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Drug Study
DRUG ORDER
(Generic
name, PHARMACOLOGI DESIRED NURSING
INDICATIONS AND ADVERSE EFFECTS OF
Dosage, C ACTION OF ACTION ON RESPONSIBILITIES
CONTRAINDICATIONS THE DRUG
Route, DRUG THE CLIENT /PRECAUTIONS
Frequency,
etc.)
Amphotericin Increased cell Indications: CNS: headache, fever, Treat fungal • Monitor VS q15-
B 0.15 cc + membrane • Treatment of chills, peripheral nerve infection 30 min during
1.35 cc D5W permeability in severe, possibly pain, paresthesias, first inf; note
OD susceptible fatal fungal peripheral neuropathy, changes in
organisms by infections seizures, dizziness pulse, BP.
binding sterols in EENT: tinnitus, deafness, • Monitor blood
fungal membrane; Contraindications: diplopia, blurred vision studies
decreases • Hypersensitivity GI: nausea, vomiting, • Monitor weight
potassium, sodium • Severe bone anorexia, diarrhea, weekly; if weight
and nutrients in marrow depression cramps, hemorrhagic increases 2lb/wk,
the cell gastroenteritis, acute liver edema is
failure present; renal
GU: hypokalemia, damage should
axotemia, hyposthenuria, be considered.
renal tubular acidosis, • Monitor for renal
nephrocalcinosis,
toxicity;
permanent renal
increasing BUN
impairment, anuria,
and serum
oliguria
creatinine
Blood: normochromic and
normocytic anemia, • Monitor for
thrombocytopenia, hepatotoxicity;
agranulocytosis, increasing AST,
leucopenia, eosinophilia, ALT, alkaline
hypokalemia, phophatase
hyponatremia, • Monitor for
hypomagnesemia allergic reaction
Integumentary: burning, • Monitor for
irritation, pain, necrosis at hypokalemia
inj site with extravasation,
flushing, dermatitis, skin
rash Precautions:
MS: athralgia, myalgia, • Pregnancy, renal
generalized pain, disease,
weakness, weight loss lactation
Meropenem 30 Interferes with cell Indications: CNS: fever, somnolence, Treat • Assess patient
mg IV q12h wall replication of • For serious seizures, dizziness, bacterial for previous
susceptible infections caused weakness, headache, infection sensitivity
organisms; by gram-positive myoclonia reaction to
osmotically or gram-negative CV: hypotension, carbapenems
unstable cell wall organisms palpitations • Assess patient
swells and bursts GI: diarrhea, nausea, for signs and
from osmotic Contraindications: vomiting, symptoms of
pressure • Hypersensitivity to pseudomembraneous infection,
meropenem or colitis, hepatitis, glossitis including
imipenem Blood: eosinophilia, characteristics of
neutropenia, decreased wounds, sputum,
Hgb, Hct urine, stool
Integumentary: rash, • Complete C/S
urticaria, pruritus, pain at tests before
inj site, phlebitis, beginning drug
erythema at inj site therapy
RESP: chest discomfort, • Assess for
dyspnea, hyperventilation
allergic
reactions,
anaphylaxis
• Identify urine
output
• Monitor blood
studies
• Monitor
electrolytes
• Assess bowel
pattern daily
• Monitor for
bleeding
Precautions:
• Pregnancy,
lactation, renal
disease, elderly
Furosemide Acts on the Indications: CNS: headache, fatigue, Increase • Assess patient
0.65 mg IV OD ascending loop of • Edema in CHF, weakness, vertigo, patient’s for tinnitus,
Henle in the nephritic paresthesias urine output hearing loss, ear
kidney; inhibiting syndrome, ascites CV: orthstatic pain
reabsorption of hypotension, chest pain, • Monitor for renal,
electrolytes Contraindications: ECG changes, circulatory cardiac,
sodium and • Hypersensitivity to collapse neiurologic, GI,
chloride, causing sulfonamides EENT: loss of hearing, ear pulmonary
excretion of • Anuria, pain, tinnitus, blurred manifestation of
sodium, calcium, hypovolemia, vision hypokalemia:
magnesium, infants, lactation, ELECTROLYTES: acidic urine,
chloride, water and electrolyte hypokalemia, decreased urine
some potassium depletion hypochloremic alkalosis, osmolality,
hypoagnesemia, nocturia,
hyperuricemia polyuria and
ENDO: hyperglycemia polydipsia
GI: nausea, diarrhea, dry • Monitor for CNS,
mouth, vomiting, GI,
anorexia, cramps, cardiovascular,
pancreatitis integumentary,
GU: polyuria, reanl failure, neurologic
glycosuria manifestations
HEMA: of hypocalcemia:
thrombocytopenia, personality
agranulocytosis, changes,
leucopenia, anemia anxiety,
INTEG: rash, pruritus, disturbances
purpura, sweating, • Monitor for
photosensitivity, urticaria
manifestations
MS: cramps, stiffness
of hyponatremia
• Monitor
electrolytes
Precautions:
• Pregnancy, DM,
dehydration,
severe renal
disease,
cirrhosis, ascites
Ciprofloxacin 7 Bactericidal; Indications: CNS: Headache, Treat • Assess patient
mg IV q12h interferes with • For the treatment dizziness, insomnia, bacterial for signs and
DNA replication in of infections fatigue, somnolence, infections symptoms of
susceptible caused by depression, blurred infection
bacteria susceptible gram- vision • Obtain C/S
preventing cell negative bacteria, CV: Arrhythmias, before beginning
reproduction. including E. coli, P. hypotension, angina drug therapy
mirabilis, K. EENT: Dry eye, eye pain, • Assess for
pneumoniae, keratopathy anaphylaxis
Enterobacter GI: Nausea, vomiting, dry • Identify urine
cloacae, P. mouth, diarrhea, output
vulgaris, P. abdominal pain • Monitor blood
rettgeri, M. Hematologic: Elevated studies
morganii, P. BUN, AST, ALT, serum • Monitor
aeruginosa, creatinine and alkaline
electrolytes
Citrobacter phosphatase;
• Assess bowel
freundii, S. decreased WBC,
aureus, S. neutrophil count, Hct pattern daily
epidermidis, group Other: Fever, rash • Monitor for
D streptococci bleeding
Contraindications: Precautions:
• Allergy to • Pregnancy,
ciprofloxacin, lactation,
norfloxacin or children, renal
other disease,
fluoroquinolones, epilepsy
pregnancy,
lactation.
Pentoxifylline Decreases blood Indications: CNS: headache, anxiety, Decrease • Monitor BP and
1.3 mg + 4.7 viscosity, • Intermittent tremors, confusion, blood respirations
cc D5W OD x stimulates claudication dizziness viscosity • Assess for
6o VSP x 6 prostacyclin related to chronic CV: Angina, dysrhythmias, intermittent
days production, occlusive vascular palpiptations, claudication
increasing blood disease hypotension, chest
flow by increasing • Sickle cell anemia pain, dyspnea Precautions:
flexibility of RBCs, EENT: blurred vision, • Pregnancy,
reduces platelet Contraindications: earache, increased angina pectoris,
aggregation, • Hypersensitivity salivation, sore throat, cardiac disease,
decreases conjunctivitis
• Retinal, cerebral impaired renal
fibrinogen GI: dyspepsia, nausea, function,
hemorrhage
concentration vomiting, anorexia, children, hepatic
belching, constipation, disease
dry mouth, thrist
INTEG: rash, pruritus,
urticaria, brittle
fingernails
Other: epistaxis, flulike
symptoms, nasal
congestion, malaise,
weight changes
Piperacillin- Interferes with cell Indications: CNS: headache, insomnia, Bactericidal • Assess patient
tazobactam 70 wall replication of • Respiratory tract, dizziness, fever, effects for for previous
mg IV q8h x susceptible skin, bone and lethargy, Methicillin- sensitivity
30 mins organisms; joint infections hallucinations, anxiety, resistant reaction to
osmotically • Infections from depression Staphylococ penicillins
unstable cell wall penicillinase- GI: nausea, vomiting, cus aureus • Assess patient
swells and bursts producing diarrhea, abdominal for signs and
from osmotic staphylococci pain, constipation, symptoms of
pressure pseudomembranous infection
Contraindications: colitis • Obtain C&S
• Hypersensitivity, GU: oliguria, proteinuria, before beginning
neonates hematuria, drug therapy
glomerulonephritis • Assess for
HEMA: anemia, increased
allergic reactions
bleeding time, bone
• Identify urine
barrow depression
INTEG: rash, pruritus output
META: hypokalemia, • Monitor blood
hypernatremia studies
SYST: anaphylaxis, serum • Monitor
sickness electrolytes
• Assess bowel
pattern daily
• Monitor for
bleeding
• Assess for
overgrowth of
infection
Precautions:
• Pregnancy,
lactation,
seizures,
hypersensitivity
to
cephalosporins,
renal
insufficiency in
children
Midazolam Acts mainly at the Indications: CNS: Transient, mild Sedation • monitor BP,
0.15 mg IV qh limbic system and • IV or IM: Sedation, drowsiness (initially); pulse, respiration
reticular formation; anxiolysis, and sedation, depression, • monitor inj site
potentiates the amnesia prior to lethargy, apathy, for redness,
effects of GABA, an diagnostic, fatigue, light- pain, swelling
inhibitory therapeutic, or headedness, • assess
neurotransmitter; endoscopic disorientation, anterograde
anxiolytic and procedures or restlessness, amnesia
amnesia effects surgery confusion, crying, • assess for
occur at doses • Induction of delirium, headache, apnea,
below those general anesthesia slurred speech, respiratory
needed to cause • Continuous dysarthria, stupor, depression
sedation, ataxia; sedation of rigidity, tremor,
has little effect on intubated and dystonia, vertigo, Precautions:
cortical function. mechanically euphoria, • COPD, CHF,
ventilated patients nervousness, difficulty chronc renal
as a component of in concentration, vivid failure, chills,
anesthesia or dreams, psychomotor debilitated,
during treatment retardation, neonates
in the critical care extrapyramidal
setting symptoms; mild
• Unlabeled uses: paradoxical excitatory
Treatment of reactions (during first
epileptic seizure or 2 wk of treatment),
refractory status visual and auditory
epilepticus disturbances, diplopia,
nystagmus, depressed
Contraindications: hearing, nasal
congestion
• hypersensitivity to
CV: Bradycardia,
benzodiazepines;
tachycardia, CV
psychoses, acute
collapse, hypertension,
narrow-angle
hypotension,
glaucoma, shock,
palpitations, edema
coma, acute
Dermatologic: Urticaria,
alcoholic
pruritus, skin rash,
intoxication;
dermatitis
pregnancy (cleft
GI: Constipation, diarrhea,
lip or palate,
dry mouth, salivation,
inguinal hernia,
nausea, anorexia,
cardiac defects,
vomiting, difficulty in
microcephaly,
swallowing, gastric
pyloric stenosis
disorders, elevations
have been
of blood enzymes:
reported when
LDH, alkaline
used in first
phosphatase, AST, ALT,
trimester;
hepatic dysfunction,
neonatal
jaundice
withdrawal
GU: Incontinence, urinary
syndrome
retention, changes in
reported in
libido, menstrual
infants); neonates.
irregularities
Hematologic: Decreased
Hct, blood dyscrasias
Other: Phlebitis and
thrombosis at IV
injection sites,
hiccups, fever,
diaphoresis,
paresthesias, muscular
disturbances,
gynecomastia; pain,
burning, and redness
after IM injection
Contraindications:
• infections,
especially
tuberculosis,
fungal infections,
amebiasis,
vaccinia and
varicella, and
antibiotic-resistant
infections, allergy
to any component
of the preparation
used.
Erythromycin Bacteriostatic or Indications: CNS: Reversible hearing • Assess patient
125g/5ml 0.15 bactericidal in • Acute infections loss, confusion, for signs and
ml po q6h susceptible caused by uncontrollable emotions, symptoms of
bacteria; binds to sensitive strains of abnormal thinking infection
cell membrane, Streptococcus CV: Ventricular • Obtain C&S
causing change in pneumoniae, arrhythmias (with IV) results before
protein function, Mycoplasma GI: Abdominal cramping, beginning
leading to cell pneumoniae, anorexia, diarrhea, therapy
death. Listeria vomiting, • Assess for
monocytogenes, pseudomembranous allergic reactions
Legionella colitis, hepatotoxicity • Identify urine
pneumophila Hypersensitivity:
output
• URIs, lower Allergic reactions ranging
• Monitor blood
from rash to anaphylaxis
respiratory tract studies
Other: Superinfections
infections, skin • Monitor
and soft-tissue electrolytes
infections caused • Assess bowel
by group A beta- pattern daily
hemolytic
• Assess for
streptococci when
overgrowth of
oral treatment is
infection
preferred to
injectable
Precautions:
benzathine
• Pregnancy,
penicillin
lactation
• In conjunction with
sulfonamides in
URIs caused by
Haemophilus
influenzae
• As an adjunct to
antitoxin in
infections caused
by
Corynebacterium
diphtheriae and
Corynebacterium
minutissimum
• Prophylaxis
against alpha-
hemolytic
streptococcal
endocarditis
before dental or
other procedures
in patients allergic
to penicillin who
have valvular
heart disease
Contraindications:
• Allergy to
erythromycin
Conraindications:
• allergy to
spironolactone,
hyperkalemia,
renal disease,
anuria, amiloride
or triamterene
use.
Precautions:
• pregnancy,
elderly, CHF,
hepatic disease,
cor pulmonale,
hepatic disease,
DM,
hyperthyroidism,
hypertension
• •