NAME OF THE DRUG

MECHANISM OF ACTION Decreases fever by inhibiting the effects of pyrogens on the hypothalamus heat regulating centers & by a hypothalamic action leading to sweating & vasodilatation. Relieves pain by inhibiting prostaglandin synthesis at the CNS but does not have antiinflammatory action because of its minimal effect on peripheral prostaglandin synthesis.

SIDE EFFECTS

INDICATIONS

CONTRAINDICATION S Hypersensitivity intolerance to tartrazine (yellow dye #5), alcohol, table sugar, saccharin with allergy to acetaminophen

NURSING RESPONSIBILITIES Assess patients fever or pain: type of pain, location, intensity, duration, temperature, and diaphoresis.

Generic name: Paracetamol Classification: Analgesics Antipyretic Dosage: 300 mg Route: PO

Nausea Vomiting Abdominal pain Drowsiness Renal failure

Relief of mild-tomoderate pain; treatment of fever.

(high prolonged doses) Convulsion

Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.

Frequency: q 4hrs, PRN for Temperature of 38o C

Teach patient to recognize signs of chronic overdose: bleeding,, malaise, fever,

Tell patient to notify prescriber for fever lasting for more than 3 days.
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Name of the Drug

Mechanism of Action Diphenhydramine blocks histamine H1-receptors on effectors cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some ant cholinergic action.

Side Effects

Indications

Contraindications

Nursing Responsibilities

Generic name: Diphenhydramine

CNS: headache, fatigue, anxiety, tremors, vertigo, confusion, depression, seizures, hallucinations CV: tachycardia, palpitations, orthostaic hypotension, heart failure EENT: blurred vision GI: dry mouth, nausea, vomiting, constipation, flatulence GU: urinary frequency, urine retention Hematologic: leukopenia Skin: photosensitivity, dermatitis

Relief of symptoms associated with perennial and seasonal allergic rhinitis; vasomotor rhinitis; allergic conjunctivitis; mild, uncomplicated urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; adjunctive therapy in anaphylactic reactions

Cardiac disease or hypertension Glaucoma Gastric or duodenal ulcers

Caution the client that the medication may cause drowsiness

Brand name: Benadryl

Dosage: 50 mg.

Tell the client to take the medication with food to decrease GI upset.

Frequency Preparation for Operating Room Route: IVTT

Explain to the client that arising quickly form a lying or sitting position may cause orthostatic hypotension.

Active and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism (including druginduced parkinsonism and extrapyramidal reactions),

Classification: Antihistamine, Anti-motion sickness drug, Sedative-hypnotic, Antiparkinsonian, Cough suppressant

When taking these medications, the client needs to have blood cells counts, renal function, hepatic function, and blood pressure monitored.

Syrup formulation: Suppression of cough due to colds or allergy

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Name of the Drug Generic name: Ketorolac Brand name: Toradol Dosage: 30mg Frequency Q8hrs Route: IVTT Classification: Nonsteroidal antiinflammatory agents, nonopioid analagesics

Mechanism of Action Inhibits prostaglandin synthesis, producing peripherally mediated analgesia, also has antipyretic and antiinflammatory properties.

Side Effects CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache RESP: asthma & dyspnea CV: edema, pallor, vasodilation GI: GI Bleeding, abnormal taste, diarrhea, dry mouth, dyspepsia, GI pain, nausea GU: oliguria, renal toxicity, urinary frequency NEURO: paresthesia

Indications Short term management of moderate to severe acute post-op pain

Contraindications Hypersensitivity Known alcohol intolerance History of GI bleeding Renal impairment (dosage reduction may be required) Cardiovascular disease

Nursing Responsibilities Patients who have asthma, aspirininduced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.

Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration.

Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndromes (chills,fever,muscles aches, pain) occur.

Take with food or after meal.

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Name of the Drug

Mechanism of Action Binds to opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin, which also modifies the ascending pain pathway.

Side Effects

Indications

Contraindications

Nursing Responsibilities

Generic name: Tramadol Brand name: Ultram Dosage: 50 mg Frequency Q6hrs Route: IVTT Classification: Analgesic

Dizziness Nausea Drowsiness Dry mouth, Constipation Headache Sweating Vomiting Itching Rash Visual disturbances Vertigo

To treat moderate to moderately severe pain.

Hypersensitivity to tramadol, opioids, or any component of the formulation; opioiddependent patients; acute intoxication with alcohol, hypnotics, centrally-acting analgesics, opioids, or psychotropic drug.

Reassess level of pain at least 30 minutes after administration.

Monitor CV and respiratory status. Withhold dose and notify prescriber if respirations decrease or rate is below 12 bpm

Avoid giving tramadol to patients with acute abdominal conditions because it may mask evidence and disrupt assessment of the abdomen.

Inform client that medication may cause CNS depression and/or respiratory depression, particularly when combined with other CNS depressant.

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NAME OF THE DRUG Generic name: Celecoxib Brand name: Celebrex Dosage: 200mg Frequency BID, PRN after last dose of Ketorolac Route: PO Classification: central nervous system agent, analgesic, nsaid, cyclooxygenase-2 inhibitor, antipyretic

MECHANISM OF ACTION Exhibits antiinflammatory, analgesic and antipyreticaction due to inhibition of the enzyme COX-2

SIDE EFFECTS

INDICATIONS

CONTRAINDICATIONS

NURSING RESPONSIBILITIES Assess patients history of allergic reaction to the drug Monitor complete blood count, electrolyte levels, creatinine clearance, and occult fecal blood test and liver function test results every 6 to 12months

CNS: dizziness, drowsiness, headache, insomnia, fatigue CV: peripheral edema EENT: ophthalmic effects, tinnitus, pharyngitis, rhinitis GI: nausea, diarrhea, constipation, abdominal pain, dyspepsia, flatulence, dry mouth, GI bleeding GU: menorrhagia

For relief of the signs and symptoms of osteoarthritis. For relief of the signs and symptoms of rheumatoid arthritis in adults. For the management of acute pain in adults.

Hypersensitivity to drug, sulfonamides,or other NSAIDs

Severe hepatic impairment History of asthma Late pregnancy Breastfeeding

Instruct patient to take drug with food Advise patient to immediately report bloody stools, blood in vomit, or signs or symptoms of liver damage (nausea, fatigue, lethargy, pruritus, yellowing of eyes or skin, tenderness on upper right side of abdomen, or flu like symptoms)

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DRUG Generic Name: Cefazolin Classification: Anti-Infectives Brand Name: Ancef Dosage:1g Frequency: q8 hrs Route: IVTT

MECHANISM OF ACTION Interferes with bacterial cell wall synthesis by inhibiting the final step in the cross linking of peptidoglycan strands. Peptidoglycan makes cell membranes rigid and protective. Without it, bacterial cells rupture and die. ADVERSE REACTIONS: CNS: Chills, fever, headache, seizures CV: Edema EENT: Hearing loss GI: Abdominal cramps, diarrhea, elevated liver function test results, hepatic failure, hepatitis, hepatomegaly, nausea, oral candidiasis, pseudomembranous colitis, vomiting RESP: Dyspnea SKIN: Ecchymosis, erythema, erythema multiforme, pruritus, rash, Stevens-Johnson syndrome Other: Anaphylaxis; injection site pain, redness, and swelling; super infection

INDICATION

CONTRAINDICATION

NSG. RESPONSIBILITIES Observe 10 rights in giving medications Use cefazolin cautiously in patients with impaired renal function or a history of GI disease, particularly colitis. Also use cautiously in patients hypersensitive to penicillin because cross-sensitivity has occurred in about 10% of such patients. If possible, obtain culture and sensitivity test results, as ordered, before giving drug. Administer I.M injection deep into large muscle mass, such as the gluteus maximus. Store reconstituted drug up to 24 hours at room temperature or 10 days refrigerated. Monitor I.V. site irritation, phlebitis, for

To treat respiratory tract infections caused by group A beta-hemolytic streptococci, Haemophilus influenzae, Klebsiella species, Staphylococcus aureus, and Streptococcus pneumoniae; skin and soft-tissue infections caused by S. aureus, group A beta- hemolytic and other strains of streptococci.

Hypersensitivity to cephalosporins or their components

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DRUG Generic Name: Ketorolac Tromethamine Classification: Analgesic Brand Name: Toradol Dosage: 30 mg Frequency:q6 hrs Route: IVTT

MECHANISM OF ACTION

INDICATIO N

CONTRAINDICATION

NSG. RESPONSIBILITIES Observe 10 rights in giving medications.

Blocks cyclooxygenase, an enzyme needed to synthesize prostaglandins. Prostaglandins mediate inflammatory response and cause local vasodilation, swelling, and pain. They also promote pain transmission from periphery to spinal cord. By blocking cyclooxygenase and inhibiting prostaglandins, this NSAID reduces To treat inflammation and relieves pain. moderate to severe pain. ADVERSE REACTIONS: CNS: Aseptic meningitis, cerebral hemorrhage, coma, dizziness, drowsiness, headache, psychosis, seizures, stroke CV: Edema, fluid retention, hypertension EENT: Laryngeal edema, stomatitis ENDO: Hyperglycemia GI: Abdominal pain; acute pancreatitis; bloating; constipation; diarrhea; diverticulitis; flatulence; GI bleeding, perforation, or ulceration; hepatitis; hepatic failure; jaundice; indigestion; nausea; perforation of stomach or intestines; vomiting; worsening of inflammatory bowel disease RESP: Bronchospasm, pneumonia, respiratory depression SKIN: Diaphoresis, erythema multiforme, exfoliative dermatitis, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.

Advanced renal impairment or risk of renal impairment due to volume depletion; before or during surgery if hemostasis is critical; breastfeeding; cerebrovascular bleeding; concurrent use of aspirin or other salicylates, other NSAIDs, or probenecid; hemorrhagic diathesis; history of GI bleeding, GI perforation, or peptic ulcer disease; hemophilia or other bleeding problems, including coagulation or platelet function disorders; hypersensitivity to ketorolac tromethamine, aspirin, other NSAIDs, or their components; incomplete hemostasis; labor and delivery; treatment of perioperative pain during coronary artery bypass graft surgery.

Read ketorolac label carefully. Dont use I.M form for I.V route. Know that ketorolac isnt for intrathecal or epidural use. Give I.V injection over at least 15 seconds. Notify prescriber if pain relief is inadequate or breakthrough pain occurs between doses because supplemental doses of an opiod analgesic may be required. Use ketorolac with extreme caution in patients with history of ulcer disease or GI bleeding because NSAIDs like ketorolac increase risk of GI bleeding and ulceration. Monitor patients vital signs.

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DRUG Generic Name: Penicillin G Sodium Classification: Antibiotic Brand Name Pentids Dosage: 5 million I units Frequency:q6 Route: IVTT

MECHANISM OF ACTION Inhibits final stage of bacterial cell wall synthesis by competitively binding to penicillin-binding proteins inside the cell wall. Penicillin-binding proteins are responsible for various steps in bacterial cell wall synthesis. By binding to these proteins, penicillin leads to cell wall lysis. ADVERSE REACTIONS: CNS: Confusion, dizziness, dysphasia, hallucinations, headache, lethargy, sciatic nerve irritation, seizures CV: Labile blood pressure, palpitations EENT: Black hairy tongue, oral candidiasis, stomatitis, taste perversion GI: Abdominal pain, diarrhea, elevated liver function test results (transient), indigestion, nausea, pseudomembranous colitis SKIN: Rash Other: Electrolyte imbalances; injection site necrosis, pain, or redness

INDICATION

CONTRAINDICATIO N

NSG. RESPONSIBILITIES Observe 10 rights in giving medications. Reconstitute vials of penicillin for injection with sterile water for injection, D5W, or sodium chloride for injection. Administer penicillin at least 1 hour before other antibiotics. Monitor serum sodium level and assess for early signs of heart failure in patients receiving high doses of penicillin G sodium.

To treat systemic infections caused by gram-positive organisms. To treat syphilis of more Hypersensitivity to penicillin or its than 1 years duration. components. To treat bacterial meningitis.

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DRUG Generic Name: Ciprofloxacin Classification: Antibiotic Brand Name: Cipro Dosage:500mg Frequency: TID Route: Per Orem

MECHANISM OF ACTION Inhibits the enzyme DNA gyrase, which is responsible for the unwinding and supercoiling of bacterial DNA before it replicates. By inhibiting this enzyme, ciprofloxacin causes bacterial cells to die. ADVERSE REACTIONS: CNS: Agitation, anxiety, cerebral thrombosis, confusion, dizziness, headache, insomnia, lightheadedness, migraine, nightmares, paranoia, peripheral neuropathy, restlessness, seizures, syncope, toxic psychosis CV: Angina, atrial flutter, cardiopulmonary arrest, cardiovascular collapse, hypertension, MI, orthostatic hypotension, palpitations, phlebitis, tachycardia, EENT: Oral candidiasis GI: Abdominal pain, constipation, diarrhea,elevated liver function test results, flatulence, GI bleeding, hepatic failure or necrosis, hepatitis, indigestion, intestinal perforation, jaundice, nausea, pancreatitis, pseudomembranous colitis, vomiting SKIN: Erythema multiforme, exfoliative dermatitis, photosensitivity, rash, StevensJohnson syndrome, toxic epidermal necrolysis, urticaria RESP: Bronchospasm, pulmonary embolism, respiratory arrest

INDICATION

CONTRAINDI CATION

NSG. RESPONSIBILITIES Observe 10 rights in giving medications. Obtain culture and sensitivity test results, as ordered, before giving ciprofloxacin. Store reconstituted solution up to 14 days at room temperature or refrigerated. Assess patients hepatic, renal, and hematologic functions periodically, as ordered, if hes receiving prolonged therapy. Monitor patient closely for diarrhea, which may reflect pseudomembranous colitis. If it occurs, notify prescriber and expect to withhold drug and treat diarrhea.

To prevent inhalation anthrax after exposure or to treat inhalation anthrax. To treat acute sinusitis caused by gram negative organisms. To treat mild to severe nosocomial pneumonia caused by susceptible organisms.

Hypersensitivity to ciprofloxacin, quinolones, or their components.

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DRUG Generic Name: Nalbuphine Hydrochloride Classification: Opiod Analgesic Brand Name: Nubain Dosage: 10mg Frequency: To call to Operating Room Route: IVTT

MECHANISM OF ACTION Binds with and stimulates mu and kappa opiate receptors in the spinal cord and higher levels in the CNS. In this way, nalbuphine alters the perception of and emotional response to pain. ADVERSE REACTIONS: CNS: Confusion, depression, dizziness, euphoria, fatigue, hallucinations, headache, nervousness, restlessness, seizures, syncope, tiredness, weakness CV: Hypertension, hypotension, tachycardia EENT: Blurred vision, diplopia, dry mouth GI: Abdominal cramps, anorexia, constipation, nausea, vomiting RESP: Dyspnea, pulmonary edema, respiratory depression, wheezing SKIN: Diaphoresis, flushing, pruritus, rash, sensation of warmth, urticaria Other: Injection site burning, pain, redness, swelling, and warmth

INDICATION

CONTRAINDICATIO N

NSG. RESPONSIBILITIES Observe 10 medications. rights in giving

To relieve moderate to severe pain As adjunct to Hypersensitivity to anesthesia. nalidixic acid or its components, porphyria, seizure disorder, use with melphalan or other related chemotherapeutic alkylating drugs.

Avoid giving drug within 2 hours of didanosine; multivitamins that contain iron or zinc; sucralfate; or antacid that contains aluminum, calcium, or magnesium. If patient also takes cyclosporine or theophylline, monitor blood level of these drugs and adjust dosage, as prescribed. If patient has a history of seizures or cerebral arteriosclerosis, monitor for seizures during nalidixic acid therapy. If nalidixic acid therapy exceeds 2 weeks, monitor patients blood counts and renal and liver function test results periodically, as ordered.

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