Name of Drug: N- Acetylcysteine

Therapeutic Class: Mucolytics

Pharmacologic Class: L- cysteine derivatives
Controlled Substance Schedule:
Pharmacodynamics: Drug Action
N- Acetylcysteine reduces the viscosity of pulmonary secretions by splitting disulfide
linkages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to
treat acetaminophen toxicity.
Therapeutic Use:
Acetylcysteine lowers viscosity and facilitates the removal of secretions.
Precautions and Contraindications
 Contraindicated in patients hypersensitive to drug
 Use cautiously in elderly or deliberated patients with severe respiratory
insufficiency.
Dynamics-Side Effects/Adverse Effects:
CNS: fever, drowsiness
CV: chest tightness, flushing, tachycardia, edema
EENT: rhinorrhea, pharyngitis, throat tightness
GI: nausea, stomatitis, vomiting
Respiratory: bronchospasm, cough, dyspnea, rhonchi
Skin: clamminess, pruritus, rash, urticaria
Drug-Drug Interactions

Nursing Considerations
 Monitor cough type and frequency
 During IV NAC administration, patients need to be monitored for manifestations
of anaphylactoid reaction as described earlier.
 Monitor for S&S of aspiration of excess secretions, and for bronchospasm
(unpredictable); withhold drug and notify physician immediately if either occurs.
 Flushing and skin erythema may occur 30 to 60 minutes of I.V. infusion and
usually resolve without stopping infusion.
 Warn patient that drug may have a foul taste or smell that may be distressing.
 Instruct patient to cough to clear airway before aerosol administration
Name of Drug: Cetirizine
Therapeutic Class: Antihistamines
Pharmacologic Class: Piperazine derivatives
Controlled Substance Schedule:

Pharmacodynamics: Drug Action

Cetirizine is a potent H1-receptor antagonist and thus an antihistamine without significant
anticholinergic or CNS activity. Low lipophilicity combined with its H1-receptor selectivity
probably accounts for its relative lack of anticholinergic and sedative properties.
Therapeutic Use:
Effectively treats allergic rhinitis, and chronic urticaria by eliminating or reducing the
local and systemic effects of histamine release.
Precautions and Contraindications
 Hypersensitivity to H1-receptor antihistamines; lactation, children <2 y.
 During breastfeeding, antihistamines shouldn’t be used because many of these
drugs appear in human milk and may cause unusual excitability in the infant.
 Children, especially those younger than age 6, may experience paradoxical
hyperexcitability with restlessness, insomnia, nervousness, euphoria, tremors, and
seizures; give cautiously
 Elderly patients usually are more sensitive to the adverse effects of
antihistamines, especially dizziness, sedation, hypotension, and urine retention;
use cautiously and monitor these patients closely.
Dynamics-Side Effects/Adverse Effects:
GI: Constipation, diarrhea, dry mouth. CNS: Drowsiness, sedation, headache, depression.
Drug-Drug Interactions
 Theophylline may decrease cetirizine clearance leading to toxicity
Nursing Considerations
 Monitor for drug interactions. As the drug is highly protein bound, the potential
for interactions with other protein-bound drugs exists.
 Monitor for sedation, especially the older adult.
 Do not use in combination with OTC antihistamines.
 Do not engage in driving or other hazardous activities, before experiencing your
responses to the drug.
 Do not breast feed while taking this drug without consulting physician.
Name of Drug: Paracetamol
Therapeutic Class: Analgesics
Pharmacologic Class: Para-aminophenol
Controlled Substance Schedule:

Pharmacodynamics: Drug Action

 Thought to produce analgesia by inhibiting prostaglandin and other substances
that sensitize pain receptors. Drug may relieve fever through central action in the
hypothalamic heat-regulating center.
Therapeutic Use:
 Provides temporary analgesia for mild to moderate pain. In addition,
acetaminophen lowers body temperature in individuals with a fever.
Precautions and Contraindications
 Hypersensitivity to acetaminophen or phenacetin; use with alcohol.

Dynamics-Side Effects/Adverse Effects:
CNS: agitation (I.V.), anxiety, fatigue, headache, insomnia, pyrexia.
CV: HTN, hypotension, peripheral edema, periorbital edema, tachycardia (I.V.).
GI: nausea, vomiting, abdominal pain, diarrhea, constipation (I.V.).
GU: oliguria (I.V.)
Hematologic: hemolytic anemia, leukopenia, neutropenia, pancytopenia, anemia.
Drug-Drug Interactions
 Cholestyramine may decrease acetaminophen absorption. With chronic
coadministration, BARBITURATES, carbamazepine, phenytoin, and rifampin
may increase potential for chronic hepatotoxicity. Chronic, excessive ingestion of
alcohol will increase risk of hepatotoxicity.
Nursing Considerations
 Monitor for S&S of: hepatotoxicity, even with moderate acetaminophen doses,
especially in individuals with poor nutrition or who have ingested alcohol over
prolonged periods; poisoning, usually from accidental ingestion or suicide
 attempts; potential abuse from psychological dependence (withdrawal has been
associated with restless and excited responses).
 Do not take other medications (e.g., cold preparations) containing acetaminophen
without medical advice; overdosing and chronic use can cause liver damage and
other toxic effects.
 Do not self-medicate adults for pain more than 10 d (5 d in children) without
consulting a physician.
 Do not use this medication without medical direction for: fever persisting longer
than 3 d, fever over 39.5° C (103° F), or recurrent fever.
 Do not give children more than 5 doses in 24 h unless prescribed by physician.
 Do not breast feed while taking this drug without consulting physician.
Name of Drug: Ceftriaxone 2g/IV
Therapeutic Class: Anti-Infectives
Pharmacologic Class: Third-Generation Cephalosporins
Controlled substance schedule:
Pharmacodynamics
Cephalosporins exhibit time-dependent killing (T > MIC)
Ceftriaxone is a cephalosporin/cephamycin beta-lactam antibiotic used in the
treatment of bacterial infections caused by susceptible, usually gram-positive, organisms.
Ceftriaxone has in vitro activity against gram-positive aerobic, gram-negative aerobic,
and anaerobic bacteria. The bactericidal activity of ceftriaxone results from the inhibition
of cell wall synthesis and is mediated through ceftriaxone binding to penicillin-binding
proteins (PBPs). Ceftriaxone is stable against hydrolysis by a variety of beta-lactamases,
including penicillinases, and cephalosporinases and extended-spectrum beta-lactamases.
However, resistance to ceftriaxone usually occurs through beta-lactamase hydrolysis,
altered PBPs, or reduced bacterial cell permeability. Ceftriaxone should not be mixed
with or giving in the same IV line as diluents/products containing calcium as they may
cause ceftriaxone to precipitate. Ceftriaxone use may also cause biliary sludge or
gallbladder pseudolithiasis
Therapeutic Use
Ceftriaxone is indicated in the treatment of the following infections in adults and children
including term neonates (from birth):
 Bacterial Meningitis
 Community acquired pneumonia
 Hospital acquired pneumonia
 Acute otitis media
 Intra-abdominal infections
 Complicated urinary tract infections (including pyelonephritis)
 Infections of bones and joints
 Complicated skin and soft tissue infections
 Gonorrhea
 Syphilis
 Bacterial endocarditis
Ceftriaxone may be used:
 For treatment of acute exacerbations of chronic obstructive pulmonary disease in
adults
  For treatment of disseminated Lyme borreliosis (early (stage II) and late (stage
III)) in adults and children including neonates from 15 days of age.
 For Pre-operative prophylaxis of surgical site infections
 In the management of neutropenic patients with fever that is suspected to be due
to a bacterial infection
 In the treatment of patients with bacteremia that occurs in association with, or is
suspected to be associated with, any of the infections listed above
 Ceftriaxone should be co-administered with other antibacterial agents whenever
the possible range of causative bacteria would not fall within its spectrum (see
section 4.4).
 Consideration should be given to official guidance on the appropriate use of
antibacterial agents.

Precautions and Contraindications

Precautions
 Hypersensitivity reactions
 Interaction with calcium containing products
 Immune mediated hemolytic anemia
 Colitis/Overgrowth of non-susceptible microorganisms
 Severe renal and hepatic insufficiency
 Interference with serological testing
 History of GI disease: Colitis
 Biliary lithiasis
 Biliary stasis
 Renal lithiasis: Renal Impaitment
 Encephalopathy
Contraindications
 History of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of
beta-lactam antibacterial agent (penicillin, monobactams and carbapenems).
 Premature neonates up to a postmenstrual age of 41 weeks
 Hyperbilirubinemic neonates; increased risk for bilirubin encephalopathy
(kernicterus)
Dynamics- Side Effects/Adverse Effects
CNS: SEIZURES (HIGH DOSES). .
GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, cholelithiasis, sludging in the
gallbladder.
Derm: rashes, urticaria. 
 Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia, thrombocytosis. 
Local: pain at IM site, phlebitis at IV site. 
Misc.: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, superinfection.

Drug-drug interaction
 Nitrates/Nitrites: Nitroglycerin, nitroprusside, nitric oxide, nitrous oxide
 Local anesthetics: Benzocaine, lidocaine, bupivacaine, mepivacaine, tetracaine,
prilocaine, procaine, articaine
 Antineoplastic agents: cyclophosphamide, flutamide, rasburicase, isofamide,
hydroxyurea
 Antibiotics: dapsone, sulfonamides, nitrofurantoin, paraaminosalicylic acid
 Antimalarials: chloroquine, primaquine
 Anticonvulsants: phenytoin, sodium valproate, phenobarbital
 Other drugs: acetaminophen, metoclopramide, sulfa drugs (i.e., sulfasalazine),
quinine
Nursing considerations
 Watch for seizures; notify physician immediately if patient develops or increases
seizure activity.
 Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain,
fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea,
vomiting, heartburn). Notify physician or nursing staff immediately of these signs.
 Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms
(tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash,
pruritus, urticaria). Notify physician or nursing staff immediately if these reactions
occur.
 Monitor signs of blood dyscrasias, including eosinophilia (fatigue, weakness,
myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain),
leukopenia (fever, sore throat, mucosal lesions, signs of infection), thrombocytopenia
(bruising, nose bleeds, bleeding gums, other unusual bleeding), or thrombocytosis
(headache, dizziness, chest pain, fainting, visual disturbances, numbness or tingling in
the hands and feet). Report these signs to the physician.
 Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive
injection site reactions to the physician.
Name of Drug: CELECOXIB
Therapeutic Class: NSAIDs

Pharmacologic class: Cyclooxygenase-2 inhibitors

Pharmacodynamics: Drug Action

Celecoxib exerts its anti-inflammatory and analgesic activities through blocking the
synthesis of various inflammatory prostanoids (PG). The prostanoids, which include PGs
and thromboxane, are the end products of fatty acid metabolism produced by tissue-
specific COX enzymatic activity.

Therapeutic Use

Celecoxib is used to relieve pain, tenderness, swelling and stiffness caused by

osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid
arthritis (arthritis caused by swelling of the lining of the joints), and ankylosing
spondylitis (arthritis that mainly affects the spine).

Precautions and Contraindications

Call your doctor right away if you have a rash, itching, trouble breathing or swallowing,
or any swelling of your hands, face, or mouth while you are using this medicine.
Tell your doctor if you or your child have unexplained weight gain or edema (fluid
retention or body swelling) with this medicine.
Celecoxib is contraindicated in patients with salicylate hypersensitivity or NSAIDs
hypersensitivity who have experienced asthma, urticaria, or allergic reactions after taking
aspirin or other NSAIDs. Severe, rarely fatal, anaphylactoid reactions to NSAIDs have
been reported in such patients.

Dynamics- Side Effects/ Adverse effects

 stomach pain, heartburn, gas, diarrhea, constipation, nausea, vomiting;

 swelling in your hands or feet;
 dizziness; or
 cold symptoms such as stuffy nose, sneezing, sore throat.
ADVERSE EFFECT

 Unexplained weight gain

 shortness of breath or difficulty breathing

 swelling of the abdomen, feet, ankles, or lower legs

 diarrhea

 nausea

 excessive tiredness

 unusual bleeding or bruising

 itching

 lack of energy

 loss of appetite

 pain in the upper right part of the stomach

 yellowing of the skin or eyes

 flu-like symptoms

 blisters

 fever

 rash

 hives

 swelling of the face, throat, tongue, lips, eyes, or hands

 hoarseness

 difficulty swallowing or breathing

 pale skin

 fast heartbeat

 cloudy, discolored, or bloody urine

 back pain

 difficult or painful urination

 frequent urination, especially at night

Drug- Drug Interactions

Nursing Considerations
Name of Drug: METFORMIN
Therapeutic Class: antidiabetics

Pharmacologic class: biguanides

Pharmacodynamics: Drug Action

Metformin lowers both basal and PPG. It works by suppressing excessive hepatic
glucose production, through a reduction in gluconeogenesis.

Therapeutic Use

Metformin works by helping to restore your body's proper response to the insulin you
naturally produce. It also decreases the amount of sugar that your liver makes and that your
stomach/intestines absorb.

Precautions and Contraindications

Contraindicated in patients hypersensitive to drug and in those with hepatic disease or

metabolic acidosis or lactic acidosis, including diabetic ketoacidosis with or without coma.

Not indicated for use in patients with type 1 diabetes mellitus

Dynamics: Side Effects/ Adverse effects

CNS: asthenia, headache, dizziness, chills, light headedness,

CV: chest discomfort, palpitations, HTN.

EENT: rhinitis

GI: diarrhea, nausea, vomiting, abdominal bloating, flatulence, anorexia, taste disorder,
abnormal stools, constipation, dyspepsia, weight loss.

Metabolic: hypoglycemia

Musculoskeletal: myalgia, limb pain.

RESPIRATORY: URI

SKIN: flushing, nail disorder, diaphoresis

Drug- Drug Interactions

 Beta blockers: hypoglycemia may be difficult to recognize in patients using beta

blockers. Monitor patients and blood glucose.
 Calcium channel blockers, corticosteroids, estrogens, fosphenytoin, hormonal
contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin,
sympathomimetics, thiazide and other diuretics, thryroid drugs: may produce
hyperglycemia. Monitor patient’s glycemic control.

Nursing Considerations

 Metformin is the drug of choice for overweight patients for whom dieting has not
controlled diabetes. Can also be used in patients who are not overweight and when
diabetes cannot be controlled with sulphonylurea treatment.

Advantages include lower incidence of weight gain.

 Gastrointestinal complaints are more common with higher doses.

 To avoid lactic acidosis do not use in patients with even mild renal
problems.
 Store in a tight container in a cool place

Generic Name:
Vitamin B complex

Brand Name:
Aduvit

Classification:
Multivitamins

Dosage:
1 tab OD

Route: Oral
Mechanism of Action:

-B complex vitamins consist of 8 vitamins. Thiamine, Riboflavine, Naicin, Pantothenic acid,

pyridoxine, Cyanocobalamin, Biotin and Folic Acid.
.

Adverse Effect:
-Niacin commonly causes flushing and headache, although this can be avoided by taking it in the
form of inositol hexaniacinate. Large doses of Riboflavin results in very bright yellow urine.
Indication:

-B complex vitamins include B1, B2, B3, B6, B7, B9 and B12.

-In disorders requiring parents administration of vitamins and pre/post operative patient.

-Prophylaxis of vitamin b complex deficiency.

-When requirements are increased as in fever, severe burns, increased metabolism gestational
disorders that interfering with intake or absorption of vitamins, prolonged or wasting diseases
alcoholism.

Contraindication

-Known hypersensitive to any components is a contraindication for its use.

Before:
-Verify doctor’s order.

-Know the reason for giving the medication.

-Check for contraindications.

-Verify the right dosage.

-Give medication on time.

During:
-Verify the clients identity.

-Inform the purpose of the medication.

-Assess the route of administration.

-Check patient’s status.

-Administer on time

After:

-Instruct the client to report any problems.

-Ensure safety of the client.

-Dispose all materials

-Document the findings

Generic Name:
Tranexamic Acid

Brand Name:
Cyklokapron
Lysteda

Classification:
Therapeutic: hemostatic agents

Pharmacologic: fibrinolysis inhibitors

Mechanism of Action:

Tranexamic acid competitively inhibits activation of plasminogen thereby reducing

conversion of plasminogen to plasmin (fibrinolysin), an enzyme that degrades fibrin clots,
fibrinogen, and other plasma proteins, including the procoagulant factors V and VIII.
In patients with hereditary angioedema, inhibition of the formation and activity of plasmin by
tranexamic acid may prevent attacks of angioedema by decreasing plasmin-induced activation of
the first complement protein (C1).

Adverse Effect:

Nausea
Vomiting
Diarrhea
Hypotension
Thromboembolic, e.g., arterial, venous, embolic;
Neurologic, e.g., visual impairment, convulsions, headache, mental status changes; myoclonus;
Rash

Indication:

-Patients with hemophilia for short-term use (two to eight days)

-To reduce or prevent hemorrhage during and following tooth extraction.

-Treatment of severe localized bleeding secondary to hyperfibrinolysis, including epistaxis,

hyphema, or hypermenorrhea (menorrhagia) and hemorrhage following certain surgical
procedures

-Treatment of hereditary angioedema

Contraindication

-Hypersensitivity to tranexamic acid or any of the ingredients

-Acquired defective color vision, since this prohibits measuring one endpoint that should be
followed as a measure of toxicity.

-Subarachnoid hemorrhage

-Active intravascular clotting

Nursing Consideration

Before:

-Monitor blood pressure, pulse, and respiratory status as indicated by severity of bleeding.

-Monitor for overt bleeding every 15–30 min.

-Monitor neurologic status (pupils, level of consciousness, motor activity) in patients with
subarachnoid hemorrhage.

-Assess for thromboembolic complications. (especially in patients with history). Notify physician
of positive Homans’ sign, leg pain hemorrhage, edema, hemoptysis, dyspnea, or chest pain.

-Monitor platelet count and clotting factors prior to and periodically throughout therapy in
patients with systemic fibrinolysis.

During:

-Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely.

After:

-Instruct patient to notify the nurse immediately if bleeding recurs or if thromboembolic

symptoms develop.

-Caution patient to make position changes slowly to avoid orthostatic hypotension.

-Document the findings