DRUG STUDY Drug Data Generic Name Hydrocortisone Brand Name Cortef, SoluCortef, Hydrocortone, Cortenema Dosage 20-240

mg/day in single dose or divided doses Order: 50mg IVTT every 6 hours Classification Pharmacologi c Class Adrenal cortical steroid Corticosteroid Glucocorticoid Therapeutic Class Hormone Pregnancy category C Mechanism of Action Enters target cells and binds to cytoplasmic receptor; initiates many complex reactions that are responsible for its antiinflammatory, immunosuppressive (glucocorticoid), and saltretaining (mineralocorticoid) actions. Some actions may be undesirable, depending on drug use. Indication -Replacement therapy in adrenal cortical insufficiency - Allergic states severe or incapacitating allergic conditions - Hematologic disorders - Ulcerative colitis Contraindications Concentrations - Allergy to any component of the drug - Fungal infections - Amebiasis - Hepatitis B - Vaccinia or varicella - Antibiotic-resistant infections - Immunosuppression Precaution - Kidney disease - Liver disease - Cirrhosis - Hypothyroidism - Ulcerative colitis with impending perforation - Diverticulitis - Recent GI surgery - Active or latent peptic ulcer - Inflammatory bowel disease - Hypertension - Heart failure - Thromboembolic tendencies - Osteoporosis - Convulsive disorders - Metastatic carcinoma - Diabetes mellitus - TB - Lactation Adverse Reaction CNS: Vertigo, headache, paresthesias, insomnia, seizures, psychosis CV: Hypotension, shock, HPN and heart failure secondary to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias Dermatologic: Thin, fragile skin, petechiae, ecchymoses, purpura, striae, subcutaneous fat atrophy EENT: Cataracts, glaucoma, increased IOP Endocrine: Amenorrhea, irregular mens, growth retardation, decreased carbohydrate tolerance and DM, cushingoid state, HPA suppression systemic , hyperglycemia GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased appetite and weight gain Hematologic: Na and fluid retention, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy and loss of muscle mass, osteoporosis, spontaneous fractures Other: Immunosuppression, aggravation or masking of infections, impaired wound healing Nursing Responsibilities Before - Assess for contraindications. - Assess body weight, skin color, V/S, urinalysis, serum electrolytes, X-rays, CBC. - Arrange for increased dosage when patient is subject to unusual stress. - Do not give live vaccines with immunosuppressive doses of hydrocortisone. - Observe the 15 rights of drug administration. During - Give daily before 9am to mimic normal peak diurnal corticosteroid levels. - Space multiple doses evenly throughout the day. - Use minimal doses for minimal duration to minimize adverse effects. - Do not give IM injections if patient has thrombocytopenic purpura. - Taper doses when discontinuing high-dose or long-term therapy. After - Monitor client for at least 30 minutes. - Educate client on the side effects of the medication and what to expect. - Instruct client to report pain at injection site. - Instruct client to take drug exactly as prescribed. - Dispose of used materials properly. - Document that drug has been given.

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Drug Data Generic Name ceftriaxone Brand Name Forgram Dosage 1 gram in 1 vial distilled 30 cc wateer

Classification Cephalosporins

dissolve in 10mL water + of D5

Order: 900mg + 30cc D5 water Once a day ANST(-)

Mechanism of Action Works by inhibiting the mucopeptide synthesis in the bacterial cell wall. The beta-lactam moiety of Ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial cytoplasmic membrane. These enzymes are involved in cell-wall synthesis and cell division. By binding to these enzymes, Ceftriaxone results in the formation of of defective cell walls and cell death.

Indication Treatment of infections of the lower resp tract, acute bacterial otitis media, skin & skin structure infection, UTI, uncomplicated gonorrhea, pelvic inflammatory disease, bacterial septicemia, bone & joint infections, intraabdominal infections, meningitis.

Contraindications Hypersensitivity to cephalosporins. Hypersensitivity to lidocaine (IM inj)

Adverse Reaction Pain Induration Phlebitis Rash Diarrhea Thrombocytosis Leucopenia Glossitis Respiratory superinfections

Nursing Responsibilities Assess patients previous sensitivity reaction to penicillin or other cephalosphorins. Assess patient for signs and symptoms of infection before and during the treatment Obtain C&S before beginning drug therapy to identify if correct treatment has been initiated. Assess for allergic reaction. Monitor hematologic,electrolytes, renal and hepatic function. Assess for possible superinfection: itching fever, malaise, redness, diarhhea

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Drug Data Generic Name Aminophylline (theophylline ethylenediamide) Brand Name Corophyllin , Paladron , Phyllocontin, Somophyllin, Somophyllin-DF, Truphylline Order: 1cc of aminophylline + 3cc of distilled water IVTT every 6 hours

Classification BRONCHODILA TOR (RESPIRATORY SMOOTH MUSCLE RELAXANT); XANTHINE

Mechanism of Action Aminophylline is a salt of theophylline with effects similar to those of other xanthines (e.g., caffeine and theobromine). Action is dependent on theophylline content (approximately 80%) and is measured as theophylline in the serum.

Indication - To prevent and relieve symptoms of acute bronchial asthma and treatment of bronchospasm associated with chronic bronchitis and emphysema.

Contraindications Concentrations Hypersensitivity to xanthine derivatives or to ethylenediamine component; cardiac arrhythmias. Safety during pregnancy (category C) or lactation is not established. on

Adverse Reaction CNS: Nervousness, restlessness, depression, insomnia, irritability, headache, dizziness, muscle hyperactivity, convulsions. CV: Cardiac arrhythmias, tachycardia (with rapid IV), hyperventilation, chest pain, severe hypotension, cardiac arrest. GI: Nausea, vomiting, anorexia, hematemesis, diarrhea, epigastric pain

Nursing Responsibilities Monitor for S&S of toxicity (generally related to theophylline serum levels over 20 mg/mL). Observe patients receiving parenteral drug closely for signs of hypotension, arrhythmias, and convulsions until serum theophylline stabilizes within the therapeutic range. Note: High incidence of toxicity is associated with rectal suppository use due to erratic rate of absorption. Monitor & record vital signs and I&O. A sudden, sharp, unexplained rise in heart rate may indicate toxicity. Lab tests: Monitor serum theophylline levels. Note: Older adults, acutely ill, and patients with severe respiratory problems, liver dysfunction, or pulmonary edema are at greater risk of toxicity due to reduced drug clearance. Note: Children appear more susceptible to CNS stimulating effects of xanthines (nervousness, restlessness, insomnia, hyperactive reflexes, twitching, convulsions). Dosage reduction may be indicated.

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Drug Data Generic Name Cefuroxime Brand Name Ceftin Order: 450mg IVTT every 8 hour ANST(-)

Classification Therapeutic: Anti-infectives Pharmacologic: Second generation Cephalosporins Pregnancy Catergory B

Mechanism of Action Bind to bacterial cell wall membrane, causing cell death Therapeutic Effects: Bactericidal action

Indication - Treatment of It is effective for the treatment of penicillinaseproducingNeisseria gonorrhoea(PPNG). Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/tonsilliti s, sinusitis, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection.

Contraindications Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Adverse Reaction GI: Diarrhea, nausea, antibioticassociated colitis. Skin: Ra sh , pruritus, urticaria. Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance. Hemat: Hemolytic anemia MISC: Anaphylaxis

Nursing Responsibilities Before: Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated. Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance. During: Inspect IM and IV injection sites frequently for signs of phlebitis. Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly. Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes. Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy. After: Instruct patient to take medication around the clock at evenly spaced times and to finish the medication completely, even if feeling better Advise patient to report signs of superinfection and allergy Instruct patient to notify health professional if fever and diarrhea develop

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Drug Data

Classification

Mechanism of Action

Indication

Contraindications

Adverse Reaction

Nursing Responsibilities

Generic Name Oxacillin sodium Brand Name Bactocill Order: 450mg IVTT every 6 hours ANST(-)

Penicillinaseresistant penicillins

Bactericidal: Inhibits cell wall synthesis of sensitive organisms, causing cell death. TE: Kills susceptible bacteria.

- Treatment of infections due to penicillinaseproducing staphylococci.

Contraindicated with allergies to penicillins, cephalosphorins or other allergens.

CNS: lethargy, hallucinations, seizures GI: glossitis, stomatitis, GU: nephritis, hematuria, azotemia Hemat: anemia, thrombocytopenia Local: pain

Culture infection before treatment; reculture if response is not as expected. Continue therapy for at least 2 days after infection has disappeared, usually 710 days. Institute seizure precautions. Instruct patient to report DOB, nausea and mouth sores. Monitor vital signs, electrolytes and renal function studies. Encourage or provide regular oral hygiene. Prepare the patient for urine studies.

Drug Data Generic Name Ipratropium + salbutamol Brand Name Combivent Order: 1 neb every 4 hours

Classification Anticholinergic

Mechanism of Action The ipratropium ingredient is an anticholinergic drug which relaxes smooth muscle in the lung. The salbutamol ingredient is a beta-2 agonist which stimulates beta-2 sites in the lungs to relax the bronchi. TE: Relieves bronchospasms.

Indication Bronchodilator for maintenance therapy of bronchospasm

Contraindications Contraindicated with hypersensitivity to atropine or its derivatives.

Adverse Reaction CNS: dizziness, blurred vision GI: nausea, dry mouth Respi: dyspnea, bronchospasms, horseness CV: palpitations, chest pain

Nursing Responsibilities Monitor the patients vital signs, noting hypotension and an irregular or abnormal pulse. Maintain a quiet, comfortable environment to minimize anxiety and perhaps decrease palpitations. Teach the patient pursedlip breathing, diaphragmatic breathing, and chest splinting.

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Drug Data Generic Name Paracetamol Brand Name Tylenol Order: 120mg/5ml every 4 hours

Classification Analgesics ( Non-opioid) Antipyretics

Mechanism of Action Paracetamol may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of morphine is believed to involve decreased permeability of the cell membrane to sodium, which results in diminished transmission of pain impulses therefore analgesia.

Indication Temporary relief of pain and discomfort from headache, fever, cold, flu, minor muscular aches, overexertion, menstrual cramps, toothache, minor arthritic pain.

Contraindications

Adverse Reaction Hematologic: hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia. Hepatic: liver damage, jaundice Metabolic: hypoglycemia Skin: rash, urticuria

Nursing Responsibilities . Assess patients pain or temperature before therapy and regularly thereafter. (Students Drug Handbook, 2009: 101) 2, Asses patients drug history and calculate total daily dosage accordingly. (Students Drug Handbook, 2009: 101) 3. Be alert for signs of reactions and drug interactions. (Students Drug Handbook, 2009: 101) 4. Assess patients and familys knowledge of drug therapy. (Students Drug Handbook, 2009: 101)

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Name of Drug Brand name:

Classification Anticonvulsant

Mechanism of Actions Cofactor of many enzyme

Indications IV or IM:

Contraindications Contraindicated

Adverse Effects / Side Effects SLE: syndrome

Nursing Responsibility Assess possibility for

magnesium sulfate Dosage/Route/ Frequency 2.5g through IV 5g through IM at each buttocks q6o

systems involved in neurochemical transmission and muscular excitability; prevents or controls seizures by blocking neuromuscular transmission; attracts and retains water in the intestinal lumen and distends bowel to promote mass movement and relieve constipation

preeclampsia or eclampsia To correct or prevent hypomagnesemia in patients or parenteral nutrition

with allergy to magnesium products; heart block, myocardial damage; fecal impaction, intestinal and biliary tract obstruction, Do not give during 2 hours preceding delivery because of risk of magnesium toxicity to the neonate

joint-swelling, fever) reaction, anemia, agranulocytosis, hepatitis, glomerulonephritis, acute renal failure.

interactions w/ other drugs or herbal products the patient may be taking especially anything that may impact blood pressure before start treatment. Monitor patients closely during and following infusions. Observe orthostatic precautions.

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