IX.

DRUG STUDY

NAME AND DOSE, MECHANISM OF INDICATIONS CONTRAINDI ADVERSE NURSING

CLASSIFICATION FREQUENCY, ACTION CATIONS EFFECTS RESPONSIBILITIES
OF DRUG ROUTE,
DURATION OF
ADMINISTRATIO
N
Brand Name: 160g IV q4 PRN It provides Fever reduction. Hypersensitivity to Body as a Whole: Assessment & Drug
BIOGESIC temporary Temporary relief of acetaminophen or Negligible with Effects
analgesia for mild mild to moderate phenacetin recommended  Monitor for
Generic Name: to moderate pain. pain.  dosage; rash. S&S of:
PARACETAMOL In addition, hepatotoxicity,
acetaminophen Acute poisoning: even with
CLASSIFICATION: lowers body Anorexia, nausea, moderate
Nonopioid analgesic temperature in vomiting, dizziness, acetaminophen
individuals with a lethargy, diaphoresis, doses,
fever. chills, epigastric or especially in
abdominal pain, individuals
diarrhea; onset of with poor
hepatotoxicity— nutrition or
elevation of serum who have
transaminases (ALT, ingested
AST) and bilirubin; alcohol over
hypoglycemia, prolonged
hepatic coma, acute periods;
renal failure (rare). poisoning,
usually from
Chronic ingestion: accidental
Neutropenia, ingestion or
pancytopenia, suicide
leukopenia, attempts;
thrombocytopenic potential abuse
purpura, from
hepatotoxicity in psychological
alcoholics, renal dependence
damage. (withdrawal
has been
associated
with restless
and excited
responses).
Patient & Family
Education
 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.
NAME AND DOSE, MECHANISM INDICATIONS CONTRAINDI ADVERSE NURSING
CLASSIFICATION FREQUENCY, OF ACTION CATIONS EFFECTS RESPONSIBILITIES
OF DRUG ROUTE,
DURATION OF
ADMINISTRATIO
N
Brand Name: 15mg IV q8 Pulmonary severe renal disease contraindicated in CNS: Headache, Assessment
Lasix edema, edema in patients with fatigue, weakness,  Assess fluid
Generic Name: CHF, hypokalemia (only vertigo, paresthesias status. Monitor
FUROSEMIDE nephrotic to be administered daily weight,
syndrome after correction), CV: Orthostatic intake and output
CLASSIFICATION: severe hypotension, chest ratios, amount and
Loop diuretic hyponatremia, pain, ECG changes, location of edema,
hypotension, circulatory collapse lung sounds, skin
azotemia, turgor, and
oliguria/anuria. EENT: Loss of mucous
hearing, ear pain, membranes.
tinnitus, blurred Notify health care
vision professional if
thirst, dry mouth,
ELECT: lethargy,
Hypokalemia, weakness,
hypochloremic hypotension, or
alkalosis, oliguria occurs.
hypomagnesemia,  Monitor BP and
hyperuricemia, pulse before and
hypocalcemia, during
hyponatremia, administration.
metabolic alkalosis Monitor
frequency of
ENDO: prescription refills
Hyperglycemia to determine
compliance in
GI: Nausea, diarrhea, patients treated for
dry mouth, vomiting, hypertension.
anorexia, cramps, oral  Geri: Diuretic use
or gastric irritations, is associated with
pancreatitis increased risk for
falls in older
GU: Polyuria, renal adults. Assess
failure, glycosuria, falls risk and
bladder spasms implement fall
prevention
HEMA: strategies.
Thrombocytopenia,  Assess patients
agranulocytosis, receiving digoxin
leukopenia, for anorexia,
neutropenia, anemia nausea, vomiting,
muscle cramps,
INTEG: Rash, paresthesia, and
pruritus, purpura, confusion.
StevensJohnson Patients taking
syndrome, sweating, digoxin are at
photosensitivity, increased risk of
urticaria digoxin toxicity
because of the
MS: Cramps, stiffness potassium-
depleting effect of
SYST: Toxic the diuretic.
epidermal necrolysis Potassium
supplements or
potassium-sparing
diuretics may be
used concurrently
to prevent
hypokalemia.
 Assess patient for
tinnitus and
hearing loss.
Audiometry is
recommended for
patients receiving
prolonged high-
dose IV therapy.
Hearing loss is
most common
after rapid or
high-dose IV
administration in
patients with
decreased renal
function or those
taking other
ototoxic drugs.
 Assess for allergy
to sulfonamides.
 Assess patient for
skin rash
frequently during
therapy.
Discontinue
furosemide at first
sign of rash; may
be life-
threatening.
Stevens-Johnson
syndrome, toxic
epidermal
necrolysis, or
 erythema
multiforme may
develop. Treat
symptomatically;
may recur once
treatment is
stopped.
Patient/family education
• Teach patient to take the
medication early in
the day to prevent
nocturia
• Instruct the patient to
take with food or milk if
GI symptoms of nausea
and anorexia occur
• Teach patient to
maintain a record of
weight
on a weekly basis and
notify physician of
weight
loss of .5 lb
• Caution the patient that
this product causes a
loss of potassium, that
food rich in potassium
should be added to the
diet; refer to a dietitian
for assistance in planning
• Caution the patient to
rise slowly from sitting
or reclining positions, not
to exercise in hot
weather or stand for
prolonged periods
because
orthostatic hypotension
will be enhanced; lie
down if dizziness occurs
• Advise patient to wear
protective clothing and
sunscreen to prevent
photosensitivity
• Caution patient not to
use alcohol or any OTC
medications without
physician’s approval;
serious product reactions
may occur
• Emphasize the need to
contact physician
immediately if muscle
cramps, weakness,
nausea,
dizziness, or numbness
occurs
• Teach patient to take
and record own B/P and
pulse
• Advise patient to
continue taking medica
tion even if feeling better;
this product controls
symptoms but does not
cure the condition
 • Advise the patient with
hypertension to
continue other medical
treatment (exercise,
weight loss, relaxation
techniques, cessation of
smoking)

NAME AND DOSE, MECHANISM OF INDICATIONS CONTRAINDI ADVERSE EFFECTS NURSING

CLASSIFICATION FREQUENCY, ACTION CATIONS RESPONSIBILITIES
OF DRUG ROUTE,
DURATION OF
ADMINISTRATION
Brand Name: 750, 000 IV q6 Interferes with  Pneumonia, Hypersensitivity to NS: Lethargy, Assessment
Penicillin VK ANST cell wall  scarlet  fever penicillins or hallucinations, anxiety, • Assess patient for
Generic Name: replication of  cephalosporins depression, twitching, previous sensitivity
PEN-G susceptible  coma, seizures, reaction
organisms;  hyperreflexia to penicillins or
CLASSIFICATION osmotically  cephalosporins;
: unstable cell wall GI: Nausea, vomiting, cross-sensitivity
Broad-spectrum swells and bursts diarrhea, increased between penicillins
antiinfective from osmotic AST, ALT, abdominal and cephalosporins is
pressure, resulting pain, glossitis, colitis, common
in cell death pseudomembranous • Assess patient for
colitis signs and symptoms
of infection including
GU: Oliguria, characteristics of
proteinuria, hematuria, wounds, sputum,
vaginitis, moniliasis, urine, stool,
glomerulonephritis, WBC .10,000/
renal tubular damage mm3
, earache, fever;
HEMA: Anemia, obtain information
increased bleeding baseline, during
time, bone marrow treatment
depression,
granulocytopenia, • Monitor blood
hemolytic anemia studies: AST, ALT,
CBC, Hct,
META: Hyperkalemia, bilirubin, LDH,
hypokalemia, alkaline phosphatase,
alkalosis, Coombs’
hypernatremia test monthly if
patient is on long-
MISC: Local pain, term therapy
tenderness and fever • Monitor
with IM inj, electrolytes:
anaphylaxis serum potassium, sodium,
sickness, Stevens- chloride monthly if
Johnson syndrome patient is on long-
term therapy
• Assess bowel
pattern daily; if
severe diarrhea
occurs, product
should be
discontinued; may
indicate
pseudomembranous
colitis
• Monitor for
bleeding:
ecchymosis, bleeding
gums, hematuria,
stool guaiac daily if
on longterm therapy
• Assess for
overgrowth of
infection:
perineal itching,
fever, malaise,
redness, pain,
swelling, drainage,
rash, diarrhea, change
in
cough, sputum
Patient/family
education
• Teach patient to
report sore throat,
bruising,
bleeding, joint pain;
may indicate blood
dyscrasias (rare)
• Advise patient to
contact prescriber if
vaginal
itching, loose foul-
smelling stools, furry
tongue
occur; may indicate
superinfection
• Instruct patient to
take all medication
prescribed for the
length of time
ordered
• Advise patient to
 notify prescriber of
diarrhea
with blood or pus,
which may indicate
pseudomembranous
colitis

NAME AND DOSE, MECHANISM OF INDICATIONS CONTRAINDI ADVERSE EFFECTS NURSING

CLASSIFICATIO FREQUENCY, ACTION CATIONS RESPONSIBILITIES
N OF DRUG ROUTE,
DURATION OF
ADMINISTRATIO
N
Brand Name: 25mg ½ TAB BID Selectively  CHF, left- Children, CNS: Fever, chills  Monitor
Capoten suppresses renin ventricular hypersensitivity, CV: Hypotension, blood
angiotensin- dysfunction (LVD) heart block, postural hypotension, pressure and
Generic Name: aldosterone after MI, diabetic potassium-sparing tachycardia, angina pulse
CAPTOPRIL system; inhibits  nephropathy, diuretics, bilateral GI: Loss of taste, frequently.
ACE;  prevents proteinuria renal artery increased liver  Monitor
Classification: the conversion of stenosis, function tests weight and
Angiotensin- angiotensin I to angioedema assesses
converting enzyme angiotensin renal artery GU: Impotence, patient
(ACE) inhibitor, stenosis, dysuria, nocturia, frequently for
Antihypertensive angioedema proteinuria, nephrotic signs of fluid
syndrome, acute overload if
reversible renal with
failure, polyuria, concurrent
oliguria, frequency diuretic
therapy.
HEMA: Neutropenia,  assessments
agranulocytosis, of urine
pancytopenia, protein may
thrombocytopenia, be ordered.
anemia Proteinuria
INTEG: Rash, pruritus and nephrotic
MISC: Angioedema, syndrome
hyperkalemia RESP: may occur
Bronchospasm, with therapy.
dyspnea, cough  Monitor
BUN, Crea
and
electrolyte
levels
periodically.
 WBC should
be monitored
prior to
therapy and
periodically
thereafter.
 May cause
false positive
result for
urine acetone
Patient/Family
Health Teachings
 Instruct
patient to take
captopril
exactly as
directed.
Missed dose
should be
taken as soon
as
remembered
 but not if
almost time
for next dose.
 Do not double
doses.
 Instruct
patient not to
discontinue
captopril
therapy unless
directed by
health care
provider.
 Encourage
patient to
comply with
additional
interventions
for
hypertension.
 Instruct
patient and
family on
proper
technique of
blood
pressure
monitoring.
Advice them
to check
blood
pressure at
least weekly
 and to report
any
significant
changes.
 Caution
patient to
avoid foods
containing
high levels of
sodium or
potassium.
 Advice
patient that
any changes
in taste
sensation will
reverse itself
within 8-12
weeks.
 Instruct
patient to
change
position
slowly to
minimize
occurrence of
orthostatic
hypotension.
 Advice
patient that
exercising in
hot weather
may increase
 hypotensive
effect.
 Instruct
patient to
consult with a
health care
provider
before taking
any over the
counter
medications
or cold
remedies.
 Advice
patient of
ingesting
excessive
amount of tea,
coffee or cola.
 Advice
patient to
avoid driving
or other
activities that
require
alertness until
response to
therapy is
known.
 Instruct
patient to
notify health
care provider
 if rash, sore
throat, fever,
irregular heart
beat, chest
pain, swelling
of face, eyes,
lips or tongue
and difficulty
of breathing
occurs.
 Emphasize
importance of
follow up
examinations
for
monitoring
purposes.