DRUG NAME DOSAGE MECHANISM OF ACTION INDICATION CONTRAINDICATIONS ADVERSE EFFECTS NURSING CONSIDERATIONS

RANITIDINE 75 mg, 150 mg, 300 mg Potent anti-ulcer drug that Short-term treatment of Hypersensitivity to ranitidine; NS: Headache, malaise,  Potential toxicity results from
Classifications: tablets; 25 mg, 150 mg competitively and active duodenal ulcer; acute porphyria; OTC dizziness, somnolence, decreased clearance
GASTROINTESTIN effervescent tablets; 150 mg, reversibly inhibits maintenance therapy administration in children <12 y. insomnia, vertigo, mental (elimination) and therefore
AL AGENT; 300 mg capsules; 15 mg/mL histamine action at H2- for duodenal ulcer confusion, agitation, prolonged action; greatest in
ANTISECRETORY syrup; 0.5 mg/mL, 25 mg/mL receptor sites on parietal patient after healing of depression, hallucinations in the older adult patients or
(H2-RECEPTOR injection cells, thus blocking gastric acute ulcer; treatment older adults.  those with hepatic or renal
ANTAGONIST) acid secretion. Indirectly of gastroesophageal CV: Bradycardia (with rapid IV dysfunction.
Prototype: reduces pepsin secretion reflux disease; short- push).   Lab tests: Periodic liver
Cimetidine but appears to have term treatment of GI: Constipation, nausea, functions. Monitor creatinine
Pregnancy minimal effect on fasting active, benign gastric abdominal pain, diarrhea.  clearance if renal dysfunction
Category: B and postprandial serum ulcer; treatment of Skin: Rash.  is present or suspected. When
gastrin concentrations or pathologic GI Hematologic: Reversible clearance is <50 mL/min,
secretion of gastric intrinsic hypersecretory decrease in WBC count, manufacturer recommends
factor or mucus. conditions (e.g., thrombocytopenia. reduction of the dose to 150
Zollinger-Ellison Body as a
mg once q24h with cautious
syndrome, systemic Whole: Hypersensitivity
and gradual reduction of the
mastocytosis, and reactions, anaphylaxis (rare).
interval to q12h or less, if
postoperative
necessary.
hypersecretion);
 Be alert for early signs of
heartburn.
hepatotoxicity (though low
and thought to be a
hypersensitivity reaction):
jaundice (dark urine, pruritus,
yellow sclera and skin),
elevated transaminases
(especially ALT) and LDH.
 Long-term therapy may lead
to vitamin B12 deficiency.
  Long duration of action
provides ulcer pain relief that
is maintained through the
night as well as the day.
  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.
 Adhere to scheduled periodic
laboratory checkups during
ranitidine treatment.
 Do not supplement therapy
with OTC remedies for
gastric distress or pain
without physician's advice
(e.g., Mylanta II reduces
ranitidine absorption).
 Do not smoke; research
shows smoking decreases
ranitidine efficacy and
adversely affects ulcer
healing.
 Do not breast feed while
taking this drug without
consulting physician.

MAGNESIUM 0.8 mEq/mL, 1 mEq/mL, 4 Orally: Acts as a laxative by Orally to relieve acute Myocardial damage; heart block; Body as a Whole: Flushing,  Observe constantly when
SULFATE mEq/mL injection osmotic retention of fluid, constipation and to cardiac arrest except for certain sweating, extreme thirst, given IV. Check BP and
Classifications: which distends colon, evacuate bowel in arrhythmias; IV administration sedation, confusion, depressed pulse q10–15 min or more
GASTROINTESTIN increases water content of preparation for x-ray of during the 2 h preceding delivery; reflexes or no reflexes, muscle often if indicated.
AL AGENT; SALINE feces, and causes intestines. Parenterally PO use in patients with weakness, flaccid paralysis,  Lab tests: Monitor plasma
CATHARTIC; mechanical stimulation of
REPLACEMENT bowel activity.
AGENT; Parenterally: Acts as a CNS
ANTICONVULSAN depressant and also as a
T Prototype: depressant of smooth,
Magnesium skeletal, and cardiac
Hydroxide muscle function.
Pregnancy Anticonvulsant properties
Category: A thought to be produced by
CNS depression, principally
by decreasing the amount
of acetylcholine liberated
from motor nerve
terminals, thus producing
peripheral neuromuscular
blockade.
to control seizures in abdominal pain, nausea, hypothermia.  magnesium levels in patients
toxemia of pregnancy, vomiting, fecal impaction, or CV: Hypotension, depressed receiving drug parenterally
epilepsy, and acute intestinal irritation, obstruction, cardiac function, complete (normal: 1.8–3.0 mEq/L).
nephritis and for or perforation. heart block, circulatory Plasma levels in excess of 4
prophylaxis and collapse.  mEq/L are reflected in
treatment of Respiratory: Respiratory depressed deep tendon
hypomagnesemia. paralysis.  reflexes and other symptoms
Topically to reduce Metabolic: Hypermagnesemia, of magnesium intoxication
edema, inflammation, hypocalcemia, dehydration, (see ADVERSE EFFECTS).
and itching. electrolyte imbalance including Cardiac arrest occurs at levels
hypocalcemia with repeated in excess of 25 mEq/L.
laxative use. Monitor calcium and
phosphorus levels also.
 Early indicators of
magnesium toxicity
(hypermagnesemia) include
cathartic effect, profound
thirst, feeling of warmth,
sedation, confusion,
depressed deep tendon
reflexes, and muscle
weakness.
 Monitor respiratory rate
closely. Report immediately
if rate falls below 12.
 Test patellar reflex before
each repeated parenteral dose.
Depression or absence of
reflexes is a useful index of
early magnesium
intoxication.
 Check urinary output,
especially in patients with
 impaired kidney function.
Therapy is generally not
continued if urinary output is
less than 100 mL during the 4
h preceding each dose.
 Observe newborns of mothers
who received parenteral
magnesium sulfate within a
few hours of delivery for
signs of toxicity, including
respiratory and
neuromuscular depression.
 Observe patients receiving
drug for hypomagnesemia for
improvement in these signs
of deficiency: Irritability,
choreiform movements,
tremors, tetany, twitching,
muscle cramps, tachycardia,
hypertension, psychotic
behavior.
 Have calcium gluconate
readily available in case of
magnesium sulfate toxicity.


DIAZEPAM 2 mg, 5 mg, 10 mg tablets; 1 Psychotherapeutic agent Drug of choice for Injectable form: Shock, coma, Body as a Whole: Throat and  Monitor for adverse
Classifications: mg/mL, 5 mg/mL, 5 mg/5 mL related to status epilepticus. acute alcohol intoxication, chest reactions. Most are dose
CENTRAL oral solution; 5 mg/mL chlordiazepoxide; Management of depressed vital signs, obstetrical pain. CNS: Drowsiness, fatigue, related. Physician will rely on
NERVOUS injection; 2.5 mg, 5 mg, 10 reportedly superior in anxiety disorders, for patients, infants <30 d of ataxia, confusion, paradoxic accurate observation and
SYSTEM AGENT; mg, 15 mg, 20 mg rectal gel antianxiety and short-term relief of age. Tablet form: Infants <6 mo rage, dizziness, vertigo, reports of patient response to
BENZODIAZEPINE anticonvulsant activity, anxiety symptoms, to of age, acute narrow-angle amnesia, vivid dreams, the drug to determine lowest
ANTICONVULSAN with somewhat shorter allay anxiety and glaucoma, untreated open-angle headache, slurred speech, effective maintenance dose.
T; ANXIOLYTIC duration of action. Like glaucoma; during or within 14 d tremor; EEG changes, tardive
Pregnancy chlordiazepoxide, it tension prior to of MAO inhibitor therapy. Safe dyskinesia. CV: Hypotension,  Monitor for therapeutic
Category: D appears to act at both surgery, cardioversion use during pregnancy (category tachycardia, effectiveness. Maximum
Controlled limbic and subcortical and endoscopic D) and lactation is not edema, cardiovascular effect may require 1–2 wk;
Substance: levels of CNS. procedures, as an established. collapse. Special patient tolerance to
Schedule IV amnesic, and Senses: Blurred vision, therapeutic effects may
treatment for restless diplopia, develop after 4 wk of
legs. Also used to nystagmus. GI: Xerostomia, treatment.
alleviate acute nausea, constipation, hepatic  Observe necessary preventive
withdrawal symptoms dysfunction. Urogenital: Incon precautions for suicidal
of alcoholism, voiding tinence, urinary retention, tendencies that may be
problems in older gynecomastia (prolonged use), present in anxiety states
adults, and menstrual irregularities, accompanied by depression.
adjunctively for relief ovulation  Observe patient closely and
of skeletal muscle failure. Respiratory: Hiccups, monitor vital signs when
spasm associated with coughing, laryngospasm. Other diazepam is given
: Pain, venous thrombosis,
cerebral palsy, parenterally; hypotension,
phlebitis at injection site.
paraplegia, athetosis, muscular weakness,
stiff-man syndrome, tachycardia, and respiratory
tetanus. depression may occur.
 Lab tests: Periodic CBC and
liver function tests during
prolonged therapy.
 Supervise ambulation.
Adverse reactions such as
drowsiness and ataxia are
more likely to occur in older
adults and debilitated or those
receiving larger doses.
Dosage adjustment may be
necessary.
 Monitor I&O ratio, including
urinary and bowel
elimination.

CEFUROXIME 125 mg, 250 mg, 500 mg Semisynthetic second-
Classifications: tablets; 125 mg/5 mL, 250 generation cephalosporin
ANTIINFECTIVE; mg/5 mL suspension; 750 antibiotic with structure
ANTIBIOTIC; mg, 1.5 g injection similar to that of the
SECOND- penicillins. Resistance
GENERATION against beta-lactamase-
CEPHALOSPORIN producing strains exceeds
Prototype: that of first generation
Cefonicid sodium cephalosporins.
Pregnancy Antimicrobial spectrum of
Category: B activity resembles that of
cefonicid. 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
Infections caused by
susceptible organisms in
the lower respiratory
tract, urinary tract, skin,
and skin structures; also
used for treatment of
meningitis, gonorrhea,
and otitis media and for
perioperative
prophylaxis (e.g., open-
heart surgery), early
Lyme disease.
Hypersensitivity to
cephalosporins and related
antibiotics; pregnancy (category
B), lactation.
Body as a
Whole: Thrombophlebitis (IV
site); pain, burning, cellulitis (IM
site); superinfections, positive
Coombs'
test. GI: Diarrhea, nausea,
antibiotic-associated
colitis. Skin: Rash, pruritus,
urticaria. Urogenital: Increase
d serum creatinine and BUN,
decreased creatinine clearance.
 Note: Smoking increases
metabolism of diazepam;
lowering clinical
effectiveness. Heavy smokers
may need a higher dose than
the nonsmoker.
 Note: Psychic and physical
dependence may occur in
patients on long-term high
dosage therapy, in those with
histories of alcohol or drug
addiction, or in those who
self-medicate.
 Determine history of
hypersensitivity reactions to
cephalosporins, penicillins,
and history of allergies,
particularly to drugs, before
therapy is initiated.
 Lab tests: Perform culture
and sensitivity tests before
initiation of therapy and
periodically during therapy if
indicated. Therapy may be
instituted pending test results.
Monitor periodically BUN
and creatinine clearance.
 Inspect IM and IV injection
sites frequently for signs of
phlebitis.
 Report onset of loose stools
 bacterium. Partial cross-
allergenicity between other
beta-lactam antibiotics and
cephalosporins has been
reported.
tetanus toxoid Vial, 7.5 mL Tetanus is a vaccine used
Brand Name: primary immunization
Tetanus Drug against Tetanus. Tetanus
Class: Vaccines, may be used alone or with
Inactivated, other medications. Tetanus
Bacterial belongs to a class of drugs
called Vaccines,
Inactivated, Bacterial. It is
not known if Tetanus is
safe and effective in
children younger than 7
years of age.
or diarrhea. Although
pseudomembranous colitis
(see Signs & Symptoms,
Appendix F) rarely occurs,
this potentially life-
threatening complication
should be ruled out as the
cause of diarrhea during and
after antibiotic therapy.
 Monitor for manifestations of
hypersensitivity (see
Appendix F). Discontinue
drug and report their
appearance promptly.
 Monitor I&O rates and
pattern: Especially important
in severely ill patients
receiving high doses. Report
any significant changes.

Primary immunization History of serious allergic reaction BODY SYSTEM AS A  The principles of
schedule for children (i.e., anaphylaxis) to vaccine WHOLE management of tetanus
under 7 years of age components or encephalopathy redness, warmth, edema, include sedation and control
(prior to seventh (e.g., coma or prolonged seizures) induration with or without of muscle spasms,
birthday) should consist not attributable to an identifiable tenderness as well as neutralization of tetanus
of five doses of a cause within 7 days of urticaria, and rash. Malaise,
toxin, prevention of
vaccine containing administration of a vaccine with transient fever, pain,
hypotension, nausea and production of tetanus toxin
tetanus toxoid (tetanus pertussis components (this is a by use of antibiotics to which
arthralgia may develop in
(tetanus toxoid) contraindication for the pertussis Clostridium tetani is
some patients after the
toxoid) . The initial components injection. susceptible and by wound
three doses are given as NERVOUS SYSTEM debridement, treatment of
Diphtheria and Tetanus neurological complications complications, including
Toxoid (tetanus (tetanus 18,19 including cochlear
toxoid) toxoid) s and lesion, 20 brachial plexus autonomic dysfunction,
Acellular Pertussis neuropathies, 20,21 paralysis
Vaccine Adsorbed of the radial nerve, 22
(DTaP) vaccine, paralysis of the recurrent
administered nerve, 20 accommodation
intramuscularly at paresis, Guillain-Barré
intervals of 4 to 8 syndrome, and EEG
disturbances with
weeks.
encephalopathy.