Nursing

Name of Drug Classification Mechanism of Action Indication Contraindication Side Effects

Responsibilities
Generic Name: Pharmacologic Co-trimoxazole is generally bactericidal; it treatment of infections • hematologic toxicity: CNS: headache, mental Before
Sulfamethoxazole and Class: acts by sequential blockade of folic acid due to susceptible neutropenia, depression, aseptic - Check
Trimethoprim; Sulfonamide and enzymes in the synthesis pathway. The organisms thrombocytopenia, meningitis, apathy, seizures, doctor’s order.
Cotrimoxazole folate antagonist sulfamethoxazole component inhibits agranulocytosis, hallucinations, ataxia, - Assess
formation of dihydrofolic acid from para- aplasticanemia nervousness, fatigue, vertigo, allergies to the
Trade/Brand Name: aminobenzoic (PABA), whereas trimethoprim Patient’s Indication: insomnia. drug
Bactrim, Septra Therapeutic inhibits dihydrofolate reductase. Both drugs  Primary • contraindicated in CV: thrombophlebitis. - Caution
Class: block folic acid synthesis, preventing bacterial prophylaxis in patients with known EENT: tinnitus. patient of the
Patients’ Dose: Antibiotic cell synthesis of essential nucleic acids. HIV- infected hypersensitivity to GI: nausea, vomiting, different side
100/160 mg/tab patients trimethoprim or sulfonamides, diarrhea, abdominal pain, effects.
Pharmacokinetics:  Treat bacterial or with documented anorexia, stomatitis, - Obtain
Route: Absorption: Well absorbed from the GI tract infection megaloblastic anemia pancreatitis, baseline vital
Oral (PO) after oral administration. (PTB) secondary to folate deficiency pseudomembranous colitis. signs.
Distribution: Distributed widely into body GU: toxic nephrosis with - Prepare drugs
Form: tissues and fluids • use with caution in oliguria and anuria, properly at
Tablet Metabolism: Metabolized by the liver. patients with impaired renal or crystalluria, hematuria, right dosage.
Excretion: Both components of co- hepatic function or with interstitial nephritis. During
Maximum dose: trimoxazole are excreted primarily in urine by possible folate or G-6-PD Hematologic: - Verify
glomerular filtration and renal tubular deficiency agranulocytosis, aplastic patient’s
Minimum dose: secretion anemia, megaloblastic identity.
100/160 mg/tab Route Onset Peak Duration anemia, thrombocytopenia, - Explain to
PO Unknown 1-4 hrs Unknown leukopenia, hemolytic patient the
Availability: anemia, pancytopenia. purpose of
 Injection: Interaction Hepatic: jaundice, hepatic medication.
trimethoprim DRUGS necrosis. - Take
16 mg/ml and Drug-drug. Cyclosporine: Musculoskeletal: arthralgia, medication
sulfamethoxaz Increases risk of myalgia, muscle weakness. with some
ole 80 mg/ml nephrotoxicity. Avoid use Respiratory: pulmonary food or drink.
 Suspension: together. infiltrates. This will stop
trimethoprim Digoxin: Increases digoxin Skin: erythema multiforme the patient
40 mg and levels. Monitor serum levels (Stevens-Johnson syndrome), from feeling
sulfamethoxaz closely. generalized skin eruptions, sick or nausea.
ole 200 mg/5 Indomethacin: May increase epidermal necrolysis, - Give with a
ml sulfamethoxazole levels. exfoliative dermatitis, full glass of
 Tablets: Dosage adjustment may be photosensitivity, urticaria, water.
trimethoprim needed. pruritus. - Maintain
100 mg and Methotrexate: Increases Other: hypersensitivity adequate fluid
 methotrexate levels. Use reactions (serum sickness, intake (at least
together cautiously. drug fever, anaphylaxis), 1,500 mL)
Oral anticoagulants: Co- rhabdomyolysis. during
trimoxazole may inhibit therapy.
hepatic metabolism, enhancing When an exanthema appears After
anticoagulant effects. Observe the treatment must be - Evaluate
patient for signs of bleeding. discontinued! therapeutic
sulfamethoxaz Oral sulfonylureas: Enhances response
ole 160 mg hypoglycemic effects. Monitor - Report any
blood glucose levels. suspected
Content: Para-aminobenzoic acid: adverse effects
Each Co-Trimoxazole Antagonizes sulfonamide to health care
100 mg/160 mg Forte effects. Monitor patient professional
Tablet contains 160 mg closely. who
sulfamethoxazole and Phenytoin: Inhibits phenytoin prescribed the
100 mg trimethoprim. metabolism. Dosage medication.
adjustment may be needed. - Document
Pyrimethamine: May cause correctly and
megaloblastic anemia with accordingly.
pyrimethamine doses greater PLUS 2 MORE
than 25 mg weekly. Avoid use INTERVENTIONS
together.
Tricyclic antidepressants:
Decreases antidepressant
effect. Monitor patient closely.
Zidovudine: May increase
serum zidovudine level.
Monitor patient carefully.
Vallerand, A., Sanoski, Vallerand, A., Vallerand, A., Sanoski, C., & Deglin, J. Vallerand, A., Sanoski, Vallerand, A., Sanoski, C., & Vallerand, A., Sanoski, C., & Vallerand, A., Sanoski,
C., & Deglin, J. (2017). Sanoski, C., & (2017). Drug Guide for Nurses. 15th Ed. FA C., & Deglin, J. (2017). Deglin, J. (2017). Drug Guide Deglin, J. (2017). Drug Guide C., & Deglin, J. (2017).
Drug Guide for Nurses. Deglin, J. (2017). Davis Company: Philadelphia Drug Guide for Nurses. for Nurses. 15th Ed. FA Davis for Nurses. 15th Ed. FA Davis Drug Guide for Nurses.
15th Ed. FA Davis Drug Guide for 15th Ed. FA Davis Company: Philadelphia Company: Philadelphia 15th Ed. FA Davis
Company: Philadelphia Nurses. 15th Ed. Schull, P. D. (2013). McGraw-Hill nurses Company: Philadelphia Company: Philadelphia
FA Davis drug handbook. New York: McGraw-Hill Schull, P. D. (2013). McGraw- Schull, P. D. (2013).
Schull, P. D. (2013). Company: Medical. Schull, P. D. (2013). Hill nurses drug handbook. McGraw-Hill nurses drug Schull, P. D. (2013).
McGraw-Hill nurses Philadelphia McGraw-Hill nurses New York: McGraw-Hill handbook. New York: McGraw-Hill nurses
drug handbook. New JONES & BARTLETT LEARNING. (2018). drug handbook. New Medical. McGraw-Hill Medical. drug handbook. New
York: McGraw-Hill Schull, P. D. Nurses Drug Handbook. SUDBURY. York: McGraw-Hill York: McGraw-Hill
Medical. (2013). McGraw- Medical. JONES & BARTLETT JONES & BARTLETT Medical.
Hill nurses drug co-trimoxazole (trimethoprim- LEARNING. (2018). Nurses LEARNING. (2018). Nurses
 sulfamethoxazole). (n.d.). Glowm. JONES & BARTLETT Drug Handbook. SUDBURY. Drug Handbook. SUDBURY. JONES & BARTLETT
JONES & BARTLETT https://www.glowm.com/resources/glowm/cd/ LEARNING. (2018). LEARNING. (2018).
LEARNING. (2018). handbook. New pages/drugs/c087.html Nurses Drug TRIMETHOPRIM- Nurses Drug
Nurses Drug Handbook. York: McGraw- Handbook. SUDBURY. SULFAMETHOXAZOLE Handbook.
SUDBURY. Hill Medical. (TMP-SMZ). (n.d.). SUDBURY.
co-trimoxazole RobHolland.
co-trimoxazole JONES & (trimethoprim- http://robholland.com/Nursin Contributor, N. T.
(trimethoprim- BARTLETT sulfamethoxazole). g/Drug_Guide/data/monograp (2019, August 1).
sulfamethoxazole). LEARNING. (n.d.). Glowm. hframes/T081.html Trimethoprim. Nursing
(n.d.). Glowm. (2018). Nurses https://www.glowm.co Times.
https://www.glowm.co Drug Handbook. m/resources/glowm/cd/ https://www.nursingtim
m/resources/glowm/cd/ SUDBURY. pages/drugs/c087.html es.net/clinical-archive/i
pages/drugs/c087.html mmunology/trimethopri
m-29-01-2004/

Name of Drug Classification Mechanism of Action Indication Contraindication Side Effects Nursing Responsibilities
Generic Name: Pharmacologic Ipratropium bromide is an The combination of Hypersensitivity to CNS: dizziness,blurred Before
Salbutamol + Class: anticholinergic albuterol and ipratropium salbutamol, ipratropium vision 1. Check the doctor’s order
Ipratropium Anticholinergic (parasympatholytic) agent which is used to prevent or fenoterol, atropine or 2. Assess allergy to the drug
appears to inhibit vagally- wheezing, difficulty its derivatives. GI: nausea, drymouth 3. Caution patient of the different
Trade/Brand Name: mediated reflexes by breathing, chest Hypertrophic obstructive side effects
Combivent, DuoNeb, Therapeutic antagonizing the action of tightness, and coughing cardiomyopathy, Respi: 4. Obtain baseline vital signs
Breva Class: acetylcholine, the transmitter in people with chronic tachyarrhythmia. dyspnea,bronchospasms 5. Prepare drugs properly at the
Bronchodilator agent released at the obstructive pulmonary ,horseness right dosage.
Patients’ Dose: neuromuscular junctions in the disease (COPD; a group
Salbutamol + lung. Anticholinergics prevent of diseases that affect the CV: palpitations,chest
Ipratropium neb q 6H the increases in intracellular lungs and airways) such pain During
concentration of Ca++ which is as chronic bronchitis 1. Verify patient’s identity
Route: caused by interaction of (swelling of the air Interaction 2. Explain to patient the purpose of
Inhalation acetylcholine with the passages that lead to the DRUGS medication
muscarinic receptors on lungs) and emphysema Increased adverse effects 3. To inhale the solution as a
Form: bronchial smooth muscle. (damage to the air sacs in with corticosteroids, nebulizer, teach these steps to the
Nebulizer solution the lungs). Albuterol and xanthine derivatives, patient:
Salbutamol relaxes bronchial, ipratropium combination diuretics. - Remove one vial of medication
Maximum dose: uterine, and vascular smooth
<6 times/ 24 hours muscle by stimulating beta 2
receptors.
Minimum dose:
4 times/ 24 hours
Pharmacokinetics
Availability: Absorption: Ipratropium:
Inhalation Solution (vial) Rapidly absorbed after
inhalation. Bioavailability:
Content: <10%; Salbutamol: Rapidly and
Albuterol Sulfate 2.5 mg completely absorbed after
in 3mL inhalation. Time to peak plasma
Ipratropium Bromide 0.5 concentration: Within 3 hours.
mg in 3mL Distribution: Ipratropium:
Plasma protein binding: <20%.
Metabolism: Ipratropium:
Partially metabolised to inactive
ester hydrolysis products;
Salbutamol: Undergoes first-pass
metabolism in the liver and
possibly in the gut wall.
Metabolised to inactive sulfate
conjugate.
Excretion: Ipratropium: Via
urine and faeces. Terminal
elimination half-life: 1.6 hours.
Salbutamol: Via urine (as
metabolites and unchanged
drug); faeces (small amounts).
Elimination half-life: 3-7 hours.
Half life:
- Salbutamol: 4 hr; Ipratropium:
2 hr
Peak:
- Salbutamol: 2-3 hr;
Ipratropium: 1-2 hr
Onset:
- Salbutamol: 15-30 minutes;
Ipratropium: 5-15 minutes
is used by people whose from the foil pouch. Put the rest of
symptoms have not been the vials back into the pouch until
controlled by a single you are ready to use them.
inhaled medication. - Twist off the top of the vial and
squeeze all of the liquid into the
reservoir of the nebulizer.
Patient’s Indication: - Connect the nebulizer reservoir to
 Prevent the mouthpiece or face mask.
difficulty in - Connect the nebulizer reservoir to
breathing, chest the compressor.
tightness. And - Put the mouthpiece in your mouth
coughing (PTB or put on the face mask. Sit in a
also affects the comfortable, upright position and
lungs and its turn on the compressor.
airways) - Breathe in calmly, deeply, and
evenly through your mouth for
about 5 to 15 minutes until mist
stops forming in the nebulizer
chamber.
After
1. Monitor vital signs noting
hypotension and an irregular or
abnormal pulse.
2. Monitor for adverse effects.
3. Maintain a quiet, comfortable
environment to minimize anxiety.
4. Document correctly and
accordingly.
 Duration
-- Salbutamol: 4-8 hr;
Ipratropium: 3-6 hr

Vallerand, A., Vallerand, A., Sanoski, C., & Vallerand, A., Sanoski, Vallerand, A., Sanoski, Vallerand, A., Sanoski, Vallerand, A., Sanoski, C., &
Sanoski, C., & Deglin, J. (2017). Drug Guide C., & Deglin, J. (2017). C., & Deglin, J. (2017). C., & Deglin, J. (2017). Deglin, J. (2017). Drug Guide for
Deglin, J. (2017). for Nurses. 15th Ed. FA Davis Drug Guide for Nurses. Drug Guide for Nurses. Drug Guide for Nurses. Nurses. 15th Ed. FA Davis
Drug Guide for Company: Philadelphia 15th Ed. FA Davis 15th Ed. FA Davis 15th Ed. FA Davis Company: Philadelphia
Vallerand, A., Sanoski, Nurses. 15th Ed. Company: Philadelphia Company: Philadelphia Company: Philadelphia
C., & Deglin, J. (2017). FA Davis Schull, P. D. (2013). McGraw- Schull, P. D. (2013). McGraw-Hill
Drug Guide for Nurses. Company: Hill nurses drug handbook. New Schull, P. D. (2013). Schull, P. D. (2013). Schull, P. D. (2013). nurses drug handbook. New York:
15th Ed. FA Davis Philadelphia York: McGraw-Hill Medical. McGraw-Hill nurses drug McGraw-Hill nurses drug McGraw-Hill nurses McGraw-Hill Medical.
Company: Philadelphia handbook. New York: handbook. New York: drug handbook. New
Schull, P. D. JONES & BARTLETT McGraw-Hill Medical. McGraw-Hill Medical. York: McGraw-Hill JONES & BARTLETT
Schull, P. D. (2013). (2013). McGraw- LEARNING. (2018). Nurses Medical. LEARNING. (2018). Nurses Drug
McGraw-Hill nurses drug Hill nurses drug Drug Handbook. SUDBURY. JONES & BARTLETT JONES & BARTLETT Handbook. SUDBURY.
handbook. New York: handbook. New LEARNING. (2018). LEARNING. (2018). JONES & BARTLETT
McGraw-Hill Medical. York: McGraw- Nurses Drug Handbook. Nurses Drug Handbook. LEARNING. (2018).
Hill Medical. SUDBURY. SUDBURY. Nurses Drug Handbook.
JONES & BARTLETT SUDBURY.
LEARNING. (2018). JONES &
Nurses Drug Handbook. BARTLETT
SUDBURY. LEARNING.
(2018). Nurses
Drug Handbook.
SUDBURY.