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DRUG STUDY
Drug#1
Date ordered: 1-12-2010
Generic Name: Tramadol HCl
Brand Name: Dolcet
CIassification: Analgesic (opioid), central analgesic
Indications: Management of moderate or moderately severe pain
Contraindications: Hypersensitivity, acute intoxication with any CNS depressant.
ActuaI Dosage: 50 mg 1 tab PRN for pain
Mechanism of action: Not completely understood, binds to opioid receptors and
inhibits reuptake of norepinephrine, serotonin; does not cause histamine release or
affect heart rate.
Adverse reactions:
CNS: Dizziness, CNS stimulation, somnolence, headache, anxiety, confusion, euphoria.
CV: Vasodilation, orthostatic hypotension, tachycardia, hypertension, abnormal ECG
GI: Nausea, constipation, vomiting, dry mouth, diarrhea, abdominal pain, anorexia,
flatulence, G bleeding
GU: Urinary retention/frequency, menopausal, symptoms, dysuria, menstrual disorder
INTEG: Pruritus, rash, urticaria, vesicles
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Assess the duration, location, onset and type of pain the patient is experiencing
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W Monitor the patient's blood pressure and pulse.

W Offer the patient cola and dry crackers to relieve nausea, sips of tepid water to
help relieve dry mouth.
W Monitor pattern of daily bowel activity and stool consistency.
W Warn the pt to notify he physician if he or she experiences chest pain, difficulty in
breathing, excessive sedation, muscle weakness, palpitation, seizures, severe
constipation or tremors.
RationaIe: This drug was given since the client experience severe flank pain Left
radiating to the right.

Drug#2
Date ordered: 1-12-2010
Generic Name: Ferrous sulfate
Brand Name: Fortifer Fa
CIassification: Antianemics
Indications: Prevention & treatment of ron deficiency & nutritional anemia. Folate
deficiency in pregnant women and for the prevention of neural tube defects in infants.
Contraindications: Hypersensitivity, ulcerative colitis/regional enteritis,
hemosiderosis/hemochromatosis, peptic ulcer disease, hemolytic anemia, cirrhosis.
ActuaI Dosage: 1 tab OD
Mechanism of action: Replaces iron stores needed for red blood cell development,
energy and O
2
transport;sulfate contains 20 % elemental iron; iron,30%; ferrous sulfate
exsiccated.
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Adverse reactions:
GI: Nausea, constipation, epigastric pain, black and red tarry stools; vomiting, diarrhea.
INTEG: Temporarily discolored tooth enamel and eyes.
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Monitor blood studies; Hct, Hgb, reticulocytes, bilirubin before treatment, at least
monthly.
W Give between meals for best absorption; may give with juice.
W nstruct the client not to crush or chew tabs.
W Store in airtight, light-resistant container.
W Advise the patient that iron will make stools black or dark green.
W Caution the patient to avoid reclining position for 15-30 mins after taking drugs to
avoid esophageal erosion; to follow diet high in iron.
RationaIe: This drug was given since the patient has decrease hematocrit (0.36
volume %) and haemoglobin count (119g/L) which may indicate anemia.

Drug#3
Date ordered: 1-13-2010
Generic Name: Potassium Citrate
Brand Name: Acalka
CIassification: Antiurolithic
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Indications: -Treatment of patients with renal lithiasis and hypocitraturia, chronic

formers of calcium oxalate, phospate calculia.
- Uric acid lithiasis alone or accompanied by calcium lithiasis
Contraindications: Renal disease (severe), severe hemolytic disease, Addison's
disease, hyperkalemia, acute dehydration, extensive tissue breakdown.
ActuaI Dosage: 1 tab OD
Mechanism of action: Needed for adequate transmission of nerve impulses and
cardiac contraction, renal function, intracellular ion maintenance.
Adverse reactions:
CNS: Confusion
CV: Bradycardia, cardiac depression, dysrhythmias, arrest,
GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel
GU: Oliguria
INTEG: Cold extremities, rash
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Monitor potassium level during treatment (3.5 to 5.0 mg/dL is normal level)
W Monitor and O ratio; watch for decreased urinary output; notify prescriber
immediately; check urinary pH in patients receiving the drug as urinary acidifier.
W Assess cardiac status: rate and rhythm.
W The tablets must not be masticated or diluted.
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W Must not be administered to patients receiving potassium-sparing diuretics

(traimterene, spirolactone, or amyloride).
W nstruct the patient to follow a diet w/o salt and increase the intake of fluids.
RationaIe: This drug was given to treat and prevent formation of urinary calculi since
the ultrasound result of the patient shows that she has pelvolithiasis with moderate
hydronephrosis left (1.9cm).

Drug#4
Date ordered: 1-13-2010
Generic Name: Pinene alpha + beta, Camphene, Cineol, Fenchone, Borneol, Anethol
and Olive Oil
Brand Name: Rowatinex
CIassification: Antiurolithic
Indications: For the treatment of urinary tract spasm and inflammation associated with
urolithiasis. Cystitis, renal colic, UT, post-op prophylaxis of calculi. Assists in the
dissolution and expulsion of stones in the renal system.
Contraindications: 1st trimester of pregnancy.
ActuaI Dosage: 2 cap TD
Mechanism of action: Promotes a diuresis and relaxes urinary tract spasm, thus
assisting the passage of stones. The therapeutic effect of the balanced combination of
terpenes reduces urinary tract inflammation, stimulating renal blood flow through the
kidneys and increasing the output of less concentrated urine.
Adverse reactions: No side effects have been reported.
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Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Liquid intake should be increased during therapy.
W Store at temperatures not exceeding 30 degrees Celcius.
RationaIe: This drug was given to treat and prevent formation of urinary calculi since
the ultrasound result of the patient shows that she has pelvolithiasis with moderate
hydronephrosis left (1.9cm).

Drug#5
Date ordered: 1-29-2011
Generic Name: Cefuroxime
Brand Name: Zinacef
CIassification: Antibiotic, 2
nd
Generation Cephalosporins
Indications: Susceptible infections, Respiratory Tract nfections, Surgical prophylaxis
and Urinary Tract nfections caused by Escherichia coli and Klebsiella spp
Contraindications: Hypersensitivity to cephalosporins.
ActuaI Dosage: 750mg/vial ANST (-) slow V q8 hours
Mechanism of action: Chemical effect: nhibits cell-wall synthesis promoting osmotic
instability; usually bactericidal.
%herapeutic effect: Hinders or kills susceptible bacteria, including many gram-positive
organisms and enteric gram-negative bacilli.
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Adverse reactions:
CNS: Dizziness, headache, fatigue, paresthesia, fever, chills, confusion
GI: Diarrhea, nausea, vomiting, anorexia, stomach cramps, colitis, jaundice, heartburn
GU: Vaginitis, pruritus, candidiasis, renal failure, dysuria
HEMA: Leukopenia, thrombocytopenia, anemia, neutropenia, eosinophilia
INTEG: Rash, urticaria, dermatitis
Respi: dyspnea
Syst: Anaphylaxis, superinfection
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Be alert for adverse reactions and drug interactions.
W f adverse G reactions occur, monitor patient's hydration.
W Educate patient to take drug exactly as prescribed, even after he feels better.
W Tell patient to report adverse reactions.
W Check the patency of the V line.
W Check the site for inflammation or dislodged V.
W Regulate VF at a prescribed rate, as ordered.
W Give VTT slowly.
RationaIe: This drug is given to the patient to treat or manage respiratory and urinary
tract infection.


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Drug#6
Date ordered: 1-29-2011
Generic Name: Ambroxol
Brand Name: Mucosolvan
CIassification: Mucolytic
Indications: Respiratory tract diseases associated w/ abnormal bronchial secretions,
particularly in exacerbations of asthmatic bronchitis & chronic bronchitis, bronchial
asthma; pre- & post-op treatment
Contraindications: Hypersensitivity, saying disease stomach and duodenal ulcers,
pregnancy and breastfeeding.
ActuaI Dosage: 15 mg/5mL 1 tsp PO TD after meals
Mechanism of action: Acts like detergent by liquefying and loosening thick mucus
secretions so they can be expectorated.
Adverse reactions:
GI: nausea, stomach discomfort, anorexia, stomachache, and diarrhea are occasionally
reported.
INTEG: Rash.
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Obtain history of allergies on said medication.
W Monitor for signs and symptoms of aspiration of excess secretions and for
bronchospasm.
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W Teach the patient to report difficulty with clearing the airway or any other
respiratory distress.
RationaIe: This drug is given to the patient to help loosen thick secretions which so that
it can be expectorated.


Drug#7
Date ordered: 1-31-2011
Generic Name: Fluticasone/Salmeterol
Brand Name: Seretide 250 Diskus
CIassification: long acting
2
-agonist, corticosteroid, inhalation, antiasthmatic
Indications: Regular treatment of reversible obstructive airways disease (ROAD),
including asthma where use of combination therapy (bronchodilator & inhaled
corticosteroid) is appropriate. Maintenance treatment of COPD including chronic
bronchitis & emphysema.
Contraindications: Hypersensitivity primary treatment in status asthmaticus.
ActuaI Dosage: 1 puff 2x a day gargle water after each puff
Mechanism of action: Salmeterol, a long acting
2
-agonist which acts locally in the
lung to mediate bronchodilation. Fluticasone, a corticosteroid with mainly glucocorticoid
activity, reduce symptoms and exacerbations of asthma
Adverse reactions:
CNS: Tremor, headache
CV: palpitations &, cardiac arrhythmias
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GI: candidiasis of mouth & throat, oropharyngeal irritation

RESPI: Hoarseness, paradoxical bronchospasm
OTHER: hypersensitivity reactions
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Assess respiratory status: lung sounds, pulmonary function tests during and
several months after change from systemic to inhalation corticosteroid.
W Monitor adrenal function tests periodically: hypothalamic-pituitary-adrenal axis
suppression in long-term treatment.
W Give at 1 minute intervals.
W Advise patient to use bronchodilator first before using inhalation, if taking both.
RationaIe: This drug is given to the patient to manage or treat asthma attack that
causes bronchospasm.

Drug#8
Date ordered: 1-29-2011
Generic Name: pratropium bromide and Albuterol sulfate
Brand Name: Combivent
CIassification: Anticholinergic, bronchodilator, adrenergic
2
-agonist, sympathomimetic
Indications: Bronchodilatation during bronchospasm for patients with COPD.
Prevention of exercise-induced asthma, bronchitis, emphysema, bronchoectasis,
reversible airway obstruction.
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Contraindications: Hypersensitivity to this product, atropine, soya lecithin.

ActuaI Dosage: 1 neb + VSS 3cc q 8 hours only during waking hours.
Mechanism of action: nhibits interaction of acetylcholine at receptor sites on the
bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate
(cGMP) and bronchodilatation.
Adverse reactions:
CNS: Anxiety, dizziness, headache, nervousness,
CV: Palpitations
EENT: Dry mouth, blurred vision
ENTEG: Rash
RESP: Cough, worsening of symptoms, bronchospasm
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Monitor respiratory function: vital capacity, FEV, ABGs, lung sounds, heart rate,
rhythm (baseline during treatment).
W Monitor for evidence of allergic reactions, paradoxic bronchospasm; withhold
dose and notify prescriber.
W Use solution in nebulizer with a mouthpiece rather than a facemask.
W Give this medication before other medications and allow at least 5 min between
each.

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RationaIe: This drug is given to promote bronchodilation during bronchospasm since

the patient has lower respiratory tract infection.

Drug#9
Date ordered: 1-29-2011
Generic Name: Etoricoxib
Brand Name: Arcoxia
CIassification: Nonsteroidal Anti-inflammatory Drugs (NSADs)
Indications: For the treatment of rheumatoid arthritis, osteoarthritis, ankylosing
spondylitis, chronic low back pain, acute pain and gout.
Contraindications: nflammatory bowel disease, severe congestive heart failure, active
peptic ulceration, cerebrovascular disease and lactation
ActuaI Dosage: 1 tab PO
Mechanism of action: Selectively inhibits isoform 2 of cyclo-oxigenase enzyme (COX-
2). This reduces the generation of prostaglandins (PGs) from arachidonic acid.
Adverse reactions:
CNS: dizziness, nervousness, depression, headache, drowsiness, insomnia, vertigo,
tinnitus, photosensitivity, paraesthesia
CV: ischemic cardiac events, hypertension, chest pain
GI: G disorders, dry mouth, taste disturbance, mouth ulcers; appetite and weight
changes
HEMA: blood disorders
GU: fluid retention, Renal toxicity
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Other: hypersensitivity reactions

Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W nstruct client to avoid alcohol and maintain adequate hydration (2-3 L/day of
fluids) unless instructed to restrict fluid intake.
W Monitor for signs of pain relief, such as an increased appetite and activity
W Give drug with food if G upset occurs.
W Discontinue drug if hypersensitivity reactions occur.
W Do not exceed the recommended dosage.

RationaIe: This drug is given since the patient since the patient experienced flank pain.

Drug#10
Date ordered: 1-30-2011
Generic Name: Paracetamol
Brand Name: Not specified
CIassification: Antipyretic , Analgesic (nonopioid)
Indications: antipyretic in patients with aspirin allergy, hemostatic disturbances,
bleeding diatheses, upper G disease, gouty arthritis
Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically
significant antirheumatic and anti-inflammatory effects)
Common cold, flu, other viral and bacterial infections with pain and fever
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Contraindications: with allergy to acetaminophen.

Use cautiously with impaired hepatic function, chronic alcoholism.
ActuaI Dosage: 250mg/5ml 8ml for fever q 4-6 hours /300mg (1amp) slow VTT PRN q
4-6 hours
Mechanism of action: Reduces fever by acting directly on the hypothalamic heat-
regulating center to cause vasodilation and sweating, which helps dissipate heat.
Analgesic: Site and mechanism of action unclear.
Adverse reactions:
CNS: Headache
CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested
daily for several weeks or when doses of 4 g/day are ingested for 1 yr
GI: Hepatic toxicity and failure, jaundice
GU: Acute kidney failure, renal tubular necrosis
HematoIogic: Methemoglobinemiacyanosis; hemolytic anemiahematuria, anuria;
neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia
Hypersensitivity: Rash, fever
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Do not exceed the recommended dosage.
W Avoid using multiple preparations containing acetaminophen. Carefully check all
OTC products.
W Discontinue drug if hypersensitivity reactions occur.
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W Treatment of overdose: Monitor serum levels regularly, N-acetylcysteine should

be available as a specific antidote; basic life support measures may be
necessary.
Teaching Point:
W Do not take for longer than 10 days.
W Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
W Avoid the use of other over-the-counter preparations. They may contain
acetaminophen, and serious overdosage can occur. f you need an over-the-
counter preparation, consult your health care provider
W Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in
voiding patterns.
RationaIe: This drug was given since the client was experiencing fever.

Drug#11
Date ordered: 1/30/2011
Generic Name: Azithromycin
Brand Name: Zithromax
CIassification: Macrolide Antibiotic
Indications: Treatment for lower respiratory tract infection: Community-acquired
pneumonia due to S. pneumonia, H. influenza.
Contraindications: Hypersensitivity to azithromycin, erethromycin, or macrolide
antibiotic. Use cautiously with gonorrhea or syphilis, pseudomembranous colitis, hepatic
or renal impairment and lactation.
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ActuaI Dosage: 250mg/5ml 2 tsp OD (2 hours after lunch)

Mechanism of action: Bacteriostatic or bactericidal in susceptible bacteria.
Adverse reactions:
CNS: dizziness, headache, vertigo, samnolence
GI: diarrhea, abdominal pain, nausea, dyspepsia
Other: Superinfection,angioedema, rash, vaginitis
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy
W Take the full course prescribed. Do not take with antacids. Oral suspension can
be taken with or without food.
W nstruct patient that she may experience these side effects: stomach cramping,
discomfort, diarrhea, fatigue and headache.
W Report severe or watery diarrhea, severe nausea, or vomiting, rash or itching,
mouth sores and vaginal sores.
RationaIe: This drug is given as a treatment for pneumonia since the patient's chest PA
result implies that she has pneumonia.

Drug#12
Date ordered: 1-31-2011
Generic Name: Raloxifene Hydrochloride
Brand Name: Evista
CIassification: Selective estrogen receptor modulator
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Indications: Treatment and prevention of osteoporosis in postmenopausal women

Contraindications: Active or history of venous thromboembolic events, such as deep
vein thrombosis, pulmonary embolism and retinal vein thrombosis, pregnancy, those
who may become pregnant.
ActuaI Dosage: 60mg 1 tab OD
Mechanism of action: A selective estrogen receptor modulator that affects some
receptor as estrogen.
%herapeutic effect: Like estrogen, prevents bone loss and improves lipid profile.
Adverse reactions:
CNS: depression, insomnia, vertigo, neuralgia, hypoesthesia
CV: venous thromboembolism
DERMA: hot flashes, skin rash
GI: nausea, vomiting, food distaste,
GU: vaginal bleeding, vaginal discharges
OTHERS: Peripheral edema
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
W Assess pt's and family's knowledge about drug therapy.
W Administer without regard to food.
W Arrange for periodic blood counts during therapy.
W Take drug as prescribed.
W nstruct the patient that she may experience these side effects (bone pain; hot
flashes, nausea, vomiting, weight gain, dizziness, headache)
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W Report marked weaknesses, sleepiness, mental confusion, pain or swelling of

the legs, shortness of breath and blurred vision.
RationaIe: This drug is given to the patient to return calcium in the bone and prevent
accumulation of excess calcium in the blood which contributes in the formation of renal
calculi.

Drug#13
Date ordered: 1-31-2011
Generic Name: Docusate Na
Brand Name: otosol
CIassification: unc. Class:Laxative, emollient
Chem. Class: Anionic surfactant
Indications: Removal ear wax
Contraindications: Perforated eardrum; ear inflammation.
ActuaI Dosage: 3 drops TD left ear
Mechanism of action: Cerumenolytic, because of its low surface tension and its water
solubility, rapidly penetrates the dry matrix of the wax which can then be syringed away
readily, or in less severe and in persistent cases, is ejected by normal physiological
processes.
Adverse reactions:
INTEG: skin rash, itching/burning/redness/swelling or pain in or around the ears.
Nursing ResponsibiIities:
W Observe the 12 rights in drug administration
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W Assess pt's and family's knowledge about drug therapy

W Use unless otherwise directed by the doctor.
W Let the patient lie on the side, with the affected ear uppermost, turning the head
sideways slightly towards the surface on which the patient is lying. With the
dropper in the cap, fill the ear canal with Otosol.
W Let the patient stay in this position for 4 or 5 min then insert a cotton wool plug. f
the other ear is affected, repeat for that ear the same way.
W nstruct the patient apply Otosol for 2 consecutive nights, which should be
immediately before an appointment with a doctor.
W nstruct the client to report skin rash, itching/burning/redness/swelling or pain in
or around the ears.
RationaIe: This drug is given to serve as a treatment for condition that involves use of a
wax softening agent (cerumenolytic) to disperse the cerumen.