DRUG STUDY

GENERIC NAME: Rabeprazole

Brand name: Aciphex, Aciphex Sprinkle
Drug Classification: Proton pump inhibitors

DOSAGE, ROUTE, SIDE EFFECTS and

MECHANISM OF
FREQUENCY (prescribed and INDICATION ADVERSE REACTIONS
ACTION
recommended) (by system)
Prescribed: Healing and Action: Blocks proton Adverse Effects:
40mg tab PO OD maintenance of healing pump activity and gastric CNS: headache, pain,
of erosive or ulcerative acid secretion by inhibiting dizziness.
Recommended: gastroesophageal gastric hydrogen–
Healing of erosive or ulcerative reflux disease (GERD); potassium CV: peripheral edema.
GERD healing of duodenal adenosine triphosphatase
Adults: 20 mg PO daily for 4 to 8 ulcers; treatment of (an enzyme) at secretory EENT: pharyngitis.
weeks. hypersecretory surface of gastric parietal
Additional 8-week course may be conditions. cells. GI: abdominal
considered, if needed. pain, constipation, diarrhea,
Route: PO flatulence, nausea,
Maintenance of healing of vomiting, dry mouth, taste
erosive or ulcerative GERD Onset: <1hr perversion.
Adults: 20 mg PO daily for up to
12 months. Peak: 1-6 ½ hr Hepatic:
elevated liver enzyme
Healing of duodenal ulcers Duration: 24hrs levels, hepatitis, hepatic
Adults: 20 mg PO daily after encephalopathy.
morning meal for up to 4 weeks. Absorption: 52%
bioavailability.  Musculoskeletal:
Pathologic hypersecretory arthralgia,
conditions, including Zollinger- Distribution: 96% protein myalgia.
Ellison syndrome bound.  Other: infection
Adults: Initially, 60 mg PO daily;
may increase, as needed, to 100 Metabolism: Metabolized
mg PO daily or 60 mg PO in liver by CYP3A and
b.i.d. CYP2C19. 

Symptomatic GERD, including Elimination: Excreted

daytime and nighttime primarily in urine. 
heartburn
Adults: 20 mg PO daily for 4 Half-Life: 1–2 h.
weeks. May consider additional 4-
week course, if needed.
Children age 12 and older: 20 mg
PO daily for up to 8 weeks.

GERD (Aciphex Sprinkle)

Children ages 1 to 11 weighing
15 kg or more: 10 mg PO once
daily for up to 12 weeks.
Children ages 1 to 11 weighing
less than 15 kg: 5 mg PO once
daily for up to 12 weeks. May
increase to 10 mg once daily if
inadequate response.

Helicobacter pylori eradication,

to reduce risk of duodenal
ulcer recurrence
Adults: 20 mg PO b.i.d.,
combined with amoxicillin 1,000
mg PO b.i.d. and clarithromycin
500
mg PO b.i.d., for 7 days with
morning and evening meals.

NURSING RESPONSIBILITIES
CONTRAINDICATION/S
(at least 10)
 Contraindicated in patients 1. Watch for signs of blood clots. Greatest risk of thromboembolic
hypersensitive to drug, other events occurs during first 4months of treatment.Watch for breast
benzimidazoles (lansoprazole, abnormalities; drug doesn't eliminate risk of breast cancer.
omeprazole), or components of 2. Conduct breast examinations and mammograms before starting, and
these formulations and with regularly during, therapy.
rilpivirine-containing products. 3. Effect on bone mineral density beyond 2 years of drug treatment isn't
 In H. pylori eradication, known.
clarithromycin is contraindicated 4. For osteoporosis treatment, add supplemental calcium (average of
in patients hypersensitive to 1,500 mg daily) and vitamin
macrolides and in those taking 5. D (400 to 800 units daily) to the diet if daily intake is inadequate.
pimozide; amoxicillin is 6. Monitor triglyceride level if previous treatment with estrogen caused
contraindicated in patients elevation.
hypersensitive to penicillin or 7. Advise patient to avoid long periods of restricted movement (such as
cephalosporins. during traveling) because
 Avoid use in patients with severe 8. of increased risk of venous thromboembolic events.• Inform patient
hepatic impairment. If necessary, that hot flashes or flushing may occur and that drug doesn't aid in
monitor for adverse reactions. reducing
 Long-term (1 year or more) and 9. them.
multiple daily-dose rabeprazole 10. Instruct patient to practice other bone loss-prevention measures,
therapy may be associated with including taking supplemental
an increased risk of osteoporosis- 11. calcium and vitamin D if dietary intake is inadequate, performing
related fractures of the hip, wrist, weight-bearing exercises, and
or spine. Use lowest dosage and 12. stopping alcohol consumption and smoking.
shortest duration of therapy 13. Tell patient that drug may be taken without regard for food.
appropriate to condition being 14. Advise patient to report unexplained uterine bleeding or breast
treated. May consider vitamin D abnormalities during therapy.
and calcium supplementation and 15. Explain adverse reactions and instruct patient to read patient
following appropriate guidelines to information insert before starting therapy and each time prescription is
reduce risk of fractures in patients renewed.
at risk.
 Acute interstitial nephritis has
been observed in patients taking
rabeprazole and may occur at any
point during therapy. Discontinue
drug if this condition develops.
 Vitamin B12 malabsorption and
deficiency have been reported in
patients receiving prolonged daily
treatment (longer than 3 years)
with acid suppressants.
 Cutaneous lupus erythematosus
(CLE) and SLE have been
reported, occurring as both new
onset and an exacerbation of
existing autoimmune disease in
patients of all ages within weeks
to years after continuous drug
therapy.
 •Long-term use (1 year or more)
may increase risk of fundic gland
polyps. Use lowest dosage and
shortest duration of therapy
appropriate to condition being
treated.

GENERIC NAME: Paracetamol
Brand name: Abenol, A’Cenol, Acephen, Anacin-3. Anuphen, APAP, Atasol, Campain, Datril Extra Strength, Dolanex,
Exdol, Halenol, Liquiprin, Panadol, Pedric, Robigesic, Rounox, Tapar, Tylenol, Tempra, Valadol
Drug Classification: Analgesics (Non-Opioid) and Antipyretics
DOSAGE, ROUTE,
FREQUENCY (prescribed and
recommended)
Prescibed:
650mg tab PO TID
Recommended:
Oral
Post-immunisation pyrexia
Child: 2-3 months 60 mg as a
single dose. May give 2nd dose
after 4-6 hours if needed. Max: 4
doses daily.
Oral
Fever, Mild to moderate pain
Adult: 0.5-1 g 4-6 hourly. Max: 4
g daily. Child: 1-2 months 30-60
mg 8 hourly. Max: 60 mg/kg/day;
3-<6 months 60 mg. 6 months to
<2 years 120 mg; 2-<4 years 180
mg; 4-<6 years 240 mg; 6-<8
years 240 or 250 mg; 8-<10
years 360 or 375 mg; 10-<12
years 480 or 500 mg; 12-16
years 480 or 750mg. Administer
4-6 hourly if necessary. Max: 4
doses in 24 hours.
Oral
Hepatic Impairment: Mild to
moderate pain; fever
Dosage reduction may be
needed. Recommendation:
Max:≤2-3g daily.
Intravenous
Hepatic Impairment: Mild or
moderate: Max 3g daily.
Severe: Contraindicated
Rectal
Fever, Mild to moderate pain
Adult: As supp: 0.5-1 g 4-6
hourly. Max: 4 g daily. Child: 3
months to <1 year 60-125 mg; 1-
<5 years 125-250 mg: 5-<12
years 250-500 mg; 12-17 years
500 mg. Given 4-6 hourly if
needed. Max: 4 doses/day.
Rectal
Post-immunisation pyrexia
Child: 2-3 months 60 mg as a
single dose. May give 2nd dose
after 4-6 hours if needed.
Intravenous
Renal Impairment
<30 ml/min (increase dosing
interval to 6hrly. Max 3g daily)
DRUG STUDY
SIDE EFFECTS and
MECHANISM OF
INDICATION ADVERSE REACTIONS
ACTION
(by system)
Mild to moderate pain Action: Potentially Fatal:
and fever. Paracetamol exhibits Hepatotoxicity, acute renal
analgesic action by tubular necrosis. Rarely,
peripheral blockage of hypersensitivity reactions
pain impulse generation. such as acute generalised
It produces antipyresis by exanthematous pustulosis
inhibiting the (AGEP), Stevens-Johnson
hypothalamic heat- syndrome (SJS), toxic
regulating centre. Its epidermal necrolysis (TEN).
weak anti-inflammatory
activity is related to Significant:
inhibition of prostaglandin Thrombocytopenia,
synthesis in the CNS. leucopenia, neutropenia,
Synonym: pancytopenia,
acetaminophen. methaemoglobinaemia,
agranulocytosis,
Onset: Oral: <1 hour. IV: angioedema, pain and
5-10 minutes (analgesia); burning sensation at inj site.
within 30 minutes Rarely, hypotension and
(antipyretic). tachycardia.
Peak: 0.5–2 h.  GI disorders: Nausea,
vomiting, constipation.
Duration: Oral, IV: 4-6
hours (analgesia). IV: ≥6 Nervous system
hours (antipyretic). disorders: Headache.
Pharmacokinetics: Psychiatric disorders:
Absorption: Well Insomnia.
absorbed after oral and
rectal administration. Skin and subcutaneous
Time to peak plasma tissue disorders:
concentration: Approx 10- Erythema, flushing, pruritus.
60 minutes (oral); 15
minutes (IV); approx 2-3
hours (rectal).
Distribution: Distributed
into most body tissues.
Crosses placenta and
enters breast milk.
Plasma protein binding:
Approx 10-25%.
Metabolism: Mainly
metabolised in the liver
via glucuronic and sulfuric
acid conjugation. N-
acetyl-p-benzoquinone
imine (NAPQI), a minor
metabolite produced by
CYP2E1 and CYP3A4, is
further metabolised via
conjugation with
 glutathione in the liver
and kidneys.

Excretion: Mainly via

urine (<5% as unchanged
drug; 60-80% as
glucuronide metabolites
and 20-30% as sulphate
metabolites).

Elimination half-life:
Approx 1-3 hours.

NURSING RESPONSIBILITIES
CONTRAINDICATION/S
(at least 10)
1. Monitor for ssx of: hepatotoxicity, even with moderate
 Hypersensitivity to acetaminophen doses, especially in individuals with poor nutrition
acetaminophen or phenacetin; or who have ingested alcohol over prolonged periods; poisoning,
use with alcohol. usually from accidental ingestion or suicide attempts; potential
abuse from psychological dependence (withdrawal has been
associated with restless and excited responses).
2. Do not take other medications (e.g., cold preparations) containing
acetaminophen without medical advice; overdosing and chronic
use can cause liver damage and other toxic effects.
3. Do not self-medicate adults for pain more than 10 d (5 d in
children) without consulting a physician.
4. Do not use this medication without medical direction for: fever
persisting longer than 3 d, fever over 39.5° C (103° F), or
recurrent fever.
5. Do not give children more than 5 doses in 24 h unless prescribed
by physician.
6. Do not breast feed while taking this drug without consulting
physician.
7. Administer tablets or caplets whole or crushed and give with fluid
of patient's choice.
8. Chewable tablets should be thoroughly chewed and wetted
before they are swallowed.
9. Do not coadminister with a high carbohydrate meal; absorption
rate may be significantly retarded.
10. Store in light-resistant containers at room temperature, preferably
between 15°–30° C (59°–86° F).

DRUG STUDY
GENERIC NAME: Amoxicillin and Clavulanic Acid: Amoxiclav
Brand name: Augmentin, Augmentin-ES600, Augmentin XR, Clavulin
Drug Classification: Antiinfective; Beta-Lactam Antibiotic; Aminopenicillin
DOSAGE, ROUTE,
FREQUENCY (prescribed
and recommended)
Prescribed:
1.2g IVTT OD
Recommended:
Mild to Moderate Infections
Adult: PO 250 or 500 mg tablet
(each with 125 mg clavulanic
acid) q8–12h; Sustained-
release tabs: 2 tablets (2000
mg amoxicillin/125 mg
clavulanate) q12h x 7–10 d
Child: PO <40 kg, 20–40
mg/kg/d (based on amoxicillin
component) divided q8–12h;
>3 mo, 90 mg/kg/d of 600 ES
divided q12h x 10 d
Neonate/Infant: PO <3 mo, 30
mg/kg/d (amoxicillin) divided
q12h
INDICATION
Infections caused by
susceptible beta-
lactamase-producing
organisms: lower
respiratory tract
infections, acute bacterial
sinusitis, community
acquired pneumonia,
otitis media, sinusitis, skin
and skin structure
infections, and UTI.
MECHANISM OF
ACTION
Description: Amoxicillin,
a semi-synthetic penicillin,
inhibits bacterial cell wall
synthesis by binding to 1
or more of the penicillin-
binding proteins (PBPs),
thereby blocking the final
transpeptidation step of
peptidoglycan synthesis
in the bacterial cell walls.
It is susceptible to
degradation by β-
lactamases which are
produced by certain
resistant bacteria.
Clavulanic acid, a β-
lactam structurally related
to penicillin, binds and
inhibits β-lactamases,
thereby preventing
amoxicillin inactivation
and expands the
amoxicillin spectrum of
activity. It does not exert
clinically significant
antibacterial effect alone.
Synonym: Co-amoxiclav
Pharmacokinetics:
Absorption: Amoxicillin:
Rapidly and well
absorbed from the
gastrointestinal tract.
Increased absorption and
decreased
gastrointestinal upset with
food. Bioavailability:
Approx 70%.
Peak: 1–2 h.  sickness-like syndrome,
Distribution: Amoxicillin:
IV: Readily distributed into
body tissues and fluids
except the brain and CSF.
Crosses placenta and
enters breast milk.
Volume of distribution:
Approx 0.3-0.4 L/kg.
Plasma protein binding:
Approx 18%. Clavulanic
acid: IV: Well distributed
into body tissues and
fluids (e.g. gall bladder,
abdominal or muscle
tissues, skin, fat, synovial
SIDE EFFECTS and
ADVERSE REACTIONS
(by system)
Potentially Fatal: Severe
hypersensitivity reactions,
including anaphylactoid and
severe cutaneous reactions
(e.g. acute generalised
exanthematous pustulosis);
Clostridium difficile-
associated diarrhoea or
pseudomembranous colitis.
Rarely, hepatic dysfunction
(e.g. cholestatic jaundice,
hepatitis).
Significant: Diarrhoea,
fungal or bacterial
superinfection, convulsions
(at high doses or in patients
with renal impairment),
morbilliform rash (in
patients with
mononucleosis). Rarely,
crystalluria (IV),
prothrombin time
prolongation.
Blood and lymphatic
system disorders:
Haemolytic anaemia,
reversible agranulocytosis.
Rarely, thrombocytopenia,
reversible leucopenia or
neutropenia.
GI disorders: Nausea,
vomiting, indigestion, black
hairy tongue.
Immune system
disorders: Serum
urticaria, hypersensitivity
vasculitis. Infections and
infestations:
Mucocutaneous candidosis.
Investigations: Increased
AST/ALT.
Nervous system
disorders: Headache,
dizziness, reversible
hyperactivity.
Renal and urinary
disorders: Interstitial
nephritis.
 and peritoneal fluids, bile, Reproductive system and
pus). Crosses placenta breast disorders: Vaginal
and enters breast milk. mycosis.
Volume of distribution:
Approx 0.2 L/kg. Plasma Skin and subcutaneous
protein binding: Approx tissue disorders: Rash,
25%. pruritus, Stevens-Johnson
syndrome. Rarely,
Metabolism: Amoxicillin: erythema multiforme.
Metabolised to a limited
extent to form inactive
penicilloic acid.
Clavulanic acid:
Extensively metabolised.

Excretion: Amoxicillin:
Mainly via urine (approx
60-80% as unchanged
drug). Elimination half-life:
Approx 1.3 hours.
Clavulanic acid: Via urine
(approx 25-40% as
unchanged drug); faeces;
expired air. Elimination
half-life: Approx 1 hour.

NURSING RESPONSIBILITIES
CONTRAINDICATION/S
(at least 10)
1. Determine previous hypersensitivity reactions to penicillins,
 Hypersensitivity or history cephalosporins, and other allergens prior to therapy.
 of hypersensitivity
reactions to amoxicillin,
clavulanic acid, or other β-
lactam antibacterials.
 History of cholestatic
jaundice or hepatic
dysfunction associated
with amoxicillin/clavulanic
acid treatment. As
extended-release tab:
Severe renal impairment
(CrCl <30 mL/min) and
patients undergoing
haemodialysis.
GENERIC NAME: Azithromycin
Brand name: Zithromax, Zmax
Drug Classification: Antiinfective, Macrolide Antibiotic
2. Lab tests: Baseline C&S tests prior to initiation of therapy; start drug
pending results.
3. 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.
4. Note: Generalized, erythematous, maculopapular rash (ampicillin rash)
is not due to hypersensitivity. It is usually mild, but can be severe.
Report onset of rash to physician, since hypersensitivity should be ruled
out.
5. Female patients should report onset of symptoms of Candidal
vaginitis (e.g., moderate amount of white, cheesy, nonodorous vaginal
discharge; vaginal inflammation and itching; vulvar excoriation,
inflammation, burning, itching). Therapy may have to be discontinued.
6. Note: Use Clinistix or TesTape when monitoring urinary glucose to avoid
false readings with diabetes mellitus.
7. Do not breast feed while taking this drug without consulting physician.
8. Give at the start of a meal to minimize GI upset and enhance absorption.
9. Note that both 250- and 500-mg tablets contain the exact amount of
clavulanic acid (125 mg and potassium salt); therefore, two 250-mg
tablets are not equivalent to one 500-mg tablet.
10. Reconstitute oral suspension by adding amount of water specified on
container to provide a 5 mL suspension. Tap bottle before adding water
to loosen powder, then add water in 2 portions, agitating suspension well
before each addition.
11. Agitate suspension well just before administration of each dose.
12. Give dialysis patient an additional 2 doses on the day of dialysis; one
dose before and another dose after dialysis.
13. Store tablets in tight containers at <24° C (71° F). Reconstituted oral
suspension should be refrigerated at 2°–8° C (36°–46° F), then
discarded after 10 d.
DRUG STUDY
 DOSAGE, ROUTE,
FREQUENCY (prescribed and
recommended)
Prescribed:
500mg tab OD PO
Recommended:
Bacterial Infections
Adult: PO 500 mg on day 1, then
250 mg q24h for 4 more d IV 500
mg q.d. for at least 2 d,
administer 1 mg/mL over 3 h or 2
mg/mL over 1 h
Child: PO 6 mo, 10 mg/kg on
day 1, then 5 mg/kg for 4 more d
(max: 250 mg/d)
Acute Bacterial Sinusitis
Adult: PO 500 mg once daily x 3
d. Zmax: single one-time dose of
2 g.
Child: PO 6 mo, 10 mg/kg once
daily x 3 d
Otitis Media
Child: PO >6 mo, 30 mg/kg as a
single dose or 10 mg/kg once
daily (not to exceed 500 mg/d)
for 3 d or 10 mg/kg as a single
dose on day 1 followed by 5
mg/kg/d on days 2–5
Gonorrhea
Adult: PO 2 g as a single dose
Chancroid
Adult: PO 1 g as a single dose
Child: PO 20 mg/kg as single
dose (max: 1 g)
SIDE EFFECTS and
MECHANISM OF
INDICATION ADVERSE REACTIONS
ACTION
(by system)
Pneumonia, lower Description: Potentially Fatal: Rarely,
respiratory tract Azithromycin is a serious hypersensitivity
infections, macrolide antibiotic under reactions (e.g. anaphylaxis,
pharyngitis/tonsillitis, the azalide group. It angioedema, Stevens-
gonorrhea, inhibits RNA-dependent Johnson syndrome, toxic
nongonococcal protein synthesis by epidermal necrolysis, acute
urethritis, skin and skin binding to the 50s generalised exanthematous
structure infections due ribosomal subunit, pustulosis drug reaction
to susceptible preventing the with eosinophilia and
organisms, otitis translocation of peptide systemic symptoms),
media, Mycobacterium chains. fulminant hepatitis leading
avium–intracellulare co to liver failure, prolonged
mplex infections, acute Pharmacokinetics: cardiac repolarisation and
bacterial Absorption: Rapidly QT interval, cardiac
sinusitis. Zmax: acute absorbed from the arrhythmia, torsades de
bacterial sinusitis and gastrointestinal tract. pointes, Clostridium difficile
community acquired Bioavailability: Approx associated diarrhea
pneumonia. 37%. (CDAD).
Time to peak plasma Significant: Myasthenia
concentration: Approx 2- gravis.
3 hours (oral, immediate
release). Ear and labyrinth
disorders: Deafness.
Distribution: Extensively Eye disorders: Pruritus,
distributed in the tissues burning, stinging of the eye
(skin, lungs, tonsils, or ocular discomfort, sticky
cervix) and sputum. eye sensation, foreign body
Present in breastmilk. sensation (ophthalmic).
Volume of distribution:
31-33 L/kg. Plasma GI disorders: Diarrhoea,
protein-binding: 7-51%. vomiting, abdominal pain,
nausea, flatulence,
Metabolism: Metabolised dyspepsia, dysgeusia.
in the liver to inactive
metabolites. General disorders and
admin site conditions:
Excretion: Via bile (50%, Injection site pain, fatigue.
as unchanged drug);
urine (6-14%, as Investigations: Decreased
unchanged drug). lymphocyte count and
Terminal elimination half- blood bicarbonate;
life: 68-72 hours increased eosinophil count,
(conventional basophils, monocytes and
preparations); 59 hours neutrophils.
(extended release).
Metabolism and nutrition
disorders: Anorexia.
Musculoskeletal and
connective tissue
disorders: Arthralgia.
Nervous system
disorders: Headache,
dizziness, paraesthesia.
Skin and subcutaneous
tissue disorders: Pruritus,

CONTRAINDICATION/S
 Hypersensitivity to macrolide
antibiotics.
 History of hepatic
dysfunction/cholestatic jaundice
following previous antibiotic use.
rash.
NURSING RESPONSIBILITIES
(at least 10)
1. Monitor patient for superinfection. Drug may cause overgrowth of
nonsusceptible bacteria or
fungi.
2. Monitor patient for CDAD, which may range in severity from mild
diarrhea to fatal
colitis.
3. Consider full risk profile when choosing appropriate antibiotic therapy.
Alternative
macrolide or fluoroquinolone class drugs also have the potential to
cause QT-interval
prolongation and other significant adverse effects.
4. Monitor patient for allergic and skin reactions. Discontinue drug if
reactions occur. Be aware
that allergic symptoms may recur when symptomatic therapy is
discontinued; patient may
require prolonged monitoring and treatment.
5. Monitor patient for jaundice, hepatotoxicity, and hepatitis. Discontinue
drug immediately if
signs and symptoms (yellowing of skin or sclera, abdominal pain,
nausea, vomiting, dark urine)
occur.
6. Exacerbation and new onset of myasthenia gravis have occurred with
azithromycin use.
7. Tell patient to take drug as prescribed, even after feeling better.
8. Advise patient to avoid excessive sunlight and to wear protective
clothing and use sunscreen
when outside.
9. Tell patient to report adverse reactions promptly.
10. Instruct parents and caregivers to contact prescriber if vomiting or
irritability with feeding
occurs during or after azithromycin use in neonates (treatment up to
42 days of life).
11. Warn patient to seek immediate medical care for irregular heartbeat,
shortness of
breath, dizziness, or fainting.
12. Advise patient not to stop taking drug without first contacting health
care provider.
13. Tell patient that tablets and suspension can be taken with or without
food. Food may reduce GI
upset.
14. Instruct patient to thoroughly wash hands before instilling ophthalmic
solution.
15. Tell patient to avoid contaminating ophthalmic applicator tip and not
to let tip touch eye,
fingers, or other surfaces.
16. Instruct patient how to instill ophthalmic solution.
17. Advise patient to avoid contact lenses when diagnosed with bacterial
conjuncti vitis.

GENERIC NAME: Levofloxacin
Brand name: Levaquin, Iquix, Quixin
Drug Classification: Fluoroquinolones; Antiinfective; Antibiotic; Quinolone
DOSAGE, ROUTE,
FREQUENCY (prescribed and
recommended)
Prescribed:
500mg IVTT OD
Recommended:
Bacterial Infections
Adult: PO 500 mg on day 1, then
250 mg q24h for 4 more d IV 500
mg q.d. for at least 2 d,
administer 1 mg/mL over 3 h or 2
mg/mL over 1 h
Child: PO 6 mo, 10 mg/kg on day
1, then 5 mg/kg for 4 more d
(max: 250 mg/d)
Acute Bacterial Sinusitis
Adult: PO 500 mg once daily x 3
d. Zmax: single one-time dose of
2 g.
Child: PO 6 mo, 10 mg/kg once
daily x 3 d
Otitis Media
Child: PO >6 mo, 30 mg/kg as a
single dose or 10 mg/kg once
daily (not to exceed 500 mg/d)
for 3 d or 10 mg/kg as a single
dose on day 1 followed by 5
mg/kg/d on days 2–5
Gonorrhea
Adult: PO 2 g as a single dose
Chancroid
Adult: PO 1 g as a single dose
Child: PO 20 mg/kg as single
dose (max: 1 g)
DRUG STUDY
MECHANISM OF
INDICATION
ACTION
Treatment of maxillary A broad-spectrum
sinusitis, acute fluoroquinolone antibiotic
exacerbations of that inhibits DNA-gyrase,
bacterial bronchitis, an enzyme necessary for
community-acquired bacterial replication,
pneumonia, transcription, repair, and
uncomplicated skin/skin recombination.
structure infections,
UTI, acute Pharmacokinetics:
pyelonephritis caused Absorption: Rapidly and
by susceptible bacteria; completely absorbed from
acute bacterial sinusitis; the gastrointestinal tract
chronic bacterial (oral). Absolute
prostatitis; bacterial bioavailability: Approx
conjunctivitis. 99% (oral).
Time to peak plasma
concentration: Within 1-
2 hours (oral).
Distribution: Widely
distributed into body
tissues including
bronchial mucosa and
lungs, enters breastmilk.
Volume of distribution:
1.27 L/kg. Plasma protein
binding: Approx 24-38%,
mainly to albumin.
Metabolism: Minimally
metabolised in the liver.
Excretion: Mainly via
urine (approx 87% as
unchanged drug, <5% as
metabolites); faeces
(<4%). Elimination half-
life: 6-8 hours; 0.5-1 hour
(inhalation).
SIDE EFFECTS and
ADVERSE REACTIONS
(by system)
Significant:
CNS effects including
seizures, increased
intracranial pressure,
lightheadedness, dizziness,
tremor; psychotic reactions
(e.g. hallucinations,
nervousness, delirium),
sensory or sensorimotor
peripheral neuropathy,
prolonged QT interval,
blood glucose disturbances
(hypo-/hyperglycaemia),
phototoxicity, superinfection
(prolonged use),
bronchospasm, cough or
productive cough,
haemoptysis,
fluoroquinolone-resistant P.
aeruginosa (inhalation),
exacerbation of myasthenia
gravis, interstitial nephritis,
acute renal insufficiency or
failure, hypotension (rapid
or bolus IV infusion).
Rarely, tendinitis, tendon
rupture, suicidal thoughts,
self-endangering behaviour,
crystalluria, cylindruria,
torsades de pointes,
Stevens-Johnson
syndrome, toxic epidermal
necrolysis, hepatic
necrosis.
Blood and lymphatic
system disorders: Rarely,
pancytopenia,
agranulocytosis, haemolytic
or aplastic anaemia,
leukopenia, eosinophilia.

Cardiac disorders:
Dyspnoea, chest pain,
arrhythmia.

Eye disorders: Ocular

burning, decreased vision
and mucous strand, blurred
vision, eye pain, eye
irritation, eyelid oedema,
eye pruritus, chemosis,
photophobia, conjunctivitis,
dry eye syndrome.

Gastrointestinal
disorders: Diarrhoea,
vomiting, nausea,
dyspepsia, constipation,
abdominal pain.

General disorders and

admin site conditions:
Fatigue, fever, asthenia,
hyperhidrosis.

Hepatobiliary disorders:
Rarely, hepatitis, jaundice.

Injury, poisoning and

procedural
complications: Infusion
site reaction (e.g. pain,
reddening), phlebitis.
Investigations: Increased
hepatic enzymes
(ALT/AST, alkaline
phosphatase, GGT),
decreased forced expiratory
volume.

Metabolism and nutrition

disorders: Anorexia,
oedema.

Musculoskeletal and
connective tissue
disorders: Arthralgia,
myalgia.

Nervous system
disorders: Headache,
vertigo, dysgeusia.

Psychiatric disorders:
Insomnia.

Reproductive system and

breast disorders:
Vaginitis.

Respiratory, thoracic and

mediastinal disorders:

CONTRAINDICATION/S
 Drug is associated with increased
risk of tendinitis and tendon
rupture,especially in patients
older than age 60, in patients
taking corticosteroids, and in
those with heart, kidney, or lung
transplants.
 Drug may exacerbate muscle
weakness in patients with
myasthenia gravis. Avoid using
fluoroquinolones in patients with a
history of myasthenia gravis.
 Reserve drug for patients who
have no alternative treatment
options for uncomplicated UTI,
acute exacerbation of chronic
bronchitis, and acute sinusitis.
 Drug is associated with an
increased incidence of
musculoskeletal disorders in
pediatric patients.
 Drug may increase risk of aortic
dissection or rupture when used
systemically.
 Contraindicated in patients
hypersensitive to drug, its
components, or other
fluoroquinolones.
 Patients receiving systemic drug
have an increased risk of
hyperglycemia and hypoglycemia,
which can result in coma.
 Use cautiously in patients with
history of seizure disorders or
other CNS diseases, such as
cerebral arteriosclerosis.
 Use cautiously and with dosage
adjustment in patients with renal
impairment.
Increased bronchial
secretions, rarely, allergic
pneumonitis.
Skin and subcutaneous
tissue disorders: Rash,
pruritus.
Vascular disorders:
Rarely, vasculitis.
NURSING RESPONSIBILITIES
(at least 10)
1. Fluoroquinolones have been associated with disabling and potentially
irreversible serious adverse reactions that have occurred together,
including tendinitis and tendon
rupture, peripheral neuropathy, and CNS effects (seizures, toxic
psychoses, increased ICP,
pseudotumor cerebri, tremors, restlessness, anxiety, light-
headedness, confusion, hallucinations,
paranoia, depression, nightmares, insomnia and, rarely, suicidal
thoughts or acts). If any of these
serious adverse reactions occur, discontinue drug immediately.
2. Monitor patients for signs and symptoms of aortic aneurysm,
dissection, and rupture
(sudden, severe, and constant pain in the stomach, chest, or back;
throbbing in the stomach area,
deep pain in the back or side of the stomach; steady, gnawing pain in
the stomach that lasts for
hours or days; pain in the jaw, neck, back, or chest; coughing or
hoarseness; shortness of breath
or trouble swallowing). Discontinue drug immediately if any of these
aortic disorders are
suspected.
3. Patients with acute hypersensitivity reactions may need treatment
with epinephrine, oxygen, IV
fluids, antihistamines, corticosteroids, pressor amines, and airway
management.
4. Monitor patient for signs and symptoms of peripheral neuropathy
(pain,
burning, tingling, numbness, weakness, or a change in sensation to
light touch, pain, temperature,
or sense of body position), and report them immediately to health
care provider.
5. Most antibacterials can cause pseudomembranous colitis. If diarrhea
occurs, notify prescriber;
drug may be stopped.
6. Drug may cause an abnormal ECG.
7. Monitor patients receiving systemic drug for symptoms of
hypoglycemia (confusion,
pounding or rapid heartbeat, dizziness, pale skin, shakiness,
sweating, unusual hunger, trembling,
headache, weakness, irritability, unusual anxiety). Immediately
discontinue drug for blood
glucose disturbances, and switch to a nonfluoroquinolone antibiotic if
possible.
8. Monitor patients receiving systemic drug for psychiatric adverse
reactions
(disturbances in attention, disorientation, agitation, nervousness,
 memory impairment, delirium).
9. Discontinue drug for CNS side effects, including psychiatric adverse
reactions.

10. If P. aeruginosa is a confirmed or suspected pathogen, use with a

beta-lactam.
11. Monitor glucose level and results of renal function tests, LFTs, and
blood counts.

DRUG STUDY
GENERIC NAME: Dextromethorphan + Guaiphenesin + Ammonium chloride + Chlorpheniramine maleate
Brand name: Grilinctus
Drug Classification: Antitussive; Expectorant; Electrolyte and Water Balance Agents; Antihistamines

DOSAGE, ROUTE, SIDE EFFECTS and

MECHANISM OF
FREQUENCY (prescribed and INDICATION ADVERSE REACTIONS
ACTION
recommended) (by system)
Prescribed: Topical Topical Topical
Grilinctus 2 top PO BID Indicated for the Grilinctus syrup contains Integumentary:
treatment of dry, scaly Ammonium Chloride, The most frequent adverse
Recommended: skin (xerosis) and Chlorpheniramine, experiences in patients with
Oral ichthyosis vulgaris, and Dextromethorphan, and xerosis are transient
Adult dose 5-10ml of Syrup daily for the temporary relief Guaifenesin. Ammonium stinging (1 in 30 patients),
in 2-3 divided doses of itching associated chloride and Guaifenesin burning (1 in 30 patients),
with these condition. reduce the mucous and erythema (1 in 50 patients)
Topical irritation in the throat, and peeling (1 in 60
Twice daily or as directed bythe Oral airways, and patients). Other adverse
physician Allergy: Used for lungs. Dextromethorphan reactions which occur less
symptomatic relief of acts on the brain's cough frequently are irritation,
allergy centre and reduces the eczema, petechiae,
urge to cough. dryness, and
Rhinitis: Used in cases Chlorpheniramine inhibits hyperpigmentation. Due to
of allergic Rhinitis (Hay chemical substances like the more severe initial skin
fever) prostaglandins which conditions associated with
cause swelling and ichthyosis, there was a
Emergency: Used as irritation in the throat and higher incidence of
an adjunct in the lungs. transient stinging, burning
emergency treatment of and erythema (each
Anaphylactic Shock and Oral occurring in 1 in 10
severe angioedema Grilinctus syrup contains patients).
Ammonium Chloride,
Insect Sting: Used in Chlorpheniramine, Oral
cases of Insect Stings Dextromethorphan, and Gastrointestinal:
Guaifenesin. Ammonium Nausea, upset stomach,
Pruritis: Used in cases chloride and Guaifenesin diarrhea, stomach pain,
of Pruritis of allergic reduce the mucous and vomiting
origin irritation in the throat,
airways, and lungs. CNS: Sleepiness,
Others: Used to treat Dextromethorphan acts dizziness, headache
Dry cough, Bronchitis, on the brain's cough
Common cold, and centre and reduces the Integumentary: Rash,
Nasal Congestion urge to cough. hives
Chlorpheniramine inhibits
chemical substances like Immunologic: Allergic
prostaglandins which reaction
cause swelling and
irritation in the throat and

CONTRAINDICATION/S
Topical
 Grilinctus Syrup (Ammonium
Chloride) Lactate Lotion, 12% is
contraindicated in those patients
with a history of hypersensitivity
to Ammonium Chloride,
Chlorpheniramine Maleate,
Dextromethorphan Hydrobromide,
Guaifenesin.
Oral
 If you are allergic to Ammonium
Chloride, Chlorpheniramine,
Dextromethorphan, Guaifenesin,
or any other ingredient of this
syrup.
 If you are currently taking
psychiatric treatment, have a
respiratory disorder, or prone to
get such disorders.
 Grilinctus syrup should not be
used for children under 12 years
of age.
lungs
NURSING RESPONSIBILITIES
(at least 10)
Topical
1. It is for external use only. Avoid contact with eyes, lips, or mucous
membranes.
2. Patients should minimize or avoid use of this product on areas of the
skin that may be exposed to natural or artificial sunlight, including the
face. If sun exposure is unavoidable, clothing should be worn to
protect the skin.
3. This medication may cause transient stinging or burning when applied
to skin with fissures, erosions, or abrasions (for example, after
shaving the legs).
4. If the skin condition worsens with treatment, the medication should be
promptly discontinued.
Oral
5. Use a measuring cup or spoon to dispense exact quantities.
6. Do not consume this syrup directly from the bottle.
7. Do not take a double dose of this syrup to compensate the missed
one, continue with the regular dose schedule.
8. The risk of side effects such as confusion, shakiness, irritation and
diarrhoea increases when this syrup is taken together with medicines
used to treat psychotic disorders.
9. Alcohol should not be consumed with Grillinctus syrup as it increases
the unwanted effects of this medicine.
10. Grillinctus syrup is not recommended for use in lactating mothers, as
components of this syrup pass into the milk and may also affect milk
production.
 DRUG STUDY
GENERIC NAME: D5 0.9 NaCl
Brand name: 5% Dextrose and 0.9% Sodium Chloride Injection, USP
Drug Classification: Electrolytes balance agents

DOSAGE, ROUTE, SIDE EFFECTS and

MECHANISM OF
FREQUENCY (prescribed and INDICATION ADVERSE REACTIONS
ACTION
recommended) (by system)
Prescribed: Intravenous solutions Dextrose and sodium Fever, infection at the site
Intravenous containing dextrose and chloride solutions are of inj, venous thrombosis or
1L @20gtts/min sodium chloride are used as sources of phlebitis extending from the
indicated for parenteral electrolytes, calories and site of inj, extravasation and
Recommended: replenishment of fluid, water for hydration. hypervolaemia.
Depending on the weight, age, minimal carbohydrate Sodium and chloride ions
and clinical condition of the calories, and sodium are responsible for
patient. chloride as required by regulating the acid-base
the clinical condition of balance of the body.
the patient. Dextrose is a source of
calories. It is readily
metabolised and helps to
decrease losses of body
protein and nitrogen. It
also promotes glycogen
deposition and decreases
or prevents ketosis.

CONTRAINDICATION/S
 Solutions
containing dextrose may be
contraindicated in patients with
known allergy to corn or corn
products.
NURSING RESPONSIBILITIES
(at least 10)
1. Caution when used in patients with CHF, severe renal impairment or
clinical conditions whereby there is sodium retention with oedema.
2. Monitor serum potassium levels.
3. Not to be administered concurrently with blood through the same
infusion set due to risk of agglomeration.
4. Caution when used in patients receiving corticosteroids or
corticotropin. Pregnancy.
5. Check for leaks by squeezing container firmly. If leaks are found,
discard unit as sterility may be impaired.
6. Additives may be incompatible. Consult with pharmacist, if available.
When introducing additives, use aseptic technique, mix thoroughly
and do not store.
7. If an adverse reaction does occur, discontinue the infusion, evaluate
the patient, institute appropriate therapeutic countermeasures and
save the remainder of the fluid for examination if deemed necessary.
8. Solutions containing dextrose should be used with caution in patients
with known subclinical or overt diabetes mellitus.
9. Do not administer unless solution is clear and container is
undamaged. Discard unused portion.
10. Exposure of pharmaceutical products to heat should be minimized.
Avoid excessive heat. Protect from freezing. Store at 20 to 25°C (68
to 77°F).