DRUG STUDY

MECHANISM CONTRAINDICATION NURSING

DRUG NAME DRUG CLASS INDICATIONS ADVERSE EFFECTS
OF ACTION S RESPONSIBILITIES
Dextrose in Chemical class: Prevents protein To treat insulin- For all solutions: Diabetic CNS: Confusion, fever Before:
Water (50%) Monosaccharide and nitrogen loss, induced coma with excessively
D5W promotes hypoglycemia elevated blood glucose GU: Glycosuria ● Obtain history of the
glycogen level patient’s fluid and
Therapeutic deposition, Other: Dehydration; electrolytes status before
class: prevents or For concentrated hyperosmolar coma; therapy and reassess
Dosage: Antidiabetic, decreases ketosis, solutions: hypervolemia; regularly.
@ 10cc + 14 cc nutritional and, in large Anuria, alcohol withdrawal hypovolemia; injection-
supplement amounts, acts as syndrome in dehydrated site extravasation with ● Before giving the bottle,
an osmotic patient, glucose-galactose tissue necrosis, infection, check for the correct
diuretic. Dextrose malabsorption syndrome, phlebitis, and venous patient to be
is readily hepatic coma, thrombosis administered.
metabolized and hypersensitivity to corn or
undergoes corn products, intracranial ● Check for the correct
oxidation to or intraspinal hemorrhage, fluid to be given.
carbon dioxide overhydration
and water. The ● Assess infusion site
oral form— regularly for signs of
glucose—is infiltration, such as pain
absorbed directly or swelling.
into the
bloodstream from ● Assess patient’s blood
the intestines and glucose level frequently
is distributed, to determine
used, or stored in effectiveness and detect
the liver. hyperglycemia.

● Assess patient for

glucosuria by using a
urine reagent strip or
collecting a urine sample
and reviewing urinalysis
results.
 During:

● Upon inserting the

chamber to another,
make sure that it is
inserted well.

● Be alert for fluid

overload.

● Check for the patient’s

comfort.

After:

● Infuse the IV well to its

prescribed rate.

● Check for the presence of

bubbles in the IV tube.

● Evaluate the patient’s

knowledge of therapy.

Reference: Jones and Bartlett (2018), Nurse’s Drug Handbook 17th edition
 DRUG STUDY
MECHANISM NURSING
DRUG NAME DRUG CLASS INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS
OF ACTION RESPONSIBILITIES
Moxifloxacin Chemical class: Inhibits synthesis To treat acute Hypersensitivity to CNS: Abnormal gait, Before:
Fluoroquinolone of bacterial exacerbation of moxifloxacin, other altered coordination, ● Determine if patient has a
Drug enzyme DNA chronic bronchitis fluoroquinolones, or their anxiety, confusion, history of CNS disorder,
Availability: Therapeutic gyrase by caused by H. components; myasthenia depression, dizziness, such as cerebral
class: counteracting influenzae, H. gravis fever, hallucinations, arteriosclerosis or
Dosage: Antibiotic excessive parainfluenzae, headache, increased epilepsy, because drug
supercoiling of Klebsiella intracranial pressure may lower seizure
DNA during pneumoniae, M. (including pseudotumor threshold. Notify
replication or catarrhalis, S. cerebri), insomnia, prescriber before starting
transcription. pneumoniae, or peripheral neuropathy, drug, and take seizure
Inhibiting DNA Staphylococcus psychosis, psychotic precautions.
gyrase causes aureus reaction, seizures,
rapid- and slow- suicidal ideation, ● Obtain a fluid or tissue
growing bacterial syncope, tremors specimen for culture and
cells to die. sensitivity, as ordered.
CV: Hypertension, Expect to begin therapy
hypotension, palpitations, before results are
peripheral edema, available.
prolonged QTc interval,
tachycardia, vasculitis, During:
vasodilation, ventricular ● Infuse drug over 60
tachyarrhythmias minutes with readyto-use
flexible bags with 400
EENT: Altered taste, mg of moxifloxacin in
deafness or other hearing 250 ml of 0.8% saline.
impairments, laryngeal Don’t dilute further.
edema, vision loss
● Know that if giving
ENDO: Hyperglycemia, through Y-type tubing or
hypoglycemia piggyback, stop other
solutions during
GI: Abdominal pain, moxifloxacin infusion,
abnormal liver enzymes, and flush the line before
acute hepatic necrosis, and after infusion with a
cholestatic hepatitis, compatible solution, such
diarrhea, dyspepsia, as 1M sodium chloride,
hepatic failure, hepatitis, 5% dextrose, sterile
jaundice, nausea, water for injection, 10%
pseudomembranous dextrose, lactated
colitis, vomiting Ringer’s or normal saline
solution. Also flush line
GU: Acute renal before and after giving
insufficiency or failure, other drugs in same I.V.
interstitial nephritis line.

HEME: Agranulocytosis, After:

aplastic anemia,
eosinophilia, hemolytic ● Monitor patient for
anemia, leukopenia, central nervous adverse
pancytopenia, prolonged reactions such as
PT, thrombocytopenia confusion, depression,
dizziness, hallucinations,
MS: Arthralgia; muscle peripheral neuropathy,
weakness; myalgia; suicidal ideation, and
tendon inflammation, tremors. If any occurs,
pain, or rupture notify prescriber and
expect moxifloxacin to
RESP: Allergic be discontinued.
pneumonitis
● Monitor patient for
SKIN: Photosensitivity, diarrhea. If profuse,
rash, Stevens–Johnson watery diarrhea develops,
syndrome, toxic contact prescriber and
epidermal necrolysis expect to obtain a stool
specimen to rule out
Other: Anaphylaxis, pseudomembranous
anaphylactic shock, colitis caused by
angioedema, serum Clostridium difficile. If
sickness, worsening of diarrhea occurs, notify
 myasthenia gravis prescriber and expect to
withhold moxifloxacin
and treat with fluids, an
antibiotic effective
against C. difficile,
electrolytes, fluids, and
protein, as ordered.

● Monitor patient’s blood

glucose, especially in
diabetic patients
receiving concomitant
treatment with insulin or
an oral hypoglycemic
agent, for changes in
blood glucose levels that
could become decreased
or increased. If
dysglycemia occurs, treat
according to standard of
care and expect that drug
may need to be
discontinued.

Reference: Jones and Bartlett (2018), Nurse’s Drug Handbook 17th edition
 DRUG STUDY
DRUG MECHANISM OF NURSING
DRUG NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS
CLASS ACTION RESPONSIBILITIES
Ceftriaxone Chemical Interferes with To treat infections of Calcium-containing I.V. CNS: Chills, fever, Before:
sodium class: bacterial cell wall the lower respiratory solutions; headache, hypertonia, ● Obtain culture and
(Pluxone) Third- synthesis by tract, skin, soft hyperbilirubinemic or reversible hyperactivity, sensitivity results, if
generation inhibiting cross- tissue, urinary tract, premature neonates; seizures possible and as ordered,
cephalosporin, linking of bones, and joints; hypersensitivity to before giving drug
Dosage: 7- peptidoglycan intra-abdominal ceftriaxone, other CV: Edema
2 gm IV drip NST aminocephalos strands. infections; and betalactam antibacterials or ● Protect powder from
OD poranic acid Peptidoglycan makes septicemia caused by cephalosporins, pencillins, EENT: Glossitis, hearing light.
the cell membrane anaerobes (including or their components; loss, stomatitis
Therapeutic rigid and protective. Bacteroides bivius, intravenous administration ● For I.V. use, reconstitute
class: Without it, bacterial Bacteroides fragilis, of ceftriaxone solutions GI: Abdominal cramps, with an appropriate
Antibiotic cells rupture and die. Bacteroides containing lidocaine; cholestasis, Clostridium diluent, such as sterile
melaninogenicus, neonates who are 28 days difficile–associated water for injection or
and old or less if they’re diarrhea, diarrhea, sodium chloride for
Peptostreptococcus expected to need calcium- elevated liver enzymes, injection, as follows: for
species), gram containing solutions, gallbladder dysfunction, 250-mg vial, add 2.4 ml;
negative organisms including parenteral hepatic failure, hepatitis, for 500-mg vial, add 4.8
(including nutrition. hepatomegaly, nausea, ml; for 1-g vial, add 9.6
Citrobacter species, oral candidiasis, ml; and for 2-g vial, add
Enterobacter pancreatitis, 19.2 ml to yield 100
aerogenes, pseudolithiasis, mg/ml. For piggyback
Escherichia coli, pseudomembranous bottles, reconstitute with
Haemophilus colitis, vomiting 10 ml of diluent indicated
influenzae, above for 1-g bottle and
Klebsiella species, GU: Acute renal failure, 20 ml for 2-g bottle.
Neisseria species, elevated BUN level, After reconstitution,
Proteus mirabilis, nephrotoxicity, oliguria, further dilute to 50 to 100
Proteus vulgaris, renal failure, vaginal ml with diluent indicated
Providencia species, candidiasis, ureteric above and infuse over 30
Salmonella species, obstruction, urolithiasis minutes. Never use a
Serratia marcescens, diluent that contains
Shigella, and some HEME: Agranulocytosis, calcium, such as Ringer’s
strains of aplastic anemia, solution or Hartmann’s
Pseudomonas eosinophilia, hemolytic solution, because a
aeruginosa), and anemia, hemorrhage, precipitate can form and
gram-positive hypoprothrombinemia, may be fatal if injected.
organisms (including leukopenia, neutropenia,
Staphylococcus thrombocytopenia,
aureus, unusual bleeding During:
Streptococcus ● Check the patency of the
pneumoniae, and MS: Arthralgia IV site and the IV line
Streptococcus
pyogenes) RESP: Allergic ● Have vitamin K ready in
pneumonitis, dyspnea case
hypoprothrombinemia
SKIN: Allergic occurs.
dermatitis, ecchymosis,
erythema, erythema ● Do not mix ceftriaxone
multiforme, exanthema, with any other
pruritus, rash, Stevens– antimicrobial drug.
Johnson syndrome, toxic
epidermal necrolysis, ● Discontinue if
urticaria hypersensitivity reaction
occurs.
Other: Anaphylaxis; drug
fever; injectionsite pain, After:
redness, and swelling; ● Urge patient to report
serum sickness; watery, bloody stools to
superinfection prescriber immediately,
even up to 2 months after
drug therapy has ended.

● Advise patient to report

any hypersensitivity
reactions, such as a rash,
itching skin, or hives, to
prescriber immediately
and to stop taking the
 drug.

Reference: Jones and Bartlett (2018), Nurse’s Drug Handbook 17th edition

DRUG STUDY
DRUG MECHANISM OF NURSING
DRUG NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS
CLASS ACTION RESPONSIBILITIES
 Tramadol Chemical Binds with mu To relieve pain Alcohol intoxication; CNS: Agitation, anxiety, Before:
hydrochloride class: receptors and severe enough to excessive use of central- asthenia, depression, ● Assess for
Cyclohexanol inhibits the reuptake require opioid-like acting analgesics, dizziness, emotional hypersensitivity to
of norepinephrine treatment and for hypnotics, opioids, or other lability, euphoria, fatigue, tramadol, seizures
Dosage: and serotonin, which which alternative psychotropic drugs; fever, hallucinations,
50 mg slow IVTT Therapeutic may account for treatment options hypersensitivity to tramadol headache, hypertonia, ● Be aware that tramadol
now then OD class: tramadol’s analgesic such as nonopioid or its components; use hypoesthesia, insomnia, shouldn’t be given to
Analgesic effect. analgesics or opioid within 14 days of MAO lethargy, nervousness, patients with a history of
combination inhibitor therapy paresthesia, restlessness, anaphylactoid reactions
products are rigors, seizures, serotonin to codeine or other
inadequate or not syndrome, somnolence, opioids.
tolerated suicidal ideation, tremor,
vertigo, weakness ● Avoid giving tramadol to
patients with acute
CV: Chest pain, abdominal conditions
orthostatic hypotension, because it may mask
vasodilation evidence and disrupt
assessment of the
EENT: Blurred vision, abdomen
dry mouth, nasal or sinus
congestion, sore throat, During:
vision changes ● Administer with food or
milk to prevent GI upset
ENDO: Adrenal
insufficiency, hot flashes ● Measure and record
regular weights to
GI: Abdominal pain, monitor fluid changes
anorexia, constipation,
diarrhea, indigestion, ● Administer drug early in
nausea, vomiting the day so increased
urination will not disturb
GU: Decreased libido, sleep.
erectile dysfunction,
impotence, infertility, lack
of menstruation, urinary
frequency, urine retention
MS: Arthralgia; back, After:
limb, or neck pain ● Monitor serum
electrolytes, hydration
RESP: Cough, dyspnea and liver function during
 long-term therapy
SKIN: Diaphoresis, ● Provide diet rich in
dermatitis, flushing, potassium or give
pruritus, rash supplemental potassium.

Other: Flu-like illness,

physical and
psychological dependence

Reference: Jones and Bartlett (2018), Nurse’s Drug Handbook 17th edition

DRUG STUDY
DRUG MECHANISM OF NURSING
DRUG NAME INDICATIONS CONTRAINDICATIONS ADVERSE EFFECTS
CLASS ACTION RESPONSIBILITIES
Insulin Glargine Chemical Lower blood glucose Control of Hypoglycemia; Allergy or Endo: hypoglycemia. Before:
(Basagine) class: by: stimulating hyperglycemia in hypersensitivity to a ● Assess patient for signs
Pancreatics glucose uptake in patients with type 1 particular type of insulin, Fluid and electrolytes: and symptoms of
skeletal muscle and or type 2 diabetes preservatives, or other hypokalemia. hypoglycemia and
Dosage: Therapeutic fat, inhibiting mellitus. additives. hyperglycemia
20 units SQ -OD class: hepatic glucose Local: lipodystrophy, periodically during
qpm Antidiabetics, production. Other pruritis, erythema, therapy
Hormones actions: inhibition of swelling.
lipolysis and ● Do not use if cloudy,
proteolysis, Misc: allergic reactions discolored, or unusually
enhanced protein including anaphylaxis. viscous. Store unopened
synthesis. vials and cartridges of
insulin glargine and
insulin detemir in the
refrigerator; do not
freeze. If unable to
refrigerate, the 10-mL
vial of insulin glargine
can be kept in a cool
place unrefrigerated for
up to 28 days. Once the
cartridge is placed in a
pen, do not refrigerate.
After initial use, insulin
detemir vials, cartridges,
or a prefilled syringe may
be stored in a cool place
for 42 days. Do not store
in-use cartridges and pre-
filled syringes in
refrigerator or with
needle in place. Keep
away from direct heat
and sunlight.

During:
● Rotate injection sites.

● Administer insulin
 glargine once daily at the
same time each day.

● Administer daily insulin

detemir with evening
meal or at bedtime. With
twice daily insulin
detemir, administer
evening dose with
evening meal, at bedtime,
or 12 hr after morning
dose.

● Do not administer insulin

detemir or insulin
glargineIV or in insulin
pumps.

After:
● Instruct patient and
family on proper
technique for
administration. Include
type of insulin,
equipment (syringe,
cartridge pens, alcohol
swabs), storage, and
place to discard syringes.
Discuss the importance
of not changing brands of
insulin or syringes,
selection and rotation of
injection sites, and
compliance with
therapeutic regimen.
Patients taking insulin
detemir should be given
the Patient Information
circular for this product.
 ● Instruct patient and
family in proper testing
of serum glucose and
ketones. These tests
should be closely
monitored during periods
of stress or illness and
health care professional
notified of significant
changes.

● Advise patient to notify

health care professional
if nausea, vomiting, or
fever develops, if unable
to eat regular diet, or if
blood glucose levels are
not controlled.

Reference: Davis (2017), Davis’s Drug Guide for Nurses 15th edition