BROKENSHIRE COLLEGE

MADAPO, DAVAO CITY

DRUG STUDY

Name of Patient: ___________________________________________ Age: ______Sex:__________ Civil Status: ___________________Religion:_____________________________________

Chief Complaint/Reason for Admission: ___________________________________________________________________________________________________________________________
Date & Time of Admission:_______________________________________________ Accompanied By/Informant:______________________________________________________________
Medical Diagnosis/Impression:_____________________________________________Operation Performed (if any):_____________________________________________________________

Generic Name Brand Name General Mechanism of Action Route of Indications Contraindication Adverse Nursing
Classification Dosage Reaction/s Responsibility
Acetaminophen Calpol Analgesic Thought to produce Orally Fever Contraindications to  Assess for an allergy
analgesia by Oral Syrup: Children ages 6-8 using acetaminophen Adverse effects of to acetaminophen. 
inhibiting 250mg/5mL weighing 21.8 to include acetaminophen  Assess for pain by
prostaglandin and 7.5mL Q6 27.2kg: 320mg PO hypersensitivity to administered having the patient
other substances that 30mins prior every 4 hours p.r.n. acetaminophen, orally or rectally rate on a scale of 1-
sensitize pain Vancomycin Maximum of 5 severe hepatic may include the 10, and describe
receptors. Drug may doses a day. impairment, or following: characteristics,
relieve fever through severe active hepatic duration, and
central action in the disease.  Skin rash, frequency. Assess
hypothalamic heat- hypersensitivity for chronic
regulating center reactions conditions that
Nephrotoxicity warrant the use of
(elevations in acetaminophen such
BUN, creatinine) as arthritis. 
Hematological:  If given as an
anemia, antipyretic, assess
leukopenia, temperature. 
neutropenia,  Assess for
pancytopenia acetaminophen
Metabolic and toxicity: nausea,
electrolyte vomiting, abdominal
pain, elevated
bilirubin and liver
enzymes. 
Decreased serum  Routinely monitor
bicarbonate the effectiveness of
Decreased acetaminophen by
concentrations of assessing pain levels
sodium and and fever
calcium reduction.  
 Hyperammonemia  For patients who are
Hyperchloremia at risk for
Hyperuricemia hepatotoxicity or
Increased serum renal toxicity, the
glucose nurse should closely
Increased monitor AST and
bilirubin and ALT levels and
alkaline BUN and
phosphatase creatinine. 
 Acetaminophen can
cause hematologic
reactions. The nurse
should monitor for
anemia and
decreased red and
white blood counts. 
 The antidote for
acetaminophen
overdose is N-
acetylcysteine given
either orally or IV.

Submitted by:______________________________________________________________ Clinical Instructor:_______________________________________________________________

Year & Section:__________________________________________ Date Submitted:___________________________________________

BROKENSHIRE COLLEGE
MADAPO, DAVAO CITY
DRUG STUDY
Name of Patient: __________________________________________________ Age: ______Sex:__________ Civil Status: ___________________Religion:_____________________________
Chief Complaint/Reason for Admission: ___________________________________________________________________________________________________________________________
Date & Time of Admission:______________________________________________________Accompanied By/Informant:_______________________________________________________
Medical Diagnosis/Impression:___________________________________________________Operation Performed (if any):_______________________________________________________

Generic Name Brand Name General Mechanism of Route of Indications Contraindication Adverse Reaction/s Nursing Responsibility
Classification Action Dosage
Ciprofloxacin Ciproxin Antibiotics Inhibits bacterial Oral Used to treat Contraindications to GI disturbances;  History: Allergy to
DNA synthesis, Tablet: complicated intra- ciprofloxacin include headache, tremor, ciprofloxacin,
mainly by blocking 500mg/tab abdominal patients with confusion, norfloxacin or other
DNA gyrase, ½ tab BID infection, severe documented convulsions; quinolones; renal
bactericidal or complicated hypersensitivity to the rashes; joint pain; dysfunction; seizures;
bone or joint drug or components of phototoxicity. lactation
infection, severe the formulation. Transient increases  Physical: Skin color,
respiratory tract Anaphylactoid in serum creatinine. lesions; T;
infection, severe reactions and Hematological, orientation, reflexes,
skin or skin- anaphylaxis following hepatic and renal affect; mucous
structure infection, the first dose of disturbances. membranes, bowel
severe UTI, ciprofloxacin have Vasculitis, sounds; LFTs, renal
pyelonephritis, been reported in the pseudomembranous function tests
Nosocomial literature. The colitis and  Arrange for culture
pneumonia, concurrent tachycardia. and sensitivity tests
Chronic bacterial administration Phototoxicity. before beginning
prostatitis, lower of tizanidine for therapy.
respiratory tract muscle spasms is also  Continue therapy for
infection, mild to a 2 days after signs and
moderate acute contraindication. The symptoms of
sinusitis. pharmacokinetics of infection are gone.
tizanidine are altered  Be aware
by CYP1A2 inhibition that Proquin XR is
(ciprofloxacin), not interchangeable
leading to with other forms.
increased tizanidine  Ensure that the
levels and decreased patient swallows ER
psychomotor activity, tablets whole; do not
blood pressure, and cut, crush, or chew.
heart rate. Avoid  Ensure that patient is
ciprofloxacin and its well hydrated.
fluoroquinolone class  Give antacids at least
in patients with 2 hr after dosing.
myasthenia gravis  Monitor clinical
because it may response; if no
 exacerbate muscle improvement is seen
weaknesses. or a relapse occurs,
repeat culture and
sensitivity.
 Encourage patient to
complete full course
of therapy.
 If an antacid is
needed, take it at least
2 hours before or
after dose.
 Take Proquin
XR with the main
meal of the day.
 Do not touch tip of
eye ointment or
solution for this may
contaminate the
product.
 Drink plenty of fluids
while you are taking
this drug.
 You may experience
these side effects:
Nausea, vomiting,
abdominal pain (eat
frequent small
meals); diarrhea or
constipation;
drowsiness, blurring
of vision, dizziness
(observe caution if
driving or using
dangerous
equipment).
 Report rash, visual
changes, severe GI
problems, weakness,
tremors.

Submitted by:____________________________________________________________________________ Clinical Instructor:_________________________________________________

Year & Section:__________________________________________ Date Submitted:___________________________________________

BROKENSHIRE COLLEGE
MADAPO, DAVAO CITY
DRUG STUDY

Name of Patient: _________________________________________________________ Age: ______Sex:__________ Civil Status:

___________________Religion:_____________________________________
Chief Complaint/Reason for Admission:
_________________________________________________________________________________________________________________________________________
Date & Time of Admission:_____________________________________________________________ Accompanied
By/Informant:______________________________________________________________
Medical Diagnosis/Impression:___________________________________________________________ Operation Performed (if
any):_____________________________________________________________

Generic Name Brand Name General Mechanism of Action Route of Indications Contraindication Adverse Nursing
Classification Dosage Reaction/s Responsibility
Submitted by:____________________________________________________________________________ Clinical
Instructor:_______________________________________________________________
Year & Section:__________________________________________ Date Submitted:___________________________________________

BROKENSHIRE COLLEGE
MADAPO, DAVAO CITY
DRUG STUDY

Name of Patient: _________________________________________________________ Age: ______Sex:__________ Civil Status:

___________________Religion:_____________________________________
Chief Complaint/Reason for Admission:
_________________________________________________________________________________________________________________________________________
Date & Time of Admission:_____________________________________________________________ Accompanied
By/Informant:______________________________________________________________
Medical Diagnosis/Impression:___________________________________________________________ Operation Performed (if
any):_____________________________________________________________

Generic Name Brand Name General Mechanism of Action Route of Indications Contraindication Adverse Nursing
Classification Dosage Reaction/s Responsibility

Submitted by:____________________________________________________________________________ Clinical

Instructor:_______________________________________________________________
Year & Section:__________________________________________ Date Submitted:___________________________________________