DRUG STUDY: metronidazole

Drug Data
Generic Name

Classification
Pharmacologic
Class:

Metronidazole
Trade Name
Nitroimidazole
Flagyl, Metric 21,
Noritade
Patients Dose
Metronidazole 500mg
1 tab TID PO
Minimum Dose
PO : 250mg TID
IV : 100mg /mL
Maximum Dose
PO : 750 mg TID 610days
IV : 100mg/mL
Contents
Metronidazole

Therapeutic
Class:

Antibacterial
Antiprotozoal

Mechanism of Action
Pharmacokinetics
Onset:
PO: uknown IV:
immediate
Topical: unknown
Peak :
PO: 1-2 hrs IV:
immediate
Topical: 6-10hrs
Duration:
PO, IV, Topical: unknown
Therapeutic Effects:
Hinders growth of
selected organisms,
including most
anaerobic bacteria and
protozoa
Drug Half Life

Indication
General Indications
>amebic hepatic
abscess
>intestinal
amebiasis
>trichomoniasis
>retractory
trichomoniasis
>bacterial infection
caused by
anaerobic
microorganisms
>to prevent
postoperative
infection in
contaminated
colorectal surgery
>pelvic
inflammatory
disease

Contraindications

Contraindications
>hypersensitivity
>hypersensitivity to
parabens
>first trimester of pregnancy

Precautions
>history of blood dyscrasias;
seizures or neurologic
problems
>severe hepatic impairment
>pregnancy, lactation and
children

Drug interactions
>cimetidine
>phenobarbital
>warfarin
>disulfiram
>fluorouracil

Availability
Capsules: 375 mg
Injection: 5mg/mL
Oral suspension:
200mg/5ml
Tablets:
200mg,250mg,400mg
,500mg
Topical gel: 0.75 %,1
%

EENT:
Tearing(topical
only)
GI: abdominal pain,
anorexia, nausea
and vomiting,
diarrhea, dry
mouth, glossitis
Derm: rashes,
urticarial, mild
dryness, skin
irritation
Hemat: leukopenia

Pregnancy Risk
Category:
B

Adverse Reactions
CNS: seizures,
dizziness,
headache

Local: Phlebitis at
Iv site
Neuro: peripheral
neuropathy
Misc:
superinfection

Nursing Responsibilities
Before
>assess pts. Infection
>watch carefully for edema because it
may cause sodium retention
>assess skin for severity areas of local
adverse reactions
>record number and character of stools
>assess pts and familys knowledge of
drug therapy
During
>give drug with meals to minimize GI
distress
>to treat trichomoniasis, give drug for
7days instead of 2-g single dose
>use only after T.vaginalis has been
confirmed by wet smear
>tablets may be crushed for pts. with
difficult swallowing
>do not use aluminium needles or hubs,
color will turn orange/rust
After
>tell pt. that metallic taste and dark or
red brown urine may occur
>instruct pt. to take oral form with meals
to minimize reactions
>instruct to complete full course of
therapy
>tell pt. not to use alcohol or drugs that
contain alcohol.
>may cause dizziness/ light headedness

Routes of
administration
PO, IV, Topical
Source: NDH 2008
p.827

Source: NDH
2008 p.827

Source: NDH 2008

p.827

Source: NDH 2008

p.827

Source: NDH 2008 p.827

Source:
NDH 2008 p.827

Source:
NDH 2008 p.827

DRUG STUDY
DRUG
Gentamicin
Sulfate
(Pediatric
Gentamicin
Sulfate)
Dosages
ADULTS
3 mg/kg/day in 3
equal doses q 8
hr IM or IV. Up
to 5 mg/kg/day
in 34 equal
doses in
severe infections.
For IV use, a
loading dose of
12 mg/kg may
be infused over
3060
min, followed by
a maintenance
dose, usually for
710 days.
PID: 2 mg/kg
IV followed by
1.5 mg/kg tid
plus clindamycin
600 mg IV qid.
Continue for at
least 4 days and
at least 48 hr
after patient

CLASSIFICATION

MECHANISM OF
ACTION

INDICATION

CONTRAINDICATION

SIDE EFFECTS

NURSING RESPONSIBILITY

Aminoglycoside

Bactericidal:
Inhibits protein
synthesis in
susceptible strains
of gram-negative
bacteria;
appears to disrupt
functional integrity
of bacterial cell
membrane, causing
cell death.

Parenteral
Serious infections
caused by
susceptible strains
of Pseudomonas
aeruginosa,
Proteus species,
Escherichia coli,
KlebsiellaEnterobacterSerratia species,
Citrobacter,
Staphylococcus
species
Serious infections
when causative
organisms are not
known (often in
conjunction
with a penicillin or
cephalosporin)
Unlabeled use:
With clindamycin
as alternative
regimen in PID
Intrathecal
Gram-negative
infections
Serious CNS
infections caused
by susceptible
Pseudomonas
species
Ophthalmic

Contraindicated with
allergy to any
aminoglycosides.
Use cautiously with renal
or hepatic disease;
preexisting hearing loss;
active
infection with herpes,
vaccinia, varicella, fungal
infections, myobacterial
infections (ophthalmic
preparations); myasthenia
gravis; parkinsonism;
infant
botulism; burn patients;
lactation; pregnancy.

CNS: Ototoxicity
tinnitus, dizziness,
vertigo, deafness
(partially reversible
to
irreversible),
vestibular paralysis,
confusion,
disorientation,
depression, lethargy,
nystagmus, visual
disturbances,
headache,
numbness, tingling,
tremor,
paresthesias, muscle
twitching, seizures,
muscular weakness,
neuromuscular
blockade
CV: Palpitations,
hypotension,
hypertension
GI: Hepatic
toxicity, nausea,
vomiting, anorexia,
weight loss,
stomatitis,
increased salivation
GU:
Nephrotoxicity
Hematologic:
Leukemoid reaction,
agranulocytosis,

Give by IM route if at all possible;

give by deep IM injection.
Culture infected area before
therapy.
Use 2 mg/mL intrathecal
preparation without preservatives,
for intrathecal use.
Avoid long-term therapies because
of increased risk of toxicities.
Reduction in
dose may be clinically indicated.
Patients with edema or ascites may
have lower peak concentrations due
to
expanded extracellular fluid volume.
Cleanse area before application of
dermatologic preparations.
Ensure adequate hydration of
patient before and during therapy.
Monitor renal function tests, CBCs,
serum drug levels during long-term
therapy.
Consult with prescriber to adjust
dosage.

improves, then
continue
clindamycin 450
mg orally qid for
1014 days total
therapy.
Surgical
prophylaxis
regimens:
Several complex,
multidrug
prophylaxis
regimens
are available for
preoperative use;
consult
manufacturer's
instructions.
PEDIATRIC
PATIENTS
22.5 mg/kg q 8
hr IM or IV.
Infants and
neonates: 2.5
mg/kg q 8 hr.
Premature or
full-term
neonates: 2.5
mg/kg q 12 hr.

Preparations
Treatment of
superficial ocular
infections due to
strains of
microorganisms
susceptible to
gentamicin
Topical
Dermatologic
Preparation
Infection
prophylaxis in
minor skin
abrasions and
treatment of
superficial
infections of the
skin due to
susceptible
organisms
amenable to local
treatment
Gentamicinimpregnated
PMAA beads on
surgical wire
Orphan drug use:
Treatment of
chronic
osteomyelitis of
post-traumatic,
postoperative, or
hematogenous
origin
Gentamicin
liposome injection
Orphan drug use:
Treatment of
disseminated

granulocytosis,
leukopenia,
leukocytosis,
thrombocytopenia,
eosinophilia,
pancytopenia,
anemia, hemolytic
anemia, increased or
decreased
reticulocyte count,
electrolyte
disturbances
Hypersensitivity:
Purpura, rash,
urticaria, exfoliative
dermatitis, itching
Local: Pain,
irritation,
arachnoiditis at IM
injection sites
Other: Fever,
apnea,
splenomegaly, joint
pain, superinfections
Ophthalmic
preparations
Local: Transient
irritation, burning,
stinging, itching,
angioneurotic
edema,
urticaria, vesicular
and maculopapular
dermatitis
Topical
dermatologic
preparations
Local:
Photosensitization,
superinfections

Myobacterium
aviumintracellulare
infection

NAME

DRUG ACTION

Mechanism of Action:
Generic:
Ranitidine

Brand: Zantac

Special Precautions

Inhibits the action of histamine at the H2 receptor site

located primarily in gastric parietal cells, resulting in
inhibition of gastric acid secretion
has some antibacterial action against H. pylori

Classification:
Anti-ulcer

Pregnancy
Lactation
(excreted in breast
milk)

Geriatric patients
(more
susceptible to
adverse CNS
reactions)

Renal
impairments
Cirrhosis

CONTRAINDICATIONS

Hypersensitivity, Cross-sensitivity may occur; some oral

liquids contain alcohol and should be avoided in patients
with known intolerance

NURSING INTERVENTION

Mode of
Administration

Indications

Route: Oral

Dosage: 50mg

Timing:OD

Treatment and prevention of heartburn, acid indigestion,

and sour stomach.
Prophylaxis of GI hemorrhage from stress ulceration

Adverse Effects

Drug Interactions

Instruct patient not to take new medication w/o consulting

physician
Instruct patient to take as directed and do not increase dose
Allow 1 hour between any other antacid and ranitidine
Avoid excessive alcohol
Assess patient for epigastric or abdominal pain and frank or
occult blood in the stool, emesis, or gastric aspirate
Nurse should know that it may cause false-positive results for
urine protein; test with sulfosalicylic acid
Inform patient that it may cause drowsiness or dizziness
Inform patient that increased fluid and fiber intake may minimize
constipation
Advise patient to report onset of black, tarry stools; fever, sore
throat; diarrhea; dizziness; rash; confusion; or hallucinations to
health car professional promptly
Inform patient that medication may temporarily cause stools and
tongue to appear gray black
Instruct patients to monitor for and report occurrence of
drug-induced adverse reaction

DRUG STUDY
Name
Generic Name:
CEFUROXIME
Brand Name:
ZOLTAX
Classification:
ANTIBIOTIC
Frequency:
BID
Dosage:
1 tab 500 mg
Route:
PO

Mechanism of Action
Second-generation cephalosporin
that inhibits cell-wall synthesis,
promoting osmotic instability;
usually bactericidal.

Indication/Contraindication
Indication:

Side Effects
Body as a Whole:
Thrombophlebitis (IV site);
pain,burning, cellulitis( IM
site);superinfections,positive
Coombs'test.

Pharyngitis, tonsillitis, infections

of the urinary and lower
respiratory tracts, and skin and
skin-structure infections caused by
Streptococcus pneumoniae and S.
GI:
pyogenes, Haemophillus
Diarrhea,
influenzae, Staphylococcus aureus, nausea, antibiotic-associated
Escherichia coli.
colitis.
Contraindicated:
* Contraindicated in patients
hypersensitive to drug.
* Use cautiously in patients
hypersensitive to penicillin
because of possibility of crosssensitivity with other beta-lactam
antibiotics.
* Use with caution in breastfeeding women and in patients
with history of colitis or renal
sufficiency.

Skin:
Rash, pruritus, urticaria.
Urogenital:
Increased serum cretonne and
BUN, decreased creatinine
clearance

Nursing Responsibility
Determine history of
hypersensitivity
reactions to
cephalosphorins,
penicillins and history
of allergies
particularly to drugs
before therapy is
initiated.
Report onselt of loose
stools
Absorption of
cefuroxime is
enhanced by food.
Notify prescriber
about rashes or
superinfections

Drug Study
Drug Name
Generic Name:
Oxacillin
Classification:
Penicillin
Dosage:

DRUG

Therapeutic Action
A penicillinase
resistant penicillin
that inhibits cell-wall
synthesis during
microorganism
multiplication;
bacteria resists
penicillins by
producing
penicilllinase
enzymes that convert
penicillins to
inactivate penecillic
acids. Oxacillin
resists these
enzymes.

INDICATIONS

Generic Name: Carbamazepine

Tramadol
(Tegretol, Tegretol
XR , Equetro,
Brand Name:
Carbatrol) reduces
Ultram, Ultram the effect of
ER
tramadol by
increasing its
inactivation in the

Indication
Systemic infections
caused by
penicillinaseproducing
staphylococci
specifically eye
infections

CONTRAINDICATIONS
Tramadol may increase
central nervous system and
respiratory depression when
combined with alcohol,
anesthetics, narcotics,
tranquilizers or sedative
hypnotics.

Contraindication
Contraindicated to

patients
hypersensitive to
drug and its contents

DRUG STUDY
ACTIONS
Tramadol is used
in the
management of
moderate to
moderately
severe pain.
Extended release
tablets are used

Side Effects/
Adverse Effects
fever, sore
throat,
and headache with
a severe blistering,
peeling, and red
skinrash;diarrhea t
hat is watery or
bloody; fever,
chills, body aches,
flu symptoms;easy
bruising or
bleeding, unusual
weakness;
urinating less than
usual or not at all;
severe skin rash,
itching, or peeling;
agitation,
confusion, unusual
thoughts or
behavior; or
seizure.

SIDE EFFECTS
Tramadol is generally
well tolerated, and
side effects are
usually transient.
Commonly reported
side effects include
nausea, constipation,
dizziness, headache,

Nursing
Responsibilities
Use cautiously in
patients with other
drug allergy,
especially to
cephalosporins.

Obtain
specimen for culture
and sensitivity tests
before first dose.
Give 1-2 hours
before or 2-3 hours
after meals to
prevent gastric
irritation.

NURSING RESPONSIBILITIES
Assess type, location, and intensity of
pain before and 2-3 hr (peak) after
administration.
Assess BP & RR before and periodically
during administration. Respiratory
depression has not occurred with
recommended doses.

body. Quinidine
(Quinaglute,
Quinidex) reduces
the inactivation of
tramadol, thereby
increasing the
concentration of
tramadol by 50%60%. Combining
tramadol with
monoamine oxidase
inhibitors (for
example, Parnate)
or selective
serotonin inhibitors
((SSRIs, for
example, fluoxetine
Prozac]) may result
in severe side
effects such as
seizures or a
condition called
serotonin syndrome.

for moderate to
moderately
severe chronic
pain in adults
who require
continuous
treatment for an
extended period.

drowsiness, and
vomiting. Less
commonly reported
side effects include
itching, sweating, dry
mouth, diarrhea,
rash, visual
disturbances, and
vertigo. Some
patients who
received tramadol
have reported
seizures. Abrupt
withdrawal of
tramadol may result
in anxiety, sweating,
insomnia, rigors,
pain, nausea,
diarrhea, tremors,
and hallucinations.

Assess bowel function routinely.

Prevention of constipation should be
instituted with increased intake of fluids and
bulk and with laxatives to minimize
constipating effects.
Assess previous analgesic history.
Tramadol is not recommended for patients
dependent on opioids or who have
previously received opioids for more than 1
wk; may cause opioid withdrawal
symptoms.
Prolonged use may lead to physical and
psychological dependence and tolerance,
although these may be milder than with
opioids. This should not prevent patient
from receiving adequate analgesia. Most
patients who receive tramadol for pain d not
develop psychological dependence. If
tolerance develops, changing to an opioid
agonist may be required to relieve pain.
Tramadol is considered to provide more
analgesia than codeine 60 mg but less than
combined aspirin 650mg/codeine 60 mg for
acute postoperative pain.
Monitor patient for seizures. May occur
within recommended dose range. Risk
increased with higher doses and inpatients
taking antidepressants (SSRIs, tricyclics, or
Mao inhibitors), opioid analgesics, or other
durgs that decrese the seizure threshold.
Overdose may cause respiratory
depression and seizures. Naloxone
(Narcan) may reverse some, but not all, of
the symptoms of overdose. Treatment

should be symptomatic and supportive.

Maintain adequate respiratory exchange.
Encourage patient to cough and breathe
deeply every 2 hr to prevent atelactasis and
pneumonia.
DRUG ORDER

Generic Name:
Ketorolac
Tromethamine
Brand Name:
Toradol
Classification:
Anti-pyretic
NSAID
Dosage:
30mg (3 doses)
Route:
IVTT
Frequency:
Every 6 hours

MECHANISM OF
ACTION

Anti-inflammatory and
analgesic activity;
inhibits prostaglandins
and leukotriene
synthesis

INDICATIONS

Short-term
management of pain
(up to 5 days)

CONTRAINDICATIONS

ADVERSE EFFECTS
OF THE DRUG

Contraindicated with
significant renal
impairment, aspirin
allergy, recent GI bleed
or perforation Use
cautiously with impaired
hearing; allergies;
hepatic conditions

CNS:
headache,
dizziness,
somnolence,
insomnia,
fatigue,
dizziness
tinnitus,
ophthalmologic effects

NURSING
RESPONSIBILITIES/
PRECAUTIONS
Renal impairment,
Impaired hearing,
allergies, hepatic,
Skin color and lesions,
orientation, reflexes,
peripheral sensation,
clotting times, CBC,
adventitious sounds
Be aware that patient
may be at risk for CV
events, GI bleeding,
renal toxicity, monitor
accordingly
.
Keep emergency
equipment readily
available at time of
initial dose, in case of
severe hypersensitivity
reaction.
Protect drug vials from
light.
Administer every 6 hrs
to maintain serum

levels and control pain.

DRUG STUDY
Drug Data

Classification

Mechanism of
Actions

Indications

Contraindications

Adverse
Reactions

Nursing
Responsibilities

Generic Name:
Pantoprazole

Belongs to the class of

proton pump
inhibitors.

Trade Name:
Pantoloc
Patient Dose:
40 mg 1 vial IV, after
breakfast

Drug Name
Genenric
name:
Ceftriazone
Brand Name:

Inhibits both basal and

stimulated gastric acid
secretion by
suppressing the final
step in acids
production, through
the inhabitation of the
proton pump by
binding to and
inhibiting hydrogenpotassium adenosine
triphosphatase, the
enzyme system
located at the
secretory surface of
the gastric parietal
cell.

Duodenal and gastric

ulcer, moderate and
severe reflux
esophagitis.
Eradication of H.
pylori inpatient with
peptic ulcers,
pathological hyper
secretory conditions.
Symptomatic
improvement and
healing of mild reflux
esophagitis.
Prevention of gastroduodenal ulcers
induced by NSAID in
patients at risk with a
need for continuous
NSAID treatment.

Known
hypersensitivity to
any of the
constituents of
Pantoloc or of the
combination partners.
Mild gastrointestinal
complaints eg,
nervous dyspepsia.
Pantoloc must not be
used in combination
treatment for
eradication of H.
pylori in patients
with moderate to
severe hepatic or
renal dysfunction.

Occasionally headache
or diarrhea. Isolated
cases of edema,
blurred vision, fever,
dizziness,
thrombophlebitis,
depression or myalgia
subsiding after
termination of therapy.

Assess underlying
condition before therapy
and thereafter to monitor
drug effectiveness.
Assess GI symptoms:
epigastric/abdominal
pain, bleeding and
anorexia. Monitor for
possible drug induced
adverse reaction.

Classification

Action

Indication

Consideration

Side Effect

Nursing Consideration

3rd
generation
cephalospori
n.

Works by
inhibiting the
mucopeptide
synthesis in the
bacterial cell wall.
The beta-lactam

Indicated in patients
with neurologic
complications,
carditis and arthritis.
It is also effective in
Gram negative

Hypersensitive to
cephalosporins,
penicillins and
related
antibiotics.

Pain
Induration
Phlebitis
Rash
Diarrhea

Assess patients
previous
sensitivityreaction to
penicillin or other
cephalosphorins.
Assess patient for

Forgram
Dosage:
450mg TIV
q12

moiety of
Ceftriaxone binds
to
carboxypeptidase
s,
endopeptidases,
and
transpeptidases in
the bacterial
cytoplasmicmemb
rane. These
enzymes are
involved in cellwall synthesis and
cell division. By
binding to these
enzymes,
Ceftriaxone
results in the
formation of of
defective cell
walls and cell
death.

infections;
Meningitis,
Gonorrhea. It is also
for Bone and joint
infections, Lower
respiratory tract
infections, middle ear
infection, PID,
Septicemia and
Urinary Tract
infections.

Thrombocytosis
Leucopenia
Glossitis
Respiratory
super infections

signs and symptoms

of infection before
andduring the
treatment
Obtain C&S before
beginning drug
therapy toidentify if
correcttreatment has
beeninitiated.
Report signs such as
petechiae,
ecchymotic areas,
epistaxis or other
forms of unexplained
bleeding.
Monitor hematologic,
electrolytes, renal
and hepatic function.
Assess for possibles
upper infection:
itching fever,
malaise, redness