DRUG STUDY: MANNITOL

BRAND NAME Prescribed and

GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action

Generic name: PRESCRIBED: Increases osmolarity Edema; promote Active intracranial CNS: Dizziness, Assess neurologic status:
of glomerular filtrate, systemic diuresis in bleeding, headache, seizures, LOC, ICP reading, pupil size
Mannitol 235 cc IV Q6H which raises osmotic cerebral edema, hypersensitivity, rebound increased and reaction when product is
decrease intraocular
Brand name: Recommended: pressure of fluid in anuria, severe ICP, confusion given for increased ICP
pressure, improve
renal tubules; there is renal function in acute pulmonary
Osmitrol, Resectisol Diuresis in product a decrease in congestion, edema, CV: Edema, • Assess for vision changes
renal failure, chemical
intoxication reabsorption of water, severe dehydration, hypotension, or eye discomfort or pain
poisoning, urinary
Classsification hypertension, before, during treatment
electrolytes; increases bladder irrigation progressive heart
Adult and child .12 yr: tachycardia, CHF, (increases intraocular
Diuretic-osmotic in urinary output, disease, renal failure,
5%-10% SOL thrombophlebitis, pressure); neurologic checks,
sodium, chloride, acute MI, aneurysm,
continuously up to angina-like chest ICP during treatment
potassium, calcium, stroke
200 g IV, while pains, fever, chills, (increased ICP)
phosphorus, uric acid,
maintaining 100-500 circulatory overload,
urea, magnesium • Assess patient for tinnitus,
ml urine output/hr PVCs
hearing loss, ear pain;
EENT: Loss of periodic testing of hearing is
hearing, blurred needed when high doses of
vision, nasal this product are given by IV
congestion, decreased route
intraocular pressure
life-threatening • Assess fluid volume status:
maraviroc check I&O ratios and record
hourly urine values, CVP,
ELECT: Fluid,  breath sounds, weight,
electrolyte  distended red veins, crackles
imbalances,  in lungs, color, quality, and
acidosis, electrolyte specific gravity of urine, skin
loss, dehydration, turgor, adequacy of pulses,
hyper/ hypokalemia moist mucous membranes
GI: Nausea, vomiting, (provide adequate fluids),
dry mouth, diarrhea bilateral lung sounds,
GU: Marked  peripheral pitting edema.
diuresis, urinary 
retention, thirst Assess for dehydration;
symptoms of decreasing
RESP: Pulmonary  output, thirst, hypotension,
congestion, cough, dry mouth and mucous
dyspnea membranes should be
reported

• Monitor electrolytes:
potassium, sodium, calcium,
magnesium; also include
BUN, ABGs, CVP, PAP,
CBC; regularly monitor
serum and urine levels of
sodium and potassium

• Assess B/P before, during

therapy with patient lying,
standing, and sitting as
appropriate; orthostatic
hypotension can occur
rapidly

• Monitor for rebound ICP:

headache, confusion Pati
 DRUG STUDY: OXACILLIN
BRAND NAME Prescribed and
GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action

Generic name: PRESCRIBED: Semisynthetic, acid- Primarily, infections Hypersensitivity to Body as a Assessment & Drug Effects
stable, penicillinase- caused by penicillins or Whole: Thrombophle
Oxacillin Sodium 1,762 mg IV Q6hr resistant isoxazolyl penicillinase- cephalosporins. bitis (IV therapy),  Ask patient prior to
producing first dose about
Brand name: Recommended: penicillin. superinfections,
staphylococci and hypersensitivity
penicillin-resistant wheezing, sneezing, reactions to
Bactodil, Staphylococcal Infect staphylococci. May be fever, anaphylaxis. penicillins,
Prostaphlin ions used to initiate cephalosporins, and
therapy in suspected  GI: Nausea, other allergens.
Child: PO 50–100 staphylococcal vomiting,  Lab tests: periodic
mg/kg/d in 4 divided infections pending flatulence, diarrhea, h liver functions, CBC
Classification: doses IM/IV 50–150 culture and sensitivity epatocellular with differential,
mg/kg/d divided q4– test results. As with platelet count, and
Antiinfective, 6h dysfunction (elevated
antibiotic penicillin. other penicillins, AST, ALT, hepatitis).  urinalysis.
Neonate: IV 50–100 serum concentrations  Hepatic dysfunction
mg/kg/d divided q6– are enhanced by (possibly a
12h Hematologic: Eosino
concurrent use of philia, leukopenia, hypersensitivity
probenecid. reaction) has been
thrombocytopenia,
associated with IV
granulocytopenia, agr oxacillin; it is
anulocytosis; reversible with
neutropenia (reported discontinuation of
in children).  drug. Symptoms may
resemble viral
Skin: Pruritus, rash, hepatitis or general
urticaria.  signs of
hypersensitivity and
Urogenital: Interstitia should be reported
l nephritis, transient promptly: hives, rash,
hematuria, fever, nausea,
vomiting, abdominal
albuminuria, azotemia
discomfort, anorexia,
(newborns and infants
on high doses).
 Withhold next drug
malaise, jaundice
(with dark yellow to
brown urine, light-
colored or clay-
colored stools,
pruritus).
dose and report the
onset of
hypersensitivity
reactions and
superinfections (see
Appendix F).

Patient & Family

Education

 Take oral medication

around the clock, do
not miss a dose. Take
all of the medication
prescribed even if
you feel better, unless
otherwise directed by
physician.
 Do not breast feed
while taking this drug
without consulting
physician.
 DRUG STUDY: METRONIDAZOLE

BRAND NAME Prescribed and

GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action

Generic name: PRESCRIBED: Synthetic compound Intestinal amebiasis, Blood dyscrasias; Body as a Whole: Assessment & Drug
with direct amebic abscess, active CNS disease; Hypersensitivity Effects
Metronidazole 353 mg IV Q6H trichomonacidal and trichomoniasis, first trimester of (rash, urticaria,
refractory -Discontinue therapy
Brand name: DOSAGE AND amebicidal activity as pregnancy (category pruritus, flushing),
trichomoniasis, immediately if symptoms
ROUTE: well as antibacterial bacterial anaerobic B), lactation. fever, fleeting joint
flagyl activity against pains, overgrowth of of CNS toxicity (see
infections, giardiasis;
Anaerobic Infections anaerobic bacteria and Candida. Appendix F) develop.
septicemia,
Classification:
some gram-negative endocarditis, bone, -Monitor especially for
Child: PO/IV 30 joint, and lower CNS: Vertigo,
Antiinfective; bacteria. seizures and peripheral
mg/kg/d divided q6h respiratory tract headache, ataxia,
Antiprotozoal, (max: 4 g/d) neuropathy (e.g.,
infections, rosaocea confusion, irritability,
Amebicide; Antibiotic numbness and paresthesia
depression,
Neonate: PO/IV 7.5– of extremities).
restlessness,
15 mg/kg/d divided
weakness, fatigue, -Lab tests: Obtain total
q12–48h
drowsiness, insomnia, and differential WBC
Pseudomembranous paresthesias, sensory counts before, during, and
Colitis neuropathy (rare). after therapy, especially if

Child: PO 30 mg/kg/d GI: Nausea, vomiting, a second course is

anorexia, epigastric necessary.
divided q6h times 7 d
distress, abdominal -Monitor for S&S of
cramps, diarrhea, sodium retention,
constipation, dry especially in patients on
mouth, metallic or corticosteroid therapy or
bitter taste, proctitis. with a history of CHF.
Urogenital: Polyuria, -Monitor patients on
dysuria, pyuria, lithium for elevated
incontinence, cystitis,
decreased libido, lithium levels.
dyspareunia, dryness
of vagina and vulva, -Report appearance of
sense of pelvic candidiasis or its
pressure. Special becoming more prominent
Senses: Nasal with therapy to physician
congestion. promptly.

CV: ECG changes -Repeat feces

(flattening of T wave). examinations, usually up
to 3 mo, to ensure that
amebae have been
eliminated.

Patient & Family

Education

-Adhere closely to the

established regimen
without schedule
interruption or changing
the dose.

-Refrain from intercourse

during therapy for
trichomoniasis unless
male partner wears a
condom to prevent
reinfection.

-Have sexual partners

receive concurrent
treatment. Asymptomatic
trichomoniasis in the male
is a frequent source of
 reinfection of the female.

-Do not drink alcohol

during therapy; may
induce a disulfiram-type
reaction (see Appendix F).
Avoid alcohol or alcohol-
containing medications
for at least 48 h after
treatment is completed.
Urine may appear dark or
reddish brown (especially
with higher than
recommended doses).
This appears to have no
clinical significance.

-Report symptoms of
candidal overgrowth:
Furry tongue, color
changes of tongue,
glossitis, stomatitis;
vaginitis, curd-like, milky
vaginal discharge;
proctitis. Treatment with a
candidacidal agent may be
indicated.

-Do not breast feed while

taking this drug.

DRUG STUDY: OFLOXACIN

 BRAND NAME Prescribed and
GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action

Generic name: PRESCRIBED: A fluoroquinolone Chlamydia Hypersensitivity to Assessment & Drug Effects
antibiotic with a broad trachomatis infection, ofloxacin or other
Ofloxacin 3 drops TID spectrum of activity uncomplicated quinolone CNS: Headache, - Lab tests: Do C&S
against gram-positive gonorrhea, prostatitis, antibacterial agents; dizziness, insomnia, tests prior to initial
Brand name: Recommended: hallucinations.
and gram-negative respiratory tract tendon pain; sunlight dose. Treatment may
floxin, floxin otic, Otitis Media with aerobic and anaerobic infections, skin and (UV) exposure; viral be implemented
GI: Nausea, vomiting,
ocuflox Perforation bacteria. Inhibits skin structure infection; pregnancy pending results.
diarrhea, GI
DNA gyrase, an infections, urinary (category C); - Determine history of
Classsification: Child: Otic >1 y, 5 discomfort.
enzyme necessary for tract infections due to lactation. hypersensitivity
drops (0.25 mL) q12h Urogenital: Pruritus, reactions to
Antiinfective, bacterial DNA susceptible bacteria,
for 14 d pain, irritation, quinolones or other
Antibiotic, Quinolone replication and some superficial ocular
aspects of its infections, pelvic burning, vaginitis, drugs before therapy
transcription, repair, inflammatory disease. vaginal discharge, is started.
recombination, and Otic: otitis externa, dysmenorrhea, - Withhold ofloxacin
transposition. otitis media with menorrhagia, dysuria, and notify physician
perforated tympanic urinary frequency. at first sign of a skin
membranes. rash or other allergic
Skin: Pruritus, rash. reaction.
Other: Cartilage - Monitor for seizures,
erosion. especially in patients
with known or
suspected CNS
disorders.
Discontinue
ofloxacin and notify
physician
immediately if
seizure occurs.
- Assess for signs and
 symptoms of
superinfection (see
Appendix F).

Patient & Family

Education

- Drink fluids liberally

unless
contraindicated.
- Be aware that
dizziness or light-
headedness may
occur; use
appropriate caution.
- Avoid excessive
sunlight or artificial
ultraviolet light
because of the
possibility of
phototoxicity.
- Do not breast feed
while taking this
drug.
 DRUG STUDY: PARACETAMOL
BRAND NAME Prescribed and
GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action

Generic name: PRESCRIBED: Produces analgesia by Fever reduction. Hypersensitivity to Body as a Whole: Assessment & Drug Effects
unknown mechanism, Temporary relief of acetaminophen or Negligible with
Paracetamol 300mg IVTT Q6H perhaps by action on mild to moderate pain. phenacetin; use with recommended dosage; -Monitor for S&S of:
PRN peripheral nervous Generally as alcohol. rash. hepatotoxicity, even with
Brand name: moderate acetaminophen
Recommended: system. Reduces fever substitute for aspirin
Tempra by direct action on when the latter is not Acute poisoning: doses, especially in
Mild to Moderate hypothalamus heat- tolerated or is Anorexia, nausea, individuals with poor
Classsification: Pain, Fever vomiting, dizziness, nutrition or who have
regulating center with contraindicated.
consequent peripheral lethargy, diaphoresis, ingested alcohol over
Central Nervous Child: PO 10–15
vasodilation, chills, epigastric or prolonged periods;
System Agent; mg/kg q4–6h PR 2–5
sweating, and abdominal pain, poisoning, usually from
Nonnarcotic y, 120 mg q4–6h
dissipation of heat. diarrhea; onset of accidental ingestion or
Analgesic, (max: 720 mg/d); 6–
Unlike aspirin, hepatotoxicity— suicide attempts; potential
Antipyretic 12 y, 325 mg q4–6h
acetaminophen has elevation of serum abuse from psychological
(max: 2.6 g/d) transaminases (ALT, dependence (withdrawal has
little effect on platelet
aggregation, does not AST) and bilirubin; been associated with restless
Neonate: PO 10–15
affect bleeding time, hypoglycemia, hepatic and excited responses).
mg/kg q6–8h
and generally coma, acute renal
failure (rare). Patient & Family
produces no gastric Education
bleeding. Chronic ingestion:
Neutropenia, -Do not take other
pancytopenia, medications (e.g., cold
leukopenia, preparations) containing
thrombocytopenic acetaminophen without
purpura, medical advice; overdosing
hepatotoxicity in and chronic use can cause
alcoholics, renal liver damage and other toxic
damage.
 effects.

-Do not self-medicate adults

for pain more than 10 d (5 d
in children) without
consulting a physician.

-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.

-Do not give children more

than 5 doses in 24 h unless
prescribed by physician.

DRUG STUDY: CEFTRIAXONE

BRAND NAME Prescribed and
GENERIC NAME Recommended dosage, Mechanism
CLASSIFICATION frequency, and route Of Indication Contraindication Adverse Reaction Nursing Responsibilities
of administration Action
Generic name: PRESCRIBED: Semisynthetic third- Serious lower  Hypersensitivity to CNS: Headache, Assessment & Drug Effects
generation respiratory tract,  cephalosporins, dizziness, weakness,
Ceftriaxone 2mg IV drip Q12H cephalosporin urinary tract,  infants ,1 mo paresthesia, fever,  Determine history of
hypersensitivity
Brand name: Recommended: antibiotic. skin, gonococcal,  chills, seizures,
reactions to
Preferentially binds to intraabdominal  dyskinesia (cefdinir) cephalosporins and
Rocephin Moderate to Severe one or more of the infections; septicemia, penicillins and
Infections penicillin-binding meningitis; bone, joint CV: Heart failure,
history of other
Classsification: syncope (cefdinir)
proteins (PBP) located infections, otitis allergies, particularly
Child: IV/IM 50–75 to drugs, before
Antiinfective, on cell walls of media, PID EENT: Oral
mg/kg/d in 2 divided therapy is initiated.
Antibiotic, Third- susceptible organisms. candidiasis
doses (max: 2 g/d)  Lab tests: Perform
Generation This inhibits third and
culture and
Cephalosporin Meningitis final stage of bacterial GI: Nausea, vomiting,
sensitivity tests
cell wall synthesis, diarrhea, anorexia, before initiation of
Child: IV/IM 75 thus killing the pain, glossitis, therapy and
mg/kg loading dose, bacterium. bleeding; increased periodically during
then 100 mg/kg/d in 2 AST, ALT, bilirubin, therapy. Dosage may
divided doses (max: 4 LDH, alkaline be started pending
g/d) phosphatase; test results. Periodic
coagulation studies
abdominal pain,
(PT and INR) should
pseudomembranous be done.
colitis, cholestasis  Inspect injection sites
(cefotaxime) for induration and
inflammation. Rotate
GU: Proteinuria, sites. Note IV
vaginitis, pruritus, injection sites for
candidiasis, increased signs of phlebitis
BUN, nephrotoxicity, (redness, swelling,
pain).
renal failure
 Monitor for
HEMA: Leukopenia, manifestations of
hypersensitivity (see
thrombocytopenia,
Appendix F). Report
agranulocytosis, their appearance
anemia, neutropenia, promptly and
lymphocytosis, discontinue drug.
 Watch for and report
eosinophilia, signs: petechiae,
pancytopenia, ecchymotic areas,
hemolytic anemia epistaxis, or any
unexplained
INTEG: Rash, bleeding. Ceftriaxone
urticaria, dermatitis appears to alter
vitamin K–producing
MS: Arthralgia
gut bacteria;
(cefditoren) therefore,
hypoprothrombinemi
RESP: Dyspnea
c bleeding may
SYST: Anaphylaxis, occur.
serum sickness,  Check for fever if
Stevens-Johnson diarrhea occurs:
syndrome, toxic Report both
epidermal necrolysis promptly. The
cefdinir incidence of
antibiotic-produced
pseudomembranous
colitis (see Appendix
F) is higher than with
most cephalosporins.
Most vulnerable
patients: chronically
ill or debilitated older
adult patients
undergoing
abdominal surgery.

Patient & Family

Education

 Report any signs of

bleeding.
 Report loose stools or
diarrhea promptly.
 Do not breast feed
while taking this drug
without consulting
physician.