DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

CONTRAINDICATION
GENERIC: Binds to intracellular glucocorticoid INDICATION/s: CNS: BEFORE
PREDNISOLONE receptors and suppresses To treat adrenal insufficiency and Euphoria, headache, insomnia,
inflammatory and acute and chronic inflammatory and nervousness, psychosis, restlessness, Dx:
BRAND: PRELONE immune responses by: immunosuppressive disorders seizures, vertigo a. Check for allergies

THERAPEUTIC: • inhibiting neutrophil and monocyte
IMMUNOSUPPRESSANT accumulation at inflammation site
and suppressing their phagocytic and
PHARMACOLOGIC: bactericidal activity
GLUCOCORTICOID
• stabilizing lysosomal membranes
DOSAGE: 1.06 mkD
ROUTE: ORAL • suppressing antigen response of
macrophages and helper T cells
• inhibiting synthesis of
inflammatory response mediators,
such as cytokines, interleukins, and
prostaglandins.
SOURCE: Jones & Bartlett
Learning (2021) Nurse’s Drug
Handbook
To treat acute exacerbations of
multiple sclerosis
To treat uncontrolled asthma in
children taking inhaled
corticosteroids
and long-acting bronchodilators
To treat pediatric nephrotic
syndrome
CONTRAINDICATION/s:
Hypersensitivity to prednisolone or
its components, idiopathic
thrombocytopenic
purpura (I.M. form), systemic fungal
infection
DRUG TO DRUG
INTERACTION:
aminoglutethimide: Possibly loss of
induced adrenal suppression
amphotericin B, diuretics: Possibly
severe hypokalemia
antacids, cholestyramine, colestipol:
Decreased prednisolone absorption
anticholinesterase agents: Possibly
CV:
Edema, heart failure, hypertension
EENT:
Cataracts, exophthalmos, glaucoma,
increased ocular pressure
ENDO:
Adrenal insufficiency, Cushing’s
syndrome, growth suppression in
children, hyperglycemia
GI:
Anorexia, GI bleeding and ulceration,
increased appetite, indigestion,
intestinal perforation, nausea,
pancreatitis, vomiting
GU:
Menstrual irregularities
MS:
Avascular necrosis of joints, bone
fractures, muscle atrophy or weakness,
myalgia, osteoporosis, tendon rupture
(local injection only)
b. Assess patient regularly for
evidence of such reactions,
including heart failure and
hypertension
c. Monitor patient’s intake,
output, and daily weight
Tx:
a. Give once-daily doses in the
morning to mirror body’s normal
cortisol secretion.
b. Perform a thorough physical
assessment to establish baseline
data before drug therapy begins
c. Restrict amount of drug
available to patient.
EDx:
a. Instruct patient to take oral
prednisolone with food to decrease
stomach upset and to take once-
daily dose in the morning.
b. Emphasize need to take drug
exactly as prescribed, taking too
severe weakness in patients with
myasthenia
gravis.
barbiturates, phenytoin, rifampin:
Decreased prednisolone effects
cyclosporine: Increased risk of
seizures
digoxin: Possibly arrhythmias and
digitalis toxicity from hypokalemia
estrogens, oral contraceptives:
Decreased clearance, increased
elimination half-life, and increased
therapeutic and toxic effects of
prednisolone
insulin, oral antidiabetics: Increased
risk of hyperglycemia
ketoconazole, macrolide antibiotics:
Possibly decreased prednisolone
metabolism
isoniazid, salicylates: Decreased
blood level of these drugs
live or inactivated vaccines, toxoids:
Possibly diminished response to
vaccines
or toxoids
NSAIDs: Increased risk of GI
ulceration and bleeding, possibly
added
therapeutic effect when NSAIDs are
used to treat arthritis
warfarin: Possibly inhibition of
warfarin effect
DRUG TO FOOD
INTERACTION:
SKIN:
Acne; cutaneous or subcutaneous
atrophy (with frequent repository
injections); diaphoresis; ecchymosis;
flushing; petechiae; striae; thin, fragile
skin
OTHERS:
Delayed wound healing,
hypernatremia, hypokalemia, injection-
site
scarring, negative nitrogen balance
much increases risk of serious
adverse reactions.
c. Instruct patient taking orally
disintegrating tablets to remove
tablet from blister pack only when
ready to take drug and to place
tablet on tongue. Warn her not to
break, cut, or split tablets.
DURING
Dx:
a. Monitor for adverse effects
such as heart failure or hypertension
b. Check for drug to drug or drug
to food interactions
c. Monitor the patient’s intake,
output, and daily intake
Tx:
a. Assist patient in taking the
medication
b. Keep in mind that prednisolone
can produce many adverse reactions
so take safety precautions.
c. Limit assess to drug if patient
is experiencing adverse effects to
reduce harm.
EDx:
sodium-containing foods: Increased
risk of edema and hypertension a. Instruct patient to avoid
alcohol during therapy because of
increased risk of GI ulcers and
bleeding.

b. Instruct patient to avoid

hazardous activities until drug’s
CNS effects are known.

c. Advise patient to avoid people

with contagious infections because
drug has an immunosuppressant
effect. Instruct her to notify
prescriber immediately about
exposure to measles or chickenpox.

AFTER

Dx:
a. Monitor growth pattern in
children; prednisolone may retard
bone growth.

b. Monitor patient’s intake,

output, and daily weight.

c. Monitor for side effects

Tx:
a. Provide safety measures (e.g.,
adequate lighting, raised side rails,
etc.) to prevent injuries.

b. Keep in mind that prednisolone

 can produce many adverse reactions
so take safety precautions.

c. Prolonged use may cause

hypothalamic-pituitary-adrenal
suppression.

EDx:
a. Advise patient to comply with
follow-up visits to assess drug’s
effectiveness and detect adverse
reactions.

b. Instruct patient to notify

prescriber immediately about joint
pain, swelling, tarry stools, and
visual disturbances. Also instruct
her to report signs of infection or
injury for up to 12 months after
therapy.

c. Instruct diabetic patient to

check her blood glucose level often
because prednisolone may cause
hyperglycemia.

DRUG NAME MECHANISM OF ACTION INDICATION / ADVERSE EFFECT NURSING RESPONSIBILITIES

CONTRAINDICATION
GENERIC: RIFAMPIN Inhibits bacterial and mycobacterial INDICATION/s:
(RIFAMPICIN) RNA synthesis by binding to DNA As adjunct to treat tuberculosis
dependent caused by all strains of
BRAND: RIMACTANE RNA polymerase, thereby blocking Mycobacterium
RNA transcription. Exhibits dose Tuberculosis
THERAPEUTIC: dependent
ANTIMYCOBACTERIAL bactericidal or bacteriostatic action. To eliminate meningococci from
ANTITUBECULAR Rifampin is highly effective nasopharynx of asymptomatic
against rapidly dividing bacilli in carriers of Neisseria meningitidis
extracellular cavitary lesions, such
PHARMACOLOGIC: as those CONTRAINDICATION/s:
SEMISYNTHETIC found in the nasopharynx. Concurrent use of atazanavir,
RIFAMYCIN darunavir, fosamprenavir,
SOURCE: Jones & Bartlett praziquantel,
Learning (2021) Nurse’s Drug ritonavir/saquinavir, saquinavir, or
DOSAGE: 15 mkD Handbook tipranavir; hypersensitivity to
ROUTE: ORAL rifampin, other rifamycins or their
components
DRUG TO DRUG
INTERACTION:
antacids: Possibly reduced rifampin
absorption
antiarrhythmics (disopyramide,
mexiletine, quinidine, propafenone,
tocainide),
anticonvulsants (phenytoin),
antiestrogens (tamoxifen,
toremifene), antifungals
(fluconazole, itraconazole,
ketoconazole), antipsychotics
(haloperidol),
antiretrovirals (atazanavir,
darunavir, efavirenz,
fosamprenavir, indinavir,
CNS:
Ataxia, behavioral changes, chills,
confusion, difficulty concentrating,
dizziness, drowsiness, fatigue, fever,
generalized numbness, headache,
paresthesia, psychoses
CV:
Hypotension, myopathy, vasculitis
EENT:
Conjunctivitis; discolored saliva,
sputum, tears, and teeth; mouth or
tongue soreness; periorbital edema;
visual disturbances
ENDO:
Adrenal insufficiency (rare),
hyperglycemia or hypoglycemia (in
patients with diabetes)
GI:
Abdominal cramps, anorexia,
cholestasis, diarrhea, discolored
feces, elevated liver enzymes,
epigastric discomfort, flatulence,
heartburn, hepatitis, jaundice, nausea,
pseudomembranous colitis, shock-
like syndrome with
hepatic involvement, vomiting
GU:
Acute renal failure or tubular
necrosis, discolored urine, elevated
BUN and serum uric acid, hematuria,
BEFORE
Dx:
a. Monitor patient for signs and
symptoms of hypersensitivity reactions
b. Monitor patient for rash or other
skin abnormalities
c. Check for allergies before
administering the drug
Tx:
a. Check if it the right drug and the
right patient
b. Obtain blood samples or other
specimens for culture and sensitivity
testing, as ordered, before giving
rifampin and throughout therapy to
monitor response to drug
c. Perform a thorough physical
assessment to establish baseline data
before drug therapy begins
EDx:
a. Instruct patient to take rifampin 1
hour before or 2 hours after a meal with
a full glass of water.
b. Emphasize the need to take drug
exactly as prescribed. Explain that not
completing the full course of therapy or
skipping doses may decrease the
effectiveness of the treatment and
saquinavir, tipranavir, zidovudine),
benzodiazepines (diazepam),
benzodiazepine-related drugs
(zopiclone, zolpidem), beta
blockers (metoprolol,
propranolol), calcium channel
blockers (diltiazem, nifedipine,
verapamil),
chloramphenicol, clarithromycin,
corticosteroids (prednisolone),
dapsone,
digoxin, doxycycline, enalapril,
fluoroquinolones (moxifloxacin,
perfloxacin),
hepatitis C antiviral (daclatasvir,
simeprevir, sofosbuvir, telaprevir),
hypoglycemic agents oral
(glipizide, glyburide),
immunosuppressive agents
(cyclosporine, tacrolimus),
irinotecan, levothyroxine, losartan,
methadone,
narcotic analgesics (morphine,
oxycodone), praziquantel, quinine,
selective 5-
HT3 receptor antagonists
(ondansetron), statins (simvastatin),
systemic
hormonal contraceptives
(estrogens, progestins),
telithromycin, theophylline,
thiazolidinediones (rosiglitazone),
tricyclic antidepressants
(nortriptyline),
warfarin: Decreased exposure and
interstitial nephritis, menstrual
disturbances, renal insufficiency
HEME:
Agranulocytosis (rare), decreased
hemoglobin, disseminated
intravascular coagulation (DIC),
eosinophilia, hemolytic anemia,
leukopenia,
neutropenia, purpura,
thrombocytopenia (rare)
MS: Arthralgia, extremity pain,
muscle weakness, myalgia (rare)
RESP:
Acute bronchospasm, shortness of
breath, wheezing
SKIN:
Acute generalized exanthematous
pustulosis, discolored skin and sweat,
erythema multiforme, flushing,
pemphigoid reaction, pruritus, rash,
Stevens–Johnson syndrome, toxic
epidermal necrolysis, urticaria
Other:
Anaphylaxis, angioedema, drug
reaction with eosinophilia and
systemic symptoms (DRESS), flu-
like symptoms, lymphadenopathy
increase the chance that resistance to
drug may develop, making it
ineffective to treat an infection patient
might develop in the future. Emphasize
importance of compliance with the full
course of therapy.
c. Explain that drug may discolor
feces, saliva, skin, sputum, sweat, tears,
teeth, and urine reddish brown to
reddish orange or yellow. Discoloration
of teeth and soft contact lenses may be
permanent.
DURING
Dx:
a. Monitor patient’s signs and
symptoms for reactions.
b. Check for drug to drug or drug to
food interactions.
c. Monitor patient’s skin for
abnormalities that can be life-
threatening
Tx:
a. Assist patient in taking the
medication
b. Provide safety measures (e.g.,
adequate lighting, raised side rails, etc.)
to prevent injuries.
effectiveness of these drugs
atovaquone: Decreased
concentration of atovaquone and
increased concentration
of rifampin, which may increase
risk of toxicities
cotrimoxazole, probenecid:
Increased rifampin concentration
halothane, isoniazid: Possibly
hepatotoxicity
ritonavir/saquinavir: Increased risk
of severe hepatotoxicity
DRUG TO FOOD
INTERACTION:
c. Provide supportive care to the
patient
EDx:
a. Advise patient who takes an oral
contraceptive to use an additional form
of birth control during rifampin
therapy.
b. Instruct patient to notify prescriber
about anorexia, cough, darkened urine,
fever, flu-like symptoms, joint pain or
swelling, malaise, nausea, rash,
shortness of breath, swollen lymph
nodes, vomiting, wheezing, and
yellowish eyes or skin.
c. Advise patient to avoid alcohol,
herbal products, or any drug that
adversely affects the liver (without
prescriber consent) during rifampin
therapy.
AFTER
Dx:
a. Assess knowledge/teach patient
appropriate use of interventions to
reduce side effects, and adverse
symptoms to report
b. Monitor the effectiveness of the
drug exhibited by decrease in
symptoms
 c. Monitor patient for signs and
symptoms of hypersensitivity reactions

Tx:
a. Provide comfort measures to help
patient tolerate drug effects.

b. Monitor for adverse effects such as

generalized numbness, headache,
paresthesia, psychoses

c. Provide safety measures (e.g.

adequate lighting, raised side rails, etc.)
to prevent injuries.

EDx:
a. Instruct patient to notify prescriber
if no improvement occurs within 2 to 3
weeks.

b. Inform patient with diabetes

mellitus that rifampin therapy may
affect his blood glucose levels and to
monitor his blood glucose levels
closely.

c. Tell patient to inform all

prescribers of rifampin therapy.

d. Instruct patient to notify prescriber

immediately if rash or other skin
abnormalities occur, as reaction may
become severe.