University of the Philippines

The Health Sciences Center

COLLEGE OF NURSING
Sotejo Hall, Pedro Gil Street, Manila

Drug Study

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

Amphotericin B Increased cell Indications: CNS: headache, fever, chills, Treat fungal  Monitor VS q15-30
0.15 cc + 1.35 membrane  Treatment of severe, peripheral nerve pain, infection min during first inf;
cc D5W OD permeability in possibly fatal fungal paresthesias, peripheral note changes in
susceptible organisms infections neuropathy, seizures, pulse, BP.
by binding sterols in dizziness  Monitor blood
fungal membrane; Contraindications: EENT: tinnitus, deafness, studies
decreases potassium,  Hypersensitivity diplopia, blurred vision  Monitor weight
sodium and nutrients  Severe bone marrow GI: nausea, vomiting, weekly; if weight
in the cell depression anorexia, diarrhea, cramps, increases 2lb/wk,
hemorrhagic gastroenteritis, edema is present;
acute liver failure renal damage
GU: hypokalemia, axotemia, should be
hyposthenuria, renal tubular considered.
acidosis, nephrocalcinosis,  Monitor for renal
permanent renal impairment, toxicity; increasing
anuria, oliguria BUN and serum
Blood: normochromic and creatinine
normocytic anemia,  Monitor for
thrombocytopenia, hepatotoxicity;
agranulocytosis, leucopenia, increasing AST,
eosinophilia, hypokalemia, ALT, alkaline
hyponatremia, phophatase
hypomagnesemia  Monitor for allergic
Integumentary: burning, reaction
irritation, pain, necrosis at inj  Monitor for
site with extravasation, hypokalemia
flushing, dermatitis, skin rash
MS: athralgia, myalgia, Precautions:
generalized pain, weakness,  Pregnancy, renal
weight loss disease, lactation
Meropenem 30 Interferes with cell Indications: CNS: fever, somnolence, Treat bacterial  Assess patient for
mg IV q12h wall replication of  For serious infections seizures, dizziness, weakness, infection previous sensitivity
susceptible caused by gram- headache, myoclonia reaction to
organisms; positive or gram- CV: hypotension, palpitations carbapenems
osmotically unstable negative organisms GI: diarrhea, nausea,  Assess patient for
cell wall swells and vomiting, signs and
bursts from osmotic Contraindications: pseudomembraneous colitis, symptoms of
pressure  Hypersensitivity to hepatitis, glossitis infection, including
meropenem or Blood: eosinophilia, characteristics of
imipenem neutropenia, decreased Hgb, wounds, sputum,
Hct urine, stool
Integumentary: rash,  Complete C/S tests
urticaria, pruritus, pain at inj before beginning
site, phlebitis, erythema at inj drug therapy
site  Assess for allergic
RESP: chest discomfort, reactions,
dyspnea, hyperventilation 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 Acts on the ascending Indications: CNS: headache, fatigue, Increase  Assess patient for
mg IV OD loop of Henle in the  Edema in CHF, weakness, vertigo, patient’s urine tinnitus, hearing
kidney; inhibiting nephritic syndrome, paresthesias output loss, ear pain
reabsorption of ascites CV: orthstatic hypotension,  Monitor for renal,
electrolytes sodium chest pain, ECG changes, cardiac,
and chloride, causing Contraindications: circulatory collapse neiurologic, GI,
excretion of sodium,  Hypersensitivity to EENT: loss of hearing, ear pulmonary
calcium, magnesium, sulfonamides pain, tinnitus, blurred vision manifestation of
chloride, water and  Anuria, hypovolemia, ELECTROLYTES: hypokalemia: acidic
some potassium infants, lactation, hypokalemia, hypochloremic urine, decreased
electrolyte depletion alkalosis, hypoagnesemia, urine osmolality,
hyperuricemia nocturia, polyuria
ENDO: hyperglycemia and polydipsia
GI: nausea, diarrhea, dry  Monitor for CNS,
mouth, vomiting, anorexia, GI, cardiovascular,
cramps, pancreatitis integumentary,
GU: polyuria, reanl failure, neurologic
glycosuria manifestations of
HEMA: thrombocytopenia, hypocalcemia:
agranulocytosis, leucopenia, personality
anemia changes, anxiety,
INTEG: rash, pruritus, disturbances
purpura, sweating,  Monitor for
photosensitivity, urticaria manifestations of
MS: cramps, stiffness hyponatremia
 Monitor electrolytes

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

Pentoxifylline 1.3 Decreases blood Indications: CNS: headache, anxiety, Decrease  Monitor BP and
mg + 4.7 cc viscosity, stimulates  Intermittent tremors, confusion, blood viscosity respirations
D5W OD x 6o prostacyclin claudication related dizziness  Assess for
VSP x 6 days production, to chronic occlusive CV: Angina, dysrhythmias, intermittent
increasing blood flow vascular disease palpiptations, claudication
by increasing  Sickle cell anemia hypotension, chest pain,
flexibility of RBCs, dyspnea Precautions:
reduces platelet Contraindications: EENT: blurred vision,  Pregnancy, angina
aggregation,  Hypersensitivity earache, increased pectoris, cardiac
decreases fibrinogen  Retinal, cerebral salivation, sore throat, disease, impaired
concentration hemorrhage conjunctivitis renal function,
GI: dyspepsia, nausea, children, hepatic
vomiting, anorexia, disease
belching, constipation, 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 for
tazobactam 70 wall replication of  Respiratory tract, dizziness, fever, lethargy, effects for previous sensitivity
mg IV q8h x 30 susceptible skin, bone and joint hallucinations, anxiety, Methicillin- reaction to
mins organisms; infections depression resistant penicillins
osmotically unstable  Infections from GI: nausea, vomiting, Staphylococcu  Assess patient for
cell wall swells and penicillinase- diarrhea, abdominal pain, s aureus signs and
bursts from osmotic producing constipation, symptoms of
pressure staphylococci pseudomembranous infection
colitis  Obtain C&S before
 Contraindications:
Midazolam 0.15 Acts mainly at the Indications:
mg IV qh limbic system and
reticular formation;
potentiates the
effects of GABA, an
inhibitory
neurotransmitter;
anxiolytic and
amnesia effects occur
at doses below those
needed to cause
sedation, ataxia; has
little effect on cortical
function.
GU: oliguria, proteinuria, beginning drug
 Hypersensitivity, hematuria, therapy
neonates glomerulonephritis  Assess for allergic
HEMA: anemia, increased reactions
bleeding time, bone  Identify urine
barrow depression output
INTEG: rash, pruritus  Monitor blood
META: hypokalemia, studies
hypernatremia  Monitor electrolytes
SYST: anaphylaxis, serum  Assess bowel
sickness pattern daily
 Monitor for
bleeding
 Assess for
overgrowth of
infection
Precautions:
 Pregnancy,
lactation, seizures,
hypersensitivity to
cephalosporins,
renal insufficiency
in children
CNS: Transient, mild Sedation  monitor BP, pulse,
 IV or IM: Sedation, drowsiness (initially); respiration
anxiolysis, and sedation, depression,  monitor inj site for
amnesia prior to lethargy, apathy, fatigue, redness, pain,
diagnostic, light-headedness, swelling
therapeutic, or disorientation,  assess anterograde
endoscopic restlessness, confusion, amnesia
procedures or crying, delirium,  assess for apnea,
surgery headache, slurred speech, respiratory
 Induction of general dysarthria, stupor, depression
anesthesia rigidity, tremor, dystonia,
 Continuous sedation vertigo, euphoria, Precautions:
of intubated and nervousness, difficulty in  COPD, CHF, chronc
mechanically concentration, vivid renal failure, chills,
ventilated patients as dreams, psychomotor debilitated,
a component of retardation, neonates
anesthesia or during extrapyramidal
treatment in the symptoms; mild
critical care setting paradoxical excitatory
 Unlabeled uses: reactions (during first 2
 Treatment of wk of treatment), visual
epileptic seizure or and auditory
refractory status disturbances, diplopia,
epilepticus nystagmus, depressed
hearing, nasal congestion
Contraindications: CV: Bradycardia, tachycardia,
 hypersensitivity to CV collapse, hypertension,
benzodiazepines; hypotension, palpitations,
psychoses, acute edema
narrow-angle Dermatologic: Urticaria,
glaucoma, shock, pruritus, skin rash,
coma, acute alcoholic dermatitis
intoxication; GI: Constipation, diarrhea,
pregnancy (cleft lip dry mouth, salivation,
or palate, inguinal nausea, anorexia,
hernia, cardiac vomiting, difficulty in
defects, swallowing, gastric
microcephaly, pyloric disorders, elevations of
stenosis have been blood enzymes: LDH,
reported when used alkaline phosphatase,
in first trimester; AST, ALT, hepatic
neonatal withdrawal dysfunction, jaundice
syndrome reported in GU: Incontinence, urinary
infants); neonates. retention, changes in
libido, menstrual
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 0.15 Inhibits transmission Indications: CNS: skeletal muscle Skeletal  monitor for
mg IV qh (defer of nerve impulses by  Facilitation of weakness muscle electrolyte
MAP <26) binding with endotracheal INTEG: urticaria paralysis imbalances
cholinergic receptor intubation, skeletal RESP: prolonged apnea,  monitor patient’s
sites, antagonizing muscle relaxation possible respiratory paralysis, VS
action of during mechanical bronchospasm, flushing,  monitor patient’s
acetylcholine; no ventilation wheezing recovery
 analgesic response SYST: anaphylaxis  monitor allergic
Contraindications: reactions
 hypersensitivity
Precautions:
 cardiac disease,
pregnancy,
electrolyte
imbalances,
dehydration,
neuromuscular
disease
Dexamethasone Enters target cells Indications: CNS: Seizures, vertigo, Decrease  monitor potassium,
0.16 mg IV q6h and binds to specific  Hypercalcemia headaches, pseudotumor inflammation blood, urine
x 6 doses receptors, initiating associated with cerebri, euphoria, insomnia, glucose while on
many complex cancer mood swings, depression, long term therapy
reactions that are  Short-term psychosis, intracerebral  monitor weight
responsible for its management of hemorrhage, reversible daily
anti-inflammatory various inflammatory cerebral atrophy in infants,  monitor VS q4h
and and allergic cataracts, increased IOP,  monitor I&O ratio;
immunosuppressive disorders, such as glaucoma be alert for
effects. rheumatoid arthritis, CV: Hypertension, CHF, decreasing urinary
collagen diseases necrotizing angiitis output
(SLE), dermatologic Endocrine: Growth  assess infection
diseases retardation, decreased  assess mental
(pemphigus), status carbohydrate tolerance, status
asthmaticus, and diabetes mellitus, cushingoid
autoimmune state, secondary Precautions:
disorders adrenocortical and pituitary  pregnancy,
 Hematologic unresponsiveness lactation, DM,
disorders: GI: Peptic or esophageal glaucoma,osteopor
Thrombocytopenic ulcer, pancreatitis, abdominal osis, seizure
purpura, distention disorders,
erythroblastopenia GU: Amenorrhea, irregular ulcerative colitis,
 Trichinosis with menses CHF, myasthenia
neurologic or Hematologic: Fluid and gravis, renal
myocardial electrolyte disturbances, disease, peptic
involvement negative nitrogen balance, ulcer.
 Cerebral edema increased blood sugar,
associated with brain glycosuria, increased serum
tumor, craniotomy, cholesterol, decreased serum
or head injury T3 and T4 levels
 Testing Hypersensitivity:
adrenocortical Anaphylactoid or
hyperfunction hypersensitivity reactions
  Unlabeled uses: Musculoskeletal: Muscle
Antiemetic for weakness, steroid myopathy,
cisplatin-induced loss of muscle mass,
vomiting, diagnosis osteoporosis, spontaneous
of depression fractures
 Respiratory inhalant: Other: Impaired wound
Control of bronchial healing; petechiae;
asthma requiring ecchymoses; increased
corticosteroids in sweating; thin and fragile
conjunction with skin; acne;
other therapy immunosuppression and
 Intranasal: Relief of masking of signs of infection;
symptoms of activation of latent infections,
seasonal or perennial including TB, fungal, and viral
rhinitis that responds eye infections; pneumonia;
poorly to other abscess; septic infection; GI
treatments and GU infections
 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 loss,  Assess patient for
125g/5ml 0.15 bactericidal in  Acute infections confusion, uncontrollable signs and
ml po q6h susceptible bacteria; caused by sensitive emotions, abnormal thinking symptoms of
binds to cell strains of CV: Ventricular infection
membrane, causing Streptococcus arrhythmias (with IV)  Obtain C&S results
change in protein pneumoniae, GI: Abdominal cramping, before beginning
function, leading to Mycoplasma anorexia, diarrhea, vomiting, therapy
cell death. pneumoniae, Listeria pseudomembranous  Assess for allergic
monocytogenes, colitis, hepatotoxicity reactions
Legionella Hypersensitivity: Allergic  Identify urine
pneumophila reactions ranging from rash to output
  URIs, lower anaphylaxis  Monitor blood
respiratory tract Other: Superinfections studies
infections, skin and  Monitor electrolytes
soft-tissue infections  Assess bowel
caused by group A pattern daily
beta-hemolytic  Assess for
streptococci when overgrowth of
oral treatment is infection
preferred to
injectable benzathine Precautions:
penicillin  Pregnancy,
 In conjunction with lactation
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 blocks Indications: CNS: Dizziness, headache, Increased  monitor for
0.75 mg/tab ½ the effects of  Diagnosis and drowsiness, fatigue, ataxia, urine output manifestations of
tab OD aldosterone in the maintenance of confusion hyperkalemia
renal tubule, causing primary Dermatologic: Rash,  monitor for
loss of sodium and hyperaldosteronism urticaria manifestations of
water and retention  Adjunctive therapy in GI: Cramping, diarrhea, dry hyponatermia
of potassium. edema associated mouth, thirst, vomiting.  Assess fluid volume
 with CHF, nephrotic GU: Impotence, irregular status: I&O ratios;
syndrome, hepatic menses, amenorrhea, crackles in lung,
cirrhosis when other postmenopausal bleeding urine quality
therapies are Hematologic: Hyperkalemia,  Monitor electrolytes
inadequate or hyponatremia,
inappropriate agranulocytosis Precautions:
 Treatment of Other: Carcinogenic in  Dehydration,
hypokalemia or animals, deepening of the hepatic disease,
prevention of voice, hirsutism, lactation, renal
hypokalemia in gynecomastia disease, electrolyte
patients who would imbalances
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, short-term
treatment of acne
vulgaris

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

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

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