Drug Study

Ciprofloxacin
GENERIC

NAME: Ciprofloxacin
BRAND NAME: Cipro
CLASSIFICATION:
Antibacterial,
Fluoroquinolone
MODE OF ACTION: Bactericidal; interfere
with DNA replication in susceptible bacteria
preventing cell reproduction.
SUGGESTED DOSE: 500mg 1tab BID
ORDERED DOSE: November 10, 2015
500mg 1tab BID

 INDICATION:

Used to treat infections of the

skin, lung, airways, bones, and joints caused
by susceptible bacteria.
CONTRAINDICATION: Contraindicated with
allergy to ciprofloxacin, other quinolone class
of antimicrobial agents. Use cautiously with
renal dysfunction, seizures, tendinitis or
tendon rupture.
SIDE EFFECTS: Nausea, diarrhea, dizziness,
lightheadedness, headache
ADVERSE EFFECTS: Heartburn, difficulty of
breathing, rapid heartbeat, fever, joint or
muscle pain, seizure

 INTERACTION:
Decreased

therapeutic effect with iron salts.

Decreased absorption with antacids.
Increased serum levels and toxic effects of
theophyllines.
NURSING RESPONSIBILITY:
Instruct the patient not to take it with dairy
products such as milk or yogurt
Do not take or eat a lot of caffeine products
within 6 hours before or 2 hours after.
Instruct client to report any adverse reaction
to the physician.
Inform patient that it may cause swelling or
tearing of a tendons
Take it to what the doctor recommended.

Bactroban
GENERIC

NAME: Mupirocin
BRAND NAME: Bactroban
CLASSIFICATION: Antibacterial
MODE OF ACTION: It kills sensitive bacteria
by stopping the production of essential
proteins needed by the bacteria to survive.
SUGGESTED DOSE: Apply a small amount
of the ointment as directed.
ORDERED DOSE: November 10, 2015
Bactroban Ointment BID

 INDICATION:

Treatment of secondarily infected

traumatic skin lesions due to susceptible strains
of S. aureus and S. pyogenes.
CONTRAINDICATION:
Contraindicated
in
patients with known hypersensitivity to any of
the constituents of the cream.
SIDE EFFECTS: Blistering, crusting, irritation,
itching, or reddening, cracked, dry, scaly skin,
pain, swelling, tenderness, warmth on the skin
ADVERSE EFFECTS: severe itching, lightness
in the chest, severe allergic reaction
INTERACTION: No known interactions

 NURSING

RESPONSIBILITY:
Asses the affect part for discharges,
redness
Wash hands before and after using it.
Clean and dry the affected area. Apply
a small amount of the ointment as
directed.
If the infection gets worse or does not
improve consult the doctor.
Report if any side effects occur like
fever, rash

Algesia
GENERIC

NAME: Tramadol Hydrochloride

BRAND NAME: Algesia
CLASSIFICATION: Analgesic, centrally acting
MODE
OF ACTION: Binds to mu-opioid
receptors and inhibits the reuptake of
norepinephrine and serotonin; causes many
effects similar to the opioids but does not have
the respiratory depressant effects.
SUGGESTED DOSE: 1-2 tabs 4-6 hourly as
needed for pain relief
ORDERED DOSE: November 11, 2015 1tab TID

 INDICATION:

Management of moderate to

severe pain
CONTRAINDICATION: Hypersensitivity to
codeine or opioids. Acute intoxication with
alcohol, hypnotics, narcotics, centrally-acting
analgesics or opioid drugs.
SIDE EFFECTS: chest pain, blurred vision,
headache, nausea
ADVERSE
EFFECTS:
change
in
consciousness, dizziness, fatigue, vomiting
INTERACTION: Carbamazepine, quinidine,
warfarin, depressants

 NURSING

RESPONSIBILITY:
Assess
skin
color,
texture,
lesions,
orientation, reflexes
Control environment if sweating or CNS
effects occurs
Limit use in patient with past or present
history of addiction on opioids
May experience side effects: dizziness,
sedation, drowsiness, impaired visual acuity.
Report nausea, vomiting, dizziness, severe
constipation

Losartan Potassium
GENERIC

NAME: Losartan Potassium

BRAND NAME: Cozaar
CLASSIFICATION: Antihypertensive
MODE OF ACTION: Selectively blocks the
binding of angiotensin II to specific tissue
receptors found in the vascular smooth muscle
and adrenal gland; thus action blocks the
vasoconstriction effect of the renin-angiotensin
system as well as the release of aldosterone
leading to decreased blood pressure.

 SUGGESTED

DOSE: 50mg/100mg/500mg

1tab OD
ORDERED DOSE:
November 11, 2015 Losartan 50mg 1tab BID
November 12, 2015 Losartan 100mg 1tab OD
INDICATION: Hypertension, DM type 2, CHF
CONTRAINDICATION:
Hypotension,
pregnancy, and lactation
SIDE
EFFECTS:
Headache,
dizziness,
nausea
ADVERSE
EFFECTS:
Chest
pain,
hypotension, sinus disorder

 INTERACTION:

Decreased serum levels and

effectiveness
if
taken
concurrently
with
phenobarbital. Losartan is converted to an active
that inhibit ketoconazole, fluconazole, diltiazem
may decrease the antihypertensive effects of
losartan.
NURSING RESPONSIBILITY:
Monitor for blood pressure, ECG, pulse frequently
Monitor intake and output
Assess for signs and symptoms of CHF
Assess for signs and symptoms of hypotension
Instruct patient to have a low fat low sodium
diet
Monitor for signs of hyperkalemia

Paracetamol
GENERIC

NAME: Paracetamol
BRAND NAME: Biogesic
CLASSIFICATION: Analgesic, Antipyretic
MODE OF ACTION: Reduces fever by acting
directly on the hypothalamic heat-regulating
center to cause vasodilation and sweating,
which helps dissipate heat.
Relieves pain by inhibiting prostaglandin
synthesis at the CNS but does not have antiinflammatory action because of its minimal
effect on peripheral prostaglandin synthesis.

SUGGESTED DOSE: 500mg orally every 4-6 hours

ORDERED
DOSE:
November
10,
2015
Paracetamol 500mg 1tab q4 PRN
INDICATION: Symptomatic relief of pain and fever.
CONTRAINDICATION:
Contraindicated
with
allergy to acetaminophen. Use cautiously with
impaired hepatic function, chronic alcoholism,
pregnancy, lactation
SIDE
EFFECTS:
Nausea,
vomiting,
rash,
abdominal pain
ADVERSE
EFFECTS: Hepatotoxicity, hepatic
seizure, renal failure, thrombocytopenia, cyanosis,
jaundice

 INTERACTION:

Increased toxicity with longterm, excessive ethanol ingestion, increased

risk of hepatotoxicity and possible decreased
therapeutic
effects
with
barbiturates.
Possible
reduced
absorption
of
acetaminophen with activated charcoal.
NURSING RESPONSIBILITY:
Monitor Vital Sign
Do TSB, if fever occurs
Report N&V. cyanosis, shortness of breath
and abdominal pain as these are signs of
toxicity.
Report paleness, weakness and heart beat
skips
Report abdominal pain, jaundice, dark urine,
itchiness or clay-colored stools.

Ketorolac Tromethamine
GENERIC

NAME: Ketorolac Tromethamine

BRAND NAME: Toradol
CLASSIFICATION:
Nonsteroidal
antiinflammatory agents, nonopioid analgesics
MODE OF ACTION: Anti-inflammatory and
analgesic activity; inhibits prostaglandin and
leukotriene synthesis.
SUGGESTED DOSE: Adult Parenteral Single
dose 60mg IM or 30mg IV
ORDERED DOSE: November 11, 2015
Ketorolac 40mg IVTT q8 PRN

INDICATION: Short term Management of pain

(up to 5 days)
CONTRAINDICATION:
Contraindicated
with
significant renal impairment, during labor and
delivery, lactation; use cautiously with impaired
hearing; allergies; hepatic, CV and GI condition
SIDE EFFECTS: upset stomach, mild nausea or
vomiting,
diarrhea,
constipation,
dizziness,
headache, drowsiness, sweating
ADVERSE EFFECTS: Hypertension, tinnitus,
thrombocytopenia, renal toxicity
INTERACTION: Increased risk of nephrotoxicity
with other nephrotoxins, increased risk of
bleeding with anticoagulants.

 NURSING

RESPONSIBILITY:
Monitor BP upon administration. < 90/80
never administer. Refer to doctor.
Patients who have asthma, aspirin-induced
allergy, and nasal polyps are at increased
risk
for
developing
hypersensitivity
reactions. Assess for rhinitis, asthma, and
urticaria.
Assess pain (note type, location, and
intensity) prior to and 1-2hr following
administration.
Ketorolac therapy should always be given
initially by the IM or IV route. Oral therapy
should be used only as a continuation of
parenteral therapy.
Monitor for adverse reactions, especially

Tetanus Toxoid
GENERIC

NAME: Anti-tetanus serum

BRAND NAME: Tetanus toxoid
CLASSIFICATION: EPI vaccine, Anti-tetanus
MODE OF ACTION: Tetanus toxoid absorbed
induces active immunity to tetanus antigen
by stimulating the immune system to
produce specific antitoxin.
SUGGESTED
DOSE: After the initial
immunization series is completed, a booster
dose of 0.5mL of tetanus toxoid should be
given intramuscularly every 10 years to

 ORDERED

DOSE: November 10, 2015 TT

0.5eu IM 11:00pm
INDICATION: For booster injection only for
persons 7 years of age or older against
tetanus.
CONTRAINDICATION:
Hypersensitivity,
febrile illness and other acute infections,
patients with low immune response.
SIDE EFFECTS: Redness, warmth, edema,
rash, fever, ain, nausea
ADVERSE EFFECTS: paralysis of the radial
nerve, Guillian-Burre syndrome
INTERACTION:
Patients who are on
immunosuppressive
therapy,
including
alkylating
agents,
antimetabolites,
corticosteroids may have a reduced immune

 NURSING

RESPONSIBILITY:
Special care should be taken to ensure that
the injection does not enter the blood vessel
Monitor Vital sign
Educate the patient to increase fluid intake
Educate patient that pain and tenderness in
the injection site may occur.
Determine date of last tetanus immunization
Advise patient for proper fever reducing drug
dose for fever reaction

Human Tetanus Immune Globulin

GENERIC

NAME:

Human

Tetanus

Immune

Globulin
BRAND NAME:
CLASSIFICATION:
MODE OF ACTION: Neutralizes toxin produced
by clostridium tetani, the cause of tetanus.
SUGGESTED DOSE: IM 250 units
ORDERED DOSE: November 10, 2015 HTIG
250units/mL IM 11:05PM

INDICATION:
Prophylaxis
against
tetanus
following injury in patients whose immunization is
incomplete or uncertain.
CONTRAINDICATION: no known contraindication
SIDE EFFECTS: Slight soreness at the injection
site,
slight
temperature
elevation,
hypersensitivity.
ADVERSE
EFFECTS:
Nephrotic
syndrome,
anaphylactic shock, bleeding disorders
INTERACTION: Antibodies in immunoglobulin
preparations may interfere with the response to
live viral vaccines. Defer use of such vaccines
until approximately 3 months after tetanus
immune globulin (human) administration.

 NURSING

RESPONSIBILITY:
Inform patient that slight soreness at
injection site or slight temperature elevation
may occur
Advise patient to complete the tetanus
toxoid immunization as required
Special care should be taken to ensure that
the injection does not enter the blood vessel
Monitor Vital sign
Educate the patient to increase fluid intake

Midazolam
GENERIC

NAME: Midazolam
BRAND NAME: Dormicum
CLASSIFICATION: Anxiolytics/Hypnotics and
Sedatives/Anticonvulsant
MODE
OF
ACTION:
short
acting
benzodiazepine, it exerts sedative and
hypnotic, muscle relaxant, anxiolytic and
anticonvulsant
actions.
Potentiates
the
effects of gamma aminobutyrate (GABA), an
inhibitory neurotransmitter.

ORDERED DOSE: November 11, 2015 15mg

tab 1hour prior to OR
INDICATION:
Sedation,
amnesia
prior
to
diagnostics, therapeutic or endoscopic procedures
or surgery, induction of general anesthesia
CONTRAINDICATION:
Contraindicated
with
hypersensitivity to benzodiazepines, shock, coma,
pregnancy, acute alcoholic intoxication. Use
cautiously in elderly or debilitated patients with
impaired liver or kidney function.
SIDE EFFECTS: headache, drowsiness, rash,
nausea, vomiting, pain, tenderness, chills,
weakness
ADVERSE EFFECTS: tachycardia, cardiac arrest,
amnesia,
confusion,
nervousness,
vision
disturbances, blurred vision, decreased tidal
volume, decrease RR

INTERACTION: Risk of CNS depression if

combined with alcohol, antihistamines, opioids,
other sedatives. Decreased metabolism and
increased effects of midazolam with grapefruit
juice.
NURSING RESPONSIBILITY:
Arrange to reduce dosage of midazolam if patient
is also being given opioid analgesics; reduce
dosage by at least 50%and monitor patient closely.
Monitor level of consciousness before, during, and
for at least2-6 hours after administration of
midazolam.
Carefully monitor Pulse, Blood Pressure, and
respirations during administration.

Risek
GENERIC

NAME: Omeprazole
BRAND NAME: Risek
CLASSIFICATION: Antacids, Proton pump
inhibitor
MODE OF ACTION: Gastric acid pump
inhibitor: Suppresses gastric acid secretion
by specific inhibition of hydrogen potassium
ATPase enzyme system at the secretory
surface of the gastric parietal cells; blocks
final step of acid production.
SUGGESTED DOSE: 10, 20, 40mg DR
tablets

INDICATION: Short term treatment of active

duodenal ulcers. First line therapy in treatment of
heartburn or GERD, prophylaxis of acid aspiration,
eradication of H.pylori.
CONTRAINDICATION:
Contraindicated
with
hypersensitivity to omeprazole or its components.
Use cautiously with pregnany lactation.
SIDE EFFECTS: Headache, dizziness, fatigue, rash
ADVERSE EFFECTS: Nausea, abdominal pain,
hematuria, mild transient increases in liver function
test.
INTERACTION:
Increased serum levels and
potential increase in toxicity of benzodiazepines,
warfarin.

NURSING RESPONSIBILITY:
Monitor Initial vital signs.
Report any changes in urinary elimination such as
pain or discomfort associated with urination, or blood
in urine.
Report severe diarrhea; drug may need to be
discontinued.
Take the drug before meals. Swallow the capsules
whole; do not chew, open, or crush them.
May experience these side effects: Dizziness;
headache (request medications); nausea, vomiting,
diarrhea (maintain proper nutrition); symptoms of
URI, cough (do not self-medicate; consult with your
health care provider if uncomfortable).
Report severe headache, worsening of symptoms,
fever, chills.
Instruct patient to increase oral fluid.
Monitor I&O rates and pattern: Especially important in
severely ill patients receiving high doses. Report

Amlodipine
GENERIC

NAME: Amlodipine
BRAND NAME: Norvasc
CLASSIFICATION: Calcium channel-blocker,
Antihypertensive
MODE OF ACTION: Inhibits the transport of
calcium into myocardial and vascular smooth
muscle cells, resulting in inhibition of excitation
contraction
coupling
and
subsequent
contraction. Systemic vasodilation resulting in
decreased
blood
pressure.
Coronary
vasodilation resulting in decreased frequency
and severity of attacks of angina.

SUGGESTED DOSE: 2.5mg, 5mg, 10mg per day

ORDERED DOSE: November 12, 2015 5mg 1tab
OD
INDICATION: Hypertension alone or in combination
with other antihypertensives. Chronic stable angina
alone or in combination with other antianginal
drugs.
CONTRAINDICATION:
Hypersensitivity,
blood
pressure <90mmhg. Use cautiously in: severe
hepatic impairment, geriatric patients, history of
chronic heart failure.
SIDE EFFECTS: Headache, peripheral edema,
nausea, vomiting
ADVERSE EFFECTS: palpitation, tachycardia, chest
pain, fatigue, light-headedness

INTERACTION: Diltiazem increase plasma levels

of amlodipine further decrease bp
Grapefruit juice increase plasma amlodipine
levels
NURSING RESPONSIBILITY:
Monitor blood pressure and pulse rate
Monitor intake and output.
Assess for signs of CHF (peripheral edema, rales,
crackles, dyspnea)
Advised patient to take medication as directed.
Take care to have support when standing and
walking due to possible dose related light
headedness
Report shortness of breath, palpitation