Name of Drug: Meperidine Hydrochloride

Brand Name: Demerol

Chemical/Therapeutic Classification: Central Nervous System Agent; Narcotic (Opiate) Agonist Analgesic

Indication: Relief of moderate to severe pain, for preoperative medication, for support of anesthesia,
and for obstetric analgesia.

Contraindication: Hypersensitivity to meperidine; convulsive disorders; acute abdominal conditions

prior to diagnosis; pregnancy prior to labor [(category B), at term (category D)], lactation.

Dosage: IM/SC 50–100 mg when pains become regular, may be repeated q1–3h

Drug Action: Synthetic morphine-like compound. Chemically dissimilar to morphine, but in equianalgesic
doses it is qualitatively comparable. Usual doses produce either no pupillary change or slight miosis, but
overdosage results in marked miosis or mydriasis. Also, unlike morphine, has little or no antidiarrheic or
antitussive action. Produces CNS stimulation in toxic doses.

Side Effects and Adverse Reactions:

Body as a Whole: Allergic (Pruritus, urticaria, skin rashes, wheal and flare over IV site), profuse
perspiration. 
CNS: Dizziness, weakness, euphoria, dysphoria, sedation, headache, uncoordinated muscle movements,
disorientation, decreased cough reflex, miosis, corneal anesthesia, respiratory depression. Toxic doses:
muscle twitching, tremors, hyperactive reflexes, excitement, hypersensitivity to external stimuli,
agitation, confusion, hallucinations, dilated pupils, convulsions. 
CV: Facial flushing, light-headedness, hypotension, syncope, palpitation, bradycardia,
tachycardia, cardiovascular collapse, cardiac arrest (toxic doses). 
GI: Dry mouth, nausea, vomiting, constipation, biliary tract spasm. 
Urogenital: Oliguria, urinary retention. 
Respiratory: Respiratory depression in newborn, bronchoconstriction (large doses). 
Skin: Phlebitis (following IV use), pain, tissue irritation and induration, particularly following
subcutaneous injection. 
Metabolic: Increased levels of serum amylase, BSP retention, bilirubin, AST, ALT.

Nursing Responsibilities:
Assessment & Drug Effects
 Give narcotic analgesics in the smallest effective dose and for the least period of time
compatible with patient's needs.
 Assess patient's need for prn medication. Record time of onset, duration, and quality of pain.
 Note respiratory rate, depth, and rhythm and size of pupils in patients receiving repeated doses.
If respirations are 12/min or below and pupils are constricted or dilated (see ACTIONS AND
USES) or breathing is shallow, or if signs of CNS hyperactivity are present, consult physician
before administering drug.
  Monitor vital signs closely. Heart rate may increase markedly, and hypotension may occur.
Meperidine may cause severe hypotension in postoperative patients and those with depleted
blood volume.
 Schedule deep breathing, coughing (unless contraindicated), and changes in position at intervals
to help to overcome respiratory depressant effects.
 Chart patient's response to drug and evaluate continued need.
 Repeated use can lead to tolerance as well as psychic and physical dependence of the morphine
type.
 Be aware that abrupt discontinuation following repeated use results in morphine-like
withdrawal symptoms. Symptoms develop more rapidly (within 3 h, peaking in 8–12 h) and are
of shorter duration than with morphine. Nausea, vomiting, diarrhea, and pupillary dilatation are
less prominent, but muscle twitching, restlessness, and nervousness are greater than produced
by morphine.
Patient & Family Education
 Do not smoke and walk without assistance after receiving the drug. Bed side rails may be
advisable.
 Be aware nausea, vomiting, dizziness, and faintness associated with fall in BP are more
pronounced when walking than when lying down (these symptoms may also occur in patients
without pain who are given meperidine). Symptoms are aggravated by the head-up position.
 Do not drive or engage in potentially hazardous activities until any drowsiness and dizziness
have passed.
 Do not take other CNS depressants or drink alcohol because of their additive effects.
 Do not breast feed while using this drug.

Name of Drug: Promethazine Hydrochloride

Brand Name: Phenergan

Chemical/Therapeutic Classification: Gastrointestinal Agent; Antiemetic; Antivertigo Agent;

Phenothiazine

Indication: Symptomatic relief of various allergic conditions, to ameliorate and prevent reactions to
blood and plasma, and in prophylaxis and treatment of motion sickness, nausea, and vomiting.
Preoperative, postoperative, and obstetric sedation and as adjunct to analgesics for control of pain.

Contraindication: Hypersensitivity to phenothiazines; narrow-angle glaucoma; stenosing peptic ulcer,

pyloroduodenal obstruction; prostatic hypertrophy; bladder neck obstruction; epilepsy; bone marrow
depression; comatose or severely depressed states; pregnancy (category C), lactation, newborn or
premature infants, acutely ill or dehydrated children; children <2 y; Reye's syndrome, encephalopathy,
hepatic diseases.

Dosage: PO/PR/IM/IV 12.5–25 mg q4–6h prn

Drug Action: Long-acting derivative of phenothiazine with marked antihistamine activity and prominent
sedative, amnesic, antiemetic, and anti-motion-sickness actions. Unlike other phenothiazine derivatives,
relatively free of extrapyramidal adverse effects; however, in high doses it carries same potential for
toxicity.

Side Effects and Adverse Reactions:

Body as a Whole: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal
reactions, nightmares (in children), CNS stimulation, abnormal movements. 
Respiratory: Irregular respirations, respiratory depression, apnea. 
CNS: Sedation drowsiness, confusion, dizziness, disturbed coordination, restlessness, tremors. 
CV: Transient mild hypotension or hypertension. 
GI: Anorexia, nausea, vomiting, constipation. 
Hematologic: Leukopenia, agranulocytosis. 
Special Senses: Blurred vision, dry mouth, nose, or throat. 
Skin: Photosensitivity. 
Urogenital: Urinary retention.

Nursing Responsibilities:
Assessment & Drug Effects
 Supervise ambulation. Promethazine sometimes produces marked sedation and dizziness.
 Be aware that antiemetic action may mask symptoms of unrecognized disease and signs of drug
overdosage as well as dizziness, vertigo, or tinnitus associated with toxic doses of aspirin or
other ototoxic drugs.
 Patients in pain may develop involuntary (athetoid) movements of upper extremities following
parenteral administration. These symptoms usually disappear after pain is controlled.
 Monitor respiratory function in patients with respiratory problems, particularly children. Drug
may suppress cough reflex and cause thickening of bronchial secretions.
Patient & Family Education
 For motion sickness: Take initial dose 30–60 min before anticipated travel and repeat at 8–12 h
intervals if necessary. For duration of journey, repeat dose on arising and again at evening meal.
 Do not drive or engage in other potentially hazardous activities requiring mental alertness and
normal reaction time until response to drug is known.
 Avoid sunlamps or prolonged exposure to sunlight. Use sunscreen lotion during initial drug
therapy.
 Do not take OTC medications without physician's approval.
 Avoid alcohol and other CNS depressants.
 Relieve dry mouth by frequent rinses with water or by increasing noncaloric fluid intake (if
allowed), chewing sugarless gum, or sucking hard candy. If these measures fail, add a saliva
substitute (e.g., Moi-Stir, Orex, Xero-Lube).
 Do not breast feed while taking this drug.

Name of Drug: Penicillin G Potassium

Brand Name: Megacillin

Chemical/Therapeutic Classification: Anti-infective; Beta-Lactam Antibiotic; Natural Penicillin

Indication: Moderate to severe systemic infections caused by penicillin-sensitive microorganisms:

actinomycosis, anthrax, diphtheria (carrier state), empyema, erysipelas, gas gangrene, gonorrheal
infections, leptospirosis, mastoiditis, meningitis, acute osteomyelitis, otitis media, pinta, pneumonia, rat-
bite fever, sinus infections; certain staphylococcal infections; streptococcal infections, including scarlet
fever; syphilis (all stages), tetanus, urinary tract infections, Vincent's gingivostomatitis, yaws.

Contraindication: Hypersensitivity to any of the penicillins or cephalosporins; administration of oral drug

to patients with severe infections; nausea, vomiting, hypermotility, gastric dilatation; cardiospasm. Use
of penicillin G sodium in patients on sodium restriction. Safety during pregnancy (category B) or
lactation is not established.

Dosage: PO 1.6–3.2 million U divided q6h IV/IM 1.2–24 million U divided q4h

Drug Action: Acid-labile, penicillinase-sensitive, natural penicillin. Antimicrobial spectrum is relatively

narrow compared to that of the semisynthetic penicillins. Bactericidal at therapeutic serum levels;
bacteriostatic at lower concentrations. Acts by interfering with synthesis of mucopeptides essential to
formation and integrity of bacterial cell wall. Action is inhibited by penicillinase; therefore, penicillin G is
ineffective against many strains of Staphylococcus aureus.

Side Effects and Adverse Reactions:

Body as a Whole: Coughing, sneezing, feeling of uneasiness; systemic anaphylaxis, fever, widespread
increase in capillary permeability and vasodilation with resulting edema (mouth, tongue, pharynx,
larynx), laryngospasm, malaise, serum sickness (fever, malaise, pruritus, urticaria, lymphadenopathy,
arthralgia, angioedema of face and extremities, neuritis prostration, eosinophilia), SLE-like syndrome,
Injection site reactions (pain, inflammation, abscess, phlebitis), superinfections (especially
with Candida and gram-negative bacteria), neuromuscular irritability (twitching, lethargy, confusion,
stupor, hyperreflexia, multifocal myoclonus, localized or generalized seizures, coma). 
CV: Hypotension, circulatory collapse, cardiac arrhythmias, cardiac arrest. 
GI: Vomiting, diarrhea, severe abdominal cramps, nausea, epigastric distress, diarrhea, flatulence, dark
discoloration of tongue, sore mouth or tongue. 
Urogenital: Interstitial nephritis, Loeffler's syndrome, vasculitis. 
Hematologic: Hemolytic anemia, thrombocytopenia. 
Metabolic: Hyperkalemia (penicillin G potassium); hypokalemia, alkalosis, hypernatremia, CHF (penicillin
G sodium). 
Respiratory: Bronchospasm, asthma. 
Skin: Itchy palms or axilla, pruritus, urticaria, flushed skin, delayed skin rashes ranging from urticaria to
exfoliative dermatitis, Stevens-Johnson syndrome, fixed-drug eruptions, contact dermatitis.

Nursing Responsibilities:
Assessment & Drug Effects
 Obtain an exact history of patient's previous exposure and sensitivity to penicillins and
cephalosporins and other allergic reactions of any kind prior to treatment with penicillin.
  Hypersensitivity reactions are more likely to occur with parenteral penicillin but may also occur
with the oral drug. Skin rash is the most common type allergic reaction and should be reported
promptly to physician.
 Lab tests: Perform C&S tests prior to initiation of therapy; treatment may be started before
results are known. Evaluate renal, hepatic, and hematologic systems at regular intervals in
patients on high-dose therapy. Additionally, check electrolyte balance periodically in patients
receiving high parenteral doses.
 Observe all patients closely for at least 30 min following administration of parenteral penicillin.
The rapid appearance of a red flare or wheal at the IM or IV injection site is a possible sign of
sensitivity. Also suspect an allergic reaction if patient becomes irritable, has nausea and
vomiting, breathing difficulty, or sudden fever. Report any of the foregoing to physician
immediately.
 Be aware that reactions to penicillin may be rapid in onset or may not appear for days or weeks.
Symptoms usually disappear fairly quickly once drug is stopped, but in some patients may
persist for 5 d or more and require hospitalization for treatment.
 Allergy to penicillin is unpredictable. It has occurred in patients with a negative history of
penicillin allergy and also in patients with no known prior contact with penicillin (sensitization
may have occurred from penicillin used commercially in foods and beverages).
 Be alert for neuromuscular irritability in patients receiving parenteral penicillin in excess of 20
million U/d who have renal insufficiency, hyponatremia, or underlying CNS disease, notably
myasthenia gravis or epilepsy. Seizure precautions are indicated. Symptoms usually begin with
twitching, especially of face and extremities.
 Monitor I&O, particularly in patients receiving high parenteral doses. Report oliguria, hematuria,
and changes in I&O ratio. Consult physician regarding optimum fluid intake. Dehydration
increases the concentration of drug in kidneys and can cause renal irritation and damage.
 Observe closely for signs of toxicity: Neonates, young infants, the older adult, and patients with
impaired kidney function receiving high-dose penicillin therapy. Urinary excretion of penicillin is
significantly delayed in these patients.
 Observe patients on high-dose therapy closely for evidence of bleeding, and bleeding time
should be monitored. (In high doses, penicillin interferes with platelet aggregation.)
Patient & Family Education
 Understand that hypersensitivity reaction may be delayed. Report skin rashes, itching, fever,
malaise, and other signs of a delayed reaction to physician immediately (see ADVERSE EFFECTS).
 Penicillin is to be taken around the clock (i.e., t.i.d. means q8h, q.i.d. means q6h, etc.). Do not
miss any doses and continue taking medication until it is all gone, unless otherwise directed by
the physician.
 Measure liquid dosage form with specially marked measuring device; household teaspoons vary
in size and measure.
 Notify physician if following symptoms appear when taking penicillin for treatment of syphilis
(i.e., Jarisch-Herxheimer reaction occurs 8–24 h after treatment): Headache, chills, fever,
myalgia, arthralgia, malaise, and worsening of syphilitic skin lesions. Reaction is usually self-
limiting. Check with physician if symptoms do not improve within a few days or get worse.
 Report S&S of superinfection (see Appendix F).
 Understand importance of medical follow-up; present evidence suggests that
glomerulonephritis, a possible complication of streptococcal infection, may not be prevented by
penicillin.
 Do not breast feed while taking this drug without consulting physician.
Name of Drug: Ampicillin

Brand Name: Ampicin

Chemical/Therapeutic Classification: Anti-infective; Antibiotic; Aminopenicillin

Indication: A broad-spectrum semisynthetic, aminopenicillin is highly bactericidal even at low

concentrations, but is inactivated by penicillinase (beta-lactamase).

Contraindication: Hypersensitivity to penicillin derivatives; infectious mononucleosis.

Dosage: PO 250–500 mg q6h IV/IM 250 mg–2 g q6h

Drug Action: A broad-spectrum semisynthetic, aminopenicillin is highly bactericidal even at low

concentrations, but is inactivated by penicillinase (beta-lactamase).

Side Effects and Adverse Reactions:

Body as a Whole: Similar to those for penicillin G. Hypersensitivity (pruritus, urticaria, eosinophilia,
hemolytic anemia, interstitial nephritis, anaphylactoid reaction); superinfections. 
CNS: Convulsive seizures with high doses. 
GI: Diarrhea, nausea, vomiting, pseudomembranous colitis. 
Other: Severe pain (following IM); phlebitis (following IV). 
Skin: Rash.

Nursing Responsibilities:
Assessment & Drug Effects
 Determine previous hypersensitivity reactions to penicillins, cephalosporins, and other allergens
prior to therapy.
 Lab tests: Baseline C&S tests prior to initiation of therapy; start drug pending results. Baseline
and periodic assessments of renal, hepatic, and hematologic functions, particularly during
prolonged or high-dose therapy.
 Note: Sodium content of drug must be considered in patients on sodium restriction.
 Inspect skin daily and instruct patient to do the same. The appearance of a rash should be
carefully evaluated to differentiate a nonallergenic ampicillin rash from a hypersensitivity
reaction. Report rash promptly to physician.
 Note: Incidence of ampicillin rash is higher in patients with infectious mononucleosis or other
viral infections, Salmonella infections, lymphocytic leukemia, or hyperuricemia or in patients
taking allopurinol.
 Take medication around the clock; continue taking medication until it is all gone (usually 10 d)
unless otherwise directed by physician or pharmacist.
Patient & Family Education
 Note: Ampicillin rash is believed to be nonallergenic and therefore its appearance is not an
absolute contraindication to future therapy.
 Report diarrhea to physician; do not self-medicate. Give a detailed report to the physician
regarding onset, duration, character of stools, associated symptoms, temperature and weight
 loss (if any) to help rule out the possibility of drug-induced, potentially fatal pseudomembranous
colitis (see Appendix F).
 Report S&S of superinfection (onset of black, hairy tongue; oral lesions or soreness; rectal or
vaginal itching; vaginal discharge; loose, foul-smelling stools; or unusual odor to urine).
 Notify physician if no improvement is noted within a few days after therapy is started.
 Do not breast feed while taking this drug without consulting physician.

Name of Drug: Gentamicin Sulfate

Brand Name: Garamycin

Chemical/Therapeutic Classification: Anti-infective; Aminoglycoside Antibiotic

Indication: Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary
tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are
ineffective or are contraindicated. Has been used in combination with other antibiotics.

Contraindication: History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe
use during pregnancy (category C) or lactation is not established.

Dosage: IV/IM 1.5–2 mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses

Drug Action: Broad-spectrum aminoglycoside antibiotic derived from Micromonospora purpurea.

Side Effects and Adverse Reactions:

Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. 
CNS: neuromuscular blockade: skeletal muscle weakness, apnea, respiratory paralysis (high doses);
arachnoiditis (intrathecal use). 
CV: hypotension or hypertension. 
GI: Nausea, vomiting, transient increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly,
splenomegaly. 
Hematologic: Increased or decreased reticulocyte counts; granulocytopenia, thrombocytopenia (fever,
bleeding tendency), thrombocytopenic purpura, anemia. 
Body as a Whole: Hypersensitivity (rash, pruritus, urticaria, exfoliative dermatitis, eosinophilia, burning
sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis). 
Urogenital: Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN,
nonprotein nitrogen, serum creatinine; decreased creatinine clearance. 
Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome
of hypocalcemia (tetany, weakness, hypokalemia, hypomagnesemia). 

Nursing Responsibilities:
Assessment & Drug Effects
 Lab tests: Perform C&S and renal function prior to first dose and periodically during therapy;
therapy may begin pending test results. Determine creatinine clearance and serum drug
 concentrations at frequent intervals, particularly for patients with impaired renal function,
infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d,
patients with fever or extensive burns, edema, obesity.
 Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.
 Note: Dosages are generally adjusted to maintain peak serum gentamicin concentrations of 4–
10 g/mL, and trough concentrations of 1–2 g/mL. Peak concentrations above 12 g/mL and
trough concentrations above 2 g/mL are associated with toxicity.
 Draw blood specimens for peak serum gentamicin concentration 30 min–1h after IM
administration, and 30 min after completion of a 30–60 min IV infusion. Draw blood specimens
for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.
 Check baseline weight and vital signs; determine vestibular and auditory function before
therapy and at regular intervals. Check vestibular and auditory function again 3–4 wk after drug
is discontinued (the time that deafness is most likely to occur).
 Monitor I&O. Keep patient well hydrated to prevent chemical irritation of renal tubules. Report
oliguria, unusual appearance of urine, change in I&O ratio or pattern, and presence of edema
(prolongs elimination time).
 Note: Ototoxic effect (see Appendix F) is greatest on the vestibular branch of eighth cranial
(acoustic) nerve (symptoms: headache, dizziness or vertigo, nausea and vomiting with motion,
ataxia, nystagmus). However, damage to the auditory branch (tinnitus, roaring noises, sensation
of fullness in ears, hearing impairment) may also occur. Report promptly to prevent permanent
damage.
 Watch for S&S of bacterial overgrowth (opportunistic infections) with resistant or
nonsusceptible organisms (diarrhea, anogenital itching, vaginal discharge, stomatitis, glossitis).
Patient & Family Education
 Note: When using topical applications: Avoid excessive exposure to sunlight because of danger
of photosensitivity; withhold medication and notify physician if condition fails to improve within
1 wk, worsens, or signs of irritation or sensitivity occur; and apply medication as directed and
only for length of time prescribed (overuse can result in superinfections).
 Do not breast feed while taking this drug without consulting physician.