Drug Data

Generic Name RIFAMPICIN Trade Name Ripadine Contents Rifampicin Patients Dose 3 tabs pre-breakfast (combination with INH, PZA, Ethambutol) Minimum Dose 10 mg/kg PO Maximum Dose 600 mg PO Availability Capsules: 150 mg, 300 mg Route of Administration Oral

Classification
Therapeutic Antituberculotics Pregnancy Risk Category C

Mechanism of Action
Inhibits DNAdependent RNA polymerase which impairs RNA synthesis; Bactericidal Onset Unknown Peak 2-4 hrs Duration Unknown

Indication
Rifampicin is given together with other antituberculotics to treat active TB.

Contraindication
Hypersensitivity Precautions Liver Disease

Side Effects
CNS: headache, fatigue, drowsiness, behavioral changes, dizziness, mental confusion, generalized numbness, ataxia CV: shock RESPI: shortness of breath, wheezing EENT: visual disturbances, exudative conjunctivitis GI: epigastric distress, anorexia, nausea, vomiting, abdominal pain, diarrhea, flatulence, sore mouth and tongue, pseudomembranous colitis, pancreatitis GU: hemoglobinuria, hematuria, acute renal failure, menstrual disturbances HEMAT: hepatotoxicity METAB: hyperuricemia MUSCULO: osteomalacia MISC: discoloration of body fluids, flulike syndrome

Nursing Responsibilities
Before

1. Assess for hypersensitivity. 2. Perform mycobacterium studies and susceptibility test prior to and periodically to detect possible resistance. 3. Assess lung sound and sputums characteristic periodically during the treatment. 4. Assess for contraindications. 5. Obtain baseline vital signs. 1. Observe 15 rights of drug administration. 2. Administer on an empty stomach at least 1 hour before or 2 hours after meals with full glass of water. 3. Administer solutions diluted in 500ml over 3 hours and solutions diluted in 100ml over 30 minutes. 4. Do not admix with other solutions or medications. Instruct for possible side/ adverse effect of drug.

During

After

1. Advise patient to take medication as directed. 2. Caution patient to avoid use of alcohol during the therapy. 3. Instruct patient to report if occurrence of flu-like symptoms and hepatitis is visible. 4. Emphasize the importance of regular follow-up check-up.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins.[64-65]

Drug Data
Generic Name ISONIAZID Trade Name Isotamine, Nydrazid Contents Isoniazid Patients Dose 3 tabs pre-breakfast (combination with rifampicin, PZA, Ethambutol) Minimum Dose 5 mg/kg daily PO Maximum Dose 300 mg/day Availability Tablets: 100 mg, 300 mg Oral Solution: 50 mg/5 ml Injection: 100 mg/ml Route of Administration Oral, Intramuscular

Classification
Therapeutic Antituberculotics Pregnancy Risk Category C

Mechanism of Action
Unknown; may inhibit cell-wall biosynthesis by interfering with lipid and DNA synthesis; Bactericidal Onset Unknown Peak 1-2 hrs Duration Unknown

Indication
Isoniazid is given together with other antituberculotics to treat active TB.

Contraindication
Acute hepatic disease or isoniazid- related liver damage Precautions Geriatric patients Chronic alcoholism Seizure disorders ( especially if taking phenytoin) Severe renal impairment

Side Effects
CNS: peripheral neuropathy, seizures, toxic encephalopathy, memory impairment, toxic psychosis EENT: optic neuritis and atrophy GI: epigastric distress, nausea, vomiting, HEMAT: agranulocytosis, hemolytic anemia, aplastic anemia, eosinophilia, thrombocytopenia, sideroblastic anemia METAB: hyperglycemia, metabolic acidosis, hypocalcemia, hyphophosphatemia SKIN: irraitation at injection site OTHER: rheumatic and lupuslike syndromes, hypersensitivity reactions, pyridoxine deficiency, gynecomastia

Nursing Responsibilities
Before
1. Obtain Mycobacterium studies and susceptibility tests prior to and periodically throughout therapy to detect possible resistance. 2. Assess for hypersensitivity. 3. Assess for contraindication. 4. Assess for possible pregnancy and lactation. 5. Assess patients nutritional status.

During
1. Observe the 15 rights of drug administration. 2. The drug may be administered with food or antacids if GI irritation occurs, although antacids containing should not be taken within 1 hour of administration. 3. If isoniazid over dosage occurs, treatment with pyridoxine is instituted. 4. Inform patient on possible side/adverse effects of drug.

After
1. Advise patient to take medication exactly as directed. 2. Report immediately visual acuity, eye pain, or blurred vision occurs. 3. Caution patient to avoid the use of alcohol during this therapy. 4. Ingestion of Swiss or cheeses, tuna, should also be avoided. 5. Emphasize the importance of regular followup and ophthalmologic exams to monitor progress and to check for side effects.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins. [60-62]

Drug Data
Generic Name PYRAZINAMIDE Trade Name Tebrazid Contents Pyrazinamide Patients Dose 3 tabs pre-breakfast (combination with rifampicin, isoniazid, Ethambutol) Minimum Dose 15- 30 mg/kg /day Maximum Dose 2 g/day Availability Tablets: 500 mg Route of Administration Oral

Classification
Therapeutic Antituberculotics Pregnancy Risk Category C

Mechanism of Action
Unknown Onset Unknown Peak 1-2 hrs Duration Unknown

Indication
Pyrazinamide is given together with other antituberculotics to treat active TB.

Contraindication
Hypersensitivity Severe hepatic disease Acute gout Precautions Diabetes mellitus Renal failure Gout

Side Effects
CNS: malaise, fever CV: ECG changes, arrythmias GI: anorexia, nausea, vomiting, HEMAT: thrombocytopenia, sideroblastic anemia HEPAT: hepatitis, hepatotoxicity METAB: hyperuricemia MUSCULO: arhralgia, myalgia SKIN: rash, urticaria, pruritus, photosensitivity OTHER: gout, porphyria

Nursing Responsibilities
Before
1. Assess for hypersensitivity. Assess for other contraindications. 2. Perform mycobacterium studies and susceptibility tests prior to and periodically to detect possible resistance. 3. Assess bone marrow status.

During
1. Observe 15 rights of drug administration. 2. Administer on an empty stomach at least 1 hour before or 2 hours after meals with full glass of water. 3. Monitor renal and liver function tests. 4. Discontinue the drug immediately if hypersensitivity reactions occur. 5. Inform patient on possible side/adverse effects.

After
1. Encourage to eat small frequent meals as tolerated, perform frequent mouth care, and drink adequate fluid. 2. Ensure that the patient receives full course of the therapy. 3. Report any abnormalities immediately. 4. Emphasize importance of follow- up.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins. [62-63]

Drug Data
Generic Name ETHAMBUTOL HYDROCHLORIDE Trade Name Myambutol Contents Ethambutol Patients Dose 3 tabs pre-breakfast (combination with rifampicin, isoniazid, Ethambutol) Minimum Dose 15mg/kg/day PO Maximum Dose 25 mg/kg/day PO Availability Tablets: 100mg, 400 mg Route of Administration Oral

Classification
Therapeutic Antituberculotics Pregnancy Risk Category B

Mechanism of Action
Unknown; may inhibit synthesis of one or more metabolites of susceptible bacteria, changing cell metabolism during cell division; Bacteriostatic Onset Unknown Peak 2-4 hrs Duration Unknown

Indication
Ethambutol is given together with other antituberculotics to treat active TB to prevent drugresistance.

Contraindication
Children < 13 years old Hypersensitivity Optic neuritis Precautions Impaired renal function Cataracts Recurrent eye inflammation Gout Diabetic retinopathy

Side Effects
CNS: headache, dizziness, fever, mental confusion, hallucinations, malaise, peripheral neuritis RESPI: bloody sputum EENT: optic neuritis GI:, abdominal pain, anorexia, GI upset, nausea, vomiting HEMAT: thrombocytopenia METAB: hyperuricemia MUSCULO: joint pain SKIN: dermatitis, pruritus, toxic epidermal necrolysis OTHER: anaphylactoid reactions, precipitation of acute gout

Nursing Responsibilities
Before
1. Assess for hypersensitivity.
2. Perform mycobacterium studies and susceptibility to detect possible resistance. 3. Assess renal and liver function tests. 4. Assess for possible pregnancy. 5. Assess for other contraindications.

During
1. Observe 15 rights of drug administration. 2. Administer on an empty stomach or 1 hour before or 2 hours after meals with full glass of water. 3. Monitor renal and liver function tests. 4. Discontinue drug immediately if hypersensitivity reactions occur. 5. Inform patient on possible side/ adverse effects.

After
1. Encourage to eat small frequent meals as tolerated, perform frequent mouth care, and drink adequate fluids. 2. Advise patient to take medications as directed. 3. Ensure that patient receives the full course of the therapy. 4. Report any unusuality to health care professionals immediately. 5. Emphasize follow- up check- up.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins. [59-60]

Drug Data
Generic Name VITAMIN BCOMPLEX Patients Dose 1 tab OD Minimum Dose 10mg PO daily Maximum Dose 50 mg PO daily Availability Tablets: 10-500mg Injection: 100 mg/ml Route of Administration Oral, Intravenous

Classification
Therapeutic vitamins Pregnancy Risk Category unknown

Mechanism of Action
Required for amino acids carbohydrate, and lipid metabolism Used in the transport of amino acids, formation of neurotransmitters and synthesis of heme.

Indication
Vitamin BComplex is given to prevent peripheral neuritis as a side effect of isoniazid.

Contraindication
Hypersensitivity Precautions Parkinsons disease Pregnancy

Side Effects
For excessive dose only: NEURO: sensory neuropathy MISC: pyridoxinedependency syndrome

Nursing Responsibilities
Before
1. Assess for vitamin B deficiency. 2. Assess for hypersensitivity to some components of drug. 3. Assess for Parkinsons disease. 4. Take baseline vital signs. 5. Institute seizure precaution for pyridoxine- dependency syndrome.

During
1. Observe 15 rights of drug administration. 2. Tablets should be swallowed whole, without crushing, breaking or chewing. 3. Rotate sites for IM administration. 4. Protect drug from light. 5. Inform patient on possible side/adverse effects of drug.

After
1. Advise patient to take medication as directed. 2. Encourage to comply with recommended diet. 3. Emphasize the importance of follow- up exams to evaluate progress. 4. Patients self- medicating should be cautioned not to exceed RDA.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins.[1202-1203]

Drug Data
Generic Name POTASSIUM CHLORIDE Trade Name Kalium Durules Contents Potassium Chloride Patients Dose 2 tabs TID PO Minimum Dose 40 mEq/day Maximum Dose 100 mEq/day Availability Extended- release tabs: 8-20 mEq Extended- release capsules Oral suspension: 1030 mEq/15 ml Solution for IV infusion: 10 mEq/L Route of Administration Oral, Intravenous

Classification
Therapeutic Mineral and electrolyte replacement/ supplements Pregnancy Risk Category C

Mechanism of Action
Miantain acid- base balance, isotonicity, and electro physiologic balance of the cell Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis, and carbohydrate metabolism. Pharmacokinetics Well- absorbed following oral administration Enters ECF; then actively transported into cells Excreted by the kidneys Half- life Unknown Onset Unknown Peak 1-2 hrs Duration Unknown

Indication
Potassium chloride ( Kalium durules) is given to manage hypokalemia since the clients serum potassium level is 3.32 mmol/L which is below the reference of 3.5-5.3 mmol/L.

Contraindication
Hyperkalemia Severe renal impairment Untreated Addisons disease Severe tissue trauma Hypersensitivity to Tartrazine Precautions Cardiac disease Renal impairment Diabetes mellitus ( liquids may contain sugar) Hypomagnesemia ( may make correction of hypokalemia more difficult) GI hypomotility

Side Effects
CNS: confusion, restlessness, weakness CV: ECG changes, arrythmias GI: abdominal pain, diarrhea, flatulence, nausea, vomiting NEURO: paralysis, paresthesia LOCAL: irritation at IV site

Nursing Responsibilities
Before
1. Assess for hypersensitivity to tartrazine. 2. Assess renal function. 3. Determine serum potassium level. Assess cardiac status and note presence or history of arrythmias. 4. Obtain baseline vital signs. 5. Explain therapeutic effects of medication to facilitate compliance. 6. Inform client of possible adverse or side effects.

During
1. Prepare medication aseptically. 2. Administer with or after meals to decrease gastric irritation. 3. Give with a full glass of water. 4. Instruct not to chew tablets. 5. Observe for signs of hypersensitivity.

After
1. Monitor serum potassium levels. 2. Monitor vital signs frequently especially pulse rate and blood pressure. Monitor intake and output. 3. Monitor ECG results and note presence of arrythmias. Refer accordingly. 4. Instruct client and SO that medication should be taken as directed. 5. Instruct client and SO to avoid salt substitutes or low- salt foods unless approved by the primary health care provider. 6. Advise to include foods rich in dietary potassium such as avocado, raw carrot, raw tomato, beef, pork, banana, dried fruits such as raisins, milk, and orange juice. Instruct to report dark, tarry, or bloody stools; weakness, unusual fatigue or tingling of extremities.

Source: Daviss Drug Guide for Nurses. 2005. 9th Ed. Thailand: F.A. Davis Company.[867-870]

Drug Data
Generic Name CIPROFLOXACIN Trade Name Cipro, Cipro XR Contents Ciprofloxacin Patients Dose 500 mg 1 tab BID PO Minimum Dose 250 mg q 12h PO Maximum Dose 750 mg q 12h PO Availability Tablets: 250 mg, 500 mg, 750 mg Extended- release tabs: 250, 500, 750 mg Oral Solution: 250 mg/5 ml Solution for Injection: 200 mg/20ml Route of Administration Oral, Intravenous

Classification
Therapeutic Anti- infectives (antibacterial) Pharmacologic Fluorquinolones Pregnancy Risk Category C

Mechanism of Action
Inhibit bacterial DNA synthesis by inhibiting DNA gyrase Therapeutic Effects
Death of susceptible bacteria Active against gram (+) pathogens, gram () bacteria, and anaerobic pathogens Additional spectrum includes Mycobacterium tuberculosis

Indication
Ciprofloxacin is given to treat respiratory infections including pulmonary tuberculosis.

Contraindication
Hypersensitivity pregnancy Precautions underlying CNS pathology renal impairment cirrhosis dialysis patients lactation Food- Drug Interaction impaired absorption with concurrent tube feedings because of metal cations should not be taken with milk or yougurt alone but may be taken with other dietary calcium

Side Effects
CNS: confusion, dizziness, drowsiness, headache, insomnia, tremors, hallucination, lightheadedness, seizures CV: vasodilation, arrythmias GI: abdominal pain, diarrhea, nausea, pseudomembranous colitis GU: interstitial systitis, vaginitis DERM: photosensitivity, phototoxicity ENDO: hyperglycemia, hypoglycemia MS: tendonitis, tendon rupture MISC: anaphylaxis

Nursing Responsibilities
Before
1. Assess for hypersensitivity. 2. Obtain history of drug therapy. 3. Obtain specimen for culture and sensitivity. 4. Assess renal and hepatic status. 5. Obtain baseline vital signs. 6. Inform client of therapeutic effects of medication.

During
1. Prepare medication aseptically. 2. Administer with meal to decrease gastric irritation. 3. Administer with a full glass of water. 4. Observe for signs of hypersensitivity. 5. Do not administer concurrently with milk and yogurt.

Pharmacokinetics
Well- absorbed after oral administration (70%) Widely distributed; high tissue and urinary levels are achieved 15% metabolized by the liver, 40-50% excreted unchanged by the kidneys

After
1. Monitor vital signs. 2. Instruct client to take medication as directed; do not double dose. 3. Instruct to complete course of therapy even if feeling better. 4. Advise to wear protective clothing and sunglasses if photosensitivity develops. 5. Instruct to report signs of superinfection such as furry overgrowth of tongue, loose or foul smelling stools, and the like.

Half- life 4 hrs Onset Rapid Peak 1-2 hrs

6. Instruct to report to health care provider immediately

if rash, tendon pain, or inflammation occurs; therapy should be discontinued.

Duration 12 hrs

Source: Daviss Drug Guide for Nurses. 2005. 9th Ed. Thailand: F.A. Davis Company.[435-442]

Drug Data
Generic Name ALBUTEROL Trade Name Salbutamol Contents Albuterol Patients Dose Neb q 4 hr Minimum Dose 2.5 mg 3-4x/day Maximum Dose 2.5 mg 3-4x/day Availability Inhalation solution: 0.63mg/3mL, 0.5 mg/Ml,5 mg/Ml Tablets: 2 mg, 4 mg Route of Administration Oral, Inhalation

Classification
Therapeutic Bronchodilators Pharmacologic Adrenergics Pregnancy Risk Category C

Mechanism of Action
Binds to beta2adrenergic receptors in airway smooth muscle, leading to activation of adenylcyclase and increased levels of cyclic-3, 5 adenosine monophosphate (cAMP). Increases in cAMP activate kinases which inhibit the phosphorylation of myosin and decrease intracellular calcium which relaxes airway smooth muscles with subsequent bronchodilation.

Indication
Albuterol (Salbutamol) is given to relieve airway obstruction due to excessive mucus secretions.

Contraindication
Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons (some inhalers) Precautions Cardiac disease Hypertension Hyperthyroidism Diabetes Glaucoma geriatric patients pregnancy, lactation, children excessive use may lead to tolerance and paradoxical bronchospasm

Side Effects
CNS: nervousness, restlessness, tremor, headache, insomnia CV: chest pain, palipitations, angina, hypertension, arrythmias GI: nausea, vomiting ENDO: hyperglycemia F & E: hypokalemia NEURO: tremor

Nursing Responsibilities
Before
1. Assess for hypersensitivity. 2. Obtain history of drug therapy. 3. Assess cardiac and pulmonary status. 4. Assess if client has hyperthyroidism, diabetes, or glaucoma. Notify prescriber accordingly. 5. Obtain baseline serum potassium levels. 6. Note amount, color, and character of sputum produced. Inform client of therapeutic effects of medication.

During
1. For nebulization, compressed air or oxygen flow should be 6-10 L/min; a single treatment of 3 mL lasts about 10 minutes. 2. Observe for paradoxical bronchospasm. 3. Withhold medication if paradoxical bronchospasm occurs and notify prescriber. 4. Allow at least 1 minute between inhalations. 5. Observe for hypersensitivity reactions.

Pharmacokinetics
Well- absorbed after oral administration Rapidly undergoes extensive metabolism Small amounts appear in breastmilk Extensively metabolized by the liver and other tissues

After
1. Teach client effective coughing. 2. Encourage to expectorate secretions. 3. Teach how to discard sputum properly. 4. Monitor vital signs. 5. Instruct SO to administer medication as directed. 6. Teach SO on the proper use of nebulizer. Advise to rinse mouth, to minimize dry mouth, after each inhalation dose.

Half- life 3.8 hrs Onset 5-15 mins Peak 60-90 mins Duration 3-6 hrs

7. Monitor ECG results and note presence of

arrythmias.

Source: Daviss Drug Guide for Nurses. 2005. 9th Ed. Thailand: F.A. Davis Company.[16-18]

Drug Data
Generic Name Paracetamol Trade Name Biogesic Patients Dose 500mg/tab 1 tab prn Minimum Dose 500mg Maximum Dose 500mg Contents N-acetyl-paminophenol Availability Suppositories80, 120, 125, 300, 325, 650 mg; chewable tablets80 mg; tablets160, 325, 500, 650 mg; caplets 160, 500, 650 mg; gelcaps650 mg; capsules325, 500 mg; elixir80 mg/2.5 mL, 80 mg/5 mL, 120 mg/5 mL, 160 mg/5 mL; liquid 160 mg/5 mL, 500 mg/15 mL; solution80 mg/1.66 mL, 100 mg/mL; drops80 mg/0.8 mL; sprinkle capsules80, 160 mg Routes of administration PO, IVTT

Classification
Pharmacologic Class: Analgesic (nonnarcotic) Therapeutic Class: Antipyretic Pregnancy Risk Category B

Mechanism of Action
Reduces fever by direct action on hypothalamus heat regulating center with consequent peripheral vasodilation, sweating and dissipation of heat. Unlike aspirin, acetaminophen has little effect on platelet aggregation, does not affect bleeding time and produces no gastric bleeding

Indication
Fever reduction Temporary relief of mild to moderate pain Substitute for aspirin when the latter is not tolerated or is contraindicated . Patients Actual Indication Fever

Contraindication
Hypersensitivity to acetaminophen or phenacetin; use with alcohol

Side Effects

Nursing Responsibilities
Before

CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/d are ingested daily for several weeks or when doses of 4 g/d are ingested for 1 year GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemiahematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitivity: Rash, fever

Precautions
Children below 3 yrs old unless directed by the physicilan Repeated administration to patients with anemia or hepatic disease Arthritic of rheumatoid condition Alcoholism, malnutrition Thrombocytopenia pregnancy

Pharmacokinetics
A: rapid and almost complete absorption from GIT; less complete absorption from rectal suppository. D: well distributed in all body fluids, crosses placenta M: extensively metabolized in liver E: urine and breasmilk.

1. Document indications for therapy. 2. Acetaminophen should not be taken for more than 5 days for pain in children , 10 days for pain in adults, more than 3 days for fever in adults or children without consulting provider. 3. History: Allergy to acetaminophen, impaired hepatic function, chronic alcoholism, pregnancy, lactation Physical: Skin color, lesions; T; liver evaluation; CBC, liver and renal function tests. 4. Check temperature before administering drug.

During

Onset: rapid Peak : 0.5 2 hrs. Duration : 3 4 hours Drug Half Life : 1 3 hours

Drug interactions Cholestyramine / decrease absorption Barbiturates, Carbamazepine, Phenytoin, and Rifampin / increase potential for chronic hepatotoxicity Ingestion of alcohol will increase risk for hepatotoxicity

1. Give drug with food if GI upset is noted. 2. Discontinue drug if hypersensitivity reactions occur. 3. Chewable tablets should be thoroughly chewed and wetted before they are swallowed. 4. Do not administer with a high carbohydrate meal; absorption rate may be significantly retarded.

After

1. Observe for the following side effects: stomach upset, loss of appetite, nausea (take drug with food); dizziness. 2. Report rash or hives 3. Monitor CBC, liver, and renal function studies 4. Phenacetin, the major active metabolite of acetaminophen, may cause the urine to be dark brown or wine-colored. 5. Any unexplained pain or fever that persists for more than 5 days require medical evaluation.

Source: Nursing Drug Handbook. 2006. Philadelphia: Lippincott Williams and Wilkins.[64-65]