoms are
Stevens-Johnson controlled by
syndrome, toxic reducing
epidermal dosage or
necrolysis, administering
exacerbation of with compatible
SLE). Clostridium foods.
difficile-associated  Be alert to
disease (CDAD), evidence of
hepatotoxicity. superinfections
(see Appendix
F). Regularly
inspect tongue
and mucous
membrane of
 mouth for
candidiasis
(thrush).
Suspect
superinfection if
patient
complains of
irritation or
soreness of
mouth, tongue,
throat, vagina,
or anus, or
persistent
itching of any
area, diarrhea,
or foul-smelling
excreta or
discharge.
 Withhold drug
and notify
physician if
superinfection
develops.
Superinfections
occur most
frequently in
patients
receiving
prolonged
therapy, the
debilitated, or
those who have
diabetes,
leukemia,
systemic LE, or
lymphoma.
 Women taking
oral
contraceptives
reportedly are
more
susceptible to
vaginal
candidiasis.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
 consideration
ANTI TB AGENT Isoniazid inhibits the For the Treatment Hypersensitivity. Peripheral neuritis,  Monitor for
Generic name: synthesis of mycoloic of Tuberculosis Patient w/ acute psychotic reactions, therapeutic
Isoniazid acids in susceptible liver disease or a convulsions, optic effectiveness:
bacteria which results in history of neuritis, transient Evident within
Brand name: loss of acid-fastness isoniazid- increases in liver the first 2–3 wk
Isonid and disruption of associated hepatic enzymes; of therapy. Over
bacterial cell wall. At injury. haematological 90% of patients
Dose: therapeutic levels, it is effects (e.g. receiving
5mg/kg bacteriocidal against anaemias, optimal therapy
actively growing agranulocytosis, have negative
Route: intracellular and thrombocytopenia, sputum by the
P.O extracellular Mycobacte eosinophilia); sixth month.
rium hypersensitivity  Perform
tuberculosis organisms reactions include appropriate
Frequency: skin eruptions susceptibility
2x a week (including erythema tests before
multiforme), fever, initiation of
vasculitis; nausea, therapy and
vomiting, dry mouth, periodically
constipation, thereafter to
pellagra, purpura, detect possible
hyperglycaemia, bacterial
lupus-like resistance.
syndrome, vertigo,  Lab tests:
hyperreflexia, Monitor hepatic
urinary retention, function
gynaecomastia. periodically.
Isoniazid
hepatitis
(sometimes
fatal) usually
develops during
the first 3–6 mo
of treatment, but
may occur at
 any time during
therapy; much
more frequent in
patients 35 y or
older, especially
in those who
ingest alcohol
daily.
 Monitor for
visual
disturbance. An
eye examination
may be
warranted.
 Note:
Inactivation of
the drug is
genetically
determined.
Slow
inactivation
leads to high
plasma drug
levels and
increased risk of
toxicity.
 Withhold all
drugs and notify
physician of
hypersensitivity
reaction
immediately;
generally occurs
within 3–7 wk
after initiation of
therapy.
  Do not breast
feed while
taking this drug
without
consulting
physician.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
 Antileprotics Dapsone inhibits folic For the Treatment Hypersensitivity. Anaemia, peripheral  Monitor for
Generic name: acid synthesis by of Leprosy Severe anaemia, neuropathy, therapeutic
Dapsone preventing normal porphyria. haemolysis and effectiveness
bacterial utilization of methaemoglobinae that may not
Brand name: para-amino benzoic mia (dose-related), appear for
Lepravir acid (PABA). nephrotic syndrome, leprosy until
psychological after 3–6 mo of
Dose: changes, hepatitis. therapy. Skin
100 mg Others: Nausea, lesions respond
vomiting, anorexia, well; recovery
Route: headache, from nerve
P.O maculopapular rash, involvement is
toxic epidermal usually limited.
necrolysis, Stevens-  Lab tests:
Frequency: Johnson syndrome. Perform
OD Topical: Dryness, baseline then
redness, oiliness weekly CBC
and peeling at during the first
application site.. month of
therapy, at
monthly
intervals for at
least 6 mo, and
semiannually
thereafter.
 Determine
periodic
dapsone blood
levels.
 Perform liver
function tests in
patients who
complain of
malaise, fever,
chills, anorexia,
nausea,
 vomiting, and
have jaundice.
Dapsone
therapy is
usually
suspended until
etiology is
identified.
 Monitor severity
of anemia.
Nearly all
patients
demonstrate
hemolysis.
Manufacturer
states that Hgb
level is
generally
decreased by
1–2 g/dL;
reticulocytes
increase by 2–
12%; RBC life
span is
shortened; and
methemoglobin
emia occurs in
most patients
receiving
dapsone.
 Monitor
temperature
during first few
weeks of
therapy. If fever
is frequent or
 severe, leprosy
reactional state
should be ruled
out. Reduction
of or interruption
of therapy may
be sufficient for
improvement.
 Report cyanotic
appearance or
mucous
membranes
with brownish
hue to physician
as possible
methemoglobin
emia.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
 Macrolides Telithromycin is a For the Treatment Known Diarrhoea, nausea,  Monitor ECG in
Generic name: semisynthetic ketolide of Community- hypersensitivity to vomiting, abdominal patients at risk
Telithromycin antibiotic that blocks acquired telithromycin and pain, flatulence, for QTc interval
protein synthesis by pneumonia. other macrolides, dizziness, prolongation
Brand name: binding to domains II history of hepatitis headache, vertigo, (i.e.,
and V of 23S ribosomal and/or jaundice insomnia, bradycardia).
RNA of the 50S associated w/ drowsiness, taste  Withhold drug
Dose: ribosome subunit. It macrolide therapy, and smell and notify
800mg may also inhibit the myasthenia gravis. disturbances, physician for
assembly of nascent Patient w/ paraesthesia, S&S of QTc
Route: ribosomal units. congenital or eosinophilia, rash, interval
P.O known history of arrhythmias, prolongation
QT interval hypotension, such as
prolongation. bradycardia, visual dizziness or
Frequency: Patient w/ renal or disturbances, fainting; liver
OD for 7 days hepatic syncope, dysfunction.
impairment angioedema,  Lab tests:
receiving anaphylaxis, baseline LFTs,
colchicine. erythema BUN and
Concomitant multiforme, muscle creatinine,
admin w/ drugs cramps. serum
that prolong QT Potentially potassium.
interval and are Fatal: Hepatotoxicit  Stop taking drug
CYP3A4 y including fulminant and notify
substrates, HMG- hepatitis, hepatic physician for
CoA reductase necrosis and episodes of
inhibitors hepatic failure, dizziness or
metabolised by acute resp failure in fainting;
CYP3A4 or ergot patient w/ jaundice (yellow
alkaloid myasthenia color of the skin
derivatives.. gravis, Clostridium and/or eyes).
difficile-associated  Exercise
disease (CDAD). caution when
engaging in
potentially
hazardous
 activities; visual
disturbances
(e.g., blurred
vision, difficulty
focusing, double
vision) are
potential side
effects of this
drug. If visual
problems occur,
avoid quick
changes in
viewing
between close
and distant
objects.
 Do not breast
feed while
taking this drug
without
consulting
physician.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
 Macrolides Clindamycin, a  Anaerobic Hypersensitivity to Significant: Superinf  Take oral drug
Generic name: lincosamide antibiotic, infections; Disease clindamycin & ection. with a full glass of
Clindamycin inhibits bacterial protein due to Gram- lincomycin. GI Blood and lymphatic water or with food.
synthesis by reversibly positive bacteria. disease especially system  Take full
Brand name: binding to the 50S w/ history of disorders: Leucope prescribed course
Clindagen ribosomal subunit, colitis. Diarrhea... nia, agranulocytosis, of oral drug. Do
thereby preventing the eosinophilia, not stop taking
Dose: peptide bond formation, neutropenia, without notifying
150 mg ribosome assembly and thrombocytopenia. health care
translation process. Gastrointestinal provider.
Route: disorders: Diarrhoea  You may
P.O , abdominal pain, experience these
nausea, vomiting, side effects:
oesophagitis, Nausea, vomiting
Frequency: oesephageal ulcer. (eat frequent small
TID General disorders meals);
and admin site superinfections in
conditions: Applicati the mouth, vagina
on site reactions (use frequent
(e.g. inflammation, hygiene measures;
irritation, burning request treatment
sensation, pain, if severe).
dryness, oiliness),  Report severe
inj site reactions or watery diarrhea,
(e.g. pain, irritation, abdominal pain,
abscess, inflamed mouth or
induration). vagina, skin rash
Hepatobiliary or lesions.
disorders: Jaundice.
Immune system
disorders: Urticaria.
Infections and
infestations: Cervicit
is, vaginal
candidiasis,
vaginitis.
Investigations: Abno
rmal LFT.
Nervous system
disorders: Dysgeusi
a, headache,
dizziness.
Renal and urinary
disorders: Azotaemi
a, oliguria,
proteinuria.
Reproductive
system and breast
disorders: Vulvovagi
nal irritation, vaginal
moniliasis.
Skin and
subcutaneous
tissue
disorders: Maculopa
pular rash, pruritus,
erythema,
seborrhoea, contact
dermatitis.
Vascular
disorders: Hypotens
ion (IV),
thrombophlebitis
(IV).).
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIINFECTIVE;  Erythromycin inhibits Prophylaxis of Hypersensitivity Significant: Fungal  Monitor for
Generic name: MACROLIDE protein synthesis by surgical infections, or bacterial adverse GI
Erythromycin ANTIBIOTIC binding to the 50S Respiratory tract superinfection effects.
ribosomal subunit of infections, Skin and (e.g. C. difficile- Pseudomembra
Brand name: susceptible organisms soft tissue associated nous
Sensomed resulting in blockage of infections, diarrhoea [CDAD]); enterocolitis
erythromycin transpeptidation. Susceptible Gram- myasthenia gravis; (see Appendix
negative infections, infantile F), a potentially
Dose: Susceptible Gram- hypertrophic pyloric life-threatening
2% topical solution positive infections stenosis; condition, may
hepatotoxicity. occur during or
Route: Blood and lymphatic after antibiotic
Topical system therapy.
disorders: Eosinophi  Observe for
lia. S&S of
Frequency: Eye superinfection
once disorders: Mitochon by overgrowth
drial optic of
neuropathy. nonsusceptible
Gastrointestinal bacteria or
disorders: Nausea, fungi.
vomiting, abdominal Emergence of
pain, diarrhoea, resistant
pancreatitis. staphylococcal
General disorders strains is highly
and administration predictable
site during
conditions: Fever, prolonged
malaise.. therapy.
 Lab tests:
Periodic liver
function tests
during
prolonged
 therapy.
 Notify physician
for S&S of
superinfection
Antiviral Agents
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Rimantadine inhibits Prophylaxis of Hypersensitivity to Nausea, vomiting,  Monitor
Generic name: viral replication via influenza A drugs of the abdominal pain, carefully for
Rimantadine interference of the adamantane diarrhoea, seizure activity
influenza A viral M2 class, such as dyspepsia, in patients with
Brand name: protein. The M2 protein rimantadine and xerostomia, taste a history of
is a membrane protein amantadine. alteration, anorexia, seizures.
Dose: that acts as an ion headache, Seizures are an
100mg channel; it is involved in insomnia, impaired indication to
several aspects of viral concentration, discontinue the
Route: replication. By nervousness, drug.
P.O interfering with the ion dizziness, asthenia,  Monitor cardiac,
channel function of M2 ataxia, respiratory, and
Frequency: protein, rimantadine bronchospasm, neurologic
OD possibly inhibits the depression, skin status while on
uncoating of the virus rash and tinnitus. drug. Report
and prevents viral Potentially palpitations,
maturation in selected Fatal: Cardiac hypertension,
strains of influenza A. failure and heart dyspnea, or
WHO has noted in an block. pedal edema.
alert dated 5 May 2009  Report
that tests on viral bothersome
samples obtained from adverse effects
patients in Mexico and to physician;
United States affected especially
by the current new hallucinations,
influenza A H1N1 strain palpitations,
are resistant to difficulty
adamantanes, including breathing, and
rimantadine. swelling of legs.
 Use caution
with hazardous
activities until
reaction to drug
is known.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Zidovudine is converted HIV infection Hypersensitivity; Dizziness,  Contact
Generic name: intracellularly to abnormally low headache, malaise, physician
Zidovudine zidovudine neutrophil counts myalgia, GI promptly if
triphosphate, which (<0.75 x 109/L) or symptoms (e.g. health status
Brand name: inhibits replication of Hb levels (<7.5 abdominal pain, worsens or any
AZIDOTHYMIDINE retroviruses, including g/dL or 4.65 diarrhoea, nausea, unusual
HIV, by interfering w/ mmol/L); newborn vomiting), anorexia, symptoms
Dose: viral RNA-directed DNA infants w/ immune develop.
250mg polymerase (reverse hyperbilirubinaemi reconstitution  Understand that
transcriptase). a requiring syndrome, this drug is not
Route: treatment other lipodystrophy, a cure for HIV
P.O than phototherapy, metabolic infection; you
or w/ increased abnormalities, will continue to
Frequency: transaminase mitochondrial be at risk for
BID levels >5 times the dysfunction, opportunistic
ULN. Lactation. osteonecrosis; infections.
Concomitant use raised liver  Do not share
w/ interferon alfa enzymes, creatine drug with
(w/ or w/o phosphokinase; others; take
ribavirin) in HIV hyperbilirubinaemia, drug exactly as
and hepatitis B or myalgia, myositis. prescribed.
C virus co-infected Rarely, aplastic  Drug
patients.. anaemia, pure red does NOT redu
cell aplasia, ce the risk of
pancytopenia, transmission of
thrombocytopenia, HIV infection
rhabdomyolysis, through body
cardiomyopathy, fluids.
convulsions,  Do not breast
pancreatitis. feed while
taking this drug;
it is not known if
the drug is
secreted in
human milk.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Aciclovir is converted to Suppression of Hypersensitivity to Significant: Contact  Monitor for S&S
Generic name: aciclovir recurrent herpes aciclovir and sensitisation of: reinfection in
Acyclovir monophosphate by simplex  similar antivirals (topical). pregnant
virus-specific thymidine e.g. valaciclovir. Gastrointestinal patients;
Brand name: kinase then further disorders: Nausea, acyclovir-
Zylovir converted to aciclovir vomiting, diarrhoea, induced
triphosphate by other abdominal pain. neurologic
Dose: cellular enzymes. General disorders symptoms in
200mg Aciclovir triphosphate and administration patients with
competes with site history of
Route: deoxyguanosine conditions: Fatigue, neurologic
P.O triphosphate for viral fever. problems; drug
DNA polymerase and Investigations: Incre resistance in
Frequency: incorporates into viral ased liver enzymes immunocompro
Every 4 hours DNA to block DNA (reversible), BUN mised patients
synthesis and viral and creatinine. receiving
replication. Nervous system prolonged or
disorders: Headach repeated
e, dizziness. therapy; acute
Skin and renal failure with
subcutaneous concomitant use
tissue with other
disorders: Pruritus, nephrotoxic
rashes, drugs or
photosensitivity, preexisting
urticaria, renal disease.
accelerated diffuse   Monitor
hair loss. baseline and
Vascular periodic renal
disorders: Phlebitis function studies,
(IV).. particularly with
IV
administration.
Elevations of
 BUN and serum
creatinine and
decreases in
creatinine
clearance
indicate need
for dosage
adjustment,
discontinuation
of drug, or
correction of
fluid and
electrolyte
balance.
 Monitor for
adverse effects
and viral
resistance with
long-term
prophylactic use
of the oral drug.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
 consideration
ANTIVIRAL Enfuvirtide, is an HIV HIV-1 infection. Hypersensitivity. Significant: Hyperse  Monitor closely
Generic name: fusion protein inhibitor Lactation. nsitivity reactions for S&S of
which interferes w/ entry (e.g. rash, fever, pneumonia,
Enfuvirtide of HIV type 1 (HIV-1) nausea and especially with
into the host cell by vomiting, chills, low initial CD4
Brand name: binding to viral rigors, hypotension, count, high
glycoprotein gp41 elevated serum liver initial viral load,
subunit, thereby transaminases), IV drug use,
Dose: inhibiting viral and immune smoking, or
90 mg cellular membrane reconstitution prior history of
fusion w/ the CD4 cell syndrome, bacterial lung disease.
Route: receptor. pneumonia, inj site  Lab tests:
P.O reaction (e.g. mild to Periodic LFTs,
moderate serum lipase
Frequency: pain/discomfort, and amylase,
BID induration, lipid profile, and
erythema, pruritus, CBC with
ecchymosis). differential.
Nervous: Anxiety,  Do not breast
flu-like symptoms, feed while
peripheral taking this drug.
neuropathy,
weakness,
insomnia,
depression,
nightmare,
irritability,
hypoaesthesia,
tremor, vertigo,
asthenia.
GI: Abdominal pain,
anorexia, dry mouth,
nausea, diarrhoea,
constipation,
pancreatitis, GERD.
 Resp: Cough,
sinusitis.
Genitourinary: Neph
rolithiasis.
Endocrine: Wt loss,
hyperglycaemia,
hypertriglyceridaemi
a, DM.
Haematologic: Lymp
hadenopathy,
eosinophilia,
haematuria.
Musculoskeletal: Li
mb pain, myalgia,
osteonecrosis.
Ophthalmologic: Co
njunctivitis.
Otic: Ear infection.
Dermatologic: Dry
skin, seborrheic
eczema, acne.

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Maraviroc, a synthetic HIV-1 infection. Hypersensitivity. Significant: Postural  Be alert for
Generic name: HIV-1 entry inhibitor, Lactation. hypotension,
selectively and Concomitant use immune signs of liver
Maraviroc reversibly antagonises w/ potent CYP3A reconstitution toxicity,
CC chemokine enzyme inhibitors syndrome,
Brand name: receptor-5 (CCR5) and inducers in increased risk of including
 coreceptors found on patients w/ severe infection and anorexia,
Dose: human CD4+ cells. This (CrCl <30 mL/min) malignancy,
300mg prevents interaction of renal impairment osteonecrosis, MI, abdominal pain,
HIV-1 glycoprotein 120 or ESRD. myocardial severe nausea
Route: (gp120) and CCR5 ischaemia.
P.O necessary for CCR5- Nervous: Asthenia, and vomiting,
tropic HIV-1 to enter dizziness, yellow skin or
Frequency: cells. headache,
eyes, fever,
BID somnolence,
insomnia, sore throat,
depression, malaise,
malaise,
paraesthesia, weakness,
dysaesthesia, facial edema,
seizures.
GI: Abdominal pain lethargy, and
and distention, unusual
constipation,
bleeding or
diarrhoea,
dyspepsia, nausea, bruising. Report
vomiting, anorexia, these signs to
flatulence.
Resp: Cough, upper the physician or
resp tract infection. nursing staff
Hepatic: Cirrhosis.
Genitourinary: Rena immediately.
l failure, proteinuria,
bladder problems.  Monitor signs of
Haematologic: Neutr
allergic
openia, bone
marrow depression. reactions,
Musculoskeletal: Mu including
scle spasm, back
pain, myositis, pulmonary
rhabdomyolysis, symptoms
increased creatine
(tightness in the
kinase. throat and
Dermatologic: Prurit
us. chest,
wheezing,
dyspnea) or
skin reactions
(rash, pruritus,
urticaria). Notify
physician or
nursing staff
immediately if
these reactions
occur.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Raltegravir inhibits the HIV-1 infection. Hypersensitivity. ignificant: Depressio  Be alert for
Generic name: catalytic activity of HIV- Pre-term n (including suicidal
1 integrase, an enzyme neonates. ideation and signs of liver
Raltegravir essential for the Lactation. behaviour), toxicity,
covalent insertion of rhabdomyolysis,
Brand name: unintegrated linear viral myopathy, including
DNA into the host cell increased serum anorexia,
genome, thereby creatine kinase,
Dose: abdominal pain,
preventing the osteonecrosis, fat
400mg propagation of the HIV- redistribution or severe nausea
1 provirus. accumulation (e.g. and vomiting,
Route: central obesity,
P.O buffalo hump, yellow skin or
peripheral and facial eyes, fever,
Frequency: wasting, breast
BID enlargement, sore throat,
cushingoid malaise,
appearance),
weakness,
immune
reconstitution facial edema,
syndrome (e.g. lethargy, and
activation of Graves’
disease, unusual
polymyositis, bleeding or
Guillain-Barré
syndrome), bruising. Report
hypersensitivity these signs to
reactions (e.g. rash,
the physician or
constitutional
symptoms). nursing staff
Blood and lymphatic immediately.
system
disorders: Anaemia,
neutropenia,  Monitor signs of
thrombocytopenia. allergic
Cardiac
disorders: Palpitatio reactions,
ns, sinus including
bradycardia,
ventricular pulmonary
extrasystoles. symptoms
Ear and labyrinth
(tightness in the
disorders: Tinnitus.
Eye throat and
disorders: Visual chest,
impairment.
Gastrointestinal wheezing,
disorders: Abdomin dyspnea) or
al distention or pain,
diarrhoea, skin reactions
flatulence, nausea, (rash, pruritus,
vomiting, dyspepsia,
urticaria). Notify
gastritis,
gastroenteritis. physician or
General disorders nursing staff
and admin site
conditions: Asthenia immediately if
, fatigue, pyrexia, these reactions
oedema.
Hepatobiliary occur.
disorders: Hepatitis.
Infections and
infestations: Herpes
zoster.
Investigations: Atypi
cal lymphocytes,
increased ALT/AST,
blood triglycerides,
lipase, pancreatic
amylase, and blood
bilirubin.
Metabolism and
nutrition
disorders: Decrease
d appetite,
hyperglycaemia,
dyslipidaemia.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Adefovir, an acyclic Chronic hepatitis B. Hypersensitivity. Nephrotoxicity  Monitor
Generic name: nucleotide analogue of Lactation. (chronic use); GI baseline and
adenosine effects (e.g. nausea, periodic renal
Adefovir monophosphate is flatulence, function tests
phosphorylated to the diarrhoea, (monitor more
Brand name: active metabolite dyspepsia, vomiting, often with pre-
adefovir diphosphate, abdominal pain, existing
which then inhibits pancreatitis), impairment or
Dose: hepatitis B virus (HBV) headache, asthenia, other risk
10mg DNA polymerase pruritus, skin rash, factors for renal
(reverse transcriptase) proximal renal impairment);
Route: by competing w/ the tubulopathy, monitor periodic
P.O natural substrate Fanconi syndrome, liver function
deoxyadenosine hypophosphatemia, tests, creatinine
Frequency: triphosphate and by raised liver enzymes kinase, serum
OD causing DNA chain and serum amylase, and
termination after its creatinine routine blood
incorporation into viral concentrations, chemistries
DNA, thus resulting to renal failure, renal including serum
inhibition of viral insufficiency, electrolytes.
replication. myopathy,  Withhold drug
osteomalacia. and notify
physician if
lactic acidosis is
suspected [e.g.,
hyperventilation,
lethargy,
plasma pH
<7.35 and
lactate >5–6
mol/L (mEq/L)].

 Report any of
the following to
 physician: blood
in urine,
unexplained
weakness, or
exacerbation of
S&S of
hepatitis.
 Patients who
discontinue
adefovir should
be monitored at
repeated
intervals over a
period of time
for hepatic
function.
 Do not breast
feed while
taking this drug.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIVIRAL Nevirapine is a non- HIV Infection Hypersensitivity. Skin rash, nausea,  Obtain baseline
Generic name: nucleoside reverse Lactation. Severe vomiting, headache, and periodic
transcriptase inhibitor hepatic abnormal LFT, liver and kidney
Nevirapine that acts against HIV-1. impairment.. fatigue, diarrhoea, function tests,
It binds directly to abdominal pain routine blood
Brand name: reverse transcriptase chemistry, and
and thereby blocks the CBC.
RNA-dependent and  Monitor weight,
Dose: DNA-dependent DNA temperature,
200mg polymerase activities by respiratory
disrupting the enzyme's status with
Route: catalytic site.replication. chest x-ray
P.O throughout
therapy.
Frequency:  Monitor
OD for 14 days carefully,
especially
during first 6 wk
of therapy, for
severe rash
(with or without
fever, blistering,
oral lesions,
conjunctivitis,
swelling, joint
aches, or
general
malaise).
 Withhold drug
and notify
physician if rash
develops or liver
function tests
are abnormal.
Antifun
gal
Agents
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIFUNGAL Fluconazole, a triazole oropharyngeal Hypersensitivity. Significant: QT  Monitor for
Generic name: derivative antifungal candidiasis, Concomitant use interval allergic
agent, inhibits the Oesophageal with astemizole, prolongation. response.
Fluconazole fungal CYP450 candidiasis, cisapride, Rarely, anaphylaxis. Patients allergic
mediated 14 α- Chronic atrophic quinidine, Blood and lymphatic to other azole
Brand name: lanesterol candidiasis, terfenadine, system antifungals may
Funzole demethylation, thereby Prophylaxis of pimozide, disorders: Agranulo be allergic to
decreasing ergosterol fungal infections erythromycin... cytosis, anaemia, fluconazole.
Dose: biosynthesis and in leucopenia,  Lab tests:
100mg inhibiting fungal cell immunocompromi thrombocytopenia, Monitor BUN,
membrane formation.. sed patients neutropenia. serum
Route: Gastrointestinal creatinine, and
P.O disorders: Nausea, liver function.
vomiting, diarrhoea,  Note: Drug may
Frequency: abdominal pain, cause
OD for 14 days flatulence, elevations of the
dyspepsia, following
constipation, dry laboratory
mouth. serum values:
General disorders ALT, AST,
and admin site alkaline
conditions: Fatigue, phosphatase,
malaise, asthenia, bilirubin.
fever.  Monitor for S&S
Immune system of
disorders: Angioede hepatotoxicity.
ma, urticaria.
Metabolism and
nutrition
disorders: Hypercho
lesteremia,
hypertriglyceridaemi
a, hyperlipidaemia,
hypokalaemia,
anorexia.
Musculoskeletal
and connective
tissue
disorders: Myalgia.
Nervous system
disorders: Headach
e, dizziness,
dysgeusia,
paraesthesia,
tremor, vertigo.
Psychiatric
disorders: Insomnia,
somnolence.
Skin and
subcutaneous
tissue
disorders: Rash,
pruritus, increased
sweating,
alopecia.pain
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIFUNGAL Has broad-spectrum Dermal infections Ophthalmic uses; GI: Abnormal liver  Monitor for
Generic name: fungicidal activity. Acts including tinea systemic function tests; Evaluate
by altering fungal cell pedis, tinea cruris, mycoses. Safe occasional nausea effectiveness of
Clotrimazole membrane permeability, tinea corporis, tinea use during and vomiting (with treatment.
permitting loss of versicolor; also pregnancy oral Report any
Brand name: phosphorous vulvovaginal and (category C for troche). Skin: Stingi signs of skin
LUTRIMIN compounds, potassium, oropharyngeal oral troches, ng, erythema, irritation with
and other essential candidiasis. category B for edema, vesication, dermal
Dose: intracellular constituents topical desquamation, preparations.
1% cream with consequent loss of preparations), pruritus, urticaria,  Anticipate signs
ability to replicate... lactation, and in skin of clinical
Route: children <3 y not fissures. Urogenital improvement
topical established.... : Mild burning within the first
sensation, lower week of drug
Frequency: abdominal cramps, use.
BID bloating, cystitis,  Use
urethritis, mild clotrimazole as
urinary frequency, directed and for
vulval erythema and the length of
itching, pain and time prescribed
vaginal soreness by physician.
during intercourse.  Generally,
clinical
improvement is
apparent during
first week of
therapy. Report
to physician if
condition
worsens or if
signs of irritation
 or sensitivity
develop, or if no
improvement is
noted after 4 wk
of therapy.
 If receiving the
drug vaginally,
your sexual
partner may
experience
burning and
irritation of
penis or
urethritis; refrain
from sexual
intercourse
during therapy
or have sexual
partner wear a
condom.

Antipro
tozoal
agents
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIMALARIAL Antimalarial activity is Suppression and Hypersensitivity to Body as a  Monitor for
Generic name: believed to be based on treatment of 4- Whole: Slight changes in
its ability to form malaria caused aminoquinolines, weight loss, vision.
Chloroquine complexes with DNA of by P. malariae, P. psoriasis; myalgia, Retinopathy
parasite, thereby ovale, P. vivax, and porphyria, renal lymphedema of (generally
Brand name: inhibiting replication and susceptible forms disease, 4- upper irreversible) can
Aralen transcription to RNA of P. aminoquinoline- limbs. CV: Hypotens be progressive
Hydrochloride and nucleic acid falciparum, and in induced retinal or ion; ECG even after
synthesis. Highly active the treatment of visual field changes. GI: Diarrh termination of
Dose: against asexual extraintestinal changes; long- ea, abdominal therapy. Patient
500mg erythrocytic forms of the amebiasis. term therapy in cramps, nausea, vo may be
four species Concomitant children; miting, asymptomatic
Route: of Plasmodium: P. therapy with pregnancy anorexia. Hematolo or complain of
PO vivax, P. malariae, P. primaquine is (category C), gic: Hemolytic night blindness,
ovale, and most strains necessary for lactation. Safe use anemia in patients scotomas,
Frequency: of P. falciparum. Action radical cure of P. in women of with G6PD visual field
BID mechanism is unknown. vivax and P. childbearing deficiency. CNS: Mil changes,
malariae malarias. potential not d transient blurred vision,
established. headache, fatigue, or difficulty in
irritability, confusion, focusing.
nightmares, skeletal Chloroquine
muscle weakness, should be
paresthesias, discontinued
reduced reflexes, immediately.
vertigo. Skin: Bleac  Question
hing of scalp, patients on
eyebrows, body long-term
hair, and freckles, therapy
pruritus, patchy regularly about
alopecia skeletal muscle
(reversible). Special weakness.
Senses: (usually Periodic tests
reversible): Blurred should be made
 vision, disturbances of muscle
of accommodation, strength and
night blindness, deep tendon
scotomas, visual reflexes.
field defects, Positive signs
photophobia, are indications
corneal edema, to terminate
opacity or deposits, therapy.
ototoxicity (rare).

Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIINFECTIVE;  Synthetic compound Asymptomatic and Blood dyscrasias; Hypersensitivity  Discontinue
Generic name: ANTITRICHOMO with direct symptomatic active CNS (rash, urticaria, therapy
NAL; AMEBICIDE trichomonacidal and trichomoniasis in disease; first pruritus, flushing), immediately if
; ANTIBIOTIC amebicidal activity as females and males; trimester of fever, fleeting joint symptoms of
 well as antibacterial acute intestinal pregnancy pains, overgrowth CNS toxicity
Metronidazole activity against amebiasis and (category B), of Candida. CNS: V (see Appendix
anaerobic bacteria and amebic liver lactation. ertigo, headache, F) develop.
Brand name: some gram-negative abscess; ataxia, confusion, Monitor
Flagyl bacteria. preoperative irritability, especially for
prophylaxis in depression, seizures and
Dose: colorectal surgery, restlessness, peripheral
500mg elective weakness, fatigue, neuropathy
hysterectomy or drowsiness, (e.g., numbness
Route: vaginal repair, and insomnia, and paresthesia
PO emergency paresthesias, of extremities).
appendectomy. IV sensory neuropathy  Lab tests:
Frequency: metronidazole is (rare). GI: Nausea,  Obtain total and
BID used for the vomiting, anorexia, differential WBC
treatment of epigastric distress, counts before,
serious infections abdominal cramps, during, and after
caused by diarrhea, therapy,
susceptible constipation, dry especially if a
anaerobic bacteria mouth, metallic or second course
in intraabdominal bitter taste, proctitis is necessary.
infections, skin  Monitor for S&S
infections, of sodium
gynecologic retention,
infections, especially in
septicemia, and for patients on
both pre- and corticosteroid
postoperative therapy or with
prophylaxis, a history of
bacterial CHF.
vaginosis. Topical:   Monitor patients
Rosacea.. on lithium for
elevated lithium
levels.
 Report
appearance of
candidiasis or
 its becoming
more prominent
with therapy to
physician
promptly.
 Repeat feces
examinations,
usually up to 3
mo, to ensure
that amebae
have been
eliminated.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
ANTIINFECTIVE; Carbamate with Treatment Safety during GI: Transient  Initiate second
Generic name: ANTHELMINTIC unusually broad of Trichuris pregnancy abdominal pain, course of
spectrum of trichiura (whipworm (category C), diarrhea. Body as a treatment if cure
Mebendazole anthelmintic activity. ), Enterobius lactation, or in Whole: Dizziness, does not occur
Mechanism of action vermicularis (pinwo children <2 y is not fever (possibly due within 3 wk.
Brand name: not known. rm), Ascaris established. to tissue necrosis in  Examine and
Vermox lumbricoides (round cysts). treat all family
worm), Ancylostom members
Dose: a simultaneously
100mg duodenale (commo because
n pinworms are
Route: hookworm), Necato readily
PO r transmitted from
americanus (Ameri person to
Frequency: can hookworm) in person.
PRN single or mixed
infections. Patient & Family
Education

 Practice
thorough hand
washing after
touching any
potentially
contaminated
item.
 Change
underclothing,
bedclothes,
towels, and
facecloths daily;
bathe
 frequently,
preferably by
showering.
Infected person
should sleep
alone.
 Do not breast
feed while
taking this drug
without
consulting
physician.

.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
Cytotoxic Chlorambucil is an Hodgkin's Lactation. ignificant: Myelosup  Leukopenia
Generic name: Chemotherapy alkylating agent that is disease. presion, infertility usually
derived from (i.e. sterility in develops after
Chlorambucil chlormethine. It prepubertal/pubertal the third week
Non-Hodgkin’s
interferes w/ DNA lymphoma males, azoospermia of treatment; it
Brand name: replication and RNA in adult males, may continue
transcription by Chronic amenorrhoea), for up to 10 d
alkylation and cross- lymphocytic secondary after last dose,
Dose: linking the cellular DNA malignancy (e.g. then rapidly
leukaemia
200mcg strands, thereby leading acute leukaemia). return to
to disruption of the Rarely, focal and/or normal.
Route: nucleic acid function. generalised  Avoid or reduce
PO seizures, erythema to minimum
multiforme, Stevens injections and
Frequency: Johnson syndrome, other invasive
OD toxic epidermal procedures
necrolysis. (e.g., rectal
Nervous: Peripheral temperatures,
neuropathy, enemas) when
agitation, ataxia. platelet count is
GI: Nausea, low because of
vomiting, diarrhoea, danger of
abdominal pain, bleeding.
anorexia, oral  Monitor for S&S
ulceration. of skin rashes,
Resp: Interstitial which are rare,
pneumonia. but appear to
Hepatic: Hepatotoxi show a
city, jaundice. consistent
Genitourinary: Steril pattern: pustular
e cystitis. eruption on
Haematologic: Leuc mouth, chin,
openia (i.e. cheeks;
neutropenia, urticarial
lymphopenia), erythema on
thrombocytopenia, trunk that
anaemia, spreads to legs.
pancytopenia, The rash occurs
irreversible bone early in
marrow failure. treatment period
Dermatologic: Rash, and lasts about
urticaria, 10 d after last
angioedema, dose.
dermatitis, pruritus,  Notify physician
occurrence or if the following
exacerbation of symptoms
herpes zoster. occur: unusual
Others: Hyperuricae bleeding or
mia, drug fever. bruising, sores
on lips or in
mouth; flank,
stomach, or
joint pain; fever,
chills, or other
signs of
infection, sore
throat, cough,
dyspnea.
 Report
immediately the
onset of
cutaneous
reaction.
 Drink at least
10–12 glasses
(240 mL [8 oz]
each) of fluid
per day, if not
contraindicated,
 and report to
physician if
urine output
decreases
below normal
amounts.
 Report to
physician
immediately if
pregnant, as
there is a
potential hazard
to the fetus.
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
Cytotoxic Methotrexate is a folic Principally in Pregnancy Headache, drowsine  Obtain baseline
Generic name: Chemotherapy /  acid antagonist that combination (category D), men ss, blurred vision, liver and kidney
Immunosuppress inhibits DNA synthesis. regimens to and women in dizziness, aphasia, function, CBC
Methotrexate ants It irreversibly binds to maintain induced childbearing age; hemiparesis; with differential,
dihydrofolate reductase, remissions in lactation; hepatic arachnoiditis, platelet count,
Brand name: inhibiting the formation neoplastic and renal convulsions (after and chest x-
Pterin of reduced folates, and diseases. insufficiency; intrathecal rays. Repeat
thymidylate synthetase, Effective in concomitant administration); weekly during
Dose: resulting in inhibition of treatment of administration of mental confusion, therapy. Monitor
15-30mg purine and thymidylic gestational hepatotoxic drugs tremors, ataxia, blood glucose
acid synthesis. choriocarcinoma and hematopoietic coma. GI: Hepatoto and HbA1c
Route: and hydatidiform depressants; xicity, GI ulcerations periodically in
PO mole and as alcohol; ultraviolet and diabetics.
immunosuppress exposure to hemorrhage, ulcerat  Prolonged
Frequency: ant in kidney psoriatic lesions; ive stomatitis, treatment with
OD for 5 days transplantation, pre-existing blood glossitis, small frequent
for acute and dyscrasias. gingivitis, pharyngiti doses may lead
subacute s, nausea, vomiting, to
leukemias and . diarrhea, hepatic hepatotoxicity,
leukemic cirrhosis. Urogenita which is best
meningitis, l: Defective diagnosed by
especially in oogenesis or liver biopsy.
children. Used in spermatogenesis,  Monitor for and
lymphosarcoma, nephropathy, report ulcerative
in certain hematuria, stomatitis with
inoperable tumors menstrual glossitis and
of head, neck, and dysfunction, gingivitis, often
pelvis, and in infertility, abortion, the first signs of
mycosis fetal toxicity. Inspect
fungoides. Also defects. Hematolog mouth daily;
used to treat ic: Leukopenia, report patchy
severe psoriasis thrombocytopenia, a necrotic areas,
nonresponsive to nemia, marked bleeding and
other forms of myelosuppression, discomfort, or
therapy, aplastic bone overgrowth
rheumatoid marrow, (black, furry
arthritis.. telangiectasis, tongue).
thrombophlebitis at  Monitor I&O
intraarterial catheter ratio and
site, pattern. Keep
hypogammaglobulin patient well
emia, and hydrated (about
hyperuricemia. Skin 2000 mL/24 h).
: Erythematous  Prevent
rashes, pruritus, exposure to
urticaria, folliculitis, infections or
vasculitis, colds during
photosensitivity, periods of
depigmentation, leukopenia. Be
hyperpigmentation, alert to onset of
alopecia. Body as a agranulocytosis
Whole: Malaise, (cough, extreme
undue fatigue, fatigue, sore
systemic toxicity throat, chills,
(after intrathecal fever) and
and intraarterial report
administration), symptoms
chills, fever, promptly.
decreased  Be alert for and
resistance to report
infection, symptoms of
septicemia, thrombocytopen
osteoporosis, ia (e.g.,
metabolic changes ecchymoses,
precipitating petechiae,
diabetes epistaxis,
and sudden death, melena,
pneumonitis, hematuria,
pulmonary fibrosis. vaginal
bleeding, slow
and protracted
oozing following
trauma).
 Name of Drug Classification Mechanism of Action Indication Contraindication Adverse Effects Nursing
consideration
Cytotoxic Doxorubicin is a To produce Myelosuppression, Hypersensitivity (red  Stop infusion,
Generic name: Chemotherapy cytotoxic anthracycline regression in impaired cardiac flare around remove IV
DOXORUBICIN antibiotic. The cytotoxic neoplastic function, injection site, needle, and
action results from its conditions, obstructive erythema, skin rash, notify physician
Brand name: binding to DNA and including acute jaundice, previous pruritus, promptly if
Rubex inhibition of nucleic acid lymphoblastic and treatment with angioedema, patient
synthesis. Doxorubicin myeloblastic complete urticaria, complains of
Dose: has been shown to leukemias, Wilms' cumulative doses eosinophilia, fever, stinging or
20mg produce regression in a tumor, of doxorubicin or chills, anaphylactoid burning
variety of disseminated neuroblastoma, soft daunorubicin; reaction). CV: Serio sensation at the
Route: malignancies. tissue and bone lactation. Safe use us, irreversible injection site.
IV sarcomas, breast during pregnancy myocardial toxicity  Monitor any
and ovary (category D) is not with delayed CHF, area of
Frequency: carcinomas, established. ventricular extravasation
Once weekly lymphomas, arrhythmias, acute closely for 3–4
bronchogenic . left ventricular wk. If ulceration
carcinoma, ovarian failure, begins (usually
cancer relapse. hypertension, 1–4 wk after
Generally used in hypotension, extravasation),
combined cardiomyopathy. GI:  a plastic
modalities with Stomatitis, esophagi surgeon should
surgery, radiation, tis with ulcerations; be consulted.
and nausea, vomiting,  Begin a flow
immunotherapy. anorexia, inanition, chart to
Effective diarrhea. Hematolog establish
pretreatment to ic: Severe baseline data.
sensitize superficial myelosuppression ( Include
tumors to local 60–85% of temperature,
radiation therapy. patients); leukopeni pulse,
Kaposi's sarcoma a (principally respiration, BP,
(Doxil). granulocytes) , thro body weight,
mbocytopenia, laboratory
anemia. Skin: Hyper values, and I&O
pigmentation of nail ratio and
beds, tongue, and pattern.
buccal mucosa  Lab tests:
(especially in Baseline and
blacks); complete periodic hepatic
alopecia (reversible) function, renal
, hyperpigmentation function, CBC
of dermal creases with differential
(especially in throughout
children), therapy.
rash, recall  Note: The nadir
phenomenon (skin of leukopenia
reaction due to prior (an expected
radiotherapy). Other 1000/mm3)
: Lacrimation, typically occurs
drowsiness, fever, 10–14 d after
facial flush with too single dose,
rapid IV infusion with recovery
rate, microscopic occurring within
hematuria, 21 d.
hyperuricemia, han  Evaluate
d-foot cardiac function
syndrome. With (ECG) prior to
extravasation: initiation of
severe cellulitis, therapy, at
vesication, tissue regular
necrosis, lymphangit intervals, and at
is, phlebosclerosis end of therapy.
 Be alert to and
report early
signs of
cardiotoxicity
(see Appendix
F). Acute life-
threatening
arrhythmias
may occur
 within a few
hours of drug
administration.
 Report promptly
objective signs
of hepatic
dysfunction
(jaundice, dark
urine, pruritus)
or kidney
dysfunction
(altered I&O
ratio and
pattern, local
discomfort with
voiding).
 Promote
fastidious oral
hygiene,
especially
before and after
meals.
Stomatitis,
generally
maximal in
second week of
therapy,
frequently
begins with a
burning
sensation
accompanied by
erythema of oral
mucosa that
may progress to
ulceration and
 dysphagia in 2
or 3 d.
 Report signs of
superinfection
(see Appendix
F) promptly;
these may
result from
antibiotic
therapy during
leukopenic
period.
 Avoid rectal
medications and
use of rectal
thermometer;
rectal trauma is
associated with
bloody diarrhea
resulting from
an antiblastic
effect on rapidly
growing
intestinal
mucosal cells.