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University of the Philippines

The Health Sciences Center


COLLEGE OF NURSING
Sotejo Hall, Pedro Gil Street, Manila

Drug Study

DRUG ORDER
(Generic
name, PHARMACOLOGI DESIRED NURSING
INDICATIONS AND ADVERSE EFFECTS OF
Dosage, C ACTION OF ACTION ON RESPONSIBILITIES
CONTRAINDICATIONS THE DRUG
Route, DRUG THE CLIENT /PRECAUTIONS
Frequency,
etc.)

Amphotericin Increased cell Indications: CNS: headache, fever, Treat fungal • Monitor VS q15-
B 0.15 cc + membrane • Treatment of chills, peripheral nerve infection 30 min during
1.35 cc D5W permeability in severe, possibly pain, paresthesias, first inf; note
OD susceptible fatal fungal peripheral neuropathy, changes in
organisms by infections seizures, dizziness pulse, BP.
binding sterols in EENT: tinnitus, deafness, • Monitor blood
fungal membrane; Contraindications: diplopia, blurred vision studies
decreases • Hypersensitivity GI: nausea, vomiting, • Monitor weight
potassium, sodium • Severe bone anorexia, diarrhea, weekly; if weight
and nutrients in marrow depression cramps, hemorrhagic increases 2lb/wk,
the cell gastroenteritis, acute liver edema is
failure present; renal
GU: hypokalemia, damage should
axotemia, hyposthenuria, be considered.
renal tubular acidosis, • Monitor for renal
nephrocalcinosis,
toxicity;
permanent renal
increasing BUN
impairment, anuria,
and serum
oliguria
creatinine
Blood: normochromic and
normocytic anemia, • Monitor for
thrombocytopenia, hepatotoxicity;
agranulocytosis, increasing AST,
leucopenia, eosinophilia, ALT, alkaline
hypokalemia, phophatase
hyponatremia, • Monitor for
hypomagnesemia allergic reaction
Integumentary: burning, • Monitor for
irritation, pain, necrosis at hypokalemia
inj site with extravasation,
flushing, dermatitis, skin
rash Precautions:
MS: athralgia, myalgia, • Pregnancy, renal
generalized pain, disease,
weakness, weight loss lactation

Meropenem 30 Interferes with cell Indications: CNS: fever, somnolence, Treat • Assess patient
mg IV q12h wall replication of • For serious seizures, dizziness, bacterial for previous
susceptible infections caused weakness, headache, infection sensitivity
organisms; by gram-positive myoclonia reaction to
osmotically or gram-negative CV: hypotension, carbapenems
unstable cell wall organisms palpitations • Assess patient
swells and bursts GI: diarrhea, nausea, for signs and
from osmotic Contraindications: vomiting, symptoms of
pressure • Hypersensitivity to pseudomembraneous infection,
meropenem or colitis, hepatitis, glossitis including
imipenem Blood: eosinophilia, characteristics of
neutropenia, decreased wounds, sputum,
Hgb, Hct urine, stool
Integumentary: rash, • Complete C/S
urticaria, pruritus, pain at tests before
inj site, phlebitis, beginning drug
erythema at inj site therapy
RESP: chest discomfort, • Assess for
dyspnea, hyperventilation
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 Acts on the Indications: CNS: headache, fatigue, Increase • Assess patient
0.65 mg IV OD ascending loop of • Edema in CHF, weakness, vertigo, patient’s for tinnitus,
Henle in the nephritic paresthesias urine output hearing loss, ear
kidney; inhibiting syndrome, ascites CV: orthstatic pain
reabsorption of hypotension, chest pain, • Monitor for renal,
electrolytes Contraindications: ECG changes, circulatory cardiac,
sodium and • Hypersensitivity to collapse neiurologic, GI,
chloride, causing sulfonamides EENT: loss of hearing, ear pulmonary
excretion of • Anuria, pain, tinnitus, blurred manifestation of
sodium, calcium, hypovolemia, vision hypokalemia:
magnesium, infants, lactation, ELECTROLYTES: acidic urine,
chloride, water and electrolyte hypokalemia, decreased urine
some potassium depletion hypochloremic alkalosis, osmolality,
hypoagnesemia, nocturia,
hyperuricemia polyuria and
ENDO: hyperglycemia polydipsia
GI: nausea, diarrhea, dry • Monitor for CNS,
mouth, vomiting, GI,
anorexia, cramps, cardiovascular,
pancreatitis integumentary,
GU: polyuria, reanl failure, neurologic
glycosuria manifestations
HEMA: of hypocalcemia:
thrombocytopenia, personality
agranulocytosis, changes,
leucopenia, anemia anxiety,
INTEG: rash, pruritus, disturbances
purpura, sweating, • Monitor for
photosensitivity, urticaria
manifestations
MS: cramps, stiffness
of hyponatremia
• Monitor
electrolytes

Precautions:
• Pregnancy, DM,
dehydration,
severe renal
disease,
cirrhosis, ascites
Ciprofloxacin 7 Bactericidal; Indications: CNS: Headache, Treat • Assess patient
mg IV q12h interferes with • For the treatment dizziness, insomnia, bacterial for signs and
DNA replication in of infections fatigue, somnolence, infections symptoms of
susceptible caused by depression, blurred infection
bacteria susceptible gram- vision • Obtain C/S
preventing cell negative bacteria, CV: Arrhythmias, before beginning
reproduction. including E. coli, P. hypotension, angina drug therapy
mirabilis, K. EENT: Dry eye, eye pain, • Assess for
pneumoniae, keratopathy anaphylaxis
Enterobacter GI: Nausea, vomiting, dry • Identify urine
cloacae, P. mouth, diarrhea, output
vulgaris, P. abdominal pain • Monitor blood
rettgeri, M. Hematologic: Elevated studies
morganii, P. BUN, AST, ALT, serum • Monitor
aeruginosa, creatinine and alkaline
electrolytes
Citrobacter phosphatase;
• Assess bowel
freundii, S. decreased WBC,
aureus, S. neutrophil count, Hct pattern daily
epidermidis, group Other: Fever, rash • Monitor for
D streptococci bleeding

Contraindications: Precautions:
• Allergy to • Pregnancy,
ciprofloxacin, lactation,
norfloxacin or children, renal
other disease,
fluoroquinolones, epilepsy
pregnancy,
lactation.

Pentoxifylline Decreases blood Indications: CNS: headache, anxiety, Decrease • Monitor BP and
1.3 mg + 4.7 viscosity, • Intermittent tremors, confusion, blood respirations
cc D5W OD x stimulates claudication dizziness viscosity • Assess for
6o VSP x 6 prostacyclin related to chronic CV: Angina, dysrhythmias, intermittent
days production, occlusive vascular palpiptations, claudication
increasing blood disease hypotension, chest
flow by increasing • Sickle cell anemia pain, dyspnea Precautions:
flexibility of RBCs, EENT: blurred vision, • Pregnancy,
reduces platelet Contraindications: earache, increased angina pectoris,
aggregation, • Hypersensitivity salivation, sore throat, cardiac disease,
decreases conjunctivitis
• Retinal, cerebral impaired renal
fibrinogen GI: dyspepsia, nausea, function,
hemorrhage
concentration vomiting, anorexia, children, hepatic
belching, constipation, disease
dry mouth, thrist
INTEG: rash, pruritus,
urticaria, brittle
fingernails
Other: epistaxis, flulike
symptoms, nasal
congestion, malaise,
weight changes
Piperacillin- Interferes with cell Indications: CNS: headache, insomnia, Bactericidal • Assess patient
tazobactam 70 wall replication of • Respiratory tract, dizziness, fever, effects for for previous
mg IV q8h x susceptible skin, bone and lethargy, Methicillin- sensitivity
30 mins organisms; joint infections hallucinations, anxiety, resistant reaction to
osmotically • Infections from depression Staphylococ penicillins
unstable cell wall penicillinase- GI: nausea, vomiting, cus aureus • Assess patient
swells and bursts producing diarrhea, abdominal for signs and
from osmotic staphylococci pain, constipation, symptoms of
pressure pseudomembranous infection
Contraindications: colitis • Obtain C&S
• Hypersensitivity, GU: oliguria, proteinuria, before beginning
neonates hematuria, drug therapy
glomerulonephritis • Assess for
HEMA: anemia, increased
allergic reactions
bleeding time, bone
• Identify urine
barrow depression
INTEG: rash, pruritus output
META: hypokalemia, • Monitor blood
hypernatremia studies
SYST: anaphylaxis, serum • Monitor
sickness electrolytes
• Assess bowel
pattern daily
• Monitor for
bleeding
• Assess for
overgrowth of
infection

Precautions:
• Pregnancy,
lactation,
seizures,
hypersensitivity
to
cephalosporins,
renal
insufficiency in
children
Midazolam Acts mainly at the Indications: CNS: Transient, mild Sedation • monitor BP,
0.15 mg IV qh limbic system and • IV or IM: Sedation, drowsiness (initially); pulse, respiration
reticular formation; anxiolysis, and sedation, depression, • monitor inj site
potentiates the amnesia prior to lethargy, apathy, for redness,
effects of GABA, an diagnostic, fatigue, light- pain, swelling
inhibitory therapeutic, or headedness, • assess
neurotransmitter; endoscopic disorientation, anterograde
anxiolytic and procedures or restlessness, amnesia
amnesia effects surgery confusion, crying, • assess for
occur at doses • Induction of delirium, headache, apnea,
below those general anesthesia slurred speech, respiratory
needed to cause • Continuous dysarthria, stupor, depression
sedation, ataxia; sedation of rigidity, tremor,
has little effect on intubated and dystonia, vertigo, Precautions:
cortical function. mechanically euphoria, • COPD, CHF,
ventilated patients nervousness, difficulty chronc renal
as a component of in concentration, vivid failure, chills,
anesthesia or dreams, psychomotor debilitated,
during treatment retardation, neonates
in the critical care extrapyramidal
setting symptoms; mild
• Unlabeled uses: paradoxical excitatory
Treatment of reactions (during first
epileptic seizure or 2 wk of treatment),
refractory status visual and auditory
epilepticus disturbances, diplopia,
nystagmus, depressed
Contraindications: hearing, nasal
congestion
• hypersensitivity to
CV: Bradycardia,
benzodiazepines;
tachycardia, CV
psychoses, acute
collapse, hypertension,
narrow-angle
hypotension,
glaucoma, shock,
palpitations, edema
coma, acute
Dermatologic: Urticaria,
alcoholic
pruritus, skin rash,
intoxication;
dermatitis
pregnancy (cleft
GI: Constipation, diarrhea,
lip or palate,
dry mouth, salivation,
inguinal hernia,
nausea, anorexia,
cardiac defects,
vomiting, difficulty in
microcephaly,
swallowing, gastric
pyloric stenosis
disorders, elevations
have been
of blood enzymes:
reported when
LDH, alkaline
used in first
phosphatase, AST, ALT,
trimester;
hepatic dysfunction,
neonatal
jaundice
withdrawal
GU: Incontinence, urinary
syndrome
retention, changes in
reported in
libido, menstrual
infants); neonates.
irregularities
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 Inhibits Indications: CNS: skeletal muscle Skeletal • monitor for


0.15 mg IV qh transmission of • Facilitation of weakness muscle electrolyte
(defer MAP nerve impulses by endotracheal INTEG: urticaria paralysis imbalances
<26) binding with intubation, RESP: prolonged apnea, • monitor patient’s
cholinergic skeletal muscle possible respiratory VS
receptor sites, relaxation during paralysis, bronchospasm, • monitor patient’s
antagonizing mechanical flushing, wheezing recovery
action of ventilation SYST: anaphylaxis • monitor allergic
acetylcholine; no
reactions
analgesic response Contraindications:
• hypersensitivity Precautions:
• cardiac disease,
pregnancy,
electrolyte
imbalances,
dehydration,
neuromuscular
disease
Dexamethaso Enters target cells Indications: CNS: Seizures, vertigo, Decrease • monitor
ne 0.16 mg IV and binds to • Hypercalcemia headaches, pseudotumor inflammatio potassium,
q6h x 6 doses specific receptors, associated with cerebri, euphoria, n blood, urine
initiating many cancer insomnia, mood swings, glucose while on
complex reactions • Short-term depression, psychosis, long term
that are management of intracerebral hemorrhage, therapy
responsible for its various reversible cerebral • monitor weight
anti-inflammatory inflammatory and atrophy in infants, daily
and allergic disorders, cataracts, increased IOP, • monitor VS q4h
immunosuppressiv such as glaucoma • monitor I&O
e effects. rheumatoid CV: Hypertension, CHF,
ratio; be alert for
arthritis, collagen necrotizing angiitis
decreasing
diseases (SLE), Endocrine: Growth
urinary output
dermatologic retardation, decreased
diseases carbohydrate tolerance, • assess infection
(pemphigus), diabetes mellitus, • assess mental
status cushingoid state, status
asthmaticus, and secondary adrenocortical
autoimmune and pituitary Precautions:
disorders unresponsiveness • pregnancy,
• Hematologic GI: Peptic or esophageal lactation, DM,
disorders: ulcer, pancreatitis, glaucoma,osteop
Thrombocytopenic abdominal distention orosis, seizure
purpura, GU: Amenorrhea, disorders,
erythroblastopenia irregular menses ulcerative colitis,
• Trichinosis with Hematologic: Fluid and CHF, myasthenia
electrolyte disturbances, gravis, renal
neurologic or
negative nitrogen balance, disease, peptic
myocardial
increased blood sugar, ulcer.
involvement
glycosuria, increased
• Cerebral edema
serum cholesterol,
associated with decreased serum T3 and T4
brain tumor, levels
craniotomy, or Hypersensitivity:
head injury Anaphylactoid or
• Testing hypersensitivity reactions
adrenocortical Musculoskeletal: Muscle
hyperfunction weakness, steroid
• Unlabeled uses: myopathy, loss of muscle
Antiemetic for mass, osteoporosis,
cisplatin-induced spontaneous fractures
vomiting, Other: Impaired wound
diagnosis of healing; petechiae;
depression ecchymoses; increased
• Respiratory sweating; thin and fragile
inhalant: Control skin; acne;
of bronchial immunosuppression and
asthma requiring masking of signs of
corticosteroids in infection; activation of
conjunction with latent infections, including
other therapy TB, fungal, and viral eye
• Intranasal: Relief infections; pneumonia;
of symptoms of abscess; septic infection;
seasonal or GI and GU infections
perennial rhinitis
that responds
poorly to other
treatments
• Ophthalmic
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.
Erythromycin Bacteriostatic or Indications: CNS: Reversible hearing • Assess patient
125g/5ml 0.15 bactericidal in • Acute infections loss, confusion, for signs and
ml po q6h susceptible caused by uncontrollable emotions, symptoms of
bacteria; binds to sensitive strains of abnormal thinking infection
cell membrane, Streptococcus CV: Ventricular • Obtain C&S
causing change in pneumoniae, arrhythmias (with IV) results before
protein function, Mycoplasma GI: Abdominal cramping, beginning
leading to cell pneumoniae, anorexia, diarrhea, therapy
death. Listeria vomiting, • Assess for
monocytogenes, pseudomembranous allergic reactions
Legionella colitis, hepatotoxicity • Identify urine
pneumophila Hypersensitivity:
output
• URIs, lower Allergic reactions ranging
• Monitor blood
from rash to anaphylaxis
respiratory tract studies
Other: Superinfections
infections, skin • Monitor
and soft-tissue electrolytes
infections caused • Assess bowel
by group A beta- pattern daily
hemolytic
• Assess for
streptococci when
overgrowth of
oral treatment is
infection
preferred to
injectable
Precautions:
benzathine
• Pregnancy,
penicillin
lactation
• In conjunction with
sulfonamides in
URIs caused by
Haemophilus
influenzae
• As an adjunct to
antitoxin in
infections caused
by
Corynebacterium
diphtheriae and
Corynebacterium
minutissimum
• Prophylaxis
against alpha-
hemolytic
streptococcal
endocarditis
before dental or
other procedures
in patients allergic
to penicillin who
have valvular
heart disease
Contraindications:
• Allergy to
erythromycin

Spironolactone Competitively Indications: CNS: Dizziness, Increased • monitor for


0.75 mg/tab ½ blocks the effects • Diagnosis and headache, drowsiness, urine output manifestations
tab OD of aldosterone in maintenance of fatigue, ataxia, confusion of hyperkalemia
the renal tubule, primary Dermatologic: Rash, • monitor for
causing loss of hyperaldosteronis urticaria manifestations
sodium and water m GI: Cramping, diarrhea, of hyponatermia
and retention of • Adjunctive therapy dry mouth, thirst, • Assess fluid
potassium. in edema vomiting. volume status:
associated with GU: Impotence, irregular I&O ratios;
CHF, nephrotic menses, amenorrhea, crackles in lung,
syndrome, hepatic postmenopausal bleeding urine quality
cirrhosis when Hematologic: • Monitor
other therapies Hyperkalemia,
electrolytes
are inadequate or hyponatremia,
inappropriate agranulocytosis
Precautions:
• Treatment of Other: Carcinogenic in
• Dehydration,
hypokalemia or animals, deepening of the
voice, hirsutism, hepatic disease,
prevention of
hypokalemia in gynecomastia lactation, renal
patients who disease,
would be at high electrolyte
risk if hypokalemia imbalances
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, short-
term treatment of
acne vulgaris

Conraindications:
• allergy to
spironolactone,
hyperkalemia,
renal disease,
anuria, amiloride
or triamterene
use.

Theophylline Relaxes smooth Indications: CNS: anxiety, Breathe • monitor


1.4 mg po muscle of • Bronchospasm of restlessness, insomnia, without theophylline
q12h respiratory system COPD dizziness, seizures, difficulty blood levels
by blocking • Bronchial asthma headache, muscle • monitor I&O
phosphodiesterase • Chronic bronchitis twitching, tremors • assess for signs
, which increases CV: palpitations, sinus of toxicity:
cAMP, which Contraindications: tachycardia, hypotension, irritability,
increases dysrhythmias
• Hypersensitivity to insomnia,
bronchodilation, xanthines ENDO: hyperglycemia restlessness,
dieresis, • tachydysrhythmias GI: nausea, vomiting, tremors
circulation, CNS anorexia, diarrhea, bitter • monitor
stimulation taste, gastric distress respiratory rate,
INTEG: flushing, urticaria rhythm and
RESP: increased rate depth
• assess for
allergic reactions

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