Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Furosemide Lasix Loop diuretic 20 mg Furosemide, like other loop diuretics, acts by inhibiting NKCC2, the luminal Na-K-2Cl symporter in the thick ascending limb of the loop of Henle. The action on the distal tubules is independent of any inhibitory effect on carbonic anhydrase or aldosterone; it also abolishes the corticomedullary osmotic gradient and blocks negative as well as positive free water clearance. Oral, IV: edema associated with heart failure, cirrhosis, renal disease IV: Acute pulmonary edema Oral: Hypertension Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); anuria, severe renal failure; hepatic coma; pregnancy, lactation Use cautiously with SLE, gout, diabetis mellitus CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme

Indications

Contraindications

Side/Adverse Effects

GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice GU: Polyuria, nocturia, glycosuria, urinary bladder spasm Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalances, hyperglycemia, hyperuricemia Other: Muscle cramps and muscle spams

Nursing Responsibilities

1. 2. 3. 4.

Administer with food or milk to prevent GI upset Reduce dosage if given with other antihypertensives, readjust dosage gradually as BP responds Give early in the day so that increased urination will not disturb sleep Instruct client to record intermittent therapy on a calendar or dated envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset. Inform that blood glucose levels may become temporarily elevated in patients with diabetes after starting this drug Inform client of side effects like increased volume and frequency

5. 6.

of urination, dizziness, drowsiness, sensitivity to sunlight, increased thirst 7. Instruct to report loss or gain of more than 3 pounds in 1 day, swelling in ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action Indications

Piperacillin sodium and Tazobactam sodium Zosyn Antibiotic, penicillin 4.5 g now then 2.25 g ivtt q 8 ANST The beta-lactamase inhibitors are recognized as substrates for the betalactamases produced by bacteria. This allows the actual beta-lactams to attack the bacterial cell wall by binding to penicillin binding proteins Uncomplicated and complicated skin and skin structure infections (including cutaneous abscesses) Hypersensitivity to penicillins, cephalosporins, or beta-lactamase inhibitors. - anaphylaxis - bronchospasm - death - seizure - psedomembranous colitis - leukopenia

Contraindications

Adverse Effects

Nursing Responsibilities

1. Before giving drug, ask patient about allergic reactions to penicillins. 2. Obtain specimen for culture and sensitivity tests before giving first dose. 3. Monitor urinalysis, renal, liver function tests and reduce dosage for patients with renal impairment. 4. Teach client to report: any pain at injection site to check for side effects of maculopapular or rash; fever to monitor CNS function.

5. Use cautiously in patients with: sodium restriction, renal

impairment 6. Observe patient for signs and symptoms of anaphylaxis. Keep epinephrine, an antihistamine, and resuscitation equipment close

by in the event of an anaphylactic reaction.

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Ranitidine Zantac Histamine H2 receptor blocking drug 50 mg IVTT q8 The H2 antagonists are competitive inhibitors of histamine at the parietal cell H2 receptor. They suppress the normal secretion of acid by parietal cells and the meal-stimulated secretion of acid. They accomplish this by two mechanisms: histamine released by ECL cells in the stomach is blocked from binding on parietal cell H2 receptors which stimulate acid secretion, and other substances that promote acid secretion (such as gastrin and acetylcholine) have a reduced effect on parietal cells when the H2 receptors are blocked. Ranitidine is used for short-term treatment of active duodenal ulcer. It is also used in the prevention of duodenal ulcer recurrence. Ranitidine can be used for the treatment of active benign gastric ulcer, pathologic GI hypersecretory conditions, acute gastroesophageal reflux disease (GERD), and erosive esophagitis. Cirrhosis of the liver, impaired renal or hepatic function. Headache, abdominal pain, constipation, diarrhea, N&V Diarrhea Constipation Headache Reversible Hepatitis Blood dyscrasias 1. Use cautiously with impaired renal or hepatic function. 2. Administer oral drug with meals and at bedtime. 3. Decrease doses in renal failure.

Indications

Contraindications

Side/Adverse Effects

Nursing Responsibilities

4. Provide concurrent antacid therapy to relieve pain. 5. Remind patient to take once-daily prescription drug at bedtime for best results.

6. Urge patient to avoid cigarette smoking because this may

increase gastric acid secretion and worsen disease.

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Metoclopramide

Plasil, Reglan Antiemetics 10 mg IVTT q8 PRN for NV Metoclopramide inhibits gastric smooth muscle relaxation produced by dopamine, therefore increasing cholinergic response of the gastrointestinal smooth muscle. It accelerates intestinal transit and gastric emptying by preventing relaxation of gastric body and increasing the phasic activity of antrum. Simultaneously, this action is accompanied by relaxation of the upper small intestine, resulting in an improved coordination between the body and antrum of the stomach and the upper small intestine. Metoclopramide also decreases reflux into the esophagus by increasing the resting pressure of the lower esophageal sphincter and improves acid clearance from the esophagus by increasing amplitude of esophageal peristaltic contractions. Management of esophageal reflux Treatment and prevention of postoperative nausea and vomiting Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous, e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation. Metoclopramide is contraindicated in patients with pheochro-mocytoma because the drug may cause a hypertensive crisis, probably due to release of catecholamines from the tumor. Such hypertensive crises may be controlled by phen-tolamine. Metoclopramide is contraindicated in patients with known sensitivity or intolerance to the drug. Metoclopramide should not be used in epileptics or patients receiving other drugs which are likely to cause extrapyramidal reactions, since the frequency and severity of seizures or extrapyramidal reactions may be increased. CNS: Restlessness, drowsiness, fatigue, insomnia, headache, confusion, dizziness Endocrine: amenorrhea, gynecomastia Cardiovascular: Hypotension, hypertension, supraventricular tachycardia, bradycardia, fluid retention, acute congestive heart failure and possible AV block GI: Nausea and bowel disturbances, primarily diarrhea Renal: Urinary frequency and incontinence Allergic Reactions: rash, urticaria, bronchospasm 1. Inform client that it may cause drowsiness. 2. Advise patient to avoid concurrent use of alcohol and other CNS depressant while taking this medication. 3. Advise patient to notify health care professional immediately if

Indications

Contraindications

Side/Adverse Effects

Nursing Responsibilities

4. 5. 6. 7.

involuntary movement of eyes, face or limbs occurs. Observe the client for severe side effects.Avoid driving and other potentially hazardous activities for a few hours after drug administration. Instruct the client to avoid alcohol and other CNS depressants. Instruct the client to report S&S of acute dystonia, such as trembling hands and facial grimacing, immediately. Monitor for possible hypernatremia and hypokalemia.

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Paracetamol

Panadol, Perflagan Antipyretic, Analgesic 300mg IVTT This drug decreases fever by inhibiting the effects of pyrogens on the hypothalamic heat regulating centers and by a hypothalamic action leading to sweating and vasodilation. It relieves pain by inhibiting prostaglandin synthesis at the CNS, but does not have anti-inflammatory action because of its minimal effect of peripheral prostaglandin synthesis. o This drug is indicated to relieve mild to moderate pain due to headache, muscle and joint pain, backache and period pains. o It is used to bring down high temperature and can be given to children after vaccinations to prevent post-immunization pyrexia. o Contraindicated with allergy to acetaminophens. o Contraindicated with analgesic nephropathy, renal and hepatic impairment. CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 58 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemiacyanosis; hemolytic anemia hematuria, anuria; neutropenia, leukopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitivity: Rash, fever 1. Instruct patient to not self-medicate children for pain more than 5 days, without consulting a physician. 2. Inform patient to not use this drug for fever persisting longer than 3 days, fever over 39.5C, or recurrent fever. 3. Give drug with food if GI upset occurs. 4. Inform patient to report rash, unusual bleeding or bruising, yellowing of the skin or eyes, or changes in voiding patterns. 5. Advise patient to avoid alcohol; acute poisoning with liver may result. 6. Teach patient to recognize signs of chronic overdose: bleeding bruising, malaise, fever, sore throat.

Indications

Contraindications

Side/Adverse Effects

Nursing Responsibilities

7. Inform patient that urine may become dark brown as a result of phenacetin (metabolite of acetaminophen). Generic Name Brand Name Omeprazole

Prilosec, Zegerid Anti-Ulcer Agents Enzyme Inhibitors Proton-pump Inhibitors 20 MG IVTT BID ONCE ON NPO Omeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell. By acting specifically on the proton pump, omeprazole blocks the final step in acid production, thus reducing gastric acidity. o For the treatment of acid-reflux disorders (GERD), peptic ulcer disease, H. pylori eradication, and prevention of gastroinetestinal bleeds with NSAID use. o Omeprazole is contraindicated in patients with known hypersensitivity to substituted benzimidazoles or to any component of the formulation. Hypersensitivity reactions may include anaphylaxis, anaphylactic shock, angioedema, bronchospasm, interstitial nephritis, and urticaria The most common side effects are diarrhea, nausea, vomiting, headaches, rash and dizziness. Nervousness, abnormal heartbeat, muscle pain, weakness, leg cramps, and water retention occur infrequently.

Drug Classification Ordered Dosage/Frequency Mechanism of Action

Indications

Contraindications

Side/Adverse Effects

1. 2. 3.
Nursing Responsibilities

Question if Gastrointestinal discomfort, nausea, and diarrhea occurs. Instruct the patient to take the drug before meals. Caution patient to swallow capsules wholenot to open, chew, or crush them. Administer antacids with omeprazole, if needed. Advice the patient to have regular medical follow-up visits. Inform the patient that he may experience these side effects: Dizziness; headache; nausea, vomiting, diarrhea; symptoms of URI, cough. Inform the patient to report severe headache, worsening of symptoms, fever, chills.

4. 5. 6.

7.

Generic Name Brand Name

Parecoxib Dynastat

Drug Classification Ordered Dosage/Frequency Mechanism of Action

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) 40 MG 1 AMP IVTT NOW It has a very high selectivity for inhibiting cyclo-oxygenase-2 (COX-2) mediated prostaglandin synthesis to reduce mediators of pain and inflammation. The selective inhibition of COX-2 is coupled with reduced GI toxicity, but associated increased risk for thrombotic events and renal impairment have been noted.

Indications

Post-op pain
Aspirin or NSAID hypersensitivity; allergy to sulphonamides; inflammatory bowel disease; moderate to severe heart failure; ischaemic heart disease, peripheral arterial disease, or cerebrovascular disease; following CABG; active peptic ulceration; severe hepatic impairment (Child-Pugh score 10); pregnancy (3rd trimester) and lactation. Rash, ulcerations or any other signs of an allergic reaction; GI disturbances and bleeding; hypotension; hypertension; back pain; oedema; numbness; agitation or sleeping difficulties; anaemia; sore throat or difficulty breathing; pruritus; decreased urine output; jaundice, abnormal liver function; low platelet count; skin swelling, blistering or peeling; kidney failure; heart failure, heart attack, bradycardia, arrhythmia. Potentially Fatal: Anaphylaxis, Steven-Johnson syndrome, toxic epidermal necrolysis. 1. Educate patients about the various side effects of the drug. 2. Instruct the patient to report if the effects become severe or if bleeding or GI pain occur.

Contraindications

Side/Adverse Effects

Nursing Responsibilities

3. Advice patients to watch closely for the occurrence of any unusual bleeding such as in the stoll. 4. Monitor for therapeutic effects, which vary according to the condition being treated. 5. Advice the patient to comply with medication treatment regimen.

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Potassium chloride Kalium Durule Electrolytes 1 tab TID Supplemental potassium in the form of high potassium food or potassium chloride may be able to restore normal potassium levels.

Indications

Contraindications

For hypokalemia As prophylaxis during treatment with diuretics To prevent and treat potassium, deficit secondary to diuretics or corticosteroid therapy. - Also indicated when potassium, is depleted by severe vomiting, prolonged diuresis and diabetic acidosis. Renal insufficiency, hyperkalemia, untreated Addison's disease, constriction of the esophagus &/or obstructive changes in the alimentary tract. Nausea; Vomiting; GI discomfort; Stomach pain; Arrhythmias, Heart block, Hypotension Cardiac arrest Hyperkalemia Respiratory paralysis . 1. Tell patient to take drug with or after meals with full glass of water of fruit juice to lessen GI distress. 2. Administer while patient is sitting up or standing (never in recumbent position) to prevent drug-induced esophagus. 3. Advice patient to comply with medication treatment regimen. 4. Instruct patient to report if sever stomach pain occurs.

Side/Adverse Effects

Nursing Responsibilities

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Losartan Cozaar Angiotensin receptor blockers (ARBs) Maintenance Losartan and its longer acting active metabolite (E-3174) interfere with the binding of angiotensin II to the angiotensin II AT1-receptor by, themselves, binding reversibly to the receptors in vascular smooth muscle and the adrenal gland. As angiotensin II is a vasoconstrictor, which also stimulates the synthesis and release of aldosterone, blockage of its effects results in decreases in systemic vascular resistance. Neither Losartan or its metabolite inhibit the angiotensin converting enzyme, other hormone receptors, or ion channels.

Indications

Losartan is used for treating hypertension, left ventricular hypertrophy

(increase in muscle) and diabetic nephropathy (kidney disease). It may be used alone or in combination with other drugs. COZAAR is contraindicated in patients who are hypersensitive to any component of this product. In clinical studies the overall incidence of side effects was similar to placebo. Side effects reported included diarrhea, muscle cramps, dizziness,insomnia, and nasal congestion. Losartan also may

Contraindications Side/Adverse Effects

cause a persistent cough, increase serum potassium, and angioedema. 1. Monitor patients BP. 2. Tell patient to avoid salt substitutes. 3. Monitor patient closely in any situation that may lead to a decrease in BP secondary to reduction in fluid volume excessive perspiration, dehydration, vomiting, diarrhea excessive hypotension can occur. 4. Instruct patient to take drug without regard to meals. 5. Advice client to comply with medication as ordered by the physician. 6. Inform the patient that he may experience side effects of this drug. 7. Tell the patient to report if fever, chills, dizziness occur.

Nursing Responsibilities

Generic Name Brand Name Drug Classification Ordered Dosage/Frequency Mechanism of Action

Tetanus toxoid Tetanus Toxoid Adsorbed Vaccine 0.5 cc on SQ Right Tetanus is caused by a toxin released by a bacterial organism. The serum contains antibodies to the toxin produced by the bacterium Clostridium tetani. The antibodies inactivate the toxin in the blood stream and prevent an individual from experiencing tetanus.

Indications

Toxoid is indicated for booster injection only for persons 7 years of

age or older against tetanus HYPERSENSITIVITY TO ANY COMPONENT OF THE VACCINE, INCLUDINGTHIMEROSAL, A MERCURY DERIVATIVE, IS A CONTRAINDICATION FOR FURTHER USE OF THIS VACCINE. Diarrhea; headache; mild fever or chills; minor pain, swelling, or redness at the injection site; nausea; stomach pain; tiredness; vomiting. 1. Maintain adequate airway and ventilation.

Contraindications Side/Adverse Effects

2. Maintain an intravenous line. 3. Monitor client for signs of arrythmias. 4. Prevent client from having spasms by:
Nursing Responsibilities

- Controlling the environment - Avoiding stress, pain, coughing, or flatus to occur to the patient - Avoid touching, turning, and jarring the bed of the client

5. Protect the client from injury. 6. Provide comfort measures.