DRUG STUDY

PNSS
Generic Name: 0.9% Sodium Chloride Solution

Brand Name: Plain NSS

Classification: Isotinic

Uses: The most commonly used crystalloid worldwide is normal saline which is used in the management and
treatment of dehydration (e.g., hypovolemia, shock), metabolic alkalosis in the presence of fluid loss, and mild
sodium depletion.

Actions: Normal Saline isa sterile, nonpyrogenic solution for fluid and electrolyte
replenishment

Contraindications: Heart failure, pulmonary edema, renal impairment, sodium

retention.

Adverse Effects: Febrile respinse, infection at the site of injection, venous thrombosis or

phlebitis extending from the site of injection, extravasion, and hypervolemia.

Nursing Implications: 

 Document baseline data. Before infusion, assess the patient’s vital signs, edema status, lung
sounds, and heart sounds. Continue monitoring during and after the infusion. 
 Observe for signs of fluid overload. Look for signs of hypervolemia such as hypertension,
bounding pulse, pulmonary crackles, dyspnea, shortness of breath, peripheral edema, jugular
venous distention, and extra heart sounds. 
 Monitor manifestations of continued hypovolemia. Look for signs that indicate continued
hypovolemia such as, decreased urine output, poor skin turgor, tachycardia, weak pulse,
and hypotension.
 Prevent hypervolemia. Patients being treated for hypovolemia can quickly develop fluid
overload following rapid or over infusion of isotonic IV fluids. 
 Elevate the head of the bed at 35 to 45 degrees.
 Elevate the patient’s legs. If edema is present, elevateUnless contraindicated, position the
client in semi-Fowler’s position.  the legs of the patient to promote venous return.
 Educate patients and families. Teach patients and families to recognize signs and
symptoms of fluid volume overload. Instruct patients to notify their nurse if they have trouble
breathing or notice any swelling. 
 Close monitoring for patients with heart failure. Because isotonic fluids expand the
intravascular space, patients with hypertension and heart failure should be carefully
monitored for signs of fluid overload. 

Patient and Family Education: Sodium Chloride Injection, USP should be used with great

care, if at all, in patients with congestive heart failure, severe renal insufficiency, and in
clinical states in which there exists edema with sodium retention. In patients with
diminished renal function, administration of Sodium Chloride (sodium chloride (sodium
chloride injection) injection) Injection, USP may result in sodium retention.

D5LR

Generic Name: 0.9% Sodium Chloride Solution

Brand Name: Dextrose 5% in lactated Ringer (D5LR)

Classification: Hypertonic, Nonpyrogenic, Parenteral fluid, electrolyte and nutrient

replenisher

Uses: These solutions are indicated for parenteral replacement of extracellular losses of fluid and
electrolytes, with or without minimal carbohydrate calories, as required by the clinical condition of
the patient.

Actions: Hypertonic solutions are those that have an effective osmolarity greater than
the body fluids. This pulls the fluid into the vascular by osmosis resulting in an increase
vascular volume. It raises intravascular osmotic pressure and provides fluid, electrolytes
and calories for energy.

Contraindications: Hypersensitivity to any of the components.

Adverse Effects: itching, hives, swelling of the face, puffy eyes, coughing, sneezing, sore
throat, difficulty breathing, fever, and injection site reactions (infection, swelling,
redness)

Nursing Implications: 

 Do not administer unless solution is clear and container is undamaged.

 Caution must be exercised in the administration of parenteral fluids, especially
those containing sodium ions to patients receiving corticosteroids or corticotrophin.
 Solution containing acetate should be used with caution as excess administration
may result in metabolic alkalosis.
 Solution containing dextrose should be used with caution in patients with known
subclinical or overt diabetes mellitus.
 Discard unused portion.
 In very low birth weight infants, excessive or rapid administration of dextrose
injection may result in increased serum osmolality and possible intracerebral
hemorrhage.
 Properly label the IV Fluid
 Observe aseptic technique when changing IV fluid

Patient and Family Education: 

 This medicine may cause changes in the pH level of the blood, which may be life-
threatening and require immediate medical attention. Talk to your doctor if you
have any concern.
 This medicine may cause hypercalcemia (high calcium level in the blood).
 Instruct patient to report any allergic reaction.

Paracetamol 

Generic Name: Paracetamol

Brand Name: Biogesic

Classification: Nonnarcotic analgesics and antipyretics

Uses: It helps treat pain and reduce a high temperature (fever). It is  typically used to
relieve mild or moderate pain, such as headaches, toothache or sprains, and lessen
fevers caused by illnesses such as cough and colds

Actions: To produce analgesia by blocking generation of pain impulses, probably by

inhibiting prostaglandin synthesis in the CNS or the synthesis or action of other
substances that is sensitive pain receptors to mechanical or chemical situation. It is
thought to lessen fever by central action hypothalamic heat regulating center.

Therapeutic effects: It changes the way the body senses pain and to remove heat in the
body.

Contraindications: Hypersensitivity to drug

Adverse Effects: 

HEMATOLOCGIC: hemolytic anemia,neutropenia,leukopenia,pancytopenia

HEPATIC: liver damage, jaundice

METABOLIC: hypoglycemia 

SKIN: rash, urticaria

Nursing Implications: 

*Use liquid form for children and patients who have difficulty swallowing 

*Use cautiously in patients with history of chronic alcohol use because hepatotoxicity
has occurred after therapeutic doses.

*Acetaminophen may produce false positive decreases in glucose levels in home

monitoring systems

Patient and Family Education: 

*Tell parents to consult prescriber before giving drug to children younger than age 2.

*Tell patient not to use for marked fever (higher than 103.1 F [39.5 C] fever persisting
longer than 3 days, or recurrent fever unless directed by prescriber

*Advise patient that drug is only for short term use and to consult prescriber if giving to
children for longer than 3 days or recurrent fever unless directed by prescriber

*Warn patient that high doses or unsupervised long term use can cause hepatic
damage. Excessive ingestion of alcohol may increase the risk of hepatotoxicity.

Tramadol

Generic Name: Tramadol

Brand Name: Ultram, Ultram ER

Classification:Opioid analgesic 

Uses: Tramadol is used to relieve moderate to moderately severe pain, including pain
after surgery.

Actions: Tramadol is used in 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.

Therapeutic effects: It works in the brain to change how your body feels and responds to
pain.

Contraindications: Hypersensitivity to tramadol, head injuries, lactation

Adverse Effects: Sweating, dizziness, nausea

Nursing Implications: 

*Assess bowel and bladder function

*Monitor vital sign and assess for orthostatic hypertension.

Patient and Family Education: 

*Advise patient to cough and breath deeply every 2 hrs to prevent atelectasis and
pneumonia.

*Tell the patient that she may experience this side effects: dizziness, sedation,
drowsiness, impaired visual acuity (avoid driving or performing tasks that require
alertness); nausea, loss of appetite (lie quietly, eat frequent small meals,.

Ranitidine 

Generic Name: Ranitidine

Brand Name: Zantac

Classification: Histamine 2 antagonist

Uses: It was used for indigestion, heartburn and acid reflux, gastro-oesophageal reflux
disease (GORD – this is when you keep getting acid reflux), and to prevent and treat
stomach ulcers.

Actions: Competitively inhibits the action of histamine at the H2 receptors of the gastric
parietal cells which inhibits gastric acid secretion, gastric volume, and hydrogen ion
concentration are reduced. Does not affect pepsin secretion, pentagastrin-stimulated
intrinsic factor secretion, or serum gastrin.

Therapeutic effects: 

Contraindications: Hypersensitivity to ranitidine or any component of the formulation

Adverse Effects: Nausea, vomiting, anemia, diarrhea

Nursing Implications:

*Do not give any new medication during therapy without consulting physician

*Increase fluid intake once allowed by the physician.

Patient and Family Education: 

*Instruct patient to avoid taking any new medication during therapy without consulting
prescriber

*Instruct patient to avoid alcohol and follow diet as prescriber recommends.

Metrodinazole

Generic Name: Metrodinazole

Brand Name: Flagyl

Classification: Antibiotic, Antibacterial, Amebicide, Antiprotozoal

Uses: It is used to treat skin infections, rosacea and mouth infections, including infected
gums and dental abscesses. It's also used to treat conditions such as bacterial vaginosis
and pelvic inflammatory disease.

Actions: Inhibits growth of amoebae by binding to DNA resulting in loss of helical

structure, strand breakage, inhibition of nucleic acid synthesis and cell death

Therapeutic effects: It works by stopping the growth of certain bacteria and parasites.

Contraindications: 

*Active organic disease of the CNS

*Drug Allergy

*Blood dyscrasia

Adverse Effects: Nausea, vomiting, diarrhea

Nursing Implications: 

*Assess vital signs

*Document indications for therapy and symptom characteristics

Patient and Family Education: 

*Educate patient that metallic taste, dark o red brown urine may occur and is normal

*Instruct the patient to not take alcohol having the drug therapy

Cefuroxime 

Generic Name: Cefuroxime

Brand Name: Ceftin

Classification: Cephalosporin Antibiotics 

Uses: Cefuroxime is used to treat a wide variety of bacterial infections. It may also be
used to prevent infection from certain surgeries. It belongs to a class of drugs known as
cephalosporin antibiotics

Actions: Cefuroxime is a second hand generation cephalosporin that cell-wall synthesis,

promoting osmotic instability; usually batericidal.

Therapeutic effects: It works by stopping the growth of bacteria. This antibiotic treats
only bacterial infections. 
Contraindications: Cefuroxime is contraindicated in patients hypersensitive to drugs or
other cephalosporins.

Adverse Effects: 

CV: phlebitis, thrombophlebitis.

GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea.

SKIN: maculopapular and erythematous rashes, uticaria, pain, induration, sterile

abscesses, temperature elevation, tissue sloughing at I.M injection site.

Nursing Implications:

*Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms

(tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash,
pruritus, urticaria).

*Do not confuse drug with other cephalosporins that sound alike.

*Use cautiously in patients hypersensitive to penicillin because of possibility of cross-

sensitivity with other beta-lactam antibiotics. Also use cautiously in breastfeeding
women in patients with history of colitis and renal insufficiency.

*Obtain specimen for culture and sensitivity tests before giving first dose. Therapy may
begin pending results.

Patient and Family Education: 

*Instruct patient and family/caregivers to report other troublesome side effects such as
severe or prolonged skin problems (rash, hives,dermatitis) or GI problems (nausea,
vomiting,diarrhea,cramps)

*Tell patient to notify prescriber about loose stools or diarrhea.

*Instruct patient to take oral form with food. If patient has difficulty swallowing tablets,
show the patient how to dissolve or crush tablets but warn the patient that the bitter
taste is hard to mask, even with food. If suspension is being used, tell patient to shake
container well before measuring dose.

*Advise patient receiving drug I.V to report discomfort at I.V insertion site.
Multivitamins + iron

Generic Name: Multivitamins + iron 

Brand Name: Mulvitron

Classification: Multivitamins with minerals 

Uses: Multivitamins with iron are used to provide vitamins and iron that are not taken in
through the diet. They are also used to treat iron or vitamin deficiencies caused by
illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Actions: An essential mineral found in hemoglobin, myoglobin, and many enzymes.

Enters the bloodstream and is transported to the organs of the reticuloendothelial
system (liver, spleen, bone marrow), where it is separated out and becomes part of iron
stores.

Therapeutic effects: Prevention of deficiency or replacement in patients whose

nutritional status is questionable, replacement in patients who are unable to ingest oral
feedings or vitamins

Contraindications: In patients who are allergic to its active ingredients 

Adverse Effects:

GI: Diarrhea, nausea, vomiting

CN: Headache, seizure, dizziness

CV: Hypotension, hypertension

Respiratory: Cough, dyspnea

Nursing Implications:
*Observe proper dosage of medications

*Note other drugs patient is taking to avoid possible interactions

Patient and Family Education: 

*Instruct patient to report immediately any symptoms of severe adverse effects that
would arise for prompt intervention.

*Tell patient what are the possible adverse effects that she will experience

VITAMIN C + ZINC

Generic Name:  Iron and Vitamin C

Brand Name: Nearly C

Classification: Vitamin and mineral combinations

Uses: This medication is an iron supplement used to treat or prevent low blood levels of

iron (such as those caused by anemia or during pregnancy). Ascorbic acid (vitamin C)
improves the absorption of iron from the stomach.

Actions: Vitamin C and zinc have many health benefiits, including aiding immunity,
reducing the risk of age-related eye diseases and helping wounds heal. Vitamin C also
helps the absorption of plant-based iron, while zinc is required for the body to make
DNA and for cell division

Therapeutic effect: Increases protection mechanism of the immune system, thus

supporting wound healing. Necessary for wound healing and resistance to infection.

Contraindications: Use of sodium ascorbate in patients on sodium restriction; use of

calcium ascorbate in patients receiving digitalis. Safety during pregnancy (category C) or
lactation is not established.

Adverse Effects: GI: Nausea, vomiting, heartburn, diarrhea, or abdominal cramps (high

doses). Hematologic: Acute hemolytic anemia (patients with deficiency of G6PD); sickle
cell crisis. CNS: Headache or insomnia (high doses). Urogenital: Urethritis, dysuria,
crystalluria, hyperoxaluria, or hyperuricemia (high doses). Other: Mild soreness at
injection site; dizziness and temporary faintness with rapid IV administration.

Nursing Implications: 
 Lab tests: Periodic Hct & Hgb, serum electrolytes.
 Monitor for S&S of acute hemolytic anemia, sickle cell crisis.

Patient and Family Education: 

 High doses of vitamin C are not recommended during pregnancy.

 Take large doses of vitamin C in divided amounts because the body uses only what
is needed at a particular time and excretes the rest in urine.
 Megadoses can interfere with absorption of vitamin B12.
 Note: Vitamin C increases the absorption of iron when taken at the same time as
iron-rich foods.
 Do not breast feed while taking this drug without consulting physician.

SENNA CONCENTRATE

Generic Name: Senna Concentrate

Brand Name: Senokot

Classification: Laxative

Uses: used to treat constipation. They may also be used to clean out the intestines before
a bowel examination/surgery. Sennosides are known as stimulant laxatives. They work
by keeping water in the intestines, which causes movement of the intestines.

Actions: Promotes incorporation of water into stool, resulting in softer fecal mass. May
also promote electrolyte and water secretion into the colon.
Contraindications: Hypersensitivity; appendicitis, fecal impaction, irritable colon,
nausea, vomiting, undiagnosed abdominal pain, intestinal obstruction; pregnancy
(category C), lactation.

Adverse Effects: GI: Abdominal cramps, flatulence, nausea, watery diarrhea, excessive

loss of water and electrolytes, weight loss, melanotic segmentation of colonic mucosa
(reversible).

Nursing Implications: Reduce dose in patients who experience considerable abdominal

cramping.

Patient and Family Education: 

 Be aware that drug may alter urine and feces color; yellowish brown (acid), reddish
brown (alkaline).
 Continued use may lead to dependence. Consult physician if constipation persists.
 See bisacodyl for additional nursing implications.
 Do not breast feed while taking this drug.

BISACODYL

Generic Name: Bisacodyl

Brand Name: Dulcolax

Classification: Gastrointestinal agent; stimulant laxative

Uses: Temporary relief of acute constipation and for evacuation of colon before surgery,
proctoscopic, sigmoidoscopic, and radiologic examinations. Also used to cleanse colon
before delivery and to relieve constipation in patients with spinal cord damage.

Actions: Expands intestinal fluid volume by increasing epithelial permeability.

Therapeutic effects: Induces peristaltic contractions by direct stimulation of sensory

nerve endings in the colonic wall.
Contraindications: Acute surgical abdomen, nausea, vomiting, abdominal cramps,
intestinal obstruction, fecal impaction; use of rectal suppository in presence of anal or
rectal fissures, ulcerated hemorrhoids, proctitis.

Adverse Effects: Systemic effects not reported. Mild cramping, nausea, diarrhea, fluid
and electrolyte disturbances (especially potassium and calcium).

Nursing Implications: 
 Evaluate periodically patient's need for continued use of drug; bisacodyl usually
produces 1 or 2 soft formed stools daily.
 Monitor patients receiving concomitant anticoagulants. Indiscriminate use of
laxatives results in decreased absorption of vitamin K.

Patient and Family Education: 

 Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid
intake includes at least 6–8 glasses/d.
 Do not breast feed while taking this drug without consulting physician.