Ceftriaxone (Rocephin)

Indication: Treatment of: : Skin and skin structure infections, Bone and joint infections, Complicated and
uncomplicated urinary tract infections, Lower respiratory tract infections, Intra-abdominal infections,
Septicemia, Meningitis, Otitis media. Perioperative prophylaxis.
Contraindication: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins
Adverse effect/Side effects: CNS- SEIZURES (HIGH DOSES). GI- PSEUDOMEMBRANOUS
COLITIS, diarrhea, cholelithiasis, gallbladder sludging. Derm: rashes, urticaria. Hemat: bleeding,
eosinophilia, hemolytic anemia, leukopenia, thrombocytosis. Local: pain at IM site, phlebitis at IV
site. Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, superinfection.
Interaction: Should not be administered concomitantly with any calcium-containing solutions.
Nursing Implication: Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
edema, wheezing). Discontinue the drug and notify health care professional immediately if these
symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of
an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to
health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy. Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
WBC) at beginning of and throughout therapy. May cause positive results for Coombs' test. Advise patient to report
signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools)
and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea contains blood,
mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.

Enoxaparin (Lovenox)
Indication: Prevention of venous thromboembolism (VTE) (deep vein thrombosis (DVT) and/or
pulmonary embolism (PE)) in surgical or medical patients. Treatment of DVT with or without PE (with
warfarin). Prevention of ischemic complications (with aspirin) from unstable angina and non-ST-segmentelevation MI. Treatment of acute ST-segment-elevation MI (with thrombolytics or percutaneous coronary
intervention).
Adverse effect/Side effects: NS: dizziness, headache, insomnia. CV: edema. GI: constipation, liver
enzymes, nausea, vomiting. GU: urinary retention. Derm: ecchymoses, pruritus, rash, urticaria. F and
E hyperkalemia. Hemat: bleeding, anemia, thrombocytopenia. Local: erythema at injection site,
hematoma, irritation, pain. Misc: fever.
Interaction- Risk of bleeding may be by concurrent use of drugs that affect platelet function and
coagulation, including warfarin, aspirin, thrombolytic agents, NSAIDs,dipyridamole, some penicillins,
clopidogrel, abciximab, eptifibatide, tirofiban, ticlopidine, and dextran.
Nursing Implication: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising;
black, tarry stools; hematuria; fall in hematocrit or BP; guaiac-positive stools); bleeding from surgical site. Notify
health care professional if these occur. Toxicity and Overdose: For overdose, protamine sulfate 1 mg for each mg of
enoxaparin should be administered by slow IV injection. Assess location, duration, intensity, and precipitating
factors of anginal pain. Monitor patient for hypersensitivity reactions (chills, fever, urticaria). Report signs to health
care professional. May cause hyperkalemia. May cause in AST and ALT levels. Monitor CBC, platelet count, and
stools for occult blood periodically during therapy. If thrombocytopenia occurs, monitor closely. If hematocrit
decreases unexpectedly, assess patient for potential bleeding sites. If excessive bruising occurs, ice-cube massage of
site before injection may lessen bruising.

Pantroprazole (Protonix)

Indication: GERD; djunctive treatment of duodenal ulcers associated with Helicobacter pylori.
Adverse effect/Side effects: CNS: headache. GI: abdominal pain, diarrhea, eructation,
flatulence. Endo: hyperglycemia. F and E hypomagnesemia (especially if treatment duration 3 mo). MS: bone
fracture.
Interaction- May absorption of drugs requiring acid pH,
including ketoconazole,itraconazole, atazanavir, ampicillin esters, and iron salts. May risk of bleeding
withwarfarin(monitor INR/PT). May the antiplatelet effects of clopidogrel. Hypomagnesemia risk
of digoxin toxicity.
Nursing Implication: Assess patient routinely for epigastric or abdominal pain and for frank or occult blood in
stool, emesis, or gastric aspirate. May cause abnormal liver function tests, including AST, ALT, alkaline
phosphatase, and bilirubin. May cause hypomagnesemia. Monitor serum magnesium prior to and periodically during
therapy. instruct patient to take medication as directed for the full course of therapy, even if feeling better. Advise
patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI
irritation. Advise patient to report onset of black, tarry stools; diarrhea; or abdominal pain to health care professional
promptly. Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal
products being taken and consult health care professional before taking any new medications.

Propranolol (Inderal)
Beta blockers; antianginals, antiarrhythmics (Class II), antihypertensives, vascular headache suppressants
Indication: Management of hypertension, angina, arrhythmias, hypertrophic cardiomyopathy,
thyrotoxicosis, essential tremors, pheochromocytoma. Also used in the prevention and management of
MI, and the prevention of vascular headaches.
Adverse effect/Side effects: NS: fatigue, weakness, anxiety, dizziness, drowsiness, insomnia, memory
loss, mental depression, mental status changes, nervousness, nightmares. EENT: blurred vision, dry eyes,
nasal stuffiness. Resp: bronchospasm,
wheezing. CV: ARRHYTHMIAS, BRADYCARDIA,HF, PULMONARY EDEMA, orthostatic
hypotension, peripheral vasoconstriction.GI: constipation, diarrhea, nausea. GU: erectile dysfunction,
libido. Derm: ERYTHEMA MULTIFORME, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON
SYNDROME, TOXIC EPIDERMAL NECROLYSIS, itching, rash. Endo: hyperglycemia, hypoglycemia
( in children).MS: arthralgia, back pain, muscle cramps,
myopathy. Neuro: paresthesia.Misc: ANAPHYLAXIS, drug-induced lupus syndrome.
Nursing Implication: Monitor BP and pulse frequently during dose adjustment period and periodically
during therapy. Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias,
hypertension, or myocardial ischemia. Drug should be tapered over a 2-week period before
discontinuation. Assess patient carefully during tapering and after medication is discontinued. Consider
that patients taking propranolol for non-cardiac indications may have undiagnosed cardiac disease. Abrupt
discontinuation or withdrawal over too-short a period of time (less than 9 days) should be avoided. Assess
for orthostatic hypotension when assisting patient up from supine position. Monitor intake and output
ratios and daily weight. Assess patient routinely for evidence of fluid overload (peripheral edema,
dyspnea, rales/crackles, fatigue, weight gain, jugular venous distention).Assess for rash periodically
during therapy. May cause Stevens-Johnson syndrome. Discontinue therapy if severe or if accompanied
with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis
and/or eosinophilia.
Lab Test Considerations: May cause BUN, serum lipoprotein, potassium, triglyceride, and uric acid
levels. May cause ANA titers.
May cause or in blood glucose levels. In labile diabetic patients, hypoglycemia may be accompanied
by precipitous of BP.

Toxicity and Overdose: Monitor patients receiving beta blockers for signs of overdose (bradycardia,
severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures). Notify
health care professional immediately if these signs occur.
PO: Take apical pulse prior to administering. If <50 bpm or if arrhythmia occurs, withhold medication
and notify physician or other health care professional. Administer with meals or directly after eating to
enhance absorption.
Swallow extended release tablets whole; do not crush, break, or chew. Propranolol tablets may be crushed
and mixed with food.
Mix propranolol oral solution with liquid or semisolid food (water, juices, applesauce, puddings). To
ensure entire dose is taken, rinse glass with more liquid or have patient consume all of the applesauce or
pudding. Do not store after mixing.

Acetaminophen +Hydrocodone
Indication: Used mainly in combination with nonopioid analgesics (acetaminophen/ibuprofen) in the
management of moderate to severe pain. Antitussive (usually in combination products with
decongestants)
Contraindication:
Adverse effect/Side effects: CNS: confusion, dizziness, sedation, euphoria, hallucinations, headache,
unusual dreams.EENT: blurred vision, diplopia, miosis. Resp: respiratory depression. CV: hypotension,
bradycardia. GI: constipation, dyspepsia, nausea, vomiting. GU: urinary
retention.Derm: sweating. Misc: physical dependence, psychological dependence, tolerance.
Interaction- Use with extreme caution in patients receiving MAO inhibitors (may produce severe,
unpredictable reactionsdo not use within 14 days of each other)
Nursing Implication: Toxicity and Overdose: If an opioid antagonist is required to reverse respiratory
depression or coma, naloxone (Narcan) is the antidote. High Alert: Accidental overdose of opioid
analgesics has resulted in fatalities. Before administering, clarify all ambiguous orders; have second
practitioner independently check original order and dose calculations. Advise patient to take medication
as directed and not to take more than the recommended amount. Severe and permanent liver damage may
result from prolonged use or high doses of acetaminophen. Renal damage may occur with prolonged use
of acetaminophen or ibuprofen. Doses of nonopioid agents should not exceed the maximum
recommended daily dose. Instruct patient on how and when to ask for and take pain medication. May
cause drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. Caution
patient to avoid driving or other activities requiring alertness until response to the medication is known.
Advise patient to change positions slowly to minimize orthostatic hypotension. Caution patient to avoid
concurrent use of alcohol or other CNS depressants with this medication. Encourage patient to turn,
cough, and breathe deeply every 2 hr to prevent atelectasis. Advise patient that good oral hygiene,
frequent mouth rinses, and sugarless gum or candy may decrease dry mouth.
Indication:
Contraindication:
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