Dosage, Route,

Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: Tranexamic acid is a To treat patients with CV: central retinal Do not administer Independent
synthetic analog of possible bleeding or artery and vein tranexamic acid
Tranexamic acid 500 mg/cap 1 cap the aminoacid lysine. suspected bleeding obstruction intravenously with blood Monitor vital signs
It serves as an EENT:central retinal or solutions containing
Route: antifibrolytic by artery penicillin Unsual change of bleeing
reversibly binding GI: abdominal pain pattern should be
Brand: PO four to five lysine GU: acute renal Monitor patient closely immediately reported
receptor sites on cortical necrosis for allergic reactions to
Frequency: plasminoges or HEME: anemia tranexamic acid such as Inform the client that she
plasmin. This dypnea that may require should inform the physician
Q8H; PRN for prevents plasmin emergency medical immediately if severe side
hemoptysis from binding to and treatment effects occur.
preserves the
framework of fibrins Instruct patient to swallow
Timing: matrix structure. tranexamic acid tablets
whole, without chewing or
8 4 12 breaking them.

Advise patient to report any

changes in the vision or
ocular discomforts.

Dependent

Administer medications as
prescribed by the physician.

Collaborative

Monitor platelet count and

clotting factors prior to and
periodically throughout
 therapy.

Classification Contraindications Side Effects

Active thromboembolic Nausea, vomiting,
Functional: disease; history or diarrhea, muscle
thromboembolism, cramps, facial
antifibrinolytic hypersensitivity to flushing, dyspnea
tranexamic acid or its
components
Chemical:

Synthetic lysine
amino acid
derivative
 Dosage, Route,
Name of Drug Frequency and Mechanism of Action
Timing
Generic: Dosage: Decreases viscosity of
600 mg/tab 1 pulmonary secretions by viscid, or thickened
acetylcysteine tab breaking disulfide links mucus secretions in
that bind glycoproteins in pneumonia.
Brand: mucus. Reduces liver
Route: dilute damage from
Fluimucil with 1/2 H2O, acetaminophen overdose.
PO Usually, acetaminophens
toxic metabolites bind
with glutathione in the
Frequency: OD liver, which detoxifies
them. When
acetaminophen overdose
Timing: 8 depletes glutathione
stores, toxic metabolites
bind with protein in liver
cells, killing them.
Acetylcysteine maintains
or restores levels of
glutathione or acts as its
substitute, which reduces
liver damage from
acetaminophen overdose.
Indication Adverse Reactions Special Precautions
To liquefy abnormal, CV: Edema, To avoid fluid overload and
hypertension, possibly fatal hyponatremia
hypotension, or seizures, adjust total
tachycardia administered volume, as
EENT:Rhinorrhea, ordered, for patients
stomatitis, tooth weighing less than 40 kg
damage (88 lb) and for those who
GI:Anorexia, need fluid restriction.
constipation, secretions, prepare to perform
hepatotoxicity, Acetylcysteine should be
RESP:Bronchospasm, used cautiously in patients
chest tightness, cough, with asthma or a history of
hemoptysis, respiratory bronchospasm because
distress, shortness of drug may adversely affect
breath, stridor, respiratory function.
wheezing SKIN: Clammy
skin, facial flushing, Be aware that
pruritus, rash, urticaria acetylcysteine may have a
Other:Anaphylaxis, disagreeable odor, which
angioedema disappears as treatment
progresses.
Refrigerate opened vials
and discard after
96 hours.
If patient vomits loading
dose or any maintenance
dose within 1 hour of
administration, repeat dose
as prescribed.
Keep in mind that suicidal
patient may not provide
reliable information about
vomiting. Watch such a
patient to ensure that he
Nursing Responsibilities
Independent
Monitor vital signs
Assess type, frequency, and
characteristics of patients
cough. Particularly note
sputum. If cough doesnt clear
mechanical suctioning.
Instruct the patient to follow
directions exactly.
Tell patient to avoid driving or
other hazardous activities
Instruct patient to notify
prescriber immediately about
nausea, rash, or vomiting.
Warn patient about
acetylcysteines unpleasant
smell; reassure him that it
subsides as treatment
progresses.
Dependent
To decrease mucus viscosity,
urge patient to consume 2 to 3 L
of fluid daily unless
contraindicated by another
condition.
 ingests all of prescribed
dosage. Administer drug as prescribed
by the physician

Collaborative

Monitor patient for tachycardia.

Classification Contraindications Side Effects

Hypersensitivity to Nausea, vomiting, tooth
Functional: acetylcysteine,no damage, chills,
Antidote (for contraindications when dizziness, drowsiness,
acetaminophen used as antidote fever, headache.
overdose),
mucolyti

Chemical:

N-acetyl
derivative of
cysteine
 Dosage, Route,
Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: Decreases hepatic Management of type 2 Lactic acidosis occurs Respiratory impairment, Independent
500mg production of glucose. diabetes mellitus as rarely (0.03 cases/1,000 CHF, dehydration,
Metformin Decreases absorption monotherapy or pts) but is a serious and impaired hepatic Monitor vital signs
hydrochloride of glucose, improves concomitantly with oral often fatal (50%) function, excessive
insulin sensitivity. sulfonylurea or insulin. complication decrease in acute/chronic alcohol Assess baseline glucose, renal
Route:
Therapeutic Effect: blood pH, electrolyte intake. function tests.
P.O.
Improves glycemic disturbances. Symptoms
control, include unexplained Inform physician if any untoward
Brand: stabilizes/decreases hyperventilation, signs and symptoms occur.
Frequency: body weight, improves myalgia, malaise,
TID lipid profile. drowsiness. May advance Give metformin tablet with meals,
to cardiovascular which decreases and slightly delays
collapse (shock), acute absorption, thus reducing the risk of
CHF, acute MI, prerenal adverse GI reactions.
Timing: azotemia.
8 1 6 Instruct patient to take metformin
during breakfast if taking drug once a
day

Stress importance of following the

prescribed diet, exercising regularly,
controlling weight, and checking
blood glucose level.

Caution patient to avoid alcohol,

which can increase the risk of
hypoglycemia.

Teach patient how to measure blood

glucose level and recognize
hyperglycemia and hypoglycemia.

Dependent

Discontinue metformin, immediately

if evidence of lactic acidosis appears.

Administer drug as prescribed by the

physician
 Collaborative

Monitor fasting serum glucose, Hgb

A1c, renal function, Hgb, Hct, RBC.

Monitor folic acid, renal function,

assess for hypoglycemia

Classification Contraindications Side Effects

Renal disease/ Occasional (greater than
Functional: dysfunction; abnormal 3%): GI disturbances
Antidiabetic creatinine clearance from (diarrhea, nausea,
any cause including MI, vomiting, abdominal
acute CHF, septicemia, or bloating, flatulence,
shock; acute or chronic anorexia) that are
Chemical:
metabolic acidosis. transient and resolve
Dimethylbiguani spontaneously during
de therapy. Rare (3%1%):
Unpleasant/metallic
taste that resolves
spontaneously during
therapy.
 Dosage, Route,
Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: Selectively inhibits Treatment for Exfoliative skin Hepatic/renal Independent
Fluconazole 100mg fungal CYP450 pneumonia. disorders, serious impairment,
dependent enzyme hepatic effects, blood hypersensitivity to Monitor vital signs
lanosterol 14-- dyscrasias (eosinophilia, other triazoles (e.g.,
Assess infected area. Establish
Route: demethylase, the thrombocytopenia, itraconazole,
baselines for CBC, serum
Brand: P.O. enzyme that anemia, leukopenia) terconazole),
potassium, hepatic function
converts lanosterol have been reported imidazoles (e.g., studies
to ergosterol. rarely. butoconazole,
Frequency: Subsequent loss of ketoconazole). Monitor daily pattern of bowel
OD normal sterol activity, stool consistency.
correlates with the Age-related renal
accumulation of 14- impairment may Assess for dizziness; provide
-methyl sterols in require dosage assistance as needed.
Timing: fungi and may be adjustment.
8 responsible for the Notify physician of dark urine, pale
stool, jaundiced skin or sclera of
fungistatic activity.
eyes, rash, pruritus.

Assess for rash every 8 hours

during the therapy

Advise patient to complete entire

course of treatment

Alert patient that fluconazole may

change the taste of food

Dependent

Administer drug as prescribed by

the physician

Collaborative

Monitor serum hepatic/ renal

function tests.
Classification Contraindications Side Effects
Hypersensitivity to the Occasional (4%1%):
Functional: drug and its Hypersensitivity reaction
Systemic components (chills, fever, pruritus,
antifungal rash), dizziness,
drowsiness, headache,
constipation, diarrhea,
Chemical: nausea, vomiting,
Triazole abdominal pain.
derivative
 Dosage, Route,
Name of Drug Frequency and Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing
Generic: Dosage: Inhibits the enzyme Temporary relief of Hematologic: Use cautiously in Independent
cyclooxygenase, blocking pain and discomfort Hemolytic anemia, patients with long term
Monitor vital signs and assess
Paracetamol 500 mg/tab 1 tab prostaglandin production from headache, leukopenia, alcohol use because pain scale
and interfering with pain fever, cold, flu. neutropenia, therapeuticdoses cause Use liquid form for children and
Route: impulse generation in the pancytopenia, hepatotoxicity in these patients who have difficulty
peripheral nervous thrombocytopenia patients swallowing.
Brand: PO system.Acetaminophen also Hepatic: liver In children, dont exceed five
doses in 24 hours.
acts directly on damage, jaundice Advise patient that drug is only for
Biogesic Frequency: temperature-regulating Metabolic: short term use and to consult the
Q4H PRN for center in the hypothalamus hypoglycemia physician if giving to children for
fever by inhibiting synthesis of longer than 5 days or adults for
prostaglandin E2. longer than 10 days.
Advise patient or caregiver that
many over the counter products
Timing: contain acetaminophen; be aware
of this when calculating total daily
dose.
Warn patient that high doses or
unsupervised long term use can
cause liver damage.
Teach patient to recognize signs of
hepatotoxicity,such as
bleeding,easy bruising, and
malaise, which commonly occurs
with chronic overdose.

Dependent

Administer medication as
prescribed by the physician

Collaborative

Monitor liver function test

results,including AST,ALT, bilirubin,
and creatinine levels, as ordered.

Monitor renal function in patient

 on long term therapy. Keep in mind
that blood or albumin in urine may
indicate nephritis; decreased urine
output may indicate renal failure;
and dark brown urine may indicate
presence of the metabolite
phenacetin

Classification Contraindications Side Effects

Contraindicated to GI: Abdominal pain,
Functional: patients hepatotoxicity,
hypersensitivity to nausea, vomiting
Antipyretic, the drug. SKIN:Jaundice, rash,
nonopioid urticaria Other:
analgesic Angioedema,
hypoglycemic coma
Chemical:
Nonsalicylate,
paraaminophenol
derivative
 Dosage, Route,
Name of Drug Frequency and Mechanism of Action Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing
Generic: Dosage: Enters target cells and Replacement therapy in Na and fluid Know that elderly are at Independent
100 mg binds adrenal cortical retention, high risk for osteoporosis
Monitor vital signs
Hydrocortisone to cytoplasmic insufficiency- Allergic hypocalcemia, during long term therapy.
Route: receptor; states severe increased blood Assess for contraindications.
initiates many complex or incapacitating allergic sugar Caution patient to avoid
PO reactions that are conditions ,increased serum people with infections Do not give live vaccines with
responsible cholesterol, beacause drug can immunosuppressive
Brand: doses of hydrocortisone.
Frequency: for its anti- decreased T3 and T4 suppress immune
inflammatory, levels system, increasing risk of Give daily before 9am to mimic
Q6H immunosuppressive infection. normal peak diurnal corticosteroid
(glucocorticoid), levels.
Timing: and salt-retaining
Space multiple doses evenly
(mineralocorticoid) throughout the day.
12 6 12 6 actions.
Use minimal doses for minimal
duration to minimize adverse
effects.

Educate client on the side effects

of the medication and what to
expect.

Dependent

Administer medication as
prescribed by the physician

Taper doses when discontinuing

high-dose or long-term therapy

Arrange for increased dosage when

patient is subject to unusual stress.

Collaborative

Assess body weight, skin color, V/S,

urinalysis, serum electrolytes, X-rays,
CBC.
Classification Contraindications Side Effects
Allergy to any component Headache, nausea,
Functional: of the drug vomiting, abdominal
distention
Adrenocorticoid Fungal infections
replacement,
anti- Amebiasis
inflammatory
Hepatitis B
Chemical:
Vaccinia or varicella
Glucocorticoid
Antibiotic-resistant
infections

Immunosuppression
 Dosage, Route,
Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: Destroys bacteria by Treatment for lower respiratory Antibiotic-associated Hypersensitivity to Independent
inhibiting Addition tract infections; Pneumonia colitis, other penicillins, cephalosporins,
(Adults) superinfections other allergens; renal
Ampicillin Sodium 500 mg/cap 1 cap of sulbactam Monitor vital signs
enhances drugs (abdominal cramps, impairment; CNS disorders,
severe watery particularly with history of Inquire about history of
Route: resistance to beta-
Brand: diarrhea, fever) may seizures; concurrent use seizures.
lactamase, an enzyme
result from altered with valproic acid.
PO that can inactivate bacterial balance. Monitor daily pattern of bowel
ampicillin. Anaphylactic reactions Elderly: Age-related renal activity, stool consistency,
Frequency: have been reported. impairment may require nausea, vomiting.Evaluate
Seizures may occur in dosage adjustment. hydration status.
Q8H; PRN for those with CNS
hemoptysis disorders), bacterial Avoid giving ampicillin to Monitor I&O, renal/ hepatic
meningitis, renal patients with non-nucleosis function tests.
impairment. because of increased risk of
Timing: rash. Monitor patient closely for
anaphylaxis, which may be life-
Expect to give ampicillin for threatening. Patients at
8 4 12
48 to 72 hours after patient greatest risk are those with a
becomes asymptomatic. history of multiple allergies,
For streptococcal infection, hypersensitivity to
expect to give ampicillin for cephalosporins, or a history of
at least 10 days after asthma, hay fever,or urticaria.
cultures show streptococcal
eradication to reduce risk Inform physician of persistent
of rheumatic fever or diarrhea, abdominal cramps,
glomerulonephritis fever.

Dependent

Administer medications as
prescribed by the physician.

Collaborative

Monitor serum electrolytes,

 esp. potassium.

If long-term or high-dose
ampicillin therapy is required,
closely monitor results of renal
and liver function tests and
CBCs.
Classification Contraindications Side Effects
Active thromboembolic Frequent (5%3%):
Functional: disease; history or Diarrhea, nausea,
thromboembolism, vomiting, headache,
Antibiotic hypersensitivity to inflammation at
tranexamic acid or its injection site.
components Occasional (2%): Oral
Chemical:
candidiasis, rash,
pruritus. Rare (less
Semisynthetic than 2%): Constipation,
aminopenicillin glossitis.
 Dosage, Route,
Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: Binds to a ribosomal To treat community-acquired CNS: Use azithromycin cautiously in Independent
azithromycin 500 mg/tab 1 tab subunit of susceptible pneumonia Aggressiveness,agitation, patients with hepatic
bacteria, blocking anxietyasthenia, malaise, dysfunction (drug is Monitor vital signs
peptide translocation nervousness, paresthesia, metabolized in the liver) or
and inhibiting RNA- seizures, somnolence, renal dysfunction (effects are
Monitor bowel elimination; if
Route: PO dependent protein syncope, vertigo CV: unknown in this group).
synthesis. Drug Chest pain, edema,
needed, obtain stool culture to
Brand:
concentrates in elevated serum CK level, Dont give azithromycin by rule out pseudomembranous
phagocytes, hypotension, I.V. bolus or I.M. injection colitis. If it occurs, expect to
macrophages, and palpitations, prolonged because it may cause stop azithromycin and give
Frequency: fibroblasts, which release QT interval, torsades de erythema,pain,swelling,tender fluid, electrolytes, and
OD it slowly and may help pointes, ventricular ness, or other reaction at the antibiotics effective with
move it to infection sites. tachycardia EENT:Hearing site. Infuse it over 60 minutes Clostridium difficile.
loss, mucocutaneous or longer, as prescribed
candidiasis, perversion or (typically 1 mg/ml over 3 Assess patient for bacterial or
loss of taste or smell, hours or 2 mg/ml over 1
Timing: 8 fungal superinfection, which
tinnitus ENDO: hour.)
Hyperglycemia GI:
may occur with prolonged or
Abdominal pain, repeated therapy. If it occurs,
anorexia, cholestatic expect to give another
jaundice, elevated liver antibiotic or antifungal.
function test results,
flatulence, hepatic Tell patient to take
necrosis or failure, azithromycin capsules 1 hour
hepatitis, nausea, before or 2 to 3 hours after
pancreatitis, food. Instruct patient to take
pseudomembranous
tablets or suspension without
colitis, GU:Acute renal
failure, elevated BUN and
regard to food.
serum creatinine levels,
nephritis, vaginal Urge patient to consult
candidiasis prescriber before taking OTC
HEME:Leukopenia, drugs, including antacids. If
neutropenia, theyre prescribed, tell patient
thrombocytopenia to take azithromycin 1 hour
MS:Arthralgia before or 2 to 3 hours after
SKIN:Erythema taking antacids.
multiforme,photosensitiv
ity,pruritus,rash,Stevens-
Johnson syndrome, toxic
Dependent
epidermal necrolysis,
urticaria Other:Allergic Administer medications as
reaction, anaphylaxis, prescribed by the physician.
 angioedema,elevated
serum phosphorus level, Collaborative
hyperkalemia, infusion
site reaction (such as If hepatic function is impaired,
pain and redness),new or
monitor liver function studies
worsening myasthenia
syndrome, superinfection
because drug is eliminated
mainly by the liver.

Obtain culture and sensitivity

test results, if possible, before
starting therapy.

Classification Contraindications Side Effects

Hypersensitivity to
Functional: azithromycin,erythromycin,
ketolide antibiotics, or other
macrolide antibiotics
Antibiotic
Dizziness, fatigue,
headache, hyperactivity,
Vomiting, constipation,
diarrhea, dyspepsia

Chemical:

Azalide (subclass
of macrolide)
 Dosage, Route,
Name of Drug Frequency and Mechanism of Indication Adverse Reactions Special Precautions Nursing Responsibilities
Timing Action
Generic: Dosage: 1 The ipratropium Used as a bronchodilator to CNS: Anxiety, dizziness, Use cautiously in patients Independent
nebule ingredient is an control and prevent drowsiness, headache, with cardiac disorders,
reversible airway hyperkinesia, insomnia, diabetes mellitus, digitalis Monitor vital signs esp respiratory
Ipratropium + anticholinergic drug irritability, vertigo, intoxication, hypertension, rate
salbutamol which relaxes smooth obstruction caused by
weakness CV: Angina; hyperthyroidism, or history of
Pneumonia
muscle in the lung. arrhythmias, including seizures.Albuterol can worsen Assess lung sounds, pulse and
Brand: Route: The salbutamol atrial fibrillation, these conditions. blood pressure before
Pulmonary ingredient is a beta- extrasystoles, administration and during peak of
supraventricular Thyrotoxicosis. Inhaled medication.
Combivent Inhalation 2agonist which tachycardia,and salbutamol prep are not
stimulatesbeta-2 tachycardia;chest pain; appropriatefor managing Observe for paradoxical
sites in the lungs to hypertension; premature labour. bronchospasm (wheezing). If
relax the bronchi. hypotension; palpitations condition occurs, with hold
Frequency: EENT: Altered taste,dry Excess inhaler use which medication and notify physician.
mouth and throat, ear may lead to tolerance
Q6H pain, glossitis, and paradoxical Instruct mother to take missed
hoarseness, bronchospasm dose as soon as
oropharyngeal edema, remembered, spacing remaining
pharyngitis, rhinitis, taste Use Cautiously to doses at regular intervals.
Timing: perversion patients with known
ENDO:Hyperglycemia Inform the mother not to smoke
12 6 12 6 GI:Anorexia, diarrhea,
sensitivity to atropine, near the child & to avoid
dysphagia, heartburn, soybeans, soy alecithin, respiratory irritants
nausea, vomiting GU:UTI and peanuts
MS: Muscle cramps RESP: Advise the mother to rinse the
Bronchospasm, cough, childs mouth w/ water after each
dyspnea, paradoxical inhalation dose to minimize dry
bronchospasm,pulmonar mouth
y edema SKIN:
Diaphoresis, flushing, Advise patient to wait at least 1
pallor, pruritus, rash, minute between inhalations.
urticaria Other:
Angioedema, Instruct patient to wash
hypokalemia, infection, mouthpiece with water once a
metabolic acidosis week and let it air-dry.

Be aware that drug tolerance can

develop with prolonged use.

Dependent

Administer drug as prescribed by

 the physician

Collaborative

Monitor serum potassium level

because albuterol may cause
transient hypokalemia

Monitor pulmonary function tests

before initiating therapy
&periodically throughout course to
determine effectiveness
of medication

Classification Contraindications Side Effects

Contraindicated with Nervousness
Functional: hypersensitivity to the drug;
tachyarrhythmias,tachycardia
Anticholinergic, cause by digitalis intoxication.
Restlessness
bronchodilator
Hypersensitivity to adrenergic a Tremor
mines
Chemical: Chest pain
Hypersensitivity to
fluorocarbons
Selective beta2- Palpitations
adrenergic agonist,
sympathomimetic

Quaternary N-
methyl isopropyl
derivative of
noratropine