Drug Data Generic Name Metoclopramide Trade Name Reglan, Maxolon Dosages 10-15 mg PO up to 4 times/day 30 minutes before each

meal and at bedtime for 2-8 weeks Contents Metoclopramide Availability and color Tablets: 5, 10 mg Oral solution: 1 mg/mL Injection: 5 mg/mL Routes of administration Oral Intramuscular Intravenous

Classification Pharmacologic Class Dopaminergic blocker Therapeutic Class Antiemetic GI stimulant Pregnancy Risk Factor B

Mechanism of Action Stimulates motility of upper GI tract without stimulating gastric, billiary, or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes pyloric sphincter, which, when combined with effects on motility, accelerates gastric emptying and intestinal transit; little effect on gallbladder or colon motility; increases lower esophageal sphincter pressure; has sedative properties; induces release of prolactin. Pharmacokinetics D: Crosses placenta; enters breast milk M: Hepatic E: Urine Drug Half Life 5-6 hours

Indication - Relief of symptoms of acute and reccurent diabetic gastroparesis - Short-term therapy for adults with symptomatic GERD who fail to respond to conventional therapy - Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy - Prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable - Facilitation of smallbowel intubation when tube does not pass the pylorus with conventional maneuvers - Stimulation of gastric emptying and intestinal transit of barium when delayed emptying interferes with radiologic examination of the stomach or small intestine - Unlabeled uses: Improvement of lactation; treatment of nausea and vomiting of a variety of etiologies: hyperemesis gravidarum, gastric ulcer, anorexia nervosa
Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783

Contraindications Concentrations - Allergy to metoclopramide - GI hemorrhage - Mechanical obstruction or perforation - Pheochromocytoma - Epilepsy Precaution - Previously detected breast cancer - Lactation - Pregnancy - Fluid overload - Renal impairment Drug interaction Drug to drug - Decreased absorption of digoxin from the stomach - Increased toxic and immunosuppressive effects of cyclosporine - Increased neuromuscular blocking effect of succinylcholine

Adverse Reaction CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parinsonismlike reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea

Nursing Responsibilities Before - Observe 15 rights in drug administration. - Assess for allergy to metoclopramide. - Assess for other contraindications. - Keep diphenhydramine injection readily available in case extrapyramidal reactions occur (50 mg IM). - Have phentolamine readily available in case of hypertensive crisis. During - Monitor BP carefully dring IV administration. - Monitor for extrapyramidal reactions, and consult physician if they occur. - Monitor diabetic patients. - Give direct IV doses slowly over 1-2 minutes. - For IV infusion, give over at least 15 minutes. After - Dispose of used materials properly. - Educate patient about side effects. - Instruct to report involuntary movement of the face, eyes, or limbs, severe depression, severe diarrhea. - Instruct patient to take drug exactly as prescribed. - Instruct not to use alcohol, sleep remedies or sedatives; serious sedation could occur. - Do proper documentation.

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 783784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 783

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783-784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 783-784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, p. 784

Source: Karch, Amy: 2009 Lippincotts Nursing Drug Guide, pp. 784-785

NAME OF DRUGS

CLASSIFICATION And ACTION

INDICATIONS

CONTRAINDICATED

ADVERSE REACTIONS

NURSING RESPONSIBILITIES

MONITORING PARAMETERS

Generic name: Ceftriaxone sodium Brand name: Rocephine Dosage: Every 8 hours IV

Pharmacologic class: Third-generation cephalosporin Pregnancy risk category B anti-infectives

Uncomplicated gonococcal vulvovaginitis UTI; lower respiratory tract, gynecologic, bone or joint, intra-abdominal, skin, or skin structure infection; septicemia Meningitis Perioperative prevention Acute bacterial otitis media Neurologic complications, carditis, and arthritis from penicillin G-refractory Lyme disease

Contraindicated in patints hypersensitive to drug or other cephalosporins.

Action: third-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.

CNS: fever, headache, dizziness CV: phlebitis, GI: diarrhea, pseudomembranous colitis GU: genital pruritus, candidiasis Hema: thrombocytosis, eosinophilia, leukopenia Skin: pain, induration, tenderness at injection site, rash, pruritus Other: hypersensitivity reactions, serum sickness, anaphylaxis, chills

Before giving drug, ask patient if he is allergic to penicillins or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose.

Monitor PT and INR in patients with impaired vit. K synthesis or low vit. K stores. Vit. K may be needed.

Drug

Mechanism of Action

Indication

Contraindicati ons

Adverse Reaction

Nursing Responsibilities

Drug Data

Generic Name: Non-opioidwith Interferes Paracetamol analgesics and cell wall Trade Name Trade Name: antipyretics of replication Avastoph Abenol, acephen, aceta susceptible elixir, acetaminophen, organisms, the Classification anacin, tempra, tylenolcell Anti-infective, wall, Pts Dose: Antibiotic rendered 50 mg IVTT T.I.D. osmotically Minimum Dose: unstable, swell, Dosage 10-15 mg/kg/ dose q4 bursts from 150 hrs, prn mg P.O.every osmotic 6 hoursDose: Maximum pressure; resists 650 mgP.O. q4-6hrs orthe penicillinase of 1 gRoutes TID or QID or prn action that administration Content: inactivates IVTT ANST (-) Acetamenophen 500 penicillins. mg diphenylhydramine citrate 38mg Availability: Caplets,capsule, oral syrup,oral suspension Route of Administration: P.O., IVTT

Generic Name Cloxacillin

Classification

Mechanism of Action

Indication

Contraindication

Adverse Reaction

Nursing Responsibilities

Treatment of completeHistory of EENT: Concentration: occasionally, A>rapid and General Before: 1.) Hematologic Perform skin testing before giving the medication. infections caused hypersensitivit laryngeal edema, D>25% protein-bound. Indication: Contraindicated in Hemolytic >orient self to patient RATIONALE: To prevent anaphylactic shock when by pneumococci, Level isnt connected y to penicillins >mild pain or patients hypertensive to anemia, >note significant lab results Group A betaand fever Skin: drug urticaria, skin administered. strongly with analgesic neutropenia, >note pts drug allergy hemolytic cephallosporin rashes, exfoliative effect but is with toxicity >osteoarthritis >Explain effects 2.) leucopenia, Administer drug slowly to the IVtherapeutic line streptococci, and s. Sever dermatitis, rash M>90-95% metabolized Precaution: pancytopenia, of the drug The drug is very irritating to the tissue and penicillin pneumonia, in liver G Patients Use cautiously in RATIONALE: thrombocytopeni Calculate dose effectively blood vessels. Injecting slowly the drug prevents phlebitis sensitive emphysema, GI: GI disturbances, E>in urine Indication: patients with history of a and accurately staphylococci. bacteremia, nausea, vomiting, >patient is febrile chronic alcohol abuse 3.) Explain to the patient that antibiotic therapy lasts pericarditis, distress, for 7 days will take the drug without any miss. Onset: Unknown and also has epigastric because hepatotoxicity Hepatic During: Prophylaxis: meningitis and diarrhea and Peak: 1-3 hrs arthritis may occur after the RATIONALE: Liver damage >use formto tokill children Taking the drug for 7liquid days helps the Staphylococcal purulent and flatulence, antibioticDuration: 1-3 hrs therapeutic dose (with toxic >administer as directed bacteria and growth. infection during septic arthritis associated Half-life: 1-4 hrs doses), jaundice >warn pt to avoid alcoholic major during the pseudomembranous 4.) Make sure that the patient takes the drug at the Drug-drug: intake same time of the day. And also to prevent them cardiovascular and acute the colitis Chemical Effect: may Barbiturates, Metabolic being drug resistant. orthopedic stage. Subproduce analgesic effect carbamazepine,hydantoi Hypoglycemia After: surgery. conjunctival GU: interstitial RATIONALE: To prevent growth of bacteria and reaction to by blocking pain ns,isoniazid, rifampin >hypersensitivity infections. nephritis and vasculitis continue the efficacy of the drug. impulses, by inhibiting with high dose use of Skin caution prostaglandin or pain receptor sebsitizer. May relieve fever by acting in hypothalamic heatregulating center. Therapeutic Effect: Relieves pain and reduces fever these drugs, may reduce 5.) Rash, urticaria >management of side effects Provide rest and comfort. Hematologic: therapeutic effects and >evaluate drug effectiveness eosinophilia, RATIONALE: the drug may cause enhanced hapatotoxic of thedizziness drug which is a agranulocytosis, normal side effect of the drug. effects. Avoid use anemia, together. 6.) Assess for any signs of hypersensitivity reaction thrombocytopenia, such as purpura, rash, urticaria, exfoliative transient rise in dermatitis, itching Drug-food: transminases and Caffeine may enhance RATIONALE: to discontinue the therapy and alkaline phophatase analgesic effects.
immediately call the physician for an antidotE

Other: hypersensitivity reactions, serum sickness-like reactions, fever