Drug Study CEFUROXIME Dosage: Zinacef 750 mg IVTT (December 14-15, 2010) Zinnat 500 mg/tab 1tab PO (December

16-17, 2010) Action: A second-generation cephalosphorin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Indication: treatment of seriousinfections of the lower respiratory and urinary tracts and skin and skin-structure infections Contraindications: Contraindicated in patients hypersensitive to drug or other cephalosporins. Adverse Effects: CV: phlebitis, thrombophlebitis GI: psuedomembranous colitis, nausea, anorexia, vomiting, diarrhea Hematologic: transient neutropenia, eosinophilia, hemolytic anemia, thrombocytopenia Skin: macupapular and erythematous rashes, pain, sterile abscesses, elevated temperature Other: hypersensitivity reactions, serum sickness, anaphylaxis Nursing Considerations: - Use cautiously in patients hypersensitive to penicillin because of possibility of crosssensitivity with other beta-lactam antibiotics. Also use cautiously in breast feeding women and in patients with history of colitis and renal insufficiency. - Absorption is enhanced with food - Monitor signs and symptoms of superinfection - Tablets may be crushed or dissolved in small amounts of fluids for patients who cant swallow. - Tell patient to follow drug regimen even if he is feeling better. - Tell patient to refer for loose stoolsor diarrhea. BUPIVACAINE HYDROCHLORIDE Dosage: Sensorcaine Nubain 5-10 mL via epidural catheter (December 14-15, 2010) Action: Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction. Indication: local or regional anesthesia or analgesia in surgical procedures. Contraindications: children under 12 years, for spinal or topical anesthesia or paracervical block, and in patients with known history of hypersentivity. Adverse Reactions: CNS: anxiety, nervousness, seizures followed by drowsiness CV: arrhythmias, bradycardia, cardiac arrest, hypotension, myocardial depression EENT: blurred vision, tinnitus GI: nausea, vomiting RESP: respiratory arrest SKIN: dermatologic reactions, status asthmaticus OTHER: anaphylactoid reaction, anaphylaxis, edema Nursing Considerations:

Prior to administration, advise patients of the possibility of temporary loss of sensation and muscle function Inform patient of decreased muscle strength, sensation to heat, cold, pain until the effect of the drug wears off. Monitor for effectiveness of anesthesia and adverse reactions. Use necessary caution to reduce incidence of possible injury until full sensation returns. Monitor for return of sensation. Tell patient to avoid accidental injuries

RANITIDINE Dosage: Ulcin 50 mg IVTT x 3 doses (December 14-15, 2010) Action: Histamine 2 blocker. Competitively inhibits action of histamine on the H 2 at receptors sites at parietal cells, decreasing gastric acid secretions. Indications: treat and prevent ulcers in the stomach and intestines. Also treats gastroesophageal reflux disease Contraindications: hypersensitivity, and those with acute porphyria Adverse Reactions: CNS: vertigo, malaise, headache EENT: blurred vision HEPATIC: jaundice OTHER: anaphylaxis, angio-edema Nursing Considerations: - Assess patient for abdominal pain. Note presence of blood in emesis, stool or gastric aspirate. - Instruct patient to avoid drinking alcoholic or acidic drinks while taking the drug to reduce the risk of damage to the GI tract. - Instruct patient on proper use of OTC preparation as indicated. - Remind patient taking prescription drug once daily to take it at bedtime for best results. - Instruct patient to take without regards to meals because absorption isnt affected by food. - Urge patient to avoid cigarette smoking because it may increas gastric acid secretion andworsen disease. - Advise to dissolve drug in 6-8 ounces of water before taking. ETORICOXIB Dosage: Cercoxia 120 mg/tab 1tab OD (December 16-17, 2010) Action: blocks the action of cyclo-oxygenase,which produces prostaglandins that cause pain, swelling and inflammation therefore relieving pain and inflammation. Indication: treatment for acute pain, acute gout, rheumatoid arthritis and osteoarthritis Contraindications: contraindicated to patients with allergic reastions to aspirin or NSAIDs. Not to be used for children under 16 years of age. To be used cautiously to patients with hepatic and renal impairments, GI, heart and cerebrovascular diseases, and uncontrolled hypertension. Pregnant and breast feeding women. Adverse Reactions:

GI: nausea, vomiting, diarrhea, heartburn, pain in the abdomen CNS: headache, dizziness, insomnia, drowsiness, confusion, hallucinations, anxiety, fatigue, CV: increased BP, decreased platelets Other: swelling of legs, ankles or feet, allergic reactions,taste alteration, mouth ulcers Nursing Considerations: - Use cautiously in patients with history of renal or hepatic impairment or GI bleeding, ulceration and perforation. - Refer any signs of stomach disorders such as vomiting of blood, black, tarry, and/or bloodstained stools. - Tell patient to take drug with milk or meals to minimize discomfort. - Advise patient to avoid taking aspirin or alcohol - Advise to use sunblock, wear protective clothing and avoid prolonged exposure to sunlight. - Tell patient to keep drug in blister packs for storage - Keep drug in a cool dry place MULTIVITAMINS + Fe Dosage: Trihemic 1 cap OD PO ac (December 16-17, 2010) Action: Replaces lost iron and folic acid Indication: Treatment & prevention of Fe-deficiency & concomitant folic acid deficiency with associated deficiency intake or increase need for vit.B-complex in nonpregnant adults. Contraindications: Use cautiously with pernicious anemia, with chronic renal failure & receiving acetylsalicylic acid. Adverse Reactions: Allergic reactions, GI effects, hyperbilirubinemia, acneform vulgaris deterioration, bright yellow urine, flushing, dizziness or faintness, stone formation, crystalluria, black discoloration of stool. Nursing Considerations: - Monitor vital signs. - Turn patient with headache slowly - Stay at patients side to avoid falls when fainting discontinue using drug if allergic RXNS appear - Report any unusualities - Instruct patient to take the full course of the drug.
Notify patient that drug may change color of stool

PHOSPHO SODA Dosage: 45 mL with juice PO (December 13, 2010; 4pm) Action: Sodium biphosphate and sodium phosphate are forms of phosphorus, which is a naturally occurring substance that is important in every cell in the body. Indication: Treatment constipation and to clean the bowel before surgery, x-rays, endoscopy, or other intestinal procedures. Also used for general care after surgery and to help relieve impacted bowels.

Contraindications: contraindicated to patients with kidney disease, dehydration, or an electrolyte imbalance, heart disease, liver disease, recent stomach surgery, a bowel perforation or obstruction, colitis or inflammatory bowel disease, seizures. Adverse Reactions: rectal bleeding, nobowel movement after use, sores or ulcers around rectum, seizures, arrythmias, urinating less than usual or not at all, confusion, drowsiness, increased thirst, mood changes, loss of appetite, nausea, vomiting,shortness of breath, abdominal pain, dizziness, headache Nursing Considerations: - drink a full glass (8 ounces) of water or other clear liquid each time you use this medication - take the oral liquid on an empty stomach when you first get out of bed, at least 30 minutes before eating. You may also take the medicine at bedtime. FLAGYSTATIN suppository Dosage: 1 hour prior to OR (December 14, 2010; 8am) Action: converts metronidazole to reduction products that interact with DNA to cause destruction of helical DNA structure and strand leading to a protein synthesis inhibition and cell death in susceptible organisms. Indication: treat mixed vaginal infection due to due to Trichomonas vaginalis and Candida albicans (vaginal moniliasis). Contraindications: allergic reactions to any ingredient in this medicine if you have neurological disorders or a history of blood dyscrasia, hypothyroidism or hypoadrenalism Adverse Reactions: Allergic reaction (rash, itching, redness, burning, vaginal burning and granular sensation; bitter taste, nausea and vomiting, Other: Spots on the skin around the knees, welts all over the body, aching and swelling of wrists and ankles, pruritus, headache, coated tongue and fatigue. Nursing Considerations: - store drug in a cool place. - Do not take OTC drugs with the prescription - Tell patient to follow drug regimen. - Remind patient not to take double doses when missed a previous one. ATROPINE SULFATE Dosage: 0.4 mg IM at left deltoid (December 14, 2010; 8am) Action: An anticholinergic that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes, thereby enhancing conduction through AV node and increasing the heart rate. Indication: symptomatic bradycardia, bradyarrythmia, preoperatively to diminish secretions and block vagal reflexes, adjunct treatment of peptic ulcers disease and treatment of functional GI disorders. Contraindications: contraindicated in patients hypersensitive to the drug and in those with acute angle-closure glaucoma, obstructive uropathy, obstructive disease of GI tract, paralytic ileus, toxic megacolon, intestinal atony, unstable CV status and acute hemorrhage, tachycardia, myocardial ischemia, asthma, myesthenia gravis.

Adverse Reactions: CNS: headache, restlessness, ataxia, disorientation, hallucinations, insomnia, dizziness, excitement, agitation and confusion. CV: palpatations, bradycardia, tachycardia EENT: photophobia, blurred vision, mydriasis, increased intraocular pressure GI: dry mouth, thirst, constipation, nausea, vomiting GU: urine retention, impotence OTHER: anaphylaxis Nursing Considerations: - Monitor fluid intake and urine output. - Monitor patients for paradoxical initial bradycardia. - Watch for tachycardia in cardiac patients because it may lead to ventricular fibrillation. - Use cautiously in patients with Down Syndrome because they may be more sensitive to the drug. - Teach patient hoe to handle anticholinergic effects - Advise patient to report serious or persistent adverse reactions promptly - Suggest use of sunglasses due to photosensitivity BENADRYL Dosage: 25 mg IM at left deltoid (December 14, 2010; 8am) Action: Competes with histamine for H1 receptor sites on effector cells. Provides local anesthesia by preventing initiation and transmission on nerve impulses. Also suppresses cough reflex. Indication: Sedation, Rhinitis, Non-productive cough, allergic symptoms, motion sickness, night time sleep aid. Contraindications: Patients hypersensitive to drug, in newborns, in premature neonates, in breastfeeding women, and in patients with angle-closure glaucoma, peptic ulcer, bladder neck obstruction, and acute asthmatic attacks. Adverse Reactions: CNS: Drowsiness, headache, vertigo, sedation, sleepiness, dizziness, seizures. CV: palpatations, hypotension, tachycardia EENT: diplopia, blurred vision, nasal congestion, tinnitus GI: nausea, vomiting, diarrhea, dry mouth, constipation, epigastric distress GU: dysuria, urine retention, urinary frequency, hematologic hemolytic anemia thrombocytopenia RESP: thickening of bronchial secretions SKIN: photosensitivity, rash OTHER: anaphylactic shock Nursing Considerations: - Instruct to take with food or milk to reduce GI distress. - Inform patient that coffee or tea may reduce drowsiness. Urge caution if palpatations develop. - Inform patient that sugarless gum, hard candy or ice chips may relieve dry mouth. - Alternate injection sites to prevent irritation

Instruct patient to take drug 30 minutes before travel to prvent motion sickness Warn patient to avoid alcohol and hazardous activities that require alertness until CNS effects of drug are known Warn patient of possible photosensitivity reactions. Advise to use of a sunblock.

EPHEDRINE SULFATE Dosage: 2.5 mg (December 14, 2010; 12:30pm) Action: Relaxes bronchial smooth muscles by stimulating Beta 2 receptors. Also stimulates Alpha and Beta receptors and is a direct-and-indirect-acting sympathomimetic. Indication: To correct anesthesia-induced hypotension, bronchodilation, nasal decongestion. Contraindications: Hypersensitivity, cardiac arrhythmia, coronary artery disease, angle closure glaucoma, angina pectoris, substantial organic heart disease or cardiovascular disease . Contraindicated to those receiving MAO inhibitors. Adverse Reactions: CNS: Insomnia, nervousness, dizziness, headache, euphoria, confusion, cerebral hemorrhage CV: palpatations, tachycardia, hypertension, arrhythmia. EENT: dry nose and throat GI: nausea, vomiting, anorexia GU: urine retention, painful urination caused by visceral sphincter spasm SKIN: diaphoresis Nursing Considerations: - Report excessive nervousness or excitation, inabilityl to sleep, facial flushing, pounding heartbeat, muscle tremors or weakness, chest pains or palpatations, coughing or increase sweating. - Take drug 2 hours before bedtime to prevent insomnia. - Tell patient taking oral form of drug at home to take last dose of day at least 2 hours before bedtime. - Drug isnt a substitute for blood or fluid volume replacement. - Warn patient not to take OTC or herbal drugs that contain ephedrine without consulting prescriber. KETOROLAC TROMETHAMINE Dosage: 30 mg slow IVTT (December 15, 2010; 1:30pm) Action: produces anti-inflammatory, analgesic, and antipyretic effect possibly by inhibiting prostaglandin synthesis. Indication: management for moderately severe acute pain for single dose treatment. Contraindications: hypersensitivity, contraindicated to those with active peptic ulcer disease, recent GI bleeding or perforation, advanced renal impairment, risk for renal impairment for volume depletion, suspected or confirmed cerebro-vascular bleeding, hemorrhagic diathesis, incomplete hemostasis, or high risk of bleeding. Also contraindicated for prophylactic analgesic before major surgery or intraoperatively when hemostasis is critical. Adverse Reactions: CNS: drowsiness, sedation, dizziness, headache CV: edema, hypertension, palpatations, arrhythmia

GI: nausea, dyspepsia, GI pain, diarrhea, vomiting, flatulence, stomatitis GU: hematologic decrease platelet adhesion SKIN: pruritus, rash, diaphoresis OTHER: pain at injection site Nursing Considerations: - Report signs of bleeding as drug may inhibit platelet function. - Instruct patient not to smoke cigarettes or drink alcohol, which can cause irritation to the stomach and can make it more susceptible to damages caused by the drug. - Advise patient not to stand or sit up quickly as the drug may cause dizziness. - Instruct patient to brush or floss teeth carefully. Drug may cause patient to bleed more easily. - Advise patient that black or tarry stool may occur as a side effect of the drug. - Not recommended for children - Warn patient receiving drug IM that pain may occur at injection site.