College of Our Lady of Mt.

Carmel
Bachelor of Science in Nursing Department

COLLEGE DEPARTMENT
College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing
S.Y 2023-2024

MEDICAL SURGICAL NURSING

NCM 112 (RLE)
DRUG STUDY

Submitted by:
De Jesus, Fatima Kate M.
BSN 3

Submitted to:
Mr. Mikel Renz Cariño, RN

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College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

DRUG STUDY #1

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 GENERIC NAME  Furosemide
BRAND NAME/S  Apo-Furosemide, Lasix, Novo-Semide
DOSAGECollege of Our Lady
Acute of Mt.
pulmonary Carmel
edema
 Adults: 40 mg IV injected slowly over 1 to 2 minutes;
Bachelor of Science in Nursing Department
then 80 mg IV over 1 to 2 minutes after 1 hour if needed.

Edema
 Adults: 20 to 80 mg PO daily in the morning. If response
is inadequate, give a second dose, and each succeeding
dose, every 6 to 8 hours. Carefully increase dose in 20-
to 40-mg in- crements up to 600 mg daily. Once effective
dose is attained, may give once daily or b.i.d. Or, 20 to
40 mg IV or IM, increased by 20 mg 2 hours after
previous dose until desired effect achieved.
 Infants and children: 2 mg/kg PO daily, in- creased by 1
to 2 mg/kg in 6 to 8 hours if needed; carefully adjusted
up to maximum of 6 mg/kg if needed. Or, 1 mg/kg
slowly IV or IM. May increase dosage by 1 mg/kg 2
hours after previous dose if needed up to 6 mg/kg.
Maximum dose is 1 mg/kg/day for premature infants.

HTN
 Adults: 20 to 40 mg PO b.i.d. Dosage adjusted based on
response. Usual dose is 40 to 80 mg/day in two divided
doses. May be used as adjunct to other antihypertensives
if needed

ADMINISTRATION

PO
 To prevent nocturia, give in the morning. d Give second
dose if ordered in early after- noon, 6 to 8 hours after
morning dose.
 Store tablets in light-resistant container to prevent
discoloration (doesn't affect potency).
 If discolored yellow, don't use. For direct injection, give
over 1 to 2 min- utes.

Alert: For high-dose, intermittent infusion in adults, dilute

with D5W, NSS, or lactated Ringer solution. To avoid
ototoxicity, infuse at a rate no greater than 4 mg/minute. Use
prepared infusion solution within 24 hours.

Incompatibilities: Acidic solutions, am- rinone,

ciprofloxacin, milrinone, and various others. Consult a drug
incompatibility refer- ence for more information.

AVAILABLE DOSAGE FORMS
Prescribed and Recommended dosage,
frequency and route of administration
MECHANISM OF ACTIONS
INDICATIONS
IM
 To prevent nocturia, give in the morning. Give second
dose if ordered in early after- noon, 6 to 8 hours after
morning dose.
 Record administration site
 Injection : 10mg/mL
 Oral solution: 10mg/mL, 40mg/5mL
 Tablets: 20mg, 40mg, 80mg, 500mg
 40 mg tab, oral OD
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Inhibits sodium and chloride reabsorption at the proximal
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and distal tubules and the ascending loop of Henle.
 Furosemide is indicated for the treatment of edema
associated with congestive heart failure, cirrhosis of the
liver, and renal disease, including the nephrotic
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

References:
Nursing Drug Handbook 2022 42 nd edition - Wolters Kluwer

Furosemide, oral tablet. (2022, June 13). https://medicalnewstoday.com/articles/furosemide-oral-

tablet

Furosemide: MedlinePlus Drug Information. (n.d.).

https://medlineplus.gov/druginfo/meds/a682858.html

Furosemide (Oral Route) Precautions - Mayo Clinic. (n.d.).

https://www.mayoclinic.org/drugssupplements/furosemide-oral-route/precautions/drg 20071281?
p=1#:~:text=Descriptions,disease%2C%20or%20other%20medical%20conditions.

DRUG STUDY #2
GENERIC NAME  Cefuroxime axetil
 Cefuroxime sodium
BRAND NAME/S  Zinacef
DOSAGE Adjust-a-dose (for all indications):
 For in- jectable form in adults with CrCl of 10 to 20
mL/minute, give 750 mg IV or IM every al 12 hours; if
CrCl is less than 10 mL/minute, give 750 mg IV or IM
every 24 hours. Give patients on hemodialysis an

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College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

additional dose after hemodialysis.

 Serious lower respiratory tract infec- tion, UTI, skin or
skin-structure infection, bone or joint infection,
septicemia, menin gitis, and gonorrhea

Adults and children age 13 and older:

 750 mg to 1.5 g cefuroxime sodium IV or IM every 8
hours for 5 to 10 days. For life-threatening infections
and infections caused by less sus- ceptible organisms,
1.5 g IV or IM every 6 hours; for bacterial meningitis,
up to 3 g IV every 8 hours.

Children ages 3 months to 12 years:

 50 to 100 mg/kg/day cefuroxime sodium IV or IM in
equally divided doses every 6 to 8 hours. Use higher
dosage of 100 mg/kg/day, not to exceed maximum adult
dosage, for more severe or serious infections. For
bacterial meningitis, 200 to 240 mg/kg/day cefurox- ime
sodium IV in divided doses every 6 to 8 hours.

Perioperative prophylaxis Adults:

 1.5 g IV 30 to 60 minutes before ini tial incision; in
lengthy operations, 750 mg IVor IM every 8 hours. For
open-heart surgery, of anesthesia and then s for a total
dose of 6 g. 1.5 g IV at induction every 12 hours.

Mild to moderate acute bacterial exacerbations of

chronic bronchitis:
 Adults and children age 13 and older: 250 or 500 mg
PO every 12 hours for 10 days.

Acute bacterial maxillary sinusitis

 Adults and children age 13 and older: 250mg PO every
12 hours for 10 days.
 Children ages 3 months to 12 years: 250 mg every 12
hours for 10 days. For children who can't swallow
tablets whole, 30 mg/kg/day oral suspension in two
divided doses for 10 days. Maximum daily dose for
suspensionm is 1,000 mg.

Pharyngitis and tonsillitis

 Adults and children age 13 and older: 250 mg PO every
12 hours for 10 days.
 Children ages 3 months to 12 years: 125 mg PO every
12 hours for 10 days. For chil- dren who can't swallow
tablets whole, give 20 mg/kg daily of oral suspension in
two divided doses for 10 days. Maximum daily dose for
suspension is 500 mg.

Otitis media

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College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

 Children ages 3 months to 12 years: 250 mg PO every

12 hours for 10 days. For chidren who can't swallow
tablets whole, give 30 mg/kg/day of oral suspension in
two divided doses for 10 days. Maximum daily dose for
suspension is 1,000 mg.

Uncomplicated skin and skin-structure infection

 Adults and children age 13 and older: 250 or 500 mg
PO every 12 hours for 10 days.

Uncomplicated UTI
 Adults: 250 mg PO every 12 hours for 7 to 10 days.

Uncomplicated gonorrhea
 Adults: 1,000 mg PO as a single dose. Or, 1.5 g IM with
1 g probenecid PO for one dose.

Early Lyme disease

 Adults and children age 13 and older: 500 mg PO every
12 hours for 20 days.

Impetigo
 Children ages 3 months to 12 years; 30 mg/ kg/day of
oral suspension in two divided doses for 10 days.
Maximum daily dose, 1,000 mg.

ADMINISTRATION
 Obtain specimen for culture and sensitivity tests before
giving first dose. May start therapy while awaiting
results.
 Before giving drug, ensure patient isn't allergic to
penicillins or cephalosporins.

PO
 Alert: Tablets and oral suspension aren't bioequivalent
and aren't substitutable on a milligram-per-milligram
basis.
 Shake suspension well before each use.
 Give tablets without regard for meals; give oral
suspension with food.
 Patients who can't swallow the tablet whole should
receive the oral suspension. Don't crush tablets due to
bitter taste.
 Store suspension at room temperature be- fore
reconstitution or under refrigeration after reconstitution.
Discard reconstituted suspension after 10 days.

IV
 Reconstitute each 750-mg vial with 8 mL and each 1.5-
g vial with 16 mL of sterile water for injection.

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department
AVAILABLE DOSAGE FORMS
Prescribed and Recommended dosage,
frequency and route of administration
MECHANISM OF ACTION
INDICATION
GENERAL INDICATIONS
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 Withdraw entire contents of vial for a dose
 For direct injectioninject over 3 to 5 min- utes into a
large vein or into the tubing of a free-flowing IV
solution.
 For intermittent infusion, add reconstituted drug to 100
mL DW, NSS for injection, or other compatible IV
solution.
 Infuse over 15 to 60 minutes.
 Incompatibilities: Azithromycin, ciprofloxacin,
cisatracurium, clarithromycin, doxapram, filgrastim,
fluconazole, genta- micin, midazolam, ranitidine,
sodium bicar- bonate injection, vancomycin, vinorel
binetartrate
IM
 Before giving drug, ensure patient isn't allergic to
penicillins or cephalosporins.
 Obtain specimen for culture and sensitivity tests before
giving first dose. Therapy begin while awaiting results.
 Reconstitute 750-mg vial with 3 mL sterile water for
injection.
 Inject deep into a large muscle, such as the gluteus
maximus or the side of the thigh.
Cefuroxime axetil
 Suspension: 125 mg/5 mL, 250 mg/5 mL
 Tablets: 125 mg, 250 mg, 500 mg
Cefuroxime sodium
 Infusion: 750 mg, 1.5 g
 Injection: 750 mg, 1.5 g
 Cefuroxime sodium 1.5g IV 30 min prior to OR
 Inhibits cell-wall synthesis, promoting osmotic
instability; usually bactericidal
 Cefuroxime is a cephalosporin indicated for the
treatment of a variety of infections including acute
bacterial otitis media, several upper respiratory tract
infections, skin infections, urinary tract infections,
gonorrhea, early Lyme disease, and impetigo.
 For the treatment of many different types of bacterial
infections such as bronchitis, sinusitis, tonsillitis, ear
infections, skin infections, gonorrhea, and urinary tract
infections.
 Associated Conditions; Acute Bacterial Exacerbation of
Chronic Bronchitis (ABECB), Animal bite, Bacterial
Infections, Bone and Joint, Infections, Impetigo, Lower
Respiratory Tract Infection (LRTI), Lyme Disease,
 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

Maxillary, Sinusitis, Meningitis, Neisseria,

Gonorrhoeae Infection, Septicemia, Skin and
Subcutaneous Tissue, Bacterial Infections, Urinary
Tract Infection, Bacterial otitis media, Mild
Streptococcal pharyngitis, Mild Streptococcal tonsillitis,
Moderate Streptococcal pharyngitis, Moderate
Streptococcal tonsillitis.
PATIENT-BASED INDICATIONS  Antibiotic therapy with cefuroxime-tobramycin would
be useful in cancer patients with bacterial
complications because of its effectiveness and
tolerability.
 It may also be used to prevent infection from certain
surgeries. This medication belongs to a class of drugs
known as cephalosporin antibiotics. It works by
stopping the growth of bacteria.
CONTRAINDICATIONS  Contraindicated in patients hypersensitive to drug or
other cephalosporins.
 Use cautiously in patients hypersensi- tive to penicillin
because of possibility of cross-sensitivity with other
beta-lactam antibiotics
 According to the CDC, oral cephalosporins aren't
recommended to treat gonococcal in- fections.
 According to clinical practice guidelines, cefotaxime or
ceftriaxone should be used to treat childhood bacterial
meningitis and pneumococcal and meningococcal
meningitis caused by penicillin-resistant strains and
Haemophilus influenzae type b meningitis.
 Use cautiously in patients with history of colitis and in
those with renal insufficiency.
 Some products may contain phenylalanine or sodium.
 Alert: Drug cause CDAD and pseudomembranous
colitis ranging from mild to life-threatening, which can
occur even 2 months after therapy.
 Some cephalosporins have been associated with seizures
in patients with renal im- pairment when the dosage
wasn't reduced. If drug-associated seizures occur,
discontinue drug and treat with anticonvulsant therapy if
indicated.
 Dialyzable drug: Yes.
COMMON SIDE EFFECTS  CV: phlebitis, thrombophlebitis.
 Gl: diarrhea, pseudomembranous colitis, nausea,
anorexia, vomiting.
 Hematologic: hemolytic anemia, thrombocytopenia,
transient neu- tropenia, eosinophilia.
 Skin: maculopapular and erythematous rashes, urticaria,
pain, in duration, sterile abscesses, temperature
elevation, tissue sloughing at IM injection site.
 Other: anaphylaxis, hypersensitivity reactions, serum
sickness.

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 College of Our Lady of Mt. Carmel
Bachelor of Science in Nursing Department

SIDE EFFECTS OBSERVED  Stomach or abdominal pain

DRUG-DRUG INTERACTIONS
NURSING RESPONSIBILITIES
 Aminoglycosides: May cause synergistic activity
against some organisms; may increase nephrotoxicity.
Monitor patient's renal function closely.
 Estrogen-based contraceptives: May decrease
contraceptive absorption and effectiveness. Patient
should avoid use together or use non- hormonal
contraception for duration of antibiotic (or 14 days,
whichever is longer) and for 7 days after completion of
antibiotic.
 Live-virus vaccines: May decrease effectiveness of
live-virus vaccines. Concurrent use isn't recommended.
 Loop diuretics: May increase risk of adverse renal
reactions. Monitor renal function.
 Probenecid: May inhibit excretion and increase
cefuroxime level. Probenecid may be used for this
effect.
 Warfarin: May increase anticoagulation effects.
Monitor PT and INR closely
 Monitor patient for signs and symptoms
ofsuperinfection and diarrhea and treat appro- priately.
 Drug may increase INR and risk of bleeding. Monitor
patient.
 Look alike sound alike: Don't confuse drug with other
cephalosporins that sound alike.

References:
Nursing Drug Handbook 2022 42 nd edition - Wolters Kluwer

Azzoni, P. (1980, December 1). Cefuroxime-tobramycin Therapy in Cancer Patients with Bacterial Infections.
Tumori Journal; SAGE Publishing. https://doi.org/10.1177/030089168006600612

Cefuroxime (Injection Route, Intravenous Route). (2023, February 7). https://www.mayoclinic.org/drugs-

supplements/cefuroxime-injection-route-intravenous-route/description/drg-
20062607#:~:text=Descriptions,bacteria%20or%20preventing%20their%20growth.

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