DRUG STUDY (Table 3)

General Nursing Responsibilities:

 Verify any medication order and make sure it’s complete. The order should include the drug name, dosage,
frequency and route of administration. If any element is missing, check with the practitioner.
 Check the patient's medical record for an allergy or contraindication to the prescribed medication. If an allergy or
contraindications exist, don't administer the medication and notify the practitioner.
 Prepare medications for one patient at a time.
 Educate patients about their medications. Encourage them to speak up if something seems amiss.
 Follow the 10 rights of medication administration
 Minimize distractions and interruptions while preparing and administering medications to avoid medication
errors.
 Be familiar with high-alert medication (such as anticoagulants, antidiabetic agents, sedatives, and
chemotherapeutic drugs). Ask another nurse to perform an independent double check and rectify any
discrepancies BEFORE administering the drug.
 For patients receiving IV opioid medication, frequently monitor respiratory rate, sedation level, and oxygen
saturation level or exhaled carbon dioxide to decrease the risk of adverse reactions associated with IV opioid use.
If adverse reactions occur, respond promptly to prevent treatment delays.
 Administer high-alert intravenous medication infusions via a programmable infusion device utilizing dose error-
reduction software.
 Reconcile the patient’s medications at each care transition and when a new medication is ordered to reduce the
risk for medication errors, including omissions, duplications, dosing errors, and drug interactions.
 Educate and provide written instructions to the patient and family (or caregiver) regarding prescribed medications
for use when at home and verify their understanding prior to discharge.

NAME OF MECHANI DOSAG INDICA CONTRAIND ADVERSE NURSING ALERT

DRUGS SM OF E TION ICATIONS REACTION
ACTION
Paracetamol Paracetamo Ordered Used to Hypersensitivi Significant:  To be given via slow IV
l exhibits : reduce ty to Thrombocytopenia, pushto minimize
CLASSIFIC analgesic 06/11/2 the Paracetamol. leucopenia, irritation and burning
ATION: action by 0 patient’s Severe hepatic neutropenia, sensation
Analgesic peripheral fever impairment or pancytopenia,  Assess patient for
(Non-opioid) blockage of 200mg active liver methaemoglobinaemia history of liver disease
& pain IV now disease. , agranulocytosis,  Advise patient and/or
Antipyretics impulse thenq4 angioedema, pain and relative to report Nausea
generation. prn for burning sensation at and vomiting, cyanosis,
It produces fever T inj site. Rarely, shortness of breath and
antipyresis 37.8 C hypotension and abdominal pain as these
by tachycardia. are signs of toxicity.
inhibiting  Advise patient and/or
the Potentially Fatal: relative to report
hypothalam Hepatotoxicity, acute paleness, weakness and
ic heat- renal tubular necrosis. heart beat skips
regulating Rarely,  Advise patient and/or
centre. Its hypersensitivity relative to report
weak anti- reactions such as acute abdominal pain,
inflammato generalised yellowish discoloration
ry activity exanthematous of the skin, dark urine,
is related to pustulosis (AGEP), itchiness or clay-colored
inhibition Stevens-Johnson stools.
of syndrome (SJS), toxic  Drug Interaction:
prostagland epidermal necrolysis Decreased serum
in synthesis (TEN). concentrations with
in the CNS. some anticonvulsants
(e.g. phenytoin,
phenobarbital)

Phenytoin Phenytoin Ordered Parenter Intravenous Hypersensitivity, lack  Assess patient for
acts as an : al administration of appetite, headache, history of
CLASSIFIC anticonvuls 06/9/20 administ in sinus dizziness, tremor, hypersensitivity to
ATION: ant by ration: bradycardia, transient nervousness, hydantoins; sinus
Antiepileptic increasing 300mg Control heart block, or insomnia, GI bradycardia, AV heart
efflux or IV now of status Stokes-Adams disturbances (e.g. block, Stokes-Adams
decreasing as epileptic syndrome. nausea, vomiting, syndrome,
influx of Loading us of the constipation), hyperglycemia
sodium dose grand tenderness and  Use only clear
ions across then mal type hyperplasia of the parenteral solutions; a
cell 50mg gums, acne, hirsutism, faint yellow color may
 membranes IV q12 coarsening of the develop, but this has no
in the as facial features, rashes, effect on potency. If the
motor mainten osteomalacia. solution is refrigerated
cortex ance or frozen, a precipitate
during dose Phenytoin toxicity might form, but this will
generation manifested as a dissolve if the solution
of nerve syndrome of is allowed to stand at
impulses; cerebellar, vestibular, room temperature.
thus ocular effects, notably  Do not use solutions
stabilizing nystagmus, diplopia, that have haziness or a
neuronal slurred speech, and precipitate.
membranes ataxia; also with  Administer IV slowly to
and mental confusion, prevent severe
decreasing dyskinesias, hypotension; the margin
seizure exacerbations of of safety between full
activity. seizure frequency, therapeutic and toxic
hyperglycaemia. doses is small.
 Phwnytoin is
Potentially Fatal: compatible with PNSS
Toxic epidermal solution;it should be
necrolysis, Stevens- given sandwiched with
Johnson syndrome. PNSS if patient is
hooked to other IV
fluids in order to avoid
precipitaiton
 Continually monitor
patient’s cardiac rhythm
and check BP frequently
and regularly during IV
infusion.
 Monitor injection sites
carefully; drug solutions
are very alkaline and
irritating.
 Reduce dosage,
discontinue phenytoin,
or substitute other
antiepileptic medication
gradually; abrupt
discontinuation may
precipitate status
epilepticus.
 Solutions for injection
may cause local
irritation or phlebitis.
 Prolonged use may
produce subtle effects
on mental function and
cognition, especially in
children. Monitor the
patient accordingly.

Salbutamol It promotes Ordered Salbuta Patient with a Dose related:  Nursing assessment
the : mol is history of hypokalemia, tremor, should include listening
CLASSIFIC production 07/18/2 indicate hypersensitivit nervousness, mild to lung sound, obtaining
ATION: of 0 d for the y to any of its tachycardia blood pressure and heart
Bronchodilat intracellula sympto components. rate prior to use and
or r cyclic Salbuta matic during use.
adenosine mol neb relief  It’s important to assess
monophosp 1 neb and for paradoxical
hate q15mins preventi bronchospasm, which is
(cAMP), x3 on of the opposite of the
which doses broncho intended reaction of
enhances then q4 spasm salbutamol.
the binding post  If a person has a seizure
of extubati disoder, use of this drug
intracellula on is cautioned.
r calcium to
the cell
membrane.
This action
decreases
the calcium
 concentrati
on within
cells and
results in
the
relaxation
of smooth
muscle and
thus,
bronchodila
tion.

Ceftriaxone Ceftriaxone Ordered In many Hypersensitivi Significant:  Ceftriaxone is

is a 3rd : pediatric ty to hypersensitivity incompatible with
CLASSIFIC generation 06/09/2 infectio cephalosporins reactions such as vancomycin,
ATION: cephalospo 0 us or history of Stevens-Johnson aminoglycosides,
3rd rin disease severe syndrome, toxic fluconazole and with
Generation antibiotic. 1,000mg program hypersensitivit epidermal necrolysis Calcium containing
cephalospori It binds to 1 + 20cc s, y to other type (TEN)/Lyell’s solutions such as
n antibiotic or more D5W ceftriax of β-lactam syndrome, Ringer’s solution.
penicillin- via one is antibiotic (e.g. hypersensitivity, renal  Special Precaution for
binding soluset x the penicillins, and gallbladder patients with history of
proteins 30minut preferre monobactams, precipitation, allergy to penicillins or
(PBPs) es q12 d drug carbapenems). pancreatitis secondary any drug,
inhibiting ANST for CNS to biliary obstruction, hypercalciuria.
the final (-) infectio renal lithiasis,  Monitor patient
transpeptid n superinfection. forpPain, induration and
ation step because Blood and lymphatic tenderness at injection
of of its system disorders: site. Dilute the
peptidoglyc ability Eosinophilia, medication and give via
an to leucopenia, slow IV drip.
synthesis in penetrat thrombocytopenia.  Instruct patient/ S.O.
bacterial e the that this drug may cause
cell wall, Cerebro Gastrointestinal dizziness.
leading to -spin. disorders: Diarrhea,  Fall precaution and
bacterial oral candidiasis. ensure siderails are
cell lysis always up.
and death. Potentially Fatal:  Drug Interactions:
Severe haemolytic May increase
anemia, anaphylactic nephrotoxicity of
shock, Clostridium aminoglycosides. May
difficile-associated diminish therapeutic
diarrhoea (CDAD). effect of BCG, typhoid
vaccine
Fatal: Administration
with Calcium-
containing IV solutions
may cause precipitation
of a crystalline material
in the lungs and
kidneys.

Midazolam Midazolam Ordered Midazol Severe Anterograde amnesia,  Monitor Respirations

binds to : am is respiratory CNS depression, and BP( may cause
CLASSIFIC stereospecif 06/09/2 now the failure or acute hypotension, hypotension) specially
ATION: ic 0 recomm respiratory paradoxical reactions prior to giving of the
Belongs to benzodiaze ended depression, (e.g. hyperactive or medication.
the class of pine 2.5mg first-line acute narrow- aggressive behaviour);  Drug interaction May
benzodiazepi receptors IV now drug for angle decreased tidal volume potentiate the action of
ne on the then prn treating glaucoma, and/or respiratory rate, other CNS depressants
derivatives postsynapti for convulsi myasthenia cough; drowsiness, including other
c GABA active ve status gravis, sleep oversedation, analgesics and
neuron at seizure epileptic apnea headache, seizure-like barbiturates.
several us. syndrome. activity; nystagmus;  Caution also with Food
sites within amnesia, bigeminy, interaction such as
the Central bradycardia, grapefruit juice may
Nervous bronchospasm, increase serum
System, confusion, dyspnea, concentrations of
including delirium, euphoria, midazolam.
the limbic excessive salivation,
system, hallucinations,
reticular hyperventilation,
formation. laryngospasm,
 Enhanceme premature ventricular
nt of the contractions,
inhibitory tachycardia, wheezing;
effect of physical and
GABA on psychological
neuronal dependence
excitability (prolonged use).
results by Potentially Fatal:
increased Respiratory
neuronal depression, respiratory
membrane arrest; hypoventilation,
permeabilit airway obstruction,
y to and apnea which can
Chloride lead to hypoxia or
ions, which cardiac arrest.
results in
hyper
polarization
(a less
excitable
state) and
stabilisatio
n.
Benzodiaze
pine
receptors
and effects
appear to
be linked to
the GABA-
A
receptors.

Omeprazole It blocks Ordered In the Allergies to Significant:  Monitor Mg

the final : intensiv proton pump Hypomagnasemia, concentrations prior to
CLASSIFIC step in 06/10/2 e care inhibitor. cutaneous lupus initiation of therapy and
ATION gastric acid 0 unit, It is erythematosus, SLE, periodically thereafter.
Proton pump secretion omepraz contraindicate osteoporosis-related  Drug Interactions:
inhibitor by specific 30mg ole is d to patients fractures, carcinoma, May decrease
inhibition IV now used as with Clostridium difficile- metabolism of diazepam
of then OD Prophyl hypomagnese associated diarrhea, and phenytoin.
adenosine axis for mia, SLE, interstitial nephritis,
triphosphat Stress broken bone, Vitamin B12
ase ulcer osteoporosis, deficiency (long-term
(ATPase) liver disease. therapy),
enzyme gastrointestinal
system infection (e.g.
present on salmonella,
the Campylobacter).
secretory Hepatobiliary
surface of disorders: Increased
the gastric liver enzymes.
parietal Nervous system
cell. Both disorders:
basal and Somnolence,
stimulated paraesthesia, vertigo.
acid are Psychiatric disorders:
inhibited. Insomnia.

Phenobarbit Phenobarbi Ordered Used as Severe Bradycardia, syncope,  Health teachings should
al tal is a : a respiratory hypotension; anxiety, be provided and be
long-acting 06/12/2 mainten depression, agitation, ataxia, CNS emphasized regarding
CLASSIFIC barbiturate. 0 ance acute excitation or the strict compliance in
ATION It depresses dose in intermittent depression, confusion, taking medications as
Belongs to the sensory 30mg controlli porphyria. dizziness, drowsiness, ordered by the
the class of cortex, /tab 1 ng Severe renal hallucinations, physician.
barbiturates reduces tab in seizures and hepatic hangover effect,  Patient Counseling
and motor Am impairment. headache, Information
derivatives activity, 60mg/ hyperkinesias;  Monitoring of CBC,
antiepileptics changes tab 1 tab constipation, nausea, Liver fucntion tests,
/ anti cerebellar in pm vomiting; mental status and
convulsant function agranulocytosis, seizure activity of the
and thrombocytopenia, patient.
 produces megaloblastic  Monitor patient for
drowsiness, anaemia; oliguria; pain Symptoms and refer to
sedation at the injection site, physician if observed:
and thrombophlebitis with hypotension, hypotonia,
hypnosis. IV use; laryngospasm, hyporeflexia,
Its respiratory depression, hypothermia, absent
anticonvuls apnoea (esp w/ rapid bowel sounds, cardiac
ant IV use), arrest, respiratory and
property is hypoventilation Cardiovascular
exhibited at Potentially Fatal: depression, signs and
high doses. Stevens-Johnson symptoms of shock
syndrome, toxic leading to renal failure,
epidermal necrolysis. prolonged coma.
 Drug Interactions:
May increase CNS
depressant effect w/
phenytoin, and other
anticonvulsants.

Epinephrine It Ordered Used as Hypersensitivi Cardiovascular  Instruct patient to seek

stimulates : tempora ty to any of its disorders; difficulty in immediate medical
CLASSIFIC α- and β- 06/13/2 ry relief components; micturition with attention if symptoms
ATION adrenergic 0 from cardiac urinary retention; not relieved within 20
Anti receptors broncho arrhythmias or dyspnea; minutes or become
asthmatic resulting in Epineph spasm tachycardia. hyperglycemia; worse following
relaxation rine neb after weakness, tremors; administration
of smooth 2 cc q removal hypokalemia.  Do not use if product is
muscle of 15 of brown in color or
the minutes endotrac cloudy
bronchial x3 heal  Do not use if product is
tree. doses tube pinkish or darker than
then q4 (post slightly yellow, or if it
x 24 extubati contains a precipitate.
hours on)
Hydrocortis Hydrocortis Ordered Hydroco Untreated Sodium and fluid  Drug Interaction:
one one is a : rtisone serious retention, Potassium Reduced efficacy with
corticostero 06/13/2 is infections and calcium depletion, concurrent use of
CLASSIFIC id used for 0 approve (except Muscle wasting, phenytoin and
ATION its anti- d as a tuberculous weakness, barbiturates.
Corticosteroi inflammato 80mg prescript meningitis or osteoporosis. GI  Food Interaction:
ds ry IV now ion septic shock), disturbances and Interferes with calcium
properties. then steroid Idiopathic bleeding. Increased absorption
Its anti- 20mg medicati thrombocytope appetite and delayed  Special Precautions for
inflammato IV q12, on that nic purpura, wound healing. patients with epilepsy,
ry action is 12 hours is Documented Bruising, striae, patients on prolonged
due to the after indicate hypersensitivit hirsutism, acne, therapy.
suppression first d to y to flushing. Increased  Hydrocortisone should
of dose prevent hydrocortisone intracranial pressure, be given as Slow IV
migration laryngea . psychosis, menstrual push.
of l edema irregularities.  It should be tapered
polymorph or Hyperglycemia, down prior to
onuclear stridor. glycosuria, DM, discontinuing the
leukocytes obesity, moon-face, medication.
and buffalo hump.
reversal of Suppression of
increased pituitary-
capillary adrenocortical system.
permeabilit Growth retardation in
y. childn (prolonged
therapy). Increased
susceptibility for
infection.
Potentially Fatal:
Abrupt withdrawal
leading to acute
adrenal insufficiency.
Rapid IV Injection
may cause
cardiovascular
collapse.