Gigante, Ma. Kristel T.

| BSN – 2B February 13, 2022

DRUG STUDY
Learning Outcomes:
1. Apply appropriate nursing concepts and actions holistically and comprehensively.
2. Familiarize with the different medications used to manage high risk postpartum complications.

CIPROFLOXACIN
Drug Data Classification Mechanism Therapeutics Effects Nursing
of Action Responsibilities
Generic Name: Therapeutic Ciprofloxacin Indications: Side Effects: Nursing
Ciprofloxacin Class: inhibits Cipro is 1. Nausea Considerations:
Antibiotics bacterial DNA indicated to 2. Diarrhea 1. Monitor
Brand Name: synthesis, patient with: 3. Changes in patient’s intake
Cipro, Cipro XR, Pharmacologic mainly by 1. Skin And Skin liver function and output, and
and ProQuin XR Class: blocking DNA Structure tests observe patient
Fluoroquino- gyrase; Infections 4. Vomiting for signs of
Dosage: lones bacteriacidal. 2. Bone And Joint 5. Rash crystalluria.
Infusion (pre- Ciprofloxacin Infections 6. Vaginal yeast 2. Black Box
mixed): 200 mg in Pregnancy is the 3. Complicated infection Warning:
100 mL D5W, 400 Category: antibiotic of Intra-Abdominal 7. Pain or Tendon rupture
mg in 200 mL D5W C choice for Infections discomfort in the may occur in
Injection: 200 mg, initial 4. Infectious abdomen patients
400 mg prophylactic Diarrhea 8. Headache receiving
Suspension therapy 5. Typhoid Fever quinolones. If
(oral): 250 mg/5 among (Enteric Fever) Adverse pain or
mL (5%), 500 asymptomatic 6. Uncomplicated Reactions: inflammation
mg/5 mL (10%) pregnant Cervical And 1. CNS: seizures, occurs or if
Tablets women Urethral confusion, patient ruptures
(extended- exposed to Gonorrhea headache, a tendon, stop
release, film- Bacillus 7. Inhalational restlessness drug.
coated): 500 mg, anthracis. Anthrax (Post- 2. GI: pseudo- 3. ALERT:
1000 mg Exposure) membranous Monitor patients
Tablets (film- 8. Plague colitis, diarrhea, for signs and
coated): 100 mg, 9. Chronic nausea, vomiting symptoms of
250 mg, 500 mg, Bacterial 3. GU: aortic aneurysm,
750 mg Prostatitis crystalluria, dissection and
10. Lower interstitial rupture.
Route: Respiratory Tract nephritis Discontinue drug
1. PO Infections 4. Hematologic: immediately if
- Extended and 11. UTI leukopenia, any of aortic
immediate release 12. Acute sinusitis neutropenia, disorders are
oral forms aren’t 13. Acute thrombocyto- suspected.
interchangeable. Uncomplicated penia, 4. ALERT:
- Obtain specimen Cystitis eosinophilia Monitor patients
for culture and 5. Musculo- for signs of
sensitivity tests Contraindications: skeletal: tendon peripheral
before giving first Cipro is rupture neuropathy, and
dose. Begin contraindicated 6. Skin: rash, SJS, report them
therapy while to patient with: toxic epidermal immediately to
awaiting results. 1. Sensitive to necrolysis the practitioner.
fluoroquinolones.
- To avoid 2. Diabetes Other: 5. ALERT:
decreasing the 3. Low blood hypersensi- Immediately
effects of sugar tivity reactions report signs and
ciprofloxacin, give 4. G6PD deficiency symptoms of
at least 2 hours 5. Low amount of hepatitis and
before or 6 hours magnesium in the Ciprofloxacin discontinue the
after certain drugs blood cause problems drug.
and vitamins. Food 6. Low amount of with the baby's 6. Long-term
doesn’t affect potassium in the muscle and therapy may
absorption but blood skeletal growth result in over-
may delay peak 7. Low seizure as well as joint growth of
levels. threshold pain and organisms
- Caffeine should 8. Pseudotumor potential nerve resistant to drug.
be avoided during cerebri damage in the 7. ALERT:
therapy with this 9. Myasthenia mother. Monitor patients
drug because of gravis Fluoroquinolones receiving
potential for 10. Slow heartbeat can increase the systemic drug for
increased caffeine 11. Inflammation risk of aortic symptoms of
effects. of a tendon tears or ruptures. hypoglycemic.
- Give drug with 12. Rupture of a Immediately
plenty of fluids to tendon discontinue drug
reduce risk of 13. Seizures for blood glucose
urine crystals. 14. High pressure disturbances,
- Don’t crush or within the skull and switch to a
split extended- 15. Kidney, lung, non-
release tablets. and heart fluoquinolone
- Shake oral transplant antibiotic if
suspension 16. Dissection of possible.
vigorously each the aorta
time before use for 17. Chronic kidney Patient Teaching:
approximately 15 disease stage 3B 1. Tell patient to
seconds; don’t give (moderate), take drug as
through feeding chronic kidney prescribed, even
tube. disease stage 4 after feeling
(severe), and better.
2. IV chronic kidney 2. Advise patient
- Obtain specimen disease stage 5 to drink plenty of
for culture and (failure) fluids to reduce
sensitivity tests 18. Kidney disease risk of urine
before giving first with likely crystals.
dose. Begin reduction in 3. Advise patient
therapy while kidney function not to crush,
awaiting results. 19. Aneurysm of split, or chew the
- Dilute drug to 1 to aorta extended-release
2 mg/mL using 20. Marfan tablets.
D5W or NSS for syndrome 4. ALERT: Warn
injection. 21. Ehlers-Danlos patient to seek
- If giving drug syndrome immediate
through a Y-type 22. Congenital medical
set, stop the other myasthenic attention for
IV solution while syndrome signs or
infusing. 23. Loeys-Dietz symptoms of
- Infuse over 1 syndrome aortic aneurysm,
hour into a large dissection, or
vein to minimize rupture.
discomfort and 5. ALERT: Warm
vein irritation. patient to
immediately
Frequency: notify prescriber
Adults: 250 to 500 for signs and
milligrams (mg) 2 symptoms of
times a day, taken serious adverse
every 12 hours for reactions,
7 to 14 days. including
unusual joint or
Appearance: tendon pain,
muscle
weakness, “pins
and needles”
tingling or
pricking
sensation,
numbness in the
arms or legs,
confusion or
hallucinations.
6. ALERT:
Caution patients
that significantly
low blood sugar
levels can occur.
Instruct patients
how to manage
symptoms and to
immediately
report any
occurrence to the
prescriber.
Cont. of Nursing Responsibilities (Patient Teaching):

7. ALERT: Advise patient with diabetes that they may need to monitor blood glucose levels more frequently during
therapy.
8. ALERT: Inform patients to immediately report psychiatric adverse reactions and that these can occur after just
one dose.
9. Warn patient to avoid hazardous tasks that requires alertness, such as driving, until effects of drug are known.
10. Instruct patient to avoid caffeine while taking drug because of potential for increased caffeine effects.
11. Advise patient that hypersensitivity reactions may occur even after first dose. If a rash or other allergic reaction
occurs, tell patient to stop drug immediately and notify prescriber.
12. Tell patient that tendon rupture can occur with drug and to notify prescriber if pain or inflammation occurs.
13. Tell patient to avoid excessive sunlight or artificial ultraviolet light during therapy.
 PAXIL
Drug Data Classification Mechanism of Therapeutics Effects Nursing
Action Responsibilities
Generic Name: Therapeutic Thought to be Indications: Side Effects: Nursing
Paroxetine Class: linked to drug’s Paxil is indicated 1. Headache Considerations:
Hydrochloride Antidepressant inhibition of to patient with: 2. Nervousness 1. Patients taking
CNS neuronal 1. Depression 3. Restlessness Paxil CR for
Brand Name: Pharmacologic uptake of (excluding 4. Drowsiness PMDD should be
Paxil, Paxil CR Class: serotonin. Brisdelle) 5. Dizziness periodically
SSRIs Paroxetine 2. Obsessive 6. Nasal reassessed to
Dosage: block the Compulsive irritation determine the
Suspension: 10 Pregnancy serotonin Disorder (OCD) 7. Sleep need for
mg/5 mL Category: reuptake 3. Panic Disorder problems continued
Tablets: 10 mg, D transporter (excluding (insomnia) treatment.
20 mg, 30 mg, (SERT) and Brisdelle) 8. Nausea 2. If signs or
40 mg thus increase 4. Social Anxiety 9. Constipation symptoms of
Tablets the Disorder (SAD) 10. Weight psychosis occur
(controlled- concentration 5. Generalized changes or increase,
release): 12.5 of synaptic Anxiety Disorder 11. Decreased expect
mg, 25 mg, 37.5 serotonin. (GAD) sex drive prescriber to
mg 6. Posttraumatic 12. Impotence reduce dosage.
Stress Disorder 13. Difficulty Record mood
Route: (PTSD) having an changes. Monitor
1. PO 7. Premenstrual orgasm patient for
- Give drug in Dysphoric 14. Dry mouth suicidal
the morning Disorder (PMDD) 15. Yawning tendencies, and
without regard 16. Ringing in allow only a
for food. Contraindications: the ears. minimum supply
- Don’t split or Paxil is of drug.
crush contraindicated Adverse 3. Black Box
controlled- to patient with: Reactions: Warning: Drug
release tablets. 1. A disorder with 1. CNS: may increase the
- Shake oral excess asthenia, risk of suicidal
suspension well antidiuretic dizziness, thinking and
before each use. hormone called headache, behavior ages
Measure with syndrome of insomnia, 18-24 years old
oral syringe or inappropriate somnolence, during the first 2
calibrated antidiuretic tremor, months of
measuring hormone. nervousness, treatment,
device. 2. Low amount of suicidal especially in
sodium in the behavior, those with major
Frequency: blood. anxiety, depressive
Adults: At first, 3. In increased paresthesia, disorder or other
20 milligrams risk of bleeding confusion, psychiatric
(mg) once a 4. Manic behavior agitation disorder.
day, usually 5. Manic- 2. CV: 4. Black Box
taken in the depression palpitations, Warning:
morning. 6. Suicidal vasodilation, Monitor patients
thoughts HTN, of all ages who
Older adults: 7. Serotonin tachycardia, are started on
At first, 10 mg syndrome, a type chest pain antidepressant
once a day, of disorder with 3. EENT: therapy and
usually taken in high serotonin blurred vision, observe closely
the morning. levels tinnitus, lump for clinical
or tightness in worsening,
 8. Closed angle throat, suicidality, or
Appearance: glaucoma pharyngitis, unusual changes
9. Liver problems rhinitis, in behavior.
10. Bleeding from sinusitis 5. ALERT: Don’t
stomach, 4. GI: dry stop drug
esophagus or mouth, nausea, abruptly.
duodenum constipation, Withdrawal or
11. Severe renal diarrhea, discontinuation
impairment flatulence, syndrome may
12. Seizures vomiting, occur if drug is
13. A feeling of dyspepsia, stopped abruptly
restlessness with dysgeusia, Symptoms
inability to sit still increased or include
14. Broken bone decreased headache,
due to disease or appetite, myalgia, lethargy
illness. abdominal pain and general
5. GU: flulike
ejaculatory symptoms.
disturbances, Taper drug
sexual slowly over 1 to
dysfunction, 2 weeks.
Cont. of Effects (Adverse Effects):

urinary frequency, other urinary disorders, dysmenorrhea, female genital tract disease
6. Musculoskeletal: myopathy, myalgia, myasthenia, back pain
7. Skin: diaphoresis, rash, pruritus
8. Respiratory: dyspnea

Others: decreased libido, yawning.

Using Paxil during pregnancy may increase risk for miscarriage and the newborn can experience heart defects if the
mother use Paxil while pregnant. If patient is taking paroxetine during the 3rd trimester and/or near the time of
delivery, her baby might have some difficulties for the first few days of life. The baby could have jitteriness, increased
muscle tone, irritability, altered sleep patterns, tremors (shivers), difficulty eating and some problems with breathing.
Most babies who are exposed to paroxetine do not have these signs. When they are present, they are usually mild and
go away on their own.

Cont. of Nursing Responsibilities (Nursing Considerations):

6. ALERT: Combining triptans with an SSRI or an SSNRI may cause serotonin syndrome or NMS-like reactions.
Signs and symptoms of serotonin syndrome may include restlessness, hallucinations, loss of coordination, fast
heartbeat, rapid changes in BP, increased body temperature, overactive reflexes, nausea, vomiting and diarrhea.
7. Look alike – sound alike: Don’t confuse paroxetine with fluoxetine or paclitaxel. Don’t confuse paxil with doxil,
paclitaxel, plavix, or taxol.

Patient Teaching:
1. Black Box Warning: Advise families and caregivers to closely observe patient for increased suicidal thinking and
behavior.
2. ALERT: Teach patient to recognize and immediately report signs and symptoms of serotonin toxicity.
3. Tell patient that drug may be taken with or without food, usually in morning.
4. Tell patient not to break, crush, or chew controlled-release tablets.
5. Warn patients to avoid activities that require alertness and good coordination until effects of drug are known.
 6. Tell patient to avoid alcohol and to consult prescriber before taking other prescription or OTC drugs or herbal
medicines.
7. Instruct patient not to stop taking drug abruptly.

References:
 Wolters Kluwer, Nursing 2021 Drug Handbook\
 U.S. Food and Drug Administration (2017), Ciprofloxacin Use by Pregnant and Lactating Women
https://www.fda.gov/drugs/bioterrorism-and-drug-preparedness/ciprofloxacin-use-pregnant-and-
lactating-women
 Zara Risoldi Cochrane, Pharm.D., M.S., FASCP (2019), Medications You Should Avoid During Pregnancy
https://www.healthline.com/health/pregnancy/category-c-drugs
 RxWiki (2020), Ciprofloxacin
https://www.rxwiki.com/ciprofloxacin
 John P. Cunha, DO, FACOEP (2021), Cipro
https://www.rxlist.com/cipro-drug.htm#description
 The Recovery Village Drug and Alcohol Rehab (2021), Taking Paxil During Pregnancy: What You Need to
Know
https://www.therecoveryvillage.com/paxil-addiction/paxil-while-pregnant/
 IBM Micromedex (2021), Paroxetine (Oral Route)
https://www.mayoclinic.org/drugs-supplements/paroxetine-oral-route/proper-use/drg-20067632
 WebMD (2005-2022), Common and Rare Side Effects for ciprofloxacin oral
https://www.webmd.com/drugs/2/drug-7748/ciprofloxacin-oral/details/list-contraindications