Romeo Victor M.

Valderrama
BSN-2A
Generic Name
Streptomycin
Minimum Dose
15 mg/kg daily IM
x 2-3 mos
Maximum Dose
1 g/kg daily IM x
2-3 mos

Brand Name
Streptomycin

Classification
Therapeutic:
Antitubercular/
Antiinfective

Pharmacologic:
Protein Synthesis
Inhibitor

Mechanism of Action
Interferes
with
protein
synthesis in bacterial cell by
binding to ribosomal 30 S,
causing inaccurate peptide
sequence to form in protein
chain, causing bacterial death

Indications
Pulmonary
tuberculosis, as an
adjunct
Streptococcal
endocarditis
Enterococcal
endocacrditis

Adverse Reactions
CNS: confusion, depression,
numbness, tremors,
seizures, muscle twitching,
neurotoxicity, dizziness
CV: hypotension, myocarditis,
palpitations
EENT: ototoxicity, deafness,
visual disturbances, tinnitus
GI: abdominal distress,
anorexia, nausea, vomiting,
increased AST, ALT,
hepatomegaly, hepatic
necrosis, sploenomegaly
GU: oliguria, hematuria,
renal damage, azotemia,
renal failure, nephrotoxicity
INTEG: dermatitis, pruritus,
rash, burning, alopecia
HEMA: agranulocytosis,
thrombocytopenia,
leucopenia, eosinophilia,
anemia

Nursing Considerations
Before
Assess:
Weight
before
treatment;
calculation of dosage is usually
based on ideal body weight
I & O ratio, U/A daily for
proteinuria, cells, casts
Deafness by audiometric testing,
ringing, roaring in ears
C&S before starting treatment to
identify infecting organism
Vestibular dysfunction; nausea,
vomiting, dizziness, headache
During
Administer:
IM inj in large muscle mass,
rotate inj sites
Drug in evenly spaced doses to
maintain blood level
Antiemetic if vomiting occurs
Adequate fluids of 2-3 L/day
unless contraindicated to prevent
irritation of tubules
After:
Teach/Tell patient/SO to:
Serum peak 20-30 min after IM
inj, trough level drawn 8 hr;
acceptable levels- peak 5-25
mcg/ml, trough should not be >5
mcg/ml
To report headache, dizziness,
renal impairment
To report loss of hearing, ringing,
roaring in ears, fullness in head.

Romeo Victor M. Valderrama

BSN-2A

Generic Name
Penicillin G
Benzathine
Minimum Dose
300,000 units IM
Maximum Dose
2.4 million units
IM weekly for 3
weeks

Brand Name
Penadur

Classification
Therapeutic:
Anti-infective,
Antibiotic
Pharmacologic:
Penicillin

Mechanism of Action
Interferes with bacterial cell
wall synthesis during active
multiplication, causing cell
wall death and resultant
bactericidal activity against
susceptible bacteria.

Indications
General Indications
- Severe infections
caused by sensitive
organisms
(streptococci)
- URTI caused by
sensitive streptococci
- Treatment of syphilis,
bejel, congenital
syphilis, pinta, yaws
- Prophylaxis of
rheumatic fever and
chorea

Adverse Reactions
CNS: Lethargy,
hallucinations, seizures

Nursing Considerations

Before
- Observe 15 rights of drug
administration.
GI: Glossitis, stomatitis,
- Reduce dosage with hepatic or
gastritis, sore mouth, furry renal failure.
tongue, black hairy
- Assess for hypersensitivity to
tongue, nausea, vomiting,
drug.
diarrhea, abdominal pain,
- Assess for any
bloody diarrhea,
contraindications to the drug.
enterocolitis,
- Educate about side effects of
pseudomembranous colitis, drug.
nonspecific hepatitis
During
GU: Nephritis
- Drug is not for IV use. Do not
inject or mix with other IV
Hematologic: Anemia,
solutions.
thrombocytopenia,
- Give IM injection in upper
leukopenia, neutropenia,
outer quadrant of the buttock.
prolonged bleeding itme
- Avoid contact with the needle.
- Withdraw needle as quickly as
Hypersensitivity: Rash,
possible to avoid discomfort.
fever, wheezing,
- Stay with patient throughout
anaphylaxis
whole duration of
administration.
Local: Pain, phlebitis,
thrombosis at injection
After
site, Jarisch-Herxheimer
- Monitor client for at least 30
reaction when used to treat minutes.
syphilis
- Arrange for regular follow-up,
including blood tests, to evaluate
effects.

Other: Superinfections,
sodium overload leading to
heart failure

- Instruct to report difficulty

breathing, rashes, severe pain at
injection site, mouth sores,
unusual bleeding or bruising.
- Instruct to take medication as
directed for the full course of
therapy, even if feeling better.
- Do proper documentation.

Romeo Victor M. Valderrama

BSN-2A
Generic Name
Hepatits B
Vaccine
Child: IM
Recombivax 0.5
mL (5 mcg) at 0,
1, and 6 mo;
Engerix-B 0.5
mL (10 mcg) at
0, 1, and 6 mo or
0, 1, 2, and 12
mos.
Adult: IM
Recombivax 1
mL (10 mcg) at
0, 1, and 6 mo;
Engerix-B 1 mL
(20 mcg) at 0, 1,
and 6 mo or 0, 1,
2, and 12 mos

Brand Name
Recombivax HB

Classification
Therapeutic:
Anti-infective,
Antibiotic
Pharmacologic:
Vaccine

Mechanism of Action
Vaccine; has been shown to
elicit antibodies to HBV.

Indications
Prevention of infection
caused by all known
subtypes of hepatitisB
virus.

Adverse Reactions
Body Whole:Mild local
tenderness at injection site,
local inflammatory
reaction (swelling, heat,
redness, induration, pain);
fever, malaise, fatigue,
headache, dizziness,
faintness, leg cramps,
myalgia, arthralgia.
GI:Nausea,vomiting,
diarrhea.
Skin:Rash,urticaria,
pruritus.

Nursing Considerations
Note:The ACIP
recommends serologic
confirmation of
postvaccination immunity in
patients undergoing dialysis
and in immunodeficient
patients.
Monitor temperature.Some
patients develop a
temperature elevation of
38.3 C (101 F) following
vaccination that may last 1
or 2 days
Learn potential adverse
reaction.
Do not breast feed while
taking this drug without
consulting physician.

Romeo Victor M. Valderrama

BSN-2A

Generic Name
Rabies Vaccine
Adult: IM- Preexposure
vaccination:
Primary course
consists of 3
doses; 1 ml on
days 0, 7 and 21
or 28. Booster
dose: 1 ml based
on antibody
titers.
Post-exposure
vaccination:
Vaccinate as
soon as possible
after exposure
and may be
stopped if it is
shown that the
patient was not
at risk.
Patients who did
not receive
proper primary
immunization: 5
doses of 1 ml
each on days 0,
3, 7, 14 and 28
(patients should

Brand Name
Imovax

Classification
Therapeutic:
Anti-rabies
Pharmacologic:
Immunizing Agents

Mechanism of Action
Rabies vaccine induces the
formation of protective
antibodies to rabies virus,
thereby providing active
immunity to rabies virus.

Indications
Pre-exposure and postexposure
prophylaxis against
rabies.

Adverse Reactions
Central nervous system:
Dizziness, malaise,
encephalomyelitis,
transverse myelitis, fever,
pain, headache,
neuroparalytic reactions
Dermatologic: Itching,
erythema
Gastrointestinal: Nausea,
abdominal pain
Local: Local discomfort,
pain at injection site
Neuromuscular &
skeletal: Myalgia

Nursing Considerations
For intramuscular injection
only.
This rabies vaccine product
must not be administered
intradermally.
In older children and adults
it should be given in deltoid
area for best response.

also receive
rabies 1g with
the 1st dose);
patients who
have received
primary
immunization: 2
doses of 1 ml on
days 0 and 3.

Romeo Victor M. Valderrama

BSN2-A

Generic Name
Tetanus Immune
globulin
Adult: Prophylax
is: 250 units,
increased to 500
units if >24 hr
have elapsed or
following burns
or there is risk of
heavy
contamination.
Treatment: 150
units/kg, given
by IM inj into
multiple sites.
Child: Prophylax
is: 250 units,
increased to 500
units if >24 hr
have elapsed or
following burns
or there is risk of
heavy
contamination.
Treatment: 150
units/kg, given
by IM inj into
multiple sites.

Brand Name
Tetagam

Classification
Therapeutic:
Anti-tetanus
Pharmacologic:
Immune sera and
immunoglobulins,
human tetanus
immunoglobulin

Mechanism of Action
Depletes nerve endings of
dopamine in the brain and is
used to control movement
disorders.

Indications
Postexposure
prophylaxis
Immediate prophylaxis
after tetanus prone
injuries in patients

Adverse Reactions

Immune system
disorders-Allergic
reactions including
fall in blood
pressure , dyspnea ,
cutaneous reaction,
in isolated cases
reaching as far as
anaphylactic shock,
even when the
patient has shown
no hypersensitivity
to previous
administration of
immunoglobulins.

Genaralized
reactions- Chills,
fever, headache,
malaise, nausea,
vomiting, arthralgia
and moderate back
pain.

Heart and vascular

disordersCardiovascular
reactions
particularly if the
product is

Not adequately
vaccinated
Whose immunization
status is not known
with certainty
With severe deficiency
in antibody production.

Nursing Considerations
Prior to immunization, ask
about previous reaction to
immunization
Inform the patient that he
should exhibit caution when
driving or performing
skilled tasks.
It should not be given
intravenously.
Skin test should not be
done.

inadveretently
injected
intravascularly.
Local reactions at the
injection site- Local pain,
tenderness or swelling.