Drug Study

Ciprofloxacin

GENERIC NAME: CiprofloxacinBRAND NAME: CiproCLASSIFICATION: Antibacterial,

FluoroquinoloneMODE OF ACTION: Bactericidal; interfere

with DNA replication in susceptible bacteria preventing cell reproduction.

SUGGESTED DOSE: 500mg 1tab BIDORDERED 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 yogurtDo 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 tendonsTake it to what the doctor recommended.

Bactroban

GENERIC NAME: MupirocinBRAND NAME: BactrobanCLASSIFICATION: AntibacterialMODE 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,

rednessWash 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 HydrochlorideBRAND NAME: AlgesiaCLASSIFICATION: Analgesic, centrally actingMODE 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, reflexesControl environment if sweating or CNS

effects occursLimit use in patient with past or present

history of addiction on opioidsMay 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 BIDNovember 12, 2015 Losartan 100mg 1tab OD INDICATION: Hypertension, DM type 2, CHFCONTRAINDICATION: Hypotension,

pregnancy, and lactationSIDE 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: ParacetamolBRAND NAME: BiogesicCLASSIFICATION: Analgesic, AntipyreticMODE 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 anti-inflammatory 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 long-term, 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 SignDo 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.

Phenmacetin may cause urine to become dark brown or wine-colored.

Ketorolac Tromethamine

GENERIC NAME: Ketorolac TromethamineBRAND NAME: ToradolCLASSIFICATION: Nonsteroidal anti-

inflammatory agents, nonopioid analgesicsMODE 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 prolonged bleeding time and CNS reactions

Monitor fluid intake and output.

Tetanus Toxoid

GENERIC NAME: Anti-tetanus serumBRAND NAME: Tetanus toxoidCLASSIFICATION: EPI vaccine, Anti-tetanusMODE 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 maintain adequate immunity.

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 response to vaccines.

NURSING RESPONSIBILITY:Special care should be taken to ensure that

the injection does not enter the blood vesselMonitor Vital signEducate the patient to increase fluid intakeEducate patient that pain and tenderness in

the injection site may occur.Determine date of last tetanus immunizationAdvise 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 signEducate the patient to increase fluid intake

Midazolam

GENERIC NAME: MidazolamBRAND NAME: DormicumCLASSIFICATION: Anxiolytics/Hypnotics and

Sedatives/AnticonvulsantMODE 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 ½ 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: OmeprazoleBRAND NAME: RisekCLASSIFICATION: Antacids, Proton pump

inhibitorMODE 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

ORDERED DOSE: November 11, 2015 40mg itab HS prior to OR

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 immediately if significant changes.

Instruct patient or watcher to report unusualities.

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