IX.

DRUG STUDY

PRE MEDICATIONS

Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Cephalosporin The prophylactic administ First generation  Cefazolin for CNS: headache,  Obtain
Cefazolin first – generation ration of cefazolin cephalosporin that injection is confusion, seizures specimen for
preoperatively, inhibit its cell wall contraindicated in culture and
patients with known CV: phlebitis, sensitivity tests
intraoperatively, and synthesis, thrombophlebitis
allergy to the before giving
Dosage: postoperatively may promoting osmotic with IV injection the first dose.
2 gm + IV (-) reduce the incidence of instability, usually cephalosporin
group of antibiotics.
ANST certain postoperative infec bactericidal. GI: anorexia,  Inject drug IM
tions in patients vomiting, without further
undergoing surgical abdominal cramps, dilution. This
procedures which are
oral candidiasis drug isn’t as
painful as other
classified as contaminated GU: vaginitis, cephalosporins.
or potentially genital pruritus, Give injection
contaminated (e.g., candidiasis deep into a
vaginal hysterectomy, large muscle,
and cholecystectomy in Hematologic: such as the
high-risk patients such as neutropenia, gluteus
leucopenia, maximus or
those older than 70 years,
eosinophilia, lateral aspect of
with acute cholecystitis, thrombocytopenia the thigh.
obstructive jaundice, or
common duct bile stones.
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Histamine H2 – Prevention of stress Ranitidine  Cirrhosis of the CNS: malaise,  Drug appears in
Ranitidine receptor blocking ulcer. competitively inhibits liver, impaired vertigo breast milk. Use
hydrochloride drug the action of histamine renal or hepatic cautiously in
function. EENT: blurred breastfeeding
Gastroesophageal at H2 – receptors in vision women.
Dosage: reflux disease. gastric parietal cells.
1 amp TIV This reduces basal and  Allergy to Hematologic:  For IV injection,
nocturnal gastric acid ranitidine and thrombocytopenia, dilute 50 mg in
lactation. granulocytopenia 0.9% NaCl
secretions as well as
that caused by injection to a
Hepatic: jaundice total volume of
histamine, food,
20 mL. Give
amino acids, insulin Skin: burning, diluted solution
and pentagastrin. itching at injection over 5 min or
site more. For
intermittent IV
Other: anaphylaxis, infusion, dilute
angioedema 50 mg in 100 mL
D5W; give over
15 – 20 min.

 For continuous
IV infusion, add
ranitidine
injection to
D5W.
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Gastrointestinal Gastroesophageal Dopamine antagonist  Gastrointestinal CNS: anxiety,  Drug has been
Metoclopramide stimulant reflux, Post – that acts by hemorrhage, drowsiness, investigationally to
operative nausea and increasing sensitivity obstruction, or fatigue, promote post –
perforation; depression, partum lactation and
Dosage: vomiting. to acetylcholine; insomnia,
epilepsy; distents treat anorexia
1 amp TIV results in increased confusion, nervosa, dizziness,
motility of the upper taking drugs likely
headache, and intractable
to cause extra – dizziness, fever
GI tract and hiccups.
pyramidal
relaxation of the
symptoms, such as CV: transient  Drug appears in
pyloric sphincter and
phenothiazines. hypertension, breast milk. Use
duodenal bulb. Pheochromocytoma hypotension, cautiously in
Facilitates intubation tachycardia, breastfeeding
of the small bowel bradycardia women.
and speeds transit of
a barium meal. GI: nausea,
Produces sedation, bowel  Inject slowly IV
includes release of disturbances, over 1 – 2 min to
diarrhea prevent transient
prolactin, increases
feelings of anxiety
circulating GI: urinary and restlessness.
aldosterone levels frequency,
and is an antiemetic. incontinence,  For IV use, dilute
prolactin doses greater than
secretion 10 mg in 50 mL of
D5W, D5/0.45%
Respiratory: NaCl, RL, Ringer’s
bronchiospasm injection, or NaCl;
infuse over 15 min.
Skin: rash
POST MEDICATIONS

Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Nonsteroidal Anti – Short term May inhibit  Hypersensitivity CNS: drowsiness,  Carefully
Ketorolac inflammatory drug management of prostaglandin to the drug or sedation, dizziness, observe patient
allergic headache with
tromethamine severe, acute pain synthesis to
symptoms coagulopathies
that requires produce anti – CV: edema,
(angioedema, and those taking
analgesia at the inflammatory, palpitations, anti – coagulants.
Dosage: opiate level. analgesic and anti – bronchospasm) to
hypertension,
aspirin or other
30 mg IV q 6 RTC pyretic effect. arrhythmias  Drug inhibits
NSAIDs. platelet
ANST x 4 doses
GI: nausea, aggregation and
 Use with aspirin dyspepsia, GI pain, can prolong
or other NSAIDs. diarrhea, peptic bleeding time.
ulceration,
 Advanced renal vomiting,  Don’t give drug
impairment and constipation, epidurally or
in those at risk flatulence, intratherally
for renal failure. stomatitis because of
alcohol content.
Hematologic:
decreased platelet
 Use in labor, adhesion, purpura,
delivery, or  Put pressure on
prolonged bleeding site for 15 to 30
during lactation. time seconds after
injection to
Skin: rash, minimize local
diaphoresis, effect.
pruritus
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Nonsteroidal Anti- Acute pain, for Inhibit  Use in severe CNS: dizziness,  Watch for signs
Celecoxib inflammatory drug treatment of prostaglandin hepatic headache, insomnia and symptoms of
(COX – 2 inhibitor) primary synthesis, impairment, in overt and occult
those who have CV: peripheral bleeding.
Dosage: dysmenorrhea impending edema
200 mg BID RTC x cyclooxygenase – 2 shown an allergic
reaction to  NSAIDs such as
3 days then BID (COX – 2) to EENT: pharyngitis, celecoxib can
PRN produce anti- sulfonamides, or rhinitis, sinusitis cause fluid
in those who have retention;
inflammatory,
experienced GI: abdominal monitor patient
analgesic and anti-
asthma, urticaria, pain, diarrhea, with
pyretic. or allergic – type dyspepsia, hypertension,
reactions after flatulence, nausea edema or heart
taking aspirin or failure.
other NSAIDs. Musculosketletal:
Use in late back pain
pregnancy (may  Before starting
cause premature Metabolic: drug therapy,
hyperchlorema rehydrate
closure of ductus
arteriosus). dehydrated
Respiratory: upper patient.
Lactation. respiratory tract
infection  Drug can be
given without
regard to meals,
but foods may
decrease GI
upset.
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Analgesic, Management of A centrally acting  Use for obstetric CNS: dizziness,  Reassess
Tramadol centrally – acting moderate to synthesis analgesic preoperative vertigo, headache, patient’s level of
medication or for anxiety, confusion, pain at least 30
hydrochloride moderately severe compound not
postdelivery sleep disorder minutes after
pain. chemically related to
analgesia in administration.
opioids. Thought to CV: vasodilation
nursing mothers.
Dosage: bind to opioid  Monitor CV and
50 mg IVF q 8 receptors and inhibit EENT: visual Respiratory
RTC x 3 doses reuptake of disturbances status.
norepinephrine and
GI: nausea and
serotonin.
vomiting,  Monitor bowel
constipation, and bladder
anorexia, function.
abdominal pain Anticipate need
for laxative.
GU: urine
retention, urinary
frequency,
menopausal
symptoms
proteinuria

Skin: pruritus, rash,

diaphoresis
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Gastrointestinal Gastroesophageal Dopamine antagonist  Gastrointestinal CNS: anxiety,  Drug has been
Metoclopramide stimulant reflux, Post – that acts by hemorrhage, drowsiness, investigationally to
operative nausea and increasing sensitivity obstruction, or fatigue, promote post –
perforation; depression, partum lactation and
Dosage: vomiting. to acetylcholine; insomnia,
epilepsy; distents treat anorexia
10 mg IV q 8 results in increased confusion, nervosa, dizziness,
PRN x nausea, motility of the upper taking drugs likely
headache, and intractable
to cause extra – dizziness, fever
vomiting GI tract and hiccups.
pyramidal
relaxation of the
symptoms, such as CV: transient  Drug appears in
pyloric sphincter and
phenothiazines. hypertension, breast milk. Use
duodenal bulb. Pheochromocytoma hypotension, cautiously in
Facilitates intubation tachycardia, breastfeeding
of the small bowel bradycardia women.
and speeds transit of
a barium meal. GI: nausea,
Produces sedation, bowel  Inject slowly IV
includes release of disturbances, over 1 – 2 min to
diarrhea prevent transient
prolactin, increases
feelings of anxiety
circulating GI: urinary and restlessness.
aldosterone levels frequency,
and is an antiemetic. incontinence,  For IV use, dilute
prolactin doses greater than
secretion 10 mg in 50 mL of
D5W, D5/0.45%
Respiratory: NaCl, RL, Ringer’s
bronchiospasm injection, or NaCl;
infuse over 15 min.
Skin: rash
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Cephalosporin The prophylactic administ First generation  Cefazolin for CNS: headache,  Obtain
Cefazolin first – generation ration of cefazolin cephalosporin that injection is confusion, specimen for
contraindicated in seizures culture and
preoperatively, inhibit its cell wall
patients with sensitivity tests
intraoperatively, and synthesis, CV: phlebitis,
known allergy to before giving
Dosage: postoperatively may promoting osmotic thrombophlebitis the first dose.
1 gm IV q 8 reduce the incidence of instability, usually the cephalosporin
with IV injection
group of
certain postoperative infe bactericidal.  Inject drug IM
antibiotics. GI: anorexia, without further
ctions in patients
undergoing surgical vomiting, dilution. This
procedures which are
abdominal drug isn’t as
cramps, oral painful as other
classified as contaminated candidiasis cephalosporins.
or potentially Give injection
contaminated (e.g., GU: vaginitis, deep into a
vaginal hysterectomy, genital pruritus, large muscle,
and cholecystectomy in candidiasis such as the
high-risk patients such as gluteus
Hematologic: maximus or
those older than 70 years,
neutropenia, lateral aspect
with acute cholecystitis, leucopenia, of the thigh.
obstructive jaundice, or eosinophilia,
common duct bile stones. thrombocytopenia
 Drug Classification Indication MOA Contraindications Adverse Effects Nursing Considerations

Generic Name: Antifibrinolytic Treatment of Tranexamic acid  Hypersensitivity to CNS: dizziness  Monitor blood pressure,
Tranexamic severe localized competitively tranexamic acid or pulse, and respiratory
any of the EENT: visual status as indicated by
acid bleeding inhibits activation
ingredients. abnormalities severity of bleeding.
secondary to of plasminogen
Dosage: hyperfibrinolysis, thereby reducing CV: hypotension,  Assess for
1 gm IV q 6 including conversion of  Acquired defective thromboembolism, thromboembolic
epistaxis, plasminogen to color vision, since thrombosis complications.(especially
this prohibits in patients with history).
hyphema, or plasmin
measuring one GI: diarrhea, Notify physician of
hypermenorrhea (fibrinolysin), an
endpoint that nausea, vomiting positive Homans’ sign,
(menorrhagia) and enzyme that
should be followed leg pain hemorrhage,
hemorrhage degrades fibrin as a measure of edema, hemoptysis,
following certain clots, fibrinogen, toxicity. dyspnea, or chest pain.
surgical and other plasma
procedures proteins, including  Stabilize IV catheter to
the procoagulant  Subarachnoid minimize
factors V and VIII. hemorrhage. thrombophlebitis.
Monitor site closely.
 Active
 Caution patient to make
intravascular position changes slowly
clotting to avoid orthostatic
hypotension.
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Cephalosporin, Preoperative Second – generation  Allergy to CNS: phlebitis,  Cefuroxime
Cefuroxime second generation prophylaxis in cephalosporin that cephalosporin or thrombophlebitis axetil tabs may
sodium, clients undergoing inhibits cell wall penicillin. be crushed, if
GI: nausea and absolutely
Cefuroxime surgical procedures synthesis, promoting vomiting, anorexia, necessary for
axetil (e.g., vaginal osmotic instability; diarrhea patients who
hysterectomy) usually becatericidal. can’t swallow
classified as clean – Hematologic: tablets.
Dosage: contaminated or Cefuroxime axetil is hemolytic anemia
5 mg per cap BID potentially used PO, whereas  For direct IV,
Skin: urticaria, reconstitute 750
contaminated. cefuroxime sodium is
pain, temperature mg in 8 mL
used either IM or IV. elevation, sterile water,
sloughing IM give over 3 – 5
injection site min. For
intermittent
Other: IV,further dilute
hypersensitivity in 100 mL of
reactions, serum dextrose or
sickness, saline solution;
anaphylaxis. infuse over 30
min.

 Prior to
reconstitution,
protect drug
from light. The
powder and
reconstituted
drug may darken
 without affecting
potency.
Drug Classification Indication MOA Contraindications Adverse Effects Nursing
Considerations

Generic Name: Hematologic drug, Prophylaxis and Provides elemental  Hemolytic CNS: nausea and  Between meals
Ferrous sulfate anti – anemic, iron treatment of iron iron, an essential anemia, vomiting, are preferable.
pyridoxine – epigastric pain,
deficiency and iron component in the
responsive constipation, black  Drug can be
deficiency anemias. formation of stool, diarrhea,
anemia, and given with some
Dosage: hemoglobin. anorexia foods, although
Tab OD cirrhosis of the
absorption may
liver. Other: temporarily be decreased.
 Use in those with stained teeth from
normal iron liquid forms
balance.  Oral iron may
turn stool black.
Although this
unabsorbed iron
is harmless it
could mask
melena.

 Monitor
hemoglobin,
hematocrit and
reticulocyte.
 Drug Classification Indication MOA Contraindications Adverse Effects Nursing
Considerations

Generic Name: Nonsteroidal Anti- Acute pain, for Mefenamic acid has  Hypersensitivity to CNS: dizziness,  Assess patients
Mefenamic acid inflammatory drug treatment of analgesic, anti- drug; GI insomnia, who develop
inflammation, or drowsiness, severe diarrhea
primary inflammatory, and
ulceration. Safety nervousness, and vomiting for
Dosage: dysmenorrhea, antipyretic properties. confusion,
during late dehydration and
500 mg per cap q short term Potent inhibitor of headache electrolyte
8 PVA for pain treatment of mild prostaglandin pregnancy
imbalance.
(category C), or GI:severe
to moderate pain synthesis in vitro. Its
lactation is not diarrhea,  Discontinue drug
from various mode of action may
established. ulceration, and promptly if
conditions, due to a decrease of
bleeding; nausea, diarrhea, dark
decrease blood prostaglandins in
 Known vomiting, stools,
loss from peripheral tissues. hypersensitivity abdominal hematemesis,
menstrual periods involves inhibition of (e.g., anaphylactic cramps, flatus, epistaxis, or rash
and pain. cyclooxygenase reactions and constipation, occur.
(COX-1 and COX-2) serious skin heaptotoxicity
reactions) to
Mefenamic acid or
Skin: rash,  Monitor blood
urticaria, glucose for loss
any components of
reddening, of glycemic
the drug product blistering and control if
peeling of skin diabetic.

Hematologic:
leukopenia,
eosinophilia,
agranulocytosis,
bone marrow
hypoplasia
 Nursing
Drug Classification Indication MOA Contraindications Adverse Effects
Considerations

Generic Name: Cephalosporin, Preoperative Second –  Allergy to CNS: phlebitis,  Cefuroxime

Cefuroxime second generation prophylaxis in generation cephalosporin or thrombophlebitis axetil tabs may
sodium, clients undergoing cephalosporin that penicillin. be crushed, if
GI: nausea and absolutely
Cefuroxime axetil surgical procedures inhibits cell wall vomiting, anorexia, necessary for
(e.g., vaginal synthesis, diarrhea patients who
hysterectomy) promoting osmotic can’t swallow
Dosage: classified as clean – instability; usually Hematologic: tablets.
contaminated or becatericidal. hemolytic anemia
potentially  For direct IV,
Skin: urticaria, reconstitute 750
contaminated. Cefuroxime axetil
pain, temperature mg in 8 mL
is used PO, elevation, sterile water,
whereas sloughing IM give over 3 – 5
 cefuroxime sodium injection site min. For
is used either IM or intermittent
IV. Other: IV,further dilute
hypersensitivity in 100 mL of
reactions, serum dextrose or
sickness, saline solution;
anaphylaxis. infuse over 30
min.

 Prior to
reconstitution,
protect drug
from light. The
powder and
reconstituted
drug may darken
without affecting
potency.
Drug Classification Indication MOA Contraindications Adverse Effects Nursing
Considerations
Generic Name: Hematologic drug, Prophylaxis and Provides elemental  Hemolytic CNS: nausea and  Between meals
Ferrous sulfate anti – anemic, iron treatment of iron iron, an essential anemia, vomiting, are preferable.
pyridoxine – epigastric pain,
deficiency and iron component in the
responsive constipation, black  Drug can be
deficiency anemias. formation of stool, diarrhea,
anemia, and given with some
Dosage: hemoglobin. anorexia foods, although
cirrhosis of the
absorption may
liver. Other: temporarily be decreased.
 Use in those with stained teeth from
normal iron liquid forms
balance.  Oral iron may
turn stool black.
Although this
unabsorbed iron
is harmless it
could mask
melena.

 Monitor
hemoglobin,
hematocrit and
reticulocyte.