SITI WAN NURAINATASA BINTI NAZRI WAN

BENZYL PENICILLIN

BISACODRYL

BROMHEXINE HCL

BUDESONIDE

BUPIVACAINE

20
SITI WAN NURAINATASA BINTI NAZRI WAN

BENZYLPENICILLIN SODIUM / BEPEN

(Antibiotic)

Indications:
Wound, pyogenic skin & soft tissue & respiratory tract infections. Penicillin-sensitive infections
e.g., generalised infections & septicaemia; acute & chronic osteomyelitis, subacute bacterial
endocarditis & meningitis. Tetanus, actinomycosis, anthrax, rat-bite fever, listeriosis & severe
Lyme disease. Gonococcal arthritis or endocarditis, congenital syphilis & neurosyphilis.
Diphtheria, brain abscesses & pastoralises.
Available Dose:
3 g, 600 mg
Recommended dosage:
Adult
600-3,600 mg daily in 4-6 divided doses, depending on indication.
Meningitis
Up to 14.4 g IV daily in divided doses.
Bacterial endocarditis
7.2-12 g IV daily in divided doses.
Childn 1 mth-12 year
100 mg/kg daily in 4 divided doses. Max: 4 g daily.
Infant 1-4 week
75 mg/kg daily in 3 divided doses.
Newborn
50 mg/kg daily in 2 divided doses.
Meningococcal disease
Adult & children >12 year
2.4 g every 4 hr.
Childn 1 mth-12 year
180-300 mg/kg daily in 4-6 divided doses. Max: 12 g daily.
Infant 1-4 week
150 mg/kg daily in 3 divided doses.
Newborn
100 mg/kg daily in 2 divided doses.
Premature & neonate
Not more frequent than every 8-12 hr.
Renal insufficiency
0.6-1.2 g no more frequent than every 8-10 hr.
Advanced liver disease associated w/ severe renal failure
Reduce to 300 mg every 8 hr.
Haemodialysis
Additional 300 mg every 6 hr during procedure
Route Of Administration:
Intravenous
Mode Of Action:
Benzylpenicillin sodium BP is a beta-lactam antibiotic. It is bactericidal by inhibiting bacterial
cell wall biosynthesis.

21
SITI WAN NURAINATASA BINTI NAZRI WAN

Special Warnings:
Discontinue use if allergic reactions occur. Hypersensitivity to penicillins, cephalosphorins,
carbapenems or other β-lactam agents. Overgrowth of nonsusceptible organisms w/
prolonged use. Pseudomembranous colitis. Diabetes. Hypokalemia, hypernatremia. Skin
sensitization. Monitor electrolyte balance, blood count & renal function in high-dose
prolonged treatment. Renal impairment. Pregnancy & lactation. Elderly.

Possible Side Effects:

1. Muscle Spasm
2. Mild Skin Rash
3. Overreactive Reflexes
4. Nausea
5. Hyperventilation
6. Reaction at injection site
7. Diarrhoea
8. Dizziness
9. Tachycardia
10. Vomiting

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Benzylpenicillin is a
very potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Monitor signs for hypernatremia
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent small
meals); fast heart rate. Nasal solution may cause burning or stinging when first used
(transient). Ophthalmic solution may cause slight stinging when first used (transient);
headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to avoid smoking and driving.

22
SITI WAN NURAINATASA BINTI NAZRI WAN

BISACODYL / BISACODYL YSP

(Laxative)

Indications:
Constipation
Available Dose:
10 mg, 5 mg
Recommended dosage:
Adult
One 10-mg supp.
Children 4-10 year
One 5-mg supp.
Route Of Administration:
Suppository (rectum insertion)
Mode Of Action:
Bisacodyl works by stimulating enteric neurons to cause peristalsis, i.e., colonic contractions. It
is also a contact laxative; it increases fluid and salt secretion. The action of bisacodyl on
the small intestine is negligible; stimulant laxatives mainly promote evacuation of the colon
Special Warnings:
Inflammatory bowel disease, rectal fissures, ulcerated haemorrhoids. Prolonged use. Children.

Possible Side Effects:

1. Abdominal cramp
2. Local irritation
3. Bradycardia
4. Nausea
5. Excessive Thrist
6. Rectal Burning
7. Diarrhoea
8. Weakness
9. Vertigo
10. Vomiting

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Bisacodyl is a very
potent drug; small errors in dosage can cause serious adverse effects. Double-
check paediatric dosage.
2. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent
small meals); fast heart rate. Nasal solution may cause burning or stinging when
first used (transient). Ophthalmic solution may cause slight stinging when first
used (transient); headache or brow ache (only during the first few days).
3. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
4. Advice patient to avoid smoking and driving.

23
SITI WAN NURAINATASA BINTI NAZRI WAN

BROMHEXINE HCL / BISLAN

(Mucolytics)

Indications:
Respiratory disorders associated w/ viscid or excessive mucus.
Available Dose:
8 mg per tab
Recommended dosage:
Adult
1tab tds.
Childn 5-10 year
½ tab qds,
<5 year
½ tab bd
Route Of Administration:
Oral
Mode Of Action:
Bromhexine is a mucolytic agent that acts on the mucus gland in the respiratory tract to
change the structure of bronchial secretion. It enhances the transport of mucus by reducing
its viscosity and increases cilia activity resulting in enhanced mucociliary clearance. This
secretolytic and secretomotor effect in the bronchial tract facilitates expectoration and
relieves cough.
Special Warnings:
Patient with existing or history of gastric ulceration; asthma. Severe renal and hepatic
impairment. Children. Pregnancy and lactation.

Possible Side Effects:

1. Ear Irritation
2. Allergic Skin rash
3. Bradycardia
4. Nausea
5. Breathing difficulties
6. Sweating
7. Diarrhoea
8. Headache
9. Edema
10. Vomiting

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Bromhexine is a
very potent drug; small errors in dosage can cause serious adverse effects.
Double-check paediatric dosage.
2. Protect drug from light, extreme heat, and freezing; do not use pink or brown
colour tablet.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent

24
SITI WAN NURAINATASA BINTI NAZRI WAN

small meals); fast heart rate. Nasal solution may cause burning or stinging when
first used (transient). Ophthalmic solution may cause slight stinging when first
used (transient); headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to avoid smoking and driving.

25
SITI WAN NURAINATASA BINTI NAZRI WAN

BUDESONIDE / PULMICORT

(Corticosteroid)

Indications:
Inhalation/Respiratory
Available Dose:
0.25 mg/ml, 0.5 mg/ml
Recommended dosage:
Bronchial asthma
Adult
Initially 1-2 mg bd. Maintenance: 0.5-1 mg bd.
Children
Initially 0.5-1 mg bd. Maintenance: 0.25-0.5 mg bd.
Acute laryngotracheobronchitis (croup)
Infant & children
2 mg as single dose or 2 1-mg dose separated by 30 min, every 12 hr up to 36 hr or until clinical
improvement.
COPD exacerbations
4-8 mg daily in 2-4 divided doses. Max: Not >10 days.
Route Of Administration:
Inhalation
Mode Of Action:
Budesonide is a corticosteroid with potent glucocorticoid activity. It controls the rate of protein
synthesis, inhibits the migration of polymorphonuclear leukocytes and fibroblasts, reverses the
capillary permeability and lysosomal stabilisation at the cellular level to prevent or control
inflammation.
Special Warnings:
Patients with diabetes mellitus, myasthenia gravis, thyroid disease, COPD, CV disease (e.g.
CHF, hypertension, acute MI), gastrointestinal disease (e.g. diverticulitis, fresh intestinal
anastomoses, active or latent peptic ulcer), infections (e.g. oral, nasal or ocular herpes
simplex, active or quiescent TB, untreated fungal, bacterial, systemic viral or parasitic
infections), cataracts, glaucoma, seizure disorders, and severe affective disorders (e.g. manic-
depressive illness, previous steroid-induced psychosis); major risk factors for decreased bone
mineral count (e.g. prolonged immobilisation, osteoporosis, postmenopausal status, tobacco
use, poor nutrition); recent nasal surgery or trauma. Avoid abrupt withdrawal. Renal and
hepatic impairment. Children. Pregnancy and lactation.

Possible Side Effects:

1. Heartburn
2. Sore Throat
3. Bradycardia
4. Nausea
5. Muscle Ache
6. Easy Bruising
7. Diarrhoea
8. Headache
9. Vomiting

26
SITI WAN NURAINATASA BINTI NAZRI WAN

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Budesonide is a
very potent drug; small errors in dosage can cause serious adverse effects.
Double-check paediatric dosage.
2. Encourage patient to use decongestant to clear blocked nasal passages first.
3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,
apprehension (use caution if driving or performing tasks that require alertness);
anxiety, emotional changes; nausea, vomiting, change in taste (eat frequent
small meals); fast heart rate. Nasal solution may cause burning or stinging when
first used (transient). Ophthalmic solution may cause slight stinging when first
used (transient); headache or brow ache (only during the first few days).
4. Assess allergic reactions and vital signs after administration especially cardiac
rhythm and blood pressure.
5. Advice patient to shake the consister well before use to enhance maximum
therapy.

27
SITI WAN NURAINATASA BINTI NAZRI WAN

BUPIVACAINE / PHARMANIAGA BUPIVACAINE 0.5%

(Anaesthetic)

Indications:
Local or regional anaesth & analgesia.
Available Dose:
100 mg/ 20ml
Recommended dosage:
Individualized dosage. Max: 2 mg/kg.
Route Of Administration:
Intravenous
Mode Of Action:
Bupivacaine blocks both the initiation and conduction of nerve impulses reducing the
permeability of neuronal membranes to Na ions resulting in inhibition of depolarization w/
resultant blockade of conduction.
Special Warnings:
Hypersensitivity. Major peripheral nerve block. Patient w/ epilepsy, impaired cardiac
conduction, bradycardia, severe shock, or digitalis intoxication; impaired CV function; Stokes-
Adams syndrome or Wolff-Parkinson-White syndrome; preexisting neurological or
neuromuscular disease eg, myasthenia gravis; serious CNS or spinal cord diseases eg,
meningitis, spinal fluid block, cranial or spinal haemorrhage, tumours, poliomyelitis, syphilis, TB
or metastatic spinal cord lesions; hyperthyroidism. Insert IV cannula prior to local anaesth inj.
Constant monitoring of CV & resp vital signs & patient's state of consciousness after each inj.
Inadvertent intravascular or subarachnoid inj; post-op IA continuous infusion. Concomitant use
w/ anti-arrhythmic class III drugs eg, amiodarone. May affect ability to drive or operate
machinery. Advanced hepatic disease, severe renal or hepatic impairment. Pregnancy.
Childn <12 yr. Elderly, debilitated patients including w/ partial or complete conduction block.

Possible Side Effects:

1. Apnoea
2. Haemorrhage
3. Bradycardia
4. Nausea
5. Congestive heart failure
6. Cortical proliferation of long bones
7. Diarrhoea
8. Disseminated intravascular coagulation
9. Edema
10. Vomiting

Nursing Responsibilities:
1. Use extreme caution when calculating and preparing doses; Bupivacaine
is a very potent drug; small errors in dosage can cause serious adverse
effects. Double-check paediatric dosage.
2. Protect drug from light, extreme heat, and freezing; do not use pink or
brown colour tablet.

28
SITI WAN NURAINATASA BINTI NAZRI WAN

3. Educate patient about the side effects: Dizziness, drowsiness, fatigue,

apprehension (use caution if driving or performing tasks that require
alertness); anxiety, emotional changes; nausea, vomiting, change in taste
(eat frequent small meals); fast heart rate. Nasal solution may cause burning
or stinging when first used (transient). Ophthalmic solution may cause slight
stinging when first used (transient); headache or brow ache (only during the
first few days).
4. Assess allergic reactions and vital signs after administration especially
cardiac rhythm and blood pressure.
5. Advice patient to avoid smoking and driving.

29