MULTIVITAMINS

ACTION

DOSE:

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS
OF THE DRUG
Supplies
the Indications:
GI:
Discomfort,
needed

Vitamin and mineral deficiencies associated with

vomiting
and
vitamins
and
restricted
diets
and
inadequate
food
intake.
diarrhea
may
minerals, which
Disturbances of growth and development, exposure
occur related to
are needed for
to acute and chronic infectious diseases
amount
of
the
optimal
functioning of
elemental
iron
the
body
taken
systems.
Contraindications:

Renal:
occasional

Those containing high doses of calcium are not for

yellow discoloration of
urine may occur
patients with hypercalcemia or hypercalciuria
Intolerance or inability to absorb iron, hemochromatosis,
pernicious anemia.

CEFTRIAXONE
ACTION
Inhibits cell-wall
synthesis,
promoting
osmotic
instability
;
Hinders or kills
susceptible
bacteria: usually
gram-negative
bacteria
and
some
grampositive bacteria

NURSING RESPONSIBILITIES /PRECAUTIONS

Advise patients to take drug after eating to avoid GI
upset because of iron.
Explain to client the effects to be expected from
taking this medication

DOSE:

INDICATIONS AND CONTRAINDICATIONS

ADVERSE EFFECTS OF
THE DRUG
Indications:
GI: diarrhea

Serious infections of lower respiratory tracts

Hematologic:

Bacteremia or septicemia caused by susceptible

thrombocytosis,
microorganisms
such
as
streptococci,
leukopenia
Staphylococcus
aureus,
S.
epidermidis,
Skin: pain, induration,
rash
Escherichia
coli,
Klebsiella
pneumoniae,
Haemophilus influenzae, Neisseria meningitides,
N.
gonorrhhoea,
Enterobacter,
Proteus,
Pseudomonas, Peptostreptococcus, Serratia
marcescens.
Contraindications:
Contraindicated in patients hypersensitive to drug or to
other cephalosporins
Use cautiously in patients with history of sensitivity to
penicillin.

NURSING RESPONSIBILITIES /PRECAUTIONS

Assess patients infection before therapy, and
reassess regularly thereafter
Ask patient/water about previous reactions to
cephalosporins or penicillin before giving the
first dose.
Monitor patients hydration status
Tell patients watcher to report adverse reactions
promptly
Tell patients watcher to notify prescriber
immediately if loose stools or diarrhea occur.

PHENOBARBITAL
ACTION
Produces
all
levels of CNS
depression:
Depresses the
sensory cortex,
decreases
motor activity,
and
alters
cerebellar
function
Inhibits

transmission in
the
nervous
system
and
raises
the
seizure

threshold
in
motor cortex.
Therapeutic
Effects:
Prevents and
stops seizure
activity;
promotes
calmness and
sleep

INDICATIONS
AND
CONTRAINDICATIONS
Indication:

Anticonvulsant in tonicclonic (grand mal),

partial, and febrile
seizures in children;
for all forms of
epilepsy
except
absence seizures

Contraindication:

Hypersensitivity
Comatose patients or
those with preexisting
CNS
depression
Uncontrolled
severe
pain

DOSE:
ADVERSE
DRUG

EFFECTS

OF

THE

NURSING RESPONSIBILITIES /PRECAUTIONS

CNS: lethargy, drowsiness, Cautious use:

hangover
Additive CNS depression with other CNS depressants,
Resp: respiratory depression;
including alcohol, antihistamines, opioids, and other
apnea
IVlaryngospasm,
sedative/hypnotics
bronchospasm.

CV: IVhypotension.
GI:
constipation,
diarrhea,
nausea, vomiting.
Skin: rashes, urticaria
Local: phlebitis at IV site.

May induce hepatic enzymes that metabolize other

drugs, decreasing their effectiveness, including
hormonal contraceptives, warfarin, chloramphenicol,
cyclosporine, dacarbazine, corticosteroids, tricyclic
antidepressants,
felodipine,
clonazepam,
carbamazepine,
verapamil,
theophylline,
metronidazole, griseofulvin and quinidine
May increase the risk of hepatic toxicity of
acetaminophen
MAO inhibitors, valproic acid, or divalproex may
decrease the metabolism of phenobarbital,
increasing sedation
May increase the risk of hematologic toxicity with
cyclophosphamide
TIME/ACTION PROFILE (sedation)
ONSET /PEAK /DURATION
PO /3060 min /unknown />6 hr
IM, SC /1030 min /unknown /46 hr
IV /5 min /30 min/ 46 hr
General Info: Monitor respiratory status, pulse, and
blood pressure in patients before and after giving
phenobarbital. Equipment for resuscitation and
artificial ventilation should be readily available.
Respiratory depression is dose-dependent.
Seizures:
Assess
location,
duration,
and
characteristics of seizure activity.
Lab Test Considerations: Patients on prolonged
therapy should have hepatic and renal function and
CBC evaluated periodically.
Serum folate concentrations should be monitored
periodically during therapy because of increased
folate requirements of patients on long-term
anticonvulsant therapy with phenobarbital.
May cause decreased serum bilirubin concentrations
in epileptics.
Toxicity and Overdose: Serum phenobarbital levels
may be monitored when used as an anticonvulsant.
Therapeutic blood levels are 1040 mcg/ml.
Symptoms of toxicity include confusion, drowsiness,
dyspnea, slurred speech, and staggering

PARACETAMOL
ACTION

Commonly used
for the relief of
headaches,
minor
aches
and
pains,
Paracetamol
exerts
its
analgesic and
antipyretic effect
by decreasing
the synthesis of
prostaglandins
in the CNS
through COX2
inhibition.
It
serves
to
decrease the
amount
of
circulating
prostaglandins
that may serve
as mediators of
pain and fever.
Therapeutic
Effects: relief of
pain and fever

DOSE:

INDICATIONS AND
CONTRAINDICATI
ONS
Indications:
Fever
Contraindications:
It is contraindicated
for patients with
hypersensitivity
reactions
to
paracetamol.
Products containing
alcohol, aspartame,
saccharin, sugar, or
tartrazine
(FDC
yellow dye #5)
should be avoided
in patients who
have
hypersensitivity or
intolerance to these
compounds.

ADVERSE
EFFECTS OF
THE DRUG
GI:
hepatotoxicity
(overdose),
hepatic failure
GU: renal failure
(high
doses/chronic
use)
Integumentary
System: rash,
urticaria.

NURSING RESPONSIBILITIES /PRECAUTIONS

Chronic high-dose acetaminophen (>2 g/day) may increase the risk of bleeding with
warfarin (PT should be monitored regularly and INR should not exceed 4)

Hepatotoxicity is additive with other hepatotoxic substances, including alcohol

Concurrent use of sulfinpyrazone, isoniazid, rifampin, rifabutin, phenytoin,

barbiturates, and carbamazepine may increase the risk of acetaminophen-induced
liver damage (limit self-medication); these agents will also decrease therapeutic
effects of acetaminophen

Combined use with salicylates or NSAIDs increases the risk of adverse renal
effects.

General Info: Assess overall health status before administering acetaminophen.

Malnourished patients are at higher risk of developing hepatotoxicity with chronic use
of usual doses of this drug.
o

Assess amount, frequency, and type of drugs taken in patients selfmedicating, especially with OTC drugs. Prolonged use of acetaminophen
alone or combined with salicylates or NSAIDs increases the risk of adverse
renal effects. For short-term use, combined doses of acetaminophen and
salicylates should not exceed the recommended dose of either drug given
alone.

Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia,

and malaise).

Toxicity and Overdose: If overdose occurs, N-acetylcysteine (Mucomyst) is the

antidote

Advise patient to take medication exactly as directed and not to take more than the
recommended amount. Chronic excessive use of >4 g/day (2 g in patients with
chronic alcoholism) may lead to hepatotoxicity, renal, or cardiac damage. Adults
should not take acetaminophen longer than 10 days and children not longer than 5
days unless directed by health care professional. Short-term doses of
acetaminophen with salicylates or NSAIDs should not exceed the recommended
daily dose of either drug alone.

Advise parents or caregivers to check concentrations of liquid preparations.

FOLIC ACID

DOSE:

ACTION

INDICATIONS AND CONTRAINDICATIONS

Vitamin B complex
essential
for
nucleoprotein synthesis
and maintenance of
normal erythropoiesis.
Acts
against folic
acid deficiency
that
impairs
thymidylate
synthesis and results in
production of defective
DNA that leads to
megaloblast formation
and arrest of bone
marrow maturation

Indications:
Folate
deficiency,
macrocytic
anemia,
and megaloblastic anemiasassociated with
malabsorption syndromes, alcoholism, primary
liver disease, inadequate dietary intake,
pregnancy, infancy, and childhood
Contraindications:

Hypersensitivity or allergies

ZINC SULFATE
ACTION

INDICATIONS AND CONTRAINDICATIONS

Acts as an
integral part of
several
enzymes
important
to
protein
and
carbohydrate
metabolism,
wound healing,
maintenance of
normal growth
and
skin
hydration, and
senses of taste
and smell.

Indications:
Dietary supplementation; treatment or prevention of zinc
deficiencies.
Contraindications:
Direct injection of undiluted solution into peripheral
vein.

ADVERSE EFFECTS
OF THE DRUG

GI:
nausea,
epigastric pain,
vomiting,
constipation,
black
stools,
diarrhea,
anorexia

NURSING RESPONSIBILITIES /PRECAUTIONS

GI upset may be related to dose.
Between meal doses are preferable.
Absorption may be decreased with foods.
Enteric coated products reduce GI upset but
also reduces absorption.
.

DOSE:
ADVERSE EFFECTS
OF THE DRUG

GI:
nausea,
vomiting (if taken
in large doses)

NURSING RESPONSIBILITIES /PRECAUTIONS

Tell watcher to contact health care provider if

patient experiences nausea, severe vomiting,
dehydration, or restlessness.

Tell patient to take with food if GI upset occurs,

but to avoid foods high in calcium, phosphorus,
and phytate. Inform patient that bran, caffeine,
and dairy products may decrease absorption
Do not give injection undiluted by direct injection
into a peripheral vein