Medication Indication Mechanism of action Contraindication Side effects / Adverse

effects
Nursing Responsibilities
Meropenem
trihydrate
(Meropen)

Classification:
antibacterial

Dosage: 1 gm
IV q 8h
Treatment of:
Intra-abdominal
infections.
Binds to bacterial
cell wall, resulting
in cell death.
Meropenem
resists the actions
of many enzymes
that degrade
most other
penicillins and
penicillin like anti-
infective.
Hypersensitivity

CNS: seizures,
dizziness, headache
Resp: apnea,
GI: constipation,
diarrhea, nausea,
vomiting
Derm: rash
Local: inflammation at
injection site, phlebitis
Misc: allergic
reactions including
Anaphylaxis
Assess patient for previous sensitivity reaction to
carbapenems.
Assess patient for signs and symptoms of infection,
including characteristics of wounds, sputum, urine,
stool
Complete C/S tests before beginning drug therapy
Assess for allergic reactions, anaphylaxis
Identify urine output
Monitor blood studies
Monitor electrolytes
Assess bowel pattern daily
Monitor for bleeding

Precautions:
Pregnancy, lactation, renal disease, elderly
Paracetamol
(Tempra)

Classification:
antipyretic,
analgesic

Dosage: 1 cap
q4 PRN for
temp. > 38C
Relief of mild-to-
moderate pain;
treatment of fever.
Decreases fever by
inhibiting the
effects of pyrogens
on the
hypothalamus
heat regulating
centers & by a
hypothalamic
action leading to
sweating &
vasodilatation.
Relieves pain by
inhibiting
prostaglandin
synthesis at the
CNS but does not
have anti-
Hypersensitivit
y
Contraindicate
d with allergy
to
acetaminophen
Stimulation
Drowsiness
nausea, vomiting
abdominal pain
hepatotoxicity
hepatic
seizure(overdose,
Renal failure(high,
prolonged doses)
leucopenia
neutropenia
hemolytic anemia
(long term use)
thrombocytopenia
rash
urticaria
Assess patients fever or pain: type of pain, location,
intensity, duration, temperature, and diaphoresis.
Assess allergic reactions: rash, urticaria; if these occur,
drug may have to be discontinued.
Teach patient to recognize signs of chronic overdose:
bleeding, bruising, malaise, fever, sore throat.
Tell patient to notify prescriber for pain/ fever lasting
for more than 3 days.
inflammatory
action because of
its minimal effect
on peripheral
prostaglandin
synthesis.
cyanosis
anemia
jaundice
Azithromycin
(Zithromycin)


Classification:
antibiotic

Dosage: 500
mg 1/2 tab BID
Treatment of
lower
respiratory
infections:
Acute bacterial
exacerbations
of COPD due
to
Haemophilus
influenzae,
Moraxella
catarrhalis,
Streptococcus
pneumoniae;
community-
acquired
pneumonia
due to S.
pneumoniae,
H. influenzae

Azithromycin
blocks
transpeptidation
by binding to 50s
ribosomal subunit
of susceptible
organisms and
disrupting RNA-
dependent protein
synthesis at the
chain elongation
step.

Contraindicate
d with
hypersensitivit
y to
azithromycin,
erythromycin,
or any
macrolide
antibiotic.
Use cautiously
with gonorrhea
or syphilis,
pseudomembr
anous colitis,
hepatic or
renal
impairment,
lactation.

Mild to moderate
nausea, vomiting
abdominal pain
dyspepsia
flatulence
diarrhea
cramping
angioedema
jaundice
dizziness
headache
vertigo
somnolence
transient elevations
of liver enzyme
values.

History: Hypersensitivity to azithromycin,
erythromycin, or any macrolide antibiotic; gonorrhea
or syphilis, pseudomembranous colitis, hepatic or renal
impairment, lactation
Physical: Site of infection; skin color, lesions;
orientation, GI output, bowel sounds, liver evaluation;
culture and sensitivity tests of infection, urinalysis,
LFTs, renal function tests
Culture site of infection before therapy.
Administer on an empty stomach 1 hr before or 23 hr
after meals. Food affects the absorption of this drug.
Prepare Zmax by adding 60 mL water to bottle, shake
well.
Counsel patients being treated for STDs about
appropriate precautions and additional therapy.
Take the full course prescribed. Do not take with
antacids. Tablets and oral suspension can be taken
with or without food.
Report severe or watery diarrhea, severe nausea or
vomiting, rash or itching, mouth sores, vaginal sores.

Fenoterol
(Bendual)

Classification:
Reversible airways
obstruction
Fenoterol is a direct-
acting
sympathomimetic
agent with
Hypertrophic
obstructive
cardiomyopathy;
tachyarrhythmia;
Fine tremor of
skeletal muscle,
palpitations,
tachycardia,
Check inhaler technique.
Ensure that patients are able to correctly use the
delivery device for their medication and consider use
Antiasthmatic

Dosage: 1 neb
q6h
predominant -
adrenoceptor
stimulant activity
largely selective for 2-
receptors.
hypersensitivity. nervous tension,
headaches,
peripheral
vasodilatation,
muscle cramps
(rare), cough, local
irritation,
paradoxical
bronchoconstriction
, sweating,
weakness.

of a space if appropriate.
If administering by nebulizers use a mouthpiece rather
than face mask.
If administered by nebulizer the dilution of the solution
should be adjusted according to equipment and length
of administration.
Paradoxical bronchospasm has occurred with
nebulized solution, therefore first dose should be used
under medical supervision.
Evaluate therapeutic response.
Advise patients not to exceed the prescribed dose.
Rinse mouth after each use of the inhaler.
Frequent drinks and the use of sugar-free gum can
help with dry mouth.
Seek medical attention if more than the usual dosage is
required.
Keep delivery devices clean and dry.
Take a missed dose as soon as remembered unless it is
almost time for the next dose. Do not take a double
dose.
Avoid getting in eyes.
Acetylcysteine
(Fluimucil)

Classification:
mucolytic

Adjuvant therapy
in patients with
abnormal, viscid,
or inspissated
mucous secretions
in acute and
Acetylcysteine
probably acts by
disrupting disulfide
linkages of
mucoproteins in
purulent and
Hypersensitivity Stomatitis
nausea, vomiting
fever
rhinorrhea
drowsiness
clamminess
During IV infusion, carefully monitor for fluid overload
and signs of hyponatremia (i.e., changes in mental
status).
Monitor for S&S of aspiration of excess secretions, and
for bronchospasm (unpredictable); withhold drug and
notify physician immediately if either occurs.
Dosage: 200
mg 1/2 sachet
+ 50 cc H2O
BID
chronic
bronchopulmonary
diseases, and in
pulmonary
complications of
cystic fibrosis and
surgery,
tracheostomy, and
atelectasis. Also
used in diagnostic
bronchial studies
and as an antidote
for acute
acetaminophen
poisoning.
nonpurulent
secretions.
chest tightness
Broncho
constriction.
Lab tests: Monitor ABGs, pulmonary functions and
pulse oximetry as indicated.
Have suction apparatus immediately available.
Increased volume of respiratory tract fluid may be
liberated; suction or endotracheal aspiration may be
necessary to establish and maintain an open airway.
Older adults and debilitated patients are particularly at
risk.
Nausea and vomiting may occur, particularly when face
mask is used, due to unpleasant odor of drug and
excess volume of liquefied bronchial secretions.
Patient & Family Education
Report difficulty with clearing the airway or any other
respiratory distress.
Report nausea, as an antiemetic may be indicated.
Note: Unpleasant odor of inhaled drug becomes less
noticeable with continued use.
Do not breast feed while taking this drug without
consulting physician.
Repamipide
(Mucopro)

Classification:
Antacids,
Antireflux
Agents &
Antiulcerants

Dosage: 1 tab
tid
Treatment of PUD,
gastric mucosal
lesions in acute &
chronic gastritis
concomitantly w/
anti-secretory
agents. Prevention
of NSAID-induced
gastropathy.
Rebamipide is a
mucosal protective
agent and is
postulated to increase
gastric blood flow,
prostaglandin
biosynthesis and
decrease free oxygen
radicals.
Hypersensitivity Rash, pruritus &
eczematous drug
eruption.
GI: Rarely, dry
mouth,
constipation,
sensation of
abdominal
enlargement,
diarrhea, nausea,
vomiting,
heartburn,
Monitor for resolution of GI symptom
Assess CBC in liver function tests
Assess constipation
Monitor electrolytes levels as appropriate
abdominal pain &
belching.
Lactulose
(Lilac)

Classification:
hyperosmotic
laxative

Dosage: 25 mg
2 tabs OD
Constipation,
salmonellosis.
Treatment of
hepatic
encephalopathy.
Lactulose promotes
peristalsis by
producing an osmotic
effect in the colon with
resultant distention. In
hepatic
encephalopathy, it
reduces absorption of
ammonium ions and
toxic nitrogenous
compounds, resulting
in reduced blood
ammonia
concentrations.
Patients who
require a low
lactose diet; with
galactosemia or
disaccharide
deficiency; with
intestinal
obstruction.
GI: Flatulence,
belching, abdominal
cramps, pain, and
distention (initial
dose); diarrhea
(excessive dose);
nausea, vomiting,
colon accumulation
of hydrogen gas;
hypernatremia.
Assessment
Assess patients condition before therapy and reassess
regularly thereafter to monitor drugs effectiveness.
Assess lifestyle in relation to fluids, bulk and exercise
for patient with hepatic encephalopathy, regularly
assess mental condition (clearing of confusion,
lethargy, restlessness, irritability) and ammonia level
(30-70 mg/100 mL).
Monitor for possible adverse GI reaction.
Monitor fluid and electrolyte status: urine output,
input-output ratio to identify fluid loss, hypokalemia
and hypernatremia.
Monitor for increased glucose levels in diabetic
patients.
Assess patients and familys knowledge of drug
therapy.
Implementation
Advice patient to dilute drug with juice or water or
take with food to improve taste
Teach patient that normal bowel movements do not
always occur daily and that adequate fluid
consumption is necessary Inform patient of possible
adverse effects and the need to notify physician
immediately if these occurs.
Remind patient not to use in presence of abdominal
pain, nausea and vomiting. Instruct patient to notify
physician if constipation is unrelieved or symptoms of
electrolyte imbalance occur; muscle cramps, pain,
weakness, dizziness and excessive thirst Inform patient
that bowel tone may be lost if used as laxative for long
term therapy.
Do not give at bedtime because it may interfere with
sleep.
Inform patient that diarrhea may indicate over dosage.