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Pharmacological Studies DRUG Cephradine 500mg 1 tab TID GENERAL ACTION Antibiotic Cephalosporin e Cephradine inhibits the third

and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillinbinding proteins (PBPs) located inside the bacterial cell wall. Penicillinbinding proteins are responsible for several steps in the synthesis of the cell wall and are found in quantities of several hundred to SPECIFIC ACTION INDICATION *serves as prophylaxis for post-surgical and post partal infections. *URINARY TRACT INFECTIONS, Other indications: *RESPIRATORY TRACT INFECTIONS (e.g., tonsillitis, pharyngitis, and lobar pneumonia) OTITIS MEDIA caused by group A beta-hemolytic streptococci, SKIN AND SKIN STRUCTURE INFECTIONS caused by staphylococci CONTRAINDICATIONS Cephradine is contraindicated in conditions like Hypersensitivity. Cephradine liver, heart and stomach possible problems, Cephradine contraindications, important information I should know about Cephradine. s ADVERSE EFFCTS SIDE EFFECTS: * Stomach upset, dizziness, or diarrhea may occur. *Unlikely but serious side effects occur: chest tightness. *unlikely but very serious side effects occur: new signs of infection (e.g., persistent sore throat or fever), mental/mood changes (such as confusion). *This medication may rarely cause a severe intestinal condition (Clostridium difficileassociated diarrhea) due to a NURSING RESPONSIBLITIES

Before taking cephradine, assess if patient is allergic to it; or to penicillins or other cephalosporins; or if you have any other allergies. Assess if patient has a medical history, especially of: kidney disease, intestinal disease (colitis).Kidney function declines as you grow older. This medication is removed by the kidneys. Therefore, elderly people may be more sensitive to this drug. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with the patient. This medication passes into breast milk. Consult your doctor before breast-feeding.

several thousand molecules per bacterial cell. Penicillinbinding proteins vary among different bacterial species. Thus, the intrinsic activity of cephradine as well as other cephalosporin s and penicillins against a particular organism depends on their ability to gain access to and bind with the necessary PBP.

type of resistant bacteria. *This condition may occur during treatment or weeks to months after treatment has stopped.

DRUG Ibuprofen 200mg 1 tab TID

GENERAL ACTION nonsteroidal anti-

SPECIFIC ACTION Non-steroidal antiinflammatory

INDICATION

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ADVERSE EFFCTS

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*Ibuprofen is used for the

There are no adequate studies of ibuprofen in pregnant

*Ibuprofen appears to have the lowest

*Assess pain.

inflammator y drugs (NSAIDs)

drugs such as ibuprofen work by inhibiting the enzyme cyclooxygena se (COX), which converts arachidonic acid to prostaglandin H2 (PGH2). PGH2, in turn, is converted by other enzymes to several other prostaglandin s (which are mediators of pain, inflammation, and fever) and to thromboxane A2 (which stimulates platelet aggregation, leading to the formation of blood clots).

treatment of mild to moderate pain, inflammation and from the surgical site. Other indications are: *menstrual craps *arthritis

women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart..

incidence of digestive adverse drug reactions (ADRs) of all the non-selective NSAIDs. However, this holds true only at lower doses of ibuprofen, so overthe-counter preparations of ibuprofen are, in general, labeled to advise a maximum daily dose of 1,200 mg. *Common adverse effects include: nausea, dyspepsia, gastrointestinal ulceration/bleeding, raised liver enzymes, diarrhea, constipation, epistaxis, headache, dizziness, priapism, rash, salt and fluid retention, and hypertension. *A study from 2010 has shown that regular use of NSAIDs was

Assess musculoskeletal status: ROM before dose and 1 hr after. - Monitor liver function studies - Monitor renal function studies - Monitor blood studies: CBC, Hgb, Hct, protime if patient is on long-term therapy -Check I&O ratio - Assess hepatotoxicity - Assess for allergic reactions, visual changes and ototoxicity - Identify prior drug history Identify fever: length of time in evidence and related symptoms

associated with an increase in hearing loss. *Infrequent adverse effects include: esophageal ulceration, heart failure, hyperkalemia, renal impairment, confusion, and bronchospasm.

DRUG Bisacodyl 1 tab TID

GENERAL ACTION Laxative

SPECIFIC ACTION Bisacodyl works by stimulating enteric nerves to cause colonic mass movements. It is also a contact laxative; it increases fluid and NaCl secretion. Action of bisacodyl on small intestine

INDICATION

CONTRAINDICATIONS

ADVERSE EFFCTS GI: Bloating; lightheadedness; nausea; rectal irritation; stomach fullness, cramps, or discomfort; vomiting. * severe hypersensitivity reaction. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of

NURSING RESPONSIBLITIES

Bisacodyl is primarily indicated in conditions like Bowel evacuation, Bowel preparation, Constipation, Prior to radiological procedures and surgery.

Hypersensitivirty. drug/class/compon.

*Assess bowel patterns and bowel sounds. *give another method to treat constipation whether possible.

acute abdomen abdominal pain, undiagnosed

undiagnosed nausea/vomiting

is negligible; stimulant laxatives mainly promote evacuation of the colon. [edit]

GI obstruction or ileus GI perforation toxic megacolon gastroenteritis rectal bleeding appendicitis

caution if inflammatory bowel dz

the mouth, face, lips, or tongue); bloody stools; chest pain; confusion; decreased urination; fainting; muscle weakness or cramping; persistent or severe nausea or vomiting; rectal bleeding; seizures; severe bloating or abdominal swelling; severe stomach pain; slow or irregular heartbeat; symptoms of dehydration (eg, very dry mouth or eyes, increased thirst, fast heartbeat, dizziness, headache); vomiting of blood. ADVERSE EFFCTS NURSING RESPONSIBLITIES

DRUG Paracetamol 500mg 1 tab

GENERAL ACTION Analgesic Antipyretic

SPECIFIC ACTION Antipyretic: Reduces fever by acting directly on the

INDICATION

CONTRAINDICATIONS

Analgesicantipyretic in patients with aspirin allergy, hemostatic

Contraindications Contraindicated with allergy to acetaminophen. - Use cautiously with impaired

-CNS :Headache CV: Chest pain, dyspnea, myocardial damagewhen doses

*Monitor liver function studies; may cause hepatic toxicity at doses >4g/day - Monitor renal function

hypothalamic heatregulating center to cause vasodilation and sweating, which helps dissipate heat. Analgesic:Site and mechanism of action unclea

disturbances, bleeding diatheses, upper GI disease, gouty arthritis - Arthritis and rheumatic disorders involving musculoskelet al pain (but lacks clinically significant antirheumatic and antiinflammatory effects) - Common cold, flu, other viral and bacterial infections with pain and fever - Unlabeled use: Prophylactic for children receiving DPT

hepatic function, chronic alcoholism, -pregnancy, lactation

of 58 g/day are ingested daily for several weeks or when doses of 4g/day are ingested for 1 yr GI: Hepatic toxicity and failure,jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemiahematuria, anuria ;neutropenia, leucopenia, pancytopenia, thrombocytopenia Hypersensitivity: fever

studies; albumin indicates nephritis - Monitor blood studies, especially CBC and pro-time if patient is on long-term therapy. -Check I&O ratio; decreasing output may indicate renal failure. -Assess for fever and pain Assess hepatotoxicity: dark urine, clay- colored stools - Assess allergic reactions: rash

vaccination to reduce incidence of fever and pain

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DRUG

GENERAL ACTION Antibiotic Cephalospori ne

SPECIFIC ACTION

INDICATION

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ADVERSE EFFCTS

NURSING RESPONSIBLITIES Assess if patient is allergic to cefuroxime, penicillin, cefaclor (Ceclor), cefadroxil (Duricef),

Cefuroxime

For the treatment of many different types of bacterial infections such

Cefuroxime for Injection USP and Dextrose Injection USP is contraindicated in patients with known allergy to the cephalosporin group of antibiotics. Solutions containing

- diaper rash; - diarrhea; - difficulty breathing or swallowing; - hives; - itching;

as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections.

dextrose may be contraindicated in patients with hypersensitivity to corn products.

- painful sores in the mouth or throat; - severe skin rash; - stomach pain; - upset stomach; - vaginal itching and discharge; - vomiting; - wheezing;

cefamandole (Lorabid), or any other medications. Assess what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products patient are taking. Assess if patient has have or have ever had kidney or liver disease, colitis, or stomach problems.

DRUG Ketorolac 30mg now then q 8H for pain

GENERAL ACTION Nonsteroidal antiinflammatory agents, nonopioid

SPECIFIC ACTION -Inhibits prostaglandin synthesis, producing peripherally mediated

INDICATION Short term management of pain (not to exceed 5 days total for all routes combined)

CONTRAINDICATIONS DRUG INTERACTIONS: Probenecid (Benemid) should not be combined with ketorolac because it reduces the elimination of ketorolac by the kidneys. This may lead to increased levels of ketorolac in

ADVERSE EFFCTS - CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP:

Assess if patient is pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking cefuroxime, call your doctor. NURSING RESPONSIBLITIES Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma,

analagesic

analgesia - Also have antipyretic and antiinflammatory properties. - Therapeutic effect: Decreased pain

the body and increased side effects from ketorolac. Ketorolac may increase the blood levels of lithium (Eskalith) by reducing the elimination of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity. Concomitant use of ketorolac and angiotensin converting enzyme (ACE) inhibitors may reduce the function of the kidneys. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin) should avoid ketorolac because ketorolac also thins the blood, and excessive blood thinning may lead to bleeding. PREGNANCY: There are no adequate studies in pregnant women. Ketorolac should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. NSAIDs may cause cardiovascular side effects during late pregnancy.

1) asthma 2) dyspnea - CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea 4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL: 1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis.

and urticaria. - Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.

NURSING MOTHERS: Ketorolac should not be used by nursing mothers because it is excreted in breast-milk.