Generic Name: paracetamol

Trade Name: Calpol

Classification: Analgesic

Indication: Relief of mild-to-moderate pain; treatment of fever

Contraindications: Patients with hypersensitivity, allergy to acetaminophen

Action: Relieves pain by inhibiting prostaglandin synthesis at the CNS

Side Effects: Nausea/vomiting, fatigue, constipation

Adverse Effects: Drowsiness, abdominal pain, cyanosis, convulsion

Nursing Responsibilities:

 Assess patient’s pain: type, location, intensity, and duration.

 Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.

 Teach family to recognize signs and symptoms of chronic overdose: bleeding, bruising, fever,
sore throat.
Drug name: salbutamol

Trade Name: Albuterol

Classification: Bronchodilators

Mechanism of action: Relaxes bronchial, uterine, and vascular smooth muscle by stimulating beta 2
receptors.

Indications: - To prevent or treat bronchospasm in patients with reversible obstructive airway disease

- To prevent exercise-induced bronchospasm

Contraindications:

- Patients that is hypersensitive to drug or its ingredients

- Use cautiously in patients with CV disorders (including coronary insufficiency and hypertension),
hyperthyroidism or diabetes mellitus and in those who are unusually responsive to adrenergics

- Use extended-release tablets cautiously in patients with GI narrowing

Side effects: headache, feeling nervous, restless, excitable or shaky, fast, slow or uneven heartbeat, bad
taste in the mouth, dry mouth, sore throat and cough, inability to sleep

Adverse reactions: - CNS: tremor, nervousness, dizziness, insomnia, headache, hyperactivity, weakness,
CNS stimulation, malaise.

- CV: tachycardia, palpitations, hypertension

- EENT: dry and irritated nose and throat with inhaled form, nasal congestion, epistaxis,
hoarseness

- GI: heartburn, nausea, vomiting, anorexia, altered taste, increased appetite

- Metabolic: hypokalemia

- Musculoskeletal: muscle cramps

- Respiratory: bronchospasm, cough, wheezing, dyspnea, bronchitis, increased sputum

- Other: hypersensitivity reactions

Nursing considerations:

 Administer accurately because adverse reactions and tolerance might occur.

 Raise side rails up because client might be restless and drowsy because of this drug.

 Keep room well-lit and see to it that client has a person with him closely in case of vertigo.

 Assess pulse for rhythm.

  Provide oral care or let patient gurgle after inhalation to get rid of the unpleasant aftertaste of
the inhalation.

 Auscultate lungs for presence of adventitious breath sounds that may signal pulmonary edema,
airway resistance or bronchospasm.

 Inspect client’s nail bed and oral mucosa for pallor.

  Place client in position of comfort to facilitate optimum rest and sleep.

Client and Family Teaching:

 Advise patient to seek assistance in performing activities of daily living because the risk of
feeling weak as well as having vertigo, drowsiness, and headache is possible.

 Educate client about avoiding stimulus that might precipitate vertigo such as too much light and
too much noise both in forms of talking and loud music and television.

 Instruct client to rise slowly from bed or when changing positions from lying to sitting to
standing.

 Advise client to have small frequent feedings to avoid increasing risk of vomiting and heartburn.

 Emphasize with the family and the client the importance of wiping off sweat to avoid easy
breakdown of skin integrity.

 Instruct client to report palpitations and increasing difficulty of breathing.

 Encourage family to provide opportunity for the client to express his or her feelings as
apprehension and anxiety are common side effects of the drug.

 Instruct client to increase oral fluid intake to facilitate drug excretion.

 Instruct client to avoid spicy and oily foods to prevent risk of developing heartburn.

 Emphasize with the client the importance of gurgling after inhalation to prevent dry mouth.
Drug name: nalbuphine

Trade Name: Nubain

Classification: opioid analgesics

Mechanism of action: Binds to opiate receptors in the CNS. Alters the perception of and response to
painful stimuli while producing generalized CNS depression. In addition, has partial antagonist
properties, which may result in opioid withdrawal in physically dependent patients. 

Indications: Moderate-to-severe pain. Also provides Analgesia during labor, Sedation before surgery,
Supplement to balanced anesthesia

Contraindications: History of hypersensitivity to drug. Safety during pregnancy (category C) or lactation

is not established. Prolonged use during pregnancy could result in neonatal withdrawal.

Side effects: dizziness, headache, sedation, confusion

Adverse reactions: dysphoria, euphoria, floating feeling, hallucinations, unusual dreams

Nursing considerations:

 Assess blood pressure (BP) and compare to normal values. Report a sustained increase in BP
(hypertension) or a fall in BP when patient assumes a more upright position (lying to standing,
sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician
when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.
 Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria,
confusion, hallucinations). Notify physician or nurse immediately if patient is unconscious or
extremely difficult to arouse.
 Assess symptoms of respiratory depression, including decreased respiratory rate, confusion,
bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing
(dyspnea). Withhold drug and notify physician if respiratory rate falls below 12.
 Monitor pulse oximetry and perform pulmonary function tests to quantify suspected changes in
ventilation and respiratory function. Excessive respiratory depression requires emergency care.
 Guard against falls and trauma (hip fractures, head injury). Implement fall-prevention strategies,
especially if patient exhibits sedation, dizziness, or blurred vision.
 Administer with caution to patients with hepatic or renal impairment.
Drug name: ceftriaxone

Trade Name: Rocephin

Classification: third-generation cephalosporins

Mechanism of action: Semisynthetic third-generation cephalosporin antibiotic. Preferentially binds to

one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible
organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the
bacterium.

Indications: Treatment of Skin and skin structure infections, Bone and joint infections, Complicated and
uncomplicated urinary tract infections, Uncomplicated gynecologic infections, including
gonorrhea, Lower respiratory tract infections, intra-abdominal infections, septicemia,
Meningitis, otitis media. Perioperative prophylaxis.

Contraindications: Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B).

Side effects: Nausea, vomiting, headache

Adverse reactions: Pruritus, fever, chills, pain, diarrhea, and induration at IM injection site; phlebitis (IV
site).

Nursing considerations:

 Determine history of hypersensitivity reactions to cephalosporins and penicillin and history of

other allergies, particularly to drugs, before therapy is initiated.
 Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for
signs of phlebitis (redness, swelling, pain).
 Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding.
Ceftriaxone appears to alter vitamin K–producing gut bacteria; therefore, hypoprothrombinemia
bleeding may occur.
 Check for fever if diarrhea occurs: Report both promptly.
 Report any signs of bleeding.
Drug name: ranitidine

Trade Name: Zantac

Classification: histamine H2 antagonists

Mechanism of actions: Inhibits the action of histamine at the H 2 receptor site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid secretion. Therapeutic Effects: Healing and
prevention of ulcers. Decreased symptoms of gastroesophageal reflux. Decreased secretion of
gastric acid.

Indications: Short-term treatment of active duodenal ulcers and benign gastric ulcers. Maintenance
therapy for duodenal and gastric ulcers after healing of active ulcer(s). Management of gastric
hypersecretory states (Zollinger-Ellison syndrome). IV: Prevention and treatment of stress-
induced upper GI bleeding in critically ill patients.

Contraindications: Hypersensitivity to ranitidine; acute porphyria; OTC administration in children <12 y.

Side effects:

Adverse reactions: Headache, malaise, dizziness, somnolence, insomnia, vertigo, mental confusion,
agitation, depression, hallucinations in older adults, constipation, abdominal pain, reversible
decrease in WBC count, thrombocytopenia.

Nursing considerations:

 Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive
injection site reactions to the physician.
 Be alert for early signs of hepatotoxicity (though low and thought to be a hypersensitivity
reaction): jaundice (dark urine, pruritus, yellow sclera and skin), elevated transaminases
(especially ALT) and LDH.
 Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the
throat or chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify
physician or nursing staff immediately if these reactions occur.
 Be aware that even if symptomatic relief is provided by ranitidine, this should not be interpreted
as absence of gastric malignancy. Follow-up examinations will be scheduled after therapy is
discontinued.