Drug Name Classification Action Indication Adverse Reaction Contraindications Nursing

Considerations
GENERIC NAME:
Piperacillin /
Tazobactam

BRAND NAME:
Zosyn


4.5mg IV Q8















Anti-infective;
Beta-lactam
antibiotic; Anti-
pseudomonal
penicillin


Antibacterial
combination
product
consisting of the
semisynthetic
piperacillin and
the beta-
lactamase
inhibitor
tazobactam.
Tazobactam
component does
not decrease the
activity of the
piperacillin
component
against
susceptible
organisms
Treatment of moderate
to severe infections
caused by piperacillin-
resistant,
piperacillin/tazobactam
susceptible, beta-
lactamaseproducing
strains of
microorganisms in the
following conditions:
severe infections, intra-
abdominal abscess,
community-acquired
pneumonia (moderate
severity only),
nosocomial pneumonia
(moderate to severe)
CNS: Headache,
insomnia, fever.

GI: Diarrhea,
constipation,
nausea, vomiting,
dyspepsia,
pseudomembranous
colitis.

Skin: Rash, pruritus,
hypersensitivity
reactions.
Hypersensitivity to
piperacillin,
tazobactam,
penicillins,
cephalosporins, or
beta-lactamase
inhibitors such as
clavulanic acid and
sulbactam.

-Obtain history of
hypersensitivity to
penicillins,
cephalosporins, or
other drugs prior to
administration.

-Lab tests: C&S prior
to first dose of the
drug; start drug
pending results.
Monitor hematologic
status with
prolonged therapy
(Hct and Hgb, CBC
with differential and
platelet count).

-Monitor patient
carefully during the
first 30 min after
initiation of the
infusion for signs of
hypersensitivity

-Report rash, itching,
or other signs of
hypersensitivity
immediately.

-Report loose stools
or diarrhea as these
may indicate
pseudomembranous
colitis.



Drug Name Classification Action Indication Adverse Reaction Contraindications Nursing
Considerations
GENERIC NAME:
Metronidazole

BRAND NAME:
Flagyl

500mg IV Q8















Antiinfective;
Antitrichomonal;
Amebicide;
Antibiotic


It is synthetic
compound with
direct
trichomonacidal
and amebicidal
activity as well as
antibacterial activity
against anaerobic
bacteria and some
gram-negative
bacteria
It is used for
preoperative
prophylaxis
In colorectal
surgery. IV
metronidazole is
used for the
treatment of
serious infections
caused by
susceptible
anaerobic bacteria
in intra-abdominal
infections, skin
infections and for
both pre- and post
operative
prophylaxis
BODY AS A WHOLE:
Hypersensitivity,
fever, fleeting joints
pains, overgrowth
of candida

CNS: Vertigo,
headache,
confusion,
irritability, fatigue

GI: Nausea,
vomiting, anorexia,
diarrhea,
constipation, dry
mouth

SPECIAL SENSES:
Nasal congestion

CV: ECG changes
(flattening of T
wave)


Blood dyscrasias;
Active CNS disease
-Discontinue therapy
immediately if
symptoms of CNS
toxicity develop.

-Monitor especially for
seizures and
peripheral neuropathy
(e.g., numbness and
paresthesia of
extremities).

-Lab tests: Obtain
total and differential
WBC counts before,
during, and after
therapy, especially if a
second course is
necessary.

-Monitor for S&S of
sodium retention,
especially in patients
on corticosteroid
therapy or with a
history of CHF.

-Monitor patients on
lithium for elevated
lithium levels.

-Repeat feces
examinations, usually
up to 3 months, to
ensure that amebae
have been eliminated.


Drug Name Classification Action Indication Adverse Reaction Contraindications Nursing
Considerations
GENERIC NAME:
Tramadol

BRAND NAME:
Dolcet

50mg IV Q8





























Non-opoid
derivative;
Analgesics
Tramadol is used in
the management of
moderate to
moderately severe
pain. Extended
release tablets are
used for moderate
to moderately
severe chronic pain
in adults who
require continuous
treatment for an
extended period.

Moderate to severe
pain
Commonly reported
side effects include
nausea,
constipation,
dizziness, headache,
drowsiness, and
vomiting.
Contraindicated
with allergy to
tramadol or opioids
or acute
intoxication with
alcohol, opioids,
or psychotropic drugs.

Renal impairement
& increase ICP
hypersensitivity
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.

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 Name Classification Action Indication Adverse Reaction Contraindications Nursing
Considerations
GENERIC NAME:
Insulin Glargine

BRAND NAME:
Lantus

24 5c SQ OD



























Hormone
Intermediate- acting
Insulin
Insulin is a hormone
secreted by the
pancrease that, by
receptor-mediated
effects, promotes
the storage of the
body's fuels,
facilitating the
transport of
metabolites and
ions (potassium)
through cell
membranes and
stimulating the
synthesis of
glycogen from
glucose, of fats from
lipids, and proteins
from amino acids.

-Treatment of type
1 (insulin-
dependent)
diabetes
-Treatment of type
2 (noninsulin-
dependent)
diabetes that
cannot be
controlled by diet or
oral agents
-Treatment of
severe ketoacidosis
or diabetic coma
(regular insulin
injection)
-Treatment of
hyperkalemia with
infusion of glucose
to produce a shift of
potassium into the
cells
-Highly purified and
human insulins
promoted for short
courses of therapy
(surgery,
intercurrent
disease), newly
diagnosed patients,
patients with poor
metabolic control,
and patients with
gestational diabetes
-Insulin injection
concentrated
indicated for
treatment of
- Hypersensitivity:
Rash, anaphylaxis
or angioedema
-Local: Allergy
local reactions at
injection site
redness, swelling,
itching; usually
resolves in a few
days to a few
weeks; a change in
type or species
source of insulin
may be tried;
lipodystrophy;
pruritus
-Metabolic:
Hypoglycemia;
ketoacidosis

-Contraindicated
with allergy to pork
products (varies
with preparations;
human insulin not
contraindicated
with pork allergy).

-Ensure uniform
dispersion of insulin
suspensions by
rolling the vial gently
between hands;
avoid vigorous
shaking.

-Give maintenance
doses SC, rotating
injection sites
regularly to decrease
incidence of
lipodystrophy; give
regular insulin IV or
IM in severe
ketoacidosis or
diabetic coma.

-Do not give insulin
injection
concentrated IV;
severe anaphylactic
reactions can occur.

-Use caution when
mixing two types of
insulin; always draw
the regular insulin
into the syringe first;
if mixing with insulin
lispro, draw the
lispro first; use
mixtures of regular
and NPH or regular
and Lente insulins
within 515 min of
combining them;
Lantus insulin (insulin
glargine) cannot be
diabetic patients
with marked insulin
resistance
(requirements of >
200 units/day)
-Glargine (Lantus):
Treatment of adult
patients with type 2
diabetes who
require basal insulin
control of
hyperglycemia
-Treatment of
adults and children
> 6 yr who require
baseline insulin
control


mixed in solution
with any other drug,
including other
insulins.

-Double-check, or
have a colleague
check, the dosage
drawn up for
pediatric patients,
for patients receiving
concentrated insulin
injection, or patients
receiving very small
doses; even small
errors in dosage can
cause serious
problems.

-Carefully monitor
patients being
switched from one
type of insulin to
another carefully;
dosage adjustments
are often needed.
Human insulins often
require smaller doses
than beef or pork
insulin; monitor
cautiously if patients
are switched; lispro
insulin is given 15
min before a meal.

-Store insulin in a
cool place away from
direct sunlight.
Refrigeration is
preferred. Do not

freeze insulin. Insulin
prefilled in glass or
plastic syringes is
stable for 1 wk
refrigerated; this is a
safe way of ensuring
proper dosage for
patients with limited
vision or who have
problems with
drawing up insulin.

-Monitor urine or
serum glucose levels
frequently to
determine
effectiveness of drug
and dosage. Patients
can learn to adjust
insulin dosage on a
sliding scale based on
test results.

-Monitor insulin
needs during times
of trauma or severe
stress; dosage
adjustments may be
needed.

-Keep life support
equipment and
glucose readily
available to deal with
ketoacidosis or
hypoglycemic
reactions.