University of the Philippines The Health Sciences Center COLLEGE OF NURSING Sotejo Hall, Pedro Gil Street, Manila

Drug Study DRUG ORDER (Generic name, Dosage, Route, Frequency, etc.) Amphotericin B 0.15 cc + 1.35 cc D5W OD

PHARMACOLOGI C ACTION OF DRUG

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS OF THE DRUG

DESIRED ACTION ON THE CLIENT

NURSING RESPONSIBILITIES /PRECAUTIONS

Increased cell membrane permeability in susceptible organisms by binding sterols in fungal membrane; decreases potassium, sodium and nutrients in the cell

Indications: Treatment of severe, possibly fatal fungal infections Contraindications: Hypersensitivity Severe bone marrow depression

CNS: headache, fever, chills, peripheral nerve pain, paresthesias, peripheral neuropathy, seizures, dizziness EENT: tinnitus, deafness, diplopia, blurred vision GI: nausea, vomiting, anorexia, diarrhea, cramps, hemorrhagic gastroenteritis, acute liver failure GU: hypokalemia, axotemia, hyposthenuria, renal tubular acidosis, nephrocalcinosis, permanent renal impairment, anuria, oliguria Blood: normochromic and normocytic anemia, thrombocytopenia, agranulocytosis, leucopenia, eosinophilia, hypokalemia, hyponatremia, hypomagnesemia Integumentary: burning, irritation, pain, necrosis at inj site with extravasation, flushing, dermatitis, skin

Treat fungal infection

Monitor VS q1530 min during first inf; note changes in pulse, BP. Monitor blood studies Monitor weight weekly; if weight increases 2lb/wk, edema is present; renal damage should be considered. Monitor for renal toxicity; increasing BUN and serum creatinine Monitor for hepatotoxicity; increasing AST, ALT, alkaline phophatase Monitor for allergic reaction Monitor for hypokalemia

rash MS: athralgia, myalgia, generalized pain, weakness, weight loss Meropenem 30 mg IV q12h Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells and bursts from osmotic pressure Indications: For serious infections caused by gram-positive or gram-negative organisms Contraindications: Hypersensitivity to meropenem or imipenem CNS: fever, somnolence, seizures, dizziness, weakness, headache, myoclonia CV: hypotension, palpitations GI: diarrhea, nausea, vomiting, pseudomembraneous colitis, hepatitis, glossitis Blood: eosinophilia, neutropenia, decreased Hgb, Hct Integumentary: rash, urticaria, pruritus, pain at inj site, phlebitis, erythema at inj site RESP: chest discomfort, dyspnea, hyperventilation Treat bacterial infection

Precautions: Pregnancy, renal disease, lactation 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

Furosemide 0.65 mg IV OD

Acts on the ascending loop of Henle in the kidney; inhibiting reabsorption of electrolytes sodium and chloride, causing excretion of sodium, calcium, magnesium, chloride, water and some potassium

Indications: Edema in CHF, nephritic syndrome, ascites Contraindications: Hypersensitivity to sulfonamides Anuria, hypovolemia, infants, lactation, electrolyte depletion

CNS: headache, fatigue, weakness, vertigo, paresthesias CV: orthstatic hypotension, chest pain, ECG changes, circulatory collapse EENT: loss of hearing, ear pain, tinnitus, blurred vision ELECTROLYTES: hypokalemia, hypochloremic alkalosis, hypoagnesemia, hyperuricemia ENDO: hyperglycemia GI: nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, pancreatitis GU: polyuria, reanl failure, glycosuria HEMA: thrombocytopenia, agranulocytosis, leucopenia, anemia INTEG: rash, pruritus, purpura, sweating, photosensitivity, urticaria MS: cramps, stiffness

Increase patients urine output

Assess patient for tinnitus, hearing loss, ear pain Monitor for renal, cardiac, neiurologic, GI, pulmonary manifestation of hypokalemia: acidic urine, decreased urine osmolality, nocturia, polyuria and polydipsia Monitor for CNS, GI, cardiovascular, integumentary, neurologic manifestations of hypocalcemia: personality changes, anxiety, disturbances Monitor for manifestations of hyponatremia Monitor electrolytes

Ciprofloxacin 7 mg IV q12h

Bactericidal; interferes with DNA replication in susceptible bacteria preventing cell

Indications: For the treatment of infections caused by susceptible gramnegative bacteria,

CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision CV: Arrhythmias,

Treat bacterial infections

Precautions: Pregnancy, DM, dehydration, severe renal disease, cirrhosis, ascites Assess patient for signs and symptoms of infection Obtain C/S before beginning

reproduction.

including E. coli, P. mirabilis, K. pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii, S. aureus, S. epidermidis, group D streptococci Contraindications: Allergy to ciprofloxacin, norfloxacin or other fluoroquinolones, pregnancy, lactation.

hypotension, angina EENT: Dry eye, eye pain, keratopathy GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain Hematologic: Elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, neutrophil count, Hct Other: Fever, rash

drug therapy Assess for anaphylaxis Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding

Precautions: Pregnancy, lactation, children, renal disease, epilepsy

Pentoxifylline 1.3 mg + 4.7 cc D5W OD x 6o VSP x 6 days

Decreases blood viscosity, stimulates prostacyclin production, increasing blood flow by increasing flexibility of RBCs, reduces platelet aggregation, decreases fibrinogen concentration

Indications: Intermittent claudication related to chronic occlusive vascular disease Sickle cell anemia Contraindications: Hypersensitivity Retinal, cerebral hemorrhage

CNS: headache, anxiety, tremors, confusion, dizziness CV: Angina, dysrhythmias, palpiptations, hypotension, chest pain, dyspnea EENT: blurred vision, earache, increased salivation, sore throat, conjunctivitis GI: dyspepsia, nausea, vomiting, anorexia, belching, constipation, dry mouth, thrist INTEG: rash, pruritus, urticaria, brittle fingernails Other: epistaxis, flulike symptoms, nasal congestion, malaise, weight changes

Decrease blood viscosity

Monitor BP and respirations Assess for intermittent claudication

Precautions: Pregnancy, angina pectoris, cardiac disease, impaired renal function, children, hepatic disease

Piperacillintazobactam 70 mg IV q8h x 30 mins

Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells and bursts from osmotic pressure

Indications: Respiratory tract, skin, bone and joint infections Infections from penicillinaseproducing staphylococci Contraindications: Hypersensitivity, neonates

CNS: headache, insomnia, dizziness, fever, lethargy, hallucinations, anxiety, depression GI: nausea, vomiting, diarrhea, abdominal pain, constipation, pseudomembranous colitis GU: oliguria, proteinuria, hematuria, glomerulonephritis HEMA: anemia, increased bleeding time, bone barrow depression INTEG: rash, pruritus META: hypokalemia, hypernatremia SYST: anaphylaxis, serum sickness

Bactericidal effects for Methicillinresistant Staphylococ cus aureus

Assess patient for previous sensitivity reaction to penicillins Assess patient for signs and symptoms of infection Obtain C&S before beginning drug therapy Assess for allergic reactions Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Monitor for bleeding Assess for overgrowth of infection

Midazolam 0.15 mg IV qh

Acts mainly at the limbic system and reticular formation; potentiates the effects of GABA, an inhibitory

Indications: IV or IM: Sedation, anxiolysis, and amnesia prior to diagnostic, therapeutic, or

CNS: Transient, mild drowsiness (initially); sedation, depression, lethargy, apathy, fatigue, lightheadedness,

Sedation

Precautions: Pregnancy, lactation, seizures, hypersensitivity to cephalosporins, renal insufficiency in children monitor BP, pulse, respiration monitor inj site for redness, pain, swelling assess

neurotransmitter; anxiolytic and amnesia effects occur at doses below those needed to cause sedation, ataxia; has little effect on cortical function.

endoscopic procedures or surgery Induction of general anesthesia Continuous sedation of intubated and mechanically ventilated patients as a component of anesthesia or during treatment in the critical care setting Unlabeled uses: Treatment of epileptic seizure or refractory status epilepticus

Contraindications: hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in first trimester; neonatal withdrawal syndrome reported in infants); neonates.

disorientation, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in concentration, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions (during first 2 wk of treatment), visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema Dermatologic: Urticaria, pruritus, skin rash, dermatitis GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice GU: Incontinence, urinary retention, changes in libido, menstrual irregularities

anterograde amnesia assess for apnea, respiratory depression

Precautions: COPD, CHF, chronc renal failure, chills, debilitated, neonates

Hematologic: Decreased Hct, blood dyscrasias Other: Phlebitis and thrombosis at IV injection sites, hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia; pain, burning, and redness after IM injection Vecuronium 0.15 mg IV qh (defer MAP <26) Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine; no analgesic response Indications: Facilitation of endotracheal intubation, skeletal muscle relaxation during mechanical ventilation Contraindications: hypersensitivity CNS: skeletal muscle weakness INTEG: urticaria RESP: prolonged apnea, possible respiratory paralysis, bronchospasm, flushing, wheezing SYST: anaphylaxis Skeletal muscle paralysis monitor for electrolyte imbalances monitor patients VS monitor patients recovery monitor allergic reactions

Dexamethaso ne 0.16 mg IV q6h x 6 doses

Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible for its anti-inflammatory and immunosuppressiv e effects.

Indications: Hypercalcemia associated with cancer Short-term management of various inflammatory and allergic disorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic

CNS: Seizures, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings, depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, cataracts, increased IOP, glaucoma CV: Hypertension, CHF, necrotizing angiitis Endocrine: Growth retardation, decreased

Decrease inflammatio n

Precautions: cardiac disease, pregnancy, electrolyte imbalances, dehydration, neuromuscular disease monitor potassium, blood, urine glucose while on long term therapy monitor weight daily monitor VS q4h monitor I&O ratio; be alert for decreasing urinary output

diseases (pemphigus), status asthmaticus, and autoimmune disorders Hematologic disorders: Thrombocytopenic purpura, erythroblastopenia Trichinosis with neurologic or myocardial involvement Cerebral edema associated with brain tumor, craniotomy, or head injury Testing adrenocortical hyperfunction Unlabeled uses: Antiemetic for cisplatin-induced vomiting, diagnosis of depression Respiratory inhalant: Control of bronchial asthma requiring corticosteroids in conjunction with other therapy Intranasal: Relief of symptoms of seasonal or perennial rhinitis that responds poorly to other treatments Ophthalmic

carbohydrate tolerance, diabetes mellitus, cushingoid state, secondary adrenocortical and pituitary unresponsiveness GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention GU: Amenorrhea, irregular menses Hematologic: Fluid and electrolyte disturbances, negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreased serum T3 and T4 levels Hypersensitivity: Anaphylactoid or hypersensitivity reactions Musculoskeletal: Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures Other: Impaired wound healing; petechiae; ecchymoses; increased sweating; thin and fragile skin; acne; immunosuppression and masking of signs of infection; activation of latent infections, including TB, fungal, and viral eye infections; pneumonia; abscess; septic infection; GI and GU infections

assess infection assess mental status

Precautions: pregnancy, lactation, DM, glaucoma,osteop orosis, seizure disorders, ulcerative colitis, CHF, myasthenia gravis, renal disease, peptic ulcer.

preparations: Inflammation of the lid, conjunctiva, cornea, and globe Contraindications: infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and varicella, and antibiotic-resistant infections, allergy to any component of the preparation used. Indications: Acute infections caused by sensitive strains of Streptococcus pneumoniae, Mycoplasma pneumoniae, Listeria monocytogenes, Legionella pneumophila URIs, lower respiratory tract infections, skin and soft-tissue infections caused by group A betahemolytic streptococci when oral treatment is preferred to injectable benzathine penicillin In conjunction with

Erythromycin 125g/5ml 0.15 ml po q6h

Bacteriostatic or bactericidal in susceptible bacteria; binds to cell membrane, causing change in protein function, leading to cell death.

CNS: Reversible hearing loss, confusion, uncontrollable emotions, abnormal thinking CV: Ventricular arrhythmias (with IV) GI: Abdominal cramping, anorexia, diarrhea, vomiting, pseudomembranous colitis, hepatotoxicity Hypersensitivity: Allergic reactions ranging from rash to anaphylaxis Other: Superinfections

Assess patient for signs and symptoms of infection Obtain C&S results before beginning therapy Assess for allergic reactions Identify urine output Monitor blood studies Monitor electrolytes Assess bowel pattern daily Assess for overgrowth of infection

Precautions: Pregnancy, lactation

sulfonamides in URIs caused by Haemophilus influenzae As an adjunct to antitoxin in infections caused by Corynebacterium diphtheriae and Corynebacterium minutissimum Prophylaxis against alphahemolytic streptococcal endocarditis before dental or other procedures in patients allergic to penicillin who have valvular heart disease Contraindications: Allergy to erythromycin Spironolactone 0.75 mg/tab tab OD Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium. Indications: Diagnosis and maintenance of primary hyperaldosteronis m Adjunctive therapy in edema associated with CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or inappropriate Treatment of hypokalemia or prevention of CNS: Dizziness, headache, drowsiness, fatigue, ataxia, confusion Dermatologic: Rash, urticaria GI: Cramping, diarrhea, dry mouth, thirst, vomiting. GU: Impotence, irregular menses, amenorrhea, postmenopausal bleeding Hematologic: Hyperkalemia, hyponatremia, agranulocytosis Other: Carcinogenic in animals, deepening of the voice, hirsutism, Increased urine output monitor for manifestations of hyperkalemia monitor for manifestations of hyponatermia Assess fluid volume status: I&O ratios; crackles in lung, urine quality Monitor electrolytes

Precautions: Dehydration, hepatic disease,

hypokalemia in patients who would be at high risk if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias Essential hypertension, usually in combination with other drugs Unlabeled uses: Treatment of hirsutism due to its antiandrogenic properties, palliation of symptoms of PMS, treatment of familial male precocious puberty, shortterm treatment of acne vulgaris

gynecomastia

lactation, renal disease, electrolyte imbalances

Conraindications: allergy to spironolactone, hyperkalemia, renal disease, anuria, amiloride or triamterene use. Theophylline 1.4 mg po q12h Relaxes smooth muscle of respiratory system by blocking phosphodiesterase , which increases cAMP, which increases Indications: Bronchospasm of COPD Bronchial asthma Chronic bronchitis Contraindications: Hypersensitivity to CNS: anxiety, restlessness, insomnia, dizziness, seizures, headache, muscle twitching, tremors CV: palpitations, sinus tachycardia, hypotension, dysrhythmias Breathe without difficulty monitor theophylline blood levels monitor I&O assess for signs of toxicity: irritability, insomnia,

bronchodilation, dieresis, circulation, CNS stimulation

xanthines tachydysrhythmias

ENDO: hyperglycemia GI: nausea, vomiting, anorexia, diarrhea, bitter taste, gastric distress INTEG: flushing, urticaria RESP: increased rate

restlessness, tremors monitor respiratory rate, rhythm and depth assess for allergic reactions

Precautions: pregnancy, elderly, CHF, hepatic disease, cor pulmonale, hepatic disease, DM, hyperthyroidism, hypertension